2012 module exam Flashcards
1
Q
Which of the following describes the action of glutamate dehydrogenase on synaptic transmission?
§ Acetylcholine production
§ Increased γ-aminobutyric acid (GABA) synthesis
§ Increased K+
§ Increased catecholamine synthesis
A
§ Increased γ-aminobutyric acid (GABA) synthesis
2
Q
A patient with anterior spinal artery occlusion. What will he present with?
A
Loss of thermal senses in both sides
3
Q
What is damaged if the distal muscles of the right lower limb showed spastic paralysis?
A
Right lateral corticospinal tract
4
Q
What is essential for the regeneration of peripheral neurons after injury?
§ Proliferating Schwann cells
§ Intact myelin
A
§ Proliferating Schwann cells
*Two things are important for regeneration of neurons: mitosis of Schwann cells (from distal to proximal) to form band fiber and presence of intact basal lamina / endoneurium
5
Q
Which nuclei does the medial leminiscus originate from?
A
Cuneate and gracile nuclei
6
Q
Which receptor detects vibration?
A
Pacinian corpuscle
7
Q
Which receptor detects different modalities of sensation?
A
Free nerve ending
8
Q
What best describes spasticity?
§ The extensors of the lower limb have increased tone
§ Occurs only if there is a lesion in the corticospinal tract
§ Occurs immediately after UMN lesion
A
§ The extensors of the lower limb have increased tone
9
Q
What best describes reciprocal innervation of the Golgi tendon organ reflex?
A
Stimulation of Ib afferents and excitation of antagonist muscle
10
Q
What is a characteristic of an upper motor neuron lesion?
§ Rigidity
§ Ankle clonus
A
§ Ankle clonus
11
Q
How does a slow adapting receptor react to a 60 second stimulus?
§ Action potentials increase gradually in the first 10 seconds
§ Receptor potential increases throughout
§ Action potentials rapidly increases then decays
§ Continuous action potential firing rate
A
§ Action potentials rapidly increases then decays
12
Q
A 66 years old male presented with left leg and arm weakness. Examination showed loss of vibration and proprioception in the affected side. Tongue is also deviated to the right upon protrusion. Diagnose.
A
Right medial medullary syndrome
13
Q
What is the response of neurons to demyelination?
A
Increase in ion-pumps
14
Q
Where would you find pseudounipolar neurons?
A
Mesencephalic nucleus of trigeminal nerve
15
Q
What is the origin of the preganglionic parasympathetic fibers to the submandibular gland?
A
Superior salivatory nucleus
16
Q
What is the difference between muscarinic and nicotinic receptors?
A
Nicotinic receptors are ligand-gated ion channels that cause rapid
depolarization upon stimulation
17
Q
Which nucleus is present at the level of the superior colliculus?
A
Red nucleus
18
Q
A 49-year old woman had a history of remitting and relapsing neurological symptoms including optic neuritis and transverse myelitis. She died and an autopsy was performed. They found irregular periventricular plaques. What is the most likely diagnosis?
A
Multiple sclerosis
19
Q
A 39-year old Japanese woman had a history of bilateral visual disturbances and autoimmune disease. Which of the following will be seen?
A
Autoantibodies against aquaporin 4
20
Q
A section from a patient with a demyelinating disorder showed change in color when adding Toluidine Blue stain. Which is most likely?
A
Metachromatic leukodystrophy
21
Q
An old man with AIDS and showed white matter demyelination. Diagnose.
A
Progressive multifocal leukoencephalopathy
22
Q
What type of damage occurs in myasthenia gravis?
§ Antibody mediated
§ Perforin
§ TNF
§ T cytotoxic cells
A
§ Antibody mediated
23
Q
A 50-year women has drooping in her mouth corner but when asked to lift her eyebrows up, there was wrinkling on both sides of the forehead. Where is the lesion?
A
Facial nerve, UMN lesion
24
Q
Which nerve is affected in Bell’s palsy?
A
Facial nerve, LMN lesion
25
Which area is associated with the abducent nucleus?
