TERM 2

WEEK 13
 DISCLAIMER:
•  What we say is from our past experiences
•  What we point out in these slides is from our past
experiences
•  DO NOT ONLY STUDY WHAT WE POINT OUT
•  But do pay a little more attention to it
 PRACTICE QUESTIONS

•  Go to this website:
•  https://pollev.com/grapefruitvo584
•  A 47-year-old man presents to his neurologist with an unsteady, broad-
based gait and slow, slurred speech. Neurologic examination reveals
dysdiadochokinesia, intention tremor, hypotonia, and nystagmus. The
patient’s lesion is in a brain structure that derives from which of the
following embryonic structures?
•  (A) Diencephalon
•  (B) Mesencephalon
•  (C) Metencephalon
•  (D) Myelencephalon
•  (E) Telencephalon
•  A 47-year-old man presents to his neurologist with an unsteady, broad-
based gait and slow, slurred speech. Neurologic examination reveals
dysdiadochokinesia, intention tremor, hypotonia, and nystagmus. The
patient’s lesion is in a brain structure that derives from which of the
following embryonic structures?
•  (A) Diencephalon (everything with thalamus, pituitary, and neural retina)
•  (B) Mesencephalon (midbrain)
•  (C) Metencephalon (cerebellum and pons)
•  (D) Myelencephalon (medulla oblongata)
•  (E) Telencephalon (left and right cerebral hemisphere)
•  MRI reveals that a 62-year-old man has a brain tumor growing in his
interhemispheric fissure at the level of the central sulcus. The tumor
produces neurologic dysfunction of the cerebral cortex on either side of
the tumor. A neurologic examination of this patient would most likely
reveal
•  (A) ataxia
•  (B) hemiplegia
•  (C) paraplegia
•  (D) quadriplegia
•  (E) rigidity
•  MRI reveals that a 62-year-old man has a brain tumor growing in his
interhemispheric fissure at the level of the central sulcus. The tumor
produces neurologic dysfunction of the cerebral cortex on either side of
the tumor. A neurologic examination of this patient would most likely
reveal
•  (A) ataxia (cerebellum)
•  (B) hemiplegia (one side)
•  (C) paraplegia
•  (D) quadriplegia (extremely big on both sides, which is unlikely)
•  (E) rigidity
•  A 45 year-old man has some minor motor weakness on his right side. His
right hand has a resting tremor and his right arm does not swing during
walking. His left hand and arm do not show these abnormalities. His right
arm, but not his left arm, shows cogwheel rigidity. On the basis of these
findings alone, it is likely that this man is suffering from:

•  A. a stroke affecting the right subthalamic nucleus

•  B. Parkinson’s disease in the earliest stage
•  C. Huntington’s chorea
•  D. spasmodic torticollis
•  E. a tumor in the flocculonodular lobe
•  A 45 year-old man has some minor motor weakness on his right side.
His right hand has a resting tremor and his right arm does not swing
during walking. His left hand and arm do not show these abnormalities.
His right arm, but not his left arm, shows cogwheel rigidity. On the basis
of these findings alone, it is likely that this man is suffering from:
•  A. a stroke affecting the right subthalamic nucleus
•  B. Parkinson’s disease in the earliest stage
•  C. Huntington’s chorea
•  D. spasmodic torticollis
•  E. a tumor in the flocculonodular lobe
•  A 50-year-old man presents to the emergency department after a motor
vehicle collision. He denies loss of consciousness and is complaining of severe
back pain. On initial survey, he has bilateral breath sounds and 97% oxygen
saturation on room air. His blood pressure is 146/87 mm Hg, and he has equal
pulses throughout. Neurologic examination reveals right lower extremity
paralysis with a positive Babinski sign. His patellar and Achilles reflexes are
hyper-reflexive on the right side. Sensory examination of the right lower
extremity reveals a loss of tactile, vibratory, and proprioceptive senses, and the
left lower extremity does not respond to pain or cold stimuli. Transection of
which fiber tract resulted in the left lower extremity sensory aberration?

•  A) Left corticospinal
•  B) Left dorsal columns
•  C) Left dorsal spinocerebellar
•  D) Left spinothalamic
•  E) Right corticospinal
•  F) Right dorsal columns
•  G) Right dorsal spinocerebellar
•  G) Right spinothalamic
•  A 50-year-old man presents to the emergency department after a motor
vehicle collision. He denies loss of consciousness and is complaining of severe
back pain. On initial survey, he has bilateral breath sounds and 97% oxygen
saturation on room air. His blood pressure is 146/87 mm Hg, and he has equal
pulses throughout. Neurologic examination reveals right lower extremity
paralysis with a positive Babinski sign. His patellar and Achilles reflexes are
hyperreflexive on the right side. Sensory examination of the right lower
extremity reveals a loss of tactile, vibratory, and proprioceptive senses, and the
left lower extremity does not respond to pain or cold stimuli. Transection of
which fiber tract resulted in the left lower extremity sensory aberration?

•  A) Left corticospinal
•  B) Left dorsal columns
•  C) Left dorsal spinocerebellar
•  D) Left spinothalamic
•  E) Right corticospinal
•  F) Right dorsal columns
•  G) Right dorsal spinocerebellar
•  G) Right spinothalamic
•  A 28-year-old man arrives home to his apartment following a heated
argument with his girlfriend. Shortly after arriving home, his roommate
observes his obvious distress and asks whether he is okay. Immediately
the man snaps at his roommate and tells him to "back off" and to "stop
barging into [his] personal life." Which defense mechanism is this man
exhibiting?

•  A) Acting out
•  B) Displacement
•  C) Projection
•  D) Reaction formation
•  E) Suppression
•  A 28-year-old man arrives home to his apartment following a heated
argument with his girlfriend. Shortly after arriving home, his roommate
observes his obvious distress and asks whether he is okay. Immediately
the man snaps at his roommate and tells him to "back off" and to "stop
barging into [his] personal life." Which defense mechanism is this man
exhibiting?

