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298 Neurosciences 2010; Vol.

15 (4)
?
Multiple
Choice
Questions
Section
Te Neuroscience Journal introduces this new section on multiple choice
questions as part of its commitment to continuous education and learning
in Neurosciences. Experts in various neuroscience specialties are invited to
participate with their knowledge and expertise in this section.
Neurology, neurosurgery, and other board residents are encouraged to read
this section to improve their knowledge and direct their reading for written
examinations.
General Neurology
Sadaga Alawi, MD.
From the Division of Neurology, Department of Clinical Neurosciences, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia.
E-mail: sadagaalawi@hotmail.com
Choose the most appropriate single answer.
1. Dementia with Lewy bodies is characterized by the following
a. early visual hallucinations
b. sensitivity to neuroleptics
c. lack of response to levodopa
d. marked uctuation of mental status
e. all true
2. In patients with brain metastases, the most frequent sites of primary tumor are
a. gastrointestinal tract tumors
b. gynecological tumors
c. the lung and the breast
d. renal cell carcinoma
e. the prostate
3. All are true regarding Kluver-Bucy syndrome EXCEPT
a. it results from bilateral temporal lesions involving the amygdala nuclei
b. clinical features include hypermetamorphosis, visual agnosia, and blunted emotional aect
c. aggression is a component of the syndrome
d. hypersexuality and hyperorality are components of the syndrome
e. none of the above
4. A unilateral P100 abnormality indicates all of the following lesions EXCEPT
a. unilateral demyelinating process
b. tumor of the occipital lobe
c. optic nerve glioma
d. glaucoma
e. optic nerve compression in one eye
5. All the following statements about neurologic manifestations of Lyme disease are true EXCEPT
a. Most patients have a history of erythema chronicum migrans (ECM)
b. Facial weakness is an early occurrence (within 2 months of the appearance of the lesion)
c. Most patients have a history of arthritis
d. Te second most common cranial neuropathy is of the VIIIth nerve
e. Nerve conduction studies are usually normal in Lyme neuropathy
299 Neurosciences 2010; Vol. 15 (4)
Answers:
1. e
Te combination of early visual hallucinations, markedly uctuating mental status, sensitivity to neuroleptics, and lack
of response to levodopa are characteristic of dementia and Lewy bodies.
1,2
2. c
In patients with brain metastases, the most frequent sites of primary tumor are the lung, skin (melanoma), the breast.
Te next most frequent are gynecological and gastrointestinal tract tumors.
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3. c
Kluver-Bucy syndrome results from bilateral temporal lesions involving the amygdala nuclei. Clinical features include
hypermetamorphosis, hyperorality, hypersexuality, visual agnosia, and blunted emotional eect. Aggression is a not a
component of the syndrome.
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4. b
A unilateral P100 abnormality indicates a lesion of the anterior visual pathway such as unilateral demyelinating process,
optic nerve glioma, glaucoma, or optic nerve compression in one eye. A tumor of the occipital lobe would cause a
bilateral abnormality or little or no eect on this P100.
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5. e
Te spectrum of neurologic disorders reported with Lyme disease is large and the clinical course is not yet fully
understood. Diagnosis is not always clear cut, as most, but not all patients have a history of ECM and arthritis. Te
history of a tick bite is more dicult to ascertain because the tick vector is the size of the period at the end of this
sentence. Facial and VIIIth nerve lesions occur early, often within a month of ECM. Polyneuropathy is a common
long-term problem, with abnormalities evident on electrophysiologic studies. Improvement in symptoms parallels
improvement in electrical studies.
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References

1. Ala TA, Yang KH, Sung JH, Frey WH 2nd. Hallucinations and signs of parkinsonism help distinguish patients with dementia
and cortical Lewy bodies from patients with Alzheimers disease at presentation: a clinicopathological study. J Neurol Neurosurg
Psychiatry 1997; 62: 16-21.
2. McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, et al. Consensus guidelines for the clinical and
pathologic diagnosis of dementia with Lewy bodies (DLB): report of the consortium on DLB international workshop. Neurology
1996; 47: 1113-1124. Review.
3. Bradley WG, Daro RB, Fenichel GM, Marsden CD, editors. Neurology in Clinical Practice. Boston (MA): Butterworth-
Heinemann; 1996.
4. Mendez MF. Pick Disease. In: Feinberg TE, Farah MJ, editors. Behavioral Neurology and Neuropsychology. New York (NY):
McGraw-Hill Co.; 1997.
5. Chiappa KH. Evoked Potentials in Clinical Medicine. New York (NY): Raven Press; 1990.
6. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med 1990; 323: 1438-
1444.
General Neurology