Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Neurologic Disorders--->Neuro Oncology
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Question 1# Print Question

A 29-year-old woman with no known past medical history is admitted to the ICU with status epilepticus. Her family reports that she complained of headaches, fevers, and myalgias that started a few days prior to presentation. On exam, you notice abnormal movements of her lips and mouth, but no evidence of seizure activity on EEG. A brain MRI is unremarkable. CSF obtained via lumbar puncture was notable for 14 WBCs, no RBC, mildly elevated protein, and normal glucose. CSF culture is negative and PCR for HSV is also negative. Anti-NMDA antibody in the CSF and serum is positive.

What is the MOST appropriate next step to make a diagnosis?

A. Repeat brain MRI to assess for progression of the disease
B. Repeat CSF collection for cytology and flow cytometry to rule out CNS lymphoma
C. Send serum for anti-ANA and anti-dsDNA antibodies to confirm the diagnosis of systemic lupus erythematosus (SLE)
D. Pelvic ultrasound to rule out ovarian teratoma

Question 2# Print Question

A 52-year-old woman with past medical history of infiltrating lobular carcinoma of the breast status post left mastectomy and neoadjuvant chemotherapy is brought to the ER by her family, reporting a 3-day history of headaches, nausea, vomiting, diplopia, and a witnessed fall prior to presentation. Neurological examination is notable for medial deviation of the right eye and inability to completely close the eyes. Lumbar puncture is performed and while waiting for the results, a brain MRI is obtained, which is notable for diffuse leptomeningeal contrast enhancement of the cortical surface and the basal cisterns along the ventral surface of the brainstem.

What is the CSF profile most consistent with this patient’s presentation? 

A. Elevated protein, low glucose, lymphocytic pleocytosis
B. Elevated protein, low glucose, neutrophilic pleocytosis
C. Normal protein, normal glucose, lymphocytic pleocytosis
D. Mildly elevated protein, normal glucose, normal WBC count

Question 3# Print Question

A 72-year-old man with past medical history of hypertension and prostate cancer status post radiation therapy is brought to ED after sustaining a witnessed mechanical fall. He denies loss of consciousness and reports that his head did not hit the floor. He reports a 3-week history of progressive lower back pain radiating down his left leg. The day before he experienced two episodes of fecal incontinence. A head CT is negative for any acute abnormalities. MRI spine shows collapsed L2 -L4 lumbar vertebrae and a mass invading the spinal cord with surrounding vasogenic edema.

What is the most appropriate next step in management?

A. Stat consult to spine surgery for emergent surgery
B. Stat consult to radiation oncologist for emergent radiation therapy
C. Administer IV steroids
D. Consult interventional radiology to obtain a biopsy

Question 4# Print Question

A 46-year-old patient with a history of known glioblastoma multiforme of the right temporal lobe has a witnessed seizure. He is now postictal and lethargic. A head CT is performed which reveals a heterogeneous mass with hemorrhage into the tumor and a large amount of vasogenic edema leading to mass effect on the midbrain. After his postictal period has resolved,

which set of clinical findings would be most suggestive of uncal herniation?

A. Ipsilateral pupillary dilation, decreased level of consciousness
B. Ipsilateral pupillary dilation, decreased level of consciousness, contralateral weakness
C. Contralateral pupillary dilation, decreased level of consciousness, ipsilateral weakness
D. Ipsilateral pupillary dilation and imaging revealing mass effect on the midbrain

Category: Critical Care Medicine-Neurologic Disorders--->Neuro Oncology
Page: 1 of 1