i.!

\
WIF{DS{}R UI{IVER. SITV SCidSCL GF ME SICINE
BR.IGHTONS EST'A'{'ES, ST.KTTT'S & NEVTS
SEF,TEST'ER
N
<-/
Etj RCSCiENCE - TINAL
.4.&!
trXAMINATION
C 24rH,2S09
Tinre: 9.G0 - 1 tr:S0
i
Daie:
.{t
svmmetricai ioss oipain and icnipcra'.ur'e oir iire siioulder aiea on both Sides
of the body with no ioss oitactile sensation. Pain and temperature and tactile
sensation Are normai over the rest oithe body. This condition rvoitici be due mo
stly' iikely to lesion of : anterior r,.",hiie commissure from C2 to C4 .
A nqficrrt ciispiays a
b) anierior,.'ohite cornmissure from Tl lo T5 c) Aniei"oiateral system on right
at C2 d) Lraraceniral lobule on the left
2. Fibers tirat descend lrom brainstem to spinal cord to inhibit pain transmissi
on arise in:
a) b) c)
,l Lrt
r'cd nticieus i-iucleus raphe
iragnus
e
il'onia1 lcbe \ ,,ll nf thp ,:hnr.r.
i. Loss of pain and renrperarure sensation from the ievel of the right little li
nger and the rest 'firc- bociy beicn,on rhe right srde wouid most likeiy De caus
ed by a iesion of the: a) leit Anterolateral s-vstem at C6 b) leli Antelolaterai
system at T2
of
'
ct right Attterolateral system at C6
d)
i'ight Aitierolateiai system at C8
3
4. An 62 1,crr'-oid $,'cilel presents with a right homcnymous hemianopia r.viih
macular sparing. l-he vessel rrrost iiliei;' .r'' calrse this deircit is: a) mid
cle ceiebiai I b) anterici cerebt'al c) anterior cnoioidal .i) supei'ict' cel'eb
ellar' c) posterioi cerebrai
A 65 yeai'-oiri hy'perteesi-,'e rnan is brought Io tile .mergrnci'' after a s'*d
Cen onset weakness on The lefi sicle oi'iris boCl'and botli lin'ibs. A MRI shor,
r's an inf-arct irt iite upper rnedulia. Which ofThe foilor,ving sillictllfes '*
ouicl callse this condition?
5.
x)
c d
b)
e)
) )
lateral r.esti-bulospinal ti'act corticospittai traci reticlilospinai tract i'u'
orospinai ti'act
corlicobiiibariiact
6. A 42 year-oici man v;sits his cloctor because he has had troiibie cherving an
d he could not feel the texture of tite fbod. E::amination Reveals rveakness of
masticatory muscles on the right side and a CT irtrage shor.,s a smali tllntor i
n the Pons area. Which cther symptom is this man likely to have?
a) r,i,eakness oithe i'iglit arrr, b) loss of baiance. nausea, and trystagnlus"
c)
7.
cl)
loss of pain sensaiion fiorn the right face loss of tactiie sensation from the l
igirt iace
sees her
physician because siie has had trouble walking. During Evaluation. the rl,oman s
tlit-nbles and f-ails towards the 1et1 iiequentll'. Her arm tnovements are Accur
ate aird without tremor. en MRi shows an iniarci in tiie iri'aiirsieii:r. Which
of the Foiior.l'ing sti'Llctures cor-tici be responsibie for this condition? a)
right leticulosPinal tract }.1, iefr lateral vestibuiospinal tract rl teri corti
co5pinal tract f. \-/ il right cei'ebeilar hemisphere , e) right laterai vestibr
-riospinai tract
A 60 year-olci woman
and feil several times. He visited hospital .on ph.v-sical exalrination it rvas
iound that he had sluired speech i{is muscle strength was good, but ivhen askecl
to do the f.risei;-rp:lgss-!$L,heJlfleC- hfq no.se, and developed a severe trem
or as his fi'ger appr-6acheci nis iffitrtonatior-r-s.,pination of both hands was
very slow and very irregular. FIe ,....u ,,,..,:.,..rir.. c...r, his le.-t wide
anart. This man most likely has a rvv.:J in,r ir*e,rr,!erl' end nlenlin,r \\JlN
gu^J Lur)tLqLllrJ. r'-".'"g.
