NeuroAnatomy Flashcards
(142 cards)
1
Q
Regions of the brain devoid of a blood-brain barrier include all the following EXCEPT?\
A. Pineal body
B. Subfornical organ
C. Organum vasculosum of the lamina terminalis
D. Median eminence of the hypothalamus
E. Habenular nucleus
A
A. Pineal body
B. Subfornical organ
C. Organum vasculosum of the lamina terminalis
D. Median eminence of the hypothalamus
E. Habenular nucleus
The pineal body, subfornical organ, organum vasculo- sum of the lamina terminalis, median eminence of the hypothalamus, neurohypophysis, subcommissural organ, and the area postrema are devoid of a blood-brain barrier and are commonly referred to as circumventricular organs. The habenular nucleus is not a circumventricular organ (Carpenter, pp. 18-20; Kandel, p. 1293).
2
Q
What is the major outtlow tract of the basal ganglia?
A. Lenticular fasciculus (Fore1’s field H2)
B. Ansa lenticularis
C. Thalamic fasciculus (Forel’s field HI)
D. .Ansa reticularis
E. .Mammillothalamic tractA. Lenticular fasciculus (Fore1’s field H2)
A
What is the major outtlow tract of the basal ganglia?
A. Lenticular fasciculus (Fore1’s field H2)
B. Ansa lenticularis
C. Thalamic fasciculus (Forel’s field HI)
D. .Ansa reticularis
E. .Mammillothalamic tractA. Lenticular fasciculus (Fore1’s field H2)
The major fibers projecting from the basal ganglia ori- ginate in the medial globus pallidus as a fiber tract Imown as the lenticular fasciculus, or Forel’s field H2. Another tract, Imown as ansa lenticularis, loops around the internal cap- sule, merges with the lenticular fasciculus in Forel’s field H, and continues with the dentatorubrothalamic tract as the thalamic fasciculus (Forel’s field HI). These fibers then synapse in the centromedian (ervI), ventrolateral (VL), and ventroanterior (VA) nuclei of the thalamus before being relayed to the cerebral cortex. Three other efferent tracts of the basal ganglia include the pallidosubthalamic, pallido- habenular (via the stria medullaris), and pallidotegmental, which terminate in the subthalamic nucleus, habenular nucleus, and midbrain tegmentum, respectively (Carpenter, pp.341-344).
3
Q
Injury to Guillain-Mollaret’s triangle can produce?
A. Ann tremor
B. Torsional nystagmus
C. Hypotonia
D. Deafness
E. Myoclonus
A
A. Ann tremor
B. Torsional nystagmus
C. Hypotonia
D. Deafness
E. Myoclonus
Guillain-Mollaret’s triangle is a physiologic connection between the red nucleus, inferior olives, and dentate nucleus of the cerebellum. Injury to this pathway has been known to result in palatal myoclonus. This occurs mainly from hyper- trophic degeneration of the inferior olive secondary to either red or dentate nucleus damage. Other muscles of branchial origin (face, tongue, vocal cords, and diaphragm) may also be affected. Vascular lesions and multiple sclerosis are common causes of secondary palatal myoclonus that persists during sleep. The etiology of primary myoclonus is unclear and is often associated with bothersome clicking sounds in the ear caused by contractions of the tensor veli palatini (CN V) muscles, which open the eustachian tubes. Primary my-
oclonus disappears during sleep (Merritt, pp. 666-667; WiU<ins, p. 149).
4
Q
Through what structure do fibers from the inferior olives reach the cerebellum?
A. Superior cerebellar peduncle
B. Inferior cerebellar peduncle
C. Middle cerebellar peduncle
D. V estibular nucleus
E. Flocculonodular lobe
A
A. Superior cerebellar peduncle
B. Inferior cerebellar peduncle
C. Middle cerebellar peduncle
D. V estibular nucleus
E. Flocculonodular lobe
The fibers exiting the inferior olive are climbing fibers and reach the cerebellum through the inferior cerebellar peduncle. Climbing fibers are excitatory and synapse with Purkinje cells in a distinctive morphologic fashion. They wrap around the cell body and dendrites of Purkinje cells, where numerous synaptic contacts are made. Each climbingfiber contacts 1 to 10 Purkinje cells, and each Purkinje cell receives input from only a single climbing fiber. The re-
sponse elicited by the interaction between climbing fibers and Purkinje cells is believed to be the most powerful in the CNS and results in a large action potential (complex spike) 2 secondary to Ca + influx into the Purkinje cell. The other major afferent fibers reaching the cerebellum are mossy fibers, which intluence Purltinje cells indirectly through synapses with granule cells (Carpenter, pp. 230-234).
5
Q
All of the following are association fibers EXCEPT?
A. Superior longitudinal fasciculus
B. A.rcuate fasciculus
C. Uncinate fasciculus
D. Corona radiata
E. Cingulum
A
All of the following are association fibers EXCEPT?
A. Superior longitudinal fasciculus
B. A.rcuate fasciculus
C. Uncinate fasciculus
D. Corona radiata
E. Cingulum
The corona radiata is made up of projection fibers conveying impulses to subcortical structures including the thalamus, basal ganglia, brainstem, and spinal cord. The superior and inferior longitudinal fasciculus, arcuate fascicu- lus, uncinate faSCiculus, external capsule, and cingulum are six of the more notable association fibers that connect differ- ent lobes within the same hemisphere. Commissural fibers connect corresponding regions of the two hemispheres, which include the corpus callosum, anterior commissure, and hippocampal commissure (Carpenter, pp. 33- 37).
6
Q
First-order neurons involved in pupillary dilation originate in what structure?
A. Thalamus
B. Hypothalamus
C. Superior colliculus
D. Superior cervical ganglia
E. Edinger-Westphal nucleus
A
A. Thalamus
B. Hypothalamus
C. Superior colliculus
D. Superior cervical ganglia
E. Edinger-Westphal nucleus
First-order neurons involved with pupillary dilation originate in the hypothalamus and descend through the brainstem and cervical spinal cord to the TI-T2 level of the spinal cord. They then synapse on ipsilateral preganglionic sympathetic fibers, exit the cord, travel with the sympathetic fibers as second-order neurons, and synapse on postgan- glionic sympathetic fibers. The third-order neurons travel with the internal carotid artery to the orbit and innervate the radial smooth muscle of the iris (Kandel, p. 905).
7
Q
The basal nucleus (of Meynert) contains what type of neurons?
A. Cholinergic
B. Adrenergic
C. Serotonergic
D. Dopaminergic
E. Noradrenergic
A
A. Cholinergic
B. Adrenergic
C. Serotonergic
D. Dopaminergic
E. Noradrenergic
The basal nucleus (of Meynert) contains neurons with acetylcholine that project to the cingulate gyrus, septal nuclei, and the nucleus of the diagonal band of Broca. Dopaminergic fibers are located mainly in the substantia nigra and ventral tegmental area, which mostly serve the striatum and portions of the frontal lobe. Norepinephrine- containing neurons are found in the locus ceruleus, project to the cerebral cortex, and have been implicated in depres- sion and anxiety disorders (including panic attacks). The raphe nuclei consist of brainstem neurons that contain sero- tonin, which project rostrally and caudally. The rostrally projecting fibers originate mainly in the midbrain and rostral pons and have been implicated in mood disorders after injury. The descending projections, originating from the caudal pons and medulla, terminate in the medulla, cerebellum, and spinal cord. One function implicated with these descending fibers is the regulation of afferent (nocicep- tive) information from the periphery (Kandel, pp. 282-297).
8
Q
Beginning the incision for an anterior iliac crest graft ap- proximately 3 cmlateral to the anterior iliac spine attempts to avoid injury of what structure(s)?
1. Sartorius muscle
2. Lateral femoral
cutaneous nerve
3. Ilioinguinal ligament
4. Iliacus muscle
A. 1,2, and 3 are correct
B. 1 and 2 are correct
C. 2 and 4 are correct
D. Only 4 is correct
E. All of the above
A
A. 1,2, and 3 are correct
B. 1 and 2 are correct
C. 2 and 4 are correct
D. Only 4 is correct
E. All of the above
Beginning the incision for an anterior iliac crest graft approximately 3 cm lateral to the anterior iliac spine avoids the attachments of the sartorius muscle and ilioinguinal ligament. The lateral femoral cutaneous nerve courses through this region and is also vulnerable to injury with this approach, but it does not attach to or originate from the iliac crest (Connolly, pp. 818-819).
9
Q
Mossy fibers originating in the dentate gyrus terminate here
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
A
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
10
Q
Extremely vulnerable to hypoxia
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
A
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
11
Q
Schaffer collaterals project to the pyramidal neurons of this subfield
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
A
Schaffer collaterals project to the pyramidal neurons of this subfield
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
12
Q
Lies in the concavity of the dentate gyrus
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
A
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
13
Q
Vestigial remnant of hippocampal formation
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
A
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
14
Q
Injury of this sector may produce remote memory problems
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
A
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
15
Q
Largest sector
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
A
A. CA1
B. CA2
C. CA3
D. CA4
E. Indusium griseum
F. Dentate gyrus
G. None of the above
16
Q
In normal individuals, the direct and indirect circuits of the basal ganglia are balanced by?
