Beruflich Dokumente
Kultur Dokumente
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\\\\ Dysfunction of the III-IV-VI cranial nerves is characterized by all symptoms except \\\ Diplopia, phtosis
\\\ Myosis,
\\\ Midriasis
\\ Ambliopia- amaurosis
\\\\ Dysfunction of the III-IV-VI cranial nerves is characterized by all symptoms except \\\ Diplopia, phtosis
\\\ Myosis,
\\\ Horner symptom
\\ Ambliopia- amaurosis
\\\\ Pathology of pupils is characterised by \\ Anisokoria
\\\ Phtosis
\\\ Homonymos hemianophsia
\\\ Bitemporal hemianophsia
\\\\ Homonymos hemianophsia is characterised by \\ Amaurosis in the same sides of visual fields of both eyes
\\\ Amaurosis in the different sides of visual fields of both eyes
\\\ Cortical blindness
\\\ Bilaterla amaurosis
\\\\ Heteronymos hemianophsia is characterised by \\\ Amaurosis in the same sides of visual fields of both eyes
\\ Amaurosis in the different sides of visual fields of both eyes
\\\ Cortical blindness
\\\ Bilaterla amaurosis
\\\\ Altered consciousness is defined as \\\ Dementia
\\\ Sleep
\\ Delirium
\\\ Vertigo
#@ The single form of altered consciousness is
\\ Confusional state
\\\ sleep
\\\ Lethargy
\\\ Catatonic stupor
\\\\ Which condition do not correspond to the term altered conciousness?
\\\ Confusion, delirium
\\\ stupor, Coma
\\ Panic attack
\\\ Lethargy
\\\\ The deepest level of altered concsiousness is
\\\ Stupor
\\\ Syncope
\\ Coma
\\\ Lethargy
\\\\ Which statement is correct \\\ Coma is caused by damage at the level of medulla oblongata
\\\ In comatose state it is neseccary to have motor activity
\\\ Glasgow coma scale evaluate only depth of coma.
\\ Score 8-4 at Glasgow Coma Scale corresponds with coma.
\\\\ Which score of Glasgow Coma Scale corresponds with coma
\\\ Score 15-14
\\ Score 8-4
\\\ Score 13-9
\\\ Score 3
\\\\ Among listed below conditions, focal cause of coma state can be attributed to
\\\ Hyperglicemia
\\\ Hepatargia
\\\ Mixedema
\\ Epidural hematoma
\\\\ Among listed below conditions, diffusel cause of coma state can be attributed to
\\\ Epidural hematoma
\\\ Intracerebral hemorrhage
\\ Encephalitis
\\\ Cerebellar infarction
\\\\ Among listed below conditions, subtentorial cause of coma state can be attributed to \\\ Anterior cerebral artery infarcion
\\\ Hypoglicemia
\\\ Lobar hemorrhage
\\ Cerebellar infarction
\\\\ Development of coma in the case of subtentorial mass lesion is caused by
\\ Medular dislocation
\\\ Horizontal dislocation
\\\ Diffuse systemic damage of the brain
\\\ Transtentorial dislocation.
\\\\ Urgent measures for comatose patient include \\ Permeability of airway system (A), adequate breathing (B), stable circulation (C)
\\\ Neurovizualisation
\\\ Lumbalur puncture
\\\ Correction of hypotheermy
\\\\ Urgent measures for comatose patient include
\\ Correction of possible hypoglicemia
\\\ Neurovizualisation
\\\ Detailed neurological examination
\\\ Correction of hypotheermy
\\\\ Coma which is preceeded by delirium and where focal neurological symptoms are absent indicates
on \\ Metabolic coma
\\\ Brain tumor
\\\ Brain stem stroke
\\\\ From listed below statements correct is that\\\ Locked in syndrome is caused by damage of diencephalon
\\ Locked in syndrome can be caused by pontine hemorrhage
\\\ Locked in syndrome is accompanied by altered consiousness
\\\ In Locked in syndrome horizontal eye movements are preserved
\\\\ From listed below statements criteria of brain death is
\\\ Glasgow coma scale score 6
\\\ Presence of oculovestibular and oculocephalic reflexes
\\\ Myotic and areactive pupils
\\ Glasgow coma scale score 3
\\\\ From listed below statements criteria of brain death is \\ Glasgow coma scale score 3
\\\ Hypotension
\\\ Hypothermia
\\\ In coma caused by barbiturate intoxication isoelectric EEG pattern
\\\\ Clinical symptoms of hydrocephaly consists of \\\ VII cranial nerve palsy
\\ Lower limb paraparesis and ataxia
\\\ Down gaze paresis
\\\ Upper limb par paresis
\\\\ Clinical symptoms of hydrocephaly consists of \\\ Hemiparesis
\\\ Bulbar syndrome
\\ Upper gaze palsy
\\\ III cranial nerve palsy
\\\\ Clinical symptoms of normotensive hydrocephaly consists of \\ Cognitive decline
\\\ Extrapyramidal syndrome
\\\ Complex partial seizures
\\\ Dissociative sensory disturbances
\\\\ Hydrocephaly can be treated by
\\ Ventriculoperitoneal shunting
\\\ Enlargement of foramen Monro
\\\ Resection of cerebellar tonsiles
\\\ Ventricular drainage.
\\\\ Benign intracranial Hypertension can be caused \\\ Endocrine pathology
\\\ Bronchial asthma
\\\ Thyreotoxicosis
\\ Gastric ulcer
\\\\ In embriogenesis stage of primary neurulation includes \\\ 1-2 month gestation
\\\ 4-7 week of gestation
\\\ 3-5 month of gestation
\\ 3-4 week of gestation
\\\\ In embriogenesis stage of secondary neurulation includes \\\ 1-2 month gestation
\\ 4-7 week of gestation
\\\ 3-5 month of gestation
\\\ 3-4 week of gestation
\\\\ In embriogenesis stage of migration includes \\\ 1-2 month gestation
\\\ 4-7 month of gestation
\\ 3-5 month of gestation
\\\ 3-4 week of gestation
\\\\ In embriogenesis stage of proliferation includes \\\ 1-2 month gestation
\\\ 2-4 month of gestation
\\\ 3-5 month of gestation
\\ 3-4 week of gestation
\\\\ In embriogenesis stage of myelinisation includes \\\ 1-2 month gestation
\\\ 2-4 month of gestation
\\\ 3-5 month of gestation
\\ develops at postnatal stage
\\\\ Disorder of primary neurulation includes \\\ Vascular malformations of the foetus
\\\ Cerebral malformations
\\ Anencephaly
\\\ Scoliosis.
\\\\ Disorder of primary neurulation includes \\\ Vascular malformations of the foetus
\\\ Cerebral malformations
\\ Encephalocele
\\\ Scoliosis.
\\\\ Disorder of primary neurulation includes \\\ Vascular malformations of the foetus
\\\ Cerebral malformations
\\\ Scoliosis.
\\ Myelomeningocele
\\\\ Term cerebral palsy supposes \\\ Amaurosis and anacusis developped in early life.
\\\ Astasia-abasia devellopped in early life
\\\ Autonomic failure developped in early life
\\ Disorders of movement and posture developped in early life
\\\\ Important disorder of migration is \\\ Phakomatosis
\\\ Cerebral palsy
\\ Lissencephaly and Schizencephaly
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\\\ Radish-blue naevus, involving distribution of the I root of the trigeminal nerve .
\\\ Multiple hemangioblastomas at the retina
\\\\ Encephalo-facial angiomatosis is characterised by \\\ Hypopigmental areas and butterfly like redish-brown nodules adenoma sebaceum
\\\ Caffe-au lait patches and neurofibromas across the nerves
\\ Radish-blue naevus, involving distribution of the I root of the trigeminal nerve .
