Neurology Questions Notes - Dental

Dental: Neurology Questions Notes - Dental

The document Neurology Questions Notes - Dental is a part of Dental category.
All you need of Dental at this link: Dental
 Page 1


Neurology:Question 1  
A 39-year-old executive comes to the office for a follow-up visit. She had a generalized tonic-
clonic seizure 1 week ago, witnessed by her husband, who reports that the seizure started 
suddenly. She had tonic extension and stiffening of her whole body followed by rhythmic jerking 
movements of her arms, trunk, and legs. The patient had no warning prior to the seizure, and 
afterward fell into a deep sleep. She was hospitalized. Wake and sleep electroencephalography 
and magnetic resonance imaging of the brain with contrast were normal, and she was sent home 
on a maintenance dose of phenytoin. The patient states that, for the 4 nights prior to the seizure, 
she slept no more than 2 hours a night in order to finish an assignment. There is no personal or 
family history of seizures. Neurologic examination is normal.  
Which of the following is the most appropriate next step in management?  
A. Continue phenytoin  
B. Discontinue phenytoin  
C. Discontinue phenytoin and begin carbamazepine  
D. Discontinue phenytoin and begin valproic acid  
E. Discontinue phenytoin and begin gabapentin  
 
Neurology:Question 2  
A 73-year-old woman has transient left hemiparesis lasting 20 minutes and calls your office that 
same day to inform you. She has a history of intermittent nonvalvular atrial fibrillation, angina 
pectoris, and hypertension. At the time of her call, she is completely asymptomatic. Her only 
antithrombotic therapy is aspirin, 81 mg daily.  
What is the optimal initial management for this patient?  
A. Schedule an office appointment within 1 week.  
B. Schedule transesophageal echocardiography.  
C. Schedule Holter monitoring.  
D. Schedule outpatient carotid duplex ultrasonography.  
E. Obtain emergency computed tomography.  
 
Neurology:Question 3  
A 35-year-old woman comes to the office with a 1-day history of blurred vision and retro-orbital 
pain with movement of the right eye. Past medical history is unremarkable. On examination, she 
has a right afferent pupillary defect. Visual acuity is 20/200 in the right eye with a dense central 
scotoma, and 20/25 in the left eye. Funduscopic examination is normal bilaterally. The rest of the 
neurologic examination is normal. Magnetic resonance imaging of the brain shows one 
nonenhancing periventricular white matter lesion. The patient refuses lumbar puncture for 
examination of cerebrospinal fluid. Treatment with intravenous methylprednisolone improves her 
optic neuritis.  
Which of the following should be done to monitor for development of multiple sclerosis?  
A. Repeat examination only when patient has a new neurologic symptom  
B. Serial visual evoked potential studies in 6 months  
C. Formal visual field studies in 6 months  
D. Follow-up magnetic resonance imaging of the brain with gadolinium in 6 months  
E. Serial nerve conduction velocity examinations in 6 months  
 
 
Page 2


Neurology:Question 1  
A 39-year-old executive comes to the office for a follow-up visit. She had a generalized tonic-
clonic seizure 1 week ago, witnessed by her husband, who reports that the seizure started 
suddenly. She had tonic extension and stiffening of her whole body followed by rhythmic jerking 
movements of her arms, trunk, and legs. The patient had no warning prior to the seizure, and 
afterward fell into a deep sleep. She was hospitalized. Wake and sleep electroencephalography 
and magnetic resonance imaging of the brain with contrast were normal, and she was sent home 
on a maintenance dose of phenytoin. The patient states that, for the 4 nights prior to the seizure, 
she slept no more than 2 hours a night in order to finish an assignment. There is no personal or 
family history of seizures. Neurologic examination is normal.  
Which of the following is the most appropriate next step in management?  
A. Continue phenytoin  
B. Discontinue phenytoin  
C. Discontinue phenytoin and begin carbamazepine  
D. Discontinue phenytoin and begin valproic acid  
E. Discontinue phenytoin and begin gabapentin  
 
Neurology:Question 2  
A 73-year-old woman has transient left hemiparesis lasting 20 minutes and calls your office that 
same day to inform you. She has a history of intermittent nonvalvular atrial fibrillation, angina 
pectoris, and hypertension. At the time of her call, she is completely asymptomatic. Her only 
antithrombotic therapy is aspirin, 81 mg daily.  
What is the optimal initial management for this patient?  
A. Schedule an office appointment within 1 week.  
B. Schedule transesophageal echocardiography.  
C. Schedule Holter monitoring.  
D. Schedule outpatient carotid duplex ultrasonography.  
E. Obtain emergency computed tomography.  
 
