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Res Quizzes > Residents Monthly Exam > Flashcards

Residents Monthly Exam Flashcards

1
Q

Which of the following intramedullary brainstem syndromes is INCORRECTLY matched? (Adams 805, 2015 RITE Question).
A. Parinaud Syndrome: paralysis of upward gaze and accommodation; fixed pupils
B. Benedikt Syndrome: oculomotor palsy, contralateral cerebellar ataxia, tremor, choreoathetosis
C. Claude syndrome: oculomotor palsy, contralateral cerebellar ataxia, tremor
D. Wallenberg syndrome: contralateral CN V, IX, X, XI palsy, ipsilateral Horner syndrome, contralateral hypoesthesia
E. Millard Gubler syndrome: CN VI, VII palsy, contralateral hemiplegia

A

D. Wallenberg syndrome: contralateral CN V, IX, X, XI palsy, ipsilateral Horner syndrome, contralateral hypoesthesia

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2
Q 
Causes of stroke in the young include the following EXCEPT? (Adams 834; 2015 RITE Question)
A. Protein C deficiency
B. factor V Leiden mutation  
C. Protein S deficiency 
D. Increased aPTTT 
E. Excess Antithrombin III
A

Excess Antithrombin III

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3
Q

All of the following are ABSOLUTE contraindications to rTPA administration EXCEPT? (Adams 814; SSPG 86; 2015 RITE Question)
A. Current use of anticoagulation with INR >3.0 or PT >15 sec
B. Platelet count

A

A. Current use of anticoagulation with INR >3.0 or PT >15 sec

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4
Q 
Which of the following MRI sequence is good detecting hemorrhages and calcifications? (Adams 794; 2015 RITE Question) 
A. T1-weighted
B. T2-weighted
C. T2-FLAIR
D. DWI
E. Susceptibility sequence
A

E. Susceptibility sequence

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5
Q

With regards to hemicraniectomy in malignant MCA Infarction, which of the following statements is FALSE? (SSPG 97-100; often asked in NSS Conference; favorite question of Dr. Jamora)
A. For patients managed conservatively, the mortality rate is 20.8% for patients 60 yrs.
B. According to the STATE Criteria, decompressive hemicraniectomy is best done within 72 hours from the ictus.
C. Indications for emergent hemicraniectomy include asymmetry, midline shift >10 mm at the septum pelucidum, midline shift >5mm at the pineal gland.
D. Removal of bone flap decreases ICP by 15% and opening of the dura reduces ICP by 70%.
E. Dimensions of the bone flap recommended is 12 cm x 9 cm.

A

B. According to the STATE Criteria, decompressive hemicraniectomy is best done within 72 hours from the ictus.

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6
Q 
KK, 58/M, presented with a 2 hour history of sudden-onset aphasia, R facial asymmetry, R hemiplegia and drowsiness. Thanks to the BAT team, he was deemed a good candidate for thrombolysis. He weighs 110 kg. What is the dose of the rtPA that should be given to KK as BOLUS? (Adams 813, SSPG 86, 87) 
A. 9.9 mg
B. 9.0 mg
C.  89.1 mg
D. 91 mg
E. 66 mg
A

B. 9.0 mg

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7
Q

What is the present CHADS Score and CHADSVASC score of the BB, 68/F who is a known hypertensive with failure symptoms (NYHA FC III) and atrial fibrillation? She was also admitted a year ago for NSTE-ACS. She now presented with sudden-onset aphasia and R hemiplegia. Pertinent labs on admission include an RBS of 200 mg/dL, FBS of 120 mg/dL and an HbA1c of 6.8 (use ADA 2010 guidelines to diagnose DM). (Adams 784, SSPG 111)
A. CHADS score of 3, CHADSVASC score of 6
D. CHADS score of 5, CHADSVASC score of 8
B. CHADS score of 3, CHADSVASC score of 8
E. CHADS score of 6, CHADSVASC score of 8
C. CHADS score of 5, CHADSVASC score of 6

A

D. CHADS score of 5, CHADSVASC score of 8

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8
Q

Which of the following is an INCORRECT statement regarding the risk of stroke after a Transient Ischemic Attack? (Adams 786)
A. Approximately 20% of infarcts follow within a month after the TIA.
B. Approximately 50% of infarcts follow within 3 months after the TIA.
C. The 5-year cumulative rate of fatal or nonfatal cerebral infarction after TIA is 23%.
D. The occurrence of carotid TIAs is also a predictor of myocardial infarction.
E. The rate of myocardial infarction in patients with TIA is as high as 21% and in other studies, it even exceeded the risk of stroke.

A

B. Approximately 50% of infarcts follow within 3 months after the TIA.

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9
Q

Which of the following statements is CORRECT regarding Amaurosis fugax or TMB? (Adams 787)
A. Most of the visual episodes evolve swiftly over 5-30 minutes and are painless.
B. The risk of stroke following TMB is higher compared to cerebral TIAs from a carotid disease.
C. Patients with TMB describe their symptoms as having a homonymous hemianopsia.
D. The risk of stroke over 3 years following TMB is as low as 2% if there are no other comorbidities such as DM and atherosclerosis.
E. The pathology in TMB is that of a clot occluding the posterior cerebral artery.

