21 October 2005

Biomed 262: Neurologic Pathophysiology

Mid-Term !"M#N"T#ON
1$ " patie%t prese%ts &ith a complai%t o' &ea(%ess$ )is %eurologic e*ami%atio% re+eals symmetric
bilateral &ea(%ess o' all 'our limbs &ith distal greater tha% pro*imal &ea(%ess$ )is se%sory
e*ami%atio% re+eals decreased se%satio% o' all modalities i% the distal limbs i% a glo+e-stoc(i%g
distributio%$ ,e'le* e*ami%atio% re+eals that all deep te%do% re'le*es are abse%t$
)is ill%ess li(ely is locali-ed to
"$ Neuromuscular .u%ctio% disease
B$ /er+ical spi%al cord lesio%
C. Polyneuropathy
0$ Muscle disease
$ Bi'ro%tal cerebral lobe lesio%s
2$ " patie%t prese%ts &ith se+ere1 progressi+e1 bilateral upper a%d lo&er e*tremity &ea(%ess$ ,ece%tly he
has also %oted uri%ary i%co%ti%e%ce$ Neurologic e*ami%atio% re+eals %ormal me%tal status a%d cra%ial
%er+e e*ami%atio%$ Motor e*ami%atio% i% the upper e*tremities re+eals 235 &ea(%ess i% all muscles o'
the upper e*tremities$ Both legs are &ea(: hip a%d (%ee 'le*ors 2- to 2351 (%ee e*te%sors 2 to 4351
a%(le e*te%sors a%d 'le*ors 1-235$ "ll deep te%do% re'le*es are bris($ There are bilateral e*te%sor
pla%tar respo%ses 5Babi%s(i sig%s6$ 7e%satio% is reduced i% all areas belo& a hori-o%tal li%e that ca% be
dra&% at the patie%t8s upper thora*$
)is problem is most li(ely attributed to
"$ /auda e9ui%a lesio%
B$ Poly%europathy
/$ Muscle disease
D. Cervical spinal cord lesion
$ Brai%stem lesio%
4$ " patie%t prese%ts &ith gait ata*ia$ )is e*ami%atio% re+eals %ormal me%tal status a%d cra%ial %er+e
e*ami%atio% 5%o %ystagmus61 %ormal stre%gth a%d se%satio% i% his limbs a%d %ormal re'le*es$ :ait is
&ide based a%d u%steady$
)is problem is most li(ely attributed to
A. Cerebellar stroke
B$ ;estibular %euro%itis
/$ Posterior colum% dys'u%ctio% due to B12 de'icit
0$ 7e%sory %europathy
$ Muscle disease
2$ " patie%t prese%ts &ith le't hemiparesis o' o%e day8s duratio%$ The 'i%di%g o% e*ami%atio% that MO7T
speci'ically suggests a brai%stem lesio% is
"$ #%creased to%e o' the le't arm a%d leg
B$ ,ight ga-e pre'ere%ce
/$ <e't spatial %eglect
D. Right facial muscle weakness
$ Positi+e Babi%s(i respo%se o% the le't
5$ =hich o' the 'ollo&i%g &ould NOT e*plai% a patie%t bei%g u%respo%si+e to deep pai% 5i% coma6>
"$ "cute re%al 'ailure &ith e*tremely high B?N a%d creati%i%e
B. Right internal capsule lacunar infarction
/$ <arge midli%e po%ti%e hemorrhage
0$ "cute herpes e%cephalitis &ith destructio% o' both temporal lobes
$ Prolo%ged cardiac arrest 'ollo&ed by success'ul restoratio% o' cardiac 'u%ctio%
6$ =hich o' the 'ollo&i%g is NOT co%siste%t &ith the diag%osis o' brai% death>
"$ No respo%se to deep pai%
B$ "bse%ce o' all brai%stem re'le*es
C. Cause of coma is not known
0$ There is %o possibility o' reco+ery
$ /essatio% o' brai% 'u%ctio% has bee% docume%ted 'or 22 hours
@-A$ " @A year old ma% &ith %o prior medical history de+elops sudde% aphasia1 right hemiplegia1 %ausea
a%d +omiti%g$ O+er the %e*t 20 mi%utes he becomes dro&sy1 /T sca% re+eals a large hyperde%se
lesio% o' the le't 'ro%tal lobe &ith mass e''ect produci%g le't to right shi't$ Blood pressure a%d e(g are
%ormal$
=hich o' the 'ollo&i%g pathologies is the most li(ely cause o' this hemorrhage>
A. Amyloid angiopathy
B$ )yperte%si+e small artery disease
/$ "rterio+e%ous mal'ormatio%
0$ "%eurysm
$ /ocai%e abuse
A$ The &i'e o' the patie%t i% 9uestio% B@ as(s about his li(elihood o' sur+i+al$ Cou respo%d that this most
depe%ds o%:
