Neuroscience Final, Presentation Questions

Question 1

1. A four year old female is brought to the emergency department by her mother. The mother reports that the patient has been experiencing fever, headache, nausea, and vomiting for the past two days. Upon physical examination, the patient has significantly limited range of motion of the neck. The physician begins to suspect meningitis. What procedure will be used to diagnose the meningitis?
   a. X-ray
   b. Lumbar puncture
   c. CT scan
   d. IV angiogram

Answer 1

b. Lumbar puncture

Question 2

2. Which one of the following is at risk for contracting meningitis?
   a. A 4 year old unvaccinated male
   b. A 25 year old male living in a dormitory
   c. A pregnant 22 year old
   d. A 70 year old male who is immunocompromised
   e. All of the above

Answer 2

e. All of the above

Question 3

3. A patient presents to the emergency department with the following symptoms: stiff neck, severe headache, vomiting, high fever, and confusion. Using your neuroscience background, you can immediately diagnose and conclude that the aforementioned individual has what disease?
   a. Fabry disease
   b. Goodpasture syndrome
   c. Meningitis
   d. Fatal familial insomnia
   e. Wernicke’s disease

Answer 3

c. Meningitis

Question 4

1. A patient presents with the inability to produce language (spoken, written, or manual).  What is the most likely type of aphasia affecting this patient?
A. Wernicke’s Aphasia
B. Broca’s Aphasia
C. Global Aphasia
D. Conduction Aphasia

Answer 4

B. Broca’s Aphasia

Question 5

2. A patient presents with the inability to understand or grasp the meaning of spoken words in sentences.  Which type of aphasia is this patient most likely suffering from?
A. Wernicke’s Aphasia
B. Broca’s Aphasia
C. Global Aphasia
D. Conduction Aphasia

Answer 5

A. Wernicke’s Aphasia

Question 6

3. Which aphasia is correlated with a large MCA infarct (both superior and inferior divisions)?
A. Wernicke’s Aphasia
B. Broca’s Aphasia
C. Global Aphasia
D. Conduction Aphasia

Answer 6

C. Global Aphasia

Question 7

4. Name the aphasia which involves damage to the arcuate fasciculus (the area connecting Broca’s and Wernicke’s areas)?
A. Wernicke’s Aphasia
B. Broca’s Aphasia
C. Global Aphasia
D. Conduction Aphasia

Answer 7

D. Conduction Aphasia

Question 8

1. Huntington’s Chorea is an inherited disease. It is classified as what pattern of inheritance?
   a. X-linked recessive
   b. Autosomal dominant
   c. Autosomal recessive
   d. X-linked dominant

Answer 8

b. Autosomal dominant

Question 9

2. During what age range is Huntington’s disease most commonly onset?
   a. 15-20 years
   b. 6-12 months
   c. 30-50 years
   d. 70-85 years

Answer 9

c. 30-50 years

Question 10

3. A 40 y.o. male presents with choreiform movements and episodes of depression. What disease is this person most likely suffering from?
   a. Parkinson’s
   b. Huntington’s
   c. Alzheimer’s
   d. Multiple Sclerosis

Answer 10

b. Huntington’s

Question 11

1. A parent brings her 2 year old child into the doctor’s office. Mom tells the doctor her son has been experiencing difficulty communicating, having social challenges with other children and unusual behavior and interests. The physician says the child has intellectual disability associated with
   A. Asperger syndrome
   B. Attention-deficit/hyperactivity disorder (ADHD)
   C. Autistic disorder (classic autism)
   D. Obsessive compulsive disorder (OCD)

Answer 11

C. Autistic disorder (classic autism)

Question 12

2. Because early intervention is so critical for a positive prognosis of Autism Spectrum Disorder (ASD), which of the following treatment methods is most effective?
   A. Pivotal Response Training
   B. Early Intensive Behavioral Intervention
   C. Discrete Trial Teaching
   D. Speech Therapy

