AAFP Board Review - Neural Exam Questions And
Answers 100% Verified
A 42-year-old male with a 4-year history of multiple sclerosis (MS) presents with an
acute attack
manifested by ataxia, incoordination, and dysarthria. Which one of the following is
indicated for
managing this flare-up of his MS? (check one)
A. Fingolimod (Gilenya)
B. Glatiramer (Copaxone)
C. Interferon-β (Avonex, Betaseron)
D. Methylprednisolone (Medrol)
E. Pramipexole (Mirapex) - ANSWER D. Methylprednisolone (Medrol)
sclerosis (MS) (SOR A). A Cochrane review found no significant differences in outcomes
based on the route of administration.
Disease-modifying agents (DMAR) e.g. interferon beta, glatiramer, and
immunosuppressants e.g. as fingolimod may decrease the frequency of exacerbations
and slow the progression of MS but are not the agents of first choice for treatment of
acute flareups.
Pramipexole does not have a primary role in the treatment of MS, although it might be
used to treat certain specific symptoms as an adjunct therapy.
A 50-year-old male presents to your office with a 1-hour history of an intense
retro-orbital headache. This started while he was jogging and eased somewhat when he
stopped, but has persisted along with some pain in his neck. Other than a blood
pressure of 165/100 mm Hg, his
examination is unremarkable. Noncontrast CT of the head is also unremarkable. His
pain has persisted after 2 hours in the emergency department.
Which one of the following would be most appropriate at this time? (check one)
A. MRI of the head
, B. Angiography
C. Nifedipine (Procardia) sublingually
D. Sumatriptan (Imitrex) subcutaneously
E. A lumbar puncture - ANSWER A. MRI of the head
nontraumatic subarachnoid hemorrhage
Risk factors: smoking, hypertension, heavy alcohol use, and a family history of
aneurysm or
hemorrhagic stroke.
The initial evaluation should consist of noncontrast CT of the head (SOR C). If it is
negative or equivocal the next step would be to perform a lumbar puncture to determine
whether or not
the cerebrospinal fluid is xanthochromic.
The absence of xanthochromia rules out subarachnoid hemorrhage (SOR C).
A 36-year-old female presents with the sudden onset of severe headache, nausea, and
photophobia. Her level of consciousness is progressively diminishing. Which one of the
following would be the most appropriate next step? (check one)
A. Head CT without contrast
B. Head CT with contrast
C. Head MRI
D. Lumbar puncture
E. CT angiography - ANSWER A. Head CT w/out contrast - subarachnoid hemorrhage
- useful for identifying other sources for the headache, for predicting the site of the
aneurysm, and for predicting cerebral vasospasm and poor outcome.
- As blood is cleared from the affected area, CT sensitivity drops to 93% within 24 hours,
and to 50% at 7 days.
- Patients with a positive CT result for subarachnoid hemorrhage should proceed
directly to angiography and treatment.
- Patients with a suspected subarachnoid hemorrhage who have negative or equivocal
results on head CT should have a lumbar puncture. MRI and CT with contrast are not
used for the diagnosis of acute subarachnoid hemorrhage.
, A 60-year-old right-handed white male arrives in the emergency department with
symptoms and signs consistent with a stroke. His past medical history is significant for
tobacco abuse and chronic treated hypertension. He is alert and afebrile. His pulse rate
is 100 beats/min, respirations 20/min, and blood pressure 190/95 mm Hg. He has a
moderate right-sided hemiparesis and is aphasic. There are no other significant
physical findings.
While appropriate tests are being ordered, immediate management in the emergency
department should include which one of the following? (check one)
A. Monitoring oxygenation status with pulse oximetry
B. Prompt lowering of systolic blood pressure to <140 mm Hg
C. Beginning an intravenous heparin infusion
D. Restricting fluid intake to 75 cc/hr
E. Giving parenteral corticosteroids - ANSWER A. Monitoring oxygenation status with
pulse oximetry
- Maintaining adequate tissue oxygenation is important for stroke
- Hypoxia leads to anaerobic metabolism and depletion of energy stores, increasing
brain injury. - potential need for oxygen should be assessed using pulse oximetry or
blood gas measurement. -
- Overzealous use of antihypertensive drugs is contraindicated, since this can reduce
cerebral perfusion.
- blood pressure goal: Mean Arterial Pressure is >130 mm Hg or systolic blood pressure
is >220 mm Hg.
