00
Correct
00
Incorrect
00 : 00 : 0 00
Session Time
00 : 00
Average Question Time ( Secs)
Retry this test Dashboard

  • Question 1 - When one is silently counting, what part of his brain will show increased...

    Correct

    • When one is silently counting, what part of his brain will show increased regional cerebral blood flow (rCBF)?

      Your Answer: Supplementary motor area

      Explanation:

      Regional cerebral blood flow (rCBF) increases in the superior speech cortex (supplementary motor area) during periods of silent counting, whereas speaking aloud will do so in the motor cortex and medial temporal lobe, along with the superior speech cortex.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      15.5
      Seconds

  • Question 2 - A 45 year old lady has been diagnosed with Friedreich's ataxia that has...

    Correct

    • A 45 year old lady has been diagnosed with Friedreich's ataxia that has affected her medial group of nuclei in the anterior horn of the spinal cord. Which of the following structures will have their muscles affected?

      Your Answer: Axial muscles

      Explanation:

      The cells in the anterior horn can be arranged in the following three main groups: medial, lateral and central. The medial group of nuclei in the anterior horn of the spinal cord are located along the entire length of the spinal cord and are responsible for the innervation of the axial muscles of the body ( muscles of the head and neck region). Thus this disease will most likely affect the functioning of the muscles of the head and neck.

    • This question is part of the following fields:

      • Anatomy
      • Neurology
      45.6
      Seconds

  • Question 3 - If a 55-year old gentleman who has suffered a stroke, develops a tremor...

    Correct

    • If a 55-year old gentleman who has suffered a stroke, develops a tremor in his fingers that worsens on reaching for an object, what part of his brain is likely to be involved?

      Your Answer: Cerebellum

      Explanation:

      The cerebellum plays an important role in the integration of sensory perception and motor output. Multiple neural pathways link the cerebellum with the motor cortex and the spinocerebellar tract. The cerebellum uses the constant feedback on body position to fine-tune the movements and integrates these pathways. The patient described here has a characteristic cerebellar tremor that is a slow, broad tremor of the extremities and occurs at the end of a purposeful movement.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      20.3
      Seconds

  • Question 4 - Dysarthria, nystagmus and a tremor worsening with directed movement are likely to be...

    Incorrect

    • Dysarthria, nystagmus and a tremor worsening with directed movement are likely to be seen in:

      Your Answer: Parkinsonism

      Correct Answer: Cerebellar disease

      Explanation:

      The given symptoms are seen in diseases affecting the cerebellum. A cerebellar tremor is a slow tremor that occurs at the end of a purposeful movement. It is seen in cerebellar disease, such as multiple sclerosis or some inherited degenerative disorders and chronic alcoholism. Classically, tremors are produced in the same side of the body as a one-sided lesion. Cerebellar disease can also result in a wing-beating’ type of tremor called rubral or Holmes’ tremor – a combination of rest, action and postural tremors. Other signs of cerebellar disease include dysarthria (speech problems), nystagmus (rapid, involuntary rolling of the eyes), gait problems and postural tremor of the trunk and neck.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      15.8
      Seconds

  • Question 5 - A 60-year-old woman complains of left sided headaches which have been recurring for...

    Incorrect

    • A 60-year-old woman complains of left sided headaches which have been recurring for several years. She recently suffered from a focal seizure for the first time a few days ago. A CT scan shows a mass in the left hemisphere of the brain. The most likely diagnosis is:

      Your Answer: Schwannoma

      Correct Answer: Meningioma

      Explanation:

      Meningiomas are a common benign intracranial tumour, and their incidence is higher in women between the ages of 40-60 years old. Many of these tumours are asymptomatic and are diagnosed incidentally, although some of them may have malignant presentations (less than 2% of cases). These benign tumours can develop wherever there is dura, over the convexities near the venous sinuses, along the base of the skull, in the posterior fossa and, within the ventricles.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      37.9
      Seconds

  • Question 6 - A 70-year-old man who was previously healthy develops a rapidly progressing neurological deficit....

    Incorrect

    • A 70-year-old man who was previously healthy develops a rapidly progressing neurological deficit. A MRI reveals a large, poorly defined mass with central necrosis in his left temporal lobe. What is the most likely diagnosis?

      Your Answer: Low-grade astrocytoma

      Correct Answer: Glioblastoma multiforme

      Explanation:

      Glioblastoma multiforme, or grade 4 astrocytoma, is the most common and aggressive primary brain tumour. They are formed by small areas of necrotising tissue surrounded by highly anaplastic cells. Most of them arise from the deep white matter of the brain and quickly infiltrate it, becoming very large before they are symptomatic. The most common symptom is progressive memory, personality or neurological deficit due to temporal and frontal lobe involvement. It is most common in men, and risk factors include: neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau disease, Li-Fraumeni syndrome, and Turcot syndrome.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      35.7
      Seconds

  • Question 7 - A 70-year-old man suffers an ischaemic stroke and develops a left homonymous hemianopia....

