Neuro 1

Question 1

Which vascular structure provides blood supply to the brainstem?

Answer 1

basilar artery

Question 2

A patient complains of a loss of temperature sensation to a distinct area of the body. This could be due to a lesion in which of the following?

Answer 2

spinothalamic tract

Question 3

A known characteristic of upper motor neurons is which of the following?

Answer 3

they never leave the central nervous system

Question 4

A patient undergoes lumbar puncture, is found to have predominantly lymphocytes, leading to a presumptive diagnosis of viral meningitis. Which of these is most likely involved?

Answer 4

enteroviruses

Question 5

Which amino acid-derived neurotransmitter plays a predominantly inhibitory role in the brain?

Answer 5

gamma amino butyric acid (GABA)

Question 6

A target organ system effect of norepinephrine is which of the following?

Answer 6

decreased GI motility

Question 7

Parasympathetic stimulation results in which of the following end organ effects?

Answer 7

pupil constriction

Question 8

Which symptom is part of the classic spectrum for muscarinic receptor activation, such as one might see in mushroom poisoning?

Answer 8

diarrhea

Question 9

Which artery is part of the circle of Willis?

Answer 9

posterior cerebral

Question 10

A patient experiences a sharp stabbing pain that radiates over the mandible and extends around the temporomandibular joint and then deep into the ear. The pain is triggered by smiling and touching his face. Which cranial nerve is involved?

Answer 10

CN V

Question 11

Which objective finding is consistent with right unilateral blindness with normal sympathetic and parasympathetic innervations to both irises?

Answer 11

a light directed in the left eye produces a consensual reaction in the right eye

Question 12

A patient is diagnosed with a disease in which autoantibodies ‘inactivate’ receptors at the neuromuscular junction. This patient would most likely derive benefit from an agent that inhibits which of the following enzymes?

Answer 12

acetylcholinesterase

Question 13

Which factor will aid in the ability of a molecule to penetrate the blood-brain barrier?

Answer 13

high lipid solubility

Question 14

Which risk factor is most closely associated with intraparenchymal brain hemorrhage?

Answer 14

hypertension

Question 15

Sympathetic pre-ganglionic nerve terminals generally release which neurotransmitter?

Answer 15

acetylcholine

Question 16

Which choice represents the correct order of events in synaptic transmission?

Answer 16

neurotransmitter synthesis; vesicular storage; release

Question 17

Which enzyme degrades the principal neurotransmitter found at the neuromuscular junction?

Answer 17

acetylcholinesterase

Question 18

A 44 year old male patient presents with flaccid paralysis of the lower extremities. Which of the following choices is most likely related to this problem?

Answer 18

a lower motor neuron lesion

Question 19

Which substance can be converted to glucose to supply the needs of the brain during starvation?

Answer 19

amino acids

Question 20

Which spinal tract is a motor pathway?

Answer 20

corticospinal tract

Question 21

A 31 year old female patient presents to clinic with blurry vision and dizziness. She also reports an unusual tingling feeling in the calf of her right leg. Which of the following would be highest on your differential list?

Answer 21

multiple sclerosis

Question 22

During surgical removal of an invasive glioma from the skull base, cranial nerves IX and X are accidentally cut bilaterally. What would be the immediate change in the patient’s hemodynamic condition?

Answer 22

tachycardia with hypertension

Question 23

Which amino acid neurotransmitter plays a predominantly excitatory role in the central nervous system?

Answer 23

glutamate

Question 24

Which of the following end-organ effects would be due to parasympathetic stimulation?

Answer 24

increased urination

Question 25

Why is peristalsis considered an intrinsic neuronal reflex?

Answer 25

all neurons are contained within the gut wall

Question 26

An unusual patient presents to your neurology clinic. He has fluent speech but he uses incorrect words, inserts nonexistent words into his speech, and strings normal words together randomly. Where in the brain might you expect to find a lesion?

Answer 26

left temporal lobe

Question 27

A 56 year old woman presents with burning and tingling in the thumb, index finger, and middle finger of her right hand. She states the pain is worse at night and after working on her keyboard. Her symptoms are most likely caused by entrapment of which nerve?

Answer 27

median

Question 28

Commissure fibers joining the cerebral hemispheres are located in which structure?

