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Pathophysiology Neruo PPT 3-4

Total questions: 171

Worksheet time: 1hrs 26mins

Name
Class
Date
1.

A coup brain injury occurs when?

a)

Brain strikes the skull at the same side as the strike or trauma

b)

Brain strikes the opposite side of the strike or trauma

c)

Brain strikes the floor of the cranial fossa

2.

A countercoup brain injury occurs when?

a)

Brain strikes the same side as the strike or trauma

b)

Brain strikes the opposite side of the strike or trauma

c)

Brain strikes the floor of the cranial cavity

d)

Brain strikes the roof of the cranial cavity

3.

When do cerebral contusions most often occur?

a)

Mild Trauma

b)

Bullet Wounds

c)

Moderate/Severe Trauma

d)

Iatrogenic

4.

Concussions present with?

a)

Glasgow Coma Scale 13-15

b)

Confusion and Amnesia

c)

No memory of accident/events immediate before/after injury

d)

All choices are correct

5.

What areas of the brain are usually affected by cerebral contusions?

a)

Orbital Surfaces of Frontal Lobe + Tips Of Temporal Lobe

b)

Orbital Surfaces of Parietal Lobe + Tips Of Occipital Lobe

c)

Surface of Temporal Lobe + Tips Of Parietal Lobe

d)

Tips Of Temporal Lobe

6.

Diffuse axonal injury occurs most frequently in?

a)

Slap on the Head and Sports

b)

MVA's and Blows to Unsupported Head

c)

Iatrogenic

d)

Slip and Falls

7.

In diffuse axonal injury, the cerebrum ___ around the brainstem.

a)

Flexes (Axons Stretch, Twist, Tear)

b)

Extends (Axons Stretch, Twist, Tear)

c)

Pivots (Axons Stretch, Twist, Tear)

d)

Hemorrhages (Axons Stretch, Twist, Tear)

8.

Where is brain damage most severe in diffuse axonal injury?

a)

Left Temporal Lobe

b)

Occipital Lobe

c)

Frontal Right Lobe

d)

Midline Structures

9.

Axonal distortion + stretching causes efflux of ___ to ECF and influx of ___ into axons.

a)

K+ ; Ca++

b)

Na+ ; Mg++

c)

PO4+ ; Ca++

d)

Ca++ ; Na+

10.

After K+ and Ca++ changes occur in diffuse axonal injury, what neurotransmitter is released?

a)

Nitric Oxide = Excitotoxic Cascade

b)

Glutamate = Excitotoxic Cascade

c)

Urea = Excitotoxic Cascade

d)

Acetylcholine = Excitotoxic Cascade

11.

Due to the excitotoxic cascade, what happens to energy and Na+/K+ ATP Pump?

a)

Overworked Pump + Too Much Energy Created

b)

Overworked Pump + Necrosis

c)

Overworked Pump + Energy Depletion

d)

Overworked Pump + Hypercalcimea

12.

What is the result of axonal distortion and stretching?

a)

Increased Magnesium

b)

Increased Depolarization Speed

c)

Increased Collagen Production

d)

Glycolysis = lactic acidosis = oxidative dysfunction = edema = death

13.

Severe DAI patients usually become unconscious almost immediately and enter what state?

a)

Coma or Vegetative State

b)

Death

c)

Delirium

d)

Minimally Conscious State

14.

An epidural hematoma is typically secondary to?

a)

Rupture of Temporal Artery due to fracture of occipital lobe

b)

Rupture of MMA due to fracture of temporal lobe

c)

Rupture of Basilar Artery due to Circle of Willis Miscommunication

d)

Rupture of MMA due to sleeping too much

15.

Middle Meningeal Artery (MMA) is a branch off of what artery

a)

Mandibular Artery

b)

Internal Iliac Artery

c)

Maxillary Artery

d)

Verterbral Arteries

16.

Initial presentation of an epidural hematoma is called _____ interval.

a)

altered mental status

b)

delirious

c)

bleeding

d)

lucid (Normal)

17.

As hematoma grows in epidural space, there is brain compression causing ____ ICP and ___ herniation.

a)

Decreased ; Transtentorial

b)

Increased ; Transtentorial

c)

Decreased ; Infratentorial

d)

Decreased ; Vertebral Disc

18.

On CT scan for an epidural hematoma, you will have a

a)

Ovaled Shape

b)

Triangular in Shape

c)

Lens Shaped Biconvex (dura peeling)

d)

Spotty Appearance

19.

Subdural hematoma is typically secondary to ____ vein rupture.

a)

Jugular

b)

Subclavian

c)

Vena Cava

d)

Bridging (Emissary)

20.

What is a the most common cause of subdural hematoma?

a)

Atheroma Plaque Rupture

b)

CVA

c)

Head Trauma

d)

MI

21.

What are some major risk factors for a subdural hematoma?

a)

All choices are correct

b)

Elderly

c)

Chronic Alcohol Use

d)

Previous TBI

22.

