SEIZURES
WHICH OF THE FOLLOWING SURGICAL PROCEDURES CAN BE USED IN THE TREATMENT OF EPILEPSY REFRACTORY TO MEDICATIONS?
(A) ELECTRICAL STIMULATION OF THE VAGUS NERVE
(B) ELECTROLYTIC LESION OF THE GLOBUS PALLIDUS
(C) DEEP BRAIN STIMULATION OF THE CEREBELLUM
(D) DEEP BRAIN STIMULATION OF THE SUBTHALAMIC NUCLEUS
(A) ELECTRICAL STIMULATION OF THE VAGUS NERVE
Somnambulism during childhood is associated with which of the following stages of sleep measured by an EEG?
(A) STAGE IV
(B) STAGE IV
(C) STAGE IV
(D) STAGE IV
(E) REM
(D) STAGE IV
Which of the following, if present in the brain, is considered to be a sign of pathological brain aging?
A. Lipofuscin
B. Neuromelanin
C. Tau aggregates
D. Corpora amylacea
E. Hippocampal sclerosis
E. Hippocampal sclerosis
A 35 YO WITH A HISTORY OF VISUAL LOSS D/T BILATERAL OPTIC ATROPHY DEVELOPS WEAKNESS AND SENSORY LOSS FROM THE MID-CHEST TO FEET. A MRI SCAN OF THE SPINAL CORD DEMONSTRATES AN ABNORMAL LONGITUDINAL LESION IN THE SPINAL CORD. ELEVATED TITERS OF ABS TO WHICH OF THE FOLLOWING ARE ASSOCIATED WITH THIS SYNDROME?
(A) AQUAPORIN-4
(B) NMDA RECEPTOR
(C) Ach RECEPTOR
(D) GLUTAMIC ACID DECARBOXYLASE
(E) LEUCINE RICH GLIOMA INACTIVATED-1
(A) AQUAPORIN-4
A 25 year old patient presents to the emergency department for two hours of involuntary movements. They started taking risperidone two days ago. The patient's eyes are conjugately deviated up and to the right in a sustained manner. They have no abnormal mouth or tongue movements and the remainder of the neurological examination is normal. Which clinical syndrome is most likely?
(A) ACUTE AKATHESIA
(B) TARDIVE DYSKINESIA
(C) ACUTE DYSTONIC REACTION
(D) DRUG INDUCED PARKINSONISM
(E) NEUROLEPTIC MALIGNANT SYNDROME
(C) ACUTE DYSTONIC REACTION
WHICH OF THE FOLLOWING ANTICONVULSANT AGENTS IS MOST APPROPRIATE FOR PRIMARY GENERALIZED SEIZURES, INCLUDING TONIC-CLONIC, ATONIC AND MYOCLONIC SEIZURE TYPES?
(A) DEPAKOTE
(B) PHENYTOIN
(C) OXCARBAZEPINE
(D) CARBAMAZEPINE
(E) VALBENAZINE
(A) DEPAKOTE
A PATIENT REPORTS INSOMNIA, FREQUENT NIGHTTIME AWAKENINGS AND EXCESSIVE DAYTIME SLEEPINESS. A SLEEP STUDY REVEALS BRIEF LOWER EXTREMITY JERKS WITH BRIEF REPEATED AROUSALS. THE PATIENT IS UNAWARE OF THESE MOVEMENTS. WHICH OF THE FOLLOWING DIAGNOSES IS CONSISTENT WITH THE PATIENT'S PRESENTATION?
(A) NARCOLEPSY
(B) PRIMARY INSOMNIA
(C) SLEEP TERROR DISORDER
(D) PERIODIC LIMB MOVEMENT DISORDER
(E) CIRCADIAN RHYTHM SLEEP DISORDER
(D) PERIODIC LIMB MOVEMENT DISORDER
A patient with mild cognitive disorder is followed every six months in neuropsychiatry clinic in the second year. Parkinsonian features emerge and cognitive capacity becomes more fluctuant with wide variability in attention and alertness. What is an additional core feature
of the likely diagnosis?
A. Word-finding difficulties
B. Impulse control problems
C. REM sleep behavior disorder
D. Severe neuroleptic sensitivity
E. Recurrent visual hallucinations
E. Recurrent visual hallucinations
Which of the following cells are involved in the regulation of neurogenesis, synaptic function, and removal of debris after neuronal cell death and injury?