"$ )is age a%d cardiac stability
B$ )is i%tracra%ial pressure
C. The sie of the hemorrhage
0$ )is blood pressure
$ The results o' surgery 'or the hemorrhage
D$ " 55 year old &oma% &ith a lo%g history o' hyperte%sio% de+elops sudde% hemiparesis$ /t sca% re+eals
a large basal ga%glia hemorrhage$ 7he becomes comatose &ithi% a matter o' hours$ )er 'amily as(s
&hether you pla% to per'orm a co%+e%tio%al catheter a%giogram$
Cour best respo%se &ould be:
"$ Ces1 because a% a%eurysm is li(ely to be 'ou%d a%d could be treated$
B$ Ces1 because a% ";M is li(ely to be 'ou%d a%d could be treated$
/$ Ces1 because the i%'ormatio% could be used to treat impe%di%g brai% her%iatio%$
D. !o" because the angiogram most likely will reveal no abnormality.
$ No1 because the patie%t has too se+ere a grade o' subarach%oid hemorrhage to be%e'it 'rom treatme%t$
10-12$ " 6D year old &oma% su''ers sudde% headache 'ollo&ed by loss o' co%scious%ess1 #% the ,1 she is
dro&sy1 &ith stable +ital sig%s1 %ormal cra%ial %er+es a%d a %ormal motor a%d se%sory e*am$ /T sca%
re+eals di''use subarach%oid blood$ The most li(ely 'i%di%g o% catheter a%giogram &ould be:
"$ Normal
B$ ";M
C. #accular aneurysm
0$ Brai% tumor
$ Basilar artery thrombosis
11$ The patie%t8s 'amily as(s you about her prog%osis 'or sur+i+al$ Cou &ould tell them that her prog%osis is
related to
"$ the degree o' bleedi%g see% o% /T
B$ her age
/$ &hether the a%giogram sho&s +asospasm
0$ the si-e a%d locatio% o' the hemorrhage
$. her level of consciousness
12$ Treatme%t optio%s 'or this patie%t i%clude all o' the 'ollo&i%g !/PT:
"$ #%serti%g coils i%to the a%eurysm
B$ /lippi%g the %ec( o' the a%eurysm
C. %perating &ust to remove the blood
0$ :i+i%g calcium cha%%el bloc(ers a%d hydratio% to a+oid +asospasm
$ Placi%g a +e%tricular shu%t i' hydrocephalus occurs
14-1@$ Match each o' the 'ollo&i%g cli%ical prese%tatio%s 514-1@6 &ith the si%gle arterial site o'
atherosclerosis 5"-6 &ith &hich it is most li(ely associated:
5"% a%s&er may be used o%ce1 more tha% o%ce1 or %ot at all6
14$ Tra%sie%t bilateral 5both eyes6 +isual loss e
12$ )emia%opic +isual 'ield cut1 %o other symptoms b
15$ Tra%sie%t aphasia a%d right hemiparesis c
16$ /oma1 ophthalmoplegia a%d 9uadriparesis e
1@$ ?%ilateral leg &ea(%ess d
"$ Posterior /ommu%icati%g "rtery
B$ Posterior /erebral "rtery
/$ Middle /erebral "rtery
0$ "%terior /erebral "rtery
$ Basilar "rtery
1A-1D$ Ms$ " is a 52 year old &oma% se%t to a %eurologist 'or se+ere headaches$ 7he had headaches
i%termitte%tly 'or 4A years &hich had %ot i%creased i% 're9ue%cy a%d still occurred &ee(ly$ The
headaches usually came o% duri%g the day1 heralded by a% odd 'eeli%g o' malaise1 a%d &ere
accompa%ied by %ausea1 +omiti%g1 a%d %oise a%d light se%siti+ity$ The headaches &ere o'te% le't sided
but occasio%ally &ere right sided or bilateral$ 7he described the pai% as se+ere a%d throbbi%g$ 7he
're9ue%tly had to stop &hate+er she &as doi%g a%d lie do&% i% a dar( room &ith curtai%s dra&%$ The
headaches lasted 'or se+eral hours a%d occasio%ally1 'or days$ O'te%1 the headaches &ere preceded
by %umb%ess o' her right side &hich started o% her ha%d a%d spread to her arm1 'ollo&ed by di''iculty
spea(i%g a%d u%dersta%di%g others$ This lasted 20 -40 mi%utes a%d subsided as the headache
&orse%ed$ )er mother a%d a% au%t had se+ere headaches as &ell$ 7he &or(ed as a% accou%ta%t1
smo(ed 2 pac(s o' cigarettes per day a%d dra%( alcohol rarely because it brought o% headaches$ )er
