

McqMate
These multiple-choice questions (MCQs) are designed to enhance your knowledge and understanding in the following areas: Biology .
1. |
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. |
2. |
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. |
3. |
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. |
4. |
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. |
5. |
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. |
6. |
What is the survival rate of a Hunt and Hess Grade 5 SAH? |
A. | 0% |
B. | 5% |
C. | 10% |
D. | 15% |
E. | 20% |
Answer» C. 10% |
7. |
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. |
8. |
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. |
9. |
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. |
10. |
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. |
11. |
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. |
12. |
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. |
13. |
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. |
14. |
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. |
15. |
Which of the following drugs is unlikely to cause seizure in withdrawal/ |
A. | Cocaine |
B. | Narcotics |
C. | Benzodiazepines |
D. | Alcohol |
E. | Tricyclics |
Answer» E. Tricyclics |
16. |
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. |
17. |
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. |
18. |
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. |
19. |
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. |
20. |
Which of the following peripheral neurological nerve lesions will not result in proximal weakness greater than peripheral? |
A. | Radiculopathy |
B. | Neuropathy |
C. | Neuromuscular junction disease |
D. | Myopathy |
E. | All of the above result in more marked proximal weakness. |
Answer» B. Neuropathy |
21. |
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. |
22. |
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. |
23. |
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. |
24. |
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. |
25. |
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. |
26. |
Which statement is incorrect regarding meningitis? |
A. | 90% of cases occur in the first 5 years, with peak at 6 months of age. |
B. | Damage is due to the inflammatory response not bacterial toxins. |
C. | Brudzinski’s sign is involuntary hip flexion with passive neck flexion. |
D. | CT may be normal even in the presence of elevated ICP in up to 45%. |
E. | LP is always abnormal with bacterial meningitis. |
Answer» E. LP is always abnormal with bacterial meningitis. |
27. |
A CSF shows opening pressure of 30 cm H2O , protein of 0.1, glucose of 2.0, WCC of 100, and no organisms on gram stain. Which type of meningitis does this fit with? |
A. | Acute bacterial. |
B. | Viral meningitis. |
C. | Normal result. |
D. | TB meningitis |
E. | TB meningitis or partly treated bacterial meningitis. |
Answer» E. TB meningitis or partly treated bacterial meningitis. |
28. |
Which is true regarding treatment of meningitis? |
A. | Empiric treatment in adults consists of ceftriaxone 2g IV. |
B. | There is no evidence to support dexamethasone in infants with meningitis especially with Hib meningitis. |
C. | Strep pneumoniae is becoming increasingly resistant to ceftriaxone in Australia as well as penicillin. |
D. | Neisseria meningitis has high rates of resistance to benzylpen, so ceftriaxone is the first treatment of choice now. |
E. | There is no parental treatment available for cryptocccocal meningitis. |
Answer» C. Strep pneumoniae is becoming increasingly resistant to ceftriaxone in Australia as well as penicillin. |
29. |
Which is incorrect regarding encephalitis? |
A. | MRI shows characteristic temporal and frontal lobe changes in HSV. |
B. | CSF usually shows aseptic meningitis. |
C. | PCR for HSV is insensitive but very specific. |
D. | Acyclovir has only been shown to be effective in HSV, but is also used in herpes zoster encephalitis. |
