Neurology Review for IM Residents

Questions
1 Major inhibitory neurotransmitter in the Brain
a. Acetylcholine
b. Glutamate
c. Gamma-Aminobutyric acid
d. Dopamine
e. Glycine
2 Etiologies of Stroke, except:
a. Rheumatic atrial fibrillation is the most common cause of cerebral embolism
b. Venous sinus thrombosis occurs as a complication of oral contraceptive use,
pregnancy, postpartum period, and dehydration
c. Thrombus formation on atherosclerotic plaques may embolize to intracranial arteries
producing an artery-to-artery embolic stroke
d. Dissection of the internal carotid or vertebral arteries is a common source of embolic
stroke in young patients aged <60
e. Amphetamines and Cocaine may cause stroke on the basis of acute hypertension or
drug-induced vasculopathy
3 Characteristic/s of Multiple Sclerosis, except:
a. Cigarette smoking is a risk factor
b. Lesions typically develop at different times and in different CNS locations
c. More common in men than women
d. Age of onset is typically between 20 and 40 years
e. Mononuclear cell pleocytosis and an increased level of IgG is seen in the CSF
4 In a patient with rapidly evolving ascending motor paralysis, which of the following findings
will cast doubt on a diagnosis of Guillain-Barre Syndrome?
a. Tingling sensation in the extremities
b. Facial diparesis
c. Involvement of lower cranial nerves
d. Fever
e. Attenuated deep tendon reflexes
5 True of Myasthenia Gravis, except
a. Fundamental defect is a decrease in the number of available AChRs at the presynaptic
muscle membrane
b. Rapid reduction of >1015% in the amplitude of the evoked responses is seen on
electrodiagnostic testing
c. The presence of anti-AChR antibodies is virtually diagnostic of MG, but a negative test
does not exclude the disease
d. Diplopia and ptosis are common initial complaints
e. Cardinal features are weakness and fatigability of muscle
6 True of Sodium regulation in the Brain, except
a. Neurologic symptoms occur depending not only on the absolute value of Na but also
on the rate of fall
b. Osmotic demyelination as a result of rapid rise in serum sodium is limited to the
brainstem
c. Serum sodium >160 mmol/L causes cellular metabolic processes to fail and
encephalopathy will result
 d. Isovolemic hyponatremia in SIADH is managed with water restriction or administration
of AVP antagonists
e. Cerebral salt-wasting syndrome is a hypovolemic hypotonic hyponatremia seen in
subarachnoid hemorrhage
7 Finding/s helpful for localizing the lesion to the spinal cord
a. Seizure
b. Isolated Cranial Nerve abnormality
c. Sphincter dysfunction
d. Sparing of sensation
e. Stocking or glove distribution of sensory loss
8 Most common site of Hypertensive ICH
a. Basal ganglia
b. Midbrain
c. Cerebral cortex
d. Ventricles
e. Medulla
9 Which of the following best describes a state of stupor
a. Patient can be transiently awakened by vigorous stimuli
b. Characterized by easy arousal and the persistence of alertness for brief periods
c. Awake-appearing but nonresponsive
d. Awake patient but has no means of producing speech or volitional movement
e. Patient is able to form impressions and think but remains virtually immobile and mute
10 True of Cerebral blood flow (CBF) except
a. Increases with hypercapnia and acidosis
b. Decreases with hypocapnia and alkalosis
c. Decrease in CBF lowers ICP
d. Inversely related to perfusion pressure at the extreme limits of MAP or Cerebral
perfusion pressure
e. Regulated via alterations in cerebrovascular resistance
11 True of Wernickes Disease, except
a. Due to cobalamine deficiency
b. Malnutrition is a risk
c. Characteristic triad of ophthalmoplegia, ataxia, and global confusion
d. Abnormal enhancement of the mammillary bodies is a typical finding on contrast MRI
e. Later development of Korsakoff psychosis
12 Major cause/s of delayed neurologic deficit in SAH, except
a. Rerupture
b. Vasospasm
c. Hydrocephalus
d. Hyponatremia
e. Seizure
13 Normal CSF finding/s, except
a. WBC count <5/uL
b. Glucose 40 mg/dL
c. Protein 55 mg/dL
d. Opening pressure 50 mmH2O
e. 60% lymphocytes, 30% monocytes/macrophages
14 Which of the following CSF findings suggest Tuberculous Meningitis
a. WBC count 50/uL , predominantly lymphocytes, Glucose 35 mg/dL, Protein 150 mg/dL
b. WBC count 25/uL , predominantly lymphocytes, Glucose 45 mg/dL, Protein 30 mg/dL
c. WBC count 1050/uL , >80% PMNs, Glucose 35 mg/dL, Protein 120 mg/dL
d. WBC count 100/uL , predominantly lymphocytes, Glucose 55 mg/dL, Protein 50 mg/dL
e. WBC count 4/uL , 60% lymphocytes, Glucose 45 mg/dL, Protein 45 mg/dL

15 When should the first dose of dexamethasone be given in a patient suspected to have
pneumococcal bacterial meningitis
a. 10 min after the first dose of antibiotics
b. 20 min before the first dose of antibiotics
c. Within an hour after the 1st antibiotic dose
d. Before the 2nd antibiotic dose
e. Together with the 1st antibiotic dose