Neurology 2013 (60q)

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1) Which of the following describes alexia without agraphia?

a) Inability to read words and letters; injury to right occipital lobe

b) Inability to read words and letters; injury to Left occipital lobe
c) Inability to read words, conserved ability to read letters; injury to left occipital lobe
d) problem understanding written words; injury to occipital lobes both sides
e) problem understanding between colours

2) what is a feature of poliomyelitis?

a) CSF with elevated protein and no inflammatory cells

b) no injury in bulbar muscles; injury just in limbs (injury? Damage?)
c) asymmetric flaccid paralysis

3) woman 30 years old with cough and headache subsequently disengages (ie breaks off from
the conversation) and shakes her head backwards and forwards in repetitive motions, returns to
consciousness and wants to sleep. Which type of attack did she experience?

a) absence
b) myotonic clonic seizure
c) simple focal seizure
d) complex focal seizure
e) juvenile myoclonic epilepsy

4) concerning Wallenberg, all of the following symptoms are part of the syndrome except

a) difficulty swallowing
b) horner's syndrome
c) ipsilateral loss of pain and temperature sensation
d) contralateral loss of pain and temperature sensation
e) hoarse voice

5) which is the most common cause of mononeuritis complex?

a) trauma
b) diabetes

c) vasculitis
d) toxic damage
e) hepatitis c

6) which of the following statements about movement disorders is incorrect?

a) injury mostly to autonomous SMA

b) injury mostly at the back and less at the periphery PSP
c) Parkinsonism induced my medication is symmetrical
d) goes with forward flexion PSP

7) what is an element of Millard-Gubler syndrome?

a) damage to cnVI and VII, motor damage contralateral

b) damage to cnVI and VII, motor damage ipsilateral
c) damage to cnIII
d) damage to cnVI and another nerve

8) which must be in an untreated migraine?

a) unilateral
b) pulsating
c) worsening with change in movement
d) over 4 hours
e) all of the above

9) young married woman 25 years old wants to become pregnant, is being treated with valproic
acid and is sick with juvenile myoclonic seizure. What do you do?

a) continue current treatment and check drug levels in the blood

b) recommend switching from valproate to carbamazepine
c) recommend switching from valproate to lamictal
d) stop medical treatment and continue to follow the patient

10) a basketball player sprains his leg at the end of the last quarter, in the dressing room he
feels pain in the ankle when he removed his shoe. Which of the following cannot explain this
phenomenon?

a) c slow pain fibers are not myelinated, the pain sensation transfers to a different area
b) modulation of the pain sensation by the limbic system
c) compounds like endorphins, adrenaline, and norepinephrine participate in the
regulation of pain

d) the pain is likely to respond to NSAIDS

11) which is not a common side effect of stimulants?

a) loss of appetite
b) headaches
c) seizures
d) nausea
e) sleep disturbance

12) which is not true about ADHD?

a) chronic disturbance
b) family tendency
c) disturbance in concentration without disruption in brain function
d) present in 4.4% of adults
e) etiology is a complex of genetics, environment, and something else

13) the formatting for this question in the Hebrew version was all messed up. Here is what I
think it said: recurrent fits in a 64 year old man with blood pressure 160/90, weakness in right
side of body lasts 15 seconds. Ekg shows atrial fib, history of diabetes and dyslipidemia; what is
the risk of subsequent TIA? Sorry, the original version of this question probably also sucked
ultra balls

a) 1%
b) 4%
c) 8%
d) 18%
e) 24%

14) 70 year old man suddenly loses sight, loss of colour vision, dull pain on eye movement.
Visual acuity 6/60 in one eye, 6/6 in other eye. Attached is diagram of visual field (just kidding,
It's posted at http://imgur.com/uQSWFgX )
Which is correct about what caused the problem?

a) anterior ischemic event

b) optic neuritis
c) cavernous sinus hemangioma
d) bilateral occipital neuralgia
e) glaucoma

15) which is not correct about Parkinson's?

a) asymmetrical expression from the beginning

b) orthostasis from the beginning
c) rigidity from the beginning
d) muscle pains from the beginning
e) tremor from the beginning

16) which is not correct about status epilepticus?

a) event lasts over 5 minutes

b) it is a medical emergency
c) every type of epilepsy can advance to this situation
d) all patients who cease medical treatment on their own will experience an event like
this

17) what is the mechanism of poliomyelitis?

a) UMN
b) DRG
c) viral infection of the basal ganglia
d) motor neuropathy, viral
e) autoimmune disease of lateral corticospinal tract

