Neuroanatomy Quiz 1.0 PDF

Lesion of the trunks of the brachial plexus is most likely to occur from a penetrating wound into which of the following labeled areas in the given drawing of the neck regions? -A.A B.B C.C D.D E.E In the provided CT scan of the head, an opening in the skull is identified at the tip of the bla...

Lesion of the trunks of the brachial plexus is most likely to occur from a penetrating wound into which of the following labeled areas in the given drawing of the neck regions? -A.A B.B C.C D.D E.E In the provided CT scan of the head, an opening in the skull is identified at the tip of the black arrow. What cranial nerve exits the cranium via this opening? (A) Trochlear nerve (B) Trigeminal nerve (C) Facial nerve -(D) Glossopharyngeal nerve (E) Hypoglossal nerve A 42-year-old woman noticed that her right upper eyelid was dropped and her right pupil was constricted. She goes to her physician where a thorough examination revealed ptosis, miosis, anhydrosis, flushing of her face, and narrowing of the palpebral fissure on the right side of the patient. Which of the following structure is most likely damaged in this patient? (A) Superior division of the oculomotor nerve -(B) Superior cervical ganglion (C) Nerve of the pterygoid canal (D) Ciliary ganglion (E) Ophthalmic division of trigeminal nerve A bony overgrowth narrows the pterygomaxillary fissure, compressing the third part of the maxillary artery. As a result, blood flow will be reduced in which of the following arteries? (A) Superfi cial temporal -(B) Sphenopalatine (C) Inferior alveolar (D) Middle meningeal (E) Ophthalmic What muscle will continue to function despite facial nerve paralysis? (A) Zygomaticus major (B) Levator labii superioris (C) Buccinator -(D) Masseter (E) Platysma A 15-year-old young man developed cavernous sinus thrombophlebitis after a 1-week history of a single acne-like lesion at the anterior tip of his nose. He presented with a headache, periorbital edema, diplopia, and fever. What vein is the most likely route for the spread of this infection to the cavernous sinus? -(A) Ophthalmic (B) Superior cerebral (C) Great cerebral (of Galen) (D) Maxillary (E) Supraorbital 16-year-old girl experiences mild ptosis and miosis in her right eye following resection of a lymphangioma from the apex of her right lung. Vision in each eye is normal. These findings are most likely due to a lesion involving which structure on the right? (A) Cervical posterior roots (B) Thoracic posterior roots -(C) Thoracic anterior roots (D) Thoracic posterior primary rami (E) Thoracic gray rami communicantes A 22-year-old man receives a stab wound in the left anterior cervical region, at the C2 vertebral level. The wound was 3 cm deep and located anterior to the sternocleidomastoid muscle and superior to the greater horn of the hyoid bone. During a postoperative examination, the patient displays dysarthria, or difficulty speaking. Which of the following structures is most likely damaged? -(A) Hypoglossal nerve (B) Accessory nerve (C) Mandibular division of trigeminal nerve (D) Lingual branch of glossopharyngeal nerve (E) Roots of the brachial plexus Which of the following is true of the occipital eye field? A. It is localized to a relatively small area. B. It subserves pursuit eye movements that are largely voluntary. C. Lesions in this area are associated with transient deviation of the eyes away from the side of the lesion. D. The threshold for excitation in this area is lower than in the frontal eye fields. -E. With lesions in this area, the patient can direct the eyes to a particular location on command. The intracranial dura is innervated by I. cranial nerve V II. upper cervical spinal nerves III. cranial nerve X IV. cranial nerve VII -A. I, II, III B. I, III C. II, IV D. IV E. all of the above The anterior choroidal artery supplies portions of each of the following structures except the: A. amygdala B. globus pallidus C. hippocampus -D. hypothalamus E. internal capsule Efferent fibers from the dentate nuclei: A. are somatopically arranged in the thalamus with the head represented laterally and caudal body parts medially -B. influence activity of motor neurons in the contralateral cerebral cortex C. leave the cerebellum via the middle cerebellar peduncle D. mainly terminate in the red nucleus E. project to the ipsilateral ventral lateral thalamic nuclei The pulvinar has well-defined projections to the I. occipital cortex II. parietal cortex III. temporal cortex IV. frontal cortex -A.I. II, III B.I, III C.II, IV D.IV E.all of the above Each of the following is true of the supplemental motor cortex (MII) except: A. Some of the neurons project directly to the spinal cord. B. The body is somatopically represented. -C. The neurons in this area exhibit movement-related activity only if the motor task is performed with the contralateral limbs. D. The threshold for stimulation is higher than for the primary motor cortex (MI). E. Unilateral ablations produce no permanent deficit in the maintenance of posture or capacity for movement. Each is true of dorsolateral fibers entering the dorsolateral spinal cord except: A. Root fibers of spinal ganglia separate into a medial and lateral bundle. B. The central processes of each dorsal root ganglion divide into both ascending and descending branches. C The lateral bundle conveys impulses from free nerve endings. -D. The medial bundle consists of thinly myelinated or unmyelinated fibers, whereas the lateral bundle is thickly myelinated. E. The medial bundle conveys impulses from Golgi tendon organs. Which of the following structures is not present on a transverse section of the medulla taken at midolive? A.accessory cuneate nucleus B. dorsal nucleus of X C. nucleus ambiguus D. nucleus of the solitary tract -E. superior vestibular nucleus Which of the following fiber tracts is not a part of the limbic system? A. diagonal band of Broca B. fornix C. mammillothalamic tract D. medial forebrain bundle -E. thalamic fasciculus The secondary somatic sensory area (SII) is located on the: A. medial surface of the superior frontal gyrus B. medial surface of the superior parietal lobule -C. superior bank of the lateral sulcus D. ventral posterolateral nucleus of the thalamus E. same area as the primary somatic sensory area The external urethral sphincter is innervated by: A. parasympathetic pelvic nerves -B. somatic pudendal nerves C. sympathetic hypogastric nerves D. A and B E. B and C Regions of the brain devoid of a blood-brain barrier (circumventricular organs) include each of the following except: -A. indusium griseum B. median eminence C. organum vasculosum of the lamina terminalis D. pineal gland E. subfornicat organ Uncrossed fibers of the optic tract terminate on which layers of the lateral geniculate? A. 1.3, and 5 B. 1,4, and 6 -C. 2,3, and 5 D. 2,4, and 6 E. 2,5. and 6 Substances can cross the blood-brain barrier via I. active transport II. carrier-mediated transport III. diffusion IV. vesicular transport -A. I, II,III B. I, III C. II, IV D. IV E. all of the above Each of the following is true of corticobulbar fibers except: A. Fibers projecting to the posterior column nuclei leave the pyramids and enter these nuclei via the medial lemniscus or reticular formation. B. Fibers projecting to trigeminal sensory nuclei and the nucleus solitaries are derived predominantly from frontoparietal cortical areas. -C. Pseudobulbar palsy can result from unilateral lesions involving corticobulbar fibers. D. The supranuclear innervation of motor cranial nerve nuclei is largely bilateral. E. Unilateral lesions involving corticobulbar fibers produce paralysis of contralateral lower facial muscles only. Each of the following characterizes a pathway involved in the pupillary light reflex except: -A. Crossed and uncrossed fibers of the optic tract terminate on the lateral geniculate body. B. Efferent fibers from the pretectal olivary nucleus cross in the posterior commissure and end in visceral cell columns of the oculomotor nerve complex. C. Efferent fibers from the pretectal olivary nucleus cross ventral to the cerebral aqueduct and end in the visceral cell columns of the oculomotor complex. D. Postganglionic fibers from the ciliary ganglion project to the sphincter of the iris. E. Preganglionic fibers from the nuclei of the oculomotor complex travel with fibers of the third nerve and synapse in the ciliary ganglion. Afferent sources of fiber pathways to the septal nuclei include the I. amygdala II. hypothalamus III. hippocampus IV. basal ganglia -A. I, II,III B. 1.III C. II. IV D. IV E. all of the above The anterior choroidal artery supplies parts of the: I. caudate nucleus II. optic tract III. thalamus IV. anterior limb of the internal capsule -A. I, II, III B. I, III C. II, IV D. IV E. all of the above Which of the following is not an afferent connection of the basal ganglia? -A. cerebral cortex to globus pallidus B. cerebral cortex to putamen C. substantia nigra to caudate nucleus D. subthalamic nucleus to globus pallidus E. thalamus to caudate nucleus Most of the fibers of the stria terminalis originate from the -A. amygdala B. anterior hypothalamus C. arcuate nucleus D. habenula E. septal nuclei Cells that give rise to commissural fibers that interconnect homologous cortical areas via the corpus callosum are found in layer A. I B. II -C. III D. IV E. V Major striatal efferent projections include: A. amygdala and globus pallidus -B. globus pallidus and substantia nigra C. substantia nigra and amygdala D. substantia nigra and thalamus E. thalamus and globus pallidus Fibers from the nucleus ambiguus make contribution to: I. cranial nerve IX II. cranial nerve XI III. cranial nerve X IV. cranial nerve VII -A. I, II,III B. I, III C. II, IV D. IV E. all of the above Functional components of the facial and intermediate nerves include I. general somatic afferent fibers II. general visceral afferent fibers III. special visceral afferent fibers IV. special visceral efferent fibers A. I, II, III B. I, III C. II, IV D. IV -E. all of the above Lesions of the lateral lemniscus produce: A. bilateral complete deafness -B. bilateral partial deafness, greater in the contralateral ear C. bilateral partial deafness, greater in the ipsilateral ear D. unilateral, contralateral deafness E. unilateral, ipsilateral deafness The superior orbital fissure is traversed by which combination of cranial nerves? A. III. IV, and VI only B. III, IV, Vl, and Vl only -C. III, IV, VI, V,. and V2 only D. II.III, IV, VI. Vl, and V2 only E. II,III, IV, VI, and V1 only Fibers in the superior cerebellar peduncle synapse in which of the following thalamic nuclei? I. ventral anterior II. ventral lateral III. rostra1 interlaminar nuclei IV. ventral posterolateral A. I, II, III B. I, III -C. II, IV D. IV E. all of the above The limbic lobe is composed of all the following except the: -A. amygdala B. cingulate gyrus C. dentate gyms D. parahipp&ampal gyrus E. subcallosal gyrus The internal cerebral vein receives each of the following veins except the: A. choroidal vein B. epithalamic vein -C. great cerebral vein of Galen D. septa1 vein E. thalamostriate vein The striate cortex corresponds to area: -A. 17 B. 18 C. 19 D. 41 E. 42 The internal capsule is supplied by branches of the: I. middle cerebral artery II. anterior cerebral artery III. internal carotid artery IV. posterior cerebral artery -A. I. II,III B. I, III C. II, IV D. IV E. all of the above A discrete unilateral lesion of the abducens nucleus produces paralysis of movement of A. both eyes away from the lesion -B. both eyes toward the lesion C. the contralateral eye toward the lesion D. the ipsilateral eye away frorn the lesion E. the ipsilateral eye toward the lesion Fibers originating in the substantia nigra synapse on each of the following structures except the: A. caudate -B. globus pallidus C. putamen D. superior colliculus E. thalamus The blood-brain barrier is formed by (the): A. astrocytic foot processes B. basement membrane C ependymal lining cells D. microglia. -E. tight junctions of the capillary endothelium The nucleus pulposus of the intervertebral disk is formed from the: A. chondrification of the centrum of the vertebral body B. myotome -C. notochord D. primitive streak E. sclerotome Each of the following cell groups is derived from the alar plate except the: -A. nucleus ambiguus B. principal sensory nucleus of CN V C. solitary nucleus D. spinal trigeminal nucleus E. vestibular nucleus The telencephalon gives rise to each of the following except the: A. amygdala B. caudate C. claustrum -D. globus pallidus E. putamen Neural crest derivatives include all of the following except the: A. adrenal medulla B. dorsal root ganglion of cranial and spinal nerves -C. neurons of the cerebral cortex D. pigmented layers of the retina E. sympathetic ganglia of the autonomic nervous system Which of the following progressions from primary vesicle to secondary vesicle to adult derivative is correct? A. mesencephalon to rhomboencephalon to medulla B. prosencephalon to diencephalon to midbrain C. prosencephalon to telencephalon to thalami -D. rhomboencephalon to metencephalon to cerebellum E. rhomboencephalon to myelencephalon to pons Which of the following combinations of nuclei originate from the basal plate of the developing brain of the embryo? (A) Abducens + spinal trigeminal (B) Cochlear + oculomotor -(C) Hypoglossal + nucleus ambiguus (D) Hypoglossal + vestibular (E) Mesencephalic of trigeminal + oculomotor A 31-year-old woman has a sonogram at the end of the first trimester of her second pregnancy. This study reveals failure of the posture neuropore to close at the appropriate time and the probability of this baby being born with a spina bifida. Normally, this portion of the neural tube is closed by about which of the following times? (A) 20 days (B) 22 days -(C) 26 days (D) 30 days (E) 34 days Which of the following layers of the meninges characteristically has numerous tight (occluding) junctions between its cells? -(A) Arachnoid mater (B) Dura + arachnoid (C) Meningeal dura (D) Periosteal dura (E) Pia mater A 58-year-old man is suffering from a neurodegenerative disease characterized by numerous CAG (cytosine-adenineguanine) repeats on chromosome 4. His MRI reveals bilaterally enlarged anterior horns of the lateral ventricles. Which of the following would be most obviously diminished in this man to result in his enlarged ventricles? (A) Amygdaloid nucleus (B) Anterior nucleus of thalamus (C) Body of the caudate nucleus -(D) Head of the caudate nucleus (E) Hippocampus proper Production of cerebrospinal fluid in a healthy normal individual is an active process that proceeds against a pressure gradient. Which of the following is especially numerous in cells subserving this function? (A) Endoplasmic reticulum (B) Lysosomes -(C) Mitochondria (D) Nucleus (E) Synaptic vesicles The MRI of an 11-year-old girl reveals a highly vascular tumor that appears to originate from the rostral portions of the choroid plexus located within the temporal horn of the lateral ventricle. Which of the following is the most likely candidate for the vascular supply to this tumor? -(A) Anterior choroidal artery (B) Anterior inferior cerebellar artery (C) Lateral posterior choroidal artery (D) Medial posterior choroidal artery (E) Medial striate artery Which of the following structures would be regarded as being located in the medial wall of the lateral ventricle? (A) Amygdaloid nucleus (B) Caudate nucleus, head, body, tail -(C) Hippocampus and fornix (D) Stria terminalis, terminal vein (E) Ventricular surface of dorsal thalamus A 69-year-old man presents at the Emergency Department with the complaint of a sudden onset of difficulty walking. The examination reveals that he is ataxic, is unable to do the heel-to-shin test, and has dysmetria. An MRI (T2 weighted) reveals the lesion shown in the image below. Based on this image, occlusion of which of the following most likely resulted in this man’s deficits? (A) Anterior inferior cerebellar artery -(B) Distal posterior inferior cerebellar artery (C) Medial posterior choroidal artery (D) Proximal posterior inferior cerebellar artery (E) Superior cerebellar artery MRI revealsA patient with a mass in the ambient cistern presumably compressing the trochlear nerve. In addition to this nerve, which of the following vascular structures would most likely be compromised by this mass? (A) Anterior cerebral vein -(B) Basal vein of Rosenthal (C) Deep middle cerebral vein (D) Internal cerebral vein (E) Vein of Galen A 71-year-old man is transported to the Emergency Department after collapsing at his home. The examination reveals right-sided paralysis and right-sided loss of somatosensory information, all on the upper and lower extremities, and a right homonymous hemianopsia. Which of the following vessels is most likely obstructed in this case? (A) Anterior choroidal artery -(B) Lateral striate artery (C) Medial striate artery (D) Lateral posterior choroidal artery (E) Thalamoperforating artery During a routine neurological examination on a 35-year-old woman, the physician gently taps on the patellar tendon to activate the knee jerk, or quadriceps, reflex. The resulting reflex is within a normal range. Which of the following receptors is activated in response to this stimulus? (A) Golgi tendon organ (B) Merkel cell complex -(C) Muscle spindle (D) Pacinian corpuscle (E) Ruffi ni complex Which of the following laminae of the spinal cord gray matter (the Rexed laminae) contains the cell bodies of the intermediolateral cell column? (A) IV (B) V (C) VI -(D) VII (E) VIII A 46-year-old construction worker is brought to the Emergency Department following a fall at his workplace. Muscle stretch reflexes are within normal ranges. The man has a bilateral loss of pain and thermal sensations over his upper extremities. Which of the following is most likely damaged to result in this deficit? -(A) Anterior white commissure (B) Anterolateral system on the left (C) Anterolateral system on the right (D) Bilateral posterior columns (E) Bilateral gracile fascicule Which of the following spinal laminae would be most affected in Polio? (A) I (B) II (C) V (D) VIII -(E) IX The telencephalon has failed to develop properly. Which part of the brain may be adversely affected? A. The mammillary bodies -B. The hippocampus C. The neurohypophysis D. The thalamus E. The pineal gland Your patient has suffered from a small lacunar infarct of the thalamus. Occlusion of which of the following vessels might cause the infarct? A. Medial striate artery -B. Deep branch of the PCA C. Recurrent artery of Heubner D. Lenticulostriate artery E. Anterior choroidal artery In a surgical procedure, a derivative of curare is used to induce muscle paralysis. By what mechanism does curare induce the paralysis? A. By binding to presynaptic calcium ion channels -B. By binding to nicotinic receptors C. By inducing antibodies to bind to nicotinic receptors D. By binding to the presynaptic membrane E. By reducing the amount of ACh synthesized in the synaptic terminal At which of the following receptors might the drug act as an agonist to enhance Long-Term Potentiation? A. A metabotropic receptor -B. An NMDA receptor C. A D2 receptor D. An AMPA receptor E. A G-protein coupled receptor Your patient has received a painful wound. All of the following neural structures are active in the suppression of pain except: A. Neurons in the periaqueductal gray of the midbrain B. Neurons in lamina II C. Neurons in the brainstem D. Medial division dorsal root fibers -E. Neurons in lamina V Your patient has suffered trauma to the spinal cord. During a period of spinal shock, what might you expect to observe in the patient? A. Hyperactive reflexes below the lesion -B. Flaccid weakness below the lesion C. A spastic bladder D. A clasp knife reflex E. A Babinski sign A tumor is beginning to compress the right side of the spinal cord at the C3 spinal cord segment and is impinging on the corticospinal and spinothalamic tracts. What might you expect to observe first in the patient? A. Alteration of pain and temperature sensations from the left upper limb -B. Alteration of pain and temperature sensations from the left lower limb C. Spastic weakness of the left upper limb D. Spastic weakness of the left lower limb E. Bilateral loss of pain and temperature sensations from sacral dermatomes Which of the following combinations of cranial nerves may be collectively referred to as the cranial nerves (CNs) of the ponsmedulla junction? (A) CNs III, IV, VI (B) CNs V, VI, IX (C) CNs XI, X, XII -(D) CNs VI, VII, VIII (E) CNs VIII, IX, X A 60-year-old man presents to his family physician with what he calls a “problem seeing.” The examination reveals that his vision is normal, but his right eye is deviated slightly inward, and does not abduct on attempted gaze to the right. There are no other findings. Which of the following is the most likely location of this lesion in this patient? (A) Abducens nucleus on the left -(B) Abducens nucleus on the right (C) Abducens root in the basilar pons on the right (D) Abducnes root on the right (E) Abducens root on the left A 23-year-old man is transported from the site of a motorcycle collision to the Emergency Department. He is conscious and the examination reveals that the man has diffi culty swallowing, loss of sensation on the pharyngeal wall, hoarseness, and weakness of the trapezius muscle. CT reveals a basal skull fracture. This fracture went through which of the following foramina to produce these deficits? (A) Foramen ovale (B) Foramen rotundum (C) Hypoglossal canal -(D) Jugular foramen (E) Superior orbital fi ssure A 51-year-old man presents with a complaint of numbness on his face. The examination localizes this sensory deficit to the skin over the mandible, the mandibular teeth, floor of the oral cavity, and lower lip. In addition, the muscles of mastication are weak. Which of the following is most likely involved? (A) Foramen rotundum -(B) Foramen ovale (C) Foramen spinosum (D) Infraorbital foramen (E) Superior orbital fi ssure A 32-year-old woman visits her family physician with the complaint of a persistent low-grade discomfort in her eyes. The examination reveals that the conjunctiva of the woman’s eyes is somewhat infl amed and that she has an apparent lack of tear production Which of the following cranial nerve nuclei specifically participates in the secretory function that is compromised in this woman? (A) Dorsal motor vagal nucleus (B) Inferior salivatory nucleus (C) Nucleus ambiguus (D) Solitary nucleus -(E) Superior salivatory nucleus A patient has hoarseness and difficulty swallowing, loss of pain and temperature sensations from the body contralateral to the lesion and from the face ipsilateral to the lesion, and Horner’s syndrome. A single lesion that accounts for all of the signs or symptoms is in: A. The medial medulla -B. The lateral medulla C. The caudal pons D. The rostral pons E. The midbrain A patient cannot wrinkle his forehead or shut his eye on the side of the lesion. The affected eye is also dry and red, and the patient complains of being sensitive to loud sounds. An internal strabismus is present on the side of the facial weakness. The patient also has weak upper and lower limbs and elevated muscle stretch reflexes contralateral to the facial weakness. A single lesion that accounts for all of the signs or symptoms is in: A. The medial medulla B. The lateral medulla -C. The caudal pons D. The rostral pons E. The midbrain A patient has a dilated pupil, a laterally deviated eye, loss of the near response on the side of the lesion, and weak upper and lower limbs contralateral to the side of the lesion. A single lesion that accounts for all of the signs or symptoms is in: A. The medial medulla B. The lateral medulla C. The caudal pons D. The rostral pons -E. The midbrain A patient has a loss of vibratory sense from the left side of the body and a spastic hemiparesis on the left, and the tongue deviates toward the right on protrusion. What blood vessel may have been involved in a stroke? A. Posterior inferior cerebellar artery B. Basilar artery -C. Anterior spinal artery D. Paramedian branches of the basilar artery E. Deep branches of a posterior cerebral artery A patient has nasal regurgitation of liquids during swallowing and nasal speech, miosis and ptosis of the right pupil and eyelid, respectively, and