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[OS 202] Lecture Exam B > OS 202 B Samplex 2015 > Flashcards

OS 202 B Samplex 2015 Flashcards

1
Q

How does central facial palsy manifest?

A. Weakness of the entire half of the face ipsilateral to the lesion
B. Weakness of the entire half of the face contralateral to the lesion
C. Weakness of the lower half of the face ipsilateral to the lesion
D. Weakness of the lower half of the face contralateral to the lesion
E. Weakness of both sides of the lower half of the face

A

D

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2
Q

How will the motor weakness manifest if there is a lesion in the left pons?

A. Right central facial palsy and weakness of the right arm and right leg
B. Left peripheral facial palsy and weakness of the right arm and right leg
C. Left peripheral facial palsy and weakness of the left arm and left leg
D. Left central palsy and weakness of the left arm and left leg

A

B

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3
Q

All the following cranial nerve motor nuclei originate in the pons except?

A. Facial Nerve
B. Trigeminal Nerve
C. Oculomotor Nerve
D. Vagus Nerve
E. Abducens Nerve
A

C

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4
Q

In the homunculus of the primary motor cortex, the area of the brain responsible for leg movement is at the sides of the interhemispheric fissure. This area is supplied by what artery?

A. Anterior Cerebral Artery
B. Middle Cerebral Artery
C. Posterior Cerebral Artery
D. Superior Cerebellar Artery
E. Inferior Cerebellar Artery
A

A

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5
Q

The corticospinal tract passes through what part of the internal capsule?

A. Anterior Limb
B. Genu
C. Posterior Limb
D. Upper Part
E. Lower Part
A

C

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6
Q

Which of the following statements is not true regarding the corticospinal tract?

A. The crossed fibers occupy the lateral funiculus of the spinal cord
B. The uncrossed fibers occupy the anteromedial portion of the spinal cord
C. In the lamellation at the level of the upper cervical spinal cord, the fibers for the legs are located medial to the fibers for the arms
D. The descending fibers decussate before going down to the spinal cord
E. The corticospinal tract is part of the upper motor neuron system

A

C

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7
Q

Which of the following manifestations is not consistent with upper motor neuron damage?

A. Spasticity
B. Hyperreflexia
C. Fibrillations
D. Babinski Sign
E. Clonus
A

C

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8
Q

Which of the following is not true with regard to the reflex arc of a muscle stretch reflex?

A. Monosynaptic
B. Can be facilitated by the Jendrassik Maneuver
C. The synapse is outside the spinal cord because it is a lower motor neuron function
D. Enhanced by a damaged corticospinal tract
E. The reflex is reduced if the peripheral nerve is injured

A

C

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9
Q

If a golgi tendon organ is stimulated, what will happen to the muscle?

A. The muscle contracts
B. The muscle relaxes
C. The muscle fibrillates
D. The muscle fasciculates
E. The muscle shortens
A

B

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10
Q

What is the neurotransmitter in the final common pathway?

A. Serotonin
B. Epinephrine
C. Dopamine
D. Acetylcholine
E. Glutamate
A

D

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11
Q

Which of the following neurotransmitters is particularly important to attention to novel and potentially challenging stimuli?

A. Serotonin
B. Dopamine
C. Acetylcholine
D. Norepinephrine

A

D

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12
Q

If a person can answer simple question and carry out command but is easily distracted and unable to pursue sustained activities, which of the following is/are intact in this individual?

A. Attention
B. Vigilance
C. Alertness
D. All of the Above

A

C

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13
Q

Which of the following neural components release a chemical most relevant to both memory and general attention?

A. Nucleus Locus Ceruleus
B. Brainstem Raphe Nuclei
C. Tuberomamillary Nucleus
D. Nucleus Basalis of Meynert

A

B

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14
Q

All of the following features are characteristic of the ascending system for consciousness, as opposed to that of the Ascending Sensory Systems, EXCEPT:

A. It involves specific thalamic nuclei
B. It modulates cortical reactivity to stimuli
C. It consists of diffuse multineuronal pathways
D. It occupies the inner tube of the central nervous system

A

D

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15
Q

Which of the following is/are function of serotonin?

A. Attention to novel and potentially challenging stimuli
B. Regulation of mood and affect
C. Inhibition of non-REM sleep
D. All of the above

A

B

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16
Q

The triggering mechanism of the genesis of REM sleep depends on neurons which release:

A. Serotonin
B. Acetylcholine
C. Norepinephrine
D. Gamma Amino Butyric Acid (GABA)

A

B

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17
Q

The internal circadian pacemaker of the body:

A. Preoptic nucleus
B. Supraoptic nucleus
C. Paraventricular nucleus
D. Suprachiasmatic nucleus

A

D

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18
Q

Ponto-geniculo-occipital spikes (PGO) are associated with what stage of sleep?

