front 1 Which triad is assessed first to judge global brain function before proceeding with the rest of the neurologic examination? A. Naming, repetition, praxis | back 1 B. Alertness, attention, cooperation |
front 2 Which network is most critical for maintaining normal alertness? A. Basal ganglia and cerebellum | back 2 D. Reticular formation, thalamus, cerebrum |
front 3 A patient speaks fluently and follows commands but cannot count backward or recite months in reverse order. Which domain is primarily impaired? A. Attention | back 3 A. Attention |
front 4 Marked deficits in attention and cooperation during the interview may arise from which general processes? A. Cerebellar lesions or dementia | back 4 C. Focal lesions or dementia |
front 5 Asking a patient for full name, current location, and date primarily tests which cognitive function? A. Working memory | back 5 B. Long-term memory |
front 6 Short-term memory on bedside mental-status testing is most closely associated with which system? A. Limbic system | back 6 A. Limbic system |
front 7 After ensuring the material was initially registered, which method best tests recent memory? A. Immediate digit repetition | back 7 D. Story recall after 3–5 minutes |
front 8 del | back 8 del |
front 9 A patient accurately registers a short story, completes distraction tasks, but cannot recall it 4 minutes later. Which lesion location is most consistent? A. Posterior parietal cortex | back 9 B. Medial temporal-diencephalic limbic circuit |
front 10 Which bedside task most directly assesses attention during the initial mental-status screening? A. Months backward recitation | back 10 A. Months backward recitation |
front 11 After bilateral medial temporal injury, a patient remembers childhood but cannot form new memories after hospitalization. Which deficit is present? A. Retrograde amnesia | back 11 B. Anterograde amnesia |
front 12 After a head injury, a patient cannot recall the collision or events immediately before it, but can learn new information during rehab. Which deficit is present? A. Retrograde amnesia | back 12 A. Retrograde amnesia |
front 13 Asking a patient about a major historical event most directly assesses: A. Immediate memory | back 13 D. Remote memory |
front 14 Language testing during the mental-status exam primarily localizes to which hemisphere in most people? A. Right non-dominant hemisphere | back 14 C. Left dominant hemisphere |
front 15 During spontaneous speech, a patient says “fork” when shown a spoon. This is best described as: A. Paraphasic error | back 15 A. Paraphasic error |
front 16 A patient uses made-up words during otherwise fluent conversation. This finding is called: A. Dysarthria | back 16 D. Neologisms |
front 17 Which abnormality in spontaneous speech should specifically raise concern for dominant hemisphere dysfunction? A. Major grammatical errors | back 17 A. Major grammatical errors |
front 18 Besides spontaneous speech, which additional function should be assessed when screening the dominant hemisphere? A. Construction | back 18 B. Comprehension |
front 19 Asking a patient to name objects, repeat words, read, and write most directly tests the: A. Limbic memory circuit | back 19 D. Left dominant hemisphere |
front 20 These bedside language tasks assess the hemisphere containing which classic cortical language regions? A. Broca and Wernicke areas | back 20 A. Broca and Wernicke areas |
front 21 Gerstmann syndrome most strongly localizes to the: A. Right non-dominant parietal lobe | back 21 C. Left dominant parietal lobe |
front 22 Which set best matches Gerstmann syndrome? A. Apraxia, neglect, extinction, anosognosia | back 22 D. Agraphia, acalculia, finger agnosia, right-left confusion |
front 23 A patient can speak and follow commands but cannot write a sentence despite intact hand strength. This deficit is: A. Aphasia | back 23 B. Agraphia |
front 24 Inability to perform mathematical calculations on bedside testing is termed: A. Dysgraphia | back 24 C. Acalculia |
front 25 A patient cannot identify or name individual fingers when asked. This finding is: A. Finger agnosia | back 25 A. Finger agnosia |
front 26 Dominant parietal lobe dysfunction often occurs together with: A. Visual agnosia | back 26 B. Aphasia |
front 27 A patient with a right parietal lesion ignores food on the left side of the tray. This syndrome is: A. Alexia | back 27 D. Hemi-neglect |
