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Neurology > Clinical Examination > Flashcards

Clinical Examination Flashcards

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

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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

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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

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4
Q

Where is the defect in Weber syndrome?
a. subthalamic core
b. mesencephalon
c. Pons
d. medulla oblongata

A

b. mesencephalon

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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

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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

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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

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8
Q

Dorsolateral medulla oblongata syndrome is:
a. Weber syndrome
b. Wallenberg syndrome
c. Benedict’s syndrome
d. Jackson syndrome

A

b. Wallenberg syndrome

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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

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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

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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

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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

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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

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14
Q

What is not typical of cerebellar palsy?
a. festination
b. ataxia of walking
c. tremor
d. nystagmus

A

a. festination

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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

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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

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17
Q

Dysarthria and hemiparesis on the right. What is defective?
a. cerebral grey

A

a. cerebral grey

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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

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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

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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

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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

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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

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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

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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

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25
Q

. 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

A

c. walking is affected relatively late in the course of the disease in patients
with normotensive hydrocephalus

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26
Q

Cerebellar gait is characterised by:
a. walking on a wide base
b. festination
c. steps of different lengths
d. gait imbalance

A

a. walking on a wide base

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27
Q

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

a. Positive Romberg

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28
Q

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

A

c. patient with positive Romberg’s sign

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29
Q

Who will not know the position of the decisions?
a. patient with a positive Romberg test

A

a. patient with a positive Romberg test

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30
Q

Walking on X occurs because:
a. cerebellar malformations
b. spastic paraparesis
c. polyneuropathies
d. myopathy

A

b. spastic paraparesis

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31
Q

What is the cause of walking on X?
a. increased adductor tone.

A

a. increased adductor tone.

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32
Q

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

a. peroneal nerve damage
b. L4 and L5 root defects

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33
Q

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

a. the little brain

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34
Q

https://www.youtube.com/watch?v=kAiIfulpYzU. It’s about:
a. marche a petit pas
b. atactic walking
c. Parkinsonian gait
d. rocking walk

A

b. atactic walking

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35
Q

https://www.youtube.com/watch?v=j86omOwx0Hk. It is about:
a. marche a petit pas
b. atactic walking
c. Parkinsonian gait
d. rocking walk

A

c. Parkinsonian gait

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36
Q

https://www.youtube.com/watch?v=y160w4sAQNw. It’s about:
a. rocking walk
b. hemiplegic walking
c. atactic walking
d. cock-walking

A

b. hemiplegic walking

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37
Q

Extrapyramidal dysarthria is characterised by:
a. quiet, monotone speech
b. chanted speech
c. nasal speech
d. pseudobulbar language

A

a. quiet, monotone speech

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38
Q

Dysarthria is a sign of failure:
a. the little brain
b. basal ganglia
c. facial nerve
d. missing teeth
e. all of the above

A

e. all of the above

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39
Q

The sequence of multi-digit numbers is used to find out:
a. attention
b. computing
c. Repetition
d. memory

A

a. attention

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40
Q

A patient with cognitive decline drew the clock completely wrong. What is it?
a. anozognosia
b. neglect syndrome
c. structural apraxia
d. agraphia

A

c. structural apraxia

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41
Q

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

A

b. non-dominant parietal lobe

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42
Q

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

A

d. transcortical sensory
aphasia

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43
Q

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

A

c. transient global amnesia

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44
Q

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

A

e. conductive aphasia

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45
Q

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

A

b. dominant hemisphere temporal lobe

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46
Q

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

a. right upper quadrant

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47
Q

What is not a cortical disorder:
a. aphasia
b. agnosia
c. apraxia
d. agraphia
e. Dysphonia

A

e. Dysphonia

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48
Q

A patient with laryngitis will have:
a. Dysphonia
b. disarthria
c. aphasia

A

a. Dysphonia

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49
Q

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

A

e. no answer is correct

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49
Q

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

A

b. the arcuate bundle is defective

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49
Q

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

A

c. apraxia of dress
f. non-dominant parietal

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49
Q

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

A

b. anozognosia

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50
Q

Which structure is characteristic of conductive aphasia?
a. cingulum
b. fornicum
c. the arcuate fascicle
d. of the corpus callosum
e. Broca’s area

A

c. the arcuate fascicle

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51
Q

What do we call a disorder of skilled movements?
a. ataxia
b. apraxia
c. atony
d. akinesia

