Neurology 1

Question 1

Answer 1

Answer: Listeria monocytogenes

Question 2

Answer 2

Answer: Neisseria meningitidis

Important gram negative diplococci include N. meningitidis, N. gonorrhoeae, and M. catarrhalis (an important cause of bronchopneumonia in COPD patients).

Question 3

Answer 3

Answer: Iron deficiency anaemia

A watershed stroke is a form of ischaemic stroke. They tend to be caused by insufficient blood flow to the brain (e.g. carotid artery stenosis, arrhythmia or heart failure) or a vascular blockage/restriction far upstream of the infarct. This results in an infarct of the border zones between the tissues supplied by the ACA, MCA, and PCA.

Question 4

Answer 4

Answer: Osteoarthritis

A lumbar puncture can still be performed in patients with joint disease, but it can be more challenging due to decreased range of motion in the vertebral joints. Lumbar punctures can be performed under image guidance with the involvement of interventional radiologists.

Question 5

Answer 5

Answer: Acetylcholine receptor antibody

Question 6

Answer 6

Answer: Absence seizures

Question 7

Answer 7

Answer: Trinucleotide repeat expansion

Question 8

Answer 8

Answer: Stylomastoid foramen

Question 9

Answer 9

Answer: Ethosuximide

Question 10

Answer 10

Answer: Cuneate nucleus

The cuneate nucleus, one of the dorsal column nuclei, is a wedge-shaped nucleus in the closed part of the medulla oblongata. It contains cells that give rise to the cuneate tubercle, visible on the posterior aspect of the medulla. It lies laterally to the gracile nucleus and medial to the spinal trigeminal nucleus in the medulla.

Question 11

Answer 11

Answer: Sixth nerve palsy

Question 12

Answer 12

Answer: Fourth nerve palsy

Question 13

Answer 13

Answer: Amygdaloid body

Question 14

Answer 14

Answer: There is no interaction between valproate sodium and oral contraceptive pills

There is no interaction between valproate sodium and oral contraceptive pills. Some antiepileptic drugs, such as phenobarbital, primidone, phenytoin, carbamazepine, oxcarbazepine, and topiramate, are enzyme inducers and have been shown to increase the metabolism of ethinyl estradiol and progestogens. However, valproate sodium does not have this interaction and contraceptive preparations in normal doses can be used in patients taking valproate sodium.

Question 15

Answer 15

Answer: Columns of fornix

Question 16

Answer 16

Answer: HSV

Question 17

Answer 17

Answer: Third nerve palsy

Question 18

Answer 18

Answer: Vestibular nucleus

The vestibular nuclei are the cranial nuclei for the vestibular nerve.

Question 19

Answer 19

Answer: A marked decrease in pulmonary diffusing capacity

Question 20

Answer 20

Question 21

Answer 21

Answer: Midazolam

This patient has status epilepticus (SE), which is traditionally defined as a single seizure or series of seizures lasting 30 minutes or more in which the patient fails to regain consciousness between the seizures. Any seizure lasting more than 5 minutes is unlikely to stop on its own, and treatment should be initiated immediately. The initial care of a patient in SE includes airway assessment, establishing an intravenous line, monitoring hemodynamic status, aggressive supportive care, and assessing and treating any underlying metabolic, toxic, and infectious etiologies.

Question 22

Answer 22

Answer: Video electroencephalography (video EEG)

Video EEG monitoring is the criterion standard for classifying the type of seizure or syndrome or for diagnosing pseudoseizures. This study can be performed to rule out an epileptic etiology with a high degree of confidence if the patient has demonstrable impairment of consciousness during the spell in question, without abnormality on the EEG. Video EEG is also used to characterize the type of seizure and epileptic syndrome to optimize pharmacologic treatment and for presurgical workup.

