Neuro Exam Questions With Complete Solutions
absence (petit mal) seizure Correct Answer diffuse brain
involvement. brief lapse of consciousness -- pt usually unaware
of attacks. brief staring episodes, eyelid twitching, no post-ictal
phase
may be clonic (jerking), tonic (stiffness), or atonic (loss of
postural tone). MC in childhood --> usually ceases by 20y
EEG: bilateral symmetric 3Hz spike and wave action or may be
normal
ACh Correct Answer activates muscle at NMJ from LMN to
effector muscle cell regulating movement.
increased in parkinson's due to dopamine depletion, black
widow spider venom, mushroom toxicity, organophosphate
poisoning -- pesticides and sarin gas
decreased in alzheimers, huntington, MDD, botulism toxin
alzheimer dz dx Correct Answer CT: cerebral cortex atrophy
on CT scan. may r/o other causes
alzheimer dz pathophys Correct Answer MC type of dementia
loss of brain cells, *amyloid deposition (senile plaques) in the
brain, *neurofibrillary tangles (tau protein)
,cholinergic deficiency --> memory, language, visuospatial
changes. normal reflexes
alzheimer dz sx Correct Answer short term memory loss 1st
sx, progresses to long-term memory loss, disorientation,
behavioral and personality changes. usually gradual
alzheimer dz tx Correct Answer acc-esterase inhibitors:
donepezil (aricept), tacrine, rivastigmine, galantamine
-moa: reverses cholinergic deficiency and sx relief (does not
slow dz progression)
NMDA antagonist: memantine
-moa: blocks NMDA receptor, slowing ca influx and nerve
damage. glutamate is an excitatory NT of the NDMA receptor.
excitotoxicity causes cell death. NMDA antagonists reduce
glutamate excitotoxicity. may be adjunctive
amyotrophic lateral sclerosis (ALS) (lou gehrigs disease)
pathophys Correct Answer necrosis of both upper and lower
motor neurons --> progressive motor degeneration
amyotrophic lateral sclerosis (ALS) (lou gehrigs disease) sx
Correct Answer muscle weakness, loss of ability to initiate and
control motor movements
mixed upper and lower motor neuron signs:
-upper: spasticity, stiffness, hyperreflexia
-lower: progressiv bilateral fasciculations, muscle atrophy,
hyporeflexia, muscle weakness
,bulbar sx: dysphagia, dysarthria, speech problems, eventual
respiratory dysfunction
sensation, urinary sphincter, and voluntary eye movements
spared
amyotrophic lateral sclerosis (ALS) (lou gehrigs disease) tx
Correct Answer riluzole reduces progression for up to 6mo
usually fatal w/in 3-5y of onset
anterior cerebral artery stroke sx Correct Answer 2%.
contralateral sensory/motor loss/hemiparesis: *greater in
leg/foot* --> upper extremity --> abnormal gait
face spared: speech preservation. slow responses
frontal lobe and mental status impairment: impaired judgement,
confusion, personality changes (flat affect)
*urinary incontinence*: UMN weakness
gaze preference towards side of lesion (early on)
anterior cervical cord syndrome Correct Answer because
ANT couldn't walk to the bathroom in the TeePee, he peed his
pants when his bladder busted into flecks
ANT: anterior cord syndrome
couldn't walk: lower extremity motor deficits
, TeePee: loss of temp and pain sensation (spinothalamic), light
touch
Peed his pants: bladder dysfunction
Flex: flexion compression MOI
MC after blowout vertebral body burst fracture (flexion).
anterior spinal artery injury or occlusion. direct anterior cord
compression. aortic dissection, SLE, AIDs
anterior circulation ischemic stroke lesion -- dominant side
lesions (usually L hemisphere) Correct Answer R
hemiparesis, R sensory loss, R homonymous hemianopsia,
dysarthria, aphasia (difficulty remembering words, speaking, or
writing), agra-his, decreased math comprehension
anterior circulation ischemic stroke lesion -- non-dominant side
lesions (usually right hemisphere) Correct Answer left
hemiparesis, left sensory loss, L sided neglect (anosognosia), L
homonymous hemianopsia (apraxia), dysarthria (inability to
articulate words), spatial/time defects, flat affect, impaired
judgement, impulsivity
astrocytoma dx Correct Answer CT or MRI w/ contrast: grade
I and II non-enhancing. grade III and IV are enhancing
brain biopsy: usually guided by imaging studies. histologic
appearance includes:
-*pilocytic*: sacs of fluid (cystic) or enclosed w/ cyst. slow
growing. can become very large. *rosenthal fibers*
(eosinophilic corkscrew fibers)
-*diffuse*: micro cysts and mucus-like fluid
absence (petit mal) seizure Correct Answer diffuse brain
involvement. brief lapse of consciousness -- pt usually unaware
of attacks. brief staring episodes, eyelid twitching, no post-ictal
phase
may be clonic (jerking), tonic (stiffness), or atonic (loss of
postural tone). MC in childhood --> usually ceases by 20y
EEG: bilateral symmetric 3Hz spike and wave action or may be
normal
ACh Correct Answer activates muscle at NMJ from LMN to
effector muscle cell regulating movement.
