Anatomy and Physiology
QUESTIONS
1. The diencephalon consists of all of the following structures except:
A. thalamus
B. subthalamus
C. pons
D. putamen
E. all of the above
2. Which subclavian artery would you inject with contrast to demonstrate both the carotid and vertebral circulation?
A. Left subclavian
B. Right subclavian
C. Neither, you cannot see both the carotid and vertebral circulation.
D. Either, you can see both the carotid and vertebral circulation with either subclavian artery.
3. An epidural hemorrhage results in a tear in what vessel?
A. Bridging veins
B. Middle meningeal artery
C. Anterior choroidal artery
D. None of the above
E. All of the above
View Answer
3. Answer: B. The middle meningeal artery, which lies outside the dura and forms a groove in the cranial bone. Epidural hemorrhage generally coincides with a skull fracture.
4. Occlusion of which area of the circle of Willis will result in total unilateral blindness?
A. Ophthalmic artery
B. Anterior choroidal artery
C. Vertebral artery
D. Anterior spinal artery
5. Hemisection of the spinal cord at the level of T1 actually produces contralateral loss of pain/temperature sensation at what level?
A. T1
B. T2
C. T3
D. C7
View Answer
5. Answer: C. T3 and below. Fibers do not all cross over immediately. Most ascend one or two segments before they cross over. Also, the pain-temperature fibers in the spinothalamic tract are arranged so that the leg fibers are lateral to the arm fibers. Outside compression of the cord on the spinothalamic tract may affect the fibers of the lower extremities first.
6. A 35-year-old male presents with bilateral paralysis, fasciculations, and muscle atrophy at and below T1 along with bilateral pain and temperature loss at the level of T2. What is the cause of his symptoms?
A. Middle cerebral artery (MCA) stroke
B. Carbon monoxide poisoning
C. Syringomyelia
D. Amyotrophic lateral sclerosis (ALS)
E. None of the above
View Answer
6. Answer: C. Syringomyelia is a degenerative disease of the spinal cord (or brain stem) of unknown cause, which usually affects the pain and temperature fibers that are crossing at the level of involvement. It can vary in size, shape, and symmetry and can sometimes involve other parts of the cord (such as the anterior horn as in this case).
7. Common causes of carpal tunnel syndrome include all of the following except:
A. rheumatoid arthritis
B. diabetes mellitus
C. acromegaly
D. pregnancy
E. all of the above are possible causes of carpal tunnel syndrome
8. Which one of the following carries the majority of the information from the outside into the cerebellum?
A. Granule cells
B. Basket cells
C. Mossy fibers
D. Dentate nucleus
View Answer
8. Answer: C. Mossy fibers make up 99% of the incoming fibers. They transmit impulses exclusively from the spinal cord and the vestibular and pontine nuclei by using granule cells as mediators; enter via all three peduncles. Aspartate is probably the main neurotransmitter.
9. Dejerine-Roussy syndrome can be associated with?
A. Lesion in the oculomotor nerve
B. Lesion in the left occipital lobe
C. Lesion in the ventral posterior area of the thalamus
D. Lesion in the lateral geniculate nucleus
View Answer
9. Answer: C. Lesions in the ventroposterior (VP) area of the thalamus produce contralateral sensory loss to all modalities and can be associated with the thalamic pain syndrome in affected areas as anesthesia dolorosa.
10. Klüver-Bucy syndrome is associated with which disease?
A. Pick’s disease
B. Guillain-Barré syndrome
C. Grave’s disease
D. Lambert-Eaton syndrome
E. None of the above
View Answer
10. Answer: A. Pick’s disease. Any process that results in bilateral damage to the temporal lobes can cause this syndrome. The classic symptoms associated are hyperoral, increased appetite, hypersexual, and docile behavior.
11. A 42-year-old male with a history of alcoholism presents to the hospital with confusion, diplopia (ophthalmoparesis), unsteady gait, and nystagmus. The most likely cause for these symptoms is thiamine deficiency. Where is the lesion?
A. Edinger-Westphal nucleus
B. Mamillary bodies
C. Left parietal lobe
D. Nucleus solitarius
E. None of the above
View Answer
11. Answer: B. Mamillary bodies. Wernicke’s encephalopathy due to thiamine deficiency is often seen in alcoholics. The lesion is usually located in the mamillary bodies, dorsomedial nucleus of the thalamus, periaqueductal gray, and oculomotor nuclei.
12. Which of the following is true regarding a lesion of the right vestibular nuclei?
A. The left paramedian pontine reticular formation (PPRF) is more active than the right PPRF.
B. The fast phase of nystagmus is to the right.
C. Stumbling to the left
D. The left lateral vestibulospinal tract is more active than the right.
E. Slow phase of nystagmus to the left
View Answer
12. Answer: D. The lateral vestibulospinal tract is an ipsilateral tract that runs down the entire length of the spinal cord. Therefore, the left vestibulospinal tract would be the primary functioning tract.
13. Which of the following statements is not true?
A. Weakness is the least common sign of a cerebellar lesion.
B. Golgi cells in the cerebellum lie in the granule cell layer and are excitatory.
C. Basket cells in the cerebellum excite Purkinje cell firing.
D. Fastigial nucleus receives input from Purkinje cells in the cerebellum.
View Answer
13. Answer: C. Granule cells are the only excitatory cells in the cerebellum, and the basket cells are inhibiting the Purkinje cells. Basket cells surround or wrap around the Purkinje cells.
