CHAPTER 10- Nervous System

Question 1

A 76-year-old patient arrives at the office with his wife with complaints of episodes of slurred speech, word-finding difficulties, and numbness in his arm. The first priority in management is:

1. Tell him to take an aspirin right away.
2. Order a CT scan.
3. Send him to the ER.
4. Perform an EKG.

Answer 1

3. Send him to the ER.

An aspirin is incorrect if you are concerned of stroke and you are not sure if it is hemorrhagic or ischemic in origin. A CT is reasonable, but should be done emergently upon admission to the ER. An EKG would be applicable for chest pain or hospital admission.

Question 2

Which one of these patients are most at risk for ischemic stroke?

1. A patient with atrial fibrillation on Coumadin with INR of 1.2
2. A patient with 2ppd tobacco history of 40 years who quit 5 years ago
3. A patient on anticoagulation therapy with INR of 4.0
4. A hypertensive patient currently being treated with Losartan

Answer 2

1. A patient with atrial fibrillation on Coumadin with INR of 1.2

The patient who is out of his therapeutic window and at risk for a thromboembolic event (INR range 2–3). Smokers who quit are at greater risk than non-smokers, but at 5 years their risk drops to half that of smokers.

Question 3

Initial urgent treatment for dizziness is associated with which of the following?

1. Tinnitus
2. Diabetes
3. Nausea and vomiting
4. Dysphasia

Answer 3

4. Dysphasia

This is the only correct answer because it could be associated with stroke or TIA. The others are all non-urgent symptoms or associations.

Question 4

Which of the following situations is NOT considered a “Red Flag” for referral for a patient the FNP is seeing in his/her practice?

1. A patient who presents with an abnormal perception of movement (sensation of spinning)
2. A patient with peripheral nerve compression
3. A patient with no response to treatment or improvement from standard therapy
4. Acute or sudden onset of symptoms—change in LOC, visual change

Answer 4

1. A patient who presents with an abnormal perception of movement (sensation of spinning)

All of the answers are red flags for referral except vertigo.

Question 5

What is the first symptom seen in the majority of Parkinson’s patients?

1. Intention tremor
2. Bradykinesia
3. Rest tremor
4. Rigidity

Answer 5

3. Rest tremor

Asymmetric tremor at rest is usually seen in one hand as a presenting symptom for PD. Intention tremor is also known as essential tremor and presents symmetrically in a different population. The other symptoms are seen later in the disease.

Question 6

A 73-year-old female patient presents with limb paralysis nystagmus, vertigo, nausea, slurred speech, and cerebellar ataxia. An occlusion of which part of the brain is suspected?

1. Occipital and temporal lobes, dorsal surface of thalamus, upper part of cerebellum, midbrain
2. Anterior cerebral surfaces
3. Posterior cerebral surfaces
4. Parts of the medulla

Answer 6

1. Occipital and temporal lobes, dorsal surface of thalamus, upper part of cerebellum, midbrain

The most common areas of occlusion are the ICA or MCA. The midbrain, upper part of the cerebellum and dorsal surface of the thalamus receive blood from the basilar artery, which also supplies the temporal and occipital lobes. Thus, the patient exhibits symptoms in the regions of the brain that have been affected with slurred speech, cerebellar ataxia, nausea and vertigo, and limb paralysis, nystagmus. The posterior cerebral surface would result in bilateral motor sensory, visual complaints, and contralateral hemiplegia. Answer D would result in pain, temperature, and sensation impairment, as well as vertigo and dysphagia—in a contralateral fashion.

Question 7

Dysarthria, dysphagia, and diplophia are signs of which of the following?

1. Peripheral vertigo
2. Central vertigo
3. Presyncopal causes of vertigo
4. Psychogenic causes of vertigo

Answer 7

2. Central vertigo

These are all signs of stroke, therefore they are not consistent with Peripheral vertigo, Presyncopal causes of vertigo, or Psychogenic causes of vertigo.

Question 8

What diagnostic maneuver reproduces the characteristics of vertigo?

1. Epley maneuver
2. Dix–Hallpike maneuver
3. Lying prone on the exam table
4. VNG (video nystagnography)

Answer 8

2. Dix–Hallpike maneuver

The Epley maneuver is the repositioning maneuver used to treat BPPV, while the Dix–Hallpike will elicit nystagmus and vertigo.

Question 9

A patient presents with dizziness, delayed clockwise rotational clockwise nystagmus, and spinning for less than a minute after position change and denial of hearing loss and headache. The appropriate diagnostic evaluation to use would be what?

