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PRITE NEURO EXAM QUESTIONS AND CORRECT ANSWERS!!
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41 y/o without family h/o corticocerebellar degeneration presents with 3-month h/o ataxia of gait/limbs, dysarthria, and progressive nystagmus. MRI and CSF normal. 1) Antibody panel with presence of? 2) What type of tumor is likely present? - ANSWER 1) anti-Yo 2) Ovarian Carcinoma
Essential criterion for the declaration of brain death prior to organ donation requires? - ANSWER A positive apnea test
EEG that reveals posterior alpha and anterior beta activity is most likely to have been obtained from whom? - ANSWER A relaxed adult with eyes closed
10 y/o child freq episodes brief lapses of consciousness without premonitory sxs. Lasts 2-10 seconds, followed by immediate and full resumption of consciousness without awareness of what has happened. These ictal episodes most likely caused by what kind szs: - ANSWER Absence
Neuronal enzyme that is the target of drugs to treat Alzheimer's i.e. galantamine and rivastigmine - ANSWER Acetyl cholinesterase
Complications of a cerebellar hemorrhage? - ANSWER Acute hydrocephalus
Progressive weakness over several days - absent reflexes worse in lower extremities - slow conduction velocity, conduction block - ANSWER Acute inflammatory polyneuropathy
Weakness in limbs 2 weeks after a viral gastroenteritis. Weakness in UE/LE, absent DTRs. Spinal fluid shows no cells and elevated protein. - ANSWER Acute inflammatory polyneuropathy
Young pt recovering from flew-like illness w/ progressive weakness and numbness of legs and feet. Weakness and numbness below middle of thorax. Increased LE DTR's, extensor plantar reflexes. Urinary incontinence. LP 23 mononuclear cells, protein level 37, nml glucose - ANSWER Acute transverse myelitis
The single most consistently documented and significant risk factor in the epidemiology of tardive dyskinesia is? - ANSWER Advanced age
Known risk factors for dementia: - ANSWER Age, family hx, female, Down Syndrome
What psychoactive drug produces amnesia? - ANSWER Alcohol
What baseline labs should be taken before starting tacrine? - ANSWER ALT and AST (baseline and f/u)
Clock drawing test is quickly administered and sensitive screen for which d/o? - ANSWER Alzheimer's
Individuals over 40yo with Down's syndrome frequently develops: - ANSWER Alzheimer's
Amyloid precursor protein in - ANSWER Alzheimer's Disease
Most common cause of dementia: - ANSWER Alzheimer's disease
45 year old with gradual progressive weakness over the past 3-4 months, particularly in the LUE. - ANSWER Amyotrophic lateral sclerosis
Atrophy of the intrinsic muscles of the right arm and forearm. Reflexes are generally brisk, plantar reflexes are extensor. Electrophysiology shows widespread fasciculations, fibrillation and sharp waves. Dx? - ANSWER Amyotrophic lateral
An 80yo pt with Alzheimer's is brought in for increasingly combative behavior. Daughter would like to keep the pt at home if possible. What interventions would be most helpful in this situation? - ANSWER Assessing for caregiver burnout
Inability to recognize objects by touch: - ANSWER Astereognosis
Adult LP with opening pressure 190, protein 110, glucose 27, leukocytes 5,000. Dx? - ANSWER Bacterial meningitis
Characteristics of Parkinson's tremor - ANSWER Being Inhibited with Volitional Movement
Visual problem in pituitary tumor compressing optic chiasm - ANSWER Bitemporal Hemianopsia
5 y/o cannot maintain eyes open, attempts to look at person/object results in tonic eyelid closure. Can watch television without difficulty. Extraocular movements normal. Dx? - ANSWER Blepharospasm
53 y/o with insidious onset of blurred vision, diplopia x1 day, ptosis, 6th nerve palsy, unreactive pupils, hoarse voice, dysarthria, weak neck muscles. EMG has increased amplitude with repetitive nerve stimulation. Dx? - ANSWER Botulism
