Examplify question bank 2/2 Flashcards
Refer to the attached diagram, ignoring the connection from STN to SNc. What would be the effect of stimulation of GPi?
A. Increased movement
B. Decreased movement
C. No effect on movement
B. Decreased movement
Rationale: Stimulation of GPi would lead to increased inhibition of the thalamus and hence decreased movement
Attachment:
Refer to the attached diagram, ignoring the connection from STN to SNc. What would be the effect of destruction of GPi?
A. Increased movement
B. Decreased movement
C. No effect on movement
Rationale: Destruction of would lead to decreased inhibition of the thalamus and hence increased movement
Refer to the attached diagram, ignoring the connection from STN to SNc. What would be the effect of destruction of the subthalamic nucleus?
A. Increased movement
B. Decreased movement
C. No effect on movement
A. Increased movement
Refer to the attached diagram, ignoring the connection from STN to SNc. What would be the effect of stimulating the subthalamic nucleus?
A. Increased movement
B. Decreased movement
C. No effect on movement
Rationale: Stimulation of STN would cause increased activity in GPi/SNr which would in turn cause increased inhibition of the thalamus.
In the internal capsule, where would fibres representing the lower limbs be found?
A. Anterior limb
B. Genu
C. Posterior limb
C. Posterior limb
Rationale: The posterior limb contains UMNs destined for most of the body. The
genu contains UMNs destined for the face. The anterior limb contains a number of fibres which are not relevant to your studies
Which structure in the midbrain is important for motor control?
A. Medial lemniscus
B. Periaqueductal grey
C. Red nucleus
Rationale: The red nucleus participates in some complex circuits with the
cerebellum and motor cortex. These are not important. It is also the origin of the (rudimentary) rubrospinal tract. The periaqueductal grey does not have a major motor role. The superior colliculus does project down the cord in the tectospinal tract synapsing on LMNs. Hence both b or c could be argued to be correct
Refer to the atached diagram, ignoring the connection between STN and GPe. Destruction of the subthalamic nucleus could result in which of the following
A. Decreased movement
B. Increased movement
C. No effect on movement
B. Increased movement
Rationale: STN damage can lead to (hemi)ballismus – involuntary, explosive movements. Damage to the STN leads to decreased stimulation of GPi and SNr, hence decreased inhibition of the thalamus and ultimately increased motor cortical activity.
Parkinson’s disease is characterised by which triplet of signs?
A. Hyporeflexia, fasciculation and wasting
B. Hypotonia, nystagmus and intention tremor
C. Tremor, rigidity and bradykinesia
Rationale: Option a describes LMN lesions. Option b describes cerebellar lesions
C. Tremor, rigidity and bradykinesia
Rationale: Option a describes LMN lesions. Option b describes cerebellar lesions
Upper motor neurone lesions lead to spasticity because…?
A. Increased activity to flexors
B. Increased overall activity in the corticospinal tract
C. Loss of descending inhibition of lower motor neurones
Rationale: Both flexors and extensors are affected equally in UMN lesions but
flexors are more powerful, hence flexed spastic posture. There is actually decreased overall activity in the CST. Spasticity occurs due to loss of descending inhibitory tone on the LMNs
Loss of descending inhibition of lower motor neurones
Rationale: Both flexors and extensors are affected equally in UMN lesions but
flexors are more powerful, hence flexed spastic posture. There is actually decreased overall activity in the CST. Spasticity occurs due to loss of descending inhibitory tone on the LMNs
Hyporeflexia is most likely to be a feature of which condition?
A. Dorsal column lesions
B. Early stages of UMN lesions
C. Late stages of UMN lesions
B. Early stages of UMN lesions
Rationale: Early in a UMN lesion there is flaccid paralysis due to spinal shock. Late stages of UMN lesions have hyperreflexia. Dorsal column lesions do not tend to grossly affect spinal reflexes
A patient has suffered a stroke affecting the internal capsule near the genu. How will his facial weakness manifest?
A. Weakness of the contralateral lower face
B. Weakness of the contralateral upper face
C. Weakness of the ipsilateral upper face
Rationale: The upper face has a bilateral UMN innervation, hence is spared in
strokes. The lower face receives a contralateral UMN innervation. The genu contains UMNs supplying the face.
Lower motor neurone lesions can lead to which of the following signs?
A. Fasciculation B. Hyperreflexia C. Hypertonia
A
Rationale: The other two are features of upper motor neurone lesions
A neurologist is reviewing a patient in epilepsy clinic. She initially presented with feelings of déjà vu and olfactory hallucinations. When the neurologist asks the patient if she has had any more of these episodes she responds in the following way: “well it might be by the by but we had a lovely holiday up on the moon near Scarborough”.
