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Israel Alfonso. MD INSTRUCTIONS READ EACH QUESTION
GIVE IT YOUR BEST SHOT GO TO THE NEXT SLIDE OR SLIDES FOR CLUES THEN, GO ON TO THE NEXT SLIDE FOR THE CORRECT ANSWER GOOD LUCK! Israel Alfonso. MD
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1. THE MOST IMPORTANT COMPONENT OF THE NEUROLOGICAL EVALUATION IS:
A. HISTORY B. PHYSICAL EXAMINATION C. EEG INTERPRETATION D. MRI INTERPRETATION
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TIME THE PHYSICAL EXAMINATION REVEALS WHAT IS PRESENT AT THE TIME AND DURING (SHORT TIME) THE EXAMINATION. THE PHYSICAL EXAMINATION REVEALS MORE INFORMATION PER TIME UNIT THAN THE HISTORY BUT LESS OVER ALL INFORMATION. HISTORY REVEALS WHAT WAS PRESENT DURING A PROLONGED PERIOD OF TIME. PE (20%) VALUE % HISTORY (80%) 20 5
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1. THE MOST IMPORTANT COMPONENT OF THE NEUROLOGICAL EVALUATION IS:
A. HISTORY B. PHYSICAL EXAMINATION C. EEG INTERPRETATION D. MRI FINDINGS
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2. MOST CHILDREN CONTRIBUTE TO THEIR OWN MEDICAL HISTORY BY:
A MONTHS B MONTHS C. 2 YEARS D. 3-4 YEARS
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1 2 3 4 5 6 Y NEUROLOGICAL EXAMINATION 1/4 1/2 3/4
AGE THAT A CHILD STARTS CONTRIBUTING TO HIS OWN MEDICAL HISTORICAL 1 2 3 4 5 6 Y 1/4 1/2 3/4 OBSERVATION REFLEX & REACTION PLAYING COMMANDS & IMITATING
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2. MOST CHILDREN CONTRIBUTE TO THEIR OWN MEDICAL HISTORY BY:
A MONTHS B MONTHS C. 2 YEARS D. 3-4 YEARS
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3. REGRESSION OVER A LONG TIME (MORE THAN 1 YEAR) MOST LIKELY INDICATES:
A. A DEGENERATIVE DISORDER B. A TUMOR C. TRAUMA D. VASCULAR ACCIDENT
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WHICH PATHOLOGICAL PROCESS IS MORE
COMPATIBLE WITH THE CLINICAL COURSE ? ♣♦♠ ♣ ♦♠♥ ♥♪♫ ♪♫■▼ ♫■▼ ♫ ■ ♫ ■ * DEFICIT 1 min 1 h 1 d 1 w 1 mo 1 y ♣ SEIZURES ♥ VASCULAR ■ INFECTIOUS ♦ TRAUMA ♪ TOXINS ▼ DEMYELINATION ♠ O & GLUCOSE ♫ INBORN ERROR OF METABOLISM TUMOR * 2 DEGENERATIVE
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3. REGRESSION OVER A LONG TIME (MORE THAN 1 YEAR) MUST LIKELY INDICATES:
A. A DEGENERATIVE DISORDER B. A TUMOR C. TRAUMA D. VASCULAR ACCIDENT
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4. A 3 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING EXCEPT:
A. SUPPORT WEIGHT ON FOREARMS B. OPENS HANDS SPONTANEOUSLY C. COOS AND LAUGHS D. SHOWS LIKES AND DISLIKES
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COOS BABBLES LAUGHS 3 6 MA…PA MA…PA PA… MA PA… MA 9
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4. A 3 MONTHS OLD SHOULD BE EXPECTED (UPPER RANGE OF NORMAL) TO DO ALL OF THE FOLLOWING, EXCEPT:
A. SUPPORT WEIGHT ON FOREARMS B. OPENS HANDS SPONTANEOUSLY C. COOS AND LAUGHS D. SHOWS LIKES AND DISLIKES
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5. A 3 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING EXCEPT:
A. SUPPORT WEIGHT ON FOREARMS B. OPENS HANDS SPONTANEOUSLY C. COOS AND LAUGHS D. PLAY PAT-A-CAKE, PEEK-A-BOO
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COOS BABBLES LAUGHS 3 6 MA…PA MA…PA PA… MA PA… MA 9
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5. A 3 MONTHS OLD SHOULD BE EXPECTED (UPPER RANGE OF NORMAL) TO DO ALL OF THE FOLLOWING, EXCEPT:
A. SUPPORT WEIGHT ON FOREARMS B. OPENS HANDS SPONTANEOUSLY C. COOS AND LAUGHS D. PLAY PAT-A-CAKE, PEEK-A-BOO
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6. AN INFANT WHO IS ABLE TO SUPPORT WEIGHT ON FOREARMS, OPENS HANDS SPONTANEOUSLY, COOS AND LAUGHS, AND SMILES APPROPRIATELY BUT IS UNABLE TO TRANSFER OBJECTS OR SHOW LIKES AND DISLIKES SHOULD BE: A. 3 MONTHS OF AGE B. 6 MONTHS OF AGE C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
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COOS BABBLES LAUGHS 3 6 MA…PA MA…PA PA… MA PA… MA 9
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6. AN INFANT WHO IS ABLE TO SUPPORT WEIGHT ON FOREARMS, OPENS HANDS SPONTANEOUSLY, COOS AND LAUGHS, AND SMILES APPROPRIATELY BUT IS UNABLE TO TRANSFER OBJECTS OR TO SHOW LIKES AND DISLIKES SHOULD BE: A. 3 MONTHS OF AGE B. 6 MONTHS OF AGE C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
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7. A 6 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING, EXCEPT:
A. SIT MOMENTARILY B. TRANSFERS OBJECTS C. IMITATE SOUNDS D. SHOWS LIKES AND DISLIKES
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COOS BABBLES LAUGHS 3 6 MA…PA MA…PA PA… MA PA… MA 9
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7. A 6 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING EXCEPT:
A. SIT MOMENTARILY B. TRANSFERS OBJECTS C. IMITATE SOUNDS D. SHOWS LIKES AND DISLIKES
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8. AN INFANT WHO IS ABLE TO PULL TO STAND, USE PINCER GRASP, PLAY PAT-A-CAKE AND PEEK-A-BOO, IMITATES SOUNDS AND SMILE APPROPRIATELY BUT IS UNABLE TO RELEASE AN OBJECTS ON COMMANDS OR TO COME WHEN CALLED SHOULD BE: A. 3 MONTHS OF AGE B. 6 MONTHS OF AGE C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
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9 12 MA…PA MA…PA PA… MA PA… MA MOMMY GIVE TO MOMMY ! PAPA
COME TO MOMMY !
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8. AN INFANT WHO IS ABLE TO PULL TO STAND, USE PINCER GRASP, PLAY PAT-A-CAKE AND PEEK-A-BOO, IMITATES SOUNDS AND SMILE APPROPRIATELY BUT IS UNABLE TO RELEASE AN OBJECTS ON COMMANDS OR TO COME WHEN CALLED SHOULD BE: A. 3 MONTHS OF AGE B. 6 MONTHS OF AGE C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
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9. AN INFANT WHO IS ABLE TO SMILE SPONTANEOUSLY, USE PINCER GRASP, AND IMITATES SOUNDS BUT IS UNABLE TO RELEASE AN OBJECTS ON COMMANDS OR TO RUN SHOULD BE: A. 3 MONTHS OF AGE B. 6 MONTHS OF AGE C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
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9 12 MA…PA MA…PA PA… MA PA… MA MOMMY GIVE TO MOMMY ! PAPA
COME TO MOMMY !
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9. AN INFANT WHO IS ABLE TO SMILE SPONTANEOUSLY, USE PINCER GRASP, AND IMITATES SOUNDS BUT IS UNABLE TO RELEASE AN OBJECTS ON COMMANDS OR TO RUN SHOULD BE: A. 3 MONTHS OF AGE B. 6 MONTHS OF AGE C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
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10. AN INFANT WHO IS ABLE TO SMILE SPONTANEOUSLY, USE PINCER GRASP, COOS AND LAUGH, PLAY PAT-A-CAKE AND PEEK-A-BOO, AND IMITATES SOUNDS BUT IS UNABLE TO RELEASE AN OBJECTS ON COMMANDS OR TO COME WHEN CALLED SHOULD BE: A. 3 MONTHS OF AGE B. 6 MONTHS OF AGE C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
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9 12 MA…PA MA…PA PA… MA PA… MA MAMMY GIVE TO MAMMY ! PAPA
COME TO MAMMY !
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THE TRICK TO ANSWER A QUESTION REGARDING DEVELOPMENTAL AGE IS TO KNOW THOSE CARTOON BY HEART (THE SAME AS THE MULTIPLICATION TABLES). THE APPROACH TO DEVELOPMENTAL QUESTIONS IS TO LOOK FOR THE ACTIONS THAT THE INFANT CAN DO (IN THE QUESTION OR IN THE ANSWERS) AND WRITE BY THE SIDE OF EVERY ACTION THE APPROPRIATE AGE. IF YOU SEE AN ACTION THAT YOU CAN NOT AGE DISREGARD IT.
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10. AN INFANT WHO IS ABLE TO SMILE SPONTANEOUSLY, USE PINCER GRASP, COOS AND LAUGH, PLAY PAT-A-CAKE AND PEEK-A-BOO, AND IMITATES SOUNDS BUT IS UNABLE TO RELEASE AN OBJECTS ON COMMANDS OR TO COME WHEN CALLED SHOULD BE: A. 3 MONTHS OF AGE B. 6 MONTHS OF AGE C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
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11. A 12 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING EXCEPT:
A. SIT MOMENTARILY B. USE PINCER GRASP C. COME WHEN CALLED D. MIMIC ACTIONS OF OTHERS
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12 18 MOMMY GIVE TO MOMMY ! PAPA COME TO MAMMY !
MOMMY, PAPA, YES, NO, CAT, MILK 18
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11. A 12 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING EXCEPT:
A. SIT MOMENTARILY = 6 B. USE PINCER GRASP = 9 C. COME WHEN CALLED = 12 D. MIMIC ACTIONS OF OTHERS = 18
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12. A 12 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING EXCEPT:
A. WALK WITH ONE HAND HELD B. RELEASE AN OBJECT ON COMMAND C. COME WHEN CALLED D. FEED FROM SPOON
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12 18 MOMMY GIVE TO MOMMY ! PAPA COME TO MOMMY !
MAMMY, PAPA, YES, NO, CAT, MILK 18
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12. A 12 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING EXCEPT:
A. WALK WITH ONE HAND HELD = 12 B. RELEASE AN OBJECT ON COMMAND = 12 C. COME WHEN CALLED = 12 D. FEED FROM A SPOON = 18
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13. A CHILD WHO IS ABLE TO SMILE SPONTANEOUSLY, USE PINCER GRASP, WALK UPSTAIRS WITH ASSISTANCE BUT IS UNABLE TO BUILD A TOWER OF SIX BLOCKS IS: A. 12 MONTHS OF AGE B. 18 MONTHS OF AGE C. 24 MONTHS OF AGE D. 36 MONTHS OF AGE
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COOS BABBLES LAUGHS 3 6 MA…PA MA…PA PA… MA PA… MA 9
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12 18 GIVE TO MOMMY ! MOMMY PAPA COME TO MOMMY !