Rapid onset of right facial weakness, left limb weakness, diplopia - ANSWER Brain Stem Infarction
8 y/o observed to have brief episodes (seconds) of interruption of consciousness. Associated with automatism such as lip smacking. What is EEG likely to show? - ANSWER Burst od 3 cycles per second spike & wave activity
3 days s/p cardiac arrest and CPR, a 73-year-old man is comatose. His eyes are open
but he does not fix and follow with his eyes. Doll's eyes elicits full horizontal eye movements. His spontaneous limb movements are symmetrical. The reflexes are mildly hyperactive. The EEG shows? - ANSWER Burst suppression pattern
Motor speech paradigm activation task on fMRI - hyperactivity in right temporal lobe. Damage is where? - ANSWER Calcarine fissure
Drug for trigeminal neuralgia (most effective in treatment) - ANSWER carbamazepine
34 y/o with persistent numbness in thumb/forefinger/middle finger/palm in the fourth month of pregnancy. Pain radiates to forearm, clumsiness and weakness with holding objects. Dx? - ANSWER Carpal tunnel syndrome
Ability of catatonic pt to hold same position - ANSWER Catalepsy
Which term describes state of immobility that is constantly maintained? - ANSWER Cataplexy
Fall from a ladder with persistent back pain and inability to void. Bilateral leg weakness, decreased pinprick in sacral and perianal area. Dx? - ANSWER Cauda equina compression
66 y/o M in ED w/ sudden occipital HA, dizziness, vertigo, N/V, unable to stand, mild lethargy, slurred speech. Exam shows small reactive pupils, gaze deviated to the R, nystagmus, w/ occasional ocular bobbing, R facial weakness, decreased R corneal reflex, truncal ataxia, b/l hyperreflexia, b/l Babinski. Dx? - ANSWER Cerebellar hemorrhage
65 y/o with h/o HTN, Meniere's with sudden vertigo, N/V, worse with head movement, R beating nystagmus on lateral gaze, finger to nose testing is ataxic, poor balance and dysarthria. Dx? - ANSWER Cerebellar infarct
Normal Romberg w eyes open but loses balance with eyes closed. Where is
New-onset back pain after shoveling - left paraspinal muscle spasm, negative straight leg raise, reflexes symmetric, no weakness, no sensory deficit. Management: - ANSWER Conservative (bed rest) with NSAIDS
Brown-Sequard syndrome includes: - ANSWER Contralateral loss of pain and temp sensation beginning below lesion
Post stroke depression in an 80 y/o pt who is R handed is associated with cognitive impairments that - ANSWER Correlate with left hemispheric involvement
Pt in ED with sudden HA and collapsing, some lethargy. Exam shows rigid neck, no papilledema, no focal CN or motor signs. The initial test should be? - ANSWER CT Head
What is the role of the hippocampus and parahippocampal gyrus? - ANSWER Declarative memory (facts)
Seen in electrophysiologic testing in myasthenia gravis - ANSWER Decremental response to repetitive stimulation
52 y/o w/ depression and HTN, severe headaches, "not himself" x 10 days. Poor eye contact, inattentive, picking at clothes, muttering, nodding off - ANSWER Delirium
Binswanger disease has pseudobulbar state, gait disorder, AND: - ANSWER Dementia
25 y/o pt with pain in L periorbital region, followed by blurring then loss of vision in left eye. Exam normal but no reaction when light shone on L eye. This is consistent w: - ANSWER Demyelinating lesion of L optic nerve
What does functional MRI measure? - ANSWER Detects blood flow
Orbital pain with L eye paralysis of adduction and elevation of the eye but normal pupil function. Dx? - ANSWER Diabetic 3rd nerve palsy
55 y/o with DM and HTN develops R periorbital pain and diplopia. Exam=paralysis of abduction of R eye. - ANSWER Diabetic 6th nerve palsy
CT scan is better then MRI for what? - ANSWER Differentiating hemorrhaging from edema.
