Epilepsy:

A 23-year-old woman is brought to the emergency department by her partner due to an

episode of jerky movements that involved stiffening and twitching all over her body.
According to the partner, the episode started 30 minutes ago while the patient was working
on her laptop, and it lasted approximately one minute. The patient lost consciousness after
the episode for approximately 5 minutes. The patient has recently been under significant
stress working on a company presentation. Past medical and surgical history is
noncontributory, and the patient has not had any previous similar episodes. She takes no
medications. Vitals are within normal limits. The patient appears confused and is unable to
recall what happened. Physical examination shows a bite mark on the left side of the tongue.
Which of the following is the most likely diagnosis?
A. Generalized tonic-clonic seizure✅
B. Vasovagal syncope
C. Epilepsy
D. Status epilepticus
E. Psychogenic non-epileptic seizure

Parkinsonism :

A 65-year-old man presents with a tremor in his right hand. His tremor is most apparent at
rest and improves with movement. His movements are noticeably slower and he has
difficulty initiating movement. On a physical exam, the patient appears apathetic and has
rigidity with passive arm movement. Gait testing is notable for shuffling with a stooped
posture, what’s the most likely diagnosis ?
A. Parkinson’s disease. ✅
B. Huntington's disease
C. Essential tremor.
D. Dementia of Lewy body.

Seizure & Epilepsy:

An 8-year-old boy is brought to the emergency department 3 hours after having a 2-minute
episode of violent, jerky movements of his right arm at school. He was sweating profusely
during the episode and did not lose consciousness. He remembers having felt a chill down his
spine before the episode. Following the episode, he experienced weakness in the right arm
and was not able to lift it above his head for 2 hours. Three weeks ago, he had a sore throat
that resolved with over-the-counter medication. He was born at term and his mother
remembers him having an episode of jerky movements when he had a high-grade fever as a
toddler. There is no family history of serious illness, although his father passed away in a
motor vehicle accident approximately 1 year ago. His temperature is 37.0°C (98.6°F), pulse is
98/min, and blood pressure is 94/54 mm Hg. Physical and neurologic examinations show no
abnormalities. A complete blood count and serum concentrations of glucose, electrolytes,
calcium, and creatinine are within the reference range. Which of the following is the most
likely diagnosis?

A. Sydenham chorea.
B. Sporadic transient tic disorder.
C. Conversion disorder.
D. Hemiplegic migraine.
E. Focal seizure r

Answer: E.

A 9-year-old boy is brought to the physician by his mother to establish care after moving to a
new city. He lives at home with his mother and older brother. He was having trouble in
school until he was started on ethosuximide by a previous physician; he is now performing
well in school. This patient is undergoing treatment for a condition that most likely presented
with which of the following symptoms?

A. Regression of verbal skills and stereotyped hand-wringing

B. Limited attention span and poor impulse control
C. Overwhelming daytime sleepiness and hypnagogic hallucinations
D. Episodic jerky movements of the arm and impaired consciousness
E. Frequent episodes of blank staring and eye fluttering

Answer: D
Movements disorders & Dementias

A 65-year-old diabetic man has a history of a cerebellar stroke. The stroke occurred 5 years
ago, and he says that he has now fully recovered. He cannot recall the symptoms, but his
medical records state that he presented with left- sided dysdiadochokinesia. Which of the
following was most likely impaired?

a. Successive finger movements

b. Heel-to-toe walking

c. Rapid alternating movements

d. Tremor suppression

Answer : C

A 40 years old literary agent has had worsening tremor of the hands .This has been present
for 2 years, but has increasingly impaired her work ability because she is frequently required
to take her clients to lunch, and she is embarrassed by her inability to eat and drink normally.
A glass of wine with meal topically helps somewhat. O/E there is a mild head tremor, but no
rest tremor of the hands. When she holds a pen by the tip at arm’s length, however a coarse
tremor is readily apparent. Examination is otherwise normal. Which of the following might
be the underlying cause?

