Austin Block 2

1

A 25 year old male is brought to the Emergency Department by ambulance after a car accident. He was alert at the scene of the accident but is unconscious on arrival. His left pupil is dilated. The most likely diagnosis is:


  Rupture of the left orbit

  Fracture of the base of the skull

  Extradural haematoma

  Traumatic seizure

  Intracerebral haemorrhage

2

The function of the second cranial nerve can be tested by all of the following except:


  Examination of visual acuity

  Examination for nystagmus

  Examination of pupillary reflexes

  Examination of visual fields

  Examination with a Snellen chart

3

Clinical signs found with compression of the S1 nerve root include:


  Loss of knee reflex

  Sensory deficit of the medial side of the calf

  Loss of joint position sense

  Loss of the ankle reflex

  Increased temperature of the foot

4

Facial nerve paralysis is demonstrated by:


  Asking the patient to protrude the tongue

  Testing the reaction of the pupil to light

  Testing the reaction of the pupil to accommodation

  Testing pin prick sensation on the face

  Asking the patient to show his or her teeth

5

All of the following statements about the carpal tunnel syndrome are true except:


  Women are more commonly affected than men

  It occurs more commonly in patients with rheumatoid arthritis

  The symptoms tend to occur at night

  Tingling is a characteristic symptom

  The radial pulse is weaker on the affected side

6

The skin at the tip of the index finger is supplied by the:


  radial nerve only .

  radial and median nerves

  median and ulnar nerves

  ulnar nerve only

  median nerve only

7

Which of the following pairs of spinal nerves supplies adjacent dermatomes on the trunk:


  C3 and T1

  C4 and T1

  C4 and T2

  C4 and T3

  None of the above

8

Which of the following indicates complete transection of the cord immediately after spinal cord injury:


  Loss of motor power but not sensation

  Loss of sensation, but not motor power

  Flaccid paralysis, loss of all sensory modalities, and loss of reflexes below the involved segments

  Loss of sensation and power in both legs with normal reflexes

  Spasticity and hyperreflexia below the involved segments

9

A 24 year old previously well woman complains of a 10 days history of progressive tingling in the hands and feet. Neurological examination reveals absent deep tendon reflexes in all limbs as well as symmetrical distal weakness. There are no sensory signs. The most likely diagnosis in this patient is:


  subacute combined degeneration of the spinal cord

  myaesthenia gravis

  acute demyelinating polyneuropathy (Guillain-Barre syndrome)

  multiple sclerosis

  motor neurone disease

10

The defect in visual fields most commonly associated with a pituitary tumour is:


  homonymous hemianopia

  central scotoma

  bitemporal hemianopia

  total blindness in one field

  peripheral constriction and enlargement of the blind spot

11

The most typical single features of a radial nerve lesion is:


  Weakness of triceps

  Weakness of biceps

  Weakness of brachioradialis

  Wrist drop

  Claw hand

12

The commonest cause of a median nerve palsy is:


  The carpal tunnel syndrome

  Laceration

  Fracture of the shaft of the radius

  Fracture of the shaft of the ulna

  Gun shot wounds

13

A 52 year old man presents with neck pain and pain radiating into the lateral forearm, including the thumb. Neurological examination reveals a sensory deficit over the lateral aspect of the thumb, weakness of biceps and a diminished biceps reflex. The affected nerve root is:


  5th cervical

  6th cervical

  7th cervical

  8th cervical

  1st thoracic

14

A 72 year old woman presents because of pain in her left cheek precipitated by eating or touching her face under the left eye. The pain lasts for 30 to 60 seconds. The patient is most likely to benefitfrom:


  indomethacin

  penicillin

  blockade of the infraorbital nerve

  carbamazepine

  corticosteroids

15

The adverse reactions of dystonia and tardive dyskinesia are most commonly encountered after treatment with:


  Phenothiazines

  Lithium carbonate

  SSRI's

  Mono-amine oxidase inhibitors

  Benzodiazepines