A

D. The risk of stroke over 3 years following TMB is as low as 2% if there are no other comorbidities such as DM and atherosclerosis.

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10
Q 
This disease entity is characterized by dementia caused by caused by multiple strokes from vascular causes such as hypertension and atherosclerosis. (Adams 831)
A. Binswanger disease
C. CARASIL 
E. MELAS
B. CADASIL 
D. Moyamoya Disease
A

A. Binswanger disease

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11
Q

Which of the following statements is INCORRECT regarding the use of statins for secondary stroke prevention and the evidence to support its use? (Adams 819)
A. The most comprehensive study of statins to date is the SPARCL trial.
B. Administration of a lipid-lowering drug are advisable even if lipid levels are normal.
C. The stroke reduction risk of high dose statin administration is as high as 20% percent over 5 years.
D. Whether it is adequate to adapt the recommendations of the SPARCL trial is still unclear.
E. Patients with TIA were also included in the SPARCL trial.

A

C. The stroke reduction risk of high dose statin administration is as high as 20% percent over 5 years.

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12
Q

Which of the following statements regarding the immediate heparin administration or an equivalent such as Enoxaparin is FALSE? (Adams 815)
A. It can be used in basilar artery thrombosis with fluctuating deficits and impending carotid artery occlusion.
B. This practice is based on clinical practice and that supporting clinical studies have not been carried out.
C. Most authorities have found trial based evidence to support the use of heparin in basilar artery thrombosis.
D. Administration of anticoagulants is not of great value once the stroke is already fully developed.
E. Several studies support the use of anticoagulation in stroke due to certain cardioembolic sources, particularly atrial fibrillation

A

C. Most authorities have found trial based evidence to support the use of heparin in basilar artery thrombosis.

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13
Q

Which of the following is NOT a characteristic of Moyamoya Disease? (Adams 830-831)
A. There is an extensive anastomotic vascular network at the base of the brain.
B. It is found around and distal to the circle of Willis and is associated with segmental stenosis or occlusion of the terminal intracranial parts of both ICA.
C. The pathology behind the disease is the distal carotid occlusion due to atheroma formation.
D. Anticoagulation is considered risky for patients with Moyamoya Disease due to the risk of ICH.
E. Certain surgical measures are available and have been reported to reduce the number of ischemic attacks.

A

B. It is found around and distal to the circle of Willis and is associated with segmental stenosis or occlusion of the terminal intracranial parts of both ICA.

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14
Q

Madame Claudia Buenavista, 70/F, with a prior stroke and nonvalvular AF, has been maintained on Warfarin for the past 6 months. She now consulted at the PGH OPD Polyclinic because she wants to be switched to a NOAC. Her latest INR obtained that day was 2.3. What is the next step that you should do? (SSPG 119; common clinical dilemma especially of Ath)
A. Start NOAC immediately or the next day.
B. Repeat INR after 24 hours and if

A

A. Start NOAC immediately or the next day.

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15
Q

. Lola Purita Hinampas, a 70/F, has been on Rivaroxaban for the past 3 months but now comes back to you because she wants to be switched to Warfarin due to financial constraints. What is the most appropriate action to do? (SSPG 119; common clinical dilemma especially of Ath)
A. Discontinue NOAC and obtain baseline INR first 24 hours after the last intake of NOAC prior to starting Warfarin.
B. Administer Warfarin together with NOAC until INR is within target.
C. Discontinue NOAC then start Warfarin but bridge with Enoxaparin.
D. Switch immediately to Warfarin after you discontinue NOAC.
E. It is not advisable to switch from NOAC to Warfarin. Never; don’t even bother.

A

B. Administer Warfarin together with NOAC until INR is within target.

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16
Q

Which MRI findings are consistent with an infarct within 12 hours PI? (SSPG 147; 2015 RITE Question)
A. T1 hyperintense, T2-FLAIR hypointense, DWI hyperintense, ADC hypointense
B. T1 hypointense, T2-FLAIR hyperintense, DWI hyperintense, ADC hyperintense
C. T1 hypointense, T2-FLAIR hypointense, DWI hyperintense, ADC hypointense
D. T1 hypointense, T2-FLAIR hyperintense, DWI hypointense, ADC hyperintense
E. T1 hypointense, T2-FLAIR hyperintense, DWI hyperintense, ADC hypointense

A

E. T1 hypointense, T2-FLAIR hyperintense, DWI hyperintense, ADC hypointense

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17
Q

Which MRI findings are seen in hypertensive ICH in the hyperacute state? (SSPG 151; 2015 RITE)
A. T1 hyperintense, T2 hypointense, GRE hypointense with blooming bright signal
B. T1 hypointense, T2 hypointense, GRE hypointense with blooming bright signal
C. T1 hypointense, T2 hyperintense, GRE hyperintense with blooming dark signal
D. T1 hyperintense, T2 hyperintense, GRE hyperintense with blooming dark signal
E. T1 hyperintense, T2 hyperintense, GRE hypointense with blooming bright signal

