Neurology Flashcards
8% of the EORE Blueprint (40 cards)
What are the components of Charcot neurological triad that are associated with multiple sclerosis?
- Nystagmus
- Intention tremor
- Scanning speech
A 22-year-old man presents to your office after experiencing a head injury while playing football 3 days ago. He lost consciousness for less than 5 seconds after hitting his head during a tackle. Upon regaining consciousness, he was taken to the hospital for evaluation due to experiencing symptoms of headache, nausea, and mild confusion. Computed tomography of the head was negative for any acute findings. The patient now has questions about return to activity and ongoing health maintenance after a concussion. Which of the following is the most appropriate guidance?
A) Annual brain imaging
B) Cognitive rehabilitation
C) Immediate return to activity
D) Stepwise return to activity
Stepwise return to activity
Which cranial nerve is affected in Bell’s Palsy?
Cranial Nerve VII (facial nerve)
What is the most common cause of Bell’s Palsy?
Idiopathic, though herpes simplex virus (HSV) reactivation is commonly suspected
What is the first line treatment for Bell’s Palsy?
Corticosteroids (prednisone)
What is a key distinguishing feature of Bell’s Palsy from a central cause of facial weakness (e.g., stroke)?
Bell’s Palsy affects both the upper and lower face, whereas central causes spare the forehead.
A 35-year-old woman presents with sudden onset right-sided facial weakness. She is unable to raise her right eyebrow or close her right eye. She denies limb weakness or speech difficulties. Physical examination reveals complete right-sided facial paralysis, including the forehead. Which of the following is the most likely diagnosis?
A) Stroke
B) Bell’s Palsy
C) Myasthenia gravis
D) Multiple sclerosis
Bell’s Palsy
Bell’s Palsy causes peripheral facial paralysis, affecting both the upper and lower face. The inability to raise the eyebrow and close the eye suggests a lower motor neuron lesion of the facial nerve.
A 45-year-old man presents with sudden onset left-sided facial weakness. He reports difficulty closing his left eye and raising his left eyebrow. He was recently treated for a cold sore. What is the most appropriate initial treatment for this patient?
A) Antibiotics
B) Antiviral therapy alone
C) High-dose corticosteroids
D) Low-dose corticosteroids and antiviral therapy
Low-dose corticosteroids and antiviral therapy
The recommended treatment for Bell’s Palsy includes corticosteroids to reduce inflammation, and antivirals may be considered, especially if there is evidence of a viral trigger such as herpes simplex.
A 50-year-old woman presents with sudden right-sided facial paralysis and difficulty closing her right eye. She also reports dry eyes and decreased tear production on the affected side. What is the most important next step in managing her dry eyes?
A) Oral corticosteroids
B) Surgical intervention
C) Artificial tears and eye patching
D) Antiviral therapy
Artificial tears and eye patching
Bell’s Palsy can impair the ability to close the eye, leading to dry eyes and potential corneal damage. Artificial tears and eye patching are necessary to protect the eye from drying and injury.
A 40-year-old male presents with right-sided facial paralysis that began 2 days ago. He cannot close his right eye or smile on the right side. He has no history of trauma or previous neurological deficits. Examination reveals right-sided lower motor neuron facial weakness. Which of the following clinical signs helps distinguish Bell’s Palsy from a stroke?
A) Facial droop involving the entire face, including the forehead
B) Sudden onset of symptoms
C) Absence of headache or altered mental status
D) Involvement of the upper extremities
Facial droop involving the entire face, including the forehead
A 34-year-old man presents with acute onset left-sided facial paralysis. He is diagnosed with Bell’s Palsy. Which of the following best describes the pathophysiology of this condition?
A) Demyelination of the facial nerve
B) Inflammation and edema of the facial nerve
C) Autoimmune destruction of the facial nerve
D) Ischemia of the facial nerve
Inflammation and edema of the facial nerve
What is the inheritance pattern of Huntington Disease?
Which type of genetic mutation causes Huntington Disease?
Autosomal Dominant
Trinucleotide (CAG) repeat expansion on chromosome 4
What are the three primary clinical features of Huntington Disease?
At what age do symptoms typically present?
- Motor Dysfunction (chorea)
- Cognitive Decline
- Psychiatric symptoms
Between 30 and 50 years of age
What is the definitive test for diagnosing Huntington disease?
Genetic testing to identify the CAG repeat expansion in the HTT gene.
A 45-year-old man presents with involuntary jerking movements, irritability, and difficulty with memory and concentration. His father had a similar condition and died at age 55. On physical exam, he has choreiform movements of the upper extremities. Which of the following is the most likely diagnosis?
A) Parkinson’s disease
B) Huntington disease
C) Amyotrophic lateral sclerosis (ALS)
D) Multiple sclerosis
Huntington’s Disease
The patient presents with chorea, cognitive decline, and a family history consistent with Huntington disease, an autosomal dominant neurodegenerative disorder.
A 40-year-old woman with a family history of Huntington disease is experiencing mood swings, irritability, and mild memory problems. She is worried she may have inherited the condition. Which of the following tests would confirm the diagnosis?
A) MRI of the brain
B) Serum C-reactive protein
C) Genetic testing for CAG repeat expansion
D) Electromyography (EMG)
Genetic testing for CAG repeat expansion
Genetic testing is the definitive method for diagnosing Huntington disease by detecting the CAG repeat expansion in the HTT gene.
A 50-year-old man with Huntington disease presents with worsening motor symptoms, including involuntary movements and gait instability. He also reports increased irritability and difficulty concentrating. What is the best treatment option for managing his chorea?
A) Levodopa
B) Tetrabenazine
C) Donepezil
D) Carbamazepine
Tetrabenazine
Tetrabenazine is commonly used to manage the chorea associated with Huntington disease by depleting dopamine and reducing involuntary movements.
A 46-year-old man with Huntington disease presents with progressive difficulty walking and frequent falls. MRI of the brain reveals atrophy of the caudate nucleus. Which of the following best explains the pathophysiology of Huntington disease?
A) Degeneration of dopaminergic neurons in the substantia nigra
B) Loss of lower motor neurons in the anterior horn of the spinal cord
C) Atrophy of the caudate nucleus and putamen in the basal ganglia
D) Demyelination of white matter in the central nervous system
Atrophy of the caudate nucleus and putamen in the basal ganglia
What is the characteristic location of pain in cluster headaches?
What is the typical duration of cluster headaches?
Unilateral, typically around the eye or temporal
15 minutes to 3 hours
What is the first-line abortive treatment for cluster headaches?
100% oxygen therapy
What is a common autonomic symptom associated with cluster headache?
Lacrimation, rhinorrhea, or ptosis on the affected side
What is the first-line prophylactic medication for preventing cluster headaches?
Verapamil
A 30-year-old male presents to the emergency department with intense, right-sided orbital pain, tearing, and nasal congestion. The pain started 45 minutes ago and is unbearable. He has had similar episodes over the past few days. Which of the following findings is typically associated with this condition?
A) Bilateral eye tearing
B) Mydriasis (pupil dilation)
C) Horner’s syndrome (ptosis, miosis, anhidrosis)
D) Vision loss
Horner’s Syndrome (ptosis, miosis, anhidrosis)
Cluster headaches are associated with autonomic symptoms on the affected side, including Horner’s syndrome, which involves ptosis (drooping eyelid), miosis (constricted pupil), and anhidrosis (loss of sweating).
What is the most common initial presentation of multiple sclerosis?
Optic neuritis (painful vision loss) or sensory disturbances (numbness or tingling)
