NCA623 -Neuro DIsorders Exam
Study Guide
A 50-year-old women presents to the emergency department with complaints of acute
left sided facial pain, inability to close her left eye and left ear pain that developed over
the last 12-hours. You suspect Bell's Palsy. Which of the following symptoms would NOT
be expected?
Ability to smile
Abnormal corneal reflex.
Excessive tearing or dry eye.
Smooth forehead. - Answer Ability to smile
All of the following are true about depression the geriatric patient population EXCEPT:
Depression in the elderly is part of the normal advanced aging process.
Depression in the elderly often goes unrecognized.
Depression in the elderly increases the risk of cardiac disease.
Depression in the elderly can lead to cognitive impairment. - Answer Depression in the
elderly is part of the normal advanced aging process.
A 52-year-old male presents with a rapidly progressive weakness in his legs that is
moving up the trunk. He also has absent reflexes and no sensory change. You learn that
this patient had been diagnosed with flu a month ago but has fully recovered from the
virus. Based on what you know about complications from the flu, which of the following
differentials diagnosis would be most likely?
Peripheral neuropathy.
Multiple Slcerosis.
Guillain Barre syndrome.
Myasthenia Gravis. - Answer Guillain Barre syndrome. - ground to brain
A 44-year-old woman with advanced HIV disease is evaluated in the emergency
department. She complains of a 1-week history of HA, fever, and malaise w/o nuchal
rigidity. A head CT shows mild atrophy, but no mass lesions. A LP is performed and
analysis of the CSF shows a WBC count of 30 cells/mm3 predominantly lymphocytes,
,protein - 100 mg/dL, glucose 38 mg/dL, and negative Gram's stain. The CSF opening
pressure was measured as 32 cm H2O. Which of the following would you suspect?
-Pt may require serial lumber punctures until the opening pressure is less than 25 cm
H20 for 5 consecutive days.
-Pt most likely has a self-limiting viral meningitis since her symptoms are not life
threatening. She will need supportive care only.
-Pt most likely has an opportunistic fungal infection such as Cryptococcus neoformans
or Listeria monocytogenes; the most common causes of meningitis in HIV infected
patients.
-Pt has a Strept pneumo - Answer That this patient most likely has an opportunistic
fungal infection such as Cryptococcus neoformans or Listeria monocytogenes; the most
common causes of meningitis in HIV infected patients.
A 32-year-old male with a recent skateboard fall and subsequent diagnosis of a basal
skull fracture is admitted to the trauma floor. Over the past 24 hours he begins to have
signs and symptoms of fever, nuchal rigidity, and changes in mental status. The trauma
AGACNP performs a lumbar puncture and decides to start the patient on empiric
antibiotic therapy for bacterial meningitis, pending CSF results. All of the antibiotic
combinations below are acceptable initial treatment regimens EXCEPT:
vancomycin + meropenem.
ceftriaxone + vancomycin + dexamethasone.
ceftriaxone + ampicillin + vancomycin + acyclovir.
piperacillin-tazobactam + vancomycin. - Answer piperacillin-tazobactam + vancomycin
A 25-year-old female is diagnosed with bacterial meningitis and has a positive Kernig's
sign. What is a positive Kernig's sign?
Passive flexion of the head while supine, which elicits flexion of the thighs and legs.
When the thigh is flexed at the hip and knee at 90 degree angles, and subsequent
extension of the leg is painful.
Straight leg raising, which produces pain in the back.
Pain with tapping of the median nerve. - Answer When the thigh is flexed at the hip and
knee at 90 degree angles, and subsequent extension of the leg is painful
A 42 year old woman presents to the Emergency Department with complaints of
weakness, dizziness, lack of coordination, and difficulty with gait. She underwent
magnetic resonance imaging (MRI) which indicated spinal lesions and examination of
the cerebral spinal fluid (CSF) indicated oligoclonal bands and elevated immunoglobulin
G (IgG). Which of the following is the most likely diagnosis?
,Multiple sclerosis.
Neurofibromatosis.
Menier's Disease.
Amyotrophic lateral sclerosis (ALS). - Answer Multiple sclerosis.
A 40-year-old woman is suspected of having Myasthenia Gravis. You order a Tensilon
test. If the patient does in fact have Myasthenia Gravis, the Tensilon test will reveal
which of the following?
repetitive muscle spasm after stimulation.
decreased muscle strength.
increased muscle strength.
slowly increasing muscle strength with repetitive stimulation. - Answer increased
muscle strength.
A 23-year old female with a history of epilepsy has been taking valproate sodium for the
past 5 years. She presents to neurology clinic and states she wants to start a family. She
has not had any seizures for the past 3 years. What is the most appropriate step in this
patient's care?
Continue valproate sodium and begin folic acid supplementation.
