NEUROLOGY YR2012 1st LE BATCH 2015 1. The course, Neurology 1, aims to accomplish all of the following EXCEPT: A.

Bridge the gap between neuroanatomy and neurologic diseases B. Teach neuro exam C. Teach the basic principles of localization D. Teach the major categories of neurologic disease 2. The basic steps in arriving at a neurologic diagnosis includes all of the following, EXCEPT: A. Data gathering B. Anatomic localization C. Etiologic diagnosis D. None of the above Answer: D (None of the above) Remember that you are arriving at a neurologic diagnosis, this is not anatomic localization. So it should end at the etiologic diagnosis. 3. Data gathering involves all of the following, EXCEPT: A. Anatomic localization B. History taking C. General physical exam D. Neurologic exam 4. The strategy adopted by the Department of Clinical Neurosciences in teaching the course, Neurology 1 is: A. Teach localization on a regional basis B. Teach localization from data gathered from the neuro exam C. Correlate signs and symptoms with the pathology of disease D. None of the above 5. Anatomic localization involves: A. Listing all abnormal neurologic signs B. …. C. Finding the intersection D. All of the above 6. All of the following are benefits of localization, EXCEPT: A. Establishes the etiologic diagnosis B. Direct diagnostic work-up C. Estimates the size of the lesion D. Limits the differential diagnosis 7. Finding the intersection establishes the: A. Anatomic Diagnosis B. ….. C. Both D. Neither 8. Infratentorial means: A. The lesion is in the brainstem B. C. The lesion is lower motor neuron in type D. Lesion is below the neck

9. In a patient presenting with acute hemiparesis, the finding of aphasia indicates that the lesion is in the: A. Internal Capsule B. Cortex C. Subcortical white matter D. Cerebral peduncle 10. In paralysis of the face, arm and leg on the same side the intersection includes all of the following, EXCEPT: A. Cerebral Cortex B. Subcortical white matter C. Internal capsule D. Midbrain E. Lower pons 11. If the lesion causing weakness of the arm and leg on the same side is in the pons (esp. lower pons), one would expect: A. A peripheral type of facial paralysis opposite the above hemiparesis B. ….. C. A peripheral type of facial paralysis on the same side of the weakness of the arm and leg D. A central type of paralysis on the same side of the weakness of the arm and leg 12. The cause for the facial paralysis in the above case is involvement of the: A. undecussated corticobulbar tract B. Facial nucleus C. Facial nerve D. Corticospinal tract 13. Mononuclear blindness is due to a lesion in the: A. Optic Chiasm B. Optic tract C. Lateral geniculate body D. Optic Nerve E. Optic radiations 14. Homonymous hemianopia is caused by a lesion in any of the following EXCEPT: A. Lateral geniculate body B. Meyer’s loop C. Entire breadth of optic radiations D. Optic tract E. Occipital cortex 15. If the lesion causing the hemianopia is associated with a hemiparesis, the lesion is most likely: A. In occipital cortex B. Optic Tract C. Temporal lobe D. Anterior Parietal lobe 16. A major difference of the corticospinal tract from the corticobulbar tract is: A. It carries only motor fibers B. Lesion in it would cause an upper motor neuron type of paralysis C. It decussates just before it supplies the target anterior horn cells D. The decussation is at a fixed point whether it would be intended for the arms or the legs

17. A patient who is numb on one side and weak on the opposite side has a lesion in the: A. Spinal Cord B. Brainstem C. Cerebral hemispheres D. Peripheral nerve E. Cerebellum 18. In addition to the above, further testing would reveal loss of joint position sense: A. Opposite the lesion B. On the same side at the loss of pain & temperature C. On the same side as the hemiparesis D. None of the above 19. A 33 year old female presented with paraparesis. The resident orders lumbosacral spine x-ray, finds nothing and sends the patient home. 2 weeks later, the paraparesis has worsened. The neurologist consulted found a sharp sensory level at the level of the umbilicus. Thoracic spine film revealed Pott’s disease involving thoracic spine. Failure to localize correctly failed to take advantage of which of the following benefits of anatomic localization? A. Directs diagnostic work-up B. Estimate the extent of the lesion C. Limits differential diagnosis D. Guards against going straight to an etiologic diagnosis 20. All of the following are supratentorial structures, EXCEPT: A. Cerebral Hemisphere B. Basal ganglia C. Thalamus D. Midbrain 21. A fairly large lesion in the temporal lobe will most likely produce: A. Homonymous Hemianopsia B. Superior quadrantanopia C. ….. D. Bitemporal Hemianopsia E. No visual field defect 22. The above is most likely due to the involvement of the: A. Optic tract B. Meyer’s loop C. ….. D. Lateral geniculate body 23. A 55 year old doctor noted that he developed facial asymmetry while on duty. His BP was 180/100. On exam, the right eyebrow does not elevate well, the right eyes does not close completely and the left angle of the mouth is pulled to the left on showing teeth but the right angle of the mouth fails to move. There are no other neurologic deficits. Most likely site of the lesion is: A. Extra-axial (specifically right extra-axial) B. Intra-axial C. Pons left D. Pons, right E. Intermedullary

