neuro exam 2009

8/13/2019 Neuro Exam 2009

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8/13/2019 Neuro Exam 2009


6. A 42 year-oici man v;sits his cloctor because he has had troiibie cherving and he could not feel the

texture of tite fbod. E::amination Reveals rveakness of masticatory muscles on the right side and a CT

irtrage shor.,s a smali tllntor in the Pons area. Which cther symptom is this man likely to have?

a) r,i,eakness oithe i'iglit arrr,

b) loss of baiance. nausea, and trystagnlus"

c) loss of pain sensaiion fiorn the right face

cl) loss of tactiie sensation from the ligirt iace

7. A 60 year-olci woman sees her physician because siie has had trouble walking. During

Evaluation. the rl,oman stlit-nbles and f-ails towards the 1et1 iiequentll'. Her arm tnovements are

Accurate aird without tremor. en MRi shows an iniarci in tiie iri'aiirsieii:r. Which of the

Foiior.l'ing sti'Llctures cor-tici be responsibie for this condition?

a) right leticulosPinal tract

}.1, iefr lateral vestibuiospinal tract

f. rl teri cortico5pinal tract\-/il right cei'ebeilar hemisphere, e) right laterai vestibr-riospinai tract

g. A 55-year old man began to stumble frequently. and feil several times. He visited hospital .on

ph.v-sical exalrination it rvas iound that he had sluired speech i{is muscle strength was good, but

ivhen askecl to do the f.risei;-rp:lgss- $L,heJlfleC- hfq no.se, and developed a severe tremor as his

fi'ger appr-6acheci nis iffitrtonatior-r-s.,pination of both hands was very slow and very irregular. FIe

,....u ^J ,,,..,:.,..rir.. c...r, in,r ir*e,rr, erl' end nlenlin,r his le.-t wide anart. This man most likely has a\\JlNgu Lur)tLqLllrJ. rvv.:J r'-".'"-

lesion olthe:a) uppei nloior neliron

ni cerebeiilinl

,*...{ lornel ;:lott;r ilcul'on

'LtP hrsai garr".lir

7ci none oi-ahoie

t). V,i hich o1'1ite i'olloiving staiements aboitt the ceiebeiia;: peduncles is NOT true?

a) tire middie ierebeliar peduncle contains axons irom ihe contralateral and ipsilateral

pontine nuclci

propriccepiive information

sr"rpe rioipeduttcie

fiom the ior,'er body enters the cerebelir"rm via thefr.

c) tire denlate liilcleils seuds axons to the

I d) pa* of tile cet'ebl'o-pontine-cerebeilai

10. A 23-,rear.-ol,C tei:-raie is invoived in an argiiment at rvlrich tiu-ie she sustains a stab wound to

tire righr neck. Ci.r erai::ination she is noiecl ro have <ieviaiion of hertongue to the right. Thisfinding is due to arii injr'rry to the

.,."d) R.ight h1'Pcglossal nerve

,j"-' r l Le ti ilr,.'oSltr:sll llervev

c ) i{iglit Giossophali'llgeai nefve

ti) Lefi GiosscPirarYngeal neive

c) Vagus ilei'\'e

brainsrem via the superior cerebellar peduncie

pathr.va,v iitr''olves the middle cerebeilar peduncie

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8/13/2019 Neuro Exam 2009


17 Which of the fbiio-r"'ing are exampies of lou'ei' mclor neurons?

a) nelrrolts i:i lamina IX of the spinal cord

b) lateral vestibtrlospinal tract

c ) itypoglossal rlttcietls

A{ ril ol'iite rhtrrc

F c) {anci C

Which oi'rire fbiicv,,ing cor-rditions is TRUE in a normal person lvho is initiating a movement?

a) ar0ns liotn tire cerebral cortex inhibit ceils in ihe Putamen

t ) :r..:i-',1s fror-n tl-re giob-,rs pallidus inhibit ceils in the ventral lateral nucleus

c) argr1s frop1 ti're plltanen inhibit cells in the globus pallidtis

d) axons fiom the illltamen excite cells in ti-re giobus paliidus

& e) arons from the globus pallidus excite celis in ihe ventral laterai nucleus

Ail c,t'ihe fblior,r'ing w'culd be lound in the Klr-rver-Br:cy syndrome ercept:

a) H,vperoralitl'.

d Lr) HyposexualitY.c) Psycliic biindr-ress.

d) Obesitl'.

c) Altered endocrine responses.

rrr A lrorrc'r'r.qe e+ctinn thr.orrqh the hrainstem contains F'c1ingcr Westphal nucleus. What other:\.r. n Ll arlJv r,)v ou rrurt

structllre )'oli cxpect to see in ihe same section?

