Neuro Exam
Complex regional pain syndrome
30. A 53-year-old female presents with a past medical history of a fractured right wrist. She now complains of severe diffuse burning pain in her right hand associated with edema and color changes that started about 1 month later. Which of the following is the most likely diagnosis? ©Kaplan A. Osteonecrosis B. Nonunion of fracture C. Raynaud phenomenon D. Neurogenic arthropathy E. Complex regional pain syndrome
Early mobilization after injury
31. Which of the following is recommended to decrease the incidence of developing complex regional pain syndrome? ©Kaplan A. Strict glucose control B. Decrease level of stress C. Early mobilization after injury D. Adequate use of pain control medication E. Vitamin D and calcium supplementation
E
32. Which of the following are the most common adverse effects from opioid analgesics? ©Kaplan A. Euphoria, seizures, and pruritus B. Mydriasis, anemia, and dizziness C. Myopathy, hyperthermia, and pruritus D. Edema, sedation, and change in mental status E. Sedation, constipation, and respiratory depression
lack of dopamine
33. Which of the following is the pathophysiologic mechanism behind Parkinson's disease? ©Kaplan A. Proteinaceous inclusion bodies in neurons B. Demyelination of peripheral nerves C. Amyloid buildup in microglia cells D. Antibodies to acetylcholine E. Lack of dopamine
CN VI
34. Which of the following cranial nerves controls the lateral rectus muscle of the eye? ©Kaplan A. CN V B. CN VI C. CN VII D. CN VIII E. CN XII
Multi infarct dementia
16. A 72-year-old male with history of diabetes mellitus and hypertension presents with worsening periods of confusion. The patient's daughter describes sudden periods of her father appearing to have "spells," which result in worsening of his confusion. On physical examination, pulse is 92 irregularly irregular and blood pressure is 185/102. Mental status examination reveals cognitive deficits. An MRI of the brain reveals several areas of impaired blood flow. Which of the following is the most likely diagnosis? ©Kaplan A. Myasthenia gravis B. Alzheimer disease C. Huntington disease D. Subdural hematoma E. Multi-infarct dementia
HTN
17. Which of the following is the leading risk factor for the possible development of an ischemic stroke? ©Kaplan A. Obesity B. Hypertension C. Diabetes mellitus D. Heavy alcohol use E. Cigarette smoking
E
18. A 52-year-old female presents to the emergency department with the sudden onset of a severe headache described as "the worst headache of her life." A CT scan of the brain reveals a hemorrhage in the subarachnoid space. An arteriogram locates the involved area. Which of the following is the most appropriate intervention? ©Kaplan A. Deep brain stimulation B. Carotid endarterectomy C. Surgical decompression D. Systemic anticoagulation E. Endovascular embolization
Total protein
19. Which of the following would be elevated in the CSF in a patient with viral meningitis? ©Kaplan A. Segmented neutrophils B. Oligoclonal bands C. Total protein D. Glucose E. Chloride
Bulging fontanelle
20. A 1-month-old infant presents with suspected meningitis. Which of the following is the most reliable physical examination finding that will be present? ©Kaplan A. High fever B. Nuchal rigidity C. Bulging fontanelle D. Positive Kernig sign E. Positive Brudzinski sign
Bacterial meningitis
21. A patient presents with suspected meningitis. A lumbar puncture reveals the following findings: markedly elevated opening pressure with a predominance of polymorphonuclear neutrophils. Which of the following is the most likely etiology? ©Kaplan A. Viral meningitis B. Fungal meningitis C. Aseptic meningitis D. Bacterial meningitis E. Mycobacterial meningitis
Group B strep
22. A 1-month-old infant presents with fever, irritability, and poor feeding. A Gram stain of cerebral spinal fluid reveals the presence of gram-positive cocci arranged in pairs. Which of the following is the most likely etiology? ©Kaplan A. Escherichia coli B. Neisseria meningitidis C. Group B Streptococcus D. Staphylococcus aureus E. Listeria monocytogenes
