Neurology Quiz | Neuroq quiz | Practice MCQ #mcq.ImBooz

• (A) Drug toxicity
• (B) No pathologic lesion in the brain
• (C) Unilateral parietal lobe damage
• (D) Parinaud syndrome

Check AnswerSolution[B]:-This type of nystagmus is called optokinetic nystagmus. It is a pattern of eye movements that should be elicitable with the normal patient. If the nystagmus is less obvious on rotating the drum in a given direction, the patient may have a parietal lesion responsible for the asymmetric response.

• (A) Chorioretinitis
• (B) Occlusion of the central retinal vein
• (C) Occlusion of the central retinal artery
• (D) Optic neuritis

Check AnswerSolution[C]:-Occlusion of the central retinal artery may be due to atheromatous particles, fibrin-platelet emboli, or local retinal artery compression. The visual loss is usually painless and irreversible. Occlusion of the internal carotid artery-the artery from which the ophthalmic and ultimately the retinal arteries originate-need not produce ischemic damage to the retina if collateral supply to the retinal artery is sufficient. Thrombosis of the retinal vein produces engorged tortuous veins and streaky linear retinal hemorrhages. Visual loss is more variable with venous occlusion compared with central retinal artery.

• (A) Transthoracic echocardiogram
• (B) Brain MRI
• (C) Brain CT
• (D) Carotid ultrasound

Check AnswerSolution[D]:-Emboli that arise in or travel through the internal carotid artery may exit to the ophthalmic artery and cause obstruction. The transient ischemia that occurs before the embolus breaks up usually produces transient visual loss in the ipsilateral eye. Amaurosis fugax is by definition a fleeting loss of vision.

• (A) Orbital cellulitis
• (B) Cavernous sinus thrombosis
• (C) Transverse sinus thrombosis
• (D) Optic neuritis

Check AnswerSolution[A]:-The fact that vision is preserved excludes optic neuritis and cavernous sinus thrombosis. Optic neuritis will produce pain in the affected eye and may be associated with a normal optic disc, but visual acuity should be deficient and an afferent pupillary defect should be apparent. Cavernous sinus thrombosis usually produces prop-tosis and pain, but impaired venous drainage from the eye should interfere with acuity, and the retina should appear profoundly disturbed. With a diphtheritic polyneuropathy, an ophthalmoplegia may develop, but this would not be limited to one eye and is not usually associated with facial trauma. Transverse sinus thrombosis may produce cerebrocortical dysfunction or stroke, but ophthalmoplegia would not be a manifestation of this problem. The history and examination findings are classic for a superficial infection developing into orbital cellulites.

• (A) A cervical spinal cord tumor
• (B) A brainstem glioma
• (C) MS
• (D) Benign tonic pupillary dilatation

Check AnswerSolution[D]:-This pupillary abnormality is called Adie tonic pupil. It is usually seen in otherwise healthy young women and may occur in isolation or in association with absent tendon reflexes. Local trauma to the eye should be considered if only one pupil is affected. If both pupils are affected, drug use should be considered. It is probably due to degeneration of the ciliary ganglia. Although the cause is obscure, it may reflect a mild polyneuropathy. In most cases this is a benign phenomenon.

• (A) Completely normal (no defect)
• (B) Reacts poorly to light but accommodates well
• (C) Accommodates poorly but reacts well to light
• (D) Is pinpoint and regular in shape

Check AnswerSolution[B]:-The patient with neurosyphilis may develop an Argyll Robertson pupil. The pupil is usually poorly reactive to light, small, and irregular in shape. Both eyes or only one eye may be affected. Although reactivity to light is deficient, pupillary accommodation with changes in distance from the eye is usually good. The pupillary reaction may, however, be complicated by optic atrophy, which also may develop as a consequence of neurosyphilis. Pinpoint pupils are seen in pontine disease due to interruption of the pupillodilator pathways in the brainstem. The fixed and dilated pupil is generally a sign of third-nerve injury due to compression of the nerve by a vascular or other mass. In the patient with diminished consciousness and hemiparesis, the concern is for herniation. Other, more benign causes of the fixed and dilated pupil include uveitis, Adie tonic pupil, and drug-induced iridoplegia (ie, paralysis of the iris by intentional or accidental application of sympathomimetic or anticholinergic medications).