front 28 On double simultaneous stimulation, a patient detects a left-sided touch alone but ignores it when both sides are touched together. This phenomenon is: A. Confabulation | back 28 B. Extinction |
front 29 A patient with left hemiplegia insists nothing is wrong with the left side of the body. This unawareness is: A. Aphasia | back 29 D. Anosognosia |
front 30 A patient with non-dominant parietal damage omits the left half of a clock when drawing it. This most strongly reflects failure of: A. Construction tasks | back 30 A. Construction tasks |
front 31 A patient with suspected frontal lobe dysfunction is asked to copy an alternating sequence of shapes but keeps drawing the same figure repeatedly. This abnormality is best termed: A. Extinction | back 31 B. Perseveration |
front 32 Difficulty with sequencing tasks during the mental-status exam most strongly suggests dysfunction of the: A. Frontal lobe | back 32 A. Frontal lobe |
front 33 Which bedside finding is most consistent with frontal dysfunction? A. Loss of vibration sense | back 33 B. Repeated motor set failure |
front 34 Failure of the Luria Manual Sequence Task most directly reflects impaired: A. Visual memory | back 34 C. Motor sequencing |
front 35 A patient cannot sustain successive learned motor acts during examination, despite understanding instructions and having full strength. This is most consistent with: A. Motor impersistence | back 35 A. Motor impersistence |
front 36 The Auditory Go-No-Go test primarily assesses a patient’s ability to: A. Retain verbal information | back 36 B. Suppress inappropriate movements |
front 37 A patient with frontal disease is apathetic and has markedly reduced initiative and poor judgment formation. This syndrome is called: A. Abulia | back 37 A. Abulia |
front 38 In the mental-status exam, abulia refers to a reduction in the ability to: A. Smell familiar odors | back 38 C. Make judgments |
front 39 Apraxia is best defined as the loss of the ability to carry out skilled movements despite preserved: A. Reflexes and tone | back 39 B. Desire and physical ability |
front 40 A patient understands the command, has full strength, and wants to comply, but cannot perform a learned gesture. Which diagnosis best fits? A. Apraxia | back 40 A. Apraxia |
front 41 Apraxia is not explained by which of the following? A. Higher-order planning failure | back 41 D. Upper motor neuron lesion |
front 42 del | back 42 del |
front 43 During the final global assessment, which additional domains should be revisited besides apraxia? A. Tone, bulk, fasciculations | back 43 B. Logic, hallucinations, mood |
front 44 Delusions and hallucinations on exam should prompt consideration of what often-forgetten issues? A. Psychiatric or neurological disease | back 44 C. Toxic or metabolic causes |
front 45 Routine testing of cranial nerve I is generally avoided unless: A. Aphasia is suspected | back 45 B. Specific pathology is suspected |
front 46 Loss of smell may result from which of the following? A. Obstruction, nerve, intracranial lesion | back 46 A. Obstruction, nerve, intracranial lesion |
front 47 Early loss of smell is classically associated with: A. Huntington and ALS | back 47 B. Alzheimer and Parkinson disease |
front 48 A patient with progressive anosmia has no nasal congestion. Which mechanism still remains plausible? A. Nasal obstruction only | back 48 B. Peripheral nerve cause |
front 49 Funduscopic examination with an ophthalmoscope is primarily used to evaluate for damage to the: A. Retina and retinal vessels | back 49 A. Retina and retinal vessels |
front 50 A bedside eye chart assessment of each eye most directly tests: A. Stereopsis | back 50 B. Visual acuity |
front 51 Which additional bedside visual function is specifically included along with acuity and fields in this exam framework? A. Corneal reflex | back 51 C. Color vision |
front 52 When red appears less vivid in one eye than the other, this asymmetry suggests dysfunction of: A. CN II | back 52 A. CN II |
front 53 Double simultaneous visual stimulation showing failure to report one side despite seeing each side alone suggests: A. Papilledema | back 53 C. Hemi-neglect |
front 54 Visual extinction is tested by asking the patient to report: A. Light brightness only | back 54 B. Finger number seen |
front 55 Pupillary light responses primarily assess which cranial nerves together? A. II and III | back 55 A. II and III |
front 56 del | back 56 del |
front 57 Failure of the consensual response can result from which lesion pair? A. Ipsilateral III, ipsilateral IV | back 57 C. Ipsilateral II, contralateral III |
