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TIRED YEAR > Neuro LQ2 > Flashcards

Neuro LQ2 Flashcards

1
Q
  1. Which of the following statements is False?
    A. Most primary brain tumors are glial tumors.
    B. Brain metastases are less common than primary brain tumors
    C. Seizures are a common presenting symptom of low- grade gliomas
    D. Risk factors for primary brain tumors include ionizing radiation and immunosuppression.
A

B. Brain metastases are less common than primary brain tumors

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2
Q
  1. Which of the following statements is False?
    A. Oligodendrogliomas are characterized by cells with a “fried egg” appearance and branching capillaries.
    B. Oligodendrogliomas are characterized by codeletion of 1p/19q gene
    C. Oligodendrogliomas usually have IDH mutations
    D. Oligodendrogliomas most commonly occur in the temporal lobe
A

D. Oligodendrogliomas most commonly occur in the temporal lobe

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3
Q

Which of the following cancers is least likely to spread to the brain?
A. Breast
B. Gastrointestinal
C. Melanoma
D. Prostate

A

D. Prostate

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4
Q
  1. Which of the following cancers is least likely to cause hemorrhagic metastases?

A. Thyroid
B. Gastrointestinal
C. Melanoma
D. Renal

A

B. Gastrointestinal

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5
Q
  1. A 28- year- old woman who presents with headache and vomiting is diagnosed with a brain tumor in the emergency department. Computed tomography (CT) indicates a mass effect. What is recommended to be done first?

A. Start an anti- epileptic medication, preferably one that is not an enzyme inducer, such as Levetiracetam 500 mg/tablet TID or Valproic Acid 500 mg/tab TID
B. Start Dexamethasone 8mg/day
C. Start Temozolomide with Whole Brain Radiotherapy at 3000 cGy in 10 fractions D. Order an electroencephalogram (EEG)

A

B. Start Dexamethasone 8mg/day

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6
Q
  1. Fill in the blank: Meningiomas arise from _

A. Dura cells
B. Arachnoidal cap cells
C. Pia cells
D. Oligodendrocytes

A

B. Arachnoidal cap cells

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7
Q
  1. Which of the following is not a characteristic of meningiomas?

A. They tend to be more common in women
B. Psammoma bodies are present
C. They are common in patients with MEN 1
D. They are commonly located at the cerebral convexities

A

C. They are common in patients with MEN 1

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8
Q
  1. Which of the following statements is false?

A. Most primary central nervous system (CNS) lymphomas are B- cell lymphomas.
B. Primary CNS lymphoma responds well to steroids but recurs.
C. Primary CNS lymphoma can resemble glioblastoma multiforme on MRI.
D. Primary CNS lymphoma only occurs as a single, localized lesion

A

D. Primary CNS lymphoma only occurs as a single, localized lesion

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9
Q
  1. Which of the following cysts is associated with sudden death.
    A. Colloid cyst
    B. Epidermoid cyst
    C. Neurenteric cyst
    D. Rathke’s cleft cyst
A

A. Colloid cyst

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10
Q
  1. Which of the following findings predicts a better prognosis in oligodendrogliomas and grade III astrocytomas?
    A. Epidermal growth factor receptor amplification
    B. Deletion of phosphatase and tensin homolog (PTEN)
    C. Mutation in isocitrate dehydrogenase 1 and 2
    D. N- Myc gene amplification
A

C. Mutation in isocitrate dehydrogenase 1 and 2

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11
Q
  1. Which of the following statements regarding Seizures is False?

a. It occurs when there is a paroxysmal synchronous neuronal activity in the Brain
b. 5-10% of the population will have at least one seizure in their lifetime
c. The highest incidence occurs during infancy and early childhood
d. The Electroencephalogram is one of the diagnostic tools for Seizures and Epilepsy

A

c. The highest incidence occurs during infancy and early childhood

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12
Q
  1. A 4- year- old girl presents with her first nonfebrile seizure. Which of the following statements is False?

A. An EEG is recommended.
B. Starting an anti- epileptic drug (AED) is needed and will impact her long- term prognosis.on 2
C. If the risks of medication are less than the risks associated with a second seizure, an AED can be prescribed after the first seizure.
D. If imaging is performed, magnetic resonance imaging (MRI) is preferred to computed tomography (CT).

A

B. Starting an anti- epileptic drug (AED) is needed and will impact her long- term prognosis.on 2

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13
Q
  1. What is the most common generalized epilepsy syndrome in adults?