A. The opposing actions of the dopaminergic nigrostriatal projections on the Dl and D2 receptor subtypes in the putamen
B. The inhibitory activity of the subthalamic nucleus on the globus pallidus interna
C. The increased activity of GABAergic neurons in the internal segment of the globus pallidus by the direct pathway
D. The ascending dopaminergic fibers originating in the midbrain tegmentum and synapsing in the pars com- pacta of the substantia nigra (int1uencing Dl and D2 receptors in the globus pallidus)
E. All of the above
A
A. The opposing actions of the dopaminergic nigrostriatal projections on the Dl and D2 receptor subtypes in the putamen
B. The inhibitory activity of the subthalamic nucleus on the globus pallidus interna
C. The increased activity of GABAergic neurons in the internal segment of the globus pallidus by the direct pathway
D. The ascending dopaminergic fibers originating in the midbrain tegmentum and synapsing in the pars com- pacta of the substantia nigra (int1uencing Dl and D2 receptors in the globus pallidus)
E. All of the above
The dopaminergic projections of the SNc to the stria- tum facilitate movements by influencing the direct and indi- rect pathways. The nigrostriatal projections to the spiny neurons of the direct pathway (DI receptors) are excitatory, while the nigrostriatal projections to the spiny neurons of the indirect pathway (D2 receptors) are inhibitory. In normal individuals, the direct and indirect circuits of the basal gan- glia are balanced by the opposing actions of these projections on these receptors. The loss of SNc dopaminergic projections to the striatum results in hICl’eased activity of the indirect circuit (and decreased activity of the direct circuit), which accounts for the hypokinetic aspects of Parkinson’s disease. It is important to realize, however, that the segregation of the DI and D2 receptors between the direct and indirect path- ways is probably not as strict as described above, but it still serves as a nice framework to explain the differential action
of dopamine on striatal output.
The subthalamic nucleus has an excitatory effect on
the internal segment of the globus pallidus via the indirect pathway. In normal individuals, the activation of striatal GABAergic neurons inhibits GABAergic neurons within the internal segment of the globus pallidus instead of activat- ing them. The ascending dopaminergic activating system originates in the brainstem reticular activating system and ascends to form multiple supratentorial connections with structures such as the thalamus, hypothalamus, cingulate gyrus, and basal ganglia. Injury of this monoamine pathway has not been shown to result in movement-related disorders; instead, it causes apathetic states such as akinetic mutism (Kandel, pp. 856-864; Youmans, pp. 2673-2674, 2687- 2689).
17
Q
A visual lesion producing a central defect in one field with a superior temporal defect in the opposite may be orig- inating in what location?
A. Anterior chiasm
B. Occipitallobe
C. Temporal lobe
D. Optic nerve
E. Inferior parietal lobe
A
A. Anterior chiasm
B. Occipitallobe
C. Temporal lobe
D. Optic nerve
E. Inferior parietal lobe
18
Q
Fibers from the frontal eye fields pass through the genu of the internal capsule, decussate in the pons, and synapse in what structure involved with saccades?
A. Medial longitudinal fasciculus (MLF)
B. Inferior colliculus
C. Edinger-Westphal nucleus
D. Solitary nucleus
E. Paramedian pontine reticular formation (PPRF)
A
A. Medial longitudinal fasciculus (MLF)
B. Inferior colliculus
C. Edinger-Westphal nucleus
D. Solitary nucleus
E. Paramedian pontine reticular formation (PPRF)
19
Q
Select one letter head- ing (in parenthesis) from Figure 2.19-2.2SQ with which it is most closely associated. Each lettered heading may be used once, more than once, or not at all.
Occlusion of this vessel is the most common cause of lateral medullary (Wallenberg) syndrome
A
B
C
D
E
A
A
B
C
D
E
20
Q
Select one letter head- ing (in parenthesis) from Figure 2.19-2.2SQ with which it is most closely associated. Each lettered heading may be used once, more than once, or not at all.
Supplies the pyramis, tuber, flocullus and caudal part of pontine tegmentum
A
B
C
D
E
A
A
B
C
D
E
21
Q
Select one letter heading (in parenthesis) from Figure 2.19-2.2SQ with which it is most closely associated. Each lettered heading may be used once, more than once, or not at all.
Occlusion can produce contralateral hearing impairment
A
B
C
D
E
A
A
B
C
D
E
22
Q
Select one letter head- ing (in parenthesis) from Figure 2.19-2.2SQ with which it is most closely associated. Each lettered heading may be used once, more than once, or not at all.
Vessel commonly associated with trigeminal neuralgia
A
B
C
D
E
A
A
B
C
D
E
23
Q
Select one letter head- ing (in parenthesis) from Figure 2.19-2.2SQ with which it is most closely associated. Each lettered heading may be used once, more than once, or not at all.
Vessel at most risk of injury during Chiari decompression
A
B
C
D
E
A
A
B
C
D
E
24
Q
Select one letter head- ing (in parenthesis) from Figure 2.19-2.2SQ with which it is most closely associated. Each lettered heading may be used once, more than once, or not at all.
The dentate nucleus is mainly supplied by this vessel
A
B
C
D
E
A
A
B
C
D
E
25
Select one letter head- ing (in parenthesis) from Figure 2.19-2.2SQ with which it is most closely associated. Each lettered heading may be used once, more than once, or not at all.
Supplies the middle cerebellar peduncle
A
B
C
D
E
A
B
**C**
D
E
26
Fibers passing from the amygdala to the hypothalamus may travel in what fiber bundle?
A. Stria medullaris
B. Fornix
C. Stria tenninalis
D. Medial forebrain bundle
E. Cingulum
A
B
**C**
D
E
27
A cerebellar glomerulus consists of all of the following
EXCEPT?
A. Climbing fibers
B. Glial capsule
C. Dendrites of granule neurons
D. 1-\..'(ons and dendrites of Golgi type II neurons
E. Mossy fibers
**A**
B
C
D
E
28
The major site for neuroblast proliferation in the CNS is
A. Layer III of the cerebral cortex
B. Periventricular ependymal region
C. White matter
D. Spinal cord
E. Arachnoid layer
A
**B**
C
D
E
29
Which cell represents the only output of the cerebellar cortex?
A. Granule cell
B. Golgi cell
C. Stellate cell
D. Purltinje cell
E. Horizontal cell
A. Granule cell
B. Golgi cell
C. Stellate cell
**D. Purltinje cell **
E. Horizontal cell
30
What structures pass through the annulus tendineus (of
Zinn)?
1. Ophthalmic vein
2. Lateral rectus muscle
3. Lacrimal branch of ophthalmic nerve
4. Inferior division of oculomotor nerve
A. 1, 2, and 3 are correct
B. 1 and 3 are correct
C. 2 and 4 are correct
D. Only 4 is correct
E. All of the above
A. 1, 2, and 3 are correct
B. 1 and 3 are correct
**C. 2 and 4 are correct **
D. Only 4 is correct
E. All of the above
31
Nerve supplies muscles that are antagonists to the serratus anterior
**K**
32
Injury to this nerve may result in winged scapula
**A**
33
Innervates teres minor muscle
**I**
34
Injury to this nerve will result in flexion wealmess, especially when the forearm is supin
**J**
35
Innervates supinator muscle
**G**
36
Nerve most commonly affected by entrapment neuropathy
**H**
37
A pure lesion of a branch of this nerve can result in
wealmess of the long flexors of the thumb and index finger
(producing a pinch sign) and pronator quadratus
**H**
38
Injury of tlus nerve may occur in Guyan's canal
**F**
39
Compression of this nerve may occur by a ligament that
bridges the supracondylar process to the medial epicondyle
**H**
40
Innervates the interossei 111uscles
**F**
41
Supplies sensation to the anteromedial and posteromedial forearm down to the wr
**E**
42
Entrapment in quadrilateral space
**I**
43
All are features of the cerebral cortex EXCEPT?
A. Vague cytoarchitectural boundaries
B. Laminar arrangement of neurons
C. Conspicuous stripes of unmyelinated fibers
D. Radial or columnar arrangement of neurons
E. Numerous pyramidal cells in layer V of the visual cortex that send fibers to the brainstem for visually directed reflexive eye movements
All are features of the cerebral cortex EXCEPT?
A. Vague cytoarchitectural boundaries
B. Laminar arrangement of neurons
**C. Conspicuous stripes of unmyelinated fibers**
D. Radial or columnar arrangement of neurons
E. Numerous pyramidal cells in layer V of the visual cortex that send fibers to the brainstem for visually directed reflexive eye movements
## Footnote
The cells of the cerebral cortex show both a laminar
and radial or columnar arrangement. Several areas of cortex
have grossly visible stripes of myelinated fibers, most notably
the band of Gennari in layer IV of the occipital cortex. Most
cytoarchitectural boundaries are vague rather than sharp.
The large pyramidal neurons located in layer V of the visual
receptive cortex send axons to the brainstem that mediate
visually directed reflex eye movements (Carpenter, pp. 390-
433)
44
The arcuate fasciculus is composed of association fibersn interconnecting which structures?
A. Superior parietal lobule and occipital lobe
B. Superior and middle frontal gyrus and temporal lobe
C. Superior and inferior frontal gyrus and limbic lobe
D. Thalamus and amygdala
E. Orbital frontal gyri and temporal lobe
A. Superior parietal lobule and occipital lobe
**B. Superior and middle frontal gyrus and temporal lobe **
C. Superior and inferior frontal gyrus and limbic lobe
D. Thalamus and amygdala
E. Orbital frontal gyri and temporal lobe
## Footnote
The arcuate fasciculus projects from the superior
temporal gyrus (STG) to the superior and middle frontal
gyri. More commonly, it is known as the tract that links the
receptive area of speech in the superior temporal gyrus
(Wernicke's area) with the inferior frontal gyrus (Broca's
area). Lesions in this tract often produce conduction aphasia, in which patients have fluent speech with poor repetition
of spoken language. Wernicke's aphasia (WA) is a receptive
aphasia characterir,ed by poor comprehension of spoken
language, neologisms, literal and verbal pill·aphasias, poor
repetition, and a lack of concern regarding the speech problem. Injury to Broca's area results in an executive aphasia
characterir,ed by slow and effortful speech , agrammatic
sounds, and telegraphic speech. The uncinate fasciculus
connects the orbital frontal gyri with the anterior portions of
the temporal lobe, while the cingulum connects the medial
regions of the frontal and parietal lobes with the parahippocampal and temporal regions. The fibers of the superior
and inferior longitudinal fasciculus lie close to the arcuate
fasciculus and connect the parietal and occipital lobes with
the frontal and temporal lobes, respectively. The anterior
commissure (association tract) crosses the midline rostral
to the fornix and has two parts: the smaller anterior portion
interconnects the olfactory bulbs, and the larger posterior
portion interconnects the middle and inferior temporal gyri
(Carpenter, pp. 33-37).
