Biology — Quiz

A Prevalence is higher in woman. B Most improve during pregnancy C It is idiopathic, and usually last less than 72 hrs. D Ketorolac has been shown to be superior to chlorpromazine in the management of migraines.

A Most common in the 40-60 year age group. B 70% are due to AV malformations. C Female: male = 2:1 D Smoking increases your risk 3-10 fold.

A Up to 20% experience a sentinel bleed. B A sixth cranial nerve palsy can represent a growing aneurysm in cavernous sinus. C Seizures occur in 50% of patients D Photophobia is often more marked than patients with migraines.

A Non contrast CT becomes less sensitive with time following bleed. B 5-10% of patients with negative CT will have SAH C Presence of xanthochromia is the gold standard for diagnosing SAH on LP. D Xanthochromia is present in all patients with SAH at 6 hrs post bleed.

A Nimodipine has only been proven to be of benefit orally in preventing vasospasm. B 10-30% of patients will rebleed, with 20% within the first 2 weeks. C Vasospasm and delayed neurological deficit peak at day 1 post bleed. D

A A. 0% B 5% C 10% D 15%

A Majority older than 50 yrs. B More common in men. C Ischaemic optic neuritis is most feared complication. D Up to 50% of patients also have polymyalgia rheumatica.

A Aspirin 150 mg/day reduces risk of subsequent stroke by about 30% B Clopidagrel was shown in the CAPRIE study to have a slight advantage over aspirin in stroke prevention. C Anticoagulation of patients with TIA’s secondary to thrombosis has been shown to improve outcome. D Carotid endarterectomy will reduce death rate by almost 50% in patients with greater than 80% stenosis.

A 80% are MCA territory. B MCA syndrome is usually embolic, and arm is usually more affected than leg. C Lacunar infarcts usually have partial or complete recovery over 4-6 weeks. D Internuclear ophthalmoplegia usually results from anterior cerebral artery occlusion.

A Effacement of cortical sulci B Compression of ventricular system C Hyper dense clot in MCA D All are possible early signs of infarct.

A Clear benefit has been shown in at least 2 randomized controlled trials that TPA reduces mortality in CVA. B Patients up to 6 hrs post infarct have been shown to benefit from thrombolysis. C The NINDS trial showed that improvement in patients treated within 3 hrs with thrombolysis. D ECASS trial thrombolysed patients within 3 hrs with TPA and showed improvements in all outcomes compared with placebo.

A A. Fast phase of nystagmus toward lesion. B Horizontal or rotational nystagmus present. C Severe vertigo associated with vomiting and diaphoresis D Visual fixation improves nystagmus.

A Labyrinthitis is the most common cause. B BPPV is characterized by a latency period of 1-5 secs between provocative head position and onset of nystagmus. C Tinnitus and hearing loss are associated with Meniere’s disease. D Vestibular neuronitis is typically non recurring.

A Cerebellar CVA’s will often present with truncal ataxia. B Vertebrobasilar insufficiency will produce vertigo lasting typically less than a few mins. C Multiple sclerosis can cause vertigo which typically lasts a few mins and is recurring. D Vertigo can be associated with migraines either as aura or part of the migraine.

A Cocaine B Narcotics C Benzodiazepines D Tricyclics

A Idiopathic seizures usually start age 5-20 yrs. B Post head trauma seizures usually begin within 2 years of trauma. C Acute strokes are the most common cause in > 65 yr olds. D Space occupying lesions account for 1% of new seizures age 35-65.

A Diazepam has the most rapid onset of the BDZ’s. B The LD of phenytoin needs to be decreased in renal impairment. C . Phenobarbital has duration of action of 3 days. D Paraldehyde can be used rectally at a dose of 0.3mls/kg.

A There is decreased risk of seizures in pregnancy. B Eclamptic seizures are typically brief, self-terminating preceded by headache and visual disturbances. C Pseudo seizures are often recognized by pelvic thrusting which occurs in 45%. D Pseudo seizures are often recognized by pelvic thrusting which occurs in 45%.

