The 1st semester Examination for 17IC&16MBBS in 2020-2021

DATE:2020/12/25 Time: hours Total marks:

CLASS: 16 秋网络班 ROLL NO:916905048 Name:DIAN SRI
WAHYUNI

1.B 2.E 3.A 4.B 5.E 6.B 7.D 8.E 9.D 10.C
11.A 12.C 13.A 14.D 15.B 16.B 17.C 18.A 19. C 20.B

mark marker checker I Multiple choices question, （There are 20 questions, 2

points for one question）
Directions: Each item below contains a question or
incomplete statement followed by suggested response. Select the one best response to
each question (example)
1、A 61- year-old woman presents with flaccid paralysis, atrophy, fasciculation, and
hyporeflexia.( B )
A、upper motor neuron disease
B、lower motor neuron disease
C、myelopathy
D、motor aphasia
E、 sensory aphasia

2、What is the diagnosis of epilepsy based on（ E ）

A、neurological examination
B、skull X-ray
C、Brain CT or MRI brain
D、cerebrospinal fluid
E、history and EEG
3、Generalized tonic-clonic seizures showed（ A）
A、loss of consciousness, limb rigidity, followed by clonic convulsions
B、brief unconsciousness
C、conscious, limb seizure
D、paroxysmal headache
E、paroxysmal limbs twitch

4 、 A 35-year-old previously healthy woman complains of a severe, excruciating

headache and then has a transient loss of consciousness. There are no focal neurologic
findings. The next step in evaluation would be( B)
A、CT scan
B、MRI
C、carotid angiogram
D、Holter monitor
5、What is stage 5 Parkinson's disease?（ E ）
A、unilateral limb movement
B、bilateral limb movement
C、postural instability
D、akinesia -rigidity
E , Complete ADL( activities of daily living )dependence
6、A 55-year-old diabetic woman suddenly develops weakness of the left side of her
face as well as of her right arm and leg. She also has diplopia on left lateral gaze. The
responsible lesion is probably located in the（ B）
A、right cerebral hemisphere
B、left cerebral hemisphere
C、right side of the brainstem
D、left side of the brainstem
7 、 A 26-year-old heroin addict has been using a street version of artificial heroin, the drug
actually contains 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) .the neurological syndrome
for which he is at risk is clinically indistinguishable from which of following（ D ）
A、Huntington’s disease
B、Friedreich ataxia
C、sydenham's disease
D、Parkinson’s disease
E、amyotrophic lateral sclerosis
8、Which of the following is not a common feature of epilepsy.( E )
A、paroxysmal
B、Transient
C、Repeatable
D、 stereotyped
E 、Periodic
8 、 Which of the following grades of muscle strength best describes a patient with
movement possible against some resistance? （ D）
A、0/5 B、1/5 C、2/5 D、3/5 E、4/5 F、5/5
10、How to select antiepileptic drugs？ （ C ）
A、incentives attack
B、cause seizures
C、seizure type
D、attack frequency
E、EEG abnormalities
11、If this patient were to be expected to L-dopa, which of the following would most likely be
evoked（ A ）
A、 Generalized seizure
B、Partial seizure
C、Intention tremor
D、 Scanning speech
E、 Writhing and jerking movements of the limbs
12、What is the first choice for Status epilepticus？（ C ）
A、chloral hydrate enema
B、intravenous phenytoin
C、intravenous diazepam
D、intramuscular injection of chlorpromazine
E、intramuscular injection of sodium pentobarbital
13、Acute transverse myelitis refers to（ A ）
A、The white matter of spinal cord demyelinating or necrosis caused by acute
across the damage
B、The spinal canal placeholder lesions caused by compression of the spinal
cord
C、spinal cord vascular dysplasia
D 、 Spinal congenital dysplasia, embryonic neural tube closure is not
complete
E、 nervous system degenerative disease Caused by lack of the vitamin B12.
A 61-year-old right-handed man presents with involuntary twitches of
his left hand. He first noticed between 6 months and 1 year ago that when
he is at rest, his left hand shakes. He can stop the shaking by looking at his
hand and concentrating. The shaking does not impair his activities in any
way. He has no trouble holding a glass of water. There is no tremor in his
right hand, and his lower extremities are not affected. He has had no trouble
walking, and there have been no falls. There have been no behavioral
or language changes. On examination, a left hand tremor is evident when
the man is distracted. His handwriting is mildly tremulous. He has bilateral
cogwheel rigidity with contralateral activation, which is worse on the left.
His rapid alternating movements are bradykinetic on the left.
14、The most likely diagnosis in this case is which of the following?（D ）
A、Epilepsy
B、Guillain-Barré syndrome
C、Multiple sclerosis
D、Parkinson’s disease
E、Stroke
15、Which brain structures are currently targets for deep brain stimulation
in patients with this disease?（ B ）
A、Globus pallidus, medulla, and parietal lobe
B、Globus pallidus, subthalamic nucleus, and thalamus
C、Hippocampus, medulla, and thalamus

