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Which one of the following is the LEAST likely precipitating factor to migraine headaches?



A gloves and stocking neuropathy is seen in which of the following disease?



An otherwise healthy 74 year old man has a history of slowly developing progressive memory loss and dementia associated with urinary incontinence and gait disturbance resembling ataxia. He was previously alert. This presentation is most consistent with which of the following?



An HIV positive male presents with headache, fever, photophobia, and nuchal rigidity. What is the most likely diagnosis?



An 80 year old nursing home resident becomes increasingly confused over the past several years. He now presents with a respiratory illness accompanied by agitation and disorientation. A head MRI is obtained and a coronal by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=199227&Page=11#42578774">SECTION shown below. Later, the man dies of his illness, and an autopsy is performed. Histologic examination of the cerebral structures indicated by the arrows reveals accumulation of senile plaques and neurofibrillary tangles. Which of the following are these structures?



A 47 year old man is brought to the hospital with syncope. He was found to have orthostatic hypotension, excess sweating, urinary incontinence, and impotence. No signs of bradykinesia, tremors, rigidity, or dehydration were present. Mild ataxia was present. No peripheral neuropathy was detected. The most likely diagnosis is



A 42 year old man develops progressive weakness culminating in paralysis. Upper and lower motor neurons are lost. The disease progresses to complete paralysis of all voluntary muscles and he dies in respiratory failure. Which CNS site would show the most marked neuronal loss at autopsy?



A 45 year old unconscious person is brought to the emergency room. Physical examination reveals that the patient is bradycardic and hypotensive. The loss of consciousness is transient, and when the patient awakes he exhibits retrograde amnesia. The most likely diagnosis is



A young adult has progressive intellectual deterioration, weakness seizures and ataxia. Investigations show an abnormality of an by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=199227&Page=15#95807102">IMPORTANT mitochondrial enzyme. This person is most likely suffering from which one of the following?



A 68 year old has persistent shooting pains, lower limb ataxia, and bladder dysfunction. Examination shows small irregular pupils that constrict with accommodation but not in response to by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=199227&Page=16#39252629">LIGHT. AVDRL test is positive. Spinal cord CT scan would most likely demonstrate atrophy of



A 36 year old man develops hemiparesis, ataxia, homonymous hemianopia, and cognitive deterioration. Brain MRI shows widespread areas of abnormal T2 signal in the white matter. EEG shows diffuse diffuse slowing over both cerebral hemispheres. Brain biopsy reveals demyelination with abnormal giant oligodendrocytes, some of which contain eosinophilic inclusions. This condition is most closely related to which disease?



A 65-year-old man has increasingly severe memory disturbances for 10 months. He takes finastride for BPH but he is again dribbling urine continuously for the past few months. MMSE shows mild-to-moderate short-term memory deficits. No Papilledema exists but the patient cannot walk straight and walks with a broad base. Screening tests are within normal limits. Which of the following is the most appropriate next step in management?



A 35-year-old woman consults an ophthalmologist because of double vision and droopy eyelids. She also has complaints of generalized muscle weakness. She had been healthy until this time and does not take any medications. She is referred for testing. Intravenous injection of edrophonium dramatically, but only briefly, reverse her symptoms. This patient´s probable disease has a pathophysiologic basis that is closest to that of which of the following conditions?



A 55-year-old man c/o prostate cancer (untreated) has difficulty walking and severe weakness in his right lower extremity and arm over the past week. There is complete paralysis and loss of position/vibratory sense of the right arm and leg, Babinski sign on the right foot, and left-sided loss of pain and temperature in the left arm and leg. What is the next step in the management?



A 70 year old c/o Parkinson´s disease and depression is confused and delirious. He had not come out of his apartment for a routine walk for the last two days. Only relevant examination findings are dilated and non-reactive pupils. He has good muscle strength in all his extremities. Deep tendon reflexes are normal.

