Clinical Examination Flashcards
(172 cards)
1
Q
Joint damage to cranial nerves III, IV, VI and V1 suggests a lesion in:
a. of the mesencephalon
b. ponsu
c. medulli oblongati
d. cavernous sinus
A
d. cavernous sinus
2
Q
Herniation of the tonsils of the cerebellum through the foramen magnum due to an
expansive process in the posterior fossa causes:
a. CN III defect
b. CN XII defect
c. compression of the medulla oblongata with respiratory arrest
d. spinal cord compression
A
c. compression of the medulla oblongata with respiratory arrest
3
Q
Where is the defect if all the muscles animated by N. facialis are affected?
a. after exit through the stylomastoid foramen
b. in the facialis canal
A
b. in the facialis canal
4
Q
Where is the defect in Weber syndrome?
a. subthalamic core
b. mesencephalon
c. Pons
d. medulla oblongata
A
b. mesencephalon
5
Q
Weber syndrome is characterised by:
a. contralateral CN III defect and contralateral hemiparesis
b. ipsilateral CN III defect and contralateral hemiparesis
c. contralateral hemiballism
d. ipsilateral hemiballism
A
b. ipsilateral CN III defect and contralateral hemiparesis
6
Q
Impaired consciousness in a 25-year-old cyclist with ocular haematoma
(blueing of the upper and lower eyelids) due to:
a. diffuse encephalopathies
b. extensive supratentorial lesions
c. infratentorial lesions
d. all of the above
2.Which investigation would you order from him?
e. CT
f. EEG
g. MRI
h. lumbar puncture
A
1b. extensive supratentorial lesions
2e. CT
7
Q
Disconjugated eyeballs are indicative of a disorder of consciousness due to:
a. diffuse encephalopathies
b. supratentorial lesions
c. infratentorial lesions
d. all of the above
A
c. infratentorial lesions
8
Q
Dorsolateral medulla oblongata syndrome is:
a. Weber syndrome
b. Wallenberg syndrome
c. Benedict’s syndrome
d. Jackson syndrome
A
b. Wallenberg syndrome
9
Q
In uncus herniation due to oedema in the setting of a malignant brain tumour, the
brain nerve will be affected first:
a. II
b. III
c. IV
d. V
A
b. III
10
Q
. Cerebral nerves that have their nuclei in the pons:
a. N. oculomotorius
b. N. abducens
c. N. facialis
d. N. olfactorius
e. N. hypoglossus
A
b. N. abducens
c. N. facialis
11
Q
Which of the following structures does not belong to the Papes Circle?
a. hippocampus
b. narcotic telephones
c. fornix
d. cingulum
e. all of the above are part of the Papez circle
A
e. all of the above are part of the Papez circle
12
Q
A 43-year-old patient developed progressive headaches over a few weeks and
morning sickness for the last three days. MRI shows a large left parietal tumour.
Which of the following signs does the specialist find on examination?
a. patient cannot distinguish left/right, cannot do arithmetic, right-sided
hemianopsia, left-sided hemiparesis
b. patient cannot distinguish left/right, cannot do arithmetic, right-sided
hemianopsia, right-sided hemiparesis
c. patient cannot distinguish left/right, cannot do maths, has visual field
loss and right-sided hemiparesis
d. Patient cannot distinguish left/right, cannot do maths, visual field
loss, cannot repeat words
e. patient cannot distinguish left/right, cannot do maths, cannot understand
speech and has no visual field loss
A
d. Patient cannot distinguish left/right, cannot do maths, visual field
loss, cannot repeat words
13
Q
It is not a sign of frontal lobe function impairment:
a. pathological test according to Luria
b. concrete interpretation of proverbs
c. perseveration
d. primitive reflexes present
e. neologisms
A
e. neologisms
14
Q
What is not typical of cerebellar palsy?
a. festination
b. ataxia of walking
c. tremor
d. nystagmus
A
a. festination
15
Q
Which sign would be expected in a left hemisphere tumour at the convexity of
the parietal lobe?
a. apraxia of dress
b. hypaesthesia and hypalgesia of the left lower limb
c. agnosia of the fingers
d. left homonymous upper quadrantopsy
e. sensory extinction phenomenon right
A
c. agnosia of the fingers
16
Q
The lesion in the left medial longitudinal fascicle will appear as:
a. the adduction of the right eye will be disturbed when looking to the left, and
nystagmus will appear on the left eye when abducting
b. the adduction of the left eye will be disturbed when looking to the
right, and nystagmus will occur in the right eye when abducting
A
b. the adduction of the left eye will be disturbed when looking to the
right, and nystagmus will occur in the right eye when abducting
17
Q
Dysarthria and hemiparesis on the right. What is defective?
a. cerebral grey
A
a. cerebral grey
18
Q
. Images of defective sensation in the same place as in ulnaris. Where is the lesion
most proximal?
a. wrist
b. The elbow
c. root C8
A
b. The elbow
19
Q
. What fibres carry sensations of proprioception and vibration to the brain?
