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WIF{DS{}R UI{IVER. SITV SCidSCL GF ME SICINE
BR.IGHTONS EST'A'{'ES, ST.KTTT'S & NEVTS
SEF,TEST'ER
N

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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 mostly' 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 transmission arise in:

a) b) c)
,l Lrt

r'cd nticieus i-iucleus raphe

iragnus

il'onia1 lcbe \ ,,ll nf thp ,:hnr.r.

i. Loss of pain and renrperarure sensation from the ievel of the right little linger and the rest 'firc- bociy beicn,on rhe right srde wouid most likeiy De caused 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

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) midcle ceiebiai I b) anterici cerebt'al c) anterior cnoioidal .i) supei'ict' cel'ebellar' c) posterioi cerebrai

A 65 yeai'-oiri hy'perteesi-,'e rnan is brought Io tile .mergrnci'' after a s'*dCen 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 and he could not feel the texture of tite fbod. E::amination Reveals rveakness of masticatory muscles on the right side and a CT irtrage shor.,s a smali tllntor in the Pons area. Which cther symptom is this man likely to have?

a) r,i,eakness oithe i'iglit arrr, b) loss of baiance. nausea, and trystagnlus"

c)
7.

cl)

loss of pain sensaiion fiorn the right face loss of tactiie sensation from the ligirt iace
sees her

physician because siie has had trouble walking. During Evaluation. the rl,oman stlit-nbles and f-ails towards the 1et1 iiequentll'. Her arm tnovements are Accurate aird without tremor. en MRi shows an iniarci in tiie iri'aiirsieii:r. Which of the Foiior.l'ing sti'Llctures cor-tici be responsibie for this condition? a) right leticulosPinal tract }.1, iefr lateral vestibuiospinal tract rl teri cortico5pinal 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 tremor 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 \\JlNgu^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 ipsilateral pontine nuclci propriccepiive information fiom the ior,'er body enters the cerebelir"rm via the sr"rpe rioipeduttcie tire denlate liilcleils seuds axons 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.

10.

23-,rear.-ol,C tei:-raie is invoived in an argiiment at rvlrich tiu-ie she sustains a stab wound to tire righr neck. Ci.r erai::ination she is noiecl ro have <ieviaiion of hertongue to the right. This

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 GiosscPirarYngeal neive

c)

Vagus ilei'\'e

24)/<

11. Sensorl infbrmation fl"om the cochlea of both ears reaches all of the ibllowing nuclei EXCEPT:

a) superior olir,'ar1' nucleus b) dorsal cochlear nucleus

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 apraxia. it has a map of the ipsilateral body with small discrete arcas devoted to each muscle.

V c)

d) e) a)

It is important fbr motor pianning anci bimanuai cooi'dinaiiot-i. lt works entirel,v* independentl.v olthe basal ganglia. Singie nellrons in area 4 can influence 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 input from climbing fibers. Receives excitatory input from parallel fibers. vz are excited 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 gyrus

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 surface 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 Weinicke's aphasia demonstraie fluent spontaneous speech d) dama-9e to ti"re inibrior temforai 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

18.

Which oi'rire fbiicv,,ing cor-rditions is TRUE in a normal person lvho is initiating a movement? a) ar0ns liotn tire cerebral cortex inhibit ceils in ihe Putamen t ) :r..:i-',1s fror-n tl-re giob-,rs pallidus inhibit ceils in the ventral lateral nucleus c) argr1s frop1 ti're plltanen inhibit cells in the globus pallidtis d) axons fiom the illltamen excite cells in ti-re giobus paliidus & e) arons from the globus pallidus excite celis in ihe ventral laterai nucleus

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.

c)
d) c)

Lr) HyposexualitY.

rrr :\.r.

lrorrc'r'r.qe e+ctinn thr.orrqh the hrainstem contains F'c1ingcr Westphal nucleus. 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 closed whether the ner-rrologist llered cr extendetl his toe. there is likel,v clamage io A. the iascicr-ilus cllneatus $.1 rit. fascicLrius 3r'acilis d. _iil.' 3ltlcl(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 lesion 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 alidali s subnuc eus /// E f.t triqetltilial mesencephalic tlttcieus
1