A 55-year old man began to stumble frequently.
lesion olthe:
a) ni
'LtP 7ci
t).
V,i
,*...{
uppei nloior neliron cerebeiilinl lornel ;:lott;r ilcul'on hrsai garr".lir none
oi-ahoie
hich o1'1ite i'olloiving staiements aboitt the ceiebeiia;: peduncles is NOT true
? a) tire middie ierebeliar peduncle contains axons irom ihe contralateral and i
psilateral pontine nuclci propriccepiive information fiom the ior,'er body enter
s the cerebelir"rm via the sr"rpe rioipeduttcie tire denlate liilcleils seuds ax
ons to the brainsrem via the superior cerebellar peduncie c) d) pa* of tile cet'
ebl'o-pontine-cerebeilai pathr.va,v iitr''olves the middle cerebeilar peduncie
fr.
I
10.
23-,rear.-ol,C tei:-raie is invoived in an argiiment at rvlrich tiu-ie she susta
ins a stab wound to tire righr neck. Ci.r erai::ination she is noiecl ro have <i
eviaiion of hertongue to the right. This
A
finding is due to arii injr'rry to the .,."d) R.ight h1'Pcglossal nerve ,j"-' r
l Le ti ilr,.'oSltr:sll llerve nefve v c ) i{iglit Giossophali'llgeai ti) Lefi G
iosscPirarYngeal neive
c)
Vagus ilei'\'e
24)/<
11. Sensorl infbrmation fl"om the cochlea of both ears reaches all of the ibllow
ing nuclei EXCEPT:
a) superior olir,'ar1' nucleus b) dorsal cochlear nucleus
W
d) f\/, GD
c)
inlerior colliculus
r-nedial genicr-ilate nucieus both ears are represented in ail of these ni-rciei
12. Coqce{ring primai,v ntotor cortex. area 4: Lesions in arca J result in aprax
ia. it has a map of the ipsilateral body with small discrete arcas devoted to ea
ch muscle.
V c)
d) e) a)
It is important fbr motor pianning anci bimanuai cooi'dinaiiot-i. lt works entir
el,v* independentl.v olthe basal ganglia. Singie nellrons in area 4 can influenc
e motoneuron poois for several muscles. of iire cerebellar cofiex
13. The Pr,rrkinf e cells
AX " @) d)
Provides the oniy output of the cerebellar deep nuclei. Receives inhibitory inpu
t from climbing fibers. Receives excitatory input from parallel fibers. vz are e
xcited by the axons of the basket cells
14. Prirnary aliditon, col'tex is located in: the tlie parietal lobe. posterior
--"f b) the lateral sut'face cf the occipital lobe c) the superior temPoral gyru
s
to
post central gyrus
'
d) e)
the inferior temporai gyrus the iniericr iiontal gyrus
15. A tumor located in the ibr-rrth ventricle that presses on the dorsolaterai s
urface of the caudal pons
nright prgdtrce ali of the following symptoms EXCEPT: ,.{\ io:s ot'haiance
c) r'omiting d) iailing ei Bebinski sign
i 5. Which of the
b)
1l-\'stagmus
following siatements about langr-rage is TRUE?
aiea controls comprehension oi lanquage -t}.-'Broca's "-"'"" b) i1 most pegple.
language is controlied by the right cerebrai hemisphere c) people r.vith Weinick
e's aphasia demonstraie fluent spontaneous speech d) dama-9e to ti"re inibrior t
emforai iobe produces language disorders e) Corrical ai:eas involved in language
inclr-rde areas 9, 10 and 5,7.
l':
!i
J
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
18.
Which oi'rire fbiicv,,ing cor-rditions is TRUE in a normal person lvho is initia
ting a movement? a) ar0ns liotn tire cerebral cortex inhibit ceils in ihe Putame
n t ) :r..:i-',1s fror-n tl-re giob-,rs pallidus inhibit ceils in the ventral la
teral nucleus c) argr1s frop1 ti're plltanen inhibit cells in the globus pallidt
is 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
19.
Ail c,t'ihe fblior,r'ing w'culd
be lound in the Klr-rver-Br:cy syndrome ercept:
a)
H,vperoralitl'. Psycliic biindr-ress. Obesitl'. Altered endocrine responses.
d
c)
d) c)
Lr) HyposexualitY.
rrr :\.r.
lrorrc'r'r.qe e+ctinn thr.orrqh the hrainstem contains F'c1ingcr Westphal nucleu
s. What other ou!rrurt Ll arlJv!r,)v structllre )'oli cxpect to see in ihe same
section? A n
A.
