usmle board review step 1

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Neuroscience

Board ReviewStep I # 1

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The anterior border of the parietal cortexis the:A. parieto-occipital sulcusB. the parieto-frontal sulcusC. the central sulcusD. the lateral fissureE. none of the above

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C. the central sulcus

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Which of the following mark the borderbetween the pons and midbrain on thedorsal surface of the brainstem?A. pontomedullary junctionB. exit of the oculomotor nerveC. exit of the trochlear nerveD. superior colliculus caudal edge

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C. exit of the trochlear nerve

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The rostral end of the corpus callosum iscalled the:A. GenuB. SpleniumC. BodyD. Anterior Horn

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A. Genu

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What separates the parietal and occipitallobes on the medial surface of the brain?A. preoccipital notchB. nothing but an imaginary lineC. the calcarine sulcusD. the parieto-occipital sulcus

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D. the parieto-occipital sulcus

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Which of the following neurotransmitters is themain inhibitory neurotransmitter of the CNS?A. Substance PB. DopamineC. AcetylcholineD. EnkephalinE. Gamma Amino Butyric Acid (GABA)

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E. Gamma Amino Butyric Acid (GABA)

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Which of the following is NOT acatecholamine neurotransmitters?A. tyrosineB. dopamineC. norepinephrineD. epinephrineE. all are catecholamines

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A. tyrosine

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The common enzyme in the synthesis ofall of the catecholamine neurotransmittersis called:A. choline acetyl transferaseB. catechol-O-methyl transferaseC. dopamine -B- hydroxylaseD. tyrosine hydroxylase

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D. tyrosine hydroxylase

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Alpha motor neurons contain which of thefollowing enzymes?A. tyrosine hydroxylaseB. choline acetyl transferaseC. dopamine beta hydroxylaseD. catechol -O- methyl transferase

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B. choline acetyl transferase

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Which of the following would be useful inreducing skeletal muscle tone?A. nicotineB. muscarineC. curareD. atropine

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C. curare

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The gaps in the myelin coating of axonsare called:A. collateralsB. axon hillocksC. nodes of RanvierD. axon boutons

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C. nodes of Ranvier

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The gap between neurons is called:A. ephapseB. synapseC. Node of RanvierD. Nothing. There is no gap betweenneurons.

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B. synapse

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Dorsal root ganglion cells in the adultPNS are normally of what structural type:A. Purkinje cell typeB. unipolor or pseudounipolarC. bipolarD. multipolar

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B. unipolor or pseudounipolar

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Spinal bifida results from:A. failure of closure of the anterior neuroporeB. failure of closure of the posterior neuroporeC. blockage of the ventriclesD. b and cE. all of the above

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B. failure of closure of the posteriorneuropore

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Which of the following areas is derivedfrom the rhombencephalon?A. midbrainB. ponsC. medullaD. b and cE. all of the above

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D. b and c

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The postnatal growth of the brain from about350 to 1400 grams is primarily due to:A. increased numbers of neuronsB. increased amount of cerebrospinal fluidC. mylenation of axons and development ofblood vesselsD. increased numbers of axons and dendrites

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C. mylenation of axons and developmentof blood vessels

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The sinus that directly connects to thejugular vein is the:A. inferior sagittal sinusB. the cavernous sinusC. the transverse sinusD. the sigmoid sinusE. the superior sagittal sinus

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D. the sigmoid sinus

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Blockage of the subarachnoidgranulations produces:A. non-communicating hydrocephalusB. communicating hydrocephalusC. spina bifidaD. thrombosis

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A. non-communicating hydrocephalus

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The lumbar cistern is a region of:A. the dura materB. the subarachnoid spaceC. the pia materD. the sinuses

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B. the subarachnoid space

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Uncal herniation occurs when the uncusof the temporal lobe compresses themidbrain. This occurs when the uncus ispushed:A. into the foramen magnumB. under the tentorial notchC. under the falx cerebriD. rostrally

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B. under the tentorial notch

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If a patient showed non-communicatinghydrocephalus with enlarged lateral ventricles,but normal third and fourth ventricles, then thereis most likely blockage in:A. cerebral aqueductB. medial apertureC. lateral aperturesD. foramen of Monro

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D. foramen of Monro

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Damage to the level of the spinal cord that liesbelow the L1 vertebra should result in loss ofsensory or motor function:A. on the anterior top of the thighB. on the foot onlyC. the upper and lower limbs on the ipsilateralsideD. on the foot and posterior aspect of the leg,thigh and buttocks

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D. on the foot and posterior aspect of theleg, thigh and buttocks

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The dorsolateral motor column of theventral horn is most prominent at the:A. cervical levelB. thoracic levelC. coccygeal levelD. sacral level

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A. cervical level

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A positive Romberg sign occurs whenthere is damage to:A. the superior cerebellar pedunclesB. unconscious proprioceptive pathwaysC. the cerebellar hemispheresD. the vestibular nuclei

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B. unconscious proprioceptive pathways

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Atropy and Fasciculations in theabdominal muscles just below theumbilicus indicate a lower motor neuronlesion at:A. Upper Cervical levels of the spinal cordB. L1, L2 or L3 levels of the spinal cordC. T6, T7, T8 levels of the spinal cordD. T11 or T12 levels of the spinal cord

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D. T11 or T12 levels of the spinal cord

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Which of the following arteries supply thelateral medulla with blood?A. anterior spinalB. basilarC. posterior inferior cerebellar arteryD. anterior inferior cerebellar arteryE. posterior cerebral

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C. posterior inferior cerebellar artery

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Unilateral blockage of the posteriorcerebral artery, and the resultingbrainstem damage, often produces a lossof fine touch and pain sensation on thewhich side?A. ipsilateralB. contralateralC. bilateral

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B. contralateral, due to damage to themedial lemniscus and ALF in themidbrain.

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Which of the following are NOT a branchof the internal carotid artery?A. anterior cerebral arteryB. middle cerebral arteryC. posterior cerebral arteryD. opthalamic artery

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C. posterior cerebral artery

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The anterior inferior cerebellar artery is adirect branch of:A. the vertebral arteryB. the anterior cerebral arteryC. the basilar arteryD. the internal carotid

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C. the basilar artery

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Blockage of the paramedian branches of thebasilar artery usually affects the abducensnerve. If the lesion grows laterally, what othercranial nerve is likely to be affected as well.A. facialB. hypoglossalC. vestibulocochlearD. glossopharyngeal

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A. facial

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The adult brain is about 2% or so of theadult body. What percent of the bloodpumped by the heart flows to the brain?A. 1%B. 2%C. 15%D. 30%

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C. 15%

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Blockage of what artery is likely toproduce damage to the visual cortex,oculomotor nerve and the corticospinaltract?A. superior cerebellarB. anterior cerebralC. middle cerebralD. posterior cerebral

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D. posterior cerebral.Superior alternating hemiplegia, a.k.a.Weber’s syndrome.

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What vessel supplies thisgyrus?

A. Anterior cerebral artery.

B. Middle cerebral artery.

C. Posterior cerebralartery.

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The correct answer is A.The cingulate gyrus is located on themedial surface of eachhemisphere above the corpus callosum,and is vascularized bybranches of the anterior cerebral artery.

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Which of the following is incorrect in regard tocerebrospinal fluid?A. It is normally clear and colorless.B. Increased glucose concentration is usuallymeaningless.C. Normal concentration of lymphocytes isapproximately 100/mm3.D. Normal specific gravity is approximately1.007.E. Normal pressure is approximately 160 mm.H2O cerebrospinal fluid.

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C. Normal concentration of lymphocytesis approximately 100/mm3.

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All of the following are true in regard to spinal corddevelopment except.A. The sulcus limitans delimits the alar from the basalplates.B. Alar neuroblasts are always formed before basalneuroblasts.C. The general visceral afferent and general visceralefferent cell columns lie closest to the sulcus limitans.D. Spinal dysraphism is where there is duplication of thedorsal horns.E. The gray matter of the adult represents the mantlelayer of the embryo.

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B. Alar neuroblasts are always formedbefore basal neuroblasts

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All of the following would be found in theKluver-Bucy syndrome except:A. Hyperorality.B. Hyposexuality.C. Psychic blindness.D. Obesity.E. Altered endocrine responses.

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B. Hyposexuality.

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A 70 year old male presents with a 2 day history of worseninggeneralized headache and increasing obtundation. He nowcomplains of stiffness in his neck. Vital signs include T 38.7 C,pulse 85, respirations 23, and blood pressure 130/85 mm Hg. ACBC reveals a WBC count of 16,850/microliter. Serum electrolytesreveal a sodium of 145 mmol/L, potassium 4.3 mmol/L, chloride103 mmol/L, CO2 26 mmol/L, urea nitrogen 18 mg/dL, and glucose88 mg/dL. A lumbar puncture yields cloudy cerebrospinal fluid witha glucose of 32 mg/dL, protein 146 mg/dL, and cell count of 3800WBCs (95% PMNs and 5 % mononuclears) and 122 RBCs. Thiscondition has the potential to result (sooner or later) in all of thefollowing complications EXCEPT:A HydrocephalusB Thrombosis and infarctionC AbscessD Subdural hematomaE Cerebellar tonsillar herniation

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(D) CORRECT. A subdural hematoma isa typical complication of traumatic injury,not bacterial meningitis.