Obtain repeat EEG and MRI to help guide decisions on continued use of antiepileptic
medication (AED therapy) vs. changing to another medication prior to pregnancy.
Switch from valproate sodium to another anti-epileptic drug to reduce teratogenic risk.
Add a second antiepileptic drug since pregnancy may affect seizure control. - Answer
Obtain repeat EEG and MRI to help guide decisions on continued use of antiepileptic
medication (AED therapy) vs. changing to another medication prior to pregnancy.
A 29-year-old male presents to the neurology clinic for follow-up evaluation of epilepsy
that started 9 years ago. Currently he average 3-4 seizures per month. His seizures are
preceded by a warning of deja vu and a rising abdominal sensation, followed by lip
smacking and speech arrest for 1-2 minutes then postictal disorientation and amnesia.
What is the patient's most likely diagnosis?
Simple partial seizures
Lennox-Gastaut Syndrome
Complex partial seizures
Atypical absence seizures - Answer Complex partial seizures - more than one movement
- lip smacking and speech arrest AND abnormal LOC
, At what point is someone diagnosed with epilepsy? - Answer Must have 2 or more
unprovoked* seizures separated by at least 24 hours that was not caused by some
known medical condition
All of the following are potential causes for seizures or increased seizure risk potential
from baseline EXCEPT:
-Hypoglycemia
-Alcohol and drug use
-Brain tumor
-adherence with current epileptic regimen - Answer -adherence with current epileptic
regimen
Other causes:
-Fever
-Antimicrobials (-penems)
-CNS infection (meningitis)
-Head trauma
-Metabolic disorders (acidosis, uremia)
-Vascular disease
-Stroke
In adults, what is usually the first sign of a brain tumor? - Answer Seizures (focal in
character)
-Get CT or MRI on everyone after 20yo
What is the most common cause of a seizure > 60 yo? - Answer CVA
True/False: Absence nonmotor seizures is a form of a generalized seizure and has no
post-ictal state - Answer True
A 20 year old male presents for an epilepsy follow-up after being diagnosed about 10
years ago. He averages about 3 seizures per month. His seizures are preceded by a
warning of deja-vu and queasiness of the abdomen, followed by lip smacking and
speech arrest for 1-2 minutes, then postictal disorientation and amnesia occur. As an
advanced provider you understand that his most likely diagnosis is:
-Lennox-Gaustatu Syndrome
Study Guide
A 50-year-old women presents to the emergency department with complaints of acute
left sided facial pain, inability to close her left eye and left ear pain that developed over
the last 12-hours. You suspect Bell's Palsy. Which of the following symptoms would NOT
be expected?
Ability to smile
Abnormal corneal reflex.
Excessive tearing or dry eye.
Smooth forehead. - Answer Ability to smile
All of the following are true about depression the geriatric patient population EXCEPT:
Depression in the elderly is part of the normal advanced aging process.
Depression in the elderly often goes unrecognized.
Depression in the elderly increases the risk of cardiac disease.
Depression in the elderly can lead to cognitive impairment. - Answer Depression in the
elderly is part of the normal advanced aging process.
A 52-year-old male presents with a rapidly progressive weakness in his legs that is
moving up the trunk. He also has absent reflexes and no sensory change. You learn that
this patient had been diagnosed with flu a month ago but has fully recovered from the
virus. Based on what you know about complications from the flu, which of the following
differentials diagnosis would be most likely?
Peripheral neuropathy.
Multiple Slcerosis.
Guillain Barre syndrome.
Myasthenia Gravis. - Answer Guillain Barre syndrome. - ground to brain
A 44-year-old woman with advanced HIV disease is evaluated in the emergency
department. She complains of a 1-week history of HA, fever, and malaise w/o nuchal
rigidity. A head CT shows mild atrophy, but no mass lesions. A LP is performed and
analysis of the CSF shows a WBC count of 30 cells/mm3 predominantly lymphocytes,
,protein - 100 mg/dL, glucose 38 mg/dL, and negative Gram's stain. The CSF opening
pressure was measured as 32 cm H2O. Which of the following would you suspect?
-Pt may require serial lumber punctures until the opening pressure is less than 25 cm
H20 for 5 consecutive days.
-Pt most likely has a self-limiting viral meningitis since her symptoms are not life
threatening. She will need supportive care only.
-Pt most likely has an opportunistic fungal infection such as Cryptococcus neoformans
or Listeria monocytogenes; the most common causes of meningitis in HIV infected
patients.
-Pt has a Strept pneumo - Answer That this patient most likely has an opportunistic
fungal infection such as Cryptococcus neoformans or Listeria monocytogenes; the most
common causes of meningitis in HIV infected patients.
