Neurology

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Atrial Fibrillation & Recurrent Stroke

In patients with atrial fibrillation-related stroke treated with appropriate anticoagulation, the risk of recurrent stroke remains high.

  • True
  • False
Volume 41.1 - Question 30

Gabapentinoids and Heart Failure

Compared to new users of gabapentin, new users of pregabalin had higher rates of incident heart failure hospitalizations in patients aged 65 to 89 years with chronic non cancer pain and no history of heart failure.

  • True
  • False
Volume 41.1 - Question 23

Neuropathic Pain

Which one of the following statements about the treatment of neuropathic pain is false?

  • Duloxetine results in at least a 50% reduction in pain.
  • There is good evidence to support the use of venlafaxine.
  • Pregabalin at dosages of 300 mg/day or greater leads to at least moderate benefit.
  • Topiramate has no benefit.
Volume 41.1 - Question 22

Sudbury Clinical Decision Rule for Vertigo

The Sudbury vertigo risk score can identify the risk for a serious diagnosis in patients presenting with vertigo.

  • True
  • False
Volume 41.1 - Question 20

Head Injuries in Older Adults

Which one of the following is not a risk factor for traumatic intracranial hemorrhage in patients 65 years or older presenting in the emergency department for a ground-level fall-related head injury?

  • Focal neurologic signs
  • External signs of head trauma
  • Male sex
  • Oral anticoagulant use
Volume 41.1 - Question 19

Blood Pressure Treatment in Hemorrhagic Stroke

Intensive BP-lowering initiated within several hours of intracerebral haemorrhage onset improves functional recovery.

  • True
  • False
Volume 41.1 - Question 4

Cervical Fractures in Older Adults

Which one of the following statements about cervical fractures in older adults is false?

  • The most frequent mechanism is fall from a standing position.
  • They carry a lower mortality rate than hip fractures.
  • One-year mortality for cervical fractures without spinal cord injury is greater than 20%.
  • The most common cervical fracture in older adults involves C2.
Volume 41.1 - Question 2

Gepants and Migraine

Which one of the following statements regarding calcitonin gene-related peptide receptor antagonists (gepants) in the treatment of acute migraine is false?

  • They inhibit neuroinflammation and vasodilation associated with migraine development.
  • They have demonstrated superiority compared to placebo for improved function at 2 hours.
  • There are no vascular contraindications.
  • They have been approved for treatment in children.
Volume 40.6 - Question 21

Triptans and Migraines

Which one of the following statements about triptans for the acute treatment of migraines is false?

  • There is no evidence for difference in treatment outcomes between various triptans.
  • Nearly one-third of patients using triptans will have inadequate response.
  • They are approved for use in children younger than six.
  • They should be avoided in patients with a history of myocardial infarction.
Volume 40.6 - Question 20

Golf and Risk of Parkinson Disease

Living within 1 to 3 miles of a golf course is associated with an increased risk of parkinson disease.

  • True
  • False
Volume 40.6 - Question 17

Endovascular Management of Vertebrobasilar Stroke

In patients with vertebrobasilar artery occlusion with moderate to severe symptoms, endovascular therapy increased the likelihood of achieving a favourable functional outcome.

  • True
  • False
Volume 40.4 - Question 32

Transfusion Threshold in Acute Brain Injury

A liberal transfusion threshold, targeting a hemoglobin of 9g/dL compared to a restrictive  strategy targeting a hemoglobin of 7g/dL, was associated with a lower risk of unfavorable neurological outcome at 180 days in patients with acute brain injury.

  • True
  • False
Volume 40.4 - Question 31

Anti-Amyloid Therapies for Alzheimer Disease

Which one of the following statements about anti-amyloid therapies for Alzheimer disease is false?

  • They have shown evidence for slowing clinical disease progression.
  • Eligibility criteria would include the confirmation of the presence of amyloid in the brain by either amyloid-PET scan or CSF analysis.
  • Treatment would be reserved for patients with moderate to severe disease.
  • Follow up magnetic resonance imaging of the brain is required to screen for development of amyloid-related imaging abnormalities.
Volume 40.3 - Question 3

Sudden Vision Loss

Which one of the following statements about the management of sudden vision loss is false?