Cluster headache
23. A 45-year-old male presents with complaints of recurring headaches. He states the headache begins abruptly without any warning. The headaches are described as severe pain around the left eye associated with unilateral nasal congestion and lacrimation. Which of the following is the most likely diagnosis? ©Kaplan A. Classic migraine B. Giant cell arteritis C. Cluster headache D. Tension headache E. Complicated migraine
Classic migraine
24. A 24-year-old female presents with a history of worsening episodes of headache. She describes the headaches as throbbing and localized to the right temporal region that lasts about 6 hours. She states that she usually gets a headache when she is working on a project that affects her normal sleep pattern. She does experience visual disturbances prior to onset of the headache, which is also associated with nausea and vomiting. Which of the following is the most likely diagnosis? ©Kaplan A. Classic migraine B. Giant cell arteritis C. Cluster headache D. Tension headache E. Pseudotumor cerebri
CT scan
35. An 80-year-old woman presents to the emergency room with left hemiparesis. Her husband states that she fell in the bathroom 48 hours ago but denies there was any loss of consciousness. The husband also states that his wife was a little confused this morning. On examination a dilated right pupil is noted. Which of the following tests should be obtained first? ©Kaplan A. MRI B. EEG C. CT scan D. Skull x-ray E. Spinal tap
speech and PT
4. A 60-year-old male presents with a several year history of tremor in his left arm as well as a generalized slowness of voluntary movements. On physical examination, a relatively immobile face with limited blinking is noted. Gait is slow with short steps. There is no muscle weakness and deep tendon reflexes are normal. Which of the following is the most appropriate treatment at this time? ©Kaplan A. Speech and physical therapy B. Cognitive behavioral therapy C. Occupational therapy D. Relaxation techniques E. Psychotherapy
amygdala
5. Which of the following parts of the brain is central to the processing of fear and anxiety? ©Kaplan A. Amygdala B. Thalamus C. Ventral horn D. Basal ganglia E. Prefrontal cortex
D
6. In addition to chorea and behavioral disturbances, which of the following is a common associated clinical manifestation in patients with Huntington disease? ©Kaplan A. Convulsive activity B. Blurry, double vision C. Difficulty swallowing D. Progressive dementia E. Generalized weakness
myasthenia gravis
7. Which of the following conditions is diagnosed in a patient testing positive for the acetylcholine-receptor antibody test? ©Kaplan A. Cerebral palsy B. Multiple sclerosis C. Myasthenia gravis D. Alzheimer disease E. Guillain-Barre syndrome
Parkinsons disease
8. A 55-year-old male patient presents with a resting tremor involving the right hand associated with a gradual slowness of all voluntary movements and speech. On physical examination, a mask-like facial expression is also noted. Which of the following is the most likely diagnosis? ©Kaplan A. Multiple sclerosis B. Parkinson disease C. Myasthenia gravis D. Huntington disease E. Sydenham's chorea
Thymectomy
9. A 45-year-old female with myasthenia gravis is not well controlled on anticholinesterase medications. Which of the following is the next most appropriate intervention? ©Kaplan A. Thymectomy B. Adrenalectomy C. Radiation therapy D. Immunosuppressive therapy E. Potassium channel antagonists
MRI
A 35-year-old female presents with weakness, blurry vision, and impaired balance. Lhermitte's sign is positive. Which is the next best step in the evaluation of this patient? ©Kaplan Cerebral spinal fluid cell count and differential Electroencephalography Evoked potentials Magnetic resonance imaging Electromyelogram
Bells palsy
