Neurology - Headache and pain(100) Flashcards

1
Q

NEU - 2.1
What is the most prevalent type of primary headaches?
A) Tension-type headache
B) migraine without aura
C) cluster headache
D) migraine with aura

A

ANSWER
A) Tension-type headache

EXPLANATION
according to epidemiological data

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2
Q

NEU - 2.2
Characteristic features of migraine, except:
A) pulsating pain
B) mostly unilateral
C) physical activity increases the intensity
D) dizziness
E) duration is 4–72 hours

A

ANSWER
D) dizziness

EXPLANATION
The dissiness is not among the criteria of migraine (not a characteristic feature of migraine) according to the International Headache Society

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3
Q

NEU - 2.3
The average duration of migraine attacks is:
A) less, than 4 hours
B) 0.5-1 day
C) 4 days
D) one week

A

ANSWER
B) 0.5-1 day

EXPLANATION
The duration of the migraine is 4-72 hours (International Headache Society)

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4
Q

NEU - 2.4
What is the prevalence of migraine in adults?
A) 1–2%
B) 5–7%
C) 8–12%
D) more, than 20%

A

ANSWER
C) 8–12%

EXPLANATION
According to epidemiological data

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5
Q

NEU - 2.5
Which accompanying sign is not a diagnostic feature of migraine?
A) nausea, vomiting
B) phonophobia
C) photophobia
D) osmophobia (hypersensitivity to odors)

A

ANSWER
D) osmophobia (hypersensitivity to odors)

EXPLANATION
Osmophobia is not a diagnostic feature of migraine (International Headache Society)

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6
Q

NEU - 2.6
Which primary headache is more prevalent in males than in females?
A) migraine with aura
B) migraine without aura
C) tension-type headache
D) cluster headache

A

ANSWER
D) cluster headache

EXPLANATION
According to clinical observations, cluster headache is more prevalent in males than in females (among the primary headaches)

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7
Q

NEU - 2.7
The onset of primary headaches may be, except:
A) in childhood
B) at young age (in the 2–3. decades)
C) in the 4th decade
D) above 60. years

A

ANSWER
D) above 60. years

EXPLANATION
Headache that occurs in the 5th decade or later refers to symptomatic headache.

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8
Q

NEU - 2.8
Accompanying signs of cluster headache, except:
A) miosis
B) ptosis
C) conjunctival injection
D) paraesthesia on the contralateral side of the headache
E) bradycardia

A

ANSWER
D) paraesthesia on the contralateral side of the headache

EXPLANATION
Hemiparaesthesia doesn’t occure in cluster headache

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9
Q

NEU - 2.9
What is the menstrual migraine?
A) subtype of migraine with a specific condition where the timing of attacks is linked to the menstrual cycle
B) migraine, where at least one of the attacks occurs during menstrual period
C) the most severe headaches occur during menstrual period
D) headaches exclusively occur between the menarche and climax

A

ANSWER
A) subtype of migraine with a specific condition where the timing of attacks is linked to the menstrual cycle

EXPLANATION
The term means that menstrual migraine is a subtype of migraine with a specific condition where the timing of attacks is linked to the menstrual cycle exclusively

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10
Q

NEU - 2.10
What is the characteristic nerve conduction velocity of unmyelinitaed pain-transmitting C fibers?
A) 70–120 m/s
B) 70–100 m/s
C) 15–40 m/s
D) 0.2–2 m/s

A

ANSWER
D) 0.2–2 m/s

EXPLANATION
According to electrophysiological data

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11
Q

NEU - 2.11
What is lateral cordotomy?
A) lesion in the ventral posterolateral nucleus of the thalamus
B) incision of the posterior funiculus in the spinal cord
C) a surgical procedure that injures the spinothalamic lateral tract in the spinal cord
D) electric stimulation of periaqueductal gray matter in the brainstem in order to alleviate severe pain

A

ANSWER
C) a surgical procedure that injures the spinothalamic lateral tract in the spinal cord

EXPLANATION
Incision of the spinothalamic lateral tract in the spinal cord in order to achieve loss of pain

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12
Q

NEU - 2.12
Abdominal lancinating pain is a characteristic sign of:
A) spinal cord disease
B) tabes dorsalis
C) trigeminal-neuralgia
D) multiple mononeuritis

A

ANSWER
B) tabes dorsalis
EXPLANATION
Lancinating pain is a symptom of lues when granulomatous inflammation infiltrate posterior roots of thoracic spine and ganglion coeliacum and cause pain with sharp quality and very short duration

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13
Q

NEU - 2.13
What can not be the cause of trigeminal neuralgia?
A) idiopathic origin
B) multiple sclerosis
C) somatoform disturbance
D) cancer

A

ANSWER
C) somatoform disturbance

EXPLANATION
Trigeminal neuralgia is well localized, is very sharp and is a triggered pain with a duration of a couple of seconds. It can be idiopahic or symptomatic.

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14
Q

NEU - 2.14
What is the difference between neuralgic and radicular pain?
A) characteristics of the pain
B) intensity of the pain
C) the pain can not be well localized
D) duration of the pain

A

ANSWER
D) duration of the pain

EXPLANATION
The radicular pains have longer duration and are costant, it can be povoked by stretching of the root (Lasegue sign) and increased abdimonal pressure (coughing, sneezing). Neuralgic pain lasts for seconds, is sharp, can be triggered, and is restricted to one nerve supply.

