Neurology - Part 1 of 2

Question 1

Visual problem in pituitary tumor compressing optic chiasm (10x)

Answer 1

BITEMPORAL HEMIANOPSIA

Question 2

Unsteady gait, appendicular ataxia in LE only and normal eye movement. Walks with lurching broad-based gait. (8x)

Answer 2

CEREBELLAR DEGENERATION (ALCOHOLIC)

Question 3

Severe occipital HA, BL papilledema and no other abnormalities. Chronic acne treated with isotretinoin. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 22mg/dl protein. CT is normal. (7x)

Answer 3

PSEUDOTUMOR CEREBRI

Question 4

66 y/o c/o frequent falls, several-month hx of anxiety, unwillingness to leave home. On exam, mild impairment of vertical gaze on smooth pursuit/ saccades, mild axial rigidity & minimal rigidity of upper extremities, along w mild slowness of movement on finger tapping, hand opening & wrist opposition. Posture nml. Gait tentative/awkward, but w/o shuffling, ataxia, tremor. Pt is slow in arising from a chair. Most likely dx: (7x)

Answer 4

PROGRESSIVE SUPRANUCLEAR PALSY

Question 5

79 y/o pt with a deteriorating mental state over a 3-week period has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the pt. Myoclonic jerks are also seen. Diagnosis: (5x)

Answer 5

SPONGIFORM ENCEPHALOPATHY

Question 6

Pt presents with a slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or headaches are reported. Likely diagnosis? (4x)

Answer 6

NORMAL PRESSURE HYDROCEPHALUS

Question 7

65 y/o pt fell several times past 6 mos. MSE nml. Smooth pursuit, saccadic movements impaired. Worse w vertical gaze. Full ROM w doll head maneuver. Mild symmetric rigidity/bradykinesia, no tremor. MRI/CSF/labs unremarkable. Dx? (4x)

Answer 7

PROGRESSIVE SUPRANUCLEAR PALSY

Question 8

28y/o with emotional lability and impulsivity. LFT’s elevated. Close relative had similar sx and died at 30y/o from hepatic failure. Which blood level would be diagnostic? (3x)

Answer 8

CERULOPLASMIN

Question 9

Pt w/ acute onset of pain and decreased vision in the R eye. Colors look faded when viewed through the R eye. On exam, has a R afferent pupillary defect and a swollen right optic disc. Pt spontaneously recovers over the next 6 wks. Likely to develop later: (3x)

Answer 9

MULTIPLE SCLEROSIS

Question 10

9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6 months ago, and at Tanner stage 4. Dx? (2x)

Answer 10

HYPOTHALAMIC HAMARTOMA

Question 11

5 y/o with 4 month history of morning HA, vomiting, and recent problems with gait, falls, and diplopia: (2x)

Answer 11

MEDULLOBLASTOMA

Question 12

70 y/o develops flaccid paralysis following severe water intoxication. He develops dysphagia and dysarthria without other cranial nerve involvement. Sensory exam is limited but grossly normal, DTR’s are symmetric, and cognition is intact. Likely dx: (2x)

Answer 12

CENTRAL PONTINE MYELINOLYSIS

Question 13

Young adult gained 70 lbs in last year c/o daily severe headaches sometimes associated with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but ventricles smaller than usual. Goal of treatment in this case: (2x)

Answer 13

PREVENT BLINDNESS

Question 14

Superior homonymous quadrantic defects in the visual fields result from lesions to which of the following structures? (2x)

Answer 14

TEMPORAL OPTIC RADIATIONS

Question 15

Tremor with a frequency of around 3 Hz, irregular amplitude, most evident towards the end of reaching movements: (2x)

Answer 15

CEREBELLAR TUMOR

Question 16

Pt with several days of fever and severe headaches presents to ED b/o generalized seizure. Pt is confused and somnolent. Also reported to have been irritable and has c/o foul smells. T2 MRI displayed (hyperintensity of left temporal): (2x)

Answer 16

HERPES ENCEPHALITIS

Question 17

Acute onset of fever, sore throat, diplopia, & dysarthria. Exam reveals an inflamed throat, left adductor nerve palsy w/ impairment of vertical pursuit, diffuse hyperreflexia w/ bilateral clonus, lower ext spasticity, & mild right hemiparesis. CT is uninformative. Spinal fluid has protein of 24, 10 mononuclear cells, and glucose of 70. Dx? (2x)

Answer 17

MULTIPLE SCLEROSIS

Question 18

Which is the most reliable finding from CSF analysis for a pt with multiple sclerosis in the chronic progressive phase of the dz? (2x)

Answer 18

PRESENCE OF OLIGOCLONAL BANDS

Question 19

Benign intracranial HTN etiology: (2x)

Answer 19

HYPERVITAMINOSIS A

Question 20

Gait abnormality, slow movement, asymmetric UE rigidity. Difficulty in voluntary vertical upward/downward gaze. Slowness/rigidity improved slightly with levodopa. Later has problems with horizontal & vertical gaze. Oculocephalic reflexes normal. Involuntary saccades. (2x)

Answer 20

PROGRESSIVE SUPRANUCLEAR PALSY

Question 21

Pt with several days of fever and severe headaches presents to ED b/o generalized seizure. Pt is confused and somnolent. Also reported to have been irritable and has c/o foul smells. T2 MRI displayed (hyperintensity of left temporal): (2x)

Answer 21

HERPES ENCEPHALITIS

Question 22

Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory and gustatory hallucinations. The most likely medical cause of this presentation is: (2x)

Answer 22

HERPES SIMPLEX VIRUS (HSV) INFECTION

Question 23

What condition is a forerunner of MS? (2x)

Answer 23

TRANSVERSE MYELITIS

Question 24

Head injury with personality changes, impulsivity and euphoria. Site of injury?

Answer 24

ORBITOFRONTAL CORTEX

Question 25

What is the transmissible element that causes progressive decline and myoclonic jerks. Brain biopsy shows spongiform changes?

Answer 25

PRION

Question 26

Kluver-Bucy syndrome: placisity, hyperorality, hypersexuality and hyperphagia, can be induced in animals with bilateral resection of which structure?

Answer 26

TEMPORAL LOBES

Question 27

Most common psych complication from TBI

Answer 27

DEPRESSION

Question 28

Executive dysfxn comes from damage to?

Answer 28

FRONTO-SUBCORTICAL

Question 29

36 yo pt w/ double vision, vertigo, vomiting, paresis of medial rectus on lateral gaze w/ coarse nystagmus in abducting eye w/ lateral eye movement

Answer 29

MULTIPLE SCLEROSIS

Question 30

35 yo pt w/ new onset headache, what suggests mass lesion w/ raised ICP?

Answer 30

PAPILLEDEMA ON EYE EXAM

Question 31

Aphasia secondary to lesion in posterior third of left superior temporal gyrus

Answer 31

WERNICKE

Question 32

57 y/o has new onset speech difficulty cannot name objects and sometimes cannot say “yes or no” and cannot repeat “no ifs, ands or buts” but can follow verbal and written commands. No problems with chewing/swallowing. What is the condition? (x2)

Answer 32

BROCA’S APHASIA

Question 33

5 y/o presents w/ sudden onset of slurred speech and gait difficulty. Exam shows truncal ataxia and nystagmus, mild dysarthria and extensor plantar responses. Recent h/o measles. MRI, UA, blood work unremarkable. Dx?

Answer 33

ACUTE CEREBELLITIS

Question 34

Abulia refers to impairment in ability to:

Answer 34

SPONTANEOUSLY MOVE AND SPEAK (inability to act decisively, absence of willpower)

Question 35

Prosopagnosia is:

Answer 35

INABILITY TO RECOGNIZE FACES

Question 36

Inability to recognize objects by touch:

Answer 36

ASTEREOGNOSIS

Question 37

Which cancer has the highest likelihood of going to brain?

Answer 37

LUNG

Question 38

Etiology of meningitis assoc with fever, HA, CSF pleocytosis with lymphocyte predominance, slightly elevated CSF protein, and normal CSF glucose

Answer 38

COXSACKIE VIRUS

Question 39

Most common solid tumor of the CNS in kids

Answer 39

NEUROBLASTOMA

Question 40

75 yo patient evaluated for progressive gait, urine incontinence, and cognitive decline. After removal of csf, there is improvement in gait and balance. What would CT show?

