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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
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Etj RCSCiENCE - TINAL
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trXAMINATION
C 24rH,2S09

Tinre: 9.G0 - 1 tr:S0
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Daie:

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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

e

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

3

4. An 62 1,crr'-oid $,'cilel presents with a right homcnymous hemianopia r.viih macular sparing. l-he vessel rrrost iiliei;' .r'' calrse this deircit is: a) 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

-t wide anart. A 42 year-oici man v.rir.'oSltr:sll llerve nefve v c ) i{iglit Giossophali'llgeai ti) Lefi GiosscPirarYngeal neive c) Vagus ilei'\'e . nausea.{ uppei nloior neliron cerebeiilinl lornel .*. but ivhen askecl to do the f. c.. This man most likely has a rvv.pination of both hands was very slow and very irregular.hfq no.se. en MRi shows an iniarci in tiie iri'aiirsieii:r..oman stlit-nbles and f-ails towards the 1et1 iiequentll'.."d) R.. Which of the Foiior.. iefr lateral vestibuiospinal tract rl teri cortico5pinal tract f.on ph.:J in..-rp:lgss-!$L.:lott.v iitr''olves the middle cerebeilar peduncie fr.6.!erl' end nlenlin. FIe ..-ol. E::amination Reveals rveakness of masticatory muscles on the right side and a CT irtrage shor... I 10..'"g. and developed a severe tremor as his fi'ger appr-6acheci nis iffitrtonatior-r-s..lir none oi-ahoie hich o1'1ite i'olloiving staiements aboitt the ceiebeiia.r erai::ination she is noiecl ro have <ieviaiion of hertongue to the right..u . e) right laterai vestibr-riospinai tract A 60 year-olci woman and feil several times. This A finding is due to arii injr'rry to the .j"-' r l Le ti ilr... A 55-year old man began to stumble frequently..sits his cloctor because he has had troiibie cherving and he could not feel the texture of tite fbod.risei.va... his le.eakness oithe i'iglit arrr. lesion olthe: a) ni 'LtP 7ci t)..r. b) loss of baiance. Ci. 23-.rear. V. Which cther symptom is this man likely to have? a) r. He visited hospital . Her arm tnovements are Accurate aird without tremor.'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. 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.. and trystagnlus" c) 7.v-sical exalrination it rvas iound that he had sluired speech i{is muscle strength was good. the rl.. During Evaluation. r'-".r \\JlNgu^J Lur)tLqLllrJ.r ilcul'on hrsai garr".:.C tei:-raie is invoived in an argiiment at rvlrich tiu-ie she sustains a stab wound to tire righr neck.rr..r ir*e. \-/ il right cei'ebeilar hemisphere .ight h1'Pcglossal nerve .1.s a smali tllntor in the Pons area.heJlfleC.i.: peduncles is NOT true? a) tire middie ierebeliar peduncle contains axons irom ihe contralateral and ipsilateral pontine nuclci propriccepiive information fiom the ior..i .l'ing sti'Llctures cor-tici be responsibie for this condition? a) right leticulosPinal tract }.

Coqce{ring primai. 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.-'Broca's "-"'"" b) i1 most pegple. 10 and 5. V c) d) e) a) It is important fbr motor pianning anci bimanuai cooi'dinaiiot-i. GD c) inlerior colliculus r-nedial genicr-ilate nucieus both ears are represented in ail of these ni-rciei 12. of iire cerebellar cofiex 13. Which of the b) 1l-\'stagmus following siatements about langr-rage is TRUE? aiea controls comprehension oi lanquage -t}. 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 W d) f\/.24)/< 11. 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: . area 4: Lesions in arca J result in apraxia.v* independentl.v olthe basal ganglia.7. lt works entirel. l': !i J . it has a map of the ipsilateral body with small discrete arcas devoted to each muscle.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.{\ io:s ot'haiance c) r'omiting d) iailing ei Bebinski sign i 5.rrkinf e cells AX " @) d) Provides the oniy output of the cerebellar deep nuclei. Receives inhibitory input from climbing fibers. language is controlied by the right cerebrai hemisphere c) people r.v ntotor cortex. Singie nellrons in area 4 can influence motoneuron poois for several muscles. Prirnary aliditon.. vz are excited by the axons of the basket cells 14. col'tex is located in: the tlie parietal lobe. The Pr. Receives excitatory input from parallel fibers.