1. MRI
2. CT with contrast
3. No studies are necessary.
4. EKG

Answer 9

3. No studies are necessary.

Vertigo without neurologic deficits requires no imaging. It is a clinical diagnosis.

Question 10

An 82-year-old patient presents with a history of TIA and confusion. A sensitive neurologic test for stroke would be what?

1. The pronator drift
2. Epley maneuver
3. Visual field exam
4. Get-up-and-go test

Answer 10

1. The pronator drift

The pronator drift will show upper motor neuron weakness if the patients arm drifts, as well as confusion if they are unable to follow instructions. The Epley maneuver is done for vertigo. Visual fields should be assessed as part of a neuro exam, and the get-up-and-go test is a timed mobility test for the elderly.

Question 11

The CHA2DS2–VASc Index is used for categorizing patients according to risk. These risk factors include all of the following EXCEPT:

1. Diabetes.
2. Stroke/TIA.
3. Age 65–74.
4. Drugs.

Answer 11

4. Drugs.

All of the answers are variables used to assess the risk to start anticoagulation except for drugs. Additional variables include sex, vascular disease, LVEF, thromboembolism, PAD, CHF.

Question 12

A patient with multiple sclerosis presents with concerns of exacerbation. The nurse practitioner knows the examination will likely present with the following:

1. Tremor at rest
2. Hyperreflexia + Babiniski, upper motor neuron signs, ataxic gait
3. Hyporeflexia, decreased reflexes, hypotonia, sensory disturbance
4. Sensory deficit that follows a single dermatomal distribution

Answer 12

2. Hyperreflexia + Babiniski, upper motor neuron signs, ataxic gait

Would be a Parkinson’s patient, Hyporeflexia, decreased reflexes, hypotonia, sensory disturbance is incorrect. Sensory deficit does not follow single dermatomal distributions.

Question 13

A child presents with febrile seizures. Which statement offers the BEST information for the education of the family by the NP?

1. These types usually present as absence or simple partial seizures.
2. The child will usually need anticonvulsant therapy for 6 months.
3. There is a higher risk of developing epilepsy later in life (greater than the general population).
4. Most occur on the first day of fever; > 75% > 102 degrees.

Answer 13

4. Most occur on the first day of fever; > 75% > 102 degrees.

Febrile seizures occur with fever > 100, 75% > 102, and in the absence of an identifiable cause. They do not require treatment and usually occur on the first day the fever does. They are typically generalized, less than 15 minutes in duration, and may have tonic clinic activity. The risk for developing epilepsy later in life is slightly increased from that of the general population (1%).

Question 14

Ménière’s disease is an idiopathic disorder that is characterized by which of the following?

1. Episodic attacks of vertigo lasting less than a minute and hearing loss
2. Dizziness, double vision, hearing loss, tinnitus, vertigo
3. Episodic attacks of vertigo, tinnitus, aural fullness, and hearing loss
4. Disabling attacks of vertigo, diplopia, hearing loss, tinnitus, and aural fullness

Answer 14

3. Episodic attacks of vertigo, tinnitus, aural fullness, and hearing loss

By definition, Ménière’s has the classic symptoms of vertigo tinnitus and hearing loss accompanied by aural fullness. The condition can be chronic or can resolve. There is an extensive differential for dizziness and double vision, including stroke; MS is not associated with Ménière’s.

Question 15

A primary headache differs from a secondary headache in what way?

1. A primary headache is the first headache of someone’s life.
2. A secondary headache presents with an aura.
3. A secondary headache is a result of abnormal anatomic pathology.
4. A primary headache is due to systemic disease.

Answer 15

3. A secondary headache is a result of abnormal anatomic pathology.

It is also due to systemic disease. A migraine presents with an aura 20% of the time.

Question 16

First-line treatment for essential tremor is which of the following?

1. Propranolol (Inderal)
2. Alprazalam (Xanax)
3. Amitryptylline (Elavil)
4. Alcohol

Answer 16

1. Propranolol (Inderal)

Though many patients will self-medicate with alcohol, and it will suppress the symptoms, beta-blockers are the first-line treatment.

Question 17

A 62-year-old woman complains of severe lancinating pain in her right cheek that worsens with cold drinks or teeth brushing. She is afraid to chew or eat because it seems to initiate the attack. The most likely diagnosis is which of the following?

