Neurology: TBL Questions Flashcards by Christy Scoullar

Which lamina of the trilaminar embryo does the nervous system derive from?

A. Ectoderm

B. Endoderm

C. Mesoderm

D. Neural crest

A. Ectoderm

CNS neurons
Ependymal cells (inner lining of ventricles, make CSF)
Oligodendrocytes
Astrocytes

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The neural crest cells go on to form which cell types?

A. Brain

B. Spinal cord

C. Ventral motor neurons

D. Dorsal root ganglia

D. Dorsal root ganglia

In addition to:

PNS
Sensory ganglia
Autonomic ganglia and plexuses
Neural glia
Schwann cells

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During regionalisation which statement is true?

A. Bone Morphogenic Protein helps to specify the ventral/motor part of the spinal cord.

B. Bone Morphogenic Protein helps to specify the dorsal/sensory part of the spinal cord.

C. Bone Morphogenic Protein is released by the notochord to pattern the sensory nerves.

D. Bone Morphogenic Protein is released by the notochord to specify the identity of motor neurons.

B. Bone Morphogenic Protein helps to specify the dorsal/sensory part of the spinal cord.

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The lateral ventricles develop from the cavity of which of the following?

A. Diencephalon

B. Mesencephalon

C. Rhombencephalon

D. Telencephalon

D. Telencephalon

Cerebral hemispheres
Basal ganglia
Lateral ventricles

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A typical peripheral nerve when observed in cross section in a stained section under the light microscope will be seen to consist of bundles of axons contained within fascicles. Which cell defines or forms the boundary of the fascicle?

A. Endoneurium

B. Epineurium

C. Schwann Cell

D. Perineural cell

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The discriminatory function of the blood brain barrier is a consequence of:

A. Capillary fenestrations

B. Tight junctions between endothelial cells

C. Endothelial basement membrane thickness

D. Gap junctions between endothelial cells

B. Tight junctions between endothelial cells

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CSF production involves which of the following?

A. Arachnoid granulations

B. Choroid Plexuses

C. Transudate from small cerebral veins in the cerebral hemispheres into ventricles

D. Production by cells within the pia mater on the surface of the brain

B. Choroid Plexuses produced here by specialised ependymal cells

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A superior sagittal vein thrombosis is likely to have what effect upon CSF pressure?

A. Reduced absorption of CSF across the arachnoid granulations and a rise in CSF pressure

B. A decrease in the CSF pressure because of a drop in venous pressure inside the skull

C. No change in CSF pressure as there is no connection between the CSF and the cerebral venous system

D. As the production of CSF is pressure dependent any increase in venous back pressure will reduce CSF production. There will be no overall change in CSF pressure

A. Reduced absorption of CSF across the arachnoid granulations and a rise in CSF pressure

CSF production is pressure indepependent, CSF absorption is pressure dependent

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How does a Chiari 2 malformation cause hydrocephalus?

A. By causing obstruction to CSF flow at point A

B. By causing obstruction to CSF flow at point B

C. By causing obstruction to CSF flow at point C

D. By causing obstruction to CSF flow at point D

B. By causing obstruction to CSF flow at point B

Smaller posterior fossa in cranium
Herniation of cerebellar vermis and tonsils through foramen magnum with aqueductal stenosis: non-communicating hydrocephalus.
Usually associated with lumbosacral myelomeningocele

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Which is correct about hydrocephalus?

A. Hydrocephalus is defined as an increase in CSF volume

B. Hydrocephalus does not cause localising signs

C. In children papilledema is a common sign

D. Hydrocephalus is defined as an increase in CSF pressure

A. Hydrocephalus is defined as an increase in CSF volume

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Sympathetic pre-ganglionic neurones are located in which of the following regions?

A. Nucleus of the solitary tract in the medulla

B. Parabrachial nucleus in the pons

C. Paraventricular nucleus in the hypothalamus

D. Preoptic area in the hypothalamus

E. Intermediolateral cell column in the spinal cord

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Which of the following spinal tracts is most involved in skilled movement?

