Download methodological developments to practical classes on neurology for

SMOLENSK STATE MEDICAL UNIVERSITY
DEPARTMENT OF NEUROLOGY AND NEUROSURGERY
METHODOLOGICAL DEVELOPMENTS
TO PRACTICAL CLASSES
ON NEUROLOGY
FOR THE STUDENTS
OF FOREIGN FACULTY
аutumn semester
Smolensk
2016
1
GENERAL NEUROLOGY
THEME 1:
THE PHYSIOLOGY AND PATHOLOGY OF MOTOR FUNCTION.THE
METHODS OF INVESTIGATION OF MOTOR FUNCTIONS, WAYS OF
ELICITING OF PHYSIOLOGICAL AND PATHOLOGICAL REFLEXES.
MOVEMENT DISORDERS: CENTRAL AND PERIPHERAL PARALYSIS.
Quizzes
Select one correct answer
1. Which IS NOT characteristic of the upper motor neuron lesion?
a. global atrophy
b. hyperreflexia
c. individual atrophy
d. central palsy signs (i.e. pyramidal signs)
e. diminished superficial abdominal reflexes
f. increased tone in the antigravity muscles
2. Which IS NOT a feature of upper motor neuron disease?
a. exaggerated reflexes
b. Babinski sign
c. ophthalmoplegia
d. fasciculations
3. Which of the following IS NOT characteristic of a lesion of the lower
motor neuron?
a. individual paresis
b. individual atrophy
c. diminished deep tendon reflexes
d. Achilles clonus
e. fasciculation
f. extensor plantar reflex
4. Muscle hypotonia would be expected in a damage to all of the following
structures EXCEPT:
a. peripheral nerve
b. cerebellum
c. thalamus
d. lower motoneuron
5. Characteristic features of spasticity – the muscle tone is increased:
a. in flexors of the arms and in extensors of the legs
b. in flexors of the arms and legs
c. in extensors of the arms and legs
d. in all muscle groups
6. Cog-wheel rigidity can be found in:
a. Foster Kennedy syndrome
b. Parkinson's disease
c. Wernicke encephalopathy
d. multiple sclerosis
7. Which of the following IS NOT indicative of a damage to the pyramidal
tract?
a. spasticity
2
b. hyperreflexia
c. Babinski sign
d. muscle fasciculation
8. Which of the following signs IS NOT indicative of a damage to the
pyramidal tract?
a. Babinski
b. Brudzinski
c. Rossolimo
d. Chaddock
9. Which of the following DOES NOT participate in regulation of the muscle
tone?
a. muscle spindle
b. motor neuron in the ventral horn of the spinal cord
c. cerebellum
d. spinothalamic tract
10. The decussation of the corticospinal tracts occurs:
a. in the internal capsule
b. near the caudal extremity of the medulla oblongata
c. above the sensory decussation
d. in the ventral pons
e. in the ventral funiculus of the spinal cord
11. In the pathway of the pyramidal tract, the axons project through all of
the following EXCEPT:
a. corona radiata
b. posterior limb of the internal capsule
c. pedunculuscerebri
d. pontinetegmentum
e. lateral funiculus of the spinal cord
f. anterior funiculus of the spinal cord
12. Which of the following tracts DOES NOT decussate along their course?
a. dorsal spinocerebellar
b. ventral spinocerebellar
c. spinothalamic
d. medial lemniscus
e. spinotectal
f. rubrospinal
13. Where is the primary motor cortex located?
a. in the parietal lobe
b. in the postcentralgyrus
c. in the precentralgyrus
d. in the temporal lobe
e. in the operculum
f. in the prefrontal area
14. All of the following are superficial reflexes EXCEPT:
a. flexor plantar reflex
b. abdominal reflexes
c. conjunctival reflex
d. cremasteric reflex
e. masseter reflex
15. Which IS NOT a deep tendon reflex?
a. corneal reflex
b. masseter reflex
3
c. triceps reflex
d. biceps reflex
e. Achilles reflex
f. patella reflex
Quizzes
Select all correct answers
1. Tick the items that describe UPPER MOTOR NEURON LESION (central
paralysis)
muscle weakness
muscle atrophy
musclehypotonycity
musclehypertonycity (spasticity)
fasciculations or fibrillations
diminishing of superficial reflexes
exaggeration of muscle stretch reflexes
pathological reflexes
clonus
abnormal associated movements
2. Tick the items that describe LOWER MOTOR NEURON LESION
(peripheral paralysis)
muscle weakness
muscle atrophy
musclehypotonycity
musclehypertonycity (spasticity)
fasciculations or fibrillations
diminishing of superficial reflexes
exaggeration of muscle stretch reflexes
pathological reflexes
clonus
abnormal associated movements
3. Tick the PHYSIOLOGICAL (seen in healthy subjects) MUSCLE
STRETCH REFLEXES in the list following
the biceps reflex
the middle abdominal reflex
the cremasteric reflex
the plantar reflex
the Babinski sign
the triceps reflex
the Achilles (triceps surae) reflex
the palmomental reflex of Marinesco-Radovici
the Rossolimo sign
flexion spinal defense reflex
4. Tick the CORTICOSPINAL (PYRAMIDAL) TRACT RESPONSES in the
list following
the biceps reflex
4
the middle abdominal reflex
the cremasteric reflex
the plantar reflex
the Babinski sign
the triceps reflex
the Achilles (triceps surae) reflex
the palmomental reflex of Marinesco-Radovici
the Rossolimo sign
flexion spinal defense reflex
Write the missing signs of the central and peripheral paralysis
SIGN
Weakness
PERIPHERAL
PARALYSIS
Focal, segmental
Tone
Hypotonicity
Atrophy
Fasciculations
Muscle stretch
reflexes
Superficial reflexes
Pathological reflexes
Associated
movements and
defense reflexes
Clonus
In the involved muscles
Often present
Diminished/absent
CENTRAL PARALYSIS
Generalized, involves
entire extremities
Hypertonicity
(spasticity)
No localized atrophy
Absent
Exaggerated
Normal
No
No
Diminished/absent
Present
Occasionally
present
No
Occasionally
present
Sign pathological reflexes
A-
B-
5
C-
D–
Write the missing structures in the scheme
neuraxes
(precentral convolution)
corona radiata
internal capsule
genu and the anterior
2/3 of the posterior limb
THE PYRAMIDAL PATHWAY
The corticospinal tract deals with
discrete, isolated motor responses
thalamus
n. caudatus
(caput)
pedunculus cerebri
the corticonuclear tract
pons
pyramid
80% - 90% fibers decussate
smaller ventral corticospinal tract
descends uncrossed in the ipsilateral
ventral funiculus and usually does not
extend below the midthoracic region
(usually cross before terminating)
lateral corticospinal
tract
the lateral funiculus
of the spinal cord
C1
Th
muscle
6
THEME 2:
SENSORY SYSTEM AND ITS DISORDERS.METHODS OF
INVESTIGATION.PHYSIOLOGY AND PATHOLOGY OF PAIN.