--K C. Centrai canal
D.
---4,. i'rirrciPal :lticl:iis of V
l)eniatc nucicus
$.i:ci
riucicut
21. Duri'g a peurological exanination. a patient cannot teli v'tth his eyes clos
ed whether the ner-rrologist llered cr extendetl his toe. there is likel,v clama
ge io A. the iascicr-ilus cllneatus $.1 rit. fascicLrius 3r'acilis d. _iil.' 3lt
lcl(l:rici'ul Sr Sterit llttli:ll ii ol'lire dot'sal holrt '-MH ilte r eltiral r
,r'hite commissltre
sensation 22. l,oss oi-pain atld iei.uperatru'c- seltsation lroni tiie ieit side
olthe face rvith otherfaciai rer"naining i-tttt'mai cor-rlci oe cilte to a lesi
on in the .\. left irigeillirral lemnisct-ts B. right irigemii-rai lemniscus {'.
ieit t;:iyenliiral car:dalis subnucleus ,- -@ri siit tr:i ger-r.i i rlal c alid
ali s subnuc eus /// E f.t triqetltilial mesencephalic tlttcieus
1
23. The n1ost common location r,vhere blockage of CSF llorvresults iir hydroceph
alus is: A. interventricular ioratnen of lvlonro B. choroicl plexus ccl'uht'al a
qLtc.litct ''-1{ D. lirtcral lbranten ol'Luschka E. cistema maEna 24. Rupture of
the middle r.neningeal aftery was a 1ikei1'cause oithe recent death of a 14-yea
r 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''dlocephal
us B. epidural hematoma C. sr-ibdural hematoma D. subarachnoid hemorrhage 25. Da
mage to the follolliug structure could primariiy result in ihe accumulation of c
erebrospinal f-luicl in tlre sr-rbarachnoid space due to decrease in the reabsor
ption? A. Perineuronai spaces B. I-eptomeningeal vessels C. Epenciynta olthe ven
tricles -ddD. Arachnoid granulations and villi 25. Yor-rr pa.Licrii iras siifl-e
ie,j lrom a small lacunai iniarct of the thalamus. Occlusion of r.vhich of the l
bllowing vessels might cause the ini-arct? A. Medial striate anery R. Deep br:rr
tch of the PCA C. iiecr-rrrent afieill oi }ler"ibner D. Lenti cr-ri ostriaie art
el'r' ,.2 Anterior choroirial arteLv 27. A patieni I'omits r ioiently' in respon
se 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 ar
ter,v
B.'An MCA C. A posteriot' cot-nmlinicatii-rg afier-y D. An ACi\ E. A vertebrai a
rierv
choices below er-restions 2c)-j3: Match rhe fbllow'ing type of hydrocephalus to
the most appropriate at ail): not cr once, than more (each choice ma)'be used cn
ce.
29. Patient 30. Patierrt 31. Patient 32. Patient 3j. Patient
r\ ri
iras a tumor that is compressing the cerebrai aqueduct. iras a tumcr in the suba
rachnoid space.
itas enlargecl ventricles seconciary to a loss of neurons due to Aizheimer's dis
ease. has CSF absorption problen-rs atthe ievei oiil-re arachnoid granuiations.
itiis bladciel ploblerns anC u'alks as iiirisiher ieei are stuck to the floor.
