PRITE Clinical Neurology
Which group of drivers has the highest rate of motor vehicle crashes?
16-24 yo men
What proportion of autism patients has seizures?
33%
What percent of alzheimer disease cases are attributable to genes coding for APP (chromosome 21) presinillin 1 (chromosome 14) and presenillin 2 (chromosome 1)?
5%
Assuming a temporal lobectomy is safety performed, what is the likelihood of complete or near complete remission of her seizures?
75%
What proportion of adults with well documented PNES also has epileptic seizures?
< 10 %
If 2 AEDs fail to suppress seizures, what is the likelihood that the addition of a third will be successful?
<5%
A 71 yo patient who was diagnosed with Parkinson disease three years ago is brought to the clinic for changes in mood and thinking. The patient's motor symptoms are well controlled on carbidopa/levodopa. The patient's spouse states that the patient has trouble getting up and motivated to do anything, and the patient does not express interest in attending social events. There has also been a recent "slowness" in the patient's thinking, with the symptoms remaining stable throughout the day. There is no report of sadness, worthlessness, or suicidal ideation. Cognitive evaluation is unremarkable except for slow processing. Which of the following is the most likely explanation for the patient's symptoms? A. Apathy B. Anxiety C. Catatonia D. Psychosis E. Depression
A. Apathy
35 yo with HIV w/ CD4 <200 presents with left hemiparesis and bilateral ataxia that has evolved over past several weeks. Cognitive function WNL. MRI shows several large areas of demyelination, w/o mass effect, in the cerebral hemispheres. Which test would most likely indicate the diagnosis?
A. CSF analysis for JC virus
Which of the following chemotherapy agents is most commonly associated with a distal sensory polyneuropathy? A. Cisplatin B. Lapatinib C. Methotrexate D. Gemcitabine E. Temozolomide
A. Cisplatin
Elderly man flails his arms and strikes his wife while sleeping. Has minimal cognitive impairment. PSG shows REM without atonia. A consultant correctly labels his behavior "dream enactment." Which of the following is the best treatment?
A. Clonazepam
When observed in a young adult, bilateral paresis fo the medial rectus muscle of the eye on attempted lateral gaze, with a coarse nystagmus in the abducting eye, is characteristic of which of the following conditions? A. Multiple sclerosis B. Small pontine infarct C. Phencyclidine intoxication D. Wernicke encephalopathy E. Bilateral third nerve damage
A. Multiple sclerosis
Which of the following fulfills a diagnostic requirement for obstructive sleep apnea hypopnea?
A. PSG evidence of at least five obstructive apneas or hypopneas per hour of sleep and either snoring or other breathing disturbance or EDS (excessive daytime sleepiness)
OF the following parasomnias, which one arises in REM sleep? a. REM sleep behavior disorder b. Sexsomnia c. Somnambulism d. Sleep terrors
A. REM sleep behavior disorder
When used to treat narcolepsy, which is the mechanism of action of methylphenidate and amphetamine?
A. they enhance dopamine activity
After developing lethary and confusion, 30 yo woman with history of focal seizures is brought to the emergency room. Which is most likely cause?
AED intoxication
What is the effect of ART on HIV associated dementia and longevity?
ART improves cognitive function and increases longevity in patients with HIV associated dementia
EEG abnormality with seizure type: generalized 3 Hz spike and wave
Absence seizures
Amnesia in Alzheimer's may be most closely associated with deficiency of which of the following substances?
Acetylcholine
What do the following conditions have in common: toluene abuse, MS, PML, metachromatic leukodystrophy, and adrenoleukodystrophy?
All affect cerebral white matter
Which of the following are risk factors for HIV associated dementia in AIDS patients? A. Anemia B. Weight loss C. Late stages of AIDS D. high viral load E. All of the above
All of the above
In which condition will anosmia most likely develop?
Alzheimer's
Which 3 conditions feature intraneuronal tau proteins?
Alzheimer's FTD PSP
Which light bulb color gives a relatively soporific effect?
Amber light
Which of the following types of medication is least likely to be helpful in treating alzheimer's disease?
An anticholinergic medication
Following her third miscarriage, a 29 yo woman sought psychiatric consultation for depression. In reviewing her history, the psychiatrists found that her migraines had flared up and, because of a persistent recent calf-cramp, she was no longer able to exercise. Which of the following tests should be performed?
Anticardiolipin Abs
After being given a medication, a 66 yo man developed forgetfulness, dry mouth, blurred vision, and urinary retention. Which was the most likely type of medication?
Anticholinergic
Which of the following statements is true regarding individuals with mild cognitive impairment?
Approximately 10% progress from MCI to dementia disease annually
Which statement concerning sleep maturation from infancy to older childhood is true?
As they mature, children sleep less and dream even less
Pattern of inheritance of Familial Alzheimer's
Autosomal dominant
By what age do children consolidate their sleep into nighttime and give up their afternoon nap? A. 2 years B. 4 years C. 6 years D. 8 years
B. 4 years
Buffy, 18 yo freshman works part-time as waitress, describes excessive daytime sleepiness (EDS). For past 2 years has had irresistible urges to sleep about 2x daily, weakness when laughing, and occasionally total paralysis when attempting to wake for morning classes. Which one of the following is the next best step?
B. After 7 full nights of sleep, PSG followed by a multiple sleep latency test (MSLT)
During a neurological examination an 80 yo patient is unable to demonstrate how to blow out a match. Motor and sensory function are normal, and the rest of the neurological examination is unremarkable. The patient's inability to perform this action is termed: A. Atonia B. Apraxia C. Aphasia D. Areflexia E. Agraphesthesia
B. Apraxia
A 75 yo presents with new onset "confusion." Upon further evaluation, the patient seems to have trouble speaking and is able to communicate with single words or sentences but often cannot think of the word he wants to say. Some sentences do not make sense, and the patient utters phrases such as "the snoodle linkered in the yard" when referrring to the dog.He is unable to repeat the phrase "no ifs, ands or buts." he is able to follow commands, and seems to understand the questions. This type of language disorder is consistent with which of the following types of aphasia? A. Global B. Broca's C. Wernicke D. Conduction E. Transcortical
B. Broca's (expressive)
A 72 yo patient presents with subacute onset of progressive ataxia of gait and limbs. Laboratory testing reveals the presence of an anti-Yo antibody in the serum. Which of the following tests should be ordered next? A. Single photon emission computed tomography scan of the brain B. Computed tomography scan of the chest, abdomen and pelvis C. MRI brain D. Serial titers of Anti-yo antibody E. MRI spine
B. CT chest, abdomen, pelvis
Which of the following medication classes is most likely to exacerbate physiological tremor? A. Barbiturates B. Corticosteroids C. Benzodiazepines D. Ca Channel blockers E. Beta adrenergic antagonists
B. Corticosteroids
A patient undergoes a multiple sleep latency test (MSLT) and is diagnosed with narcolepsy. What finding on MSLT would confirm the diagnosis? A. Increased sleep latency B. Decreased REM latency C. Decreased total REM sleep D. Increased total REM sleep E. Decreased sleep efficiency
B. Decreased REM latency
Jacob, a 50 yo man is brought for psych consult by his wife because he has become "distant, inattentive, and confused" during the previous several months. Two months before those symptoms developed, he began to have progressively severe insomnia, which hypnotics, antidepressants, and other psychotropic medicines did not alleviate. Jacob's older sister recently died after 18 months of a similar illness. The psychiatrist found that the patient had personality changes, cognitive deficits, and subtle myoclonus. An internist found that he had tachycardia and labile hypertension. Of the following, which is the most likely illness? a. Creutzfeld-Jakob Disease b. Fatal familial insomnia c. Iatrogenic sleep disorder d. Lewy Bodies disease
B. Fatal familial insomnia
In which sleep stage do sleep spindles and K complexes appear?
B. N2 of NREM
Which of the following statements concerning OCD symptoms and OCD in Tourette Disorder is FALSE?
B. Obsessions and compulsions as a manifestation of TOurette disorder are indistinguishable from those in pure OCD. (in Tourette disorder, obsessions typically relate to sex, violence, and aggression)
Which of the following medications is an effective first-line treatment for patients with restless leg syndrome? A. Carbamazepine B. Pramipexole C. Clonazepam D. IMipramine E. Gabapentin
B. Pramipexole
A 54 yo patient awakens with weakness of the right hand. The patient reports having spent most of the previous night drinking at a bar, and then falling asleep at home with the right arm draped over the armrest of a chair. Examination demonstrates weakness of wrist and finger extension, with preserved grip strength. the most likely cause of this weakness is injury to which of the following peripheral nerves? A. Ulnar B. Radial C. Median D. Axillary E. Musculocutaneous
B. Radial
Of the following, which is the most effective treatment of cataplexy?