Answer 12

B. Early Intensive Behavioral Intervention

Question 13

3. Who is more susceptible to Autism Spectrum Disorder?
   A. males are four times more likely than females
   B. females are more susceptible than males

Answer 13

A. males are four times more likely than females

Question 14

Which of the following is a disorder characterized by tumorous growths along the nervous tissue including the brain, spinal cord and nerves?
A.	Neurofibromatosis
B.	Epilepsy
C.	Spastic Paraplegia
D.	Guillain-Barré Syndrome

Answer 14

A. Neurofibromatosis

Question 15

Neurofibromatosis is an autosomal dominant genetic disorder due to a mutation of the NF1 gene on which chromosome?
A.	2
B.	17
C.	10
D.	X

Answer 15

B. 17

Question 16

NF1 appears early on in childhood, either at birth or shortly afterward. It is characterized by which of the following?
A.	Hair loss
B.	Freckling of the skin
C.	Increased bone strength
D.	Weight gain

Answer 16

B. Freckling of the skin

Question 17

1. Which of the following conditions increases your risk of developing thalamic pain syndrome?
   a. COPD
   b. hypertension
   c. hypotension
   d. hearing loss

Answer 17

b. hypertension

Question 18

2. The classic form of trigeminal neuralgia (TN1) is characterized by:
   a. extreme, sporadic burning or shock-like pain that occurs in episodes.
   b. constant burning, aching, or stabbing pain of lower intensity.

Answer 18

a. extreme, sporadic burning or shock-like pain that occurs in episodes.

Question 19

3. A patient came to ED with a severe headache. He had been suffering from several attacks of unprovoked headache lasting 4-72 hours, severe enough to markedly restrict or even prohibit routine daily activity and accompanied by nausea or light/ sound sensitivity for the last two years. what would be the most possible diagnosis for the patient?
   a. Pituitary tumor
   b. Epidural hemorrhage
   c. Migraine
   d. Meningitis

Answer 19

c. Migraine

Question 20

1. Central nervous system (CNS) tumors differ from other tumors in regards to the rate at which the spread.
   a. CNS tumors spread faster than all tumors
   b. Tumors of the brain and spinal cord almost never spread to other parts of the body
   c. CNS tumors only spread to the neck if originates from brain and thoracic cavity if originates from the spinal cord.
   d. CNS tumors always spreads to other organs
   e. CNS tumors do not spread because they go away on their own

Answer 20

b. Tumors of the brain and spinal cord almost never spread to other parts of the body

Question 21

2. Jeff has lung cancer and he is terrified about the cancer spreading to his brain. If the cancer spreads to his brain, the cancer will be classified as what type of tumor?
   a. Primary CNS Tumor
   b. Spinal Cord Tumor
   c. Metastatic CNS Tumors
   d. Necrosis

Answer 21

c. Metastatic CNS Tumors

Question 22

3. The second most common cause of cancer in pediatric patients is
   a. Lesh Nyan Syndrome
   b. Maple Syrup Urine Disease
   c. Neimann-Pick Diease
   d. Primary malignant CNS Tumors
   e. Fabry Disease

Answer 22

d. Primary malignant CNS Tumors

Question 23

1. A 48 year old female presents to your office complaining of progressive tingling, numbness and weakness that began in her toes three weeks ago and spread to her upper legs, hands and arms. She states she is recovering from a prolonged viral infection. After further evaluation a diagnosis of Guillain-Barre syndrome is made. What is the primary cause of your patient’s symptoms?
   a. Demyelination of axons in the central nervous system
   b. Inhibition of voltage gated sodium channels in the peripheral nervous system
   c. Destruction of voltage gated sodium channels in the peripheral nervous system
   d. Demyelination of axons in the peripheral nervous system

Answer 23

d. Demyelination of axons in the peripheral nervous system

Question 24

2. Which of the following describes a similarity between multiple sclerosis and Guillain-Barre syndrome?
   a. Both conditions begin with tingling in the bilateral lower extremities that spreads proximally and to the upper extremities.
   b. In both conditions patients may see a gradual return of functions lost during the course of the disease.
   c. In both conditions loss of vision is a common symptom.
   d. Both conditions typically follow bacterial or viral infection.