front 58 del | back 58 del |
front 59 An impaired direct pupillary response may result from: A. Contralateral II lesion | back 59 B. Ipsilateral II lesion |
front 60 Which structure, if paralyzed, can impair either direct or consensual constriction in the affected eye? A. Dilator muscle | back 60 C. Sphincter muscle |
front 61 A decreased direct response caused by CN II dysfunction is best termed: A. Argyll Robertson pupil | back 61 B. Afferent pupillary defect |
front 62 Which bedside maneuver is used to demonstrate an afferent pupillary defect? A. Cover-uncover test | back 62 C. Swinging light test |
front 63 Brief normal oscillations in pupil size during examination are called: A. Horner waves | back 63 B. Hippus |
front 64 Which pupillary response is tested by having the patient shift gaze to a near object? A. Visual extinction | back 64 D. Accommodation response |
front 65 Sparing of accommodation with absent light response most strongly suggests a lesion in the: A. Internal capsule | back 65 B. Pretectal region |
front 66 In the provided framework, impairment of the consensual response may reflect a lesion involving the brain’s: A. Red nucleus | back 66 B. Edinger-Westphal region |
front 67 Extraocular movement testing of cranial nerves III, IV, and VI is performed by asking the patient to: A. Blink rapidly | back 67 D. Look all directions |
front 68 While testing ocular motility, the examiner should ensure the patient’s: A. Jaw remains clenched | back 68 B. Head does not move |
front 69 Having the patient track a target across horizontal and vertical planes primarily assesses: A. Saccadic suppression | back 69 B. Smooth pursuit |
front 70 Convergence is tested by asking the patient to: A. Read distant letters | back 70 C. Fixate a near target |
front 71 Failure of both eyes to remain fixed on the same target during convergence indicates: A. Dysconjugate gaze | back 71 A. Dysconjugate gaze |
front 72 Dysconjugate gaze during convergence commonly produces: A. Ptosis | back 72 C. Diplopia |
front 73 A patient has normal acuity but misses stimuli in one hemifield only during simultaneous bilateral presentation. This most strongly suggests: A. Cataract | back 73 D. Visual extinction |
front 74 A patient is asked to rapidly shift gaze from the examiner’s finger to a penlight across the room. Which type of eye movement is being tested? A. Smooth pursuit | back 74 B. Saccades |
front 75 Saccades are best defined as eye movements used to: A. Track moving targets smoothly | back 75 C. Rapidly refixate between targets |
front 76 Optokinetic nystagmus is commonly tested by: A. Covering one eye alternately | back 76 D. Moving parallel stripes past gaze |
front 77 During optokinetic nystagmus testing, the patient is instructed to: A. Follow one stripe, then next | back 77 A. Follow one stripe, then next |
front 78 Optokinetic nystagmus normally contains which two components? A. Direct and consensual phases | back 78 C. Fast and slow phases |
front 79 Bedside optokinetic testing is especially useful for detecting impaired: A. Facial sensation or asymmetric saccades | back 79 B. Smooth movement or asymmetric saccades |
front 80 Spontaneous abnormal nystagmus on exam may suggest: A. Dominant parietal dysfunction | back 80 D. Toxic metabolite buildup |
front 81 In a comatose patient, eye movement may be assessed using: A. Oculocephalic or caloric testing | back 81 A. Oculocephalic or caloric testing |
front 82 Facial sensation in cranial nerve testing can be screened using: A. Tuning fork or pinwheel | back 82 C. Cotton wisp or sharp object |
front 83 Simultaneous bilateral facial stimuli are used to test for: A. Jaw jerk | back 83 D. Tactile extinction |
front 84 The corneal reflex depends on which afferent-efferent pair? A. V afferent, VII efferent | back 84 A. V afferent, VII efferent |
front 85 The corneal reflex is elicited by: A. Tapping the nasal bridge | back 85 D. Touching the cornea lightly |
front 86 A patient feels corneal touch but does not blink. According to the provided framework, this pattern usually suggests: A. Left parietal lesion | back 86 B. Right parietal lesion |
front 87 The jaw jerk reflex is tested by: A. Tapping jaw with mouth open | back 87 A. Tapping jaw with mouth open |
front 88 The jaw jerk reflex evaluates muscles of mastication carried by: A. CN VII only | back 88 B. CN V3 only |
