Neurology Flashcards
(122 cards)
1
Q
Which of the symptoms accompanying severe migraine attach is the most common?
A. Fortification spectra
B. Nausea
C. Visual disturbance
D. Photopsia
A
B. Nausea
2
Q
First line treatment of painful neuropathy
A. Pregabalin
B. Tramadol
C. Venlafaxine
D. Vitamin B
A
A. Pregabalin - 50-100mg TID
3
Q
Which of the following isthe most common cause of cardioembolic stroke?
A. Prosthetic valves
B. Ischemic cardiomyopathy
C. Non valvular AF
D. Myocardial infarction
A
C. Non valvular AF
4
Q
The most common cognitive ability lost in dementia
A. Memory
B. Judgment
C. Language
D. Problem solving
A
A. Memory - amnesia, loss of memory function
5
Q
Which of the following imaging modality is the preferred choice for evaluation of acute intracranial hemorrhage?
A. Plain cranial MRI
B. Plain cranial CT SCAN
C. Contrast enhanced MRI
D. Contrast enhanced CT SCAN
A
B. Plain cranial CT SCAN
6
Q
The neurotransmitter pathway that is more affected in memory and attention dysfunction is the
A. Dopaminergic
B. Cholinergic
C. Serotonergic
D. Noradrenergic
A
B. Cholinergic - attention and memory function
7
Q
“Shadow Plaques” are
A. Disrupted Blood Brain Barrier
B. Perivenular cuffing by T-cells
C. Partial remyelination of naked axons
D. Astrocytic proliferation
A
C. Partial remyelination of naked axons
8
Q
The basic treatment of Alzheimer’s Disease is the use of:
a. Vaccination
b. Estrogen Replacement
c. Use of Glutamate Antagonist
d. Use of Levetiracetam
e. Use of Acetylcholinesterase
Inhibitor
A
e. Use of Acetylcholinesterase
Inhibitor
9
Q
NOT TRUE of Herpes Simplex Encephalitis, the patient may have:
a. Fever, headache, seizures
b. Managed supportively: antibiotic use is optional
c. CSF analysis may show many RBC even if non-traumatic
d. May have EEG and MRI abnormalities in the frontotemporal area
A
b. Managed supportively: antibiotic
use is optional
10
Q
If the patient has ptosis due to Botulism, if ice pack is placed over the ptotic eye, there will be:
a. Result is unpredictable
b. No change in the ptosis
c. Worsening of the ptosis
d. Improvement of the ptosis
A
d. Improvement of the ptosis
Applying an ice pack to the ptotic eye can help improve ptosis temporarily by causing vasoconstriction and reducing swelling in the surrounding tissues.
The cold temperature can stimulate muscle contraction and may enhance the function of the Levator Palpebrae Superioris muscle, resulting in a temporary improvement of the ptosis.
11
Q
Which of the following medication reduces the risk of vasospasm
a. Felodipine
b. Amlodipine
c. Clonidine
d. Nimodipine
A
d. Nimodipine
12
Q
Not a motor feature of PD:
a. Masked facies
b. Freezing
c. Hypophonia
d. Action Tumor
e. Drooling
A
d. Action Tumor
13
Q
The most common cause of Viral Meningitis is:
a. Influenza Virus
b. Adenovirus
c. Herpes Virus
d. Enterovirus
e. Mumps Virus
A
d. Enterovirus
14
Q
Which among the anticonvulsants
modulate the release of synaptic vesicles
a. Carbamazepine
b. Valproic Acid
c. Lamotrigine
d. Phenytoin
e. Levetiracetam
A
e. Levetiracetam
15
Q
Which of the following is the most
common site for intracranial hemorrhage
a. Subarachnoid Space
b. Frontal Lobe
c. Ventricles
d. Parietal Lobe
e. Basal Ganglia
A
e. Basal Ganglia
esp putamen
16
Q
Which of the following statement/s is/are TRUE regarding EEG?
a. The absence of electrographic activity exclude a diagnosis of seizure
b. EEG is always abnormal during Generalized Tonic-Clonic Seizures
c. Typical Absence Seizure EEG shows a generalized slow spike and slow-wave pattern with a frequency of 2.5 per second
d. Activating procedures are undertaken while the EEG is recorded in an attempt to prevent seizure occurrence
A
b. EEG is always abnormal during Generalized Tonic-Clonic Seizures
17
Q
Which of the following statement/s regarding epilepsy is/are CORRECT?
a. It describes a condition in which a person has recurrent seizures due to a chronic, underlying process
b. It refers to a single disease entity phenomenon rather than single disease entity
c. It is recurrent seizures secondary to a correctable or avoidable cause
d. It is two or more provoked seizures
A
a. It describes a condition in which a
person has recurrent seizures due
to a chronic, underlying process
18
Q
Which of the following statement/s is/are TRUE regarding small vessel stroke syndrome pure motor hemiparesis
a. Accounts for 40% of all strokes
b. Usually due to infarct in the
centrum semi-ovale
c. Usually involves either the face, arm, or leg
d. Results following atherothrombotic or lipohyalinotic occlusion
A
c. Usually involves either the face, arm, or leg
19
Q
Treatment of ACUTE attacks of MS or initial demyelinating episode will be:
a. Glatiramer Acetate
b. Interferon
c. Fingolimod
d. Glucocorticoids
A
d. Glucocorticoids
20
Q
More common manifestation of Multiple Sclerosis does NOT include:
a. Paresthesia
b. Weakness
c. Visual Problems
d. Ataxia
e. Sensory Loss
A
d. Ataxia
21
Q
Differential diagnosis in a patient with dementia-like cognitive deficits will NOT include:
a. Prion Diseases
b. Hyperthyroidism
c. Clinical Depression
d. Subdural Hematoma
A
b. Hyperthyroidism
22
Q
Which of the following modality is NOT effective in lowering ICP due to edema secondary to Intracerebral Hematoma?