B. Sodium oxybate (Xyrem)
Electrocerebral silence on an EEG typically indicates brain death; however, other conditions may also abolish EEG activity. Of the following, which two other conditions also produce electrocerebral silence?
Barbiturate overdose Hypothermia
A 32 yo presents with new onset headache characterized by unilateral, stabbing eye pain. During these episodes the patient develops runny nose and conjunctival injection on the same side as the headache. These episodes occur every evening after falling asleep and last up to two hours. Bsaed on this history the patient most likely has: A. Sleep apnea B. Seizure disorder C. Cluster headache D. Migraine headache E. Transient ischemic attacks
C. Cluster headache
Event-related potentials on electroencephalograph are currently most useful for confirming which of the following diagnoses? A. Schizophrenia B. Panic Disorder C. Conversion disorder D. Bipolar affective disorder E. Female orgasmic disorder
C. Conversion disorder
As individuals age, which of the following changes is most apt to occur? A. Increase in REM, slow-wave, and total sleep time B. Decrease in total sleep time, but an increase in REM and slow-wave sleep C. Decrease in slow-wave sleep and total sleep D. None of the above
C. Decreased in slow-wave sleep and total sleep
When testing for the babinski reflex, what alternative stimuli can be used by the examiner to overcome the withdrawal response by a patient? A. Flicking the big toe B. Dorsiflexing the foot C. Downward scraping of shin D. Tapping dorsum of foot E. Squeezing of the foot by the examiner
C. Downward scraping of shin
High voltage delta activity associated with slow eye-rolling movements on polysomnogram is characteristic of what stage of sleep? A. N1 B. N2 C. N3 D. REM
C. N3
58 yo man has RLS. Wife reports once he falls asleep, his legs jerk in flurries at approximately 30 second intervals. A polysomnogram (PSG) confirms the periodic bursts of muscle activity and leg movement. What is the name of these movements?
C. Periodic limb movements
50 yo with Fatal familial insomnia undergoes further evaluation. Which of the following features is likely to be present?
C. Spongiform cerebra cortical changes (this is a prion illness)
The primary purpose of computed tomography scan in the evaluation of a patient suspected of having an acute ischemic stroke is to: A. Identify the site of ischemia B. quantiify cerebral blood flow C. Exclude the presence of hemorrhage D. identify pateints with microvascular occlusions E. Estimate the extent of potentially salvageable tissue
C. exclude the presence of hemorrhage
EEG pattern with most likely cause: periodic complexes
CJD
Histologic finding with disease: spongiform encephalopathy
CJD
50 yo man struggles to stay awake during the day. Has restless nighttime sleep and according to his girlfriend snores loudly. His PSG shows decreases in the blood oxygen concentration followed by brief arousals. What is the best treatment for excessive daytime sleepiness?
CPAP
When an immediate diagnosis is essential, as in the emergency room, which of the following is the best test to diagnose a cerebral hemorrhage?
CT Head
25 yo woman w/ epilepsy that iw well controlled with carbamazepine developed pharyngitis. Physician prescribed erythromycin. Rapidly developed ataxia, nystagmus, diplopia. In retrospect, what caused her symtoms?
Carbamazepine toxicity
Two alzheimer's patients have similar lab results, but one is a university professor while other is blue collar. What explains difference in MMSE exam results? (professor scores higher than blue collar)
Cognitive reserve
14-3-3 protein in CSF. Diagnosis?
Creutzfeld Jakob Diseasee
An 82 yo man presents with progressive dementia and myoclonus over three months. An EEG demonstrates periodic sharp waves with a frequency of 1Hz over both hemispheres. Which of the following is the most likely diagnosis? A. Hepatic failure B. Status epilepticus C. Alzheimer's disease D. Creutzfeld-Jacob Disease E. Hashimoto encephalopathy
D. Creutzfeld Jakob disease
Which of the following MRI techniques is most likely to reveal the abnormalities of ischemic stroke earliest? A. Gradient echo B. T1 weighted MRI C. T2 weighted MRI D. Diffusion weighted MRI E> Fluid attenuated inversion recovery
D. Diffusion weighted MRI
A 71 yo patient with no prior medical history presents to an emergency department with a recent and severe "thunderclap" headache. The patient also notes unilateral eye pain and blurred vision. Examination reveals mildly dilated pupils and conjunctival injection. Which of the following diagnostic tests is most likely to reveal the most likely cause of this patient's headache? A. Lumbar puncture B. Temporal artery biopsy C. Magnetic resonance angiography D. Intraocular pressured measurement E. Cranial computed tomography without IV contrast
D. Intraocular pressure measurement
Which of the following is associated with increased risk of depression in patients with MS? A. older age B. Female sex C. Type of deficit D. Lesion volume E. Family history of depression
D. Lesion volume
Which of the following is most likely to be free of any significant interaction with other antiepileptic medications? A. Topiramate B. Lamotrigine C. Valproic Acid D. Levetiracetam E. Oxcarbazepine
D. Levetiracetam
A 72 yo patient developed sudden onset of memory loss, and was unaware of how the patient and spouse arrived at the supermarket. The spouse noted that the patient was able to drive without problem, but appeared anxious during much of the trip. The patient was able to appropriately answer questions, but then didn't remember the conversation. The entire episode lasted 3 hours, after which time the patient returned to baseline. The most likely diagnosis is: A. Presyncope B. Complicated migraine C. Complex partial seizure D. Transient global amnesia E. Posterior circulation stroke
D. Transient Global Amnesia (TGA)
In a child with Tourette disorder, what is the effect of treating ADHD with stimulants?
D. after a brief exacerbation of tics, stimulants will suppress ADHD
Dr. Anna, 32 yo psychiatry resident in third trimester of first pregnancy reports unusual feelings in her legs to her training analyst. Beginning 2 weeks before, whenever she was "on the couch," she wanted to move her feet and walk around - as if to avoid further insights. Although characteristically reticent, the analyst remarked that it was more than a fantasy because he had leaned over and saw her feet moving. Dr. Anna had no other symptoms and was taking no medications. Which is the most likely pregnancy related disorder according to DSM-5 definitions? A. Tremor B. Eclampsia C. Restless Leg Syndrome (RLS) D. None of the above
D. none of the above (pregnancy precludes a diagnosis of RLS)
Which histologic feature determines the severity of alzheimer's dementia most closely?
Degree of synapse loss
Of the following, with which illness are visual hallucinations most closely associated?
Dementia w/ Lewy Bodies
70 yo with mild cognitive impairment and parkinsonism experiences hallucinations and capgras delusion. Diagnosis?
Dementia w/ lewy bodies
Histologic finding with disease: staining with alpha synuclein Abs
Dementia w/ lewy bodies & parkinson disease
70 yo retired teacher experiences visual hallucinations and parkinsonism
Dementia with lewy bodies
Which of the following is false regarding the cognitive subsection of Alzheimer Disease Assessment Scale (ADAS-Cog)?
Despite the advantages of the ADAS-Cog, the MMSE is the standard test in assessing pharmacologic treatment in Alzheimer's
A man with alcoholism and epilepsy is taking phenytoin. He presents with confusion, nystagmus, and ataxia. A routine medical and neurologic evaluation reveals no abnormal findings, except that he has alcohol on his breath. What should be the two first steps?
Determine the blood alcohol and glucose concentrations & administer thiamine
family of 45 yo waiter bring him in for strange behavior and confusion. Extensive work-up negative. Cannot recall name, birthday, address. Affect restricted, language normal. Diagnosis?
Dissociative amnesia
For patient with RLS, which medication is first line treatment?
Dopamine agonists
Patients with which of the following neurological disorders have been reported to have the highest prevalence of pathological laughing and crying? A. MS B. Parkinsons C. TBI D. MSA E. ALS
E. ALS
Which of the following is the most effective treatment of spasmodic torticollis? A. Gabapentin B. Topiramate C. Glatiramer acetate D. Levodopa/carbidopa E. Botulinum toxin
E. Botulinum toxin
A 27 yo patient is seen for intermittent muscle twitching. Examination demonstrates full strength with normal muscle bulk. An EMG demonstrates spontaneous discharges which are relatively constant and represent firing of the motor unit. These findings are typical of: A. Cramps B. spasms C. myokymia D. fibrillations E. Fasciculations
E. Fasciculations
Which of the following is most likely to reduce psychotic symptoms in patients with parkinson disease without worsening motor symptoms? A. quetiapine B. Mirtazapine C. Aripiprazole D. Rivastigmine E. Pimavanserin
E. Pimavanserin
A stroke in which of the following arterial territories would result in an inability to read, but with preserved ability to write? A. Carotid B. Basilar C. Vertebral D. Middle cerebral E. Posterior cerebral
E. Posterior cerebral
A 65 yo patient has fallen several times over the past 6 months. The patient's mental status exam is normal. Smooth pursuit and saccadic movements are impaired, more prominently for vertical gaze, but full range of motion is easily elicited by doll's head maneuvers. The patient has mild symmetric rigidity and bradykinesia. There is no tremor. A brain MRI scan is unremarkable, as are the results of CSF and routine laboratories including toxic drugs screen. Which of the following is the most likely patient diagnosis? A. Corticobasal degeneration B. Olivopontocerebellar degeneration C. Idiopathic Parkinson Disease D. Primary progressive aphasia E. Progressive supranuclear palsy
E. Progressive supranuclear palsy
The physician directs a patient with a tremor to tap one hand at a different rate to see if the tremor can be entrained to be at the same rate as the tapping hand. This is a method to test for which of the following types of tremor? A. Kinetic B. Intention C. Postural D. Essential E. Psychogenic
E. psychogenic
Which of the following is a false statement regarding EEG changes associated with bilateral ECT?
