neuro clinical vignettes
You are assessing a patient who recently experienced a partial seizure. As the physician assistant, you know that which statement by the patient indicates the patient may have experienced a focal impaired awareness (complex partial) seizure? A. "My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this." B. "I remember having vision changes, but it didn't last long." C. "I woke up on the floor with my mouth bleeding." D. "After the seizure I was very sleepy, and I had a headache for several hours."
"My friend reported that during the seizure I was staring off and rubbing my hands together, but I don't remember doing this."
A 60 y/o Asian male presents to the ED complaining of a sudden severe headache, nausea, and dizziness that occurred as he was having some drinks at a local bar. He has a PMI of alcohol abuse and used to be an avid cocaine user. The patient is A&Ox 3, w/ a BP of 158/92, However his pupils are unequal in size and are responding inappropriately to light stimulation. CT imaging suggests no masses but a finding of blood localized within the brain tissue. Which of the following is the most likely cause of this patients headache? a. Epidural hematoma b. Chronic subdural hematoma c. Intraparenchymal Hemorrhage d. Ruptured cerebral aneurysm
Chronic subdural hematoma
A 38 yr old female comes to the office because of intermittent blurring of vision in her right eye for 1 year. She says these episodes usually last a week, and then completely resolve. Other symptoms she has intermittently experienced are difficulty in maintaining balance while walking and urinary urgency. An MRI scan of her brain is obtained and revealed plaques. What is the most likely diagnosis? A. ALS B. MS C. Bell Palsy D. Myasthenia Gravis
MS
After a long tour around the world, a Pianist starts noticing pain, numbness, tingling in the first 3 digits and radial half of 4th digit at night time. What is your diagnosis, and what is the proper treatment? a. Ulnar Neuropathy, Treatment:NSAIDs b. Ulnar Neuropathy, treatment: Padding elbow c. Median Neuropathy, Treatment: NSAIDs d. Median Neuropathy, Treatment: Padding elbow
Median Neuropathy, Treatment: NSAIDs
A 35 yo female patient with a h/o diabetes and obesity presents to your office complaining of a loss of sensation on the median side of her palm from her thumb to her ring finger. She has been experiencing an aching and shooting pain in the area and this morning felt weakness and had difficulty pouring her coffee. She denies any arm or dorsal hand weakness/pain. What is the likely diagnosis? A. Median neuropathy (Carpal Tunnel Syndrome) B. Cervical radiculopathy C. Ulnar neuropathy D. Radial neuropathy
Median neuropathy (Carpal Tunnel Syndrome)
Your patient is 65 years old and C/O intermittent neurologic dysfunction and speech disturbances that lasted for 30 minutes. You immediately think it may be from a transient ischemic attack (TIA). What is the patient's ABCD2 score and risk of stroke? Patient is not on any medications and has no significant PMH. BP: 136/82. Physical Exam shows no weakness. A. 6, High risk B. 4, Moderate risk C. 3, Moderate risk D. 3, Low risk
3, Low risk
A mother comes in c/o unusual behavior/language in her 14 y/o daughter, Lindsay. Mom reports random episodes of angry cursing and mocking of her words, and wants to know if there is something wrong with her brain as Lindsay denies having any control over her actions during these episodes. What are possible courses of treatment for Lindsay? a. Behavioral therapy and reassurance that most patients outgrow this disorder by adulthood b. Alpha adrenergic agonists c. Antipsychotics d. Surgery e. Botulinum toxin f. All of the above
All of the above
A 70 year old man was brought in the ED for left sided weakness for 1 hr. The reports that he suddenly could not move his leg at home. Pt denies history of bleeding disorders or recent surgery but admits to PMHx of hypercholesterolemia, HTN, AFib, and tobacco use. His PE shows 5/5 strength in LUE and 1/5 strength in LLE with a decrease in sensation in the left leg and foot. CT showed no hemorrhages. What is the next best step in treatment? A) Alteplase B) ASA C) Clopidogrel D) Warfarin
Alteplase
A 72 y/o man with a with a PMHx of diabetes mellitus, renal insufficiency, and HTN presents to the clinic complaining of burning and tingling pain in his feet. What agent would you prescribe? a) Phenobarbital b) Amitryptyline c) Celecoxib d) Codeine
Amitryptyline