A 32-year-old male with a recent skateboard fall and subsequent diagnosis of a basal
skull fracture is admitted to the trauma floor. Over the past 24 hours he begins to have
signs and symptoms of fever, nuchal rigidity, and changes in mental status. The trauma
AGACNP performs a lumbar puncture and decides to start the patient on empiric
antibiotic therapy for bacterial meningitis, pending CSF results. All of the antibiotic
combinations below are acceptable initial treatment regimens EXCEPT:
vancomycin + meropenem.
ceftriaxone + vancomycin + dexamethasone.
ceftriaxone + ampicillin + vancomycin + acyclovir.
piperacillin-tazobactam + vancomycin. - Answer piperacillin-tazobactam + vancomycin
A 25-year-old female is diagnosed with bacterial meningitis and has a positive Kernig's
sign. What is a positive Kernig's sign?
Passive flexion of the head while supine, which elicits flexion of the thighs and legs.
When the thigh is flexed at the hip and knee at 90 degree angles, and subsequent
extension of the leg is painful.
Straight leg raising, which produces pain in the back.
Pain with tapping of the median nerve. - Answer When the thigh is flexed at the hip and
knee at 90 degree angles, and subsequent extension of the leg is painful
A 42 year old woman presents to the Emergency Department with complaints of
weakness, dizziness, lack of coordination, and difficulty with gait. She underwent
magnetic resonance imaging (MRI) which indicated spinal lesions and examination of
the cerebral spinal fluid (CSF) indicated oligoclonal bands and elevated immunoglobulin
G (IgG). Which of the following is the most likely diagnosis?
,Multiple sclerosis.
Neurofibromatosis.
Menier's Disease.
Amyotrophic lateral sclerosis (ALS). - Answer Multiple sclerosis.
A 40-year-old woman is suspected of having Myasthenia Gravis. You order a Tensilon
test. If the patient does in fact have Myasthenia Gravis, the Tensilon test will reveal
which of the following?
repetitive muscle spasm after stimulation.
decreased muscle strength.
increased muscle strength.
slowly increasing muscle strength with repetitive stimulation. - Answer increased
muscle strength.
A 23-year old female with a history of epilepsy has been taking valproate sodium for the
past 5 years. She presents to neurology clinic and states she wants to start a family. She
has not had any seizures for the past 3 years. What is the most appropriate step in this
patient's care?
Continue valproate sodium and begin folic acid supplementation.
Obtain repeat EEG and MRI to help guide decisions on continued use of antiepileptic
medication (AED therapy) vs. changing to another medication prior to pregnancy.
Switch from valproate sodium to another anti-epileptic drug to reduce teratogenic risk.
Add a second antiepileptic drug since pregnancy may affect seizure control. - Answer
Obtain repeat EEG and MRI to help guide decisions on continued use of antiepileptic
medication (AED therapy) vs. changing to another medication prior to pregnancy.
A 29-year-old male presents to the neurology clinic for follow-up evaluation of epilepsy
that started 9 years ago. Currently he average 3-4 seizures per month. His seizures are
preceded by a warning of deja vu and a rising abdominal sensation, followed by lip
smacking and speech arrest for 1-2 minutes then postictal disorientation and amnesia.
What is the patient's most likely diagnosis?
Simple partial seizures
Lennox-Gastaut Syndrome
Complex partial seizures
Atypical absence seizures - Answer Complex partial seizures - more than one movement
- lip smacking and speech arrest AND abnormal LOC
, At what point is someone diagnosed with epilepsy? - Answer Must have 2 or more
unprovoked* seizures separated by at least 24 hours that was not caused by some
known medical condition
All of the following are potential causes for seizures or increased seizure risk potential
from baseline EXCEPT:
-Hypoglycemia
-Alcohol and drug use
-Brain tumor
-adherence with current epileptic regimen - Answer -adherence with current epileptic
regimen
Other causes:
-Fever
-Antimicrobials (-penems)
-CNS infection (meningitis)
-Head trauma
-Metabolic disorders (acidosis, uremia)
-Vascular disease
-Stroke
In adults, what is usually the first sign of a brain tumor? - Answer Seizures (focal in
character)
-Get CT or MRI on everyone after 20yo
What is the most common cause of a seizure > 60 yo? - Answer CVA
True/False: Absence nonmotor seizures is a form of a generalized seizure and has no
post-ictal state - Answer True
A 20 year old male presents for an epilepsy follow-up after being diagnosed about 10
years ago. He averages about 3 seizures per month. His seizures are preceded by a
warning of deja-vu and queasiness of the abdomen, followed by lip smacking and
speech arrest for 1-2 minutes, then postictal disorientation and amnesia occur. As an
advanced provider you understand that his most likely diagnosis is:
-Lennox-Gaustatu Syndrome
