Anatomy

Question 1

What is the function of the Ventromedial nucleus of the hypothalamus?

What does injury result in?

Answer 1

Satiety

Injury: Hyperphagia –> Weight gain

“VentroMedial injury makes you Very Massive”

Question 2

What is the function of the lateral nucleus of the hypothalamus?

What does injury result in?

Answer 2

Hunger

Injury: Anorexia and Failure to thrive

“Lateral injury makes you Lean”

Question 3

What is the function of the posterior nucleus of the hypothalamus?

Answer 3

Heating, sympathetic

“Hot Pocket”

Question 4

What is the function of the anterior nucleus of the hypothalamus?

Answer 4

Cooling, parasympathetic

“Anterior nucleus for A/C”

Question 5

What is the function of the suprachiasmatic nucleus of the hypothalamus?

Answer 5

Circadian Rhythm

“You need sleep to be charismatic”

Question 6

What is the function of the supraoptic and paraventricular nuclei of the hypothalamus?

Answer 6

Synthesize ADH and Oxytocin

Question 7

What is the function of the supraoptic and paraventricular nuclei of the hypothalamus?

Answer 7

Synthesize ADH and Oxytocin

Question 8

What is the function of the arcuate nucleus of the hypothalamus?

Answer 8

Secretion of dopamine, GHrH and GnRH

Question 9

What is the function of the preoptic nucleus of the hypothalamus?

Answer 9

Sexual Behaviour

(releases GnRH)

Question 10

Wallenberg Sydrome

1. Occurs due to occlusion of which artery?
2. How does it present?

Answer 10

1. Posterior Inferior Cerebellar Artery (PICA)
2. Presents as:
   - vertigo/nystagmus
   - loss of pain/temp. sensation on ipsilateral face + contralateral bofy
   - Ipsilateral Horner Syndorme (ptosis, myosis, anhidrosis)

Question 11

A patient comes to the hospital due to right arm tingling and numbness. Shortly after he develops right sided convulsions followed by a generalized tonic-clonic seizure.

Where did this seizure orginiate?

Answer 11

D - The Primary Somatosensory Cortex

(Postcentral Gyrus)

The initial right arm tingling was most likely due to a partial (focal) seizure, where conciousness remains intact, which then later on spread to the postcentral gyrus, the Primary Motor Cortex which then resulted in the convulsions.

Question 12

Broca’s Aphasia

1. What happens to speech?
2. What happens to comprehension?
3. Where does the lesion occur?

Answer 12

1. Speech is nonfluent
2. Comprehension is intact
3. B - Inferior Frontal Gyrus

“broken boca”

boca = mouth in spanish

Question 13

Wernicke’s Aphasia

1. What happens to speech?
2. What happens to comprehension?
3. Where does the lesion occur?

Answer 13

1. Speech is fluent but lacks meaning
2. Comprehension is impaired
3. E - Superior Temporal Gyrus

“Wernicke is wordy but makes no sense”

Question 14

Conduction Aphasia

1. What happens to speech?
2. What happens to comprehension?
3. Where does the lesion occur?
4. What happens to repetition?

Answer 14

1. Speech is fluent
2. Comprehension is intact
3. Arcuate FasCiculus
4. Lack repetition

(they cannot repeat a sentence after hearing it)

Question 15

Which cranial nerve would be at risk during biopsy of a lymph node in posterior triangle of the neck?

How would impairment of this nerve present?

Answer 15

Accessory (XI) Nerve

It would present with drooping of the shoulder and impaired abduction of the arm above the horizontal since the accessory nerve innervates the trapezius muscle

Question 16

What is the function of the thalamus?

Answer 16

It is the major relay for all ascending sensory information except olfaction

Question 17

Ventral Postero-Lateral Nucleus of the Thalamus

1. From which tracts does it recive input?
2. What sensations is it responsible for?

Answer 17

1.

Spinothalamic

Dorsal Column/Medial Lemniscus

2.

Vibration, Pain, Pressure, Proprioception, Light touch, Temp

“VPL –> VPPPLt”

Question 18

Ventral Postero-Medial Nucleus of the Thalamus

1. From which tracts does it recive input?
2. What sensations is it responsible for?

Answer 18

1.

Trigeminal Pathway

Gustatory Pathway

2.

Face Sensation

Taste

“Makeup goes on the face”

Question 19

Lateral Geniculate Nucleus of the Thalamus

1. From which tracts does it recive input?
2. What sensations is it responsible for?

Answer 19

1.

Optic nerve (CNII), Optic chiasm, Optic Tract

2.