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15
Q

NEU - 2.15
What is the diagnosis of the case:
The patient has paroxysmal attacks with lancinating pain, restricted always to one side of the throat, back of the tongue, tonsil and ear. The pain lasts for seconds and can be triggered by swallowing (drinking liquids).
A) trigeminal-neuralgia
B) glossopharyngeal-neuralgia
C) occipital-neuralgia
D) tonsillitis

A

ANSWER
B) glossopharyngeal-neuralgia

EXPLANATION
Localisation of the pain suggests the region innervated by glossopharyngeal-nerve

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16
Q

NEU - 2.16
Which one is contraindicated for migraine prophylaxis?
A) antihistamine, antiserotonine drugs
B) anticonvulsants
C) calcium channel blockers
D) ergotamine, dihydroergotamine preparations

A

ANSWER
D) ergotamine, dihydroergotamine preparations

EXPLANATION
Ergotamine, dihydroergotamine preparations can be used only to treat acute migraine attacks with limited frequency and amount because of the danger of ergotism and status migrainosus.

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17
Q

NEU - 2.17
Useful in acute cluster headache, except for:
A) O2 inhalation
B) indometacine
C) sumatriptane
D) lithium

A

ANSWER
D) lithium

EXPLANATION
Lithium is not effective in acute cluster headache, only for prophylaxis.

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18
Q

NEU - 2.18
Which one is effective in prophylaxis of cluster headache?
A) beta blockers
B) minor analgesics
C) calcium channel blockers
D) tricyclic antidepressants

A

ANSWER
C) calcium channel blockers

EXPLANATION
Verapamil, a calcium channel blocker was proved to be effective for cluster headache prophylaxis.

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19
Q

NEU - 2.19
It can be effective in the treatment of tension type headache:
A) antihistamines
B) antihypertensives
C) tricyclic antidepressants
D) MAO-inhibitors

A

ANSWER
C) tricyclic antidepressants

EXPLANATION
Low dose prolonged use of tricyclic antidepressants is proved for the preventive treatment of tension type headache.

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20
Q

NEU - 2.20
A 45-year-old men lifting a heavy object experienced a sudden low back pain. The pain irradiates to his right buttock, posterior thigh, popliteal region and little toe. Upon examination he had Lasegue sign on the right side, missing right Achilles reflex and hypaesthesia of the little toe. Which root is affected?
A) L2 root
B) L3 root
C) L4 root
D) L5 root
E) S1 root

A

ANSWER
E) S1 root

EXPLANATION
Localisation of the pain, Lasegue positivity, loss of Achilles reflex and the hypaesthesia suggest S1 root involvement.

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21
Q

NEU - 2.21
First choice of treatment for trigeminal neuralgia is:
A) clonazepam
B) alcoholic ganglion infiltration
C) carbamazepine
D) retroganglionar neurotomy
E) none of them

A

ANSWER
C) carbamazepine

EXPLANATION
According to the guidelines carbamazepine in adequate dose is the most effective drug for the treatment of neuralgic pain. If carbamazepine monotherapy fails, combination with gabapentin is recommended.

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22
Q

NEU - 2.22
Which symptom can be caused by unruptured intracranial aneurysm?
A) signs of oculomotor nerve lesion
B) visual field defect
C) ipsilateral recurring headache
D) ipsilateral facial pain
E) all of them

A

ANSWER
E) all of them

EXPLANATION
All of the mentioned complains and symptoms may occur.

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23
Q

NEU - 2.23
A 50-year-old man experienced a sudden-onset headache during physical exercise with stiff neck, seizures, oculomotor nerve palsy and quickly developed coma. The probable diagnosis is:
A) bacterial meningitis
B) spontaneous aneurysmal subarachnoid haemorrhage
C) ruptured brain abscess
D) haemorrhage in a glioma
E) brain metastasis

A

ANSWER
B) spontaneous aneurysmal subarachnoid haemorrhage

EXPLANATION
Acute complaints and disturbance of consciousness in a middle-aged man during physical exercise suggest subarachnoid haemorrhage. The most probable source of the bleeding is a ruptured intracranial aneursym.

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24
Q

NEU - 2.24
The least typical statement for temporal arteritis:
A) steroid treatment can only be administered if biopsy confirmed the diagnosis
B) occurs above 50 years of age
C) a subtype of giant cell arteritis
D) characterized by headache, elevated erythrocyte sedimentation rate

A

ANSWER
A) steroid treatment can only be administered if biopsy confirmed the diagnosis

EXPLANATION
Steroid treatment should be started promptly once the diagnosis is suspected because of the danger of visual loss.

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25
Q

NEU - 2.25
Characteristic for alcoholic polyneuopathy:
A) persistent lancinating pain
B) sensory disturbance of the lower extremities, diminished reflexes
C) no vegetative symptoms
D) normal conduction velocity of the peroneal nerve
E) hyperthermia

A

ANSWER
B) sensory disturbance of the lower extremities, diminished reflexes

EXPLANATION
Typical signs of alcoholic polyneuropathy: numbness and burning pain in the leg, foot and sole, hypaesthesia in all of the sensory functions with a distal predominance, and diminished or absent deep tendon reflexes.