    Incorrect

    • A 70-year-old man suffers an ischaemic stroke and develops a left homonymous hemianopia. Where is the likely infarct?

      Your Answer:

      Correct Answer: Right occipital lobe

      Explanation:

      The man has a left homonymous hemianopia which means he is unable to view objects in the left visual field. This information is processed by the right primary visual cortex which lies in the right occipital lobe.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 8 - In which situation is a stretch reflex such as knee jerk likely to...

    Incorrect

    • In which situation is a stretch reflex such as knee jerk likely to be exaggerated?

      Your Answer:

      Correct Answer: In upper motor neuron lesion

      Explanation:

      A stretch reflex is a monosynaptic reflex that causes muscle contraction in response to stretching within that muscle. The sensory apparatus in a muscle that are sensitive to stretch are the muscle spindles. The patellar (knee jerk) reflex is an example. In upper motor neuron lesions, the stretch reflexes tend to be brisk due to loss of inhibitory signals on gamma neurons through the lateral reticulospinal tract.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 9 - Rapid Eye Movement (REM) sleep is typically associated with: ...

    Incorrect

    • Rapid Eye Movement (REM) sleep is typically associated with:

      Your Answer:

      Correct Answer: Penile erections

      Explanation:

      Normal sleep comprises of alternate cycles between slow-wave sleep (non-REM sleep) and REM sleep. REM sleep is characterized by increased metabolic brain activity and EEG desynchronization. Somnambulism (sleepwalking), enuresis (bedwetting) and night terrors all occur during slow-wave sleep or during arousal from slow-wave sleep. In comparison, REM sleep is characterized by hypotonia of major muscle groups (excluding ocular muscles), dreams, nightmares and penile erection.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 10 - A 25-year-old football player suffers severe head trauma during a game. Physical examination...

    Incorrect

    • A 25-year-old football player suffers severe head trauma during a game. Physical examination reveals a decerebrate posture and bilateral papilledema. A CT scan reveals marked diffuse cerebral oedema. This condition will be most severe in which component of the brain?

      Your Answer:

      Correct Answer: White matter

      Explanation:

      The greatest amount of salt and water increase with cerebral oedema occurs within the white matter. Any swelling from oedema, haemorrhage or haematoma increases the intracranial pressure (ICP). As the ICP increases, the cerebral perfusion decreases and brain tissue can become ischaemic, even leading to brain death.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 11 - Which of the following veins is prostate cancer most likely to metastasize through?...

    Incorrect

    • Which of the following veins is prostate cancer most likely to metastasize through?

      Your Answer:

      Correct Answer: Internal vertebral venous plexus

      Explanation:

      The internal vertebral veins are the most likely route of metastasis as they are valveless. They serve an important clinical role as they are the route of free travel for cancerous cells to other body structures. The other veins on the list have valves and would be the least likely routes for metastasis.

    • This question is part of the following fields:

      • Anatomy
      • Neurology
      0
      Seconds

  • Question 12 - A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect: ...

    Incorrect

    • A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect:

      Your Answer:

      Correct Answer: Regulation of circadian rhythm

      Explanation:

      The suprachiasmatic nucleus (SCN) in the hypothalamus is responsible for controlling endogenous circadian rhythms and destruction of the SCN leads to a loss of circadian rhythm.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 13 - A patient presents with loss of fine touch and sense of proprioception in...

    Incorrect

    • A patient presents with loss of fine touch and sense of proprioception in the lower part of the body (below T6). He is likely to have a lesion involving:

      Your Answer:

      Correct Answer: Gracile nucleus

      Explanation:

      The gracile nucleus is located in the medulla oblongata and is one of the dorsal column nuclei involved in the sensation of fine touch and proprioception. It contains second-order neurons of the dorsal column–medial lemniscus system, that receive inputs from sensory neurones of the dorsal root ganglia and send axons that synapse in the thalamus.

      The gracile nucleus and fasciculus carry epicritic, kinaesthetic and conscious proprioceptive information from the lower part of the body (below the level of T6 in the spinal cord). Similar information from the upper part of body (above T6, except for face and ear) is carried by the cuneate nucleus and fasciculus. The information from face and ear is carried by the primary sensory trigeminal nucleus.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 14 - Which of these laboratory findings will indicate a fetal neural tube defect when...