A. Stage 1 nREM sleep
B. Stage 2 nREM sleep
C. Stage 3 nREM sleep
D. Stage 4 nREM sleep
E. REM sleep
A

E

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19
Q

In what stage of sleep would slow waves constitute 20-50% of total EEG activity?

A. Stage 1 nREM sleep 
B. Stage 2 nREM sleep
C. Stage 3 nREM sleep
D. Stage 4 nREM sleep
E. REM sleep
A

C

Note that stages 3 and 4 of nREM sleep have recently been merged into a single stage 3. As usual though, the lectures take precedence even if they are outdated…

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20
Q

All of the following are features of REM sleep EXCEPT:

A. Fluctuations of heart rate and respiration
B. Rapid conjugate eye movements
C. Vivid, story-like dreams
D. Increase in muscle tone

A

D

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21
Q

Which of the following is/are true of both excitatory post-synaptic potential (EPSP) and generator potential? They are both______:

A. Ligand-gated
B. Graded responses
C. Generated by opening of non-specific channels
D. All of the above statements are true

A

B

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22
Q

All generator potentials are______:

A. Are depolarizing currents
B. Initiate depolarization in the sensory nerve fibers
C. Are propagated potentials
D. All of the above statements are true

A

A

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23
Q

The intensity of a given sensation is related to all of the following EXCEPT:

A. Amplitude of the action potential
B. Frequency of the action potential
C. Number of receptors activated
D. Variation in the activity of a given receptor

A

D

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24
Q

Which of the following receptors are being tested in the vibratory sense examination?

A. Pacinian corpuscles
B. Ruffini endings
C. Meissner’s corpuscles
D. Free nerve endings

A

A

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25
Q

Which of the following neural pathways give rise to more precise information about modality, intensity and localization of the sensation?

A. Spinothalamic
B. Propriospinal
C. Spinal mesencephalic
D. Spinal reticular

A

B

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26
Q

In stereognosis, the receptors that contribute to the perception of shape are the

A. Pacinian corpuscles
B. Ruffini endings
C. Meissner’s corpuscles
D. Free nerve endings

A

C

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27
Q

Which of the following statements is true of visceral pain?

A. It is rapidly adapting
B. It generally tends to be sharp
C. It resembles the 2nd slow pain of somatic pain
D. It is primarily mediated by A-delta fibers

A

C

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28
Q

A vague aching pain along the inguinal area may be a referred pain from

A. Stones in the ureter
B. A spinal cord irritation at L1 level
C. Either of the above
D. None of the above

A

C

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29
Q

What do the golgi tendon organs regulate?

A. Muscle length
B. Muscle tension
C. Velocity of muscle contraction
D. All of the above

A

B

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30
Q

Stretching the muscle spindles will produce an increased firing of which neural structures?

A. IA fibers
B. Alpha motor neurons of the synergistic muscles
C. Inhibitory interneuron to the antagonistic alpha motor neurons
D. All of the above

A

D

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31
Q

Which of the following conditions will produce hypotonic muscles?

A. Decreased firing of the alpha motor neurons
B. Increased firing of the gamma motor neurons
C. Increased firing of the IB fibers from the tendon organs
D. All of the above

A

D

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32
Q

If you are to synthesize a drug that inhibits pain, what type would it be?

A. A drug that inhibits voltage-gated Ca++ channels at the presynaptic neurons
B. A drug that inhibits μ receptors
C. A drug that enhances the reuptake of noradrenaline into the presynaptic terminals
D. A drug that enhances the activity of Substance P

A

C

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33
Q

In contrast to the rod receptors in the visual systems, cones:

A. Have a lower threshold for light waves
B. Provides achromatic vision
C. Are responsible for visual acuity
D. Are scattered throughout the retina

A

C

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34
Q

Which visual modality is subserved by the magnocellular pathway?

A. Perception of movement
B. Color
C. Shape
D. Orientation of the object

A

A

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35
Q

As you read this question, your eyes accommodate to provide clear vision for reading. During accommodation all of the following occur EXCEPT:

A. Contraction of the cilliary muscles
B. Pupillary constriction
C. Flattening of the lens
D. Ocular convergence

A

C

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36
Q

The impedance-matching problem between the middle and inner ears is corrected by which of the following mechanisms?

A. The ossicular chain decreases the amplitude of vibration while increasing the force of vibration through the middle and inner ear
B. The total pressure acting on the smaller oval window is increased because of high aerial ration between the tympanic membrane and oval window
C. The effective force that travels through the middles is greatly increased
D. All of the above

A

A

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37
Q

An individual whose branch of the facial nerve
that innervates the stapedius muscle is severed,
he/she will hear sound that is_______.

