Neurologi Flashcards
When does Wernicke-encephalopathy occur?
Select one:
In all diseases or conditions associated with lack of vitamin B1
In Wernicke-encephalopathy brain MRI does NOT show changes in the following
territories:
occipital lobe
Which drug is the most effective in painful diabetic neuropathy
pregabalin
Our 60-year-old patient is complaining about strong, progressive, unilateral temporal headache. Mastication worsens the pain. Erythrocyte sedimentation rate is significantly elevated. What is our suspected diagnosis?
Arteritis temporalis
Our patient has been diagnosed with rheumatoid arthritis. Now she is complaining about neck pain and progressiv weakness of the extremites. Which is our suspected diagnosis
Atlantoaxial subluxation
When should we start antiepileptic treatment in case of a patient who has brain
metastases?
After the first seizure
Which clinical condition has to be considered as a neurological
emergency?
anisocoria
Unconscious patient with bradycardia, elevated systolic blood pressure (200/90
mmHg), all the extremities are extended, respiration is irregular. Possible
reason:
transtentorial herniation
Vasogenic cerebral edema
all
Possible complication of cerebellar infarction
occlusive hydrocephalus
Painful stimulus in the trigeminal zone does not lead to any motor reactions or
eye opening of the comatose patient, but the blood pressure and the heart rate
is elevating. How should be evaluated this phenomenon?
Brainstem is responsive
What is the correct definition of TIA?
temporary neurological dysfunction due to ischemia in the brain, the spinal cord
or in the retina without the development of acute infarct
What is the most common cause of stroke in young adults among the following?
Select one:
large vessel dissection
What could be the symptoms of left posterior cerebral artery stroke?
right homonymous hemianopsy
A headache provoked by physical activity, straining, or coughing can be caused by:
Arnold-Chiari malformation
Intracranial space-occupying lesions can cause
all of the above
Which of the following is characteristic for serotonin syndrome?
A) May be caused by overdosing or medicinal interactions
B) Headache and agitation are common symptoms
C) Fever and tachycardia may be present
E) Tremor, myoclonus, hyperreflexia, and clonus may be present
ANSWER: A B C and E
Which statement is true? (dyskinesia)
dyskinesias/hyperkinesias are always abnormal movements
What percent of parkinsonian patients develop dementia
In 40% of parkinsonian patients
What is the most severe side effect of lamotrigine
toxic epidermal necrolysis
It is true for focal epilepsy
It originates most frequently in the temporal lobe
The most common clinical presentation of neuroborreliosis
peripheral facial nerve palsy
Possible cause of aseptic meningitis
vaccination
Leading pathogen of bacterial meningitis in immuncompromised patients
Listeria monocytogenes
Paranoia and psychosis could be prodromal signs of
NMDA-encephalitis
Leading sign in encephalitis
seizure
altered consciousness
fever
Answer: all of the above
The following is characteristic for diffuse Lewy body dementia:
parkinsonism, visual hallucinations, fluctuation
Typical initial symptom of Alzheimer’s disease:
episodic memory dysfunction
Which antiepileptic drug would you choose first in focal epilepsy caused by brain
metastasis?
Carbamazepine
Which of the following causes vasogenic brain edema?
Brain metastasis
Typical feature of intramedullary tumor of the cord:
Dissociated sensory loss
Which of the following is correct (increased ICP)
Elevation of intracranial pressure alone does not exclude lumbar puncture
True for spinal ataxia
Worsens when eyes are closed
The diagnosis of subacute combined degeneration involves
Spinal MRI, lab tests
Which could be a symptom of cervical disc herniation?
Irradiating pain to upper extremities
Atrophy of hand muscles
Unstable gait
Answer: all of them
Which one refers to S.1 radiculopathy?
Sensory loss on the lateral part of the leg, weakness of the m. triceps surae
Patient with SLE developed almost complete transversal spinal
cord lesion within 3 days. Possible diagnosis?
