Download Chean Chung Shen

nd
2
year neurology Q&A
By Chean Chung Shen
EMQ 1: Cranial nerve anatomy
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Abducent nerve
Accessory nerve
Facial nerve
Glossopharyngeal nerve
Hypoglossal nerve
Occulomotor nerve
Trigeminal nerve
Trochlear nerve
Vagus nerve
Vestibulocochlear nerve
Olfactory nerve
Optic nerve
For each of the statements below, select
the most appropriate cranial nerve from the
above list.
1. Forms the afferent pathway of gag
reflex
D
2. Innervates the levator palpebrae
superioris F
3. Required for a normal cough
I
4. Innervates the stapedius muscle C
5. Required to look downwards and
outwards H
6. Associated with herpes zoster
ophthalmicus G
EMQ 2: Cranial nerve anatomy & lesion
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Abducent nerve
Accessory nerve
Facial nerve
Glossopharyngeal nerve
Hypoglossal nerve
Occulomotor nerve
Trigeminal nerve
Trochlear nerve
Vagus nerve
Vestibulocochlear nerve
Olfactory nerve
Optic nerve
1.
2.
3.
4.
5.
6.
Damage is accompanied by the
inability to whistle C
Innervates the orbicularis oculi
C
Associated with false localising sign A
Associated with posterior
communicating artery aneurysm F
Only cranial nerve that exits from the
dorsal part of the brainstem
H
Longest cranial nerve
H
SBA question 1
A previously fit and well 34-year-old man presents with a 10-day history of
flu-like illness and weakness in his lower limbs. Neurological examination of
his cranial nerves and upper limbs is normal but his lower limbs have grade
4/5 distal weakness, diminished reflexes and equivocal plantar responses.
Vibration and joint position sense and light touch are also reduced distally.
Which of the following is the most likely diagnosis?
A. Gullain-Barre syndrome
B. Multiple sclerosis
C. Poliomyelitis
D. Spinal cord compression
E. Motor neurone disease
SBA question 2
Which of the following is the BEST explanation of ‘forehead sparing’ in
upper motor neuron lesion?
A. Bilateral innervation in the brainstem
B. Partial stroke
C. Occulomotor nerve is usually not affected
D. Weakness of levator palpebrae superioris
E. Weakness of Muller muscle causing partial ptosis
SBA Question 3
A previously fit and well 75-year-old man presents to his GP with a 3month history of insidious worsening of his right hand tremor. On
examination, his gait is slow and has poor ‘swing through’. There is an
associated ‘cog-wheeling’ of the right upper limb.
Which of the following is the most likely diagnosis?
A. Alzheimer’s disease
B. Multisystem atrophy
C. Post-encephalitic parkinsonism
D. Idiopathic Parkinson disease
E. Progressive supranuclear palsy
SBA question 4
Which of the following neurotransmitters are excitatory?
A. Glutamate
B. GABA
C. Dopamine
D. Serotonin
E. Glycine
Neurotransmitter
Foramen of the skull
Foramen rotundum- Maxillary nerve (V2)
Foramen lacerum- artery of pterygoid canal, Meningeal branch
of ascending pharyngeal artery, Occipital arteryemissary vein
Foramen ovale- Mandibular nerve (V3)
Foramen magnum- anterior and posterior spinal arteries, vertebral
arteries, accessory nerve
Foramen cecum- emissary veins to superior sagittal sinus from the
upper part of the nose
Foramen spinosum- Middle meningeal artery and meningeal branch of
the mandibular nerve
EMQ 3: Memory loss
A.
B.
C.
D.
E.
F.
G.
H.
Implicit memory
Explicit memory
Episodic memory
Semantic memory
Short-term memory
Anterograde memory
Retrograde memory
Transient global amnesia
1. Associated with driving a car and
other complex motor skills, which
are learned motor responses, not
available to conscious access A
2. Recalling autobiographic details C
3. General store of world knowledge D
4. Acquisition of new material F
5. Recall of previously learnt
information G
6. Working memory responsible for
immediate recall of small amounts
of material E
Dementia types:
- Alzheimer’s disease
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia/ Picks
dementia/ ‘semantic dementia’
- Alcoholic dementia
- Pseudodementia
- Normal pressure hydrocephalus
(gait dyspraxia, urinary
incontinence, cognitive
impairment)
Hydrocephalus
• Communicating:
- More common
- Due to blockage outside the
ventricular system
- Most commonly occur in the
arachnoid villi
- Example: post-meningitic
• Non-communicating
- Obstruction with the ventricular
system
- Example: aqueductal stenosis,
pineal tumour
EMQ 4: Neurological terms
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
Dyspraxia
Dyscalculia
Dysarthria
Dysgraphia
Agnosia
Prosopagnosia
Aphasia
Dysphasia
Dystonia
Dyskinesia
Dyslexia
Dysnomia
1.
