Nokea
What is going to happen to a patient with multiple sclerosis (MS)?
- A. You will have either periods of attacks and remissions or progression of nerve damage over time.
- B. You need to plan for a continuous loss of movement
- C. sensory functions
- D. and mental capabilities.
Correct Answer: A
Rationale: MS can follow relapsing-remitting or progressive courses
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A 38-year-old female presents with muscle fatigue that is worse by the end of the day. She reports to have myalgias in the back of her neck, and at times her head "drops." She also states to sees "double" when watching television, or reading for a prolonged period of time. On physical examination, ptosis is produced when asking the patient to look at the ceiling without blinking. Pupillary function is intact. Appropriate serologic testing is obtained. On repetitive nerve stimulation, the amplitude of the compound muscle action potential progressively declines. Which of the following is most likely the diagnosis?
- A. Botulism
- B. Lambert-Eaton myasthenic syndrome
- C. Acute inflammatory demyelinating polyradiculopathy
- D. Myasthenia gravis
Correct Answer: D
Rationale: The patient's symptoms of fatigable weakness, ptosis, and diplopia, along with the decremental response on repetitive nerve stimulation, are classic for myasthenia gravis. This autoimmune disorder is caused by antibodies against acetylcholine receptors at the neuromuscular junction, leading to impaired muscle contraction. Botulism and Lambert-Eaton syndrome also cause weakness but have different clinical and electrophysiological features. Multiple sclerosis and acute inflammatory demyelinating polyradiculopathy do not typically present with fatigable weakness.
Treatment of the patient with antidepressants will most likely do what?
- A. Improve cognitive function
- B. Not alter the course of either condition
- C. Cause interactions with the drugs used to treat the dementia
- D. Be contraindicated because of the central nervous system (CNS)€“depressant effect of antidepressants
Correct Answer: B
Rationale: Antidepressants do not alter the progression of dementia
Regarding the blood supply of the cerebral cortex
- A. Middle cerebral is contralateral arm, leg and speech areas
- B. Anterior cerebral is contralateral leg, micturition and defaecation
- C. Middle cerebral is ipsilateral arm, face and vision
- D. Posterior cerebral is ipsilateral vision
Correct Answer: B
Rationale: The anterior cerebral artery supplies the medial surface of the brain, including areas responsible for motor and sensory functions of the contralateral leg. It also influences micturition and defecation.
What does an abnormal response in the assessment of the plantar reflex indicate?
- A. Possible neurological dysfunction, such as an upper motor neuron lesion.
- B. Normal reflex response.
- C. Absence of reflex abnormalities.
- D. Clear, coordinated movements.
Correct Answer: A
Rationale: An abnormal plantar reflex, such as toe extension (Babinski sign), suggests possible upper motor neuron dysfunction. A normal reflex involves toe flexion.
Dysphasia suggests the impairment of:
- A. speech
- B. gait
- C. swallowing
- D. movement
Correct Answer: A
Rationale: Speech is the correct answer because dysphasia refers to a language disorder that affects the ability to produce or comprehend spoken or written language. It is typically caused by damage to the language centers of the brain, such as Broca's or Wernicke's areas, and results in difficulties with communication.