§ Basilar pons
§ Arcuate nucleus
§ Spinal nucleus of trigeminal nerve
§ Basilar pons
26
A patient with carotid dissection and right pinpoint pupils. Diagnose.
Horner’s syndrome
27
What will cause ipsilateral Horner’s syndrome and limb ataxia, but contralateral loss of pain and temperature?
Lateral medullary syndrome
28
Which of the following reflexes extends to either side of the body?
§ Flexor reflex
§ Crossed extensor reflex
§ Reciprocal inhibition
§ Crossed extensor reflex
29
What is the effect when these is a lesion of the upper part of the pyramid?
Contralateral upper and lower limb paralysis
30
Which nucleus is responsible for touch and pressure sensation from the face?
Main sensory nucleus of trigeminal nerve
31
What is a characteristic of proteolipid protein?
§ High positive charge
§ High negative charge
§ Amphiphilic
§ Hydrophobic
§ Hydrophobic
32
A 53-year old man suffers from motor disability, mood disturbances, and he has a mutation in NOTCH3. What is his condition?
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy)
33
What is the function of the anterior association area when a person wants to hold a cup?
Decides whether to pick up the cup or not
34
The prefrontal cortex projects to which of the following structures?
§ Thalamus
§ Nucleus accumbens
§ Internal capsule
§ Sublentiform nucleus
§ Nucleus accumbens
35
Severe systemic hypotension is a serious clinical condition. What is the main clinical concern regarding its hemodynamic effects in the brain?
§ Increased intracranial pressure
§ Decrease cerebral blood flow
§ Increased intracranial pressure
36
What mainly affects the blood flow when activity of neurons increases under normal conditions?
Release of glutamate from neurons
37
What connects the frontal lobes of both hemispheres?
Forceps minor
38
What is connected by the forceps major?
Occipital lobes
39
Enlargement of the posterior horn of lateral ventricle will compress what?
§ Tapetum
§ Forceps major
§ Optic radiation
§ Optic radiation
*The tapetum is superior to the posterior horn and the optic radiation is lateral to it; however, enlargement of the posterior horn more likely to be lateral due to less tissue.
40
Which one of the following will cause hemiplegia?
§ Peripheral neuropathy
§ Myopathy
§ Lumbar disk herniation
§ Subdural hematoma
§ Subdural hematoma
41
Which of the following worsens the outcome of a patient with acute ischemic stroke?
§ Reduction of blood sugar
§ Nil per oral
§ Aspirin within 24 hours
§ Reduction of systolic blood pressure to <140 mmHg
§ Reduction of systolic blood pressure to <140 mmHg
42
Which of the following nuclei project to the cingulate gyrus?
Anterior thalamic nuclei
43
Which of the following is linked to the limbic system?
Habenular commissure
44
Which of the following is involved in constriction of arterioles?
Conversion of arachidonic acid into 20-hydroxyeicosatetraenoic acid in
arteriole smooth muscle
45
What is responsible for lateral inhibition?
Release of GABA from interneurons
46
What is responsible for dilation of arterioles during ischemia?
Increase in CO2
47
A woman with a brain tumor and astereognosis. What part of her brain is most likely injured?
§ Posterior parietal cortex
§ Primary sensory cortex
§ Somatosensory association cortex
§ Posterior parietal cortex
48
A patient who suffered from a cerebrovascular accident developed spatial agnosia. Which part of the brain is affected?
Posterior parietal cortex
49
Which thalamic nucleus projects diffusely to the cerebral cortex?
Medial dorsal
50
Damage to which structure causes deficit in working memory?
Prefrontal cortex
51
Diffuse pattern of cortical injury is seen in which of the following?
§ Ischemic infarction
§ Global cerebral ischemia
§ Lacunar infarcts
§ Intracerebral hemorrhage
§ Global cerebral ischemia
52
Which of the following is more likely to cause multiple small cerebral infarcts affecting arterioles?
§ Lacunar infarcts
§ Charcot-bouchard aneurysm
§ Lacunar infarcts
53
A patient with personal neglect syndrome failed to recognize contralateral side of his body and denied his arm belonged to him. What is affected?
