Neuro Phase 1 Flashcards by Shemikah Colleton

A previously normal 56-year-old woman comes to the emergency department because of a “flu-like” illness. She complains of nausea and vomiting, unilateral tingling in the leg, and a headache involving the eye and forehead. She is alert and fully oriented. Motor, sensory, gait and coordination examinations are normal. Cranial nerve examination is normal, aside from the visual field disorder indicated in the plot. The neurologic examination suggests an occlusion of which of the following vessels?

A) Left middle cerebral artery
B) Left posterior cerebral artery

C) Right middle cerebral artery
D) Right posterior cerebral artery

E) Posterior communicating artery

B) Left posterior cerebral artery

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The blood-brain barrier depends on the intercellular junctions between

A) astrocyte end-feet and endothelial cells
B) endothelial cells and endothelial cells
C) endothelial cells and neurons

D) microglia and endothelial cells

E) pericytes and endothelial cells

B) endothelial cells and endothelial cells

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A)left cerebral peduncle

B)left medullary pyramid

C)left motor cortex

D)right internal capsule

E)right red nucleus

B) left medullary pyramid

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A 22-year-old man is brought to the emergency department because of a suprahyoid stab wound that extends from one side of the neck to the other. His tongue deviates to the right when protruded; there is no loss of sensory modality on the tongue. The injury most likely involves which of the following nerves?  

A) Left hypoglossal
B) Left vagus
C) Right hypoglossal
D) Right glossopharyngeal

E) Right lingual

C) Right hypoglossal

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A 65-year-old woman has had double vision, difficulty keeping her eyes open, and diffuse weakness for the past several months. She has bilateral ptosis that worsens with sustained upward gaze, limited horizontal and vertical movements in both eyes, and nasal speech. Her symptoms and signs improve transiently following intravenous injection of edrophonium. An abnormality is most likely to be found in which of the following structures?

A) Anterior horn cell
B) Motor cortex
C) Neuromuscular junction

D) Peripheral nerve
E) Skeletal muscle

C) Neuromuscular junction

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Pain impulses from the tip ofthe tongue would most likely be carried to neurons in which of the following ganglia?

A) Geniculate
B) Otic

C) Pterygopalatine

D) Superior vagal

E) Trigeminal

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A woman who recently gave birth has elevated prolactin levels. The gland responsible for secretion of this hormone is derived from which of the following structures?

A) Cerebral vesicle
B) Infundibulum
C) Neurohypophysis
D) Proctodeum
E) Rathke’s pouch

E) Rathke’s pouch

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A 45-year-old man has a progressively severe headache. Funduscopic examination discloses blurred margins and bulging of the optic discs. The retinal veins are engorged and show no pulsatile flow. Which of the following is the mechanism most likely to explain these findings?  
A) Acute occlusion of the retinal artery
B) Demyelination of the optic nerve
C) Increased intracranial pressure
D) Inflammation of the anterior chamber
E) Inflammation of the optic nerve

C) Increased intracranial pressure

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A 45-year-old man has abnormal circadian variation in body temperature, disruption of the sleep-wake cycle, and an impaired nocturnal surge of secretion of melatonin. An MRI of the brain is most likely to show a lesion involving which of the following nuclei?

A)Accessory optic

B)Lateral prep-tic

C)Pretectal

D)Suprachiasmatic

E)Supraoptic

D) Suprachiasmatic

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Regeneration of axons in the peripheral nervous system is associated with

*1) trophic factors
2) appropriate extracellular matrix
3) Schwann cell tubes**

4) active microglia

A)1,2,3 only

B)1,3 only

C)2,4 only

D)4 only

E)All are correct

A) 1,2,3 only

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Unilateral deafness would be produced by unilateral destruction of the

*1) medial geniculate body
2) organ of Corti
3) auditory cortex**

4) cochlear nucleus

A)1,2,3 only

B)1,3 only

C)2,4 only

D)4 only

E) All are correct

C) 2,4 only

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A 41-year-old man is injured in a motorcycle accident. He is taken to the hospital by a rescue helicopter and treated for abdominal, spinal, and head injuries. Three weeks later he is examined by a neurologist, who notes that the patient has left-sided facial swelling and discoloration, slight drooping of the left eyelid, and a constricted pupil on the left side. There are no other motor or sensory abnormalities. Which of the following is the most likely cause of this patient’s ocular disorder?
A) A lesion of cranial nerve VI
B) A lesion of the midbrain
C) A lesion of the oculomotor nerve
D) A lesion of the thoracic spinal cord
E) Myasthenia gravis