MOMMY, PAPA, YES, NO, CAT, MILK 18
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GIVE ME COOKY 24
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3 9 13. A CHILD WHO IS ABLE TO SMILE SPONTANEOUSLY, USE PINCER GRASP, WALK UPSTAIRS WITH ASSISTANCE BUT IS UNABLE TO BUILD A TOWER OF SIX BLOCKS IS: A. 12 MONTHS OF AGE B. 18 MONTHS OF AGE C. 24 MONTHS OF AGE D. 36 MONTHS OF AGE -24 18
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13. AN CHILD WHO IS ABLE TO SMILE SPONTANEOUSLY, USE PINCER GRASP, WALK UPSTAIRS WITH ASSISTANCE BUT IS UNABLE TO BUILD A TOWER OF SIX BLOCKS IS: A. 12 MONTHS OF AGE B. 18 MONTHS OF AGE C. 24 MONTHS OF AGE D. 36 MONTHS OF AGE
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14. AN 18 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING EXCEPT:
A. WALK UPSTAIRS WITH ASSISTANCE B. RELEASE AN OBJECT ON COMMAND C. FEED WITH A SPOON D. BUILD A TOWER OF SIX BLOCKS
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COOS BABBLES LAUGHS 3 6 MA…PA MA…PA PA… MA PA… MA 9
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12 18 MOMMY GIVE TO MOMMY ! PAPA COME TO MOMMY !
MOMMY, PAPA, YES, NO, CAT, MILK 18
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GIVE ME COOKY 24
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14. AN 18 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING, EXCEPT:
A. WALK UPSTAIRS WITH ASSISTANCE = 18 B. RELEASE AN OBJECT ON COMMAND =12 C. FEED WITH A SPOON =18 D. BUILD A TOWER OF SIX BLOCKS = 24
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15. A 24 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING, EXCEPT:
A. RUN B. PLAY WITH OTHER CHILDREN C. HAVE 5 WORD SENTENCES D. BUILD A TOWER OF SIX BLOCKS
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12 18 MOMMY GIVE TO MAMMY ! PAPA COME TO MOMMY !
MOMMY, PAPA, YES, NO, CAT, MILK 18
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GIVE ME COOKY 24
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B. PLAY WITH OTHER CHILDREN = 24 C. HAVE 5 WORD SENTENCES = ?
15. AN 24 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING, EXCEPT: A. RUN = 24 B. PLAY WITH OTHER CHILDREN = 24 C. HAVE 5 WORD SENTENCES = ? D. BUILD A TOWER OF SIX BLOCKS = 24 AT 24 MONTHS, A NORMAL CHILD IS EXPECTED TO MAKE 3 WORDS SENTENCES, HE MAY MAKE 5 WORD SENTENCES BUT HE DOES NOT HAVE TO, TO BE NORMAL
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15. AN 24 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING, EXCEPT:
A. RUN B. PLAY WITH OTHER CHILDREN C. HAVE 5 WORD SENTENCES D. BUILD A TOWER OF SIX BLOCKS
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16. AT HOW MANY WEEKS OF CONCEPTIONAL SHOULD CONSISTENT PERIODS OF AROUSAL BE EXPECTED?
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AROUSAL SYSTEM CEREBRAL CORTEX BRAIN MIDBRAIN DIENCEPHALON PONS 26 28
30 32 34 W AROUSAL GA MEDULLA SPINAL CORD ASCENDING RETICULAR ACTIVATING SYSTEM ARAS OUTPUT FIBERS ARAS INPUT FIBERS
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16. AT HOW MANY WEEKS OF GESTATION SHOULD CONSISTENT PERIODS OF AROUSAL BE EXPECTED?
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17. THE POSTERIOR FONTANEL USUALLY CLOSES BY:
A. 2 WEEKS B. 3 MONTHS C. 8 WEEKS D. 8 MONTHS
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SAGITTAL METOPIC ANTERIOR (9[18]24 M) CORONAL SPHENOIDAL POSTERIOR (6-8 W) LAMBDOIDAL MASTOID OCCIPITAL SQUAMOUS
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17. THE POSTERIOR FONTANEL USUALLY CLOSES BY:
A. 2 WEEKS B. 3 MONTHS C. 8 WEEKS D. 8 MONTHS
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18. THE AVERAGE TIME OF CLOSURE OF THE ANTERIOR FONTANEL IS:
A. 12 MONTHS B. 24 MONTHS C. 18 MONTHS D. 8 MONTHS
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SAGITTAL METOPIC ANTERIOR (9[18]24 M) CORONAL SPHENOIDAL POSTERIOR (6-8 W) LAMBDOID MASTOID OCCIPITAL SQUAMOUS
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18. THE AVERAGE TIME OF CLOSURE OF THE ANTERIOR FONTANEL IS:
A. 12 MONTHS B. 24 MONTHS C. 18 MONTHS D. 8 MONTHS
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19. THE ANTERIOR FONTANEL MAY CLOSE IN A NORMAL PATIENT AS EARLY AS:
A. 18 MONTHS B. 9 MONTHS C. 24 MONTHS D. 6 MONTHS
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SAGITTAL METOPIC ANTERIOR (9[18]24 M) CORONAL SPHENOIDAL POSTERIOR (6-8 W) LAMBDOID MASTOID OCCIPITAL SQUAMOUS
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19. THE ANTERIOR FONTANEL MAY CLOSE IN A NORMAL PATIENT AS EARLY AS:
A. 18 MONTHS B. 9 MONTHS C. 24 MONTHS D. 6 MONTHS
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20. VIGOROUS CRYING CAN NOT PRODUCE A BULGING FONTANEL IN A NORMAL INFANT.
A. TRUE B. FALSE
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* * NO CAUSE WAS FOUND IN THIS PATIENT
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20. VIGOROUS CRYING CAN NOT PRODUCE A BULGING FONTANEL IN A NORMAL INFANT.
A. TRUE B. FALSE
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21. YOU HEAR A SOFT SYMMETRICAL HEAD BRUIT IN A FEBRILE 3 YEAR OLD
21. YOU HEAR A SOFT SYMMETRICAL HEAD BRUIT IN A FEBRILE 3 YEAR OLD. WHAT SHOULD YOU DO? A. SEND HIM FOR A NEUROLOGICAL EVALUATION B. SPINAL TAP C. AN MRI OF THE BRAIN WITH CONTRAST D. DO A CBC
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< 4 Y FEVER NORMAL ANEMIA ANEMIA ICP AVM AVM
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21. YOU HEAR A SOFT SYMMETRICAL HEAD BRUIT IN A FEBRILE 3 YEAR OLD
21. YOU HEAR A SOFT SYMMETRICAL HEAD BRUIT IN A FEBRILE 3 YEAR OLD. WHAT SHOULD YOU DO? A. SEND HIM FOR A NEUROLOGICAL EVALUATION B. SPINAL TAP C. AN MRI OF THE BRAIN WITH CONTRAST D. DO A CBC
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22. THE FOLLOWING ARE COMMON FINDINGS IN A 4 YEAR WITH PAPILLEDEMA EXCEPT:
A. CONSTRICTION OF THE ARTERIOLES AROUND THE DISC B. INDISTINGUISHABLE NASAL OPTIC DISC EDGE AND NORMAL TEMPORAL OPTIC DISC EDGE C. PRESERVATION OF VISUAL ACUITY AND COLOR VISION D. ENLARGED BLIND SPOT
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ICP = NORMAL ARTERIOLE CAPILLARY ICP = INCREASE ICP PRODUCES THE CUSHING TRIAD (BRADYCARDIA, HYPERTENSION DUE TO ARTERIOLES CONSTRICTION, AND IRREGULAR RESPIRATION), THE RETINAL VASCULATURE ARE NOT IMMUNE. THE TEMPORAL EDGE IS THE FIRST TO GO.
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NORMAL PAPILLEDEMA MACULA DISK NASAL NASAL R L L TEMPORAL HEMORRHAGE NASAL IN PAPILLEDEMA THE TEMPORAL EDGE GOES FIRST EDGE
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22. THE FOLLOWING ARE COMMON FINDINGS IN A 4 YEAR WITH PAPILLEDEMA, EXCEPT:
A. CONSTRICTION OF THE ARTERIOLES AROUND THE DISC B. INDISTINGUISHABLE NASAL OPTIC DISC EDGE AND NORMAL TEMPORAL OPTIC DISC EDGE C. PRESERVATION OF VISUAL ACUITY AND COLOR VISION D. ENLARGED BLIND SPOT
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23. WHAT IS THE % OF NORMAL FULL TERM NEONATES WITH RETINAL HEMORRHAGES DURING THE FIRST 2 WEEKS OF LIFE? A. 10 TO 20 B. 5 TO 10 C. 30 TO 40 D. 80 TO 90
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% IN NELSON’S 13 EDITION: 10%
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23. WHAT IS THE % OF NORMAL FULL TERM NEONATES WITH RETINAL HEMORRHAGES DURING THE FIRST 2 WEEKS OF LIFE? A. 10 TO 20 B. 5 TO 10 C. 30 TO 40 (BUT LITTLE) D. 80 TO 90
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24. YOU LOOK AT THE FUNDI OF A 4 WEEK OLD PATIENT, YOU SEE RETINAL HEMORRHAGES. WHAT SHOULD YOU DO?
A. SEND TO THE OPHTHALMOLOGIST B. TELL THE MOTHER NOT TO WORRY C. GET A CBC D. ADMIT THE PATIENT
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INFECTION DISC DYSPLASIA NORMAL FUNDUS AICARDI SYNDROME CHERRY RED SPOT HEMORRHAGE CALCIFICATION ABUSE, ABUSE !!
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24. YOU LOOK AT THE FUNDI OF A 4 WEEK OLD FULL TERM PATIENT, YOU SEE RETINAL HEMORRHAGES. WHAT SHOULD YOU DO? A. SEND TO THE OPHTHALMOLOGIST B. TELL THE MOTHER NOT TO WORRY C. GET A CBC D. ADMIT THE PATIENT (THE USUAL BLEED IN NORMAL FULL TERM NEONATES DO NOT LAST FOR 1 MONTH)
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25. YOU LOOK AT THE FUNDI OF A 5 YEAR OLD PATIENT, YOU SEE A MACULAR STAR. WHAT SHOULD YOU DO?
A. SEND TO THE OPHTHALMOLOGIST B. TELL THE MOTHER NOT TO WORRY C. GET A CBC D. ADMIT THE PATIENT
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MACULAR STAR (YELLOW LINES IRRADIATING FROM MACULA): LATE SIGN OF PAPILLEDEMA, IT IS DUE TO EDEMA WITHIN THE HENLE LAYER OF THE MACULA; IT MAY ALSO OCCUR WITH PAPILLITIS.
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25. YOU LOOK AT THE FUNDI OF A 5 YEAR OLD PATIENT, YOU SEE A MACULAR STAR. WHAT SHOULD YOU DO?