Lab tests show:






































Sodium 134mEq/L
Potassium 4.6mEq/L
Chloride 102mEq/L
Bicarbonate 26mEq/L
BUN 16mg/dL
Creatinine 0.8mg/dL
Glucose 80mg/dL
Calcium 9.2mg/dL

CT scan of the head shows some cerebral atrophy. There are no acute changes. What is the most likely etiology of the patient´s delirium?



A 50-year-old hypertensive man has a severe headache and nausea 12 hours. He also had a headache the day before his current symptoms that resolved with "an aspirin and a smoke" and else he is fine. The headache is rated 10. It is mainly occipital and extends to the base of his neck. No other important history exists. He is afebrile, BP= 168/105mmHg, pulse = 72/min, and respirations of 20/min. Nuchal rigidity exists. A non-contrast stat CT shows no evidence of an intracerebral bleed. Which of the following is the most appropriate next diagnostic test?



A 47-year-old man complains of clear, watery discharge from his left by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=199227&Page=23#25828540">EAR 2 days after an accident. He had a head injury, but a CT scan of the head did not reveal any significant abnormalities. Now he also has a mild headache. His personal and past medical history is unremarkable. Examination is normal except watery discharge from the left ear. What is the most rapid test to be done for this ear discharge?



A 30-year-old woman has gradually worsening unsteadiness. Neuroimaging studies reveal a well-circumscribed cystic mass, a mural nodule in the right cerebellar hemisphere. Significant hematologic values include:














Hematocrit: 55%
Red blood cells: 6x106/mm3

The patient undergoes surgical excision of the cerebellar tumor. The histologic diagnosis is: "Hemangioblastoma."Further clinical investigations lead to discovery of a vascular tumor in the right retina. Which of the following syndromes is most likely responsible for this clinical presentation?



A 19-year-old student has headache. She sees black spots and zigzag patterns in her field of vision. Once, she also felt numb in her hand. Headaches are throbbing, unilateral, and can last over a day when at their worst. It worsens with coughs or sneezes with 2-3 attacks/month. Which of is the most efficacious prophylactic therapy?



A 29-year-old woman with a past medical history of hypothyroidism and depression has episodic dizziness for 3 months with each episode of 20 to 30 seconds. She feels as though she is physically moving, although she is not. It occurs when she turns her head up or to the left. She denies any tinnitus or hearing loss. She takes levothyroxine and paroxetine. Relavant examination shows lateral nystagmus; otherwise she is good. What is the most likely diagnosis?









A 69-year-old man (one pack smoker per day for 40 years) has a 6-month history of headache after a transient ischemic attack. He has chronic pruritus, flushing, and sweating. Being vitally stable, he has facial plethora and a soft systolic murmur at the lower sternal border. His spleen is palpable 2 cm below the left costal margin.



















Hct: 60%
Hb: 18 g/dL
Leukocyte count: 16,000/mm3
Platelet count: 700,000/mm3

A serum erythropoietin level is very low. The patient is started on aspirin and scheduled phlebotomies. Which of the following is in appropriate adjuvant therapy for this patient?



A 39-year-old IV drug user has lower back pain for 3 days, after he helped rearranging some furniture. There is no radiation. Temperature is 39.4 °C (103.0 °F), blood pressure is 108/65 mm Hg, and pulse is 102 min. There is no spine tenderness, and straight leg raise testing is normal. Neurologic testing of the lower extremities is normal. Which of the following is the most appropriate diagnosis study?



A 22 year old male recovered from the immediate effects of a head injury sustained in a motor by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=199227&Page=29#69047473">CYCLE accident three months previously. Which one is the most likely delayed consequence of severe traumatic brain injury?



A 28 year old male has a 2 year history of intermittent tingling sensation involving his left side. It starts in his fingers and spreads in 10-20 seconds to affect the whole arm and leg on the same side. The attacks only last for one minute. The most likely diagnosis is



35-year-old Lily has a 5-year-old son and a 2-year-old daughter. Previously she had two spontaneous abortions. After her last child, she developed a DVT and received three months of warfarin anticoagulation. She presents with left sided weakness with pyramidal signs. CT head scan showed a right middle cerebral artery territory infarct. What is the diagnosis?



