Neurology Clinical Correlates

1. A person with hydrocephalus suffers from blocked circulation of cerebrospinal fluid. Fortunately, this condition can sometimes be alleviated by the insertion of a shunt.

True

False

Hydrocephalus is a condition characterized by the blockage of cerebrospinal fluid circulation in the brain. This blockage can lead to an accumulation of fluid, causing increased pressure on the brain. Fortunately, one possible treatment for hydrocephalus is the insertion of a shunt. A shunt is a medical device that helps redirect the excess fluid to another part of the body, relieving the pressure on the brain. Therefore, the statement "A person with hydrocephalus suffers from blocked circulation of cerebrospinal fluid. Fortunately, this condition can sometimes be alleviated by the insertion of a shunt" is true.

Explanation

Hydrocephalus is a condition characterized by the blockage of cerebrospinal fluid circulation in the brain. This blockage can lead to an accumulation of fluid, causing increased pressure on the brain. Fortunately, one possible treatment for hydrocephalus is the insertion of a shunt. A shunt is a medical device that helps redirect the excess fluid to another part of the body, relieving the pressure on the brain. Therefore, the statement "A person with hydrocephalus suffers from blocked circulation of cerebrospinal fluid. Fortunately, this condition can sometimes be alleviated by the insertion of a shunt" is true.

2. Which of the following symptoms are most commonly associated with an upper motor neuron lesion?

Hyporeflexia

Hyperreflexia

Adductor spasms

Flu-like symptoms

Upper motor neuron lesions are often associated with hyperreflexia, hypertonicity, paralysis, paresis, hyperstiffness, and abnormal reflexes such as the Babinski reflex.

Explanation

Upper motor neuron lesions are often associated with hyperreflexia, hypertonicity, paralysis, paresis, hyperstiffness, and abnormal reflexes such as the Babinski reflex.

3. Your client's wife is confused about what caused her husband's Alzheimer's and what is happening inside his brain. You tell her that while the cause of Alzheimer's is unknown, you can tell her a little about what neural mechanisms are at work during the course of the disease. Which of the following might you mention?

Neurofibrillary tangles caused by abnormal tau (a protein) in the neurons

Degeneration of dopamine-producing cells in the substantia nigra (part of the basal ganglia)

Neuritic plaques caused by extracellular deposits of amyloid (a fibrous protein) between neurons

Injury to the optic chiasm (the intersection of two hemiretinas)

Both A & C

Answer "B" describes a cause of Parkinson's. Answer "D" describes an injury to the visual system. In addition to options "A" and "C," you might mention decreased ACh in the basal nucleus of the frontal lobe as another neural mechanism involved in Alzheimer's.

Explanation

Answer "B" describes a cause of Parkinson's. Answer "D" describes an injury to the visual system. In addition to options "A" and "C," you might mention decreased ACh in the basal nucleus of the frontal lobe as another neural mechanism involved in Alzheimer's.

4. If a client complained of dark or blurred central vision, what would you first suspect he or she might have?

Bilateral hemianopia

Macular degeneration

A spinal cord injury

Acoustic neuroma

Macular degeneration occurs when the central vision is lost or impaired. Bilateral hemianopia would involve bilateral loss of the peripheral vision field. A spinal cord injury would not necessarily be accompanied by any vision problems. Acoustic neuroma would cause problems with hearing and balance, not vision.

Explanation

Macular degeneration occurs when the central vision is lost or impaired. Bilateral hemianopia would involve bilateral loss of the peripheral vision field. A spinal cord injury would not necessarily be accompanied by any vision problems. Acoustic neuroma would cause problems with hearing and balance, not vision.

5. One of your clients, an eight-year old boy, has Duchenne's Muscular Dystrophy (DMD). Which of the following symptoms would he be most likely to demonstrate?

Enlarged calf muscles

Ptosis

Gower's sign

Pounding headache

Both A & C

DMD causes Gower's sign (occurring when a patient must use his or her arms and hands to "walk" up from a squatting position due to lack of lower extremity strength) as well as enlarged calf muscles (due to fatty deposits, not larger muscles). A pounding headache would be a symptom of autonomic dysreflexia. Ptosis, or drooping eyelids, would not be caused by DMD.

