Neuro 07-1

24 Questions | Total Attempts: 23

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Neuro 07-1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Questions and Answers
  • 1. 
    <!--[if !supportLists]-->1.                <!--[endif]-->A pituitary tumor that protrudes through the diaphragma sella is most likely to cause:
    • A. 

      Bilateral cecocentral scotomata.

    • B. 

      Bilateral lower field cut.

    • C. 

      Bitemporal hemianopia.

    • D. 

      Binasal hemianopia.

    • E. 

      Diplopia.

  • 2. 
    <!--[if !supportLists]-->3.                <!--[endif]-->The diagnosis of myasthenia gravis can be established in 80 to 90 percent of cases by identification of serum antibodies against:
    • A. 

      Acetylcholinesterase.

    • B. 

      Acetylcholine receptors.

    • C. 

      Motor end-plate sarcolemma

    • D. 

      L-type voltage-dependent calcium channels.

    • E. 

      Myofibrils.

  • 3. 
    <!--[if !supportLists]-->7.                 <!--[endif]-->In a patient with dementia, the occurrence of intermittent confusion, hallucinations, and psychotic behavior, with unusual sensitivity to the extrapyramidal effects of neuroleptic drugs would suggest a diagnosis of:
    • A. 

      Pick's disease.

    • B. 

      Alzheimer's disease.

    • C. 

      Diffuse Lewy body disease.

    • D. 

      Normal pressure hydrocephalus.

    • E. 

      Vascular dementia.

  • 4. 
    <!--[if !supportLists]-->10.             <!--[endif]-->A 32-year-old female complains of daily headaches that are dull and bilateral. They are not associated with nausea or vomiting. Examination is normal except for the presence of bilateral papilledema. Routine brain imaging studies show no abnormalities. The diagnostic procedure that is most likely to help in establishing the diagnosis is:
    • A. 

      Lumbar puncture.

    • B. 

      ocular tonometry.

    • C. 

      Temporal artery biopsy.

    • D. 

      Radionuclide cisternogram.

    • E. 

      Magnetic resonance venography.

  • 5. 
    <!--[if !supportLists]-->24.               <!--[endif]-->A patient who is known to be HIV -positive develops progressive loss of memory, accompanied by inattention and lack of motivation. The patient complains of poor coordination. The lumbar puncture is normal. The computed tomography (CT) scan shows atrophy. The magnetic resonance imaging (MRI) scan shows diffuse and confluent white matter changes in T2 sequences, without any mass effect and without any enhancement with gadolinium. The most likely diagnosis is:
    • A. 

      Toxoplasmosis.

    • B. 

      CNS lymphoma.

    • C. 

      HIV -associated dementia.

    • D. 

      Cryptococcal meningitis.

    • E. 

      Progressive multifocal leukoencephalopathy.

  • 6. 
    <!--[if !supportLists]-->27.               <!--[endif]-->Gait characterized by postural instability accompanied by festination and truncal rigidity is seen in:
    • A. 

      Alzheimer's disease.

    • B. 

      Alcoholic cerebellar degeneration.

    • C. 

      Hysterical gait

    • D. 

      Cervical spondylosis.

    • E. 

      Parkinson's disease.

  • 7. 
    <!--[if !supportLists]-->38.               <!--[endif]-->A 48-year-old woman says that she is contemplating suicide unless someone can relieve her pain. She describes the pain as severe jabs lasting only a few seconds, triggered by a gentle breeze blowing on her cheek or by washing her face. The woman states that the pain has caused her to become a prisoner in her own house. The diagnosis most likely is:
    • A. 

      Agoraphobia.

    • B. 

      Tic douloureux.

    • C. 

      A dental abscess.

    • D. 

      Somatization disorder.

    • E. 

      Postherpetic neuralgia.

  • 8. 
    <!--[if !supportLists]-->60.               <!--[endif]-->Characteristic lesions seen in the computed tomography (CT) scans of patients who have had coma associated with carbon monoxide poisoning are located in which of the following areas of the brain?
    • A. 

      Hypothalamus

    • B. 

      Globus pallidus

    • C. 

      Dentate nucleus

    • D. 

      Corpus callosum

    • E. 

      Cingulate gyrus

  • 9. 
    <!--[if !supportLists]-->61.               <!--[endif]-->A 28-year-old patient, who works as a carpenter, was hit from behind by a small van while driving. The following day the patient awoke with severe back pain radiating into the left ankle when he moved. He calls his employer and requests a sick day. He is told that he must get a doctor's excuse if he wishes to keep his job. The patient reports that coughing and sneezing exacerbate the pain. Upon examination, he has weakness of plantarflexion of the left foot and decreased ankle jerk on the left. Straight leg raising reveals severe pain beyond 45 degrees on the left. The most likely diagnosis is:
    • A. 

