Neurology_Inflammatory Diseases and MS

Question 1

Acute stage of viral meningitis is not associated with:
A) common negative clinical findings of cranial CT
B) negative findings on EEG exam
C) cloudy liquor, elevated cell and protein count
D) elevated lymphocyte count in the CSF

Answer 1

C) cloudy liquor, elevated cell and protein count

Question 2

Acute stage of purulent meningitis is not associated with:
A) epileptic seizures
B) confusion
C) violent headaches
D) elevated lymphocyte and monocyte count in the CSF

Answer 2

D) elevated lymphocyte and monocyte count in the CSF

Question 3

Characteristics of Guillain–Barre syndrome include:
A) segmental demyelinisation may be accompanied by axonal damage
B) axonal lesion does not occur
C) only sensory axonal lesion occurs
D) damage to myelin sheeth is always associated with axonal damage

Answer 3

A) segmental demyelinisation may be accompanied by axonal damage

Question 4

Useful in prion disease treatment:
A) penicillin
B) AZT (azidothymidin)
C) macrolides
D) none of the above

Answer 4

D) none of the above

Question 5

Initial stage of optic neuritis is characterized by central scotoma and:
A) papillary hyperaemia
B) papillary oedema
C) slight blur in vitreous humor
D) all of the above
E) none of the above

Answer 5

E) none of the above

Question 6

Characteristic symptoms of encephalitis, except:
A) headache
B) decreased protein content in CSF
C) cranial nerve symptoms
D) changes in sleep rhythm
E) confusion, fever, headache, epileptic seizures

Answer 6

B) decreased protein content in CSF

Question 6

Observed meningitis symptoms may include:
A) vomiting
B) avoiding light
C) signs of meningeal irritation
D) all of the above
E) none of the above

Answer 6

D) all of the above

Question 7

Which examination is least informative in polyneuropathy?
A) neurography
B) examination of reflexes
C) muscle biopsy
D) nerve biopsy

Answer 7

C) muscle biopsy

Question 8

Of the following diagnostic procedures, which is most commonly pathological in Multiple Sclerosis?
A) eye movement examination
B) cranial CT
C) EEG
D) myelography

Answer 8

A) eye movement examination

Question 9

Leading clinical signs of acute Guillain–Barre syndrome are:
1) possible cranial nerve lesion
2) ascending paresis
3) flaccid or absent deep reflexes
4) muscular atrophy
A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 9

A) answers 1, 2 and 3 are correct

1) possible cranial nerve lesion
2) ascending paresis
3) flaccid or absent deep reflexes

Question 9

Characteristic alterations in the CSF in multiple sclerosis:
1) increased glucose content
2) elevated levels of relative immunglobulin- IgG values
3) increased polymorphonuclear leucocyte count in 1/3 of cases
4) increased protein content in app. 1/3 of cases
A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 9

C) answer 2 and 4 correct

2) elevated levels of relative immunglobulin- IgG values
4) increased protein content in app. 1/3 of cases

Question 9

Diagnostic criteria for NMO (neuromyelitis opticA) are:
1) Clinical signs of optic neuritis and/or spinal lesion
2) Presence of aquaporin-4 antibodies in serum
3) Presence of LTM (extensive myelitis overlying several segments) on spinal MR findings
4) Presence of OGP (sign of intrathecal IgG synthesis) in CSF
A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 9

A) answer 1, 2 and 3 correct

1) Clinical signs of optic neuritis and/or spinal lesion
2) Presence of aquaporin-4 antibodies in serum
3) Presence of LTM (extensive myelitis overlying several segments) on spinal MR findings

Question 10

Characteristics of multiple sclerosis are:
1) it is more common is white people
2) it is most common in a relapse-remission pathological form
3) multifocal neurological symptoms
4) first symptoms usually present over age 50
A) answer 1, 2 and 3 are correct
B) answer 1 and 3 are correct
C) answer 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 10

A) answer 1, 2 and 3 are correct

1) it is more common is white people
2) it is most common in a relapse-remission pathological form
3) multifocal neurological symptoms

Question 11

Characteristic symptoms of Guillain–Barre syndrome are:
1) flaccid paresis, absent deep reflexes
2) sensory deficit does not occur
3) cell-protein dissociation is commonly observed in the CSF
4) survival extends usually for a few months, maximum two years
A) answers 1, 2 and 3 correct
B) answers 1 and 3 correct
C) answers 2 and 4 correct
D) only answer 4 correct
E) all of the answers correct