18) which is not typical appearance of MS?

a) cerebellar damage
b) transverse myelitis
c) optic neuritis
d) aphasia

19) what is the most forgotten focal disease in AIDS?

a) cryptococcus
b) toxoplasma
c) PML
c) CMV
d) HSV

20) 72 year old man has background of diabetes and hypertension; comes in with weakness in
right side, Bell's palsy left side, nystagmus to right side. Left carotid 70% occluded. What is
correct about treatment?

a) urgent endarthroscopy
b) not to intervene because the occlusion is not in the symptomatic artery
c) not to intervene because the level of occlusion is low
d) intervene, but three months after the event

21) Which of the following is characteristic of an extrapyramidal disease but NOT Parkinsons?

a) Slowness at the start of the disease

b) Tremor at the start of the disease
c) Orthostatic hypotension at the start of the disease
d) Ataxia at the start of the disease

22) Which of the following is the most common in CJD?

a) Myoclonus
b) Extrapyramidal
c) Behavioral/cognitive problems
d) Pyramidal
e) ?

23) What is the most common focal infective complication associated with HIV?

a) Cryptococcus
b) Toxoplasmosis
c) PML
d) CMV encephalitis
e) HSV encephalitis

24) Which of the following is INCORRECT regarding PML?

a) The disease is common, found in approximately 50% of AIDS patients

b) Diffuse hemispheric demyelination
c) Generally CSF has a normal appearance
d) ?
e) All answers are CORRECT

25) image of epidural bleed in a lens-shape, which is incorrect?

a) incidence of bleeding is in 1% of all head trauma

b) common in those aged >70 years
c) majority are from arterial bleed
d) ?

26) which does not fit with regard to parkinson?

a) ataxia from the onset

b) muscle pains from the onset

c) rigidity from the onset
d) extrapyramidal disturbance from the onset

27) a 73 year old man with colon cancer is referred for bacterial meningitis. Before culture
results come back you should treat him with which of the following?

a) rocephin
b) rocephin + doxy
c) rocephin + ampicillin
d) rocephin + acyclovir

28) an 18 year old man with double vision, on exam cannot adduct left eye, and there is ptosis
of left eye. Where is the damage?

a) orbit
b) frontal eye field
c) fibers connecting between pons and midbrain
d) NMJ

29) which of the following is incorrect about the pathology of movement disorders?

a) in huntington's disease there is overactivity of the indirect pathway

b) GABA is an inhibitory neurotransmitter, glutamate is excitatory
c) GPI inhibits thalamus
d) cortex has excitatory influence (effect? Not sure which is the best translation of
here)

30) a 35 year old woman has MS. Over 6 years she has 3 exacerbations, and after 10 years the
disease worsens. Which type of MS does she have now?

a) remitting-relapsing
b) primary progressive
c) secondary progressive
d) progressive relapsing

31) all of the following are correct regarding states of consciousness except:

a) A significant decrease in arousal and awareness is what coma, sleep, and general
anesthesia all have in common
b) what differentiates between vegetative state and consciousness is reduced arousal
c) in locked in syndrome there is a very high state of arousal and awareness

32) all of the following are true about the gracilis except:

a) conveys senses of proprioception and vibration

b) pathways arrive at brainstem to gracilis nuclei and coneatus via lateral lemniscus

c) gracilis is found on posterior column and transmits sense of depth

d) damage here could be caused by tertiary syphilis or lack of copper b12 (that's the
direct translation, FYI copper is a component of b12, not sure exactly what " b12"
is)

33) which is correct regarding meningovascular syphilis?

a) it is suspected diagnosis for stroke in a young patient

b) classically presents 15-25 years after infection
c) ataxia is the common finding on neurological examination

34) trigeminal neuralgia, which is incorrect:

a) attack lasts several hours

b) traeatment with tegretol is thought to be effective
c) it is permitted to treat surgically
d) pain in the area of the face

35) a 70 year old man arrives to your clinic with memory problems and cognitive decline, his
sister explains that their mother had the same symptoms at the age of 68, what is reasonable to
find in the patient?

a) mutant APP
b) APO E-4
c) mutant PSEN
d) MM homozygous (?)

36) which is correct about oligoclonal antibodies in CSF?

a) they are found to exist in all patients with multiple sclerosis

b) they indicate the intra-thecal production of antibodies (?)
c) the level of antibodies is found in correlation with clinic (?)
d) a unique finding only in MS

37) woman with motor damage to left arm and leg, damage to proprioception from left side, and
does not feel pain in right leg. What is injured?

a) cervical spinal cord

b) thoracic spinal cord from right side
c) thoracic spinal cord from left side

(Hebrew version was missing question 38, relax people you're gonna pass the exam - don't get
your knickers in a knot). . .