Answer 28

corpus callosum

Question 29

A patient with hyperactive knee and ankle reflexes and upward plantar reflex is likely to have a problem in which spinal tract?

Answer 29

corticospinal tract

Question 30

A possible upper motor neuron deficit would be suggested by which finding?

Answer 30

spasticity

Question 31

Blood supply to the anterior brain

Answer 31

internal carotids

Question 32

blood supply to the posterior brain

Answer 32

vertebral arteries, basilar

Question 33

cranial nerve III emerges between these two arteries

Answer 33

PCA, SCA

Question 34

cranial nerve VI emerges anterior to this artery

Answer 34

Basilar

Question 35

Functions of dorsal columns, medial lemniscus

Answer 35

discriminative touch (two-point), conscious proprioception, vibration sensitivity

Question 36

functions of spinothalamic tract

Answer 36

pain and temperature

Question 37

function of dorsal spinocerebellar tract

Answer 37

unconscious proprioception

Question 38

corticospinal tract function

Answer 38

voluntary movement (cortex to cord, upper motor neurons)

Question 39

spinothalamic first order neurons

Answer 39

body part into dorsal roots

Question 40

spinothalamic second order neurons

Answer 40

cross over in spinal cord, ascend to thalamus

Question 41

spinothalamic third order neurons

Answer 41

thalamus to somatosensory cortex for conscious awareness

Question 42

upper motor neurons are contained entirely within

Answer 42

the central nervous system

Question 43

lower motor neurons innervate

Answer 43

skeletal muscles

Question 44

damage to upper motor neurons leads to

Answer 44

``` spastic paralysis hyperreflexia increased muscle tone upward Babinski loss of fine voluntary movements ```

Question 45

damage to lower motor neurons leads to

Answer 45

``` flaccid paralysis decreased superficial reflexes decreased tone fasciculations or fibrillations severe muscle atrophy ```

Question 46

corticospinal decussation (define and location)

Answer 46

crossover of upper motor neurons, lower medulla

Question 47

red nucleus location

Answer 47

central midbrain, next to substantia nigra

Question 48

decorticate posture (define and location of lesion)

Answer 48

flexor posture, lesion above red nucleus

Question 49

decerebrate posture (define and location of lesion)

Answer 49

extensor posture, lesion below red nucleus

Question 50

sympathetic eyes

Answer 50

dilate, increased acuity

Question 51

sympathetic skin

Answer 51

vasoconstriction, piloerection, sweaty

Question 52

sympathetic cardiovascular

Answer 52

increased cardiac output

Question 53

sympathetic pulmonary

Answer 53

bronchodilation, maximum air exchange

Question 54

sympathetic renal

Answer 54

constrict renal vessels, decrease urine production

Question 55

sympathetic hepatic

Answer 55

glycogen breakdown

Question 56

sympathetic reproductive

Answer 56

ejaculation

Question 57

sympathetic adrenals

Answer 57

release adrenaline

Question 58

parasympathetic eyes

Answer 58

constrict pupil

Question 59

parasympathetic skin

Answer 59

not directly innervated by PNS

Question 60

parasympathetic cardiovascular

Answer 60

decrease rate and strength of cardiac contraction

Question 61

parasympathetic pulmonary

Answer 61

bronchoconstriction, increase bronchial secretion

Question 62

sympathetic gastrointestinal

Answer 62

decrease motility

Question 63

parasympathetic gastrointestinal

Answer 63

stimulates motility and secretion

Question 64

parasympathetic bladder

Answer 64

facilitates urination

Question 65

parasympathetic hepatic

Answer 65

promotes glycogen production, conservation, increased bile secretion

Question 66

parasympathetic reproductive

Answer 66

increase blood flow to erectile tissues

Question 67

parasympathetic adrenals

Answer 67

not directly innervated by PNS

Question 68

how to penetrate the blood-brain barrier (4)

Answer 68

high lipid solubility low molecular weight low ionic charge activate transport receptors

Question 69

processes that open the blood-brain barrier (4)

Answer 69

Ischemia vessel exposure to inflammatory cytokines or factors produced by tumors hypertension hyperosmolar solution arterial injections

Question 70

consequences of opening the blood-brain barrier (4)