Answer 11

B) answers 1 and 3 correct

1) flaccid paresis, absent deep reflexes
3) cell-protein dissociation is commonly observed in the CSF

Question 12

Common chronic symptoms of multiple sclerosis are:
1) pathological tiredness (fatigue)
2) disordered optic pathways and eye movement
3) vigorous reflexes
4) epilepsy
A) answers 1, 2 and 3 correct
B) answers 1 and 3 correct
C) answers 2 and 4 correct
D) only answer 4 correct
E) all of the answers correct

Answer 12

A) answers 1, 2 and 3 correct

1) pathological tiredness (fatigue)
2) disordered optic pathways and eye movement
3) vigorous reflexes

Question 13

Common clinical signs of multiple sclerosis are:
1) paraesthesia
2) optic neuritis
3) paresis
4) ataxia
A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 13

E) all 4 answers are correct

1) paraesthesia
2) optic neuritis
3) paresis
4) ataxia

Question 14

24 Common chronic symptoms of multiple sclerosis may be:
1) dizziness
2) confabulation
3) weakness in the extremities, spasticity
4) brain oedema
A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 14

B) answers 1 and 3 are correct

1) dizziness
3) weakness in the extremities, spasticity

Question 15

Useful diagnostic procedures of multiple sclerosis:
1) patient’s medical history and detailed neurological examination
2) cranial MRI examination
3) evoked potential tests
4) CSF test
A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 15

E) all 4 answers correct

1) patient’s medical history and detailed neurological examination
2) cranial MRI examination
3) evoked potential tests
4) CSF test

Question 16

The following patients are at an increased risk for multiple sclerosis:
1) young adults
2) women
3) North-European whites
4) a person who has a close relative suffering from multiple sclerosis
A) answers 1, 2 and 3 correct
B) answers 1 and 3 correct
C) answers 2 and 4 correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 16

E) all 4 answers are correct

1) young adults
2) women
3) North-European whites
4) a person who has a close relative suffering from multiple sclerosis

Question 17

Diagnostic specificities of multiple sclerosis (MS):
1) high IgG index in the CSF is specific for MS
2) extended latency values on VEP (visually evoked potentials) are specific for MS
3) gadolinium accumulating white matter lesions detected on MRI are specific for MS
4) dissemination of clinical signs in space and time is prime criterion for the diagnosis
A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 17

D) only answer 4 is correct

4) dissemination of clinical signs in space and time is prime criterion for the diagnosis

Question 18

During the treatment of multiple sclerosis relapse:
1) high dose intravenous methylprednisolon for 3–5 days are administered
2) steroid use is not prescribed in the treatment of psychosis
3) in severe diabetes or acute infection, steroids are not administered
4) beta-interferon is administered instantenously
A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 18

A) answer 1, 2 and 3 correct

1) high dose intravenous methylprednisolon for 3–5 days are administered
2) steroid use is not prescribed in the treatment of psychosis
3) in severe diabetes or acute infection, steroids are not administered

Question 19

Spasticity in multiple sclerosis may be reduced using the following medications:
1) dantrolen
2) tizanidine
3) botulinumtoxin
4) baclofen
A) answers 1, 2 and 3 correct
B) answers 1 and 3 correct
C) answers 2 and 4 correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 19

C) answers 2 and 4 correct

Question 20

The following drugs are used to reduce multiple sclerosis relapse rate:
1) azathioprin
2) ABCR self-administered injections (beta-interferons, glatiramer acetate)
3) INH (isonicid)
4) monoclonal antibodies (natalizumab, alemtuzumab)
A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 20

C) answers 2 and 4 are correct

2) ABCR self-administered injections (beta-interferons, glatiramer acetate)

4) monoclonal antibodies (natalizumab, alemtuzumab)

Question 21

In multiple sclerosis, introduction of immunomodulatory treatment should be indicated:
1) in relapsing-remitting clinical form, during the active phase
2) in the primary, progressive form
3) in the early stage, until the patient retains mobility
4) in a secondary, progressive form, over age 50
A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 21

B) answer 1 and 3 correct

1) in relapsing-remitting clinical form, during the
3) in the early stage, until the patient retains mobility

Question 22

Side effects of interferon treatment: 1) fever and influenza-like symptoms at the beginning of treatment 2) may increase symptoms of depression 3) local reaction on the site of injection 4) it increases blood pressure A) answers 1, 2 and 3 correct B) answers 1 and 3 correct C) answers 2 and 4 correct D) only answer 4 is correct E) all 4 answers are correct