Quizzes
Select one correct answer
1. Where is the primary sensory cortex located?
a. in the frontal lobe
b. in the temporal lobe
c. in the parietal lobe
d. in the prefrontal area
e. in the cingulate gyrus
f. in the angular gyrus
2. All of the following structures are sensitive to pain EXCEPT:
a. periosteum
b. meninges
c. majority of blood vessels
d. brain parenchyma
3. All of the following are sensory receptors EXCEPT:
a. Merkel's disks
b. Hassall corpuscles
c. Meissner's corpuscles
d. Paccinian corpuscles
e. Ruffini endings
f. Krause end bulbs
4. Impairment of position sense could be caused by a lesion in which of the
following structures:
a. ventral root
b. central part of the spinal cord
c. ventral horn of the spinal cord
d. posterior funiculus of the spinal cord
e. lateral funiculus
f. ventral funiculus
Quizzes
Select all correct answers
1) The receptors providing information about the position of joints are:
proprioceptors
skin receptors
free nerve endings
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receptorsin the labyrinth
interoceptors
2) The proprioceptive impulses are conducted by:
posteriorfuniculi
anteriorspinothalamic tract
lateralspinothalamic tract
corticospinal pathway
rubrospinal pathway
3) The primary sensory cortex is located in:
occipital lobe
medial surface of temporal lobe
parietal lobe
olfactory sulci of frontal lobe
septapellucida
4) The fibers carrying propriceptive impulses from legs and lower trunk run
in:
fasciculusgracilis
fascilculuscuneatus
anteriorspinothalamic tract
lateralspinothalamic tract
corticospinal tract
5) The dissociated sensory loss is seen in:
peripheral nerve lesions
root lesions
dorsal root ganglion lesions
spinal cord lesion
thalamus lesions
6) The receptors transmitting pain and temperature are:
proprioceptors
free nerve endings
receptorsin the labyrinth
interoceptors
pseudo-unipolar ganglion cell
7) The tactile impulses are conducted by:
posteriorfuniculi
anteriorspinothalamic tract
lateralspinothalamic tract
corticospinal pathway
rubrospinal pathway
8) The second neuron of lateral spinothalamic tract is located in:
substantiagelatinosa
nucleusintermedius
8
nucleuscuneatus
medial surface of temporal lobe
parietal lobe
9) The fibers carrying propriceptive impulses from chest, arms, and neck run
in:
fasciculusgracilis
fascilculuscuneatus
anteriorspinothalamic tract
lateralspinothalamic tract
corticospinal tract
10)
The lesion of dorsal root ganglion appears as (more than one answer is
suggested):
segmentalsensory diminution
sensory diminution in distal segments of extremities (gloves and stocking)
lancinating pain
trophic changes in the extremities
dissociated sensory loss
11)
The inability of perceiving and understanding the form and nature of
objects by touch is known as:
astereognosis
graphanesthesia
autotopagnosia
anosognosia
dysphasia
12)
A patients with sensitive ataxia:
tends to fall with his eyes closed
tends to fall with his eyes opened
presents with impairment of cerebellar functions
has posterior columns lesion
hasgloves and stocking sensory loss distribution
13)
Which of the following DOESNOT carry sensory information?
laterallemniscus
mediallemniscus
ventral root
dorsal root
peripheral nerve
14)
Pallesthesia is the ability to:
perceive the presence of vibration
perceive pain and temperature
discriminate two-point stimulation
perceive deep pressure
is abnormal sensations experienced in absence of any stimulation
9
15)
The lesion of the peripheral nervesmay have the following features
(more than one answer is suggested):
segmentalsensory diminution
sensory diminution in the distribution of the nerve affected
thesensory loss is often dissociated
paresthesias and pain are probable
trophic changes in the extremities
Write types of sensory disorders
АBCD-
10
Write the missing structures in the scheme
11
THEME 3:
DISORDERS OF THE SPINAL CORD AND PERIPHERAL
NERVES.DIRORDERS OF URINATION, DEFECATION AND
GENITAL FUNCTIONS.
