Which is NOT correct regarding migraines?
|A.||Prevalence is higher in woman.|
|B.||Most improve during pregnancy|
|C.||It is idiopathic, and usually last less than 72 hrs.|
|D.||Ketorolac has been shown to be superior to chlorpromazine in the management of migraines.|
|E.||Sumatriptan is contraindicated in pregnancy.|
|Answer» D. Ketorolac has been shown to be superior to chlorpromazine in the management of migraines.|
Which is NOT true of non-traumatic subarachnoid haemorrhage?
|A.||Most common in the 40-60 year age group.|
|B.||70% are due to AV malformations.|
|C.||Female: male = 2:1|
|D.||Smoking increases your risk 3-10 fold.|
|E.||50% of patients die or are permanently disabled from the initial event.|
|Answer» B. 70% are due to AV malformations.|
Which is true regarding the presentation of SAH?
|A.||Up to 20% experience a sentinel bleed.|
|B.||A sixth cranial nerve palsy can represent a growing aneurysm in cavernous sinus.|
|C.||Seizures occur in 50% of patients.|
|D.||Photophobia is often more marked than patients with migraines.|
|E.||Syncope occurs in the minority of patients.|
|Answer» B. A sixth cranial nerve palsy can represent a growing aneurysm in cavernous sinus.|
Which is INCORRECT regarding investigation of SAH?
|A.||Non contrast CT becomes less sensitive with time following bleed.|
|B.||5-10% of patients with negative CT will have SAH.|
|C.||Presence of xanthochromia is the gold standard for diagnosing SAH on LP.|
|D.||Xanthochromia is present in all patients with SAH at 6 hrs post bleed.|
|E.||MRI angiography is not reliable enough to use for diagnosis and surgical planning of patients with proven SAH.|
|Answer» D. Xanthochromia is present in all patients with SAH at 6 hrs post bleed.|
Which is INCORRECT regarding treatment and complications of SAH?
|A.||Nimodipine has only been proven to be of benefit orally in preventing vasospasm.|
|B.||10-30% of patients will rebleed, with 20% within the first 2 weeks.|
|C.||Vasospasm and delayed neurological deficit peak at day 1 post bleed.|
|D.||Hyponatremia is common due to excessive naturesis.|
|E.||The ECG often shows non-specific changes of widened QRS, prolonged QT and ST and T changes suggestive of ischaemia.|
|Answer» C. Vasospasm and delayed neurological deficit peak at day 1 post bleed.|
What is the survival rate of a Hunt and Hess Grade 5 SAH?
|Answer» C. 10%|
Which is NOT correct regarding temporal arteritis?
|A.||Majority older than 50 yrs.|
|B.||More common in men.|
|C.||Ischaemic optic neuritis is most feared complication.|
|D.||Up to 50% of patients also have polymyalgia rheumatica.|
|E.||Jaw claudication in the history is highly suggestive of temporal arteritis.|
|Answer» B. More common in men.|
Which is INCORRECT of treatment of TIA’s?
|A.||Aspirin 150 mg/day reduces risk of subsequent stroke by about 30%.|
|B.||Clopidagrel was shown in the CAPRIE study to have a slight advantage over aspirin in stroke prevention.|
|C.||Anticoagulation of patients with TIA’s secondary to thrombosis has been shown to improve outcome.|
|D.||Carotid endarterectomy will reduce death rate by almost 50% in patients with greater than 80% stenosis.|
|E.||Patients with considerable carotid stenosis (>70%), should be admitted for anticoagulation pending consideration for surgery.|
|Answer» C. Anticoagulation of patients with TIA’s secondary to thrombosis has been shown to improve outcome.|
Which is INCORRECT regarding cerebral infarction?
|A.||80% are MCA territory.|
|B.||MCA syndrome is usually embolic, and arm is usually more affected than leg.|
|C.||Lacunar infarcts usually have partial or complete recovery over 4-6 weeks.|
|D.||Lateral medullary syndrome can result in ipsilateral UMN 7, 9 & 10 CN palsy and Horner’s syndrome with contralateral spinothalamic loss.|
|E.||Internuclear ophthalmoplegia usually results from anterior cerebral artery occlusion.|
|Answer» E. Internuclear ophthalmoplegia usually results from anterior cerebral artery occlusion.|
Which is not an early sign of cerebral infarction on CT?