Answer 22

A) answers 1, 2 and 3 correct 1) fever and influenza-like symptoms at the beginning of treatment 2) may increase symptoms of depression 3) local reaction on the site of injection

Question 22

Link the abnormal laboratory results with the matching pathological clinical picture. GM1 antibodies appear in the serum or CSF A) acute Guillain–Barré syndrome B) multifocal motor neuropathy C) multiple sclerosis D) adrenoleukodystrophy

Answer 22

B) multifocal motor neuropathy

Question 23

Link the abnormal laboratory results with the matching pathological clinical picture. Oligoclonal gammopathy is present in the CSF A) acute Guillain–Barré syndrome B) multifocal motor neuropathy C) multiple sclerosis D) adrenoleukodystrophy

Answer 23

C) multiple sclerosis

Question 24

Link the abnormal laboratory results with the matching pathological clinical picture. Cell-protein dissociation in the CSF is typical A) acute Guillain–Barré syndrome B) multifocal motor neuropathy C) multiple sclerosis D) adrenoleukodystrophy

Answer 24

A) acute Guillain–Barré syndrome

Question 25

Link the abnormal laboratory results with the matching pathological clinical picture. Long chain saturated fatty acids accumulate in the serum A) acute Guillain–Barré syndrome B) multifocal motor neuropathy C) multiple sclerosis D) adrenoleukodystrophy

Answer 25

D) adrenoleukodystrophy

Question 26

Match the following: A JC virus infection, acquired in childhood, usually plays a part in the disease A) progressive multifocal leukoencephalopathy (PML) B) tuberculosis C) aspergillosis D) toxoplasmosis

Answer 26

A) progressive multifocal leukoencephalopathy (PML)

Question 27

Match the following: Fungal disease A) progressive multifocal leukoencephalopathy (PML) B) tuberculosis C) aspergillosis D) toxoplasmosis

Answer 27

C) aspergillosis

Question 28

Match the following: Domestic cats play a part in its spreading A) progressive multifocal leukoencephalopathy (PML) B) tuberculosis C) aspergillosis D) toxoplasmosis

Answer 28

D) toxoplasmosis

Question 29

Match the following: It can cause septic embolism in the brain A) progressive multifocal leukoencephalopathy (PML) B) tuberculosis C) aspergillosis D) toxoplasmosis

Answer 29

C) aspergillosis

Question 30

Match the following: Sudden onset of idiopathic facial paralysis A) Ramsay Hunt syndrome B) Bell's palsy C) Guillain-Barré syndrome D) Melkersson-Rosenthal syndrome

Answer 30

B) Bell's palsy

Question 31

Match the following: Facial paralysis caused by the herpes of the ear canal A) Ramsay Hunt syndrome B) Bell's palsy C) Guillain-Barré syndrome D) Melkersson-Rosenthal syndrome

Answer 31

A) Ramsay Hunt syndrome

Question 32

Match the following: Facial paralysis with swollen lips A) Ramsay Hunt syndrome B) Bell's palsy C) Guillain-Barré syndrome D) Melkersson-Rosenthal syndrome

Answer 32

D) Melkersson-Rosenthal syndrome

Question 33

Match the following: Bilateral facial paralysis may occur A) Ramsay Hunt syndrome B) Bell's palsy C) Guillain-Barré syndrome D) Melkersson-Rosenthal syndrome

Answer 33

C) Guillain-Barré syndrome

Question 34

Based on the signs and symptoms, the case can be: A 48 years old male patient, who regularly consumes alcohol, became restless in the morning on the day of the hospital admission, and suffered a Grand Mal Seizure. He was scheduled for a surgery due to colon cancer half a year ago. Three days prior to the admission, he experienced a fever and his temperature rose to 38 ° C. Upon examination, a mild stiffness in the neck, a horizontal nystagmus (while looking in both directions), and a moderate limb and trunk ataxia were discovered. He was slightly somnolent. A) purulent meningitis B) brain abscess C) brain tumor of metastatic origin D) all of the above E) none of the above

