ROSH REVIEW-Neurology | Questions & Answers (100 %Score) Latest Updated
2024/2025 Comprehensive Questions A+ Graded Answers | With Expert Solutions
Which of the following is correct regarding multiple sclerosis?
ABecomes more prevalent the farther you live from the equator
BMore common in men
CRetinal tear is a common presenting symptom
DWorsens during the course of pregnancy - Correct Answer ( A )
Explanation:
Multiple sclerosis (MS) is most common in people of Northern European descent.
Caucasians develop MS at nearly twice the rate of African Americans in the United
States. In many areas of the world, MS is more prevalent in temperate latitudes
(approaching 1 in 500 in some locations) and becomes less prevalent toward the
equator (1 in 20,000 or rare case reports only in some locations). Multiple sclerosis is a
disease characterized by multifocal areas of demyelination in the brain and spinal cord,
with associated inflammatory cell infiltrates, reactive gliosis, and axonal degeneration. It
typically presents in young adults with episodic neurologic dysfunction. Pathologically,
most cases are characterized by multifocal areas of demyelination and gross gliotic
scarring in the brain and spinal cord. Classic locations of these lesions, called plaques,
are the optic nerves, periventricular white matter, deep white matter, juxtacortical white
matter, corpus callosum, cerebellar peduncles, and dorsolateral spinal cord. The
presentation of MS is quite variable. The classic presentation involves acute to
subacute onset of impaired vision or sensation. Patients may often describe fatigue,
depression, bladder urgency, weakness, impaired balance, and impaired coordination.
Multiple sclerosis occurs 2- to 2.5-fold more frequently in women than in men (B), a sex
predilection that is common in autoimmune diseases. Optic neuritis, not retinal tear (C)
is a classic presenting syndrome, typically with visual symptoms in one eye. Many
women with MS successfully have multiple children, and the symptoms of MS diminish
during pregnancy (D), especially by the third trimester, when the frequency of
exacerbations is reduced by approximately two thirds.
One Step Further
Question: Do patients with relapsing-remitting MS ever convert to other types of MS? -
Answer: Most patients presenting with relapsing-remitting MS convert to secondary-
progressive MS after 20 to 40 years
Which of the following is true about myasthenia gravis?
Limb weakness and dysarthria are the most common presenting symptoms
Muscle weakness tends to worsen after long periods of rest
,Optic neuritis is commonly associated with the condition
Symptoms are decreased by cooling - Correct Answer ( D )
Explanation:
Myasthenia gravis (MG) is an autoimmune disease characterized by muscle weakness
and fatigue seen particularly with repetitive use of voluntary muscles. It is caused by
antibodies that attack and reduce the number of nicotinic acetylcholine receptors
leading to a decrease in response to acetylcholine. Cooling improves the symptoms of
myasthenia gravis. This is the basis of the "ice test." When ptosis is present, an ice
pack is placed over the affected eye for two minutes, and the ptosis resolves. It is
thought that local cooling results in a slowing of the kinetics of the acetylcholine
receptor, allowing for a prolonged effect of acetylcholine and improvement of symptoms.
The most frequent initial symptoms of myasthenia gravis are bulbar, typically with ptosis
and diplopia (A) due to ocular muscular weakness, or weakness of the levator
palpebrae superioris. Muscle weakness tends to improve (B) after long periods of rest.
Patients become weaker with repetitive activity. Optic neuritis (C) is associated with
multiple sclerosis, not myasthenia gravis.
One Step Further
Question: Myasthenia gravis is often misdiagnosed in the elderly population as what
condition? - Answer: Ischemic stroke, especially when there is new-onset facial
weakness.
A 56-year-old woman presents with burning pain and tingling on the palmar surfaces of
digits 1-3 of her right hand. The pain has been present for several months and awakens
her at night. There is no atrophy or weakness of her hand. However, volar wrist
percussion causes a shock-like pain extending to the palmar surfaces of digits 1-3.
Which of the following tests proved positive in this examination?
Finkelstein
Phalen
Spurling
Tinel - Correct Answer ( D )
Explanation:
A Tinel test is considered positive when percussion of the volar wrist in the region of the
median nerve produces tingling or a shock-like pain in the palmar surfaces of digits 1-3.
This test is generally sensitive and specific for clinically diagnosing carpal tunnel
syndrome, an entrapment neuropathy due to some form of compression or narrowing of
the carpal tunnel that impinges the median nerve. Other physical exam findings may
include a positive Phalen sign in which flexion of both wrists to 90 degrees for one
minute causes pain or tingling in the median nerve distribution. The carpal compression
test, in which the clinician applies steady, direct pressure over the carpal tunnel to elicit
tingling, may be even more sensitive for the condition. Carpal tunnel syndrome
generally presents with pain and tingling in the median nerve distribution and may
initially bother the patient only during sleep. A history of performing repetitive activities
may be noted. Diabetes mellitus and fluid retention during pregnancy can also
,contribute to carpal tunnel compression. A work-up for carpal tunnel syndrome may
include an ultrasound to observe flattening of the median nerve, or electromyography
and nerve conduction studies to differentiate it from a more proximal neuropathy. A trial
of wrist extension splinting, as well as NSAIDs and corticosteroids, may help. Surgical
carpal tunnel release can be considered for symptoms beyond 12 months of
conservative treatment.