a. thin myelinated sensory fibres
b. thick myelinated sensory fibres
c. thick unmyelinated sensory fibres
d. thin unmyelinated sensory fibres
A
b. thick myelinated sensory fibres
20
Q
. Connect:
A. dorsolateral prefrontal cortex
B. premotor cortex
C. putamen
D. fusiform gyrus
E. angular gyrus
1 . face recognition
2 . automatic movements
3 . movement planning
4 . working memory
5 . finger recognition
A
b. A4, B3, C2, D1, E5
21
Q
https://youtu.be/y-keNcCMo6Y
Where is the lesion?
a. upper mesencephalon
b. inferior mesencephalon
c. Pons
d. lower part of the medulla oblongata
A
c. Pons
22
Q
A 72-year-old patient walks with short steps, slipping and sliding. He is least likely to
have:
a. polyneuropathy
b. Parkinsonism
c. normotensive hydrocephalus
d. many small heart attacks in the whites
e. Parkinsonism plus
A
a. polyneuropathy
23
Q
The cockerel’s walk occurs in weakness:
a. plantar flexors of the ankle
b. dorsal ankle flexors
c. extensor knees
d. pelvic muscles
A
b. dorsal ankle flexors
24
Q
Cock’s walk occurs when:
a. defects of the n. peroneus
b. L5 spinal cord segment defect
c. distal muscular atrophy
d. all of the above
A
d. all of the above
25
. For walking in neurological patients, everything applies
except:
a. is an important part of the neurological examination
b. some diseases can be identified from the way you walk
c. walking is affected relatively late in the course of the disease in patients
with normotensive hydrocephalus
d. Parkinson's patients walk hunched forward, with shorter steps on a narrow
base, with their arms less able to follow their gait
e. the examination looks at the width of the base of the gait, symmetry,
length of steps, hand tracking, specific gait patterns characteristic of the
impairment of particular structures
c. walking is affected relatively late in the course of the disease in patients
with normotensive hydrocephalus
26
Cerebellar gait is characterised by:
a. walking on a wide base
b. festination
c. steps of different lengths
d. gait imbalance
a. walking on a wide base
27
Palhipaesthesia and lack of awareness of joint position are expected in someone with s/z:
a. Positive Romberg
b. marche a petits pas
c. cock-walking
d. walking with a shuffle
a. Positive Romberg
28
Which of the following patients is most likely to have a loss of sensation of
vibration and position of the joints in their feet?
a. cock-walking patient
b. patient with marche a petit pas
c. patient with positive Romberg's sign
d. patient with plantar response in extension
e. patient with vertigo and nystagmus
c. patient with positive Romberg's sign
29
Who will not know the position of the decisions?
a. patient with a positive Romberg test
a. patient with a positive Romberg test
30
Walking on X occurs because:
a. cerebellar malformations
b. spastic paraparesis
c. polyneuropathies
d. myopathy
b. spastic paraparesis
31
What is the cause of walking on X?
a. increased adductor tone.
a. increased adductor tone.
32
Peroneal walking will be found in:
a. peroneal nerve damage
b. L4 and L5 root defects
c. upper motor neuron damage
d. anterior tibial nerve palsy
a. peroneal nerve damage
b. L4 and L5 root defects
33
https://www.youtube.com/watch?v=eBvzFkcvScg. The defect is in:
a. the little brain
b. basal ganglia
c. subcortical whites
d. n. peroneus communis
a. the little brain
34
https://www.youtube.com/watch?v=kAiIfulpYzU. It's about:
a. marche a petit pas
b. atactic walking
c. Parkinsonian gait
d. rocking walk
b. atactic walking
35
https://www.youtube.com/watch?v=j86omOwx0Hk. It is about:
a. marche a petit pas
b. atactic walking
c. Parkinsonian gait
d. rocking walk
c. Parkinsonian gait
36
https://www.youtube.com/watch?v=y160w4sAQNw. It's about:
a. rocking walk
b. hemiplegic walking
c. atactic walking
d. cock-walking
b. hemiplegic walking
37
Extrapyramidal dysarthria is characterised by:
a. quiet, monotone speech
b. chanted speech
c. nasal speech
d. pseudobulbar language
a. quiet, monotone speech
38
Dysarthria is a sign of failure:
a. the little brain
b. basal ganglia
c. facial nerve
d. missing teeth
e. all of the above
e. all of the above
39
The sequence of multi-digit numbers is used to find out:
a. attention
b. computing
c. Repetition
d. memory
a. attention
40
A patient with cognitive decline drew the clock completely wrong. What is it?
a. anozognosia
b. neglect syndrome
c. structural apraxia
d. agraphia
c. structural apraxia
41
A patient who is unable to draw a clock will have a normal defect:
a. dominant parietal lobe
b. non-dominant parietal lobe
c. of a dominant frontal lobe
d. non-dominant frontal lobe
b. non-dominant parietal lobe
42
The patient does not understand
speech, speaks spontaneously, uses
neologisms and may repeat. It is most
likely:
a. Broca's aphasia
b. Wernicke's aphasia
c. transcortical motor aphasia
d. transcortical sensory
aphasia
e. conductive aphasia
d. transcortical sensory
aphasia
43
A 55-year-old man arrives at the clinic
with his wife. Five hours ago, he was
confused, repeating "What's going on?".