A 40-year-old woman presents to the clinic with a history of ear pain. The patient states that the right ear pain started three days ago but as of today she has noted drooping on the right side of her face. On physical examination, the patient is not able to close her right eye or wrinkle the right side of her forehead. Which of the following is the most likely diagnosis? ©Kaplan A. Parotid gland obstruction B. Trigeminal neuralgia C. Occipital brain tumor D. Acoustic neuroma E. Bell's palsy
Biofeedback techniques
A 43-year-old female presents with several episodes of generalized headaches described as a tight band around her head. The headache normally gets progressively worse over a day or two. She states they are worse when she is tired, but denies any warning symptoms. She states that the headaches are occurring very frequently and she has been losing a lot of time at work. Physical examination is essentially unremarkable. In addition to pharmacological therapy, which of the following is the most appropriate additional intervention? © Kaplan Acupuncture Botulinum toxin A Deep brain stimulation Biofeedback techniques Greater occipital nerve injection
Stabilize airway
A 45 year old, with a history of tonic-clonic seizures currently on phenytoin (Dilantin), presents with continuous seizure activity without regaining intervening consciousness. Which of the following is the best first step in the intervention of this patient? ©Kaplan A. Begin intravenous lorazepam B. Obtain serum phenytoin level C. Change to fosphenytoin D. Electroencephalogram E. Stabilize airway
Thymectomy
A 45-year-old female with myasthenia gravis is not well controlled on anticholinesterase medications. Which of the following is the next most appropriate intervention? © Kaplan A. Thymectomy B. Adrenalectomy C. Radiation therapy D. Immunosuppressive therapy E. Potassium channel antagonists
Endovascular embolism
A 52-year-old female presents to the emergency department with the sudden onset of a severe headache described as "the worst headache of her life." A CT scan of the brain reveals a hemorrhage in the subarachnoid space. An arteriogram locates the involved area. Which of the following is the most appropriate intervention? © Kaplan A. Deep brain stimulation B. Carotid endarterectomy C. Surgical decompression D. Systemic anticoagulation E. Endovascular embolization
Alzheimers dementia
A 60-year-old man presents with memory loss and gradual inability to complete business functions. The loss of cognitive ability has led to distress in his social and occupational functioning. According to his family, he is requiring more assistance with activities of daily living. There is no history of psychiatric disorders, alcoholism, or substance abuse. Physical examination and basic laboratory testing are normal. Which of the following is the most likely diagnosis? © Kaplan A. Pseudodementia B. Vascular dementia C. Alzheimer's dementia D. Creutzfeldt-Jakob disease E. Frontotemporal lobe dementia
increase in resistance to passive movement
A 62-year-old male presents with trouble walking, which has been getting progressively worse. His wife states that he can no longer keep up with her when they are walking for exercise, and she has noticed that he does not swing his arms like he used to. Previously, he had to wait for her to catch up to him, but now she has to wait for him. He denies any exercise intolerance or dyspnea. Which of the following is an additional physical examination finding that would most likely be seen in this patient? © Kaplan A. Rapid repetitive movements B. Decreased deep tendon reflexes C. Fine symmetrical tremor with activity D. Increase in resistance to passive movement E. Bony prominence of the forehead with increased blinking
D
A 65-year-old male, accompanied by his wife, presents with the concern that he is acting strange. She states that four years ago her husband persistently rubbed her breast while at the store. He has also begun doing these things more and more. He has started to draw on the walls at home and eats constantly. Which of the following is the most likely diagnosis? © Kaplan A. Lewy body dementia B. Alzheimer's dementia C. Multi-infarct dementia D. Frontotemporal dementia E. Creutzfeldt-Jakob disease
