Neurology NMT12

Motor System
Differentiation between UMNL & LMNL:
1. Muscle power
2. Muscle
wasting
3. Muscle tone
4. Deep reflexes
5. Pathological
deep reflexes
6. Clonus
7. Superficial
reflexes
8. Plantar reflex
(Babinski)
9. Fasciculations

UMNL

LMNL

Paralysis or weakness below the

level of the lesion.
No wasting & if present it is late
and due to disuse atrophy.

Paralysis or weakness at the

level of the lesion.
Early & marked wasting due to
loss of muscle tone.

Hypertonia (spasticity) below

the level of the lesion.
Hyperreflexia below the level.

Hypotonia (flaccidity) at the

level of the lesion.
Hyporeflexia at the level.

May be present

Absent

May be present

Absent

Lost if the lesion is above the

segmental supply of the reflex.

Lost if the lesion involves the

supply of the reflex.

Positive, i.e. dorsiflexion of the

big toe fanning of the other
toes.
Absent

Plantar flexion of the toes, or

no response.
May be present in irritative
lesion of the AHCs

Sensory System
Types of Sensations:

Somatic
Superficial
Pain
Temp.
Touch

Deep

Cortical

Vibration
Joint
Muscles
Nerves

Visceral
Sensations from
internal viscera

Tactile Localization
2 point discrimination
Stereognosis
Graphosthesia

Special
Smell
Vision
Hearing

Dissociated sensory Loss: Lost Pain &Temp. and preserved Touch & Deep..

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Cranial Nerves
Olfactory I

Function: Sense of smell

Lesion:
- Anosmia: Loss of sense of smell
- Olfactory Hallucination: False perception of bad smell

Optic Nerve II
Function: Sense of Vision
Lesion : Differs according to the site in the pathway:
1. Lesion in the optic nerve:
- Ipsilateral loss of vision
- Loss of direct & consensual light reflex.
2. Lesion in the optic chiasma:
- Bitemporal Hemianopia.
3. Lesion in the optic tract:
- Contralateral Homonymous Hemianopia (bilateral half blindness).
4. Lesion in the optic radiation (upper fibers):
- Lower quadrant Contralateral Homonymous Hemianopia.
- Preservation of the light reflex.
5. Lesion in the optic radiation (lower fibers):
- Upper quadrant Contralateral Homonymous Hemianopia.
- Preservation of the light reflex.
In complete lesion of the optic radiation, there will be:
- Contralateral Homonymous Hemianopia (bilateral half blindness).
- Preservation of the light reflex.
6. Lesion in the occipital lobe:
- Contralateral Homonymous Hemianopia (bilateral half blindness).
- Preservation of light reflex
- Preservation of the macular vision (due to double blood supply).
MOST IMPORTANT: Optic Tract and Optic Radiation..

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Occulomotor III

Function: Extra ocular ms. Movement, elevation of upper eyelid, papillary constriction

Lesion:
A) External ophthalmoplesia:
1. Ptosis
2. Divergent paralytic squint (the eye looks out & down due to the unopposed action
of the lateral rectus "Cr N 6 " & the superior oblique " Cr N 4 " ).
3. Diplopia
B) Internal ophthalmoplesia:
1. Ipsilateral mydriasis.
2. Ipsilateral loss of light reflex: loss of direct light reflex on the affected eye.
Trochular IV

Function: Extra ocular Movement :Inward and Downward Superior Oblique

Lesion:
1. Limitation of eye movement on looking inwards & downwards.
2. Diplopia

Abducent VI

Function: Extra ocular Movement: Outward Lateral Rectus

Lesion:
1. Limitation of eye movement on looking outwards.
2. Diplopia.

Trigeminal V

Sensory:
- Ophthalmic
- Maxillary
- Mandibular
Motor:
- Ms of Mastication: Temporalis, Masster, Mylohyoid, Tensor Palate, anterior belly of
Digastric.
N.B. Trigeminal conducts sensations from face (except angle of mandible supplied by C2) ,
anterior 2/3 of tongue and buccal activity.

