NEUROLOGY MAY 2017 FINALS

MULTIPLE CHOICE. Choose the best answer.

1. In most polyneuropathies, the following is usually the first to be affected:

a. Proximal upper extremities
b. Distal upper extremities
c. Proximal lower extremities
d. Distal lower extremities
2. Which of the following could cause acute paraplegia, hypotonia, and areflexia?
a. Gunshot wound to T12 level
b. GBS
c. Myasthenia Gravis
d. Poliomyelitis
3. A 35 year old male complaining of 7 days duration of progressive lower extremity weakness.
This started 10 days after an episode of “flu”/ Exam showed proximal (3-4/5) more than distal
(4-5/5) LE weakness. Reduced reflexes and tone were noted. He also noted UE and LE
numbness. The exam also showed reduced Pin Prick/Light Touch and cold sensation in both
hands and feet mainly distally. What is the most likely diagnosis?
a. Acute poliomyelitis
b. Spinal cord infarction
c. Guillian Barre Syndrome
d. (L) MCA infarction
4. Autonomic dysfunction will most likeliy be due to which among the following:
a. Myopathy (IPM)
b. Neuropathy (Diabetic)
c. NMJ dysfunction (Myasthenia Gravis)
d. Motor neuron disease (ALS)
5. Which of the following is not a characteristic of polyneuropathy?
a. fairly symmetrical involvement
b. sensory level
c. may or may not be painful
d. distal stocking glove
6. Which statement regarding Guillian-Barre syndrome os incorrect?
a. majority are precipitated by a previous infectious process
b. rapidly evolving areflexic motor paralysis
c. fever and constitutional symptoms are always present
d. autoimmune mechanism
7. What is the typical CSF finding among patients with Guillian Barre syndrome?
a. Increase opening pressure
b. low CSF glucose
c. albumin-cytologic dissociation
 d. pleocytoci
8. Which of the following are large-fiber neuropathy symptoms, EXCEPT
a. weakness
b. areflexia
c. sensory ataxia
d. pain and temperature disturbance
9. What is the most common etiology of mononeuropathy multiplex?
a. infectious
b. granulomatous disease
c. vasculitis
d. idiopathic
10. What is the most common form of Diabetic Polyneuropathy
a. cranial neuropathy
b. distal symmetrical
c. truncal neuropathy
d. acute/subacute proximal
11. True statement regarding Guillian-Barre syndrome, Except:
a. majority have good recovery
b. acellular rise in csf protein
c. precipitated by infection
d. areflexic pure motor neuropathy
12. Common causes of neuropathy due to chronic heavy metal exposure, EXCEPT:
a. thallium
b. asbestos
c. lead
d. manganese
13. The organism with a polysaccharide capsule that is a frequent cause of meningitis with peak
incidence at age 12 months is due to:
a. Haemophilus influenza
b. Listeria monocytogenes
c. Staphylococcus epidermidis
d. Streptococcal pneumonia
14. What is the most common organism causing bacterial CNS infection in children?
a. Streptococcus pneumonia
b. Haemophilus influenza
c. E.coli
d. Neisseria meningitides
15. The organism that characteristically produces epidemic meningitis with petechial rash and
Waterhouse Freidrichsen syndrome is:
a. Neisseria meningitides
b. Listeria monocytogenes
c. Haemophilus influenza
 d. Staphylococcus aureus
16. A 6 y/o patient diagnosed with CNS infection is positive for gram (+) diplococcic. What is the
most likely organism?
a. Streptococcus pneumonia
b. Haemophilus influenza
c. E.coli
d. Neisseria meningitides
17. A 28 year old female who recently gave birth found out that her baby developed poor suck,
persistent fever and low APGAR score. The baby was suspected to have neonatal meningitits.
What is the organism that is commonly acquired in the birth canal that causes meningitis in
neonates?
a. Listeria monocytogenes
b. Haemophilus influenza
c. Staphyloccocus epidermidis
d. Staphyloccocus aureus
18. A 25 y/o female patient presented with subacute onset of behavioral changes, fever, headache,
seizures along with radiologic imaging studies showing hemorrhagic necrosis of the inferomedial
temporal lobes is most likely due to?
a. Progressive multifocal leukoencephalopathy
b. Subacute sclerosis panecephalitis
c. Herpes simplex encephalitis
d. Pneumococcal meningoencephalitis
19. Streptococcal pneumonia infection is not commonly seen among patients who are ___.
a. splenetomized
b. geriatric
c. immunosuppressed
d. recurrent meningitis
20. Which among the following is not a typical CSF picture of bacterial meningitis?
a. elevated opening and closing pressure
b. Pleocytosis 250-100,000/ mm3
c. predominance of neutrophils (90%)
d. protein is higher that 45 mg/dL
e. glucose is near normal