  • Because intravenous thrombolysis may be beneficial in selected patients with central artery occlusion within the first 4.5 hours, emergent consultation with a stroke neurologist is recommended in the hyperacute period.
  • Following embolic central retinal artery occlusion, underlying modifiable systemic risk factors should be addressed because the patient is at high risk of a cerebrovascular event or a similar incident in the second eye.
  • When there is high clinical suspicion for giant cell arteritis, empiric steroids should be delayed until a temporal artery biopsy is obtained.
  • High-dose corticosteroids are the first-line treatment for acute optic neuritis because they shorten visual recovery time compared with placebo.
Volume 40.3 - Question 1

Carpal Tunnel Syndrome Management

Which one of the following statements about the management of carpal tunnel syndrome is false?

  • Up to one-half of patients with nonsevere symptoms spontaneously improve within 2 years.
  • Splints should be worn for at least 1 to 2 months.
  • Short courses of prednisone (i.e., less than 2 weeks) are more effective than local corticosteroid injections.
  • Yoga can improve pain and grip strength compared with wrist splinting.
Volume 40.2 - Question 12

Carpal Tunnel Syndrome

Which one of the following statements about carpal tunnel syndrome (CTS) is false?

  • Thenar atrophy has a very high specificity for CTS.
  • Phalen test and Tinel sign individually have high sensitivity and specificity.
  • Nerve conduction studies are normal in up to 15 to 25% of patients.
  • There is limited evidence for the use of ultrasonography for the diagnosis of CTS.
Volume 40.2 - Question 11

Parkinson’s Disease

Which one of the following statements about Parkinson’s disease is false?

  • Nonmotor symptoms often predate the onset of motor symptoms by many years.
  • No imaging technique can confirm the diagnosis.
  • Motor symptoms of slowness tend to be symmetric.
  • No available pharmacologic therapy slows progression of the disease.
Volume 40.1 - Question 31

Postural Insoles in Stroke

In stroke patients, postural insoles improve static balance, gait symmetry, and spatiotemporal gait parameters compared with physical therapy alone.

  • True
  • False
Volume 40.1 - Question 30

Vestibular Rehabilitation after Stroke

Patients suffering from stroke can continue to see improvement in balance and gait with vestibular rehabilitation therapy up to 6 months after stroke onset.

  • True
  • False
Volume 39.6 - Question 34

Lixisenatide in Parkinson’s Disease

In early Parkinson’s disease, glucagon-like peptide-1 (GLP-1) receptor agonist lixisenatide results in less progression of motor disability than placebo at 12 months.

  • True
  • False
Volume 39.6 - Question 33

The Twitchy Tongue - An Approach

Which one of the following statements about hyperkinetic movements of the tongue is false?

  • Epileptic conditions are a situation in which hyperkinetic movements of the tongue may be represented.
  • Cortical infarcts could be manifested as tongue tremors.
  • Tardive dyskinesia does not involve any parts of the tongue.
  • Isolated tongue tremor may be a presentation of idiopathic Parkinson’s disease.
Volume 39.6 - Question 25

Lumbar Spinal Stenosis

Which one of the following statements about lumbar spinal stenosis is false?

  • Loss of balance associated with low back pain has a 70% sensitivity for lumbar spinal stenosis.
  • A wide-based gait with a positive Romberg sign has a 90% specificity for lumbar spinal stenosis.
  • Computed tomography myelography is recommended over MRI to provide diagnostic information for patients with lumbar spinal stenosis symptoms.
  • Symptoms are aggravated by walking and relieved by bending forward.
Volume 39.6 - Question 22

Cavernous Malformations of the Central Nervous System

Which one of the following statements about cavernous malformations of the central nervous system is false? 

  • Sporadic, single cerebral cavernous malformations (CCMs) are most common.   
  • Radiation-induced CCMs typically develop within 2 years after cranial radiation therapy.   
  • Focal seizures are a common presentation.   
  • Routine use of anti-thrombotic medication does not appear to increase the risk of CCM bleeding. 
Volume 39.5 - Question 34

Blood Pressure Management Post Endovascular Thrombectomy for Stroke

Intensive blood pressure reduction versus conservative blood pressure management following endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion reduces which one of the following? 