|A.||Loss of cortical grey/white matter distinction.|
|B.||Effacement of cortical sulci|
|C.||Compression of ventricular system|
|D.||Hyper dense clot in MCA.|
|E.||All are possible early signs of infarct.|
|Answer» E. All are possible early signs of infarct.|
Which is true of thrombolysis in cerebral infarct?
|A.||Clear benefit has been shown in at least 2 randomized controlled trials that TPA reduces mortality in CVA.|
|B.||Patients up to 6 hrs post infarct have been shown to benefit from thrombolysis.|
|C.||Larger infarcts tend to have more benefit from thrombolysis.|
|D.||The NINDS trial showed that improvement in patients treated within 3 hrs with thrombolysis.|
|E.||ECASS trial thrombolysed patients within 3 hrs with TPA and showed improvements in all outcomes compared with placebo.|
|Answer» E. ECASS trial thrombolysed patients within 3 hrs with TPA and showed improvements in all outcomes compared with placebo.|
Which feature of vertigo is more likely to make it central rather than peripheral?
|A.||Fast phase of nystagmus toward lesion.|
|B.||Horizontal or rotational nystagmus present.|
|C.||Severe vertigo associated with vomiting and diaphoresis.|
|D.||Visual fixation improves nystagmus.|
|E.||Hall pike manoeuvre positive.|
|Answer» A. Fast phase of nystagmus toward lesion.|
Which statement regarding peripheral vertigo is incorrect?
|A.||Labyrinthitis is the most common cause.|
|B.||BPPV is characterized by a latency period of 1-5 secs between provocative head position and onset of nystagmus.|
|C.||Tinnitus and hearing loss are associated with Meniere’s disease.|
|D.||Vestibular neuronitis is typically non recurring.|
|E.||Acoustic neuromas typically cause gradual onset of vertigo.|
|Answer» A. Labyrinthitis is the most common cause.|
Which statement regarding central vertigo is incorrect?
|A.||Cerebellar CVA’s will often present with truncal ataxia.|
|B.||Vertebrobasilar insufficiency will produce vertigo lasting typically less than a few mins.|
|C.||Multiple sclerosis can cause vertigo which typically lasts a few mins and is recurring.|
|D.||Vertigo can be associated with migraines either as aura or part of the migraine.|
|E.||Wallenberg syndrome or lateral medullary infarction of brainstem is associated with vertigo and Horner’s syndrome|
|Answer» C. Multiple sclerosis can cause vertigo which typically lasts a few mins and is recurring.|
Which of the following drugs is unlikely to cause seizure in withdrawal/
|Answer» E. Tricyclics|
Which is INCORRECT regarding the aetiology of seizures?
|A.||Idiopathic seizures usually start age 5-20 yrs.|
|B.||Post head trauma seizures usually begin within 2 years of trauma.|
|C.||Acute strokes are the most common cause in > 65 yr olds.|
|D.||Space occupying lesions account for 1% of new seizures age 35-65.|
|E.||Phenylketonuria may cause seizures.|
|Answer» D. Space occupying lesions account for 1% of new seizures age 35-65.|
Which statement is incorrect regarding treatment of seizures?
|A.||Diazepam has the most rapid onset of the BDZ’s.|
|B.||The LD of phenytoin needs to be decreased in renal impairment.|
|C.||Phenobarbital has duration of action of 3 days.|
|D.||Paraldehyde can be used rectally at a dose of 0.3mls/kg.|
|E.||Phenytoin is usually ineffective in seizures secondary to alcohol withdrawal or intoxication.|
|Answer» B. The LD of phenytoin needs to be decreased in renal impairment.|
Which is incorrect of seizures?