B
A 65-year-old man presents to your clinic after falling several times within the past few months. On examination, his most notable findings are an unstable, wide-based gait and marked retropulsion. He does have bradykinesia with masked facies and dysarthria. You find no evidence of cogwheeling or resting tremor. His symptoms do not respond to levodopa/carbidopa. During the next few months, his eye movements are notable for slowing of vertical saccades and fast phases. A. L-dopa-resistant Parkinson's disease B. Progressive supranuclear palsy C. Normal pressure hydrocephalus D. Amyotrophic lateral sclerosis
C
A 65-year-old patient presents to the emergency department with right facial droop. On physical examination, the right side of the patient's mouth droops, eyebrows raise symmetrically, frown is symmetric, and the eye closes but right offers little resistance to opening. Which of the following is the most likely cause of these findings? ©Kaplan A. Upper and lower motor neuron damage to cranial nerve VI on the right B. Upper and lower motor neuron damage to cranial nerve VI on the right C. Upper motor neuron damage to cranial nerve VII in left hemisphere D. Lower motor neuron damage to cranial nerve V on the right E. Lower motor neuron damage to cranial nerve IX on the left
Bacterial meningitis
A 68-year-old woman presents to the emergency room with fever and a severe headache. She has also noted a stiff neck and some drowsiness. On physical examination, she has temperature 38.8°C (101.8°F), blood pressure 110/70 mm Hg, and pulse 110/minute. The neck is resistant to flexion. The patient is somewhat lethargic but does answer questions. Lumbar puncture reveals an elevated WBC count with 90% neutrophils and low glucose. Which of the following is the most likely diagnosis? ©Kaplan A. Brain abscess B. Viral meningitis C. Fungal meningitis D. Bacterial meningitis E. West Nile encephalitis
R PCA
A Pt reports changes in vision and mildly decreased sensation with mild weakness on the L side. Upon examination the Pt is unable to see to the L side, has ocular nerve palsy, depth blindness and lateral deviation of their OS(left eye). What vessel is involved? L MCA R MCA L PCA R PCA L ACA R ACA L ICA R ICA
tilt table testing
A healthy 23-year-old patient is seen in the office for evaluation of syncope. There are no red flag findings on the history or physical examination and no cardiac disease is suspected. The patient had been at a concert recently in the hot summer and admitted to drinking alcohol prior to the concert. The patient admitted that this was not the first instance that a syncopal episode occurred. Which of the following is the most appropriate next step in this patient's evaluation? © Kaplan A. Holter monitor B. Tilt table testing C. Echocardiogram D. Fasting blood sugar E. 3-hour glucose tolerance test
Anterior cord syndrome
A patient falls from a galloping horse. The patient sustains acute neurological trauma to the spinal cord, is unable to move either lower extremity, and cannot identify pain or temperature sensation in this same area. The patient is able to identify vibration and proprioception is intact. Which of the following is the most likely diagnosis? © Kaplan A. Compete cord transection B. Posterior cord syndrome C. Anterior cord syndrome D. Central cord syndrome E. Brown-Sequard lesion
Stereotactic Aspiration
A patient is diagnosed with a brain abscess. In addition to antibiotic therapy, which of the following is the preferred adjunctive therapy? © Kaplan A. Radiation therapy B. Initial corticosteroids C. Stereotactic aspiration D. Surgical excision of abscess E. Intracranial shunt procedure
TPA
A patient presents to the emergency department with complaints of left-sided weakness and difficulty with speech. The patient s symptoms began abruptly one hour ago. The patient undergoes CT of the brain without contrast, and no intracranial bleeding is noted. Barring any contraindications for care, which of the following is the next step for this patient? © Kaplan A. Clopidogrel (Plavix) B. Atenolol (Tenormin) C. Warfarin (Coumadin) D. MRI to confirm no bleeding E. Tissue plasminogen activator (TPA)