ECT induced EEG slowing is associated with ineffective treatment of depression
Which of these statements regarding epilepsy, the EEG, and ECT treatments is false?
ECT is contraindicated when epilepsy is comorbid with depression
Match the tremor type with the effective medicine(s)? cerebellar tremor a. levodopa (L-dopa) b. propranolol (inderal) c. amantadine (symmetrel) d. trihexyphenidyl (artane) e. primidone (mysoline) f. none of the above
F. None of the above
58 yo female depressed, gave up job. dresses inappropriate to weather. Reluctant to participate in conversation. 24 on MMSE. Neuro exam normal. CT shows atrophy of frontal lobes. Father had same problem at similar age. Diagnosis?
FTD
59 yo banker has lost ability to complete financial arrangements. Knows individual facts of each deal, fails to follow the sequence of established procedures. Wife reported that he has begun to tell off-color jokes (change of character). Otherwise apathetic and speaks only when prodded. MMSE was 25. General neuro exam normal. Cause?
FTD
Histologic finding with disease: argentophilic intraneuronal inclusions
FTD
Histologic finding with disease: accumulation of tau
FTD & alzheimers
T or F? A cerebral cortex biopsy is appropriate for the diagnosis of Alzheimer's disease?
False
T or F? Inheriting the E4-E4 pair causes alzheimers disease?
False
T or F? MMSE reliably distinguishes Alzheimer's from Vascular cognitive impairment?
False
T or F? Studies consistently correlate poststroke depression with infarcts in the left frontal lobe.
False
Which effect will fluvoxamine have on metabolism of caffeine?
Fluvoxamine will raise caffeine levels
Which of the following characteristics most reliably distinguishes neurocognitive disorder due to vascular disease from alzheimer dementia?
Focal physical findings
Which of the following is the greatest risk factor for depression complicating seizures?
Focal seizures with altered consciousness
Elevated serum concentration of homocysteine is a risk factor for stroke and MI. Which is the best method to reduce an elevated serum homocysteine concentration?
Folic Acid
5 yo boy with brief, completely unprovoked episodes of laughter over past 6 months. Last about 30 seconds. Cannot communicate with him during episodes. Seems to be saying "Hee, hee, hee." Boy was developmentally and physically normal. EEG shows generalized spike and wave discharges during the events that it captured. MRI reveals hypothalamic hamartoma. Which is most accurate diagnosis?
Gelastic seizures
Which of the following is least likely to unfavorably impact an individual's score on MMSE?
Gender
Nucleus basalis of Meynert
Group of neurons beneath the globus pallidus
Which test should a woman of asian ancestry undergo before a physician prescribes carbamazepine?
HLA-B 1502 allele
for patients in a persistent vegetative state who determines the health-care plans, goals of care, and whether artificial life-sustaining devices are to remain in place?
Health-care proxy
Most frequently occurring nonepidemic form of encephalitis?
Herpes simplex encephalitis
In which condition are the anterior horns of the lateral ventricles convex (bowed outward)?
Huntingtons
Patient experiences 10 days of excess sleep "like a hibernating bear" only wakes to eat and masturbate. Behavior returns to normal for a lengthy period, then has another episode while away at college. MRI, LP, EEG and tox all negative. Disorder?
Hypersomnolence disorder
Which of the following statements concerning patients with poststroke depression is false?
If ECT is indicated, it can be given with impunity
Cerebral Ach Effect of: Physostigmine
Increase
In depressed patients, which one of the following is the most typical sleep-related change?
Increased cortical secretion and advanced REM period
Which of the following statements concerning suvorexant is true?
It blocks the orexin receptor
Which skin lesion is most closely associated with AIDS?
Kaposi Sarcoma
What is duration of the serum prolactin level elevation after GTC or complex partial seizure?
Less than 1 hour
Which of the following AEDs undergoes almost complete renal clearance and would, strictly from a pharmacological viewpoint, be most appropriate for patients with hepatic insufficiency?
Levetiracetam
Joe is in good physical and psychological health. He complains of inability to fall asleep until 1 AM. Moreover, he fails to obtain a restful night's sleep. What advice should the physician offer?
Limit daytime naps, avoid alcohol, use the bed only for sleeping, exercise during the daytime and practice other elements of good sleep hygiene.
80 yo has mild forgetfulness and score of 19 on MMSE. Neuro exam normal. Blood tests and CTH negative. ApoE test shows E4 allele. Which statement is most valid in this case?
Little or no education and ApoE4 alleles are each risk factors for Alzheimer's disease.
Which CSF pattern is a marker for Alzheimer's?
Low ABeta and high tau protein concentrations
What is best screening instrument for dementia after MMSE?
MOCA
Which test will reveal abnormalities in central pontine myelinolysis?
MRI
Which is the best test for demonstrating mesial temporal sclerosis?
MRI of brain
Which CNS cells does HIV primarily infect?
Macrophages and microglia
Advancing age leads to loss of neurons in the cerebral cortex and many deep structures. Which of the following structures is not subject to age related neuron loss?
Mamillary bodies
Which medicine used in treatment of alzheimer's blocks NMDA receptors?
Memantine
In wernicke-korsakoff, which cognitive domain is most impaired?
Memory
The diagnosis of NPH has received much attention because installation of a ventriculo-peritoneal shunt may correct the dementia. Most cases are idiopathic. Which condition predisposes a patient to NPH?
Meningitis
10 yo boy has episodes of being unresponsive and having weakness on one side or the other of his body. The episodes began about 1 year before the visit, occur approximately once a month and last several hours. He agrees with his parents description and adds that during episodes, his head hurts and he is nauseated. Between episodes, he is normal in every respect. Of the following, which is the most likely diagnosis?
Migraine
3 months after surviving a drug overdose, a 3 yo man lies in his hospital bed, quadriparetic and almost mute. However, he has regained enough strength to reach for his food and with some assistance feed himself with a spoon. He looks directly at examiners and appears to watch televised sports events. He usually says, "No, no" when someone begins to change the channel. His EEG when he is alert shows slow backgrounds activity and PET shows markedly decreased cerebral cortical metabolism. Which of the following diagnoses most accurately describes his condition?
Minimal conscious state
Which physiologic change is associated with normal REM sleep?
Muscle atonia
40 yo woman develops sudden paresis of L upper and lower face. Diagnosed with lyme disease and receives two rounds of antibiotics without resolution of symptoms. Will an additional course of antibiotics provide relief moreso than placebo?
NO
College student sexually attacks his roommate on several occasions between 2-3 am. Roommate crossed the room, climbed into the bed, fondled him. Although he agrees that he awoke on or near his roommates bed, he denies any sexual advances and could not recall any details. Admitted that he had been sleep deprived and consumed alcohol prior to the event. PSG revealed masturbation during NREM sleep. Diagnosis?
NREM sleep arousal disorder with sexual behavior (sexomnia)
WHich of the following conditions has the lowest incidence of epilepsy?
Neurofibromatosis type 2
In the clinical antipsychotic trials of intervention effectiveness - alcheimer's disease (CATIE-AD) study, atypical antipsychotics improved which measure relative to placebo?
Neuropsychiatric Inventory total score
Patient has alcohol withdrawal seizures. Should you start an AED at discharge?
No
A man with no neurologic symptoms requests DNA testing of his ApoE status, finds out he has two ApoE4 alleles. What is the most likely consequence of learning this result?
No significant short term psychological risks
From which area of the brain does cholinergic stimulation of the cerebral cortex predominantly originate?
Nucleus basalis of Meynert
In patients with asymptomatic carotid stenosis, what degree of stenosis should prompt a carotid endarterectomy?
Optimal medical management may be as effective as endarterectomy in preventing stroke in patients with asymptomatic carotid stenosis
malnourished man with history of chronic alcohol abuse admitted with seizures and delirium. Receives rapid infusion of hypertonic salium after noting hyponatremia to 119 mEq/L. Patient experiences nystagmus, dysarthria, quadriparesis, and ataxia as well as confusion and disorientation. CT Head and blood tests w/o abnormality. Explanation?
