PRITE - Neurology

Monique Simpson
Quiz by Monique Simpson, updated more than 1 year ago
Monique Simpson
Created by Monique Simpson almost 5 years ago
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Description

Collection of PRITE Neurology questions from 2014 to 2015

Resource summary

Question 1

Question
A 73yo woman found on the floor at home seems unaware of her ability to use her left upper and lower extremities. Although her left arm is flaccid at her side, she denies that there is anything wrong. When she is asked to raise the left upper extremity, she raises the right one. When the psychiatrist lifts her arm up and asks, "Whose arm is this?" she responds, "Yours." This type of behavior is most indicative of a lesion in the right:
Answer
  • Thalamus
  • Parietal Lobe
  • Cingulate Gyrus
  • Inferior Temporal Gyrus
  • Orbitofrontal Cortex

Question 2

Question
Which of the following is characteristic of non-REM sleep?
Answer
  • Dreaming
  • Decreased movements
  • Increased autonomic activity
  • Increased cerebral blood flow
  • Decreased recall of dream activity

Question 3

Question
The following recording obtained from a patient in an ICU is most consistent with which of the following?
Answer
  • Brain Death
  • Normal Brain Function
  • Metabolic Encephalopathy
  • Non-convulsive status epilepticus
  • Large MCA stroke

Question 4

Question
A 19yo pt is evaluated for episodes of getting out of bed during the night and moving about the bedroom in a frenzied manner while asleep. The patient appears frightened during these episodes and has, on occasion, self-injured. Which of the following is typical for this sleep phenomenon?
Answer
  • Onset in childhood
  • Occurs during REM sleep
  • Organized activity is common
  • Eyes are closed during the episode
  • Associated with an increased risk of seizures

Question 5

Question
A 47yo patient develops new onset of vertigo, diplopia, gait imbalance and severe occipital pain during chiropractic manipulation of the neck. Which of the following is the most likely diagnosis?
Answer
  • Hemorrhage
  • Cardiac embolus
  • Cervical disc herniation
  • Vertebral artery dissection
  • Small vessel occlusive disease

Question 6

Question
Which of the following tremors has a frequency of around 3 Hz, irregular amplitude and is most evident toward the end of reaching movements?
Answer
  • Essential tremor
  • Physiologic tremor
  • Cerebellar tremor
  • Parkinsonian tremor
  • Dystonic tremor

Question 7

Question
Which of the following is the molecular mechanism of action of ketamine?
Answer
  • Agonist at endamide receptors
  • Antagonist at serotonin 1A receptors
  • Partial agonist at kappa opiate receptors
  • Antagonist at N-methyl-D-aspartate receptors
  • Positive allosteric modulator of GABA receptors
  • Agonist at N-methyl-D-aspartate receptors

Question 8

Question
A patient with several days of fever and severe headaches is brought to the ER following a generalized seizure. The patient is confused, and tends to fall asleep easily. The family reports that the patient has been irritable and has complained of foul smells in the house. The figure displays the T2-weighted images obtained in the ED. Which of the following is the most likely diagnosis?
Answer
  • Multiple Sclerosis
  • Herpes Encephalitis
  • Neuroblastoma multiforme
  • Subarachnoid hemorrhage
  • Progressive multifocal leukoencephalopathy

Question 9

Question
Which of the following neurotransmitters is predominantly inhibitory?
Answer
  • Norepinephrine
  • Glutamate
  • Dopamine
  • Tyrosine
  • Glycine

Question 10

Question
A 37yo patient who works as a truck driver presents with numbness of the left hand. The patient reports that the episodes of numbness have been increasing in frequency and severity over the last 2 years and the patient's grip has weakened. On examination, reduced pinprick sensation is noted on the patient's left little and ring fingers. The hypothenar muscles seem small. Which of the following most likely explains these findings?
Answer
  • Carotid artery stenosis
  • C-6 radiculopathy
  • Ulnar nerve lesion
  • Median nerve entrapment
  • Myasthenia Gravis