A. Dorsal column

B. Reticulospinal

C. Vestibulospinal

D. Corticospinal

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A 62 year old man complains of trouble walking. On examination, he cannot stand on tip toes and has weakness of dorsiflexion of both ankles. His calves and anterior tibial compartments are wasted. His ankle jerks are absent. These signs are consistent with which type of syndrome?

A. Extrapyramidal

B. Lower motor neurone

C. Neuromuscular junction

D. Upper motor neurone

B. Lower motor neurone

Anterior horn, brainstem or spinal cord out

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Which are the three layers of the cerebellar gray matter?

A. Axonal, dendritic and cell body layers

B. Basket cell, interneuron and synaptic layers

C. Dura mater, arachnoid and pia mater

D. Molecular, purkinje and granular layers

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With reference to the spinal cord image, which of the following would be a likely sign after a lesion to X (shaded area)?

A. Contralateral motor weakness

B. Ipsilateral analgesia

C. Contralateral spasticity

D. Ipsilateral motor weakness

E. Contralateral paraesthesia

D. Ipsilateral motor weakness

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A lesion to which of the following ascending tracts in the spinal cord generates the signs or symptoms described: A patient has reduced ability to detect pin-prick on the skin of their right leg.

A. Left spinothalamic tract

B. Right spinothalamic tract

C. Left dorsal column tract

D. Right dorsal column tract

A. Left spinothalamic tract

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Which of the following symptoms commonly occurs during the initial stages following a spinal cord injury?

A. Hyperreflexia

B. Hypertension and tachycardia

C. Hypertonia

D. Hypotonia

E. Hypertension and bradycardia

D. Hypotonia

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After traumatic injury to the brain or spinal cord, which substance is released from the traumatised tissue that can lead to further damage to surrounding tissue?

A. Glutamate

B. Ketones

C. Lactic acid

D. Prostaglandin E

A. Glutamate

Excitatory neuron: acts on NMDA and AMPA receptors which are over-expressed = excess calcium release

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A patient experiences decreased proprioception in the left lower limb. A lesion to which of the following ascending tracts in the spinal cord generates the signs or symptoms described?

A. Left dorsal column tract

B. Right dorsal column tract

C. Left spinothalamic tract

D. Right spinothalamic tract

A. Left dorsal column tract

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Hyperalgesia is defined as which of the following?

A. Decreased sensitivity to pain

B. Increased sensitivity to touch

C. Increased sensitivity to pain

D. Pain response to non-noxious stimulus

C. Increased sensitivity to pain

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The posterior communicating artery connects which of the following vessels?

A. Vertebral artery to basilar artery

B. Left vertebral artery to right vertebral artery

C. Posterior cerebral artery to anterior cerebral artery

D. Posterior cerebral artery to internal carotid artery

E. Left anterior cerebral artery to right anterior cerebral artery

D. Posterior cerebral artery to internal carotid artery

The major neurotransmitter that characterises the cells of the brainstem raphe nuclei is which of the following?

A. Glutamate

B. Noradrenaline

C. Dopamine

D. Acetylcholine

E. Serotonin

Contributor to feelings of well-being and happiness
Regulates the sleep cycle along with melatonin
Regulates intestinal movements.

A 70-year old woman was admitted to the emergency department with a suspected stroke. Radiology showed an infracted region corresponding to the shaded area shown in the photograph. Occlusion of which of the following arteries may have caused infarction in this area?

A. Internal carotid artery

B. Middle cerebral artery

C. Posterior cerebral artery

D. Anterior cerebral artery

E. Lenticulostriate artery

D. Anterior cerebral artery

A 68-year-old male presents to the Emergency Department 2 hours after the onset of symptoms suggestive of acute stroke. With regard to the immediate management of this patient, which of the following statements about medical imaging is correct?

