LE 1 NEURO 2024 Flashcards
Which of the following terms describes a person who wakes up and then goes back to sleep?
A. Lethargic
B. Alert
C. Obtunded
D. Stupor
A. Lethargic
Rationale:
According to Harrison’s Principles of Internal Medicine, lethargy is a state in which a person is drowsy but can be aroused to full wakefulness, though they may return to sleep when left undisturbed. This differentiates it from stupor or obtundation, where arousal to full wakefulness is more challenging and often requires persistent stimuli.
Which of the following is not a characteristic of uncal herniation?
A. Large non-reactive pupil
B. Respiratory arrest
C. Decreased sensorium
D. Intractable seizure
D. Intractable seizure
Rationale:
Uncal herniation typically presents with symptoms such as a large non-reactive pupil due to compression of the oculomotor nerve, respiratory arrest due to brainstem compression, and decreased sensorium. Intractable seizures are not a primary characteristic of uncal herniation as described in Harrison’s.
Which of the following tumors has a supratentorial location?
A. Schwannoma
B. Astrocytoma
C. Oligodendroglioma
D. Germinoma
C. Oligodendroglioma
Rationale: According to Harrison’s Principles of Internal Medicine, oligodendrogliomas are typically located in the supratentorial region of the brain. They are glial tumors that commonly occur in the cerebral hemispheres, particularly in the frontal and temporal lobes. In contrast, Schwannomas are usually found in the peripheral nervous system, often affecting the cranial nerves (e.g., vestibular Schwannoma). Astrocytomas can occur in both supratentorial and infratentorial regions, but the term itself is not specific to a location. Germinomas are typically found in the midline structures such as the pineal or suprasellar regions, which can be considered either supratentorial or infratentorial based on their exact location.
Which CNS infection presents as a focal neurologic lesion due to a parasite acquired from cats, especially in an immunocompromised state?
A. Cerebral malaria
B. Toxoplasmosis
C. Neuroschistosomiasis
D. Neurocysticercosis
B. Toxoplasmosis
Rationale:
Toxoplasmosis, particularly in immunocompromised individuals, such as those with HIV/AIDS, presents with focal neurological lesions. This infection is caused by the parasite Toxoplasma gondii, which can be acquired from cats.
Which of the following may cause coma without lateralizing neurologic signs, EXCEPT:
A. Hypoglycemia
B. Anoxia
C. Brain abscess
D. Diabetic ketoacidosis
C. Brain abscess
Rationale:
Coma without lateralizing neurologic signs is typically seen in metabolic conditions like hypoglycemia, anoxia, or diabetic ketoacidosis. A brain abscess, however, usually presents with focal neurological deficits, making it an exception.
Which of the following secondary brain insults can be avoided, EXCEPT:
A. Hypoglycemia
B. Hypoxia
C. Hypothermia
D. Hyperglycemia
C. Hypothermia
Rationale:
Secondary brain insults such as hypoglycemia, hypoxia, and hyperglycemia can be managed and avoided with proper medical care. Hypothermia, however, can be therapeutic in certain cases to reduce metabolic demand and secondary brain injury.
Which of the following is true about contusion injuries?
A. May be found at the point of impact or the opposite pole
B. It is a special type of deep white matter lesion due to shearing of axons
C. Neuroimaging is usually unremarkable
D. All of the above
A. May be found at the point of impact or the anti-polar area
Rationale:
Contusion injuries, as described in Harrison’s, can occur at the site of impact (coup injury) or on the opposite side of the brain (contrecoup injury). These injuries are typically visible on neuroimaging and can lead to significant clinical symptoms.
Which of the following is true about diffuse axonal injury?
A. Results from widespread mechanical disruption or shearing of axons
B. May explain the persistent coma or vegetative state after a closed head injury
C. May explain the persistent coma or vegetative state after a closed head injury
D. All of the above
D. All of the above
Rationale:
Diffuse axonal injury (DAI) results from widespread shearing forces that disrupt axons, often due to high-velocity impacts. This condition can explain persistent coma or vegetative states following closed head injuries. Harrison’s notes that DAI is a significant cause of morbidity in traumatic brain injuries.
Which of the following is a sign associated with skull base fractures?
A. Hemotympanum
B. Raccoon sign
C. Lid lag
D. Battle sign
D. Battle sign
Rationale:
Battle sign, or postauricular ecchymosis, is a classic indicator of a basilar skull fracture. Other signs include hemotympanum and raccoon eyes, but not lid lag.