front 89 In the jaw jerk reflex, CN V3 serves which role? A. Both afferent and efferent | back 89 A. Both afferent and efferent |
front 90 Hyperreflexia of the jaw jerk most strongly suggests: A. Lower motor neuron lesion | back 90 C. Upper motor neuron lesion |
front 91 Cranial nerve VII alone can be screened initially by looking for: A. Dysphagia with phonation | back 91 D. Facial asymmetry at rest |
front 92 Bilateral facial weakness that may be subtle on examination is termed: A. Hemifacial spasm | back 92 C. Facial diplegia |
front 93 Unilateral facial weakness is often best demonstrated by asking the patient to: A. Open mouth widely | back 93 D. Smile or make faces |
front 94 Cranial nerve VII can also be tested by applying which tastes to each side of the tongue? A. Salt and quinine | back 94 B. Sugar and lemon juice |
front 95 A lower motor neuron lesion of cranial nerve VII classically causes weakness of the: A. Contralateral face, forehead spared | back 95 D. Ipsilateral face including forehead |
front 96 An upper motor neuron facial lesion typically causes weakness of the: A. Contralateral face, forehead spared | back 96 A. Contralateral face, forehead spared |
front 97 Hearing for cranial nerve VIII can be screened by: A. Whispering into both ears | back 97 C. Light noise, then side localization |
front 98 In a patient with vertigo, specific bedside maneuvers may help distinguish: A. Retinal from cortical loss | back 98 B. Peripheral from central lesions |
front 99 The vestibulo-ocular reflex is especially helpful to test in patients with limitation of: A. Smell or taste | back 99 D. Horizontal or vertical gaze |
front 100 The oculocephalic maneuver is performed by: A. Turning head rapidly, eyes open | back 100 A. Turning head rapidly, eyes open |
front 101 Normal doll’s eyes are present when the eyes: A. Move with head rotation | back 101 B. Shift opposite head turn |
front 102 According to the material, the only way to test CN VIII in a comatose patient is with the: A. Corneal reflex | back 102 C. Oculocephalic maneuver |
front 103 Unilateral cranial nerve VIII deficits are most often produced by: A. Cortical lesions | back 103 D. Peripheral lesions |
front 104 Which cranial nerve set is involved in articulation and may contribute to dysarthria? A. 2, 3, 4, 6 | back 104 C. 5, 7, 9, 10, 12 |
front 105 A patient has slurred, poorly pronounced speech but intact word choice and comprehension. This pattern is most consistent with: A. Aphasia | back 105 B. Dysarthria |
front 106 Which speech deficit reflects abnormal word choice rather than abnormal pronunciation? A. Aphasia | back 106 A. Aphasia |
front 107 Cranial nerve XI is tested most directly by asking the patient to: A. Smile and close eyes | back 107 B. Shrug shoulders and turn head |
front 108 Weakness of which muscle is specifically assessed when the patient turns the head during CN XI testing? A. Temporalis | back 108 C. Sternocleidomastoid |
front 109 In contralateral upper motor neuron lesions, the sternocleidomastoid is often: A. Completely denervated | back 109 C. Partially spared |
front 110 Partial sparing of the sternocleidomastoid with contralateral upper motor neuron lesions is said to resemble the sparing pattern seen with: A. CN 2 and pupil | back 110 D. CN 5 and forehead |
front 111 Examination of CN XII includes looking at the resting tongue for: A. Rigidity and tremor | back 111 C. Atrophy and fasciculations |
front 112 A lower motor neuron lesion of CN XII causes tongue weakness on the: A. Ipsilateral side | back 112 A. Ipsilateral side |
front 113 An upper motor neuron lesion affecting CN XII causes tongue weakness on the: A. Ipsilateral side | back 113 B. Contralateral side |
front 114 A patient’s tongue shows quivering movements while resting on the mouth floor. These movements are best described as: A. Clonus | back 114 C. Fasciculations |
front 115 Which finding on tongue inspection most strongly favors a lower motor neuron lesion? A. Hyperreflexia | back 115 B. Atrophy with fasciculations |
front 116 The first step of the motor exam includes observing for: A. Sensory extinction and graphesthesia | back 116 B. Twitches, tremors, posture |
front 117 Involuntary movements seen on general motor observation may suggest lesions involving the: A. Basal ganglia or cerebellum | back 117 A. Basal ganglia or cerebellum |
front 118 Involuntary movements may also occur with: A. Pure language disorders | back 118 B. Toxic or metabolic conditions |
