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NEUROLOGY TEST > chapter 55-56 > Flashcards

chapter 55-56 Flashcards

1
Q

A 65-year-old man presents with left hemiparesis and sensory loss with incomplete hemianopia.
CT shows a small area of early edema in the right hemisphere with cortical and subcortical
involvement in the parietal area. ECG shows new atrial fibrillation Which is the most appropriate
approach to management of anticoagulation?
A. Immediate anticoagulation
B. Repeat scan the following day and consider anticoagulation if there is no hemorrhage or
the infarction is not large
C. Repeat the scan after one week and anticoagulate if there is no bleeding
D. Anticoagulate one month after the stroke, if he is neurologically stable or improving

A

b

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2
Q

A 54-year-old female is resuscitated following out-of-hospital cardiac arrest. She is comatose
initially, but arouses over several hours. She is starting to respond purposefully by the next day.
One week later, she loses the ground she has gained and slips back into decreased mentation,
cortical blindness, then unresponsiveness. Which is the most likely cause?
A. Acute cardioemboiic infarction
B. DIG with multiorgan failure
C. Late demyelinating encephalopathy
D. Aortic dissection as a late complication of resuscitation

A

c

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3
Q

Which of the following statements are true concerning cognitive disturbance in patients
following cardiac bypass surgery?
A. Cognitive disturbance is rare
B. Cognitive disturbance is related to hypotension or cerebral emboli
C. Cognitive disturbance recovers within one year from surgery
D. All are true

A

b

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4
Q

A 60-year-old man presents with tremor and ataxia. Imaging studies and routine laboratory tests
are normal. In eliciting the history, the patient reports taking metaclopramide, sertraline,
amiodarone, and propranolol. Which of ihese agents are likely to contribute to die clinical
presentation?
1. Propranolol
2. Amiodarone
3. Sertraline
4. Metoclopramide
Select: A - 1, 2, 3. B - i, 3. C - 2,4. D = 4 only. E = All

A

c

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5
Q

Which of the following statements are true regarding neurologic complications of systemic lupus
erythematosus?
1. Neurologic complications are present in more than 50% of patients
2. PNS involvement of SLE is more common than central involvement
3. The most common neurologic complications of SLE are psychiatric disorders
4. Stroke in patients with SLE is due to antiphospholipid antibodies
Select: A = 1,2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

b

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6
Q

A 56-year-old man presents with confusion and is found on examination to have uveitis and oral
and genital ulcers. Which is the most likely diagnosis?
A. Sarcoidosis
B. Scleroderma
C. Behcet’s disease
D. Lupus cerebritis
E. None of these

A

c

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7
Q 
Which is the most common neurologic complication of progressive systemic sclerosis
(scleroderma)?
A. Sensorimotor neuropathy
B. Meningitis
C. Encephalitis
D. Oculomotor palsy
A

a

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8
Q

A 58-year-old female with severe COPD is admitted to the ICU with respiratory
decompensation. She becomes septic and develops renal and hepatic failure. Encephalopathy
develops and becomes profound to the point of unresponsiveness. Which is the most likely
diagnosis?
A. Bacterial meningitis
B. Viral encephalitis
C. Diffuse encephalopathy as a component of the sepsis syndrome
D. Hepatic encephalopathy

A

c

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9
Q

A 36-year-old female presents with an episode of transient left eye visual loss. Evaluation is
normal except for positive anticardiolipin IgG antibody. Which is the implication of this finding?
A. The patient has SLE complicated by armphospholipid antibody syndrome
B. The anticardiolipin antibody predisposes to thrombotic disorders
C. The anticardiolipin antibody is an incidental finding and has no clinical implications in the
patient

A

b

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10
Q

A patient with bilateral facial palsy is found to have sarcoidosis on the basis of lung and muscle
involvement. Which of ihe following statements are true regarding management?
A. Corticosteroid administration is essential to improvement
B. Intravenous immunoglooulin is the most effective treatment
C. Radiation therapy is used for meningeal involvement
D. Neurologic symptoms may remit without treatment

A

d

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11
Q

An 8-year-old male presents with arthritis, rhinorrhea, persistent cough, fever, and malaise. His
neurologic findings are diagnosed as mononeuropathy multiplex. Which is the most likely
diagnosis?
A. Mixed connective tissue disease
B. Behcet’s disease
C. Wegener’s granulomatosis
D. Polyarteritis nodosa

