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346 Cards in this Set

  • Front
  • Back
constant flexion of all limbs
position of comfort
bell palsy's
unilateral CN 7 palsy
Pathway of center of gravity
1. extremely smooth movement
2. has vertical displacement of 2 inches
3. has side to side displacement of 2 inches
4. will make a "figure 8" in space
gait cycle
stance phase 40%; swing phase 60%
1. heel contact
2. foot flat
3. mid stance
4. heel off
5. toe off (right after this, the leg goes into swing phase (last 40% of cycle))
step length
distance between right and left foot after one step
stride length
distance between 2 placements of the same foot
vertical displacement when walking
2 inches
Manual muscle exam (range of motion)
0- total paralysis
1- palpable or visible contraction
2-active movement- full ROM, eliminated w/ gravity
3-active movement- full ROM against gravity (not resistance)
4-moderate resistance
5-full resistance, normal strength
Paralyses
1-quadriceps paralysis
2-ankle dorsiflexion (L4 lesion tibialis anterior mm); patient has foot drop; patient uses steepage gait
3-flaccid hemiplegia (stroke patient); patient's leg moves in semicircular fashion
4-Trendelendurg gait (gluteus medius paralysis); patient's pelvis drops on side opposite the lesion; associated w/ abductorsof leg
Charcot-Marie_Tooth
Peroneal nerve disease
compass gait
jerky walking movement; represents walking if person had sticks for legs w/ pelvic rotation
Tibiofemoral angle
important in lateral displacement
Parkinson's Disease
Shuffling gait
T for tremor (resting)
R for rigidity
A for akinesia
P for posture instability ( most important to PM &R)
Multiple sclerosis
intention tremor
Scissors gait
associated with cerebral palsy and spastic diplegia
Cerebral palsy
cerebrum defect of multiple cause; occurs before during or after birth; patient talks a lot and has difficult use of limbs
Becker
Xp21
A qaulitative abnormality in dystrophin proteins molecular weight
benign
Duchenne
1. lack of dystrophin
2. gower sign
3. pseudohypertrophy (big fatty calves)
4. Late walker (3-6) with stumbling
5. Stop walking at about 10 y/o
6. Spine develops sclerosis, osteoporosis after loss of walking ability
7. death: pneumonia and proximal weakness
Muscular dystrophy
associated with wide limb gait
autonomic dysreflexia
1-vasomotor response to the noxious stimuli below the level of injury
2-occurs in patient's w/ an injury at T6 or above
3-noxious stimuli- bladder distension, blocked catheter, overfilled drainage bags, UTI, stones
4-signs &symptoms- migraine headache, incr BP, flushing, diaphoresis above level of injury, goosebumps
Treatment of autonomic dysreflexia
1- have person sit upright
2- in and out cath disimpactation -> slowly remove noxious stimuli
3-monitor BP, give Ca channel blocker to prevent stroke
Alzheimers Disease is a complication of patient w/ above T6 injury when given anesthesia. Should use....
1-general anesthesia + halothane
or
2-local nerve block
or
3-spinal anesthesia
patient w/ altered sensorium after being dehydrated w/ peripheral LM symptoms and MCV of 101
symptoms are due to pernicious anemia
most common cause of adult disabilities
stroke
which should you check for before treating a quadiplegic w/ headaches
none of the above
phantom pain is
psychogenic pain
anti-spasticity meds are indicated in stroke patients with
all of the above
which is not true with Guillan Barre syndrome
axonal neuropathy predominates
25 year old female w/ spinal cord injury
tell her that fertility will be normal and menses will return within 6 mths
shortened pedicles secondary to
abnormal posterior development ....
running back w/ transient quadriplegia
due to spinal stensosis
which is seen w/ vascular claudication but not with neurologic claudication
early onset of pain w/ walking uphill
phase of a motor unit
is related to collateral nerve sproat conduction
pain does not travel in which of the following
A alpha and B fibers
Brown sequard syndrome is seen with
fracture dislocation of L3
Patient with ASIA A classification spinal cord injury w/ fever
do urinalysis and blood culture first
sexual intercourse
requires 5 METS
the gate control theory of pain explains all of the following except
the anti-inflammatory response
what ASIA scale is a female mobile with a walker
Class D
Leading cause of spinal cord injury in women
motor vehicle collision
which is not seen in pain
changes in lymphatic clearing
the outcome of stroke rehab is affected by
all of the following
which is not a component autonomic hyperreflexia
history of headaches
autonomic dysreflexia is seen woth spinal cord injuries of level
above T6
parasympathetic supply to the bladder
S2-4
Which is contraindication to Tx w/ tPA
distant history of gastritis
in spinal injury above the level of T6
body temp varies w/ ambient temp
7 yr old boy
1.non-communicating hydrocephalus
2. radiosensitive
3. pineal region
4.Perinaud's syndrome
25 yr old w/ HIV and ring enhancing lesion
1. CNS lymphoma
2. cerebral toxoplasmosis
25 yr old w/ HIV and nonenhancing mass
low grade glioma
Treatment for AV malformation
1. surgical excision
2. anti-convulsants
Brainstem glioma
1. radiation therapy and steroid TX
2. rarely treated w/ surgery
3. causes increased ICP late
4. causes CN signs on the same side of mass
5. may be biopsied when well circumscribed
6.cause crossed CN and corticospinal tract dysfxn
cervical spine x-rays in trauma
1. should include C7-T1
2.flex-extension film is part of series
3. x -ray of cervical spine may be supplemented by CT scan
associated w/ communicating hydrocephalus
1. chronic meningitis
2. sarcoidosis
3.
Duchenne Erb Palsy
1. Weakness of the biceps mm
2. the arm hangs limp at the side and the biceps jerk is lost
Tx for convexity meningioma
1. steroids are used to reduce vasogenic edema
2. complete excision w/ dural attachment is pallative (possible)
anterior cord syndrome
loss of motor, pinprick, temp
for patient w/ trauma where is injury
at level where strength first decreases
heel strike phase of gait
pretibial muscles
no hypotension seen in
autonomic hyperreflexia
autonomic hyperdysreflexia seen in which injuries
above T6
intial spinal cord injury workup
UA and cultures
the most common metabolic complication of.....
hypercalcemia
central cord syndrome
due to hyperextension of cervical spine
spinal cord vascular supply
mid-thoracic region vulnerable to ischemia
phantom pain included all:
gate control, massage, rarely severe, narcotics
injury above T6 affect on temp
varies with ambient temp, associated with autonomic dysreflexia
the effects of exercise training include all except
increased minute ventilation
pain sensation is transmitted via
A delta and C fibers
in terms of cardiac rehab the patients goal are measured in metabolic equivalents (METS)= which of the following is true?