front 119 Fasciculations are often best seen in which locations? A. Forearm, calf, tongue base | back 119 B. Intrinsic hand, shoulder, thigh |
front 120 Palpation tenderness during the motor exam may suggest: A. Myositis | back 120 A. Myositis |
front 121 A rubbery muscle texture due to pseudohypertrophy is most suggestive of: A. Myositis | back 121 B. Muscular dystrophy |
front 122 When testing tone, the examiner should move each limb: A. Against maximal resistance | back 122 B. At several joints |
front 123 Abnormal tone can help distinguish between upper and lower motor neuron lesions because: A. Sensory tracts decussate twice | back 123 B. Motor tracts are crossed |
front 124 In the acute setting, upper motor neuron lesions may initially present with: A. Hyperreflexia and spasticity only | back 124 B. Flaccidity with decreased reflexes |
front 125 Over time, an acute upper motor neuron lesion classically evolves toward: A. Persistent areflexia only | back 125 B. Hyperreflexia and increased tone |
front 126 Which finding is generally absent in typical upper motor neuron lesions, especially early on? A. Weakness | back 126 C. Fasciculations |
front 127 In the acute setting, upper motor neuron lesions usually do not show: A. Atrophy | back 127 A. Atrophy |
front 128 A patient has increased tone, awkward fine finger movements, and impaired toe tapping. This pattern may suggest a lesion involving the: A. Basal ganglia | back 128 A. Basal ganglia |
front 129 Drift testing is primarily used to look for: A. Loss of vibration | back 129 B. Involuntary arm deviation |
front 130 Strength testing of individual muscle groups is most useful because patterns of weakness can localize lesions to the: A. Retina or lens | back 130 B. White matter, segment, nerve |
front 131 Proper strength testing requires the examiner to isolate the target muscle and support it from the: A. Distal side | back 131 C. Proximal side |
front 132 Which statement best describes proper manual muscle testing technique? A. Test multiple muscles together | back 132 D. Isolate muscle and test bilaterally |
front 133 A deep tendon reflex is elicited by using a reflex hammer to: A. Stretch a tendon | back 133 A. Stretch a tendon |
front 134 A reflex cannot initially be obtained in an anxious patient. Which maneuver is appropriate according to the provided framework? A. Ask for slight contraction | back 134 A. Ask for slight contraction |
front 135 Repetitive rhythmic contraction of a muscle after stretch is termed: A. Fasciculation | back 135 B. Clonus |
front 136 Clonus is most likely to be seen when reflexes are: A. Absent | back 136 C. Brisk |
front 137 Hyperreflexia may include “spreading,” meaning: A. Both pupils constrict | back 137 B. Unrelated muscles also respond |
front 138 Reflex testing can be especially useful for lesion localization in patients with: A. Cataracts or glaucoma | back 138 C. Coma or spinal injury |
front 139 Stroking the abdominal wall above the umbilicus should produce abdominal contraction mediated primarily by: A. T6–T8 | back 139 B. T8–T10 |
front 140 Abdominal contraction elicited below the umbilicus primarily tests: A. T8–T10 | back 140 B. T10–T12 |
front 141 Stroking the upper thigh skin normally elicits the cremasteric reflex mediated by: A. T10–T12 | back 141 B. L1–L2 |
front 142 The cremasteric reflex is best elicited by stimulating the: A. Lower abdomen | back 142 D. Upper thigh skin |
front 143 Pressure on the bulbocavernous region should produce anal contraction mediated by: A. L1–L2 | back 143 D. S2–S4 |
front 144 The bulbocavernous reflex is identified by observing: A. Plantar flexion | back 144 B. Anal contraction |
front 145 Sharp pressure in the perianal area is used to test the: A. Cremasteric reflex | back 145 C. Anal wink |
front 146 The anal wink reflex primarily assesses which spinal segments? A. T10–T12 | back 146 D. S2–S4 |
front 147 Hoffman's sign indicates heightened reflex activity involving the: A. Toe extensors | back 147 C. Finger flexors |
front 148 A positive Hoffman's sign most directly reflects: A. Finger flexor hyperreflexia | back 148 A. Finger flexor hyperreflexia |
front 149 In the provided motor exam sequence, drift testing is best classified as part of assessing: A. Sensory/postural holding | back 149 C. Strength/postural holding |
front 150 A patient has asymmetric weakness isolated to muscles supplied by a single peripheral nerve. Which component of the exam most directly helped localize this pattern? A. Bilateral plantar testing | back 150 B. Individual muscle strength testing |