A. Louder than usual
B. Softer than usual
C. Normal
D. NOTA

A

A

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38
Q

Which of the following statement/s is true about
the Organ of Corti?

A. Glutamate is the neurotransmitter of the hair cells
B. Most of the auditory information from the periphery is carried by the inner hair cells
C. The basal portion of the Organ of Corti transduces high frequency sound waves
D. All of the above are true

A

D

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39
Q

What is/are the adequate stimuli of the
semicircular canal?

A. Rotatory motion
B. Angular acceleration
C. Change in temperature
D. All of the above

A

D

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40
Q

Which of the following semicircular canals are
correctly paired?

A. Left horizontal canal- right horizontal
canal
B. Left horizontal canal- right posterior canal
C. Left horizontal canal- right superior canal
D. None of the above are correctly paired

A

A

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41
Q

The following statement/s is/are true of the vestibulo-ocular reflex.

A. It is initiated by the stimulation of the photoreceptors
B. The reflex can be elicited even under dark illumination
C. The eye movement that it produces serves as feedback to the vestibular apparatus
D. None of the above

A

B

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42
Q

Which of the following systems must be tested if a patient complains of a ‘feeling of imbalance’?

A. Cerebellum
B. Dorsal column
C. Visual and vestibular
D. All of the above

A

D

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43
Q

Which of the following taste sensations is exclusively transduced via G-protein coupled receptors?

A. Sour
B. Bitter
C. Sweet
D. Umami

A

C

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44
Q

Which of the following statements is/are true about the olfactory sense?

A. The discrimination threshold of the sense of smell is lower than taste sensation
B. The odorant-binding proteins facilitate the transport of the odorants from cell surface to the receptors
C. The presence of the different transduction signals and 2nd messengers ensure that the olfactory signals are amplified
D. All of the above statements are true

A

D

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45
Q

Which of the following show functional deterioration as one ages?

A. Accommodative power of the eyes
B. Rate of mental calculation
C. Sleep latency
D. All of the above

A

D

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46
Q

Mini-Mental Status Examination is equivalent to doing a full higher cortical function testing.

A. True
B. False
C. Sometimes
D. All the time

A

B

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47
Q

Asking for a historical event or a verifiable personal event (“What school did you last attend?”) tests

A. Immediate memory
B. Recent memory
C. Delayed memory
D. Remote memory

A

D

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48
Q

Echolalia, palilalia, and neologisms are often seen in testing lesions of the

A. Frontal lobe
B. Parietal lobe
C. Temporal lobe
D. Occipital lobe

A

C

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49
Q

Dressing apraxia and left hemineglect are prominent features of lesion in the

A. Frontal lobes
B. Right thalamus
C. Right parietal
D. Non-dominant temporal

A

C

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50
Q

Denotes utter denial of an obvious handicap or illness such as hemiplegia or even blindness

A. Anosognosia
B. Astereognosia
C. Visual agnosia
D. Hemineglect

A

A

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51
Q

The primary olfactory center of the brain is found within which cortical area?

A. Entorrhinal
B. Parahippocampus
C. Periamygdaloid
D. Frontal

A

B

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52
Q

Olfactory hallucinations are commonly associated with what other pathology?

A. Nasal congestion
B. Gliomas
C. Blindness
D. Seizure disorders

A

D

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53
Q

The flavour of chicken is best distinguished in which structure/area?

A. Tip of the tongue
B. Sides of the tongue
C. Back of the tongue
D. None of the above

A

A

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54
Q

Proprioception is a function of which sensory end organ?

A. Utricle
B. Cochlea
C. Saccule
D. None of the above

A

D

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55
Q

Inertia plays an important role in the mechanical stimulation of which structure?

A. Macula
B. Cupula
C. Ampulla
D. Tympanic Membrane

A

B

56
Q

Inhibitory signals to the Organ of Corti come from which structure?

A. Lateral lemniscus
B. Primary auditory center
C. Superior olivary complex
D. Inferior colliculus

A

C

57
Q

Which of the following visual components are mostly transmitted via M fibers?

A. Motion
B. Form
C. Color
D. None of the above

A

A

58
Q

Retinotopic arrangements of fibers are insured by specific layering of this structure:

A. Retina
B. Optic chiasm
C. Superior colliculus
D. Lateral geniculate nucleus

A

D

59
Q

If you see an object disappear from your lateral field of vision, which structures in the eye are the light rays from the object falling on?

A. Macula
B. Retinal artery arcade
C. Optic disc
D. Foveola

A

B

If the object disappeared in the middle of the visual field, then the light rays it reflected fell on the blind spot. By elimination, only B can be true

60
Q

Reading a patient’s chart prior to your preceptorials, you read that the patient has: (+) Marcus Gunn pupil, OS. Which of the following near exam findings will you expect?

