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1. Guillain-Barré Syndrome Prognosis Q1. A 12-year-old girl presents with rapidly progressive dysarthria, dysphagia, and ascending weakness following a sore throat. What is the most accurate prognostic statement? A. Mortality is 50% in most cases B. Full recovery is rare in Guillain-Barré syndrome C. Most patients recover fully with supportive care D. EMG findings do not affect prognosis Correct Answer: C. Most patients recover fully with supportive care Rationale: About 85% of patients with Guillain-Barré syndrome (GBS) achieve full recovery within a year. However, severe or axonal EMG patterns indicate worse prognosis. Mortality is generally 5% with good supportive care, especially ventilatory support when needed. 2. Cluster Headache Treatment Q2. A 45-year-old man presents with severe unilateral retro-orbital stabbing headache with lacrimation, rhinorrhea, and miosis. What is the most appropriate acute treatment? A. Ibuprofen B. Sumatriptan C. Amitriptyline D. Propranolol Correct Answer: B. Sumatriptan Rationale: This is a classic cluster headache. Acute (abortive) therapy includes high-flow oxygen and triptans (e.g., sumatriptan), which rapidly abort attacks by causing vasoconstriction via 5-HT1 receptor agonism. 3. Heat Stroke vs Heat Disorders Q3. A patient on chlorpromazine develops hyperthermia (41°C), confusion, seizures, and organ dysfunction after heat exposure. What is the diagnosis? A. Heat cramps B. Heat exhaustion C. Heat stroke D. Neuroleptic malignant syndrome Correct Answer: C. Heat stroke Rationale: Heat stroke presents with severe hyperthermia and CNS dysfunction (confusion, seizures). Neuroleptics impair thermoregulation, increasing risk. NMS is unrelated to environmental heat exposure and has rigidity as a hallmark. 4. Wilson Disease Q4. A teenager with hepatitis, neurologic symptoms, low ceruloplasmin, and Kayser-Fleischer rings most likely has? A. Krabbe disease B. Lesch-Nyhan syndrome C. Wilson disease D. Marfan syndrome Correct Answer: C. Wilson disease Rationale: Wilson disease is an autosomal recessive disorder of copper metabolism (ATP7B mutation), leading to copper accumulation in liver, brain, and cornea (Kayser-Fleischer rings). 5. Complex Regional Pain Syndrome Q5. A woman develops severe burning pain and allodynia after a healed fracture with immobilization. Best treatment? A. Heparin B. Gabapentin C. Methadone D. Probenecid Correct Answer: B. Gabapentin Rationale: CRPS is treated with physical therapy and neuropathic pain agents. Gabapentin is effective for neuropathic pain. Opioids are not first-line; heparin and probenecid are unrelated. 6. Bell’s Palsy Treatment Q6. A patient with acute facial paralysis after influenza should be treated with: A. Ibuprofen alone B. Prednisone alone C. Acyclovir alone D. Prednisone + acyclovir Correct Answer: D. Prednisone + acyclovir Rationale: Bell’s palsy is commonly linked to HSV reactivation. Combined corticosteroid + antiviral therapy within 72 hours improves recovery more than either alone. 7. Meningitis Diagnosis in Infant Q7. A febrile infant with seizures and bulging fontanelle is suspected of having meningitis. Most important diagnostic test? A. CBC B. Urinalysis C. Serum glucose D. CSF analysis Correct Answer: D. CSF analysis Rationale: CSF examination via lumbar puncture is the gold standard for diagnosing meningitis. Blood tests support but do not confirm diagnosis. 8. Restless Legs Syndrome Q8. A patient with leg discomfort at rest and sleep disturbance most likely has? A. Peripheral neuropathy B. DVT C. Restless legs syndrome D. Alcoholic neuropathy Correct Answer: C. Restless legs syndrome Rationale: RLS is characterized by unpleasant sensations in legs at rest with an urge to move, worse at night, and relieved by movement. 9. Cluster Headache Pathophysiology Q9. Cluster headaches are caused by: A. IgE-mediated histamine release B. Brain tumor growth C. Stress-induced muscle tension D. Trigeminal autonomic activation causing vasodilation Correct Answer: D. Trigeminal autonomic activation causing vasodilation Rationale: Cluster headaches involve trigeminal nerve activation and parasympathetic overactivity leading to cranial vasodilation and autonomic symptoms (lacrimation, rhinorrhea). 10. Amaurosis Fugax Q10. A patient with transient monocular vision loss (“curtain falling”) is most likely to have abnormal: A. EEG B. ESR C. Carotid ultrasound D. CT brain Correct Answer: C. Carotid ultrasound Rationale: Amaurosis fugax is caused by emboli from carotid artery stenosis. Carotid ultrasound is the best diagnostic test. 11. Fuel-Oil Use in Buildings Q11. Fuel-oil in buildings is primarily used for what purpose? A. Cooling systems only B. Lighting systems C. Emergency generators and heating equipment D. Water purification systems Correct Answer: C. Emergency generators and heating equipment Rationale: Fuel-oil is mainly used in stationary equipment such as emergency generators and building heating systems. 12. P-98 Certificate Role Q12. What is required to supervise fuel-oil transfer in a building? A. FDNY firefighter certification B. DOB construction license C. P-98 Certificate of Fitness D. EPA certification Correct Answer: C. P-98 Certificate of Fitness Rationale: The P-98 COF is required for supervision of fuel-oil storage, transfer, and piping systems in buildings. 13. Weekly Inspection Requirement Q13. Fuel-oil storage tanks and piping must be inspected how often for leaks? A. Daily B. Weekly C. Monthly D. Annually Correct Answer: B. Weekly Rationale: Weekly inspections are required to detect leaks and ensure system safety. 14. Vacuum Gauge Function Q14. What does a vacuum gauge in an oil system measure? A. Oil temperature B. Pressure above atmospheric pressure C. Pressure below atmospheric pressure D. Flow rate of combustion gases Correct Answer: C. Pressure below atmospheric pressure Rationale: A vacuum gauge detects suction pressure issues and helps identify blockages in the system. 15. Excessive Vacuum Reading Indicates Q15. Excessive vacuum readings in an oil system usually indicate: A. Excess fuel flow B. Obstruction in suction line C. Burner overheating D. Electrical failure Correct Answer: B. Obstruction in suction line Rationale: A high vacuum suggests a blockage such as a dirty strainer or restricted oil flow.