Neurology V

Question 1

What movement disorder is associated with Creutzfeldt-Jakob disease?

Answer 1

Myoclonus (“startle myoclonus”)

Question 2

What movement disorders (2) are associated with Huntington disease?

[…] and […]

Answer 2

Chorea and Athetosis

Question 3

What MRI finding is associated with multiple sclerosis?

Answer 3

Periventricular plaques

areas of oligodendrocyte loss and reactive gliosis with preservation of axons; also may involve juxtacortical, infratentorial, and spinal cord regions

Question 4

What nerve is responsible for corneal sensation?

Answer 4

Ophthalmic branch of the trigeminal nerve (V1)

damage to this nerve results in corneal anesthesia

Question 5

What nerve(s) are found medially within the cavernous sinus?

Answer 5

CN VI

Question 6

What nerve(s) are found on the lateral walls of the cavernous sinus?

Answer 6

CN III, IV, V1, V2

Question 7

What neurological pathology classically causes bilateral internuclear ophthalmoplegia?

Answer 7

Multiple sclerosis

Question 8

What neurological pathology manifests as Parkinsonism with orthostatic hypotension, impotence, incontinence, or other autonomic dysfunction?

Answer 8

Multiple system atrophy (Shy-Drager syndrome)

anti-Parkinsonism drugs are generally ineffective; treatment is aimed at intravascular volume expansion (e.g. fludrocortisone, salt supplements)

Question 9

What neurological pathology typically presents with nerve damage in two or more nerves in separate parts of the body in a patient with vasculitis?

Answer 9

Mononeuritis multiplex

typically manifests as asymmetric peripheral nerve findings, such as wrist and foot drop

Question 10

What neurological side effect is associated with vincristine use?

Answer 10

Peripheral neuropathy

other common causative agents of peripheral neuropathy include platinum-based medications (e.g. cisplatin) and taxanes (e.g. paclitaxel)

Question 11

What pathogen is the most common cause of spinal epidural abscess?

Answer 11

Staphylococcus aureus (65%)

classically presents with a triad of fever, focal/severe back pain, and neurologic findings

Question 12

What retinal pathology is associated with a “blood and thunder” appearance on funduscopy?

Answer 12

Central retinal vein occlusion

due to dilated and tortuous veins and scattered, diffuse hemorrhages

Question 13

What retinal pathology is associated with AV nicking, copper/silver wiring, and/or flame hemorrhages on funduscopy?

Answer 13

Hypertensive retinopathy

Question 14

What sensory deficits does ALS present with?

Answer 14

None

important distinguishing feature from syringomyelia and ASA occlusion

Question 15

What symptom is characteristic of early Alzheimer’s disease?

Answer 15

Short-term memory loss

later symptoms include impaired long-term memory and cognitive abilities, which interrupt activities of daily living

Question 16

What syndrome is associated with lesion of the following areas: […]

1. Spinothalamic tract
2. Spinal trigeminal nucleus
3. Sympathetic fibers
4. Nucleus ambiguus (CN IX, X)
5. Vestibular nucleus (CN VIII)
6. Inferior cerebellar peduncle

Answer 16

What syndrome is associated with lesion of the following areas: lateral medullary (Wallenberg) syndrome

1. Spinothalamic tract
2. Spinal trigeminal nucleus
3. Sympathetic fibers
4. Nucleus ambiguus (CN IX, X)
5. Vestibular nucleus (CN VIII)
6. Inferior cerebellar peduncle

the lateral “S” tracts and CN X involvement suggest lateral medulla;

note: the vestibular portion of CN VIII is more commonly associated with lateral medullary lesions

Question 17

What test is most likely to reveal the underlying etiology of amaurosis fugax?

Answer 17

Duplex ultrasound of the neck

most commonly due to atherosclerotic emboli from the ipsilateral carotid artery

Question 18

What test is needed to definitely rule out subarachnoid hemorrhage in patients with a normal CT scan?

Answer 18

Lumbar puncture

Question 19

What time of day is typically associated with worsening of delirium?

Answer 19

Nighttime (“sundowning”)

thus management of delirium should include minimizing disturbances at night

Question 20

What type of hydrocephalus may be seen with Huntington disease?