Tension headache
A patient presents with a headache. She describes the headache as bilateral and bandlike around her head. She states that the pain is a dull, steady pain that lasts for days. Which of the following is the most likely diagnosis? ©Kaplan Brain tumor Cluster headache Tension headache Migraine headache Subarachnoid hemorrhage
Rupture of saccular aneurysm
A patient presents with a spontaneous subarachnoid hemorrhage without any known history of trauma. Which of the following is the most likely cause? © Kaplan A. Intracranial infection B. Rupture of saccular aneurysm C. Intracranial venous thrombosis D. Embolic occlusion of the middle cerebral artery E. Atherosclerotic obstruction of the anterior cerebral artery
Neisseria meningitides
A patient with suspected meningitis presents with an associated petechial rash. Which of the following organisms is the most likely cause of this patient s meningitis? © Kaplan A. Neisseria meningitides B. Staphylococcus aureus C. Listeria monocytogenes D. Cryptococcus neoformans E. Streptococcus pneumonia
Electromyogram
Which of the following tests is most useful to assess the functional status of the peripheral nervous system? A. CT Scan B. PET Scan C. Myelogram D. Electromyogram E. Magnetic resonance imaging
Total protein
Which of the following would be elevated in the CSF in a patient with viral meningitis? © Kaplan A. Segmented neutrophils B. Oligoclonal bands C. Total protein D. Glucose E. Chloride
A. The ACA has 3 numbered parts B. The MCA has 4 numbered parts, not 3 C. The PCA has 4 numbered parts, not 3 D. Lacunar strokes occur off of the MCA, not the ACA E. The *A*CA vascularizes the genu of the corpus callosum, not the PCA
Which statements are Correct? A. The ACA has 3 numbered parts B. The MCA has 3 numbered parts C. The PCA has 3 numbered parts D. Lacunar strokes occur off of the ACA E. The PCA vascularizes the genu of the corpus callosum
A, D, E
Which statements are correct? A. CT is faster than MRI B. MRI is more accurate for bone disorders C. MRI is the usual emergency head modality D. MRI is more sensitive to motion artifact E CT is able to be used if the patient has a metal implant
Basal nuclei
Which structure 's failure is associated with Parkinson's disease? pons cerebellum pyramidal tracts basal nucei
All of them
Cerebellar functions and diseases include which of the following? MA A. Axial posture B. Coordination of learned movements C. Memory for complex motor movements D. Dysarthria is present in cerebellar disease E. Nystagmus is present in cerebellar disease
Aura Hypermotor movements
Frontal lobe epilepsy signs and symptom include: MA Long duration with no clustering Visual hallucinations Aura Hypermotor movements Post ictal confusion, often severe
Correct TENS unit Correct NSAIDS Correct Opiods Correct Chocolate Correct Rubbing affected area (all but beta 1 agonists)
How can nociceptive signals be disrupted? MA A. TENS unit B. NSAIDS C. Opiods D. Chocolate E. Rubbing affected area F. Beta 1 agonists
4
How many parts to the posterior cerebral artery? 1 2 3 4
Subarachnoid hemorrhage
Nimodipine (Nimotop) is indicated for use in which of the following conditions to lower the risk of spasm in blood vessels? © Kaplan A. Status epilepticus B. Transient ischemic attack C. Intracerebral hemorrhage D. Subarachnoid hemorrhage E. Middle cerebral artery stroke
Blindness
Pharmacological treatment with prednisone is indicated early in suspected giant cell arteritis to prevent which of the following potential complications? © Kaplan A. Blindness B. Inflammatory syndrome C. Polymyalgia rheumatic D. Thoracic aortic aneurysm E. Temporomandibular joint disease
Parkinsons
Pill rolling tremors is associated with what disease? Parkinson's Alzheimer's MCA stroke Being in the PA program
mood
Serotonin is associated with: memory euphoria pleasure mood
Correct CBC, tox panel Correct IV access Correct Airway management