D) A lesion of the thoracic spinal cord

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A patient has spastic paralysis of this left extremities. His tongue deviates to the right when protruded and is atrophied on the right side. There are on other neurologic abnormalities. Structures likely to be damaged by the lesion include the

1) right corticobulbar tract

2) right hypoglossal (XII) nerve

*3) left medullary pyramid
4) right medullary pyramid**

A) 1,2,3 only

B) 1,3 only

C) 2,4 only

D) 4 only

E) All are correct

C) 2,4 only

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A patient’s left hypoglossal nerve (CN XII) is injured during a carotid endarterectomy. Which of the following would most likely result rom this injury?

A) Decreased gag reflex on the left
B) Decreased salivation from the left submandibular and sublingual salivary glands

C) Deviation of the tongue to the left on protrusion

D) Inability to elevate the pharynx on the left during swallowing
E) Inability to perceive sweet and salt tase sensation on the anterior part of the left side of the tongue

C) Deviation of the tongue to the left on protrusio

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A fracture of the cribriform plates that tears the meninges is likely to result in

*1) loss of the sense of smell
2) rupture of the nasolacrimal duct
3) leakage of cerebrospinal fluid into the nasal cavity**

4) injury to the maxillary division of the trigeminal (V) nerve

A) 1,2,3 only

B) 1,3 only

C) 2,4 only

D) 4 only

E) All are correct

B) 1,3 only

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The area of the brain most closely associated with recent memory is the

A) septum
B) frontal cortex
C) cingulate cortex

D) uncus
E) hippocampus

E) hippocampus

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Which of the following statements represents the major difference between olfaction and other sensory systems?
A) Olfactory pathways are directly linked with gustatory pathways
B) Olfactory pathways have no direct access to the thalamus

C) Olfactory receptors code their responses without action potentials

D) Peripheral olfactory pathways are crossed
E) Substance P is primarily used in olfactory pathways

B) Olfactory pathways have no direct access to the thalamus

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The nucleus solitarius receives taste inputs from the

*1) tongue through the facial (VII) nerve
2) epiglottis through the vagus (X) nerve
3) tongue through the glossopharyngeal (IX) nerve**

4) tongue through the hypoglossal (XII) nerve

A) 1,2,3 only

B) 1,3 only

C) 2,4 only

D) 4 only

E) All are correct

A) 1,2,3 only

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Homonymous visual field defects can be associated with lesions of the

*1) visual cortex
2) lateral geniculate body
3) optic radiation**

4) optic (II) nerve

A) 1,2,3 only

B) 1,3 only

C) 2,4 only

D) 4 only

E) All are correct

A) 1,2,3 only

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The most striking differences between the composition of cerebrospinal fluid and plasma is in

A) concentration of glucose
B) concentration of postassium

C) concentration of protein

D) concentration of sodiumE) osmolality

C) concentration of protein

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During a bar fight, a 20-year-old man is stabbed with an ice pick. The weapon passes through the superior orbital fissure. Which of the following is most likely to be severed as the ice pick passes through this fissure?

A) Abducens nerve

B) Facial nerve
C) Mandibular nerve
D) Maxillary nerve
E) Middle meningeal artery

F) Ophthalmic artery
G) Optic nerve

A) Abducens nerve

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Administration of an experimental drug that acts on peripheral nervous system (PNS) myelin is shown to increase the space constant (increase insulating effect of myelin) of an axon in a peripheral nerve. Action potentials traveling down the axon would be predicted to be

A) faster
B) larger
C) slower
D) smaller
E) unchanged

A) faster

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The meningeal derivative that is in close association with blood vessels passing into the cerebral cortex

A) Arachnoid
B) Dura mater, inner layer

C) Dura mater, outer layer

D) Pia mater

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Loss of pain and temperature on the right side of the face

A) A

B) B

C) C

D) D

E) E

A) A

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In most right-handed people, which of the following are localized predominantly in the left cerebral hemisphere? * *1) Processing of spatial perception 2) Registration and comprehension of language** **3) Processing of emotional material** **4) Mathematical abilities** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

C) 2,4 only

A patient with Bell palsy [paralysis of the facial (VII) nerve] experiences food collecting in his oral vestibule. Paralysis of which of the following muscles would most likely cause this problem? A) Buccinator B) Masseter C) Mentalis D) Orbicularis oris E) Zygomaticus major