A. Non-contrast computed tomography is performed to detect brain ischaemia

B. Contrast enhanced computed tomography is performed if the patient has had nil by mouth for 4 hours

C. Carotid Doppler ultrasound is performed to assess the patency of the carotid arteries

D. Skull x-ray is performed to exclude bony trauma

E. Non-contrast computed tomography is performed to exclude haemorrhage

**The non-contrast computed tomography (CT) scan below shows which of the following pathologies?** **A.** Subdural haemorrhage **B.** Intracerebral haemorrhage **C.** Ischaemic infarction **D.** Extradural haemorrhage **E.** Arteriovenous malformation

**B. Intracerebral haemorrhage** * Most commonly caused by systemic hypertension * Amyloid angiopathy (recurrent lobar haemorrhagic stroke in the elderly) * Vasculitis * Neoplasm * May be secondary to reperfusion injury in ischaemic stroke

**A 59 year-old man presents with acute onset of a left hemiparesis without any other neurological signs. On CT scan he has evidence of multiple previous small infarcts (2-5 mm in diameter) in the deep white matter of his brain. What is the major risk factor associated with this type of infarction in the brain?** **A.** Arterial hypertension **B.** Family history of lacunar infarcts **C.** Hyperlipidemia **D.** Notch 3 gene mutations **E.** Obesity

**A. Arterial hypertension** Lacunar infarct, fibrin deposition in arteries Other risk factors include: * Smoking * Diabetes * Family history

**Which of the following statements concerning cerebrovascular disease is correct?** **A.** Penetrating artery infarcts are usually more than 50 mm in diameter **B.** A haemorrhage affecting predominantly the cerebral cortex is likely to be secondary to arterial hypertension **C.** Most occlusions of the internal carotid artery result in an infarct only in the territory of the anterior cerebral artery **D.** Macrophages start removing infarcted brain tissue after about 15 days **E.** Embolic cerebral infarcts often have a haemorrhagic component

**E.** Embolic cerebral infarcts often have a haemorrhagic component

**The age of a cerebral infarct can be estimated pathologically by the cell type that predominates within the infarct. What is the time course of appearance (from earliest to latest) of the following cells (foamy macrophages, neutrophils and reactive astrocytes) in the evolution of a cerebral infarct?** **A.** Astrocytes then macrophages then neutrophils **B.** Astrocytes then neutrophils then macrophages **C.** Macrophages then neutrophils then astrocytes **D.** Neutrophils then astrocytes then macrophages **E.** Neutrophils then macrophages then astrocytes

**E.** Neutrophils then macrophages then astrocytes

**Which of the following concerning a subdural haemorrhage is correct?** **A.** The bleeding is usually arterial, rather than venous, in nature **B.** A subdural haemorrhage is often caused by a minor head injury, where consciousness is not lost **C.** The subdural space communicates with the subarachnoid space **D.** The bleeding is usually caused by trauma to dural venous sinuses **E.** Increasing size of a chronic subdural haemorrhage is due to malignant transformation of stressed endothelial cells

**B. A subdural haemorrhage is often caused by a minor head injury, where consciousness is not lost** Due to stretch and sheering force, age makes the vessels more rigid and more susceptible to injury and in alcoholics when there is brain atrophy

**Extradural haemorrhage is a life-threatening condition that usually follows blunt trauma to the head. Which of the following best describes the underlying pathology?** **A.** Rupture of subarachnoid veins **B.** Rupture of the middle cerebral artery **C.** Rupture of small arterioles in the cerebral substance **D.** Hypertensive change in blood vessels **E.** Rupture of meningeal arteries

**E.** Rupture of meningeal arteries

**A 35-year-old previously healthy man suddenly develops a severe headache and collapses. On examination, he is obtunded and has neck stiffness. What is the most likely diagnosis?** **A.** Migraine **B.** Meningitis **C.** Cluster headache **D.** Subarachnoid haemorrhage **E.** Subdural haemorrhage

**D. Subarachnoid haemorrhage** * Usually due to a ruptured berry aneurysm * Neck stiffness occurs because blood acts as an irritant to the meninges * Pain is described as a thunderclap headache