A. $.i:ci riucicut---4,.

--K i'rirrciPal :lticl:iis of V

C. Centrai canal

D. l)eniatc nucicus

21. Duri'g a peurological exanination. a patient cannot teli v'tth his eyes closed whether the

ner-rrologist llered cr extendetl his toe. there is likel,v clamage io

A. the iascicr-ilus cllneatus

$.1 rit. fascicLrius 3r'acilisd. _iil.' 3ltlcl(l:rici'ul Sr Sterit

-Mllttli:ll ii ol'lire dot'sal holrt

' H ilte r eltiral r,r'hite commissltre

22. l,oss oi-pain atld iei.uperatru'c- seltsation lroni tiie ieit side olthe face rvith otherfaciai sensation

rer"naining i-tttt'mai cor-rlci oe cilte to a lesion in the

.\. left irigeillirral lemnisct-tsB. right irigemii-rai lemniscus

{'. ieit t;:iyenliiral car:dalis subnucleus

,- -@ri siit tr:i ger-r.i i rlal c alidali s subnuc 1 eus

/// E f.t triqetltilial mesencephalic tlttcieus

18.

19.

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23. The n1ost common location r,vhere blockage of CSF llorvresults iir hydrocephalus is:

A. interventricular ioratnen of lvlonro

B. choroicl plexus

1{ ccl'uht'al aqLtc.litct''- D. lirtcral lbranten ol'Luschka

E. cistemamaEna

24. Rupture of the middle r.neningeal aftery was a 1ikei1'cause oithe recent death of a 14-year old bo"v

who sufferecl a fatai bion,to the temporal region of tire skuii. The callse of death would

result rnost iiltely iiom:A. contmunicating h1''dlocephalus

B. epidural hematoma

C. sr-ibdural hematoma

D. subarachnoid hemorrhage

25. Damage to the follolliug structure could primariiy result in ihe accumulation of cerebrospinal

f-luicl in tlre sr-rbarachnoid space due to decrease in the reabsorption?

A. Perineuronai spaces

B. I-eptomeningeal vessels

C. Epenciynta olthe ventricles

-ddD. Arachnoid granulations and villi

25. Yor-rr pa.Licrii iras siifl-eie,j lrom a small lacunai iniarct of the thalamus. Occlusion of

r.vhich of the lbllowing vessels might cause the ini-arct?

A. Medial striate anery

R. Deep br:rrtch of the PCA

C. iiecr-rrrent afieill oi }ler"ibner

D. Lenti cr-ri ostriaie artel'r'

,.2 Anterior choroirial arteLv

27. A patieni I'omits r ioiently' in response to'.oxins preseni in CSF. What area of the CNS responded

to tire toxit-ts and initiatei the reflex vomiting?

r\. Organr"rrri vascuiosun-;

B. Area postl'ema

C. Sr-rbfornical organ

-<fi. Median e irtittencc- 'i,. Pineal i:lrlnd

28. A paticnt has valvr:lai ireart disease that gives rise to an embolus. ivhich enters an internal carotid

arteiy. In vrhich branch of the anterior circulaticn is ihe emboius most 1ikely to become iodged?

A. l'he anteriol' communicating arter,v

B.'An MCAC. A posteriot' cot-nmlinicatii-rg afier-y

D. An ACi\E. A vertebrai arierv

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8/13/2019 Neuro Exam 2009


38. A tulnor pressing against the dorsal funiculus of the spinal cord at lumbar levels has caused

neurological deficits. Your patient might have:

/.tA biiateral loss of pair-r and temperature seitsations from sacral dermatomes

B. :\ltered r ibratory sense iir the lorver limbs

C. A loss ol-irrotopathic serlsations frotn thoracic dermatomes

D. Bilaterai spastic rveakt-iess in the lower iirnbs

E. A loss of re{'lexes iit tire upper limbs

39. g. A cclnstruction vvoi"ker talls off a ladder anci lractures a vertebra. A neuroiogical exam

conducted ? weeks aiter the accident reveals thai ihe indir,iduai has a complete hemisection of the

right sicle of tlie spinai cord at T5. In this patient. you might expect a pain anci temperature ioss:

A. ln the Llppel'and low'er limbs on the left

B. In all det'matomes beloiv T7 on the letl

C. Irythe T-1 dcrmatonte on the right--./^ ,

.,ZfBelow thr' T5 dermatome on the right

E. That is caused by degeneration of dorsal root ganglion celis below T7 on the left.

40. You would expeci a spastic weakness in this patient to be:A. lpsilateral to and below the level of the lesion

B. Ipsilateral to and above the level olthe lesion

C. Observecl before the onset olspinal shock

D. Contralatcrai to ard below the level of the lesion

E. Bilaterai to anci at iire ievei oiiiie iesioir

41 . A ner.r,bcrn inlant has difficuity sucking, swallowing, or breaihing and has flaccid w'eakness in the

limbs. What kind of motor disorder might the patieni have?

/-. Polionrr elitist

B. Amvotrorriric laieral sclcrosis

C. ii/eidnig-Hoffn'tunn diseaseD. Guillai rt-Ban'd sYniirot.ne

E. llvasthertie grai is

42. The anter.ior spinai efier,v- iras been occluded at the point r,vhere it suppiies the midthoracic

segnlents ol-the spinal col'C. Wllat might you expeci youi patient io have?

fspasti. ,reaknlss oiboth upper limbs

B. Altered tolich sensaticns in both lorver limbs

C. Hyporefleria in both ioi.i'er iinbs

aR Bilater.al clegeneration of LMNs in the ventral horns olthe liinrbal spinal cord

\$Bilaterai Babinski signs

"'43. yor-rr patieni l-ias suif-ereci rrauma to the spinal cord. During a period ol spinal shock, w.hat might

)'ou expect to observe in the patient?

A. tlyperactir e reflexes beiorv the lesion

B. Flaccid lreakness beicu the lesion

C. A spastic biadder *o.

D A clasp itnif-e rei1ex

E.'A Babinslii sisn

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44. The foilowir"rs staiemeni is not true in regard to cerebellar iesions.

A. A positive Romberg sign is present

B. Tren-iol is present dr:ring lnovements (iniention tremcr)

C. The patient is unabie ro perform rapid alterr-rating morrements (adiadochokinesis)

D. Movenrents are not f-lnid but are broken r-rp inio separate joint mor,'ements (decomposition olrurlwerncrrts)

E-All detlcits are contialaterai to the lesion

45. The superior cerebellar peduncies can'y.

A. Dorsal spinocerebellar f-rbers

B. Cugeocelebellar tiberst)- -/

-W entral spinocerebei lar ll bersr'

D. Olivocerc'beliar' fibers

E. None of the above

46. The preiror-rtai cortex (areas 9, 10, i 1 and 12) is essential for':

4fixatiuct thinking

B.JudgmerrtC. Foresight

-D. Tact

p/^l ol'1hc rbor e

47 . A 57-year old woman was examined by a neurologist for a suspected brain tumor. With the

patient's eyes closed. a spoon rvas placed in her right hand and she was asked to recognize the

object. After nloviit_s the spoon around in her irand. she .'r,as unable to recognize it, Fiowever. on

openin-u iter eyes the patient irnmediately recognized the object. This woman most likely has a

tumor il-t:

A. occipital lobe

ftrperi or parietal lobeinf'erior parietal iobe

inr-erior temporal lobe

orbitonredial cortex in lrontal lobe

48. During voluniarl iirorenreirt. alpha motor nellfoirs in ihe spinai cord ma,v receive input from

*--,$escentiirrg axons ir, tiie spinal corcl arising frorn ali of the following EXCEPT:t A/ red nuicleus

