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83 Cards in this Set

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1. Pt has “electric-shock” like pains in lower extremities. He has begun to exhibit severe locomotor ataxia (lower extremities). Neurological testing: Loss of vibration sense in several dermatomes of both lower extremities, loss of position sense in lower extremities. Motor testing and Cranial nerve testing is unremarkable.?
Tertiary syphilis (tabes dorsalis)
2. Pt has weakness in right hand and fingers. Neurological exam: no evidence of sensory deficit, only severe paresis of the right upper extremity with wrist clonus.?
Left pre-central gyrus
3. Following the flu, pt begins to show weakness, particularly in extremities. Weakness follows a “myotomal pattern”. Nerve conduction velocities innervating the weakened muscles are significantly reduced.
Post-infectious polyradiculitis (gullian barre)
4. Elderly Pt has episodes of weakness, numbness, and tingling sensations in hands and fingers, bilaterally. Elevation of arms reproduces the symptoms. Sensory loss is specific to type II modalities.?
Diabetic neuropathy
The area most implicated in Huntington’s disease?
Caudate nucleus
6. An astrocytoma involving the upper cervical spinal cord (C-4) which has caused degeneration of axons of the medial most portions of the lateral funiculus on the left-->?
Paresis with hyperreflexia in the left upper extremity only
7. Pt. has weakness in Rt lower extremity, difficulty with speech, chewing and swallowing. Neurological test: Severe paresis in Rt leg and foot. On protrusion of tongue it is observed to deviate markedly to the left. If neoplastic… where?
Medullary pyramid – left
8. Pt has muscular spasms involving the muscles on the right side of their neck, which follow voluntary contractions, and last ~30-45sec. Contractions are associated with increased EMG activity. Distractional tests are positive.?
Torticollis dystonia
9. Pt has large scotomas in Rt half of Left eye’s vision, and in the Rt half of the Right eyes vision. Lesion of?
Left optic tract, OR thrombus – complete block of calcarine artery - left
A lesion involving the Rt medullary pyramid would result in?
Voluntary paralysis of the left hand and foot
A unilateral lesion involving the lateral aspect of the medulla would be expected to cause?
Ipsilateral loss of pain and temp sense from the face and contra-lateral loss of pain and temp from the extremities
Pt has scotoma in the lateral portion of Rt eye’s vision. Left eye is normal. Due to lesion?
Medial fibers of the right optic nerve, OR nasal retina of the right eye
13. Pt has tingling and numbness (hypoesthesia) involving both upper and lower extremities bilaterally, exacerbated when bearing down (valsalva). Neuro testing shows loss of tactile discrimination and vibration sense in both upper and lower extremities, bilaterally. Temp and sharp / dull sensations are normal. Most likely?
Tumor involving posterior aspect of the upper cervical spinal cord.
Burning radiating pains in his lower extremities, bilaterally. “loss of feeling” in legs and feet. Neuro testing shows loss of temp and pin prick appreciation in lower extremities bilaterally. Vibration, position sense are normal.?
Tumor involving anterior region of thoracic or upper lumbar cord.
15. Pt has progressive loss of feeling in fingers and toes. Sensory testing shows loss of pain an tem particularly in cooler regions of all four extremities?
Hansen’s disease (leprosy)
16. Pt has progressive onset of weakness, numbness and pain involving his left leg and foot for over a year now. Cranial nerve testing is unremarkable, as well as upper extremity testing. Left lower extremity reveals significant deficits in position and vibratory appreciation involving the left foot and toes. Achilles reflex is depressed on the left. Paresis involving the muscles of the left foot and leg.?
Tumor – spinal canal – involving lumbosacral roots (cauda equina) – left
17. Pt has severe paresis, atrophy and fasciculations involving the wrist extensors of the left upper extremity along with severe paresis, + Babinski’s and ankle clonus in left lower extrem. Selective loss of pain and temp in the right lower extrem.
Thrombus – branches of anterior spinal artery – C-6 – left
18. Right side hemiparesis with wrist and ankle clonus and Babinski’s sign coupled with diplopia elicited upon conjugal gaze to the left is indicative of a lesion involving the ?
Left pons
19. Loss of vibratory appreciation and postion sense with paresis and babinski signs in both feet with severe bilateral lingual paresis. Tumor where?
The anterior regions of the medulla oblongata bilaterally
20. Axons of third order cell bodies involved in the transmission of auditory information would be found in?
Lateral lemniscus
Vertigo due to deep upper brainstem infarctions (pontine &midbrain tegmentum) can usually be distinguished by the observation of?
vertical nystagmus
22. Pt has episode of radiating burning sensations on the right side of face, and left foot and calf. They spread up to his left thigh and then hand and forearm. The episode subsides later. Neuro testing: loss of temp and pinprick appreciation on the Rt side of face and in various locations along the entire left side of the body.?
