Neurology Quiz | Practice MCQ #mcq.ImBooz

• (A) Type 1 neurofibromatosis (von Recklinghausen disease)
• (B) Type 2 neurofibromatosis
• (C) Meningeal carcinomatosis
• (D) Multifocal meningiomas

Check AnswerSolution[B]:-Schwannomas most often occur on the eighth cranial nerve (CN), but they may also develop on the fifth, seventh, ninth, or tenth CNs. With type 2 neurofibromatosis, bilateral tumors are more the rule than the exception. The tumors that develop on the eighth CN usually develop on the vestibular division of the nerve

• (A) Anterior perforated substance
• (B) Lateral olfactory gyrus (prepiriform area)
• (C) Posterior third of the first temporal gyrus
• (D) Angular gyrus

Check AnswerSolution[B]:-The olfactory tract divides into medial and lateral striae. The medial stria sends fibers across the anterior commissure to the opposite hemisphere. The lateral stria terminates in the medial and cortical nuclei of the amygdaloid complex, as well as the prepiriform area. This primary olfactory cortex is in area 34 of Brodmann and is restricted to a small area on the end of the hippocampal gyrus and the uncus. This distribution of fibers makes olfaction unique among the senses in that it does not send fibers through the thalamus

• (A) The newborn period
• (B) Infancy
• (C) Childhood
• (D) Adolescence

Check AnswerSolution[D]:-Development of genitalia and secondary sexual characteristics during puberty and adolescence is usually negligible in boys affected by Kallmann syndrome. The olfactory defect is congenital, but may be unsuspected until the hypogonadism becomes apparent. The defects responsible for both the anosmia and hypogonadism are developmental rather than acquired. Until the defect in secondary sexual characteristics becomes apparent, the affected person is usually perceived as normal.

• (A) Subarachnoid blood causes pial adhesions on the olfactory nerve.
• (B) Injury to the temporal tip injures the olfactory cortex.
• (C) Torsion on the brainstem injures trigeminal tracts.
• (D) Shearing forces sever filaments of the receptor cells as they cross the cribriform plate.

Check AnswerSolution[D]:-Anosmia is most likely to develop with head trauma if the trauma is sufficient to cause a skull fracture. If anosmia does occur in the setting of a skull fracture, it is likely to be permanent. With head trauma that does not cause a fracture, anosmia will persist in about 75% of cases.

• (A) Pseudotumor cerebri
• (B) Multiple sclerosis (MS)
• (C) Olfactory groove meningioma
• (D) Craniopharyngioma

Check AnswerSolution[C]:-Ipsilateral optic atrophy and contralateral papilledema in association with an intracranial tumor constitute the Foster-Kennedy syndrome. A meningioma of the olfactory groove may produce this syndrome if it extends posteriorly to involve the ipsilateral optic nerve. Compression on the optic nerve by the tumor produces atrophy and interferes with transmission of the increased intracranial pressure (ICP) down the optic sheath. The increased ICP is reflected in the papilledema apparent in the contralateral eye.

• (A) Benign positional vertigo (BPV)
• (B) Multiple sclerosis (MS)
• (C) Olfactory groove meningioma
• (D) Craniopharyngioma

Check AnswerSolution[A]:-Benign positional vertigo commonly affects people in middle age or older. It is characterized by recurrent attacks of rotational vertigo occurring on changes in head position, typically lying down or turning onto the side of the affected ear. The symptoms may persist on standing as well, leaving the patient with a continuous sense of disequilibrium. Provocative maneuvers (Nylan-Barany or Hallpike maneuver) are used to confirm that the patient’s complaint is due to a peripheral cause of vestibulopathy rather than a central process affecting the brainstem. In a peripheral vestibulopathy, putting the patient’s head in a position hanging at 45� off the end of the examining table, with the head turned to the affected side, will produce rotatory nystagmus with a latency of up to 40 second, a brief duration (generally less than 1 minute), and fatigability (a decrease in symptoms and signs with successive maneuvers). The cause of BPV is thought to be related to a calcified piece of otolithic material moving within the posterior semicircular canal. Treatment may include vestibular exercises, in which the patient performs provocative maneuvers at home, or maneuvers designed to free the otolith from the posterior semicircular canal

• (A) Meniere disease
• (B) Promethazine
• (C) Penicillin
• (D) Dimenhydrinate

Check AnswerSolution[A]:-Meniere disease is characterized by repeated brief episodes of fullness in the ear, tinnitus, hearing loss, and severe vertigo. The episodes may last from hours to days. Attacks may be so severe that they cause the patient to fall to the ground due to severe disequilibrium. The cause is generally idiopathic, but is thought to relate to distension of the semicircular canal and an increase in the volume of the endolymphatic fluid. For this reason, the condition has been called endolymphatic hydrops. Treatment is generally with salt restriction and diuretics. Surgery with endolymphatic shunts is of unproven value.