  • Functional independence.   
  • 90-day mortality.   
  • Symptomatic intracranial hemorrhage.   
  • Hypotensive events. 
Volume 39.5 - Question 33

MOCA Cutoff Scores in Diverse Settings

Current Montreal Cognitive Assessment (MoCA) cutoff scores are appropriate for diverse populations in an urban setting. 

  • True
  • False
Volume 39.5 - Question 20

Brexpiprazole in Alzheimer Disease

Brexpiprazole improves agitation scores in adults with Alzheimer disease and agitated behaviors. 

  • True
  • False
Volume 39.5 - Question 18

Dementia

Three years of daily use of a single strong anticholinergic medication at the minimum effective dose recommended for older people is associated with 50% increased odds of dementia.

  • True
  • False
Volume 35.61 - Question 28

Epilepsy

Volume 39.4 - Question 44

Antihypertensive Treatment Post Stroke

Among patients with mild-to-moderate acute ischaemic stroke and systolic blood pressure between 140 mm Hg and <220 mm Hg who did not receive intravenous thrombolytic treatment, early antihypertensive treatment (day 1 to 2 vs day 8) reduces the odds of dependency or death at 90 days. 

  • True
  • False
Volume 39.4 - Question 32

Advance Care Planning and Huntington Disease

In patients with Huntington disease, engaging in advance care planning discussions does not cause untoward effects on suicidal thoughts and behaviours. 

  • True
  • False
Volume 39.4 - Question 18

Essential Tremor

Injection of botulinum toxin into each splenius capitis muscle on day 0 and during week 12 was more effective than placebo in reducing the severity of isolated or essential head tremor at 18 weeks.

  • True
  • False
Volume 39.3 - Question 32

Levetiracetam for Status Epilepticus in Epilepsy

After initial benzodiazepine therapy, intravenous levetiracetam is superior to valproic acid for the management of status epilepticus. 

  • True
  • False
Volume 37.3 - Question 33

Cluster Headache Treatment

Which one of the following therapies is not recommended for the treatment of cluster headaches?

  • 100% oxygen
  • Nasal lidocaine
  • Long-term use of corticosteroids
  • Melatonin
Volume 37.3 - Question 25

Cluster Headache

Which one of the following statements about cluster headache is false?

  • Photophobia is a typical symptom.
  • It is associated with one or more ipsilateral autonomic symptoms including conjunctival injection and lacrimation.
  • It can last from 15 to 180 minutes.
  • Neuroimaging with computed tomography or magnetic resonance imaging is not routinely recommended.
Volume 37.3 - Question 24

Neurologic Complications after Cardiac Surgery

Neurologic complications after cardiac surgery have been classically divided into type 1 and type 2 deficits. Type 1 deficits — stroke or transient ischemic attack related to perioperative hypoperfusion, embolization or hemorrhage — occur in about 2% of patients undergoing cardiac surgery, usually early in the perioperative period. Type 2 deficits (previously termed “pump-brain”) include more subtle neurocognitive complications such as postoperative cognitive dysfunction, delirium and mood disorders.  Which one of the following statements about type 2 deficits is false? 

  • Postoperative cognitive dysfunction occurs in about 50%–70% of patients in the first week postoperatively.  
  • Less than 10% of affected patients continue to experience cognitive dysfunction 1 year later.  
  • Older age is a risk factor.  
  • Subtle cognitive deficiencies might only be noticed later by caretakers at home.
Volume 36.6 - Question 30

Canadian TIA Score

In adult patients presenting to emergency department after transient ischaemic attack, the Canadian TIA Score outperformed the ABCD2 tool to stratify seven-day risk of stroke. 

  • True
  • False
Volume 36.6 - Question 25

Non-Consensus Transient Ischemic Attack

Which one of the following statements about patients with non-consensus transient ischemic attack (TIA) as compared to classic TIA is false?