Myelitis transversa
Not typical for Syringomyelia:
Spinal ataxia
The conduction velocity of the fastest conducting motor fibers is
100 m/s
The meaning of allodynia is
pain provoked by touch
All of the below may cause foot drop, EXCEPT ONE
tibial nerve lesion
A key element in the diagnosis of Guillain-Barré syndrome
EMG
If nystagmus, ataxia and hemiparesis appears acutely in a 20-year-old patient,
we primarily consider
Vertebrobasilar cerebrovascular insufficiency
Where do the fila olfactoria enter the skull
Through the lamina cribrosa
The major sign of retrobulbar neuritis:
Relatively fast progressing decrease in visual acuity
In left sided „upper motor neuron” (central) facial palsy
There is a mouth drop on the left side, the left side of the mouth moves less
when smiling, but eye-closure and forehead wrinkling is performed with normal
strength on both sides.
Which cranial nerves have a role in taste sensation
CN. VII. and IX.
In left sided peripheral lesion of the vestibular nerve the patient falls and
deviates
To the left
Which of the following may be a symptom of myasthenia gravis?
Fluctuating ptosis
Which of the following electrophysiological methods is useful in the diagnosis of
myasthenia gravis?
Repetitive nerve stimulation
The common characteristic of secondary (symptomatic) headaches is:
the headache is only one symptom of the underlying pathology
space-occupying lesions: Select one:
it affects 12 to 16% of the population
which description is characteristic for chronic tension type headache`
Bilateral, mild, pressing headache on at least 180 days per year
intracranial space occupying lesions can cause
All of the above
The diagnosis of primary headaches is based on
the characteristic symptomology of the attach’s and a negative neurological examination
the following are ture for sumatriptan except
it can be administered during the pregnancy (for headache treatment)
Which among these belongs to the group of primary headaches
all of the above
Has been proven to be effective for the oral treatment of migraine
attacks Select one:
acetilsalycilic acid 1000mg
(Aspirin)
The following are adequate prophylactic treatment options for medication overuse headache: Select one:
valproate, topiramate, antidepressants
medication overuse headache can be caused by
sumatriptan taken on more than 3 days a week
One of the answers is true for secondary headaches: Select one
beside the headache, the symptoms of the primary condition are discernible
Which is the most common type of headache? Select one
tension type headache, affecting 30 to 35% of the population
A headache provoked by physical activity, straining, or coughing can be
caused by: Select one:
Arnold-Chiari malformation
One of the answers is true for primary headaches: Select one:
the attacks of a given patient are usually similar to each other
Opiates for the treatment of a migraine attack Select one:
are not recommended due to their unsatisfactory efficacy and the danger of addiction
The following is true for medication overuse headache:
all of the above
Migraine aura is a neurological symptom that: Select one:
patient education, analgesic withdrawal, prophylactic treatment
Headache caused by subarachnoidal bleeding has the
following characteristics: Select one:
a sudden-onset, severe head pain
Which among these is a primary headache? Select one:
tension type headache
The following are effective for the treatment of cluster headache,
except:
50% oxygen and 50% carbon dioxide through a non-rebreather mask
For the treatment of medication overuse headache Select one:
beside withdrawing the painkillers prophylactic medication and ‘rescue medication’ is also necessary
These fibers have a decisive role in the pathomechanism
sensory fibers of the first branch of
the trigeminal nerve
Primary headaches: Select one
activation of the trigeminovascular system
Which description is characteristic for cluster headache?
very severe, unilateral, periorbital headache with ipsilateral lacrimation, conjunctival injection, or
nasal discharge
These headaches belong to the primary headaches, except for:
medication overuse headache
To our current knowledge, migraine is caused by:
primary
dysfunction of the pain-sensitive system of the head
These belong to the group of primary headaches: Select one:
migraine, tension
type headache, cluster headache
Which is NOT characteristic for postherpetic neuralgia? Select one:
it is
less common in the elderly
Chronic migraine can be diagnosed, if a patient has had: Select one:
has more than 15 migraine days per month for more than 3 months
Which of the following is characteristic for giant cell arteritis?