Answer 70

vasogenic cerebral edema wbc in brain or CSF toxins into brain infectious organisms into brain

Question 71

CSF made in

Answer 71

choroid plexuses

Question 72

CSF glucose : Blood glucose

Answer 72

60-70% (~55)

Question 73

contraindications for LP (4)

Answer 73

mass in CNS with elevated ICP obstructive hydrocephalus overlying lumbar skin infection bleeding disorder or thromboctopenia

Question 74

major neurotransmitter in ANS

Answer 74

acetylcholine (only preganglionic in SNS)

Question 75

symptoms of muscarine intoxication

Answer 75

Salivation Lacrimation Urination Defecation

Question 76

Acetylcholine acts on cardiac, eye, bronchioles, GI tract, bladder, and glands like

Answer 76

parasympathetic

Question 77

ACh in CNS function

Answer 77

cognition

Question 78

ACh in PNS function

Answer 78

voluntary movement

Question 79

dopamine function

Answer 79

drug abuse, parkinson, schizophrenia

Question 80

norepinephrine function

Answer 80

attention and arousal

Question 81

serotonin, other name

Answer 81

5HT

Question 82

serotonin function

Answer 82

mood, sleep, pain, temperature

Question 83

histamine function

Answer 83

arousal, pain threshold, gut secretion, allergic reaction

Question 84

glutamate function

Answer 84

learning and memory, epilepsy

Question 85

GABA function

Answer 85

sedation

Question 86

Glycine function

Answer 86

inhibitory transmitter in spinal cord

Question 87

two types of primary glaucoma

Answer 87

narrow angle, wide angle

Question 88

narrow angle glaucoma

Answer 88

requires drug treatment for management of acute attack

Question 89

wide angle glaucoma

Answer 89

gradual, insidious | requires chronic drug therapy

Question 90

drug for narrow angle glaucoma attack

Answer 90

pliocarpine, miotic action, reverses mydriasis from atropine

Question 91

high pressure in the baroreceptors turns on

Answer 91

parasympathetic

Question 92

total blindness of right eye lesion location

Answer 92

right optic nerve

Question 93

right nasal hemianopsia lesion location

Answer 93

right optic nerve at junction with optic chiasm

Question 94

define homonymous and heteronymous hemianopsia

Answer 94

homonymous - both eyes lose same (directional) visual field | heteronymous - both eyes lose nasal or temporal visual field

Question 95

left homonymous hemianopsia lesion location

Answer 95

right optic tract

Question 96

bitemporal heteronymous hemianopsia lesion location

Answer 96

optic chiasm

Question 97

CN ? brings light in for pupillary response | CN ? elicits response

Answer 97

II, III

Question 98

classic clinical features of meningitis (4)

Answer 98

fever headache stiff neck relative preservation of mental status

Question 99

glucose in CSF, viral vs bacterial meningitis

Answer 99

low in bacterial, normal in viral

Question 100

3 cardinal features of myasthenia gravis

Answer 100

weakness fatigability of skeletal muscles normal reflexes and sensory function

Question 101

5 clinical features of Guillain-Barre

Answer 101

symmetrical ascending flaccid motor paralysis limb parestesias loss of deep tendon reflexes facial and respiratory weakness (sometimes) autonomic dysfunction

Question 102

treatment of Guillain-Barre

Answer 102

good nursing plasmaphoresis, IVIG physical therapy for contractures, strength

Question 103

5 cardinal signs of parkinson's

Answer 103

``` resting tremor (pill-rolling) posture instability cogwheel rigidity bradykinesia micrographia ```

Question 104

3 types of parkinson syndromes

Answer 104

primary, secondary, parkinson-plus

Question 105

GI side effects of L-dopa

Answer 105

nausea

Question 106

cardiovascular side effects of L-dopa

Answer 106

tachycardia, a-fib

Question 107

psych side effects of L-dopa

Answer 107

nightmares, hallucinations

Question 108

kinetic side effects of L-dopa

Answer 108

dyskenesia (like parkinsons)

Question 109

5 signs of Horner's syndrome

Answer 109

``` Pseudoptosis (drooping of upper eyelid) Miosis (constriction of pupil) Enophthalmos Anhidrosis Dilation of skin arterioles ```