D、Medulla, occipital lobe, and subthalamic nucleus

E、 Parietal lobe, temporal lobe, and thalamus
16、Which of the following would you use to treat this person?（ B ）
A、Alteplase
B、Carbidopa-levodopa
C、Glatiramer
D、Interferon β-1A
E、Sertraline
17、Neurons remaining in the substantia nigra of the patient with this
disease may exhibit（ C ）
A、Intranuclear inclusion bodies
B、Intranuclear and intracytoplasmic inclusion bodies
C、Intracytoplasmic inclusion bodies
D、Neurofibrillary tangles
E、Amyloid plaques
18 、 A 70-year-old woman presents with poorly articulated phrases but understand
commands.（ A）
A、Conduction aphasia
B、Global aphasia
C、anomic aphasia
D、motor aphasia
E、 sensory aphasia
19 、 A 70-year-old man walks by moving his right leg forward by abducting and
circumduction.（ C）
A、ataxic gait
B、Parkinsonian gait
C、Spastic hemiplegic gait
D、Steppage gait
E、Scissor gait
20 、 A 73-year-old man with a history of hypertension complains of sudden
impairment of vision affecting the right eye. His examination now is normal. The
episodes of visual loss are most likely related to ( B )
A、Retinal vein thrombosis
B、Central retinal artery ischemia
C、Posterior cerebral artery ischemia
D、Middle cerebral artery ischemia
E、Posterior ciliary artery ischemia

mark marker checker Ⅱ. Please explain the medical terminology (for

example: 5 points for each term, total score
20)

Status epilepticus：
Seizure continue for more than 30 minutes without ceasing spontaneoulsly, or which r
ecur so frequently that full consciousness is not restored between successice episodes.
Diazepam of the first choice. 10~20mg iv，3~5mg/min;
Or we can say status epilepticus is The condition resulting either from the failure of
the mechanism responsible for seizure termination or from the initation of
mechanism, which lead to abnormally, prolonged seizures (after time point t1). It is a
condition, which can have long- term consequences (after time point t2), including
neuronal death, neuronal injury, and alteration of neuronal networks, depending on the
type and duration of seizures.

Transient Ischemic Attack：

Is an acute loss of neurological function caused by ischemia with symptoms lasting
minutes – hours (by definition, < 24 hours) , The other definition is acute, focal
neurological deficit with clinical resolution over a period of minutes or up to an hour
and which is whought to be due to inadequate cerebral or ocular blood supply as a
result of arterial thrombosis , low flow or embolism . The characteristic of Transient
ischemic attact ; is 50~70 years old, male , Sudden onset of symptoms and signs of
localized neurological deficits rapidly occurred, A few minutes to a peak, a few
minutes or more than 10 minutes to alleviate, do not leave sequel, Recurrent attacks,
symptoms are similar each time, Often associated with hypertension, diabetes, heart
disease, hyperlipidemia, etc.

Aphasia：
Aphasia is A disorder of speech communication in the cortex of the brain resulting fro
m impairment of speech function when consciousness, pronunciation and articulation 
are normal. In contrast to: peripheral speech problems (dysarthria) , non-linguistic
cognitive impairments, impairments of writing and reading , loss of language due to
psychotic states, congenital or developmental structural abnormalities , and problems
of language acquisition

Parkinson's Mask:
Is loss of facial expressions associated with parkinson’s disease, the condition gives
the affected person a fixed , mask-like expression. The parkinson’s mask also make
The loss of some of the control of the face and head muscles creates a stare-like featur
e that is referred to as the "Parkinson Mask." The eyes don't blink as much; the smile, 
if there is one, appears forced or is of a short duration. The stiff neck and shoulders re
mind us of Frankenstein. There may be uncontrolled movements that vary from exces
sive to a Zombie-like absence. The hunched back is a reminder ofthe bell ringer from 
Notre Dame. There can be a funny gait, drooling, an unkempt appearance, and - heave
n forbid - a body odor! This all adds up to an approachability that is uncomfortable, if 
not repelling.
 mar marker checker Ⅲ.Answer question ( 10 points for each question, total
k score 40)

1、 How to treat myasthenia gravis?