Non-dominant hemisphere
54
Which of the following is lesioned in a person with apathy and leg weakness?
§ Frontal cortex
§ Dominant parietal cortex
§ Frontal cortex
55
A patient who had a cerebrovascular accident turns his eyes to the left side when trying to rotate her head to the right. In which area do you expect the lesion?
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§ Brodmann area 8
§ Brodmann area 4
§ Brodmann area 17
§ Brodmann area 19
§ Brodmann area 11
```
§ Brodmann area 8
56
What connects the temporal lobes?
Anterior commissure
57
If there is an ‘error’ during movement, the inferior olivary nucleus will send complex signals to which cell in the cerebellar cortex?
§ Purkinje cells
§ Granule cells
§ Purkinje cells
58
Which movement disorder can be classified as hyperkinetic and hypokinetic depending on the stage?
§ Parkinson’s disease
§ Alzheimer’s disease
§ GABAergic chorea
§ Essential tremor
§ GABAergic chorea
59
Which of the following is an antagonist to peripheral dopaminergic receptors used to treat the side effects of L-dopa such as anorexia and nausea?
Domperidone
60
Two doctors were arguing on assigning a cutoff level for CK2. One chose 10 U/L and the other 20 U/L. Knowing that the higher the CK level, the higher is the risk of developing a disease, which of the following is true?
§ The lower cutoff has higher sensitivity
§ The lower cutoff has higher specificity
§ The specificity of both cutoffs are the same
§ The lower cutoff has higher sensitivity
61
Which of the following is variable with prevalence and is important to rule out the disease?
Pretest probability
62
Which movement disorder is characterized by abnormality of muscle contraction that causes abnormal posture of the body part?
```
§ Dystonia
§ Tremor
§ Chorea
§ Tic disorder
§ Myoclonus
```
§ Dystonia
63
Which of the following is a familial neurodegenerative disease characterized by mutations in leucine-rich repeat kinase 2 (LRRK2)?
Parkinson’s disease
64
Caudate nucleus receives extensive input from?
Association cortex
*Input of the caudate is association cortex and output is prefrontal cortex (by way of VA, DM), while input of putamen is sensory, motor, premotor, and supplementary motor cortices and output is supplementary motor (by way of VA/VL)
65
On nose-to-finger examination, a 65 years old woman have right dysmetria, dysdiadochokinesia, and intentional tremor. What is the most likely diagnosis?
Tumor on right cerebellar hemisphere
66
What structure lies superior to the thalamus?
Stria terminalis
67
Which of the following is associated with α-synuclein inclusions in oligodendrocytes?
Multiple system atrophy
68
An old lady presented with involuntary rhythmic, oscillations in her eyes. What is this called?
Nystagmus
69
A patient is unable to perform rapidly alternating movements of hand pronation and supination. What is this called?
Dysdiadochokinesia
70
What is the effect of dopaminergic neurons on the direct pathway during strong stimuli?
Activation of D1 receptor and increased calcium influx
71
What is affected in Parkinson’s disease?
Substantia nigra
72
What will be damaged in case of a lesion in the superior cerebellar peduncle?
Dentothalamic tract
73
Which of the following drug is a muscarinic antagonist?
Benztropine
74
Which condition is characterized by CGG repeats?
Fragile X syndrome
75
Which of the following has α-synuclein aggregates?
Parkinson’s disease
76
What is damaged in balance disturbance?
Cerebellum
77
A patient was admitted to the hospital with signs and symptoms related to the vestibular dysfunction. Which of the following structures are affected?
Flocculonodular lobe
78
Which of the following is involved in selection of movements from internal cues?
Supplementary motor area
79
What is the function of Brodmann area 6?
Select sequences of movement
80
A decrease in which of the following increase sensitivity?
False negatives
81
Which of the following is a DOPA decarboxylase inhibitor?
Benserazide
82
What best describes a seizure that shows diffuse cortical activity from the start?
Primary generalized seizure
83
A 31-year-old female previously healthy, suddenly suffered from a headache and fell unconscious. MRI revealed subarachnoid hemorrhage at the base of the brain. CSF sample had increased RBCs but no WBCs and a slight rise in protein and no glucose. What is the most likely cause?
