Neurology - Neuromuscular diseases(38)

Question 1

NEU - 6.1
Which symptom is not characteristic for Myasthenia gravis?
A) diplopia
B) ptosis
C) dysarthria
D) aphasia
E) muscle weakness worsening with physical exercise

Answer 1

ANSWER
D) aphasia

EXPLANATION
Aphasia: disturbance of higher integral process of the brain due to the damage of certain cortical areas and connecting pathways. It is not the symptom of myasthenia gravis (MG).

Question 2

NEU - 6.2
First-choice treatment in Myasthenia gravis:
A) atropin
B) acetylcholinesterase inhibitors
C) steroid
D) plasma exchange therapy
E) vitamins

Answer 2

ANSWER
B) acetylcholinesterase inhibitors

EXPLANATION
Acetylcholinesterase inhibitors: Myasthenia gravis is caused by the disturbance of neuromuscular transmission due to the damage of the postsynaptic membrane function triggered by the anti-ACh-receptor antibody.

Question 3

NEU - 6.3
Motor neurone disease:
A) Eaton–Lambert syndrome
B) Amyotrophic lateral sclerosis
C) Duchenne muscular dystrophy
D) Guillain–Barré syndrome

Answer 3

ANSWER
B) Amyotrophic lateral sclerosis

EXPLANATION
Eaton-Lambert-syndrome is the disease of the presynaptic neuromuscular transmission (usually caused by anti-calcium channel antibodies of paraneoplastic origin) Amyotrophic lateral sclerosis: signs of both upper and lower motor neuron lesion can be observed Duchenne disease: X-linked muscular dystrophy of recessive inheritance Guillain-Barré-syndrome: inflammatory, immune-mediated polyganglioradiculitis with segmental demyelinisation

Question 4

NEU - 6.4
Which symptom is not characteristic for Amyotrophic lateral sclerosis?
A) Babinski-reflex (extensor plantar reflex)
B) atrophy of the small hand muscles
C) fasciculation
D) dysphagia
E) paraesthesia

Answer 4

ANSWER
E) paraesthesia

EXPLANATION
Paraesthesia: not a sign of ALS. Sensory system is not affected in this disease. ALS is a disease of both the lower and upper motor neurons (with the degeneration of the corticospinal tract).

Question 5

NEU - 6.5
Which is not characteristic for Guillain–Barré syndrome?
A) albuminocytologic dissociation in the CSF
B) ascending paresis
C) cranial nerves are never affected
D) segmental demyelinisation
E) mortality is under 3%

Answer 5

ANSWER
C) cranial nerves are never affected

EXPLANATION
Involvement of cranial nerves can be present in 50% of cases. Signs of lower cranial nerve dysfunction: dysarthria, dysphagia.

Question 6

NEU - 6.6
When to suspect polymyositis?
A) numbness with paresis
B) paresis starts in the proximal limb muscles
C) normal erythrocyte sedimentation rate
D) paresis in the proximal limb muscles along with fever and pain

Answer 6

ANSWER
D) paresis in the proximal limb muscles along with fever and pain

EXPLANATION
Polymyositis: generalized, subacutely progressing, mostly symmetric, chronic disease of the skeletal muscles with histologic signs of inflammation. Weakness of truncal and proximal muscles of the extremities associated with pain and fewer. (Pathological immunological processes in the background.)

Question 7

NEU - 6.7
Which is not characteristic for polymyositis?
A) weakness of the proximal muscles
B) weakness of the external ocular muscles
C) weakness of the muscles of the neck
D) muscle pain

Answer 7

ANSWER
B) weakness of the external ocular muscles

EXPLANATION
Polymyositis: generalized, subacutely progressing, mostly symmetric, chronic disease of the skeletal muscles with histologic signs of inflammation. Weakness of truncal and proximal muscles of the extremities associated with pain and fewer. (Pathological immunological processes in the background.) Weakness of the ocular muscles is not typical of the disease. Myositis of the periocular muscles is part of the steril inflammation of the structures of the orbita.