\\\ Multiple hemangioblastomas at the retina
\\\\ Attention deficit hyperactivityu disease (ADHD)
\\\ Coexistance of motor, sensor and extrapyramidal pathology
\\ Coexistance of neurological, cognitive and behavioral disturbances
\\\ Coexistance of cerebellar, cognitive and paroxusmal disturbances.
\\\ Coexistance of visual, auditory and cognitive disturbances.
\\\\ For demyelinating diseases pathological hallmark is
\\\ Appearance of calcification in grey matter.
\\\ Damage of cell membranes.
\\ Damage of myelin sheath .
\\\ Prolifration of mesoglia in white matter of the brain.
\\\\ Demyelinisation can be caused by \\\ Ageing of the nervous system.
\\\ Tymor of nerve fibers
\\ Immune-mediated pathology
\\\ Vascular pathology
\\\\ In dismyelinating pathology destroying of myelin sheath is due to \\\ Traumatic injury
\\\ Ishemic pathology
\\ Genetic deficit
\\\ Immune-mediated pathology
\\\\ Myelin of CNS is formed by \\\ Astrocytes
\\ Oligodendroglial cells
\\\ Microglial cells
\\\ Ependimal cells
\\\\ From listed below diseases demyelinating pathology is \\\ Hemorrhagic strokei
\\\ eepilepsy
\\ Acute hemorrhagic leucoencephalopathy
\\\ Migraine
\\\\ For multiple sclerosis it is typical presence of
\\\ Focal seizures
\\\ Meningeal signs
\\\ High temperature
\\ Remmitting attacks of focal or multifocal neurological disfunction .
\\\\ Multiple sclerosis is frequent \\\ In newborns
\\\ At the age 10-15 years
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\\\ 15 days
\\\ 20 days
\\ 30 days.
\\\\ Frequency of attacks of multiple sclerosis is defined by their number during
\\\ 6 month
\\\ 8 month
\\\ 10 month
\\ 12 month
\\\\ MRI diagnostin criteria of multiple sclerosis are determined as
\\\ 1 or two demyelinating lesions
\\\ Lesions more than 2 mm in diameter
\\ one or more lesion in periventricular space, subtentorial area or corpus callosum
\\\ Round or ovale shaped of lesion of less than 1mm in diameter .
\\\\ Acute disseminating encephalomyelitis is treated by
\\ Corticostroids
\\\ Anticonvulsants
\\\ Immune stimulating drugs
\\\ Vasoactive drugs.
\\\\ For myelitis transversa it is typical presence of \\ Paraplegia and anesthesia
\\\ Hemiplegia and hemianesthesia
\\\ Alternatrive syndroms
\\\ Dissociative sensory disturbances.
\\\\ Primary headache include \\\ Headache caused by subdural hematoma
\\\ Headache caused by arteriitis
\\ Cluster headachei
\\\ Headache caused by arterial dissection
\\\\ Diagnostic criteria of migraine include
\\\ Bilateral headache filling as like a band
\\\ Preserved phisical activity
\\ Nausea and vomiting
\\\ Absence of photo-phonophobia
\\\\ Diagnostic criteria of migraine include
\\\ Bilateral headache filling as like a band
\\\ Preserved phisical activity
\\\ Absence of nausea and vomiting
\\ Pulsating headache
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Internal capsule
Thalamus
Hippocampus
Globus pallidus
\\\\ Occlusion of which of the following arteries typically produces lateral medullary infarction
syndrome? \\\ Basilar artery
\\ Vertebral artery
\\\ Superior cerebellar artery
\\\ Anterior inferior cerebellar artery(AICA)
\\\\ A 72-year-old woman has the abrupt onset of the right face and hand weakness, disturbed speech
production and a right homonymous hemianopsia. This is most likely attributable to occlusion of the \\ Left middle cerebral artery
\\\ Left anterior cerebral artery
\\\ Left vertebrobasilar artery
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Which of the following would be the most appropriate next diagnostic test? \\\ Creatine phosphokinase
\\\ Holter monitor
\\\ Visual evoked potentials
\\ Carotid artery Doppler ultrasound
\\\\ A 73-year old man with a history of hypertension complains of a 10-min episodes of left-sided
weakness and slurred speech. On further questioning he relates three brief episodes in the last month of
sudden impairment of vision affecting the right eye. His examination now is normal.
The episodes of visual loss are most likely related to \\\ Retinal vein thrombosis
\\ Central retinal artery ischemia
\\\ Posterior cerebral artery ischemia
\\\ Middle cerebral artery ischemia
\\\\ A 73-year old man with a history of hypertension complains of a 10-min episodes of left-sided
weakness and slurred speech. On further questioning he relates three brief episodes in the last month of
sudden impairment of vision affecting the right eye. His examination now is normal.
A thorough evaluation reveals that patient has a 90% stenosis of the right internal carotid artery at the
bifurcation. The management option most likely to prevent a future stroke is which of the following?\\\ Warfarin
\\\ Carotid artery angioplasty
\\ Carotid endarterectomy
\\\ Extracranial-intracranial bypass
\\\\ A 62-year old man with a history of myocardial infarction awakens with a dense right sided
hemiplegia. His eyes are tonically deviated to the leftand he doesnot respond to threat on the right side of
his visual field. He appears to be alert and resonds to pain on the left side of his body. His speech is
unintelligible and nonfluent and he follows no instructions. Efforts to get him to repeat simple pfrases
cocsistently fail.Pick the language disturbance that best explaines the clinical picture \\\
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Brocas aphasia
Wernickes aphasia
Global aphasia
Conduction aphasia
\\\\ A 45-year-old woman with chronic atrial fibrillation discontinues warfarin treatment and abruptly
develops problems with language comprehension. She is able to produce some intelligible phrases and
produces sound quite fluently; however, she is unable to follow simple instructions or to repeat simple
phrases On attempting to write, she becomes very frustrated and agitated. Emergency MRI reveals a
lesion of the left temporal lobe, that extends into the superior temporal gyrus. Pick the language
disturbance that best explaines the clinical picture\\\ Brocas aphasia
\\ Wernickes aphasia
\\\ Transcortical sensory aphasia
\\\ Anomic aphasia
\\\\ A 71-year-old man develops headache and slight difficulty speaking while having sexual intercourse.
He has a long-standing history of hypertension, but has been on medication for more than 7 years. He
makes frequent errprs in finding words and follows complex commands somewhat inconsistently. The
most obvious dfect in his language function is his inability to repeat the simplest of phrases without
making repeated errors. An emergency CT scan reveals an intracerebral hemrrahage in the left parietal
lobe that appears to communicate with the lateral ventricle. Pick the language disturbance that best
explaines the clinical picture \\\ Brocas aphasia
\\\ Wernickes aphasia
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\\\\ A 78-year-old man sufferrs a cardiac arrest while being treated in an emergency room for chest pain.