A. Juvenile absence epilepsy
B. Juvenile myoclonic epilepsy
C. Epilepsy with GTC seizures alone
D. Childhood absence epilepsy

A

B. Juvenile myoclonic epilepsy

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14
Q

. A 30- year- old woman presents in generalized status epilepticus. Which of the following medications should be administered intravenously first?
A. Diazepam
B. Fosphenytoin
C. Levetiracetam
D. Lorazepam

A

D. Lorazepam

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15
Q
  1. Which of the following anti- epileptic medications is broad spectrum?

A. Carbamazepine
B. Ethosuximide
C. Oxcarbazepine
D. Valproic acid

A

D. Valproic acid

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16
Q
  1. Which of the following medications affects sodium channels differently than the others?

A. Phenytoin
B. Lamotrigine
C. Oxcarbazepine
D. Lacosamide

A

D. Lacosamide

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17
Q
  1. Which of the following medications modulates synaptic vesicle protein 2A (SV2A)?

A. Levetiracetam
B. Lacosamide
C. Lamotrigine
D. Valproic acid

A

A. Levetiracetam

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18
Q
  1. Which of the following features is more consistent with psychogenic nonepileptic seizures than with epilepsy?

A. Tongue- biting
B. The event is stereotyped.
C. Prolonged events occur only in public settings.
D. Significant postictal confusion

A

C. Prolonged events occur only in public settings.

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19
Q
  1. You have just admitted a young man with a prior history of seizure disorder who was witnessed to have a seizure. His family’s description suggests a focal seizure involving the left hand that spread to involve the entire arm. He did not lose consciousness. He was brought in 2 hours after symptom onset and is currently awake, alert, and oriented. He has not had any further seizures but has been unable to move his left hand since his seizure. His electrolytes and complete blood count are within normal limits. A non contrast CT scan of his head is unremarkable.On examination, sensation is intact in the affected limb, but his strength is 0 out of 5 in the musculature of the left hand. What is the best course of action at this time?

A. Cerebral angiogram
B. Lumbar puncture
C. Magnetic resonance angiogram
D. Psychiatric evaluation
E. Reassess in a few hours

A

E. Reassess in a few hours

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20
Q
  1. A 37-year-old man is witnessed by his family to have a generalized tonic-clonic seizure at a party. He does not have a known seizure disorder. There is no history of head trauma, stroke, or tumor. The patient is unemployed, married, and takes no medication. Physical examination shows no skin abnormalities and no stigmata of chronic liver or renal disease. The patient is post ictal. His neck is difficult to maneuver due to stiffness.His white blood cell count is 19,000/μL and platelets 200,000/μL. Glucose is 102 mg/dL, sodium 136 meq/dL, calcium 9.5 mg/dL, magnesium 2.2 mg/dL,SGOT 18 U/L, blood urea nitrogen 7 mg/dL, and creatinine 0.8 mg/dL. Which next step is most appropriate in this patient’s management?

A. Plain Cranial CT scan
B. Lumbar puncture
C. Magnetic resonance imaging
D. Substance abuse counseling

A

B. Lumbar puncture

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21
Q
  1. What are the two most common brain tumors of childhood?

A. Medulloblastoma and pilocytic astrocytoma
B. Ependymoma and germinoma
C. Oligodendroglioma and ganglioglioma
D. Schwannoma and meningioma

A

A. Medulloblastoma and pilocytic astrocytoma

22
Q
  1. A 55- year- old woman presents with headache and gradual onset of left lower extremity weakness. MRI shows a ring-enhancing lesion involving the right frontal area, with central necrosis and surrounding edema. Which of the following is your likely diagnosis

A. Glioblastoma multiforme
B. Anaplastic astrocytoma
C. Lymphoma
D. Atypical teratoid/ rhabdoid tumor

A

A. Glioblastoma multiforme

23
Q
  1. Subependymal giant cell astrocytomas (SEGAs) areassociated with which disease?

A. Ataxia- telangiectasia
B. Neurofibromatosis type 1
C. Tuberous sclerosis complex
D. Von Hippel‒Lindau disease

A

C. Tuberous sclerosis complex

24
Q
  1. Loss of heterozygosity (LOH) for 1p and 19q predicts sensitivity to chemotherapy with PCV (procarbazine, lomustine, and vincristine) in which type of tumor?