5-7 METS adequate for most sedentary jobs
ASIA B
sensory sparing, no motion
what does not affect microscopic changes and pain
increased lymphatic clearance
most common cause of spinal cord injury in the US
motor vechicle accidents
what influences the outcome of stroke rehab
all the above
psychologic rxn to disability
severity of apralysis
aprexia
visual perceptual disturbance
ASIA A
complete loss
ASIA C
motor <3/5
ASIA D
motor >3/5
ASIA E
normal
what does SACH stand for
solid, ankle, cushion, heal
Fracture dislocation of L3
True-spastic paralysis below lesion
True-contralateral loss of pain and tempbelow lesion
True- ipsilateral loss of proprioception below lesion
False-horizontal hemisection of spinal cord
incorrect statement regarding stroke
AV malformations seldom bleed before 40
Child who develops episodes of staring and is doing poorly in school
Petit mal or absence seizures
TX ethosuxemide
spikes-assoc w/ slow waves, spike at 3 sec
Adult has aura with seizure
partial complex seizure
Lateral pontine syndrome
Anterior inferior cerebellar artery
cant move eye to rt or left
diplopia to left
whole face paresis
left pontine gaze center and CN VII- can close right eye
Multiple sclerosis
sudden vertigo, loss of balance, convergence preserved, corneal reflex lost, MRI T2 weighted,
ALS
progressive weakness, dysphagia, dysarthria, tongue fasicculations, anterior.ventral horns, no sensory deficits
huntingtons chorea
tongue protusion
striatum/caudate
triplet repeat CAG on chr 4
no intention tremor
depression
ldopa can induce chorea in Huntingtons patient
tonic clonic seizures
boy with loss of concentration for last couple yrs, aura, and shrill cry, incontinence
LP- w/ xanthochromia
MCA UMN versus LMN
if entire side of face affected then LMN, if lower face then contralateeral UMN (cortex)
medulloblastoma
child, HA in morning, unsteady gait,
location-right cerebellar hemisphere
DOES NOT have decreased visual acuity at onset
l'arbre (m.)
tree
Syringomyelia
B/L loss of pain and temp in cape and arm distribution
central spinal cord cavitation
No CN palies
B/L MLF syndrome
monocular abduction
nystagmus
mouth drooling
20-40
lesion in brainstem
normal convergence
remission and exacerbations
lateral meduallary syndrome
PICA
difficulty swallowing
horners
decreased CN 9, 10
lesion involving the left inferior cerebellar peduncle would explain which symptoms
left sided ataxia and dysmetria
degeneration of the substantia nigra and presence of Lewy bodies are associated with
Parkinson
dystonia disorders of the basal ganglia manifests with all of the following except
intention tremors
lesion of subthalamus nucleus is associated with
contralateral hemiballismus
blood supply to internal capsule
lenticulostriate arteries
if more than one tract is involved (sensory, visual, motor) where is the lesion
posterior limb of the internal capsule bc thats where all the tracts are together
Broca aphasia lesion location
left inferior frontal gyrus
1. The minimum cerebral perfusion pressure suggested in the tx of most pts with severe traumatic brain injury is:
a. 60mm Hg
2. In pts with decerebrate rigidity
a. There is upper pontine damage.
3. In hyperventilation one expects to achieve:
a. A reduction in cerebral edema.
4. In pts with decorticate rigidity:
a. There is upper midbrain damage
10. A 10 year old child presents with short stature and symptoms of raised ICP. CT of the head shows calcified cystic suprasellar mass. The most likely dx is:
a. Craniopharyngioma
9. The tx of pts with glioblastoma multiforme is:
a. Surgery, radiation, and chemotherapy
8. A 32 year old male presents with weakness of the right limbs. MRI of the brain shows a homogenously enhancing left frontal mass compatible with meningioma. The tx is:
a. Surgery
7. Appropriate initial radiological study in a pt with acute traumatic brain injury is:
a. CAT scan of the head without contrast.
6. A 35 year old pt passed out after he was assaulted and struck in the head. He then regained consciousness, however, in the ER, he became comatose with dilated sluggishly reactive left pupil and mild right hemiparesis. The most likely dx is:
a. Left epidural hematomas
5. In the tx of pts with raised intracranial pressure:
a. ICP of 20mm Hg is threshold value for tx
4. In pts with decorticate rigidity:
a. There is upper midbrain damage
13. Regarding metastatic brain tumors:
a. Surgery is recommended for solitary metastasis at favorable sites
14. A seven-year-old patient presents with headache, nausea, vomiting and incoordination, MRI of the brain reveals midline cerebellar mass. The differential diagnosis includes:
a. A and C (where A = medulloblastoma and C = ependymoma)
15. Regarding Medulloblastomas:
a. Treatment is surgery and radiation therapy to the Craniospinal axis.
12. Regarding Hemangioblastomas:
a. B and C (where B = the tumors are frequently cystic with mural nodule and C = the lesions can coexist with congenital cysts in the pancreas, kidneys and liver)
26. The proper width of a doorway to allow transit of a power wheelchair without turning is at least
a. 36 inches
27. In the management of the neurogenic bowel, bissacodyl (Dulcolax) tablets and suppositories are
a. Colonic stimulants that stimulate and enhance the gastrocolic reflex and thereby induce peristalsis in the colon
28. Which surgical option would be most appropriate for a patient with rheumatoid arthritis who has severe uncontrollable knee pain and loss of function?
a. Hemiarthroplasty
29. A 65-year-old woman describes a 6-year history of progressive pain and stiffness in her left knee, right hip and distal fingers. Plain radiographs of her left knee and right hip demonstrate osteophytes and asymmetric joint space narrowing with subchondral bony sclerosis. The most likely diagnosis is
a. osteoarthritis
11. Brain stem gliomas: DROPPED
a. Peak age is the sixth decade
b. The tumors are frequently cystic with mural nodule
c. The lesions can coexist with congenital cysts in the pancreas, kidneys, and liver
d. Are more common in adults
25. A 50 year old male experiences the worst headache of his life. His neck is stiff and he has photophobia. He is alert and he has no focal neurological deficit. CT Head shows subarachnoid hemorrhage and cerebral angiogram shows aneurysm of right internal carotid artery bifurcation.
a. Hydrocephalus is a possible complication
24. Astereognosis is associated with a lesion of the contralateral:
a. Parietal lobe
23. The spinal cord in adults usually terminates at:
a. Upper border of L3
b. Lower border of L1
22. Oligodendrogliomas
a. Are often calcified
21. Acute subdural hematomas
a. Has a mortality rate of 50% to 60% in several series
20. In a patient with traumatic brain injury, a risk factor for developing post traumatic seizures is
a. Glasgow Coma Scale 11
19. The predominant features of the Cushing Reflex observed in patients with raised intracranial pressures are
a. Hypertension and brachycardia
18. Brachycephaly is premature closure of
a. Sagittal suture
17. Neurological deficits involving the lower extremities are more frequently seen in patients with
a. Myelomeningocele
16. The most common location of colloid cyst in the brain is in:
a. Third ventricle
A 69 year old patient has a right parietal lobe lesion on CT scan of the head. He has a left sided hemi neglect syndrome. Which of the following will be correct?
B. He will have a cortical sensory deficit with astereognosis on the left hand
11. A 71 year old patient presents with inability to communicate and gait difficulties. His CT scan of the head reveals an infarction of the left frontal cortical and subcortical regions. Which of the following is correct?
