Case 22 Questions 16-30

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Enjoy working thorugh the following questions. We hope they aid your learning. If you have any issues or feedback, please email [email protected]

Question 16

Which of these cognitive deficits fits with an infarction of the posterior cerebral artery?

  1. Visual disturbances
  2. Weakness in hand, arm, face
  3. Aphasia
  4. Weakness in opposite leg and shoulder
  5. Personality problems

The correct answer is option a, Visual disturbances

Option 1 is the correct answer. The posterior cerebral artery supplies the occipital lobe (which is responsible for visual processing), the temporal lobe, thalamus and hippocampus. Infarction in the middle cerebral artery will cause weakness in the hand, arm and face, aphasia and neglect (e.g. of left or right side). The anterior cerebral artery can cause weakness in opposite leg and shoulder, and personality problems.

Question 17

Which of these is not a core feature of Parkinson’s?

  1. Bradykinesia
  2. Muscular rigidity
  3. Resting tremor
  4. Postural instability
  5. Cerebellar signs

The correct answer is option e, Cerebellar signs

Cerebellar signs are in fact part of the exclusion criteria for Parkinson’s disease. According to the UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria you should diagnose Parkinsons if someone has bradykinesia and one of – muscular rigidity, 4-6Hz resting tremor or postural instability not caused by primary visual, vestibular, cerebellar or proprioceptive dysfunction.

Question 18

Which of these reversible dementias can be treated with Thiamine (vitamin B1)?

  1. Substance abuse
  2. Korsakoff syndrome
  3. Syphilis
  4. Normal pressure hydrocephalus
  5. Hypothyroidism

The correct answer is option b, Korsakoff syndrome

Korsakoff syndrome is caused by a severe deficiency in thiamine, usually due to alcohol misuse. Treatment would be to give high doses of thiamine immediately then they may need other types of nutrition and hydration

Question 19

Which brainstem nucleus is responsible for relaying taste information to the thalamus?

  1. Hypoglossal nucleus
  2. Accessory nucleus
  3. Nucleus ambiguus
  4. Nucleus of the solitary tract
  5. Inferior salivatory

The correct answer is option d, Nucleus of the solitary tract

The correct answer here is the nucleus of the solitary tract.
The hypoglossal nucleus controls tongue movements.
Accessory innervates sternocleidomastoid and trapezius
The nucleus ambiguus contains cell bodies of nerves that innervate the soft palate, pharynx and larynx.
The inferior salivatory innervates salivary glands

Question 20

What would be the result of damage to the temporal lobe?

  1. Problems with executive function, motor control, attention
  2. Multimodal sensory integration and spatial orientation
  3. Hearing, memory, perceptual organisation, emotions
  4. Visual perception
  5. Personality problems

The correct answer is option c, Hearing, memory, perceptual organisation, emotions

The function of the temporal lobe is thought to be hearing, memory, perceptual organisation and emotions.
Option 1 describes the function of the frontal lobe, 2 the parietal lobe and 4 the occipital lobe. Option 5 can be caused by infarction of the ACA or frontal lobe damage.

Question 21

Which of the following is not a typical sign of an ageing brain?

  1. Ventricular expansion
  2. Plasticity deficit
  3. Localised ischaemia
  4. Altered neurotransmitter levels
  5. Accumulated DNA damage

The correct answer is option c,Localised ischaemia

Localised cerebral ischaemia is a sign of stroke. Evidence of previous cerebral ischaemia may point you towards a diagnosis of vascular dementia which, although associated with the elderly population, is not a typical feature.

Question 22

Which of the following imaging techniques would be used to measure cerebral blood flow using gamma radiation?

  1. CT
  2. MRI
  3. SPECT
  4. PET
  5. Electrophysiology

The correct answer is option c, SPECT

SPECT shows up orange (hyperperfusion) or purple (hypoperfusion) to demonstrate perfusion of cerebral tissues.
CT shows tissue density and is particularly useful for visualising haemorrhage vs ischaemia in stroke.
MRI provides good contrast between the soft tissues in the body
Although PET shows perfusion, it relies on the decay of radiotracers to produce an image. Electrophysiology directly measures neuronal activity of the brain

Question 23

Which of the following medications used in the treatment of Parkinson’s is a precursor of dopamine?

