chapter 1-2-3

Question 1

Which of the following historical findings would argue against spinal cause for paraparesis? 
A.  Urinary incontinence 
B.  Headache 
C.  Sudden onset 
D.  Absence of back pain

Answer 1

B. HEadache

Question 2

Sarcoidosis may cause which of the following'? 
A.  Bell's palsy 
B.  Diabetes insipidus 
C.   Ophthalmoplegia 
D.  Peripheral neuropathy  
E.  All of the above

Answer 2

E. All of the above

Question 3

Occam’s razor, a basic logical precept, when applied to central nervous system localization,
states that multiple signs are more likely to be due to a single lesion than multiple lesions.
Which of the following disorders seem to contradict this when considering cerebral
localization?
A. ALS
B. Vasculitis
C. Cardiogenic emboli
D. Multiple sclerosis
E. None of these

Answer 3

E

Question 4

Questions 1-4 through 1-6 present isolated historical data. On the basis of this limited
information, select the most likely diagnosis for each from the following list.
A. Multiple sclerosis
B. Sarcoidosis
C. Peripheral neuropathy
D. ALS
E. Acoustic neuroma

Numbness and burning of the feet.

Answer 4

C

Question 5

Questions 1-4 through 1-6 present isolated historical data. On the basis of this limited
information, select the most likely diagnosis for each from the following list.
A. Multiple sclerosis
B. Sarcoidosis
C. Peripheral neuropathy
D. ALS

Multiple episodes of numbness or weakness or visual loss over years, with a duration of
days to weeks.
E. Acoustic neuroma

Answer 5

A

Question 6

Questions 1-4 through 1-6 present isolated historical data. On the basis of this limited
information, select the most likely diagnosis for each from the following list.
A. Multiple sclerosis
B. Sarcoidosis
C. Peripheral neuropathy
D. ALS
E. Acoustic neuroma

Weak on one side and unable to hear from one ear.

Answer 6

E

Question 7

The complaint of "blackout" refers to which elemental symptom?
A. Loss of vision
B. Confusion
C Loss of consciousness
D. Memory lapse
E. Any of the above

Answer 7

E

Question 8

Which is the least important aspect of the screening neurologic examination?
A. Visual fields
B. Tendon reflexes
C. Olfaction
D. Muscle strength
E. Sensation to pin prick

Answer 8

C

Question 9

Gastric bypass surgery can produce neurologic disturbance by virtue of which of the following disorders?
A. Vitamin B12 deficiency
B. Thiamine deficiency
C. Vitamin E deficiency
D. Riboflavin deficiency

Answer 9

A

Question 10

A simple faint is provoked by which of the following?
A. Prolonged standing
B. Emotional stress
C. Unpleasant visual stimuli
D. Pain
E. All of the above

Answer 10

E

Question 11

Which feature suggests that the cause for an episode of loss of consciousness was a
seizure rather than cardiac or vasovagal syncope?
A. Precipitation by emotional stress
B. Confusion upon awakening
C. Twitching of the arms during the blackout
D. Weakness upon awakening
E. All of the above

Answer 11

B

Question 12

For the following symptoms in each question, select whether the finding is most
suggestive of which cause of an episode of loss of consciousness.
A Cardiac arrhythmia
B. Vasodepressor syncope
C. Seizure
D. None of these

Provocation by emotional stress.

Answer 12

B

Question 13

For the following symptoms in each question, select whether the finding is most
suggestive of which cause of an episode of loss of consciousness.
A Cardiac arrhythmia
B. Vasodepressor syncope
C. Seizure
D. None of these

Palpitations or fluttering in the chest.

Answer 13

A

Question 14

For the following symptoms in each question, select whether the finding is most
suggestive of which cause of an episode of loss of consciousness.
A Cardiac arrhythmia
B. Vasodepressor syncope
C. Seizure
D. None of these

Patient with a blackout spell is found TO have a mild left hemiparesis.