24. The finding of aphasia in a patient suspected to have a lesion in the internal capsule because of hemiparesis: A. Confirms the localization B. Puts the lesion in the cerebral cortex C. Indicates the presence of 2 lesions D. Implies that the lesion is smaller than previously expected 25. If the cause of the hemiparesis of the face, arm, and leg were a midbrain lesion, one would expect: A. An associated CN III palsy opposite the hemiparesis B. An associated CN III palsy on the same side of the hemiparesis C. An associated CN 3 palsy opposite the location of the lesion D. Facial paralysis opposite the arm and leg paresis **it cannot be on the same side because the lesion in the midbrain will hit the undeccusated CST If it is undecussated, you will always produce a hemiparesis on the opposite side of the lesion. 26. A 50 y/o right handed male was brought to the ER because of inability to express himself. His brain imaging showed a suspicious problem in BA 44 and 45, this is in his: A. Left Frontal B. Left temporal C. Left parietal D. Left occipital 27. The involved gyrus/gyri in the above case is/are: A. Superior Gyrus B. Middle gyrus C. Inferior gyrus D. Entire lobe 28. An eighth-month old boy was brought to the OPD because of irritability and increased sleeping time on fundoscopy there is bilateral papilledema . . . A. The anterior fontanelle closed prematurely (closes in 18mos) B. The posterior fontanelle closed prematurely C. Both closed prematurely D. Nothing is abnormal 29. In the above case, the ultrasound focused on the: A. Bregma B. Lambda C. Longitudinal fissure D. 30. An 18y.o female came to the neurology clinic because of frequent headaches. Brain CT scan showed that the cerebral hemispheres are not symmetrical, the radiologist made reference to the: A. Central Sulcus of Rolando B. Lateral Sylvian fissure C. Longitudinal fissure D. Parietooccipital sulcus 31. A. Frontal B. Parietal C. ….. D. Occipital

32. A bus driver had a vehicular accident in EDSA, when interviewed by the MMDA he keeps on talking without sense and cannot follow simple instructions, he has a problem with: A. Left frontal B. Left parietal C. Left temporal D. Left occipital 33. The lesion in the case above is adjacent to the: A. Primary Visual Cortex B. Primary Auditory Cortex C. primary motor cortex D. Primary sensory cortex 34. The primary sensory cortex is where: A. The Corticospinal tract will originate B. The CST will terminate C. The STT will originate D. The STT will terminate 35. The primary motor cortex is where: A. The Corticospinal tract will originate B. The CST will terminate C. The STT will originate D. The STT will terminate 36. Lesions of the supramarginal and angular gyrus results in Gerstmann’s syndrome located in the: A. Inferior Frontal B. Posterior parietal C. Inferior temporal D. Posterior Occipital 37. The areas surrounding the calcarine and parietooccipital sulcus is the: A. Primary Auditory Cortex B. Primary Visual Cortex C. Primary motor cortex D. Primary sensory cortex 38. The CST decussates at the level of the: A. Primary Sensory Cortex B. Thalamic projections C. Spinal cord (2-3segments below) D. Medulla 39. Which cerebellar peduncle connects the midbrain with the cerebellum? A. Restiform Body B. Brachium pontis C. Brachium Conjunctivum D. Inferior Cerebellar peduncle