Resuscitation is initiated immediately, but profound hypotension is observed for at least 20 minutes. A
cardiac rhythm is restored, but the patienr remains unconscious for the next 3 days. When he is awake,
alert and extubated, his speech is limited to repetition of words and sounds produced by those around
him. He has no apparent comprehention of language and produces few sounds spontaneously. Whenever
the patient is spoken to, he fairly accurately repeats what was said to him. Pick the language disturbance
that best explaines the clinical picture
\\\ Transcortical motor aphasia
\\\ Anomic aphasia
\\\ Global aphasia
\\ Mixed transcortical apasia
\\\\ A 75-year old man with a history of recent memory impairment is admitted with headache, confusion,
and a left homonymous hemianopsia. He has recently had two episodes of brief unresponsiveness. There
is no history of hypertension. Computed tomography (CT) scan shows a right occipital lobe hemorrhage
with some subarachnoid extension of the blood. An MRI scan with gradient echo sequence reveals foci of
hemosiderin in the right temporal and left frontal cortex. The likely cause of this patients symptoms and
signs is
\\\ Gliomatosis cerebri
\\\ Multi-infarct-dementia
\\\ Mycoic aneurism
\\ Amyloid angiopathy
\\\\ A 61year-old man with a history of hypertension has been in exellent health until he presents with
vertigo and , dunsteadyness lasting for two days. He then developes nausea, vomiting, dysphagia,
hoarseness, ataxia, left facial pain, and right-sided sensory loss. There is no weakness. On examination,
he is alert, with a normal mental status. He vomits with head movement. There is skew deviation of the
eyes, left ptosis, clumsiness of the left arm,and titubation. He has loss of pain and temperature sesation in
the left foot. He is unable to walk. Magnetic resonance imaging(MRI) in this patient might be expected to
show which of the following? \\\ Basilar artery tip aneurysm
\\\ Right lateral medullary infarction
\\ Left lateral medullary infarction
\\\ Left medial medullary infarction
\\\\ A 61year-old man with a history of hypertension has been in excellent health until he presents with
vertigo and , dunsteadyness lasting for two days. He then develops nausea, vomiting, dysphagia,
hoarseness, ataxia, left facial pain, and right-sided sensory loss. There is no weakness. On examination,
he is alert, with a normal mental status. He vomits with head movement. There is skew deviation of the
eyes, left ptosis, clumsiness of the left arm,and titubation. He has loss of pain and temperature sensation
in the left foot. He is unable to walk. The dysphagia in this case is secondary to involvement of which of
the following structures? -
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Nucleus silitarius
Nucleus and descending tract of CNV5
Nucleus ambiguus
Lateral spinothalamic tract
\\\\ A 61year-old man with a history of hypertension has been in exellent health until he presents with
vertigo and , dunsteadyness lasting for two days. He then developes nausea, vomiting, dysphagia,
hoarseness, ataxia, left facial pain, and right-sided sensory loss. There is no weakness. On examination,
he is alert, with a normal mental status. He vomits with head movement. There is skew deviation of the
eyes, left ptosis, clumsiness of the left arm,and titubation. He has loss of pain and temperature sesation in
the left foot. He is unable to walk.Right sided sensory loss is secondary to involvement of which of the
following structures? \\\ The right lateral spinothalamic tract
\\ The left.lateral spinothalamic tract
\\\ Nucleus and descending tract of CNV5
\\\ Ninth and Tenth cranial nerves
\\\\ The most striking neurologic complication of von Economos encephalitis (encephalitis lethargica), a
type of encephalitis that occurred in epidemic proportions along with viral influenca between 1917 and
1928 was \\\ Blindness
\\\ Hearing loss
\\\ Paraplegia
\\ Parkinsonism
\\\\ A 17-year old female presents initially with fever and progressive weakness. An extensive
neurological evaluation including EMG suggests a motor neuron disease. The motor neuron disease
most certainly trased to a virus is \\ Poliomyelitis
\\\ Subacute sclerosing panencephalitis
\\\ Progressive multifocal leukoencephalopathy(PML)
\\\ Subacute encephalomyelitis
\\\\ A 12-year-old boy has left body weakness . An MRI scan reveals a polycystic lesion The parasitic
brain lesion most likely to have a large cyst containing numerous daughter cysts is that associated with \\\ Taenia solium
\\\ Schistosoma haematobium
\\ Taenia echinococcus
\\\ Diphyllobothrim latum
\\\ A 17-year-old right-handed boy has had infectious meningitis 8 times over the past 3 years He has
otherwise been healthy and developed normally. Reccurent meningitis developes in persons with \\\ Otitis media
\\\ Epilepsy
\\\ Multiple sclerosisi
\\ Cerebrospinal fluid (CSF) leaks
\\\\ A 72 year-old right-handed woman has 2 days of headache and fever, followed by worsening
confusion. she is taken to the hospital after having a generalized seizure/ A head CT is consistent with left
temporal hemorrhage and swelling/ Localization of encephaliis to the medial temporal or orbital frontal
regions of the brain is most consistent with \\\ Trponema pallidum
\\\ Varicella zoster virus
\\ Herpes simplex virus
\\\ Cryptococcus neoformans
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\\\\ A 72 year-old right-handed woman has 2 days of headache and fever, followed by worsening
confusion. she is taken to the hospital after having a generalized seizure/ A head CT is consistent with left
temporal hemorrhage and swelling. Neuroimaging of the brain before attempting a lumbar puncture is
advisable in cases of acute encephalitis because \\\ The diagnosis may be evident on the basis of MRI alone
\\ Massive edema in the temporal lobe may make herniation imminent
\\\ The CT picture may determine whether a brain biopsy should be obtained
\\\ Shunting of the ventricules is usually indicated and the imaging studies are needed to direct the
placement of the shunt
\\\\ A 72 year-old right-handed woman has 2 days of headache and fever, followed by worsening
confusion. she is taken to the hospital after having a generalized seizure/ A head CT is consistent with left
temporal hemorrhage and swelling CSF testing establishes this case as being the commonest form of
acute encephalitis.The CSF changes late in the course of the disease typically include \\ An increased number of lymphocytes
\\\ Glucose content of less than two-thirds the serum level
\\\ A protain content of less than 45 mg/dL
\\\ A normal opening pressure
e.A predominance of polymorphonuclear white cells
\\\\ A 72 year-old right-handed woman has 2 days of headache and fever, followed by worsening
confusion. she is taken to the hospital after having a generalized seizure/ A head CT is consistent with left
temporal hemorrhage and swelling. CSF testing establishes this case as being the commonest form of
acute encephalitis. With this disease EEG may exhibit \\\ Activity over the frontal regions
\\\ Activity over the frontal regions
\\\ Three-per-second spike and wave discharges
\\ Bilateral, periodic epileptiform discharges
\\\\ A 55-year-old woman has a progressive dementia over the past year. Over the last 3 months she has
developed dysarthria, myoclonus intention tremor and hyperreflexia. Her CSF VDRL is positive. This
patients symptoms are being caused by which of the following? \\\ A response to penicillin treatment
\\\ An autoummune reaction
\\\ An acute meningoencephalitis
\\ A chronic meningoencephalitis
\\\\ A 55-year-old woman has a progressive dementia over the past year. Over the last 3 months she has
developed dysarthria, myoclonus intention tremor and hyperreflexia. Her CSF VDRL is positive This
patients symptoms are being caused by a chronic meningoencephalitis. This patients underlying disease
may present a picture easily confused with brain tumor if \\\ A reaction to penicillin occurs
\\ An intracranial gumma forms
\\\ Tabes dorsales is the primary manifestation of the disease
\\\ Meningovascular syphilis develops
\\\\ A 18-year-old man notices tingling about his ankles 2 weeks after an upper respiratory tract infection.
