Neurology

Question 1

What are the components of Charcot neurological triad that are associated with multiple sclerosis?

Answer 1

• Nystagmus
• Intention tremor
• Scanning speech

Question 2

A 22-year-old man presents to your office after experiencing a head injury while playing football 3 days ago. He lost consciousness for less than 5 seconds after hitting his head during a tackle. Upon regaining consciousness, he was taken to the hospital for evaluation due to experiencing symptoms of headache, nausea, and mild confusion. Computed tomography of the head was negative for any acute findings. The patient now has questions about return to activity and ongoing health maintenance after a concussion. Which of the following is the most appropriate guidance?

A) Annual brain imaging
B) Cognitive rehabilitation
C) Immediate return to activity
D) Stepwise return to activity

Answer 2

Stepwise return to activity

Question 3

Which cranial nerve is affected in Bell’s Palsy?

Answer 3

Cranial Nerve VII (facial nerve)

Question 4

What is the most common cause of Bell’s Palsy?

Answer 4

Idiopathic, though herpes simplex virus (HSV) reactivation is commonly suspected

Question 5

What is the first line treatment for Bell’s Palsy?

Answer 5

Corticosteroids (prednisone)

Question 6

What is a key distinguishing feature of Bell’s Palsy from a central cause of facial weakness (e.g., stroke)?

Answer 6

Bell’s Palsy affects both the upper and lower face, whereas central causes spare the forehead.

Question 7

A 35-year-old woman presents with sudden onset right-sided facial weakness. She is unable to raise her right eyebrow or close her right eye. She denies limb weakness or speech difficulties. Physical examination reveals complete right-sided facial paralysis, including the forehead. Which of the following is the most likely diagnosis?

A) Stroke
B) Bell’s Palsy
C) Myasthenia gravis
D) Multiple sclerosis

Answer 7

Bell’s Palsy

Bell’s Palsy causes peripheral facial paralysis, affecting both the upper and lower face. The inability to raise the eyebrow and close the eye suggests a lower motor neuron lesion of the facial nerve.

Question 8

A 45-year-old man presents with sudden onset left-sided facial weakness. He reports difficulty closing his left eye and raising his left eyebrow. He was recently treated for a cold sore. What is the most appropriate initial treatment for this patient?

A) Antibiotics
B) Antiviral therapy alone
C) High-dose corticosteroids
D) Low-dose corticosteroids and antiviral therapy

Answer 8

Low-dose corticosteroids and antiviral therapy

The recommended treatment for Bell’s Palsy includes corticosteroids to reduce inflammation, and antivirals may be considered, especially if there is evidence of a viral trigger such as herpes simplex.

Question 9

A 50-year-old woman presents with sudden right-sided facial paralysis and difficulty closing her right eye. She also reports dry eyes and decreased tear production on the affected side. What is the most important next step in managing her dry eyes?

A) Oral corticosteroids
B) Surgical intervention
C) Artificial tears and eye patching
D) Antiviral therapy

Answer 9

Artificial tears and eye patching

Bell’s Palsy can impair the ability to close the eye, leading to dry eyes and potential corneal damage. Artificial tears and eye patching are necessary to protect the eye from drying and injury.

Question 10

A 40-year-old male presents with right-sided facial paralysis that began 2 days ago. He cannot close his right eye or smile on the right side. He has no history of trauma or previous neurological deficits. Examination reveals right-sided lower motor neuron facial weakness. Which of the following clinical signs helps distinguish Bell’s Palsy from a stroke?

A) Facial droop involving the entire face, including the forehead
B) Sudden onset of symptoms
C) Absence of headache or altered mental status
D) Involvement of the upper extremities

Answer 10

Facial droop involving the entire face, including the forehead

Question 11

A 34-year-old man presents with acute onset left-sided facial paralysis. He is diagnosed with Bell’s Palsy. Which of the following best describes the pathophysiology of this condition?

A) Demyelination of the facial nerve
B) Inflammation and edema of the facial nerve
C) Autoimmune destruction of the facial nerve
D) Ischemia of the facial nerve

Answer 11

Inflammation and edema of the facial nerve

Question 12

What is the inheritance pattern of Huntington Disease?

Which type of genetic mutation causes Huntington Disease?

Answer 12

Autosomal Dominant

Trinucleotide (CAG) repeat expansion on chromosome 4

Question 13

What are the three primary clinical features of Huntington Disease?

At what age do symptoms typically present?

