Assiut University
Faculty of Medicine
Neurology and Psychiatry Department
End of term Exam
Name:…………………………………………………
Section:…………..
Time: 1 hour
Date: 25/6/2012
-------------------------------------------------------------------------------------------------I}- Read the following case scenario and answer the following questions:
A 17-year-old girl, right handed, brought by her family with weakness of
the right upper and lower limbs with deviation of the angel of the mouth
towards the left side of two days duration. She had history of left ear
discharge one week before the onset. On examination, temp was 39.5C, she
had neck stiffness, responded well to pin brick bilaterally, but she couldn't
understand most of the commands, and she could not express her complaint.
1- What is the type of speech defect in this patient?
…Mixed expressive and receptive aphasia………………………………(1/4)
2- What is the clinical diagnosis?
*Rt. Hemiplegia, aphasia, Rt UMN facial paralysis, with positive
meningeal signs…..………………………………………………………...(1/2)
3-What is the etiological diagnosis?
…Meningio- encephalitis; Meningitis with brain abscess formation…...(1/4)
4- Mention two appropriate investigations in this case.
a)- Neuroimaging: CT or MRI………………………….………………. (1/4 )
b)- CSF analysis……………………………………………………………(1/4)
4- Mention two appropriate lines of treatment.
a)- Dehydrating measures; Mannitol ,and Corticosteroids……………(1/4)
b)- Good umbrella of antibiotics (Cefatrioxone, Penicillin G,
Chloramphenicol )………………………………………………………….(1/4)
II}- Read the following case scenario and answer the following questions:
A 27-year-old man, started to complain of weakness of both lower limbs,
which ascends to involve the upper limbs, and facial muscles, along the
course of the following two days. Later on he suffered numbness of both lower
and upper limbs, along the whole circumference of the limbs, extending from
the tips of the toes, and fingers up to the knees and elbows. On arrival, the
attendants gave a history of flu-like symptoms 2 weeks prior to this illness. On
examination, the patient was cyanosed, together with weakness of the four
limbs which was proximal more than distal.
1- The distribution of numbness in the underlined statement takes the form of
…Glove and stock hyposthesia..………………………………...................(1/4)
2- What is the type of weakness in this case (upper or lower motor neuron
lesion?
Lower motor neurone lesion.………………................................................(1/4)
3-What is your expectation about?
a)- deep reflexes: Hyporeflexia.………………………………………………(1/4)
b)- Planter response : Flexor or no response……………………………....(1/4)
4- The most appropriate investigations is Electrophysiology (EMG, NCV, F
and H reflex)……………………………………………………………………(1/4)
5-What is your clinical diagnosis?
…Post-infective Radiculoneuropathy ( Guillain Barre Syndrome)….……..(1/4)
6- Two recommended lines of treatment
a)-… Corticosteroids, IVIG, Plasmapheresis.……………………………….(1/4)
b)-…ICU for respiratory distress..…………………………………………….(1/4)
III}- Put (T) in front of the correct answer and (F) in front of the wrong one { 1
mark for each }:
1- In Duchenne muscular dystrophy:
*- Typically presents in the second decade of life…………………………..( F )
*- Manifests clinically only in Males………………………………………........( T)
*- Cardiomyopathy is the commonest cause of death……………………….( T)
*- There is selective weakness of neck muscles……...………………………(F )
2-The following are common causes of seizures:
*- Frontal lobe tumors………………………………………………………….…( T)
*- Encephalitis………………………………………………………………….…( T )
*- Myelitis……………………………………………………………………….….( F )
*- Cerebrovascular stroke…………………………………………………......…( T )
3- In Friedreich's ataxia the following are associated features:
*- Homonymous hemianopia…………………….…………………………..…..( F )
*- Bilateral positive Babinsiki sign...…………………………………………..…( T)
*- Diabetes mellitus…………………………………………………………….....( T )
*- Pes cavus…………………………………………………………………….....( T )
4- The following are among the diagnostic criteria of Parkinson's disease:
*- Cogwheel rigidity……………………………………………………………....(T )
*)- Kinetic tremors………………………………………………………………...( F )
*)- Bradykinesia………………………………………………………………..…( T )
*)- High steppage gait…………………………………………………………....(F )
IV }- Localize the neurological site of the lesion responsible for each of the
following (2 marks):
1- Increased ICT, with bitemporal hemianopia, and galactorrhea
……Pitutary tumor………………………………………………….…………..…( )
2- Jacket sensory loss Intramedullary lesion….…………………...………..…( )
3- RT hemiplegia with LT lower motor neuron facial palsy
……Left pontin lesion..………………………………………………….……..…( )
4- Lost direct corneal reflex (RT), and intact indirect one (LT).