o%ly other medical problem &as lo%gsta%di%g hyperte%sio%$
)er physical e*am &as %ormal1 i%cludi%g 'u%doscopic e*am$
Cou order a head /T sca% a%d it is %ormal$ ?po% 'ollo& up +isit1 the patie%t tells you she has had three
spells o' a di''ere%t type i%+ol+i%g right eye bli%d%ess1 u%associated &ith headache a%d lasti%g o%ly
mi%utes at a time$
Cou tell her that
"$ her headaches a%d %eurological symptoms are all due to migrai%e a%d she re9uires %o 'urther testi%g
B$ her headaches a%d %eurological symptoms are all due to temporal arteritis a%d she %eeds 'urther tests
/$ she li(ely has a brai% tumor a%d %eeds more tests
D. her chronic headaches and neurological symptoms may be due to migraine but the newer
neurological symptoms re'uire additional evaluation
$ her %e& %eurological symptoms may be due to a me%i%geal process a%d she %eeds 'urther tests
1D$ The patie%t agrees &ith you a%d your %e*t step is to
"$ prescribe a%timigrai%e therapy
B$ order a temporal artery biopsy
/$ co%sult a %eurosurgeo% about brai% surgery
D. order a carotid ultrasound and start aspirin therapy
$ per'orm a lumbar pu%cture
20$ " patie%t &ith %o symptoms is 'ou%d to ha+e a carotid artery bruit$ )is doctor orders a carotid ultrasou%d
&hich re+eals a @0E diameter ste%osis o' the right i%ter%al carotid artery$ =hich o' the 'ollo&i%g
stateme%ts are true>
"$ The patie%t8s stro(e ris( 'rom this lesio% is about 2E per year
B$ 7urgery is the best treatme%t 'or this lesio%$
/$ 7urgery cuts the stro(e ris( 'rom this lesio% i% hal'$
0$ 7urgery i%creases the patie%t8s cha%ces o' li+i%g the %e*t year &ithout a stro(e 'rom this lesio% 'rom DAE
to DDE$
$. All the statements are true.
21$ Drop 'uestion " 45 year old ma% prese%ts &ith %e& o%set o' sei-ures$ M,# re+eals a %o%-e%ha%ci%g
lesio% i% the le't 'ro%tal lobe$ Biopsy is per'ormed$ /ytoge%etic a%alysis o' tumor tissue re+eals a
deletio% o' the short arm o' chromosome 1 a%d a deletio% o' the lo%g arm o' chromosome 1D 51-p:1D-9
deletio%6$
=hat is the most li(ely diag%osis i% this case>
"$ astrocytoma
B$ oligode%droglioma
/$ glioblastoma multi'orme
0$ me%i%gioma
$ primary ce%tral %er+ous system lymphoma
22$ " 55 year old &oma% u%der&e%t complete resectio% o' a T2N0M01 stage #B ade%ocarci%oma o' the lu%g
o%e year ago$ 7he %o& prese%ts &ith o%e-mo%th history o' gradually i%creasi%g headaches a%d mild le't
sided &ea(%ess$ "% M,# o' the brai% re+eals a solitary co%trast e%ha%ced mass i% the right 'ro%tal lobe$
/T sca% o' the chest a%d abdome% re+eal %o e+ide%ce o' recurre%t disease$ The presumpti+e diag%osis
is a solitary brai% recurre%ce o' her lu%g ca%cer$
=hich o' the 'ollo&i%g therapeutic approaches are most li(ely to e*te%d her li'e a%d reduce the ris( o'
%eurologic deterioratio%>
"$ )igh dose steroids a%d obser+atio%
B$ =hole brai% radiatio% therapy
/$ 7urgical resectio% alo%e
D. #urgical resection followed by whole brain radiation
$ 7urgical resectio% a%d ad.u+a%t chemotherapy
24$ =hich o' the 'ollo&i%g stateme%ts is true &ith regard to astrocytoma>
"$ 7urgical resectio% ca% cure the ma.ority o' patie%ts &ith lo& grade 5di''usely i%'iltrati%g6 astrocytoma$
B$ #% adults1 it is most o'te% located i% the posterior 'ossa$
/$ The prog%osis o' astrocytoma is superior to that o' oligode%droglioma$
D. (ost diffusely infiltrating )low grade* astrocytomas and anaplastic astrocytomas will eventually
transform into glioblastoma multiforme.
