Exam 3 - Stroke, Seizure, Syncope, Concussion Review Questions

Generalized Absence Seizures

A 5th grader that has episodes of seeming to not pay attention in class, and is seen staring out the window is evaluated with an EEG, slight abnormality is seen in his occipital lobe. He has memory loss of these episodes. The most likely diagnosis is?

- Jacksonian Seizures

- Generalized Absence Seizures

- Generalized Tonic Clonic Seizure

- Parietal Lobe Seizures

Simple Partial Seizures

A 9th grader that has episodes of seeming to not pay attention in class, and is seen starring out the window is evaluated with an EEG, slight abnormality is seen in his motor cortex. During the episodes there is a clonic movement of the right forearm and hand. The most likely diagnosis is?

- Auditory hallucinations

- Generalized Partial Seizures

- Generalized Tonic Clonic Seizures

- Simple Partial Seizures

PICA Right

A 45-year-old woman presents to the ER with dysphagia, diplopia, dysarthria, ataxia, loss of pain and temperature change over the right face and left upper and lower extremity. The symptoms began 24 hours ago after a motor vehicle accident pulling out of her hairdresser's office. All other neurologic examination procedures are normal, She has a long history of hypertension. Which artery is most likely affected?

- Left PICA

- Internal Carotid Right

- PICA Right

- Anterior Vertebral Right

Saccular Berry

Which of the following is the most common type of aneurysm in the human brain, most often benign, and located in the anterior circulation region of the cortex?

- Arteriovenous Malformation

- Internal Carotid Supraclinoid

- Saccular Berry

- Carotid

Posterior Cerebral

A 65-year-old male, 40 pack year smoker, type 2 diabetic, hypertensive, retired army captain presents to your office with a history of a severe headache with loss of vision on the left periphery for 2 days after a retired officers retreat where he played football. His neck is stiff and he wants you to adjust it. On exam he has left homomonous hemianopia, his central vision is intact bilaterally, loss of cervical range of motion active and passive cause pain.

In your infinite wisdom you insist on a head CT which most likely shows an infarct in which artery based on the history and exam?

- Middle Cerebral

- Anterior Cerebral

- Posterior Cerebral

- PICA

Generalized tonic clonic seizures

A patient that is found unconscious displaying alternating postures of hyperflexion and hyper extension followed by a post icthl fatigue phase is most likely suffering from which of the following conditions?

- Focal Impaired Aware Seizures

- Generalized tonic clonic seizures

- Jacksonian seizures

- Brain stem stroke

Webers: affects the crus cereri (CST), and the oculomotor nucleus from a lesion of the basal branches of the PCA

In which of the following syndromes are the following clinical deficits most often seen: contralateral hemiplegia, oculomotor palsy due to a lesion of the corticonuclear fibers in the crus cerebri?

- Claude's: results in contralateral ataxia, and oculomotor palsy

- Webers: affects the crus cereri (CST), and the oculomotor nucleus from a lesion of the basal branches of the PCA

- Wallenberg's: PICA lesion

- Medial Medullary wedge: contralateral CST loss, IPSI tongue weakness, Contra DCML loss

Claude's

- 3rd nerve palsy with c/I ataxia

- Red nucleus lateral (dL branches)

Webers

- 3rd nerve palsy with c/I hemiplegia

- Cerebral peduncle (basal branches)

Benedicts

Claude's and Webers together

Subthalamic

c/I hemiballismus

Thalamic dejerine Roussy syndrome

c/I hemisensory loss followed by severe agonizing pain

Subarachnoid Hemorrhage

A 59-year-old man is brought to his family physician by his wife. He complains of the worst headache of his life 10/10. He has a long term history of smoking, which has led to peripheral vascular disease of his legs bilaterally. His speech is aphasic and he is having difficulty moving his left arm; He is also exhibiting facial palsy below the eye on the left. An emergency ct reveals a lesion at the tip of the lateral superior cortex outer periphery affecting the linings of the brain. Which of the following is most likely the diagnosis?

- Left PICA Aneurysm

- Epidural Hematoma

- Berry Aneurysm of the posterior communicating artery

- Subarachnoid Hemorrhage

Epidural hematoma

Which of the following conditions is most likely a result of head trauma?

- Arteriovenous malformation

- Epidural hematoma

- Saccular Aneurysm

- Infundibular Aneurysm

Middle Cerebral Artery Stroke

Which of the following diagnoses should be suspected in a patient that presents to the clinic with a facial paralysis, dysarthria and arm paralysis which is acute in nature.

- Vertebral Artery Insufficiency Syndrome

- Middle Cerebral Artery Stroke

- Tumor of the Motor System

- Syringomyelia

Compression of the lateral femoral cutaneous nerve

Officer Rivera is a regular in your office, he/she comes in for a regular checkup and mentions that he/she has recently developed increased tingling and burning sensation in his anterior and lateral thigh. He/she also mentions that he/she has recently been given a new work belt that seems to be tighter than his previous one. What may be the cause of the symptoms?

- Compression of the lateral femoral cutaneous nerve

- Compression of ilioinguinal nerve

- Compression of sciatic nerve

- Disc herniation L4/L5

Diabetic Neuropathy

A patient that complains of burning of the feet bilaterally with paresthesia, has a history of type 2 diabetes for 20 years and admits to an uncontrolled diet stating he has a sweet tooth. On exam the following are noted: loss of vibration in the feet, and loss of proprioception bilaterally. Romberg's is positive with eyes closed and the Achilles reflexes grade 1+ bilaterally. Which of the following is the most correct neurologic diagnosis?

- Sensory neuropathy with demyelinating disease

- Alcoholic neuropathy

- Diabetic Neuropathy

- L5 Radiculopathy

Right Posterior Cerebral

A 65-year-old male, 40 pack year smoker, type 2 diabetic, hypertensive, retired army Captain presents to your office with a history of a severe headache with loss of vision on the left periphery for 2 days after a retired officers retreat where he played football. His neck is stiff and he wants you to crack it. On exam he has left homomonous hemianopia, his central vision is intact bilaterally, loss of cervical range of motion active and passive cause pain. In your infinite wisdom you insist on a head CT which most likely shows an infarct based on the history and exam?

- PICA Right

- Left Middle Cerebral Superior Segment

- Left Anterior Cerebral

- Right Posterior Cerebral

Posterior inferior cerebellar right

A 45-year-old woman presents to the ER with dysphagia, diplopia, dysarthria, ataxia, loss of pain and temperature change over the right face and left upper and lower extremity. The symptoms began 24 hours ago after a motor vehicle accident pulling out of her hairdresser's office. All other neurologic examination procedures are normal, She has a long history of hypertension. Which artery is most likely affected?

- Anterior inferior cerebellar right

- Posterior inferior cerebellar left

- Posterior inferior cerebellar right

- Middle cerebral left

Posterior column fibers

An 84-year-old woman presents to her physician with the complaint of difficulty walking. The examination reveals that the woman has an unsteady gait and tends to forcibly slap her feet to the floor as she walks. She has no other deficits. The physician concludes that the woman has sensory ataxia. Degenerative changes in which the following would most likely explain this deficit?

- Anterolateral system fibers

- Corticospinal fibers

- Posterior column fibers

- Posterior root fibers

- Vestibulospinal and reticulospinal fibers