Differential Diagnosis (DDx) by Location
Differential Diagnosis (DDx) by Signs and Symptoms
1. True or False. The following are potential causes of myelopathy: |
| G7 p.1186:15mm |
a. stenosis, cervical, or thoracic | true |
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b. anemia, chronic | true |
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c. Cushing disease | true |
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d. Lyme disease | true |
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e. acquired immunodeficiency syndrome (AIDS) | true |
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2. How does anemia produce myelopathy? |
| G7 p.1186:15mm |
a. chronic: e_____ h_____, b_____ m_____ h_____, and c_____ c_____ | extramedullary hematopoiesis, bone marrow hypertrophy, and cord compression |
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b. pernicious: s_____ c_____ d_____ | subacute combined degeneration |
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3. How does Cushing disease produce myelopathy? |
| G7 p.1186:55mm |
a. e_____ l_____ | epidural lipomatosis |
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4. True or False. The following are neoplastic masses causing myelopathy, in order of most common to least common: |
| G7 p.1186:95mm |
a. extradural, intradural extramedullary, intramedullary | true (It follows anatomically outside to inside, most to least common.) |
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b. intradural extramedullary, extradural, intramedullary | false |
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c. intramedullary, extradural, intradural extramedullary | false |
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d. extradural, intramedullary, intradural extramedullary | false |
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5. What is the frequency of spinal cord tumors? |
| G7 p.1186:96mm and G7 p.728:60mm |
a. Extradural: _____% | 55% |
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b. Intradural extramedullary: _____% | 40% |
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c. Intradural intramedullary: _____% | 5% | |
6. Complete the following regarding spinal cord infarction: |
| G7 p.1186:166mm |
a. The most common artery involved is _____ _____ _____. | anterior spinal artery |
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b. The most common level of involvement is _____. | T4 |
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c. Why? | watershed area |
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d. It spares _____ _____ | posterior columns |
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e. caused by _____ and | hypotension |
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f. due to |
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i. ath_____ | atherosclerosis |
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ii. emb_____ | embolization |
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iii. cla_____ a_____ | clamping aorta |
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iv. aor_____ d_____ | aortic dissection |
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v. s_____ p_____ in the presence of s_____ s_____. | sitting position in the presence of spinal stenosis | G7 p.1186:166mm |
7. Necrotizing myelopathy associated with spontaneous thrombosis of a spinal cord arteriovenous malformation (AVM) presenting as spastic → flaccid paraplegia with ascending sensory level is called _____. | Foix-Alajouanine | G7 p.1187:50mm |
8. True or False. Regarding acute (idiopathic) transverse myelitis: |
| G7 p.1187:85mm |
a. Clinical onset is indistinguishable from acute spinal cord compression. | true |
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b. Normal imaging is expected, including CT, myelogram and MRI. | true |
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c. Cerebrospinal fluid (CSF) analysis shows pleocytosis and hyperproteinemia. | true |
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d. The thoracic region is the most common level. | true |
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e. The most common onset is 20 to 40 years of age. | false (Most common onset is first 2 decades of life, other answers define the disease.) |
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f. Usually results in a diagnosis of multiple sclerosis | false (MS is diagnosed in only 7%.) | G7 p.1187:100mm |
9. Abdominal cutaneous reflexes are almost always absent in _____ _____. | multiple sclerosis | G7 p.1187:110mm |
10. True or False. Regarding Devic syndrome: |
| G7 p.1187:113mm and G7 p.728:60mm |
a. It is characterized by acute bilateral retinitis and transverse myelitis. | false (acute bilateral optic neuritis, not retinitis, and myelopathy) |
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b. The transverse myelitis can be a cause of complete block on myelography. | true |
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c. It is more common in Asia than in the United States. | true |
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d. It is a variant of multiple sclerosis (MS). | true | |
11. What is another name for Devic syndrome? | neuromyelitis optica | G7 p.1187:114mm |
12. True or False. The following are part of the correct mechanism responsible for pernicious anemia: |
| G7 p.1187:148mm |
a. malabsorption of B12 in the proximal ileum | false (malabsorption of B12 in distal ileum) |
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b. lack of secretion of intrinsic factor by pancreas | false (lack of secretion by gastric parietal cells) |
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c. dysfunction of gastric parietal cells | true (malabsorption of B12 in the distal ileum due to lack of secretion of intrinsic factor, a small polypeptide, by gastric parietal cells) |
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d. downregulation of cyclic adenosine monophosphate (cAMP)—mediated transport of B12 | false |
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13. Matching. Match the disease with the important feature. |
| G7 p.1187:162mm and G7 p.1188:120mm and G7 p.1188:150mm |