Neurology:Question 3  
A 35-year-old woman comes to the office with a 1-day history of blurred vision and retro-orbital 
pain with movement of the right eye. Past medical history is unremarkable. On examination, she 
has a right afferent pupillary defect. Visual acuity is 20/200 in the right eye with a dense central 
scotoma, and 20/25 in the left eye. Funduscopic examination is normal bilaterally. The rest of the 
neurologic examination is normal. Magnetic resonance imaging of the brain shows one 
nonenhancing periventricular white matter lesion. The patient refuses lumbar puncture for 
examination of cerebrospinal fluid. Treatment with intravenous methylprednisolone improves her 
optic neuritis.  
Which of the following should be done to monitor for development of multiple sclerosis?  
A. Repeat examination only when patient has a new neurologic symptom  
B. Serial visual evoked potential studies in 6 months  
C. Formal visual field studies in 6 months  
D. Follow-up magnetic resonance imaging of the brain with gadolinium in 6 months  
E. Serial nerve conduction velocity examinations in 6 months  
 
 
Neurology:Question 4  
A 42-year-old man comes to the emergency department because he had a 10-minute generalized 
tonic-clonic seizure that occurred during sleep 2 hours earlier. He reports a 1-month history of 
constant, progressively worsening headache, mild right-hand clumsiness, and occasional word-
finding difficulty. There is no significant past medical history. Neurologic examination reveals 
mild expressive language difficulties and a subtle right hemiparesis with right-sided 
hyperreflexia. The remainder of the physical examination is normal. Chest radiograph is normal. 
Computed tomographic scan is shown.  
 
Which of the following is the most likely cause of this patients findings?  
A. Brain metastasis  
B. Glioblastoma multiforme  
C. Toxoplasmosis  
D. Lymphoma of the central nervous system  
E. Bacterial abscess  
 
Neurology:Question 5  
A 36-year-old woman with a 15-year history of headaches comes to the office for a follow-up 
visit. Initially, she had moderate to severe bilateral pulsatile, frontal headaches accompanied by 
nausea, light and noise sensitivity, and occasional vomiting. They occurred one to two times each 
month and lasted 24 to 36 hours. In the last 2 years, she has developed a daily mild to moderate 
bilateral frontal headache that is present when she awakens and lasts all day. Approximately once 
per week she has a headache that is similar to her previous episodic headaches but less severe. 
She takes amitriptyline, 75 mg at bedtime, as a prophylactic agent. She takes 
acetaminophen/caffeine/butalbital, 4 tablets/d, and rizatriptan, 10 to 20 mg, one to two days per 
week for more severe headaches. Physical and neurologic examinations are normal.  
What is the most appropriate next step in managing this patients headache disorder?  
A. Discontinue amitriptyline and initiate treatment with divalproex sodium.  
B. Discontinue acetaminophen/caffeine/butalbital.  
C. Discontinue rizatriptan.  
D. Increase dose of amitriptyline.  
 
Page 3


Neurology:Question 1  
A 39-year-old executive comes to the office for a follow-up visit. She had a generalized tonic-
clonic seizure 1 week ago, witnessed by her husband, who reports that the seizure started 
suddenly. She had tonic extension and stiffening of her whole body followed by rhythmic jerking 
movements of her arms, trunk, and legs. The patient had no warning prior to the seizure, and 
afterward fell into a deep sleep. She was hospitalized. Wake and sleep electroencephalography 
and magnetic resonance imaging of the brain with contrast were normal, and she was sent home 
on a maintenance dose of phenytoin. The patient states that, for the 4 nights prior to the seizure, 
she slept no more than 2 hours a night in order to finish an assignment. There is no personal or 
family history of seizures. Neurologic examination is normal.  
Which of the following is the most appropriate next step in management?  
A. Continue phenytoin  
B. Discontinue phenytoin  
C. Discontinue phenytoin and begin carbamazepine  
D. Discontinue phenytoin and begin valproic acid  
E. Discontinue phenytoin and begin gabapentin  
 
Neurology:Question 2  
A 73-year-old woman has transient left hemiparesis lasting 20 minutes and calls your office that 
same day to inform you. She has a history of intermittent nonvalvular atrial fibrillation, angina 
pectoris, and hypertension. At the time of her call, she is completely asymptomatic. Her only 
antithrombotic therapy is aspirin, 81 mg daily.  
What is the optimal initial management for this patient?  
A. Schedule an office appointment within 1 week.  
B. Schedule transesophageal echocardiography.  
C. Schedule Holter monitoring.  
D. Schedule outpatient carotid duplex ultrasonography.  
E. Obtain emergency computed tomography.  
 
