Block 5 Neuro Reglodi Case Reviews W Expl

25 Questions | Total Attempts: 225

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Block 5 Neuro Reglodi Case Reviews W Expl

Questions and Answers
  • 1. 
    • A. 

      Diagnosis: acute disseminating encephalomyelitis, resulting from the viral infection she had. This spread to orbital infection manifesting in blurry vision.

    • B. 

      Diagnosis: Viral meningitis, leading to severe neck pain when looking downwards (nuchal rigidity), inhibiting her from seeing the play from the upper row. Later meningeal plaques led to the involvement of the optic nerve around the sellar region.

    • C. 

      Multiple system degeneration, a neurodegenerative disease affecting long tracts along ventricles. The first attack was due to the optic radiation involvement along the border of the lateral ventricle. The viral infection she had before triggered the autoimmune disease. The second attack was due to the degenerating optic nerve on one side.

    • D. 

      Diagnosis: carotid aneurism. The first attack was caused by the forced position of the head to see the play and so the aneurism was pushed against the optic chiasm from the side. The second attack was caused by slow further growth of the aneurism, compressing the optic nerve.

    • E. 

      Diagnosis: multiple sclerosis. The first attack affected her optic radiation in the occipital lobe, resulting in inferior sectoranopia (not seeing well from the upper rows of the theater). Second attack affected her optic nerve, which is a very common symptom of this disease.

  • 2. 
    • A. 

      Inferior vestibular nucleus

    • B. 

      Ventral cochlear nucleus

    • C. 

      Superior olivary nucleus

    • D. 

      Inferior colliculus

    • E. 

      Lateral geniculate nucleus

  • 3. 
    • A. 

      A sebum plug was swollen due to repeated water exposure, leading to a conductive hearing loss

    • B. 

      Using Weber`s test, he could hear the sound better on his right side

    • C. 

      Using Rinne`s test, he could hear the sound better when the fork was moved to his ear.

    • D. 

      Middle ear infection is the most probable cause, resulting in sensorineural hearing loss

    • E. 

      Applying the Epley`s maneuver, his condition got better

  • 4. 
    Which statement is true for visual transmission?
    • A. 

      Rod bipolar cells transmit information when light is on

    • B. 

      On bipolar cells are hyperpolarized when light is on in the center of the receptive field

    • C. 

      Off ganglion cells are depolarized when on bipolar cells are depolarized

    • D. 

      On ganglion cells increase their firing rate when their on bipolar cells are depolarized

    • E. 

      Depolarization of a cone in the periphery of the receptive field leads to hyperpolarization of the on bipolar cell in the periphery

  • 5. 
    • A. 

      The chemotherapy damaged the vestibulocochlear nerve on both sides.

    • B. 

      Cisplatin led to toxic damage of the outer hair cells.

    • C. 

      Due to chemotherapy, one of the metastatic sites at the internal acoustic meatus got edemic, compressing the cochlear nerves.

    • D. 

      Chemotherapy made the patient more susceptible to infections, and he had a severe middle ear infection, leading to hearing loss.

    • E. 

      Metastatic spot in the rhomboid fossa in the vestibular area compressed one of the cochlear nuclei.

  • 6. 
    What is true for adaptation when you enter from sunlight into a dark room?
    • A. 

      Retinal pigment is bleached and it needs time to recover

    • B. 

      Sensitivity is very high and it will decrease only after a few minutes

    • C. 

      Vision has to switch from scotopic to photopic vision

    • D. 

      Rods are not active in sunlight and they need some time to be reactivated

    • E. 

      11-­‐cis retinal has to be reconverted into all trans retinal to be able to sense light in a dark room

  • 7. 
    • A. 

      Frontal lobe tumor involving the cortical eye field

    • B. 

      Parietal lobe tumor leading to visual agnosia

    • C. 

      Craniopharyngioma

    • D. 

      Temporal lobe tumor with the involvement of the Meyer`s loop

    • E. 

      Occipital lobe tumor around the calcarine sulcus

  • 8. 
    Which statement is true for color blindness?
    • A. 

      The most common form affects the rods

    • B. 

      Blue color blindness is more common in men, because blue pigment gene is coded on the X chromosome

    • C. 

      Red-­‐green color blindness is more common in men, because these genes are coded on the X chromosome

    • D. 

      Achromatopsia is the most common form of color blindness

    • E. 

      Lack of red or green pigment alone leads only to mild color blindness

  • 9. 
    • A. 

      Occipital lobe tumor, with macular sparing. Because his high acuity vision was intact, he did not notice the visual problem.

    • B. 

      Prostate cancer spreading in the brain and giving metastasis in different parts, explaining the variety of symptoms. The visual pathway was not affected.

    • C. 

      Craniopharyngioma combined with ocular albinism. In ocular albinism, the nasal retinal fibers do not cross, that is why he did not have any visual deficits.

    • D. 

      Pituitary tumor (causing acromegaly) growing downwards toward the sphenoid sinus instead of upwards, therefore not causing visual deficits.

    • E. 

      Hypophyseal sclerosis due to the early head trauma. In this case, the hypophysis is shrinking instead of growing, so no visual deficit is caused.