• (A) Aminoglycoside toxicity
• (B) Frontal lobe
• (C) Parietal lobe
• (D) Temporal lobe

Check AnswerSolution[A]:-Aminoglycoside antibiotics may cause vestibulopathy and ototoxicity. The vestibular end organ is affected by streptomycin and gentamicin; kanamycin, tobramycin, and neomycin tend to have a greater effect on the cochlea. Disequilibrium may progress after exposure. The cause is probably related to the fact that these drugs are concentrated in the endolymphatic fluid, exposing the cochlear hair cells to high levels of the drug. Renal disease may exacerbate the effects of the drugs.

• (A) Vertebral artery occlusion
• (B) Frontal lobe
• (C) Parietal lobe
• (D) Temporal lobe

Check AnswerSolution[A]:-This patient has a history of progressive vertigo, ataxia, sensory loss, dysphagia, and hiccups, all symptoms of the lateral medullary syndrome, usually due to distal vertebral artery occlusion. This patient’s hemianopsia reflects the probable occurrence of occipital lobe infarction, perhaps related to embolism from the occluded vertebral artery. This could have occurred at the time of the lateral medullary stroke or at an independent time. The preceding history of dizzy episodes is indicative of the importance of a thorough evaluation for the cause of dizziness in the elderly patient, particularly when other symptoms occur as well.

• (A) Dorsal spinal root disease
• (B) Ventral spinal root disease
• (C) Arcuate fasciculus damage
• (D) Motor neuron disease

Check AnswerSolution[D]:-Motor neuron disease in the anterior horns of the spinal cord and damage to the corticospinal tracts or motor neurons contributing axons to the corticospinal tracts would account for these neurological signs. Damage to the dorsal spinal root would be expected to produce sensory, rather than motor, deficits and would produce areflexia, rather than hyperreflexia, at the level of the injury. Damage to the ventral spinal roots would produce weakness and wasting, but no spasticity or hyperreflexia would develop. Purkinje cell damage would be expected to produce ataxia without substantial weakness. The arcuate fasciculus connects elements of the cerebral cortex not involved in the regulation of strength or motor tone.

• (A) 2-to-4 months
• (B) 1-to-2 months
• (C) 3 days-to-3 weeks
• (D) 5-to-25 minutes

Check AnswerSolution[C]:-Spinal shock is a transient phenomenon that occurs with damage to fibers from upper motor neurons. The spasticity that usually develops within a few days of the spinal cord injury is presumed to represent exaggeration of the normal stretch reflexes in the limbs disconnected from upper motor neuron control. The evolution from spinal shock to spasticity is much more typical of spinal cord injuries than it is of cerebrocortical injuries, but even with cerebrocortical injuries there is usually an interval of hours to days during which limbs that eventually become hyperreflexic and spastic are hyporeflexic and flaccid.

• (A) Deltoid muscle
• (B) Long thoracic nerve
• (C) Serratus anterior muscle
• (D) Suprascapular nerve

Check AnswerSolution[B]:-Winging of the scapula most often occurs with weakness of the serratus anterior muscle. This is innervated by the long thoracic nerve, whose course starts high enough and runs superficially enough to allow injury to the nerve with deep dissection into the root of the neck. The long thoracic nerve is derived from C5, C6, and C7. Winging is elicited by having the patient push against a wall with the hands at shoulder level. With this maneuver, the scapula with the weak serratus anterior will be pulled away from the back and the vertical margin of the scapula will stick out from the back. Injuries to the long thoracic nerve are usually unilateral and are often due to trauma or surgical manipulation.

• (A) Flexion
• (B) Extension
• (C) Torsion
• (D) Spondylolisthesis

Check AnswerSolution[A]:-Extreme flexion of the lumbar spine is likely in automobile accidents and in falls in which the person is upright. Fracture of a lumbar vertebral body may be seen in vehicular accidents when the victim is restrained during a high-speed impact by a seat belt without a shoulder harness. The rapid and extreme forward flexion of the lumbar spine may produce a variety of spinal injuries, ranging from fractures to dislocations. Fractures suffered during falls in which the person is upright, such as may occur when someone jumps off a building, are usually compression fractures of the vertebral body. Fracture of the vertebral body will usually produce pain coincidental with the injury. Patients with fractures of the vertebral body that occur without trauma or with inconsequential trauma must be investigated for malignant processes, such as metastatic carcinoma, multiple myeloma, and unsuspected osteomyelitis.