Headache
Claudication of the masticatory muscles
May cause permanent visual loss
The contraindications of triptans include:
Pregnancy
Angina, or myocardial infarction
Uncontrolled hypertension
Answer: all of the above
In headaches associated with space-occupying lesions: Select one:
pain
is progressive
Which statement describes best the pathomechanism of cluster
headache? Select one
it is caused by the activation of the trigeminal nerve and the salivatory (parasympathetic) nucleus
In order to diagnose migraine, the following are always necessary: Select one:
a detailed
history, general medical and neurological examination
Migraine can be diagnosed if a severe, unilateral, pulsationg headache is accompanied by:
A) nausea or vomiting
B) olfactory hallucinations
Both A and C responses are correct
It is effective for the acute treatment of the migraine attack:
sumatriptan (Imigran
Medication overuse headache
usually appears in patients with a preexisting migraine or tension type headache
The cause of the pain in migraine is:
the activation of the trigeminovascular system
The treatment of medication overuse headache is
patient education, analgesic withdrawal, prophylactic treatment
A neurovascularis compression is NOT present in which location?
radial nerve
compression – wrist drop
Which of the following could suggest carbon monoxide poisoning?
all of the above
In status epilepticus:
The seizure might present in non-convulsive form.
Which of the following statements regarding epilepsy surgery is correct?
epilepsy surgery is a treatment of last resort reserved for patients who have tried all available
antiepileptic drug, but still have seizures.
Which of the following statements is not true regarding the pathomechanism of epilepsy
Focal epilepsies originate most frequently from the occipital lobe.
It is not specific for an absence seizure
It occurs most frequently in elderly patients
The most significant risk factor for seizure recurrence following a first unprovoked seizure
is which of the following? Select one:
the
patient had febrile seizures in childhood
Which of the following antiepileptic drugs is not recommended during pregnancy?
Damage of the cell membrane
Antiepileptic drugs
Might cause tremor
Focal motor epileptic seizure is frequently followed by: Select one
Todd-paresis
It is true for focal epilepsy
It originates most frequently in the temporal lobe.
What is the most severe side effect of lamotrigine? Select one
toxic epidermal
necrolysis
Which of the following statements is not true regarding the pathomechanism of epilepsy:
Focal epilepsies originate most frequently from the occipital lobe.
What is the most common site of ulnar nerve lesion? Select one
elbow
All of the below are infectious diseaeses associated with polyneuropathy EXCEPT:
HIV
What is the most common cause of polyneuropathy in the developed countries?
diabetes mellitus
The meaning of allodynia
pain provoked by touch
All of the below belong to the polyneuropathies EXCEPT
TOS (Thoracic outlet syndrome)
All of the below are among the symptoms of polyneuropathy EXCEPT ON
attacks of paleness in the extremities
Neurotmesis is:
a
loss of continuity of the complete nerve
Group of the drugs effective in the symptomatic treatment of neuropathic pain:
tricycyclic antidepressants
All of the below are symptoms of carpal tunnel syndrome EXCEPT
benediction hand
The Seddon-Sunderland classification is a classification of:
the types of reinnervation
Diagnostic methods of the diseases of the peripheral nervous system:
EMG
What is the most common site of radial nerve lesion?
spiral groove of the radial nerve on the humerus
All of the below are among the symptoms of damage of the peripheral nervous system EXCEPT
clonus
The differential diagnosis of typical thoracic outlet syndrome includes the following,
EXCEPT:
raising the arm up
high
What can be a cause of brachial plexus lesion?
Parsonage-Turner syndrome
The conduction velocity of the fastest conducting motor fibers is:
100 m/s
All of the below are may cause foot drop, EXCEPT ONE
tibial nerve lesion
What can be a cause of brachial plexus lesion
Parsonage-Turner syndrome
A key element in the diagnosis of Guillain-Barré syndrome:
EMG
The conduction velocity of the fastest conducting motor fibers is:
100
m/s
In the case of loss of continuity of axons, the regeneration depends on:
the distance between the site of the lesion and the muscle to be reinnervated
Which statement is incorrect? Select one: (muscle dystrophy)
The out of frame deletion leads to the less severe Duchenne muscular dystrophy with a better
prognosis.
Symptoms of MELAS disease are : (1 answer is not correct) Select one:
Myoglobinuria
n myasthenia gravis, 3 of the following medications are commonly used: Select one or more:
Azathioprine
Pyridostigmine
Methylprednisolone
Which medication is the treatment of first choice in polymyositis? Select one:
Methylprednisolone
. One of the following agents can cause toxic myopathy: Select one:
Statins
Clinical symptoms of muscle disorders: which is incorrect? Select one
Increased muscle tone
What type of diagnostic tests are recommended if the patient complains of shortness of breath
during exercise or even rest, morning headache, and lightheadedness. Three answers are correct.