25 y/o male with 7 months of depression, forgetfulness, weight loss, insomnia, and painful tingling in both feet and incoordination. Involuntary choreic movements of BL UE, is apathetic and monosyllabic. Labs normal. EEG mild diffuse slowing. CT/MRI normal. During admission he develops severe akinetic mutism and seizures and dies. Brain autopsy shows: - ANSWER diffuse amyloid plaques, spongiform neuronal degeneration, and severe astrogliosis
Dementing illness with limb and axial rigidity tremor, fluctuations in cognitive function, confusion states, hallucinosis and other symptoms of psychosis. Dx? - ANSWER Diffuse lewy body disease
A consult is requested for an inpatient on a medical ward who is agitated and hallucinating. Pt appears to be flushed and hot with dry skin, mydriasis, a rapid pulse and diminished bowel sounds. What is your first recommendation? - ANSWER Discontinue anticholinergic drugs
What does the cerebellum do in the human adult brain? - ANSWER Diverse roles in movement, behavior, and learning
Neurotransmitter assoc w/ reward & reinforcement in nicotine dependence - ANSWER Dopamine
A 70 y/o +HIV heroin abuser is treated with Lopinavir and Ritonavir and fluoxetine for MDD. Hep C was dx and treated 2 months ago. Since then pt is more irritable, insomnia, and diarrhea. Why? - ANSWER Drug-drug interaction
Young adult w/ headache behind left ear. 2 days later twisting of face. Impaired taste sensation. Paralysis of forehead, lower face on left, incomplete closure of left eye w/ blinking. No sensory deficit or other cranial nerve deficit. MRI shows: - ANSWER Gadolinium enhancement of left facial nerve
What area of the body has the most serotonin? - ANSWER GI tract
First sz with focal onset and second generalization in a 58 y/o patient is most likely the consequence of what? - ANSWER Glioblastoma multiforme
Cancer patient on chemo is disoriented and agitated. Afebrile VSS. Neg neuro exam. Poor attention, cog impairment. Held for observation. CT neg, EEG diffuse slowing. Treat with: - ANSWER Haldol
80 y/o Alzheimer's with increasingly combative behavior. Family wants to keep at home. Give what med? - ANSWER Haldol
Treatment of Huntington's chorea - ANSWER Haloperidol
Loss of pain and temp sensation on one side with motor paralysis and propioception on the other. Spinal syndrome is: - ANSWER Hemisection
Fever, HA, seizures, confusion, stupor, and coma, evolving over several days. EEG with lateralized high-voltage sharp waves arising in the L temporal region, with slow wave complexes repeating at 2-3 second intervals. CT low-density lesion in L temporal lobe. - ANSWER Herpes Simplex Encephalitis
49 year old develops seizure disorder that is difficult to control. CSF shows lymphocytic pleocytosis and many RBC's. MRI shows T2 hyperintensity in the Left temporal lobe, with gadolinium enhancement in this area in T1 weighted image. EEG shows periodic discharges. Dx? - ANSWER Herpes Simplex Encephalitis
Treatment for Huntington's disease: - ANSWER High potency antipsychotics
Spinal fluid of patient w/ acute inflammatory polyneuropathy shows: - ANSWER High protein, normal cell count
Component of type A behavior most reliable risk factor for CAD - ANSWER Hostility
98 y/o M in ER, unconscious after choking on chicken. Pt had a progressive neuro condition presented in his early 30's w involuntary irregular movements of all extremities and face but after 15 yr course evolved into rigid, akinetic condition w diff swallowing and speaking. Also progressive dementia and full time care. After obstruction was relieved pt remained unconscious, had cardiac arrest and died. PM exam showed generalized brain atrophy. (Path picture of brain atrophy). Diagnosis: - ANSWER Huntington's disease
Cross section of the brain picture with generalized atrophy: - ANSWER Huntington's disease
Neurofibrillary tangles in Alzheimer's are composed of: - ANSWER Hyperphosphorylated tau proteins
Benign intracranial HTN etiology: - ANSWER Hypervitaminosis A
Mild confusion, lethargy, thirst, polydipsia - ANSWER Hyponatremia
A 32 y/o s/p thyroidectomy presents c/o frequent panic attack, progressive cognitive inefficiency, perceptual disturbances, severe muscle cramps, and carpopedal spasm. PE shows alopecia and absent DTR. DX? - ANSWER Hypoparathyroidism
20 y/o with 1 yr of bitemporal headaches, polydipsia, polyuria, bulimia. For 2 months emotional outburst aggressive and transient confusion neuro exam normal. What will MRI of brain show? - ANSWER Hypothalamic tumor
