Term 3, CPC 4 Quiz

1. A 66 year old lady presents to her GP with complaints of forgetfulness. She has started to forget appointments Given below is an image showing microscopic appearance of the brain from autopsy of a patient who had similar complaints. What is the most prominent histopathological feature shown?

Neurofibrillary tangles

Amyloid plaques

Senile plaques

Reactive gliosis

Perivascular T lymphocytes

Note intracellular tangle of fibres with nucleus at one end. Typical of neurofibrillary tangles.

Explanation

Note intracellular tangle of fibres with nucleus at one end. Typical of neurofibrillary tangles.

2. A 60 year old lady presents with fatigue and tiredness. On examination she looks pale. She is a vegetarian. She has decreased sensation in both legs and has mild coordination problems. Degeneration of areas 1 & 3 in the below line diagram of her spinal cord suggests deficiency of which of the following?

Vitamin A

Vitamin B1

Vitamin B2

Vitamin B6

Vitamin B12

Posterior and lateral column degeneration is seen in severe combined degeneration of the cord in severe B12 deficiency. (read about this condition).

Explanation

Posterior and lateral column degeneration is seen in severe combined degeneration of the cord in severe B12 deficiency. (read about this condition).

3. An 80 year old man dies of pneumonia in hospital. He has shown progressive memory loss over the past decade along with language deficits and loss of motor skills. Microscopic examination of his brain shows numerous neocortical neuritic plaques and neurofibrillary tangles. The core of each plaque stains positive with congo red. Which of the following mechanisms is responsible for this stain positivity?

Aggregatioon of a β peptide

Mutation in the tau gene

Dopamine deficiency

Change in the Prion protein

Mutation in HD gene

4. A 72 year old man presents with a recent onset of Parkinson's disease and rapidly progressive dementia. Of the following histological features, which is most likely to be found in his brain?

Neurofibrillary tangles

Lewy body

Amyloid deposits

Lacunar infarcts

Pick’s bodies

5. A 59 year old female patient dies following relapsing and progressive attacks of proximal limb weakness leading to total immobility and respiratory failure. The below image shows histopathological features of a biopsy taken from her Hippocampus, stained for myelin. What is the most likely diagnosis?

Pick's disease

Alzheimer's disease

Huntingtons disease

Multiple sclerosis

Parkinson's disease

Central area of demyelination with Perivascular inflammatory cells around capillary are typical of multiple sclerosis.

Explanation

Central area of demyelination with Perivascular inflammatory cells around capillary are typical of multiple sclerosis.

6. A 55 year old male presented with relapsing limb weakness progressive since 3 years. The below image shows an MRI scan of his head. What is the most significant pathological feature shown?

Multiple healed infarcts

Multiple demyelinating plaques

Secondary deposits

Subarachnoid haemorrhages

Multiple Amyloid plaques

Typical feature of multiple demylinating plaques in the periventricular region.

Explanation

Typical feature of multiple demylinating plaques in the periventricular region.

7. A 62 year old minister mentions that recently he is having trouble composing his sermons, which he used to be good at. There are no other neurological abnormalities. What is the most likely differential diagnosis?

Huntingtons disease

Pick's disease

Senile dementia

Alzheimer's disease

Parkinson's disease

Age, typical presentation of higher intellect without neurological abnormality.

Explanation

Age, typical presentation of higher intellect without neurological abnormality.

8. A 63 year old man complains of trouble swallowing and has hoarseness. On physical exam, he is noted to have ptosis and a constricted pupil on the left, and a diminished gag reflex. Neurological examination shows decreased pain and temperature sensation on the left side of his face and on the right side of his body. Of the following vessels, which is most likely to be occluded?

Anterior inferior cerebellar artery (AICA)

Anterior spinal artery

Middle cerebral artery (MCA)

Posterior cerebral artery (PCA)

Posterior inferior cerebellar artery (PICA)

9. The below image shows a brain specimen from an 84 year old male who presented with severe dementia. What is the most prominent pathological feature in the image?

Neurofibrillary tangles

Amyloid plaques

Haemorrhages

Dilated ventricles

Cerebral atrophy

Widened sulci and narrow gyri due to cerebral atrophy. Dilated ventricle is secondary to atrophy.

Explanation

Widened sulci and narrow gyri due to cerebral atrophy. Dilated ventricle is secondary to atrophy.

10. A 52 year old male patient presented with progressive aphasia and dementia. Despite treatment his conditioned worsened and he died secondary to lung infection. The below image shows histopathological feature in the hippocampus of his brain. What is the most prominent pathological feature?

A β amyloid plaques

Lymphocytes

Reactive gliosis

Pick bodies

Lewy bodies

Note uniform round inclusions within neurons, typical of Pick bodies in Picks disease.

Explanation

Note uniform round inclusions within neurons, typical of Pick bodies in Picks disease.

11. A 60 year old man is brought to the physician by his wife, as she has noticed changes in his personality over the past 18 months. From a pleasant, cheerful person he has become very irritable. A few months later he has become aphasic. He has no motor or sensory deficits, no tremors or gait disturbances. MRI shows marked temporal and frontal gyral atrophy. His frontal cortex shows extensive neuronal damage, some neurons showing intracytoplasmic faintly eosinophilic round inclusion bodies which stain positive for tau protein. What is the most likely diagnosis?

Alzeimer’s disease

Pick’s disease

Parkinson’s disease

Vascular dementia

Huntingtons disease

Although similar clinical features can be seen in Alzheimer, differentiating feature is the round eosinophilic inclusion bodies (pick bodies). Also early onset aphasia is more typical in Pick’s disease.

Explanation

Although similar clinical features can be seen in Alzheimer, differentiating feature is the round eosinophilic inclusion bodies (pick bodies). Also early onset aphasia is more typical in Pick’s disease.