clinical neurology soal 71-100

Question 70

What characteristics of motor unit potentials are typical soon after reinnervation?
A. prolonged, high amplitude, and polyphasic .
B.prolonged, low amplitude, and polyphasic
C shortened, high amplitude, and polyphasic
D. shortened, low amplitude, and polyphasic
E. none of the above

Answer 70

B. prolonged, low amplitude, and polyphasic

Question 71

Which of the following ocular findings is not seen in myasthenia gravis?
A. abnormal pupillary response to accommodation
B. normal pupillary response to light
C. weakness of extraocular muscles
D. weakness of eye closure
E. weakness of eye opening

Answer 71

A. abnormal pupillary response to accommodation
V&A p. 1537. Normal pupillary response to light and accommodation, together with extraocular and orbicularis oculi muscle weakness, is highly suggestive of myasthenia gravis.

Question 72

Risk  factors for carpal tunnel syndrome include 
I.  acromegaly 
11.  amyloidosis 
Ill.  hypothyroidism
 IV.  pregnancy 
A.  I,  11, 111 
B.  I,  111 
C.  11, IV 
D.  IV 
E.  all of  the  above

Answer 72

E. all of the above

Question 73

Which of the following is true of neurologic findings in sarcoidosis?
A Cranial nerve VI is most frequently involved.
B. Sarcoidosis occurs in 25% of cases of sarcoid.
C. Polydipsia, polyuria, somnolence, and obesity are common features.
D. The granulomatous infiltration is most prominent over the hemispheres.
E. Visual disturbances are usually secondary to lesions in the occipital cortex.

Answer 73

C. Polydipsia, polyuria, somnolence, and obesity are common features. V&A pp. 760-762. Neurologic involvement in sarcoidosis occurs in 5% of cases. A granulomatous inflammatory response most prevalent at the base of the brain is seen. Visual disturbances (due to lesions in and around the optic nerves and chiasm) and polydipsia, polyuria, somnolence, or obesity (due to involvement of the pituitary and hypothalamus) are the usual features. The facial nerve is the most common cranial nerve involved.

Question 74

All of the following are associated with narcolepsy except
A. increased total number of hours per day spent sleeping
B. cataplexp
C. hypnagogic hallucinations
D. sleep paralysis
E. sleep patterns beginning with the rapid eye movements (REM) stage

Answer 74

A. increased total number of hours per day spent sleeping V&A pp. 421-423. The nocturnal sleep of a narcoleptic is often reduced, but frequent naps are taken during the day; hence the total number of hours spent sleeping is similar to a normal individual. The other responses are asso- ciated with narcolepsy.

Question 75

Which of the following signs or symptoms occurring in a young person is the most suggestive of multiple sclerosis?
A bilateral internuclear ophthalmoplegia
B gait ataxia
C Lhermitte’s sign
D optic neuritis
E vertigo

Answer 75

A. bilateral internuclear ophthalmoplegia
V&A pp. 961 -964. The initial manifestation of MS in 25% of all patients is opticneuritis, and about 50% of patients who present with optic neuritis will even-tually develop MS. Bilateral internuclear ophthalmoplegia occurring in ayoung person, however, is virtually diagnostic of MS.

Question 76

The muscles most often involved in thyroid ophthalmopathy are the
A. inferior, superior, and medial recti
B. inferior rectus and superior oblique
C. lateral and superior recti
D. lateral rectus and superior oblique
E. medial rectus and inferior oblique

Answer 76

A. inferior, superior, and medial recti
V&A p. 288. Upgaze or downgaze is usually more limited than lateral gaze. These deficits are caused by an inflammatory infiltration of the inferior and medial recti, leading to contractures of these muscles.

Question 77

Most cases of “idiopathic” hemifacial spasm are thought to result from
A. ephaptic transmission
B. hypersensitivity of facial muscles
C. hypocalcemia
D. psychiatric disorders
E. recurrence of latent viral infection

Answer 77

A. ephaptic transmission
V&A p. 1455. The spasm is thought to be caused by nerve root compression and segmental demyelination, which leads to impulses conducted in one motor fiber being transmitted to neighboring fibers (ephaptic transmission).

Question 78

The diagnosis of neurosarcoidosis is based on
A. biopsy evidence of sarcoid granulomas in non-central nervous system (CNS) tissue and neurologic findings
B. computed tomography ((3) scan showing meningeal involvement
C. increased sedimentation rate and hyperglobulinemia
D. increased serum levels of angiotensin-converting enzyme
E. MRI findings of periventricular and white matter changes

Answer 78

A. biopsy evidence of sarcoid granulomas in non-central nervous system (CNS) tissue and neurologic findings
V&A p. 762. Although all of the options are seen in active neurocarcoidosis, the diagnosis is made on the basis of answer A.