C. He has occlusion of the left middle cerebral artery cortical branches
10. A 60 year old diabetic patient presents with sudden onset of ptosis of the left eye, diplopia on looking to her right side and a fixed dilated left pupil Which of the following is correct?
A. She has a lesion of the left Oculomotor nerve
9. A 38 year old patient presents with recurrent episodes of twitching of the left side of his face and clonic jerking of his left arm lasting five minutes each time. He is fully conscious during these episodes. Which of the following is likely?
E. He most likely has an irritative right frontal lobe focal lesion
8. A 23 year old young woman presents with diplopia on looking laterally on either side. She had an episode of optic neuritis at the age of 18 years from which she totally recovered. She is diagnosed as having internuclear ophthalmoplegia at this visit. Which of the following findings is most likely?
A. She will have preserved convergence
7. A 65 year old patient presents with decreased pain and temperature of both his legs up to his mid calves and absent ankle jerks (reflexes). He also has distal weakness of both his feet. Which of the following is most likely?
D. He most likely has peripheral neuritis
6. A patient has a tumor compressing the spinal cord at the left T4 level of the thoracic cord resulting in Brown Sequard's syndrome. Which of the following is correct?
C. The patient will have a sensory level with loss of pain and temperature on the right side of his body below T6
5. A patient is found comatose with gaze deviation to the right side and inability to move the left side of his body. The tone on the left side is flaccid and the reflexes are depressed. The left plantar reflex is extensor (Babinski's response). Which of the following is correct?
C. The patient will have tonic gaze deviation to the side injected with ice cold water
4. A patient is found comatose with weakness of all extremities (quadriplegia), small pin point pupils, respiratory difficulties and absent oculo vestibulo cephalic reflex. Which of the following is most appropriate?
E. The patient most likely has a pontine hemorrhage causing his comatose state
3. A patient presents with left sided hemiparesis, hemisensory deficit and homonymous hemianopsia. Which of the following is correct?
B. The patient will have accompanying left sided central facial weakness involving the left lower part of the face
2. A patient presents with sudden onset of inability to speak and right sided weakness. He can follow commands but cannot repeat or spontaneously produce any words. Which of the following is correct?
B. The patient has a lesion involving the left inferior frontal gyrus and the corticospinal tract
1. A patient presents with weakness of the right side of the face and left side of the body. Which of the following is correct?
D. The patient will have a lesion involving the right pons
Proper width of a doorway to allow transit of a power wheelchair without turning
30 inches
In the management of the neurogenic bowel, dulcolax tablets and suppositories are
contact irritants that act directly on the colonic mucosa to produce peristalsis throughout the colon
Which surgical option would be most appropriate for a patient with rheumatoid arthritis who has severe uncontrollable knee pain-
arthrodesis arthrodesis is surgically inducing ossification between two joints to relieve intractable pain/ pain refractory to meds
Sixty five yo woman describes a six year history of progresssive pain and stiffness in her left knee right hip and distal fingers. Plain radiographs of her left knee and right hip have osteophytes and asymmetric joint space narrowing with subchondral sclerosis...most likely diagnosis
osteoarthritis
Which of the hollowing prosthetic knee mechanisms provide good swing phase control at variable cadences and low energy expenditure.
hydraulic
C-leg = microprocessor in knee joint. For above knee amputation. Allows walking on uneven terrain. Provides good stance and swing, and allows walking at variable speeds
Unilateral above knee amputee ambulates at his usual comfortable pace. His additional energy expenditure per minute as compared to a normal individual is
None? This is wrong challenge
Below Knee = Speed is 36% slower; Expends 40% more energy
Above Knee = Speed is 43% slower; Expends 89% more energy
A circumducted gait in a man with an above knee amputation is most likely due to
inadequate socket suspension
Circumduction is circular motion of a limb. More precisely, it is mov’t of limb in a conical fashion such that the distal end moves in an arc. Poor socket suspension in above-knee prosthetic can result in circumduction
Multidisciplinary approach in chronic pain management include all of the following except
Recreational therapy so pharmacotherapy, behavioral therapy and patient education
Chronic pain may be managed by pharmacotherapy, behavioral therapy, and patient education. NOT recreational therapy
Factors not involved in chronic neuropathic pain.
Not mediated by glutamate and nt interfacing with the nmda receptors...(right answers...peripheral nervous system sensitization, central nervous system sensitization, poorly managed acute pain)
Which of the following is the most important factor influencing your selection of a preferred treatment
safety
Most important factor when selecting a DOC is safety
Person who steps on a thumb tack and reacts by taking his foot off utilizes..
... Large diameter peripheral nerve a-fibers
Thrombotic stroke...
Happens during sleep
Thrombotic strokes tend to occur over night or early morning because blood pressure is low at these times. Not high enuff to overcome flow barriers set up by thrombi
Management of this patient would include the following except...
urgent reduction of bp
Cushing reflex
bradycardia and hypertension due to increased intracranial pressure
Modifiable risk factor for thrombotic stroke is.
htn
Modifiable risk factors are: HTN, DM, smoking, hyperlipidemia
Non-modifiable risk factors are: age, sex, fam history, race
Patients most likely to benefit from phrenic nerve pacemakers following traumatic spinal cord injuries are those with.
... c1 quadriplegia
Phrenic nerve is C3, 4 and 5. Damage above brachial plexus (C5-T1) leads to quadriplegia and respiratory failure
Indications for diaphragmatic pacing include
phrenic nerve lesion
Successful semen collection using electroejaculation will generally not be successful in spinal cord injured males with absence of function in
t10-12
The americans with disability act was passed in order to
ensure that workers with disabilities have equal access in the work environment
Individuals with spinal cord injury are generally considered to be at risk for autonomic dysreflexia if their injury level is above
...t6
Autonomic dysreflexia/ hyperreflexia seen in spinal cord injuries especially above T6. Due to dumping of NE into circulation. Result is hypertension (SBP > 300mmHg), diaphoresis, flushing/ facial erythema, goose bumps, nasal stuffiness, intense headaches. SBP goes up over 40mmHg from normal – this should raise suspicion for autonomic dysreflexia. Seen in bladder and bowel distension. Also in conditions like multiple sclerosis.
Can occur days to years after spinal cord injury. So pt w/ h/o spinal cord injury presenting w/ severe headaches, facial redness, HTN – think autonomic dysrefleixa
Treat by catheterization of bladder to remove stimulus
Add vasodilators like sublingual nitrates and oral clonidine
Acupuncture is described as reducing pain through neuromodulation. Through what mechanism is neuromodulation theorized to reduce pain
Endogenous endorphins and enkephalins
Neuromodulation reduces pain by the following mechanisms:
- Stimulate cortical descending inhibitory pathways
- Production of endogenous endorphins and enkephalins
- Gate ctrl mech = stimulation of large diameter fiber stimulates substantia gelatinosa to inhibit activation of transmitter cells; therefore, no transduction of pain.
A 22yo female sustains a spinal cord injury, resulting in c5 quadriplegia. She is admitted to a spinal cord injury rehabiliation unit one month postinjury. She reports that she missed her menstrual period while in the acute care unit. Her pregnancy test is negative. You advise that...