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A 68 year old woman has been placed in a nursing home by herson because she can no longer be cared for at home. She iscontinually wandering away from the house and getting lost in theneighborhood. She has difficulty keeping her room in order. Shemisplaces articles of clothing and sometimes dresses herself in anodd fashion. These problems have gotten progessively worse overthe past 6 years. She took early retirement as an accountantbecause she was having trouble keeping her clients accounts inorder. There is no history of trauma. She has no history of seizures.Which set of histopathologic findings is most typical for herunderlying disease process:A Atrophy of caudate nucleus and gliosisB Wallerian degeneration and gliosisC Substantia nigra depigmentation and loss of neuronsD Grouped atrophy of muscle with anterior horn cell lossE Neurofibrillary tangles and senile neuritic plaques

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(E) CORRECT. Plaques and tangles aretypical for Alzheimer's disease, the mostcommon form of senile dementia.

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During radical prostatectomy, the anesthesiologistreports a drop in blood pressure in a 73-year-old male.The hypotension persists for 30 minutes despiteintervention with pressor agents. The most likelyconsequence of this prolonged hypotensive episode isdevelopment of:A HydranencephalyB Linear parasaggital infarctionC Lacunar infarcts of basal gangliaD Parietal lobe hemorrhagic infarctE Anterior pituitary necrosis

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(B) CORRECT. The most sensitive areasof the brain to ischemia will be the'watershed' areas between anterior andmiddle cerebral arterial circulations.

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A 28 year old male undergoes induction chemotherapy for acutemyelogenous leukemia. He becomes severely pancytopenic, with aWBC count of 1320/microliter, Hgb 7.9 g/dL, and platelet count of72,000/microliter. He becomes comatose. A CT scan of the headreveals a right parietal hemorrhage. He dies a day later. Atautopsy, he is found to have a right middle cerebral arterialthrombosis with right parietal hemorrhagic infarction. Which of thefollowing infectious agents is most likely to produce these findings:A Herpes simplex virusB Toxoplasma gondiiC Human immunodeficiency virusD CytomegalovirusE Aspergillus niger

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(E) CORRECT. Aspergillus loves toinvade blood vessels and producethrombosis. Neutropenia is a risk foraspergillosis.

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A baby is born prematurely at 29 weeks gestational age to a G2 P1woman whose previous pregnancy resulted in a normal term birth.She reported no difficulties with the current pregnancy, though shecontinued to smoke 1 pack of cigarettes per day. Following thedelivery, the baby receives surfactant therapy and does notdevelop respiratory distress from hyaline membrane disease.However, it is noted that the baby has a seizure during the next dayof life. The most likely pathologic lesion to explain this complicationis:A Intraventricular hemorrhageB Intracerebellar hemorrhageC Subdural hematomaD Subgaleal hemorrhageE Epidural hemorrhage

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(A) CORRECT. A premature child,particularly in the gestational age rangefrom 22 to 30 weeks, is at risk forgerminal matrix hemorrhage, which oftenextends into the intraventricular region.

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Following an episode of severe head trauma suffered ina motorcycle accident, an 18 year old female is noted tohave decerebrate posturing. Funduscopic examinationreveals marked bilateral papilledema. A CT scanreveals changes of marked diffuse cerebral edema.This increase in brain volume because of an increase insodium and water content is most likely to be severestin which of the following components:A Neuronal cell bodiesB MeningesC White matterD DuraE Ependyma

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(C) CORRECT. The greatest amount ofsalt and water increase with cerebraledema occurs within white matter.

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A 31 year old female has noted recent difficulty with writing. Shehas difficulty controlling her hand movements, and the writing isnearly illegible. A neurological examination reveals decreasedstrength in the right upper extremity and decreased sensation overthe left lower extremity. She has no decrease in mentation, andthere is no reported seizure activity. A lumbar puncture isperformed, and the CSF contains elevated levels of IgG, somemononuclear cells, and oligoclonal bands on gel electrophoresis.Which of the following pathologic findings in the CNS best accountsfor these findings:A Loss of pigmented neurons in the substantia nigraB Perivascular lymphocytes with demyelinated axons in whitematterC Increased neurofibrillary tangles and neuritic plaques in thecortexD Periventricular lymphoid aggregates with cells marking withCD19E Foci of multnucleated cells and macrophages in grey and whitematter

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(B) CORRECT. The findings point tomultiple sclerosis, which is marked byplaques of demyelination. Theperivascular lymphocytes suggest aninflammatory etiology, but the cause ofthis disease is unknown. MS can presentwith a host of variable neurologicproblems because the plaques ofdemyelination can occur almost anywherein the brain.

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A 23 year old primagravida has a fetalultrasound performed at 17 weeks gestation.There is no family history of inherited diseases.The pregnancy has been uncomplicated. Whichof the following congenital conditions is themost likely to be seen in this setting:A AnencephalyB EncephaloceleC Arnold-Chiari malformationD LissencephalyE Holoprosencephaly

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(A) CORRECT. This occurs in about 1birth per 1000. It is usually not associatedwith chromosomal abnormalities. It maybe associated with maternal folatedeficiency.

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A 28 year old G3 P2 woman has had an uncomplicatedpregnancy. An ultrasound is performed at 16 weeksgestation, and the findings prompt performance of anamniocentesis. The amniotic fluid is found to have anelevated alpha fetoprotein. Which of the followingfindings seen on ultrasound examination of the fetus ismost likely to have been present:A HoloprosencephalyB HydrocephalusC EncephaloceleD Hydrops fetalisE Spina bifida

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(C) CORRECT. This is a form of neuraltube defect in which the occiput is notformed and herniation of brain occurs.Alpha fetoprotein is increased in amnioticfluid or maternal serum.

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A 50-year-old African-American male had a bloodpressure of 182/108 mm Hg at the last visit to hisphysician several months ago. He refuses to take anymedications. He is admitted to the hospital aftersuddenly losing consciousness. When he is aroused, hecannot speak and he cannot move his right arm or hisright leg. He probably has:A An embolus to the middle cerebral arteryB A subfrontal meningiomaC Cerebral venous thrombosisD Alzheimer's diseaseE Hemorrhage into the putamen

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(E) CORRECT. The basal ganglia regionis the typical location for hypertensivehemorrhages.

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A 52 year old male has a history of chronic alcoholism. He isadmitted after an episode of trauma in which he fell and hit theback of his head. A head CT scan shows no intracranialhemorrhage. He continues to exhibit decreased mentation and abrain MRI scan is performed that shows anterior vermian atrophy ofthe cerebellum. Of the following physical examination findings,which would he most likely have:A Choreiform movementsB NystagmusC Truncal and lower limb ataxiaD Tremor at rest that diminishes or disappears with movementE Short-term memory loss

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(C) CORRECT. Cerebellar disease oftenmanifests with ataxia.

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A previously healthy 31-year-old female suddenlyloses consciousness and is taken to the hospitalwhere an emergent head CT scan revealsextensive subarachnoid hemorrhage at the base ofthe brain. She is afebrile. A lumbar puncture yieldscerebrospinal fluid with many red blood cells, but nowhite blood cells. The CSF protein is slightlyincreased, but the glucose is normal. Which of thefollowing conditions do you most strongly suspectthat she has:A Acute bacterial meningitisB Ruptured berry aneurysmC Progressive multifocal leukoencephalitisD Tay-Sachs diseaseE Parkinson's disease

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(B) CORRECT. About 1% of thepopulation have such an aneurysm. Theycan rupture suddenly.

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Several members of a large family are affected by theonset of decreasing mental function and motorcoordination when they reach middle age. Theirmovements are marked by choreoathetosis. Genetictesting reveals increased trinucleotide CAG repeats.Which of the following structures is most likely to appeargrossly abnormal at autopsy of the affected persons::A Caudate nucleusB MidbrainC Temporal lobeD Locus ceruleusE Dorsal root ganglion

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(A) CORRECT. Huntington disease (HD)is inherited in an autosomal dominantpattern. The gene is on chromosome 4,coding for a protein called huntingtin.Normally, there are 11 to 34 copies of theCAG repeat. There are more copies withHD; a greater number of copies correlateswith earlier onset of the disease.

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A 50 year old male has been imbibing martinis (shaken,not stirred) for several hours while at the blackjacktable. He wanders off, and several minutes later isfound down. Paramedics arrive, and discover a bruiseon his posterior occiput, but no other signs of trauma.He is transported to the hospital in stable condition, withvital signs showing blood pressure 115/80 mm Hg,temperature 36.5 C., pulse 81, and respirations 20. Onarrival, his blood ethanol is 330 mg/dL. He becomesprogressively obtunded. His right pupil is 8 mm and theleft 4 mm. A head CT scan reveals a collection of bloodin the right subdural region. Damage to which of thefollowing structures has resulted in these findings:A Middle meningeal arteryB Cavernous sinusC Middle cerebral arteryD Dural bridging veinE Great vein of Galen

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(D) CORRECT. Falls in older persons,with some degree of cerebral atrophy canresult in tearing of the bridging veins,which bare more exposed, and lead todevelopment of a subdural hematoma.Such hematomas can develop over avariable length of time.

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Enlargement of the cerebral ventricles fromobstruction to the flow of cerebrospinal fluid isLEAST likely to occur from which of thefollowing conditions:A Previous meningitis from PneumococcusB Forking of the aqueduct of SylviusC Epidural hematomaD EpendymomaE Intraventricular hemorrhage


(A) CORRECT. Postmeningitic statesmore typically lead to communicatinghydrocephalus from deficient reabsorptionof CSF.


A 48 year old woman has developed chronic renalfailure, and a renal scan shows bilaterally enlargedkidneys with multiple cysts. She has the suddenonset of a severe headache. A cerebral angiogramdemonstrates marked narrowing of cerebral arterybranches near the base of the brain, consistent withvasospasm, but no intraparenchymal hemorrhageis present. Which of the following conditions mostlikely produced these findings:A Bacterial meningitisB Severe atherosclerosisC Malignant hypertensionD Cerebral edemaE Subarachnoid hemorrhage


(E) CORRECT. The blood irritates the arteries.This effect is often delayed by several daysfollowing the initial hemorrhagic event. Berryaneurysms are located in the circle of Willis atthe base of the brain, and rupture leads toextravasation of blood into the subarachnoidspace. Her renal scan suggests a diagnosis ofdominant polycystic kidney disease (DPKD).About 10% of persons with DPKD develop berryaneurysms.