A. Paralysis of the EOM’s of the L eye
B. (-) consensual reflex of the R pupil (light on the L eye)
C. (-) constriction of the R pupil, swinging flashlight from L to R
D. (+) increased constriction of the R pupil, swinging flashlight from L to R

A

0

61
Q

If you are allowed to do only one test, what would you choose to do for your patient consulting for severe headache?

A. History taking
B. Complete neurological examination
C. MRI of the head
D. Examination of the fundus for papilledema

A

A

62
Q

The preferred standardized sequence of getting the history is:

A. Chief Complaint, General Data, History of Present Illness, Review of Systems, Past Medical History, Personal and Social History
B. General Data, Chief Complaint, History of Present Illness, Review of Systems, Past Medical History, Family History, Personal and Social History
C. General Data, Chief Complaint, History of Present Illness, Personal and Social History, Review of Systems, Past Medical History, Family History
D. None of the above

A

B

63
Q

In the “OSCD PQRST UVW + AAA” guide for dissecting the History of Present Illness, the “V” stands for:

A. Vital evidence
B. Deja vu
C. Verification of details
D. Vilateral manifestation of symptoms

A

B

64
Q

The preferred standardized sequence of doing the neurological examination is:

A. CN Exam, Motor Exam (motor testing, cerebellar exam, reflexes), Sensory Exam, Meningeal Exam, MSE
B. MSE, CN Exam, Sensory Exam, Motor Exam (motor testing, cerebellar exam, reflexes), Meningeal Exam
C. MSE, CN Exam, Motor Exam (motor testing, cerebellar testing, reflexes), Sensory Exam, Meningeal Exam
D. MSE, CN Exam, Motor Exam (motor testing, cerebellar testing, reflexes), Meningeal Exam, Sensory Exam

A

C

65
Q

True about cranial nerves EXCEPT:

A. The afferent arc of the corneal reflex is through sensory CN V; the efferent arc is mediated by CN VII
B. The afferent arc of the jaw jerk is mediated through sensory CN V; the efferent arc by motor CN V
C. The afferent arc of the pupillary light reflex is CN II while the efferent arc is CN VII
D. The afferent arc of the gag reflex is CN IX while the efferent arc is CN X

A

C

66
Q

Things that you check when you examine the
pupils using the flashlight EXCEPT:

A. Exact size of the pupil that is measured in millimetres
B. Symmetry of pupils where a right anisocoria means the right pupil is smaller than the left
C. Shape (round, oval or irregular)
D. Direct and consensual light reflex

A

B

67
Q

Using the swinging flashlight test, if eye ‘A’ is blind due to damaged optic nerve:

A. When light is shine on eye ‘A’: no response in either eye (negative direct and consensual responses)
B. When light is shine on eye ‘B’: positive direct on eye B and consensual response on eye A
C. Both statements are true
D. Both statements are false

A

C

68
Q

Using the swinging flashlight test,

A. If eye A had damaged CN 3, there will be negative direct, but positive consensual response of eye B
B. If eye B had damaged to CN 2, there will be negative direct, but positive consensual response of eye A
C. Both statements are true
D. Both statements are false

A

A

69
Q

All eye muscles are controlled by CNIII EXCEPT:

A. Lateral rectus by CN 6
B. Superior oblique by CN 4
C. A and B
D. None of the above

A

C

70
Q

Part of the examination of CN 7 EXCEPT:

A. With lips firmly opposed, ask the patient to puff out their cheeks
B. The patient opens the mouth against resistance
C. Ask the patient to smile
D. Ask the patient to wrinkle their eyebrows and then close their eyes tightly

A

B

71
Q

True about CN 7 EXCEPT:

A. The more obvious the facial asymmetry , the more a peripheral facial palsy is entertained
B. The right and left upper motor neurons (UMN’s) each innervate both the right and left lower motor neurons (LMN’s) that allow the forehead to move up and down
C. The LMN’s that control the muscles of the lower face are only innervated by the UMN from the opposite side of the face
D. None of the above (all are true)

A

D

72
Q

To check for the sensory function of facial nerve (CN7):

A. CN 7 is responsible for carrying taste sensations from the anterior 2/3 of the tongue
B. Taste is often tested only when specific pathology of the facial nerve is suspected
C. Sugar, salt or lemon juice on a cotton swab is applied to the lateral aspect of each side of the tongue and patient identifies the taste
D. A, B and C
E. A and B only

A

D

73
Q

TRUE about CN IX and CN X

A. If CN IX and CN X on the left is not functioning, the uvula will be pulled to the right
B. CN IX is responsible for taste in the posterior 1/3 of the tongue
C. CN X provides parasympathetic innervations to the heart
D. A, B and C
E. A and B only

