Multiple Choice Questions (MCQ)

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Category: Medicine--->Neurology
Page: 4

Question 16#Print Question

A 45-year-old woman presents to her physician with an 8-month history of gradually increasing limb weakness. She first noticed difficulty climbing stairs, then problems rising from a chair, and, finally, lifting her arms above shoulder level. Aside from some difficulty swallowing, she has no ocular, bulbar, or sphincter problems and no sensory complaints. Family history is negative for neurological disease. Examination reveals significant proximal limb and neck muscle weakness with minimal atrophy, normal sensory findings, and normal deep tendon reflexes.

Which of the following is the most likely diagnosis in this patient? 

a. Polymyositis
b. Cervical myelopathy
c. Myasthenia gravis
d. Mononeuritis multiplex
e. Limb-girdle muscular dystrophy

Question 17#Print Question

A 55-year-old diabetic woman suddenly develops weakness of the left side of her face as well as of her right arm and leg. She also has diplopia on left lateral gaze.

Where is the responsible lesion? 

a. Right cerebral hemisphere
b. Left cerebral hemisphere
c. Right side of the brainstem
d. Left side of the brainstem
e. Right median longitudinal fasciculus

Question 18#Print Question

A 26-year-old woman presents for follow-up of her multiple sclerosis. She has had two separate episodes of optic neuritis and has noticed stutteringly progressive weakness in her lower extremities. She has a mild neurogenic bladder. Her symptoms have been stable over the past 4 months. MRI scanning reveals several plaques in the periventricular white matter (MR scan shown here) and several other plaques in the brainstem.

What is the best next step in her management?

a. Intravenous methylprednisolone 1 g daily for 3 days
b. Oral cyclophosphamide
c. Oral anticholinergics for the urinary incontinence and observation of the demyelinating process
d. Interferon-beta
e. Intravenous mitoxantrone every 3 months

Question 19#Print Question

A 58-year-old woman has a history of alcohol abuse, coronary artery disease, and atrial fibrillation. Her medications include metoprolol, lisinopril, simvastatin, and warfarin. She develops urinary urgency and frequency and is treated with oxycodone and ciprofloxacin. Three days later she develops a headache, dizziness, vomiting, and has difficulty walking. On neurological examination her strength, sensation (including vibratory sensation), and reflexes are normal. She walks with an uncoordinated, unsteady gait. On testing of coordination in the upper extremities, she displays past-pointing and poor rapid alternating movements with her right upper extremity. In the lower extremities, her heel-shin testing also reveals poor coordination on the right. INR is 6.5 (normal < 1, therapeutic for warfarin 2.0–3.0).

What is the most likely cause of her neurologic findings? 

a. Right cerebellar hemorrhage
b. Multiple small infarcts in the basal ganglia
c. Adverse effects of oxycodone
d. Alcohol abuse
e. Posterior column degeneration as a result of vitamin deficiency

Question 20#Print Question

A 68-year-old man is seen in the emergency room after an unwitnessed syncopal episode. His wife heard a strange noise and found him confused and on the floor of the living room where he had been watching television. His wife tells you that he has no ongoing medical problems, does not take any medications, and does not use alcohol or illicit drugs. On examination the patient is drowsy, has a tongue laceration, and his pants are wet with urine. Serum electrolytes (including calcium) are normal and urine drug screen is negative.

Which of the following is the best next step in evaluation? 

a. MRI scan of brain
b. Lumbar puncture
c. Holter monitor
d. CT scan of head
e. Echocardiography

Category: Medicine--->Neurology
Page: 4 of 5