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Facial VII
Motor: Platysma, Posterior belly of digastrics, Stapedius, Stylohyoid, Facial muscles.
Sensory: ant. 2/3 of tongue
Autonomic: Lacrimal, Submandibular & Sublingual salivary glands
Differentiation between UMNL & LMNL of Facial Paralysis

UMNL

LMNL

- Affects the pyramidal tract above

the Facial nucleus.
- Paralysis of the muscles of LOWER
HALF of the face on the OPPOSITE
SIDE of the lesion (supplied from
the opposite pyramidal only).
- Paralysis involves the voluntary
movement, BUT: spares the
emotional & associated movements
(supplied from the extra-pyramidal
fibers).
- Paralysis is associated with
Hypertonia and Hyperreflexia.
- There is associated Hemiplegia on
the SAME SIDE of the Facial
paralysis.

- Affects the Facial Motor Nucleus, or,

the Nerve itself.
- Paralysis of ALL MUSCLES of the
face (upper & lower halves), on the
SAME SIDE of the lesion.
- Paralysis involves the voluntary,
emotional and associated
movements.

- Paralysis is associated with Hypotonia

and Hyporeflexia.
- If there is Hemiplesia, it is on the
OPPOSITE SIDE of the facial
paralysis (crossed Hemiplagia).

Horners Syndrome:
Partial Ptosis
Myosis
Enophthalmos
Anhydrosis

Stroke
Transient Ischemia attacks (TIAs) predispose to stroke.
Risk factors of stroke:
1. Non-modifiable:
Age: old
Sex: male : Female = 3 : 1
Type A personality: Nervous, intellectual.

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Genetic factors: Positive family history.

2. Modifiable:
a) High risk:
Heart disease: especially valvular heart diseases & AF
Hyperlipidemia: total cholesterol, LDL, HDL.
HYPERTENSION: cause endothelial damage.
Diabetes mellitus.
Cigarette smoking.
b) Less risk:
Obesity.
Diet: rich in saturated fat & cholesterol.
Physical inactivity.
Psychological stress.
Hyperurecemia.
Homocysteinemia.
Heavy alcohol intake.
CCPs.

Hemiplegia
C/p:
General
Acute Onset
Stage of flaccidity (2-6 weeks)
Neuronal shock

Tone flaccidity
-ve superficial
Deep reflexes
reflexes
Planter reflex
Coma Asymmetry lateralization sign

Gradual Onset

Remittent onset(DS)

Stage of spasticity
Weakness

ULExtensors
LLFlexors

Spasticity

ULFlexors
LLExtensors

-ve

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Specific Site

Ipsilateral

Spinal
Brown-Squared Syndrome
Dicuss.

Brain Stem
Crossed

Cerebral
dicussation

Motor Hemiplegia Opposite

Dicuss.
Sensory Cranial n. LMN Same
Dicuss.

At site Motor LMNL

Sensory Loss of all

Below site Motor UMNL

Sensory Deep sensory loss
Cortical
Subcortical

Superficial sensory loss

Pain & Temp. Contralateral
Touch Both sides

Capsular
Complete

Pain & Temp.

Blood Supply of Brain

Posterior inferior cerebellar artery occlusion:
1.
2.
3.
4.
5.
6.

Acute onset associated with syncope, hiccup, vomiting, vertigo and pain over the face.
Ipsilateral cerebellar ataxia (nystagmus, dysarthria, incoordination).
Ipsilateral Horner's syndrome.
Ipsilateral palate-pharyngeo-laryngeal paralysis & weakness of sternomastoid & trapezius.
Ipsilateral loss of pain and temperature sensations over the face.
Contralateral loss of pain and temperature sensations over the body.

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Paraplegia
Extra-medullary

Intra-medullary

HISTORY
Onset
Sphincteric affection

Painful
Late or absent

Painless
Early

CLINICAL PICTURE
Sensory

Sphincteric affection

Sensory level:
Jacket sensory loss:
Below which all types of
Of dissociated nature (lost
sensations are diminished. pain & temp. & preserved
touch & deep).
Sacral affection:
Early loss of sensations in
the saddle area (S3,4,5).
Late or absent

Sacral spare:
Preserved sensations in
the saddle area (S3,4,5).
Early

Marked of pressure.
Complete dynamic block.
Froin's syndrome.
Diagnostic
Possible vertebral lesion.
Saddle-shaped block.

