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

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

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. 6-12 MONTHS B. 12-18 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

2. MOST CHILDREN CONTRIBUTE TO THEIR OWN MEDICAL HISTORY BY: A. 6-12 MONTHS B. 12-18 MONTHS C. 2 YEARS D. 3-4 YEARS

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

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

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

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

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

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

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

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

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

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

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 !

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

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 !

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

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 !

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.

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

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

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

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

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

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

12 18 GIVE TO MOMMY ! MOMMY PAPA COME TO MOMMY ! MOMMY, PAPA, YES, NO, CAT, MILK 18

GIVE ME COOKY 24

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

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

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

12 18 MOMMY GIVE TO MOMMY ! PAPA COME TO MOMMY ! MOMMY, PAPA, YES, NO, CAT, MILK 18

GIVE ME COOKY 24

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

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

GIVE ME COOKY 24

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

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

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

16. AT HOW MANY WEEKS OF GESTATION SHOULD CONSISTENT PERIODS OF AROUSAL BE EXPECTED?

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

17. THE POSTERIOR FONTANEL USUALLY CLOSES BY: A. 2 WEEKS B. 3 MONTHS C. 8 WEEKS D. 8 MONTHS

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

18. THE AVERAGE TIME OF CLOSURE OF THE ANTERIOR FONTANEL IS: A. 12 MONTHS B. 24 MONTHS C. 18 MONTHS D. 8 MONTHS

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

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

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

20. VIGOROUS CRYING CAN NOT PRODUCE A BULGING FONTANEL IN A NORMAL INFANT. A. TRUE B. FALSE

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

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

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.

NORMAL PAPILLEDEMA MACULA DISK NASAL NASAL R L L TEMPORAL HEMORRHAGE NASAL IN PAPILLEDEMA THE TEMPORAL EDGE GOES FIRST EDGE

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

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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30 - 40% IN NELSON’S 13 EDITION: 10%

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

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 !!

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)

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.

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

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

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

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

27. THE NORMAL ADULT VISUAL ACUITY IS REACHED BY: A. 9 MONTHS B. 6 MONTHS C. 12 MONTHS D. 18 MONTHS

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

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

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

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

30. WHICH OF THE FOLLOWING IS NOT A SIGN OF HORNER SYNDROME? A. MIOSIS B. PTOSIS C. EXOPHTHALMUS D. IPSILATERAL ANIDROSIS OF THE FACE

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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

30. WHICH OF THE FOLLOWING IS NOT A SIGN OF HORNER SYNDROME? A. MIOSIS B. PTOSIS C. EXOPHTHALMUS D. IPSILATERAL ANHIDROSIS OF THE FACE

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 =

31. EYE DROPS HELP DISTINGUISH AMONG THE DIFFERENT TYPES OF HORNER SYNDROME? A. TRUE B. FALSE

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

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.

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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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

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

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

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

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

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

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

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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

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

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

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)

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

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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

* * 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

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

MIDBRAIN BETTER RESPONSE TO NEAR THAN LIGHT NORMAL ARGYLL ROBISON PATHWAY FOR NEAR ACCOMMODATION PRETECTAL NUCLEUS EDINGER-WESTPHAL NUCLEUS PATHWAY FOR LIGHT MIDBRAIN

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

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

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

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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

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

39. VERTICAL NYSTAGMUS AND VERTICAL DISPLACEMENT OF THE EYE IS ALWAYS ABNORMAL. A. TRUE B. FALSE

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YES, THEY ARE!

39. VERTICAL NYSTAGMUS AND VERTICAL DISPLACEMENT OF THE EYE IS ALWAYS ABNORMAL. A. TRUE B. FALSE

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

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ABSENCE OF THE DEPRESSOR ANGULI ORIS (LEFT) NORMAL GENERAL EVALUATION NORMAL NEUROLOGICAL EVALUATION AFFECTED SIDE OF THE LIP IS INVERTED

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)

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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COOS LAUGHS 3

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

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

42. DOLL’S EYE MANEUVER DEMONSTRATES COMPLETE EYE MOVEMENTS AS EARLY AS: A. 22 WEEKS B. 25 WEEKS C. 33 WEEKS D. 35 WEEKS

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)

43. A RUPTURED TYMPANIC MEMBRANE IS A CONTRAINDICATION FOR CALORIC TESTING. A. TRUE B. FALSE

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)

