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NEUROLOGY TEST > chapter 19-20-21-22-23 > Flashcards

chapter 19-20-21-22-23 Flashcards

1
Q

Which of the following statements are true regarding the Weber test?
1. Helps to differentiate conductive from sensorineural hearing loss
2. The tuning fork is placed on the skull in the midline of the forehead
3. Lateralization to the side of poorer hearing indicates conductive loss
4. Lateralization to the side of better hearing indicates sensorineural hearing loss on the side of
the deficit
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

e

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2
Q

Which of the following statements are time regarding the Rinne test?
1. Patients with normal hearing perceive the bone conduction louder than the air conduction
2. Patients with sensorineural hearing loss perceive bone conduction louder than air conduction
3. Patients with conductive hearing loss perceive air conduction louder than bone conduction
4. Compares bone conduction to air conduction
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

d

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3
Q

A patient presents with hearing loss and tinnitus affecting the left ear. Examination shows
decreased hearing sensitivity across all frequencies. Speech discrimination is normal. Which is
the most likely lesion?
A. Conductive hearing loss
B. Sensorineural hearing loss
C. Cannot determine on the basis of the supplied information

A

a

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4
Q

A patient presents with bilateral hearing loss and tinnitus. Testing shows hearing loss most
severe in high frequencies, and the shows loudness recruitment. Which is the most likely lesion?
A. Conductive hearing less
B. Cochlear dysfunction
C. Acoustic nerve dysfunction
D. Cannot be determined from these data

A

b

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5
Q

Which of the following statements are true regarding treatment of tinnitus?
A. Anticonvulsants reduce the amplitude of tinnitus
B. Masking is effective treatment for most patients with tinnitus
C. Tinnitus in the absence of other symptoms or signs is never due to serious pathology
D. There is no effective medical treatment to reduce tinnitus

A

d

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6
Q

Which of the following statements is true regarding word recognition?
A. Word recognition is relatively spared in sensorineural hearing loss
B. Poor word recognition with preserved hearing sensitivity suggests conversion reaction
C. Word recognition is relatively spared in conductive hearing loss
D. Word recognition is maintained in patients with cochlear hearing loss until there is severe loss
of sensation

A

c

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7
Q

A patient presents with seizures and is found on examination to have unilateral anosmia. Which
is the most likely diagnosis?
A. Olfactory groove meningioma
B. Idiopathic seizure with incidental anosmia due to sinus disease
C. Temporal lobe mass with extension into the inferior frontal region
D. Sinus disease with extension into the brain

A

a

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8
Q

A young man returns to the clinic six months following a closed head injury. Headaches and
dizziness have abated, but he has anosmia. Which of the following statements are true?
A. The prognosis for recovery of smell is good
B. Anosmia means that the patient had a skull fracture
C. The anosmia is likely to be permanent
D. Anosmia is always bilateral

A

c

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9
Q 
Which of the following are normal aging changes in olfaction?
A. Reduced sensitivity
B. Impaired discrimination
C. Resultant alteration in food choices
D. Impaired odor identification
E. All of the above
A

e

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10
Q 
Which of the following agents produces impaired taste sensation?
A. Pipe smoke
B. Calcium channel blockers
C. Antifungal agents
D. Sumatriptan nasal spray
E. All of these
A

e

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11
Q

Which of the following are true regarding taste dysfunction after head injury?
A. Taste disorder is uncommon after head injury
B. Recovery is much less complete than recovery of olfaction after head injury
C. Taste deficit from head injury is due to peripheral nerve lesion and not due to brain damage
D. Cerebral injury does not produce taste defect

A

a

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12
Q

Which of the following statements is true regarding function of die trigeminal nerve in olfactory
sensation?
A. Trigeminal nerve carries a portion of primary olfactory afferent axons
B. Trigeminal nerve carries sensation of olfactory region irritability which adds to the olfactory
perception
C. Trigeminal nerve plays no significant role in olfactory sensation
D. Trigeminal nerve efferents modulate the sensitivity of olfactory sensation

A

b

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13
Q 
The olfactory tract terminates in which of the following regions?
A. Piriform cortex
B. Hippocampus
C. Uncus
D. Amygdaloid complex
E. All of the above
A

e

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14
Q

Unilateral loss of smell is not noticed by the patient.