$ "strocytoma represe%ts a% u%commo% primary brai% tumor i% adults$
22$ " 50 year-old ma% prese%ts &ith a o%e-&ee( history o' %e& o%set o' ti%gli%g o% the right side o' his 'ace
a%d right upper e*tremity associated &ith slurred speech$ Physical e*ami%atio% re+eals dysarthria a%d
mild &ea(%ess o% the right side$ " T-1 &eighted M,# o' the brai% per'ormed &ith gadoli%ium re+eals a
ri%g e%ha%ci%g mass &ith surrou%di%g edema$ The presumpti+e diag%osis is glioblastoma multi'orme
5:BM6$
Based upo% this diag%osis1 &hich &ould be the most appropriate treatme%t optio%:
"$ 7tereotactic biopsy 'ollo&ed by radiatio% therapy
B$ 7tereotactic biopsy 'ollo&ed by radiatio% a%d corticosteroids
/$ 7tereotactic biopsy 'ollo&ed by radiatio% a%d chemotherapy
D. #urgical debulking followed by radiation therapy
$ 7urgical debul(i%g 'ollo&ed by radiatio% therapy a%d chemotherapy
25$ =ith respect to M, imagi%g o' the adult brai%1
"$ O% a T1-&eighted M, image1 'at a%d subacute blood 5methemoglobi%6 are both relati+ely lo&er i% sig%al
i%te%sity tha% cerebral corte*$
B$ O% a T1-&eighted M, image1 cerebrospi%al 'luid is higher i% sig%al i%te%sity tha% %ormal &hite matter$
/$ O% a T2-&eighted M, image1 cerebrospi%al 'luid is relati+ely lo&er i% sig%al i%te%sity tha% deep grey
matter$
D. Compared to normal white matter" most focal lesions in the brain are hypointense on a T+,
weighted (R image" and hyperintense on a T-,weighted (R image.
$ The co%trast age%t most o'te% used i% M, imagi%g 5chelate o' gadoli%ium6 is co%trai%dicated i% patie%ts
&ith re%al 'ailure o% hemodialysis$
26$ =hich o%e o' the 'ollo&i%g correctly lists the 'ollo&i%g tissues 'rom most radiode%se to least radiode%se
o% a %o%co%trast head /T:
"$ bo%eFacute hemorrhageFdeep grey matterFairF/7G$
B. bone.acute hemorrhage.cerebral white matter.C#/.air.
/$ acute hemorrhageFbo%eFcerebral &hite matterF/7GF'at$
0$ bo%eFacute hemorrhageF/7GFcerebral &hite matterFair$
$ acute hemorrhageFbo%eFdeep grey matterF'atF/7G$
Gor 9uestio%s B2@ to B41 select the %euroimagi%g test that may pro+ide the most specific answer to the
cli%ical 9uestio% i%dicated$
2@$ =hether or %ot subarach%oid hemorrhage is the cause o' se+ere headache i% a 4A year old &oma%$
"$ lateral s(ull radiograph
B$ tra%scra%ial 0oppler ultrasou%d
/$ 7P/T sca%
D. noncontrast CT scan
$ co%trast-e%ha%ced M, imagi%g
2A$ The cause o' cer+ical myelopathy i% a 6D year old ma%$
"$ lateral s(ull radiograph
B$ tra%scra%ial 0oppler so%ogram
/$ 7P/T sca%
0$ co%trast-e%ha%ced /T sca%
$ M, imagi%g o' the cer+ical spi%e
2D$ =hether or %ot small-+essel +asculitis is the cause o' ischemic i%'arctio% i% a 42 year old ma% &ith
history o' amphetami%e abuse$
"$ lateral s(ull radiograph
B$ duple* so%ogram
/$ 7P/T sca%
0$ co%trast-e%ha%ced /T sca%
$. conventional catheter angiogram
40$ =hether or %ot there is 'ocal high-grade ste%osis i% the pro*imal i%ter%al carotid artery$
"$ /T a%giography
B$ M, a%giography
/$ co%+e%tio%al catheter a%giography
0$ duple* so%ography
$. all of the above
41$ =hether or %ot there is thoracic cord compressio% i% a 66 year old &oma% &ith carci%oma o' the breast$
"$ plai% 'ilm radiographs o' the spi%e
B$ radio%uclide bo%e sca%
C. (R imaging of the spine
0$ /T sca% o' the spi%e
$ G0:-PT sca%
42$ =ith respect to imagi%g tests used i% %eurodiag%osis1
"$ the pharmaco(i%etics o' high-'re9ue%cy sou%d &a+es is the basis o' image co%trast i% ultrasou%d$
B$ the comple* i%teractio%s a%d rela*atio% o' tissue proto%s i% &ater a%d 'at1 placed i% a stro%g e*ter%al
mag%etic 'ield1 is the basis 'or image co%trast i% electroe%cephalography$
C. computed tomography )CT* is based on the differential absorption of 0,rays as they are
attenuated during their transmission through the body part of interest.
0$ positro%-emissio% is the basis 'or locali-atio% o' the radiotracer i% si%gle-photo% emissio% computed
tomography 57P/T6$
$ gadoli%ium-chelate co%trast age%ts cause prolo%gatio% o' the T2 rela*atio% time i% tissues &ith a de'icie%t
blood brai% barrier re%deri%g these tissues hyperi%te%se o% co%+e%tio%al T2-&eighted imagi%g$
44-45$ " 2D year old ma% &ith %o past history o' a%y sig%i'ica%ce prese%ts &ith 2 &ee(s o' e*cruciati%g1
periorbital1 le't sided head3'ace pai%$ The pai% lasts 25 mi%utes a%d is succeeded by a dull ache that
lasts hours$ )e admits to teari%g a%d red%ess o' the le't eye a%d his &i'e says that his eye droops &he%
he is i% pai%$ The pai% usually occurs t&ice a %ight at about the same time$ )e is a'ebrile &ith a %ormal
e*am &he% i% the o''ice$
=hat is the most li(ely diag%osis>
"$ "cute si%usitis
B. Cluster headache
/$ Migrai%e
0$ Temporal arteritis
$ Orbital pseudotumor
42$ =hat is the 'irst study &ould you do>
"$ /T o' the si%uses a%d brai%
B$ /athether carotid a%giogram
C. (R1 of the brain with contrast
0$ 7edime%tatio% rate
$ No%e o' the abo+e
45$ #' he also complai%ed o' a purule%t %asal discharge a%d had a mild 'e+er1 a%d his e*am sho&ed
periorbital edema1 &hich o' the abo+e &ould you do 'irst>
"$ /T o' the si%uses a%d brai%
B$ /atheter carotid a%giogram
C. (R1 of the brain with contrast
0$ 7edime%tatio% rate
$ No%e o' the abo+e
