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NEUROLOGY TEST > chapter 58-59 > Flashcards

chapter 58-59 Flashcards

1
Q 
Cellular phone use has been shown to produce an increased incidence of which of the following
types of brain tumor?
A. Acoustic neuroma
B. Astrocytoma
C. Meningioma
D. None of these
A

d

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2
Q

Which of the following statements regarding the epidemiology of malignant brain tumors is
NOT correct?
A. The incidence has not substantially increased within the past 10 years
B. Maximal incidence is in the young-adult population
C. Whites have a higher incidence than blacks
D. Males have a higher incidence than Females

A

b

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3
Q

Which is the major cause of the increase in incidence of primary CNS Lymphoma?
A. AIDS
B. Cancer chemotherapy
C. Decrease in death from vascular disease
D. Increased detection by use of MRI

A

no highlight

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4
Q 
Patients who were treated for tinea capitis with radiation as children have increased incidence of
which types of brain tumors?
A. Malignant gliomas
B. Meningiomas
C. Nerve sheath tumors
D. All of these
E. None of these
A

d

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5
Q

Question 58B-1:
Which of the following tumors can produce immunoreactivity for GFAP?
1. Medulloblastoma
2. Oligodendroglioma
3. Gangliogliomas
4. Astrocytoma
Select: A = 1,2,3. B = 1,3.C = 2,4. D = 4 only. E - All

A

oligodendroglioma

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6
Q 
Which is the most common primary brain tumor in adults?
A. Astrocytoma
B. Anaplastic astrocytoma
C. Glioblastoma
D. PNET
A

c

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7
Q

A. Anaplastic Astrocytoma
B. Astrocytoma
C. Glioblastoma
D. Meningioma

A

d

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8
Q

A patient being evaluated for headache has an MRI ordered. This shows normal brain except for
midline lipoma. There is no real mass effect. Which is the best clinical approach to evaluation
and management?
A. Clinical follow-up without surgery
B. Stereotactic biopsy
C Surgical removal and patnologic analysis
D. Stereotactic radiosurgery

A

a

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9
Q

A patient with metastatic tumor to the brain has focal seizures with secondary generalization.
She requires an antiepileptic drug, but there is concern over hepatic induction and drug
interactions with planned chemotherapy. Which agents would be least likely to produce altered
hepatic metabolism?
1. Carbamazepine
2. Levetiracetam
3. Phenytoin
4. Gabapentin
Select: A = 1,2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

c

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10
Q 
What effect would surgical resection be expected to have on the control of seizures in the patient
described above?
A. Improved control
B. No change
C. Worsened control
A

a

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11
Q 
Which is the most important agent for management of cerebral edema in patients with brain
tumors?
A. Corticosteroids
B. Glycerol
C. Hyperventilation
D. Mannitol
A

a

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12
Q

Which of the following features characterize headache due to brain tumor?
A. Increased frequency and/or severity.
B. Morning headache with improvement in the afternoon and evening.
C. Exacerbation of the headache by cough, sneeze, or straining.
D. Headache does not respond to tripians
Select: A - 1. 2, 3. B = 1, 3. C = 2, 4. D - 4 only. E = All

A

a

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13
Q

The image shows the sagittal MRI of a patient with lower thoracic back pain and leg weakness.
Which is the most likely diagnosis?
A. Epidural spinal cord compression from primary neural tumor
B. Epidural spinal cord compression from metastasis
C. Intradural tumor, most likely meningioma
D. Intramedullary tumor, most likely glioma

A

b

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14
Q

The image shows the MRI of a patient with complex partial seizures of recent onset. The images
are Tl-weighted without and with contrast administration.
Which is the most likely diagnosis?
A.Astrocytoma
B. Anaplastic astrocytoma
C. Glioblastoma
D. Metastatic tumor

A

c

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15
Q 
The image shows the enhanced Tl MR1 of a patient with seizures.
Which is the most likely diagnosis?
A. Low-grade glioma
B. Malignant glioma
C. Metastatic tumor
D. Mesial temporal sclerosis
A

a

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16
Q 
The images are of a child who presents with ataxia, nausea, and vomiting.
What is the most likely diagnosis?
A. Brainstem glioma
B. Cerebellar astrocytoma
C. Medulloblastoma
D. Metastatic tumor
A

c

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17
Q

Chemotherapy is used for which of the following tumor types?
1. Glioblastoma
2. Lymphoma
3. Anaplastic oligodendrogliomas
4. Meningioma
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

glioblastoma

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18
Q

A patient with malignant glioma has biopsy then stereotactic radiosurgery of a lesion which is in
an unresectable location. Two years later, the patient has recurrent mass effect on the scan and
the diagnostic considerations are recurrent tumor or radiation necrosis. Which is the best
approach to evaluation and management?
A. Lumbar puncture
B. PET
C. Repeat MRI in one month
D. Stereotactic biopsy