A 70 y/o male presented with difficulty with swallowing, chewing, and speaking. PE reveals loss of ability to initiate and control motor movements. Electromyography which shows widespread denervation changes. What is the likely diagnosis in this patient? A. Amyotrophic Lateral Sclerosis (ALS) B. Tourette disorder C. Trigeminal neuralgia D. Bell Palsy
Amyotrophic Lateral Sclerosis (ALS)
A 9 - year-old male patient is being evaluated for seizures. While in the child's room talking with the child's parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn't recall the event. This is known as what type of seizure? A. Focal Impaired Awareness (complex partial) B. Atonic C. Tonic-clonic D. Absence
Absence
A 6th grade student is at school and feeling very anxious about an upcoming test today. During lunch prior to the test, he was talking to his friend, when all of the sudden his friend explained that he started staring into space, while sitting upright, and not responding to the questions he was asking him. His friend started tapping him on the shoulder, but he didn't react. The friend reports this lasted about 30 seconds. When his friend told him this after he was alert again, he didn't believe that had just happened. What type of neurological issue might this student have? A. ADHD B. Generalized Tonic/Clonic Seizures C. Absence Seizures D. Status Epilepticus
Absence Seizures
Mother presents to your office concerned that her 8 year old child is not paying attention during class. She reports the child's teacher says he is often staring into space blinking repeatedly and doesn't respond to questions. She is concerned that he may have a learning disability. What is in your differential and what test will you order? A. Hearing loss, audiogram B. Absence seizure, EEG C. Tourette's disorder, no diagnostic testing D. Generalized anxiety disorder, psychiatric referral
Absence seizure, EEG
Per EMS report the patient, a 17 Year old female, was standing at her locker at school when she suddenly collapsed and started to seize. Patient has recently been complaining of headaches And her family states that there is a familial history of Sudden brain bleeds. What is the most likely diagnosis and what imaging is the gold standard? A) Hemorrhagic Brain Tumor: CT angiography B) Arteriovenous Malformation: Cerebral angiography C) Subdural Hematoma: CT Scan D) Epidural Hematoma: MRI
Arteriovenous Malformation: Cerebral angiography
A 24 y/o male presents to the ER very ill. Patient complains of headache,fever, and nuchal rigidity. Suddenly, he gets confused as he is trying to describe his symptoms. Kernig and Brudzinski sign are positive. Results from the lumbar puncture of CSF are the following: very elevated WBC, protein elevated, and glucose is low. What type of meningitis does the patient have? A) Fungal meningitis B) Bacterial meningitis C) Viral meningitis D) None of the above
Bacterial meningitis
what is a rescue medication used for partial seizures with a focal discharge? a. Benzo b. Kepro
Benzo
Your 50 y/o pt tells you they are adopted and have an unknown family history, and are concerned because last year they were diagnosed with an essential tremor and were unsuccessfully treated, and is having more motor movements than before, and saw on WebMD something called Huntington's disease. You perform a neurological exam and find tremors that are more progressed unilaterally, rigidity, shuffled gait, and increased tone in his limbs. What will his MRI show? A. Caudate atrophy B. White matter focal lesions C. Brain imaging is normal D. Atrophy of substantia nigra
Brain imaging is normal
A 46 years old man comes to the emergency department because of the sudden onset of inability to move the right side of his face. Physical examination shows drooping of the corner of the mouth. Motor examination shows difficulty smiling and puffing out the cheeks; no abnormalities are noted in raising the eyebrows or wrinkling the forehead. Which of the following is the most likely the nerve damage of these findings? a. CN 5 b. CN 7 c. CN 10 d. CN 8
CN 7
A 58 year old asain male patient is rushed into the ER because of a worsening headache , nausea, vomiting, contralateral hemiplegia, and contralateral hemiparesis. He is lethargic and having episodes of altered mental status. His past medical history consists of hypertension. The patient is also a fond user of cocaine. You completed your physical exam and you rate his ICH score to be of a score of 4. What is your diagnostic tool of choice and what does his prognosis look like? A: CT of head , mortality rate of 20% B: CT of head with contrast, mortality rate of 90-100% C: MRI with 100% mortality rate D. CT of head without contrast mortality rate of 90-100%
