Download RITE Practice Questions

RITE Practice Questions
Question Bank 1
What is the most prominent efferent pathway
from the amygdala?
1. Amygalofugal pathway
2. Stria terminalis
3. Anterior hypothalamic nuclei
4. Medial pre-optic area
What is the most prominent efferent pathway
from the amygdala?
1. Amygalofugal pathway
2. Stria terminalis
3. Anterior hypothalamic nuclei
4. Medial pre-optic area
The amygdala receives inputs from all senses
as well as visceral inputs from the
hypothalamus, septal area, orbital cortex and
parabrachial nuclei (gustatory and olfactory
processing).
The most prominent efferent pathway from
the amygdaloid nuclear complex is the stria
terminalis. Most of the fibers arise from the
corticomedial part of the nuclear complex.
They arch along the medial border of the
caudate near its junction with the
thalamus. The largest termination is the
nucleus of the stria terminalis. This is located
lateral to the columns of the fornix and
dorsal to the anterior commissure. Other
terminations include the anterior
hypothalamic nuclei and the medial preoptic
area.
At autopsy one would expect the neurons that
produce what neuropeptide to be reduced or
absent in a nacroleptic patient?
1. Ghrelin
2. Leptin
3. Orexin
4. Scretin
At autopsy one would expect the neurons that
produce what neuropeptide to be reduced or
absent in a nacroleptic patient?
1. Ghrelin
2. Leptin
3. Orexin
4. Scretin
The hypocretin/orexin neurons of the lateral hypothalamus innervate the cholinergic
and monoaminergic cell groups of the brainstem involved in control of REM sleep.
Experimental and clinical evidence indicate that hypocretin neurons are affected in
narcolepsy. Ghelin is the neuropeptide that promotes hunger and leptin is the
neuropeptide that promotes setiety. Scretin is found in the gut, so let’s be honest who
cares what it does.
Belsomra/suvorexant (orexin
antagonist)
Which of trigeminal nuclei extends into the
cervical spinal cord?
1. Principal sensory nuclei
2. Spinal trigeminal nuclei
3. Mesencephalic nuclei
4. Dorsal spinal nuclei
Which of trigeminal nuclei extends into the
cervical spinal cord?
1. Principal sensory nuclei
2. Spinal trigeminal nuclei
3. Mesencephalic nuclei
4. Dorsal spinal nuclei
Caudally, the spinal trigeminal nucleus blends into the substantia
gelatinosa (Lamina II) of the first two cervical segments.
Damage to the dominant hemisphere angular
gyrus will result in the following named
syndrome?
1. Anton syndrome
2. Gestmann syndrome
3. Dejerine-Roussy syndrome
4. Balint syndrome
Damage to the dominant hemisphere angular
gyrus will result in the following named
syndrome?
1. Anton syndrome
2. Gestmann syndrome
3. Dejerine-Roussy syndrome
4. Balint syndrome
The inferior parietal lobule is composed of the angular and supramarginal gyrus.
Damage to the supramarginal gryus in the dominant hemisphere may cause a fluent
aphasia. Lesions to the angular gyrus cause Gerstmann syndrome characterized by
1. Agraphia
2. Acalcula
3. Finger agnosia
4. Left right confusion
Anton Syndrome
The ultimate form of agnosagnosia. Cortical blindness but patient will deny they are
blind.
Dejerine-Roussey
Post-thalamic stroke pain syndrome.
Balint Syndrome
Bilateral posterior parietal lesions, often watershed infarcts. Characterized by the
following:
1. Optic ataxia: may see and recognize objects, but difficulty reaching for them,
movement is misdirected
2. Ocular apraxia: difficult in visual scanning, not able to maintain fixation
3. Simultangnosia: inability to perceive more than a single object at a time
The basal vein of Rosenthal drains to what
venous structure?
1. Superior sagital sinus
2. Inferior sagital sinus
3. Torcula
4. Great vein of galen
The basal vein of Rosenthal drains to what
venous structure?
1. Superior sagital sinus
2. Inferior sagital sinus
3. Torcula
4. Great vein of galen
The straight (rectus) sinus receives venous blood directly from the inferior sagittal sinus.
The basal vein of Rosenthal drains into the great cerebral vein (vein of Galen), which
subsequently drains into the straight sinus.
An 8 year old child has cerebral palsy and a
resulting spastic paraparesis. Which of the
follow has the best level of evidence for
management of the lower extremity spasticity?