Osmotic demyelination syndrome
23 yo med student experimenting with Marijuana. Experienced anxiety and fear. Brought to ER with hallucinations, agitation, fever, and nystagmus. Increasing agitation developed, culminating in a seizure. What is most likely culprit?
PCP
The family of a previously healthy 65 yo bartender who has suffered repeated falls during the previous several months brings him to a neurologist for evaluation. The neurologist encounters a dull man who is slow to speak and very slow in moving about. He has a facial grimace, but denies anger and all other emotions. He is oriented and eventually recalls 4/6 digits. His muscle strength and DTRs are normal, but muscle tone is increased. Despite having postural instability walks erect with short steps and appropriate stance. He cannot look upward or downward. Diagnosis?
PSP
Which two conditions feature alpha synuclein
Parkinson's Dementia w/ Lewy Bodies
Which of the following conditions is not a complication of professional boxing?
Peripheral neuropathy
A volunteer in a study reeceives an overdose of scopolamine. Which would be best antidote?
Physostigmine
Where are the nuclei that generate the rapid eye movements that accompany dreams?
Pons
Young man with schizophrenia comes in delirious, had LAI olanzapine earlier that day. Cause?
Post injections delirium/sedation syndrome (PDSS)
Of the following, which is the most common risk factor for delirium?
Preexisting dementia
19 yo w/ deterioration in personality, cognitive impairment, painful burning sensation in feet, myoclonic jerks. No family history neuro/psych illness. Lab work-up negative. EEG shows disorganized and slow background but no distinctive abnormal features. Neurosurgeon performs biopsy. Cortex shows microscopic vacuoles. Diagnosis?
Prion infection
In which phase of sleep are seizures least likely to occur?
REM
In the night following sleep deprivation, which of the following characteristically occurs?
REM and N3 sleep phases rebound
23 yo gets eval for sensation of falling with sudden contraction in his leg and back muscles upon falling asleep. Felt as if he were preventing the fall. This sequence occurs 2x/month. Most apt to occur after exhausting day. Frightens him and prevents him from sleeping another 30 minutes. Strategy?
Reassure him that he is experiencing a benign condition (called hypnic jerks)
Black on CT Head represents what?
Remote stroke
Which of the following is associated with postictal eeg depression?
Slow, low voltage EEG activity
A test for alzheimer's has high sensitivity and low specificity. What would be the most likely effect of reducing the proportion of false-positive results?
Specificity would increase
Allergic reaction evident on skin that often involves the gastrointestinal mucosa
Steven johnson syndrome
Which condition involving neuronal death is characterized by cellular infiltrates but does not require cellular energy?
Stroke
16 yo rural boy loses interest in school, farm work, friends. Parents bring him for evaluation. Neurologist detects mild but definite cognitive impairment and subtle myoclonus. EEG shows periodic sharp-wave complexes and the CSF contains markedly elevated level of Abs to measles, but no cells and no 14-3-3 protein. Which illness does the eval indicate?
Subacute sclerosing panencephalitis
34 yo woman reports tossing and turning. Lies in bed at 1030. Falls asleep at MN, wakes refreshed at 645. Productive day, pleasant evening. Which approach should prudent physician take?
Suggest CBT
Which substance accumulates in the brain of patients with PSP?
Tau
What are the findings on immunologic staining in FTD?
Tau deposits
Which of the following hypnotics reduces slow wave REM sleep?
Temazepam (BZDs)
valproate and carbamazepine induce neural tube closure defects. Which of the following is not a neural tube closure defect?
Tetralogy of Fallot
Which of the following statements concerning neural tube defects is false?
The neural tube is derived from endoderm. (formed by invagination of ectoderm)
Which of the following statements is false concerning suicide in epilepsy patients?
The suicide rate among epilepsy patients is one to three-fold greater than among the general population
How do carbamazepine and phenytoin interact with oral contraceptives?
These AEDs decrease the contraceptive effectiveness, risking conception
85 yo man can't move legs after surgery. Has clear sensorium, good memory and judgement, intact cranial nerves, and normal strength and DTRs in his arms and hands. Flaccid areflexic paraplegia, hypalgesia to pin below the umbilicus, and urinary retention that he did not appreciate. In contrast, position and vibration sensation were preserved in his legs and feet. Where is the lesion?
Thoracic spinal cord
Which one of the following statements does not describe todd's paralysis?
Todd's hemiparesis may follow any seizure
Most common cause of multiple discrete lesions in AIDS patients?
Toxoplasmosis
T or F? BZDs and barbs induce beta EEG activity
True
T or F? Epileptic criminals are no more likely than other criminals to commit violent crimes.
True
T or F? epileptic individuals are more likely than others to be convicted of a crime and sent to prison
True
T or F? psychotropic medications may confound the diagnosis of neurologic illness by altering the EEG
True
A 6 yo boy has absence seizures with paroxysms of 3 Hz spike and wave EEG activity. He was unable to tolerate ethosuxamide (Zarontin). Which AED should be tried next?
VPA
Which of the following AEDs inhibits cytochrome P450 and readily causes toxic concentrations of lamotrigine when given in combination?
Valproate
Which AEDs is/are associated with PCOS and hyperandrogenism?
Valproate and phenytoin
A 73 yo woman arises from a vigorous hair washing at her local beauty parlor and finds that she is vertiginous and nauseous. A physician finds nystagmus and truncal ataxia. Her symptoms and signs resolve over 1 hour. Which is the most likely cause of her disturbance?
Vertebrobasilar artery TIA
In a 70 yo man who has normal cognitive and physical function, which sensation is most likely to be lost?
Vibration
Which variety of amnesia is typically accompanied by peripheral neuropathy?
Wernicke-korsakoff
Which of the following statements regarding post-stroke anxiety is true?
When anxiety complicates depression in stroke patients, depression has a longer duration
During combat, a soldier loses both eyes. Without external cues, which circadian rhythms will he most likely follow?
a steady 24.5-25 hour cycle
A 35 yo woman sought chiropractic treatment of neck muscle spasms. In the middle of vigorous manipulation, she suddenly developed vertigo, nausea, and vomiting. On exam, a neurologist found dysarthria, nystagmus, right-sided ptosis and miosis, numbness of the left arm and leg, and ataxia on right finger-to-nose movement. What is the most likely etiology of her condition?
a traumatic dissection of the right vertebral artery
When its comorbidities complicate Tourette Disorder, in which sequence do they unfold?
a. ADHD, then motor tics, then vocal tics, then OCD symptoms
Which is the essential neurotransmitter feature of the globus pallidus?
a. An inhibitory gamma-aminobutyric acid (GABA) based nucleus
Which neurodegenerative illness is frequently comorbid with REM sleep behavior disorder?
a. Dementia with Lewy bodies
In Huntington disease, which protein does the huntingtin gene transcribe?
a. Huntingtin
A 70 yo engineer w/ parkinson disease for about 5 years has begun to gamble for the first time in his life. Although he has neither won nor lost much money, he has spent inordinate amounts of time in casinos. He feels compelled to gamble, but he enjoys all aspects of it. He had depression 10 years ago, but currently has no disturbance in his mood. WHich is the most likely explanation for his new pasttime?
a. Impulse control disorder
A neuro exam of a 17 yo boy, who has had declining schoolwork, reveals dysarthria, tremor, and a brown-green ring at the periphery of each cornea. Which of the following laboratory abnormalities is most likely to be found?
a. Little or no copper-transporting serum protein
Which condition is NOT associated with sleep-onset REM periods (SOREMPs)?
a. RLS (restless leg syndrome)
Which illnesses do neurologists term "polyglutamine"? (More than one answer is correct)
a. Spinocerebellar ataxia (SCA) subtypes c. Huntington disease
Which 3 of the following neurodegenerative disorders do neurologists label "tauopathies"? a. Alzheimer disease b. frontotemporal dementia c. progressive supranuclear palsy d. dementia with Lewy body disease e. Parkinson disease
a. alzheimer disease b. Frontotemporal dementia c. Progressive supranuclear palsy
50 yo systems analyst has been taking SSRIs for 10 years. She states that her face pulls to the left and her left eyelid closes. The movements are more intense during anxiety and appear in bursts lasting several seconds to a few minutes, but they are not painful. The eyelid closure interferes with her driving her car. Which of the following conditions is probably responsible for her movements?
a. an aberrant blood vessel at the cerebellopontine angle
A 67 yo man is comatose 1 week after sustaining a brainstem infarction. Among other abnormalities, his palate spontaneously elevates symmetrically - as though he were saying "ah" - at a regular rate of 120 times per minute. What is the origin of this movement disorder?
a. an infarction in the medulla's inferior olivary nuclei, midbrain's red nuclei, or cerebellum's dentate nuclei, or their connections
Which is the most appropriate term for the tendency of a genetic illness to produce symptoms in increasingly younger victims in successive generations?