Answer 40

ENLARGEMENT OF THE FRONTAL HORNS

Question 41

41 y/o chronic fatigue, cognitive impairment, reduced perceptual motor speed, poor effort maintenance, and irritability (MRI: hyperintensity in frontal lobe and what looks like a finger protrusion)

Answer 41

MULTIPLE SCLEROSIS

Question 42

25 y/o pt c/o severe HA and vomiting. Pain is dull and mostly in occipital region. Exam: b/l severe papilledema, otherwise WNL. LP: opening pressure: 200mmH2O, no cells, 62mg/dl glucose, 31 mg/dl protein. CT: normal. Dx?

Answer 42

PSEUDOTUMOR CEREBRI

Question 43

Histology consistent with Jakob-Creutzfeldt disease

Answer 43

CYTOSOLIC VACUOLATION OF NEURONS AND GLIA WITH PRION INCLUSIONS

Question 44

Dx for 68yo c/o falls. PE shows upright rigid posture, stiff gait, extended knees, and pivoting while turning.

Answer 44

PROGRESSIVE SUPRANUCLEAR PALSY

Question 45

Diagnosis of 32yo woman w/ vertigo and INO

Answer 45

MULTIPLE SCLEROSIS

Question 46

A 66 yo complains of frequent falls. ON exam, the pt has difficulty with upward gaze, and has severe axial rigidity which is less apparent in upper or lower extremities. There is mild slowness of movement on finger tapping, hand opening and wrist opposition and the patient’s fingers acquire cramped pastures with the effort of the task. The pt’s neck posture is extended. Gait is somewhat slow, with short steps, and The pt is slow when arising from a chair. What is most likely diagnosis?

Answer 46

PROGRESSIVE SUPRANUCLEAR PALSY

Question 47

70 y/o pt develops confusion, lethargy, and generalized tonic-clonic seizure. Lab reveals serum sodium of 95mEq/L. This is most likely a complication of excessively rapid correction of which metabolic problem?

Answer 47

CENTRAL PONTINE MYELINOLYSIS

Question 48

Hippocampal atrophy has been identified in all of the following disorders:

Answer 48

MDD, ALZHEIMER’S DISEASE, PTSD. (NOT DISSOCIATIVE AMNESIA)

Question 49

Severe occipital HA, BL papilledema and vomiting. Just started birth control pills. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 31mg/dl protein, RBC 400. CT is normal.

Answer 49

SAGITTAL SINUS THROMBOSIS

Question 50

Condition most likely to account for the presence of cognitive impairment in a pt with untreated Hep C (HCV) infection and normal ammonia level who is HIV sero- negative:

Answer 50

HCV INFECTION OF BRAIN

Question 51

Delayed neurological deterioration following carbon monoxide-induced coma is most likely manifested by:

Answer 51

PARKINSONISM

Question 52

Causative agent of progressive multifocal leukoencephalopathy (PML):

Answer 52

JC VIRUS

Question 53

Location of characteristic lesions seen in CT scans of pt with carbon monoxide poisoning associated comas?

Answer 53

GLOBUS PALLIDUS

Question 54

68 y/o pt is depressed following a hip surgery. Pt is withdrawn, looks blank, shows dysarthria, weakness, PMR, hyperreflexia, and has trouble swallowing. MRI of the head will show:

Answer 54

PERIVENTRICULAR WHITE MATTER DEMYELINATION

Question 55

Adult LP with opening pressure 190, protein 110, glucose 27, leukocytes 5,000. Dx?

Answer 55

BACTERIAL MENINGITIS

Question 56

75 y/o M, Korean war veteran, with gradual development of forgetfulness and cognitive deterioration, presents with very fast /slurred speech and impaired gait. A head CT shows some generalized atrophy, unusual for his age. The LP show 35 WBC, lymphocytosis and the protein level is 110mg/Dl and elevated gamma globulin. Dx:

Answer 56

NEUROSYPHILIS

Question 57

Inability to carry out motor activites on verbal command despite intact comprehension & motor function indicates?

Answer 57

APRAXIA

Question 58

80yo pt is unable to blow out match although motor and sensory function are normal. What is this called?

Answer 58

APRAXIA

Question 59

Most common cause of aseptic meningitis:

Answer 59

ENTERIC VIRUS

Question 60

25 y/o M w 7 months depression, forgetfulness, weight loss, insomnia, painful tingling in both feet+incoordination. Involuntary choreic movements of B/L UE, apathetic, monosyllabic. Labs normal. EEG: mild diffuse slowing. CT/MRI nml. During admission develops severe akinetic mutism, seizures, dies. Brain autopsy shows:

Answer 60

DIFFUSE AMYLOID PLAQUES, SPONGIFORM NEURONAL DEGENERATION, AND SEVERE ASTROGLIOSIS

Question 61

52 y/o pt with EtOH dependence present with several days of severe headache, nausea, and low grade fever. Physical exam reveals mild disorientation, nuchal rigidity, and mild spasticity in the lower extremities. A head CT is unrevealing. LP: 55/mm3 leukocytes (mostly lymphocytes), 45 mg/dl glucose, protein: 43 mg/dl, and presence of occasional gram positive spherical cells. The most likely causative organism is:

Answer 61

CRYPTOCOCCUS NEOFORMANS

Question 62

CT & MRI show ventriculomegaly are out of proportion to sulcal atrophy. This is suggestive of what diagnosis?

Answer 62

NORMAL PRESSURE HYDROCEPHALUS

Question 63

49 y/o pt with ETOH dependence is brought to the ED with a one-week history of malaise, headache, diplopia, lethargy and confusion. On examination, the pt has a temp of 38.2 C, stiff neck, medical deviation of the right eye with impaired abduction and hoarseness. CSF: 114 leukocytes, predominantly monocytes, a protein of 132mg/dl, and glucose of 29mg/dl. Likely type of meningitis:

Answer 63

TUBERCULOUS

Question 64

Closed TBI, initially no LOC, then 20 minutes later LOC. Patient recovers in 5 minutes.

Answer 64

VASOVAGAL SYNCOPAL ATTACK

Question 65

15 y/o pt fell to the ground after being hit in the head while playing soccer. Pt did not lose consciousness, but was confused for following 20min.The next day, pt reported a headache and irritable, neuro exam normal. Best recommendation to family about pt:

Answer 65

SHOULD BE EXAMINED IN 2 WKS BEFORE RESUMING PLAY

Question 66

In ER following MVA, receives IV dextrose 5%. Experiences confusion, oculomotor paralysis, and dysarthria:

Answer 66

WERNICKE’S ENCEPHALOPATHY

Question 67

Which of following is invariably the first manifestation of neurosyphilis?

Answer 67

MENINGITIS

Question 68

14 y/o @ summer camp develops severe headache and fever, drowsiness, stiffness of neck on passive forward flexion, petechial rash and skin pallor. Spinal tap reveals opening pressure 200mm H20, 84%neutrophils (7,000 nucleated cells), glucose level of 128mg/dl, and protein level of 33mg/dl. Most likely causative agent?

Answer 68

MENINGOCOCCUS

Question 69

Which hormone is secreted in functional pituitary adenoma:

Answer 69

PROLACTIN

Question 70

Primary characteristic of Wernicke encephalopathy

Answer 70

ACUTE ONSET

Question 71

52 y/o M presents with a chief complaint of gait difficulties. On exam: mild dysarthria, very mild finger to nose ataxia and minimal heel to shin ataxia. Romberg test: negative, but very unsteady while walking and walks with a broad-based, lurching gait. The plantar reflexes are flexor. Imaging studies are most likely to demonstrate:

Answer 71

CEREBELLAR VERMIS ATROPHY

Question 72

75 y/o WWII veteran w/ gradual onset forgetfulness, intellectual deterioration, fast/slurred speech, gait impaired, CT with normal atrophy. LP: 35WBCs (most lymph), protein 110, increased gamma globulin. Dx?

Answer 72

NEUROSYPHILIS

Question 73

41 y/o pt w/o family h/o corticocerebellar degeneration presents with 3-month h/o ataxia of gait/limbs, dysarthria, and progressive nystagmus. MRI and CSF normal. 1) Antibody panel with presence of? 2) What type of tumor is likely present?

Answer 73

1) ANTI-YO 2) OVARIAN CARCINOMA

Question 74

MRI finding for woman with memory decline, urinary incontinence, and trouble walking

Answer 74

DILATION OF VENTRICLES

Question 75

Effortful, nonfluent speech with decreased speech output; where is the lesion?