Where is the epileptic focus?
a. Right parietal lobe
b. Left occipital lobe
c. Left frontal lobe
d. Left thalamus
e. Left temporal lobe
which side of the bopdy does the left cerebellum control
You are observing a post mortem examination on an elderly patient who died following a head injury. Removal of the brain indicates that it has a low weight, narrow gyri and wide sulci.
a. What is the most likely diagnosis to explain these pathological findings? 1 mark
alzheimers
You are observing a post mortem examination on an elderly patient who died following a head injury. Removal of the brain indicates that it has a low weight, narrow gyri and wide sulci.
b. Give two molecular pathologies that may be detected upon microscopic examination of the brain in this patient. 2 marks
Amyloid plaque
Neurofibillary tangles
Patients suffering from with AD often become drowsy and unresponsive during its later stages. Which two parts of the brain are required for the maintenance of consciousness, and how do they interact? 2 marks
cortex
reticular formation
The parents of a three year old boy bring him to the neurology clinic complaining that he has periods where he stops ‘paying attention’, but then after a few seconds continues where he left off. Epilepsy is diagnosed. Which form is most likely?
A. Petit mal
B. Temporal lobe
C. Tonic clonic
Which of the following is a common cause of excessive daytime sleepiness?
A. Brainstem stroke
B. Narcolepsy
C. Sleep apnoea
C. Sleep apnoea
A rapid onset dementia in a young person might be suggestive of which condition?
A. Alzheimer’s disease
B. Lewy body dementia
C. Prion disease
Rationale: Alzheimer’s and Lewy body dementia tend to come on more slowly (the latter with Parkinsonian features). In a patient like this, also consider an aggressive brain tumour which could cause a similar clinical picture
C. Prion disease
Rationale: Alzheimer’s and Lewy body dementia tend to come on more slowly (the latter with Parkinsonian features). In a patient like this, also consider an aggressive brain tumour which could cause a similar clinical picture
In assessing the motor response in the GCS, which scores the lowest?
A. Extension to pain
B. Obeying commands
C. Withdrawal from pain
A. Extension to pain
Best to consider the GCS responses with respect to how ‘physiological’ they are. Clearly, obeying commands is the norm. If the best response is withdrawal to pain then this is clearly more physiological/appropriate than extension to pain. Obeying commands scores 6, withdrawal to pain scores 4 and extension to pain scores 2
A normally fit and well elderly woman is seen in the emergency department with recent onset of confusion. As the admitting doctor, what might be a sensible early investigation to perform?
A. Blood cultures
B. Urine dipstick
C. White cell count
B. Urine dipstick
Cushing’s response is characterised by which features?
A. Hypertension and bradycardia
B. Hypertension and tachycardia
C. Hypotension and bradycardia
A. Hypertension and bradycardia
Rationale: Cushing’s response is a response which is seen when the ICP gets very high. Its aetiology is unclear but may involve compression of the cardiovascular centres in the medulla. Usually (say following blood loss) hypotension would be accompanied by tachycardia, to maintain cardiac output.
Following a head injury, a downward trend in the GCS combined with pupillary dilatation might suggest what?
A. Brain herniation is unlikely
B. Normal intracranial pressure
C. Increasing intracranial pressure
C. Increasing intracranial pressure
Which brain structure is crucial for consolidation of implicit memory?
A. Basal ganglia
B. Cerebellum
C. Hippocampus
A patient is unable to repeat the name of an object when spoken, although they are able to point to the physical object the word refers to. They are able to articulate words clearly. Where is the lesion?
A. Arcuate fasciculus
B. Broca’s area
C. Wernicke’s area
You notice on the stroke ward that a patient has only eaten the right half of their dinner. Which lobe is likely to have been damaged?
A. Right parietal lobe
B. Left parietal lobe
C. Occipital lobe
A. Right parietal lobe
A patient has a large tumour in the left temporal lobe resected. Which visual defect might result?
A. Left homonymous hemianopia
B. Right inferior homonymous quadrantanopia
C. Right superior homonymous quadrantanopia
A patient with epilepsy frequently experiences the smell of oranges immediately before a seizure. Where is the causative lesion most likely to be?
A. Frontal lobe B. Parietal lobe C. Temporal lobe
C. Temporal lobe
The presence of xanthochromia in the CSF suggests what?
A. A subarachnoid haemorrhage occurred less than 12 hours ago
B. A subarachnoid haemorrhage occurred more than 12 hours ago
C. Blood entered the CSF as a result of damage to a vessel during lumbar puncture
B. A subarachnoid haemorrhage occurred more than 12 hours ago
An aneurysm of the posterior communicating artery can compress which cranial nerve?
A. Oculomotor
B. Optic
C. Trigeminal
What is a normal intracranial pressure?
A. 0.1 mmHg B. 10 mmHg C. 30 mmHg
B. 10 mmHg
Which of the following levels of spinal cord injury is LEAST likely to require ventilatory support?