At the moment, he is doing fine on
examination, we do not notice any
peculiarities, he does not remember that
period. What did he have?
a. TIA
b. ischaemic stroke
c. transient global amnesia
c. transient global amnesia
44
Which aphasia is found in a patient who
cannot repeat, understands normally
and speaks fluently?
a. Broca's aphasia
b. Wernicke's aphasia
c. transcortical motor aphasia
d. transcortical sensory
aphasia
e. conductive aphasia
e. conductive aphasia
45
In Wernicke's aphasia, he is affected:
a. frontal lobe of the dominant hemisphere
b. dominant hemisphere temporal lobe
c. frontal lobe of the nondominant hemisphere
d. shadow lobe of the nondominant hemisphere
b. dominant hemisphere temporal lobe
46
The patient has Wernicke's aphasia, what else does he have?
a. right upper quadrant
b. left upper quadrant
c. right lower quadrantopsy
d. left lower quadrantopsy
a. right upper quadrant
47
What is not a cortical disorder:
a. aphasia
b. agnosia
c. apraxia
d. agraphia
e. Dysphonia
e. Dysphonia
48
A patient with laryngitis will have:
a. Dysphonia
b. disarthria
c. aphasia
a. Dysphonia
49
The patient speaks and pronounces normally, understands everything, repeats what aphasia is like:
a. Brock's aphasia
b. Wernicke's aphasia
c. conductive aphasia
d. transcortical aphasia
e. no answer is correct
e. no answer is correct
49
What's wrong with transcortical sensory aphasia?
a. the patient may repeat the words
b. the arcuate bundle is defective
c. the patient speaks fluently
d. the patient does not understand speech
b. the arcuate bundle is defective
49
The gentleman has not been able to dress himself for some time. It's about:
a. ideomotor apraxia
b. Ideation apraxia
c. apraxia of dress
d. structural apraxia
Where is the lesion?
e. dominant parietal
f. non-dominant parietal
g. Frontal
c. apraxia of dress
f. non-dominant parietal
49
Trader denies sensory loss down the left arm, what is it?
a. Anton syndrome
b. anozognosia
c. sensory extinction
d. all of the above
e. none of the above
b. anozognosia
50
Which structure is characteristic of conductive aphasia?
a. cingulum
b. fornicum
c. the arcuate fascicle
d. of the corpus callosum
e. Broca's area
c. the arcuate fascicle
51
What do we call a disorder of skilled movements?
a. ataxia
b. apraxia
c. atony
d. akinesia
b. apraxia
52
https://www.youtube.com/watch?v=hHo-y7WJIlU. Where is the fault?
a. left parietal
b. right parietal
c. left occipital
d. right occipital
b. right parietal
53
A video of an elderly patient who kept repeating certain words. Most likely
diagnosis:
a. Gilles de la Tourette syndrome
b. Dementia
c. transcortical aphasia
c. transcortical aphasia
54
The patient cannot read the map. Where is the malfunction?
a. dominant frontal cortex
b. dominant parietal cortex
c. non-dominant frontal cortex
d. non-dominant parietal cortex
d. non-dominant parietal cortex
55
The patient does not recognise himself in the mirror. What do we call this?
a. anosognosia
b. prosopagnosia
c. haemisomatoagnosia
d. Stereoagnosia
Where is the defect?
e. non-dominant parietal cortex
f. dominant parietal cortex
g. dominant frontal cortex
h. fusiform gyrus
b. prosopagnosia
h. fusiform gyrus
56
A medical student takes a drink in a crawl space. What will be present?
a. Dysphasia
b. dysarthria
c. Dysphonia
Where is the disruption?
d. frontal cortex
e. Little Brains
f. lower cranial nerves
b. dysarthria
e. Little Brains
57
Which aphasia is characterised by neologisms?
a. for Wernicke's aphasia
b. for Broca's aphasia
c. for global aphasia
d. for conductive aphasia
a. for Wernicke's aphasia
58
How many right-handed people are left hemisphere dominant for speech?
a. 30%
b. 70%
c. 90%
d. 99%
e. the left hemisphere is never dominant for speech
d. 99%
59
The left hemisphere is dominant in left-handed people. v
a. 10%
b. 30%
c. 50%
d. 70%
d. 70%
60
The characteristics of locked-in syndrome are:
a. defect in the ventral pons
b. defect in the ventral medulla
c. okara in the mesencephalon
d. the patient is able to make vertical eye movements
e. the reticular formation is intact
a. defect in the ventral pons
d. the patient is able to make vertical eye movements
e. the reticular formation is intact
61
GCS in a patient who opens his eyes to pain, responds unintelligibly and
localises the pain will be
a. 0
b. 3
c. 6
d. 9
e. 12
d. 9
62
A patient who opens his eyes to pain, mumbles unintelligible words and responds
to pain with an extensor will have a GCS:
a. 0
b. 3
c. 6
d. 9
e. 12
c. 6
63
.An object is placed in the patient's hands and, with the eyes closed, the patient does
not recognise it. It is:
a. anosognosia
b. prosopagnosia
c. hemisomatoagnosia
d. stereoagnosia
d. stereoagnosia
64
The fluid will leak at the corner of the patient's mouth, making it difficult to pronounce
the syllable:
a. Bye, bye, bye
b. Ta, ta, ta
c. That, that, that
d. La, la, la, la
a. Bye, bye, bye
65
The first clinical sign of CN III failure due to uncus herniation is:
a. ptosis ipsilateral
b. ptosis contralateral
c. wide and unresponsive pupil ipsilaterally
d. wide and unresponsive pupil contralaterally
c. wide and unresponsive pupil ipsilaterally
66
Which reflex is least appropriate when assessing an unconscious patient?