increased in parkinson's due to dopamine depletion, black
widow spider venom, mushroom toxicity, organophosphate
poisoning -- pesticides and sarin gas
decreased in alzheimers, huntington, MDD, botulism toxin
alzheimer dz dx Correct Answer CT: cerebral cortex atrophy
on CT scan. may r/o other causes
alzheimer dz pathophys Correct Answer MC type of dementia
loss of brain cells, *amyloid deposition (senile plaques) in the
brain, *neurofibrillary tangles (tau protein)
,cholinergic deficiency --> memory, language, visuospatial
changes. normal reflexes
alzheimer dz sx Correct Answer short term memory loss 1st
sx, progresses to long-term memory loss, disorientation,
behavioral and personality changes. usually gradual
alzheimer dz tx Correct Answer acc-esterase inhibitors:
donepezil (aricept), tacrine, rivastigmine, galantamine
-moa: reverses cholinergic deficiency and sx relief (does not
slow dz progression)
NMDA antagonist: memantine
-moa: blocks NMDA receptor, slowing ca influx and nerve
damage. glutamate is an excitatory NT of the NDMA receptor.
excitotoxicity causes cell death. NMDA antagonists reduce
glutamate excitotoxicity. may be adjunctive
amyotrophic lateral sclerosis (ALS) (lou gehrigs disease)
pathophys Correct Answer necrosis of both upper and lower
motor neurons --> progressive motor degeneration
amyotrophic lateral sclerosis (ALS) (lou gehrigs disease) sx
Correct Answer muscle weakness, loss of ability to initiate and
control motor movements
mixed upper and lower motor neuron signs:
-upper: spasticity, stiffness, hyperreflexia
-lower: progressiv bilateral fasciculations, muscle atrophy,
hyporeflexia, muscle weakness
,bulbar sx: dysphagia, dysarthria, speech problems, eventual
respiratory dysfunction
sensation, urinary sphincter, and voluntary eye movements
spared
amyotrophic lateral sclerosis (ALS) (lou gehrigs disease) tx
Correct Answer riluzole reduces progression for up to 6mo
usually fatal w/in 3-5y of onset
anterior cerebral artery stroke sx Correct Answer 2%.
contralateral sensory/motor loss/hemiparesis: *greater in
leg/foot* --> upper extremity --> abnormal gait
face spared: speech preservation. slow responses
frontal lobe and mental status impairment: impaired judgement,
confusion, personality changes (flat affect)
*urinary incontinence*: UMN weakness
gaze preference towards side of lesion (early on)
anterior cervical cord syndrome Correct Answer because
ANT couldn't walk to the bathroom in the TeePee, he peed his
pants when his bladder busted into flecks
ANT: anterior cord syndrome
couldn't walk: lower extremity motor deficits
, TeePee: loss of temp and pain sensation (spinothalamic), light
touch
Peed his pants: bladder dysfunction
Flex: flexion compression MOI
MC after blowout vertebral body burst fracture (flexion).
anterior spinal artery injury or occlusion. direct anterior cord
compression. aortic dissection, SLE, AIDs
anterior circulation ischemic stroke lesion -- dominant side
lesions (usually L hemisphere) Correct Answer R
hemiparesis, R sensory loss, R homonymous hemianopsia,
dysarthria, aphasia (difficulty remembering words, speaking, or
writing), agra-his, decreased math comprehension
anterior circulation ischemic stroke lesion -- non-dominant side
lesions (usually right hemisphere) Correct Answer left
hemiparesis, left sensory loss, L sided neglect (anosognosia), L
homonymous hemianopsia (apraxia), dysarthria (inability to
articulate words), spatial/time defects, flat affect, impaired
judgement, impulsivity
astrocytoma dx Correct Answer CT or MRI w/ contrast: grade
I and II non-enhancing. grade III and IV are enhancing
brain biopsy: usually guided by imaging studies. histologic
appearance includes:
-*pilocytic*: sacs of fluid (cystic) or enclosed w/ cyst. slow
growing. can become very large. *rosenthal fibers*
(eosinophilic corkscrew fibers)
-*diffuse*: micro cysts and mucus-like fluid