1. Sinus infection
2. Abscessed tooth
3. Trigeminal neuralgia
4. Bell’s palsy

Answer 17

3. Trigeminal neuralgia

Classic symptoms of trigeminal neuralgia is shock-like severe lancinating unilateral pain in the sensory distribution of the trigeminal nerve (CN V), often initiated by cold, chewing, or a sensory stimulus. The etiology is often unknown. Bell’s palsy does not present this way or with the same distribution.

Question 18

What test for carpal tunnel syndrome reports a positive finding for tingling after passive flexion of the wrist for 1 minute?

1. Tinel’s sign
2. C-T-S test
3. Radial test
4. Phalen’s Sign

Answer 18

4. Phalen’s Sign

Phalen’s sign—numbness and tingling in the median nerve distribution of the fingers.

Question 19

A 35-year-old male c/o (complaints of) the abrupt onset of recurrent “ice pick” headaches behind one eye. He presents to the NP’s office with an acute episode. On physical exam, the patient is noted to have tearing in one eye, ptosis, and nasal discharge/congestion. The NP’s plan for therapeutic management would be which of the following?

1. High-dose NSAIDs
2. High-dose oxygen 7–10 L
3. Send to the ER for CT scan
4. Verapamil

Answer 19

2. High-dose oxygen 7–10 L

This patient meets the classic presentation for cluster headache. He does not need to go to the ER, especially with a “recurrent” history. The presentation of a Horner’s-like syndrome is normal. He will respond to high-dose oxygen for acute treatment. Verapamil should also be titrated or adjusted for prevention.

Question 20

A 72-year-old patient presents with c/o headache with unilateral marked scalp tenderness. You note induration of the temporal artery. Upon checking his labs, the FNP expect to find which of the following?

1. Normal CRP
2. ESR 100 mm or >
3. WBC >15,000
4. Positive western blot

Answer 20

2. ESR 100 mm or >

The ESR would be elevated with a diagnosis of temporal arteritis, which is what this patient most likely has. The CRP should be elevated. The other findings are not consistent with the condition.

Question 21

When the FNP administers the Mini-mental status exam (MMSE) and asks what is the difference between a river and a lake? He/she is actually measuring which of the following?

1. Education level
2. Memory
3. Abstract thinking
4. Plasticity

Answer 21

3. Abstract thinking

Asking about similarities and differences is abstract thinking. Memory testing would be day, date, month, season etc. The test does not take into account the educational level or measure plasticity.

Question 22

A 22-year-old patient with no cardiovascular history presents with a history of a unilateral headache accompanied by nausea, vomiting, photophobia, or phonobia. What further diagnostics are required to establish the diagnosis?

1. CT
2. MRI
3. No further laboratory investigation is needed
4. CBC with differential

Answer 22

3. No further laboratory investigation is needed

The diagnosis is established on the basis of clinical findings. If there are clinical features that may suggest an alternative diagnosis, then additional laboratory investigations are necessary. If appropriate therapy is initiated and there is a lack of response, than an alternate diagnosis would also be considered.

Question 23

Which of the following medications is the best choice for acute treatment of the patient who presents with unilateral headache accompanied by nausea, vomiting, photophobia or phonophobia?

1. Triptans
2. Beta-blockers
3. NSAIDs
4. Narcotics

Answer 23

1. Triptans

Beta-blockers are preventative therapy. NSAIDs may be used for tension headache or episodic headache. Narcotics are not first-line. Triptans are first-line therapy for a patient without cardiovascular history.

Question 24

Which CN is responsible for shoulder shrugging?

1. CN X
2. CN XI
3. CN IX
4. CN XII

Answer 24

2. CN XI

The vagus nerve is 10, the hypopharyngeal nerve is 9, and hypoglossal is 12; the nerve responsible for the shoulder shrug is CN 11.

Question 25

Which CNs are being tested with EOM?

1. A CN III, IV, VI
2. CN III, IV, V
3. CN II, III, IV
4. CN II, IV, V

Answer 25

1. A CN III, IV, VI

CN 3—oculomotor medial deviation and all other directions, 4-trochlear (innervates superior oblique and downward gaze), 6 abducens (innervates lateral recturs and lateral gaze). Extraocular range of motion. CN V is the trigeminal nerve.

Question 26

The next patient to be seen by the FNP is a 16-year-old old high school soccer player who suffered a Gr 1 concussion. The best advice at this time would be which of the following?