    Incorrect

    • Which of these laboratory findings will indicate a fetal neural tube defect when done between 15 and 20 weeks of pregnancy?

      Your Answer:

      Correct Answer: Increased alpha-fetoprotein

      Explanation:

      Maternal serum screening during the second trimester is a non-invasive way of identifying women at increased risk of having children with a neural tube defect and should be offered to all pregnant women. The results are most accurate when the sample is taken between 15 and 20 weeks of gestation. Elevated levels of alpha-fetoprotein suggest open spina bifida, anencephaly, risk of pregnancy complications, or multiple pregnancy.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 15 - A cerebellar tremor can be differentiated from a Parkinsonian tremor in that: ...

    Incorrect

    • A cerebellar tremor can be differentiated from a Parkinsonian tremor in that:

      Your Answer:

      Correct Answer: It only occurs during voluntary movements

      Explanation:

      Cerebellar disease leads to intention tremors, which is absent at rest and appears at the onset of voluntary movements. In comparison, Parkinson’s tremor is present at rest. Frequency of tremor is a less reliable means to differentiate between the two as the oscillation amplitude of the tremor is not constant throughout a voluntary action.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 16 - When the pitch of a sound increases, what is the physiological response seen...

    Incorrect

    • When the pitch of a sound increases, what is the physiological response seen in the listener?

      Your Answer:

      Correct Answer: The location of maximal basilar membrane displacement moves toward the base of the cochlea

      Explanation:

      An increase in the frequency of sound waves results in a change in the position of maximal displacement of the basilar membrane in the cochlea. Low pitch sound produces maximal displacement towards the cochlear apex and greatest activation of hair cells there. With an increasing pitch, the site of greatest displacement moves towards the cochlear base. However, increased amplitude of displacement, increase in the number of activated hair cells, increased frequency of discharge of units in the auditory nerve and increase in the range of frequencies to which such units respond, are all seen in increases in the intensity or a sound stimulus.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 17 - A 20-year old gentleman was brought to the emergency department with headache and...

    Incorrect

    • A 20-year old gentleman was brought to the emergency department with headache and nausea for 2 days. He also complained of intolerance to bright light and loud sounds. Lumbar puncture showed glucose < 45 mg/dl, protein > 5 mg/dl and neutrophil leucocytosis. The likely diagnosis is:

      Your Answer:

      Correct Answer: Meningitis

      Explanation:

      Diagnosis of meningitis can be carried out with examination of cerebrospinal fluid (CSF) with a lumbar puncture (LP). In a case of bacterial meningitis, the CSF analysis will show:

      – Opening pressure: > 180 mmH2O

      – White blood cell count: 10–10 000/μl with neutrophil predominance

      – Glucose: < 40 mg/dl – CSF glucose to serum glucose ratio: < 0.4 – Protein: > 4.5 mg/dl

      – Gram stain: positive in > 60%

      – Culture: positive in > 80%

      – Latex agglutination: may be positive in meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli and group B streptococci

      – Limulus, lysates: positive in Gram-negative meningitis

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 18 - A patient with a long standing lower motor neuron lesion will have: ...

    Incorrect

    • A patient with a long standing lower motor neuron lesion will have:

      Your Answer:

      Correct Answer: Muscle wasting

      Explanation:

      Lower motor neurons (LMNs) connect the brainstem and spinal cord to muscle fibres. Damage to lower motor neurons is indicated by abnormal electromyographic potentials, fasciculations, paralysis, weakening and wasting of skeletal muscles.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 19 - A 32-year old gentleman came to the emergency department, complaining of progressively increasing...

    Incorrect

    • A 32-year old gentleman came to the emergency department, complaining of progressively increasing weakness in his arms and legs over 5 days. On examination, there is symmetrical weakness on both sides of his face, along with weakness of the proximal and distal muscles of all four limbs. No loss of sensation noted. Deep tendon reflexes could not be elicited and plantar responses were downward. On enquiry, it was revealed that he had an upper respiratory tract infection 10 days ago. The likely diagnosis is:

      Your Answer:

      Correct Answer: Guillain–Barré syndrome

      Explanation:

      Guillain–Barré syndrome (GBS) is an acute, autoimmune polyradiculoneuropathy which affects the peripheral nervous system and is usually triggered by an acute infectious process. 75% patients have a history of acute infection within the past 1–4 weeks, usually respiratory or gastrointestinal. immunisations have also been implicated. The most common form is acute inflammatory demyelinating polyneuropathy. It results in an ascending paralysis with complete loss of deep tendon reflexes. Treatment includes immunoglobulins and supportive care. However, the disease may be fatal due to severe pulmonary complications and dysautonomia.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 20 - A 58-year-old woman has had a headache, fever, lethargy and nausea for the...