Answer 13

• Motor Dysfunction (chorea)
• Cognitive Decline
• Psychiatric symptoms

Between 30 and 50 years of age

Question 14

What is the definitive test for diagnosing Huntington disease?

Answer 14

Genetic testing to identify the CAG repeat expansion in the HTT gene.

Question 15

A 45-year-old man presents with involuntary jerking movements, irritability, and difficulty with memory and concentration. His father had a similar condition and died at age 55. On physical exam, he has choreiform movements of the upper extremities. Which of the following is the most likely diagnosis?

A) Parkinson’s disease
B) Huntington disease
C) Amyotrophic lateral sclerosis (ALS)
D) Multiple sclerosis

Answer 15

Huntington’s Disease

The patient presents with chorea, cognitive decline, and a family history consistent with Huntington disease, an autosomal dominant neurodegenerative disorder.

Question 16

A 40-year-old woman with a family history of Huntington disease is experiencing mood swings, irritability, and mild memory problems. She is worried she may have inherited the condition. Which of the following tests would confirm the diagnosis?

A) MRI of the brain
B) Serum C-reactive protein
C) Genetic testing for CAG repeat expansion
D) Electromyography (EMG)

Answer 16

Genetic testing for CAG repeat expansion

Genetic testing is the definitive method for diagnosing Huntington disease by detecting the CAG repeat expansion in the HTT gene.

Question 17

A 50-year-old man with Huntington disease presents with worsening motor symptoms, including involuntary movements and gait instability. He also reports increased irritability and difficulty concentrating. What is the best treatment option for managing his chorea?

A) Levodopa
B) Tetrabenazine
C) Donepezil
D) Carbamazepine

Answer 17

Tetrabenazine

Tetrabenazine is commonly used to manage the chorea associated with Huntington disease by depleting dopamine and reducing involuntary movements.

Question 18

A 46-year-old man with Huntington disease presents with progressive difficulty walking and frequent falls. MRI of the brain reveals atrophy of the caudate nucleus. Which of the following best explains the pathophysiology of Huntington disease?

A) Degeneration of dopaminergic neurons in the substantia nigra
B) Loss of lower motor neurons in the anterior horn of the spinal cord
C) Atrophy of the caudate nucleus and putamen in the basal ganglia
D) Demyelination of white matter in the central nervous system

Answer 18

Atrophy of the caudate nucleus and putamen in the basal ganglia

Question 19

What is the characteristic location of pain in cluster headaches?

What is the typical duration of cluster headaches?

Answer 19

Unilateral, typically around the eye or temporal

15 minutes to 3 hours

Question 20

What is the first-line abortive treatment for cluster headaches?

Answer 20

100% oxygen therapy

Question 21

What is a common autonomic symptom associated with cluster headache?

Answer 21

Lacrimation, rhinorrhea, or ptosis on the affected side

Question 22

What is the first-line prophylactic medication for preventing cluster headaches?

Answer 22

Verapamil

Question 23

A 30-year-old male presents to the emergency department with intense, right-sided orbital pain, tearing, and nasal congestion. The pain started 45 minutes ago and is unbearable. He has had similar episodes over the past few days. Which of the following findings is typically associated with this condition?

A) Bilateral eye tearing
B) Mydriasis (pupil dilation)
C) Horner’s syndrome (ptosis, miosis, anhidrosis)
D) Vision loss

Answer 23

Horner’s Syndrome (ptosis, miosis, anhidrosis)

Cluster headaches are associated with autonomic symptoms on the affected side, including Horner’s syndrome, which involves ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (loss of sweating).

Question 24

What is the most common initial presentation of multiple sclerosis?

Answer 24

Optic neuritis (painful vision loss) or sensory disturbances (numbness or tingling)

Question 25

Which diagnostic test is most useful in confirming a diagnosis of multiple sclerosis?

Answer 25

MRI of the brain and spinal cord with gadolinium, showing demyelinating lesions

Question 26

What is the hallmark finding in the cerebrospinal fluid (CSF) of patients with multiple sclerosis?

Answer 26

Oligoclonal Bands

Question 27

What is the primary treatment for acute exacerbations of multiple sclerosis?

Answer 27

High-dose corticosteroids (methylprednisolone)

Question 28

What class of medications is commonly used for long-term disease-modifying treatment in multiple sclerosis?

Answer 28

Disease-modifying therapies (DMTs), such as interferon beta or glatiramer acetate.