Where is the subdural hematoma located?

a)

Blood Between Pia Mater and Arachnoid (Crescent Shape)

b)

Blood between dura and arachnoid (Crescent Shape)

c)

Blood between dura and arachnoid (Biconcave Lens Shape)

d)

Blood between dura and pia mater(Crescent Shape)

23.

Clinical presentation of Subdural Hematoma (SDH)?

a)

Chronic: Headache, Cognitive Impairment, Unsteady Gait

b)

Acute: Symptoms of Increased ICP

c)

All choices are correct

24.

Most common cause of subrachnoid hemorrhage?

a)

Arterial Aneurysm Rupture in Subarachnoid Space

b)

Myocardial Infarction in Subarachnoid Space

c)

Atheroma plaque 100% obstruction

d)

Torsades de Pointes

25.

A traumatic subarachnoid hemorrhage (SAH) occurs due to?

a)

Mallory Weiss Tears

b)

Atrial Fibrillation

c)

Myocadial Infarction

d)

Rupture of corticomeningeal vessels or hemorrhagic contusions

26.

What are some risk factors of subarachnoid hemorrhage?

a)

Atrial Fibrillation

b)

Total Knee Replacements

c)

Alcoholism/Atherosclerotic Disease

d)

Lumbar Laminectomy/Discectomy

27.

In a subarachnoid hemorrhage, blood accumulates in the ____ space, where major blood vessels of the brain are housed.

a)

Pia Mater

b)

Subarachnoid

c)

Dura Mater

d)

Dead Space

28.

Blood in the Subarachnoid Space leads to ___ and ___ of arachnoid and can lead to hydrocephalus.

a)

Vasoconstriction ; Fibrosis

b)

Vasodilation ; Necrosis

c)

Vasodilation ; Regeneration

d)

Vasoconstriction ; Expansion

29.

What can you use to diagnose/detect SAH?

a)

Xray

b)

Ultrasound

c)

PET Scan

d)

CT Scan

30.

Clinical presentation of SAH?

a)

Lateralization to aneurysm

b)

Worse Headache of Life

c)

Thunderclap Headache

d)

Photophobia, altered consciousness, coma

e)

All choices are correct

31.

A skull fracture may lead to infection because of?

a)

CSF pressure induces bacterial growth

b)

CSF causes infection and inflammation

c)

Communication with septic areas such as sinuses

d)

Communication between basilar and pontine arteries becomes compromised

32.

True/False: Skull fractures always indicate brain damage

a)

True

b)

False

33.

Two classifications of skull fractures are ___ and ___.

a)

Linear and Depressed

b)

Shattered and Bubbled

c)

Sprinted and Cracked

d)

Cracked and Linear

34.

A basilar skull fracture at the petrous temporal bone can lead to?

a)

CSF Otorrhea (Raccoon Eyes SIgn)

b)

CSF Ophthalmorrhea (Raccoon eyes Sign)

c)

CSF Rhinorrhea, Bruising around the eyes (Raccoon Eyes Sign)

d)

CSF Otorrhea, Bruising over mastoid (Battle Sign)

35.

A basilar skull fracture over the anterior cranial fossa can lead to?

a)

CSF Rhinorrhea l Bruising around the mastoid (Battle Sign)

b)

CSF Otorrhea ; Bruising around the mastoid (Battle Sign)

c)

CSF Rhinorrhea ; Bruising around the Eyes (Raccoon Eyes Sign)

d)

CSF Otorrhea (Bruising around the Eyes)

36.

Temporal bone fractures can cause ossicular chain disruption and hemotympanum which can cause?

a)

Mastoiditis

b)

Conductive Deafness

c)

Sensorineural Deafness

d)

Cerumen Impaction

37.

Vernet syndrome is also known as?

a)

Jugular Foramen Syndrome

b)

Carotid Foramen Syndrome

c)

Charcot Marie Tooth Disease

d)

Wilson's Disease

38.

Syndrome that results from loss of communication between brain and Nervous System Efferents due to Multiple causes is called? (Cord Hemorrhage, Edema, Transection)

a)

Kyphosis

b)

Vertebral Fracure

c)

Spina Bifida

d)

Spinal Shock

39.

What Cranial Nerves are involved in Vernet's Syndrome?

a)

CN IX, X, XI

b)

Impaired Phonation, Aspiration, Ipsilateral Paralysis of vocal Cords

c)

Ipsilateral Paralysis of Soft palate, SCM, and Trapezius

d)

All choices are correct

40.

In spinal shock syndrome, there is complete loss of activity/reflexes below injury and manifests with

a)

Flaccid Paralysis

b)

Loss of control for bladder/rectum

c)

Transient BP Drop

d)

Difficulty Thermal Control

e)

All choices are correct

41.

How long does spinal shock usually last?

a)

10 days exactly

b)

4 months

c)

7-20 days

d)

6 weeks

42.