Answer 14

C

Question 15

A 71-year-old man presents with episodes of loss of consciousness associated with brief
twitching during the unconsciousness. The syncope is recurrent and provoked by shaving,
especially during shaving of the neck.
Which is the most likely diagnosis?
A. Seizure
B. Paroxysmal supraventricular tachycardia
C. Carotid vascular disease
D. Reflex cardiac arrhythmia

Answer 15

D

Question 16

Which of the following can be causes of syncope?
1. Basilar migraine
2. Cervical osteoarthritis
3. Subclavian steal
4. Carotid occlusive disease
Select: A = 1, 2. 3. B = I, 3. C = 2,4. C = 4 only. E = All

Answer 16

E

Question 17

Which of the following statements are true regarding micturition syncope?
1. Most common in men
2. Exacerbated by ethanol use
3. Usually nocturnal
4. Associated with supraventricular tachycardia
Select: A= 1,2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

Answer 17

A

Question 18

A 24-year-old female presents with syncope preceded by lightheadedness she has loss of
consciousness without any motor activity. Which studies are indicated for evaluation?
1. CBC
2. ECG
3. Echocardiogram
4. EEC
Select A = 1, 2, 3. B = i, 3. C = 2, 4. D = 4 only. E = All

Answer 18

A

Question 19

The following questions present brief vignettes. For each, select the correct diagnosis
from the fallowing list.
A. Absence seizure
B. Complex partial seizure
C. Both
D. Neither

24-year-old man with episodes of loss of consciousness without loss of posture, followed
by several minutes of confusion.

Answer 19

B

Question 20

The following questions present brief vignettes. For each, select the correct diagnosis
from the fallowing list.
A. Absence seizure
B. Complex partial seizure
C. Both
D. Neither

16-year-old female with episodes of loss of responsiveness for a few seconds without loss
of posture. Normal function immediately following the episode.

Answer 20

A

Question 21

The following questions present brief vignettes. For each, select the correct diagnosis
from the fallowing list.
A. Absence seizure
B. Complex partial seizure
C. Both
D. Neither

Automatisms are present during the seizure.

Answer 21

C

Question 22

Which of the following features suggests pseudoseizure (nonepileptic seizure).
1. Occur solely or exclusively in sleep
2. Pelvic thrusting is common
3. Urinary incontinence is common
4. May be precipitated by photic stimulation or hyperventilation
Select A = 1, 2, 3. B =1, 3. C = 2, 4. D = 4 only. E = All

Answer 22

C

Question 23

Breath-holding spells are differentiated from seizures by which of the following features?
A. Breath-holding spells occur several times per day whereas seizures are usually
less common
B. Clonic activity is seen only with epilepsy and not with breath-holding spells
C. Breath-holding spells occur without provocation, whereas epilepsy is frequently
startle induced
D. Incontinence is only seen with epilepsy and not with breath-holding spells
E. All of the above

Answer 23

A

Question 24

Which of the following can cause episodic loss of consciousness?
A. Aqueductal stenosis
B. Colloid cyst of the third ventricle
C. Chiari malformation
D. Increased intracranial pressure
E. All of the above

Answer 24

E

Question 25

Which of the following conditions predisposes to episodic falls?
A. Common origin of both anterior cerebral arteries
B. Obstruction of third-ventricular outflow
C. Basilar artery thrombotic disease
D. Spinal cord damage
E. All of the above

Answer 25

E

Question 26

Patients with Parkinson's disease are more likely to fall Which of the following is not a
common contributing factor?
A. Peak-dose dyskinesia
B. Off periods
C. impaired postural reflexes
D. Convulsive motor activity

Answer 26

D

Question 27

Aging predisposes to fails by which of the following mechanisms?
1. Impaired proprioception
2. Arthritis
3. Impaired vision
4. Loss of muscle bulk
Select: A = 1, 2. 3. B = 1. 3. C = 2.4. D = 4 only. E = All

Answer 27

E

Question 28

Cataplexy is an uncommon cause of falls and is associate with narcolepsy. Which of the
following is not a cardinal feature of narcolepsy?
A. Excessive daytime sleepiness
B. Hypnagogic hallucinations
C. Poor nocturnal sleep
D. Sleep paralysis

Answer 28

C

Question 29

HOW can cataplexy be differentiated from epilepsy?
A. Epileptic syncope does not occur without other signs of convulsive activity
B. Cataplexy is provoked whereas epilepsy is typically not provoked
C. Consciousness is preserved in cataplexy but disturbed in patients with epilepsy
D. Arrhythmias are typical of cataplexy but not seizures

Answer 29

B

Question 30

The following questions present brief clinical information. For each, select the condition
which is most likely to be associated with the disorder.
A. Parkinson’s disease
B. Progressive supranuclear palsy
C. Both
D. Neither
Associated with rigidity.