front 151 A patient with bifrontal damage begins exhibiting grasp and sucking behaviors during examination. These findings are best classified as re-emergence of: A. Primitive reflexes | back 151 A. Primitive reflexes |
front 152 Which reflex pair is specifically listed as primitive reflexes that may re-emerge with frontal lobe lesions? A. Corneal and gag | back 152 B. Root and suck |
front 153 Repeated tapping between the eyes while the patient tries to keep the eyes open is testing the: A. Palmomental reflex | back 153 C. Glabellar response |
front 154 Continued blinking during repeated glabellar tapping is abnormal and is called: A. Bell phenomenon | back 154 B. Myerson’s sign |
front 155 Myerson’s sign is classically noted in: A. Myasthenia gravis | back 155 B. Parkinson disease |
front 156 The palmomental reflex is elicited by scraping the: A. Forehead skin | back 156 C. Thenar eminence |
front 157 A positive palmomental reflex produces contraction of the ipsilateral: A. Buccinator muscle | back 157 B. Mentalis muscle |
front 158 Primitive reflexes such as grasp, snout, root, and suck most strongly suggest dysfunction of the: A. Frontal lobe | back 158 A. Frontal lobe |
front 159 Abnormal posturing responses are associated with damage to the: A. Ascending sensory pathways | back 159 B. Descending motor pathways |
front 160 Characterized by stiff, flexed arms bent inward toward the chest, clenched fists, and extended legs A. Decorticate posturing | back 160 A. Decorticate posturing |
front 161 Characterized by rigid extension of the arms and legs, adducted shoulders, pronated forearms, and flexed fingers: A. Decorticate posturing | back 161 B. Decerebrate posturing |
front 162 Cerebellar dysfunction often presents primarily with impaired: A. Language and naming | back 162 B. Coordination and gait |
front 163 Ataxia is best described as: A. Pure weakness of extremities | back 163 B. Abnormal coordination movements |
front 164 Which description best matches ataxic movements in the provided material? A. Fine rhythmic resting tremor | back 164 C. Medium-large irregular oscillations |
front 165 Ataxia commonly occurs together with: A. Aphasia | back 165 B. Overshoot |
front 166 Appendicular ataxia is most associated with lesions of the: A. Cerebellar hemispheres | back 166 A. Cerebellar hemispheres |
front 167 Which bedside test is specifically listed for upper-limb appendicular coordination? A. Romberg test | back 167 C. Finger-to-nose test |
front 168 Which bedside test is specifically listed for lower-limb coordination? A. Heel-to-shin test | back 168 A. Heel-to-shin test |
front 169 Tests of appendicular coordination incorporate many sensory and motor subsystems and assess how well they: A. Cross in the medulla | back 169 B. Function together |
front 170 Truncal ataxia primarily affects: A. Distal finger movements | back 170 B. Proximal gait musculature |
front 171 Truncal ataxia is most strongly associated with a lesion of the: A. Cerebellar hemisphere | back 171 B. Midline cerebellar vermis |
front 172 A patient has severe instability of stance and gait with relatively spared finger-to-nose testing. This pattern most strongly suggests: A. Appendicular ataxia | back 172 B. Truncal ataxia |
front 173 Which pair of systems can be uncovered by Romberg testing in this framework? A. Cerebellar or vestibular | back 173 A. Cerebellar or vestibular |
front 174 Subtle gait abnormalities may be accentuated during examination by asking the patient to: A. Walk on toes or heels | back 174 A. Walk on toes or heels |
front 175 A patient can simulate stepping movements normally while supine but cannot initiate walking when upright. This pattern is most consistent with: A. Truncal ataxia | back 175 B. Gait apraxia |
front 176 Which bedside tool is specifically listed for testing fine touch? A. Cotton swab | back 176 A. Cotton swab |
front 177 Pain sensation in the sensory exam can be tested using the: A. Sharp scalpel edge | back 177 C. Dull safety pin end |
front 178 Temperature sensation is specifically assessed using: A. Warm water vial | back 178 B. Cold metal |
front 179 Two-point discrimination is tested using: A. Cotton and tuning fork | back 179 D. Calipers or bent paper clip |
front 180 Graphesthesia is tested by asking the patient with eyes closed to identify: A. A finger touched twice | back 180 C. A letter drawn on palm |