A 19-year-old boy presents with rapidly progressive ascending weakness over three days beginning in the feet and hands and migrating towards the trunk. He has a history of gastroenteritis. Which one of the following is the most appropriate treatment?



A woman becomes dizzy and hypotensive on standing up after receiving lidocaine injection for melanoma excision on her leg. What is the most likely cause?



A white male aged 80 has a transient ischemic attack. A carotid duplex study reveals an 85% stenosis in the affected carotid artery. Which one of the following would be the most appropriate management at this time?



A male aged 80 year presented with acute right-sided weakness. Examination revealed minimal right weakness, impaired elevation of the right shoulder, with relatively preserved right hand strength. Global weakness was present in right leg which was maximum in foot. Which of the following arteries is most likely to have been affected?



Which viral infection is most likely to cause CNS involvement and focal neurological findings?



A 70 year old has suffered a fall. His daughter reports that for several months, she has noticed that he walks with smaller, shuffling footsteps and that his spine and arms seem always to be flexed when walking. Which cannot be found in this patient?



The sleep disorder that is in general class of circadian sleep disorders and may respond to bright by DealXplorer" href="http://www.interface.edu.pk/medical-exams/test.php?u=33509&t=199281&Page=8#86861027">LIGHT therapy is



A patient taking lithium develops weakness, lethargy and intolerance to heat. The appropriate investigation that must be done is



A 68 year old man has a follow up appointment with his physician. In the course of discussing his back pain, he mentions that he is concerned about his wife, who has recently been diagnosed with cancer. What would be the physician´s best response at this time?



A 77-year-old female suffered severe cerebral infarction and is unlikely to survive without mechanical ventilation. A son brings a living will signed by the patient a month ago stating that patient does not want to be kept alive by mechanical ventilation. Daughter brings documents granting her healthcare power of attorney but dated 2 years ago, and requests the life support to continue. What should the physician do?



A 48 year old man is diagnosed with a CNS tumor, and is treated with both chemotherapy and radiation. Despite therapy, the patient dies 11 months later. An autopsy is performed, revealing a large tumor extending from the right to the left cerebral hemispheres across the corpus callosum. The feature that is most strongly associated with this patient´s tumor is



A 44 year old man presents to the emergency department with severe headache and vomiting. A CT scan is performed which shows a well circumscribed cystic lesion within the 3rd ventricle. There is no calcium deposition. The cyst is surgically removed. Microscopic examination reveals that the wall of the cyst consists of a single layer of much producing columnar epithelium with a ciliated apical surface. The most likely diagnosis is



A 10 year boy is suspected to have Friedreich´s ataxia. The nuclei that would be expected to undergo trans-synaptic degeneration as a consequence of primary degeneration affecting dorsal root ganglia in this patient´s condition are



Which of the following is not a clinical feature of multi infarct dementia?



A 76 year old woman complains of experiencing headaches and progressive confusion for the last month. Left hemianopia is present and she cannot dress herself. A CT scan demonstrates a large, irregularly enhancing mass in the right parietal lobe. No systemic disease is present. The most likely diagnosis is



A 66-year-old chronic alcoholic man has developed increasing memory problems and confusion over three months. He has become listless and has had increasing difficulty in recalling events. He has bilateral headache for two months. His gait is unsteady and wide-based. The likely diagnosis is:



A 35 year old alcoholic woman presents to the emergency department in an intoxicated state. On physical examination, she is disoriented and confused, and has ataxia, dysarthria and oculomotor paralysis. Which substance should be administered first to this patient intravenously?



A 40-year-old male with HIV presents with lethargy, confusion, personality change and a seizure. CT shows multiple uniformly enhancing mass lesions in both cerebral hemispheres. What treatment is indicated?



All are signs of carpal tunnel syndrome, except



Out of the following, which pairs of CNS lesions and corresponding visual field defects is correct?



