Neuro

Question 1

Immunocompromised patient with gradual onset of symptoms such as hemiparesis, speech disturbances, vision, and gait with multiple, hypodense, non-enhancing lesions?

Answer 1

PML progressive multifocal leukoencephalopathy

Question 2

Pt with a pulsatile headache and tinnitus with risk factor of steroid or OCPS, trauma, obesity with inrceased intracranial pressure?

Answer 2

pseudotumor cerebri

Question 3

Pt with a brief episode of impaired consciousness with automatisms and post-ictal confusion?

Answer 3

complex partial seizure

Question 4

Pt presents with contralateral hemianesthesia that can be accompanied by transient hemiparesis, athetosis, or ballistic movements?

Answer 4

thalamic stroke (Dejerine-Roussy syndrome)

Question 5

What is the CSF analysis in a patient with Guillain-Barre syndrome?

Answer 5

The protein is high, and the rest are normal.

Question 6

23 YOF w/ and acute headache of pulsating, unilateral with nausea and photophobia has vomited 5 times. what is the most appropriate initial mangement step?

Answer 6

antiemetics such as prochlorperazine or metoclopramide, chlorpromazine.

Question 7

How do you dtermine a patient to be brain dead?

Answer 7

Absentee of cortical and brain stem functions. However spinal cord may still be intact.

Question 8

Most likely finding in a patient’s CSF examination that has paraplegia, urinary incontinence and urgency and impaired vibration and proprioception in her left forearm?

Answer 8

Oligoclonal bands are present in 90% of MS patients.

Question 9

Prominent flexing of right hip and knee and right foot slapping to the floor with each step. What is the gait abnormality?

Answer 9

L5 radiculopathy.

Question 10

Bilateral lower extremity consitent with UMN dz with hyperrflexia, and decreased sensation. may include compromised bladder or bowel control

Answer 10

Spinal cord compression

Question 11

Stroke that involves the internal capsule thereby resulting in pure motor dysfunction. These are ischemic strokes so small that can’t be detected in CT scans.

Answer 11

Small vessel hyalinosis

Question 12

What is the most likely diagnosis in a female who has recurrent attacks of focal neurologic dysfunction that occur at non-predictable time intervals?

Answer 12

Multiple sclerosis and MRI is diagnostic test of choice for identifying demyelinating lesions.

Question 13

what is the pathologic process in a ptient with cancer that has a symmetric erythematous rash in his fingers and muscle weakness?

Answer 13

dermatomyositis. fiber atrophy.

Question 14

healthy white female w/ new onset of seizures with a 2 day history of fever and headaches. her CSF is high in lymphocytes and RBC. What is the most likely diagnosis?

Answer 14

Herpes simplex encephalitis. PCR analysis of HSV DNA in spinal fluid is gold standard and IV acyclovir in the TOC.

Question 15

arm weakness and speech difficulty. He expresses himself slowly with difficulty, but he understands words spoken to him. Where is most likely the lesion?

Answer 15

Dominant frontal lobe.

Question 16

Patient with severe occipital headache, ataxia right-sided facial weakness and deviation of the eyes to the left side. what is the most likely diagnosis?

Answer 16

Cerebellar hemorrhage

Question 17

hemiparesis, Hemi-sensory loss, homonymous hemianopsia, stupor, and coma?

Answer 17

Putamen hemorrhage

Question 18

Deep coma and paraplegia iwth pinpoint pupils reactive to light and decerebrate rigidity?

Answer 18

Pontine hemorrhage

Question 19

Pt with essential tremors comes with abdominal pain, confusion, headaches, hallucinations, and dizziness. What caused the patient’s new symptoms?

Answer 19

Primidone is an anticonvulsant that may precipitate acute intermittent porphyria.

Question 20

What medications slows down the long-term progression of multiple sclerosis?

Answer 20

Interferon-beta. High-dose corticosteroids are used during acute attacks.

Question 21

Patient with pseudotumor cerebri with papiledema is at most risk of what?

Answer 21

blindness

Question 22

How do you diagnose normal pressure hydrocephalus?

Answer 22

Enlarged ventricles in CT or MRI and normal opening pressure in lumbar punctures

Question 23

How do you treat Normal pressure hydrocephalus?

Answer 23

perform serial large volume lumbar punctures and a ventriculoperitoneal shunt may be placed.

Question 24

What is the best therapy for an elderly patient who is concerned with recent memory loss and very irritable and fatigue with loss of interest and sleep and appetite?

Answer 24

SSRI. patients with Alzheimer’s usually aren’t aware of their memory impairment

Question 25

What is the DOC for trigeminal neuralgia?

Answer 25

carbamazepine

Question 26

What is the DOC for the treatment of idiopathic benign intracranial hypertension?

Answer 26

Acetazolamide

Question 27

What is the best way to diagnose acoustic neuromas?

Answer 27

MRI with gadolinium

Question 28

Pt presents with nausea, vomiting, headaches that are worse in the morning, vision changes, papilledema, cranial nerve deficits, somnolence confusion, unsteadiness, and cushing’s reflex (hypertension and bradycardia) what is the most likely diagnosis?

Answer 28

Intracranial hypertension

Question 29

What is the best next step in management in a patient with unprovoked seizures and unclear history?

Answer 29

CT scan w/out contrast to rule out hemorrhage

Question 30

What is the best TOC for agitation in elderly patients?

Answer 30

low-dose haloperidol

Question 31

What is the major cause of morbidity and mortality in a patient with a subarachnoid hemorrhage?

Answer 31

VAsospasm with symptomatic ischemia and infarction. Therefore give calcium channel blockers to prevent vasospasm

Question 32

What is the most likely diagnosis in a patient with parkinsonism, orthostatic hypotension, impotence, incontinence, or other autonomic symptoms?

Answer 32

Multiple system atrophy

Question 33

What is the most likely diagnosis in a 21 YOM with sever headaches and CT positive for a ring-enhanced lesion in the left frontal lobe and fluid collection in the left maxillary sinus?

Answer 33

Anaerobic bacterial infection (abscess)

Question 34

What is the best potential treatment for MS?

Answer 34

Glatiramer acetate

Question 35

What is the best way to monitor respiratory function in a patient with impending respiratory failure?

Answer 35

Vital capacity.

Question 36

a 27 YOM with poor appetite, loss of interest, impaired sleep, weight loss, and poor memory has a PMH of past IV drug abuse. What is the best next step in management?

Answer 36

HIV testing

Question 37

Pt tends to sway to the left even with his eyes open and cautiously lurches to the left while walking. What is the most likely diagnosis?

Answer 37

Cerebellar tumor which represents itself as ipsilateral ataxia, nystagmus, intention tremors, and loss of coordination.

Question 38

Patient with progressive fatigue low hematocrit and elevated bilirubin levels with no family history of blood disorder. Blood smear shows spherocytes without central pallor and a positive coombs’ test. What is the most likely diagnosis?

Answer 38

Autoimmmune hemolytic anemia

Question 39

In a patient with breast cancer witha HER2 gene amplification that will be started on trastuzumab. What important test should you perform prior to starting the regimen?

Answer 39

Echocardiography because trastuzumab is cardiotoxic.

Question 40

What is the diagnostic criteria of monoclonal gammopathy of undetermined significance?

Answer 40

asymptomatic elevation of a monoclonal protein detected on protein electrophoresis and excluding multiple myeloma (renal insufficiency, hypercalcemia, anemia, and lytic bone lesions