Neurology:Question 3  
A 35-year-old woman comes to the office with a 1-day history of blurred vision and retro-orbital 
pain with movement of the right eye. Past medical history is unremarkable. On examination, she 
has a right afferent pupillary defect. Visual acuity is 20/200 in the right eye with a dense central 
scotoma, and 20/25 in the left eye. Funduscopic examination is normal bilaterally. The rest of the 
neurologic examination is normal. Magnetic resonance imaging of the brain shows one 
nonenhancing periventricular white matter lesion. The patient refuses lumbar puncture for 
examination of cerebrospinal fluid. Treatment with intravenous methylprednisolone improves her 
optic neuritis.  
Which of the following should be done to monitor for development of multiple sclerosis?  
A. Repeat examination only when patient has a new neurologic symptom  
B. Serial visual evoked potential studies in 6 months  
C. Formal visual field studies in 6 months  
D. Follow-up magnetic resonance imaging of the brain with gadolinium in 6 months  
E. Serial nerve conduction velocity examinations in 6 months  
 
 
Neurology:Question 4  
A 42-year-old man comes to the emergency department because he had a 10-minute generalized 
tonic-clonic seizure that occurred during sleep 2 hours earlier. He reports a 1-month history of 
constant, progressively worsening headache, mild right-hand clumsiness, and occasional word-
finding difficulty. There is no significant past medical history. Neurologic examination reveals 
mild expressive language difficulties and a subtle right hemiparesis with right-sided 
hyperreflexia. The remainder of the physical examination is normal. Chest radiograph is normal. 
Computed tomographic scan is shown.  
 
Which of the following is the most likely cause of this patients findings?  
A. Brain metastasis  
B. Glioblastoma multiforme  
C. Toxoplasmosis  
D. Lymphoma of the central nervous system  
E. Bacterial abscess  
 
Neurology:Question 5  
A 36-year-old woman with a 15-year history of headaches comes to the office for a follow-up 
visit. Initially, she had moderate to severe bilateral pulsatile, frontal headaches accompanied by 
nausea, light and noise sensitivity, and occasional vomiting. They occurred one to two times each 
month and lasted 24 to 36 hours. In the last 2 years, she has developed a daily mild to moderate 
bilateral frontal headache that is present when she awakens and lasts all day. Approximately once 
per week she has a headache that is similar to her previous episodic headaches but less severe. 
She takes amitriptyline, 75 mg at bedtime, as a prophylactic agent. She takes 
acetaminophen/caffeine/butalbital, 4 tablets/d, and rizatriptan, 10 to 20 mg, one to two days per 
week for more severe headaches. Physical and neurologic examinations are normal.  
What is the most appropriate next step in managing this patients headache disorder?  
A. Discontinue amitriptyline and initiate treatment with divalproex sodium.  
B. Discontinue acetaminophen/caffeine/butalbital.  
C. Discontinue rizatriptan.  
D. Increase dose of amitriptyline.  
 
Neurology:Question 6  
A 65-year-old man has weakness and wasting of his left hand and muscle twitching involving his 
arms  
and thighs. The symptoms have progressed over 5 months. There is no associated pain or 
paresthesia. Neurologic examination reveals severe weakness and atrophy of the left thenar and 
hypothenar muscles, and mild weakness of left foot dorsiflexion. Muscle stretch reflexes are 
hyperactive and symmetric. Sensation is normal. Magnetic resonance imaging of the cervical 
spine was obtained by an orthopedic surgeon 2 weeks earlier and is normal.  
Which of the following is the most appropriate next step?  
A. Muscle biopsy  
B. Nerve biopsy  
C. Serum creatine kinase determination  
D. Electromyography  
E. Genetic testing  
 
 
Neurology:Question 7  
A 46-year-old woman comes to the office for management of a 4-mm left middle cerebral artery 
aneurysm. The aneurysm was found when the patient had magnetic resonance angiography and 
imaging for evaluation of a chronic headache disorder. Medical history is limited to chronic 
migraine headaches and smoking. Neurologic examination is normal.  
Which of the following is the most appropriate next step in this patient’s management?  
A. Arteriography  
B. Computed tomographic angiography  
C. Follow-up magnetic resonance angiography in 6 months  
D. Aneurysm clipping  
 