Question 23

Answer 23

Answer: Obtain an EEG and a neuroimaging study

Question 24

Answer 24

Answer: Obtain a repeat EEG and MRI to help guide decisions on continued use of sodium valproate prior to pregnancy

Question 25

Answer 25

**Answer: Spinal trigeminal nucleus**

Question 26

Answer 26

**Answer: Ethmoid**

Question 27

Answer 27

**Answer: Prolongs GABA-mediated chloride channel openings**

Question 28

Answer 28

**Answer: Nucleus ambiguus** ## Footnote The nucleus ambiguus is a group of large motor neurons, situated deep in the medullary reticular formation. The nucleus ambiguus contains the cell bodies of nerves that innervate the muscles of the soft palate, pharynx, and larynx which are strongly associated with speech and swallowing. As well as motor neurons, the nucleus ambiguus in its "external formation" contains cholinergic preganglionic parasympathetic neurons for the heart.

Question 29

Answer 29

**Answer: Valproic acid** ## Footnote Similar to valproic acid, carbamazepine increases the risk of neural tube defects; however, it does not increase the risk of other malformations.

Question 30

* A) Coxsackie virus * B) Cryptococcus neoformans * C) Herpes Simplex Virus (HSV) * D) Staphylococcus aureus * E) Streptococcus pneumonia

Answer 30

**Answer: Herpes simplex virus (HSV)**

Question 31

Answer 31

**Answer: Decorticate rigidity**

Question 32

Answer 32

**Answer: Carbamazepine**

Question 33

Answer 33

**Answer: Partial seizures originating in the temporal lobe**

Question 34

Answer 34

**Answer: Head trauma**

Question 35

Answer 35

**Answer: Bitemporal heteronymous hemianopsia**

Question 36

Answer 36

**Answer: Contralateral homonymous hemianopsia with macular sparing**

Question 37

What part of the brain is shown here?

Answer 37

Midbrain

Question 38

Answer 38

**Answer: GABA**

Question 39

Answer 39

**Answer: The substantia nigra compacta** ## Footnote Dopamine from the substantia nigra compacta excites the direct pathway (via dopamine 1 receptors) and inhibits the indirect pathway (via dopamine 2 receptors) of the basal ganglia; resulting in net excitation of the motor cortex and thusly increased movement.

Question 40

Answer 40

**Answer: B₁₂**

Question 41

What part of the brain is shown here?

Answer 41

Superior Colliculus

Question 42

Answer 42

**Answer: Fasciculus gracilis**

Question 43

Answer 43

**Answer: Parkinson's disease**

Question 44

Answer 44

**Answer: Middle cerebral artery**

Question 45

Answer 45

**Answer: Neurofibromatosis**

Question 46

Answer 46

**Answer: Right lateral funiculus**

Question 47

Answer 47

**Answer: Multiple sclerosis** ## Footnote Oligoclonal bands are an important indicator in the diagnosis of multiple sclerosis.

Question 48

What part of the brain is shown here?

Answer 48

Hippocampus

Question 49

Answer 49

**Answer: hypertension with a wide pulse pressure, bradycardia, irregular breathing**

Question 50

What part of the brain is shown here?

Answer 50

Amygdala

Question 51

What part of the brain is shown here?

Answer 51

Hippocampus

Question 52

Answer 52

**Answer: Glioblastoma** ## Footnote bilateral glioblastoma (butterfly glioma)

Question 53

Answer 53

**Answer: Oculomotor (III)** ## Footnote A complete oculomotor nerve palsy will result in a characteristic down and out position in the affected eye. The eye will be displaced outward "exotropia" and displaced downward "hypotropia"; outward because the lateral rectus (innervated by the sixth cranial nerve) maintains muscle tone in comparison to the paralyzed medial rectus. The eye will be displaced downward, because the superior oblique (innervated by the fourth cranial or trochlear nerve), is unantagonized by the paralyzed superior rectus, inferior rectus and inferior oblique. The affected individual will also have a ptosis, or drooping of the eyelid, and mydriasis (pupil dilation).

Question 54

What part of the brain is shown here?

Answer 54

Left amygdala

Question 55

Answer 55

**Answer: Subfalcine herniation**

Question 56

Answer 56

**Answer: Posterior spinocerebellar tract**

Question 57

Answer 57

**Answer: Bleeding diathesis** ## Footnote Absolute contraindications for an LP include anticoagulant therapy, bleeding diathesis, and evidence of localised infection in the lumbar region. Other factors - e.g. signs of raised ICP, immunocompromise, decreased GCS - may also warrant the use of CT first.

