WEEK 1: Clinical Localization [Dr Salonga]

Question 1

speech disorder vs receptive language disorder vs expressive disorder

Answer 1

Speech d/o - difficulty producing sounds, as well as disorders of voice quality. (stuttering)
Receptive Language D/o - difficulty comprehending what is said.
expressive disorder - difficulty using spoken language

Question 2

most severe form of aphasia: cannot comprehend and cannot express

Answer 2

global aphasia

Question 3

type of aphasia where there is difficulty retrieving desired words: it’s on the tip of my tongue

Answer 3

anomic aphasia

Question 4

level of sensorium would indicate lesion along the course of

Answer 4

ARAS ( ascending reticular activating system)

Question 5

dysfunction of the extrapyramidal motor system of the basal ganglia woould lead to what symptoms? (2)

Answer 5

excessive involuntary movements (positive symptoms)
slow movements ( negative symptoms)

Question 6

sustained abnormal postures of limbs, neck, trunk, tongue or fixed upward deviation of the eyes

Answer 6

dystonia

Question 7

classifications of dystonia?

Answer 7

Focal, multifocal, segmental, hemidystonia, generalized dystonia

Question 8

blown pupils would indicate?

Answer 8

temporal lobe herniation with third nerve compression - , patient is likely comatose

Question 9

triad of horner syndrome?

Answer 9

ptosis, miosis, anhidrosis on the same side.

may isa pa eh, enopthalmos

Question 10

what causes the ptosis in horner syndrome?

Answer 10

paresis of Mueller muscle

Question 11

how would you describe the pupillary light reaction, reflex eye movement and motor response to pain if the lesion is in early diencephalic?

Answer 11

Pupillary: normal at first then constrict;
responds to doll eye maneuver;
localizes to pain

Question 12

how would you describe the pupillary light reaction, reflex eye movement and motor response to pain if the lesion is in late diencephalic?

Answer 12

smaller pupil, then constricts;
responds to doll eye maneuver;
decorticate

Question 13

how would you describe the pupillary light reaction, reflex eye movement and motor response to pain if the lesion is in midbrain?

Answer 13

dilated pupil and negative pupillary reflex;
responds to caloric testing;
decerebrate positioning

Question 14

how would you describe the pupillary light reaction, reflex eye movement and motor response to pain if the lesion is in pons/upper medulla?

Answer 14

dilated pupil and negative pupillary reflex
negative caloric testing
no response to pain.

Question 15

Rinne’s test is used to?

Answer 15

compare perception of sound via bone and air. in normal ear, air>bone

Question 16

Weber test how?

Answer 16

put tuning fork in the forehead. Normally, patient hears sound equally in both ears.

Question 17

in unilateral cerebellar disease, if there is problem in balance there is deviation to the side of lesion or contrralateral?

Answer 17

side of the lesion

Question 18

kernig’s sign how to elicit?

Answer 18

flexing the patient’s hip 90 degrees extend the patient’s knee (K for knee)

Question 19

Brudzinski how to elicit?

Answer 19

flex the patient’s neck then the sign will be flexion of the pt’s hips and knees,

Question 20

the primary study of choice in the evaluation of an acute change in mental status, focal neurologic findings, acute trauma to the brain and spine, suspected subarachnoid hemorrhage, and conducting hearing loss.

Answer 20

CT Scan

Question 21

more sensitive in the detection of early disease associated with increased water content.

Answer 21

MRI

Question 22

superior in the posterior fossa due to beam hardening artifacts in the latter modality.

Answer 22

MR

Question 23

used primarily for the detection of extracranial metastatic disease

Answer 23

FDG-PET (fluoro deoxy glucose) Positron Emission Tomography

Question 24

indicated for evaluating intracranial small vessel pathology (such as vasculitis) for assessing vascular malformations and anuerysms

Answer 24

catheter angiography

Question 25

carries the greatest risk of morbidity of all diagnostic imaging procedures

Answer 25

angiography

Question 26

tests are complimentary in the evaluation of patients with peripheral nerve and muscle diseases.

Answer 26

EMG and NCV

Question 27

Steps in the diagnosis of neurologic disorders?

Answer 27

(ACPED)
anatomic dx
clinical dx or syndromic dx
patho dx
etiologic dx
diagnostics

Question 28

The question of “where” the lesion is should first be answered
before determining the possible etiology. T or F?

Answer 28

T

Question 29

Loss of meaning to perception

Answer 29

agnosia

Question 30

difficulty producing sounds as well as disorders of voice quality.

Answer 30

speech disorder

Question 31

perfect score in MMSE

Answer 31

30
<25 there is some concern, pt should be followed up
20 - means that there is a cognitive impairment

Question 32

in weber’s test, what should be the result?

Answer 32

If a patient has a unilateral sensorineural hearing loss, the sound will lateralise – move to the good ear. If a patient has unilateral conductive hearing loss, the tuning fork sound would be heard loudest in the affected ear. (SUCA)

Question 33

If the patient falls over both with eyes closed and opened, then there is a problem in

Answer 33

proprioception

Question 34

This is the first function to be lost in alcoholic cerebellar cortical degeneration

Answer 34

tandem walking

Question 35

characteristic of cerebellar dysfunction It results in the individual pronouncing each syllable separately

Answer 35

slurrerd staccato

Question 36

_______ nystagmus this is associated more with cerebellar;

if it is________ on one side it is mostly associated with vestibular.

Answer 36

vertical;

horizontal

Question 37

positive sign in pronator drift?

Answer 37

Observe the hands / arm for signs of pronation / movement

• A slow upward drift in one arm is suggestive of a lesion in the contralateral cerebellum

Question 38

positive test in rebound phenomenon?

Answer 38

Positive test: Their arm shoots up above the position it originally was (this is suggestive of cerebellar disease)

Question 39

is used primarily for the detection of extracranial metastatic disease

Answer 39

FDG PET

Question 40

carries the greatest risk of morbidity of all diagnostic imaging procedures,

Answer 40

Cather angiography