Neurology 1

A 73-year-old unconscious female arrives in the ED via EMS after a fall injury at home. She opens her eyes when asked to and responds verbally to your questions but is confused and disoriented. You notice a large hematoma on the left side of her scalp and deformity of her right wrist. She grimaces when you palpate the scalp injury and attempts to pull her arm away when you palpate the injured wrist. What is her initial Glasgow coma scale (GCS)?

A 10-year-old male presents with headache, myalgia, photophobia, and neck pain. Vital signs are significant for a heart rate of 124 beats/minute and an oral temperature of 102.8. During your physical examination, forced flexion of the neck causes involuntary flexion of her hips and knees. This is a positive ________ sign.

Presence of Babinski sign is an indication of which of the following?

An 18-year-old male (new patient) presents to your neurology office for evaluation of a 3-month history of a worsening coarse, rhythmic, postural tremors of the upper extremities. He states that the tremors are present at rest and worsen when he is writing and when he is “stressed”. He denies any dysesthesias or muscular weakness. He states that his father had similar tremors but not until he was in his 50’s. Which of the following is the most likely cause of his symptoms?

A 29 year old male presents to the ER after he slipped and fell, striking the back of his head. His wife states that after he suffered an initial loss of consciousness, he was “himself” and seemed fine. A few hours ago he became drowsy and began to complain of headache, prompting his visit to the ER. A CT of the brain is performed and is shown below. What is this patient’s diagnosis?

A 66 year old male with a history of atrial fibrillation presents to the ER with headache, nausea and vomiting. Nuchal rigidity is appreciated during his exam. His medications include warfarin, diltiazem and simvastatin. His BP is 159/94, pulse 84 and irregular and temperature is 99.8 degrees Fahrenheit. CT of the brain is obtained and is shown below. Which of the following is the most likely diagnosis?

Which of the following is the common pathophysiologic abnormality in all patients who have syncope?

The presence of which of the following differentiates peripheral cranial nerve VII palsy in Ramsay Hunt syndrome from the typical Bell’s palsy?

A 13-year-old male was admitted to the hospital three days ago after a cycling accident in which he lost consciousness due to blunt head trauma (he wasn’t wearing a helmet). He regained consciousness in the ER prior to admission. He has numerous superficial abrasions on the torso and extremities which are being treated with topical antibiotics. On the third hospital day, the patient is returned to the emergency department because he develops a headache, dyspnea, productive cough, an oral temperature of 103.4 degrees F and he is confused. Further examination reveals a new cranial nerve IV palsy and nuchal rigidity. Chest X-ray is normal. CT scan of the brain is negative. Blood cultures are pending. Cerebrospinal fluid gram stain reveals gram positive diplococci. Which of the following is the most likely diagnosis?

A 34-year-old woman who has multiple sclerosis has a 2 day history of worsening pain and blurred vision in her right eye. Which of the following is the most likely ocular diagnosis?

Which of the following is a muscarinic antagonist?

Which of the following is the best initial diagnostic study in the evaluation of a patient who has sustained severe head trauma and is comatose?

A 67-year-old man with a medical history significant for hypertension has a fever of 103°F, stiff neck, nausea, and vomiting. Evaluation reveals that he has a peripheral white blood cell count of 28,000 and normal results from a computed tomography (CT) scan of the head; in addition, the opening and closing pressure is normal. The cerebrospinal fluid (CSF) findings are as follows: glucose is 29 (serum is 80), red blood cells are 30, protein is 85, and white blood cells are 4400 (90% polys). Which of the following is the most likely cause of the patient’s acute meningitis?

A patient is first seen with complaint of an episode of left arm “heaviness,” paresthesias, and the sensation of a “window shade” being pulled over his eye. The episode lasted approximately 10 minutes and resolved completely. Which of the following is the most likely diagnosis?

Methods of stroke prevention include all the following except:

Which of the following is the visual disturbance typically described during a transient ischemic attack (TIA)?

The pathology associated with the late stages of neurosyphilis includes all of the following except:

A 23-year-old woman has a sudden onset of light headedness, dizziness, and weakness while she is waiting in line to buy popcorn at the movies. These symptoms are immediately followed by a sudden and brief loss of consciousness. Which of the following is the most likely etiology?

Which of the following medications is indicated in the management of Alzheimer’s disease?

Which of the following clinical features is/are associated with acute meningitis in infants?

A 75-year-old female patient is brought to the clinic by her daughter, who believes she maybe suffering from a degenerative mental disorder. Although she has a strong memory and awareness, the patient exhibits frequent bouts of extreme euphoria, apathy, and disinhibition. She also frequently displays several primitive reflexes like the palmomental reflex and the palmar grasp. She has no history of strokes. Based on her condition, what is the patient’s most likely diagnosis?

A diabetic 56-year-old male patient arrives at the hospital with apparent muscular weakness on the left side of his face. He reports waking up in the morning with a pronounced pain in his left ear and then discovered that he was unable to move any part of the left side of his face. His general health is otherwise normal and unremarkable. Based on this information, which of the following diagnoses is most likely to be correct?

A 58-year-old male patient is brought to the clinic by his wife, who reports recent changes in mental status. The patient presents with intellectual decline, changes in personality, slowed mental activity, and expressive aphasia. You believe he may have a brain tumor. Based on the patient’s symptoms, what part of his brain has most likely been affected?

A 37-year-old male construction worker is brought to the emergency room after a falling tool struck him in the head. He exhibits some symptoms that suggest brain trauma, likely a concussion. Which of the following symptoms would more likely indicate a different diagnosis?

You are treating a 68-year-old male patient with Parkinson’s disease. Which of the following medications would you prescribe to specifically treat the tremor associated with this condition?

A 17-year-old male patient presents with a high fever, persistent headache, vomiting, and a stiff neck. He has also developed a petechial rash. You diagnose him with bacterial meningitis. Based on the patient’s symptoms, which of the following pathogens is most likely to be the cause of the patient’s condition?

An 8-year-old boy presents with involuntary, excessive eye blinking, facial grimacing, and shoulder shrugging. In addition, he also has been noticed muttering inappropriate words and repeating words or phrases he hears from other people. Which of the following is the most appropriate diagnosis?

A 10-year-old boy is brought to the clinic by his mother after sustaining a head injury during soccer practice. He was shoved by another player, fell, and hit his head on the ground. He has dizziness and a headache. He had ringing in the ears for a few minutes after it happened and felt dazed afterward, but did not lose consciousness. Initial neurologic exam checking vision, coordination, hearing, reflexes, memory, and concentration are normal. The patient has some difficulty with balance. You suspect a mild concussion. What test should you order first?

A 72-year-old man is brought into the clinic by ambulance. He is obese and has hypertension and hypercholesterolemia. His blood pressure is 180/100. He fell in the bathroom, and could not get up. He has weakness of the left arm and leg, left facial drooping, confusion, difficulty speaking, and numbness in the left arm. What is the most likely diagnosis?

A 25-year-old woman comes to the office complaining of severe headaches. She said they started several months ago, and have been increasing in frequency to about once every two weeks. The pain is isolated to the left side of her head, and she says it is an intense, throbbing pain. She is experiencing nausea, vomiting, and sensitivity to light and loud noises. She denies any head injury. What is the most likely diagnosis?