In a patient with recent onset of alcohol amnestic disorder, the mental status test most likely to be done poorly is memory of which of the following?



The most common cause of fainting is which of the following?



A chronic alcoholic has Wernicke´s encephalopathy. Lab data show a decrease in erythrocyte transketolase activity. He also shows signs of peripheral neuropathy. What is the deficiency involved?



Following a nerve injury that results in axonal injury, the approximate rate at which the axons regenerate is



The optimal treatment for cerebellar disease is which one of the following?



Depending on the site or involvement, diabetic neuropathy does NOT present clinically as which of the following?



An alcoholic male aged 67 years is diagnosed with heatstroke. Which of the following factor is NOT supportive of a diagnosis of heatstroke over heat exhaustion?



A 25 year old white female suddenly develops unilateral loss of vision and diplopia followed by dysarthria, hyperreflexia, vertigo, and parasthesias. Over a period of time these neurological signs and symptoms relapse and aggravated during pregnancy and a bronchitis episode. Brain CT scan would reveal



A 74 year old woman with Alzheimer´s disease suddenly becomes comatose and dies due to an intracranial hemorrhage that caused severe damage to her entire left cerebral hemisphere. No evidence of trauma is present. The most likely caused of this hemorrhage is



A 40-year-old hypertensive and type 1 diabetic has involuntary jerking movements of his upper extremities, facial grimacing, and choreiform movements for the last 8 to 10 months. He has also had trouble with his memory. One occasion, he has lost his way while walking home. What would be the most appropriate therapy for the patient´s involuntary movements?



A 10-year-old boy has difficulty walking, headache, nausea, and vomiting for the past 3 days. He has nuchal rigidity and papilledema. A CT scan reveals an infiltrating cerebellar tumor in the midline (vermis) with plaque-like extensions onto the cerebellar surface. There is no cystic component. The fourth ventricle is compressed, and the third and lateral ventricles are dilated. His 3 siblings are all healthy. Which of the following is the most likely diagnosis?



A 27-year-old man has weakness and tingling that began in hind feet and has since progressed to involve his thighs and upper limb making him somewhat unsteady. He had diarrhea 3 weeks back. Reflexes are absent. Which is most appropriate in confirming the diagnosis?



A 29-year-old woman has had a throbbing headache of the left supra-orbital area for the last 2 hours along nausea. She has had similar episodes in the past at the time of menses. No neck stiffness, fever, or recent head trauma exists. One hour ago, she took 400 mg ibuprofen, with no relief. She has no other medical issues and rest examination is normal. Which of the following is the appropriate management at this time?



A 45-year-old woman has generalized weakness and a sensation of "pins and needles" for the past week. She exercise daily, rarely drinks alcohol, and is a strict vegetarian. Being vitally stable, she has weakness of the proximal and distal muscles of the lower extremities. Deep tendon reflexes are increased. The gait is ataxic. Which of the following is the most likely diagnosis?



A 65-year-old Caucasian man who has multiple myeloma presents complaining of rapidly progressing weakness of his legs. He also complains of back pain, numbness in his legs bilaterally, and a few episodes of urinary incontinence. He was diagnosed with multiple myeloma 3 months prior and is undergoing treatment with thalidomide and systemic corticosteroids. Which of the following is the most likely cause of his new complaints?



A 61 year old man was admitted a month ago with a left hemiparesis due to a right thalamic infarction. He re-presents with painful subluxation of his left shoulder. 2 weeks later he develops severe, constant burning left shoulder pain which radiates down his arm. He found no relief from paracetamol. Most likely to relieve his pain is which one of the following?



A lesion of the frontal lobe causes which one of the following?



A male aged 50 years is admitted to hospital in an unconscious state and smelling of alcohol. One hour after admission he become suddenly sweaty with a regular tachycardia of 110/min and a BP of 100/50 mmHg. The likely condition is which one of the following?



A right carotid artery stenosis could not account for which one of the following?