Quizzes
Select one correct answer
1. The total number of spinal nerves are
a. 30 pairs
b. 31 pairs
c. 29 pairs
d. none of the above
2. The spinal cord ends at the level of
a. T12 vertebra
b. L1 vertebra
c. L3 vertebra
d. S1 vertebra
3. Sacral sparing is a feature of
a. intramedullary lesion
b. extramedullary lesion
c. extradural abscess
d. transverse myelitis (i. e. complete spinal cord transection)
4. Horner's syndrome occurs in spinal cord lesions above
a. T6
b. T2
c. C6
d. C4
5. Which of the following segment is involved in the knee jerk?
a. L1
b. L4
c. L5
d. S1
6. Loss of the Achilles reflex results from the lesion to the:
a. L4 segmentum
b. L3 segmentum
c. S1 segmentum
d. L2 segmentum
e. Th12 segmentum
f. none of the above
7. Characteristic signs of conusmedullaris syndrome include EXCEPT:
a. central palsy signs (i.e. pyramidal signs)
b. sphincter dysfunction
c. perineal sensory deficit
d. symmetric neurological signs
e. loss of anal reflex
f. sexual dysfunction
8. Which of the following IS NOT a feature of the caudaequina syndrome?
a. flaccid paresis
b. hyporeflexia
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c. central palsy signs (i.e. pyramidal signs)
d. asymmetric neurological signs
e. symmetric neurological signs
f. muscle atrophy
9. All of the following may be the anatomical basis of spastic paraparesis
involving legs EXCEPT:
a. parasagittal processes
b. lesion in the pontine base
c. damage to the thoracical spinal cord
d. lesion to the ventral tegmental area
10. Which of the following is indicative of a complete unilateral lesion of the
dorsal column?
a. intact vibratory sensation ipsilaterally below the level of the lesion
b. ipsilateral loss of conscious proprioception below the level of the lesion
c. contralateral loss of discriminative touch starting at 1-2 segments below the
level of the lesion
d. contralateral loss of conscious proprioception below the level of the lesion
e. loss of pain and temperature sensations ipsilaterally below the level of the
lesion
f. none of the above
11. The cell bodies of the preganglionic sympathetic neurons are located in
the:
a. ventral horn horn of the spinal cord
b. dorsal horn of the spinal cord
c. nucleus proprius
d. sacral level of the spinal cord
e. none of the above
f. all of the above
12. Which IS NOT characteristic of radial nerve lesion?
a. ape hand
b. weakness of finger extension
c. the forearm is a prone position
d. wrist drop
e. weakness of wrist extension
f. all of the above
13. Which of the following statement IS NOT TRUE regarding the upper
plexus brachialis lesion (Erb-Duchenne)?
a. Horner's syndrome is present
b. the patients are unable to abduct their shoulder
c. the patients are unable to laterally rotate their upper arm
d. the affected upper extremity is in internal rotation and pronation
e. the patients present in a “waiter’s tip” position
f. the affected roots are: C5 and C6
14. “Steppage gait” may associate with the injury of the:
a. tibial nerve
b. peroneal nerve
c. femoral nerve
d. sural nerve
e. cervical spinal cord
f. superficial femoral nerve
13
Quizzes
Select all correct answers
1.
CERVICAL ENLARGEMENT in the spinal cord is located on the
level of:
 C5-Th1 segments
 L1-S2 segments
 Th1-L3 segments
 S2-S4 segments
 C3-C8 segments
2.
Where does the PYRAMIDAL (corticospinal) PATHWAY go in the
spinal cord?
lateral column
anterior column
dorsal column
anterior horn
posterior horn
3.
COMPLETE TRANSECTION of the spinal cord is followed by:
flaccid palsy on the level of the lesion
flaccid palsy below the level of the lesion
spastic palsy below the level of the lesion
loss of all types of sensations below the level of the lesion
dissotiated type of sensory loss below the level of the lesion
4.
Lesion on C1-C5 LEVEL is characterized by:
upper paraplegia
tetraplegia
loss of all types of sensations below the level of the lesion
dissotiated type of sensory loss below the level of the lesion
upper neuron type of bladder dysfunction
5.
The signs of DORSAL FUNICULI lesion are:
hemiplegia
loss of proprioceptive sensation below the lesion
loss of pain and temperature sensation below the level of the lesion
loss of all types of sensations below the level of the lesion
sensitive ataxia
6.
of:
LUMBAR ENLARGEMENT in the spinal cord is located on the level
 C5-Th1 segments
 L1-S2 segments
 Th1-L3 segments
 S2-S4 segments
 C3-C8 segments
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7.
Where does the LATERAL SPINOTHALAMIC PATHWAY go in
the spinal cord?
lateral column
anterior column
dorsal column
anterior horn
posterior horn
8.
THE BROWN-SEQUARD SYNDROME is:
lateralhemisection of the spinal cord
loss of pain and temperature sensation on the contralateral side
loss of pain and temperature sensation on the side of the lesion
loss of proprioception and tatctile sensation on the contralateral side
central palsy on the side of the lesion
9.
Lesion on C5-Th1 LEVEL is characterized by:
flaccid palsy of hands
flaccid palsy of legs
spastic palsy of legs
complete sensory loss below the lesion
 Horner’s syndrome
10.
The signs of POSTERIOR ROOT lesion are:
tetraplegia
segmental flaccid palsy
segmental sensory loss
loss of pain and temperature sensation below the level of the lesion
sensitive ataxia
11.
INTERMEDIOLATER CELL COLUMN in the spinal cord is found
on the level of:
 C5-Th1 segments
 L1-S2 segments
 Th1-L3 segments
 S2-S4 segments
 C3-C8 segments
12.
Where does the FASCICULUS CUNEATUS go in the spinal cord?
lateral column
anterior column
dorsal column
anterior horn
posterior horn
13.