A 41 year old woman had a worsening headache for thepast week, along with a fever and increasingobtundation,. A head CT scan reveals a solitary 3 cmdiameter lesion with ring enhancement located in theright parietal lobe. A stereotactic biopsy is performedand a frozen section shows granulation tissue withadjacent collagenization, gliosis, and edema. Theprobable cause for these findings is:A Chronic brain abscessB AspergillosisC Progressive multifocal leukocencephalopathyD ToxoplasmosisE Rabies


(A) CORRECT. Granulation tissue withfibrosis is a typical reaction to a cerebralabscess. Collagen deposition around aring enhancing lesion is typical for anabscess that organizes. A commonsource for such a brain abscess is a lunginfection.


A 66-year-old male is finding that he has more difficultymoving about. He is annoyed by a tremor in his hands,but the tremor goes away when he performs routinetasks using his hands. His friends remark that he seemsmore sullen and doesn't smile at them, but only stareswith a fixed expression on his face. He has not sufferedany loss of mental ability. Which of the followingdiseases is he most likely to have:A Amyotrophic lateral sclerosis (ALS)B Alzheimer's diseaseC Parkinson's diseaseD Niemann-Pick diseaseE Tuberous sclerosis


(C) CORRECT. The tremor at rest istypical for Parkinson's disease. A 'mask-like' facies is another manifestation of thisdegenerative disease resulting from lossof pigmented neurons in the substantianigra.


A 72 year old female has a five year history ofworsening mental functioning with trouble rememberingthings. She has no problems with movement. She isnoted on an MRI scan of the brain to havesymmetrically increased size of the lateral ventriclesalong with cerebral cortical atrophy in a mainly frontaland parietal distribution. A lumbar puncture reveals anormal opening pressure, and analysis of the clear,colorless cerebrospinal fluid reveals a glucose andprotein which are in normal ranges. Cell count on theCSF shows 3 WBCs (all lymphocytes) and 1 RBC. Afunduscopic examination is normal. Which of thefollowing findings is most likely associated with herunderlying disease process:A Loss of gamma aminobutyric acidB Presence of the e4 allele of apolipoprotein EC Increased numbers of Lewy bodiesD Perivascular mononuclear inflammationE Loss of Betz cells


(B) CORRECT. She has findingscharacteristic for Alzheimer's disease.The neuritic plaques have amyloid cores,and patients may also have a congophilicangiopathy.


A 26 year old previously healthy woman has the suddenonset of mental confusion. She has a seizure and isbrought to the hospital. Her vital signs show bloodpressure 100/60 mm Hg, temperature 37 C., pulse 89,and respirations 22. A lumbar puncture reveals anormal opening pressure, and clear, colorlesscerebrospinal fluid is obtained with 1 RBC and 20WBC's (all lymphocytes), with normal glucose andprotein. An MRI scan reveals swelling of the righttemporal lobe with hemorrhagic areas. Which of thefollowing infectious agents is the most likely cause forthese findings:A Herpes simplex virusB Influenza virusC Mycobacterium tuberculosisD Hemophilus influenzaeE Neisseria meningitidis


(A) CORRECT. Hemorrhagic lesions of thetemporal lobe are typical for Herpes simplexvirus infection. Affected persons do not have tobe immunocompromised. (Note: when thispatient was brought to the ER, the examiningphysician initially passed the problem off as a'drug overdose' which was his default diagnosisfor any mental problem in a young person, butthe family refused to accept that and pressedhim for further workup).


Which is NOT a pain sensitive structure:A. ScalpB. Brain parenchymaC. Trigeminal nerveD. Cranial sinusesE. 3rd cervical nerve


The correct answer is B.The cranial structures that are insensitiveto pain include: Parenchyma of the brain,Ependyma and choroid plexus, Pia mater,arachnoid membrane and parts of thedura mater, and the skull (periosteumslightly sensitive.)


A 45 year old man complains of nocturnal severeheadaches which typically awaken him from sleepabout two hours after going to bed. He states that thepain is intense and most frequently on the right side ofthe head. His wife has noted some flushing of that sideof the face. The headaches are 20 minutes in durationand occur repeatedly for weeks at a time and thenabate.The most likely diagnosis is:A. Ophthalmopelegic migraineB. Brain TumorC. Tension headacheD. Cluster headache


The correct answer is D.These are unilateral headaches almost alwaysoccurring the same side associated withflushing, sweating, rhinorrhea, lacrimation,ptosis, and occasionally Horner's syndrome. Itoccurs most frequently in men and lasts 10minutes to 1 hour. It occurs in clusters (severalheadaches a week with long periods of time inbetween in which the patients are headachefree.


A 45 year old man complains of nocturnal severeheadaches which typically awaken him from sleepabout two hours after going to bed. He states that thepain is intense and most frequently on the right side ofthe head. His wife has noted some flushing of that sideof the face. The headaches are 20 minutes in durationand occur repeatedly for weeks at a time and thenabate.The workup and treatment should be:A. Intravenous compazineB. MRI scan as soon as possibleC. A routine CT scan and treatment with amitriptylineD. Ergotamine and/or Oxygen


The correct answer is D.Treat with sub-lingual, inhalational, orintramuscular Ergotamine, Oxygen,Lidocaine nose drops, and/orSumatriptan.


Absence Seizures (Petit Mal) arecharacterized by which of the following:A. Post ictal confusionB. Loss of postural controlC. Typical duration of 1 to 2 minutesD. All of the aboveE. None of the above


The correct answer is E.Absence seizures involve a abrupt loss &return of consciousness (brief), oftenwithout major motor component (eg. eyeblinking). It can occur hundreds per daywithout recognition. Onset usually inyoung children.


Match the epilepsy type with thetreatment:Idiopathic genralized tonic-clonic epilepsyA. ACTH and/or vigabatrinB. Valproic acidC. Phenytoin or Tegretol or Valproic acidD. Ethosuximide or Valproic acidE. Felbamate or Clonazepam


The correct answer is C.Carbamazepine will also work.


Match the epilepsy type with thetreatment:Juvenile myoclonic epilepsyA. ACTH and/or vigabatrinB. Valproic acidC. Phenytoin or Tegretol or Valproic acidD. Ethosuximide or Valproic acidE. Felbamate or Clonazepam


The correct answer is B.


Match the epilepsy type with thetreatment:Childhood absence epilepsyA. ACTH and/or vigabatrinB. Valproic acidC. Phenytoin or Tegretol or Valproic acidD. Ethosuximide or Valproic acidE. Felbamate or Clonazepam


The correct answer is D.


A patient with Wernicke's Encephalopathyis likely to have which of the followingclinical findings:

A. AtaxiaB. NystagmusC. Bilateral 6th nerve palsiesD. All of the aboveE. None of the above


The correct answer is D.Clinical findings include Oculomotor signs(Nystagmus, Bilateral 6th nerve palsies -weakness/paralysis of abduction,horizontal diplopia, internal strabismus, &abnormal response to caloric stimulation),Global confusional-apathetic state,Memory disorder (Korsakoff’s), & ETOHwithdrawal.


In Alzheimer's Disease the amount ofatrophy seen on CT or MRI scan stronglycorrelates with the degree of dementia.A. TrueB. False


B. The correct answer is False.Degree of atrophy inconsistently relatedto degree of dementia.


Which are treatable causes of dementiaA. Hypothyroidism (myxedema)B. Creutzfeldt-Jakob diseaseC. B12 deficiencyD. All of the aboveE. A & C only


The correct answer is E.Hypothyroidism treatment consists oflevothyroxine. B12 deficiency treatmentcalls for regular intramuscular B12.


In a patient with suspected multiple sclerosiswhich finding(s) in the spinal fluid would causeyou to consider alternative diagnoses:A. Protein greater than 100 mg/dlB. Oligoclonal bands are presentC. Cell count greater than 50 per cubic milliliterD. A and CE. None of the above


The correct answer is D.In MS, serum electrophoresis is normal:Total CSF protein rarely exceeds 100mg%, and while modest elevations ofCSF WBC count are common, thenumber rarely exceeds 50/cu.mm.


A 21 year old woman is brought to the emergency room because ofintense vertigo. She had been in good health until 2 days prior whenshe first experienced nausea and mild vertigo. The next day she noteddiplopia. Past medical history is significant for a bout of optic neuritison the right lasting 2 weeks when she was age 18. The optic neuritiscompletely resolved over 3 weeks. You are called to the emergencyroom to consult on the patients current condition. Your examinationdemonstrates paleness of the left optic nerve, bilateral internuclearophthalmopelegia and severe vertigo precipitated immediately by smallmovements of the head. The patient has intention tremors in bothupper extremities. Motor strength is normal in the upper extremities;however, she has mild weakness in both lower extremities. Reflexesare normal in the upper extremities and hyperactive in the lowerextremities. Babinski signs are present bilaterally. Sensoryexamination reveals a level of numbness from the T12 dermatomes ondown to the feet bilaterally.

The clinical examination demonstrates abnormalities in :A. Optic nerveB. Brainstem and CerebellumC. Thoracic spinal cordD. All of the aboveE. A & C only


The correct answer is D.This condition affects multiple areas ofwhite matter within the central nervoussystem.