Question 79

seen most often in children with neuroblastoma
A limbic encephalitis
B. Eaton-Lambert syndrome
C. Moersch-Woltman (stiff-man) syndrome D. opsoclonus-myoclonus
E. sensory neuropathy

Answer 79

D. opsoclonus-myoclonus

Question 80

anti-Hu antibodies 
A limbic  encephalitis 
B.  Eaton-Lambert  syndrome 
C.  Moersch-Woltman (stiff-man) syndrome D.  opsoclonus-myoclonus 
E.  sensory neuropathy

Answer 80

E. sensory neuropathy

Question 81

anti-Ri  antibodies
A limbic  encephalitis 
B.  Eaton-Lambert  syndrome 
C.  Moersch-Woltman (stiff-man) syndrome D.  opsoclonus-myoclonus 
E.  sensory neuropathy

Answer 81

D. opsoclonus-myoclonus

Question 82

autoantibodies to voltage-gated calcium channels
A limbic encephalitis
B. Eaton-Lambert syndrome
C. Moersch-Woltman (stiff-man) syndrome D. opsoclonus-myoclonus
E. sensory neuropathy

Answer 82

B. Eaton-Lambert syndrome

Question 83

autoantibodies to glutamic acid decaboxylase
A limbic encephalitis
B. Eaton-Lambert syndrome
C. Moersch-Woltman (stiff-man) syndrome D. opsoclonus-myoclonus
E. sensory neuropathy

Answer 83

C. Moersch-Woltman (stiff-man) syndrome
For questions 80-84 see Mer pp. 727.893. The IgG antibody in patients with Eaton-Lambert syndrome (associated with small-cell carcinoma of the lung) reacts with presynaptic voltage-gated calcium channels. The Moersch-Woltman syndrome is characterized by involuntary muscle rigidity and spasms, and 60% of patients have autoantibodies to glutamic acid decarboxylase. Underlying tumors are often found. Most cases of paraneoplastic sensory neuropathy are associated with small-cell carcinoma of the lung or lym- phoma, and an antinuclear antibody (anti-Hu) is found in 70% of these patients. Paraneoplastic opsoclonus in adults is associated with breast cancer and an antineuronal antibody (anti-Ri).

Question 84

contralateral hemiparesis sparing the face, contralateral loss of position and vibration sense, ipsilateral paralysis, and atrophy of the tongue
A. basilar syndrome
B. lateral medullary syndrome (vertebral or posteroinferior cerebellar artery [PICA] occlusion)
C lateral superior pontine syndrome (superior cerebellar artery occlusion)
D. medial medullary occlusion
E. none of the above

Answer 84

D. medial medullary occlusion

Question 85

contralateral pain and temperature loss in the body, ipsilateral Homer’s syndrome, ipsilateral ataxia, ipsilateral paralysis of the palate and vocal cords, and ipsilateral pain and numbness in the face
A. basilar syndrome
B. lateral medullary syndrome (vertebral or posteroinferior cerebellar artery [PICA] occlusion)
C lateral superior pontine syndrome (superior cerebellar artery occlusion)
D. medial medullary occlusion
E. none of the above

Answer 85

B. lateral medullary syndrome (vertebral or posteroinferior cerebellar artery [PICA] occlusion)

Question 86

ipsilateral cerebellar ataxia, contralateral loss of pain and temperature in the body, partial deafness, and nausea and vomiting
A. basilar syndrome
B. lateral medullary syndrome (vertebral or posteroinferior cerebellar artery [PICA] occlusion)
C lateral superior pontine syndrome (superior cerebellar artery occlusion)
D. medial medullary occlusion
E. none of the above

Answer 86

C. lateral superior pontine syndrome (superior cerebellar artery occlusion)

Question 87

bilateral motor weakness in all extremities, bilateral cerebellar ataxia, and diplopia
A. basilar syndrome
B. lateral medullary syndrome (vertebral or posteroinferior cerebellar artery [PICA] occlusion)
C lateral superior pontine syndrome (superior cerebellar artery occlusion)
D. medial medullary occlusion
E. none of the above

Answer 87

A. basilar syndrome

Question 88

The lesion in hemiballismus is localized to the contralateral
A. brachium conjunctivum
B. caudate nucleus
C. dorsomedial nucleus of the thalamus D. substantia nigra
E. subthalamic nucleus