Pt with double vision when looking to the left shows her eyes on primary gaze. On left gaze the right eye fails to adduct and there is nystagmus in the left eye. On right gaze and vertical gaze the eyes move normally. Dx? - ANSWER Internuclear ophthalmoplegia
63 y/o with new onset aphasia and R hemiparesis, 2 days ago had milder/similar symptoms that resolved in 30 minutes, yesterday had similar episode x45 minutes. Current sx started 1.5 hrs ago. CT shows no stroke or hemorrhage. Tx? - ANSWER Intravenous thrombolytic agents
Pt with hypertension develops painless vision loss on the left eye. PE revels blindness in the left eye and afferent papillary defect on the left. MRI shows several T hyperintensities in the white matter periventricularly. No corpus callosum lesions. No enhancement with gadolinium. Dx? - ANSWER Ischemic optic neuropathy
Patient with hypertension develops vertigo, nausea, vomiting, hiccups, left sided face numbness, nystagmus, hoarseness, ataxia of the limbs, staggering gait, and is falling to the left. Dx? - ANSWER Lateral medullary stroke
Higher frequency & greater severity of depression associated w/ cortical & subcortical strokes - ANSWER Left anterior frontal
65 y/o with HTN collapsed. In ED is stuporous, R hemiparesis + hemisensory deficit, eyes deviate to L. CT would show intraparenchymal hemorrhage in: - ANSWER Left basal ganglia
Head & eyes deviate to right and right arm extends immediately before a generalized tonic-clonic seizure - ANSWER Left cerebral hemisphere
Visual disturbances associated with occlusion of the right posterior cerebral artery? - ANSWER Left homonymous hemianopsia
58 y/o s/p CABG - anomia for fingers and body parts, errors involving right and left,
inability to write thoughts/take notes/make calculations. Fluent speech and excellent comprehension - ANSWER Left medial temporal stroke
Loss of ability to execute previously learned motor activities (which is not the result of demonstrable weakness, ataxia or sensory loss) is associated with lesions of? - ANSWER Left parietal cortex
65 y/o M 6 months confusion episodes, disorientation, visual hallucinations of children playing in his room. Hallucinated images are fully formed, colorful, vivid and pt has little insight into their nature. No AH. Wife says he is normal between episodes. Exam: Normal language, memory, mod diff with trails test, mild diff with serial subtractions, mild symmetric rigidity and bradykinesia. Brain MRI unremarkable. CSF, routine labs and UDS normal. Diagnosis: - ANSWER Lewy body dementia
75 y/o with mild intermittent forgetfulness, hallucinations, delusions, confusion. Frequent falls and dizziness when getting out of bed. BP laying down 135/90, standing 100/55. BL limb and axial rigidity without tremor. Dx? - ANSWER Lewy Body disease
Complex partial epilepsy aura has what symptom? - ANSWER Lip smacking
What is the diagnostic value of transient paresis or aphasia after a seizure? - ANSWER Localizes the focus of seizure
Delirium in HIV patients treated with what parental agent? - ANSWER Low dose of a high-potency antipsychotic
Patient s/p surgery develops weakness and wasting of small muscles of the hand and sensory loss of the ulnar border of the hand and inner forearm. Dx? - ANSWER Lower brachial plexus paralysis
Young pt new onset headaches w/ periods of visual obscuration. Papilledema. MRI nml. Best test: - ANSWER Lumbar puncture
What cognitive enhancers is an NMDA receptor antagonist? - ANSWER Memantine
Neuronal damage from excitotoxicity secondary to glutamate sensitivity. Treat with: - ANSWER Memantine
Memory loss pattern in dissociative amnesia - ANSWER Memory loss occurs for a discrete period of time
Recurrent deafness, tinnitus then vertigo - ANSWER Meniere's disease
Drug-addicted healthcare professional experiences seizure that is not a withdrawal phenomenon. Cause? - ANSWER Meperidine
DM patient with creeping paresthesias and burning pain in L anterolateral thigh. DTRs normal, no weakness. Dx? - ANSWER Meralgia paresethetica
32 y/o with partial complex seizures refractory to treatment, picture of MRI shown. (picture) - ANSWER Mesial temporal sclerosis
52 y/o with h/o unipolar depression is brought to ED with a first episode of catatonia. Patient is on no meds, UDS is neg. Further w/u should initially focus on what factor? - ANSWER Metabolic disorders
Multifocal myoclonus in a comatose patient indicates: - ANSWER Metabolic Encephalopathy
TD in 63 y/o w/ end stage renal failure. Culprit: - ANSWER Metoclopramide