A) Buccinator

A 20-year-old man is brought to the emergency department 1 hour after he was involved in a motorcycle collision. He was not wearing a helmet. Physical examination shows clear fluid dripping from the nose. X-rays show a fracture of the cribriform plate of the ethmoid bone. This patient is at greatest risk for impairment of which of the following senses? A) Balance B) Hearing C) Olfaction D) Taste from the anterior two thirds of the tongue E) Taste from the posterior one third of the tongue F) Vision

C) Olfaction

Tritiated amino acids may be incorporated into proteins by neurons and the radioactive proteins transported to the axon terminals of these neurons. If tritiated amino acids were injected into the ventrobasal thalamus (nuclei VPL and VPM) on the left, one would find radioactive axon terminals in the left * *1) spinal gray matter 2) dorsal column nuclei 3) dentate nucleus of the cerebellum** **4) somatosensory cortex** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

D) 4 only

A developmental abnormality of midline endoderm is A) cysts of Rathke’s pouch B) dermoid cyst C) pilonidal sinus or cyst D) spina bifida E) thyroglossal cyst (craniopharyngeal canal)

E) thyroglossal cyst (craniopharyngeal canal)

The nerve supply of the tongue is derived, in part, from the nerve of the * *1) first branchial arch (mandibular division of V) 2) second branchial arch (VII) 3) third branchial arch (IX)** **4) fourth branchial arch (X)** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

A) 1,2,3 only

A 68-year-old woman has the sudden onset of weakness in her right arm and leg. She can speak, but her words are not enunciated clearly. Neurologic examination 6 weeks later shows an extensor plantar reflex on the right. When she is asked to protrude her tongue, it deviates to the left, and the muscle in the left side of the tongue shows considerable atrophy. Which of the following labeled areas in the transverse sections of the brain stem is most likely damaged? A)A B)B C)C D)D E) E

B) B

Question #32: In the ear, sensory receptive hair cells are found in the * *1) organ of Corti 2) maculae of the saccule and utricle 3) cristae amupllares of the semicircular ducts** **4) striae vascualres of the cochlear duct** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

A) 1,2,3 only

Nissl bodies correspond to which of the following cytoplasmic organelles? A) Golgi apparatus B) Mitochondria C) Nucleoli D) Rough endoplasmic reticulum E) Smooth endoplasmic reticulum

Decreased ability to plan or organize, increased impulsivity, and inappropriateness of affect is most often associated with lesions of the A) hippocampus-fornix-mammillary body complex B) midline thalamic nuclei C) orbital-frontal and temporal cortexes D) parietal cortex, bilaterally E) substantia nigra and striatum

C) orbital-frontal and temporal cortexes

A 3-year-old girl with mild craniofacial dysmorphosis has profound hearing deficits. Further evaluation indicates profound sensory auditory deficits and vestibular problems. Altered development of which of the following is most likely to account for these observations?   A) Ectodermal placode B) Intermediate mesoderm C) Lateral plate mesoderm D) Neural crest cell E) Paraxial mesoderm F) Prochordal mesoderm

D) Neural crest cell

A patient has a right spastic hemiparesis and diminished proprioception and two-point discrimination of the right arm and leg. The tongue deviates to the left when protruded, and the left half of the tongue is atrophied. There are no other abnormalities. The diminished two-point discrimination is most likely due to a lesion of the A) dorsal columns of the right cervical spinal cord B) left cerebral cortex C) left medial lemniscus D) right spinocerebellar tract E) right ventrobasal thalamus

C) left medial lemniscus

The utricle is a specialized part of the labyrinth that A) responds primarily to angular acceleration B) is concerned with perception of vibratory stimuli C) is a slow-adapting receptor responding to movements of the endolymphatic fluid D) responds primarily to linear acceleration E) mediates nystagmus when warm water is flush through the external auditory canal

D) responds primarily to linear acceleration

A new drug is developed that prevents the demyelinization occurring in the progress of multiple sclerosis. The drug protects the cells responsible for the synthesis and maintenance of myelin in the central nervous system. These cells are most likely which of the following?   A) Astrocyte B) Ependymal cell C) Microglial cell D) Oligodendrocyte E) Schwann cell

D) Oligodendrocyte

Each of the following sensory pathways to the cerebral correct relays in the thalamus EXCEPT that for A) pain and temperature B) audition C) vision D) olfaction E) two-point discrimination