B. cerebrai cortex

tl cerebelinm

D. \esiibiliai'nuciei "--

k reticrrirr ibrntarioir

49. Concurreni fiexion oiboih ll'rists in response to eiectrical stimulaiion is characteristic of which

a5p.gf tlte itct'r oits Sr:ieill'l-(r)lPosi.c:riral g\ r'Lrs

B. Vestihrrlospittaj u'act

C. Dentaie nucleus

-/ Priu.,rr'\ rTrctor cofic\ir. Sunlricnrerttar\ ntoior coric\

8/13/2019 Neuro Exam 2009


44. The folloi,ving siateixent is not true in regarci to cerebellar iesions.A. A positive Rcmberg si,sn is present

i]. Trerrior rs present dLrling rno\ ements (inienlion ircnlcl')C. The patieni is i-urabie to perforn rapid alternating iliovements (adiadochokinesis)D. Moventents are not tlLiid btit are broken up inio sepaiate joint molemc-nrS (decornposirion of

nyrvements)

., E: All dellcits are contlalateral ic the lesion

aJ.

LJ Cuneocelebellar fibers

The supcrior cerebeliar

Dorsal spinocerebellar

cerebeliun"r

vesiibuial nuciei

reticular fbrnaticn

peduncles carry.

f-ibers

f rbersntral :pi rrocerebei Iar

Olivocerebeliar fibers

None of the above

46. -ihe prefroniai cortex (areas 9, 10, i l and 12) is esseniial for:

4fr,\bt.rru rhinkirig

B..ludgmentC. Foresight

S. Tact(ts*qlt o t'rhc rbor e..x/

47 . A- -57-),ear old woman w'as examined bypatient's e1'es closed" a spoon was placed

object. After moving tiie spoon aror"rnd in

opening her eyes tl:e patier-it irnrnediately

tiimor ir-r:

A. occipital lobe

-/-'-.Vwpclit, r' pari eial lohe- ('. inf'erii'r' parietal iobc

D. ittt-ei'iu;' terrtoorai obca ..iW orbitonreciiai cortex in lrontai lobe

.i8. During voh-ri-ltary

escencling axons

red nucler,rs

cerebrai cortex

a neurologist for a suspected brain tumor. With the

in irer right hand and she was asked to recognize theher hand. she r,vas unabie to recognize it. However. onrecognized the object. This woman most likely has a

rrnr p,rrpirf einlre nr4{6l nei}Ioils in the SOinal COrd nfaf, feCeiVe infUt ffOnf'l.,,*

in the spinal coi'd arisins iior:.: ali of tlie fol1on'ing EXCEPT:

49. Concr"rrrent flexion oiboth wrists inat'er of ilt,' it,'r't orts sr slclll'.'F"'

(rll Posiccniral gr lLi>

B. Vestil-'uiospinal tract

C. Dentaie nucle';s

.{ Pritrrrir'\ lnolor c0r'ie\F. SupDi;irrentar\ i-noioi' coricx

response io eiecirical stimulation is characteristic of which

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50. Languagc anci speech recl'.rire the participation of bcih Wernicke's area atld Broca's area. These

tn,c'' regior-ts ril-the brain ccmnrunicate with each other rria a flber bundle called

A. The thaianocorticai tiacr

B. The reticuiar activatirtg system

C. The prefiontal lobe

D. The lbrnix-VTltc lt'cLlate lh>cie Lrltts

5i. Which srrllctlire ir-r tlie brainstern and spinai cord is NOT a target of descending control

systems originating in the hypothalamr'rs?1 - I-: _,--_^

A. L\LlClCLlS aIIiulBLlLls

B. Dorsal motor nucieus of ti-re vagus .,/-Q Intelrnediolateral ceil column

^_\ ^Q , Octrlontotor nucleLts

52. The dopar.lii.iergic brain-reward circuitr-v of the iinibic system and hypcthaiamus is involved in

A. tenrpcrature reguiaiiot-i

B. body' weight regulationC. r'elease of oxytocin alrd vasopressin

-.*,D<-adtlictive behaviors including drugs, sex and gambling acidictions. etc.

53. Lesions of u,hich oi' the foliowing pairs of hypothalamic areas will affect the animal's (or

l.;uman's) abilit,v to reguiate body weight at a set point?