1. Tizanidine
2. Intra-thecal baclofen
3. Botulinum injections
4. Diazepam
An 8 year old child has cerebral palsy and a
resulting spastic paraparesis. Which of the
follow has the best level of evidence for
management of the lower extremity spasticity?
1. Tizanidine
2. Intra-thecal baclofen
3. Botulinum injections
4. Diazepam
For localized spasticity, Botulinum Toxin type A was
established as an effective treatment to reduce spasticity
in an AAN Practice Parameter from 2010. Tizanidine was
deemed possibly effective but there was limited data
about side effect profile and its effect on function for
generalized spastcity Diazepam was deemed probably
effective but there limited day available about its effect
on function and side effects. There was also insufficient
data on the use of dantrolene, oral baclofen, and
intrathecal baclofen. Therefore, for localized/segmental
spasticity that warrants treatment, it was recommended
that Botulinum toxin type A be offered as an effective and
generally safe treatment (Level A).
An Indiana farm presents to cognitive clinic due
to progressive memory concerns. He notes that
over the last year he has suffered from chronic
diarrhea and weight loss. On exam you notice
that his eyes converge whenever he makes a
chewing motion. What is his diagnosis?
1. HIV associated dementia
2. PML
3. Whipples
4. CJD
An Indiana farm presents to cognitive clinic due
to progressive memory concerns. He notes that
over the last year he has suffered from chronic
diarrhea and weight loss. On exam you notice
that his eyes converge and he is frequently
making a chewing motion. What is his
diagnosis?
1. HIV associated dementia
2. PML
3. Whipples
4. CJD
Tropheryma whippelii is the organism identified as the cause of
Whipple disease. Patients typically present with gastrointestinal
complaints including diarrhea, malabsorption and weight loss. Other
symptoms may include lymphadenopathy, hyperpigmented skin,
movement disorders, oculomasticatory myodysrhythmia and
dementia. Diagnosis can be made with duodenal biopsy or CSF PCR.
Oculomasticatory myorhythmia is a unique movement disorder that is
pathognomonic of Whipple's disease. Patients exhibit continuous
smooth pendular convergent and divergent oscillations of the eyes at
primary position, with saccades, with fixation, and even during sleep.
Concurrent synchronous contraction of masticatory muscles (e.g.
masseter, genioglossus) but not palatal muscle characterizes this
condition
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What is the most common genetic mutations
that has been associated with familial
Alzheimers disease.
1. Amyloid precursor protein
2. Presenillin 1
3. Presenillin 2
4. ApoE4
What is the most common genetic mutations
that has been associated with familial
Alzheimers disease.
1. Amyloid precursor protein
2. Presenillin 1
3. Presenillin 2
4. ApoE4
Although all the genetic mutations listed have
been associated with Alzheimer's disease, the
presenilin 1 mutations are the most common
cause of familial Alzheimer's disease (up to 70%
of familial cases). ApoE4 homozygosity is not a
genetic mutation but is categorized as a
susceptibility gene. Presence of an ApoE4 gene
can increase risk of Alzheimers by 5-15 fold.
Atypical anti-psychotics come with the following
black box warning. When used in patient’s with
dementia there is an increased risk of:
1. Death
2. Wandering behavior
3. Seizures
4. Apathy
Atypical anti-psychotics come with the following
black box warning. When used in patient’s with
dementia there is an increased risk of:
1. Death
2. Wandering behavior
3. Seizures
4. Apathy
An elderly patient with behavioral problems is
brought to your clinic by his family because he
seems to be inappropriately grabbing at objects
in his environment. This is an example of…
1. Foster-Kennedy Syndrome
2. Utilization behavior
3. Kluver-Busey Syndrome
4. Grasp Reflex
An elderly patient with behavioral problems is
brought to your clinic by his family because he
seems to be inappropriately grabbing at objects
in his environment. This is an example of…
1. Foster-Kennedy Syndrome
2. Utilization behavior
3. Kluver-Busey Syndrome
4. Grasp Reflex
This patient is best described as displaying utilization behavior. Patients with
this disorder are described as reaching out and using objects in the
environment in an automatic manner. She has pushed a shopping cart many
times and when given a cart she uses it automatically which distracted her
from the visual threshold issue she had in crossing the street. Individuals that
show utilization behavior all typically have pathologies in the frontal lobes
and frontal-striatal systems. It has been conceptualized that hese behaviors
result from an imbalance between proposed medial (voluntary, goal directed,
and future directed) and lateral(automatic, stimulus bound, and visually
based) motor systems.