D) olfaction

Components of the cornea include * *1) adrenergic sympathetic nerves 2) collagenous fibers 3) blood vessels** **4) sensory nerves** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

C) 2,4 only

During a physical examination a physician elicits a pupillary light reflex by shining a light into a patient’s eye. The iris contracts, thereby constricting the pupil. Where are the cell bodies of the preganglionic neurons found that are responsible for this response? A) Oculomotor nucleus B) Edinger-Westphal nucleus C) Ciliary ganglion D) Precentral gyrus E) Geniculate ganglion

B) Edinger-Westphal nucleus

A 4-month-old boy is brought to the physician by his mother for a well-child examination. He is at the 98th percentile for head circumference. Physical examination shows dilation of the scalp veins and spasticity of the lower extremities. The physician suspects excessive cerebrospinal fluid accumulation in the ventricular system of the brain. The source of this fluid is most likely which of the following?   A) Choroid plexus B) Dura mater C) Pia mater D) Roof of the third ventricle

A) Choroid plexus

A stroke resulting in damage to the internal capsule characteristically produces A) ballismus B) chorea C) cogwheel rigidity D) spastic paralysis E) tremor

D) spastic paralysis

The anterior cerebral artery supplies the A) auditory association cortex B) face area of the primary sensory cortex C) foot area of the primary motor cortex D) frontal cortical eye fields E) primary visual cortex

C) foot area of the primary motor cortex

A 69-year-old man presents with unilateral hearing loss. A lesion in which of the following structures could be responsible for this loss? A) Inferior colliculus B) Lateral lemniscus C) Medial geniculate body' D) Medial lemniscus E) Organ of Corti F) Superior olivary nucleus

E) Organ of Corti

Cell migration results in six layers of neurons A) Archicortex B) Cerebellum C) Neocortex D) Retina E) Spinal cord

C) Neocortex

The chorda tympani branch of the facial (VII) nerve carries A) motor fibers to the stapedius muscle B) parasympathetic fibers to the parotid gland C) sensation from the tympanic membrane D) taste from the anterior two-thirds of the tongue E) taste from the posterior one-third of the tongue

D) taste from the anterior two-thirds of the tongue

Body temperature is controlled by hypothalamic centers that * *1) respond to information from peripheral temperature receptors 2) change heat production but not heat loss 3) respond to changes in brain temperature** **4) have efferent outflow restricted to autonomic pathways** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

B) 1,3 only

Studies of which of the following best document cerebral hemispheric specialization? A) Autonomic responsiveness B) Cognitive responses to stress C) Eye fixation D) Language E) Right- and left-handedness

D) Language

Localized electrical stimulation of the motor cortex can elicit * *1) all the movements involved in tying one’s shoe laces 2) the reliving of a past experience 3) all the movements involved in throwing a ball** **4) contraction of some muscles** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

D) 4 only

A 47-year-old man presents to his neurologist with an unsteady, broad-based gait and slow, slurred speech. Neurologic examination reveals dysdiadochokinesia, intention tremor, hypotonia, and nystagmus. The patient’s lesion is in a brain structure that derives from which of the following embryonic structures A) Diencephalon B) Mesencephalon C) Metencephalon D) Myelencephalon E) Telencephalon

C) Metencephalon

Receptor cells of taste buds * *1) are replaced after injury 2) are specially adapted epithelial cells** **3) contain presynaptic vesicles** **4) are primary neurons with the cell body in the geniculate ganglion** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

A) 1,2,3 only

The internal capsule contains * *1) ascending axons of thalamic neurons 2) descending axons to the corpus striatum 3) descending axons to the pons and spinal cord 4) descending axons to the midbrain and medulla oblongata** ## Footnote A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

E) All are correct

A 45-year-old man has an obvious mass on the right side of his face. It is determined that he has a benign tumor of the parotid gland, and the tumor is exiled. After surgical excision of the tumor, it is noted that the patient’s mouth droops on the right side and, when asked to smile, his smile asymmetrical. The patient is able to open and close both eyes normally and can wrinkle his forehead symmetrically and raise both eyebrow. Sensation is normal on both sides of his face. Which of the following is most likely cause of the finding? A) Damage to branches of the mental nerve B) Damage to branches of the infraorbital nerve C) Damage to branches of the facial nerve D) Damage to branches of the glossopharyngeal nerve E) Damage to branches of the hypoglossal nerve