A Finkelstein test (A) requires sharp, ulnar deviation of the thumb while the fingers are
flexed around the thumb into a fist. Pain at the wrist is suggestive of deQuervain
tenosynovitis. A Phalen test (B) is positive when flexion of both wrists to 90 degrees for
one minute causes pain or tingling in the median nerve distribution. Like
One Step Further
Question: Which muscle group will show weakness and atrophy as carpal tunnel
syndrome progresses? - Answer: The thenar muscle (abductor pollicis brevis) becomes
weak and atrophied in carpal tunnel syndrome.
During an exam, passive flexion of a patient's neck causes a reflexive flexion of his hips
and knees. What is this finding called?
Brudzinski sign
Griesinger's sign
Kernig's sign
Levine's sign - Correct Answer ( A )
Explanation:
This finding describes Brudzinski sign, which is used as an indicator of meningeal
irritation such as in patients with acute meningitis. The test is performed by applying
flexion to the patient's neck. A positive test is the observance of a reflexive flexion of the
hips and knees. Care should be taken regarding a positive Brudzinski sign, as this does
not always indicate acute meningitis. In addition to meningitis, it can also be observed in
patients with subarachnoid hemorrhage or encephalitis. All conditions that cause
meningeal irritation.
Griesinger's sign (B) is swelling of the posterior auricular area and may be seen with
certain types of sinus thrombosis. Kernig's sign (C) is usually assessed along with
Brudzinski. It is performed by flexing the hip and knee to 90° and then attempting to
extend the knee. This will cause significant pain in a patient with meningeal irritation.
One Step Further
Question: What cerebrospinal fluid (CSF) findings are seen in bacterial meningitis? -
Answer: High protein, low glucose, presence of polymorphonuclear cells.
A 65-year-old man is brought to the ED after a fall. He says he has had trouble walking
"for a while." His examination is significant for normal cranial nerve function, normal
strength, a resting tremor, and difficulty stopping when he is walking. What is the
cellular pathology associated with this condition?
, Demyelination
Lewy bodies
Loss of anterior horn cells
Neurofibrillary tangles - Correct Answer ( B )
Explanation:
This patient is showing signs of Parkinson's disease, a chronic neurologic condition. It is
characterized by intracellular cytoplasmic inclusions called Lewy bodies, dopaminergic
neuron loss in the substantia nigra, and depigmentation along with gliosis of pigmented
areas in the midbrain. The symptoms can be remembered with the mnemonic TRAP:
resting Tremor, cogwheel Rigidity, Akinesia, and impairment of Posture or equilibrium. It
is treated with drugs to increase central dopamine levels, dopamine receptor agonists
(carbidopa and levodopa), and anticholinergic agents (which offset the movement
effects induced by diminished dopamine). There is no cure for Parkinson's disease. The
most common cause of death is respiratory failure.
Demyelination (A) is associated with multiple sclerosis and Guillain-Barré syndrome.
Loss of anterior horn cells (C) is associated with amyotrophic lateral sclerosis (ALS), a
progressive degenerative of upper and lower motor neuron disease. Neurofibrillary
tangles (D) and amyloid plaques are thought to be responsible for Alzheimer's disease,
which is a progressive cognitive disorder
A 49-year-old woman with a history of osteoarthritis presents stating that she feels like
the room around her is spinning. She reports a similar episode three weeks ago, and
since then, has had an intermittent ringing sound in her ears. Her husband adds that
over the same time frame she also has developed some difficulty hearing from the left
ear. During your exam, the patient has an episode of non-bilious vomiting and states
that the room is spinning again. Vital signs are normal. Which of the following is the
most likely diagnosis?
Benign paroxysmal positional vertigo (BPPV)
Ménière's disease
Salicylate toxicity
Vestibular neuronitis - orrect Answer ( B )
Explanation:
This patient has Ménière's disease. This disorder is associated with increased
endolymph within the cochlea and labyrinth. The common triad is tinnitus, vertigo, and
unilateral hearing loss (sensorineural). A key finding in Ménière's disease is fluctuating
hearing loss. Episodes are abrupt in onset and associated with nausea and vomiting.
There are often long, symptom-free intervals between attacks.
Salicylate (aspirin) toxicity (C) is associated with tinnitus and reversible hearing loss.
The patient has a history of osteoarthritis and may be using aspirin for her pain;
however, salicylate toxicity is usually associated with bilateral hearing loss. Symptoms
of vertigo are also uncommon in such patients.