CT of head without contrast mortality rate of 90-100%
A 51-year-old man with no significant past medical history comes to the office complaining of difficulty walking x3 days. He initially felt weak in both feet, but now the weakness has spread across both lower legs. He also states that he got food poisoning after eating some sketchy chicken last week. His labs show elevated albumin in his CSF. Which of the following organisms was this patient likely infected with prior to his difficulty walking? a. Campylobacter jejuni b. Klebsiella pneumoniae c. E. Coli d. D. Salmonella
Campylobacter jejuni
A mother brings her 17 year old daughter to the ED for having a seizure during dinner. The patient is confused but remembers having "deja vu" at the dinner table but otherwise does not recall the event. Her mother reports that during the seizure, her daughter started smacking her lips and then "passed out". A. Absence Seizure B. Simple Partial Seizure C. Complex Partial Seizure D. Tonic/Clonic Seizure
Complex Partial Seizure
A 7-year-old boy comes to the emergency department because he has been experiencing several staring episodes during which he was unresponsive to those around him. These episodes are often accompanied by lip smacking. After the episodes the boy continues on with his daily activities, and does not realize he has suffered an unresponsive episode. Which of the following is the primary diagnostic test for this patient's disorder? A. Electroencephalogram B. Echocardiogram C. MRI D. Cardiac stress test
Electroencephalogram
A 30 y/o woman comes to the office because of intermittent blurry vision in her right eye for the past 3 years. She says these episodes usually last a few weeks, and then completely resolve. At other times, she has noticed blurring of the vision in her left eye, and pain while moving her affected eyes. She has also experienced difficulty in maintaining balance while walking, as well as urinary urgency. Which of the following is most likely to be found during further investigations? A. Elevated intracranial pressure B. Elevated hemoglobin A1C C. Atrophy of the cerebral cortex D. Death of upper and lower neurons E. Elevated IgG in CSF
Elevated IgG in CSF
Which of the following findings is characteristic of lower motor neuron deficit? a. Hyperreflexia b. Clasp knife rigidity c. Dysdiadochokinesis d. Flaccid paralysis e. Sensory loss
Flaccid paralysis
A 64-yr-old female comes to your office complaining of new worsening HA, some weakness and sudden nausea & vomiting. You order a CTH and notice multiple lesions in the brain. What is your next step in diagnosing this patient? A. Biospy B. Lumbar puncture C. Cerbral angiography D. Full body scan
Full body scan
A 27 year-old female presents to your office for evaluation of weakness, visual loss, and sensory loss over the right great toe. These symptoms have occurred during three episodes approximately three months apart with each episode lasting about three days. Which of the following tests would be most useful in further evaluating this patient? A. MRI of the brain B. Electromyograph C. Glucose tolerance test D. Electroencephalograph
MRI of the brain
A 16 y/o autistic girl was standing in the living room with her family. All of a sudden she drops to the floor losing consciousness. Her brother noticed her extremities stiffen and her legs and arms starts to jerk erratically. She was in this state for 2 minutes, afterwards it stopped and she went into a deep sleep. If this patient had an EEG on her while she had a seizure what type of wave patterns would you expect? A. 3hz spike wave pattern B. Focal discharges near the focus C. Generalized spike waves D. Alpha waves
Generalized spike waves
A 50-yr-old pt comes to your office complaining of new jerky movements that he cannot control. In your history you find he has some recent depression and has been forgetful. He mentions that his grandfather had something like this but never knew his diagnosis. What test would you do to help you definitively determine your dx? A. MRI B. Genetic testing C. Blood test D. Nerve conduction study
Genetic testing
A 54 yo male smoker presents with vague headaches with associated vomiting that awakens him from sleep occasionally or occurs when waking up. This has been happening for about 2 weeks. The headache usually resolves about an hour into his morning routine. The patient is afebrile. What is the cause of this patient headaches? A. Cluster headaches B. Migraines C. Glioblastoma D. Giant Cell Arteritis
