ABPN Neurological Examination and Conditions 5

Question 1

A patient opens eyes to pain (2), gives confused speech (4), and localizes to pain (5). What is the total Glasgow Coma Scale score?

Accepted Answer

11

Answer

GCS is the sum of the eye (2), verbal (4), and motor (5) components, totaling 11.

Question 2

Homonymous hemianopia (loss of the same visual field in both eyes) results from a lesion where?

Accepted Answer

Optic tract or occipital cortex behind the chiasm

Answer

Lesions posterior to the optic chiasm affect the same visual field in both eyes, producing homonymous hemianopia.

Question 3

A patient develops facial droop involving the forehead on one side with inability to close the eye. This localizes the lesion to:

Accepted Answer

Lower motor neuron facial nerve (Bell's palsy)

Answer

Forehead involvement indicates a peripheral (lower motor neuron) CN VII lesion, since the upper face has bilateral cortical innervation.

Question 4

Which finding is characteristic of a cerebellar rather than a sensory ataxia?

Accepted Answer

Ataxia unchanged by eye closure

Answer

Cerebellar ataxia does not significantly worsen with eyes closed, unlike sensory ataxia which relies on visual compensation.

Question 5

The Kernig sign, resistance and pain on extending the knee with the hip flexed, indicates:

Accepted Answer

Meningeal irritation

Answer

A positive Kernig sign reflects meningeal irritation, as seen in meningitis or subarachnoid hemorrhage.

American Board of Psychiatry and Neurology Practice Test