45
A 27-year-old male presents to the emergency 1'00111
with ptosis of the right eyelid and' pupillary constriction of
the same eye, but no gaze palsy or diplopia. The most likely
explanation for this is a lesion in what location?
A. CN II
B. CN III
C. CNV
D. CN VII
E. Carotid sympathetic nerve
A. CN II
B. CN III
C. CNV
D. CN VII
**E. Carotid sympathetic nerve**
## Footnote
The combination of pupillary constriction and ptosis
suggests a Horner's syndrome. Two muscles elevate the eyelid: the levator palpebrae (CN III) and the superior tarsal
muscle of rvIulier (carotid sympathetic nerve). The key to
further differentiation is the size of the pupil. A lesion of
cranial nerve III may likely result in pupillodilation (due to
pupilloconstrictor muscle paralysis), whereas injury to the
sympathetic nerve would result in pupil constriction, as seen
in this patient. In addition, the ptosis of sympathetic paralysis may improve when the patient volitionally looks up,
because the levator palpebrae is the muscle that mediates
voluntary upward gaze . The lesion causing injury to the sympathetics may originate in any location along the descending
pathways from the hypothalamus through the spinal cord
and out through the peripheral pathways along the sympathetic chain and carotid artery (see discussion for question
6) (Brazis, pp. 181-182; Greenberg, p. 578).
46
What region(s) of the striate cortex do NOT contain ocular dominance columns?
1. The cortical region representing the blind spot of the
retina
2. The cortical region representing the nasal half of the
ipsilateral retina
3. The cortical region representing the monocular temporal crescent of the visual field
4. The columnar system, which is mainly concerned with
line orientation and retinal position
A. 1,2, and 3 are correct
B. 1 and 3 are correct
C. 2 and 4 are correct
D. Only 4 is correct
E. All of the above
A. 1,2, and 3 are correct
**B. 1 and 3 are correct **
C. 2 and 4 are correct
D. Only 4 is correct
E. All of the above
## Footnote
The striate cortex is organized in both vertical and
horizontal systems. The vertical or columnar system is
mainly concerned with line orientation, retinal position,
detection of movements, and ocular dominance. The two
regions of the striate cortex that do not contain ocular
dominance columns include the region representing the
blind spot of the eye and the cortical region representing the
monocular temporal crescent of the visual fields (Carpenter,
pp.411- 414).
47
Prone to injury during obstetric and gynecologic
procedures
**D**
48
Nerve associated with "meralgia paresthetica"
**A**
49
Nerve likely to be damaged by hematoma in the pelvis
**B**
50
Diabetic amyotrophy is most likely to affect this site
**E**
51
Supplies the pectineus and gracilis muscles
**D**
52
A gray ramus communicans, which extends between a
sympathetic trunk ganglion and anterior primary ramus of a
spinal nerve, contains which of the following?
A. General somatic afferent fibers
B. Myelinated fibers
C. Preganglionic sympathetic neurons
D. Fibers that become the enteric nervous system
E. Adrenergic fibers
A. General somatic afferent fibers
B. Myelinated fibers
C. Preganglionic sympathetic neurons
D. Fibers that become the enteric nervous system
**E. Adrenergic fibers**
53
Muscles that are innervated by the ansa cervi calis include
all of the following EXCEPT?
A. Omohyoid
B. Geniohyoid
C. Thyrohyoid
D. Geniohyoid
E. Stylohyoid
A. Omohyoid
B. Geniohyoid
C. Thyrohyoid
D. Geniohyoid
**E. Stylohyoid**
54
A 46-year-old male with a remote history of a gunshot
wound to the face and intravenous drug abuse presents to the
emergency room with fevers and swelling on the left side of
his neck and face . A CT scan reveals an abscess adjacent to
the pterygopalatine fossa. This infection may directly track
to all of the following compartments EXCEPT?
A. Orbital cavity
B. Nasal cavity
C. Middle cranial fossa
D. Inner ear
E. Oral cavity
A. Orbital cavity
B. Nasal cavity
C. Middle cranial fossa
**D. Inner ear**
E. Oral cavity
55
Match the lesion site with the corresponding
clinical abnormality:
Short ciliary nerves
A. Ivlarcus-Gunn pupil
B. Horner's pupil
C. Adie's pupil (ToniC pupil)
D. Argyll-Robertson pupil
E. None of the above
A. Ivlarcus-Gunn pupil
B. Horner's pupil
**C. Adie's pupil (ToniC pupil)**
D. Argyll-Robertson pupil
E. None of the above
56
Match the lesion site with the corresponding
clinical abnormality:
Superior cervical ganglion
A. Ivlarcus-Gunn pupil
B. Horner's pupil
C. Adie's pupil (ToniC pupil)
D. Argyll-Robertson pupil
E. None of the above
A. Ivlarcus-Gunn pupil
**B. Horner's pupil**
C. Adie's pupil (ToniC pupil)
D. Argyll-Robertson pupil
E. None of the above
57
Match the lesion site with the corresponding
clinical abnormality:
Dorsal midbrain
A. Ivlarcus-Gunn pupil
B. Horner's pupil
C. Adie's pupil (ToniC pupil)
D. Argyll-Robertson pupil
E. None of the above
A. Ivlarcus-Gunn pupil
B. Horner's pupil
C. Adie's pupil (ToniC pupil)
**D. Argyll-Robertson pupil**
E. None of the above
58
Match the lesion site with the corresponding
clinical abnormality: *Retina*
A. Ivlarcus-Gunn pupil
B. Horner's pupil
C. Adie's pupil (ToniC pupil)
D. Argyll-Robertson pupil
E. None of the above
**A. Ivlarcus-Gunn pupil **
B. Horner's pupil
C. Adie's pupil (ToniC pupil)
D. Argyll-Robertson pupil
E. None of the above
59
The term lentiform ntlclei refers to what structure(s)?
A. Caudate nucleus and globus pallidum
B. Putamen and amygdala
C. Putamen and globus pallidus
D. Caudate nucleus, globus pallid us, and putamen
E. Globus pallidus
A. Caudate nucleus and globus pallidum
B. Putamen and amygdala
**C. Putamen and globus pallidus**
D. Caudate nucleus, globus pallid us, and putamen
E. Globus pallidus
60
The subthalamic nucleus (STN) receives its
input from which of the following structures?
A. Ventral lateral (VL) nucleus of the thalamus
B. Centromedian (Cl"l) nucleus of the thalamus
C. Lateral globus pallidus
D. Medial globus pallidus
E. Cerebral cortex
A. Ventral lateral (VL) nucleus of the thalamus
B. Centromedian (Cl"l) nucleus of the thalamus
**C. Lateral globus pallidus **
D. Medial globus pallidus
E. Cerebral cortex
61
All of the following are afferent tracts through the inferior
cerebellar peduncle EXCEPT?
A: Vestibulocerebellar
B. Olivocerebellar
C. Dorsal spinocerebellar
D. Reticulocerebellar
E. Corticopontocerebellar
A
B
C
D
**E**
62
Axons of which cells leave layer V of the neocortex primarily as projection fiber
A. Stellate cells
B. Fusiform cells
C. Pyramidal cells
D. Horizontal cells
E. Fusiform cells
A
B
**C**
D
E
63
Which body part has the largest relative representation
in the sensorimotor cortex?
A. Genitalia
B. Middle finger
C. Nipple
D. Thumb
E. Index finger
A
B
C
**D**
E
64
A major difference between the archicortex and neocortex includes what?
A. Absence of lamination in the archicortex
B. A six-layer arrangement of the archicortex
C. Presence of a superfiCial layer of white matter in the archicortex
D. Lack of Betz cells in the archicortex
E. The archicortex has major connections only with the limbic system
A
B
**C**
D
E
## Footnote
Both the archicortex and neocortex are laminated,
contain pyramidal neurons, and have connections with the
limbic system. One major difference is that the archicortex
has a distinct superficial layer of white matter, in comparison
to the neocortex, which has white matter on its inner surface
(Carpenter, pp. 390-396).
65
Which nucleus of the hypothalamus is involved with
production of hypothalamic-releasing factors and gives rise
to the tuberohypophysial tract?
A. Dorsomedial
B. Suprachiasmatic
C. Arcuate
D. Posterior
E. Preoptic
A
B
**C**
D
E
## Footnote
The nuclei of the hypothalamus are divided by an
imaginary plane formed by the columns of the fornix and
mammillothalamic tract into medial and lateral groups. The
medial hypothalamic area is again divided into four regions
from anterior to posterior: preoptic, supraoptic, tuberal, and
mammillary regions. Each of these regions contains a separa te subgroup of nuclei.
66
Which of the follOWing constellations about hypothalamic
function is/are correct?
1. Lateral and posterior hypothalamic regions concerned
with sympathetic responses
2. Anterior and medial hypothalamic regions control
parasympathetic responses
3. Localized, bilateral lesions of the ventromedial nucleus
in the tuberal region can produce hyperphagia
4. Bilateral posterior hypothalamic lesions can produce pOikilothermia
A. 1,2, and 3 are correct
B. 1 and 3 are correct
C. 2 and 4 are correct
D. Only 4 is correct
E. All of the above
A
B
C
D
**E**
## Footnote
The supraoptic and para ventricular nuclei of the
hypothalamus synthesize and secrete vasopressin and oxytocin, respectively. The anterior portion of the hypothalamus controls mechanisms that dissipate heat. Stimulation
of this area causes dilation of blood vessels and sweating,
which lowers body temperature. Stimulation of the posterior
hypothalamus results in vasoconstriction of blood vessels,
inhibition of sweating, and possibly shiveri11g, which may
increase body temperature. The posterior (mainly) and lateral
hypothalamic nuclei are also involved with the sympathetic
nervous system control. The lateral region of the hypothalamus is sometimes referred to as either the hunger and thirst
center, as stimulation can result in increased food and water
intake. Stimulation of the medial region of the hypothalamus
results in decreased food intake; it is often referred to as the
satiety center. The suprachiasmatic nucleus controls circadian rhythms, and the anterior and preoptic nuclei help to
control parasympathetic responses as well as gonadotropin
secretion (Carpenter, pp. 317- 324).