…Right lower motor neuron facial palsy……………………………………...( )
V}- Fill in the spaces:
(2 degrees)
1- The drug of choice in treatment of Petit Mal epilepsy is…Ethosuximide/
Sodium Valproate/ clonazepam.., and…Lamotrogine……is the least
teratogenic antiepileptic drug for use during pregnancy.
2- Thrombolytic therapy is recommended for ischemic stroke during ……the
first 3 hours .of stroke.
3-Hypothyroidism, renal, hepatic encephalopathy and, chronic subdural
hematoma are common causes of reversible dementia.
4- The typical course of Multiple sclerosis is relapsing remitting and its most
sensitive diagnostic tool is MRI ……………………………………………..
VI}- Match the number of each sign of group (1) in front of the appropriate
lesion of group (II) ( 3marks):
Group I
Group II
a) *- Precipitency
(
)- Subarachnoid heamorrhage
b)*- subacute combined degeneration
( d )-Spinal Paraplegia at D10
c) *- Aura
( c )- Classic Migraine
d) *- Beevor's sign
( b )- Vit. B12 deficincy
( a )- Partial bilateral pyramidal tract
lesion
(
)- Vit D deficincy
( )- Lateral spinothalamic tract
lesion
(
)- Common Migraine
PSYCHIATRY (6 MARKS)
I- Read the following case scenario and answer the following questions (2
marks):
A 14-year-old boy is brought to the emergency department after being found
in the basement of his home by his parents during the middle of a school day.
The boy was working on a project he claimed would solve the fuel crisis. The
patient was involved in a clash with the school teacher after being asked to
leave the school because it was so late. The boy claimed that the teacher was
a foreign spy trying to stop his progress. The parents are very proud of their
son's interest in science but admit that he has been more difficult to manage
lately. He can't stop talking about his project. For the past few weeks, he gets
minimal sleep. Despite this, he seems to have plenty of energy and amazes
his parents' friends with detailed plans of how he is going to save the world.
His train of thought is difficult to follow. He paces around the examination
room. Although he has no suspects in mind, he is concerned that his life may
be in danger because of the importance of his work.
the most likely diagnosis is:
……………………………………………………………………………………………
Two thought disorders in the case
a…………………………………………………………………………………………
b…………………………………………………………………………………………
.
One drug used in treatment………………………………………………………….
One drug used in prophylaxis of the case……………………………………………
II- The following matching questions contain 5 choices (A–E) followed by 4
numbered statements (1-4). Select the single best choice that best
corresponds to the given statement. Each choice and statement can be used
only once. (2 marks)
A.
B.
C.
D.
E.
Thought form and speech
Appearance and behavior
Mood
Thought content
Insight
1. ‘I don’t know what to do, doctor. I know that they are monitoring my actions
using special radio waves and there’s no way I can get away from it.’
(Answer:
)
2. ‘I’m not eating anymore, and I constantly feel guilty for everything. I feel
like I’m in a deep trench and I’m suffering down below.’
(Answer:
)
3. ‘After that, I decided to go home … Home and away … Swaying my way.’
(Answer:
)
4. ‘I don’t need these tablets … Everything that is happening to me is real!
I’m not mad and I’m definitely not staying in hospital.’
(Answer:
)
III- Which of the following statement is not a feature of somatoform
disorders? (One mark)
a) Presence of physical complaints without any organic finding.
b) Absence of physiological mechanisms to explain the patient's
complaint.
c) Presence of delusions and hallucinations.
IV- When eliciting suicidal risk, which of the following questions
should be avoided if possible? (One mark)
a) Do you have any plans to kill yourself?
b) How are you feeling in your mood?
c) Have you ever considered life is not worth living?
d) Have you ever wanted to go to sleep and never wake up?
e) Non of the above.
GGD LUCK!!!!!!!!!!