A. Locked-in syndrome

B. Parkinson’s disease

C. Essential tremor (T)

D. Hyperthyroidism

Answe : C

Parkinson Disease:

A 58-year-old woman comes to the physician because of a 6-month history of difficulty

walking, clumsiness of her arms and legs, and slurred speech. Physical examination shows
masked facies and a slow, shuffling gait. When her ankles are passively flexed, there is
involuntary, jerky resistance. Treatment is initiated with a combination of levodopa and
carbidopa. The addition of carbidopa is most likely to decrease the risk of which of the
following potential adverse drug effects?
 A. Resting tremor
B. Orthostatic hypotension
C. Urinary retention
D. Visual hallucinations
E. Dyskinesia

Answer: B

Dementia:

A 73-year-old woman is brought to the physician by her son because of increasing

forgetfulness over the past 2 years. Initially, she used to misplace keys and forget her dog's
name or her phone number. Now, she often forgets about what she has seen on television
or read about the day before. She used to go for a walk every morning but stopped one
month ago after she became lost on her way back home. Her son has prevented her from
cooking because she has had episodes of leaving the gas stove oven on after cooking a
meal. She becomes agitated when asked questions directly but is unconcerned when her
son reports her history and says he is overprotective of her. She has hypertension, coronary
artery disease, and hypercholesterolemia. Current medications include aspirin, enalapril,
carvedilol, and atorvastatin. She is alert and oriented to place and person but not to time.
Vital signs are within normal limits. Short- and long-term memory deficits are present. Her
speech rhythm is normal but is frequently interrupted as she thinks of words to frame her
sentences. She makes multiple errors while performing serial sevens. Her clock drawing is
impaired, and she draws 14 numbers. Which of the following is the most likely diagnosis?

A. Lewy body dementia

B. Frontotemporal dementia
C. Vascular dementia
D. Normal aging
E. Alzheimer disease

Answer: E

Delirium and Coma:

Six days after undergoing surgical repair of a hip fracture, a previously healthy 79-year-old
woman is agitated and confused. She is unarousable during the day, but then is awake and
impulsive during the night, requiring frequent reorientation. Her husband says that she
usually drinks one to two glasses of wine weekly. Her only current medication is oxycodone
for pain. Her vital signs are within normal limits. She is distressed and oriented to person but
not to place or time. Neurologic examination shows inattentiveness but no focal deficits.
Urine dipstick is normal. Which of the following is the most likely cause of her current
condition?

A. Dementia
B. Alcohol withdrawal
C. Opioid intoxication
D. Delirium
E. Schizophrenia

Answer: D

Multiple Sclerosis:

A 28-year-old woman comes to the physician because of increasingly frequent episodes of

double vision for 2 days. She was seen in the emergency department for an episode of
imbalance and decreased sensation in her right arm 3 months ago. Examination shows
impaired adduction of the right eye with left lateral gaze but normal convergence of both
eyes. Deep tendon reflexes are 4+ in all extremities. The Romberg test is positive. An MRI of
the brain shows hyperintense oval plaques in the periventricular region and a plaque in the
midbrain on T2-weighted images. Microscopic examination of material from the midbrain
plaque would most likely show which of the following?

A. Eosinophilic intracytoplasmic inclusion bodies

B. Loss of axons and atrophy of oligodendrocytes
C. Lymphocytic infiltration of the endoneurium
D. Extracellular deposits of amyloid peptides
E. Demyelination with partial preservation of axons

Answer: E

A 27-year-old woman comes to the emergency department because of progressive numbness

and weakness in her left arm and left leg for 2 days. During this period, she has also had
urinary urgency and incontinence. Three months ago, she had blurry vision, difficulty
distinguishing colors, and headache for one week, all of which have since resolved. Her
temperature is 37°C (98.6°F), pulse is 78/min, respirations are 14/min, and blood pressure is
110/68 mm Hg. Muscle strength in the extremities is 3/5 on the left and 5/5 on the right.
Upon flexion of the neck, the patient experiences a shooting electric sensation that travels
down the spine. MRI of the brain shows gadolinium-enhancing lesions in the right central
sulcus, cervical spinal cord, and optic nerve. Which of the following is the most appropriate
next step in management?