A

c

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12
Q 
Which would be the most likely neurologic complication of cystic fibrosis?
A. Cranial neuropathies
P. Sleep apnea
C. Lethargy and confusion
D. Muscle spasms and contractures
A

c

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13
Q 
Hepatic encephalopathy can be expected to produce which of the following symptoms?
A. Tremor
B. Confusion
C. Anxiety
D. Personality change
E. All of these
A

e

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14
Q 
Which is the most likely presentation of hypothyroidism in the neonatal period?
A. Hypotonia
B. Arthrogryposis
C. Ocular motor palsy
D. No clinical findings
A

d

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15
Q 
Which are potential presentations ofsepto-optic dysplasia?
A. Normal neurologic function
B. Mental retardation
C. Spasticity
D. Seizures
E. Any of these
A

e

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16
Q 
Which is the most common neurologic complication of diabetes mellitus in children?
A. Stroke
B. Mononeuropathy multiplex
C. Peripheral polyneuropathy
D. Cranial neuropathy
A

c

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17
Q

A child undergoing intrathecal chemotherapy for leukemia with ara-C develops progressive
weakness with areflexia. There are no corticospinal tract signs. Acute polyneuropathy is
diagnosed. Which is the most likely cause?
A. Neoplastic meningitis
B. Ara-C toxicity
C. Guillain-Barre synarome
D. Transverse myelitis

A

b

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18
Q

A 14-year-old child sustains a head injury during a sporting practice. He loses consciousness
briefly, then is confused, but is normal by the time he is seen in lire emergency department. His
prior history is remarkable for hemophilia. Which would be the most appropriate management
approach?
A. CT performed in the ED prior to discharge
B. CT scheduled for the next working day
C. MRI scheduled for the next working day.
D. Discharged home with instructions on monitoring by family

A

a

19
Q

Sjogren’s syndrome can be seen as a complication of which of the following conditions?

  1. SLE
  2. JRA
  3. MCTD
  4. Derma to myositis
A

e

20
Q 
A 12-year-old child presents with headache, behavioral change, then seizures. Examination
shows rash, low weight, and hypertension. Which of the following tests confirms the diagnosis
of polyarteritis nodosa?
A. C-reactive protein
B. Low complement levels
C. Positive ANCA
D. Elevated ESR
E. None of these
A

e

21
Q

Question 56A-1:
Serial scans on a patient with severe head injury show increasing ventricular size and cortical
atrophy. Which is the interpretation of these findings?
A. Obstructive hydrocephalus
B. Communicating hydrocephalus
C. Progressive cerebral atrophy
D. None of these

A

c

22
Q

Which of the following correctly summarizes the adverse effects of repetitive head injury?
A. Repeated head injury increases the risk of degenerative dementia later in life
B. Repeated head injury has a greater effect on brain function than single injuries
C. Hypoxia or hypotension following a head injury can serve as a second injury
D. All of these are true

A

d

23
Q 
Shearing injuries are most common in which portion of the brain?
A. Fronto-polar cortex
B. Anterior temporal cortex
C. Deep white matter
D. Brainstem
A

c

24
Q

Patients with head injury who sustain subsequent hypoxia have a poorer prognosis. Which are
potential causes?
1. Increased cerebral edema
2. Second-injury effect
3. Cerebral hemorrhage
4. Hypothermia
Select: A = I, 2, 3. B = 1, 3. C = 2. 4. D = 4 only. E = All

A

a

25
Q

A patient with severe head injury is low unresponsive. Eye examination shows bilateral
midposition pupils. Light in the left eye produces constriction of both pupils. Light in the right
results in no response from either side. Which is the most likely lesion?
A. Right optic nerve
B. Left optic nerve
C Right oculomotor nerve
D. Left oculomotoi nerve
E. Brainstem

A

a

26
Q

A patient with head injury has ventilatory failure and intubation is to be performed. Which is the
most appropriate procedure?
A. Sedation and pharmacological paralysis
B. Sedation without paralysis
C. Paralysis without sedation
D. Neither

A

a

27
Q

The patient mentioned above is successfully intubated and placed on mechanical ventilation.
What is the role of hyperventilation?
A. Hyperventilation is performed routinely to reduce intracranialpressure
B. Hyperventilation is performed only if there is deterioration
C. Hyperventilation is never performed

A

b

28
Q

A patient is brought to the ED with severe head injury by the paramedics. There are no responses
and no roving gaze. You want to check doll’s maneuvers, but the paramedics have placed the
patient in cervical stabilization. There is no external evidence of cervical spine injury. Which is
the best approach?
A. Remove the stabilization and test oculocephalic maneuvers
B. Loosen the stabilization and move the neck only a few degrees to examine, then restore ihe
stabilization until radiographic clearance is obtained
C. Clear the cervical spine radiographically prior to removing the stabilization to examine
the patient

A

c

29
Q 
A patient seen in the emergency department for closed head injury has the following findings on
examination:
Alert and conversant Opens eyes spontaneously Follows commands Which is the correct
Glasgow Coma scale?
A. 0
B. 1
C. 2
D. 14
E. 15
A

e

30
Q

A 78-year-old man presents to the ED with severe closed head injury. He is unresponsive and
has no pupillary responses or oculocephalic reflexes. GCS is 3. CT shows large left frontal and
central intraparenchymal hematoma. How would you advise the family regarding possible
surgery?
A. Prognosis is ‘good with or without surgery
B. Prognosis is poor without surgery but can be good with immediate surgery
C. Prognosis for good recovery is very-poor with or without surgery