A. SEND TO THE OPHTHALMOLOGIST B. TELL THE MOTHER NOT TO WORRY C. GET A CBC D. ADMIT THE PATIENT
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26. VISUAL FIXATION AND THE ABILITY TO FOLLOW A BRILLIANT TARGET ARE PRESENT BY:
A. 40 WEEKS GA B. 32 WEEKS GA C. 30 WEEKS GA D. 36 WEEKS GA
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AT TERM
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26. VISUAL FIXATION AND THE ABILITY TO FOLLOW A BRILLIANT TARGET ARE PRESENT BY:
A. 40 WEEKS GA B. 32 WEEKS GA C. 30 WEEKS GA D. 36 WEEKS GA
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27. THE NORMAL ADULT VISUAL ACUITY IS REACHED BY:
A. 9 MONTHS B. 6 MONTHS C. 12 MONTHS D. 18 MONTHS
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20/20 BABBLES 6
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27. THE NORMAL ADULT VISUAL ACUITY IS REACHED BY:
A. 9 MONTHS B. 6 MONTHS C. 12 MONTHS D. 18 MONTHS
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28. OBJECT RECOGNITION IS THE BASIS FOR WHICH OF THE FOLLOWING EYE CHARTS:
A. E GAME CHART B. SNELLEN EYE CHART C. ALLEN EYE CHART D. ALL OF THE ABOVE
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ALLEN EYE CHART
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28. OBJECT RECOGNITION IS THE BASIS FOR WHICH OF THE FOLLOWING EYE CHARTS:
A. E GAME CHART B. SNELLEN EYE CHART C. ALLEN EYE CHART D. ALL OF THE ABOVE
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29. THE PUPILS MAY REACT TO LIGHT AS EARLY AS _____ WEEKS OF GESTATION.
A. 28 TO 32 WEEKS B. 24 TO 26 WEEKS C. 26 TO 28 WEEKS D. 22 TO 24 WEEKS
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PUPIL REACT TO LIGHT GA 26 28 30 32 34 W NO SOMETIMES YES
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29. THE PUPILS MAY REACT TO LIGHT AS EARLY AS _____ WEEKS OF GESTATION.
A. 28 TO 32 WEEKS B. 24 TO 26 WEEKS C. 26 TO 28 WEEKS D. 22 TO 24 WEEKS
156
30. WHICH OF THE FOLLOWING IS NOT A SIGN OF HORNER SYNDROME?
A. MIOSIS B. PTOSIS C. EXOPHTHALMUS D. IPSILATERAL ANIDROSIS OF THE FACE
157
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OCULOSYMPATHETIC DISORDER
HORNER SYNDROME PTOSIS MILD (UPPER EYE LID 2-3 MM DOWN; LOWER 1-2 MM UP), PRODUCING THE APPEARANCE OF ENOPHTHALMOS), MIOSIS ANHIDROSIS (IF 1ST OR 2ND NEURON AFFECTED, NOT IF 3RD NEURON IS AFFECTED). CHARACTERISTICS OF HORNER SYNDROME PUPILLARY ASYMMETRY WORSE IN THE DARK PUPILLARY REACTIVITY TO LIGHT IS NORMAL EXTRAOCULAR MOVEMENTS ARE NORMAL PTOSIS OF THE LOWER EYELID (1-2 MM UP ) HETEROCHROMIA IF CONGENITAL
160
30. WHICH OF THE FOLLOWING IS NOT A SIGN OF HORNER SYNDROME?
A. MIOSIS B. PTOSIS C. EXOPHTHALMUS D. IPSILATERAL ANHIDROSIS OF THE FACE
161
31. EYE DROPS HELP DISTINGUISH AMONG THE DIFFERENT TYPES OF HORNER SYNDROME?
A. TRUE B. FALSE
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EYE DROPS DEAD 1% H AMP NEURON # 3 = # 1 # 1 # 2 # 3 # 3 # 2 # 3
NOREPINEPHRINE =
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31. EYE DROPS HELP DISTINGUISH AMONG THE DIFFERENT TYPES OF HORNER SYNDROME?
A. TRUE B. FALSE
166
32. WHICH OF THE FOLLOWING MUSCLE IS NOT INNERVATED BY THE OCULOMOTOR NERVE?
A. LEVATOR PALPEBRAE SUPERIORIS B. MUSCLE OF MULLER C. MEDIAL RECTUS D. INFERIOR OBLIQUE
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III EYE MUSCLE INNERVATION LPS CN III (OCULOMOTOR) sphincter MR IO SR
IR CN VI (ABDUCENT) CN IV (TROCLEAR) SO C7 LR IO SR SR IO MR LPS LPS LR LR IR IR SO SO
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32. WHICH OF THE FOLLOWING MUSCLE IS NOT INNERVATED BY THE OCULOMOTOR NERVE?
A. LEVATOR PALPEBRAE SUPERIORIS B. MUSCLE OF MULLER C. MEDIAL RECTUS D. INFERIOR OBLIQUE THE MUSCLES OF MULLER (UPPER AND LOWER EYELID) IS INNERVATED BY THE SYMPATHETIC SYSTEM.
171
33. WHICH OF THE FOLLOWING MUSCLE IS NOT INNERVATED BY THE OCULOMOTOR NERVE?
A. LEVATOR PALPEBRAE SUPERIORIS B. INFERIOR RECTUS C. SUPERIOR RECTUS D. DILATOR OF THE PUPIL
172
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III EYE MUSCLE INNERVATION LPS CN III (OCULOMOTOR) sphincter MR IO SR
IR CN VI (ABDUCENT) CN IV (TROCLEAR) SO C7 LR IO SR SR IO MR LPS LPS LR LR IR IR SO SO
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33. WHICH OF THE FOLLOWING MUSCLE IS NOT INNERVATED BY THE OCULOMOTOR NERVE?
A. LEVATOR PALPEBRAE SUPERIORIS B. INFERIOR RECTUS C. SUPERIOR RECTUS D. DILATOR OF THE PUPIL
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34. WHICH NERVE PALSY PRODUCES AN UPWARD AND OUTWARD DEVIATION OF THE EYE?
A. OCULOMOTOR NERVE B. TROCHLEAR NERVE C. ABDUCENS NERVE D. SYMPATHETIC NERVE
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III CN III (OCULOMOTOR) CN IV (TROCLEAR) C7 CN VI (ABDUCENT) IO SR MR
SO IR LR CN VI (ABDUCENT) CN IV (TROCLEAR) CN III (OCULOMOTOR) III C7 LPS
180
III CN III (OCULOMOTOR) CN IV (TROCLEAR) C7 CN VI (ABDUCENT) IO SR MR
SO IR LR CN VI (ABDUCENT) CN IV (TROCLEAR) CN III (OCULOMOTOR) III C7 LPS
181
III CN III (OCULOMOTOR) CN IV (TROCLEAR) C7 CN VI (ABDUCENT) IO SR MR
SO IR LR CN VI (ABDUCENT) CN IV (TROCLEAR) CN III (OCULOMOTOR) III C7 LPS
182
34. WHICH NERVE PALSY PRODUCES AN UPWARD AND OUTWARD DEVIATION OF THE EYE?
A. OCULOMOTOR NERVE B. TROCHLEAR NERVE C. ABDUCENS NERVE D. SYMPATHETIC NERVE
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35. INTERNUCLEAR OPHTHALMOPLEGIA IS DUE TO A LESION OF THE:
A. VESTIBULAR NUCLEUS B. CRANIAL NERVE VIII C. MEDIAL LONGITUDINAL FASCICLE D. PARAPONTINE RETICULAR FORMATION
184
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INTERNUCLEAR OPHTHALMOPLEGIA
FIBERS FROM AREA 8 MLF CN III (MR) CN III (MR) CN VI (LR) CN VI (LR) PPRF PPRF
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35. INTERNUCLEAR OPHTHALMOPLEGIA IS DUE TO A LESION OF THE:
A. VESTIBULAR NUCLEUS B. CRANIAL NERVE VIII C. MEDIAL LONGITUDINAL FASCICLE D. PARAPONTINE RETICULAR FORMATION
188
36. ALL OF THE FOLLOWING ARE CHARACTERISTICS OF UNILATERAL INTERNUCLEAR OPHTHALMOPLEGIA EXCEPT:
A. INABILITY TO LOOK IN WITH THE ADDUCTING EYE B. NYSTAGMUS IN THE ABDUCTING EYE C. NORMAL CONVERGENCE D. FIBROSIS OF THE LATERAL RECTUS MUSCLE
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1 2 IO SR SR IO MR LPS LPS LR LR CN III (MR) IR IR SO SO IO SR SR IO
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36. ALL OF THE FOLLOWING ARE CHARACTERISTICS OF UNILATERAL INTERNUCLEAR OPHTHALMOPLEGIA, EXCEPT:
A. INABILITY TO LOOK IN WITH THE ADDUCTING EYE B. NYSTAGMUS IN THE ABDUCTING EYE C. NORMAL CONVERGENCE ( IN CONVERGENCE THE SIGNAL FOR THE ADDUCTION EYE DOES NOT TRAVEL IN THE MLF) D. FIBROSIS OF THE LATERAL RECTUS MUSCLE (DUANE SYNDROME, THE ADDUCTING EYE NEVER GO IN)
193
37. WHICH OF THE FOLLOWING MUSCLE IS AFFECTED IN A PATIENT WITH INTERNAL OPHTHALMOPLEGIA?
A. DILATOR OF THE PUPIL B. SPHINCTER OF THE PUPIL C. LEVATOR PALPEBRAE SUPERIORIS D. MUSCLE OF MULLER
194
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INTERNAL OPHTHALMOPLEGIA
ONLY THE PUPIL ! BRAIN PRETECTAL NUCLEUS The stimulus that triggers the release of acetylcholine by the parasympathetic fibers is light. The light travels unilaterally in the optic nerve of each eye until the optic chiasm. The optic nerves are represented by the purple and blue solid lines arising from the circles representing the eyes. At the level of the chiasm the fibers from each optic nerve divide and decussate. They are represented in this cartoon by the broken purple and blue lines. After decussating the fibers proceed backwards as the optic tract to reach the pretectal nuclei. The pretectal nuclei are represented as round gray structures in the brain and midbrain drawings. Fibers of the pretectal nuclei travel to the ipsilateral and contralateral Edinger-Westphal nuclei. In the brainstem drawings the ipsilateral connections from the pretectal nuclei to the Edinger-Westphal nuclei are represented by solid light blue and pink lines; whereas the contralateral connections are represented by broken lines of the same colors. The Edinger Westphal nuclei is represented as a green round structure in the brain drawing and as two semicircular structure in the midbrain drawings. It is worth noticing that by virtue of the decussation of the nasal fibers at the optic chiasm the light reaching the each Edinger Westphal nuclei is from both eyes. The fibers from the neurons in the Edinger Westphal travel with those of most of the extraocular muscle in the third nerve. The third nerve fibers travels through the midbrain forming the third nerve fascicle. The fascicle passes through the red nucleus and cerebral peduncle. It travels through the subarachnoid space into the cavernous sinus and enters the orbit through the superior orbital fissure. Ultimately, the fibers from the nucleus of Edinger-Westphal reach the ciliary ganglion and make contact with the neurons in these structures. The axons of the neurons in the ciliary ganglion reach the sphincter of the pupil via the inferior division of the oculomotor nerve. CILIARY GANGLION EDINGER-WESTPHAL NUCLEUS MIDBRAIN CN III
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* * BETTER RESPONSE TO NEAR THAN LIGHT ADIE’S TONIC PUPIL NORMAL TONIC
CILIARY GANGLION LESION, LEADING TO ABERRANT OF SPHINCTER MUSCLE INNERVATION BY NEURONS INTENDED TO INNERVATE THE CILIARY MUSCLE
198
III LPS CN III (OCULOMOTOR) MR IO SR IR SPHINCTER CN IV (TROCLEAR) SO
CN VI (ABDUCENT) LR IO SR SR IO MR LPS LPS LR LR IR IR SO SO HUTCHINSON PUPIL
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MIDBRAIN BETTER RESPONSE TO NEAR THAN LIGHT NORMAL ARGYLL ROBISON
PATHWAY FOR NEAR ACCOMMODATION PRETECTAL NUCLEUS EDINGER-WESTPHAL NUCLEUS PATHWAY FOR LIGHT MIDBRAIN
200
INTERNAL OPHTHALMOPLEGIA IS A CN III LESION THAT ONLY AFFECTS THE PUPIL, THERE ARE TWO INTERNAL OPHTHALMOPLEGIA SYNDROMES: (1) ADIE’S TONIC PUPIL AND (2) HUTCHINSON PUPIL ARGYLL ROBINSON PUPIL IS NOT CONSIDERED AN INTERNAL OPHTHALMOPLEGIA BECAUSE ALTHOUGH IT HAS POOR LIGHT REACTIVITY, IT IS NOT ASSOCIATED WITH CN III DYSFUNCTION
