clinical neurology 1-36 Flashcards
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
B. dissociated nystagmus (internuclear ophthalmoplegia)
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
E. ocular bobbing
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
G. spasmus mutans
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
C. downbeat nystagmus
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
F. seesaw nystagmus
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
D. impairment of optokinetic nystagmus
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. convergence nystagmus
- 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.
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.
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
B. Away from a parietal lobe lesion
4 to 7 Hz A alpha B beta C delta D theta E 3-per-second spike and wave
D. theta
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
D. theta
recorded from the frontal lobes symmetrically A alpha B beta C delta D theta E 3-per-second spike and wave
B. beta
associated with absence seizures A alpha B beta C delta D theta E 3-per-second spike and wave
E. 3-per-second spike and wave
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. alpha
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)
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.
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.
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.
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
E. all of the above
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
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.
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
E. third nerve palsy
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.
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.
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
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.
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.
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.
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
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.
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
e. all of the above
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
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.
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
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.
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
C. it is usually painless V&A p. 287. Diabetic third nerve palsy is usually painful.
transverse white lines in the fingernails A. arsenic poisoning B. lead poisoning C. manganese poisoning D. mercury poisoning E. phosphorus poisoning
A. arsenic poisoning
black lines at the gingival margins A. arsenic poisoning B. lead poisoning C. manganese poisoning D. mercury poisoning E. phosphorus poisoning
B. lead poisoning
Later symptoms resemble those of Parkinson's disease. A. arsenic poisoning B. lead poisoning C. manganese poisoning D. mercury poisoning E. phosphorus poisoning
C. manganese poisoning
treated with atropine A. arsenic poisoning B. lead poisoning C. manganese poisoning D. mercury poisoning E. phosphorus poisoning
E. phosphorus poisoning
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
D. mercury poisoning
characterized by mood changes, tremors, and a cerebellar syndrome A. arsenic poisoning B. lead poisoning C. manganese poisoning D. mercury poisoning E. phosphorus poisoning
D. mercury poisoning
treated with ethylenediaminetetraacetic acid (EDTA) and dimercaprol (BAL) A. arsenic poisoning B. lead poisoning C. manganese poisoning D. mercury poisoning E. phosphorus poisoning
B. lead poisoning
increased excretion of urinary coproporphyrin A. arsenic poisoning B. lead poisoning C. manganese poisoning D. mercury poisoning E. phosphorus poisoning
B. lead poisoning
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. arsenic poisoning