a. anticipation
Which TWO structures comprise the striatum? a. caudate b. putamen c. globus pallidus d. subthalamic nucleus e. substantia nigra
a. caudate b. putamen
A 60 yo priest who had parkinson disease for 4 years has begun to develop episodes of kicking and punching lasting several minutes during his sleep. The episodes differ from each other and do not include incontinence or tongue biting. The man has no recollection of them in the morning. which would be the best treatment?
a. clonazepam
When the hear deliberate or accidental noises, certain members of a large family living in Maine respond by leaping upwards, screaming, and throwing any object from their hands. WHich is the most likely explanation for their response?
a. culture bound behavior
What is the biochemical deficiency in dopa-responsive dystonia?
a. deficiency of the cofactor for synthesis of tyrosine hydroxylase
Which THREE of the following Parkinson disease symptoms will NOT respond to an increase in dopaminergic medications? a. dementia b. tremor c. rigidity d. bradykinesia e. depression f. hallucinations
a. dementia e. depression f. hallucinations
WHich of the following complications is the most common reason why families place parkinson disease patients in nursing homes?
a. hallucinations and delusions
Which three of these statements apply to spasmodic torticollis?
a. it may consist of any combination of laterocollis, retrocollis, and anterocollis as well as torticollis d. Light pressure to the chin in a counter-rotational direction may transiently overcome it e. whether a manifestation of tardive dystonia or an idiopathic condition, botulinum toxin injections greatly reduce torticollis
Match the tremor type with the effective medicine(s)? Parkinson Disease a. levodopa (L-dopa) b. propranolol (inderal) c. amantadine (symmetrel) d. trihexyphenidyl (artane) e. primidone (mysoline) f. none of the above
a. levodopa (L-dopa) c. amantadine (symmetrel) d. Trihexyphenidyl (artane)
After developing personality changes and slowed thinking for 1-2 years, a 39 yo high school music teacher presents for evaluation. He relates that his father died at age 65 years from Huntington disease, but his mother is alive and well. A neuro exam shows subtle chorea, motor impersistence, and jerky saccades. After the neurologist offers a clinical diagnosis of Huntington disease, the patient agrees to undergo genetic testing. Which of the following patterns will the test most likely show?
a. maternal gene, 20 CAG repeats, paternal gene, 45 CAG repeats
Which FOUR illnesses result from excessive trinucleotide repeats? a. myotonic dystrophy b. depression c. fragile X syndrome d. Alzheimer disease e. Huntington disease f. Duchenne Muscular Dystrophy g. certain spinocerebellar ataxias (SCAs)
a. myotonic dystrophy c. fragile X syndrome e. Huntington disease g. certain spinocerebellar ataxias (SCAs)
Which of the following conditions will the Abnormal Involuntary Movement Scale (AIMS) capture?
a. oral-bucco-lingual dyskinesia
Which Parkinson disease patients are most apt to cause depression in their caregivers?
a. patients with depression
Match illness with inheritance pattern: Red-green color blindness
a. recessive sex-linked
Which is the effect of stimulation of D1 receptors in the striatum by dopamine?
a. the interaction STIMULATES adenylate cyclase activity
Which single statement is TRUE regarding the CAG trinucleotide repeats in Huntington disease? a. The pathologic sequence is located on chromosome 4 b. Normal individuals do not have CAG trinucleotide repeats c. the number of repeats in patients' sperm and eggs remain stable d. an affected mother's gene would be more unstable than an affected father's
a. the pathologic sequence is located on chromosome 4
Which of the following is TRUE concerning zolpidem and zaleplon?
a. these medicines are hypnotic agents probably because they increase GABAa activity
Which ratio determines sleep efficiency?
a. total sleep time to time in bed
which feature suggests a frontal lobe seizure rather than another form of complex partial seizure?
absence of aura, duration of less than 1 minute and little postictal symptomatology
Presenting feature of: frontotemporal dementia
aggressive and other behavioral disturbances
Which of the following drugs crosses the placenta? phenobarbital methadone carbamazepine topiramate all of the above
all of the above
Histologic finding with disease: neurofibrilary tangles
alzheimers
Which of the following conditions is not associated with the presence of triphasic waves on EEG?
alzheimers (triphasic = metabolic)
Which neurocognitive disorder will result from infections, trauma or posterior cerebral artery strokes that damage the mesial portion of both temporal lobes?
amnesia
28 yo man has several seizures. Previous evals contributed these to congenital cerebral injury. He is enrolled in a methadone program for narcotic addiction. After stabilization with IV BZD, physician change AED to phenytoin and continue methadone. Several days later, agitation, anxiety to the point of incoherence, diaphoresis, and tachycardia develop. What should be prescribed?
an increase in daily methadone dose (phenytoin induces)
In this synthetic pathway, what does X represent? Tryptophan -> X -> Nacetyl-X -> melatonin
an indolamine (X is serotonin which is an indolamine)
Which statement regarding landau-kleffner syndrome is false?
antiepileptic medications are of no benefit in LKS
Of the following, which medication category will reduce the incidence of neurocognitive disorder due to vascular disease?
antihypertensive medications
which is a cause of obstructive hydrocephalus?
aqueductal stenosis
Through which structure is CSF normally absorbed?
arachnoid villi
Which of the following is the standard therapy for vertebrobasilar artery TIAs?
aspirin
6 signs of phenytoin intoxication
ataxia of gait nystagmus dysarthria lethargy or stupor dysmetria on heel shin testing tremor on finger nose testing
elderly man swallows entire bottle of donepezil. Becomes unconscious, hypotensive, and markedly bradycardic. Which med should be administered?
atropine
Pattern of inheritance of Familial creutzfeld jakob?
autosomal dominant
Pattern of inheritance of huntington disease
autosomal dominant
Pattern of inheritance of Wilson disease?
autosomal recessive
A previously well 8 yo girl who was a gifted chess player, began to develop dystonic movements of her legs that interfered with her after-school athletic activities and incapacitated her every evening. She remained undiagnosed for 18 months. By then, she clearly had dystonia that was present almost throughout the entire day but still worse at night. No family member has a similar problem. Of the following, which is the most likely diagnosis?
b dopa-responsive dystonia
What percent of Parkinson disease patients have anosmia?
b. 90%
Which 3 descriptions pertain to obscenities in Tourette disorder?
b. About 15% or less of patients make obscene vocal tics (coprolalia) D. When they occur, obscene vocal tics develop late in the course e. occasionally, patients make obscene gestures (Copropraxia)
With which of the following dopamine receptor subtypes do all antiparkinson dopamine agonists interact?
b. D2
Which feature distinguishes dementia as a symptom of Parkinson disease from dementia as a symptom of dementia with Lewy Body disease?
b. Dementia is one of the first symptoms of Lewy Body disease but not Parkinson Disease
Which of the following statements concerning Lesch-Nyhan syndrome is false?
b. It is transmitted as an autosomal dominant genetic illness (it is X linked recessive)
Which is the most sensitive screening test for the onset of dementia in Parkinson disease patients?
b. MoCA
Which feature characterizes the childhood variety of Huntington Disease?
b. Rigidity
WHich of the following does NOT describe free radicals?
b. They are stable
Which 4 disorders cause dementia in adolescents? a. CJD b. Wilson Disease c. Choreoathetotic cerebral palsy d. Huntington disease e. subacute sclerosing panencephalitis f. variant CJD g. dopamine responsive dystonia
b. Wilson Disease d. Huntington disease e. subacute sclerosing panencephalitis f. variant CJD
What is the effect of administering allopurinol to Lesch-Nyhan syndrome patients?
b. allopurinol decreases serum uric acid concentrations, but it has no effect on the dystonia or self-injurious behavior
Match illness with inheritance pattern: Wilson disease
b. autosomal recessive
what effect do tricyclic and serotonergic antidepressants exert on REM sleep?
b. decrease it
A psychiatrist is asked to evaluate an immobile, expressionless, mute 21 year old woman who stares straight ahead. The psychiatrist cannot engage her but is able to position her limbs in a variety of positions that she holds for at least 10 minutes. The patient's records reveal a history of a mood disorder. While awaiting a neurology consultation, which of the following is the best initial management of this patient?
b. give a therapeutic trial of a benzodiazepine
since infancy, a 25 yo man has had involuntary, slow, twisting movements of his face, mouth, trunk, and limbs. The neck muscles have hypertrophied. He performs poorly on standard intelligence tests. Which 2 of the following statements regarding his condition are TRUE? a. His children might inherit this condition b. he probably performs poorly on standard intelligence tests, in part, because he is dysarthric and unable to use his hands c. He probably has congenital abnormalities in the basal ganglia d. his condition is not associated with cognitive impairments
b. he probably performs poorly on standard intelligence tests, in part, because he is dysarthric and unable to use his hands c. He probably has congenital abnormalities in the basal ganglia (he probably has athetosis - form of cerebral palsy)
A family brings its 72 yo patriarch for evaluation of dementia that developed during the past 4-6 months. The neuro exam reveals mild rigidity and bradykinesia, as well as a dysfunction in multiple cognitive domains. Which one of the following statements is best applied to the case?