Which of the following statements pertains to subdural hemorrhage?
A. A lucid interval several minutes to hours prior to coma is more common in subdural hemorrhage
B. It is usually due to rupture of the bridging veins
C. Would present as a concave or crescent-shaped hypodensity on CT scan
D. Would present as a crescent-shaped hyperdense lesion on CT scan
D. Would present as a crescent-shaped hyperdense lesion on CT scan
Rationale:
Subdural hemorrhage is typically caused by the rupture of bridging veins and presents as a crescent-shaped hyperdense (acute) lesion on a CT scan. A lucid interval is more commonly associated with epidural hemorrhage.
What is the most common cause of cardioembolic stroke worldwide?
A. Atrial Fibrillation
B. Myocardial Infarction
C. Endocarditis
D. Valve Replacement
A. Atrial Fibrillation
Rationale:
Atrial fibrillation is the most common cause of cardioembolic stroke worldwide. It increases the risk of stroke significantly due to the formation of clots in the atria, which can travel to the brain and cause an embolic stroke.
Which of the following is assessed in the CHA₂DS₂-VASc score for stroke risk assessment?
A. Age ≥65 years
B. History of myocardial infarction
C. Chronic obstructive pulmonary disease (COPD)
D. Hyperlipidemia
A. Age ≥65 years
Rationale:
The CHA₂DS₂-VASc score assesses stroke risk in patients with atrial fibrillation. It includes criteria such as age ≥65 years, but not history of myocardial infarction, COPD, or hyperlipidemia.
A patient in the ER had a cranial CT showing massive intracranial hemorrhage. The management should include:
A. Thrombolysis using rPA
B. Use mannitol to decrease ICP
C. Hyperventilation
D. Surgical evacuation
B. Use mannitol to decrease ICP
Rationale:
For a patient with a massive intracranial hemorrhage, using mannitol to decrease intracranial pressure (ICP) is appropriate. Thrombolysis is contraindicated in hemorrhagic stroke, and hyperventilation is not a standard first-line treatment in this context.
A patient has a BP of 200/110. Compute for Mean Arterial Pressure (MAP).
A. 140
B. 180
C. 200
D. 240
A. 140
Which of the following is NOT a subtle sign of an early infarct on CT scan?
A. Dense MCA sign
B. Insular ribbon sign
C. Hyperdense lesion in the internal capsule
D. Obscuration of the lentiform nucleus
C. Hyperdense lesion in the internal capsule
Rationale:
Early signs of infarct on CT scan include the dense MCA sign, insular ribbon sign, and obscuration of the lentiform nucleus. A hyperdense lesion in the internal capsule is not a recognized subtle early sign.
What is a CT scan finding characteristic of subarachnoid hemorrhage?
A. Punctate hypodensities in bilateral white matter areas
B. Hummingbird sign
C. Rim-enhancing lesions on cranial CT scan with contrast
D. Hyperdensity in the basal cisterns and sulci
D. Hyperdensity in the basal cisterns and sulci
Rationale:
Subarachnoid hemorrhage typically presents with hyperdensity in the basal cisterns and sulci on CT scan due to the presence of blood in the subarachnoid space.
Which of the following is true about acute stroke?
A. It is best managed with thrombolysis if given within 6 hours of symptom onset.
B. Immediate surgical intervention is always required.
C. Aspirin is contraindicated in the acute phase.
D. MRI is less sensitive than CT in detecting acute ischemic changes.
A. It is best managed with thrombolysis if given within 6 hours of symptom onset.
Rationale:
Acute ischemic stroke is best managed with thrombolysis (such as tPA) if administered within a window period, typically within 4.5 hours of symptom onset. MRI is more sensitive than CT in detecting acute ischemic changes.
Which of the following is not assessed in the NIH Stroke Scale (NIHSS)?
A. Level of Consciousness
B. Motor Function
C. Sensory Function
D. Emotional Response
D. Emotional Response
Rationale:
The NIH Stroke Scale assesses the level of consciousness, motor function, sensory function, and other neurological functions but does not include emotional response.
The following are anticoagulants, EXCEPT:
A. Edoxaban
B. Rivaroxaban
C. Dabigatran
D. Aspirin
D. Aspirin
Rationale:
Edoxaban, Rivaroxaban, and Dabigatran are anticoagulants. Aspirin is an antiplatelet agent, not an anticoagulant.