67
The deep peroneal nerve innervates which of the following muscles?
1. Extensor hallucis longus
2. Extensor digitorum longus
3. Tibialis anterior
4. Peroneus longus
A. 1,2, and 3 are correct
B. 1 and 3 are correct
C. 2 and 4 are correct
D. Only 4 is correct
E. All of the above
**A **
B
C
D
E
## Footnote
The sciatic nerve (L4-S3) is the major branch of the
sacral plexus and is also the largest nerve in the body. The
sciatic nerve consists of the tibial and common peroneal
nerves. The tibial nerve (L4-S3) innervates the tlexors of
the leg, including the semitendinosus, semimembranosus,
biceps femoriS, gastrocnemius, soleus, flexor hallucis longus,
flexor digitorum longus, popliteus, tibialis posterior, and
plantaris. The tibial nerve gives rise to the lateral sural cutaneous nerve , which unites with the communicating branch
of the peroneal nerve to form the sural nerve. This nerve supplies cutaneous innervation to the lateral inferior leg and
lateral foot. The tibial nerve may become entrapped in the
tarsal tunnel posterior and inferior to the medial malleolus,
which results in pain and paresthesias in the toes and sole
of the foot (often sparing the heel because these sensory
branches often originate proximal to the tarsal tunnel) and
weakness on plantartlexion. The common peroneal nerve
(L4-S2) innervates extensors and adductors of the leg (and
part of the biceps femoris) and gives rise to the lateral sural
cutaneous nerve (to the inferolateralleg), the deep peroneal
nerve , and the superficial peronea l nerve . The deep peroneal
nerve innervates the foot and toe extensors (tibialis anterior,
extensor hallucis longus, extensor cligitorum longus) and
provides sensation to a small area between the great and
second toes. The superficial peroneal nerve innervates the
peroneus longus/brevis (foot eversion) and the skin of the
distal anterior leg, the dorsum of the foot, and the digits.
Lesions of the common peroneal nerve (most common) result in paralysis of dorsit1exion (foot-drop) and foot eversion .
The posterior femoral cutaneous nerve (Sl-S3) innervates
the skin of the inferior buttocks, perineum, posterior thigh ,
and proximal leg (Greenberg, pp. 522, 544- 546).
68
The posterior limb of the internal capsule contains all
the following tracts EXCEPT?
A. Prefrontal corticopontine
B. Corticospinal
C. Corticotectal
D. Corticorubral
E. Superior thalamic radiations
**A**
B
C
D
E
## Footnote
The corticospinal, frontopontine, superior thalamic radiations, and a relatively smaller
number of corticotectal and corti co rubra 1 fibers run in the
posterior limb of the internal capsule. The prefrontal COl·ticopontine tract and anterior thalamic radiations run in the
anterior limb of the internal capsule, while the corticobulbar
and corticoreticular tracts are contained within the genu of
the internal capsule (Carpenter, p. 282).
69
What is the most common neurotransmitter found in the
thalamus?
A. Glutamate
B. Aspartate
C. GABA
D. Acetylcholine
E. Substance P
A
B
**C**
D
E
## Footnote
Although glutamate appears to be the main neurotransmitter of the corticothalamic tracts, the thalamus itself
is rich in GJ-\BA. Virtually all cells of the thalamus are rich in
this neurotransmitter; in primates, the major projections of
the medial pallidum to the VA and VL nuclei of the thalamus
are GABAergic. Moreover, the projections from the pars
reticulata of the substantia nigra to the VA and MD nuclei
of the thalamus are also rich in GABA (Carpenter, pp. 278-
279).
70
Crossed fibers of the optic tract terminate in which layers
of the lateral geniculate body?
A. 2,4, and 6
B. 1,4, and 6
C. 2, 3, and 5
D. 1,3, and 5
E. 2,5, and 6
A
**B **
C
D
E
## Footnote
The LGN contains sL'I: layers, numbered 1 through 6.
The ventralmost layers contain large cells and are lmown as
"magnocellular"; they receive their input from M ganglion
cells. The dorsal four layers are Imown as "parvocellular" and
receive their input from p ganglion cells. An individual layer
receives input from only one eye. Fibers from the contralateral nasal hel11iretina synapse in layers 1,4, and 6, and fibers
from the ipsilateral temporal hemiretina synapse in layers 2,
3, and 5 (Kandel, pp. 528-532)
71
Which of the following is NOT a deep nucleus of the
cerebellum?
A. Fastigial
B. Fusiform
C. Embolifonn
D. Globose
E. Dentate
A
**B**
C
D
E
## Footnote
The cerebellum comprises the fastigial, globose, emboliform, and dentate nuclei. The globose and emboliform
nuclei together are known as the interposed nuclei. These
nuclei correspond to the three functional divisions of the
cerebellum: the vestibulocerebellul11, spinocerebellul11, and
cerebrocerebellum. The vermis projects via the fastigial
nucleus to the cortex and brainstem giving rise to the medial descending systems controlling proximal musculature. The
intermediate zone of the cerebellum projects via the interposed nuclei to cortical and brainstem regions, which give
rise to the lateral descending pathways controlling distal
limb muscles. The lateral zone projects to the dentate
nucleus, which forms connections with the motor and
premo tor areas of the cerebral cortex for the planning of
voluntary movements (Carpenter, pp. 234-236).
72
I-low far behind the coronal suture is the motor strip
generally located?
A. 1-2 cm
B. 2-3 cm
C. 4-5 cm
D. 7-8 cm
E. 9-10 cm
A
B
**C**
D
E
## Footnote
The motor strip generally lies 4 to 5.4 cm behind the
coronal suture (Greenberg, pp. 97- 98).
73
Injury of the cranial nerve piercing this foramen results
in diplopia and weak gaze when looking down and out
**B**
74
Nerve that traverses this foramen later joins with the
deep petrosal nerve to become the nerve to the pterygoid
canal
**F**
75
Injury to a small branch of the nerve passing through this
canal results in hyperacusis
**G**
76
The nerve passing through this foramen innervates the
tensor veli palatini muscle
**D**
77
The cranial nerve passing through tins foramen innervated
by the superior saliva tory nucleus to produce salivation
**G**
78
The nerve passing through this foramen gives rise to
general visceral efferent (GVE) fibers that supply the parotid
gland
**H**
79
The cell bodies of these afferent fibers are located in the
nodosal ganglion and enter the skull through this foramen
**H**
80
The lesser petrosal nerve traverses this foramen
**E**
81
This foramen is traversed by a nerve that gives off the
chorda tympani fibers
**G**
82
Transmits the ophthalmic vein
**B**
83
A 45-year-old male is found to have diplopia with weakness of downward and medial gaze of the right eye. He also
has significant difficulty walking down steps without tilting
his head for better visualization. \Vhat cranial nerve is most
likely affected?
A. Right oculomotor nerve
B. Left oculomotor nerve
C. Left trochlear nerve
D. Right trochlear nerve
E. Right abducens nerve
A
B
**C**
D
E
## Footnote
The trochlear nucleus is located in the tegmentum
of the mesencephalon at the level of the inferior colliculus,
ventral to the cerebral aqueduct. i\.xons leaving this nucleus
course dOl'sally around the aqueduct, decussate within the
superior medullary velum, and exit the brainstem on the
dorsal surface (only cranial nerve to exit the brainstem dorsally and decussate after exiting the brainstem). Since the
trochlear nerve crosses to the other side, it innervates the
contralateral superior oblique muscle. Of note, the trochlear
nerve passes through the cavernous sinus along with cranial
nerves III, V1 , sometimes V2 , and VI. Cranial nerves III, VI'
V2 , and IV run along the lateral wall of the sinus, while cranial
nerve VI runs more medially and adjacent to the internal
carotid artery. Injury to the superior oblique muscle or
trochlear nerve results in diplopia, with wealmess of downward and medial gaze. Patients have most difficulty walking
down stairs, and because of the tendency to tilt the head
to compensate for the affected superior oblique muscle,
fourth nerve palsies should be included in the differential
for torticollis (Wilson-Pauwels, pp. 70-77).
84
The following statements are true of the corticospinal
tract EXCEPT?
