4X Neuro Module – Coma

1) A young female patient is brought to ER. She is unconscious and unarousable. A CT scan is done
and the neuroradiologist reports that she has herniation syndrome. What is the most likely cause of
her loss of consciousness?

A) she is in coma due to primary lesions of her cerebral cortex

B) she is in coma due to primary lesions of her thalamus
C) she is in coma due to primary lesions of her reticular formation
D) she is in coma due to secondary lesions of her reticular formation
E) she is not in coma, it’s only that her reticular activating system has been inactivated

2) The MRI of a 49-year-old woman with brain tumor and ataxic breathing shows tonsillar herniation.
Which of the following portions of the brain stem would be most adversely affected by tonsillar
herniation?

A) Caudal midbrain
B) Rostral midbrain
C) Rostral Pons
D) Rostral Diencephalon
E) Medulla

3) Roth is a 28-year-old Caucasian All American Super Bowl quarter back star who on arrival at the
emergency room after a motorbike accident with no helmet on, was jovial, ebullient and fully
aware. He urged to be discharged home as he had no obvious physical injuries. About 30 minutes
after his arrival, Roth lapsed into coma with no evident motor deficit. The most likely cause of
coma in this patient is:

A) Acute Subarachnoid hemorrhage

B) Acute Subdural hemorrhage
C) Acute Parenchymatous hemorrhage
D) Acute Epidural hemorrhage
E) Acute Lateral ventricle hemorrhage

4) At about 7.30 a.m. the day after Christmas, the son of a 71 year old extremely obese African
American male called 911 for an ambulance saying that he is unable to wake up his father. At ER,
the attending physician suspecting a metabolic disorder obtained blood samples from the patient
for lab work up. Which of the following metabolic disorders is the most likely cause of coma in this
patient?

A) Hyperchloremic alkalosis
B) Respiratory acidosis
C) Diabetes Mellitus
D) Metabolic alkalosis
E) Acute aspirin overdose

5) Placing a small amount of cold water in a patient’s right external auditory meatus will under normal
circumstances result in:

A) Nystagmus with a quick component to the left

B) Both eyes drifting slowly to the left
C) The right eye looking to the left
D) Nystagmus with a quick component to the right
E) Both eyes looking upwards
 6) A 25-year-old male was brought to the ER. It was not possible to obtain a history from the patient,
however a bystander said that he was struck by a motor vehicle. On performing the Glasgow coma
scale the findings in response to pain the findings were: no response to eye opening, flexion of
upper extremities at elbows but extension of lower extremities and incomprehensible sounds. If
the brain stem of this patient is intact, which of the following statements concerning this patient is
correct?

A) The patient is unconscious and there is in no deviation of the eyes

B) The caloric test with cold water causes deviation of the eyes to the opposite side of irrigation then
jerking movements to the same side
C) The caloric test with cold water causes deviation of the eyes to the same side of irrigation then
jerking movements to the opposite side
D) The caloric test with cold water causes deviation of the eyes to the opposite side of irrigation
E) The caloric test with cold water causes deviation of the eyes to the same side of irrigation
F) The patient is conscious

7) Which of the following Glasgow coma scores would be the most consistent with a diagnosis of
severe diffuse axonal injury?

A) 14
B) 15
C) 10
D) 9
E) 8

8) What is the part of the reticular formation (RF) that is dedicated to reception of somatosensory
inputs?

A) the Raphe nuclei

B) the magnocellular RF
C) the locus coeruleus
D) the lateral RF
E) the paramedial RF

9) Lateral Reticulospinal tract arises from:

A) Raphe nucleus
B) lateral reticular formation at the medulla level
C) lateral reticular formation at the pons level
D) medial reticular formation at the medulla level
E) medial reticular formation at the pons level

1d, 2e, 3d, 4c,

5a, 6e, 7e, 8d, 9d.