  1. Risperidone
  2. Levodopa
  3. Rasagiline
  4. Procyclidine
  5. Opicapone

The correct answer is option b, Levodopa

Levodopa is
Risperidone is an atypical or second generation antipsychotic which antagonises D2 receptors.
Rasagiline is a monoamine oxidase-B inhibitor
Procyclidine is an anticholinergic
Opicapone is a catechol-O-methyltransferase inhibitor which is often prescribed with levodopa as it prevents peripheral breakdown.

Question 24

Colin is 62 and has recently been prescribed levodopa for Parkinson’s. He has a PMHx of hypertension for which he takes ramipril. He has presented in to hospital as his partner is concerned about him. Which of the following side effects is colin most likely to be experiencing?

  1. Fever, muscle rigidity and altered mental state
  2. GI upset, fever and dehydration
  3. Acute dystonia, akathisia and tardive dyskinesia
  4. Homonymous hemianopia, unilateral weakness and higher cortical deficit
  5. Confusion, tachycardia and myoclonus

The correct answer is option a, Fever, muscle rigidity and altered mental state

These are the typical triad of symptoms often seen in neuroleptic malignant syndrome. This is a life threatening reaction in response to neuroleptic medication (e.g. anti-Parkinsons) GI upset, fever and dehydration is suggestive of an infective picture Acute dystonia, akathisia and tardive dyskinesia are typical extra pyramidal side effects. Homonymous hemianopia, unilateral weakness and higher cortical deficit are classical signs of a TACS. Confusion, tachycardia and myoclonus are symptoms of serotonin syndrome.

Question 25

Which of the following is not true of prions?

  1. Prions induce abnormal folding of normal cellular proteins in the brain
  2. Prions can cause spongiform encephalopathies
  3. Prions consist of a nucleic acid molecule surrounded by a protein layer
  4. Prion disease can result in problems with memory and movement
  5. most common prion disease affecting humans is CJD

The correct answer is option c, Prions consist of a nucleic acid molecule surrounded by a protein layer

Viruses consist of a nucleic acid molecule with a protein layer. Prions do not contain genetic material; they are misfolded proteins.

Question 26

Which of the following structures is not involved in the formation of non declarative memory?

  1. Striatum
  2. Neocortex
  3. Amygdala
  4. Medial temporal lobe
  5. Cerebellum

The correct answer is option d, Medial temporal lobe

The medial temporal lobe is key in declarative memory.

Question 27

Which of the following pathologies is most associated with cerebral deposition of alpha synuclein?

  1. Lewy Body Dementia
  2. Alzheimer’s dementia
  3. Huntington’s disease
  4. Vascular dementia
  5. Frontotemporal dementia

The correct answer is option a, Lewy Body Dementia

Alzheimers is associated with beta amyloid plaques and neurofibrillary tangles.
Huntington’s is a genetic mutation resulting in downregulation of GABA
Vascular dementia is caused by a single large cerebrovascular event or multiple infarctions/haemorrhages
Frontotemporal dementia is caused by TAU and TDP-43 inclusions

Question 28

Which of the following pathologies is the main lesion underlying vascular dementia?

  1. Cerebral ischaemic infarct
  2. Cerebral hypoperfusion
  3. Cortical atrophy
  4. Cerebral haemorrhage
  5. Temporal lobe sclerosis

The correct answer is option a, Cerebral ischaemic infarct

Question 29

Which of the following is not a recognised tool for assessing cognition?

  1. MMSE
  2. 4-AT
  3. MoCA
  4. ACE-III
  5. GPCOG-25

The correct answer is option b, 4-AT

The 4-AT is a tool to screen for delirium.
ACE-III is the UKs tool for assessing cognition however we regularly use MoCA (Canadian).
GPCOG-25 is a set of 25 questions used in primary care to assess cognition.

Credits

  • 16-20 (Angharad James 3rd year),
  • 21-29 (Mollie Ward, 3rd year)