a loss of pain and temperature sensations from the body opposite the ocular signs. The patient notes that food tastes funny and that the right side of the face is dry. What blood vessel may have been involved in a stroke? -A. Posterior inferior cerebellar artery B. Basilar artery C. Anterior spinal artery D. Paramedian branches of the basilar artery E. Deep branches of a posterior cerebral artery A patient has a laterally deviated left eye, a ptosis of the left eyelid, and a dilated left pupil. The patient can shut the affected eye but cannot prevent saliva from dripping from the corner of the mouth on the right. There are elevated muscle stretch reflexes and weakness in the right upper and lower limbs. What blood vessel may have been involved in a stroke? A. Posterior inferior cerebellar artery B. Basilar artery C. Anterior inferior cerebellar artery D. Paramedian branches of the basilar artery -E. Thalamoperforating branches of a posterior cerebral artery A patient has numbness of the face and scalp on the right, burns the anterior part of the tongue but cannot feel the stimulus, and has weakness in chewing on the right. When the left cornea is stimulated both eyes blink, but when the right cornea is stimulated neither eye blinks. Localize the probable lesion site. -A. Trigeminal nerve B. Spinal nucleus of V C. Principal sensory nucleus of V D. Ventral trigeminal tract E. Mesencephalic nucleus of V A complete destructive lesion of the facial nerve just as it emerges from the brainstem will result in retrograde chromatolysis in which of the following nuclei? A. Nucleus ambiguus B. Inferior salivatory nucleus -C. Superior salivatory nucleus D. Ventral cochlear nucleus E. Solitary nucleus A 55-year-old male patient develops dancelike involuntary movements. You diagnose the patient as having a degenerative neurological disease that was also evident in the patient’s father and uncle. Where is the most likely site of the degeneration? A. Globus pallidus, internal segment B. VL nucleus of the thalamus -C. Head of caudate nucleus D. Substantia nigra, pars compacta E. Putamen A hypertensive patient suffers a lacunar infarct and develops uncontrollable violent flinging movements of the left upper limb. Where is the lesion? A. Left globus pallidus internal segment -B. Right subthalamic nucleus C. Left substantia nigra D. Right VL nucleus E. Right substantia nigra Over a period of years, a construction worker begins to have difficulty hammering nails using his right arm and hand. When he walks, he seems to teeter to the right. A neurological exam reveals that muscle strength is 5/5 in both the upper and lower limbs, but the patient exhibits a tremor when attempting to touch his right index finger to the tip of his nose. Cranial nerve testing and the rest of the neurological exam are normal. Where might a lesion be located that accounts for all of the patient’s symptoms? A. Anterior part of the vermis bilaterally B. Lateral part of the hemisphere on the right -C. The vermis and cerebellar hemisphere on the right D. Head of the caudate nucleus on the right E. Inferior olivary nuclei on the right Your patient has a tumor in the third ventricle, which is compressing the hypothalamus and exhibits signs associated with a decreased output of vasopressin by the posterior pituitary. What structure has the tumor compressed? -A. Supraoptic nucleus B. Suprachiasmatic nucleus C. Arcuate nucleus D. Medial preoptic nucleus E. Ventromedial nucleus Your patient has been diagnosed with an eating disorder. The patient seems to have lost a significant amount of weight in the last year. A lesion in which of the following areas might have caused the patient’s problem? A. Medial preoptic nucleus B. Paraventricular nucleus C. Mammillary body D. Ventromedial nucleus of hypothalamus -E. Lateral part of the anterior zone of hypothalamus Your patient has an inability to voluntarily look to the right using horizontal conjugate gaze. What region of the CNS might be a site of the lesion? A. Brodmann area 17 B. Rostral interstitial nucleus on the right C. Right frontal eye field D. Medial longitudinal fasciculus -E. Right PPRF Your patient develops an inability to adduct either eye during horizontal gaze. Convergence is intact, and the pupillary light reflex is normal bilaterally. Where is the lesion? A. Frontal eye field B. Oculomotor nerve C. Abducens nerve D. Pretectal nuclei -E. Medial longitudinal fasciculus Your patient has a visual field deficit caused by a complete lesion of an optic tract. Which of the following terms may be used to characterize the deficit? -A. Homonymous B. Bitemporal C. Ipsilateral D. Monocular E. Quadrantanopsia Your patient has a complete lesion of the right optic nerve. Where might there be anterograde degeneration of the affected axon terminals? A. In laminae 2, 3, and 5 of the left lateral geniculate nucleus B. In the ganglion cell layer of the retina C. In the supraoptic nucleus of the hypothalamus -D. In laminae 1, 4, and 6 of the left lateral geniculate nucleus E. In the Edinger-Westphal nuclei A 41-year-old man had a violent headache and was found unresponsive. Both lower limbs were weak and spastic. The upper limbs were also weak, but the patient could move them slightly. Verbal communication was impossible. Horizontal gaze in either direction was abolished, but the patient could look up and down with both eyes, and could partially close both eyes. What might the patient have? A. One-and-a-half syndrome B. Internuclear ophthalmoplegia -C. Locked-in state D. Medial midbrain syndrome E. Parinaud’s syndrome When visual field defect is right homonymous hemianopsia, where might the site of a lesion be located? A. Optic tract on the left B. Meyer’s loop on the left C. Primary visual cortex in the left occipital lobe -D. Visual radiations on the left E. Frontal eye field on the left Your patient has suffered a stroke caused by occlusion of the superficial branches of the right ACA. The patient may have: A. A loss of pain and temperature sensations in the left upper limb -B. A spastic weakness of the left lower limb C. Lower face weakness on the left D. Inability to look to the left with both eyes E. A loss of discriminative touch from the right side of the face Your female patient has suffered a stroke. She has difficulty copying simple diagrams, even though she hears and understands your requests to do so. You notice that she only has makeup on the right side of her face and does not seem to know where her left hand is in space. Where is her lesion? A. Left prefrontal cortex -B. Right parietal lobe C. Left temporal lobe D. Right occipital lobe E. Left parietal lobe A middle-aged man suddenly has difficulty reading but hears and understands what is being said to him. He also has difficulty writing, even though the strength in his upper limbs is 5/5, and he is unable to pick up a pen using the thumb and index finger of his right hand. The patient seems to have lost the ability to add and subtract, despite being able to understand the request to do so. A diagnosis of the patient’s condition might be: A. Alzheimer’s disease -B. Gerstmann’s syndrome C. Balint’s syndrome D. Frontal lobe syndrome E. Transcortical apraxia Which of the following thalamic nuclei is located within the internal medullary lamina and, therefore, is commonly referred to as one of the intralaminar nuclei? (A) Anterior (B) Dorsomedial -(C) Centromedian (D) Lateral dorsal (E) Thalamic reticular Which of the following thalamic nuclei is primarily responsible for conveying pain, thermal, and discriminative touch sensations for the face to the appropriate part of the primary somatosensory cortex? (A) Centromedian (B) Pulvinar (C) Ventral lateral (D) Ventral posterolateral -(E) Ventral posteromedial An association nucleus of the thalamus is one that receives input from several different sources and projects to widespread cortical regions that are not specifically motor or sensory in function. Which of the following nuclei fi ts these criteria? (A) Anterior -(B) Dorsomedial (C) Lateral geniculate (D) Ventral lateral (E) Ventral posterolatera Which of the following thalamic nuclei is an essential synaptic station in those circuits relayed through the dorsal thalamus (such as the Papez circuit) that are related to functions of the limbic system? -(A) Anterior (B) Centromedian (C) Dorsomedial (D) Ventral lateral (E) Ventral posteromedial Which of the following thalamic, or hypothalamic, nuclei is the primary target of the fiber bundle indicated at the arrow in the image below? (A) Anterior (B) Centromedian (C) Habenular -(D) Mammillary (E) Supraoptic A 69-year-old man is brought to the Emergency Department. He is somewhat somnolent and complains of a headache. The examination reveals normal cranial nerve function but a profound right-sided weakness and loss of pain sensation and discriminative touch on his right upper and lower extremities. MRI reveals a hemorrhagic stroke in the internal capsule. Based on this man’s deficits, this lesion is most likely located in which of the following? (A) Anterior limb (B) Genu -(C) Posterior limb (D) Retrolenticular limb (E) Sublenticular limb A 77-year-old woman has a sudden headache and loses consciousness. The next day, after she had regained consciousness, she was aphasic, a bit somnolent, was able to answer questions with “yes” or “no,” but was unable to construct even a short sentence. The woman seems to be fully aware of her situation. MRI revealed a lesion in the cerebral cortex. This lesion is most likely located in which of the following? (A) Angular gyrus + supramarginal gyrus (B) Anterior + posterior paracentral gyri (C) Cuneus + lingual gyrus -(D) Pars opercularis + pars triangularis (E) Uncus + parahippocampal gyrus A 69-year-old man is brought to his family physician by his wife. The results of the examination reveal deficits that suggest that the man has had a precipitous vascular event. A CT of brain revealing a small stroke in the genu of the internal capsule. Which of the following fi ber populations is most affected in this man’s stroke? (A) Corticonigral -(B) Corticonuclear (C) Corticopontine (D) Corticospinal (E) Corticostriatal A 78-year-old man is brought to the family physician by his wife. The examination revealed that the man seems to not understand the questions being asked, and, when he responds, his answers are essentially unintelligible. He also has great difficulty reading and writing. MRI reveals a lesion in the cerebral cortex. Based on his symptoms, which of the following is the most likely location of this lesion? (A) Anterior and posterior paracentral gyri (B) Cuneus and lingual gyri (C) Pars opercularis and pars triangularis -(D) Supramarginal and angular gyri (E) Transverse temporal gyrus What is the primary target of dentate nucleus efferent fibers? -A. VL nucleus of thalamus B.VM nucleus of thalamus C.Centromedian nucleus of thalamus D.Interlaminar nucleus of thalamus E.Pulvinar What is the neurotransmitter of the Renshaw cell: A. Glutamate B.GABA C.ACh -D.Glycine E.Seratonin What is the only output of the cerebellar cortex? -A. Purkinje cell B.Basket cell C.Granular cell D.Pyramidal cell E.Astroid cell What structures are connected by the stria medullary thalami? A. septal nuclei and mammillary bodies -B. septal nuclei and habenular nuclei C.hypothalamus and anterior commissure D.thalamus and posterior commisure E.amygdala and mammillary bodies Where do first-order sympathetic neurons to papillary dilator originate? -A. Hypothalamus B. Thalamus C.Motor cerebral cortes D. Edinger-Westphal nucleus E.Superior collicolus Where do pre-ganglionic parasympathetic fibers destined for the lacrimal glands synapse? A. Cilliary ganglion -B. Sphenopalatine ganglion C.Otic ganglion D. Submaxillary ganglion E.Optic ganglion Whiuch muscle spindle afferent fibers transmit information about muscle contraction velocity? -A. Ia fibers B. Ib fibers C. Ic fibers D. II fibers E.III fibers What drug is a GABA-B agonist: A. Benzodiazepam B. Naloxone C. Butolin toxin -D.Baclofen E.Morphine What is the only sensory modality bypasses the thalamus: smell -A. Smell B. Taste C. Vision D. Hearing E.Touching What is the rate limiting enzyme in