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Neuro Flashcards

1
Q

A patient presented with sudden-onset dysarthria, weakness and numbness of his left arm and leg, and a visual field defect at his right side. Which of the following is the most likely affected vessel?

a.Proximal middle cerebral artery, right

b.Proximal middle cerebral artery, left

c.Superior division, middle cerebral artery, right

d.Inferior division, middle cerebral artery, left

A

Proximal middle cerebral artery, right

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2
Q

A patient presented with severe sudden-onset vertigo associated with numbness of the left side of her face as well as the right side of her body. Which of the following is the most likely affected vessel?

a.Proximal posterior cerebral artery, right

b.Proximal posterior cerebral artery, left

c.Vertebral artery, right

d. Vertebral artery, left

A

Vertebral artery, left

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3
Q

A patient presented with recurrent 5-minute episodes of intense dizziness associated with blurring of vision, dysarthria, facial numbness, and left-sided body weakness. This occurs several times in a day and resolves spontaneously. Which of the following is the most common etiology consistent with the patient’s condition?

a.Atherothrombotic

b.Aneurysmal

c.Cardioembolic

d.Carotid disease

A

Cardioembolic

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4
Q

A decrease in cerebral blood flow to zero causes death of brain tissue in:

a.1-3 minutes

b.4-10 minutes

c.15-30 minutes

d.30-90 minutes

A

4-10 minutes

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5
Q

Which of the following features suggest a stroke of a hemorrhagic nature?

a.Fully awake patient

b.Deficit is maximal at onset

c.Improving symptoms after onset

d.Higher initial blood pressure

A

Higher initial blood pressure

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6
Q

A patient with ischemic stroke with ictus identified 1 hour prior is considered for thrombolytic therapy. At which of the following BP thresholds should BP reduction be considered for this patient?

a.>170/100

b.>185/110

c.>200/100

d.>220/120

A

> 185/110

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7
Q

A patient with ischemic stroke presents with onset of symptoms 4 hours ago. He was admitted 2 months ago for appendectomy and had a subarachnoid hemorrhage (SAH) 5 years ago from a ruptured aneurysm that was eventually repaired. His current BP is 170/100. Which of the following features is a contraindication for thrombolysis in this patient?

a.Blood pressure

b.History of recent surgery

c.Past history of SAH

d.Time from onset of symptoms

A

Past history of SAH

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8
Q

The organism most often responsible for community-acquired bacterial meningitis is:

a.Neisseria meningitidis

b.Group B streptococci

c.Streptococcus pneumoniae

d.Listeria monocytogenes

A

Streptococcus pneumoniae

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9
Q

Which of the following patients with meningitis is most likely to yield gram negative bacilli in CSF culture?

a.Patient with diabetes with history of chronic urinary tract infection

b.Patient who underwent shunting procedure for hydrocephalus

c.Pregnant patient who recently went to cheese-tasting party

d.Patient diagnosed with complement deficiency

A

Patient with diabetes with history of chronic urinary tract infection

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10
Q

For Questions 10 and 11: A patient presented with a 1-day history of fever, headache, vomiting, and neck pain with movement. On physical examination, he has dilated, poorly reactive pupils and bilateral sixth nerve palsy. Which of the following diagnostic tests should be prioritized for this patient?

a.Plain cranial CT

b.Blood cultures

c.Cranial MRI

d.Lumbar puncture

A

Blood cultures

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11
Q

Which of the following would be an expected lumbar puncture/CSF finding for this patient?

a.Glucose > 100 mg/dL

b.Neutrophils < 100 cells/µL

c.Opening pressure < 180 mmH20

d.Protein > 45 mg/dL

A

Protein > 45 mg/dL

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12
Q

Which of the following pairs correctly describes seizure presentations?

a. Absence: loss of postural control

b. Atonic: no postictal confusion

c. Generalized: ictal phase lowers BP

d. Myoclonic: focal type of seizure

A

Atonic: no postictal confusion

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13
Q

Which of the following characteristics differentiates a complex febrile seizure from a simple febrile seizure?

a. Begins with involuntary movements of hand

b.No increased risk of developing epilepsy

c. Single event with symmetric manifestation

d. With family history of epilepsy

A

Begins with involuntary movements of hand

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14
Q

Which of the following presentation/s is/are not consistent with status epilepticus?