a. Hypertonic saline
b. Induced hyperventilation
c. Ventriculostomy
d. Glucocorticoids
e. Osmotic Diuretic
A
d. Glucocorticoids
23
Q
True of Myasthenic Weakness, EXCEPT:
a. Weakness manifest of facial
muscles bring out the
snarl expression
b. May be asymmetric
c. EOM and lid weakness are early
common complaints
d. Limb weakness is often distal
e. Facial weakness produces snarling
expression when patient attempt to smile
A
d. Limb weakness is often distal
24
Q
What is the gold standard in diagnosing intracranial aneurysm?
a. CTA
b. PET
c. MRA
d. 4-vessel Angiography
e. Transcranial Doppler Studies
A
d. 4-vessel Angiography
25
Which among the anticonvulsant has systematic side effect of gingival hyperplasia and hirsutism:
a. Levetiracetam
b. Lacosamide
c. Lamotrigine
d. Phenytoin
e. Phenobarbital
d. Phenytoin
26
The recommended workup of a patient in presenting as recurrent short duration hemiparesis suspected as having MS is:
a. Cranial MRI
b. Evoked Potentials
c. LP with CSF analysis
d. Cranial CT Scan
e. EEG
a. Cranial MRI
## Footnote
Cranial MRI (Magnetic Resonance Imaging):
* This is considered a key diagnostic tool for evaluating patients with suspected MS.
* MRI can detect the presence of characteristic brain lesions, such as white matter lesions, that are indicative of MS.
* It helps in assessing the location, size, and distribution of the lesions, which can aid in
of vertical eye
diagnosis and progression
27
Dementia plus disinhibition, aphasia, overeating is seen in:
a. Dementia with Lewy Body Disease
b. Vascular Dementia
c. Alzheimer’s
d. Corticobasal Degeneration
e. Frontotemporal Dementia
e. Frontotemporal Dementia
28
Which of the following patient has the greatest chance of remaining seizure- free sufficient after drug withdrawal?
a. S.T., 17-year-old, female with abnormal neurologic examination, seizure free for 2 years
b. R.G., 25-year-old, with focal slowing noted on recent EEG, seizure free for 2.5 years
c. M.J., 23 years old, female, with multiple types of seizures, seizure-free for 2.5 years
d. J.C., 35 year old, male with low-grade glioma, seizure free for 2.5 years
e. A.R,. 18 years old, female, with generalized tonic clonic seizure free for 2 years
e. A.R,. 18 years old, female, with generalized tonic clonic seizure free for 2 years
29
The pseudocoma in which an awake patient has no means of producing speech and volitional limb movement
with retention movement:
a. Catatonia
b. Coma Vigil
c. Akinetic Mutism
d. Locked-In State
d. Locked-In State
## Footnote
Akinetic Mutism refers to a partially or fully awake state in which the patient remains virtually immobile and mute but can form impressions and think, as demonstrated by later recounting of events.
* This condition results from dam- age in the regions of the medial thalamic nuclei or the frontal lobes (particularly lesions situated deeply or on the orbitofrontal surfaces)
Catatonia is a hypomobile and mute syndrome that occurs usually as part of a major psychosis, typically schizophrenia or major depression.
30
TRUE in patients with Atypical parkinsonism
a. Presence of motor asymmetry
b. Late involvement of speech dysfunction
c. Typically will have rigidity and bradykinesia
d. Slower progression of symptoms compared to true PD
e. Good response to Levodopa treatment
c. Typically will have rigidity and bradykinesia
31
Which of the following statement/s regarding cardioembolic stroke is/are correct?
a. Tend to occur suddenly with maximum neurologic deficit at onset
b. Most significant cause is Valvular Atrial Fibrillation
c. Responsible for 40% of Ischemic Strokes
d. Antiplatelet is the ideal treatment of choice
a. Tend to occur suddenly with maximum neurologic deficit at onset
32
The most objective finding suggestive of an infection in the CSF analysis is:
a. Decreased protein
b. Increased protein
c. Decreased sugar
d. Pleocytosis
e. Turbidity
d. Pleocytosis
## Footnote
Pleocytosis refers to an increased number of cells in the cerebrospinal fluid (CSF), specifically an increase in white blood cells (WBCs). In the context of CSF analysis, pleocytosis is a strong indicator of an inflammatory response, including an infection in the central nervous system.
Other findings, such as changes in protein levels, sugar levels, or turbidity, can also be observed in CSF analysis during an infection, but pleocytosis is considered the most reliable and objective indicator in this context.