40. The spinal cord has enlargements that correspond to the segments involved in supplying nerves to the upper and lower extremities namely: A. Cervical and Thoracic B. Cervical & lumbar C. Cervical and sacral D. Thoracic and lumbar 41. The arterial trunk coarses at the …. sylvian fissure to supply the cerebral convexities A. Anterior Cerebral Artery B. Middle cerebral artery C. Internal Carotid Artery D. Posterior cerebral artery (PCA) 42. 37y/o female complains of unilateral anosmia, she fell from the stairs and hit her face. You ordered an X-ray to view the: A. Maxillary bone B. Sella Turcica C. Cribriform plate D. Parietal bone 43. The vertebral artery enters the posterior cranial fossa through the: A. Transverse foramen of C6 B. Foramen lacerum C. Medulla D. Foramen magnum 44. Which of the following cranial nerve is not found in the PONS? A. Oculomotor B. Trigeminal C. Facial D. Abducens MATCHING TYPE: Structure D. 45. Pons E. 46. Spinal Cord A. 47. Corpus Callosum E. 48. Lateral Medulla (PICA from vertebral) B. 49. Brocas area C. 50. Occipital area

Blood Supply A. ACA B. MCA C. PCA D. Basilar E. Vertebral

51. Which of the following is/are predominantly left cerebral hemispheric functions? A. Analytical Thinking B. Language C. Number skills D. All of the above 52. Which of the following is/are predominantly right hemispheric function? A. Music and art awareness B. Intuitive thinking (gut-feel) C. Left handedness D. All of the above

53. Which of the following is/are required before a speech disturbance can be qualified as aphasia? A. Patient must have simple motor and sensory deficits B. Patient’s perceptual & intellectual functions must be impaired C. Patient must have the difficulty in comprehension, repeating or producing meaningful speech D. All of the above 54. Important aspects of the Mental Status Examination that can be gathered from history taking and interview: A. Range, stability, quality and appropriateness of affect B. Thought process & content C. Perception D. All of the above 55. On Mental Status Examination, a person with purely psychiatric disturbance, like schizophrenia is most likely to show disturbance in: A. Thought process B. Thought content C. Insight D. All of the above 56. When a patient has a lesion in or around the left superior temporal gyrus, his speech may show which of the following: A. Anomia B. Paraphasia & neologism C. Recurring utterance or verbal stereotypy D. All of the above 57. Examiner “you went for a walk, how did you like it?” patient: “the grass is groan, the grass is greel” may be indicative of: A. Receptive Dysphasia B. Expressive dysphasia C. Conductive aphasia (repetition problem) D. All of the above **The patient is substituting words. Patient has no problem with understanding and expressing. 58. Patient with dysphasia with a lesion purely confined to the frontal lobe may likely manifest: A. Contralateral Hemiparesis B. Astereognosis C. Constructional aphasia D. All of the above 59. Important aspects of the Mental Status Exam that can be gathered from history taking and interview: A. Range, Stability, Quality and Appropriateness of affect B. Thought process & content C. Perception D. All of the above 60. Patient with left frontal brain tumor manifesting as cognitive decline for the past 6 months came in for an admission in the neurology ward, patient is subjected to different tests to determine what part of the brain is affected by the tumor. Which of the ff test may be utilized to test executive functioning A. Clock Drawing test B. Trail making A & B sets C. …. D. All of the above

61. Asking the patient to count backwards from 100-50, naming the days of the week or months of the year in a reverse order will test the patient’s: A. Registration of information B. Retrieval of stored information C. Attention and concentration (immediate recall) D. All of the above 62. A 38y/o male who is known a drug addict suffered a stroke and was asked to subtract 7 from 100 down the line as part of the cycle Folsteins’s MMSE. This is his response: 93, 86, 80, 73, 66 A. 4 B. 3 C. 2 D. 1 63. 65 y/o hypertensive male suffered a stroke causing a lesion from left precentral gyri to the posterior parietal area, which of the following will likely to be noted in a neurological examination? (Malabo po ung recording eh) A. Nonfluent dysphasia, Right Hemiparesis with greater affection of the right lower half of the face and upper extremity B. Right astereognosis & anosognosia, Right spastic hemiparesis with Right central facial paresis C. Spastic right hemiparesis … finger agnosia, and right-left disorientation (in the said condition, you will most likely get a gerstmann syndrome, conditions should include both left and right disorientation due the extent of damage) D. Spastic right hemiparesis with global cognitive impairment 64. Loss of ability to carry out learned complex task in proper order such as putting on socks or clothes A. Ideatiomotor apraxia B. Anosognosia C. Limb incoordination D. All of the above

65. This is the drawing of a patient with brain tumor. What will be your interpretation? A. Normal praxis B. Probable sparing of the posterior parietal lobe C. Absence of sensory extinction D. All of the above 66. This is a clock drawn by a particular patient… He is asked to draw a clock, with the time ten minutes past two. Which of the ff may be deduced:

11 12 1 10 9 8 7 A. B. C. D. 6 5 2 3 4

Executive function may be impaired His score for this particular test is ¼- impaired  right score is 2/4 He probably cannot read time All of the above

67. A nursing student was suffering from… on the right side was asked to copy a triangle, a pentagon and a square. What can be induced from his drawing?