Injury to the thoracic, lumbar, and sacral segments will lead to?

a)

Paraplegia (Upper Extremities + Thorax Organs)

b)

Paraplegia (Lower Extremities + Pelvic Organs)

c)

Tetraplegia (Upper Extremities + Thorax Organs)

d)

Unilateral Hemiplegia

43.

Spinal cord injury to cervical spine can lead to?

a)

Paraplegia (Impairment to Pelvic Orans + Lower Extremities)

b)

Tetraplegia (impairment to all 4 limbs + pelvic organs)

c)

Hemiplegia

44.

Before complete injury diagnosis is made in spinal injury, patients must not have?

a)

Dilated Pupils

b)

Involuntary Anal Contraction and Perianal abscess

c)

Voluntary Anal Contractions and Perianal contractions

d)

Lack of dermatomes T4, T10, and L1-5.

45.

Incomplete spinal cord injury to the descending tracts will produce?

a)

Motor Impairment

b)

Pain and Temperature Perception Impairment

c)

Light Touch Perception Impairment

d)

Auditory Disturbance

46.

Incomplete spinal cord injury to the dorsal column ascending tracts will produce?

a)

Auditory Impairment

b)

Pain and Temperature impairment

c)

Light touch impairment

d)

Deep Touch, Vibration, Proprioception Impairment

47.

Incomplete spinal cord injury to the ascending tracts will produce generally?

a)

Motor Impairment

b)

Auditory Impairment

c)

Sensory Impairment

d)

Emotional Impairment

48.

Incomplete injury to the lateral spinothalamic ascending tract will produce?

a)

Vibration, Deep TOuch, Proprioception Impairment

b)

Pain and Temperature Impairment

c)

Light Touch Impairment

d)

Auditory Impairment

49.

Central cord syndrome most commonly affects?

a)

Elderly

b)

Children

c)

Adolescents

d)

Young Adults (20-32)

50.

Incomplete injury to the ventral spinothalamic ascending tract will produce?

a)

Auditory Impairment

b)

Deep Touch, Vibration, Proprioception Impairment

c)

Pain and Temperature Impairment

d)

Light Touch Impairment

51.

Clinical Presentation of Central Cord Syndrome?

a)

Muscle Hypertrophy, Allodyinia, Burning in the Proximal Upper Extremities

b)

Muscle Atrophy, Fatigue, Allodyinia, Burning in the Distal Upper Extremities

c)

Weakness, Impaired Hand Dexterity, Hyperpathia, burning in distal Upper Extremities

d)

Pure Allodynia

52.

What is the mechanism of central cord syndrome?

a)

Stretching/Compression of Spinal Cord, = Edema & Destruction of Anterior Corticospinal Tract

b)

Stretching/Compression of Spinal Cord, = Edema & Destruction of Lateral Corticospinal Tract

c)

Stretching/Compression of Spinal Cord, = Edema & Destruction of Corticobulbar Tract

d)

Stretching/Compression of Spinal Cord, = Edema & Destruction of Spinothalamic Tract

53.

Where will the motor deficit be worse in the Central Cord Syndrome?

a)

Upper Extremities (Hands Worse)

b)

Upper Extremities (Shoulders Worse)

c)

Lower Extremities (Hip Joint Worse)

d)

Lower Extremities (Ankles Worse)

54.

What are the late findings in Central Cord Syndrome?

a)

LMN Signs (Clumsiness) Upper Extremities

b)

UMN Signs (spasticity) in Lower Extremities

c)

All choices are correct

55.

What tracts are affected in anterior cord syndrome?

a)

Lateral Corticospinal Tract (Motor Fine movement of Ipsilateral limbs)

b)

Latreal Spinothalamic Tract (Pain and Temp)

c)

All choices are correct

56.

What is the mechanism behind anterior cord syndrome?

a)

Flexion/Compression Injury

b)

Kyphosis

c)

Glycogenolysis

d)

Transsection

57.

Brown-Sequard syndrome is caused by?

a)

Cholesterol

b)

Penetrating Trauma (Hemisection)

c)

Diabetes

d)

Hypetension

58.

What is present in Brown-Sequard Syndrome?

a)

Loss of sensations + Paralysis depending on which tracts are damaged

b)

Hyperpathia

c)

Cauda Equina Syndrome

59.

Brown Sequard Syndrome causes ipsilateral deficit by damage to what tracts?

a)

Lateral Corticospinal Tracts and Dorsal Columns

b)

Corticoculbar

c)

Bilateral Tracts Completely

60.

Brown Sequard Syndrome causes contralateral deficit by damage to what tracts?

a)

Lateral Corticospinal Tract

b)

Dorsal Columns

c)

Lateral Spinothalamic Tract (Pain and Temp)

61.