Which test(s) or evaluations would you proceed with?A. MRI scans of the brain and/or spinal cordB. Neurosurgical consultationC. Spinal tap to determine if oligoclonal bands are presentD. All of the aboveE. A & C only


The correct answer is E.Radiological studies are often useful to be certain thatother causes of neurologic disease are not present aswell as to confirm the presence of lesions in the whitematter. MRI scans are more useful and may showcharacteristic white matter lesions in over 80% ofpatients. Spinal taps are helpful because CSFgammaglobulin is elevated in ~75% of patients at sometime during the disease. In addition, when agarose gel,acrylamide electrophoresis or isoelectric focusing areused, it can be observed that gammaglobulin migratesin more than one band (oligoclonal pattern) in 80-95%of patients even if their gammaglobulin is normal.



The most likely diagnosis is:A. Herpes encephalitisB. Multiple sclerosisC. Brainstem strokeD. Cerebellar hemorrhageE. Ruptured basilar artery aneurysm


The correct answer is B.MS is rare before puberty and ordinarliy starts beforeage 50. Symptoms include motor weakness,paresthesia and other sensory disorders, optic neuritis,unsteady gait and other cerebellar signs. Symptomsmay develop rapidly in the course of hours or days orless frequently may take weeks to reach their maximum.The Babinski response consists of dorsiflexion of thebig toe and fanning of other toes in response to strokingthe lateral border of the foot (S1 dermatome); flexion atthe hip and knee may also occur. Such a responseindicates an upper motor neuron lesion involving thecontralateral motor cortex or the corticospinal tract.


In narcolepsy the following are usually foundA. Polysomnography is abnormal and themultiple sleep latency test is normalB. HLA type DR2/DQW1C. The full tetrad of daytime sleepiness, sleepparalysis, hypnagogic hallucinations andcataplexyD. All of the aboveE. A&C only


The correct answer is B.HLA markers DR2/DQW1 are found muchmore frequently in narcoleptics than in thegeneral population.


Restless Legs Syndrome is associatedwithA. UremiaB. Iron deficiencyC. Insomnia in the elderlyD. All of the aboveE. A&C only


The correct answer is D.This is a neurologic cause of insomnia ordaytime sleepiness in the elderly, theuremic, and those with a positive familyhistory. It is also associated with irondeficiency, peripheral neuropathy, andperipheral vascular disease.


The normal sleep architecture featuresslow wave sleep (stages 3&4) in themiddle third of the night.A. TrueB. False


B. The correct answer is False.SWS is concentrated during the first thirdof the night. (REM is concentrated duringthe last third of the night. About half of thenight is spent in stage 2 sleep.)


In Locked In Syndrome the patient isunconscious.A. TrueB. False


B. The correct answer is False.Locked in syndrome ("coma vigile") is nota form of coma-consciousness ispreserved, but patient's motor function issufficiently impaired to prevent outwardexpression of thought and behavior. (Dueto extensive or transverse high brainstemlesions.)


Swelling of the hemispheres and basalganglia bilaterally with compression of thediencephalon and adjoining midbrain ischaracteristic of:A. Central HerniationB. UncalHerniationC. Cingulate Gyrus HerniationD. All of the aboveE. None of the above


The correct answer is A.Central herniation: Involves swelling ofhemispheres and basal ganglia bilaterally(usually), Compresses diencephalon andadjoining midbrain caudally through the tentorialnotch, and Results in diencephalic and midbrain(upper brainstem) damage secondary tocompression, ischemia and or hemorrhage(traction on penetrating vessels of midbrain andpons.)


Pinpoint pupils in the unconscious patientare consistent with which level ofinvolvement:A. DiencephalonB. TectumC. MidbrainD. PonsE. None of the above


The correct answer is D.Note: In addition to this and the above,another level which can be identified bypupil involvement is compression of thethird cranial nerve in uncal herniation.This will cause a unilateral, fixed, dilatedpupil ("blown pupil")


Decerebrate posturing is seen inunconscious patients with lesions orcompression at which level.A. Midbrain or PonsB. Diencephalon


The correct answer is A.Lower lesions (midbrain-pons) causedecerebrate posturing.


Initial evaluation of the spinal cord injuredpatient requires:A. Careful attention to the "ABCs" ofresuscitation (airway, breathing andcirculation)B. Emergency MRI scanC. EMG (electromyogram)D. HyperventilationE. All of the above


The correct answer is A.Initial evaluation involves careful attentionto “ABCs” of resuscitation and alsocareful attention to associated injuries. Inaddition, the spinal column needs to beimmobilized.


Matching the reflex with its neurologiclevel:Ankle jerkA. C5-C6B. L3-L4C. S1-S2D. C7-C8


The correct answer is C.(Tibial nerve)


Matching the reflex with its neurologiclevel:Knee jerkA. C5-C6B. L3-L4C. S1-S2D. C7-C8


The correct answer is B.(Femoral nerve)


Matching the reflex with its neurologiclevel:Biceps jerkA. C5-C6B. L3-L4C. S1-S2D. C7-C8


The correct answer is A.(Musculocutaneous nerve)


Which is/are true of Parkinson Disease:A. The disease is characterized bybradykinesia, tremor and rigidityB. There is prominent loss of neurons in thesubstantia nigraC. Lack of facial expression (Masked facies)and diminshed blink rate are common featuresD. All of the aboveE. A & C only


The correct answer is D.Onset is with tremor. Patient simultaneouslydevelops rigidity and brady kinesia which ismanifested by a stooped, fixed posture, maskedfacies, diminished blink rate, difficulty initiatingand maintaing movements, propulsion andretropulsion, and typical festinating gait.Pathology consists of degeneration ofpigmented neurons of the mesencephalon andbrain stem. Most prominent is the loss ofdopamine cell bodies in the substantia nigra.


Tourette's syndrome may be transmittedas an autosomal recessive trait withstriking uniformity of phenotypicexpression.A. TrueB. False


B. The correct answer is False.Tourette’s Syndrome may be transmittedas an autosomal dominant trait with atremendous variability in phenotypicexpression.


The genetics of Huntington's chorea ischaracterized by which of the following:A. Expansion of a trinucleotide repeatB. The gene is located on the shortarm of chromosome 4C. Autosomal dominant inheritanceD. All of the aboveE. A&C only


The correct answer is D.It is characterized by the triad ofautosomal dominant inheritance,movement disorder, & dementia. Thegene is located on the terminal band ofthe short arm of chromosome 4. Themutation results from the expansion of aCAG repeat.


Clinical manifestations of Huntington'schorea include all with the exception of:A. Emotional lability and depressionB. DementiaC. Rigidity and spasticity in the laterstages of the diseaseD. Profound sensory loss


The correct answer is D.Profound sensory loss is not a symptomof Huntington's


Management of elevated intracranial pressureincludes:A. Modest hyperventilation to pCO2 of 30 to 35B. MannitolC. Elevation of the head 20 to 30 degreesavoiding neck vein compressionD. Avoidance of antihypertensive medicationsE. All of the above


The correct answer is E.Intubate with modest hyperventilation topCO2 of 30, IV Mannitol, IV Furosemide,Elevate head 20 - 30 degrees avoidingneck vein compression, sedate with IVmorphine as needed to keep quiet orparalyze with pancuronium, avoidhypertensives.


Major complications of SubarchnoidHemorrhage Include:A. RebleedB. HydrocephalusC. VasospasmD. All of the aboveE. A & C only


The correct answer is D.Major complications include: Rebleed,Vasospasm (symptomatic ischemia orinfarct), Hydrocephalus, Cardiac(subendocardial infarction, arrhythmias),and Pulmonary (neurogenic edema)


Torn bridging veins and/or arteriolesA. Subarachnoid hemorrhageB. Epidural hemorrhageC. Acute subdural hemorrhageD. Intracerebral hematoma


The correct answer is C.Usually traumatic, from torn brainarterioles or bridging vein. Usuallyassociated with severe brain injury,hemispheric contusions or diffuse shockinjury.


Hemorrhage in the basal gangliaA. Subarachnoid hemorrhageB. Epidural hemorrhageC. Acute subdural hemorrhageD. Intracerebral hematoma


The correct answer is D.Sites of hematomas include basalganglia/internal capsule (causeshemiparesis and dysphasia), cerebellar(causes ataxia and dizziness) and pontine(causes coma and cranial nerve deficits.)


Torn middle meningeal arteryA. Subarachnoid hemorrhageB. Epidural hemorrhageC. Acute subdural hemorrhageD. Intracerebral hematoma


The correct answer is B.Traumatic, usually torn meningeal artery.Commonly associated with skull fracture.Brain is usually without significant injury.


Which is/are symptomatic of a transientischemic attack (TIA).A. SyncopeB. Transient monocular blindnessC. Vertigo by itselfD. All of the aboveE. A & C only


The correct answer is B.Numbness of hand and cheek, weaknessof hand or leg, transient monocularblindness, and less commonly languagedisturbance, are symptoms of TIA.


Cardiac sources of emboli includeA. Prosthetic heart valvesB. Mitral stenosisC. Atrial fibrillationD. Mural (heart wall) thrombus followinganterior myocardial infarctionE. All of the above


The correct answer is E.Cardiac source for embolism includes:Atrial fibrillation, Mitral stenosis, Aorticstenosis, Prosthetic heart valves,Ventricular aneurysm, Following anteriorMI, Dilated cardiomyopathy, Paradoxicalthrough atrial septal defect, congenitalheart disease, Bacterial endocarditis, andMarantic endocarditis.


Matching Stroke Manifestations withNeuroanatomic localizationPure motor strokeA. ThalamusB. Internal capsuleC. Dominant frontal lobe


The correct answer is B.Pure motor stroke implicates an insultwhere corticospinal fibers are closelygrouped, such as the internal capsule.