33
Which of the following statement/s regarding psychogenic seizures is/are TRUE?
a. Often last shorter than epileptic seizure
b. Must exclude a concurrent diagnosis of epilepsy
c. Usually accompanied by a rise in serum prolactin immediately post-ictus
d. Often a part of a conversion reaction precipitated by a psychological distress
d. Often a part of a conversion reaction precipitated by a psychological distress
34
Which of the following anticonvulsant is the drug of choice for patients having mixed type of generalized seizures?
a. Phenytoin
b. Valproic Acid
c. Levetiracetam
d. Lamotrigine
e. Carbamazepine
b. Valproic Acid
35
True of GBS,EXCEPT
a. If more than 2 weeks have elapsed from onset of motor symptoms immunotherapy effects uncertain
b. Autoimmune mechanism both cellular and humoral
c. 70% of cases occur 1-3 weeks after an acute infectious process
d. CSF analysis show elevated protein without pleocytosis
e. AMSAN show demyelinating pathology after electrodiagnostic test
e. AMSAN show demyelinating pathology after electrodiagnostic test
## Footnote
AMSAN is characterized by axonal damage and loss rather than demyelination, and this can be detected through electrodiagnostic tests such as nerve conduction studies (NCS) and electromyography (EMG).
36
In a patient with peripheral nervous system disorder, pure motor manifestation will NOT be seen in a patient with:
a. Carpal Tunnel Syndrome
b. Botulinum Toxicity
c. Muscle Dystrophy
d. Myasthenia Gravis
e. Atorvastatin
e. Atorvastatin
## Footnote
Pure motor manifestations are not typically associated with atorvastatin intake, which is a medication commonly used to lower cholesterol levels. Atorvastatin is primarily used to manage dyslipidemia and reduce the risk of cardiovascular events. It does not typically cause peripheral nervous system disorders characterized by pure motor manifestations.
37
Restricted vertical movement is typical of:
a. Multisystem Atrophy
b. Progressive Supranuclear Palsy
c. Corticobasal Degeneration
d. Parkinson’s Disease
b. Progressive Supranuclear Palsy
38
The common manifestation of Herpes Simplex Encephalitis EXCEPT:
a. Papilledema
b. Seizures
c. Behavioral Changes
d. Altered Sensorium
a. Papilledema
39
Work up that should NOT be done routinely in patient suspected of ocular myasthenia gravis:
a. Tensilon Test
b. Cranial CT Scan
c. Routine Electromyography
d. Repetitive Nerve Stimulation
e. Ach R Antibody Test
d. Repetitive Nerve Stimulation
40
NOT true of the epidemiology of MS:
a. Higher risk for identical twins than fraternal twins
b. Threefold more common in females than males
c. Geographical gradients are observed
d. Whites have lower risks compared to blacks
d. Whites have lower risks compared to blacks
41
Which of the following signs and symptoms is seen OPPOSITE the lesion in patient with lateral medullary symptoms?
a. Pain, numbness, impaired sensation over half of the face
b. Numbness of arm, trunk, or leg
c. Ataxia of limbs
d. Impaired pain and thermal sense over half the body
e. Horner’s syndrome
b. Numbness of arm, trunk, or leg
42
The most common clinical type of MS is:
a. Secondary Progressive
b. Monophasic
c. Bout MS (RMS)
d. Primary Progressive
c. Bout MS (RMS)
43
The earliest and most common manifestation of Diabetic Peripheral Neuropathy:
a. Sensory
b. Motor
c. Autonomy
d. Sensory-Motor
a. Sensory
44
Whichofthefollowingimagingmodality is the preferred choice for evaluation of Acute Intracranial Hemorrhage?
a. Contrast-Enhanced CT Scan
b. Plain Cranial MRI
c. Contrast-Enhanced MRI
d. Skull X-Ray
e. Plain Cranial CT Scan
e. Plain Cranial CT Scan
45
Which of the following seizure type/s is/are post-ictal confusion typically observed?
a. Generalized Tonic-Clonic Seizure
b. Absence Seizure
c. Myoclonic Seizure
d. Atonic Seizure
a. Generalized Tonic-Clonic Seizure
46
Destruction of the Medulla is NOT
manifested as:
a. Absent gag reflex
b. Irreversible apnea
c. Presence of agonal gaps
d. Presence of cough reflex
d. Presence of cough reflex
## Footnote
a. Absent gag reflex: The medulla is responsible for coordinating the gag reflex, so its destruction would typically result in the absence of the gag reflex.
b. Irreversible apnea: The medulla plays a crucial role in regulating breathing. Destruction of the medulla can lead to the loss of the respiratory centers, resulting in irreversible apnea (cessation of breathing).
c. Presence of agonal gaps: Agonal gaps are abnormal, irregular gasps or pauses in breathing that occur in the final moments before death. These can be a manifestation of medullary dysfunction or damage.
d. Presence of cough reflex: The cough reflex is primarily mediated by the medulla, and its destruction would typically result in the loss or absence of the cough reflex.