Pathophysiology behind the anterior cord syndrome?

a)

Injury to Anterior Cord by direct Compression and Anterior Spinal Artery Damage

b)

Damage to the Middle Cerebral Artery

c)

Damage to the anterior cerebral artery

d)

Damage to the Pontine Arteries

62.

Cauda equina syndrome results in?

a)

Unilateral leg anesthesia, bowel and bladder incontinence, priapism, and lower extremity motor changes

b)

Bilateral Leg anesthesia, Priapism, Bowel and bladder incontinence

c)

Bilateral leg anesthesia, bowel and bladder retention, impotence and Lower extremity motor changes

d)

Priapism

63.

What is a key difference between cauda equina and Conus Medullaris?

a)

Cauda Equina= Upper LMN/UMN Involvement /// Conus Medullaris= LMN Involvement

b)

Cauda Equina= Medulla Oblongata Involvement /// Conus Medullaris= Upper LMN/UMN Involvement

c)

Cauda Equina= No Neuronal Involvement /// Conus Medullaris= Upper LMN/UMN Involvement

d)

Cauda Equina= LMN Involvement /// Conus Medullaris= Upper LMN/UMN Involvement

64.

What is the most common etiology of cauda equina syndrome?

a)

Kyphosis

b)

Rupture of Cortex of Brain

c)

Disc Herniation

d)

Neuropathy

65.

Presentation of cauda equina ___ and ___. Presentation of conus medullaris is ___ and ___.

a)

Bilateral ; Unilateral or asymmetric ; Sudden ; Gradual

b)

Gradual ; Unilateral or asymmetric ; Sudden ; Bilateral

c)

Gradual and Bilateral ; Sudden and Unilateral

66.

Radicular pain is more prominent in?

a)

Cauda Equina

b)

Conus Medullaris

c)

Kyphosis

d)

Transsection

67.

In conus medullaris, only reflex affected is achilles. In cauda equina,

a)

Achilles and Bicep Tendon Reflex is affected

b)

Achilles and Tricep Tendon Reflex is affected

c)

All tendons are affected

d)

Achilles and Knee Jerk Reflex is affected

68.

Impotence is more prominent in which syndrome?

a)

Cauda Equina

b)

Conus Medullaris

c)

LBP

d)

Lumbar Fracture

69.

What are some major risk factors for Low back pain?

a)

Young Age

b)

Blood Donations

c)

Obesity and Smoking

d)

Singing

70.

What is the leading cause of disability?

a)

Pregnancy

b)

Cervicalgia

c)

HIV/AIDS

d)

LBP

71.

Discogenic back pain is caused by?

a)

HIV/AIDS

b)

Degeneration of Intervertebral Disc

c)

Conus Medullaris

d)

Diabetes Insipidus

72.

Straight leg raise test in discogenic back pain is?

a)

Positive

b)

Negative

73.

What type of radiculopathy is present with discogenic back pain

a)

Upper Extremity

b)

Lower Extremity

c)

All extremities

d)

None

74.

What exacerbates discogenic back pain?

a)

Bending

b)

Sitting

c)

Lifting

d)

All choices correct

75.

Spondylolysis is

a)

stress fracture through pars interarticularis

b)

MVA injury due to whiplash

c)

Rupture of Annulus Fibrosus

d)

Leakage of contents within the annulus

76.

What vertebrae are usually affected by Spondylolysis

a)

L3-5

b)

S1-3

c)

C3-6

d)

C3-5

77.

Pain from spondylolysis/spondylolisthesis can radiate to?

a)

Face

b)

Both feet

c)

Buttocks

d)

RIght Foot

78.

Spondylolisthesis occurs due to?

a)

XX

b)

X

c)

XX

d)

Untreated spondylolysis and a fractured part sips forward on vertebra, damaging below it.

79.

A CVA is defined as

a)

acute neruo injury from brain ischemia/hemorrhage

b)

acute hormonal injury

c)

acute heartbrak

d)

myocardial ischemia

80.

What are some types of CVA ischemia?

a)

Leg Pain

b)

Thrombus, Hypoperfusion

c)

Diabetes

d)

Amyloids

81.

Reduced blood supply to brain may cause infarction also known as

a)

Hardening Necrosis

b)

Hypertension

c)

Liquefactive necrosis

82.

What are some types of CVA hemorrhage?

a)

Intracranial Hemorrhage

b)

Subarachnoid Hemorrhage

c)

All choices are correct

83.

What area of the brain is most sensitive/vulnreable to ischemia?

a)

Pituitary Gland

b)

Hippocampus

c)

Pineal Gland

d)

AMygdala

84.

Brain ischemia from large artery disease is usually because of thrombosis in the?

a)

Circle of Willis Circulation

b)

Aorta

c)

Internal Iliac Atery

d)

Ovarian Arteries

85.

Small artery disease may cause brain ischemia due to?

a)

Reynauds Phenomenom

b)

DVT

c)

Small Bowel Obstruction

d)

Lacunar Infarcts (Penetrating Arteries)

86.

