Common Neurological Disorders

Question 1

_________ is an important sensory system that informs us when, where, and how severely we are injured.

Answer 1

Pain

Question 2

___________ may cause secondary headaches in overweight young women. It may present with papilledema and cause vision loss. A lumbar puncture helps to relieve the pain.

Answer 2

Benign intracranial hypertension (or pseudotumor cerebri)

Question 3

___________ may cause daily progressive headaches. It can be associated with focal findings, seizures, and headaches that are usually worse in the morning.

Answer 3

Brain tumors

Question 4

__________ are chronic, daily secondary headaches following a head injury. They’re usually associated with depression and poor sleep.

Answer 4

Post-traumatic headaches

Question 5

___________ is a fairly rare cause of facial pain and headache. It may present with focal sinus tenderness, stuffiness, and fever.

Answer 5

Sinusitis

Question 6

____________ may cause a headache and facial pain associated with speaking or chewing.

Answer 6

Temporomandibular joint syndrome

Question 7

___________ has a rapid but gradual onset. It is associated with neck stiffness, photophobia, fever, nausea, and vomiting.

Answer 7

Meningitis

Question 8

In cases of meningitis, a(n) _________________ should be obtained, followed by treatment with IV antibiotics.

Answer 8

Emergent lumbar puncture

Question 9

(Viral/Bacterial) meningitis is less severe and usually resolves in a few days.

Answer 9

Viral

Question 10

What condition is shown in the following image? What abnormalities are shown?

Answer 10

• Hemorrhaged blood outlined in red.
• This is characteristic of a subarachnoid hemorrhage.

Question 11

(T/F) A recurrent headache is more likely to result in a poor prognosis.

Answer 11

False. Recurrent headaches are less likely to be a serious medical condition.

Question 12

If a patient presents with a prodrome or aura before severe headaches, it is more likely to be a(n) ____________.

Answer 12

Migraine

Question 13

A unilateral headache suggests a(n) ____________.

Answer 13

Migraine

Question 14

A bifrontal or bitemporal headache suggests a(n) _____________.

Answer 14

Tension (muscle-type) headache

Question 15

Description of a headache as “throbbing” or pulsatile suggests a(n) _____________.

Answer 15

Migraine

Question 16

A fever accompanying a headache may suggest either ____________ or ____________.

Answer 16

Meningitis or sinusitis

Question 17

A headache accompanied by nausea, vomiting, and phonophobia suggests a(n) ______________.

Answer 17

Migraine

Question 18

Rhinorrhea and bloodshot sclera of the eye suggest a(n) ________________.

Answer 18

Cluster headache

Question 19

A headache accompanied by neck stiffness suggests ____________ or ___________.

Answer 19

Subarachnoid hemorrhage or meningitis

Question 20

Tenderness of the temple, especially around the area of the temporal artery suggests _________________.

Answer 20

Temporal arteritis

• Jaw claudication - Pain or weakness with chewing
• Scalp tenderness
• Can cause blindness - Requires steroids immediately

Question 21

A headache accompanied by tenderness over the sinuses suggests ____________.

Answer 21

Sinusitis

Question 22

_____________ results from inflammation and infection of the meninges. It may stem from a contiguous or hematogenous infection, such as an ear or sinus infection.

Answer 22

Meningitis

Question 23

Meningitis presents with _____________ sign, or when flexion of the neck causes hip flexion in order to prevent tension on lumbar roots.

Answer 23

Brudzinski‘s sign

Question 24

Meningitis presents with _____________ sign, or when extension of the knee with the hip flexed causes pain due to tension on lumbar roots.

Answer 24

Kernig‘s sign

Question 25

In most cases of **meningitis**, there is a(n) (increase/decrease) of **white blood cells**, (increase/decrease) of **protein**, and (high/normal or low) **glucose** within the **CSF**.

Answer 25

* **Increased** WBCs * **Increased** protein * **Normal** or **low** glucose

Question 26

The **ankle jerk** and **plantar reflex** are mediated by what spinal nerves?

Answer 26

**S1** and **S2**

Question 27

The **patellar reflex** is mediated by what spinal nerves?

Answer 27

**L3** and **L4**

Question 28

The **biceps reflex** is mediated by what spinal nerves?

Answer 28

**C5** and **C6**

Question 29

The **triceps reflex** is mediated by what spinal nerves?

Answer 29

**C7** and **C8**

Question 30

What is the useful mnemonic to remember clinical reflexes?

Answer 30

* S1,2 - Buckle my shoe (ankle jerk and plantar reflex) * L3,4 - Kick down the door (patellar reflex) * C5,6 - Pick up sticks (biceps reflex) * C7,8 - Lay them straight (triceps reflex)

Question 31

\_\_\_ radiculopathy results in the **inability to walk** on one's **toes**.

Answer 31

**S1**

Question 32

\_\_\_ radiculopathy results in the **inability to walk** on one's **heels**.

Answer 32

**L5**

Question 33

(Binocular/Monocular) double vision is experienced when a **double image** is **seen** with **both eyes open**, but **goes away when one eye is closed**.

Answer 33

**Binocular**

Question 34

(Binocular/Monocular) double vision is experienced when a **double image is seen with both eyes open** and the **image persists after one eye is closed**.