  • They had a lower 90–day stroke risk after index event. 
  • They were less likely to seek medical attention on day of event. 
  • They were more likely to have recurrent strokes before seeking medical attention. 
  • There is a similar 10–year risk of all major vascular events. 
Volume 36.6 - Question 1

Drugs for Multiple Sclerosis

Which one of the following statements about the use of medications to treat Multiple Sclerosis (MS) is false? 

  • Patients with highly active relapsing MS should receive initial treatment with high efficacy disease modifying drugs such as natalizumab or an anti-CD20 antibody.   
  • For less active cases of MS, a less effective drug with less toxicity such as interferon beta or glatiramer acetate may be appropriate.   
  • Interferon beta is not considered safe for use in pregnancy.   
  • Glatiramer acetate can reduce clinical relapse rates of MS by about 30%. 
Volume 36.5 - Question 23

Peripheral Nerve Blocks for Primary Headaches

Peripheral nerve blocks are effective as a rapid treatment option for the treatment of primary headache disorders, which include migraine, tension headache, and cluster headaches.

  • True
  • False
Volume 37.6 - Question 18

Acute Liver Failure

N-acetylcysteine improves overall survival in the treatment of non-acetaminophen-related acute liver injury. 

  • True
  • False
Volume 36.3 - Question 33

Migraine

Which one of the following statements about migraine is false? 

  •  Aura symptoms may occur in the absence of a subsequent headache.   
  • There is good evidence to support dietary approaches for the treatment of migraine in adults.   
  • If one oral triptan is ineffective, others in the drug class may provide adequate pain relief.   
  • Topiramate has been shown to be effective for chronic migraine. 
Volume 36.3 - Question 24

Trigeminal Neuralgia

Which one of the following statements about trigeminal neuralgia is false? 

  • Triggered paroxysmal pain is reported by over 90% of patients.  
  • The location of the pain is not always concordant with the site of a sensory trigger.  
  • Patients rarely report pain between paroxysmal attacks.  
  • Microvascular decompression has become the favored surgical procedure in cases that do not respond to medication. 
Volume 36.2 - Question 28

Post Lumbar Puncture Headache

Which one of the following has been associated with a reduction in post lumbar puncture headache occurrence?

  • Fluid supplementation
  • Smaller needle diameter
  • Use of non-cutting needle
  • Decubitus position after procedure
Volume 37.2 - Question 21

Migraine

Volume 37.4 - Question 43

Intracranial Hemorrhage and Anticoagulation

The risk of intracranial hemorrhage after a head injury for patients 65 years and older on a direct oral anticoagulant is significantly higher compared with patients not on anticoagulation.

  • True
  • False
Volume 37.4 - Question 40

Abdominal Aortic Aneurysms

Which one of the following statements about abdominal aortic aneurysms is false?

  • Randomized trials involving mostly white men have shown no survival advantage with surgery over close surveillance for aneurysms measuring less than 5.5 cm.
  • A diameter of 5.0 cm is an appropriate threshold for repair in women.
  • Aneurysms of 3.0 to 3.9 cm should be followed with ultrasound every three years.
  • Statins have been shown to reduce growth.
Volume 37.4 - Question 39

Concussion

Advising patients under 25 years of age diagnosed with a concussion to abstain from screen time for 48 hours after injury may shorten the duration of concussion symptoms.

  • True
  • False
Volume 37.4 - Question 38

DOAC and ICH

In patients with atrial fibrillation, direct oral anticoagulants (DOACs) are associated with less intracranial hemorrhage risk than vitamin K antagonists.

  • True
  • False
Volume 37.4 - Question 28

Emergency Complaints

Among patients presenting to the emergency department, which one of the following complaints has the worst 7 day mortality?

  • Altered mental status
  • Generalized weakness
  • Abdominal pain
  • Chest pain
Volume 37.4 - Question 22

Multiple Sclerosis and Epstein-Barr Virus

The risk of Multiple sclerosis is significantly increased after infection with Epstein-Barr Virus.

  • True
  • False
Volume 37.4 - Question 20

Transient Global Amnesia Recurrence Risk

Which one of the following factors is not associated with an increased risk of recurrence of transient global amnesia? 