What is the spectrum of Alzheimer’s Disease where mild changes in memory and thinking abilities become noticeable, but there is no impairment of function in activities of daily living?
A. Mild Cognitive Impairment
B. Mild AD
C. Pre-clinical Stage
D. Severe AD
E. Moderate AD
A. Mild Cognitive Impairment
Rationale:
Mild Cognitive Impairment (MCI) is a stage in Alzheimer’s disease where there are mild changes in memory and thinking abilities, but daily activities are not significantly impaired.
Which of the following parameters is NOT tested in the Mini-Mental State Examination (MMSE)?
A. Orientation
B. Recall
C. Attention
D. Fund of Information
D. Fund of Information
Rationale:
The MMSE tests orientation, recall, attention, calculation, language, and the ability to follow simple commands. It does not assess the “fund of information,” which refers to general knowledge and cultural information.
Which progressive dementia is associated with prion disease, presenting with pyramidal or extrapyramidal symptoms, visual/cerebellar dysfunction, myoclonus, and eventually akinetic mutism?
A. Subacute Sclerosing Panencephalitis
B. Wilson’s Disease
C. Creutzfeldt-Jakob Disease
D. Wernicke’s-Korsakoff Syndrome
C. Creutzfeldt-Jakob Disease
Rationale:
Creutzfeldt-Jakob Disease (CJD) is a prion disease that presents with rapidly progressive dementia, motor dysfunction, myoclonus, and can lead to akinetic mutism. This distinguishes it from other progressive dementias.
MC, a 70-year-old male, was admitted to the emergency room with sudden onset right-sided weakness and slurring of speech 2 hours ago. On examination, he was drowsy and had right hemiplegia, right central facial palsy, and right homonymous hemianopia. His blood pressure was 180/110. Compute the Mean Arterial Pressure (MAP).
A. 136
B. 160
C. 126
D. 133
D. 133
Which of the following statements about the Glasgow Coma Score is correct?
A. Decerebrate posturing is given a score of 2
B. Verbal response of incomprehensible sounds is given a score of 3
C. Eye opening to pain is given a score of 2
D. Spontaneous movement of extremities is given a score of 4
C. Eye opening to pain is given a score of 2
Rationale:
The Glasgow Coma Score (GCS) assigns scores for eye, verbal, and motor responses. Eye opening to pain is scored as 2. Decerebrate posturing (extension to pain) is scored as 2 for motor response, incomprehensible sounds are scored as 2 for verbal response, and spontaneous movement of extremities would be scored as 6 for motor response.
Which microorganism causes acute bacterial meningitis with rapid onset, associated with rash and shock?
A. Haemophilus influenzae
B. Neisseria meningitidis
C. Streptococcus pneumoniae
D. Pseudomonas aeruginosa
B. Neisseria meningitidis
Rationale:
Neisseria meningitidis is known for causing acute bacterial meningitis, which often presents rapidly with symptoms including a characteristic rash and can progress to shock, especially in cases of meningococcemia.
Which of the following microorganisms is NOT commonly associated with bacterial meningitis?
A. Streptococcus pneumoniae
B. Haemophilus influenzae
C. Neisseria meningitidis
D. Pseudomonas aeruginosa
D. Pseudomonas aeruginosa
Rationale:
Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis are common causes of bacterial meningitis. Pseudomonas aeruginosa is not typically associated with bacterial meningitis in otherwise healthy individuals.
What is the usual duration of antibiotic treatment for acute bacterial meningitis?
A. 10-14 days
B. 18-21 days
C. 5-7 days
D. 30 days
A. 10-14 days
Rationale:
The typical duration for antibiotic treatment of acute bacterial meningitis is 10-14 days, though it can vary based on the causative organism and clinical response.
What is a danger associated with infections in the triangle of the face?
A. Infection spread to the cavernous sinus
B. Infection spread to the brainstem
C. Infection spread to the orbit
D. Infection spread to the lymph nodes
A. Infection spread to the cavernous sinus
Rationale:
Infections in the “danger triangle” of the face (from the corners of the mouth to the bridge of the nose) can spread to the cavernous sinus via venous connections, leading to cavernous sinus thrombosis.
Which CNS infection is caused by the yeast Cryptococcus neoformans?
A. Meningitis
B. Encephalitis
C. Abscess
D. Myelitis
A. Meningitis
Rationale:
Cryptococcus neoformans commonly causes cryptococcal meningitis, particularly in immunocompromised individuals such as those with HIV/AIDS.
