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NINJA PRITE 2020 NEUROLOGY
EXAM QUESTIONS WITH CORRECT ANSWERS
"Young adult gained 70 lbs in last year c/o daily severe headaches sometimes associated with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but ventricles
smaller than usual. Goal of treatment in this case: (2x) - CORRECT ANSWER PREVENT
BLINDNESS"
"Superior homonymous quadratic defects in the visual fields result from lesions to which of the
following structures? (2x) - CORRECT ANSWER TEMPORAL OPTIC RADIATIONS"
"Tremor with a frequency of around 3 Hz, irregular amplitude, most evident towards the end of
reaching movements: (2x) - CORRECT ANSWER CEREBELLAR TUMOR"
"Pt with several days of fever & severe headaches presents to ED d/t generalized seizure. Pt is confused & somnolent. Also reported been irritable and c/o foul smells. T2 MRI displayed
(hyperintensity of left temporal): (4x) - CORRECT ANSWER HERPES ENCEPHALITIS"
"Acute onset of fever, sore throat, diplopia, & dysarthria. Exam reveals an inflamed throat, left adductor nerve palsy w/ impairment of vertical pursuit, diffuse hyperreflexia w/ bilateral clonus, lower ext spasticity, & mild right hemiparesis. CT is uninformative. Spinal fluid has
protein of 24, 10 mononuclear cells, and glucose of 70. Dx? (2x) - CORRECT ANSWER
MULTIPLE SCLEROSIS"
"5 y/o presents w/ sudden onset of slurred speech and gait difficulty. Exam shows truncal ataxia and nystagmus, mild dysarthria and extensor plantar responses. Recent h/o measles. MRI, UA,
blood work unremarkable. Dx? - CORRECT ANSWER ACUTE CEREBELLITIS"
"Abulia refers to impairment in ability to: - CORRECT ANSWER SPONTANEOUSLY MOVE
AND SPEAK (inability to act decisively, absence of willpower)"
"Prosopagnosia is... - CORRECT ANSWER inability to recognize faces"
"56 yo M with normal brain scan and no prior psych history is impulsive and disinhibited with
personality changes. What would a PET scan likely show? - CORRECT ANSWER BILATERAL
TEMPORAL LOBES W/ REDUCED PERFUSION"
"Inability to recognize objects by touch: - CORRECT ANSWER astereognosis"
"cancer highest likelihood to met to the brain? - CORRECT ANSWER lung"
"Etiology of meningitis assoc with fever, HA, CSF pleocytosis with lymphocyte predominance,
slightly elevated CSF protein, and normal CSF glucose - CORRECT ANSWER COXSACKIE
VIRUS"
"Most common solid tumor of the CNS in kids - CORRECT ANSWER Neuroblastoma"
"75 yo patient evaluated for progressive gait, urine incontinence, and cognitive decline. After
removal of CSF, there is improvement in gait and balance. What would CT show? - CORRECT
ANSWER ENLARGEMENT OF THE FRONTAL HORNS"
"41 y/o chronic fatigue, cognitive impairment, reduced perceptual motor speed, poor effort maintenance, and irritability (MRI: hyperintensity in frontal lobe and what looks like a finger
protrusion) - CORRECT ANSWER MS"
"25 y/o pt c/o severe HA and vomiting. Pain is dull and mostly in the occipital region. Exam: b/l severe papilledema, otherwise WNL. LP: opening pressure: 200mmH2O, no cells, 62mg/dl
glucose, 31 mg/dl protein. CT: normal. Dx? - CORRECT ANSWER Pseudotumor cerebri"
"Histology consistent with Jakob-Creutzfeldt disease - CORRECT ANSWER CYTOSOLIC
VACUOLATION OF NEURONS AND GLIA WITH PRION INCLUSIONS"
"Dx for 68yo c/o falls. PE shows upright rigid posture, stiff gait, extended knees, and pivoting
while turning. - CORRECT ANSWER PROGRESSIVE SUPRANUCLEAR PALSY"
"Diagnosis of 32yo woman w/ vertigo and internuclear ophthalmalopolegia - CORRECT
ANSWER multiple sclerosis"
"Which of the following is invariably the first manifestation of neurosyphilis? - CORRECT
ANSWER Meningitis"
"14 y/o @ summer camp develops severe headache and fever, drowsiness, stiffness of neck on passive forward flexion, petechial rash and skin pallor. Spinal tap reveals opening pressure 200mm H20, 84%neutrophils (7,000 nucleated cells), glucose level of 128mg/dl, and protein level
of 33mg/dl. Most likely causative agent? - CORRECT ANSWER MENINGOCOCCUS"
"hormone secreted in functional pituitary adenoma: - CORRECT ANSWER prolactin"
"Chiropractic adjustments are a known precipitant for which of the following acute conditions?