•  A) Acting out
•  B) Displacement
•  C) Projection
•  D) Reaction formation
•  E) Suppression
•  A 43-year-old woman in a psychiatry ward is admitted to a medical floor
after attempting suicide by medication overdose. She states that she
recently broke up (for the fifth time) with her boyfriend, who disapproves
of her cocaine and marijuana use. She also states that she has made
”hundreds” of suicide attempts and has been hospitalized many times. She
is very compliant during the interview as she states that ”I only like
doctors, not nurses, because only doctors understand me!” Physical
examination reveals tachycardia, reddened conjunctivae, and an eroded
nasal septum. Which of the following defense mechanisms is most closely
associated with this patient’s condition?

•  A) Displacement
•  B) Paranoia
•  C) Reaction formation
•  D) Splitting
•  E) Sublimation
•  A 43-year-old woman in a psychiatry ward is admitted to a medical floor
after attempting suicide by medication overdose. She states that she
recently broke up (for the fifth time) with her boyfriend, who disapproves
of her cocaine and marijuana use. She also states that she has made
”hundreds” of suicide attempts and has been hospitalized many times. She
is very compliant during the interview as she states that ”I only like
doctors, not nurses, because only doctors understand me!” Physical
examination reveals tachycardia, reddened conjunctivae, and an eroded
nasal septum. Which of the following defense mechanisms is most closely
associated with this patient’s condition?

•  A) Displacement
•  B) Paranoia
•  C) Reaction formation
•  D) Splitting
•  E) Sublimation
•  A previously normal 56-year-old woman comes to the emergency department because
of a “flu-like” illness. She complains of nausea and vomiting, unilateral tingling in the
leg, and a headache involving the eye and forehead. She is alert and fully oriented.
Motor, sensory, gait, and coordination examinations are normal. Cranial nerve
examination is normal, aside from the visual field disorder indicated in the plot below.
The neurologic examination suggests an occlusion of which of the following vessels?

•  (A) Left middle cerebral artery

•  (B) Left posterior cerebral artery
•  (C) Right middle cerebral artery
•  (D) Right posterior cerebral artery
•  (E) Posterior communicating artery
•  A previously normal 56-year-old woman comes to the emergency department because
of a “flu-like” illness. She complains of nausea and vomiting, unilateral tingling in the
leg, and a headache involving the eye and forehead. She is alert and fully oriented.
Motor, sensory, gait, and coordination examinations are normal. Cranial nerve
examination is normal, aside from the visual field disorder indicated in the plot below.
The neurologic examination suggests an occlusion of which of the following vessels?

•  (A) Left middle cerebral artery

•  (B) Left posterior cerebral artery
•  (C) Right middle cerebral artery
•  (D) Right posterior cerebral artery
•  (E) Posterior communicating artery
•  During a physical examination a physician elicits a pupillary light reflex by
shining a light into a patient’s eye. The iris contracts, thereby constricting
the pupil. Where are the cell bodies of the preganglionic neurons found
that are responsible for this response?
•  (A) Oculomotor nucleus
•  (B) Edinger-Westphal nucleus
•  (C) Ciliary ganglion
•  (D) Precentral gyrus
•  (E) Geniculate ganglion
•  During a physical examination a physician elicits a pupillary light reflex by
shining a light into a patient’s eye. The iris contracts, thereby constricting
the pupil. Where are the cell bodies of the preganglionic neurons found
that are responsible for this response?
•  (A) Oculomotor nucleus
•  (B) Edinger-Westphal nucleus
•  (C) Ciliary ganglion
•  (D) Precentral gyrus
•  (E) Geniculate ganglion
•  A 31-year-old man presents to his family physician with the complaint of
occasional problems with his eyes. The history reveals that the man sees what
he calls “dark areas” as he looks around that will “go away then come back”
and occasionally he sees “two of everything.” He thinks that the cycles are
becoming more frequent, but he is not sure. The examination reveals a visual
field deficit, diplopia, and a decreased appreciation of vibratory sense on his
right lower extremity. Suspecting multiple sclerosis, the physician orders an
MRI which shows demyelination within the area of the brain outlined on the
image below. Which of the following visual field deficits would most likely
correlate with the location of this man’s lesion?
•  A 31-year-old man presents to his family physician with the complaint of
occasional problems with his eyes. The history reveals that the man sees what
he calls “dark areas” as he looks around that will “go away then come back”
and occasionally he sees “two of everything.” He thinks that the cycles are
becoming more frequent, but he is not sure. The examination reveals a visual fi
eld defi cit, diplopia, and a decreased appreciation of vibratory sense on his
right lower extremity. Suspecting multiple sclerosis, the physician orders an
MRI which shows demyelination within the area of the brain outlined on the
image below. Which of the following visual field deficits would most likely
correlate with the location of this man’s lesion?
•  A 47-year-old man suddenly realizes the he must hold papers at arm’s
length in an attempt to get them into focus. Which of the following specifi
es this condition in this man?
•  (A) Amblyopia
•  (B) Mydriasis
•  (C) Myopia
•  (D) Presbyopia
•  (E) Visual agnosia
•  A 47-year-old man suddenly realizes the he must hold papers at arm’s
length in an attempt to get them into focus. Which of the following specifies
this condition in this man?
•  (A) Amblyopia
•  (B) Mydriasis
•  (C) Myopia
•  (D) Presbyopia
•  (E) Visual agnosia
•  A 24-year-old woman is brought to the Emergency Department from the site of
a motor vehicle collision. The examination reveals that she has a compound
fracture of her femur and tibia, facial injuries, and a probable crush injury to
the orbit. CT reveals fractured orbital walls, blood in the orbit, and optic nerve
damage as shown in the image below. When this patient is conscious and a full
neurological examination is conducted, and a light is shined in the right eye,
which of the following will be most noticeable?
•  (A) Blindness in the left eye
•  (B) Blindness in the right

eye
•  (C) Loss of corneal reflex in
right eye

•  (D) Loss of pupillary light

reflex in left eye only
•  (E) Loss of pupillary light
reflex in right eye only
•  A 24-year-old woman is brought to the Emergency Department from the site of
a motor vehicle collision. The examination reveals that she has a compound
fracture of her femur and tibia, facial injuries, and a probable crush injury to
the orbit. CT reveals fractured orbital walls, blood in the orbit, and optic nerve
damage as shown in the image below. When this patient is conscious and a full
neurological examination is conducted, and a light is shined in the right eye,
which of the following will be most noticeable?
•  (A) Blindness in the left eye
•  (B) Blindness in the right