A. Nonconrtrtunicaring hvdrocephalus
_-.6{ L.Om rlt
Lll
Ii
'.^^+t,^-
gatil lB 1^-.1-.-..^.^L^1.'I l) Llt ursPl r4r Lrr
C
Hydrocephalus ex vaclio D.' Normal pressure iry'drocephaius E. More than oi.ie c
hoice in A-D is corect
34. you are cieveioping a drug ro cross the blood-brain barrier. Which of the fo
llowing is the most ii.uirortant eietr.ient that maintains the integrity of the
blood-brain barrier? io lipici-soi ubie substances ,-4r{esistance - B. Tight jr-
rnctiot-ts betr.r'eeu astrocyte foot processes C. Tight jLrnctions betr,r'eetl c
apillary endotheliai cells D. Gap junctions betweetr capiliary endothelial cells
j_5. Whieh ot-the follor,ving neural structures consists
f
1
cf axons that have the capacity to regenerate
if
lt /
A. A tract B. A fascicLriLrs
'/ED. A dorsal co!umn
E. A leurniscirs 36. A neuroiggicai exan: of ycur paiient reveals a ioss olvibia
iory sense in the lower lirnb on the rigiit" weakpcss and h,vperactive reflexes
in the io.wer iin-rb on the right. and a loss of paiu and 't ten-iperature titat
begins eior,*",.the T8 ciei'maiome on the le1t. Where is the lesion? A. T6 spin
erl corci segnteitt c'n tiie i'ight B. T8 spirtai cord segmeiit on ihe r"ight C.
T10 spiuai coi'd segtneni on the right Il. T8 spinai cord seqment on the lef1 E
. l'6 spinal cord segnient on the ieft feel the 37. your pliierlr corrpiaii'rs t
hat ire burried 1-ris l-rand on i:is portabie heater but did not note that the p
atient has stiirir_rlus. Thc patient aiso notes that he has difficuity using eit
her hand. You ol intrinsic no respo'rse to pinpricli in skin oieither hand. arm.
or shouider and a biiateral wasting irand muscles. You suspect that ti-re patie
nt has: *A. Syringcnrl'e1ia B. \'lultiple :r'lercsis C. Poliomi ciitls D. B t'or
l'n - S c uarC s,'-.ild ro t-ile E. .A.mvctrc;tthic lateiai scierosis
c1
,\ dot'slii itrot
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 l
oss of re{'lexes iit tire upper limbs
talls off a ladder anci lractures a vertebra. A neuroiogical exam conducted ? we
eks aiter the accident reveals thai ihe indir,iduai has a complete hemisection o
f 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.
39. g.
A cclnstruction
vvoi"ker
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 l
esion 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 elitis t/-.B
. Amvotrorriric laieral sclcrosis C. ii/eidnig-Hoffn'tunn disease D. 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 sup
piies the midthoracic segnlents ol-the spinal col'C. Wllat might you expeci youi
patient io have? fspasti. ,reaknlss oiboth upper limbs B. Altered tolich sensat
icns in both lorver limbs C. Hyporefleria in both ioi.i'er iinbs spinal cord aR
Bilater.al clegeneration of LMNs in the ventral horns olthe liinrbal Babinski si
gns
\$Bilaterai
"'
43. yor-rr patieni l-ias suif-ereci rrauma to the spinal cord. During a period o
l spinal shock, w.hat might )'ou expect to observe in the patient? A. tlyperacti
r e reflexes beiorv the lesion B. Flaccid lreakness beicu the lesion C. A spasti
c biadder *o. D A clasp itnif-e rei1ex E.'A Babinslii sisn
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 (inie
ntion 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 separa
te joint mor,'ements (decomposition
rurlwerncrrts)
ol
E-All
detlcits are contialaterai to the lesion
45. The superior cerebellar peduncies can'y. A. Dorsal spinocerebellar f-rbers B
. Cugeocelebellar tibers t)- -/ entral spinocerebei lar ll bers r'-W D. Olivocer
c'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.Judgmerrt C. 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. W
ith 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. s
he .'r,as unable to recognize it, Fiowever. on openin-u iter eyes the patient ir
nmediately recognized the object. This woman most likely has a tumor il-t: A. oc
cipital lobe ftrperi or parietal lobe inf'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 ir, tiie spinal corcl arising frorn ali of the following EXC
EPT: *--,$escentiirrg axons t A/ red nuicleus B. cerebrai cortex tl cerebelinm
D. k
\esiibiliai'nuciei "-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)l Posi.c:riral g\
