Neuro=======-04-1ip

27 Questions | Total Attempts: 16

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Neuro=======-04-1ip

Neuro---------04-1


Questions and Answers
  • 1. 
    13.        Coarsening of the facial features and hirsutism are undesirable side effects of:
    • A. 

      Tiagabine.

    • B. 

      Phenytoin.

    • C. 

      Gabapentin.

    • D. 

      Lamotrigine.

    • E. 

      Valproic acid.

  • 2. 
    19.        A young male executive in a brokerage company states that he is often awakened by a severe headache about 4:00 AM. The headache is excruciating and lasts approximately one hour. It is accompanied by unilateral lacrimation, rhinorrhea, and ptosis. Although he is under considerable stress, he has not noted any temporal association of the headache to identifiable periods of stress. This pattern of pain is very suggestive of:
    • A. 

      Herpes zoster.

    • B. 

      Cluster headaches.

    • C. 

      Sphenoid sinusitis.

    • D. 

      Trigeminal neuralgia.

    • E. 

      Acute angle-closure glaucoma.

  • 3. 
    21.        A 68-year-old patient experiences progressive stiffness of the legs while walking. The patient's sleep is disturbed by spasms of the lower extremities. Examination shows a very stiff-legged gait, with a tendency to adduct the legs while walking. In the lower extremities, the tone is increased, with a spastic catch. The reflexes show hyperactive knee jerks and clonus of the ankle jerks. The Romberg test shows increased sway with the eyes closed. Which of the following is the most likely diagnosis?
    • A. 

      Parkinson's disease

    • B. 

      Cervical spondylosis

    • C. 

      Restless legs syndrome

    • D. 

      Normal pressure hydrocephalus

    • E. 

      Falx meningioma

  • 4. 
    26. In the examination of a 32-year-old woman with vertigo and diplopia, it is found that when she looks to the left, she has nystagmus of the left eye only, with failure of adduction of the right eye. This disorder of ocular motility suggests the diagnosis of:
    • A. 

      Optic neuritis.

    • B. 

      Multiple sclerosis.

    • C. 

      Congenital nystagmus.

    • D. 

      Diabetic sixth nerve palsy.

    • E. 

      Progressive supranuclear palsy.

  • 5. 
    32.        Complex partial seizures are distinguished from simple partial seizures by the presence of:
    • A. 

      Olfactory hallucinations.

    • B. 

      A postictal confusional state and agitation.

    • C. 

      Repetitive, bizarre movements of the limbs.

    • D. 

      Motor and sensory manifestations of the seizure.

    • E. 

      Altered responsiveness to outside stimuli without loss of consciousness.

  • 6. 
    39.        Sinusoidal waves at 9 to 11 Hz are recorded in the electroencephalogram (EEG) during which of the following circumstances?
    • A. 

      Wakefulness with eyes closed

    • B. 

      Wakefulness with eyes open

    • C. 

      Light sleep

    • D. 

      Deep sleep

    • E. 

      Hypnosis

  • 7. 
    71.        A 73-year-old woman found on the floor at home seems unaware of her inability to use her left upper and lower extremities. Although her left arm is flaccid at her side, she denies that there is anything wrong. When she is asked to raise the left upper extremity, she raises the right one. When the psychiatrist lifts her left arm up and asks, "Whose arm is this?", she responds, "Yours." This type of behavior is most indicative of a lesion in the right:
    • A. 

      Thalamus.

    • B. 

      parietal lobe.

    • C. 

      Cingulate gyrus.

    • D. 

      Inferior temporal gyrus

    • E. 

      Orbitofrontal cortex.

  • 8. 
    80.        A 75-year-old man, a veteran of World War II, has had a gradual development of forgetfulness and intellectual deterioration. His speech tends to be very fast and slurred, making him difficult to understand. His gait is impaired. A CT scan shows some generalized atrophy, which is not unusual for his age. The lumbar puncture shows 35 WBCs, mostly lymphocytes, and the protein level is 110 mg/dL. The gamma globulin in cerebrospinal fluid is elevated. An important diagnostic consideration in this patient is:
    • A. 

      Neurosyphilis.

    • B. 

      CNS lymphoma.

    • C. 

      Mad cow disease.

    • D. 

      Herpes encephalitis.

    • E. 

      Creutzfeldt-Jakob disease

  • 9. 
    100.    A patient is asked to stand erect with the heels together and arms at his sides. He is able to maintain this position easily, without swaying, as long as his eyes are open. Upon closing his eyes, however, he quickly loses his balance and must open his eyes to avoid falling. This indicates dysfunction of the:
    • A. 

      Cerebellar vermis.

    • B. 

      Dorsal columns

    • C. 

      Nigrostriatal system.

    • D. 

      Subthalamic nucleus.

    • E. 

      Vestibular ganglion

  • 10. 
    107.    During her second pregnancy, a 35-year-old patient who does secretarial work notes numbness in the left hand, with tingling of the thumb and forefinger. At night, the patient awakens frequently with pain in the hand, forearm, and shoulder. Examination shows a sensory deficit in the palmar side of the hand, which includes the middle finger, forefinger, and thumb, and splits the ring finger. There is no motor deficit. Reflexes are normal. This is most consistent with:
    • A. 

      Median nerve entrapment at the wrist.

    • B. 

      Ulnar nerve entrapment at the elbow.

    • C. 

      Thoracic outlet syndrome.

    • D. 

      C6 radiculopathy.

  • 11. 
    103.    The diagnostic value associated with the presence of transient paresis of an arm or aphasia after an epileptic seizure is that it:
    • A. 

      Indicates the etiology.