    Incorrect

    • A 58-year-old woman has had a headache, fever, lethargy and nausea for the last 10 days. He undergoes a CT scan which reveals a lesion in his frontal lobe, which, after a biopsy, is found to be formed by granulation tissue with collagenisation, gliosis and oedema. What's the most likely diagnosis?

      Your Answer:

      Correct Answer: Chronic brain abscess

      Explanation:

      A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. In a CT scan, an abscess appears as an oedematous mass with ring enhancement.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 21 - A 66-year-old man complains of constant headaches. On physical examination, the only relevant...

    Incorrect

    • A 66-year-old man complains of constant headaches. On physical examination, the only relevant sign is a dark brown mole located on left his arm which has grown in size over the years and is itchy and painful. A MRI of the brain revealed a solitary lesion at the grey-white junction in the right frontal lobe, without ring enhancement. This lesion is most likely to be:

      Your Answer:

      Correct Answer: Metastatic carcinoma

      Explanation:

      The location of the mass at the grey–white junction is typical of a metastasis. The most frequent types of metastatic brain tumours originate in the lung, skin, kidney, breast and colon. These tumour cells reach the brain via the bloodstream. This patient is likely to have skin cancer, which caused the metastatic brain tumour.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 22 - After a cerebral infarction, which of these histopathogical findings is most likely to...

    Incorrect

    • After a cerebral infarction, which of these histopathogical findings is most likely to be found?

      Your Answer:

      Correct Answer: Liquefactive necrosis

      Explanation:

      The brain has a high lipid content and typically undergoes liquefaction with ischaemic injury, because it contains little connective tissue but high amounts of digestive enzymes.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 23 - Mechanical distortion, and not K+ channels are responsible for distortion of which of...

    Incorrect

    • Mechanical distortion, and not K+ channels are responsible for distortion of which of the following structures?

      Your Answer:

      Correct Answer: Pacinian corpuscle

      Explanation:

      Pacinian corpuscles are a type of mechanoreceptor, sensitive to deep pressure, touch and high-frequency vibration. The Pacinian corpuscles are ovoid and about 1 mm long. In the centre of the corpuscle is the inner bulb, which is a fluid-filled cavity with a single afferent unmyelinated nerve ending. Any deformation in the corpuscle causes the generation of action potentials by opening of pressure-sensitive sodium ion channels in the axon membrane. This allows influx of sodium ions, creating a receptor potential (independent of potassium channels).

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 24 - Which nerve mediates the sensation to itch from the skin that is just...

    Incorrect

    • Which nerve mediates the sensation to itch from the skin that is just over the base of the spine of your scapula?

      Your Answer:

      Correct Answer: Dorsal primary ramus of C7

      Explanation:

      The first branches off spinal nerves are called the dorsal and ventral rami. The dorsal rami mediate sensation of the skin over the back and motor supply to the true muscles of the back whilst the ventral rami gives sensation to the skin over the limbs and the skin that is over the ventral side of the trunk. It also gives motor supply to the skeletal muscles of the neck, the trunk and extremities. Hence, itchiness of the part of the skin that is over the spine of the scapula would be mediated by the primary ramus of C7. Accessory nerve doesn’t have any sensory innervation.

    • This question is part of the following fields:

      • Anatomy
      • Neurology
      0
      Seconds

  • Question 25 - Which of these illnesses is most likely to precede Guillain-Barré syndrome? ...

    Incorrect

    • Which of these illnesses is most likely to precede Guillain-Barré syndrome?

      Your Answer:

      Correct Answer: Viral pneumonia

      Explanation:

      Guillain–Barré syndrome (GBS) is characterized by a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. In about two-thirds of patients, the syndrome begins 5 days to 3 weeks after an infectious disease, surgery or vaccination. Infection is the trigger in over 50% of patients; common pathogens include Campylobacter jejuni, enteric viruses, herpesviruses (including cytomegalovirus and those causing infectious mononucleosis) and Mycoplasma species. The underlying mechanism involves an autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nerves and damages their myelin insulation, although the cause for this is still unknown.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 26 - Which of the following clinical signs will be demonstrated in a case of...

    Incorrect

    • Which of the following clinical signs will be demonstrated in a case of Brown-Séquard syndrome due to hemisection of the spinal cord at mid-thoracic level?

