Demyelination Periph Neuropathy MCQ's

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

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

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

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

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

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

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?