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ROSH Review Neuro Exam Questions and answers
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ROSH Review Neuro Exam Questions and answers
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ROSH Review NeuroExam Questions and
answers
A 78-year-old man presents to the emergency department after being
involved in a motor vehicle collision. He was the restrained driver in a car
that was rear-ended, and he describes a “whiplash” injury in which his
head went suddenly forward and then backward. He reports pain in his
neck and has difficulty grasping things with both hands. Physical
examination reveals weakness and loss of deep tendon reflexes in both
upper extremities and normal strength in both lower extremities. On
questioning, he reports having intermittent neck pain, tingling in his
hands, and feeling “clumsy” prior to the injury, but it was much less
severe. Which of the following is the most likely diagnosis?
A Anterior cord syndrome
B Brown-Séquard syndrome
C Central cord syndrome
D Posterior cord syndrome
C Central cord syndrome
A 25-year-old woman presents to the emergency department with
complaints of severe fatigue, visual disturbances, and paresthesias of the
right side of her face and arm ongoing for the past two weeks. Which of
the following is the best imaging study to evaluate for demyelinating
lesions in her brain?
A. Computed tomography of the brain with intravenous contrast
B. Evoked potentials
C. Magnetic resonance imaging of the brain with intravenous gadolinium
D. Optical coherence tomography
C. Magnetic resonance imaging of the brain with intravenous gadolinium
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,A patient presents to the emergency department following a seizure.
Witnesses report that they saw the patient staring into space followed by
repetitive lip smacking and chewing motions that lasted about two
minutes. During this period of time, the patient was not responsive to
external stimulation and remained confused for several minutes after the
episode. Which of the following describes the type of seizure this patient
experienced?
A. Absence seizure
B. Complex partial seizure
C. Simple partial seizure
D. Tonic-clonic seizure
B. Complex partial seizure
Which of the following cerebrospinal fluid analysis findings is most
supportive of bacterial meningitis?
A. Decreased glucose concentration
B. Elevated lymphocyte count
C. Normal protein concentration
D. Normal white blood cell concentration
A. Decreased glucose concentration
Which of the following blood vessels commonly causes compression of the
trigeminal nerve root in trigeminal neuralgia?
A. Middle cerebral artery
B. Posterior cerebral artery
C. Superior cerebellar artery
D. Superior petrosal sinus
C. Superior cerebellar artery
A 50-year-old man presents to his primary care provider with a complaint
of shakiness. He states that he noticed the shakiness years ago, but it has
been getting progressively worse. He is concerned because his father had
the same problem. At this point, he has difficulty drinking from a glass as
his hands shake when he reaches for the glass and again when he is
drinking. He has noticed his head is also shaky at times. On physical
exam, a bilateral tremor is noted in the upper limbs when the patient is
standing with his arms outstretched. A bilateral tremor is also noted when
the patient performs finger-to-nose testing. Screening for heavy metal
poisoning was negative. There are negative findings on imaging. Which of
,the following would be the preferred initial treatment to decrease the
amplitude of the tremors?
A. Alcohol
B. Levodopa
C. Phenobarbital
D. Propranolol
D. Propranolol
Which of the following interventions is the first-line therapy for the
prevention of blindness associated with giant cell arteritis?
A. Disease-modifying antirheumatic drug
B. Glucocorticoids
C. Nonsteroidal anti-inflammatory medications
D. Surgery
B. Glucocorticoids
Which of the following describes the most common pathogenesis of a
brain abscess?
A. Direct extension
B. Hematogenous spread
C. Intracranial surgery
D. Skull fracture
A. Direct extension
55-year-old man with a history of lung cancer presents with a four-month
history of persistent, dull headache that has progressively worsened over
the past month. He states that the constant headache will wake him up at
night. It is aggravated when he bends down or if he moves the wrong way.
He has noticed that he has occasional blurred vision and has had episodes
of nausea and vomiting that also seem to be increasing. He has been
feeling weak and is confused at times when listening to conversations.
Physical exam is not remarkable. Which of the following is the most likely
diagnosis?
A. Meningitis
B. Metastatic tumor
C. Pheochromocytoma
D. Subarachnoid hemorrhage
, B. Metastatic tumor
Which of the following is the treatment of choice for trigeminal neuralgia?
A. Amitriptyline
B. Carbamazepine
C. Ibuprofen
D. Prednisone
B. Carbamazepine
A 45-year-old man with a 30 pack-year history of smoking presents to the
emergency department after losing consciousness while moving a large
piece of furniture about an hour ago. He states that he now has a left-
sided headache that has gotten worse over the past hour and is now 10
out of 10 on the visual analog scale for pain. He has some nausea and
confusion. He states that he had a similar headache a week ago that
resolved. On physical exam, he has elevated blood pressure, decreased
range of motion on head flexion, and retinal hemorrhages. An
electrocardiogram shows ST segment depression, QT interval
prolongation, deep symmetric T wave inversions, and prominent U waves.
Which of the following is the most likely diagnosis?
A. Cluster headache
B. Meningitis
C. Migraine headache
D. Subarachnoid hemorrhage
D. Subarachnoid hemorrhage
A 22-year-old man presents to his primary care provider six weeks after
breaking his right ulna. The patient states that his arm felt better after
being set, but he has noticed he has had pain and swelling for the past
two days in that area that seems to have spread to his upper arm as well.
He states that it hurts when he touches the skin of the arm or forearm. On
physical exam, the right arm and forearm are painful to palpation and
light touch. There is some erythema and edema. The area is warm to the
touch. There is no pain to passive or active stretching, but there is
decreased strength. Laboratory results, which include complete blood
count, erythrocyte sedimentation rate, and C-reactive protein, are
unremarkable. Bone scintigraphy shows active bone resorption in the
area. Doppler ultrasound is unremarkable. Which of the following is the
most likely diagnosis?
A. Cellulitis
B. Compartment syndrome
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