B A C B LATERAL (HORIZONTAL) PATIENT LOOKING AT YOU PATIENT LOOKING TO HIS LEFT C B PATIENT FLAT IN BED

30 O A B PATIENT FLAT IN BED PATIENT HEAD ELEVATED

44. THE PATIENT’S HEAD SHOULD BE ELEVATED ___ DEGREES FOR COLD CALORIC TESTING.

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

45. A HORSE VOICE AND A WEAK GAG MAYBE A SIGN OF CN ___ INJURY. A. IX B. X C. XII D. XIII

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

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

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

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

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

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

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

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

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

50. THE BEST MUSCLE TO SEE FASCICULATION IS THE _____. A. BICEPS B. QUADRICEPS C. TRICEPS D. TONGUE

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

51. MUSCLE TONE: THE DEGREE OF RESISTANCE OF A MUSCLE WHEN AN INDIVIDUAL JOINT IS MOVED PASSIVELY? A. TRUE B. FALSE

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

40 SHOULDER JOINT BECOMES LESS ADDUCEABLE WITH TIME

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

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

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

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

THE KNEE BECOMES LESS EXTENDABLE WITH TIME 110 80 40

54. AT WHAT GESTATIONAL AGE DOES THE POPLITEAL ANGLE REACH 80 DEGREE? A. 24 WEEKS B. 32 WEEKS C. 34 WEEKS D. 40 WEEKS

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

55. INITIAL RESISTANCE TO PASSIVE MOVEMENTS FOLLOWED BY A SUDDEN RELEASE (CLASP-KNIFE PHENOMENON). A. SPASTICITY B. CLONUS C. RIGIDITY D. OPISTHOTONOS

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

56. A NORMAL NEONATE CAN HAVE 5 TO 10 BEATS OF CLONUS IN ONE FOOT AND NONE IN THE OTHER? A. TRUE B. FALSE

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

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

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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28 30 32 34 36 38 40

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

59. CEREBELLAR VERMIS DAMAGE PRODUCES: A. LIMB ATAXIA B. TRUNCAL ATAXIA C. INTENTIONAL LIMB TREMOR D. FINGER TO NOSE TEST ABNORMALITIES

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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

59. CEREBELLAR VERMIS DAMAGE PRODUCES: A. LIMB ATAXIA B. TRUNCAL ATAXIA C. INTENTIONAL LIMB TREMOR D. FINGER TO NOSE TEST ABNORMALITIES

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

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RED NUCLEUS DECORTICATE RIGIDITY

* * DECEREBRATE RIGIDITY SUPERIOR COLLICULI RED NUCLEUS WILL DISAPPEAR IF DORSAL ROOT IS CUT * DECEREBRATE RIGIDITY VESTIBULAR NUCLEUS

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

61. ALL OF THE FOLLOWING ARE SIGNS OF CEREBELLAR DYSFUNCTION, EXCEPT? A. DYSMETRIA B. ROMBERG SIGN C. REBOUND D. DYSDIADOCHOKINESIA

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INTENTIONAL TREMOR DYSDIADOCHOKINESIA DYSMETRIA REBOUND TRUNCAL ATAXIA TRANSIENT MUTISM MAY OCCUR AFTER EXTENSIVE CEREBELLAR SURGERY WITH BILATERAL MANIPULATION; DYSARTHRIA

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

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

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PRONATE THE EXTENDED ARM

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

63. ALL THE FOLLOWING ARE SIGN OF BASAL GANGLIA DYSFUNCTION, EXCEPT A. COGWHEEL RIGIDITY B. CHOREA AND ATHETOSIS C. REBOUND D. DYSTONIA

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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

INTENTIONAL TREMOR DYSDIADOCHOKINESIA DYSMETRIA REBOUND TRUNCAL ATAXIA

63. ALL THE FOLLOWING ARE SIGN OF BASAL GANGLIA DYSFUNCTION, EXCEPT A. COGWHEEL RIGIDITY B. CHOREA AND ATHETOSIS C. REBOUND D. DYSTONIA

64. CROSS ADDUCTOR RESPONSE IS NORMAL UNTIL? A. 6-7 MONTHS B. 1-2 YEARS C. 3-4 YEARS D. 2 ½ YEARS

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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

64. CROSS ADDUCTOR RESPONSE IS NORMAL UNTIL? A. 6-7 MONTHS B. 1-2 YEARS C. 3-4 YEARS D. 2 ½ YEARS

65. INCREASED DEEP TENDON REFLEXES ARE MORE LIKELY TO OCCUR WITH ____ DYSFUNCTION? A. MYONEURAL JUNCTION B. CEREBELLUM C. CEREBRAL D. NERVE