A

C. T1 hypointense, T2 hyperintense, GRE hyperintense with blooming dark signal

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18
Q 
What is the Spetzler-Martin score for an AVM in the left temporal lobe, which was found to have a nidus diameter size of 5.2 cm and with deep draining veins on 4VA? (SSPG 134) 
A. 2	
B. 3	
C. 4	
D. 5 	
E. 6
A

C. 4

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19
Q

WW, a 45/M was brought at the ER due to sudden-onset severe headache. On neurologic examination, he was rousable to tapping, able to nod to communicate, with R CFP and R hemiplegia (0/5). On NCCT, there was blood in the basal cisterns, thickest on the R Sylvian fissure (~1 mm thick). What is the clinical grade of this patient based on Hunt-Hess classification? What is the radiologic grade of the SAH based on Fisher scale? (SSPG 129-130)

A. Hunt & Hess Grade 3, Fisher 2
D. Hunt & Hess Grade 4, Fisher 3
B. Hunt & Hess Grade 4, Fisher 2
E. Hunt & Hess Grade 1, Fisher 3
C. Hunt & Hess Grade 3, Fisher 3
A

D. Hunt & Hess Grade 4, Fisher 3

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20
Q

With regards to Citicoline, which of the following statements is INCORRECT? (SSPG 81-82).
A. In patient data pooling analysis from 4 trials, oral citicoline given within the first 24 hours of moderate to severe ischemic stroke increased the probability of global recovery by 30% at 3 months.
B. Citicoline is avoided in patients with hemorrhagic stroke as its safety profile is not well investigated in this subset of patients.
C. According to the ICTUS trial, global recovery at 90 days was similar in patients who received Citicoline and in those who received placebo.
D. Some of the reasons why the ICTUS trial did not show any advantageous benefit with the use of Citicoline include randomization of more severe stroke and the substantial number of patients receiving thrombolytic therapy, resulting to a ceiling effect from maximum improvement.
E. According to the SSPG, the use of drugs with neuroprotective properties, such as Citicoline, remains a matter of preference of the attending physician.

A

B. Citicoline is avoided in patients with hemorrhagic stroke as its safety profile is not well investigated in this subset of patients.

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21
Q

Which of the following NOAC and their corresponding dose has been shown to be superior to Warfarin in preventing ischemic stroke? (SSPG 114; favorite question of Dr. San Jose)
A. Dabigatran 110 mg BID
B. Dabigatran 150 mg BID
C. Rivaroxaban 20 mg OD
D. Apixaban 5 mg BID
E. None. No NOAC has been found superior to Warfarin in preventing ischemic stroke.

A

B. Dabigatran 150 mg BID

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22
Q

Which of the following statements is INCORRECT about rtPA administration? (SSPG 86-88)
A. The target pretreatment BP is 80 years old, oral anticoagulant intake regardless of INR, NIHSS >21 and patients with a history of both ischemic stroke and diabetes.

A

E. Exclusion criteria for extension of rtPA to 4.5 hours post-ictus include age > 80 years old, oral anticoagulant intake regardless of INR, NIHSS >21 and patients with a history of both ischemic stroke and diabetes.

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23
Q 
NOAC/s that can be given per NGT include which of the following? (SSPG 116, 2015 RITE Q.)
A. Dabigatran 
C. Apixaban 
E. B & C only
B. Rivaroxaban 
D. A & B only
A

E. B & C only

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24
Q 
NOAC/s that is a direct thrombin inhibitor. (SSPG 120)
A. Dabigatran 				
D. A & B only 
B. Rivaroxaban 
C. B & C only 
C. Apixaban
A

A. Dabigatran

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25
Q

Early signs of an infarct on plain cranial CT include all of the following EXCEPT? (SSPG 142-144)
A. dense MCA sign
D. obscuration of the lentiform nucleus
B. perilesional edema
E. loss of grey matter and white matter differentiation
C. insular ribbon sign

A

B. perilesional edema

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26
Q 
In acute bacterial meningitis, Ampicillin is given when there is an infection of which organism? (Adams 705)
A. Streptococcus pneumoniae 
D. Haemophilus influenzae
B. Neisseria meningitides 
E. Group B streptococcus 
C. Listeria
A

C. Listeria

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27
Q

In patients from countries such as the Philippines, high rates of resistance to INH are reported. Which of the following antibiotics is then added as a 5th drug? (Adams 720, 2015 RITE Question)
A. Quinolone D. Ethionamide
B. Macrolide E. Capreomycin
C. Streptomycin

A

D. Ethionamide

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28
Q

Focal collection of epithelioid cells surrounded by a rim of lymphocytes forming noncaseating granuloma are found in which disease entity? (Adams 721; 2015 RITE Question)
A. Blastomycosis D. Tuberculosis
B. Melioidosis E. Toxoplasmosis
C. Sarcoidosis

A

C. Sarcoidosis

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29
Q

Which of the following statements is INCORRECT about Neurosyphilis? (Adams 723-724; 2015 RITE)
A. The treponeme usually invades the CNS within 3-18 months of inoculation.
B. Neurosyphilitic meningitis occurs in 25% of all cases of syphilis.
C. All forms of neurosyphilis begin as meningitis.
D. Clinical syndromes such as syphilitic meningitis, meningovascular syphilis, general paresis, tabes dorsalis, optic atrophy, and meningomyelitis often exist in pure form.
E. Congenital syphilis are similar to those of the late-acquired forms.