• (A) Cyclosporine toxicity
• (B) Steroid psychosis
• (C) Occipital lobe infarction
• (D) Ischemic optic neuropathies

Check AnswerSolution[A]:-Cyclosporine and tacrolimus (FK 506; Prograf) may both induce a syndrome resembling hypertensive encephalopathy, which has been called by some reversible posterior leukoencephalopathy, although it involves more than white matter and may also occur in the anterior frontal regions. In the setting of cyclosporine use, patients may develop headache, visual dysfunction related to occipital lobe dysfunction, confusion, and seizures. Usually there is associated hypertension. The visual loss may include cortical blindness or scotomas. Imaging may show bilateral, more or less symmetrical signal changes in the white matter and occasionally the cortex of the occipital and parietal lobes.

• (A) Cyclosporine toxicity
• (B) Occipital lobe lymphoma
• (C) Tobacco-alcohol amblyopia
• (D) Ischemic optic neuropathies

Check AnswerSolution[D]:-Ischemic optic neuropathy, often called anterior ischemic optic neuropathy, is the most common cause of acute monocular blindness. This condition presents as sudden, painless loss of vision in one eye. Symptoms may progress over several days, and the visual loss is permanent. The visual field defect is typically an inferior altitudinal defect, with involvement of central vision and a consequent loss of acuity. In up to one-third of patients, the opposite eye may become involved soon afterward. Hypertension and diabetes mellitus appear to be risk factors, as for most small-vessel disease. The responsible arterial occlusion is of the posterior ciliary artery, a branch of the ophthalmic artery, which supplies the optic nerve. Typically, this condition is not associated with carotid artery disease. Giant cell arteritis (temporal arteritis) needs to be excluded, because it can be treated with steroids.

• (A) Papilledema
• (B) Optic disc pallor
• (C) Retinal exudates
• (D) Retinal vein enlargement

Check AnswerSolution[B]:-At the time of the initial injury to the optic nerve, the nerve may appear swollen on funduscopy. As the swelling resolves, however, the disc typically appears pale. This optic nerve pallor serves as a sign of previous injury, and it may be seen after injury due to either infarction (as in ischemic optic neuropathy) or inflammation of the optic nerve (as in MS and optic neuritis).

• (A) Neuronal degeneration
• (B) Calcification of ligaments stabilizing the ossicles
• (C) Weakness of the tensor tympani
• (D) Weakness of the stapedius muscle

Check AnswerSolution[A]:-This is a normal Rinne test indicating that middle ear deafness is not present. Presbycusis is the most common cause of hearing loss in the elderly. High-frequency perception is impaired in this disorder because of sensorineural damage. The neurons most likely affected in this degenerative disorder are the spiral ganglion neurons of the cochlea.

• (A) There is no temporal lobe representation for hearing.
• (B) Each cochlear nucleus projects to both temporal lobes.
• (C) Deafness results with nondominant hemisphere damage.
• (D) Both thalamic and temporal lobe damage must occur.

Check AnswerSolution[B]:-Hearing in each ear is represented bilaterally even at the level of the brainstem. Lesions rarely produce sufficient damage in the brainstem to cause unilateral deafness, unless they are so massive that the patient is unlikely to be responsive to most stimuli and unlikely to survive. If there is unilateral deafness, the patient should be evaluated to determine whether the hearing loss is conductive or sensorineural.

• (A) Louder than that transmitted by bone conduction
• (B) Quieter than that transmitted by bone conduction
• (C) Lower pitched than that transmitted by bone conduction
• (D) Higher pitched than that transmitted by bone conduction

Check AnswerSolution[B]:-The traditional test for detecting conductive deafness is the Rinne test. The vibrating tuning fork is applied to the mastoid process. When the patient can no longer hear the vibration of the fork, it is taken off the skull and moved to the external auditory meatus. With nerve deafness, acuity may be generally reduced, but perception with air conduction will be superior to that with bone conduction. This will also be true in normal persons. With conductive hearing loss, the sound waves are transmitted more effectively to the cochlea directly through the bones of the skull than through the air and along the pathway that starts at the external auditory meatus.