Answer 20

Hydrocephalus ex vacuo

dilation of the ventricles secondary to caudate and putamen atrophy

Question 21

What underlying neurological pathology should be suspected in a patient with bilateral trigeminal neuralgia?

Answer 21

Multiple sclerosis

demyelination of the trigeminal nerve nucleus or nerve root causes improper signaling of the nerve and paroxysms of severe pain

Question 22

When facial nerve palsy is idiopathic it is called […] palsy.

Answer 22

When facial nerve palsy is idiopathic it is called Bell’s palsy.

causes of facial nerve palsy include Lyme disease, herpes simplex, herpses zoster (Ramsay Hunt syndrome), sarcoidosis, tumors, and diabetes mellitus

Question 23

Which “language center” is located in the inferior frontal gyrus of the frontal lobe?

Answer 23

Broca’s area

Question 24

Which “language center” is located in the superior temporal gyrus of the temporal lobe?

Answer 24

Wernicke’s area

Question 25

Which "language center" is the center for language comprehension?

Answer 25

Wernicke's area

Question 26

Which "language center" is the center for motor speech?

Answer 26

Broca's area

Question 27

Which anti-epileptic medications (2) may be used for migraine prophylaxis?

Answer 27

topiramate and valproic acid

Question 28

Which antiplatelet agent is recommended for all patients within 24 hours of ischemic stroke presentation?

Answer 28

Aspirin if recurrent strokes occur with aspirin therapy, dipyridamole should be added to the treatment regimen or the patient should be switched to clopidogrel (aspirin + clopidogrel is associated with increased bleeding risk)

Question 29

Which area of the brain is likely affected in a stroke resulting in hemispatial neglect syndrome?

Answer 29

Non-dominant parietal cortex characterized by neglect of the contralateral half of the body

Question 30

Which areas of the spinal cord are spared in a complete occlusion of the anterior spinal artery? [...] and Lissaeur's tract

Answer 30

**Dorsal column** and Lissaeur's tract

Question 31

Which areas of the spinal cord are spared in a complete occlusion of the anterior spinal artery? Dorsal column and [...]

Answer 31

Dorsal column and **Lissaeur's tract**

Question 32

Which artery is likely affected in a stroke resulting in motor/sensory deficits in the lower limb and urinary incontinence?

Answer 32

Anterior cerebral artery urinary incontinence due to involvement of the frontal micturition center; ACA strokes may also present with primitive reflexes and behavioral symptoms

Question 33

Which cerebral artery supplies the language centers (Broca's area, Wernicke's area)?

Answer 33

Middle cerebral artery

Question 34

Which class of antibiotics is associated with ototoxicity and/or vestibulopathy with an abnormal head thrust test?

Answer 34

Aminoglycosides may manifest as a sensation of objects moving around in the visual field when looking in any direction (oscillopsia)

Question 35

Which class of antidepressant medication may be used for migraine prophylaxis?

Answer 35

Tricyclic antidepressants (e.g. amitriptyline)

Question 36

Which class of autonomic drugs may be used for migraine prophylaxis?

Answer 36

β-blockers (e.g. propanolol)

Question 37

Which CN III fibers (motor or parasympathetic) are affected first by compression?

Answer 37

Parasympathetics e.g. posterior communicating artery aneurysm, uncal herniation

Question 38

Which CN III fibers (motor or parasympathetic) are affected first by vascular disease?

Answer 38

Motor decreased diffusion of oxygen and nutients to interior fibers from compromised vasculature that resides on outside of nerve; e.g. diabetes mellitus

Question 39

Which CNS tumor compresses the optic chiasm, causing bitemporal hemianopsia, in children?

Answer 39

Craniopharyngioma may be confused with pituitary adenoma (more common in adults)

Question 40

Which CNS tumor is characterized by cholesterol crystals found in "motor-oil"-like fluid within the tumor?

Answer 40

Craniopharyngioma

Question 41

Which cranial nerve lesion presents with diploplia that is worse while reading or walking downstairs?

Answer 41

CN IV (trochlear)

Question 42

Which intracranial hemorrhage is seen in the image below?

Answer 42

Subarachnoid hemorrhage

Question 43

Which intracranial hemorrhage presents as the "worst headache of my life"?