A. Dimethyl fumarate therapy

B. Interferon beta therapy
C. Administer IV methylprednisolone

D. Plasmapheresis
E. Administer tissue plasminogen activator

Answer: C

Epilepsy

The primary mechanism to assess seizure intensity, duration, and frequency is often

A) EEG.

B) MRI.

C) physical exam.

D) the patient's and/or witnesses' reports.

Answer: D

Stroke

. The most common focal neurologic sign of a TIA is the sudden onset of
A) paralysis.
B) imbalance.
C) transient monocular blindness.
D) unilateral weakness/numbness.

Answer: D

a 27 year-old Caucasian female came to your clinic complaining of impaired

vision with pain when moving the eye, and tremors when she tries to grab
things on the table. examination she had Hyporeflexia in her facial and abdominal
muscles. you suspect multiple sclerosis what is the initial test to request
1-Plain MRI
2-cbc
3-x-ray
4-none of the above
The correct answer is A. Plain MRI

A 78-year-old man is brought in to the emergency department by ambulance after

his wife noticed that he began slurring his speech and had developed facial
asymmetry during dinner approximately 30 minutes ago. His past medical history is
remarkable for hypertension and diabetes. His temperature is 99.1°F (37.3°C), blood
pressure is 154/99 mmHg, pulse is 89/min, respirations are 12/min, and oxygen
saturation is 98% on room air. Neurologic exam reveals right upper and lower
extremity weakness and an asymmetric smile. Which of the following is the next best
step in management?
A-Alteplase
B-Aspirin
C-CT head
d-MRI brain

The correct answer is C. (CT head)

epilepsy and seizure

A 16-year-old boy is brought to the ED by para- medics while seizing. The neighbors who called 911
report that he has a long-standing seizure disorder and add that they believe he often abuses cocaine;
they are unaware of how long he was seizing before they found him 20 minutes ago. On arrival to the
ED the patient’s pulse is 125/min, blood pressure is 160/100 mm Hg, temperature is 38.9°C (102°F),
and respiratory rate is 22/min. On examination the patient has his arms extended rigidly at his side
and is arching his back rhythmically and ap- pears to be aspirating. Nasopharyngeal intuba- tion is
successful on the second attempt by the ED resident on call; intravenous access is ob- tained. Which
of the following is the most ap- propriate next step in management?

(A) Intravenous glucose, thiamine, and nalox- one, and oxygen via face mask
(B) Intravenous lorazepam and phenytoin
(C) Intravenous phenobarbital
(D) Neuromuscular blockade
(E) Placement of electroencephalographic monitor

Answer B

epilepsy and seizure

A homeless man is brought to the ED in a confused state following a seizure in public. Witnesses
report the seizure as occurring sud- denly and lasting at least 2 or 3 minutes. A first responder on the
scene says “he swung his arms and his entire body shook.” On examina- tion, the patient’s tongue is
unharmed, al- though his pants are covered in fresh urine. He is oriented to person but not place or
time and has no recollection of what happened, but is aware he has “some sort” of seizure disorder for
which he “occasionally” takes an unnamed medication that he is not carrying. More in- depth
questioning reveals that he has been us- ing increasing amounts of cocaine and heroin since he was
kicked out of a group home and rarely takes his seizure medication as a result. An
electroencephalogram of this patient dur- ing the episode would most likely show which of the
following?
(A) A 3-Hz spike-and-wave pattern
(B) A triphasic discharge pattern in sporadic fashion
(C) Generalized seizure activity affecting one hemisphere
(D) Seizure activity involving both hemi-spheres
(E) Seizure activity localized to a discrete por-tion of one hemisphere

Answer D

epilepsy and seizure

A 34-year-old woman is having her medications tapered in the epilepsy monitoring unit. She has a convulsive
seizure that does not stop after 5 min, even after she receives a lorazepam injection. A second intravenous drug
is given. Infusing which of the following antiepileptic drugs at more than 50 mg/min in an adult may evoke a
cardiac arrhythmia?