a. Patient with uremia and generalized tonic-clonic movements lasting 10 minutes

b. Confused patient with involuntary twitching of the right hand for the past hour

c. Patient presenting with rapid blinking and chewing motions with persistent lack of response for 20 minutes

d. Patient with persistent flailing of limbs and hip thrusting for 30 minutes

A

Patient with persistent flailing of limbs and hip thrusting for 30 minutes

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15
Q

Which of the following is an anticonvulsant used in early refractory status epilepticus (30 min to 48 hours)?

a.Levetiracetam 25 mg/kg

b.Midazolam 0.2 mg/kg

c.Phenytoin 20 mg/kg

d.Pentobarbital 5 mg/kg

A

Midazolam 0.2 mg/kg

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16
Q

Which of the following fits the diagnostic criteria for migraine?

a. Patient with severe unilateral headache with vomiting lasting 5 hours

b.Patient with unilateral throbbing headache with phonophobia lasting 3 hours

c.Patient with moderate periorbital headache with photophobia lasting 24 hours

d.Patient with unilateral severe headache aggravated by movement lasting 48 hours

A

Patient with severe unilateral headache with vomiting lasting 5 hours

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17
Q

Which of the following options correctly match the migraine drug class with its pharmacologic action?

a.Lasmiditan: 5-HT1D agonist

b.NSAID: cyclooxygenase inhibitor

c.Metoclopramide: dopamine receptor agonist

d.Triptan: 5-HT1B and 5-HT1D antagonis

A

NSAID: cyclooxygenase inhibitor

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18
Q

What is the most common etiology of tumors in the brain?

a.Astrocytoma

b.CNS lymphoma

c.Meningioma

d. Metastases

A

Metastases

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19
Q

A patient presents with 3 months of severe headache and progressing left arm and leg weakness. On investigation, cranial MRI showed an enhancing mass on the right frontal area with perilesional edema. Which of the following interventions would be appropriate?

a.Dexamethasone 4 mg tablet twice daily

b.Levetiracetam 500 mg tablet twice daily

c.Mannitol 100 grams intravenously over 24 hours

d. Enoxaparin 0.6 units injected subcutaneously twice daily

A

Dexamethasone 4 mg tablet twice daily

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20
Q

A patient who had acute gastroenteritis treated with ciprofloxacin 2 weeks ago returns to the clinic for unsteadiness when walking. On physical examination, there was facial diparesis with lack of reflexes on bilateral knees and ankles. Which laboratory features would be consistent with this patient’s most likely condition?

a. CSF glucose level 80 mg/dL

b. CSF protein 15 g/L

c. CSF lymphocytes 150 cells/µL

d. CSF opening pressure 200 mmH2O

A

CSF protein 15 g/L

21
Q

What is the fundamental defect in myasthenia gravis?

a. Decrease in the amount of acetylcholine in the synaptic cleft

b. Decrease in the number of available acetylcholine receptors

c. Increased rundown of neuromuscular transmission

d. Hypertrophy of the postsynaptic folds

A

Decrease in the number of available acetylcholine receptors

22
Q

Which of the following is consistent with the clinical presentation of myasthenia gravis?

a. Extraocular muscles are involved early

b. Facial presentation is a “sardonic grin”

c. Muscle weakness more distal than proximal

d. Weakness improves with repeated movements

A

Extraocular muscles are involved early

23
Q

What is the most common mononeuropathy among diabetics?

a. Cranial nerves III, VI, VI

b. Lateral femoral nerve

c. Median nerve

d. Peroneal nerve

A

Median nerve

24
Q

A 72/F presented to the OPD progressive forgetfulness in the last few years. Recently, she forgot how to find her way home after a trip to the market. Her children observed that she had difficulty finding words during conversations, and would forget events from the previous days. Cranial CT scan showed bilateral medial temporal atrophy. Which of the following would resolve the patient’s most likely condition?

a. Levodopa-carbidopa

b. Memantine

c. Methylcobalamin

d. None of the above

A

None of the above

25
Q

The most important cardinal feature of Parkinson Disease (PD) is
a. rest/resting tremor
b. rigidity
c. bradykinesia
d. cognitive impairment