-+. Preopric area: pu.tici'ioi ai'eat' B. Lateral hypothalantr"is; medial hypothalamus

C. Medial parvoceilr:lar nucieus; n'iagnocellular nucleus &

' D. Strpraciriasmatic nttcleus: supraoptic nttcletts

54-57. For the foliowing4 questions. match the limbic system structures on the left with their

functions .iesci'ibsd iri tl're siatements below. Each ansu'ei can be tlsed oniv once.

r\.-.-5-1..{mrgd*ia 1 \ \--55. llammij.lq-thalamic traci iJ56. Fornir hl ,.57. Cinguiate g;vrus (-.A. Region:il blcod ilow iiicreases in this subject r;hen feallul stirniiius is sirown.

B. The arops lrom the hippocamplls to the manmillaly bodies travei in this structure.

C. The neocortical strucrure r.i,ith major inpui io the hippocampus.

D. Origin ol ma.jol ascincling pathwa,v to tl-re hippocampus and a major descendir-rg pathwal'

io tite bt'lrinstem and spinai cord

58. A 55-,vear-old male patieni develops dancelike inr:oluntary lnovements. You diagnose the patient

as l-raving a clegene'rative neuiological disease that rvas also evident in the patient's father and uncle.

Where is tire utost iikel,v site olthe degeneration?

A. Globr-rs pallidus. internai segment

B. VL nucieits of iire tiraiamus

C. Head ol'e lritdate lliicicus

-..-FSubstattiint:igra. pal's coinpacta

E. Putameil

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59. A hy,pertensive patienr suliers a iacunar ii-rfarct anci cievelops uncontrollabie violent flinging

i-novements ol'ii-re 1eft-irpper 1imb. Where is the iesion?

A. Left globLis paliicius itrterriai segment

B. Right subti.ialamic t.tLtcletis

('. l.eli stthstrrtttia nista

-{xig, \'I rrucleLri

'/' E. Right srrh.r:trntia nigt'a

60. Your paticnt has been ciiagnosed r,vith an eating disordei. The patient seems to have iost a

significant aprount of n,eight in the last year. A lesion in v"'hich of the tbliowing areas might have

cai-tsed the prtient's Pi'ob1em?

lffiedial l'reoptic ttticleits

-oS Parar entricttiat' nitcleiis

C. Mammiliar-v body

D. Ventrorlcdial nucielt-s oi h1'pothaiamus

E. Laterai part of the anterior zone of hypothalamus

61-62. Use the iollowing case vignette to answer qr-restions 68 & 69:'

On New year.'s Eve. an elderly male staggers into the emergency room smelling of alcohol,

uns6aven. apd l-raving iro rvallet or identification. The patient gave his name but did not remember his

address or arv other personal intbrmation. The parient said he was on a business trip to the city but

cor-rld not recall where he was staying. When questioned 5 minutes later, he could not remember whyc'r^ 1.,r,. ^:-l:-^ *i ^r ^-A i,-{oniifi-rl

^.c nf lhc nrrrseq as a lliulrthe WaS ln tne Clty, Claime0 ne \^r'as alt Uil-Lruty d.llrlltt- yiivr' arrLt ruvrtlrrrllr " ^-'--'-

attepdant. ,\ ner-rrologicai eram revealed a.gaze,-ev:rked nyslagjlus-in all directions. His muscle

strength 'ur':ls 5/,5. but he 'vr;alked with a brofd-based gait'

5i. Togethr:i'" these signs anci symptoms sr-iggest that the patient may have:

A. Alzheinrer's disease

B. Sr-rbacutc combinecl degeneration

C. I luntirr3itili's ciisca:.'

rD. .orsal',rl'i''s s1 itdi'omc

-E-. \.r',tosr triiilis-a'

62. Wl-rat tuisilt be one siie of t:errroryJ

f A. Head oi'tiie caticiate nLtcieirs l-lB. Substarttia nigla, pars colrpacta

ciegeneration in the patieni in the previous description?

righr using hcrizontal conjugate gaze' What

C. Mammiilar,v bociies

D. Ver-rtrob:rsal conPierE. Basal nltcleus oillervil.ert

63. A patient has an inabilitf io voluntarily look tc the

regiou olti^re CNS might be a site of the lesion?

A. Brodt-naltrl area l7B. Rostral irtterstitial tlitcieris on the right

C. Right fl'oiital e,ve l-reld

I D. h'{edial krngitudiital fasciculr-rs VlE. R.ight PPRF

10

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64. Your patient develops an inability

intact. ar.rd ilie pupillary iiglit reflex is

A. Frontal e1"e field

B. Oculorttotor llerve

C. Abducerts llerve

I). Pretecill rttrcleiP E. Medial longiturdinal iirsciculus

to adduct either e;-e durln-u horizontal gaze. Convergence is

normal bilateralll'. Wheie is the lesion?