eye
•  (C) Loss of corneal reflex in
right eye

•  (D) Loss of pupillary light

reflex in left eye only
•  (E) Loss of pupillary light
reflex in right eye only
•  A 35 year-old man shows an intention tremor of the left arm and hand
whereas his right arm and hand are normal. He has dysarthria and also
shows dysdiadochokinesia when asked to produce repetitive movements
of his left hand. His movement disorder was of sudden onset and it is likely
that he has suffered a stroke affecting the:
•  A. lateral cerebellar hemisphere on the left
•  B. globus pallidus external segment on the left
•  C. internal capsule on the left
•  D. both subthalamic nuclei on the right and left
•  E. paravermis of the cerebellum on the right
•  A 35 year-old man shows an intention tremor of the left arm and hand
whereas his right arm and hand are normal. He has dysarthria and also
shows dysdiadochokinesia when asked to produce repetitive movements
of his left hand. His movement disorder was of sudden onset and it is likely
that he has suffered a stroke affecting the:
•  A. lateral cerebellar hemisphere on the left
•  B. globus pallidus external segment on the left
•  C. internal capsule on the left
•  D. both subthalamic nuclei on the right and left
•  E. paravermis of the cerebellum on the right
•  A 29-year-old woman visits her family physician with the main complaint of irregular
menses. The examination also reveals that the woman has had trouble sleeping (usually
not an issue), and has generally not felt well for the last several weeks. A visual field
examination by confrontation reveals a deficit, and subsequent MRI shows a small
pituitary lesion that is impinging on the area indicated by the outline in the image
below. Based on the position of this lesion, which of the following visual field deficits
would you most likely expect to see in this woman?
•  A 29-year-old woman visits her family physician with the main complaint of irregular
menses. The examination also reveals that the woman has had trouble sleeping (usually
not an issue), and has generally not felt well for the last several weeks. A visual fi eld
examination by confrontation reveals a deficit, and subsequent MRI shows a small
pituitary lesion that is impinging on the area indicated by the outline in the image
below. Based on the position of this lesion, which of the following visual field deficits
would you most likely expect to see in this woman?
•  A 32-year-old woman presents to the physician with weakness of both
upper extremities, headaches, and multiple second-degree burns on her
hands. The patient has no prior significant medical history and cannot
recall any recent episodes of trauma. Although physical examination
uncovers no motor deficits in either upper extremity, it reveals the absence
of pain and temperature sensation in the upper extremities bilaterally.
Position and vibration sense are intact in the upper extremities, and there
are no lower extremity abnormalities. An MRI of the spinal column shows
dilation within the cervical spinal cord. Which diagnosis is consistent with
this patient’s findings?

•  A) Communicating hydrocephalus
•  B) Congenital aqueductal stenosis
•  C) Dandy-Walker syndrome
•  D) Syringomyelia
•  E) Wallenberg (lateral medullary) syndrome
•  A 32-year-old woman presents to the physician with weakness of both
upper extremities, headaches, and multiple second-degree burns on her
hands. The patient has no prior significant medical history and cannot
recall any recent episodes of trauma. Although physical examination
uncovers no motor deficits in either upper extremity, it reveals the absence
of pain and temperature sensation in the upper extremities bilaterally.
Position and vibration sense are intact in the upper extremities, and there
are no lower extremity abnormalities. An MRI of the spinal column shows
dilation within the cervical spinal cord. Which diagnosis is consistent with
this patient’s findings?

•  A) Communicating hydrocephalus
•  B) Congenital aqueductal stenosis
•  C) Dandy-Walker syndrome
•  D) Syringomyelia
•  E) Wallenberg (lateral medullary) syndrome
•  In lateral gaze testing, a patient is unable to look towards the left with both
eyes, but can look towards the right with both eyes. The lesion is most
likely located in the
•  A. left PPRF
•  B. right MLF
•  C. left MLF
•  D. right PPRF
•  E. right PPRF and MLF
•  F. left PPRF and MLF
•  In lateral gaze testing, a patient is unable to look towards the left with both
eyes, but can look towards the right with both eyes. The lesion is most
likely located in the
•  A. left PPRF
•  B. right MLF
•  C. left MLF
•  D. right PPRF
•  E. right PPRF and MLF
•  F. left PPRF and MLF
•  A diminished left direct and left consensual reponse in corneal reflex
testing, reduced air and bone conduction in Rinne's test on the left side
and a flattened left nasolabial fold are symptom(s) of a lesion of:
•  A. right CN VII and left CN V
•  B. left CN VIII and right CN VII
•  C. left CN VIII and CN VII
•  D. right CN VIII and right CN VII
•  E. left CN VII and left CN V
•  A diminished left direct and left consensual reponse in corneal reflex
testing, reduced air and bone conduction in Rinne's test on the left side
and a flattened left nasolabial fold are symptom(s) of a lesion of:
•  A. right CN VII and left CN V
•  B. left CN VIII and right CN VII
•  C. left CN VIII and CN VII
•  D. right CN VIII and right CN VII
•  E. left CN VII and left CN V
•  At which point can there be unilateral hearing loss?

A. Lesion 4
B. Lesions 1, 2, 3 and 5
C. Lesion 1
D. Lesion 5
E. Lesions 1 and 5
•  At which point can there be unilateral hearing loss?