  •  Earlier age at time of first episode 
  • Personal history of migraine 
  •  Family history of migraine 
  •  Characteristic electroencephalographic findings
Volume 36.1 - Question 27

Painful Diabetic Neuropathy

Which one of the following approaches is most effective in treating painful diabetic neuropathy not well controlled with monotherapy? 

  • Amitriptyline supplemented with pregabalin. 
  • Pregabalin supplemented with amitriptyline. 
  • Duloxetine supplemented with pregabalin. 
  • There is no difference between the three options. 
Volume 38.1 - Question 22

Carpal Tunnel Syndrome

Which one of the following statements about carpal tunnel syndrome is false?

  • Computer mouse use is associated with a higher prevalence.
  • The 6-item CTS (CTS-6) questionnaire has specificity comparable to electrodiagnostic testing.
  • Nocturnal wrist-neutral splinting is associated with a lower rates of symptom resolution than wrist-extension splinting.
  • Steroid injection temporarily relieves symptoms.
Volume 38.2 - Question 19

Tenecteplase for Acute Ischemic Stroke

For treatment of acute ischaemic stroke, use of tenecteplase results in similar functional outcomes compared to alteplase in patients presenting with acute ischaemic stroke who meet standard criteria for thrombolysis.

  • True
  • False
Volume 38.2 - Question 12

ALS: Prognostication in Advanced Illness

Which one of the following statements about Amyotrophic Lateral Sclerosis (ALS) is false?

  • Most patient with ALS have a linear pattern of decline.
  • Median survival from time of onset is 3 to 5 years..
  • Clinician gestalt by an ALS specialist that is aware of the patient’s clinical scenario is crucial for accurate prognostication.
  • Most patients who are not mechanically ventilated experience a distressing death.
Volume 37.5 - Question 32

Community-Acquired Bacterial Meningitis

Which one of the following statements about community-acquired bacterial meningitis in patients of 80 years and older is false?

  • Diabetes is a common pre-disposing condition.
  • More than 70% of patients had the triad of fever, neck stiffness and altered consciousness.
  • Streptococcus pneumoniae is the most common causative organism.
  • Atypical causative pathogens should be considered when starting empirical antimicrobial therapy in this age group.
Volume 37.5 - Question 18

Transient Ischemic Attack and Minor Stroke

Which one of the following statements about transient ischemic attack and minor stroke is false?

  • Patients with more than a 50% stenosis of the extra-cranial carotid arteries are at the highest risk of recurrence.
  • 21 days of dual antiplatelet therapy is superior to ASA alone for preventing stroke in medium to high-risk patients.
  • Hypertension is responsible for about 40% of total stroke burden.
  • A high dose statin is associated with a greater than 5% absolute risk reduction of subsequent stroke after 2.5 years of follow-up.
Volume 38.4 - Question 26

Parkinson Disease

Which one of the following is a common feature of Parkinson Disease?

  • Neck and trunk rigidity more prominent than limb rigidity.
  • Prominent postural instability early in the course of illness.
  • Absence of nonmotor symptoms after 5 years.
  • Neuropsychiatric symptoms in early stages.
Volume 38.3 - Question 30

Minor Stroke

For patients with minor nondisabling acute ischemic stroke, 90-day functional outcome following treatment with dual antiplatelet therapy is non-inferior to intravenous alteplase. 

  • True
  • False
Volume 39.1 - Question 28

Return to School Following Concussion

Following acute concussion in youth aged 8-18, an early return to school may be associated with a lower symptom burden and, ultimately, faster recovery. 

  • True
  • False
Volume 39.1 - Question 27

The MIND Diet to Prevent Cognitive Decline

The Mediterranean-DASH Intervention for Neurodegenerative Delay (the MIND diet) slows cognitive decline in cognitively unimpaired elderly adults with a family history of dementia. 

  • True
  • False
Volume 39.1 - Question 22

Prescribing for Common Complications of Spinal Injury

Antibiotics should be offered for routine prophylaxis (e.g., when changing indwelling catheters) in patients with recurrent urinary tract infection and spinal cord injury.

