Practice Questions Flashcards
What study is most useful to rule out on intracerebral hemorrhage?
A. Electrocradiogram
B. Non contrast head CT
C. Complete blood count
D. Cerebral arteriogram
B. Non-contrast head CT
A 43-year-old women with a history of previous brain tumors is found unconsious in her home by a visiting neighbor. She has urinated on herself and there is a small amount of blood and saliva coming from the inside of her mouth. Which of the following is the most likely diagnosis?
A. cardiogenic syncope
B. Vasovagal syncope
C. Seizure
D. Orthstatic hypotension
C. Seizure
An 81-year-old pt arrives to the ER with acute left hemiparesis and neglect. What finding is most important in determining eligibility for thrombolytic treatment?
A. Time of last known well less than 4.5 hrs
B. Hx of previous MI
C. Pt taking any antihypretensive meds
D. Distant hx of GI bleed
A. Time of last known well less than 4.5 hrs
After recieving stroke therapy, the patient is being discharged home on physical therapy. The usual treatment would include long-term medical management with antiplatelet or anticoag. If present, which of the following condition would benefit most from anticoag instead of antiplatelet therapy?
A. Diabetes
B. Ischemic heart disease
C. Carotid stenosis
D. Atrial fibrillation
D. Atrial Fibrillation
A 59 y/o healthy man presents with 6-week history of right frontal temporal headaches associated with difficulty concentrating, weight loss, and coughing. His headaches are often associated with nausea and are dull in nature. His wife reports personality changes and the patient himself recognizes mood disturbances. His examination is notable for decreased arm swing on left, questionable weakness of left finger extensors and a left Babinski sign.
What is the likely diagnosis?
Metastatic brain tumor affecting the right cerebral hemisphere
What is the next diagnostic step?
For metastatic brain tumor
MRI of the brain with and without contrast
What would the next step in treatment therapy?
For metastatic brain tumor
start of steroids and anticonvulsants
A 56 y/o male who is complaining of confusion and motor deficits is noted to have multiple lesions to the brain. A metastatic tumor is suspected. Which of the following is the most common tumor causing brain metastasis?
A. Breast
B. Melanoma
C. Renal
D. Lung
E. Thyroid
D. Lung
A 50 y/o male is noted to have some symptoms suggestive of a brain tumor which of the found symptom for brain tumor?
A. Personality changes
B. Papilledema
C. Seizures
D. Headache
E. ataxia
D. HA
Case Question
* A 19-year-old man is evaluated for a 2-week history of shaking episodes sometimes associated with falling that are followed by a period of unresponsiveness. He reports having a 30-minute episode just before getting in the car to go to this appointment. Episodes have been occurring daily, sometimes as often as four times a day and last 20-45 minutes.
According to the patient’s mother, the episodes involve limb shaking with the eyes closed, intermittent cessation of breathing, and a reddening of the face.
The patient remains standing for a few seconds after the shaking starts but on occasion becomes limp and falls. He does not respond when his name is called, or his arms or legs are lightly touched. The shaking, which gradually increased and decreases in intensity, typically involves both arms and sometimes the legs.
He is exhausted but oriented and responsive afterward and has rapid breathing.
All physical examination findings are normal.
Which of the following is the most likely diagnosis?
A. Convulsive status epilepticus
B. Generalized tonic-clonic seizures
C. Myoclonic seizure
D. Psychogenic nonepileptic spell/event
D. Psychogenic nonepileptic spell/event
A 45-year-old male with a history of smoking presents after experiencing a generalized tonic-clonic seizure. He has been experiencing dull left-sided headaches over the past two months. His examination reveals hyperreflexia on the right with mild weakness on the right illopsoas and finger extensor muscles. The MRI of the brain shows a large 7 cm x 10 cm lesion over the left frontal region with associated midline shift. A chest x-ray shows a leff lower lobe mass. What are your next steps?
* A. consult neurosurgery for immediate brain biopsy and debulking.
B. Start dexamethasone at a dose of 10 mg followed by 4 mg every 6 hours.
Concomitantly begin an anticonvulsant mediation.
C. Start dexamethasone at a dose of 100 mg followed by 4 mg every 6 hours and hold off on starting anticonvulsant medication.
D. Consult oncology service to assist you in deciding on chemotherapy.
E. Start whole brain radiation therapy.
B. Start dexamethasone at a dose of 10 mg followed by 4 mg every 6 hours.
A 24-year-old graduate student was studying late at night for an examination. As he looked at his textbook, he realized that his left arm and leg were numb. He dismissed the complaint, recalling that 6-7 months ago he had similar symptoms. He rose from his desk and noticed that he had poor balance. He queried whether his vision was blurred and remembered that he had some blurred vision approximately 1 to 2 years earlier but that this resolved. He had not seen a physician for any of these previous symptoms. He went to bed and decided that he would seek medical consultation the next day. What is the most likely diagnosis?
Multiple sclerosis
What is the next diagnostic step?
For MS
see a doctor
undergo neurologic assessment
Bloof studies, lumbar puncture
What is the next step in therapy?
For MS
IV corticosteriod followed by immune modulatory therapy directed at improving the disease course
A 28-year-old man is noted to have double vision and leg weakness. A suspicion of MS is entertained. Which of the following findings would be consistent with the diagnosis?
A. Oligoclonal bands in CSF
B. Increased N-acetyl aspartate with MR spectroscopy
C. Abnormal peripheral nerve conduction by nerve conduction studies.
D. Meningeal enhancement on contrast MRI of the brain.
A. Oligoclonal bands in CSF