Tranverse damage of the ANTERIOR HALF of the spinal cordis
followed by:
spastic palsy below the lesion
segmental spastic palsy
15
segmental flaccid palsy
dissotiated type of sensory loss
complete sensory loss below the lesion
14.
Lesion on L1-S2 LEVEL is characterized by:
flaccid palsy of hands
flaccid palsy of legs
spastic palsy of legs
sensory loss in legs and saddle
lower motor neuron type of bladder dysfunction
15.
The signs of SPINAL NERVE lesion are:
spastic palsy below the lesion
segmental flaccid palsy
segmental sensory loss
loss of pain and temperature sensation below the level of the lesion
often – herpes zoster
16.
PARASYMPATHETIC CELLS innervating the bladder are foundon
the level of:
 C5-Th1 segments
 L1-S2 segments
 Th1-L3 segments
 S2-S4 segments
 C3-C8 segments
17.
Alpha motor neurons are located in:
lateral column
anterior column
dorsal column
anterior horn
posterior horn
18.
Tranverse damage of the POSTERIOR HALF of the spinal cordis
followed by:
spastic palsy below the lesion
segmental flaccid palsy
dissotiated type of sensory loss
complete sensory loss below the lesion
sensory ataxia
19.
Lesion on L4-S2 LEVEL is characterized by:
absence of ankle jerk (Achilles reflex)
spastic palsy of posterior group of leg muscles
paraanesthesia
upper motor neuron type of bladder dysfunction
lower motor neuron type of bladder dysfunction
20.
The features of SPINAL SHOCK (diaschisis) are:
16
flaccid paralysis below the lesion
spastic paralysis below the lesion
loss of all type of sensations below the level of the lesion
loss of pain and temperature sensation below the level of the lesion
absence of autonomic function
Mach the structures of human spinal cord on the picture below with their
names.
___ ventral root
___ dorsal root
___ dorsal root
ganglion
___ anterior horn
___ posterior horn
___ anterior column
___ posterior column
___ lateral column
___ central canal
Namethedamagednerve.
1–
2–
3–
17
Quizzes
1.
A patient presents with tetraplegia, difficulty of breathing, loss of all types
of sensation below the neck, upper neuron type of bladder dysfunction. At which
level of the spinal cord can the lesion be located?
____________________
2.
A patient presents with tetraplegia: flaccid palsy in hands and spastic palsy
in legs, loss of all types of sensation from the level of upper parts of chest, upper
neuron type of bladder dysfunction.At which level of the spinal cord can the
lesion be located?
____________________
3.
A patient presents with lower spastic paraplegia, loss of all types of
sensation from the level of the nipples, upper neuron type of bladder
dysfunction.At which level of the spinal cord can the lesion be located?
4.
A patient presents with lower flaccid paraplegia, lower paraanesthesia,
upper neuron type of bladder dysfunction. At which level of the spinal cord can
the lesion be located?
____________________
5.
A patient presents with flaccid paresis in the posterior group of muscles of
the legs. Achilles reflex is absent on both sides. Sensory loss below the buttocks
and in the saddle region is found. Upper neuron type of bladder dysfunction is
present. At which level of the spinal cord can the lesion be located?
____________________
6.
A patient presents with no visible motor dysfunction, but anal reflex is
lost. Sensory loss in found in the saddle region. Suffers from involuntary urination
without retention. At which level of the spinal cord can the lesion be located?
7.
Describe the clinical features of complete spinal cord transection at the
level of cervical enlargement:
motor function: 1) __________________________________________________
and2) ____________________________________________________________
sensory function:____________________________________________________
autonomic nervous system function:_____________________________________
bladder function:____________________________________________________
8.
Describe the clinical features of Brown-Sequard syndrome:
On the same side:
motor function: _____________________________________________________
sensory function: ___________________________________________________
On the opposite side:
motor function: _____________________________________________________
sensory function: ___________________________________________________
18
9.
Describe the clinical features of Horner’s syndrome:
level of the spinal cord lesion: ____________
1) ____________________________
2) ____________________________
3) ____________________________
10. Put down the types of bladder dysfunction: upper or lower motor neuron
lesion
1) The patient complains of difficulty in controlling his waterworks: he is unable
to hold the urine, and urinates frequently and almost involuntary, with small
quantities of urine. The bladder is not significantly
distended._________________________________________________________
_________
2) The patient complains of inability to void the bladder, it is distended; the urine
is discharging frequently and involuntary by
drops._____________________________________________________________
_____
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THEME 4:
CRANIAL NERVES (I-XII PAIRS).SYNDROMES OF LESION.
VOLUNTARY AND INVOLUNTARY EYE MOVEMENTS. BRAIN STEM
LESION SYNDROMES.MEDULLARY SYNDROMES, BULBAR,
PSEUDOBULBAR (SUPRANUCLEAR) AND ALTERNATING PALSIES.