A

c. Bradykinesia

26
Q

Parkinsonism is a general term that is used to define a symptom complex manifesting with
bradykinesia with rigidity and/or tremor. It has a wide differential diagnosis and can reflect
damage to the different parts of the basal ganglia. The basal ganglia comprise a group of
subcortical nuclei that include:

a. amygdala
b. pituitary gland
c. subthalamic nucleus
d. cerebellar vermis

A

c. subthalamic nucleus

27
Q

“Lubag” or X-linked dystonia-parkinsonism (XDP) otherwise known as DYT3 was reported by
Dr. Lillian Lee in landmark paper in 1976. DYT3 commonly affects Filipino males in their 3rd
decade. It is endemic in the Visayas particularly in

a. Bacolod
b. Capiz
c. Cebu
d. Romblon

A

b. Capiz

28
Q

Cornerstone in management of typical PD is:

a. dopamine agonists
b. levodopa
c. MAO-B inhibitors
d. COMT inhibitors

A

b. levodopa

29
Q

The following clinical presentation is categorized under hypokinetic movements

a. athethosis
b. bradykinesia
c. dystonia
d. tic

A

b. bradykinesia

30
Q

Patients chronically given typical neuroleptic medications for psychiatric disorders may
develop tardive syndromes months to years after initiation of such regimen. One option we must
be foremostly careful in doing is:

a. abrupt cessation or withdrawal of medications
b. perform botulinum injections
c. gradual switch to atypical antipsychotics
d. add valproic acid to regimen.

A

a. abrupt cessation or withdrawal of medications

31
Q
  1. Which refers to continuous seizures or repetitive, discrete seizures with impaired consciousness in the interictal period? This is an emergency and MUST be treated immediately.

a. Epileptic Spasms
b. Status Epilepticus
c. Generalized Tonic-Clonic Seizures
d. Focal Seizure with Impaired Awareness

A

b. Status Epilepticus

32
Q

Which antiepileptic drug is contraindicated in pregnant women?
a. Topiramate
b. Lacosamide
c. Valproic acid
d. Levetiracetam

A

c. Valproic acid

33
Q

Chronic head-pain syndrome characterized by bilateral tight, band-like discomfort. The pain typically builds slowly, fluctuates in severity, and may persist more or less continuously for many days.
a. Cluster Headache
b. Migraine Headache
c. Hemicrania Continua
d. Tension-Type Headache

A

d. Tension-Type Headache

34
Q
  1. Patients with an increasing frequency of migraine attacks or with attacks that are either unresponsive or poorly responsive to abortive treatments can be given which treatment?
    a. Ibuprofen
    b. Propranolol
    c. Sumatriptan
    d. Acetaminophen
A

b. Propranolol

35
Q

What is the most common cause of dementia in the elderly?
a. Vascular Dementia
b. Lewy Body Disease (LBD)
c. Alzheimer’s Disease (AD)
d. Frontotemporal Dementia (FTD)

A

c. Alzheimer’s Disease (AD)

36
Q

This is a relatively uncommon but treatable cause of dementia. This should be considered especially if with the clinical triad of abnormal gait (ataxic or apractic), dementia (usually mild to moderate, with an emphasis on executive impairment), and urinary urgency or incontinence.

a. Korsakoff’s syndrome
b. Huntington’s Disease
c. Creutzfeldt-Jakob disease
d. Normal-pressure Hydrocephalus

A

d. Normal-pressure Hydrocephalus

37
Q

Intravenous recombinant tissue plasminogen activator (rTPA) in acute ischemic stroke can be given ___ hours from the onset of symptoms (ictus).
a. ≤ 1 hour
b. ≤ 3 hours
c. ≤ 4.5 hours
d. ≤ 6 hours

A

c. ≤ 4.5 hours

38
Q

This is the imaging modality of choice in patients with acute stroke since it can identify or exclude hemorrhage as the cause of the stroke, AND it is more readily available in most centers:

a. CT- scan (non-contrast)
b. CT- scan (contrast)
c. MRI (non-contrast)
d. MRI with contrast

A

a. CT- scan (non-contrast)

39
Q
  1. Because TIAs may herald stroke, they are an important risk factor that should be considered separately and urgently. TIAs are episodes of stroke symptoms that last only briefly; the standard definition of duration is <24 h, BUT most TIAs last <1 h. If a relevant brain infarction is identified on brain imaging, the clinical entity is now classified as ischemic stroke regardless of the duration of symptoms. Therefore, the definition of TIA (Transient ischemic attack) is:
    a. All neurologic signs and symptoms resolve, with evidence of brain infarction on brain imaging
    b. All neurologic signs and symptoms resolve, without evidence of brain infarction on brain imaging
    c. Some neurologic signs and symptoms resolve, with evidence of brain infarction on brain imaging
    d. Some neurologic signs and symptoms resolve, without evidence of brain infarction on brain imaging
A

b. All neurologic signs and symptoms resolve, without evidence of brain infarction on brain imaging