Select one or more:
Sleep test
Pulmonary function test
Blood gas analysis
Which statement is incorrect? (corticosteroids)
Due to corticosteroid treatment, endomysial infiltration of CD8 positive T-lymphocytes and
macrophages is present.
In two of the following diseases, pathological decrement is obtained with repetitive 3 Hz
stimulation: Select one or more:
Eaton-Lambert syndrome
Myasthenia gravis
Which statement is incorrect? (thymoid cells)
Antibodies against thymic myoid cells are responsible for the dysfunction of neuromuscular
transmission.
One of the following laboratory parameters is not increased in inflammatory myopathy. Select one:
ALP
One of the following symptoms is typical for dermatomyositis: (only one answer is correct)
A. Gottron papules
. In electromyography, three of the following features are present in myopathy. Select one or more:
Small and short motor units
Polyphasic motor units
Spontaneous activity, such as positive sharp waves
One of the statements is incorrect (anaerobic metabolism)
When anaerobic metabolism is impaired, serum lactate levels increase.
In one of the following diseases, muscle biopsy is not informative: Select one:
Myasthenia gravis
In one of the diseases below, the following symptoms are characteristic: muscle involvement,
cataract, gynecomastia, endocrine dysfunction, and cardiomyopathy. Select one:
Myotonic dystrophy
One of the following disorders does not belong to the group of muscular dystrophies: Select one:
Eaton Lambert syndrome
One of the following diseases does not belong to the group of hereditary metabolic myopathies:
Disorders due to the dysfunction of cytosolic molecules, such as calpain, telethonin, and titin.
Two of the following statements about physiotherapy recommended for patients with muscle
disorders are correct.
A) Concentric muscle exercise and passive physiotherapy are recommended.
B) An improvement of aerobic capacity may be achieved by a low to moderate level aerobic
exercise program.
Which statement is incorrect (Duchenne)
The out of frame deletion leads to the less severe Duchenne muscular dystrophy with a better
prognosis.
One of the following diseases does not belong to the group of hereditary metabolic myopathies:
Disorders due to the dysfunction of cytosolic molecules, such as calpain, telethonin, and titin
Clinical symptoms of muscle disorders: which is incorrect? Select one:
Increased muscle tone
Which modality would you use in the diagnosis of spinal vascular disorders? Select one:
MR
Recommended in Low back pain:
Clomipramin (tricyclic antidepresszant)
In which type of symptoms would you categorize: spinal ataxia because of cervical disc
herniation
symptoms of spinal cord
tracts
In which type of symptoms would you categorize: m. biceps brachii dysfunction (paresis)
because of cervical disc herniation?
segmental and radicular signs
Not true for syringomyelia:
Association with tethered cord syndrome
The typical location of thoraco-lumbar spinal cord injury is:
Thoraco-lumbar junction
In which type of symptoms would you categorize: neck pain because of cervical disc herniation?
local
signs
The following is not recommended in the prehospital care of spinal cord trauma
Transport of the comatose patient without intratracheal intubation
Correct for the dissociated sensory loss:
It is due to an isolated spinothalamic deficit
Which is the most frequent type of spinal intramedullar tumors?
Ependymoma
Which one of the following indicates radicular sign on the lower limb?
Laségue sign
Patient with SLE developed almost complete transversal spinal cord lesion within 3 days.
Possible diagnosis?
Myelitis transversa
What is the most common location of spinal tumors?
Extradural
What is the least common site of spinal tumors?
Intramedullary
Which one refers to S.1 radiculopathy?
Sensory loss on the lateral part of the leg, weakness of the m. triceps surae
The following is not characteristic of cervical discal herniation:
Central spinal cord syndrome
Characteristic for lumbar discal herniation except:
Not associated with pain
Which could be a symptom of cervical disc herniation?
All of them
In which groups of spinal tumors can be classified the spinal meningeomas? (depending on the
location) Select one:
intradural-extramedullar
What is the most common type of spinal extradural tumor?