A. Microglia
B. Schwann cells
C. Oligodendrocytes
D. Fibrous astrocytes
E. Protoplasmic astrocytes
A. MICROGLIA
Which of the following symptoms is typical of idiopathic Parkinson's disease, rather than another Parkinsonian Syndrome?
(A) VERTICAL GAZE PALSY
(B) FAILURE TO RESPOND TO LEVIDOPA
(C) EARLY SEVERE AUTONOMIC DYSFUNCTION
(D) ASSYMETRICAL ONSET AND PROGRESSION OF MOTOR SYMPTOMS
(E) ONSET OF DEMENTIA DURING THE FIRST YEAR ROF MOTOR SYMPTOMS
(D) ASSYMETRICAL ONSET AND PROGRESSION OF MOTOR SYMPTOMS
A 28-year-old female patient is referred to a psychiatrist by her primary care physician due to a recent onset of episodes of altered behavior which last about one to two minutes at most. The patient's spouse notes that when these episodes occur while the patient is cooking, she will place all the clean silverware back in the dishwasher. During the episodes the spouse has observed the patient making chewing movements, and indicates that he is unable to interrupt the patient's behavior. After the episode, the patient has no recollection of the events. A magnetic resonance imaging scan is normal. Which of the following is the most likely diagnosis?
(A) FUGE STATES
(B) DISSOCIATIVE STATES
(C) PEDUNCULAR HALLUCINOSIS
(D) TRANSIENT GLOBAL AMNESIA
(E) COMPLEX PARTIAL SEIZURES
(E) COMPLEX PARTIAL SEIZURES
WHICH OF THE FOLLOWING SLEEP STAGES DIMINISHES OVER THE LIFESPAN, AND MAY BE NEARLY OR TOTALLY ABSENT IN OLDER ADULTS?
(A) STAGE 1
(B) STAGE 2
(C) REM SLEEP
(D) NON-REM SLEEP
(E) SLOW WAVE SLEEP
(C) REM SLEEP
WHICH OF THE FOLLOWING IS THE MOST CONSISTENTLY DESCRIBED NEUROCHEMICAL ABNORMALITY IN ALZHEIMER DISEASE OF MODERATE SEVERITY?
(A) INCREASED GLUTAMATE ACTIVITY
(B) INCREASED SENSITIVITY OF HISTAMINIC RECEPTORS
(C) DECREASED CHOLINE ACETYLTRANSFERASE ACTIVITY
(D) DECREASED SENSITIVITY OF SEROTONERGIC RECEPTORS
(E) DECREASED ACETALDEHYDE DEHYDROGENASE ACTIVITY
(C) DECREASED CHOLINE ACETYLTRANSFERASE ACTIVITY
WHICH ONE OF THE FOLLOWING IS NOT A CLINICAL FEATURE HIGHLY SUGGESTIVE OF MULTIPLE SCLEROSIS?
(A) OPTIC NEURITIS
(B) WORSENING W/ ELEVATED BODY TEMP
(C) FATIGUE
(D) STEADY PROGRESSION FROM INITIAL ONSET
(E) LHERMITTE'S SIGN
(D) STEADY PROGRESSION FROM INITIAL ONSET
A previously healthy 16-year-old boy presents to this physician for episodes of hypersomnolence. For the past 2 weeks, he has been sleeping up to 20 hours per day. He has associated binge eating, hypersexuality, hallucinations, and episodes of amnesia. Which is the most likely diagnosis?
a. Anti-IgLON5 disease
b. Frontal lobe epilepsy
c. REM sleep behavior disorder
d. Kleine-Levin syndrome
e. narcolepsy with cataplexy
(D) KLEINE-LEVIN SYNDROME
Which of the following antiepileptic medications reduces the efficacy of oral contraceptives?
(A) VALPROATE
(B) GABAPENTIN
(C) ZONISAMIDE
(D) LEVETERICETAM
(E) CARBAMAZEPINE
(E) CARBAMAZEPINE
A 32 YO PATIENT HAS EPISODES OF IRRESISTIBLE SLEEPINESS, AND FALLS ASLEEP WHILE DRIVING. THE PATIENT REPORTS EXPERIENCING EPISODES OF PARALYSIS AND HALLUCINATIONS UPON AWAKENING. THESE SYMPTOMS ARE BEST EXPLAINED BY A DEFICIENCY IN WHICH OF THE FOLLOWING?
