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NeurologicalDisordersPracticeTest

Questions
1.Amyloidplaquesandneurofibrillarytanglesarethehallmarksof:
a.Alzheimer'sdisease
b.Amyotrophiclateralsclerosis
c.AtaxiaTelengiectasia
d.Autism
2.Difficultyspeakingandunderstandingspeechistermed:
a.Apnea
b.Ataxia
c.Aphasia
d.Dyslexia
3.Themostcommonformoftransientfacialparalysisis:
a.Alzheimer'sdisease
b.Transientischemicattack
c.Bell'spalsy
d.Erb'spalsy
4.Graduallyincreasingpainandweaknessandnumbnessinthehandorwristthat
radiatesupthearmsuggest:
a.Amyotrophiclateralsclerosis
b.Carpaltunnelsyndrome
c.BlochSulzbergerSyndrome
d.Dystonia
5.AllofthefollowingmaybeassociatedwithGuillainBarreSyndromeexcept:
a.Weakeningortinglingsensationinthelegs
b.Weaknessinthearmsandupperbody
c.Nearlycompleteparalysis
d.Firstsymptomisalteredmentalstatus
6.Whichofthefollowingstatementaboutherpeszosterisnottrue?

a.Itiscausedbythevaricellazostervirus
b.Itcausesburning,tinglingpainandlesions,generallyononesideofthebody
c.Anyonewhohashadchickenpoxisatriskofpostherpeticneuralgia
d.Itisasexuallytransmitteddisease
7.Diagnostictestsforepilepsyincludeallofthefollowingexcept:
a.Simplebloodtests
b.EEG
c.Brainscan
d.Wadatest
8.Treatmentforepilepsytoeliminateorsharplyreducethefrequencyofseizuresmay
involveallofthefollowingexcept:
a.Cognitivebehavioraltherapy
b.Narrowspectrumandbroadspectrumantiepilepticdrugs
c.Vagusnervestimulation
d.Surgery
9.Themostcommoninheritedneurologicaldisorderis:
a.BlochSulzbergerSyndrome
b.CharcotMarieToothdisease
c.Alper'sdisease
d.AspergerSyndrome
10.Asevereformofepilepsythatappearsduringthefirstyearoflifeiscalled:
a.DandyWalkersyndrome
b.Devic'ssyndrome
c.Dravetsyndrome
d.Fabrydisease
11.Lackofceramidetrihexosidase,alsoknownasalphagalactosideAcauses:
a.Fahr'ssyndrome
bFabrydisease
c.Fishersyndrome
d.Gaucher'sdisease
12.Symptomsoftrigeminalneuralgiamayincludeallofthefollowingexcept:

a.Extreme,intermittentfacialpaininthejaworcheek
b.Tinglingornumbnessononesideoftheface
c.Paintriggeredbycontactwiththefaceorfacialmovements
d.Inabilitytoswallow
13.AllofthefollowingaretrueaboutTourettesyndromeexcept:
a.Drugtreatmentcompletelyeliminatessymptoms
b.Itisinvoluntaryandmaybeachroniccondition
c.Symptomsaregenerallymostsevereduringadolescence
d.Symptomsaregenerallydetectedinchildren
14.Huntington'sdiseaseisaheritabledisorderthatinvolves:
a.Suddenparalysis
b.Chorea,lossofcognitiveabilities,andemotionaldisturbance
c.Uncontrollableswearingandrepetitiveactions
d.Inabilitytorecognizefaces
15.Allofthefollowingstatementsaboutamyotrophiclateralsclerosisaretrueexcept:
a.Itcausesdegenerationanddeathofupperandlowermotorneurons
b.Patientslosestrengthandcontrolofvoluntarymuscles
c.Itimpairscognitionandsenses
d.Itprogressesrapidlyandisfatal
16.ChildrenwithAngelmansyndromegenerallydisplayallofthefollowingexcept:
a.Developmentaldelaysandspeechimpairment
b.Feedingproblems
c.Seizures
d.Lossofhearingandsenseofsmell
17.Allofthefollowingaretrueaboutautismexcept:
a.Affectedpersonshavecommunication,interpersonal,andbehavioralproblems
b.Affectedpersonsdisplayobsessiveorrepetitivebehaviorsandinterests
c.Itisthedirectresultofimmunizationwiththimerosalcontainingvaccines
d.Earlyinterventionisassociatedwithimprovedoutcomes
18.Brainandspinaltumorsmaybetreatedwithanyorallofthefollowingmodalities
except:

a.Surgery
b.Radiation
c.Chemotherapy
d.Positronemissiontomography
19.SymptomsofParkinson'sdiseaseincludeallofthefollowingexcept:
a.Tremorsofthehands,arms,legs,jaw,andface
b.Stifflimbs
c.Bradykinesiaandimpairedbalance
d.Impairedcognition
20.Narcolepsyisadisordercharacterizedby:
a.Narcoticabuse
b.Grandmalseizures
c.Relianceonsoporificdrugs
d.Inabilitytoregulatesleepwakecycles

