Neurology 7

A 37-year-old female awakes with left-sided facial weakness and vague periauricular pain. She is unable to close her left eye. Which of the following is believed to be a risk factor for this condition?

A patient suffering from cluster headaches will usually complain of:

A 27-year-old man has sudden, recurrent episodes of falling asleep during the day. Narcolepsy is diagnosed. The patient is most likely to have which of the following associated symptoms?

A 33-year-old woman has a 1 month history of continuous bilateral leg movements associated with unpleasant paresthesias only when lying in bed. Leg movement immediately relieves the symptoms. Restless legs syndrome is diagnosed. Which of the following is the most important serum diagnostic test?

An 80-year-old man has Parkinson’s disease. A depletion in the brain of which of the following is the pathophysiologic basis of the disease?

An 86-year-old man has Alzheimer’s disease. Which of the following classes of medicine is the preferred initial therapy?

A 34-year-old woman has newly diagnosed migraine headaches. Which of the following is the mechanism of action of her prescribed sumatriptan?

A 54-year-old male presents with ptosis, facial muscle weakness, diplopia, and dysphagia which has been progressively worsening for the past year. Based on his symptomology, he is most likely suffering from which of the following conditions?

Which of the following conditions has a high-incidence of associated thymus abnormalities?

A 6-year-old boy is brought to the ER complaining of a headache and throat pain which have been present since he awoke this morning. His parents state that he is currently being treated for an ear infection with amoxicillin and acetaminophen. Past medical history is significant for recurrent ear infections. Vital signs are BP: 108/60mmHg; heart rate: 96bpm and regular; respirations: 20 breaths/min, non-labored; temp: 102.4° F (oral). Physical exam reveals a mildly agitated child who is oriented x3. A diffuse purpuric skin rash is present. HEENT exam is significant for neck pain and stiffness. Which of the following is the most likely diagnosis?

A 7-year-old patient is brought to the ED by his parents due to an acute onset of nausea and emesis today. They note several episodes of emesis and “dry heaves” since awakening. The patient has also been “very sleepy” for the past two days. He “seems confused” and is irritable when they talk to him. He was treated for bronchitis with OTC medications and was getting better prior to today. Vital signs are stable and he is afebrile. Mental Status Examination reveals mild confusion. Physical exam is unremarkable except for moderate epigastric tenderness. This patient is most likely suffering from which of the following conditions?

A 54-year-old female presents to the emergency room for evaluation of a “severe” left side headache. She describes a very sudden onset two hours ago while at work. She had a single episode of emesis just prior to coming to the ER. Vital signs are BP: 202/112mmHg; heart rate: 96bpm, regular; respirations: 20 breaths/min, non-labored; temp: 98.4° F (oral). Neck stiffness and decreased range of motion are present. Neurological examination reveals slight weakness on the right side. CT scan shows hyperdense areas in the left frontoparietal region without a midline shift. Based on this patient’s history and exam findings, which of the following is the correct diagnosis?

A 32-year-old male was struck in the head by a softball during an intramural game and was unconscious for about a minute (according to bystanders). He arrives via EMS and your initial assessment reveals no neurological sequelae. As you are getting ready to send the patient home he asks for a couple of Tylenol because he is getting a headache. He appears a little drowsy and his grip is weak on the right side. You send him back to his bed and order a stat CT scan. Which of the following do you anticipate to see on his scan?

A 74-year-old female with a long-standing history of poorly controlled diabetes and hypertension, presents to your office. Her family has brought her concerned as the patient is having difficulty speaking since last night. The patient states she had been feeling well before last night at which time the symptoms suddenly occurred. The patient was unable to get dressed unassisted and specifically was having difficulty buttoning her shirt. The patient states that she feels her mouth and hands are not doing what she wants them to. Which of the following is the most likely diagnosis?

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?

A 46-year-old woman is brought to the emergency department following a high-speed motor vehicle accident. On physician examination she is alert, awake and oriented to time, place and person, vital signs on admission are; heart rate 52 bpm and blood pressure 70/40. , She is unable to move any of her four extremities and the extremities are warm and pink. Which of the following is the most likely diagnosis?

A 75-year-old man has experienced periodic weakness in the right arm that last several minutes for the past two months. He has a past medical history significant for hypertension. Physical examination reveals a lout left carotid bruit. Which of the following is the most appropriate next step?

A patient sustains a fall, and has injuries to the left side of her head. She is determined to have an epidural hematoma on computed tomography scan. The blood is most likely from which of the following vessels?

The latest lab work done on an 81-year-old male with advanced Parkinson’s shows increasing liver impairment. Which drug used to treat Parkinson’s could be causing this problem?

A 71-year-old male is brought to the emergency room by his daughter. She states that he suffers from periodic memory loss and has been diagnosed with early Alzheimer’s disease. Presently, his symptoms include excessive skeletal muscle contractions, salivation, lacrimation, difficulty breathing, and bradycardia. She has brought the list of medications he takes. You suspect an overdose of which of the following drugs?

A 3 month old baby is brought to the emergency department because she is very lethargic. Her parents report that she had been irritable and vomiting all day, and has always been a very “colicky” baby.   You suspect that she may have shaken baby syndrome and CT scan confirms that there is a subdural hematoma. Which of the following findings would also support the diagnosis of shaken baby syndrome?

A 2 month old male is brought to the emergency room with a 24 hour history of irritability and fevers. Which of the following physical examination findings would be the most sensitive for meningitis in a patient of this age?

You are performing a newborn examination on a term female born to a 43-year-old mother. You observe that the infant is hypotonic, brachycephalic, has a flattened nasal bridge, upward slanting palpebral fissures, epicanthial folds and a large protruding tongue. A heart murmur consistent with a ventricular septal defect is detected as well. Which of the following chromosomal defects is most likely the cause of this infant’s abnormalities?

What is the most prevalent etiology of dementia in the United States?

Which of the following is the best initial medication for treatment of mild-to-moderate Alzheimer’s disease?