      Your Answer:

      Correct Answer: Ipsilateral spastic paralysis, ipsilateral loss of vibration and proprioception (position sense) and contralateral loss of pain and temperature sensation beginning one or two segments below the lesion

      Explanation:

      Brown–Séquard syndrome results due to lateral hemisection of the spinal cord and results in a loss of motricity (paralysis and ataxia) and sensation. The hemisection of the cord results in a lesion of each of the three main neural systems: the principal upper motor neurone pathway of the corticospinal tract, one or both dorsal columns and the spinothalamic tract. As a result of the injury to these three main brain pathways the patient will present with three lesions. The corticospinal lesion produces spastic paralysis on the same side of the body (the loss of moderation by the upper motor neurons). The lesion to fasciculus gracilis or fasciculus cuneatus results in ipsilateral loss of vibration and proprioception (position sense). The loss of the spinothalamic tract leads to pain and temperature sensation being lost from the contralateral side beginning one or two segments below the lesion. At the lesion site, all sensory modalities are lost on the same side, and an ipsilateral flaccid paralysis.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 27 - The primary motor cortex is located in the: ...

    Incorrect

    • The primary motor cortex is located in the:

      Your Answer:

      Correct Answer: Precentral gyrus

      Explanation:

      The primary motor cortex is located in the dorsal part of the precentral gyrus and the anterior bank of the central sulcus. The precentral gyrus lies anterior to the postcentral gyrus and is separated from it by a central sulcus. Its anterior border is the precentral sulcus, while inferiorly it borders to the lateral fissure (Sylvian fissure).

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 28 - upon stroking the plantar surface of a patient's foot, extension of toes was...

    Incorrect

    • upon stroking the plantar surface of a patient's foot, extension of toes was noted. This is likely to be accompanied with:

      Your Answer:

      Correct Answer: Spasticity

      Explanation:

      An upper motor neuron lesion affects the neural pathway above the anterior horn cell or motor nuclei of the cranial nerves, whereas a lower motor neurone lesion affects nerve fibres travelling from the anterior horn of the spinal cord to the relevant muscles. An upper motor neurone lesions results in the following:

      – Spasticity in the extensor muscles (lower limbs) or flexor muscles (upper limbs).

      – ‘clasp-knife’ response where initial resistance to movement is followed by relaxation

      – Weakness in the flexors (lower limbs) or extensors (upper limbs) with no muscle wasting

      – Brisk tendon jerk reflexes

      – Positive Babinski sign (on stimulation of the sole of the foot, the big toe is raised rather than curled downwards)

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 29 - Which of the following tumours has the best prognosis following surgery? ...

    Incorrect

    • Which of the following tumours has the best prognosis following surgery?

      Your Answer:

      Correct Answer: Schwannoma

      Explanation:

      Schwannomas are histologically benign neoplasms that arise from nerve sheaths, most commonly from sensory nerve roots. They are generally contained within a capsule, and so can be surgically removed without injuring the associated nerve root. They are histologically benign and less than 1% become malignant.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 30 - A sudden loud sound is more likely to result in cochlear damage than...

    Incorrect

    • A sudden loud sound is more likely to result in cochlear damage than a slowly developing loud sound. This is because:

      Your Answer:

      Correct Answer: There is a latent period before the attenuation reflex can occur

      Explanation:

      On transmission of a loud sound into the central nervous system, an attenuation reflex occurs after a latent period of 40-80 ms. This reflex contracts the two muscles that pull malleus and stapes closer, developing a high degree of rigidity in the entire ossicular chain. This reduces the ossicular conduction of low frequency sounds to the cochlea by 30-40 decibels. In this way, the cochlea is protected from damage due to loud sounds (these are low frequency sounds) when they develop slowly.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 31 - Which of the following will be affected by a lesion in the posterior...

    Incorrect

    • Which of the following will be affected by a lesion in the posterior column-medial lemniscus system?

      Your Answer:

      Correct Answer: Fine touch

      Explanation:

      The posterior column–medial lemniscus (PCML) pathway is a sensory pathway that transmits fine touch and conscious proprioceptive information from the body to the brain. As the posterior columns are also known as dorsal columns, the pathway is also called the dorsal column–medial lemniscus system or DCML.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 32 - A patient presents with loss of pain and temperature sensation in the left...

    Incorrect

    • A patient presents with loss of pain and temperature sensation in the left leg. He is likely to have a lesion involving:

      Your Answer:

      Correct Answer: Right lateral spinothalamic tract

      Explanation:

      The spinothalamic tract is a sensory pathway originating in the spinal cord that transmits information to the thalamus. There are two main parts of the spinothalamic tract: the lateral spinothalamic tract transmits pain and temperature and the anterior spinothalamic tract transmits touch (crude touch). The decussation of this pathway occurs at the level of the spinal cord. Hence, a unilateral lesion of the lateral spinothalamic tract causes contralateral loss of pain and temperature.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 33 - A 36-year-old woman suddenly suffers from a generalized seizure. She was previously healthy....