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DEEP TENDON REFLEXES

65. INCREASED DEEP TENDON REFLEXES ARE MORE LIKELY TO OCCUR WITH ____ DYSFUNCTION? A. MYONEURAL JUNCTION B. CEREBELLUM C. CEREBRAL D. NERVE

66. MOST INFANT SHOW INITIAL ____ OF THE GREAT TOE ON PLANTAR STIMULATION. A. FLEXION B. EXTENSION C. PRONATION D. SUPINATION

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INFANT BABINSKI SIGN

66. MOST INFANT SHOW INITIAL ____ OF THE GREAT TOE ON PLANTAR STIMULATION. A. FLEXION B. EXTENSION C. PRONATION D. SUPINATION

67. AN ASYMMETRICAL MORO REFLEX MAY SIGNIFY ALL OF THE FOLLOWING EXCEPT? A. FRACTURED CLAVICLE B. BRACHIAL PLEXUS INJURY C. HEMIPARESIS D. SPASTIC QUADRIPARESIS

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QUADRI- HEMI- PARA- MONO- DI- = BILATERAL (CORRESPONDING LIMB OR FACE -PLEGIA = PARALYSIS -PARESIS = WEAKNESS

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

68. PALMAR GRASP IS FIRST ELICITED BY ___ WEEKS OF GESTATION?

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PALMAR GRASP REFLEX & NECK TRACTION RESPONSE 41 37 35 32 28 26

PALMAR GRASP REFLEX FACILITATED BY SUCKING BILATERAL ACUTE: DECREASED 3 M 6 28 32 W GA ONSET FULLY BILATERAL ACUTE: DECREASED CHRONIC: DECREASED UNILATERAL WEAKNESS

68. PALMAR GRASP IS FIRST ELICITED BY ___ WEEKS OF GESTATION?

69. AN OBLIGATORY ASYMMETRICAL TONIC NECK RESPONSE IS NORMAL AT 1 MONTH OF AGE. A. TRUE B. FALSE

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* ASYMMETRICAL TONIC NECK REFLEX ABNORMAL IF OBLIGATORY BY EXAMINER 35 W GA * FULLY ABNORMAL IF OBLIGATORY 3 6 7 M

69. AN OBLIGATORY ASYMMETRICAL TONIC NECK RESPONSE IS NORMAL AT 1 MONTH OF AGE? A. TRUE B. FALSE

70. THE PARACHUTE REFLEX COULD BE PRESENT AS EARLY AS? A. 7- 8 MONTHS B. 10-11 MONTHS C. 14-16 MONTHS D. 18 MONTHS

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PARACHUTE REFLEX 6 M 12 FULLY 3 9

70. THE PARACHUTE REFLEX SHOULD BE PRESENT AS EARLY AS? A. 7-8 MONTHS B. 10-11 MONTHS C. 14-16 MONTHS D. 18 MONTHS

71. THE ROOTING REFLEX SHOULD BE FULLY ESTABLISHED AS EARLY AS? A. 32 WEEKS B. 34 WEEKS C. 36 WEEKS D. 38 WEEKS

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ROOTING REFLEX * 3 4 32 36 W GA FULLY 1 * FROM NELSON’S

* * 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

71. THE ROOTING REFLEX SHOULD BE PRESENT AS EARLY AS? A. 36 WEEKS B. 34 WEEKS C. 32 WEEKS D. 38 WEEKS

72. THE MORO REFLEX SHOULD DISAPPEAR BY? A. 7-8 MONTHS B. 5-6 MONTHS C. 10-11 MONTHS D. 18 MONTHS

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MORO EXTENSION REFLEX 28 32 37 W GA FULLY 3 6 M

72. THE MORO REFLEX SHOULD DISAPPEAR BY? A. 7-8 MONTHS B. 5-6 MONTHS C. 10-11 MONTHS D. 18 MONTHS

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

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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 SENSORY TESTING 1 2 3 4 5 6 Y 1/4 1/2 3/4 OBSERVATION REFLEX & REACTION PLAYING COMMANDS & IMITATING

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

74. CIRCUMDUCTION GAIT IS A SIGN OF? A. PARAPARESIS B. QUADRIPARESIS C. HEMIPARESIS D. UPPER ARM DIPLEGIA

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WEAKNESS CIRCUMDUCTION GAIT

74. CIRCUMDUCTION GAIT IS A SIGN OF? A. PARAPARESIS B. QUADRIPARESIS C. HEMIPARESIS D. UPPER ARM DIPLEGIA

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

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SIGNS DUE TO WEAKNESS TRUNK MUSCLES (SCOLIOSIS) PROXIMAL LOWER LIMB MUSCLES (WADDLING) DISTAL LOWER LIMB MUSCLES (FOOT DROP) FACIAL MUSCLES (FACIAL DIPLEGIA)