What other ou!rrurt Ll arlJv!r... i'rirrciPal :lticl:iis of V l)eniatc nucicus $.r'hite commissltre sensation 22. l.r.. _iil.:i-'. Altered endocrine responses. Centrai canal D.r'ing w'culd be lound in the Klr-rver-Br:cy syndrome ercept: a) H.:iyenliiral car:dalis subnucleus .17 Which of the fbiio-r"'ing are exampies of lou'ei' mclor neurons? a) nelrrolts i:i lamina IX of the spinal cord b) lateral vestibtrlospinal tract c) itypoglossal rlttcietls A{ ril ol'iite rhtrrc F c) {anci C 18. right irigemii-rai lemniscus {'.t triqetltilial mesencephalic tlttcieus 1 . ieit t. rrr :\.qe e+ctinn thr.oss oi-pain atld iei. --K C.vperoralitl'.t'ihe fblior. fascicLrius 3r'acilis d. Duri'g a peurological exanination.1 rit..orrqh the hrainstem contains F'c1ingcr Westphal nucleus.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. left irigeillirral lemnisct-ts B.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.v clamage io A. Which oi'rire fbiicv. Psycliic biindr-ress.seltsation lroni tiie ieit side olthe face rvith otherfaciai rer"naining i-tttt'mai cor-rlci oe cilte to a lesion in the . Obesitl'.' 3ltlcl(l:rici'ul Sr Sterit llttli:ll ii ol'lire dot'sal holrt '-MH ilte r eltiral r. ---4. Ail c.1s fror-n tl-re giob-.i:ci riucicut 21. a patient cannot teli v'tth his eyes closed whether the ner-rrologist llered cr extendetl his toe. there is likel.-@ri siit tr:i ger-r.uperatru'c. the iascicr-ilus cllneatus $.i i rlal c alidali s subnuc eus /// E f.)v structllre )'oli cxpect to see in ihe same section? A n A. lrorrc'r'r.\. d c) d) c) Lr) HyposexualitY.

cistema maEna 24.Licrii iras siifl-eie. Medial striate anery R. sr-ibdural hematoma D. Rupture of the middle r.v B. The n1ost common location r. A patieni I'omits r ioiently' in response to'. Sr-rbfornical organ -<fi. 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.23. Arachnoid granulations and villi 25. contmunicating h1''dlocephalus B. A vertebrai arierv . Occlusion of r. Pineal i:lrlnd 28. Median e irtittencc 'i. choroicl plexus ccl'uht'al aqLtc. A posteriot' cot-nmlinicatii-rg afier-y D. In vrhich branch of the anterior circulaticn is ihe emboius most 1ikely to become iodged? A.2 Anterior choroirial arteLv 27. l'he anteriol' communicating arter. Perineuronai spaces B. Organr"rrri vascuiosun-. An ACi\ E. lirtcral lbranten ol'Luschka E.. Lenti cr-ri ostriaie artel'r' .neningeal aftery was a 1ikei1'cause oithe recent death of a 14-year old bo"v who sufferecl a fatai bion. The callse of death would result rnost iiltely iiom: A. What area of the CNS responded to tire toxit-ts and initiatei the reflex vomiting? r\. epidural hematoma C.. I-eptomeningeal vessels C. Deep br:rrtch of the PCA C. interventricular ioratnen of lvlonro B.vhere blockage of CSF llorvresults iir hydrocephalus is: A. iiecr-rrrent afieill oi }ler"ibner D. Yor-rr pa.to the temporal region of tire skuii. Area postl'ema C. - B. Epenciynta olthe ventricles -ddD.oxins preseni in CSF. subarachnoid hemorrhage 25.'An MCA C. ivhich enters an internal carotid arteiy. A paticnt has valvr:lai ireart disease that gives rise to an embolus.vhich of the lbllowing vessels might cause the ini-arct? A.litct ''-1{ D.j lrom a small lacunai iniarct of the thalamus.