(A) GABA
(B) OREXIN
(C) CORTISOL
(D) MELATONIN
(E) ADENOSINE
(B) OREXIN
A RETIRED NFL PLAYER DEVELOPS SLOWLY PROGRESSIVE COGNITIVE PROBLEMS AND IS FOUND DEAD AFTER AN INTENTIONAL DRUG OVERDOSE. HIS CLINICAL SYMPTOMS CONSISTED OF EPISODES OF MEMORY LOSS, MOOD LABILITY AND PSYCHOMOTOR SLOWING. HE HAD SUFFERED MULTIPLE CONCUSSIONS DURING HIS FOOTBALL CAREER. ACCUMULATION OF WHICH SUBSTANCE WOULD MOST LIKELY BE FOUND ON BRAIN AUTOPSY?
(A) AMYLOID
(B) LIPOFUSCIN
(C) TAU PROTEINS
(D) PRION PROTEINS
(E) ALPHA SYNUCLEIN
(C) TAU PROTEINS
Which the following types of glial cells assist in forming myelin sheaths in the peripheral nervous system?
(A) SCHWANN
(B) MICROGLIA
(C) ASTROCYTES
(D) EPENDYMAL
(E) OLIGODENDROCYTES
(A) SCHWANN
Degeneration of the dorsal nucleus of thalamus in the mammillary bodies is found in which the following disorders?
a. Wilson disease
b. Alzheimer disease
c. Parkinson disease
d. Huntington disease
e. Wernicke-Korsakoff syndrome
(E) WERNICKE-KORSAKOFF SYNDROME
Which the following antiseizure medications is most likely to affect the metabolism of other drugs through cytochrome P450 pathways?
(A) GABAPENTIN
(B) TOPIRIMATE
(C) ETHOSUXIMIDE
(D) LEVETIRACETAM
(E) ZONISAMIDE
(B) TOPIRIMATE
A PATIENT UNDERGOES A MULTIPLE SLEEP LATENCY TEST (MSLT) AND IS DIAGNOSED WITH NARCOLEPSY. WHAT FINDING ON THE MSLT WOULD CONFIRM THE DIAGNOSIS?
(A) INCREASED SLEEP LATENCY
(B) DECREASED REM LATENCY
(C) DECREASED TOTAL REM SLEEP
(D) INCREASED TOTAL NREM SLEEP
(E) DECREASED SLEEP EFFICIENCY
(B) DECREASED REM LATENCY
WHICH OF THE FOLLOWING FINDINGS IS CHARACTERISTIC OF ALZHEIMER DISEASE?
(A) AMYLOID PLAQUES AND NEUROFIBRILLARY TANGLES
(B) CHRONIC ISCHEMIC CHANGES
(C) DOPAMINE DEPLETION IN THE SUBSTANTIA NIGRA
(D) EOSINOPHILIC INTRACYTOPLASMIC INCLUSIONS
(A) AMYLOID PLAQUES AND NEUROFIBRILLARY TANGLES
A patient with multiple sclerosis treated with natalizumab for two years has developed cognitive decline and weakness. MRI of the brain shows multiple non enhancing plaques in subcortical white matter, not thought to be due to acute exacerbation of multiple sclerosis. Reactivation of which of the following quiescent infections is most likely cause of the findings
a. Toxoplasmosis
b. Herpes simplex virus
c. Borrelia Burgdorferi
D. John Cunningham virus
E. HIV
D. John Cunningham virus
A patient expresses concerns about unusual new behaviors during sleep. The patient used to talk during their sleep occasionally, but now shouts during sleep almost every night. The patient has kicked their partner during sleep on multiple occasions and has no recollection of these episodes. The presence of these symptoms suggest that the patient is at increased risk of later developing a major neurocognitive disorder due to:
a. HIV infection
b. multiple sclerosis
c. Lewy body disease
d. traumatic brain injury
e. frontotemporal degeneration
(C) LEWY BODY DISEASE