Neuro Midterm 2

1. A 41 year old woman complains to her family physician about recurring episodes
of sharp pain that seem to originate from around her mouth and check. The pain is
so intense that she is unable to eat, brush her teeth or apply make-up. Where is the
lesion most likely located? (select all that apply)
a. Primary motor cortex: Facial region
b. Internal capsule: posterior limb
c. Internal capsule: anterior limb
d. Midbrain
2. Which of the following portions of the ventricular system does not contain
choroid plexus? (select all that apply)
a. Cerebral aqueduct
b. Fourth ventricle
c. Lateral ventricle
d. Interventricular foramen
e. Third ventricle
3. Which of the following represents the most common cause of blood in the
subarachnoid space (subarachnoid hemorrhage)?
a. Bleeding from an arteriovenous malformation
b. Bleeding from a meningioma
c. Bleeding from an aneurysm
d. Trauma to the brain
4. A 76 year old man presents with a resting tremor, bradykinesia, and stooped
posture. These observations suggest loss of a prominent population of cells in the
brain. Which of the following structures is most likely affected in this patient?
a. Lateral cerebellar nucleus
b. Locus ceruleus
c. Red nucleus
d. Substantia nigra
e. Subthalamic nucleus
5. A 78 year old man presents with deficits suggesting an occlusion of the posterior
spinal artery at spinal cord levels C4-T2. Which of the following structures are in
the territory served by this vessel at these levels?
a. Anterolaterla system
b. Cuneate fasciculus
c. Gracile nucleus
d. Lateral corticospinal tract
e. Medial longitudinal fasciculus
6. Which of the following symptoms is located within the territory served by
branches of the PICA by clinicians?
a. Weakness in UE & LE
b. Deviation in the tongue movement
c. Impairment of vibration and touch-pressure sensation
d. Difficulty with alleviating pain
e. Impaired taste, gag reflex, aortic reflex, and cough reflex

7. Which of the following neurotransmitters is associated with the cells in the

somatomotor cortexthat project to the spinal cord as corticospinal tract?
a. Acetylcholine
b. Dopamine
c. Gamma Aminobutyric acid
d. Glutamate
e. Serotonin
For Questions 8 & 9:
A 57 year old woman presents with the main complaint of difficulty speaking. The
examination reveals that the womans tongue deviates to the right on attempted
protrusion. When she says Ah her soft palate elevates slightly on the left and the uvula
deviates to the same side.
8. This combination of deficits would most likely indicate a small lesion in which of
the following?
a. Crus cerebri on the right
b. Genu of the internal capsule on the left
c. Genu on the internal capsule on the right
d. Lateral medulla on the right
e. Medial medulla on the right
9. If the same symptoms occurred on the span of minutes to hours, then what artery
might be occluded?
a. Lenticulostriate artery
b. Posterior cerebral artery
c. Anterior spinal artery
d. Posterior inferior cerebellar artery
10. A 64 year old man is brought to a rural health clinic by a neighbor. The history
reveals that the man is a recluse, lives by himself, and does not regularly visit a
physician. The examination reveals that the man has difficulty walking, chorea,
and dystonia, and is suffering dementia. The neighbor believes that the mans
father died from a similar disease. A tentative diagnosis of Huntingtons disease is
made. Absence of which of the following structures in a MRI of this man would
be consistent with this diagnosis?
a. Anterior lobe of cerebellum
b. Head of the caudate
c. Lateral thalamic nucleus
d. Substantia nigra
e. Subthalamic nucleus
11. A 59 year old man, who is a family physician, confides in a neurology colleague
that he believes he has early stage Parkinsons disease. The neurologic
examination reveals a slight resting tremor of the left hand, a slow gait, and a lack
of the normal range of facial expression for this man. Which of the following is
the most likely location of the degenerative changes at this stage of this
physicians disease?
a. Bilateral substantia nigra

b.
c.
d.
e.