A Mortality at 60 mins of status is around 30%. B Leucocytosis up to 20,000 is very common. C In phase 1 there is increased cerebral metabolism, hyperglycaemia, hyperpyrexia and hypertension. D Muscle relaxants should be used in intubated patients to avoid self- inflicted injury.

A Radiculopathy B Neuropathy C Neuromuscular junction disease D Myopathy

A Onset in females usually 2nd and 3rd decades, males 7th and 8th decades. B The thymus is abnormal in 75% and removal will improve symptoms in the majority. C Acute crises in these patients can be due to myasthenia crisis or cholinergic crisis secondary to the medication. D Muscle weakness is more marked peripherally.

A 80% of patients will have antecedent infection with Campylobacter jejuni. B CSF will show low protein, high glucose and often a pleocytosis up to 100. C High dose immune globulin and plasmapheresis have been shown to be equally efficacious in reducing length of illness. D Severe cases will not only involve demyelination but also axonal degeneration.

A Carpal tunnel syndrome usually produces more pain at night. B Bell’s palsy cause sudden facial weakness with peak paralysis seen at 48 hrs. C Use of steroids and acyclovir has been advocated for treatment of Bell’s palsy as one study showed reduced length of paralysis. D Ulnar nerve entrapment usually occurs at the wrist resulting in numbness of 5th digit and half of 4th digit.

A It is 2-3 times more common in females B The most common reported symptom initially is sensory loss. C Optic neuritis is usually unilateral can afferent pupillary response may be present. D The majority of patients will show plaques on MRI T2 weighted scans.

A It is 2-3 times more common in females B The most common reported symptom initially is sensory loss. C Optic neuritis is usually unilateral can afferent pupillary response may be present. D The majority of patients will show plaques on MRI T2 weighted scans.

A Interferon and glatiramer have bee shown to reduce number of relapses in relapsingremitting MS. B IV immunoglobulin monthly for 2 years has shown to reduce annual exacerbations in relapsing-remitting MS. C No treatment currently exists for primary progressive MS to modify the disease. D Exacerbations of MS are treated with methlypred IV as studies have shown this to be superior to other glucocorticoids.

A 90% of cases occur in the first 5 years, with peak at 6 months of age. B Damage is due to the inflammatory response not bacterial toxins. C CT may be normal even in the presence of elevated ICP in up to 45%. D LP is always abnormal with bacterial meningitis.

A Acute bacterial. B Viral meningitis C Normal result D TB meningitis or partly treated bacterial meningitis.

A Empiric treatment in adults consists of ceftriaxone 2g IV. B There is no evidence to support dexamethasone in infants with meningitis especially with Hib meningitis C Strep pneumoniae is becoming increasingly resistant to ceftriaxone in Australia as well as penicillin. D There is no parental treatment available for cryptocccocal meningitis.

A MRI shows characteristic temporal and frontal lobe changes in HSV. B CSF usually shows aseptic meningitis. C PCR for HSV is insensitive but very specific. D Acyclovir has only been shown to be effective in HSV, but is also used in herpes zoster encephalitis.

A Classical triad of headache, fever and focal neurological deficit occurs in over 80% of patients. B CT without contrast may miss the diagnosis. C Lumbar puncture is contraindicated. D Spread is haematogenous, contiguous or from neursurg or penetrating trauma.

A female B 1st degree relative with SAH C polycystic ovaries D smoking

A 10% B 20% C 30% D 50%

A 1 B 2 C 3 D 4

A 24 hours=95% detection B 3 days = 75% detection C 1 week 50% detection D 1 hour= 100% detection

A Inspection of CSF with the naked eye reliably detects zanhtochromia B it is present in all CSF at 6 hours C it remains in CSF for 2 weeks D it is detected with spectrophotometry

A it usually occurs at day 4-14 B it effects 30% of pts with SAH C it has a 30% morbidity and mortality untreated D hypertensive therapy with iv fluids and inotropes is contrindicated

A thrombolysis if less than 3 hours and normal CT B aspirin C specialized stoke unit D warfarin if atrial fibrillation

