Neurological Practice Questions

Correct Answer: A) Right cerebral hemisphere (left motor cortex)

Rationale: The motor cortex crosses over (decussates) in the medulla; the right motor cortex controls the left body side. Facial droop, weakness, and speech difficulties (slurred from facial weakness and/or expressive aphasia if Broca's area involved) indicate a right-hemisphere stroke affecting the left precentral gyrus. Time is critical: this patient needs imaging (CT/MRI) and assessment for thrombolytic or thrombectomy eligibility (within 4.5 hours for tPA).

Key Concept: Remember FAST for stroke recognition: Face drooping, Arm weakness, Speech difficulty, Time to call 911. Contralateral motor/sensory deficits indicate anterior circulation stroke. Posterior circulation strokes affect coordination, vision, and brainstem signs (vertigo, nystagmus).

Correct Answer: B) Establish airway, administer oxygen, prevent injury

Rationale: During status epilepticus, airway protection is the priority to prevent aspiration and hypoxia. Oxygen maintains cerebral perfusion. Preventing injury means clearing the area of hazards and positioning on side. Never insert objects in the mouth (risk of injury and airway obstruction). Don't restrain—gentle positioning suffices. IV anticonvulsants (lorazepam, fosphenytoin) are needed urgently to stop the seizure, not oral medication.

Key Concept: Status epilepticus is a medical emergency with high mortality. Rapid seizure termination is critical. First-line treatment: IV benzodiazepines (lorazepam 4 mg IV) repeated if needed. Second-line: phenytoin, levetiracetam, or fosphenytoin. Supportive care: airway management, prevent aspiration, monitor for complications (rhabdomyolysis, acute kidney injury).

Correct Answer: C) Total 9, indicating severe head injury

Rationale: GCS total = 3 + 2 + 4 = 9. GCS severity: 13-15 mild, 9-12 moderate, ≤8 severe. A score of 9 indicates severe head injury. This patient needs ICU monitoring, frequent neuro checks, and vigilance for increased intracranial pressure (ICP). They may need intubation to protect airway. GCS is reassessed frequently to detect deterioration (indicating increased ICP) or improvement.

Key Concept: GCS is essential for assessing level of consciousness in neurological conditions. Score ≤8 indicates need for airway protection. Serial GCS measurements detect trends. Factors affecting GCS: sedation, alcohol/drugs, locked-in syndrome. Pupil checks and motor response are key indicators of herniation risk.

Correct Answer: B) Amino acids compete with levodopa for intestinal absorption and blood-brain transport

Rationale: Levodopa is absorbed via the large neutral amino acid transporter (LAT). Dietary protein (containing amino acids like tyrosine, phenylalanine) competes for this same transporter, reducing levodopa absorption and CNS delivery. This decreases medication efficacy and symptom control. Levodopa should be taken on an empty stomach or with low-protein meals. Timing meals away from doses improves medication effect.

Key Concept: Parkinson's medications: levodopa/carbidopa (symptom control), dopamine agonists, MAO-B inhibitors, COMT inhibitors. Long-term levodopa use causes complications: on-off fluctuations, dyskinesias, motor complications. Patient education on timing, protein avoidance during medication, and realistic expectations about disease progression is essential.

Correct Answer: B) Spinal shock with loss of reflexes and hypotension

Rationale: Spinal shock occurs immediately after SCI, causing flaccid paralysis, loss of reflexes, and hypotension (loss of sympathetic tone). Duration is days to weeks. Management: aggressive fluid resuscitation, vasopressors if needed for mean arterial pressure maintenance (goal >65 mmHg to improve spinal perfusion), and methylprednisolone within 8 hours if indicated. After spinal shock resolves, autonomic dysreflexia becomes the concern (hypertensive crisis triggered by noxious stimuli below injury in pts with high thoracic/cervical injuries).

Key Concept: SCI management requires immediate stabilization, preventing secondary injury, and careful neurological monitoring. Long-term complications include bowel/bladder dysfunction, sexual dysfunction, respiratory compromise (cervical injuries), and psychological adjustment. Rehabilitation and patient education are essential for optimal outcomes.