A. Lesion 4
B. Lesions 1, 2, 3 and 5
C. Lesion 1
D. Lesion 5
E. Lesions 1 and 5
•  The picture above shows the extraocular
responses of a comatose patient during
caloric testing. The responses indicate
•  A. a lesion of the left vestibular system
during cold water application into the right
ear
•  B. no damage to the vestibular system
during cold water application into the right
ear
•  C. no damage to the vestibular system
during cold water application into the left
ear
•  D. a lesion of the right vestibular system
during cold water application into the left
ear
•  The picture above shows the extraocular
responses of a comatose patient during
caloric testing. The responses indicate
•  A. a lesion of the left vestibular system
during cold water application into the right
ear
•  B. no damage to the vestibular system
during cold water application into the right
ear
•  C. no damage to the vestibular system
during cold water application into the left
ear
•  D. a lesion of the right vestibular system
during cold water application into the left
ear
•  A 76-year-old man presents to the emergency department with abnormal
arm movements. His wife reports that he “threw his coffee cup” this
morning and has been unable to control the movements of his right arm
and leg since that time. He has a history of poorly controlled hypertension
and type 2 diabetes mellitus. On physical examination, the patient
demonstrates violent, flinging, and circular movements of his proximal
right arm and leg. No abnormalities are present on the patient's left side. A
lesion in which of the following brain locations would lead to this
syndrome?

•  A) Nucleus accumbens
•  B) The amygdala
•  C) The contralateral substantia nigra pars compacta
•  D) The contralateral subthalamic nucleus
•  E) The ipsilateral cerebellar hemisphere
•  A 76-year-old man presents to the emergency department with abnormal
arm movements. His wife reports that he “threw his coffee cup” this
morning and has been unable to control the movements of his right arm
and leg since that time. He has a history of poorly controlled hypertension
and type 2 diabetes mellitus. On physical examination, the patient
demonstrates violent, flinging, and circular movements of his proximal
right arm and leg. No abnormalities are present on the patient's left side. A
lesion in which of the following brain locations would lead to this
syndrome?

•  A) Nucleus accumbens
•  B) The amygdala
•  C) The contralateral substantia nigra pars compacta
•  D) The contralateral subthalamic nucleus
•  E) The ipsilateral cerebellar hemisphere
•  A 24-year-old woman with no significant medical history complains of
double vision that began 2 weeks ago. However, it only occurs when she
looks to either side. Additionally, she reports feeling weak and fatigued
after using the sauna at her local gym over the last few months. On
neurologic examination, when the patient attempts to look to the left, her
right eye does not adduct past the midline, and her left eye exhibits
beating horizontal movements. When she looks to the right, her left eye
exhibits the same signs while the right eye “beats.” Her physician suspects
a particular condition, and decides to order an MRI of the brain. The MRI
would most likely reveal a lesion in which of the following locations?

•  A) Arcuate fasciculus
•  B) Bilateral lesion of Edinger-Westphal nuclei
•  C) Frontal eye field
•  D) Medial lemniscus
•  E) Medial longitudinal fasciculus
•  A 24-year-old woman with no significant medical history complains of
double vision that began 2 weeks ago. However, it only occurs when she
looks to either side. Additionally, she reports feeling weak and fatigued
after using the sauna at her local gym over the last few months. On
neurologic examination, when the patient attempts to look to the left, her
right eye does not adduct past the midline, and her left eye exhibits
beating horizontal movements. When she looks to the right, her left eye
exhibits the same signs while the right eye “beats.” Her physician suspects
a particular condition, and decides to order an MRI of the brain. The MRI
would most likely reveal a lesion in which of the following locations?

•  A) Arcuate fasciculus
•  B) Bilateral lesion of Edinger-Westphal nuclei
•  C) Frontal eye field
•  D) Medial lemniscus
•  E) Medial longitudinal fasciculus
•  Shortly after going through an ugly divorce, Dr. Smith sees a patient in
whom chronic myelogenous leukemia was recently diagnosed. The patient
looks strikingly like Dr. Smith's ex-husband. As they are going over the
options for treatment, the patient tells Dr. Smith that imatinib, the best
available therapy, is prohibitively expensive for him. Dr. Smith tells him that
there is nothing she can do, even though she knows of low-cost programs
for patients who cannot afford the drug. Which of the following is
influencing Dr. Smith's thinking?

•  A) Countertransference
•  B) Negative transference
•  C) Positive transference
•  D) Projection
•  E) Sublimation
•  Shortly after going through an ugly divorce, Dr. Smith sees a patient in
whom chronic myelogenous leukemia was recently diagnosed. The patient
looks strikingly like Dr. Smith's ex-husband. As they are going over the
options for treatment, the patient tells Dr. Smith that imatinib, the best
available therapy, is prohibitively expensive for him. Dr. Smith tells him that
there is nothing she can do, even though she knows of low-cost programs
for patients who cannot afford the drug. Which of the following is
influencing Dr. Smith's thinking?