Moderate of pressure.
Partial dynamic block.
NO Froin's syndrome.
Diagnostic
Normal
Fusiform-shaped block.

INVESTIGATIONS
CSF

CT & MRI
Plain X-ray
Myelography

Froin's syndrome:
Marked increase in proteins leading to:
- Spontanous coagulation.
- Xanthochromia. (yellowish discoloration)
- Cyto-albuminous dissociation. ( proteins BUT near normal cell count)

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Pier Marie Foix test: Firm +ve planter flexion of toes and foot resulting in spontaneous flexion of
hip and knee, if paraplegia is passing from extension to flexion.

Cauda Equina
Clinical picture of CONUS MEDULLARIS LESION:
1.
2.
3.
4.

Early urinary incontinence (autonomic bladder) & stool incontinence.

Impotence.
Sensory loss in the saddle area. (usually of dissociated nature)
No motor or sensory affection in the LLs.

Extra pyramidal and Parkinsonism

Clinical picture of PARKINSNISM:
1. Static tremors.
2. Rigidity (Hypertonia).
3. Bradykinesia (Loss of emotional & associative movements).

Chorea
-

Static
Irregular
Sudden
Jerky
Pseudopurposive

Cerebellar and Ataxia

Heridofamilial
Friedreichs Ataxia
-

Age: it occurs in the 1st decades of life.

Onset & course: gradual onset & slowly progressive course.
Pathology: there is degeneration of :
a) Cerebellum especially the: archi-cerebellum.
b) Pyramidal tracts.
c) Posterior columns.
d) Peripheral nerves.

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-

loss of superficial and deep sensations - loss of deep tendon reflexes

Associations: DCM, Congenital heart disease, Pes cavus.

Marie's Ataxia
-

Age: it occurs in the 2nd & 3rd decades of life.

Onset & course: gradual onset & slowly progressive course.
Pathology: there is degeneration of :
e) Cerebellum especially the : neo-cerebellum.
f) Pyramidal tracts.
Associations: Mental impairment.
exaggerated deep reflexes
ocular nerve palsy

Peripheral neuritis
Causes of motor neuropathy:
1.
2.
3.
4.

Peroneal muscle atrophy.

Lead neuropathy.
Diphthentic neuropathy.
GBS.

Causes of sensory neuropathy:

1.
2.
3.
4.
5.

Alcoholic neuropathy.
Arsenic neuropathy.
Diabetic neuropathy.
Leprotic neuropathy.
Vitamin deficiency neuropathy.

Causes of lost ankle reflex & preserved knee reflex:

1. Peripheral neuritis.
2. Epiconus.
3. Cauda equine affecting S1 root.

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Epilepsy
Generalized

Partial

Grand Mal

Petit Mal

- Carbamazepine
- Phenytoin

Atonic Seizures

- Valproate
- Succinamide

Simple

- Valproate
- Clonazepam

Anti-epileptic drugs:
1.
2.
3.
4.
5.
6.

Barbiturates (Phenobarbitone).
Hydantoin (Epanutin).
Carbamazepine.
Clonazepam.
Valproate.
Succinamide.

Important Reflexes
Deep reflexes:

Upper limbs:
-

Biceps reflex C5,6

Brachioradialis reflex C5,6
Triceps reflex C6,7

Lower limbs:
-

Knee reflex L2,3,4

Ankle reflex S1,2

Superficial reflexes:
o Planter reflex S1,2

Others:
o Adductor L4
o Jaw C2
o Supraspinatus C3,4

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PartialGeneralized
Complex

Neurology NMT12
o Gluteal L4,5
o Cremasteric L1
o Anal reflex: S3,4,5

EXAMS
Put () or (x)
Underlined words = explain why the statement is wrong
1.
2.
3.
4.
5.
6.

LMNL is characterized by early & marked wasting.