46$ " patie%t reports chro%ic %ec( pai% a%d slo&ly i%creasi%g &ea(%ess o' both upper arms$ )e me%tio%s
that he rece%tly cut his 'i%ger &hile coo(i%g but did %ot %otice it u%til he sa& blood co+eri%g the cutti%g
board$ )e de%ied ha+i%g problems ha%dli%g the +egetables he &as cutti%g$ O% e*am he had mild
atrophy o' the upper arms &ith dimi%ished deep te%do% re'le*es but his legs &ere stro%g but mildly
spastic$
The most li(ely locali-atio% 'or this lesio% is:
"$ /er+ical polyradiculopathy 5multiple %er+e root process6
B. Central cord around C 2
/$ Posterior cer+ical cord compressio%
0$ "%terior cer+ical cord tumor
$ /auda e9ui%a lesio%
4@$ drop 'uestion " 20 year old ma% &ith a se+ere a%*iety disorder reports the sudde% o%set o' bac( pai%
&ith paralysis a%d %umb%ess o' the le't leg$ )is e*am re+eals paralysis o' all leg muscles o% the le't1
%ormal to%e1 a%d %umb%ess to all modalities belo& the le't groi%$ 0eep te%do% re'le*es are %ormal a%d
symmetric$ The Babi%s(i re'le* is abse%t$
This is li(ely to be a psychiatric problem rather tha% a cord lesio% because:
"$ To ha+e a %umb a%d &ea( leg1 the lesio% should be i% the brai%1 %ot the spi%e so that the bac( pai% is
physiologically u%related$
B$ " spi%al cord lesio% causi%g &ea(%ess ipsilaterally should cause %umb%ess co%tralaterally$
/$ " ce%tral cord lesio% &ould cause dissociated se%sory loss o% both sides
0$ There are %o re'le* ab%ormalities a%d the %umb%ess is i% a %o%-physiological distributio%$
$ "ll o' the abo+e stateme%ts are true$
4A$ Poliomyelitis is a +iral me%i%gitis that a''ects a%terior hor% cells o%ly$ #t there'ore produces a pure lo&er
motor %euro% sy%drome$
=hich o%e o' the 'ollo&i%g &ould be e*pected>
"$ Bladder i%co%ti%e%ce
B$ " se%sory le+el
C. Reduced or absent deep tendon refle0es
0$ Positi+e Babi%s(i re'le*
$ ,educed a%al sphi%cter to%e
4D$ " lesio% o' the thoracic spi%al cord &ould be li(ely to cause &hich o' the 'ollo&i%g bladder problems>
"$ ,educed urge%cy but i%creased 're9ue%cy
B$ #%creased urge%cy but reduced 're9ue%cy
/$ ,educed urge%cy a%d reduced 're9ue%cy
D. 1ncreased urgency and increased fre'uency
$ /o%sta%t lea(age 5dribbli%g6
20$ "ll o' the 'ollo&i%g are e*ample o' seco%dary brai% i%.uries i% a head trauma +ictim except
"$ )ypo*ia
B$ )ypote%sio%
C. Depressed skull fracture
0$ #%tracra%ial hyperte%sio%
21$ " s(ull 'racture o+erlyi%g the middle me%i%geal groo+e raises the suspicio% o'
"$ 7ubdural hematoma
B. $pidural hematoma
/$ ,aised i%tracra%ial pressure
0$ Tra%ste%torial her%iatio%
$ 0i''use "*o%al #%.ury
22$ 7ig%s o' tra%ste%torial her%iatio% i%clude all o' the 'ollo&i%g except:
"$ ?%ilateral third %er+e palsy
B$ /o%tralateral ab%ormal motor mo+eme%ts
/$ "ltered co%scious%ess
D. Battle3s sign )ecchymosis behind the ear*
24$ 7ubdural hematoma is typically seco%dary to:
"$ ,uptured a%eurysm
B. Tearing of superficial veins
/$ <aceratio% o' the middle me%i%geal artery
0$ Basal s(ull 'racture
$ 0i''use "*o%al #%.ury
22$ " 25 year old ma% prese%ts to the , &ith a &it%essed ge%erali-ed to%ic-clo%ic sei-ure$ "'ter
reco+eri%g a bit1 he describes a type o' &ar%i%g that preceded his co%+ulsio%: a 'eeli%g o' risi%g
abdomi%al distress1 &hich mo+ed 'rom his gut to his chest a%d i%to his head1 a'ter &hich he is am%estic$
#% hi%dsight1 he had bee% e*perie%ci%g ide%tical odd gastric spells o' risi%g abdomi%al distress o+er the
precedi%g year that lasted 10-60 seco%ds each$ )e had e+e% bee% to his doctor &ho prescribed
a%tacids 'or presumed re'lu*$ )e has complete recall o' these gastric spellsH they did %ot atte%uate his