A. B. C. D.

Probable sensory neglect Constructional Apraxis he has no constructional apraxia bec. he can draw the other half Visual Agnosia All of the above

68. A ten year old epileptic was asked to demonstrate: Blow me a kiss, comb your hair, whistle a tune. He was unable to do anything. In the absence of paralysis, the patient is most likely manifesting: A. Auditory agnosia (inability to identify sounds) B. Idiomotor apraxia (inability to demonstrate learned actions in the absence of paralysis) C. Perceptive dysphasia (inability to understand language) 69. A 15-year old… has progressive lapse of memory, inability to make decisions and planning things.. and increasing social withdrawal.. is most likely to exhibit: A. (+) snout, rooting reflex B. (+) palmomental reflex C. (+) Grasp reflex D. all of the above *Bifrontal lobe disorders; all are primitive reflexes seen in bifrontal lobe disease 70. Which of the following is/are manifestations of a cortical motor strip lesion? A. Contralateral spastic hemiparesis B. Extensor toe response on superficial plantar stimulation C. (+) Hoffman’s sign (like a Babinski of arm) D. All of the above (UMN lesions) 71. Lesions in the temporal lobe may manifest as: A. cortical deafness B. lapses of memory, emotion, and behavior C. Wernicke’s dysphasia if dominant hemisphere is involved D. All of the above 72. Lesions affecting the parietal lobe may result in: A. Inability to carry out a commanded task despite retention of motor and sensory function B. loss of recognition of familiar objects despite retention of motor and sensory function (anosognosia) C. inability to calculate with a dominant hemispheric lesion (acalculia) D. all of the above 73. A 77-year old hypertensive… bilateral loss of vision.. You were told by the resident that the blindness is cortical in origin (sorry guys I really cant understand the voice recording!) Which of the following will you see upon examination: A. Bilaterally dilated pupil B. (-) consensual reflex C. (-) direct light reflex D. (+) direct and consensual light reflex * Pathway for pupillary light reflex are all pre-chiasmatic; visual pathway is damaged but pathway for pupillary light reflex is not affected

74. A left-handed individual with a right-sided parietal mass. You may expect the following with your neurological exam: A. Agraphia B. FInger agnosia C. Right & left disorientation D. All of the above *agraphia, finger agnosia, R & L disorientation = Gertzmann syndrome 75. You asked a patient with eyes closed to identify objects. You placed/ let the patient touch 3 objects on his left hand. He wasn’t able to identify any of the three. You then tried tracing numbers on his left palm, again he wasn’t able to identify. Same tests done on the right hand, but now all were properly executed. The patient most likely: A. Has lesion in parietal lobe B. The patient can’t read or write C. On further examinations he might show evidences of dyslexia * Dyslexia is inability to read due to a lesion in posterior parietal supramarginal and angular gyrus on the dominant side. The patient has cortical sensory abnormalities referable to right domi nant lobe, and so it can’t be dyslexia because it affects the non-dominant lobe. 76. The following statements is/are true of the olfactory nerve except: A. Oldest sensory nerve B. Detects odor as its function C. influence social & sexual behaviour D. mostly myelinated axons E. all are true *Most are unmyelinated 77. The olfactory bulb is located in the: A. Inferobasal frontal lobe 78. The following statements are true of the olfactory receptors: A. Located in upper third of nasal cavity C. Olfactory receptors are all bipolar neurons D. No exemptions

79. The olfactory nerve pass through which structure: cribriform plate 80. The primary olfactory complex is in the: A. Prepiriform cortex B. Uncus 82. In examining Cranial nerve I, the statement: “we should not use alcohol as test substance” is: A. True B. False 83. The ff statements are true of the optic nerve except: A. Formed by ganglion cells B. Has 4 parts C. Fibers follow topical arrangements in the retina D. No exemptions

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