2010 module exam Flashcards
RT optic nerve lesion?
Blindness in RT eye
What are the correct properties to be able to pass BBB?
C
A patient with injury to the brain was asked to draw the left pic, but his drawing was the one on the right, where the lesion is located?
Right temporo-parietal junction
Which of the following contains sympathetic & parasympathetic fibers?
Striaterminalis
If you stretch a muscle you will evoke which of the following? (not sure)
- inhibitory interneurons stretch
reflex = knee jerk = excite! contraction = golgi tendon organ = inhibitory
Which of the following nuclei will receive information about the sensation?
Ventrolateral nucleus
A patient presented with developmental abnormality in the central canal.
What most likely would be the presentation?
Bilateral loss of sensation in the neck region ( Not sure)
Which artery is blocked in wellenberg syndrome (lateral medullary syndrome)?
Vertebral artery (PICA wasn’t in the choices)
A patient presented with muscle weakness, fasciculations (signs of LMN), where
do you suspect the lesion?
Lesion in the anterior horn of the spinal cord
How does fast adapting receptors receive stimulus and generate the potential?
Getting the stimulus at the beginning and end
Loss of sensation to the medial one half of the fingers with atrophy to the
interosseous muscles of the hand?
Ulnar nerve injury
Dorsal horn of the spinal cord is developed from?
Alarplate
A patient with polio will have?
Lower limb loss of deep tendon reflex (hyporeflexia), muscle wasting and weakness
What receptor is responsible for keeping the upright posture (standing)?
- Muscle spindle
- Ruffini
Muscle spindle
Activation of the Parasympathetic system will cause what?
Increase GI activity
Which part of the face will lose function if there is an injury to the right facial nerve at the stylomastoid foramen?
Right Lower Face
Patient presented with ptosis and pupil constriction?
- Descending sympathetic fibers
- 3rd Nerve Palsy
- Descending sympathetic fibers
What most likely would be the signs seen in patient with segmental
demylination?
Hyporeflexia & muscle weakness (Explanation: NOT muscle wasting
because axon is not cut its just demylinated)
Young female with MS presented with visual abnormality, in direct reflex the eye
more dilated than indirect reflex of the same eye?
- Optic neuritis
- Right afferent papillary defect is affected
- Optic neuritis
A patient with a lung cancer presented with ptosis & miosia & anhidrosis?
Horner’s syndrome
(Explanation: The sympathetic tract passes next to the apex of the lung so any tumor in the apex can compress the sympathetic tract)
Ptosis with dilated pupil?
Occulomotor nerve palsy
Brain lipid metabolism is characterized by?
Synthesis of long chain fatty acid
An old lady complains of hypertension, diabetes, horizontal diplopia, &
convergent squint?
Abducent nerve lesion
Peroxisomal defect (learning topic biochemwk) lipotoxicity due to?
accumaltion of long chain fatty acid
Long chain fatty acids must be metabolized first in peroxisome
Sustained stimulation of pontine reticular fibers causes what?
Increase tone of antigravity muscles
Lesion in corticobulbar tract of the internal capsule?
Contra lateral paralysis in lower part of the face
A 57 year old man has lateral deviation of the eyeball, where is the lesion?
- Abducent nerve
- Occulomotor nerve
- Occulomotor nerve
The cause of Alzheimer’s disease?
Increasedβ-secretase activity
Central pontine myelinolysis happens due to?
Hyponatremia
A Japanese patient presented with NMO. What is true about the disease?
Antibodies against aquaporine 4 water channels
(Scenario) Female presented with sudden onset of paralysis on left arm and leg, loss of pain, temperature from half of her face, her eyes deviated laterally toward the right, ptosis, & dilated pupil.
which of the following is responsible for the loss of pain and temperature from the face?
Spinal nucleus of CN V
(Scenario) Female presented with sudden onset of paralysis on left arm and leg, loss of pain, temperature from half of her face, her eyes deviated laterally toward the right, ptosis, & dilated pupil.
which part of the brain is affected?
Superior midbrain
(Scenario) Female presented with sudden onset of paralysis on left arm and leg, loss of pain, temperature from half of her face, her eyes deviated laterally toward the right, ptosis, & dilated pupil.
which artery is most likely to be affected?
Posterior cerebral artery
What is the method of choice to diagnose a patient with CVA?
- CT
- MRI
CT
What is the sensory-motor hierarchy upon cortical function?
somatosensory cortex -> parieto-occipital -> pre-frontal association -> premotor -> primary motor (Flip Flop Concept)
Working memory in which part?
Prefrontal (Anterior Association Area)
A person with severe hypotension (MAP<50mmHg) what will happen to the brain?
reduce cerebral blood flow (Explanation: because less than 50 out of auto
regulation range)
What types of cells are present in the 5th cerebral cortical layer?
Pyramidal cells
What type of herniation can occur in the temporal lobe?
- Tentoriem
- Cantral ….
- Tentoriem
A 76 years old man has confusion and deeping coma after a cardiogenic shock, a
week later, he died. Autopsy would reveal?