a. Carbamazepine
b. Diazepam

c. Phenobarbital

d. Clonazepam

e. Phenytoin

Answer E

epilepsy and seizure

A 44-year-old man presents with left arm shaking. Two days ago, the patient noticed left arm paresthesias along
the lateral aspect of his left arm and left fourth and fifth fingers while he was reading. He thinks he may have
been leaning on his left arm at the time; the symptoms resolved after 30 seconds. This morning, he noted the
same feelings, lasting a few sec- onds, but then his fourth and fifth fingers started shaking rhythmically, and the
shaking then spread to all of his fingers, his hand, and then his arm up to his elbow. This episode lasted a total of
30 seconds. He denies any strange smells or tastes, visual changes, or weakness. Afterward, his fingers felt
locked in position for a few seconds. Then he felt as if he did not have control of his hand and had difficulty
donning his socks. He and his wife decided to drive to emergency room, and in the car he had trouble putting his
seat belt latch into its socket. Examination and routine labs are normal. Which of the following is the most
appropriate next action?
A- Discharge the patient to follow up in clinic in 2 weeks
B- Obtain a brain MRI
C- Obtain an electroencephalogram
D- Obtain an orthopedic consult
E- Order electromyography and nerve conduction studies
Answer B

epilepsy and seizure

An 18-year-old girl riding on the back of her boyfriend’s motorcycle without a helmet is brought in with a left
frontal skull fracture and cortical contusion. GCS is 10. She is admitted to the intensive care unit. She has had
no seizures. Which of the following is true regarding anticonvulsant ther- apy in this case?
A- It is contraindicated due to risk of rash
B- It is best achieved using phenobarbital
C- It is likely to cause increased cerebral edema
D- It is indicated to reduce the incidence of late posttraumatic epilepsy
E- It is indicated to reduce the incidence of early posttraumatic seizures
Answer E
Parkinson :

A 61-year-old right-handed man presents with 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 his lower extremities are not affected. He has had no trouble
walking, and there have been no falls. There have been no behav- ioral or language changes. On examination, a
tremor of the left hand is evi- dent when the man is distracted. His handwriting is mildly tremulous. He has
bilateral cogwheel rigidity with contralateral activation, which is worse on the left. His rapid alternating
movements are bradykinetic on the left. Which of the following is the most likely diagnosis in this case?
A- Epilepsy
B- Guillain-Barré syndrome
C- Multiple sclerosis
D- Parkinson’s disease
E- Stroke
Answer D

A 67-year-old man is brought to the neurologist by his wife for bizarre behaviors. She said that at times he would be difficult
to understand and disorganized. He also said that he has seen animals on top of the television which was disturbing for him.
He would speak in his sleep. Physical examination is notable for postural instability and upper extremity rigidity. Which of
the following might be the underlying cause ?
A) Alzheimer disease
B) Dementia with Lewy bodies
C) Vascular dementia
D) Fronto-temporal dementia

Answer B

• A 68-year-old man presents to his neurologist for a follow-up visit. He experienced his second ischemic stroke
approximately 6 months ago and has minimal neurological deficits. He continues to take his aspirin, maximum intensity
statin, and lisinopril. He is accompanied by his wife, who said he has been having trouble with planning or solving complex
tasks. Physical examination is notable for impaired executive functioning. An MRI brain demonstrates cortical ischemic
changes. Which of the following might be the underlying cause ?
A) Alzheimer disease
B) Dementia with Lewy bodies
C) Vascular dementia
D) Fronto-temporal dementia

Answer C

Parkinson :

A 26-year-old heroin addict has been using a street version of artificial heroin. The drug actually contains 1-
methyl-4-phenyl-1,2,3,6- tetrahydropyridine (MPTP). The neurological syndrome for which he is at risk is
clinically indistinguishable from which of the following?
A- Huntington’s disease
B- Friedreich’s disease
C- Sydenham’s chorea
D- Parkinson’s disease
E- Amyotrophic lateral sclerosis
Answer D
A 67-year-old man comes to the physician because of a worsening tremor that began 1 year
ago. The tremor affects his left hand and improves when he uses his hand to complete a task.
He also reports feeling stiffer throughout the day, and he has fallen twice in the past year. He
has not noticed any changes in his cognition or mood. He has not had difficulty sleeping, but
his wife says that he would kick and punch while dreaming for almost a decade. His mother
has Alzheimer disease. He drinks two cans of beer daily. He takes no medications. He
appears well-nourished. Vital signs are within normal limits. The patient maintains a blank
stare throughout the visit. Further evaluation is most likely to show which of the following?