•  A) Countertransference
•  B) Negative transference
•  C) Positive transference
•  D) Projection
•  E) Sublimation
•  In performing the H-test a patient is told to follow the finger of the
examiner. In a gaze towards the right side he is not able to perform an
upward gaze with his left eye. He has a weakness of '
•  A. left CN VI
•  B. left superior oblique muscle
•  C. left CN IV
•  D. left inferior oblique muscle
•  E. left inferior rechtus muscle
•  In performing the H-test a patient is told to follow the finger of the
examiner. In a gaze towards the right side he is not able to perform an
upward gaze with his left eye. He has a weakness of '
•  A. left CN VI
•  B. left superior oblique muscle
•  C. left CN IV
•  D. left inferior oblique muscle
•  E. left inferior rechtus muscle
•  A 79-year-old woman complains to her physician that she is having
trouble seeing; she has no history of visual problems. The visual field
examination reveals a right superior quadrantanopia, and the
ophthalmoscopic examination shows no frank abnormalities of the optic
disc or retinal vasculature. Which of the following represents the most
likely location of the lesion in this woman?
•  (A) Left lateral geniculate nucleus
•  (B) Left Meyer loop
•  (C) Left optic radiations
•  (D) Right Meyer loop
•  (E) Right optic tract
•  A 79-year-old woman complains to her physician that she is having
trouble seeing; she has no history of visual problems. The visual field
examination reveals a right superior quadrantanopia, and the
ophthalmoscopic examination shows no frank abnormalities of the optic
disc or retinal vasculature. Which of the following represents the most
likely location of the lesion in this woman?
•  (A) Left lateral geniculate nucleus
•  (B) Left Meyer loop
•  (C) Left optic radiations
•  (D) Right Meyer loop
•  (E) Right optic tract
•  Which of the following describes the sequence of physiological events
that take place in a rod when it is exposed to photons of light?
•  (A) Depolarization with a corresponding increase in glutamate release
•  (B) Depolarization with no change in glutamate release
•  (C) Hyperpolarization with no change in glutamate release
•  (D) Hyperpolarization with a corresponding decrease in glutamate
release
•  (E) Hyperpolarization with a corresponding increase in glutamate release
•  Which of the following describes the sequence of physiological events
that take place in a rod when it is exposed to photons of light?
•  (A) Depolarization with a corresponding increase in glutamate release
•  (B) Depolarization with no change in glutamate release
•  (C) Hyperpolarization with no change in glutamate release
•  (D) Hyperpolarization with a corresponding decrease in glutamate
release
•  (E) Hyperpolarization with a corresponding increase in glutamate release
•  After touching the right cornea with a cotton swab the patient's eyes did
not blink bilaterally. Touching the left cornea induced a blink of the
right eye. You conclude the the lesioned structure(s) is (are):
•  A. left CN VII
•  B. right CN VII
•  C. findings in corneal reflex testing as mentioned above are not
possible
•  D. right CN V and left CN VII
•  E. left CN V and VII
•  F. left CN V
•  G. left CN V and right CN VII
•  H. right CN V and VII
•  I. right CN V
•  After touching the right cornea with a cotton swab the patient's eyes did
not blink bilaterally. Touching the left cornea induced a blink of the
right eye. You conclude the the lesioned structure(s) is (are):
•  A. left CN VII
•  B. right CN VII
•  C. findings in corneal reflex testing as mentioned above are not
possible
•  D. right CN V and left CN VII
•  E. left CN V and VII
•  F. left CN V
•  G. left CN V and right CN VII
•  H. right CN V and VII
•  I. right CN V
•  A 31-year-old woman presents to her family physician with a complaint of
“seeing two of everything.” She is referred to a neurologist. The history
reveals that this problem has been more noticeable at some times and less
noticeable at other times; she has experienced this over several weeks.
The examination reveals that the woman has weakness of ocular movement
in both eyes, more pronounced on the left, drooping of both eyelids, also
more pronounced on the left, and slight weakness of the left upper
extremity when compared to the right. She also notes that she feels worse
later in the day. The evidence clearly suggests a disease related to a failure
of neurotransmitter function. Which of the following is most likely involved
in this woman’s disease?
•  (A) Acetylcholine
•  (B) Dopamine
•  (C) Histamine
•  (D) Glutamate
•  (E) Glycine
•  A 31-year-old woman presents to her family physician with a complaint of
“seeing two of everything.” She is referred to a neurologist. The history
reveals that this problem has been more noticeable at some times and less
noticeable at other times; she has experienced this over several weeks.
The examination reveals that the woman has weakness of ocular movement
in both eyes, more pronounced on the left, drooping of both eyelids, also
more pronounced on the left, and slight weakness of the left upper
extremity when compared to the right. She also notes that she feels worse
later in the day. The evidence clearly suggests a disease related to a failure
of neurotransmitter function. Which of the following is most likely involved
in this woman’s disease?
•  (A) Acetylcholine
•  (B) Dopamine
•  (C) Histamine
•  (D) Glutamate
•  (E) Glycine
•  Descending fibers from supraspinal centers excite motor neurons within
the anterior horn that innervate intrafusal muscle fibers. Contraction of
these muscle fibers results in increased activity in Aα (also called Ia)
fibers which activate alpha motor neurons that excite extrafusal muscle
fibers. What is this circuit called?
•  (A) Babinski reflex
•  (B) Crossed extensor reflex
•  (C) Flexor reflex
•  (D) Gamma loop
•  (E) Reciprocal inhibition
•  Descending fibers from supraspinal centers excite motor neurons within
the anterior horn that innervate intrafusal muscle fibers. Contraction of
these muscle fibers results in increased activity in Aα (also called Ia)
fibers which activate alpha motor neurons that excite extrafusal muscle
fibers. What is this circuit called?
•  (A) Babinski reflex
•  (B) Crossed extensor reflex
•  (C) Flexor reflex
•  (D) Gamma loop
•  (E) Reciprocal inhibition
•  A 24-year-old man is stabbed in the neck. Neurologic examination reveals
left-sided hemiparesis. There is complete loss of discriminatory joint
position and vibration sensation below C8 on the left side. On the right
side, there is loss of pain and temperature sensation below C8. It can be
expected that an MRI of the cervical spinal cord will show which of the
following findings?
•  (A) A complete transection of the spinal cord
•  (B) A hemisection of the left side of the cord
•  (C) A lesion of the dorsal columns of the cord on the left side
•  (D) A lesion of the lateral funiculus on the left side
•  (E) Damage to cervical dorsal roots on left side
•  A 24-year-old man is stabbed in the neck. Neurologic examination reveals
left-sided hemiparesis. There is complete loss of discriminatory joint
position and vibration sensation below C8 on the left side. On the right
side, there is loss of pain and temperature sensation below C8. It can be
expected that an MRI of the cervical spinal cord will show which of the
following findings?
•  (A) A complete transection of the spinal cord
•  (B) A hemisection of the left side of the cord
•  (C) A lesion of the dorsal columns of the cord on the left side
•  (D) A lesion of the lateral funiculus on the left side
•  (E) Damage to cervical dorsal roots on left side
•  A neuroscientist decides to perform a study that requires him to increase
the concentration of norepinephrine in the cortex of an animal subject. He
does this by electrically stimulating a nucleus in the brain. Which of the
following nuclei is the most important source of noradrenergic innervation
to the cerebral cortex?
•  (A) Basal nucleus of Meynert
•  (B) Caudate nucleus
•  (C) Locus caeruleus
•  (D) Raphe nucleus
•  (E) Substantia nigra
•  (F) Ventral tegmental area
•  A neuroscientist decides to perform a study that requires him to increase
the concentration of norepinephrine in the cortex of an animal subject. He
does this by electrically stimulating a nucleus in the brain. Which of the
following nuclei is the most important source of noradrenergic innervation
to the cerebral cortex?
•  (A) Basal nucleus of Meynert
•  (B) Caudate nucleus
•  (C) Locus caeruleus
•  (D) Raphe nucleus
•  (E) Substantia nigra
•  (F) Ventral tegmental area
•  A 67-year-old man has an abnormal neurologic exam. An
electroencephalogram is subsequently performed and reveals delta waves
(Sleep like waves) over his left frontal lobe. Which of the following was the
most likely abnormal finding on his neurologic exam?
•  (A) Left hemiparesis
•  (B) Left hemisensory loss
•  (C) Left homonymous hemianopia
•  (D) Right hemiparesis
•  (E) Right hemisensory loss
•  (F) Right homonymous hemianopia
•  A 67-year-old man has an abnormal neurologic exam. An
electroencephalogram is subsequently performed and reveals delta waves
(sleep like waves) over his left frontal lobe. Which of the following was the
most likely abnormal finding on his neurologic exam?
•  (A) Left hemiparesis