Explanation

DMD causes Gower's sign (occurring when a patient must use his or her arms and hands to "walk" up from a squatting position due to lack of lower extremity strength) as well as enlarged calf muscles (due to fatty deposits, not larger muscles). A pounding headache would be a symptom of autonomic dysreflexia. Ptosis, or drooping eyelids, would not be caused by DMD.

6. You meet a new client and learn that she has cerebral palsy. Before you even read her chart, you know that she will either have occulta, meningocele, or myelomeningocele.

True

False

Occulta, meningocele, and myelomeningocele are the three kinds of spina bifida (listed here from mildest to most severe). Different kinds of cerebral palsy include spastic diplegia, hemiplegia, and complex/spastic tetraplegia.

Explanation

Occulta, meningocele, and myelomeningocele are the three kinds of spina bifida (listed here from mildest to most severe). Different kinds of cerebral palsy include spastic diplegia, hemiplegia, and complex/spastic tetraplegia.

7. Spinal polio attacks which of the following neuroanatomical structures?

Basal ganglia

Upper motor neuron bodies

Brachial plexus

Lower motor neuron bodies

While bulbar polio attacks the central nervous system cell bodies, spinal polio attacks the lower motor neuron bodies. The basal ganglia and brachial plexus are not generally involved in polio.

Explanation

While bulbar polio attacks the central nervous system cell bodies, spinal polio attacks the lower motor neuron bodies. The basal ganglia and brachial plexus are not generally involved in polio.

8. You are looking at the autopsied brain of a person who suffered from Alzheimer's Disease. Which of the following structural changes would best confirm his or her diagnosis?

Cortical atrophy

Lack of a blood-brain barrier

Enlarged ventricles

Degeneration of the hippocampus

A, C, & D

In addition to the structural changes listed above, Alzheimer's can also cause degeneration of the amygdala, basal nucleus of the frontal lobe, locus cereleus and raphe nucleus.

Explanation

In addition to the structural changes listed above, Alzheimer's can also cause degeneration of the amygdala, basal nucleus of the frontal lobe, locus cereleus and raphe nucleus.

9. After a car accident, one of your clients has Brown-Sequard syndrome, which means that he has suffered a hemisection of his spinal cord. What would you expect to see in terms of his somatosensory functioning?

Contralateral loss of pain and temperature sensation

Ipsilateral paralysis

Ipsilateral loss of proprioception and discriminative touch

All of the above

Because the STT tract decussates at the level of the spinal cord and the DCML tract decussates in the medulla, the loss of pain and temperature (STT) will be felt contralaterally, while the loss of proprioception and discriminative touch will be felt ipsilaterally. In addition, paralysis will occur ipsilaterally in every spinal cord injury.

Explanation

Because the STT tract decussates at the level of the spinal cord and the DCML tract decussates in the medulla, the loss of pain and temperature (STT) will be felt contralaterally, while the loss of proprioception and discriminative touch will be felt ipsilaterally. In addition, paralysis will occur ipsilaterally in every spinal cord injury.

10. What is the etiology of Multiple Sclerosis?

Birth injury

Autoimmune

Virus

Amnesia

Unknown

Multiple Sclerosis is an autoimmune disorder causing demyelination of the oligodendrocytes in the central nervous system.

Explanation

Multiple Sclerosis is an autoimmune disorder causing demyelination of the oligodendrocytes in the central nervous system.

11. Your client complains that although she has no visual impairments, she is unable to recognize familiar faces. You conclude that she must have alexia, a type of agnosia.

True

False

You would conclude that your client had prosopagnosia, a type of agnosia that involves the inability to recognize familiar faces. Alexia, another type of agnosia, is the inability to comprehend written language. (Agnosia is a general term for the inability to recognize or make sense of incoming information despite intact sensory abilities.)