a. zenic reactions
b. Masseter reflex
c. corneal reflex
d. pharyngeal reflex
b. Masseter reflex
67
A patient with a left abducens defect will have his head moved to:
a. left
b. right
c. Up
d. down
a. left
68
What kind of visual field loss is expected in a patient with a pituitary adenoma:
a. monocular central scotoma
b. bitemporal haemianopsia
c. homonymous hemianopsia
d. homonymous quadrantopsy
b. bitemporal haemianopsia
69
A patient who has food and drink leaking out of his nose will find it difficult to
pronounce a syllable:
a. la
b. has
c. that
d. See
c. that
70
Thomas Mann observed in the demented Adrian Leverkuhn's novel Doctor Faustus
that the pupils were not properly round, but rather dilated, not reacting to the light,
which speaks for:
a. Hutchinson's pupil
b. The Marcus-Gunn phenomenon
c. pupillotony (Adie's pupil)
d. Argyll-Robertson pupil
d. Argyll-Robertson pupil
71
Which nerve is damaged in the picture?
(man has left eye looking down and outwards)
a. Oculomotor impairment
b. Horner's syndrome
c. abducens malformation
d. trochlear defect
a. Oculomotor impairment
72
IMAGE - a tongue deviating to the left. Where is the defect?
a. n. hypoglossus left
b. n. hypoglossus right
c. n. trigeminus right
d. n. trigeminus left
a. n. hypoglossus left
73
Left abducens paresis is characterised by:
a. no double image when looking to the right
b. double image when looking to the left, image divided vertically
c. double image when looking to the left, when the right eye is covered, the inner
image remains
a. no double image when looking to the right
74
Internuclear ophthalmoplegia is characterised by:
a. inability to look up and nystagmus
b. abduction incompetence and pendular nystagmus of the ipsilateral eye
c. inability to adduct one eye and nystagmus in the other eye
d. inability to look down and pendular nystagmus
e. inability to accommodate and pendular nystagmus of the opposite eye
c. inability to adduct one eye and nystagmus in the other eye
75
Rapid oscillations of the eyeballs in all directions are called:
a. opsoklonus
b. nystagmus
c. oscillopsia
d. Ocular myorhythmia
a. opsoklonus
76
Homonymous haemianopsia is obtained in lesions:
a. optical tract
b. n. opticusa
c. optical chiasmas
d. Retinas
a. optical tract
77
In an oculomotor lesion, the eyeball is looking at the eyeball:
a. up and out
b. down and out
c. up and in
d. down and in
b. down and out
78
IMAGE: patient looking to the right, left eye is worse turned to the right. It is a brain
nerve defect:
a. III
b. IV
c. V
d. VI
e. VII
a. III
79
In Horner's syndrome:
a. ptosis, miosis, monophthalmos, anhidrosis
b. ptosis, mydriasis, exophthalmos, anhidrosis
c. miosis, monophthalmos, anhidrosis
d. mydriasis, monophthalmos, anhidrosis
a. ptosis, miosis, monophthalmos, anhidrosis
80
Marcus-Gunn:
a. alternating illumination causes the affected pupil to constrict
b. alternating illumination causes the affected pupil to dilate
c. when the unaffected pupil is illuminated, both pupils constrict symmetrically
b. alternating illumination causes the affected pupil to dilate
81
When does hyperacusis occur?
a. in case of a CN VII defect
b. in CN VIII failure
c. in case of CN X failure
a. in case of a CN VII defect
82
For paresis of the left n. abducens:
a. double image at rest
b. double image when looking to the left, normal at rest
c. the double image disappears when looking to the right
c. the double image disappears when looking to the right
83
Cerebral nerve III palsy, where do the eyes go?
a. outwards and downwards
b. outwards and upwards
c. inwards and downwards
d. inwards and upwards
e. outside
a. outwards and downwards
84
Olfactory hallucinations occur in:
a. temporal lobe epilepsy
b. Dementia
a. temporal lobe epilepsy
85
One type first facial paresis, then hearing loss, then absent corneal reflex. No
abduction of the eye possible. All symptoms on the right. Where is the lesion?
a. cerebropontine as
b. in the facialis canal
c. on top of the pars petrosa of the
iris
Which optic nerve is damaged in this
patient?
d. III
e. IV
f. VI
a. cerebropontine as
f. VI
86
Where does negative myoclonus occur?
