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Book Reviews and APKs > Rembe - Chapter 7 (MS) > Flashcards

Rembe - Chapter 7 (MS) Flashcards

Clinical Neurology

1
Q

In an advanced peripheral neuropathy of diabetes mellitus, which of the following complications might likely occur or be present?

Anorexia
Charcot joint of the knee
Cerebral congestion
Papilledema

A

Charcot joint of the knee

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2
Q

In athetosis, the most probable site of pathology is

Cranial nerve V
Globus pallidus
Motor cortex
Neuromuscular junction

A

Globus pallidus

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2
Q

Immediately following a transection of the spinal cord, which of the following changes can be expected?

a. Increase in skeletal muscle tone
b. Spinal shock lasting 2 days
c. Retention of urine and feces
d. Hypotension

A

c. Retention of urine and feces

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3
Q

A cerebrovascular accident patient, with left-sided weakness of upper and lower extremity likely has a lesion located in the

Brainstem
Medulla
Left cerebral hemisphere
Right cerebral hemisphere

A

Right cerebral hemisphere

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3
Q

A patient with a head injury has symptoms of rising temperature and a slowing of respiration and pulse. What might cause these symptoms?

a. Injury to the cortical motor speech area
b. Injury to the vital centers within the medulla
c .Organization of the blood clot
d .Lesion in the occipital lobe

A

b. Injury to the vital centers within the medulla

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3
Q

All of the following statements apply to diabetes insipidus EXCEPT:

a. Lesions of the pancreas give rise to the disorder
b. The patient experiences excessive thirst
c. There is excessive output of urine of low specific gravity
d. There is insufficient secretion of antidiuretic hormone

A

a. Lesions of the pancreas give rise to the disorder

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4
Q

Treatment of cervical spondylosis after sudden onset or exacerbation of radicular pain and motor weakness following insult includes

Bed rest
Adequate use of analgesics
Radiant heat
All of the above

A

All of the above

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5
Q

During progressive cerebral anoxia, the first clinical sign that occurs is

Perceptual and visual difficulties
Unconsciousness
Decerebration
Impairment of judgment

A

Impairment of judgment

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6
Q

A common cause of epidural compression of the spinal cord is

Tay-Sachs disease
Hodgkin’s disease
Werdnig-Hoffman syndrome
Erb-Duchenne-Klumpke syndrome

A

Hodgkin’s disease

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7
Q

Demyelinating diseases of the central nervous system include all of the following EXCEPT

Multiple sclerosis
Alzheimer’s disease
Niemann-Pick disease
Schilder’s disease

A

Alzheimer’s disease

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8
Q

All of the following apply to Hodgkin’s disease EXCEPT

a. Clinical features include general symptoms of fever, weakness, weight loss, and anemia
b. Varying neurological manifestations
c. More common in females
d. Herpes zoster is not an uncommon concomitant

A

c. More common in females

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9
Q

Which of the following is most frequently associated with a subarachnoid hemorrhage?

Severe hypertension
Mycotic aneurysm
“Berry” aneurysm
Atherosclerotic aneurysm

A

“Berry” aneurysm

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10
Q

Primary diseases of muscle include all of the following EXCEPT

a. Progressive muscular dystrophy
b. Myasthenia gravis
c. Myotonia congenital
d. Infantile spinal muscular atrophy (Werdnig-Hoffman syndrome)

A

d. Infantile spinal muscular atrophy (Werdnig-Hoffman syndrome)

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11
Q

Changes in the neurological status of a patient, following a motorcycle accident, indicate damage. Which of the following would be most significant?

a. Localization of headaches
b. Pain and edema near the eye
c. Increase in pulse and respiratory rate
d. Change from alertness to increased lethargy

A

d. Change from alertness to increased lethargy

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12
Q

A positive Romberg test indicates

a. Serology for syphilis
b. Test for high protein in cerebrospinal fluid
c. High leukocyte count in cerebrospinal fluid
d .Swaying while standing with eyes closed

A

d. Swaying while standing with eyes closed

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13
Q

All of the following are characteristic of a lower motor neuron lesion, EXCEPT

a. Spastic paralysis below the level of the lesion
b. Atrophy of muscles below level of lesion
c .Depressed reflexes below level of lesion
d. Fasciculations

A

Spastic paralysis below the level of the lesion

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13
Q

Clinical features of multiple sclerosis include all of the following, EXCEPT

Motor weakness
Visual symptoms (e.g., diplopia)
Ataxia of gait
Bradykinesia

A

Bradykinesia

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14
Q

The disorder of movement of quick oscillation of eyes while fixing gaze on an object, as a result of a cerebellar tumor, is known as