front 181 Graphesthesia is considered a test of: A. Primary nociception | back 181 B. Higher cortical sensation |
front 182 Stereognosis is tested by asking the patient to close the eyes and identify: A. The direction of toe movement | back 182 B. Easy objects in hand |
front 183 Higher-order sensory testing differs from primary sensory testing because it assesses: A. Brainstem reflex arcs | back 183 B. Cortical sensory processing |
front 184 del | back 184 del |
front 185 A patient has impaired vibration in the toes, intact pinprick, and preserved graphesthesia. Which statement is most accurate? A. Deficit must be cortical | back 185 B. Sensory lesions localize widely |
front 186 A complete sensory exam in this framework should include primary modalities plus: A. Palatal and gag reflexes | back 186 B. Higher cortical sensation tests |
front 187 Before beginning the neurologic examination in a comatose patient, the clinician should first: A. Check plantar responses | back 187 C. Complete general exam |
front 188 Coma is best defined as: A. Eyes open, no movement | back 188 B. Unarousable unresponsiveness with eyes closed |
front 189 In the notes, coma is described as: A. A fixed all-or-none state | back 189 D. A continuum of responsiveness |
front 190 Which documentation style is preferred when describing coma severity? A. Use one-word labels only | back 190 B. Describe responses to stimuli |
front 191 Damage to which structure can directly impair consciousness? A. Caudate nucleus | back 191 B. Reticular formation |
front 192 Which additional lesion pattern can impair consciousness? A. Unilateral occipital lesion | back 192 B. Bilateral thalamic injury |
front 193 Which nonstructural process can also cause coma-like depressed consciousness? A. Toxic or metabolic disturbance | back 193 A. Toxic or metabolic disturbance |
front 194 A patient has profoundly decreased responsiveness, but the eyes are open, appear normal, and may even move. This is most consistent with: A. Catatonia | back 194 C. Akinetic mutism |
front 195 Markedly decreased responsiveness associated with psychiatric illness is most consistent with: A. Catatonia | back 195 A. Catatonia |
front 196 A conscious patient can perceive sensation but cannot perform motor actions because of a brainstem lesion. This syndrome is: A. Akinetic mutism | back 196 B. Locked-in syndrome |
front 197 Besides brainstem injury, locked-in syndrome may also result from: A. Basal ganglia hemorrhage | back 197 C. Peripheral neuromuscular blockade |
front 198 In a comatose patient, ophthalmoscopic evidence of papilledema most strongly suggests: A. Raised intracranial pressure | back 198 A. Raised intracranial pressure |
front 199 Blink-to-threat is used mainly to obtain a rough bedside estimate of: A. Color vision | back 199 C. Visual fields |
front 200 According to the notes, blink-to-threat is most appropriate in: A. Fully cooperative patients | back 200 B. Noncooperative conscious patients |
front 201 Blink-to-threat is performed by: A. Flashing light into pupil | back 201 C. Moving a hand toward eye |
front 202 In coma, pupillary light responses are particularly useful because toxic or metabolic causes usually: A. Produce blown pupils | back 202 B. Spare the pupils |
front 203 Bilaterally blown pupils in coma should raise concern for: A. Midbrain lesion or herniation | back 203 A. Midbrain lesion or herniation |
front 204 Bilaterally small but reactive pupils are classically associated with: A. Midbrain compression | back 204 B. Pontine lesions |
front 205 Bilateral pinpoint pupils in an unresponsive patient most strongly suggest: A. Opiate overdose | back 205 A. Opiate overdose |
front 206 Absent doll’s eyes in a comatose patient suggests dysfunction of the: A. Cerebellum | back 206 B. Brainstem |
front 207 In caloric testing, cold water in one ear should classically produce a fast phase of nystagmus toward the: A. Same side | back 207 B. Opposite side |
front 208 In many comatose patients, the fast phase of caloric nystagmus may be absent, leaving only: A. Vertical drift away | back 208 B. Slow deviation to cold ear |
front 209 Presence of an oculocephalic or caloric eye movement response indicates preserved: A. Cerebellar hemisphere function | back 209 C. Brainstem function |
front 210 A preserved corneal reflex in coma should produce: A. Facial grimacing | back 210 A. Facial grimacing |
front 211 During airway management, preserved lower cranial nerve reflex function may already be noted because the gag response is often observed during: A. Funduscopic examination | back 211 B. Intubation |
