2010Exam 2 - solutions - Name EID Quiz 2 BME 365R Nov. 4,...

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Unformatted text preview: Name EID Quiz 2 BME 365R Nov. 4, 2010 1. A patient presents with the visual fields shown here. The most likely diagnosis is: _._ right posterior cerebral occlusion tuital‘y adenoma c. meningioma in the right orbit d. meningioma in the left orbit 2. A patient presents with the eye movement disorder shown here. What is the CN involved? a. left IV r“?! em 0. left VI d. right III e. right VI 3. The spinal cord ends at this level: a. T12 0. L4 d. 81 4. All of the following are part of Bell’s Palsy EXCEPT: a. increased sensitivity to sound C trouble chewing c. decreased tearing d. loss of taste sensation 5. If the vagus nerves were cut bilaterally, all of the following would occur EXCEPT: ®vheezing b. decreased GI peristalsis c. decreased- heart rate Morena/Q 442% d. hoarse voice e. difficulty swallowing 6. The mandibular branch of the trigeminal nerve exits the intracranial space here: a. foramen spinosuni F ramen ovalle c. foramen rotundum d. superior orbital fissure 7. A patient presents with a history of transient visual loss in the right eye only lasting about 2 minutes. All of the following tests might be helpful EXCEPT: a. carotid Doppler b. blood pressure check 0, lipid screen ETC scan of the orbits 8. A patient has a right liemisection of the mid-thoracic spinal cord. The sensory defect expected: a. loss of P&T on the right leg, loss of proprioception on the left leg b. loss of P&T on the left leg, loss of proprioception in the left leg @033 of P&T on the left leg, loss of proprioception in the right leg . loss of P&T in the right arm, loss of proprioception in the right leg 9. The patient with the right mid—thoracic hemisection of the spinal cord would have what motor defect? a. weakness in the right arm and leg b. weakness in the left arm and leg @akness in the right leg ' d. weakness in the left leg CASE #1: A 49 year old woman with severe hypertension and Parkinson’s Disease had a sudden loss of strength in her left arm and leg. She fell and was brought to the Brackenridge ER by ambulance. On arrival she was obtunded. Neurological examination showed no papilledema, normal pupils, no P&T or proprioception on the left face 01' body, left facial weakness in the lower face, the tongue deviated to the left when protruded, complete paralysis of the left upper and lower extremities, deep tendon reflexes were absent in the left upper extremity and increased in the left lower extremity and a left Babinski reflex was present 10. What cranial nerves are involved? CN involved, pathology affects supranuclear innervation ' . V, XII C. V, IX, XI (1. VII, Xll 1 1. What is the likely site of the pathology? a. left cortex involving motor and somatosensory cortex b. right motor cortex and medial lemniscus 0. right medulla fight basal ganglia and adjacent structures l2. The most likely artery involved: a. left middle cerebral artery b. right middle cerebral artery A vertebral artery @ nuculostriate artery CASE#2: A 63 year-old secretary came to the clinic with the chief complaint that her right hand and fingers “did not want to cooperate”. She admitted that her body movements had become slow and her handwriting had become scribbly. Neurological exam showed that her intellectual abilities were unimpaired, she had moderate slowness of speech, loss of facial expression, and difficulty initiating movements in the upper extremities. There was no muscle atrophy and no weakness in any extremity. Passive movement of the right arm was stiff and jerky. There was a fine resting tremor in the right hand. 13. The most likely site of the pathology is: a. right cerebral cortex b. left cerebral cortex @sal ganglia d. cerebellum CASE#3: A 50 year~old woman experienced a seizure 3 months prior to admission. During the past 2 months, she thought that her memory was failing and she had several episodes lasting minutes during which her thoughts would be “all jumbled—up” and her right hand would feel heavy. Two weeks ago she began to suffer a constant frontal headache. She noticed some changes in vision and presented to the neoro-ophthalmologist for examination. The examination revealed that olfaction was totally absent on the left side of her nose but normal on the right. The right optic nerve had papilledema and the left optic nerve was pale and atrophic. Visual acuity was 20/20 OD and 20/400 OS. The muscles of facial expression were weak on the right but normal on the left. DTRs were brisk on the right body and normal on the left. 14. Where is the tumor? a. left frontal meninges pressing on the motor cortex _ . ‘ight frontal meninges pressing on the motor cortex afi' e of the left frontal lobe u. mesencephalon near the superior colliculus CASE#4: A 21 year-old right-handed motorcyclist has brought to the Brackenridge ER by the police who found him lying unconscious without a helmet after crashing into a tree. He had several facial abrasions and a laceration above his right car which was sutured in the ER. He had a headache but was otherwise awake and conscious. Neurological examination including pupils and extraocular movements was normal. While being discharged, he had a sudden deterioration in his condition. He became unresponsive with shallow, irregular breathing and his right pupil became dilated and unresponsive. His blood pressure increased dramatically. 