Disease: |
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| G7 p.1187:162mm |
Important feature: |
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a. Ascending weakness |
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b. Atrophic weakness of hands |
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c. Symmetrical paresthesias |
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d. Posterior column involvement |
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e. Normal sensation |
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f. Dementia |
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g. Areflexia |
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h. Serum B12 levels |
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i. Fasciculations |
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j. Shilling test |
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k. Preserved sphincter control |
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l. Treat with B12 |
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m. Proprioception difficulty |
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14. How might AIDS produce myelopathy? | vacuolization of spinal cord | |
15. Complete the following about sciatica: |
| G7 p.1188:183mm |
a. The sciatic nerve contains roots from_____ to_____. | L4 to S3 |
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b. |
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i. The nerve passes out of the_____ | pelvis |
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ii. through the g_____ s_____ f_____. | greater sciatic foramen |
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c. |
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i. In the lower third of the thigh it divides into the t_____ | tibial |
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ii. and the c_____ _____ nerves. | common peroneal |
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16. Complete the following about herpes zoster: |
| G7 p.1189:87mm |
a. Rarely it might mimic_____. | radiculopathy |
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b. Lumbosacral dermatomas are involved in_____ to_____%. | 10 to 15% |
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c. Significantly, pain is independent of_____. | position |
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d. Typical herpetic skin lesions follow pain in_____ to0_____days. | 3 to 8 |
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e. True or False. Motor weakness can occur. | true |
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f. True or False. Urinary retention can occur. | true |
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g. If so, it is due to_____ paralysis. | detrusor |
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h. |
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i. If motor symptoms occur_____% have good recovery | 55% |
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ii. and_____% have fair to good recovery. | 30% |
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17. Complete the following regarding differential diagnosis by signs and symptoms: |
| G7 p.1189:170mm |
a. Pain produced in the sciatic distribution with weakness of external rotation and abduction of the hip is called _____. | piriformis syndrome due to sciatic nerve entrapment by piriformis muscle. (Symptoms are exacerbated by Freiberg test [forced internal rotation of hip with thigh extension]). |
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b. The Friedberg test consists of forced_____ _____ of _____ | internal rotation of hip |
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c. and thigh_____. | extension |
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d. Significance of the Frieberg test is that it_____ the symptoms of the | exacerbates |
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e. p_____ s_____. | piriformis syndrome | |
18. Complete the following about extraspinal tumors causing sciatica: |
| G7 p.1190:60mm |
a. Pain is almost always |
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i. i_____ | insidious |
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ii. p_____ | progressive |
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iii. c_____ | constant |
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iv. not affected by_____ | position |
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v. worse at_____ in 80% and | night |
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vi. not benefited by_____ therapy | conservative |
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b. Diagnosis is best made by |
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i. h_____ | history |
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ii. r_____ | radiographs |
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iii. of the entire p_____ | pelvis |
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iv. and p_____ f_____ | proximal femur |
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19. Femoral neuropathy is often mistakenly identified as a radiculopathy at what level? | L4 | G7 p.1190:120mm |
20. Answer the following about femoral neuropathy: |
| G7 p.1190:125mm |
a. Femoral neuropathy may be mistaken for radiculopathy at what level? | L4 |
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b. That mistake can occur because both share weakness of the _____ muscle. | quadriceps |
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c. That mistake should be avoided because sensory distribution is different. |
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i. Femoral nerve serves the_____ _____. | anterior thigh |
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ii. L4 serves the knee to the_____ _____ and | medial malleolus |
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iii. spares the_____ _____ motor weakness is different. | anterior thigh |
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iv. Femoral nerve has weak_____. | iliopsoas |
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v. Femoral nerve has strong_____ _____. | thigh adductors |