A. C4
B. L2
C. T3
B. L2
The anterior communicating artery connects which two structures?
A. The anterior and posterior circulations
B. The anterior cerebral arteries
C. The posterior cerebral artery to the anterior cerebral artery
A stroke patient is found to have a homonymous superior quadrantanopia. Which lobe has been damaged?
A. Occipital B. Parietal C. Temporal
temporal
Which factor may increase the risk of chronic subdural haemorrhage?
A. Dementia
B. Procoagulant state
C. Young age
Dementia
With regard to the corticospinal tract, the posterior limb of the internal capsule classically represents which regions of the body?
A. Face
B. Trunk and lower limbs
C. Viscera
B. Trunk and lower limbs
Herniation of the uncus of the temporal lobe can result in which of the following?
A. Damage to the vagus nerve
B. Ipsilateral third nerve palsy
C. Ischaemia in the medial part of the motor cortex
Ipsilateral third nerve palsy
Occlusion of the proximal portion of the superior cerebellar artery may lead to damage to which other structure?
A. Medulla B. Midbrain C. Pons
A patient presents with visual and sensory disturbance. Examination reveals right homonymous hemianopia with macular sparing and sensory deficit affecting all of the right side. Which vessel is most likely to have been occluded?
A. Left middle cerebral artery
B. Left posterior cerebral artery
C. Right posterior cerebral artery
Following occlusion of the anterior cerebral artery a patient develops raised intracranial pressure and herniates part of their cerebral cortex. Which part of the cortex is particularly vulnerable?
A. Cingulate cortex
B. Prefrontal cortex
C. Primary visual cortex
A stroke patient is found to have a homonymous inferior quadrantanopia. Which lobe has been damaged?
A. Occipital B. Parietal C. Temporal
parietal
A patient has suffered a stroke leading to weakness of the face and upper and lower limbs but with no other clinical features. Which vessel has been occluded?
A. A lenticulostriate artery
B. The basilar artery
C. The middle cerebral artery
A. A lenticulostriate artery
The posterior communicating artery connects which two structures?
A. The anterior and posterior circulations
B. The anterior cerebral arteries
C. The posterior cerebral artery to the anterior cerebral artery
A. The anterior and posterior circulations
Which of the following are not recommended for the long term management of anxiety disorders?
A. Benzodiazepines
B. Pregabalin
C. Selective Serotonin Reuptake Inhibitors (SSRIs)
. Benzodiazepines
Which of the following is not true regarding GABA?
A. Benzodiazepines increase GABA transmission
B. GABA is the main inhibitory neurotransmitter
C. GABA levels are increased in the cortex of patients with anxiety disorders
Deep brain stimulation of the subthalamic nucleus in OCD patients will have which of the following effects? Feel free to refer to the basal ganglia diagram in the workbook.
A. Increased excitation of globus pallidus internus and substatia nigra pars reticulata B. Increased inhibition of globus pallidus internus and substantia nigra pars reticulata C. No effect on globus pallidus internus and substatia nigra pars reticulata
✓✡✎ Increased excitation of globus pallidus internus and substatia nigra pars reticulata
Which of the following is a theory regarding the pathophysiology of OCD?
A. Increased activity in the orbitofrontal cortex
B. Reduced activity in cingulate cortex
C. Re-entry circuits in basal ganglia
Which of the following is a theory regarding the pathophysiology of OCD?
A. Increased activity in the orbitofrontal cortex
B. Reduced activity in cingulate cortex
C. Re-entry circuits in basal ganglia
Which of the following about the epidemiology of OCD in adults is correct?
A. 75% of patients will start experiencing symptoms before the age of 30
B. It is more common in women
C. There is a lifetime prevalence of around 0.2%
75% of patients will start experiencing symptoms before the age of 30
Reduction in size of which structure has not been widely recorded in patients with schizophrenia?
A. Amygdala
B. Prefrontal cortex
C. Ventricles
In which of the following structures would you not find D2 receptors?
A. Neocortex
B. Striatum
C. Substantia nigra
Which dopamine pathway is thought to be overactive in schizophrenia?
A. Mesocortical
B. Mesolimbic
C. Tuberoinfundibular
mesolimbic
A patient presents with bizarre behaviour including inappropriate laughter and childlike behaviour. He displays disjointed speech and thought disorder on examination. Which is the most appropriate diagnosis?
A. Hebephrenic schizophrenia
B. Paranoid schizophrenia
C. Simple schizophrenia
✓✡✎ Hebephrenic schizophrenia
The hebephrenic or disorganized subtype of schizophrenia is typified by shallow and inappropriate emotional responses, foolish or bizarre behaviour, false beliefs (delusions), and false perceptions (hallucinations).