A. Ependymomas
B. Medulloblastomas
C. Oligodendrogliomas
D. Retinoblastomas

A

C. Oligodendrogliomas

25
Q
  1. A 20- year- old man presents with decreased hearing and unsteadiness. MRI shows mass lesions in the internal auditory canals bilaterally. Pathology shows Antoni A and Antoni B patterns and Verocay bodies. What are these lesions?

A. Ependymomas
B. Schwannomas
C. Meningiomas
D. Central neurocytomas

A

B. Schwannomas

26
Q
  1. In the patient from Number 25, Which of the following diagnoses should be considered?

A. Tuberous sclerosis complex
B. Neurofibromatosis type 1
C. Neurofibromatosis type 2
D. Ménière disease

A

C. Neurofibromatosis type 2

27
Q
  1. The most efficacious single agent in the chemotherapeutic treatment of malignant gliomas is

A. a nitrosourea derivative (BCNU, CCNU)
B. procarbazine
C. temozolomide
D. vincristine

A

C. temozolomide

28
Q
  1. Which of the following statements is true about primary central nervous system lymphoma inimmunocompetent patients?

A. It is more common before age 40.
B. Glucocorticoids should be administrated before stereotactic biopsy.
C. The survival rate significantly improves with tumor resection.
D. The B lymphocyte phenotype is found in more than 80% of cases.

A

D. The B lymphocyte phenotype is found in more than 80% of cases.

29
Q
  1. Which of the following statements is true of Medulloblastoma?

A. It typically arises from the vermis and the roof of the fourth ventricle.
B. Its peak incidence is at the age of 20 years.
C. Hydrocephalus is usually seen late in the course of the disease.
D. Radiotherapy has no benefit in the management of medulloblastoma.

A

A. It typically arises from the vermis and the roof of the fourth ventricle.

30
Q
  1. An 18 year old male student came in to your clinic because of headache, visual field deficits and hypopituitarism. Cranial MRI revealed the presence of a Craniopharyngioma. What is the treatment that you will advise to your patient?

A. Transcranial or Transphenoidal Surgical Resection
B. Transcranial or Transphenoidal Surgical Resection followed by postoperative radiation
C. Transcranial or Transphenoidal Surgical Resection followed by chemotherapy D. Chemotherapy followed by radiotherapy

A

B. Transcranial or Transphenoidal Surgical Resection followed by postoperative radiation

31
Q

31.A 36-year-old man is brought to the emergency department because of a seizure. His family reports he has a history of seizure disorder but stopped his medications a month ago due to financial issues. He had a brief seizure at home that stopped within a few minutes. However, 15minutes later he began seizing again and the tonic-clonic activity has persisted for 30 minutes. On physical examination he is afebrile, hypertensive, and actively seizing.All of the following are potential therapies for his condition EXCEPT:

A. Carbamazepine
B. Lorazepam
C. Phenbarbital
D. Valproic Acid

A

A. Carbamazepine

32
Q
  1. The following are part of the 2017 ILAE Classification of Seizure except:

A. Focal Onset, Aware, Motor Onset
B. Focal Onset Aware, Non-motor Onset
C. Complex Partial Seizure
D. Focal to Bilateral Tonic Clonic Seizure

A

C. Complex Partial Seizure

33
Q
  1. The following are findings that can be seen in Interictal EEG except

A. Sharp Waves
B. Spikes
C. Spikes and Wave
D. Sine Wave

A

D. Sine Wave

34
Q
  1. The following are possible additional features of Focal Motor Seizures except

A. Jacksonian March
B.Todd’s Paralysis
C. Burst Suppression Pattern
D. Epilepsia Partialis Continua

A

C. Burst Suppression Pattern

35
Q
  1. Which of the following is a manifestation of a focal seizure arising from the temporal lobe

A. Vertigo
B. Flashing Lights
C. Visual Hallucinations
D. Deja Vu

A

D. Deja Vu

36
Q
  1. A 10 year old elementary student was brought to you for consult. The mother said that every feeding time, the patient will have episodes of blank stares and seem to be unaware of his environment. The episodes lasts for less than 10 seconds. After which the child is able to go back to feeding as if nothing happened. What is your initial impression for the patient?

A. Juvenile Myoclonic Epilepsy
B. Typical Absence Seizure
C. Atypical Absence Seizure
D. West Syndrome

A

B. Typical Absence Seizure

37
Q
  1. You have advised the patient in number 36 to undergo EEG examination. What is the expected EEG findings for this patient?