(2x) - CORRECT ANSWER Verterbal Artery Dissection"
"most common complication of temporal arteritis is caused by occlusion of the: (2x) - CORRECT
ANSWER Ophthalmic Artery"
"most common possible cause of a posterior cerebral artery infarct in 36 y/o F with hx of
migraine: (2x) - CORRECT ANSWER Oral Contraceptive Pills"
"left middle cerebral artery gait abnormality? - CORRECT ANSWER circumduction"
"45 y/o with right hemiparesis, CT shows left internal capsule ischemic changes extending to adjacent basal ganglia + old lacunar injury of R caudate head. LP - 65 wbcs (mostly lymphocytes),
78 protein, 63 glucose, + rapip plasma reagin (RPR) antibodies. Tx? - CORRECT ANSWER
Penicillin"
"CT Head Large hypodensity on Right frontal and parietal lobes - CORRECT ANSWER Mid.
Cereb. Art. Stroke w/ residual LEFT-sided weakness."
"Contralateral leg weakness with personality changes is an injury where - CORRECT
ANSWER anterior cerebral artery"
"61 y/o with left frontal lobe damage secondary to cerebrovascular accident may be predisposed
to which psychiatric syndrome? - CORRECT ANSWER major depressive disorder"
"72 y/o pt had lacunar infarct in middle cerebral artery territory. Echo is normal. Doppler studies of neck arteries reveal less than 50% occlusion on both carotid arteries. EKG is normal. The best
strategies to reduce recurrent stroke: - CORRECT ANSWER ANTIPLATELET THERAPY WITH
ASPIRIN AND DIPYRIDAMOLE"
"50 y/o pt recently began having VH of children playing. VH are fully formed, colorful and vivid, but with no sound. Pt is not scared or disturbed, but rather amused. On exam, normal language, memory, cranial nerves, no weakness or involuntary movement, no sensory deficits. DTR:
symmetric. CSF/UDS nml. - CORRECT ANSWER POSTERIOR CEREBRAL ARTERY
ISCHEMIA"
"Why would brains >65 years old or a history of alcoholism more susceptible to chronic subdural
hematoma? - CORRECT ANSWER CORTICAL ATROPHY (LONGER DISTANCE FOR BRIDGING
VEINS TO BE DAMAGED)"
"most common manifestation of acute neurosyphilis? - CORRECT ANSWER Stroke"
"65 y/o pt wakes up with right-sided hemiparesis and motor aphasia. Pt is immediately brought to the emergency department and an evaluation is completed within 1 hour. Neurological exam: no additional abnormalities. Head CT w/o contrast: no additional abnormalities. Which is the
appropriate next step in management? - CORRECT ANSWER ASPIRIN"
"Abnormal elevated metabolic findings associated with increased risk of stroke in patients under
50 - CORRECT ANSWER PLASMA HOMOCYSTEINE"
"Acute onset of dense sensorimotor deficit in the contralateral face and arm, with milder involvement of the lower extremity, associated with gaze deviation toward the opposite side of
the deficit, likely indicates occlusion of - CORRECT ANSWER superior division of middle
cerebral artery"
"CT scan with occipital and intraventricular hyper-intensities: - CORRECT ANSWER
parenchymal hemorrhage"
"Which med has secondary prevention against embolic stroke in pts with A-fib? - CORRECT
ANSWER oral warfarin."
"As opposed to strokes caused by arterial embolism or thrombosis, those caused by *cerebral
vein or venous sinus thrombosis* are: - CORRECT ANSWER associated with seizures at
onset" "Pt who 5 days ago experienced ruptured aneurysm located in left middle cerebral artery develops fluctuating aphasia and hemiparesis with no significant headaches. underlying cause?
CORRECT ANSWER vasospasm"
"63 y/o with new onset aphasia and right hemiparesis, 2 days ago had milder/similar symptoms that resolved in 30 minutes, yesterday had similar episode x 45 minutes. Current Sx started 1.5 hrs
ago. CT shows no stroke or hemorrhage. Tx? - CORRECT ANSWER INTRAVENOUS
THROMBOLYTIC AGENTS"
"57 y/o diabetic pt =w/ HTN c/o several episodes of visual loss, "curtain falling" over his L eye, transient speech and language disturbance, and mild Right hemiparesis that lasted 2 hrs.
Suggests presence of what? - CORRECT ANSWER EXTRACRANIAL LEFT INTERNAL
CAROTID STENOSIS"
"Head injury w/ loss of consciousness -> lucid interval x hours -> rapid progressing coma.