Question 58

Answer 58

**Answer: 150 mL**

Question 59

What part of the brain is shown here?

Answer 59

Posterior Commissure

Question 60

Answer 60

**Answer: lateral, median** ## Footnote Cerebrospinal fluid keeps the brain buoyant, protects brain tissue from mechanical injury, prevents ischaemia, allows for homeostatic regulation of substances between cells in the brain, and removes waste products. About 500mL of CSF is produced per day, mostly by the choroid plexus in the lateral ventricles. The CSF moves from the lateral ventricles to the third ventricle via the interventricular foramina, then to the fourth ventricle via the cerebral aqueduct. It then passes into the subarachnoid space through the median aperture and the two lateral apertures.

Question 61

Answer 61

**Answer: vagus (X), away from**

Question 62

Answer 62

**Answer: Anosmia**

Question 63

Answer 63

**Answer: The glossopharyngeal nerve only**

Question 64

Answer 64

**Answer: Chorda tympani branch of facial nerve only**

Question 65

Answer 65

**Answer: Fourth nerve palsy**

Question 66

Answer 66

**Answer: Its afferent nerve is the optic (CN II) and its efferent nerve is the oculomotor (CN III)**

Question 67

Answer 67

**Answer: Left ophthalmic nerve (branch of trigeminal nerve)**

Question 68

Answer 68

**Answer: Right cerebellum** ## Footnote Right cerebellum is correct. Cerebellar lesions cause a disturbance of equilibrium, muscle tone, and execution of movement. The patient's symptoms indicate an intention tremor, which is associated with cerebellar damage. Lateral lesions of the cerebellum impair limb movements ipsilateral to the lesion. The patient’s tremor in the right hand and falling to the right suggest that the lesion is in the right side of the cerebellum.

Question 69

Answer 69

**Answer: Conjugate vertical gaze** ## Footnote Parinaud syndrome is paralysis of conjugate vertical gaze due to a lesion (e.g. stroke, hydrocephalus, pinealoma) affecting the superior colliculus.

Question 70

Answer 70

**Answer: Option C**

Question 71

Answer 71

**Answer: Pilocytic Astrocytoma** ## Footnote On imaging, pilocytic astrocytomas typically show a cystic lesion with an attached mural nodule.

Question 72

Answer 72

**Answer: bradycardia, hypertension with widened pulse pressure, irregular breathing** ## Footnote The Cushing Reflex is a late sign of raised intracranial pressure and typically indicates imminent brain herniation. When the arterial pressure is less than the ICP, the hypothalamus activates the sympathetic nervous system, causing peripheral vasoconstriction and an increase in cardiac output, which raises arterial pressure. The increased arterial blood pressure stimulates the baroreceptors in the carotid bodies, which causes bradycardia.

Question 73

Answer 73

**Answer: Middle cerebral artery**

Question 74

Answer 74

**Answer: Meningioma** ## Footnote On imaging, meningiomas typically present as round masses attached to the dura.

Question 75

Answer 75

**Answer: Lateral corticospinal tract**

Question 76

Answer 76

**Answer: Lateral reticulospinal tract**

Question 77

Answer 77

**Answer: Oligodendroglioma** ## Footnote Micrograph of an oligodendroglioma showing the characteristic branching, small, chicken wire-like blood vessels and fried egg-like cells, with clear cytoplasm and well-defined cell borders. H&E stain.

Question 78

Answer 78

**Answer: C7**

Question 79

Answer 79

**Answer: Anterior cerebral artery**

Question 80

Answer 80

**Answer: Vertebral artery**

Question 81

Answer 81

**Answer: Epidural haemorrhage** ## Footnote Epidural haemorrhage is due to rupture of the middle meningeal artery (often by trauma to the temporoparietal bone). It typically shows up on CT scans as a biconcave disk.

Question 82

Answer 82

**Answer: Pia mater**

Question 83

Answer 83

**Answer: Choroid plexus papilloma**

Question 84

Answer 84

**Answer: Internal carotid artery**

Question 85

Answer 85

**Answer: Schwannoma** ## Footnote Schwannomas often present with tinnitus and loss of hearing as a result of CNVIII involvement.