Kluver-Busey syndrome : (abnormal "docile" affect, excessive abnormal eating and
hypersexual behavior). This syndrome results from bilateral anterior temporal lobe
lesions, and can be seen in herpes simplex encephalitis, Pick's disease, anoxic-ischemic
lesions in the anterior medial temporal lobes, and after bilateral temporal lobectomy.
The follow CSF pattern is consistent with high
risk of progression from amnestic MCI to
alzheimers:
1. High Tau, low beta-amyloid
2. High tau, high beta-amyloid
3. Low tau, high beta-amyloid
4. Low tau, low beta-amyloid
The follow CSF pattern is consistent with high
risk of progression from amnestic MCI to
alzheimers:
1. High Tau, low beta-amyloid
2. High tau, high beta-amyloid
3. Low tau, high beta-amyloid
4. Low tau, low beta-amyloid
Cerebrospinal fluid (CSF) tau levels in Alzheimer
disease (AD) patients are thought to occur after
being released from dying and damaged
neurons. The CSF levels of beta-amyloid 1-42 are
decreased secondary to the accumulation of
amyloid in the neuritic plaques. This pattern has
been shown to have sensitivity and specificity of
85% in predicting conversion from mild cognitive
impairment (MCI) to AD.
The parents of a newborn child elect to defer
hearing screen and their child fails as 8 weeks of
age due to sensorineural hearing loss. The
audiologist refers the patient to neurology
because they notice abnormal movements in
the child. On exam the child has absence of upgaze. Excess of which of the following products
of metabolism can lead to this clinical picture?
1. Ammonia
2. Bilirubin
3. Uric acid
4. Branched chain amino acids
The parents of a newborn child elect to defer
hearing screen and their child fails as 8 weeks of
age due to sensorineural hearing loss. The
audiologist refers the patient to neurology
because they notice abnormal movements in
the child. On exam the child has absence of upgaze. Excess of which of the following products
of metabolism can lead to this clinical picture?
1. Ammonia
2. Bilirubin
3. Uric acid
4. Branched chain amino acids
The manifestations of full-blown kernicterus
(bilirubin encephalopathy) include
choreoathetoid cerebral palsy, abnormal
voluntary eye movements with lack of upgaze
(sun setting sign), and sensorineural hearing
loss. In otherwise well term infants, indirect
bilirubin is generally higher than 25 mcg/ml
prior to any neurologic sequelae, and jaundice is
clinically obvious.
Kernicterus
A Word on CP
Cerebral palsy is a group of movement disorders that affect young children. One third
will also have cognitive deficits. CP has four phenotypic subtypes: spastic, ataxic,
athetoid, and mixed.
You are asked to acutely evaluate a patient who
has just had a carotid endarterectomy and is
hypertensive to 180-200s immediately post-op.
He an acute onset headache which he describes
as the worst of life. On the way to head CT the
patient loses consciousness. His imaging shows:
What is the most likely diagnosis?
1. Amyloid angiopathy
2. Ruptured AVM
3. Cerebral hyperperfusion syndrome
4. Ruptured intra-cranial ICA
What is the most likely diagnosis?
1. Amyloid angiopathy
2. Ruptured AVM
3. Cerebral hyperperfusion syndrome
4. Ruptured intra-cranial ICA
This is an example of cerebral hyperperfusion
syndrome. The full-blown syndrome may be seen
after revascularization of an artery (either with
surgery or stenting) and consists of headache,
neurologic deficit and seizures. Risk factors for
developing this syndrome: perioperatively poorlycontrolled blood pressures, high-grade stenosis,
and history of recent endarterectomy on the
contralateral side. The syndrome is suspected to
result from loss of cerebral autoregulation
resulting in hyperdynamic blood flow through the
revascularized blood vessel.
A 60 year old female was referred to our department by her
general practitioner due to a 3 year history of paroxistic
sharp pain attacks located in the left side of the pharynx and
the base of the tongue, with radiation to the ipsilateral
cheek and ear. The paroxysms were usually triggered by
swallowing and chewing, and sometimes they were
associated with loss of consciousness, 10–15 s of duration.
The patient had already been referred to a cardiologist, an
ENT specialist and a neurologist. An MRI brain was normal.
A trial of which medication is indicated?