Answer 75

ANTERIOR FRONTAL GYRUS

Question 76

A 50 yo BIB ED for SA by being in a closed garage with the cars running for several hours. CT brain 2 weeks later would show

Answer 76

LESION IN GLOBUS PALLIDUS

Question 77

Which of the following tests is recommended by the American Academy of Neurology to establish the diagnosis of brain death?

Answer 77

APNEA TEST

Question 78

Essential criterion for declaration of brain death prior to organ donation requires?

Answer 78

A POSITIVE APNEA TEST

Question 79

43 y/o newly AIDS pt has increasing social withdrawal and irritability over several weeks. Can’t remember phone number, unable to do chores, appears distracted. Mild right hemiparesis, left limb ataxia, and bilateral visual field defects. LP: normal cell counts, protein, and glucose. T2 Scan is shown. What is the diagnosis:

Answer 79

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS

Question 80

Risk factor for depression in MS patients

Answer 80

LESION VOLUME

Question 81

Right handed pt recently underwent neurosurgery is now unable to name objects in left hand when blind folded. He was able to name them when displayed on a screen. Where was the surgery?

Answer 81

CORPUS CALLOSUM

Question 82

Bilateral paresis of medial rectus muscle during lateral gaze with course nystagmus in abducting eye characteristic of:

Answer 82

MULTIPLE SCLEROSIS

Question 83

82 year old with progressive dementia, myoclonus over 3 months. EEG shows periodic sharp waves with 1hz over both hemispheres. Dx?

Answer 83

CREUTZFELDT–JAKOB DISEASE

Question 84

62 y/o M w/ DM is not making sense, saying “thar szing is phrumper zu stalking”. Normal intonation but no one in the family can understand it. He verbally responds to Qs w similar utterances but fails to successfully execute any instruction. (8x)

Answer 84

WERNICKE’S APHASIA

Question 85

Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes weakness of R extremities and severe dysfluent aphasia, but CT at 1:30 PM has no acute lesion. Most appropriate treatment: (4x)

Answer 85

TPA

Question 86

Head CT w/ lens-shaped hyperdensity (x2)

Answer 86

EPIDURAL HEMATOMA

Question 87

A life threatening complication of cerebellar hemorrhage is: (2x)

Answer 87

ACUTE HYDROCEPHALUS

Question 88

A 72 yo patient had an embolic infarct in the middle cerebral artery territory. ECG shows no structural abnormalities. Doppler studies of the neck arteries reveal less than 50% occlusion on both carotid arteries. An EKG reveals AFib. Which of the following strategies has the best likelihood of reducing recurrent strokes in this patient? (2x)

Answer 88

ANTICOAGULATION WITH WARFARIN

Question 89

68 y/o pt w/ hypertension develops rapidly progressing right arm and leg weakness, with deviation of the eyes to the left. Within 30 minutes of the onset of this deficit, pt became increasingly sleepy. Two hours after the onset, the patient became unresponsive. On exam: dense right hemiplegia, eyes deviated to the left, pupils: equal and reactive, a right facial weakness to grimace elicited by noxious stimuli. Cough and gag reflexes: present. Which CT finding is most likely? (2x)

Answer 89

LEFT PUTAMINAL HEMORRHAGE

Question 90

A pt has multiple stroke like symptoms of short duration over several days. And has new onset symptoms for the last 90 minutes. CT scan shows no evidence of stroke or hemorrhage. What is the appropriate treatment? (2x)

Answer 90

INTRAVENOUS THROMBOLYTIC AGENTS

Question 91

70 y/o pt was hospitalized because of a middle cerebral artery stroke. The psychiatrist was asked to evaluate the pt. The pt has non-fluent aphasia. Which most likely characterized the pt’s interaction with the psychiatrist? (2x)

Answer 91

THE PT WAS ABLE TO FOLLOW THE VERBAL REQUEST, “CLOSE YOUR EYES.”

Question 92

Most common psychiatric presentation following a stroke? (2x)

Answer 92

DEPRESSION

Question 93

Chiropractic adjustments are a known precipitant for which of the following acute conditions? (2x)

Answer 93

VERTEBRAL ARTERY DISSECTION

Question 94

The most common complication of temporal arteritis is caused by occlusion of the: (2x)

Answer 94

OPHTHALMIC ARTERY

Question 95

The most common possible cause of a posterior cerebral artery infarct in 36 y/o F with hx of migraine: (2x)

Answer 95

ORAL CONTRACEPTIVES

Question 96

45 y/o with R hemiparesis, CT shows L internal capsule ischemic changes extending to adjacent basal ganglia + old lacunar injury of R caudate head. LP – 65 wbcs (mostly lymphocytes), 78 protein, 63 glucose, + reagin antibodies. Tx?

Answer 96

PCN

Question 97

CT Head Large hypodensity on R frontal and parietal lobes

Answer 97

MCA STROKE W/ RESIDUAL L SIDED WEAKNESS

Question 98

Contralateral leg weakness with personality changes is an injury where

Answer 98

ANTERIOR CEREBRAL

Question 99

61 y/o with left frontal lobe damage secondary to cerebrovascular accident may be predisposed to which psychiatric syndrome?

Answer 99

MDD

Question 100

72 y/o pt had a lacunar infarct in the middle cerebral artery territory. Echo is normal. Doppler studies of neck arteries reveal less than 50% occlusion on both carotid arteries. EKG is normal. The best strategies to reduce recurrent stroke:

Answer 100

ANTIPLATELET THERAPY WITH ASPIRIN AND DIPYRIDAMOLE

Question 101

50 y/o pt recently began having VH of children playing. VH are fully formed, colorful and vivid, but with no sound. Pt is not scared or disturbed, but rather amused. On exam, normal language, memory, cranial nerves, no weakness or involuntary movement, no sensory deficits. DTR: symmetric. CSF/UDS nml.

Answer 101

POSTERIOR CEREBRAL ARTERY ISCHEMIA

Question 102

Why would brains >65 years old or a history of alcoholism more susceptible to chronic subdural hematoma?

Answer 102

CORTICAL ATROPHY (LONGER DISTANCE FOR BRIDGING VEINS TO BE DAMAGED)

Question 103

What is the most common manifestation of acute neurosyphilis?

Answer 103

STROKE

Question 104

65 y/o pt wakes up with right-sided hemiparesis and motor aphasia. Pt is immediately brought to the emergency department and an evaluation is completed within 1 hour. Neurological exam: no additional abnormalities. Head CT w/o contrast: no additional abnormalities. Which is the appropriate next step in management?

Answer 104

ASPIRIN

Question 105

Abnormal elevated metabolic findings associated with increased risk of stroke in patients under 50

Answer 105

PLASMA HOMOCYSTEINE

Question 106

Acute onset of dense sensorimotor deficit in the contralateral face and arm, with milder involvement of the lower extremity, associated with gaze deviation toward the opposite side of the deficit, likely indicates occlusion of:

Answer 106

SUPERIOR DIVISION OF THE MCA

Question 107

CT scan with occipital and intraventricular hyper-intensities:

Answer 107

PARENCHYMAL HEMORRHAGE

Question 108

Which med has secondary prevention against embolic stroke in pts with A-fib?

Answer 108

ORAL WARFARIN

Question 109

As opposed to strokes caused by arterial embolism or thrombosis, those caused by cerebral vein or venous sinus thrombosis are:

Answer 109

ASSOCIATED WITH SEIZURES AT ONSET

Question 110

Pt who 5 days ago experienced a ruptured aneurysm located in the left middle cerebral artery develops a fluctuating aphasia and hemiparesis with no significant headaches. Underlying event:

Answer 110

VASOSPASM

Question 111

63 y/o with new onset aphasia and R hemiparesis, 2 days ago had milder/similar symptoms that resolved in 30 minutes, yesterday had similar episode x 45 minutes. Current Sx started 1.5 hrs ago. CT shows no stroke or hemorrhage. Tx?

Answer 111

INTRAVENOUS THROMBOLYTIC AGENTS

Question 112

57 y/o diabetic pt =w/ HTN c/o several episodes of visual loss, “curtain falling” over his L eye, transient speech and language disturbance, and mild R hemiparesis that lasted 2 hrs. Suggests presence of what?

Answer 112

EXTRACRANIAL LEFT INTERNAL CAROTID STENOSIS

Question 113

Head injury, LOC -> lucid interval x hours -> rapid progressing coma. Hemorrhage?