A

D. Clinical syndromes such as syphilitic meningitis, meningovascular syphilis, general paresis, tabes dorsalis, optic atrophy, and meningomyelitis often exist in pure form.

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30
Q

What is the recommended treatment in the first stage of Borreliosis? (Adams 730; 2015 RITE Question)
A. Oral doxycycline D. Tetracycline
B. 3rd generation cephalosporin +Vancomycin E. Penicillin G
C. Amoxicillin

A

A. Oral doxycycline

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31
Q 
Which of the following is a rapidly fatal disease characterized by headache, seizures, coma and a retinopathy with orange or white discoloration of the retinal vessels? (Adams 735; 2015 RITE Question) 
A. Amebic meningoencephalitis 			
D. Trichinellosis 
B. Malaria 
E. Meningococcal meningitis  
C. Trypanosomiasis
A

B. Malaria

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32
Q 
Recurrent bacterial meningitis is often caused by which organism? (Adams 704)
	A. Streptococcus pneumoniae 	
	D. Legionella 
	B. Neisseria meningitides 		
	E. Group B streptococcus 
	C. Listeria
A

A. Streptococcus pneumoniae

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33
Q

What is the empiric antiobiotic for acute bacterial meningitis for immunocompetent patients, aged 18-50 years old? (Adams 705, 2015 RITE Question)
A. 3rd generation cephalosporin + Vancomycin + Ampicillin
D. Penicillin G
B. Cefotaxime + Ampicillin
E. Vancomycin + Ceftazidime
C. Vancomycin + Ampicillin + Ceftazidime

A

A. 3rd generation cephalosporin + Vancomycin + Ampicillin

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34
Q

What is the most common variant of CJD? (Adams 770; 2015 RITE Question)
A. VV D. MV1
B. MM1 E. MV2
C. MM2

A

B. MM1

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35
Q

What is the causative agent of Progressive Multifocal Leukoencephalopathy (PMLE)? (Adams 767; 2015 RITE Question)
A. HTLV D. EBV
B. HIV E. HSV
C. JC virus

A

C. JC virus

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36
Q

Ito ang dahilan kung bakit nakaupo na lang si Apolinario Mabini. (Philippine History; #utangnaloob)
A. Neurosyphilis
D. HIV Myelopathy
B. Poliomyelitis
E. Rabies infection
C. HTLV-1 Infection (Tropical Spastic Paraparesis)

A

B. Poliomyelitis

37
Q 
Which of the following is an EEG finding that is highly suggestive of HSV infection? (Adams 751)
A. GPEDs 		
B. Triphasic waves 
C. PLEDs 	
D. NCSE 
E. FIRDA
A

C. PLEDs

38
Q 
Subacute Sclerosing Panencephalitis (SSPE) is a result of chronic infection of which virus? (Adams 766) 
	A. Varicella 
	B. Measles	
	C. Mumps 
	D. Rubella 
	E. HSV
A

B. Measles

39
Q

What is the recommended treatment for HSV encephalitis? (Adams 752)
A. Acyclovir at 30 mg/kg/day x 7 days
D. Valacyclovir at 30 mg/kg/day x 7 days
B. Acyclovir at 30 mg/kg/day x 10-14 days
E. None
C. Acyclovir at 30 mg/kg/day x 21 days

A

B. Acyclovir at 30 mg/kg/day x 10-14 days

40
Q

Granulation tissue or capsule formation in Brain Abscess is evident after how many weeks from the onset of infection? (Adams 716)
A.

A

C. 2 weeks

41
Q

In contrast to a malignancy, what is the characteristic MRI finding in the early stage of brain abscess formation (cerebritis)? (Adams 716; favorite question of Dr. Ison)
A. restricted diffusion / hyperintense on DWI
D. hyperintense on GRE
B. hypointense on DWI
E. hypointense on GRE
C. isointense on DWI

A

A. restricted diffusion / hyperintense on DWI

42
Q

. Blood cultures should always be obtained when suspecting acute bacterial meningitis but how many percent will show positive results? (Adams 703)
A.