A

b

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19
Q

Many forms of chemotherapy for malignant gliomas do not get across the blood brain barrier
well. Therefore, methods are needed to improve delivery of chemotherapy to the tumor. Which
are viable alternatives?
1. Chemotherapy in biodegradable polymers
2. Osmotic agents to open the blood brain barrier prior to chemotherapy
3, Intrathecal administration of chemotherapy
4. High dose chemotherapy with stem cell rescue
Select: A = 1.2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

a

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20
Q 
Which is the most important therapy for improving life span in patients with malignant
astrocytomas?
A. Chemotherapy
B. Corticosteroids
C. Radiation therapy
D. Recurrent surgery
A

c

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21
Q 
Which treatments are typically needed for patients with juvenile pilocytic astrocytoma?
A.Chemotherapy
B. Radiation therapy
C. Surgery
D. All of these
A

c

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22
Q

A 17-year-old male presents with headache, nausea, and vomiting which are episodic and
sometimes positional. MRI shows a lesion in the third ventricle with some mottled enhancement.
Which is the most likely diagnosis?
A. Colloid cyst
B. Dermoid
C. Epidermoid
D. PNET

A

a

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23
Q 
The image shows sagittal MRI of a young girl who presents with short stature, bitemporal visual
field loss, and headache.
Which is the most likely diagnosis?
A. Colloid cyst
B. Craniopharingioma
C. Ependymoma
D. Epidermoid cyst
A

b

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24
Q

A pineal-region tumor is identified in a child and stereotactic biopsy shows germinoma. What
would be appropriate treatment for the tumor?
A. Radiation
B. Conventional surgery
C. Chemotherapy
D. Stereotactic radiosurgery
Select: A = 1, 2, 3. B - 1, 3. C = 2, 4. D = 4 only. E = All

A

radiatioon and chemotherapy

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25
Q

A patient with non small cell lung cancer is found to have three cerebral metastases. There have
been no seizures. Which is the appropriate approach to use of AEDs?
A AEDs only if seizures develop
B. Prophylactic AEDs from time of diagnosis
C. Prophylactic AEDs if the metastases fail to improve with treatment

A

a

26
Q

A woman with breast cancer is found to have a single enhancing lesion in the right frontal
region. It has the typical appearance on MRI of metastasis. There is no other known active
disease. Which is the best approach to further evaluation and management?
A. Chemotherapy
B. Stereotactic biopsy before making a decision on treatment
C. Stereotactic radiosurgery
D. Surgical resection

A

d

27
Q

A patient with breast cancer presents with back pain There are no pyramidal tract signs and no
weakness. MRI shows metastasis to the T9 vertebral body, but there is no cord compression.
What would be appropriate treatment?
A. Intrathecal chemotherapy
B. Radiation therapy to the lesion
C. Radiation therapy to the whole neuraxis
D. Surgical removal and replacement of the vertebral bodv

A

b

28
Q

A woman with a history of breast cancer presents with headache, nausea, and mild confusion.
She finished chemotherapy for her initial diagnosis approximately 6 months ago, and her
laboratory’ studies have been normal except for chronic reduction in white blood cell count. MRI
of the brain is normal. CSF shows Lymphocytic pleocytosis, elevation in protein, reduction in
glucose, negative cultures, smears, CIE, and cytology. Which is the most likely diagnosis?
A. Cryptococcal meningitis
B. HSV encephalitis
C. Neoplastic meningitis
D. Tuberculous meningitis

A

c

29
Q

Which of the following are paraneoplastic syndromes?
1. Encephalomyelitis
2. Motor neuron degeneration
3. Opsoclonus-myoclonus syndrome
4. Stiff-man syndrome
Select: A = 1,2,3. B = 1,3. C = 2, 4. D= 1 only. E = All

A

e

30
Q

Which of the following treatments can be helpful for patients with limbic encephalitis?
l) Steroids
2) IVIg
3) Treatment of the tumor
4) Acyclovir
Select: A = 1, 2, 3. B = 1, 3. C = 2,4. D = 4 only. E = All

