SPEX Neurology 5 — Questions and Answers
Question 1: A 40-year-old presents with episodic severe unilateral periorbital pain lasting 30–90 minutes, associated with ipsilateral lacrimation and rhinorrhea, occurring in clusters. What is the diagnosis?
- Migraine with aura
- Cluster headache (Correct answer)
- Trigeminal neuralgia
- Giant cell arteritis
Correct answer: Cluster headache
Cluster headaches are severe unilateral periorbital headaches with autonomic features (lacrimation, rhinorrhea, ptosis) occurring in temporal clusters.
Question 2: Which finding on EEG is pathognomonic for herpes simplex encephalitis?
- 3 Hz spike-and-wave discharges
- Periodic lateralized epileptiform discharges (PLEDs) in temporal regions (Correct answer)
- Burst suppression pattern
- Generalized slowing
Correct answer: Periodic lateralized epileptiform discharges (PLEDs) in temporal regions
HSV encephalitis classically produces periodic lateralized epileptiform discharges (PLEDs) in the temporal lobes on EEG.
Question 3: A patient with known epilepsy presents with continuous seizure activity lasting 30 minutes. What is the first-line treatment?
- Phenytoin IV
- Lorazepam IV (Correct answer)
- Levetiracetam IV
- Phenobarbital IV
Correct answer: Lorazepam IV
Benzodiazepines such as lorazepam are first-line for status epilepticus because of rapid onset and efficacy in terminating seizures.
Question 4: Which sign is assessed by asking a supine patient to flex the hip to 90 degrees and then extend the knee, with pain or resistance indicating meningeal irritation?
- Kernig's sign (Correct answer)
- Brudzinski's sign
- Lhermitte's sign
- Romberg's sign
Correct answer: Kernig's sign
Kernig's sign tests meningeal irritation by resistance or pain with knee extension after hip flexion to 90 degrees.
Question 5: A patient presents with asymmetric limb weakness, tongue fasciculations, hyperreflexia, and dysarthria. Which disease is most likely?
- Multiple sclerosis
- Amyotrophic lateral sclerosis (Correct answer)
- Spinal muscular atrophy
- Cervical myelopathy
Correct answer: Amyotrophic lateral sclerosis
ALS involves simultaneous upper (hyperreflexia) and lower (fasciculations, atrophy) motor neuron degeneration without sensory loss.
Question 6: Which of the following is the most common type of primary brain tumor in adults?
- Meningioma
- Glioblastoma multiforme (Correct answer)
- Oligodendroglioma
- Ependymoma
Correct answer: Glioblastoma multiforme
Glioblastoma multiforme (GBM) is the most common and most malignant primary brain tumor in adults, with a median survival of 14–16 months.
Question 7: A 72-year-old develops progressive cognitive decline, gait disturbance, and urinary incontinence. MRI shows enlarged ventricles without cortical atrophy. What is the likely diagnosis?
- Alzheimer's disease
- Vascular dementia
- Normal pressure hydrocephalus (Correct answer)
- Creutzfeldt-Jakob disease
Correct answer: Normal pressure hydrocephalus
Normal pressure hydrocephalus (NPH) presents with the classic triad of dementia, gait apraxia (magnetic gait), and urinary incontinence with ventriculomegaly on imaging.
SPEX Neurology 5
A 40-year-old presents with episodic severe unilateral periorbital pain lasting 30–90 minutes, associated with ipsilateral lacrimation and rhinorrhea, occurring in clusters.
What is the diagnosis?