r'Lrs B. Vestihrrlospittaj u'act C. Dentaie nucleus -/ir. Priu.,rr'\ rTrctor co
fic\ Sunlricnrerttar\ ntoior coric\
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 ili
ovements (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
The supcrior cerebeliar peduncles carry. Dorsal spinocerebellar f-ibers Cuneocel
ebellar fibers entral :pi rrocerebei Iar f rbers Olivocerebeliar fibers None of
the above
46. -ihe prefroniai cortex (areas 9, 10, i
l
and 12) is esseniial for:
..x/
4fr,\bt.rru rhinkirig B..ludgment C. Foresight S. Tact (ts*qlt o t'rhc rbor e
47 . A- -57-),ear old woman w'as examined by a neurologist for a suspected brain
tumor. With the patient's e1'es closed" a spoon was placed in irer right hand a
nd she was asked to recognize the
object. After moving tiie spoon aror"rnd in her hand. she r,vas unabie to recogn
ize it. However. on opening her eyes tl:e patier-it irnrnediately recognized the
object. This woman most likely has a tiimor ir-r: A. occipital lobe -/-' t, r'
pari eial lohe --.Vwpcli ('. inf'erii'r' parietal iobc D. ittt-ei'iu;' terrtoora
i !obc ..i cortex in lrontai lobe W orbitonreciiai
a
.i8. During voh-ri-ltary rrnr p,rrpirf *'l.,,* einlre nr4{6l nei}Ioils in the SO
inal COrd nfaf, feCeiVe infUt ffOnf escencling axons in the spinal coi'd arisins
iior:.: ali of tlie fol1on'ing EXCEPT: red nucler,rs cerebrai cortex
cerebeliun"r
vesiibuial nuciei reticular fbrnaticn
49. Concr"rrrent flexion oiboth wrists in response io eiecirical stimulation is
characteristic of which at'er of ilt,' it,'r't orts sr slclll'.' F"' (rll Posicc
niral gr lLi> B. Vestil-'uiospinal tract C. Dentaie nucle';s .{F. Pritrrrir'\ ln
olor c0r'ie\ SupDi;irrentar\ i-noioi' coricx
50. Languagc anci speech recl'.rire the participation of bcih Wernicke's area at
ld Broca's area. These tn,c'' regior-ts ril-the brain ccmnrunicate with each oth
er rria a flber bundle called A. The thaianocorticai tiacr B. The reticuiar acti
vatirtg system C. The prefiontal lobe D. The lbrnix -VTltc lt'cLlate lh>cie Lrlt
ts
5i. Which srrllctlire ir-r tlie brainstern and spinai cord
systems originating in the hypothalamr'rs?
is NOT a target of descending control
A.
L\LlClCLlS aIIiulBLlLls
1
- I-: _,--_^
B.
-Q ^_\ Q!,
Dorsal motor nucieus of ti-re vagus Intelrnediolateral ceil column ^ nucleLts Oc
trlontotor
.,/
52. The dopar.lii.iergic brain-reward circuitr-v of the iinibic system and hypct
haiamus is involved in A. tenrpcrature reguiaiiot-i B. body' weight regulation C
. r'elease of oxytocin alrd vasopressin drugs, sex and gambling acidictions. etc
. -.*,D<-adtlictive behaviors including 53. Lesions of u,hich oi' the foliowing
pairs of hypothalamic areas l.;uman's) abilit,v to reguiate body weight at a set
point? Preopric area: pu.tici'ioi ai'ea t' -+. B. Lateral hypothalantr"is; medi
al hypothalamus C. Medial parvoceilr:lar nucieus; n'iagnocellular nucleus & ' D.
Strpraciriasmatic nttcleus: supraoptic nttcletts
54-57.
will affect the animal's (or
system structures on the left with their can be tlsed oniv once. ansu'ei functio
ns .iesci'ibsd iri tl're siatements below. Each
For the foliowing 4 questions. match the limbic
5-1..{mrgd*ia 1 \ 55. llammij.lq-thalamic traci
r\.-.-
56. Fornir ,. 57. Cinguiate g;vrus (-. A. Region:il blcod ilow iiicreases in thi
s 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 sit
e olthe degeneration? A. Globr-rs pallidus. internai segment B. VL nucieits of i
ire tiraiamus C. Head ol'e lritdate lliicicus t:igra. pal's coinpacta -..-FSubst
attiin E. Putameil
hl
\-iJ
'/' -{xig
59. A hy,pertensive patienr suliers a iacunar ii-rfarct anci cievelops uncontrol
labie violent flinging i-novements ol'ii-re 1eft-irpper 1imb. Where is the iesio
n? A. Left globLis paliicius itrterriai segment B. Right subti.ialamic t.tLtclet
is ('. l.eli stthstrrtttia nista rrucleLri , E. Right srrh.r:trntia nigt'a
\'I
60. Your paticnt has been ciiagnosed r,vith an eating disordei. The patient seem
s 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? lffiedi
al l'reoptic ttticleits Parar entricttiat' nitcleiis -oS Mammiliar-v body C. D.