40
Q
  1. Because TIAs may herald stroke, they are an important risk factor that should be considered separately and urgently. TIAs are episodes of stroke symptoms that last only briefly; the standard definition of duration is <24 h, BUT most TIAs last <1 h. If a relevant brain infarction is identified on brain imaging, the clinical entity is now classified as ischemic stroke regardless of the duration of symptoms. Therefore, the definition of TIA (Transient ischemic attack) is:
    a. All neurologic signs and symptoms resolve, with evidence of brain infarction on brain imaging
    b. All neurologic signs and symptoms resolve, without evidence of brain infarction on brain imaging
    c. Some neurologic signs and symptoms resolve, with evidence of brain infarction on brain imaging
    d. Some neurologic signs and symptoms resolve, without evidence of brain infarction on brain imaging
A

b. All neurologic signs and symptoms resolve, without evidence of brain infarction on brain imaging

41
Q

A 60 year old male was found unconscious on his bathroom floor. An ambulance was called. Initial BP was 180/100. En route, patient had one episode of vomiting. At the ED, he was noted to have anisocoria (left pupil 5mm, right pupil 2mm), LUE and LLE withdrew to pain; RUE and RLE had no response to pain, with positive toe extensor sign (Babinski). BAT was activated. Plain cranial CT showed acute intracerebral hemorrhage at the left temporal lobe. With these information, what is the most possible cause of this patient’s lobar ICH?
a. coagulopathy
b. amyloid angiopathy
c. arteriovenous malformation
d. drug use (cocaine and / or amphetamine)
e. any of the above

A

e. any of the above

42
Q

A relative arrived and disclosed that the patient is being maintained on Dabigatran for his permanent AF. Knowing that ICH associated with anticoagulant therapy may evolve for as long as 24-48 hours, rapid correction of coagulopathy should be done and can be achieved by giving:
a. Vitamin K
b. Idarucizumab
c. Fresh Frozen Plasma
d. Andexanet alfa

A

b. Idarucizumab

43
Q
  1. Bacterial meningitis is a medical emergency. The goal is to begin antibiotic therapy within 60 minutes of a patients’ arrival in the emergency room. Which of the following is true of bacterial meningitis treatment?

a. Empiric therapy for immunocompetent, 18-50 year-olds should include a combination of dexamethasone, a third or fourth generation cephalosporin plus vancomycin
b. Dose of Ceftriaxone is 2grams once daily
c. Standard therapy for streptococcus pneumoniae is ceftazidime or cefepime
d. Most cases of bacterial meningitis should be treated for a period of 21 days, in full doses parenterally

A

a. Empiric therapy for immunocompetent, 18-50 year-olds should include a combination of dexamethasone, a third or fourth generation cephalosporin plus vancomycin

44
Q

Which of the following antibiotics is appropriate treatment for the specified bacterium?

a. Streptococcus pneumonia-Metronidazole
b. Penicillin resistant Neisseria meningitidis- ceftriaxone
c. Listeria monocytogenes-vancomycin
d. Pseudomonas aeruginosa-ceftriaxone

A

b. Penicillin resistant Neisseria meningitidis- ceftriaxone

45
Q

Dementia is defined as an acquired deterioration in cognitive abilities that impairs the successful performance of daily activities. Most common cognitive dysfunction dementia is

a. Compulsions
b. Episodic memory loss
c. Disinhibition
d. Poor calculation

A

b. Episodic memory loss

46
Q

The strongest risk factor for dementia is
a. Age
b. Genetic background
c. History of head trauma
d. Low educational attainment

A

a. Age

47
Q

The choice of laboratory tests in the evaluation of dementia is complex and should be tailored to the individual patient. Should neuroimaging studies be utilized, entorhinal cortex and hippocampal atrophy are most commonly seen in the following type of dementia:
a. Alzheimer’s Disease
b. Creutzfeld-Jacob Disease
c. Frontotemporal Dementia
d. Vascular Dementia

A

a. Alzheimer’s Disease

48
Q

Routine tests performed in investigating dementia are

a. Angiogram, brain biopsy, PET
b. Apolipoprotein E, lab screen for autoantibodies, urine heavy metals
c. Chest-ray, liver and renal function tests
d. Complete blood count, electrolytes, thyroid function test

A

d. Complete blood count, electrolytes, thyroid function test

49
Q

The most important cardinal feature of Parkinson Disease (PD) is

a. rest/ resting tremor
b. Rigidity
c. Bradykinesia
d. Cognitive impairment

A

c. Bradykinesia

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