Ruptured berry aneurysm
84
A patient was driving a car without wearing the seatbelts and had a road traffic accident. What is this type of trauma?
§ Diffuse axonal injury
§ Frontal-temporal countre-coup
§ Concussion
§ Diffuse axonal injury
85
Which of the following will cause sodium channel mediated epilepsy?
SCN1A
86
A medical emergency of continuous seizure or more than one seizure without returning to normal in between. What best describes this condition?
Status epilepticus
87
What is the difference between antipsychotics that preferentially block the D2Rs and those that have strong anticholinergic activity such as thioridazine?
Thioridazine has lower incidence of extrapyramidal signs
88
A person fell from the second floor on his buttocks and fractured his skull. No pelvic or femoral fractures occurred. Which type of cranial fracture is this?
Ring basal fracture
89
The electroencephalogram (EEG) signals originate from which of the following?
§ Postsynaptic potentials of dendrites
§ Myelinated axons
§ Soma
§ All axons
§ Postsynaptic potentials of dendrites
90
What is the drug of choice for absence seizures?
Ethosuximide
91
Which drug irreversibly inhibits the enzyme GABA transaminase?
Vigabatrin
92
What is the mechanism of action of amitryptilline?
Inhibit neuronal reuptake of noradrenaline and 5-hydroxytryptamine
93
What is the mechanism of action of phenytoin?
Blocks Na+ channels
94
What will result from an impact of a hammer on the skull?
Small depressed fracture
95
Which of the following is a cause of reversible dementia?
Hypothyroidism
96
A patient seems awake and arousable but not responsive to external stimuli. Which of the following best describes him?
Persistent vegetative state
97
Elderly man with acute memory impairment, decreased attention, and his symptoms worsen at night. What does he have?
Delirum
98
In epilepsy, there is increased synchronized electrical activity in the brain, and this is related to increased activity of what?
§ Ionotropic glutamatergic
§ Metabotropic glutamenergic
§ Ionotropic glutamatergic
99
What will be recorded in the EEG when paroxysmal depolarization shift occurs in a population of neurons?
§ Sharp wave
§ Polyspike
§ Spike slow wave
§ Sharp wave
100
Which region of the brain when stimulated leads to aggression and increased food intake?
Lateral hypothalamus
101
Which region when lesioned leads to chronic hyperthermia?
§ Preoptic area
§ Posterior nucleus
§ Preoptic area
* Anterior hypothalamus ↓ heat (i.e. lesion will ↑ heat), while posterior
hypothalamus conserves heat (i.e. lesion will cause hypothermia)
102
Which drugs causes malignant hyperthermia?
Halothane
103
What is the mechanism of action of donepezil?
Inhibition of acetylcholinesterase
104
What is the mechanism of action of memantine?
Blockade of NMDA receptor
105
What is associated with the heavy phosphorylated neurofibrils in Alzheimer’s disease?
Tau
106
What describes the enzymatic changes seen in Alzheimer’s disease?
Increased β secretase activity
107
Wrong processing in which of the following produces Aβ42 peptides?
Amyloid precursor protein
108
What forms the plaques seen extracellularly in Alzheimer’s disease?
§ Amyloid precursor protein
§ Tau
§ Aβ peptides
§ Aβ peptides
109
What is the mechanism of action of benzodiazepines?
Enhance GABA-A mediated inhibition through modulatory site
110
Which drug is given to calm patient prior to surgery?
Midazolam
111
An 18-year old student has multiple sclerosis and severe anxiety. Which sedative drug is used to treat his muscle strains and reduce his anxiety?
§ Diazepam
§ Ramelteon
§ Zaleplon
§ Zolpidem
§ Diazepam
112
What controls the circadian rhythm?
Suprachiasmatic nucleus
113
Stimulation of the POMC/CART in which nucleus leads to decreased food intake?
§ Arcuate nucleus
§ Lateral hypothalamic nucleus
§ Ventromedial hypothalamic nucleus
§ Arcuate nucleus
114
What is a characteristic of local anesthetics?
