Basics of Neurology MCQ Question with Answer

Basics of Neurology MCQ with detailed explanation for interview, entrance and competitive exams. Explanation are given for understanding.

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Question No : 57
Topic: Mini Mental Status Exam (or MMSE)
Subject: Medicine
A 63-year-old retired teacher shared with his primary care physician (PCP) during a routine office visit that he has noticed increasing difficulty with his memory. Otherwise he is in good health and requiring no medication.
Which one of the following psychological tests is a valuable screening device to be used by primary care physicians in this type of situation?

MMPI

WAIS

Thematic Apperception Test

Mini-Mental State Exam

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Question No : 58
Topic: Seizure
Subject: Medicine
A 75-year-old male is brought to your office 1 month after a stroke that involved the left anterior cerebral artery, manifested by leg weakness, initial incontinence, and slowness in mentation. He experienced seizure activity on the second day after his stroke, but this was controlled by phenytoin (Dilantin). He has improved significantly and is now ambulatory. His family states that he now has episodic confusion, sleepiness, and clumsiness, which is preceded by paresthesias and dizziness, although no tonicclonic activity has been noted. He remains very drowsy for several hours after these episodes. He was wearing a cardiac monitor during one episode, but it showed nothing remarkable. His phenytoin level is therapeutic, and a CBC, metabolic profile, and magnesium level are all normal.
Which one of the following would be the most appropriate next step?

Discontinue the phenytoin

Add phenobarbital to the phenytoin

Begin bupropion (Wellbutrin)

Begin lamotrigine (Lamictal)

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Correct Answer : D

Explanation
Up to 50% of cases of epilepsy in the geriatric population result from cerebrovascular disease. Risk factors for post-stroke epilepsy include cortical involvement, hemorrhage, and large size. Approximately 35% of those who experience an acute stroke-related seizure develop post-stroke epilepsy, compared to only 9% of those who do not have acute seizure activity. The most common seizures in the elderly are complex partial seizures, but they do not have the typical presentation seen in younger people (aura, d�j� vu, olfactory hallucinations). Geriatric patients are more likely to have nonspecific preceding symptoms, such as vaguely localized paresthesias, dizziness, and muscle cramps. Those present may note episodic confusion, drowsiness, or clumsiness more than tonic-clonic movements. The postictal state is likely to be prolonged in the elderly. Misdiagnosis of these seizures is very common, with the diagnosis often delayed as much as 2 years from the time of the stroke. The most valuable diagnostic tool is a reliable history from those who witness the event.
Treating seizures in the elderly by using antiepileptic drugs (AEDs) is complicated by a number of factors. Pharmacokinetics are influenced by decreases in hepatic metabolism, renal elimination, plasma proteins, and protein binding. Many elderly patients are on a multiple-medication regimen that increases the risk of drug interactions, and many AEDs are enzyme inducing, which increases the risk of osteoporosis. The elderly also are more sensitive to side effects.
The choice of AEDs should be individualized, although many experts suggest early use of newer AEDs such as topiramate, gabapentin, lamotrigine, or levetiracetam because of fewer side effects and better pharmacokinetics. Monotherapy is preferred, if possible, and older drugs are less expensive, but limited by side effects.
In the case described here, the patient is having breakthrough seizures despite therapeutic levels of phenytoin. Switching to lamotrigine would be preferable and is less likely to cause side effects. When transitioning from one agent to another it would be best to gradually decrease the phenytoin rather than abruptly discontinuing it. The addition of phenobarbital would further increase drowsiness. Bupropion and modafinil may actually increase seizures.

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Question No : 59
Topic: Mini Mental Status Exam (or MMSE)
Subject: Medicine
In healthy adults, performance on the Folstein Mini-Mental State Examination is affected by which one of the following?

Educational attainment

Socioeconomic status

Gender

Race

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Question No : 60
Topic: Seizure
Subject: Medicine
A patient is on carbamazepine for his new onset seizures. He has now had 3 attacks in last 2 weeks. His serum level of carbamazepine is within the therapeutic range.
What is the next step in management?

Repeat CT scan and EEG

Add another agent (eg. Phenytoin)

Re-check carbamazepine level in 2 weeks

Check CBC, CMP and TSH/FT4

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Question No : 61
Topic: Postherpetic Neuralgia
Subject: Medicine
When given during acute herpes zoster (varicella) infection, which one of the following drugs has been shown to reduce the incidence of postherpetic neuralgia?

Imipramine (Tofranil)

Capsaicin (Zostrix)

Amitriptyline

Acyclovir (Zovirax)

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Question No : 62
Topic: Adverse Drug Effect
Subject: Medicine
Which one of the following is most associated with falls in older adults?

Diphenhydramine (Benadryl)

Atorvastatin (Lipitor)

Metformin (Glucophage)

Memantine (Namenda)

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Question No : 63
Topic: Seizure
Subject: Medicine
A 36-year-old male with a history of a seizure disorder is brought to the emergency department with generalized tonic-clonic activity. Emergency medical personnel report this has been ongoing for 20 minutes.
After initial resuscitative measures, the preferred medication in this situation is:

Phenytoin (Dilantin)

Fosphenytoin (Cerebyx)

Naloxone

Lorazepam (Ativan)

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