Thrombotic CVAs present with?

a)

Speech difficulties and Recurrent/progressive symptoms with improvement periods

b)

Recurrent/progressive symptoms with improvement periods

c)

Speech difficulties

d)

All choices correct

87.

Embolic CVAs present with?

a)

Sudden/maximum deficit onset

b)

Slow/Poor deficit

c)

Poor defict onset

d)

Asymptomatic

88.

Most common artery affected in CVAs?

a)

Anterior Cerebral Artery

b)

Basilar Artery

c)

Pontine Artery

d)

Middle Cerebral Artery

89.

Middle cerebral artery CVA will produce

a)

contralateral arm/face sensory/motor dysfunction (aphasia) (Hemi-Neglect NonDominant)

b)

ipsilateral arm/face sensory dysfunction (aphasia) (Hemi-Neglect NonDominant)

c)

ipsilateral arm/face sensory/motor dysfunction (aphasia) (Hemi-Neglect NonDominant)

d)

ipsilateral leg sensory dysfunction (aphasia) (Hemi-Neglect NonDominant)

90.

Anterior cerebral artery CVA presentation?

a)

Ipsilateral leg weakness, light touch/proprioception deficit, hemiparkinsonism

b)

Contralateral leg weakness, light touch/proprioception deficit, asterixis, hemiparkinsonism

c)

Contralateral leg spasm, light touch/proprioception hypersensitivity, hemiparkinsonism

d)

Contralateral leg weakness only

91.

Posterior cerebral arteries, vertebral arteries, and basilar arteries CVAs present with?

a)

Vertigo

b)

Ataxia

c)

Nystagmus

d)

Diplopia/Visual Defects

e)

All choices are correct

92.

Systemic hypoperfusion can be caused by?

a)

Cardiac arrest, MI, Pulm. Embolism, Etc

b)

LBP

c)

Cervicalgia

d)

Shoulder Pain/ Nausea/Vomiting

93.

Symptoms of systemic hypoperfusion?

a)

Pallor, hypotension

b)

Tachycardia or severe Bradychardia

c)

Neurological symptoms, usually symmetric

d)

All choices are correct

94.

Watershed areas are the ones mostly affected by systemic hypoperfusion. What are the symptoms?

a)

(1) Blindness, Stupor, Weakness of shoulders and thigh

b)

(2) Man in a Barrel Syndrome

c)

Sciatica

d)

Choices 1 and 2 are correct

95.

Clinical presentation of Intracerebral Hemorrhage?

a)

Focal symptoms to headaches/Vomit/ Coma

b)

Diffuse symptoms including Death

c)

Generalized nerve pain

d)

Death

96.

What are some causes of intracerebral hemorrhage?

a)

HTN

b)

Trauma

c)

Amyloid Angiopathy

d)

ALl choices are correct

97.

If right putamen/internal capsule is affected by Intracerebral Hemorrhage?

a)

Right Limb Motor/Sensory Signs

b)

Left Limb Motor/Sensory Signs

c)

Bilateral Limb Motor/Sensory Signs

d)

Asymptomatic

98.

If the cerebellum is affected by ICH?

a)

difficulty walking/ataxia

b)

broca's aphasia

c)

wenickes encephalopathy

d)

visual disturbances

99.

If the left temporal lobe is affected by ICH?

a)

dysphagia

b)

visual changes

c)

thyroxicosis

d)

aphasia

100.

Name the three combos that can diagnose a migraine?

a)

Unilateral Headache/Throbbing/Nausea

b)

Worse with activity/ Unilateral Headache/Vomiting

c)

Photophobia/Unilateral Headache/Throbbing

d)

Auras/Unilateral Headache/Throbbing

101.

What are some symptoms of the promonitory phase of a migraine?

a)

Tiredness, irritability, loss of concentration, stiff neck, food cravings

b)

Aura up to 1 hour (Motor, Sensory Visual)

c)

Headaches

d)

Irritability, Fatigue, Depression (Hrs to days)

102.

Cluster Headaches are unilateral and the patho for it is?

a)

Occipital Neuralgia

b)

Hypothalamic activation with secondary activation of trigeminal autonomic reflex

c)

TSH reduction in response to thyroxicosis

d)

Pineal Gland stimulation in response to the painful stimulus

103.

In cluster headaches, pain afferents though __ nerve area, proceeds to the ___ complex and ___ and proceeds to activation of cortical pain transmission areas.

a)

thalamus ; trigeminal nerve ; trigeminocervical

b)

XX

c)

Trigeminal Nerve ; trigeminocervical ; thalamus

d)

xX

104.

Cluster headaches make people ___. (Strictly Unilateral)

a)

Restless/Agitated

b)

Groggy and Slow

c)

Depressed

d)

Tired

105.

Tension like headaches have __-__ feeling.

a)

unilateral like

b)

Barrel like

c)

Band like

d)

pushing ike

106.