 AChE drugs provides symptomatic benefit without influencing the course of

the underlying disease.
 pyridostigmine, at doses individually determined but usually between 60 and
180 mg q.q.d.
 Small doses of atropine may attenuate side effects such as diarrhea.
 thymectomy should be performed in patients under 60 years of age.
 usually leads to symptomatic benefit or remission
 However, its beneficial effect may not be evident immediately.
 Treatments are initiated with the patient in hospital, since weakness may
initially be exacerbated.
 An initial high dose of predinisone (60-80mg/d orally) can gradually be
tapered to a relatively low maintenance level (10-20 mg/d) as improvement
occurs.
 It can also be given in place of corticosteroids to patients who show no
sustained benefit with low doses.
 The usual dose is 1-3 mg/kg/d, increased from a lower initial dose.
 plasmapheresis (PE) may be used during an acute exacerbation, myasthenic
crisis, or under certain special circumstances, e.g. prior to surgery.
 intravenous immunoglobulins (IVIG) have been used to provide temporary
benefit in circumstances similar to those in which PE is used.
 Crisis: respiratory and bulbar complications require appropriate supportive
measures, e.g. assisted ventilation and/or nasogastric feeding.
 PE and IVIG are needed.

2、 Please tell the indication and the contraindication of lumber puncture.

- Indications of lumbar puncture :

●Diagnosis of central nervous system (CNS) infection
●Diagnosis of subarachnoid hemorrhage (SAH)
●Evaluation diagnosis of demylinating or inflammatory CNS processes
●Infusion of anesthetic, chemotherapy, contrast agents into the spinal canal

 Contraindications of lumbar puncture :

•Suspected intracranial mass lesion
•Local infection
•Coagulopathy
• Suspected spinal cord mass lesion
•Open craniocerebral injury etc.
3、What are the risk factors of stroke？
-Fixed
 Age
 Gender (male>female)
 Race (Asian>european)
 Heredity
 Previous Vascular
Event.eg:MI, Peripheral embolism
 High fibrinogen
-Modifable
 High blood pressure
 Heart disease (atrial fibrillation, heart failure, endocarditis)
 Diabetes mellitus
 Hyperlipidemia
 Smoking
 Excess alcohol consumption
 Oral contraceptives
 Social deprivation
 Obesity, sedentary lifestyle
4、What are the 4 Cardinal signs of Parkinson's disease?
 tremor
 hypokinesia
 rigidity
 abnormal gait and posture

●Tremor
 ➢4-6Hz like pill-rolling
 ➢Most Conspicuous at rest----static tremor
 ➢Increase at times of emotional stress
 ➢Improve during voluntary activity
 ➢Begins in the hand or foot
 ➢The face and mouth involved as well
 ➢Ultimately be present in all of the limbs
 Rigidity
Characteristic clinical feature :
 Stiffness of the limbs---lead-pipe rigidity
 Combined with tremor, there is jerky element, which is termed as cogwheel
rigidity
 hypokinesia
 Slowness of voluntary movement
 Reduction in automatic movement：swinging arms Reduction
 Masklike face
 Voice of low volume and tends to be poorly modulated
 Impaired rapidly alternating movement, but power is normal
 Handwriting is small tremulous, and hard to read(micrographia)
 Abnormal gait and posture
 The patient generally fings it difficult to get up from bed and tends to adopt a
flexed posture on standing. Its often difficult to start walking. The gait itself is
characterized by small, shuffling steps.
 Generally some unsteadiness on turning, and may be difficult in stopping. In
advanced cases, the patient tends to walk with increasing speed to prevent a
fall because of the altered center of gravity that results from the abnormal
posture.