A

b. apraxia

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52
Q

https://www.youtube.com/watch?v=hHo-y7WJIlU. Where is the fault?
a. left parietal
b. right parietal
c. left occipital
d. right occipital

A

b. right parietal

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53
Q

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

A

c. transcortical aphasia

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54
Q

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

A

d. non-dominant parietal cortex

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55
Q

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

A

b. prosopagnosia
h. fusiform gyrus

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56
Q

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

A

b. dysarthria
e. Little Brains

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57
Q

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

a. for Wernicke’s aphasia

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58
Q

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

A

d. 99%

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59
Q

The left hemisphere is dominant in left-handed people. v
a. 10%
b. 30%
c. 50%
d. 70%

A

d. 70%

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60
Q

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

a. defect in the ventral pons
d. the patient is able to make vertical eye movements
e. the reticular formation is intact

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61
Q

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

A

d. 9

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62
Q

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

A

c. 6

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63
Q

.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

A

d. stereoagnosia

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64
Q

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

a. Bye, bye, bye

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65
Q

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

A

c. wide and unresponsive pupil ipsilaterally

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66
Q

Which reflex is least appropriate when assessing an unconscious patient?
a. zenic reactions
b. Masseter reflex
c. corneal reflex
d. pharyngeal reflex

A

b. Masseter reflex

67
Q

A patient with a left abducens defect will have his head moved to:
a. left
b. right
c. Up
d. down

A

a. left

68
Q

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

A

b. bitemporal haemianopsia

69
Q

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

A

c. that

70
Q

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

A

d. Argyll-Robertson pupil

71
Q

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

a. Oculomotor impairment

72
Q

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

a. n. hypoglossus left

73
Q

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

a. no double image when looking to the right

74
Q

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

A

c. inability to adduct one eye and nystagmus in the other eye

75
Q

Rapid oscillations of the eyeballs in all directions are called:
a. opsoklonus
b. nystagmus
c. oscillopsia
d. Ocular myorhythmia

A

a. opsoklonus

76
Q

Homonymous haemianopsia is obtained in lesions:
a. optical tract
b. n. opticusa
c. optical chiasmas
d. Retinas

A

a. optical tract

77
Q

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

A

b. down and out

78
Q

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

a. III

79
Q

In Horner’s syndrome:
a. ptosis, miosis, monophthalmos, anhidrosis
b. ptosis, mydriasis, exophthalmos, anhidrosis
c. miosis, monophthalmos, anhidrosis
d. mydriasis, monophthalmos, anhidrosis

A

a. ptosis, miosis, monophthalmos, anhidrosis

80
Q

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

A

b. alternating illumination causes the affected pupil to dilate

81
Q

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

a. in case of a CN VII defect

82
Q

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

A

c. the double image disappears when looking to the right

83
Q

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

a. outwards and downwards

84
Q

Olfactory hallucinations occur in:
a. temporal lobe epilepsy
b. Dementia

A

a. temporal lobe epilepsy

85
Q

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

a. cerebropontine as
f. VI

86
Q

Where does negative myoclonus occur?
a. a few types of encephalopathy, none of the above,
b. epilepsy

A

b. epilepsy

87
Q

In which case the facial nerve is not affected:
a. sarcoidosis
b. neuroborreliosis
c. Guillan-Barre syndrome
d. CIDP
e. Ramsay-Hunt syndrome

A

None

88
Q

Ptosis is not here:
a. Bell’s palsy
b. myasthenia gravis
c. oculopharyngeal muscular dystrophy
d. Wallenberg syndrome
e. myotonic dystrophy

A

a. Bell’s palsy

But actually Bell’s Palsy presents with ptosis, so I don’t really know i

89
Q

We do not test for anosmia in:
a. Alzheimer’s disease
b. Head injuries
c. Parkinson’s disease
d. Multiple sclerosis
e. Frontotemporal dementia

A

d. Multiple sclerosis

MS affects the axons in CNS, not peripheric, only optic nerve involved

90
Q

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

A

e. all of the above are found in facialis defects

91
Q

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

a. inspection, active mobility, passive mobility, tone, strength, reflexes

92
Q

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

a. n. ulnaris and adduction of the thumb

93
Q

Which muscle is responsible for knee extension?
a. m. quadriceps femoris
b. m. iliopsoas
c. m. biceps femoris
d. m. gluteus medius