**Which cranial nerve carries fibres from the nucleus ambiguus of the brainstem?** ## Footnote **A.** IX **B.** VII **C.** III **D.** V **E.** XI

**A.** IX

**In the midbrain image shown below, what is the name of the structure indicated by shaded region of X?** **A.** Dorsal motor nucleus of vagus **B.** Hypoglossal nucleus **C.** Abducent nucleus **D.** Oculomotor nucleus **E.** Trochlear nucleus

**D.** Oculomotor nucleus

**A patient complains that they have intermittent double vision. This is most noticeable on looking down and to the left. The cranial nerve palsy most likely to produce this deficit is which of the following?** **A.** A right sixth nerve palsy **B.** A left sixth nerve palsy **C.** A right fourth nerve palsy **D.** A left fourth nerve palsy **E.** A right third nerve palsy

**C.** A right fourth nerve palsy

**A patient complains of a hoarse voice, difficulty swallowing and choking when drinking fluids. Examination reveals visible weakness of elevation of the palate, depression of palatal sensation, and loss of gag reflex. Which cranial nerve lesion(s) are responsible for the signs and symptoms described?** **A.** X lesion **B.** V and VII lesion **C.** V and X lesion **D.** IX and X lesion **E.** XII lesion

**D.** IX and X lesion

**Which of the following molecules requires the action of a specific transporter to enter the brain from the systemic circulation?** **A.** Caffeine **B.** D-glucose **C.** Dopamine **D.** Ethanol **E.** Heroin

**B. D-glucose** * Water soluble and requires GLUT-1 glucose transporter to cross the BBB * GLUT-1 transporter is insulin insensitive

**Which of the following infectious agents spreads to the central nervous system by retrograde axonal transport?** **A.** Cytomegalovirus **B.** Human immunodeficiency virus **C.** John Cunningham (JC) virus **D.** Polio virus **E.** Rabies virus

**E.** Rabies virus

**Which of the following features of a cerebrospinal fluid (CSF) examination is suggestive of a viral rather than a bacterial infection?** **A.** Raised neutrophil count **B.** Cloudy CSF **C.** Low glucose concentration **D.** Raised lymphocyte count **E.** Raised red blood cell count

**D. Raised lymphocyte count** * Most distinguishing feature of bacterial infection in CSF is raised lymphocyte count * Glucose often normal * Protein can be normal or slightly raised * Uncommon to have raised pressure

**A 75-year-old woman is brought into hospital by her husband. He says that she has complained of headache for the last 2 days and has now become confused and is behaving oddly with garbled speech. Examination reveals her to be febrile and drowsy but without motor signs. CSF examination shows an increase in white cells and an EEG reports some focal slowing with epileptiform features in the left temporal lobe. What is the most likely diagnosis?** **A.** Intracranial tumour **B.** Temporal lobe epilepsy **C.** Bacterial meningitis **D.** Left middle cerebral artery infarct **E.** Herpes simplex encephalitis

**E.** Herpes simplex encephalitis * Likely reactivation of HSV-1 * Infection primarily involves temporal lobes * Increase in WCC (majority monocytes) * EEG: paroxysmal lateralised epileptiform (PLED) discharges in temporal lobe (characteristic of herpes simplex encephalitis)

**The most appropriate choice for empirically treating a patient over 2 months of age with suspected acute bacterial meningitis is?** **A.** Rifampicin and ceftriaxone and acyclovir **B.** Ceftriaxone and gentamicin and acyclovir and dexamethasone **C.** Vancomycin and ceftriaxone and acyclovir **D.** Vancomycin and ceftriaxone **E.** Vancomycin and ceftriaxone and dexamethasone

**E. Vancomycin and ceftriaxone and dexamethasone** Most likely pathogens: * Strep pneumoniae * Neisseria meninigtidis * Group B strep * Listeria Dexamethasone added: * Has been shown to improve hearing outcomes with HiB meningitis * Decreases mortality in adults with pneumococcal meningitis * Needs to be given BEFORE or WITH first dose of antibiotics