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26
Q

NEU - 2.26
Typical in Wallenberg syndrome:
A) contralateral pain
B) ipsilateral hypalgesia
C) contralateral hemihypalgesia
D) ipsilateral facial hypalgesia and contralateral hypalgesia below C2

A

ANSWER
D) ipsilateral facial hypalgesia and contralateral hypalgesia below C2

EXPLANATION
Wallenberg sy is caused by lesion of the dorsolateral medulla oblongata (territory of the posterior inferior cerebellar artery). The decussated spinothalamic and not yet decussated descending trigeminal tract is located at this region, lesion of them results in crossed (alternating) sensory loss (below C2 on the contralateral side of the body and ipsilaterally on the face: algetic, tactile and thermal hypaesthesia).

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27
Q

NEU - 2.27
What is dissociated sensory loss?
A) loss of pain sensation, but temperature sensation is intact
B) pain sensation is intact, but loss of temperature sensation
C) pain sensation is intact, but loss of temperature, vibration and joint position sense
D) loss of pain and temperature sensation, but vibration and joint position sense intact

A

ANSWER
D) loss of pain and temperature sensation, but vibration and joint position sense intact

EXPLANATION
In the daily clinical practice dissociated sensory loss means lesion of the spinothalamic tract, with preserved posterior column function, so it is equal to syringomyelic sensory loss.

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28
Q

NEU - 2.28
Bending down the head worsens the headache, if it is caused by:
A) glaucoma
B) maxillary sinusitis
C) tension type headache
D) cluster headache

A

ANSWER
B) maxillary sinusitis

EXPLANATION
Headache caused by sinusitis typically worsens with bending down. Consequent venous congestion may be the explanation.

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29
Q

NEU - 2.29
Symmetric burning, stabbing pain at the distal part of the extremities, especially on the legs typical for:
A) polyneuropathy
B) radiculitis
C) myositis
D) Lambert–Eaton syndrome

A

ANSWER
A) polyneuropathy

EXPLANATION
Type and localization of the pain suggests polyneuropathy.

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30
Q

NEU - 2.30
Typical in migraine, except for:
A) unilateral in more than half of the cases
B) frequently vegetative symptoms
C) EEG always negative
D) ocular symptom in ophtalmoplegic migraine may last for several days
E) frequently aspirin is effective

A

ANSWER
C) EEG always negative

EXPLANATION
Aspecific EEG alterations may be observed in migraine patients.

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31
Q

NEU - 2.31
80 years old alcoholic patient fell and had a head injury one month ago, he has complained headache for 2-3 weeks, and has developed a progressing left sided hemiparesis and anisocoria. The most likely diagnosis is:
A) cerebral contusion
B) right sided frontal lobe glioblastoma
C) right sided subdural haematoma
D) occlusion of the right sided middle cerebral artery

A

ANSWER
C) right sided subdural haematoma

EXPLANATION
The previously suffered head trauma, clinical symptoms (headache, left hemiparesis), anamnestic data (old age, regular alcohol consumption) refer to subdural haematoma.

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32
Q

NEU - 2.32
Shooting pain, dysuria, ataxia associated with pupil disorder, areflexia, and proprioceptiv sensory disturbance suggest the following disease:
A) Mixed connective tissue disease
B) Tabes dorsalis
C) Multiple sclerosis
D) Syringomyelia

A

ANSWER
B) Tabes dorsalis

EXPLANATION
The symptoms described are typical for tabes dorsalis.

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33
Q

NEU - 2.33
Trigeminal-neuralgia is the least common in the following division of the trigeminal nerve:
A) V/2
B) V/3
C) V/1
D) V/2 + V/3

A

ANSWER
C) V/1

EXPLANATION
V/1 localisation is the rarest form in primary (idiopathic) trigeminal neuralgia.

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34
Q

NEU - 2.34
A 54-year-old hypertonic male patient presented with sudden onset of vertigo, headache and vomiting. At the examination the patient was alert, he had nystagmus and one sided limb ataxia without paresis. Which diagnosis is the most likely?
A) pons bleeding
B) bleeding in the internal capsule
C) cerebellar bleeding
D) subarachnoideal haemorrhage
E) basilar artery aneurysm

A

ANSWER
C) cerebellar bleeding

EXPLANATION
Symptoms of cerebellar haemorrhage are repeated vomiting, headache in the nuchal region, dizziness, nystagmus, cerebellar ataxia. A sudden tonsillar herniation is the most dangerous risk of cerebellar bleeding, which refers to a bad prognosis even in case of surgical intervention.

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35
Q

NEU - 2.35
What is the order of the appearance of herpes zoster symptoms:
A) pain-vesicles-pigmentation
B) vesicles–pigmentation–pain
C) pain–pigmentation–vesicles
D) pigmentation– vesicles–pain
E) vesicles–pain–pigmentation

A

ANSWER
A) pain-vesicles-pigmentation

EXPLANATION
Radicular pain may precede the diagnostic skin lesions (vesicles) by days.