Answer 34

Monocular

Question 35

(Binocular/Monocular) double vision is usually due to a problem with **ocular alignment**.

Answer 35

Binocular

Question 36

(Binocular/Monocular) double vision is usually due to a **local eye disease** or **refractive error**.

Answer 36

Monocular

Question 37

What **systemic diseases** can cause **double vision**?

Answer 37

* Thyroid disease * Wernicke's encephalopathy * Myasthenia gravis * Ophthalmoplegic migraines

Question 38

**Palsies** of what **cranial nerves** can cause **double vision**?

Answer 38

* CN **III** (Oculomotor) * CN **IV** (Trochlear) * CN **VI** (Abducens)

Question 39

What are the rules of **diplopia**?

Answer 39

* The **false image** is always the **outer image**. * The **false image** always comes from the **affected eye**. * **Cover each eye** to see which generates false image.

Question 40

**Acute** or **sudden weakness** of muscles suggests \_\_\_\_\_\_\_\_\_\_.

Answer 40

Stroke

Question 41

**Chronic** or **insidious weakness** of **muscles** suggests \_\_\_\_\_\_\_\_\_.

Answer 41

**Neurodegenerative** disease, such as **ALS**.

Question 42

Muscle weakness that **worsens** toward the **end** of the day suggests \_\_\_\_\_\_\_\_\_\_\_\_.

Answer 42

**Myasthenia gravis**

Question 43

**Muscle weakness** accompanied by **muscle wasting** and **fasciculations**, **flaccid** muscle tone, and **hyporeflexia** suggests \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 43

**Lower motor neuron** lesion

Question 44

**Muscle weakness** accompanied by **spastic muscle** tone, **hyperreflexia**, or a **Babinski** reflex suggests \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 44

**Upper motor neuron** lesion

Question 45

If **dysesthesia** is accompanied by **pain**, it usually points to \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 45

**Peripheral nerve** problems

Question 46

(T/F) In a case of **dysesthesia**, you should **test all modalities** of the patient for sensation, including light touch, pinprick sensations, temperature, vibration, and joint position.

Answer 46

True.

Question 47

(T/F) In neuropathies, **shorter nerves** tend to be affected **first**.

Answer 47

False. **Longer nerves** tend to be **affected first**. **Symptoms** usually appear in the **feet** and **progress upwards** over months to years.

Question 48

In cases of neuropathy, when **numbness reaches the knee**, the _____________ begin to be affected.

Answer 48

Fingertips

Question 49

**Imaging** (usually/rarely) helps **localize nerve lesions** in cases of neuropathy.

Answer 49

Rarely

Question 50

One of the most useful tests for diagnosing and determining the extent of neuropathy is a(n) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 50

Nerve conduction study

Question 51

\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is an **autoimmune**, **acute**, **demyelinating** disease of the **PNS**. It causes destruction of **axonal myelin** and subsequent slowing and blocking of nerve conduction. Patients often present with **weakness**, **areflexia**, and **sensory abnormalities** such as **hyperesthesia**. This condition may be preceded by a **GI** or **upper respiratory** **infection**.

Answer 51

**Guillain**-**Barre** syndrome

Question 52

**Guillain**-**Barre** presents with (increased/decreased) levels of **protein** in the **CSF**, but **normal cell populations**.

Answer 52

**Increased** protein

Question 53

(T/F) Imaging plays an important role in the diagnosis if Guillain-Barre syndrome.

Answer 53

False. **Imaging plays no role** in the diagnosis of this illness.

Question 54

A score of \_\_/30 is considered normal on the **mini mental exam** (**MME**).

Answer 54

27/30

Question 55

A **stepwise progression** of **forgetfulness** is more likely to be \_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 55

**Multi**-**infarct dementia**

Question 56

A **sudden** or **rapid decline** in **memory** may point toward \_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 56

**Creutzfeldt**-**Jakob** disease (mad cow disease)

Question 57

The most prominent type of dementia is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 57

**Alzheimer's** disease

Question 58

A **normal** response on the **swinging**-**light test** is the (dilation/constriction) of the **pupil**.

Answer 58

**Constriction**

Question 59

**Periventricular plaques** referred to as "**Dawson**'**s fingers**" are very suggestive of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 59

**Multiple Sclerosis**

Question 60

What disease is the patient in the following image most likely to have?

Answer 60

* "**Dawson's fingers**" highlighted by arrows. * This is characteristic of **Multiple Sclerosis**.

Question 61

(T/F) The **CSF** of a patient afflicted with **Guillain**-**Barre** syndrome will have **oligoclonal** **bands** upon **electrophoresis** due to **intrathecal** (inside the spinal cord) **IgG** synthesis.

Answer 61

False. The CSF of a patient afflicted with **Multiple Sclerosis** will have these **oligoclonal** **bands**.

Question 62

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is a disease characterized by **bradykinesia**, **resting tremors**, **cogwheel rigidity** (jerky resistance to passive movement of muscles), and **postural** **instability**. Its pathology stems from a failure of the **substantia nigra** to produce the required amounts of **dopamine** for use in the maintenance of muscle control.

Answer 62

**Parkinson's** disease