What is the most common location of an oligodendroglioma?
A. Frontal lobe
B. Parietal lobe
C. Occipital lobe
D. Temporal lobe
A. Frontal lobe
Rationale:
Oligodendrogliomas most commonly occur in the frontal lobe of the brain. This location is typical for these types of tumors and aligns with clinical and radiological findings.
In which part of the brain does Herpes Simplex Virus (HSV) have a predilection to?
A. Lingual Gyrus
B. Mesial Temporal Lobe and Insula
C. Orbitofrontal Cortex
D. Thalamus
B. Mesial Temporal Lobe and Insula
Rationale:
HSV encephalitis commonly affects the mesial temporal lobe and insular regions of the brain, leading to symptoms such as fever, headache, seizures, and focal neurological deficits.
What is the first-line treatment for HSV encephalitis?
A. Acyclovir
B. Valacyclovir
C. Interferon-alpha
D. Ganciclovir
A. Acyclovir
Rationale:
Acyclovir is the first-line treatment for HSV encephalitis. It is an antiviral medication that is effective in reducing the viral load and improving clinical outcomes if administered promptly.
Which of the following is the most common primary brain tumor in adults?
A. Astrocytoma
B. Glioblastoma Multiforme
C. Glioma
D. Metastasis
B. Glioblastoma Multiforme
Rationale:
Glioblastoma Multiforme (GBM) is the most common and aggressive primary brain tumor in adults. It is a high-grade astrocytoma and is characterized by rapid growth and poor prognosis.
A 3-year-old boy presents with progressive headache and vomiting. Cranial MRI shows a mass. What is the most likely diagnosis?
A. Cerebellar Abscess
B. Pilocytic Astrocytoma
C. Meningitis
D. Glioblastoma Multiforme
B. Pilocytic Astrocytoma
Rationale:
In children, pilocytic astrocytoma is a common brain tumor, especially in the posterior fossa, presenting with symptoms such as headache and vomiting due to increased intracranial pressure. Glioblastoma Multiforme is rare in this age group.
Which of the following tumors does NOT have an infratentorial location?
A. Oligodendroglioma
B. Medulloblastoma
C. None of the choices
D. Schwannoma
A. Oligodendroglioma
Rationale:
Oligodendrogliomas are typically located in the supratentorial region of the brain, especially in the cerebral hemispheres. Medulloblastomas and Schwannomas are commonly found in the infratentorial region.
This peripheral nerve disorder might be described as a “dying forward” phenomenon, a process in which the nerve degenerates from the point of axonal damage outward:
A. Axonal Degeneration
B. Wallerian Degeneration
C. Segmental Degeneration
D. Neuropraxia
B. Wallerian Degeneration
Rationale:
Wallerian Degeneration is a process where the part of the axon distal to the site of injury degenerates, often described as a “dying forward” phenomenon.
Which of the following signs and symptoms may be attributed to an acute stroke?
A. 2-week history of fever and headache
B. Gradual progression of left-sided weakness
C. Unilateral ptosis usually noted in the acute phase
D. Sudden loss of vision in one eye
D. Sudden loss of vision in one eye
Rationale:
Acute stroke can present with sudden onset of neurological deficits, including loss of vision in one eye (amaurosis fugax), which may be due to embolism or other vascular events. Other options do not typically present suddenly as stroke symptoms do.
Which of the following statements is incorrect regarding febrile seizures?
A. The overall prevalence is 10%
B. EEG is usually normal
C. Usually occur between 3 months to 5 years of age with peak incidence between 18-24 months
D. The most common seizure occurring in late infancy and early childhood
A. The overall prevalence is 10%
Rationale:
Febrile seizures are the most common type of seizure during childhood, reportedly occurring in 2-5% of children aged 6 months to 5 years. The statement that the overall prevalence is 10% is incorrect, as the actual prevalence is significantly lower.
EEG findings in a patient with Infantile Spasms or West Syndrome typically show:
A. High-voltage spikes in the contralateral centrotemporal area
B. Continuous multifocal spikes and slow waves of large amplitude
C. Slow 1-2 Hz spike and wave pattern
D. Generalized bursts of 4-6 Hz irregular polyspike activity
B. Continuous multifocal spikes and slow waves of large amplitude
Rationale:
West Syndrome, or Infantile Spasms, is characterized by a specific EEG pattern called hypsarrhythmia, which includes continuous multifocal spikes and slow waves of large amplitude.