Dysmetria
Asynergia
Adiadochokinesia
Nystagmus

A

Nystagmus

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15
Q

A cerebral infarction of the middle cerebral artery would probably cause all of the following symptoms EXCEPT

Aphasia
Ipsilateral Horner’s syndrome
Hemianopsia
Contralateral hemiplegia

A

Ipsilateral Horner’s syndrome

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16
Q

The inability to perform tapping movements quickly and smoothly is known as

Asynergia
Nystagmus
Adiadochokinesia
Dysmetria

A

Adiadochokinesia

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17
Q

Syringomyelia is characterized by all of the following EXCEPT

a. Atrophy of small muscles of the hand
b. Painless burns of fingers
c. Viral etiology
d. Cavitation and gliosis in spinal cord

A

c. Viral etiology

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18
Q

Which of the following is characteristic of a transient ischemic attack?

a. Lasting damage to the brain
b. Similar to epileptic seizure
c. No residual after attack
d. Hemiparesis is a residual

A

c. No residual after attack

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18
Q

Clinical features of ataxic cerebral palsy include all of the following, EXCEPT

Hypertonic from birth
Dysmetria
Intention tremor
Truncal ataxia

A

Hypertonic from birth

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19
Q

A condition that is due to involvement of the extrapyramidal system is

Ataxia
Athetosis
Spasticity
Hemiplegic cerebral palsy

A

Athetosis

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20
Q

Which of the following has a viral etiology?

Parkinsonism
Guillain-Barre syndrome
Schrider’s disease
Multiple sclerosis

A

Guillain-Barre syndrome

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21
Q

Dysmetria is a disorder of movement as a result of a cerebellar tumor. Which of the following describes this movement?

a. Error in range of movement
b. Oscillation
c. Lack of cooperation between muscles
d. Deviation from line of movement

A

a. Error in range of movement

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22
Q

Segmental levels of C5,6 include innervations for the

Biceps reflex
Triceps reflex
Brachioradialis reflex
Hoffman reflex

A

Brachioradialis reflex

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23
Q

Segmental levels of C7,8 include innervations for the

Triceps reflex
Brachioradalis reflex
Hoffman reflex
Finger jerk

A

Triceps reflex

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24
Q

Neurologic disorders resulting from defects at the neuromuscular junction include

Myasthenia gravis
Guillan-Barre syndrome
Parkinsonism
None of the above

A

Myasthenia gravis

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25
Q

Neurologic manifestations of Hodgkin’s disease include

a. Compression lesions of the spinal cord
b. Peripheral nerve involvement
c. Involvement of the meninges and base of skull
d. All of the above

A

All of the above

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26
Q

Which of the following diagnostic studies is used to visualize the intracranial vascular areas?

Brain scan
Arteriography
Tomography (CAT)
X-ray

A

Arteriography

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27
Q

Disorders with involuntary movements include

Parkinson’s disease
Dystonia musculorum deformans
Huntington’s chorea
All of the above

A

All of the above

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28
Q

Which lesions or diseases result in visible wasting or atrophy of the muscles involved

Posterior horn cells
Posterior spinal roots
Motor axons
Dorsal spinal roots

A

Motor axons

29
Q

Which of the following diagnostic procedures is able to demonstrate hematomas, hemorrhage, and infarcts?

Tomography (CAT)
Brain scan
Arteriography
Electroencephalogram

A

Tomography (CAT)

30
Q

Myoclonus occurs as part of the clinical picture of many disorders. It

a. Is a neuromuscular disorder originating from the central nervous system
b. Consists of irregular, asynergic, and jactitious contractions of muscle
c. Produces nonrepetitive, brief, involuntary movements
d. All of the above

A

All of the above

30
Q

Peripheral neuropathy may occur in

Arsenic poisoning
Lead poisoning
Thiamine deficiency
All of the above

A

All of the above

31
Q

In Wilson’s disease (hepatolenticular degeneration) there is

Vitamin B12 deficiency
A macroglobulinemia
Renal failure
Increased absorption of copper from the intestinal tract

A

Increased absorption of copper from the intestinal tract

32
Q

Hypotension syncope may occur from

a. Sudden decrease in cardiac output
b. Increase in venous return to the heart
c. Sudden increase in peripheral vascular resistance
d. Sudden decrease of the carotid artery’s function

A

a. Sudden decrease in cardiac output

33
Q

In comparing the clinical features of a brain abscess with those of a subdural empyema, the latter is

a. Less likely to produce focal signs
b. Usually not associated with any systemic signs of infection
c. Characterized by cerebrospinal fluid which is xanthochromic without cells in the majority of cases
d. All of the above

A

d. All of the above

33
Q

In the acute care of a cerebrovascular accident, which of the following critical factors should be considered?