Answer 24

b. In both conditions patients may see a gradual return of functions lost during the course of the disease.

Question 25

3. A 46 year old man is admitted to the ER following progressive numbness and loss of function in his lower limbs beginning two weeks prior. A diagnosis of Guillain-Barre syndrome is made. The patient appears to be responding to treatment, but his wife is worried there is no chance he will regain the use of his lower limbs. What can you tell his wife to reassure her? a. While recovery may take months or even years 70% of people with GBS eventually experience full recovery. b. Guillain-Barre syndrome is a treatable disease and 70% of patients experience relief of symptoms before being discharged from the hospital. c. He will probably recover some function of his lower limbs, but in a majority of cases numbness and some motor deficits persist for the rest of a patient’s life. d. While he is unlikely to regain the use of his lower limbs, the mortality rate for patients with Guillain-Barre syndrome is below 20% and most patients will not require mechanical ventilation for the rest of their life.

Answer 25

a. While recovery may take months or even years 70% of people with GBS eventually experience full recovery.

Question 26

``` Which disease is characterized by its degenerative effect on the basal ganglia (specifically substantia nigra) with hallmark symptoms of rigidity, difficulty initiating movements, and resting hand tremors? A. Huntington’s disease B. Parkinson’s disease C. Multiple sclerosis D. Alzheimer’s disease ```

Answer 26

B. Parkinson’s disease

Question 27

Which of the following disorders is classified as a hypokinetic movement disorder? Huntington’s disease Parkinson’s disease Multiple sclerosis Alzheimer’s disease

Answer 27

B. Parkinson’s disease

Question 28

What are the two MAIN characteristics that increase the risk of having Parkinson’s disease? Age and gender Environmental factors and head trauma Smoking and drug use Ethnicity and drinking coffee

Answer 28

A. Age and gender

Question 29

17 year old male presents to the emergency department with complaint of headache, nausea, and vomiting after sustaining a head-on collision with another individual while playing football. His neurological examination is unremarkable with no significant focal deficits. In addition, CT imaging demonstrates no evidence of an intracranial hemorrhage. Thus, the patient is diagnosed with a mild traumatic brain injury. Given your knowledge about mild traumatic brain injuries, which would a physician recommend for further treatment? A. Bed rest for one week and opioid medication for pain control B. Cognitive and physical rest, as well as over the counter pain relievers for symptomatic relief C. Admission to the hospital for serial neurological exams D. Craniotomy for decompression

Answer 29

B. Cognitive and physical rest, as well as over the counter pain relievers for symptomatic relief

Question 30

Which individual is at the greatest risk for severe traumatic brain injury? A. 55 year old male who participates in long distance running and weekly strength training exercise B. Healthy 28 year old female with no prior history of traumatic injuries C. 1 year old female who is learning how to walk D. 78 year old male taking Warfarin (anticoagulant medication)

Answer 30

D. 78 year old male taking Warfarin (anticoagulant medication)

Question 31

``` What is the leading cause of a severe traumatic brain injury resulting in death for individuals who are 65 years of age or older? A. Motor vehicle accidents B. Sports injury C. Falls D. Assault ```

Answer 31

C. Falls

Question 32

1. An older patient presents to an annual checkup with severe confusion. Her family states that they have noticed significant changes in the patient over the past four or five years, including a steady and sharp decline in her memory and cognitive reasoning. The patient has also grown increasingly apathetic to social conventions and was diagnosed with clinical depression in the previous year. No changes are noted in the patient’s physical health or motility. Assuming these symptoms and behavioral changes indicate dementia, which of the following would most likely be found in a hypothetical biopsy of this patient’s cerebral cortex? a. Degeneration of the substantia nigra pars compacta b. Accumulation of neurotoxic beta-amyloid plaques and tau neurofibrillary tangles c. Substantial demyelination in the posterior limb of the internal capsule d. Meningeal inflammation

