Disseminated intravascular coagulation (DIC) differs from thrombotic thrombocytopenic purpura. In this reference the DIC is most likely characterized by:
A. Significant numbers of schistocytes
B. A brisk reticulocytosis
C. Decreased coagulation factor levels
D. Significant thrombocytopenia
Correct answer : C. Decreased coagulation factor levels
In DIC, the levels of coagulation factors are decreased. Whereas in TTP, coagulation factor levels are normal.
Isolated 3rd nerve palsy is seen in?
A. Frontal lobe tumor
B. Weber’s syndrome
C. Diabetes
D. All of the above
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The most sensitive test for the diagnosis of myasthenia gravis is:
A. Elevated serum ACh-receptor binding antibodies
B. Repetitive nerve stimulation test
C. Positive edrophonium test
D. Measurement of jitter by single fibre electromyography
Correct answer : C. Positive edrophonium test
Edrophonium test has 95% sensitivity for detection of systemic myasthenia gravis and 85% sensitivity for that of ocular variety.
(Note : This is the answer given in Mudit Khanna. But Harrison writes that it is used infrequently to diagnose MG and is limited to situations when other investigations do not yield a conclusive diagnosis. Other sources state single fibre electromyography to be the most sensitive test.)
All of the following are true about manifestations of vitamin E deficiency, except:
A. Hemolytic anemia
B. Posterior column abnormalities
C. Cerebellar ataxia
D. Autonomic dysfunction
Correct answer : D. Autonomic dysfunction
Autonomic dysfunction is not seen with vitamin E deficiency.
Vitamin B12 deficiency can give rise to all of the following, except:
A. Myelopathy
B. Optic atrophy
C. Peripheral neuropathy
D. Myopathy
Correct answer : D. Myopathy
Myopathy is not seen with vitamin B12 deficiency.
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Medicine – MCQ 174 – Neurological channelopathies
All of the following are neurologic channelopathies except:
A. Hypokalemic periodic paralysis
B. Episodic ataxia type 1
C. Familial hemiplegic migraine
D. Spinocerebellar ataxia 1
Correct answer : D. Spinocerebellar ataxia 1
Spinocerebellar ataxia (SCA) type 1 is not a neurological channelopathy. But SCA type 6 is a neurological channelopathy.
EEG is usually abnormal in all of the following, except:
A. Subacute sclerosing panencephalitis
B. Locked — in state
C. Creutzfeldt — Jakob disease
D. Hepatic encephalopathy
Correct answer : B. Locked — in state
In locked in state, normal alpha activity is found in EEG.
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Medicine – MCQ 171 – 45 year old male with alcohol dependence
A 45 year old male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:
A. Korsakoff’s psychosis
B. Wernicke encephalopathy
C. De Clerambault syndrome
D. Delirium tremens
Correct answer : B. Wernicke encephalopathy
Wernicke encephalopathy is characterised by a triad of confusion, ophthalmoplegia and ataxia in an alcoholic patient.
A 40 year old male with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onsent of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for a few hours. There is history of his having missed the alcohol drink for 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgement and insight. He is most likely to be suffering from:
A. Alcoholic hallucinosis
B. Delirium tremens
C. Wernicke encephalopathy
D. Korsakoff’ s psychosis
Correct answer : B. Delirium tremens
The clinical picture is characteristic of Delirium tremens.