Matching Stroke Manifestations withNeuroanatomic localizationExpressive aphasia with right arm andfacial weaknessA. ThalamusB. Internal CapsuleC. Dominant Frontal Lobe


The correct answer is C.The presence of aphasia and thedifference in weakness between face/arm& leg localizes the injury to dominantfrontal lobe cortex & white matter.


Matching Stroke Manifestations withNeuroanatomic localizationPure sensory lossA. ThalamusB. Internal CapsuleC. Dominant Frontal Lobe


The correct answer is A.This implicates the thalamus and is alsousually lacunar.


The spinal fluid in viral meningitis istypically characterized by lymphocytesand normal glucose:

A. True B. False


A. The correct answer is True.Although there is a transientpredominance of PMNs within the firstfew hours, the CSF formula quicklychanges to a predominant lymphocytosisaccompanied by a slight rise in protein.Glucose values are usually in the normalrange.


Which is the most frequent non-epidemicnecrotizing encephalitis in the UnitedStates?A. Western EquineB. CaliforniaC. St. LouisD. Eastern EquineE. Herpes


The correct answer is E.Herpes is non-epidemic.


Which are true for Herpes encepahlitis:A. If the illness is suspected then acyclovirshould be started immediately and then an MRIand spinal fluid examination should beobtained.B. The EEG is rarely abnormalC. The PCR on spinal fluid is very infrequentlypositive for Herpes DNAD. All of the aboveE. A&C only


The correct answer is A.Acyclovir reduces the mortality of Herpesencephlitis, but there is still a significantmorbidity among survivors so it isimperative to establish the diagnosis ofthis condition at the earliest possible time.


Basilar meningitis may have severeconsequences which include:A. VasculitisB. HydrocephalusC. Cranial nerve VII palsyD. All of the aboveE. A & C only


The correct answer is D.Other severe consequences includecortical ischemia due to vasculitis w/occlusion or loss of vascular autoregulation, and increased intracranialpressure.


The most frequent causes of bacterialmeningitis in the adult are:A. Pneumococcus and meningococcusB. Hemophilus influenzae andmeningococcusC. Staph aureus and listeriamonocytogenesD. Staph aureus and E. coli


The correct answer is A.


The spinal fluid in bacterial meningitis ischaracterized by:A. Polymorphonuclear leukocytes andincreased glucoseB. Increased protein and increased glucoseC. Polymorphonuclear leukocytes anddecreased glucoseD. Decreased protein and increased glucose


The correct answer is C.In addition, protein is increased and gramstain detection of bacteria is oftenpositive.


The spinal fluid in bacterial meningitis ischaracterized by:A. Polymorphonuclear leukocytes andincreased glucoseB. Increased protein and increased glucoseC. Polymorphonuclear leukocytes anddecreased glucoseD. Decreased protein and increased glucose


The correct answer is C.

You are correct! In addition, protein isincreased and gram stain detection ofbacteria is often positive.


A 29 year old HIV positive man with previous and ongoing intravenousdrug use is initially referred to you for evaluation of pain and numbness inthe feet. Examination, at that time, revealed impaired sensation to pin,temperature and touch to the mid calf level symmetrically and absentankle reflexes. The patient did not have Babinski signs and strength isnormal in all extremities. Nerve conduction studies demonstrate milddecrease in nerve conduction velocities in the all four extremities.Two months later you see the patient in the clinic because of a newcomplaint of increasing neck pain for the past three days. Pain is nowradiating from the neck into the upper extremities and the patient iscomplaining of weakness in the legs. The patient has a fever of 101.5degrees and pain on motion of the neck in all directions. Your neurologicexamination shows depressed biceps and increased triceps reflexes.Knee jerks (patellar reflexes) are increased and the patient now hasBabinski signs bilaterally. You also find mild weakness and spasticity inboth legs.The patients second problem (neck pain with radiation to the arms) willrequire evaluationWhich test should be obtained?A. MRI of the cervical spineB. Nerve biopsyC. Repeat nerve conduction studiesD. Lumbar puncture (spinal tap) to determine CSF protein and cell counts


The correct answer is A.MRI is the diagnostic procedure of choicefor focal infections, followed by CT scan.


A 29 year old HIV positive man with previous and ongoing intravenousdrug use is initially referred to you for evaluation of pain and numbnessin the feet. Examination, at that time, revealed impaired sensation topin, temperature and touch to the mid calf level symmetrically andabsent ankle reflexes. The patient did not have Babinski signs andstrength is normal in all extremities. Nerve conduction studiesdemonstrate mild decrease in nerve conduction velocities in the all fourextremities.Two months later you see the patient in the clinic because of a newcomplaint of increasing neck pain for the past three days. Pain is nowradiating from the neck into the upper extremities and the patient iscomplaining of weakness in the legs. The patient has a fever of 101.5degrees and pain on motion of the neck in all directions. Yourneurologic examination shows depressed biceps and increased tricepsreflexes. Knee jerks (patellar reflexes) are increased and the patientnow has Babinski signs bilaterally. You also find mild weakness andspasticity in both legs.The most likely diagnosis is:A. Chronic inflammatory demyelinating polyneuropathyB. HIV myelopathyC. Spinal epidural abscessD. Ruptured cervical diskE. Spinal meningioma


The correct answer is C.Symptoms of spinal epidural abscessoccur in 4 stages: Focal pain, Radicularpain, Long tract signs, and Signs of cordtransection.


Match the feature(s) with the myopathy:Cardiac Conduction DefectA. PolymyositisB. Myotonic DystrophyC. Duchenne's DystrophyD. All of the Above


The correct answer is B.Other associated features include: Frontalbalding, Cataracts, Intellectual dullness(esp. younger onset), Abdominal pain,Intestinal dysmotility, Testicular atrophy,Endocrine & bone abnormalities andRespiratory insufficiency.


Match the feature(s) with the myopathy:Enlarged Trinucleotide RepeatA. PolymyositisB. Myotonic DystrophyC. Duchenne's DystrophyD. All of the Above


The correct answer is B.Myotonic Dystrophy is due to atrinucleotide repeat in the myotoninprotein knase (MPK) gene onchromosome 19. The trinucleotide repeatincreases in size in successive generationcausing anticipation.


Match the feature(s) with the myopathy:Autosomal dominant inheritanceA. PolymyositisB. Myotonic DystrophyC. Duchenne's DystrophyD. All of the Above


The correct answer is B.


Match the feature(s) with the myopathy:Gower's sign and X-linked RecessiveInheritanceA. PolymyositisB. Myotonic DystrophyC. Duchenne's DystrophyD. All of the Above


The correct answer is C.Gower’s sign: Patient places hand orhands on knees and effectively “crawls upthe legs” to arise from the floor. Otherfindings include: Pelvic & shoulder girdleweakness, Calf hypertrophy, Waddlinggait, Lordosis, Abnormal (or inability to)run, and Heel cord contractures.


Match the visual field with the location:Bitemporal hemianopiaA. Right Optic NerveB. Right Parietal LobeC. Right Temporal LobeD. Left Occipital LobeE. Optic Chiasm


The correct answer is E.The major lesions that produce visualimpairment at the level of the opticchiasm are tumors, especially of pituitaryorigin. The classic pattern of visual deficitis bitemporal hemianopia.


Match the visual field with the location:Left superior quadrantanopiaA. Right Optic NerveB. Right Parietal LobeC. Right Temporal LobeD. Left Occipital LobeE. Optic Chiasm


The correct answer is C.With lesions in the temporal lobe, wheretumors are the most common cause, thefield deficit is denser superiorly thaninferiorly, resulting in a superiorquandrantanopia (pie in the sky deficit).


Match the visual field with the location:Blind in Right eyeA. Right Optic NerveB. Right Parietal LobeC. Right Temporal LobeD. Left Occipital LobeE. Optic Chiasm


The correct answer is A.A complete lesion of the right optic nervecauses blindness in the right eye.


A stillbirth occurs at 28 weeks gestation to a 30 year oldG2 P1 woman whose previous pregnancy resulted in anormal term birth. At autopsy, the cerebrum of the fetusdemonstrates extensive diffuse periventricular areas ofnecrosis. Which of the following infections is most likelyto have caused these findings:A Taenia soliumB CytomegalovirusC PoliovirusD CandidaE Syphilis


(B) CORRECT. Remember TORCH forcongenital infections. The 'T' fortoxoplasmosis and the 'C' forcytomegalovirus are most likely to involvethe CNS. The extent of necrosis andcalcification with cytomegalovirus can beconsiderable.


A 73 year old male has exhibited problemsremembering things for several months, and he is notedto confabulate. He dies as a consequence of ahepatocellular carcinoma. At autopsy, his braindemonstrates bilaterally small mammillary bodies thatshow brown discoloration. Microscopically, there isgliosis and vascular proliferation and hemosiderindeposition. These findings are most typical for:A Multiple sclerosisB Parkinson's diseaseC Amyotrophic lateral sclerosisD Wernicke-Korsakoff syndromeE Huntington's disease


(D) CORRECT. Wernicke's disease canalso lead to hemorrhage and/or loss ofperiaqueductal grey matter. TheWernicke-Korsakoff syndrome is seenwith chronic alcoholism. The mechanismmay have to do with thiamine deficiency.(Micronodular cirrhosis with alcoholism isa risk for hepatocellular carcinoma.)


