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page 143
Neurology
Questions
ANATOMY AND PHYSIOLOGY
1.
2.
1.
2.
3.
4.
1.
2.
3.
4.
Decrease in acetylcholine
Decrease in dopamine
Increase in dopamine
Increase in norepinephrine
3.
Which substances cross the blood-brain barrier quickly? Which substances cross it slowly? (p. 398)
______________________________________________________________________________
4.
Match the area of the hypothalamus with its function. (p. 398)
_____ A. Anterior hypothalamus
_____ B. Lateral area
_____ C. Paraventricular nucleus
_____ D. Posterior hypothalamus
_____ E. Suprachiasmatic nucleus
_____ F. Supraoptic nucleus
_____ G. Ventromedial area
5.
1.
2.
3.
4.
5.
6.
7.
Circadian rhythm
Cooling
Heating
Hunger
Makes ADH
Makes oxytoxin
Satiety
What are the five functions of the limbic system? (p. 399) _________________________________
______________________________________________________________________________
6.
How does loss of dopamine in Parkinsons disease affect the excitatory pathway? How does it
affect the inhibitory pathway? (p. 400) _______________________________________________
______________________________________________________________________________
______________________________________________________________________________
page 144
7.
In the image below, identify the components of the excitatory and inhibitory pathways. (p. 400)
8.
9.
What are the cardinal features of Parkinsons disease? (p. 401) ____________________________
______________________________________________________________________________
10.
Athetosis __________________________________________________________________
B.
Chorea ___________________________________________________________________
C.
Dystonia __________________________________________________________________
D.
Myoclonus ________________________________________________________________
Copyright 2011 by MedIQ Learning, LLC
11.
page 145
Match the area of a brain lesion with its clinical effect(s). (p. 403)
_____ A. Anterograde amnesia
_____ B. Contralateral hemiballismus
_____ C. Deficits in concentration, orientation and judgment
_____ D. Eyes look away from side of lesion
_____ E. Eyes look toward side of lesion
_____ F. Intention tremor and limb ataxia
_____ G. Klver-Bucy syndrome
_____ H. Reduced levels of arousal and wakefulness
_____ I. Spatial neglect syndrome
_____ J. Tremor at rest, chorea, or athetosis
_____ K. Truncal ataxia and dysarthria
_____ L. Wernicke-Korsakoff syndrome
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Amygdala
Basal ganglia
Cerebellar hemisphere
Cerebellar vermis
Frontal eye fields
Frontal lobe
Hippocampus
Mamillary bodies
PPRF
Reticular activating system
Right parietal lobe
Subthalamic nucleus
12.
13.
What is the major vascular territory covered by the ACA? MCA? PCA? (pp. 404-405) ___________
______________________________________________________________________________
14.
15.
On CT, an epidural hematoma _______________ (does/does not) cross suture lines, while a
subdural hematoma _______________ (does/does not) cross suture lines. (p. 406)
16.
A 50-year-old woman presents to the emergency department with a headache and numbness on
the right side. Her speech is difficult to understand, and her mouth droops when talking.
Noncontrast CT of the head shows bright areas. Should tPA be administered? (p. 407) _________
17.
What are the symptoms of normal pressure hydrocephalus? (p. 408) ________________________
______________________________________________________________________________
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18.
Which spinal nerves exit the intervertebral foramina above the corresponding vertebra? Which
spinal nerves exit the foramina below the corresponding vertebrae? (p. 408) __________________
19.
20.
In the chart below, compare and contrast the characteristics of upper vs. lower motor neuron
lesions. (p. 410)
Characteristic
UMN Lesion
LMN Lesion
Atrophy
Babinski reflex
Clasp knife spasticity
Fasciculation
Reflexes
Spastic paralysis
Tone
Weakness
21.
For each lesion in the image, identify the motor deficit and associated diseases. (pp. 411-412)
A. ____________________________________________________________________________
B. ____________________________________________________________________________
C. ____________________________________________________________________________
D. ____________________________________________________________________________
E. ____________________________________________________________________________
F. ____________________________________________________________________________
G. ____________________________________________________________________________
22.
Horners syndrome is associated with which three lesions? (p. 413) ________________________
______________________________________________________________________________
Copyright 2011 by MedIQ Learning, LLC
23.
page 147
Fill in the chart below describing the cranial nerves. (pp. 416-416)
CN
Name
Function
Type (Sensory/
Motor/Both)
Location in
Brainstem
I
II
III
IV
V
VI
VII
VIII
IX
XI
XII
24.
page 148
25.
If there is a lesion in CNs V and VII, which reflex is impaired? (p. 416) _______________________
26.
27.
With a lesion in CN X, the uvula deviates _______________ (toward/away from) the side of the
lesion. (p. 418)
28.
With a lesion in CN XI, the head turns _______________ (toward/away from) the side of the lesion.
(p. 418)
29.
With a lesion in CN XII, the tongue deviates _______________ (toward/away from) the side of the
lesion. (p. 418)
30.
What is the obstruction in open/wide angle glaucoma? What is the obstruction in closed/narrow
angle glaucoma? Which one is painful? (p. 421) ________________________________________
______________________________________________________________________________
31.
Referring to the image below, which cranial nerve and muscle are tested with each movement?
(pp. 421-422)
Identify the type of visual field defect in the image below. (p. 423)
33.
page 149
Horizontal diplopia develops in a 26-year-old woman with multiple sclerosis. Examination reveals
she cannot adduct her left eye past midline and has a left-beating nystagmus in her right eye when
looking to the right. However, her left eye can adduct during convergence. Where is the lesion most
likely located? (pp. 424-425)? ______________________________________________________
PATHOLOGY
34.
Match the type of dementia with its defining characteristic. (p. 425)
_____ A. Alzheimers disease
_____ B. Creutzfeld-Jakob disease
_____ C. Frontotemporal dementia
_____ D. Lewy body dementia
35.
1.
2.
3.
4.
-Synuclein defect
Neurofibrillary tangles
Prions
Tau protein
For each case, identify the type of seizure and its first-line treatment. (pp. 426-431)
A.
A teenage boy suddenly stiffens, falls down, and experiences rhythmic jerking of his
extremities lasting 1 minute. ___________________________________________________
B.
A 7-year-old boy is referred to his primary physician for behavioral problems at school. He
spaces out during class. EEG shows a 3-Hz spike-and-wave pattern.
__________________________________________________________________________
36.
37.
C.
A 1-year-old girl is brought to the emergency department because she had been shaking and
unresponsive for 30 seconds. Her rectal temperature is 104F. ________________________
D.
A 45-year-old man who suffered a concussion from a car accident has episodes of jerky
movements of his left arm that he cannot control. He remembers the incident itself, but had
blacked out afterward. ________________________________________________________
For each case, identify the most likely neurocutaneous disorder. (p. 427)
A.
A 6-month-old presents with her first seizure. Woods lamp examination shows several areas
of hypopigmentation over her trunk and extremities. ________________________________
B.
A 6-month-old has a port wine stain over his left eye and cheek, extending to the tip of his
nose, with a sharp drop-off to normal-toned skin on the right side of his face. _____________
C.
A 6-month-old has congestive heart failure. Imaging shows a cavernous hemangioma in the
liver. ______________________________________________________________________
D.
A 6-month-old has multiple hyperpigmented brown macules scattered over the trunk and
upper extremities. ___________________________________________________________
For each case, identify the most likely brain tumor. (p. 428-429)
A.
A 49-year-old man presents with a 2-month history of morning headaches. CT of the head
shows a heterogenous-appearing mass with irregular borders crossing the corpus callosum.
__________________________________________________________________________
B.
C.
A 4-year-old boy presents with a 1-month history of morning headaches, abnormal gait, and
dysmetria. Imaging shows a pilocytic appearance in the posterior fossa. _________________
D.
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38.
PHARMACOLOGY
39.
Match the drug with its indication for use. (pp 430-433)
_____ A. Acute status epilepticus
_____ B. Absence seizures
_____ C. Chronic pain
_____ D. Closed/narrow angle glaucoma
_____ E. Induction of anesthesia
_____ F. Insomina
_____ G. Opiate dependency
_____ H. Seizure prophylaxis in pregnancy
40.
1.
2.
3.
4.
5.
6.
7.
8.
Diazepam
Ethosuximide
Methadone
Phenobarbital
Pilocarpine
Thiopental
Tramadol
Zolpidem
Describe the mechanism of action for each drug commonly used to treat Parkinsons disease. (pp.
435-436)
A.
Benztropine ________________________________________________________________
B.
Bromocriptine ______________________________________________________________
C.
L-dopa/carbidopa ___________________________________________________________
D.
Selegiline __________________________________________________________________
Answers
ANATOMY AND PHYSIOLOGY
1.
2.
3.
Nonpolar/lipid-soluble substances cross rapidly (via diffusion); glucose and amino acids cross
slowly (by carrier-mediated transport).
4.
5.
6.