A. Approximately 3% of corticospinal fibers originate from Betz pyramidal cells
B. Corticospinal fibers incompletely decussate in the medulla to form a larger lateral corticospinal tract and a smaller anterior corticospinal tract
C. The majority of cervical corticospinal fibers are found medially and sacral fibers are found laterally
D. Corticospinal lesions result in hyperactive tendon jerk retlexes, extensor toe response, and spasticity after a period of hypotonia
E. Terminates primarily on a motor neurons in lamina IX of the spinal cord
A
B
C
D
**E**
## Footnote
The corticospinal tracts originate in layer V of the
cerebral cortex, pass through the corona radiata and posterior limb of the internal capsule, form the middle third of
the cerebral peduncles and the pyramids of the medulla, and
terminate primarily on interneurons of lamina VII in the
spinal cord. Approximately 40% of corticospinal fibers originate in the parietal lobe, 30% are from the motor cortex (area
4), 30% from the supplementary motor area (area 6), and
only 3% originate from the giant Betz pyramidal cells of the
motor cortex. Around two-thirds of the corticospinal fibers
are myelinated, and there are approximately 1 million corticospinal fibers in each pyramid of the medulla. Corticospinal
fibers incompletely decussate in the medulla and form the
large crossed lateral corticospinal tract (90% of fibers), the
smaller uncrossed anterior corticospinal tract, and the very
small uncrossed anterolateral corticospinal tract. The lateral
corticospinal tracts descend in the lateral funiculus to all
levels of the spinal cord and synapse in laminae IV, V, VI,
and VII of the spinal gray. The anterior corticospinal tracts
descend adjacent to the anterior median fissure of the spinal
cord and terminate primarily in cervical segments. The
majority of these fibers (90%) decussate at upper cervical
levels of the spinal cord in the anterior white commissure
before synapsing in lamina VII of the spinal gray. The
uncrossed anterolateral corticospinal tracts (10%) descend
ventral to the lateral corticospinal tracts to terminate in the
intermediate gray and base of the posterior horns of the
spinal cord. A relatively small number of corticospinal fibers
synapse directly on motor neurons in the anterior horn of
the spinal cord. Within the spinal cord, cervical corticospinal
fibers are located medially, and sacral fibers are found laterally. The corticospinal tracts are responsible for voluntary
skilled movements of the extremities. Significant corticospinal tract lesions may cause hypotonia followed by hyperactive deep tendon retlexes, extensor toe response (Babinski
sign), and loss of superficial abdominal and cremasteric reHexes (Carpenter, pp. 94- 97; Martin, pp. 144-145).
85
Papez's circuit includes all of the following structures
EXCEPT?
A. Amygdala
B. FornLx
C. Mammillary bodies
D. Cingulate gyrus
E. Hippocampus
**A**
B
C
D
E
## Footnote
The limbic lobe is not a true lobe of the brain but
rather a functional collection of structures that regulates higher activities such as memory and emotion. It does not
include the amygdala. Papez's circuit runs from the hippocampus to the fornix to the mammillary body. Fibers
are then relayed to the anterior nucleus of the thalamus
(through the mammillothalamic tract) to the cingulate
gyrus and back to the hippocampus through the cingulate
bundle. The term limbic system includes the limbic lobe
and its associated subcortical nuclei, including the amygdala, hypothalamus, septal, and certain hypothalamic nuclei
(Kandel, pp. 986- 987; Carpenter, pp. 376, 384-386).
86
The predominant type of synapse in the retina is'?
A. Electrical
B. Connexin-dependent
C. Chemical
D. Calcium-dependent
E. cAMP-dependent
A
B
**C **
D
E
## Footnote
The retina contains both electrical and chemical
synapses. Photo receptors and horizontal cells are connected
to each other via gap junctions, but, as in the rest of the
brain, chemical synapses predominate in the retina. Most
are calcium-independent and appear to work by cGIl'lP.
(See discussion for question 27 in Chapter 1, Neurobiology
Answers, for further discussion of phototransduction.)
(Kandel, pp. 492-506).
87
The inner nuclear layer of the retina contains what type
of cell(s) ?
1. Bipolar cells
2. Horizontal cells
3. Amacrine cells
4. Ganglion cells
A. 1, 2, and 3
B. 1 and3
C. 2 and4
D. Only 4 is correct
E. All of the above
**A**
B
C
D
E
## Footnote
The innermost retinal cell layer (ganglion cell layer)
is named after the retinal output cells. The axons of
ganglion cells are unmyelinated, which facilitates light transmission to the photoreceptor layer of the outer retina.
The layers superficial to the ganglion cell layer include the
inner synaptic (plexiform) layer, inner nuclear layer, outer
synaptic (plexiform) layer, and outer nuclear layer. The
outer nuclear layer contains the cell bodies of the rods
(night vision) and cones (daylight vision). The inner nuclear
layer contains the cell bodies of the retinal interneurons,
which include the bipolar cells, horizontal cells, and
amacrine cells. Bipolar cells link photoreceptors directly
with the ganglion cells, while the actions of horizontal and
amacrine cells enhance visual contrast through interactions
between laterally located photoreceptor cells and bipolar
cells. Horizontal cells are located on the outer part of the
inner nuclear layer, while amacrine cells are located on
the inner portion. Amacrine cells contain dopamine. MUlier
cells are the principal retinal neuroglial cells (Martin,
pp. 164-171; Kandel, p. 515).
88
Area 5
**M**
89
Superior colliculus
**E**
90
Medial lemniscus
**F**
91
Mammillothalamic tractj fornix
**I**
92
Inferior colliculusj lateral lemniscus
**K**
93
Optic tract
**J**
94
Trigeminothalamic tract
**L**
95
Cerebellar nuclei
**D**
96
All of the following statements concerning the medulla oblongata are correct EXCEPT?
A. Extends from the pyramidal decussation to the inferior pontine sulcus
B. Receives a portion of its blood supply from the posterior spinal artery
C. Gives rise to GVE fibers that synapse in the otic ganglia
D. Gives rise to the lateral vestibular nucleus
E. Is the origin of GVE fibers that synapse in the sinoatrial and atrioventricular nodes of the heart
A
B
C
**D**
E
## Footnote
The medulla oblongata contains GVE fibers that originate in the inferior saliva tory
nucleus and gives rise to the fibers that synapse in the otic
ganglia.to control parotid gland secretion. It also contains the
nucleus ambiguus, which gives rise to the vagal preganglionic
parasympathetic GVE fibers that synapse in the sinoatrial
and atrioventricular nodes of the heart. The medulla extends
from the pyramidal decussation to the inferior pontine
sulcus and also contains the corticospinal tracts, medial
lemniscus, medial longitudinal faSCiculus, hypoglossal nuclei,
olivary nuclei, spinal lemniscus, spinocerebellar tracts, spinal
trigeminal tract and nucleus, inferior cerebellar peduncle,
dorsal motor nucleus of CN X, solitary tract, CN nuclei of
IX to Xl (although it also houses portions of CN V and CN
VIII), as well as the inferior and medial vestibular nuclei. The
lateral vestibular nuclei are mainly in the pons. The medulla
receives its blood supply fr0111 the posterior spinal artery,
anterior spinal artery, PICA, and branches originating from
the vertebral arteries (Carpenter, pp. 115-150).
97
A 54-year-old male presents with ptosis, miosis, and hemianhydrosis on the left side, loss of vibration sensation in the right leg, loss of pain and temperature on the face , trunk,
and extremities on the right, as well as severe atmda and intention tremor on the left side. The lesion responsible for this constellation of problems is most likely in what location?
A. Caudal midbrain tegmentum, left side
B. Rostral medulla, medial zone , right side
C. Caudal medulla, lateral zone, left side
D. Pontine isthmus, dorsal lateral region, left side
E. Posterior limb of the internal capsule
A
B
C
**D**
E
## Footnote
The most Ill,ely cause of the constellation of
signs/symptoms reported in this patient is a lesion in the
dorsolateral zone of the pontine isthmus on the left side
(lateral superior pontine syndrome). Interruption of the
descending sympathetic tract resulted in the ipsilateral
Horner's syndrome. Involvement of the lateral aspect (includes leg fibers) of the medial lemniscus resulted in loss
of Vibratory sensation and other dorsal column deficits on
the contralateral side. Damage to the trigeminothalamic
tract and spinothalamic tracts in this location would account
for the contralateral hemianesthesia of the face and body.
Disruption of the superior cerebellar peduncle can lead
to the severe ataxia and tremor on the ipsilateral side
(Carpenter, pp. 151-191; Fix, pp. 184- 186).
98
An infarct involving the paramedian part of the midbrain
would most likely affect what structures?
1. Oculomotor nerve roots (CN III)
2. Red nucleus
3. Dentatorubrothalamic tract
4. Laterallemniscus
A. 1,2, and 3 are correct
B. 1 and 3 are correct
C. 2 and4 are correct
D. Only 4 is correct
E. 1-\11 of the above
**A**
B
C
D
E
## Footnote
Paramedian midbrain
(Benedikt's) syndrome results from occlusion of the paramedian midbrain branches of the PCA and/or basilar artery.
Structures affected include the CN III nerve roots (eye
abduction and depression due to unopposed action of lateral
rectus and superior oblique muscles) as well as the red
nucleus and dentatorubrothalamic tract (intention tremor
and at[L'(ia). Medial midbrain (Weber's) syndrome results
from occlusion of medial midbrain branches, which can result in CN III palsy, corticobulbar tract injury (contralateral
faci al wealmess), and corticospinal tract injury (contralateral hemiparesis or hemiplegia) (Fix, pp. 187- 188; Carpenter,
pp. 192-223).
99
All of the following structures are involved with taste sensation EXCEPT?
A. Cranial nerves VII, IX, andX
B. Solitary nucleus
C. Para brachial nucleus
D. Hypothalamus
E. Para bigeminal nucleus
A
B
C
D
**E**
## Footnote
The gustatory system innervates the speCial visceral
afferent (SVA) modality of taste. Taste buds located on the
tongue, epiglottis, and palate are innervated by the SVA fibers
of CN VII, IX, and X. First-order neurons are pseudounipolar
ganglion cells located in the geniculate ganglion of Cl',T\T II,
the petrosal ganglion of DC, and the nodose ganglion of X.
These fibers project centrally to the solitary nucleus, which
then projects, via the central tegmental tract, to the parabrachial nucleus of the pons and VPM nucleus of the thalamus.
The parabrachial nucleus then projects to the hypothalamus
and amygdala, whereas the VPM projects to gustatory area 43
(parietal operculum) and parainsular cortex. Area 43 then
projects via way of the entorhinal cortex to the hippocampal
formation. The parabigeminal nucleus functions with the
superior colliculus in processina visual information (Fix,
pp. 254-256, Carpenter, pp.137, 140, 143, 171, 271, 418).
100
For proper motor function, the motor cortex receives
inputs from all of the following structures EXCEPT?