A

a. m. quadriceps femoris

94
Q

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

A

c. sternocleidomastoid and trapezius

95
Q

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

a. spinal segment C6 and n. musculocutaneus

96
Q

A hanging arm indicates a malfunction:
a. n. radialis
b. n. ulnaris
c. n. medianus
d. n. musculocutaneus

A

a. n. radialis

97
Q

What we don’t observe when inspecting muscles:
a. fasciculations
b. fibrillation
c. myoclonus
d. myokimi

A

b. fibrillation

98
Q

What does the L4 dermatome correspond to?
a. lateral tibia
b. medial shin
c. the back of the foot
d. sole

A

b. medial shin

99
Q

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

a. deltoid and biceps

100
Q

The clawed hand occurs in:
a. a blow to the elbow
b. carpal tunnel syndrome
c. humerus fracture

A

a. a blow to the elbow

101
Q

Which muscle belongs to the L5 myotome?
a. tibialis anterior
b. quadriceps femoris
c. soleus
d. gastrocnemius

A

a. tibialis anterior

102
Q

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

A

d. in peroneal defects inversion is preserved, but not in L5 defects

103
Q

Paraplegia, sensory loss is from the nipples down, where is the level of impairment?
a. C7
b. Th2
c. Th4
d. Th8

A

c. Th4

104
Q

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

a. N. radialis, C7

105
Q

It revitalises the serratus anterior muscle:
a. n. thoracicus longus
b. n. axillaris
c. n. radialis
d. nn. intercostales

A

a. n. thoracicus longus

106
Q

Which of the following is a negative motor symptom?
a. weakness
b. fasciculations
c. cramps
d. myokimia
e. tremor

A

a. weakness

107
Q

Atrophy of the 1st dorsal interosseus, indicating a defect of which spinal
cord segment?
a. C5
b. C7
c. Th1

A

c. Th1

108
Q

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

A

c. 2

109
Q

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

A

c. defect of the right half of
the lumbar spinal cord

110
Q

Failure of the sympathicus results in:
a. tachycardia
b. bronchodilatation
c. pupil constriction
d. gastroparesis

A

c. pupil constriction

111
Q

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

a. blood pressure measurement standing and lying down

112
Q

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

A

e. none of the above

113
Q

Activation of β2 receptors results in:
a. Heart rate drop
b. Peripheral vasoconstriction
c. Lipid breakdown
d. Bronchial dilatation
e. None of the above

A

d. Bronchial dilatation

114
Q

What do α1 -adrenergic receptors do?
a. peripheral vasoconstriction
b. bronchial dilatation
c. bronchial constriction
d. increase in heart rate
e. pupil constriction

A

a. peripheral vasoconstriction

115
Q

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

A

b. the sympathetic has only long poganglion fibres

116
Q

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

A

b. in both, acetylcholine is the only neurotransmitter between
preganglionic and postganglionic fibres

117
Q

Activation of β1 receptors results in:
a. increased heart rate
b. contraction of skeletal muscles
c. bronchial dilation
d. lipolizo

A

a. increased heart rate

118
Q

Activation of the parasympathetic leads to
a. bronchial dilation
b. bronchoconstriction
c. pupil dilation
d. lipolizo

A

b. bronchoconstriction

119
Q

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

A

c. are short, non-myelinated and secrete acetylcholine

120
Q

Caused by a sympathiser:
a. piloerection
b. vasoconstriction
c. bradikadijo
d. tachycardia
e. a+b+c
f. a+b+d
g. b+c+d

A

f. a+b+d

121
Q

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

A

b. slower reacting, more diffuse

122
Q

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

A

c. postganglionic neurons tend to be short

123
Q

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

A

c. bronchoconstriction
e. increased gastrointestinal motility

124
Q

Which process is least likely to cause symptoms that last for years?
a. degenerative
b. Hereditary
c. congenital
d. neoplasm

A

d. neoplasm

125
Q

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

A

c. spastic paresis

126
Q

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

A

b. Bell’s paresis on the right

127
Q

Non-neurological manifestations of Friedreich’s ataxia:
a. cataracts
b. cardiomyopathy
c. chronic renal failure
d. diabetes mellitus
e. liver disease

A

b. cardiomyopathy
d. diabetes mellitus

128
Q

Where do we get the most acute symptoms?
a. vascular aetiology
b. degenerative aetiology
c. inflammatory aetiology

A

a. vascular aetiology

129
Q

Which patient showed us the importance of the hippocampus?
a. Phineas Gage
b. H. M.
c. Lou Gehrig
d. Woody Allen
e. Alois Alzheimer

A

b. H. M.