Global cerebral ischemia
When reading out laud, which of the following is bypassed?
Wenicke’s area
What is the most common etiology of lacunar infarcts?
Systemic hypertension
What is a specific feature of supplementary motor association cortex?
- Doesn’t have a somatotopicpicture
- When stimulated, activates bilateral limb movement
- When stimulated, activates a specific group of muscles
- Independent of premotor and motor cortex
- Found in the anterior lateral side of the cortex
- Found in the anterior lateral side of the cortex
A patient who can not recognize an object in his hand, which type of
agnosia?
Astereognosia
A patient who can not recognize his left side of his body, which type of agnosia?
Personal neglect
An old man who had aneurysm in his MCA, what type of hemorrhage is most
likely to accur?
Subarachnoid
What’s true about functional columns of the cerebral cortex?
Different columns can activate the same muscle for different synergic
movements
The blood supply to certain area of the brain increases due to what?
Glutamate release
Cerebellum develops from which embryological structure?
Rhombic lips
On MRI, structure present in midline of sagittal section of the brain?
Pineal body
Damage to the subthalamusprodues which disease?
Hemibalism
If a person imagines doing a sequence in his fingers, which part of the brain is
active?
Supplementary motor area
Which of the following physiological processes involves Motor Skill
Learning ?
Long-Term Depression (Cerebellum)
What is the mechanism behind coordination of movement in cerebellum?
Feed-forward mechansim
Cerebellum uses go-stop effect to coordinate movement. What causes this damping effect?
- collaterals of mossay& climbing fibers to deep nuclei before going to purkunje
- Complex spikes ( I think those are in LTD to learn new things, not for
normal go-stop)
- collaterals of mossay& climbing fibers to deep nuclei before going to purkunje
Characteristic features of idiopathic parkinson’s disease?
- Not responding to lavedopa treatment
- Bradycardia, cogwheel rigidy, resting tremor
- Falling after 2 years of disease
- Bilateral weakness & rigidity, no tremor
- Bradycardia, cogwheel rigidy, resting tremor
What is a character of CAG repeats?
- There is always translation & transcription
- It causes polyA repetition
- There is always translation & transcription
Which of the following will be disinhibited when strial neurons are
activated in the basal ganglia?
Thalamocortical in the direct pathway
A Tri-nucleotide CAG repeats disease with a normal BP of 11-12 and
abnormal expansion of 68-69 BP?
- Hungtington’s disease
- Spinocerebrallar ataxia??
?
Degeneration of strial neurons causes which disease?
Hungtington’s disease
Characteristic of polyglutamate tracts?
Abnormal tri-nucleotide repeats
A woman fell on the Rt side of her head. CT showed a fissure fracture in the Rt temporal bone. She was kept under observation and 4 hrs later she suffered from headache and went into coma. What is expected to be found on CT?
- Right extradural hematoma
- Left contre-coup cerebral hemorrhage
- Right extradural hematoma
The CBF is reduced to 30 due to systemic hypotension after 2 hrs the mean arterial
pressure was normalized and CBF retained to normal, consequences on electrical activity will be?
- No effect on electrical activity
- Permanent loss of electrical activity
- Transient but short loss of electrical activity
- Transient but prolonged loss of electrical activity
- Transient but short loss of electrical activity
A 25 years old student suddenly starts staring at the wall for 60 sec, his friend noticed him picking at his buttons and making some chewing movement, and he’s not responding to his friend’s request, what he’s experiencing?
Complex partial seizure
Which wave will be recorded on EEG in occipital lobe, when the patient is in dark room then we open the lights?
Beta waves
Origin of fornix?
Molecular of hippocampus (Pyramidal) (NOT sure)
Which hormone regulates circadian rhythm?
Melatonin
A patient with multi-infarcts dementia, What would you see in autopsy?
Cystic spaces
If bilateral hippocumpus were removed. How the patient will present?
Can’t form new long term memory
5- Which of the following is hyperphosphorelated in Alzheimer’s disease?
Tau
What causes spike of the interictal discharge?
Paroxysmal depolarization shift
Retrograde injury to the hippocampus is caused by what?
Fornix
A brain CT of an old man showed multiple infarcts, which type of dementia he’s
most likely to develop?
Vasculardementia
Dopaminergic reward system
Nucleus accumbance
Which area is responsible for hunger?
Lateral hypothalamus
Which of the following is characteristic of findings of a women that had an infection
during the 1st trimester of pregnancy?
Ring enhancing lesion
Infection from goat milk?
BrucellaMelitensis
What is the causative organism of cerebral abscess in bone transplant
patient?
- Candida
- Aspergillus Fumigatus
- Cryptococcus
- Candida
An old patient with history of bronchectesis presented with a lesion in the brain. what most likely would it be?
Cerebral Abscess
In which stage malaria will adhere to endothelial linings ?
ring stage (not sure)
A patient presented with esonophilic intracytoplasmic inclusions in the
purkinjie cells of cerebellum &brainstem ?
Rabies encephalitis
A patient presented with lesions filled with plasma cells & spiral micro
organism?
