Q-21. Horner’s syndrome is seen in all except
a) Carotid artery aneurysm
b) Medial medullary syndrome
c) Multiple sclerosis
d) Surgical treatment of Reynaud’s Syndrome
Answer: Medial medullary syndrome
Explanation:
Horner syndrome results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis, partial ptosis, and anhidrosis.
Causes of Horner syndrome:
First-order neuron lesions: Arnold-Chiari malformation, Basal meningitis (e.g., syphilis), Basal skull tumors, Wallenberg syndrome/lateral medullary syndrome, Demyelinating disease (e.g., multiple sclerosis), Lesions in the hypothalamus or medulla, Intra-pontine hemorrhage, Pituitary tumor, Syringomyelia
Neck trauma e.g., Surgical treatment of Reynaud’s Syndrome- Cervical symphathectomy
Horner syndrome occurring in association with spinal cord trauma suggests a high cervical cord lesion because it does not occur with lesions below T2 or T3
Second-order neuron lesions: Pan-coast tumor, Birth trauma with injury to lower brachial plexus, Cervical rib, Aneurysm or dissection of the aorta, Lesions of the subclavian or common carotid artery, Central venous catheterization, Trauma or surgical injury, Chest tubes, Lymph-adenopathy, Mandibular tooth abscess, Lesions of the middle ear and Neuroblastoma
Third-order neuron lesions: Internal carotid artery dissection, Raeder syndrome (para-trigeminal syndrome), Carotid cavernous fistula, Cluster or migraine headache and Herpes zoster
Q-22. Which one of the following about Horner’s syndrome is not correct?
a) Miosis
b) Anhidrosis
c) Hyper-chromatic iris
d) Apparent exophthalmos
Answer: Apparent exophthalmos
Explanation:
Horner syndrome results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis, partial ptosis, and anhidrosis.
Iris hetero-chromia (hetero-chromia iridis) – The affected iris may remain blue when the other iris changes to brown; this may be present if the lesion is in a child younger than 2 years but is uncommon in older patients.
Iris pigmentation is under sympathetic control during development, which is completed by the age of 2 years
Signs: Miosis, partial ptosis, anhidrosis, enophthalmos, loss of ciliospinal reflex and bloodshot conjunctiva
Q-23. Treatment of choice of Kawasaki disease
a) IV Immunoglobulin
b) Steroid
c) Dapsone
d) Methotrexate
Answer: IV Immunoglobulin
Explanation:
Kawasaki disease (KD) is an acute febrile vasculitic syndrome of early childhood that, although it has a good prognosis with treatment, can lead to death from coronary artery aneurysm (CAA) in a very small percentage of patients.
The principal goal of treatment is to prevent coronary artery disease and to relieve symptoms.
High dose of IV immunoglobulin along with aspirin reduces likelihood of coronary artery disease in Kawasaki disease.
Steroid-Typically in patients unresponsive to standard treatment
Q-24. Pseudo-tumor Cerebri is seen in
a) Obese Female of 20-40 years
b) Obese Male of 20-40 years
c) Thin Female of 50-60 years
d) Thin Male of 50-60 years
Answer: Obese Female of 20-40 years
Explanation:
Idiopathic intracranial hypertension or pseudo tumor cerebri, or benign intracranial hypertension is a disorder of unknown etiology that predominantly affects obese women of childbearing age.
The primary problem is chronically elevated intracranial pressure (ICP), and the most important neurologic manifestation is papillo-edema, which may lead to progressive optic atrophy and blindness.
The main symptoms are headache, nausea, and vomiting, as well as pulsatile tinnitus, double vision and other visual symptoms. If untreated, it may lead to swelling of the optic disc in the eye, which can progress to vision loss.
Q-25. Type of wave in Metabolic Encephalopathy
a) Alpha
b) Beta
c) Gamma
d) Delta
Answer: Delta
Explanation:
An EEG showing diffuse slowing of the background and presence of triphasic waves is highly suggestive of a metabolic encephalopathy.
The most prominent component is a positive sharp wave that is preceded by a short-duration negative sharp wave and followed by a long-duration negative slow wave.
Though triphasic waves are most frequently mentioned in hepatic encephalopathy, they can also be seen in uremic encephalopathy, or even in aged psychiatric patients treated with lithium.
