100% CORRECT ANSWERS|LATEST
A patient with a known seizure disorder is admitted to the hospital with altered mental
status. His phenytoin (Dilantin) level is 35.6. What is the most appropriate action? -
ANSWER Hold phenytoin and rec heck a level the next day; a normal level 10-20
mcg/mL. Supratherapeutic levels can cause confusion, nausea, urticaria, nystagmus,
hypotension, and cardiac arrhythmias.
Which of the following are sources of an embolic stroke? - ANSWER Patent foramen
ovale; A patent foramen ovale (PFO) is a hole between the left and right atria of the heart. It
normally closes shortly after birth. This condition may cause the formation of clots which
can travel to the brain leading to a transient ischemic attack or stroke. Tx-antiplatelet meds
or blood thinners. HTN, obesity and HDL are risk factors for thrombotic stroke.
A patient c/o of a headache for the past several wks is dx with a subacute subdural
hematoma. Which of the following is not an appropriate course of action? -
ANSWER Administer levetiracetam (Keppra); Antiepileptic drugs are not indicated
for subacute hemorrhagic brain injuries. The greatest risk of seizure is in the first two weeks
following the incident. If no seizure has occurred during this time then antiepileptic drugs do
not need to be prescribed for the patient.
Which of the following regarding astrocytomas is NOT correct? - ANSWER Grace IV
astrocytomas are benign; Astrocytomas arise from astrocytes, which are a type of glial cell;
they are the most common glial tumor. Surgical resection in conjunction with chemotherapy
and radiation are common treatments. Grade I and II are generally benign slow growing
tumors seen in children, whereas grades III and IV are malignant and typically seen in adults.
A pt is dx with amyotrophic lateral sclerosis (ALS) and the pt's wife is concerned abt their
children developing this condition. Which of the following is an appropriate response? -
ANSWER Its etiology is unknown; this neuromuscular degenerative disease occurs at
1
, random with no clearly associated risk factors. Individuals with this sporadic form of the
disease do not have a family history of ALS, and their family members not considered to be
at increased risk for developing it. In a small majority of cases occur with a family hx of this
disease. Multiple gene mutations are involved with developing this condition.
A pt presents with unilateral sharp, throbbing HA associated with eye pain and watering.
What is the most likely dx? - ANSWER Cluster headache; due to unknown etiology.
They are characterized by unilateral symptoms that may involve the eye on the ipsilateral
side. Tx-triptan drugs, calcium channel blockers, and steroids.
A child is born with dozens of cafe-au-lait spots and axillary freckling. What is the most likely
dx? - ANSWER Neurofibromatosis; occurs d/t a genetic defect, which causes tumors
to arise from nerve cells. Complications that may occur from this disorder include deafness,
HTN, seizures, hydrocephalus, scoliosis, pathologic fxs, kyphosis, and vision problems.
Common signs and symptoms include light brown spots on the skin alled cafe-au-lait spots,
abnormal development of the spin, skull, or long bones, freckling in the are of the armpit or
the groin. and disturbances in balance.
A child with spinal bifida develops worsening headaches and visual problems. An MRI of the
brain reveals herniation of the brainstem and lower part of the cerebellum extending into
the foramen magnum. Which type of Chiari malformation does this condition describe? -
ANSWER Type II; the most common type of Chiari malformation. Type I is where the
lower part of the cerebellum, but not the brainstem extends into the foramen magnum.
Type III is where part of the cerebellum and the brainstem extend through the foramen
magnum into the spinal cord causing severe neurologic impairment. Chiari malformation
type IV is not associated with herniation of the brain through the foramen magnum; it
involves an underdeveloped cerebellum. This type is usually fatal in infancy.
Which of the following is the most common presenting symptom for Chiari malformation? -
ANSWER Occipital headaches; caused by the herniation of the brain through the
skull base. Other signs and symptoms include diplopia, nystagmus, visual changes, and
balance difficulties.
A pt presenting with dysarthria and lethargy is being evaluated in the ER for possible stroke.