 
Neurology:Question 8  
A 71-year-old man comes to the office because of slowness, tremor, stiffness, and difficulty with 
dexterity, such as buttoning clothes. The problems developed insidiously over the last few years, 
and have caused him to curtail his activities severely. On examination, he has a shuffling gait, 
tremor of one hand while walking, and reduced arm swing (right more than left). Rapid 
alternating movements are very slow, especially in the right limbs. Passive movement of his 
limbs reveals rigidity. Neurologic examination is otherwise normal.  
Which of the following is the most appropriate management for this patient?  
A. No treatment  
B. Selegiline  
C. Amantadine  
D. Carbidopa/levodopa  
E. Entacapone  
 
 
 
Page 4


Neurology:Question 1  
A 39-year-old executive comes to the office for a follow-up visit. She had a generalized tonic-
clonic seizure 1 week ago, witnessed by her husband, who reports that the seizure started 
suddenly. She had tonic extension and stiffening of her whole body followed by rhythmic jerking 
movements of her arms, trunk, and legs. The patient had no warning prior to the seizure, and 
afterward fell into a deep sleep. She was hospitalized. Wake and sleep electroencephalography 
and magnetic resonance imaging of the brain with contrast were normal, and she was sent home 
on a maintenance dose of phenytoin. The patient states that, for the 4 nights prior to the seizure, 
she slept no more than 2 hours a night in order to finish an assignment. There is no personal or 
family history of seizures. Neurologic examination is normal.  
Which of the following is the most appropriate next step in management?  
A. Continue phenytoin  
B. Discontinue phenytoin  
C. Discontinue phenytoin and begin carbamazepine  
D. Discontinue phenytoin and begin valproic acid  
E. Discontinue phenytoin and begin gabapentin  
 
Neurology:Question 2  
A 73-year-old woman has transient left hemiparesis lasting 20 minutes and calls your office that 
same day to inform you. She has a history of intermittent nonvalvular atrial fibrillation, angina 
pectoris, and hypertension. At the time of her call, she is completely asymptomatic. Her only 
antithrombotic therapy is aspirin, 81 mg daily.  
What is the optimal initial management for this patient?  
A. Schedule an office appointment within 1 week.  
B. Schedule transesophageal echocardiography.  
C. Schedule Holter monitoring.  
D. Schedule outpatient carotid duplex ultrasonography.  
E. Obtain emergency computed tomography.  
 
Neurology:Question 3  
A 35-year-old woman comes to the office with a 1-day history of blurred vision and retro-orbital 
pain with movement of the right eye. Past medical history is unremarkable. On examination, she 
has a right afferent pupillary defect. Visual acuity is 20/200 in the right eye with a dense central 
scotoma, and 20/25 in the left eye. Funduscopic examination is normal bilaterally. The rest of the 
neurologic examination is normal. Magnetic resonance imaging of the brain shows one 
nonenhancing periventricular white matter lesion. The patient refuses lumbar puncture for 
examination of cerebrospinal fluid. Treatment with intravenous methylprednisolone improves her 
optic neuritis.  
Which of the following should be done to monitor for development of multiple sclerosis?  
A. Repeat examination only when patient has a new neurologic symptom  
B. Serial visual evoked potential studies in 6 months  
C. Formal visual field studies in 6 months  
D. Follow-up magnetic resonance imaging of the brain with gadolinium in 6 months  
E. Serial nerve conduction velocity examinations in 6 months  
 
 
Neurology:Question 4  
A 42-year-old man comes to the emergency department because he had a 10-minute generalized 
tonic-clonic seizure that occurred during sleep 2 hours earlier. He reports a 1-month history of 
constant, progressively worsening headache, mild right-hand clumsiness, and occasional word-
finding difficulty. There is no significant past medical history. Neurologic examination reveals 
mild expressive language difficulties and a subtle right hemiparesis with right-sided 
hyperreflexia. The remainder of the physical examination is normal. Chest radiograph is normal. 
Computed tomographic scan is shown.  
 
