Neuro Midterm 5 Practice.docx

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A. Spinous process B. Facet joint C. Pars articularis D. Pedicle A patient presents to your clinic after surviving a gunshot wound to the head. The damage was somehow only localized to the thalamus, and the patient is now unfortunately deaf. What part of the thalamus was most likely damaged? A. Medial geniculate B. Lateral geniculate C. Mediodorsal D. Lateral dorsal A stillborn infant exhibited severe facial abnormalities and upon autopsy it was discovered that the brain lacked significant gyri and sulci. At this point, the most likely diagnosis is: A. Anencephaly B. Chiari malformation C. Craniorachischisis D. Holoprosencephaly E. Spina bifida During the second trimester of a pregnant 24-year-old, abnormally high levels of alpha-fetoprotein are found in her blood. Such elevated levels may be indicative of what fetal abnormality? A. Chiari malformation B. Failure of neural crest migration C. Holoprosencephaly D. Hydrocephalus E. Neural tube defect Failure of the metencephalon to develop correctly will have the greatest effect on: A. Memory and learning B. Motor functions C. Personality D. Reflex withdrawal E. Vision Failure of proper neural crest migration will have the greatest impact on: A. Microglia B. Myelination in the PNS

C. Pituitary gland development D. Secondary afferent fibers that cross the midline E. Flow of CSF through the ventricles An older woman slips on the ice and smacks the back of her head on the sidewalk. What function/characteristic is most likely to be compromised from an injury to the posterior aspect of the cerebrum? A. Hearing B. Olfaction C. Personality D. Somatosensation E. Vision A hemisection lesion of the thoracic spinal cord (Brown-Sequard) produces the following deficit: A. Bilateral loss of reflex activity below the level of the lesion B. Contralateral loss of fine touch superior to the level of the lesion C. Contralateral loss of pain and temperature above the level of the lesion D. Ipsilateral loss of pain and temperature below the level of the lesion E. Ipsilateral loss of voluntary motor activity below the level of the lesion Choose the equivalent pairing of terms with regard to terms of orientation in the brain. A. Anterior/dorsal B. Caudal/inferior C. Posterior/inferior D. Rostral/superior E. Superior/dorsal An older patient with a cerebellopontine angle tumor is most likely to have deficits associated with which cranial nerve? A. III B. V C. VII D. X E. XII A patient reports to his physician with difficulty swallowing and slurred speech upon waking one morning. The physician asks the patient to “stick out” his tongue, upon which the tongue deviates to the right. The most likely site of injury is the: A. Left facial motor nucleus

B. Left nucleus ambiguus C. Medial longitudinal fasciculus on the left D. Right hypoglossal nucleus E. Trigeminal motor nucleus on the right A patient with a history of uncal herniation, in which the midbrain is compressed against the tentorial notch, is most likely to present with: A. Dry mouth B. Lack of pain sensation on one side of the face C. Difficulty swallowing D. Problems moving the eyes E. Vertigo An individual with a tumor that compresses (only) the oculomotor nerve, will present with: A. Constricted pupils B. Diminished corneal blink reflex C. Dry eye D. Lack of taste over the anterior two-thirds of the tongue E. The eyes pointed down and out The cell bodies responsible for control of the muscles of mastication are found in the: A. Facial motor nucleus B. Mesencephalic nucleus C. Nucleus ambiguus D. Solitary nucleus E. Trigeminal motor nucleus Damage to which of the following would cause flaccid paralysis and hyporeflexia? A. Abducens nucleus B. Internal capsule C. Motor cortex D. Spinothalamic tract E. Thalamus

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Most CSF is resorbed from the subarachnoid space into the: A. Confluence of the sinuses B. Epidural space C. Internal jugular vein D. Lateral ventricle E. Superior sagittal sinus The resting membrane potential for a typical neuron within the peripheral and central nervous system is? A. +50 mV B. 0 mV C. -50 mV D. -70 mV E. - 90 mV This resting membrane potential from the question above is partly due to… A. Increased Na+ ions outside of the neuron B. Increased K+ ions outside of the neuron C. Increased Cl- ions outside of the neuron D. Increased Ca+2 ions outside of the neuron Which type of ion is most likely to cross the neuronal membrane during the resting state? A. K+ B. Na+ C. Ca+2 D. Cl E. SW+2 If sodium is allowed to freely move across the neuronal membrane, the neuronal membrane potential would be measured at? A. +50 mV B. +20 mV C. 0 mV D. -50 mV E. -90 mV