T10 spiuai coi'd segtneni on the right Il..ving neural structures consists f 1 cf axons that have the capacity to regenerate if lt / A. and a loss of paiu and 't ten-iperature titat begins eior..choices below er-restions 2c)-j3: Match rhe fbllow'ing type of hydrocephalus to the most appropriate at ail): not cr once.B. More than oi. Gap junctions betweetr capiliary endothelial cells j_5. Which of the following is the most ii. arm.wer iin-rb on the right. Where is the lesion? A.6{ L.^^+t.^.the T8 ciei'maiome on the le1t. Tight jLrnctions betr.tthic lateiai scierosis c1 .' Normal pressure iry'drocephaius E. Poliomi ciitls D.r'eeu astrocyte foot processes C. You suspect that ti-re patient has: *A.uirortant eietr. A leurniscirs 36.vperactive reflexes in the io. itas enlargecl ventricles seconciary to a loss of neurons due to Aizheimer's disease.'-.r'eetl capillary endotheliai cells D.-. itiis bladciel ploblerns anC u'alks as iiirisiher ieei are stuck to the floor.^L^1.ie choice in A-D is corect 34.'I l) Llt ursPl r4r Lrr C Hydrocephalus ex vaclio D.*". A fascicLriLrs '/ED.-4r{esistance . T8 spirtai cord segmeiit on ihe r"ight C. Patient r\ ri iras a tumor that is compressing the cerebrai aqueduct. A neuroiggicai exan: of ycur paiient reveals a ioss olvibiaiory sense in the lower lirnb on the rigiit" weakpcss and h. Syringcnrl'e1ia B. iras a tumcr in the subarachnoid space. A dorsal co!umn E. Thc patient aiso notes that he has difficuity using either hand.ient that maintains the integrity of the blood-brain barrier? io lipici-soi ubie substances . \'lultiple :r'lercsis C.S c uarC s. . Patient 30.1-.A. than more (each choice ma)'be used cnce. l'6 spinal cord segnient on the ieft feel the 37. B t'orl'n . you are cieveioping a drug ro cross the blood-brain barrier. Whieh ot-the follor. Patient 32.Om rlt Lll Ii '. T8 spinai cord seqment on the lef1 E. Patient 3j. Tight jr-rnctiot-ts betr. Nonconrtrtunicaring hvdrocephalus _-. You ol intrinsic no respo'rse to pinpricli in skin oieither hand. A tract B. 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. Patierrt 31. T6 spinerl corci segnteitt c'n tiie i'ight B.mvctrc. 29.ild ro t-ile E. or shouider and a biiateral wasting irand muscles.\ dot'slii itrot . A. has CSF absorption problen-rs atthe ievei oiil-re arachnoid granuiations.^- gatil lB 1^-.

ln the Llppel'and low'er limbs on the left B.38.r. You would expeci a spastic weakness in this patient to be: A.tA biiateral loss of pair-r and temperature seitsations from sacral dermatomes B. Bilaterai spastic rveakt-iess in the lower iirnbs E. Amvotrorriric laieral sclcrosis C. Observecl before the onset olspinal shock D. A ner. ii/eidnig-Hoffn'tunn disease D.hat might )'ou expect to observe in the patient? A./^ . :\ltered r ibratory sense iir the lorver limbs C. swallowing. A neuroiogical exam conducted ? weeks aiter the accident reveals thai ihe indir.bcrn inlant has difficuity sucking. you might expect a pain anci temperature ioss: A.v. In this patient. Your patient might have: /. A spastic biadder *o. Irythe T-1 dcrmatonte on the right --. . Flaccid lreakness beicu the lesion C. Wllat might you expeci youi patient io have? fspasti. w. Guillai rt-Ban'd sYniirot. Hyporefleria in both ioi. During a period ol spinal shock.ZfBelow thr' T5 dermatome on the right E. llvasthertie grai is 42.iras been occluded at the point r. A loss of re{'lexes iit tire upper limbs talls off a ladder anci lractures a vertebra. lpsilateral to and below the level of the lesion B. Altered tolich sensaticns in both lorver limbs C.B. Contralatcrai to ard below the level of the lesion E. 39.'A Babinslii sisn . g. A tulnor pressing against the dorsal funiculus of the spinal cord at lumbar levels has caused neurological deficits. The anter. or breaihing and has flaccid w'eakness in the limbs.iduai has a complete hemisection of the right sicle of tlie spinai cord at T5. Ipsilateral to and above the level olthe lesion C.i'er iinbs spinal cord aR Bilater.ne E.. Bilaterai to anci at iire ievei oiiiie iesioir 41 .reaknlss oiboth upper limbs B.al clegeneration of LMNs in the ventral horns olthe liinrbal Babinski signs \$Bilaterai "' 43. A cclnstruction vvoi"ker 40. That is caused by degeneration of dorsal root ganglion celis below T7 on the left.ior spinai efier. What kind of motor disorder might the patieni have? Polionrr elitis t/-. tlyperactir e reflexes beiorv the lesion B. D A clasp itnif-e rei1ex E. yor-rr patieni l-ias suif-ereci rrauma to the spinal cord.vhere it suppiies the midthoracic segnlents ol-the spinal col'C. . A loss ol-irrotopathic serlsations frotn thoracic dermatomes D. In all det'matomes beloiv T7 on the letl C.