T. True F. False

A

t

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15
Q

Patients with Parkinson’s disease have impaired olfactory detection.
T. True F. False

A

t

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16
Q

Bell’s palsy can cause loss of taste over the posterior third of the tongue.
T. True F. False

A

f

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17
Q

Which of the following statements concerning activity-dependent headache are true?
1. Most exertional headaches are benign
2. Exertional headache is worrisome for posterior fossa lesion
3. Positional headache exacerbated by upright posture suggests low CSF pressure
4. Recurrent headache during sexual activity is most likely due to unruptured aneurysm
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

a

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18
Q

Which of the following are true regarding cluster headache?
1. Headache is usually bilateral but may be unilateral
2. Headache may change sides between clusters
3. Alcohol precipitates migraine but not cluster headache
4. Pain of cluster may be in the lower half of the face
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

c

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19
Q

Migraine aura can be difficult to differentiate from brain ischemia. Which of the following are
differentiating features?
1. Aura symptoms spread over minutes whereas stroke symptoms have an abrupt onset
2. If more than one modality is affected by an aura, they have a staggered onset
3. Visual symptoms are the most common auras
4. Aura symptoms which develop during the headache phase are more likely to be due to
migrainous infarction
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

a

20
Q

Which of the following clinical features suggests temporomandibular joint dysfunction?
1. Clenching of the teeth
2. Tenderness in the temporal region
3. TMJ clicking
4. Increased range of motion of the TMJ
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

b

21
Q

Some headache syndromes are hereditary. Which of the following statements regarding
hereditary are true?
1. Migraine is often inherited
2. Cluster is inherited in less than 10% of cases
3. Familial hemiplegic migraine is inherited as an autosomal dominant trait
4. Tension headache has a familial tendency
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

e

22
Q 
For the following questions, indicate the most likely diagnosis from the following list:
A. Migraine
D. Cluster headache
C. Tension headache
D. Increased intracranial pressure
E. Decreased intracranial pressure .
F. Trigeminal neuralgia
G. TMJ pain
Headache which is markedly worsened by upright posture, and relieved by lying down.
A

e

23
Q 
For the following questions, indicate the most likely diagnosis from the following list:
A. Migraine
D. Cluster headache
C. Tension headache
D. Increased intracranial pressure
E. Decreased intracranial pressure .
F. Trigeminal neuralgia
G. TMJ pain

Episodic unilateral throbbing headache without neurologic symptoms or signs. The patient has
nausea and photophobia with the attacks, but no symptoms between attacks.

A

a

24
Q 
For the following questions, indicate the most likely diagnosis from the following list:
A. Migraine
D. Cluster headache
C. Tension headache
D. Increased intracranial pressure
E. Decreased intracranial pressure .
F. Trigeminal neuralgia
G. TMJ pain
Headache which is worse in the morning, is better when upright.
A

d

25
Q 
For the following questions, indicate the most likely diagnosis from the following list:
A. Migraine
D. Cluster headache
C. Tension headache
D. Increased intracranial pressure
E. Decreased intracranial pressure .
F. Trigeminal neuralgia
G. TMJ pain
Episodes of unilateral lancinating pain lasting seconds to a minute. No neurologic deficit.
A

f

26
Q 
For the following questions, indicate the most likely diagnosis from the following list:
A. Migraine
D. Cluster headache
C. Tension headache
D. Increased intracranial pressure
E. Decreased intracranial pressure .
F. Trigeminal neuralgia
G. TMJ pain
Episodes of severe but brief unilateral periorbital headache.
A

b

27
Q

A patient presents with blurred vision. Examination shows difficulty with upgaze to command
but is able to look upward with pursuit. Lids appear retracted. Pupils are nonreactive. Which of
toe folio wing are possible causes of this presentation?
A. Multiple sclerosis
B. Hydrocephalus
C. Pineal tumor
D. Stroke
E. Any of the above

A

e

28
Q

Which of the following are clinical features of internuclear ophthalmoplegia (INO)?
A. Lateral gaze shows paresis of abduction of one eye and nystagmus of the other eye
B. Lateral gaze shows paresis of adduction of one eye and nystagmus of the other eye
C. Inability of adduct either eye
D. Inability to abduct either eye

A

a

29
Q 
Which of the following conditions may produce total ophthalmoplegia?
A. Myasthenia gravis
B. Thyroid ophthalmopathy
C. Botulism
D. Wernicke's encephalopathy
E. All of the above
A

e

30
Q

A patient presents with complaint of diplopia and is found on examination to have inability to
look left with either eye. When looking to the right, the left eye fails to adduct while the right eye
abducts and has superimposed nystagmus. Which of the following statements is true?
A. The patient has an INO when looking to the left
B. Myasthenia is the most likely
C. This finding is usually congenital
D. The patient has one-and-a-half syndrome