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vi. L4 has strong_____. | iliopsoas |
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vii. L4 has weak_____ _____. | thigh adductors |
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21. Peroneal nerve palsy may be mistaken for radiculopathy at what level? | L5 | G7 p.1190:133mm |
22. Complete the following regarding differential diagnosis by signs and symptoms: |
| G7 p.1191:32mm |
a. Congenital degeneration of anterior horn cells leading to weakness, areflexia, tongue fasciculations, with normal sensation is W_____-H_____ d_____ | Werdnig-Hoffmann disease |
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b. also known as s_____ m_____a_____ | spinal muscular atrophy |
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c. also known as f_____ i_____ s_____ | floppy infant syndrome | |
23. The most common etiology for pure motor hemiplegia without sensory loss is | G7 p.1192:50mm | |
a. l_____ i_____ of the | lacunar infarct |
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b. c_____ i_____ c_____. | contralateral internal capsule |
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24. Can hypoglycemia be associated with hemiparesis? | yes, treat with glucose— hemiparesis may clear | G7 p.1192:68mm |
25. Complete the following about back pain: |
| G7 p.1192:120mm |
a. Will patients with abdominal or vascular etiology of back pain keep still, or writhe in pain? | writhe in pain |
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i. example: a_____ a_____ a_____ | abdominal aortic aneurysm |
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b. Pain at bed rest. Think:_____ _____ | spine tumor |
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c. Relieved by aspirin. Think:_____ osteoid osteoma |
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d. Back pain on percussion. Think:_____ | infection |
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26. Complete the following regarding differential diagnosis by signs and symptoms: |
| G7 p.1192:145mm |
a. Nocturnal back pain relieved by aspirin is suggestive of _____ _____. | osteoid osteoma (or benign osteoblastoma) |
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b. Morning back stiffness, hip pain, hip swelling, failure to get relief at rest, and improvement with exercise is suggestive of_____ or_____ _____. | sacroiliitis or early ankylosing spondylitis |
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27. Complete the following regarding cauda equina. Cauda equina syndrome has the following criteria: |
| G7 p.1193:62mm |
a. p_____ a_____ | perineal anesthesia |
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b. u_____ i_____ | urinary incontinence |
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c. p_____ w_____ | progressive weakness |
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28. Complete the following regarding annular tears: |
| G7 p.1193:103mm |
a. assymptomatic in 50- to 60-year-old patients in _____% | 40% |
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b. assymptomatic in 60- to 70-year-old patients in _____% | 75% |
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29. Complete the following regarding Schmorl nodes: |
| G7 p.1193:179mm |
a. defined as d_____ h_____ | disc herniation |
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b. through the c_____ e_____ p_____ | cartilaginous end plate |
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c. into the v_____ b_____ | vertebral body |
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d. seen in_____% of asymptomatic patients | 19% | |
30. Complete the following about chronic low back pain: |
| G7 p. 1194:19mm |
a. Symptoms persist after 3 months in_____%. | 5% |
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b. Structural diagnosis is possible in only_____% of these. | 50% |
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c. Erosive changes adjacent to sacroiliac (SI) joint and positive test for human leukocyte antigen-B27 (HLA-B27) suggest the diagnosis of a_____ s_____. | ankylosing spondylitis | G7 p. 1194:40mm |
d. In foot drop of unknown etiology, which muscle strength tests help differentiate peroneal nerve palsy from L4/L5 radiculopathy? |
| G7 p. 1194:85mm |
i. p_____ t_____ (f_____ i_____) | posterior tibialis (foot inversion) |
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ii. g_____ m_____ (i_____ r_____ f_____ h_____) | gluteus medius (internal rotation flexed hip)( Both are spared in a peroneal nerve palsy, and both are involved with radiculopathy.) |
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e. Which division of the sciatic nerve is more sensitive to injury, the peroneal or the tibial division? | peroneal division is more sensitive to injury | G7 p. 1195:16mm |
31. For a patient with foot drop, lesion could be at |
| G7 p.1195:26mm |
a. main trunk of_____ _____ | sciatic nerve |
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b. p_____ d_____ | peroneal division |
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c. L_____ or L_____ radiculopathy | L4 or L5 |
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d. c_____ p_____ nerve | common peroneal |
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e. s_____ p_____ nerve | superficial peroneal |
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f. d_____ p_____ nerve | deep peroneal |
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32. Study Chart. Examine the following functions tests and the muscles for a patient with foot drop: |
| G7 p.1195:27mm |
a. Adduct thigh | Adductors L2-3 |
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b. Extend knee | Quadriceps L2-3-4 |
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c. Internally rotate thigh | Gluteus medius L4-5 S1 |
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d. Dig heel into bed | Gluteus maximus L5 S1-2 |
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e. Flex knee with thigh flexed | Biceps femoris L5 S1-2 |
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f. Foot planter flexion | Gastrocnemius |