Question 29

A 32-year-old woman presents with sudden onset of vision loss in her right eye, associated with pain when moving her eye. She also reports tingling in her legs and difficulty with balance. MRI of the brain shows multiple hyperintense lesions in the periventricular area. What is the most likely diagnosis?

A) Guillain-Barré syndrome
B) Multiple sclerosis
C) Myasthenia gravis
D) Transverse myelitis

Answer 29

Multiple Sclerosis

Question 30

A 34-year-old man with a diagnosis of relapsing-remitting multiple sclerosis presents with a new onset of leg weakness and difficulty walking. MRI shows new lesions in the spinal cord. Which of the following is the most appropriate treatment for his acute exacerbation?

A) Methotrexate
B) High-dose intravenous corticosteroids
C) Plasma exchange
D) Intravenous immunoglobulin (IVIG)

Answer 30

High-dose intravenous corticosteroids

Question 31

A 36-year-old woman with multiple sclerosis presents with worsening muscle spasticity in her legs. Her walking has become more difficult, and she has increased stiffness and spasms. Which of the following is the most appropriate treatment for managing her spasticity?

A) Diazepam
B) Baclofen
C) Gabapentin
D) Prednisone

Answer 31

Baclofen

Baclofen is a muscle relaxant commonly used to manage spasticity in patients with multiple sclerosis, helping to reduce muscle stiffness and improve mobility.

Question 32

A 29-year-old woman presents with blurred vision, double vision, and sensory disturbances in her legs. She is diagnosed with multiple sclerosis. Which of the following best describes the underlying pathophysiology of multiple sclerosis?

A) Autoimmune destruction of peripheral nerves
B) Immune-mediated demyelination of the central nervous system
C) Accumulation of amyloid plaques in the brain
D) Degeneration of motor neurons in the spinal cord

Answer 32

Immune-mediated demyelination of the central nervous system

Question 33

What is the typical duration of symptoms in a transient ischemic attack (TIA)?

Answer 33

Symptoms typically last less than 24 hours, often resolving within minutes to an hour

Question 34

What is the most common cause of TIA?

Answer 34

Atherosclerosis leading to transient occlusion of cerebral blood flow

Question 35

What imaging modality is most commonly used to assess for acute ischemic changes in a TIA?

Answer 35

MRI with diffusion-weighted imaging (DWI)

Question 36

What is the first-line medication for secondary prevention after a TIA?

Answer 36

Antiplatelet therapy (ASA or clopridogrel)

Question 37

A 65-year-old man presents to the emergency department with sudden onset of left-sided weakness and slurred speech that resolved spontaneously after 30 minutes. He has a history of hypertension and smoking. Physical exam is now normal. CT scan of the head shows no acute abnormalities. What is the most likely diagnosis?

A) Stroke
B) Transient ischemic attack (TIA)
C) Migraine with aura
D) Bell’s palsy

Answer 37

TIA

Question 38

A 72-year-old woman presents with right-sided weakness and difficulty speaking, which lasted 15 minutes before resolving. She has a history of hypertension and diabetes. Her ABCD² score is 5. Which of the following is the most appropriate next step?

A) Discharge with outpatient follow-up
B) Start anticoagulation immediately
C) Admit for further workup and observation
D) Order carotid angioplasty

Answer 38

Admit for further workup and observation

An ABCD² score of 5 indicates a moderate to high risk of stroke, warranting hospital admission for further evaluation, including imaging, echocardiogram, and monitoring for recurrent events.

Question 39

A 68-year-old man presents with a history of transient left-sided weakness and slurred speech that lasted 20 minutes. He is diagnosed with a TIA. Which of the following medications should be initiated to prevent future strokes?

A) Warfarin
B) Clopidogrel
C) Heparin
D) Acetaminophen

Answer 39

Clopidogrel

Antiplatelet therapy, such as aspirin or clopidogrel, is recommended for secondary stroke prevention in patients who have had a TIA and are not candidates for anticoagulation.

Question 40

A 70-year-old man presents with transient weakness in his left arm and leg that resolved within 30 minutes. He has a history of coronary artery disease and hypertension. Which of the following best explains the underlying pathophysiology of a transient ischemic attack (TIA)?

A) Ischemia caused by temporary occlusion of a cerebral artery
B) Hemorrhage in the subarachnoid space
C) Inflammation of the cerebral vessels
D) Compression of cranial nerves due to mass effect

Answer 40

Ischemia caused by temporary occlusion of a cerebral artery

A TIA is caused by a temporary reduction in blood flow to the brain, often due to emboli or thrombosis, leading to transient ischemia without permanent damage.