A right MCA B left MCA C right anterior cerebral artery D left anterior cerebral artery

A streptokinase has the same risk benefit profile as tPA B the mortaility rate of tPA given within three hours of onset of ischemic stroke is lower than that of the stoke without thrombolysis C the mortality rate of tPA given within three hours of onset of ischemic stroke is higher than that of the stoke without thrombolysis D the long term disability rate in patients surviving their stoke is less if they were given tPA

A in a patient with an anterior circulation ischemic event, the presence of a bruit suggests a moderately severe stenosis B in a patient with an anterior circulation ischemic event, the absence of a bruit dismisses a moderately severe stenosis C a symptomatic stenosis >70% is often operated upon D an asymptomatic stenosis of > 70% is usually not operated upon

A all B vertebro basilar ischemic stroke C anterior circulation ischemic stroke with no prior history of cerebrovascular disease D ischemic stroke or TIA secondary to proven cardioembolic source

A pathophysiology involves inflammation of the trigeminovascular system B serotonin plays an integral part C the aura, if present, should last less than 60 mins and be totally reversible D it is typically bilateral, pulsating and occipital

A cluster headaches are short lived lasting 15-180 mins B oxygen can releve a majority of cluster headaches C temperal arteritis usually produces an ESR of 20 D temporal arteritis can cause ischemic optic neuritis if left untreated

A 2.5% B 5% C 10% D 15%

A 20 mins B 30 mins C 40 mins D 50 mins

A the loading dose is 15-20 mg/kg B if a pt on phenytoin arrives in status epilepticus then the full loading dose should still be given C side effects include hypotension and bradyarrythmias D it is extremely effective in alcohol induced seizures

A there is little evidence to support any particular one B the dose of clonazepam in a child is 0.5 mg, and an adult 1mg C diazepam can be safely used PR, IM or IV D the rectal dose of diazepam for a 3 year old is about 5mg

A rhythmic thrusting of the pelvis B extremity movements out of phase bilaterally C recall of events during the seizure D tongue biting

A Ceftriaxone 2gm and Benzylpenicillin 1.8gm B Ceftriaxone 2gm C Benzylpenicillin 1.8gm D Ceftriaxone 2gm and Benzylpenicillin 1.8gm and Vancomycin 500mg

A give antibiotics immediately B 10 mins C 20 mins D 30 mins

A antigenic studies are useful where partial treatment with antibiotics renders CSF sterile on culture B in viral meningitis the main white cells usually seen are monocytes C you would expect to see a raised CSF pressure in bacterial meningitis D in viral meningitis you would expect to see a low glucose and a high protein

A there is no prophylaxis available for pneumococcus only meningococcus and Hib B it does not need to be given to the index case C it should include all household contact where there has been close contact eg. Share eating utensils D it should be given to the attending medical staff only if they did mouth to mouth

A associated vomiting B worsens with position change C associated tinnitus D vertical nystagmus

A horizontal nystagmus B dysarthria C vomiting D constant for eight hours

A frequently patients report an antecedent viral illness B classical motor weakness is greater and earliest in the legs C there is a lack of deep tendon reflexes D there is peripheral sensory loss greater in the arms than the legs

A The use of steroids is well proven to decrease duration of illness B Steroids are definitely not of use if the presentation is one week post symptom onset C The feature that excludes it from an upper motor nerve lesion is the inability to furrow the forehead D Other cranial nerves are always normal

A prednisolone B chlorpromazine C lithium D penicillin

A motor weakness is usually of proximal extremities and bulbar B there is usually no sensory loss C. there is usually no reflex loss C symptoms are often worse as the day progresses D it is due to anitibodies formed against acetylcholineesterase

A 30% of patients will initially present with optic neuritis B CSF protein and gammaglobulin levels are reduced in MS . C nearly all patients will demonstrate some abnormality on MRI D the overall life expectancy is not usually reduced with MS

A right MCA B left MCA C right anterior cerebral artery D left anterior cerebral artery

A associated vomiting B worsens with position change C associated tinnitus D vertical nystagmus