      Malingering.

    • B. 

      Lumbar sprain.

    • C. 

      Sciatic nerve entrapment.

    • D. 

      Sciatic nerve entrapment.

    • E. 

      Peroneal nerve compression.

  • 10. 
    <!--[if !supportLists]-->68.               <!--[endif]-->A 46-year-old patient develops painful jabs in the face after having a root canal dental repair. The pain is sharp, stabbing, and involves the cheek area. It seems to be triggered by any touch in the interior or exterior of the right cheek. Even a breeze on the patient's face can trigger the pain. Dental workup does not reveal any explanation for the pain. A magnetic resonance imaging (MRI) scan is normal. Which of the following treatments is most likely to be successful in controlling the patient's pain?
    • A. 

      Acyclovir

    • B. 

      Prednisone

    • C. 

      Gabapentin

    • D. 

      Tooth extraction

    • E. 

      Temporomandibular joint repair

  • 11. 
    <!--[if !supportLists]-->70.               <!--[endif]-->The inability to carry out motor activities on verbal command despite intact comprehension and motor function indicates a diagnosis of:
    • A. 

      Alexia.

    • B. 

      Apraxia.

    • C. 

      Aphasia.

    • D. 

      Agnosia.

    • E. 

      Akinesia.

  • 12. 
    <!--[if !supportLists]-->76.               <!--[endif]-->On Wednesday at 10 A.M., a 63-year-old male patient presents to the emergency department (ED) with new onset aphasia and right hemiparesis. His wife reports that the problems began 2 days previously, but he refused to seek medical attention. On Monday, he had a similar, but milder, episode lasting 30 minutes. On Tuesday evening, he had a second episode lasting 45 minutes. Today, his deficit started suddenly at 8:30 A.M. while he was brushing his teeth. The computerized tomography (CT) scan shows no evidence of stroke or hemorrhage. The treatment of choice is:
    • A. 

      Intravenous thrombolytic agents.

    • B. 

      Heparin.

    • C. 

      Aspirin.

    • D. 

      Ticlopidine.

    • E. 

      Dipyridamole.

  • 13. 
    <!--[if !supportLists]-->79.               <!--[endif]-->A 34-year-old woman with diabetes mellitus has an acute onset of left facial weakness, involving the forehead and the perioral musculature equally. The onset of the facial weakness was preceded by pain in the left ear and mastoid, and by a sensation of discomfort in the left ear with loud noises or low-pitch sounds. These symptoms are most consistent with:
    • A. 

      facial dystonia.

    • B. 

      Trigeminal neuralgia.

    • C. 

      Acute lateral medullary infarct.

    • D. 

      Left Homer syndrome.

    • E. 

      Bell's palsy.

  • 14. 
    <!--[if !supportLists]-->85.              <!--[endif]-->Chiropractic adjustments are a known precipitant for which of the following acute conditions?
    • A. 

      Brachial plexitis

    • B. 

      Sacroiliac separation

    • C. 

      Lumbosacral subluxation

    • D. 

      Vertebral artery dissection

    • E. 

      Anterior spinal artery occlusion

  • 15. 
    <!--[if !supportLists]-->90.              <!--[endif]-->A 36-year-old patient presents with depression. He has a 3-year history of subtle but progressive change in his personality, with irritability, impulsive outbursts, and eccentric or inappropriate social interactions. His symptoms have resulted in the recent loss of his job of 10 years, and he is now markedly withdrawn and very fidgety. On examination, the patient has increased eye blinking, marked tongue impersistence, mild bradykinesia and akinesia, and mild hyperreflexia without clonus. The patient's father died of severe dementia at age 55. Which of the following is the most likely diagnosis?
    • A. 

      Corticobasal degeneration

    • B. 

      Frontotemporal dementia

    • C. 

      Huntington's disease

    • D. 

      Early-onset Alzheimer's disease

    • E. 

      New variant Creutzfeldt-Jakob disease

  • 16. 
    <!--[if !supportLists]-->93.               <!--[endif]-->A 29-year-old patient is brought to the emergency department with acute onset of fever (39.5°C), a sore throat, diplopia, and dysarthria. General examination reveals an inflamed throat, left adductor nerve palsy with impairment of vertical pursuit, diffuse hyperreflexia with bilateral clonus, lower extremity spasticity, and mild right hemiparesis. A computed tomography (CT) scan of the brain without contrast is uninformative. Spinal fluid has a protein of 24 mg/dl, 10 mononuclear cells, and a glucose of 70 mg/dl. Which of the following is the most likely diagnosis?
    • A. 

      Multiple sclerosis

    • B. 

      Behcet's disease

    • C. 

      CNS lymphoma

    • D. 

      Multiple myeloma

    • E. 

      Amyotrophic lateral sclerosis

  • 17. 
    <!--[if !supportLists]-->101.          <!--[endif]-->A 40-year-old patient complains of an inability to sit still and describes feeling an inner tension. During the examination, the patient is noted to constantly shift the body and legs, cross and uncross the legs, and swing the free leg. While in the waiting room, the nurses reported that the patient paced the hall continuously. The patient reveals that he had a "nervous breakdown" 2 years earlier and had received a course of neuroleptic medication until recently. This set of symptoms and signs is known as:
    • A. 

      Akathisia.

    • B. 

      Spasticity.

    • C. 

      Agitated depression.

    • D. 

      Restless leg syndrome.

    • E. 

      tardive tic disorder.

  • 18. 
    <!--[if !supportLists]-->106.          <!--[endif]-->A 52-year-old patient complains of difficulty sleeping. When trying to sleep, the patient experiences unpleasant aching and drawing sensations in the calves and thighs, associated with a crawling feeling. These sensations force him to move his legs, which brings transient relief. Symptoms are worsened by fatigue. His neurological examination is umemarkable, and appropriate laboratory studies are within normal limits. Which of the following medications is appropriate treatment for this condition?
    • A. 

      Risperidone

    • B. 

      Olanzapine

    • C. 

      Pergolide

    • D. 

      Methylphenidate

    • E. 

      Benztropine

  • 19. 
    <!--[if !supportLists]-->116.          <!--[endif]-->Which of the following electrodiagnostic test findings is most indicative of a demyelinating neuropathic process?
    • A. 

      Conduction block

    • B. 

      Delayed sensory latency

    • C. 

      Decreased amplitude of motor responses

    • D. 

      Decremental response to repetitive stimulation

    • E. 

      Fibrillations and positive sharp waves

  • 20. 
    <!--[if !supportLists]-->130.          <!--[endif]-->A patient with known myasthenia gravis and a mild respiratory infection develops severe respiratory fatigue, restlessness, and diaphoresis. The patient appears anxious and tremulous. The initial management of this problem requires which of the following interventions?
    • A. 

      Plasmapheresis

    • B. 

      Mechanical ventilation

    • C. 

      Intravenous steroids

    • D. 

      Intravenous neostigmine

    • E. 

      Intravenous gamma globulin

  • 21. 
    <!--[if !supportLists]-->132.          <!--[endif]-->A 60-year-old patient complains of difficulty walking. On examination, the patient displays a spastic gait disorder in which the legs are held stiff and the feet scrape against the floor as the legs circumduct with each step. Deep tendon reflexes are increased, and the plantar responses are extensor bilaterally. This clinical picture is most likely associated with:
    • A. 

      Cerebellar atrophy.

    • B. 

      peripheral neuropathy.

    • C. 

      Cervical spondylosis.

    • D. 

      Lumbar spinal stenosis.

    • E. 

      Parkinson's disease.

  • 22. 
    <!--[if !supportLists]-->140.          <!--[endif]-->Internuclear ophthalmoplegia is an ocular motility disorder often observed in patients with:
    • A. 

      Amblyopia.

    • B. 

      Multiple sclerosis.

    • C. 

      Amyotrophic lateral sclerosis.

    • D. 

      Spinocerebellar degenerations.

    • E. 

      Huntington's chorea.

  • 23. 
    <!--[if !supportLists]-->142.          <!--[endif]-->Abortive treatment of common migraine is best achieved with which of the following medications?
    • A. 

      Duloxetine

    • B. 

      Topiramate

    • C. 

      Desipramine

    • D. 

      Rizatriptan

  • 24. 
    <!--[if !supportLists]-->143.          <!--[endif]-->The clinical sequence of sudden severe headache, vomiting, collapse, relative preservation of consciousness, few or no lateralizing neurological signs, and neck stiffness is most characteristic of which of the following vascular lesions?
    • A. 

      Subdural hemorrhage

    • B. 

      Epidural hemorrhage

    • C. 

      Intracerebral hemorrhage

    • D. 

      Subarachnoid hemorrhage