Glioblastoma
A 45 year old women arrives at your primary care office c/o back pain. She has noticed over the past couple weeks that she is having trouble at the gym with leg exercises that she has been doing for years. What diagnostic test should be ordered first to further diagnose this patient? A. MRI w/ contrast B. MRI w/o contrast C. Genetic testing D. CT
MRI w/ contrast
A 52-year-old man comes to the clinic because of severe headaches that are worse in the morning and not relieved by over the counter painkillers for the past several months. His colleagues also report he has been more forgetful and has had increasing difficulty concentrating and completing tasks at work. Physical examination shows that he is afebrile and has no vision changes or nuchal rigidity. Neuro exam is unremarkable. CT imaging of his head shows a large heterogeneous right hemispheric mass. Magnetic resonance imaging with and without contrast shows a heterogeneous enhancing lesion in the right temporal lobe with hypodensities suggested central necrosis. What is the most likely diagnosis? A) Glioblastoma Multiforme B) Meningioma C) Meningitis D) Pseudotumor cerebri
Glioblastoma Multiforme
27 y/o female presented to the ED earlier today experiencing neurological symptoms. She received a CT head where she was diagnosed a primary parietal brain tumor. Which of the following was most likely her presenting "neurological symptom"? a. Personality changes & Urinary incontinence b. Hemianesthesia & receptive aphasia c. Olfactory Hallucinations & behavioral changes d. Gait abnormalities & difficulty concentrating
Hemianesthesia & receptive aphasia
A 60-year-old patients develops a sudden severe headache followed by a decreased level of consciousness. Blood work and a computed tomography (CT)scan of the head without contrast are normal. What is the most appropriate next step in evaluating this patient? A. CT scan of the head with contrast B. Electroencephalography (EEG) C. Lumbar puncture D. Magnetic resonance imaging (MRI) of the brain E. Tilt-table testing
Lumbar puncture
A 18 y.o patient was eating some french fries with his friends when all of a sudden the patient slouches over. The patient then begins shaking uncontrollably all over his body. His friends quickly call 911 and he is sent to the hospital. Throughout the short ambulance ride, the patient would slowly come to, but then all of a sudden would return to shaking. This happened 5 times on the way to hospital and he is slowly regaining consciousness on the way in. You are the emergency PA on staff. What EEG finding would you most likely find based on the symptoms and what treatment would you provide? A. EEG shows 3Hz spike waves; Ethosuximide (Zarontin) B. EEG shows focal discharges; IV Levetiracetam C. EEG is normal; IV Benzodiazepines D. EEG shows focal discharges; immediate surgical resection of seizure focus E. EEG shows generalized spike and wave patterns; Lamotrigine (Lamictal)
EEG is normal; IV Benzodiazepines
What would the EEG show and what treatment do you provide for absence seizures? A. EEG shows 3Hz spike waves; Ethosuximide (Zarontin) B. EEG shows focal discharges; IV Levetiracetam C. EEG is normal; IV Benzodiazepines D. EEG shows focal discharges; immediate surgical resection of seizure focus E. EEG shows generalized spike and wave patterns; Lamotrigine (Lamictal)
EEG shows 3Hz spike waves; Ethosuximide (Zarontin)
what would the EEG show and what treatment do you provide for partial seizures? A. EEG shows 3Hz spike waves; Ethosuximide (Zarontin) B. EEG shows focal discharges; IV Levetiracetam C. EEG is normal; IV Benzodiazepines D. EEG shows focal discharges; immediate surgical resection of seizure focus E. EEG shows generalized spike and wave patterns; Lamotrigine (Lamictal)
EEG shows focal discharges; IV Levetiracetam
what would you find on EEG and what treatment would you provide for a patient with generalized tonic-clonic seizures? A. EEG shows 3Hz spike waves; Ethosuximide (Zarontin) B. EEG shows focal discharges; IV Levetiracetam C. EEG is normal; IV Benzodiazepines D. EEG shows focal discharges; immediate surgical resection of seizure focus E. EEG shows generalized spike and wave patterns; Lamotrigine (Lamictal)
EEG shows generalized spike and wave patterns; Lamotrigine (Lamictal)