T
Lost pain, touch with preserved temperature is called dissociated sensory loss.
F
Ophthalmic, Maxillary & Mandibular are branches from Facial nerve.
F
Spinal accessory nerve supplies trapezius & sternomastoid.
T
Capsular hemiplegia = incomplete hemiplegia.
F
Intramedullary paraplegia characterized by jacket sensory loss & late sphincteric affection.
F
F (i.e. glioma is
7. Extramedullary causes of paraplegia include all the following (glioma,,).
not a cause)
8. Polyneuropathy is characterized by bilateral affection of both limbs distal>proximal &
T
extensors>flexors.
9. Deep sensory loss leads to sensory ataxia.
T
10. Chorea is rapid, jerky, pseudopurposeful movement with hypertonia.
F
11. Froin syndrome contains spontaneous coagulation, xanthochromatosis & cytoalbuminous
T
dissociation.
12. Finger, adductor & patellar reflexes are pathological deep reflexes.
T
13. Pyramidal weakness in extensors UL, LL.
F
14. In myopathy there is absent knee reflex & preserved ankle reflex.
T
15. In UMNL of facial nerve, there is loss of emotional & associated movements.
F
16. In intramedullary paraplegia there is preserved sacral sensation.
T
17. TIAs predispose to stroke.
T
18. Diabetic neurpathy is mainly motor.
F
19. Trigeminal nerve is mixed (sensory & motor).
T
20. Spasticity, fasciculations, hyperreflexia & +ve Babiniski are criteria of UMNL.
F
21. Horner's syndrome is characterized by the following: partial ptosis, anhydrosis,
T
enophthalmos & miosis.
22. Crossed hemiplegia is characterized by pyramidal weakness of same side & LMNL of
F
cranial nerves on opposite side.
23. Anosmia means abnormal perception of smell.
F
24. Carbamazepine, Barbiturate, Valproate & Zarontin are all antiepileptic.
T
25. HTN, Diabetes, hyperuricemia & polycythemia are risk factors for stroke.
T
26. Waddling gait is characterized by weakness of gluteus maximus muscle.
F
27. Parkinson disease characterized by hypertonia, loss of emotions, bradykinesia, loss of
F

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postural reflexes & ECG changes.
28. Polyneuropathy loss of reflexes distal than proximal.
29. Jaw is supplied by C2.
30. There is sacral spare in intramedullary tumor.
31. In myopathy there is lost ankle & preserved knee.
32. Brown Sequard syndrome is accompanied by ipsilateral loss of superficial sensations &
temperature and contralateral loss of deep sensations.
33. Autonomic epilepsy is type of generalized epilepsy.
34. Parasagittal tumor can cause paraplegia.
35. Trigeminal nerve supplies sensation to all face except angle of mandible by C1.
36. There is spare of sacral sensations in intramedullary paraplegia.
37. In Brown Sequard syndrome there is ipsilateral loss of deep sensations, superficial
sensations, pain & temperature.
38. There is early wasting in LMNL.
39. Peripheral neuropathy affects periphery & more in extensors than flexors.
40. Extramedullary paraplegia present with pain.
41. Causes of extramedullary paraplegia include meningioma, neurofibroma,
syringomyeloma.
42. LMNL presents early with early wasting
43. UMNL includes hyperreflexia, pathological deep reflexes, fasciculations & +ve Babiniski.
44. Complete partial seizures present with aura, loss of consciousness, automatism and
amnesia.
45. Intramedullary paraplegia presents with jacket sensory loss and dissociation and late
sphincteric affection.
46. Intramedullary paraplegia presents with jacket sensory loss, loss of pain, touch preserved
temperature.
47. Spasticity affects flexors of UL & LL with hyperreflexia.
48. Crossed hemiplegia is characterized by pyramidal weakness of one side & LMNL of cranial
nerves on opposite side.
49. Dissociated sensory means lost pain & touch sensation with preserved deep sensation
50. Lost knee reflex & preserved ankle reflex is a sign of myopathy
51. dystonia is involuntary, very slow, torsion movement associated with hypotonia during
the movement
52. carbamazepine, clonazepam, isonized, valproate & succinimide all are antiepileptic
agents
53. trochlear nerve (supplying the inferior oblique muscle) is tested by asking the patients to
look inwards & downwards
54. Lesion of the optic radiation cause contralateral homonymous heminanopia with
preserved light reflex
55. Upper motor neurone facial nerve lesion affects voluntary, emotional & associative
movements

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T
T
T
F
F
F
T
F
T
F
T
T
T
F
T
F
T
F
F
F
F

F
T
F
F
F
T
F

Neurology NMT12
56. meningioma, neurofibroma, glioma, pott's disease all are causes of extra medullary
paraplegia

Choose the correct answer

1) Complex partial seizures include all except:
a.
b.
c.
d.
e.