E. | Mortality from HSV is higher than herpes zoster or CMV. |
Answer» C. PCR for HSV is insensitive but very specific. |
30. |
Which is INCORRECT regarding cerebral abscess? |
A. | Classical triad of headache, fever and focal neurological deficit occurs in over 80% of patients. |
B. | CT without contrast may miss the diagnosis. |
C. | Lumbar puncture is contraindicated. |
D. | Spread is haematogenous, contiguous or from neursurg or penetrating trauma. |
E. | Anaerobes predominate as infecting organisms. |
Answer» A. Classical triad of headache, fever and focal neurological deficit occurs in over 80% of patients. |
31. |
Which is not a risk factor for subarachnoid haemorrhage? |
A. | female |
B. | 1st degree relative with SAH |
C. | polycystic ovaries |
D. | smoking |
E. | Marfans syndrome, coarctation of the aorta |
Answer» C. polycystic ovaries |
32. |
What percentage of pts with SAH have a prior sentinal warning hemorrhage ? |
A. | 10% |
B. | 20% |
C. | 30% |
D. | 40% |
E. | 50% |
Answer» E. 50% |
33. |
A patient with a SAH has a severe headache with nuchal rigidity but no focal neurological signs.What is her Hunt and Hess classification? |
A. | 1 |
B. | 2 |
C. | 3 |
D. | 4 |
E. | 5 |
Answer» B. 2 |
34. |
Which statement is incorrect with regards to non contrast CT in SAH |
A. | <12 hours =97.5% detection |
B. | 24 hours=95% detection |
C. | 1 week 50% detection |
D. | 3 days = 75% detection |
E. | 1 hour= 100% detection |
Answer» E. 1 hour= 100% detection |
35. |
Which statement is FALSE about zanthocromia and SAH? |
A. | Inspection of CSF with the naked eye reliably detects zanhtochromia |
B. | it is present in all CSF at 6 hours |
C. | it remains in CSF for 2 weeks |
D. | it is not present in a traumatic tap |
E. | it is detected with spectrophotometry |
Answer» B. it is present in all CSF at 6 hours |
36. |
Which statement is INCORRECT with regards to vasospasm in SAH? |
A. | it usually occurs at day 4-14 |
B. | it effects 30% of pts with SAH |
C. | it has a 30% morbidity and mortality untreated |
D. | hypertensive therapy with iv fluids and inotropes is contrindicated |
E. | the treatment of choice is Nimodipine |
Answer» D. hypertensive therapy with iv fluids and inotropes is contrindicated |
37. |
Which interventions are NOT recommended and proven in Australia for treatment of ischemic strokes? |
A. | thrombolysis if less than 3 hours and normal CT |
B. | aspirin |
C. | specialized stoke unit |
D. | warfarin if atrial fibrillation |
E. | clopridogil |
Answer» A. thrombolysis if less than 3 hours and normal CT |
38. |
A patient presents with right sided arm weakeness and a R facial droop with aphasia. Which artery distribution is the likely to be the cause of her stoke? |
A. | right MCA |
B. | left MCA |
C. | right anterior cerebral artery |
D. | left anterior cerebral artery |
E. | left vertebrobasilar system |
Answer» B. left MCA |
39. |
Which is true of the recent trial (NINDS) of thrombolysis in acute ischemic stroke? |
A. | streptokinase has the same risk benefit profile as tPA |
B. | the mortaility rate of tPA given within three hours of onset of ischemic stroke is lower than that of the stoke without thrombolysis |
C. | the mortality rate of tPA given within three hours of onset of ischemic stroke is higher than that of the stoke without thrombolysis |
D. | the long term disability rate in patients surviving their stoke is less if they were given tPA |
E. | the long term disability rate in patients surviving their stoke is higher if they were given tPA |
Answer» D. the long term disability rate in patients surviving their stoke is less if they were given tPA |
40. |
Which statement is FALSE about carotid stenoses? |
A. | in a patient with an anterior circulation ischemic event, the presence of a bruit suggests a moderately severe stenosis |
B. | in a patient with an anterior circulation ischemic event, the absence of a bruit dismisses a moderately severe stenosis |
C. | a symptomatic stenosis >70% is often operated upon |
