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Diabetic Peripheral Neuropathy

Multiple Choice Questions in Neurology: A 50-year-old obese female patient presented in OPD with complaints of burning & tingling sensation in her feet for six months. She had off & on lower backache since six months. She had  medical history of dyslipidemia, hypertension and diabetes mellitus for the last five years. She was on Atorvastatin, Metoprolol, Losartan and Metformin. Examination of the patient revealed hyperesthesia and decreased vibration sense in the feet. Bilateral ankle jerks were absent. What could be the most probable diagnosis of this female? Diabetic PolyneuropathyLumbosacral RadiculopathyAtorvastatin Induced Muscle CrampsMetformin can cause lactic acidosis and leads to muscle pain and cramps Discussion: Burning & tingling sensations are paresthesias. Predominantly distal paresthesias are suggestive of peripheral neuropathy. She was suffering from Diabetes mellitus, which also favors the diagnosis of peripheral neuropathy. Though, she had off & on low…

Glasgow Coma Scale in Intubated Patients

Multiple Choice Questions in Neurology: A 60 year old male patient, known case of Diabetes mellitus and chronic hypertension, presented with sudden onset of right sided hemiparesis and altered mental status. The patient was aspirated and gasping in the emergency room. He was immediately intubated and put on ventilatory support in an intensive care ward. While the patient was on ventilator, doctor examined the patient. He was able to localize painful stimulus from left side of hand. He was able to open eyes on painful stimulus, but unable to open eyes on voice command. What was the Glasgow Coma Scale (GCS) of that patient? 681012Recommendations: Glasgow Coma Scale is very frequently asked topic in neurology entrance examination question paper. This topic should be included in your neurology question bank. Glasgow Coma Scale (GCS) in Tracheostomized or Intubated Patients Glasgow Coma Scale is a neurological scale to assess the level of consciousness of the patient. It is developed by Gr…

Pediatric Migraine Headache

High Yield Facts ⭆1. About fifty percent of the pediatric migraine patients continue to have migraine headache in adulthood. 2. Like adult migraine, Topiramate and Amitriptyline can be used as pharmacological prophylactic therapy in Pediatric Migraine. 3. Childhood onset migraine is a primary headache disorder. 4. Worldwide prevalence of Pediatric Migraine headache is around 7% to 8%. 5. About 30% of migraine patients, first start headache in childhood. 6. Before puberty, incidence of migraine headache is equal in male and female.
Pediatric Migraine HeadacheQuestion True about Pediatric Migraine Headache, except:
Pediatric migraine has no risk of developing adulthood migraine.Like adult migraine, Topiramate and Amitriptyline can be used as pharmacological prophylactic therapy in pediatric migrainePediatric migraine headache is a primary headacheWorldwide prevalence of pediatric migraine headache is around 7% to 8%References:Al-Twaijri, Waleed A., and Michael I. Shevell. "Pediatric m…

Acetylcholine Receptors

High Yield Facts ⭆ Acetylcholine released in postsynaptic cleft and binds to α-subunit of acetylcholine receptor. When acetylcholine bind a nicotinic AchR, a conformational change occurs in the receptor, resulting in the formation of an ion pore. The opening of a ion pore produces a rapid increase in the cellular permeability of sodium and calcium ions, resulting in the depolarisation and excitation of the muscle cell. It activate the sodium channel and depolarizes the nerve fibers. Direction of transmission of nerve impulse from postsynaptic junction to nerve fibers.Question Which of the following ion channel opens, when acetylcholine (ACh) binds to acetylcholine receptor (AChR) at postsynaptic junction?Potassium (K)Chloride (Cl)Calcium (Ca)Sodium (Na)Acetylcholine Receptors Two types of Acetylcholine Receptor:
Muscarinic Type: G-Protein Coupled Receptor. Slow metabolic response through intracellular secondary messenger system involving an increase of intracellular calcium to transmi…

Neuromuscular Junction

High Yield Facts ⭆ Synaptic transmission at the neuromuscular junction begins when an action potential reaches the presynaptic terminal of a motor neuron, which activates voltage dependent calcium channels to allow calcium ions to enter the neuron. Calcium ions bind to synaptic vesicles, triggering vesicle fusion with the cell membrane and subsequent neurotransmitter release from the motor neuron into the synaptic cleft. Motor neurons release acetylcholine (ACh) neurotransmitter, which diffuses across the synaptic cleft and binds to nicotinic acetylcholine ionotropic receptors (nAChRs) on the cell membrane of the muscle fiber. The binding of ACh to the receptor can depolarize the muscle fiber, results in muscle contraction.
Normally, Acetylcholine (ACh) binds to α-subunit of Acetylcholine Receptor (AChR) at postsynaptic junction. Which ion is responsible for transmission of impulse from postsynaptic junction to nerve fibers?Chloride (Cl)Calcium (Ca)Sodium (Na)Magnesium (Mg)Neuromuscula…

Blood Supply of Spinal Cord

How many spinal arteries supply the human spinal cord?Three ArteriesFour ArteriesFive ArteriesTwo ArteriesBlood Supply of Spinal CordArterial Supply The spinal cord is supplied by Three Longitudinal Arteries: One Anterior Spinal Artery supplies the anterior two-thirds of the spinal cord.Two Posterior Spinal Arteries supply the posterior one-third of the spinal cord.[Mnemonics: Posterior is Paired, Posterior = Paired] Venous Drainage There is a complex network of intrinsic, extrinsic, and extradural systems. The anterior and posterior spinal veins and anterior and posterior radicular veins are freely communicate with the internal vertebral plexus in the epidural space. This drains into the cerebral dural venous sinuses and cerebral veins as well as the external vertebral plexus. The veins of the spinal cord and vertebral column are valveless.
Reference: Bosmia AN, Hogan E, Loukas M, Tubbs RS, Cohen‐Gadol AA. Blood supply to the human spinal cord: part I. Anatomy and hemodynamics. Clinical…

Which of the following is a Histone Deacetylase Inhibitor?

Question: Which of the following is a Histone Deacetylase Inhibitor?PhenytoinSodium ValproateCarbamazepineLevetiracetam  Histone Deacetylase Inhibitor Histone deacetylase-9 (HDAC9) gene is associated with pathogenesis of large artery ischemic stroke. HDAC9 inhibitor may prevent ischemic stroke. Sodium Valproate is a nonspecific Histone Deacetylase Inhibitor. Sodium Valproate therapy given after ischemic stroke may be associated with reduced recurrent stroke rate. Reference: Brookes RL, Crichton S, Wolfe CD, Yi Q, Li L, Hankey GJ, Rothwell PM, Markus HS. Sodium Valproate, a Histone Deacetylase Inhibitor, Is Associated With Reduced Stroke Risk After Previous Ischemic Stroke or Transient Ischemic Attack. Stroke. 2018 Jan;49(1):54-61. [Answer is 2. Sodium Valproate]