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CBR neurology > clinical neurology 1-36 > Flashcards

clinical neurology 1-36 Flashcards

1
Q 
a  common sign  of  multiple sclerosis
A. convergence nystagmus
B.  dissociated  nystagmus (internuclear ophthalmoplegia)
C.  downbeat nystagmus 
D.  impairment  of  optokinetic  nystagmus 
E.  ocular bobbing 
F.  seesaw nystagmus 
G.  spasmus  mutans
A

B. dissociated nystagmus (internuclear ophthalmoplegia)

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2
Q

most often associated with large destructive
lesions of the pons
A. convergence nystagmus
B. dissociated nystagmus (internuclear ophthalmoplegia)
C. downbeat nystagmus
D. impairment of optokinetic nystagmus
E. ocular bobbing
F. seesaw nystagmus
G. spasmus mutans

A

E. ocular bobbing

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3
Q 
seen exclusively in infants
A.  convergence nystagmus
 B.  dissociated  nystagmus (internuclear ophthalmoplegia)
C.  downbeat nystagmus 
D.  impairment  of  optokinetic  nystagmus 
E.  ocular bobbing
F.  seesaw nystagmus
G.  spasmus  mutans
A

G. spasmus mutans

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4
Q 
associated with lesions  of  the  
cervicomedullary junction 
A.  convergence nystagmus 
B.  dissociated  nystagmus (internuclear ophthalmoplegia) 
C.  downbeat nystagmus 
D.  impairment  of  optokinetic  nystagmus 
E.  ocular bobbing 
F.  seesaw nystagmus 
G.  spasmus  mutans
A

C. downbeat nystagmus

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5
Q

associated with lesions of the parasellar
region
A. convergence nystagmus
B. dissociated nystagmus (internuclear ophthalmoplegia)
C. downbeat nystagmus
D. impairment of optokinetic nystagmus
E. ocular bobbing
F. seesaw nystagmus
G. spasmus mutans

A

F. seesaw nystagmus

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6
Q

associated with lesions of the parietal
lobe
A. convergence nystagmus
B. dissociated nystagmus (internuclear ophthalmoplegia)
C. downbeat nystagmus
D. impairment of optokinetic nystagmus E. ocular bobbing
F. seesaw nystagmus
G. spasmus mutans

A

D. impairment of optokinetic nystagmus

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7
Q 
associated with lesions  of  the  pineal
 region
A.  convergence nystagmus 
B.  dissociated  nystagmus (internuclear ophthalmoplegia) 
C.  downbeat nystagmus 
D.  impairment  of  optokinetic  nystagmus E.  ocular bobbing 
F.  seesaw nystagmus 
G.  spasmus  mutans
A

A. convergence nystagmus

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8
Q
  1. Which of the following is false of
    seizure foci?
    A. Epileptic foci are slower in binding and removing acetylcholine than nor- mal cortex.
    B. Firing of neurons in the focus is reflected by periodic spike discharges in the electroencephalogram (EEG).
    C. If unchecked, cortical excitation may spread to the subcortical nuclei.
    D. Neurons surrounding the focus are initially hyperpolarized and are GABAnergic.
    E. The change in seizure discharge from the tonic phase to the clonic phase results from inhibition from the neurons surrounding the focus.
A

E. The change in seizure discharge from the tonic phase to the clonic phase results from inhibition from the neurons surrounding the focus. V&A pp. 345-346. The change from the tonic to the clonic phase results from diencenphalic inhibition of the firing cortex.

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9
Q 
An abnormal optokinetic response is  more likely  to be obtained  by rotating the optokinetic  nystagmus drum 
A.  away from an occipital lobe lesion 
B.  away from a parietal  lobe leson 
C.  toward  an occipital lobe lesion 
D.  toward  a parietal  lobe lesion 
E.  toward  a temporal lobe lesion
A

B. Away from a parietal lobe lesion

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10
Q 
4 to 7 Hz
A  alpha 
B  beta 
C delta 
D theta 
E 3-per-second spike and  wave
A

D. theta

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11
Q 
normally  may  be present over  the  temporal  lobes of  the  elderly 
A  alpha 
B  beta 
C delta 
D theta
E 3-per-second spike and  wave
A

D. theta

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12
Q 
recorded from  the  frontal  lobes symmetrically 
A  alpha 
B  beta 
C delta 
D theta 
E 3-per-second spike and  wave
A

B. beta

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13
Q 
associated with absence seizures 
A  alpha 
B  beta 
C delta 
D theta 
E 3-per-second spike and  wave
A

E. 3-per-second spike and wave

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14
Q 
attenuated or  abolished  with eye  opening or mental activity 
A  alpha 
B  beta 
C delta 
D theta 
E 3-per-second spike and  wave
A

A. alpha

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15
Q 
Which of  the  following drugs  is  least effective  in  the  treatment of  trigeminal neuralgia?
A.  baclofen
B.  carbamazepine 
C.  clonazepam
D.  phenytoin 
E.  ketorolac  tromethamine  (Toradol)
A

E. ketorolac tromethamine (Toradol) V&A p. 198. Toradol, a nonsteroidal anti-inflammatory drug (NSAID), is not helpful in relieving the pain of trigeminal neuralgia.