Question 11

Question
The sural nerve biopsy in an adult patient with Charcot Marie Tooth type 1 (perennial muscular atrophy) is shown below. On exam the patient exhibits diminished lower extremity DTRs and deformities of feet bilaterally. These deformities are typical of which of the following molecular abnormalities?
Answer
  • Mutation in the connexin 32 gene
  • Mutation in the myelin transcription factor
  • Deletion in the nerve growth factor beta gene
  • Duplication in the myelin binding protein gene
  • Duplication of the peripheral myelin protein gene

Question 12

Question
A 62yo pt has a several-yr hx of progressive personality changes characterized by dull emotions, lack of initiative and apathy. Autopsy is likely to reveal atrophy of the:
Answer
  • Cerebellum
  • Frontal Lobe
  • Parietal Lobe
  • Substantia Nigra
  • Corticospinal tracts

Question 13

Question
The MRI scan of the brain of a 35yo woman with new onset left arm and leg numbness is shown below. Which of the following is the most likely diagnosis?
Answer
  • Adrenoleukodystrophy
  • Lyme Disease
  • Brain Metastases
  • Multiple Sclerosis
  • Lacunar Strokes

Question 14

Question
A 22yo obese woman presents with intermittent headache for the past several months. Neurologic exam is normal with the exception of bilateral papilledema on fundoscopic examination. MRI shows no structural abnormalities. An LP is performed in order to confirm the suspected diagnosis. Which of the following abnormalities of the spinal fluid is most likely to explain the patient's symptoms?
Answer
  • increased pressure
  • increased protein level
  • elevated WBC
  • decreased glucose
  • decreased microglobulins

Question 15

Question
Tau staining of hippocampal tissue from a patient with progressive dementia is seen below. Which of the following is the most likely diagnosis?
Answer
  • Parkinson disease
  • Alzheimer disease
  • Huntington disease
  • Creutzfelt-Jakob disease
  • Dementia with Lewy Bodies

Question 16

Question
A 40yo pt presents with new-onset of seizures characterized by bilateral thrashing movements of the arms and legs. Which of the following would suggest a non-epileptic etiology of these events?
Answer
  • Tongue biting
  • Postictal confusion
  • Eyes remain open
  • Urinary incontinence
  • Following commands

Question 17

Question
A 25yo pt presents with new onset sz. On exam the patient has multiple brownish skin lesions, subcutaneous nodules and freckling of the axilla. Which of the following is the most likely diagnosis?
Answer
  • Melanoma
  • Fabry disease
  • Tuberous sclerosis
  • Sturge Weber syndrome
  • Neurofibromatosis type 1

Question 18

Question
Which of the following is characterized by a trinucleotide repeat expansion on genetic testing?
Answer
  • Alzheimer disease
  • Huntington disease
  • Mitochondrial myopathy
  • Amyotrophic lateral sclerosis
  • Charcot Marie Tooth Type 1A

Question 19

Question
Which of the following medications is most effective for migraine prophylaxis?
Answer
  • Sumatriptan
  • Topiramate
  • Fluoxetine
  • Duloxetine
  • Naproxen

Question 20

Question
The diagnostic value associated with the presence of transient paresis of an arm or aphasia after an epileptic seizure is that it:
Answer
  • Indicates the etiology
  • Helps localize the focus
  • Indicates good prognosis
  • Helps in the selection of treatment

Question 21

Question
Which of the following is the principal mechanism of termination of the synaptic activity of dopamine in the pre-frontal cortex?
Answer
  • Repute by dopamine transporter
  • Degradation by monoamine oxidase
  • Diffusion away from the synaptic cleft
  • Degradation by catechol-o-methyl transferase

Question 22

Question
A 56yo pt w/DM and HTN who smokes complains of the acute onset of vertigo, nausea, vomiting and unsteady gait. Examination shows decreased sensation to pinprick in the left side of the face, ataxia of the left upper and lower extremities, nystagmus and hoarseness. As the patient walks, they veer to the left. The most likely diagnosis is:
Answer
  • Meniere disease
  • Lateral Medullary stroke
  • Cerebellar stroke
  • Vestibular neuronitis