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g. Invert plantar flexed foot | Tibialis posterior L4-5 |
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h. Evert foot | Peroneus longus and brevis L5 S1 |
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33. Adduct thigh. |
| G7 p.1195:35mm |
a. Utilizes_____ muscles | adductor |
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b. Nerve:_____ | obturator |
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c. Roots:_____ | L2, 3 |
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d. If weak means lesion includes more than the_____ _____ | sciatic roots | |
34. Extend knee. |
| G7 p.1195:35mm |
a. Utilizes_____ muscles | quadriceps |
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b. Nerve:_____ | femoral |
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c. Root:_____ | L2, 3, 4 |
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d. If weak means lesion includes more than_____ _____ | sciatic roots |
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35. Internally rotate thigh. |
| G7 p.1195:62mm |
a. Utilizes_____ _____ muscles | gluteus maximus |
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b. Nerve:_____ | superior gluteal |
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c. Root:_____ | L4, 5, S1 |
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d. If weak means lesion is very_____ | proximal |
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36. Dig heel into bed. |
| G7 p.1195:62mm |
a. Utilizes_____ _____ muscles | gluteus maximus |
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b. Nerve:_____ | inferior gluteal |
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c. Roots:_____ _____ and_____ | L5-S1, 2 |
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d. If weak the injury is very_____ | proximal |
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37. Flex knee with thigh flexed. |
| G7 p.1195:76mm |
a. Utilizes_____ _____ muscles | lateral hamstrings |
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b. Nerve: _____ | sciatic |
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c. Roots:_____ _____ and_____ | L5, S1, 2 |
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d. If weak there is injury to the_____ _____ | sciatic nerve |
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38. Foot plantar flexion. |
| G7 p.1195:76mm |
a. Utilizes_____ _____ muscles | gastrocnemius |
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b. Nerve:_____ | sciatic |
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c. Roots:_____ | L5 |
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d. If weak there is injury to the_____ _____ | sciatic nerve |
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39. Invert plantar flexed foot. |
| G7 p.1195:92mm |
a. Utilizes_____ _____ muscles | posterior tibial |
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b. Nerve:_____ | tibial |
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c. Roots:_____ and_____ | L4, 5 |
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d. If weak there is injury to the_____ _____ | tibial nerve |
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e. If strong but there is foot drop, it means that there is injury distal to the take-off of the_____ _____ | common peroneal |
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40. Evert the foot. |
| G7 p.1195:92mm |
a. Utilizes_____ _____ muscles | peroneus longus and brevis |
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b. Nerve:_____ | superficial peroneal |
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c. Roots:_____ and _____ | L5, S1 |
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d. Preservation of these with foot drop means lesion is in the _____ _____ nerve | deep peroneal | |
41. What are ways to differentiate foot drop from injury to the |
| G7 p.1195:162mm |
a. deep peroneal nerve? |
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i. motor weakness manifests by_____ _____ | foot drop (weak foot extension) |
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ii. muscle that is weak is the_____ _____ | anterior tibial (dorsiflexion) |
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iii. sensory loss_____ _____ | web space |
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b. common peroneal nerve? |
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i. deficit is a _____ _____ | foot drop |
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ii. muscles involved are a_____ t_____ and p_____ l_____ and b_____ | anterior tibial and peroneus longus and brevis |
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iii. weakness of_____ and_____ _____ | eversion and foot drop |
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iv. sensory loss of_____ _____ and _____ | lateral leg and foot |
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42. List the ways to differentiate. |
| G7 p.1195:182mm |
a. plexus lesions on electromyography (EMG) _____ _____ | paraspinals normal |
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b. root lesion on EMG_____ _____ | paraspinals abnormal |
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c. superficial peroneal nerve |
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i. motor weakness of _____ | eversion |
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ii. muscles that are weak are the_____ _____ and_____ | peroneus longus and brevis |
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iii. Any foot drop? | no |
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iv. sensory loss at the_____ _____ and_____ | lateral leg and foot |
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43. Complete the following regarding differential diagnosis by signs and symptoms: |
| G7 p.1196:29mm |
a. Painless foot drop is likely due to_____ _____. | peroneal palsy |
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b. Painful foot drop is likely due to_____. | radiculopathy |
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c. Painless foot drop with no sensory loss could be due to _____ _____. | parasagittal lesion |