Tension headaches are __ and ___.

a)

Bilateral and Non-Throbbing

b)

Unilateral and Throbbing

c)

Hemorrhagic and Traumatic

d)

Depressive and Throbbing

107.

Pathophysiology of tension type headache?

a)

XXXXXXX

b)

XXXX

c)

Peripheral activation or sensitization of myofascial nociceptors (1st order neurons), 2nd and then 3rd order neurons, = stimuli normally innocuous is interpreted as pain

d)

XXXXXXXX

108.

Treatment for tension headaches?

a)

Aspirin and Ibuprofen

b)

Warfarin and Pradaxa

c)

Amitriptyline and Nitric Oxide Synthatase Inhibitors

109.

Guillain Barre Syndrome is a type of ___ disorder.

a)

Demyelinating

b)

exhaustive

c)

metabolic

d)

hypertensive

110.

Guillain Barre is an Acute immune mediated demyelinating paralyzing illness that is usually provoked by

a)

Myocardial Infarction

b)

Diabetes

c)

Hypertension

d)

Preceding Infection

111.

In Guillain-Barre syndrome, a viral infection induces immune response = cross reactivity with myelin/axon proteins. This leads to?

a)

Multifocal Inflammatory Demyelination starting at nerve roots

b)

Unifocal inflammation at the finger joints

c)

Inflammation of GI Mucosa

d)

Dermatological Conditions such as Acanthosis Nigricans

112.

Activated T Cells followed by Macrophage invasion causes ____ and complement/immunoglobulin deposition on myelin and schwann cells

a)

Demyelination

b)

Degranulation

c)

Mast Cell Activation

d)

Severe Combined Immunodeficiency

113.

What is the most common preceding event for Guillain Barre Syndrome?

a)

HIV

b)

Cryptococcus Infection

c)

H. Influenzae Infection

d)

Campylobacter Infection

114.

Clinical Presentation for Guillain Barre Syndrome?

a)

Weakness that starts at the legs

b)

Diminished reflexes

c)

Paresthesias in hands/feet

d)

Back Pain = Spinal Tap results in high Protein but normal WBC's

e)

All Choices Are Correct

115.

Radiculopathies can occur due to __ compression, inflammation and trauma.

a)

Arm

b)

Leg

c)

Spinal Root

d)

Foot

116.

Plexus injuries can occur due to?

a)

Positioning/IM Injections

b)

Infection

c)

Sleeping too much

d)

Growth Hormone

117.

Neuropathies are due to ___ injury.

a)

Central Nerve

b)

AStrocyte

c)

Peripheral Nerve

d)

BBB

118.

Pure sensory or pure motor or autonomic neuropathies are termed?

a)

Neuronopathies

b)

Periphalonopathies

c)

Centrolonopathies

d)

Diabetes

119.

Ganglionopathies are also known as ___ neuropathies.

a)

Motor

b)

Bulbar

c)

Sensory

120.

Peripheral Neuropathies are usually ___.

a)

Sensorimotor

b)

Neural

c)

Brain

d)

Infectious

121.

Myelinopathies that are uniform are ___.

a)

Acquired

b)

Lost

c)

Found

d)

Hereditary

122.

Myelinopathies that are uniform are ___.

a)

Lost

b)

Acquired

c)

Found

d)

Hereditary

123.

Large fiber neuropathies can cause loss of joint position and ___ sense and sensory ataxia.

a)

vibration

b)

pain

c)

temperature

d)

proprioception

124.

Small fiber neuropathy can cause

a)

impairment of pain perception, temperature and autonomic functions

b)

XX

c)

XX

d)

XX

125.

Mononeuropathy multiplex can be caused by?

a)

Leprosy

b)

Vasculitis

c)

All choices are correct

126.

Polyneuropathy is usually caused by ___.

a)

Systemic, Metabolic and Toxic causes

b)

Low Back Pain

c)

Vomit

d)

Nausea

127.

Charcot Marie Tooth disease is characterized by

a)

acquired neuropathies with metabolic derangements

b)

acquired neuropathies without metabolic derangements

c)

inherited neuropathies without metabolic derangement

d)

inherited neuropathies with metabolic derangement

128.

Myasthenia Gravis is an autoimmune disorder mediated by

a)

Antibodies against the Ach receptor (Block but dont destroy)

b)

Antibodies against the NE receptor (Block but dont destroy)

c)

Antibodies against the Ach receptor (Block and destroy)

d)

Antibodies against the Epi receptor (Block but dont destroy)

129.

What type of hypersensitivity reaction is myasthenia gravis?

a)

Type 1

b)

Type 2

c)

Type 3

d)

Type 4

130.

What are major risk factors for myasthenia gravis?

a)

HLA-B8, Penicillamine, Aminoglycosides

b)

Sulfonamides

c)

Too Much Hypertension

d)

Too Much Sugar

131.