•  (B) Left hemisensory loss
•  (C) Left homonymous hemianopia
•  (D) Right hemiparesis
•  (E) Right hemisensory loss
•  (F) Right homonymous hemianopia
•  A 45-year-old garbage collector has severe neck pain and weakness in his
left upper extremity. He has gotten no relief from over-thecounter
medications. He denies any history of trauma. On examination the patient
is thin and walks with his neck tilted to the left side. The patient has limited
neck flexion and extension secondary to pain. The patient has a normal
motor and sensory examination of all extremities, with the exception of the
left upper extremity. His left radial forearm and thumb are numb to the
touch (decreased sensation to light touch). The patient has a decreased
brachioradialis reflex and slight weakness of his wrist extensors. Plain
radiographs appear normal. Which of the following is the most likely
diagnosis?
•  (A) Compression of his left C6 nerve root
•  (B) Compression of his left thoracic first nerve root (T1)
•  (C) Compression of his right T1 nerve root
•  (D) A tumor in his lumbar spine
•  (E) A tumor in his sacral spine
•  A 45-year-old garbage collector has severe neck pain and weakness in his
left upper extremity. He has gotten no relief from over-thecounter
medications. He denies any history of trauma. On examination the patient
is thin and walks with his neck tilted to the left side. The patient has limited
neck flexion and extension secondary to pain. The patient has a normal
motor and sensory examination of all extremities, with the exception of the
left upper extremity. His left radial forearm and thumb are numb to the
touch (decreased sensation to light touch). The patient has a decreased
brachioradialis reflex and slight weakness of his wrist extensors. Plain
radiographs appear normal. Which of the following is the most likely
diagnosis?
•  (A) Compression of his left C6 nerve root
•  (B) Compression of his left thoracic first nerve root (T1)
•  (C) Compression of his right T1 nerve root
•  (D) A tumor in his lumbar spine
•  (E) A tumor in his sacral spine
•  A motor neuron, located in vicinity of the midline in the ventral portion of
the ventral horn most likely innervates:
•  A. A flexor muscle of a distal limb
•  B. An extensor muscle of a distal limb
•  C. A flexor muscle of a proximal limb
•  D. An extensor muscle of a proximal limb
•  A motor neuron, located in vicinity of the midline in the ventral portion of
the ventral horn most likely innervates:
•  A. A flexor muscle of a distal limb
•  B. An extensor muscle of a distal limb
•  C. A flexor muscle of a proximal limb
•  D. An extensor muscle of a proximal limb
•  The application of a brief stretch to a muscle spindle Ia afferent neuron
initiates action potentials in its axon because:
•  A. the sensory ending has stretched-gated Na channels giving a graded
depolarizing receptor potential
•  B. the sensory ending is temporarily made leaky to all ions
•  C. the stretch of the sensory ending causes the production of cAMP that
gates channel opening
•  D. voltage-gated Na channels in the sensory ending are also sensitive
directly to mechanical stimuli
•  E. the mechanical displacement is transmitted to the axon hillock where
it excites the axon
•  The application of a brief stretch to a muscle spindle Ia afferent neuron
initiates action potentials in its axon because:
•  A. the sensory ending has stretched-gated Na channels giving a graded
depolarizing receptor potential
•  B. the sensory ending is temporarily made leaky to all ions
•  C. the stretch of the sensory ending causes the production of cAMP that
gates channel opening
•  D. voltage-gated Na channels in the sensory ending are also sensitive
directly to mechanical stimuli
•  E. the mechanical displacement is transmitted to the axon hillock where
it excites the axon
•  A Neurologist sees three patients in her clinic. These are a 23-year-old man
with a Brown-Séquard syndrome resulting from trauma at C3-5, a 69-year-
old woman with a Wallenberg syndrome, and a 79-year-old man with a
hemorrhagic stroke in the lateral portions of the pontine tegmentum. In
addition to the expected deficits, a careful examination would also reveal
which of the following in all three patients?
•  (A) A loss of discriminative touch on the forehead
•  (B) A loss of pain and thermal sensation on one side of the face
•  (C) Constriction of the pupil (miosis) on the side of the lesion
•  (D) Deviation of the tongue and uvula on attempted phonation
•  (E) Weakness of the digits on the side opposite the lesion
•  A Neurologist sees three patients in her clinic. These are a 23-year-old man
with a Brown-Séquard syndrome resulting from trauma at C3-5, a 69-year-
old woman with a Wallenberg syndrome, and a 79-year-old man with a
hemorrhagic stroke in the lateral portions of the pontine tegmentum. In
addition to the expected deficits, a careful examination would also reveal
which of the following in all three patients?
•  (A) A loss of discriminative touch on the forehead
•  (B) A loss of pain and thermal sensation on one side of the face
•  (C) Constriction of the pupil (miosis) on the side of the lesion
•  (D) Deviation of the tongue and uvula on attempted phonation
•  (E) Weakness of the digits on the side opposite the lesion
•  A 37-year-old woman presents to her family
physician with intermittent physical
problems. She is referred to a neurologist
and, after a thorough examination, a tentative
diagnosis of multiple sclerosis is made. MRI
shows an area of demyelination in the region
indicated by the arrow in the image below.
Which of the following deficits would
correlate most specifically with the location
of this lesion?
•  (A) Tongue deviates to the left, weak left
upper and lower
•  extremities
•  (B) Tongue deviates to the left, weak left
lower extremity
•  (C) Tongue deviates to the right, weak left
upper and lower
•  extremities
•  (D) Tongue deviates to the right, weak left
lower extremity
•  (E) Tongue deviates to the right, weak left
upper extremity
•  A 37-year-old woman presents to her family
physician with intermittent physical
problems. She is referred to a neurologist
and, after a thorough examination, a tentative
diagnosis of multiple sclerosis is made. MRI
shows an area of demyelination in the region
indicated by the arrow in the image below.
Which of the following deficits would
correlate most specifically with the location
of this lesion?
•  (A) Tongue deviates to the left, weak left
upper and lower
•  extremities
•  (B) Tongue deviates to the left, weak left
lower extremity
•  (C) Tongue deviates to the right, weak left
upper and lower
•  extremities
•  (D) Tongue deviates to the right, weak left
lower extremity
•  (E) Tongue deviates to the right, weak left
upper extremity
•  A 47-year-old man is brought to the Emergency Department from the site
of a motor vehicle collision. The examination reveals facial injuries with a
probable broken nose, a compound fracture of the left humerus, and large
bruises/contusions on his left thigh. CT confirms these observations and
shows a skull fracture in the left frontal region, extensive intracranial
hemorrhage, a fracture through the left orbit, and a fractured pelvis. The
man is unconscious and within 6 hours exhibits decorticate posturing.
Excessive action in which of the following tracts/systems would explain the
flexion of the upper extremities in this man?
•  (A) Anterolateral
•  (B) Corticospinal
•  (C) Reticulospinal
•  (D) Rubrospinal
•  (E) Vestibulospinal
•  A 47-year-old man is brought to the Emergency Department from the site
of a motor vehicle collision. The examination reveals facial injuries with a
probable broken nose, a compound fracture of the left humerus, and large
bruises/contusions on his left thigh. CT confirms these observations and
shows a skull fracture in the left frontal region, extensive intracranial
hemorrhage, a fracture through the left orbit, and a fractured pelvis. The
man is unconscious and within 6 hours exhibits decorticate posturing.
Excessive action in which of the following tracts/systems would explain the
flexion of the upper extremities in this man?
•  (A) Anterolateral
•  (B) Corticospinal
•  (C) Reticulospinal
•  (D) Rubrospinal
•  (E) Vestibulospinal
•  A 71-year-old farmer is transported to the Emergency Department after
collapsing while working in his barn. According to EMS personnel, the
man’s wife found him after he failed to come to the house for a noonday
meal. The man was conscious and coherent, and indicated that his problem
“came on real sudden.” The examination revealed a profound weakness of
his left upper and lower extremities, dilation of the right pupil, and loss of
most voluntary movement of his right eye. MRI showed a localized lesion
presumably of vascular origin.
•  A 71-year-old farmer is transported to the Emergency Department after
collapsing while working in his barn. According to EMS personnel, the
man’s wife found him after he failed to come to the house for a noonday
meal. The man was conscious and coherent, and indicated that his problem
“came on real sudden.” The examination revealed a profound weakness of
his left upper and lower extremities, dilation of the right pupil, and loss of
most voluntary movement of his right eye. MRI showed a localized lesion
presumably of vascular origin.