Which of the following is the most likely cause of this patients findings?  
A. Brain metastasis  
B. Glioblastoma multiforme  
C. Toxoplasmosis  
D. Lymphoma of the central nervous system  
E. Bacterial abscess  
 
Neurology:Question 5  
A 36-year-old woman with a 15-year history of headaches comes to the office for a follow-up 
visit. Initially, she had moderate to severe bilateral pulsatile, frontal headaches accompanied by 
nausea, light and noise sensitivity, and occasional vomiting. They occurred one to two times each 
month and lasted 24 to 36 hours. In the last 2 years, she has developed a daily mild to moderate 
bilateral frontal headache that is present when she awakens and lasts all day. Approximately once 
per week she has a headache that is similar to her previous episodic headaches but less severe. 
She takes amitriptyline, 75 mg at bedtime, as a prophylactic agent. She takes 
acetaminophen/caffeine/butalbital, 4 tablets/d, and rizatriptan, 10 to 20 mg, one to two days per 
week for more severe headaches. Physical and neurologic examinations are normal.  
What is the most appropriate next step in managing this patients headache disorder?  
A. Discontinue amitriptyline and initiate treatment with divalproex sodium.  
B. Discontinue acetaminophen/caffeine/butalbital.  
C. Discontinue rizatriptan.  
D. Increase dose of amitriptyline.  
 
Neurology:Question 6  
A 65-year-old man has weakness and wasting of his left hand and muscle twitching involving his 
arms  
and thighs. The symptoms have progressed over 5 months. There is no associated pain or 
paresthesia. Neurologic examination reveals severe weakness and atrophy of the left thenar and 
hypothenar muscles, and mild weakness of left foot dorsiflexion. Muscle stretch reflexes are 
hyperactive and symmetric. Sensation is normal. Magnetic resonance imaging of the cervical 
spine was obtained by an orthopedic surgeon 2 weeks earlier and is normal.  
Which of the following is the most appropriate next step?  
A. Muscle biopsy  
B. Nerve biopsy  
C. Serum creatine kinase determination  
D. Electromyography  
E. Genetic testing  
 
 
Neurology:Question 7  
A 46-year-old woman comes to the office for management of a 4-mm left middle cerebral artery 
aneurysm. The aneurysm was found when the patient had magnetic resonance angiography and 
imaging for evaluation of a chronic headache disorder. Medical history is limited to chronic 
migraine headaches and smoking. Neurologic examination is normal.  
Which of the following is the most appropriate next step in this patient’s management?  
A. Arteriography  
B. Computed tomographic angiography  
C. Follow-up magnetic resonance angiography in 6 months  
D. Aneurysm clipping  
 
 
Neurology:Question 8  
A 71-year-old man comes to the office because of slowness, tremor, stiffness, and difficulty with 
dexterity, such as buttoning clothes. The problems developed insidiously over the last few years, 
and have caused him to curtail his activities severely. On examination, he has a shuffling gait, 
tremor of one hand while walking, and reduced arm swing (right more than left). Rapid 
alternating movements are very slow, especially in the right limbs. Passive movement of his 
limbs reveals rigidity. Neurologic examination is otherwise normal.  
Which of the following is the most appropriate management for this patient?  
A. No treatment  
B. Selegiline  
C. Amantadine  
D. Carbidopa/levodopa  
E. Entacapone  
 
 
 
Neurology:Question 9  
A 68-year-old man is under evaluation for memory difficulty that, according to his wife, began 
insidiously 3 or 4 years earlier. He has difficulty remembering recent events. For example, he 
forgets appointments and recent conversations, and forgot that a close relative had recently died. 
He is no longer able to manage his own checkbook or operate his car without getting lost. 
Medical history is unremarkable. Physical examination is normal. Mental status examination 
shows prominent memory loss and difficulty drawing a complex figure. Magnetic resonance 
imaging of the brain shows only mild cerebral atrophy.  
Which of the following is the most likely diagnosis?  
A. Alzheimer’s disease  
B. Dementia with Lewy bodies  
C. Vascular dementia  
D. Frontotemporal dementia  
E. Creutzfeldt-Jakob disease  
 
 
Neurology:Question 10  
A 23-year-old woman comes to the office with her husband for evaluation of recent onset of 
unusual behavior. While providing the clinical history, the patient begins to cry. Shortly after that 
the patients arms start shaking. Gradually, the shaking becomes more pronounced and involves 
her legs and head. The patients breathing becomes deep and fast. This continues on and off for 
several minutes. The shaking stops gradually. The patient opens her eyes and states that she has a 
headache and is very tired and dizzy. Family history is positive for seizures in the patients cousin. 
There has been a significant amount of family stress recently.  
Which of the following is the most likely diagnosis?  
A. Syncope  
B. Nonepileptic event (pseudoseizure)  
C. Partial seizure with secondary generalization  
D. Generalized tonic-clonic seizure  
E. Basilar migraine  
 