Answer 113

EPIDURAL

Question 114

Poststroke depression in 80 yo pt (R handed) is assoc w cognitive impairments that:

Answer 114

CORRELATE WITH LEFT HEMISPHERIC INVOLVEMENT

Question 115

66 y/o M in ED w/ sudden occipital HA, dizziness, vertigo, N/V, unable to stand, mild lethargy, slurred speech. Exam: small reactive pupils, gaze deviated to the R, nystagmus, w/ occasional ocular bobbing, R facial weakness, decreased R corneal reflex, truncal ataxia, b/l hyperreflexia, b/l Babinski. Dx?

Answer 115

CEREBELLAR HEMORRHAGE

Question 116

50 y/o pt is in the ED for acute onset of neck pain radiating down the left arm, progressive gait difficulty, and urinary incontinence. This test should be administered immediately:

Answer 116

MRI SCAN OF THE CERVICAL SPINE TO EXCLUDE A DIAGNOSIS OF SPINAL CORD COMPRESSION.

Question 117

In managing acute ischemic stroke, administer this within 48 hrs of onset of stroke for beneficial effect in reducing risk of recurrent stroke, disability and death:

Answer 117

ASPIRIN

Question 118

70 y/o pt w/ attacks of “whirling sensations” w/n/v, diplopia, dysarthria, tingling of lips. Occurs several times daily for 1 minute, severe that pt collapses and is immobilized when symptoms start. No residual s/s, no tinnitus, hearing impairment, ALOC or association with any particular activity. Dx?

Answer 118

VERTEBROBASILAR INSUFFICIENCY

Question 119

Vascular lesion most characteristic of sudden severe headache, vomiting, collapse, relative preservation of consciousness, few or no lateralizing neurological signs, and neck stiffness:

Answer 119

SUBARACHNOID HEMORRHAGE

Question 120

Head CT demonstrates which dx (grainy picture with diffuse speckling in posterior region, unilateral)

Answer 120

SUBARACHNOID HEMORRHAGE

Question 121

Mental status changes after CABG, fluent speech and excellent comprehension, inability to name fingers and body parts, right and left orientation errors inability to write down thoughts and calculation, but with good reading comprehension:

Answer 121

AN EMBOLIC STROKE AFFECTING LEFT ANGULAR GYRUS

Question 122

70 y/o F sudden onset paralysis R foot and leg. R arm and hand slightly affected. No aphasia or visual field deficit. Over weeks found with loss of bladder control, abulia and lack of spontaneity. Which vascular area:

Answer 122

ANTERIOR CEREBRAL ARTERY (LEFT)

Question 123

Pts in a locked in state following basilar artery occlusion typically retain what movement?

Answer 123

EYELIDS AND VERTICAL GAZE

Question 124

83 yo pt with mild HTN comes in with new onset headache and left hemiparesis. MRI shows right parietal lobe hemorrhage, small occipital hemorrhage and evidence of previous hemorrhage in right temporal and left parietal regions. What is likely etiology for these findings?

Answer 124

AMYLOID ANGIOPATHY

Question 125

39 y/o pt with hx of multiple miscarriages develops an acute left sided hemiparesis. Work up reveals elevated anticardiolipin titers and no other risk factors for stroke. Appropriate intervention at this point is?

Answer 125

PLASMAPHERESIS

Question 126

In which arterial area would a stroke resolve in inability to read but preserved ability to write?

Answer 126

POSTERIOR CEREBRAL

Question 127

71yo pt w/ Parkinson’s x3yrs p/w difficulties getting up, is not motivated to do anything, has no interest in social events, and has “slowness” in thinking; although motor sx well controlled on Sinemet, sx stable throughout day and no sadness, worthlessness, or SI. Cognitive eval shows slow processing. What is most likely explanation?

Answer 127

APATHY

Question 128

65 y/o M with 6 mo h/o confusion episodes, disorientation, VHs of children playing in his room. Hallucinated images are fully formed, colorful, vivid and pt has little insight into their nature. No AH. Wife says he is normal between episodes. Exam: Normal language, memory, mod diff with trails test, mild diff with serial subtractions, mild symmetric rigidity and bradykinesia. Brain MRI unremarkable. CSF, routine labs and UDS normal. Diagnosis: (7x)

Answer 128

LEWY BODY DEMENTIA

Question 129

When combined with functional neuroimaging, which of the following biomarkers is most likely to identify those geriatric pts with mild cognitive impairment most at risk for developing Alzheimer’s disease? (7x)

Answer 129

E-4 APOLIPOPROTEIN E ALLELE

Question 130

80 y/o with VH and worsening gait, episodic confusion, disturbed sleep, fighting in sleep, bilateral rigidity, masked facies. Levodopa/carbidopa improved movement temporarily. Diagnosis? (4x)

Answer 130

DEMENTIA WITH LEWY BODIES

Question 131

80 y/o pt with Alzheimer’s is brought in for increasingly combative behavior. Daughter would like to keep the pt at home if possible. What interventions would be most helpful in this situation? (3x)

Answer 131

ASSESSING FOR CAREGIVER BURNOUT

Question 132

91 y/o hospice pt w/ cachexia, end stage dementia, and renal impairment has stopped eating and drinking. What comfort measure would be most appropriate? (3x)

Answer 132

FREQUENT SMALL SIPS OF WATER

Question 133

Which of the following is the most specific factor for distinguishing delirium from dementia of the Alzheimer type? (2x)

Answer 133

FLUCTUATING AROUSAL

Question 134

Neurocognitive functions most likely to show decline in people over 65 years of age? (x2)

Answer 134

INFORMATION PROCESSING SPEED

Question 135

Over the course of several months, a 46 yo pt w no past psych hx becomes emotionally labile/irritable. Pt undergoes personality changes, is observed to laugh inappropriately when neighbor kids taunt stray cat. Within 2 yrs pt is convinced all food has germs. Memory is preserved. Pt is no longer able to work/live independently. Neuropsych testing shows impaired language/attn. (2x)

Answer 135

FRONTOTEMPORAL DEMENTIA

Question 136

Excess activation of which receptor contributes to cell death in Alzheimer dx?

Answer 136

NMDA

Question 137

Test that differentiates Alzheimer’s from frontal-temporal dementia

Answer 137

SINGLE PHOTON EMISSION CT SCAN

Question 138

Neurocog d/o with fluctuating rate of progression, visual spatial impairment and early unilateral resting tremor and increased muscle tone.

Answer 138

DEMENTIA WITH LEWY BODIES

Question 139

Confabulation is:

Answer 139

UNCONSCIOUS FILLING IN OF MEMORY GAPS

Question 140

What test is most helpful to distinguish dementia vs delirium

Answer 140

EEG

Question 141

Suggests delirium rather than dementia:

Answer 141

CLOUDING OF CONSCIOUSNESS

Question 142

85 yo patient with hx of dementia admitted for agitation becomes more confused and angry. What lab should you get?

Answer 142

UA

Question 143

Picture of tau staining for pt with progressive dementia. Dx?

Answer 143

ALZHEIMER’S

Question 144

80yo p/w insidious forgetfulness f/b progressive language impairment 2yr later with difficulty using common tools/appliances. Dx?

Answer 144

ALZHEIMER’S DISEASE

Question 145

Which cancer treatment may be followed by a subcortical dementia due to a leukoencephalopathy with onset after 6 months post-treatment?

Answer 145

WHOLE BRAIN RADIATION

Question 146

A pt who has been receiving dialysis tx for years has become more disoriented, has memory loss. Physical exam normal, nursing staff report that pt has begun to have seizures. Blood lab testing shows no obvious etiology, neurodiagnostics show no suggestive findings. What most likely accounts for this presentation?

Answer 146

DIALYSIS DEMENTIA

Question 147

FTD with mutation in chromosome 17 is assoc with abnormal intraneuronal deposition of which protein?

Answer 147

TAU

Question 148

A doc meets with a pt and family to discuss treatment of pt’s mild Alzheimer’s disease. There are no other neurological or psychiatric symptoms or findings. The most appropriate course of action would be to:

Answer 148

BEGIN CHOLINESTERASE INHIBITOR TREATMENT

Question 149

74 y/o, right-handed patient presents with significant memory loss, expressive aphasia, and left plantar extensor response. The most likely diagnosis is:

Answer 149

VASCULAR DEMENTIA

Question 150

Earliest evidence of cell loss in pts with Alzheimer’s Dz typically occurs in which of the following areas of the brain?

Answer 150

ENTORHINAL CORTEX

Question 151

74 y/o F suspicious, poor ADLs, personality changes, most likely dx:

Answer 151

PICK’S DISEASE

Question 152

Protein mutation associated with Alzheimer disease in people younger than 60 yo

Answer 152

AMYLOID PRECURSOR

Question 153

80 y/o pt w/ no prior psych hx, more forgetful, having difficulty with ADLs. However, pt is able to conduct routine social activities so that casual acquaintances don’t notice abnormalities. What is the dx?