Vision

“Lateral see the Light“

Question 20

Medial Geniculate Nucleus of the Thalamus

1. From which tracts does it recive input?
2. What sensations is it responsible for?

Answer 20

1.

Superior Olive

Inferior Colliculus

2.

Hearing

“Medial hears the Music“

Question 21

Ventral Lateral Nucleus of the Thalamus

1. From which tracts does it recive input?
2. What sensations is it responsible for?

Answer 21

1.

Basal Ganglia

Cerebellum

2.

Motor

“Very Loud Motor”

Question 22

Lacunar Infarcts

1. Main location
2. How do they most commonly occur?
3. How do they appear in the brain?

Answer 22

1. Lenticulostriate artery
2. Lipohyalinosis with small vessel occlusion
3. Small fluid filled cavities

Question 23

What foramen are in the Anterior Cranial Fossa? (1)

Answer 23

Cribiform plate

Question 24

What foramen are in the Middle Cranial Fossa? (5)

Answer 24

1. Optic Canal
2. Superior Orbital Fissure
3. Foramen Rotundum
4. Foramen Ovale
5. Foramen Spinosum

Question 25

What foramen are in the **Posterior Cranial Fossa**? (4)

Answer 25

1. Internal Auditory Meatus 2. Jugular foramen 3. Hypoglossal Canal 4. Foramen magnum

Question 26

What passes through the cribiform plate?

Answer 26

Olfactory Nerve (CN I)

Question 27

What passes through the optic canal?

Answer 27

Optic Nerve (CN II) Opthalmic artery

Question 28

What passes through the Superior Orbital Fissure?

Answer 28

CN III -- occulomotor nerve CN IV -- Trochlear nerve CN V₁ -- Opthalmic brance of Trigeminal n. CN VI

Question 29

What passes through the foramen rotundum?

Answer 29

CN V₂ -- Maxillary branch of Trigeminal nerve

Question 30

What passes through the foramen ovale?

Answer 30

CN V₃ -- Mandibular branch of the trigeminal nerve

Question 31

What passes through the foramen spinosum?

Answer 31

Middle meningeal artery

Question 32

What passes through the internal auditory meatus?

Answer 32

CN VII - Facial CN VIII - Glosopharyngeal

Question 33

What passes through the jugular foramen?

Answer 33

CN IX - Glossopharyngeal n. CN X - Vagus n. CN XI - Acessory n. Jugular Vein

Question 34

What passes through the hypoglosal canal?

Answer 34

CN XII - hypoglossal nerve

Question 35

What passes through the foramen magnum?

Answer 35

Brainstem Vertebral Arteries Spinal root of CN XI (Accessory n.)

Question 36

**_Muscles of Mastication_** 1. What muscles are used to open jaw? 2. What muscles are used to close jaw? 3. What nerve innervates these muscles?

Answer 36

1. **M**asseter, te**M**poralis, **M**edial pterygoid "**M**'s **M**unch" 2. **L**ateral pterygoid "**L**ateral **L**owers" 3. **CN V₃** - Mandibular branch of the trigeminal nerve

Question 37

**_Lumbar Puncture_** 1. Where should it be given? 2. What can be used as a landmark?

Answer 37

1. Between **L3-L4 or L4-L5** "Between L3 and L5 to keep the cord alive" 2. **Illiac crests** ---\> at level of **L4**

Question 38

**_Bell Palsy_** 1. What nerve does it involve? 2. What is the main symptom? 3. What are the other associated symptoms?

Answer 38

1. Facial nerve 2. Unilateral facial paralysis 3. impaired eye closure, eyebrow sagging, dissapearance of nasolabial fold, inability to smile/frown, decreased tearing, hyperacusis (increased sensitivity to sound)

Question 39

A patient complains of difficulty hearing and ear pain in areas of loud noice. What cranial nerve is most likely impaired and why?

Answer 39

The **Facial Nerve** (CN VII) The facial nerve innervates the **stapedius muscle** which stabilizes the stapes in the ear

Question 40

What is the pathway of the **Pupillary Light Reflex**?

Answer 40

1. Light in either **retina** sends a signal via the **optic nerve** to the **pretectal nuclei** in **midbrain** 2. This activates the **Edinger-Westphal nuclei bilaterally** which then **activates both occulomotor nerves** 3. **Both** pupils constrict

Question 41

CN III (occulomotor damage) 1. Can be caused by an anuerysm of which artery? 2. Which letter does this artery correspond to? 3. How does it present?