Status epilepticus treatment at 0-5 minutes include. MA CBC, tox panel IV access Airway management Neuro exam complete Diazepam 0.2 mg/kg at 5 mg/min IV Propofol
Correct Diazepam Correct Meclizine
The treatment(s) for viral labyrinthitis are: MA Epley maneuver Diazepam Meclizine Dexamethasone Gabapentin
B, C, D
What are the Correct matches? A. Anomia = inability to express oneself through speech B. Apraxia = misuse of objects C. Amnesia = memory loss D Agnosia = inability to recognize smells, tastes E. Aphasia = cannot remember names of objects
All of them
What causes generalized seizures? MA Hypoxia Infection Drug withdrawal Electrolyte imbalances Head trauma Sleep deprivation Almost any organ failure
Correct Amitriptyline Correct Metoprolol Correct Gabapentin
What drugs are indicated for prophylactic migraine HA therapy? MA Prednisolone Amitriptyline Metoprolol Gabapentin Dexamethasone Metoclopramide
5-10 mmHg
What is a normal ICP range? 1-10 mmHg 5-15 mmHg 20-25mmHg 60-90 mmHg
50%
What is the chance a person with an unprovoked seizure will have another one in their lifetime? 95% 75% 50% 10% Cannot express the risk mathematically
Meningitis, viral
What serious disease may present with Brudzinski sign? ICA aneurysm rupture MCA stroke right side Meningitis, viral PCA thrombus Myasthenia gravis
Photophobia Does not worsen with activity last 0.5 hr to a week
Which are usual finding in a tension headache? MA Throbbing Severe Last 0.5 hr to a week Photophobia Does not worsen with activity Does not extend down the nuchal region
Foot drop Bell s palsy Carpal tunnel syndrome Morton s neuroma
Which diseases are examples of mononeuropathies? MA Foot drop Bell s palsy Carpal tunnel syndrome Guillian Barre Charcot Marie Tooth Morton s neuroma
Depakote Levetiracetam
Which drugs are appropriate for all types of seizures? Dilantin Depakote Carbamzepine Levetiracetam
Parietal = coordination
Which lobe and function match is incorrect? A. frontal = movement B. parietal = coordination C. occiptial = vision D. temporal = memory and emotions
Sensorioneural hearing loss
Which of the following conditions is most likely prevented with the use of corticosteroids as part of the treatment regimen in patients with bacterial meningitis? © Kaplan A. Petechial rash B. Chronic seizures C. Facial nerve palsy D. Sensorineural hearing loss E. Subarachnoid hemorrhage
Muscle atrophy
Which of the following findings would be expected in a patient suspected of having lower motor neuron disease? A. Hyperactive deep tendon reflexes B. Partial facial paralysis C. Positive Babinski sign D. Muscle spasticity E. Muscle atrophy
Varicella zoster virus
Which of the following infectious agents has been implicated as a potential cause of some cases of Bell palsy? © Kaplan A. West Nile virus B. Borrelia borgdorferi C. Varicella-zoster virus D. Listeria monocytogenes E. Human immunodeficiency virus
Aerobic exercise
Which of the following interventions has proved beneficial in decreasing the functional decline in patients with Alzheimer disease? A. Psychotherapy B. Aerobic exercise C. Memory drill exercises D. Early psychoactive medication E. Computerized cognitive training
Chorea
Which of the following is a common movement abnormality noted in patients with Huntington's disease? ©Kaplan A. Chorea B. Collier's sign C. Lip smacking D. Pill-rolling tremor E. Jacksonian march
E
Which of the following is an appropriate preventive technique to teach patients prone to neurally mediated syncope in an attempt to decrease episodes? © Kaplan A. Epley maneuver B. Brandt-Daroff exercises C. Balance and gait training D. Neck movement exercises E. Isometric counterpressure limb maneuvers
C
Which of the following is correct description of a chemical synapse, our most common type of synapse in the body? A. It allows ions and chemicals to pass directly from one cell to another. B. It involves gap junctions and a very quick propagation of the signal. C. It allows integration of many inhibitory and excitatory signals. D. It involves bidirectional flow between the cells.