A. Parietal cortex
B. Basal ganglia
C. Dentate nucleus
D. Primary somesthetic area (S I)
E. Centromedian (CM) nucleus of the thalamus
A
B
C
D
**E**
## Footnote
The parafascicular, centromedian, and rostral
intralaminar nuclei of the thalamus lie within the internal
medullary lamina and are lmown as the intralaminar nuclei
of the thalamus. The parafascicular nucleus of the thalamus
lies medial to the centromedian nucleus and ventral to the
dorsomedial nuclei of the thalamus. While the projections of
the parafascicular and centromedian nuclei of the thalamus remain ill-defined, the majority are believed to terminate
in the striatum. Cells of the centromedian nucleus project
principally to the putamen, where they terminate in a
mosaic-type pattern, and cells from the parafascicular
nucleus project to the caudate nucleus. Few tracts project to
both regions of the striatum. The majority of motor activities
are influenced by the thalamus, cerebellum, basal ganglia,
peripheral receptors, and other cortical areas. The basal ganglia and cerebellum provide priming and feedback functions
for smoothly executed movements. Sensory feedback concerning position sense are provided by the dorsal columnmedial lemniscus (via the ventral posterior lateral [VPLj
nucleus of the thalamus), which is necessary to make both
accurate and sequential movements. Complex voluntary
motor activity is aided by the premo tor region of the posterior parietal region (area 5), which helps with goal-directed
movements that require transformation of sensory representations of the environment into limb and hand movements,
a process termed sensorimotor transformation (Carpenter,
pp. 424- 425; Kandel, pp. 756- 779).
101
Nitric OXide, a potent second messenger, is synthesized
from which of the follOWing?
A. Lysine
B. Arginine
C. Tyrosine
D. Dopamine
E. Beta lipoprotein
A
**B**
C
D
E
## Footnote
Nitric oxide is synthesized from the amino acid
arginine by the enzyme nitric oxide synthase (NOS). Nitric
oxide easily diffuses across the plasma membrane of target
cells. Within target cells, nitric oxide binds guanylyl cyclase
to stimulate the production of cGIvIP. Nitric oxide is synthesized by endothelial cells and then acts upon smooth muscle
cells to induce relaxation. Nitric oxide is a potent vasodilator,
but it has a short half-life (5 to 10 seconds). Within neurons,
NOS is activated by a calCium/calmodulin-dependent enzyme after glutamate binds and activates the NMDA channel
(Ka ndel, p. 295).
102
Which of the follOWing fibers violate the Bell-Magendie
law?
A. Peripheral proprioceptive fibers
B. Unmyelinated C fibers from pelvic viscera
C. Lower extremity motor fibers to appendicular musculature
D. General visceral efferent fibers to the proximal GI tract
E. None of the above
A
**B**
C
D
E
## Footnote
The BeLl-.Magendie law states that all motor fibers
exit the spinal cord via the ventral roots and all sensory fibers
enter the spinal cord via the dorsal roots. Unmyelinated C
fibers that transmit pain and temperature information from
the pelvic viscera reside in the ventral roots from L5 to S3 ,
thus violating the Bell-Magendie law. The cell bodies of these
neurons reside in the dorsal root ganglia, like other sensory
neurons (DeMyer, p. 55).
103
Which of the follOWing descending tracts utilizes serotonin as its neurotransmitter?
A. Tectospinal
B. Medial longitudinal fasciculus (MLF)
C. Reticulospinal
D. Vestibulospinal
E. Rubrospinal
A
B
**C**
D
E
## Footnote
The reticulospinal tracts originate largely in the
brainstem reticular formation (pons and medulla) and project to all spinal levels. The raphe nuclei of the reticular
formation contain serotonergic projections that compose
a portion of the reticulospinal tracts. These serotonergic
projections synapse in laminae I, II, and V of the spinal cord
(especially cervical levels) to influence afferent nociceptive impulses from the periphery (Carpenter, pp. 101-104).
104
What is the target of substantia nigra efferent fibers?
A. Thalamus
B. Internal segment of the globus pallidus
C. Striatum
D. A and C
E. A, B, and C
A
B
C
**D**
E
## Footnote
Efferent fibers from the substantia nigra project to
the striatum (pars compacta efferents) and thalamus (pars
reticulata efferents). Nigrothalamic fibers terminate primarily in the VA and MD thalamic nuclei. A small comp efferent fibers from the pars reticulata also project to the
pedunculopontine nucleus (Carpenter, pp. 218-220).
105
Which of the following structures contains olfactory
projections to the hypothalamus?
A. Lateral olfactory stria
B. Medial forebrain bundle
C. Stria medullary thalami
D .. Diagonal band of Broca
E. Laterallemniscus
A
**B**
C
D
E
## Footnote
The medial forebrain bundle sends fibers from the
basal olfactory regions, the septal nuclei, the periamygdaloid
region, and the subiculum to the lateral preoptic and
hypothalamic regions (Carpenter, p. 304).
106
All of the following contain parasympathetic fibers
EXCEPT?
A. CNVII
B. CNIX
C. CNX
D. CNXI
E. CN III
A
B
C
**D**
E
## Footnote
The spinal accessory nerve (XI) does not carry
parasympathetic fibers but instead carries branchial motor
fibers to the sternocleidomastoid and trapezius muscles
(Wilson-Pauwels, p. 205).
107
Match the following:
Abductor pollicis brevis
A. Mainly CS
B. Thoracodorsal nerve
C. A.'{illary nerve
D. Anterior interosseous nerve
E. illnar nerve
F. Median nerve
G. Radial nerve
H. Suprascapular nerve
I. Musculocutaneous nerve
A
B
C
D
E
**F **
G
H
I
108
Match the following:
Infraspinatus
A. Mainly CS
B. Thoracodorsal nerve
C. A.'{illary nerve
D. Anterior interosseous nerve
E. illnar nerve
F. Median nerve
G. Radial nerve
H. Suprascapular nerve
I. Musculocutaneous nerve
A
B
C
D
E
F
G
**H**
I
109
Match the following:
Deltoid
A. Mainly CS
B. Thoracodorsal nerve
C. A.'{illary nerve
D. Anterior interosseous nerve
E. illnar nerve
F. Median nerve
G. Radial nerve
H. Suprascapular nerve
I. Musculocutaneous nerve
A
B
**C**
D
E
F
G
H
I
110
Match the following:
Brachioradialis
A. Mainly CS
B. Thoracodorsal nerve
C. A.'{illary nerve
D. Anterior interosseous nerve
E. illnar nerve
F. Median nerve
G. Radial nerve
H. Suprascapular nerve
I. Musculocutaneous nerve
A
B
C
D
E
F
**G**
H
I
111
Match the following:
Biceps
A. Mainly CS
B. Thoracodorsal nerve
C. A.'{illary nerve
D. Anterior interosseous nerve
E. illnar nerve
F. Median nerve
G. Radial nerve
H. Suprascapular nerve
I. Musculocutaneous nerve
A
B
C
D
E
F
G
H
**I**
112
Match the following:
Adductor pollicis
A. Mainly CS
B. Thoracodorsal nerve
C. A.'{illary nerve
D. Anterior interosseous nerve
E. illnar nerve
F. Median nerve
G. Radial nerve
H. Suprascapular nerve
I. Musculocutaneous nerve
A
B
C
D
**E**
F
G
H
I
113
Match the following:
Pronator quadratus
A. Mainly CS
B. Thoracodorsal nerve
C. A.'{illary nerve
D. Anterior interosseous nerve
E. illnar nerve
F. Median nerve
G. Radial nerve
H. Suprascapular nerve
I. Musculocutaneous nerve
A
B
C
**D**
E
F
G
H
I
114
Match the following:
Rhomboid
A. Mainly CS
B. Thoracodorsal nerve
C. A.'{illary nerve
D. Anterior interosseous nerve
E. illnar nerve
F. Median nerve
G. Radial nerve
H. Suprascapular nerve
I. Musculocutaneous nerve
**A**
B
C
D
E
F
G
H
I
115
Match the following:
Latissimus dorsi
A. Mainly CS
B. Thoracodorsal nerve
C. A.'{illary nerve
D. Anterior interosseous nerve
E. illnar nerve
F. Median nerve
G. Radial nerve
H. Suprascapular nerve
I. Musculocutaneous nerve
A
**B**
C
D
E
F
G
H
I
116
Match the syndrome with the associated clinical
findings:
Mutism, gait disturbance, and incontinence
A. Orbitofrontal (frontal pole) syndrome
B. Frontal convexity syndrome
C. Medial frontal syndrome
D. None of the above
A
B
**C**
D
## Footnote
The orbitofrontal
cortex is linked to the limbic and reticular areas; therefore
lesions of this area can lead to behavioral abnormalities.
l'vlost commonly, orbitofrontal (frontal pole) lesions can
result in euphoria , emotional lability, poor judgment and
insight, explosiveness, and distractibility. The lateral frontal
cortex is linked to motor structures, therefore damage to this
area can lead to disturbances of action with apathy, indifference, psychomotor retardation , motor preservation and
impersistence, and poor abstraction. The medial frontal
syndrome is associated with mutism, gait disturbances,
incontinence, "salutatory seizures," "alien hand syndrome, "
and apraxia of gait or "magnetic gait" (paracentral lobule).
Exploring objects orally is a feature of temporal lobe dysfunction (Brazis, pp. 473- 474, 509, 522- 524).
117
Match the syndrome with the associated clinical
findings:
Indifference, apathy, motor preservation, and impersistence
A. Orbitofrontal (frontal pole) syndrome
B. Frontal convexity syndrome
C. Medial frontal syndrome
D. None of the above
A
**B**
C
D
## Footnote
The orbitofrontal
cortex is linked to the limbic and reticular areas; therefore
lesions of this area can lead to behavioral abnormalities.
l'vlost commonly, orbitofrontal (frontal pole) lesions can
result in euphoria , emotional lability, poor judgment and
insight, explosiveness, and distractibility. The lateral frontal
cortex is linked to motor structures, therefore damage to this
area can lead to disturbances of action with apathy, indifference, psychomotor retardation , motor preservation and
impersistence, and poor abstraction. The medial frontal
syndrome is associated with mutism, gait disturbances,
incontinence, "salutatory seizures," "alien hand syndrome, "
and apraxia of gait or "magnetic gait" (paracentral lobule).