Hemorrhage? - CORRECT ANSWER epidural hemorrhage"
"28y/o with emotional lability and impulsivity. LFT's elevated. Close relative had similar sx and
died at 30y/o from hepatic failure. Which blood level would be diagnostic? (3x) - CORRECT
ANSWER CERULOPLASMIN"
"Pt w/ acute onset of pain and decreased vision in the R eye. Colors look faded when viewed through the R eye. On exam, has a R afferent pupillary defect and a swollen right optic disc. Pt
spontaneously recovers over the next 6 wks. Likely to develop later: (3x) - CORRECT
ANSWER MULTIPLE SCLEROSIS"
"9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6 months ago, and at Tanner
stage 4. Dx? (2x) - CORRECT ANSWER HYPOTHALAMIC HAMARTOMA"
"5 yo w/ 4 month history of morning HA, vomiting, and recent problems with gait, falls, and
diplopia: (2x) - CORRECT ANSWER MEDULLOBLASTOMA"
"70 y/o develops flaccid paralysis following severe water intoxication. He develops dysphagia and dysarthria without other cranial nerve involvement. Sensory exam is limited but grossly normal,
DTR's are symmetric, and cognition is intact. Likely dx: (2x) - CORRECT ANSWER CENTRAL
PONTINE MYELINOLYSIS"
"Which is the most reliable finding from CSF analysis for a pt with multiple sclerosis in the
chronic progressive phase of the dz? (2x) - CORRECT ANSWER PRESENCE OF OLIGOCLONAL
BANDS"
"Benign intracranial HTN etiology: (2x) - CORRECT ANSWER HYPERVITAMINOSIS A"
"Gait abnormality, slow movement, asymmetric UE rigidity. Difficulty in voluntary vertical upward/downward gaze. Slowness/rigidity improved slightly with levodopa. Later has problems
with horizontal & vertical gaze. Oculocephalic reflexes normal. Involuntary saccades. (2x) -
CORRECT ANSWER PROGRESSIVE SUPRANUCLEAR PALSY"
"Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory and
gustatory hallucinations. The most likely medical cause of this presentation is: (2x) - CORRECT
ANSWER HERPES SIMPLEX VIRUS (HSV) INFECTION"
"What condition is a forerunner of MS? (2x) - CORRECT ANSWER TRANSVERSE MYELITIS"
"Location of characteristic lesions seen in CT scans of pt with carbon monoxide poisoning
associated comas? (2x) - CORRECT ANSWER GLOBUS PALLIDUS"
"Hx of dementia and myoclonus shows what pathologic changes with cresyl violet changes -
CORRECT ANSWER CYTOSOLIC VACUOLATION OF NEUROGLIA WITH PRION
INCLUSIONS"
"presentation expected with Wernicke's encephalopathy? - CORRECT ANSWER AMNESIA,
CONFABULATION, LACK OF INSIGHT"
"AIDS pt with new onset headache and cognitive decline, MRI shows multiple ring enhancing
lesions, cause? - CORRECT ANSWER TOXOPLASMOSIS GONDII"
"Neuropsych test examines both visuospatial & executive functions? - CORRECT ANSWER
CLOCK DRAWING"
"Image of a clock, with all the numbers drawn only on the right hand side, lesion? - CORRECT
ANSWER PARIETAL LOBE"
"Head injury with personality changes, impulsivity and euphoria. region affected? - CORRECT
ANSWER OFC"
"transmissible element that causes progressive decline and myoclonic jerks. Brain biopsy shows
spongiform changes? - CORRECT ANSWER PRION"
"Kluver-Bucy syndrome: plasticity, hyperorality, hypersexuality and hyperphagia, can be
induced in animals with bilateral resection of which structure? - CORRECT ANSWER
TEMPORAL LOBES"
"Most common psych complication from TBI - CORRECT ANSWER DEPRESSION"
"executive dysfunction comes from damage to the ______-______ areas - CORRECT ANSWER
fronto-subcortical" "36 yo pt w/ double vision, vertigo, vomiting, paresis of medial rectus on lateral gaze w/ coarse
nystagmus in abducting eye w/ lateral eye movement - CORRECT ANSWER MULTIPLE
SCLEROSIS"
"35 yo pt w/ new onset headache, what PE finding suggests mass lesion w/ raised ICP? -
CORRECT ANSWER PAPILLEDEMA ON EYE EXAM"
"A type of aphasia 2/2 to lesion in posterior third of left superior temporal gyrus - CORRECT
ANSWER WERNICKE"
"75 y/o M, Korean war veteran, with gradual development of forgetfulness and cognitive deterioration, presents with very fast /slurred speech and impaired gait. A head CT shows some generalized atrophy, unusual for his age. The LP shows 35 WBC, lymphocytosis and the protein
level is 110mg/Dl and elevated gamma globulin. Dx: - CORRECT ANSWER neurosyphilis"
"Inability to carry out motor activities on verbal command despite intact comprehension &