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16
Q

Which of the following is true of papilledema?
A. Absence of venous pulsations is a reliable indicator of papilledema.
B. Pupillary light reflexes remain normal. C. The congested capillaries derive from the central retinal vein.
D. Unilateral edema of the optic disk is never seen.
E. Visual acuity usually decreases.

A

B. Pupillary light reflexes remain normal. V&A pp. 258-260. Venous pulsations are absent in 10 to 15% of normal indi- viduals. The congested capillaries are derived from the short ciliary arteries. Unilateral edema can occur with optic nerve tumors. Visual acuity is usually normal in papilledema. Answer B is correct.

17
Q 
Which of  the  following can occur  in  glossopharyngeal neuralgia?
 I.  pain  in  the throat 
11.  syncope 
111.  pain in  the ear
 IV.  bradycardia 
A.  I,  11,  111 
B.  I,  111 
C.  11,  IV 
D.  IV 
E.  all of  the  above
A

E. all of the above

18
Q 
Features of  trisomy 13 (Patau's syndrome)  include 
I.  microcephaly 
ii.  hypertonia 
Ill.  cleft lip and palate 
IV.  dextrocardia
 A.  I,  11,111 
B.  I,  111 
C.  11. IV 
D.  IV 
E.  all of  the  above
A

E. all of the above V&A p. 1067. Other features of this dysgenetic syndrome include corneal opacities, polydactyly, impaired hearing, and severe mental retardation. Death usually occurs in early childhood.

19
Q 
Which of  the  following is  not a feature  of  Parinaud's syndrome? 
A.  dissociated  light-near response 
B.  lid retraction 
C.  nystagmus retractorius 
D.  paralysis  of  upgaze
E.  third nerve palsy
A

E. third nerve palsy

20
Q

Which of the following is true of tuberculous meningitis?
A. Headache is usually absent.
B. If untreated, the clinical course is self-limited.
C. The inflammatory exudate is confined to the subarachnoid space.
D. The inflammatory exudate is found mainly at the convexities.
E. The protein content of the cerebrospinal fluid (CSF) is almost always elevated.

A

E. The protein content of the cerebrospinal fluid (CSF) is almost always elevated. V&A pp. 757-758. Headache occurs in more than half the cases. Confusion, coma, and death usually result if the patient is untreated. The inflammatory exudate occurs mainly in the basal meninges and frequently invades the underlying brain by spreading via pial vessels. The cerebrospinal fluid (CSF) protein is always elevated to 100 to 200 mg/dL or higher.

21
Q

Which of the following CSF findings is least suggestive of acute multiple sclerosis?
A. an lgG index greater than 1.7
B. increased myelin basic protein
C. increased protein to 200 mg/dL
D. presence of oligoclonal bands
E. slight to moderate monocytic pleocytosis

A

C. increased protein to 200 mg/dL V&A pp. 968-969. The CSF protein is slightly increased in about 40% of patients with multiple sclerosis (MS). A concentration of >I00 mg/dL is rare. If the ratio of CSF lgG/serum IgG to CSF albumin/serum albumin is more than 1.7, the diagnosis of MS is probable. This ratio is known as the IgG index.

22
Q

Each of the following is true of myasthenia gravis except
A. A decrementing response to peripheral nerve stimulation is typical.
B. Aminoglycoside antibiotics may worsen the symptoms.
C. Females are more frequently affected in the < 40 age group.
D. Females predominate in the subset of patients with a thymoma.
E. Ten to 15% of patients have no antibodies to the acetylcholine receptor.

A

D. Females predominate in the subset of patients with a thymoma. V&A pp. 1537-1540, 1542. The majority of patients with myasthenia gravis harboring a thymoma are older (50-60 years) and male. The disease is 2 to 3 times more common in women than men in patients < 40 years of age. A decrease in muscle action potential with nerve stimulation at 3 Hz (a decre- menting reponse) is seen. Certain aminoglycoside antibiotics can impair trans- mitter release by inhibiting calcium ion fluxes at the neuromuscular junction.