If potassium ions are allowed to freely move across the neuronal membrane, the neuronal membrane potential would be measured at? A. +50 mV B. +20 mV C. 0 mV D. -50 mV E. -90 mV The threshold for a neuronal action potential is best described as? A. A direct function of the Na+/K+ pump B. Opening of multiple voltage gated Na+ channels at the same time C. Opening of multiple voltage gated K+ channels at the same time D. Slow opening of voltage gated Na+ channels E. Slow opening of voltage gated K+ channels The absolute refractory period of a neuronal action potential is best described as… A. Opening of voltage gated Na channels B. Opening of voltage gated K channels C. Inactivation of voltage gated Na channels D. Inactivation of voltage gated K channels E. Influx of Ca ions Hyperpolarization of a neuronal action potential is driven by… A. voltage gated K channels and efflux of K B. voltage gated K channels and influx of K C. voltage gated Na channels and efflux of Na D. voltage gated Na channels and influx of Na E. voltage gated Cl channels and influx of Cl A common class of medications (i.e., topiramate, valproic acid, carbamazepine, etc.) are used to reduce epileptic activity in humans. What would be a reasonable mechanism of action for these types of medications? A. prolong the duration of the inactivation of K+ channels B. prolong the inactivation of Na+ channels C. increase duration of opening of Na+ channels D. decrease the membrane threshold E. shorten the duration of K+ channel opening

An increase in extracellular Na+ applied to a nerve axon ( hypernatremia ) would most likely result in? A. A decrease in the duration of a typical action potential B. A decrease in the hyperpolarization of a typical action potential C. An increase in the duration of a typical action potential D. An increase in the peak height of a typical action potential E. No change in the shape of a typical action potential Drug A applied to a nerve axon decreases the duration of action potential without affecting resting potential or peak amplitude. Which of the following is the most likely mechanism of action of Drug A? A. Block voltage-dependent Na permeability B. Increase rate of Na channel inactivation C. Decrease in voltage-dependent Na permeability D. Increase rate of voltage-dependent changes in K permeability E. Inhibition of Na/K pump A novel drug to reduce epileptic activity of neurons was discovered. Which of these would be a reasonable mechanism of action for this new drug? A. Change the neuronal threshold for action potential from -50mV to -60mV B. Change the resting membrane potential from -70mV to -60mV C. Increase the time of opening of voltage gated K channels D. Shorten the time of voltage gated Na channel inactivation E. Shorten the time of voltage gated K channel inactivation An infant is brought to the emergency department with a suspected sting from a scorpion. She is experiencing muscle twitching and thrashing, rapid eye movements, some drooling, increased sweating, signs of pain, and difficulty breathing. After administering an antivenom, ABCs are closely monitored. What is the most likely mechanism of the scorpion toxin? A. Inhibition of voltage gated Na channels B. Inhibition of inactivation of voltage gated Na channels C. Activation of the voltage gated K channels D. Inhibition of the Na/K pump E. Inhibition of vesicular release of acetylcholine A medication that inhibits the Na/K pump would result in…

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A. Depolarization B. Hyperpolarization C. No change The direction of propagation of an action potential in a myelinated axon is away from the neuronal cell body. THe flow of the wave of depolarization back toward the cell body is prevented by which of the following? A. High density of voltage-gated Na channels att the nodes B. Low density of voltage-gated K channels at the nodes C. High capacitance of axonal membrane beneath the myelin sheath D. Hyperpolarized (refractory) state of the nodal membrane in that direction E. Electrogenic activity of the Na/K ATPase in the nodal membrane A patient comes into the ED stating they feel sick and are having trouble moving their limbs, experiencing muscle cramps and severe weakness. You (an incredibly smart and well-prepared medical student) notice some muscle twitching and an abnormal heart rhythm. Blood work returns, indicating hypokalemia. How would this affect the resting membrane potential? A. Depolarization B. Hyperpolarization C. No change A 28-yo pregnant woman comes to the ED because of regular, forceful contractions. She states she had no prenatal care. Her labor is uneventful and she delivers a 3.3 kg boy with the malformation shown. Anatomy of the hard palate posterior to the incisive foramen appears normal. A failure of fusion of which of the following processes is responsible for this finding?

A. Lateral Nasal Prominences B. Lateral & Maxillary Prominences C. Maxillary Prominences D. Medial Nasal Prominences E. Medial & Maxillary Prominences You see a 30-year-old female patient for a follow-up after removing a tumor of a benign adenoma in the right cheek. She mentions that lately she has been experiencing swelling and pain of that cheek, especially while eating and drinking. Examination reveals a mass near the site of the recent operation. Which structure was likely injured during the operation? A. Auriculotemporal Nerve B. Buccal Branch of the Mandibular Nerve (V3) C. Facial Nerve D. Masseter E. Parotid Duct You see a 40-year-old male patient for reporting severe jaw pain and difficulty closing his mouth. He is a professional opera singer and noticed that the pain began before a performance during warmup exercises. MRI of the head reveals anterior displacement of the articular disc of the temporomandibular joint. Excessive action of which muscle likely triggered this condition? A. Buccinator B. Lateral Pterygoid C. Masseter D. Medial Pterygoid E. Temporalis

You see a 55-year-old male patient for a follow-up after biopsy of his right cervical lymph nodes. He reports that he has been having trouble reaching high objects. Examination reveals lateral scapular winging of the right scapula. Which additional actions might he have difficulty performing? A. Abduction of the arm at the shoulder B. Elevation of the hyoid C. Elevation of the scapula D. Protraction of the scapula E. Turning head up and to the right A16-year-old female patient that recently recovered from mononucleosis comes to your clinic reporting a midline mass on her anterior neck just superior to the thyroid cartilage. The mass is tender to the touch and moves up and down when she swallows or protrudes her tongue. What developmental process likely failed resulting in this condition? A. Ectopic thyroid gland B. Failed closure of pharyngeal cleft 2 C. Failed closure of the thyroglossal duct D. Migration of neural crest cells to pharyngeal pouch 3/4 E. Migration of neural crest cells to arch 6 Following a right carotid endarterectomy a patient returns for a follow-up appointment reporting difficulty eating and speaking. The tongue deviates to the right when protruded. Which nerve in the neck is impacted? A. Hypoglossal Nerve CN XII B. Inferior Laryngeal Nerve C. Superior Laryngeal Nerve D. Sympathetic Chain E. Vagus Nerve CN X A patient with elevated heart rate and blood pressure is examined by a battery of physicians, and they conclude that the patient’s condition is due to a deficiency of loss of the carotid sinus reflex. Which of the following is damaged as a component of this reflex? A. Baroreceptor afferent fibers from cranial nerve XI B. Glossopharyngeal efferent fibers C. Interneurons within the nucleus ambiguus of the medulla D. Efferent fibers contained in the intermediate component of the facial nerve E. Vagal efferent fibers

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A patient has a tendency to have elevated blood pressure and heart rate, which can be controlled in part, by a calcium channel blocker. Which of the following statements most accurately characterizes the effects of neurotransmitters upon calcium currents in heart muscle cells? A. They are reduced by norepinephrine acting through β-receptors B. They are increased by norepinephrine acting through β-receptors C. They are increased by acetylcholine acting on muscarinic receptors D. They are increased by acetylcholine acting on nicotinic receptors E. They are increased by serotonin acting on serotonin 1A receptors What cranial nerves contain parasympathetic components? A. II, III, V, VII, IX, X B. III, V, VII, IX, X C. III, VII, IX, X D. V, VII, IX, X Which of the cranial nerves with Parasympathetic activity utilizes the Pterygopalantine ganglia? A. III B. VII C. IX D. X A 58-year old female was suffering from hypertension and the drugs presently available to her seemed to be of little help. Recently, a new drug was approved for distribution and the patient’s physician recommended that she try it. The specific feature of this drug is that it selectively blocks synaptic transmission in autonomic ganglia in order to control blood pressure. Which of the following best characterizes this drug? A. Cholinergic antagonist B. Noradrenergic antagonist C. Serotonergic antagonist D. γ-Aminobutyric acid (GABA)ergic antagonist E. Peptidergic antagonist After receiving a diagnosis of having elevated blood pressure, an attempt is made to control blood pressure by preventing the synthesis and storage of norepinephrine. Which of the following should be applied to achieve this result? A. Guanethidine sulfate B. Reserpine

C. Phenoxybenzamine hydrochloride D. Hexametthonium chloride E. Metoprolol A patient is transported from a distant hospital to your surgical service by air ambulance. He had abdominal surgery and in the postoperative care unit he received a drug that was clearly not indicated. The drug caused intense contraction of the detrusor and trigone muscles of his bladder. The first dose failed to cause emptying of the bladder, so a second dose was given. However, and unknown to his prior care team, he has a mass that rather significantly obstructs his urethra, and has structural weakening in a portion of his bladder. Upon administration of the drug he first suffered retrograde urine flow that caused renal damage. Soon thereafter his bladder wall ruptured. Which drug or drug class most likely caused these adverse effects? A. Albuterol B. Atropine or another anti-muscarinic C. Bethanechol (a muscarinic agonist) D. Propranolol or a similar β-blocker E. Furosemide You see a patient that can’t move the tagged muscle on the left side of their face. If the nerve to this muscle is damaged, what other function would your patient have trouble performing? A. Depressing the Pharynx/Larynx B. Depressing the Mandible C. Elevating the Mandible D. Protruding the Tongue E. Tightening the Cheek You see a patient that requests surgical removal of the tagged structure. Injury to nearby nerves is a major potential complication to removal. Which nerve is at greatest risk for injury in removal

of this structure? A. Hypoglossal n. CN XII B. Recurrent laryngeal n. C. Spinal accessory n. CN XI D. Superior laryngeal n. E. Vagus n. CN X You see a 15-year-old patient with chronic acne at your emergency clinic reporting severe headache. The patient has a fever and physical examination shows bilateral lateral gaze palsy and periorbital edema. MRI imaging reveals a septic thrombus within the cavernous sinus. Which vessel most likely transmitted infection to the cavernous sinus? A. Angular Vein B. Basilar Artery C. Internal Jugular Vein D. Middle Meningeal Artery E. Superficial Temporal Vein You see a patient for a follow-up visit following surgery to remove cervical lymph nodes, resulting in injury to the tagged structure. They report on their intake form that they are having difficulty swallowing and talking. You ask them to open their mouth, protrude their tongue, and say ‘ah’. What functional deficit would you most likely observe?

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A. Deviation of tongue to the left B. Deviation of tongue to the right C. Deviation of uvula (back of soft palate) to the left D. Deviation of uvula (back of soft palate) to the right E. Inability to open the mouth. You see a 40-year-old female patient reporting muscle cramps, eye pain, and sore throat. You observe that her eyes protrude from the orbit and that there is a midline mass on the tongue that is inflamed. This mass is a result of which of the following processes? A. Failed differentiation of pouch 2 B. Failed migration of thyroid tissue C. Insufficient supply of neural crest cells to arch 3 D. Persistence of pharyngeal cleft 2. E. Persistence of the thyroglossal duct. A 40-year-old patient receives middle ear surgery after perforating the tympanic membrane during an explosion caused by an industrial accident at their job. A few days later they visit your clinic reporting that food tastes metallic and unpleasant. What additional impact would this injury have in this patient? A. Dryness of the ipsilateral Eye B. Inability to wink ipsilateral eyelids. C. Paresthesia of the ipsilateral anterior tongue. D. Paresthesia of the ipsilateral lower jaw and chin E. Reduced activity of the ipsilateral submandibular/sublingual glands You see a 6-month-old infant patient displays left lateral flexion of the neck and rotation of the face to the right. You suspect fibrosis of a neck muscle due to trauma during birth. Which muscle is most likely affected in this patient? A. Infrahyoid Muscles B. Platysma C. Sternocleidomastoid D. Suprahyoid Muscles E. Trapezius An 80-year-old woman visits her primary care physician to report facial pain and difficulty opening her mouth. Radiography reveals osteoarthritis of the pictured joint. Which of the following nerves detect the pain resulting from this injury?

A. Auriculotemporal n. B. Chorda tympani C. Inferior alveolar n. D. Lesser Petrosal n. E. Lingual n. A patient presents with right hand weakness. All the following could be cause right hand weakness except: A. Median neuropathy B. Ulnar neuropathy C. Radial neuropathy D. Medial Cord plexopathy E. Lateral Cord Plexopathy F. Upper Trunk Plexopathy (In case MSK didn’t drill this into our heads hard enough) Extensor weakness of hand can be caused by injury to: A. Median Nerve B. Ulnar Nerve C. Radial Nerve D. Axillary Nerve E. Musculocutaneous Nerve Patient presents with right thumb numbness. This could be caused by all of the following except: A. Median neuropathy B. Radial Neuropathy C. Upper Trunk Plexopathy D. Lower Trunk Plexopathy

A patient comes to you with numbness only on the plantar surface of the right foot. This could be due to: A. Common peroneal neuropathy B. Tibial Neuropathy C. Femoral neuropathy D. Superior Gluteal Nerve Myasthenia gravis is caused by antibodies to A. Muscarinic receptors B. Nicotinic receptors C. Glutamate receptor D. Glycine Receptors A 40-year-old patient comes to ED with complaint of diplopia and ptosis that gets worse by the end of the day for the last 4 months. He has a nasal speech. He can’t keep his neck upright and he has dysarthria and dysphagia. What should you do to manage him? A. Admit him to ICU and start him on intravenous immunoglobulins B. Prescribe prednisone 60 mg every day and give him an outpatient neurology appointment C. Tell him that he has myasthenia gravis, and he would benefit from an urgent thymectomy D. Discharge patient home on pyridostigmine Which of the following statement is incorrect about neuromuscular junction disorders A. They all cause muscle weakness B. Lambert Eaton syndrome is caused by antibodies against voltage gated sodium channels C. Lambert Eaton syndrome results in hyporeflexia D. Botulism is a presynaptic disorder You see a 38 year old woman in your clinic who was recently diagnosed with small-cell carcinoma of the lung. She complains to you that her “arms and legs get tired super fast” and that she can’t seem to keep her eyelids open. Which of the following conditions are you most concerned about? A. Myasthenia Gravis

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B. Guillain-Barre Syndrome C. Lambert Eaton Syndrome D. Left Pontine Stroke A 32yo male is brought to the ED by a co-worker. He works as a gardener at the Botanical Gardens. He is showing some signs of facial grimacing and is experiencing muscle spasms of the neck and abdomen that have gotten worse over the past 24hrs. His co-worker brought him in because of his labored breathing and asked if there was anything you could do to help his muscles relax. Upon examination, he does not have any abnormal sensory findings aside from some slight pain from the muscle spasms. His cranial nerves were intact except for an increased jaw-jerk reflex and increased facial muscle contraction. Which of the following mechanisms may be responsible for his symptoms? A. Muscle aches conducted by gamma motor neurons due to overworking B. Increased type Ia and II somatosensory nerve fiber activity C. Exposure to a toxin that inhibits inactivation of the voltage gated Na+ channels D. Exposure to a toxin that inhibits the release of acetylcholine E. Exposure to a toxin that inhibits the release of glycine A 4 YO is brought into the Emergency Department with symptoms of muscle twitching as well as increased pain and touch sensations in the left leg. The mother tells you that the child was playing in the garage and started crying. She lets the physician know that there is some bug spray and mouse poison in the garage but does not think the child got into these. She thinks that maybe the child was bitten or stung by something. Based on what you know, what might be the most likely cause of these symptoms? A. The child was exposed to strychnine in the mouse poison B. The child was exposed to an organophosphate in the bug spray C. The child may have been exposed to some rusty nails in the garage and may have tetanus D. The child may have been stung by a bee E. The child may have been bitten by a black widow Which of these correctly describes the mechanism of action of the toxin this child was exposed to? A. antagonist of glycine receptor preventing inhibitory glycine release in postsynaptic cholinergic neuron (inhibit inhibitory effect) resulting in increased excitability B. bind to acetylcholinesterase enzyme that is supposed to break down ACh to end communication, prevent ACh breakdown resulting in overstimulation of postsynaptic nerve

C. finds glycine and GABA inhibitory neurons and cleaves vesicle associated membrane protein (synaptobrevin) to inhibit release of glycine or GABA D. A Type I hypersensitivity causing allergic inflammatory response E. forms pores in lipid membrane, induces influx of calcium that promotes neurotransmitter release You are a neurology resident in clinic seeing a patient who was recently diagnosed with ALS. You prescribe this patient a medication that is commonly prescribed to help manage ALS symptoms. The following month you see this patient in clinic again and they are complaining of episodes of dizziness and drowsiness since starting this medication. Which of the following describes the mechanism of action of the medication you most likely prescribed? A. Agonist at the GABA-A chloride channel B. Agonist at the GABA-B G-protein receptor C. Agonist at the nicotinic neuromuscular receptor D. Antagonist at the intracellular calcium channel (ryanodine receptor) E. Inhibitor of Ach release in the neuromuscular junction What is the name of the drug described in the above question? A. Diazepam B. Baclofen C. Succinylcholine D. Dantrolene E. Morphine Tapping the tendon of the left biceps caused an exaggerated reflex in a patient who suffered a right MCA stroke 3 weeks ago. The arm is not used for any activity; it is spastic and held flexed. The most likely explanation for the observed spasticity and hyperreflexivity is: A. Loss of contacts between UMNs and spinal inhibitory interneurons B. Loss of contacts between UMNs and spinal LMNs C. Without input from UMNs, the LMNs fail to integrate inputs from the Ia afferents D. Without input from UMNs, the LMNs fail to integrate inputs from the Ib afferents E. Due to paralysis and disuse, the arm becomes rigid and hyperreactive Which of the following options correctly describes a bladder in storage mode? A. Maintained by inputs from the parasympathetic nervous system

B. Preganglionic nerves project from S1-S3 C. Preganglionic nerves will synapse at the inferior mesenteric ganglion D. Postganglionic neurons are very short A physician would perform a spinal tap to test for meningitis where there is no spinal cord, to prevent damage. Between what vertebrae would there be no spinal cord? A. C6-C7 B. L1-L2 C. L4-L5 D. T11-T12 E. There is spinal cord present at all levels. A middle-aged man has severe pain and skin lesions in the umbilicus region of his abdomen. A diagnosis of shingles (a herpes zoster virus that lives within the peripheral nerves) is made. What spinal nerve innervates the dermatome that contains the umbilicus? A. C7 B. L2 C. T6 D. T10 E. S1 Injury to the entire left side of the spinal cord at L2 would result in: A. Loss of left leg touch and proprioception, loss of pain and temperature of the right leg, left leg weakness, and increased left leg reflexes. B. Loss of left leg touch and proprioception, loss of pain and temperature of the left leg, left leg weakness, and increased left leg reflexes. C. Loss of left leg touch and proprioception, loss of pain and temperature in both legs, left leg weakness, and increased weakness. D. Loss of right leg touch and proprioception, loss of pain and temperature of the right leg, left leg weakness, and increased left leg reflexes. E. Loss of right leg touch and proprioception, loss of pain and temperature of the right leg, left leg weakness, and increased right leg reflexes. The postganglionic neurons of the parasympathetic nervous system release

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_______________as a neurotransmitter to act at _________________receptors on organs. A. acetylcholine; adrenergic B. acetylcholine; muscarinic C. acetylcholine; nicotinic D. epinephrine; adrenergic E. epinephrine; muscarinic An infarct of the anterior spinal artery at the L4 level resulting in the loss of blood supply would result in: A. Weakness in both legs, Babinski's sign in both feet, loss of pain and temperature perception in both legs with normal touch sensation in both legs B. Weakness in both legs, no Babinski's sign in feet, a loss of pain and temperature perception in both legs with normal touch sensation in both legs C. Weakness in both legs, no Babinski's sign in feet, a loss of pain and temperature perception in both legs, loss of touch sensation in both legs D. Increased reflexes in both legs, Babinski's sign in both feet, a loss of pain and temperature perception in both legs with normal touch sensation in both legs E. Increased reflexes in both legs, Babinski's sign in both feet, a loss of pain and temperature in both legs with a loss of touch sensation in both legs A patient arrives in the ED after a severe bike crash with the inability to feel touch on the left side of their arm, body and leg. Temperature and pain sensation are normal on both sides of the body and there is no signs of weakness with normal reflexes. Where might the damage be? A. L lumbar posterior column B. L cervical posterior column C. R lumber ventral horn D. R cervical ventral horn A patient arrives at the ED after a knife stabbing during a domestic argument. During your physical exam you notice the patient’s right side arm and leg demonstrate increased reflexes with some minor weakness in the right arm and right leg. You also notice a Babinski sign on the right foot. A. R lateral funiculus B. L lateral funiculus C. R anterior Horn D. L dorsal column

A 53-year old man is diagnosed with a tumor localized to the thalamus that disrupts most but not all types of sensations. Which of the following sensations would still function despite the presence of the tumor? A. Olfaction B. Conscious proprioception C. Taste D. Vision e. Auditory A 23-year-old woman is exposed to a neurotoxin that selectively destroyed the Purkinje cell layer of the cerebellum, resulting in loss of balance and coordination. Of the structures or regions indicated below, which one is most directly affected by the loss of Purkinje cells? A. Red nucleus B. Reticular formation C. Deep cerebellar nnuclei D. Ventrolateral (VL) nucleus (thalamus) E. Spinal cord A 62yo man presents to your clinic for leg weakness and loss of balance. During your thorough history you find out that this patient consumes significant amount of alcohol daily. Which of the following structures of the cerebellum is typically affected by alcohol intake first? A. Vermis B. Floculus C. Nodulus D. Lateral hemisphere A 57-year-old man develops weakness in his right hand which came on gradually and slowly. He ignored it in the beginning, but it continued to get worse. 9 months later, he noticed that his left arm developed the same weakness, and it progressed where his arm also was involved, and he could not shampoo his hair. You examine him and find fasciculations on his deltoid muscle, biceps muscle and atrophy of bilateral FDI muscles. Interestingly he has hyperreflexia on examination in both arms. You notice that he has slightly nasal speech and he complains about occasionally chocking on food. He has no history of neck trauma or spinal surgery. He does not have any history of polio. You are most worried that he has: A. Amyotrophic lateral sclerosis B. Myasthenia gravis C. Ischemic stroke in Medulla D. Myelopathy at C4 E. Bilateral C5 radiculopathy A 21-year-old man is being evaluated for muscular weakness that started when he was 13 years old and is getting worse with time. He is noticed to have lower motor neuron signs on