Question 86

Answer 86

**Answer: Oculomotor** ## Footnote Oculomotor. Cranial nerves III, VII and X and S3–5 spinal nerves carry parasympathetic fibres.

Question 87

Answer 87

**Answer: the left substantia nigra** ## Footnote The left basal ganglia and substantia nigra influence the right side of the body. Parkinson's disease typically begins unilaterally, however the tremor soon becomes bilateral.

Question 88

Answer 88

**Answer: Anterior inferior cerebellar artery**

Question 89

Answer 89

**Answer: Glioblastoma** ## Footnote On histology, glioblastomas typically show regions of necrosis surrounded by tumour cells and endothelial cell proliferation.

Question 90

Answer 90

**Answer: Oligodendroglioma**

Question 91

Answer 91

**Answer: Basilar artery**

Question 92

Answer 92

**Answer: S2, S3**

Question 93

Answer 93

**Answer: Neisseria meningitidis**

Question 94

Answer 94

**Answer: Hemangioblastomas**

Question 95

Answer 95

**Answer: Skin; supraspinous ligaments; interspinous ligaments; ligamentum flavum; epidural space; dura; subarachnoid membrane into subarachnoid space** ## Footnote There is no such thing as the intraspinous ligament. The correct ligament is the interspinous ligaments (interspinal ligaments), which are thin membranous ligaments that connect adjoining spinous processes of the vertebra.

Question 96

Answer 96

**Answer: Vestibulospinal tracts**

Question 97

Answer 97

**Answer: Craniopharyngioma** ## Footnote Presents as a supratentorial mass in a child or young adult; may compress the optic chiasm leading to bitemporal hemianopsia

Question 98

Answer 98

**Answer: Posterior inferior cerebellar artery**

Question 99

Answer 99

**Answer: Anterior white commissure**

Question 100

Answer 100

**Answer: Trisomy 21** ## Footnote Gene for β-APP is present on chromosome 21. Most individuals with Down syndrome (trisomy 21) develop Alzheimer disease by the age of 40 (early-onset).

Question 101

Answer 101

**Answer: Inhibits action of monoamine transporters**

Question 102

Answer 102

**Answer: Vertebral artery**

Question 103

Answer 103

**Answer: Facial nerve (VII)** ## Footnote The facial nerve passes through, but does not innervate, the parotid gland. Within the parotid gland it bifurcates into the temporofacial and cervicofacial divisions, which further subdivide.

Question 104

Answer 104

**Answer: Tectospinal tract**

Question 105

Answer 105

**Answer: Medial reticulospinal tract**

Question 106

Answer 106

**Answer: Uncal transtentorial herniation**

Question 107

Answer 107

**Answer: Superior cerebellar artery**

Question 108

Answer 108

**Answer: Option 3**

Question 109

Answer 109

**Answer: Occipital lobe**

Question 110

Answer 110

**Answer: Striatum of the basal ganglia**

Question 111

Answer 111

**Answer: Giant cell arteritis**

Question 112

Answer 112

**Answer: Anterior communicating artery**

Question 113

Answer 113

**Answer: Olfactory bulb**

Question 114

Answer 114

**Answer: β-Amyloid (Aβ), Alzheimer’s disease** ## Footnote Alzheimer's Disease is characterized by the formation of beta-amyloid plaques, as shown here. Senile plaques appear as small collections of dark, irregular, thread-like structures often with a brownish material in the centre. The central core is represented by amyloid and the irregular, beaded linear structures represent abnormal neurites (small dendrites and axons with degenerative changes).

Question 115

Answer 115

**Answer: Bacterial meningitis**

Question 116

Answer 116

**Answer: Miosis** ## Footnote Opioid intoxication typically produces: miosis, confusion, obtundation, euphoria, central respiratory depression, constipation.

Question 117

Answer 117

**Answer: Subarachnoid haemorrhage**

Question 118

Answer 118

**Answer: Olfactory tract**

Question 119

Answer 119

**Answer: Corticospinal tract**

Question 120

Answer 120

**Answer: Rubrospinal tract**

Question 121

Answer 121

**Answer: facial nerve**

Question 122

Answer 122

**Answer: Ependymoma** ## Footnote Perivascular pseudorosettes are a characteristic finding on biopsy

Question 123

Answer 123

**Answer: Neurofibrillary tangles with tau protein**

Question 124

Answer 124

**Answer: Pilocytic Astrocytoma**

Question 125

What kind of visual field pathology would a lesion at pin 9 cause?