Answer 34

D) all of the above

Question 35

If the CSF examination will take place, the case of purulent meningitis stands, if: A 48 years old male patient, who regularly consumes alcohol, became restless in the morning on the day of the hospital admission, and suffered a Grand Mal Seizure. He was scheduled for a surgery due to colon cancer half a year ago. Three days prior to the admission, he experienced a fever and his temperature rose to 38 ° C. Upon examination, a mild stiffness in the neck, a horizontal nystagmus (while looking in both directions), and a moderate limb and trunk ataxia were discovered. He was slightly somnolent. 1) clear CSF 2) increased amount of white blood cells 3) oligoclonal gammopathy 4) 1 g/l quantities of total protein A) answer 1, 2 and 3 correct B) answer 1 and 3 correct C) answer 2 and 4 correct D) only answer 4 correct E) all 4 answers correct

Answer 35

C) answer 2 and 4 correct 2) increased amount of white blood cells 4) 1 g/l quantities of total protein

Question 36

Which of the following examinations is to be carried out first? A 48 years old male patient, who regularly consumes alcohol, became restless in the morning on the day of the hospital admission, and suffered a Grand Mal Seizure. He was scheduled for a surgery due to colon cancer half a year ago. Three days prior to the admission, he experienced a fever and his temperature rose to 38 ° C. Upon examination, a mild stiffness in the neck, a horizontal nystagmus (while looking in both directions), and a moderate limb and trunk ataxia were discovered. He was slightly somnolent. A) chest X-ray B) ECG C) EEG D) CT E) lumbar puncture

Answer 36

D) CT

Question 37

The brain contusion almost always involves a loss of consciousness, and no abnormalities are visible on the CT scan and the CSF is often bloody. A) true B) false

Answer 37

B) false

Question 38

The postoperative survival of patients suffering from glioblastoma multiforme usually ranges from a few months up to a year or two. A) true B) false

Answer 38

A) true

Question 39

The number of cells increases and protein content decreases in the CSF during encephalitis. A) true B) false

Answer 39

B) false

Question 40

Brain abscess is often caused by an extracerebral premise. A) true B) false

Answer 40

A) true

Question 41

Cauda equina syndrome is not pyramidal. A) true B) false

Answer 41

A) true

Question 42

The visual evoked potential (VEP) is still intact in most patients suffering from multiple sclerosis. A) true B) false

Answer 42

B) false

Question 43

Generally, a vertical nystagmus can be observed in the case of vertigo of peripheral origin. A) true B) false

Answer 43

B) false

Question 44

The level of the anti-measles antigens rises in the CSF during neuromyelitis optica. A) true B) false

Answer 44

B) false

Question 45

Multiple sclerosis is a disease of unknown etiology, in which environmental, genetic and immunological factors may play a role in its development. A) true B) false

Answer 45

A) true

Question 46

Multiple sclerosis is an autoimmune disease, in which T-cell mediated immune response has an important role. A) true B) false

Answer 46

A) true

Question 47

With multiple sclerosis, the myelin sheath suffers a segmental damage, the axon, however, remains in good condition. A) true B) false

Answer 47

B) false

Question 48

The most common form of multiple sclerosis is the manifestation with relapses and remitting. A) true B) false

Answer 48

A) true

Question 49

69 In about 10% of the multiples sclerosis diseases, it occurs in a primary progressive form from the beginning. A) true B) false

Answer 49

A) true

Question 50

The relapsing-remitting multiple sclerosis with the later stage of the clinical course develops into a secondary progressive form. A) true B) false

Answer 50

A) true

Question 51

The primary progressive form of multiple sclerosis can develop into a secondary progressive form. A) true B) false

Answer 51

B) false

Question 52

Generally, the prognosis of the primary progressive form of the disease is worse than the relapse-remitting form or the secondary progressive form of multiple sclerosis. A) true B) false

Answer 52

A) true

Question 53

With appropriate treatment and care, the life expectancy of patients with multiple sclerosis is only a few years less than that of the general population of the same age. A) true B) false

Answer 53

A) true

Question 54

The diagnosis of multiple sclerosis is not of clinical symptoms, but is based on the CSF and the MRI test results. A) true B) false

Answer 54

B) false

Question 55

The cranial MRI is important, but not specific, in the effective diagnosis of multiple sclerosis. A) true B) false

Answer 55

A) true

Question 56

Without specific treatment, neuromyelitis optica leads to serious permanent damage or even death. A) true B) false

Answer 56

A) true

Question 57

Neuromyelitis optica is a T cell-mediated autoimmune disease, like multiple sclerosis and the treatment is identical. A) true B) false

Answer 57

B) false

Question 58

In the background of epileptic illnesses, the inflammatory disease of the nervous system can never be found. A) true B) false

Answer 58

B) false