35 y/o female runner mentions she has over the past couple months she has been experiencing pins and needs to her legs that only lasts for a couple hours. When this happens she is fatigued, and has an uncoordinated gait. You order an head CT which is inconclusive, her MRI shows white matter lesions, and her LP has elevated IgG. What would you prescribe for this patient? A. Corticosteroids and Diazepam B. Anticholinergics C. Levodopa D. Corticosteroid and Anticholinergic
Corticosteroids and Diazepam
A 74 y/o man comes in for his annual physical with a PMH of DM and HTN. You notice that he shuffled his way into the exam room and sat hunched over in the chair. During the exam, you also notice extremely shaky hands at rest, but when he reached over to pick up his glasses, his hands appeared to become more steady. You also notice that his arms appeared rigid while reaching over for his glasses. What is the most likely cause of his symptoms? A. ACh deficiency B. Serotonin deficiency C. Dopamine deficiency D. Oxytocin deficiency
Dopamine deficiency
what is the EEG finding and what treatment would you provide for a patient who is STATUS epilepticus? A. EEG - 3Hz spike waves; tx - Ethosuximide (Zarontin) B. EEG - focal discharges; tx - IV Levetiracetam C. EEG - normal; IV Benzodiazepines D. EEG - focal discharges; immediate surgical resection of seizure focus E. EEG - generalized spike and wave patterns; Lamotrigine (Lamictal)
EEG - 3Hz spike waves; tx - Ethosuximide (Zarontin)
A 15 y/o male is brought into the ED for skateboarding straight into a wall with no helmet. While receiving report from the first responders who brought him in, they mention the patient was unconscious when they arrived but is awake now. They also mention that the patient has a skull fracture on the right side of his head, and while en route to the hospital they observed a blown right pupil. Since you're a superstar, you ordered a CT of his head upon arrival. What do you suspect is going on with this patient? His CT can be found below: A. Subarachnoid Hemorrhage B. Intracranial Hemorrhage (ICH) C. Subdural Hematoma D. Epidural Hematoma
Epidural Hematoma
An 8 year old boy is brought to the ED by his mother because he fell off the swingset in the backyard. His little sister was screaming for their mother because her brother was "asleep" after landing on his head. By the time their mother got out there, the boy was awake and walking around but was confused about what happened. His GCS is 7 upon arrival and his pupils are dilated. A head CT is ordered. Which of the following do you expect to be his diagnosis? A. Acute Subdural Hematoma B. Chronic Subdural Hematoma C. Epidural Hematoma D. Intraparenchymal Hemorrhage
Epidural Hematoma
Emily, a 35 y/o F, was skiing when she crashed into a tree and passed out briefly. When she woke up she insisted she was fine to her husband. She only has a few scrapes & bruises. Her husband would not be persuaded by Emily and took her to the ER. The PA did a CT scan w/out contrast and saw a biconvex deformity on the image. What should the PA begin treatment for? A. Stroke B. Epidural Hematoma C. Acute Subdural Hematoma D. Ruptured Aneurysm
Epidural Hematoma
25 y/o female presents to your clinic complaining of involuntary movement of her hands when taking notes in class or typing her sneakers. She is a PA student and has been feeling a lot of anxiety lately. For the past two weeks, she noticed no involuntary movements after having drinks with her friends. PE shows no other significant neurological findings. What is your diagnosis and treatment? A.Multiple Sclerosis: Acetazolamide B. Essential tremor: treatment not usually needed C. Parkinson: Plasmapheresis D. Essential tremor: Levodopa-carbidopa
Essential tremor: treatment not usually needed
A 9-year-old boy is performing poorly in school. His teacher is frustrated because he is frequently seen "staring off into space" and not paying attention. You suspect a seizure, what would you give this boy as the most effective first line of treatment management? A) No treatment B) Lamotrigine C) Acetylcholinesterase inhibitors/Pyridostigmine D) Ethosuximide
Ethosuximide
The student in the prior question is brought to a neurologist by his mother, based on a referral from his PCP. Imaging and lab studies are completed, which are found to be normal. An EEG is done on the student, which shows 3-Hz spike-and-wave discharge complexes. What would be the first line treatment for this patient? a. Ethosuximide (Zarontin) b. Lamotrigine (Lamictal) c. Treatment is not needed at this time. It would be best to continue monitoring the student's symptoms. d. Surgery is needed.