C) Damage to branches of the facial nerve

In humans, the left hemisphere of the brain generally appears to be involved in * *1) language acquisition 2) appreciation of music and art 3) mathematical reasoning** **4) spatioperceptual abilities** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

B) 1,3 only

A medial student decides to conduct an neurochemical experiment to measure extracellular neurotransmitter levels in the brain following electrical stimulation of the raphe nuclei. Which of the following neurotransmitter levels would be expected rise? A) Acetylcholine B) Dopamine C) Gamma-amino-butyric acid (GABA) D) Norepinephrine E) Serotonin

E) Serotonin

Loss of sympathetic innervation to one side of the head results in * *1) partial ptosis 2) absence of a pupillary light reflex 3) loss of sweating** **4) pupillary dilation** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

B) 1,3 only

Transection of a nerve supplying a skeletal muscle usually causes * *1) muscle atrophy 2) chromatolysis of motor neurons 3) fibrillations in muscle fibers** **4) appearance of new extrajunctional acetylcholine receptors** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

E) All are correct

In the diagram of the cerebral cortex, lettered areas represent lesions. In a person with left hemisphere dominance, select the lesion that would cause an inability to understand spoken words A)A B)B C)C D)D

D)D

Loss of pain and temperature in the left extremities A)A B)B C)C D)D E)E

C)C

Nerves that must be intact to elicit a corneal blink reflex include the * *1) ophthalmic division of the trigeminal (V) 2) oculomotor (III) 3) facial (VII)** **4) nasociliary branch of the trigeminal (V)** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

B) 1,3 only

Sensory innervation of the larynx is by branches from the A) trigeminal (V) nerve B) facial (VII) nerve C) vestibulocochelar (VIII) nerve D) glossopharyngeal (IX) nerve E) vagus (X) nerve

E) vagus (X) nerve

The meningeal derivative which contributes to the formation of the choroid plexuses A) Arachnoid B) Dura mater, inner layer C) Dura mater, outer layer D) Pia mater

D) Pia mater

An architect sustains a penetrating head injury that selectively damages portions of his right parental and right temporal lobes. Six months later, he still cannot manage his job. His functional disability will probably include difficulty in **1) understanding instructions** * *2) drawing plans 3) calculating dimensions 4) remembering configurations** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

C) 2,4 only

A 47-year-old man had a cordotomy in which the white matter of the anterior right quadrant of the spinal cord was cut at the level of the second cervical segment. The primary purpose of this procedure was to A) reduce involuntary movement in the right arm B) relieve intractable pain on the left side of the body C) bring about a loss of sense of touch on the right side of the body D) relieve intractable pain on the right side of the body E) restore control over the heart beat

B) relieve intractable pain on the left side of the body

Following a blow to the side of the head, extradural hemorrhage is usually caused by bleeding from the A) cavernous sinus B) emissary veins (connections between intracranial sinuses and external veins) C) middle cerebral artery D) middle meningeal vessels E) superior sagittal sinus

D) middle meningeal vessels

Target of axons arising from neural crest cells A) Archiocortex B) Cerebellum C) Neocortex D) Retina E) Spinal cord

E) Spinal cord

In the diagram of the cerebral cortex, lettered areas represent lesions. In a person with left hemisphere dominance, select the lesion that would cause an inability to speak and write fluently A)A B)B C)C D)D

A)A

Upper motor neurons that influence the activity of spinal motor neurons are found in the * *1) brain stem reticular formation 2) red nucleus** **3) vestibular nuclei** **4) motor cortex** A) 1,2,3 only B) 1,3 only C) 2,4 only D) 4 only E) All are correct

E) All are correct

A patient has sudden paralysis of facial expression on the entire left side of his face with inability to move his left eye laterally. The remainder of the physical examination is unremarkable. The patient most likely ahs A) a lower motor neuron (LMN) lesion involving the abducens (VI) nerve and an upper motor neuron (UMN) lesion involving the facial (VII) nerve B) an LMN lesion involving both he abducens (VI) and trigeminal (V) nerves C) an LMN lesion involving the facial (VII) nerve and a UMN lesion involving the abducens (VI) nerve D) an LMN lesion involving both the facial (VII) and the abducens (VI) nerves E) a UMN lesion involving the abducens (VI) and facial (VII) nerves

D) an LMN lesion involving both the facial (VII) and the abducens (VI) nerves

Neuro Phase 1 Flashcards

(70 cards)