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1 | |
A 30-year-old male complains of unilateral headaches with rhinorrhea and tearing of the eye on the side of the headache. Episodes are precipitated by alcohol. Headaches may become a problem for weeks to months, after which a headache-free period occurs. The most likely diagnosis is |
| | A) | Migraine |
| | B) | Cluster headache |
| | C) | Sinusitis |
| | D) | Tension headache |
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2 | |
A 35-year-old previously healthy woman complains of a severe, excruciating headache and then has a transient loss of consciousness. There are no focal neurologic findings. The next step in evaluation is |
| | A) | CT scan without contrast |
| | B) | CT scan with contrast |
| | C) | Carotid angiogram |
| | D) | Holter monitor |
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3 | |
A 70-year-old male complains of the sudden onset of syncope. It occurs without warning and with no sweating, dizziness, or light-headedness. He believes episodes tend to occur when he turns his head too quickly or sometimes when he is shaving. The best way to make a definitive diagnosis in this patient is |
| | A) | ECG |
| | B) | Carotid massage with ECG monitoring |
| | C) | Holter monitor |
| | D) | Electrophysiologic studies to evaluate the AV node |
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4 | |
Which of the following is correct with respect to treatment of this patient? |
| | A) | Riluzole arrests the underlying pathologic process in ALS |
| | B) | Riluzole was FDA approved for ALS because it improves survival rate |
| | C) | Riluzole has no significant side effects |
| | D) | Insulin-like growth factor is another alternative for the treatment of ALS |
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5 | |
A 20-year-old woman complains of weakness that is worse in the afternoon, worse during repetitive activity, and improved by rest. When fatigued, the patient is unable to hold her head up, speak, or chew her food. On physical exam, there is no loss of reflexes, sensation, or coordination. The underlying pathogenesis of this disease is |
| | A) | Serum antiacetylcholine receptor antibodies causing neuromuscular transmission failure |
| | B) | Destruction of anterior horn cells by virus |
| | C) | Progressive muscular atrophy |
| | D) | Demyelinating disease |
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6 | |
The diagnosis of myasthenia gravis is made by a positive edrophonium test, repetitive nerve stimulation test of a weak muscle, and antiacetylcholine receptor antibody assay. MRI of the mediastinum is now indicated to |
| | A) | Rule out tuberculosis before starting prednisone |
| | B) | Rule out thymoma |
| | C) | Look for small cell carcinoma and Lambert-Eaton syndrome |
| | D) | Rule out sarcoidosis |
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7 | |
A 45-year-old woman presents to her physician with an 8-month
history of gradually increasing limb weakness. She first noticed difficulty climbing stairs, then problems rising from chairs, walking more than half a block, and, finally, lifting her arms above shoulder level. Aside from some difficulty swallowing, she has no ocular, bulbar, or sphincter problems and no sensory complaints. Family history is negative for neurological disease. Examination reveals significant proximal limb and neck muscle weakness with minimal atrophy, normal sensory findings, and intact deep tendon reflexes. The most likely diagnosis in this patient is |
| | A) | Polymyositis |
| | B) | Cervical myelopathy |
| | C) | Myasthenia gravis |
| | D) | Mononeuropathy multiplex |
| | E) | Limb-girdle muscular dystrophy |
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8 | |
A 55-year-old diabetic woman suddenly develops weakness of the left side of her face as well as of her right arm and leg. She also has diplopia on left lateral gaze. The responsible lesion is probably located in the |
| | A) | Right cerebral hemisphere |
| | B) | Left cerebral hemisphere |
| | C) | Right side of the brainstem |
| | D) | Left side of the brainstem |
| | E) | Right medial longitudinal fasciculus |
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9 | |
A 40-year-old woman complains of headache associated with visual disturbance. Of the histories described below, which one suggests migraine headache as a likely diagnosis? |
| | A) | Numbness or tingling of the left face, lips, and hand lasting for 5 to 15 min, followed by throbbing headache |
| | B) | An increasingly throbbing headache associated with unilateral visual loss and generalized muscle aches |
| | C) | A continuous headache associated with sleepiness, nausea, ataxia, and incoordination of the right upper limb |
| | D) | An intense left retroorbital headache associated with transient left-sided ptosis and rhinorrhea |
| | E) | A visual field defect that persists following cessation of a unilateral headache |
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10 | |
A 60-year-old man with Parkinson's disease is receiving levodopa/cardiodopa therapy and complains of uncontrollable facial movements. Which of the following is correct? |
| | A) | Limb and facial dyskinesias are unusual side effects of chronic levodopa therapy |
| | B) | Levodopa treatment, while ameliorating symptoms, does not alter the natural history of the disease |
| | C) | Bromocriptine works by increasing the release of dopamine from the substantia nigra |
| | D) | Trihexyphenidyl and benztropine mesylate have minimal side effects in the elderly |
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