A- Reduced amplitude on foot tapping

B- Start myoclonus

C- impaired vertical eye-movement

D- horizontal gaze nystagmus

Answer : A

A 62-year-old man comes to the physician because of gradual onset of bilateral ankle
swelling over the past month. He also noticed reddish blotches of skin around his ankles. Five
weeks ago, he came to the physician with difficulty walking and a resting tremor. He was
diagnosed with Parkinson disease and started on medication. He has a history of hypertension
and his antihypertensive medications were also adjusted. His temperature is 37.3°C (99.1°F),
pulse is 64/min, respirations are 13/min, and blood pressure is 124/74 mm Hg. Physical
examination shows bilateral 2+ edema in the ankles. There is purple-red discoloration on the
lower legs in a reticular pattern. Neurologic examination shows resting tremor in both hands
and bilateral cogwheel rigidity in the elbows. Which of the following pharmacotherapies is
the most likely cause of this patient's edema?

A- Selegiline

B- Carbidopa/levodopa
C- Entacapone

D- Amantadine

Answer: D

72-year-old woman with Parkinson’s disease, complaining of a very annoying tremor of the
dominant right hand. She is not on any medications. She states that her tremor is the only
feature that disturbs her functioning, which of the following medications would be most
likely to improve her tremor ?

A- Procyclidine

B- Amitriptyline

C- Bromocriptine

D- Carbidopa/Levodopa

Anwer: D

After several years of successful anti-Parkinsonian treatment, a patient abruptly develops acute episodes of
profound bradykinesia and rigidity. Remission of these signs occurs as abruptly as the onset. This patient prob-
ably suffers from which of the following?
A- Acute dystonia
B- Absence attacks
C- On-off phenomenon
D- Complex partial seizures
E- Drug toxicity
Answer C

Dementia and cognitive disorder:

A 55-year-old man has a steep decline in his cognitive abilities over a 3-month period. Initial testing is
nondiagnostic. He continues to progress and develops myoclonus and a left hemiparesis. Eventually, he dies of
an aspiration about 8 months after the onset of symptoms. In the diseases that cause dementia, myoclonus is
usually most evident in which of the following?
A- Alzheimer’s disease
B- Creutzfeldt-Jakob disease
C- Parkinson’s disease
D- Huntington’s disease
E- Pick’s disease
Answer B

Dementia and cognitive disorder:

An 82-year-old man has 6 months of worsening memory loss. His family is concerned, and he is taken to a
physician. Following an extensive evaluation and neuropsychological testing, he is diagnosed with dementia.
Which of the following is the most common cause of dementia in the gen- eral population?
A- Epilepsy
B- Vascular disease
C- Alzheimer’s disease
D- Parkinson’s disease
E- Head trauma
Answer C

MS:
A 23-year-old woman has had 1 week of worsening facial pain. She describes it as an intense shooting pain that
comes and goes. It is present only on her right face. Which of the following is most likely to be this patient’s
underlying problem?
A- Multiple sclerosis
B- Tolosa-Hunt syndrome
C- Migraine
D- Anterior communicating artery aneurysm
E- Falx meningioma
Answer A