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

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

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SIGNS DUE TO WEAKNESS TRUNK MUSCLES (SCOLIOSIS) PROXIMAL LOWER LIMB MUSCLES (WADDLING) DISTAL LOWER LIMB MUSCLES (FOOT DROP) FACIAL MUSCLES (FACIAL DIPLEGIA)

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

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

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GOWER SIGN

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

78. POOR HEEL TO TOE OR TANDEM WALKING OCCURS WITH: A. PROXIMAL WEAKNESS B. CEREBELLAR DISEASE C. BRAIN DISEASE D. ALL OF THE ABOVE

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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

78. POOR HEAL TO TOE OR TANDEM WALKING OCCURS WITH: A. PROXIMAL WEAKNESS B. CEREBELLAR DISEASE C. BRAIN DISEASE D. ALL OF THE ABOVE

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

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COOS BABBLES LAUGHS 3 6 MA…PA MA…PA PA… MA PA… MA 9

12 18 MOMMY GIVE TO MOMMY ! PAPA COME TO MOMMY ! MAMMY, PAPA, YES, NO, CAT 18

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

80. AT WHAT AGE DO MOST CHILDREN START RIDING A TRICYCLE? A. 1 YEAR B. 2 YEARS C. 3 YEARS D. 4 YEARS

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GIVE ME COOKY 24

18 9 12 36 24 30 6 3

80. AT WHAT AGE DO MOST CHILDREN SART RIDING A TRICYCLE? A. 1 YEAR B. 2 YEARS C. 3 YEARS D. 4 YEARS

81. FEAR OF DARKNESS USUALLY STARTS BY : A. 1 YEAR B. 2 YEARS C. 3 YEARS D. 4 YEARS

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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

81. FEAR OF DARKNESS USUALLY STARTS BY : A. 1 YEAR B. 2 YEARS C. 3 YEARS D. 4 YEARS

82. AT WHAT AGE DO MOST CHILDREN START COPYING A TRIANGLE? A. 2 YEAR B. 3 YEARS C. 4 YEARS D. 5 YEARS

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* * * 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

82. AT WHAT AGE DO MOST CHILDREN START COPPING A TRIANGLE : A. 2 YEAR B. 3 YEARS C. 4 YEARS D. 5 YEARS

83. AT WHAT AGE DO MOST CHILDREN START THROWING A BALL OVERHAND? A. 2 YEAR B. 3 YEARS C. 4 YEARS D. 5 YEARS

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BLUE GREEN COUNTS TO 4 RED YELLOW COUNTS TO 10 48 60

83. AT WHAT AGE DO MOST CHILDREN START THROWING A BALL OVERHAND: A. 3 YEAR B. 3 YEARS C. 4 YEARS D. 5 YEARS

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

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BLUE GREEN COUNTS TO 4 RED YELLOW COUNTS TO 10 48 60

* * * 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

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

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

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48 60 BLUE GREEN RED YELLOW COUNTS TO 4 COUNTS TO 10 TO THE TOILET ALONE 60

* * * 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

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

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

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# 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

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

% 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

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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

% 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

% 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

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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

% 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

% 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

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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

% 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

% 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

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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

% 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

% 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

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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

% 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

92. THE HEAD CIRCUMFERENCE OF A TERM INFANT AT BIRTH USUALLY IS? A. 30-31 CMS B. 30-35 CMS C. 34-35 CMS D. 34-40 CMS

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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

92. THE HEAD CIRCUMFERENCE OF A TERM INFANT AT BIRTH USUALLY IS? A. 30-31 CMS B. 30-35 CMS C. 34-35 CMS D. 34-40 CMS

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

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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

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

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

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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

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

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

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HEAD GROWTH PRETERM 0.5 0.75 1/W CMS 1 2 3 4 5 W 40 GA

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

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

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HYSTERICAL BLINDNESS NORMAL NORMAL FUNDUS NORMAL OPTOKINETIC NYSTAGMUS CALM DESPITE THE STORM!

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”

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

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HYSTERICAL VISUAL FIELD DEFECTS DO YOU SEE IT? TUNNEL VISION REAL VISUAL FIELD DEFECTS DO YOU SEE IT? YES! NO!