Idiopathic
Aura
Amnesia
Absence
Automatisam

Answer: A
2) All are superficial reflexes except:
a.
b.
c.
d.

abdominal
cremasteric
gluteal
brachio-radialis

Answer: D
3) Cerebral hemiplegia contains:
a.
b.
c.
d.

coma
convulsions
dysphasia
complete hemiplegia

Answer: D
4) Marie's ataxia
a.
b.
c.
d.
e.

affects neo-cerebellum
preserved superficial sensations
exaggerated deep reflexes
mental impairment
lost deep sensations

Answer: E
5) All are deep sensations except:
a. muscle sense
b. nerve sense

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c. tendon sense
d. tactile localization
e. vibration sense
Answer: D
6) All causes motor neuropathy except:
a.
b.
c.
d.

lead neuropathy
alcoholic
porphyria
diphteric

Answer: B
7) All cause hypotonia except:
a. cerebellar ataxia
b. chorea
c. dystonia
Answer: C
8) fredreich's ataxia characterized by following except:
a.
b.
c.
d.

pyramidal tract lesion

skeletal deformities
post column lesion
ocular nerve palsy

Answer: D
9) Root value of knee reflex is:
a.
b.
c.
d.

L2
L3
L 2,3
L 2.3.4

Answer: D
10) All are cortical sensations except:
a. tactile discrimination
b. localization
c. stereogenesis

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d. Romberg
Answer: D

11) The following are the muscles supplied by the trigeminal nerve except :
a.
b.
c.
d.
e.

temporalis
masseter
mylohyoid
posterior belly of digastric
tensor palate

Answer: D
12) The root supply of supraspinatus reflex is:
a.
b.
c.
d.
e.

C 2,3
C 3,4
C 3,4,5
C 4,5
C 5,6

Answer: B
13) The root supply of cremasteric reflex is:
a.
b.
c.
d.
e.

L 3,4
L 1,2,3
L 2,3
L 1,2
L1

Answer: E
14) The following are cortical sensations except:
a.
b.
c.
d.
e.

tactile localization
stereognesis
nerve sense
graphosthesia
perceptual rivanly

Answer: C

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15) The following are causes of motor neuropathy except:

a.
b.
c.
d.
e.

lead neuropathy
diphtheritic neuropathy
arsenic neuropathy
perphysia
acute infective neuropathy

Answer: C
16) friedreich's ataxia is characterized by the following except:
a.
b.
c.
d.
e.

impaired superficial & deep sensations

skeletal deformities
ECG changes
gait ataxia
3rd & 4th decaded

Answer: E
17) Horners syndrome is characterized by the following except:
a.
b.
c.
d.
e.

incomplete ptosis
miosis
enophthalmos
anhydrosis
parasympathetic paralysis

Answer: E
18) Intra medullary paraplegia is characterized by the following except:
a.
b.
c.
d.
e.

sacral spare
jacket sensory loss
dissociated sensory loss
early bladder disturbances
the froin's syndrome