The pt has Glasgow Coma Scale (GCS) of 12, BP of 150/72, pulse ox of 96% on room air, BG
2
A patient with a known seizure disorder is admitted to the hospital with altered mental
status. His phenytoin (Dilantin) level is 35.6. What is the most appropriate action? -
ANSWER Hold phenytoin and rec heck a level the next day; a normal level 10-20
mcg/mL. Supratherapeutic levels can cause confusion, nausea, urticaria, nystagmus,
hypotension, and cardiac arrhythmias.
Which of the following are sources of an embolic stroke? - ANSWER Patent foramen
ovale; A patent foramen ovale (PFO) is a hole between the left and right atria of the heart. It
normally closes shortly after birth. This condition may cause the formation of clots which
can travel to the brain leading to a transient ischemic attack or stroke. Tx-antiplatelet meds
or blood thinners. HTN, obesity and HDL are risk factors for thrombotic stroke.
A patient c/o of a headache for the past several wks is dx with a subacute subdural
hematoma. Which of the following is not an appropriate course of action? -
ANSWER Administer levetiracetam (Keppra); Antiepileptic drugs are not indicated
for subacute hemorrhagic brain injuries. The greatest risk of seizure is in the first two weeks
following the incident. If no seizure has occurred during this time then antiepileptic drugs do
not need to be prescribed for the patient.
Which of the following regarding astrocytomas is NOT correct? - ANSWER Grace IV
astrocytomas are benign; Astrocytomas arise from astrocytes, which are a type of glial cell;
they are the most common glial tumor. Surgical resection in conjunction with chemotherapy
and radiation are common treatments. Grade I and II are generally benign slow growing
tumors seen in children, whereas grades III and IV are malignant and typically seen in adults.
A pt is dx with amyotrophic lateral sclerosis (ALS) and the pt's wife is concerned abt their
children developing this condition. Which of the following is an appropriate response? -
ANSWER Its etiology is unknown; this neuromuscular degenerative disease occurs at
1
, random with no clearly associated risk factors. Individuals with this sporadic form of the
disease do not have a family history of ALS, and their family members not considered to be
at increased risk for developing it. In a small majority of cases occur with a family hx of this
disease. Multiple gene mutations are involved with developing this condition.
A pt presents with unilateral sharp, throbbing HA associated with eye pain and watering.
What is the most likely dx? - ANSWER Cluster headache; due to unknown etiology.
They are characterized by unilateral symptoms that may involve the eye on the ipsilateral
side. Tx-triptan drugs, calcium channel blockers, and steroids.
A child is born with dozens of cafe-au-lait spots and axillary freckling. What is the most likely
dx? - ANSWER Neurofibromatosis; occurs d/t a genetic defect, which causes tumors
to arise from nerve cells. Complications that may occur from this disorder include deafness,
HTN, seizures, hydrocephalus, scoliosis, pathologic fxs, kyphosis, and vision problems.
Common signs and symptoms include light brown spots on the skin alled cafe-au-lait spots,
abnormal development of the spin, skull, or long bones, freckling in the are of the armpit or
the groin. and disturbances in balance.
A child with spinal bifida develops worsening headaches and visual problems. An MRI of the
brain reveals herniation of the brainstem and lower part of the cerebellum extending into
the foramen magnum. Which type of Chiari malformation does this condition describe? -
ANSWER Type II; the most common type of Chiari malformation. Type I is where the
lower part of the cerebellum, but not the brainstem extends into the foramen magnum.
Type III is where part of the cerebellum and the brainstem extend through the foramen
magnum into the spinal cord causing severe neurologic impairment. Chiari malformation
type IV is not associated with herniation of the brain through the foramen magnum; it
involves an underdeveloped cerebellum. This type is usually fatal in infancy.
Which of the following is the most common presenting symptom for Chiari malformation? -
ANSWER Occipital headaches; caused by the herniation of the brain through the
skull base. Other signs and symptoms include diplopia, nystagmus, visual changes, and
balance difficulties.
A pt presenting with dysarthria and lethargy is being evaluated in the ER for possible stroke.
The pt has Glasgow Coma Scale (GCS) of 12, BP of 150/72, pulse ox of 96% on room air, BG
2