65. An 18-year-oid patieiti sr-tifers a below knee ampuiaiiorr in a road traffic accident. He experiences

phantom lintb pain fbilor,r'ing tire surger,v. "Phantom limb" is an example of :

A. sensitizatior-i of cutatreoi-ts pain endrr-rgs ciue to injury

B. sensor)'projection

C. referred pain

D.-Pai n ttitrti it lat i oti

,E psychtrl,r Lical hailrrciilnion

66. Substance P is reieased fiomA. nociceptive aft-erent endings

B. .flrst order nociceptirre terminal in the dorsal holn

C. first order- nechanosensitive terminais in the dorsal horn4-

\-/ L). iermlnals of descending fibers from the raphe nucletts in the dorsal horn -z'- E. both A arrJ B abor c

67. Opioid peptides are released from

A. r,rociceptive afl-erent endings

B. ilrst orcler nociceptive terminai in the dorsal horn

C. first oicicl ntechancsensitive terminais in the dorsal horrl

D. iermilalsof-descending fibers iiom the raphe nucleus in the dorsai horn

E. both C anci D abcve

68. The most commoi'r inhiL"ritoi)'transmitter in the spinalcord is:

A. acetylcitoline

B. glutanl:.ttc

C. glycine

D. serotouitl

lE\cee,^ w/-

69. The abiiir.v to identif,v the value of unseen coins in,voiir pocket as,vor-i handle them depends

on an intact:A. anteriol spinothaiamic lract

y' B. lateral spiriothalamic tract J( . nredirl ictttniscti:

,-D& spinal tract oI-V /'f f ,] u.nttol lrosicro nredial tlliclelts ,v/t\J/

11

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70. A 63 lear-oid Patient is

Hand. a siorr shul'flinc .ait.

Could be catised b1' a lesiotl

A. subtlialatt-tic t"lttcieus

B. cerebellar hemisPl-rei'e

C. coriicospinal tract 7

D. Subsiarxia nigra"-/

seen in a ciinic u'ith il-re foiiorving symptoms: a testillg tremor in the

difficulty arising fiorn a chair when seated. T]-rese symptoms

in the:

71,. Ar-r 62 lcar-olc1. \\,onterr presents u,ith a right homcnvrro'Js herlianopia r,r'ith macular sparing.

Tlie vessel ntosi likel1"io callse this deflcit is:

A. rniciciie cerebrai

B.--anteri..rt' cerebral-<

,,.t . itnteritrt' chcr"oidai' D. superior cerebellarr

E. posterior cerebral

72-76. Match the lbllor,vins neurotransmitter to the approOriate tissue associated:

-\72. Aninhibitory neLlrorransmitter used by neurons for-Lnd throughout the CNS. i \73. Used b.v pregangiionic autonomic u*otts' f) r7-1. An ere irrtory lteurotrallslnitter gsed bY'50%-of CNS neurons. L-75. Used b1' tteurons in tire nucleus accumbens. l)1A D-^A,,^,-',.1 hrr rrprrrnr,c in t1-re incrts certtlerls t1-/ \r. t lvuLlllLl t/ y ilvlrrvr

u

A. GABAB. Glutantate

C. Acetrvlcht-litle

L).I)opamiire

E. Norepinepi.rrine

77. A63-1,ear-oid marr conrplains of trouble srvaliowir-ig anci hcarseuess. On physicai exam, he is

'otedio have ptosis and a constlicted pupil or"r the 1eit. anti a diminished gag reflex. Neurological

examipaiior-i shorvs ciecreased pain and tempei:aiure sensation on the ieft side of his lace and on

the right sicie oihis bod-v. Which of the follow'ing vessels is most iikeiy occliided?