front 212 Abnormal posturing in coma most strongly suggests damage to: A. Ascending sensory pathways | back 212 B. Descending motor pathways |
front 213 Posturing responses in coma may involve which muscle groups? A. Axial muscles only | back 213 C. Flexor or extensor groups |
front 214 A comatose patient extends the arms and legs in response to pain. This pattern most strongly localizes to the: A. Cerebral cortex only | back 214 C. Lower brainstem |
front 215 A patient demonstrates decorticate posturing to noxious stimulation. This pattern is usually associated with lesions: A. In lower brainstem | back 215 B. At midbrain and above |
front 216 Which statement best distinguishes posturing from a pain-withdrawal reflex? A. Posturing avoids the stimulus | back 216 C. Posturing moves toward pain |
front 217 Lower-limb flexor posturing involving hip, knee, and ankle flexion is called: A. Clonus | back 217 B. Triple flexion |
front 218 Triple flexion can occur even without a functional: A. Spinal cord | back 218 C. Brainstem |
front 219 In the comatose patient, coordination and gait are generally: A. Fully assessable | back 219 B. Usually not testable |
front 220 On palpation of the skull after trauma, a palpable discontinuity of cranial bone is called: A. Battle’s sign | back 220 C. Bony step-off |
front 221 Clear fluid leaking from the nose after head trauma most strongly suggests: A. Ethmoid skull-base fracture | back 221 A. Ethmoid skull-base fracture |
front 222 CSF otorrhea after head trauma most strongly points to fracture involving the: A. Ethmoid bone | back 222 B. Temporal bone |
front 223 Dark blood seen behind the tympanic membrane after cranial trauma is termed: A. CSF rhinorrhea | back 223 D. Hemotympanum |
front 224 Bruising over the mastoid process after trauma is known as: A. Raccoon eyes | back 224 B. Battle’s sign |
front 225 Dark periorbital bruising after a basilar skull fracture is called: A. Bony step-off | back 225 C. Raccoon eyes |
front 226 To diagnose brain death, there must be no evidence of function in the: A. Cerebellum | back 226 C. Brainstem |
front 227 Which bedside physiologic study must be included in brain death assessment according to the material? A. Romberg test | back 227 B. Caloric test |
front 228 During the apnea test, brain death is supported when the patient: A. Hyperventilates off ventilator | back 228 C. Shows no respirations despite high pCO2 |
front 229 Which finding would argue against brain death? A. Absent caloric response | back 229 D. Posturing to stimulus |
front 230 Which reflex activity may still be present in brain death because it is brain-independent? A. Corneal reflex | back 230 B. Triple flexion |
front 231 Deep tendon reflexes may still persist in brain death because they are mediated primarily by the: A. Brainstem | back 231 C. Spinal cord |
front 232 Which test pair is specifically described as confirmatory for brain death? A. EEG and angiogram | back 232 A. EEG and angiogram |
front 233 A patient develops weakness and numbness after emotional stress, but no focal neurologic lesion is found. This most strongly suggests: A. Somatization disorder | back 233 B. Conversion disorder |
front 234 A patient has many shifting physical complaints over time affecting multiple organ systems. This pattern is most consistent with: A. Conversion disorder | back 234 C. Somatization disorder |
front 235 Which group is specifically listed as psychogenic neurologic presentations? A. Coma, amnesia, seizures | back 235 A. Coma, amnesia, seizures |
front 236 Which distinction best separates factitious disorder from malingering? A. Internal reward vs external gain | back 236 A. Internal reward vs external gain |
front 237 In the hand-drop test for pseudocoma, the examiner raises the hand above the head and releases it. A truly comatose patient would be expected to: A. Flinch away quickly | back 237 C. Not avoid the face |
front 238 Saccadic eye movements should generally be absent in true coma. Their presence should raise concern for: A. Brain death | back 238 B. Locked-in syndrome |
front 239 During repeated strength testing, inconsistent or variable resistance is most suggestive of: A. Cerebellar ataxia | back 239 C. Psychogenic weakness |
front 240 Which bedside sensory claim is specifically unreliable because the structure resonates? A. Vibration over sternum | back 240 A. Vibration over sternum |