23. The n1ost common location r,vhere blockage of CSF llorvresults iir hydrocephalus is: A. interventricular ioratnen of lvlonro B. choroicl plexus ccl'uht'al aqLtc.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-year old bo"v who sufferecl a fatai bion,to the temporal region of tire skuii. The callse of death would result rnost iiltely iiom: A. contmunicating h1''dlocephalus B. epidural hematoma C. sr-ibdural hematoma D. subarachnoid hemorrhage 25. Damage to the follolliug structure could primariiy result in ihe accumulation of cerebrospinal f-luicl in tlre sr-rbarachnoid space due to decrease in the reabsorption? A. Perineuronai spaces B. I-eptomeningeal vessels C. Epenciynta olthe ventricles -ddD. Arachnoid granulations and villi 25. Yor-rr pa.Licrii iras siifl-eie,j lrom a small lacunai iniarct of the thalamus. Occlusion of r.vhich of the lbllowing vessels might cause the ini-arct? A. Medial striate anery R. Deep br:rrtch of the PCA C. iiecr-rrrent afieill oi }ler"ibner D. Lenti cr-ri ostriaie artel'r' ,.2 Anterior choroirial arteLv 27. A patieni I'omits r ioiently' in response to'.oxins preseni in CSF. What area of the CNS responded to tire toxit-ts and initiatei the reflex vomiting?

r\.

Organr"rrri vascuiosun-;

B. Area postl'ema C. Sr-rbfornical organ -<fi. Median e irtittencc 'i,. Pineal i:lrlnd
28. A paticnt has valvr:lai ireart disease that gives rise to an embolus. ivhich enters an internal carotid arteiy. In vrhich branch of the anterior circulaticn is ihe emboius most 1ikely to become iodged? A. l'he anteriol' communicating arter,v

B.'An MCA C. A posteriot' cot-nmlinicatii-rg afier-y D. An ACi\ E. A vertebrai arierv

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 cnce.

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 subarachnoid space.

itas enlargecl ventricles seconciary to a loss of neurons due to Aizheimer's disease. 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

Hydrocephalus ex vaclio D.' Normal pressure iry'drocephaius E. More than oi.ie choice in A-D is corect

34. you are cieveioping a drug ro cross the blood-brain barrier. Which of the following 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 capillary 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 olvibiaiory 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 spinerl 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 that ire burried 1-ris l-rand on i:is portabie heater but did not note that the patient has stiirir_rlus. Thc patient aiso notes that he has difficuity using either 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 patient has: *A. Syringcnrl'e1ia B. \'lultiple :r'lercsis C. Poliomi ciitls D. B t'orl'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 loss of re{'lexes iit tire upper limbs

talls off a ladder anci lractures a vertebra. A neuroiogical exam conducted ? weeks aiter the accident reveals thai ihe indir,iduai has a complete hemisection of the right sicle of tlie spinai cord at T5. In this patient. you might expect a pain anci temperature ioss: A. ln the Llppel'and low'er limbs on the left B. In all det'matomes beloiv T7 on the letl C. Irythe T-1 dcrmatonte on the right --./^ , .,ZfBelow thr' T5 dermatome on the right E. That is caused by degeneration of dorsal root ganglion celis below T7 on the left.
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 lesion C. Observecl before the onset olspinal shock D. Contralatcrai to ard below the level of the lesion E. Bilaterai to anci at iire ievei oiiiie iesioir
41 .

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 suppiies the midthoracic segnlents ol-the spinal col'C. Wllat might you expeci youi patient io have? fspasti. ,reaknlss oiboth upper limbs B. Altered tolich sensaticns in both lorver limbs C. Hyporefleria in both ioi.i'er iinbs spinal cord aR Bilater.al clegeneration of LMNs in the ventral horns olthe liinrbal Babinski signs

\$Bilaterai

"'

43. yor-rr patieni l-ias suif-ereci rrauma to the spinal cord. During a period ol spinal shock, w.hat might )'ou expect to observe in the patient? A. tlyperactir e reflexes beiorv the lesion B. Flaccid lreakness beicu the lesion C. A spastic biadder *o. D A clasp itnif-e rei1ex E.'A Babinslii sisn

44. The foilowir"rs staiemeni is not true in regard to cerebellar iesions. A. A positive Romberg sign is present B. Tren-iol is present dr:ring lnovements (iniention tremcr) C. The patient is unabie ro perform rapid alterr-rating morrements (adiadochokinesis) D. Movenrents are not f-lnid but are broken r-rp inio separate joint mor,'ements (decomposition
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. Olivocerc'beliar' fibers E. None of the above 46. The preiror-rtai cortex (areas 9, 10, i 1 and 12) is essential for': 4fixatiuct thinking B.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. With the patient's eyes closed. a spoon rvas placed in her right hand and she was asked to recognize the object. After nloviit_s the spoon around in her irand. she .'r,as unable to recognize it, Fiowever. on openin-u iter eyes the patient irnmediately recognized the object. This woman most likely has a tumor il-t: A. occipital lobe ftrperi or parietal 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 EXCEPT: *--,$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 cofic\ 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 iliovements (adiadochokinesis) D. Moventents are not tlLiid btit are broken up inio sepaiate joint molemc-nrS (decornposirion of nyrvements) ., E: All dellcits are contlalateral ic the lesion
aJ.

