Neuro ILA formatives

Question 1

While you are clerking an elderly gentleman, the patient can understand what you are asking, but they are unable to construct sentences in response. His responses are limited to a few disjointed words. which lobe is damaged?

• dominant frontal lobe
• left temporal lobe
• dominant parietal lobe
• occipital lobe
• brainstem

Answer 1

Dominant frontal lobe - broca’s area is located here and is needed for the production of speech and words

Question 2

while examining an elderly lady who arrives on the stroke pathway, it becomes apparent that she has complete loss of her left visual field. which lobe is damaged?

• right frontal
• left frontal
• left ocipital
• right ocipital

Answer 2

Right Ocipital lobe - bilateral hemianopia as vision has contralateral sensation

Question 3

The patient doesn’t appear to understand any questions and is speaking what seems to be gobbledegook. what lobe is damaged?

• dominant frontal lobe
• left temporal lobe
• dominant parietal lobe
• occipital lobe
• brainstem

Answer 3

left temporal lobe - wernicke’s area is located here and is responsible for speech comprehension

Question 4

a patient came to A&E very distresses because she woke up to find she couldn’t feel the right side of her face or right arm or leg. what lobe is damaged?

• frontal lobe
• temporal lobe
• parietal lobe
• occipital lobe
• brainstem

Answer 4

parietal lobe - postcentral gryus contains the somatosensory cortex

Question 5

a patient came to A&E very distressed because he woke up to find he couldn’t move the right side of his face or right leg or arm. what lobe is damaged?

• frontal lobe
• temporal lobe
• parietal lobe
• occipital lobe
• brainstem

Answer 5

frontal lobe - precentral gryus is located he and contains the primary motor cortex

Question 6

up til a month ago a patients wife would have described her husband as shy, polite and charming. she says he has been acting unusual recently and has been spending money impulsively, prone to aggressive outbursts and often rude to passersby. what lobe is damaged?

• frontal lobe
• temporal lobe
• parietal lobe
• occipital lobe
• brainstem

Answer 6

Frontal lobe - the frontal lobe is responsible for personality, impulse control, sexual and social behaviors.

Question 7

a patient is unable to move or feel his left leg/foot. which artery is blocked?

• Right anterior cerebral artery
• left anterior cerebral artery
• right middle cerebral artery
• left middle cerebral artery
• posterior cerebral artery

Answer 7

right anterior cerebral artery

• anterior cerebral arteries supply the anteromedial parts of the brain and corpus callosum
• it’s right ACA because motor innervation is contralateral

Question 8

a patient presents with right sided drooping of her facial muscles, slurred speech and an inability to move her right arm. which artery is blocked?

• Right anterior cerebral artery
• left anterior cerebral artery
• right middle cerebral artery
• left middle cerebral artery
• posterior cerebral artery

Answer 8

Left middle cerebral artery

• middle cerebral arteries supply lateral parts of the brain
• left because of contralateral innervation

Question 9

patient presents with complete right sided visual field deficit. which artery is blocked?

• anterior cerebral artery
• right middle cerebral artery
• left middle cerebral artery
• left posterior cerebral artery
• right posterior cerebral artery

Answer 9

Left posterior cerebral artery

• posterior cerebral arteries supply the medial and lateral parts of the posterior cerebrum
• left because visual sensation is contralateral

Question 10

at what level in the CNS does the corticospinal tract decussate?

Answer 10

medulla

Question 11

the parents of a 5 year old boy noted that he was unable to stand after playing with his toys on the floor. he ended up having to inch his hands up his thighs to get himself into a standing position. where is the problem located?

• upper motor neurone
• lower motor neurone
• peripheral nerve
• neruomuscular junction
• muscle

Answer 11

muscle - some path bull

Question 12

A man felt immediate back pain and a popping sensation after lifting a heavy box. the next day he noticed he was tripping over his right foot and that it was dragging along the floor. where is the problem?

• upper motor neurone
• lower motor neurone
• peripheral nerve
• neruomuscular junction
• muscle

Answer 12

lower motor neurone

lower motor neurone damage

• reflexes are diminished or absent
• babinski sign absent
• fasciculations present
• tone is decreasedd
• atrophy is profound

Question 13

a patient presents with a stiff flexed arm and a stiff extended leg (both left sided) which the patient finds difficult to bend? where is the problem?

• upper motor neurone
• lower motor neurone
• peripheral nerve
• neruomuscular junction
• muscle

Answer 13

Upper motor neurone

Upper motor neurone damage

• reflexes hyperactive
• babinski sign present
• fasciculations absent
• tone is increased
• atrophy is minimal

Question 14

female presents with weakness in her left leg. she was in your clinic 2 years ago with visual distrubances and sensory loss over the left forearm. the symptoms persisted for several weeks then gradually resolved. what is the likely diagnosis?