A 50-year-old male complained of headaches,becoming irritable and acting strangely about a monthafter being involved in a vehicular accident in which hewas not wearing any restraint and struck his headagainst the windshield of his van. He did not loseconsciousness at that time or at any point therafter. Hehad a minor contusion to his forhead. This history ismost consistent with the development of a (an):A Epidural hematomaB Chronic subdural hematomaC Cerebral contusionsD Subarachnoid hemorrhageE Intracerebral hematoma


(B) CORRECT. The continued presenceof a subdural hematoma leads to theproblems described, even if it is relativelysmall.


A young healthy male, a major league baseball player,developed progressive, symmetric muscular weaknessof his upper extremities over the course of severalyears. Then he developed difficulty speaking andswallowing. He did not have myalgias or arthralgias. Heremained afebrile. His mental function never becamediminished. He is most likely to have:A Amyotrophic lateral sclerosisB von Recklinghausen's diseaseC Multiple sclerosisD Werdnig-Hoffman diseaseE Guillain-Barre syndrome


(A) CORRECT. The course isprogressive. Bulbar involvement can leadto problems speaking and eating, with riskfor aspiration. This disease often goes bythe eponym of another baseball player,Lou Gehrig, who could not play first baseanymore.


A 20 year old previously healthy male has recently been inductedinto the army. Several weeks into basic training, he experiences asevere headache for an entire day. He had been healthy prior tothis, noting only a mild sore throat the prior day. He goes to thebase physician, who records vital signs of T 39.2 C, P 90, R 22,and BP 110/70 mm Hg. A lumbar puncture is performed andexamination of the cerebrospinal fluid shows 2 RBC's, 34,000WBC's, glucose of 20 mg/dl (serum 75 mg/dL), and protein of 105mg/dl. Which of the following additional laboratory tests would bethe most helpful in reaching a diagnosis:A Cryptococcal antigenB Acid fast stainC India inkD Serology for Herpes simplexE Gram stain


(E) CORRECT. The findings point to abacterial infection. The most likelyorganism at this age and under thesecircumstances is Neisseria meningitidis.The portal of infection may be apharyngitis.


At autopsy, the brain of a 47 year old male is normal in size, withno cortical atrophy. The cerebral arteries show no atherosclerosis.Coronal sections reveal scattered periventricular plaques ofdemyelination from 0.3 to 1 cm in size. Microscopically, theseplaques have loss of myelin as seen with the luxol fast blue (LFB)stain, but axonal preservation as seen with the Bodian silver stain.This disease process is characterized by all of the followingfindings EXCEPT:A Onset in early adulthoodB Oligoclonal bands in the CSFC Association with influenza virus infectionD Plaques of demyelination in white matterE A relapsing and remitting course


(C) CORRECT. This is the falsestatement. Multiple sclerosis (MS) is notassociated with influenza virus.


A 45 year old man has had a severe headache for a week.Physical examination reveals papilledema on the right. A head CTscan reveals a marked right to left midline shift. An MRI scandemonstrates a 6 cm enhancing mass lesion in the right parietalregion with marked surrounding edema. He develops a dilatedpupil on the right and soon thereafter loses consciousness anddies. At autopsy, which of the following lesions is most likely to befound:A Superior sagittal sinus thrombosisB Right cerebellar hemispheric hemorrhageC Pontine hemorrhagesD Thrombosis of the posterior cerebral arteryE Diffuse subarachnoid hemorrhage


(C) CORRECT. The brain swelling leadsto herniation, which damages smallperforating vessels and results in Durethemorrhages in the pons and midbrain.


A 43 year old woman develops a progressive, ascending motorweakness over several days. She is hospitalized and requiresintubation with mechanical ventilation. She is afebrile. A lumbarpuncture is performed with normal opening pressure and yieldsclear, colorless CSF with normal glucose, increased protein, andcell count of 5/microliter, all lymphocytes. She gradually recoversover the next month. Which of the following conditions most likelypreceded the onset of her illness:A KetoacidosisB Viral pneumoniaC Staphylococcus aureus septicemiaD Systemic lupus erythematosusE Vitamin B12 deficiency


(B) CORRECT. Guillain-Barré syndrome,an acute idiopathic polyneuritis, is felt tobe immunologic. About 75% of caseshave a history of a preceding infection,including viral (cytomegalovirus) andbacterial (Campylobacter jejuni) agents.


A 50 year old female has become comatose.She has papilledema on the right onfunduscopic examination. Cerebellar tonsillarherniation is suspected. Which of the followingconditions would be LEAST likely to explainthese findings in this patient:A Wernicke's diseaseB Cerebral abscessC Glioblastoma multiformeD Chronic subdural hematomaE Hypertensive intraparenchymal hemorrhage


(A) CORRECT. The lesions of Wernicke'sdisease are unlikely to increaseintracranial pressure.


The mother of a 5 year old girl realizes that her childhas spent all of Saturday in bed. The girl is listless andnot arousable, so her mother takes the child to theemergency room. The examining physician notes atemperature of 38.8 C and nuchal rigidity. A lumbarpuncture yields slightly cloudy CSF with an elevatedprotein and decreased glucose. A culture of CSF ismost likely to yield:A Hemophilus infuenzaeB Cryptococcus neoformansC Aspergillus fumigatusD Mycobacterium tuberculosisE Cytomegalovirus


(A) CORRECT. The findings point to abacterial meningitis, and H. influenzae isthe most likely organism to cause thisfinding in children.


A 45 year old female noticed tinnitus in her left ear whichprogressed over some weeks to hearing loss in that ear. Onphysical examination she is found to have a marked decrease inhearing on the left, with Rinne test indicating air conduction betterthan bone conduction. The other cranial nerves I - VII and IX - XIIare intact. A brain MRI scan revealed a solitary, fairly discreet, 3cm mass located in the region of the left cerebellopontine angle.Which of the following statements is most appropriate to tell thepatient regarding these findings:A You are unlikely to survive for more than a yearB Remissions and exacerbations are likely to occur in comingyearsC Other family members should undergo MR imaging of the brainD The lesion can be resected with a good prognosisE A test for HIV-1 is likely to be positive


(D) CORRECT. The findings arecharacteristic for schwannoma, called anacoustic neuroma when the 8th cranialnerve is involved. These are benignneoplasms. A solitary mass is unlikely tobe part of neurofibromatosis.


A 65 year old male has general paresis with increasingloss of higher mental functions. A VDRL is positive oncerebrospinal fluid obtained by lumbar puncture. TheCSF protein and glucose are normal, and there is 1mononuclear cell present. Which of the followingpathologic findings is UNLIKELY to be a feature of hisdisease:A Cortical neuronal loss with atrophyB Hemorrhagic encephalitisC Chronic meningitisD EndarteritisE Atrophy of spinal cord dorsal columns


(B) CORRECT. This is not a feature ofneurosyphilis. Hemorrhagic encephalitiswould be more typical of herpes simplexvirus infection


A 53 year old woman has had transient ischemicattacks (TIAs) for several years. She then has thesudden onset of a left hemiparesis. Four months later,an MRI scan of the brain shows findings consistent witha cystic 4 cm area in the right frontal-parietal region.Which of the following underlying conditions is she mostlikely to have:A Occlusive coronary atherosclerosisB Chronic meningitisC Alzheimer diseaseD Glioblastoma multiformeE Cerebral arterial vasculitis


(A) CORRECT. These findings suggest a'stroke' from cerebral infarction. Mostbrain infarcts result fromthromboembolism. The most commonsource for emboli is the heart. Coronaryatherosclerosis can result in myocardialinfarction with overlying endocardial muralthrombosis. Such mural thrombi canembolize to the systemic circulation.


A 50-year-old male has a history of falling multiple timesover the past few years. On his last hospital admission,he was noted to have a contusion on the scalp at hisocciput. His blood ethanol was .29 gm% (290 mg/dL).Which of the following lesions is LEAST likely to befound in this patient:A Cerebral contusionsB Basal ganglia hemorrhageC Wernicke's diseaseD Subdural hematomaE Central pontine myelinolysis


(B) CORRECT. Such hemorrhages are afeature of hypertension, not alcoholism.


A 54 year old female develops a a distal, symmetric,primarily sensory polyneuropathy over a period ofseveral months. She also has a non-healing ulcerationon the ball of her left foot. She had a myocardialinfarction last year but recovered and is doing wellfollowing angioplasty. Which of the following laboratorytest findings would you most likely expect to be present:A Decreased (20 mg/dL) glucose in CSFB Pap smear showing changes of herpes simplex virusinfectionC Markedly increased blood lead of 50 micrograms/dLD Chromosome analysis with a 47, XX, +21 karyotypeE Elevated serum glucose of 195 mg/dL


(E) CORRECT. Diabetic neuropathy isprobably the most common form ofperipheral neuropathy in the UnitedStates and Europe. She also has a'diabetic foot' from severe peripheralvascular atherosclerosis, and the MI isconsistent with severe occlusive coronaryatherosclerosis.


A 53-year-old male has a 6 month course of rapidlyprogressive dementia along with myoclonus. A cerebralelectroencephalogram shows periodic biphasicsynchronous sharp-wave complexes that aresuperimposed upon a slow background rhythm. He diesfrom bronchopneumonia. At autopsy, his brain appearsgrossly normal, but a spongiform encephalopathy isseen microscopically in a section of the cerebral cortex(which was put in concentrated formic acid for 1 hourprior to processing). He most likely has:A Alzheimer's diseaseB Creutzfeldt-Jakob diseaseC AIDS dementiaD RabiesE Herpes viral encephalitis


(B) CORRECT. The incidence of thisdisease is about 1 per 1,000,000. It iscaused by an abnormal prion protein. Theformic acid pretreatment of the specimenwill inactivate this protein.


