Demyelination Periph Neuropathy MCQ's

1. Your neighbor felt ill a week ago with what appeared to be the flu. Four days ago he started complaining of weakness in both of his legs, as well as aches in pains. Yesterday he said that could no longer hold objects in his hand without much effort. He was sent to a neurologist for electromyography which revealed impaired conduction in many of his peripheral nerves. This pattern of symptoms is likely due to

Guillain barre syndrome

Multiple sclerosis

Diabetic neuropathy

Myasthenia gravis

Lambert eaton syndrome

The pattern of symptoms described, including weakness in the legs, difficulty holding objects, and impaired conduction in peripheral nerves, is consistent with Guillain-Barre syndrome. This is a rare neurological disorder where the body's immune system mistakenly attacks the peripheral nerves, leading to muscle weakness and paralysis. The progression of symptoms from flu-like illness to weakness in the legs and hands aligns with the typical course of Guillain-Barre syndrome. Multiple sclerosis, diabetic neuropathy, myasthenia gravis, and Lambert-Eaton syndrome may present with similar symptoms, but the specific pattern described here is most indicative of Guillain-Barre syndrome.

Explanation

The pattern of symptoms described, including weakness in the legs, difficulty holding objects, and impaired conduction in peripheral nerves, is consistent with Guillain-Barre syndrome. This is a rare neurological disorder where the body's immune system mistakenly attacks the peripheral nerves, leading to muscle weakness and paralysis. The progression of symptoms from flu-like illness to weakness in the legs and hands aligns with the typical course of Guillain-Barre syndrome. Multiple sclerosis, diabetic neuropathy, myasthenia gravis, and Lambert-Eaton syndrome may present with similar symptoms, but the specific pattern described here is most indicative of Guillain-Barre syndrome.

2. A 34 year old woman presents with blurry and dim vision in the left eye and some parasthesias, especially involving the right upper limb. She says that she has had occasional bouts of poor vision over the past few years as well as occasional muscle weakness. What disorder is she most likely experiencing?

Guillian garre syndrome

Multiple sclerosis

Radiculopathy

Diabetic polyneuroapathy

Duchenne muscular dystrophy

The woman's symptoms of blurry and dim vision, along with paresthesias and occasional bouts of poor vision and muscle weakness, are consistent with multiple sclerosis (MS). MS is a chronic autoimmune disease that affects the central nervous system, causing damage to the protective covering of nerve fibers. This can result in a wide range of symptoms, including vision problems, numbness or tingling, muscle weakness, and fatigue. The other options, such as Guillian Barre syndrome, radiculopathy, diabetic polyneuropathy, and Duchenne muscular dystrophy, do not fully explain the combination of symptoms described by the woman.

Explanation

The woman's symptoms of blurry and dim vision, along with paresthesias and occasional bouts of poor vision and muscle weakness, are consistent with multiple sclerosis (MS). MS is a chronic autoimmune disease that affects the central nervous system, causing damage to the protective covering of nerve fibers. This can result in a wide range of symptoms, including vision problems, numbness or tingling, muscle weakness, and fatigue. The other options, such as Guillian Barre syndrome, radiculopathy, diabetic polyneuropathy, and Duchenne muscular dystrophy, do not fully explain the combination of symptoms described by the woman.

3. A 20 year old woman attends to the hospital with rapidly ascending weakness in her distal extremities, involving proximal muscles. On physical examination there is absence of deep tendon reflexes and a spinal tap reveals the CSF protein to be increased, glucose is half the amount of plasma and scant cells are reported. She stated had recovered from a viral respiratory tract infection two weeks before. A biopsy study of a peripheral nerve had inflammation and demyelination. The most likely diagnosis in this patient is:

Myasthenia gravis

Guillain-Barre syndrome

Syringomyelia

Charcot-Marie-Tooth disease (Type 1)

Metabolic neuropathy

The patient's presentation is consistent with Guillain-Barre syndrome. The rapidly ascending weakness, involvement of proximal muscles, absence of deep tendon reflexes, and increased CSF protein with low glucose are all characteristic features of Guillain-Barre syndrome. The history of a preceding viral respiratory tract infection is also common in this condition. The biopsy findings of inflammation and demyelination in a peripheral nerve further support the diagnosis of Guillain-Barre syndrome. Myasthenia gravis is characterized by fluctuating weakness and is not associated with CSF abnormalities. Syringomyelia, Charcot-Marie-Tooth disease, and metabolic neuropathy would not typically present with rapidly ascending weakness and CSF abnormalities.