Left globus pallidus

Left substantia nigra
Right globus pallidus
Right substantia nigra

For Questions 12 through 14:

A 34 year old woman presents with the complaint of seeing two of everything
(diplopia). The history reveals that the woman becomes tired during the workday to the
point where she frequently must leave her workplace early. The woman said that her
vision problems appeared first, and later she noticed that, when she drank, it would go
down the wrong pipe. The examination reveals weakness of the ocular muscle, difficulty
in swallowing (dysphagia), and mild weakness of the upper extremities. Sensation is
normal. Further laboratory tests indicate that the woman has a neurotransmitter disease.
12. Based on the history and symptoms experienced by this woman, which of the
following is the most likely cause of her medical condition?
a. Amyotrophic Lateral Sclerosis
b. Huntingtons disease
c. Myasthenia gravis
d. Multiple sclerosis
e. Parkinson disease
13. Which of the following represents the most likely location of the neurotransmitter
dysfunction in this woman?
a. At the termination of the corticonuclear fibers
b. At the termination of corticospinal fibers
c. At the neuromuscular junction
d. Within the basal nuclei
e. Within the cerebellum
14. Which of the following represents the neurotransmitter most likely affected in this
woman?
a. Acetylcholine
b. Dopamine
c. Glutamine
d. GABA
e. Serotonin
For the questions 15 through 18:
A 67 year old man visits his family physician with the complaint that he is not able to
do things like I used to. The examination reveals that the man is not able to perform
rapid alternating movements with his L UE, and is not able to touch his left index finger
to his nose because of a tremor that worsens as the finger approaches the nose. He is able
to do these movements on the right. When he walks, he is unsteady with a tendency to
fall to the left. He has no sensory deficits.
15. Which of the following terms specifically designates the inability of this man to
perform rapid alternating movments?
a. Dysarthria
b. Dysdiadochokinesia

c. Dysmetria
d. Intention tremor
e. Resting tremor
16. Which of the following terms specifically designates this mans inability to touch
his nose with his index finger?
a. Dysmetria
b. Intention tremor
c. Rebound phenomenon
d. Resting tremor
e. Static tremor
17. The MRI of this man shows an infarcted area in the brain. Based on the deficits
this man is experiencing, which of the following represents the most likely
location of the lesion?
a. Basal nuclei of the left side
b. Basal nuclei of the right side
c. Cerebellar cortex and nuclei on the left side
d. Cerebellar cortex and nuclei on the right side
e. Midbrain on the right side
18. Assuming the lesion to the result of the occlusion of an artery, which of the
following is the most likely candidate?
a. Left anterior inferior cerebellar artery
b. Left superior cerebellar artery
c. Lenticulostriate arteries on the left
d. Right anterior inferior cerebellar artery
e. Right superior cerebellar artery
For questions 19 & 20:
A 41-year old trumpet player for the LA Philharmonic Orchestra was reprimanded by his
conductor for playing out of tune. The musician had been having difficulty reading his
music and had also been having more problems than usual playing his horn; he went to
his physician. On his way to the doctors office, he had to pull his car off the freeway
because he was violently sick and his head was spinning. Upon reaching the
physicians office, the physician conducted a brief neurological exam and noted that the
man was totally deaf in his right ear and his eye showed prominent left-beating
nystagmus. The musician also had a flaccid right lower lip and a flattened right
nasolabial fold. His right eye was red and dry and had no corneal reflex. Sensations in
his body and face were normal, as were deep tendon reflexes in his entire body.
19. Where was the lesion?
a. Midbrain
b. Pons
c. Medulla
d. Pontomedullary junction
20. What systems were involved? (Select all that apply)

a.
b.
c.
d.
e.

Cochlear division of the CN VIII

Vestibular division of the CN VIII
Facial Nerve CN VII
Trigeminal Nerve CN V
Abducens Nerve CN VI

True/ False section: If false, please write below what changes are necessary for it to be
true.
21. Bells palsy is a result of a central lesion that results in an irreversible change in
the motor supply to the contralateral face.
22. A lesion to the corticobulbar tract between the Trigemminal Nucleus & Abducens
Nucleus would result in the uvula deviating to the same side.
23. Signs of UMN syndrome are: positive Babinski, hypertonicity, weakness, atrophy,
fasciculations, loss of fractionation and clonus.
24. Disinhibition of the globus pallidus internus is what mediates the freezing
symptoms in individuals with Parkinsons Disease.
25. Flexion withdrawal reflex is a polysynaptic reflex.
26.
Within the internal structures of a muscle, the presence of spasticity occurs
as a result of the loss of disinhibition via the lateral reticulospinal tract.