**A 32-year-old woman had separate episodes of unilateral visual loss, ataxia, and altered left-sided bodily sensation. She made a sub-total recovery from each of these episodes. She died six months after the last episode in a motor vehicle accident. Many lesions were found in the white matter of her brain at post-mortem. Which of the following is correct concerning this type of lesion (arrow)?** ## Footnote **A.** Axons are likely to be mostly intact in these lesions **B.** The lesions are found in men more often than women **C.** Myelin loss in these lesions occurs secondary to axonal loss **D.** These lesions are often due to infection with JC virus

**A.** Axons are likely to be mostly intact in these lesions

**A blow to the fronto-temporal region of the skull may result in significant injury to structures that pass through cranial foramina. Which of the following structures may be damaged as they pass through the optic canal?** **A.** Optic nerve and infraorbital nerve **B.** Oculomotor nerve and optic nerve **C.** Ophthalmic artery and ophthalmic vein **D.** Ophthalmic artery and optic nerve **E.** Optic nerve and superior ophthalmic vein

**D.** Ophthalmic artery and optic nerve

**The photoreceptors of the retina synapse directly with which of the following?** ## Footnote **A.** The ganglion cells **B.** The bipolar cells **C.** Pigment epithelium **D.** Superior colliculus cells **E.** Lateral geniculate cells

**B.** The bipolar cells

**The foveal region of the retina provides high visual acuity. This is attributable to which of the following?** **A.** Low photoreceptor density and high convergence **B.** High photoreceptor density and high convergence **C.** High photoreceptor density and divergence **D.** High photoreceptor density and low convergence **E.** Low photoreceptor density and low convergence

**D.** High photoreceptor density and low convergence

**A 50-year-old man presents with headache and visual disturbance. Coincidentally, visual testing reveals mild red-green colour discrimination. A family history reveals that his maternal uncle was "colour blind". Accurate colour vision testing requires which of the following?** **A.** Asking the patient to name the colours of objects in the examination room **B.** Ophthalmoscopic examination to note the colour of the fundus **C.** Testing number recognition on pseudoisochromatic plates **D.** MRI examination of the eye **E.** Slit lamp examination for visualisation of the retina

**C.** Testing number recognition on pseudoisochromatic plates

**Which cranial nerve is actually a central nervous system white matter tract?** ## Footnote **A.** Trochlea nerve **B.** Oculomotor nerve **C.** Optic nerve **D.** Trigeminal nerve **E.** Abducens nerve

**C.** Optic nerve

**On a peripheral nerve biopsy you see an axon that is missing a portion of its myelin sheath that extends from one node of Ranvier to the next. This absence is likely to be due to damage to which of the following cells?** **A.** A single oligodendrocyte **B.** A single Schwann cell **C.** Multiple dendritic cells **D.** Multiple oligodendrocytes **E.** Multiple Schwann cells

**B.** A single Schwann cell

**Which of the following is true regarding the change in visual accommodation associated with increasing age?** **A.** Decreases as the ciliary muscles become weaker **B.** Decreases as the lens loses elasticity **C.** Increases **D.** Does not affect the refractory power of the eye **E.** Is constant throughout life

**B.** Decreases as the lens loses elasticity

**A 50-year-old man is found to have impaired vision in the left field of both eyes. Which of the following is the most likely site for a lesion producing this?** **A.** The left optic nerve **B.** The left optic radiation **C.** The optic chiasm **D.** The right optic nerve **E.** The right optic radiation

**E.** The right optic radiation

**A 63-year-old man with known atrial fibrillation suddenly develops a visual field defect. This is characterised by failure to detect objects in the lower right quadrant of both eyes. This finding is likely to be due to a lesion at which of the following sites?** **A.** Occipital lobe **B.** Optic chiasm **C.** Optic nerves **D.** Parietal lobe **E.** Temporal lobe

**D.** Parietal lobe