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36
Q

NEU - 2.36
Herpes zoster most often affects the:
A) ganglion geniculi
B) the maxillary division of the trigeminal nerve
C) the cervical region
D) the thoracic region
E) the lumbar region

A

ANSWER
D) the thoracic region

EXPLANATION
The characteristic localisation is the trunk, the Hungarian name ’shingles’ refer to this location. Among the localisations listed, the thoracic region (chest) is the most common.

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37
Q

NEU - 2.37
Childhood head injury is frequently associated with the following symptom(s):
A) vertigo
B) epileptic seizure
C) headache
D) all of them
E) none of them

A

ANSWER
D) all of them

EXPLANATION
According to clinical observations childhood head injury is frequently associated with vertigo, epileptic seizure and headache.

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38
Q

NEU - 2.38
The first symptom(s) of the brain tumor in childhood:
A) seizure and coma
B) change of behavior
C) headache and vomiting
D) hemiparesis and hyperreflexia
E) none of them

A

ANSWER
C) headache and vomiting

EXPLANATION
In childhood, posterior fossa tumors are frequent, therefore the C answer is the most appropriate.

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39
Q

NEU - 2.39
In a 31-year-old man constant bifrontal headache and blurred vision has been present for 2 weeks. In the last 1 week he became somnolent, sometimes he slept 20 hours. In a previous history, there was an accident 3 months ago, when he fell down from a moving vehicle and he hit his head, the skin of the skull was lacerated. During the examination bilateral papilla edema, dilated right pupil and left hemiparesis were observed. The most probable diagnosis is:

A) dementia paralytica
B) chronic subdural haematoma
C) bromine intoxication
D) brain haemorrhage

A

ANSWER
B) chronic subdural haematoma

EXPLANATION
The accident, headache, somnolence, signs of increased intracranial pressure and the focal signs suggest a suspicion of chronic subdural haematoma.

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40
Q

NEU - 2.41
Which disease is associated with the following signs and symptoms: headache, anemia, polymyalgia rheumatica, increased erythrocyte sedimentation rate (ESR), jaw claudication, low fever and leukocytosis?
A) meningitis tubercolosa
B) lupus erythematosus
C) arteritis temporalis

A

ANSWER
C) arteritis temporalis

EXPLANATION
The symptoms suggest temporal arteritis.

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41
Q

NEU - 2.42
Which is true for cerebral venous thrombosis:
A) epileptic seizure occurs rarely
B) there is a septic focus or inflammation in the background
C) headache and delirium are common, disturbance of consciousness and seizure are rare
D) there is no headache or vomiting
E) focal neurological symptoms are rare

A

ANSWER
B) there is a septic focus or inflammation in the background

EXPLANATION
The A, C., D, E answers are wrong.

42
Q

NEU - 2.43
The most typical feature(s) in cerebral aneurysm rupture is/are:
A) sudden onset of headache, vomiting and sometimes disturbance of consciousness
B) typically occurs in the morning
C) the liquor is not diagnostic
D) hemiparesis
E) the liqour is xanthochrome immediately after the rupture of the aneurysm

A

ANSWER
A) sudden onset of headache, vomiting and sometimes disturbance of consciousness

EXPLANATION
Only the A answer is correct, the others are false.

43
Q

NEU - 2.44
Characteristics for brain tumors:
A) the symptoms are usually progressive and are associated with headache and signs of increased intracranial pressure
B) liquor is always abnormal
C) at least 2/3 of the brain tumors are metastases
D) although the glioblastoma multiforme is malignant but circumscribed
E) the brain tumors make up nearly one-third of all tumors

A

ANSWER
A) the symptoms are usually progressive and are associated with headache and signs of increased intracranial pressure

EXPLANATION
Only the A answer is correct, the others are false.

44
Q

NEU - 2.45
Which of the following diseases does not cause chronic progressive headache:
A) thrombosis of superior sagittal sinus
B) migraine
C) hydrocephalus non-communicans
D) intracranial space occupying lesion

A

ANSWER
B) migraine

EXPLANATION
Migraine causes not chronic, but paroxysmal headaches.

45
Q

NEU - 2.46
The following types of headaches are associated with vegetative signs, except:
A) cluster headache
B) migraine
C) occipital neuralgia
D) subarachnoid haemorrhage

A

ANSWER
C) occipital neuralgia

EXPLANATION
Among the diseases listed, occipital neuralgia is the only one which is not associated with vegetative signs.

46
Q

NEU - 2.47
Which of the following diseases causes pain?
A) myasthenia gravis
B) myositis
C) dystrophia musculorum progressiva
D) Brown–Sequard-syndroma

A

ANSWER
B) myositis

EXPLANATION
Only myositis is painful.

47
Q

NEU - 2.48
In which localisation can disc herniation cause pain radiating into the thumb?
A) CII–CIII
B) CIV–CV
C) CV–CVI
D) CVI–CVII

A

ANSWER
C) CV–CVI

EXPLANATION
Radiating pain in the thumb indicates the lesion of the C6 root. At the cervival region cervical roots exit the spinal column right above the vertebra of the same number as the root itself, so in our example the lesion may be caused by herniation of the CV—VI disc.

