INS Exam 2 2014

Question 1

The cavernous sinus usually drains into the:

Sigmoid sinus

Superior petrosal sinus

Inferior petrosal sinus

Sphenoparietal sinus

Superior and inferior petrosal sinuses

Answer 1

Superior and inferior petrosal sinuses

Question 2

Identify the structure among the following that is a proprioceptor:

Paccinian corpuscle

Meissners corpuscle

Neuromuscular spindle

Ruffini corpuscle

Krause end bulb

Answer 2

Neuromuscular spindle

Question 3

Which of the following is a correct distinction between the sympathetic (SNS) and parasympathetic (PNS) branches of the ANS?

Postganglionic fibers of the PNS use norepinephrine, whereas those of the SNS use acetylcholine.

The SNS postganglionic cell bodies are largely present in a chain alongside the spinal cord, whereas the PNS ganglia are more peripherally distributed and close to target tissues.

The PNS has long postganglionic fibers, whereas the SNS has quite short postganglionic fibers.

The PNS is activated during exercise, whereas the SNS is active during feeding.

All of the above

Answer 3

The SNS postganglionic cell bodies are largely present in a chain alongside the spinal cord, whereas the PNS ganglia are more peripherally distributed and close to target tissues.

Question 4

hronic subdural hematomas are most commonly associated with

A clear history of trauma; arterial bleeding; temporal location; no pre-existing brain disease; associated brain edema and contusions common

No or vague history of trauma; arterial bleeding; fronto-parietal location; no pre-existing brain disease; associated brain edema and contusions uncommon

A clear history of trauma; venous bleeding; temporal location; pre-existing brain atrophy; associated brain edema and contusions common

No or vague history of trauma; venous bleeding; fronto-parietal location; pre-existing brain atrophy; associated brain edema and contusions uncommon

Answer 4

No or vague history of trauma; venous bleeding; fronto-parietal location; pre-existing brain atrophy; associated brain edema and contusions uncommon

Question 5

Which of the following is MOST likely to be associated with thrombosis located in the mid-section of the right internal carotid artery

Cerebral infarction manifested with coagulative necrosis

Atherosclerosis involving the internal carotid arteries

Longstanding history of atrial fibrillation

A liquefactive cerebral infarction with numerous viable and nonviable appearing red blood cells

Right-sided heart failure with mural thrombosis

Answer 5

Atherosclerosis involving the internal carotid arteries

Question 6

A 13-year-old developed an intraspinal neoplasm. Microscopic examination revealed a cellular neoplasm which conspicuously exhibited acellular fibrillary regions around blood vessels. Of the following, the tumor is most likely

Astrocytoma

Choroid plexus papilloma

Ependymoma

Ganglioglioma

Lymphoma

Medulloblastoma

Answer 6

Ependymoma

Question 7

Which of the following drugs blocks both sympathetic and parasympathetic transmission?

Atropine

Curare

Scopolamine

Trimethaphan

Neostigmine

Answer 7

Trimethaphan

Question 8

An ophthalmologist used a receptor antagonist to examine the eye. The drug not only dilates the pupil but also impaired the patient’s ability to focus his eyes up close. The drug is most likely

Acetylcholine

Epinephrine

Pilocarpine

Homatropine

Cocaine

Answer 8

Homatropine

Question 9

Treatment of myasthenia gravis has as its goal:

Depletion of T lymphocytes by thymectomy

Increase in transmitter at the neuromuscular junction

Immunomodulation

Removal of disease causing immunoglobulins by dialysis

A, B & C

All of the above

Answer 9

A, B & C

Question 10

The myasthenic syndrome called Eaton-Lambert is associated with:

Malignancy

Incremental conduction with repetitive stimulation

Post ganglionic changes

Response to pyridostigmine

A & B

A, B & C

All of the above

Answer 10

A & B

Question 11

There are four motor subsystems. Which one of the following is not considered a subsystem of the neural circuits for movement control?

Basal ganglia

Descending upper motor neuron pathway

Cerebellum

Thalamus

Local circuits in the brainstem

Answer 11

Thalamus

Question 12

The ratio between the alpha motor neuron and the number of muscle fibers it innervates is associated with the degree of skillfulness needed in the movement. Lower ratio (an average 1:3) controls

Head movements

Postural muscle

The large, fast contracting muscles used in sprinting

Eye muscles

All of the above

Answer 12

Eye muscles

Question 13

Size principle in recruitment of motor neurons means that

Low threshold slow (3) motor units are recruited first

For the highest levels of activity, only fast fatigable motor units are recruited

Fast fatigable resistant motor units provide the tension required for standing

Jumping requires recruitment of only slow motor units

Answer 13

Low threshold slow (3) motor units are recruited first

Question 14

Upper motor neurons involved with the control of distal muscles would most likely project to the spinal cord in which of the following patterns?

Lateral gray matter of anterior spinal horn

Lateral gray matter of posterior spinal horn

Medial gray matter of anterior spinal horn

Medial gray matter of posterior spinal horn

In equal proportions to both lateral and medial gray matter

Answer 14

Lateral gray matter of anterior spinal horn

Question 15

The sensory receptors in the stretch reflex are located in the

Meissners corpuscles

Golgi tendon organs

Intrafusal muscle fibers in muscle spindles

Pacinian corpuscles

Extrafusal muscle fibers

Answer 15

Intrafusal muscle fibers in muscle spindles

Question 16

A 74-year old woman developed right face, arm and leg weakness. The patient was residing in a rehabilitation facility while recovering from an infection. She was doing well until one morning when she suddenly developed slurred speech and right sided weakness. Medical history was notable for hypertension, coronary artery disease and recent onset of atrial fibrillation. Motor examination also revealed right hyper-reflexia and Babinski sign including dysarthria, decreased right plate movement and rightward tongue deviation with no sensory deficits. The most likely cause of the symptoms was interruption of

Basal ganglia circuitry

The corticospinal and corticobulbar pathway on the right

The corticospinal and corticobulbar pathway on the left

Anterior limb of internal capsule on the right

Anterior limb of internal capsule on the left

Answer 16

The corticospinal and corticobulbar pathway on the left

Question 17

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that is mainly an impairment of

Serotonergic neurons

Cholinergic neurons

Alpha motor neurons

Gamma motor neurons

Answer 17

Alpha motor neurons

Question 18

When you pull on a handle, the biceps muscle is contracted. To ensure postural stability, contraction of the gastrocnemius muscle precedes that of the biceps. Two desending upper motor tracts are activated during these movements. What are these two tracts?

Corticospinal, rubrospinal

Corticospinal, vestibulospinal

Corticospinal, reticulospinal

Vestibulospinal, reticulospinal

Rubrospinal, reticulospinal

Answer 18

Corticospinal, reticulospinal

Question 19

Which of the following structures is involved in micturition?

Orbital-medial prefrontal cortex

A pontine autonomic center

Somatic motor neurons

Sympathetic and parasympathetic postganglionic neurons

All of the above

Answer 19

All of the above

Question 20

The drug sildenafil, which increases nitric oxide by inhibiting a phosphodiesterase, directly aids

Cognitive aspects of reproduction

The functioning of sympathetic preganglionic neurons

The functioning of sympathetic preganglionic neurons

The relaxation of venous (cavernous) sinusoids

The stimulation of prostatic and vaginal secretions

Answer 20

The relaxation of venous (cavernous) sinusoids

Question 21

After surgery to treat an occluded left common carotid artery, a 71-year-old man exhibits, on the left side, flushing of the face, a slight ptosis, and a constricted pupil that does not dilate in dim light. These observations suggest that an unintentional consequence of the surgery was injury to which of the following?