Atrophy of right temporal lobe on cross section associated with occlusion of: - ANSWER Middle cerebral artery
Flashing lights traveling slowly from left to right in left visual field persist 30 minutes followed by difficulty with expression and concentration that subsides after 30 minutes, followed by headache and nausea. PE and MRI are normal. Dx? - ANSWER Migraine w/ aura
Horner's syndrome is characterized by? - ANSWER Miosis, ptosis, & anhidrosis of forehead
Transient symptom associated with carotid stenosis: *** - ANSWER Monocular blindness
As opposed to strokes caused by arterial embolism or thrombosis, those caused by cerebral vein or venous sinus thrombosis are - ANSWER More often associated with seizures at onset
Patient treated conservatively with analgesics and muscle relaxants, continues to have back pain radiating to R leg, increased by coughing/sneezing. Tenderness in lumbar paravertebral area, decreased R ankle jerk, weak flexion of right foot. Next step in management: - ANSWER MRI lumbar spine
50 y/o male with acute neck pain radiating down L arm, gait problems, urinary incontinence. What test should be ordered? - ANSWER MRI of C spine to r/o cord compression
77 y/o gets numbness and aching in buttocks and thighs down to legs when walking > 100 ft. Better after sitting down. How to Dx? - ANSWER MRI of lumbar spine
Internuclear ophthalmoplegia is an ocular motility disorder often seen in patients with: - ANSWER Multiple Sclerosis
Female with vertigo and diplopia, when looks left has isolated L eye nystagmus, and cannot adduct R eye. Dx? - ANSWER Multiple Sclerosis
41 y/o chronic fatigue, cognitive impairment, reduced perceptual motor speed, poor
reinforcing effects of opiates, cocaine, amphetamines, nicotine, PCP, and alcohol? - ANSWER Nucleus Accumbens
In patients with pronounced defects in recent memory, remote memory is: - ANSWER Often deficient on close examination even when it seems well preserved
25 y/o female with L eye pain which increases with moving the eye. Diminished acuity in L eye, pupils constrict well with light on R eye, but only constrict weakly with light on L eye. Dx? - ANSWER Optic neuritis
Which med has secondary prevention against embolic stroke in patients with Afib? - ANSWER Oral warfarin
26 year old with sudden onset back pain. Spasms in the right paraspinal muscles in the lumbar region. Straight leg raising on the right is limited by sharp pain at 45 degrees. Ankle jerk on Left is diminished. No muscle weakness, no sensory deficit. Next step? - ANSWER Order MRI scan of the lumbar spine
CT scan with occipital and intraventricular hyperintensities - ANSWER Parenchymal hemorrhage
73 y/o found on floor, unaware of L UE/LE. Flaccid L arm, but denies anything wrong and when asked to raise L arm raises R. When asked which arm is her L, she replies "yours." Dx? - ANSWER Parietal lobe CVA
Gait disturbance w/ involuntary acceleration - ANSWER Parkinson's disease
Lewy bodies visualized - ANSWER Parkinson's disease
Gait consisting of : postural instability, festination, & truncal rigidity is seen in what condition? - ANSWER Parkinson's disease
Resting, non-intentional tremor - ANSWER Parkinson's disease
In treating migraines, triptans should NOT be given to: - ANSWER Patients with CAD
Best pharmacologic tx for Restless Legs Syndrome? - ANSWER Pergolide
14 year old after a demanding physical test becomes extremely weak and unable to stand. PE is positive for depressed DTR's. Labs: K=2.8. h/o similar episodes after strenuous exercises. EKG: minimally prolonged PR, QRS, QT interval. Father and grandfather had similar episodes. Dx? - ANSWER Periodic paralysis
49 y/o w/ DM2 presents with severe burning of soles of feet and insomnia b/c the touch of the sheet against the feet is painful. Exam shows decreased sensation to pin and touch up to ankle, 50% reduction in vibratory sense at ankle and impaired proprioception at toes. Ankle jerks are absent, but knee jerks present. Dx? - ANSWER Peripheral neuropathy
Unilateral foot drop with steppage gait indicates: - ANSWER Peroneal nerve compression
Two days after bowel surgery, 53 y/o is delirious. Correctly draws a square when asked, but then continues to draw squares when asked to draw other shapes. MSE would reveal: - ANSWER Perseveration
Neuroimaging that measures neuronal glucose metabolism - ANSWER PET scan
74F PI, suspicious, poor ADL's - ANSWER Pick's disease
Abnormal elevated metabolic findings associated with increased risk of stroke in patients under 50 - ANSWER Plasma homocysteine