• (A) Frontal lobe
• (B) Parietal lobe
• (C) Temporal lobe
• (D) Occipital lobe

Check AnswerSolution[C]:-Mastoiditis may extend either supratentorially into the temporal lobe or infratentorially into the cerebellum. Cerebellar involvement is likely to produce ataxia, vertigo, nausea, vomiting, and morning headache. Temporal lobe extension causes a fluent aphasia by damaging the Wernicke area in the superior temporal gyrus. The lesion in either the cerebellum or the temporal lobe is usually an abscess formed by bacteria responsible for the mastoiditis. Surgical removal of the abscess is essential in either location, as progression of the abscess in either the cerebellum or the temporal lobe will be lethal.

• (A) High-tone sensorineural loss
• (B) Low-tone sensorineural loss
• (C) High-tone conductive loss
• (D) Low-tone conductive loss

Check AnswerSolution[A]:-The principal site of damage with acoustic trauma is the cochlea. Mechanical trauma may produce a high-tone conductive loss by perforating the eardrum. A strictly acoustic insult would not be expected to convey enough energy to the tympanum to disrupt it, but it may convey enough energy to the cochlea to shear off receptor filaments from hair cells

• (A) Superior cerebellar artery
• (B) Posterior inferior cerebellar artery (PICA)
• (C) Anterior inferior cerebellar artery (AICA)
• (D) Anterior spinal artery

Check AnswerSolution[B]:-The PICA has both medial and lateral branches. The medial branches supply the brainstem. With occlusion of these, vestibular nuclei in the brainstem are infarcted, and vertigo is common. Even with an occlusion limited to the lateral branches, vertigo is likely. If no brainstem damage occurs, cerebellar flocculonodular lobule injury may induce vertigo.

• (A) Left subclavian artery
• (B) Internal carotid arteries bilaterally
• (C) Vertebrobasilar system
• (D) Internal maxillary artery

Check AnswerSolution[C]:-The vertebral arteries ascend through foramens in the transverse processes of the cervical vertebrae. With bony spurs on the vertebrae or with severe atherosclerotic disease in the vertebral arteries, flow through the vertebrobasilar system may be transiently reduced when the head is extended or rotated. Because vertigo may be positional without any associated vascular insufficiency, a diagnosis of vertebrobasilar ischemia should be reached only after other causes, such as cerebellar tumor, have been eliminated.

• (A) Overall frequencies
• (B) Primarily over high frequencies
• (C) Primarily over middle frequencies
• (D) Primarily over low frequencies

Check AnswerSolution[D]:-Unlike the deficit of presbycusis, lower tones are most susceptible to impaired perception during the initial phases of M�ni�re disease. The severity of the hearing loss typically fluctuates considerably. As fluctuations in the low-tone loss abate, high tones become progressively more involved. The attacks of vertigo associated with M�ni�re disease usually abate as hearing loss in the affected ear peaks.

• (A) Promethazine
• (B) Penicillin
• (C) Dimenhydrinate
• (D) Acetylsalicylic acid

Check AnswerSolution[D]:-Salicylates, as well as alcohol, quinine, and aminoglycoside antibiotics, may produce a toxic labyrinthitis with vertigo as a prominent feature. Vertigo is also a common sequela of head trauma or whiplash injury. Promethazine, dimenhydrinate, and meclizine are all commonly used agents to reduce symptoms of vertigo

• (A) Alcohol
• (B) Aspirin
• (C) Glucose
• (D) Diazepam

Check AnswerSolution[B]:-Aspirin may produce tinnitus in persons usually unaffected by this problem. Patients on high doses of aspirin for rheumatoid arthritis are especially susceptible to this drug-induced tinnitus. Those patients with chronic tinnitus from acoustic trauma or M�ni�re disease will find that their symptoms worsen with aspirin.

• (A) Medulloblastoma
• (B) Acoustic schwannoma
• (C) Neurofibroma
• (D) Ependymoma

Check AnswerSolution[C]:-Cafe au lait spots characteristically occur in both type 1 and type 2 neurofibromatosis. Meningiomas, acoustic schwannomas, and other types of central nervous system (CNS) tumors occur with these hereditary disorders, but the neurofibroma is the most common lesion. Type 1 neurofibromatosis develops with a defect on chromosome 17; type 2 develops with a defect on chromosome 22.