A 31-year-old female presents with throbbing right-sided headache that she rates as 8/10 in intensity. She states her pain began approximately 12 hours ago, and is accompanied by nausea. She finds some relief when sitting in a quiet, dark room. She reports that prior to the onset of her headache, she noticed a 'bright spot' in her left lateral vision that later expanded to form a crescent with 'zigzagging' lines of color that has made her feel as if she was 'blind.' This lasted 30 minutes and then resolved, and was followed by the headache. She experiences similar episodes approximately once every two months. Physical exam is completely normal. Which of the following is the most appropriate initial step in management?

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Neurological Assessment Questions Questions

Question 1 of 5

A 31-year-old female presents with throbbing right-sided headache that she rates as 8/10 in intensity. She states her pain began approximately 12 hours ago, and is accompanied by nausea. She finds some relief when sitting in a quiet, dark room. She reports that prior to the onset of her headache, she noticed a 'bright spot' in her left lateral vision that later expanded to form a crescent with 'zigzagging' lines of color that has made her feel as if she was 'blind.' This lasted 30 minutes and then resolved, and was followed by the headache. She experiences similar episodes approximately once every two months. Physical exam is completely normal. Which of the following is the most appropriate initial step in management?

Correct Answer: B

Rationale: Migraine with aura (visual scotoma) and throbbing headache with nausea/photophobia responds acutely to triptans (e.g., sumatriptan). Ondansetron treats nausea, propranolol is prophylactic, and verapamil is for cluster headaches.

Question 2 of 5

A 62-year-old man is brought to the emergency department by his wife because 'he's been acting strangely.' She noticed that during social gatherings he would not say much, and would mostly sit by himself. He barely bathes. When left in place he would stay there until he is told to move. He would not seek his favorite activities including watching football but when sat in front of the TV he seemed to enjoy it. On the Montreal Cognitive Assessment (MoCA) testing, he could not complete the trails testing, his clock was disorganized, and he named only 3 items starting with the letter 'F' in 60 seconds. His free recall was poor but improved with cuing. His visuospatial functioning was relatively spared. He had paratonia, but no other abnormalities on motor exam. Magnetic resonance imaging of the brain showed frontal atrophy, but no other focal abnormalities. Which of the following is most likely the diagnosis?

Correct Answer: C

Rationale: Apathy, disinhibition, and executive dysfunction with frontal atrophy suggest behavioral variant frontotemporal dementia. Alzheimer’s affects memory more, depression lacks atrophy, and Parkinson’s involves motor symptoms.

Question 3 of 5

The central communication conduit between the brain and the rest of the body is the

Correct Answer: C

Rationale: The spinal cord serves as the primary pathway for signals between the brain and the body, connecting the central nervous system (CNS) to the peripheral nervous system (PNS). The brain stem regulates vital functions, but the spinal cord is the conduit.

Question 4 of 5

The gap between the transmitting and receiving neurons in a chemical synapse is known as the

Correct Answer: D

Rationale: The synaptic cleft is the small space between the presynaptic and postsynaptic neurons where chemical transmission occurs.

Question 5 of 5

The brain and sensory system of a bilaterally symmetric organism function most like

Correct Answer: B

Rationale: The brain directs the body like a pilot, processing sensory input and coordinating responses in bilaterally symmetric organisms.

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