multiple sclerosis

1 When considering a diagnosis of relapsing-remitting MS in a patient who presents with optic neuritis:

A What history would be very suggestive?

B Can a diagnosis be made after

a single clinical episode?

C What would be the recommended course of action?

D Why might an MRI scan and blood tests be arranged?

E Would you expect a lumbar puncture to be required in all cases for diagnosis?

F What would you advise the patient about life expectancy?

2 Your patient with diagnosed relapsing-remitting MS becomes pregnant.

A What do you advise her about the risks of relapse during pregnancy and the puerperium?

B She asks if her baby will develop the condition. What do you say?

3 Which of the following therapeutic measures are generally considered useful in relapsing-remitting MS?

A Steroids

True ■ False ■

B Vitamin B12

True ■ False ■

C Beta interferon

True ■ False ■

D Natalizumab

True ■ False ■

E Methotrexate

True ■ False ■

F Physiotherapy

True ■ False ■

4 A If the condition enters the progressive phase, which of the measures above remain useful?

B Spasticity may be a complication of MS. List two drugs that may be useful to control symptoms.

Parkinson's disease

5 List four conditions that may produce parkinsonian symptoms.

6 Which of the following clinical features would support a diagnosis of Parkinson's disease?

A Rest tremor present

True ■ False ■

B Negative response to large doses

of levodopa

True ■ False ■

C Excellent response to levodopa

True ■ False ■

D Unilateral onset

True ■ False ■

E A patient with a sustained remission

True ■ False ■

F Strictly unilateral features three years after onset

True ■ False ■

7 A If a patient presents and there is

a clinical suspicion of Parkinson's disease, should treatment normally

be started immediately?

B What action is advised?

C In a relatively young patient,

what group of drugs might be

used initially?

D What is the likely risk of associated depression in a patient with Parkinson's disease?

E As the patient ages, what is the likelihood of developing dementia?

PERIPHERAL NEUROPATHY

8 List the four main causes of peripheral neuropathies worldwide.

9 Which of the following statements about Guillain-Barré syndrome

are true?

A It may be fatal.

True ■ False ■

B It requires aggressive treatment

with steroids.

True ■ False ■

C Less than 10% of patients are left with residual disability.

True ■ False ■

D There is ascending sensory loss and weakness.

True ■ False ■

E It is preceded by an infectious episode in about half of cases.

True ■ False ■

10 Match the following signs to

the likely pathological condition

or feature.

A Postural hypotension

B Generalised areflexia and thickened nerves

C Romberg's sign

D Foot drop

E Facial nerve involvement

1 Distal weakness

2 Demyelination

3 Autonomic neuropathy

4 Sarcoidosis

5 Large fibre disturbance in the

spinal cord

genetic haemochromatosis

11 A Where is iron normally absorbed?

B What is the problem in genetic haemochromatosis?

C Why do women present later

than men?

D What is the inheritance of the condition?

E Which racial group is most at risk?

12 Which of the following are signs directly attributable to late stage genetic haemochromatosis?

A Enlarged spleen

True ■ False ■

B Slate grey skin

True ■ False ■

C Diabetes

True ■ False ■

D Liver disease

True ■ False ■

Drug misuse

13 Which of the following statements concerning drug abuse are true?

A 5% of the population have consumed opiates.

True ■ False ■

B 24% of 16- to 29-year-olds have consumed an illegal drug.

True ■ False ■

C Tobacco smoking offers a protective effect against drug abuse.

True ■ False ■

D Drop-out rates from therapy

are high.

True ■ False ■

14 Screening of urine can detect illicit drugs. Rank the following drugs according to which will be excreted over a longer period (quickest to slowest).

A Amphetamines and methamphetamines

B Cannabis (single use)

C Long-acting benzodiazepines

D Cocaine

E Heroin

lower limb problems

15 What non-pharmacological measure can be used to treat suppurative ulcers?

16 Match the characteristics listed with the appropriate type of

leg ulcer:

A Gaiter areas B Foot and toes

C More painful D Larger

E Irregular edge F Shallower

G Ooze blood when pressure applied H Greyish and unhealthy looking base

I Oedematous leg

J Treated with compression

Venous:

Arterial: