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Flashcards in chapter 38-39-40-41-42 Deck (40):
1

Which of the following are appropriate tests for neurologic bedside evaluation of a patient with
suspected Alzheimer's disease?
1. MMSE
2. Clock drawing test
3. Dementia rating scale
4. Halsteact-Reitan battery

a

2

Which of the following statements are true regarding mild cognitive impairment?
1. MCI is a normal accompaniment to aging
2. MCI cannot be arrested with current medications
3. All patients with MCI progress to AD
4. Impairment in cognitive performance other than memory predicts decline in patients with
MCI

c

3

A patient presents for evaluation of memory and is found to have moderate memory loss with
short-term memory mostly affected. The patient has a history of atrial fibrillation and multiple
cerebral infarctions. Imaging shows chronic multifocal ischemic disease. Which is the most likely
diagnosis?
A. Alzheimer's disease
B. Vascular dementia
C. Cognitive changes with aging
D. Frontotemporal dementia

b

4

A patient presents for evaluation of memory I0S5 and is found to have global cognitive deficit,
including deficit of short term memory, language, attention, and visual perception. There is a
history of coronary artery disease vvith CABG three-years ago. Neurologic examination is
otherwise normal, including motor and coordination, cranial nerves, reflex. and gait. Which is
the most likely diagnosis?
A. Vascular dementia
B. Alzheimer's disease
C. Frontotemporal dementia
D. Mixed vascular-degenerative dementia

b

5

Which of the following clinical presentations is most likely to progress to Alzheimer's disease?
A. Amnestic MCI
B. MCI with multiple domains impaired
C. MCI with single nonmemory domain affected

a

6

Which of the following statements are true regarding frontotemporal dementia?
A. Patients can have progressive social and behavioral changes
B. Patients can have progressive fluent aphasia
C. Patients can have progressive nonfiuent aphasia
D. AH are true

d

7

Which of the following statements is true regarding neuropsychological changes in Parkinson's
disease?
A. Cognitive deficits develop in 30% of patients with PD
B. Dementia develops in the majority of patients with PD
C. Cognitive deficits are present in the majority of patients with PD
D. Cholinestcrase inhibitors have no effect on the treatment of AD

d

8

Huntington's disease is associated with marked cognitive deficits. Which of the following
statements are true regarding HD?
A. The most dramatic early cognitive changes are in executive runcbons
B. Learning and memory deficits are common in HD
C. Memory deficit is equivalent across the periods of ihe patient's life
D. All are true

d

9

A 12-year-old girl presents with motor and phonic tics which have a duration and character to
make the diagnosis of Tourette's syndrome. She has had learning difficulties in school and
neuropsychological evaluation shows attcntional deficit and mood disorders. Which is the most
appropriate clinical impression?
A. The neuropsychological findings cannot be explained by Tourette's syndrome, and another
etiology for the learning difficulty and tics should be sought
B. The neuropsychologic findings are common and independent of the Tourette's syndrome
C. The neuropsychologic symptoms and findings are typical of Tourette's syndrome
D. The neuropsychologic findings are suspect, and repeat evaluation by a second examiner is
needed

c

10

A 53-year-old man presents with memory loss. He carried the diagnosis of multiple sclerosis on
the basis of previous attacks of optic neuritis and hemiparesis which completely resolved.
Examination shows deficit in short-term memory without othei neurologic abnormality. There
are no signs of aphasia, neglect, or spatial difficulty. MRI shows multiple areas of increased
signal intensity on T2-weighted and FLAIR imaging. None of the lesions enhance with
gadolinium. Which is the most likely diagnosis?
A. Alzheimer's disease superimposed upon MS
B. Vascular dementia, with ihe original diagnosis of MS being incorrect
C. Vascular dementia, superimposed on the earlier unrelated MS
D Cognitive deimii associated wiih MS

d

11

A 74-year-old man presents with difficulty with voluntary gaze, but reflex eye movements with
head turning are relatively preserved. What is the most likely cause?
A. Myasthenia gravis
B. Stroke
C. Diabetic mononeuropathy
D. Multiple sclerosis

b

12

Which of the following are typical of ocular motor apraxia?
A. Inability to perform voluntary saccades
B. Preservation of spontaneous saccades
C. Can be congenital
D. All are true

d

13

A 76-year-old man presents with diplopia and is found on examination to have absent
adduction of the left eye with right gaze, associated with nystagmus of the right eye. He has a
history of diabetes but not hypertension or hyperlipidemia. Which is the most likely diagnosis?
A. Internuclear ophthalmoplegia due to multiple sclerosis
B. Internuclear ophthalmoplegia due to vascular disease
C. Sixth nerve palsy due to diabetes
D. Mvasthenia gravis

b

14

An 80-year-old woman presents with right gaze palsy plus the inability to adduct the right eye
with left gaze; there is some associated nystagmus of the left eye Which is the most
he lesion?
A. Cavernous sinus
B. Midbrain
C. Pons
D. Medulla

c

15

A patient presents with spasmodic ocular deviations, mainiy upward in direction. The eye
movements are eonjugate. Whieii is the most likely diagnosis?
A. Postencephalitic Parkinson's disease Stroke
B.Stroke
C. Neuroleptics
D. Multiple sclerosis

c

16

A patient presents with diplopia and is found to have a vertical deviation with one eye slightly
higher than the other. Eye movements are otherwise conjugate with the deviation about the
same with gaze. Wroch is the most likely diagnosis?
A. Ocular mvasthenia
B. Midbrain tumor
C. Fourth nerve palsy
D.Skew deviation due to vascular disease

d

17

A newborn male is found to have esotropia during- initial examination, and this is felt to be
normal. Two weeks later, the child is seen for follow-up and is found to have exotropia. There
are no other neurologic deficits. Which is the correct conclusion?
A. The child had a posterior fossa tumor which is expanding
B. The child has congenital strabismus
C. The child most likely has a mitochondrial defect
D. The child most likely has a thyroid disorder
E. The child is normal

e

18

Which is the clinical import of "wrong-way eyes"?
A. Normal variant response
B. False localizing sign
C. Indicates functional ocular motor abnormality
D. None of the above

d

19

A patient presents with coma following out-of-hospital cardiac arrest. Examination shows
conjugate horizontal rhythmic oscillation which cycles about every 5 seconds. Which is the
correct conclusion about this finding?
A. This indicates psychogenic unresponsiveness
B. This is a poor prognostic sign
C. This is an excellent prognostic sign
D. This is usually due to a lesion of the caudal pons and medulla

b

20

A patient presents with visual loss and is found on examination to have a bitemporal
hemianopia. Which is the correct conclusion?
A. The patient has a lesion at or near the chiasm
B. The patient has a lesion of the lateral geniculate
C. The patient has tandem lesions of both optic nerves
D The localization caimot be determined from the supplied information

a

21

A patient presents with visual loss and is found on examination to have a ceonplcse;
homonymous hemianopia. Which is the correct conclusion regarding- localization?
A. Trie lesion is of the occipital lobe
B. The lesion is of the parietal lobe, and subcortical white matter
C. The lesion is most likely at the lateral geniculate
D. The lesion can be anywhere between the chiasm and the occipital cortex.

d

22

Lesions of the optic tract are most likely to produce hemianopia. In which localization:are the
defects likely congruent rather than noncongruent?
A. Anterior retrochiasmal lesions
B. Posterior retrochiasrnal lesions
C. Chiasmal lesions
D. There is no localizing value to the congruence of the defect

b

23

The brainstem auditory evoked potential (BAEP) or auditory brainstem response (ABR) is a
sensitive test for evaluation of the acoustic pathways including acoustic nerve. Which wave is
generated by the acoustic nerve?
A. I
B. Ill
C. V
D.None of these

a

24

What is the role of exercise therapy in treatment of patients with peripheral vestibulopathy?
A. There is no proved role for exercise therapy, and rest for patients with vestibulopathy is most
helpful
B. Exercise therapy can be curative, and often is among the most effective treatments
C. Exercise therapy can help patients with benign positional vertigo but does not help patients
with other causes of peripheral vestibulopathy

b

25

A patient with presumed conductive hearing loss on the basis of audiometry has acoustic reflex
testing and is found to have an absent reflex. Which is the most appropriate interpretation of
these findings?
A. The absent acoustic reflex supports the diagnosis of conductive hearing loss
B. The absent acoustic reflexes is most likely due to technical difficulties
C. The absent acoustic reflex contradicts the diagnosis of conductive hearing loss
D. The acoustic reflex does not add information to the diagnostic decision

a

26

A patient presents with complaints of tinnitus in the right ear, but seems to have normal
hearing on bedside testing. Acoustic reflex testing shows present reflex measured on both sides
with stimulation of the left ear, but no reflex on either side with testing of the right ear. Which
is the most likely site of the lesion?
A. Cochlea
B. Acoustic nerve
C. Facial nerve
D. Brainstem

b

27

You perform the interpretation of an A.BR in an adult, but no historical information is provided.
He response is normal except for an increased I—III interpeak latency. Which is the most likely
diagnosis?
A. Multiple sclerosis
B. Acoustic schwannoma
C. Brainstem vascular disease
D. Cochlear Hearing loss

b

28

Which of the following medications are used for management of patients with peripheral
vestibulopathy?
1. Promethazine
2. Meclizine
3. Diazepam
4. Ephedrine

e

29

Which of the following statements are true regarding the auditory brainstem response (ABR)?
1. ABR is used to differentiate sensorineural from conductive hearing loss
2. ABR is used to identify acoustic nerve lesions
3 Wave III is generated at interior colliculus
4. Loss of all waves usually indicates severe hearing loss

c

30

Which of the following statements are tree regarding electronystagmograms?
1. The most important criterion for abnormality is a difference in response between the ears
2. Visual fixation can suppress much of the ENG response during caloric testing
3. Vertical eye movements are typically not tested
4. Primary position nystagmus can alter the nystagmus evoked by caloric testing

e

31

MSA can have urologic symptoms and signs at the time of diagnosis. Which uroiogic features
suggest consideration of MSA?
A. Loss of parasympathetic innervation of the detrusor
B. Poor contractility and incomplete emptying
C. Incontinence
D. Denervation of the sphincter due to loss of anterior horn cells
E. All are true

e

32

Which of the following is reasonable first-line treatment for detrusor overactivity?
A. Botulinum-A toxin
B. Cannabis
C. Anticholinergic medications
D. Desmopressin
E. All of the above

c

33

Patients with spinal cord disease may have overactivity of the bladder and incomplete
emptying. Which is the most effective management for these issues?
A. Anticholinergic for the overactivity and intermittent self-catheterization for the incomplete
emptying
B. Anticholinergic for the incomplete emptying and intermittent self-catheterization for the
incomplete emptying
C. Intermittent self-catheterization treats both conditions
D. Anticholinergics treat both conditions

a

34

A patient with multiple sclerosis loses the ability to self catheterize. Which would be the next
technique to manage incomplete bladder emptying?
A. Suprapubic catheter
B. Foley catheter
C. Nursing visits through home health around the clock for bladder care

b

35

The patient above has a Foley catheter for some time, but then he develops marked detrusor
overactivity and there is forced leakage around the catheter. Cneck of the catheter does not
reveal obstructions. Which would be the next best step?
A. Suprapubic catheter
B. Replace the Foley catheter with one of larger diameter which can allow faster urine flow
C. Continue present management, but place absorbent garments for the leakage

a

36

Erectile dysfunction is common in male patients with neurologic and vascular disease. Which is
the most appropriate first-line treatment?
A. Sildenafil
B. Implanted prosthesis
C. Prostaglandin E1 injection

a

37

Sacral nerve stimulators are occasionally used for patients with incontinence. Which is the most
likely mechanism of action?
A Stimulation of sphincter motor neurons 10 inhibit incontinence
B. Stimulation of pelvic afferents which have an inhibitory effect on the detrusor
C. Excitatory block of the detrusor muscle

b

38

The following questions present urologic problems. For each, select the best surgical procedure
from the following list.
A. Bladder neck suspension
B. Augmentation cystoplasty
C. Artificial sphincter
D. Urinary diversion with stoma collection bag
Sphincter failure.

a

39

The following questions present urologic problems. For each, select the best surgical procedure
from the following list.
A. Bladder neck suspension
B. Augmentation cystoplasty
C. Artificial sphincter
D. Urinary diversion with stoma collection bag
Stress incontinence.

a

40

The following questions present urologic problems. For each, select the best surgical procedure
from the following list.
A. Bladder neck suspension
B. Augmentation cystoplasty
C. Artificial sphincter
D. Urinary diversion with stoma collection bag
Intractable incontinence.

d