Explanation

The patient's presentation is consistent with Guillain-Barre syndrome. The rapidly ascending weakness, involvement of proximal muscles, absence of deep tendon reflexes, and increased CSF protein with low glucose are all characteristic features of Guillain-Barre syndrome. The history of a preceding viral respiratory tract infection is also common in this condition. The biopsy findings of inflammation and demyelination in a peripheral nerve further support the diagnosis of Guillain-Barre syndrome. Myasthenia gravis is characterized by fluctuating weakness and is not associated with CSF abnormalities. Syringomyelia, Charcot-Marie-Tooth disease, and metabolic neuropathy would not typically present with rapidly ascending weakness and CSF abnormalities.

4. A 23-year-old woman presents with loss of vision in the right eye accompanied by slight pain in that eye. She has reduced visual acuity in the right eye and loss of direct and consensual light reflexes when light is shown into that eye. No other neurological abnormalities were observed. Axial MRI showed hyper-intense lesions in the right optic nerve and periventricular regions of the anterior horn and body of the lateral ventricles bilaterally. The periventricular lesions were of varying sizes. The most likely diagnosis in this patient is:

Guillain-Barre syndrome

Stroke

Complicated migraine

Multiple sclerosis

Temporal arteritis

The patient's symptoms of loss of vision in one eye, reduced visual acuity, and loss of direct and consensual light reflexes suggest an optic nerve problem. The MRI findings of hyper-intense lesions in the right optic nerve and periventricular regions are consistent with multiple sclerosis (MS), which is known to cause demyelination and inflammation in the central nervous system. Guillain-Barre syndrome typically presents with weakness and sensory abnormalities, not visual symptoms. Stroke would not explain the optic nerve involvement or periventricular lesions. Complicated migraine is less likely given the MRI findings. Temporal arteritis would typically present with headache and jaw claudication, not loss of vision and periventricular lesions.

Explanation

The patient's symptoms of loss of vision in one eye, reduced visual acuity, and loss of direct and consensual light reflexes suggest an optic nerve problem. The MRI findings of hyper-intense lesions in the right optic nerve and periventricular regions are consistent with multiple sclerosis (MS), which is known to cause demyelination and inflammation in the central nervous system. Guillain-Barre syndrome typically presents with weakness and sensory abnormalities, not visual symptoms. Stroke would not explain the optic nerve involvement or periventricular lesions. Complicated migraine is less likely given the MRI findings. Temporal arteritis would typically present with headache and jaw claudication, not loss of vision and periventricular lesions.

5. A 36-year-old woman tells you that she had daily headaches and blurred vision for 2-3 weeks about 6 months ago. The headaches are gone but her vision is still a bit blurred. Now in the last 2 weeks she has noted weakness in both arms and trouble picking up small items with her right hand—she cannot pick up a dime with her eyes closed. She also says that her left foot feels as though she is walking in deep sand and she often trips. Her complaints are consistent with which of the following disorders?

Myasthenia gravis

ALS

B12 deficiency

Multiple sclerosis

The woman's symptoms of daily headaches, blurred vision, weakness in both arms, trouble picking up small items, difficulty walking, and frequent tripping are consistent with multiple sclerosis (MS). MS is a chronic autoimmune disease that affects the central nervous system, causing inflammation and damage to the myelin sheath that covers nerve fibers. This can result in a wide range of symptoms, including vision problems, muscle weakness, and coordination difficulties. The fact that her symptoms have persisted for several months also aligns with the chronic nature of MS.

Explanation

The woman's symptoms of daily headaches, blurred vision, weakness in both arms, trouble picking up small items, difficulty walking, and frequent tripping are consistent with multiple sclerosis (MS). MS is a chronic autoimmune disease that affects the central nervous system, causing inflammation and damage to the myelin sheath that covers nerve fibers. This can result in a wide range of symptoms, including vision problems, muscle weakness, and coordination difficulties. The fact that her symptoms have persisted for several months also aligns with the chronic nature of MS.

6. Which of the following brain structures are the most common sites for formation of demyelinating plaques in advanced multiple sclerosis?