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Answer: E

19) 11-Antiepileptic ttt include all except :Isoniazid

20) 12-Shock stage .except: Spasticity
21) 13-Planter reflex stimulated by all the following except:Gower sign
22) 14-Duchene ..except:Autosomal dominant
23) 15-Gluteal reflex: L4,L5
24) 16-Generalized epilepsy includes all except : Autonomic
25) 17-Horner's syndrome includes all except :Complete ptosis
26) 18-3rd nerve (oculomotor) supplies all except:Dilatot Pupillae
27) 19-Gluteal reflex supplied by :L4,L5
28) 20-Biceps reflex supplied by :C5,C6
29) 21-UMNL of facial include all except :emotional&associated movements
30) 22-Foster Kennedy syndrome all are true except:affecting temporal lobe
31) 23-Cortical sensations include all except :Romberg test
32) 24-Trigeminal nerve supplies all except : Posterior belly of digastrics
33) 25-All cause hypotonia except :dystonia
34) 26-Planter reflex stimulated by all except:Gower method
35) 27-3rd cranial nerve (oculomotor) supplies all except :Dilator papillae
36) 28-Trigeminal nerve supplies all except :Posterior belly of digastrics
37) 29-Biceps reflex supplies by :C5,C6
38) 30-Gluteal reflex supplies by :L4,L5
39) 31-Planter reflex stimulated by all except: Gower method
40) 32-Horner's syndrome includes all except: Complete ptosis or mydrasis
41) 33-Foster kennedy syndrome all are true except : affecting Temporal lobe
42) 34-All are causes of hypotonia except: dystonia
43) 35-Hypotonia is caused by the following except : dystonia
44) 36-UMNL of facial paralysis includes the following except : Paralysis of lower half of the face
,loss of emotional movements

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45) 37-Horner syndrome includes all except:Complete ptosis
46) 38-Pathological reflexes are : Finger,Patellar adductor,Jaw

Neurology 2009
MODEL EXAM (I)
Put () or (x)
1. Lesion of optic radiation leads to contra-lateral homonymous hemianopia with lost light reflex.
2. The trochlear nerve (supplying inferior oblique muscle) lesion leads to failure of eye movement
inward & downward.
3. Trigeminal nerve supplies the temporalis, pterygoids, posterior belly of digastric & masseter
muscles.
4. LMNL of trigeminal nerve affects voluntary movements, emotional & associated movements of
the face.
5. Brown Squared syndrome is characterized by contra-lateral superficial sensory loss & ipsi-lateral
deep sensory loss.
6. Crossed hemiplegia means hemiplegia & LMNL of cranial nerve on the opposite side of the lesion.
7. Occlusion of posterior inferior cerebellar artery (Wallenberg's syndrome) is characterized by ipsilateral Horner's syndrome, ipsi-lateral loss of superficial sensations on the face & contra-lateral
hemiparesis.
8. In Piere Marie Foix test; firm passive planter flexion of the toes & foot results in spontaneous
flexion of hip & extension of the knee if paraplegia is passing from extension to flexion.
9. Intramedullary paraplegia is painless with symmetrical weakness, jacket sensory loss of
dissociative in nature with sacral spare & late bladder disturbance.
10. Conus Medullaris lesion is characterized by early urinary & fecal incontinence, impotence &
dissociated sensory loss of the saddle area.
11. Causes of motor neuropathy include Lead, Porphyria, diphtheria, Leprosy & Landry Guillian Barre.
12. Marie's ataxia is characterized by neocerebellar ataxia, exaggerated deep reflexes, ocular nerve
palsy & mental impairment.
13. Chorea is involuntary, static, sudden jerky & dysrythmic movement.

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14. Root supply of cremastric reflex is L2.
15. Root supply of planter reflex is S1.
16. Root supply of adductor reflex is L3, 4, 5.

MODEL ANSWER (I)

1. (False) preserved light reflex.
2. (False) supplying superior oblique muscle.
3. (False) anterior belly of digastrics.
4. (False) LMNL of facial nerve.
5. (True)
6. (False) LMNL of cranial nerve on the same side.
7. (True)
8. (False) flexion of the hip & the knee.
9. (False) early bladder disturbance.
10. (True)
11. (False) except leprosy.
12. (True).
13. (True)
14. (False) L1.
15. (False) S1, S2.
16. (False) L4.