A 59-year-old has unsteadiness and ataxia along a recent history of nausea and epigastric pain for which she takes an antacid and Cimetidine. She also takes Phenytoin for eight years for her fits. She had also been prescribed amitriptyline for depression, was receiving post-menopausal hormone replacement therapy and was self-medicating with St John´s wort. Which of the following drugs is most likely to be responsible for her presentation?



A female keyboard operator of age 35 year develops pain and numbness in her hands in outer three and a half fingers, palmar aspect. Which of the following is most likely to have been injured?



A patients with known type II diabetes mellitus who is treated with Clorpropamide, is brought to the ER unconscious. His blood sugar is very low. You give the patient 1 ampule of D5 and the patient wakes up promptly. The next appropriate management is



What is a sign of toxicity when evaluating a patient on chronic phenytoin (Dilantin) therapy for a seizure disorder?



A male patient has decided to quit smoking and is gone cigarette free for a few weeks now. If he undergoes smoking withdrawal, the most likely symptom he will have is



A 44-year-old keyboard operator develops the insidious onset of numbness and tingling in her right thumb and index finger. The symptoms are worst at night. Which of the following findings is she most likely to have?



A 70 year old man has been in excellent health. He is brought to the emergency room following a motor vehicle accident. A thorough workup, including imaging of the spine, thorax, and head, is negative, but the patient is admitted for overnight observation. His injuries include several lacerations to the face and extremities as well several contusions to the thorax. He is admitted to the hospital three weeks later for confusion. He is not oriented to time or place, and can recall only 1 out of 6 objective after 3 minutes. Rest of the neurological exam is normal. The most likely diagnosis is



Which one of the following statements is true of Wernicke´s syndrome?



Which of the following neurotransmitter systems has the most pharmacologic support in the pathogenesis of migrane?



A 40 year old female begins to develop progressive neurologic symptoms. Her grandmother had lived with these symptoms for 6 years and died at the age of 61. She states that her father developed similar symptoms and died of the disease 3 years later at the age of 55. The neurodegenerative condition that is consistent with this type of history is



A 25 year old healthy male suffers an automobile accident. He sustains severe head trauma and develops fever, chills, a clear nasal discharge, and a headache six days later. He is most likely having



A woman aged 22 years has headache with neck rigidity. CSF WBC count is 220 cells/ml, which corresponds to a predominant majority of polymorphonuclear cells. Glucose level is 20 mg/dl. The most likely diagnosis is



An immigrant from a third world country has chronic headaches accompanied by chronic mild nuchal rigidity. CSF analysis shows a chronic inflammatory infiltrate i.e., lymphocytes, plasma cells, macrophages, and fibroblasts. The most likely causative agent is



A 20 year old female has had several episodes of headaches usually along nausea and vomiting in the last few years. It comes on suddenly, affecting mainly the left side of the head. Each episode lasts 4-5 hours. During the episode the patient likes to go to her room and turn off the lights. No other relevant findings exist and CNS and HEENT examination is normal. What is the most likely diagnosis?



A 10-year-old girl was recently diagnosed with generalized tonic-clonic epilepsy. Her parents are concerned with the diagnosis and are seeking advice regarding what they should do when the child has a seizure. Which of the following suggestions is appropriate?



A 40-year-old HIV/AIDS man had a seizure. He reports history of fatigue, chronic diarrhea, and 1 week of progressive left-sided weakness along intermittent night sweats, occasional rigors, and a loss of appetite. His last CD4+ lymphocyte count was 138cells/mm3 and the HIV viral load was 650,000 copies/mm3. He is thin and cachectic with a mild left hemiparesis. MRI reveals one large ring-enhancing lesion. He is treated suspecting CNS toxoplasmosis but 10 days later, he worsens and continues having weakness and night sweats. Which is the most appropriate next step?