Explanation

You would conclude that your client had prosopagnosia, a type of agnosia that involves the inability to recognize familiar faces. Alexia, another type of agnosia, is the inability to comprehend written language. (Agnosia is a general term for the inability to recognize or make sense of incoming information despite intact sensory abilities.)

12. You just met a client who herniated a disk after moving heavy boxes at work. What can you tell him about his prognosis?

He should expect ipsilateral paralysis and contralateral somatosensory loss

He will need surgery, but luckily herniated disks usually resolve within six weeks post-surgery

He should expect bilateral paralysis and ipsilateral somatosensory loss

There will likely be no need for surgery. The injury usually resolves itself within six weeks

A herniated disk occurs when there is compression of a spinal disk on to the nerve root. Symptoms can include pain, numbness, and weakness. Generally, symptoms resolve without surgical intervention within six weeks.

Explanation

A herniated disk occurs when there is compression of a spinal disk on to the nerve root. Symptoms can include pain, numbness, and weakness. Generally, symptoms resolve without surgical intervention within six weeks.

13. You ask your client to use a carrot scraper to peel a carrot. Instead, she appears to try to cut the carrot scraper with the carrot. What diagnosis might you suspect she has?

Ideomotor limb apraxia

Conceptual limb apraxia

Ideational limb apraxia

Dressing apraxia

Apraxia is defined as the inability to perform purposeful movement (in the absence of paralyis or paresis). It is most often caused by damage to the left hemisphere. In ideomotor limb apraxia, the patient is unable to carry out a motor command. In conceptual limb apraxia, the patient has difficulty using tools. In ideational limb apraxia, the patient is unable to create a plan for a specific movement and has difficulty sequencing. Dressing apaxia involves the inability to dress oneself.

Explanation

Apraxia is defined as the inability to perform purposeful movement (in the absence of paralyis or paresis). It is most often caused by damage to the left hemisphere. In ideomotor limb apraxia, the patient is unable to carry out a motor command. In conceptual limb apraxia, the patient has difficulty using tools. In ideational limb apraxia, the patient is unable to create a plan for a specific movement and has difficulty sequencing. Dressing apaxia involves the inability to dress oneself.

14. Which of the following best describes Dementia?

A disorder seen in chronic alcoholism and severe malnutrition causing damage to the mammillary bodies

An age-related, progressive, irreversible brain disorder

A non-specific illness syndrome in which areas of cognition are impaired

The loss of long-term memory

None of the above

Dementia, a non-specific illness syndrome in which areas of cognition are impaired, can affect problem solving, learning, memory, orientation, and judgment, among other things. Answer "A" describes Korsakov's syndrome. Answer "B" describes Alzheimer's disease. Answer "D" describes amnesia.

Explanation

Dementia, a non-specific illness syndrome in which areas of cognition are impaired, can affect problem solving, learning, memory, orientation, and judgment, among other things. Answer "A" describes Korsakov's syndrome. Answer "B" describes Alzheimer's disease. Answer "D" describes amnesia.

15. Your client has trouble with a complex perceptual function called figure ground discrimination. Which of the following activities might she have the most trouble with?

Moving through her living room without bumping into the coffee table

Discriminating between the left and right sides of her body

Picking out a black pen from a drawer full of other pens

Remembering the route from her house to her daughter's school

Your client would have trouble picking a black pen out of a drawer of other pens because figure ground discrimination allows us to differentiate foreground objects from background objects. She would have a hard time avoiding the coffee table if she had no spatial relations, and she would have difficulty discriminating between the left and right sides of her body if she had right/left discrimination problems. Remembering the route from her house to her daughter's school would require good topographical orientation.

Explanation

Your client would have trouble picking a black pen out of a drawer of other pens because figure ground discrimination allows us to differentiate foreground objects from background objects. She would have a hard time avoiding the coffee table if she had no spatial relations, and she would have difficulty discriminating between the left and right sides of her body if she had right/left discrimination problems. Remembering the route from her house to her daughter's school would require good topographical orientation.