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Neurology Blueprint
Questions, Answers, and Explanations
Question 1
1. Your patient is a 56 year old male that presents after he passed out. He
denies any chest pain or shortness of breath. He is on no medication and
has no known medical problems. On exam he has a II/VI systolic murmur.
His vitals are as follows BP-112/68, HR-92, Temp-98.6 F, RR-20, SpO2
99% on room air. Which of the following tests would have the highest yield
in possibly detecting an etiology of his syncope?
A.
B.
C.
D.
CTA of Chest with IV contrast
Troponin
Echocardiogram
MRI of Brain
Answer 1
1. Choice C is the correct answer. This patient likely has cardiac
syncope given his history and physical exam findings. A systolic
murmur can be present in aortic stenosis which can lead to syncope.
An ECHO would also be helpful to assess his ejection fraction to look
for any evidence of cardiomyopathy. While thoracic aortic dissection
and pulmonary embolism can lead to syncope, this patient is not
symptomatic and has normal vital signs. A CTA of chest would be low
yield. Neuroimaging in cases of syncope is low yield. Most cases of
syncope are do to orthostatic changes, cardiac etiology or reflex
(vasovagal) syncope. A troponin would not be helpful.
Question 2
2. Your patient is a 45 year old male that has a history of diabetes complains
of bilateral lower extremity numbness and pain in a glove like distribution.
There is no evidence of swelling or cellulitis. He states that this is been worse
over the last several months. He states that pain is worse at night. He has no
change in the pain with exertion. Which of the following medications would be
the best to start managing this patient's symptoms?
A.
B.
C.
D.
Norco
Ultram
Plavix
Lyrica
Answer 2
2. Choice D is the correct answer. This patient has
peripheral neuropathy likely secondary to his diabetes.
Plavix would be appropriate if you thought the patient had
intermittent claudication. The patient's symptoms do not
changes with exertion. Norco and Ultram should be
avoided with patients with chronic pain because of
tolerance issues and abuse potential.
Question 3
3. Your patient is a 45 year old female that presents with recurrent
headaches that are unilateral accompanied by ipsilateral rhinorrhea
and eye watering with the headache. The patient states she gets them
several times a month. Which of the following medications are
recommended for prevention of these types of headaches?
A. Depakote
B. Verapamil
C. Norvasc
D. Oxygen
Answer 3
3. Choice B is the correct answer. Verapamil
is the first line medication for prevention of
cluster headaches. Oxygen is actually used as
abortive treatment for cluster headaches.
Norvasc does not have any role for prevention
of cluster headaches. Depakote is usually not
used for prevention of cluster headaches.
Question 4
4. Your patient is a 23 year old male the presents with headache, fever,
nausea, vomiting, neck pain and photophobia. He is alert and oriented times 3.
His vital signs are as follows: Temp 103.1 degrees F, BP 112/72, HR 118, RR22, SpO2 98%. His spinal fluid analysis is as follows WBC 347, RBC 0,
Glucose and protein normal. Which is the most likely diagnosis?
A.
B.
C.
D.
Viral Encephalitis
Viral Meningitis
Bacterial Meningitis
Fungal Meningitis
Answer 4
4. Choice B is the correct answer. One major
differentiation between encephalitis and meningitis is that
patients with encephalitis will have some alteration of
consciousness or mental status changes. It is possible to
have both. This patient has a normal mental status. WBC
over 5 in the CSF suggests meningitis. Patients with
bacterial meningitis typically have a WBC in CSF over
1000. With viral meningitis the glucose is normal, and with
bacterial meningitis the glucose is low.
Question 5
5. Your patient is a 72 year old male that present with an
essential tremor. Which of the following medications would
likely work best in controlling his symptoms?
A. Primidone
B. Ativan
C. Selegiline
D. Baclofen
Answer 5
5. Choice A is the correct answer. Primidone
is first line medication for essential tremor.
Selegine is a second or third line medication for
Parkinson Disease. Ativan may help tremor but
may make the patient prone to falling. Baclofen
would not help tremor.
Question 6
6. All of the following are characteristics of Parkinson Disease except:
A. Patients with Parkinson can have postural instability
B. The tremor of Parkinson is at rest and decreases with intentional
action
C. Cognitive dysfunction and dementia are not usually seen with
Parkinson disease
D. Levodopa is considered first line treatment in Parkinson Disease.
Answer 6
6. Choice C is the correct answer. Cognitive
dysfunction and dementia are common with
Parkinson Disease.
Question 7
7. Your patient is a 34 year old male that presents with recurrent
headaches that you ordered an MRI and MRA. His MRI/MRA of the
brain reveals a 3 mm cerebral aneurysm. Which of the following is the
best management option?
A. Recommend routine monitoring of this aneurysm every two to three
years with an MRA of head.
B. Call neurosurgery and recommend immediate removal
C. Recommend a CTA of head for further characterization.
D. Start the patient on Fioricet
Answer 7
7. Choice A is the correct answer. Surgical
intervention is not recommended until they are over 7
mm. The current standard of care is to get an MRA or
CTA of head every 2-3 years to monitor the growth. A
cerebral aneurysm of this side is not causing
symptoms so starting the patient on Fioricet for this is
not recommended. A CTA of head will not
characterize this aneurysm any further.
Question 8
8. Your patient is a 54 year old male that presents with right side facial
droop, dysarthria, right upper and right lower extremity weakness. His
vital signs are as follows: BP 156/92, Pulse 89, RR 14, Temp 98.4
degrees F, and SpO2 96%. Which of the following should be the first
management plan?
A.
B.
C.
D.
Get a POC Glucose
CT scan of Head without contrast
ASA 325 mg PO now
Give the patient TPA
Answer 8
8. Choice A is the correct answer. Any patient with a
neurologic deficit the first step is to get a POC glucose.
Hypoglycemia can mimic a CVA. The patient needs a CT
scan of his head, especially if he is not hypoglycemic. If
the CT scan demonstrates a thrombotic stroke and no
bleeding. Aspirin should be given if the CT scan does not
show any signs of bleeding. This patient may be a
candidate for TPA, more information has to be obtained to
see if he is a candidate and does not meet any exclusion
criteria for TPA.
Question 9
9. Your patient is a 45 year old male that presents with a history of IV
drug use and has an acute thrombotic CVA by CT scan with no
evidence of bleeding. His BP is 235/120 and HR is 88. Which of the
following antihypertensive is the best choice to manage his blood
pressure.
A.
B.
C.
D.
Mannitol
Labetalol
Cardene
Nitroglycerin
Answer 9
9. Choice C is the correct answer. Cardene is the
medication of choice in this situation. Labetalol would also
be acceptable if there was no concern for illicit drug use.
Cocaine which is a potent alpha agonists. Beta blocker
when they are administered can cause unopposed alpha
stimulation and be fatal. Mannitol is sometimes indicated
to decrease ICP in cases of severe cerebral edema.
Question 10
10. All of the following are common causes for
decreased level of consciousness:
A.Hyperthyroidism
B.High Ammonia
C.Sepsis
D.Massive cerebral hemorrhage
Answer 10
10. Choice A is the correct answer.
Hyperthyroidism is usually not a common
cause of decreased level of consciousness.
High ammonia, sepsis, and massive cerebral
hemorrhage are all common causes of cerebral
hemorrhage.