All of the above
In which type of symptoms would you categorize: neck pain because of cervical disc herniation?
local signs
Which vertebra’s traumatic fracture is the Hangsman fracture? Select one:
CII
Not typical for Syringomyelia:
Spinal ataxia
Not correct for acute transverse lesion:
Spinal automatisms
Transverse myelitis is often seen in:
Systemic lupus erythematosus
Correct for the dissociated sensory loss:
It is due to an isolated spinothalamic deficit
Which symptom is NOT caused by C. VI-VII disc herniation?
Respiratory arrest
True for spinal ataxia:
Worsens when eyes are closed
The diagnosis of subacute combined degeneration involves:
Spinal MRI, lab tests
What is the optimal method to confirm cervical discal herniation?
MRI
Most probable disgnosis of a 45 years-old female patient, who developed cervical necrotizing
intramedullary lesion within 2 days?
Devic disease
Which could be a symptoms of chronic stage of spinal shock?
Both of the previosly listed symptoms
Which symptom means absolute need for surgerry in case of lumbar disc herniation?
Paralysis of foot plantarflexion
Which one is a spinal developmental disease?
All of the above
The following is characteristic for diffuse Lewy body dementia:
parkinsonism, visual hallucinations, fluctuation, delurium
The following is/are used in the diagnosis of Alzheimer’s disease:
a. MRI
b. PET
c. CSF
d. All of the above (CORRECT)
Required diagnostic method in Alzheimer’s disease:
MRI
True in Alzheimer’s dementia
Could cause 60% of all dementia
Which of the followings are not true?
Sensory disturbance is characteristic for ALS
When FTD is suspected, MRI is useful because:
Excludes focal intracranial lesions
The following are parts of the Mini Mental State Examination (MMSE), EXCEPT:
copying intersecting hexagons
Atrophy is most prominent in the following brain areas in Alzheimer’s disease:
temporal lobe
True for the prodromal stage of Alzheimer’s disease:
slight (minor) neurocognitive disturbance is detected
Usual clinical symptom in frontotemporal dementia:
Aphasia
The criteria of definitive diagnosis of ALS are met in which of the following
Progressive upper and lower motorneuron syndrome on the trunk, on an upper and a
lower limb
Mandatory laboratory test in the diagnosis of dementia:
a. TSH
.Treatment options in BPSD symptoms are:
risperidone
Electromyographic findings in ALS:
Fibrillation potentials are frequently detected
The following is characteristic for Creutzfeldt-Jakob’s disease:
dementia, myoclonus, cerebellar signs
In conformational diseases
the secondary structure of the proteins is changed
Differentiating FTD may be difficult from:
Alzheimer’s disease
Characteristic inclusions in Alzheimer’s disease:
neurofibrillary tangles, senile plaques
Typical initial symptom of Alzheimer’s disease:
episodic memory dysfunction
Characteristic for Alzheimer’s disease: Select one:
- Beta-amyloid deposition in the brain
- Neurofibrillary tangles formation in the brain
ANSWER: both of them
True in the diagnosis of Alzheimer’s disease
only
neuropathological diagnosis is definitive
Diagnostic test in establishing cognitive decline:
- clock drawing test
- MMSE
ANSWER: Both of them
The following are typical for Alzheimer’s
disease, EXCEPT
pathological EEG
FTD: Select one
is presently
untreatable
Which symptom is NOT met in hypertensive encephalopathy? Select one:
flaccid paraparesis
Typical CT scan findings in hypertensive encephalopathy are:
Patchy hypodensity around the occipital and frontal horns of the lateral ventricles
Which of the following is true for intracerebral hemorrhage?
Urgent CT scan shows hyperdensity.
The normal values of blood pressure are:
<120 / <80 mmHg
What percent of hypertensive patients have essential hypertension? Select one:
95%
In which disease might posterior reversible encephalopathy syndrome visible on the
imaging appear? Select one:
Hypertensive encephalopathy
Typical CT scan findings in hypertensive encephalopathy are:
Patchy hypodensity around the occipital and frontal horns of the lateral ventricles
Which value of blood pressure may cause hypertensive encephalopathy?
220/125 Hgmm
Lumbosacral radiculo-plexo-neuropathy is characterized by?
acute-subacute course weakness is associated
Which one is the most frequent diabetic neuropathy?
chronic distal sensorimotor neuropathy
Diabetes mellitus Select
- Increases the risk of ischemic stroke
- The probability of cardiovascular events is decreased by the concomitant treatment of other multiple risk factors
Which are the symptoms of the chronic distal sensorimotor polyneuropathy?