§ Adrenaline is used as an adjunct to prolong duration of action
§ Weak acids
§ Amides have short duration of action
§ Esters have long duration of action
§ Adrenaline is used as an adjunct to prolong duration of action
115
What links sensory information to emotionally relevant behaviour, particularly in response to fear and anger?
§ Thalamus
§ Amygdala
§ Amygdala
116
Which structure develops from the basal plate?
§ Intermediolateral horn
§ Clark’s nucleus
§ Spinal nucleus of trigeminal nerve
§ Intermediolateral horn
117
Acetylcholinesterase inhibitors affect which of the following?
§ Acetylcholine degradation
§ Acetylcholine synthesis
§ Acetylcholine degradation
118
Which of the following increases the metabolism of brown adipose tissue when stimulated?
Posterior hypothalamus
119
A woman with a lesion in the medulla had breathing that is fast with decreased amplitude. What best describes this breathing?
Ataxic breathing
120
What is the most probable cause of sporadic CJD?
Spontaneous refolding PrPc
121
Gram-positive bacilli were seen in a section taken from an old lady. Which of the following is the most likely cause?
Listeria monocytogenes
122
A 53-year old women that has undergone renal transplant and had Gram positive branching bacilli. What is the likely cause?
Nocardia asteroides
123
A 2-year old child with meningitis caused by a Gram-negative coccobacilli. What would be the appropriate preventive measure for his sibling?
§ Ciprofloxacin single dose
§ Conjugated vaccine C for children > 2 years
§ Rifampicin for siblings < 5 years old
§ Rifampicin for siblings < 5 years old
124
Which of the following best represents the properties of a drug that passes the blood-brain barrier?
High lipid solubility, low molecular weight, low amount of hydrogen bonds with water
125
A 60 years old male in an acute confusional state. He has multiple metabolic abnormalities and cardiac failure. Breathing pattern shows hyperapnea and apnea (crescendo-decrescendo). What is this breathing called?
Cheyne-Stokes respiration
126
A patient had respiratory depression, hypertension, and bradycardia. Which of the following describes his symptoms?
Cushing’s triad
127
Which of the following is associated with increased permeability of endothelial cells in the presence of a tumor or abscess?
Vasogenic edema
128
A female coming back from Hajj with headache, nausea and vomiting. Which of the following is a rapid diagnostic test for detecting meningococcal meningitis?
```
§ Blood culture
§ Urine antigen
§ CSF culture
§ CSF antigen
§ Nasopharyngeal culture
```
§ CSF antigen
129
A 25-year-old patient with acute meningitis. Gram-negative diplococci were isolated. Which of the following is the most likely organism?
Neisseria meningitidis
130
What characterizes the toxic prion protein PrPsc?
Increased β sheet structure
131
Which vitamin deficiency causes Wernicke-Korsakoff syndrome?
Vitamin B1 (thiamine)
132
A 30-year old male with meningitis. MRI showed hyperintensity in his temporal lobes. Which drug should be given?
Acyclovir
133
What is the most likely causative organism of endogenous endophthalmitis?
Candida albicans
134
CSF of a 2-year old girl with meningitis showed Gram-positive diplococci. What is the most likely causative organism?
§ Streptococcus pneumoniae
§ Streptococcus agalactiae
§ Streptococcus pneumoniae
135
A 3-year old boy presents with hydrocephalus and perivascular lymphocytes and neuron degeneration. CSF shows increased protein and lymphocytes. What is expected to be seen on examination of the brain?
§ Diffuse cerebral edema
§ Hemorrhagic necrosis in his temporal lobe
§ Hemorrhagic necrosis in his temporal lobe
136
Which tumor is characterized by palisading nuclei surrounding pink areas (Verocay bodies)?
Schwnannoma
137
What causes necrotizing inflammation with destruction of inferior frontal and anterior temporal lobes?
Herpes simplex encephalitis
138
Which of the following tumor is characterized by perivascular pseudorosettes?
Ependymoma
139
A 3-month old boy presented with hydrocephalus, convulsions, and pericytic vascular lymphocytes. He also had intracytoplasmic inclusions. What is the diagnosis?