• (A) Brown-Sequard (hemisection) syndrome
• (B) Complete transection
• (C) Posterior column syndrome
• (D) Syringomyelic syndrome

Check AnswerSolution[A]:-Hemisection of the spinal cord results in a contralateral loss of pain and thermal sensation due to spinothalamic damage and ipsilateral loss of proprioception due to posterior column damage. There is also an ipsilateral motor paralysis due to destruction of the corticospinal and rubrospinal tracts as well as motor neurons. Complete transection of the spinal cord would cause a bilateral spastic paralysis, and there would be no conscious appreciation of any cutaneous or deep sensation in the area below the transection. Posterior column syndrome would result in a bilateral loss of proprioception below the lesion, with relative preservation of pain and temperature sensation. Syringomyelic syndrome results from a lesion of the central gray matter. Pain and temperature fibers that cross at the anterior commissure are affected, which may result in bilateral loss of these sensations over several dermatomes. However, tactile sensation is spared. The most common cause of this type of syndrome is syringomyelia. Trauma, hemorrhage, or tumors are other possible etiologies. If the lesion becomes large enough, then other spinal cord systems become affected as well. Tabetic syndrome results from damage to proprioceptive and other dorsal root fibers. It is classically caused by syphilis. Symptoms include paresthesias, pain, and abnormalities of gait. Vibration sense is most affected.

• (A) Fasciculations
• (B) Fibrillations
• (C) Flaccid paralysis
• (D) Spastic paralysis

Check AnswerSolution[D]:-This patient has an upper motor neuron lesion. The damage has been done proximal to the synapse of the anterior horn of the spinal cord. He will therefore develop a spastic paralysis. Fasciculations, fibrillations, flaccid paralysis, and hyporeflexia are all found following lower motor neuron lesions (at the anterior horn cell or more distally).

• (A) At the medulla
• (B) At the midbrain
• (C) At the pons
• (D) At the thalamus

Check AnswerSolution[A]:-After the primary sensory fiber enters the spinal cord, the ascending branch enters the dorsal columns and travels to the medulla. The fibers from the legs and trunk travel medially in the fasciculus gracilis, whereas those from the arm and neck travel laterally in the fasciculus cuneatus. These first-order neurons synapse in the medulla, and then the second-order neurons decussate as the internal arcuate fibers and ascend in the medial lemniscus. The second-order fibers synapse in the ventroposterolateral nucleus of the thalamus, which then synapses on the somatosensory cortex.

• (A) Syphilis
• (B) Atherosclerosis
• (C) Diabetes mellitus
• (D) Chronic hypertension

Check AnswerSolution[B]:-Syphilis may produce an aortic aneurysm, but this is characteristically at the level of the thoracic aorta (the arch of the aorta). With aneurysmal dilatation of the aorta, defects in the wall of the vessel may be exacerbated, and dissection of the aortic wall may develop. As this dissection extends into branches of the aorta, it usually narrows and may occlude the lumen of the vessels. Diabetes mellitus may contribute to the formation of atherosclerotic damage in the wall of the aorta, but it is the atherosclerosis itself that is most implicated in the eventual deterioration of the vascular wall. Chronic hypertension may develop with damage that involves the renal arteries, but hypertension would not be expected to be the cause of the aortic pathology

• (A) Conversion disorder
• (B) Multiple sclerosis (MS)
• (C) Spinal cord compression
• (D) Spinal cord infarct

Check AnswerSolution[D]:-This patient probably has a spinal cord infarction from an anterior spinal artery occlusion. The posterior cord may be spared, preserving joint proprioception. Bilateral lower extremity deficits without cranial nerve or mental status findings would be an exceedingly unusual cerebral stroke presentation. There is no information, such as psychological stressors or a nonphysiologic examination, to suggest a conversion disorder in this case. MS causes neurological deficits over space and time. In this case we have a single deficit at a single point in time. History of metastatic cancer or trauma might make the physician suspect spinal cord compression.

• (A) C2 to C5
• (B) C5 to C8
• (C) T2 to T8
• (D) T10 to L1

Check AnswerSolution[D]:-The artery of Adamkiewicz is a major anterior radicular artery and may supply the lower two-thirds of the spinal cord. It is at risk of occlusion during abdominal aortic aneurysm repair. Other branches of the aorta or internal iliac arteries may also supply the thoracic and lumbar cord. The upper segments of the spinal cord are usually supplied off the vertebral arteries.

• (A) Exactly at the level of the lesion
• (B) Four or five segments above the lesion
• (C) Four or five segments below the lesion
• (D) One or two segments below the lesion

Check AnswerSolution[D]:-The spinothalamic system is responsible for pain and temperature sensation. It enters the spinal cord through the dorsal root ganglion. The second-order neurons then ascend one or two levels as they cross in the anterior gray commissure. Thus a lesion of the right spinothalamic tract at the T8 spinal cord level would result in a contralateral loss of pain and temperature on the left body beginning at approximately the T9-to-T10 dermatome.