motor function indicates? - CORRECT ANSWER apraxia"
"80yo pt is unable to blow out match although motor and sensory function are normal. What is
this called? - CORRECT ANSWER apraxia"
"Most common cause of aseptic meningitis: - CORRECT ANSWER enteric virus"
"25 y/o M w 7 months depression, forgetfulness, weight loss, insomnia, painful tingling in both feet + incoordination. Involuntary choreic movements of bilateral upper extremity apathetic, monosyllabic. Labs normal. EEG: mild diffuse slowing. CT/MRI nml. During admission develops
severe akinetic mutism, seizures, and dies. Brain autopsy shows: - CORRECT ANSWER
DIFFUSE AMYLOID PLAQUES, SPONGIFORM NEURONAL DEGENERATION, AND SEVERE
ASTROGLIOSIS"
"52 y/o pt with EtOH dependence present with several days of severe headache, nausea, and low grade fever. Physical exam reveals mild disorientation, nuchal rigidity, and mild spasticity in the lower extremities. A head CT is unrevealing. LP: 55/mm3 leukocytes (mostly lymphocytes), 45 mg/dl glucose, protein: 43 mg/dl, and presence of occasional gram positive spherical cells. The
most likely causative organism is: - CORRECT ANSWER CRYPTOCOCCUS NEOFORMANS"
"CT & MRI show ventriculomegaly are out of proportion to sulcal atrophy. - CORRECT
ANSWER Normal Pressure Hydrocephalus"
"49 y/o pt with ETOH dependence is brought to the ED with a onew eek history of malaise, headache, diplopia, lethargy and confusion. On examination, the pt has a temp of 38.2 C, stiff neck, medical deviation of the right eye with impaired abduction and hoarseness. CSF: 114 leukocytes, predominantly monocytes, a protein of 132mg/dl, and glucose of 29mg/dl. Likely type
of meningitis: - CORRECT ANSWER TUBERCULOUS"
"Closed TBI, initially no LOC, then 20 minutes later LOC. Patient recovers in 5 minutes. -
CORRECT ANSWER Vasovagal Syncope Attack"
"15 y/o pt fell to ground after being hit in head while playing soccer. Pt did not lose consciousness, but was confused for following 20min. Next day, pt reported headache & irritable, neuro exam
normal. Best recommendation to family about pt: - CORRECT ANSWER SHOULD BE
EXAMINED IN 2 WKS BEFORE RESUMING PLAY"
"In ER following MVA, receives IV dextrose 5%. Experiences confusion, oculomotor paralysis,
and dysarthria: - CORRECT ANSWER Wernicke's Encephalopathy"
"43 y/o newly AIDS pt has increasing social withdrawal and irritability over several weeks. Can't remember phone number, unable to do chores, appears distracted. Mild right hemiparesis, left limb ataxia, and bilateral visual field defects. LP: normal cell counts, protein, and glucose. T2 Scan
is shown. Dx? - CORRECT ANSWER PROGRESSIVE MULTIFOCAL LEUKOENCEPHALITIS"
"Risk factor for depression in MS patients - CORRECT ANSWER Lesion volume"
"Right handed pt recently underwent neurosurgery is now unable to name objects in left hand when blind folded. He was able to name them when displayed on a screen. Where was the
surgery? - CORRECT ANSWER CORPUS CALLOSUM"
"Bilateral paresis of medial rectus muscle during lateral gaze with course nystagmus in
abducting eye characteristic of: - CORRECT ANSWER multiple sclerosis"
"82 year old with progressive dementia, myoclonus over 3 months. EEG shows *periodic sharp
waves* with 1hz over both hemispheres. Dx? - CORRECT ANSWER Creutzfeldt-Jakob
Disease" "62 y/o M w/ DM is not making sense, saying "thar szing is phrumper zu stalking". Normal intonation but no one in the family can understand it. He verbally responds to Qs w similar
utterances but fails to successfully execute any instruction. (8x) - CORRECT ANSWER
Wernicke's Aphasia" "Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes weakness of R extremities and severe dysfluent aphasia, but CT at 1:30 PM has no acute lesion. Most appropriate
treatment: (4x) - CORRECT ANSWER push TPA"
"Head CT w/ lens-shaped hyperdensity (2x) - CORRECT ANSWER Epidural Hematoma"
"A life threatening complication of cerebellar hemorrhage is: (2x) - CORRECT ANSWER
acute hydrocephalus" "A 72 yo patient had an embolic infarct in the middle cerebral artery territory. ECG shows no structural abnormalities. Doppler studies of the neck arteries reveal less than 50% occlusion on both carotid arteries. An EKG reveals AFib. Which of the following strategies has the best
