Physician Assistant Physician Assistant Neurological System Disorders 2 — Questions and Answers
Question 1: A 70-year-old presents with progressive resting tremor, bradykinesia, and cogwheel rigidity. What is the most likely diagnosis?
- Essential tremor
- Parkinson's disease (Correct answer)
- Wilson's disease
- Huntington's disease
Correct answer: Parkinson's disease
Parkinson's disease presents with the classic triad of resting tremor, bradykinesia, and rigidity, typically beginning unilaterally in older adults.
Question 2: Which neurotransmitter is deficient in Parkinson's disease?
- Serotonin
- Acetylcholine
- Dopamine (Correct answer)
- GABA
Correct answer: Dopamine
Parkinson's disease results from degeneration of dopaminergic neurons in the substantia nigra, leading to dopamine deficiency in the nigrostriatal pathway.
Question 3: A patient presents with sudden severe headache, nuchal rigidity, photophobia, and fever. CSF analysis shows cloudy fluid, elevated protein, low glucose, and neutrophilic pleocytosis. What is the most appropriate immediate treatment?
- Await culture results before starting antibiotics
- IV ceftriaxone and dexamethasone empirically (Correct answer)
- Oral amoxicillin and close outpatient follow-up
- IV acyclovir only
Correct answer: IV ceftriaxone and dexamethasone empirically
Bacterial meningitis is a medical emergency; empiric IV ceftriaxone and dexamethasone (to reduce inflammation) should be started immediately without waiting for culture results.
Question 4: Which type of seizure is characterized by sudden loss of muscle tone causing the patient to fall?
- Absence seizure
- Myoclonic seizure
- Atonic seizure (Correct answer)
- Tonic-clonic seizure
Correct answer: Atonic seizure
Atonic (drop) seizures involve sudden loss of postural muscle tone, causing the patient to fall abruptly without warning.
Question 5: A 30-year-old with epilepsy presents in status epilepticus. After two doses of lorazepam, seizures persist. What is the next pharmacological treatment?
- Oral phenytoin
- IV levetiracetam or fosphenytoin (Correct answer)
- Oral valproate
- Repeat lorazepam indefinitely
Correct answer: IV levetiracetam or fosphenytoin
After benzodiazepine failure in status epilepticus, the next step is IV second-line agents such as levetiracetam, fosphenytoin, or valproate per established treatment algorithms.
Question 6: A 50-year-old presents with symmetric ascending weakness and areflexia following a GI infection 3 weeks prior. CSF shows albuminocytologic dissociation. What is the most likely diagnosis?
- Multiple sclerosis
- Myasthenia gravis
- Guillain-Barré syndrome (Correct answer)
- Amyotrophic lateral sclerosis
Correct answer: Guillain-Barré syndrome
Guillain-Barré syndrome presents with ascending flaccid paralysis, areflexia, and CSF albuminocytologic dissociation (elevated protein with normal cell count), often following infection.
Physician Assistant Physician Assistant Neurological System Disorders 2
A 70-year-old presents with progressive resting tremor, bradykinesia, and cogwheel rigidity.
What is the most likely diagnosis?