DSE of Nrves and Mscles

Question 1

1. Fothergill’s disease is another name for

(a) Facial palsy
(b) Bell’s palsy
(c) Tic Douloureux
(d) Hemifacial atrophy

Answer 1

(c) Fothergill’s disease, also known as Tic Douloureux is
classified as a major neuralgia and affects the trigeminal
nerve.

Question 2

2. The syndrome characterized by miosis, ptosis and anhidrosis
   and vasodilatation over face is

(a) Hurler syndrome
(b) Horner syndrome
(c) Gardner syndrome
(d) Treacher Collins syndrome

Answer 2

(b) The chief significance of this syndrome is that it indicates a
primary disease. Thus lesions in the brainstem-like tumors
or infections in cervical or high thoracic cord will produce
this syndrome.

Question 3

3. Development of trigeminal neuralgia in young individuals may
   suggest the possibility of _______ .

(a) Hemifacial atrophy
(b) Hemifacial hypertrophy
(c) Gigantism
(d) Multiple myeloma

Answer 3

(a) Also known as Parry-Romberg syndrome, it is manifested
by progressive atrophy of some or all of the tissues of one
side of the face. Trigeminal neuralgia as well as Bell’s palsy
may occur if the V and VII cranial nerves are involved in the
atrophy.

Question 4

4. Which of the following statements is true regarding trigeminal
   neuralgia?

(a) Affects females more than males
(b) Affects left side of face more than right side
(c) Tumors or aneurysms are one of its causes
(d) Older adults are more frequently affected

Answer 4

(b) It is a completely unexplained fact that right side of face is
affected more than the left side in a ratio of about 1.7 to 1.

Question 5

5. The pain of trigeminal neuralgia is described as

(a) Lancinating
(b) Throbbing
(c) Dull ache
(d) Continuous

Answer 5

. (a) The pain of trigeminal neuralgia is typically described as
stabbing, searing or lancinating type which is often initiated
by the touching of one of the many trigger zones on the face

Question 6

6. All of the following landmarks except __________ are considered
   as trigger zones of trigeminal neuralgia.

(a) Palate
(b) Vermilion border of lip
(c) Buccal mucosa
(d) Tongue

Answer 6

(b) Apart from vermilion zone, alae of nose, cheeks and
periorbital region are also common trigger zones on face.

Question 7

7. Which clinical condition must be differentiated from trigeminal
   neuralgia before establishing the diagnosis?

(a) Bell palsy
(b) Migraine
(c) Hurler syndrome
(d) Multiple sclerosis

Answer 7

(b) Migraine or migrainous neuralgia can sometimes be
confused with trigeminal neuralgia, but the headache of
migraine is persistent, at least over a period of hours and
has no trigger zone.

Question 8

8. A clinically similar condition called postherpetic neuralgia occurs
   after _________ infection.

(a) Chickenpox
(b) Herpes simplex
(c) Herpes zoster
(d) Herpangina

Answer 8

(c) The postherpetic neuralgia usually involves the ophthalmic
division of the trigeminal nerve, but commonly regresses
within 2–3 weeks.

Question 9

9. How can postherpetic neuralgia be clinically differentiated from
   trigeminal neuralgia?

(a) Positive history of skin lesions prior to neuralgia
(b) Presence of trigger zones on face
(c) Histopathological examination
(d) Laboratory investigations

Answer 9

(a) Herpes zoster is a re-infection by Varicella zoster
(chickenpox) virus infection which occurs due to the virus
remaining latent within the trigeminal ganglion after the
chickenpox infection has subsided. Thus post-herpetic
neuralgia can easily be detected by confirming the prior
occurrence of typical lesions prior to development of
neuralgia

Question 10

10. Which of the following drugs has been found to be beneficial in
    the treatment of trigeminal neuralgia in the recent years?

