Q4: A 20 year old single woman presents with an 8 month history of short lived
attacks of numbness in her right side of the body that resolved spontaneously
after few days. Each attack lasted for about 3 weeks. She denied any sphincteric
problems or back pain. She is on medications, no history of illicit drug abuse or
alcohol intake, and a negative family history of such a complaint. She stated that
she did not practice sex till now. Examination revealed bilateral grade 4 plus
pyramidal weakness and upgoing planters in both lower limbs, with prominent
disc pallor on right sided fundoscopy. Which one of the following investigations
is useless?
a. Brain MRI study with contrast.
b. Cervico-dorsal MRI with contrast.
c. CSF analysis.
d. Visual evoked potentials.
e. Nerve conduction study and EMG for the lower limbs.
Q5: A 6 year old boy brought by his parents because he can not cope with other
children while playing with them. His mother said that her son is becoming lazy
gradually over a period of 2 years, and his gait is strange like a duck.
Examination revealed proximal symmetrical non-tender weakness of grade 4
minus, intact ankle and knee reflexes and downgoing planters in his both lower
limbs with a waddling gait; but his calves appeared to be unusually full and
doughy.
What is the unreasonable step?
a. Measuring serum CPK level.
b. Doing muscle biopsy.
c. Ordering an ECG.
d. Doing an echocardiographic study.
e. Sending for a nerve conduction study.
Q6: A 68 year old man who was reasonably well and healthy presents with a 4
week history of inability to stand from his low chair and combing his hair. He
did admit to some difficulty in swallowing and his body aches as well. He is on
medications, nonsmoker and nonalcoholic. Examination revealed symmetrical
proximal tender weakness of grade 4 minus in the shoulder and pelvic girdles,
intact reflexes throughout and down going planters. No detectable skin rash.
What is your next step?
a. Brain CT scan with contrast.
b. MRI of the lumbosacral spine.
c. EMG.
d. Urea and electrolytes.
e. Anti- centromere antibodies.