An infant displays failure to reach developmentalmilestones. There is a prominent 2 cm lumbarmeningomyelocele. An MRI scan of the braindemonstrates downward extension of the cerebellarvermis and displacement of the medulla from a smallposterior fossa into the foramen magnum. There istenting of the tectum of the midbrain. The cerebralventricles are enlarged. The spinal cord has findings ofhydromyelia. Which of the following conditions is mostlikely to account for these findings:A Dandy-Walker malformationB Viral meningoencephalitisC Arnold-Chiari malformationD Maternal folate deficiencyE Werdnig-Hoffman disease


(C) CORRECT. The findings are those ofa Chiari type II malformation.


A 22 year old male has recently emigrated from MexicoCity. He has the sudden onset of a seizure disorderwhile working as a chef in a restaurant. The MR scan ofthe brain reveals a 2 cm rounded cyst in the righttemporal lobe cortex and another 1.5 cm cyst in thesubarachnoid space over the left parietal lobe. Bothlesions are non-enhancing. A lumbar puncture yieldscolorless CSF under normal pressure. The protein andglucose are normal. There are 5 WBCs (4 monos, 1PMN). Which of the following conditions is most likely tobe present:A Metastatic adenocarcinomaB HIV encephalopathyC Left atrial mural thrombosisD CysticercosisE Hypertension


(D) CORRECT. This infection resultswhen man becomes the accidentalintermediate host for Taenia solium (porktapeworm). The larvae may lodge inmany organs but in the brain they areprimarily found in the subarachnoid spaceand the cortex.They become encystedand the cysts within the subarachnoidspace move around and can obstructCSF flow leading to life threateninghydrocephalus.


Several weeks after the appearance of anexpanding ring-like rash on her forearm, a 29-year-old female develops a stiff neck, left facialdroop, and chest pain. These problemsprobably developed as a consequence of:A The bite of a deer tickB Mercury poisoningC Taking a cephalosporinD Sexual intercourseE Systemic lupus erythematosus


(A) CORRECT. The findings suggesterythema migrans along with neurologicsequelae and pericarditis that result fromLyme disease.


A 61 year old male has had a chronic cough for manyyears as a result of smoking 2 packs of cigarettes perday. Recently, he has noted headaches. His physicianon neurologic exam can find no localizing signs. An MRIscan reveals a solitary 3.5 cm lesion that is located atthe grey-white junction in the posterior left frontal lobe.There is no ring enhancement. A stereotactic biopsy ofthis lesion is most likely to show:A An organizing abscessB Viral inclusionsC A plaque of demyelinationD Neuronal loss with gliosisE Metastatic carcinoma


(E) CORRECT. The location of the massat the grey-white junction is typical for ametastasis. Smoking increases the riskfor development of lung and renalcarcinomas that are the most commonsources for metastases to brain in males.


A 45 year old male complained of asevere headache. He was noted onphysical examination to havepapilledema on the right. He thenbecame obtunded and died. The grosspathologic finding seen here is most likelyto have been produced as aconsequence of:A Ocular melanomaB Berry aneurysm ruptureC Glioblastoma multiformeD Multiple sclerosisE Meningococcemia


C is CORRECT.A glioblastoma multiforme is a large, fast-growing neoplasm that can produceunilateral brain swelling and papilledema.


This lesion appeared on CT scan as a discreet mass beneath the dura andwas seen to compress the underlying cerebral hemisphere. The patient is a45 year old female who presented with headaches for the past month. Thebest diagnosis is:A MeningiomaB Astrocytoma, low gradeC EpendymomaD MetastasisE Tuberculoma


A is CORRECT.A meningioma is a benign neoplasm thatis slow-growing and can compress theunderlying brain without invasion. Theparasagittal region is a common location.


This 79 year old woman was driving her car when she had the sudden onset of a severeheadache. She pulled in to a service station and stopped the car. Then she slumped overthe wheel. She was taken to the emergency room, where she remained comatose and diedhours later. The most likely explanation for the gross appearance seen here is:A Glioblastoma multiformeB Thromboembolization with cerebral infarctionC Multiple sclerosisD Ruptured berry aneurysmE Huntington's disease


D is CORRECT.Rupture of a berry aneurysm involving thecircle of Willis and its branches is asudden event that produces hemorrhageinto the subarachnoid space at the baseof the brain.


A 60 year old male has the lesion shown here at autopsy. He had suddenly lost consciousness,and when he again became alert, he was unable to move his left arm or speak. Which of thefollowing underlying disease processes is he most likely to have to explain these findings:A Hypertension with chronic renal failureB Rheumatic heart disease with left atrial mural thrombosisC Chronic alcoholism with micronodular cirrhosisD Acquired immunodeficiency syndrome with low CD4 counE Papillary thyroid carcinoma with metastases to bone


B is CORRECT.Cerebral infarction can be the result ofthromboembolic disease. Manythromboemboli originate in the left side ofthe heart. Thromboembolic cerebralinfarctions can have hemorrhage, sincethe embolus may not completely occludethe artery.


For the past year, a 34 year old woman has been treated with highdose immunosuppressive therapy, including prednisone andcytoxan, for high grade lupus nephritis. She now presents withincreasing headache and decreased mentation for about a week. Acomplete blood count reveals that her WBC count is markedlydecreased. Based upon the microscopic appearance of the lesionseen here with Gomori methenamine silver stain (next slide), themost likely explanation for these findings is:A Progressive multifocal leukoencephalopathyB Multiple sclerosisC AspergillosisD Herpes simplex encephalitisE Cryptococcosis


C is CORRECT.The branching septate hyphae invadingthe vascular wall are typical for infectionwith Aspergillus.


A 75 year old female has had progressively worsening mental function, as indicated by her son whenhe brings his mother to see you. The son states that his mother is now frequently getting lost in theneighborhood. He relates that she cannot easily feed or dress herself. She often does not seem toknow who he his. After a year-long course in a nursing home, she dies from a respiratory infection. Thebrain at autopsy weighs 1025 gm and demonstrates frontal and parietal atrophy, with ex vacuoventricular dilation. The light microscopic appearance of the frontal cortex is seen here withBielschowsky silver stain. Which of the following statements best characterizes this process:A A bloodborne pathogen led to this illnessB An amyloid angiopathy can be presentC Inheritance of this disease occurs in an autosomal dominant fashionD A response to dopaminergic pharmacologic agents is often observedE Aluminum toxicity can explain these findings


B is CORRECT.Amyloid can be present within the senileplaques of Alzheimer's disease as well asin peripheral cerebral arteries. Sometimesthe amyloid angiopathy leads tointraparenchymal or subarachnoidhemorrhage.


Cerebral cortex that histologically shows numeroussenile plaques is most consistent with which of thefollowing histories:A A 48-year-old male with choreiform movementsB A 30-year-old female with sudden loss ofconsciousnessC A 44-year-old male with progressive muscularweaknessD A 40-year-old female with Down's syndromeE A 2-year-old boy with blindness and decreasedneurologic function


(D) CORRECT.The histologic finding is typical ofAlzheimer's disease. Persons with Down'ssyndrome who live to middle age oftendevelop Alzheimer's disease.


A 69-year-old male with a history of a remotemyocardial infarction is found at autopsy tohave a 4-cm diameter area of softening in theregion of the left middle cerebral arterydistribution. This is most consistent with:A VasculitisB Arterial embolizationC Venous thrombosisD HypertensionE Mycotic aneurysm


(B) CORRECT. The appearance of theinfarction in the major blood flowdistribution and the previous history ofheart disease suggests embolic disease.


A 50-year-old female has had right-sidedheadaches for 5 years, but recently noted mildweakness in her right hand. A CT scan shows awell circumscribed lateral mass compressingthe right hemisphere at the frontal-parietaljunction. This is probably a:A MedulloblastomaB Metastatic carcinomaC SchwannomaD Glioblastoma multiformeE Meningioma


(E) CORRECT. This is a slow-growingdural mass compressing the brain.


A 65-year-old male has been healthy all his lifeuntil a sudden seizure. Neurologic exam revealsno focal abnormalities. A CT scan reveals apoorly demarcated large mass with centralnecrosis in the right frontal lobe. The most likelydiagnosis is:A Glioblastoma multiformeB MedulloblastomaC Low grade astrocytomaD MeningiomaE Choroid plexus tumor


(A) CORRECT. High grade gliomas aremost likely to occur in adults and in thecerebral hemispheres. They are oftenlarge and infiltrative.


True statements regarding intracranial berryaneurysms include all of the following EXCEPT:A They are present at birth.B Subarachnoid hemorrhage could result fromrupture.C They can be associated with dominantpolycystic kidney disease.D Rupture is probably not associated withsystemic hypertension.E Intraparenchymal hemorrhage could resultfrom rupture.


(A) CORRECT. Although the arterialmedial weakness was present, theaneurysm itself developed over time.


A 52-year-old male with chronic respiratorydifficulty dies from bronchopneumonia. Atautopsy, the anterior spinal nerve roots areatrophic, and spinal cord anterior horns showneuronal loss with gliosis. These findings aremost consistent with:A Gullain-Barre syndromeB PoliomyelitisC Rabies infectionD BotulismE Amyotrophic lateral sclerosis


(B) CORRECT. Poliovirus infection leadsto destruction of anterior horn cells. Theanterior (motor) spinal nerve roots thenatrophy.


A 78-year-old male who suffers ischemicinjury with cerebral infarction most likelyhas which of the following histopathologicfindings:A Gangrenous necrosisB Liquefactive necrosisC Coagulative necrosisD Caseous necrosisE Fat necrosis


(B) CORRECT. The brain has a high lipidcontent and typically undergoesliquefaction with ischemic injury.