A

D

74
Q

TRUE in testing the spinal accessory nerve (CN
XI)

A. Tested by placing your hands on top of the patient’s shoulder asking patient to shrug his shoulder while your provide resistance
B. Tested by placing your open left hand against the patient’s right cheek and ask them to turn into your hand while you provide resistance
C. Difficulty or weakness of the head turning to the right against examiner’s resistance suggests lesion of the right spinal accessory nerve
D. A, B and C
E. A and B only

A

E

75
Q

TRUE regarding the Hypoglossal nerve
EXCEPT:

A. CN XII is a purely motor cranial nerve
B. Inspect for fasciculation and atrophy while tongue is protruded out and not while resting inside the floor of the mouth
C. If there is any suggestion of deviation to one side/ weakness, direct them to push the tip of their tongue into either cheek while you provide counter pressure from the outside
D. If the face is asymmetrical, the tongue may falsely appear to deviate

A

B

76
Q

TRUE in testing for the olfactory nerve (CN I)
EXCEPT:

A. This is rarely tested in clinical practice
B. Examination is usually performed to investigate a specific complaint rather than as a screening test
C. To make sure that the stimulus is adequate, use ammonia
D. The olfactory nerve is a special afferent cranial nerve composed of sensory fibers only

A

C

77
Q

Steps in testing visual acuity EXCEPT:

A. Make sure patient removes their prescription glasses as you are interested in their uncorrected vision
B. Hold a Rosenbaum (near vision) pocket card at a 14 inch ‘reading’ distance
C. Have the patient cover one eye at a time with a card
D. Ask the patient to read progressively smaller letters until they can go no further

A

A

78
Q

The proper sequence of steps/tests done before
a patient is said to have blindness:

A. Counting fingers > Perception of direction of light > Appreciation of hand movements > Perception of light > If still nothing seen, blind
B. Counting of fingers > Appreciation of hand movements > Perception of direction of light > Perception of light > If still nothing seen, blind
C. Counting fingers > Perception of light > Appreciation of hand movements > Perception of direction of light > If still nothing seen, blind
D. None of the above

A

B

79
Q

Steps in examining the visual acuity, you would

A. Confront the patient by stationing yourself directly in front. Start with your left eye directly in line with the patient’s right eye at a distance of about 1 meter. The patient covers the left eye with the left hand
B. Hold up your left finger just outside your own peripheral field, the inferior temporal quadrant. Hold the finger equidistant between your eye and the patient’s
C. Ideally the finger should extend beyond the perimeter of the field. Wiggle the finger slowly and it very slowly toward the central field
D. None of the above

A

D

80
Q

TRUE regarding results of visual field testing:

A. A defect in visual field limited to one eye suggests lesion of the optic nerve anterior to the optic chiasm
B. A bitemporal hemianopsia suggests a lesion in the optic chiasm
C. A homonymous field defect suggests a lesion behind the optic chiasm
D. A, B and C
E. A and B only

A

D

81
Q

TRUE about a patient with left homonomous
hemianopsia EXCEPT:

A. Has a lesion in the left optic nerve
B. Does not have a brainstem lesion
C. Has a lesion after the optic chiasm
D. Has a lesion in the right hemisphere

A

A

82
Q

Approach to a patient with suspected conductive
hearing loss:

A. First determine by history and crude acuity testing which ear has the hearing problem
B. IN doing the Rinne’s test, bone conduction (BC) will be greater than air conduction (AC) in the affected ear
C. In doing the Weber’s test, the sound will lateralize to the affected ear
D. A, B and C
E. A and B only

A

D

83
Q

Approach to a patient with suspected
sensorineural hearing loss:

A. First determine by history and crude acuity testing which ear has the hearing problem
B. In doing the Rinne’s test, air conduction will be greater than bone conduction in the affected ear
C. In doing the Weber’s test, the sound will lateralize to the affected ear
D. A, B and C
E. A and B only

A

E

84
Q

True about testing CN 5 or Trigeminal nerve:

A. There are three separate division of CN 5 that the examiner should check individually
B. The trigeminal nerve innervates the scalp to the vertex not just to the hairline
C. The angle of the jaw is not supplied by CN 5 but by the greater auricular nerve, a branch of CN 7
D. A and B only

A

D

85
Q

In testing for the motor function of CN 5:

A. Look at the side of the face and check for atrophy of the masseter and temporalis muscles
B. Ask the patient to clench his teeth and feel the masseter and temporalis muscles
C. Ask the patient to open the mouth against your resisting hand placed under the chin
D. A, B and C
E. A and B only

A

D

86
Q

Before doing the somatic motor strength testing,
you should first INSPECT for the following EXCEPT:

A. Observe body position
B. Look for atrophy
C. Check for muscle tone
D. Check for involuntary muscle movements

A

C

87
Q

A movement disorder characterized by wild
flinging movement of a part of the body

A. Chorea
B. Hemiballismus
C. Athetosis
D. Dystonia

A

B

88
Q

In checking for tone, the least effective way to
make a patient relax is to:

A. Ask the patient to relax
B. Ask patient to count down from 100
C. Converse with patient with irrelevant topic
D. Ask the patient to spell WORLD backward

A

A

89
Q

TRUE about terms used in reporting the tone of
muscles EXCEPT:

A. Gegenhalten or Paratonia is a condition when tremor is aggravated or increased when one checks for tone
B. When the heel easily leaves the bed when the knee is lifted quickly, this is called spasticity
C. Lead pipe rigidity is characterized by increased resistance throughout the whole range of movement of joint
D. If there is regular intermittent break in tone throughout the whole range: cogwheel rigidity

A

A

90
Q

TRUE about spasticity and rigidity

A. Spasticity suggests extrapyramidal involvement
B. In rigidity, clonus is expected to be present
C. To check for rigidity, the examiner must do a quick jerk of the extremity
D. None of the above

A

D

It is rigidity that usually has extrapyramidal involvement (ex. Parkinson’s - basal ganglia) Clonus is associated with UMN lesions. Rigidity is checked by moving the extremity through its whole range of motion.

91
Q

The suggested sequence for the orderly testing
of motor strength of upper extremities

A. Arm abductors, elbow flexors, elbow extensors, flexing the forearm while in semiprone position, wrist flexors, wrist extensors
B. Arm abductors, elbow flexors, elbow extensors, wrist flexors, wrist extensors, flexing the forearm while in semiprone position
C. Elbow flexors, arm abductors, elbow extensors, flexing the forearm while in semiprone position, wrist flexors, wrist extensors
D. Arm abductors, elbow flexors, wrist extensors, elbow extensors, wrist flexors, flexion of the forearm while in semiprone position

A

A

92
Q

TRUE about doing the pronator test

A. Ask patient to extend the arms with palms facing downwards
B. The patient can do this test with eyes opened or eyes closed
C. A pronator drift suggests a lower motor neuron lesions
D. None of the above

A

D

93
Q

TRUE about grading of motor strength

A. If movement can be elicited when gravity is eliminated, this is graded 2/5
B. If patient can flicker or move a little the muscle being tested, this is graded as 1/5
C. In the MRC grading of motor strength, MRC stands for Medical Royal College (of London) and not Motor Rating Coding
D. A, B and C

A

D

94
Q

Regarding nerve innervations of the upper extremity:

A. The C5 is involved in arm abduction
B. The musculocutaneous nerve is the nerve involved for elbow flexion
C. The small muscles of the hand is innervated by C7
D. A, B and C
E. A and B

A

E

95
Q

Things you can examine when you observe the
patient during walking

A. You can check for strength of plantar flexors by asking the patient to walk on heels
B. You can check for strength of foot dorsiflexors by asking the patient to walk on toes
C. In Parkinson’s Disease, you can appreciate the poor arm swing and the shuffling gait
D. Tandem walk is a test for posterior column tract and patient should be asked to close their eyes while walking a straight line

A

C

96
Q

TRUE about performing the motor strength
examination:

A. Matching principle: Select movements that just about match the examiner’s own strength
B. The Length Strength principle: the muscles are strongest when acting from their shortest position
C. The Length Strength principle: the muscles are weakest when acting from the longest position
D. A and B only
E. A, B and C

A

E

97
Q

In testing the stance:

A. Cerebellar ataxia is not ameliorated by visual orientation
B. Have the patient stand in one place and check for imbalance. This is a test of balance, incorporating inpit from the visual, cerebellar, proprioceptive and vestibular systems
C. If they are able to maintain balance with eyes open, have them close their eyes, removing visual input. This is referred to as the Romberg test where loss of balance suggests impaired cerebellar function
D. A, B and C
E. A and B only

A

D

98
Q

In testing gait, all are true EXCEPT:

A. Parkinsonan shuffling gait: lack of arm swinging, difficulty initiating/ stopping
B. Foot drop: compensate with high stepping
C. Spastic hemiparesis: leg is flexed, foot is plantarflexed
D. Cerebellar ataxia: unsteady, wide-based gait, difficulty with turns, veers towards side of lesion

A

C

99
Q

The least helpful test in doing the cerebellar testing

A. Checking for nystagmus
B. Finger to nose test
C. Checking for hypotonia
D. Alternating movements: thigh patting of palm patting
E. Overshooting: arm displacement and arm pulling test
F. Heel to shin