Her menstrual period should return in a year
Strength needed to regain walking ability
Need 3/5 strength to regain walking ability
Wide gaits
Muscular dystrophy – wide-limb gait
-Alcoholics – wide-based gait
charcot Maries Tooth
Charcot-Marie-Tooth – bilateral foot drop due to demyelination of peroneal nerve
Central cord syndrome
-Central cord syndrome is a disorder of gray matter and crossing STTs. There is weakness in upper extremities greater than that in lower extremities. During recovery, function returns to lower extremities first. Causes include trauma, syringomyelia, tumors, anterior spinal artery ischemia, contusion injury
what determines gait
determinants of gait include pelvic rotation, pelvic tilt, knee flexion in stance phase, foot and knee mechanisms, lateral displacement of pelvis (tibiofemoral angle important in that)
one complete gait cycle
-one complete gait cycle includes the stance phase of one leg and the swing phase of that same leg
A 7 year old boy presents with headaches and vomiting over a 2 week period, followed by lethargy and ataxia. Examination shows impairment of pupillary reflexes, impairment of convergence, paralysis of upward gaze and papilledema. Which of the following may likely be true?
d) Non-communicating hydrocephalus is usually associated. a) A tumor here is usually radiosensitive. a) A pineal region tumor is likely. b) The patient has Perinaud’s Syndrome.
A 25 year old HIV+ patient presents with an 8 week history of progressive left-sided headaches and weakness of the right arm. CT scan shows a single enhancing periventricular brain mass. Which of the following may be true?
a) CNS lymphoma is most likely.
a) Cerebral toxoplasmosis is most likely.

a) A primary brain tumor.
b) A lymphoma.
c) A metastatic tumor.
A 25 year old HIV+ patient presents with a 12 month week history of progressive left-sided headaches and weakness of the right arm. CT scan shows a solitary nonenhancing mass. Which of the following may be true?
e) A low grade glioma is most likely.
Which of the following is a good treatment for an arteriovenous malformation?
a) Surgical excision
b) Anti-convulsants
Which of the following may likely be true regarding a brainstem glioma?
a) Is usually treated with radiation therapy and steroids.
e) Are rarely treated with surgery.
d) Causes increased ICP late.
c) Usually causes cranial nerve signs on the same side of the mass.
c) Usually cause crossed cranial nerve and corticospinal tract dysfunction.
a) May be biopsied when well-circumscribed.
Which of the following may be correct about cervical spine x-rays in trauma?
c) Should include C7-T1.
e) X-rays of the cervical spine may be supplemented by CT scan.
e) A x-ray alone is adequate to clear the C-spine
b) The flex-extension film is a routine x-ray that is part of the series.
Which of the following are associated with communicating hydrocephalus?
e) Chronic meningitis
c) Sarcoidosis
Which of the following are true regarding treatment for a convexity meningioma?
e) Steroids are used to reduce vasogenic edema.
c) Complete excision with the dural attachment is usually palliative.
c) Complete excision with the dural attachment is usually possible.
Duchenne-Erb Palsy results from injury to the 5th and 6th cervical roots, the upper trunk or the upper and middle trunks of the brachial plexus. Which of the findings below could be caused by this?
e) Weakness of the biceps muscle
c) The arm hangs limp at the side and the biceps jerk is lost
A 15 year old presents with early morning headache, vomiting and papilledema, initiated by changes in position and straining, progressing over three years. CT scan shows a mass in the right frontal lobe. Which of the following may be true?
d) Surgery radiation and chemotherapy are the best treatment.
A 25 year old man is struck on the right side of the head with a softball which causes a swelling on the head. The patient begins having severe headaches, lethargy and vomiting several hours later. The patient is taken to the ECA where a skull x-ray shows a skull fracture that crosses the middle meningeal groove. Which of the following may be true?
a) The patient should be followed as an outpatient
b) The patient likely has an epidural hematoma.
b) CT scan and admission seem appropriate.
c) A follow-up skull x-ray is usually necessary.
Which of the following deficits may likely occur in a patient with an incomplete lesion due to acute spinal cord compression at T12?
b) Motor deficit in the legs with sacral sparing
Which of the following deficits may likely occur in a patient with an incomplete lesion due to acute spinal cord compression at T8?
a) A T10 sensory level
Which of the following deficits may likely occur in a patient with an incomplete lesion due to acute spinal cord compression at T10?
A L1 sensory level
Which of the following deficits may likely occur in a patient with an incomplete lesion due to acute spinal cord compression at T6?
a) A T8 sensory level.
Which of the following may be considered good treatment for increased intracranial pressure?
Glycerol
Hyperventilation
Barbituates
Mannitol
Which of the following may be true regarding increased ICP?
e) Is relieved by head elevation
Which of the following may cause increased ICP?
Subarachnoid hemorrhage
Which of the following are classic signs of increased ICP?
b) Is associated with hypertension
A patient presents with a GCS of 11 after a head injury with a left dilated and fixed pupil, serosanguineous drainage from the nose, a right hemiparesis, a left periorbital ecchymoses, withdrawal to pain and eye opening to voice. Which of the following may be true?
d) The patient has confused speech.
b) The patient has inappropriate words.
A patient presents with a GCS of 9 after a head injury with a left dilated and fixed pupil to direct and consensual light, serosanguineous drainage from the nose and a left hemiparesis. Which of the following may be true?
a) The patient has a right brainstem compression.
d) The patient has a third nerve palsy.
A patient is in a coma after a head injurt with a left fixed and dilated pupil to direct light which dilates when light is shown into the right eye. Which of the following may likely be true?
b) The patient has an afferent pupillary defect.
Which of the following may be treated with lumbar puncture?
b) Communicating hydrocephalus
e) Pseudotumor cerebri
Which of the following are true regarding treatment for a malignant astrocytoma?
a) Radiotherapy is usually given.
b) Chemotherapy is usually administered.
c) Complete excision when possible is recommended.
Which of the following are true regarding meningiomas?
b) Are excised with their dural attachment.
a) Rarely invade the brain.
c) Are rarely malignant.
e) Are more common in the elderly.
c) Are most frequently parasagittal.
The meningomyelocele often presents in the lumbrosacral region at birth. What is most likely to be true regarding lumbosacral meningomyeloceles?
d) Are repaired to prevent meningitis.
a) Are usually associated with bowel and bladder dysfunction.

b) Frequently require a shunt placement for hydrocephalus.
c) Are usually repaired at birth.
Meralgia paresthetica:
b) Is worsened by extension movement of the hips
b) May be bilateral
Which of the following are associated with non-communicating hydrocephalus?
Dandy Walker cyst
b) Arnold Chiari malformation
c) Colloid cyst
An obese young 24 year old female presents with a two month history of headache, blurred vision and vomiting. On examination, she is found to have bilateraly sixth nerve palsies, 20/400 vision, papilledema, a pulse of 50 and blood pressure of 180/100, but no other neuro findings. CT shows non-communicating hydrocephalus. Which of the following may be true?
a) The patient has pseudotumor cerebri.
c) A lumbar puncture may reduce ICP.