(a) Rifampicin
(b) Dilantin sodium
(c) Benzene
(d) Corticosteroids

Answer 10

(b) Dilantin sodium has given good results in control of trigeminal
neuralgia in early as well as advanced cases. Reports,
however, indicate that it should be used continuously as its
cessation has led to recurrence of neuralgia in some cases

Question 11

11. Which region of face is affected in sphenopalatine neuralgia?

(a) Maxilla
(b) Mandible
(c) Back of head
(d) Lower lip

Answer 11

(a) Sphenopalatine ganglion neuralgia is believed nowadays to
be a variant of migraine and is characterized by unilateral
paroxysms of intense pain in regions of maxilla, zygoma,
ear and mastoid, base of nose and periorbital region.

Question 12

12. Identify the incorrect statement amongst the below given
    statements regarding causalgia.

(a) Arises after injury to sectioning of peripheral sensory nerve
(b) Usually follows extraction of multirooted tooth
(c) Pain is described as a dull ache
(d) Pain has a typical burning quality

Answer 12

(c) The pain of causalgia in fact derives its name from the typical
burning variety and interestingly may be elicited not only by
actual touch stimulation but also by emotional disturbances

Question 13

13. Glossodynia refers to painful

(a) Ears
(b) Tongue
(c) Nose
(d) Mouth

Answer 13

(b) Painful tongue can be caused by various local and systemic
disorders like anemias, diabetes, gastric disturbances like
hyper or hypoacidity, xerostomia, psychogenic factors,
periodontal disease, trigeminal neuralgia, referred pain
from teeth abscesses, angioneurotic edema, excessive use
of spices, antibiotic therapy and local causes like irritating
dentures flanges or clasps, etc.

Question 14

14. Which amongst the following can cause glossodynia?

(a) Pernicious anemia
(b) Chickenpox
(c) Vertigo
(d) Tuberculosis

Answer 14

(c) Glossodynia or burning tongue is one of the important
symptoms of advanced pernicious anemia and is manifested
as red, smooth tongue devoid of papillae.

Question 15

15. Frey’s syndrome occurs as a result of damage to _____ nerve.

(a) Mandibular
(b) Ophthalmic
(c) Auriculotemporal
(d) Ascending pharyngeal

Answer 15

(c) Frey’s syndrome occurs as a result of damage to the
auriculotemporal nerve and subsequent reinnervation of
sweat glands by parasympathetic nerves

Question 16

16. The chief complaint of patient suffering from Frey’s syndrome is

(a) Flushing and sweating of face during eating
(b) Pain in the parotid region during eating
(c) Pain in the tongue during swallowing
(d) Paroxysmal attacks of pain in face during winter season

Answer 16

(a) The sweating that occurs in Frey’s syndrome is typically seen
on the temporal region and its severity may be increased by
consumption of spicy foods.

Question 17

17. Frey’s syndrome must be considered as a possible complication
    following

(a) Maxillary resection
(b) Nasal reconstruction
(c) Incorrect infraorbital nerve block
(d) Parotid tumor removal surgeries

Answer 17

(d) The possibility of Frey’s syndrome must always be
considered after surgeries involving areas supplied by the
ninth cranial nerve. It has been reported as a complication
in as high as 80% of cases following parotidectomy due to
various causes

Question 18

18. Which amongst the following is associated with etiology of Bell’s
    palsy?

(a) Parotidectomy
(b) Syphilis
(c) Gardner syndrome
(d) Gingivectomy

Answer 18

(a) Terminal branches of facial nerve pass through the parotid
gland. Thus any surgical procedure involving the parotid
gland need to be approached with due caution.

Question 19

19. Which virus is now believed to be the one responsible for causing
    Bell palsy?
    (a) Herpes simplex (b) Varicella zoster
    (c) Cytomegalovirus (d) Epstein-Barr

Answer 19

(a) Herpes simplex as well as herpes zoster are implicated in
the etiology of Bell palsy especially in childhood cases. This
occurs due to reactivation of the viruses residing latent
within the geniculate ganglion

Question 20

20. Drooping of corner of mouth, drooling of saliva, watering of eyes
    and inability to wink are indicative of

(a) Auriculotemporal syndrome
(b) Sphenopalatine neuralgia
(c) Facial paralysis
(d) Trigeminal neuralgia

Answer 20

(c) Features of muscular paralyses are drooping of corner of
mouth, watering of eye, and inability to wink. Patient has a typical mask-like appearance and eating as well as speech
may become difficult.