Myasthenia gravis also has possibility of autoantibodies that are

a)

against the NE receptor

b)

against tsh receptor

c)

against muscle-specific receptor Tyrosine Kinase (MuSK)

132.

Myasthenia gravis is associated with thymoma and ___.

a)

HIV

b)

Dementia

c)

Retinal Detachment

d)

Thymic Hyperplasia

133.

What is a myasthenic crisis?

a)

Emergency that as disease progresses, quadriplegia ensues, extremely difficult to swallow + respiratory arrest.

b)

Extreme Projectile Vomiting

c)

Excessive diarrhea

d)

Does not Exist

134.

Clinical features of myasthenia gravis?

a)

Fluctuating muscle weakness, usually with ocular symptoms

b)

Bulbar Symptoms( Dysphagia, Dysarthria)

c)

Proximal Muscle Weakness

d)

All choices are correct

135.

What are two differentials for Myasthenia Gravis?

a)

Lambert Eaton Myasthenic SYndrome (LEMS)

b)

Botulism (Poor impaired pupillary response to light)

c)

CVA

d)

Myocardial Infarction

136.

Lambert Eaton Syndrome is characterized by?

a)

XX

b)

XX

c)

Progressive weakness that improves with activity temporarily

d)

XX

137.

Lambert Eaton Syndrome is what type of Hypersensitivity?

a)

Type 2

b)

Type 4

c)

Type 1

d)

It isn't

138.

What antibodies are present in Lambert Eaton Syndrome?

a)

Antibodies against PRESYNAPTIC, Volatge gated Ca++ channels and causes decreased Ach release

b)

Same AB's as in Myasthenia Gravis (Against Ach Receptor)

139.

What is Lambert Eaton Syndrome associated with?

a)

Small Cell Carcinoma of the Lung

b)

Autoimmune disorders

c)

Diabetes Type 2

d)

Diabetes Type 3

140.

Clinical presentation of Lambert Eaton Syndrome?

a)

Proximal muscle weakness (difficulty raising from chair, climbing starirs)

b)

Decreased Tendon Reflexes

c)

Autonomic symptoms (dry mouth, impotence)

d)

All choices are correct

141.

How does Lambert Eaton Syndrome improve?

a)

Muscle Use + Spares extraocular muscles

b)

Muscle Rest + Spares extraocular muscles

c)

Muscle Use + Destroys extraocular muscles

d)

It doesn't

142.

Why do we use Edrophonium tst?

a)

To test the ears

b)

to rest the eyes due to Ach Autoantibodies

c)

to confirm myasthenia gravis and rule out LES

d)

to confirm Lambert Eaton Syndrome and rule out Myasthenia Gravis

143.

What is botulism?

a)

Paralytic Ileus

b)

Paralytic Disease caused by neurotoxins of C. Botulinum

c)

Paralysis of Buttocks

d)

Prof......X

144.

Presentation of botulism?

a)

Unilateral descending paralysis of muscles innvervated by cranial, spinal, and cholinergic autonomic nerves BUT adrenergic and sensory nerves and CNS are ok

b)

Bilateral descending paralysis of muscles innvervated by cranial, spinal, and cholinergic autonomic nerves and adrenergic and sensory nerves and CNS are impaired

c)

Bilateral descending paralysis of muscles innvervated by cranial, spinal, and cholinergic autonomic nerves BUT adrenergic and sensory nerves and CNS are ok

d)

Bilateral descending flaccidity of muscles innvervated by cranial, spinal, and cholinergic autonomic nerves BUT adrenergic and sensory nerves and CNS are ok

145.

What is the mechanism behind C. Botulinum neurotoxin?

a)

Binds receptors on Presynaptic membrane = internalized to vesicles = proteolysis of SNARE proteins = BLOCK Ach release

b)

XX

c)

XX

d)

XX

146.

Difference between grade 1/grade 2 cerebral tumors and grade 3/grade 4 cerebral tumors

a)

Grade 1 and 2= slow growing

b)

Grade 3 and 4= fast growing

c)

Grade 1 and 2= fast growing

d)

Grade 3 and 4= slow growing

147.

Primary Intra Cerebral = EMO-A

a)

Ependymal

b)

Medulloblastoma

c)

Oligodendrocytoma

d)

Astrocytoma

148.

Primary Extracerebral= PMN

a)

Pituitary

b)

Nerve Sheath

c)

Meningioma

d)

XX

149.

Primary tumors tend to be ___ in adults and ___ in children.

a)

Supratentorial ; Infratentorial

b)

Infratentorial ; Supratentorial

c)

Cute ; Tiny

d)

Slugy ;Fat based

150.

What is the most common glioma?

a)

Oligodendrocytoma

b)

AStrocytoma

c)

Ependymoma

d)

Thymoma

151.