201
37. WHICH OF THE FOLLOWING MUSCLE IS AFFECTED IN A PATIENT WITH INTERNAL OPHTHALMOPLEGIA?
A. DILATOR OF THE PUPIL B. SPHINCTER OF THE PUPIL C. LEVATOR PALPEBRAE SUPERIORIS D. MUSCLE OF MULLER
202
38. WHICH OF THE FOLLOWING MUSCLE IS NOT AFFECTED IN A PATIENT WITH EXTERNAL OPHTHALMOPLEGIA?
A. MEDIAL RECTUS B. SPHINCTER OF THE PUPIL C. SUPERIOR OBLIQUE D. INFERIOR RECTUS
203
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III LPS CN III (OCULOMOTOR) MR IO SR IR CN IV (TROCLEAR) SO C7
CN VI (ABDUCENT) LR IO SR SR IO MR LPS LPS LR LR IR IR SO SO
206
38. WHICH OF THE FOLLOWING MUSCLE IS NOT AFFECTED IN A PATIENT WITH EXTERNAL OPHTHALMOPLEGIA?
A. MEDIAL RECTUS B. SPHINCTER OF THE PUPIL C. SUPERIOR OBLIQUE D. INFERIOR RECTUS EXTERNAL OPHTHALMOPLEGIA: PTOSIS AND PARALYSIS OF ALL EXTRAOCULAR EYE MUSCLES
207
39. VERTICAL NYSTAGMUS AND VERTICAL DISPLACEMENT OF THE EYE IS ALWAYS ABNORMAL.
A. TRUE B. FALSE
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YES, THEY ARE!
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39. VERTICAL NYSTAGMUS AND VERTICAL DISPLACEMENT OF THE EYE IS ALWAYS ABNORMAL.
A. TRUE B. FALSE
212
40. THE MOTOR FUNCTION OF THE TRIGEMINAL NERVE IS TESTED BY EXAMINATION OF THE FOLLOWING MUSCLES EXCEPT: A. MASSETERS (JAW JERK) B. PTERYGOID C. TEMPORALIS MUSCLE D. DEPRESSOR ANGULARIS ORIS
213
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ABSENCE OF THE DEPRESSOR ANGULI ORIS (LEFT)
NORMAL GENERAL EVALUATION NORMAL NEUROLOGICAL EVALUATION AFFECTED SIDE OF THE LIP IS INVERTED
216
40. THE MOTOR FUNCTION OF THE TRIGEMINAL NERVE IS TESTED BY EXAMINATION OF THE FOLLOWING MUSCLES, EXCEPT: A. MASSETERS (JAW JERK) B. PTERYGOID C. TEMPORALIS MUSCLE D. DEPRESSOR ANGULARIS ORIS (THIS MUSCLE IS INNERVATED BY THE FACIAL NERVE)
217
41. AT WHAT AGE WILL AN INFANT START TO LOOK IN THE DIRECTION OF THE SOUND SOURCE?
A. 3 MONTHS B. 6 MONTHS C. 9 MONTHS D. 18 MONTHS
218
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COOS LAUGHS 3
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41. AT WHAT AGE WILL AN INFANT START TO LOOK IN THE DIRECTION OF THE SOUND SOURCE?
A. 3 MONTHS B. 6 MONTHS C. 9 MONTHS D. 18 MONTHS
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42. DOLL’S EYE MANEUVER DEMONSTRATES COMPLETE EYE MOVEMENTS AS EARLY AS:
A. 22 WEEKS GA B. 25 WEEKS GA C. 33 WEEKS GA D. 35 WEEKS GA
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DOLL’S MANEUVERS BIRTH LEFT GA 24 25 26 27 28 29 30 W CN III (MR) + +
CN VI 5 15 D + BIRTH CN VIII R + C7 LEFT
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42. DOLL’S EYE MANEUVER DEMONSTRATES COMPLETE EYE MOVEMENTS AS EARLY AS:
A. 22 WEEKS B. 25 WEEKS C. 33 WEEKS D. 35 WEEKS
227
43. A RUPTURED TYMPANIC MEMBRANE IS A CONTRAINDICATION FOR CALORIC TESTING.
A. TRUE B. FALSE
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LATERAL (HORIZONTAL) SUPERIOR: (ROTATORY) POSTERIOR: (VERTICAL) VESTIBULAR GANGLION CN VIII (AUDITORY) UTRICULE DIRTY WATER (INFECTION) TYMPANIC MEMBRANE CN VII CN VIII (VESTIBULAR)
231
43. A RUPTURED TYMPANIC MEMBRANE IS A CONTRAINDICATION FOR CALORIC TESTING.
A. TRUE B. FALSE
232
44. THE PATIENT’S HEAD SHOULD BE ELEVATED ___ DEGREES FOR COLD CALORIC TESTING.
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LATERAL (HORIZONTAL) SUPERIOR: (ROTATORY) POSTERIOR: (VERTICAL) VESTIBULAR GANGLION CN VIII (AUDITORY) UTRICULE TYMPANIC MEMBRANE CN VII CN VIII (VESTIBULAR)
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B A C B LATERAL (HORIZONTAL) PATIENT LOOKING AT YOU
PATIENT LOOKING TO HIS LEFT C B PATIENT FLAT IN BED
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30 O A B PATIENT FLAT IN BED PATIENT HEAD ELEVATED
238
44. THE PATIENT’S HEAD SHOULD BE ELEVATED ___ DEGREES FOR COLD CALORIC TESTING.
239
45. A HOARSE VOICE AND A WEAK GAG MAYBE A SIGN OF CN ___ INJURY.
A. IX B. X C. XII D. XIII
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GAG IX X C7 X IX XII b XII X X VOCAL CORD
243
45. A HORSE VOICE AND A WEAK GAG MAYBE A SIGN OF CN ___ INJURY.
A. IX B. X C. XII D. XIII
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46. WHICH OF THE FOLLOWING SET OF CRANIAL NERVES CAN BE INJURED BY ANOMALIES IN THE REGION OF THE FORAMEN MAGNUM? A. V, IX B. XI, X C. VIII, XII D. XI, XII
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FORAMEN MAGNUM SYNDROME
MIDBRAIN CN XII CN XI PONS CN X MEDULLA CN IX JUGULAR FORAMEN SYNDROME CERVICAL SPINE JUGULAR FORAMEN FORAMEN MAGNUM
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46. WHICH OF THE FOLLOWING SET OF CRANIAL NERVES CAN BE INJURED BY ANOMALIES IN THE REGION OF THE FORAMEN MAGNUM? A. V, IX B. XI, X C. VIII, XII D. XI, XII THE MOST FREQUENT ANOMALY IN THE REGION OF THE FORAMEN MAGNUM IS CHIARI TYPE I
249
47. CHILD COOPERATION FOR DIRECT MUSCLE TESTING IS USUALLY PRESENT BY?
A. 6 MONTHS B. 1-2 YEARS C. 3-4 YEARS D. 2½ YEARS
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1 2 3 4 5 6 Y NEUROLOGICAL EXAMINATION 1/4 1/2 3/4
AGE THAT A CHILD COOPERATES FOR DIRECT MUSCLE TESTING 1 2 3 4 5 6 Y 1/4 1/2 3/4 OBSERVATION REFLEX & REACTION PLAYING COMMANDS & IMITATING
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47. CHILD COOPERATION FOR DIRECT MUSCLE TESTING IS USUALLY PRESENT BY?
A. 6 MONTHS B. 1-2 YEARS C. 3-4 YEARS D. 2½ YEARS
254
48. THE USE OF THE HANDS TO CLIMB UP THE LEGS TO STAND UP IS CALLED?
A. MELLER LOOP B. GOWERS SIGN C. BABINSKI SIGN D. LOUPE SIGN
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GOWERS SIGN
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48. THE USE OF THE HANDS TO CLIMB UP THE LEGS TO STAND UP IS CALLED?
A. MELLER LOOP B. GOWERS SIGN C. BABINSKI SIGN D. LOUPE SIGN
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49. A MUSCLE THAT SHOWS ACTIVE MOVEMENT AGAINST GRAVITY BUT NOT AGAINST RESISTANCE, SHOULD BE GRADED? A. 2 B. 3 C. 4 D. 5
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0: NO CONTRACTION 1: TRACE OF CONTRACTION 2: ACTIVE MOVEMENTS, NO GRAVITY (G) 3: ACTIVE MOVEMENTS AGAINST G 4: MOVEMENT AGAINST RESISTANCE & G 5: NORMAL POWER
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49. A MUSCLE THAT SHOWS ACTIVE MOVEMENT AGAINST GRAVITY BUT NOT AGAINST RESISTANCE, SHOULD BE GRADED? A. 2: ACTIVE MOVEMENTS, NO GRAVITY (G) B. 3: ACTIVE MOVEMENTS AGAINST G C. 4: MOVEMENT AGAINST RESISTANCE & G D. 5: NORMAL POWER
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50. THE BEST MUSCLE TO SEE FASCICULATION IS THE _____.
A. BICEPS B. QUADRICEPS C. TRICEPS D. TONGUE
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GAG NO SUBCUTANEOUS FAT IX X XII IX X XII PAIN, TEMP & TOUCH TASTE IX
V VII IX X C7 X IX XII b XII NO SUBCUTANEOUS FAT
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50. THE BEST MUSCLE TO SEE FASCICULATION IS THE _____.
A. BICEPS B. QUADRICEPS C. TRICEPS D. TONGUE
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51. MUSCLE TONE: THE DEGREE OF RESISTANCE OF A MUSCLE WHEN AN INDIVIDUAL JOINT IS MOVED PASSIVELY.