 
Neurology:Question 11  
A 65-year-old woman comes to the emergency department because of mild left hem iparesis and 
mild left-sided sensory deficit that began suddenly 2 days earlier. She has a history of myocardial 
infarction and takes aspirin, 81 mg daily.  
Which of the following is the most appropriate next step in the management of this patient?  
A. Increase the aspirin dose to 325 mg daily.  
B. Discontinue aspirin and begin clopidogrel, 75 mg daily.  
C. Change aspirin to combined low-dose aspirin/extended-release dipyridamole.  
D. Discontinue aspirin and begin warfarin (target international normalized ratio, 2.0 to 3.0).  
E. Initiate inpatient diagnostic evaluation.  
 
 
Page 5


Neurology:Question 1  
A 39-year-old executive comes to the office for a follow-up visit. She had a generalized tonic-
clonic seizure 1 week ago, witnessed by her husband, who reports that the seizure started 
suddenly. She had tonic extension and stiffening of her whole body followed by rhythmic jerking 
movements of her arms, trunk, and legs. The patient had no warning prior to the seizure, and 
afterward fell into a deep sleep. She was hospitalized. Wake and sleep electroencephalography 
and magnetic resonance imaging of the brain with contrast were normal, and she was sent home 
on a maintenance dose of phenytoin. The patient states that, for the 4 nights prior to the seizure, 
she slept no more than 2 hours a night in order to finish an assignment. There is no personal or 
family history of seizures. Neurologic examination is normal.  
Which of the following is the most appropriate next step in management?  
A. Continue phenytoin  
B. Discontinue phenytoin  
C. Discontinue phenytoin and begin carbamazepine  
D. Discontinue phenytoin and begin valproic acid  
E. Discontinue phenytoin and begin gabapentin  
 
Neurology:Question 2  
A 73-year-old woman has transient left hemiparesis lasting 20 minutes and calls your office that 
same day to inform you. She has a history of intermittent nonvalvular atrial fibrillation, angina 
pectoris, and hypertension. At the time of her call, she is completely asymptomatic. Her only 
antithrombotic therapy is aspirin, 81 mg daily.  
What is the optimal initial management for this patient?  
A. Schedule an office appointment within 1 week.  
B. Schedule transesophageal echocardiography.  
C. Schedule Holter monitoring.  
D. Schedule outpatient carotid duplex ultrasonography.  
E. Obtain emergency computed tomography.  
 
Neurology:Question 3  
A 35-year-old woman comes to the office with a 1-day history of blurred vision and retro-orbital 
pain with movement of the right eye. Past medical history is unremarkable. On examination, she 
has a right afferent pupillary defect. Visual acuity is 20/200 in the right eye with a dense central 
scotoma, and 20/25 in the left eye. Funduscopic examination is normal bilaterally. The rest of the 
neurologic examination is normal. Magnetic resonance imaging of the brain shows one 
nonenhancing periventricular white matter lesion. The patient refuses lumbar puncture for 
examination of cerebrospinal fluid. Treatment with intravenous methylprednisolone improves her 
optic neuritis.  
Which of the following should be done to monitor for development of multiple sclerosis?  
A. Repeat examination only when patient has a new neurologic symptom  
B. Serial visual evoked potential studies in 6 months  
C. Formal visual field studies in 6 months  
D. Follow-up magnetic resonance imaging of the brain with gadolinium in 6 months  
E. Serial nerve conduction velocity examinations in 6 months  
 
 
Neurology:Question 4  
A 42-year-old man comes to the emergency department because he had a 10-minute generalized 
tonic-clonic seizure that occurred during sleep 2 hours earlier. He reports a 1-month history of 
constant, progressively worsening headache, mild right-hand clumsiness, and occasional word-
finding difficulty. There is no significant past medical history. Neurologic examination reveals 
mild expressive language difficulties and a subtle right hemiparesis with right-sided 
hyperreflexia. The remainder of the physical examination is normal. Chest radiograph is normal. 
Computed tomographic scan is shown.  
 