  • True
  • False
Volume 38.4 - Question 15

Management of Epilepsy During Pregnancy and Lactation

Which one of the following statements regarding the management of epilepsy during pregnancy and lactation is false?

  • Rates of successful pregnancy in women with epilepsy are generally comparable with other women.
  • Valproate has the highest risk of major congenital malformations.
  • Levetiracetam and lamotrigine have the lowest risk of major congenital malformations.
  • Breastfeeding in women with epilepsy is not recommended.
Volume 39.2 - Question 29

Lead Toxicity

Which one of the following statements about lead toxicity is false?

  • Lead is toxic to all organ systems.
  • Stripping of old paint is an important source of exposure.
  • Screening for blood lead is recommended for the routine work up of anemia.
  • Removal from exposure is the most important aspect of management of lead poisoning.
Volume 39.2 - Question 23

Wilson’s Disease

Which one of the following statements about Wilson’s disease is false?

  • Dysarthria is often the first prominent neurological symptom.
  • Serum ceruloplasmin level alone is adequate for diagnosis.
  • Acute liver failure may be the first manifestation.
  • Screening of all first-degree relatives is mandatory.
Volume 39.2 - Question 18

Intervention in Early Dementia

Compared to usual care, an intensive exercise and functional activity therapy intervention in adults with early dementia improves activities of daily living.

  • True
  • False
Volume 39.2 - Question 11

Parkinson – Treatment

Which one of the following about the treatment of Parkinson Disease is false?

  • Delaying levodopa initiation until severe symptoms develop worsens disability.
  • Medications for Parkinson Disease should not be stopped abruptly.
  • Psyllium is the treatment of choice for constipation.
  • Botulinum toxin A injections are highly effective for the treatment of sialorrhea.
Volume 38.6 - Question 36

Bell Palsy

Which one of the following statements about Bell palsy is false?

  • The facial weakness usually spares the forehead.
  • Ipsilateral recurrent Bell palsy suggests an underlying tumor.
  • Patients should not be treated with antivirals alone.
  • Combination therapy with corticosteroids and antivirals leads to lower rates of synkinesis.
Volume 38.6 - Question 30

Parkinson Disease and Trichloroethylene

Remote occupational exposure to trichloroethylene in drinking water may increase the risk of Parkinson disease.

  • True
  • False
Volume 38.6 - Question 9

Migraine

Volume 38.5 - Question 42

Late Endovascular Treatment for Ischemic Stroke

Endovascular treatment is efficacious for patients with ischaemic stroke caused by an anterior circulation large-vessel occlusion who presented 6–24 h from onset or last seen well, and who were selected on the basis of the presence of collateral flow on CTA.

  • True
  • False
Volume 38.5 - Question 38

Diagnosis and Management of Patients with Polyneuropathy

Which one of the following statements about polyneuropathy is false?

  • Common mimics include cervical myelopathy.
  • A pattern of multiple concurrent mononeuropathies suggests a vasculitis cause.
  • Autonomic symptoms do not occur.
  • Tricyclic antidepressants have similar efficacy to serotonin norepinephrine reuptake inhibitors in painful diabetic neuropathy.
Volume 38.5 - Question 24

Pharmacologic Prevention of Migraine

Which one of the following statements about migraine prevention is false?

  • Migraine prophylaxis should be offered to patients with 4 or more migraine headache days per month.
  • Preventative treatment should be considered for patients with atypical aura.
  • OnabotulinumtoxinA (Botox) injection has shown a reduction in headache days by 50% or more.
  • Calcitonin gene-related peptide monoclonal antibodies take 6 months to show statistically significant treatment effect.
Volume 38.5 - Question 13

Neonatal Seizures

Which one of the following statements about neonatal seizures is false?

  • The definition includes seizures occurring within 44 weeks of postmenstrual age in preterm infants.
  • They rarely begin in a generalized fashion.
  • Those caused by hypoxic ischemic encephalopathy tend to peak in severity within 24 hours.
  • Phenytoin is the recommended first-line anti-seizure medication, regardless of cause.
Volume 38.5 - Question 7

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