Quizzes
Select all correct answers
1. Visual pathway includes all of the following EXCEPT:
a. lateral geniculate body
b. area striata
c. medial geniculate body
d. superior colliculus
e. area peristriata
2. An upper homonymous quadrantanopsia can arise from:
a. area striata
b. ipsilateral occipital lobe
c. contralateral parietal lobe
d. contralateral temporal lobe
e. optic chiasm
f. optic tract
3. Foster-Kennedy syndrome is characterized by all of the following
EXCEPT:
a. ipsilateral anosmia
b. contralateral papilledema
c. ipsilateral papilledema
d. ipsilateral optic atrophy
e. raised intracranial pressure
f. headache
4. EdingerWestphal nucleus lies
a. in the pontinetegmentum
b. between the red nuclei
c. in the floor of the fourth ventricle
d. between the inferior olives
e. in periaquaductal grey at level of superior colliculus
f. in periaquaductal grey at level of inferior colliculus
5. Miosis is associated to:
a. Horner syndrome
b. pontine bleeding
c. cholinergic toxicity
d. opiate overdose
e. all of the above
f. none of the above
6. Which of the following muscle is supplied by the trochlear nerve?
a. rectus superior
b. sphincter pupillae
c. levatorpalpebrae superior
d. obliquus superior
e. rectus inferior
20
f. obliquus inferior
7. The contents of the superior orbital fissure include EXCEPT:
a. oculomotor nerve
b. abducent nerve
c. facial nerve
d. trochlear nerve
e. ophthalmic nerve
8. The pathway for the pupillary light reflex DOES NOT involve:
a. pretectal nuclei
b. optic tract
c. optic radiation
d. brachium of superior colliculus
e. optic chiasm
f. third cranial nerve
9. The motor nucleus and the chief sensory nucleus of the trigeminal nerve
are located in the:
a. lower pons
b. middle pons
c. upper pons
d. lower midbrain
e. lower medulla oblongata
f. upper midbrain
10. Which of the following passes foramen ovale?
a. maxillary nerve
b. mandibular nerve
c. oculomotor nerve
d. trochlear nerve
e. abducent nerve
f. facial nerve
11. Which of the following is true of the nuclei of the facial nerve?
a. shares nucleus ambiguus with cranial nerves IX and X
b. motor nucleus is located in the upper pons
c. parasympathetic nucleus is the inferior salivatory nucleus
d. sensory nucleus is represented by the spinal trigeminal nucleus
e. none of the above
f. all of the above
12. All of the following deficits might occur with facial nerve palsy EXCEPT:
a. dry eyes
b. weakness of the muscles of facial expression
c. loss of taste to anterior 2/3rds of tongue
d. hyperacusis
e. weakness of the temporal muscle
13. Which of the following nerves carry parasympathetic fibers?
a. oculomotor
b. facial
c. vagus
d. glossopharyngeal
e. all of the above
f. none of the above
14. Signs of bulbar syndrome are (more than one answer is suggested):
a. absence of pharyngeal reflex
b. snout reflex
21
c. dysphagia
d. dysarthria
15. Pseudobulbar paresis may result from a damage to the:
a. cranial nerve nuclei located in the medulla oblongata ipsilaterally
b. cranial nerve nuclei located in the medulla oblongata bilaterally
c. corticobulbar fibers bilaterally
d. corticobulbar fibers ipsilaterally
16. Signs of pseudobulbar palsy are (more than one answer is suggested):
a. compulsive laughter and weeping
b. dysphagia
c. dysarthria
d. aphasia
17. Alternating syndromes may associate with a lesion to the:
a. cerebellum
b. extrapyramidal system
c. brainstem
d. frontal lobes
e. thalamus
f. red nucleus
18. Which of the following is damaged in a case of left sided hemiparesis
associated with a gaze paralysis to the right?
a. right frontal lobe
b. the pons on the right side
c. the pons on the left side
d. left frontal lobe
e. medulla oblongata on the left side
f. medulla oblongata on the right side
19. Ophthalmoplegia is a characteristic feature in all of the following
EXCEPT:
a. Gradenigo syndrome
b. Nothnagel syndrome
c. Millard-Gubler syndrome
d. Benedikt syndrome
e. Weber syndrome
f. Foville syndrome
20. A lateral medullary syndrome (Wallenberg) might result from occlusion
of the:
a. posterior inferior cerebellar artery
b. posterior choroidal artery
c. vertebral artery
d. posterior cerebral artery
e. basilar artery
f. anterior inferior cerebellar artery
21. Which of the following statement IS NOT TRUE regarding oculocephalic reflex (doll's eyes)?
a. it is tested in comatose patients
b. when brainstem is intact: eyes follow direction of head rotation
c. the conscious patient will usually suppress this reflex
d. in cases of brainstem injury: eyes follow direction of head rotation
e. when brainstem is intact: eyes continue to gaze straight ahead (deviate
contralaterally)
f. the lack of this response in both eyes is part of the picture of brain death
22
22. Bilateral pinpoints pupils suggest:
a. pontine lesion
b. tectal lesion
c. midbrain lesion
d. bilateral oculomotor lesions
e. bilateral uncal herniation
f. none of the above
23. Parinaud's syndrome (upward gaze paralysis plus vertical nystagmus)
results from a lesion to the:
a. cerebellum
b. corpora quadrigemina
c. pontinetegmentum
d. medulla oblongata
e. anterior nucleus of thalamus
f. inferior colliculus
DESCRIBE THE OPLPHACTORY PATHWAY:
___________________________________________ (in the nasal cavity)
___________________________________________ (2nd neurons)
___________________________________________
___________________________________________
___________________________________________
(cortex area)
___________________________________________
(cortex area)
___________________________________________
(cortex area)
Specify the level of the lesion (central or peripheral), which caused paralysis
of facial muscles
A–
B–
23
Draw the visual field defects at the levels indicated optic nerve damage.
Optic nerve and optic pathway. a – microscopic structure of retina; b – visual
pathway interrupted by lesions; c – corresponding defects of visual fields.
24
Specify what cranial nerve corresponds to the specified body
25
THEME 5:
CEREBELLUM, THALAMUS, INTERNAL CAPSULE, BASAL
GANGLIA.SYNDROMES OF LESION. AUTONOMIC NERVOUS SYSTEM:
INVESTIGATION TECHNIQUES, MAJOR DISORDERS.