47
Presence of muteness, rigidity, incontinence is seen in what stage of Alzheimer’s Disease
a. Late
b. Middle
c. Early
d. End
d. End
48
What scale is used for prognostication for SAH?
a. ABCD2
b. Hunt and Hess
c. HAS-BLED
d. CHA2D2S-VASc
b. Hunt and Hess
49
Most common etiology of community acquired bacterial meningitis:
a. H. influenza
b. Strep. pneumoniae
c. Staph aureus
d. Listeria monocytogenes
b. Strep. pneumoniae
50
Treatment of Parkinson’s Disease does NOT include:
a. Antiviral Agent
b. MAO B Inhibitors
c. Levodopa-Carbidopa Combination
d. Dopamine Antagonists
e. COMT Inhibitors
d. Dopamine Antagonists
| *Dopamine AGONIST*
51
In comatose patients, a unilaterally large pupil heralds:
a. Central Herniation
b. Foraminal Herniation
c. Transfacial Herniation
d. Uncal Herniation
d. Uncal Herniation
52
Which of the following statement/s is/are TRUE of a typical absence seizure?
a. Usually accompanied by subtle, bilateral motor signs
b. Onset is usually in late adolescence
c. Not Accompanied by postictal confusion
d. Characterized by sudden brief lapses of consciousness with loss of postural control
a. Usually accompanied by subtle, bilateral motor signs
53
What is the traditional duration of seizure activity sufficient to meet the definition of Status Epilepticus?
a. 30-45 minutes
b. Less than 5 minutes
c. 5-10 minutes
d. 15-30 minutes
e. >60 minutes
d. 15-30 minutes
54
TRUE of Anti-AchR antibodies level testing in Myasthenia Gravis, EXCEPT
a. Presence virtually diagnostic of MG
b. The level of Anti-AchR antibodies does not correlate well with the weakness
c. A negative test rule out the diagnosis of MG
d. Ach receptor patients may be (+) for muSK antibodies
c. A negative test rule out the diagnosis of MG
| A negative test DOES NOT rule out the diagnosis of MG
55
True of Parkinson's disease
a. Pathology is best demonstrated in vthe pars reticulate of the substantia nigra
b. Non-motor symptoms may precede the cardinal motor symptoms
c. Presence of intracytoplasmic
proteinaceous inclusions known as Lewy Bodies
d. Postural instability is a nonmotor
feature of the disease
e. Degeneration of substantia nigra neurons resulting in motor symptoms occur early in the disease process
b. Non-motor symptoms may precede the cardinal motor symptoms
## Footnote
a. Pathology is best demonstrated in the pars reticulate of the substantia nigra
*- pars compacta*
c. Presence of intracytoplasmic
proteinaceous inclusions known as Lewy Bodies
*- cytoplasmic intraneural inclusiod granules (Lewy Bodies)*
d. Postural instability is a nonmotor
feature of the disease
*- motor feature*
e. Degeneration of substantia nigra neurons resulting in motor symptoms occur early in the disease process
*- end process*
56
Not casually related to development of PD:
a. Living in rural areas
b. Consumption of caffeine
c. Drinking of water from the well
d. Exposure to pesticides
b. Consumption of caffeine
## Footnote
b. Consumption of Caffeine - consumption of caffeine has actually been associated with a lower risk of developing Parkinson's disease (PD). Several studies have suggested a potential protective effect of caffeine in reducing the risk of PD. However, it's important to note that the exact mechanisms underlying this association are not fully understood.
a. Living in rural areas: There is some evidence to suggest that individuals living in rural areas may have a slightly higher risk of developing Parkinson's disease. This could be due to increased exposure to certain environmental factors, such as pesticides or well water contaminated with toxins.
c. Drinking water from the well: The presence of certain toxins or contaminants in well water has been associated with an increased risk of Parkinson's disease. Well water can sometimes
contain substances like manganese or other chemicals that may have neurotoxic effects.
d. Exposure to pesticides: Pesticide exposure has been identified as a potential risk factor for Parkinson's disease. Certain pesticides, such as rotenone and paraquat, have been linked to an increased risk of developing the condition.
57
In patients with slowly progressive dementia without normal laboratory test, which neuroimaging problem is highly suggestive of AD:
a. Multiple Cerebral Infarcts
b. Posterior Dominant Cortical Atrophy
c. Normal-Sized Hippocampus
d. Hydrocephalus
e. Frontal and Temporal Lobe
b. Posterior Dominant Cortical Atrophy
58
First-line treatment of Trigeminal Neuralgia
a. Tramadol
b. Vitamin B
c. Venlafaxine
d. Pregabalin
e. Carbamazepine
e. Carbamazepine
59
In Alzheimer’s Disease, the pathology will NOT be characterized by:
a. Normal-sized medial temporal lobe
b. Degeneration of upper brainstem nuclei
c. Presence of amyloid angiopathy
d. Presence of neuritic plaques and neurofibrillary tangles
e. Degeneration of neurons in thennucleus basalis of Meynert
a. Normal-sized medial temporal lobe
| atrophy of the medial temporal lobe
60
Which item is true with regards to the temporal evolution of neuropathy
a. Acute (days to 2 weeks)
b. Acute (hours to days)
c. Chronic (>4 weeks)
d. Subacute (2-3 weeks)
b. Acute (hours to days)
| **Acute** (<2 days)
**Subacute** (2 days - 2 weeks)
**Chronic**(>2weeks)
61
In pathogenesis of Alzheimer’s Disease,
the apoE gene allele conferring increased risk is:
a. E1
b. E2
c. E4
d. E3
c. E4
62
Dementia is associated with deficiency of:
a. Folic Acid
b. Vitamin B12
c. Vitamin B1
d. Vitamin B6
b. Vitamin B12
## Footnote
A deficiency in vitamin B12 can lead to neurological symptoms, including cognitive impairment, memory loss, confusion, and even mood disturbances. It is particularly important to ensure adequate vitamin B12 intake, as it plays a crucial role in maintaining the health of the nervous system.