Within 2 days he has weakness in dorsiflexion of both feet and within 1 week he develops problems
walking. he has no loss of bladder or bowel control. His weakness progreses rapidly over the ensuing
week and necessitates his being placed on a ventilator to support his breathing. He is quadriplegic but
retains control of his eye movements. cerebrospinal fluid reveal a protain content of greater than 1g/dL
with a normal white cell count. There are no red blood cells in the CSF\\\ Subacute sclerosing panencephalitis (SSPE)
\\\ Progressive multifocal leukoencephalopathy
\\\ Rabies encephalitis
\\ Guillain-Barre syndrome
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\\\\ A 28-year old medical student comes into emergency department complaining of fever , headache,
photophobia and myalgias over the past 12 hours.He has been studying the neuroprotective effects in
hamster model of stroke.Prior to onset of the current symptoms he had a mild fever that subsided
spontaneously and was attributed toflu.Neurological examination reveals nuchal rigidity but is
otherwise normall. He has a mild erythematose rush and mild generelised lymphadenopathy. CSF
examination shows an opening pressure of 280mm h20, while blood cell count 1000/mm(98%
mononuclear), a glucose concentration of 30mg/dL(CSF plazma glucose ratio of 0,3) and a protein
concentration of 60mg/dL. Laboratory tests show mild leukopenia and thrombocytopenia . Human
immunodeficiency virus type 1 (HIV-1) serology is negative. Which of the following is the most likely
etiological agent?\\\\ Varicella-zoster virus
\\\ Herpes simplex virus 1(HSV-1)
\\\ West Nile virus
\\ Lymphocytic choriomeningitis virus
\\\\ A 65-years old previously healthy man presents in the emergency room because of headache fever
and neck stiffness over the past 12 hours. Examination reveals temperature of 40oC, pain on flexion of
the neck and an apical systolic murmur. a chest x-ray reveals a left lower lobe pneumonia. Which of the
following is the most appropriate statement regarding dexamethasone treatment in this patient?\\\ Dexamethasone is contraindicated, given the presence of presumed bacterial meningitis, endocarditis
and pneumonia
\\\ Dexamethasone shoul be administered if the patients mental status deteriorates despite approriate
empiric antimicrobial therapy
\\\ A 10-mg dose of dexamethasone should be given prophylactically against brain edema after 24 hours
of antimicrobial therapy if blood cultures are negative
\\ A 10-mg intravenous (IV) dose of dexamethasone should be given prior to initiation of
antimicrobialtherapy and continued every 6 hours for 4 days
\\\\ A 35-year-old previously healthy men presents to the emergency room complaining of headache and
neck pain over the past 6 hours. Examination reveals temperature of 39,4oC, mild tachycardia, and
normal blood pressure. He is mildly somnolent, has pain in flexion of the neck, but no focal neurological
deficits, and has an erythematous maculopapular rash on the chest and forearms. Which of the following
antimicrobial agents should be added to the empirical regimen with cefepine and vancomycin until the
CSF results are available \\\ Ampicillin
\\\ Gentamicin
\\\ Rifampin
\\ Doxycycline
\\\\ A 22-years old college student is brought to the emergency department for headache, photophobia,
agitation, and fever that develops over the course of 6 hours. Examination reveals hyperthermia of 40oC
heart rate of 120 beats per minute and blood pressure of 80/50 mm Hg. He had petechie in the trunk,
conjunctiva and palate. He received dexamethazone 10 mg intravenouselyfollowed by ceftriaxon and
vancomycyn. CSF examination reveals an opening pressure of 360.. H2O, while blood cells
5000/mm(80%neutrophils), a glucose concentration of 10mg/dL, and a protein concentrtion of 120
mg/dL. Grams stain demonstrates gram-negative diplococci. latx particle agglutination test detected
Neisseria menengitidis antigen. Culture confirms that the strain is sensitive to penicillin.Which of the
following is the recommended specific antibiotic treatment in this patient? \\ Ampicillin intravenously for 5 to 7 days followed by oral rifampin for 2 days
\\\ Nafcillin intravenously for 10 to 21 days followed by oral ampicillin for 3 days
\\\ Ampicillin intravenously for 2 to 3 weeks followed by oral azithromycin for 5 days
\\\ Nafcillin intravenously for 5 to 7 days followed by oral rifampin for 2 days
\\\\ In a patient who is three weeks after c liver transplantation , from listed below virusess which
infection of CNS is most common?\\\ Rabies virus
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\\\\ A 22-year-old woman reports a scotoma progressing across her left visual field over the course of 30
min followed by left hemicranial throbbing pain, nausea and photophobia. Her brother and mother have
similar headaches. Which of the following is present in classic migraine but not in common migraine? \\\ Photophobia
\\\ Familial pattern
\\ Visual aura
\\\ Hemicranial pain
\\\\ Basilar migraine differs from classic migraine in the \\\ Sex of the person most often affected
\\\ Resistance of the visual system to involvement
\\ Severity of symptoms
\\\ Duration of aura
\\\\ A 23-year-old woman has had 1 week of worsening facial pain. She describes it as an intense shooting
pain that comes and goes. It is only present on her right face. Which of the following is most likely to be
this patients underlying problem?\\ Multiple sclerosis
\\\ Tolosa-Hunt syndrome
\\\ Migraine
\\\ Anterior communicating artery aneurism
\\\\ Both trigeminal neuralgia and atypical facial pain involve pain that may be \\\ Lancinating
\\\ Paroxysmal
\\\ Associated with anesthetic patches
\\ Unilateral
\\\\ 103.An obese 37-year-old woman complains of daily headache, worse in the morning, for one year.
She has episodes of transient visual obscurations affecting each eye, and also complains of pulsatile
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tinnitus. Examination is notable for bilateral papilledema. There are no other abnormalities.Select the
most likely diagnosis \\\ Carotid artery dissection
\\ Pseudotumor cerebri
\\\ Glioblastoma multiforme
\\\ Thunderclap headache
\\\\ A 42-year-old man presents with a sudden and severe headache associated with nausea. The headache
reaches maximal intensity within 5s. He has no prior history of headache. Examination is unremarkable.
Computed tomograpfy and spinal fluid examination show no evidence of blood. He later admits that he
had been engaged in sexual activity when the headache occurred Select the most likely diagnosis\\\ Carotid artery dissection
\\\ Pseudotumor cerebri
\\\ Glioblastoma multiforme
\\ Thunderclap headache
e.Analgesic rebound headach
\\\\ A 29-year-old man relates that he has had recent headaches only when standing up. The headaches
resolve quickly when he lies down, and are accompanied by mild nausea. His examination is normal
Select the most likely diagnosis \\\ Pseudotumor cerebri
\\\ Thunderclap headache
\\\ Analgesic rebound headach
\\ Intracranial hypotension
\\\\ Which of the following is typically the most difficult type of pain to treat? \\ Psychogenic pain
\\\ Intermittent somatic pain
\\\ Continuous visceral pain
\\\ Intermittent neuropathic pain
\\\\ Which of the following types of headaches is most likely to be responsive to inhalation of 100%
oxygen?\\\ Migraine headache
\\\ Tension headache
\\ Cluster headache
\\\ Cervicogenic headache
\\\\ Which of the following statements regarding the pain of multiple sclerosis(MS) is true?
\\ Trigeminal neuralgia is the most common pain disorder associated with MS
\\\ Most patients with MS have headaches associated with the desease process
\\\ Primary psychogenic pain is common in MS
\\\ The majority of MS patients with pain have central pain associated with the disease process
\\\\ Headache types more common in women include
\\ tension headache
\\\ giant cell arteriitis
\\\ migrain headache
\\\ cluster headache
\\\\ A 30- year- old man presents with a headache that started yesterday. As he was shoveling snow
yesterday, he felt a sudden pain in the front of his head. The pain does not throb and has been relatively
constant since. He says that now his neck also become a little stiff. He carries a diagnosis of migraine
headaches, but says that this is different than his usual headaches. He is afebrile and has a normal exam
except for slight photophobia and mild discomfort with neck flexion. Which action should be done next? -
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\\\\ A 30- year- old man presents with a headache that started yesterday. As he was shoveling snow
yesterday, he felt a sudden pain in the front of his head. The pain does not throb and has been relatively
constant since. He says that now his neck also become a little stiff. He carries a diagnosis of migraine
headaches, but says that this is different than his usual headaches. He is afebrile and has a normal exam
except for slight photophobia and mild discomfort with neck flexion. A head scan is normal. What should
be done next? \\\ Begin intravenous heparin
\\ Perform a lumber puncture
\\\ Obtain a brain MRI
\\\ Obtain a cerebral angiogram
\\\\ A 30- year- old man presents with a headache that started yesterday. As he was shoveling snow
yesterday, he felt a sudden pain in the front of his head. The pain does not throb and has been relatively
constant since. He says that now his neck also become a little stiff. He carries a diagnosis of migraine
headaches, but says that this is different than his usual headaches. He is afebrile and has a normal exam
except for slight photophobia and mild discomfort with neck flexion. A head scan is normal.