  • 10. 
    • A. 

      Retinal detachment

    • B. 

      Optic neuritis

    • C. 

      Cataract

    • D. 

      Glaucoma

    • E. 

      Retinal hemorrhage

  • 11. 
    • A. 

      ROP

    • B. 

      Retinitis pigmentosa

    • C. 

      Macular degeneration

    • D. 

      Oculocutaneous albinism

    • E. 

      Papilla edema

  • 12. 
    • A. 

      Bitemporal hemianopia

    • B. 

      Inferior quadrantanopia

    • C. 

      Superior quadrantanopia

    • D. 

      Homonymous hemianopia

    • E. 

      Nasal hemianopia

  • 13. 
    • A. 

      Craniopharyngioma

    • B. 

      Medulloblastoma

    • C. 

      Meningioma

    • D. 

      Retinoblastoma

    • E. 

      ROP

  • 14. 
    • A. 

      Pituitary tumor

    • B. 

      Temporal lobe epilepsy

    • C. 

      Occipital lobe stroke

    • D. 

      Acoustic neurinoma

    • E. 

      Periventricular leukomalacia

  • 15. 
    • A. 

      Left Homonymous hemianopia

    • B. 

      Bitemporal hemianopia

    • C. 

      Left upper quadrantanopia

    • D. 

      Lower right quadrantanopia

    • E. 

      Right upper quadrantanopia

  • 16. 
    • A. 

      It is indeed unnecessary because temporal lobe surgery cannot cause visual problems, only occipital lobe surgery can.

    • B. 

      Tractography would be indeed unnecessary because they have to remove the whole sclerotic lesion anyway, independent from the fibers of the optic tract passing through, leading to inferior quadrantanopia after surgery.

    • C. 

      This examination is unnecessary because the optic tract runs at approximately the same position in everyone and conventional MRI can reveal subtle individual differences.

    • D. 

      It is an additional technique to reveal the exact position of the optic tract fibers and combined with electrophysiological examination to determine the focus of epilepsy, they can indeed minimize the risk of visual deficit, which would be contralateral superior quadrantanopia

    • E. 

      Tractography visualizes the long tracts and so the optic tract is visible. Thus, it is suitable for determining the extent of the surgical intervention to avoid lesion of the Meyer`s loop, which would result in contralateral inferior sectoranopia.

  • 17. 
    The following case report was published in Neurol. Med. Chir. 2010 (Tokyo) Solitary metastatic tumor within the optic chiasm –case report
    • A. 

      Nasal hemianopia

    • B. 

      Bitemporal hemianopia

    • C. 

      Contralateral homonymous quadrantanopia

    • D. 

      Contralateral homonymous hemianopia

    • E. 

      Ipsilateral nasal sectoranopia

  • 18. 
    Which statement is true for photoreceptors in darkness?
    • A. 

      Sodium channels are closed

    • B. 

      CGMP levels are high

    • C. 

      Phosphodiesterase is activated

    • D. 

      Transducin is activated

    • E. 

      Retinal detaches from opsin

  • 19. 
    • A. 

      CN VI

    • B. 

      CN III

    • C. 

      CN V/1

    • D. 

      CN VII

    • E. 

      CN IV

  • 20. 
    • A. 

      Increased diplopia and asymmetry when looking to the right

    • B. 

      Right eye does not adduct when looking to the left

    • C. 

      Left eye does not abduct when looking to the left

    • D. 

      Right eye abduction is impaired

    • E. 

      Right eye is positioned down and out

  • 21. 
    • A. 

      Argyll Robertson syndrome

    • B. 

      Parinaud syndrome

    • C. 

      Internuclear ophthalmoplegia

    • D. 

      Horner syndrome

    • E. 

      One-­‐and-­‐a-­‐half syndrome

  • 22. 
    • A. 

      Abducent nucleus

    • B. 

      Trochlear nucleus

    • C. 

      Pontine reticular formation

    • D. 

      Oculomotor nucleus

    • E. 

      Medial longitudinal fascicle

  • 23. 
    • A. 

      Left trochlear nerve palsy with Marcus Gunn pupil

    • B. 

      Left oculomotor nerve palsy with Horner syndrome

    • C. 

      Left abducent nerve palsy with Argyll Robertson pupil

    • D. 

      Left abducent nerve palsy with Marcus Gunn pupil

    • E. 

      Left MLF lesion with midriasis

  • 24. 
    A 52-year-old man struck his occiput. A few hours later, he became aware of vertical diplopia. Brain CT disclosed no intracranial hemorrhage; however, MRI demonstrated a lesion.
    • A. 

      CN VI

    • B. 

      CN III

    • C. 

      CN IV

    • D. 

      MLF

    • E. 

      PPRF

  • 25. 
    • A. 

      Increased intracranial pressure and vertical gaze palsy

    • B. 

      Optic neuritis and CN VI lesion

    • C. 

      Optic neuritis and CN IV lesion

    • D. 

      Compression of the central retinal artery and Parinaud syndrome

    • E. 

      Macular degeneration and horizontal gaze palsy