A. TRUE B. FALSE
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MUSCLE TONE: THE DEGREE OF RESISTANCE OF A MUSCLE WHEN AN INDIVIDUAL JOINT IS MOVED PASSIVELY
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51. MUSCLE TONE: THE DEGREE OF RESISTANCE OF A MUSCLE WHEN AN INDIVIDUAL JOINT IS MOVED PASSIVELY?
A. TRUE B. FALSE
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52. AT TERM, DURING THE SCARF TEST THE ELBOW NORMALLY REACHES THE MIDSTERNUM.
A. TRUE B. FALSE
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28 30 32 34 36 38 40
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40 SHOULDER JOINT BECOMES LESS ADDUCEABLE WITH TIME
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52. AT TERM, THE ELBOW NORMALLY DOES REACH MIDSTERNUM DURING THE SCARF TEST.
A. TRUE B. FALSE 40 SHOULDER JOINT BECOMES LESS ADDUCEABLE WITH TIME
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53. TASTE OF THE ANTERIOR TWO THIRD OF THE TONGUE IS MEDIATED BY:
A. CN IX B. CN V C. CN VII D. CN XII
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PAIN, TEMP & TOUCH TASTE GAG X IX XII IX IX V VII C7 X IX XII b
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53. TASTE OF THE ANTERIOR TWO THIRD OF THE TONGUE IS MEDIATED BY:
A. CN IX B. CN V C. CN VII D. CN XII
285
54. AT WHAT GESTATIONAL AGE DOES THE POPLITEAL ANGLE REACH 80 DEGREE?
A. 24 WEEKS B. 32 WEEKS C. 34 WEEKS D. 40 WEEKS
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28 30 32 34 36 38 40
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THE KNEE BECOMES LESS EXTENDABLE WITH TIME
110 80 40
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54. AT WHAT GESTATIONAL AGE DOES THE POPLITEAL ANGLE REACH 80 DEGREE?
A. 24 WEEKS B. 32 WEEKS C. 34 WEEKS D. 40 WEEKS
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55. INITIAL RESISTANCE TO PASSIVE MOVEMENTS FOLLOWED BY A SUDDEN RELEASE (CLASP-KNIFE PHENOMENON).
A. SPASTICITY B. CLONUS C. RIGIDITY D. OPISTHOTONOS
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SPASTICITY
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55. INITIAL RESISTANCE TO PASSIVE MOVEMENTS FOLLOWED BY A SUDDEN RELEASE (CLASP-KNIFE PHENOMENON).
A. SPASTICITY B. CLONUS C. RIGIDITY D. OPISTHOTONOS
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56. A NORMAL NEONATE CAN HAVE 5 TO 10 BEATS OF CLONUS IN ONE FOOT AND NONE IN THE OTHER.
A. TRUE B. FALSE
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SYMMETRICAL UP TO 10 BEATS CAN BE NORMAL BUT THEY MUST BE SYMMETRICAL
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56. A NORMAL NEONATE CAN HAVE 5 TO 10 BEATS OF CLONUS IN ONE FOOT AND NONE IN THE OTHER?
A. TRUE B. FALSE
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57. COGWHEEL RIGIDITY IS A SIGN OF?
A. PYRAMIDAL TRACT DYSFUNCTION B. CEREBELLAR DYSFUNCTION C. BASAL GANGLIA DYSFUNCTION D. ANTERIOR HORN CELL DYSFUNCTION
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BASAL GANGLIA RIGIDITY (COGWHEEL) CHOREA & ATHETOSIS DYSTONIA
CORPUS STRIATUM BASAL GANGLIA CAUDATE NUCLEUS LENTIFORM NUCLEUS PUTAMEN GLOBUS PALLIDUS CLAUSTRUM AMYGDALA CAUDATE NUCLEUS + PUTAMEN = NEOSTRIATUM GLOBUS PALLIDUS = PALEOSTRIATUM (PALLIDUM) RIGIDITY (COGWHEEL) BASAL CHOREA & ATHETOSIS GANGLIA DYSTONIA
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57. COGWHEEL RIGIDITY IS A SIGN OF?
A. PYRAMIDAL TRACT DYSFUNCTION B. CEREBELLAR DYSFUNCTION C. BASAL GANGLIA DYSFUNCTION D. ANTERIOR HORN CELL DYSFUNCTION THE NUCLEI INCLUDED AS BEING PART OF THE BASAL GANGLIA CHANGES FROM BOOK TO BOOK
306
58. WHICH POSTURE WOULD BE EXPECTED IN A 28 WEEK CA INFANT?
A. EXTENSION IN ALL EXTREMITIES B. LOWER EXTREMITIES FLEXION C. FLEXION IN ALL EXTREMITIES D. NONE OF THE ABOVE
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309
28 30 32 34 36 38 40
310
58. WHICH POSTURE WOULD BE EXPECTED IN A 28 WEEK CA INFANT?
A. EXTENSION IN ALL EXTREMITIES B. LOWER EXTREMITIES FLEXION C. FLEXION IN ALL EXTREMITIES D. NONE OF THE ABOVE NOTE THAT THE NEONATE GOES FROM AN EXTENDED CREATURE TO A FLEXED CREATURE; AND THAT THE LEGS FLEX SOONER THAN THE ARMS
311
59. CEREBELLAR VERMIS DAMAGE PRODUCES:
A. LIMB ATAXIA B. TRUNCAL ATAXIA C. INTENTIONAL LIMB TREMOR D. FINGER TO NOSE TEST ABNORMALITIES
312
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CEREBELLAR FINDINGS VERTIGO TRUNCAL ATAXIA LIMB ATAXIA TITUBATION
DYSDIADOCHOKINESIS NYSTAGMUS DYSRHYTHMOKINESIS TORTICOLLIS KINETIC TREMOR STATIC TREMOR BROAD-BASED GAIT DYSARTHRIA DYSMETRIA NYSTAGMUS CEREBELLAR FINDINGS VERTIGO
315
59. CEREBELLAR VERMIS DAMAGE PRODUCES:
A. LIMB ATAXIA B. TRUNCAL ATAXIA C. INTENTIONAL LIMB TREMOR D. FINGER TO NOSE TEST ABNORMALITIES
316
60. DAMAGE (TRANSECTION) OF THE BRAINSTEM ABOVE THE LEVEL OF THE SUPERIOR COLLICULI IS MOST LIKELY TO PRODUCE? A. OPISTHOTONUS B. DECORTICATE RIGIDITY C. DECEREBRATE RIGIDITY D. ALL OF THE ABOVE
317
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318
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319
RED NUCLEUS DECORTICATE RIGIDITY
320
* * DECEREBRATE RIGIDITY SUPERIOR COLLICULI RED NUCLEUS
WILL DISAPPEAR IF DORSAL ROOT IS CUT * DECEREBRATE RIGIDITY VESTIBULAR NUCLEUS
321
60. DAMAGE (TRANSECTION) OF THE BRAINSTEM ABOVE THE LEVEL OF THE SUPERIOR COLLICULI IS MOST LIKELY TO PRODUCE? A. OPISTHOTONUS (NOT RELATED TO ANATOMICAL SITE OF LESION) B. DECORTICATE RIGIDITY C. DECEREBRATE RIGIDITY D. ALL OF THE ABOVE
322
61. ALL OF THE FOLLOWING ARE SIGNS OF CEREBELLAR DYSFUNCTION, EXCEPT?
A. DYSMETRIA B. ROMBERG SIGN C. REBOUND D. DYSDIADOCHOKINESIA
323
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INTENTIONAL TREMOR DYSDIADOCHOKINESIA DYSMETRIA REBOUND TRUNCAL ATAXIA
TRANSIENT MUTISM MAY OCCUR AFTER EXTENSIVE CEREBELLAR SURGERY WITH BILATERAL MANIPULATION; DYSARTHRIA
326
61. ALL OF THE FOLLOWING ARE SIGNS OF CEREBELLAR DYSFUNCTION, EXCEPT?
A. DYSMETRIA B. ROMBERG SIGN (SPINAL CORD OR SENSORY NERVE ABNORMALITY) C. REBOUND D. DYSDIADOCHOKINESIA
327
62. CHOREA IS CHARACTERIZED BY ALL OF THE FOLLOWING, EXCEPT:
A. MILK MAID SIGN AND FLAPPING HANDS B. JUMPING JACK TONGUE C. HANG UP REFLEX D. TENDENCY TO SUPINATE THE EXTENDED ARM
328
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329
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330
PRONATE THE EXTENDED ARM
331
62. CHOREA IS CHARACTERIZED BY ALL OF THE FOLLOWING, EXCEPT:
A. MILK MAID SIGN AND FLAPPING HANDS B. JUMPING JACK TONGUE C. HANG UP REFLEX D. TENDENCY TO SUPINATE THE EXTENDED ARM TENDENCY TO PRONATE THE EXTENDED ARM
332
63. ALL THE FOLLOWING ARE SIGN OF BASAL GANGLIA DYSFUNCTION, EXCEPT
A. COGWHEEL RIGIDITY B. CHOREA AND ATHETOSIS C. REBOUND D. DYSTONIA
333
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334
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335
BASAL GANGLIA RIGIDITY (COGWHEEL) CHOREA & ATHETOSIS DYSTONIA
CORPUS STRIATUM BASAL GANGLIA CAUDATE NUCLEUS LENTIFORM NUCLEUS PUTAMEN GLOBUS PALLIDUS CLAUSTRUM AMYGDALA CAUDATE NUCLEUS + PUTAMEN = NEOSTRIATUM GLOBUS PALLIDUS = PALEOSTRIATUM (PALLIDUM) RIGIDITY (COGWHEEL) BASAL CHOREA & ATHETOSIS GANGLIA DYSTONIA
336
INTENTIONAL TREMOR DYSDIADOCHOKINESIA DYSMETRIA REBOUND TRUNCAL ATAXIA
337
63. ALL THE FOLLOWING ARE SIGN OF BASAL GANGLIA DYSFUNCTION, EXCEPT
A. COGWHEEL RIGIDITY B. CHOREA AND ATHETOSIS C. REBOUND D. DYSTONIA
338
64. CROSS ADDUCTOR RESPONSE IS NORMAL UNTIL?
A. 6-7 MONTHS B. 1-2 YEARS C. 3-4 YEARS D. 2 ½ YEARS
339
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340
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DTRs Musculocu- taneous C 5-6 BICEPS Radial BRACHIORADIALIS C 5-6