Answer 153

ALZHEIMER DEMENTIA

Question 154

Neurofibrillary tangles in Alzheimer’s are composed of:

Answer 154

HYPERPHOSPHORYLATED TAU PROTEINS

Question 155

80 y/o Alzheimer’s with increasingly combative behavior. Family wants to keep at home. Give what medication?

Answer 155

HALDOL

Question 156

Dementia characterized by personality change, attention deficit, impulsivity, affect lability, indifference, perseveration, and loss of executive function. Assoc. with dysfunction in what area of the brain?

Answer 156

FRONTAL LOBE

Question 157

Early stage HIV type I associated dementia as compared to early onset dementia has which of the following deficits?

Answer 157

DECREASED PROCESSING SPEED

Question 158

Which meds have best results for treating agitation in dementia?

Answer 158

ANTIPSYCHOTICS

Question 159

Amyloid precursor protein in what cognitive disorder?

Answer 159

ALZHEIMER’S DZ

Question 160

Most common cause of dementia in pts > 65 yrs of age:

Answer 160

ALZHEIMER’S DZ

Question 161

Characteristic MRI scan finding in Alzheimer disease:

Answer 161

REDUCED HIPPOCAMPAL VOLUMES.

Question 162

Known risk factors for dementia:

Answer 162

AGE, FAM HX, FEMALE, DOWN’S SYNDROME

Question 163

Pt with vascular dementia typically has neuropathological changes assoc with:

Answer 163

BASAL GANGLIA

Question 164

An 82-yo pt has falls, ophthalmoplegia, parkinsonism and progressive dementia. Autopsy shows:

Answer 164

TAU POSITIVE NEUROFIBRILLARY TANGLES

Question 165

65 y/o is brought to the ED with disorientation and mild agitation, and is experiencing vivid VH of several children playing inside the house. Two similar episodes in the past, normal in between episodes. Normal language and memory, normal CN, mild symmetric rigidity and bradykinesia, no deficits. MRI, drug screen, CSF normal:

Answer 165

DEMENTIA WITH LEWY BODIES

Question 166

A med that is most likely to slow the progression of vascular dementia:

Answer 166

ASPIRIN

Question 167

Best rationale for using cholinesterase inhibitors in pts with Alzheimer:

Answer 167

TO REDUCE NEUROPSYCH SYMPTOMS

Question 168

The most important tool for evaluation of early and moderate dementia:

Answer 168

MMSE

Question 169

Dementia rather than depression in regards to memory has…

Answer 169

NAMING DEFICITS (RATHER THAN IMPAIRED NONVERBAL INTELLIGENCE)

Question 170

Bilat loss of neurons in the CA1 segment of the hippocampus is the most common histologic finding in patients with:

Answer 170

ALZHEIMER DEMENTIA

Question 171

Patient is Alzheimer’s dementia in clinic. Patient’s daughter is frustrated with having to care for her mother more and is considering removing her from her church group because of it. What is the most initial response by the psychiatrist?

Answer 171

TELL HER TO CONTINUE GOING TO HER CHURCH GROUP

Question 172

PET scan shows bitemporoparietal hypoperfusion in early stages of which dementia?

Answer 172

ALZHEIMERS

Question 173

65 y/o pt brought in by family for gradual onset and very slow progression of mental confusion with respect to place and time, anomia, slowness of comprehension, neglect of personal hygiene and grooming, apathy, and alterations of personality and behavior, impairment of gait and upright stance, and prominent grasp and suck reflexes. Dx? The clock drawing test is a quickly administered and sensitive screen for:

Answer 173

FRONTOTEMPORAL DEMENTIA OR ALZHEIMER DEMENTIA

Question 174

65 y/o high school grad has a MMSE score of 23, this score would suggest which of the following:

Answer 174

DEMENTIA, MILD COGNITIVE IMPAIRMENT

Question 175

Individuals over 40yo with Down’s syndrome frequently develop:

Answer 175

ALZHEIMER’S DZ

Question 176

HIV+ pt w/ memory loss, inattention, lack of motivation, & poor coordination. Normal LP. CT scan shows atrophy. MRI shows diffuse & confluent white matter changes in T2, w/o any mass effect or gadolinium enhancement. Dx?

Answer 176

HIV- ASSOCIATED DEMENTIA

Question 177

Binswanger disease has pseudobulbar state, gait disorder, AND:

Answer 177

DEMENTIA

Question 178

Clock drawing test is quickly administered and sensitive screen for which d/o?

Answer 178

ALZHEIMER’S DZ

Question 179

Brain of football player who died by suicide has findings typical of chronic traumatic encephalopathy, what is most typical pathology for this behavior?

Answer 179

TAUPATHY

Question 180

54yr old pt dies from rapidly progressing dementia associated with myoclonus, what is most likely finding at autopsy?

Answer 180

MICROVACUOLATION OF GLIA AND NEURONAL DENDRITES

Question 181

Psych eval of 82 y/o F with memory loss (mostly working memory): she frequently calls for help with bathroom but will urinate on herself (staff feel pt is doing this to get back at them). Pt frustrated with staff because she feels the sudden need to void without much warning and wishes the staff would arrive sooner because she’s embarrassed about this. MSE significant only for mod memory loss, labs are normal. Which behavioral intervention should be attempted with pt?

Answer 181

SCHEDULE REGULAR VOIDING, INDEPENDENT OF PT REQUESTS, AND SUFFICIENTLY FREQUENT TO ELIMINATE THE ACCIDENTS

Question 182

Which is important when working w/ family members who are caregivers to pts w/dementia? • There needs only be one caregiver at a time • Grief work w/fam not necessary before pt. dies • All fam to equally share caregiving responsibility • Work w/fam should enhance effectiveness of care to pt. • Fam should explore SNF options as soon as pt is diagnosed

Answer 182

WORK W/ FAMILY SHOULD ENHANCE EFFECTIVENESS OF CARE TO PT

Question 183

What characterizes executive abilities in healthy individuals >65?

Answer 183

SHOW NO SIGNIFICANT CHANGE

Question 184

Fluent speech w preserved comprehension, inability to repeat statements is consistent with what type of aphasia?

Answer 184

CONDUCTION

Question 185

In normal aging, last cognitive abilities to decline

Answer 185

WORD KNOWLEDGE

Question 186

Medicare pays for hospice care when a physician declares that a patient has a maximum life expectancy of how long?

Answer 186

6 MONTHS

Question 187

Two days after bowel surgery, 53 y/o is delirious. Correctly draws a square when asked, but then continues to draw squares when asked to draw other shapes. MSE would reveal:

Answer 187

PERSEVERATION

Question 188

Cancer patient on chemo is disoriented and agitated. Afebrile VSS. Neg neuro exam. Poor attention, cog impairment. Held for observation. CT neg, EEG diffuse slowing. Treat with:

Answer 188

HALDOL

Question 189

78 y/o pt with Alzheimer’s dementia living with spouse and daughter, starting to accuse the spouse of infidelity. On evaluation, he asserts that the spouse is unfaithful. He is alert and acts congenially with the spouse, he is on donepezil. Labs and medical workup is unrevealing of any disorder outside of dementia. Next?

Answer 189

ARRANGE FOR REGULAR EVALUATIONS OF THE PT AND REASSURE THE FAMILY.

Question 190

Family of 75 y/o pt is concerned about his safety b/c he has been forgetting to turn off stove. Psych MD suspects an evolving cognitive d/o. What is most likely to be the earliest impairment to occur in the pt?

Answer 190

INABILITY TO RECALL 3 WORDS AFTER A 3 MIN DELAY

Question 191

85 y/o nursing home pt w/ hx of dementia being more confused and screaming “fire” whenever the light next to the bed is turned on. Next step?

Answer 191

URINALYSIS

Question 192

Epigenetic drift has been postulated to contribute to what disorder?

