Multiple Choice Questions (MCQ)

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Category: Medicine--->Neurology
Page: 2

Question 6# Print Question

A 30-year-old man complains of bilateral leg weakness and clumsiness of fine movements of the right hand. Five years previously he had an episode of transient visual loss. On physical examination, there is hyperreflexia with Babinski sign and cerebellar dysmetria with poor finger-to-nose movement. When the patient is asked to look to the right, the left eye does not move normally past the midline. Nystagmus is noted in the abducting eye. A more detailed history suggests the patient has had several episodes of gait difficulty that have resolved spontaneously. He appears to be stable between these episodes. He has no systemic symptoms of fever or weight loss.

Which of the following is the most appropriate next test to order? 

A. Lumbar puncture
B. MR scan with gadolinium infusion
C. Quantitative CSF IgG levels
D. Testing for oligoclonal bands in cerebrospinal fluid
E. CT scan of the head with intravenous contrast

Question 7# Print Question

A 76-year-old woman consults you because of leg discomfort. Her legs are comfortable during the day, but in the evening she develops an uncomfortable creepy-crawly sensation that keeps her awake for hours. The feeling is temporarily relieved by movement; she will awaken, pace around, and sometimes run water on her legs to achieve relief.

Which of the following is the best initial treatment for her condition? 

A. Zolpidem 5 mg po at bedtime
B. Trazodone 50 mg po at bedtime
C. Stretching exercises of the legs
D. Pramipexole 0.125 mg po in the evening
E. Cyclobenzaprine 10 mg po at bedtime

Question 8# Print Question

A 50-year-old man complains of slowly progressive weakness over several months. Walking has become more difficult, as has using his hands. There are no sensory, bowel, or bladder complaints; he denies problems with thinking, speech, or vision. Examination shows distal muscle weakness with muscle wasting and fasciculations. There are also upper motor neuron signs, including extensor plantar reflexes and hyperreflexia in wasted muscle groups.

Which of the following tests is most likely to be abnormal in this patient? 

A. Cerebrospinal fluid white blood cell count
B. Sensory conduction studies
C. CT scan of the brain
D. Electromyography
E. Thyroid studies and vitamin B12 level

Question 9# Print Question

A 22-year-old woman seeks advice for the treatment of headaches. The first of these headaches began at age 16, but their frequency has increased to 2 to 3 per month over the past year. The headaches are not preceded by an aura. The headaches are usually bilateral, are throbbing, and are so intense that she has to go home from work. Loud noise and physical activity make the pain more severe. Each headache lasts until the evening; she will awaken the next morning without pain or nausea, and will be able to return to work. She takes acetaminophen at the onset of the headache but without benefit. She is on no other medications including oral contraceptives. Neurological examination is benign.

What is the best step in the management of these headaches? 

A. Topiramate starting at a dose of 25 mg twice daily
B. An oral triptan such as sumatriptan at the onset of pain
C. Combination acetaminophen/hydrocodone at the onset of pain
D. Long-acting propranolol 40 mg daily, increasing until the headaches are completely prevented
E. Gabapentin 300 mg daily at bedtime, increasing until the headaches are controlled

Question 10# Print Question

A 20-year-old woman complains of weakness that is worse in the afternoon, worse during prolonged activity, and improved by rest. When fatigued, the patient is unable to hold her head up or chew her food. On physical examination, she has no loss of reflexes, sensation, or coordination.

Which of the following is the likely pathogenesis of this disease?

A. Antiacetylcholine receptor antibodies causing neuromuscular transmission failure
B. Destruction of anterior horn cells by virus
C. Progressive muscular atrophy caused by spinal degeneration
D. Demyelinating disease
E. Defect in muscle glycogen breakdown

Category: Medicine--->Neurology
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