a. a few types of encephalopathy, none of the above,
b. epilepsy
b. epilepsy
87
In which case the facial nerve is not affected:
a. sarcoidosis
b. neuroborreliosis
c. Guillan-Barre syndrome
d. CIDP
e. Ramsay-Hunt syndrome
None
88
Ptosis is not here:
a. Bell's palsy
b. myasthenia gravis
c. oculopharyngeal muscular dystrophy
d. Wallenberg syndrome
e. myotonic dystrophy
a. Bell's palsy
| But actually Bell's Palsy presents with ptosis, so I don't really know i
89
We do not test for anosmia in:
a. Alzheimer's disease
b. Head injuries
c. Parkinson's disease
d. Multiple sclerosis
e. Frontotemporal dementia
d. Multiple sclerosis
| MS affects the axons in CNS, not peripheric, only optic nerve involved
90
What is not found in facial dysfunction?
a. lacrimation disorders
b. hearing impairment
c. taste disturbances
d. salivation disorders
e. all of the above are found in facialis defects
e. all of the above are found in facialis defects
91
How is the clinical muscle examination performed?
a. inspection, active mobility, passive mobility, tone, strength, reflexes
b. inspection, passive mobility, active mobility, tone, power, reflexes
c. Inspection with active mobility, passive, tone, power reflexes
d. Inspection with active mobility, tone, power, reflexes, passive mobility only
if active mobility is not perfect
a. inspection, active mobility, passive mobility, tone, strength, reflexes
92
What do we test for in the Froment test?
a. n. ulnaris and adduction of the thumb
b. n. ulnaris and opposition of the thumb
c. n. medianus and adduction of the thumb
d. n. medianus and opposition of the thumb
a. n. ulnaris and adduction of the thumb
93
Which muscle is responsible for knee extension?
a. m. quadriceps femoris
b. m. iliopsoas
c. m. biceps femoris
d. m. gluteus medius
a. m. quadriceps femoris
94
Which muscles retain function in a quadriplegic patient with C4 level injury?
a. deltoideus in biceps
b. triceps and anconeus
c. sternocleidomastoid and trapezius
d. supinator
e. dorsal and palmar interosseous muscles
c. sternocleidomastoid and trapezius
95
The biceps reflex includes:
a. spinal segment C6 and n. musculocutaneus
b. spinal cord segment C6 and n. medianus
c. C7 spinal segment and n. musculocutaneus
d. C7 spinal segment and n. medianus
a. spinal segment C6 and n. musculocutaneus
96
A hanging arm indicates a malfunction:
a. n. radialis
b. n. ulnaris
c. n. medianus
d. n. musculocutaneus
a. n. radialis
97
What we don't observe when inspecting muscles:
a. fasciculations
b. fibrillation
c. myoclonus
d. myokimi
b. fibrillation
98
What does the L4 dermatome correspond to?
a. lateral tibia
b. medial shin
c. the back of the foot
d. sole
b. medial shin
99
Which muscles of the arm are not
affected in C7 defects?
a. deltoid and biceps
b. triceps and brachioradialis
c. dorsal interossei and brachialis
d. deltoid in flexor digitorum longus
a. deltoid and biceps
100
The clawed hand occurs in:
a. a blow to the elbow
b. carpal tunnel syndrome
c. humerus fracture
a. a blow to the elbow
101
Which muscle belongs to the L5 myotome?
a. tibialis anterior
b. quadriceps femoris
c. soleus
d. gastrocnemius
a. tibialis anterior
102
What is the difference between a peroneal injury and an L5 injury?
a. the defects cannot be clinically distinguished
b. dorsal foot flexion is impaired in peroneal defects, but not in L5 defects
c. peroneal impairment results in impaired foot eversion, L5 impairment does not
d. in peroneal defects inversion is preserved, but not in L5 defects
d. in peroneal defects inversion is preserved, but not in L5 defects
103
Paraplegia, sensory loss is from the nipples down, where is the level of impairment?
a. C7
b. Th2
c. Th4
d. Th8
c. Th4
104
triceps reflex elicitation demonstrated. What are we testing?
a. N. radialis, C7
b. N. radialis, C8
c. N. musculocutaneus, C7
d. N. musculocutaneus, C8
e. N. axillaris, C7
a. N. radialis, C7
105
It revitalises the serratus anterior muscle:
a. n. thoracicus longus
b. n. axillaris
c. n. radialis
d. nn. intercostales
a. n. thoracicus longus
106
Which of the following is a negative motor symptom?
a. weakness
b. fasciculations
c. cramps
d. myokimia
e. tremor
a. weakness
107
Atrophy of the 1st dorsal interosseus, indicating a defect of which spinal
cord segment?
a. C5
b. C7
c. Th1
c. Th1
108
The patient can only bend the arm at the elbow if gravity is relieved. What is the
MRC assessment of muscle strength?
a. 0
b. 1
c. 2
d. 3
e. 4
f. 5
c. 2
109
Increased tone and loss of vibration
sensation in the right lower limb,
hypoalgesia in the left lower limb, upper
limbs unaffected. Where is the lesion?
a. in the frontal lobe on the left
b. in the central grey of
the cervical spinal cord
c. defect of the right half of
the lumbar spinal cord
d. left lumbar spinal cord
hemiplegia
c. defect of the right half of
the lumbar spinal cord
110
Failure of the sympathicus results in:
a. tachycardia
b. bronchodilatation
c. pupil constriction
d. gastroparesis
c. pupil constriction
111
The simplest test to prove an autonomic nervous system disorder?