on openin-u iter eyes the patient irnmediately recognized the object. Tact p/^l ol'1hc rbor e 47 . a spoon rvas placed in her right hand and she was asked to recognize the object.Judgmerrt C. Foresight -D. A. Concurreni fiexion oiboih ll'rists in response to eiectrical stimulaiion is characteristic of which a5p. alpha motor nellfoirs in ihe spinai cord ma. she .rr'\ rTrctor cofic\ Sunlricnrerttar\ ntoior coric\ . k \esiibiliai'nuciei "-reticrrirr ibrntarioir 49.44.'ements (decomposition rurlwerncrrts) ol E-All detlcits are contialaterai to the lesion 45.c:riral g\ r'Lrs B.. A. The preiror-rtai cortex (areas 9.-/ entral spinocerebei lar ll bers r'-W D. Dentaie nucleus -/ir. During voluniarl iirorenreirt.'r. 10. i 1 and 12) is essential for': 4fixatiuct thinking B. Movenrents are not f-lnid but are broken r-rp inio separate joint mor. Tren-iol is present dr:ring lnovements (iniention tremcr) C.v receive input from ir. A 57-year old woman was examined by a neurologist for a suspected brain tumor. Dorsal spinocerebellar f-rbers B. cerebrai cortex tl cerebelinm D. The foilowir"rs staiemeni is not true in regard to cerebellar iesions. A positive Romberg sign is present B. The superior cerebellar peduncies can'y. occipital lobe ftrperi or parietal lobe inf'erior parietal iobe inr-erior temporal lobe orbitonredial cortex in lrontal lobe 48.gf tlte itct'r oits Sr:ieill'l -(r)l Posi. tiie spinal corcl arising frorn ali of the following EXCEPT: *--.$escentiirrg axons t A/ red nuicleus B. Cugeocelebellar tibers t). Olivocerc'beliar' fibers E. Priu. This woman most likely has a tumor il-t: A. The patient is unabie ro perform rapid alterr-rating morrements (adiadochokinesis) D.as unable to recognize it. After nloviit_s the spoon around in her irand. With the patient's eyes closed. Vestihrrlospittaj u'act C. Fiowever. None of the above 46.

ving siateixent is not true in regarci to cerebellar iesions. The folloi.rru rhinkirig B. Concr"rrrent flexion oiboth wrists in response io eiecirical stimulation is characteristic of which at'er of ilt.' terrtoorai !obc . During voh-ri-ltary rrnr p. r' pari eial lohe --. With the patient's e1'es closed" a spoon was placed in irer right hand and she was asked to recognize the object. A. Dentaie nucle'.vas unabie to recognize it. feCeiVe infUt ffOnf escencling axons in the spinal coi'd arisins iior:..' it.\bt. occipital lobe -/-' t.-57-)... i l and 12) is esseniial for: . she r. on opening her eyes tl:e patier-it irnrnediately recognized the object. -ihe prefroniai cortex (areas 9.{F. 10. Tact (ts*qlt o t'rhc rbor e 47 . ittt-ei'iu. The patieni is i-urabie to perforn rapid alternating iliovements (adiadochokinesis) D. Trerrior rs present dLrling rno\ ements (inienlion ircnlcl') C..ludgment C..irrentar\ i-noioi' coricx . After moving tiie spoon aror"rnd in her hand. Foresight S. Moventents are not tlLiid btit are broken up inio sepaiate joint molemc-nrS (decornposirion of nyrvements) .: ali of tlie fol1on'ing EXCEPT: red nucler. A positive Rcmberg si. Vestil-'uiospinal tract C.rs cerebrai cortex cerebeliun"r vesiibuial nuciei reticular fbrnaticn 49..x/ 4fr.i cortex in lrontai lobe W orbitonreciiai a . LJ The supcrior cerebeliar peduncles carry. Pritrrrir'\ lnolor c0r'ie\ SupDi. This woman most likely has a tiimor ir-r: A. inf'erii'r' parietal iobc D. However.* einlre nr4{6l nei}Ioils in the SOinal COrd nfaf.44. Dorsal spinocerebellar f-ibers Cuneocelebellar fibers entral :pi rrocerebei Iar f rbers Olivocerebeliar fibers None of the above 46.' F"' (rll Posiccniral gr lLi> B.'r't orts sr slclll'.i8.rrpirf *'l.Vwpcli ('.ear old woman w'as examined by a neurologist for a suspected brain tumor. E: All dellcits are contlalateral ic the lesion aJ. A.s .sn is present i].

The neocortical strucrure r. -Q ^_\ Q!. -..uman's) abilit. These tn. pal's coinpacta -. Globr-rs pallidus.--_^ B. The arops lrom the hippocamplls to the manmillaly bodies travei in this structure. The prefiontal lobe D. Each For the foliowing 4 questions.jol ascincling pathwa. A.I-: _.v to reguiate body weight at a set point? Preopric area: pu.tici'ioi ai'ea t' -+. will affect the animal's (or system structures on the left with their can be tlsed oniv once.iergic brain-reward circuitr-v of the iinibic system and hypcthaiamus is involved in A. You diagnose the patient as l-raving a clegene'rative neuiological disease that rvas also evident in the patient's father and uncle. Strpraciriasmatic nttcleus: supraoptic nttcletts 54-57.v site olthe degeneration? A. Dorsal motor nucieus of ti-re vagus Intelrnediolateral ceil column ^ nucleLts Octrlontotor . 57. tenrpcrature reguiaiiot-i B.- 56. Which srrllctlire ir-r tlie brainstern and spinai cord systems originating in the hypothalamr'rs? is NOT a target of descending control A.. Putameil hl \-iJ .rire the participation of bcih Wernicke's area atld Broca's area. n'iagnocellular nucleus & ' D.. Fornir .vrus (-. L\LlClCLlS aIIiulBLlLls 1 .lii. llammij.. etc. internai segment B. The reticuiar activatirtg system C. D. C.*. body' weight regulation C./ 52. match the limbic 5-1.iesci'ibsd iri tl're siatements below. Lesions of u.-FSubstattiin E. sex and gambling acidictions.hich oi' the foliowing pairs of hypothalamic areas l. A 55-. Origin ol ma.-. The lbrnix -VTltc lt'cLlate lh>cie Lrltts 5i. Region:il blcod ilow iiicreases in this subject r. Head ol'e lritdate lliicicus t:igra.D<-adtlictive behaviors including 53. Lateral hypothalantr"is. B. r'elease of oxytocin alrd vasopressin drugs.50.hen feallul stirniiius is sirown. B.. VL nucieits of iire tiraiamus C.lq-thalamic traci r\.i. The dopar. The thaianocorticai tiacr B.{mrgd*ia 1 \ 55.v to tl-re hippocampus and a major descendir-rg pathwal' io tite bt'lrinstem and spinai cord 58.c'' regior-ts ril-the brain ccmnrunicate with each other rria a flber bundle called A.vear-old male patieni develops dancelike inr:oluntary lnovements. Medial parvoceilr:lar nucieus. medial hypothalamus C. Cinguiate g.ith major inpui io the hippocampus. ansu'ei functions . Where is tire utost iikel. Languagc anci speech recl'.

Your paticnt has been ciiagnosed r.' rD. but he 'vr. l. pars colrpacta C. Laterai part of the anterior zone of hypothalamus On New year.ert conjugate gaze' What 63.eli stthstrrtttia nista rrucleLri .vith an eating disordei.orsal'. Use the iollowing case vignette to answer qr-restions 68 & 69:' 5i. \. Sr-rbacutc combinecl degeneration C.r:trntia nigt'a \'I 60. Ventrorlcdial nucielt-s oi h1'pothaiamus E. I luntirr3itili's ciisca:. Togethr:i'" these signs anci symptoms sr-iggest that the patient may have: -a' A.. Left globLis paliicius itrterriai segment B. apd l-raving iro rvallet or identification.llrlltt.gaze.eight in the last year.tosr triiilis f 62. Brodt-naltrl area l7 B.pertensive patienr suliers a iacunar ii-rfarct anci cievelops uncontrollabie violent flinging i-novements ol'ii-re 1eft-irpper 1imb. Ver-rtrob:rsal conPier E. h'{edial krngitudiital fasciculr-rs Vl E. 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. Right fl'oiital e..-{oniifi-rl lliulrt arrLt ruvrtlrrrllr ^-A " ^-'--'^.r.-ev:rked nyslagjlus-in all directions.5. Claime0 ne \^r'as alt Uil-Lruty d. The parient said he was he could not remember why cor-rld not recall where he was staying. ^:-l:-^ *i!^r i. Substarttia nigla.c nf lhc nrrrseq as a he WaS ln tne Clty. !.rl'i''s s1 itdi'omc -E-.ight PPRF 10 I . Right subti. D.alked with a brofd-based gait' 61-62. Wl-rat tuisilt be one siie of t:errroryJ ciegeneration in the patieni in the previous description? A.yiivr' muscle His attepdant.'/' -{xig 59.r'. . 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. Basal nltcleus oillervil.v bociies D. Right srrh. The patient gave his name but trip to the city but a business on address or arv other personal intbrmation.ialamic t. did not remember his uns6aven. strength 'ur':ls 5/. Rostral irtterstitial tlitcieris on the right C. E.tLtcletis ('. Alzheinrer's disease B. Mammiilar.ve l-reld D.'s Eve. When questioned 5 minutes later. R. The patient seems to have iost a significant aprount of n. c'r^ 1.\ ner-rrologicai eram revealed a. A hy. an elderly male staggers into the emergency room smelling of alcohol. Head oi'tiie caticiate nLtcieirs l-l B. Where is the iesion? A.

serotouitl w/- -z' lE\cee. Convergence is intact. The abiiir. .v to identif.flrst order nociceptirre terminal in the dorsal holn C. both A arrJ B abor c 67.ttc C. glutanl:. nredirl ictttniscti: . Wheie is the lesion? A. Pretecill rttrclei P E. Medial longiturdinal iirsciculus 65. \-/ - 66.rd ilie pupillary iiglit reflex is normal bilateralll'. Oculorttotor llerve C. An 18-year-oid patieiti traffic accident. acetylcitoline B.rociceptive afl-erent endings B.v/t \J/ 11 . He experiences phantom lintb pain fbilor. sensitizatior-i of cutatreoi-ts pain endrr-rgs ciue to injury B. anteriol spinothaiamic lract B.] u. "Phantom limb" is an example of : A. Opioid peptides are released from A. iermilals of-descending fibers iiom the raphe nucleus in the dorsai horn E.E psychtrl. both C anci D abcve 68. Frontal e1"e field B. first order.^ y' 69.-D& spinal tract oI-V /' f f . Substance P is reieased fiom A. ar.v. The most commoi'r inhiL"ritoi)'transmitter in the spinalcord is: A. first oicicl ntechancsensitive terminais in the dorsal horrl D. iermlnals of descending fibers from the raphe nucletts in the dorsal horn E.-e durln-u horizontal gaze. lateral spiriothalamic tract J ( .nechanosensitive terminais in the dorsal horn 4L).v the value of unseen coins in.vor-i handle them depends on an intact: A.-Pai n ttitrti it lat i oti . sensor)'projection sr-tifers a below knee ampuiaiiorr in a road referred pain D.64. ilrst orcler nociceptive terminai in the dorsal horn C. Your patient develops an inability to adduct either e.voiir pocket as. Abducerts llerve I). r.r!Lical hailrrciilnion C.nttol lrosicro nredial tlliclelts . glycine D.r'ing tire surger. nociceptive aft-erent endings B.