An obese young 14 year old female presents with a two month history of headache, blurred vision and vomiting. On examination, she is found to have 20/40 vision, a pulse of 72 and blood pressure of 180/100, but no other neuro findings. CT shows dilated lateral, third and fourth ventricles. Which of the following may be true?
b) A ventriculoperitoneal shunt is appropriate.
An obese young 24 year old female presents with a two month history of headache, blurred vision and vomiting. On examination, she is found to have bilateraly sixth nerve palsies, 20/400 vision, papilledema, a pulse of 50 and blood pressure of 180/100, but no other neuro findings. CT shows a CPA mass and obstructive hydrocephalus. Which of the following may be true
a) The sixth nerve palsy may be a localizing sign.
b) The patient has increased intracranial pressure.
c) A lumbar puncture should not be performed.
d) All of the above.
A 65 year old patient presents with progressive, severe, early morning headaches over 2-3 years duration, worsened by positional changes and straining, associated with vomiting and other symptoms of increased ICP. Which of the following is most likely to be associated with this history?
b) Meningioma
A patient presents with progressive, severe, early morning headaches over 1-2 years duration, worsened by positional changes and straining, associated with vomiting and other symptoms of increased ICP. Which of the following is most likely to be associated with this history?
a) A colloid cyst
A 35 year old patient presents with progressive, severe, early morning headaches over 10-12 years duration, worsened by positional changes and straining, associated with vomiting and other symptoms of increased ICP. Which of the following is most likely to be associated with this history?
a) Benign astrocytoma
A patient presents to the ECA after being struck with a hammer in the parietal area. The patient complains of headache and neck pain. His pulse is 50, BP is 180/110 and there is an open depressed skull fracture of 10 mm on x-ray. Which of the following may be true?
d) Surgery should be performed emergently.
A patient presents with sudden throbbing paind behind the right eye and blurred vision. On examination, the patient has a stiff neck, subhyloid hemorrhages and a right ptosis. Which of the following may likely be true?
c) The patient has a third nerve palsy.
e) The patient has involvement of V1 in the cavernous sinus.

a) The patient has a posterior communicating artery aneurysm.
b) He has involvement of the right third cranial nerve.
c) The patient has a subarachnoid hemorrhage.
d) All of the above.
A patient presents to the ECA after being struck with a hammer in the parietal area. The patient complains of headache and neck pain. His pulse is 50, BP is 180/110 and there is an open depressed skull fracture of 1 mm on x-ray. Which of the following may be true?
a) Surgical treatment is not usually needed with such a small lesion.
A patient presents to the ECA after being struck with a hammer in the parietal area. The patient complains of headache and neck pain. His pulse is 50, BP is 180/110 and there is an obvious open depressed skull fracture of 1 cm. Which of the following may be true?
a) Surgical treatment is recommended.
b) The patient should have a CT scan.
c) Antibiotics are usually given.
d) All of the above.
e) None of the above.
The ulnar nerve supplies which of the following muscles?
d) The flexor carpi ulnaris
Video 1
Video # 1
 Difficulty standing on narrow base
 Ataxic gait, brisk reflexes on left; drift on left; past-pointing
 Nystagmus on horizontal gaze
 Vestibular pathway
 T2 weighted MRI to diagnose
 Diagnosis: Multiple sclerosis
 CSF: Myelin basic protein with oligoclonal bands
 Management: Corticosteroids and interferon
Video 2
66 yo patient with diplopia, sudden onset, difficulty walking
 Facial weakness, right ptosis, right pupil 4 cm fixed, increased left tone
 Brisk reflexes left, finger-to-nose, heel-to-shin ataxia on left, left weakness
 Right midbrain lesion
 Right CN III weakness that caused ptosis
 Midbrain lesion in right red nucleus
 UMN weakness, right cerebral peduncle
 Occlusive lesion of basilar artery
 Management: Sedation, anticonvulsant
Video 3
9 yo; progressive gait difficulty, not able to walk after 5 months
 Extreme lordosis, rapid movement decreased on right
 Trouble with hip flexon, Decreased left tone; plantar extension right foot
 Dystonia
 Basal ganglia disorder; all except intention tremor
 Degeneration of substantia nigra: Parkinson’s
 (is this really a 9 yo kid?!)
 Tripliate repeat: Huntington’s
 Degeneration of Caudate: Huntongton’s
 Lesion of subthalamic nucleus: Contralateral hemibalismus
Video 4
14 yo with hx of fever, sore throat, flattened left NLF
 Left eye does not close completely, left forehead does not wrinkle, hypotonic
 Polyradiculopathy
 Peripheral nerve dysfunction
 Bilateral LMN VII dysfunction
 Dx: Nerve conduction study
 CSF: 5 cells lymphs, 50% glucose, 150% protein
 Acute infectious polyradiculopathy (Guillain-Barre)
 Management: Immunosuppression, immwar/cyclosporine
Case 1
Sudden onset vertigo, falling to the right
 Dx with MRI of brain
 Unequal pupils: Sympathetic involvement
 Decreased corneal response: Right descending V nucleus and tract
 Occlusive vascular disease, right PICA
case 2
54 yo male with PMH HTN; left sided weakness
 Altered mental status; bp 230/120
 Conjugate deviation of eyes: Destructive lesion of right cerebral hemisphere
 Right cerebral hemorrhage with uncal herniation
 CT scan with hyperdensity of right basal ganglia
 CT scan with hyperdensity of right basal ganglia
 Tonic deviation of left eye to the left
 Minimal movement of the right eye when irrigating left ear (cold caloric response)
case 3
15 yo right-handed female; staring spells
 Poor academic performance
 Test: Hyperventilation to evoke seizure
 EEG “B”
case 4
32 yo HIV patient, headaches 2-3 weeks, fever
 Decreased appetite, nuchal rigidity, diplopia when looking to left
 Chronic CNS infection
 Left CN III (except)
 Loss of venous pulsation: Papilledema
 Large ventricles: Enhanced sulci on CT
 CSF: TB positive with acid-fast stain
case 5
45 yo male, weakness
 Distal neuropathy
 Myotonic muscular dystrophy
 Dx with EMG: “Dive-bomber” potentials
Lesion of superior temporal gyrus
 Wernicke’s aphsia, unintelligible jargon, neologisma, paraphrasing
Video 1
Video # 1
 Difficulty standing on narrow base
 Ataxic gait, brisk reflexes on left; drift on left; past-pointing
 Nystagmus on horizontal gaze
 Vestibular pathway
 T2 weighted MRI to diagnose
 Diagnosis: Multiple sclerosis
 CSF: Myelin basic protein with oligoclonal bands
 Management: Corticosteroids and interferon
Video 2
66 yo patient with diplopia, sudden onset, difficulty walking
 Facial weakness, right ptosis, right pupil 4 cm fixed, increased left tone
 Brisk reflexes left, finger-to-nose, heel-to-shin ataxia on left, left weakness
 Right midbrain lesion
 Right CN III weakness that caused ptosis
 Midbrain lesion in right red nucleus
 UMN weakness, right cerebral peduncle
 Occlusive lesion of basilar artery
 Management: Sedation, anticonvulsant
Video 3
9 yo; progressive gait difficulty, not able to walk after 5 months
 Extreme lordosis, rapid movement decreased on right
 Trouble with hip flexon, Decreased left tone; plantar extension right foot
 Dystonia
 Basal ganglia disorder; all except intention tremor
 Degeneration of substantia nigra: Parkinson’s
 (is this really a 9 yo kid?!)
