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1
Q

A 30-year-old man presents with subacute onset of weakness which develops over about five
days. He is areflexic. MRI of the lumbar spine and plexus shows enhancement of the proximal
nerve roots. Which is the most appropriate interpretation of the findings?
A. The patient has neoplastic meningitis
B. The patient has AIDP
C. The patient has plexitis
D. The patient has CIDP

A

No highights

2
Q

A 40-year-old male presents with pain in the right leg followed by weakness which worsens over
about a week. As the weakness reaches a plateau, the pain abates. Imaging of the-lumbar spine
and plexus is normal. EMG 4 weeks after onset shows distal denervation, with sparing of the
paraspinai muscles. He has no history or laboratory signs of diabetes, and there is no history of
cancer. Which is the most likely diagnosis?
A. Diabetic lumbar plexopathy
B. Idiopathic lumbosacral plexopathy
C. Lumbosacral plexus infiltration not seen on routine imaging
D. Neoplastic meningitis

A

No highights

3
Q

A patient presents with severe neuropathic pain in multiple nerve root distributions. The
symptoms have developed within one week, and are rapidly worsening. She has nuchal rigidity
and mild confusion but no fever. LP shows increased white blood cells, and cytology is positive.
She has no Known history of cancer. Which is the most appropriate clinical interpretation?
A. She has neoplastic meningitis as the presenting symptoms of cancer
B. She has infectious meningitis and the cytology is false positive
C. She has encephalitis with an unidentified virus.

A

No highights

4
Q

In evaluating a patient for a brachial plexopathy, which of the following clinical features would
suggest radiation-induced plexopathy rather than neoplastic infiltration?
1. Severe neuropathic pain
2. Upper plexus
3. Horner’s syndrome
4. Lymphedema
Select: A - 1.2. 3. B -1,3. C = 2, 4. D = 4 only. E = All

A

No highights

5
Q

A 70-year-old man with N1DDM presents with leg weakness. He has weakness of the
quadriceps and adductors with loss of the patellar reflex. Both Achilles reflexes are suppressed,
but the remainder of the reflexes are normal. Which is the most likely diagnosis?
A. Amyotrophic lateral sclerosis
B. Diabetic polyradiculoneuropathy
C. Idiopathic lumbosacral plexitis
D. Spinal stenosis

A

b

6
Q

A 30-year-old female develops a rash on her right leg, in approximately an L2 distribution. This
is associated with severe pain in the same distribution which has a neuropathic character. Which
is the most likely diagnosis?
A. Diabetic polyradiculoneuropathy
B. Herpes zoster
C. Lumbar disc disease
D. Lyme polyradiculitis

A

b

7
Q

Which of the following would be appropriate treatments for a 70-year-old with herpes zoster?
1. Amitriptyline
2. Sertraline
3. Gabapentin
4. Famciclovir
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

e

8
Q

A 70-year-old man presents with severe pain and weakness in the right leg. The pain is in the
groin and radiates down into the right leg. His only other medical problem is a recent history of
DVT with resultant warfarin therapy. Which is the most likely diagnosis?
A. Diabetic amyotrophy
B. Lumbar plexitis
C. Lumbar radiculopathy
D. Retroperitoneal hematoma

A

d

9
Q

A 68-year-old man presents with severe shoulder oain which radiates into the neck, upper chest,
and into the medial aspect of the upper arm. He has weakness of the median and ulnar-innervated
intrinsic muscles of the hand. Which of the following are reasonable differential diagnoses of
this pain7
1. Carpal tunnel syndrome
2. Cervical radiculopathy
3. Monomelic amyotrophy
4. Brachial plexopathy
Select: A = 1, 2, 3. B = i. 3 C = 2. 4. D =4 only. E - All

A

d

10
Q

The patient in the above question has MRI of the cervical spine which is normal and MRI of the
plexus which shows a mass extending from the apex of the lung in to the lower brachial plexus.
Which is the most diagnosis?
A. Lymphoma
B. Non-small cell lung cancer
C. Mesothelioma
D. Small cell lung cancer

A

b

11
Q

A 23-year-old female presents with 3 weeks of weakness most prominent distally, dysesthesias
and paresthesias. Examination is most remarkable for areflexia. Which is the most likely
diagnosis?
A. Acute inflammatory demyelinating polyradiculoneuropathy
B. Chronic inflammatory demyelinating polyradiculoneuropathy
C. Pick paralysis
D. Porphyria

A

a

12
Q

A 45-year-old female presents with numbness of both hands on digits 4 and 5, and is found on
EMG to have bilateral ulnar neuropathies with relative slowing across the elbow plus signs of
mild peripheral polyneuropathy Which is the most likely diagnosis?
A Diabetic neuropathy
B. Guillain-Barre syndrome
C. Hereditary sensorimotor neuropathy
D. Vasculitis