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

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

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SPASM OF CONVERSION FAKE NO FAKE

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

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

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FEATURES OF ASTASIA ABASIA BIZARRE GAIT EXQUISITE BALANCING ACTS INABILITY TO STAND

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

100. WHICH OF THE FOLLOWING FINDINGS IS CONSISTENT WITH A HYSTERICAL PARALYSIS? A. BABINSKI SIGN B. HOOVER SIGN C. MACEWEN SIGN D. JACK SIGN

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NORMAL YOUR HAND HEMIPLEGIA HYSTERICAL HEMIPLEGIA HOOVER SIGN

100. WHICH OF THE FOLLOWING FINDINGS IS CONSISTENT WITH A HYSTERICAL PARALYSIS? A. BABINSKI SIGN B. HOOVER SIGN C. MACEWEN SIGN D. JACK SIGN

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

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HYSTERICAL SENSORY LOSS NEUROLOGICAL SENSORY LOSS CONSISTENT BOUNDARY INCONSISTENT BOUNDARY

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

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

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PROTRUDING TONGUE LARGE TONGUE A. CRETINISM B. GLYCOGEN STORE DISEASE C. BECKWITH SYNDROME SMALL MOUTH D. TRISOMY 21

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)

103. A HOARSE CRY IS TYPICAL OF: A. INCREASED INTRACRANIAL PRESSURE B. WERDNIG-HOFFMANN DISEASE C. CRI-DU-CHAT SYNDROME D. CRETINISM

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TYPICAL CRY INCREASED INTRACRANIAL PRESSURE (HIGH PITCH) WERDNIG-HOFFMANN DISEASE (FEEBLE) CRI-DU-CHAT SYNDROME (CAT-LIKE) CRETINISM (HOARSE)

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)

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

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NECK RIGHTING REFLEX ATNR LANDAU REFLEX PARACHUTE REFLEX

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

105. SUCKING AND ROOTING REFLEXES MAY PERSIST IN AN ASLEEP INFANT UP TO 7 MONTHS. A. TRUE B. FALSE

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REFLEX ROOTING AND SUCKING LAST LONGER WHILE SLEEP

105. SUCKING AND ROOTING REFLEXES MAY PERSIST IN AN ASLEEP INFANT UP TO 7 MONTHS. A. TRUE B. FALSE

106. A COMPLETE MORO RESPONSE IS CONSISTENTLY PRESENT IN MORE THAN 75 % OF FULL TERM NEONATES. A. TRUE B. FALSE

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MORO EXTENSION REFLEX IN FULL TERM NEONATES COMPLETE 28 32 37 W GA FULLY 3 6 M IN FULL TERM NEONATES COMPLETE 25 50 75 % ONLY LIMITED ABDUCTION 25 50 75 %

106. A COMPLETE MORO RESPONSE IS PRESENT IN MORE THAN 75 % OF FULL TERM NEONATES. A. TRUE B. FALSE

107. THE SIZE OF THE PUPIL IS INFLUENCE BY ALL OF THE FOLLOWING EXCEPT: A. CIRCULATING NOREPINEPHRINE LOCAL NOREPINEPHRINE LOCAL ACETYLCHOLINE CIRCULATING ACETYLCHOLINE

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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

107. THE SIZE OF THE PUPIL IS INFLUENCE BY ALL OF THE FOLLOWING, EXCEPT: A. CIRCULATING NOREPINEPHRINE LOCAL NOREPINEPHRINE LOCAL ACETYLCHOLINE D. CIRCULATING ACETYLCHOLINE

108. THE RECEPTORS IN THE PUPILLARY SPHINCTER ARE: MUSCARINIC NICOTINIC C. NOREPINEPHRINE D. NONE OF THE ABOVE

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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.

108. THE RECEPTORS IN THE PUPILLARY SPHINCTER ARE: A. MUSCARINIC RECEPTORS NICOTINIC RECEPTORS NOREPINEPHRINE RECEPTORS NONE OF THE ABOVE

109. WHICH OF THE FOLLOWING GEOMETRICAL FIGURE WILL A CHILD DRAW FIRST: A. A CIRCLE B. A SQUARE C. A TRIANGLE D. A PENTAGON

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* * * 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

109. WHICH OF THE FOLLOWING SHAPES WILL A CHILD DRAW FIRST: A. CIRCLE B. SQUARE C. TRIANGLE D. PENTAGON

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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* * * 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

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

THE END