Answer 43

Subarachnoid hemorrhage

Question 44

Which lobes are most commonly involved in a spontaneous lobar hemorrhage secondary to cerebral amyloid angiopathy?

Answer 44

parietal and occipital occurs due to beta-amyloid deposition in the walls of small- to medium-size cerebral arteries

Question 45

Which microorganism is the most frequent precipitant of Guillain-Barre syndrome?

Answer 45

Campylobacter jejuni

Question 46

Which microorganisms (2) are the most common cause of brain abscess?

Answer 46

Viridans streptococci and Staphylococcus aureus

Question 47

Which movement disorder presents as "flapping" motion upon extension of the wrists?

Answer 47

Asterixis

Question 48

Which movement disorder presents as a high-frequency tremor with sustained posture (e.g. outstetched arms), often with a family history of tremor?

Answer 48

Essential tremor tremor at rest and with movement

Question 49

Which movement disorder presents as a slow, writhing movements, especially in the fingers?

Answer 49

Athetosis "writhing, snake-like movement"; seen with Huntington disease

Question 50

Which movement disorder presents as a slow, zigzag motion when pointing/extending toward a target?

Answer 50

Intention (cerebellar) tremor

Question 51

Which movement disorder presents as a sudden, involuntary muscle jerking that is often rhythmic and/or repetitive?

Answer 51

Myoclonus jerks; hiccups; may be seen with Creutzfeldt-Jakob disease and renal/liver failure

Question 52

Which movement disorder presents as an uncontrolled movement of distal appendages at rest that is alleviated by intentional movement?

Answer 52

Resting tremor most noticable in hands; e.g. "pill-rolling" tremor of Parkinson disease

Question 53

Which movement disorder presents as brief, irregular, unintentional muscle contractions?

Answer 53

Chorea seen with Huntington disease; tends to be non-repetitive and non-rhythmic versus myoclonus

Question 54

Which movement disorder presents as restlessness and an intense urge to move?

Answer 54

Akathisia can be seen with neuroleptic use or in Parkinson disease

Question 55

Which movement disorder presents as sudden, wild flailing of 1 arm +/- the leg on the same side?

Answer 55

Hemiballismus disruption in the indirect basal ganglia overstimulates the direct basal ganglia, producing excess muscle movement; contralateral lesion

Question 56

Which movement disorder presents as sustained, involuntary muscle contractions?

Answer 56

Dystonia e.g. Writer's cramp, blepharospasm, torticollis

Question 57

Which neuromuscular junction pathology, MG or LEMS, is characterized by diminished or absent deep tendon reflexes?

Answer 57

Lambert-Eaton myasthenic syndrome helps differentiate LEMS from myasthenia gravis (preserved reflexes); other symptoms of LEMS include symmetric proximal muscle weakness and autonomic dysfunction

Question 58

Which stroke subtype is characterized by abrupt neurological symptoms that are typically maximal at the start?

Answer 58

Embolic ischemic stroke

Question 59

Which stroke subtype is characterized by early focal neurologic symptoms that worsen over minutes to hours with possible features of increased ICP (e.g. vomiting, headache, reduced alertness)?

Answer 59

Intracerebral hemorrhagic stroke typically seen in patients with a history of uncontrolled hypertension; symptoms progress over minutes to hours

Question 60

Which subtype of dementia is characterized by a step-wise decline in executive function with only mild memory loss early in the disease course?

Answer 60

Vascular dementia early loss of executive function is classic; versus Alzheimer's disease, which has a more gradual decline and begins with short-term memory, language, and visuospatial deficits

Question 61

Which type of syncope is often preceded by nausea, bradycardia, and/or a feeling of warmth throughout the body?

Answer 61

Neurocardiogenic (vasovagal) syncope secondary to excessive vagal tone; triggers include prolonged standing, emotional distress, and painful stimuli

Question 62

Wilson disease is also known as [...].

Answer 62

Wilson disease is also known as **hepatolenticular degeneration**.

Question 63

Wilson disease is caused by an autosomal recessive defect in ATP-mediated hepatocyte [...] transport.

Answer 63

Wilson disease is caused by an autosomal recessive defect in ATP-mediated hepatocyte **copper** transport.