TRICEPS Femoral QUADRICEPS L 3-4 Tibial UP TO 6-7 M GASTROCNEMIUS SOLEUS S 1-2
342
64. CROSS ADDUCTOR RESPONSE IS NORMAL UNTIL?
A. 6-7 MONTHS B. 1-2 YEARS C. 3-4 YEARS D. 2 ½ YEARS
343
65. INCREASED DEEP TENDON REFLEXES ARE MORE LIKELY TO OCCUR WITH ____ DYSFUNCTION?
A. MYONEURAL JUNCTION B. CEREBELLUM C. CEREBRAL D. NERVE
344
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345
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346
DEEP TENDON REFLEXES
347
65. INCREASED DEEP TENDON REFLEXES ARE MORE LIKELY TO OCCUR WITH ____ DYSFUNCTION?
A. MYONEURAL JUNCTION B. CEREBELLUM C. CEREBRAL D. NERVE
348
66. MOST INFANT SHOW INITIAL ____ OF THE GREAT TOE ON PLANTAR STIMULATION.
A. FLEXION B. EXTENSION C. PRONATION D. SUPINATION
349
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350
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351
INFANT BABINSKI SIGN
352
66. MOST INFANT SHOW INITIAL ____ OF THE GREAT TOE ON PLANTAR STIMULATION.
A. FLEXION B. EXTENSION C. PRONATION D. SUPINATION
353
67. AN ASYMMETRICAL MORO REFLEX MAY SIGNIFY ALL OF THE FOLLOWING EXCEPT?
A. FRACTURED CLAVICLE B. BRACHIAL PLEXUS INJURY C. HEMIPARESIS D. SPASTIC QUADRIPARESIS
354
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355
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356
QUADRI- HEMI- PARA- MONO- DI- = BILATERAL (CORRESPONDING LIMB OR FACE -PLEGIA = PARALYSIS -PARESIS = WEAKNESS
357
67. AN ASYMMETRICAL MORO REFLEX MAY SIGNIFY ALL OF THE FOLLOWING EXCEPT?
A. FRACTURE CLAVICLE (PAIN !) B. BRACHIAL PLEXUS INJURY C. HEMIPARESIS D. SPASTIC QUADRIPARESIS
358
68. PALMAR GRASP IS FIRST ELICITED BY ___ WEEKS OF GESTATION?
359
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360
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361
PALMAR GRASP REFLEX & NECK TRACTION RESPONSE
41 37 35 32 28 26
362
PALMAR GRASP REFLEX FACILITATED BY SUCKING BILATERAL ACUTE: DECREASED
3 M 6 W GA ONSET FULLY BILATERAL ACUTE: DECREASED CHRONIC: DECREASED UNILATERAL WEAKNESS
363
68. PALMAR GRASP IS FIRST ELICITED BY ___ WEEKS OF GESTATION?
364
69. AN OBLIGATORY ASYMMETRICAL TONIC NECK RESPONSE IS NORMAL AT 1 MONTH OF AGE.
A. TRUE B. FALSE
365
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* ASYMMETRICAL TONIC NECK REFLEX ABNORMAL IF OBLIGATORY BY EXAMINER
35 W GA * FULLY ABNORMAL IF OBLIGATORY 3 6 7 M
368
69. AN OBLIGATORY ASYMMETRICAL TONIC NECK RESPONSE IS NORMAL AT 1 MONTH OF AGE?
A. TRUE B. FALSE
369
70. THE PARACHUTE REFLEX COULD BE PRESENT AS EARLY AS?
A MONTHS B MONTHS C MONTHS D. 18 MONTHS
370
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371
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PARACHUTE REFLEX 6 M 12 FULLY 3 9
373
70. THE PARACHUTE REFLEX SHOULD BE PRESENT AS EARLY AS?
A. 7-8 MONTHS B MONTHS C MONTHS D. 18 MONTHS
374
71. THE ROOTING REFLEX SHOULD BE FULLY ESTABLISHED AS EARLY AS?
A. 32 WEEKS B. 34 WEEKS C. 36 WEEKS D. 38 WEEKS
375
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376
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377
ROOTING REFLEX * 3 4 W GA FULLY 1 * FROM NELSON’S
378
* * MANEUVER FOR GLABELLA REFLEX AND ROOTING REFLEX
26 32 38 44 50 56 W CA 25 50 75 % RESULTS IN FULL TERM (FT) * FROM S. SAINT-ANNE DARGASSIES AND OTHERS
379
71. THE ROOTING REFLEX SHOULD BE PRESENT AS EARLY AS?
A. 36 WEEKS B. 34 WEEKS C. 32 WEEKS D. 38 WEEKS
380
72. THE MORO REFLEX SHOULD DISAPPEAR BY?
A. 7-8 MONTHS B. 5-6 MONTHS C MONTHS D. 18 MONTHS
381
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382
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383
MORO EXTENSION REFLEX W GA FULLY 3 6 M
384
72. THE MORO REFLEX SHOULD DISAPPEAR BY?
A. 7-8 MONTHS B. 5-6 MONTHS C MONTHS D. 18 MONTHS
385
73. CHILD COOPERATION FOR FULL SENSORY TESTING IS USUALLY PRESENT BY?
A. 4-5 YEARS B. 1-2 YEARS C. 2-4 YEARS D. 2 ½ YEARS
386
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387
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388
1 2 3 4 5 6 Y NEUROLOGICAL EXAMINATION 1/4 1/2 3/4
AGE THAT A CHILD COOPERATES FOR DIRECT SENSORY TESTING 1 2 3 4 5 6 Y 1/4 1/2 3/4 OBSERVATION REFLEX & REACTION PLAYING COMMANDS & IMITATING
389
73. CHILD COOPERATION FOR FULL SENSORY TESTING IS USUALLY PRESENT BY?
A. 4-5 YEARS B. 1-2 YEARS C. 2-4 YEARS D. 2 ½ YEARS
390
74. CIRCUMDUCTION GAIT IS A SIGN OF?
A. PARAPARESIS B. QUADRIPARESIS C. HEMIPARESIS D. UPPER ARM DIPLEGIA
391
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392
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393
WEAKNESS CIRCUMDUCTION GAIT
394
74. CIRCUMDUCTION GAIT IS A SIGN OF?
A. PARAPARESIS B. QUADRIPARESIS C. HEMIPARESIS D. UPPER ARM DIPLEGIA
395
75. A WADDLING GAIT IS DUE TO WEAKNESS OF THE:
A. TRUNK MUSCLES B. PROXIMAL LOWER LIMB MUSCLES C. DISTAL LOWER LIMB MUSCLES D. FACIAL MUSCLES
396
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397
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398
SIGNS DUE TO WEAKNESS TRUNK MUSCLES (SCOLIOSIS)
PROXIMAL LOWER LIMB MUSCLES (WADDLING) DISTAL LOWER LIMB MUSCLES (FOOT DROP) FACIAL MUSCLES (FACIAL DIPLEGIA)
399
75. A WADDLING GAIT IS DUE TO WEAKNESS OF THE:
A. TRUNK MUSCLES B. PROXIMAL LOWER LIMB MUSCLES C. DISTAL LOWER LIMB MUSCLES D. FACIAL MUSCLES
400
76. SCOLIOSIS MAY BE DUE TO WEAKNESS OF THE?
A. TRUNK MUSCLES B. PROXIMAL LOWER LIMB MUSCLES C. DISTAL LOWER LIMB MUSCLES D. FACIAL MUSCLES
401
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402
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403
SIGNS DUE TO WEAKNESS TRUNK MUSCLES (SCOLIOSIS)
PROXIMAL LOWER LIMB MUSCLES (WADDLING) DISTAL LOWER LIMB MUSCLES (FOOT DROP) FACIAL MUSCLES (FACIAL DIPLEGIA)
404
76. SCOLIOSIS MAY BE DUE TO WEAKNESS OF THE?
A. TRUNK MUSCLES B. PROXIMAL LOWER LIMB MUSCLES C. DISTAL LOWER LIMB MUSCLES D. FACIAL MUSCLES
405
77. PROXIMAL LOWER LIMB MUSCLES WEAKNESS MAY MANIFEST BY ALL OF THE POSSIBILITIES BELOW EXCEPT:
A. DIFFICULTY CLIMBING STAIRS B. COMPENSATORY LORDOSIS C. GOWER SIGN D. FLAT FEET
406
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407
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408
GOWER SIGN
409
77. PROXIMAL LOWER LIMB MUSCLES WEAKNESS MAY MANIFEST BY ALL OF THE ABOVE, EXCEPT:
A. DIFFICULTY CLIMBING STAIRS B. COMPENSATORY LORDOSIS C. GOWER SIGN D. FLAT FEET
410
78. POOR HEEL TO TOE OR TANDEM WALKING OCCURS WITH:
A. PROXIMAL WEAKNESS B. CEREBELLAR DISEASE C. BRAIN DISEASE D. ALL OF THE ABOVE
411
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412
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413
CEREBELLAR FINDINGS VERTIGO MUTISM TRUNCAL ATAXIA LIMB ATAXIA
TITUBATION DYSDIADOCHOKINESIS NYSTAGMUS DYSRHYTHMOKINESIS TORTICOLLIS KINETIC TREMOR STATIC TREMOR BROAD-BASED GAIT DYSARTHRIA DYSMETRIA NYSTAGMUS CEREBELLAR FINDINGS VERTIGO
414
78. POOR HEAL TO TOE OR TANDEM WALKING OCCURS WITH:
A. PROXIMAL WEAKNESS B. CEREBELLAR DISEASE C. BRAIN DISEASE D. ALL OF THE ABOVE
415
79. A 9 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING EXCEPT:
A. SIT MOMENTARILY B. USE PINCER GRASP C. COME WHEN CALLED D. PLAY PAT-A-CAKE
416
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417
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418
COOS BABBLES LAUGHS 3 6 MA…PA MA…PA PA… MA PA… MA 9
419
12 18 MOMMY GIVE TO MOMMY ! PAPA COME TO MOMMY !
MAMMY, PAPA, YES, NO, CAT 18
420
79. A 9 MONTHS OLD SHOULD BE EXPECTED TO DO ALL OF THE FOLLOWING, EXCEPT:
A. SIT MOMENTARILY B. USE PINCER GRASP C. COME WHEN CALLED D. PLAY PAT-A-CAKE
421
80. AT WHAT AGE DO MOST CHILDREN START RIDING A TRICYCLE?
A. 1 YEAR B. 2 YEARS C. 3 YEARS D. 4 YEARS
422
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423
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424
GIVE ME COOKY 24
425
18 9 12 36 24 30 6 3
426
80. AT WHAT AGE DO MOST CHILDREN SART RIDING A TRICYCLE?
A. 1 YEAR B. 2 YEARS C. 3 YEARS D. 4 YEARS
427
81. FEAR OF DARKNESS USUALLY STARTS BY :
A. 1 YEAR B. 2 YEARS C. 3 YEARS D. 4 YEARS
428
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429
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FEARS Sexuality Social performance Death Reality (tests) Media events
Fantasy (ghost) Bodily harm Darkness TEENS Animal, masks Separation Stranger, height Loss support, noise FEARS 1 2 3 4 5 6 7 8 9 10 11 12 Y