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d. If so how might the reflexes be? | hyperactive |
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e. This is called the_____ _____ _____. | spastic foot drop |
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44. A central nervous system (CNS) cause of foot drop is |
| G7 p.1196:60mm |
a. the result of a_____ lesion | parasagittal |
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b. and may produce a_____ reflex | Babinski |
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c. or a hyperactive_____ reflex. | Achilles (= spastic foot drop) | |
45. Complete the following regarding symptoms in the hands: |
| G7 p.1196:155mm |
a. Central cord syndrome shows more involvement in_____ than_____. | UE; LE |
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b. Syringomyelia has b_____ d_____ in the hands. | burning dysesthesias |
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46. Complete the following regarding lesion location and findings in “cruciate paralysis”: |
| G7 p.1196:180mm |
a. Physical exam shows_____ | atrophy of hands |
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b. due to pressure on the_____ | pyramidal decussations |
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c. at the level of the_____. | foramen magnum |
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47. Complete the following about radiculopathy, upper extremity: |
| G7 p.1197:120mm |
a. The “empty can” test suggests s_____ p_____. | shoulder pathology |
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b. Interscapular pain suggests c_____ r_____. | cervical radiculopathy | G7 p.1197:135mm |
48. Myocardial infarction (MI) may present with symptoms similar to a radiculopathy at what level? | left C6 | G7 p.1197:142mm |
49. Matching. Match the symptom with the position of the disc most likely to produce it. Disc: |
| G7 p.1198:23mm |
a. pain |
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b. myelopathy |
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c. bilateral symptoms |
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d. upper extremity symptoms |
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e. lower extremity symptoms |
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f. numb clumsy hands |
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50. Electric shock-like sensation radiating up or down the spine, usually with flexion and attributed to dysfunction of posterior columns is called the_____. | Lhermitte sign | |
51. True or False. Lhermitte’s sign can be seen in Hint: mc5rs |
| G7 p.1198:180mm |
a. multiple sclerosis | true |
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b. cervical spondylosis | true |
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c. cervical disc | true |
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d. cervical cord tumor | true |
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e. Chiari I | true |
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f. central cord syndrome | true |
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g. radiation myelopathy | true |
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h. subacute combined degeneration | true |
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52. Complete the following regarding one or more episodes of brief loss of consciousness (LOC): |
| G7 p.1199:70mm |
a. referred to as s_____ | syncope |
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b. prevalence is_____ | ≈ 50% (higher in elderly) |
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c. presumed etiology is_____ | vasovagal |
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53. What are the causes of syncope? |
| G7 p.1199:112mm |
a. Disorder of AV node conduction is called_____ | Stokes-Adams |
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b. Tight short collar, shaving, passing out is called_____ | carotid sinus syncope |
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c. Fainting aka_____ syncope | neurocardiogenic |
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d. |
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i. Micturition, cough called_____ | triggered syncope |
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ii. Usually associated with elevation of_____-_____ pressure | intra-thoracic |
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e. Orthostatic hypotension defined as a drop in BP of_____mm Hg on standing | 25 |
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f. Unknown etiology occurs in_____% | 40% |
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54. Complete the following about transient neurological deficit (TIA): |
| G7 p.1200:175mm |
a. By definition it lasts less than_____ hours | 24 |
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b. but usually subsides within_____. | 20 minutes |
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c. They are_____. | temporary |
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d. They are a result of_____. | ischemia |
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55. Complete the following regarding the etiology of diplopia secondary to VI nerve palsy: |
| G7 p.1201:85mm |
a. i_____ _____ _____ | ↑ ICP (pseudotumor cerebri) |
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b. s_____ _____ | sphenoid sinusitis |
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c. t_____ | tumor/mass etc. | |
56. Complete the following regarding transient ischemic attacks (TIAs): |
| G7 p.1200:175mm |
a. By definition TIAs last less than_____. | 24 hours |
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b. Most resolve within_____. | 20 minutes |
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c. Migraine paresis differs from TIA in that it_____ over several minutes. | progresses (marches) |
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d. TIA-like symptoms from cerebral amyloid angiopathy (CAA) require avoidance of_____ or_____ drugs | antiplatelet or anticoagulation | G7 p.1201:29mm |
e. because the CAA patient is more prone to_____. | hemorrhage |
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57. Complete the following about anosmia: |