E
•  Pain and thermal information are transmitted by what are commonly called
lightly myelinated and unmyelinated nerves that have a slow conduction
velocity. Lightly myelinated fibers are also called Aδ fi bers and
unmyelinated fibers are called C fibers, both having axons of small
diameter. Which of the following characterizes the latter of these fi ber
types?
•  (A) Axons lying free in the interstitial space/fluid
•  (B) Axons lying on the surface of Schwann cells in the interstitial space
•  (C) Axons lying within grooves on the Schwann cells
•  (D) Axons with only a single layer of formed myelin from Schwann cells
•  (E) Axons with fewer than three layers of formed myelin from Schwann
cells
•  Pain and thermal information are transmitted by what are commonly called
lightly myelinated and unmyelinated nerves that have a slow conduction
velocity. Lightly myelinated fibers are also called Aδ fi bers and
unmyelinated fibers are called C fibers, both having axons of small
diameter. Which of the following characterizes the latter of these fi ber
types?
•  (A) Axons lying free in the interstitial space/fluid
•  (B) Axons lying on the surface of Schwann cells in the interstitial space
•  (C) Axons lying within grooves on the Schwann cells
•  (D) Axons with only a single layer of formed myelin from Schwann cells
•  (E) Axons with fewer than three layers of formed myelin from Schwann
cells
•  A 65-year-old man with a 20-year history of type 2 diabetes presents to his
physician for regular follow-up. His medications include metformin and
long-acting insulin at night. Over the past 3 months, he has noticed calluses
developing at several locations on his feet. Results of neurologic testing are
significant for decreased vibratory sense in the feet bilaterally. Which of
the following is most likely to be damaged in this patient?
 