• stroke
• MS
• Myasthenia Gravis
• spinal cord compression
• MND

Answer 14

MS - multiple sclerosis

Question 15

a patient presents c/o her eye becoming progressively more droopy when applying makeup in the morning. weeks later she begins to experience double vision, and found it more tiring and difficult to chew food. what is the likely diagnosis?

• stroke
• MS
• Myasthenia Gravis
• spinal cord compression
• MND

Answer 15

myasthenia gravis `

Question 16

patient has a history of weakness in both hands but is now unable to open a jar. he shows wasting in both hands and over the past three weeks developed slurred speech and difficulty swallowing. what is the likely diagnosis?

• stroke
• MS
• Myasthenia Gravis
• spinal cord compression
• MND

Answer 16

MND

Question 17

Which of the following statements is true regarding the nerve action potential graph?
A) upstroke = K+ rushing into cell and down stroke = Na+ rushing out of cell
B) upstroke = Na+ rushing into cell and downstroke = K+ rushing out of cell
C) upstroke = K+ rushing out of cell and down stroke = Na+ rushing into cell
D) upstroke = Na+ rushing out of cell and down stroke = K+ rushing into cell
E) upstroke = Na+ rushing into cell and down stroke = Ca2+ rushing out of cell

Answer 17

B) the upstroke is mediated by Na+ ions rushing into the cell and the down stroke is mediated by K+ ions rushing out of the cell

Question 18

which statement regarding the peripheral nervous system is true?
A) PNS excludes cranial nerves
B) PNS only includes motor components 
C)the spinal cord is not part of the PNS
D) PNS is protected by the BBB
E) PNS is non-myelinated

Answer 18

C) the spinal cord is not part of the PNS. It’s part of the CNS

Question 19

which group of spinal nerves innervates the biceps reflex? 
A) S1/S2
B) L3/L4
C) C5/6
D) C7/8
E) C8/T1

Answer 19

C) C5/6

Question 20

which group of spinal nerves innervates the ankle reflex? 
A) S1/S2
B) L3/L4
C) C5/6
D) C7/8
E) C8/T1

Answer 20

A) S1/S2

Question 21

A lady present with an intensely itchy vesicular rash in two horizontal lines. one at the level of the nipple and one at umbilicus. what dermatomal distribution is this affecting
A) C8/10
B) T4/T10
C) T6/T12
D) T4/T12
E) T10/L1

Answer 21

B) T4/10

T4 innervates the dermatome at the level of the nipples

T10 innervates the dermatome at the level of umbilicus

Question 22

which cell type listed below is not found within the CNS?

• astrocyte
• schwann cell
• ependymal cells
• microglia
• oligodendrocytes

Answer 22

schwann cells - the provide myelination only in the PNS.

Question 23

a man is diagnosed with tabes dorsalis. he presents with a stamping gait on examination he has a loss of joint position sense and cannot feel a tuning fork placed on his medial malleolus. which tract is affected?
A. corticospinal 
B. Spinothalamic 
C. Dorsal column 
D. Rubrospinal 
E. Spinocerebellar

Answer 23

C. Dorsal column medial lemiscus pathway

it’s responsible for proprioception, pressure, vibration and fine touch.

Question 24

Bloke rocks up to A&E who chongs bare fags presents with bilateral ‘glove and stocking’ loss of pain, temperature and pin prick sensation. which tract is affected?

A. corticospinal 
B. Spinothalamic 
C. Dorsal column 
D. Rubrospinal 
E. Spinocerebellar

Answer 24

B) Spinothalamic

It’s responsible for pain, temperature, crude touch and firm pressure

Question 25

on examination a patient has brisk reflexes, increased muscle tone but has fasciculations in his right hand. which tract is affected?

A. corticospinal 
B. Spinothalamic 
C. Dorsal column 
D. Rubrospinal 
E. Spinocerebellar

Answer 25

A. Corticospinal

it’s responsible for conscious control of skeletal muscles. The case is characteristic of an UMN lesion.

Question 26

which of the following statements is true regarding ascending and descending tracts?

A. The Corticospinal tract decussates within the spinal cord
B. The spinothalamic tracts decussates within the spinal cord
C. The dorsal column decussates with the spinal cord
D. the posterior spinocerebellar decussates twice while anterior doesn’t decussate
E. The rubrospinal tract involutes by the age of 5

Answer 26

B) The spinothalamic tracts decussate 1 or 2 spinal roots above where it enters the spinal cord.

• 80% corticospinal decussates within the medulla making it the lateral corticospinal
• DCML decussates in the medulla after synapsing
• anterior spinocerebellar decussates twice and posterior doesn’t decussate

Question 27

The vagus nerve is composed of…

• parasympathetic motor fibres
• parasympathetic motor and sensory
• sympathetic motor
• sympathetic motor and sensory
• all of the above

Answer 27

Parasympathetic motor and sensory