A

C

100
Q

TRUE about cerebellar testing EXCEPT

A. The patient develops a tremor as his finger approaches its target: postural tremor
B. Finger overshoots its target: past pointing or dysmetria
C. Patient is not able to maintain an erect sitting position: truncal ataxia
D. Patient had difficulty in alternate movement while doing the pronation supination test: dysdiadochokinesia

A

A

101
Q

Regarding cerebellar lesions:

A. Unilateral incoordination suggests ipsilateral cerebellar syndrome
B. Bilateral incoordination suggests bilateral cerebellar syndrome
C. Truncal ataxia, gait ataxia, without upper limb incoordination suggests midline (vermian) cerebellar syndrome
D. A, B and C
E. A and B only

A

E

102
Q

TRUE about meningeal testing:

A. Kernig’s sign is elicited by extending the flexed knee while the leg is flexed at the hip
B. Kernig’s sign is elicited by flexing the neck and watching for the patient’s knee to flex
C. A and B are both procedures that indicate meningeal irritation
D. None of the above

A

A

103
Q

TRUE about eliciting reflexes:

A. In doing the biceps (C5) and brachioradialis (C6) reflex, you tap on your finger placed on the top of the tendon, and not directly on the patient’s
tendon
B. Tromner reflex is performed by quickly flicking the middle finger down
C. Hoffman reflex is performed by quickly flicking the middle finger up
D. All are true

A

A

104
Q

Assuming that everyone can draw the stick figure in the correct way, all are part of the standardized way of reporting muscle strength reflexes (MSR) EXCEPT:

A. ++ or +2 is given for normal MSR
B. +4 is given for hyperactive reflex with unsustained clonus
C. 0 is hyporeflexia
D. +3 is for hyperreflexia without clonus

A

C

105
Q

Whether you are extremely anxious or furious at how the examination questions were constructed, this part of your brain calms you down so you can choose the best answer:

A. Amygdala
B. Prefrontal cortex
C. Stria terminalis
D. Locus ceruleus

A

B

106
Q

Executive functions, such as the capability to plan and organize, are “localized” in the

A. Frontal lobe
B. Temporal lobe
C. Parietal lobe
D. Occipital lobe

A

A

107
Q

To be able to choose the best answer among seemingly similar test choices requires

A. A functional prefrontal cortex- so you can be happy with your choice
B. A functional prefrontal cortex- so you suppress the intense feelings you have for neurology and focus on answering the exam questions
C. A functional anterior cingulate cortex- to discern what’s right from wrong
D. A functional orbitofrontal cortex-to decide on the answer to shade in

A

C

108
Q

The supramarginal gyrus on your dominant brain hemisphere

A. Is reading aloud this exam question on your head
B. Is the evolutionary breakthrough that elevates you above the Neanderthal
C. Caps the superior temporal sulcus
D. Can cause alexia without agraphia, if damaged

A

A

109
Q

The angular gyrus

A. Combines integrated auditory and visual inputs to allow literacy
B. Caps the Sylvian fissure
C. Is synonymous with Wernicke’s area
D. Is located in the temporal lobe

A

A

110
Q

The posterior parietal cortex
A. Lies within the so-called dorsal stream of “what” pathway
B. Allows for integration of what is seen and felt with one’s movements
C. Is the seat of happiness
D. Is activated when someone clicks “like” on your Facebook comment

A

B

111
Q

Procedural memory for the correct technique of the neurological examination

A. Is found within the posterior parietal cortex
B. Is best stored in the supplementary motor area to pass the OSCE
C. Is conveyed by the occipitotemporal fibers
D. Is located in the dorsolateral prefrontal cortex

A

B

112
Q

Paying attention to the lecturer at the podium of
BSLR-East

A. Depends on an intact medial longitudinal fasciculus and PPRF
B. Does not require activating your frontal eye fields
C. Is hindered by too little electrical activity in your ascending reticular activating system
D. Is directed by your intraparietal sulcus

A

C

113
Q

Pricking your patient’s skin with a pin is actually testing the integrity of

A. Corticospinal tract
B. Spinothalamic tract
C. Dorsal columns
D. Myotome

A

B

114
Q

The neurons that decussate in the somatosensory pathway are found in

A. Dorsal root ganglion
B. Dorsal horn
C. Thalamus
D. Pyramid

A

B

115
Q

The site of decussation of the light touch pathway is within the

a. Midbrain
b. Pons
c. Medulla
d. Cervical cord

A

C

116
Q

In the laminar arrangement of fibers of the spinothalamic tract, the fibers from the lower body are found

A. Most medially
B. Most laterally
C. Dorsally
D. Ventrally

A

B

117
Q

Analogous to the posterior column nuclei of the medulla

A. Trigeminal motor nucleus
B. Mesencephalic nucleus
C. Main sensory nucleus
D. Spinal nucleus

A

A

118
Q

If a 23-year old seamstress develops sudden double vision and is unable to look to the right

A. The lesion is in the right frontal eye field
B. The lesion is in the left parapontine reticular formation
C. The lesion is in the right parapontine reticular formation
D. The lesion is in the left superior colliculus

A

C

119
Q

If a 40-year old housewife developed sudden left-sided weakness and tongue deviation to the right side

A. The lesion is in the right pons
B. The lesion is in the left dorsolateral medulla
C. The lesion is in the right ventral medulla
D. The lesion is in the right internal capsule

A

C

120
Q

Which of the following does not transmit pain impulses within the head and neck?