MS
A 21-year-old right-handed female student was working in the pho- tography lab 1 week ago, which required
standing all day. After that, she experienced a cold sensation in the left foot and her entire left leg fell asleep.
The feeling lasted 4 to 5 days and then slowly went away. Her right lower extremity was fine. Coughing,
sneezing, and the Valsalva maneuver did not worsen her symptoms. She had a slight back pain, which she
thought was due to using a poor mattress. Past history includes an episode of optic neuritis in the left eye 2 years
ago. At that time, she was reportedly depressed and was sleeping constantly. One day, her left eye became
blurred and her vision went out. In 1 week, her vision returned to normal. Her vision now is 20/20. She has not
had a repeat episode since then. She had an MRI of her brain, which was normal at that time. She drinks alco-
hol occasionally and does not use any illicit drugs. Her only medication is birth control pills. Examination is
significant for brisk reflexes and sus- tained clonus at the right ankle. Babinski sign is present on the right. Test-
ing is positive for oligoclonal bands. Which of the following is the most likely diagnosis in this case?
A- Seizure
B- Transient ischemic attack
C- Anaplastic astrocytoma
D- Multiple sclerosis
E- Parkinson’s disease
Answer D

MS
A 19-year-old man had an episode of left optic neuritis, which resolved over several weeks. Two years later
there was a monthlong episode of bladder dysfunction. The patient underwent many tests and was told that he
had multiple sclerosis. The CSF in persons with multiple sclerosis will typically exhibit which of the following?
A- Glucose content of less than 20% of the serum content
B- Persistently elevated total protein content
C- Persistently elevated immunoglobulin G (IgG) content
D- Mononuclear cell counts of greater than 100 cells per μL
E- Erythrocyte counts of greater than 10 cells per μL
Answer C

MS
A patient with multiple sclerosis has worsening leg weakness. He has severe spasms of his legs bilaterally, and
is increasingly unable to ambu- late because of this. A reasonable symptomatic treatment option would be which
of the following?
A- Cyclophosphamide
B- Baclofen
C- Gabapentin
D- Amitriptyline hydrochloride
E- Propranolol
Answer B

Multiple Sclerosis:

A 30-year-old woman presents with increasing weakness and numbness of the upper
extremities for 5 days. During this time, she has also had urinary incontinence
unrelated to sneezing or laughing. She reports that last summer during a vacation in
Mexico she had weakness and numbness of her right lower extremity that was
worse when she was outside; she regained her strength 3 weeks later. She has no
history of serious illness. She has had 10 male sexual partners in her lifetime and
uses condoms inconsistently. Vital signs are within normal limits. Examination
shows an impaired tandem gait. There is mild spasticity and muscle strength is
decreased in both upper extremities. Deep tendon reflexes are 4+ bilaterally.
Abdominal reflex is absent. Muscle strength in the right lower extremity is mildly
decreased. Sensation to vibration and fine touch is decreased over the upper
extremities. Which of the following is the most appropriate next step in diagnosis?

A- Serum vitamin B12 level

B- Antinuclear antibody testing
C- Rapid plasma reagin test
D- MRI of the brain and spine ✅
E- Electromyography

Answer: D- MRI of the brian and spine

A 28-year-old woman is concerned about her health. Today she presents with
numbness of her left leg and a sharp, electrical sensation down her back as she
flexes her neck. Her symptoms felt worse when she was on vacation in Hawaii this
past week and seems to flare up when she takes a shower.
Which condition does this patient have, and what is an appropriate treatment for it?

O A Syringomyelia; surgical intervention

O B. Lumbar radiculopathy; surgical intervention
O c. Multiple Sclerosis; Interferon alpha
O D Multiple Sclerosis; Fingolimod
O E Meningitis; vancomycin with ceftriaxone
Answer :D

An 80 years old man comes to the clinic with occasional loss of consciousness
when tilting his head back. He has diabetes and hypertension, along with a 50-pack-
year smoking history. History includes a left carotid endarterectomy and surgical
repair of an abdominal aortic aneurysm several years ago. It is determined that the
patient is likely experiencing transient brainstem ischemia when he extends his neck.
Occlusion of which of the following vessels would most likely produce these
symptoms?