Question 8

NEU - 6.8
Usual onset of facio-scapulo-humeral muscular dystrophy:
A) first years of life
B) 2nd–3rd decade
C) 4th–5th decade
D) 6th decade

Answer 8

ANSWER
B) 2nd–3rd decade

EXPLANATION
The onset of FSHD is most frequent at the 2nd and 3rd decade.

Question 9

NOT IN 2024

NEU - 6.9
Which is not characteristic for myasthenia gravis?
A) damage of the synaptic folds
B) damage of the ACh-receptors
C) damage of the ACh-containing vesicles
D) disturbance of the neuromuscular transmission

Answer 9

ANSWER
C) damage of the ACh-containing vesicles

EXPLANATION
Myasthenia gravis is caused by the disturbance of neuromuscular transmission due to the damage of the postsynaptic membrane function triggered by the anti-ACh-receptor antibody. Damage of the ACh-containing vesicles is not a pathogenetic factor of this disease.

Question 10

NEU - 6.10
Which symptom is not characteristic for myasthenia gravis?
A) pathologic fatigue of muscles
B) ocular muscles are often affected
C) bulbar muscles are often affected
D) pathologic reflexes

Answer 10

ANSWER
D) pathologic reflexes

EXPLANATION
Pathologic reflexes are signs of the pyramidal tract (central paresis), and are not signs of myasthenia gravis.

Question 11

NEU - 6.11
Which symptom is not provoked by muscarin?
A) nausea
B) salivation
C) fasciculation
D) bronchial secretion
E) vertigo

Answer 11

ANSWER
C) fasciculation

EXPLANATION
Fasciculation: it’s a nicotinergic symptom.

Question 12

NEU - 6.12
Which is not characteristic for Duchenne muscular dystrophy?
A) X-linked recessive inheritance
B) loss of ambulation at 25–30 years of age
C) selective damage of the muscles
D) markedly high CK levels at early phases
E) absence of dystrophin in skeletal muscles

Answer 12

ANSWER
B) loss of ambulation at 25–30 years of age

EXPLANATION
Duchenne disease: X-linked muscular dystrophy of recessive inheritance (severe form of dytrophia musculorum progressiva). Progressive weakness of the truncal, limb girdle, upper arm, gluteal, hip flexor and knee extensor muscles. The onset is in the infancy, patients usually die before 20-year of age.

Question 13

NEU - 6.13
Frequent symptom in ALS:
A) dementia
B) agnosia
C) problems with urination
D) all of the above
E) none of the above

Answer 13

ANSWER
E) none of the above

EXPLANATION
ALS is a disease of both the lower and upper motor neurons (with the degeneration of the corticospinal tract). Sometimes dementia is associated with ALS (not frequently). In these cases significant neuronal damage and gliosis can be observed in the premotor gyrus and the temporal lobe.

Question 14

NEU - 6.14
Which disease is associated more frequently with polymyositis?
A) adrenoleukodystrophy
B) Lyme disease
C) SLE
D) viral hepatitis

Answer 14

ANSWER
C) SLE

EXPLANATION
Polymyositis: generalized, subacutely progressing, mostly symmetric, chronic disease of the skeletal muscles with histologic signs of inflammation. Weakness of truncal and proximal muscles of the extremities associated with pain and fewer. (Pathological immunological processes in the background.) Classification: a) Myositis without other basic disease, b) Dermatomyositis: myositis associated with dermatitis, c) Paraneoplastic: myositis associated with malignances, d) Myositis associated with collagen diseases, e) Childhood form.

Question 15

NEU - 6.15
Which is not true for lower motor neuron disease?
A) individual atrophy of the muscles
B) missing or decreased deep tendon reflexes
C) fasciculation
D) problems with urination

Answer 15

ANSWER
D) problems with urination

EXPLANATION
ALS is a disease of both the lower and upper motor neurons (with the degeneration of the corticospinal tract). Problems with urination doesn’t occure in this disease. Function of the sphincter muscles and sensory system is preserved.