1. Carbamazepine
2. Indomethacin
3. Frovitriptan
4. Lasix
A 60 year old female was referred to our department by her
general practitioner due to a 3 year history of paroxistic
sharp pain attacks located in the left side of the pharynx and
the base of the tongue, with radiation to the ipsilateral
cheek and ear. The paroxysms were usually triggered by
swallowing and chewing, and sometimes they were
associated with loss of consciousness, 10–15 s of duration.
The patient had already been referred to a cardiologist, an
ENT specialist and a neurologist. An MRI brain was normal.
A trial of which medication is indicated?
1. Carbamazepine
2. Indomethacin
3. Frovitriptan
4. Lasix
This patient has idiopathic glossopharyngeal
neuralgia. Secondary causes, including skullbased tumors, have been adequately excluded
by MRI. Syncope associated with this
syndrome results from activation of the
carotid sinus branch of the glossopharyngeal
nerve, resulting in bradycardia and
hypotension due to peripheral arterial
vasodilatation. Symptomatic therapy is the
same as that used for trigeminal neuralgia.
A 28 year old female who is 8 weeks pregnant
presents to your office for evaluation of
headaches. She describes a squeezing
holocranial pressure which lasts several hours
and occurs 2-3x/week. Denied any associated
photophobia, phonophobia or nausea. She goes
on to describe her “exceptionally high pain
tolerance”. What drug is first line choice in this
patient as a headache abortive?
1. Naproxin
2. Sumatriptan
3. Propranolol
4. Tylenol
A 28 year old female who is 8 weeks pregnant
presents to your office for evaluation of
headaches. She describes a squeezing
holocranial pressure which lasts several hours
and occurs 2-3x/week. Denied any associated
photophobia, phonophobia or nausea. She goes
on to describe her “exceptionally high pain
tolerance”. What drug is first line choice in this
patient as a headache abortive?
1. Naproxin
2. Sumatriptan
3. Tramadol
4. Tylenol
These headaches, by description, are tension-type
headaches. Acetaminophen is the first-line
medication in pregnancy. Nonsteroidal antiinflammatory drugs (NSAIDs) may be used in the
first or second trimester, but acetaminophen is
preferred. Butalbital, codeine and sumatriptan
are Category C, whereas acetaminophen and
ibuprofen are Category B. Sumatriptan use should
be restricted to migraine and opiates are not
encouraged for headaches.
Which cervical dermatome abuts the second
thoracic dermatome?
1. Second
2. Eighth
3. Fourth
4. Sixth
Which cervical dermatome abuts the second
thoracic dermatome?
1. Second
2. Eighth
3. Fourth
4. Sixth
The internal carotid artery enters the skull base
through which foramen?
1. Spinosum
2. Lacerum
3. Rotundum
4. Ovale
The internal carotid artery enters the skull base
through which foramen?
1. Spinosum
2. Lacerum
3. Rotundum
4. Ovale
The maxillary nerve travels through the foramen
rotundum, the mandibular nerve travels through
the foramen ovale, the middle meningeal artery
passes through the foramen spinosum, the
glossopharyngeal nerve (as well as the vagus and
spinal accessory nerves) travels through the
jugular foramen and the internal carotid artery
traverses the foramen lacerum. The internal
carotid artery could be affected by a fracture
through the foramen lacerum.
A patient presents with acute onset ipsilateral
tongue and contralateral hemibody weakness
along which contralateral vibration and
proprioception loss. Which artery has most
likely been affected by this stroke?
1. Basilar
2. AICA
3. PICA
4. Anterior spinal
A patient presents with acute onset ipsilateral
tongue and contralateral hemibody weakness
along which contralateral vibration and
proprioception loss. Which artery has most
likely been affected by this stroke?
1. Basilar
2. AICA
3. PICA
4. Anterior spinal
The medial medullary syndrome is most commonly associated
with infarction in the anterior spinal artery distribution at
the level of the medulla. An occlusion at this level may
result in ipsilateral CNXII paralysis (fascicle of CNXII),
contralateral hemiparesis (pyramid), and contralateral loss
of position and vibratory sensation (medial lemniscus). A
bilateral lesion in this vascular territory will result in
quadriparesis, bilateral loss of proprioception and vibration,
and complete paralysis of the tongue
The cavernous sinus and superior orbital fissure
have in common all of the following nerves
except:
1. CN3
2. CN 4
3. CN 6
4. Oculo- sympathetics
5. V1
6. V2
The cavernous sinus and superior orbital fissure
have in common all of the following nerves
except:
1. CN3
2. CN 4
3. CN 6
4. Oculo- sympathetics
5. V1
6. V2