Neuro wk 1 & 2 quiz

40 questions

The mHTT gene eventually causes a progressive movement disorder by:1. 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

2. Encoding a polyglutamate expansion on the mHTT gene on chromosome 4 that leads to impaired signal transmission and eventual neuronal loss in the striatum

3. Production of polyglutamate protein that activates an autoimmune reaction against neurons by being a facilitating hapten

4. Transcriptional dysregulation of a protein on chromosome 21 causing dementia commonly seen in down’s syndrome

Loss of extrapyramidal neurons would be more likely to result in:1. Babinski reflex present2. Increased reflexes3. Reduced postural control4. Lewy body dementia

Which symptom is not extrapyramidal in cause?1. Torticollis2. Blurry vision3. Rigidity4. Akathisia

The mechanism of action of benserazide is:1. Dopamine agonist2. Monoamine oxidase B inhibitor3. Dopa decarboxylase inhibitor4. Dopamine precursor

What is the classic clinical triad describing Parkinson’s disease?1. Dementia, akinesia, Instability2. Bradykinesia, tremor, autonomic dysfunction3. Tremor, Rigidity, Dementia4. Tremor, rigidity, bradykinesia

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?1. SAH2. Epidural Hematoma3. Subdural Hematoma4. Diffuse astrocytoma

An ischemic stroke involving the anterior cerebral artery will most likely present as:1. Unilateral Leg weakness and relative sparing of the

facial muscles2. Wernicke’s aphasia and apraxia3. Confabulation and getting lost frequently in

normally familiar surroundings4. Left upper limb and facial weakness with sparing of

lower limbs

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:1. Pick disease2. Alzheimer’s disease3. Huntington’s disease4. Parkinson’s disease

Which drug would have most promise for preventing progression on Alzheimer’s disease? 1. Aβ agonist2. Dopamine agonist3. Β-secretase inhibitor4. corticosteroids

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

Grossly, Alzheimer’s disease is suspected by:• Neurofibrillary tangles• Pallor in the substantia nigra• Cortical atrophy• Parietal atrophy

All Patients with Lewy Body dementia most likely have:1. Alzheimer’s disease2. Huntington Disease3. Parkinson’s disease4. Neurofibrillary tangles

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?1. Edinger-westphal nucleus2. Pretectal nucleus3. Lateral geniculate nucleus4. Oculomotor nerve

Better prognosis of Multiple Sclerosis is associated with:1. male gender2. Optic neuritis of sensory symptoms at onset3. High frequency of attacks in the initial years4. mature age at onset

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

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?1. SAH2. Epidural Hematoma3. Subdural Hematoma4. Diffuse astrocytoma

Which of the following anomalies is characterized by an enlarged posterior cranial fossa?1. Arnold-chiari malformation2. Chiari type 1 malformation3. Dandy-walker malformation4. Microvermisia

Which of the following statements are true?1. Subfalcine herniation typically results in CN III

compression2. Transtentorial herniation typically results in

cardiorespiratory dysfunction3. Tonsillar herniation typically results in CN 8

compression4. Arnold-chiari syndrome typically results in anterior

cerebral artery haemorrhage

Which area of brain is most likely to be affected by ischemia in global shock?1. Area covered by both Anterior cerebral and Middle

cerebral arteries2. The motor cortex3. Area covered by both Middle and Posterior cerebral

arteries4. The Occipital lobe

The most likely development after severe bacterial meningitis would be1. Non-communicating hydrocephalus2. Communicating hydrocephalus3. SAH4. Syringomyelia

What is the incidence of dementia in Parkinson’s disease?1. 5 – 10%2. <65%3. 10-30%4. 40-65%

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:1. Occiptal cortex2. Optic tract3. Optic chiasm4. Optic nerve

Which of the following are the cardinal features of idiopathic Parkinson disease?1. Tremor rigidity, bradykinesia, and gaze palsy2. Tremor , bradykinesia, rigidity and postural

instability3. Bradykinesia, dementia, tremor, and rigidity4. Tremor, autonomic dysfunction, bradykinesia, and

rigidity

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?1. Most cases are familial with mutation in the α

synuclein or parkin genes2. It is characterised by the death of dopaminergic

neurons in the substantia nigra pars compacta3. Early falls are a common problem in this disorder4. Impairment of vertical gaze is a common

manifestation of this disorder

What is the pathological hallmark of Parkinson’s disease?1. Negri bodies2. Hirano bodies3. Lewy bodies4. Pick bodies

Which of the following best describes a typical multiple sclerosis relapse?1. Of acute onset, evolving over hours and improving

within 1-2 weeks2. Developing over a few days to a few weeks,

reaching a plateau for several weeks and showing recovery over months

3. Unremitting, escalating neurological symptoms resulting in permanent disability

4. Episodes of paroxysmal symptoms lasting several minutes, increase if frequency, build up and coalesce into a consistent pattern over a few days

The drugs donepezil, rivastigmine, and galantamine are used in Alzheimer’s Disease to try to raise the availability of what transmitter in the brain?1. Glutamate2. Acetylcholine3. Serotonin 4. Dopamine

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?1. Lewy bodies in cortical neurons 2. Prominent atrophy of caudate3. Lewy bodies in the substantia nigra4. Neurofibrillary tangles

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?1. Steroids are effective in improving the course of

disease2. The diagnosis of MS is based on clinical lesions

separated by time and space3. Oligo bands in the CSF are specific for multiple

sclerosis4. Invariably leads to severe disability

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:1. 62. 113. 44. 19

A 47 year old male with intense headache, lacrimation, and congestion in one eye is likely to have the following type of headache:1. Classic migraine2. Subarachnoid haemorrhage3. Trigeminal neuralgia4. Cluster headache

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?1. Cerebral angiography2. Head CT without contrast3. Skull x-ray4. Head CT with contrast

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 be1. Abortive migraine treatment2. Preventive migraine treatment 3. Reassurance and discharge home 4. Brain imaging study

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?1. Tearing of the bridging veins 2. Aneurysmal rupture 3. Arteriovenous malformation rupture4. Laceration of the middle meningeal artery

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?1. Hyperventilation2. Administration of mannitol 3. Neurosurgical decompression4. Administration of tissue plasminogen activiator

The most reliable method for distinguishing between a “traumatic” lumbar puncture and a subarachnoid haemorrhage is the presence of1. Increased opening pressure2. Increased white cell count 3. Increased red cell count 4. Xanthochromia

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 neuralgiaReassurance that her headaches likely represent recurrence of her old migrainesMRI of the brain to rule out an intracranial mass lesion

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?1. Lower the analgesic dose while beginning other

therapy 2. Reassure the patient, and refer to a psychiatrist 3. Increase the analgesic dose while initiating

biofeedback therapy4. Maintain analgesic dose while using antiepileptic

therapy

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 nimodipineCerebral angiographyCarotid doppler scan

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?1. Verapamil 2. Sumatriptan3. Amitriptyline 4. Valproic acid