Question 16

NEU - 6.16
A 25-year old female complains about gait disturbance for two months. Walking on stairs is most problematic. Laboratory tests reveal increased ESR, CK and gamma-globulin levels. What is the most likely diagnosis?

A) poliomyelitis
B) polymyositis
C) Coxsackie-infection
D) autosomal recessive muscular dystrophy
E) myasthenia gravis

Answer 16

ANSWER
B) polymyositis

EXPLANATION
Polymyositis: generalized, subacutely progressing, mostly symmetric, chronic disease of the skeletal muscles with histologic signs of inflammation. Weakness of truncal and proximal muscles of the extremities associated with pain and fewer. (Pathological immunological processes in the background.) Laboratory tests reveal increased ESR, gamma-globulin and markedly elevated CK levels.

Question 17

NEU - 6.17
Which autoimmune disease may be associated with polyneuropathy?
1) Systemic Lupus Erythematosus
2) rheumatoid arthritis
3) Wegener’s-granulomatosis
4) Sjögren-syndrome

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 17

ANSWER
E) all of the answers are correct

EXPLANATION
Polyneuropathy may be associated with all autoimmune diseases listed here.

Question 18

NEU - 6.18
Specific to the Becker’s muscular dystrophy:
1) X-linked recessive inheritance
2) the onset of symptoms is about between 5-15 years of age
3) high serum CK values
4) the dystrophin protein in the muscle is abnormal

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 18

ANSWER
E) all of the answers are correct

EXPLANATION
Becker’s-syndrome: X-linked, recessive inherited muscular dystrophy (more benign than the Duchenne dystrophy). Clinically, Becker’s syndrome is characterised by slowly progressive muscle weakness of certain muscle groups (muscles of the trunk, shoulders, upper arms, as well as gluteal muscles, hip flexors, knee extensors). Becker’s dystrophy begins in the first and second decades, and despite the weakness the patients may remain ambulatory until the 3rd decade and may live till 40 to 50 years of age. Serum CK is higher than normal, but far below than in the Duchenne syndrome.

Question 19

NEU - 6.19
In myasthenia gravis:
1) in the neuromuscular junction, the postsynaptic acetylcholine receptors are impaired
2) autoimmune disease
3) thymectomy can be an effective therapy
4) often a malignant tumor lies in the background

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 19

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
In myasthenia gravis (MG), there is an impaired transmission in the neuromuscular junction (NMJ). Anti-Ach-R antibodies bind to components of the NMJ resulting in dysfunction of these proteins and disturbance of neuromuscular transmission.Thymoma may be present as an etiologic factor, but other malignant tumors can rarely be found in the background. (Quite contrary, there are often malignant tumors in the etiology of Eaton-Lambert syndrome).

Question 20

NEU - 6.20
It contains acetylcholinesterase inhibitor:
1) pyridostigmin/Mestinon®
2) nimesulid/Mesulid®
3) neostigmin/Stigmosan®
4) urapidil/Ebrantil®

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 20

ANSWER
B) 1st and 3rd answers are correct

EXPLANATION
Pyridostigmin and neostigmin are acetylcholinesterase inhibitors, however urapidil is an antihypertensive, nimesulid is a non-steroid anti-inflammatory drug.

Question 21

NEU - 6.21
Common symptoms of ALS and acute Guillain-Barré syndrome:
1) paresthesia
2) pathological reflexes (pyramidal signs or primitive reflexes)
3) hereditary disorder
4) muscle weakness

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 21

ANSWER
D) only 4th answer is correct

EXPLANATION
The common symptom is the muscle weakness (sensory disturbance can only be found in GBS, abnormal reflex can be seen in ALS - pyramidal lesion). Only a small fraction of ALS is hereditary.

Question 22

NEU - 6.22
The typical liquor of acute Guillain-Barré syndrome is characterised by:
1) increased protein value
2) decreased protein value
3) normal cell count
4) increased cell count

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 22

ANSWER
B) 1st and 3rd answers are correct

EXPLANATION
Typical liquor finding: cell-protein dissociation (the total protein content of the CSF is increased, while the cell count is normal or only slightly elevated).