    Incorrect

    • A 36-year-old woman suddenly suffers from a generalized seizure. She was previously healthy. An emergency CT scan reveals a mass in the posterior fossa, with distortion of the lateral ventricles. After removing the tumour, the biopsy reveals it contains glial fibrillary acidic protein (GEAP). What's the most likely diagnosis?

      Your Answer:

      Correct Answer: Astrocytoma

      Explanation:

      Astrocytomas are primary intracranial tumours derived from astrocyte cells of the brain. They can arise in the cerebral hemispheres, in the posterior fossa, in the optic nerve and, rarely, in the spinal cord. These tumours express glial fibrillary acidic protein (GFAP). In almost half of cases, the first symptom of an astrocytoma is the onset of a focal or generalised seizure. Between 60% and 75% of patients will have recurrent seizures during the course of their illness. Secondary clinical sequelae may be caused by elevated intracranial pressure (ICP) cause by the direct mass effect, increased blood volume, or increased cerebrospinal fluid (CSF) volume. CT will usually show distortion of the third and lateral ventricles, with displacement of the anterior and middle cerebral arteries. Histological diagnosis with tissue biopsy will normally reveal an infiltrative character suggestive of the slow growing nature of the tumour.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 34 - Which of these infectious agents tends to affect people under 20 and over...

    Incorrect

    • Which of these infectious agents tends to affect people under 20 and over 40 years old, can cause acute encephalitis with cerebral oedema and petechial haemorrhages, along with haemorrhagic lesions of the temporal lobe. A lumbar puncture will reveal clear cerebrospinal fluid with an elevated lymphocyte count?

      Your Answer:

      Correct Answer: Herpes simplex virus

      Explanation:

      Haemorrhagic lesions of the temporal lobe are typical of Herpes simplex encephalitis (HSE). It tends to affect patients aged under 20 or over 40 years, and is often fatal if left untreated. In acute encephalitis, cerebral oedema and petechial haemorrhages occur and direct viral invasion of the brain usually damages neurones. The majority of cases of herpes encephalitis are caused by herpes simplex virus-1 (HSV-1), and about 10% of cases of herpes encephalitis are due to HSV-2, which is typically spread through sexual contact.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 35 - A recognised side-effect of prefrontal leukotomy is: ...

    Incorrect

    • A recognised side-effect of prefrontal leukotomy is:

      Your Answer:

      Correct Answer: Confusion

      Explanation:

      Used previously as a treatment for psychiatric disorders, prefrontal leucotomy severs the connection between the prefrontal cortical association area and the thalamus. This leads to functional isolation of the prefrontal and orbitofrontal association cortex. Thus, along with the desired reduction in anger and frustration, undesirable side effects included changes in mood and affect, as well as confusion.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 36 - Which of the following is a true statement regarding the pupil? ...

    Incorrect

    • Which of the following is a true statement regarding the pupil?

      Your Answer:

      Correct Answer: Phentolamine causes pupil constriction

      Explanation:

      A balance between the sympathetic tone to the radial fibres of the iris and parasympathetic tone to the pupillary sphincter muscle determines the pupil size. Phentolamine (α-adrenergic receptor blocker) causes pupillary constriction. Dilatation of the pupil occurs with increased sympathetic activity, decreased parasympathetic activity during darkness or block of muscarinic receptors by atropine.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 37 - Which of the following will show decreased hearing when tested by air conduction...

    Incorrect

    • Which of the following will show decreased hearing when tested by air conduction but normal hearing when tested by bone conduction?

      Your Answer:

      Correct Answer: Fibrosis causing fixation of the ossicles

      Explanation:

      As the cochlea is embedded into bone, the vibrations from the bone are transmitted directly to the fluid in the cochlea. Hence, any damage to the ossicles or tympanic membrane will not show an abnormal result on bone conduction test.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 38 - The primary area involved in the pathology of Parkinson's disease is: ...

    Incorrect

    • The primary area involved in the pathology of Parkinson's disease is:

      Your Answer:

      Correct Answer: Substantia nigra

      Explanation:

      Parkinson’s disease is a degenerative, movement disorder of the central nervous system, and is typically characterized by muscle rigidity, tremor and bradykinesia (in extreme cases, akinesia). Secondary symptoms include high-level cognitive dysfunction and subtle language problems.

      Parkinson’s disease is also called ‘primary Parkinsonism’ or ‘idiopathic Parkinson’s disease and is the most common cause of Parkinsonism, a group of similar symptoms. The disorder is caused due to loss of pigmented dopaminergic cells in the pars compacta region of the substantia nigra.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 39 - With respect to far accommodation, which of the following is a TRUE statement?...

