[MCQ] Coma- Part 3

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Coma- Part 3

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Question 1

Normally reactive & round pupils of midsize excludes ?

A	Midbrain damage
B	Pontine damage
C	Temporal lobe damage
D	Occipital lobe damage

Question 1 Explanation:

In coma, normally reactive & round pupils of midsize (2.5 - 5 mm) essentially excludes midbrain damage, either primary or secondary to compression

Question 2

Reaction to light is difficult to appreciate in pupils ?

A	< 2 mm in diameter
B	< 3 mm in diameter
C	< 4 mm in diameter
D	< 5 mm in diameter

Question 2 Explanation:

Reaction to light is often difficult to appreciate in pupils <2 mm in diameter

Question 3

A transitional sign that accompanies early midbrain–third nerve compression is ?

A	Pupil > 6 mm is diameter
B	Oval & slightly eccentric pupil
C	Unilateral miosis
D	Reactive and bilaterally small

Question 3 Explanation:

In coma, an oval & slightly eccentric pupil is a transitional sign that accompanies early midbrain– third nerve compression

Question 4

Bilaterally dilated & unreactive pupils indicate ?

A	Severe cortical damage
B	Severe thalamic damage
C	Severe midbrain damage
D	Severe pontine damage

Question 4 Explanation:

In coma, bilaterally dilated & unreactive pupils, indicates severe midbrain damage, usually from compression by a supratentorial mass.

Question 5

Pupils are smaller in size in which of the following ?

A	Metabolic encephalopathies
B	Hydrocephalus
C	Thalamic hemorrhage
D	All of the above

Question 6

Pupils are smaller in size in which of the following ?

A	Narcotic overdose
B	Barbiturate overdose
C	Pontine hemorrhage
D	All of the above

Question 7

Eyes turn down & inward with which of the following lesion ?

A	Frontal lobe lesions
B	Thalamic lesions
C	Pontine lesions
D	Medullary lesions

Question 7 Explanation:

Eyes turn down & inward with thalamic hemorrhage & upper midbrain lesions.

Question 8

Which of the following statements about eyes in a state of coma is correct ?

A	Eyes look toward hemispheral lesion & away from brainstem lesion
B	Eyes look away from hemispheral lesion & toward a brainstem lesion
C	Eyes look away from hemispheral or a brainstem lesion
D	Eyes look towards hemispheral or a brainstem lesion

Question 8 Explanation:

Conjugate horizontal ocular deviation to one side indicates damage to pons on the opposite side or to frontal lobe on the same side. The rule therefore is “eyes look toward a hemispheral lesion and away from a brainstem lesion”. “Wrong-way eyes” refers to eyes that may on a rare occasion turn paradoxically away from the side of a deep hemispheral lesion.

Question 9

“Ocular bobbing” is diagnostic of ?

A	Bilateral occipital infarct
B	Bilateral pontine damage
C	Bilateral temporal lobe infarct
D	Cerebellar damage

Question 9 Explanation:

“Ocular bobbing” describes a brisk downward and slow upward movement of the eyes associated with loss of horizontal eye movements and is diagnostic of bilateral pontine damage, usually from thrombosis of the basilar artery.

Question 10

“Ocular dipping” is diagnostic of ?

A	Diffuse cortical anoxic damage
B	ICSOL
C	SAH
D	Tubercular meningitis

Question 10 Explanation:

“Ocular dipping” is a slower, arrhythmic downward movement followed by a faster upward movement in patients with normal reflex horizontal gaze indicating diffuse cortical anoxic damage.

Question 11

“Doll’s eye” oculocephalic reflex is indicative of which of the following ?

A	Reduced cortical influence on brainstem & damaged brainstem pathways
B	Reduced cortical influence on brainstem & intact brainstem pathways
C	Normal cortical influence on brainstem & damaged brainstem pathways
D	Normal cortical influence on brainstem & intact brainstem pathways

Question 11 Explanation:

The oculocephalic reflexes, elicited by moving the head from side to side or vertically and observing eye movements in the direction opposite to the head movement, depend on the integrity of the ocular motor nuclei and their interconnecting tracts that extend from the midbrain to the pons and medulla. The movements, called somewhat inappropriately “doll’s eyes” (which refers more accurately to the reflex elevation of the eyelids with flexion of the neck), are normally suppressed in the awake patient. The ability to elicit them therefore indicates both reduced cortical influence on the brainstem and intact brainstem pathways, indicating that coma is caused by a lesion or dysfunction in the cerebral hemispheres. Oculovestibular & oculocephalic reflexes provide essentially the same information.