.A lumbar puncture shows 7000 red blood cells in tube 1 and 7200 in tube 4. There are 9 white blood cells
in each. The fluid is xanthochromic. The next step in managing this case is to
\\ Arrange for a cerebral angiogram and call a neurosurgical consult
\\\ Give a patient a prescription for sumatriptan and send him home
\\\ Immediately give 2g of intravenous ceftriaxone
\\\ Immediately start intravenous acyclovir
\\\\ The most definitive test for identifying intracranial aneurisms is \\\ MRI scanning
\\\ CT
\\\ PET
\\ Cerebral angiography
\\\\ A 21 year old woman presents with right arm loss of sensation that has been progressive over a few
days. Her physician is concerned that this might be some type of demyelinating disorder. A relatively
small plaque of demyelination should be evident on which of the following \\\ T1-weighted MRI
\\ T2-weighted MRI
\\\ Precontrast CT
\\\ Diffusion-weighted MRI
\\\\ A 23-year old woman complains of 2 days of visual loss associated with discomfort in the right eye.
She appears otherwise healthy, but her family reports recurrent problems with bladder control over the
prior 2 years, which she is reluctant to discuss. On neurologic examination this young women exhibits
dysmetria in her right arm, a plantar extensor response of the left foot and slurred speech. The most
informative ancillary test would be
\\\ Visual evoked response testing
\\\ Sural nerve biopsy
\\\ EEG
\\ MRI
\\\\ A 16 year-old boy is struck on the side of the head by a bottle thrown by a friend. He appears dazed
for about 30 s, but is apparently lucid for several minutes before he abruptly becomes stuporous. His
limbs on the side opposite the site of the blow are more flaccid than those on the same side as the injury.
27
On arrival in the emergency room 25 min after the accident, he is unresponsive to painfull stimuli. His
pulse is 40/min, with an ECG revealing no arrythmias. His blood pressure in both hands is 170/100 mm
Hg. Although papilledema is not evident in his fundi, he has venous distention and absent pulsation of
the retinal vasculature. The best explanation for this young mans evolving clinical signs is
\\\ A seizure disorder
\\\ A cardiac conduction defect
\\ Increased intracranial pressure
\\\ Sick sinus syndrome
\\\\ A 16 year-old boy is struck on the side of the head by a bottle thrown by a friend. He appears dazed
for about 30 s, but is apparently lucid for several minutes before he abruptly becomes stuporous. His
limbs on the side opposite the site of the blow are more flaccid than those on the same side as the injury.
On arrival in the emergency room 25 min after the accident, he is unresponsive to painfull stimuli. His
pulse is 40/min, with an ECG revealing no arrythmias. His blood pressure in both hands is 170/100 mm
Hg. Although papilledema is not evident in his fundi, he has venous distention and absent pulsation of
the retinal vasculature. The best explanation for this young mans evolving clinical signs is increased
intracranial pressure. The wisest management over the next 4 h for the patient is \\ Craniotomy
\\\ Antihypertensive medication
\\\ Transvenous pacemaker placement
\\\ Ventriculoperitoneal shunt
\\\\ A 16 year-old boy is struck on the side of the head by a bottle thrown by a friend. He appears dazed
for about 30 s, but is apparently lucid for several minutes before he abruptly becomes stuporous. His
limbs on the side opposite the site of the blow are more flaccid than those on the same side as the injury.
On arrival in the emergency room 25 min after the accident, he is unresponsive to painfull stimuli. His
pulse is 40/min, with an ECG revealing no arrythmias. His blood pressure in both hands is 170/100 mm
Hg. Although papilledema is not evident in his fundi, he has venous distention and absent pulsation of
the retinal vasculature. MRI of the patients head within the first few hours of injury should reveal \\\ A normal brain
\\\ Intracerebral hematoma
\\\ Temporallobe contusion
\\ Epidural hematoma
\\\\ A 16 year-old boy is struck on the side of the head by a bottle thrown by a friend. He appears dazed
for about 30 s, but is apparently lucid for several minutes before he abruptly becomes stuporous. His
limbs on the side opposite the site of the blow are more flaccid than those on the same side as the injury.
On arrival in the emergency room 25 min after the accident, he is unresponsive to painfull stimuli. His
pulse is 40/min, with an ECG revealing no arrythmias. His blood pressure in both hands is 170/100 mm
Hg. Although papilledema is not evident in his fundi, he has venous distention and absent pulsation of
the retinal vasculature. The best explanation for this young mans evolving clinical signs is increased
intracranial pressure. CT of the patients head within 2 h of the injury should reveal \\\ A normal brain
\\ A lens-shaped density over the frontal lobe
\\\ Increased CSF density with a fluid-fluid level
\\\ Multifocal attenuation of cortical tissue
\\\\ The elderly person who suffers relatively mild head trauma but subsequently develops a progressive
dementia over the course of several weeks is most likely to have sustained which of the following
\\\ An acute subdural hematoma
\\\ An acute epidural hematoma
\\ A chronic subdural hematoma
\\\ An intracerebral hematoma
\\\\ The most common sources of primary brain tumors are \\ Glial cells
28
\\\ Neurons
\\\ Meningeal cells
\\\ Lymphocytes
\\\\ The most common type of primary brain tumors are \\\ Meningioma
\\ Astrocytoma
\\\ Lymphosarcoma
\\\ Oligodendroglioma
\\\\ A 72-year-old woman has a head CT performed because of headaches. It is significant for a left
hemisphere mass with an overlying hyperostosis of the skull. She most likely has which of the following \\ Meningioma
\\\ Pituitary adenoma
\\\ Astrocytoma
\\\ Schwannoma
\\\\ A37-year-old man presents with visual impairment. Examination reveals a bitemporal hemianopsia.
Which of the following tumors is most likely responsible for finding \\\ Optic glioma
\\\ Occipital astrocytoma
\\\ Brainstem glioma
\\ Pituitary adenoma
\\\\ With an ependimoma of the posterior fossa, the patient is at risk of dying because of - 216
\\\ Embolifrom the tumor
\\\ Vascular occlusion by the tumor
\\\ Hemorrhagic necrosis of the tumor
\\\
\\\
\\
\\\
Heparin
Warfarim
Nimodipine
Phenytoin
\\\\ A 73-year old man with a history of hypertension complains of a 10-min episodes of leftsided weakness and slurred speech. On further questioning he relates three brief episodes in the
last month of sudden impairment of vision affecting the right eye. His examination now is
normal.
Which of the following would be the most appropriate next diagnostic test?
\\\ Creatine phosphokinase
\\\ Holter monitor
\\\ Visual evoked potentials
\\ Carotid artery Doppler ultrasound
\\\\ A 73-year old man with a history of hypertension complains of a 10-min episodes of leftsided weakness and slurred speech. On further questioning he relates three brief episodes in the
last month of sudden impairment of vision affecting the right eye. His examination now is
normal.
The episodes of visual loss are most likely related to
\\\ Retinal vein thrombosis
\\ Central retinal artery ischemia
\\\ Posterior cerebral artery ischemia
\\\ Middle cerebral artery ischemia
\\\\ A 73-year old man with a history of hypertension complains of a 10-min episodes of leftsided weakness and slurred speech. On further questioning he relates three brief episodes in the
last month of sudden impairment of vision affecting the right eye. His examination now is
normal.