1. Pupillary checks every hour, monitor vital signs
2. You may return to play as soon as your symptoms have resolved
3. Physical rest × 2 weeks, no contact sports with medical follow-up
4. Physical and cognitive rest monitored by medical personnel. Monitor for emotional symptoms, headaches difficulty remembering, feeling foggy, trouble concentrating

Answer 26

2. You may return to play as soon as your symptoms have resolved

It needs to be monitored by medical personnel; some athletes will be inappropriately anxious to return to sport.

Question 27

The classic presentation of carpal tunnel syndrome includes repetitive use and gradual onset of tingling (paresthesias) in which fingers?

1. Thumb, index, and middle finger
2. Index, middle, and fifth finger
3. All the fingers of the hand
4. Thumb

Answer 27

1. Thumb, index, and middle finger

Median nerve compression results in thumb, index finger, and middle finger symptoms.

Question 28

During the neurologic exam, a patient has had a positive Romberg test. This highlights an issue in what part of the neurologic system?

1. The sensory system and balance
2. Mental status
3. The motor system
4. The reflex system

Answer 28

1. The sensory system and balance

The Romberg test helps assess proprioception—sensory and balance.

Question 29

Which statement below best describes a positive Romberg test?

1. The patient is unable to walk in a straight line with one foot in front of the other.
2. The patient holds arms straight forward with eyes closed.
3. The patient stands with feet together, eyes closed, arms at side with excessive swaying—begins to fall down and keeps feet far apart to maintain balance.
4. Patient places outstretched arms with palms facing up and closed eyes. One arm goes downward after 5–10 seconds.

Answer 29

3. The patient stands with feet together, eyes closed, arms at side with excessive swaying—begins to fall down and keeps feet far apart to maintain balance.

Tandem gait test. The exam where the patient holds arms straight forward with their eyes closed is a negative test. The exam where the patient places their outstretched arms with palms facing up and closed eyes is a motor exam for pronator drift.

Question 30

Serious causes of headache that require immediate urgent referral include which of the following?

1. Migraine
2. Hypertension
3. Cervical spondylosis
4. TIA

Answer 30

4. TIA

A careful history and physical would delineate the cause. Migraine can be diagnosed clinically and does not need further workup. Hypertension can be serious if not controlled, but is not usually the reason for immediate urgent referral. Patients with hypertensive crisis would require an urgent referral.

Question 31

An 18-year-old male college student is being evaluated by the FNP at the student health center. He has had a fever > 102 F for approximately 24 hours and c/o severe headache. During the examination, the patient is directed to lay in a supine position and passively bend his neck toward his chest; he flexes his knees and hips. What is the name of this maneuver?

1. Brudzinski
2. Kernig
3. Cullens
4. Lachman

Answer 31

1. Brudzinski

The Lachman test is a test for integrity of the ACL. Kernig’s sign is also a test for meningeal irritation: In the supine position, with the hip flexed at 90 degrees, resistance or discomfort is felt in the back and posterior thigh with passive knee extension. Cullen’s sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus, following rupture of ectopic or intraperitoneal hemorrhage.

Question 32

Which of the following factors is NOT contributory toward the development of Bell’s palsy?

1. Pregnancy
2. Diabetes
3. Lyme disease
4. Heart disease

Answer 32

4. Heart disease

All but heart disease are contributory. Between 7–9% of patients have recurrence.

Question 33

Bell’s palsy presents as acute weakness or paralysis of the muscles supplied by which cranial nerve(s)?

1. VI
2. V
3. VII
4. VII and VIII

Answer 33

3. VII

The facial nerve is CN VII. It is the only one affected.

Question 34

A 32-year-old patient with migraines and a history of asthma is complaining of two migraine headaches per week despite treatment with triptans. The next consideration for treatment is which of the following?

1. Discontinue triptans and offer NSAIDs.
2. Start topiramate as preventative therapy.
3. Start propranolol or timolol as preventative therapy.
4. Order an MRI.

Answer 34

2. Start topiramate as preventative therapy.

The patient is a candidate for prophylaxis because she is having two or more migraines per week, and may be heading toward medication overuse. She should not use a beta-blocker with asthma; topiramate or another option should be considered. An MRI is not necessary because there is no acute change, neurologic deficits, or red flags.

Question 35

A new patient explains that she has a history of migraines with aura. Counseling should include which of the following?

1. Headaches that occur as a result of aura may last much longer and be more serious than those without.
2. There is controversy over the use of oral contraceptives and she may want to consider another form of contraception.
3. A visual scotoma (circumscribed vision loss) is caused by cerebral ischemia in the middle or posterior cerebral artery.
4. The aura can be a jabbing “ice pick” feeling in the head or over one eye that lasts seconds.

