An 8-year-old girl has episodes of behavioral arrest with simultaneous eyelid flutter lasting for 10 seconds at a time. Afterwards, she
resumes activity as if nothing happened. Similar events happen multiple times daily. She performs well at school and on the soccer
field. What is the most appropriate treatment for this child?
A 35-year-old teacher suddenly stops what she is doing. This is followed by smacking of her lips and repetitive grasping with her right hand. She does not respond when you talk to her and she stares vacantly. This lasts 45 seconds and afterwards she feels sleepy for 5 minutes. What is the cause of her symptoms?
focal seizure w/ impairment of consciousness
drowsiness from sleep deficiency
psychogenic non-epileptic spell
Which of the following is the most likely physiologic effect seen during a 3 minute tonic-clonic seizure?
reduced cerebral blood flow
decreased heart rate
increased oxygen utilization
A 6 month old baby begins having multiple episodes daily where the neck and trunk flex and the arms go out to the side, lasting 1-2 seconds. Over the last week, he has been sleeping more and interacting with his family less. A 60 minute EEG does not record any
seizures, but the background is very disorganized and has frequent epileptiform discharges. What epilepsy syndrome is present?
Juvenile myoclonic epilepsy
childhood absence epilepsy
A 35 year old woman has had epilepsy since she was 19 years old. Her typical seizure begins with a sense of epigastric rising at which time she usually calls for help. She then stares for the next 30-60 seconds while making grasping motions of the right hand and smacking her lips. She does not respond when others talk to her. She is often sleepy and confused for 15 minutes after the event. Which abnormality on the brain MRI is most common for this type of seizure?
mesial temporal sclerosis
occipital arterio-venous malformation
lateral temporal lobe cavernoma
frontal lobe cortical dysplasia
How do benzodiazepines exert an anti-convulsive effect?
through inhibition of the enzyme GABA transaminase
By increasing the frequency of chloride channel opening
through GABA reuptake inhibition
by increasing the duration of chloride channel opening
How would zero order kinetics affect the use of phenytoin in the treatment of a patient with epilepsy?
There is a wide therapeutic range because the rate of elimination is constant, independent of serum concentration.
There is difficulty achieving therapeutic levels because of an exponential decrease in concentration over time
There is a higher risk of side effects with small dose changes because elimination is constant and the system becomes saturated.
There is exponential increase in elimination over time leading to lower serum concentrations one month after starting the drug.
A healthy, young medical student is trying not to fall asleep during a boring lecture. Suddenly, a high pitch loud noise makes him feel alert and very aware of his environment. Sensory projections are received by what part of his reticular formation (RF)?
parapontine reticular formation
lateral reticular formation
medial reticular formation
A 54-year-old woman suddenly cries out in pain, clutches her head and loses consciousness. She is brought into the emergency department where she is intubated for airway protection. On neurological exam, she does not open her eyes to pain, does not grimace, and has decerebrate (extensor) posturing to noxious stimulation. Her level of consciousness is best described as which of the following?
persistent vegetative state
Serotonin is involved in creating and maintaining arousal. From which reticular formation nucleus is serotonin released?
A 50-year-old male presents to the ED after falling. His head CT shows an enlarging subdural hematoma. His Glasgow Coma Score is 10, his right pupil is dilated and unreactive, and he has hemiparesis. His vital signs show hypertension. Which of the following can explain these findings?
His intracranial pressure is likely normal, and his brain can still accommodate more intracranial volume
His intracranial pressure is likely elevated, but his brain can still accommodate an increasing hematoma
He is experiencing herniation of the cerebellar tonsils
He is experiencing herniation of the right medial temporal lobe
Which of the following best characterizes the effect of mean arterial pressure (MAP) on cerebral blood flow?
A MAP of 0 mm Hg results in maximal vasoconstriction of cerebral blood vessels
MAPs below 50 mm Hg result in passive flow due to maximum vasodilation of cerebral blood vessels
MAPs above 100 mm Hg surpass the brain's capacity to maintain autoregulation and cause cerebral injury
MAPs above 150 mg Hg result in cerebral ischemia due to pathologic vasoconstriction
Emergency medical services responded to a call in the community about a 27 year old woman who was seizing. Upon arrival, she has bilateral tonic stiffening that her friend says has been going on for 7 minutes. What is the appropriate first-line treatment given by the paramedics?