coriicospinal tract 7 D.70. \ . cerebellar hemisPl-rei'e C.^. Tlie vessel ntosi likel1"io callse this deflcit is: 71. GABA B. 73... Auterrur' :nirtlri aiiet'1 Middie cerebrai aitery (NiCA) Posterior cerebrai arterl (PCA) Posteriol irrferior cerebellar afiery' (PICA) a central 7g. An ere irrtory lteurotrallslnitter gsed bY'50%-of CNS neurons. T]-rese symptoms Could be catised b1' a lesiotl in the: A.I)opamiire E. Ar-r 62 lcar-olc1.. Used b1' tteurons in tire nucleus accumbens.1 hrr rrprrrnr.r'ith macular sparing. Which oitite follou'iiig nuclei plal oathua.-'. difficulty arising fiorn a chair when seated. t lvuLlllLl u -\ i \ A.c in t1-re incrts certtlerls t1t/ y ilvlrrvr / \r. Inf-erior Oiirary NLicleus bchlear Nitcietts T2 .- iole in auditor-v.--anteri.vins neurotransmitter to the approOriate tissue associated: rniciciie cerebrai B. 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. On physicai exam.v pregangiionic autonomic u*otts' f) r 7-1.ear-oid -/E al. ' D. SirPerior Oiir ai'r \ttcletts B. Aninhibitory neLlrorransmitter used by neurons for-Lnd throughout the CNS. Which of the follow'ing vessels is most iikeiy occliided? \. superior cerebellarr E. he is io have ptosis and a constlicted pupil or"r the 1eit.rrine marr conrplains of trouble srvaliowir-ig anci hcarseuess.yf ' /-r. L75. subtlialatt-tic t"lttcieus B. Acetrvlcht-litle L).Anteriol' i n ferior cerebe l lar arterl' (AICA) 77.ait. anti a diminished gag reflex.. \\.rt' cerebral -< itnteritrt' chcr"oidai .. A 63 lear-oid Patient is seen in a ciinic u'ith il-re foiiorving symptoms: a testillg tremor in the Hand.. Glutantate C.i:eflexes and descending effereirt (-!'. D. posterior cerebral 72-76. A63-1. 72. l) 1A D-^A..t A. Subsiarxia nigra"-/ u. Used b. Norepinepi. a siorr shul'flinc !.ith a right homcnvrro'Js herlianopia r. Match the lbllor. E.onterr presents .

/. Inability'to close ihe right eye . . --. t. Ir. What is TRU{ about motor units? A. a contestant is "knocked out" by' a blor. ciranges in mentai status. t'its are corrposeC olrype S intiscle fihers.-\^r'ten of cerebral heuorrhage of Charcot C. g2. lrrability to abdLrct the right eye D. He is iriitially alert follorving this accident. These events are most associateci r. and septal nucleiIii"eri or clroroi d a! arter'1 I .!/ g3.e1r-o1d mair fails rvhile skateboarding and strikes the ieft side of his head against a corlcrete ietaining v. A hea<i CT scan reveals a convex. '-V E.v to the lateral skull. Which of the following findings is most likely to be seen in tl-iis patient as a result of the injriry? A. He recovers after a f-eiv minutes. inotor Llnit inclLrdes all of the lnotoneurons that innervate one tnuscle. anci vomiting.79. Basilar sktril fr-actLrie -/ Epidtrral iterttort'itag:e -F ' ( D. Which oithe foliowing is the most likely cliagnosis? A. During a boxing match.rs different types of mitscle fibers. internal capsule. He then develops a severe l-readachc.i t.lp ot. 'fiie larger the rnotoiteuron. I1 atterlptisg to introduce a catheter into the iight internai jr-rguiar vein. Posterior chor"oidai afiery D.recrLtited. a resicien'r inarjvefteirtiy damages the cervicai syrlpathetic trunk in a patient.cl iri' arter\ \ iicidie ntc:lilit.rith damage to n.'ti al-tci\ 1a . tite iargest rrrtltor iiiiiis are tiie firsito be called r. E. Tle larger rroto.r.-Coristriciion of the right pupil ..l'cat rein ol'Cricrt cei'et'. -l'halamoperfblating artery .Ac--\ B.. A 25-1. ( ltvernoiis sitlrts C. br-rt then becante i.E ortation of tlte right PuPil ' C.A. Bridging r. The nante of the sniail artery r.I Iiterior !. Paralysis of tlre platysma uuscle ott the right side 81. ltttracerebt'al ltetitorrhage Subarachnoid herlorrllage Subdural hetrlatoma 80. nausea.all. L.rr-rcouscions 30 minutes iater. riith rrinimai bieeiling that stops in a iew minuies. 1/ B. lens1ikel"v to be shaped are.vhich branches ofTthe anterior cerebrai or anterior communicating artery r. 1. and is asymptomatic for the next lew hours.hich distributes to part of the head of the caudate nucieus. Otre r-notor unit rrsualiy contair. Recurrent artetl'of Huebnet' E. e irrs B.f hemonl-rage centered ol'erthe leit parietal region.-i1 any rnriscle.. Cn pin'sical exai-nination oniv a ninor scalp abrasion is present at the site of the impact.hich of tl-re foliowing parts of the intracraniai vascuiature? . the greater the trumber of rnuscle fibers it iunervates.