Answer 35

2. There is controversy over the use of oral contraceptives and she may want to consider another form of contraception.

Migraine with aura may be an independent risk factor for stroke in women < 45. Headaches following an aura do not have to last longer or be worse than those without, and the aura is not due to ischemia. The last answer describes cluster symptoms.

Question 36

An 80-year-old patient was admitted to the hospital with confusion this week. Her daughter tells the hospitalist her memory may be slipping a bit, but she was oriented and independent last week, driving herself to the market. Upon admission to the hospital, she is found to have pneumonia. Currently, she is difficult to arouse and has incoherent speech. Last night, she was up all night and seemed to know her daughter but was confused regarding place and time. Her CT was normal. The most appropriate diagnosis of consideration at this time is which of the following?

1. Dementia
2. Parkinson’s disease
3. Stroke
4. Delirium

Answer 36

4. Delirium

This meets the criteria of the acute mental disturbance characterized by confusion, impaired thinking, and cognition and attention deficit with a fluctuating course.

Question 37

A 70-year-old patient has c/o of gradual memory loss without neurologic deficits. The best method of evaluation at this time would be which of the following?

1. Administering a MMSE
2. CT of the brain
3. Neuropsychological testing
4. Meeting with the family to obtain a history

Answer 37

1. Administering a MMSE

The Mini-Mental Status Exam is a screening tool that would give you a baseline. Neuropsychological testing would be beneficial depending on the findings. Meeting with the family is always important to obtain a thorough history and for verification. The FNP would not want to do that first; only after issues were identified.

Question 38

A family member of an 85-year-old Alzheimer’s patient wants to know what the risk factors are for getting the disease? Which of the following statements would be the best response?

1. “If we can scan your brain and offer you treatment, we can prevent the disease from progressing.”
2. “They have not found an association with vascular disease, diabetes, or hypertension.”
3. “There is some genetic risk, but advancing age is the biggest risk factor.”
4. “More men than women get the disease; there is a protective effect with estrogen.”

Answer 38

3. “There is some genetic risk, but advancing age is the biggest risk factor.”

There is no preventive treatment at this time. The medications are only for once the disease is diagnosed. There is an association with vascular disease, diabetes, and hypertension. Advancing age is the biggest risk factor, with prevalence doubling every 5 years after 65. More women than men have AD.

Question 39

Which of the following medications should be considered as first-line therapy for patients with mild to moderate Alzheimer’s disease?

1. Anticholinergics
2. Ace inhibitors
3. Cholinesterase inhibitors
4. Antidepressants

Answer 39

3. Cholinesterase inhibitors

The only drugs approved for use for mild–moderate AD are the anticholinesterase inhibitors.

Question 40

A patient presents with decreased arm swing and cogwheel rigidity. What conditions are these a manifestation of?

1. Multiple sclerosis
2. Vascular dementia
3. Parkinson’s disease
4. Rheumatoid arthritis

Answer 40

3. Parkinson’s disease

Patients with Parkinson’s disease may demonstrate decreased arm swing, and cogwheel rigidity in upper limbs as a result of increased tone. Upon exam, there is resistance and a ratchetlike rhythmic contraction of the muscle as the practitioner moves the limb through the range of motion (elbow, wrist).

Question 41

A 28-year-old female presents with weakness, complaints of fatigue, recent problems with diplopia, numbness of her left arm, and some bladder changes. She remembers something similar happening last year. What would be in the differential?

1. Migraine with aura
2. Multiple sclerosis
3. Meningitis
4. Pituitary tumor

Answer 41

2. Multiple sclerosis

Multiple sclerosis presents with varying deficits at different times due to the multifocal demyelination and inflammation. Common symptoms include gait ataxia, visual loss, diplopia, paresthesias, weakness, and fatigue.

Question 42

A 22-year-old college student presents with an acute onset of high fever, chills, nausea, slight confusion, and is noted to have a headache and petechiae. The exam reveals a + Kernig’s sign. The most appropriate next step in management would be which of the following?

1. Tell him this looks viral, offer NSAIDs around the clock, check a throat culture to verify, and have the patient come back in 24–48 hours if he’s not feeling better.
2. Perform throat culture; treat empirically since he lives in a college dorm.
3. Check for mono—Send off EBV/Mono spot, throat culture, treat empirically.
4. Send him to the ER for an LP and further evaluation.

