Neurology

Question 1

A patient presents with a three day history of parasthesia in the lower extremities and now complains that his legs are “weak”. On exam, you find the achilles reflex to be absent, and the patellar reflexes are profoundly weak bilaterally. The medical history is unremarkable, except for an upper respiratory infection one week ago. Which test would be most useful in confirming your clinical suspicion?

Answer 1

Lumbar puncture

Question 2

A patient presents with a three day history of parasthesia in the lower extremities and now complains that his legs are “weak”. On exam, you find the achilles reflex to be absent, and the patellar reflexes are profoundly weak bilaterally. The medical history is unremarkable, except for an upper respiratory infection one week ago. LP shows elevated protein, but normal WBC counts. What is the most likely diagnosis?

Answer 2

Guillain-Barre Syndrome

Question 3

A 62 year-old male with a history of T2DM and HTN presents with facial droop, dysarthria, and right-sided hemiplegia that onset acutely two hours ago. Head CT is unremarkable. Assuming that there are no contraindications, which medication is most likely to benefit this patient?

Answer 3

tPA

Question 4

A patient presents with resting tremor that is noticeably worse on the left side. On exam, you find that the upper extremities demonstrate a “cogwheel” rigidity, but muscle strength is normal. You also note that the patient walks with a shuffling gait. What is the most likely diagnosis?

Answer 4

Parkinson’s disease

Question 5

A patient presents with chorea, irritability, and depression. On exam, you note hypotonia and hyper-reflexiveness. FH is remarkable for a maternal grandfather who also developed chorea, but died from suicide. Which finding on MRI would most help confirm your clinical suspicion?

Answer 5

Caudate atrophy

Question 6

A patient presents with kinetic tremor that is aggravated by stress and palliated with alcohol. Which class of medication is most likely to be of benefit to this patient?

Answer 6

beta blockers

Question 7

A patient presents with moderate unilateral, throbbing headaches and associated nausea that have occurred weekly for the past year. This patient’s condition ______ (does/does not) meet migraine criteria, most likely ______ (is/is not) associated with aura, and should be treated with abortive medications. Prophylactic treatment ______ (is/is not) indicated.

Answer 7

does, is not, is not

Question 8

A 30 year-old male patient presents with severe right-sided supraorbital headaches that have occurred 10 times in the past year. The patient reports that the headaches are often associated with drinking alcohol and that he often notices that his right eye is red and tears during the headaches. What is the most likely diagnosis?

Answer 8

Cluster headache

Question 9

A 18 year-old obese female presents with headache, blurred vision, and pulsating tinnitus. On exam, you note papilledema. Past medical history is unremarkable, except for acne treatment with tetracycline. There is no history of trauma and imaging is negative for mass lesions. What is the most likely diagnosis?

Answer 9

Idiopathic intracranial hypertension

Question 10

An unimmunized adult patient presents with headache, fever to 102 F, photohobia, and vomiting. There is a +Kernig’s sign. LP analysis shows low glucose and elevated protein. What is the most likely diagnosis?

Answer 10

Bacterial meningitis

Question 11

An unimmunized adult patient presents with headache, fever to 102 F, photohobia, and vomiting. There is a +Kernig’s sign. LP analysis shows low glucose and elevated protein. What are the two most common pathogens that might be to blame?

Answer 11

S. pneumoniae, N. Meningitidis

Question 12

An unimmunized adult patient presents with headache, fever to 102 F, photohobia, and vomiting. There is a +Kernig’s sign. LP analysis shows low glucose and elevated protein. What three medications might you start immediately?

Answer 12

Ceftriaxone, doxycycline, dexamethasone

Question 13

A 70 year-old patient with a history of HTN and Afib presents with acutely onset aphasia and unilateral motor deficits. What is the most appropriate imaging study for this patient?

Answer 13

head CT

Question 14

A patient with a history of DM and HTN presents with pain, weakness, and a “pins and needles” feeling in the hands and feet. Which two drugs are most likely to benefit this patient?

Answer 14

Gabapentin, amitriptyline

Question 15

A patient presents with a sudden onset of what she describes as “the worst headache of my life”. What is the most serious condition in your differential diagnosis?

Answer 15

Subarrachnoid hemorrhage

Question 16

A patient presents with acutely altered mental status following a three-day history of mild headache, myalgia, and fever. Kernig’s and Brudzinski’s signs are negative. What is the most likely diagnosis?

Answer 16

Encephalitis

Question 17

A patient presents with acutely altered mental status following a three-day history of mild headache, myalgia, and fever. Kernig’s and Brudzinski’s signs are negative. What is the drug of choice in treating this condition?

Answer 17

Acyclovir

Question 18

A 30 year-old female presents with exercise intolerance for the past six months. She states that even brushing her hair is exhausting. On exam, you note bilateral ptosis. What key finding do you expect to find on serology?

Answer 18

anti-AChR antibodies

Question 19

A patient presents with progressive weakness of the extremities with normal sensation. On exam, you note some muscle atrophy and hyperreflexia. Babinski reflex is positive. What is the most likely diagnosis?

Answer 19

ALS

Question 20

A 72 year-old male with a history of lung cancer presents with newly onset seizures. What is the diagnostic study of choice for this presentation?

Answer 20

brain MRI

Question 21

You are evaluating a patient for a suspected cerebral aneurysm. What is the gold standard test for this condition?

Answer 21

Angiogram

Question 22

You are evaluating a patient with an incidentally discovered 12 mm saccular cerebral aneurysm. Which two neurosurgical procedures might be used to treat this condition?

Answer 22

Clipping

Coiling

Question 23

A 14 year-old unhelmeted male falls from a skateboard, hits the side of his head against the pavement, and loses consciousness for about a minute. He regains consciousness for 15 minutes before becoming unresponsive again. This is a classic presentation of ______ ______, most likely due to laceration of the ______ ______ ______ secondary to a fracture of the ______ bone.

Answer 23

Epidural hematoma
Middle meningeal artery
Temporal

Question 24

A 14 year-old unhelmeted male falls from a skateboard, hits the side of his head against the pavement, and loses consciousness for about a minute. He regains consciousness for 15 minutes before becoming unresponsive again. Bystanders call 911. On EMS arrival, the patient is unresponsive with decerebrate posturing. BP is 215/120, HR is 42, respirations are irregular, and there is a unilateral pupil dilation. What complication of cerebral hemorrhage has occurred?

Answer 24

Herniation