A 62-year-old female with diabetes, hypertension, and dyslipidemia presents with sudden onset of forceful, flinging movements of her left arm and involuntary jerking of her left leg. She also reports transient weakness of the left arm and leg the day before. A lesion in which of the following structures would explain this patient’s symptoms?
A. Right Subthalamic Nucleus
B. Left Subthalamic Nucleus
C. Right Head of Caudate
D. Left Head of Caudate
A. Right subthalamic nucleus
Rationale:
The patient’s symptoms of sudden onset forceful, flinging movements (hemiballismus) of the left arm and leg suggest a lesion in the right subthalamic nucleus. Hemiballismus is typically caused by a lesion in the contralateral subthalamic nucleus, which results in involuntary, violent movements on the opposite side of the body. This fits with the patient’s clinical presentation and history of transient weakness, indicating a possible vascular event affecting the subthalamic nucleus.
A patient with cauda equina syndrome will likely present with the following clinical features, EXCEPT:
A. Early fecal and urinary incontinence
B. Areflexia
C. Severe radicular pain
D. Gradual and unilateral numbness and weakness of the lower extremities
A. Early fecal and urinary incontinence
Rationale:
Cauda equina syndrome typically presents with gradual onset of symptoms, including areflexia, severe radicular pain, and gradual and unilateral numbness and weakness of the lower extremities. Early fecal and urinary incontinence is not typical of cauda equina syndrome and usually occurs later in the disease progression.
Which of the following statements about cerebral edema is/are true?
A. The treatment for vasogenic edema is the use of steroids.
B. Interstitial edema due to hydrocephalus may be managed with mannitol or hypertonic saline.
C. Large infarcts are present with vasogenic type of edema.
D. Interstitial edema is usually secondary to space-occupying lesions like tumors.
A. The treatment for vasogenic edema is the use of steroids.
Rationale:
Vasogenic edema, which is due to the breakdown of the blood-brain barrier, is often treated with steroids to reduce inflammation. Interstitial edema is usually due to hydrocephalus and managed with measures like mannitol or hypertonic saline to reduce intracranial pressure. Large infarcts typically present with cytotoxic edema, not vasogenic. Space-occupying lesions like tumors usually cause vasogenic edema, not interstitial edema.
Which of the following statements is true about diffuse axonal injury?
A. Results from widespread mechanical disruption or shearing of axons.
B. Most commonly affecting the corpus callosum.
C. May explain persistent coma or vegetative state after closed head injury.
D. All of the above.
D. All of the above.
Rationale:
Diffuse axonal injury (DAI) results from widespread mechanical disruption or shearing of axons, most commonly affects the corpus callosum, and can explain persistent coma or vegetative state after closed head injury. All statements provided are true.
Which of the following drugs causes neuropathy that resembles Guillain-Barré Syndrome?
A. Arsenic
B. Mercury
C. Lithium
D. Dapsone
A. Arsenic
Rationale:
Arsenic poisoning can cause a neuropathy that mimics Guillain-Barré Syndrome, presenting with symptoms like weakness and sensory loss.
Which of the following drugs disrupts microtubules and impairs axonal transport?
A. Amiodarone
B. Colchicine
C. Vincristine
D. Dantrolene
B. Colchicine
Rationale:
Colchicine disrupts microtubules and impairs axonal transport, leading to potential neurotoxic effects.
Which test is used to assess coordination?
A. Heel to Shin Test
B. Finger to Nose Test
C. Rapid Alternating Movements
D. All of the Above
D. All of the Above
Rationale:
Coordination can be assessed using the Heel to Shin Test, Finger to Nose Test, and Rapid Alternating Movements. All these tests evaluate different aspects of cerebellar function and coordination.
Which of the following are clinical features of extramedullary spinal cord lesions?
A. Common radicular pain and ascending progression of paresthesias
B. Unusual vertebral pain and descending progression of paresthesias
C. Common radicular pain and descending progression of paresthesias
D. Unusual vertebral pain and ascending progression of paresthesias
A. Common radicular pain and ascending progression of paresthesias
Rationale: Extramedullary spinal cord lesions often cause radicular pain (pain radiating along the nerve pathway) and can lead to ascending progression of paresthesias (abnormal sensations). This pattern is due to the compression and irritation of nerve roots and spinal cord segments.