130
Q

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

a. 2-3 weeks after injury

131
Q

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

A

c. syncope

132
Q

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

A

c. MRI of the thoracic spine
g. meningeom

133
Q

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

A

e. most likely neuralgic amyotrophy

Not most likely!

134
Q

What is most likely to cause right-sided hemiparesis after 3 weeks?
a. TIA
b. subdural haematoma
c. brain tumour
d. cerebral palsy

A

b. subdural haematoma

135
Q

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

a. signs of upper motor neuron damage

136
Q

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.

A

b. Wide non-reactive pupil on the side of the herniation with
contralateral hemiplegia and quantitatively reduced
consciousness.

137
Q

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

a. loss of left frontal lobe function

138
Q

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.

A

b. The pupil on the defective side dilates when illuminated, as
confirmed by the Marcus-Gunn phenomenon.

139
Q

What is not found in non-dominant parietal disorder?
a. finger agnosias
b. anozognosia
c. apraxia of dress
d. structural apraxia

A

a. finger agnosias

140
Q

What do we call pain from non-painful stimuli?
a. allodynia
b. hyperalgesia
c. hyperpathy
d. analgesia

A

a. allodynia

141
Q

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

A

b. transient global amnesia

142
Q

Vertebrobasilar ischaemia, what doesn’t go with it:
a. diplopia
b. dysarthria
c. nystagmus
d. ataxia
e. Dysphasia

A

e. Dysphasia

143
Q

Mixed transcortical aphasia is caused by:
a. atrophy of the medial temporal lobus

A

a. atrophy of the medial temporal lobus

144
Q

A woman with ataxia and diplopia and nystagmus, eventually confusion sets in:
a. alcoholic.

A

a. alcoholic.

145
Q

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

a. PICA, Wallenberg syndrome

146
Q

Vertical gaze palsy occurs in which of the following diseases?
a. multiple sclerosis
b. Parkinson’s disease
c. Alzheimer’s disease

A

a. multiple sclerosis

147
Q

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

a. Tonic pupil
b. Hyporeflexia
c. Sweating disorders
d. Part of the symptoms can be explained by a defect in the ciliary ganglion

148
Q

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

a. Tinel’s sign

149
Q

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.

A

b. The patient loses postural tone when fully conscious and falls.

150
Q

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

a. 1 lesion

151
Q

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

A

b. Brainstem

152
Q

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

A

b. Right Pons

153
Q

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

A

b. amyotrophic lateral sclerosis

Signs of UM and LM lesions

154
Q

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

A

?

155
Q

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

A

b. 2

156
Q

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

A

b. 2

157
Q

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

a. Latency and exhaustion

158
Q

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

A

d. none of the above

159
Q

Activation of the parasympathetic arm of the autonomic nervous system causes:
a. Increased mucus secretion from the nasal mucosa

A

a. Increased mucus secretion from the nasal mucosa

160
Q

What do the parasympathetic and sympathetic systems have in common?
a. In all synapses between preganglionic and postganglionic neurons,
the neurotransmitter acetylcholine

A

a. In all synapses between preganglionic and postganglionic neurons,
the neurotransmitter acetylcholine

161
Q

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

A

c. 3

162
Q

Picture of one twisted leg (let’s say to identify a dog cavus), the owner has the legs:
a. ataxic
b. polyneuropathy

A

a. ataxic

163
Q

How would I distinguish papillitis from papililedema?
a. light reflex
b. eyeball movements
c. reduced field of vision
d. altered visual acuity

A

d. altered visual acuity

164
Q

. 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

A

b. right

165
Q

What is not compatible with retained consciousness?
a. aphasia
b. typical absenteeism
c. transient global amnesia
d. cataplexy
e. dislocated consciousness syndrome

A

b. typical absenteeism

166
Q

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

a. eyes found closed

167
Q

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

a. patient with GCS 12

168
Q

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

A

c. 3

169
Q

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

a. Wallerian degeneration

Neurology (22 decks)

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