Loss of dopamine inhibits the excitatory pathway and disinhibits (or excites) the inhibitory pathway.
page 151
7.
8.
9.
10.
A.
B.
C.
D.
11.
A-7, B-12, C-6, D-9, E-5, F-3, G-1, H-10, I-11, J-2, K-4, L-8.
page 152
12.
Wernickes; Brocas.
13.
The ACA supplies the medial surface of the brain, which covers the leg area of the motor and
sensory cortices. The MCA supplies the motor and sensory cortex of the face and arm. The PCA
supplies the occipital cortex.
14.
15.
16.
This patient has had a stroke, and the bright areas on noncontrast CT indicate hemorrhage. Thus
tPA should not be administered.
17.
18.
Nerves C1-C7 exit above the corresponding vertebra; the others exit below the corresponding
vertebrae.
19.
20.
Characteristic
UMN Lesion
LMN Lesion
Atrophy
Babinski reflex
Fasciculation
Reflexes
Spastic paralysis
Tone
Weakness
21.
page 153
A.
Lower motor neuron lesions only, attributable to destruction of anterior horns; poliomyelitis
and Werdnig-Hoffmann disease.
B.
C.
Combination of upper and lower motor neuron deficits with no sensory deficit; amyotrophic
lateral sclerosis.
D.
Complete occlusion of anterior spinal artery with sparing of dorsal columns and tract of
Lissauer.
E.
F.
G.
22.
23.
CN
Name
Function
Type (Sensory/
Motor/Both)
Location in
Brainstem
Olfactory
Smell
Sensory
In cerebrum
II
Optic
Sight
Sensory
Midbrain
III
Oculomotor
Eye movements
Pupillary constriction
Eyelid opening
Motor
Midbrain
IV
Trochlear
Eye movements
Motor
Midbrain
Trigeminal
Facial sensation
Muscles of mastication
Both
Pons
VI
Abducens
Eye movements
Motor
Pons
VII
Facial
Muscles of facial
expression
Taste from anterior two
thirds of tongue
Lacrimation
Salivation
Eyelid closing
Stapedius muscle in ear
Both
Pons
VIII
Vestibulocochlear
Hearing
Balance
Sensory
Pons
Glossopharyngeal
Both
Medulla
IX
page 154
Vagus
XI
Accessory
Head turning
Shoulder shrugging
Motor
Medulla
XII
Hypoglossal
Tongue movement
Motor
Medulla
Both
Medulla
24.
25.
26.
27.
28.
29.
30.
Open/wide angle glaucoma is due to obstructed outflow. Closed/narrow angle glaucoma is due to
obstructed flow between iris and lens. Closed/narrow angle glaucoma is painful.
31.
Line A-B (SR-SO): assesses CN III all but the superior oblique and the lateral rectus.
Line C-D (IO-IR): assesses CN IV the superior oblique.
Line E-F (MR-LR): assesses CN VI the lateral rectus.
32.
33.
page 155
The reason her left eye can adduct during convergence but not during right lateral gaze is because
the oculomotor nerve itself works perfectly, but the connection between the abducens nuclei and
the oculomotor nuclei is impeded. The message to look right does not reach the left medial
rectus, causing the right eye to beat leftward because of the dysconjugate image. (If you are still
confused, now would be an excellent time to review INO.)
PATHOLOGY
34.
35.
A.
B.
C.
Febrile seizures. Do not use anti-epileptics. Give acetaminophen for the fever. If it appears to
be a simple febrile seizure (1 seizure/illness; no previous febrile seizures), recurrence of
seizure is not likely.
D.
Simple partial seizures with secondary generalization. Virtually any anti-epileptic drug can be
used; the most common are phenytoin, carbamazepine, levetiracetam, and valproic acid.
A.
Tuberous sclerosis.
B.
Sturge-Weber syndrome.
C.
Cavernous hemangiomas can occur in isolation, but are associated with von Hippel-Lindau
disease.
D.
Neurofibromatosis type 1.
A.
Glioblastoma multiforme.
B.
Meningioma.
C.
Medulloblastoma.
D.
Craniopharyngioma.
36.
37.
38.
PHARMACOLOGY
39.
40.
A.
Inhibits acetylcholine, which preferentially excites the inhibitory pathway over the excitatory
pathway. The net effect of acetylcholine is inhibition of the thalamus.
B.
C.
Inhibits peripheral breakdown of L-dopa, which crosses the blood-brain barrier and is
converted to dopamine in the brain. The net effect is an increase of dopamine in the brain
milieu.
D.
page 156
Notes
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Copyright 2011 by MedIQ Learning, LLC