Answer 30

C

Question 31

The following questions present brief clinical information. For each, select the condition
which is most likely to be associated with the disorder.
A. Parkinson’s disease
B. Progressive supranuclear palsy
C. Both
D. Neither
Greater tendency to fall backwards.

Answer 31

B

Question 32

The following questions present brief clinical information. For each, select the condition
which is most likely to be associated with the disorder.
A. Parkinson’s disease
B. Progressive supranuclear palsy
C. Both
D. Neither
Associated with spasticity.

Answer 32

B

Question 33

The following questions present brief clinical information. For each, select the condition
which is most likely to be associated with the disorder.
A. Parkinson’s disease
B. Progressive supranuclear palsy
C. Both
D. Neither
May be preceded by REM sleep behavior disorder.

Answer 33

B

Question 34

Which cf the following statements concerning vestibular causes of falls are true?
1. Patients with Meniere’s disease may, suddenly fall without accompanying vertigo
2. Aberrant sienals from vestibular receptors result in inappropriate postural adjustment
3. Patients with vertigo can have gait ataxia and falls without appendicular ataxia
4. Peripheral vestibulopathy is the most likely cause of cryptogenic falls in middle-aged women
Select: A = 1,2, 3. B = 1, ? C = 2,4. D = 4 only. E = All

Answer 34

A

Question 35

Anterior cerebral artery ischemia can produce drop attack, fails without disturbance of
consciousness.
T. True
F. False

Answer 35

T

Question 36

Orthostatic hypotension is rarely a cause of falls in the elderly.
T. True
F. False

Answer 36

T

Question 37

Drop attacks may be exacerbated by carbamazepine in patients with Rolandic epilepsy.
T. True
F. False

Answer 37

T

Question 38

A 70-year-old right-handed man with stroke resulting in left hemiparesis has two
episodes of falls which have an incomplete history, and neither of which were observed
by health-care workers. The list below includes possible reasons for the fall.
A. Recurrent TIA
B. Another CVA
C. Seizure secondary to the first CVA
D. Simple fail associated with poor coordination associated with the fail
E. Cardiac arrhythmia with decreased cerebral perfusion
The following additional pieces of clinical information would suggest which of the above
diagnoses for the patient’s falls?
Prolonged period of somnolence and confusion following the fall.

Answer 38

C

Question 39

A 70-year-old right-handed man with stroke resulting in left hemiparesis has two
episodes of falls which have an incomplete history, and neither of which were observed
by health-care workers. The list below includes possible reasons for the fall.
A. Recurrent TIA
B. Another CVA
C. Seizure secondary to the first CVA
D. Simple fail associated with poor coordination associated with the fail
E. Cardiac arrhythmia with decreased cerebral perfusion
The following additional pieces of clinical information would suggest which of the above
diagnoses for the patient’s falls?
Presyncopal sensation and diaphoresis preceding the fall, with no sequelae.

Answer 39

E

Question 40

A 70-year-old right-handed man with stroke resulting in left hemiparesis has two
episodes of falls which have an incomplete history, and neither of which were observed
by health-care workers. The list below includes possible reasons for the fall.
A. Recurrent TIA
B. Another CVA
C. Seizure secondary to the first CVA
D. Simple fail associated with poor coordination associated with the fail
E. Cardiac arrhythmia with decreased cerebral perfusion
The following additional pieces of clinical information would suggest which of the above
diagnoses for the patient’s falls?

Patient is noted to have a transient worsening of his left hemiparesis after one of the falls
and to be unable to speak after another of the falls.

Answer 40

A

Question 41

A 70-year-old right-handed man with stroke resulting in left hemiparesis has two
episodes of falls which have an incomplete history, and neither of which were observed
by health-care workers. The list below includes possible reasons for the fall.
A. Recurrent TIA
B. Another CVA
C. Seizure secondary to the first CVA
D. Simple fail associated with poor coordination associated with the fail
E. Cardiac arrhythmia with decreased cerebral perfusion
The following additional pieces of clinical information would suggest which of the above
diagnoses for the patient’s falls?

Patient falls twice at night on the way to the bathroom. There is no neurologic change and
the patient is able to walk when assisted to his feet.

Answer 41

D