What is the electrical substrate that is responsible for the waveforms recorded in an EEG?
multiple excitatory and inhibitory post-synaptic potentials (EPSP/IPSP)
individual action potentials
summation of membrane potentials across neurons, astros, and glial cells
A 17 year old boy has bilateral stiffening of the arms and legs. Which of the following signs would be most suggestive of a nonepileptic spell?
eyes remain open during the spell, and closes eyes after the spell
answers questions slowly while he has bilateral tonic posturing
bites sides of his tongue during the spell
An otherwise healthy 50-year-old veteran comes in 4 days after undergoing a trans-sphenoidal biopsy of the pituitary gland for potential adenoma. According to his significant other, he has been confused for the last 8 hours and has clear liquid draining from his nose. Neurosurgery is consulted and he undergoes a lumbar puncture which shows gram positive diplococci. What would be the most likely findings on the CSF?
WBC of 5, Glucose of 60, Protein 60, % PMNs 0
WBC of 50, Glucose of 20, Protein 90, % PMNs 5
WBC of 300, Glucose of 40, Protein 90, % PMNs 2
WBC of 800, Glucose of 20, Protein 90, % PMNs 80
A 68-year-old woman is found to have a cerebello-pontine angle tumor. Which of the following tumors is most likely to occur in this region?
A 6-year-old boy is found to have a posterior fossa brain tumor. Given the patient's age and the location of the tumor, which of the following is the most likely diagnosis?
Which of the following is a feature of Cushing's triad?
altered mental status
systolic hypotension (narrow pulse pressure)
tonsillar herniation on MRI
Please refer to the attached image to answer the following question: In the image shown, the most important factor in determining whether or not this is a neurologic emergency is which of the following?
Neuronal injury causes dysfunction of Na/K pumps leading to higher intracellular sodium levels
Disruption of the blood brain barrier leading to accumulation of fluid in the extracellular space
Release of cytokines from dying neurons results in an inflammatory response against aquaporins
Hydrostatic forces from increased cerebral perfusion pressures increase extracellular fluid
What does the Meyer-Overton Hypothesis suggest about inhaled anesthetic agents?
Hydrophilic anesthetic agents tend to be more flammable and explosive
Agents with low blood/gas partition coefficients have slower induction and elimination times
Lipophilic anesthetic gasses tend to be more potent than hydrophilic agents
Anesthetic action maximally occurs when alveolar concentrations are below 1 MAC
Why should care be exercised when administering inhaled anesthetic agents to patients with cardiovascular instability?
Anesthetic agents tend to increase overall metabolic activity and thus increase oxygen demand
All modern anesthetic agents routinely induce cardiac arrhythmias
Most currently used inhaled anesthetics are cardiodepressants and may result in significant hypotension
Decreases in cardiac output result in significant increases in MAC
A 60-year old female presents to the emergency department with neurological signs and symptoms. Her diffusion-weighted imaging (DWI) (shown in the attached image) is diagnostic of which of the following?
A 30-year old male presents to the emergency department with fever, headache, seizure, and behavior changes. Lumbar puncture is performed to collect CSF for laboratory analysis. MRI shows FLAIR hyperintensity of the temporal lobe, hippocampi and insula (arrows in the provided images). Of the following, which is the most appropriate treatment?
IV acyclovir to treat presumed herpes encephalitis
IV corticosteroids to treat presumed multiple sclerosis flare
Neurosurgical drainage of cerebral abscess
Neurosurgical evacuation of empyema
A 35 year old female presents to your outpatient clinic with severe low back pain and pain radiating into the right leg. This began acutely 3 weeks ago. Based on history and physical, you exclude all the "red flag" conditions that can be associated with back pain. Of the following, which is the most appropriate next step?
No imaging is indicated
CT lumbar spine w/o constrast
MRI lumbar spine w/o contrast
MRI lumbar spin w/ constrast
You are treating an 18-year old patient for bacterial meningitis. Based on her age, what is the most likely cause of the infection?
A healthy 23-year-old man presents during a hot day in August with headache, fever, nausea, vomiting, and confusion. He was swimming in a local fresh water swimming hole with his family 3 days prior to presentation. On exam he is febrile and has a Kernig and Brudzinski sign. CT imaging is negative for abnormality. LP shows 10,000 cells with 85% neutrophils, glucose was 14 and protein was 200. Opening pressure was very high. Gram stain was negative. He is placed on vancomycin, ceftriaxone and ampicillin but does not improve and dies 2 days later. His CSF culture was performed BEFORE antibiotics were given and was negative. What do you suspect as the causative organism?
A patient being treated for a moderate traumatic brain injury begins to demonstrate pupillary enlargement, bradycardia, and hypertension. Which of the following is an appropriate treatment option?