BATES – Neuro Verified Solutions
A 28-year-old book editor comes to your clinic, complaining of strange episodes. He states that about
once a week for the last 3 months his left hand and arm will stiffen and then start jerking. He says that
after a few seconds his whole left arm and then hi...
BATES – Neuro Verified Solutions
A 28-year-old book editor comes to your clinic, complaining of strange episodes. He states that about
once a week for the last 3 months his left hand and arm will stiffen and then start jerking. He says that
after a few seconds his whole left arm and then his left leg will also start to jerk. He denies any loss of
consciousness or loss of bowel or bladder control. When the symptoms resolve, his arm and leg feel
tired but otherwise he feels fine. His past medical history is significant for a cyst in his brain that was
removed 6 months ago. He is married and has two children. His parents are both healthy. On
examination you see a scar over the right side of his head but otherwise his neurologic examination is
unremarkable.
What type of seizure disorder is he most likely to have?
A) Generalized tonic-clonic seizure
B) Generalized absence seizure
C) Simple partial seizure (Jacksonian)
D) Complex partial seizure
C) Simple partial seizure (Jacksonian)
A 7-year-old child is brought to your clinic by her mother. The mother states that her daughter is doing
poorly in school because she has some kind of "ADD" (attention deficit disorder). You ask the mother
what makes her think the child has ADD. The mother tells you that both at home and at school her
daughter will just zone out for several seconds and lick her lips. She states it happens at least four to six
times an hour. She says this has been happening for about a year. After several seconds of lip-licking her
daughter seems normal again. She states her daughter has been generally healthy with just normal
childhood colds and ear infections. The patient's parents are both healthy and no other family members
have had these symptoms.
What type of seizure disorder is she most likely to have?
A) Generalized tonic-clonic seizure
B) Generalized absence seizure
C) Simple partial seizure (Jacksonian)
D) Complex partial seizure
B) Generalized absence seizure
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A 37-year-old insurance agent comes to your office, complaining of trembling hands. She says that for
the past 3 months when she tries to use her hands to fix her hair or cook they shake badly. She says she
doesn't feel particularly nervous when this occurs but she worries that other people will think she has an
anxiety disorder or that she's a drinker. She admits to having some recent fatigue, trouble with vision,
and difficulty maintaining bladder control. Her past medical history is remarkable for hypothyroidism.
Her mother has lupus and her father is healthy. She has an older brother with type 1 diabetes. She is
married and has three children. She denies tobacco, alcohol, or drug use. On examination, when she
tries to reach for a pencil to fill out the health form she has obvious tremors in her dominant hand.
What type of tremor is she most likely to have?
, A) Resting tremor
B) Postural tremor
C) Intention tremor
C) Intention tremor
A 77-year-old retired school superintendent comes to your office, complaining of unsteady hands. He
says that for the past 6 months, when his hands are resting in his lap they shake uncontrollably. He says
when he holds them out in front of his body the shaking diminishes, and when he uses his hands the
shaking is also better. He also complains of some difficulty getting up out of his chair and walking
around. He denies any recent illnesses or injuries. His past medical history is significant for high blood
pressure and coronary artery disease, requiring a stent in the past. He has been married for over 50
years and has five children and 12 grandchildren. He denies any tobacco, alcohol, or drug use. His
mother died of a stroke in her 70s and his father died of a heart attack in his 60s. He has a younger sister
who has arthritis problems. His children are all essentially healthy. On examination you see a fine, pill-
rolling tremor of his left hand. His right shows less movement. His cranial nerve examination is normal.
He has some difficulty rising from his chair, his gait is slow, and it takes him time to turn around to walk
back toward you. He has almost no "arm swing" with his gait.
What type of tremor is he most likely to have?
A) Resting tremor
B) Postural tremor
C) Intention tremor
A) Resting tremor
A 48-year-old grocery store manager comes to your clinic, complaining of her head being "stuck" to one
side. She says that today she was doing her normal routine when it suddenly felt like her head was being
moved to her left and then it just stuck that way. She says it is somewhat painful because she cannot get
it moved back to normal. She denies any recent neck trauma. Her past medical history consists of type 2
diabetes and gastroparesis (slow-moving peristalsis in the digestive tract, seen in diabetes). She is on
oral medication for each. She is married and has three children. She denies tobacco, alcohol, or drug
use. Her father has diabetes and her mother passed away from breast cancer. Her children are healthy.
On examination you see a slightly overweight Hispanic woman appearing her stated age. Her head is
twisted grotesquely to her left but otherwise her examination is normal.
What form of involuntary movement does she have?
A) Chorea
B) Asbestosis
C) Tic
D) Dystonia
D) Dystonia
A 41-year-old real estate agent comes to your office, complaining that he feels like his face is paralyzed
on the left. He states that last week he felt his left eyelid was drowsy and as the day progressed he was
unable to close his eyelid all the way. Later he felt like his smile became affected also. He denies any
recent injuries but had an upper respiratory viral infection last month. His past medical history is
unremarkable. He is divorced and has one child. He smokes one pack of cigarettes a day, occasionally
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