b. his cerebral cortex, as well as substantia nigra, probably contains Lewy Bodies
a 40 yo secretary reports inability to fall asleep, frequent awakenings, and arising hours before necessary. She has excessive daytime sleepiness (EDS) that she attributes to her insomnia. Her PSG shows prolonged sleep latency, frequent arousals interrupting sleep, reduced slow wave and REM sleep, and advanced awakening. Which is the most likely diagnosis?
b. insomnia
Ms Brooks - 54 yo schoolteacher reports insomnia trying to fall asleep at 11 pm. She is active in bed between 11 pm and 2 am. Sleeps from 2 am to 630 am solid until alarm goes off. On weekends, sleeps 2 am to 10 am. Has no EDS on weekends. No mood disorder or psychiatric disturbance. Best treatment?
b. phototherapy and chronotherapy
Match the tremor type with the effective medicine(s)? Hyperthyroidism a. levodopa (L-dopa) b. propranolol (inderal) c. amantadine (symmetrel) d. trihexyphenidyl (artane) e. primidone (mysoline) f. none of the above
b. propranolol
Match the tremor type with the effective medicine(s)? Stage fright (performance anxiety) a. levodopa (L-dopa) b. propranolol (inderal) c. amantadine (symmetrel) d. trihexyphenidyl (artane) e. primidone (mysoline) f. none of the above
b. propranolol
Match the tremor type with the effective medicine(s)? Essential tremor a. levodopa (L-dopa) b. propranolol (inderal) c. amantadine (symmetrel) d. trihexyphenidyl (artane) e. primidone (mysoline) f. none of the above
b. propranolol & e. Primidone
Which TWO structures constitute the lenticular nuclei? a. caudate b. putamen c. globus pallidus d. subthalamic nucleus e. substantia nigra
b. putamen c. globus pallidus
Hospitalized on several occasions during the previous 3 years for progressively severe schizophrenia, a 29 yo man has been readmitted because of paranoid hallucinations and general deterioratin. His psychiatrists reinstituted second generation antipsychotics. Several months later, a psychiatrist notices that the patient's neck spontaneously retroverts (extends) and his limbs straighten. Which is the most appropriate description of this man's movements?
b. tardive dystonia
A 79 yo man under treatment with lithium for bipolar disorder has a fine, rapid tremor of his outstretched hands. What action should the psychiatrist take?
b. the psychiatrist should check the serum concentration of lithium because the patient may have reached a toxic serum concentration
Which is the rate limiting step in dopamine synthesis?
b. tyrosine to L-DOPA
Which of the following statements is true regarding psychogenic movement disorders in children?
b. when psychogenic movement disorders occur in children, they usually mimic tremor, dystonia, myoclonus, or gait impairment
electrocerebral silence
barbituate overdose &/or brain death
Which clinical feature argues against a diagnosis of alzheimers?
behavioral and emotional changes more pronounced than cognitive impairment
EEG pattern with most likely cause: bifrontal beta activity
benzodiazepine use
Lesion of Anton syndrome
bilateral occipital lobes
Which light bulb color alerts people and tends to prevent sleep?
blue
Which group of antidepressants has the greatest likelihood of inducing seizures?
bupropion & clomipramine
Which of the following observations would indicate essential tremor rather than psychogenic tremor in a patient's hand?
c. Administration of a propranolol (a Beta Blocker) or primidone (a congener of phenobarbital) reduces the tremor
After 6 weeks of change in personality, characterized by fearfulness, hyperreligiosity, and easily provoked anger, a 70 yo anesthesiologist consulted a neurologist, who found mild cognitive impairment but no abnormal physical neurologic findings. Routine blood tests, MRI, CSF analysis, and positron emission tomography disclosed no abnmormalities. After another 6 weeks, the neurologist found that the patient had cognitive decline to the point of dementia and small, rapid contractions of the pateint's limb and trunk muscles. WHich is the most likely explanation for the rapidly progressive dementia?
c. CJD
WHich of the following predisposes to parkinson disease?
c. Drinking well water
When neurosurgeons place the electrodes for DBS in Parkinson disease, which region is the target?
c. GPi or subthalamic nucleus
What is the most likely outcome if an asymptomatic individual with a family history of Huntington disease undergoes testing for the Huntington disease mutation and the result indicates that he carries more than 40 alleles?
c. His emotional state will be neutral or he will have some reduced anxiety
Which of the following statements is TRUE regarding sleep and schizophrenia?
c. Individuals with schizophrenia usually remain able to distinguish their dreams from hallucinations
Which of the following characterizes necrosis but not apoptosis?
c. Infiltration of mononuclear cells into the area of cell death
During one weekend, a group of 10 high school freshmen - the entire women's cheerleader team - developed tremulousness of their arms and legs whenever they walked. Also, they began to stutter when they spoke. None of them had fever or any other systemic symptom. Neurologists found no abnormality other than the movements. Which is the most likely diagnosis?
c. Mass hysteria
In episodes of which disorder are the individuals eyes typically open?
c. NREM sleep arousal disorders (sleepwalking and sleep terrors)
Which of the following statements concerning punding is false?
c. No treatment strategy will reverse this complication (reduce dopaminergic agents or add antipsychotic)
Which of the following statements is FALSE concerning somnambulism persisting or developing in adults?
c. PSGs supplemented by EEG leads reveal paroxysms of spike-and-wave activity
A 60 yo priest who had parkinson disease for 4 years has begun to develop episodes of kicking and punching lasting several minutes during his sleep. The episodes differ from each other and do not include incontinence or tongue biting. The man has no recollection of them in the morning. Which of the following tests would most likely reveal the diagnosis?
c. Polysomnogram (PSG)
A neurologist evaluates a 70 yo retired bandleader because he has fallen many times during the previous 6 months. The exam reveals axial rigidity and limb bradykinesia but no tremor. The patient cannot voluntarily look upward or downward, but when the neurologist rocks the pateint's head in a "yes-yes" pattern, the patient's eyes move vertically relative to the head. WHich is the most likely diagnosis?
c. Progressive supranuclear palsy
In the DSM-5, which of the following sleep disturbances may fulfill a diagnostic requirement for PTSD?
c. Recurrent distressing dreams in which the content of the dream is related to the traumatic event
Which of the following precludes a DSM-5 diagnosis of substance/medication induced sleep disorder?
c. Symptoms occur exclusively during delirium
The family of a patient with Parkinson disease brings him to a physician because of frightening nightmares. Another problem is that, despite taking a long-acting, controlled-release levodopa preparation (Sinemet CR) at bedtime, he awakes in the morning with rigidity. What change in medication would be most helpful?
c. Take only a regular levodopa preparationin the early evening and another immediately upon awakening in the morning 20-30 minutes before getting out of bed.
Which one of the following movement disorders is NOT accompanied or preceded by an urge to move?
c. Tremor
Match illness with inheritance pattern: DYT1 dystonia
c. autosomal dominant
Match illness with inheritance pattern: Huntington disease
c. autosomal dominant
By which mechanism does botulinum toxin treat blepharospasm and other focal dystonias?
c. botulinum toxin impedes release of Ach from the presynaptic neuron at the neuromuscular junction neuron
Why is carbidopa combined with levodopa for treatment of parkinson disease?
c. carbidopa inhibits metabolism of levodopa
Alzheimers patient becomes more confused. She is drooling, sweating and has miosis. BP is 95/50, pulse 48, temp 98.6. Which is most likely cause of patient's symptoms? a. advance of alzheimers disease b. intercurrent illness - ie pneumonia c. excessive cholinergic activity d. excessive anticholinergic activity
c. excessive cholinergic activity
Which of the following medicines is most likely to elevate the serum prolactin concentration?
c. haloperidol
What is the mechanism of action that permits propranolol to suppress essential tremor?
c. it blocks adrenergic sympathetic nervous system receptors
In the treatment of depression in Parkinson disease patients, which of the following statements is TRUE?
c. selegiline may have an activating effect
Charlie, a 35 yo woman, sought psychiatric consultation for mild depression, insomnia, and obesity. When discussing her obesity, which seems refractory to her stringent diet, charlie mentions that she cannot recall eating at night; however she states that in the morning she occasionally finds open tuna cans and once an open cat food can on the kitchen floor. Which is the most likely explanation of the debris on the kitchen floor?
c. sleep-related eating
Which medication will deplete dopamine from its presynaptic neurons and reduce hyperkinetic movement disorders, such as tics, chorea, and varieties of tardive dyskinesia?