dopamine synthesis: A. Dopa Decarboxylase B. Dopamine Hydroxylase -C. Tyrosine Hydroxylase D.Tyrosine Decarboxylase E. Phenylethanolamine N-methyltrasferase What nerve fibers mediate sensation of sharp pain? A. Aα B. Aβ C. Aγ -D. Aδ E. B Each of the following occurs in phototransduction except: A. Activated rhodopsin activates a G protein. B. Activation of cyclic guanosine monophosphate (cGMP) phosphodiesterase increases hydrolysis of cGMP to 5'-GMP. C. Current through a cGMP-activated sodium channel decreases. D. Rhodopsin is activated when light converts bound 11-cis retinal to all-trans retinal. -E. The decreased concentration of cGMP results in depolarization of the plasma membrane. Each of the following is true of the Na+/K+ pump except that it: A. contributes to the resting potential of the cell B. hyperpolarizes the membrane C. is electrogenic D. transports 3 Na+ ions out for 2 K+ ions in -E. utilizes 2 molecules of adenosine triphosphate (ATP) for every 3 Na+ ions transported Each of the following is true of events occurring during the action potential except A. A sudden increase in conductance of Na results in depolarization. -B. Chloride permeability increases during depolarization. C. During hyperpolarization, the conductance of Na is lower than normal, and the conductance of K is higher than normal. D. The decrease in Na permeability, occurring as the action potential reaches a peak, results from inactivation of Na channels. E. The presence of voltage-dependent K channels is to allow faster repolarization. The velocity of an action potential increases with a: A. high transmembrane resistance, low internal resistance, and high membrane capacitance -B. high transmembrane resistance, low internal resistance, and low membrane capacitance C. low transmembrane resistance, high internal resistance, and high membrane capacitance D. low transmembrane resistance, low internal resistance, and high membrane capacitance E. low transmembrane resistance, low internal resistance, and low membrane capacitance Which of the following is true of myelination? A. It has no effect on transmembrane resistance but increases membrane capacitance. B. It decreases both transmembrane resistance and membrane capacitance. C. It decreases transmembrane resistance and increases membrane capacitance. -D. It increases transmembrane resistance and decreases membrane capacitance. E. It increases both transmembrane resistance and membrane capacitance. Which of the following is true of axonal transport? -A. Dynamin does not use ATP. B. Dynein is the motor for anterograde fast axonal transport. C. Fast axonal transport occurs primarily along neurofilaments. D. Kinesin is the motor for retrograde fast axonal transport. E. Slow axonal transport occurs at 200 to 400 mmlday. Each of the following is true of decerebrate rigidity except: A. It results from tonic activity in the vestibulospinal and pontine reticulospinal neurons. B. It is reduced by cutting dorsal roots. -C. It is reduced by destruction of the anterior lobe of the cerebellum. D. It occurs with transection between the colliculi. E. There is increased gamma motor neuron activity. Which is true of events occurring after a typical axon is severed? A. Chromatolysis is always associated with decreased protein synthesis. B. Retraction bulbs form only at the proximal end of the cut nerve. -C. Terminal degeneration leads to the loss of presynaptic terminals. D. Wallerian degeneration occurs before terminal degeneration. E. Wallerian degeneration leads to loss of the proximal axon segment. Agents that increase the formation of cerebrospinal fluid (CSF) include I. carbon dioxide II. norepinephrine III. volatile anesthetic agents IV. carbonic anhydrase inhibitors A. I, II, III -B. I, III C. II, IV D. IV E. all of the above The sensation of sharp, pricking pain is mediated by A. Aα fibers B. Aβ fibers C. Aγfibers -D. Aδfibers E. C fibers Which is true of synaptic transmission in automatic ganglia? A. Neuronal ACh receptors contain four types of subunits. B. The slow excitatory postsynaptic potential (EPSP) is produced by muscarinic receptors closing Na+ and Ca2+ channels while opening K+ channels. C. The slow inhibitory postsynaptic potential (IPSP) is mediated by activation of muscarinic receptors that close K+ channels. -D. The fast EPSP is mediated by nicotinic ACh receptors. E. Peptides are never co-released with ACh. Each of the following is true of the neural innervation of the bladder except: -A. Increased postganglionic sympathetic activity results in bladder wall contraction. B. Increased postganglionic sympathetic activity results in a-adrenergic inhibition of parasympathetics in the pelvic ganglion. C. Motor neurons in the ventral horn of the sacral spinal cord innervate the external sphincter. D. Parasympathetic activity promotes bladder emptying. E. The internal sphincter is innervated by sympathetic fibers. As the membrane of a motor neuron becomes increasingly depolarized: A. Both EPSP and IPSP decrease. B. Both EPSP and IPSP increase. -C. EPSP decreases. and IPSP increases. D. EPSP increases, and IPSP decreases. E. There is no change in IPSP, but EPSP increases. Each of the following is true of Renshaw cells except that: A. They are part of a negative feedback loop to the motor neurons. -B. They facilitate la inhibitory interneurons that act on antagonist motor neurons. C They inhibit motor neurons that innnervate synergist muscles. D. They make divergent connections to motor neurons. E. They receive input from descending pathways. The effect of succinylcholine at the neuromuscular junction is: A. amplified by increased muscle temperature B. hyperpolarization -C. not reversed by anticholinesterase agents D. not similar to that of decamethonium E. similar to that of D-tubocurarine In the formation of nitric oxide, nitric oxide synthetase acts on the substrate: -A. arginine B. citrulline C. lysine D. ornithine E. tyrosine The pineal gland synthesizes melatonin from: A. acetylcholine B. dopamine C. histidine D. norepinephrine -E. serotonin The EPSP in spinal motor neurons results from the opening of: A. CI- channels only B. C1- and Na+ channels C. K+ channels only -D. Na+ and K+ channels E. Na+ and C1- channels The response of the carotid sinus to an increase in blood pressure is a: I. decrease in peripheral resistence II. decrease in heart rate III. decrease in force of contraction IV. decrease in blood pressure A. I, II,III B. I, III C. II, IV D. IV -E. all of the above Which of the following is true of skeletal muscle contraction? A. Calcium binds to tropomysin. -B. Rotation of myosin heads pulls thin filaments toward the center of the sarcomere. C. The detachment of cross bridges does not require ATP. D. The dissociation of aain from myosin uses energy from the hydrolysis of GTP. E. When muscle relaxes, calcium diffuses into the sarcoplasmic reticulum from the intracellular space. Each of the following agents promote alcohol dehydrogenase (ADH) release except: -A. alcohol B. angiotensin I1 C. decreased blood volume D. vomiting E. warmth of skin Each of the following is a criterion that a chemical messenger should fulfill to be considered a transmitter except: A. A specific mechanism exists for removing it from its site of action. B. It is present in the presynaptic terminal and is released in amounts sufficient to exert its action on the postsynaptic neuron or effector organ. C. It is synthesized in the neuron. -D. The enzymes that catalyzes the steps in its synthesis are cytoplasmic. E. The exogenously applied substance should mimic the action of the endogenously released transmitter. Each of the following is considered a neurotransmitter except: A. epinephrine B. glycine C. histamille D. serotonin -E. vasoactive intestinal polypeptide (VIP) Each of the following organs is innervated by both the sympathetic and parasympathetic systems except the: A. gastrointestinal tract B. heart C lungs and bronchi D. salivary glands -E. sweat glands Which of the following represents the most likely location of the receptors that monitor internal body temperature and serum osmolarity? (A) Anterolateral medulla (B) Carotid body -(C) Hypothalamus (D) Nucleus ambiguus (E) Solitary nucleus A 57-year-old man presents with the complaint of “dizziness” and being light-headed. The examination reveals that his symptoms are most obvious when he arises from a supine to a standing. Which of the following is an essential structure involved in the pathway mediating this man’s primary complaint? (A) Accessory nucleus (B) Anterolateral medulla (C) Inferior salivatory nucleus -(D) Solitary nucleus (E) Spinal trigeminal nucleus A 29-year-old woman suffered a severe spinal cord injury at C7. After several weeks, she begins to experience autonomic dysreflexia: that is, noxious stimuli to the trunk and lower extremities evoke piloerection, sweating, and hypertension. Which of the following represents the most likely cause of these responses? (A) Diminished parasympathetic refl exes (B) Diminished sympathetic refl exes (C) Exaggerated nociceptive refl exes (D) Exaggerated parasympathetic refl exes -(E) Exaggerated sympathetic refl exes Which of the following is the location of the cell bodies whose axons provide direct inhibitory innervation to the detrusor muscle of the urinary bladder? (A) Anterior horn at S2-4 (B) Dorsal motor vagal nucleus -(C) Inferior mesenteric ganglion (D) Intermediolateral cell column at L1-2 (E) Superior mesenteric ganglion A 39-year-old woman is experiencing signs and symptoms of autonomic dysfunction. To determine whether or not this patient has an intact sympathetic innervation, a small skin sample is surgically removed and prepared for immunostaining. Antibodies to which of the following would represent the best choice for this evaluation? (A) Aspartate (B) Dopamine (C) Epinephrine -(D) Neuropeptide Y (E) Neurotensin Which of the following neurotransmitters is associated with the synapse between the olfactory receptor neurons and the neurons, such as tufted cells or mitral cells, which form the olfactory tract? (A) Acetylcholine (B) Dopamine (C) GABA -(D) Glutamate (E) Histamine Which of the following is the location of the cell bodies for the primary afferent neurons conveying taste from the anterior two-thirds of the tongue? -(A) Geniculate ganglion (B) Inferior ganglion of IX (C) Inferior ganglion of X (D) Otic ganglion (E) Pterygopalatine ganglion While recovering from a motorcycle collision, a 27-year-old man complains that everything he eats “tastes funny.” Which of the following specifies the perverted or distorted sense of taste experienced by this man? (A) Ageusia (B) Alexia (C) Anosmia -(D) Dysgeusia (E) Hyposmia Damage to medial vestibulospinal fibers originating in the left vestibular nuclei would most likely produce which of the following defi cits? (A) Bilateral postural ataxia in lower extremites (B) Diffi culty moving left upper extremity -(C) Postural instability of the head only (D) Postural instability of the body on the right (E) Tremor of left upper and lower extremities Which of the following represents the location of the primary auditory cortex? (A) Angular gyrus (B) Long gyrus of the insula (C) Superior temporal gyrus (D) Supramarginal gyrus -(E) Transverse temporal gyrus For excitatory signal transduction in hair cells of the vesribular system, which of the following events is most likely to occur? (A) The stereocilia are compressed inward toward the cell surface, K+ channels in the stereocilia close, Ca2+ channels in the basolateral cell membrane close, and excitatory neurotransmitter is released (B) The stereocilia are bent away from the kinocilium, K+ channels in the stereocilia close, Ca2+ channels in the basolateral cell membrane close, and excitatory neurotransmitter is released (C) The stereocilia are rigid and do not move, endolymph motion forces K+ channels in the stereocilia to open, Ca2+ channels in the basolateral cell membrane close, and excitatory neurotransmitter is released -(D) The stereocilia are bent toward the kinocilium, K+ channels in the stereocilia open, Ca2+ channels in the basolateral cell membrane open, and excitatory neurotransmitter is released (E) The stereocilia