a. blood pressure measurement standing and lying down
b. sympathetic skin reaction
c. measurement of the amount of sweat excreted
a. blood pressure measurement standing and lying down
112
Via β2 receptors, the sympathetic pathway causes:
a. bronchoconstriction
b. increase in heart rate
c. speeding up peristalsis
d. pupil constriction
e. none of the above
e. none of the above
113
Activation of β2 receptors results in:
a. Heart rate drop
b. Peripheral vasoconstriction
c. Lipid breakdown
d. Bronchial dilatation
e. None of the above
d. Bronchial dilatation
114
What do α1 -adrenergic receptors do?
a. peripheral vasoconstriction
b. bronchial dilatation
c. bronchial constriction
d. increase in heart rate
e. pupil constriction
a. peripheral vasoconstriction
115
Mark the correct statement about the autonomic nervous system:
a. sympathetic fibres have only long preganglionic fibres
b. the sympathetic has only long poganglion fibres
c. the sympathetic has ganglia close to the targets
d. in the sympathetic synapse, the only carrier is acetylcholine
e. the only carrier between the postganglionic neuron and the muscle is
acetylcholine
b. the sympathetic has only long poganglion fibres
116
What do the sympathetic and parasympathetic nerves have in common?
a. both have generally long preganglionic fibres
b. in both, acetylcholine is the only neurotransmitter between
preganglionic and postganglionic fibres
c. in both, acetylcholine is the only neurotransmitter secreted by
postganglionic fibres
d. both have ganglia mainly along the spine
b. in both, acetylcholine is the only neurotransmitter between
preganglionic and postganglionic fibres
117
Activation of β1 receptors results in:
a. increased heart rate
b. contraction of skeletal muscles
c. bronchial dilation
d. lipolizo
a. increased heart rate
118
Activation of the parasympathetic leads to
a. bronchial dilation
b. bronchoconstriction
c. pupil dilation
d. lipolizo
b. bronchoconstriction
119
What applies to postganglionic parasympathetic fibres:
a. are long, unmyelinated and secrete acetylcholine
b. are long, myelinated and secrete acetylcholine
c. are short, non-myelinated and secrete acetylcholine
d. are short, myelinated and secrete acetylcholine
c. are short, non-myelinated and secrete acetylcholine
120
Caused by a sympathiser:
a. piloerection
b. vasoconstriction
c. bradikadijo
d. tachycardia
e. a+b+c
f. a+b+d
g. b+c+d
f. a+b+d
121
Compared to the somatic system, the autonomic nervous system is
a. more responsive, more diffuse
b. slower reacting, more diffuse
c. slower reacting, limited
d. more responsive, limited
b. slower reacting, more diffuse
122
For the parasympathetic system:
a. has paraspinal ganglia
b. postganglionic neurons are usually long
c. postganglionic neurons tend to be short
d. dopamine is the carrier between pre- and postganglionic neurons
e. between the postganglionic neuron and the effector, the carrier is dopamine
c. postganglionic neurons tend to be short
123
Which of the following is caused by parasympathetic activation?
a. piloerection
b. increased heart rate
c. bronchoconstriction
d. reduced saliva secretion
e. increased gastrointestinal motility
c. bronchoconstriction
e. increased gastrointestinal motility
124
Which process is least likely to cause symptoms that last for years?
a. degenerative
b. Hereditary
c. congenital
d. neoplasm
d. neoplasm
125
A 22-year-old female diver with cervical spine injury and sudden tetraparesis, who
improves rapidly after a few weeks. What do you find after 12 months?
a. flaccid parezo
b. hyporeflection
c. spastic paresis
d. fasciculations
e. fibrillations
c. spastic paresis
126
A 35-year-old gentleman presents with pain right behind the ear lasting 3 days, which
started after a short cold a few days earlier. On the day of the examination, he
notices that the right side of his face is strange, it is difficult to close his eye and his
mouth is asymmetrical. On examination, the forehead does not wrinkle, the eye does
not close, it is red, the right angle of the mouth does not move when laughing, the
right corneal reflex is less provocative. The gentleman is most likely to have:
a. ischaemic stroke in the left middle cerebral artery
b. Bell's paresis on the right
c. headache in raphalas
d. stroke in the right brainstem
e. migraine headache
b. Bell's paresis on the right
127
Non-neurological manifestations of Friedreich's ataxia:
a. cataracts
b. cardiomyopathy
c. chronic renal failure
d. diabetes mellitus
e. liver disease
b. cardiomyopathy
d. diabetes mellitus
128
Where do we get the most acute symptoms?
a. vascular aetiology
b. degenerative aetiology
c. inflammatory aetiology
a. vascular aetiology
129
Which patient showed us the importance of the hippocampus?
a. Phineas Gage
b. H. M.
c. Lou Gehrig
d. Woody Allen
e. Alois Alzheimer
b. H. M.
