Neuro wk 1 & 2 quiz

1. Neurowk 1 & 2 quiz 40 questions

2. The mHTT gene eventually causes a progressive movement disorder by: • Coding for a polyglutamate protein with 36 or more copies of the CAG region that associates with a-synuclein to produce toxic neuronal damage in the caudate nucleus • Encoding a polyglutamate expansion on the mHTT gene on chromosome 4 that leads to impaired signal transmission and eventual neuronal loss in the striatum • Production of polyglutamate protein that activates an autoimmune reaction against neurons by being a facilitating hapten • Transcriptional dysregulation of a protein on chromosome 21 causing dementia commonly seen in down’s syndrome

3. Loss of extrapyramidal neurons would be more likely to result in: • Babinski reflex present • Increased reflexes • Reduced postural control • Lewy body dementia

4. Which symptom is not extrapyramidal in cause? • Torticollis • Blurry vision • Rigidity • Akathisia

5. The mechanism of action of benserazide is: • Dopamine agonist • Monoamine oxidase B inhibitor • Dopa decarboxylase inhibitor • Dopamine precursor

6. What is the classic clinical triad describing Parkinson’s disease? • Dementia, akinesia, Instability • Bradykinesia, tremor, autonomic dysfunction • Tremor, Rigidity, Dementia • Tremor, rigidity, bradykinesia

7. The CT head above shows something not right, what is your spot diagnosis considering the patient had a traumatic blow to the head who is getting drowsy only 4 hours after the accident? • SAH • Epidural Hematoma • Subdural Hematoma • Diffuse astrocytoma

8. An ischemic stroke involving the anterior cerebral artery will most likely present as: • Unilateral Leg weakness and relative sparing of the facial muscles • Wernicke’s aphasia and apraxia • Confabulation and getting lost frequently in normally familiar surroundings • Left upper limb and facial weakness with sparing of lower limbs

9. The neurodegenerative disease most likely to present with profound atrophy of only the frontal and temporal lobes (evidenced by personality and language disturbances + MRI) and be associated with mutated tau protein is: • Pick disease • Alzheimer’s disease • Huntington’s disease • Parkinson’s disease

10. Which drug would have most promise for preventing progression on Alzheimer’s disease? • Aβ agonist • Dopamine agonist • Β-secretase inhibitor • corticosteroids

11. Side effects of L-Dopa include: • Bradykinesia • Hypertension • Dystonia • Hypotension

12. Grossly, Alzheimer’s disease is suspected by: • Neurofibrillary tangles • Pallor in the substantianigra • Cortical atrophy • Parietal atrophy

13. All Patients with Lewy Body dementia most likely have: • Alzheimer’s disease • Huntington Disease • Parkinson’s disease • Neurofibrillary tangles

14. Pupillary reflex goes something like this: Optic Nerve, pretectal nucleus, edinger-westphal nucleus, CNIII, Pupillary constrictor muscle. Which part of this pathway ensures a consensual reflex? • Edinger-westphal nucleus • Pretectal nucleus • Lateral geniculate nucleus • Oculomotor nerve

15. Better prognosis of Multiple Sclerosis is associated with: • male gender • Optic neuritis of sensory symptoms at onset • High frequency of attacks in the initial years • mature age at onset

16. The CT head above shows left lesion in 77 year old male who fell as he was putting his toast in the toaster, striking his head. This image was 3 weeks after the fall. He presented with hemiplegia. What is spot diagnosis?1. SAH2. Epidural Hematoma3. Subdural Hematoma4. Diffuse astrocytoma

17. If a 55 year old male presents to ED C/O ‘the worst headache I’ve ever had’ and he is known to have PCKD, HTN and IHD, what is the diagnosis you want to rule out fastest? • SAH • Epidural Hematoma • Subdural Hematoma • Diffuse astrocytoma

18. Which of the following anomalies is characterized by an enlarged posterior cranial fossa? • Arnold-chiari malformation • Chiari type 1 malformation • Dandy-walker malformation • Microvermisia

19. Which of the following statements are true? • Subfalcine herniation typically results in CN III compression • Transtentorial herniation typically results in cardiorespiratory dysfunction • Tonsillar herniation typically results in CN 8 compression • Arnold-chiari syndrome typically results in anterior cerebral artery haemorrhage

20. Which area of brain is most likely to be affected by ischemia in global shock? • Area covered by both Anterior cerebral and Middle cerebral arteries • The motor cortex • Area covered by both Middle and Posterior cerebral arteries • The Occipital lobe

21. The most likely development after severe bacterial meningitis would be • Non-communicating hydrocephalus • Communicating hydrocephalus • SAH • Syringomyelia

22. What is the incidence of dementia in Parkinson’s disease? • 5 – 10% • <65% • 10-30% • 40-65%

23. A 32 year old woman presents complaining of blurred vision and pain in the right eye.  On examination there is decreased visual acuity in the right eye that does not correct with pinhole testing.  There is a relative afferent pupillary defect on the right and testing of the right visual field shows a small central scotoma.  The most likely localisation of the lesion is the: • Occiptal cortex • Optic tract • Optic chiasm • Optic nerve

24. Which of the following are the cardinal features of idiopathic Parkinson disease? • Tremor rigidity, bradykinesia, and gaze palsy • Tremor , bradykinesia, rigidity and postural instability • Bradykinesia, dementia, tremor, and rigidity • Tremor, autonomic dysfunction, bradykinesia, and rigidity