Question 12

Midbrain and third nerve function are tested by ?

A	Pupillary reaction to light
B	Spontaneous and reflex eye movements
C	Corneal responses
D	Respiratory & pharyngeal responses

Question 13

Pontine function is tested by ?

A	Pupillary reaction to light
B	Spontaneous and reflex eye movements
C	Respiratory responses
D	Pharyngeal responses

Question 14

Pontine function is tested by ?

A	Spontaneous eye movements
B	Reflex eye movements
C	Corneal responses
D	All of the above

Question 15

Medullary function is tested by ?

A	Pupillary reaction to light
B	Spontaneous and reflex eye movements
C	Corneal responses
D	Respiratory & pharyngeal responses

Question 15 Explanation:

In coma, midbrain & third nerve function are tested by pupillary reaction to light, pontine function by spontaneous & reflex eye movements & corneal responses, and medullary function by respiratory and pharyngeal responses.

Question 16

Reflex conjugate, horizontal eye movements are dependent on ?

A	Medial longitudinal fasciculus (MLF)
B	Superior colliculus
C	Cerebellum
D	Temporal radiation

Question 16 Explanation:

Reflex conjugate, horizontal eye movements are dependent on medial longitudinal fasciculus (MLF) that interconnects sixth & contralateral third nerve nuclei.

Question 17

Acronym “COWS” that refers to ”cold water opposite, warm water same” is for which of the following ?

A	Tonic deviation of head
B	Tonic deviation of both eyes
C	Direction of nystagmus
D	All of the above

Question 17 Explanation:

Head rotation (oculocephalic reflex) or caloric stimulation of the labyrinths (oculovestibular reflex) elicits contraversive eye movements. Oculovestibular test is performed by irrigating the external auditory canal with cool water in order to induce convection currents in labyrinths. After a brief latency, result is tonic deviation of both eyes to the side of cool-water irrigation and nystagmus in the opposite direction. (Acronym “COWS” refers to direction of nystagmus - ”cold water opposite, warm water same.”) Loss of induced conjugate ocular movements indicates brainstem damage.

Question 18

Presence of corrective nystagmus indicates which of the following ?

A	Frontal lobes are functioning
B	Frontal lobes are connected to the brainstem
C	Functional or hysterical coma is likely
D	All of the above

Question 18 Explanation:

Presence of corrective nystagmus indicates that the frontal lobes are functioning and connected to the brainstem; thus functional or hysterical coma is likely.

Question 19

Corneal reflex depends on the integrity of pontine pathways between ?

A	Fifth and same sided seventh cranial nerve
B	Fifth and opposite sided seventh cranial nerve
C	Fifth and both seventh cranial nerves
D	Any of the above

Question 19 Explanation:

Corneal reflex depends on the

Question 20

Corneal reflex in conjunction with reflex eye movements is a useful test of ?

A	Midbrain function
B	Pontine function
C	Medullary function
D	All of the above

Question 20 Explanation:

Corneal reflex in conjunction with reflex eye movements is a useful test of pontine function.

Question 21

When CNS-depressant drugs are given, which of these is the first to disappear ?

A	Corneal responses
B	Reflex eye movements
C	Non-reactivity of pupils to light
D	Any of the above

Question 21 Explanation:

CNS-depressant drugs diminish or eliminate the corneal responses soon after reflex eye movements are paralyzed but before the pupils become unreactive to light.

Question 22

Agonal gasps are the result of damage to ?

A	Cortex
B	Midbrain
C	Pons
D	Medulla

Question 22 Explanation:

Agonal gasps are the result of lower brainstem (medullary) damage and are recognized as the terminal respiratory pattern of severe brain damage.

Question 23

Which of the following respiratory pattern is seen in pontomesencephalic lesions ?

A	Shallow, slow, regular
B	Cheyne-Stokes respiration
C	Kussmaul breathing
D	Tachypnea

Question 23 Explanation:

Kussmaul or rapid, deep breathing is usually seen in metabolic acidosis but may also occur with pontomesencephalic lesions.

Question 24

Cheyne-Stokes respiration in its classic cyclic form is seen in which of the following conditions ?

A	Light coma
B	Deep coma
C	Sleep
D	Awake state

Question 24 Explanation:

Cheyne-Stokes respiration in its classic cyclic form signifies bihemispheral damage or metabolic suppression and commonly accompanies light coma.