    Incorrect

    • With respect to far accommodation, which of the following is a TRUE statement?

      Your Answer:

      Correct Answer: The ciliary muscles are relaxed

      Explanation:

      Myopia or near-sightedness is a disease due to elongated eyeballs or too strong a lens. For far accommodation (focus of a distant object onto the retina), the lens needs to decrease its refractive power, or in other words, increase its focal length. This is done by relaxation of ciliary muscles which tightens the zonular fibres and flattening of the lens. Relaxation of the zonular fibres, rounding of the lens, shortening of the focal length and constriction of the pupil occurs during near accommodation.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 40 - A lesion involving the lateral geniculate nucleus of the thalamus is likely to...

    Incorrect

    • A lesion involving the lateral geniculate nucleus of the thalamus is likely to affect:

      Your Answer:

      Correct Answer: Vision

      Explanation:

      The lateral geniculate nucleus (LGN) of the thalamus is the primary processor of visual information in the central nervous system. The LGN receives information directly from the retina and sends projections directly to the primary visual cortex. The LGN likely helps the visual system focus its attention on the most important information.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 41 - The primary somatosensory cortex is located in the: ...

    Incorrect

    • The primary somatosensory cortex is located in the:

      Your Answer:

      Correct Answer: Postcentral gyrus

      Explanation:

      The primary somatic sensory cortex is located in the postcentral gyrus and is the largest cortical receiving area for information from somatosensory receptors. Through corticocortical fibres, it then sends the information to other areas of the neocortex and further analysis takes place in the posterior parietal association cortex.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 42 - Which of the following is true about myasthenia gravis? ...

    Incorrect

    • Which of the following is true about myasthenia gravis?

      Your Answer:

      Correct Answer: Response of skeletal muscle to nerve stimulation is weakened

      Explanation:

      An autoimmune disorder, myasthenia gravis leads to progressive muscle weakness. It occurs due to formation of antibodies against the nicotinic acetylcholine (ACh) receptor of the motor endplate, which leads to impaired neuromuscular transmission. Thus, nerve stimulation will lead to a weakened muscle response, but direct electrical stimulation will bring about a normal response. Diagnostic test includes improvement of muscle weakness by small doses of acetylcholinesterase inhibitors (physostigmine or edrophonium). However, a large dose of physostigmine worsens the weakness due to desensitisation of the endplate to persistent Ach. One of the investigative tools includes radiolabelled snake venom α-bungarotoxin. It is an in vitro study performed on muscle biopsy specimens and used to quantify the number of ACh receptors at the motor endplate.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 43 - Production of pain is most likely associated with: ...

    Incorrect

    • Production of pain is most likely associated with:

      Your Answer:

      Correct Answer: Substance P

      Explanation:

      Substance P is a short-chain polypeptide that functions as a neurotransmitter and as a neuromodulator, and is thus, a neuropeptide. It has been linked with pain regulation, mood disorders, stress, reinforcement, neurogenesis, respiratory rhythm, neurotoxicity, nausea and emesis. It is also a potent vasodilator as it brings about release of nitric oxide from the endothelium. Its release can also cause hypotension.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 44 - A lesion involving the lateral portion of the dorsal columns at the level...

    Incorrect

    • A lesion involving the lateral portion of the dorsal columns at the level of the nape of the neck will most likely affect:

      Your Answer:

      Correct Answer: Vibratory sensations from the ipsilateral arm

      Explanation:

      At the level mentioned in the question, the lateral portion of dorsal columns comprises of the fasciculus cuneatus. Axons carrying the sensations of touch, vibration and proprioception from the ipsilateral arm enter the spinal cord and ascend in the fasciculus cuneatus, synapsing in the nucleus cuneatus of the caudal medulla. Secondary neurons from this nucleus give rise to internal arcuate fibres, which decussate and ascend to the thalamus as the medial lemniscus. Tertiary neurons from there project to the ipsilateral somatosensory cortex. Thus, any damage to the fasciculus cuneatus will result in a deficit in tactile, proprioceptive and vibratory sensations in the ipsilateral arm, and not the contralateral arm.

      Fine motor control of the fingers is mainly carried by the ipsilateral lateral corticospinal tract in the lateral funiculus of the cord. Motor control of the contralateral foot is carried by the ipsilateral corticospinal tract in the lateral funiculus of the cord. Lack of sweating of the face could be produced by interruption of sympathetic innervation. Proprioception from the ipsilateral leg is carried by the fasciculus gracilis in the medial part of the dorsal columns.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 45 - A previously healthy 40-year-old housewife suddenly complains of a headache and loses consciousness....

