Neuro----03-02

18 Questions

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Neuro----03-02

Neuro 03-2


Questions and Answers
  • 1. 
    A 54-year-old man who is obese and has diabetes mellitus experiences pain and paresthesias in the anterolateral aspect of the left thigh. Examination reveals excellent strength of the left quadriceps, preserved left knee jerk equal to the right knee jerk, but sensory deficit to a pin prick in the symptomatic area of the left thigh. The diagnosis most likely is:
    • A. 

      Diabetic amyotrophy.

    • B. 

      Lumbar radiculopathy..

    • C. 

      Lumbar spinal stenosis.

    • D. 

      Peroneal nerve entrapment.

    • E. 

      entrapment of lateral femoral cutaneous nerve.

  • 2. 
    A 34-year-old man is referred for psychiatric evaluation 5 years after sustaining a head injury at work. Prior to the accident, he was a stable, happily married man. Since the accident, he has been described as overly talkative and restless. His wife divorced him because he was acting irresponsibly, which also resulted in termination from his job. Psychometric testing reveals that the man has average intelligence and no detectable memory deficits. The patient's clinical presentation is most consistent with damage to which of the following brain areas?
    • A. 

      Thalamus

    • B. 

      Frontal lobe

    • C. 

      Corpus striatum

    • D. 

      Amygdaloid body

    • E. 

      Nucleus accumbens

  • 3. 
    Thrombolytic treatment of acute ischemic stroke should NOT be administered if the:
    • A. 

      Patient has a headache.

    • B. 

      Patient has an aphasia.

    • C. 

      Computed tomogr:aphy (CT) scan shows a lacunar stroke.

    • D. 

      Computed tomography (CT) scan shows a large stroke in the middle cerebral artery territory.

    • E. 

      Computed tomography (CT) scan shows evidence of extensive microvascular disease

  • 4. 
    A 22-year-old patient presents with a complaint of bilateral frontotemporal throbbing headache, which becomes generalized and dull after 1 hour. During these episodes, the patient reports having nausea at times and a scalp that is sensitive to touch. The headache begins during the day and can be precipitated by stress, bright light, or noise. The patient does not have any warning signs before the onset of the pain. The clinical diagnosis of the condition is:
    • A. 

      Migraine headache.

    • B. 

      Cluster headache.

    • C. 

      Tension headache.

    • D. 

      Meningeal headache.

    • E. 

      Temporal arteritis

  • 5. 
    Findings of widespread fasciculations, fibrillations, and positive sharp waves on electromyography in a patient with gradually progressive weakness over several weeks are strongly suggestive of
    • A. 

      Multiple sclerosis.

    • B. 

      Myasthenia gravis.

    • C. 

      Guillain-Barre syndrome.

    • D. 

      Eaton-Lambert syndrome.

    • E. 

      Amyotrophic lateral sclerosis

  • 6. 
    A young adult patient with acquired immune deficiency syndrome (AIDS) develops progressive weakness of the extremities over several weeks. In addition to the weakness, examination shows a significant distal sensory deficit to pin and vibration. Nerve conduction studies show slow nerve conduction velocity and conduction block, but electromyography shows no denervation. Which of the following is the most likely diagnosis?
    • A. 

      Axonal neuropathy

    • B. 

      Transverse myelitis

    • C. 

      Eaton-Lambert syndrome

    • D. 

      Cytomegalovirus polyradiculopathy

    • E. 

      Chronic inflammatory demyelinating polyradiculoneuropathy

  • 7. 
    During a major convulsive episode, a patient's eyes deviate to the left, with tonic contraction of the trunk and limbs on the left side. Postictally, the patient's eyes deviate to the right, with hemiparesis on the left side. These findings suggest that:
    • A. 

      The patient had a pseudoseizure.

    • B. 

      The patient had complex oculomotor seizures.

    • C. 

      The episode was an acute dystonic reaction to the administration of neuroleptic agents.

    • D. 

      An EEG would be likely to reveal a seizure focus in the right frontal region.

    • E. 

      An EEG would be likely to reveal primary generalized epilepsy.

  • 8. 
    A 35-year-old patient reports episodes of flashing lights traveling slowly from left to right in the left visual field. These visual symptoms persist for about 30 minutes and are followed by difficulty expressing self and concentrating. After about 30 minutes, these neurologic symptoms seem to subside, and the patient develops a pounding headache associated with nausea. Both physical examination and a magnetic resonance imaging (MRI) scan are normaL The most likely diagnosis is:
    • A. 

      Posterior communicating aneurysm with sentinel leak.

    • B. 

      Carotid stenosis with carotidynia.

    • C. 

      Vertebrobasilar insufficiency.

    • D. 

      Occipital lobe tumor.

    • E. 

      Migraine with aura.

  • 9. 
    The spinal fluid of patients with acute inflammatory polyneuropathy typically shows:
    • A. 

      Elevated gamma globulin.

    • B. 

      High protein, normal cell count.

    • C. 

      Normal protein, lymphocytic pleocytosis.

    • D. 

      Elevated protein, lymphocytic pleocytosis.

    • E. 