2.
3.
4.
5.
6.
7.
G/L
Inability to recognise things E
Inability to recognise familiar faces F
Impairment of language function H
Impairment of articulation C
Impairment in writing D
Inability to perform complex motor
acts despite normal power, sensation,
coordination and good comprehension
A
General inability to produce words for
things a person want to take about
EMQ 5: Weakness
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Transient ischaemic attack
Stroke
Bell’s Palsy
Bulbar palsy
Pseudobulbar palsy
Quadriplegia
Paraplegia
Hemiplegia
Hemiparesis
Paraparesis
Please select the most appropriate term
that best represents the statement below:
1.
2.
3.
4.
5.
An idiopathic condition that gives
lower motor neuron signs of facial
nerve palsy C
Paralysis of both lower limbs G
Paralysis of all four limbs F
Episodes of neurological dysfunction
caused by ischaemia which usually
resolve within 24 hours A
Usually associated with amaurosis
fugax A
EMQ 6: Nerve roots and dermatomes
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
C5/6
C7/8
C8/T1
T12/L1
L1/2
L2/3
L3/4
L5/S1
S1/2
S3/4
T4
T10
T12
1. Nerve root for knee jerk reflex G
2. Innervates the levator ani
J
3. Common location for lumbar
puncture G
4. Dermatomes for umbilicus L
5. Nerve root reflex for brachioradialis
reflex A
6. Nerve root for cremasteric reflex D
EMQ 7: Upper limb innervation
A. Musculocutaneous nerve
B. Median nerve
C. Ulnar nerve
D. Radial nerve
E. Axillary nerve
F. Subscapular nerve
G. Long thoracic nerve
Please select the most appropriate
nerves associated with the following
statement:
1. Damage of the nerve causes
winging of scapula G
2. Sensory supply to the regimental
badge E
3. Nerve roots are mainly C8-T1 C
4. Innervates the brachialis,
coracobrachialis, and biceps
brachii A
5. Damage of the nerve causes
‘Saturday night palsy’ D
EMQ 7: Upper limb innervation (2)
A. Musculocutaneous nerve
B. Median nerve
C. Ulnar nerve
D. Radial nerve
E. Axillary nerve
F. Subscapular nerve
G. Long thoracic nerve
1. Damage of the nerve causes
wrist drop D
2. This nerve is compressed in
carpal tunnel syndrome B
3. Nerve damage associated with
humeral shaft fracture D
4. Nerve damage associated with
supracondylar fracture B/C
5. Most commonly damaged due to
fracture of surgical neck of
humerus E
EMQ 8: Spinal tracts
A.
Dorsal column
B.
Dorsal spinocerebellar tract
C.
Dorsolateral tract
D.
Gracile fasciculus
E.
Cuneate fasciculus
F.
Fasciculus proprius
G.
Lateral corticospinal tract
H.
Anterior corticospinal tract
I.
Substantia gelatinosa
J.
Anterior spinothalamic tract
K.
Lateral spinothalamic tract
L.
Anterior spinocerebellar tract
M. Ventral grey column (Medial reticulopsinal
and lateral reticulospinal)
Please identify the most appropriate
pathway from the list to match the
following descriptions.
1.
Carries fibres that synapse in the
upper medulla and decussate to
form the medial lemniscus
D
2.
Carries fibres that decussate in
the medullary pyramid G
3.
Carries ascending neurones
responding to cutaneous pain and
temperature J
4.
Carries predominantly ipsilateral
ascending proprioceptive fibres
from the thoracic nucleus B
5.
Lies between the dorsal root and
dorsal grey matter
C
EMQ9: Visual defects
A.
Amaurosis fugax
B.
Bitemporal hemianopia
C.
Metamorphopsia
D.
Central scotoma
E.
Cortical blindness
F.
Diplopia to left gaze
G.
Diplopia to right gaze
H.
Myopia
I.
Hypermetropia
J.
Nyctalopia
K.
Right homonymous hemianopia
L.
Retrobulbar neuritis
M.