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MODEL EXAM (II)

Put () or (x)
1. Lesion of optic tract leads to contra-lateral homonymous hemianopia with hemianopic papillary
reaction.
2. The trochlear nerve (supplying superior oblique muscle) lesion leads to failure of eye movement
outward & downward.
3. Trigeminal nerve supplies the temporalis, pterygoids, anterior belly of digastric & tensor palatal
muscles.
4. LMNL of Facial nerve affects voluntary movements, emotional & associated movements of face.
5. Brown Squared syndrome is characterized by ipsilateral hemiplegia, loss of pain and temperature
& contra-lateral deep sensory loss.
6. Crossed hemiplegia means; hemiplegia on the side of the lesion & LMNL at the opposite side.
7. Occlusion of posterior inferior cerebellar artery (Wallenberg's syndrome) is characterized by
contra-lateral Horner's syndrome, ipisilateral cerebellar ataxia & hemiparesis.
8. In Piere Marie Foix test; firm passive planter flexion of the toes & foot results in spontaneous
flextion of hip & the knee if paraplegia is passing from extention to flexion.
9. Intramedullary paraplegia is painless with symmetrical weakness, jacket sensory loss of
dissociative in nature with sacral spare & early bladder disturbance.
10. Conus Medullaris lesion is characterized by early urinary & fecal incontinence, impotence,
dissociated sensory loss of the saddle area & weakness of lower limbs.
11. Causes of motor neuropathy include Lead, Porphyria, diphtheria & Landry Guillian Barre.
12. Marie's ataxia is characterized by neocerebellar ataxia, exaggerated deep reflexes, ocular nerve
palsy, mental impairment.
13. Chorea is involuntary, Kinetic, sudden, jerky & dysrythmic movements.
14. Root supply of cremastric reflex is L1, L2.
15. Root supply of planter reflex is S1, S2, S3.
16. Root supply of adductor reflex is L3, 4.

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MODEL ANSWER (II)

1. (False) with lost light reflex.
2. (False) inward & downward.
3. (True)
4. (True)
5. (False) contra-lateral loss of pain and temperature & ipsi-lateral deep sensory loss.
6. (False) hemiplagia on the opposite side of the lesion & LMNL at the same side.
7. (False) ipsi-lateral Horner's syndrome, contal-lateral hemiparesis.
8. (True).
9. (True).
10. (False) no motor or sensory affection.
11. (True).
12. (True).
13. (False) static.
14. (False) L1.
15. (False) S1, S2.
16. (False) L4.

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Neurology NMT12

EXAM OCT. 2009

Put () or (x)
1- Muscle wasting, fasciculations, flaccidity, ankle clonus all are signs of LMNL.
2- Paralysis of the superior oblique muscle (supplied by the trochlear nevre) leads to failure of
the eye to move inward and downward.
3- UMNL of the facial nerve leads to paralysis of muscles of lower half of the face on the
opposite side of the lesion with lost emotional and associative movements.
4- Cortical hemiplega is complete, associated with coma and convulsions.
5- Waddling gait is due to weakness of gluteus maximus muscle.
6- Chorea is involuntary, static, irregular, rhythmic, sudden, jerky, pseudopurposive
movement

Choose the correct answer

1- Trigeminal nerve supplies the following muscles except:
abcde-

Temporalis.
Anterior belly of digastrics.
Mylohyoid.
Stylohyoid.
Masseter.

Answer: D
2- Brown- Sequard syndrome is characterized by the following except:
abcde-

Ipsilateral hemiplegia.
Contralateral deep sensory loss.
Lesion of one side of S.C.
Contralateral superficial sensory loss.
Touch diminishes on both sides.

Answer: B
3- Intramedullary paraplegia is characterized by the following except:

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F
T
F
F
F
F

Neurology NMT12
abcde-

Symmetrical.
Jacket sensory loss.
Dissociated sensory loss.
Cyto-albuminous dissociation.
Sacral spare.

Answer: D
4- All of the following are causes of sensory neuropathy except:
abcde-

Diabetes mellitus.
Leprosy.
Diphtheria.
Alcohol.
Arsenic.

Answer: C
5- Maries ataxia is characterized by the following except:
abcde-

Mainly neo-cerebellar.
Preserved deep reflexes.
Mental impairment.
Extrapyramidal manifestations.
Lost sensation.

Answer: E
6- The root supply of the gluteal reflex is:
abcde-

L4,L5
S1,S2
L5,S1,S2
L5,S1
L3,L4

Answer: A

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