C
Which of the following is correct description of a chemical synapse, our most common type of synapse in the body? A. It allows ions and chemicals to pass directly from one cell to another. B. It involves gap junctions and a very quick propagation of the signal. C. It allows integration of many inhibitory and excitatory signals. D. It involves bidirectional flow between the cells
Propranolol
Which of the following is most appropriate for the prophylactic treatment of migraines? ©Kaplan A. Ergotamine tartrate (Cafergot) B. Prochlorperazine (Compazine) C. Carbamazepine (Tegretol) D. Propranolol (Inderal) E. Enalapril (Vasotec)
Herpes simplex 1
Which of the following is the most common cause of viral encephalitis? © Kaplan A. West Nile B. Enteroviruses C. Varicella-zoster D. Cytomegalovirus E. Herpes simplex type 1
A
Which of the following is the preferred therapy for hydrocephalus secondary to a subarachnoid hemorrhage? ©Kaplan A. Placement of ventricular drain B. Vasopressors such as dobutamine C. Osmotic diuretics such as mannitol D. Thrombolytic such as streptokinase E. Elevation of the head of the bed and hyperventilation
Median
Which of the following nerves is assessed with the Tinel test? © Kaplan A. Radial B. Median C. Ulnar D. Brachial E. Femoral
MS: beta interferon A. Parkinson's disease: Propanolol, deep brain stimulation B. Multiple sclerosis: beta interferon, fingolimod, natalizumab (Acute- Corticosteroids) C. Myasthenia gravis: Pyridostagamine, neostigmine, prednisone D. Alzheimer's disease: Anticholinesterase drugs(Tacrine, donepezil) E. Migraine headache: i.Aspirin/ibuprofen, Triptans
Which of the following neurologic diseases is properly matched with the first-line treatment for that disease? © Kaplan A. Parkinson's disease: SSRI B. Multiple sclerosis: beta interferon C. Myasthenia gravis: mannitol D. Alzheimer's disease: lithium E. Migraine headache: morphine
B
Which of the following patients with stroke symptoms is a candidate for thrombolytic therapy with tissue plasminogen activator? © Kaplan A. History of serious head trauma 2 months ago B. Patient with current blood pressure of 160/90 C. History of intracranial hemorrhage 2 years ago D. Current symptoms present for the past 5 hours E. Upper gastrointestinal bleed due to ulcer 14 days ago
Aspirin
Which of the following pharmacological agents is the initial treatment of choice for the secondary prevention of ischemic stroke? © Kaplan A. Aspirin B. Ticlopidine (Ticlid) C. Warfarin (Coumadin) D. Enoxaparin (Lovenox) E. Tissue plasminogen activator (tPA)
Romberg
Which of the following physical examination tests measures cerebellar function? ©Kaplan A. Romberg B. Stereognosis C. Graphesthesia D. Proprioception E. Extraocular movements
C
Which of the following presentations is most true for a CVA in the L hemisphere? A. Difficulty displaying negative emotions, poor judgement (joined a PA program), speech or language impairments, full awareness of deficits B. Cautious behavior, poor judgement C. Difficulty displaying positive emotions, full awareness of deficits, delayed processing D. Poor judgement, delayed processing, full awareness of deficits
Ct of the head
10. A 42-year-old female presents with a sudden onset of a severe violent headache associated with a brief episode of loss of consciousness. She denies any previous history of headaches. Which of the following is the most appropriate initial diagnostic study? ©Kaplan A. Lumbar puncture B. CT scan of the head C. MRI scan of the brain D. Electroencephalogram E. Ultrasound of the carotids
Non contrat CT scan of the head
11. A patient presents with a suspected stroke. Which of the following is the initial diagnostic evaluation of choice to assist in distinguishing between a hemorrhagic and ischemic stroke? ©Kaplan A. MRI of the brain B. Lumbar puncture C. Electroencephalogram D. CT scan of the head with contrast E. Non-contrast CT scan of the head
MRI of the brain
12. Which of the following is the diagnostic evaluation of choice in the evaluation of a patient that is suspected of having multiple sclerosis? ©Kaplan A. MRI of the brain B. Electromyogram C. CT scan of head D. Electroencephalogram E. Creatine phosphokinase
CT scan of the head
13. A 32-year-old female with unremarkable past medical history presents to the emergency department with fever, headache, stiff neck, photophobia, and seizure activity. Which of the following is the most appropriate initial diagnostic evaluation? ©Kaplan A. MRI of the brain B. Electromyogram C. Lumbar puncture D. CT scan of the head E. Electroencephalogram
C. Dilated ventricles