23
Q

A defect in mitochondria1 DNA is found in each of the following disorders except A. Kearns-Sayre syndrome
B. Leber’s hereditary optic atrophy
C. Leigh’s subacute necrotizing encephalopathy
D. Mitochondria1 myopathy, encephalopathy, lactic acidosis, and stroke (MELAS)
E. Menkes’ syndrome

A

E. Menkes’ syndrome V&A pp. 1042-1045; Mer pp. 1002-1003. Menkes’ (kinky hair) syndrome is a rare sex-linked disease characterized by severe copper deficiency. The other disorders have point mutations or deletions of mitochondria1 DNA as part of their pathogenesis.

24
Q 
Symptoms of  spontaneous carotid  artery dissection  include 
I.  dysgeusia 
II.  eye pain 
III.  tongue weakness 
IV.  Horner's syndrome
a. I,  II, III 
b. I,  III 
c. II,  IV 
d. IV 
e. all of  the  above
A

e. all of the above

25
Q 
Memory impairment  is  caused  by discrete bilateral  lesions  of  which  of  the following structures? 
I.  amygdka 
II.  hippocampal formation 
III.  mammillary bodies 
IV.  dorsomedial nuclei  of  the  thalamus A.  I.  II, III 
B.  I,  III 
C.  II, IV 
D.  IV 
E.  all of  the  above
A

C. 11, IV V&A p. 456. Discrete, bilateral lesions in the hippocampus and dorsomedial thalamus impair memory and learning out of proportion to other cognitive functions. Stereotactic lesions of the amygdala and mammillary bodies have failed to produce these symptoms.

26
Q 
Genes  responsible  for  cavernous  malformations have  been  mapped  to chromosomes 
A.  1  and3 
B.  3  and  5 
C.  3  and7 
D.  4and 5 
E.  5  and7
A

C. 3 and7 Y p. 2168. The gene (CCMI ) responsible for familial cavernous malformations has been mapped to 7q11.2-q21. In addition. CCM2 (7p13-15) and CCM3 (3q25.2-27) have been identified in patients with cavernous malformations.

27
Q

Each of the following is characteristic of a diabetic third nerve palsy except that
A. it develops over a few hours
B. it spares the pupil
C. it is usually painless
D. the lesion involves the center of the nerve
E. the prognosis for recovery is good

A

C. it is usually painless V&A p. 287. Diabetic third nerve palsy is usually painful.

28
Q 
transverse white lines  in  the  fingernails
A.  arsenic poisoning 
B.  lead poisoning 
C.  manganese poisoning 
D.  mercury poisoning 
E.  phosphorus  poisoning
A

A. arsenic poisoning

29
Q 
black lines at the  gingival margins 
A.  arsenic poisoning 
B.  lead poisoning
C.  manganese poisoning 
D.  mercury poisoning
E.  phosphorus  poisoning
A

B. lead poisoning

30
Q 
Later symptoms resemble those of  Parkinson's disease. 
A.  arsenic poisoning 
B.  lead poisoning 
C.  manganese poisoning 
D.  mercury poisoning 
E.  phosphorus  poisoning
A

C. manganese poisoning

31
Q 
treated with atropine
A.  arsenic poisoning
B.  lead poisoning 
C.  manganese poisoning
D.  mercury poisoning 
E.  phosphorus  poisoning
A

E. phosphorus poisoning

32
Q 
Pencillamine is  the treatment  of  choice  in  the  chronic form. 
A.  arsenic poisoning 
B.  lead poisoning 
C.  manganese poisoning 
D.  mercury poisoning 
E.  phosphorus  poisoning
A

D. mercury poisoning

33
Q 
characterized by mood changes, tremors, and a cerebellar syndrome
A. arsenic poisoning
B. lead poisoning
C. manganese poisoning
D. mercury poisoning
E. phosphorus poisoning
A

D. mercury poisoning

34
Q 
treated with  ethylenediaminetetraacetic  acid  (EDTA) and dimercaprol (BAL)
A.  arsenic poisoning 
B.  lead poisoning 
C.  manganese poisoning 
D.  mercury poisoning 
E.  phosphorus  poisoning
A

B. lead poisoning

35
Q 
increased excretion  of  urinary coproporphyrin
A.  arsenic poisoning 
B.  lead poisoning 
C.  manganese poisoning 
D.  mercury poisoning 
E.  phosphorus  poisoning
A

B. lead poisoning

36
Q 
Diagnosis can be  made by the  examination of  hair samples. 
A.  arsenic poisoning 
B.  lead poisoning 
C.  manganese poisoning 
D.  mercury poisoning 
E.  phosphorus  poisoning
A

A. arsenic poisoning

CBR neurology (7 decks)

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