Ventrorlcdial nucielt-s oi h1'pothaiamus E. Laterai part of the anterior zone of
hypothalamus On New year.'s Eve. an elderly male staggers into the emergency ro
om smelling of alcohol, did not remember his uns6aven. apd l-raving iro rvallet
or identification. The patient gave his name but trip to the city but a business
on address or arv other personal intbrmation. The parient said he was he could
not remember why cor-rld not recall where he was staying. When questioned 5 minu
tes later, c'r^ 1.,r,. ^:-l:-^ *i!^r i,-{oniifi-rl lliulrt arrLt ruvrtlrrrllr ^-
A " ^-'--'^.c nf lhc nrrrseq as a he WaS ln tne Clty, Claime0 ne \^r'as alt Uil-
Lruty d.llrlltt- yiivr' muscle His attepdant. ,\ ner-rrologicai eram revealed a.
gaze,-ev:rked nyslagjlus-in all directions. strength 'ur':ls 5/,5. but he 'vr;al
ked with a brofd-based gait'
61-62. Use the
iollowing
case vignette to answer qr-restions 68
&
69:'
5i.
Togethr:i'" these signs anci symptoms sr-iggest that the patient may have:
-a'
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
f
62. Wl-rat tuisilt be one siie of t:errroryJ ciegeneration in the patieni in the
previous description? A. Head oi'tiie caticiate nLtcieirs l-l B. Substarttia ni
gla, pars colrpacta C. Mammiilar,v bociies D. Ver-rtrob:rsal conPier E. Basal nl
tcleus oillervil.ert
conjugate gaze' What 63. A patient has an inabilitf io voluntarily look tc the r
ighr using hcrizontal regiou olti^re CNS might be a site of the lesion? A. Brodt
-naltrl area l7 B. Rostral irtterstitial tlitcieris on the right C. Right fl'oii
tal e,ve l-reld D. h'{edial krngitudiital fasciculr-rs Vl E. R.ight PPRF
10
I
64. Your patient develops an inability to adduct either e;-e durln-u horizontal
gaze. Convergence is intact. ar.rd ilie pupillary iiglit reflex is normal bilate
ralll'. Wheie is the lesion? A. Frontal e1"e field B. Oculorttotor llerve C. Abd
ucerts llerve I). Pretecill rttrclei P E. Medial longiturdinal iirsciculus
65. An 18-year-oid patieiti
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
sr-tifers a below knee ampuiaiiorr in a road
referred pain D.-Pai n ttitrti it lat i oti ,E psychtrl,r!Lical hailrrciilnion
C.
\-/ -
66. Substance P is reieased fiom A. nociceptive aft-erent endings B. .flrst orde
r nociceptirre terminal in the dorsal holn C. first order- nechanosensitive term
inais in the dorsal horn 4L). iermlnals of descending fibers from the raphe nucl
etts in the dorsal horn E. both A arrJ B abor c
67. Opioid peptides are released from A. r,rociceptive afl-erent endings B. ilrs
t orcler nociceptive terminai in the dorsal horn C. first oicicl ntechancsensiti
ve terminais in the dorsal horrl D. iermilals of-descending fibers iiom the raph
e 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. gl
ycine D. serotouitl
w/-
-z'
lE\cee,^
y'
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 B. lateral sp
iriothalamic tract J ( . nredirl ictttniscti: ,-D& spinal tract oI-V /' f f ,] u
.nttol lrosicro nredial tlliclelts ,v/t
\J/
11
70. A 63 lear-oid Patient is seen in a ciinic u'ith il-re foiiorving symptoms: a
testillg tremor in the Hand. a siorr shul'flinc !.ait. difficulty arising fiorn
a chair when seated. T]-rese symptoms Could be catised b1' a lesiotl in the: A.
subtlialatt-tic t"lttcieus B. cerebellar hemisPl-rei'e C. coriicospinal tract 7
D. Subsiarxia nigra"-/
u,ith a right homcnvrro'Js herlianopia r,r'ith macular sparing. Tlie vessel ntos
i likel1"io callse this deflcit is:
71,. Ar-r 62 lcar-olc1. \\,onterr presents
. ' D. superior cerebellarr
E.
posterior cerebral 72-76. Match the lbllor,vins neurotransmitter to the approOri
ate tissue associated:
rniciciie cerebrai B.--anteri..rt' cerebral -< itnteritrt' chcr"oidai ,,.t
A.