c. tetrabenazine
WHich TWO of the following characteristics accurately describe dementia in Parkinson disease? a. it responds to levodopa b. it responds to dopamine agonists c. thought processes are typically slow d. Patients have difficulty shifting mental sets e. Aphasia and apraxia are typical manifestations of the dementia
c. thought processes are typically slow d. Patients have difficulty shifting mental sets
In rating the potential teratogenic risks of AEDs which group carries the FDA label of Category D (dangerous)?
carbamazepine and valproate
Stroke patient has extreme outrage and reacts poorly to news that he has a new stroke. What is this called?
catastrophic reaction
Which of the following is the LEAST significant risk factor for interictal psychosis?
certain EEG patterns
WHich group of antipsychotics has the greatest likelihood of inducing seizures?
chlorpromazine, clozapine
Which of the following psychotropics is most likely to cause a seizure?
clozapine
Neuritic plaque
cluster of degenerating nerve terminals surrounding an amyloid core
Medical intern awakens from sleep after working 24 hour call. Speaks incoherently. Does not remember the call. What is the term for this?
confusional arousal
Which of the following are intranuclear inclusion bodies
cowdry bodies
At what daily dose does caffeine consumption lead to caffeine toxicity?
d. 250 mg
A 45 yo diabetic man undergoing evaluation for erectile dysfunction fails to have erections during nocturnal penile tumescence (NPT) studies. Which of the following is the least likely explanation?
d. Anxiety
Which is the most common situation or emotion that precipitates cataplexy in individuals with narcolepsy-cataplexy?
d. Hearing or telling a joke
Which of the following is not a parkinson-plus syndrome? a. Multiple system atrophy (MSA) b. Corticobasal degeneration c. Progressive supranuclear palsy d. MPTP-induced parkinsonism
d. MPTP-induced parkinsonism
Into which category does DSM-5 place sleep-related sexual behavior disorder (sexomnia)?
d. NREM parasomnia
34 yo woman develops uncomfortable sensation in her feet which she cannot describe. Forces her to rub her feet and calves at night and cannot sleep. Only able to relieve by pacing for 1-2 hours. No ongoing medical illnesses and no medications. Neuro exam normal. Which lab study is inappropriate? a. serum ferritin b. pregnancy c. BUN or creatinine d. PSG
d. PSG (polysomnogram) Patient is awake. She has RLS.
Which statement is true regarding early-onset primary (DYT1) dystonia?
d. The disease is most frequent among Ashkenazi (Central and Eastern European) Jews.
Which Parkinson disease feature has the least correlation with dementia?
d. Tremor
Which one of the following nuclei is unpigmented?
d. anterior thalamic
John-Phillip, 17 yo has spent the summer starting a band. He went to sleep every night at 4 am. Anticipating the start of school on September 1, he requests that his physician prescribe an "upper" to help him remain awake during the transition. What would be the best method to change to a sleep schedule of 11 pm to 630 am?
d. delay sleep by 1 hour each night beginning August 11th
Which two of the following are considered "synucleinopathies"? a. Alzheimer disease b. frontotemporal dementia c. progressive supranuclear palsy d. dementia with Lewy body disease e. Parkinson disease
d. dementia with Lewy body disease e. Parkinson disease
For patients with depression comorbid with parkinson disease, which treatment will be least effective?
d. dopamine agonists
Which of the following statements regarding genetically determined parkinson disease is FALSE?
d. genetically determined parkinson disease cases comprise less than 1% of total cases (they comprise up to 10%)
A psychiatrist is asked to evaluate a 70 yo retired write who has developed visual hallucinations. An opthalmologist had only found mild visual impairment. During the past year, the patient had developed cognitive impairments that, according to his family fluctuate from day to day. The patient has mild slowness of movement and generally increased muscle tone. HIs neurologic examination is otherwise normal. The psychiatrist prescribes small doses of haloperidol. Several days later, the patient becomes rigid, akinetic, and unable to speak or eat. Of the following, which is the most likely underlying scenario?
d. he has dementia with Lewy Body disease
What is the implication of a patient's falling backward during the pull test?
d. impaired postural reflexes
A 69 yo retired dentist with advanced Parkinson disease underwent emergency abdominal surgery. The surgery and immediate postoperative period were uncomplicated, but the next day he developed agitation and confusion. A psychiatrist found that the patient was disoriented, incoherent, febrile, and rigid. Which is the most appropriate diagnosis?
d. neuroleptic malignant syndrome
After admission to a psychiatric unit for the onset of major depression with suicidal ideation, a 78 yo man was found to have continuous aimless tongue protrusion and some lip smacking. He had lost all of his teeth when he was a young man. Because of his recent weight loss, his denture no longer fit and he had given up wearing them. Before diagnosing tardive dyskinesia, which treatment should the medical staff institute?
d. obtaining properly fitting dentures
30 yo woman admitted for cocaine intoxication has incessant movements of her feet. She claims that she "must" walk constantly. When forced to sit, she continually abducts and adducts her legs and shuffles her feet. She is belligerent, but alert and without cognitive impairment. Which of the following is the most likely cause of her leg movements and walking?
d. persistent cocaine effect
Which is the expected benefit of DBS in Parkinson disease patients?
d. reverses bradykinesia and tremor
When falling asleep, 5 yo girl thrusts her head up and down on the pillow. Parents can rouse her and interrupt movements. Does not injure herself and if left alone, falls asleep in 5 minutes. Otherwise well. Correct statement regarding this activity?
d. the movement is "head banging," a variety of rhythmic movement disorder
Shortly after the ER physicians administered small IM dose of Haloperidol to and IV drug user with dangerous agitation and psychotic thinking, the physicians noticed that muscles throughout his entire body wer having intermittent by powerful contractions. His temperature was 103 F. His CK was 350 mg/dl. The physicians found an abscess deep in his left thigh. As the evaluation continued, laryngeal and pharyngeal contractions made his breathing difficult, his face intermittently grimaced, and his jaw clenched. Touching the patient triggered intense muscle contractions. They administered broad spectrum Abx for the infection, but anticholinergics and antihistamines did not correct the muscle contractions. Which condition best explains muscle contractions?
d. the thigh infection (trismus d/t tetanus from the thigh infection)
WHich one of the following enzymes increases the concentration of L-DOPA?
d. tyrosine hydroxylase
Cerebral Ach Effect of: scopolamine
decrease
waxing and waning of mental status
delirium
Histologic finding with disease: lewy bodies
dementia with lewy bodies
Which feature occurs more frequently in neuro-cognitive disorder due to vascular disease than in alzheimer dementia?
depression
Of the following, which is most often cited as the reason for placing alzheimer's patients in nursing homes?
disruptive behavior
What is DSM5 requirement for insomnia disorder?
distress or impairment in social, occupational, or other important area of functioning
EEG pattern with most likely cause: rapid extraocular movement artifact
dream filled sleep
Which of the following statements regarding dementia in Parkinson disease is true?
e. Dementia is more likely to complicate "non-tremor-predominant" than "tremor-predominant" Parkinson disease
A 70 yo man, under treatment for depression for 10 years, has begun to develop intermittent bilateral contractions of the orbicularis oculi. His medications included a TCA until 2 years ago, when physicians substituted an SSRI. He had a good response to the change. He has undergone two courses of ECT. The involuntary movements impair his ability to read and intensify the depression. WHat would be the best treatment?
e. administer injections of botulinum toxin (blepharospasm not related to meds nor ECT)
A nursing home's medical director sought a psychiatry consultation for a resident - a 70 yo retired disc jockey with moderately severe Parkinson disease - who recently had been refusing to attend rehabilitation and occupational therapy. On questioning by the psychiatrist, the patient was alert and generally oriented with preserved cognitive ability; however, she judged that he had depression. Which of the following statements regarding depression in this situation is most correct? a. when comorbid with parkinson disease, depression worsens cognitive impairment b. comorbid depression is a potential explanation for this patient's responding poorly to medical and physical therapy c. comorbid depression interferes with Parkinson disease patients' sleep d. comorbid depression interferes with parkinson disease patients' ability to adjust to limitations imposed by the illness e. all of the above
e. all of the above
Which of the following hypnotics is free of the risk of complex sleep-related behavior? a. ramelteon (rozerem) b. Eszopiclone (lunesta) c. Zolpidem (ambien) d. Zaleplon (sonata)
e. none of the above
Which findings are present on CT or MRI in alzheimer's disease?
enlarged third ventricl and atrophy of hippocampus
Which of the following is/are readily transferred through breast milk? a. topiramate b. lamotrigine c. phenobarbital d. ethosuxamide e. zonisamide f. all of the above
f. all of the above
Which statement about saccades is FALSE?