Answer 192

LATE ONSET ALZHEIMER’S DISEASE

Question 193

35 y/o M awakens frequently middle of night with severe HAs, which sometimes occurs nightly and lasts approx 1-2 hrs, so severe that pt is afraid to go to sleep, located around L eye and assoc with lacrimation, ptosis, & miosis. Likely dx is: (12x)

Answer 193

CLUSTER HEADACHES

Question 194

Abortive treatment of common migraines is best achieved w/ which medication? (8x)

Answer 194

RIZATRIPTAN

Question 195

Young pt with new onset severe HAs associated with periods of visual obscuration. Neuro exam is normal except for papilledema. MRI: normal and shows no mass effect. Next test? (7x)

Answer 195

LUMBAR PUNCTURE TO MEASURE PRESSURE

Question 196

Which of the following is characteristic of post lumbar puncture HA? (4x)

Answer 196

HA WORSE W/ SITTING UPRIGHT

Question 197

35 y/o reports episodes of flashing lights traveling slowly from L to R in the left visual field, symptoms persisting for about 30 minutes, followed by difficulty expressing self and concentrating. After about 30 minutes, these neurologic symptoms seem to subside, and pt develops a pounding headache associated with nausea. Both physical exam and MRI are normal. (3x)

Answer 197

MIGRAINE WITH AURA

Question 198

25 y/o has HA and vomiting. Pain is dull and in occipital region, worse when lying down. +severe papilledema b/l. LP shows opening pressure of 80 w/ normal CSF chemistry, and 120 RBC’s in last tube. D-dimer, FDP in blood are elevated. CT normal. (3x)

Answer 198

SAGITTAL SINUS THROMBOSIS

Question 199

24 yo m with nocturnal HA resulting in early am waking. ROS +rhinorrhea, nostril blocking and ipsilateral eye tearing and facial swelling. HA persists 45-60 min. Likely dx: (2x)

Answer 199

CLUSTER HA

Question 200

30 y/o with intermittent HAs, each attack lasting approx 1 hour. Attacks w/ sharp, stabbing pain around eye, tearing, and nasal congestion. Most effective abortive treatment? (2x)

Answer 200

OXYGEN

Question 201

The effective treatment for acute migraine: (2x)

Answer 201

SUMATRIPTAN

Question 202

28 y/o F reports episodes of severe HAs w nausea/vomiting. HAs can be incapacitating, often preceded by flashes of light in the right visual field. During headache, pt sometimes has difficulty expressing herself. Which med would be the appropriate to prevent these episodes? (2x)

Answer 202

TOPIRAMATE

Question 203

26-year-old obese pt presents to ER with severe headache. Pt is otherwise healthy and does not take any meds. Head CT and brain MRI are unrevealing. The only finding on exam is shown in the fundoscopic images below (blurred optic disk). What is diagnosis? (x2)

Answer 203

IDIOPATHIC INTRACRANIAL HYPERTENSION

Question 204

35 yo with hx of migraines has daily migraines for past 3 months no longer responding to sumatriptan which she now takes daily. Hx of MDD but reports okay mood. Normal physical exam. Preferred initial approach.

Answer 204

DISCONTINUE SUMATRIPTAN

Question 205

Triptan drugs should not be given in abortive treatment of migraine in pts with:

Answer 205

CAD

Question 206

25 y/o w/ VH – similar to the wavy distortions produced by heat rising from asphalt – affecting the whole of both visual fields, + vertigo, dysarthria, tingling in both hands and feet and around both sides of mouth followed by occipital headache. Most likely dx:

Answer 206

BASILAR MIGRAINE

Question 207

76 y/o pt complains of bilateral, severe, persistent headache w/ loss of vision and scalp tenderness, and stiffness of proximal musculature. Sedimentation rate: 96mm/hr. Which diagnostic procedure:

Answer 207

BIOPSY

Question 208

26 y/o F w/ 3-day hx of severe continuous non-throbbing headache, has not improved on NSAID, has mild bilateral papilledema. A head CT w and w/o contrast is shown.

Answer 208

SAGITTAL SINUS THROMBOSIS

Question 209

Pt c/o severe dull and constant headache not associated with N&V. +vision loss in left eye. +pain and stiffness of limbs. MRI shows periventricular white matter hyperintensities on T2. Elevated sed rate. Next step?

Answer 209

HIGH DOSE PREDNISONE

Question 210

35 pt is evaluated for headache syndrome characterized by paroxysms of sharp pain around the eyes and side of the head lasting 5 min and happening 10x/day. Headaches are accompanied by rhinorrhea and conjunctival erythema. Which med is most likely to give relief?

Answer 210

PROPRANOLOL

Question 211

Pt recovering from surgery of an intracranial hemorrhage 2/2 arterial aneurysm, develops a sudden onset of headache, vomiting and progressive decline of consciousness. Pupils are miotic, and abducens muscles are weak bilaterally. Etiology:

Answer 211

ACUTE HYDROCEPHALUS

Question 212

68yo with dull R-sided non-throbbing HA’s worse at night and with prolonged chewing. Best initial tx?

Answer 212

PREDNISONE

Question 213

Young adult w/ headache behind left ear. 2 days later twisting of face. Impaired taste sensation. Paralysis of forehead, lower face on left, incomplete closure of left eye w/ blinking. No sensory deficit or other cranial nerve deficit. MRI shows:

Answer 213

GADOLINIUM ENHANCEMENT OF LEFT FACIAL NERVE

Question 214

35 y/o w daily headaches over last several weeks lasting an hour. Sharp, severe, boring pain into right eye. Another element of this headache?

Answer 214

OCCURS DURING REM

Question 215

25 y/o pt with severe headache, visual loss, vomiting, bilateral babinski, and then becomes drowsy:

Answer 215

EPENDYMOMA OF THE FOURTH VENTRICLE

Question 216

32 yo has a new onset headache with unilateral stabbing eye pain, also experiences runny nose and conjunctival injection on same side as headache occurring every evening after falling asleep and last 2 hours. Diagnosis?

Answer 216

CLUSTER HA

Question 217

71 year old patient with thunderclap headache, unilateral eye pain, blurred vision, dilated pupils, conjunctival injection. Which dx test is best to reveal cause of patient’s headache

Answer 217

INTRAOCULAR PRESSURE MEASUREMENT

Question 218

Role of the hippocampus and parahippocampal gyrus? (4x)

Answer 218

DECLARATIVE MEMORY (FACTS)

Question 219

On the way to airport for vacation, 58 yo F begins to behave in very strange way. Husband notices when he talks to her she answers appropriately w fluent speech but seems to have no ability to retain any new information. She repeatedly asks where they are going, even after he has told her many times. The episode lasts for about 6 hours. The following day she is back to normal but has no recollection of the prior day events. This episode is most consist with a diagnosis of: (3x)

Answer 219

TRANSIENT GLOBAL AMNESIA

Question 220

Characteristic of alcohol-induced blackouts (2x)

Answer 220

ANTEROGRADE AMNESIA FOR A TIME WHILE HEAVILY INTOXICATED BUT AWAKE

Question 221

What characterizes the memory loss in patients with dissociative amnesia? (2x)

Answer 221

EPISODIC

Question 222

Example of declarative memory (2x)

Answer 222

RETENTION AND RECALL OF FACTS

Question 223

Pt with hx of herpes simplex and seizure d/o undergoing EEG monitoring that recorded no epileptic activity during, after and before a confused state wherein pt suddenly awoke frightened. The next day pt with baseline demeanor has no memory about that episode. (2x)

Answer 223

AMNESTIC DISORDER

Question 224

61y/o pt presents to ED with family who report that the pt unable to remember recent events. Memory problems started 2 hours prior; cognitively intact before episode. Pt is alert, anxious, frustrated: “Why am I in the hospital?” Dx: (2x)

Answer 224

TRANSIENT GLOBAL AMNESIA

Question 225

A 72 year old develops sudden onset memory loss. She didn’t know how she and spouse arrived at supermarket. The spouse noted that she could drive without issues but appeared anxious. The patient was able to appropriately answer questions but forgot the conversation and then returned to baseline. What is the most likely diagnosis?

Answer 225

TRANSIENT GLOBAL AMNESIA

Question 226

A surgeon unable to describe anatomical parts involved in one of his common surgeries is experiencing what type of memory impairment?

Answer 226

SEMANTIC

Question 227

Injury of bilateral parahippocampal cortex and hippocampal formation results in what

Answer 227

AMNESIA

Question 228

55 year old brought to ED disheveled and behaving strange, stares blankly and is mute. Doesn’t know who they are and all studies are negative. Has vague memory of “walking away from something horrible”. Dx?

Answer 228

DISSOCIATIVE AMNESIA

Question 229

A 40-year-old pt is hospitalized for eval of fever, weight loss and ataxia. Psychiatric consultation is requested as the patient seems depressed, and a family member reports that the pt has been exhibiting progressive memory loss over the last several months. Which of the following lab tests may help explain the patient’s presentation?