| G7 p.1202:80mm |
a. Most common cause is s_____ r_____ infection. | severe respiratory |
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b. |
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i. Second most common cause is_____ _____. | head injury |
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ii. For severe such cases_____ to_____% occurence. | 7 to 15% |
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58. Complete the following about cranial neuropathies: |
| G7 p.1202:52mm |
a. Congenital facial diplegia is also known as_____. | Möbius syndrome |
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b. It affects which half of the face more? | Upper |
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c. True or False. It may also involve other cranial nerves. If so, which ones? | true CN VI, III, or XII |
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d. Lyme disease can cause_____. | unilateral or bilateral seventh nerve palsy |
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e. Affects which half of the face? | lower (as in Bell palsy) |
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f. True or False. It may also involve other cranial nerves. | false |
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59. Complete the following about cavernous sinus syndrome: |
| G7 p.1204:60mm |
a. A cavernous sinus aneurysm can compress the third nerve and cause_____ | diplopia |
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b. due to_____. | ophthalmoplegia |
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c. In this form of third nerve palsy the pupil will be_____ | not dilated |
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d. because the_____ that dilate the pupil | sympathetics |
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e. are_____. | also paralyzed |
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60. Complete the following about osteopetrosis: |
| G7 p.1204:75mm |
a. It is also known as_____ | marble bone |
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b. a_____ disorder | genetic |
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c. of defective_____ resorption of bone | osteoclastic | |
d. resulting in increased_____ _____. | bone density |
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e. The most common neurologic manifestation is_____. | blindness |
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f. Treatment consists of bilateral_____ _____decompression. | optic nerve |
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61. Complete the following about monocular blindness: |
| G7 p1204:178mm |
a. Giant cell arthritis aka t_____a_____ | temporal arthritis |
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b. Usually due to ischemia of the |
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i. o_____ n_____ or | optic nerve |
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ii. o_____ t_____ | optic tract |
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iii. less likely the c_____ r_____artery | central retinal |
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62. Complete the following about exophthalmos: |
| G7 p. 1205:73mm |
a. aka p_____ | proptosis |
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b. Following trauma, think: c_____c_____ fistula | carotid cavernous |
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c. Following frontal-orbital surgery, think:_____ in_____ _____ | defect in orbital roof |
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63. Complete the following about arachnoid cyst: |
| G7 p.1207:40mm Also see |
a. aka_____ _____ | leptomeningeal cyst | G7 p. 222 |
b. Due to a d_____ of the_____ | duplication; arachnoid |
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c. Reach maximum size in_____ _____ | 1 month |
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d. Need surgery in about_____% | 30% |
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64. Complete the following regarding differential diagnosis by signs and symptoms: |
| G7 p.1208:87mm |
a. Hemifacial spasm may produce tinnitus because of s_____ m_____spasms. | stapedial muscle |
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b. High cervical lesion may cause facial sensory changes due to compression of the s_____ t_____ t_____ | spinal trigeminal tract | G7 p.1208:40mm |
c. at cervical levels down to_____. | C2-C4 |
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d. Causes of mutism include injury to |
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i. f_____l_____ | frontal lobes |
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ii. c_____g_____ | cingulate gyrus |
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iii. c_____c_____t_____ | corpus callosum plus thalamus |
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iv. c_____ | cerebellum |
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e. Swallowing difficulties can be caused by ossification of the_____ _____ _____. | anterior longitudinal ligament | |
65. Complete the following about CPA lesions: |
| G7 p.1210:133mm |
Hint: amem |
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a. |
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i. Acoustic neuroma more accurately known as v_____s_____ | vestibular schwannoma |
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ii. Occurs in_____to_____% | 80 to 90% |
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b. Meningioma occurs in_____to_____%. | 5 to 10% |
|
c. Epidermoid occurs in_____to_____%. | 5 to 7% |
|
d. Metastatic_____ | rarely |
|
66. Matching. Match the characteristic with the condition. |
| G7 p.1211:120mm |
Condition: |
|
|
|
|
|
|
|
|
Characteristic: |
|
|
a. Hearing loss occurs early in_____. |
| |
b. Facial weakness occurs early in_____. |
| |
c. Internal auditory canal (IAC) is enlarged in_____. |
| |
d. Calcification is seen in_____. |
| |
e. It represents 90% of cerebellopontine angle (CPA) tumors. |
| |
f. It represents 5 to 10% of CPA tumors. |
| |
67. Complete the following about posterior fossa tumor: |
| G7 p.1209:134mm |
a. Most likely a solitary lesion in an adult is a_____. | metastasis |