Cervical sympathetic trunk

Vagus nerve

Glossopharyngeal nerve

Ventral roots of spinal nerves C6 to C8

Facial nerve

Answer 21

Cervical sympathetic trunk

Question 22

Lesion of the pathway indicated by the arrow labeled B in figure will reduce the perception of

Touch in the ipsilateral lower extremity

Touch in the contralateral lower extremity

Pain from the ipsilateral upper extremity

Pain from the contralateral upper extremity

Touch in the ipsilateral upper extremity

Answer 22

Touch in the ipsilateral upper extremity

Question 24

Identify the structure at the tip of the arrow labeled A in Figure 1-

Substantia gelatinosa

Marginal zone

Nucleus proprius

Nucleus dorsalis of Clarke

Lissauer’s tract

Answer 24

Substantia gelatinosa

Question 25

Fiber pathway indicated by arrow labeled C in figure 3 terminates in the Dorsal root ganglia Nucleus gracilis Nucleus cuneatus Posterior parietal cortex Ventral posterolateral nucleus (VPL)

Answer 25

Ventral posterolateral nucleus (VPL)

Question 26

Axons of neurons in the nucleus indicated by arrow labeled D in figure 4 give rise to the Lateral lemniscus Medial lemniscus Anterolateral system Brachium of the superior colliculus Brachium of the inferior colliculus

Answer 26

Medial lemniscus

Question 27

Fiber pathway indicated by arrow labeled F in Figure 6 terminate in the Inferior colliculus Medial geniculate nucleus Dorsal column nuclei Ventral posterior lateral (VPL) nucleus Posterior parietal cortex

Answer 27

Ventral posterior lateral (VPL) nucleus

Question 28

Lesions of the nucleus indicated by arrow labeled E in figure 5 will likely produce impaired perception of Pain from the ipsilateral upper extremity Pain from the ipsilateral side of the face Pain from the contralateral side of the face Touch from the ipsilateral side of the face Pain from the contralateral upper extremity

Answer 28

it didn't give an answer, but i love you

Question 29

Which…. G Lateral geniculate nucleus Retina Medial geniculate nucleus Inferior colliculus Dorsal cochlear nucleus Occipital cortex (VI)

Answer 29

Retina

Question 30

Axons of neurons present in the nucleus indicated by arrow labeled H in figure 8 terminate in the Frontal cortex Parietal cortex Temporal cortex Occipital cortex

Answer 30

Occipital cortex

Question 31

Nucleus indicated by arrow labeled 1 in figure 9 receives pain, temperature and touch information from the Ipsilateral face Ipsilateral upper extremity Contralateral upper extremity Contralateral face Contralateral lower extremity

Answer 31

Contralateral face

Question 32

Axons of neurons in the nucleus indicated by arrow labeled J in figure 10 terminate in the Dorsal columns nuclei Lateral geniculate nucleus Medial geniculate nucleus Ventral posterior lateral nucleus Temporal lobe Occipital lobe

Answer 32

Medial geniculate nucleus

Question 33

Abnormality shown in the T1 weighted axial (horizontal) MRI (fig 11) will likely produce Left homonymous superior quadrantanopsia Left homonymous inferior quadrantanopsia Bitemporal hemianopsia Right homonymous hemianopsia Right homonymous superior quadrantanopsia Left homonymous hemianopsia Left homonymous hemianopsia with macular sparing

Answer 33

Left homonymous hemianopsia

Question 34

Abnormality shown in the T1 weighted sagittal MRI (Fig 12) will likely produce Decreased pain from the ipsilateral lower extremity Decreased pain from the contralateral lower extremity Decreased touch from the ipsilateral upper extremity Bilateral segmental decrease (loss) of pain in the upper extremity Bilateral segmental decrease (loss) of pain in the lower extremity

Answer 34

Bilateral segmental decrease (loss) of pain in the upper extremity

Question 35

Visual field loss depicted in figure 13 is likely to be produced by a lesion of the Optic radiations in the right parietal lobe Optic radiations in the right temporal lobe Tip of the left occipital lobe Tip of the right occipital lobe Optic chiasm Right optic tract

Answer 35

Right optic tract

Question 36

Based on microneurography, electrical stimulation of which one of the following will produce the sensation of “vibration” C-polymodal nociceptors Pacinian corpuscle Merkel receptor Meissner corpuscle Ruffini corpuscle

Answer 36

Pacinian corpuscle

Question 37

Decreased response of a sense organ to a maintained stimulus is described as Depression Inhibition Adaption Desensitization

Answer 37

Adaption

Question 38

Damage to the left posterior limb of the internal capsule will initially produce impaired perception of touch, proprioception and pain from the Upper extremity on the right side only Upper extremity on the left side only Entire body on the right side Lower extremity on the left side only Lower extremity on the right side only Right side of the face only

Answer 38

Entire body on the right side

Question 39

Lesion of which one of the following will initially produce loss of pain and temperature information on the contralateral side of the face Ventral posterior lateral nucleus of the thalamus Lateral geniculate nucleus Intralaminar nuclei Ventral posterior medial nucleus of the thalamus Spinal trigeminal nucleus Main sensory nucleus

Answer 39

Ventral posterior medial nucleus of the thalamus

Question 40

Lesion of which one of the following best explains the loss of only discriminative touch sensation in all dermatomes below the lesion Anterolateral system (ALS) Main sensory nucleus of the trigeminal nerve Dorsal columns Dorsal spinocerebellar tract Spinal trigeminal nucleus Ventral posterior lateral (VPL) nucleus

Answer 40

Dorsal columns

Question 41

Placebo-induced analgesia is produced by the release of which one of the following neurochemicals Norepinephrine Serotonin Opioid peptides Substance P Glutamine

Answer 41

Opioid peptides

Question 42

Peripheral analgesics (aspirin and non-steroidal anti-inflammatory drugs) are effective in reducing pain because they Increase the synthesis of bradykinin Increase the synthesis of serotonin Inhibit the synthesis of prostaglandins Inhibit the release of potassium from damaged cells Increase the synthesis of opioid peptides Increase the synthesis of GABA

Answer 42

Inhibit the synthesis of prostaglandins

Question 43

Which one of the following sensations is transduced by the IP3-mediated opening of the TRPM5 channel? Pain Bitter taste Audition Vision Olfaction

Answer 43

Bitter taste

Question 44

The flavor center of the brain is located in the Insular cortex Pyriform cortex Hippocampus Orbitofrontal cortex Entorhinal cortex

Answer 44

Orbitofrontal cortex

Question 45

Which one of the following cranial nerves carries pain and taste information from the posterior third of the tongue? VII X IX V VI

Answer 45

IX

Question 46

Lesions in which one of the following will likely produce a hearing deficit in only the left ear

Answer 46

nothing

Question 47

n/a

Answer 47

n/a

Question 48

Sound localization depends in part on Neurons in the auditory that can respond to interaural intensity and phase differences The tonotopic organization The somatotropic map in the post central gyrus The existence of a map of the auditory space in the auditory cortex Summation columns in the auditory cortex

Answer 48

Neurons in the auditory that can respond to interaural intensity and phase differences

Question 49

Which one of the following structures is involved in impedance matching in the auditory system Pinna External auditory canal Cochlea Basilar membrane Middle ear

Answer 49

Middle ear

Question 50

An off-center ganglion cell responds best to (i.e. fires the greatest burst of action potentials): Central illumination of its receptive field Annular illumination of the surround area of its receptive field Diffuse illumination By a moving bar of light in the surround area of its receptive field

Answer 50

Annular illumination of the surround area of its receptive field

Question 51

Lesions in which one of the following cortical visual areas will most likely impair the perception of motion V3 V4 V5 Middle temporal lobe

Answer 51

Middle temporal lobe

Question 52

Lesion of which one of the following will most likely produce right homonymous inferior quandrantanopsia Right optic tract Optic chiasm Optic radiations in the left temporal lobe Optic radiations in the right temporal lobe Optic radiations in the left parietal lobe Optic radiations in the right parietal lobe Left optic tract

Answer 52

Optic radiations in the left parietal lobe