21. Household contacts of patients with meningococcal meningitis are required to take the
following prophylaxis?
a. vaccination against Neisseria meningitides
b. Rifampicin 600mg OD x 2 days
c. Ciprofloxacin 500mg BID x 2 days
d. all of the above
22. Most common etiology of epidural abscess?
a. anaerobic bacteria
b. microaerophilic streptococcus
 c. Staphyloccocus aureus
d. all of the baove
23. Most common source of infection of brain abscess originated from the:
a. heat and lungs
b. sinuses
c. middle ear
d. mastoid cells
e. idiopathic
24. What is the most frequent initial symptom of brain abscess?
a. dizziness
b. high grade fever
c. headache
d. malaise
25. The late cerebritis stage of brain abscess occurs during this time period:
a. 1-3 days
b. 4-9 days
c. 10-14 days
d. beyond 14 days
26. Empiric antibiotic therapy for Staphyloccocal infection of the CNS:
a. Metronidazole
b. Vancomycin
c. 3rd generation cephalosporin
d. Penicillin G
27. About how many percent of survivors of brain abscess will develop neurologic sequelae?
a. 5-10%
b. 30%
c. 50%
d. 80%
28. Which among the following statement regarding CNS tumors is correct?
a. common location in adults is infratentorial
b. acute to subacute temporal profile
c. majority will have non-specific generalized signs and symptoms
d. most common etiology is chronic viral exposure
29. A 60 y/o male presenting with chronic intermittent dull non-throbbing headache for the past 5
years. For the past 2 weeks, there is increasing frequency and intensity of the headache attacks
associated with nausea. His cranial CT scan showed a moderately-enhancing extra-axial mass in
the frontal parasagittal area with Dural tail sign. What is the most likely etiology of the brain
mass based on the above findings?
a. astrocytoma
b. oligodendroglioma
c. meningioma
d. pituitary adenoma
30. Which type of tumor originated from the remnant of the primitive Rathke’s pouch?
a. dermoid cyst
b. craniopharyngioma
c. pituitary adenoma
d. schwanomma
31. A 40 y/o female complains of progressive blurring of vision especially on her lateral visual fields.
On cranial MRI, it showed an enhancing 3 x 2 cm sellar based tumor. Which statement best
describes this characteristic tumor?
a. classification is based only on radiologic imaging size
b. macroadenomas are larger and lacks endocrinologic symptoms
c. posterior lobe secretes vasopressin and ACTH
d. in commonly goes into malignant degeneration
32. Which brain tumors are associated with Antoni A and B and verocay bodies?
a. Meningioma
b. Oligodendroglioma
c. Ependymoma
d. Neurilemomma
33. What is the only well-documented environmental risk factor for the development of brain
tumors?
a. Chronic viral infection
b. ionizing radiation
c. hydrocarbon exposure
d. chronic smoking
34. What is the most common source of primary brain tumors?
a. glial cells
b. endothelial cells
c. neuronal cells
d. meningeal cells
35. The following statement is NOT true regarding CNS tumors:
a. cytotoxic edema typically occurs in the vicinity of the CNS tumoral growths
b. presence of certain diseases such as AIDS predisposes to development of CNS tumors
c. meningiomas are the most common benign intracranial tumor
d. growth rates and invasiveness of tumor vary depending on pathologic peculiarities
36. What is the most common type of primary tumor seen in the brain and spinal cord?
a. meningioma
b. astrocytoma
c. oligodendroglioma
d. neurolemomma
37. Which gene is associated with mutations in p53 tumor suppressor gene linked with increased
incidence of brain tumors, early-oset breast cancer and childhood sarcomas?
a. RB gene
b. c-myc gene
 c. Li Fraumeni gene
d. MEN 1 gene
38. Which brain tumor type is more commonly seen among immunocompromised (as in AIDS)
patients:
a. lymphocytic leukemia
b. Kaposi sarcoma
c. metastatic lymphoma
d. primary CNS lymphoma
39. Which type of brain tumor has the poorest prognosis?
a. oligodendroglioma
b. meningioma
c. glioblastoma
d. medulloblastoma
40. The clinical characteristic of headache is not likely secondary to increase intracranial pressure:
a. not precipitated by coughing
b. usually holocephalic
c. worsens with recumbancy
d. usually awaken patient from sleep
41. Which type of brain tumor is typically located in the cerebello-pontine angel (CP angle)
a. schwannoma
b. glioma
c. meningioma
d. teratoma
42. Which type of brain edema is seen in the vicinity of the tumor growths due to increased
permeability of the capillary endothelial cells causing exudation of plasma proteins?
a. cytotoxix edema
b. vasogenic edema
c. interstitial edema