Question 23

Question
Which of the following best describes the interaction between valproic acid and lamotrigine resulting in an increased risk of severe dermatological reactions?
Answer
  • Valproic acid inhibits glucurodination of lamotrigine
  • Lamotrigine reduces renal excretion of valproic acid
  • Valproic acid displaces lamotrigine from protein binding
  • Lamotrigine promotes cytochrome P450 metabolism of valproic acid

Question 24

Question
A 42yo pt c/o pain in the R neck. When distracted the pt has a tendency to rotate the neck to the left. The pt reports being able to prevent the deviation of the head by touching the chin. Examination is normal except for some spasm of the neck muscles, particularly the right SCM. The treatment of choice would be:
Answer
  • Antidepressants
  • Botulinum toxin
  • Benztropine
  • Baclofen

Question 25

Question
The presence of conduction block on a nerve conduction study indicates which of the following?
Answer
  • Denervation
  • Axonal degeneration
  • Focal demyelination
  • Increased amplitude of action potentials

Question 26

Question
The most common severe complication of temporal arteritis is caused by occlusion of the:
Answer
  • subclavian artery
  • internal carotid artery
  • coronary artery
  • ophthalmic artery
  • auditory artery

Question 27

Question
The photograph of the midbrain shown below on the left demonstrates the findings from a patient with which of the following conditions, of note, normal midbrain shown for reference on the right?
Answer
  • Glioma
  • Multiple Sclerosis
  • Brainstem stroke
  • Parkinson disease
  • Basilar artery occulsion

Question 28

Question
An 80yo male is evaluated for gait imbalance and falls. The patient's spouse reports that her husband has episodes of screaming and kicking while asleep and he describes vivid dreams of being chased. He complains of not feeling well rested after a night's sleep. The patient is at highest risk of having or developing which of the following conditions?
Answer
  • Cerebellar stroke
  • Parkinson disease
  • Huntington disease
  • Myotonic Muscular Dystrophy
  • Amyotrophic lateral sclerosis (ALS)

Question 29

Question
A 75yo pt is evaluated fro progressive gait imbalance, urinary incontinence and cognitive decline. After removal of CSF there is noticeable improvement in gait and balance. CT of the patient's brain obtained before LP would likely show which of the following?
Answer
  • Cerebellar atrophy
  • Enlargement of the frontal horns
  • Hypodensity in the left hemisphere
  • Increased intensity in the basal ganglia
  • Crescent shaped hyperintensity over the right hemisphere

Question 30

Question
Which of the following is the most effective treatment for acute migraine?
Answer
  • Propanolol
  • Valproic Acid
  • Topiramate
  • Ergotamine
  • Sumatriptan

Question 31

Question
The lesions in the brain cut shown below are most consistent with which of the following clinical presentations?
Answer
  • Ataxia, clumsy hand
  • Rigidity, bradykinesia
  • Apathy, hyper sexuality, hyperphagia
  • Amnesia, confabulation, lack of insight
  • Progressive aphasia, personality changes

Question 32

Question
The diagnosis of myasthenia graves can frequently be established by measuring antibodies against which of the following proteins?
Answer
  • Myosin
  • Myoglobin
  • Dystrophin
  • Acetylcholine receptor
  • Creatine phosphokinase

Question 33

Question
Which of the following cancers/malignancies has the highest likelihood of metastasizing to the brain?
Answer
  • Lung
  • Renal
  • Liver
  • Thyroid
  • Pancreatic

Question 34

Question
A 37yo patient was in a motor vehicle accident after falling asleep while driving. The patient's spouse reports the patient has frequent episodes of falling asleep while eating, dining, watching tv or conversing. Which of the following laboratory findings is likely to be found?
Answer
  • Increased serum melatonin
  • Decreased CSF hypocretin
  • Increased CSF protein
  • Decreased serum ferritin
  • Increased serum glucose

