10374_Anschel_1p_fm_f.qxd 6/6/03 2:21 PM Page i PRE ® TEST Neurology PreTest® Self-Assessment and Review 10374_Anschel_1p_fm_f.qxd 6/6/03 2:21 PM Page ii Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. 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This recommendation is of particular importance in connection with new or infrequently used drugs. 10374_Anschel_1p_fm_f.qxd 6/6/03 2:21 PM Page iii PRE ® TEST Neurology PreTest® Self-Assessment and Review Fifth Edition David J.Anschel, M.D. Department of Neurology Stanford University School of Medicine Stanford, California McGraw-Hill Medical Publishing Division New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto ebook_copyright 6x9.qxd 10/20/03 11:22 AM Page 1 Copyright © 2004 by The McGraw-HIll Companies, Inc. All rights reserved. Manufactured in the United States of America. 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Contents Introduction . xi The Neurological Examination and Diagnostic Tests Questions . 1 Answers, Explanations, and References . 18 Cerebrovascular Disease Questions . 33 Answers, Explanations, and References . 42 Epilepsy and Seizures Questions . 53 Answers, Explanations, and References . 62 Headache and Facial Pain Questions . 69 Answers, Explanations, and References . 75 Traumatic and Occupational Injuries Questions . 81 Answers, Explanations, and References . 86 Infections Questions . 91 Answers, Explanations, and References . 106 Neoplasms Questions . 119 Answers, Explanations, and References . 125 vii Copyright 2004 by The McGraw-Hill Companies, Inc. Click Here for Terms of Use. 10374_Anschel_1p_fm_f.qxd 6/6/03 2:21 PM Page viii viii Contents Nutritional and Metabolic Disorders Questions . 133 Answers, Explanations, and References . 143 Dementia and Cognitive Disorders Questions . 153 Answers, Explanations, and References . 161 Movement Disorders Questions . 167 Answers, Explanations, and References . 175 Disorders of Myelination Questions . 183 Answers, Explanations, and References . 191 Developmental and Hereditary Disorders Questions . 197 Answers, Explanations, and References . 209 Neuromuscular Disorders Questions . 221 Answers, Explanations, and References . 228 Toxic Injuries Questions . 235 Answers, Explanations, and References . 240 Eye Disease and Visual Disturbances Questions . 245 Answers, Explanations, and References . 258 10374_Anschel_1p_fm_f.qxd 6/6/03 2:21 PM Page ix Contents ix Disturbances of Hearing, Balance, Smell, and Taste Questions . 267 Answers, Explanations, and References . 274 Spinal Cord and Root Disease Questions . 279 Answers, Explanations, and References . 288 Peripheral Neuropathy Questions . 297 Answers, Explanations, and References . 305 Neurological Emergencies Questions . 313 Answers, Explanations, and References . 324 Bibliography . 335 Index . 337 This page intentionally left blank. 10374_Anschel_1p_fm_f.qxd 6/6/03 2:21 PM Page xi Introduction Neurology: PreTest® Self-Assessment and Review, Fifth Edition, is intended to provide medical students, house officers, and physicians with a convenient tool for assessing and improving their knowledge of neurology. The 500 questions in this book are similar to those included in Step 2 of the United States Medical Licensing Examination (USMLE). They may also be a useful study tool for the USMLE Step 3 and clerkship examinations. Each question in this book has a corresponding answer, a reference to a text that provides background for the answer, and a short discussion of various issues raised by the question and its answer. A listing of references for the entire book follows the last chapter. To simulate the time constraints imposed by the qualifying examina- tions for which this book is intended as a practice guide, the student or physician should allot about one minute for each question. After answering all questions in a chapter, as much time as necessary should be spent reviewing the explanations for each question at the end of each chapter. Attention should be given to all explanations, even if the examinee answered the questions correctly. Those seeking more information on a subject should refer to the references listed or to other standard texts in neurology. xi Copyright 2004 by The McGraw-Hill Companies, Inc. Click Here for Terms of Use. This page intentionally left blank. 10374_Anschel_1p_01_f.qxd 6/6/03 2:14 PM Page 1 The Neurological Examination and Diagnostic Tests Questions DIRECTIONS: Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question. 1. An 85-year-old man is being evaluated for gait difficulties. On examina- tion it is found that joint proprioception is absent in his toes. People with impaired position sense will usually fall if they stand with their feet together and do which of the following? a. Flex the neck b. Extend their arms in front of them c. Flex the knees d. Turn the head e. Close their eyes 1 Copyright 2004 by The McGraw-Hill Companies, Inc. Click Here for Terms of Use. 10374_Anschel_1p_01_f.qxd 6/6/03 2:14 PM Page 2 2 Neurology 2. An 81-year-old woman with a history of type II diabetes mellitus and atrial fibrillation presents with right body weakness and slurred speech. She realized that there was a problem on awakening in the morning, and her husband called EMS, who brought her to the emergency room.