While deficiencies in other B vitamins, such as folic acid (a) and vitamin B6 (d), can also have an impact on neurological health, vitamin B12 deficiency is specifically associated with an increased risk of dementia.
Vitamin B1 deficiency is associated with another condition called Wernicke-Korsakoff syndrome, which can cause cognitive impairment but is not considered a direct cause of dementia.
63
The most common cause of the vegetative and minimally conscious state is:
a. Hypoglycemia
b. Head Trauma
c. Seizures
d. Stroke
e. CNS Infection
b. Head Trauma
64
Which of the following signs and symptoms is NOT seen in a stroke involving the distribution of the Anterior Cerebral Artery?
a. Abulia
b. Conduction Aphasia
c. Cortical Sensory Loss over toes, foot, and leg
d. Gait Apraxia
e. Paralysis of opposite foot and leg
b. Conduction Aphasia
65
NOT a positive motor symptom in peripheral nervous system diseases:
a. Fasciculations
b. Weakness
c. Calf Pain
d. Hypertrophy
e. Muscle Cramps
d. Hypertrophy
## Footnote
Positive motor symptoms refer to the presence of abnormal or exaggerated movements or sensations. In the context of peripheral nervous system diseases, positive motor symptoms are often indicative of muscle or nerve dysfunction
a. Fasciculations: Fasciculations are involuntary muscle twitches or contractions and are considered a positive motor symptom.
b. Weakness: Weakness is the reduction in muscle strength and is a common positive motor symptom in peripheral nervous system diseases.
c. Calf Pain: While pain is not strictly a motor symptom, it is included in the list. Calf pain can be present in certain peripheral nerve disorders and is considered a positive symptom.
d. Hypertrophy: Hypertrophy refers to an increase in the size of muscle tissue and is not typically considered a positive motor symptom in peripheral nervous system diseases. It is more commonly associated with conditions such as muscle overuse or specific types of muscle disorders.
e. Muscle Cramps: Muscle cramps are involuntary and painful contractions of muscles. They are considered a positive motor symptom as they involve abnormal muscle activity.
66
The best treatment for the motor symptom of PD is:
a. COMT inhibitor
b. Glutamate agonist
c. Anticholinergic medication
d. Amantadine
e. Levodopa Carbidopa
e. Levodopa Carbidopa
67
Which of the following substances is NOT considered as having a toxigenic effect on the muscle?
a. Amiodarone
b. Chloroquine
c. Colchicine
d. Fenofibrate
e. Streptomycin
e. Streptomycin
68
Miotic pupil, drowsiness is seen in a patient with:
a. Transfacial herniation
b. Uncal herniation
c. Central transtentorial herniation
d. Foraminal herniation
c. Central transtentorial herniation
69
NOT TRUE of hypokalemic periodic paralysis
a. Onset of weakness usually before 25 years of age
b. Respiratory muscles usually spared
c. Associated most predominantly with calcium channel abnormality
d. Arms usually weaker than legs
e. Affects males more than females
c. Associated most predominantly with calcium channel abnormality
| assoc with mutations in genes encoding sodium channels
## Footnote
Hypokalemic periodic paralysis (HPP) is a rare genetic disorder characterized by episodes of muscle weakness or paralysis caused by low levels of potassium in the blood
a. Onset of weakness usually before 25 years of age: This is true for hypokalemic periodic paralysis. The episodes of weakness typically begin in childhood or adolescence.
b. Respiratory muscles usually spared: This is generally true for hypokalemic periodic paralysis. During episodes of weakness, respiratory muscles are typically not affected, and breathing remains unaffected.
c. Associated most predominantly with calcium channel abnormality: This statement is **not** true. Hypokalemic periodic paralysis is primarily associated with mutations in genes encoding sodium channels, particularly the SCN4A gene. It is not predominantly associated with calcium channel abnormalities.
d. Arms usually weaker than legs: This is often observed in hypokalemic periodic paralysis. During an episode, the muscles of the arms are typically more affected than the muscles of the legs.
e. Affects males more than females: This is generally true for hypokalemic periodic paralysis. The condition is more commonly seen in males than females.
70
In a patient with myopathic symptoms, which of the following should NOT be a priority?
a. Request for serum Na
b. Request for T3, T4 and TSH
c. Ask all maintenance medications
d. Request for muscle ultrasound
e. Request for FBS, glycosylated
hemoglobin
d. Request for muscle ultrasound
71
A patient who is brain dead will NOT
manifest these:
a. (+) pupillary light reflex
b. (+) flexion withdrawal
c. Absent corneal reflex
d. Absent cough reflex
a. (+) pupillary light reflex
## Footnote
When a patient is determined to be brain dead, it means that there is complete and irreversible loss of all brain function, including the brainstem. As a result, certain reflexes and responses that rely on brainstem activity will be absent.
The Pupillary Light Reflex, which involves constriction of the pupils in response to light, is mediated by the brainstem. In a brain-dead patient, this reflex will be absent, and the pupils will not constrict when exposed to light.