A

a

31
Q

Which of the following is appropriate treatment for Lambert-Eaton myasthenic syndrome? ~ “
1. Diaminopyridine
2. Plasma exchange
3. IVIg
4. Pyridostigmine and guanidine
Select: A = 1. 2. 3. B = 1.3 C - 2, 4. u = 4 only. E = All

A

IVIG

32
Q

A 50-year-old female with a history of ovarian cancer is found to have proximal weakness and
through EMG and biopsy, the diagnosis of polymyositis is made. She is 2 years from her
diagnosis and there is no sign of disease. What is the relationship between the polymyositis and
her cancer?
A. PM indicates recurrent ovarian cancer
B. PM indicates development of a second malignancy, probably Hodgkin’s disease
C. PM is a paraneoplastic effect of ovarian cancer even in the absence of demonstrable disease
D. No relationship

Select: A = 1. 2. 3. B = 1.3 C - 2, 4. u = 4 only. E = All

A

d

33
Q

A 60-year-old man is seen in the ED because of high fever, headache, confusion, diffuse
weakness which may be more prominent on the right, and elevated WBC. Which is the most
appropriate sequence of events for evaluation and treatment?
A. LP - blood cultures - antibiotics -CT
B. Blood cultures - antibiotics –CT- LP
C. CT - LP - blood cultures -antibiotics

A

b

34
Q

Which antibiotic regimen would be most appropriate for the patient discussed above?
A. Ampicillin alone
B. Cephalosporin alone
C. Cephalosporin + vancomycin
D. Cephalosporin + vancomycin + ampicillin

A

d

35
Q 
A patient presents with headache and fever, and mild left hemiparesis. Initial laboratory studies
are normal except for only mildly elevated WBC The image shows the enhanced Tl-weighted
images of the brain MRI
Which is the most likely diagnosis?
A. Bacterial abscess
B. Cysticercosis
C. Multiple metastases
D. Toxoplasmosis
A

a

36
Q

The image shows the sagittal lumbar spine MRI of a patient with prominent lower back pain.
Which of the following are seen in this image?
A. Discitis
B. Osteomyelitis
C. Spinal epidural abscess
D. All of these

A

d

37
Q 
A 36-year-old male presents with fever, headache, and confusion and develops focal seizures.
Which is the most likely diagnosis?
A. Brain abscess
B. Herpes encephalitis
C. HIV encephalitis
D. West Nile encephalitis
A

b

38
Q

In the patient described above, the CT is normal. He is too restless for MRI. CSF shows
moderate lymphocytic pleocytosis and increased red cells with mild elevation in protein. Stains
and counter immune electrophoresis are normal. Which is the next step in evaluation and
management?
A. Administration of acyclovir
B. Brain biopsy
C. EEG
D. Sedation for repeat attempt at MRI

A

a

39
Q 
Which of the following infectious agents has been implicated in Mollaret's meningitis?
A. HIV
B. HSV-1
C. HSV-2
D. VZV
A

c

40
Q

A 60-year-old female presents with headache, fever, and confusion. CSF shows a mononuclear
pleocytosis. She later develops marked weakness, and EMG shows axonal degeneration.
Serology and CSF analysis returns suggesting West Nile Virus infection. Which is the most
likely diagnosis?
A. Poliomyelitis, with false positive or coincidental WNV testing.
B. GBS with false positive or coincidental WNV testing
C. WNV encephalitis

A

c

41
Q

A patient with AIDS presents with headache and mild confusion. He has no fever and no clinical
signs of meningeal inflammation, although he does have papilledema. MRI is normal. Which is
the most likely pathogen?
A.Cryptococcus
B. HIV virus
C. Listeria
D.Toxoplasmosis

A

a

42
Q

Cryptococcal meningitis was confirmed in the patients described above. What would be the most
appropriate treatment?
A. Amphotericin B followed by fluconazole
B. Amphotericin B + flucytosine induction followed by fluconazole
C. Fluconazole induction and maintenance

A

b

43
Q

Which of the following predisposes to mucormycosis?
1. Malignancy
2. Sarcoidosis
3. Chronic corticosteroid therapy
4.Diabetes
Select: A = 1. 2. 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

e

44
Q

The image shows a coronal MRI of a patient with a mass lesion.
Although the MRI is not diagnostic, which of the following pathogens is most likely?
A. Aspergillus
B. Histoplasma
C. Cryptococcus
D. Mucormycosis