Answer 41

1. **Posterior Communicating Artery** (PCA) Aneurysm 2. **D** 3. **mydriasis/dilater pupil** **loss of pupillary light reflex, ptosis** **down-and-out gaze (since LR and SO remain intact)** **"**LR₆SO₄R₃**"**

Question 42

A patient comes in complaining about difficulty walking down the stairs but not when walking up, and difficulty reading. What cranial nerve is most likely damaged?

Answer 42

**_CN IV (trochlear)_** The trochlear nerve innervates the **superior oblique muscle** which is responsible for **downward internal rotation** Eye movements: **LR₆SO₄R₃**

Question 43

**_CN VI (abducens nerve) damage_** 1. What cant the eye do? 2. How does the affected eye present?

Answer 43

1. The eye ***cannot* abduct** **(since lateral rectus muscle is responsible for abduction)** 2. Eye ***displaced* medially** **"****LR₆SO₄R₃"**

Question 44

**_Internuclear Opthalmoplegia_** 1. Where does the lesion occur? 2. Why does it occur? 3. How does it present?

Answer 44

1. **Medial Longitudinal Fasciculus (in dorsal pons)** 2. Due to impaired crosstalk between **CN III** and **CN VI** 3. **Affected eye (ipsilateral to lesion) is unable to adduct** **Contralateral eye abducts but with nystagmus**

Question 45

In what disease are **_bilateral_** lesions of the **medial longitudinal fasiculus** seen?

Answer 45

Multiple Sclerosis "multiple (2) lesions in multiple sclerosis"

Question 46

To correct a rotator cuff tear an **interscalene nerve block** is given to anesthetize the **brachial plexus.** What is the most common complication of this nerve block?

Answer 46

**Ipsilateral diaphragm paralysis** due to the phrenic nerve passing through the interscalene sheath

Question 47

**_A patient vomits after chemotherapy:_** 1. Which area of the brain is responsible for this? 2. Where is it located? (Name + letter in picture) 3. Why does it occur?

Answer 47

1. The Chemoreceptor Trigger Zone 2. **_D_** **_The Area Postrema -_**-\> posterior medullar near 4th ventricle 3. This area recieves blood from fenestrated vessels (absent blood-brain barrier)

Question 48

**_Saddle Anesthesia_** 1. How does it present? 2. Where nerve roots are involved?

Answer 48

1. **Loss of anocutaneous reflex** (pinprick in the perianal area does not cause rapid contraction of anal sphincter) 2. **S2, S3, S4**

Question 49

**_Cavernous Carotid Aneurysm_** 1. What nerve is most likely affected and why? 2. How does it present?

Answer 49

1. **CN VI (abducens nerve)** it is **closest to the internal carotid** artery in the cavernous sinus 2. **Difficulty abducting the eye** due to **weakness of the lateral rectus** muscle (LR₆SO₄R₃)

Question 50

**Prolonged exposure to loud noises** can result in hearing loss. Why?

Answer 50

Due to damage of the sterocilliated hair cells of the organ of corti

Question 51

How does **_vertigo_** present?

Answer 51

**Spinning sensation while stationary**

Question 52

**_Maniere Disease_** 1. What is it a common cause of? 2. What other symptoms often present with it? 3. Why/how does it occur?

Answer 52

1. **_Vertigo_** 2. **Tinnitus** (hearing loss) and **hearing loss** 3. increased pressure and volume of **endolymph**

Question 53

**_Benign Paroxysmal Positional Vertigo_** 1. how does it present? 2. why/how does it occur?

Answer 53

1. **Brief episodes of Vertigo brought on by head movement** (NO auditory symptoms) 2. **Otoliths** in semicircular canals

Question 54

**_Vestibular Neuritis/Labrynthitis_** 1. How does is present? 2. Why/how does it occur?

Answer 54

1. A **single episode** of **severe vertigo** 2. **Inflammation** of vestibular nerve/labrynth

Question 55

**_Cholesteatoma_** 1. What does it cause? 2. What is it?

Answer 55

1. **Hearing loss** 2. collections of **_squamous cell debris_** that forms a mass behind the tympanic membrane

Question 57

What caused this and how do u know?

Answer 57

**_Retinal Artery Occlusion_** ## Footnote **- cherry red macula** **- retinal whitening**

Question 58

What caused this and how do you know?

Answer 58

**_Hypertension_** **- flama shaped retinal hemorrahage** **- not pictured: cotton wool-spots**

Question 59

How does diabetic retinopathy appear?

Answer 59

- new blood vessel formation - cotton-wool spots