are bent perpendicular to the kinocilium, K+ channels in the stereocilia close, Ca2+ channels in the basolateral cell membrane open, and excitatory neurotransmitter is released (E) Vestibular schwannoma on the right Which of the following receptors is especially important to the visually impaired patient when reading Braille? -(A) Merkel cell complex (B) Meissner corpuscle (C) Naked nerve ending (D) Pacinian corpuscle (E) Ruffini ending Feedback to outer hair cells that influence the relative sensitivity of the cochlea is mediated by circuits that arise primarily from which of the following? (A) Anterior cochlear nucleus (B) Facial nucleus (C) Nuclei of the lateral lemniscus -(D) Periolivary nuclei (E) Posterior cochlear nucleus A 45-year-old man presents with a loss of only pain and thermal sensations beginning at T6 and extending caudally on his left side. All other sensations are normal. Which of the following would specify this deficit? (A) Alternating hemianesthesia (B) Anesthesia (C) Conduction anesthesia -(D) Dissociated sensory loss (E) Paraesthesia A 71-year-old man complains to his family physician of difficulty walking. The examination reveals no cranial nerve deficits, a distinct sensory loss, but no muscle weakness. The man tends to put his right foot down awkwardly, but forcibly, to the floor when he walks; the left foot and both upper extremities appear to be not affected. Damage to which of the following would correlate with this man’s particular defi cit? (A) Left accessory cuneate nucleus (B) Left spinal trigeminal nucleus (C) Right cuneate nucleus -(D) Right gracile nucleus (E) Right spinal laminae I to IV The MRI of a 75-year-old woman reveals a lesion in the medulla, on the left side, that resulted from an occlusion of penetrating branches of the anterior spinal artery. This woman would most likely experience which of the following? (A) Deviation of the tongue to the right (B) Loss of discriminative touch of the left extremities -(C) Loss of discriminative touch of the right extremities (D) Loss of pain and thermal sense on the left extremities (E) Loss of pain and thermal sense on the right extremities Which of the areas indicated in the image below contains neuronal cell bodies whose axons are involved in the descending inhibition of pain in the brainstem and in the spinal cord? (A) A (B) B (C) C -(D) D (E) E A 21-year-old man is brought to the Emergency Department from the site of a motor vehicle collision. The examination reveals that he is profoundly weak on his left side , perceives vibration when a tuning fork is applied to his left clavicle, but not to his thumb or below that level, and perceives pinprick on his right thumb, index fi nger, and middle fi nger, but not on the little fi nger or below that level. This lesion is located at which of the following levels? (A) About C4 on the right (B) About C4 on the left (C) About C6 on the right -(D) About C6 on the left (E) About C8 on the left A 49-year-old man visits a neurologist at the suggestion of his family physician. The history reveals that the man has long-standing sensory deficits that have gotten progressively worse over the last 8 months. The examination reveals (1) normal cranial nerve function, (2) mild bilateral motor deficits, and (3) bilateral loss of all sensory modalities on the lower extremities. The man notes that these “funny sensory feelings” have progressed from nonexistent to severe over time. First Q: MRI reveals a single lesion, elliptical in shape, about 2 × 3 cm in size. This tumor is most likely which of the following? (A) Anaplastic astrocytoma (B) Glioblastoma multiforme (C) Oligodendroglioma -(D) Meningioma (E) Schwannoma Second Q: Impingement on which of the following structures would most likely explain the sensory deficits in this man? (A) Anterior paracentral gyrus (B) Internal capsule, posterior limb (C) Medial medulla, bilaterally (D) Postcentral gyrus -(E) Posterior paracentral gyrus During a neurological examination on a 31-year-old woman, the examining physician discovers that the pupillary light refl ex is absent in the woman’s left eye. The afferent limb of this reflex traverses which of the following? (A) Brachium conjunctivum (B) Brachium of the inferior colliculus -(C) Brachium of the superior colliculus (D) Oculomotor nerve (E) Posterior commissure A 79-year-old woman complains to her physician that she is having trouble seeing. The visual field examination reveals a right superior quadrantanopia, and the ophthalmoscopic examination shows no frank abnormalities of the optic disc or retinal vasculature. Which of the following represents the most likely location of the lesion in this woman? (A) Left lateral geniculate nucleus -(B) Left Meyer loop (C) Left optic radiations (D) Right Meyer loop (E) Right optic tract A 47-year-old man suddenly realizes the he must hold papers at arm’s length in an attempt to get them into focus. Which of the following specifies this condition in this man? (A) Amblyopia (B) Mydriasis (C) Myopia -(D) Presbyopia (E) Visual agnosia Which of the following cells of the neural retina have a center surround type of receptive field organization? (A) Amacrine cells (B) Cone photoreceptors -(C) Ganglion cells (D) Horizontal cells (E) Rod photoreceptors A 43-year-old man is brought to the Emergency Department from the site of a motor vehicle collision. The CT clearly suggests that he has a probable transected left optic nerve. Which of the following, regarding the pupillary light reflex, would confirm this observation when a light is shined in the left eye? (A) Direct and consensual response intact (B) Direct response intact, consensual absent (C) Direct response absent, consensual intact (D) Direct and consensual responses intact but diminished -(E) Direct and consensual responses absent The optic nerve is composed of axons arising from which of the following cells of the retina? (A) Amacrine cells (B) Bipolar cells -(C) Ganglion cells (D) Horizontal cells (E) Rod cells A 57-year-old man presents to his family physician with the complaint of a sudden onset of deafness. The examination reveals total deafness in his left ear and some gait disturbances. Occlusion of which of the following vessels would correlate with this man’s primary deficit? -(A) Left anterior inferior cerebellar artery (B) Left long circumferential branches of the basilar artery (C) Left posterior cerebral artery (D) Left posterior inferior cerebellar artery (E) Left posterior spinal artery A 47-year-old welder presents at the Emergency Department with sudden onset of difficulty speaking. The examination reveals slurred speech, deviation of the tongue to the right on attempted protrusion, and weakness of the lower facial muscles also on the right. CT shows a well-localized hemorrhagic lesion that is most likely located in which of the following? (A) Anterior limb of the internal capsule on the left -(B) Genu of the internal capsule on the left (C) Genu of the internal capsule on the right (D) Posterior limb of the internal capsule on the left (E) Posterior limb of the internal capsule on the right Which of the following is the receptor for the afferent limb of the patellar tendon reflex or the jaw jerk reflex? (A) Golgi tendon organ (B) Merkel cell ending -(C) Muscle spindle (D) Pacinian corpuscle (E) Ruffini ending Which of the following is a sign that would most likely be seen in a patient with a lower motor neuron lesion? (A) Hyperreflexia (B) Hypertonia -(C) Muscle fasciculations (D) Muscle groups affected (E) Muscle spasticity The MRI of a 56-year-old man presents with a sudden loss of motor function of his right hand. The MRI reveals a circumscribed cortical lesion, most likely hemorrhagic in origin. Which of the following represents the most likely location of this lesion? (A) Anterior paracentral gyrus (B) Lateral third of the precentral gyrus (C) Medial third of the precentral gyrus -(D) Middle third of the precentral gyrus (E) Middle third of the postcentral gyrus Which of the following encodes the rate of change in muscle length during contraction of a skeletal muscle? -(A) Dynamic nuclear bag fibers (B) Golgi tendon organ (C) Merkel cell ending (D) Nuclear chain fibers (E) Static nuclear bag fiber A 47-year-old man is brought to the Emergency Department from the site of a motor vehicle collision. CT shows a skull fracture in the left frontal region and extensive intracranial hemorrhage. The man is unconscious and within 6 hours exhibits decorticate posturing. Excessive action in which of the following tracts/systems would explain the flexion of the upper extremities in this man? (A) Anterolateral (B) Corticospinal (C) Reticulospinal -(D) Rubrospinal (E) Vestibulospinal A 71-year-old woman presents to her family physician with difficulty swallowing and some numbness on her face. The examination revealed a loss of sensation on the right side of the face, some moderate sensory loss on the left side of her body, and a weak right vocal fold. MRI showed a lesion in the territory of the posterior inferior cerebellar artery (PICA). Damage to which of the following structures would explain this motor deficit in this patient? (A) Hypoglossal nucleus -(B) Nucleus ambiguus (C) Restiform body (D) Solitary nucleus (E) Spinal trigeminal nucleus A 59-year-old man is transported to the Emergency Department. He is unconscious. MRI reveals a massive cerebral hemorrhage. At about 7 hours after the initial event, he presents with features of decorticate posturing; about 10 hours later, he converts to a decerebrate state. Which of the following most likely takes place to explain this change in clinical status? (A) Decreased excitatory outflow of cerebellothalamic axons (B) Decreased corticospinal excitation of spinal flexor motor neurons (C) Increased reticulospinal excitation of spinal flexor motor neurons -(D) Increased reticulospinal excitation of spinal extensor motor neurons (E) Increased rubrospinal excitation of spinal extensor motor neurons Stretch of a Golgi tendon organ will, through the appropriate synaptic circuits, ultimately result in which of the following? (A) Excitation of alpha motor neurons innervating the muscle associated with the activated tendon organ (B) Excitation of gamma motor neurons innervating muscle spindles in the muscle associated with the activated tendon organ -(C) Inhibition of alpha motor neurons innervating the muscle associated with the activated tendon organ (D) Inhibition of gamma motor neurons innervating muscle spindles in the muscle associated with the activated tendon organ (E) Monosynaptic inhibition of alpha motor neurons innervating the muscle associated with the activated tendon organ A 63-year-old man falls from a scaffolding at his place of work and is transported to the Emergency Department. The man is semicomatose. The examination reveals that cranial nerve function is within normal ranges, the man has weakness of both lower extremities, and all somatosensory input from the body is also within normal ranges. MRI shows a small single lesion. Which of the following represents the most likely location of this lesion? (A) Bilateral caudal basilar pons (B) Bilateral medial medulla -(C) Caudal part of motor decussation (D) Complete motor decussation (E) Rostral part of motor decussation A 71-year-old man is diagnosed with a middle alternating (or crossed) hemiplegia. Which of the following combination of defi cits would most likely be seen in this patient? (A) Corticospinal defi cits and deviation of the tongue to the opposite side (B) Corticospinal defi cits and dilation of the pupil on the opposite side (C) Corticospinal defi cits and loss of somatosensory information on the same side -(D) Corticospinal defi cits and weakness of lateral gaze to the opposite side (E) Corticospinal defi cits and weakness of most eye movement on the same side Descending fibers from supraspinal centers excite motor neurons within the anterior horn that innervate intrafusal muscle fibers. Contraction of these muscle fibers results in increased activity in Ia fibers which activate alpha motor neurons that excite extrafusal muscle fi bers. What is this circuit called? (A) Babinski reflex (B) Crossed extensor reflex (C) Flexor reflex -(D) Gamma loop (E) Reciprocal inhibition A 31-year-old woman presents to her physician with a complaint of “seeing two of everything.” The examination reveals that the woman has weakness of ocular movement in both eyes, more pronounced on the left, drooping of both eyelids, also more pronounced on the left, and slight weakness of the left upper extremity when compared to the right. She also notes that she feels worse later in the day. Which of the following neurotransmitters is most likely involved in this woman’s disease? -(A) Acetylcholine (B) Dopamine (C) Histamine (D) Glutamate (E) Glycine An occlusion of which of the following arteries, or group of arteries, would result in the most direct and signifi cant damage to the head of the caudate nucleus? (A) Anterior choroidal (B) Anterior communicating (C) Lenticulostriate -(D) Medial striate (E) Thalamoperforating Which of the following structures, or combination of structures, constitutes the neostriatum? (A) Globus pallidus only (B) Putamen only -(C) Putamen + caudate nucleus (D) Putamen + globus pallidus (E) Putamen + globus pallidus + caudate nucleus \ Corticostriatal excitation of striatal neurons that are projecting through the direct pathway results in which of the following? -(A) Disinhibition of thalamocortical neurons with resultant increase in activity of cerebral cortical neurons (B) Disinhibition of thalamocortical neurons with resultant decrease in activity of cerebral cortical neurons (C) Disinhibition of thalamocortical neurons with no change in the fi ring characteristics of cortical neurons (D) Inhibition of thalamocortical neurons with resultant decrease in the fi ring patterns of cortical neurons (E) Inhibition of thalamocortical neurons with resultant increase in the fi ring patterns of cortical neurons A 67-year-old man has a resting tremor that was initially seen only in his left hand, but eventually involved his right hand. As this man’s disease progressed, he experienced difficulty initiating voluntary movements and, once initiated, these movements were reduced in velocity and amplitude. Which of the following best describes this man’s movement deficit? (A) Akinesia (B) Asterixis -(C) Bradykinesia (D) Hypometria (E) Titubation Which of the following neurotransmitters is specifically associated with the subthalamopallidal fibers that project to the medial segment of the globus pallidus? (A) Acetylcholine (B) Dopamine (C) GABA -(D) Glutamate (E) Glycine A 73-year-old woman is brought to the Emergency Department by her husband. The examination reveals an otherwise healthy trim woman who had a headache followed by a sudden onset of involuntary flinging movements of her right extremities, most pronounced in her right upper extremity. CT reveals a small localized hemorrhagic lesion. This lesion is most likely located in which of the following? (A) Left caudate and putamen (B) Left globus pallidus -(C) Left subthalamic nucleus (D) Right globus pallidus (E) Right subthalamic nucleus A 69-year-old woman presents to her family physician with a motor complaint. The examination shows an intention tremor and dysmetria on her left side. CT reveals a cerebellar stroke involving cortex and nuclei. Which of the following arteries occlusion would most likely be involved to produce these deficits in this woman? (A) Left anterior inferior cerebellar artery -(B) Left superior cerebellar artery (C) Right anterior inferior cerebellar artery (D) Right posterior inferior cerebellar artery (E) Right superior cerebellar artery A 49-year-old man presents to the Emergency Department with motor disturbances. The examination reveals signs and symptoms consistent with a lesion involving the cerebellum. The cerebellum has no significant projections that course directly to the spinal cord to influence spinal lower motor neurons. Through which of the following does the cerebellum exert its most signifi cant influence on spinal motor neurons? -(A) Corticospinal fibers (B) Hypothalamospinal fibers (C) Reticulospinal fibers (D) Spinocerebellar fibers (E) Vestibulospinal fibers A 68-year-old hypertensive woman presents with an unsteady wide-based stance, and she is unable to walk in tandem (heel to toe). CT reveals a lesion in the cerebellum. Which of the following represents the most likely location of this lesion? (A) Brachium conjunctivum (B) Cortex of the anterior lobe (C) Cortex of the posterior lobe (D) Hemisphere plus dentate nucleus -(E) Nodulus, uvula, fastigial nucleus A 67-year-old man is brought to the Emergency Department with history of having progressive difficulty walking and that this condition suddenly became worse over the last 3 days. In addition, the man has hypometria and a rebound phenomenon. Which of the following generally describes the motor deficits experienced by this patient? (A) Akinesia and bradykinesia -(B) Dyssynergia or decomposition of movement (C) Flaccid paralysis with arefl exia (D) Increased muscle tone with hyperrefl exia (E) Resting tremor and festinating gait Which of the following is an excitatory neuron within the cerebellar cortex? (A) Basket cell (B) Golgi cell -(C) Granule cell (D) Purkinje cell (E) Stellate cell A 4-year-old girl is brought to the pediatrician. The mother explains that over the last 10 days, her daughter has become lethargic, has vomited a number of times, and has complained that her “head hurts”. MRI shows a large mass originating from the choroid plexus of the fourth ventricle; the mass contains flow voids suggesting that it is highly vascular. Which of the following is the most likely blood supply to this girl’s tumor? (A) Anterior choroidal artery (B) Anterior inferior cerebellar artery (C) Lateral posterior choroidal artery (D) Medial posterior choroidal artery -(E) Posterior inferior cerebellar artery A newborn infant presents with multiple developmental defects. MRI reveals several defects within the central nervous system, including the complete absence of the primary fissure. In the normal infant, this fissure separates which of the following parts of the cerebellum from each other? -(A) Anterior lobe from posterior lobe (B) Anterior lobe vermis from paravermis (C) Flocculus from nodulus (D) Flocculonodular lobe from posterior lobe (E) Posterior lobe vermis from the tonsil A 73-year-old man collapses at home. The examination in the ED reveals that the man is unable to rapidly slap his hand to his knee while alternating pronation and supination of his hand with each movement. Which of the following specifies this particular deficit? (A) Asterixis (B) Bradykinesia (C) Dysmetria -(D) Dysdiadochokinesia (E) Titubation Direct excitation of Purkinje cells by parallel fibers would, momentarily, result in which of the following? (A) Decrease in thalamic activity with corresponding increase in cortical activity -(B) Decrease in thalamic activity with corresponding decrease in cortical activity (C) Increase in thalamic activity with corresponding increase in cortical activity (D) Increase in thalamic activity with corresponding decrease in cortical activity (E) No change in thalamic activity and no change in cortical activity A 71-year-old woman is brought to the Emergency Department. The examination reveals that the woman has an alternate hemianesthesia, nystagmus, and a pronounced ataxia. MRI reveals a medullary lesion in the territory of the posterior inferior cerebellar artery. Damage to which of the following structures within this vascular territory correlates most specifically with this woman’s ambulatory difficulties? (A) Anterolateral system (B) Nucleus ambiguus -(C) Restiform body (D) Reticular formation (E) Solitary tract Which of the following is the exclusive source of climbing fibers to the cerebellar cortex? -(A) Contralateral inferior olivary nuclei (B) Contralateral pontine nuclei (C) Contralateral reticular nuclei (D) Ipsilateral inferior olivary nuclei (E) Ipsilateral pontine nuclei A 59-year-old morbidly obese man is brought to the Emergency Department after collapsing at his home. The examination also reveals that he has diplopia, his left eye is largely immobile (he can only look down and out), and he has a decreased perception of discriminative touch on his right upper extremity; the right lower extremity is not affected. Based on this combination of deficits, which specifies the probable location of this man’s lesion, he would also most likely experience which of the following deficits? (A) Asterixis on the right (B) Dysdiadochokinesia on the left (C) Intention tremor on the left (D) Tremor and ataxia on the left -(E) Tremor and ataxia on the right A 66-year-old woman is brought to the Emergency Department. The examination reveals that the woman has difficulty walking; she has significant ataxia and intention tremor on her right side and is unable to slide her right heel down her left shin, but she is not weak when tested for actual muscle strength. Which of the following represents the most likely location of this lesion? (A) Cerebellar nuclei on the left side (B) Decussation of the superior cerebellar peduncle (C) Medial midbrain (Claude syndrome) on the left (D) Superior cerebellar peduncle on the left side -(E) Superior cerebellar peduncle on the right side Which of the following cerebellar nuclei has direct bilateral projections to brainstem nuclei that, in turn, preferentially influence spinal lower motor neurons that innervate postural (axial) musculature? (A) Dentate (B) Emboliform -(C) Fastigial (D) Globose (E) Lateral Which of the following represents the brainstem bundle through which these cerebelloreticular and cerebelloolivary fibers travel? -(A) Central tegmental tract (B) Lateral lemniscus (C) Medial longitudinal fasciculus (D) Medial lemniscus (E) Posterior longitudinal fasciculus A 51-year-old man is brought to the Emergency Department. The examination reveals that the man has an intention tremor on the finger-to-nose test, is unable to do the heel-to-shin test, and has dysmetria, all on the right side. He is also ataxic when attempting to walk. Which of the following is the most likely location of this lesion? (A) The brachium conjunctivum on the right -(B) The cerebellar cortex on the right (C) The cerebellar nuclei on the right (D) The midbrain on the left (E) The midbrain on the right A 13-year-old girl is brought to the pediatrician. The history provided by the girl and her mother reveals that the girl has had headaches for a long time. The examination reveals prominent temporal and forehead veins and ataxia of the cerebellar type. Brain MRI reveals an arteriovenous malformation involving much of the superior (tentorial) surface of the cerebellum. Which of the following is the most likely source of arterial blood to this lesion? (A) Anterior inferior cerebellar artery (B) Anterior choroidal artery (C) Posterior cerebral artery (D) Posterior inferior cerebellar artery -(E) Superior cerebellar artery A 70-year-old woman presents with the complaint of difficulty walking. The examination reveals a slender, otherwise healthy woman who has ataxia, is unable to do the finger-to- nose and the heel-to-shin tests on the right, and has slurred, garbled speech. Which of the following specifically describes this pattern of speech in this woman? (A) Apraxia -(B) Dysarthria (C) Dyslexia (D) Dysmetria (E) Dysphagia Which of the following herniation syndromes may have diabetes insipidus as one of its complicating factors? (A) Cingulate -(B) Transtentorial (C) Tonsillar (D) Uncal (E) Upward cerebellar During surgery to clip basilar tip aneurysm, perforating branches of P1 are inadvertently occluded by the clip. Which of the following structures would be most adversely affected by this disruption of blood supply? (A) Anterior hypothalamic nucleus -(B) Mammillary nuclei (C) Medial preoptic nuclei (D) Paraventricular nucleus (E) Tuberal region nuclei A patient suffered after head trauma of having no appetite, and has not eaten normally for several weeks. MRI reveals a small localized defect. Which of the following represents the most likely location of this lesion? (A) Anterior hypothalamic nucleus -(B) Lateral hypothalamic nucleus (C) Mammillary nuclei (D) Suprachiasmatic nucleus (E) Ventromedial