72
The most common cause of the vegetative and minimally conscious state is:
a. Hypoglycemia
b. Seizures
c. Stroke
d. Cardiac arrest
e. CNS Infection
d. Cardiac arrest
| Cardiac arrest and/or Head Trauma
72
NOT TRUE of myasthenic weakness
a. EOM and lid weakness manifest late
b. In the majority weakness becomes generalized
c. Weakness manifest of facial muscles brings out the snarl expression
d. May be asymmetric
e. Limb weakness if often proximal
a. EOM and lid weakness manifest late
| early
73
The most common manifestation of HIV encephalopathy:
a. Behavioral changes
b. Aphasia
c. Dementia
d. Loss of consciousness
c. Dementia
74
First line treatment of painful peripheral neuropathy
a. Venlafaxine
b. Pregabalin
c. Vitamin B
d. Tramadol
b. Pregabalin
75
For corneal reflex, which are FALSE?
a. Has good prognostic value
b. (+) shows intact pontine function
c. May be elicited in both awake and comatose patients
d. (+) shows intact medullary brainstem function
d. (+) shows intact medullary brainstem function
## Footnote
a. Has good prognostic value: The corneal reflex can have prognostic value in certain clinical situations, such as coma or brainstem injury. Its absence or loss can indicate dysfunction or damage within the brainstem or cranial nerve V (trigeminal nerve).
b. (+) shows intact pontine function: This statement is false. The corneal reflex primarily involves the trigeminal nerve (cranial nerve V) and its connection with the facial nerve (cranial nerve VII). It is mediated by the brainstem, specifically the trigeminal sensory nucleus and the facial motor nucleus, which are located in the pons. Therefore, a positive corneal reflex does not specifically indicate intact pontine function but rather functioning of the brainstem structures involved.
c. May be elicited in both awake and comatose patients: The corneal reflex can be elicited in both awake and comatose patients, as long as the sensory and motor pathways involved in the reflex arc are intact. It does not rely on the patient's level of consciousness.
d. (+) shows intact medullary brainstem function:
This statement is true. The corneal reflex involves the sensory input from the cornea traveling via the trigeminal nerve to the sensory nucleus of the trigeminal nerve, which is located in the pons. The motor output for the blink response is transmitted via the facial nerve, originating from the facial motor nucleus in the pons. Therefore, a positive corneal reflex indicates intact medullary brainstem function.
76
NOT TRUE of herpes simplex encephalitis the patient may have:
a. Managed supportively: antibiotic use is optional
b. Fever, headache, seizures
c. May have EEG and MRI abnormalities in the frontotemporal area
d. CSF analysis may show many RBC even in nontraumatic
a. Managed supportively:
antibiotic use is optional
| anti-viral
77
Persistent weakness, mild tingling sensation in the toes, fingertips, hypoactive DTRs.
a. ALS
b. Statin as maintenance medication
c. Hypokalemic periodic paralysis
d. Diabetic polyneuropathy
d. Diabetic polyneuropathy
78
Neurologic findings NOT suggesting a myopathy:
a. Facial dystonia
b. Intermittent fluctuating weakness within the day
c. Presence of waddling gait by inspection
d. Distal weakness < proximal weakness
a. Facial dystonia
## Footnote
a. Facial dystonia: Facial dystonia is a movement disorder characterized by involuntary muscle contractions and spasms in the face. It is not typically associated with myopathy, which refers to muscle disease or dysfunction.
b. Intermittent fluctuating weakness within the day:
Intermittent fluctuating weakness throughout the day is more characteristic of conditions such as myasthenia gravis, which is a neuromuscular junction disorder, rather than a myopathy.
c. Presence of waddling gait by inspection: A waddling gait is often observed in patients with proximal muscle weakness, which can be seen in certain myopathies such as muscular dystrophy or inflammatory myopathies.
d. Distal weakness < proximal weakness: Distal weakness that is less severe than proximal weakness can be seen in certain neuropathies, such as peripheral neuropathy, but is not typically associated with myopathy.
79
The most objective evidence of meningitis in the CSF analysis
a. Turbidity
b. Decreased sugar
c. Decreased protein
d. Pleocytosis
d. Pleocytosis
80
Which of the following statement/s regarding epilepsy is/are CORRECT:
a. It is recurrent seizures due to a correctable or avoidable cause
b. A single unprovoked seizure with very low risk of recurrence
c. It is two or more provoked seizures
d. It describes a condition in which a person has recurrent seizures due to a chronic, underlying process
e. Having an epilepsy syndrome negates the diagnosis of epilepsy
d. It describes a condition in which a person has recurrent seizures due to a chronic, underlying process
81
Which of the following is the treatment of choice for ischemic
stroke due to non-valvular AF?
a. Warfarin
b. Clopidogrel
c. Clopidogrel
d. ASA
e. Enoxaparin
d. ASA
82
Where is the most frequent location of saccular aneurysms?
a. Ophthalmic artery
b. Tip of the basilar artery
c. Internal carotid artery
d. Posterior communicating artery
e. Anterior communicating artery
e. Anterior communicating artery
83
Which of the following is a common cause of ischemic stroke
a. Hypercoagulable disorder
b. Fibromuscular dysplasia
c. Cardiogenic
d. Vasculitis
e. Thrombosis
e. Thrombosis
84
Which of the following is the most common cause of cardioembolic stroke
a. Prosthetic valves
b. Rheumatic heart disease
c. Myocardial infarction
d. Ischemic cardiomyopathy
e. Non-valvular AF
e. Non-valvular AF
| *NonRheumatic*
85
Which of the following is the principal non-modifiable risk factor for lacunar infarction?
a. Hypercoagulable disorder
b. Smoking
c. Diabetes mellitus
d. Age
e. Hypertension
d. Age
## Footnote
Lacunar Infarction refers to a type of stroke that occurs due to the occlusion of small penetrating arteries in the brain. These arteries supply deep structures within the brain, such as the basal ganglia and internal capsule.
