clinical neurology soal 37-70 Flashcards
Which of the following is not a characteristic of Adie’s syndrome?
A. degeneration of the ciliary ganglia and postganglionic parasympathetics
B. more common in women than in men
C. no reaction to 0.1% pilocarpine solution
D. paralysis of segments of the pupillary sphincter
E. Pupil responds better to near than to light.
C. no reaction to 0.1% pilocarpine solutionV&A p. 297. An Adie’s pupil is unusually sensitive to 0.1% pilocarpine (dener- ation hypersensitivity).
Characteristics of infantile seizures include I. lip smacking 11. hypsarrythmia 111. generalized tonic-clonic activity IV. myoclonic head jerks A. I. 11, 111 B. I, 111 C. 11, IV D. IV E. all of the above
C. II, IV V&A p. 352. Infantile seizures or spasms usually begin before 6 months of age and are characterized by sudden flexor or extensor spasms of the head, trunk. and limbs and an electroencephalogram (EEG) picture of bilateral high- voltage, slow-wave activity (hypsarrythmia). Lip smacking and generalized onic-clonic activity are not features.
Muscles of the trunk and lower extremities are more frequently involved than the extraocular muscles
A. myasthenia gravis
B. myasthenic syndrome of Eaton-Lambert
C. both
D. neither
B. myasthenic syndrome of Eaton-Lambert For questions 39-42 see V&A pp. 1547-1548. These are all features of the Eaton-Lambert syndrome.
Poor response to anticholinesterase drugs
A. myasthenia gravis
B. myasthenic syndrome of Eaton-Lambert
C. both
D. neither
B. myasthenic syndrome of Eaton-Lambert
An incrementing response (marked increase in the amplitude of the action potential with,,fast rates of nerve stimulation) is typical.
A. myasthenia gravis
B. myasthenic syndrome of Eaton-Lambert
C. both
D. neither
B. myasthenic syndrome of Eaton-Lambert
associated with antibodies to the presynaptic voltage-dependent calcium channel
A. myasthenia gravis
B. myasthenic syndrome of Eaton-Lambert
C. both
D. neither
B. myasthenic syndrome of Eaton-Lambert
The dorsal scapular nerve innervates the I. supraspinatus 11. rhomboids 111. subscapularis IV. levator scapulae A. I, 11,111 B. I, 111 C 11, IV D. IV E. all of the above
C. 11. rhomboids , IV. levator scapulae
teres major
A. axillary nerve B. dorsal scapular nerve C. subscapular nerve D. suprascapular nerve E. none of the above
C. subscapular nerve
teres minor
A. axillary nerve B. dorsal scapular nerve C. subscapular nerve D. suprascapular nerve E. none of the above
A. axillary nerve
subscapularis A. axillary nerve B. dorsal scapular nerve C. subscapular nerve D. suprascapular nerve E. none of the above
C. subscapular nerve
levator scapulae A. axillary nerve B. dorsal scapular nerve C. subscapular nerve D. suprascapular nerve E. none of the above
B. dorsal scapular nerve
supraspinatus A. axillary nerve B. dorsal scapular nerve C. subscapular nerve D. suprascapular nerve E. none of the above
D. suprascapular nerve
infraspinatus A. axillary nerve B. dorsal scapular nerve C. subscapular nerve D. suprascapular nerve E. none of the above
D. suprascapular nerve
rhomboids A. axillary nerve B. dorsal scapular nerve C. subscapular nerve D. suprascapular nerve E. none of the above
B. dorsal scapular nerve
The motor unit potential in myopathy is of
A. decreased voltage and decreased duration
B. decreased voltage and increased duration
C. decreased voltage and normal duration
D. normal voltage and decreased duration
E. normal voltage and increased duration
A. decreased voltage and decreased duration
Which is true of myotonic dystrophy?
A. Frontal balding occurs only in men.
B. Lens abnormalities are rare.
C The congenital form is inherited only from the maternal line.
D. The inheritance is autosomal recessive.
E. Weakness always predates the myotonia.
C The congenital form is inherited only from the maternal line. V&A pp. 1503-1504. Frontal balding occurs in both men and women afflicted with myotonic dystrophy. Lens opacities are found by slit lamp in 90% of patients. The inheritance is autosomal dominant, and the defective gene segregates on chromosone 19. Myotonia may precede weakness by several years. Answer C is correct.
Subacute combined degeneration of the spinal cord is caused by a deficiency of A. cobalamin B. folic acid C. nicotinic acid D. pyridoxine E. thiamine
A. cobalamin V&A p. 1218. Subacute combined deficiency of the cord occurs from failure totransfer cobalamin (vitamin BIZ) across the interstitial mucosa because of lackof intrinsic factor.
The marker linked to the Huntington gene is localized to the short arm of chromosome A. 4 B. 11 C. 17 D. 22 E. none of the above
A.4
Alexia without agraphia is most likely to occur with a lesion involving the
A. left geniculocalcarine tract and corpus callosum
B. left geniculocalcarine tract and Wernicke’s area
C. left geniculocalcarine tract, corpus callosum, and Wernicke’s area
D. right geniculocalcarine tract and corpus callosum
E. right geniculocalcarine tract and Wernicke’s area
A. left geniculocalcarine tract and corpus callosum V&A pp. 494,511. The lesion described in A would render the patient blind in the right half of the visual field. Visual information reaches only the right occipital lobe but cannot be transferred to Wernicke’s area across the callo- sum. Thus the ability to read aloud and to understand the written word is lost, but the ability to understand the spoken language, speak, write, dictate, and converse is retained.