|
b. Most likely primary tumor is the_____. | hemangioblastoma |
|
c. Radiologic characteristics include |
|
|
i. v_____n_____ | vascular nodule |
|
ii. c_____ | cyst |
|
iii. s_____ _____on_____ | serpentine vessels on surface |
|
d. The tumor that is common in young adults is p_____a_____. | pilocytic astrocytoma |
|
68. Complete the following regarding differential diagnosis by location: |
| G7 p.1210:60mm |
a. The modern name for medulloblastoma is_____ _____ _____. | primitive neuroectodermal tumor (PNET) |
|
b. It usually begins at the_____, | fastigium |
|
c. which is located at the_____. | roof of the fourth ventricle |
|
d. The consistency is_____. | solid |
|
69. For posterior fossa tumors in children, give types and percentage. |
| G7 p.1210:87mm |
a. a_____ (p_____),_____% | astrocytoma (pilocytic), 27% |
|
b. b_____ _____ _____,_____% | brain stem glioma, 28% |
|
c. P_____(i.e., m_____),_____% | PNET (i.e., medulloblastoma), 27% | |
70. Complete the following about atlantoaxial subluxation: |
| G7 p.1230:144mm |
a. Incompetence of the_____ligament | transverse |
|
b. Results in increased_____ _____interval | atlantodental |
|
71. Complete the following regarding differential diagnosis by location: |
| G7 p.1231:23mm |
a. Morquio syndrome is hypoplasia of the_____ | dens |
|
b. due to a m_____. | mucopolysaccharidosis |
|
c. It may result in_____subluxation. | atlantoaxial |
|
72. Complete the following about multiple intracranial lesions on CT or MRI: |
| G7 p.1212:103mm |
a. Glioma—what % are multicentric?_____% | 6% |
|
b. Herpes simplex usually occurs in the_____lobe. | temporal | G7 p.1213:117mm |
c. MS lesions are p_____. | periventricular | G7 p.1213:25mm |
d. Dural sinus thrombosis cause multiple_____ _____. | venous infarcts | G7 p.1213:721mm |
e. Multiple hypertensive hemorrhages is likely_____ _____. | amyloid angiopathy | G7 p.1213:110mm |
73. Name the ring-enhancing lesions on computed tomography and magnetic resonance imaging (CT/MRI). |
| G7 p.1214:100mm |
Hint: haam |
|
|
a. h_____ | hematoma |
|
b. a_____ | astrocytoma |
|
c. a_____ | abscess |
|
d. m_____ | metastases |
|
74. Complete the following about ring-enhancing lesions on CT/MRI: |
| G7 p.1214:100mm |
a. A continuous ring suggests r_____h_____. | resolving hematoma |
|
b. An interrupted ring suggests m_____. | malignancy |
|
75. List the conditions that cross the corpus callosum. |
| G7 p.1215:70mm |
Hint: ms-glld |
|
|
a. m_____ s_____ | multiple sclerosis |
|
b. g_____ | glioblastoma |
|
c. l_____ | lymphoma (primary CNS) |
|
d. l_____ | lipoma |
|
e. d_____ | diffuse axonal injury | |
76. Complete the following regarding sellar and parasellar lesions: |
| G7 p.1215:95mm |
a. Adults: most common is_____ _____ | pituitary adenoma |
|
b. |
|
|
i. Children: most common are c_____ | craniopharyngioma |
|
ii. and g_____ | germinoma |
|
77. Complete the following regarding sellar lesions: |
| G7 p.1215:150mm |
a. Pituitary pseudotumor is due to_____, | hypothyroidism |
|
b. which causes chronic pituitary stimulation by_____-_____ _____. | thyrotropin-releasing hormone |
|
78. Germ cell tumors in the suprasellar area are |
| G7 p.1215:150mm |
a. more common in_____. | women |
|
b. have a triad of |
|
|
i. d_____ _____ | diabetes insipidus |
|
ii. v_____ _____ _____ | visual field defects |
|
iii. p_____ | panhypopituitarism |
|
79. Complete the following about juxtasellar masses: |
| G7 p.1216:16mm |
a. Craniopharyngioma |
|
|
i. In this region account for_____% of tumors in adults | 20% |
|
ii. and_____% in children | 54% |
|
b. Meningioma. To differentiate from pituitary macroadenoma use gadolinium. Meningiomas have: |
|
|
i. b_____h_____ e_____ | bright homogeneous enhancement |
|
ii. Epicenter is_____ | suprasellar |
|
iii. Tapered extension aka_____ _____ | dural tail |
|
iv. Sella is usually_____ _____ | not enlarged |
|
v. Rarely produce_____disturbances | endocrine |
|
vi. Tend to_____carotid artery | encase |
|
80. True or False. Regarding lymphocytic hypophysitis: |
| G7 p.1212:15mm |
a. It is rare. | true |
|
b. It may cause hypopituitarism. | true |
|
c. Most cases occur in women. | true |
|
d. It tends to selectively affect a single hormone. | true |
|
e. It requires surgery. | false (self-limiting or Rx with steroids) |
|
f. It may produce diabetes insipidus (DI). | true | |
81. Complete the following about cavum septum pellucidum (CSP): |
| G7 p.1218:45mm |
a. It is present in all_____ _____. | premature babies |
|
b. Adults have them in_____%. | 10% |
|
c. It is commonly seen in_____. | boxers |
|
82. Complete the following about cavum vergae: |
| G7 p.1218:45mm |
a. posterior to_____ | CSP |
|
b. often communicates with the_____ | CSP |
|
83. Complete the following about cavum velum interpositum: |
| G7 p.1218:45mm |
a. due to separation of the_____ | crura |
|
b. of the_____ | fornix |
|
c. with the_____above and | thalami |
|
d. the_____ _____ below | third ventricle |
|
e. present under 1 year of age in_____% | 60% |
|
f. present between 1 and 10 years old in_____% | 30% |
|
84. True or False. The most common benign primary intraorbital neoplasm is |
| G7 p.1218:128mm |
a. capillary hemangioma | false |
|
b. lymphangioma | false |
|
c. optic nerve sheath meningioma | false |
|
d. cavernous hemangioma | true |
|
e. optic glioma | false |
|
85. Matching. Match characteristics of orbital lesions with pathology (may match with more than one). |
| G7 p.1218:145mm |
Pathology: |
|
|
|
|
|
Characteristic: |
|
|
a. infantile proptosis |
|
|
b. regresses spontaneously |
| |
c. does not regress |
| |
d. painless proptosis |
| |
e. bilateral (80% of the time) |
| |
86. The most common primary ocular malignancy of childhood is_____. | melanoma | G7 p.1218:152mm |
87. Complete the following about skull lesions: |
| G7 p.1220:27mm |
a. Multiplicity suggests_____. | malignancy, especially if six or more |
|
b. Expansion of diploë suggests_____. | a benign lesion |
|
c. Peripheral sclerosis suggests_____. | a benign lesion |
|
d. Full-thickness lesions suggest_____. | malignancy |
|
e. Sharply demarcated, punched-out defects suggest_____. | myeloma | |
88. Complete the following about skull lesions: |