 Tripliate repeat: Huntington’s
 Degeneration of Caudate: Huntongton’s
 Lesion of subthalamic nucleus: Contralateral hemibalismus
Video 4
14 yo with hx of fever, sore throat, flattened left NLF
 Left eye does not close completely, left forehead does not wrinkle, hypotonic
 Polyradiculopathy
 Peripheral nerve dysfunction
 Bilateral LMN VII dysfunction
 Dx: Nerve conduction study
 CSF: 5 cells lymphs, 50% glucose, 150% protein
 Acute infectious polyradiculopathy (Guillain-Barre)
 Management: Immunosuppression, immwar/cyclosporine
Case 1
Sudden onset vertigo, falling to the right
 Dx with MRI of brain
 Unequal pupils: Sympathetic involvement
 Decreased corneal response: Right descending V nucleus and tract
 Occlusive vascular disease, right PICA
case 2
54 yo male with PMH HTN; left sided weakness
 Altered mental status; bp 230/120
 Conjugate deviation of eyes: Destructive lesion of right cerebral hemisphere
 Right cerebral hemorrhage with uncal herniation
 CT scan with hyperdensity of right basal ganglia
 CT scan with hyperdensity of right basal ganglia
 Tonic deviation of left eye to the left
 Minimal movement of the right eye when irrigating left ear (cold caloric response)
case 3
15 yo right-handed female; staring spells
 Poor academic performance
 Test: Hyperventilation to evoke seizure
 EEG “B”
Video 1
Video # 1
 Difficulty standing on narrow base
 Ataxic gait, brisk reflexes on left; drift on left; past-pointing
 Nystagmus on horizontal gaze
 Vestibular pathway
 T2 weighted MRI to diagnose
 Diagnosis: Multiple sclerosis
 CSF: Myelin basic protein with oligoclonal bands
 Management: Corticosteroids and interferon
case 4
32 yo HIV patient, headaches 2-3 weeks, fever
 Decreased appetite, nuchal rigidity, diplopia when looking to left
 Chronic CNS infection
 Left CN III (except)
 Loss of venous pulsation: Papilledema
 Large ventricles: Enhanced sulci on CT
 CSF: TB positive with acid-fast stain
Video 2
66 yo patient with diplopia, sudden onset, difficulty walking
 Facial weakness, right ptosis, right pupil 4 cm fixed, increased left tone
 Brisk reflexes left, finger-to-nose, heel-to-shin ataxia on left, left weakness
 Right midbrain lesion
 Right CN III weakness that caused ptosis
 Midbrain lesion in right red nucleus
 UMN weakness, right cerebral peduncle
 Occlusive lesion of basilar artery
 Management: Sedation, anticonvulsant
Video 3
9 yo; progressive gait difficulty, not able to walk after 5 months
 Extreme lordosis, rapid movement decreased on right
 Trouble with hip flexon, Decreased left tone; plantar extension right foot
 Dystonia
 Basal ganglia disorder; all except intention tremor
 Degeneration of substantia nigra: Parkinson’s
 (is this really a 9 yo kid?!)
 Tripliate repeat: Huntington’s
 Degeneration of Caudate: Huntongton’s
 Lesion of subthalamic nucleus: Contralateral hemibalismus
case 5
45 yo male, weakness
 Distal neuropathy
 Myotonic muscular dystrophy
 Dx with EMG: “Dive-bomber” potentials
Lesion of superior temporal gyrus
 Wernicke’s aphsia, unintelligible jargon, neologisma, paraphrasing
Video 4
14 yo with hx of fever, sore throat, flattened left NLF
 Left eye does not close completely, left forehead does not wrinkle, hypotonic
 Polyradiculopathy
 Peripheral nerve dysfunction
 Bilateral LMN VII dysfunction
 Dx: Nerve conduction study
 CSF: 5 cells lymphs, 50% glucose, 150% protein
 Acute infectious polyradiculopathy (Guillain-Barre)
 Management: Immunosuppression, immwar/cyclosporine
Case 1
Sudden onset vertigo, falling to the right
 Dx with MRI of brain
 Unequal pupils: Sympathetic involvement
 Decreased corneal response: Right descending V nucleus and tract
 Occlusive vascular disease, right PICA
case 2
54 yo male with PMH HTN; left sided weakness
 Altered mental status; bp 230/120
 Conjugate deviation of eyes: Destructive lesion of right cerebral hemisphere
 Right cerebral hemorrhage with uncal herniation
 CT scan with hyperdensity of right basal ganglia
 CT scan with hyperdensity of right basal ganglia
 Tonic deviation of left eye to the left
 Minimal movement of the right eye when irrigating left ear (cold caloric response)
case 3
15 yo right-handed female; staring spells
 Poor academic performance
 Test: Hyperventilation to evoke seizure
 EEG “B”
case 4
32 yo HIV patient, headaches 2-3 weeks, fever
 Decreased appetite, nuchal rigidity, diplopia when looking to left
 Chronic CNS infection
 Left CN III (except)
 Loss of venous pulsation: Papilledema
 Large ventricles: Enhanced sulci on CT
 CSF: TB positive with acid-fast stain
case 5
45 yo male, weakness
 Distal neuropathy
 Myotonic muscular dystrophy
 Dx with EMG: “Dive-bomber” potentials
Lesion of superior temporal gyrus
 Wernicke’s aphsia, unintelligible jargon, neologisma, paraphrasing
 Lesion of left occipital lobe: Splenium of corpus callosum
 Alexia: Right-sided homonymous hemianopsia
 Lesion of right parietal lobe
 Denial/non-recognition of body parts
Epidural hematoma
Dilated, fixed pupil:
1. Meningitis
1. Stiff neck
2. Kernig
3. Photophobia
4. Brudzinski
5. Eyeball tenderness
Normal CSF
1. Normal CSF: Opening pressures is 150-200, clear and colorless, glucose is ½ - 2/3 of the blood drawn out, protein is 15-45 and cells are 0-5
Acute pyogenic meningitis
4. Acute pyogenic menin: high temps, OP is very high 300-500, CSF is cloudy, low glucose, high protein, high count of WBCs (polys), lactate > 35. smear and culture give positive results in 80% of people who have not been treated with ABs.