|A.||There is decreased risk of seizures in pregnancy.|
|B.||Eclamptic seizures are typically brief, self-terminating preceded by headache and visual disturbances.|
|C.||Pseudo seizures are often recognized by pelvic thrusting which occurs in 45%.|
|D.||Classic ethanol withdrawal seizures occur 6-48 hrs post withdrawal but can occur up to one week after withdrawal.|
|E.||Seizures in HIV patients are usually secondary to intracranial pathology and all require urgent CT scan.|
|Answer» A. There is decreased risk of seizures in pregnancy.|
Which is incorrect regarding status epilepticus?
|A.||Mortality at 60 mins of status is around 30%.|
|B.||Leucocytosis up to 20,000 is very common.|
|C.||SE occurs most commonly in patients without prior hx of seizures and in extremes of age.|
|D.||In phase 1 there is increased cerebral metabolism, hyperglycaemia, hyperpyrexia and hypertension.|
|E.||Muscle relaxants should be used in intubated patients to avoid self- inflicted injury.|
|Answer» E. Muscle relaxants should be used in intubated patients to avoid self- inflicted injury.|
Which of the following peripheral neurological nerve lesions will not result in proximal weakness greater than peripheral?
|C.||Neuromuscular junction disease|
|E.||All of the above result in more marked proximal weakness.|
|Answer» B. Neuropathy|
Which is INCORRECT regarding myasthenia gravis?
|A.||Onset in females usually 2nd and 3rd decades, males 7th and 8th decades.|
|B.||The thymus is abnormal in 75% and removal will improve symptoms in the majority.|
|C.||Acute crises in these patients can be due to myasthenia crisis or cholinergic crisis secondary to the medication.|
|D.||Muscle weakness is more marked peripherally.|
|E.||Diagnosis with Ach receptor antibody testing is possible but false negatives occur in 15%.|
|Answer» D. Muscle weakness is more marked peripherally.|
Which is incorrect regarding Guillain Barre Syndrome?
|A.||80% of patients will have antecedent infection with Campylobacter jejuni.|
|B.||CSF will show low protein, high glucose and often a pleocytosis up to 100.|
|C.||High dose immune globulin and plasmapheresis have been shown to be equally efficacious in reducing length of illness.|
|D.||Severe cases will not only involve demyelination but also axonal degeneration.|
|E.||85% will recover to their previous normal functioning in one year.|
|Answer» A. 80% of patients will have antecedent infection with Campylobacter jejuni.|
Which is INCORRECT regarding entrapment neuropathies?
|A.||Carpal tunnel syndrome usually produces more pain at night.|
|B.||Bell’s palsy cause sudden facial weakness with peak paralysis seen at 48 hrs.|
|C.||Use of steroids and acyclovir has been advocated for treatment of Bell’s palsy as one study showed reduced length of paralysis.|
|D.||Entrapment of deep peroneal nerve will result in foot drop and paraesthesia between big toe and second toe.|
|E.||Ulnar nerve entrapment usually occurs at the wrist resulting in numbness of 5th digit and half of 4th digit.|
|Answer» E. Ulnar nerve entrapment usually occurs at the wrist resulting in numbness of 5th digit and half of 4th digit.|
Which statement is INCORRECT regarding multiple sclerosis?
|A.||It is 2-3 times more common in females|
|B.||The most common reported symptom initially is sensory loss.|
|C.||Optic neuritis is usually unilateral can afferent pupillary response may be present.|
|D.||The majority of patients will show plaques on MRI T2 weighted scans.|
|E.||CSF often shows elevated protein, gamma-globulin and slightly elevated WCC.|
|Answer» B. The most common reported symptom initially is sensory loss.|
Which is INCORRECT regarding the treatment of multiple sclerosis?
|A.||Interferon and glatiramer have bee shown to reduce number of relapses in relapsingremitting MS.|
|B.||IV immunoglobulin monthly for 2 years has shown to reduce annual exacerbations in relapsing-remitting MS.|
|C.||No treatment currently exists for primary progressive MS to modify the disease.|
|D.||Exacerbations of MS are treated with methlypred IV as studies have shown this to be superior to other glucocorticoids.|
|E.||Symptomatic treatment of muscle spasticity is usually best achieved with baclofen.|
|Answer» D. Exacerbations of MS are treated with methlypred IV as studies have shown this to be superior to other glucocorticoids.|
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