A

a

13
Q

Which of the following are reasonable clinical indications for nerve biopsy?
1. Amyloidosis
2. Vasculitis
3. Sarcoidosis
4. Guiilain-Barre syndrome
Select: A - 1.2. 3. B = !, 3. C = 2, 4.D - A oi.lv. !• - Ail

A

a

14
Q
For the following questions, select the most likely diagnosis from the following list. Each
question presents a type of neuropathy.
A. ALS
B. CIDP
C. Critical illness neuropathy
D. Diabetic neuropathy
E. Entrapment mononcuropathy
F. Guillain-Barre syndrome
G. Hereditary neuropathy
H. MMN
I. Vasculitis

A 56-year-old female with COPD is in the ICU for two weeks on. the ventilator and develops
diffuse weakness and depressed refiexes. Tone is diffusely decreased.

A

c

15
Q
For the following questions, select the most likely diagnosis from the following list. Each
question presents a type of neuropathy.
A. ALS
B. CIDP
C. Critical illness neuropathy
D. Diabetic neuropathy
E. Entrapment mononcuropathy
F. Guillain-Barre syndrome
G. Hereditary neuropathy
H. MMN
I. Vasculitis

A 30-year-old male presents with progressive asymmetric weakness mainly affecting distal limb
muscles. There are no pyramidal tract signs and no sensory symptoms. Tendon reflexes are
depressed, but only absent at the ankle.

A

h

16
Q
For the following questions, select the most likely diagnosis from the following list. Each
question presents a type of neuropathy.
A. ALS
B. CIDP
C. Critical illness neuropathy
D. Diabetic neuropathy
E. Entrapment mononcuropathy
F. Guillain-Barre syndrome
G. Hereditary neuropathy
H. MMN
I. Vasculitis

A 17-year-old female presents with progressive difficulty walking for more than two years. She
has pes cavus and hammer toes, distal weakness, absent reflexes in the legs and depressed
reflexes in the anus Nerve conduction in the legs shows motor conduction velocities of about 20
m/s, with absent sensory potentials. Conduction velocities in the arms are about 30 m/s. There
has been no history of diabetes nor is there a known family history of neuropathy.

A

g

17
Q
For the following questions, select the most likely diagnosis from the following list. Each
question presents a type of neuropathy.
A. ALS
B. CIDP
C. Critical illness neuropathy
D. Diabetic neuropathy
E. Entrapment mononcuropathy
F. Guillain-Barre syndrome
G. Hereditary neuropathy
H. MMN
I. Vasculitis

A 55-year-old female presents with progressive symmetric weakness of the arms and legs which
has been developing for almost 6 months. Examination shows distal sensory loss, weakness most
prominent in distal muscles, and areflexia. EMG shows demyelinating neuropathy with segments
of partial conduction block.

A

b

18
Q

A 50-year-old female presents with distal numbness and weakness. Examination and EMG show
mononeuropathy multiplex. CSF shows a lymphocytic pleocytosis and increased protein with
normal glucose. Which is the most likely diagnosis?
A. Diabetic neuropathy
B. Leprosy
C. Polyarteritis nodosa
D. Sarcoidosis

A

d

19
Q

A 65-year-old male presents with distal sensorimotor neuropathy with axonal and demyelinating
features. SIEP shows IgM monoclonal protein. What is the expected relationship between the
monoclonal protein and the neuropathy?
A. IgM monoclonal protein is unrelated to the neuropathy
B. IgM monoclonal protein is associated with neuropathy due to multiple myeloma
C. IgM monoclonal protein is associated with neuropathy even in the absence of myeloma

A

c

20
Q

Which of the following are possible complications of multiple myeloma?
1. Peripheral neuropathy
2. Autonomic neuropathy
3. Spinal cord compression
4. Radiculopathy
Select: A = 1, 2, 3. B = 1. 5. C - 2, 4. D = 4 only. E = All

A

e

21
Q

A 76-year-old man reports episodes of syncope associated with urination at night. He develops a
presyncopal sensation during micturition and loses consciousness if he does not immediately go
to the floor. He has no abnormalities on examination except for absent ankle reflexes. Which of
the following statements is true?
A. He has autonomic neuropathy predisposing to micturition syncope
B. He has peripheral polyneuropathy predisposing to autonomic neuropathy
C. He has micturition syncope without definite evidence of other predisposing factor

A

c

22
Q

Which of the following statements are true regarding carotid sinus hypersensitivity?
1. The syncope is neurally mediated
2. Permanent pacemaker prevents the syncope
3. Turning of the head results in hypotension
4. Tightening the collar results in hypertension
Select: A = 1,2,3. B = I, 3. C = 2,4. D - 4 only. E = Ali

