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Neurology Exam 2 (Unit 7-11) PACKRATs Q&A With Complete Solutions
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Neurology Exam 2 (Unit 7-11) PACKRATsQ&A With Complete Solutions
What test is the single most useful test in establishing the
diagnosis of multiple sclerosis?
A. Cerebral spinal fluid cell count and protein level
B. Cerebral spinal fluid immunoglobulin studies
C. Evoked potentials
D. Magnetic Resonance Imaging correct answer: (u) A. While
cerebral spinal fluid cell count, protein levels, and
immunoglobins may be abnormal they are not specific for
multiple sclerosis.
(u) B. See A for explanation.
(u) C. Evoked potentials are most useful in the detection of
subclinical involvement of neuropathways in MS, but does not
establish the diagnosis.
(c) D. The presence of plaques on MRI is a key finding in
establishing the diagnosis of MS.
A 54 year-old male smoker presents to the clinic complaining of
frequent vague headaches with associated vomiting that awaken
him from sleep occasionally and have been present upon
awakening for about two weeks. The headache typically
resolves about an hour into his morning routine. The patient is
afebrile. What is the most likely cause of this patient's
headaches?
A. Cluster headaches
B. Depression
C. Glioblastoma
,D. Giant cell arteritis correct answer: (u) A. Cluster headaches
can awaken patients, but are not usually "vague".
(u) B. See C for explanation.
(c) C. Morning headaches associated with vomiting are
indicative of increased intracranial pressure and raise concern of
a CNS tumor such as a glioblastoma.
(u) D. Giant cell arteritis presents in the older patient with
headache in the temporal region and loss of vision.
A 28 year-old female presents to the clinic complaining of a
"prickly sensation" that started bilaterally in her feet two days
ago and difficulty walking. She now has the dysesthesia from
her mid-thigh down to her toes. On physical examination she
has diminished pain and temperature sensation, absent reflexes,
loss of proprioception in her legs bilaterally, and muscle strength
is 1+/5+ in the lower extremities and 5+/5+ in the upper
extremities. What is the most likely diagnosis?
A. Guillain-Bar correct answer: (c) A. The pattern of sensory,
motor and reflex findings is consistent with the pathophysiology
of peripheral nerve demyelination that occurs in Guillain-Barré
syndrome.
(u) B. Multiple sclerosis does not present as a symmetrical
ascending paralysis.
(u) C. Patients with myasthenia gravis tend to have intermittent
symptoms that affect proximal and extraocular muscles most
notably and it also lacks sensory involvement.
(u) D. Although the exact type of cord transection can alter the
pattern of motor and sensory findings a patient with spinal cord
compression who is not in spinal shock would have
hyperreflexia instead of areflexia.
, A 45 year-old man presents for a routine appointment. He tells
you his mother and father have both had ischemic strokes in
their 70's. He does not smoke. His blood pressure is 128/80
mmHg, pulse 78/minutes and regular, respiratory rate of
12/minute. What diagnostic studies would you order to further
evaluate this patient's risk of stroke?
A. Electrocardiogram
B. Fasting lipid profile
C. Carotid Doppler ultrasound
D. MRI with gadolinium correct answer: (u) A. The main risk
factor assessed by ECG is atrial fibrillation and this patient's
regular pulse
confirms he is currently not in atrial fibrillation
(c) B. Hyperlipidemia is a known risk factors for stroke that can
be modified with treatment.
(u) C. The patient does not have signs or symptoms of carotid
stenosis at this point.
(u) D. An MRI with gadolinium would be useful in evaluating
for the presence of Berry aneurysms,
but the history of ischemic strokes does not raise the concern of
an aneurysm.
An 82 year-old male is brought to the ED after being found
unresponsive in his apartment. On physical exam his pupils are
7 mm on the right and 3 mm on the left. What would be your
initial choice in managing this patient?
A. Order a CBC, electrolytes, and toxicology screen
B. Order a CT of the head
C. Hyperventilate the patient
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