Which of the following is the most likely cause of this patients findings?  
A. Brain metastasis  
B. Glioblastoma multiforme  
C. Toxoplasmosis  
D. Lymphoma of the central nervous system  
E. Bacterial abscess  
 
Neurology:Question 5  
A 36-year-old woman with a 15-year history of headaches comes to the office for a follow-up 
visit. Initially, she had moderate to severe bilateral pulsatile, frontal headaches accompanied by 
nausea, light and noise sensitivity, and occasional vomiting. They occurred one to two times each 
month and lasted 24 to 36 hours. In the last 2 years, she has developed a daily mild to moderate 
bilateral frontal headache that is present when she awakens and lasts all day. Approximately once 
per week she has a headache that is similar to her previous episodic headaches but less severe. 
She takes amitriptyline, 75 mg at bedtime, as a prophylactic agent. She takes 
acetaminophen/caffeine/butalbital, 4 tablets/d, and rizatriptan, 10 to 20 mg, one to two days per 
week for more severe headaches. Physical and neurologic examinations are normal.  
What is the most appropriate next step in managing this patients headache disorder?  
A. Discontinue amitriptyline and initiate treatment with divalproex sodium.  
B. Discontinue acetaminophen/caffeine/butalbital.  
C. Discontinue rizatriptan.  
D. Increase dose of amitriptyline.  
 
Neurology:Question 6  
A 65-year-old man has weakness and wasting of his left hand and muscle twitching involving his 
arms  
and thighs. The symptoms have progressed over 5 months. There is no associated pain or 
paresthesia. Neurologic examination reveals severe weakness and atrophy of the left thenar and 
hypothenar muscles, and mild weakness of left foot dorsiflexion. Muscle stretch reflexes are 
hyperactive and symmetric. Sensation is normal. Magnetic resonance imaging of the cervical 
spine was obtained by an orthopedic surgeon 2 weeks earlier and is normal.  
Which of the following is the most appropriate next step?  
A. Muscle biopsy  
B. Nerve biopsy  
C. Serum creatine kinase determination  
D. Electromyography  
E. Genetic testing  
 
 
Neurology:Question 7  
A 46-year-old woman comes to the office for management of a 4-mm left middle cerebral artery 
aneurysm. The aneurysm was found when the patient had magnetic resonance angiography and 
imaging for evaluation of a chronic headache disorder. Medical history is limited to chronic 
migraine headaches and smoking. Neurologic examination is normal.  
Which of the following is the most appropriate next step in this patient’s management?  
A. Arteriography  
B. Computed tomographic angiography  
C. Follow-up magnetic resonance angiography in 6 months  
D. Aneurysm clipping  
 
 
Neurology:Question 8  
A 71-year-old man comes to the office because of slowness, tremor, stiffness, and difficulty with 
dexterity, such as buttoning clothes. The problems developed insidiously over the last few years, 
and have caused him to curtail his activities severely. On examination, he has a shuffling gait, 
tremor of one hand while walking, and reduced arm swing (right more than left). Rapid 
alternating movements are very slow, especially in the right limbs. Passive movement of his 
limbs reveals rigidity. Neurologic examination is otherwise normal.  
Which of the following is the most appropriate management for this patient?  
A. No treatment  
B. Selegiline  
C. Amantadine  
D. Carbidopa/levodopa  
E. Entacapone  
 
 
 
Neurology:Question 9  
A 68-year-old man is under evaluation for memory difficulty that, according to his wife, began 
insidiously 3 or 4 years earlier. He has difficulty remembering recent events. For example, he 
forgets appointments and recent conversations, and forgot that a close relative had recently died. 
He is no longer able to manage his own checkbook or operate his car without getting lost. 
Medical history is unremarkable. Physical examination is normal. Mental status examination 
shows prominent memory loss and difficulty drawing a complex figure. Magnetic resonance 
imaging of the brain shows only mild cerebral atrophy.  
Which of the following is the most likely diagnosis?  
A. Alzheimer’s disease  
B. Dementia with Lewy bodies  
C. Vascular dementia  
D. Frontotemporal dementia  
E. Creutzfeldt-Jakob disease  
 
 
Neurology:Question 10  
A 23-year-old woman comes to the office with her husband for evaluation of recent onset of 
unusual behavior. While providing the clinical history, the patient begins to cry. Shortly after that 
the patients arms start shaking. Gradually, the shaking becomes more pronounced and involves 
her legs and head. The patients breathing becomes deep and fast. This continues on and off for 
several minutes. The shaking stops gradually. The patient opens her eyes and states that she has a 
headache and is very tired and dizzy. Family history is positive for seizures in the patients cousin. 
There has been a significant amount of family stress recently.  
Which of the following is the most likely diagnosis?  
A. Syncope  
B. Nonepileptic event (pseudoseizure)  
C. Partial seizure with secondary generalization  
D. Generalized tonic-clonic seizure  
E. Basilar migraine  
 