48
Q

NEU - 2.49
Which of the following headaches is characterized by circadian/circannual rhythm?
A) tension type headache
B) migraine without aura
C) cluster headache
D) migraine with aura

A

ANSWER
C) cluster headache

EXPLANATION
One of the characteristics of cluster type headache is that attacks often occur at the same time of the day (circadian rhytm), or cluster periods develop in the same season af the year (circannual rhytm).

49
Q

NEU - 2.50
Which of the following headaches is often associated with depression:
A) migraine with aura
B) migraine without aura
C) cluster headache
D) tension headache

A

ANSWER
D) tension headache

EXPLANATION
In case of a patient with depression, tension type headache can often be a leading complaint. On the other hand, the mental and physical signs of depression can often be seen in patients with chronic tension type headache. A detailed psychological examination can reveal the correct diagnosis.

50
Q

NEU - 2.51
Headache caused by occlusive hydrocephalus is:
A) chronic progressive
B) intermittent
C) radiating into the nose bridge
D) hemicranial

A

ANSWER
A) chronic progressive

EXPLANATION
Occlusive hydrocephalus results in increased intracranial pressure, and the course of the headache is chronic and progressive.

51
Q

NEU - 2.52
The following diseases can cause hemifacial pain, except:
A) temporomandibular dyskinesia
B) trigeminal neuralgia
C) tension type headache
D) pulpitis (toothache)

A

ANSWER
C) tension type headache

EXPLANATION
Tension type headache usually causes frontal, bilateral headache.

52
Q

NEU - 2.53
The following diseases may be nocturnal (and thus disturbs the sleep), except:
A) trigeminal neuralgia
B) cluster headache
C) migraine without aura
D) headache caused by hydrocephalus

A

ANSWER
A) trigeminal neuralgia

EXPLANATION
Trigeminal neuralgia doesn’t disturb sleep, as triggering factors like speaking, chewing and tactile stimuli are usually not present while asleep.

53
Q

NEU - 2.54
The following diseases may cause unilateral ocular pain, except:
A) migraine
B) cluster headache
C) meningeoma of the tentorium
D) sinus cavernosus syndroma
E) increased intracranial pressure

A

ANSWER
E) increased intracranial pressure

EXPLANATION
Increased intracranial pressure causes diffuse headache.

54
Q

NEU - 2.55
What is the prevalance of headache as a primary or associated symptom in brain tumors:
A) 5–10%
B) 20–30%
C) 90–95%
D) 60–70%

A

ANSWER
D) 60–70%

EXPLANATION
According to statistical data.

55
Q

NEU - 2.56
Which of the following symptoms does not occur in migraine with aura?
A) hearing loss
B) speech disturbance
C) hemiparaesthesia
D) weakness of one of the the upper extremities

A

ANSWER
A) hearing loss

EXPLANATION
Among the symptoms listed, hearing loss does not occur in the aura phase of migraine.

56
Q

NEU - 2.57
The following aura signs may occur in migraine, except:
A) hemiparesis
B) hemiparaesthesia
C) numbness in both hands
D) aphasia

A

ANSWER
C) numbness in both hands

EXPLANATION
Numbness in both hands is not characteristic for a localised brain dysfunction

57
Q

NEU - 2.58
The following diseases cause headache with vomiting, except:
A) migraine
B) cervicogenic headache
C) increased intracranial pressure
D) hypertonic crisis

A

ANSWER
B) cervicogenic headache

EXPLANATION
Clinical data suggest that cervicogen headache is not associated with vomiting.

58
Q

NEU - 2.59
Characteristics for subarachnoid haemorrhage:
A) thunderclap headache at the nuchal region
B) the most common neurological finding is spastic hemiplegia or hemiparesis with Babinski sign
C) the most common sign is papilloedema
D) there are no meningeal signs
E) CT scan has no diagnostic value

A

ANSWER
A) thunderclap headache at the nuchal region

EXPLANATION
Subarachnoid hemorrhage is a thunderclap headache mostly in the nuchal region. The other answers cannot be accepted.

59
Q

NEU - 2.60
Characteristics for pseudotumor cerebri:
A) It is rare during pregnancy
B) It is rarely associated with endocrinopathy or treatment with medication
C) Vventricules and subarachnoid space are wider than normal
D) Visual accuity can be severely affected
E) Headache is rare

A

ANSWER
D) Visual accuity can be severely affected

EXPLANATION
The most severe symptom of pseudotumor cerebri is the visual loss. All the other answers are incorrect.

60
Q

NEU - 2.61
Meralgia paraesthetica:
A) its treatment is usually the incision of the fascia lata
B) characterised by burning pain on the surface of the inner part of the thigh
C) often caused by compression of the inguinal ligament
D) more common in women than in men
E) none of them

A

ANSWER
C) often caused by compression of the inguinal ligament

EXPLANATION
Paraesthesia in the territory of lateral cutaneus femoral nerve might be caused by the compression of the nerve.

61
Q

NEU - 2.62
What is characteristic for spondylotic headache?
A) usually unilateral
B) nuchal pain
C) pathological cervical X-ray
D) provocated by abnormal head posture
E) all of them
F) none of them

A

ANSWER
E) all of them

EXPLANATION
Based on clinical findings.

62
Q

NEU - 2.63
The treatment of migraine attacks:
A) sumatriptan
B) aspirin
C) dihydroergotamin
D) all of them

A

ANSWER
D) all of them

EXPLANATION
All of the drugs listed can be used.