Answer 32

b. Accumulation of neurotoxic beta-amyloid plaques and tau neurofibrillary tangles

Question 33

2. Alzheimer’s disease is characterized by the loss of which type of neurons? a. Dopaminergic b. Adrenergic c. Cholinergic d. Serotonergic

Answer 33

c. Cholinergic

Question 34

3. The pathogenesis of Alzheimer Disease is associated with loss of brain tissue and neurons in which of the areas of the brain? a. Amygdala b. Hippocampus c. Olfactory d. Cerebellum

Answer 34

b. Hippocampus

Question 35

1. What phase of a seizure is considered the recovery phase? a. Aura b. Postictal c. Ictal

Answer 35

b. Postictal

Question 36

2. Which of the following newly diagnosed patients would have the highest chance for a positive outcome when dealing with epilepsy? a. 16 year-old patient b. 28 year-old patient c. 11 year-old patient d. 34 year-old patient

Answer 36

c. 11 year-old patient

Question 37

3. Which of the following is not a current treatment for epilepsy? a. Deep brain stimulation b. Laser ablation c. AEDs (Anti-epileptic drugs) d. Cocaine

Answer 37

d. Cocaine*

Question 38

4. Current medications for epilepsy are effective in treating approx what proportion of the affected population? a. 100% b. 80% c. 67% d. 50%

Answer 38

c. 67%*

Question 39

``` 1. A 30 year old female with history of smoking presents to the ED complaining of prolonged double vision, tingling and pain throughout her body, an electric-shock sensation when she bends her neck forward, tremors, and unsteady gait for an long duration of time. Patient denies history of seizures, headache, chorea. What is a likely diagnosis? A. Multiple Sclerosis B. Epilepsy C. Migraine D. Huntington’s Disease ```

Answer 39

A. Multiple Sclerosis

Question 40

2. Multiple sclerosis (MS) is an autoimmune disease, resulting in messages from the nervous system to be altered or stopped completely. In individuals with MS, what does the immune system target? A. Myelin in peripheral nervous system B. Myelin in central nervous system C. Dendrites in peripheral nervous system D. Dendrites in central nervous system E. Axons of central nervous system

Answer 40

B. Myelin in central nervous system

Question 41

``` 3. What are some of the symptoms of MS? A. Partial or complete loss of vision B. Muscle weakness or partial paralysis C. Tremor, lack of coordination, unsteady gait D. All of the above ```

Answer 41

D. All of the above

Question 42

1) A 63 year old male initially presented to your office complaining of difficulty buttoning his shirt and sloppy handwriting over the past several weeks. Over the next few weeks a significant workup including labs, an MRI, and electromyelography were found to be unremarkable, and no definitive diagnosis could be made. Over the next year, his symptoms continued to worsen, adding muscle twitches, severe cramps, and worsening weakness. After excluding other likely diagnoses, the patient was diagnosed with amyotrophic lateral sclerosis. Which neurons are likely to be degraded over the course of the patient’s illness? a) Upper Motor Neurons b) Lower Motor Neurons c) Upper and Lower Motor neurons d) Neurons of the Amygdala

Answer 42

c) Upper and Lower Motor neurons

Question 43

2) What is one gene that is associated with Amyotrophic Lateral Sclerosis? a) HLA-DRB1 b) APOE gene c) SOD1 d) SAG