14. Which of the following would be the expected finding on a CT scan of the brain that supports a diagnosis of Huntington disease? ©Kaplan A. Cerebral atrophy B. Intracranial mass C. Dilated ventricles D. Multiple brain lesions E. Intracranial hemorrhage
TIA
15. A 56-year-old male with history of atrial fibrillation presents to the emergency department with abrupt onset of right-sided weakness and speech impairment. A CT scan of the brain reveals no abnormalities. The patient is admitted and the symptoms resolve within 6 hours. Which of the following is the most likely diagnosis? ©Kaplan A. Lacunar infarct B. Hemorrhagic stroke C. Transient ischemic attack D. Intraparenchymal hemorrhage E. Reversible ischemic neurologic defect
Alzheimers dementia
2. A 60-year-old man presents with memory loss and gradual inability to complete business functions. The loss of cognitive ability has led to distress in his social and occupational functioning. According to his family, he is requiring more assistance with activities of daily living. There is no history of psychiatric disorders, alcoholism, or substance abuse. Physical examination and basic laboratory testing are normal. Which of the following is the most likely diagnosis? ©Kaplan A. Pseudodementia B. Vascular dementia C. Alzheimer's dementia D. Creutzfeldt-Jakob disease E. Frontotemporal lobe dementia
Verapamil
25. A 38-year-old male presents with a history of headaches that are progressively increasing in frequency and are beginning to affect his ability to work. He states the headaches start suddenly and describes them as severe, always occurring on the left side of his head, associated with rhinorrhea and watery eyes. He denies any family history of headaches. Physical examination is essentially unremarkable. Which of the following is the most appropriate prophylactic agent that may be prescribed to decrease the frequency of headaches? ©Kaplan A. Botulinum toxin A B. Verapamil (Isoptin) C. Amitriptyline (Elavil) D. Propranolol (Inderal) E. Sumatriptan (Imitrex)
D
26. A patient presents with severe low back pain and leg pain following a sneeze. Pain extends from the buttocks posteriorly to the sole of the foot. Ankle DTR is absent and plantar reflex is decreased. Which of the following is the most likely diagnosis? ©Kaplan A. L1 radiculopathy B. L3 radiculopathy C. L5 radiculopathy D. S1 radiculopathy E. S3 radiculopathy
T4
27. A patient has loss of sensation at the level of the nipples. Which of the following dermatomes is most likely affected? ©Kaplan A. C8 B. T2 C. T4 D. T6 E. T8
weakness of wrist extension
28. Which of the following is an expected physical examination finding associated with radial nerve damage? ©Kaplan A. Hypothenar atrophy B. Weakness of wrist extension C. Pain upon thumb movement D. Decreased sensation of the fifth finger E. Slowing of arm alternating movements
Spasticity
29. A patient presents with weakness. If upper motor neuron damage is present, which of the following examination findings is most likely to be present? ©Kaplan A. Presence of muscle fasciculations B. Atrophy of the involved muscles C. Absent deep tendon reflexes D. Babinski is negative E. Spasticity
GB syndrome
3. A 40-year-old woman presents with weakness of the lower extremities. Past medical history is significant for a recent episode of influenza. On physical examination, weakness is noted in both lower extremities. Achilles reflexes are decreased bilaterally. Spinal tap reveals only an elevated total protein. Which of the following is the most likely diagnosis? ©Kaplan A. Amyotrophic lateral sclerosis (ALS) B. Guillain-Barre syndrome C. Myasthenia gravis D. Multiple sclerosis E. Fibromyalgia
CT scan
An 80-year-old woman presents to the emergency room with left hemiparesis. Her husband states that she fell in the bathroom 48 hours ago but denies there was any loss of consciousness. The husband also states that his wife was a little confused this morning. On examination a dilated right pupil is noted. Which of the following tests should be obtained first? ©Kaplan A. MRI B. EEG C. CT scan D. Skull x-ray
Topiramate
An obese 30-year-old female with a history of asthma presents with a new diagnosis of migraine headaches. Her current medications include Depo-Provera and albuterol. Which of the following medications would be most appropriate for prophylaxis of her migraines? © Kaplan A. Dihydroergotamine (DHE-45) B. Topiramate (Topamax) C. Propranolol (Inderal) D. Rizatriptan (Maxalt) E. Amitriptyline (Elavil)
B,C,D
Brain stem stroke signs can be: MA A. Neuralgia B. Cranial nerve problems C. Ataxia D. Crossed motor symptoms E. Amaurosis fugax
ACA
infarction of which vessel is associated with urinary incontinence? ACA MCA PCA Basilar