LJ

The supcrior cerebeliar peduncles carry. Dorsal spinocerebellar f-ibers Cuneocelebellar fibers entral :pi rrocerebei Iar f rbers Olivocerebeliar fibers None of the above

46. -ihe prefroniai cortex (areas 9, 10, i

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 and she was asked to recognize the

object. After moving tiie spoon aror"rnd in her hand. she r,vas unabie to recognize 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;' terrtoorai !obc ..i cortex in lrontai lobe W orbitonreciiai

.i8. During voh-ri-ltary rrnr p,rrpirf *'l.,,* einlre nr4{6l nei}Ioils in the SOinal 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 Posiccniral gr lLi> B. Vestil-'uiospinal tract C. Dentaie nucle';s .{F. Pritrrrir'\ lnolor c0r'ie\ SupDi;irrentar\ i-noioi' coricx

50. Languagc anci speech recl'.rire the participation of bcih Wernicke's area atld Broca's area. These tn,c'' regior-ts ril-the brain ccmnrunicate with each other rria a flber bundle called A. The thaianocorticai tiacr B. The reticuiar activatirtg system C. The prefiontal lobe D. The lbrnix -VTltc lt'cLlate lh>cie Lrltts

5i. Which srrllctlire ir-r tlie brainstern and spinai cord


systems originating in the hypothalamr'rs?

is NOT a target of descending control

A.

L\LlClCLlS aIIiulBLlLls

- I-: _,--_^

B.

-Q ^_\ Q!,

Dorsal motor nucieus of ti-re vagus Intelrnediolateral ceil column ^ nucleLts Octrlontotor

.,/

52. The dopar.lii.iergic brain-reward circuitr-v of the iinibic system and hypcthaiamus is involved in A. tenrpcrature reguiaiiot-i B. body' weight 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; medial 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 functions .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 this subject r;hen feallul stirniiius is sirown. B. The arops lrom the hippocamplls to the manmillaly bodies travei in this structure. C. The neocortical strucrure r.i,ith major inpui io the hippocampus. D. Origin ol ma.jol ascincling pathwa,v to tl-re hippocampus and a major descendir-rg pathwal' io tite bt'lrinstem and spinai cord
58. A 55-,vear-old male patieni develops dancelike inr:oluntary lnovements. You diagnose the patient as l-raving a clegene'rative neuiological disease that rvas also evident in the patient's father and uncle. Where is tire utost iikel,v site olthe degeneration? A. Globr-rs pallidus. internai segment B. VL nucieits of iire tiraiamus C. Head ol'e lritdate lliicicus t:igra. pal's coinpacta -..-FSubstattiin E. Putameil

hl

\-iJ

'/' -{xig

59. A hy,pertensive patienr suliers a iacunar ii-rfarct anci cievelops uncontrollabie violent flinging i-novements ol'ii-re 1eft-irpper 1imb. Where is the iesion? A. Left globLis paliicius itrterriai segment B. Right subti.ialamic t.tLtcletis ('. l.eli stthstrrtttia nista rrucleLri , E. Right srrh.r:trntia nigt'a

\'I

60. Your paticnt has been ciiagnosed r,vith an eating disordei. The patient seems to have iost a significant aprount of n,eight in the last year. A lesion in v"'hich of the tbliowing areas might have cai-tsed the prtient's Pi'ob1em? lffiedial l'reoptic ttticleits 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 room 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 minutes 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;alked 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

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 nigla, pars colrpacta C. Mammiilar,v bociies D. Ver-rtrob:rsal conPier E. Basal nltcleus oillervil.ert
conjugate gaze' What 63. A patient has an inabilitf io voluntarily look tc the righr 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'oiital e,ve l-reld D. h'{edial krngitudiital fasciculr-rs Vl E. R.ight PPRF
10

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 bilateralll'. Wheie is the lesion? A. Frontal e1"e field B. Oculorttotor llerve C. Abducerts 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 order nociceptirre terminal in the dorsal holn C. first order- nechanosensitive terminais in the dorsal horn 4L). iermlnals of descending fibers from the raphe nucletts in the dorsal horn E. both A arrJ B abor c
67. Opioid peptides are released from A. r,rociceptive afl-erent endings B. ilrst orcler nociceptive terminai in the dorsal horn C. first oicicl ntechancsensitive terminais in the dorsal horrl D. iermilals of-descending fibers iiom the raphe nucleus in the dorsai horn E. both C anci D abcve 68. The most commoi'r inhiL"ritoi)'transmitter in the spinalcord is: A. acetylcitoline B. glutanl:.ttc C. glycine D. serotouitl
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 spiriothalamic 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 ntosi 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 approOriate tissue associated:

rniciciie cerebrai B.--anteri..rt' cerebral -< itnteritrt' chcr"oidai ,,.t

A.