A. Anterior spinal artery

B. External carotid arteries
C. Internal carotid arteries
D. Internal mammary arteries
E. Subclavian arteries
Answer :E

A 65-year-old diabetic man has a history of a cerebellar stroke. The stroke occurred 5 years
ago, and he says that he has now fully recovered. He cannot recall the symptoms, but his
medical records state that he presented with left- sided dysdiadochokinesia. Which of the
following was most likely impaired?

a. Successive finger movements

b. Heel-to-toe walking

c. Rapid alternating movements

d. Tremor suppression

Answer: C

A 35-year-old man has stumbling and slurred speech. His symptoms started several months
ago and have progressed slowly but consistently. On neurological examination, he is found to
have scanning speech, nystagmus, limb dysmetria, and kinetic tremor. His intellectual
function is normal. Which of the following is the most appropriate initial investigation?

a. Lumbar puncture

b. Serum drug screen

c. Routine urinalysis

d. Brain MRI

Answer: D

36-year-old man brought to the emergency department because of a seizure. His family reports he
has a history of seizure disorder but stopped his medications a month ago due to financial issues. He
had a brief seizure at home that stopped within a few minutes. However, 15 minutes later he began
seizing again and the tonic-clonic activity has per- sisted for 30 minutes. On physical examination he
is afe- brile, hypertensive, and actively seizing. All of the following are potential therapies for his
condition EXCEPT:

A. Carbamazepine
B. Fosphenytoin
 C. Lorazepam
D. Phenobarbital
E. Valproate

Answer is A

Which of the following statements regarding Alzheimer’s disease is true?

A. Delusions are uncommon.

B. It accounts for over half of the cases of significant memory loss in patients over 70
years of age.
C. It typically presents with rapid (<6 months) significant memory loss.
D. Less than 5% of patients present with nonmemory complaints.
E. Pathologically, the most notable abnormalities are in the cerebellar regions.

Answer is B

All of the following are frequent initial symptoms of multiple sclerosis EXCEPT:

A. Optic neuritis
B. Paresthesias
C. Sensory loss
D. Visual loss
E. Weakness

Answer is D

Which of the following is the most common clinical classification of multiple sclerosis?

A. Autoimmune autonomic neuropathy

B. Primary progressive
C. Progressive relapsing
D. Relapsing/remitting
E. Secondary progressive

Answer is D

MS

Numerous drugs may be given for a short time to help relieve symptoms of multiple sclerosis
(MS) that interfere with functioning. Which of the following drugs can relieve immediate
symptoms such as loss of vision, strength, or coordination?

A. Glatiramir acetate
B. Interferon-beta injections
C. Immune globulin
D. Methylprednisone

Answer is D
Alzheimer

All of the following medications have been shown to have potential efficacy in the treatment of
Alzheimer’s disease EXCEPT:

A. Donepezil
B. Galantamine
C. Memantine
D. Oxybutynin
E. Rivastigmine

Answer is D

A 73-year-old woman is brought to the physician by her son because of increasing

forgetfulness over the past 2 years. Initially, she used to misplace keys and forget
her dog's name or her phone number. Now, she often forgets about what she has
seen on television or read about the day before. She used to go for a walk every
morning but stopped one month ago after she became lost on her way back home.
Her son has prevented her from cooking because she has had episodes of leaving
the gas stove oven on after cooking a meal. She becomes agitated when asked
questions directly but is unconcerned when her son reports her history and says he
is overprotective of her. She has hypertension, coronary artery disease, and
hypercholesterolemia. Current medications include aspirin, enalapril, carvedilol, and
atorvastatin. She is alert and oriented to place and person but not to time. Vital signs
are within normal limits. Short- and long-term memory deficits are present. Her
speech rhythm is normal but is frequently interrupted as she thinks of words to
frame her sentences. She makes multiple errors while performing serial sevens. Her
clock drawing is impaired and she draws 14 numbers. Which of the following is the
most likely diagnosis?

A-Normal pressure hydrocephalus

B-Alzheimer disease

c-Creutzfeld-Jakob disease

d-Lewy body dementia

Answer is B
Seizure

A 4-year-old patient is brought to the emergency department by her father after she "fainted."
The father states that the patient was standing in their kitchen and suddenly fell to the
ground. When he tried to speak to the patient, she did not respond and did not appear
conscious until about 20 seconds later. This patient most likely had which of the following
types of seizure?

A. Absence
B. Atonic
C. Myoclonic
D. Tonic-clonic

Answer is B