A thorough evaluation reveals that patient has a 90% stenosis of the right internal carotid artery
at the bifurcation. The management option most likely to prevent a future stroke is which of the
following?
\\\ Warfarin
\\\ Carotid artery angioplasty
\\ Carotid endarterectomy
\\\ Extracranial-intracranial bypass
\\\\ A 62-year old man with a history of myocardial infarction awakens with a dense right sided
hemiplegia. His eyes are tonically deviated to the left and he does not respond to threat on the
right side of his visual field. He appears to be alert and responds to pain on the left side of his
body. His speech is unintelligible and nonfluent and he follows no instructions. Efforts to get him
to repeat simple phrases consistently fail.
Pick the language disturbance that best explains the clinical picture
\\\ Brocas aphasia
\\\ Wernickes aphasia
\\\ Anomic aphasia
\\ Global aphasia
\\\\ A 45-year-old woman with chronic atrial fibrillation discontinues warfarin treatment and
abruptly develops problems with language comprehension. She is able to produce some
intelligible phrases and produces sound quite fluently; however, she is unable to follow simple
31
instructions or to repeat simple phrases On attempting to write, she becomes very frustrated and
agitated. Emergency MRI reveals a lesion of the left temporal lobe, that extends into the superior
temporal gyrus
Pick the language disturbance that best explains the clinical picture
\\\ Brocas aphasia
\\ Wernickes aphasia
\\\ Anomic aphasia
\\\ Global aphasia
\\\\ A 71-year-old man develops headache and slight difficulty speaking while having sexual
intercourse. He has a long-standing history of hypertension, but has been on medication for more
than 7 years. He makes frequent errors in finding words and follows complex commands
somewhat inconsistently. The most obvious defect in his language function is his inability to
repeat the simplest of phrases without making repeated errors. An emergency CT scan reveals an
intracerebral hemorrhage in the left parietal lobe that appears to communicate with the lateral
ventricle
Pick the language disturbance that best explains the clinical picture
\\\ Brocas aphasia
\\\ Wernickes aphasia
\\ Conduction aphasia
\\\ Mixed transcortical apasia
\\\\ A 24-year-old woman abruptly loses all speech during the third trimester of otherwise
uncomplicated pregnancy. She has a history of severe migraines during which she occasionally
develops a transient right hemiplegia. Her comprehension is good, and she is frustrated by her
inability to speak or write. She is unable to repeat simple phrases, but she does begin to produce
simple words within 5 days of the acute disturbance of language
Pick the language disturbance that best explains the clinical picture
\\ Brocas aphasia
\\\ Wernickes aphasia
\\\ Global aphasia
\\\ Conduction aphasia
\\\\ A 75-year old man with a history of recent memory impairment is admitted with headache,
confusion, and a left homonymous hemianopsia. He has recently had two episodes of brief
unresponsiveness. There is no history of hypertension. Computed tomography (CT) scan shows a
right occipital lobe hemorrhage with some subarachnoid extension of the blood. An MRI scan
with gradient echo sequence reveals foci of hemosiderin in the right temporal and left frontal
cortex. The likely cause of this patients symptoms and signs is
\\\ Gliomatosis cerebri
\\\ Multi-infarct-dementia
\\ Amyloid angiopathy
\\\ Undiagnosed hypertension
\\\\ A 61-year-old man with a history of hypertension has been in excellent health until he
presents with vertigo and , unsteadiness lasting for two days. He then develops nausea, vomiting,
dysphagia, hoarseness, ataxia, left facial pain, and right-sided sensory loss. There is no
weakness. On examination, he is alert, with a normal mental status. He vomits with head
movement. There is skew deviation of the eyes, left ptosis, clumsiness of the left arm, and
titubation. He has loss of pain and temperature sensation in the left foot. He is unable to walk.
32
Magnetic resonance imaging (MRI) in this patient might be expected to show which of the
following?
\\\ Basilar artery tip aneurysm
\\\ Right lateral medullary infarction
\\ Left lateral medullary infarction
\\\ Left medial medullary infarction
\\\\ A 61-year-old man with a history of hypertension has been in exellent health until he
presents with vertigo and , unsteadiness lasting for two days. He then develops nausea, vomiting,
dysphagia, hoarseness, ataxia, left facial pain, and right-sided sensory loss. There is no
weakness. On examination, he is alert, with a normal mental status. He vomits with head
movement. There is skew deviation of the eyes, left ptosis, clumsiness of the left arm, and
titubation. He has loss of pain and temperature sensation in the left foot. He is unable to walk.
Right sided sensory loss is secondary to involvement of which of the following structures?
\\\ The right lateral spinothalamic tract
\\ The left.lateral spinothalamic tract
\\\ Ninth and Tenth cranial nerves
\\\ Inferior cerebellar peduncle
\\\\ The most striking neurologic complication of von Economos encephalitis (encephalitis
lethargica), a type of encephalitis that occurred in epidemic proportions along with viral
influenca between 1917 and 1928 was
\\\ Blindness
\\\ Hearing loss
\\\ Paraplegia
\\ Parkinsonism
\\\\ A17-year-old right-handed boy has had infectious meningitis 8 times over the past 3 years
He has otherwise been healthy and developed normally. Reccurent meningitis develops in
persons with
\\\ Ottitis media
\\\ Epilepsy
\\\ Multiple sclerosisi
\\ Cerebrospinal fluid (CSF) leaks
\\\\ A 72 year-old right-handed woman has 2 days of headache and fever, followed by
worsening confusion. she is taken to the hospital after having a generalized seizure/ A head CT is
consistent with left temporal hemorrhage and swelling/ Localization of encephalitis to the medial
temporal or orbital frontal regions of the brain is most consistent with
\\\ Trponema pallidum
\\\ Varicella zoster virus
\\ Herpes simplex virus
\\\ Cryptococcus neoformans
\\\\ A 72 year-old right-handed woman has 2 days of headache and fever, followed by
worsening confusion. she is taken to the hospital after having a generalized seizure/ A head CT is
33
consistent with left temporal hemorrhage and swelling. Neuroimaging of the brain before
attempting a lumbar puncture is advisable in cases of acute encephalitis because
\\\ The diagnosis may be evident on the basis of MRI alone
\\ Massive edema in the temporal lobe may make herniation imminent
\\\ The CT picture may determine whether a brain biopsy should be obtained
\\\ Shunting of the ventricules is usually indicated and the imaging studies are needed to direct
the placement of the shunt
\\\\ A 72 year-old right-handed woman has 2 days of headache and fever, followed by
worsening confusion. she is taken to the hospital after having a generalized seizure/ A head CT is
consistent with left temporal hemorrhage and swelling CSF testing establishes this case as being
the commonest form of acute encephalitis. The CSF changes late in the course of the disease
typically include
\\ An increased number of lymphocytes
\\\ A glucose content of less than two-thirds the serum level
\\\ A protain content of less than 45 mg/dL
\\\ A normal opening pressure
\\\\ A 72 year-old right-handed woman has 2 days of headache and fever, followed by
worsening confusion. she is taken to the hospital after having a generalized seizure/ A head CT is
consistent with left temporal hemorrhage and swelling. CSF testing establishes this case as being
the commonest form of acute encephalitis. With this disease EEG may exhibit
\\\ alfa - activity over the frontal regions
\\\ beta- activity over the frontal regions
\\\ Three-per-second spike and wave discharges
\\ Bilateral, periodic epileptiform discharges
\\\\ A 55-year-old woman has a progressive dementia over the past year. Over the last 3 months
she has developed dysarthria, myoclonus intention tremor and hyperreflexia. Her CSF VDRL is
positive This patients symptoms are being caused by a chronic meningoencephalitis. This
patients underlying disease may present a picture easily confused with brain tumor if
\\\ A reaction to penicillin occurs
\\ An intracranial gumma forms
\\\ Tabes dorsalis is the primary manifestation of the disease
\\\ Meningovascular syphilis develops
\\\\ A 18-year-old man notices tingling about his ankles 2 weeks after an upper respiratory tract
infection. Within 2 days he has weakness in dorsiflexion of both feet and within 1 week he
develops problems walking. he has no loss of bladder or bowel control. His weakness progress
rapidly over the ensuing week and necessitates his being placed on a ventilator to support his
breathing. He is quadriplegic but retains control of his eye movements. cerebrospinal fluid reveal
a protein content of greater than 1g/dL with a normal white cell count. There are no red blood
cells in he CSF
\\\ Subacute sclerosing panencephalitis(SSPE)
\\\ Progressive multifocal leukoencephalopathy
\\\ Rabies encephalitis
\\ Guillain-Barre syndrome
34
\\\\ A 65-years old previously healthy man presents in the emergency room because ofheadache
fever and neck stiffness over the past 12 hours. Examination reveals temperature of 40o C, pain
on flexion of the neck and an apical systolic murmur. a chest x-ray reveals a left lower lobe
pneumonia. Which of the following is the most appropriate statement regarding dexamethasone
treatment in this patient?