1. Dorsal column – medial meniscus system
a. Carries information from Ipsilateral side. Cross at medulla.
b. Carries position (joint sense), vibration, 2 point discrimination (requires calipers), and deep touch
i. Does it feel the same of different?
c. Made up of the fasciculus gracilis (lower limbs) and fasciculus cuneatus (upper limbs). These tracks synapse in their respective nuclei in the medulla. They decussate as the medial meniscus in the medulla and synapses in the VPL (of the thalamus)
2. Ventral/Dorsal spinocerebellar fasciculus ????
a. Large joint proprioceptions: large coordinated movements.
b. Touching the tip the nose with a finger – checking right cerebellar track
c. Heal to shin
d. Tandem walk – in the vermis, therefore cant localize in a hemisphere
e. Rapid alternating movements (RAM) – dysdiakokinesia
3. Lateral funiculus
a. Spinothalamic tract
i. Contralateral pain and temp.
ii. Fibers from periphery synapse at the dorsal horn  cross over via ventral white commissure  then ascend to thalamus (VPL)
4. Brown-Sequard syndrome
a. Ipsilateral loss of DC, Coordinated movements, CST, LMN, Spinothalamic tract
b. Pain and temp opposite side absent
c. Sensory dissociation  spinal cord lesion
5. Final common pathway: α – Motor neuron
a. Lesions of ventral horn to muscle – LMN signs
i. Hypotonia, flaccid paralysis, hyporeflexia, atrophy, fasciculations
ii. Ipsilateral signs
6. Breast, lung, and prostate cancer metastasis
cause lytic lesions in vertebrae  compression fractures of vertebrae which compresses the spinal cord.
7. Corticospinal tract
a. Fine motor movements
b. Lesion anywhere above ventral horn  upper motor neuron signs
i. Paralysis paresis, spasticity, hyperreflexia, Babinski sign
c. Location in spinal cord is lateral.
8. Subacute combined degeneration
a. Vitamin B12 deficiency caused by atrophic gastritis (pernicious anemia), nutritional (alcoholics, strict vegetarians), ABs to intrinsic factor
b. Lose DC, CST, dorsal horn bilaterally (symmetric lesion)
i. Positive Romberg sign w/no DC. Alcoholic cerebellar disease can look the same way, but they stumble and sway with their eyes open. Also get a peripheral neuropathy. Definition is impairment of sensation in a stocking-glove distribution.
1. My hands are numb, can cut them off with an axe and wouldn’t feel it. He does have sensation in his feet. Therefore not peripheral neuropathy. Spinal cord ends at L1-L2. The axon to the feet is very long (longest axons are affected first with nutritional deficiencies).
c. Source of Vitamin B12 are leafy vegetables.
9. Polio
a. Anterior horn disease (LMN signs)
b. Signs: muscle weakness and fever (Ipsilateral)
i. Hyporeflexia, spasticity, hypotonia.
10. Amyotrophic lateral sclerosis (Lou Gehrig’s disease)
a. CST, anterior horn cells
i. UMN and LMN signs together
1. Spasiticity, atrophy, hypereflexia,
2. Uselessness of hand, foot drop, muscle cramps, fatigue
ii. Cranial nerves that are motor nuclei are affected except 3,4,6.
iii. They are awake and alert of what’s going on around them. They are trapped in a body.
An old lady has new onset (a year after something) 1/5 strength and proprioception spared. (*note nothing was said about fine touch*)
think the answer is anterior cord syndrome
Pt with C2 lesion has been on a vent for a year, what are options:
choices were maintain on vent, ween off vent,....
I think the answer was E which was to do nerve conduction to screen for a phrenic pacemeaker
football player gets hit on the field and starts to complain of tingling in arms in right more than left. what do you do?
answer choices were: walk him off field, take helmet off, and other stuff.
The one I thought was right: Stabilize the neck
Which is good for increased intercranial pressure?
Mannitol
Obese 14 yo female 2 month history 20/400 vision. Which is true?
LP can be performed
ECA baseball injury with sluggish right pupil? Likely?
Uncal hernia
GCS 9 serosaguinous drain from nose what is true?
Its likely a third nerve injury
Cervical x ray should?
Include the head and neck when indicated
Lesion at or above T6 likely causes?
Autonomic Hyperreflexia (or Dysreflexia)
7 y/o vomits over two weeks likely diagnosis?
Perinaud syndrome
Perinaud syndrome
It is a cluster of abnormalities of eye movements and pupil dysfunction, characterized by:
1. Paralysis of upgaze: Downward gaze is usually preserved. This vertical palsy is supranuclear, so doll's head maneuver should elevate the eyes, but eventually all upward gaze mechanisms fail.
2. Pseudo-Argyll Robertson pupils: Accommodative paresis ensues, and pupils become mid-dilated and show light-near dissociation.
3. Convergence-Retraction nystagmus: Attemps at upward gaze often produce this phenomenon. On fast up-gaze, the eyes pull in and the globes retract. The easiest way to bring out this reaction is to ask the patient to follow down-going stripes on an optokinetic drum.
4. Upper Eyelid retraction (Collier's sign)
5. Conjugate down gaze in the primary position: "setting-sun sign". Neurosurgeons will often see this sign most commonly in patients with failed ventriculoperitoneal shunts.
It is also commonly associated with bilateral papilledema. It has less commonly been associated with spasm of accommodation on attempted upward gaze, pseudoabducens palsy (also known as thalamic esotropia) or slower movements of the abducting eye than the adducting eye during horizontal saccades, see-saw nystagmus and associated ocular motility deficits including skew deviation, oculomotor nerve palsy, trochlear nerve palsy and internuclear ophthalmoplegia.
What is true regarding brain stem glioma?
Increase intercranial pressure is found late
What is truth regarding meningioma?
Most frequently occur in parasaggital region
5 y/o with progressive headaches for two months and incoordination with a CT scan showing a mass in the vermis. What is true?
Gross resection, radiation, chemotherapy are best survival
55 y/o with morning HA ,vomiting, papilledema initiated by change of postion over 3 years?
Rarely malignant tumor
The truth regarding glioblastoma?
May be multicentric
Myelomeningocele at birth?
Is associated with bowel dysfunction
Which is associate with communicating hydrocephalus?
Sarcoidosis
Pt has sudden throbbing pain behind right eye and blurred vision. Examination shows stiff neck, subhyloid hemorrhage and right ptosis. What is true?
It can be caused by V1 cavernous sinus
Which is associated with normal pressure hydrocephalus?
Ataxia, dementia and incontinence
Incomplete Spinal Syndrome with variable loss of motor, pinprick and temperature, & sensation but propioception spared?
Brown Sequard Syndrome
Excessive knee flexion in below knee amputee due to?
Flexion contracture
Good treatment for arteriovenous malformation?
Surgical excision
In analyzing fit and alignment of ischial prosthesis the…?
Ishium SHOULD be continuous in the flare (careful not to pick the option that says it should NOT)
Suprcondylar prothesis provides?
Increased mediolateral stability
Pain sensation travels via?
Aδ and C fibers
Pain does not travel in what fibers?
Aα and B fibers
All the following modalities used for treatment is explained by gate control theory except?
Anti- inflammatory meds
Right stump dressing provide all EXCEPT?
Causes stump edema via choke phenomena
To lock the elbow in an above elbow prothesis which is the movement of the arm?
Shoulder extension
Indications for diaphragmatic pacing include?