examination such as weakness, fasciculation and muscle atrophy in both legs. His hands are spared. He currently uses a walker. He does not have any urinary or bowel complaints. He does not have any sensory complaints. He did not have any other childhood illness. The most likely diagnosis is A. Poliomyelitis B. Spinal Muscular atrophy C. Amyotrophic lateral sclerosis D. Myelopathy affecting T12 E. Cauda Equina syndrome Which of the following stroke presentation patterns is most often associated with the basilar artery? A. Locked-in syndrome B. Lateral pontine syndrome C. Medial medullary syndrome D. Lateral medullary syndrome Which of the following stroke presentation patterns is most often associated with the posterior inferior cerebellar artery? A. Locked-in syndrome B. Lateral pontine syndrome C. Medial medullary syndrome D. Lateral medullary syndrome Which of the following stroke presentation patterns is most often associated with the anterior spinal artery? A. Locked-in syndrome B. Lateral pontine syndrome C. Medial medullary syndrome D. Lateral medullary syndrome A72yo male presents to your clinic complaining of some weird symptoms that started to appear this morning. Upon examination, you discover weakness of the entire left side of the face, weakness in the right upper and lower extremities, and loss of hearing on the left side. Which of the following arteries is most likely involved in this case? A. Anterior inferior cerebellar artery B. Basilar artery C. Medial cerebral artery D. Superior cerebellar artery

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A 71-year-old man with history of diabetes for the last 20 years is seen in the clinic for complaints of numbness and tingling in both feet. Which of the following you don’t expect to see on examination? A. Fasciculations B. Muscle atrophy C. Hyper-reflexia D. Flaccidity A 27-year-old man with chronic history of intermittent low back pain gained 20 lbs. over the course of summer after his wedding. One day during while he was sitting in his office chair, he experienced sudden onset low back pain with shooting pain in his right leg. He took some Tylenol and continue to work. He limped to the bathroom a few hours later with a steppage gait on the right side and he noticed that his right butt cheek did not feel the toilet seat and he could not feel the stool coming out of the rectum on the right side of the groin but his sensation on the left side was normal. He could not feel the right side of the groin while cleaning himself with toilet paper. However, he was able to urinate and defecate. Unable to bear the excruciating pain, he went to the local emergency department. What do you think is this patient suffering from: A. Cauda equina syndrome B. Conus medullaris syndrome C. Myelopathy at T5 D. Acute inflammatory demyelinating polyneuropathy A 69-year-old man with history of prostate cancer under treatment with chemotherapy is being evaluated in the emergency department because of inability to urinate for the last 16 hours. He also is experiencing numbness in the groin which is symmetric on both sides. He does not complaint about any weakness but on examination, you notice that he has some bilateral dorsiflexion weakness of about 4/5 bilaterally. His patellar and ankle jerks are hyperreflexic. Bilateral upgoing toe is found on examination as well. What is the most likely diagnosis? A. Conus medullaris syndrome B. Cauda Equina Syndrome C. Myelopathy at C5 D. Chronic inflammatory demyelinating polyneuropathy E. Acute inflammatory demyelinating polyneuropathy Describing the differences between the cauda equina and conus medullaris syndrome, which of the following statement is not true? A. Urinary symptoms are quite early in conus medullaris syndrome B. Urinary symptoms occur quite late in cauda equina syndrome C. Cauda equina results in asymmetric saddle anesthesia D. Conus medullaris results in symmetric saddle anesthesia E. Radicular pain is more severe in conus medullaris syndrome than cauda equina syndrome

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A 32-year-old man with no significant past medical history comes to the clinic with 1 week history of neck pain radiating to the right middle finger, numbness along the dorsum of the arm, forearm and hand, with weakness noted in triceps, and forearm pronation. His right triceps reflex is hypoactive, but all other reflexes are intact. Most likely diagnosis is: A. Right C7 radiculopathy B. Right c6 radiculopathy C. Lateral cord plexopathy D. Radial neuropathy E. Right C5 radiculopathy Trauma involving the intervertebral foramen between the C3 and C4 vertebrae results in damage to the anterior root of a spinal nerve. Which of the following nerve fibers are damaged? A. Motor fibers of the C3 spinal cord level B. Motor fibers of the C4 spinal cord level C. Sensory fibers of the C3 spinal cord level D. Sensory fibers of the C4 spinal cord level E. Motor and sensory fibers of the C3 spinal cord level F. Motor and sensory fibers of the C4 spinal cord level Which of the following reflexes will be lost with S1 radiculopathy A. Patellar reflex B. Ankle reflex C. Babinski reflex D. Grasp reflex E. S1 radiculopathy will not affect reflexes

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Neuro Midterm 5 Practice.docx

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