Neurosyphilis
Enlarged cells with cytoplasmic and nuclear inclusion?
CMV
Pathogenesis of cerebral malaria?
Microvascular pathology
Which of the following is associated with CJ disease?
PrP
The most common cause of meningitis in neonate?
E.coli
Supperative necrosis, gliosis, & granulation tissue are characteristics of?
Abscess
What is true about essential tremor?
- Sustained posture
- Autosomal recessive
- Sustained posture
Tumor with eosinophlic and stout processes?
Gemistocytic astrocytoma
What controls the amount of light passing in the eye?
Iris
A person doesn’t see the left side of each visual field with normal pupillary
reflex in both eyes, what most likely would be injured?
Right Lateral geniculate body
Fracture of floor of orbit, which of the following structures will be affected?
- Inferior rectus
- opthalmic Artery
- inferior oblique
Inferior rectus
What can be presented as an early sign of INO?
Diplopia (not sure)
What artery supplies the visual cortex?
Posterior cerebral artery
A lesion in the optic radiation in the temporal lobe produce which of the following?
Pie in the sky
What is the most cost effective prevention for blindness caused by cataract will be?
- Cataract vision repair surgery
- Screeing pregnant mothers to prevent from childhood blindness due to cataract
Cataract vision repair surgery
Which of the following statement is correct in th case of blindness?
- Will not affect family life
- Increase the risk of depression
Increase the risk of depression
What structure is probably involved in Hyperacuses ?
Stapedius muscle
Patient with bilateral decrease in hearing?
- Lateral lemnsci lesion
- Tensor tympani
Lateral lemnsci lesion
What structures lie in the lateral part of middle ear?
Handle of malleus & chorda tympani
which of the following is located in the Sublenticular area?
Auditory radiation
what causes Unilateral hearing loss?
Organ of corti
Which receptors are activated in central sensitization seen in pain?
NK-1 & NMDA
Stimulation of external acoustic meatus -> coughing?
Vegus nerve
M.O.A of Lidocaine?
Na channels blockers
Which drug will increase the plasma concentration of drugs taken with it?
Valporic acid (it inhibits metabolism so the drug will be active longer)
What is the M.O.A for Benserazide?
Peripheral dopa decarboxylase inhibitor
Patient receiving anti-psychotic drugs & she’s diagnosed with parkinson’s disease, what is the best drug to treat her?
Benzotropine
M.O.A. of Benzodiazepines?
- GABA-A receptor, enhancing GABA- receptor mediated inhibition
- GABA-A modulators, enhancing GABA- Mediated synaptic
inhibition
GABA-A modulators, enhancing GABA- Mediated synaptic
inhibition
Dopezepil M.O.A?
Acetylcholinestrase inhibitor
Memantine M.O.A?
NMDA antagonist
A patient will undergo surgery, but the Dr. wants him to be responsive to simple commands, what is the drug used for anesthesia?
Innovarpreparation (droperidol + fantanyl)
Cocaine M.O.A?
Blockage of presynaptic reuptake of monoamines
Which drug block levodopa effect in periphery by binding to the receptors?
Domperidone
Which drug can be used as an anxielitic and reduce muscle tone?
Diazepam
which of the following drugs causes nephrotoxicity, neuromuscular
paralysis?
Gentamicin
Drug of choice to treat herpes virus?
Acyclovir
How do morphine act?
Inhibiting adenylatecyclase, open K, close Ca
MOA-B inhibitor?
Selegiline
M.O.A of cannabis
Inhibits AC
12 year old boy, with fibrillar and microcystic fibers, bipolar, thin hair like projections?
Pilocytic astrocytoma
A patient presented with myxoid stroma & microcystic appearance & verocay bodies ?
Shwannoma
What is a character of homocystinuria?
Mental retardation
Which nerve supplies secretomotor to sub-lingual gland ?
chorda tympani (branch of facial nerve)
Ethics: A 70 year old woman with history of cataracts presents with severe loss of visual field, what is the reason that she didn’t go to the doctor earlier?
- this wouldn’t be a problem in Kuwait as it’s only in developing countries
- Existence of a male in the family with help any female to get access to health care
- Anxiety and fear of being a burden on her family doesn’t contribute her pres entation
- Women are less educated so they don’t know the symptoms that require health care
?
Deflection of steriocilia determines what?
Hyperpolarization or depolarization of the cell
Injury to what causes the no movement to the vocal fold?
Nucleus ambiguous
Tangles of arteries and veins and bleeding due to?
Arteriovenous malformation
(A scenario with 2qs, not sure about the ptosis & dilated pupil) A 50 yr old man came to the ER with hot painful sensation, ptosis, and dilated pupil, no movement of right vocal fold ..
-
EBM: Prevalence of a disease is 50%, if pre-test probability is 5%, what will happen to the test characteristics?
Sensitivity increases, increase NPV & decrease PPV specificity decrease
EBM: Two researchers argue a cut off for a diagnostic test of either 50 or 80 knowing that the higher the value the more aggressive is the disease?
The cut-off value of 50 has higher sensitivity than 80