Ethosuximide (Zarontin)
32 y/o male presents with severe, stabbing, unilateral pain from the throat to the ear. Patient does not display any motor or sensory deficit, but says pain spikes during swallowing, chewing and similar motions. What would be the diagnosis and treatment? a. Trigeminal nerve (CN -V) palsy- anticonvulsants (phenytoin/ gabapentin) + antidepressants (amitriptyline/ duloxetine) b. Glossopharyngeal nerve (CN - IX) palsy - anticonvulsants (phenytoin/ gabapentin) + antidepressants (amitriptyline/ duloxetine) c. Facial nerve (CN - VII) palsy - steroids, physical therapy d. Hypoglossal nerve (CN - XII) palsy -steroids, physical therapy
Glossopharyngeal nerve (CN - IX) palsy - anticonvulsants (phenytoin/ gabapentin) + antidepressants (amitriptyline/ duloxetine)
A 55 year old man presents to the ER with sudden onset of weakness in both extremities that initiated yesterday. Associated symptoms include paresthesias, absent deep tendon reflexes, and mild loss of cutaneous sensation bilateral lower extremities. Imaging studies shows demyelination. Which of the following is likely diagnosis? A. Myasthenia Gravis B. Transverse Myelitis C. Guillain- Barre syndrome D. Botulism
Guillain- Barre syndrome
A 45 y/o male presents with ascending symmetrical paralysis that started in his legs. On PE, the PA determines that the patient has Bell's palsy, ptosis and dysarthria. What is the most likely diagnosis? A) Amyotrophic Lateral Sclerosis B) Huntington's Disease C) Guillain-Barre Syndrome D) Multiple Sclerosis
Guillain-Barre Syndrome
A 62-year-old patient presents with unprovoked syncope with signs of hypotension. In addition to an ECG and ECHO, what other testing would you do? A. Tilt table B. Holter monitor C. EEG D. MRI
Holter monitor
A patient presents with a daily headache which has worsened over the past several months. On funduscopic examination, you notice that the optic disk edge is indistinct and the veins do not pulsate. There is an increased pressure in subarachnoid space along the optic nerve. What can possibly cause this? A) Glaucoma B) Migraine C) Visual acuity problem D) Increased intracranial pressure
Increased intracranial pressure
A 74-year-old patient presents to the emergency department with a diffuse headache, difficulty speaking, and right upper limb motor and sensory deficits including weakness and decreased sensation. The patient denies head trauma and admits to gradual worsening over the last 5 hours with one episode of vomiting just before presenting to the ED. Past medical history is significant for chronic sinusitis, hypertension, and hypertriglyceridemia. Which of the following is the most likely diagnosis? (A) Transient ischemic attack (B) Intraparenchymal hemorrhage (C) Subarachnoid hemorrhage (D) Epidural hematoma
Intraparenchymal hemorrhage
what medication is the first line for preventive recurrent partial seizures? a. Benzo b. Kepro
Kepro
A 47 year old male patient walks into the ER today. His muscles were stiffened followed by repetitive jerking. This went one for about 31 minutes without recovery from the post ictal period. His wife told the paramedics who responded that she found his lamictal bottle full since he picked it up from the pharmacy 1 month ago. What is the first line of treatment for this patient. a. Lamictal b. Phenytoin c. Lorazepam d. Oxycodone
Lorazepam
A 30 y/o female presents with vision loss that progressed over the last 7 days. She states that she has been experiencing pain when she moves eyes. On PE, the PA noted papilledema, nystagmus, hyperreflexia and muscle spasticity. What is the most likely diagnosis? A) Multiple sclerosis B) Neuromyelitis optica C) Acute glaucoma D) Optic Neuritis
Multiple sclerosis
A 57 year-old male presents with episodic diplopia over the past two months. Symptoms progressed over the last two days with the onset of bilateral facial weakness made worse with repetitive use. Weakness improves somewhat with rest. He denies fever, headache or areas of pain. Exam reveals a nasal voice, drooping eyelids and a normal sensory exam. Which of the following is the most likely diagnosis? A. Multiple sclerosis B. Guillain-Barre syndrome C. Lambert-Eaton syndrome D. Myasthenia gravis
Myasthenia gravis