    Incorrect

    • A previously healthy 40-year-old housewife suddenly complains of a headache and loses consciousness. A CT scan reveals subarachnoid haemorrhage. Which of the following is the most probable cause?

      Your Answer:

      Correct Answer: Ruptured berry aneurysm

      Explanation:

      Saccular aneurysms, also known as berry aneurysms, appear as a round outpouching and are the most common form of cerebral aneurysm. They are a congenital intracranial defect, and haemorrhage can occur at any age, but is most common between the ages of 40-65 years. A second rupture (rebleeding) sometimes occurs, most often within about 7 days of the first bleed.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 46 - A 50-year old gentleman who suffered a stroke was brought to the emergency...

    Incorrect

    • A 50-year old gentleman who suffered a stroke was brought to the emergency department by his relatives. The patient however denied the presence of paralysis of his left upper and lower limbs. What is the most likely site of the lesion in this patient?

      Your Answer:

      Correct Answer: Right posterior parietal cortex

      Explanation:

      A large injury to the non-dominant parietal cortex can make the patient neglect or refuse to acknowledge the presence of paralysis on the contralateral side. This can also involve the perception of the external world. Smaller injuries in this area which involve the precentral gyrus (primary motor cortex) or postcentral gyrus (primary sensory cortex) cause contralateral spastic paralysis or contralateral loss of tactile sensation respectively. A lesion in posterior inferior gyrus of the dominant frontal lobe results in motor aphasia. Involvement of the posterior superior gyrus of the dominant frontal lobe produces sensory aphasia.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 47 - Which nuclei of the posterior grey column of the spinal cord are likely...

    Incorrect

    • Which nuclei of the posterior grey column of the spinal cord are likely affected in a patient who has lost the sensation of pain and temperature?

      Your Answer:

      Correct Answer: Substantia gelatinosa

      Explanation:

      Substantia gelatinosa is one of the nuclei in the posterior grey column along side other posterior grey column nuclei like the nucleus dorsalis, nucleus proprius, and posteromarginal nucleus. These nuclei are a collection of cells in the posterior grey area found in throughout the spinal cord. The substantia gelatinosa receives direct input from the dorsal nerve roots (sensory), especially from thermoreceptors and nociceptors (receptors for temperature and pain).

    • This question is part of the following fields:

      • Anatomy
      • Neurology
      0
      Seconds

  • Question 48 - Which of these structures is most likely to be damaged if a patient...

    Incorrect

    • Which of these structures is most likely to be damaged if a patient loses consciousness days or weeks after an otherwise insignificant head trauma, especially in elderly patients?

      Your Answer:

      Correct Answer: Dural bridging vein

      Explanation:

      A subdural haematoma is a type of hematoma, usually associated with traumatic brain injury, in which blood collects between the dura mater and the pia-arachnoid mater. Symptoms of subdural haemorrhage have a slower onset than those of epidural haemorrhages because the lower pressure veins bleed more slowly than arteries. These injuries are more common in elderly patients, especially those taking antiplatelet or anticoagulant drugs. Oedema and increased intracranial pressure are unusual.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 49 - If your EEG shows waves with a frequency range of 8-12 Hz, the...

    Incorrect

    • If your EEG shows waves with a frequency range of 8-12 Hz, the waves most likely to be seen are:

      Your Answer:

      Correct Answer: Alpha

      Explanation:

      Electroencephalography (EEG) is the neurophysiological measurement of the electrical activity of the brain. It is done by placing electrodes on the scalp or subdurally. In reality, the electrical currents are not measured, but rather the voltage differences between different parts of the brain. Four major types of EEG activity are recognized, which are alpha, beta, delta and theta.

      Alpha waves, also known as Berger’s waves ranges in frequency from 8-12 Hz. Best detected with eyes closed, alpha waves are characteristic of a relaxed, alert state of consciousness. An alpha-like normal variant called mu is sometimes seen over the motor cortex (central scalp) and attenuates with movement or, rather, with the intention to move.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 50 - A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for...

    Incorrect

    • A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for the last 5 days. A CT scan reveals an oedematous mass with ring enhancement in the left temporal region. It is biopsied, revealing glial cells, necrosis, neutrophils and lymphocytes. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Cerebral abscess

      Explanation:

      A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. It is most frequent in the third decade of life, and when it occurs in children, it is usually associated with congenital heart disease.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Neurology (3/6) 50%
Physiology (2/3) 67%
Anatomy (1/1) 100%
Pathology (0/2) 0%
Passmed
Retry this test Dashboard