63
Q

NEU - 2.64
Excitation of the sensory cortex causes:
A) paraesthesia
B) hyperaesthesia
C) hyperalgesia

A

ANSWER
A) paraesthesia

EXPLANATION
The paraesthesia respects the somatotopy, sometimes it spreads as a sensoric Jacksonian-march.

64
Q

NEU - 2.65
Presence of headache requires urgent care, if:
1) it is a thunderclap headache (sudden onset, very severe) at the nuchal region
2) headache is associated with disturbance of consciousness
3) headache is accompanied by neurological signs
4) headache is associated with general symptoms, like fever, or joint pain

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
All of the answers are correct, because all of these symptoms refer to symptomatic headache. Urgent examination is needed.

65
Q

NEU - 2.66
Subjective sensory disturbances in polyneuropathy:
1) paraesthesia
2) cramping pain
3) burning pain
4) throbbing pain

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
B) 1st and 3rd answers are correct

EXPLANATION
Paraesthesia and burning pain are characteristic for polyneuropathy.

66
Q

NEU - 2.67
Diagnostic criteria of tension type headache:
1) band-like localisation
2) dull and pressing pain
3) mild to moderate intensity
4) physical activity does not aggravate the headache

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
According to the Internacional Headache Society, all of the characteristics listed here belong to the diagnostic criteria of tension headache.

67
Q

NEU - 2.68
Characterisctics for cluster headache:
1) always unilateral
2) extremely intense, shooting pain
3) partial Horner-symptom in the ipsilateral side of the headache
4) visual aura

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Only the first three answers are characteristic for cluster headache according to the diagnostic criteria of the Internacional Headache Society.

68
Q

NEU - 2.69
Which of the following points indicate that hormonal changes may have influence on migraine?
1) migraine develops mainly in women
2) migraine is less intense during pregnancy
3) the prevalence of migraine is decreasing after climax
4) use of oral contraceptives increases the intensity and frequency of migrainous headaches

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
All observations listed here are true and indicate the hormonal influence on migraine.

69
Q

NEU - 2.70
Treatment of migraine attacks:
1) minor analgetics
2) ergotamines, dihydroergotamines
3) sumatriptan
4) major analgetics (opioids)

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Major analgetic drugs (opioids) should be avoided because the danger of addiction.

70
Q

NEU - 2.71
What are the characteristics of chronic progressive headache?
1) the intensity of headache is increasing
2) the headache is accompanied by scintillating scotoma
3) the headache is associated with nausea and vomitus
4) episodes of headache are separated by pain-free intervals

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
B) 1st and 3rd answers are correct

EXPLANATION
The first and third answers are correct.

71
Q

NEU - 2.72
Headache caused by brain tumor may develop due to:
1) traction or stretch of intracranial vessels
2) increased intracranial pressure
3) dural involvment
4) trigeminal nerve compression

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
All of these answers are correct. Tumor may cause headache by traction, stretch, or compression of the pain-sensitive structures, including intracranial vessels, dura, nerves… However, the brain tissue itself is not sensitive to pain because it lacks pain receptors.

72
Q

NEU - 2.73
Characteristics of headache caused by tentorial meningioma:
1) ipsilateral headache in the frontal region
2) the pain radiates to the ipsilateral eye
3) chronic and progressive headache
4) the pain radiates to the ipsilateral shoulder and arm

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Tentorial meningioma does not cause radiating pain to the shoulder and arm.

73
Q

NEU - 2.74
Acoustic-neurinoma can cause:
1) trismus
2) ear pain
3) trigeminal-neuralgia on the contralateral side
4) trigeminal-neuralgia on the ipsilateral side

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
D) only 4th answer is correct

EXPLANATION
Only the fourth answer is correct: among the points listed only the ipsilateral trigeminal neuralgia can be caused by acoustic neurinoma

74
Q

NEU - 2.75
Which of the following headaches can predict/anticipate rupture of cerebral aneurysm:
1) migraine with aura
2) tension type of headache
3) short-lasting, extremely intense „predictive, anticipating” headache episodes (sentinel headache)
4) cluster headache

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
B) 1st and 3rd answers are correct

EXPLANATION
Migraine headaches with the same aura symptoms may refer to presence of cerebral aneurysm (although aneurysms are not more frequent in migraine patients than in the normal population), and short-lasting, extremely intense „predictive, anticipating” headache episodes (sentinel headache) may also warn of intracranial aneurysm.

75
Q

NEU - 2.76
Migraine can be provoked by:
1) too much sleeping
2) sleep deficit
3) stress, anxiety
4) relaxation

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
Based on detailed headache histories, all factors listed here can be provoking factors in migraine

76
Q

NEU - 2.77
Provoking factor(s) is/are in tension type headache:
1) stress
2) weather fronts
3) menstruation
4) chocolate

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Alimentary causes are not typical provoking factors in tension type headache. Eating chocolate may provoke migrain.

77
Q

NEU - 2.78
Provoking factor(s) is/are in cluster headache:
1) yellow cheese
2) bending down
3) citrus fruits
4) beer

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
D) only 4th answer is correct

EXPLANATION
In cluster period, alcoholic drinks (like beer) are well-known provoking factors for cluster headache even in small dose.