A 57-year-old woman complains of burning and tingling sensations in the left hand for several months. She has been frequently awakened at night by aching pain in the same hand. She is hypertensive for 3 years and hypercholesterolemic for 2 years and is on thiazide and atorvastatin. Pain is elicited by extreme dorsiflexion of the wrist but no sensory loss. The patient is unable to correctly identify different types of cloth by rubbing it between the left thumb and index linger. Which of the following is the most likely diagnosis?



A 70-year-old man has gait abnormalities and forgetfulness that started a couple of years ago and were gradually improving. 2 months ago, there was a sudden deterioration in cognitive function. He became more forgetful and the gait abnormality worsened. He is vitally stable. No other findings exist and there are no acute changes. What is the most likely etiology?



A 69-year-old woman has recurrent head and neck pain for the past 6 months. She had a hysterectomy with bilateral oophorectomy for extensive endometriosis at the age of 40. There is reduced range of motion of the neck and when the neck is flexed to the right, the patient experiences pain to the right arm. The patient reports occasional transient vertiginous sensations on turning her head. Which of the following is the most appropriate next step in diagnosis?



A 12-year-old boy has diminished vision along frequent throbbing headaches and peripheral visual field defects. Fundoscopy shows papilledema bilaterally. Left-sided sixth-nerve palsy is present. There are no other neurologic deficits. MRI of the head is normal. What would be the most appropriate next step?



A form of generalised seizures is which one of the following?



The vertebral level and corresponding structure that is correct is which one of the following?



A male aged 50 years has 18 months history of parasthesiae of his feet and hands. On exam there is numbness of glove and stocking distribution with generalised hyporeflexia. Nerve conduction studies revealed demyelinative sensory polyneuropathy. The most likely diagnosis is which one of the following?



A 91 year old man is immobile due to severe lower back pain. He is losing weight for 3 months and has weakness, urinary frequency, thirst, poor urinary stream and constipation. Lumbar spine X-ray show severe osteopenia and collapse of the body of the vertebra at L3. Urea and creatinine are elevated and urine dipstick blood ++ and protein +. The important immediate investigation is



A 67-year-old male presents with acute severe headache, ataxia and vomiting. Six hours later he became drowsy. He has left horizontal nystagmus, a partial left sixth cranial nerve palsy and extensor plantar responses. His blood pressure was 188/110 mmHg. What is the most likely cause?



A 62-year-old chronic hypertensive receives Lithium for her bipolar affective disorder. She was previously on anti-hypertensive therapy but recently was added another drug, after which, she developed Lithium toxicity. What drug was added?



55 year old male presents to the ED with new onset of a severe headache associated with nausea and vomiting. He is alert and oriented. Neck rigidity is negative. Anisocoria is present. The most likely diagnosis is



A physician complains of a 3 week history of awakening at night with right-hand discomfort that resolves after several minutes. Mild weakness of-thumb abduction and diminished-pain sensibility on the palmar aspect of the thumb and index finger is found on examination. The most likely diagnosis is



A lady aged 83 year with diabetes mellitus presented with sudden onset of wild flinging movements of the left arm. The movements disappeared during sleep. The most likely explanation is



Which of the following dementia cannot be benefited from specific treatment?



An 84 year old man is brought to you for the first time by his son. The father has recently seen a neurologist who performed a workup for dementia and diagnosed moderate Alzheimer´s disease. True statement regarding the use of a cholinesterase inhibitor in this patient is



A 77-year-old male presents with cognitive impairment and is diagnosed with dementia. Which of the following is the most probable cause of the dementia?



Temporal lobe lesions cause:



During epileptic discharges which of the metabolic events does NOT occur?



A 74 year old woman who has not been eating because of severe gastroenteritis is admitted to the hospital. Blood chemistry reveals a serum sodium of 125 mEq/L. Overly vigorous correction of this electrolyte imbalance would most likely damage which of the following?



A man of 48 years of age presents with an ipsilateral spastic hemiparesis. There is a loss of the senses of position and vibration, with an accompanying pin prick sensation loss and temperature sensation loss on the contralateral side. The most likely diagnosis is



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