A

C. 40-60%

43
Q

What is the most striking neurologic complication of von Economo’s encephalitis (encephalitis lethargica), a type of encephalitis that occurred in epidemic proportions along with viral influenza between 1917 and 1928? (Adams 768)
A. Blindness D. Parkinsonism
B. Hearing loss E. Incontinence
C. Paraplegia

A

D. Parkinsonism

44
Q

Rasmussen encephalitis, which causes intractable focal seizures and progressive hemiparesis, has been attributed to which of the following etiologies? (Adams 769)
A. HSV-1 Infection D. A & B
B. Autoimmune process E. A, B & C
C. CMV Infection

A

E. A, B & C

45
Q 
Antigen of the following organisms are detected in the PGH BACTIGEN test EXCEPT? (Lab result) 
	A. Streptococcus pneumoniae 			
	D. E. coli  
	B. Neisseria meningitides 		
	E. Group B streptococcus 
	C. Listeria
A

C. Listeria

46
Q 
What is the most sensitive neuroimaging test to evaluate patients with encephalitis? (IDSA 2008, p304)
	A. cranial CT with contrast 		
	D. MR spectroscopy
	B. MRI 					
	E. no recommendations 
	C. FDG-PET
A

B. MRI

47
Q

Which of the following statements is INCORRECT regarding the role of EEG in patients with encephalitis? (IDSA 2008, p304)
A. It is rarely helpful in establishing the etiology in patients with encephalitis.
B. It has a role in identifying patients with nonconvulsive seizure activity (NCSE).
C. It should be performed in all patients with encephalitis.
D. A & D are INCORRECT.
E. None of the statements above are incorrect.

A

E. None of the statements above are incorrect.

48
Q 
All of the following are signs and salient points in the history that warrant neuroimaging before LP EXCEPT? (IDSA 2004, p1269) 
	A. Immunocompromised patient 		
	D. focal neurologic deficits 
	B. patients with prior shunts		 	
	E. CN VI palsy 
	C. papilledema
A

E. CN VI palsy

49
Q

Which of the following statements is INCORRECT regarding the indications for a repeat lumbar puncture in patients with bacterial meningitis? (IDSA 2004, p1281)
A. It should be performed in all patients to document CSF sterilization and improvement of CSF parameters.
B. It should be performed in any patient who has not responded clinically after 48h of appropriate antimicrobial therapy.
C. It should be performed in neonates with gram negative bacilli infection to document sterilization and to determine the duration of antibiotic therapy.
D. A drainage catheter should be placed after shunt removal in patients with CSF shunt infection for monitoring of CSF parameters.
E. None of the above.

A

A. It should be performed in all patients to document CSF sterilization and improvement of CSF parameters.

50
Q

. Which of the following statements is INCORRECT regarding the management of increased ICP in patients with Cryptococcal meningitis? (IDSA 2010, p 295)
A. Mannitol has no proven benefit and is not routinely recommended.
B. Acetazolamide and corticosteroids should be avoided to control increased ICP.
C. If the CSF pressure is > 25 cm and there symptoms of increased intracranial pressure during induction therapy, relieve CSF by 50% of the opening pressure if it is extremely high or to a
normal pressure of 25 cm of CSF and symptoms, repeat lumbar puncture daily until the CSF pressure and symptoms have been stabilized for 12 days.
E. Despite receiving an appropriate antifungal regimen, VP shunts cannot be placed during active infection to relieve increased ICP due to the risk of peritoneal seeding of infection.

A

E. Despite receiving an appropriate antifungal regimen, VP shunts cannot be placed during active infection to relieve increased ICP due to the risk of peritoneal seeding of infection.

51
Q

Which of the following statements is INCORRECT about NPH? (Adams 624-627; 2015 RITE question)
A. The gait disorder is a late feature while urinary symptoms appear early in the illness.
B. The triad of NPH is not usually present in the early stages of the process.
C. Babinski signs are not present, headaches are infrequent and there is no papilledema.
D. CSF pressure is in a high normal level of 150-200 mmH2O but the patient has manifestations of the hydrocephalic state.
E. CT shows enlarged ventricles without atrophy or an atrophy that is disproportionate to the degree of atrophy.

A

A. The gait disorder is a late feature while urinary symptoms appear early in the illness.

52
Q

Treatment for NPH include which of the following EXCEPT? (Adams 626)
A. Drainage of large amounts of CSF (20-30 cc)
B. Lumbar drain insertion for 3 days, removing ~50 cc daily
C. Shunt surgery
D. Endoscopic third ventriculostomy
E. None of the above

A

E. None of the above

53
Q

. What is the dose of Acetazolamide that should be given to patients with Pseudotumor cerebri? (Adams 631)
A. 250 mg BID B. 250 mg TID C. 1-5 gm/day D. 5-10 gm/day E. not yet established

A

C. 1-5 gm/day

54
Q 
Which of the following treatments is done for patients with Pseudotumor cerebri who are losing vision? (Adams 631-632; 2015 RITE Question)
	A. Acetazolamide 			
	D. Corticosteroids
	B. Weight reduction		
	E. Optic Nerve Sheath Fenestration
A

E. Optic Nerve Sheath Fenestration

55
Q 
Arachnoid villi are most numerous in which of the following area? (Adams 619, 2015 RITE Question)
	A. superior sagittal sinus 		
	D. confluence of sinuses 
	B. transverse sinus			
	E. base of the brain 
	C. inferior sagittal sinus
A

A. superior sagittal sinus

56
Q 
What is the most common delayed sequelae of craniocerebral trauma? (Adams 903). 	
A. Fistula formation, eg. CCF  		
D. Epilepsy
B. Autonomic dysfunction 		
E. Hydrocephalus 
C. Dementia
A