Answer 42

4. Send him to the ER for an LP and further evaluation.

This patient matches all the features of meningitis; sudden onset fever chills, systemic illness, neck stiffness in a previously healthy young adult in group living puts him at high risk. Concerning features are the change in mental status and meningeal irritation.

Question 43

What recommendation should the NP offer to a high school soccer player who has suffered a mild concussion?

1. “You may return to play in 1 week.”
2. “You may not return to play until resolution of all of your symptoms during both exercise and rest.”
3. “You may return to play after resolution of your symptoms and a follow-up CT scan.”
4. “Since you did not suffer loss of consciousness (LOC), you may return to play.”

Answer 43

2. “You may not return to play until resolution of all of your symptoms during both exercise and rest.”

Loss of consciousness is not a reliable indicator for dysfunction or recovery. CT imaging is only used LOC with more serious TBI, rule out subarachnoid hemorrhage, post-traumatic amnesia, focal neurologic deficits, skull fracture, or an alteration in mental status that persists. For athletes, there is no set time period: There should be no return to play until there is complete resolution of all symptoms at exercise and rest.

Question 44

Patients who have experienced concussive events are at risk for developing which of the following?

1. Headache
2. Dizziness
3. Processing disturbance
4. All of these

Answer 44

4. All of these

Post-concussive syndrome can develop (headache, dizziness, concentration/processing disturbance) after concussion, as well as other long-term permanent impairment for repetitive concussions.

Question 45

Which type of dementia has a step-wise progression in memory loss, may present with an abnormal neuro exam or gait, and is often seen with multiple infarcted areas of the brain?

1. Metabolic encephalopathy
2. Alzheimer’s dementia
3. Lewy body dementia
4. Vascular dementia

Answer 45

4. Vascular dementia

Vascular Dementia is a STEPWISE progression of decrease in cognition with memory loss occurring later than AD. It often presents with an abnormal neuro exam, exaggerated DTR, weakness. AD is a gradual decline with a normal exam. There can be mixed dementia. A is treatable, and C is in same category with AD: degenerative type with fluctuating cognition.

Question 46

A patient presents with complaints of moderate headache pain that is bilateral, does not increase with activity level, but is aggravated by stress. It seems to come and go at times, but can last from one hour to sometimes all day. This is likely which of the following?

1. Migraine headache
2. Potential brain tumor
3. Tension headache
4. Cluster headache

Answer 46

3. Tension headache

Episodic tension headache is the most common, bilateral type headache and can last anywhere from 30 min to 2 days. The pain can be mild to moderate.

Question 47

A 60-year-old man with TIA and atrial fibrillation is currently being treated with Apixaban, one of the new oral anticoagulants. What is an important teaching point for this patient today?

1. He must watch the vitamin K in his diet because it can interfere with the medication.
2. He must continue to have his INR monitored, although it is less frequent than with warfarin.
3. There is a bleeding risk; discuss sign and symptoms of bleeding, bruising (GI, etc.).
4. This drug has a very long half-life, so you can take it any time you want during the day.

Answer 47

3. There is a bleeding risk; discuss sign and symptoms of bleeding, bruising (GI, etc.).

The new anticoagulant (Eliquis) apixaban blocks the blood-clotting factor Xa. It has a lower bleeding risk than warfarin, but it does remain. It does not require frequent bloodwork. It is taken twice daily and has a 12-hour half-life.

Question 48

Modifiable risk factors for stroke include which of the following?

1. Male
2. Age > 60
3. Socioeconomic status
4. Obstructive sleep apnea, alcohol consumption, obesity

Answer 48

4. Obstructive sleep apnea, alcohol consumption, obesity

The others are non-modifiable risk factors.

Question 49

A patient presents with morning headaches that has been increasing over time, papilledema, and vomiting. What is the prioritized diagnosis?

1. Meningitis
2. Migraine
3. Brain tumor
4. Stroke

Answer 49

3. Brain tumor

The classic triad of dull morning headache, papilledema, and vomiting are signs of increased intracranial pressure. Stroke would likely present with other neurologic deficits, but would also be ruled out with further evaluation. The other two do not fit the presentation.

Question 50

First-line therapy for a patient with trigeminal neuralgia is which of the following?

1. Prednisone 1/kg/d × 7 days without taper
2. Carbamazepine
3. Valtrex and prednisone
4. Amitryptilline

Answer 50

2. Carbamazepine

Carbamazepine initially 100 mg/d, gradually titrated up to 400–800 mg/d.