Delta waves are normally observed in adults in slow wave sleep. They are also seen normally in infants. Focal Delta waves occur with sub-cortical lesions, and in more general distribution with diffuse lesions of the brain, with metabolic encephalopathy.
Abnormal patterns of theta waves can be seen as a focal disturbance in sub-cortical lesions from trauma, and can be seen in generalized distribution in diffuse brain disorders, metabolic encephalopathy, deep midline disorders, and in some instances of hydrocephalus.
Q-26. Most common type spino-cerebral Ataxia in India is
a) SCA 1
b) SCA 2
c) SCA 3
d) SCA 4
Answer: SCA 2
Explanation:
Spinocerebellar ataxia (SCA) is one of a group of genetic disorders characterized by slowly progressive in-coordination of gait and is often associated with poor coordination of hands, speech, and eye movements.
Most common type spino-cerebral Ataxia in India is SCA 2.
Most common type spino-cerebral Ataxia in World is SCA 3.
Most common type spino-cerebral Ataxia in south is SCA 1.
Q-27. Fever Blister can occur due to:
a) Primary HSV-1 Infection
b) Varicella
c) Reactivation of HSV-1 Infection
d) CMV
Answer: Reactivation of HSV-1 Infection
Explanation:
Cold sores, sometimes called fever blisters, are groups of small blisters on the lip and around the mouth. The skin around the blisters is often red, swollen, and sore.
Cold sores and fever blisters are caused by the herpes simplex virus type 1 (HSV-1)
The first time HSV-1 invades the skin, it causes a primary infection, which usually occurs in childhood or adolescence. It may cause a fever, sore mouth and sore throat.
After this primary infection subsides, the virus remains dormant (inactive) indefinitely in nerve roots near the affected skin area.
In some people, the virus becomes active again from time to time and causes new active sores on the skin, usually on the lip.
These sores have become known as cold sores or fever blisters because the virus can be reactivated by a cold or fever.
Q-28. Blink reflex is used for
a) Mid pontine lesions
b) Neuro-muscular transmission
c) Axonal neuropathy
d) Motor neuron disease
Answer: Mid pontine lesions
Explanation:
The corneal reflex, also known as the blink reflex, is an involuntary blinking of the eyelids elicited by stimulation of the cornea.
The evolutionary purpose of this reflex is to protect the eyes from foreign bodies and bright lights (the latter known as the optical reflex).
The reflex is mediated by:
- The naso-ciliary branch of the ophthalmic branch (V1) of the 5th cranial nerve (trigeminal nerve) sensing the stimulus on the cornea, lid, or conjunctiva (i.e. it is the afferent).
- The temporal and zygomatic branches of the 7th cranial nerve (Facial nerve) initiating the motor response (i.e. it is the efferent).
- Mediated by centre in the pons of brainstem
Blink reflex study is a useful electro-physiological technique for evaluation of patient with involvement of trigeminal or facial nerve, variety demyelinating poly-neuropathies and central lesion in brain stem.
Q-29. All are major criteria for rheumatic fever except
a) Carditis
b) Subcutaneous nodule
c) Arthralgia
d) Chorea
Answer: Arthralgia
Explanation:
Jones Criteria for Diagnosis of Rheumatic Fever:
Major Diagnostic Criteria
Carditis
Poly-arthritis
Chorea
Erythema marginatum
Subcutaneous Nodules
Minor Diagnostic Criteria
Fever
Arthralgia
Previous rheumatic fever or rheumatic heart disease
Acute phase reactions: ESR / CRP / Leukocytosis
Prolonged PR interval
Diagnostic
Required Criteria- 2 major criteria and 0 minor criteria or 1 major criteria and 2 minor criteria
Q- 30. Blue sclera disease is
a) Marfan’s syndrome
b) Klinefelter’s syndrome
c) Osteogenesis imperfecta
d) Down’s syndrome
Answer: Osteogenesis imperfecta
Explanation:
Osteogenesis imperfecta:
Clinical features:
Severe osteoporosis
Spontaneous fracture occur in utero or during childhood
Blue sclera
Important points:
It is caused by a major mutation in the gene encoding for type I collagen, major collagen constituent of bone.
Certain polymorphism in this gene predisposes to hypo-gonadal or idiopathic osteoporosis.