AnswersandExplanations
1.A:Alzheimer'sdisease(AD)isaspecifictypeofdementiaandthemostcommonformof
dementiainpersonsage65andolder.Itisaprogressiveneurologicaldiseasethatproducesa
declineincognitivefunctionandmemoryandchangesinbehavior.Inadditiontotheabove
mentionedfeaturesofAD,thereisalossofconnectionsbetweentheneuronsinvolvedwith
learningandmemory.
2.C:Aphasiaresultsfromdamagetotheportionofthebraininvolvedincreatingand
interpretinglanguage.Aphasiaisnotadisease.Itisasymptomofaneurologicaldisorderor
injury,suchasstroke,braintumor,orheadinjury.Expressiveaphasiaisthetermforproblems
communicatingusingspokenorwrittenlanguage.Receptiveaphasiareferstoproblems
understandinglanguage.
3.C:Bell'spalsyisatemporaryparalysisthatgenerallyaffectsonesideoftheface.Itresults
fromdamageortraumatofacialnerves.Bell'spalsyhassuddenonsetwithsymptomsthatmay
includevaryingdegreesofweaknessorparalysis,droopingeyelidorcornerofthemouth,
drooling,dryeyeormouth,impairedsenseoftaste,excessivetearing,andfacialdistortion.
4.B:Carpaltunnelsyndromeiscausedbycompressionofthemediannerveinthewrist.Asthe
disorderprogresses,thereisalossofgripstrengthandmanualdexteritymaydecrease.Resting
theaffectedwrist,immobilization,icepacks,andnonsteroidalantiinflammatoryagentsmay
providereliefbyreducingswellingandpressureonthemediannerve.

5.D:GuillainBarreSyndromeisarareautoimmunediseasethatoftenfollowsarespiratoryor
gastrointestinalviralillness.Italsomayoccurfollowingsurgeryorimmunization.Thereisno
cureforGuillainBarreSyndrome;however,treatment,includingplasmapheresisandhighdose
immunoglobulintherapyadministeredintravenously,aimstoreducetheseverityofsymptoms.
6.D:Herpeszoster,commonlyknownasshingles,occursalongadermatomeandproduces
characteristicitching,burning,blisters,andpain.Itiscausedbyareactivationofthevaricella
zostervirusthatcauseschickenpox.Theseverityanddurationofanoutbreakcanbereducedby
prompttreatmentwithantiviralagents.Olderadultswhohavehadchickenpoxmaybegivena
varicellazostervirusvaccinetosignificantlyreducetheriskofdevelopingshingles.
7.A:Thediagnosisofepilepsymaybeestablishedusingtheabovementionedtestsaswellas
continuousvideoEEGmonitoring,magneticresonanceimaging(MRI)andfunctionalMRI,and
singlephotonemissioncomputedtomography(SPECT),whichtracescerebralbloodflowto
detectabnormalitiesduringandbetweenseizures.
8.A:Becausepeoplewithepilepsy,especiallychildrenandadolescents,maydevelopbehavioral
oremotionaldifficultiesinresponsetostigmatization,cognitivebehavioraltherapymaybe
consideredasadjunctivetherapy.Itisnot,however,atreatmentfortheseizuredisorder,which
forthemajorityofaffectedpersonsiscontrollablewiththeuseofantiepilepticdrugs.
9.B:CharcotMarieToothdiseaseaffectsanestimated1in2,500personsintheUnitedStates.It
isahereditarymotorandsensoryneuropathythataffectstheperipheralnerves.Assuch,
symptomsincludeweaknessofthefeetandlegsandfootdeformitiesresultingfromweak
muscles,whichinturnmayproducefootdrop,tripping,andfalls.
10.C:Dravetsyndrome,alsoknownasseveremyoclonicepilepsyofinfancy,presentswith
frequentfeverrelatedseizuresduringthefirstyearoflife.Othertypesofseizuresgenerally
occurovertime,andchildrenwithDravetsyndromeareoftendevelopmentallydelayedin
language,motor,andinterpersonalskills.
11.B:PersonswithFabrydiseasecannotefficientlymetabolizelipidsandasaresult,excessive
lipiddepositionoccursintheeyes,kidneys,cardiovascularsystem,andautonomicnervous
system.Symptomsofthisheritablediseaseincludeburningsensationsinthehands,raisedskin
lesions,andinboysespecially,cornealchanges.PersonswithFabrydiseaseareatincreasedrisk
ofheartdiseaseandstroke.
12.D:Trigeminalneuralgiaischaracterizedbysuddenonsetofseverepainthatlastslessthana
minute.Itpresentsmostcommonlyinpersonsage50andolderandamongwomen.The
frequencyandseverityofattacksrecursandremits,progressivelyworseningovertime.While
thedisordermaybedebilitating,itisnotlifethreatening.
13.A:TouretteSyndromeischaracterizedbyticsrepetitive,involuntarybehaviors,
vocalizationsandmovementssuchaseyeblinking,grimacing,andshruggingorjerkymuscle

