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Category: Medicine--->Neurology
Page: 3

Question 11# Print Question

. A 65-year-old man presents with right-sided weakness and expressive aphasia that began suddenly 2 hours ago. He has a history of osteoarthritis, gout, and hypertension. He has no history of recent head trauma or surgery. Medications include lisinopril, allopurinol, and acetaminophen. On physical examination the patient is alert. His blood pressure is 164/90 and his pulse rate is 66. He has a dense right hemiparesis and is not able to speak. Complete blood count, platelet count, prothrombin time, glucose, and ECG are normal. CT of the head without IV contrast is normal.

What is the next best step? 

A. Urgent carotid ultrasonography
B. Anticoagulation with heparin
C. Discuss risks and benefits of thrombolysis with intravenous recombinant tissue-type plasminogen activator
D. Aspirin 81 mg orally now
E. MRI scan of the brain


Question 12# Print Question

Three weeks after an upper respiratory illness, a 25-year-old man develops weakness of his legs, which progresses over several days. On physical examination he has 4/5 strength in his arms but only 2/5 in the legs bilaterally. There is no sensory deficit, but motor reflexes in the legs cannot be elicited. During a 2-day observation period the weakness ascends, and he begins to notice increasing weakness of the hands. He notices mild tingling, but the sensory examination continues to be normal.

The workup of this patient is most likely to show which of the following? 

A. Acellular spinal fluid with high protein
B. Abnormal EMG/NCV showing axonal degeneration
C. Positive edrophonium (Tensilon) test
D. Elevated CK
E. Respiratory alkalosis on arterial blood gas


Question 13# Print Question

A 32-year-old woman presents to you for evaluation of headache. The headaches began at age 18, were initially unilateral and worse around the time of her menses. Initially the use of triptans two or three times a month would provide complete relief. Over the past several years, however, the headaches have become more frequent and severe. Triptans provide only partial relief; the patient requires a combination of acetaminophen, caffeine, and butalbital to achieve some improvement. Prophylactic medications including beta-blockers, tricyclics, and topiramate have been unsuccessful in preventing the headaches, and she has been to the emergency room three times over the past 2 weeks for a “pain shot.” The general physical examination is unremarkable. Her funduscopic examination shows no evidence of papilledema, and a careful neurological examination is likewise normal.

What is the most likely explanation for her headache syndrome? 

A. Status migranosus
B. Medication overuse headache
C. Space occupying intracerebral lesion
D. CNS vasculitis
E. Pseudotumor cerebri


Question 14# Print Question

A 76-year-old woman presents with numbness and mild weakness in the legs. She has noticed mild numbness in the fingertips bilaterally. The symptoms have been slowly progressive over the past year. She rarely goes to the doctor and takes no medications. Neurological examination shows sensory loss to light touch distal to the knees and wrists in a symmetric pattern. Joint position and vibratory sensation are normal. Ankle reflexes are absent, and she has mild distal weakness.

Which of the following is the most likely abnormality on laboratory testing? 

A. Hyperglycemia
B. Macrocytic anemia with a low vitamin B12 level
C. Oligoclonal bands on CSF analysis
D. Low T4 , elevated TSH
E. Positive antiacetylcholine receptor antibody titers


Question 15# Print Question

. A 68-year-old man with a history of hypertension and coronary artery disease presents with right-sided weakness, sensory loss, and an expressive aphasia. Neuroimaging studies are shown below. In the emergency department the patient’s blood pressure is persistently 160/95.

Which of the following is the best next step in management of this patient’s blood pressure?

A. Administer IV nitroprusside
B. Administer clonidine 0.1 mg po until the blood pressure drops below 140/90
C. Observe the blood pressure
D. Administer IV mannitol
E. Administer IV labetolol




Category: Medicine--->Neurology
Page: 3 of 5