Among the options provided, age is considered the principal non-modifiable risk factor for lacunar infarction. As individuals age, the risk of developing lacunar infarcts increases. This is believed to be due to the cumulative effects of vascular changes, such as arteriosclerosis and small vessel disease, that occur over time.
While other risk factors such as hypertension (option e), smoking (option b), diabetes mellitus (option c), and hypercoagulable disorders (option a) can contribute to the development of lacunar infarction, age is considered the primary non- modifiable risk factor.
86
Which of the following dramatically worsen brain injury during ischemia?
a. Hyperkalemia
b. Hypernatremia
c. Hyperuricemia
d. Hyperglycemia
e. Hypercholesterolemia
d. Hyperglycemia
87
Whichofthefollowingisanindication
for administration of IV rTPA?
a. CT scan showing edema of >1⁄3 of MCA territory
b. Diagnosis of stroke of any type
c. Presence of concomitant hypoglycemia
d. Onset of symptom < 4.5 hours
e. High NIHSS
d. Onset of symptom < 4.5 hours
88
Which of the following is the treatment of choice for ischemic stroke due to non-valvular AF?
a. Cilostazol
b. Warfarin
c. Clopidogrel
d. Enoxaparin
e. ASA
e. ASA
88
Which of the following is the most common site for hypertensive intracranial hemorrhage?
a. Basis pontis
b. Ventral pons
c. Putamen
d. Thalamus
e. Cerebellum
c. Putamen
89
Which of the following imaging modality is the preferred choice for evaluation of acute intracranial hemorrhage?
a. Skull x-ray
b. Plain cranial CT scan
c. Plain cranial MRI
d. Contrast enhanced CT scan
e. Contrast enhanced MRI
b. Plain cranial CT scan
89
What is the most common cause of subarachnoid hemorrhage?
a. Head trauma
b. Extension into the subarachnoid space from a primary intracerebral hemorrhage
c. Anticoagulant use
d. Bleeding from an AVM
e. Rupture of saccular aneurysm
a. Head trauma
90
Which among the seizure types is typically seen in patients suffering from metabolic derangements?
a. Atonic
b. Generalized tonic clonic
c. Complex partial seizures
d. Absence
e. Simple partial seizures
b. Generalized tonic clonic
91
Which of the following points more to a syncopal attack rather than generalized tonic clonic seizure?
a. Usually accompanied by tongue biting
b. Immediate transition to unconsciousness
c. Postictal disorientation lasting for hours
d. Cyanosis during the event
e. Precipitated by valsalva maneuver
e. Precipitated by valsalva
maneuver
92
Which of the following anticonvulsants has no known significant drug interaction?
a. Phenytoin
b. Valproic acid
c. Levetiracetam
d. Lamotrigine
e. Carbamazepine
c. Levetiracetam
93
Which of the following anticonvulsants is/are formation of renal stones one of its adverse
effects?
a. Phenobarbital
b. Valproic acid
c. Phenytoin
d. Topiramate
e. Carbamazepine
d. Topiramate
94
Which of the following cranial structures is/are pain producing?
a. Choroid plexus
b. Ventricular ependyma
c. Falx cerebri
d. Brain parenchyma
e. Pial veins
e. Pial veins
## Footnote
The pia mater is a thin membrane that covers the brain and spinal cord. It is the innermost of the three layers of meninges, the membranes that surround the central nervous system. The pia mater is highly vascular, and contains many small blood vessels called Pial Veins. These veins are pain-sensitive, and can cause headaches when they are dilated or compressed.
The other structures listed are not pain-sensitive. The choroid plexus is a network of blood vessels that produces cerebrospinal fluid. The ventricular ependyma is a layer of cells that lines the ventricles of the brain. The falx cerebri is a fold of dura mater that separates the two cerebral hemispheres. The brain parenchyma is the functional tissue of the brain.
95
Which of the following headache symptoms connote a serious underlying disorder?
a. Headache with non-changing pattern
b. Recurrent headache
c. Non-progressive headache
d. New onset headache after 50 years old
e. With no accompanying systemic signs
d. New onset headache after 50 years old
96
Which of the following medications is/are effective agents for migraine prophylaxis?