      Elevated protein, polymorphonuclear pleocytosis

  • 10. 
    A 68-year-old patient develops pain in the buttocks when walking, which is associated with pain radiating down the legs and a feeling of numbness and weakness in the legs. The pain is relieved when the patient stops walking, but only when sitting. If the patient remains standing, the pain does not subside. These symptoms are most likely the result of:
    • A. 

      Vascular insufficiency of the legs.

    • B. 

      Lumbosacral plexus lesion.

    • C. 

      Lumbar spinal stenosis.

    • D. 

      Trochanteric bursitis.

    • E. 

      Aorto-iliac disease

  • 11. 
    A healthy young adult complains of a headache behind the left ear. Two days later, the patient notes twisting of the face, which is "drawn" to the right side. The patient reports that the breakfast meal this morning had a very bland and unusual taste. Examination shows complete paralysis of the forehead and lower face on the left, with incomplete closure of the left eye when the patient blinks. There is no sensory deficit. The other cranial nerves are normal. A magnetic resonance imaging (MRI) scan is likely to show:
    • A. 

      Occlusion of the left carotid artery.

    • B. 

      Thrombosis of the left cavernous sinus.

    • C. 

      Tumor in the left ponto-medullary junction.

    • D. 

      Gadolinium enhancement of the left facial nerve.

    • E. 

      Gadolinium enhancement of the left trigeminal nerve.

  • 12. 
    A 29-year-old patient reports being frequently awakened by severe headaches in the middle of the night. The headaches are unilateral, often periorbital, and are accompanied by lacrimation and rhinorrhea, as well as swelling of the face. During the headache, the patient has noted asymmetry of the pupils and hyperesthesia of the face on the side of the headache. Which of the following is the most likely diagnosis?
    • A. 

      Glaucoma

    • B. 

      Cluster headaches

    • C. 

      Sinus headaches

    • D. 

      Trigeminal neuralgia

    • E. 

      Posterior communicating artery aneurysm

  • 13. 
    Reduction in the speech discrimination score in audiometric tests is most commonly seen as a result of which of the following?
    • A. 

      Cochlear lesions

    • B. 

      Meniere's disease

    • C. 

      Receptive aphasia

    • D. 

      Hysterical deafness

    • E. 

      Eighth nerve lesions

  • 14. 
    Motor dysfunction in patients with Parkinson's disease is associated with:
    • A. 

      Increased neuronal activity in the subthalamic nucleus and pars intema of the globus pallidus.

    • B. 

      Decreased neuronal activity in the subthalamic nucleus and pars intema of the globus pallidus.

    • C. 

      Increased neuronal activity in the nucleus accumbens and dentate gyrus.

    • D. 

      Decreased neuronal activity in the nucleus accumbens and dentate gyrus.

  • 15. 
    A young adult patient presents after recovering from a flu-like illness with a few days of progressi ve weakness and numbness of both legs and feet. Examination confirms the weakness and reveals loss of sensation to all sensory modalities below the middle of the thorax. Deep tendon reflexes are brisker on the lower extremities than on the upper extremities, and plantar reflexes are extensor. The patient has had several episodes of urinary incontinence. The reminder of the neurologic examination, as well as the vital signs, are normal. A lumbar puncture reveals 23 mononuclear cells, a protein level of 37 mg/dL, and normal glucose content. Which of the following is the most likely diagnosis?
    • A. 

      Acute demyelinating polyneuropathy

    • B. 

      Acute transverse myelitis

    • C. 

      Anterior spinal artery infarction

    • D. 

      Spinal epidural abscess

  • 16. 
    A 55-year-old male patient presents with a history of weakness and clumsiness. Symptoms began several months earlier with difficulty buttoning his clothes, getting the car keys in the ignition, and performing other fine motor tasks. He noticed that the muscles in his arm and forearm twitched under the surface, and cramped easily. Over the past few months his arms have continued to weaken and lose muscle mass. On examination he has diffuse wasting and weakness on both upper extremities, fasciculations, slight spasticity on arms and legs, and hyperreflexia with extensor plantar responses. The sensory, coordination, and cranial nerve examinations are normal. The underlying pathological process affects neuronal bodies in which of the following structures?
    • A. 

      Anterior horn of the spinal cord, medial brainstem, and prerolandic cortex

    • B. 

      Posterior horn of the spinal cord, lateral brainstem, and postrolandic cortex

    • C. 

      Intermediolateral column of the spinal cord, dorsal brainstem and intralaminar thalamus

    • D. 

      Clarke's column of the spinal cord, dorsal pons, and cerebellar cortex

  • 17. 
    Irregular, unequal, and small pupils that fail to react to light, do not dilate properly in response to mydriatic drugs, but do constrict on accommodation, are seen in patients with which of the following illnesses?
    • A. 

      Syphilis

    • B. 

      Homer's syndrome

    • C. 

      Retrobulbar neuropathy

    • D. 

      Ciliary degeneration

  • 18. 
    In contrast to strokes caused by arterial thrombosis or embolism, strokes caused by cerebral vein or venous sinus thrombosis are:
    • A. 

      Seldom hemorrhagic.

    • B. 

      Seldom associated with headache.

    • C. 

      More often associated with seizures at onset.

    • D. 

      More often associated with patent foramen ovale.