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See all quizzes of Coma at here:

Coma- Part 1| Coma- Part 2| Coma- Part 3| Coma- Part 4

1 Normally reactive & round pupils of midsize excludes ?
A. Midbrain damage
B. Pontine damage
C. Temporal lobe damage
D. Occipital lobe damage

2 Reaction to light is difficult to appreciate in pupils ?
A. < 2 mm in diameter
B. < 3 mm in diameter
C. < 4 mm in diameter
D. < 5 mm in diameter

3 A transitional sign that accompanies early midbrain–third nerve
compression is ?
A. Pupil > 6 mm is diameter
B. Oval & slightly eccentric pupil
C. Unilateral miosis
D. Reactive and bilaterally small

4 Bilaterally dilated & unreactive pupils indicate ?
A. Severe cortical damage
B. Severe thalamic damage
C. Severe midbrain damage
D. Severe pontine damage

5 Pupils are smaller in size in which of the following ?
A. Metabolic encephalopathies
B. Hydrocephalus
C. Thalamic hemorrhage
D. All of the above

6 Pupils are smaller in size in which of the following ?
A. Narcotic overdose
B. Barbiturate overdose
C. Pontine hemorrhage
D. All of the above
7 Eyes turn down & inward with which of the following lesion ?
A. Frontal lobe lesions
B. Thalamic lesions
C. Pontine lesions
D. Medullary lesions

8 Which of the following statements about eyes in a state of coma is
correct ?
A. Eyes look toward hemispheral lesion & away from brainstem
lesion
B. Eyes look away from hemispheral lesion & toward a
brainstem lesion
C. Eyes look away from hemispheral or a brainstem lesion
D. Eyes look towards hemispheral or a brainstem lesion

9 “Ocular bobbing” is diagnostic of ?
A. Bilateral occipital infarct
B. Bilateral pontine damage
C. Bilateral temporal lobe infarct
D. Cerebellar damage

10 “Ocular dipping” is diagnostic of ?
A. Diffuse cortical anoxic damage
B. ICSOL
C. SAH
D. Tubercular meningitis

11 “Doll’s eye” oculocephalic reflex is indicative of which of the
following ?
A. Reduced cortical influence on brainstem & damaged
brainstem pathways
B. Reduced cortical influence on brainstem & intact brainstem
pathways
C. Normal cortical influence on brainstem & damaged brainstem
pathways
D. Normal cortical influence on brainstem & intact brainstem
pathways

12 Midbrain and third nerve function are tested by ?
A. Pupillary reaction to light
B. Spontaneous and reflex eye movements
C. Corneal responses
D. Respiratory & pharyngeal responses
13 Pontine function is tested by ?
A. Pupillary reaction to light
B. Spontaneous and reflex eye movements
C. Respiratory responses
D. Pharyngeal responses
14 Pontine function is tested by ?
A. Spontaneous eye movements
B. Reflex eye movements
C. Corneal responses
D. All of the above
15 Medullary function is tested by ?
A. Pupillary reaction to light
B. Spontaneous and reflex eye movements
C. Corneal responses
D. Respiratory & pharyngeal responses

16 Reflex conjugate, horizontal eye movements are dependent on ?
A. Medial longitudinal fasciculus (MLF)
B. Superior colliculus
C. Cerebellum
D. Temporal radiation

17 Acronym “COWS” that refers to ”cold water opposite, warm water
same” is for which of the following ?
A. Tonic deviation of head
B. Tonic deviation of both eyes
C. Direction of nystagmus
D. All of the above

18 Presence of corrective nystagmus indicates which of the following ?
A. Frontal lobes are functioning
B. Frontal lobes are connected to the brainstem
C. Functional or hysterical coma is likely
D. All of the above

19 Corneal reflex depends on the integrity of pontine pathways
between ?
A. Fifth and same sided seventh cranial nerve
B. Fifth and opposite sided seventh cranial nerve
C. Fifth and both seventh cranial nerves
D. Any of the above

20 Corneal reflex in conjunction with reflex eye movements is a
useful test of ?
A. Midbrain function
B. Pontine function
C. Medullary function
D. All of the above

21 When CNS-depressant drugs are given, which of these is the first
to disappear ?
A. Corneal responses
B. Reflex eye movements
C. Non-reactivity of pupils to light
D. Any of the above

22 Agonal gasps are the result of damage to ?
A. Cortex
B. Midbrain
C. Pons
D. Medulla

23 Which of the following respiratory pattern is seen in
pontomesencephalic lesions ?
A. Shallow, slow, regular
B. Cheyne-Stokes respiration
C. Kussmaul breathing
D. Tachypnea

24 Cheyne-Stokes respiration in its classic cyclic form is seen in
which of the following conditions ?
A. Light coma
B. Deep coma
C. Sleep
D. Awake state

Coma

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Coma- Part 3

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