Exploring objects orally is a feature of temporal lobe dysfunction (Brazis, pp. 473- 474, 509, 522- 524).
118
Match the syndrome with the associated clinical
findings:
Impulsiveness, euphoria, poor judgment
A. Orbitofrontal (frontal pole) syndrome
B. Frontal convexity syndrome
C. Medial frontal syndrome
D. None of the above
**A **
B
C
D
## Footnote
The orbitofrontal
cortex is linked to the limbic and reticular areas; therefore
lesions of this area can lead to behavioral abnormalities.
l'vlost commonly, orbitofrontal (frontal pole) lesions can
result in euphoria , emotional lability, poor judgment and
insight, explosiveness, and distractibility. The lateral frontal
cortex is linked to motor structures, therefore damage to this
area can lead to disturbances of action with apathy, indifference, psychomotor retardation , motor preservation and
impersistence, and poor abstraction. The medial frontal
syndrome is associated with mutism, gait disturbances,
incontinence, "salutatory seizures," "alien hand syndrome, "
and apraxia of gait or "magnetic gait" (paracentral lobule).
Exploring objects orally is a feature of temporal lobe dysfunction (Brazis, pp. 473- 474, 509, 522- 524).
119
Match the syndrome with the associated clinical
findings:
Tendency to explore objects orally
A. Orbitofrontal (frontal pole) syndrome
B. Frontal convexity syndrome
C. Medial frontal syndrome
D. None of the above
A. Orbitofrontal (frontal pole) syndrome
B. Frontal convexity syndrome
C. Medial frontal syndrome
**D. None of the above**
## Footnote
The orbitofrontal
cortex is linked to the limbic and reticular areas; therefore
lesions of this area can lead to behavioral abnormalities.
l'vlost commonly, orbitofrontal (frontal pole) lesions can
result in euphoria , emotional lability, poor judgment and
insight, explosiveness, and distractibility. The lateral frontal
cortex is linked to motor structures, therefore damage to this
area can lead to disturbances of action with apathy, indifference, psychomotor retardation , motor preservation and
impersistence, and poor abstraction. The medial frontal
syndrome is associated with mutism, gait disturbances,
incontinence, "salutatory seizures," "alien hand syndrome, "
and apraxia of gait or "magnetic gait" (paracentral lobule).
Exploring objects orally is a feature of temporal lobe dysfunction (Brazis, pp. 473- 474, 509, 522- 524).
120
Match the syndrome with the associated clinical
findings:
Apraxia of gait or "magnetic gait"
A. Orbitofrontal (frontal pole) syndrome
B. Frontal convexity syndrome
C. Medial frontal syndrome
D. None of the above
A. Orbitofrontal (frontal pole) syndrome
B. Frontal convexity syndrome
**C. Medial frontal syndrome**
D. None of the above
## Footnote
The orbitofrontal
cortex is linked to the limbic and reticular areas; therefore
lesions of this area can lead to behavioral abnormalities.
l'vlost commonly, orbitofrontal (frontal pole) lesions can
result in euphoria , emotional lability, poor judgment and
insight, explosiveness, and distractibility. The lateral frontal
cortex is linked to motor structures, therefore damage to this
area can lead to disturbances of action with apathy, indifference, psychomotor retardation , motor preservation and
impersistence, and poor abstraction. The medial frontal
syndrome is associated with mutism, gait disturbances,
incontinence, "salutatory seizures," "alien hand syndrome, "
and apraxia of gait or "magnetic gait" (paracentral lobule).
Exploring objects orally is a feature of temporal lobe dysfunction (Brazis, pp. 473- 474, 509, 522- 524).
121
Match the syndrome with the associated clinical
findings:
"Salutatory seizures"
A. Orbitofrontal (frontal pole) syndrome
B. Frontal convexity syndrome
C. Medial frontal syndrome
D. None of the above
A. Orbitofrontal (frontal pole) syndrome
B. Frontal convexity syndrome
**C. Medial frontal syndrome**
D. None of the above
## Footnote
The orbitofrontal
cortex is linked to the limbic and reticular areas; therefore
lesions of this area can lead to behavioral abnormalities.
l'vlost commonly, orbitofrontal (frontal pole) lesions can
result in euphoria , emotional lability, poor judgment and
insight, explosiveness, and distractibility. The lateral frontal
cortex is linked to motor structures, therefore damage to this
area can lead to disturbances of action with apathy, indifference, psychomotor retardation , motor preservation and
impersistence, and poor abstraction. The medial frontal
syndrome is associated with mutism, gait disturbances,
incontinence, "salutatory seizures," "alien hand syndrome, "
and apraxia of gait or "magnetic gait" (paracentral lobule).
Exploring objects orally is a feature of temporal lobe dysfunction (Brazis, pp. 473- 474, 509, 522- 524).
122
The vertebral arteries travel in the transverse foramina
of
A. C6 to C2
B. C4 to C2
C. C7 to Cl
D. C7 to C2
E. C8 to Cl
**A. C6 to C2 **
B. C4 to C2
C. C7 to Cl
D. C7 to C2
E. C8 to Cl
## Footnote
The vertebral artery usually travels through the
transverse foramina of C6 through C2 prior to exiting the
transverse foramen of the a,'(js and curving posteriorly and
superiorly in a groove on the upper surface of the atlas
(Greenberg, p. 107)
123
A relative afferent pupillary defect is NOT seen with
lesions involving the
A. Retina
B. Lateral geniculate body
C. Pretectal nucleus
D. Optic nerve
E. Optic chiasm
A. Retina
**B. Lateral geniculate body **
C. Pretectal nucleus
D. Optic nerve
E. Optic chiasm
## Footnote
An afferent pupillary defect (Marcus Gunn
pupil) can be diagnosed by the "swinging flashlight test."
This pupillary sign is characterized by normal bilateral
pupillary responses when the normal eye is illuminated, but pupillary dilation occurs when the flashlight is quickly
switched to the affected eye. This abnormality may be seen
with lesions involving the macula , retina , optic nerve , optic
tract, brachium of the superior colliculus, or pretectal
nucleus (Kline, pp. 127-128, Brazis, pp. 144-145).
124
If the left eye shows a relative afferent pupillary defect,
the right pupil will
A. Immediately constrict when the light is swung to the left
B. Immediately dilate when the light is swung to the right
C. Dilate when the light is swung from the right eye to the left
D. Remain unchanged when the light is swung to the left
E. Remain dilated at all times
A. Immediately constrict when the light is swung to the left
B. Immediately dilate when the light is swung to the right
**C. Dilate when the light is swung from the right eye to the left **
D. Remain unchanged when the light is swung to the left
E. Remain dilated at all times
## Footnote
An afferent pupillary defect (Marcus Gunn
pupil) can be diagnosed by the "swinging flashlight test."
This pupillary sign is characterized by normal bilateral
pupillary responses when the normal eye is illuminated, but pupillary dilation occurs when the flashlight is quickly
switched to the affected eye. This abnormality may be seen
with lesions involving the macula , retina , optic nerve , optic
tract, brachium of the superior colliculus, or pretectal
nucleus (Kline, pp. 127-128, Brazis, pp. 144-145).
125
58. Which of the following eye muscles receives contralateral nuclear innervation?
1. Inferior oblique
2. Superior rectus
3. Inferior rectus
4. Superior oblique
A. 1,2, and 3
B. 1 and 3
C. 2 and 4
D. Only 4 is correct
E. all of the above
A. 1,2, and 3
B. 1 and 3
**C. 2 and 4 **
D. Only 4 is correct
E. all of the above
## Footnote
The superior rectus (medial subnucleus of the oculomotor nucleus, CN III) and superior oblique (trochlear
nucleus, CN IV) muscles receive contralateral nuclear
innervation (Wilson-Pauwels, pp. 53, 70).
126
"Periodic alternating gaze" is usually seen with
A. Frontal seizure foci
B. Posterior fossa lesions
C. Persistent muscle spasms of the face and jaw
D. Bilateral paramedian pontine reticular formation lesions
E. Bilateral medial longitudinal fasciculus (MLF) lesions
A. Frontal seizure foci
**B. Posterior fossa lesions**
C. Persistent muscle spasms of the face and jaw
D. Bilateral paramedian pontine reticular formation lesions
E. Bilateral medial longitudinal fasciculus (MLF) lesions
## Footnote
"Periodic alternating gaze" (PAG) consists of cyclic
conjugate lateral deviation of the eyes with compensatory
head turning towards the opposite side (1 to 2 minutes),
a midline changeover period (10 to 15 seconds), which is
followed by conjugate deviation of the eyes toward the other
side (with compensatory head turning). It is most common
with diseases of the posterior fossa (pontine damage, posterior fossa ischemia, medulloblastoma, and Chiari malformations) (Brazis, pp. 212- 213).
127
For each reflex below, select the nerve that mediates the afferent limb:
Sneeze reflex
A. CNVl
B. CNV2
C. CNV3
D. CN IX
E. CNX
F. None of the above
A
**B**
C
D
E
F
## Footnote
The trigeminal nerve afferents mediate the tearing and
corneal reflex (VI)' sneeze reflex (V2), and jaw-jerk reflex
(VJ ) . The vagus nerve (X) mediates the afferent limb of the
cough reflex, while the glossopharyngeal nerve (IX) mediates
the afferent limb of the carotid sinus and gag reflexes. The
optic nerve innervates the afferent limb of the pupillary
reflex via the Edinger-Westphal nucleus (DeMyer, pp. 171,
176- 177).