Quizzes
Select all correct answers
1. Which IS NOT a part of the extrapyramidal system?
a. pallidum
b. amygdala
c. caudatum
d. substantianigra
e. corpus subthalamicum
f. putamen
2. Which of the following are collectively referred to as the lentiform
nucleus?
a. pallidum and caudatum
b. putamen and globuspallidus
c. putamen and caudate nucleus
d. striatum and subthalamic nucleus
e. red nucleus and subthalamic nucleus
f. hippocampus and subthalamic nucleus
3. Lesion to the extrapyramidal system results in all of the following
EXCEPT:
a. ballism
b. athetosis
c. chorea
d. lockjaw (trismus)
e. torsion dystonia
f. tremor
4. Hypotonic hyperkinetic syndromes include EXCEPT:
a. ballism
b. intention tremor
c. chorea
d. athetosis
e. myoclonus
5. Hypertonic-hypokinetic syndrome includes EXCEPT:
a. rigidity
b. tremor
c. akinesis
d. chorea
6. Which structure is affected in Huntington's chorea?
a. pallidum
b. amygdala
c. archistriatum
d. neostriatum
e. hippocampus
f. thalamus
26
7. The damage to which of the following structure induces hemiballism?
a. striatum
b. cerebellum
c. corpus subthalamicum
d. putamen
e. pallidum
f. amygdale
8. Adiadochokinesis refers to:
a. the inability to correctly judge distances
b. the tendency to fall, particularly with closed eyes
c. a specific form of gait disturbances
d. the inability to perform rapid alternating movements
9. Which area is involved in Parkinson's is disease?
a. neostriatum
b. substantianigra
c. pallidum
d. putamen
e. amygdala
f. claustrum
10. All of the following may result from damage to the thalamus EXCEPT:
a. dementia
b. epileptic seizures
c. thalamic hand
d. hyperkinesis
e. pain
f. apathy
11. Which of the following IS NOT a part of cerebellum?
a. declive
b. folium
c. operculum
d. uvula
e. flocculus
12. All of the following nuclei are located in the cerebellum EXCEPT:
a. dentate nucleus
b. emboliform nucleus
c. nucleus fastigii
d. nucleus ambiguus
e. globose nucleus
13. Cerebellum receives inputs from all of the following EXCEPT:
a. oliva inferior
b. vestibular nuclei
c. cerebral cortex
d. Goll, Burdach nuclei
e. nucleus rubber
14. The most important efferent projection of the cerebellum is to the:
a. red nucleus
b. corpus subthalamicum
c. caudatum
d. striatum
e. thalamus
f. frontal lobe
27
15. Muscle tonus results from cerebellar disease
a. hypertonic
b. hypotonic
c. distonic
16. Which of the following speech disturbance would be expected in a
damage to the cerebellum:
a. dysarthria
b. scanning speech
c. aphasia
d. monotone speech
17. What causes intention tremor?
a. a damage to the cerebellum
b. a lesion within the extrapyramidal system
c. anxiety
d. muscle weakness
18. Which of the following DOES NOT result from a lesion of the
cerebellum?
a. dysdiadochokinesis
b. muscle hypotonia
c. dysmetria
d. tremor at rest
e. intention tremor
f. trunk ataxia
19. Which of the following CANNOT be expected in a damage to the
cerebellum?
a. muscle hypotonia
b. dysdiadochokinesis
c. nystagmus
d. agraphia
e. intention tremor
20. Which of the following IS NOT a clinical symptom of cerebellar damage?
a. intention tremor
b. scanning speech
c. aphasia
d. dysmetria
21. The capsulaeinternae include the following parts:
a. the anterior limb
b. the posterior limb
c. the genucapsulaeinternae
d. the body capsulaeinternae
Name tests for revealing dynamic ataxia:
1.
2.
Name test for revealing static ataxia
1.
28
Sign nuclei of cerebellum (represented schematically).
1234Name the syndromes
Mask-like, expressionless face,
often with drooling
Pill rolling tremor of hands
Bent posture
Stiff, shuffling gait
______________________
____________________
______________________
______________________
Specify the correct relationship of the basal ganglia.
29
THEME 6:
CORTEX.CORTICAL LOCALIZATION.LOBAR FUNCTIONS,
SYNDROMES, AND EPILEPTIC MANIFESTATIONS.