Stabilization of vital signs
Correction of cardiac arrhythmias
Proper positioning
All of the above

A

All of the above

34
Q

Natal factors in etiology and pathogenesis of cerebral palsy include

Anoxia
No known trauma
Full-term pregnancy
Kernicterus

A

Anoxia

35
Q

Conditions which are NOT progressive include

Cerebral palsy
Multiple sclerosis
Alzheimer’s disease
Schilder’s disease

A

Cerebral palsy

36
Q

Inspection of the muscular system of a patient reveals fasciculations. These fasciculations are evidence of damage to the

Upper motor neuron
Anterior horn cell
Cerebral cortex
Motor unit

A

Anterior horn cell

37
Q

Brudzinski’s sign

a. May be present in cerebrovascular accident
b. May be present in meningeal irritation
c. Is characterized by extension at the knees when the hips are flexed
d. Is characterized by extension at the knees when the neck is flexed

A

b. May be present in meningeal irritation

38
Q

A seizure involving a momentary loss of consciousness, usually just a blank stare, is referred to as

Jacksonian seizure
Patit mal
Grand mal

A

Patit mal

39
Q

A patient presents with a sudden onset of fever, headache, and nuchal rigidity. This is followed by drowsiness, confusion, and loss of consciousness. One should suspect

Subdural hematoma
Cranial epidural abscess
Cranial subdural empyema
Acute purulent meningitis

A

Acute purulent meningitis

40
Q

Which of the following drugs is used for the treatment of Jacksonian and psychomotor seizures?

Phenacemide
Primidone
Phenytoin
Mephenyloin

A

Phenytoin

41
Q

Symptoms of subacute combined degenerations of the spinal cord include

a. Initially a paresthesia of the extremities followed by numbness and distal weakness in the limbs
b. Ataxic gait with variable degrees of spasticity in lower limbs
c. Hyperactive deep reflexes and extensor plantar responses
d. All of the above

A

d. All of the above

42
Q

Which of the following drugs is used for the treatment of petit mal seizures?

Phenacemide
Primidone
Carbamezepine
Ethosuximide

A

Ethosuximide

43
Q

The drug phenacemide is used for psychomotor seizures when the patient is not responsive to other drugs. Which of the following is NOT a side effect to this drug?

Hepatic damage
Bone marrow depression
Skin rash
Personality change

A

Skin rash

43
Q

Virus infections of the nervous system include all of the following, EXCEPT

Acute anterior poliomyelitis
Herpes zoster
Rabies
Tabes dorsalis

A

Tabes dorsalis

44
Q

The drug carbamazepine is used for major motor seizures. Which of the following is NOT a side effect?

Paresthesia of the extremities
Respiratory depression
Urinary retention
Water intoxication

A

Respiratory depression

45
Q

Chorea and choreoathetosis are characteristics symptomatic of many diseases of the nervous system including

Viral encephalitis
Systemic lupus erythematosus
Wilson’s disease
All of the above

A

All of the above

46
Q

How are the drugs phenytoin and mephenytoin similar in treatment for seizures?

Used for petit mal seizure
Same side effects
Used for myoclonic seizures
Used for Jacksonian and motor seizures

A

Used for Jacksonian and motor seizures

47
Q

The most common tumor of the brain and spinal cord is

The meningiomas
The neurilemmomas
Metastatic tumors
The gliomas

A

The gliomas

48
Q

Papilledema is a common finding in all of the following EXCEPT

Intracranial tumors
Cerebral trauma
Meningitis
Syringomyelia

A

Syringomyelia

49
Q

Sensory impairment can be expected in all of the following EXCEPT

Multiple sclerosis
Amyotrophic lateral sclerosis
Syringomyelia
Polyneuritis

A

Amyotrophic lateral sclerosis

50
Q

The condition in which there are abnormal and irresistible attacks of the desire to sleep is

Cataplexy
Cerebral norcardiosis
Trichinosis
Narcolepsy

A

Narcolepsy

51
Q

All of the following apply to myoclonus as a phenomenon EXCEPT

a. A neuromuscular disorder originating from the central nervous system
b. The attacks consist of irregular, asynergic, and jactitious contractions of muscle
c. The attacks may occur in any part of the body and may be provoked by various stimuli
d. Does not occur during drowsiness or emotional disturbance

A

d. Does not occur during drowsiness or emotional disturbance

51
Q

Which of the following drugs is related to Phenobarbital in its therapeutic uses?