d. hydrocephalic edema
43. Which among the following is a strong characteristic feature of headachw secondary to a brain
tumor?
a. unilateral throbbing quality
b. deep, intermittent, pulsatile in quality
c. nocturnal and/or first awakening, nonpulsatile headache
d. severe, sharp, intermittent headache
44. Type of childhood brain tumor associated with the histologic finding of “blue round cells”
a. astrocytoma
b. craniopharyngioma
c. medulloblastoma
d. schwannoma
45. Tuberculous meningitis (TBM) is a subacute to chronic meningitis. Its pathogenesis includes:
 a. bacterial seeding of the meninges and subpial regions of the brain and formation of
tubercles
b. a precedent viral infection leads to disruption of the blood-CSF barrier and invasion of
the bloodstream and meninges
c. rupture of one or more of these tubercles and discharge of bacteria into the
subarachnoid space
d. A and B only
e. A and C only
46. Viral meningitis is also called acute septic meningitis because of the following, EXCEPT:
a. Bacterial cultures are negative
b. Rarely fatal
c. commonly idiopathic
d. Self-limiting
47. Which of the following is/are TRUE about herpes simplex encephalitis (HSE)?
a. Almost always caused by HSV-2
b. Predilection for the medial temporal and parietal lobes
c. second to Japanese B encephalitis as the gravest and most common
d. Clinically presents with olfactory hallucinations and temporal lobe seizures at the
onset
48. Treatment for HSE:
a. Acyclovir 10 mg/kg/day for 7-10 days
b. Acyclovir 30 mg/kg/day for 10-14 days
c. Gancyclovir 10 mg/kg/day for 7-10 days
d. Gancyclovir 30 mg/kg/day for 10-14 days
49. Which among the following is the most common non-focal opportunistic infection seen in
patients with AIDS?
a. Toxoplasmosis
b. Cryptococcal meningitis
c. TB meningitis
d. Neurosyphilis
50. The most common primary brain tumors among adults:
a. Meningiomas
b. Infratentorial gliomas
c. Supratentorial gliomas
d. Pituitary adenomas
51. The most common among all gliomas in adults:
a. Glioblastoma multiforme
b. Cystic glioma
c. Ependymoma
d. Oligodendroglioma
52. Common locations of gliomas in adults, EXCEPT:
a. Brainstem
 b. Optic Nerve
c. Cerebral hemisphere
d. Hypothalamus
53. TRUE about oligodendrogliomas:
a. “fried-egg” appearance histologically
b. Located midline, along the ventricles
c. “pseudorosette” formation histologically
d. Tendency to for rosettes
54. TRUE about ependymomas:
a. Multilobar
b. Relatively avascular
c. Calcifications are common
d. “fried-egg” histologic appearance
55. Common locations of meningiomas, EXCEPT:
a. Falx cerebri
b. Cerebral convexity
c. Sphenoid bone
d. Brainstem
56. Medical decompression for brain tumors:
a. Methylprednisolone 1 gram IV infusion daily for 4 days
b. Mannitol 20% AT 0.25-1gm/kg/dose
c. IV Dexamethasone 16 to 20 mg/day
d. A and B only
e. B and C only
57. The role of neurosurgery for brain tumors:
a. Biopsy
b. Partial excision
c. Total excision
d. B and C only
e. All of the above
58. Radiotherapy for brain tumors:
a. 1,000 to 3,000 rads/cGy increase survival by 3 months average
b. 5,000 to 6,000 rads/cGy increase survival by 5 months average
c. Given to patients who refused neurosurgery
d. Given to all patients after neurosurgery
59. Chemotherapy for brain tumors:
a. Cisplatin
b. Temozolamide
c. Bromocriptine
d. A and B only
e. All of the above
 60. Contrast MRI of a 65 year old female patient showed a 4 x 5 cm meningioma over the right
cerebral convexity. What is the best management we can offer
a. Medical decompression
b. Neurosurgery
c. Adjunct chemotherapy
d. A and B only
e. All of the Above
61. First-degree relatives of patients with Myasthenia Gravis (MG) show an unusual incidence of
other autoimmune diseases such as:
a. Hyperthyroidism
b. Graves disease
c. Rheumatoid Arthritis
d. A and B only
e. All of the above
62. Association of MG with thymic disorders:
a. Only 10 to 15 percent have thymic tumors
b. only 20 percent have a non-neoplastic lymphofollicular hyperplasia
c. Management includes chest xray
d. All patients are advised to undergo radiotherapy
63. Diagnosis of MG:
a. Clinical signs and symptoms
b. Clinical, electrophysiologic
c. Clinical, electrophysiologic, pharmacologic (edrophonium)
d. electrophysiologic, pharmacologic (edrophonium)
64. Treatment of MG
a. Monthly injections of neostigmine, an anticholinesterase
b. Daily oral pyridostigmine, an anticholinesterase
c. IV dexamethasone 16 to 20 mg/day
d. Any of the above conditions
65. Myasthenic crisis:
a. Bradycardia
b. Diarrhea
c. Respiratory distress
d. small pupils