72. Aninhibitory neLlrorransmitter used by neurons for-Lnd throughout the CNS. 7
3. Used b.v pregangiionic autonomic u*otts' f) r 7-1. An ere irrtory lteurotrall
slnitter gsed bY'50%-of CNS neurons. L75. Used b1' tteurons in tire nucleus accu
mbens. l) 1A D-^A,,^,-',.1 hrr rrprrrnr,c in t1-re incrts certtlerls t1t/ y ilvl
rrvr / \r. t lvuLlllLl
u
-\ i \
A. GABA B. Glutantate C. Acetrvlcht-litle L).I)opamiire
E. Norepinepi.rrine
marr conrplains of trouble srvaliowir-ig anci hcarseuess. On physicai exam, he i
s io have ptosis and a constlicted pupil or"r the 1eit. anti a diminished gag re
flex. Neurological 'oted of his lace and on examipaiior-i shorvs ciecreased pain
and tempei:aiure sensation on the ieft side the right sicie oihis bod-v. Which
of the follow'ing vessels is most iikeiy occliided? \.,Anteriol' i n ferior cere
be l lar arterl' (AICA)
77. A63-1,ear-oid
-/E al.
D. E.
Auterrur' :nirtlri aiiet'1
Middie cerebrai aitery (NiCA) Posterior cerebrai arterl (PCA) Posteriol irrferio
r cerebellar afiery' (PICA)
a central
7g. Which oitite follou'iiig nuclei plal oathua.yf ' /-r. \ .-
iole in
auditor-v- i:eflexes and descending effereirt
(-!'.
SirPerior Oiir ai'r \ttcletts
B. Inf-erior Oiirary NLicleus bchlear Nitcietts
T2
79. During a boxing match. a contestant is "knocked out" by' a blor,v to the lat
eral 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. naus
ea, anci vomiting. Which oithe foliowing is the most likely cliagnosis? A. Basil
ar sktril fr-actLrie -/ Epidtrral iterttort'itag:e
-F ' ( D. Ir.
ltttracerebt'al ltetitorrhage Subarachnoid herlorrllage Subdural hetrlatoma
80. I1 atterlptisg to introduce a catheter into the iight internai jr-rguiar vei
n, a resicien'r inarjvefteirtiy damages the cervicai syrlpathetic trunk in a pat
ient. Which of the following findings is most likely to be seen in tl-iis patien
t 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.
1/
B. 'fiie larger the rnotoiteuron, the greater the trumber of rnuscle fibers it i
unervates. 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 t
hat innervate one tnuscle. 1.. Tle larger rroto. t'its are corrposeC olrype S in
tiscle 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 ca
udate nucieus. internal capsule. and septal nucleiIii"eri or clroroi d a! arter'
1 I ,Ac--\ B. .-\^r'ten of cerebral heuorrhage of Charcot C. Posterior chor"oida
i 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 bieei
ling that stops in a iew minuies. He is iriitially alert follorving this acciden
t. br-rt then becante i,rr-rcouscions 30 minutes iater. A hea<i CT scan reveals
a convex, lens1ikel"v to be shaped are.i t,.f hemonl-rage centered ol'erthe leit
parietal region. These events are most associateci r.rith damage to n,hich of t
l-re foliowing parts of the intracraniai vascuiature? .A. Bridging r. e irrs B.
( ltvernoiis sitlrts
C.
'-V E.
--,/,I Iiterior
!;l'cat rein ol'Cricrt cei'et',cl iri' arter\ \ iicidie ntc:lilit.'ti al-tci\
1a
needle 84. A neurologist is perfbrnling a lumbar puncture on his patient. Immedi
atel.v after the space passes tl-rrough the irlterlamiuai space between the 4th
and 5th lumbar vefiebrae. which does it enter?
EPiciural -'/--A. U. lrttratttuscttiat'
.
