Neurology

Question 1

You believe a patient has a stroke. He presents with aphasia, loss of hearing in one ear and loss of vision in his left eye. Is the blockage likely in the anterior or posterior circulation?

Answer 1

Posterior

Question 2

Under what conditions would aspirin or clopidogrel be used following a TIA as prophaylaxis?

Answer 2

These are antiplatelet medications. They would be used unless there is a known cardiac etiology for the embolism. Patients with a cardiac cause should use heparin or coumadin

Question 3

A patient who is asymptomatic should consider having an endartectomy at what percent blockage of the carotid artery? How about in a symptomatic patient?

Answer 3

70% if asymptomatic and 60% if symptomatic

Question 4

A patient presents complaining of the worst headache of his life. What might you expect his blood pressure to be?

Answer 4

This is the description for a subarachnoid hemorrhage. Blood pressure would be elevated.

Question 5

Name abortive migraine drugs

Answer 5

triptans ( sumatriptan, zolmitriptan), ergotamine

Question 6

An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis

Answer 6

SImple partial seizure

Question 7

What is the single most important thing to be concerned about with a patient in status epilepticus

Answer 7

Airway then managemnt of hyperthermia

Question 8

Describe Brudzinski’s sign

Answer 8

lift the patients head and bend at the hips

Question 9

Name medications used to break a seizure

Answer 9

Diazepam, lorazepam, phenytoin or fosphenytoin.

Question 10

There is an MRI result of multiple foci of demyelination in the white matter. What is the most likely diagnosis?

Answer 10

Multiple Sclerosis

Question 11

List 3 medications used to treat multiple sclerosis

Answer 11

Steriods, interferon-beta, copolymer

Question 12

What is the most common cause of dementia?

Answer 12

Alzheimers ( 80%)

Question 13

What are the 4 chromosomes that have been linked to dementia?

Answer 13

1,14,19,21

Question 14

Is the ankle jerk reflex or lumbar or sacral origin?

Answer 14

sacral

Question 15

A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What is the most likely diagnosis?

Answer 15

Alzheimers

Question 16

A patient complains of an aching headache which feels like a band around his head. What is the most likely diagnosis?

Answer 16

Tension Headache

Question 17

A patient present with a tremor in his right hand. He states that the tremor goes away completely when he has a beer. What is the most likely diagnosis?

Answer 17

benign essential or familial tremor

Question 18

Two medications to treat an essential tremor?

Answer 18

Beta blocker ( propanolol), Primidone

Question 19

At what age do the symptoms of Huntington’s appear?

Answer 19

30

Question 20

A 35 year old patient comes to your office because his wife made him. He has been increasingly irritable and moody. She has also noticed that he is very restless. You order a CT scan which shows cerebral atrophy as well as atrophy of the caudate nucleus. What is the most likely diagnosis?

Answer 20

Huntington’s

Question 21

Medication of choice for a patient with Tourette’s syndrome?

Answer 21

Haloperidol

Question 22

slit lamp shows Kayser- Fleischer rings. Most likely diagnosis?

Answer 22

Wilson’s Disease

Question 23

Wilson’s disease is associated with a build up of what mineral?

Answer 23

Buildup of copper because there is a deficiency of copper binding protein

Question 24

What are the genetic characteristics of Wilson’s disease?

Answer 24

Autosomal recessive, chromosome 13

Question 25

What cranial nerve is affected with Bell's Palsy?

Answer 25

7

Question 26

A LP for a patient with bacterial meningitis will show an increase or decrease in: WBC, glucose, protein?

Answer 26

elevated WBC and protein. Decreased glucose

Question 27

What symptom is associated with a classic migraine

Answer 27

Having an aura

Question 28

Elevated acetylcholine receptor antibodies should make you thin of what dx

Answer 28

myasthenia gravis

Question 29

Duchenne's and Becker's muscular dystrophy have what genetic characteristic?

Answer 29

x linked recessive

Question 30

Age range for Duchenne's muscular dystrophy?

Answer 30

3-5 years

Question 31

An EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?

Answer 31

generalized or absence seizure

Question 32

Most common cause of subarachnoid hemorrhage aside from trauma?

Answer 32

ruptured cerebral aneurysm

Question 33

Most common primary cancer sites that metastasize to the brain

Answer 33

Lung, breast, kidney

Question 34

Resting or pill rolling tremor makes you think of what dx?

Answer 34

Parkinson's

Question 35

Weakness and numbness in the left hand might be a blockage in which carotid artery?

Answer 35

right

Question 36

A patient has an intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?

Answer 36

temporal

Question 37

If you are looking for lesions associated with multiple sclerosis and you order an MRI do you order with gadolinium or without?

Answer 37

With gadolineum

Question 38

Defining symptom of Alzheimer's?

Answer 38

progressive memory impairment

Question 39

Nerve root responsible for knee jerk reflex?

Answer 39

L3-L4

Question 40

An EEG showing interictal spikes should make you think of what diagnosis?

Answer 40

Complex partial seizure

Question 41

Which is the most commonly herniated vertebral disc?

Answer 41

L4-L5 followed by L5-S1

Question 42

Three symptoms of normal pressure hydrocephalus?

Answer 42

Gait disturbance, dementia, urinary incontinence

Question 43

A patient presents with inability to speak and right sided weakness. He seems to understand speech and follows commands well. What type of aphasia should you be thinking of?

Answer 43

Broca's aphasia

Question 44

Alcohol may be a major factor in which encephalopathy?

Answer 44

Wernicke's

Question 45

A patient complains of muscle weakness and fatigability that improves with rest. What is the most likely diagnosis?

Answer 45

Myasthenia gravis

Question 46

Lead pole of cogwheel rigidity should make you think of what diagnosis?

Answer 46

Parkinson's