A patient presents with progressive visual changes over the past 2 years. On physical examination, bitemporal hemianopsia is noted. A lesion in which of the following anatomic locations is most likely to cause these findings? A. Optic Nerve B. Optic chiasm C. Optic radiation D. Optic tract
Optic chiasm
A 58 year old man is brought into the ED because of an extremely high fever. He is diagnosed with encephalitis and subsequently develops a stroke. He continues to deteriorate. After 6 days, he becomes unresponsive to painful stimulus and brain death is suspected. Which of the following non-neurological assessments is a prerequisite in establishing that brain death has occured? A)Liver function test B)Absent spinal reflex C)Normal blood pressure D)Decerebrate posture
Normal blood pressure
A 75 y/o female presents to the ED c/o headache, slurred speech, and dizziness. She reports she felt well when she went to sleep at 9:00PM and awoke at 8:00AM with symptoms. On exam, patient has right finger to nose dysmetria and horizontal nystagmus. CT head w/o contrast shows no acute ICH. What is the next best course of action? a. Treat the patient with tPA for ischemic cerebellar stroke. b. Order CTA head and neck w/ contrast to localize possible occlusion. c. Order Carotid US to evaluate for stenosis. d. Order MRI Brain w/o contrast to identify stroke
Order CTA head and neck w/ contrast to localize possible occlusion
A 58-year-old patient presents to the office with a complaint of tremor in the right hand at rest. Upon questioning, it is discovered that the tremor is getting worse and now seems to be in both arms especially when at the patient's sides. The patient also complains that food does not smell as good now and they are having trouble eating with a fork and buttoning their shirt. On physical examination, the provider notices a resting tremor, bradykinesia, rigidity, and a shuffling gait. What is the initial assessment? (A) Essential tremor (B) Wilson disease (C) Huntington disease (D) Parkinson disease
Parkinson disease
A 63 year old female presents with a 12 month history of hemiparesis. Physical examination notes a stooped posture with very slow movements and a fixed facial expression. The patient appears rigid and has difficulty getting up from a sitting position. What is the most likely diagnosis? A. Multiple Systems Atrophy B. Amyotrophic Lateral Sclerosis (ALS) C. Parkinson's Disease D. Combined systems degeneration E. Alzheimer's Disease
Parkinson's Disease
Mr.Stones displays shuffling with narrow base gait, intentional tremors, and a masked fascies. As the PA you order a CT and MRI, which results are normal. What neurological disease may this patient have? A) Huntington's disease B) Essential tremor C) Parkinson's disease D) None of the above
Parkinson's disease
A 62 y.o male patient comes into your Primary Care Office complaining of a new onset slurred speech. Patient reports that this has been going on for the past 3 hours. Patient does not complain about anything else. Patient has a history of DM and is being managed on metformin. Patient's vitals are taken. BP 162/92, RR 16, PR 84, 96% O2, 98.4F oral. A. Patient should be admitted into the hospital for further testing/management B. Patient should be sent home and monitor for 24 hours and report any changes in symptoms to PCP/PC PA next week C. Outpatient referral to the neurologist D. Patient should be sent to a Stroke Center for imaging and evaluation
Patient should be sent to a Stroke Center for imaging and evaluation
A 17 yo male patient is rushed into your office following a ATV accident. Patient is seizing with suspected hemorrhaging in the brain. A CT angiography is done and shows a large tangle of blood vessels in the left frontal side of his brain. What is the most effective treatment for this patient? a. Clipping of the vessel b. Surgery done with burr holes c. Radiation will likely be sufficient d. Radiation, endovascular embolization, and surgery would be the most effective treatment
Radiation, endovascular embolization, and surgery would be the most effective treatment