Question 23

NEU - 6.23
Therapy for acute Guillain-Barré syndrome:
1) steroid
2) vitamins (B1 vitamin)
3) azathioprine
4) plasma exchange therapy

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 23

ANSWER
C) 2nd and 4th answers are correct

EXPLANATION
In acute Guillain-Barré syndrome plasma exchange therapy and B vitamins can be used, depending on the severity of the clinical picture.

Question 24

NEU - 6.24
The neurological status of the Guillain-Barré syndrome may include:
1) paraparesis
2) hypo- or areflexia
3) hypaesthesia
4) diplegia facialis

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 24

ANSWER
E) all of the answers are correct

EXPLANATION
Acute Guillain-Barré syndrome (GBS) may include all of the symptoms listed here. GBS begins typically with distal type of paraesthesia and hypotonic paresis that may ascend in the following days. Lower cranial nerve symptoms are present in almost half of the GBS cases (dysphagia, diplegia facialis).

Question 25

NEU - 6.25 Which of the following diseases/states may cause myoglobinuria: 1) ischemic muscle destruction 2) status epilepticus 3) excessive muscle work 4) burning illness A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct

Answer 25

ANSWER E) all of the answers are correct EXPLANATION Myoglobinuria: it can be caused by all of the reported pathologies (it is associated with extensive muscle damage).

Question 26

NEU - 6.26 Factors in the etiology of lateral amyotrophic sclerosis (ALS): 1) glutamate-excitotoxicity 2) anomalies of the cerebral vascular system 3) free radical-toxicity 4) immunological factors 5) disturbance of the protein homeostasis A) 1st, 2nd and 3rd answers are correct B) 1st, 3rd and 4th answers are correct C) 2nd, 3rd and 4th answers are correct D) 2nd, 3rd and 5th answers are correct E) 2nd, and 4th answers are correct F) 3rd, 4th and 5th answers are correct

Answer 26

ANSWER B) 1st, 3rd and 4th answers are correct EXPLANATION In ALS etiology: a) glutamate excitotoxicity, b) free radical- toxicity, c) and immunological processes may play a significant role. (The etiology, however, is unclear, there are several theories.)

Question 27

NEU - 6.27 The differential diagnosis of amyotrophic lateralsclerosis (ALS) includes the following disease(s): 1) multiple sclerosis 2) multifocal motoric neuropathy 3) compression of the cervical spinal cord 4) cervical spondylosis 5) funicular myelosis A) 1st, 2nd and 3rd answers are correct B) 1st, 3rd and 4th answers are correct C) 2nd, 3rd and 4th answers are correct D) 2nd, 3rd and 5th answers are correct E) 2nd, and 4th answers are correct F) 3rd, 4th and 5th answers are correct

Answer 27

ANSWER C) 2nd, 3rd and 4th answers are correct EXPLANATION ALS is a disease of the lower and upper motoneurons with degeneration of the corticospinal tract. Those disorders should be considered in differential diagnosis, which causes purely motor symptoms including paralysis, fasciculation, muscle atrophy, and muscle tone changes. MS: can be differentiated by sensory and vegetative symptoms that are associated with MS. Multifocal motor neuropathy: causes purely motoric symptoms, therefore it should be considered in the differential diagnosis. Cervical root and cervical spinal cord compression (e.g. cervical disc herniation) lead to pyramidal lesion and spasticity (upper motoneuron signs), as well as fasciculations (lower motoneuron sign caused by radicular compression). It should also be considered in the differential diagnosis. Cervical spondylosis, discopathy may also cause fasciculation, paresis, atrophy, therefore it should be differentiated from ALS too. Funicular myelosis: can easily be differentiated by disturbance of deep-sensation.