\.,Anteriol' i n ferior cerebe l lar arterl' (AICA)

E Auterrur' :nirtlri aiiet'1-/

al. Middie cerebrai aitery (NiCA)

D. Posterior cerebrai arterl (PCA)

E. Posteriol irrferior cerebellar afiery' (PICA)

7g. Which oitite follou'iiig nuclei plal a central iole in auditor-v- i:eflexes and descending effereirt

oathua.yf' /-r. \ .-

(- '. SirPerior Oiir ai'r \ttcletts

B. Inf-erior Oiirary NLicleus

T2

bchlear Nitcietts

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79. During a boxing match. a contestant is "knocked out" by' a blor,v to the lateral skull. He recovers

after a f-eiv minutes. and is asymptomatic for the next lew hours. He then develops a severe

l-readachc. ciranges in mentai status. nausea, anci vomiting. Which oithe foliowing is the most

likely cliagnosis?

A. Basilar sktril fr-actLrie-/

-FEpidtrral iterttort'itag:e

' ( ltttracerebt'al ltetitorrhage

D. Subarachnoid herlorrllage

Ir. Subdural hetrlatoma

80. I1 atterlptisg to introduce a catheter into the iight internai jr-rguiar vein, a resicien'r inarjvefteirtiy

damages the cervicai syrlpathetic trunk in a patient. Which of the following findings is most

likely to be seen in tl-iis patient as a result of the injriry?

A.-Coristriciion of the right pupil

,E ortation of tlte right PuPil

' C. lrrability to abdLrct the right eye

.D. Inability'to close ihe right eye

E. Paralysis of tlre platysma uuscle ott the right side

81. What is TRU{ about motor units?

A. Otre r-notor unit rrsualiy contair.rs different types of mitscle fibers.

B. 'fiielarger the rnotoiteuron, the greater the trumber of rnuscle fibers it iunervates.

L.-i1 any rnriscle. tite iargest rrrtltor iiiiiis are tiie firsito be called r,lp ot- recrLtited.

/ t, inotor Llnit inclLrdes all of the lnotoneurons that innervate one tnuscle.

1 1.. Tle larger rroto. t'its are corrposeC olrype S intiscle fihers.

g2. The nante of the sniail artery r,vhich branches ofTthe anterior cerebrai or anterior communicating

artery r.r,hich distributes to part of the head of the caudate nucieus. internal capsule. and septal nuclei-. /

,Ac--\ Iii"eri or clroroi d a arter'1I B. .-\^r'ten of cerebral heuorrhage of Charcot

C. Posterior chor"oidai afiery

D. Recurrent artetl'of Huebnet'

E. -l'halamoperfblating artery

g3. A 25-1,e1r-o1d mair fails rvhile skateboarding and strikes the ieft side of his head against a

corlcrete ietaining v,.all. Cn pin'sical exai-nination oniv a ninor scalp abrasion is present at the site of

the impact. riith rrinimai bieeiling that stops in a iew minuies. He is iriitially alert follorving this

accident. br-rt then becante i,rr-rcouscions 30 minutes iater. A hea<i CT scan reveals a convex, lens-

shaped are.i t,.f hemonl-rage centered ol'erthe leit parietal region. These events are most 1ikel"v to be

associateci r.rith damage to n,hich of tl-re foliowing parts of the intracraniai vascuiature?

.A. Bridging r. e irrs

B. ( ltvernoiis sitlrts

C. ;l'cat rein ol'Cricrt--,/,

-V I Iiterior cei'et',cl iri' arter\' E. \ iicidie ntc:lilit.'ti al-tci\

1a

8/13/2019 Neuro Exam 2009


84. A neurologist is perfbrnling a lumbar puncture on

passes tl-rrough the irlterlamiuai space between

does it enter?

--A. EPiciural

-'/ U. lrttratttuscttiat'

C. Subarachnoici

. D. Subcutaneolis

E. Subdr"rrai

his patient. Immediatel.v after the needle

the 4th and 5th lumbar vefiebrae. which space

inability to close her right eye. Physicaitr.t ' r ..r- r'^ir ^--.:--- ^lliii^^^lwfiICn ol trle lulluwlllg duulLl\rll4r

85. A 24-i,ear-old. woirarl presents to her physician with an

examination r-eveais u'eakness of the right orbicLriaris ocuii.

symptoms r.r,ould likei,l'aiso be present?