A 33-year-old woman comes to the clinic for evaluation of facial weakness. Earlier in the morning, she had trouble drinking coffee as it was drooling from the right side of her face. Her partner mentioned that her face was drooping, and she noticed that she could not move her mouth or eyebrows on that side. She has not had hearing loss, ringing sensation in the ears, or difficulty walking. She underwent a right superficial parotidectomy for the resection of a pleomorphic adenoma in the parotid gland two days ago. Vitals are within normal limits. Physical examination shows asymmetry of the face with smiling. There is also loss of the right nasolabial fold, with drooping of the eyelids and lips on the right side. The rest of the examination is noncontributory. Which of the following is the most likely cause of the findings seen in this patient? A) Tick borne illness B) Reactivation of dormant virus C) Tumor of cerebellopontine angle D) UMN lesion targeting cranial nerve E) Recent surgery
Recent surgery
A 50 y/o male patient aching sensation in his legs with uncomfortable deep crawling typically at night when he gets into bed.Also having severe urge to move his legs and wake up several times at night. He denies no low back pain. What is the probable diagnosis ? a. Peripheral neuropathy b. Restless leg syndrome C. peripheral arterial disease D. Lumbar radiculopathy
Restless leg syndrome
A 17 year old female came to the clinic with an upper motor neuron lesion would exhibit which of the following findings? A. Fasciculations B. Areflexia C. Muscular atrophy D. Spasticity
Spasticity
75 y/o female is brought into the ED with numbness and weakness on the left side of her body. She appears confused and has trouble speaking. Her family says she started displaying symptoms around 1 hr previously. Her HR is 87, BP is 187/102, and temperature is 97.9. What would not be indicated as the next treatment step? a. Start IV tPA b. Administer CCB/ BB c. Check her glucose levels d. Consult with a neurologist to evaluate the case
Start IV tPA
Sarah, a 25 y/o F, was brought to the ER by her mom after saying she got a HA that was strongest at onset and caused her to vomit, shortly followed by loss of consciousness. Her mom states she was just coming home from a long day at school and sat down to turn on the TV when this happened. Imaging is shown below. What was she diagnosed with? A. Partial Complex Seizure B. Migraine C. Subarachnoid Hemorrhage D. Epidural Hemorrhage
Subarachnoid Hemorrhage
A 74 year old male is coming into the primary care office after his family saw the patient become "unresponsive" on the toilet. Family members said the patient was unconscious for a few seconds and then regained consciousness. Patient was pale and diaphoretic. What is the most likely cause of this LOC? A) Seizures B) CVA C) TIA D) Vasovagal Syncope
Vasovagal Syncope
70 year old man followed his wife to her doctor's appointment. While he was there, his wife realized that her husband's left side of the face was drooping and he was slurring his words.They immediately went to the hospital. He was under observation for 24hrs and during that time his symptoms resolved. When he got a carotid ultrasound they found that he had a 80- 99% stenosis in his ICA. He received a carotid endarterectomy a couple of days later. What was his diagnosis? a. Chronic Subdural Hematoma b. Transient Ischemic Attack c. Cerebral Aneurysm d. Arteriovenous Malformation
Transient Ischemic Attack
Karen wasn't feeling well all of a sudden. She had a headache, she was nauseous, and when she tried to ask her husband to take her to the hospital, she had trouble finding and speaking her words. She pantomimed, and he eventually got the picture. An MRI with contrast revealed multiple enhancing lesions in her brain, so Karen's Neurology PA ordered a PET scan of her body. Of the choices below, what did the PET scan most likely reveal? A. a large tumor in one of her lungs B. arterial bleeding between her skull and dura C. small tumors in her left ovary D. focal weakness
a large tumor in one of her lungs
A patient presents with weakness that worsens more and more throughout the day, but he is not experiencing any sensory deficits. The patient's Neurology PA suspects Myasthenia. Which of the following could help confirm the diagnosis? a. the presence of acetylcholine receptor autoantibodies b. an EMG that shows decremental muscle response from repetitive stimulation at rates of 3Hz c. a CT of the chest that reveals a thymoma d. all of the above
all of the above