72. Aninhibitory neLlrorransmitter used by neurons for-Lnd throughout the CNS. 73. Used b.v pregangiionic autonomic u*otts' f) r 7-1. An ere irrtory lteurotrallslnitter gsed bY'50%-of CNS neurons. L75. Used b1' tteurons in tire nucleus accumbens. l) 1A D-^A,,^,-',.1 hrr rrprrrnr,c in t1-re incrts certtlerls t1t/ y ilvlrrvr / \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 is io have ptosis and a constlicted pupil or"r the 1eit. anti a diminished gag reflex. 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 cerebe 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 irrferior 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 lateral skull. He recovers after a f-eiv minutes. and is asymptomatic for the next lew hours. He then develops a severe l-readachc. ciranges in mentai status. nausea, anci vomiting. Which oithe foliowing is the most likely cliagnosis? A. Basilar sktril fr-actLrie -/ 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 vein, a resicien'r inarjvefteirtiy damages the cervicai syrlpathetic trunk in a patient. Which of the following findings is most likely to be seen in tl-iis patient as a result of the injriry? A.-Coristriciion of the right pupil ,E ortation of tlte right PuPil ' C. lrrability to abdLrct the right eye D. Inability'to close ihe right eye . E. Paralysis of tlre platysma uuscle ott the right side

81. What is TRU{ about motor units?

A. Otre r-notor unit rrsualiy

contair.rs different types of mitscle fibers.

1/

B. 'fiie larger the rnotoiteuron, the greater the trumber of rnuscle fibers it iunervates. L.-i1 any rnriscle. tite iargest rrrtltor iiiiiis are tiie firsito be called r,lp ot- recrLtited. t, inotor Llnit inclLrdes all of the lnotoneurons that innervate one tnuscle. 1.. Tle larger rroto. t'its are corrposeC olrype S intiscle fihers.

g2. The nante of the sniail artery r,vhich branches ofTthe anterior cerebrai or anterior communicating artery r.r,hich distributes to part of the head of the caudate nucieus. internal capsule. and septal nucleiIii"eri or clroroi d a! arter'1 I ,Ac--\ B. .-\^r'ten of cerebral heuorrhage of Charcot C. Posterior chor"oidai afiery D. Recurrent artetl'of Huebnet' E. -l'halamoperfblating artery
.!/

g3. A 25-1,e1r-o1d mair fails rvhile skateboarding and strikes the ieft side of his head against a corlcrete ietaining v,.all. Cn pin'sical exai-nination oniv a ninor scalp abrasion is present at the site of the impact. riith rrinimai bieeiling that stops in a iew minuies. He is iriitially alert follorving this accident. br-rt then becante i,rr-rcouscions 30 minutes iater. A hea<i CT scan reveals a convex, 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 tl-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. Immediatel.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 physician with an inability ..rr'^ir ^--.:--tr.t ' r ^lliii^^^l examination r-eveais u'eakness of the right orbicLriaris ocuii. wfiICn ol trle lulluwlllg duulLl\rll4r 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 ( . IntetPedtrnculrr 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 vcmiting. His family .y*ii.t drooped. Afier he was taken to see a doctor, rhe neuroiogic exam demonstrated loss of side pain ald temperatlrre sensarion from his right side of the body and numbness on the left he still of his face. Ti1oggl-r vibrator.v sensation and proprioception were normal bilaterally. or paralysis spastic of had araxic gait ivitir iaiiir-rg toward the ieii side. Thele was no indication Babinslii u[*r. LIe had hoirseness to l-ris speech anci he had a diminished 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-erior 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 \rtediai 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 unabie to adduct her right e\c on attempted left lateral gaze. Convergence is intact. Both direct and consensual light reflexes are rrormai. Wiricir of the following 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 ociilomotor 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 information responsible for this response was conveyed through a (an): a) Monosynaptic reflex. b) Poiysynaptic reflex. ,t{S oinocere be I a r pat hway. -/ ,l) \one 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 head and eyes in response to visual anci auclitory f-rver connections c) Directil, irn'oiveci in and a part of the auditory pathwa-v Direciiy involved in and a part 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 meduilalis c) Terminal sulcus d) Fornix (the fimbria) e) Taii cf the caudate nucleus
.)1

93.

Match fhe fbllorving Questions:94. A lesion in opp*lt.^LrU tnalamic nucieus r,vili cause this TY ,{\ 95. This is trairsient abnorinal movements that occui'dr-iring rheumatic fever t)
96. This is due to transient sudden alterations in electrical activities of cerebral cortex This is dLre to decreased blood llou to ll'ontal iobe ( \. Schizophrettia $.-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 above

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

16