Primidone
Ethotoin
Phenacemide
Ethosuximide

A

Primidone

51
Q
A
52
Q

Lesions in the brain cause seizures. Which of the following normally do NOT elicit them?

Midbrain
Thalamus
Cerebellum
Cerebral cortex

A

Cerebellum

53
Q

In observing a patient, you note that there is absence of any response to painful stimuli. This condition is termed

Coma
Semicoma
Stupor
Obtundity

A

Coma

54
Q

A false interpretation of a sensory perception is called a

Delusion
Illusion
Hallucination
Dystonia

A

Illusion

55
Q

The treatment of preference for Parkinson’s disease is

L-dopa
Dopamine
Surgical intervention
Anticholinergic drugs

A

Anticholinergic drugs

56
Q

Examination of a patient’s visual fileds reveals a scotoma. This condition

a. Indicates that the lens is becoming opaque
b. Is a blind spot or defect within the visual field
c. Indicates pain on eye movement
d. Precedes papilledema

A

b. Is a blind spot or defect within the visual field

57
Q

The segmental level for innervations of the knee jerk (patellar reflex) is

L1,2
L2,3,4
L3,4,S1
L4,S1,2

A

L2,3,4

58
Q

The segmental levels for innervations of the ankle jerk (Achilles reflex) is

L2,3,4
L3,4,5
L5,S1,2
L5,S1

A

L5,S1,2

59
Q

The most common neurologic complication of multiple myeloma is

Headache, dizziness, syncope
Confusion, disorientation
Dysphasia
Peripheral neuropathy

A

Peripheral neuropathy

60
Q

The essential features of Wernicke’s encephalopathy are the triad of

a. Headache, dizziness, syncope
b. Opthalmoplegia, ataxia, dementia
c. Confusion, disorientation, loss of memory
d. Cerebral congestion, headache, papilledema

A

b. Opthalmoplegia, ataxia, dementia

61
Q

In stroking the outer aspect of the sole of the foot of a patient from the heel toward the small toe there is a response of dorsiflexion of the great toe, fanning of the toes, and withdrawal of the foot. This

a. Is the Babinski sign
b. Is a normal plantar reflex
c. Is a flexor plantar response
d. Indicates damage to the spinal tract

A

a. Is the Babinski sign

62
Q

The chief symptom of Parkinson’s disease are all of the following, EXCEPT

Rigidity
Tremor
Intention tremor
Masklike face

A

Masklike face

63
Q

A patient with a lucid interval following a head injury now presents with drowsiness, stupor and coma. One should suspect

a. Subacute subdural hematoma
b. Acute subdural hematoma
c. Intracerebral hematoma
d. Intracerebellar hematoma

A

a. Subacute subdural hematoma

64
Q
A
65
Q

Which of the following is a manifestation of myasthenia gravis?

a. Rigidity and tremor
b. Rapid fatigue of skeletal muscles
c. Flaccid or spasitc paralysis
d. Rapid fatigue of smooth muscle

A

b. Rapid fatigue of skeletal muscles

66
Q

Clinical features of Wilson’s disease (hepatolenticular degeneration) include

a. Generalized rigidity, bradykinesis, dysarthria, and masklike face in the dystonic form
b. Ophthalmoplegia, ataxia dementia
c. Lassitude, lethargy, restlessness, agitation
d. None of the above

A

a. Generalized rigidity, bradykinesis, dysarthria, and masklike face in the dystonic form

67
Q

Neurologic complications of moderate barbituare poisoning include

a. Resembles alcoholic intoxication
b. Voice is thick, dysarthric
c. There is ataxia and other signs of cerebellar incoordination
d. All of the above

A

d. All of the above

68
Q

The etiology and pathology of amyotrophic lateral sclerosis includes

Metabolic deficiency
Virus etiology (e.g., “slow virus” infection)
Abiotrophy
AOTA

A

AOTA

69
Q

Which of the following symptoms demonstrates a positive tensilon test

a. Immediate decrease in muscle strength
b. Ptosis-difficult with eyes
c. Muscarine effect on smooth muscle
d. Immediate increase in muscle strength

A

d. Immediate increase in muscle strength

70
Q

Pathology of what organ in the body is associated with myasthenia gravis?

Thymus
Thyroid
Heart
Liver

A

Thyroid

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