78
Q

NEU - 2.79
Which of the following may cause painful polyneuropathy?
1) Lead intoxication
2) Diabetes mellitus
3) Chronic alcoholism
4) Multiple Sclerosis

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Only the first 3 answers are correct. Multiple sclerosis does not cause polyneuropathy.

79
Q

NEU - 2.80
Which of the following may cause prosopalgia?
1) Glaucoma
2) Temporomandibular dyskinesia
3) Somatoform disorder
4) Allergic rhinitis

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
B) 1st and 3rd answers are correct

EXPLANATION
Pain caused by temporomandibular dyskinesia may resemble to trigeminal neuralgia. Allergic rhinitis is not painful.

80
Q

NEU - 2.81
Which of the following may cause epileptic seizure and headache?
1) Superior sagittal sinus thrombosis.
2) Convexity meningioma
3) Meningoencephalitis
4) Arteriovenous malformation

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
All of the diseases listed here may cause epileptic seizure and headache

81
Q

NEU - 2.82
Which of the following may cause headache?
1) Increased CSF (cerebrospinal fluid) pressure
2) Decreased CSF (cerebrospinal fluid) pressure
3) Central nervous system infection
4) Non-central nervous system infection

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
All factors listed here may cause headache.

82
Q

NEU - 2.83
Characteristics of radicular pain:
1) precisely localised
2) can be provoked
3) sharp, shooting
4) very severe

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
Presence of all characteristics listed here form the criteria of radicular pain.

83
Q

NEU - 2.84
Characteristics of thalamic pain:
1) occurs contralateral to the side of the lesion
2) occurs ipsilateral to the side of the lesion
3) severe, intolerable pain
4) mild, dull pain

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
B) 1st and 3rd answers are correct

EXPLANATION
The thalamic pain occurs contralateral to the side of the lesion, and is severe and intolerable.

84
Q

NEU - 2.85
What are the characteristics of causalgia?
1) It is associated with severe vegetative disorders
2) It is associated with throphic disorders
3) It can be provoked by external stimuli (sound, light, touch)
4) It is a severe, burning pain

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
E) all of the answers are correct

EXPLANATION
All characteristics listed here are typical for causalgia.

85
Q

NEU - 2.86
Characteristics of phantom pain:
1) may be caused by amputation neuroma
2) occurs after amputation
3) the pain is projected into the missing limb
4) can easily be treated by NSAIDs

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Treatment of phantom pain is complex, and has not been solved.

86
Q

NEU - 2.87
Radicular pain can be caused by:
1) extramedullary tumor
2) herpes Zoster
3) disc herniation
4) intramedullary tumor

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Intramedullary tumors do not cause radicular pain. All the other diseases may cause damage of a radix resulting in radicular pain.

87
Q

NEU - 2.88
Risk factor(s) for cerebral venous thrombosis:
1) oral contraceptives
2) puerperium
3) septic focus
4) thrombocyopenia

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

A

ANSWER
A) 1st, 2nd and 3rd answers are correct

EXPLANATION
Thrombocytopenia does not predispose to cerebral venous thrombosis.

88
Q

NEU-2.89-2.92
Match the headache types with the most typical symptoms:
A) Migraine
B) Cluster headache
C) Tension type headache

NEU - 2.89 - Nausea, vomitus

NEU - 2.90 - Photophobia, Phonophobia

NEU - 2.91 - Partial Horner’s syndrome

NEU - 2.92 - Pressure-like pain with diffuse localization

A

ANSWER
NEU - 2.89 - Nausea, vomitus - A)

NEU - 2.90 - Photophobia, Phonophobia - A)

NEU - 2.91 - Partial Horner’s syndrome - B)

NEU - 2.92 - Pressure-like pain with diffuse localization - C)

89
Q

NEU-2.93-2.96
Please match the headaches with their proper course/temporal prifile!
A) migraine
B) cluster headache
C) tumorous headache
D) chronic tension headache

NEU - 2.93 - Paroxysmal

NEU - 2.94 - Progressive

NEU - 2.95 - Everyday headache, the number of the days with headache is more than 15 days/month for 6 months

NEU - 2.96 - Occurs in „packages” (1-2 attacks per day for weeks, months)

A

ANSWER
NEU - 2.93 - Paroxysmal - A)

NEU - 2.94 - Progressive - C)

NEU - 2.95 - Everyday headache, the number of the days with headache is more than 15 days/month for 6 months - D)

NEU - 2.96 - Occurs in „packages” (1-2 attacks per day for weeks, months) - B)

90
Q

NEU-2.97-2.100
Match the followings:
A) median nerve
B) common peroneal nerve
C) facial nerve
D) ulnar nerve

NEU - 2.97 - Its lesion causes foot drop (steppage gait)

NEU - 2.98 - Its lesion often causes causalgia

NEU - 2.99 - Its injury causes the „Froment’s sign”

NEU - 2.100 - In case of Ramsay-Hunt syndrome this nerve is affected

A

ANSWER
NEU - 2.97 - Its lesion causes foot drop (steppage gait) - B)

NEU - 2.98 - Its lesion often causes causalgia - A)