Question 35

Question
A 17yo pt experiences a 2mth period of decreased energy and drowsiness associated with increased sleep duration, which progresses to 18hrs or more a day. This pattern is interrupted only by toileting and eating, which is increased. The patient appears to be dull, confused and socially withdrawn. The sleep EEG shows that NREM and REM cycles are normal, except for increased duration of sleep. Which of the following is the most likely diagnosis?
Answer
  • Narcolepsy
  • Sleep apnea
  • Idiopathic hypersomnia
  • Kleine-Levin syndrome
  • Kluver-Bucy syndrome

Question 36

Question
The clock drawing in the image below is consistent with a lesion in which of the following areas of the brain?
Answer
  • Brainstem
  • Cerebellum
  • Frontal lobe
  • Parietal lobe
  • Temporal lobe

Question 37

Question
Nonfluent, effortful speech with decreased speech output is most often associated with lesions of which of the following cortical structures?
Answer
  • Insula
  • Occipital gyrus
  • Angular gyrus
  • Inferior frontal gyrus
  • Superior temporal gyrus

Question 38

Question
Which of the following immunomodulators is associated with increased risk of significant depression in patients with cancer?
Answer
  • Mitoxantrone
  • Natalizumab
  • Glatiramer
  • Interferon
  • Fingolimod

Question 39

Question
A patient develops progressive weakness over several days. Examination reveals an absence of reflexes and muscular weakness that is more prominent in the lower extremities than in the upper extremities. Nerve conduction studies show slow conduction velocity, prolonged distal motor latency and conduction block. The most likely diagnosis is:
Answer
  • Polymyositis
  • Myasthenic crisis
  • Eaton-Lambert syndrome
  • Acute inflammatory polyneuropathy
  • Acute exacerbation of multiple sclerosis

Question 40

Question
Contralateral leg weakness with sparing of the face and arm associated with urinary incontinence and abulia are typical for stroke in the territory of which of the following arteries?
Answer
  • Basilar
  • Carotid
  • Middle cerebral
  • Anterior cerebral
  • Posterior cerebral

Question 41

Question
In the examination of a 32yo woman with vertigo and diplopia, it is found that when she looks to the left she has nystagmus on the left eye only, with failure of adduction of the right eye. This disorder of ocular motility suggests the diagnosis of:
Answer
  • Optic neuritis
  • Multiple sclerosis
  • Congenital nystagmus
  • Diabetic 6th nerve palsy
  • Progressive supranuclear palsy

Question 42

Question
An IV methamphetamine user develops severe back pain, followed after several days by bilateral lower extremity weakness, lower extremity sensory loss and bladder incontinence. Physical examination reveals a low-grade fever, tenderness to percussion over the second and third lumbar vertebrae, paraparesis and loss of sensation to light touch and pinprick in both legs, buttocks and the sacral region. Which of the following is the most likely explanation for this presentation?
Answer
  • Syphilitic myelitis
  • Spinal cord ischemia
  • Spinal epidural abscess
  • Tropical spastic paraparesis
  • Subacute necrotizing myelitis

Question 43

Question
A 45yo woman is evaluated for episodes of her arm feeling "like it is falling asleep" in the night. The patient describes pins and needles of the hand during the night and upon awakening. Which of the following is the most likely cause of the patient's symptoms?
Answer
  • Sleep apnea
  • Diabetic neuropathy
  • Carpal tunnel syndrome
  • Guillain Barre syndrome
  • Tranisent Ischemic Attack (TIA)

Question 44

Question
A 6yo child has brief episodes of staring lasting a few seconds. Rhythmic, fast and fine blinking movements occur during these episodes. Which of the following medications would be most appropriate to treat this child's condition?
Answer
  • Felbanate
  • Zonisamide
  • Phenobarbital
  • Valproic Acid
  • Carbamazepine
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