Deviation of the eyes to the right is most likely to occur with occlusion of the A. calcarine artery bilaterally
B. calcarine artery on the contralateral side
C. contralateral paramedian branch of the basilar artery
D. ipsilateral superior cerebellar artery
E. superior division of the contralateral middle cerebral artery
C. contralateral paramedian branch of the basilar artery V&A p. 849. Deviation of the eyes away from the lesion occurs in brainstem syndromes, for example, the medial midpontine syndrome (occlusion of the paramedian branch of the midbasilar artery). Answers B, D, and E would cause deviation of the eyes to the left.
Which of the following antiepileptic drugs has the shortest half-life? A. carbamazepine B. ethosuximide C. phenobarbital D. phenytoin E. valproate
E. valproate Of the antiepileptic drugs listed, phenobarbital has the longest half-life of 96 k 12 hours, followed by ethosuximide, 40 k 6 hours; phenytoin 24 k 12 hours; carbamazepine 12 k 4 hours; and valproate 8 f 2 hours.
weakness and atrophy of the hands A. amyotrophic lateral sclerosis B. syringomyelia C. both D. neither
C. both
Despite the atrophy of the hands and forearms in amyotrophic lateral sclerosis (ALS), diffuse hyperreflexia is seen, with absence of sensory change.
hypo- or areflexia A. amyotrophic lateral sclerosis B. syringomyelia C. both D. neither
B . syringomyelia
Despite the atrophy of the hands and forearms in amyotrophic lateral sclerosis (ALS), diffuse hyperreflexia is seen, with absence of sensory change.
absence of sensory changes A. amyotrophic lateral sclerosis B. syringomyelia C. both D. neither
A amyotrophic lateral sclerosis
Despite the atrophy of the hands and forearms in amyotrophic lateral sclerosis (ALS), diffuse hyperreflexia is seen, with absence of sensory change.
Biochemical studies of neurons from a seizure focus have shown all of the ollowing except
A. increased levels of extracellular potassium in glial scars near seizure foci .
B. decreased rate of binding and removing acetylcholine in the foci .
C. deficiency of y-aminobutyric acid (GABA)
D. decreased glycine levels .
E. decreased taurine levels
D. decreased glycine levels .
V&A p. 345. Increased glycine levels have been found in neurons in seizure foci.
The most reliable indicator of an intracellular cobalamin (vitamin B12deficiency is
A. low vitamin B12 on a microbiologic assay
B. low vitamin B12 on a radioisotope dilution assay
C. low vitamin Biz on a Schilling test
D. the finding of hypersegmented polymorphonuclear neutrophil leukocytes (PMN) in bone marrow smears
E. the finding of increased serum concentration of methylmalonic acid and homocysteine
E. the finding of increased serum concentration of methylmalonic acid and homocysteine
V&A p. 1222. Although microbiologic assay is the most accurate way to mea- sure serum cobalamin levels, the serum level is not a measure of total body cobalamin. High serum concentrations of cobalamin metabolites (methyl- malonic acid and homocysteine) are the most reliable indicators of an intra- cellular cobalamin deficiency.
Each of the following is true of radiation myelopathy (delayed progressive type) except
A. Absence of pain is typical early in the course.
B. It occurs 12 to 15 months after radiation.
C. Magnetic resonance imaging (MRI) shows abnormal signal intensity; decreased on TI and increased on T2.
D. Sensory changes usually develop after motor changes.
E. The most severe parenchymal changes are typical of infarction.
D. Sensory changes usually develop after motor changes.
V&A p. 1302. In radiation myelopathy, sensory changes usually precede theweakness.
Fasciculation potentials indicate A. motor nerve fiber irritability B. motor nerve fiber destruction C motor unit denervation D. muscle atrophy E. reinnervation of muscle units
A. motor nerve fiber irritability
di- or triphasic pattern A. fasciculation potential B. fibrillation potential C. both D. neither
B. fibrillation potential
5 to 15 ms in duration A. fasciculation potential B. fibrillation potential C. both D. neither
A. fasciculation potential
may take the form of positive sharp waves A. fasciculation potential B. fibrillation potential C. both D. neither
B. fibrillation potential
seen in poliomyelitis A. fasciculation potential B. fibrillation potential C. both D. neither
C. both
usually develops 24 to 36 hours after the death of an axon A. fasciculation potential B. fibrillation potential C. both D. neither
D. neither
may be visible through the skin A. fasciculation potential B. fibrillation potential C. both D. neither
A. fasciculation potential
For questions 65-70 see V&A pp. 1361-1362. Fibrillation potentials last from 1 to 5 ms, may take the form of positive sharp waves, and are seen 10 to 25 days after the death of an axon. Fasciculation potentials have three to five phases. Both can be seen in poliomyelitis.