movements.Ticsalsomayincludeselfharmsuchasrepetitivelypunchingoneselfaswellas
coprolaliaandecholalia.PersonswithTourettesyndromefrequentlysufferbehavioralproblems
suchashyperactivity,impulsivity,attentiondisorders,andrepetitivebehaviors.
14.B:Huntington'sdiseaseisaprogressivebraindisorderthatcausesthedegenerationofcellsin
apairofnerveclustersdeepinthebrain.Thediseaseaffectsboththebodyandthemind.HDis
causedbyasingledominantgeneandaffectsmenandwomenofallracesandethnicgroups.It
generallybeginsduringthethirdandfourthdecadesoflife;however,thereisaformofthe
diseasethatcanaffectchildrenandadolescents.
15.C:Amyotrophiclateralsclerosis(ALS),alsoknownasLouGehrig'sdisease,causesmuscle
weaknessandatrophy.AsitprogressesALSpatientshavedifficultymoving,swallowing,
speaking,andultimately,breathingontheirown.ManyALSpatientsrequiremechanical
ventilationandmostdiefromrespiratoryfailurethreetofiveyearsfromthetimeinitial
symptomsaredetected.
16.D:Angelmansyndromeisageneticdisorderthatcausesdevelopmentaldelaysandmultiple
neurologicalproblemssuchasmotordifficultiesthatimpairfunctions.ChildrenwithAngelman
syndromeareoftenhyperactiveandsufferfrommovement,balance,andsleepdisorders.They
havecharacteristicsmall,flatheadsandprotrudingtongues.Jerkymovementsarealso
characteristicofthedisorder.
17.C:Althoughtheetiologyofautismremainsunknown,itisthoughttoarisefroma
combinationofgeneticpredispositionandenvironmentaltriggers.Areviewoftheevidence
conductedbytheInstituteofMedicineconcludedthatthereisnocausalrelationshipbetween
thimerosalcontainingvaccinesandautism.
18.D:Brainandspinaltumorsmaybebenignormalignantandbenigntumorsmaybe
asymptomaticdependingontheirlocation.Symptomsofbraintumorsincludethefollowing:
headache;seizures;nauseaandvomiting;vision,hearing,andmotorproblems;andsensoryand
cognitivechanges.Symptomsofspinalcordtumorsincludepain,sensorychanges,andmotor
problems.
19.D:SymptomsofParkinson'sdiseaseoftenbeginononesideofthebodyandovertimeaffect
theentirebody.ThefourcharacteristicsymptomsofParkinson'sdiseasearetremor,rigidity,
slownessofmovement,andposturalinstability.Tremorisgenerallymostapparentatrestor
whenthepatientisstressedandimproveswithdeliberatemovement.
20.D:Narcolepsyisaneurologicaldisorderthatcausesaffectedindividualstoexperience
irresistibleboutsofsleep,causingthemtofallasleepforperiodsrangingfromsecondsto
minutesthroughouttheday.Alongwithexcessivedaytimesleepiness,personswithnarcolepsy
alsosufferfromcataplexy,hallucinationsattheonsetofsleepand/oruponawakening,and
transientcompleteparalysisattheonsetorendofsleep.

1.

Youre evaluating a 50-year-old man who presents with a headache. He


says that he notices that before his headaches, like now, he sees funny
squiggly things. He asks if you can turn off the light as you come into the
room, because the bright light is driving him nuts. Which one of the
following would you give to help with his headache?
(A) Oxygen
(B) Cyclobenzaprine (Flexeril)
(C) Lisinopril (Zestril)
(D) Terazosin (Hytrin)
(E) Ergotamine and caffeine (Cafergot)

2.

