Category: Neurology


A 67-year-old man who has smoked heavily for 45 years describes that with exertion, such as walking, he develops pain in his legs and a tingling sensation in his feet. X-rays of his spine reveal no abnormalities. Pain and weakness have become increasingly frequent over the course of several months. The pain and weakness described by the patient with exertion is probably a manifestation of which of the following?

a. Myotonia

b. Myokymia

c. Spinal claudication

d. Spondylolisthesis

e. Spondylolysis

the answer is below…

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A 19-year-old man goes swimming in an inland pond in Puerto Rico. Within a few days, he notices itching of his skin over several surfaces of his body. He is unconcerned until several weeks later when he develops lancinating pains extending down his legs and all of his toes. Over the course of just a few days, he develops paraparesis and problems with bladder and bowel control. Within one week, he is unable to stand and has severe urinary retention. Which of the following is the most appropriate plan of action on an emergency basis?

a. Initiate anticoagulation

b. Perform sensory-evoked potential testing

c. Order an MRI scan

d. Place a cervical collar

e. Perform spinal angiography

the answer is below…

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A myelogram is performed upon a patient with a subacute, worsening paraparesis. The cerebrospinal fluid (CSF) and myelogram are both unremarkable except for a slight increase in the CSF protein content. A computed tomography (CT) scan of the spine is unrevealing. Plain films of the spine are completely normal. An MRI of the lumbar cord with gadolinium reveals patchy enhancement at about the L4–L5 spinal cord level. Based on this information, which of the following is the most likely diagnosis?

a. An intraspinal hemorrhage

b. An extraparenchymal meningioma

c. An intraparenchymal ependymoma

d. A transverse myelitis

e. A syringomyelia

the answer is below…

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A 32-year-old woman with alcoholism and cocaine use dating back at least 10 years comes to the emergency room after 48 h of recurrent vomiting and hematemesis. She reports abdominal discomfort that preceded the vomiting by a few days. For at least 36 h, she has been unable to keep ethanol in her stomach. Intravenous fluid replacement is started while she is being transported to the emergency room, and while in the emergency room she describes progressive blurring of vision. Over the course of 1 h, she becomes increasingly disoriented, ataxic, and dysarthric. Which of the following is the most likely explanation for her rapid deterioration?

a. Dehydration

b. Hypomagnesemia

c. Wernicke’s encephalopathy

d. Hypoglycemia

e. Cocaine overdose

the answer is below…

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A 20-year-old ataxic woman with a family history of Friedreich’s disease develops polyuria and excessive thirst over the course of a few weeks. She notices that she becomes fatigued easily and has intermittently blurred vision. Which of the following is the most likely explanation for her symptoms?

a. Inappropriate antidiuretic hormone

b. Diabetes mellitus

c. Panhypopituitarism

d. Progressive adrenal insufficiency

e. Hypothyroidism

the answer is below…

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A 45-year-old man has noticed over the past 6 months that his sense of smell is not as sensitive as it used to be. On examination he has unilateral anosmia, ipsilateral optic atrophy, and contralateral papilledema. Which of the following is the most likely diagnosis?

a. Pseudotumor cerebri

b. Multiple sclerosis (MS)

c. Olfactory groove meningioma

d. Craniopharyngioma

e. Nasopharyngeal carcinoma

the answer is below…

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A patient with suspected multiple sclerosis undergoes multimodality evoked potentials, EEG, MRI, and CSF testing. Which of the following evoked response patterns is most often abnormal in patients with early MS?

a. Brainstem auditory evoked response (BAER)

b. Far-field somatosensory evoked response (SSER)

c. Visual evoked response (VER)

d. Jolly test

e. Sensory nerve conduction test

the answer is below…

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A college student who was previously in good health develops transient bladder incontinence that resolves slowly over a period of several weeks. Three months later, after breaking up with her boyfriend, she presents to her doctor’s office complaining of blurry vision in her right eye that developed suddenly. Which of the following is the most likely diagnosis?

a. Somatoform disorder

b. Myasthenia gravis

c. Major depression

d. Dissociative identity disorder

e. Multiple sclerosis

the answer is below…

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A 19-year-old man goes swimming in an inland pond in Puerto Rico. Within a few days, he notices itching of his skin over several surfaces of his body. He is unconcerned until several weeks later when he develops lancinating pains extending down his legs and all of his toes. Over the course of just a few days, he develops paraparesis and problems with bladder and bowel control. Within one week, he is unable to stand and has severe urinary retention. Which of the following is the most appropriate plan of action on an emergency basis?

a. Initiate anticoagulation

b. Perform sensory-evoked potential testing

c. Order an MRI scan

d. Place a cervical collar

e. Perform spinal angiography

the answer is below…

Continue reading

A 61-year-old man, who smokes five packs of cigarettes per day and has hypertension, had an abdominal aortic aneurysm repair 8 hours ago. The surgery went very well, and there were no reported perioperative complications. Now the patient is unable to move his legs and states that they are “numb.” On examination, he has a flaccid paresis of both lower extremities and has impaired pinprick sensation to a T9 level bilaterally. Joint proprioception is normal. Which of the following is the most likely diagnosis in this case?

a. Cerebral stroke

b. Conversion disorder

c. Multiple sclerosis

d. Spinal cord compression

e. Spinal cord infarct

the answer is below…

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