- distal weakness of the limbs might be associated sensory
- disturbance with glove-stocking distribution
Autonomic diabetic neuropathy may cause:
- orthostatic hypotension erectile
dysfunction - dysfunction of pupillary innervation
- diarrhea
In case of hypoglycemia: Select one or more
- if after correction of hypoglycemia impaired consciousness is preserved, we might consider
irreversibility or associated other conditions (e.g. trauma) 2. Depending on its severity, impaired
consciousness may occur in severe cases neurological signs may become irreversible
7.Which of the following is not typical for hypoglycemic
encephalopathy?
Always reversible
Which one is the most frequent diabetic neuropathy? Select one:
chronic
distal sensorimotor neuropathy
Which drug is the most effective in painful diabetic neuropathy?
pregabalin
It is TRUE for diabetic cranial mononeuropathy: Select one or more:
- it might affect the facial nerve
- oculomotor neuropathy is characterized by subacute course and painfulness of the eye
Which complication is typical for acute hyperglycemic ketoacidosis?
Focal neurological symptoms are not frequent
It is TRUE for small fiber neuropathy:
- skin biopsy aids the diagnosis
- protopathic sensation is altered on neurological examination
- it frequently needs chronic pain
- treatment burning pain and painful tingling of the limbs
Which of the following is true for myocardial infarction
The sudden decrease of cardiac output may lead to syncope or borderzone infarct
Which of the following is true for atrial fibrillation
The most common supraventricular tachyarrhythmia.
What is the most frequent complication of chronic renal
insufficiency needing dialysis?
chronic polyneuropathy
In chronic renal insufficiency Select one or more:
- the risk of hemorrhagic stroke increases
- the risk of ischemic stroke increases
The most typical neurological symptom of disequilibrium syndrome is: Select one:
Headache
In case of renal insufficiency, neurological consequences are caused by: Select one or
more:
- accumulation of toxic protein metabolites
- electrolyte disturbance
- acid-base disturbance
In case of uremic encephalopathy
- the same lab changes are associated by different individual tolerance and symptoms
- different psychiatric changes may appear
- impairment of consciousness may progress to coma
What type encephalopathy is uremic encephalopathy?
Metabolic encephalopathy
The most typical neurological symptom of disequilibrium syndrome is:
Headache
Uremic encephalopathy develops if serum creatinine is above:
700 µM/L
Disequilibrium syndrome Select
All answers are correct
The most frequent peripheral nervous system complication of chronic uremia is:
Uremic polyneuropathy
Which sign is NOT typical to the deficit of niacin (pellagra)?
dysuria
In case of high suspicion of Wernicke-encephalopathy, but lack of improvement
after iv. high dose thiamine, what should be given?
Niacin (nicotinic amide)
Central pontine myelinolysis may be seen in the diseases-conditions listed below,
EXCEPTING….
consequences of plasmapheresis
In Wernicke-encephalopathy brain MRI does NOT show changes in the following
territories:
occipital lobe
Which symptom is NOT characteristic to Wernicke-encephalopathy? Select one:
spastic paraparesis
It is TRUE for Marchiafava-Bignami-disease: Select one
it is a rare consequence of alcoholism
Which affirmation is TRUE for Wernicke-encephalopathy?
Diagnosis is based on the clinical syndrome and improvement after iv. thiamine administration.
When does Wernicke-encephalopathy occur?
In all diseases or conditions associated with lack of vitamin B1
Celiac disease may have neurological consequences. Which one is the most frequent? Select one:
Cerebellar ataxia
Which anatomic structure is preserved in funicular myelosis?
vitamin B12
Which sign is NOT seen in funicular myelosis? Select one:
abolished temperature sensation
Which hematologic entity may be associated to subacute combined myelon degeneration?
Megaloblastic anemia
The following are false, except: (primary tumor diagnosis)
The primary tumor is unknown in up to 15% of patients at the diagnosis of the metastasis
The following are true for paraneoplastic neurological syndromes, except
Caused by a hormone produced by the tumor
The following are true for nervous system metastases, except : (metastasis site)
Metastases are equally common in the spinal cord and the brain.
