chapter 35-36-37 Flashcards
Which of the following are potential risks of lumbar puncture’?
1. Downward herniation from the posterior fossa into the cervical spinal cord
2. Meningitis
3. Low pressure headache
4. Upward herniation from the posterior fossa to the cerebrum
Select: A = 1,2,3. B = 1, 3. C = 2. 4. D = 4 only. E = All
a
A 24-year-old man with AIDS presents with MR I. lesions which have the differential
diagnosis of toxoplasmosis or lymphoma. The neuroradiologist cannot be more specific
about the diagnosis. Which is the best approach to diagnosis and treatment?
A. Stereotactic brain biopsy
B. Open resection of one or more of the lesions
C. Empiric treatment of toxoplasmosis and rescanning to evaluate response
D. Empiric freatment of lymphoma and rescanning to evaluate response
c
An 85-year-old female presents with transient weakness of the right side associated with
expressive difficulty. The symptoms abate within an hour and she is back to baseline. She
has no prior history of TLA or CVA, but has severe COPD and end-stage cardiomyopathy.
Carotid duplex sonography suggests 80% stenosis of the left internal carotid artery. Which is
the best approach to subsequent evaluation and management ?
A. Cerebral arteriography with carotid erdarterectoniy if the lesion appears ulcerated or if
there is significant low-limiting stenosis
B. Cerebral arteriography with carotid stent placement if there is a significant ulcerated or
obstructive lesion
C. MRA and consideration of arteriography if the MRA shows significant stenosis
D. Antithrombotic therapy without other diagnostic studies
d
You are asked to evaluate a 10-year-old girl who had an EEG ordered by a child psychiatrist
which you interpreted. The EEG showed centrotemporal spikes. The child has a history of
learning difficulty but no symptoms which you believe to be seizures. Which is the most
appropriate clinical formulation?
A. The child has rolandic epilepsy, with unobserved nocturnal seizures. Drug treatment is
not needed unless she has daytime seizures.
B. The child has rolandic epilepsy, with unobserved nocturnal seizures. She should be
started on anticonvulsants.
C. The child has no clinical findings to suggest seizures, and anticonvulsants should not be
prescribed.
D. The child has no clinical findings to suggest seizures, but should be begun on
anticonvulsants because of the epileptiform discharges.
c
Antigliadin antibodies are typically ordered in order to diagnose which neurologic presentation? A. Peripheral neuropathy B. Motor neuron disease C. Ataxia D. Stiff man syndrome
c
Which of the following paraneoplastic antibodies has the strongest association with ovarian cancer? A. Anti-Yo(PCA-l) B. Anti-Tr (PCA-Tr) C. Anti-PCA-2 D. Anti-Hu
a
Anti-glutamic acid decaiboxyiase (GAD) antibodies are associated with which of the following disorders? A. Limbic encephalitis B. Cerebellar degeneration C. Motor neuron disease D. Stiff man syndrome
d
An increased CSF protein without a cellular response could be expected in which of the
following conditions.
A. Acute inflammatory demyelinative poly radi cu Ion europath y
B. Chronic inflammatory demyelinative polyradiculoneuropathy
C. Schwannoma
D. Spinal cord compression
E. All of these
e
You are asked to evaluate a 78-year-old man with progressive decline in memory and
cognition. The duration of the symptoms is less than three months. MRI shows ageappropriate
atrophy and some small vessel disease, but no other abnormalities. Laboratory
studies are normal. WTiich is the most appropriate formulation and plan?
A. The diagnosis is probably Alzheimer’s disease, and acetylcholinesterase inhibitor should
be started without further evaluation.
B. The diagnosis is unknown, but with the short duration of illness, brain biopsy is indicated.
C. The diagnosis is probably vasculitis, on the basis of the short duration of symptoms and
vascular changes on MRI, so cerebral angiography should be performed.
D. The diagnosis is uncertain, so additional studies including EEG and LP should be
performed.
d
Creatine kinase is elevated in patients with Duchenne muscular dystrophy. Which is the
correlation between CK levels and clinical course?
A. CK progressively increases with duration and severity of the disease
B. CK decreases with duration and severity of disease
C. CK has no correlation with disease progress and severity
D. CK levels are used to monitor medical treatment of DMD
b
Which of the following conditions can be associated with diffuse voltage attenuation of the EEG? A. Absence epilepsy B. Alzheimer's disease C. Anoxic encephalopathy D. Metabolic encephalopathy
c
The figure shows the EEG of a 9-year-old child with suspected seizures. Which is the most
likelv diagnosis?
A. Absence epilepsy
B. Juvenile myoclonic epilepsy
C. Complex partial epilepsy
D. Atypical absence seizures
Select: A = 1.2.3. B = 1.3 C=2,4. D = 4 only. E = All
a
The figure shows the EEG recording of a 65-year-oid woman with encephalopathy. No
other clinical infomiation is provided which of the following are possible diagnoses0
A. Herpes encephalitis
B. Cerebral infarctions
C. Anoxic damage
D. Meningitis
c
The figure shows the EEG of a man with progressive encephalopathy. He is presumed to
have hepatic encephalopathy on the basis of history and laboratory findings. Which is the
correct interpretation of the EEG?
A. Slow spike and wave discharge
B. Triphasic waves from the hepatic failure, without epileptiform significance
C. PLEDs from intercurrent CNS infection
D. Frequent eye blink artifact on an othervise slow background
a
You interpret the EEG of a patient who has failed to recover following cardiac arrest. The
patient has apparent myoclonic jerks. The tracing shown in the figure is obtained. The
patient is on no sedatives or anticonvulsants but is paralyzed, and shows no overt motor
activity in association with the episodic waves in the recording.
Which is the most appropriate interpretation of the record?
A. The record shows a periodic partem which is associated with post-anoxic myoclonus.
B. The record shews persistent status epilepticus which should be treated with
anticonvulsants.
C. The record shows a periodic pattern which is associated with a poorer pattern for
recovery than if the patient had alpha coma.
D. The record shows an isoelectric background with EGG artifact.
b
Which of the following are typical findings seen in the EEG of aging patients?
1. Focal sharp waves in the central region, pronounced in the sleep state
2. Higher theta and delta in the frontal and temporal regions.
3. Frontal intermittent rhythmic delta activity
4. Reduction in alpha amplitude and frequency
Select: A = 1. 2. 3. B =1,3. C = 2,4. D = 4 only E= All
b
The following questions concern patients with dementia. For each, select the most likely
diagnosis from the following list.
A. Alzheimer’s disease
B. Hydrocephalus
C. Creutzfeidt-Jakob disease
D. Vascular dementia
Normal EEG background with 8.5 Hz posterior dominant rhythm.
c