Vascular insult involving the lateral portions of the medulla on the right
23. Pt has bilateral locomotor ataxia, quadriceps rigidity and bilateral “pendular knee jerk” reflexes. Most likely?
Anterior vermis
24. Pt has headaches and neck stiffness, muscle cramps in hands, fingers and toes. During BP the muscles of the forearm go into spasm resulting in thumb extension, and finger / wrist flexion. Most likely?
hypoparathyroidism/hypocalcemia
25. “Lead pipe” rigidity is particularly characteristic of?
parkinsons
26. Following a bout of the flu, Pt has weakness, most noticeable 1-2 hrs after eating. EStim of affected muscles yield low numbers of muscle cell APs. Increasing the voltage reveals a threshold effect. Most likely?
Hyperkalemia – (Hashimoto’s autoimmune adrenalitis)
27. Pt has loss of position sense in the left lower extremity, with weakness and ankle clonus. Loss of pain and temp sense in the right lower extremity. Most likely?
Tumor affecting the lateral, posterior and anterior aspects of the thoracic or upper lumbar cord on the left.
28. Pt has weakness on Rt side of face and Rt upper extremity. Weakness of Rt facial musculature below the level of the eye. Which vascular territory?
Middle cerebral a. – left
29. Pt has attack of severe burning sensations along the left side of her body and face. Next day, Pt has diminished perceptions of vibration, sterognosis and position sense both the upper and lower extremities on the left. Pinprick appreciation is significantly reduced.?
Pontine tegmentum right
31. Ill appearing Pt has blurred vision and severe weakness involving facial muscles. Has nausea, chills and fever over the past couple of days. Ocular testing shows ptosis, and diplopia in all fields of conjugal gaze. Pupillary light reflexes are markedly slowed in one eye and absent in the other. Most likely?
Botulinum toxin poisoning
botulism toxin posioning
32. A lesion which has completely destroyed the transverse temporal gyri of the left hemisphere would be expected to cause?
Minor hearing loss in both ears.
33. Pt has tingling and numbness along the dorsal surface of their left foot and big toe. Difficulty standing on their heels with their toes in the air. Most likely?
L-4 disc – L-5 roots
34. Pt following period of fever and severe sore throat, complains of difficulty swallowing, even though the pain had gone a week earlier. Pt ahs blurred vision, stimulation of the roof of the pharynx fails to elicit any uvular deviation.
post dyptheria syndrome
35. Pt has an episode of radiating pins and needles sensations involving the right side of their face, right arm and right leg. Vascular lesion where?
Internal capsule – left
36. Pt has loss of feeling in her left lower extremity. Simultaneous pin-wheel examination reveals relative sensory deficit in the left lower extremity. However, unilateral pin-wheel testing fails to reproduce a perceptive difference in stimulus intensity between Rt and L. Most likely?
right cerebral cortex
37. Pt has scotomas in left lower quadrant of the left eye’s vision, and in the lower left quadrant of the Rt eye’s vision. Due to?
Cuneate lobule – right, OR/and medial portions of optic radiations – right
38. In which of the following conditions could the Pt develop a selective loss of pain and temp in some region of the body and preserve type II sensations in that same region?
·Tumor – central neural canal of spinal cord,
·thrombus – anterior spinal artery
. anterior spinal cord tumor
.tumor involving lateral medulla
.leprosy
39. Pt has sudden onset of muscle weakness on the right side of their face, right upper extremity and Rt lower extremity. Motor tests: wrist and ankle clonus on Rt. Facial paresis is exhibited below the level of the eye. Vascular infarct?
Internal capsule – left lenticulostriate a. branches
40. an action potential producing lesion involving the ventral posterior medial nucleus of the Rt thalamus might cause?
Severe burning pain on the left side of the face.
41. An AP producing lesion involving the left trigeminal lemniscus would result in?
Paraesthesia on the right side of the face.
42. Following the flu, Pt has weakness involving facial muscles and m.m. of proximal extremities. Contractions are found decrease in strength with repetitive movements. Most likely?
Myasthenic syndrome
43. Pt has loss of feeling in hands. Neuro test : Loss of pain and temp in a “cape like” pattern across his shoulders and in his hands and forearms, bilaterally. Most likely?