Grade 3 and 4 astrocytoma manifests in what lobe?

a)

Occipital Lobe

b)

Parietal Lobe

c)

Temporal Lobe

d)

Frontal Lobe

152.

Grade 1 astrocytoma usually manifests in?

a)

Occipital lobe

b)

children and is infratentorial

c)

children and is usually supratentorial

d)

Frontal Lobe

153.

Grade IV astrocytoma is most lethal brain tumor and is ___.

a)

Highly Vascularized and Infiltrative

b)

Poorly Vascularized and Non Infiltrative

c)

Unvascularized so it is a cold tumor = malignant

d)

Hight Infiltrative only

154.

Oligodendrocytomas tend to appear in the ___ or __ lobes. (They have a good prognosis but may progress to oligodendrocytoma)

a)

Occipital or Cerebellar

b)

Frontal and Cerebellar

c)

Frontal and Temporal Lobes

d)

Occupital lobe only

155.

Meningiomas are usually resectable and originate from ___ cells.

a)

C Cells

b)

Islet cells

c)

Cap Cells

d)

Glial Cells

156.

Neurofibromas are also called __. Usually they are located on?

a)

Schwannomas ; CN IV

b)

Schwannomas ; CN X

c)

Schwannomas ; CN III

d)

Schwannomas ; CN XI

157.

Meningiomas usually appear in ___. The major risk factors for meningiomas include

a)

Transgender individuals ; Dental Xrays, Neurofibromatosis Type 2

b)

Men ; Dental Xrays, Neurofibromatosis Type 2

c)

Women ; Dental Xrays, Neurofibromatosis Type 2

d)

Cis Gender ; Dental Xrays, Neurofibromatosis Type 2

158.

Clinical presentation of a Schwannoma? (Bilateral will only be present in Neurofibromatosis Type 2)

a)

Tinnitus

b)

Hearing Loss

c)

All choices are correct

d)

Unilateral

159.

Medulloblastoma is most common malignant intracranial tumor of ____ with poor prognosis. They usually located on ___.

a)

Childhood ; Cerebellum (May Compress 4th Ventricle= Hydrocephalus)

b)

Elderly ; Cerebellum (May Compress 4th Ventricle= Hydrocephalus)

c)

Childhood ; Frontal Lobe (May Compress 4th Ventricle= Hydrocephalus)

d)

Childhood ; Occipital Lobe (May Compress 4th Ventricle= Hydrocephalus)

160.

Craniopharyngioma usually occurs in children and is derived from? And where is it usually located

a)

Pituitary Gland ; Thyroid

b)

Frontal Lobe Pieces ; Parathyroid

c)

Epiphyseal Plates ; Long Bones

d)

Rathke's Pouch remnants ; Sella Turcia (may compress Optic Chiasm = Bitemporal Heminopsia)

161.

Ependymoma has a poor prognosis and is usually located in the? And what is is associated with?

a)

3rd Ventricle ; Conus Medullaris

b)

4th Ventricle ; Cauda Equina

c)

Cerebeal Aqueduct ; Cauda Equina

d)

Cerebral Aqueduct ; Conus Medullaris

162.

If an ependymoma is diagnosed, what are symptoms it may have been presenting with? And if it blocks CSF?

a)

Impaired Balance, Coordination and Gait

b)

Fine Motor Impairment

c)

Hydrocephalus if CSF circulation obstructed

d)

All choices are correct

163.

Most common bacterial meningitis cause are

a)

Neisseria Meningitis

b)

Strep Pneumoniae Meningitis

c)

HIV

d)

COVID-19

164.

Most common viral cause of meningitis

a)

Enteroviruses; Echovirus, Coxsackie

b)

HSV 2

c)

All choices are correct

165.

Encephalitis refers to ___. It is usually viral in etiology and the most common cause is?

a)

Infection of brain parenchyma ; HSV

b)

Infection of brain parenchyma ; HIV

c)

Infection of brain parenchyma ; H.Flu

d)

Infection of brain parenchyma ; Cryptococcus

166.

Most common 2 opportunistic causes of encephalitis?

a)

Toxoplasma

b)

CMV

c)

Cryptococcus

d)

Pneumocystis Jirovecii

167.

Encephalitis presents with?

a)

Altered Mental Status

b)

Changes in personality

c)

Problems in speech/movement

d)

All choices are correct

168.

If meninges are affected in encephalitis, this is called?

a)

XX

b)

XX

c)

XX

d)

Meningoencephalitis

169.

Clinical presentation of encephalitis?

a)

Seizures, Fever, Headache, Nausea and Vomit

b)

Physical: Altered Mental Status, Personality Changes, CN Palsies

c)

All choices are correct

170.

Meningismus is present only in ____ encephalitis.

a)

Mixed

b)

Pure

c)

Sterile

d)

Viral

171.

What signs will be present in meningitis?

a)

Kernig

b)

Brudzinski

c)

Epley Maneuver

d)

Dix Hallpike

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