431
81. FEAR OF DARKNESS USUALLY STARTS BY :
A. 1 YEAR B. 2 YEARS C. 3 YEARS D. 4 YEARS
432
82. AT WHAT AGE DO MOST CHILDREN START COPYING A TRIANGLE?
A. 2 YEAR B. 3 YEARS C. 4 YEARS D. 5 YEARS
433
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434
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435
* * * 15 18 24 30 36 48 60 ADAPTIVE BEHAVIOR MONTHS 9 CAN TELL BETWEEN
2g 3 1g 2 15 18 24 30 36 48 60 MONTHS
436
82. AT WHAT AGE DO MOST CHILDREN START COPPING A TRIANGLE :
A. 2 YEAR B. 3 YEARS C. 4 YEARS D. 5 YEARS
437
83. AT WHAT AGE DO MOST CHILDREN START THROWING A BALL OVERHAND?
A. 2 YEAR B. 3 YEARS C. 4 YEARS D. 5 YEARS
438
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439
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440
BLUE GREEN COUNTS TO 4 RED YELLOW COUNTS TO 10 48 60
441
83. AT WHAT AGE DO MOST CHILDREN START THROWING A BALL OVERHAND:
A. 3 YEAR B. 3 YEARS C. 4 YEARS D. 5 YEARS
442
84. A CHILD WHO IS ABLE TO OPEN HIS HANDS SPONTANEOUSLY, COOS AND LAUGHS, CLIMB AND TELL WHICH LINE IS LONGER, BUT IS UNABLE TO TELL WHICH OBJECT IS HEAVIER SHOULD BE: A. 5 YEARS B. 4 YEARS C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
443
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444
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445
BLUE GREEN COUNTS TO 4 RED YELLOW COUNTS TO 10 48 60
446
* * * 15 18 24 30 36 48 60 ADAPTIVE BEHAVIOR MONTHS 9 CAN TELL BETWEEN
2g 3 1g 2 15 18 24 30 36 48 60 MONTHS
447
84. A CHILD WHO IS ABLE TO OPENS HIS HANDS SPONTANEOUSLY, COOS AND LAUGHS, CLIMBS AND TELL WHICH LINE IS LONGER, BUT IS UNABLE TO TELL WHICH OBJECT IS HEAVIER SHOULD BE: A. 5 YEARS B. 4 YEARS C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
448
85. A CHILD WHO IS ABLE TO OPEN HANDS SPONTANEOUSLY, COOS AND LAUGHS, CLIMB AND TELL WHICH LINE IS LONGER, BUT IS UNABLE TO NAME 4 COLORS PROBABLY IS: A. 5 YEARS B. 4 YEARS C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
449
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450
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451
48 60 BLUE GREEN RED YELLOW COUNTS TO 4 COUNTS TO 10
TO THE TOILET ALONE 60
452
* * * 15 18 24 30 36 48 60 ADAPTIVE BEHAVIOR MONTHS 9 CAN TELL BETWEEN
2g 3 1g 2 15 18 24 30 36 48 60 MONTHS
453
85. A CHILD WHO IS ABLE TO OPEN HIS HANDS SPONTANEOUSLY, COOS AND LAUGHS, CLIMB AND TELL WHICH LINE IS LONGER, BUT IS UNABLE TO NAME 4 COLORS PROBABLY IS: A. 5 YEARS B. 4 YEARS C. 9 MONTHS OF AGE D. 12 MONTHS OF AGE
454
86. AT WHAT AGE DO MOST CHILDREN START TO REFER TO THEMSELVES BY NAME?
A. 19 MONTHS B. 4 YEARS C. 2 YEARS D. 12 MONTHS
455
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456
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457
# SMILE TO SPEECH 1.5 M 6 M JARGON (1 syllable) 12 M FIRST WORD 1-3
EXPRESSIVE LANGUAGE WORD # SMILE TO SPEECH 1.5 M 6 M JARGON (1 syllable) 12 M FIRST WORD 1-3 19 M COMBINES 2 WORDS 24 M 272 TO SELF BY NAME COMBINES 3 WORDS 2 ½ Y COMBINES 4 WORDS 3 ½ Y
458
86. AT WHAT AGE DO MOST CHILDREN START TO REFER TO THEMSELVES BY NAME?
A. 19 MONTHS B. 4 YEARS C. 2 YEARS D. 12 MONTHS
459
% 75 50 25 1 2 3 4 5 6 7 8 9 10 11 12 M PT 87. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING PT E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
460
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461
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462
DISAPPEARS AS PER ILLINGWORTH’S
DISAPPEARS AS PER NELSON’S % 75 FROM K S HOLT 50 MORO REFLEX ATNR 25 SUPPORTING NECK-RIGHTING PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
463
% 75 50 25 1 2 3 4 5 6 7 8 9 10 11 12 M 87. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
464
% 75 50 25 1 2 3 4 5 6 7 8 9 10 11 12 M 88. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
465
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466
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467
DISAPPEARS AS PER ILLINGWORTH’S
DISAPPEARS AS PER NELSON’S % 75 FROM K S HOLT 50 MORO REFLEX ATNR 25 SUPPORTING NECK-RIGHTING PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
468
% 75 50 25 1 2 3 4 5 6 7 8 9 10 11 12 M 88. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
469
% 75 50 25 PT 1 2 3 4 5 6 7 8 9 10 11 12 M 89. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING PT E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
470
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471
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472
DISAPPEARS AS PER ILLINGWORTH’S
DISAPPEARS AS PER NELSON’S % 75 FROM K S HOLT 50 MORO REFLEX ATNR 25 SUPPORTING NECK-RIGHTING PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
473
% 75 50 25 PT 1 2 3 4 5 6 7 8 9 10 11 12 M 89. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING PT E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
474
% 75 50 25 PT 1 2 3 4 5 6 7 8 9 10 11 12 M 90. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING PT E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
475
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476
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477
DISAPPEARS AS PER ILLINGWORTH’S
DISAPPEARS AS PER NELSON’S % 75 FROM K S HOLT 50 MORO REFLEX ATNR 25 SUPPORTING NECK-RIGHTING PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
478
% 75 50 25 PT 1 2 3 4 5 6 7 8 9 10 11 12 M 90. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING PT E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
479
% 75 50 25 1 2 3 4 5 6 7 8 9 10 11 12 M 91. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
480
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481
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482
DISAPPEARS AS PER ILLINGWORTH’S
DISAPPEARS AS PER NELSON’S % 75 FROM K S HOLT 50 MORO REFLEX ATNR 25 SUPPORTING NECK-RIGHTING PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
483
% 75 50 25 1 2 3 4 5 6 7 8 9 10 11 12 M 91. TEMPORAL PATTERN OF:
A. MORO REFLEX B. ATNR 25 C. SUPPORTING D. NECK-RIGHTING E. PARACHUTE 1 2 3 4 5 6 7 8 9 10 11 12 M ATNR: ASYMMETRICAL TONIC NECK RESPONSE
484
92. THE HEAD CIRCUMFERENCE OF A TERM INFANT AT BIRTH USUALLY IS?
A CMS B CMS C CMS D CMS
485
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486
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HEAD GROWTH TERM 6-4 4-3 3-2 2-1 1 2 3 4 5 6 7 8 9 10 11 12 M 34-35 43
CMS 1 2 3 4 5 6 7 8 9 10 11 12 M 34-35 43 47 CMS
488
92. THE HEAD CIRCUMFERENCE OF A TERM INFANT AT BIRTH USUALLY IS?
A CMS B CMS C CMS D CMS
489
93. THE HEAD CIRCUMFERENCE OF A NORMAL TERM INFANT USUALLY GROWS __ FROM 6 MONTHS TO 1 YEAR?
A. 9 CMS B. 5 CMS C. 12 CMS D. 1 CM
490
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491
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492
HEAD GROWTH TERM 6-4 4-3 3-2 2-1 1 2 3 4 5 6 7 8 9 10 11 12 M 34-35 43
CMS 1 2 3 4 5 6 7 8 9 10 11 12 M 34-35 43 47 CMS
493
93. THE HEAD CIRCUMFERENCE OF A NORMAL TERM INFANT AT GROWS __ FROM 6 MONTHS TO 1 YEAR?
A. 9 CMS B. 5 CMS C. 12 CMS D. 1 CM
494
94. THE HEAD CIRCUMFERENCE OF A NORMAL PRETERM INFANT (CA: 30 WEEKS) USUALLY GROWS __ FROM 34 TO 40 WEEKS? A. 9 CMS B. 6 CMS C. 3 CMS D. 1 CM
495
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HEAD GROWTH PRETERM 0.5 0.75 1/W 1 2 3 4 5 W UP TO 35 CMS BY 40 WEEKS
1 2 3 4 5 W UP TO 35 CMS BY 40 WEEKS
498
94. THE HEAD CIRCUMFERENCE OF A NORMAL PRETERM INFANT (GA: 30 WEEKS) USUALLY GROWS __ FROM 34 TO 40 WEEKS? A. 9 CMS B. 6 CMS C. 3 CMS D. 1 CM
499
95. THE HEAD CIRCUMFERENCE OF A NORMAL PRETERM INFANT (GA: 30 WEEKS) SHOULD GROW __ BY 32 WEEKS?
A. 9 CMS B. 6 CMS C. 3 CMS D. 1 CM
500
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501
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502
HEAD GROWTH PRETERM 0.5 0.75 1/W CMS 1 2 3 4 5 W 40 GA
503
95. THE HEAD CIRCUMFERENCE OF A NORMAL PRETERM INFANT (GA: 30 WEEKS) SHOULD GROW ABOUT __ BY 33 WEEKS? A. 9 CMS B. 6 CMS C. 3 CMS D. 1 CM
504
96. ALL OF THE FOLLOWING FEATURES CHARACTERIZE HYSTERICAL BLINDNESS, EXCEPT:
NORMAL FUNDUSCOPIC EXAMINATION B. PRESERVATION OF PUPILLARY LIGHT RESPONSE C. LACK OF OPTOKINETIC NYSTAGMUS D. AN EMOTIONAL STATE REFERRED AS LA BELLE INDIFFÉRENCE
505
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507
HYSTERICAL BLINDNESS NORMAL NORMAL FUNDUS NORMAL OPTOKINETIC NYSTAGMUS
CALM DESPITE THE STORM!
508
96. ALL OF THE FOLLOWING FEATURES CHARACTERIZE HYSTERICAL BLINDNESS, EXCEPT:
A. NORMAL FUNDUSCOPIC EXAMINATION B. PRESERVATION OF PUPILLARY LIGHT RESPONSE C. LACK OF OPTOKINETIC NYSTAGMUS D. AN EMOTIONAL STATE REFERRED AS “LA BELLE INDIFFÉRENCE”
509
97. ALL OF THE FOLLOWING ARE FEATURES OF HYSTERICAL VISUAL FIELD DEFECTS, EXCEPT:
A. CONCENTRIC B. TUNNEL VISION C. BILATERAL D. SIZE OF DEFECT INCREASE WITH DISTANCE
510
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511
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512
HYSTERICAL VISUAL FIELD DEFECTS
DO YOU SEE IT? TUNNEL VISION REAL VISUAL FIELD DEFECTS DO YOU SEE IT? YES! NO!
