NEUROPSYCHIATRY

FINAL ROUND
1. Choose the true statement concerning migraine headache
a. Auras in patients with migraine may include hemiplegi, ataxia, or visual field defects.
b. The pain is typically unilateral just in one side and rarely change to another side
c. The site of recurrent migraine headaches typically varies somewhat with each episode
of pain
d. Migraines are often unpredictable and typically cause severe, sharp, bitemporal pain
e. The prodrome occurs before the aura and is manifested by symptoms of depression,
elation, or hunger
2. You can isolate the function of seventh cranial nerve by:
a. Having the patient raise his eyebrows
b. Having the patient whistle or pursue lips
c. Testing the corneal reflex
d. Looking for the asymmetry of tongue extension
3. Choose the correct statement about headache:
a. Pain fibers arising from periventricular white matter as well as from intracranial
arteries and veins may contribute to headache.
b. A tumor below the tentorium will generally cause referred pain to the base of the
skull.
c. Unlike more superficial tumors, headache is an early symptom of brain lesions that lie
deep within the cortex
d. Acute CSF outflow obstruction is generally painless
e. Headache of intracranial origin, unlike pain from extracranial structures, will
generally remain unchanged with any maneuver such as direct pressure to the
temporal area or head shaking
4.

A 32-year-old man complains of a chronic, dull orbital headache. The pain is constant
and made worse by head movements. Sleeping helps, nut the pain may be present in the
morning. Neurologic examination reveals only a right plantar extensor response. The
most likely cause of this headache is:
a. Sinus infection
b. Supratentorial tumor
c. Infratentorial tumor
d. Muscle tension
e. Metabolic

5. A 40-year-old male complains of a unilateral periorbital headache accompanied by

rhinorrhea and lacrimation. He probably is experiencing:
a. Migraine with aura

b.
c.
d.
e.

Migraine without aura

Trigeminal neuralgia
Cluster headache
Temporal arteritis.

6. A 70-year-old male is brought by ambulance from home. He has an acute left hemiplegia
affecting the leg more than the arm and face. He also has grasp and suck reflexes and he
perseverates. He also has visual dysfunction and memory-cognitive impairment. The
most likely vascular territory of his stroke is in the distribution of
a. Middle cerebral artery (MCA)
b. Posterior cerebral artery (PCA)
c. Anterior cerebral artery (ACA)
d. Antero-inferior cerebellar artery (AICA)
e. Postero-inferior cerebellar artery (PICA)
7. A 63-year-old man developed a transient episode if vertigo, slurred speech, diplopia, and
paresthesias. He is symptoms free now, and clinical examination is entirely normal. His
past medical history is significant for hypertension and dyslipidemia. Which of the
following is the most likely cause for symptoms?
a. Posterior circulation transient ischemic attack (TIA)
b. Anterior communicating artery aneurysm
c. Hypertensive encephalopathy
d. Pseudobulbar palsy
e. Occlusion of the middle cerebral artery.
8. A 40-year-old-man is injured in a car accident And fractures his left elbow. He now
complains of numbness of his fourth and fifth fingers, and weakness in his hand grip.
Neurologic findings confirm weakness of handgrip with weakness of hand adduction and
abduction, and decreased sensation over the fifth finger and lateral aspect of fourth finger.
Which of the following is the most likely diagnosis?
a. Ulnar nerve injury
b. Radial nerve injury
c. Median nerve injury
d. Carpal nerve injury
e. Axillar nerve injury
9. A 68-year-old man has many months history of progressive hearing loss, unsteady gait,
tinnitus, and facial pain. An MRI scan reveals a tumor at cerebellopontine angle. Which
of the following cranial nerves is this tumor most likely affect?
a. Fourth cranial nerve
b. Fifth cranial nerve
c. Eight cranial nerve
d. Tenth cranial nerve
e. Eleventh cranial nerve

10. A 19-year-old man has had progressive ataxia of gait and great difficulty in running. In
the past year, he has developed hand clumsiness. Physical examination reveals pes cavus,
kyphoscoliosis, and both cerebellar and sensory changes in legs. Theres family history of
Friedrichs ataxia. Where are the pathologic changes seen in this condition most likely to
be found?
a. Spinal cord tracts
b. Basal ganglia
c. Cerebral cortex
d. Peripheral autonomic nerves
e. Peripheral motor nerves
11. A 31-year-old man complains of daily throbbing headaches for the las 2 weeks. He has
approximately eight episodes per day, each lasting 20 minutes. The headaches are
localized unilaterally to the left periorbital area and are accompanied by tearing of the left
eye, left ptosis, rhinnorea, and left facial redness. Which of the following is the most
likely diagnosis?
a. Migraine headache
b. Cluster headache
c. Tension type headache
d. Trigeminal neuralgia
e. Sinusitis
12. A 49-year-old woman is brought to the emergency room after suddenly losing
consciusness. Her husband states that his wife was healthy until 2 days ago complained
about severe headache. After one episode vomiting, the patient lost consciousness. On the
physical examination, she has neck stiffness. Her deep reflexes are bilaterally equal, so
does the flexor plantar response. Which of the following is the best initial diagnostic test?
a. Lumbar puncture
b. MRI of the brain
c. Angiography
d. CT scan of the brain
e. Cerebral angiography
13. A man presents with facial asymmetry. On physical examination, touching the cornea of
either eye with cotton swab results in blinking of only the left eye. The patient states that
he feels the cotton swab touch in both eyes. Which of the following is the most likely
diagnosis?
a. Lesion of left trigeminal nerve
b. Lesion of right trigeminal nerve
c. Lesion of right facial nerve
d. Lesion of left facial nerve
e. Lesion of left occulomotor nerve