•  A) Golgi tendons
•  B) Meissner corpuscles
•  C) Nociceptors
•  D) Pacinian corpuscles
•  E) Thermoreceptors
•  A 65-year-old man with a 20-year history of type 2 diabetes presents to his
physician for regular follow-up. His medications include metformin and
long-acting insulin at night. Over the past 3 months, he has noticed calluses
developing at several locations on his feet. Results of neurologic testing are
significant for decreased vibratory sense in the feet bilaterally. Which of
the following is most likely to be damaged in this patient?
 
•  A) Golgi tendons
•  B) Meissner corpuscles
•  C) Nociceptors
•  D) Pacinian corpuscles
•  E) Thermoreceptors
•  An 42-year-old woman is brought to the emergency department after her
husband noticed that she was having difficulty holding objects and
walking. Examination reveals a temperature of 98.2°F (36.7°C), heart rate
of 91/min, and blood pressure of 152/98 mm Hg. Her heart and lung
examinations are normal. Neurologic exam is notable for left lower
extremity weakness and prominently right uvular deviation. She is
subsequently diagnosed with amyotrophic lateral sclerosis. Given this
patient’s uvular deviation, which of the following neuronal tracts has been
damaged?

•  A) Upper motor neuron of left CN III

•  B) Lower motor neuron of left CN X
•  C) Upper motor neuron of left CN XII
•  D) Lower motor neuron of right CN IX
•  E) Lower motor neuron of right CN X
•  F) Upper motor neuron of right CN XII
•  An 42-year-old woman is brought to the emergency department after her
husband noticed that she was having difficulty holding objects and
walking. Examination reveals a temperature of 98.2°F (36.7°C), heart rate
of 91/min, and blood pressure of 152/98 mm Hg. Her heart and lung
examinations are normal. Neurologic exam is notable for left lower
extremity weakness and prominently right uvular deviation. She is
subsequently diagnosed with amyotrophic lateral sclerosis. Given this
patient’s uvular deviation, which of the following neuronal tracts has been
damaged?

•  A) Upper motor neuron of left CN III

•  B) Lower motor neuron of left CN X
•  C) Upper motor neuron of left CN XII
•  D) Lower motor neuron of right CN IX
•  E) Lower motor neuron of right CN X
•  F) Upper motor neuron of right CN XII
•  A 35-year-old sanitation worker with no significant past medical history
presents to the clinic with a complaint of severe lower back pain that
began suddenly as he was lifting a heavy load. He describes the pain as
sharp with radiation down his left leg and foot. He denies any bowel or
urinary incontinence. The pain is reproduced when the physician lifts the
patient’s left leg above the table at a 30-degree angle. Ankle jerk reflex
testing reveals 1+ on the left side and 2+ on the right side. Sensation to
pinprick is diminished markedly on the lateral portion of his left foot.
This patient most likely experiences weakness in which movement? 

•  A) Dorsiflexion of foot
•  B) Hip flexion
•  C) Knee extension
•  D) Plantarflexion of foot
•  E) Toe extension
•  A 35-year-old sanitation worker with no significant past medical history
presents to the clinic with a complaint of severe lower back pain that
began suddenly as he was lifting a heavy load. He describes the pain as
sharp with radiation down his left leg and foot. He denies any bowel or
urinary incontinence. The pain is reproduced when the physician lifts the
patient’s left leg above the table at a 30-degree angle. Ankle jerk reflex
testing reveals 1+ on the left side and 2+ on the right side. Sensation to
pinprick is diminished markedly on the lateral portion of his left foot.
This patient most likely experiences weakness in which movement? 

•  A) Dorsiflexion of foot
•  B) Hip flexion
•  C) Knee extension
•  D) Plantarflexion of foot
•  E) Toe extension
•  A 45-year-old man comes to his physician because of worsening weakness
in his legs. He has also recently experienced difficulty chewing and
moving his hands and fingers. Physical examination reveals fasciculations
in his calves and atrophy of the calf and thigh muscles. Spasticity and
hyperreflexia is noted in the upper extremities. After further testing, the
physician concludes the patient has amyotrophic lateral sclerosis (ALS).
Which of the following signs is specifically indicative of a lower motor
neuron (LMN) lesion?
 
•  A) 3+ knee jerk reflex
•  B) Extensor plantar response (Babinski sign)
•  C) Fasciculations
•  D) Spasticity
•  E) Weakness
•  A 45-year-old man comes to his physician because of worsening weakness
in his legs. He has also recently experienced difficulty chewing and
moving his hands and fingers. Physical examination reveals fasciculations
in his calves and atrophy of the calf and thigh muscles. Spasticity and
hyperreflexia is noted in the upper extremities. After further testing, the
physician concludes the patient has amyotrophic lateral sclerosis (ALS).
Which of the following signs is specifically indicative of a lower motor
neuron (LMN) lesion?
 
•  A) 3+ knee jerk reflex
•  B) Extensor plantar response (Babinski sign)
•  C) Fasciculations
•  D) Spasticity
•  E) Weakness
•  A 47-year-old man presents to his physician with frequent falls and an
increasing sense of muscle weakness. He has no history of neurologic disease,
recent illness, weight loss, or trauma. Mental status exam is normal, and cranial
nerves are intact. Physical examination is notable for weakness in all
extremities. Deep tendon reflexes are absent in the upper extremities and 3+
in the lower extremities, and fasciculations are present in the upper
extremities. Gait exam is significant for a L foot drop. Babinski sign is upgoing
bilaterally. The patient denies any sensory changes, and pinprick testing is
unremarkable. Laboratory and imaging studies are all within normal limits.
What findings would be expected on examination of the central nervous
system?
•  A) Demyelination of axons in the dorsal columns and spinocerebellar tracts in
the spinal cord
•  B) Demyelination of axons in the posterior limb of the internal capsule
•  C) Demyelination of peripheral nerves
•  D) Neuronal loss in anterior horn cells and connecting pathways of the
corticospinal tracts
•  E) Neuronal loss in the anterior horn cells and posterior columns in the spinal
cord
•  F) Neuronal loss purely in the anterior horn cells in the spinal cord
•  A 47-year-old man presents to his physician with frequent falls and an
increasing sense of muscle weakness. He has no history of neurologic disease,
recent illness, weight loss, or trauma. Mental status exam is normal, and cranial
nerves are intact. Physical examination is notable for weakness in all
extremities. Deep tendon reflexes are absent in the upper extremities and 3+
in the lower extremities, and fasciculations are present in the upper
extremities. Gait exam is significant for a L foot drop. Babinski sign is upgoing
bilaterally. The patient denies any sensory changes, and pinprick testing is
unremarkable. Laboratory and imaging studies are all within normal limits.
What findings would be expected on examination of the central nervous
system?
•  A) Demyelination of axons in the dorsal columns and spinocerebellar tracts in
the spinal cord
•  B) Demyelination of axons in the posterior limb of the internal capsule
•  C) Demyelination of peripheral nerves
•  D) Neuronal loss in anterior horn cells and connecting pathways of the
corticospinal tracts
•  E) Neuronal loss in the anterior horn cells and posterior columns in the spinal
cord
•  F) Neuronal loss purely in the anterior horn cells in the spinal cord