In which one of the following disorders would you see choreiform


movements?
(A) Parkinsons disease
(B) Rheumatic fever
(C) Complex regional pain syndrome
(D) Multiple sclerosis
(E) Tourettes syndrome

3.

Which one of the following signs is associated with meningitis?

(A) Applebees sign


(B) Kernigs sign
(C) Tinels sign
(D) Trousseaus sign
(E) Homans sign
4.

Youre evaluating a 45-year-old woman with a history of a solid organ


transplant. Shes on immunosuppression and presents with a fever and a
change in mental status. She isnt arousable and has become very
lethargic. Theres a question as to whether she had a seizure at home. An
MRI showed hemorrhagic changes and increased enhancement in the
temporal lobe. Which one of the following does she need at this point?
(A) Intravenous methylprednisolone (Medrol)
(B) Plasmapheresis
(C) Intravenous azithromycin (Zithromax)
(D) Intravenous acyclovir (Zovirax)
(E) Oral amoxicillin (Trimox)

5.

Which one of the following would be used in treating a peripheral


neuropathy secondary to heavy metal toxicity?
(A) Chelation
(B) Dialysis
(C) Electromyography
(D) A good colonic
(E) B12 supplementation

6.

Which of the following could be seen with the chronic use of phenytoin
(Dilantin)?
(A) Leukocytosis
(B) Increased liver function levels
(C) Hyponatremia

(D) Hypovitaminosis D
(E) Hypercalcemia

Example PANCE Answers and Explanations


Use this answer key to score the practice neurology questions. The answer
explanations give you some insight into why the correct answer is better than the
other choices.
1. E. This person has symptoms consistent with a migraine headache and the visual
disturbances described are likely scotomas (and an aura). Choice (E), ergotamine
and caffeine, is used in treating an acute migraine. Choice (A), oxygen, is one
treatment for cluster headaches. Choice (B), cyclobenzaprine, is a muscle relaxer
used for treating tension headaches. Choice (C), lisinopril, is used first-line to treat
hypertension as well as proteinuria and albuminuria secondary to diabetes. Choice
(D), terazosin, is used for hypertension as well as for benign prostatic hyperplasia.
2. B. With rheumatic fever, you may see subsequent Sydenhams chorea. With
Parkinsons, Choice (A), you see bradykinesia, muscle rigidity, and a pill-rolling
tremor. Choice (C), complex regional pain syndrome, is associated with pain, usually
in an extremity with bone changes and usually after a significant trauma. Choice (D),
multiple sclerosis, is an upper motor neuron lesion, so its associated with spasticity.
Choice (E), Tourettes, is associated with tic-like movements, especially facial and
verbal tics.
3. B. Kernigs sign (knee/leg extension) is a test for meningitis. Choice (A) isnt really
a clinical sign; its a sign that Rich is hungry and really wants to go out to eat. Choice
(C), Tinels sign, is associated with carpal tunnel syndrome. Choice (D), Trousseaus
sign, is associated with two things: hypocalcemia and a migratory thrombophlebitis,
usually associated with pancreatic cancer. Choice (E), Homans sign, is associated
with a deep venous thrombosis.
4. D. This woman has encephalitis, namely herpes encephalitis, and youre going to
give intravenous acyclovir. Look at the question setup: The patient is
immunosuppressed, presents with a fever, and has had a change in mental status.
You see the characteristic finding in hemorrhage of the temporal lobe. Choice (A),
methylprednisolone, is given for a multiple sclerosis exacerbation. Choice (B),
plasmapheresis, is given to treat myasthenia gravis and Guillain-Barr syndrome.

Choice (C), azithromycin, is one of the treatments for community-acquired


pneumonia, and Choice (E), amoxicillin, is used for treating otitis media or bacterial
sinusitis.
5. A. Heavy metal toxicity can present with a peripheral neuropathy. The treatment is
chelation therapy, because these metals are in the tissues and cant be removed by
dialysis, Choice (B). Choice (C), electromyography (EMG), is used to evaluate and
diagnose a peripheral neuropathy. Pretty much anyone can benefit from a good
colonic, Choice (D), but the colonic wont treat the problem at hand. Vitamin
B12 supplementation, Choice (E), helps only with B 12deficiency.
6. D. Phenytoin (Dilantin) is associated with low vitamin D levels because the drug
increases the metabolism of the liver and can deplete the vitamin D levels quickly.
This can lead to osteoporosis. Choice (A), leukocytosis, is associated with lithium.
You can see Choice (B), increased liver function levels, with valproic acid
(Depakote). You can see Choice (C), hyponatremia, with carbamazepine (Tegretol).
Concerning Choice (E), phenytoin isnt associated with hypercalcemia.