hypothalamic nucleus Which of the following fiber bundles contains bidirectional connections between the septal nuclei, lateral hypothalamic nucleus, tuberal nuclei, and brainstem areas such as the periaqueductal gray and the tegmental nuclei? (A) Mammillotegmental tract (B) Mammillothalamic tract -(C) Medial forebrain bundle (D) Stria terminalis (E) Stria medullaris thalami Which of the following hypothalamic nuclei is described as being sexually dimorphic, that is being larger in males than in females? (A) Lateral hypothalamic nucleus -(B) Medial preoptic nucleus (C) Paraventricular nucleus (D) Posterior hypothalamic nucleus (E) Suprachiasmatic nucleus Which of the following areas indicated in the image below is the location of the dorsomedial nucleus of the hypothalamus in this sagittal section? -(A) A (B) B (C) C (D) D (E) E After suffering a head trauma patient complains that he is constantly being cold. His temperature may drop to several degrees below normal, and he wears layers of clothes in an attempt to keep warm. Bilateral lesions in which of the following areas would most likely explain the symptoms in this boy? (A) Anterior hypothalamic area (B) Lateral hypothalamic nucleus -(C) Posterior hypothalamic area (D) Ventromedial nucleus (E) Suprachiasmatic nucleus Which of the following fier bundles contains axons that arise in the arcuate nucleus and pass to the median eminence and the base of the pituitary stem? (A) Medial forebrain bundle (B) Postcommissural fornix (C) Stria medullaris thalami (D) Supraopticohypophysial tract -(E) Tuberoinfundibular tract After damage in the area of the brain substance outlined in the image below which of the following will this patient most likely experience? (A) Asperger disorder (B) Broca aphasia -(C) Klüver-Bucy syndrome (D) Wallenberg syndrome (E) Wernicke syndrome Due to bilateral lesions in the hippocampal formation, which of the following may be experienced? (A) Aphasia with agraphia (B) Hypermetamorphosis (C) Loss of long-term memory -(D) Loss of short-term memory (E) Transient global amnesia Which of the following is a major pathway that travels in close association with the tail and body of the caudate nucleus that conveys information from the amygdala to the hypothalamus? (A) Amygdalofugal pathway (B) Cingulum (C) Medial forebrain bundle (D) Stria medullaris thalami -(E) Stria terminalis A patient had a sudden onset of difficulty walking. The examination reveals that the patient has a significant right-sided weakness, a decrease, but not a loss, of pain sensation and discriminative touch also on his right side, and seems confused and disoriented. CT shows a lesion involving the medial temporal cortex, large portions of the hippocampal formation and amygdaloid nucleus, and inferior portions of the internal capsule. This lesion most likely involves which of the following vascular territories? (A) Anterior cerebral artery, A1 -(B) Anterior choroidal artery (C) Lateral posterior choroidal artery (D) Middle cerebral artery, M1 (E) Posterior communicating artery Which of the following schemes depicts the correct sequence of information when passing through the circuit of Papez? (A) Cingulate gyrus to anterior nucleus of the thalamus to mammillary body to the subiculum (hippocampal formation) to cingulate gyrus (B) Cingulate gyrus to mammillary body to anterior nucleus of the thalamus to subiculum (hippocampal formation) to cingulate gyrus (C) Cingulate gyrus to subiculum (hippocampal formation) to anterior nucleus of the thalamus to mammillary body to cingulate gyrus -(D) Cingulate gyrus to subiculum (hippocampal formation) to mammillary body to anterior nucleus of the thalamus to cingulate gyrus (E) Cingulate gyrus to subiculum (hippocampal formation) to septal area to anterior nucleus of the thalamus to cingulate gyrus Which of the following structures is identified between the two arrows in the image below? (A) Amygdaloid complex (B) Cortex of the uncus (C) Hippocampal commissure -(D) Hippocampal formation (E) Tail of the caudate nucleus What is the age of the hematoma shown in the MRI? a) Hyperacute b) Acute -c) Early subacute d) Late subacute e) Chronic Where is the motor area of the hand on the following brain MRI? a) a , b) b, - c) c, d) d, e) e All the following statements regarding cerebral circulation and ischemia are correct EXCEPT: a) CMRO2 = 3.5 ml/100gr/min b) CMRGlu = 4.5 – 5 mg/100gr/min c) Penumbra starts when CBF decreases below 18ml/100gr/min and shown by isoelectric EEG. -d) CBF increases by increased PaCO2 and decreased H+ e) A mechanism of ischemia is excitotoxicity in which excessive glutamate is released by damaged cell ends stimulates NMDA rec. leading to increases extracellular Ca influx and Ca release from the endoplasmic reticulum. 56-year old man, complained sudden headache and vometing, GCS 13/15 with left facial paralysis. According to this presentation and the brain CT scan below, which answer is WRONG: a) SAH is WFNS grade III b) SAH is Fisher grade III c) This radiologic grade has the highest incidence of vasospasm among the other four Fisher grades. -d) Angiographic vasospasm is seen more common and later than symptomatic vasospasm. e) After securing the aneurysm, treatment of vasospasm with 3H protocole should establish SBP=200-220mmHg, CVP=10-12mmHg and Hct=30%. Regarding the CSF physiology all the following statements are correct EXCEPT: a) The rate of formation is nearly 0.4ml/kg/hour. b) The CSF formation is derived mainly by Na secretion which is a Na-K ATPase pump dependant active transport. -c) Alpha-blockers decrease CSF secretion by vasoconstricting the choroidal arteries, while Beta- blockers increase CSF secretion from the choroidal epithelium. d) The cervical:aqueductal stroke volume ratio is 15:1, which decreases in decreased compliance with aging, neurodegenerative disease and chronic shunting. e) In NPH patient, inspite of having lower CSF formation rate than normal, CSF volume increase due to lower turn-over rate. Rgarding shunt systems all the following statements are correct EXCEPT: a) Differential pressure (DP) valves opens only when there is pressure difference across the valve as CSF pressure exceeds the opening pressure, regardless of patient’s position. b) Most DP valves come in three fixed opening pressures: low (5cmH2O), medium (10cmH2O) and high (15cmH2O). c) Medtronic Strata valve comes with five performance levels (0.5-1.0-1.5-2.0-2.5) corresponding to opening pressures of 2.0-4.5-8.0-11.5-14.5 cmH2O respectively. d) Flow-regulating (FR) valves are always open and maintain constant CSF flow by increasing the opening resistance when the pressure gradient increases. -e) Anti-siphon and FR valves are useful in the presence of slit ventricles, but in FR valves obstruction is more common. Regarding the craniosynostosis all the following statements are correct EXCEPT: -a) Figure 1 shows unicoronal synostosis. b) The most common type craniosynostosis is scaphocephaly and is more common in males. c) Brachycephaly is more common in females. d) The most common genetic mutationin syndromic craniosynostosis is in genes encoding fibroblast growth factors (FGFR). e) Patient in figure 2 can present with decreased or normal mental function, progressive hydrocephalus requiring shunting and normal limbs. Regarding NTD all the following statements are correct EXCEPT: a) Rostral NT closure is nearly in day 24 and caudal NT closure in nearly in day 28. Between anti-epileptic drugs the most drug effect this closure is Valproic acid. b) Myelomeningocele (MMC) is a primary neurulation pathology and the placode is non- neurulated non-functional tissue. c) Mothers with MMC babies is recommended to avoid latex use on their child, and must consider future preconceptional Folic acid use of 4mg/day. -d) MMC if left untreated 80% dies at 2 years, if treated 80% live at 5 years, and 80% of children have IQ< 80. Coup contusions most commonly occur at the: -A. cerebral convexities B. frontal and temporal poles C. orbital surface of the frontal lobes D. posterior fossa E. ventral surface of the temporal lobe Each of the following is true of growing skull fractures except that they: A. can cross suture lines B. may be associated with underlying brain injury C. occur if the edges of the initial fracture are separated by more than 3 mm D. occur most commonly in the parietal bone -E. occur most commonly between the ages of 2 and 5 The pterion is formed by which of the following bones? -A. frontal, greater wing of the sphenoid, parietal, and squamous part of the temporal B. frontal, lesser wing of the sphenoid, parietal, and squamous part of the temporal C. frontal, greater wing of the sphenoid, parietal, and zygomatic arch D. frontal, lesser wing of the sphenoid, parietal, and zygomatic arch E. frontal, lesser wing of the sphenoid, squamous part of the temporal, and zygomatic arch Cerebral salt wasting and syndrome of inappropriate antidiuretic hormone (SIADH) may best be distinguished by measuring: A. plasma arginine vasopressin (AVP) B. serum osmolality C. serum sodium D. urine sodium -E. volume status Which antiemetic medication lowers seizure threshold: -A. Phenergan B. droperidol C. Tigan D. Zofran E. Reglan Citrate toxicity from massive transfusions results from the: -A. binding of free ionized Ca2+ B. decrease of 2,3-diphosphoglyceric acid (DPG) levels C. inactivation of factors 5 and 8 D. interaction with platelets, rendering them dysfunctional E. precipitation of autoimmune hemolytic anemia Prolongation of bleeding time usually occurs in: I. von Willebrand's disease II. use of nonsteroidal anti-inflammatory agents III. uremia IV. factor VII deficiency -A. I. II,III B. I, III C. II, IV D. IV E. all of the above Plasma levels of phenytoin are increased by all of the following except: -A. carbamazepine B. cimetidine C. Coumadin D. isoniazide E. sulfonamides Which of the following disorders leads to hypernatremia? A. Addison's disease -B. hyperaldosteronism C. hypothyroidism D. renal failure E. syndrome of inappropriate antidiuretic hormone (SIADH) Which laboratory findings in disseminated intravascular coagulation (DIC) correlates most closely with bleeding? -A. decreased fibrinogen B. increased fibrin degradation products C. increased prothrombin time (PT) D. increased partial thromboplastin time (PlT) E. increased thrombin time (lT) A normal PT, a prolonged PlT, and a bleeding disorder would result from a deficiency of factor: A. II B. V -C. VIII D. X E. XII Adequacy of pulmonary ventilation is assessed by: A. Fi02 B. oxygen saturation -C. Pa C02 D. partial pressure of O2 in blood E. tidal volume Which of the following is false of malignant hyperthermia? A. Calcium is released from the muscle cell's sarcoplasmic reticulum. B. end-tidal pC02 increases C. It is precipitated by the use of inhalational anesthetics. D. Treatment is with dantrolene. -E. Use of succinylcholine can help prevent it. Meningitis occurring within 72 hours after a basilar skull fracture is most commonly secondary to: A. Haemophilus influenzae B. Neisseria meningitidis C. Staphylococcus aureus D. Staphylococcus epidermidis -E. Streptococcus pneumoniae Postoperative shunt infections are most commonly caused by: -A. coagulase-negative staphylococci B. H. influenzae C. Pseudoqonas species D. S. aureus E. S. pneumoniae The most likely cause of a fever occurring in the first 24 hours after surgery is: -A. atelectasis B. deep vein thrombosis C. pneumonia D. urinary tract infection E. wound infection Each of the following is true of nitroprusside except: A. Cyanide is produced when the ferrous ion in the nitroprusside molecule reacts with sulfhydryl-containing compounds in the red blood cells. B. The cyanide is reduced to thiocyanate in the liver. C. The half-life of thiocyanate is 3 to 4 days. -D. Thiocyanate is excreted in the gastrointestinal (GI) tract. E. With prolonged administration, accumulation of thiocyanate may cause an acute toxic psychosis. Isoproterenol: A. acts almost exclusively on Beta receptors B. decreases SBP C. increases DBP D. increases peripheral vascular resistance (PVR) -E. relaxes smooth muscle What is the drug used for treatment of malignant hyperthermia: A.Esmolol B.Propaphol