Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine--->Inflammatory and Demyelinating
Page: 1

Question 1#Print Question

A 21-year-old male presents to the emergency department with a history of fevers to 100.4°F, headache, nausea, and vomiting for the last 48 hours. He has a history of tonic-clonic seizures for which he takes phenytoin. He has recently started taking ibuprofen for his headaches. He has no allergies. He has not had his flu shot this year, and no one else is unwell in his family. On examination, he is lying down in a dark room and requests for you to avoid turning on the light. He is somnolent but has no focal weakness. He is unable to flex his neck without discomfort.

The emergency room physician had empirically started ceftriaxone and vancomycin and performed a lumbar puncture with the following results:

CSF = cerebrospinal fluid

What is the MOST LIKELY cause of his symptoms?

a. Bacterial meningitis
b. Recent seizure
c. Herpes simplex virus meningitis
d. Ibuprofen

Question 2#Print Question

A 41-year-old African American female presents with progressive left-sided upper and lower facial muscle weakness and headaches over the last 3 months. She reports polyuria and polydipsia with >10 L of urine output per day. Lumbar puncture reveals clear cerebrospinal fluid (CSF) with WBC count 22 cells/mm3 , protein 280 mg/dL, and glucose 25 mg/dL. The gram stain and culture were negative. A slice of her MRI brain imaging showing leptomeningeal enhancement (arrows) is shown in figure below:

Which test would be MOST LIKELY to assist with the diagnosis of her condition?

a. Tensilon test
b. Chest computed tomography
c. Synacthen test
d. 24-hour urinary electrolytes

Question 3#Print Question

A homeless 35-year-old alcoholic male with a body mass index of 18 kg/m2 is admitted for seizures, encephalopathy, and dysarthria. On presentation, he had a serum sodium of 108 mmol/L, potassium 2.4 mmol/L, chloride 98 mmol/L, alanine aminotransferase 356 IU/L, aspartate aminotransferase 450 IU/L, and gamma-glutamyl transpeptidase 1200 IU/L. He was started on lactulose, thiamine replacement, and saline infusions. CT scan of brain was unremarkable. He recovered within 36 hours, coincident with a sodium correction to 130 mmol/L. The patient then deteriorated on day 6 to a catatonic state with flaccid paralysis of all extremities.

Which of the following MOST LIKELY caused his deterioration?

a. Administration of thiamine before glucose
b. Nonconvulsive status epilepticus
c. Aggressive nutritional support and elevated phosphate
d. Saline infusion

Question 4#Print Question

A 22-year-old Scandinavian female presents with acute symptoms of vision loss, headaches, fatigue, and leg weakness. She reports that her mother has a history of multiple sclerosis (MS). MRI demonstrates inflammatory lesions of the same age found in multiple areas. Despite various treatment modalities, the patient progressed to death 6 months later. 

Which of the following MS variant diseases is MOST likely?

a. Balo concentric sclerosis
b. Marburg variant
c. Schilder disease
d. Devic disease

Question 5#Print Question

A 5-year-old male presents with irritability, ataxia, headaches, and progressive somnolence. His mother reports fevers after receiving his vaccinations for measles, mumps, and rubella, 3 weeks ago. The pediatrician is highly concerned for acute disseminated encephalomyelitis (ADEM). The mother believes that the recent vaccinations are the cause of the child’s symptoms.

Which of the following statements is LEAST true?

a. The disease is typically monophasic
b. Recovery can occur in 50% to 75% of cases
c. Vaccines have been linked to ADEM
d. First-line therapy is plasmapheresis

Category: Critical Care Medicine--->Inflammatory and Demyelinating
Page: 1 of 1