SPEX Neurology 2 — Questions and Answers
Question 1: A 60-year-old presents with sudden onset of the worst headache of his life. CT head is negative. What is the next best step?
- Lumbar puncture (Correct answer)
- MRI brain with contrast
- CT angiography
- Discharge with pain management
Correct answer: Lumbar puncture
A negative CT does not rule out subarachnoid hemorrhage; lumbar puncture is required to detect xanthochromia or red blood cells.
Question 2: Which dermatome corresponds to the area over the nipple line?
- T6
- T4 (Correct answer)
- T8
- T2
Correct answer: T4
T4 supplies the nipple line and is a classic landmark for dermatome mapping.
Question 3: A patient with MS develops a painful, unilateral loss of vision with an afferent pupillary defect. What is the most likely diagnosis?
- Retinal detachment
- Optic neuritis (Correct answer)
- Central retinal artery occlusion
- Acute angle-closure glaucoma
Correct answer: Optic neuritis
Optic neuritis causes painful vision loss and a relative afferent pupillary defect (RAPD), and is strongly associated with MS.
Question 4: Which of the following is characteristic of a lower motor neuron (LMN) lesion?
- Spasticity
- Hyperreflexia
- Fasciculations (Correct answer)
- Babinski sign
Correct answer: Fasciculations
LMN lesions cause flaccid paralysis, hyporeflexia, atrophy, and fasciculations.
Question 5: A 45-year-old woman presents with bilateral leg weakness, saddle anesthesia, and urinary retention after a fall. What is the most likely diagnosis?
- Conus medullaris syndrome
- Cauda equina syndrome (Correct answer)
- Central cord syndrome
- Anterior cord syndrome
Correct answer: Cauda equina syndrome
Cauda equina syndrome presents with saddle anesthesia, bowel/bladder dysfunction, and lower extremity weakness due to compression of lumbar nerve roots.
Question 6: Which neurotransmitter is primarily 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 pars compacta.
Question 7: A patient presents with ptosis, miosis, and anhidrosis on the right side of the face. Which syndrome does this represent?
- Wallenberg syndrome
- Horner syndrome (Correct answer)
- Claude syndrome
- Weber syndrome
Correct answer: Horner syndrome
Horner syndrome consists of ptosis, miosis, and anhidrosis caused by interruption of the sympathetic pathway.
SPEX Neurology 2
A 60-year-old presents with sudden onset of the worst headache of his life.
CT head is negative.
What is the next best step?