25. A 58 year old man is seen in the neurology clinic with a 3 month history of right sided resting tremor.  On examination he is noted to have mild masking of facial expression and there is diminished swing of the right arm when he walks.  You suspect that he may have early idiopathic Parkinson’s disease.  Which of the following statements concerning this disorder is true? • Most cases are familial with mutation in the α synuclein or parkin genes • It is characterised by the death of dopaminergic neurons in the substantianigra pars compacta • Early falls are a common problem in this disorder • Impairment of vertical gaze is a common manifestation of this disorder

26. What is the pathological hallmark of Parkinson’s disease? • Negri bodies • Hirano bodies • Lewy bodies • Pick bodies

27. Which of the following best describes a typical multiple sclerosis relapse? • Of acute onset, evolving over hours and improving within 1-2 weeks • Developing over a few days to a few weeks, reaching a plateau for several weeks and showing recovery over months • Unremitting, escalating neurological symptoms resulting in permanent disability • Episodes of paroxysmal symptoms lasting several minutes, increase if frequency, build up and coalesce into a consistent pattern over a few days

28. The drugs donepezil, rivastigmine, and galantamine are used in Alzheimer’s Disease to try to raise the availability of what transmitter in the brain? • Glutamate • Acetylcholine • Serotonin • Dopamine

29. A 71 year old with a clinical diagnosis of Alzheimer’s disease come to autopsy after a fatal motor vehicle accident.  Which of the following is a neuropathological hallmark of Alzheimer’s Disease? • Lewy bodies in cortical neurons • Prominent atrophy of caudate • Lewy bodies in the substantianigra • Neurofibrillary tangles

30. A 33 year old man is noted to have exacerbations of weakness.  He is diagnosed with MS.  Which of the following is consistent with the diagnosis? • Steroids are effective in improving the course of disease • The diagnosis of MS is based on clinical lesions separated by time and space • Oligo bands in the CSF are specific for multiple sclerosis • Invariably leads to severe disability

31. A 42 year old man is brought to the neurologist for evaluation of a few months’ history of personality changes.  His family indicates that, over the previous year, he has made unusual movements with his hands, and he seems to have some memory difficulties.  His father died in his 50s with a similar clinical syndrome, including prominent chorea and dementia.   The most likely genetic abnormality will be localized on chromosome: • 6 • 11 • 4 • 19

32. A 47 year old male with intense headache, lacrimation, and congestion in one eye is likely to have the following type of headache: • Classic migraine • Subarachnoid haemorrhage • Trigeminal neuralgia • Cluster headache

33. A 68 year old man taking warfarin falls while in hospital, is found on the floor, and is difficult to rouse.  He has a new right hemiparesis and an intracranial haemorrhage is suspected.  What is the most appropriate initial radiologic study? • Cerebral angiography • Head CT without contrast • Skull x-ray • Head CT with contrast

34. A 45 year old man with a prior history of migraine headaches with aura presents to emergency complaining of a progressive headache for the last month that is different from his usual migraine.  There is no associated nausea or vomiting.  His neurological examination is completely normal.  Your next step in management should be • Abortive migraine treatment • Preventive migraine treatment • Reassurance and discharge home • Brain imaging study

35. A 53 year old construction worker is brought to the emergency department with a severe sudden onset headache accompanied by vomiting.  A CT scan demonstrates a subarachnoid haemorrhage.  Which of the following is a common cause of subarachnoid haemorrhage? • Tearing of the bridging veins • Aneurysmal rupture • Arteriovenous malformation rupture • Laceration of the middle meningeal artery

36. A 25 year old man is now comatose after suffering blunt force trauma to the head.  On the basis of history, examination and head CT scan, he is diagnosed with a epidural haematoma.  Of the following choices which is the best treatment option? • Hyperventilation • Administration of mannitol • Neurosurgical decompression • Administration of tissue plasminogen activiator

37. The most reliable method for distinguishing between a “traumatic” lumbar puncture and a subarachnoid haemorrhage is the presence of • Increased opening pressure • Increased white cell count • Increased red cell count • Xanthochromia

38. A 77 year old woman with a history of migraine in her 20s and 30s is seen by her GP with the complain that she has experienced headaches again for the first time in many years.  Upon further enquiry she reports a sense of generalised fatigue and notes that there is a discomfort over her right temple when she brushes her hair.  The neurologic examination is normal.  Which of the following would be the most appropriate clinical course? ESR, CRP and temporal artery biopsy, as giant cell arteritis is the most likely diagnosis she likely has trigeminal neuralgia Reassurance that her headaches likely represent recurrence of her old migraines MRI of the brain to rule out an intracranial mass lesion

39. A 33 year old woman complains of chronic daily headaches.  A full and thorough investigation has been negative.  Which of the following is an important principle in the initial management of this disorder? • Lower the analgesic dose while beginning other therapy • Reassure the patient, and refer to a psychiatrist • Increase the analgesic dose while initiating biofeedback therapy • Maintain analgesic dose while using antiepileptic therapy

40. A 49 year old man presents to the emergency department with acute onset severe headache, photophobia and decreased level of consciousness.  His mother had a SAH at 54 years of age.  He has no personal history of hypertension, vascular disease or elevated cholesterol levels.  On examination he is afebrile, has a BP of 148/82 and mild nuchal rigidity.  A CT scan of the head fails to reveal an abnormality.  What is the best step to take next in the management of this patient? Lumbar puncture Begin oral nimodipine Cerebral angiography Carotid doppler scan

41. A 28 year old woman presents to emergency with a severe unilateral throbbing headache accompanied by photophobia and phonophobia.  These headaches started in her teens and she has one every month.  Which of the following medications is effective as abortive treatment? • Verapamil • Sumatriptan • Amitriptyline • Valproic acid