\\\ Dexamethasone is contraindicated, given the presence of presumed bacterial meningitis,
endocarditis and pneumonia
\\\ Dexamethasone should be administered if the patients mental status deteriorates despite
appropriate empiric antimicrobial therapy
\\\ A 10-mg dose of dexamethasone should be given prophylactically against brain edema after
24 hours of antimicrobial therapy if blood cultures are negative
\\ A 10-mg intravenous (IV) dose of dexamethasone should be given prior to initiation of
antimicrobial therapy and continued every 6 hours for 4 days
\\\\ A 22-years old college student is brought to the emergency department for headache,
photophobia, agitation, and fever that develops over the course of 6 hours. Examination reveals
hyperthermia of 40 o C heart rate of 120 beats per minute and blood pressure of 80/50 mm Hg.
He had petechie in the trunk, conjunctiva and palate. He received dexamethazone 10 mg
intravenously followed by ceftriaxon and vancomycyn. CSF examination reveals an opening
pressure of 360.. H2O, while blood cells 5000/mm(80% neutrophils), a glucose concentration of
10mg/dL, and a protein concentrtion of 120 mg/dL. Grams stain demonstrates gram-negative
diplococci. Latex particle agglutination test detected Neisseria menengitidis antigen. Culture
confirms that the strain is sensitive to penicillin. Which of the following is the recommended
specific antibiotic treatment in this patient?
\\ Ampicillin intravenously for 5 to 7 days followed by oral rifampin for 2 days
\\\ Nafcillin intravenously for 10 to 21 days followed by oral ampicillin for 3 days
\\\ Ampicillin intravenously for 2 to 3 weeks followed by oral azithromycin for 5 days
\\\ Cefotaxime intravenously for 3 days followed by oral azythromycin for 5 days
\\\\ In a patient who is three weeks from orthotopic liver transplantation , from which of the
following viruses is CNS infection most common?
\\\ Rabies virus
\\\ Human herpervirus 6(HHV6)
\\\ Varicella-zoster virus
\\ Cytomegalovirus
\\\\ A 68-year old patient with a history of normal pressure hydrocephalus underwent a
ventriculoperitoneal shunt 6 months ago, with improvement of gait and cognitive functions. Over
past 2 days he has developed headache, progressive deterioration of his gait, and increased
somnolence. The patient has no history of diabetes or alcohol use. CT scan of the head reveals
minimal ventricular enlargement compared with the scan performed 2 months prior to onset of
the symptoms. CSF examination reveals an opening pressure of360-mm H2O, white blood cells
1000/mm,(80%neutrophiles),a glucose concentration of 20 mg/dl and a protein concentration of
120 mg/dL Which of the following is the most likely cause of the symptoms?
\\\ Streptococcus pneumoniae
\\\ Listeria monocytogenes
\\ Staphylococcus aureus
\\\ Escherichia coli
35
\\\\ Localization of an encephalitis to the medial temporal or orbital frontal regions of the brain
is the most consistent with
\\\ Treponema Pallidum
\\\ Varicella zoster virus
\\ Herpes simplex virus
\\\ Cryptococcus neoformans
\\\\ A 22-year-old woman reports a scotoma progressing across her left visual field over the
course of 30 min followed by left hemicranial throbbing pain, nausea and photophobia. Her
brother and mother have similar headaches. Which of the following is present in classic migraine
but not in common migraine?
\\\ Photophobia
\\\ familial pattern
\\ Visual aura
\\\ Hemicranial pain
\\\\ Basilar migraine differs from classic migraine in the
\\\ Sex of the person most often affected
\\\ Resistance of the visual system to involvement
\\ Severity of symptoms
\\\ Duration of aura
\\\\ Both trigeminal neuralgia and atypical facial pain involve pain that may be
\\\ Lancinating
\\\ Paroxysmal
\\\ Associated with anesthetic patches
\\ Unilateral
\\\\ An obese 37-year-old woman complains of daily headache, worse in the morning, for one
year. She has episodes of transient visual obscurations affecting each eye, and also complains of
pulsatile tinnitus. Examination is notable for bilateral papilledema. There are no other
abnormalities. Select the most likely diagnosis
\\\ Carotid artery dissection
\\ Pseudotumor cerebri
\\\ Glioblastoma multiforme
\\\ Thunderclap headache
\\\\ Which of the following types of headaches is most likely to be responsive to inhalation of
100% oxygen?
\\\ Migraine headache
\\\ Tension headache
\\ Cluster headache
\\\ Cervicogenic headache
\\\\ A 30- year- old man presents with a headache that started yesterday. As he was shoveling
snow yesterday, he felt a sudden pain in the front of his head. The pain does not throb and has
36
been relatively constant since. He says that now his neck also become a little stiff. He carries a
diagnosis of migraine headaches, but says that this is different than his usual headaches. He is
afebrile and has a normal exam except for slight photophobia and mild discomfort with neck
flexion. Which action should be done next?
\\\ Obtain a brain MRI
\\ Obtain a brain CT
\\\ Obtain a cerebral angiogram
\\\ Obtain an EEG
\\\\ A 30- year- old man presents with a headache that started yesterday. As he was shoveling
snow yesterday, he felt a sudden pain in the front of his head. The pain does not throb and has
been relatively constant since. He says that now his neck also become a little stiff. He carries a
diagnosis of migraine headaches, but says that this is different than his usual headaches. He is
afebrile and has a normal exam except for slight photophobia and mild discomfort with neck
flexion. A head scan is normal. What should be done next?
\\\ Begin intravenous heparin
\\ Perform a lumber puncture
\\\ Obtain a brain MRI
\\\ Obtain a cerebral angiogram
\\\\ The most definitive test for identifying intracranial aneurisms is
\\\ MRI scanning
\\\ CT
\\\ PET
\\ Cerebral angiography
\\\\ A 23-year old woman complains of 2 days of visual loss associated with discomfort in the
right eye. She appears otherwise healthy, but her family reports recurrent problems with bladder
control over the prior 2 years, which she is reluctant to discuss. On neurologic examination this
young women exhibits dysmetria in her right arm, a plantar extensor response of the left foot and
slurred speech. The most informative ancillary test would be
\\\ Visual evoked response testing
\\\ Sural nerve biopsy
\\\ EEG
\\ MRI
\\\\ A 16 year-old boy is struck on the side of the head by a bottle thrown by a friend. He appears dazed
for about 30 s, but is apparently lucid for several minutes before he abruptly becomes stuporous. His
limbs on the side opposite the site of the blow are more flaccid than those on the same side as the injury.