 
Neurology:Question 11  
A 65-year-old woman comes to the emergency department because of mild left hem iparesis and 
mild left-sided sensory deficit that began suddenly 2 days earlier. She has a history of myocardial 
infarction and takes aspirin, 81 mg daily.  
Which of the following is the most appropriate next step in the management of this patient?  
A. Increase the aspirin dose to 325 mg daily.  
B. Discontinue aspirin and begin clopidogrel, 75 mg daily.  
C. Change aspirin to combined low-dose aspirin/extended-release dipyridamole.  
D. Discontinue aspirin and begin warfarin (target international normalized ratio, 2.0 to 3.0).  
E. Initiate inpatient diagnostic evaluation.  
 
 
Neurology:Question 12  
A 74-year-old man with a history of hypertension is brought to the emergency department after 
being found unresponsive by his wife in bed. He is intubated for airway protection. Blood 
pressure is 210/90 mm Hg; pulse, 80/min; and temperature, 37 C (98.6 F). When his eyes are 
opened by the examiner, there are intermittent spontaneous downward eye movements. There are 
no spontaneous horizontal eye movements, nor are there horizontal movements in response to the 
doll’s head maneuver. The pupils are very small but reactive. He does not move any extremities 
on command. There is occasional spontaneous extensor posturing in his arms and legs, and 
Babinski’s signs are present bilaterally. He blinks his eyes three times in a row on command.  
Which of the following is the most likely cause of this patient’s condition?  
A. Anoxic encephalopathy  
B. Left middle cerebral artery stroke  
C. Pontine infarct  
D. Cerebellar infarct  
 
Neurology:Question 13  
A 42-year-old man with secondary progressive multiple sclerosis comes to the local urgent care 
facility because of increased weakness and spasticity of the legs, with increased hip flexor tone. 
Over the past 3 days he has also noted an increase in urinary urgency and frequency. Until 3 days 
ago, he had been fairly stable, with a slowly progressive course, and could walk at least 500 feet 
with one cane; spasticity had been well controlled with baclofen, 20 mg three times a day orally. 
On examination, blood pressure is 110/70mm Hg; pulse, 92/min; and temperature, 38.2 C (100.8 
F). He has bilateral internuclear ophthalmoplegia. Hip flexion is weak bilaterally. Spasticity is 
severe in the legs, with sustained clonus at both ankles. Urinalysis shows 50 to 100 
leukocytes/hpf, and 2+ leukocyte esterase.  
In addition to treatment of the urinary tract infection, which of the following is the most 
appropriate treatment?  
A. Acetaminophen  
B. Oral prednisone  
C. Intravenous methyiprednisolone  
D. Interferon beta  
E. Glatiramer acetate  
 
Neurology:Question 14  
A 34-year-old woman comes to the office because of a 2-year history of bifrontal, throbbing 
headaches that occur two to four times per month and last 8 to 16 hours. During a headache, she 
tolerates noise and sound poorly and prefers to lie down. She sometimes has associated blurred 
vision, eye tearing, and rhinorrhea, and she is occasionally unable to work during a headache. The 
headache worsens with physical activity, such as brisk walking. Physical and neurologic 
examinations, including funduscopic examination, are normal.  
Which of the following is the most likely diagnosis?  
A. Episodic tension-type headache  
B. Cluster headache  
C. Idiopathic intracranial hypertension  
D. Migraine without aura  
E. Sinus headache  
 
Read More
Use Code STAYHOME200 and get INR 200 additional OFF
Use Coupon Code

Download free EduRev App

Track your progress, build streaks, highlight & save important lessons and more!

Related Searches

practice quizzes

,

MCQs

,

video lectures

,

shortcuts and tricks

,

Previous Year Questions with Solutions

,

Extra Questions

,

pdf

,

Summary

,

Neurology Questions Notes - Dental

,

Objective type Questions

,

study material

,

past year papers

,

Sample Paper

,

Neurology Questions Notes - Dental

,

ppt

,

Viva Questions

,

Exam

,

Neurology Questions Notes - Dental

,

Semester Notes

,

mock tests for examination

,

Free

,

Important questions

;