A. Trigeminal nerve
B. Facial nerve
C. Vestibulocochlear nerve
D. Glossopharyngeal nerve

A

C

The facial nerve has a slight (somato)sensory
innervation to the external ear canal. It is CN VIII
which is purely special sensory.

121
Q

Which is not a pain-sensitive structure in the cranium?

A. Frontal lobe
B. Superior sagittal sinus
C. Meninges
D. Dura mater

A

A

122
Q

The dermatomal landmark for the 10th thoracic cord segment

A. Floating rib
B. Nipple
C. Anterior superior iliac spine
D. Umbilicus

A

D

123
Q

Pain within the posterior cranial fossa is transmitted by

A. Facial nerve
B. Glossopharyngeal nerve
C. Vagus nerve
D. B and C

A

D

124
Q

The spinal nucleus of the trigeminal nerve is analogous to which structure?

A. Dorsal horn of the spinal cord
B. Lissauer’s tract
C. Substantia Gelatinosa
D. Intermediate horn of the spinal cord

A

A

125
Q

Case: An elderly female was brought in by her son to the PGH-ER after she was found unconscious on the bathroom floor.

In your history taking, which of the following information should you elicit to make your clinical impression?

A. Time when the patient was last seen well
B. History of recent trauma
C. Associated systemic illnesses
D. List of medications
E. All of the above
A

E

While it seems like such a cop-out to have AOTA as the answer, it really is important to not forget that all of this information could factor in the patient’s problem. One should not forget to elicit this info, or regard them as trivial

126
Q

Case: An elderly female was brought in by her son to the PGH-ER after she was found unconscious on the bathroom floor.

On physical examination, which of the following vitals sign/s should you initially note?

A. Temperature
B. Respiratory rate
C. Blood pressure
D. Pulse rate/heart rate
E. All of the above
A

E

All of these vital signs should be taken immediately and none of them should be missed.

127
Q

Case: An elderly female was brought in by her son to the PGH-ER after she was found unconscious on the bathroom floor.

On neurologic examination, the patient responded only to pain by withdrawal of the right upper extremity. Which of the following levels of consciousness best describe the patient’s condition?

A. Awake
B. Drowsy
C. Stuporous
D. Comatose
E. Acute confusional state
A

C

128
Q

On testing the pupillary light and direct light reflex, which of the following cranial nerve/s are involved?

A. Cranial nerve II
B. Cranial nerve III
C. Cranial nerve IV
D. A and B
E. B and C
A

D

129
Q

In general, which of the following respiratory pattern/s would suggest the level of brain dysfunction/lesion?

A. Cheyne-Stokes
B. Central Neurogenic Hyperventilation
C. Apneustic
D. Ataxic
E. All of the above
A

E

130
Q

After an hour, the level of consciousness of the patient deteriorated. She was noted to assume a decorticate posturing. Which of the following best describe this condition?

A. Arms flexed and legs extended
B. Arms and legs flexed
C. Arms hyperextended on the side and legs extended
D. Arms and legs appropriately withdrawing to pain
E. None of the above

A

A

131
Q

The following are components of sensorium EXCEPT:

A. Consciousness
B. Orientation
C. Memory
D. Insight, judgment and planning
E. Motor response
A

E

132
Q

TRUE or FALSE: Acute confusional state is an acute onset of acquired mental disorder characterized by deficits in attention and coherence of thought and action?

A. True
B. False

A

A

133
Q

TRUE or FALSE: In defining dementia, cognitive deficits that are exclusively due to delirium, restricted brain lesions and psychiatric disorders must be excluded.

A. True
B. False

A

A

Dementia, delirium, psychiatric disorders, etc. could present with similar symptoms, so they have to be ruled out. Example: dementia and delirium have more or less exactly the same symptoms, the only difference being duration

134
Q

TRUE or FALSE: Prominent cognitive decline should be the only consideration in evaluating patients for the presence of dementia

A. True
B. False

A

B

135
Q

TRUE or FALSE: Patient odor can provide important clues to the etiology

A. True
B. False

A

A

[OS 202] Lecture Exam B (6 decks)

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