14. Examination of a patients visual fields reveals complete blindness in the left eye but the
right eye is unaffected. Ophtalmoscopic examination is normal. Which of the following
lesions is most likely causing this abnormality?
a. Lesion between the optic chiasm and lateral geniculate body
b. Lesion between the optic chiasm and retina
c. Lesion between lateral geniculate body and visual cortex
d. Lesion at the medial longitudinal fasciculus
e. Lesion bilateral of the occipital lobes
15. A 26-year-old woman presents with chief complain of weakness that worsens throughout
the day. She especially notices weakness and feeling tired when chewing food. The
patient states that she feels strong in the morning but weakness develops over the course
of the day. She also complains of her eyelids drooping and occasional diplopia.
Neurologic examination reveals ptosis after 1 minute of sustained upward gaze. Which of
the following is the most likely diagnosis?
a. Lambert Eaton myasthenic syndrome
b. Botulism
c. Myasthenia gravis
d. Multiple sclerosis
e. Guillan-barre syndrome
16. A 55-year-old woman comes to the office because she has a 20-year history of repetitive
actions and is tired of wasting time by repeating these actions. The patient says she
repeatedly checks the doors in her house to make sure they are locked, washes her hands
several times per hour, and checks her electrical appliances three times each morning
before she leaves for work. Medical history includes second-degree atrioventricular
block. Which of the following medications is the most appropriate initial therapy for this
patient's psychiatric disorder?
(A) Clomipramine
(B) Clonazepam
(C) Methylphenidate
(D) Quetiapine
(E) Sertraline

A 20-year-old woman who is a college student comes to the health services center because she
has had symptoms of depression for the past three months, since she was a victim of date rape at
a party. The patient says she was heavily intoxicated when the incident occurred and has little
memory of the event, but she was embarrassed and ashamed when she awoke at the scene and
realized what had happened. She did not seek medical care at that time. The patient says she has

not told her friends about the incident, and she has continued to attend classes and work part
time. However, she says she constantly feels sad and anxious, has become tearful and withdrawn,
and has had difficulty sleeping because of frightening nightmares. This patient most likely has
which of the following
psychiatric conditions?
(A) Acute stress disorder
(B) Adjustment disorder, unspecified
(C) Generalized anxiety disorder
(D) Major depressive disorder
(E) Post-traumatic stress disorder
A 42-year-old man is referred to the office for mental health evaluation. The patient says he has a
long-standing fear of criticism and rejection. He also has feelings of inadequacy and refuses to
try new activities because of his fear of embarrassment. The patient has held the same entry-level
position at his workplace for the past 14 years despite several opportunities for promotion.
The patient is unmarried and has only had one intimate relationship,
which lasted only a few weeks. He has few friends other than those in his model airplane club.
Which of the following personality disorders is the most likely diagnosis?
(A) Avoidant
(B) Dependent
(C) Paranoid
(D) Schizoid
A 35year old woman is brought to the emergency department by mbulance after police were
called to her home by a neighbor, who witnessed rape and robbery by two intruders. The patient
is fully alert and oriented to person, place, and time. She cannot remember anything about the
incident. Which of the following is the most likely cause of this finding?
(A) Depersonalization/derealization disorder (depersonalization disorder)
(B) Dissociative amnesia
(C) Fugue state
(D) Traumatic brain injury
(E) Volitional memory loss

A
5-year-old boy is brought to the clinic by his mother because she is worried about
changes in his behavior during the past few months. The patient's mother says he has had
episodes that occur sporadically at night during which he sits up in bed screaming, crying
incoherently, and intensely frightened. She says it is initially difficult to calm him down, and he
is usually sweating, breathing rapidly, and tremulous. The patient eventually calms down after 10
to 15 minutes and then falls asleep. Which of the following questions is most appropriate to
confirm the suspected
diagnosis of sleep terror disorder in this patient?
(A) Do his arms and legs jerk during sleep?
(B) Does he have nightmares?

(C) Does he to go to sleep late?

(D) Does he watch violent movies?
(E) Does he wet the bed?