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ROSH REVIEW-Neurology Practice Questions and Answers
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©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AMROSH REVIEW-Neurology Practice
Questions and Answers
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.
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,©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
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
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,©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
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.
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, ©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
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.
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