Answer 229

HIV

Question 230

2 months after severe brain injury, pt opens the eyes for prolonged periods but remains inattentive, does not speak, and shows no signs of awareness of the environment or inner need. Pt is capable of some rudimentary behaviors such as following a simple command, gesturing, or producing single words or brief phrases, always in an inconsistent way from one exam to another. Which of the following is the most accurate description of the pt’s condition?

Answer 230

MINIMALLY CONSCIOUS STATE

Question 231

Memory loss pattern in dissociative amnesia

Answer 231

OCCURS FOR A DISCRETE PERIOD OF TIME

Question 232

Amnesia characterized by loss of memory of events, occurs after onset of etiologic condition or agent

Answer 232

ANTEROGRADE

Question 233

What psychoactive drug produces amnesia?

Answer 233

ALCOHOL

Question 234

55 y/o pt BIB family after episode of amnesia/bewilderment lasting several hrs. CVA ruled out. Pt keeps asking what is happening. What med to administer at this point?

Answer 234

OBSERVATION WITH NO PHARMACOLOGICAL INTERVENTION

Question 235

Which of the following diagnoses involves a sense of loss of identity, often following a traumatic experience and associated with inability to recall one’s past?

Answer 235

DISSOCIATIVE FUGUE

Question 236

65yo pt lives alone, increasingly forgetful over the past year, lifelong difficulty recalling names of acquaintances, now has difficulty with phone calls and remembering appts. lives independently, drives, prepares meals, MSE with delayed recall of 4 words, otherwise normal. Pt upset by difficulty and is not depressed. symptoms most consistent with…?

Answer 236

AMNESTIC MILD COGNITIVE IMPAIRMENT

Question 237

45 y/o with nystagmus and ataxia, short term memory loss and believes wife is possessed by demons. Most appropriate treatment?

Answer 237

THIAMINE

Question 238

A conscious memory that covers for another memory that is too painful to hold in the consciousness is:

Answer 238

SCREEN MEMORY

Question 239

In pts with pronounced defects in recent memory, remote memory is:

Answer 239

OFTEN DEFICIENT ON CLOSE EXAMINATION EVEN WHEN IT SEEMS WELL PRESERVED

Question 240

“My father was very involved in my life. I remember going to football games in the snow with him” is an example of memory associated with what part of the brain?

Answer 240

MEDIAL TEMPORAL LOBE

Question 241

Working memory requires prefrontal cortex, dorsal thalamus and what other area of the brain to function?

Answer 241

HIPPOCAMPUS

Question 242

Asking a pt what the pt ate for breakfast yesterday tests:

Answer 242

RECENT MEMORY

Question 243

Question to evaluate immediate recall?

Answer 243

CAN YOU REPEAT THESE SIX NUMBERS?

Question 244

Asking pt to remember 3 things and repeat them in a few minutes is testing:

Answer 244

SHORT-TERM MEMORY

Question 245

34 y/o pt w/ hx of memory impairment dies of unknown cause for autopsy. Pathological exam: diffuse and multifocal rarefaction of cerebral white matter accompanied by scanty perivascular infiltrates of lymphocytes and clusters of a few foamy macrophages, microglial nodules, and multinucleated giant cells. Most likely Dx:

Answer 245

HIV-ASSOCIATED DEMENTIA

Question 246

Pt brought to ed by family because of concern for pts ability to recognize them since TBI one month ago. Pt had LOC after trauma. Tenderness and swelling over L temporal area. Neuro exam normal. Pt knows own name, but unable to identify family members or events related to family. What is diagnosis?

Answer 246

DISSOCIATIVE AMNESIA

Question 247

Which test correlates most strongly with pre-morbid functioning in pt w/ early dementia:

Answer 247

WECHSLER ADULT INTELLIGENCE SCALE IV VOCABULARY TEST (WAIS-IV)

Question 248

Neuropsychological test most useful in the early diagnosis of Alzheimer disease:

Answer 248

10-ITEM WORD LIST LEARNING TASK.

Question 249

Disorder with degeneration of mammillary bodies and dorsal nucleus of thalamus

Answer 249

WERNICKE-KORSAKOFF SYNDROME

Question 250

54 y/o pt has several days of low grade fever, malaise and severe pain in the right side of the ribcage. Examination reveals an erythematous rash with clusters of tense vesicles, with clear content, on a belt distribution from the front of the chest to the back under the nipple, limited to the right side. Likely causal viral agent? (4x)

Answer 250

VARICELLA ZOSTER VIRUS

Question 251

17 y/o pt has an insidious onset of unusual behavior and argumentativeness. Exam, the mouth is held slightly open. Pt has mild dysarthria and hoarseness, generalized slowness, rigidity, and a mild resting tremor of the left arm and head. rule out drug and/or alcohol abuse. Liver function tests show elevated transaminases. An increase in which laboratory test is most likely to confirm Dx? (4x)

Answer 251

URINARY COPPER EXCRETION

Question 252

45 y/o M, with recurrent episodes of LOC while wearing a shirt with a tight collar, has feeling of faintness accompanied by pallor, followed by collapse and LOC, and several seconds later by a few bilateral jerks of the arms and legs. Entire episode lasted less than one minute. Most likely explanation? (2x)

Answer 252

CAROTID SINUS SYNCOPE

Question 253

Decreases in men during andropause

Answer 253

PENILE RIGIDITY

Question 254

Normal changes with motor fxn in aging?

Answer 254

STOOPED POSTURE AND SLOWED WALKING

Question 255

55 yo diplopia when looking right, drooping of left eyelid, and drooping L eye, symptoms better in the morning

Answer 255

MYASTHENIA GRAVIS

Question 256

19 y/o F has bouts of motor agitation, often followed by intense, seemingly meaningless writing; also mood lability, tactile & olfactory hallucinations. During the interview, patient abruptly stops paying attention and begins rapidly pacing around the room. What should be the next step?

Answer 256

WAIT 15 MINS, THEN OBTAIN PROLACTIN LEVEL

Question 257

Immunocompromised patient with confusion and mild headache, b/l papilledema and cerebellar ataxia. CSF stain shows pleocytosis, inc. protein, low glucose? India ink stain shown below. What is diagnosis?

Answer 257

CRYPTOCOCCUS

Question 258

45 y/o pt has recurrent episodes of LOC. A detailed description by family: pt reporting a feeling of faintness accompanied by pallor, followed by collapse and LOC, and several seconds later by a few bilateral jerks of the arms and legs. Prior to recovery, the pt’s face and chest are flushed. No precipitating factors are identified. Which of the following is the most likely explanation:

Answer 258

CARDIAC SYNCOPE

Question 259

43 y/o pt w/ memory loss x 8 months associated with abd pain, wt loss, joint distention/pain, fever, lymphadenopathy, hyperpigmentation of skin, decrease hemoglobin, and fat in stool. Which test result is likely to be found in this patient?

Answer 259

CEREBROSPINAL FLUID WITH PAS+ CELLS INFECTED WITH TROPHERYMA

Question 260

2 y/o child w/ hx of upper respiratory infections, most likely:

Answer 260

HAEMOPHILUS INFLUENZA

Question 261

22 yo female is hospitalized with paranoia, hallucinations, abdominal pain worse with periods, physical exam shows reduced strength in upper and lower extremities and reduced tendon reflexes. Which of the following lab values is likely to be elevated and explain her symptoms?

Answer 261

PORPHOPBILINOGEN

Question 262

Component of type A behavior most reliable risk factor for CAD

Answer 262

HOSTILITY

Question 263

50 y/o pt with myasthenia gravis and a 3-day hx of cough, low-grade fever and chills, presents with great difficulty breathing. The pt appears tired and anxious, and the pt’s skin is clammy and sweaty. Initial management?

Answer 263

MECHANICAL VENTILATION

Question 264

55 y/o M with changes in his voice, orthostatic hypotension and one immobile vocal cord on inspection suffers from:

Answer 264

SHY-DRAGER SYNDROME

Question 265

Neoplasms of the thymus are associated with:

Answer 265

MYASTHENIA GRAVIS

Question 266

A 25 yr old pt develops progressive hearing loss, has acoustic neuromas and café au lait spots, diagnosis?

Answer 266

NEUROFIBROMATOSIS TYPE 2

Question 267

Pediatric Autoimmune Disorder Associated with Streptococcus (PANDAS) is associated with what disorder?