128
For each reflex below, select the nerve that mediates the afferent limb:
Cough reflex
A. CNVl
B. CNV2
C. CNV3
D. CN IX
E. CNX
F. None of the above
A
B
C
D
**E**
F
## Footnote
The trigeminal nerve afferents mediate the tearing and
corneal reflex (VI)' sneeze reflex (V2), and jaw-jerk reflex
(VJ ) . The vagus nerve (X) mediates the afferent limb of the
cough reflex, while the glossopharyngeal nerve (IX) mediates
the afferent limb of the carotid sinus and gag reflexes. The
optic nerve innervates the afferent limb of the pupillary
reflex via the Edinger-Westphal nucleus (DeMyer, pp. 171,
176- 177).
129
For each reflex below, select the nerve that mediates the afferent limb:
Gag reflexc
A. CNVl
B. CNV2
C. CNV3
D. CN IX
E. CNX
F. None of the above
A
B
C
**D**
E
F
## Footnote
The trigeminal nerve afferents mediate the tearing and
corneal reflex (VI)' sneeze reflex (V2), and jaw-jerk reflex
(VJ ) . The vagus nerve (X) mediates the afferent limb of the
cough reflex, while the glossopharyngeal nerve (IX) mediates
the afferent limb of the carotid sinus and gag reflexes. The
optic nerve innervates the afferent limb of the pupillary
reflex via the Edinger-Westphal nucleus (DeMyer, pp. 171,
176- 177).
130
For each reflex below, select the nerve that mediates the afferent limb:
Carotid sinus
A. CNVl
B. CNV2
C. CNV3
D. CN IX
E. CNX
F. None of the above
A
B
C
**D**
E
F
## Footnote
The trigeminal nerve afferents mediate the tearing and
corneal reflex (VI)' sneeze reflex (V2), and jaw-jerk reflex
(VJ ) . The vagus nerve (X) mediates the afferent limb of the
cough reflex, while the glossopharyngeal nerve (IX) mediates
the afferent limb of the carotid sinus and gag reflexes. The
optic nerve innervates the afferent limb of the pupillary
reflex via the Edinger-Westphal nucleus (DeMyer, pp. 171,
176- 177).
131
For each reflex below, select the nerve that mediates the afferent limb:
Corneal blink retlex
A. CNVl
B. CNV2
C. CNV3
D. CN IX
E. CNX
F. None of the above
**A**
B
C
D
E
F
## Footnote
The trigeminal nerve afferents mediate the tearing and
corneal reflex (VI)' sneeze reflex (V2), and jaw-jerk reflex
(VJ ) . The vagus nerve (X) mediates the afferent limb of the
cough reflex, while the glossopharyngeal nerve (IX) mediates
the afferent limb of the carotid sinus and gag reflexes. The
optic nerve innervates the afferent limb of the pupillary
reflex via the Edinger-Westphal nucleus (DeMyer, pp. 171,
176- 177).
132
For each reflex below, select the nerve that mediates the afferent limb:
Jaw-jerk reflex
A. CNVl
B. CNV2
C. CNV3
D. CN IX
E. CNX
F. None of the above
A
B
C
**D**
E
F
## Footnote
The trigeminal nerve afferents mediate the tearing and
corneal reflex (VI)' sneeze reflex (V2), and jaw-jerk reflex
(VJ ) . The vagus nerve (X) mediates the afferent limb of the
cough reflex, while the glossopharyngeal nerve (IX) mediates
the afferent limb of the carotid sinus and gag reflexes. The
optic nerve innervates the afferent limb of the pupillary
reflex via the Edinger-Westphal nucleus (DeMyer, pp. 171,
176- 177).
133
For each reflex below, select the nerve that mediates the afferent limb:
Tearing reflex
A. CNVl
B. CNV2
C. CNV3
D. CN IX
E. CNX
F. None of the above
**A**
B
C
D
E
F
## Footnote
The trigeminal nerve afferents mediate the tearing and
corneal reflex (VI)' sneeze reflex (V2), and jaw-jerk reflex
(VJ ) . The vagus nerve (X) mediates the afferent limb of the
cough reflex, while the glossopharyngeal nerve (IX) mediates
the afferent limb of the carotid sinus and gag reflexes. The
optic nerve innervates the afferent limb of the pupillary
reflex via the Edinger-Westphal nucleus (DeMyer, pp. 171,
176- 177).
134
For each reflex below, select the nerve that mediates the afferent limb:
Pupillary light reflex
A. CNVl
B. CNV2
C. CNV3
D. CN IX
E. CNX
F. None of the above
A
B
C
D
E
**F**
## Footnote
The trigeminal nerve afferents mediate the tearing and
corneal reflex (VI)' sneeze reflex (V2), and jaw-jerk reflex
(VJ ) . The vagus nerve (X) mediates the afferent limb of the
cough reflex, while the glossopharyngeal nerve (IX) mediates
the afferent limb of the carotid sinus and gag reflexes. The
optic nerve innervates the afferent limb of the pupillary
reflex via the Edinger-Westphal nucleus (DeMyer, pp. 171,
176- 177).
135
For each reflex below, select the nerve that mediates the afferent limb:
Opticoltinetic retlex
A. CNVl
B. CNV2
C. CNV3
D. CN IX
E. CNX
F. None of the above
A
B
C
D
E
**F**
## Footnote
The trigeminal nerve afferents mediate the tearing and
corneal reflex (VI)' sneeze reflex (V2), and jaw-jerk reflex
(VJ ) . The vagus nerve (X) mediates the afferent limb of the
cough reflex, while the glossopharyngeal nerve (IX) mediates
the afferent limb of the carotid sinus and gag reflexes. The
optic nerve innervates the afferent limb of the pupillary
reflex via the Edinger-Westphal nucleus (DeMyer, pp. 171,
176- 177).
136
Which of the following neurons are cholinergic?
A. Puritinje neurons of the cerebellum
B. Substantia innominata
c. Interneurons of the substantia nigra
D. Neurons in the ganglionic layer of the retina
E. Interneurons of the collicular plate
A
B
c
**D**
E
## Footnote
The ganglionic cells of the retina are considered to
be cholinergiC, while some of the neurons of the striatum,
dorsal horn, cerebellum, collicular plate, substantia nigra,
hypothalamus, pallidum, and anterior perforated substance
(substantia innominata) are considered to be GABAergic
(DeMyer, pp. 384-385).
137
A lesion in what location could result in partial bilateral
deafness?
A. Ventral cochlear nucleus
B. Dorsal cochlear nucleus
c. Inner hair cells of the retina
D. Laterallemniscus
E. Cochlear nerve
A
B
c
**D**
E
## Footnote
Since the secondary cochlear pathways are both
crossed and uncrossed, lesions of one lateral lemniscus can
result in partial bilateral deafness. Injury to the inner hair
cells of the cochlea, cochlear nerve, or ventral and dorsal
cochlear nuclei produces unilateral hearing loss (Brazis,
pp. 293-295).
138
Match the neurotransmitter with the associated
anatomic location:
Golgi type II interneurons
A. Norepinephrine
B. Serotonin
C. Dopamine
D. Acetylcholine
E. Glycine
F. GABA
G. None of the above
A
B
C
D
E
**F**
G
## Footnote
Major sites of origin of the
various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the
basal nucleus (of Meynert); GABA-golgi type II interneurons
as well as various areas of the hypothalamus, substantia
nigra , cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/
substantia nigra of midbrain, serotonin-raphe nuclei of
midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385;
Carpenter, pp. 128, 131).
139
Match the neurotransmitter with the associated
anatomic location:
Dorsal raphe nucleus
A. Norepinephrine
B. Serotonin
C. Dopamine
D. Acetylcholine
E. Glycine
F. GABA
G. None of the above
A
**B**
C
D
E
F
G
## Footnote
Major sites of origin of the
various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the
basal nucleus (of Meynert); GABA-golgi type II interneurons
as well as various areas of the hypothalamus, substantia
nigra , cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/
substantia nigra of midbrain, serotonin-raphe nuclei of
midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385;
Carpenter, pp. 128, 131).
140
Match the neurotransmitter with the associated
anatomic location:
Locus cemleus
A. Norepinephrine
B. Serotonin
C. Dopamine
D. Acetylcholine
E. Glycine
F. GABA
G. None of the above
**A**
B
C
D
E
F
G
## Footnote
Major sites of origin of the
various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the
basal nucleus (of Meynert); GABA-golgi type II interneurons
as well as various areas of the hypothalamus, substantia
nigra , cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/
substantia nigra of midbrain, serotonin-raphe nuclei of
midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385;
Carpenter, pp. 128, 131).
141
Match the neurotransmitter with the associated anatomic location:
Medial raphe nucleus
A. Norepinephrine
B. Serotonin
C. Dopamine
D. Acetylcholine
E. Glycine
F. GABA
G. None of the above
A
**B**
C
D
E
F
G
## Footnote
Major sites of origin of the
various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the
basal nucleus (of Meynert); GABA-golgi type II interneurons
as well as various areas of the hypothalamus, substantia
nigra , cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/
substantia nigra of midbrain, serotonin-raphe nuclei of
midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385;
Carpenter, pp. 128, 131).
142
Match the neurotransmitter with the associated anatomic location:
Substantia nigra
A. Norepinephrine
B. Serotonin
C. Dopamine
D. Acetylcholine
E. Glycine
F. GABA
G. None of the above
A
B
**C **
D
E
F
G
## Footnote
Major sites of origin of the
various neurotransmitters are as follows: acetylcholinegigantocellular complex of the basal forebrain including the
basal nucleus (of Meynert); GABA-golgi type II interneurons
as well as various areas of the hypothalamus, substantia
nigra , cerebellum, dorsal horns, collicular plate, and substantia innominata; dopamine-ventral tegmental region/
substantia nigra of midbrain, serotonin-raphe nuclei of
midbrain; norepinephrine-locus ceruleus (DeMyer, p. 385;
Carpenter, pp. 128, 131).