Paraventricular white matter, optic nerve, brainstem, and grey matter of the spinal cord

Paraventricular grey matter, optic nerve and chiasm, brainstem, and grey matter of the spinal cord

Basal ganglia, optic nerve, brain stem, and white matter of the spinal cord

Cerebral white matter, optic nerve and chiasm, brainstem, and white matter of the spinal cord

The correct answer is "Cerebral white matter, optic nerve and chiasm, brainstem, and white matter of the spinal cord." In advanced multiple sclerosis, demyelinating plaques are most commonly found in these brain structures. This includes the cerebral white matter, which is the white matter in the outer layer of the brain, the optic nerve and chiasm, which are responsible for transmitting visual information, the brainstem, which controls vital functions, and the white matter of the spinal cord, which transmits signals between the brain and the rest of the body.

Explanation

The correct answer is "Cerebral white matter, optic nerve and chiasm, brainstem, and white matter of the spinal cord." In advanced multiple sclerosis, demyelinating plaques are most commonly found in these brain structures. This includes the cerebral white matter, which is the white matter in the outer layer of the brain, the optic nerve and chiasm, which are responsible for transmitting visual information, the brainstem, which controls vital functions, and the white matter of the spinal cord, which transmits signals between the brain and the rest of the body.

7. A 32-year-old female presents to the emergency department complaining of numbness in her right leg that lasted several hours, which worsened when she took a warm shower. She also complained of feeling fatighed lately and she stated that 1 year ago she had an episode of transient unilateral vision loss that resolved and never recurred. vital signs: T=97.0F; BP=122/73 mmHg; HR=76 bpm;RR=18 breaths/min. Physical examination is significant for nystagmus, scanning speech, and diminished sensation in the right leg but normal strength. To confirm your presumptive diagnosis in this patient, you most likely order next:

CSF electrophoresis

Brain CT scan

Ophthalmology consultation

Complete CBC, blood chemistry and electrolytes

Electromyography

Based on the patient's symptoms and physical examination findings, the most likely diagnosis is multiple sclerosis (MS). The patient's history of transient unilateral vision loss and current symptoms of numbness in the right leg, along with the presence of nystagmus, scanning speech, and diminished sensation, are consistent with MS. CSF electrophoresis is ordered to confirm the diagnosis of MS by detecting the presence of oligoclonal bands, which are indicative of inflammation in the central nervous system. Brain CT scan, ophthalmology consultation, complete CBC, blood chemistry and electrolytes, and electromyography would not provide specific confirmation of MS.

Explanation

Based on the patient's symptoms and physical examination findings, the most likely diagnosis is multiple sclerosis (MS). The patient's history of transient unilateral vision loss and current symptoms of numbness in the right leg, along with the presence of nystagmus, scanning speech, and diminished sensation, are consistent with MS. CSF electrophoresis is ordered to confirm the diagnosis of MS by detecting the presence of oligoclonal bands, which are indicative of inflammation in the central nervous system. Brain CT scan, ophthalmology consultation, complete CBC, blood chemistry and electrolytes, and electromyography would not provide specific confirmation of MS.

8. A 33-year-old Caucasian woman comes to her family physician complaining on a tingling sensation in her toes and progressive weakness in both of her legs. On questioning, she recalls she had a minor diarrhea two weeks ago that lasted for a few days. Physical examination reveals markedly decreased patellar and Achilles tendon reflexes bilaterally. Which of the following pathologic changes can be found in patient's peripheral nerves?

The patient's symptoms of tingling sensation in her toes and progressive weakness in both legs, along with decreased patellar and Achilles tendon reflexes, suggest a peripheral nerve disorder. Given the history of recent diarrhea, the most likely diagnosis is Guillain-Barré syndrome (GBS). GBS is an autoimmune disorder characterized by inflammation of the peripheral nerves. Pathologic changes seen in GBS include demyelination and axonal degeneration of the peripheral nerves.

Explanation

The patient's symptoms of tingling sensation in her toes and progressive weakness in both legs, along with decreased patellar and Achilles tendon reflexes, suggest a peripheral nerve disorder. Given the history of recent diarrhea, the most likely diagnosis is Guillain-Barré syndrome (GBS). GBS is an autoimmune disorder characterized by inflammation of the peripheral nerves. Pathologic changes seen in GBS include demyelination and axonal degeneration of the peripheral nerves.