15. What is the most likely problem? a. subdural hematoma idural hematoma c. concussion d. intracerebral hemorrhage WMMWWMM"... . .. 16. Appropriate treatment: a. lower blood pressure b. observation Qilnediate surgical intervention . spinal tap CASE 5: A 41 year-old woman was referred with complaints of numbness and tingling in the right hand for more than a year. The ioss of sensation occurred gradually, at first only in the fingers, but now extending to the entire right hand and light forearm. She was unable to do fine work like sewing, and she sometimes dropped objects because of weakness in the right hand. Neurological evaluation showed considerable wasting and weakness of the small muscles in the right hand. The deep tendon reflexes in the right upper extremity were absent. The knee and ankle reflexes were brisk on the right and there was a Babinski reflex on the right. Pain and temperature senses were lost in the right hand and right forearm and in the left shoulder and the left lower extremity. Vibration and joint position senses were completely normal in all extremities. 17. The location of the iesion is most likely: a. internal capsule b. pens c. medulla inal cord 18. Physical exam indicates a. upper MN lesion 1). lower MN lesion @111 upper MN and lower MN lesions (1. cortical iesion in pie—central gyrus 19. The most likely diagnosis is: @fl'ingomyelia . multiple sclerosis c. myasthenia gravis d. huntington’s disease 20. Hyperkinetic syndromes such as chorea, athetosis, and hemiballismus are usually associated with pathological changes in: a. motor cortex b. medulla c. reticular formation that controls gamma MN iimervation muscle spindles d. thalamus @sal ganglia 21. A patient has a drooping left eyelid, left eye is turned out, loss of pupillary light reflex in the left eye, and weakness of the upper limbs and lower facial muscles on the right side. Where is the lesion? a, medial lefi ponto-medullary junction @somedial region of the left cerebral peduncle c. dorsolateral medulla on the left d. periaqueductal gray matter on the left 22. A motor unit consists of ne ctMN and the muscle fibers it innervates b. one aMN and the skeletal muscle it controls c. one axon terminal branch and the single muscle cell d. a single nerve and the muscle it innervates 23. All of the following are true about slow muscles EXCEPT: . oxidative metabolism tigue quickly c. low innervation density (1. narrow range of tension 24. The hormone that suppresses uterine contraction: @‘ogesterone . estrogen c. oxytocin d. melatornin 25. The musole power stroke begins when: a. actin is released by the myosin head b.ATP is hydrolyzed by the myosin head ,rganic phosphate is released from the myosin head -. actin attaches to the Inyosin head 26. Muscle strength can be graded by: @115; rate of individual (1th . modulation of sarcoplasmic calcium c. recruitment of multiple nerves d. all of the above 27. Group Ia muscle spindle afferents project to all of these EXCEPT: a. posterior columns b. dorsal spino-cerebellar tract 0. ipsilateral oMN @eml spinothalmic tract 28. A left neo-cerebellar lesion would produce all of the following symptoms EXCEPT: @lling to the right . intention tremor c. scanning speech d. nystagmus e. dysdiadochokinesia 29. Purkinje Cell complex spikes are generated by: @limbing fibers b. mossy fibers c. stellate cells d. golgi cells 30. Diminished vasopressin (diabetes insipidus): a. blood hypertonicity b. increased urine ._ osterior pituitary stroke of the above Feedback systems 31. What is the closed-ioop gain function for the system shown above?: I a. 105(s+106) 6/(s+105) c. 0.1s/(s+10'6) d. 10'2/(s+103) 32. What is the midhand gain for the closed loop? a. 106 (5135 d. 0.1 33. What is the midhand gain for the feed-forward function? 21.104 / b. 105 d. 106 34. What is the gain-bandwidth product? a. 103 b. 104 c. 105 @6 35. 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This note was uploaded on 12/13/2011 for the course BME 365R taught by Professor Rylander during the Spring '09 term at University of Texas at Austin.

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2010Exam 2 - solutions - Name EID Quiz 2 BME 365R Nov. 4,...

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