130
When is spasticity most likely to occur after a medulla spinalis lesion at Th12
level?
a. 2-3 weeks after injury
b. 3 months after injury
c. 3 days after injury
d. 6 months after injury
e. 9-12 months after injury
a. 2-3 weeks after injury
131
A 16-year-old patient in the waiting room has a black eye, falls on the floor, a mild
clonus is visible, does not bite her tongue, does not spit, and is soon conscious.
What has she experienced?
a. TIA
b. epileptic seizure
c. syncope
d. acute dizziness
c. syncope
132
A 78-year-old woman has had progressive walking problems for 2 years. She has no
pain. She feels pain and temperature changes from the navel downwards. On the left
the reflexes are brisk and the plantar response is in extension, on the right there are
no reflexes. Which investigation would you do?
a. MRI of the head
b. MRI of the cervical spine
c. MRI of the thoracic spine
d. MRI of the lumbar
spine What is most likely?
e. primary brain tumour
f. metastasis in the vertebral body
g. meningeom
h. chronic discitis
c. MRI of the thoracic spine
g. meningeom
133
A 65-year-old woman with long-standing diabetes comes for a check-up because of
severe pain in her left thigh. On examination, there is atrophy of the thigh muscles,
coarse muscle strength is reduced in left hip flexion and left knee extension
(femoralis), and the left patellar reflex is less well elicited. Which statement is false:
a. most likely diabetic polyneuropathy
b. it could be Bannwarth's syndrome, so we need to rule out Lyme
disease infection
c. it might be worth trying to relieve your pain with an antidepressant
d. careful monitoring and management of diabetes is essential
e. most likely neuralgic amyotrophy
e. most likely neuralgic amyotrophy
| Not most likely!
134
What is most likely to cause right-sided hemiparesis after 3 weeks?
a. TIA
b. subdural haematoma
c. brain tumour
d. cerebral palsy
b. subdural haematoma
135
What doesn't happen in the early stages of spinal shock?
a. signs of upper motor neuron damage
b. signs of lower motor neuron damage
c. muscle weaknesses
a. signs of upper motor neuron damage
136
In a patient with transtentorial uncal herniation, we will find:
a. Wide non-reactive pupil on the opposite side from the herniation with
contralateral hemiplegia and quantitatively reduced awareness.
b. Wide non-reactive pupil on the side of the herniation with
contralateral hemiplegia and quantitatively reduced
consciousness.
c. Bilaterally non-reactive wide pupils with contralateral hemiplegia and
quantitatively reduced awareness.
d. Paraplegia, incontinence and quantitatively reduced consciousness.
e. The pupil on the side of the herniation reacts to light but not to convergence.
b. Wide non-reactive pupil on the side of the herniation with
contralateral hemiplegia and quantitatively reduced
consciousness.
137
The patient has left-facing eyeballs and paretic right limbs. What is true for the
site/nature of the defect?
a. loss of left frontal lobe function
b. impairment of horizontal vision in the pons
c. it is internuclear ophthalmoplegia
d. overactivity in the left frontal lobe
e. psychogenic, as the signs are not anatomically compatible
a. loss of left frontal lobe function
138
In a patient with MS, we found a worsening of the left visual field. What
can we conclude?
a. Visual field loss, without abnormal pupil
b. The pupil on the defective side dilates when illuminated, as
confirmed by the Marcus-Gunn phenomenon.
c. The pupil on the uncorrupted side dilates when illuminated, confirming
the Marcus-Gunn phenomenon.
d. When the two pupils are illuminated alternately, their blinking is
seen, confirming the Marcus-Gunn phenomenon.
b. The pupil on the defective side dilates when illuminated, as
confirmed by the Marcus-Gunn phenomenon.
139
What is not found in non-dominant parietal disorder?
a. finger agnosias
b. anozognosia
c. apraxia of dress
d. structural apraxia
a. finger agnosias
140
What do we call pain from non-painful stimuli?
a. allodynia
b. hyperalgesia
c. hyperpathy
d. analgesia
a. allodynia
141
One comes into the clinic and can't remember anything for the last two hours, keeps
asking
"What happened?" Then he stops repeating the question, he's with himself, but he
doesn't remember the last two hours. It's about:
a. TIA
b. transient global amnesia
c. conductive aphasia
d. epileptic seizure
b. transient global amnesia
142
Vertebrobasilar ischaemia, what doesn't go with it:
a. diplopia
b. dysarthria
c. nystagmus
d. ataxia
e. Dysphasia
e. Dysphasia
143
Mixed transcortical aphasia is caused by:
a. atrophy of the medial temporal lobus
a. atrophy of the medial temporal lobus
144
A woman with ataxia and diplopia and nystagmus, eventually confusion sets in:
a. alcoholic.
a. alcoholic.