NEU - 2.99 - Its injury causes the „Froment’s sign” - D)

NEU - 2.100 - In case of Ramsay-Hunt syndrome this nerve is affected - C)

91
Q

NEU-2.101-2.105
Please match the following:
A) radial nerve
B) median nerve
C) ischiadic/sciatic nerve
D) femoral nerve
E) axillary nerve

NEU - 2.101 - Rarely injured upper limb nerve

NEU - 2.102 - Rarely injured lower limb nerve

NEU - 2.103 - Its lesion causes „Saturday night” palsy

NEU - 2.104 - This nerve can be injured during giving im. injection

NEU - 2.105 - This nerve is affected in carpal tunnel syndrome

A

ANSWER
NEU - 2.101 - Rarely injured upper limb nerve - E)

NEU - 2.102 - Rarely injured lower limb nerve - D)

NEU - 2.103 - Its lesion causes „Saturday night” palsy - A)

NEU - 2.104 - This nerve can be injured during giving im. injection - C)

NEU - 2.105 - This nerve is affected in carpal tunnel syndrome - B)

92
Q

NEU-2.106-2.109
Match the different headaches and the usual durations and frequencies of the headache syndromes.
A) migraine
B) cluster headache
C) chronic tension type of headache
D) neuralgia

NEU - 2.106 - duration: half-one day; frequency: once-twice a month

NEU - 2.107 - duration: half-one day; frequency: every day for weeks

NEU - 2.108 - duration: seconds; frequency: short leasting pain episodes repeat many times a day

NEU - 2.109 - duration: half-one hour; frequency: once-twice a day for weeks

A

ANSWER
NEU - 2.106 - duration: half-one day; frequency: once-twice a month - A)

NEU - 2.107 - duration: half-one day; frequency: every day for weeks - C)

NEU - 2.108 - duration: seconds; frequency: short leasting pain episodes repeat many times a day - D)

NEU - 2.109 - duration: half-one hour; frequency: once-twice a day for weeks - B)

93
Q

NEU-2.110-2.113
Match the different pain syndromes with the potential causes.
A) polyneuropathy
B) radicular pain
C) trigeminal neuralgia
D) thalamic pain

NEU - 2.110 - extramedullary tumor
NEU - 2.111 - hemispheric stroke
NEU - 2.112 - chronic alcohol consumption
NEU - 2.113 - multiple sclerosis

A

ANSWER

NEU - 2.110 - extramedullary tumor - B)
NEU - 2.111 - hemispheric stroke - D)
NEU - 2.112 - chronic alcohol consumption - A)
NEU - 2.113 - multiple sclerosis - C)

94
Q

NEU - 2.114
Most patients with cluster headache are heavy smokers, because cluster headache is caused by smoking
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

A

ANSWER
C) the statement is true, but the explanation is false;

EXPLANATION
Althought the most patients with cluster headache are smokers, the etiology of the cluster headache is not known, therefore the second statement is wrong.

95
Q

NEU - 2.115
Allergic rhinitis is quite common in migraineurs, therefore antihistamins are effective in prophylactic treatment of migraine.

A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

A

ANSWER
B) both the statement and the explanation are true but there is no causal relationship between them;

EXPLANATION
Both statements are true, but there is no causal relationship between them.

96
Q

NEU - 2.116
Relaxation training and autogen training are accepted methods in the treatment of chronic tension type of headache, because role of physical (muscle) and psychical stress are assumed to play a role in the development of this type of headache.

A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

A

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them;

EXPLANATION
Both statements are true and there is a causal relatinship between them.

97
Q

NEU - 2.117
Diagnosis of the so called special headaches provoked by coughing, physical exercise or sexual activity requires imaging techniques (cerebral CT or MRI), because these special headaches might be caused by intracranial space occupying lesions.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

A

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them;

EXPLANATION
Both statements are true, therefore space occupying intracranial lesions have to be excluded before establishment of these special headache syndromes.

98
Q

NEU - 2.118
In a cluster headache attack the pain intensity reaches its maximum slowly, therefore oral medications are effective in the attack treatment of cluster headache.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

A

ANSWER
E) both the statement and the explanation are false

EXPLANATION
Both statemnts are wrong. The pain in cluster headache attack reaches quickly its maximum intensity, therefore the oral medication is usually ineffective.

99
Q

NEU - 2.119
Migraine usually occurs daily for weeks or months, therefore one type of treatment in migraine is the prophylactic treatment.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

A

ANSWER
D) the statement is false, but the explanation itself is true

EXPLANATION
If the headache occurs every day for weeks or months, the migraine diagnosis cannot be established (this temporal profile is not typical for migraine) – the first statement is wrong. One form of the migraine treatment is the prophylactic, preventive treatment – the second statement is true.

100
Q

NEU - 2.120
Cluster headache attacks occur with clockwise regularity, therefore disturbance of hypothalamic function is supposed in the cluster period.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

A

ANSWER
A) both the statement and the explanation are true and a causal relationship exists between them;

EXPLANATION
The hypothalamus is known to contain the „biological clock”, and cluster headache occurs with clockwise regularity. Deep brain stimulation of hypothalamus was reported to be effective in treatment of cluster headache. Both statements are true, and there is a causal relationship between them.