ESA 4 - Neuro Flashcards
Question 1
A 60 year old woman has had problems with her vision for a few months. Initially she had blurring and now she reports she keeps missing objects on her left which results in her hitting her head. On examination she has a left homonymous superior quadrantanopia. Which lobe would the lesion most likely be?
a) Optic chiasm
b) Left parietal lobe
c) Left temporal lobe
d) Right parietal lobe
e) Right temporal lobe
e) Right temporal lobe
Question 2
A 79 year old woman complains that she cannot move her face. On examination she has weakness of smiling, puffing out her cheeks and closing her eye all on the left. She is still able to raise her eyebrows bilaterally.
Where is the lesion?
a) Left facial nerve
b) Right lateral motor cortex
c) Right medial motor cortex
d) Superior cervical ganglion
e) Left trigeminal nerve
b) Right lateral motor cortex
Question 3
An 87 year old man suffers a stroke that affects the visual pathway in his right parietal lobe. Which of the following visual field defects is the patient most likely to have:
a) Left inferior quadrantanopia with macular sparing
b) Left inferior quadrantanopia without macular sparing
c) Left superior quadrantanopia with macular sparing
d) Right inferior quadrantanopia with macular sparing
e) Right inferior quadrantanopia without macular sparing
b) Left inferior quadrantanopia without macular sparing
Question 4
A 76 year old man has a sudden onset sensory and motor deficit in his lower limbs. He has complete loss of all of his lower limb movements bilaterally with increased muscle tone and hyperreflexia. His plantar reflexes are upgoing. He also has loss of pain and temperature sensation from the L1 dermatome down. His upper limbs are unaffected. His proprioception, vibration, two point discrimination and fine touch remains intact.
Which part of the nervous system is most likely to be damaged?
a) Anterior spinal cord at L1
b) Central spinal cord at L1
c) Pons
d) Posterior spinal cord at L1
e) Thalamus
a) Anterior spinal cord at L1
Question 5
A 65 year old man presented to his GP with his wife. On shaking the man’s hand the GP noticed stiffness in his wrist. The man’s wife states that she has noticed her husband moving more slowly than normal and that his right hand has started to shake uncontrollably. What type of gait would you expect to see if you asked your patient to walk?
a) Antalgic gait
b) Hemiplegic gait
c) Shuffling gait
d) Stomping gait
e) Trendelenburg gait
c) Shuffling gait
Question 6
A 45 year old man presents to his GP with a six month history of erectile dysfunction. One examination the GP notes that he has gynaecomastia and is expressing small amounts of a milky fluid from his nipples. A visual field defect is also noted. Where is the lesion in the visual pathway most likely to be?
a) Lateral Geniculate Body
b) Occipital Lobe
c) Optic Chiasm
d) Parietal Lobe
e) Temporal Lobe
c) Optic Chiasm
Question 7
A medical student presents following a night drinking with dizziness and poor balance. A friend reports that whilst in town they fell backwards and hit their head on a curb. On examination they are malcoordinated and have slurred speech. What region of the brain has been affected by the injury?
a) Cerebellum
b) Lentiform nucleus
c) Postcentral gyrus
d) Precentral gyrus
e) Substantia nigra
?
Question 8
A neurosurgeon is resecting a tumour on the lateral surface of the frontal lobe. Which vessel supplies blood to the tumour?
a) A
b) B
c) C
d) D
e) E
b) B (middle cerebral artery)
Question 9
Following a head injury a patient sustains complete transection of the left optic tract. Which visual field defect would result?
a) Bitemporal hemianopia
b) Complete visual loss in left eye
c) Complete visual loss in right eye
d) Left homonymous hemianopia
e) Right homonymous hemianopia
e) Right homonymous hemianopia
Question 10
A patient suffers a stabbing which results in a right sided hemisection at C4. Which sensory modalities would be affected?
a) Bilateral glove and stocking loss of sensation
b) Right sided loss of fine touch and proprioception at and below C4
c) Right sided loss of pain and temperature sensation at and below C4
d) Right sided loss of all sensory modalities at and below C4
e) Right sided loss of all sensory modalities above C4
b) Right sided loss of fine touch and proprioception at and below C4
Question 11
A patient has been complaining of headaches to her GP, who has subsequently referred her to a specialist clinic for consideration of the diagnosis of idiopathic intracranial hypertension. In this condition the pressure of the CSF is elevated. This is confirmed by performing a lumbar puncture and measuring CSF opening pressure. In which order (Outermost to inner most) would the spinal needle have to pass in order the reach the CSF?
a. Skin – Subcutaneous tissue – Supraspinous ligament – Interspinous ligament – ligamentum flavum – Dura mater – Arachnoid mater - CSF.
b. Skin – Subcutaneous tissue – Ligamentum flavum – Interspinous ligament – Supraspinous ligament – Dura mater – Arachnoid mater - CSF.
c. Skin – Subcutaneous tissue – Dura mater - Arachnoid mater - Supraspinous ligament – Interspinous ligament – ligamentum flavum - CSF.
d. Skin – Subcutaneous tissue - Supraspinous ligament – Interspinous ligament – ligamentum flavum - annulus fibrosus - nucleus pulposus - CSF.
e. Skin – Subcutaneous tissue – Supraspinous ligament – Interspinous ligament – ligamentum flavum – Epidural space – CSF.
a. Skin – Subcutaneous tissue – Supraspinous ligament – Interspinous ligament – ligamentum flavum – Dura mater – Arachnoid mater - CSF.
Question 12
A pregnant women Is due to have an elective caesarean section due to a low lying placenta covering the internal os (placenta previa). After discussing with the woman, the anaesthetist is going to perform a spinal anaesthetic. Into which space will the needle enter to deliver the anaesthetic agent?
a) Spinal nerve
b) Dorsal root ganglion (DRG)
c) Epidural space
d) Subarachnoid space
e) Subdural space
d) Subarachnoid space
Question 13
A newborn baby presents with a tuft of hair on her back. She is diagnosed with spina bifida occulta. What level of the vertebral canal is most commonly affected in this condition?
a) Cranial
b) Lumbar
c) Lumbosacral
d) Thoracic
e) Thoracolumbar
c) Lumbosacral
Question 14
A patient presents with symptoms of a pontine stroke. Which of the following vessels is likely to be occluded?
a) Anterior Cerebral Artery
b) Basilar Artery
c) Middle Cerebral Artery
d) Posterior Cerebral Artery
e) Vertebral Artery
b) Basilar Artery
Question 15
A 79 year old man presents with a sudden painless loss of vision in his left eye. He describes it as a curtain coming down over his eye. This lasted about 20 minutes, and he now has full vision. Which of the following vessels was likely affected to cause this phenomenon?
a. Anterior Cerebral Artery
b. Central Retinal Artery
c. Middle Cerebral Artery
d. Ophthalmic Artery
e. Posterior Cerebral Artery
b. Central Retinal Artery