    • B. 

      Helps localize the focus.

    • C. 

      Indicates good prognosis.

    • D. 

      Helps in the selection of a treatment.

  • 12. 
    110.    Neurofibrillary tangles in patients with Alzheimer's disease contain which of the following abnormal proteins?
    • A. 

      Amyloid 13 protein 42

    • B. 

      Mutated a synuclein

    • C. 

      Hyperphosphorylated tau

    • D. 

      14-3-3 prion protein

  • 13. 
    116.    Positive allosteric modulators of neurotransmitter-gated, multimeric ion channels are best described by which of the following statements?
    • A. 

      Increase the probability of opening in the presence of the ligand.

    • B. 

      Reduce the elimination of the ligand from the synaptic cleft.

    • C. 

      Increase the availability of the ligand in the synaptic cleft.

    • D. 

      Bind to the channel to cause an open state.

  • 14. 
    A 32-year-old patient with partial complex seizures refractory to conventional anti epileptic treatment undergoes magnetic resonance imaging (MRI) of the brain. The result is shown in the figure above (left shows a T1-weighted image, and right shows a T2-weighted image). Which of the following is the most likely diagnosis?
    • A. 

      Glioblastoma multiformis

    • B. 

      Herpes encephalopathy

    • C. 

      Mesial temporal sclerosis

    • D. 

      Multiple sclerosis

  • 15. 
    122.    Unilateral footdrop with steppage gait is often the result of:
    • A. 

      Sural nerve compression.

    • B. 

      Femoral nerve injury.

    • C. 

      Peroneal nerve compression.

    • D. 

      Lateral femoral cutaneous nerve entrapment.

  • 16. 
    124.    Orbital pain, with paralysis of adduction of the left eye, and paralysis of elevation of the eye, but with normal pupillary function, is most likely to be associated with:
    • A. 

      Diabetic third nerve infarction.

    • B. 

      Uncal herniation.

    • C. 

      Optic neuritis.

    • D. 

      Myasthenia gravis.

  • 17. 
    126.    The treatment of the pain associated with trigeminal neuralgia is often successful by using:
    • A. 

      Levetiracetam.

    • B. 

      Gabapentin.

    • C. 

      Letriptan.

    • D. 

      Quetiapine

  • 18. 
    130.    Which of the following is a transient symptom noted in patients with carotid stenosis?
    • A. 

      Diplopia

    • B. 

      Monocular blindness

    • C. 

      Global amnesia

    • D. 

      Loss of consciousness

  • 19. 
    131.    A lumbar puncture performed on an adult reveals an opening pressure of 190 mm H20, and analysis of the spinal fluid shows a protein of 160 mg/dl, a glucose of 27 mg/dl, and 5,000 leukocytes/cu mm. These findings are most consistent with which of the following diagnoses?
    • A. 

      Bacterial meningitis

    • B. 

      Viral meningitis

    • C. 

      Meningeal carcinomatosis

    • D. 

      Subarachnoid hemorrhage

  • 20. 
    133.    A 55-year-old patient has sudden onset of apparent confusion and speaks only nonsense. The patient's verbal responses consist of mostly incomprehensible speech that seems well-articulated and with normal intonation. The patient seems unaware that the speech is not comprehensible. The patient makes phonemic and paraphasic errors, even when asked to repeat a sentence. These findings are suggestive of:
    • A. 

      Wernicke's aphasia.

    • B. 

      Schizophrenic word salad.

    • C. 

      Delirium.

    • D. 

      Conversion syndrome.

  • 21. 
    135.    In the abortive treatment of patients with migraines, triptan drugs should NOT be given to patients with:
    • A. 

      Chronic renal failure.

    • B. 

      Coronary artery disease.

    • C. 

      Asthma.

    • D. 

      Nausea and vomiting

  • 22. 
    137.   A patient with alcohol abuse has a broad-based, lurching gait and postural instability. These symptoms are most likely to be associated with which of the following magnetic resonance imaging (MR.I) findings?
    • A. 

      Severe atrophy of the frontal lobes

    • B. 

      Atrophy of cerebellar vermis

    • C. 

      Atrophy of the cervical spinal cord

    • D. 

      Peri ventricular white matter hyperintensities

  • 23. 
    140.    After three weeks of conservative management with analgesics and muscle relaxants, a patient returns complaining of persistent back pain with radiation into the right leg. Coughing and sneezing provoke radiation of the pain to the posterior part of the thigh, calf, and heel. Examination shows pain and tenderness in the lumbar paravertebral region. The ankle jerk on the right is diminished and there is weakness of the flexor muscles of the right foot. The most appropriate next step would be:
    • A. 

      A referral for physical therapy.

    • B. 

      A chiropractic manipulation.

    • C. 

      An electromyogram (EMG) and nerve conduction studies.

    • D. 

      A magnetic resonance imaging (MRI) scan of the lumbar spine.

  • 24. 
    142.    After suffering a fall from a ladder, a young adult notes severe and persistent back pain and inability to void. Neurologic examination in the emergency department shows that both of the patient's legs are weak, but there is preserved strength in the upper extremities. In the sacral and perianal area, there is impaired sensation to pin prick. Which of the following is the most likely diagnosis?
    • A. 

      Cervical myelopathy

    • B. 

      Malingering

    • C. 

      Syringomyelia

    • D. 

      Cauda equina compression

  • 25. 
    144.    Which of the following is the most effective treatment for patients with primary blepharospasm? 
    • A. 

      Ropinirole

    • B. 

      Trihexyphenidyl

    • C. 

      Gabapentin

    • D. 

      Botulinum toxin