Answer 125

Left homonymous hemianopia with macular sparing

Question 126

Answer 126

**Answer: Elevation, extorsion, abduction.**

Question 127

Answer 127

**Answer: ACA**

Question 128

Answer 128

**Answer: Glioblastoma**

Question 129

Answer 129

**Answer: Alpha-synuclein in neuronal cytoplasm**

Question 130

Answer 130

**Answer: Tearing of the cerebral bridging veins**

Question 131

Answer 131

**Answer: Metastases**

Question 132

Answer 132

**Answer: Left medial frontal lobe**

Question 133

Answer 133

**Answer: Amyotrophic lateral sclerosis - Electromyography**

Question 134

Answer 134

**Answer: Fine touch, vibration, proprioception**

Question 135

Answer 135

**Answer: Subdural haemorrhage**

Question 136

Answer 136

**Answer: maxillary artery; external carotid artery**

Question 137

Answer 137

**Answer: Ependymoma** ## Footnote Aqueductal stenosis is incorrect as it is a congenital disorder. Ependymomas are malignant tumours of ependymal cells usually seen in children. They most commonly arise in the 4th ventricle and may present with hydrocephalus.

Question 138

* A) All limbs of the internal capsule * B) Anterior limb of the internal capsule * C) Genu of the internal capsule * D) Posterior limb of the internal capsule * E) Thalamus

Answer 138

**= B) Anterior limb of the internal capsule** ## Footnote In the anterior region, the large striatum is divided into caudate and putamen by the prominent anterior limb.

Question 139

Answer 139

**Answer: Cluster headache** ## Footnote This headache is most consistent with a type of neurovascular headache called cluster headache. These occur most often in young men; have a characteristic periodicity, or cluster; and cause lacrimation, nasal stuffiness, and sometimes conjunctival inflammation. Migraines tend not to come and go in this manner, are more throbbing, and are more likely to be associated with nausea and vomiting. Sinusitis is usually bilateral with associated fever and purulent discharge. Tension headaches are usually described as bandlike, without lacrimation or nasal congestion

Question 140

Answer 140

**Answer: Subarachnoid haemorrhage**

Question 141

Answer 141

**Answer: Chorda tympani** ## Footnote The chorda tympani branch of the facial nerve passes forwards through its canaliculus into the middle ear and crosses the medial aspect of the tympanic membrane. It then passes antero-inferiorly in the infratemporal fossa. It distributes taste fibers to the anterior two-thirds of the tongue.

Question 142

Answer 142

**Answer: Schwannoma; cranial nerve Vlll**

Question 143

Answer 143

**Answer: Superior orbital fissure**

Question 144

Answer 144

**Answer: Epidural haemorrhage**

Question 145

Answer 145

**Answer: Subarachnoid haemorrhage**

Question 146

Answer 146

**Answer: Propranolol** ## Footnote Propranolol is highly lipid-soluble and so crosses the blood-brain barrier.

Question 147

Answer 147

**Answer: Epidural haemorrhage**

Question 148

Answer 148

**Answer: Start oral aciclovir ± and oral prednisolone**

Question 149

Answer 149

**Answer: A left frontal meningioma**

Question 150

Answer 150

**Answer: Medulloblastoma**

Question 151

Answer 151

**Answer: Meningioma**

Question 152

Answer 152

**Answer: Lenticulostriate or lateral striate arteries** The lateral or lenticulostriate arteries are small branches that arise at right angles from the middle cerebral artery. They are under high pressure and vulnerable to rupture, typically into the region of the extreme or external capsule, anterior limb of the internal capsule, or striatum.

Question 153

Answer 153

**Answer: Options D and B**

Question 154

Answer 154

**Answer: Subarachnoid haemorrhage** ## Footnote Saccular aneurysms are the most common cause of subarachnoid haemorrhage. They are thin-walled protrusions through areas of cerebral arteries with thin or absent tunica media.