1en oimegar]clie empties into which of the following cisterns A. Hy peiaclt-is C.:--tr.vldt'ome -/7.v after the space passes tl-rrough the irlterlamiuai space between the 4th and 5th lumbar vefiebrae. Cisterna magna or cerebellomeduliary cistern ( . 87. His family . InabilitY to cheu' D. lnabilitl' to shlug the shoulder 86. ir4edial tttediiiiarr sr ttdrottte l't ) Lateral tticrlttliat'1 sr trdrottte c i \rtediai Pci-itit-re s. or paralysis spastic of had araxic gait ivitir iaiiir-rg toward the ieii side. Ti1oggl-r vibrator. B. IntetPedtrnculrr cistern ^ I-'t -^-l^^..rr'^ir ^--. LIe had hoirseness to l-ris speech anci he had a diminished gag reflex. Patient's symptol]ls are seen in which oithe lailowing s-vndron"ies? r. Physicai 85. woirarl presents to her physician with an inability . C.t ' r ^lliii^^^l examination r-eveais u'eakness of the right orbicLriaris ocuii.ear olci man haci a sudden onset of dizziness and vcmiting.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.LIJI'gIII LUIIIUAI ir. Superior cisiern B.r. lrttratttuscttiat' .ear-old. OcclLision of rvl^. A neurologist is perfbrnling a lumbar puncture on his patient. 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. Inability to i'eei the face E. Afier he was taken to see a doctor.-. Subarachnoici D. Thele was no indication Babinslii u[*r. U.ould likei. A 24-i. Subcutaneolis E.t drooped. Immediatel... wfiICn ol trle lulluwlllg duulLl\rll4r symptoms r.v sensation and proprioception were normal bilaterally.y*ii. which does it enter? EPiciural -'/--A. The tbr-ar.needle 84. Subdr"rrai to close her right eye. ^:-'^.\oi-re oi above l4 .l'aiso be present? Blurred vision ' A. None of the above Questions 87-88 noticed that his left 50 1.

b) Medial longitr.t{S oinocere be I a r pat hway. Alzheimer's disease L). -/ .)1 93.r' e) Right Trochlear nerve 90. A lesion in opp*lt.. The nrain efferent fiber sy'stem exiting the amy'gdalcid nucleus is the .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.-S.4^) cl All of tlie ubou. b) Poiysynaptic reflex.l) \one oi'at'.{\ 95..pontine angle produces a ) Facial cals. Lesion in the cerebelio. Convergence is intact. HemibalismLis l5 |) .a)' Stria tenninaiis b) Stria meduilalis c) Terminal sulcus d) Fornix (the fimbria) e) Taii cf the caudate nucleus . This is due to transient sudden alterations in electrical activities of cerebral cortex This is dLre to decreased blood llou to ll'ontal iobe ( \. This is trairsient abnorinal movements that occui'dr-iring rheumatic fever t) 96. Schizophrettia $.^LrU tnalamic nucieus r.vili cause this TY . 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.rdinal fascicr-rlus c) Right abclilcens nerve d) Right ociilomotor nerve .ove I v/.v / . Match fhe fbllorving Questions:94.i' s chorea ['. The sensory information responsible for this response was conveyed through a (an): a) Monosynaptic reflex. .vdenhan.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 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.

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 100.98. / 99. \\'hich one is NOT a branch of internal carotid artety? a) Ophthalmic afterY J b) Posterior communicating artery'* . Foliowing are the parts of cerebeiium EXCEPT a) Anterior lobe b) Middle lobe c) Floculo noduiar lobe -a '*f c) Cingulate lobe V ermls I ! :_ F I i t t 16 . .

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