A

b

23
Q

Which of the following conditions could produce paroxysmal hypertension?
1. Pheuchromocytoma
2. Guillain-Barre syndrome
3. Porphyria
4. Posterior fossa tumor
Select: A = 1.2, 3. B = 1,3. C = 2, 4. D - 4 only. E = All

A

e

24
Q

Patients with high cervical cord lesions have a greater risk of bradycardia and cardiac arrest
during anesthesia. What is the presumed physiology of this?
A. Reflex hypertension
B. Unopposed vagal stimulation
C. Bradycardia due to catecholamine release
D. Cardiac ischemia due to hypoxia

A

b

25
Q

Which of the following statements are true regarding the sympathetic skin response?
1. SSR is usually absent in axonal neuropathies
2. SSR is usually absent in demyelinating neuropathies
3. SSR is elicited by either physiologic or electrical stimuli
4. SSR abnormalities are based on latency rather than amplitude
Select: A =1.2. 3. B =1.3. C = 2,4. D = 4 only. E = All

A

b

26
Q
The figure shows a photo of a woman with weakness which has been present for more than six
months.
Which is the most likely diagnosis?
A. Marfan's syndrome
B. Lambert-Eaton syndrome
C. Myasthenia gravis
D. Myotonic dystrophy
A

c

27
Q

What is the reason for reduced action of acetylcholine on the postjunctional membrane in
patients with myasthenia gravis?
A. Antibodies bind to the postjunctional membrane and prevent cellular action of the
acetylcholine receptor
B. Antibodies bind to the acetylcholine receptor and reduce the number of available receptors for
acetylcholine
C. Antibodies bind to the prejunctional membrane to reduce acetylcholine release

A

b

28
Q

Which of the following statements are true regarding thymomas in patients with myasthenia
gravis?
A. Thymomas are of increased frequency, but not present in the majority
B. Thymomas are present in the majority of patients
C. Thymic hyperplasia is common, but thymomas are not more common in patients with MG

A

a

29
Q

Which of the following statements are true regarding the edrophonium test in myasthenia
A. The test is positive in 90% of patients with MG
B. The test may be positive in patients with primary ocular motor nerve lesions
C. The test may be positive in patients tor neuron disease
D. The test is performed by injection of 10 nig as a single dose
Select. A = 1,2.3. B= I. 3. C -2,4. D = 4 only. E = All

A

a

30
Q

Which of the following statements are true regarding antibody testing in myasthenia?
1. AChR antibodies are detected in less than 30% of patients with ocular myasthenia
2. AChR antibodies are identified in S0% of patients with generalized myasthenia gravis
3. AChR antibodies are detected in almost all patients with congenital myasthenia
4. AChR antibodies are detected in almost all patients with thymoma
Select: A = 1,2,3. B= i, 3. C = 2, 4. D = 4 only. E = All

A

c

31
Q

A 4-month-old child presents with weakness which developed over the past few weeks. There is
poor suck and feeding, decreased pupillary reactivity, diffuse weakness with hypotonia and
decreased tendon reflexes, plus constipation. He progresses to respiratory failure and ventilatory
support. Which is the most likely diagnosis?
A. Congenital myasthenia
B. Infant botulism
C. Slow channel syndrome
D. Transitory neonatal myasthenia

A

b

32
Q

A man being evaluated for myasthenia gravis has a 15% decrement with repetitive stimulation at
3/sec. Which is the correct interpretation of the findings?
A. The RNS is normal
B. The RNS is abnormal but not characteristic of MG
C. The RNS is supportive of the diagnosis of MG, but not specific
D. The RNS is diagnostic of MG

A

c

33
Q

Which of the following statements are true regarding single-fiber EMG for evaluation of patients
with suspected MG?
1. SFEMG is the most sensitive test for neuromuscular transmission defect
2. Normal jitter in a weak muscle excludes neuromuscular transmission defect
3. Blocking is not specific for MG
4. Increased jitter is specific for MG
Select: A = 1, 2. 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

a

34
Q

Which statement describes best the position of thymectomy in management of MG?
A. Thymectomy is of most benefit for elderly patients who are poorly tolerant of medical therapy
B. Thymectomy is indicated only for thymoma
C. Thymectomy is indicated mainly for patients under rhe age of 60 with MG
D. Thymectomy of no proven benefit and should not be performed

A

c

35
Q
Which is the neoplasm most assciated with Lambert-Eaton myasthenic syndrome? .
A. Breast cancer
B. Lymphoma
C. Ovarian cancer
D. Small cell lung cancer
A

d