A. Burst-Suppression Pattern
B. Generalized Slow Spike and Wave Pattern <2.5 Hz per second
C.Generalized Symmetric 3 Hz Spike and Slow Wave Discharges
D. Generalized Slowing of the Background Activity

A

C.Generalized Symmetric 3 Hz Spike and Slow Wave Discharges

38
Q
  1. What activation procedure in the EEG examination would you expect to most likely provoke a seizure episode in patient number 36?

A. Hyperventilation
B. Sleep Deprivation
C. Photic Stimulation
D. Pain Stimulation

A

A. Hyperventilation

39
Q
  1. The following are true regarding Generalized Tonic Clonic Seizures except:

A. It occurs in about 10% of all persons with epilepsy
B. It is the most common seizure type resulting from metabolic derangements
C. The initial phase is usually tonic contraction of muscles through out the body
D. It is always followed by Todd’s Paralysis after the seizure event

A

D. It is always followed by Todd’s Paralysis after the seizure event

40
Q
  1. the most common cause of Seizure arising in Late Infancy and Early Childhood

A. Inborn Errors of Metabolism
B. Febrile Seizures
C. Trauma
D. Brain Tumor

A

B. Febrile Seizures

41
Q
  1. A 70 year old Male presented at the ER with 6 months history of progressive headache. few hours prior to admission, he had sudden onset of right facial twitching followed by clonic movement of the right upper and lower extremities. There was no loss of consciousness or post-ictal confusion. Which of the following if the most common cause of Seizure in the patient’s Age Group?

A. Trauma
B. CNS Infection
C. Brain Tumor
D. Autoantibodies

A

C. Brain Tumor

42
Q
  1. the following are true regarding the Anatomy of the Cortex except:

A. The human cerebral cortex consists of 3 to 6 layers of neurons
B.The archipallium has 3 distinct neuronal layers, and is represented by the basal ganglia, which is found in the medial temporal lobe
C. The projection neurons form excitatory synapses on post-synaptic neurons
D. The interneurons form inhibitory synapses on nearby neurons

A

B.The archipallium has 3 distinct neuronal layers, and is represented by the basal ganglia, which is found in the medial temporal lobe

43
Q
  1. In seizure, a hyperexcitable state can result from the following except:

A. increased excitatory synaptic neurotransmission
B. alternating inhibitory neurotransmission
C. an alteration in voltage-gated ion channels
D. an alteration of intra- or extra-cellular ion concentrations in favor of membrane depolarization

A

B. alternating inhibitory neurotransmission

44
Q
  1. Which of the following frequencies describe an alpha rhythm

A. <4 Hz
B. 4-7 Hz
C. 8-13 Hz
D. >13 Hz

A

C. 8-13 Hz

45
Q
  1. The most frequent diagnostic dilemma in Seizures

A. Delirium Tremens
B. Basilar Migraine
C. Benign Sleep Myoclonus
D. Syncope

A

D. Syncope

46
Q
  1. The following will increase the likelihood of starting the patient on an Antiepileptic Drug except:

A. Status Epilepticus
B. Todd’s Paralysis
C. Negative Family History
D. Abnormal EEG

A

C. Negative Family History

47
Q
  1. The following are Third Generation Anti-Seizure Drug Except:

A. Phenobarbital
B. Levetiracetam
C. Lacosamide
D. Stiripentol

A

A. Phenobarbital

48
Q

A 24 year old patient presented to you with a history of recurrent Generalized Tonic Clonic Seizure for the last 6 months. She has no previous intake of any Anti-Seizure Drug. Laboratory work-ups were done and she was noted to have a positive Pregnancy Test. The following are her best options for Anti- Seizure Drug except:

A. Lamotrigine
B. Valproic Acid
C. Levetiracetam
D. Topiramate

A

B. Valproic Acid

49
Q
  1. First line Anti-seizure Drug for Typical Absence Seizure

A. Clonazepam
B. Clobazam
C. Primidone
C. Ethosuximide

A

C. Ethosuximide

50
Q
  1. Your 25 year old Seizure patient came for follow-up check up and was inquiring about possible discontinuation of his Anti-Seizure Drug. Which of the following situations would not support your decision in discontinuing the drug?

A. On checking the seizure diary, the patient has been seizure free for 2 years
B. The patient has no family history of seizure/epilepsy
C. On Neurological exam, there was no noted neurologic deficit
D. On repeat EEG, there was occasional spikes noted on the anterior temporal area

A

D. On repeat EEG, there was occasional spikes noted on the anterior temporal area

TIRED YEAR (16 decks)

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