D. Epilepsy

57
Q 
Patients suffering from this traumatic brain lesion typically have a lucid interval first before progressing to coma. (Adams 897)
	A. Subdural Hematoma		
	D. Traumatic SAH  
	B. Contusion Hematoma		
	E. Diffuse Axonal Injury 
	C. Epidural Hematoma
A

C. Epidural Hematoma

58
Q 
To relieve raised ICP caused by TBI, which of the following hyperosmolar agents can be used? (Adams 909-910)
	A. Steroids				
	D. A & C only 
	B. Mannitol 				
	E. A, B & C 
	C. Hypertonic Saline
A

E. A, B & C

59
Q

With regards to antiseizure medications and TBI, which of the following statements is CORRECT? (Adams 904, 910)
A. Prophylactic use of AEDs is effective in preventing early seizures according to the study of Rish and Caveness.
B. Late-onset posttraumatic epilepsy are reduced if AEDs are given prophylactically from the day of injury up to 2 years.
C. AEDs are given only when seizures develop.
D. Trauma-related seizures often require multiple AEDs for control.
E. Recalcitrant posttraumatic epilepsy are common and thus excision of epileptic focus are advocated as early as possible.

A

C. AEDs are given only when seizures develop.

60
Q

Which of the following statements is INCORRECT regarding Subdural Hygroma? (Adams 900-901).
A. It is a thinly encapsulated collection of clear or slightly xanthrochromic fluid in the subdural space.
B. It can occur after an injury or after meningitis.
C. It can occur even without any known precipitant because it can arise from an arachnoidal tear.
D. In adults, hygromas are usually asymptomatic and do not require treatment.
E. Hygromas are a frequent cause of seizures in adults.

A

E. Hygromas are a frequent cause of seizures in adults.

61
Q
  1. Which of the following is false?
    a. In children and adults, third generation cephalosporins usch as ceftriaxone combined with vancomycin is probably the best initial therapy for the three major types of community acquired meningitides. (p705)
    b. Ampicillin should be added to the regimen in cases of suspected Listeria meningitis, particularly in an immunocompromised patients.
    c. If Pseudomonas is considered, such as after neurosurgery, an antipseudomonal antibiotic such as ceftazidime should be added.
    d. Repeated lumbar punctures are necessary to assess the effects of therapy.
    e. None of the above
A

Answer: D

p.705 Repeated lumbar punctures are NOT necessary as long as there is progressive clinical improvement

62
Q

Which of the following about neurosyphilis is false?

a. It is advisable that all patients with syphilis should have a spinal fluid examination.
b. The glucose content of CSF is usually normal.
c. During treatment, the first to revert to normal is the positive serologic test.
d. There is elevation of CSF total protein in neurosyphilis from 40 to 200mg/dl.
e. With either spontaneous or therapeutic remission of disease, the cells in the CSF disappear first.

A

Answer: C
Because asymptomatic neurosyphilis can be recognized only by the changes in the CSF, it is advisable that all patients with syphilis should have a spinal fluid examination.
CSF abnormalities: (1) pleocytosis of 100 cells/mm3, mostly lymphocytic; (2) elevation of total protein 40-200mg/dL (3) an increase in gamma globulin (4) positive serologic tests
Glucose is normal. With spontaneous or therapeutic remission: cells disappear first, next the total proteins turn to normal then gamma globulin concentration is reduced. The positive serologic tests are the last to revert to normal.

63
Q

Which of the following has the most impact on the incidence of stroke

a. Triglycerides
b. LDL
c. HDL
d. B & C

A

Answer: B
p. As in the case of coronary artery disease, the level of LDL cholesterol has the most impact on the incidence of stroke but elevated triglycerides may also confer risk.

64
Q

Which of the following is true regarding the mechanism if transient ischemic attacks?

a. A single transitory episode that lasts longer than 1 hour and multiple episodes of different pattern suggest atherosclerosis. (EMBOLISM)
b. Exercise and postural TIAs are particularly suggestive of stenosis of aortic branches and dissection of aortic arch.
c. TIAs are brief, reversible episodes of focal ischemic brain disturbance without evidence of cerebral infarction.
d. B & C
e. all of the above

A

Answer: D
The question is whether there is reduced blood flow or embolic particles are respobsinble for TIAs. Restated, a single transitory episode, especially if it lasts longer than 1 h, and m ultiple episodes of diff erent pattern, suggest embolism and must be distinguished from brief (2- to 1 0-min) recurrent attacks of the same clinical pattern, which s uggest TIAs from atherosclerosis and thrombosis in a large vessel. Embolization of fibrin-platelet material from atherosclerotic sites indeed may be the cause of attacks in some cases, but it is difficult to understand how attacks of identical pattern could be caused by successive emboli from a distance that enter the same arterial branch each time.