Answer 43

c) SOD1

Question 44

3) The destruction of which level of motor neuron produces the exaggerated deep tendon reflex observed in ALS? Why? a) LMN, because there would be no efferent signal to the neuromuscular junction b) UMN, because of a loss of feedback to modulate the spinal reflex arc c) UMN, because gamma motor neurons would not be able to restore muscle spindles to ‘on-line’. d) LMN, because afferent fibers from muscle spindles would have nothing to synapse upon in the ventral horn

Answer 44

b) UMN, because of a loss of feedback to modulate the spinal reflex arc

Question 45

Which of these is NOT a cause of a stroke? 1. Hemorrhage 2. Thrombosis 3. Embolism 4. Cerebral Atrophy

Answer 45

4. Cerebral Atrophy

Question 46

Which of these uncontrollable risk factors can play a large role in increasing the chances of stroke? 1. Family history and age 2. Height 3. Low Blood Pressure 4. Increasing Exercise

Answer 46

1. Family history and age

Question 47

Which of the following is a key principle of acute stroke care? 1. Achieve timely reperfusion of ischemic tissue 2. Keep patient’s head flat 3. Avoid administering IV fluids 4. Proper rehabilitative plan for the patient

Answer 47

1. Achieve timely reperfusion of ischemic tissue

Question 48

A person with Hereditary Spastic Paraplegia, primarily has degeneration of which of the following? A. Lower motor neurons B. Cranial nerves C. Upper motor neurons D. Neuromuscular Junction

Answer 48

C. Upper motor neurons

Question 49

``` A woman goes to visit her doctor with complaints of weakness and spasticity in her lower limbs that has gotten progressively worse. In addition, she has had a decrease in vision. What diagnosis can be made? A. Alzheimer B. Spastic Paraplegia C. Guillain- Barre syndrome D. Huntington's disease ```

Answer 49

B. Spastic Paraplegia

Question 50

``` Spastic Paraplegia is most likely to affect which part of the body? A. Trunk B. Head C. Arms D. Legs ```

Answer 50

D. Legs

Question 51

A 9-year-old girl is brought to the pediatrician. Her parents describe that any time she is startled, she appears to collapse and fall asleep. She also complains of waking up in the morning unable to move. Which sleep disorder should be suspected? A. Insomnia B. Jet lag C. Narcolepsy D. Night terrors

Answer 51

C. Narcolepsy

Question 52

A 28-year-old medical student appears exhausted of late. She mentions having trouble staying awake during class, along with mild sleep paralysis and trouble staying asleep overnight. What is her body most likely low in? A. Hypocretin B. Aldosterone C. Melanin D. Creatinine

Answer 52

A. Hypocretin

Question 53

Insomnia is characterized by the inability to fall asleep. Which of the following is true regarding the treatment of insomnia? A. Diets high in sodium lead to restful REM cycles. B. There are currently no known treatments of insomnia. C. Injecting acetylcholine has been directly correlated with decreasing insomnia. D. Deletion of the BMAL1 gene is associated with increased total sleep.

Answer 53

D. Deletion of the BMAL1 gene is associated with increased total sleep.

Question 54

Viral encephalitis can be chaperoned to the brain by: ``` A. CN I B. CN V C. CN VII D. CN I and CN V E. CN I and CN VII ```

Answer 54

D. CN I and CN V

Question 55

Which neurogenic receptors are most likely to be affected in encephalitis? ``` A. NMDA receptors B. Glutamate receptors C. Dopamine receptors D. CART receptors E. GABAergic receptors ```

Answer 55

A. NMDA receptors

Question 56

Patient Y presents to the clinic with fever, headache, persistent fatigue, ataxia, moodiness, and distinctive “bull’s eye” rash on lower right leg. Upon taking a history it is discovered that patient frequently spends time outdoors and discovered a tick on his right leg about 2 weeks ago. What is the most likely diagnosis? ``` A. Cerebral hypoxia B. Lyme disease C. Viral meningitis D. Cerebrovascular accident E. Tick-borne encephalitis ```

Answer 56

E. Tick-borne encephalitis