Quizzes
Select all correct answers
1. All of the following results from a damage to the frontal lobe EXCEPT:
a. upper motor neuron lesion
b. expressive aphasia
c. receptive aphasia
d. disturbance of initiative and judgment
e. gaze paralyis
f. frontal release signs
2. Damage to the right frontal eye field results in which of the following:
a. the patient cannot look upward
b. the patient cannot voluntarily look to the right
c. both eyes are deviated to the left at rest
d. both eyes are deviated to the right at rest
e. double vision occurs
f. none of the above
3. A lesion of the right frontal lobe will result in all of the following EXCEPT:
a. left sided hemiparesis
b. signs of central palsy on the left side
c. gaze paralysis to the right
d. eyes will look away from the paralyzed left limbs
e. gaze paralysis to the left
f. adversion of the head to the right
4. A lesion to the following structures results in hemiparesis EXCEPT:
a. frontal lobe
b. parietal lobe
c. internal capsule
d. cervical spinal cord
e. precentralgyrus
5. Disturbances of body schema include all EXCEPT:
a. astereognosia
b. hemineglect
c. anosognosia
d. autotopagnosia
e. finger agnosia
6. Damage to paracentrallobulus may cause:
a. hemihypaesthesia
b. polydipsia
c. retentiourinae
d. impotentiagenerandi
e. ipsilateral hemiparesis
f. contralateral quadrantanopsia
7. Damage to the temporal lobe would result in EXCEPT:
a. psychomotor seizures
b. contralateral upper quadrant anopia
30
c. uncinate fits
d. anomic aphasia
e. Wernicke aphasia
8. Signs of sensory (Wernicke’s) aphasia are
a. non-fluent, hesitant speech
b. speech nonsensical but fluent
c. nonexistent words
d. good comprehension
9. Astereognosis results from a damage to which lobe?
a. frontal
b. temporal
c. parietal
d. occipital
10. Which statement IS NOT true regarding anosognosia?
a. it was first described by the French neurologist Babinski in 1914
b. it results from a damage within the dominant hemisphere
c. it results from a damage within the subdominant hemisphere
d. it usually occurs among people who have suffered a stroke
e. the patients insist that their paralyzed limbs are functioning normally
f. it belongs to the neglect syndromes
Mach the structures of human brain on the picture below with their names
___ spinal cord
___ brain stem
___ frontal lobe
___ parietal lobe
___ temporal lobe
___ occipital lobe
___ cerebellum
31
Name the symptoms of lesion frontal lobe in dominant hemisphere
______________________
___________________________
_____________________
_________________________
32
THEME 7:
CEREBROSPINAL FLUID AND MENINGES.NEURODIAGNOSTIC
STUDIES.LUMBAR AND VENTRICULAR
PUNCTURE.ANGIOGRAPHY.ELECTROMYOGRAPHY.ELECTROENCEPH
ALOGRAPHY.EVOKED POTENTIALS.DOPPLER ULTRASOUND
EXAMINATION.COMPUTERIZED TOMOGRAPHY.MAGNETIC
RESONANCE IMAGING.
Quizzes Select all correct answers
1. CSF is produced by which of the following structures:
a. choroid plexus
b. Pacchioni granulation
c. astrocytes
d. oligodendroglia
e. microglia
f. pineal gland
2. The greatest amount CSF is produced in the:
a. spinal subarachnoid space
b. lateral ventricles
c. cisterns of the cerebrum
d. fourth ventricle
3. Indications for lumbar puncture include all EXCEPT
a. to get CSF sample
b. to inject air
c. to reduce ICT
d. to give drugs
4. Contraindications for lumbar puncture include EXCEPT:
a. papilledema
b. papillitis
c. skin infection near the puncture site
d. severe bleeding disorders
e. suspicion of increased intracranial pressure
f. acute spinal cord trauma
5. CSF (lumbar) normal findings (more than one answer is suggested):
a. clear
b. no red blood cell
c. 0-10 neutrophils
d. protein content: 0.15-0.45 g/L
e. glucose: 60-70% of plasma levels
6. Under normal condition, lumbar puncture usually reveals a CSF pressure
of:
a. 120-180 mm of water
b. 0 mm of water
c. 300-600 mm of water
d. 10-20 mm of water
e. 200-300 mm of water
7. Cell count in CSF under normal condition on lumbar puncture:
a. 20-30/3
b. 30-40/3
c. 40-50/3
33
d. 8-10/3
8. Elevated CSF protein content can be found in all of the following
EXCEPT:
a. polyneuropathy
b. cerebral tumors
c. tumors of the spinal cord
d. radiculopathies
e. meningitis
f. toxic encephalopathy
9. The contrast medium used in MRI is
a. TDA
b. Gd-DTPA
c. renograffin
d. myodil
10. Posterior cranial fossa is best visualized by
a. CT
b. MRI
c. PET scan
d. tomography
11. Which IS NOT TRUE of MRI?
a. low radiation exposure
b. no bone interference
c. delineates grey and white matter
d. visualizes spinal cord
12. Which one of the following delineates viable from nonviable tissue?
a. digital angiographv
b. PET scan
c. contrast CT
d. MRI
13. All of the following may be detected on CT scans EXCEPT:
a. cerebral ischemia within the first 6 hours
b. hydrocephalus
c. abscess
d. parenchymal hemorrhage
e. subarachnoid hemorrhage
f. old infarct
14. The risks of angiography include EXCEPT:
a. thromboembolic occlusion of the vessels investigated
b. bleeding at the puncture site
c. there are no risks
d. dissection of the vessel wall
e. infection
f. allergic reaction to contrast media
15. Following are disadvantages of digital subtraction angiography EXCEPT
a. collateral blood flow not visualized
b. requires low cardiac output
c. large volume of contrast
d. degree of stenosis is uncertain
16. Which of the following will confirm the diagnosis of the cerebral
neoplasm?
a. CT
b. Visual Evoked Potentials (VEP)
34
c. myelography
d. electromyography
e. ultrasonography
f. Brainstem Auditory Evoked Response (BAEP)
Write the missing structures in the scheme: «Brain meninges»
Write the missing structures in the scheme: «Topography intracerebral
ventricular system»
35
Write the names of tests for the detection of meningeal syndrome
АВСD-
36
Write the names of tests for the detection of meningeal syndrome
АВСD-
37
THEME 8:
PAIN IN THE BACK AND EXTREMITIES: VERTEBROGENIC
SYNDROMES, LOW BACK PAIN. MYOFASCIAL SYNDROMES.
Quizzes
Select all correct answers
1. The majority of intervertebral disk herniations occur between (more than
one answer is suggested):
a. L4-L5
b. C5-C6
c. L5-S1
d. C6-C7
2. Sign of lumbar disc herniation is:
a. scalenus syndrome
b. torticollis
c. tunnel syndrome
d. prolonged root irritation syndrome
3. Cervical cord compression due to spondylosis most often occurs at the level
of
a. C3,4
b. C4,5
c. C5,6
d. C6,7
4. Which IS NOT a feature of cord compression due to cervical spondylosis?
a. loss of vibration sense
b. pain on coughing
c. urinary incontinence
d. paresthesias in feet
Write the missing signs: Symptoms and Signs Associated with Lumbar
Radiculopathy
38
Write the missing signs: Symptoms and Signs Associated with Cervical
Radiculopathy
Write the indications for surgery of chronic back pain and spinal stenosis:
1.