Question 28

NEU - 6.28 Plasma exchange can be used with good effect in: 1) inclusion body myositis 2) myasthenia gravis 3) spinal muscle atrophy 4) Guillain–Barré-syndrome 5) amyotrophic lateralsclerosis (ALS) A) 1st, 2nd and 3rd answers are correct B) 1st, 3rd and 4th answers are correct C) 2nd, 3rd and 4th answers are correct D) 2nd, 3rd and 5th answers are correct E) 2nd and 4th answers are correct F) 3rd, 4th and 5th answers are correct

Answer 28

ANSWER E) 2nd and 4th answers are correct EXPLANATION Plasma exchange can be used with good efficacy in immune-mediated autoimmune mechanisms, like myasthenia gravis, or Guillain-Barré syndrome.

Question 29

NEU - 6.29 It can be helpful in the diagnosis of myasthenia gravis: 1) clinical symptoms 2) somatosensory evoked potential 3) repetitive stimulation 4) chest CT 5) muscle biopsy A) 1st, 2nd and 3rd answers are correct B) 1st, 3rd and 4th answers are correct C) 2nd, 3rd and 4th answers are correct D) 2nd, 3rd and 5th answers are correct E) 2nd and 4th answers are correct F) 3rd, 4th and 5th answers are correct

Answer 29

ANSWER B) 1st, 3rd and 4th answers are correct EXPLANATION Myasthenia gravis is an autoimmune disease with disturbance of transmission in the neuromuscular junction (NMJ). The disease is caused by antibodies that attack components of the postsynaptic membrane, impair neuromuscular transmission, and lead to weakness and fatigue of skeletal muscle. Muscle weakness can be generalised or localised to certain muscle groups, and involvement of the bulbar and respiratory muscles can be life threatening. The typical clinical picture is the following: muscle weakness with diurnal fluctuation; relaxation and rest improve, while physical strain worsens the symptoms; abnormal fatigue, weakness of the eye and neck muscles, double vision, ptosis, dysarthria, dysphagia are the most common symptoms. During repetitive stimulation, decrease of the amplitude and the area below the curve is characteristic. Chest CT may detect thymus pathology. The SSEP is not informative, since there is no sensory deficit. Muscle biopsy is not required for the accurate diagnosis (motor end plate examination may be performed, but the clinical picture, clinical tests, neurophysiology, edrophonium test, ACh-R antibodies and anti-muscle antibodies from serum, chest CT, and MRI are usually enough for the correct diagnosis).

Question 30

NEU - 6.30 In the Eaton-Lambert syndrome, plasmapheresis may be effective because the basis of the disease is the formation of antibodies against the acetylcholine receptor. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

Answer 30

ANSWER C) the statement is true, but the explanation is false; EXPLANATION Eaton-Lambert-syndrome: it is a neuromuscular presynaptic disorder with usually a paraneoplastic etiology. The pathophysiological basis of the disease is the production of antibodies against a presynaptic calcium-ion channel protein (i.e., not against the postsynaptic ACh receptor!!!). Disturbance of neuromuscular transmission is characteristic in the Eaton-Lambert-syndrome as well, since normal function of the presynaptic calcium-channel is necessary for ACh release. Due to the autoimmune mechanism, plasmapheresis (or immunosuppression) can be effective in the treatment of this disease.

Question 31

NEU - 6.31 The Tensilon (edrophonium) test is used to differentiate myasthenic and cholinergic crises because administration of edrophonium improves the symptoms dramatically in myasthenic crisis A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

Answer 31

ANSWER A) both the statement and the explanation are true and a causal relationship exists between them; EXPLANATION Tensilon® (edrophoniume): fast and short acting cholinesterase inhibitor, which improves both the clinical and electrophysiological myasthenic symptoms, while the cholinergic crisis is not worsened. Thus, the cholinergic and myasthenic crisis can be differentiated by the edrophonium test.

Question 32

NEU - 6.32 In Guillain–Barré-syndrome preceding viral infection can always be proved, because immunological processes play a role in the pathogenesis of the disease. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

Answer 32

ANSWER D) the statement is false, but the explanation itself is true EXPLANATION Although viral infection is a common etiologic factor in Guillain-Barré syndrome, it can not always be proved. Regarding the pathogenesis, this is an immune-mediated disease.