Answer 267

OCD

Question 268

Children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) often manifest:

Answer 268

CHOREIFORM MOVEMENTS AND OCD SYMPTOMS

Question 269

Age that corticospinal tract complete myelination

Answer 269

3 YEARS

Question 270

Alternative stimuli that can be used to overcome withdrawal response to Babinski reflex:

Answer 270

DOWNWARD SCRAPING OF THE SHIN

Question 271

This neuropsych symptoms is most commonly seen in mild neurocognititve disorder

Answer 271

DEPRESSION

Question 272

Myasthenia gravis associated w/ which EMG finding? (10x)

Answer 272

DECREASED AMPLITUDE WITH REPETITIVE MOTOR NERVE STIMULATION

Question 273

36 y/o pt w pain behind L ear progressing to numbness of L side of face, tearing of L eye, discomfort w low frequency sounds, left facial weakness on exam. Dx? (9x)

Answer 273

IDIOPATHIC BELL’S PALSY

Question 274

Treatment of Trigeminal Neuralgia: (7x)

Answer 274

GABAPENTIN (BUT MOST EFFECTIVE IS CARBAMAZEPINE)

Question 275

37 y/o truck driver w numbness of L hand, inc severity in past 2 yrs. Reduced pinprick sensation on L little/ring fingers, atrophy of hypothenar muscle. (6x)

Answer 275

ULNAR NERVE LESION

Question 276

22 y/o with pain in the right hand that radiates into the forearm and bicep muscle. Paresthesias in the palm of the hand, thumb, index, middle ring finger. Sensory systems in the ring finger split the ringer finger longitudinally. Dx? (6x)

Answer 276

MEDIAN NERVE ENTRAPMENT AT THE WRIST

Question 277

Atrophy of the intrinsic muscles of the right arm and forearm. Reflexes are generally brisk, plantar reflexes are extensor. Electrophysiology shows widespread fasciculations, fibrillation and sharp waves, normal sensation, muscle spasticity. Positive sharp waves on EMG. (5x)

Answer 277

AMYOTROPHIC LATERAL SCLEROSIS

Question 278

Stiffness of legs while walking and spasms of LE while sleeping. Stiff legged gait, adducts legs while walking. Increased LE tone/spastic catch, hyperactive knee jerks, ankle jerk clonus. Increased Romberg sway. (5x)

Answer 278

CERVICAL SPONDYLOSIS

Question 279

Persistent numbness in the L hand, decreased sensation in 4th/5th digits (palmar/dorsal), weak finger abduction/adduction especially 5th digit: (4x)

Answer 279

ULNAR NERVE ENTRAPMENT AT THE ELBOW

Question 280

Right neck pain, tends to rotate neck to left – touching the chin prevents deviation – prominent right SCM spasm. Tx? (4x)

Answer 280

BOTULINUM TOXIN

Question 281

Progressive weakness over several days – absent reflexes worse in lower extremities – slow conduction velocity, conduction block A 54-year-old patient had a viral upper respiratory infection 2 weeks ago and now presents with a 3-day episode of progressive, symmetric weakness in the legs, and tingling in the toes and fingers. On exam, Achilles and patellar deep tendon reflexes are diminished. Nerve conduction studies demonstrate decreased conduction velocity and decreased amplitude of action potentials. The most likely Dx: (4x)

Answer 281

ACUTE INFLAMMATORY DEMYELINATING POLYNEUROPATHY

Question 282

14 y/o pt after a demanding physical test becomes extremely weak and unable to stand. PE is positive for depressed DTR’s. Labs: K=2.8. Hx of similar episodes after strenuous exercises. EKG: minimally prolonged PR, QRS, QT interval. Father and grandfather had similar episodes. Dx? (3x)

Answer 282

PERIODIC PARALYSIS

Question 283

26 y/o pt w/ sudden onset back pain. Spasms in R paraspinal muscles in the lumbar region. Straight leg raising on the R is limited by sharp pain at 45 degrees. Ankle jerk on L is diminished. No muscle weakness, no sensory deficit. Next step? (3x)

Answer 283

ORDER MRI SCAN OF THE LUMBAR SPINE

Question 284

Myasthenia gravis can be diagnosed in 80-90% of cases by identification of serum antibodies against what? (3x)

Answer 284

ACETYLCHOLINE RECEPTORS

Question 285

Mechanism of action of botulinum toxin at neuromuscular junction: (3x)

Answer 285

INHIBITION OF ACETYLCHOLINE FROM PRESYNAPTIC TERMINALS

Question 286

During 2nd trimester, a pregnant 38 y/o F has numbness in both hands, particularly thumb, forefinger, middle finger bilaterally. Dorsal part of hand unaffected. Arms ache in the morning from shoulders to hands. Diagnosis: (3x)

Answer 286

MEDIAN NEUROPATHY AT THE WRIST

Question 287

An IV meth user develops severe back pain, followed after several days by bilateral lower extremity weakness/sensory loss, bladder incontinence, low grade fever, tenderness to percussion over the 2nd and 3rd lumbar vertebrae, paraparesis and loss of sensation to light touch and pinprick in both legs, buttocks & sacral region. (3x)

Answer 287

SPINAL EPIDURAL ABSCESS

Question 288

What chemo agent is most commonly assoc with distal sensory polyneuropathy? (3x)

Answer 288

CISPLATIN

Question 289

Pt w/ episodes of severe, intermittent, lancinating pain involving the posterior tongue and pharynx, w/ radiation to deep ear structures. Triggered by swallowing of cold liquids and talking. Workup: normal. Dx? (2x)

Answer 289

GLOSSOPHARYNGEAL NEURALGIA

Question 290

Contralateral loss of pain and temp sensation with motor paralysis and proprioception loss on the other. Dx? (2x)

Answer 290

BROWN-SEQUARD SYNDROME (HEMISECTION)

Question 291

Subacute combined degeneration of the posterior column of the spinal cord is associated with a deficiency of: (2x)

Answer 291

VITAMIN B12 DEFICIENCY

Question 292

Which of the following is the most effective treatment of blepharospasm? (2x)

Answer 292

BOTULINUM TOXIN

Question 293

Pt c/o progressive weakness of several days. Exam + for generalized weakness and absent reflexes. Nerve conduction studies show slowing of velocities. Dx? (2x)

Answer 293

ACUTE POLYNEUROPATHY

Question 294

65 yo pt with progressive weakness, worse when squatting and standing from a chair. C/o decreased strength in right hand. On exam, prominent weakness of the quadriceps bilaterally and on opposition of the thumb in the right hand. Atrophy of foreman muscles with normal DTRs. No other weakness noted on exam. Sensory exam normal. ROS negative. Labs show normal CK and neg for anti-transfer RNA synthase antibodies (Jo1). What is the most likely dx? (2x)

Answer 294

MYOTONIC DYSTROPHY

Question 295

30 y/o develops pain behind left ear. The following day pt complains of numbness on the L side of the face, tearing from L eye, and discomfort with low frequency sounds. Exam shows L facial weakness, but no sensory deficit. Likely diagnosis: (2x)

Answer 295

IDIOPATHIC BELL’S PALSY

Question 296

One month after a MVA, a 21y/o co persistent pain in the left shoulder and arm, with sharp pain radiating into the left thumb. Exam shows weakness of the biceps. The biceps reflex on the left is absent. The most likely diagnosis is? (2x)

Answer 296

C-6 RADICULOPATHY

Question 297

Pt c/o unpleasant aching and drawing sensations in calves and thighs associated with a crawling feeling, forcing him to move legs, bringing transient relief. Sxs worsened by fatigue. Exam nl. Best med tx? (2x)

Answer 297

PERGOLIDE (FOR RESTLESS LEG SYNDROME)

Question 298

Severe spasms and rigidity of limbs intermittently and later more persistent/continuous: (2x)

Answer 298

ANTIGLUTAMIC AND ANTIDECARBOXYLASE ANTIBODIES (anti- GAD) ANTIBODIES

Question 299

Weakness in limbs 2 weeks after a viral gastroenteritis. Weakness in UE/LE, absent DTRs. Spinal fluid shows no cells and elevated protein. EMG shows slow conduction velocity, prolonged distal motor latency, and conduction block. (2x)

Answer 299

ACUTE INFLAMMATORY POLYNEUROPATHY

Question 300

2 years after MVA with rear-end collision, pt develops BUE weakness with some muscle wasting, loss of DTRs in arms, loss of sensation to pain and temp in neck/arms/shoulders, intact sensation to touch. Most likely cause? (X2)

Answer 300

SYRINGOMYELIA