65
Q

The chemical compound released by ischemic cells which excite neurons and produce intracellular influx of Na and Ca which are in part responsible for irreversible cell injury

a. Glutamate
b. Dopamine
c. Glycine
d. Histamine
e. Serotonin

A

Answer: A

66
Q

History of swimming in fresh water, usually under sustained periods, and on finding viable trophozoites in a wet preparation of unspun spinal fluid

a. Toxoplasmosis
b. Amebic Meningoencephalitis
c. Schistosomiasis
d. Malaria

A

Answer: B p.735
Protozoal diseases:
Toxoplasmosis – Toxoplasma gondii, obligate intracellular parasite recognized in Giemsa – or Wright stained preparations
Amebic meningoencephalitis
Malaria
Trematode: cerebral lesions form in relation to directparasitic deposition of eggs in blood vessels and take the form on necrotizing an dischemic parenchymal foci that are infiltrated by eosinophils and giant cells

67
Q
  1. The term posttraumatic epilepsy usually refers to late epilepsy, i.e., to seizures that develop several weeks or months after closed head injury. How many weeks/ months in most cases?
    a. Less than a month
    b. 1-3 months
    c. 4-6 months
    d. more than 6 months
A

Answer: B

68
Q
  1. Guidelines set by the American Association of Neurological Surgeons and allied groups with routine use of ICP monitoring include:
    a. Glasgow Coma Scale is between 3 and 8 and there are abnormalities on CT scan
    b. there is no abnormality on the CT but the patient has any two of age over 40, posturing, or has systolic blood pressure below 90 mm Hg
    c. desirable level of ICP is below 25mmHg
    d. A and B only
A

Answer: D

Desirable level is below 20mmHg

69
Q
  1. Elevations in serum osmolality as a consequence of excessive concentrations of diffusible solutes such as glucose are not useful in reducing intracranial volume because they do not create gradient for water and solutes across the cerebral vasculature. Which of the following fluids is ideal?
    a. 0.5 normal saline
    b. 5% dextrose in 0.5 normal saline
    c. Lactated Ringer solution
    d. Normal saline with or without added dextrose
A

Answer: D

70
Q
  1. Treatment for Herpes Simplex encephalitis
    a. Acyclovir 20mg/kg/d
    b. Acyclovir 25 mg/kg/d
    c. Acyclovir 30 mg/kg/d
    d. Acyclovir 35 mg/kg/d
A

Answer: C

71
Q
  1. This refers to a distinctive cerebral disease in which a rapidly or subacutely progressive and profound dementia is associated with diffuse myoclonic jerks and a variety of neurologic abnormalities mainly visual and cerebellar
    a. Creutzfeldt-Jakob Disease
    b. Kuru
    c. Gerstmann-Straussler-Scheinker Syndrome
    d. Encephalitis Lethargica
A

Answer: A p.769

72
Q
  1. This disease takes the form of an afebrile, progressive cerebellar ataxia, with abnormalities of extraocular movements, weakness progressive to immobility, incontinence in the late stages and death within 3 to 6 months of onset
    a. Creutzfeldt-Jakob Disease
    b. Kuru
    c. Gerstmann-Straussler-Scheinker Syndrome
    d. Encephalitis Lethargica
A

Answer: B p.773

73
Q
  1. This is a rare, strongly familial disease inherited as an autosominal dominant trait. It begins insidiously in midlife and runs a chronic course (mean of 5 years). The main characteristics are progressive cerebellar ataxia, corticospinal tract signs, dysarthria and nystagmus
    a. Creutzfeldt-Jakob Disease
    b. Kuru
    c. Gerstmann-Straussler-Scheinker Syndrome
    d. Encephalitis Lethargica
A

Answer: C p.773

74
Q
  1. Which of the following is false of Asymptomatic Carotid Artery Stenosis?
    a. Endarterectomy does not reduce the incidence of strokes in patients with asymptomatic carotid stenosis with luminal narrowing less than 60-70%
    b. The general advice is to evaluate the lumen at 6-12 month intervals
    c. If the stenosis is advancing and becomes narrowed to about 2mm or less
    d. All of the above
A

BONUS
C should be: If the stenosis is advancing ad becomes narrowed to about 4mm or less then surgery is considered
ANSWER is C: 2mm and there is an event that could be construed as a TIA referable to the stenotic side

75
Q
  1. Which of the following is false?
    a. The use of progestin-only pills or subcutaneously implanted capsules of progestin has not been associated with stroke as far as can be currently determined.
    b. Mutations of the thrombin gene are more frequent in patients who have cerebral venous thrombosis
    c. At increased risk of stroke are women taking high-dose (0.50) –mg estrogen pills
    d. None of the above
A

Answer: D p.836

76
Q
  1. The following are causes of infantile HCP except
    a. IVH in premature infants
    b. Dandy-Walker Syndrome
    c. Type III Chiari Malformation
    d. CNSI
    e. Aqueductal atresia
A

Answer: C p. 623

77
Q
  1. Which is a neuropathologic effect of HCP
    a. Proliferation of oligodendrocytes
    b. The cortical gray matter, thalami,basal ganglia, and brainstem are usually affected
    c. The ventricles are characteristically denuded of ependyma and the choroid plexuses are flattened and fibrotic.
    d. The lumens of cerebral capillaries in biopsy preparations are dilated
    e. Predominance of neutrophils and cassation necrosis
A

Answer: C p. 624
Myelinated fibers and axons are injured, but not to the extent that one might expect from the degree of compression; minor degrees as astrocytic gliosis and loss of oligodendrocytes in the affected tissue are present to a decreasing extent away from the ventricles and represent a chronic hydrocephalic atrophy fo the brain. The ventricles are denuded of ependymal and the choroid plexuses are flattened and fibrotic.