| G7 p.1220:80mm |
a. Name the skull lesion that shows a |
|
|
i. trabecular pattern | hemangioma | G6 p.930:120mm |
ii. sunburst pattern | hemangioma |
|
iii. islands of bone pattern | fibrous dysplasia |
|
iv. site of tenderness to palpation | eosinophilic granuloma |
|
b. Another name for Paget disease that is only osteolytic is_____ _____. | osteoporosis circumscripta | G7 p.1221:87mm |
c. Eosinophilic granuloma is the mildest form of_____ _____. | histiocytosis X |
|
89. Complete the following about skull lesions: |
| G7 p.1223:35mm |
a. There is no_____lesion | intra-axial |
|
b. that grows out of the_____. | skull |
|
90. Choroid plexus calcification has the following characteristics: |
| G7 p.1224:45mm |
a. % calcified between age 40 and 50 is_____ | 75% |
|
b. rare under age_____ | 3 |
|
c. Under age 10 consider choroid plexus_____. | papilloma |
|
d. If you see calcified choroid plexus in the temporal horn consider_____. | neurofibromatosis |
|
91. Complete the following about basal ganglia calcifications: |
| G7 p.1224:55mm |
a. Are common in the_____ | elderly |
|
b. May be due to_____ | hyperparathyroidism |
|
c. Or long-term use of_____ | anticonvulsants |
|
d. Or_____disease | Fahr |
|
e. Correlated with psychiatric diseases if >_____cm | 0.5 |
|
92. Complete the following about Fahr disease: |
| G7 p.1224:75mm |
a. Cause is_____ | idiopathic |
|
b. Course is_____ | progressive |
|
c. What do we see in x-rays? | intracranial calcifications |
|
d. Where? |
|
|
i. b_____ g_____ | basal ganglia |
|
ii. s_____ | sulci |
|
iii. d_____n_____ | dentate nuclei | |
93. What are the characteristics of intraventricular lesions? Which: |
| G7 p.1224:150mm |
a. is most common? | astrocytoma |
|
b. is at foramen of Monro? | colloid cyst |
|
c. has punctate calcification? | craniopharyngioma |
|
d. fills the fourth ventricle? | medulloblastoma |
|
e. is the most common fourth ventricle low density lesion? | epidermoid |
|
f. has free-floating fat in ventricles? | dermoid |
|
g. has fat and calcification? | teratoma |
|
h. is at the septum pellucidum? | central neurocytoma |
|
94. Intraventricular meningiomas are fed by the |
| G7 p.1224:180mm |
a. a_____ c_____ a_____ | anterior choroidal artery |
|
b. and less commonly by the |
|
|
i. m_____ p_____ c_____a_____ medial posterior choroidal artery |
| |
ii. l_____ p_____ c_____a_____ | lateral posterior choroidal artery |
|
c. and are thought to arise from the _____ _____ _____. | arachnoidal cap cells |
|
95. True or False. The following intraventricular lesion is least likely to be found in the frontal horn: |
| G7 p.1225:130mm |
a. astrocytoma | false |
|
b. meningioma | false |
|
c. dermoid | false |
|
d. choroid plexus papilloma | true |
|
96. Matching. Match most common tumor type with location. |
| G7 p.1225:125mm |
Location: |
|
|
Tumor type: |
|
|
a. Colloid cyst |
| |
b. Medulloblastoma |
| |
c. Meningioma |
| |
d. Ependymoma |
| |
e. Astrocytoma |
| |
f. Choroid plexus papilloma |
| |
g. Choroid plexus carcinoma |
| |
h. Subependymoma_____ or_____ |
|
|
i. teratoma |
| |
97. Complete the following about tumors within the lateral ventricles. In adults all enhance except |
| G7 p.1226:65mm |
a. c_____ and the | cysts |
|
b. s_____. | subependymoma | |
98. Periventricular enhancing mass lesions. First consideration should be _____. | lymphoma | G7 p.1227:138mm |
99. With periventricular low density, consider: |
| G7 p.1227:138mm |
a. t_____ edema | transependymal |
|
b. m_____ s_____ | multiple sclerosis |
|
c. acute arteriosclerotic encephalopathy aka_____ _____ | Binswanger disease |
|
d. leukoaraiosis |
|
|
i. representing_____ _____ | normal aging |
|
ii. or w_____ i_____ | watershed infarction |
|
100. Ependymal enhancement can be due to |
| G7 p.1227:142mm |
a. v_____ | ventriculitis (pyogenic or viral) |
|
b. l_____ | lymphoma |
|
c. m_____ | metastasis |
|
d. g_____ | granuloma (TB) |
|
101. What does the pattern of enhancement suggest? |
| G7 p.1228:35mm |
a. Thin linear suggests v_____. | virus (CMV) |
|
b. Nodular suggests l_____. | lymphoma |
|
102. Complete the following about intraventricular hemorrhage: |
| G7 p.1228:95mm |
a. Extension from |
|
|
i. t_____ in hypertensive adult | thalamus |
|
ii. p_____ in hypertensive adult | putamen |
|
iii. s_____ in premature newborn | subependyma |
|
b. True or False. Occurs commonly with aneurysm of the |
|
|
i. MCA | false |
|
ii. A-comm | true |
|
iii. P-comm | false |
|
iv. distal basilar | false |
|
v. vein of Galen | false |
|
vi. carotid bifurcation | true |
|
vii. pericallosal | false |
|
viii. vertebral | true |
|
ix. PICA | true |
|
x. dissecting vertebral type | true |
|
103. The most common medial temporal lobe lesions are |
| G7 p.1128:145mm |
a. h_____ | hamartoma |
|
b. m_____ t_____ s_____ mesial temporal sclerosis |
| |
c. g_____ | glioma (low grade) | |
104. True or False. Esthesioneuroblastoma most commonly presents with |
| G7 p.1230:42mm |
a. pain | false |
|
b. nasal obstruction | false |
|
c. epistaxis | true |
|
d. tearing | false |
|
e. proptosis | false |
|
105. To differentiate: |
| G7 p.1230:80mm |
|
|
|
|
|
|
a. pulsatile |
| |
b. swells with Valsalva |
| |
c. hypertelorism |
| |
d. attachment to CNS |
| |
106. Destructive spondylo-arthropathy is |
| G7 p.1233:30mm |
a. the name for bone changes seen in c_____ r_____ f_____. | chronic renal failure |
|
b. It resembles i_____. | infection |
|
107. True or False. Destruction of the disc space is highly suggestive of |
| G7 p.1233:70mm |
a. tumor | false |
|
b. infection | true |
|
c. degenerative disease | false |
|
d. metabolic disease | false |
|
108. Matching. Match the destructive lesion of the spine with its cause. |
| G7 p.1233:71mm |
Cause: |
|
|
a. Destruction of disc space suggests_____. |
| |
b. Disc space not destroyed suggests _____. |
| |
c. Single-level involvement suggests _____. |
| |
d. Multiple-level involvement suggests _____. |
| |
e. Dense vertebra on x-ray suggests _____. |
| |
109. True or False. Pott disease is confined to the disc space. | false (The disc may be relatively resistant to tuberculous involvement.) | G7 p.1233:88mm |

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