513
97. ALL OF THE FOLLOWING ARE FEATURES OF HYSTERICAL VISUAL FIELD DEFECTS, EXCEPT:
A. CONCENTRIC B. TUNNEL VISION C. BILATERAL D. SIZE OF DEFECT INCREASE WITH DISTANCE
514
98. A 5 YEAR OLD GIRL DEVELOPS DOUBLE VISION DURING A MATH EXAM
98. A 5 YEAR OLD GIRL DEVELOPS DOUBLE VISION DURING A MATH EXAM. NEUROLOGICAL EXAMINATION IS NORMAL EXCEPT FOR SUSTAINED ADDUCTION OF BOTH EYES. THE MOST LIKELY DIAGNOSIS IS? A. DUANE SYNDROME B. AICARDI SYNDROME C. SPASM OF CONVERSION D. BLOBUS HYSTERICUS
515
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516
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517
SPASM OF CONVERSION FAKE NO FAKE
518
98. A 5 YEAR OLD GIRL DEVELOPS DOUBLE VISION DURING A MATH EXAM
98. A 5 YEAR OLD GIRL DEVELOPS DOUBLE VISION DURING A MATH EXAM. NEUROLOGICAL EXAMINATION IS NORMAL EXCEPT FOR SUSTAINED ADDUCTION OF BOTH EYES. THE MOST LIKELY DIAGNOSIS IS? A. DUANE SYNDROME B. AICARDI SYNDROME C. SPASM OF CONVERSION D. BLOBUS HYSTERICUS
519
99. ALL OF THE FOLLOWING ARE FEATURES OF ASTASIA ABASIA EXCEPT
A. BIZARRE GAIT B. EXQUISITE BALANCING ACTS C. INABILITY TO STAND D. ABNORMAL NEUROLOGICAL EXAM WHILE LYING DOWN
520
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521
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522
FEATURES OF ASTASIA ABASIA
BIZARRE GAIT EXQUISITE BALANCING ACTS INABILITY TO STAND
523
99. ALL OF THE FOLLOWING ARE FEATURES OF ASTASIA ABASIA, EXCEPT
A. BIZARRE GAIT B. EXQUISITE BALANCING ACTS C. INABILITY TO STAND D. ABNORMAL NEUROLOGICAL EXAM WHILE LYING DOWN
524
100. WHICH OF THE FOLLOWING FINDINGS IS CONSISTENT WITH A HYSTERICAL PARALYSIS?
A. BABINSKI SIGN B. HOOVER SIGN C. MACEWEN SIGN D. JACK SIGN
525
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NORMAL YOUR HAND HEMIPLEGIA HYSTERICAL HEMIPLEGIA HOOVER SIGN
528
100. WHICH OF THE FOLLOWING FINDINGS IS CONSISTENT WITH A HYSTERICAL PARALYSIS?
A. BABINSKI SIGN B. HOOVER SIGN C. MACEWEN SIGN D. JACK SIGN
529
101. ALL OF THE FOLLOWING ARE SIGNS OF HYSTERICAL SENSORY LOSS EXCEPT:
A. IF UNILATERAL ENDS EXACTLY AT THE MIDLINE B. A DISTINCT GLOVE DISTRIBUTION C. A DISTINCT STOCKING DISTRIBUTION D. A CONSISTENT BOUNDARY
530
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HYSTERICAL SENSORY LOSS
NEUROLOGICAL SENSORY LOSS CONSISTENT BOUNDARY INCONSISTENT BOUNDARY
533
101. ALL OF THE FOLLOWING ARE SIGNS OF HYSTERICAL SENSORY LOSS, EXCEPT:
A. IF UNILATERAL ENDS EXACTLY AT THE MIDLINE B. A DISTINCT GLOVE DISTRIBUTION C. A DISTINCT STOKING DISTRIBUTION D. A CONSISTENT BOUNDARY
534
102. THE TONGUE IS LARGE AND MAY PROTRUDE IN, ALL OF THE FOLLOWING EXCEPT:
A. CRETINISM B. GLYCOGEN STORE DISEASE C. BECKWITH SYNDROME D. TRISOMY 21
535
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PROTRUDING TONGUE LARGE TONGUE A. CRETINISM B. GLYCOGEN STORE DISEASE
C. BECKWITH SYNDROME SMALL MOUTH D. TRISOMY 21
538
102. THE TONGUE IS LARGE AND MAY PROTRUDE IN, ALL OF THE FOLLOWING EXCEPT:
A. CRETINISM B. GLYCOGEN STORE DISEASE C. BECKWITH SYNDROME D. TRISOMY 21 (THE PROTRUDING TONGUE IN TRISOMY 21 IS DUE TO A SHALLOW OROPHARYNX)
539
103. A HOARSE CRY IS TYPICAL OF:
A. INCREASED INTRACRANIAL PRESSURE B. WERDNIG-HOFFMANN DISEASE C. CRI-DU-CHAT SYNDROME D. CRETINISM
540
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TYPICAL CRY INCREASED INTRACRANIAL PRESSURE (HIGH PITCH)
WERDNIG-HOFFMANN DISEASE (FEEBLE) CRI-DU-CHAT SYNDROME (CAT-LIKE) CRETINISM (HOARSE)
543
103. A HOARSE CRY IS TYPICAL OF:
A. INCREASED INTRACRANIAL PRESSURE (HIGH PITCH) B. WERDNIG-HOFFMANN DISEASE (FEEBLE) C. CRI-DU-CHAT SYNDROME (CAT-LIKE) D. CRETINISM (HOARSE)
544
104. WHICH POSTURAL REFLEX IS PERFORMED BY FLEXING AND EXTENDING THE NECK WHILE HOLDING THE INFANT IN PRONE POSITION? A. ASYMMETRICAL TONIC NECK REFLEX (ATNR) B. NECK RIGHTING REFLEX C. LANDAU REFLEX D. PARACHUTE REFLEX
545
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546
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NECK RIGHTING REFLEX ATNR LANDAU REFLEX PARACHUTE REFLEX
548
104. WHICH POSTURAL REFLEX IS PERFORMED BY FLEXING AND EXTENDING THE NECK WHILE HOLDING THE INFANT IN PRONE POSITION? A. ASYMMETRICAL TONIC NECK REFLEX (ATNR) B. NECK RIGHTING REFLEX C. LANDAU REFLEX D. PARACHUTE REFLEX
549
105. SUCKING AND ROOTING REFLEXES MAY PERSIST IN AN ASLEEP INFANT UP TO 7 MONTHS.
A. TRUE B. FALSE
550
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REFLEX ROOTING AND SUCKING LAST LONGER WHILE SLEEP
553
105. SUCKING AND ROOTING REFLEXES MAY PERSIST IN AN ASLEEP INFANT UP TO 7 MONTHS.
A. TRUE B. FALSE
554
106. A COMPLETE MORO RESPONSE IS CONSISTENTLY PRESENT IN MORE THAN 75 % OF FULL TERM NEONATES.
A. TRUE B. FALSE
555
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MORO EXTENSION REFLEX IN FULL TERM NEONATES COMPLETE
W GA FULLY 3 6 M IN FULL TERM NEONATES COMPLETE 25 50 75 % ONLY LIMITED ABDUCTION 25 50 75 %
558
106. A COMPLETE MORO RESPONSE IS PRESENT IN MORE THAN 75 % OF FULL TERM NEONATES.
A. TRUE B. FALSE
559
107. THE SIZE OF THE PUPIL IS INFLUENCE BY ALL OF THE FOLLOWING EXCEPT:
A. CIRCULATING NOREPINEPHRINE LOCAL NOREPINEPHRINE LOCAL ACETYLCHOLINE CIRCULATING ACETYLCHOLINE
560
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561
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OCULOSYMPATHETIC PATHWAY
HYPOTHALAMUS FIRST NEURON The stimulus that control the release of nor epinephrine at the level of the constrictor muscle of the pupil is emotion, stress or the use of norepinephrine. The system involved in the released of norepinephrine at the constrictor muscle is a “3” neuron system. The term “3” neuron system denotes that from the point of origin of the system, the hypothalamus, to it’s final destination, the constrictor of the pupil, the neuronal bodies are located in 3 areas: posterior hypothalamus, the center of Budge and the superior cervical ganglion. The term does not imply that the system only has 3 neurons, since at each location there are many neurons. The first neuron is, as previously mention in the hypothalamus. The axons of these neuron travel in the right and left central sympathetic pathway from the hypothalamus to the center of Budge. The central sympathetic pathways are represented as broken light blue lines. The center of Budge is located at the level of lower cervical and high thoracic spine. The second neuron of the 3 neuron system is at the center of Budge. The axons of these neurons travel in the cervical sympathetic chain to reach the third neuron at the superior cervical ganglion. The superior cervical ganglion is at or close to the bifurcation of the carotid arteries. The axons from these neurons travel to the constrictor muscle of the pupils by hitching a ride initially with the internal carotid artery back into the cranial vault and later on with the first branch of the trigeminal nerve. These fibers reach the constrictor of the pupils as the long ciliary nerves. CIRCULATING NOREPINEPHRINE SECOND NEURON SUPERIOR CERVICAL GANGLION THIRD NEURON CENTER OF BUDGE
563
107. THE SIZE OF THE PUPIL IS INFLUENCE BY ALL OF THE FOLLOWING, EXCEPT:
A. CIRCULATING NOREPINEPHRINE LOCAL NOREPINEPHRINE LOCAL ACETYLCHOLINE D. CIRCULATING ACETYLCHOLINE
564
108. THE RECEPTORS IN THE PUPILLARY SPHINCTER ARE:
MUSCARINIC NICOTINIC C. NOREPINEPHRINE D. NONE OF THE ABOVE
565
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OCULOMOTOR NERVE PARASYMPATHETIC SYMPATHETIC Achetylcholine
Norepinephrine (NE) Muscarinic Receptor Dilator Sphincter STIMULUS STIMULUS The size of the pupils reflects the valance between the excitation of the sphincter and dilatator muscles. The sphincter of the pupil is innervated by parasympathetic fibers. The parasympathetic fibers releases acetylcholine. The acetylcholine released at the myoneural junction stimulates the muscarinic receptors of the sphincter muscle fibers. The stimulation of the muscarinic receptors produces miosis. Light is the stimulus for the parasympathetic system. The dilator of the pupil is innervated by sympathetic fibers. The sympathetic fibers release norepinephrine. The dilator muscle also responds to the circulating norepinephrine. Contraction of the dilator of the pupils produces mydriasis. Emotion and stress are the stimuli of the sympathetic system.
568
108. THE RECEPTORS IN THE PUPILLARY SPHINCTER ARE:
A. MUSCARINIC RECEPTORS NICOTINIC RECEPTORS NOREPINEPHRINE RECEPTORS NONE OF THE ABOVE
569
109. WHICH OF THE FOLLOWING GEOMETRICAL FIGURE WILL A CHILD DRAW FIRST:
A. A CIRCLE B. A SQUARE C. A TRIANGLE D. A PENTAGON
570
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571
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572
* * * 15 18 24 30 36 48 60 ADAPTIVE BEHAVIOR MONTHS 9 CAN TELL BETWEEN
2g 3 1g 2 15 18 24 30 36 48 60 MONTHS
573
109. WHICH OF THE FOLLOWING SHAPES WILL A CHILD DRAW FIRST:
A. CIRCLE B. SQUARE C. TRIANGLE D. PENTAGON
574
109. WHICH OF THE FOLLOWING A CHILD DO FIRST:
A. DROP A SMALL PEBBLE IN BOTTLE B. TAKE A SMALL PEBBLE OUT OF A BOTTLE C. DRAW A SQUARE D. DRAW A TRIANGLE
575
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576
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577
* * * 15 18 24 30 36 48 60 ADAPTIVE BEHAVIOR MONTHS 9 CAN TELL BETWEEN
2g 3 1g 2 15 18 24 30 36 48 60 MONTHS
578
109. WHICH OF THE FOLLOWING A CHILD DO FIRST:
A. DROP A SMALL PEBBLE IN BOTTLE B. TAKE A SMALL PEBBLE OUT OF A BOTTLE C. DRAW A SQUARE D. DRAW A TRIANGLE
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THE END
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