2.
3.
4.
5.
6.
39
Write the missing signs into a scheme, write tests and symptom observed in
lesions these nerves:
40
THEME 9:
PERIPHERAL NERVOUS SYSTEM DISORDERS: ACUTE
INFLAMMATORY POLYRADICULONEUROPATHY (GUILLAIN-BARRE
SYNDROME). NEUROPATHIES ASSOCIATED WITH DIABETES
MELLITUS, DIPHTERIA, ALCOHOL CONSUMPTION. NEUROPATHIES OF
FACIAL NERVE. TRIGEMINAL NEURALGIA. NEUROPATHIES OF
BRACHIAL PLEXUS, PERIPHERAL NERVES OF EXTREMITIES. TUNNEL
SYNDROMES.
Quizzes
Select all correct answers
1. Carpal tunnel syndrome is seen in
a. acromegaly
b. myxedema
c. diabetes mellitus
d. all of the above
2. Which of the following are the signs of an injury to the common peroneal
nerve (more than one answer is suggested):
a. inability to evert foot
b. loss of plantar flexion
c. loss of sensation on dorsum of foot and lateral aspect of leg
d. loss of sensation on sole of foot
3. Damage of which nerve results in clawhand, inability to flex 4 and 5
fingers, sensory loss over the ulnar side of the hand and 4 and 5 fingers, mild
trophic changes?
a. radial
b. ulnar
c. axillar
d. median
4. Damage of which nerve leads to ape hand appearance, inability to grip
hand, flex 1 and 2 finger and appose the thumb, sensory loss over the radial
portion of the hand, index and middle fingers, wasting of thenar muscles,
trophic changes and pain?
a. radial
b. ulnar
c. axillar
d. median
5. Damage of which nerve results in wrist drop with flexed fingers, sensory
loss on dorsum of the hand and forearm
a. radial
b. ulnar
c. axillar
d. median
6. Damage of which nerve leads to weakness of plantar flexion and invertion
of the foot, inability to stand on toes, sensory loss over the sole, loss of ankle
jerk?
a. tibial
b. common peroneal
41
c. femoral
d. sciatic
7. Damage of which nerve results in weakness of dorsiflexion and eversion of
the foot, walking with “foot drop”, sensory loss over the dorsum and outer
aspect of the foot?
a. tibial
b. common peroneal
c. femoral
d. sciatic
8. Peripheral neuritis is seen with deficiency of
a. pyridoxine
b. thiamine
c. pantothenic acid
d. all of the above
9. Bell’s palsy syndrome includes (more than one answer is suggested):
a. sensory loss in the half of the face
b. weakness of mimic muscles in the half of the face
c. increased or decreased lacrimation
d. diplopia
10. Treatment of Bell’s palsy include:
a. diuretics, steroids, physical methods of treatment, acupuncture
b. carbamazepin, muscle relaxants (Baklofen, Sirdalud), surgical treatment
c. antibacterial treatment, analgetics, massage
d. ergotamine, caffeine, analgetics, vasodilating drugs, acupuncture
11. Complications of Bells’s palsy are:
a. facial pain
b. secondary contracture of mimic muscles
c. facial hemispasm
d. facial hemiatrophy
e. deafness
12. Trigeminal nerve consists of the following types of nerve fibers:
a. motor and sensory fibers
b. only sensory fibers
c. motor and vegetative (autonomic) fibers
d. motor, sensory and vegetative (autonomic) fibers
13. Symptoms of trigeminal neuralgia are (more than one answer is
suggested):
a. sharp, shooting pain
b. Bell’s phenomenon
c. presence of trigger spots
d. loss of jaw reflex
14. Drug of choice in trigeminal neuralgia is
a. phenytom
b. carbamazepine
c. piroxicam
d. phenothiazine
15. Upper orbital fissure syndrome includes (more than one answer is
suggested):
a. total ophtalmoplegia with midriasis
b. ptosis
c. sensory loss in the area supplied by ophthalmic branch of trigeminal nerve
d. convergent squint
42
16. Signs of polyneuropathy are (more than one answer is suggested):
a. paresis in hands and feet
b. sensory impairment in distal parts of limbs
c. Babinski sign
d. trophic changes in distal parts of limbs
17. The most prominent sign of Guillain-Barre syndrome is:
a. areflexia
b. imbalance
c. disorientation
d. central palsy of legs
18. Following are features of small fibre neuropathy EXCEPT
a. dysesthesia
b. loss of pin prick sensation
c. loss of tendon jerks
d. autonomic dysfunction
19. Which of the following IS NOT used for the treatment of painful
polyneuropathy?
a. NSAIDs
b. tricyclic antidepressants
c. carbamazepine
d. dopamine
20. The facial nerve may be involved in all of the following disorders
EXCEPT:
a. Bell's palsy
b. Weber syndrome
c. Ramsay-Hunt syndrome
d. Melkersson-Rosenthal syndrome
e. Foville syndrome
f. Millard-Gubler syndrome
Write core features of Guillain-Barre syndrome
1.
2.
3.
4.
43
Write the symptom of neuropathies of facial nerve:
Write the missing signs into a scheme
44
Name the nerve, signs of which are shown in scheme. Describe arising in this
pathology symptom:
45