Answer 88

E. subthalamic nucleus

Question 89

The  long  thoracic  nerve innervates the 
A.  latissimus dorsi 
B.  levator  scapulae 
C.  rhomboids 
D.  serratus anterior 
E.  teres mitor

Answer 89

D. serratus anterior

Question 90

Which of the following is most consistent with the Eaton-Lambert syndrome?
A. abnormal presynaptic vesicles
B. antibodies to the acetylcholine receptor C. decreased numbers of acetylcholine receptors
D. defect in release of acetylcholine quanta
E. none of the above

Answer 90

D. defect in release of acetylcholine quanta
V&A p. 1548. In this syndrome, the presynaptic vesicles are normal, antibod- ies to the acetylcholine receptor are not present, and the extent of receptor surface is actually increased. There is, however, a defect in the release of acetylcholine quanta from the nerve terminals.

Question 91

The von Hippel-Lindau disease has  been associated with  all of  the  following  except
A.  a defect on chromosome  3 
B.  dominant inheritance 
C.  iris hamartomas 
D.  pancreatic cysts 
E.  renal cell  carcinoma

Answer 91

C. iris hamartomas

V&A p. 705. Iris harmartomas (Lisch nodules) are seen in neurofibromatosis type 1.

Question 92

Gerstmann's syndrome classically involves  a lesion in  the 
A.  dominant frontal  lobe 
B.  dominant parietal lobe 
C.  dominant temporal  lobe 
D.  nondominant parietal  lobe 
E.  nondominant temporal lobe

Answer 92

B. dominant parietal lobe

V&A p. 485. The syndrome consists of finger agnosia, left-right confusion, acalculia, and agraphia.

Question 93

Each of the following is true of dopamine pharmacology except the following:
A. Homovanillic acid is a metabolite.
B. It is derived from phenylalanine.
C. It is metabolized by monoamine oxidase (MAO).
D. The activation of the D2 receptor decreases the release of transmitter at synaptic terminals.
E. The rate-limiting step in its synthesis is dopa decarboxylase.

Answer 93

E. The rate-limiting step in its synthesis is dopa decarboxylase. V&A pp. 72-73, G&G p. 131. The rate-limiting step is tyrosine hydroxylase (converts L-tyrosine to L-hydroxyphenylalanine [L-dopa]).

Question 94

contains a dopa decarboxylase  inhibitor 
A.  amantadine 
B.  Artane  (trihexyphenidyl) 
C.  bromocriptine 
D.  Eldepryl (selegiline) 
E.  Sinemet (carbidopa-levidopa)

Answer 94

E. Sinemet (carbidopa-levidopa)

Question 95

slows progression of  the  disease in  its early stages 
A.  amantadine 
B.  Artane  (trihexyphenidyl) 
C.  bromocriptine 
D.  Eldepryl (selegiline) 
E.  Sinemet (carbidopa-levidopa)

Answer 95

D. Eldepryl (selegiline)

Question 96

stimulates Dz receptors 
A.  amantadine 
B.  Artane  (trihexyphenidyl) 
C.  bromocriptine 
D.  Eldepryl (selegiline) 
E.  Sinemet (carbidopa-levidopa)

Answer 96

C. bromocriptine

Question 97

Dryness of  the  mouth and blurred vision  are some  of  the  side  effects. 
A.  amantadine 
B.  Artane  (trihexyphenidyl) 
C.  bromocriptine 
D.  Eldepryl (selegiline) 
E.  Sinemet (carbidopa-levidopa)

Answer 97

B. Artane (trihexyphenidyl)

Question 98

inhibits intracerebral  metabolic degradation  of  dopamine 
A.  amantadine 
B.  Artane  (trihexyphenidyl) 
C.  bromocriptine 
D.  Eldepryl (selegiline) 
E.  Sinemet (carbidopa-levidopa)

Answer 98

D. Eldepryl (selegiline)
For questions 95-99 see V&A pp. 1133-1136. Amantadine is an antiviral agent that may release dopamine from striatal neurons. Artane is an anticholinergic agent. Bromocriptine is an ergot derivative. Eldepryl is a monoamine oxidase B inhibitor and slows progression of disability. Sinemet combines L-dopa with a dopa decarboxylase inhibitor.

Question 99

Wernicke's area corresponds most closely  to Brodmann's  area(s) 
A.  17 
B.  19 
C.  22 
D.  41 and  42 
E.  44

Answer 99

C. 22