D. | an asymptomatic stenosis of > 70% is usually not operated upon |
E. | all patient with stenoses < 30% should not be considered for endarterectomy |
Answer» B. in a patient with an anterior circulation ischemic event, the absence of a bruit dismisses a moderately severe stenosis |
41. |
When would heparin be given in an ischemic stroke or TIA? |
A. | all |
B. | vertebro basilar ischemic stroke |
C. | anterior circulation ischemic stroke with no prior history of cerebrovascular disease |
D. | ischemic stroke or TIA secondary to proven cardioembolic source |
E. | lacunar infarct with 80% carotid stenosis |
Answer» D. ischemic stroke or TIA secondary to proven cardioembolic source |
42. |
Which statement is FALSE regarding migraine? |
A. | pathophysiology involves inflammation of the trigeminovascular system |
B. | serotonin plays an integral part |
C. | the aura, if present, should last less than 60 mins and be totally reversible |
D. | it is typically bilateral, pulsating and occipital |
E. | the headache usually last 4-72 hours |
Answer» D. it is typically bilateral, pulsating and occipital |
43. |
Which is incorrect regarding the pharmacological treatment of migraine? |
A. | chlorpromazine is a first line agent |
B. | sumotriptan is a first line agent |
C. | dihydroergotamine should not be given if sumotriptan has already been taken |
D. | pethidine is not as effective in treatment and has a higher rebound c.f other agents |
E. | dexamethasone has been proven to decrease rate of recurrence |
Answer» E. dexamethasone has been proven to decrease rate of recurrence |
44. |
Which statement is FALSE regarding other headaches? |
A. | cluster headaches are short lived lasting 15-180 mins |
B. | oxygen can releve a majority of cluster headaches |
C. | temperal arteritis usually produces an ESR of 20 |
D. | temporal arteritis can cause ischemic optic neuritis if left untreated |
E. | treatment of temperal arteritis involves oral prednisolone |
Answer» C. temperal arteritis usually produces an ESR of 20 |
45. |
What percentage of the population will have at least one seizure in their lifetime? |
A. | 2.5% |
B. | 5% |
C. | 10% |
D. | 15% |
E. | 17.5% |
Answer» C. 10% |
46. |
How long does a pt have to be seizing for to be in Status Epilepticus? |
A. | 20 mins |
B. | 30 mins |
C. | 40 mins |
D. | 50 mins |
E. | 60 mins |
Answer» B. 30 mins |
47. |
Which statement is false about Phenytoin? |
A. | the loading dose is 15-20 mg/kg |
B. | if a pt on phenytoin arrives in status epilepticus then the full loading dose should still be given |
C. | side effects include hypotension and bradyarrythmias |
D. | it is extremely effective in alcohol induced seizures |
E. | it is contraindicated in 2nd and 3rd degree heart block |
Answer» D. it is extremely effective in alcohol induced seizures |
48. |
Which statement is false about benzodiazepines and seizures? |
A. | there is little evidence to support any particular one |
B. | the dose of clonazepam in a child is 0.5 mg, and an adult 1mg |
C. | diazepam can be safely used PR, IM or IV |
D. | the rectal dose of diazepam for a 3 year old is about 5mg |
E. | the IV dose of diazepam in a 1 year old is about 2-3mg |
Answer» C. diazepam can be safely used PR, IM or IV |
49. |
Which of the features below is not consistent with a pseudoseizure? |
A. | rhythmic thrusting of the pelvis |
B. | extremity movements out of phase bilaterally |
C. | head rolling from side to side |
D. | recall of events during the seizure |
E. | tongue biting |
Answer» E. tongue biting |
50. |
What is the recommended antibiotic regimen for empirical treatment of bacterial meningitis in a 40 year old? |
A. | Ceftriaxone 2gm and Benzylpenicillin 1.8gm |
B. | Ceftriaxone 2gm |
C. | Benzylpenicillin 1.8gm |
D. | Ceftriaxone 2gm and Benzylpenicillin 1.8gm and Vancomycin 500mg |
E. | Ceftriaxone 2gm and Vancomycin 500mg |
Answer» A. Ceftriaxone 2gm and Benzylpenicillin 1.8gm |
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