Question 21

21. Trauma to which gland can result in facial paralysis?

(a) Submandibular
(b) Parotid
(c) Sublingual
(d) Palatal

Answer 21

(b) Trauma or surgeries involving partial or total parotid gland
removal are involved with facial paralysis due to sectioning
of the facial nerve

Question 22

22. Repeated attacks of facial palsy, nonpitting, and painless edema
    of face, cheilitis granulomatosa and fissured tongue are all
    components of ________ syndrome.

(a) Frey’s
(b) Reye’s
(c) Gorlin-Goltz
(d) Melkersson-Rosenthal

Answer 22

(d) In cases of recurrent attacks of facial palsy along with
painless edema of face, cheilitis granulomatosa and fissured
tongue, one must consider the diagnosis of MelkerssonRosenthal syndrome.

Question 23

23. Unilateral, paroxysmal pain in ear, pharynx, nasopharynx, tonsils
    and posterior tongue is indicative of neuralgia of _______ nerve.

(a) V
(b) IX
(c) III
(d) VII

Answer 23

(b) Glossopharyngeal neuralgic pain is strikingly similar to
that of trigeminal neuralgia. It can be differentiated from
trigeminal neuralgia on the basis of pain in areas supplied
by respective nerves.

Question 24

24. Trigger zone in glossopharyngeal neuralgia is located in

(a) Nasopharynx
(b) Posterior oropharynx
(c) Anterior oropharynx
(d) Retromolar trigone

Answer 24

(b) Since trigger zones are located in posterior oropharynx,
glossopharyngeal neuralgia can be incited by simple acts
like swallowing, talking, yawning or coughing

Question 25

25. Which one of the following is classified under the heading of
    demyelinating diseases?

(a) Progressive hemifacial atrophy
(b) Multiple myeloma
(c) Multiple sclerosis
(d) Motor neuron disease

Answer 25

(c) Multiple sclerosis is now believed to be an autoimmune
disease caused by some isolated environmental factor
which inadvertently inactivates or dysregulates the immune
apparatus by a retroviral infection that was perhaps acquired
during childhood.

Question 26

26. One amongst the following statements is incorrect regarding
    burning mouth syndrome

(a) Burning sensation in oral mucosa in absence of visible
mucosal lesions
(b) Xerostomia is an important etiological factor
(c) Patients give a short history of presence of symptoms
(d) Strong female predilection

Answer 26

(c) History of illness in most cases is protracted with the
patients experiencing the symptoms of this disorder for a
long time. The burning sensation may be either continuous
or intermittent.

Question 27

27. One condition which must always be considered in differential
    diagnosis of any vague/atypical orofacial pain is

(a) Frey’s syndrome
(b) Eagle’s syndrome
(c) Treacher-Collins syndrome
(d) Bell’s palsy

Answer 27

(b) This syndrome occurs due to elongation or ossification of
the styloid process and can cause dysphagia, sore throat,
otalgia, glossodynia, headache and vague orofacial pain

Question 28

28. The most consistent symptom in atypical facial pain is ____ pain.
    (a) Pharyngeal
    (b) Neck
    (c) Ear
    (d) Laryngeal

Answer 28

(a) Pharyngeal pain may be caused either by formation and
subsequent rubbing of scar tissue following tonsillectomy or
impingement by ossified styloid process over the internal/
external carotid artery (carotid artery syndrome).

Question 29

29. Myasthenia gravis is a chronic disease characterized by progressive weakness of _____ skeletal muscles.
    (a) Facial
    (b) Skeletal
    (c) Cardiac
    (d) Smooth

Answer 29

(b) Myasthenia gravis is believed to be an autoimmune disorder
characterized by weakness and easy fatigability of the
skeletal muscles. The autoantibodies are directed towards
the acetylcholine receptors at the neuromuscular junction.

Question 30

30. The drug of choice that is used in the treatment of myasthenia
    gravis is also used for diagnosis of this disease is
    (a) Neomycin
    (b) Physostigmine
    (c) Acetylcholine
    (d) Noradrenaline

Answer 30

(b) Physostigmine, an anticholinesterase, when administered
intramuscularly, improves the strength of affected muscles
within minutes, although this remission is only temporary.