TRUE OR FALSE: Shade A if TRUE, and B If FALSE.

TB Meningitis

66. Meningitis is most intense in the basal meninges A

67. Septic thrombosis of vessels results to tissue necrosis and local suppurative process B
68. There is initial hyperemia and increased permeability of vessels leading to exudation of protein
and migration of neutrophils B
 69. Arteries become inflamed and occluded leading to infarctions A

CSF picture of TBM:

70. Opening pressure of 20 cm H2O B

71. WBC 25-500 per cu.mm with lymphocytic predominance A
72. Sugar/glucose 80-120 mg/dL B

Prognosis for TBM:

73. Overall mortality is still significant at 10%, infants and the elderly being at greatest risk A
74. HIV positive patients have higher mortality A

Acute viral encephalitis/meningitis:

75. CSF has lymphocytic pleocytosis, mild protein elevation and normal glucose A
76. Brain imaging (CT or MRI) shows hydrocephalus B

Diagnosis for HSE:

77. Contrast MRI shows bilateral but not symmetrical temporal lobe lesions A
78. EEG shows periodic lateralizing epileptiform discharges (PLEDs) A

Glioblastoma Multiforme:

79. Cystic and pleomorphic B

80. Average survival with aggressive treatment is 10 years B

Meningiomas:

81. A slow growing histologically benign tumor arising from arachnoid layer A
82. The most common primary brain tumor in adults B

Myasthenia Gravis (MG):

83. Ocular signs include ptosis and diplopia A

84. May involve the smooth and cardiac muscles B

Treatment for MG:

85. Thymectomy A
86. IV immunoglobulin A
87. Plasma exchange A

Multiple Choice.

88. This is the most common cause of acute to subacute generalized paralysis:
a. Diabetes Mellitus
 b. Chronic alcoholism
c. Guillian-Barre syndrome
d. Lead poisoning
89. Which is NOT included in the traid of Miller-Fisher variant of GBS?
a. Orthostatic Hypotension
b. Ophthalmoplegia
c. Areflexia
d. Ataxia
90. Variants of GBS include the following, EXCEPT:
a. Miller-Fisher
b. Acute axonal motor neuropathy
c. Pharyngeal-cervical-brachial
d. Chronic inflammatory demyelinating polyneuropathy
91. The most frequent identifiable antecedent infection in GBS:
a. HIV
b. CMV
c. Pseudomonas sp.
d. Campylobacter jejuni
92. Which of the following is TRUE about diabetic polyneuropathy?
a. The duration of Diabetes is the most important factor.
b. There is loss of unmyelinated fibers
c. It is the second most common cause of metabolic neuropathy
d. It only affects motor and sensory nerves
93. Which statement is NOT true regarding CNS tumors?
a. presence of certain diseases such as AIDS predisposes to development of some forms of
CNS tumors
b. meningiomas are the most common benign intracranial tumor
c. growth rates and invasiveness of tumor vary depending on pathologic peculiarities
d. cytotoxic edema typically occurs along the vicinity of the CNS tumoral growths
94. Which is considered the primary treatment option for multiple brain metastases ?
a. chemotherapy
b. high dose steroids
c. surgical excision
d. whole brain radiotherapy
95. The following are brain tumors likely to present with increase intracranial pressure because of
its typical midline location, EXCEPT:
a. ependymoma
b. medulloblastoma
c. pituitary adenoma
d. oligodendroglioma
96. A 27 year old female consulted a neurologist because of drooping of the eyelids usually noted
late in the afternoon. This is not apparent in the morning or upon waking up. Further
 questioning of the doctor revealed that she wouls also have on and off diplopia and hoarseness
she attributes to easy fatigability. Which among the following will be the primary diagnosis?
a. Guillian-BArre syndrome
b. Myasthenia Gravis
c. Diabetic neuropathy
d. Bell’s palsy
97. The following are information that can be derived from EMG-NCV studies
a. if weakness is due to a muscle or a nerve disease
b. if the neuropathy is axonal or demyelinating
c. if the disease is acute or chronic
d. A and B only
e. All of the above
98. True about Myasthenia gravis except:
a. More common in women than in men in younger patients
b. Associated with thymic disorders
c. May present with autonomic signs and symptoms
d. Muscles of the eyes and throat are vulnerable
e. Sensory symptoms are absent
99. Hyperostoses of the skull are the most commonly seen with which type of CNS tumor:
a. meningiomas
b. pituitary adenomas
c. astrocytomas
d. schwanommas
100. Which statement does not describe CNS meningioma?
a. dural-based extra-axial tumor
b. derived from mesoderm
c. all cases undergo adjunct chemotherapy
d. more frequent in females 2:1
e. majority are benign tumors