C.Naloxone D. succinylcholine -E. Dantrolene What barbiturate lowers seizure threshold: A.Phenobarbital B.Allobarbital -C. Methohexital D. Alphenal E. Amobarbital Failure of a miotic pupil to dilate after instilling 2 to 10% cocaine followed by 1% hydroxyamphetamine indicates a A. first-order Horner's syndrome B. second-order Horner's syndrome -C. third-order Horner's syndrome D. first- or second-order Horner's syndrome E. second- or third-order Horner's syndrome Which of the following is least suggestive of a parietal lobe lesion? A. astereognosis B. loss of position sense -C. loss of temperature sensation D. loss of two-point discrimination E. atopognosia The purest form of achromatopsia (color blindness) is caused by a lesion involving the A. left calcarine cortex B. left superior occipitotemporal region -C. right inferior occipitotemporal region D. right occipital cortex and angular gyrus E. right superior calcarine cortex Each of the following is true of Guillain-Barre syndrome except: A. Disturbances of autonomic function are common. -B. High-dose steroids form the mainstay of therapy. C. Hypo- or areflexia is characteristic. D. The mortality rate is 3%. E. The peak severity is 10 to 14 days after onset in 80% of cases. The second-order neuron in the sympathetic pathway to the pupil arises from the: A. ciliary ganglion to the iris B. Edinger-Westphal nucleus to the ciliary ganglion C. hypothalamus to the lateral horn cells at C8 to T3 -D. lateral horn cells at C8 to T3 to the superior cervical ganglion E. superior cervical ganglion to the iris One of the cerebral biochemical defects in Huntington's disease is: A. decreased dopamine -B. decreased GABA C. decreased norepinephrine D. decreased somatostatin E. increased acetylcholine Prosopagnosia is associated with lesions of the: A. anterior corpus callosum B. bilateral anterorinferior temporal lobes -C. bilateral medial temporo-occipital lobes D. occipital poles E. posterior corpus callosum A lesion of the supplementary motor cortex produces: A. echolalia B. palilalia -C. poverty of spontaneous speech D. receptive aphasia E. no speech abnormalities Lesions of be peroneal nerve produce weakness of the: A. abductor hallucis and gastrocnemius B. extensor digitorum longus and brevis and abductor hallucis C. gastrocnemius and flexor hallucis longus -D. tibialis anterior and extensor digitorum longus and brevis E. tibialis anterior and flexor digitorum brevis Type I (red) muscle fibers differ from type I1 (white) fibers in all of the following ways except that they: -A. are more fatiguable B. fire more tonically C. have a slower contraction and relaxation rates D. have more mitochondria E. have more oxidative enzymes Monoplegia without muscular atrophy is most often secondary to a lesion in the: A. brainstem -B. cortex C. internal capsule D. peripheral nerve E. spinal cord Which of the following CSF findings is least consistent with tuberculous meningitis? A. glucose of 30 mg/dL B. lymphocytic predomination after 1 week of illness C. opening pressure of 200 mm CSF -D. protein of 35 mg% E. white blood cell count (WBC) of 200 cells/mm3 The syndrome of PICA occlusion results in all of the following except: -A. contralateral Horner's syndrome B. contralateral loss of pain and temperature over the body C. ipsilateral ataxia D. ipsilateral numbness of the limbs E. ipsilateral paralysis of the palate Neurologic complications of diabetes generally thought to be vascular in origin include: I. ophthalmoplegia II. acute mononeuropathy III. mononeuritis multiplex IV. distal sensorimotor polyneuropathy -A. I, II,III B. I, III C. II, IV D. IV E. all of the above Each of the following is true of dopamine pharmacology except the following: A. Homovanillic acid is a metabolite. B. It is derived from phenylalanine. C. It is metabolized by monoamine oxidase (MAO). D. The activation of the D2 receptor decreases the release of transmitter at synaptic terminals. -E. The rate-limiting step in its synthesis is dopa decarboxylase. Which of the following is most consistent with the Eaton-Lambert syndrome? A. abnormal presynaptic vesicles B. antibodies to the acetylcholine receptor C. decreased numbers of acetylcholine receptors -D. defect in release of acetylcholine quanta E. none of the above The von Hippel-Lindau disease has been associated with all of the following except A. a defect on chromosome 3 B. dominant inheritance -C. iris hamartomas D. pancreatic cysts E. renal cell carcinoma Gerstmann's syndrome classically involves a lesion in the: A. dominant frontal lobe -B. dominant parietal lobe C. dominant temporal lobe D. nondominant parietal lobe E. nondominant temporal lobe The long thoracic nerve innervates the: A. latissimus dorsi B. levator scapulae C. rhomboids D. serratus anterior -E. teres mitor Risk factors for carpal tunnel syndrome include: I. acromegaly II. amyloidosis III. hypothyroidism IV. pregnancy A. I, II, III B. I, III C. II, IV D. IV -E. all of the above Fasciculation potentials indicate: -A. motor nerve fiber irritability B. motor nerve fiber destruction C motor unit denervation D. muscle atrophy E. reinnervation of muscle units Which of the following ocular findings is not seen in myasthenia gravis? -A. abnormal pupillary response to accommodation B. normal pupillary response to light C. weakness of extraocular muscles D. weakness of eye closure E. weakness of eye opening What neurocutaneous syndrome is associated with sphenoid dysplasia and optic gliomas? A.MEN-I B. Rendu-Osler-Weber disease -C.NF-I D.NF-II E.Von Hippel Lindau What neurocutaneous syndrome often present with epistaxis? A.MEN-I -B. Rendu-Osler-Weber disease C.NF-I D. NF-II E.Von Hippel Lindau What disorders are associated with incremental response on repetitive nerve stimulation studies? -A. Pre-synaptic disorders of NMJ B. Post-synaptic disorders of NMJ C.Renshaw cells D. Neural intranodal pathologies E.Axonopathy What GI tract infection is associated with development of Guillian-Barre syndrome? A. E.Coli B. H.Pylori -C. Campylobacter jejuni D. Salmonella E. Shigella What are the EEG findings of infantile spams (West syndrome)? A. K waves -B. Hypsarrhythmia C. Interventing spikes D. Interventing sharp waves E. Cortical Dysrrythmia What is the most common pathogen associated with cerebral abscess? -A. Streptococcus milleri B. Streptococcus viridans C. Streptococcus Pyugenes D. Staphylococcus aureus E. Staphylococcus epidermidis What arterial occlusion results in alexia without agraphia? A. Dominant MCA B. Dominant PCoM C. Non-dominant PCoM -D. Dominant PCA E. Non-dominant PCA What arterial occlusion classically associated with Wallenberg’s syndrome? A. PCA B. SCA C. AICA -D. PICA E. Basillar Artery Which of the following is true of papilledema? A. Absence of venous pulsations is a reliable indicator of papilledema. -B. Pupillary light reflexes remain normal. C. The congested capillaries derive from the central retinal vein. D. Unilateral edema of the optic disk is never seen. E. Visual acuity usually decreases. Features of trisomy 13 (Patau's syndrome) include I. microcephaly II. hypertonia III. cleft lip and palate IV. dextrocardia A. I, II,III B. I, III C. II. IV D. IV -E. all of the above Which of the following is not a feature of Parinaud's syndrome? A. dissociated light-near response B. lid retraction C. nystagmus retractorius D. paralysis of upgaze -E. third nerve palsy Memory impairment is caused by discrete bilateral lesions of which of the following structures? I. amygdla II. hippocampal formation III. mammillary bodies IV. dorsomedial nuclei of the thalamus A. I. II, III B. I, III -C. II, IV D. IV E. all of the above Alexia without agraphia is most likely to occur with a lesion involving the: -A. left geniculocalcarine tract and corpus callosum B. left geniculocalcarine tract and Wernicke's area C. left geniculocalcarine tract, corpus callosum, and Wernicke's area D. right geniculocalcarine tract and corpus callosum E. right geniculocalcarine tract and Wernicke's area Deviation of the eyes to the right is most likely to occur with occlusion of the: A. calcarine artery bilaterally B. calcarine artery on the contralateral side -C. contralateral paramedian branch of the basilar artery D. ipsilateral superior cerebellar artery E. superior division of the contralateral middle cerebral artery Which of the following antiepileptic drugs has the shortest half-life? A. carbamazepine B. ethosuximide C. phenobarbital D. phenytoin -E. valproate Dressing apraxia is associated with a lesion in the: A. dominant frontal lobe B. dominant parietal lobe C. nondominant frontal lobe -D. nondominant parietal lobe E. nondominant temporal lobe All of the following are seen in Sturge-Weber syndrome except: -A. calcified cortical vessels B. facial nevus contralateral to seizure activity C. hemisensory deficit contralateral to facial nevus D. meningeal venous angiomas E. tramline calcifications outlining the convolution of the parieto-occipital cortex The normal sensory nerve conduction velocity in the median and ulnar nerves is approximately A. 10 meters per second (mls) B. 25 m/s -C. 50 m/s D. 100 m/s' E. 150 m/s Eye findings in botulinism include: I. ptosis II. strabismus III. diplopia IV. unreactive pupils A. I, II,III B. I, III C. II, IV D. IV -E. all of the above Repetition is least likely to be affected by a: A. Broca's aphasia B. conduction aphasia C. global aphasia -D. transcortical sensory aphasia E. Wernicke's aphasia The most common neurologic complication of acquired immunodeficiency syndrome (AIDS) is: -A. dementia B. inflammatory polymyositis C. lymphoma D. myelopathy E. toxoplasmosis Each of the following lesions is characteristic of tuberous sclerosis except: A. adenoma sebaceum -B. renal cell carcinoma C. rhabdomyomas of the heart D. subependymal giant-cell astrocytes E. subungual fibromas Each of the following is seen in neurofibromatosis type 1 except: A. axillary freckling B. cafi au lait macules -C. neurofibromas of the iris D. optic gliomas E. sphenoid dysplasia What blood vessel is commonly responsible for compression of trigeminal nerve in trigeminal neuralgia? A.PSA -B.SCA C.AICA D.PICA E.ICA What is the basal cisterns contains portions of basal vein of Rosenthal? A.Sylvian B.Quadregeminal C.Prepontine -D. Ambient and crural E.Suprasellar Which of the following is associated with von Hippel-Lindau disease? I. hepatic cysts II. hemangioblastoma of the spinal cord III. renal cysts IV. renal cell carcinoma A. I, II,III B. I, III C. II. IV D. IV -E. all of the above Which one of the following cerebral metastases has the greatest tendency to hemorrhage? A. breast -B. choriocarcinoma C. gastrointestinal (GI) tract D. ovarian E. prostate Each of the following has been associated with central pontine myelinolysis except A. alcoholism B. severe burns C. rapid correction of hyponatremia D. serum hyperosmolarity -E. vitamin A excess Which of the following is not typically seen in neurofibromatosis type 2? A. acoustic neuromas B. cafe au lait spots C. cutaneous neurofibromatosis D. Lisch nodules -E. plexiform neurofibromas Acute subarachnoid hemorrhage is more difficult to diagnose on MRI than on CT because: A. Extracellular methemoglobin is isointense on T1and T2. B. Hemosiderin is isointense on T1 and T2. C. Most radiologists are not familiar with the appearance of acute subarachnoid hemorrhage on MRI. -D. The high oxygen tension in the subarachnoid space prevents conversion of oxyhemoglobin to deoxyhemoglobin. E. The low oxygen tension in the subarachnoid space prevents conversion of deoxyhemoglobin to oxyhemoglobin. Branches of the meningohypophysial trunk include the I. tentorial artery II. inferior hypophysial artery III. dorsal meningeal artery IV. superior hypophysial artery -A. I, II, III B. I, III C. II, IV D. IV E. all of the above Lesions in diffuse axonal injury are commonly found in the: I. corpus callosum II. gray-white junction III. rostra1 brainstem IV. temporal lobe -A. I, II,III B. I. III C. II, IV D. IV E. all of the above Schizencephaly is essentially a: A. demyelinating illness B. disease that first develops in the elderly -C. disorder of neuronal migration D. neurodegenerative disorder E. psychiatric disorder