Epyndemoma
44. Pt has “half moon” shaped scotoma in left half of both eye’s vision. Most likely?
Thrombus – distal branches of calcarine artery – right
45. Which of the following would distinguish a disc protrusion involving the L-5 ventral root from a meningioma affecting the lateral funiculus of the spinal cord at L-5 spinal segment?
· Flaccid paresis with fasciculations in muscles of the L-5 myotome with disc protrusion
· Neurogenic atrophy of muscles of the L-5 with disc protrusion
· Disuse atrophy of muscles of the L-5 myotome and below with meningioma
· Depressed patellar stretch reflex with disc protrusion
· Hyperactive patellar and Achilles stretch reflexes with meningioma
· Voluntary paresis without fasciculations in muscles of the L-5 myotome and below with meningioma(All the above)
46. Pt has stiff neck and intermittent cramping of the muscles of her hands and fingers. EStim of motor nerves is normal APs but spasm in mm. for beyond stim. Direct stim of mm produces spasm beyond. Most likely?
hypocalcemia
47. Pt has episodes of blurred vision. Accompanied by tingling sensations and weakness mainly in lower extremities bilaterally. Loss of position sense in lower extreme, with ataxic gait. Clonic gastrocnemius mm. when dorsiflexed. Ophthalmic exam reveals papilledema of the optic disc, particularly on the right, and vertical nystagmus. Most likely?
MS
48. Pt has weakness and numbness in both hands and feet bilaterally. Neuro test shows: loss of position sense and vibration in all four distal extrem. Clonic plantar flexion contractions when dorsiflexed.
Subacute Combined Degen
49. An action potential producing lesion involving only the medial most regions of the ventral-posterior-lateral nucleus of the left thalamus might be expected to cause..?
R UE Severe Pn
50. Pt has weakness and tingling sensations in his left lower extreme, and loss of potion sense and vibratory detection. Pain and temp are preserved. Dorsiflexion of the left foot elicits mild clonic contractions. Vascular infarct where?
Cerebral cortex – territory of the anterior cerebral a. – right
52. Pt has progressive weakness and loss of sensation in hands for the past year. Neuro testing shows loss of pain and temp in hands and forearms bilaterally. Tactile, vibration, proprioception are ok. Most likely?
Tumor of the central neural canal at lower cervical spinal levels
53. Pt has blurred vision and dizziness. Lateral gaze to Rt shows no diplopia. Down from there diplopia is elicited. Blue glass over left eye causes the lower image to turn blue. Most likely?
L trochlear N.
54. Pt exhibiting dysergia, dysmetria, and intention tremors involving their left hand and fingers has most likely suffered a lesion involving the?
PL region of L Lat Hemisphere
55. Pt has loss of vibration sense in left leg and foot, weakness and ankle clonus in the left foot, loss of Pain and temp in the Rt leg and foot with preservation of proprioception. Most likely?
A tumor affecting the lateral, posterior and anterior aspects of the thoracic cord on the left.
A lesion involving the putamen nucleus on one side would be expected to produce?
Contralateral uncontrolled ballistic movements (hemiballismus)
Corticospinal (upper motor neuron) dysfunction is characterized by?
· Voluntary paresis with spasticity
· Hyperactive stretch reflexes involving the antigravity muscles
· Asthenia(apparent weakness) involving the upper extremity extensors and leg flexors
· Disuse atrophy without fasciculations
58. A lesion involving the caudate nucleus on one side would be expected to produce?
Contralateral choreiform movements (hemichorea)
59. Pt exhibiting distal extremity paresis, with wrist and ankle clonus and + Babinski’s signs bilaterally. Most likely?
Primary Lat Sclerosis
Pt with nerve deafness in left ear. Tuning fork placed on glabellum is perceived more clearly in the?
Right Ear
61. Pt has attack of paresis involving the left side of their face and both upper and lower extremities on the right. Without additional testing most likely?
Base of Pons, Left
62. Pt developed weakness and loss of sensation particularly in the lower extremities. Nerve and muscle testing: Stim of affected muscles directly produces normal contractions. Nerve conduction velocities in both motor and sensory nerves innervating the lower extremities are significantly reduced. The weakness does not follow a myotomal pattern. Most likely?
Diabetic Neropathy
Thoracic cord lesion (T-4) involving the anterolateral quadrant would be expected to produce?
Dec Pain/Temp in Contra LE
64. Pt exhibiting dysergia, dysmetria and intention tremor involving their right foot has most likely suffered a lesion involving the ?