Viral encephalitis
140
A 60-year old female complaining of nausea, vomiting, and numbness in her left hand and foot. MRI suggested a primary brain tumor. Which one is most likely?
§ Schwannoma
§ Astrocytoma
§ Meningioma
§ Astrocytoma
*Confirmed by Dr. Kapilla
141
Oval inclusions were seen in Purkinje cells of cerebellum. Diagnose.
Rabies encephalitis
142
Which of the following affects temporal lobe?
Herpes simplex virus
143
A lesion in which of these structures would cause loss of vision in the right eye, but normal visual field in the left eye?
§ Optic nerve
§ Optic chiasm
§ Temporal lobe
§ Frontal lobe
§ Optic nerve
144
A lesion in which of these structures would make the patient see a pie in the sky?
§ Optic nerve
§ Optic chiasm
§ Temporal lobe
§ Frontal lobe
§ Temporal lobe
145
Which cell is important for ‘center-surround’ organization in the receptive field of the retina that corresponds to the visual field?
§ Horizontal cells
§ Ganglion cells
§ Amacrine cells
§ Horizontal cells
*Confirmed by Prof. Zoran Redzic
146
Which of the following structures is involved in internuclear ophthalmoplegia?
Medial longitudinal fasciculus (MLF)
147
Which layers are separated in retinal detachment?
Between RPE and photoreceptors
148
Visual pathway is related to which structure?
Lateral geniculate body
149
Which muscle is involved in the corneal reflex?
§ Orbicularis oculi
§ Levator palpebrae superioris
§ Orbicularis oculi
150
What causes depolarization in Na+ taste channels?
Increased Na+ gradient
151
Which structure receives nourishing from aqueous humor?
Cornea
152
What is true regarding diabetic retinopathy?
After 20 years, more than 75% of patient will have some form of diabetic
retinopathy
153
What is the consequence of constitutive induction of phosphodiesterases on phototransduction?
§ Leber’s congenital amaurosis
§ Color blindness
§ Night blindness
§ Complete blindness
§ Complete blindness
*Confirmed by Prof. Islam Khan
154
What fibrous structure covers the posterior 5/6 of the eyeball?
Sclera
155
Which layer forms the largest vascular structure of the eye?
Choroid
156
Where does recognition of complex sound signals occur in?
§ Associative auditory cortex
§ Primary auditory cortex
§ Associative auditory cortex
157
For an auditory signal to reach the primary auditory cortex, to which structure of the thalamus it should pass through?
§ Medial geniculate body
§ Lateral geniculate body
§ VA
§ VL
§ Medial geniculate body
158
What is responsible for sound localization?
Superior olivary nucleus
159
What is responsible for sound frequency detection?
Cochlear nerve
160
What is the normal intracranial pressure?
8-18 mmHg
161
Which headache occurs for 15-180 minutes?
§ Cluster headache
§ Scunt headache
§ Cluster headache
162
What is the origin of the meatal plug?
1st pharyngeal cleft
163
What is the origin of the Eustachian tube?
1st pharyngeal pouch
164
Damage of which of the following will cause unilateral hearing loss?
Cochlear nerve
165
What is the origin of the fibers forming the trapezoid body?
Cochlear nucleus
166
What gene is mutated in both HMSN (hereditary motor and sensory neuropathy) and HNPP (hereditary neuropathy with liability to pressure palsies)?
PMP22
167
What is the mechanism of action of morphine?
Open K+ channel, close Ca2+ channel, inhibit adenylate cyclase
168
What is the mechanism of action of neurokinin-1?
§ Increase Ca2+ release from intracellular stores via inositol trisphophate
§ Increase intracellular Ca2+ through voltage-gated Ca2+ channels
§ Increase Ca2+ release from intracellular stores via inositol trisphophate
169
Efferent fibers to the organ of Corti originate from where?
§ Superior olivary nucleus
§ Cochlear nucleus
§ Inferior colliculus
§ Medial geniculate body
§ Superior olivary nucleus
170
Which lymph node drains the upper medial part of the auricle?
Mastoid or deep cervical lymph nodes