le+el o' co%scious%ess$
=hich o' the a%s&ers belo& best 'its the isolated gastric spells>
"$ "bse%ce sei-ure
B$ "to%ic sei-ure
C. #imple Partial seiure
0$ /omple* Partial 7ei-ure
$ No%-epileptic sei-ure
25$ " 55-year old &oma% prese%ts to the , &ith a sei-ure i% &hich she 'irst %oted repetiti+e t&itchi%g o'
her le't ha%d a%d le't side o' her mouth$ O+er 40 seco%ds1 this t&itchi%g proceeded to e*te%d to the le't
shoulder a%d le't thigh t&itchi%g 'ollo&ed$
Based upo% the abo+e1 &hich o' the choices belo& is the most apt descriptio%:
"$ ,ight occipital sei-ure
B$ <e't temporal sei-ure
/$ Mesial temporal lobe sei-ure1 laterality u%certai%
D. Right frontal lobe seiure
$ )ypothalamic sei-ure
26$ drop 'uestion "ll o' the 'ollo&i%g are &ell (%o&% to be associated &ith sei-ures1 except
"$ )ypoglycemia
B$ )yperglycemia
/$ 7trobe lights
0$ Pu%ge%t odors
$ Bi%ge etha%ol co%sumptio%
2@$ drop 'uestion /o%+ulsi+e sy%cope ca% mimic a sei-ure$ "ll o' the 'ollo&i%g 'eatures ser+e to
di''ere%tiate co%+ulsi+e sy%cope 'rom sei-ure1 except
"$ Occurri%g &hile sta%di%g i% li%e o% a hot day 'or hours
B$ <ittle to %o co%'usio% 'ollo&i%g the spell
/$ 7ymmetric t&itchi%g o' the limbs
0$ 7&oo%i%g to&ard the grou%d at 'irst
$ Occurri%g &hile do%ati%g blood
2A$ "ll o' the 'ollo&i%g are co%sidered mecha%isms that are used by e*iste%t a%ti-epileptic drugs1 except:
A. Acetylcholinesterase inhibition
B$ ;oltage-gated sodium cha%%el bloc(ade
/$ "ugme%tatio% o' :"B" %eurotra%smissio%
0$ /alcium cha%%el modulatio%
$ Blu%ti%g glutamate-mediated %eurotra%smissio%
2D$ drop 'uestion ach o' the 'ollo&i%g modulates :"B"-" receptor 'u%ctio%1 except:
"$ 0ia-epam
B$ Phe%ytoi%
/$ :"B"
0$ Phe%obarbital
$ Tra%smembra%e co%ce%tratio% gradie%t o' /l
-
50$ The 'ollo&i%g are all co%sidered broad-spectrum a%ti-epileptic drugs except:
"$ ;alproate
B$ <amotrigi%e
C. Phenytoin
0$ Topiramate
$ Io%isamide
51$ drop 'uestion Ma%y o' the older a%ti-epileptic drugs1 e$g$1 phe%ytoi%1 carbama-epi%e1 +alproate a%d
phe%obarbital1 are associated &ith e*cessi+e drug i%teractio%s$ "ll o' the 'ollo&i%g are reaso%s 'or this
prope%sity except:
"$ "utoi%ductio% &ith carbama-epi%e
B$ Predomi%a%tly cleared by re%al route
/$ /ytochrome P-250 e%-yme i%ductio% &ith se+eral
0$ /ytochrome P-250 e%-yme i%hibitio% &ith +alproate
$ )igh protei% bi%di%g i% phe%ytoi% a%d +alproate
52$ drop 'uestion =hich o%e o' the 'ollo&i%g &ould NOT prese%t &ith the acute o%set o' +ertigo1 ata*ia1
%ausea a%d +omiti%g lasti%g t&o hours be'ore spo%ta%eously remitti%g>
"$ Me%iere8s 0isease
B$ ;ertebral-basilar T#"
/$ Migrai%e
0$ ;iral Neurolabyri%thitis
$ Perilymphatic 'istula
54$ =hich o%e o' the 'ollo&i%g &ould prese%t &ith brie' paro*ysms o' positio%al +ertigo a%d &ould li(ely
respo%d to pley 5particle repositio%i%g6 Ma%eu+ers>
"$ )erpes -oster oticus 5,amsay )u%t 7y%drome6
B$ Bacterial labyri%thitis$
C. Canalolithiasis
0$ Perilymphatic 'istula
$ <uetic 5syphilitic6labyri%this
52$ =hich o' the 'ollo&i%g symptoms &ould li(ely be prese%t i% the chro%ic stage o' +iral %eurolabyri%thitis
"$ 7e+ere persiste%t +ertigo
B$ 7patial disorie%tatio%
/$ Nausea a%d +omiti%g
D. Recurrent episodes of vertigo
$ 7e+ere ata*ia
55$ =hich o' the 'ollo&i%g &ould prese%t &ith paro*ysms o' +ertigo lasti%g hours1 u%ilateral heari%g loss1
ti%%itus a%d 'ull%ess i% the ear>
"$ /upulolithiasis
B$ ;ertebral-basilar T#"
C. (eniere3s Disease
0$ ;iral Neurolabyri%thitis
$ Migrai%e