C. Subarachnoici D. Subcutaneolis E. Subdr"rrai
to close her right eye. Physicai 85. A 24-i,ear-old. woirarl presents to her phy
sician with an inability ..rr'^ir ^--.:--tr.t ' r ^lliii^^^l examination r-eveai
s u'eakness of the right orbicLriaris ocuii. wfiICn ol trle lulluwlllg duulLl\rl
l4r symptoms r.r,ould likei,l'aiso be present? Blurred vision ' A. 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 ( . IntetPedtrn
culrr cistern
^ I-'t -^-l^^.. ^:-'^,.LIJI'gIII LUIIIUAI
ir.
None of the above
Questions 87-88
noticed that his left 50 1,ear olci man haci a sudden onset of dizziness and vcm
iting. His family .y*ii.t drooped. Afier he was taken to see a doctor, rhe neuro
iogic exam demonstrated loss of side pain ald temperatlrre sensarion from his ri
ght side of the body and numbness on the left he still of his face. Ti1oggl-r vi
brator.v sensation and proprioception were normal bilaterally. or paralysis spas
tic of had araxic gait ivitir iaiiir-rg toward the ieii side. Thele was no indic
ation Babinslii u[*r. LIe had hoirseness to l-ris speech anci he had a diminishe
d gag reflex.
87.
OcclLision of rvl^,ich oithe iallorving arteries produces paiient's S)nlpiulnls?
a) Anteiior cerebellar arterY n*ff' Anterior sPinal arteiY c) Postericr ini-eri
or cerebellar arterl' d) Basiiar afiel')'
88.
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 \rtedia
i Pci-itit-re s,vldt'ome
-/7.-.\oi-re oi above
l4
7-
A 46-1'ear-old wonran presents to her physician n'ith "ciouble vision" and is un
abie to adduct her right e\c on attempted left lateral gaze. Convergence is inta
ct. Both direct and consensual light reflexes are rrormai. Wiricir of the follow
ing stri-rctures is most likeiv to be afiected? a) Left ocuiotlotor nerve
89.
b) Medial longitr,rdinal fascicr-rlus c) Right abclilcens nerve d) Right ociilom
otor nerve ,.,.r' e) Right Trochlear nerve
90.
Lesion in the cerebelio- pontine angle produces a ) Facial cals,v
fi '/ d)
91'
b)
Loss oi hearir-rg Vott^rarid b \one of above
You place your irancl on a hot cake Pan and rapidly jerk it away. The sensory in
formation responsible for this response was conveyed through a (an): a) Monosyna
ptic reflex. b) Poiysynaptic reflex. ,t{S oinocere be I a r pat hway. -/ ,l) \on
e oi'at',ove
I
v/.
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 hea
d and eyes in response to visual anci auclitory f-rver connections c) Directil,
irn'oiveci in and a part of the auditory pathwa-v Direciiy involved in and a par
t of the oliactory pathwa,v / ,4^) cl All of tlie ubou. The nrain efferent fiber
sy'stem exiting the amy'gdalcid nucleus is the .a)' Stria tenninaiis b) Stria m
eduilalis c) Terminal sulcus d) Fornix (the fimbria) e) Taii cf the caudate nucl
eus
.)1
93.
Match fhe fbllorving Questions:94. A lesion in opp*lt.^LrU tnalamic nucieus r,vi
li cause this TY ,{\ 95. This is trairsient abnorinal movements that occui'dr-ir
ing rheumatic fever t)
96. This is due to transient sudden alterations in electrical activities of cere
bral cortex This is dLre to decreased blood llou to ll'ontal iobe ( \. Schizophr
ettia $.-S,vdenhan.i' s chorea ['. Alzheimer's disease L). HemibalismLis l5
|)
98.
.
\\'hich one is NOT a branch of internal carotid artety? a) Ophthalmic afterY J b
) Posterior communicating artery'*
, / 99.
c) Anterior'cerebral arrerq J d) Middle cerebral artetYJ
Posterior cerebral arterY
Which parl of the lateral ventricles extends into the temporal lobe? a) Anterior
hom Posieriot'hot'it -W honr c) Inferior '/ d) Centrai Parl e) None of the abov
e
100.
Foliowing are the parts of cerebeiium EXCEPT a) Anterior lobe b) Middle lobe c)
Floculo noduiar lobe
-a
'*f c)
Cingulate lobe V ermls
I !
:_
F
I
i
t
t
16