39) case describes a patient with findings of proximal motor damage, and CPK of 1020. What

does examination reveal?

a) anti-JO antibodies
b) anti-SS-O antibodies
c) biopsy shows necrosis and inflammatory infiltrate in muscle
d) biopsy shows large and widened motor units

40) case presentation of cerebellar injury, which of the following can be the cause?

a) B12 deficiency

41) 70 year old man with dementia, his mother had similar symptoms when she was 68, which
is correct?

a) mutation in SOD1
b) mutation in APOE4
c) mutation in APP
d) MM polymorphism in PNRP gene
e) mutation in PRESINILIN

42) which is correct regarding aseptic meningitis

a) supportive care except in cases of meningoencephalitis

b) lab results of cells 500, low glucose, high opening pressure

43) which is incorrect about Parkinson

a) By age 65, more than 5% of the population has Parkinson's

b) patients treated with L-DOPA have a higher risk of gambling
c) bothersome leg movement

44) case storyof a woman with motor damage of any kind, and damage to cnVI, which is correct
regarding damage to her eyes?

a) elevated ICP

45) case story of a head trauma, which of the following is not possible?

a) a late complication of this kind of injury is hydrocephalus

b) in an isolated injury the reason will not be hypovolemic pressure
c) main cause of trauma death outside of hospital

46) 70 year old man brought to the hospital by his daughter due to memory loss, what justifies /
does not justify diagnosis of Alzheimer's disease? (Contributor wasn't sure)

a) still sociable but has memory loss

47) which is not related to movement and stability?

a) rubrospinal tract
b) corticospinal tract
c) spinothalamic tract

48) what characterizes amnesia syndrome?

a) damage to short term memory

b) damage to medium/working memory
c) damage to long term memory
d) damage in remembering how to perform activities
e) memory disorders, accompanied by other cognitive difficulties such as language and
spatial identification

49) patient with lobar bleeding 40cc, gcs of 10, and no ventricular bleeding. Which is incorrect?

a) 20-30% mortality risk

b) surgical intervention will ideally be after 48-72 hrs
c) this patient is a candidate for surgical drainage
d) ventricular bleeding doubles mortality risk

50) A trauma patient on respirator, when weaning from the respirator is attempted he opens his
eyes for a long time, during the day it is noted that he gazes but does not respond to pain or
spontaneous limb movement. Which is true about his situation?

a) vegetative state
b) minimal consciousness
c) coma
d) locked in syndrome

51) head trauma that causes cerebellar bleeding, which is incorrect?

a) level 3 of --- must drain ventricles

b) gcs is poor, level of consciousness is low, imaging of blood near pons is indication for
surgery
c) ventricular drainage is first treatment in this case

52) bleeding within the brain (subarachnoid I think), which is incorrect

a) should only give fluids after correcting the anyeurism

b) majority of patients with this condition are hypernatremic
c) should keep systolic bp between 120-140
d) INR must be corrected

53) which causes damage to depth perception?

a) damage to right PCA

b) agenesis of corpus callosum
c) left optic neuritis
d) balint syndrome

54) an 18 year old man comes to the doctor with complaint of double vision. On examination,
damage to abduction of left eye, left eyelid, decreased sensation in the forehead above the eye.
Where is the injury?

a) pathway between pons and medulla

b) orbit
c) NMJ
d) frontal eye field

Original edition skipped question 55

56) what is most common in CJD?

a) myoclonus
b) cerebellar manifestations
c) pyramidal manifestations
d) extrapyramidal manifestations
e) dysfunction in cognition / behaviour

57) what is the mechanism of 'glove-and-stocking' sensory neuropathy in patients with

diabetes?

a) axonal degeneration
b) wallerian
c) sensory gangliopathy

58) what prevents appearance of diplopia?

a) left optic neuritis

b) bilateral occipital damage
c) damage to cavernous sinus
d) ischemia of left PCA

59) question about a patient who presents with a memory problem, question asked what type of
memory was affected

60) question about means of transmission of familial CJD

1-c. 2-c. 3-d. 4-c. 5-b(?). 6-d. 7-a. 8-c? 9-c. 10-a. 11-c. 12-c. 13-c. 14-b. 15-b. 16-d.
Subsequent answers were not provided in answer key.