78
Q
  1. The following are recommended medical regimens for Pseudotumor Cerebri except
    a. Mannitol
    b. Furosemide
    c. Acetazolamide
    d. Steroids
    e. Glycerol
A

Answer: A p. 631
Acetazolamide and osmotic agents: first step in treatment for patients who are not losing visual acuity rapidly
Large doses 1-5g/d
Glycerol and furosemide to reduce CSF formation
Weight reduction if patient is overweight
With prednisone, there is gradual recession of papilledema and a lowerin of CSF pressure 40-60mg/d

79
Q
  1. Basal skull fractures are usually associated with cranial nerve injuries. Which cranial nerve is usually affected in such injuries?
    a. II
    b. I
    c. III
    d. IV
    e. VI
A

Answer: B
p. 887 The existence of a basal fracture is also indicated by signs of cranial nerve damage. The olfactory, facial and auditory nerves are the ones most liable to injury.

80
Q
  1. Mario was driving along Taft Avenue using a motorcycle. He was not wearing a helmet during the said ride. He was brought to PGH and presented with disfiguring pulsating exophthalmos. You were the Neuro ROD examining the patient, aside from the history of trauma, which pertinent past medical history is pertinent and may be contributory to his condition?
    a. Syphilis infection
    b. Ehlers-Danlos disease
    c. Homoscystenuria
    d. HIV infection
    e. Takayasu’s Arteritis
A

Answer: B p.888

81
Q
  1. Which statement is accurate?
    a. Concussion implies a violent shaking or jarring of the brain and resulting in transient functional impairment.
    b. Concussion implies a violent shaking or jarring of the brain and resulting in permanent functional impairment.
    c. Concussion implies a violent shaking or jarring of the brain and resulting in profound and irreversible functional impairment.
    d. AOTA
    e. NOTA
A

Answer: A

82
Q
  1. The following are included in the Canadian CT head rule after contusion except:
    a. Glasgow Coma Scale score
A

Answer: E

83
Q
  1. Tom, a distinguished Neurologist, was assigned in Mamasapano for his internship prior to being appointed as the Philippines’ representative to the WHO. In the said stint, he encountered a case of a 5F who presented with persistent water nasal discharged. However, there was no way he can confirm whether this was CSF. Which can be a useful test in this setting to ascertain fluid leak?
    a. The fluid causing a handkerchief to stiffen when dried
    b. The fluid causing a handkerchief to dampen when dried
    c. The fluid causing a handkerchief to be pale when dried
    d. The fluid causing a handkerchief to stink when dried
    e. The fluid causing a handkerchief to rust when dried
A

Answer: A p.888
The nasal discharge can be identified as CSF by testing it for glucose with diabetic tets tape (mucus has no glucose) or by the presence of fluorescein or radionucleide-;abeled dye that is injected into the lumbar subarachnoide space and then absorbed by pledgets placed in the nasl cavity.
Mucus when absorbed onto a handkerchied and allowed to dry will leave the material stiff wheres CSF WILL NOT

84
Q
  1. Which is the most common etiology for community acquired bacterial meningitis among adult patients?
    a. Streptococcus
    b. Neisseria
    c. Listeria
    d. E.coli
    e. Staphylococcus
A

Answer: A p.

85
Q
  1. This is often preceded by infections in the lungs, ears, sinuses or heart valves. Also, this is suspected in alcoholics, splenectomized patients, sickle cell anemia (autosplenectomized) and in the elderly
    a. Pneumococcal meningitis
    b. Meningococcal Meningitis
    c. H. influenza meningitis
    d. Tuberculous meningitis
A

Answer: A

86
Q
  1. Lactic acid levels are usually elevated in:
    a. Bacterial menigitides
    b. Viral meningitides
    c. Fungal meningitides
    d. All of the above
    e. A & C
A

Answer: E

87
Q
  1. Given to patients with temporal arteritis to relieve the headaches
    a. Paracetamol
    b. NSAIDs
    c. Prednisone
    d. Opioids
A

Answer: C

88
Q
  1. A 56 year-old hypertensive male was brought to the ER due to sudden onset of severe headache. He was seen drowsy, however was able to answer questions and was able to follow commands. There was no facial asymmetry, and was able to move all extremities and denies sensor deficit. There was also note of nuchal rigidity. What is the Hunt and Hess score?
    a. I
    b. II
    c. III
    d. IV
    e. V
A

Answer: C

89
Q
  1. Effective treatment for most cases of reversible posterior leukoencephalopathy
    a. Antihypertensive drugs
    b. Hydration
    c. Mannitol
    d. Dexamethasone
A

Answer: A

Res Quizzes (18 decks)

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