During a fight at the Beacon Club in Casper,Wyoming, a patron is knocked backwards off abarstool and lands on the back of his head.Which of the following pathologic findings ismost likely to be present as a consequence ofthis injury:A Occipital lobe contusionsB Subarachnoid hemorrhageC Inferior frontal lobe contusionsD Anterior pituitary necrosisE Skull fracture with epidural hematoma


(C) CORRECT. This is the location for acontracoup injury following a fallbackwards.


The presence of a neural tube defect issuggested most strongly by which of thefollowing findings:A Decreased maternal serum alpha-fetoproteinB MicrocephalyC HydranencephalyD Spina bifidaE Polyhydramnios


(D) CORRECT. This suggests a possibleneural tube defect.


Progressive spastic paraparesis, opticnerve atrophy, sensory ataxia, andmarked paresthesias of the legs are mostcharacteristic of a 44-year-old male with:A Chronic alcoholismB Down's syndromeC Pernicious anemiaD Lead poisoningE Diabetes mellitus, type I


(C) CORRECT. The subacute combineddegeneration of the spinal cord (posteriorand lateral white columns) from B12deficiency leads to these findings.


A 54-year-old female has a lumbar puncture performed.The cerebrospinal fluid (CSF) opening pressure is 220mm H2O, the CSF protein 60 mg/dl, and the CSFglucose 75 mg/dl (serum glucose 105 mg/dl). Biopsy ofa 3-cm right parietal mass reveals gliosis and fibrosiswith necrosis, neutrophils, and lymphocytes. Thesefindings suggest:A Glioblastoma multiformeB Herpes simplex type II encephalitisC Vascular malformationD Subacute infarctionE Cerebral abscess


(E) CORRECT. The necrosis with fibrosisis typical for an abscess with anorganizing wall. Neovascularizationaround the organization leads to edema.


A 50-year-old Vietnam veteran had a history ofparesthesias, difficulty moving one or more extremities,loss of sensation, and ataxia over 22 years. Theseproblems would come and go, but he eventuallydeveloped paraplegia and incontinence. Which of thefollowing findings best explains his history:A Parasaggittal meningiomaB Scattered plaques of demyelinationC Shrapnel in spinal cordD Wernicke's diseaseE Progressive multifocal leuko- encephalopathy


(B) CORRECT. The history is mostconsistent with multiple sclerosis.


Which of the following statements concerningan epidural hematoma is most appropriate:A It is accompanied by a skull fracture.B The bleeding is of venous origin.C Onset of symptoms is delayed followingvascular rupture.D A fluctuating level of consciousness isevidenced by the patient.E It can occur as a result of rupture of a mycoticaneuysm.


(A) CORRECT. An epidural hematoma isalmost always preceded by a skullfracture that results in a tear of the middlemeningeal artery.


Following a mild upper respiratory flu-like illness, a 47year old male develops a rapidly ascending paralysis. Aweek later he is hospitalized and requires intubationwith mechanical ventilation. Lumbar puncture yieldsclear CSF under normal pressure with a slightlyelevated protein, but no red blood cells and only 3mononuclear cells. He gradually improves over the nextcouple of weeks. He most likely has:A Multiple sclerosisB Amyotrophic lateral sclerosisC Huntington's diseaseD Guillain-Barré syndromeE Werdnig-Hoffman disease


(D) CORRECT. About 3/4 of patientshave an antecedent viral infection. Thisdisease is thought to be the result of animmunologic response..


Loss of all somatic sensation on the rightside of the tongue is likely with damageto:A. the right hypoglossal nerveB. the left hypoglossal nerveC. the right facial nerveD. the right trigeminal nerve


D. the right trigeminal nerve


Loss of sensation on the little finger (yourpinkie) is likely to result from damage toprimary afferent fibers that enter thespinal cord at:A. L1B.C8C.C1D.T2


B. C8


Axons in the medial lemniscus cross themidline in:A. the ventral white commissureB. the pyramidal decussationC. the decussation of the dorsal columnsD. the internal arcuate fibers


D. the internal arcuate fibers


Fine touch and proprioception informationtravels through the ____ of the spinalcord.A. anterior funiculusB. lateral funiculusC. posterior funiculus


C. posterior funiculus


Fasciculus Gracilis contains axons thatmainly synapse in:A. the ipsilateral nucleus gracilisB. the contralateral ventral posteriorlateral nucleus of the thalamusC. the contralateral nucleus gracilisD. the contralateral dorsal horn


A. the ipsilateral nucleus gracilis


Axons which synapse in nucleus cuneatishave their cell bodies in:A. cervical or thoracic dorsal hornB. lumbar or sacral dorsal hornC. cervical or thoracic dorsal root gangliaD. lumbar or sacral dorsal root ganglia


C. cervical or thoracic dorsal root ganglia


Damage to the posterior funiculus at T10 on theleft side is likely to produceA. inability to detect a vibrating stimulus when itis placed on the right kneeB. loss of pain and temperature below thelesion on the contralateral sideC. inability to detect the stroke of an artist’sbrush on the bottom of the left footD. loss of the Babinski reflex below the lesionon the ipsilateral side


C. inability to detect the stroke of anartist’s brush on the bottom of the left foot


The medial lemniscus carries fine touchand proprioception information as far asA. the medullaB. the ponsC. the thalamusD. the somatosensory cortex


C. the thalamus


Damage to the most ventral region of themedial lemniscus in the middle medulla shouldresult in:A. loss of conscious proprioception in thecontralateral ankle jointB. loss of fine touch in the ipsilateral footC. loss of fine touch in the contralateral handD. loss of proprioception in the ipsilateral hipjoint


A. loss of conscious proprioception in thecontralateral ankle joint


In the sensory homunculus of thepostcentral gyrus, which area of the bodyis represented most laterally?A. the feetB. the noseC. the tongueD. the forehead


C. the tongue


When there is damage to the spinal cordthere is often an ipsilateral loss of painand temperature:A. at and below the level of the lesionB. below the level of the lesionC. above the level of the lesionD. at the level of the lesion


D. at the level of the lesion


The main neurotransmitter that isreleased both peripherally and centrallyby primary pain afferent fibers is:A. gamma amino butyric acidB. glutamateC. acetylcholineD. Substance P


D. Substance P


The reason the ALF is not the same asthe spinothalamic tract is:A. it starts in the spinal cord, but doesn’tterminate in the thalamusB. it is a fasiculus not a tractC. it is an Alien not a tractD. it contains the spinothalamic tract butalso several other tracts


D. it contains the spinothalamic tract butalso several other tracts


What type of fibers travel in thedorsolateral fasciculus (Lissaeur’s Tract)?A. primary pain afferentsB. primary touch afferentsC. secondary pain afferentsD. primary pain and touch afferents


A. primary pain afferents


The cell bodies of the axons in Lissaeur’sTract (the dorsolateral fasciculus) arelocated in:A. the dorsal root gangliaB. the dorsal hornC. the ventral hornD. the Gasserian ganglia


A. the dorsal root ganglia


Pain information that reaches the postcentralgyrus is carried by axons that originate inneurons located in:A. nucleus gracilis or cuneatisB. ventral posterior lateral nucleus of thethalamusC. dorsal horn of the spinal cordD. medial and intralaminar nuclei of thethalamus


B. ventral posterior lateral nucleus of thethalamus


In syringomyelia, the central canal of the spinalcord enlarges dramatically, especially atcervical levels. A likely outcome is:A. difficulty distinguishing coins in the patient’spocketB. ignoring a cut or burn of the hand, leading toinfectionC. loss of pain perception bilaterally at all levelsof the spinal cordD. paralysis of the upper and lower limbs with adecrease in tone.


B. ignoring a cut or burn of the hand,leading to infection


Patients with blockage of the middle cerebralartery often retain pain sensation because:A. the somatosensory cortex receives it’s bloodsupply from the anterior cerebral arteryB. blockage of the MCA may not damage thethalamusC. the somatosensory cortex does not processpain informationD. blockage of the MCA does not damage thecingulate cortex


D. blockage of the MCA does not damagethe cingulate cortex


What muscle is most responsible forabducting the eye?A. superior rectusB. superior obliqueC. inferior obliqueD. lateral rectus


D. lateral rectus


The spinal accessory nerve exits the skullthrough:A. the foramen magnumB. the internal auditory meatusC. foramen spinosumD. the jugular foramen


D. the jugular foramen


If a patient cannot look to the left with hisleft eye, then there may well be damageto:A. the abducens nerveB. the trochlear nerveC. the oculomotor nerve


A. the abducens nerve


The facial nerve closes the eye lid whilethe ___ nerve opens it.A. 5thB. 7thC. 4thD. 3rd


D. 3rd


The hypoglossal nerve exits thebrainstem at:A. the preolivary sulcusB. the postolivary sulcusC. the pontomedullary junctionD. the obex


A. the preolivary sulcus


When the eye is adducted, which muscleelevates the eye?A. superior rectusB. superior obliqueC. inferior obliqueD. inferior rectus


C. inferior oblique


Damage to the ventral midbrain is likely toproduce all of the following symptoms EXCEPT:A. difficulty in depressing the ipsilateral eyewhen it is aDductedB. a drooping eyelidC. a dilated pupilD. difficulty in depressing the ipsilateral eyewhen it is aBducted


A. difficulty in depressing the ipsilateraleye when it is aDducted


Visceral sensory fibers in the vagus nerveterminate mainly in:A. nucleus cuneatisB. nucleus ambiguousC. the nodose gangliaD. the solitary nucleus


D. the solitary nucleus


If your gag reflex was absent AND whenyour uvula was stimulated you had noconscious sensation of gagging, then it islikely that there is damage to at least:A. the vagus nerveB. the glossopharyngeal nerveC. the facial nerveD. the hypoglossal nerve


B. the glossopharyngeal nerve

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