Neurology

Neurology

PreTest® Self-Assessment and Review

PRE TEST®

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Neurology

PreTest® Self-Assessment and Review

Fifth Edition

David J.Anschel, M.D.

Department of Neurology

Stanford University School of Medicine

Stanford, California

PRE TEST®

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DOI: 10.1036/0071431373

ebook_copyright 6x9.qxd 10/20/03 11:22 AM Page 1

To Mom, Dad, and Alan

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vi

Student Reviewers

Franklin Chen

Mount Sinai School of Medicine

Class of 2003

Brandon Hill

St. Louis University

Class of 2003

Alberto Ramos-Sepulveda

Universidad Central Del Caribe, P.R.

Class of 2003

Charmaine Smith

Harvard Medical School

Class of 2003

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Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

The Neurological Examination and Diagnostic Tests

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 18

Cerebrovascular Disease

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 42

Epilepsy and Seizures

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 62

Headache and Facial Pain

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 75

Traumatic and Occupational Injuries

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 86

Infections

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 106

Neoplasms

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 125

vii

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Nutritional and Metabolic Disorders

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 143

Dementia and Cognitive Disorders

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 161

Movement Disorders

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 175

Disorders of Myelination

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 191

Developmental and Hereditary Disorders

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 209

Neuromuscular Disorders

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 228

Toxic Injuries

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 240

Eye Disease and Visual Disturbances

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 258

viii Contents

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Disturbances of Hearing, Balance, Smell, and Taste

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 274

Spinal Cord and Root Disease

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 288

Peripheral Neuropathy

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 305

Neurological Emergencies

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313

Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 324

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337

Contents ix

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xi

Introduction

Neurology: PreTest® Self-Assessment and Review, Fifth Edition, is intended to

provide medical students, house officers, and physicians with a convenient

tool for assessing and improving their knowledge of neurology. The 500

questions in this book are similar to those included in Step 2 of the United

States Medical Licensing Examination (USMLE). They may also be a useful

study tool for the USMLE Step 3 and clerkship examinations.

Each question in this book has a corresponding answer, a reference to

a text that provides background for the answer, and a short discussion of

various issues raised by the question and its answer. A listing of references

for the entire book follows the last chapter.

To simulate the time constraints imposed by the qualifying examina￾tions for which this book is intended as a practice guide, the student or

physician should allot about one minute for each question. After answering

all questions in a chapter, as much time as necessary should be spent

reviewing the explanations for each question at the end of each chapter.

Attention should be given to all explanations, even if the examinee

answered the questions correctly. Those seeking more information on a

subject should refer to the references listed or to other standard texts in

neurology.

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The Neurological

Examination and

Diagnostic Tests

Questions

DIRECTIONS: Each item below contains a question or incomplete

statement followed by suggested responses. Select the one best response to

each question.

1. An 85-year-old man is being evaluated for gait difficulties. On examina￾tion it is found that joint proprioception is absent in his toes. People with

impaired position sense will usually fall if they stand with their feet together

and do which of the following?

a. Flex the neck

b. Extend their arms in front of them

c. Flex the knees

d. Turn the head

e. Close their eyes

1

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2. An 81-year-old woman with a history of type II diabetes mellitus and

atrial fibrillation presents with right body weakness and slurred speech. She

realized that there was a problem on awakening in the morning, and her

husband called EMS, who brought her to the emergency room. There are no

word-finding difficulties, dysesthesia, or headaches. She is taking warfarin.

Physical exam findings include blood pressure of 210/95 and irregularly

irregular heartbeat. There is left side neglect with slurred speech. There is a

corticospinal pattern of weakness of the right body, with the face and upper

extremity worse than the lower extremity. Routine chemistries and cell

counts are normal. Her INR is 1.7. A head CT reveals a large left-sided sub￾dural hematoma. The intracranial material appearing most dense on com￾puted tomography (CT) of the head is which of the following?

a. Blood clot

b. White matter

c. Gray matter

d. Cerebrospinal fluid (CSF)

e. Pia mater

3. A 21-year-old woman presents with right arm loss of sensation that has

been progressive over a few days. Her physician is concerned that this

might be some type of demylinating disorder. A relatively small plaque of

demyelination, should be evident on which of the following?

a. T1-weighted MRI

b. T2-weighted MRI

c. Precontrast CT

d. Diffusion-weighted MRI

e. PET

Items 4–6

A 62-year-old right-handed man has “involuntary twitches” of his left

hand. He first noticed between 6 months and 1 year ago that when he is at

rest, his left hand shakes. He can stop the shaking by looking at his hand

and concentrating. The shaking does not impair his activities in any way.

He has no trouble holding a glass of water. There is no tremor in his right

hand and the lower extremities are not affected. He has had no trouble

walking. There have been no behavioral or language changes. On exami￾nation, a left hand tremor is evident when he is distracted. Handwriting is

mildly tremulous. He is very mildly bradykinetic on the left.

2 Neurology

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