C2 tetraplegia with denervation injury to C3, C4, C5
VIDEO 1:
61yo DM male, sudden onset of weakness on the right side of face. (Dx: occlusion of AICA)
This patient demonstrates facial weakness, which of the following statements is correct?
c. the lesion will involve the right facial nerve nucleus or nerve
52. If the lesion at the region causing the facial weakness also involved the motor tract, which of the following statement would be correct?
b. there would be initial flaccidity/hyporeflexia and later spasticity/hyperreflexia of the left side of the body
53. Which of the following ocular findings is likely to be present in this patient?
e. he will have diplopia on attempted gaze to the left side
54. Which of the following etiological factors is likely in this patient?
d. ischemic occlusion in the territory of the basilar artery
55. Which of the following radiological findings is most likely in this patient on initial presentation?
d. the CT scan will show multiple hyperintense lesions periventricularly on T2 images
56. Factors that predispose to vascular cerebral disease include all of the following except:
c. chronic use of aspirin
57. Factors that cause cerebral demyelination lesions include all of the following except:
d. Guillen-Barre syndrome (acute infectious demyelinating polyradiculopathy)
VIDEO 2:
71yo AAF in a wheelchair. She has only motor deficits, no sensory. (Dx: ALS)
58. The patient most likely has which of the following disorders?
a. motor neuron disease (amyotropic lateral sclerosis)
59. The tongue fasciculations indicate:
e. bilateral hypoglossal nuclear lesions
60. Involvement of the anterior horn cell will explain all the following findings except:
a. spasticity/hyperreflexia of extremities
61. Presentation of deep tendon reflexes in the presence of marked anterior horn cell involvement can best be explained by which of the following statements?
c. simultaneous involvement of the upper motor neurons
62. The most important diagnostic study to confirm this disorder is
e. electromyogram showing giant polyphasics and fibrillation potentials
63. All the following statements are true of this disorder except
d. only females are involved, particularly over the age of 50yrs
64. The infantile form of the disorder will manifest with all of the following except
b. preserved deep tendon reflexes
VIDEO 3:
17yo AAF who has had difficult speaking (Dx: MS)
65. The speech problem in this patient can best be attributed to
a. dyasthria denoting cerebellar dysfunction
66. The vertical nystagmus
d. lesion involving the vestibular nucleus or its projections
67. The absent right corneal reflex is due to
e. lesion involving the right trigeminal nerve
68. All of the following findings are compatible with a lesion of the right lateral medulla except
a. right sided hemiparesis
69. The clinical course with remission of symptoms suggests
c. multiple sclerosis
70. The most useful investigative finding in making the diagnosis would be
b. T-2 MRI of brain demonstrating periventricular white matter lesions
VIDEO 4:
28 yo left handed female who has uncontrollable movements (Dx: Huntington’s)
71. The major findings are consistent with dysfunction
d. caudate nucleus
72. The biochemical problem is
a. decreased acetylcholine and GABA synthesis
73. The most likely etiology is
e. Huntington’s Disease
74. The following observations are true except:
c. there is degeneration of the substantia nigra
75. Basal ganglia disorder are characterized by all of the following except
b. ataxia
76. Hemiballismus is seen accompanying lesions that involve
a. subthalamic nucleus
CASE 1:
A 16yo patient presents with episodes of “loss of consciousness” for two years. These episodes are characterized by an aura of vertigo, followed by loss of consciousness, generalized tonic and clonic movements, sometimes accompanied by urinary incontinence, each episode lasting for 2-3 mins, and followed by confusion and drowsiness for several minutes. This particular presentation was because of a similar witnessed episode, which however, was followed by server headache, photophobia and a stiff neck. His examination revealed nuchal rigidity; normal vital signs and some drowsiness. No focal deficit was observed. The optic discs were shapr and normal on fundoscopic examination
77. Which of the following tests would be most helpful?
a. xrays of the skull
b. lumbar puncture
c. MRI of C-spine
d. CT of the head
e. b and d are correct
78. Which of the following findings is likely in the CSF
c. xanthocromic fluid, RBC-50,000, WBC-135, protein-105, glucose-65
79. The findings are consistent with which of the following etiological factors?
d. acute subarachnoid hemorrhage
80. Which of the following conditions is likely to have caused seizures in this patient?
e. arteriovenous malformation of the brain with rupture into the subarachnoid space
81. What would you do next?
d. order an MRI and MRA of the brain, after stabilizing anticonvulsant levels
The patient’s loss of consciousness is most consistent with which EEG:
C (the EEG is not in the supplement packet – however it has large spikes indicating some seizures preceded by low amplitude activity)
CASE 2:
A 43yo black female, who is presently on methadone and has abused cocaine in the past, present with sudden, serve headache, diplopia and ptosis of the left eye. The left pupil is fixed and dilated.
83. The patient most likely has
b. ruptured of leaking Berry aneurysm
84. The following statement(s) will apply
a. The patient’s diplopia will be maximal on looking to the right
b. The patient will have an exotropia (outward deviation)
c. The patient will not be able to look upwards with the left eye
d. The patient is likely to have nuchal rigidity
e. all of the above
85. The most definitive test would be
a. a 4-vessel angiogram (internal carotid and vertebrals)
86. Appropriate management should not include
c. administration of thrombolytics (tpa)
87. Which of the following conditions is likely in this patient?
b. left cerebellar hemispheric astrocytoma
88. The papilledema can be associated with all of the following findings except
e. unilateral dilation of the left lateral ventricle due obstruction of the foramen of Munro
89. The head tilt is most likely due to
d. cerebellar tonsilar herniation
90) Which investigation is contraindicated?
Lumbar puncture
CASE 3:
65 y/o with known HTN black male presents 1 hour of sudden onset of 2 sided weakness, gaze deviation to the right side and slurring speech. His physical examination is otherwise normal except blood pressure 170/88.
91) All should be done except..?
Spinal tap
92) What is CT likely to reveal?
Normal with no lesion
93) Gaze deviation is likely due to?
Destructive right cerebral lesion involving projection from FEF (remember, if it’s a cortical lesion, the eyes look TO the lesion; right FEF  eyes look to the right)
94) Speech problem is likely due to ?
Involvement of right corticobulbar tract in hemisphere
95) Most important complication of tPA therapy is?
Intracerebral hemorrhage
CASE 4:
A 25 y/o HIV + patient presents with headache progressively worsening over 3 weeks, fever, and episode of generalized seizure
96) A CT scan of the head reveals mild to moderate ventricular enlargement without mass effect. What factor is likely cause of cranial nerve problems?
Brain Stem encephalitis
98) What test would be most helpful?
Cryptococcal antigen in CSF
99. An MRI reveals several ring enhancing lesions with mild edema. Initial treatment also includes
c. treatment for toxoplasmosis
100. The findings in the lower extremities can best be studied by
a. nerve conduction velocities of peripheral nerves in lower extremities
interpret coma scale
Severe, with GCS ≤ 8
Moderate, GCS 9 - 12
Minor, GCS ≥ 13.
interpret coma scale
Severe, with GCS ≤ 8
Moderate, GCS 9 - 12
Minor, GCS ≥ 13.
function of oculomotor nerve
It controls most of the eye's movement, constriction of the pupil, and maintains an open eyelid