f. neurologists consider saccadic eye movements to be normal if fixation eventually comes to rest on the target, whether or not it initially undershoots or overshoots it
Match the tremor type with the effective medicine(s)? Delirium tremens a. levodopa (L-dopa) b. propranolol (inderal) c. amantadine (symmetrel) d. trihexyphenidyl (artane) e. primidone (mysoline) f. none of the above
f. none of the above
EEG abnormality with seizure type: interictal temporal lobe spikes
focal seizures with altered consciousness
EEG abnormality with seizure type: occipital spike and wave
focal seizures with visual phenomena
suppression of seizure activity and conversion to a normal EEG that may trigger psychosis
forced normalization
77 yo telling off color jokes, ignoring prompts, urinates on himself. What area of brain is responsible for such behavior?
frontal lobe
4 yo boy develops sudden aphasia and right sided hemiparesis. No indication of trauma. CT confirms L MCA stroke. Blood tests reveal marked lactic acidosis. Results of sickle cell testing and homocysteine levels are normal. WHich of the following would be the most appropriate diagnostic test?
genetic testing
EEG pattern with most likely cause: triphasic waves
hepatic encephalopathy
In which four conditions will an EEG be helpful in suggesting a specific diagnosis?
hepatic encephalopathy CJD Psychogenic non-epilleptic seizures SSPE
In alzheimers, which region of the brain contains the greatest concentration of amyloid plaques?
hippocampus
In B12 deficiency, which two serum constituents rise?
homocysteine and methylmalonic acid
Of the following which is the most powerful stroke risk factor? Type A personality High cholesterol diet obesity cigarette use hypertension lack of exercise
hypertension
Which of the following is the most important cause of neurocognitive disorder due to vascular disease?
hypertension with small vessel disease
Which is the most frequently occurring electrolyte abnormality associated with cabamazepine or oxcarbazapine?
hyponatremia
carbamazepine is used in treatment of epilepsy patients with depression. Which of the following medications has a chemical structure most similar to carbamazepine?
imipramine
Cerebral Ach Effect of: cholinesterase inhibitors that penetrate the blood brain barrier
increase
Cerebral Ach Effect of: organic phosphate insecticides
increase
Which sleep change represents a beneficial effect of benzodiazepines?
increase in total sleep time of 10%
What is the effect of drinking large quantities of grapefruit juice on the serum concentration of carbamazepine?
increased concentrations
Which feature is usually absent in CJD?
inflammatory cells in cerebral cortex biopsies
Which of the following statements regarding rolandic epilepsy is true?
it also called childhood epilepsy with centro-temporal spikes
Which statement is false regarding the gait of the normal elderly?
it is characterized by apraxia
Which of the following AEDs is most closely associated with medication-induced psychosis, depression, and hostility?
levetiracetam
which of the following AEDs is least likely to cause osteopenia?
levetiracetam
When used a hypnotics for chronic insomnia, BZDs have many potential adverse effects. Which one of the following is not an adverse effect of BZDs?
lowered seizure threshold
45 yo w/ AIDS and CD4 of 50 develops generalized dull headache and inability to concentrate. Temp of 101. No focal findings or indication of increased ICP. An MRI shows no intracranial pathology. Which of the following would be the best diagnostic test?
lumbar puncture
In which condition is a polysomnogram most likely to show consistent abnormalities?
major depression
Which of the following would be least statistically significant risk factor for stroke? periodontal disease marijuana use cocaine use elevated C-reactive protein elevated homocysteine levels
marijuana use
Presenting feature of: Alzheimers
memory impairment
in which part of the skull are the temporal lobes situated?
middle fossa
Which of the following terms best describes the patient's condition?
minimally conscious state
Which is not a domain of cognitive function?
mood
Which pattern is most likely found on positron emission tomography (PET) and single photon emission computed tomography (SPECT) in an individual with neurocognitive disorder due to vascular disease?
multiple scattered hypometabolic regions
withdrawal from daily use of which substance is unlikely to cause seizures?
nicotine
Hoover sign positive when?
no effort with opposite side
25 yo woman with anxiety reports frequent episodes of frightening thoughts that jar her awake from sleep. Can recall her fears and is oriented and coherent upon awakening. Remains awake for an hour before returning to sleep. PSG shows that episodes arise from NREM sleep and the EEG electrodes do not show paroxysmal discharges. Most likely diagnosis?
nocturnal panic attacks
EEG pattern with most likely cause: alpha rhythm
normal resting state
EEG pattern with most likely cause: Delta activity, phase reversed over left posterior cerebrum
occipital lobe tumor
Psychiatrist prescribes olanzapine to an individual who drinks 6 cups of coffee each day. What effect will the coffee have on concentration of OLZ?
olanzapine concentration will be unexpectedly high
Which feature distinguishes cases of alzheimer's attributable to trisomy 21 from those associated with Apo-E4 on chromosome 19?
onset in the 4th/5th decades
Neurofibrillary tangles
paired, hyperphosphorylated helical filaments
excitement instead of sedation, especially with phenobarbital treatment of children and brain damaged adults
paradoxical hyperactivity
Presenting feature of: dementia with Lewy Bodies
parkinsonism and REM sleep behavior disorder
Which variety of seizure do physicians most often mis-diagnose as PNES?
partial complex seizure that originates in the frontal lobe
Lesion of Wernicke korsakoff
periventricular gray matter, mamillary bodies
Which of the following characteristics is least closely associated with poststroke depression?
poststroke psychosis
EEG pattern with most likely cause: unilateral cerebral theta and delta activity
psychosis
52 yo woman with treatment refractory seizures undergoes lobectomy, but she has developed postoperative anxiety, fearfulness, dysphoria, and "moodiness." How to restore preoperative mental status?
reinstitute AED, such as VPA
Which one of the folowing is a typical finding in a 65 yo male with Transient Global Amnesia?
retaining ability to recall his name and address
Which region of the brain is most affected by toxic-metabolic encephalopathy?
reticular activating system
which of the following conditions most often persists after ECT?
retrograde amnesia
Lesion of anosognosia for left hemiparesis
right parietal lobe
What is the effect of pregnancy on seizure frequency?
seizures tend to increase in frequency
WHich of the folllowing DSM5 requirement for the diagnosis of Hypersomnolence Disorder?
self-reported excessive sleepiness despite sleeping 7 hours
Which of the following statements concerning melatonin is true?
serotonin is a precursor in its synthesis
Which characteristic is common to the sleep pattern of both depression and sleep following sleep deprivation?
shortened REM latency
Which statement is false regarding the infective agent in spongiform encephalopathies?
similar agents cause subacute sclerosing panencephalitis
In minimally conscious state, what would EEG show?
slow and disorganized background activity
Which is the most important factor in determining most individuals sleep schedule?
social and occupational demands
Histologic finding with disease: cowdry bodies
subacute sclerosing panencephalitis
Which statement regarding depression in epilepsy patients is true?
the addition of a second or third AED to an anticonvulsant regimen is a risk factor for suicidal ideation
Which of the following statements most closely describes the course of poststroke depression in the majority of cases?
the incidence of major depression peaks 3-6 months after a stroke and has a mean duration of 6-9 months
Which statement regarding the EEG in a normal resting awake person, with eyes closed, is false
the normal background rhythm is low voltage and "fast" (Should be medium and slow)
Inducer of CYP 3a4 enzymes administered to patient on carbamazepine. What would happen to its concentration?
the plasma concentration of carbamazepine would decrease
EEG abnormality with seizure type: generalized spike and polyspike and wave
tonic-clonic seizures
Which of the following AEDs leads to weight loss?
topiramate
28 yo man with mild generalized headache has had a 3 day history of increasing left arm weakness and clumsiness. Examination reveals only mild left arm weakness and hyperactive DTRs. Routine medical evaluation reveals no abnormalities. Both CTs and MRIs show five large ring-enhancing cerebral lesions. Of the following, which is the most likely cause of his neurologic difficulties?
toxoplasmosis
T or F? in terms of psychotropic induced EEG changes, clozapine, olanzapine, and trifluoperazine produce the most, and quetiapine, loxapine, and haloperidol the least
true
T or F? lithium at toxic levels, clozapine, and TCAs may cause EEG spikes and sharp waves
true
which application of ECT is least likely to produce amnesia?
unilateral, nondominant hemisphere
Of the following risk factors for falls in elderly, which is most statistically powerful?
use of sedatives
Which of the following AEDs is an inhibitor of P450 enzymes?
valproate
Which two statements regarding the relationship of interictal violence to epilepsy are true?
violence tends to occur in schizophrenic or mentally retarded epilepsy patients, but rarely in other epilepsy patients & Crimes of adult epileptic incarcerated criminals are no more violent than those of nonepileptic ones
In which direction is travel most likely to produce jet lag?
west to east
Which of the following statements is true concerning the risk of seizures with clozapine use?
with increasing dosage of clozapine, the risk of seizures increases but the risk of agranulocytosis remains constant