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. myokym...
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
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