145
The gentleman had ataxia of one half of the body, dysarthria, Horner's syndrome
on the same side, loss of strength on one side, vertigo, nystagmus, loss of
sensation of pain and temperature on one side of the body and the opposite side
of the face. Which syndrome is it?
a. PICA, Wallenberg syndrome
a. PICA, Wallenberg syndrome
146
Vertical gaze palsy occurs in which of the following diseases?
a. multiple sclerosis
b. Parkinson's disease
c. Alzheimer's disease
a. multiple sclerosis
147
Holmes-Adie syndrome is characterised by:
a. Tonic pupil
b. Hyporeflexia
c. Sweating disorders
d. Part of the symptoms can be explained by a defect in the ciliary ganglion
a. Tonic pupil
b. Hyporeflexia
c. Sweating disorders
d. Part of the symptoms can be explained by a defect in the ciliary ganglion
148
Diagnosis of peripheral nerve involvement is aided by:
a. Tinel's sign
b. The Gowers sign
c. Lehrmitt's sign
d. The Babinski sign
a. Tinel's sign
149
What is cataplexy?
a. The patient loses consciousness and falls.
b. The patient loses postural tone when fully conscious and falls.
c. The patient loses consciousness due to hyperventilation.
d. The patient falls asleep several times during the day in inappropriate situations.
b. The patient loses postural tone when fully conscious and falls.
150
How many lesions does a patient with sensory aphasia and upper quadrant aphasia
have at least?
a. 1 lesion
b. 2 lesions
c. 3 lesions
d. 4 lesions
e. 5 lesions
a. 1 lesion
151
A patient with hemiplegia and paresis of all facial muscles on the other side of the
face - where is the problem:
a. spinal cord
b. Brainstem
c. motor cortex
d. peripheral nerves
b. Brainstem
152
If the gentleman has hemiparesis on the left and deviation of the eyeballs to the left,
where is the defect?
a. right frontal grille
b. Right Pons
c. medial longitudinal fascicle
d. epilepsy in the frontal lobe
e. it is a functional disorder
b. Right Pons
153
Male with atrophy of the anterior tibialis tibialis, plantar response in extension,
what is the probable diagnosis?
a. defect of n. peroneus communis
b. amyotrophic lateral sclerosis
c. L5 radiculopathy
d. infarction in the a. cerebri anterior
b. amyotrophic lateral sclerosis
| Signs of UM and LM lesions
154
A man was drawn who was supposed to have a puncture wound on Th6, it was
necessary to circle the right key for the colours with which the distribution of the loss
of sensation is painted:
a. pain
b. loss of feelings
c. vibration
d. palanesthesia
e. spasticity
?
155
A woman has reduced acuity in one eye and scotoma, and tingling or paresis down
her legs. How many lesions does she have at least?
a. 1
b. 2
c. 3
d. 4
b. 2
156
A man has haemiparesis over his trunk and paresis of all facial muscles on one half.
How many lesions at least?
a. 1
b. 2
c. 3
b. 2
157
Features of horizontal-rotatory nystagmus
a. Latency and exhaustion
b. Latency-free and with exhaustion
c. With latency and without exhaustion
d. No latency and no exhaustion
a. Latency and exhaustion
158
Which neurological problems are most commonly encountered by primary care
physicians?
a. Parkinson's disease
b. Multiple sclerosis
c. Alzheimer's disease
d. none of the above
d. none of the above
159
Activation of the parasympathetic arm of the autonomic nervous system causes:
a. Increased mucus secretion from the nasal mucosa
a. Increased mucus secretion from the nasal mucosa
160
What do the parasympathetic and sympathetic systems have in common?
a. In all synapses between preganglionic and postganglionic neurons,
the neurotransmitter acetylcholine
a. In all synapses between preganglionic and postganglionic neurons,
the neurotransmitter acetylcholine
161
A patient has both papillae pale on fundoscopy. He reports tingling in the left lower
limb. The status additionally includes brisk reflexes and an extensor plantar
response. How many lesions does he have?
a. 1
b. 2
c. 3
d. 4
e. diffuse nerve damage
c. 3
162
Picture of one twisted leg (let's say to identify a dog cavus), the owner has the legs:
a. ataxic
b. polyneuropathy
a. ataxic
163
How would I distinguish papillitis from papililedema?
a. light reflex
b. eyeball movements
c. reduced field of vision
d. altered visual acuity
d. altered visual acuity
164
. Oculocephalic reflex: in a healthy patient, when the head moves to the left, the
eyes move to the
a. left
b. right
c. Up
d. down
b. right
165
What is not compatible with retained consciousness?
a. aphasia
b. typical absenteeism
c. transient global amnesia
d. cataplexy
e. dislocated consciousness syndrome
b. typical absenteeism
166
What is the screening for a comatose patient?
a. eyes found closed
b. identify the patient's day-night rhythm
c. brain death is detected
d. the degree of impaired consciousness is assessed by fMRI
e. there is never spontaneous breathing
a. eyes found closed
167
In which patient do we find non-responsiveness?
a. patient with GCS 12
b. a patient in status epilepticus with generalised tonic-clonic convulsions
c. comatose patient
d. deeply saddled
e. a patient with a large stroke in the brainstem area
a. patient with GCS 12
168
A 77-year-old lady has blindness in both eyes lasting several days and
severe asymmetric paraparesis with sensory level of the nipple. How many
lesions does she have?
a. 1
b. 2
c. 3
d. 4
e. diffuse nerve damage
c. 3
169
Damage to a neuron distally is called:
a. Wallerian degeneration
b. degeneration of the axon from the end backwards ('die back')
c. segmental demyelination
a. Wallerian degeneration
