PRITE Clinical Neurology Questions & Answers

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 - ANSWERSE. Fasciculations 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 - ANSWERSB. CT chest, abdomen, pelvis 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 - ANSWERSD. Lesion volume 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 - ANSWERSC. Downward scraping of shin 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 - ANSWERSA. Multiple sclerosis 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 - ANSWERSE. Posterior cerebral 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 - ANSWERSE. Pimavanserin 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 - ANSWERSD. Transient Global Amnesia (TGA) 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 - ANSWERSB. Decreased REM latency 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 - ANSWERSE. ALS 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 - ANSWERSC. Cluster headache Black on CT Head represents what? - ANSWERSRemote stroke 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 - ANSWERSB. Apraxia 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 - ANSWERSB. Pramipexole 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 - ANSWERSE. Progressive supranuclear palsy 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 - ANSWERSC. N3 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 - ANSWERSE. Botulinum toxin 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 - ANSWERSC. exclude the presence of hemorrhage 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 - ANSWERSA. Cisplatin 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 - ANSWERSE. psychogenic 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 - ANSWERSC. Conversion disorder 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 - ANSWERSA. Apathy 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 - ANSWERSD. Levetiracetam 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 - ANSWERSB. Broca's (expressive) 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 - ANSWERSB. Radial 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 - ANSWERSB. Corticosteroids 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 - ANSWERSD. Intraocular pressure measurement 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 - ANSWERSD. 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 - ANSWERSD. Diffusion weighted MRI Which of the following statements is true regarding individuals with mild cognitive impairment? - ANSWERSApproximately 10% progress from MCI to dementia disease annually 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? - ANSWERSMamillary bodies In a 70 yo man who has normal cognitive and physical function, which sensation is most likely to be lost? - ANSWERSVibration 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? - ANSWERSMeningitis T or F? A cerebral cortex biopsy is appropriate for the diagnosis of Alzheimer's disease? - ANSWERSFalse Which histologic feature determines the severity of alzheimer's dementia most closely? - ANSWERSDegree of synapse loss Which of the following types of medication is least likely to be helpful in treating alzheimer's disease? - ANSWERSAn anticholinergic medication Pattern of inheritance of Wilson disease? - ANSWERSautosomal recessive Pattern of inheritance of huntington disease - ANSWERSautosomal dominant Pattern of inheritance of Familial creutzfeld jakob? - ANSWERSautosomal dominant Pattern of inheritance of Familial Alzheimer's - ANSWERSAutosomal dominant Neurofibrillary tangles - ANSWERSpaired, hyperphosphorylated helical filaments Neuritic plaque - ANSWERScluster of degenerating nerve terminals surrounding an amyloid core Nucleus basalis of Meynert - ANSWERSGroup of neurons beneath the globus pallidus Which findings are present on CT or MRI in alzheimer's disease? - ANSWERSenlarged third ventricl and atrophy of hippocampus Which two conditions feature alpha synuclein - ANSWERSParkinson's Dementia w/ Lewy Bodies Which 3 conditions feature intraneuronal tau proteins? - ANSWERSAlzheimer's FTD PSP From which area of the brain does cholinergic stimulation of the cerebral cortex predominantly originate? - ANSWERSNucleus basalis of Meynert Cerebral Ach Effect of: cholinesterase inhibitors that penetrate the blood brain barrier - ANSWERSincrease Cerebral Ach Effect of: scopolamine - ANSWERSdecrease Cerebral Ach Effect of: organic phosphate insecticides - ANSWERSincrease Cerebral Ach Effect of: Physostigmine - ANSWERSIncrease Which of the following is false regarding the cognitive subsection of Alzheimer Disease Assessment Scale (ADAS-Cog)? - ANSWERSDespite the advantages of the ADAS-Cog, the MMSE is the standard test in assessing pharmacologic treatment in Alzheimer's Of the following, which is the most common risk factor for delirium? - ANSWERSPreexisting dementia Which CNS cells does HIV primarily infect? - ANSWERSMacrophages and microglia 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? - ANSWERSSpecificity would increase 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? - ANSWERSNo significant short term psychological risks 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) - ANSWERSCognitive reserve Which of the following conditions is not a complication of professional boxing? - ANSWERSPeripheral neuropathy A volunteer in a study reeceives an overdose of scopolamine. Which would be best antidote? - ANSWERSPhysostigmine 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