A 68-year-old white male with diabetes mellitus is hospitalized after suffering a right
middle cerebral artery stroke. A nurse in the intensive-care unit calls to advise you that
his blood pressure is 200/110 mm Hg. You should: (check one)
A. continue monitoring the patient
B. administer labetalol (Trandate)
C. administer nicardipine (Cardene)
D. administer nitroprusside (Nitropress)
Answers 100% Verified
A 42-year-old male with a 4-year history of multiple sclerosis (MS) presents with an
acute attack
manifested by ataxia, incoordination, and dysarthria. Which one of the following is
indicated for
managing this flare-up of his MS? (check one)
A. Fingolimod (Gilenya)
B. Glatiramer (Copaxone)
C. Interferon-β (Avonex, Betaseron)
D. Methylprednisolone (Medrol)
E. Pramipexole (Mirapex) - ANSWER D. Methylprednisolone (Medrol)
sclerosis (MS) (SOR A). A Cochrane review found no significant differences in outcomes
based on the route of administration.
Disease-modifying agents (DMAR) e.g. interferon beta, glatiramer, and
immunosuppressants e.g. as fingolimod may decrease the frequency of exacerbations
and slow the progression of MS but are not the agents of first choice for treatment of
acute flareups.
Pramipexole does not have a primary role in the treatment of MS, although it might be
used to treat certain specific symptoms as an adjunct therapy.
A 50-year-old male presents to your office with a 1-hour history of an intense
retro-orbital headache. This started while he was jogging and eased somewhat when he
stopped, but has persisted along with some pain in his neck. Other than a blood
pressure of 165/100 mm Hg, his
examination is unremarkable. Noncontrast CT of the head is also unremarkable. His
pain has persisted after 2 hours in the emergency department.
Which one of the following would be most appropriate at this time? (check one)
A. MRI of the head
, B. Angiography
C. Nifedipine (Procardia) sublingually
D. Sumatriptan (Imitrex) subcutaneously
E. A lumbar puncture - ANSWER A. MRI of the head
nontraumatic subarachnoid hemorrhage
Risk factors: smoking, hypertension, heavy alcohol use, and a family history of
aneurysm or
hemorrhagic stroke.
The initial evaluation should consist of noncontrast CT of the head (SOR C). If it is
negative or equivocal the next step would be to perform a lumbar puncture to determine
whether or not
the cerebrospinal fluid is xanthochromic.
The absence of xanthochromia rules out subarachnoid hemorrhage (SOR C).
A 36-year-old female presents with the sudden onset of severe headache, nausea, and
photophobia. Her level of consciousness is progressively diminishing. Which one of the
following would be the most appropriate next step? (check one)
A. Head CT without contrast
B. Head CT with contrast
C. Head MRI
D. Lumbar puncture
E. CT angiography - ANSWER A. Head CT w/out contrast - subarachnoid hemorrhage
- useful for identifying other sources for the headache, for predicting the site of the
aneurysm, and for predicting cerebral vasospasm and poor outcome.
- As blood is cleared from the affected area, CT sensitivity drops to 93% within 24 hours,
and to 50% at 7 days.
- Patients with a positive CT result for subarachnoid hemorrhage should proceed
directly to angiography and treatment.
- Patients with a suspected subarachnoid hemorrhage who have negative or equivocal
results on head CT should have a lumbar puncture. MRI and CT with contrast are not
used for the diagnosis of acute subarachnoid hemorrhage.
, A 60-year-old right-handed white male arrives in the emergency department with
symptoms and signs consistent with a stroke. His past medical history is significant for
tobacco abuse and chronic treated hypertension. He is alert and afebrile. His pulse rate
is 100 beats/min, respirations 20/min, and blood pressure 190/95 mm Hg. He has a
moderate right-sided hemiparesis and is aphasic. There are no other significant
physical findings.
While appropriate tests are being ordered, immediate management in the emergency
department should include which one of the following? (check one)
A. Monitoring oxygenation status with pulse oximetry
B. Prompt lowering of systolic blood pressure to <140 mm Hg
C. Beginning an intravenous heparin infusion
D. Restricting fluid intake to 75 cc/hr
E. Giving parenteral corticosteroids - ANSWER A. Monitoring oxygenation status with
pulse oximetry
- Maintaining adequate tissue oxygenation is important for stroke
- Hypoxia leads to anaerobic metabolism and depletion of energy stores, increasing
brain injury. - potential need for oxygen should be assessed using pulse oximetry or
blood gas measurement. -
- Overzealous use of antihypertensive drugs is contraindicated, since this can reduce
cerebral perfusion.
- blood pressure goal: Mean Arterial Pressure is >130 mm Hg or systolic blood pressure
is >220 mm Hg.
A 68-year-old white male with diabetes mellitus is hospitalized after suffering a right
middle cerebral artery stroke. A nurse in the intensive-care unit calls to advise you that
his blood pressure is 200/110 mm Hg. You should: (check one)
A. continue monitoring the patient
B. administer labetalol (Trandate)
C. administer nicardipine (Cardene)
D. administer nitroprusside (Nitropress)