Tunnel vision
N.
Altitudinal visual loss
O.
Right homonymous superior quadrantanopia
Please select the most appropriate
visual defect that is most appropriate
for the following statements:
1. Occur with left sixth nerve palsy,
causing blurring of vision F
2. Also called loss of central vision D
3. Causing increased risk of acute
close angle glaucoma I
4. Mainly associated with macular
degeneration, when patients
complain of distorted vision C
5. Associated with retinitis pigmentosa
J
6. Associated with multiple sclerosis L
7. Associated with pituitary tumour B
8. Associated with lesion in the optic
radiation O
9. Lesion affecting temporal lobe O
EMQ 10: Intracranial haemorrhage
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Acute subdural haemorrahage
Chronic subdural haemorrhage
Extradural haemorrhage
Intracerebral haemorrhage: Anterior
cerebral artery territory
Intracerebral haemorrhage: Middle
cerebral artery territory
Intracerebral haemorrhage: Posterior
cerebral artery territory
Intracerebral haemorrhage:
Vertebrobasilar artery territory
Intracerebellar haemorrhage
Intraventricular haemorrhage
Subarachnoid haemorrhage
Please select the most appropriate diagnosis
1.
2.
3.
4.
5.
Most commonly associated with rupture of
berry aneurysm J
Can cause xanthochromia in CSF J
Associated with a lucid interval C
Post-head injury syndrome characteristic of
frontal brain damage causing behavioural
and speech as well as motor abnormalities
D
A 55-year-old hypertensive man with no
previous history of neurological events
presents with a sudden onset of right sided
hemiparesis (arm>leg) and hemisensory
loss. He is also noted to have an expressive
aphasia. He is right-handed E
EMQ11: Site of stroke
A.
B.
C.
D.
E.
F.
G.
H.
Cerebellar
Frontal cortex
Medullary
Occipital cortex
Parietal cortex
Pontine
Subcortical
Temporoparietal cortex
The following right-handed patients
have presented with a stroke. Please
choose the most appropriate
anatomical site of their stroke.
1. 70-year-old man with right upper
limb weakness, expressive
dysphasia, urinary incontinence,
and a change in his persona B
2. A 63-year-old diabetic smoker with
right hemiparesis and dyspraxia. He
is unable to draw a clock face
correctly on examination. E
3. 45-year-old with receptive
dysphasia, right hemiparesis and a
right homonymous hemianopia H
4. 54-year-old woman with nystagmus
to the left, past-pointing on the left,
and dysdiadochokinesis A
5. 67-year-old man diagnosed with
Anton’s syndrome D
SBA: Question 5
Which of the following cranial nerves is most probably the first to be
affected in cavernous sinus thrombosis?
A. Occulomotor nerve
B. Trochlear nerve
C. Trigeminal nerve
D. Abducens nerve
E. Facial nerve
SBA: Question 6
A 24-year-old student presents in the emergency department with a 6-hour
history of severe generalised headache, associated with vomiting. She is
noted to be taking oral contraceptive pill. On examination, she is in obvious
distress, with mild meningism, but she is apyrexial and has no rash.
Ophthalmoscopy shows bilateral papilloedema and a CT scan of her head
with contrast confirms the diagnosis.
Which of the following is the most likely diagnosis?
A. Benign intracranial hypertension
B. Meningitis
C. Sagittal sinus thrombosis
D. Space-occupying lesion
E. Temporal arteritis
Benign intracranial hypertension vs Sagittal
sinus thrombosis
Benign intracranial hypertension
-Also called idiopathic intracranial
hypertension
- Young women
- Associated with obesity
- Associated with visual impairment
- Generalised throbbing headache
first thing in the morning and last
thing at night
- Gradual visual field defect
Sagittal sinus thrombosis
- Hypercoaguability
- Young women
- Can be associated with sinusitis
- Headache similar to subarachnoid
haemorrhage
- Papilloedema, impaired
consciousness, maybe seizures, and
possible neurological signs
Some of the conditions to go through
•
•
•
•
•
•
•
•
•
•
•
•
Stroke
TIA
Multiple sclerosis
Intracranial haemorrhage: Subdural, extradural and subarachnoid haemorrhage
Delirium vs dementia (Alzheimer’s disease)
Epilepsy
Parkinson’s disease
Bell’s palsy
Myasthenia gravis
Mononeuropathies
Polyneuropathies
Diabetic neuropathy (Autonomic neuropathy)
Thank you for listening!