Anterolateral region of right lateral hemisphere of the cerebellum
65. Pt has scotomas in the Rt half of the Rt eye’s vision and left half of the Left eyes vision Most likely a lesion…?
Optic Chiasm
66. Pt has weakness and numbness in both upper and lower extremities, bilaterally. Neuro test: loss of position sense and vibration sense in both upper and lower extrem Bilaterally. Muscle: paresis in distal musculature of the lower and upper extrem bilaterally. Clonic contractions in Dorsiflexion of feet. Most likely?
B12 Deficiency
67. oligodentricytoma of the upper cervical spinal cord (C-4) which involved only the lateral most fibers of the spinothalamic tract on one side would be expected to produce…?
Loss of pain and temp sense on the Contralateral lower extrem only.
68. A lesion involving fasciculus cuneatus at C-3 on the right side of the spinal cord would be expected to produce?
Loss of position sense (proprioception) involving the Rt hand and fingers
Asterognosis involving the Rt hand and fingers
Sensory ataxia involving the right hand
69. A disease which causes selective degeneration of the descending voluntary motor tracts of the lateral funiculus as well as anterior horn neuronal cell bodies is…?
Amyotrophic lateral sclerosis
70. A lesion involving the fibers projecting from the lateral region of the right lateral geniculate body to the occipital cortex would result in…?
Loss of vision in the upper quadrant of the left half of the visual field
71. Pt has progressive onset of right axillary pain, with paraesthesia and hypoethesia of the ring and little finger along the medial aspect of the Rt arm and forearm. Weakness of the finger flexors and interossei muscles of the right hand. You notice mild ptosis, a narrowed papillary aperture, and noticeable dryness. Could be?
Pancost tumor of the lung
72. Results of Rinne’s test in a patient with conduction deafness in one ear would consist of?
Normal bone conduction time, and decreased air conduction hearing time
73. Pt has paresis of the muscles of the Rt side of the face, including the forehead. “ironed out” appearance on the right. Touching the cornea on either side elicits a blink response only on the left. She has severe paresis involving her left upper and lower extremities. Testing shows clonic contractions when dorsiflexed on the left. Most likely?
Base pons – right
Pt has weakness, atrophy and fasciculations involving the finger flexors of the right hand along with severe paresis, positive Babinski and ankle clonus in the right lower extremity. Loss of pain and temp sense in the left lower extremity with preservation of vibration and position sense in all extreme. Most likely?
Thrombus – branches of anterior spinal artery – C-8 – right
75. Rt side hemiparesis with spasticity involving the antigravity musculature and Babinski’s sign in combination with diplopia elicited upon conjugal gaze to the right indicates a lesion of the?
Left cerebral peduncle
76. Following the flu, pt has severe GI distress. Needle EMG reveals severe Hyperpolarization of muscle membranes. You notice joints are hyperpigmented in appearance. BP is 80/50. Most likely
Primary adrenal failure (aka: Addison’s, hypoaldosteronism,
77. Pt has scotoma in medial aspect of the Rt eye’s vision, Left eye is normal. Most likely?
Lateral most fibers of the right optic nerve, OR/and temporal retina of the right eye
Lesions involving the posterior regions of the cuneate lobule and lingual gyri are more likely to cause?
Macular (center – field) visual losses
In unilateral conduction deafness, a tuning fork placed on the glabella is “heard better” in the ?
bad ear
Pt has intermittent face pain. Loss of cutaneous sensation along the right maxillary portion of the face. Lightly stroking of this area induces an episode of severe radiating burning pain which lasts for several minutes. You would suspect?
Trigeminal neuralgia
Pt has weakness and tingling sensations involving the left side of her face, left arm and hand. Loss of vibration on the left side of the face and in the left hand and fingers. Weakness of the left facial muscles is exhibited below the level of the eye. Pain and temp sense are normal. Most likely?
Middle cerebral a. – right
82. Pt has weakness and severe muscle cramps in all extremities, most noticeable after exertion. No detectable APs during times of abnormal contraction. Possibly?
Myotonic dystrophy, OR glycogen storage disease
83. Pt has weakness in both upper and lower extremities over the last year. Bilateral paresis with wrist and ankle clonus bilaterally, and + Babinski’s in both feet. Atrophy, fasciculation and hyporeflexia in several myotomes of the upper and lower extremities. Most likely?
Amyotrophic lateral sclerosis
84. Pt has progressive weakness and numbness of lower extremities bilaterally. Bilateral paresis with ankle clonus. Loss of vibratory and position sense in both lower extremities. Pain and temp are normal except for poor localization of these applied stimuli. Most likely?
Tumor - falx cerebri - paracentral lobules
85. Pt has intermittent tingling and numbness in lateral aspect of Rt foot and toe. Difficulty supporting their own body weight when attempting to stand on toes. Probably?
L-5 disc – S-1 roots