A

d

31
Q

A patient presents with hemisensory loss with pain on the same side of the body. There is no
weakness. Which of the following statements are true regarding this condition?
1. Proprioception is preserved
2. The most likely diagnosis is multiple sclerosis
3. The pain is always stimulus-independent
4. The lesion is most likely in the ventroposterolateral nucleus of the thalamus
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

d

32
Q

Which of the following are features of the foramen magnum syndrome?
1. Hemiparesis can be present
2. Quadriparesis can be present
3. Lhermitte’s sign may be present
4. Third nerve palsy may be present
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

A

a

33
Q 
For the following questions, select the most likely localization of the lesion from the following
list.
A. Medial midbrain syndrome
B. Lateral midbrain syndrome
C. Lateral pontine syndrome
D. Medial pontine syndrome
E. Medial medullary syndrome
F. Lateral medullary syndrome
Patient has right hemiparesis, left hemiataxia, conjugate gaze paresis to the left.
A

d

34
Q 
For the following questions, select the most likely localization of the lesion from the following
list.
A. Medial midbrain syndrome
B. Lateral midbrain syndrome
C. Lateral pontine syndrome
D. Medial pontine syndrome
E. Medial medullary syndrome
F. Lateral medullary syndrome
Patient has right hemiparesis and hemiataxia, left third nerve palsy.
A

a

35
Q 
For the following questions, select the most likely localization of the lesion from the following
list.
A. Medial midbrain syndrome
B. Lateral midbrain syndrome
C. Lateral pontine syndrome
D. Medial pontine syndrome
E. Medial medullary syndrome
F. Lateral medullary syndrome

Patient has vertigo with nausea and vomiting and coordination difficulty. Examination shows
right hemiataxia, right facial numbness, and right ptosis and meiosis.

A

f

36
Q 
For the following questions, select the most likely localization of the lesion from the following
list.
A. Medial midbrain syndrome
B. Lateral midbrain syndrome
C. Lateral pontine syndrome
D. Medial pontine syndrome
E. Medial medullary syndrome
F. Lateral medullary syndrome

Patient has right hemiparesis, right neurosensory loss, and dysarthria. She has an upbeat
nystagmus with eyes in the primary position.

A

e

37
Q

Which of the following describe speech abnormality in patients with cerebellar dysfunction?
A. Slurred, mumbling, and excessively rapid, making it difficult to understand
B. Slow, slurred, with pauses and hesitations
C. Articulate with phoneme substitutions but otherwise normal content
D. impaired content but otherwise normal expression

A

b

38
Q

A 50-year-oid man presents with gait ataxia. Examination shows good independent movement of
the limbs on formal examination. Romberg is positive. Reflexes are absent. Where is the lesion?
A. Corticospinal tract
B. Basal ganglia
C. Cerebellum
D. Sensory nerves

A

d

39
Q

Which of the following ataxic disorders are inherited?
A. Friedreich’s ataxia
B. Mitochondrial encephalopathy with ragged red fibers
C. Ataxia-telangiectasia
D. Spinocerebellar ataxia type 2
E. All of the above

A

e

40
Q

Which of the following statements are true regarding ataxia from the Arnold-Chiari
malformation?
A. This is a disorder mainly of childhood
B. If a patient is not affected during childhood, they will not develop symptoms during adult life
C. Arnold-Chiari malformation produces ataxia on the basis of hydrocephalus
D. All of these are true

A

a

41
Q 
Hair loss with ataxia suggests which of the following conditions?
A. Wilson's disease
B. Ataxia telangiectasia
C. Hypothyroidism
D. Friedreich's ataxia
A

c

42
Q 
Ataxia with Keyser-Fleischer rings suggests which of the following?
A. Mitochondrial disease
B. Gaucher's disease
C. Friedreich's ataxia
D. Wilson's disease
A

d

43
Q 
Ataxia associated with cataracts suggests which of the following?
A. Wilson's disease
B. Marinesco-Sjogren syndrome
C. Friedreich's ataxia
D. Gaucher’s disease
A

b

44
Q 
Ataxia in combination with internuclear ophthalmoplegia can suggest which of the following?
A. Pontine ischemia
B. Multiple sclerosis
C. Spinocerebellar degeneration
D. A&B
E. All of the above
A

d

45
Q 
Downbeat nystagmus in association with ataxia suggests which of the following conditions?
A. Arnold-Chiari malformation
B. Basilar invagination
C. Lithium toxicity
D. Spinocerebellar ataxia
E. All of the above
A

e

46
Q

Which of the following would not be expected in patients with cerebellar ataxia due to multiple
sclerosis?
A. MRI abnormalities in the white matter of the cerebellum
B. Visual loss
C. Relapsing-remitting course
D. Ptosis
E. Diplopia

A

d

NEUROLOGY TEST (21 decks)

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