A

c

31
Q

The figure shows a CT s with closed head injury from a patient.
The figure shows a hemorrhage resulting from a closed head injury.
How would you assess the clinical presentation0
A. The appearance of the scan indicates a low probability of increased mass effect of the lesion
B. The small size of the hematoma places the patient at relatively low risk unless there is marked
increase in size of the lesion
C. Enlargement of the small hematoma can be associated with uncai herniation

A

c

32
Q

What is the role of ICP monitoring in management of patients with TBI?
A. Measurement of ICP allows for calculation of cerebral perfusion pressure
B. Increased ICP can indicate imminent neurologic deterioration so that intervention can be
performed
C. Measurement of ICP is not necessary in patients with normal CT and good functional status
D. All are true

A

d

33
Q 
Which type of hemorrhage is shown?
A. Subdural
B. Epidural
C. Subarachnoid
D. Intraparenchymal
A

d

34
Q 
Which is the most likely neurologic complication of cingulate gyrus herniation?
A. Anterior cerebral artery infarction
B. Basilar artery infarction
C. Uncal herniation
D. Transtentorial herniation
D. All are true
A

b

35
Q

A young man is in a high-speed MVA and has total paralysis below the C6 level. Imaging shows
cord contusion without transection. Four hours later, there still is no return of function. Which of
the following statements is true?
A. He is in spinal shock, so some improvement is expected
B. He is beyond the time of spinal shock so recovery is not exoected
C. He is l-evond the time when motor functions are returning from spinal shock, so the
prognosis for recovery is low

A

c

36
Q

A 74-year-old man with PD falls onto his face while walking. He presents with weakness of all
four limbs, but much more prominent in the arms. As reflexes return in the legs and become
brisk, they are persistently depressed in the arms. Which is the most likely diagnosis?
A. Central cord syndrome
B. Cervicomedullary syndrome
C. Decompensation of Chiari malformation with syrinx
D. Hematomyelia

A

a

37
Q 
The following disorders represent important syndromes affecting the spinal cord. For the
subsequent questions, select the best syndrome from the list.
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Cauda equina syndrome
D. Central cord syndrome
E. Cervicomedullary syndrome
F. Conus medullaris syndrome
G. Posterior cord syndrome

A patient presents following an MVA with flaccid leg weakness, loss of bowel and bladder
sphincter control, with some preservation of sensory function. Over the next few hours, ankle
reflexes return and are brisk.

A

no highlights

38
Q 
The following disorders represent important syndromes affecting the spinal cord. For the
subsequent questions, select the best syndrome from the list.
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Cauda equina syndrome
D. Central cord syndrome
E. Cervicomedullary syndrome
F. Conus medullaris syndrome
G. Posterior cord syndrome

A patient presents with leg weakness following MVA, with complete paralysis below
approximately T9. Sensory examination shows preservation of position sense and vibration in
the legs.

A

no highlights

39
Q 
The following disorders represent important syndromes affecting the spinal cord. For the
subsequent questions, select the best syndrome from the list.
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Cauda equina syndrome
D. Central cord syndrome
E. Cervicomedullary syndrome
F. Conus medullaris syndrome
G. Posterior cord syndrome

A man presents with GSW to the mid-cervical spine, and is found on examination to have leftsided
weakness below the level of the lesion, with ir>ss of pain anrl temperature sensation on the
right side of the body.

A

no highlights

40
Q 
The following disorders represent important syndromes affecting the spinal cord. For the
subsequent questions, select the best syndrome from the list.
A. Anterior cord syndrome
B. Brown-Sequard syndrome
C. Cauda equina syndrome
D. Central cord syndrome
E. Cervicomedullary syndrome
F. Conus medullaris syndrome
G. Posterior cord syndrome

A patient presents with MVA and flaccid paralysis in both legs. He has urinary retention.
Sensory examination shows anesthesia in a saddle-distribution.

A

no highlights

41
Q 
Which of the following types of peripheral nerves are most sensitive to traumatic injury?
A. Large-diameter myelinated axons
B. Small-diameter myelinated axons
C. Unmyelinated axons
D. There is no substantial difference
A

no highlights

42
Q 
Segmental demyelination of a peripheral nerve suggests which type of injury?
A. Compression
B. Penetrating injury
C. Ischemic damage
D. Toxic damage
A

no highlights

43
Q

An infant presents to you with Erb’s palsy with damage to the upper brachial plexus. How would
you advise the parents of the injury and prognosis ?
A. The damage is from stretch and damage to the myelin sheath, and prognosis is excellent
B. The damage is mainly to the axons from stretch and prognosis is variable and too soon
to predict
C. The damage is both axons and myelin sheath and prognosis for recovery is poor

A

b

44
Q

A geroin addict prersents with left median neuropathy secondfary to repeated injection into nthe
forearm. He never had an injection directly to the nerve as he can rememerber, but has had
gradual progressive loos of left median nerve function. Examination shows the proximal forearm
near the antecubital fossa to be fibrotic. Which is appropriate treatment ?
A. Analgesics
B. Corticosteriods
C. Surgical intervention in the forearm
D. Surgery at the carpal tunnel

A

c

NEUROLOGY TEST (21 decks)

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