A. Blurred vision' B. Hy peiaclt-is

C. InabilitY to cheu'

D. Inability to i'eei the face

E. lnabilitl' to shlug the shoulder

86. The tbr-ar.1en oimegar]clie empties into which of the following cisterns

A. Superior cisiern

B. Cisterna magna or cerebellomeduliary cistern

( . IntetPedtrnculrr cistern

^t -^-l^^.. ^:-'^,.-I-'- LUIIIUAI LIJI'gIII

ir. None of the above

Questions 87-88

87.

88.

50 1,ear olci man haci a sudden onset of dizziness and vcmiting. His family noticed that his left

.y*ii.t drooped. Afier he was taken to see a doctor, rhe neuroiogic exam demonstrated loss ofpain ald temperatlrre sensarion from his right side of the body and numbness on the left side

of his face. Ti1oggl-r vibrator.v sensation and proprioception were normal bilaterally. he still

had araxic gait ivitir iaiiir-rg toward the ieii side. Thele was no indication of spastic paralysis or

Babinslii u[*r. LIe had hoirseness to l-ris speech anci he had a diminished gag reflex.

OcclLision of rvl^,ich oithe iallorving arteries produces paiient's S)nlpiulnls?

a) Anteiior cerebellar arterY

n*ff' Anterior sPinal arteiY

c) Postericr ini-erior cerebellar arterl'

d) Basiiar afiel')'

Patient's symptol]ls are seen in which oithe lailowing s-vndron"ies?

r; ir4edial tttediiiiarr sr ttdrottte

l't ) Lateral tticrlttliat'1 sr trdrottte

c i \rtediai Pci-itit-re s,vldt'ome

-/7.-.\oi-re oi above

l4

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89. A 46-1'ear-old wonran presents to her physician n'ith "ciouble vision" and is unabie to adduct

her right e\c on attempted left lateral gaze. Convergence is intact. Both direct and consensual lightreflexes are rrormai. Wiricir of the following stri-rctures is most likeiv to be afiected?

a) Left ocuiotlotor nerve

b) Medial longitr,rdinal fascicr-rlus

c) Right abclilcens nerve

d) Right ociilomotor nerve ,.,.r'e) Right Trochlear nerve

Lesion in the cerebelio- pontine angle produces

a ) Facial cals,v

b) Loss oi hearir-rg

fi Vott^rarid b/' d) \one of above

You place your irancl on a hot cake Pan and rapidly jerk it away. The sensory informationresponsible for this response was conveyed through a (an):

a) Monosynaptic reflex.b) Poiysynaptic reflex.

,t{S oinocere be I I a r pat hway.

-/ ,l) \one oi'at',ove

The sLrperior coiliculi are considered to be

ir) Directly involved in and apart of the visual pathway

ir) Reflex centers which influence the position of the head and eyes in response to visual

anci auclitory f-rver connections

c) Directil, irn'oiveci in and a part of the auditory pathwa-v

,4^) Direciiy involved in and a part of the oliactory pathwa,v/ cl All of tlie ubou.

The nrain efferent fiber sy'stem exiting the amy'gdalcid nucleus is the

.a)' Stria tenninaiis

b) Stria meduilalisc) Terminal sulcus

d) Fornix (the fimbria)e) Taii cf the caudate nucleus

90.

91'

v/.

93.

alterations in electrical activities of cerebral

llou to ll'ontal iobe (cortex

|)

Match fhe fbllorving Questions:- .)1

94. A lesion in opp*lt.^LrU tnalamic nucieus r,vili cause this TY ,{\95. This is trairsient abnorinal movements that occui'dr-iring rheumatic fever t)96. This is due to transient sudden

This is dLre to decreased blood

\. Schizophrettia

$.-S,vdenhan.i' s chorea

['. Alzheimer's disease

L). HemibalismLis

l5

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98. . \\'hich one is NOT a branch of internal carotid artety?

a) Ophthalmic afterY Jb) Posterior communicating artery'*

c) Anterior'cerebral arrerq J, d) Middle cerebral artetYJ

/Posterior cerebral arterY

99. Which parl of the lateral ventricles extends into the temporal lobe?

a) Anterior hom

-W Posieriot'hot'it

'/ c) Inferior honr

d) Centrai Parle) None of the above

100. Foliowing are the parts of cerebeiium EXCEPT

a) Anterior lobe

b) Middle lobe

c) Floculo noduiar lobe

'*f Cingulate lobe-a

c ) V ermls

16

neuro exam 2009

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