Question 33

NEU - 6.33 In the diagnosis of Guillain-Barré syndrome the primary diagnostic tool is sural nerve biopsy, because the pathological basis of the disease is the segmental demyelination of the peripheral nerves. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

Answer 33

ANSWER D) the statement is false, but the explanation itself is true EXPLANATION In the diagnosis of the Guillain-Barré syndrome, the clinical presentation, the cerebrospinal fluid findings, the electrophysiologic findings are much more important than the sural nerve biopsy. The disease is an inflammatory polyganglioradiculoneuritis with segmental demyelination.

Question 34

NEU - 6.34 Acute Guillain-Barré syndrome has fatal outcome in 50% of the cases, because respiratory paralysis, diaphragm paralysis may occur as a complication. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

Answer 34

ANSWER D) the statement is false, but the explanation itself is true EXPLANATION Mortality of Guillain-Barré syndrome is well below 50% (about 3%). Respiratory paralysis, diaphragm paralysis may occur, when inflammation affects the cervical roots (C4 root, diaphragm) too.

Question 35

NEU - 6.35 The first diagnostic step is:A 28-year-old man presented with progressing lower extremity weakness and ascending numbness that started about a week ago. He reported that he had a strong diarrhea three weeks ago. A) cranial CT B) repetitive nerve stimulation C) thoracolumbar spine MRI D) detailed neurological physical examination

Answer 35

ANSWER D) detailed neurological physical examination EXPLANATION Detailed neurological physical examination should always be the first diagnostic step.

Question 36

NEU - 6.36 Which disease is the most likely? A 28-year-old man presented with progressing lower extremity weakness and ascending numbness that started about a week ago. He reported that he had a strong diarrhea three weeks ago. A) Guillain–Barré syndrome B) diabetic polyneuropathy C) amyotrophic lateral sclerosis D) myasthenia gravis

Answer 36

ANSWER A) Guillain–Barré syndrome EXPLANATION Diagnosis of the Guillain-Barré syndrome is based on the clinical picture: ascending numbness, weakness, which started after complaints typical for gastrointestinal infection).

Question 37

NEU - 6.37 The most likely cerebrospinal fluid finding is: A 28-year-old man presented with progressing lower extremity weakness and ascending numbness that started about a week ago. He reported that he had a strong diarrhea three weeks ago. A) decreased protein level B) normal protein protein concentration C) cell-protein dissociation D) elevated cell count

Answer 37

ANSWER C) cell-protein dissociation EXPLANATION The typical cerebrospinal fluid finding in Guillain-Barré-syndrome is a cell-protein dissociation.

Question 38

NEU - 6.38 Possible complications: A 28-year-old man presented with progressing lower extremity weakness and ascending numbness that started about a week ago. He reported that he had a strong diarrhea three weeks ago. 1) paralysis of respiratory muscles 2) cranial nerve lesion 3) deep vein thrombosis 4) vegetative disturbances A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct

Answer 38

ANSWER E) all of the answers are correct EXPLANATION Each of the options listed can occur: a) respiratory muscle paralysis: due inflammation of the cervical roots, b) cranial nerve lesion: in 50% of the cases, lower cranial nerve symptoms can be observed c) lower limb deep vein thrombosis: due to immobilisation d) vegetative disorder: orthostatic hypotension, sweating, rarely urinary and bowel incontinence.

Question 39

NEU - 6.39 In sural nerve biopsy we would find the following: A 28-year-old man presented with progressing lower extremity weakness and ascending numbness that started about a week ago. He reported that he had a strong diarrhea three weeks ago. 1) neutrophil granulocyte infiltration 2) segmental demyelination 3) intact nerve 4) axonopathy may occur A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct

Answer 39

ANSWER C) 2nd and 4th answers are correct EXPLANATION Sural nerve biopsy shows segmental demyelination, but rarely axonal damage can also be found.