A

a

45
Q

A physician presents with fever, myalgia, headache, and diaphoresis within two weeks of
returning from a conference in Costa Rica. Laboratory studies are ordered, but before he returns,
he is brought to the ED because of an acute onset of delirium and has a seizure in the ED. CT is
normal CSF is normal except for mild elevation in protein - there is no cellular response Which
of the following are in the differential diagnosis?
1 Cryptococcal meningitis
2. HSV encephalitis
3. Cysticercosio
4. Malaria
Select: A = 1.2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

c

46
Q 
The diagnosis of cerebral malaria is made on the above patient. Which is appropriate treatment
of the patient?
A. Atemether
B. Chloroquine
C. Mefloquine
D. Quinine dihydrochloride
A

d

47
Q 
What is the most common clinical presentation of primary infection with toxoplasma in
immunocompetent adults?
A. Cerebral abscess
B. Fever and lymphadenopathy
C. Meningitis
D. Pneumonia
E. Asymptomatic
A

e

48
Q

A patient with known AIDS presents with confusion and headache. CT shows multiple ringenhancing
lesions which are suggestive but not diagnostic of toxoplasmosis. Which is the next
step in evaluation and management?
A. Treatment with pyrimethamine and sulfadiazine
B. Brain biopsy
C. Surgical removal of one or more of the lesions depending on accessibility
D. Spinal tap and CSF culture

A

a

49
Q 
Which is the most common presentation of primary infection with HIV?
A. Aseptic meningitis
B. Encephalitis
C. Symptoms of acute viral syndrome
D. Asymptomatic
A

c

50
Q 
HIV-related meningitis is seen in which stage(s) of HIV infection?
A. Early
B. Midstage
C. Advanced
D. All of these
A

d

51
Q 
Long-term antiretroviral therapy is required following which of the following HIV-associated
infections?
A. Cerebral toxoplasmosis
B. Cryptococcal meningitis
C. Both
D. Neither
A

c

52
Q

A 50-year-old man with AIDS presents with left-sided weakness, partial left hemianopia. and
right hand incoordination without weakness. MRI shows multiple nonenhancing white matter
lesions. CSF is normal. Which is the most likely diagnosis?
A.Cerebral toxoplasmosis
B. HIV encephalopathy
C. Progressive multifocal leukoencephalopathy
D. Vasculitis

A

c

53
Q 
When is transmission from mother to child the most likely?
A. First trimester
B. Third trimester
C. Delivery
D. Breast-feeeding
A

c

54
Q

An HIV-positive child presents with developmental regression with cognitive and motor
impairment with a combination of pyramidal and cerebellar signs. What is the most likely
diagnosis?
A. Cerebral toxoplasmosis
B. Cryptococcal meningitis
C. HIV-associated progressive encephalopathy
D. Strokes

A

c

55
Q

The image shows the head CT of the child in the previous question.
What are the implications of the findings on the CT?
A. Basal ganglia calcification seen in some children with HPE
B. Basal ganglia calcifications as an incidental finding to HPE
C. Calcifications due to toxoplasmosis
D. Hemorrhage

A

a

56
Q

A 12-year-old child with known HIV infection presents with acute onset of left hemiparesis and
marked dysarthria. Which is the most likely diagnosis?
A.Cryptococcal meningitis
B. Stroke associated with HIV
C. Stroke independent of HIV
D. Toxoplasmosis

A

b

57
Q

A 40-year-old man presents with attacks of autonomic disturbances including tachycardia,
hypertension, and hyperthermia and is found to have tremor, ataxia, hyper-reflexia, and
myoclonus. He has mild memory difficulty but no frank dementia, and complains of insomnia
and occasional hallucinations. Which is the most likely diagnosis?
A. Creutzfeldt-Jakob disease
B. nv-CJD
C. Fatal familial insomnia
D. Kuru

A

c

58
Q

A patient with marked encephalopathy and myoclonus has 14-3-3 protein assayed in the CSF,
and this is mildly positive. What is the clinical implication of this laboratory finding?
A. Supportive but not diagnostic of CJD
B. Diagnostic of CJD
C. Of no value in evaluating this patient

A

a

59
Q 
Which is the best treatment for controlling CNS degeneration due to CJD?
A. Amantadine
B. Benzodiazepines
C. Dopamine receptor agonists
D. There is no effective treatment
A

d

60
Q

The figure shows the EEG you are asked to read. The history provided is “Encephalopathy and
myoclonus, r/o CJD.”
Which is the correct interpretation of the EEG findings?
A. EEG is supportive of the diagnosis of CJD
B. EEG is diagnostic of CJD
C. EEG is not supportive of the diagnosis of CJD
D. EEG is inconsistent of the diagnosis of CJD

A

a

NEUROLOGY TEST (21 decks)

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