a. Amitriptyline
b. Ibuprofen
c. Zolmitriptam
d. Ergotamine
e. Metoclopramine
a. Amitriptyline
97
Intoxication with this substance may mimic brain death:
a. Diazepam
b. Caffeine
c. Alcohol
d. Fluoxetine
e. Barbiturate
e. Barbiturate
98
In a myasthenic patient, the synaptic transmission is characterized as having:
a. Flattened postsynaptic folds
b. Presence of anti-Ach R antibodies
c. Decrease in the number of available Ach Rs at the postsynaptic folds
d. Normal release of acetylcholine
e. All
e. All
99
Workup that should NOT be done routinely in patients suspected of Generalized Myasthenia Gravis:
a. Tensilon test
b. Cranial CT scan
c. Repetitive nerve stimulation
d. Ach R antibody test
e. Thyroid function
e. Thyroid function
100
Positive motor symptom inperipheral neuropathy:
a. Spasticity
b. Allodynia
c. Hyperactive reflexes
d. Weakness
e. Muscle cramps
e. Muscle cramps
101
To diagnose CNS infection the to primary workup should be:
a. Cranial CT scan
b. Cranial MRI
c. Cerebral angiogram
d. CSF analysis
e. EEG
d. CSF analysis
102
The most commonly identified virus causing sporadic cases of acute encephalitis in immunocompetent adults:
a. Mumps
b. Cytomegalovirus
c. Arbovirus
d. Herpesvirus
e. Flavivirus
d. Herpesvirus
102
Increased signal intensity in MRI or EEG is suggestive of herpes simplex encephalitis if located in:
a. Fronto occipital
b. Diencephalic
c. Fronto parietal
d. Temporo parietal
e. Fronto temporal
e. Fronto temporal
103
The cardinal features of Parkinson’s disease:
a. Resting tremors
b. Rigidity
c. Gait impairment
d. All is correct
d. All is correct
104
The pathologic hallmark of PD:
a. Degeneration of Dopaminergic neurons in the pons
b. Lewy bodies
c. Reduced striatal dopamine
d. All are correct
b. Lewy bodies
## Footnote
Pathologically, the hallmark features of PD are degeneration of dopaminergic neurons in the substantia nigra pars compacta (SNc), reduced striatal dopamine, and intraneuronal proteinaceous inclusions in cell bodies and axons that stain for α- synuclein (known as Lewy bodies and Lewy neurites, collectively as Lewy pathology)
105
Multiple system atrophy is suspect when a patient presents with:
a. Autonomic dysfunction
b. Cerebellar sign
c. Atypical parkinsonism
d. All
d. All
106
The most common cause of secondary Parkinsonism:
a. Strokes
b. Carbon monoxide poisoning
c. Infection
d. Neuroleptics
d. Neuroleptics
107
Complains of diplopia and impairment of downward gaze of examination:
a. MSA-p
b. MSA-c
c. Dementia with Lewy bodies
d. PSP
d. PSP
107
Mainstay treatment of PD
a. Carbidopa
b. Dopamine agonist
c. Benserazide
d. Levodopa
d. Levodopa
108
The following side effects are more common with Dopamine Agonist than with Levodopa:
a. “Off” periods
b. Hallucinations and cognitive impairment
c. Dyskinesis
d. Nausea and vomiting
b. Hallucinations and cognitive impairment
109
Aside from levodopa, the following are approved drugs for PD:
a. MAO-B inhibitors
b. COMT inhibitors
c. Dopamine agonist
d. All
d. All
110
The most common demyelinating disorder:
a. Multiple sclerosis
b. Optic neuritis
c. Transverse myelitis
d. Acute disseminated encephalomyelitis
a. Multiple sclerosis
111
“Shadow plaques” are
a. Astrocytic proliferation
b. Partial remyelination of naked axon
c. Disrupted Blood-Brain-Barrier
d. Perivenular cuffing by T-cells
b. Partial remyelination of naked axon
112
“Gliosis” are:
a. Remyelinating axons
b. Perivenular cuffing
c. Astrocytic proliferation
d. Disrupted BBB
c. Astrocytic proliferation
113
The following statement/s is/are TRUE of MS:
a. The age of onset is typically between 40 and 60 years
b. MS is approximately threefold more common in women than men
c. MS prevalence is ten to twenty folds higher in the tropics than in temperate zones
d. All are true
b. MS is approximately threefold more common in women than men
## Footnote
The age of onset for MS is typically between 20 and 40 years, and it is more common in temperate zones than in the tropics. However, MS is not ten to twenty folds higher in the tropics than in temperate zones. In fact, the prevalence of MS is much lower in the tropics than in temperate zones.
Statistics on the prevalence of MS:
* The global prevalence of MS is estimated to be 2.5 million people.
* The highest prevalence of MS is found in northern Europe, Canada, and the United States.
* The lowest prevalence of MS is found in Africa, South America, and Asia.
The reason for the higher prevalence of MS in temperate zones is not fully understood, but it is thought to be due to a combination of genetic and environmental factors.
114
The explanation of the latitude effect on MS is:
a. The low temperature inhibits demyelination
b. The use of sunblock
c. There is protective effect of sun exposure
d. All are correct
c. There is protective effect of sun exposure
115
The following increases the risk of MS:
a. Higher socioeconomic status
b. Higher antibody titers to EBV
c. Dizygotic twins of MS
d. All are correct
b. Higher antibody titers to EBV
116
The major cause of progressive and irreversible neurologic disability in MS is:
a. Cumulative axonal loss
b. Persistent myelin antigens in CSF
c. Preservation of oligodendrocytes
d. Burst in focal inflammation
a. Cumulative axonal loss
117
Clinically definite MS Diagnostic criteria
a. Reflect pathology in anatomically non-contiguous white matter tracts
b. Two or more symptoms and two or more signs
c. Symptoms must last for more than 24hrs separated by a month or more
d. All should be fulfilled
d. All should be fulfilled