On arrival in the emergency room 25 min after the accident, he is unresponsive to painful stimuli. His
pulse is 40/min, with an ECG revealing no arrythmias. His blood pressure in both hands is 170/100 mm
Hg. Although papilledema is not evident in his fundi, he has venous distention and absent pulsation of
the retinal vasculature.
The best explanation for this young mans evolving clinical signs is
\\\ A seizure disorder
\\\ A cardiac conduction defect
\\ Increased intracranial pressure
\\\ Communicating hydrocephalus
37
\\\\ 16 year-old boy is struck on the side of the head by a bottle thrown by a friend. He appears dazed for
about 30 s, but is apparently lucid for several minutes before he abruptly becomes stuporous. His limbs
on the side opposite the site of the blow are more flaccid than those on the same side as the injury. On
arrival in the emergency room 25 min after the accident, he is unresponsive to painful stimuli. His pulse
is 40/min, with an ECG revealing no arrythmias. His blood pressure in both hands is 170/100 mm Hg.
Although papilledema is not evident in his fundi, he has venous distention and absent pulsation of the
retinal vasculature.
The best explanation for this young mans evolving clinical signs is increased intracranial pressure. The
wisest management over the next 4 h for the patient is
\\ Craniotomy
\\\ Antihypertensive medication
\\\ Transvenous pacemaker placement
\\\ Ventriculoperitoneal shunt
\\\\ A 16 year-old boy is struck on the side of the head by a bottle thrown by a friend. He appears dazed
for about 30 s, but is apparently lucid for several minutes before he abruptly becomes stuporous. His
limbs on the side opposite the site of the blow are more flaccid than those on the same side as the injury.
On arrival in the emergency room 25 min after the accident, he is unresponsive to painful stimuli. His
pulse is 40/min, with an ECG revealing no arrythmias. His blood pressure in both hands is 170/100 mm
Hg. Although papilledema is not evident in his fundi, he has venous distention and absent pulsation of
the retinal vasculature.
MRI of the patients head within the first few hours of injury should reveal
\\\ A normal brain
\\\ Intracerebral hematoma
\\\ Temporallobe contusion
\\ Epidural hematoma
\\\\ A 16 year-old boy is struck on the side of the head by a bottle thrown by a friend. He appears
dazed for about 30 s, but is apparently lucid for several minutes before he abruptly becomes
stuporous. His limbs on the side opposite the site of the blow are more flaccid than those on the
same side as the injury. On arrival in the emergency room 25 min after the accident, he is
unresponsive to painful stimuli. His pulse is 40/min, with an ECG revealing no arrythmias. His
blood pressure in both hands is 170/100 mm Hg. Although papilledema is not evident in his
fundi, he has venous distention and absent pulsation of the retinal vasculature.
The best explanation for this young mans evolving clinical signs is increased intracranial
pressure. CT of the patients head within 2 h of the injury should reveal
\\\ A normal brain
\\ A lens-shaped density over the frontal lobe
\\\ Increased CSF density with a fluid-fluid level
\\\ Multifocal attenuation of cortical tissue
\\\\ The elderly person who suffers relatively mild head trauma but subsequently develops a
progressive dementia over the course of several weeks is most likely to have sustained which of
the following
\\\ An acute subdural hematoma
\\\ An acute epidural hematoma
\\ A chronic subdural hematoma
\\\ An intracerebral hematoma
\\\\ Which of the following is the mediator of extrapiramidal system
\\\ bradikinine
\\\ epinephrine
38
\\ acetilcholine
\\\ serotonine
\\\\ Which of the following belongs to Parkinsons disease symptoms?
\\\ muscle spasticity
\\ hypokinesia
\\\ intention tremor
\\\ tremor ofd a head
\\\\ Which of the following is characteristic for Parkinsons disease?
\\\ myoclonus
\\ micrographia
\\\ ballism
\\\ athetosis
\\\\ Which of the following is most disabling symptom of Parkinsons disease?
\\\ tremor
\\\ muscle rygidity
\\ hypokinesia
\\\ shiallorea
\\\\ Which of the following is true in case of Parkinsons disease?
\\\ usually it is started with tremor
\\ usually asymmetric onset
\\\ postural disturbances from the beginning
\\\ motor fluctuations at the beginning
\\\\ In Parkinsons disease most prominent neuropathological changes are in
\\\ thalamus
\\ substantia nigra pars compacta
\\\ putamen
\\\ globus pallidus
\\\\ Which of the following is characteristic for Huntingtons disease?
\\\ cerebellar ataxia
\\ choreatic hyperkinesis
\\\ spastic tetraparesis
\\\ myorithmias
\\\\ Which of the following is characteristic for Huntingtons disease?
\\ dementia and chorea
\\\ dementia and spinocerebellar ataxia
\\\ dementia and paraparesis
\\\ dementia and truncal dystonia
\\\\ Juvenile form of Huntingtons disease is characterized by
\\\ severe choreatic hyperkinesis
\\ akinesia and rigidity
\\\ truncal dystonia
39
40
\\\\ The treatment with antiepileptic drugs (AEDs) was carried out with 20 years old woman
with generalized tonic-clonic seizures. The seizures were stopped. She has gait disorder. This is
adverse event of the following AED:
\\\ Primidone
\\\ Valproic acid
\\ Phenytoine
\\\ Carbamazepine
\\\\ The following drug can be used for the treatment of absence epilepsy:
\\\ Phenytoine
\\ Ethosuximide
\\\ Phenobarbitale
\\\ Carbamazepine
\\\\ The following drug is non-effective for treatment of focal epilepsy:
\\\ Vaplroic acid
\\\ Carbamazepine
\\\ Phenobarbitale
\\ Ethosuximide
\\\\ The following drug is non-effective for the treatment of myoclonic seizures:
\\\ Valproic acid
\\ Ethosuximide
\\\ Clonazepame
\\\ All of them
\\\\
\\\
\\\
\\\
\\
41
\\\ Vigabatrine
\\\ Phenobarbitale
\\ Valproic acid
\\\\ The following antiepileptic drug can be used for intravenous infusion as a drug of first
choice for the treatment of epileptic status:
\\\ Chlorpromazine
\\ Diazepame
\\\ Tranilcipromine
\\\ Ethosuximide
\\\\ The man with 15 year duration of epilepsy referred to urgent department with generalized
tonic-clonic seizures with continous epileptic seizures. The drug of first choice is:
\\\ Midazolame
\\ Diazepame
\\\ Alprazolame
\\\ Ethosuximide
\\\\ The following is the reason of idiopathic epileps
\\ Genetic predisposition
\\\ Congenital malformation of brain
\\\ The developmental disorder of brain
\\\ Brain trauma
\\\\ The following is the sign of cryptogenic epilepsy:
\\\ Non genetic disorders confirmed by neuroimagi
\\\ The developmental disorder of brain
\\\ Genetic predisposition
\\ Focal epileptic seizures due to brain disorder not confirmed by neuroimaging
\\\\ Average prevalence of epilepsy in the world is:
\\ 1%
\\\ 3%
\\\ 0.5%
\\\ 5%
\\\\ Alpha is EEG activity with frequency:
\\\ 1-4 Hz
\\ 8-13 Hz
\\\ 4-8 Hz
\\\ > 13 Hz
\\\\ Delta is EEG activity with frequency:
\\ 1-4 Hz
\\\ 8-13 Hz
\\\ 4-8 Hz
\\\ > 13 Hz
\\\\ Focal slow wave activity on EEG is the sign of:
\\ Local damage of brain
\\\ Thalamocortical dysfunction
\\\ Diffuse encephalopathy
42
43