14. Which of the following statements is TRUE?
A. Nerve root C3 exits above vertebra C3.
B. A C6 radiculopathy results in pain from the dorsal aspect of the thumb and index finger.
C. A C7 radiculopathy results in pain in the middle finger.
D. Spinal nerve C7 exits below vertebra C6.
E. All are true statements.
15. A complete transection of the spinal cord at C2 results in a spastic bladder immediately after the injury (during spinal shock).
A. True
B. False
View Answer
15. Answer: B. False. Consider complete transection of the spinal cord to interrupt (UMN) input to the bladder. Initially, the bladder would be atonic and fill and retain the urine immediately following the injury. Later, spasticity follows the spinal shock.
16. Which of the following statement(s) is true?
A. The supplementary motor area (SMA) and premotor cortex (PM) are both in Brodmann’s area 6.
B. The SMA and PM are both involved in premotor planning.
C. Primary motor cortex is involved in the execution of a movement.
D. Pyramidal tract neurons fire before the muscles contract in an intended movement.
E. All of the above are true.
F. None of the above
17. Which of the following statements is false?
A. The SMA becomes active when thinking of a complex motor task, even when the task is not actually performed.
B. The neurons in the SMA and primary motor cortex fire prior to a given movement.
C. Lesions in the SMA result in apraxias, whereas lesions in primary motor cortex result in contralateral paresis and upper motor neuron signs.
D. Both the SMA and primary motor cortex code for the force of a movement.
View Answer
17. Answer: D. Only the primary motor cortex codes for force. The SMA controls the “planning” of movements.
18. A 60-year-old male presents with a stroke in the left occipital lobe, and a 72-year-old male presents with controlled glaucoma for 1 year. Which patient will have worse visual acuity?
A. The stroke patient
B. The glaucoma patient
C. Neither
D. Both
View Answer
18. Answer: C. Neither. Both patients should have preserved acuity. Glaucoma does not affect acuity until very, very late in the course of the disease.
19. Which of the following structures is not paired correctly with all or part of its blood supply?
A. Anterior limb of internal capsule—medial striates
B. Dorsal part of the posterior limb of internal capsule—middle cerebral
C. Visual cortex—posterior cerebral
D. Broca’s motor speech area—middle cerebral
E. Hippocampus—anterior cerebral
View Answer
19. Answer: E. The hippocampus—anterior cerebral. Of note, the dorsal part of the posterior limb of the internal capsule receives input from the lateral striates, which come off the middle cerebral, and the ventral part comes from the anterior choroidal.
20. A lesion in the frontal association cortex on the left would most likely result in:
A. ipsilateral homonymous hemianopsia
B. resting tremor
C. Wernicke’s aphasia
D. Broca’s aphasia
E. diplopia
View Answer
20. Answer: D. Broca’s aphasia. Frontal association cortex is Brodmann’s area 45, which is Broca’s area, and lesions result in nonfluent or expressive aphasia.
21. A lesion of the ventromedial nucleus of the hypothalamus (which lies in the tuberal level) has been shown (in experimental animals) to produce:
A. diabetes insipidus
B. increased appetite (hyperphagia) and rage
C. loss of appetite
D. memory loss and aphasia
E. lack of prolactin production
22. Bilateral lesions of the ventral portion of the temporal lobes involving the hippocampal formation would most likely result in patients exhibiting which of the following signs and symptoms?
A. Difficulty expressing their thoughts
B. Trouble understanding speech and also trouble with verbal expression
C. Loss of the sensation of pain, without loss of pain sensitivity or discrimination
D. Long-term memory loss
E. Short-term memory loss
23. The mammillary bodies:
A. are damaged in Korsakoff’s syndrome
B. receive input from the fornix
C. project to the medial dorsal nucleus of the thalamus
D. are involved in temperature regulation
E. A and B
F. C and D
24. Which of the following statements is not true regarding the paraventricular nucleus of the hypothalamus?
A. Cells are involved in regulating circadian rhythm.
B. It is involved in the production of oxytocin.
C. It is involved in regulating of water balance.
D. Cells project to the posterior lobe of the pituitary gland.
View Answer
24. Answer: A. The suprachiasmatic nucleus comprises the cells that regulate our circadian rhythm.
25. Which of the following statements is correct?
A. Patients with prosopagnosia do not recognize fingers.
B. Reading disorders are called dysphagia.
C. Broca’s aphasia can be accompanied by hemiplegia.
D. Anton’s syndrome is a type of aphasia.
View Answer
25. Answer: C. Broca’s aphasia is a motor speech disorder and is also called nonfluent aphasia. Broca’s speech area lies in the inferior frontal lobe, is near the motor area, and can be associated with a left MCA occlusion.
26. Which of the following statements is correct regarding apraxias?
A. A lesion in ideomotor apraxia involves the temporal parietal junction.
B. A patient with ideomotor apraxia will use the wrong object to perform the correct action.
C. Apraxias are always associated with hemiparesis.
D. A patient with an ideal apraxia is unable to use the correct motor sequence.
E. A lesion in ideomotor apraxia involves the parietal lobe and SMA.
View Answer
26. Answer: E. It involves the parietal lobe (motor cortex) and SMA. Patients with ideomotor apraxia lose the ability to perform motor actions in the correct sequence.
27. Which of the following statements is TRUE regarding the mesocorticolimbic dopamine system?
A. It comes from the ventral tegmental area and innervates the limbic structures and visual cortex.
B. It is part of reinforcement and reward.
C. It arises from the substantia nigra and innervates the limbic and prefrontal cortical region.
D. It arises from the raphe nucleus and innervates the limbic cortical region.
View Answer
27. Answer: B. It is part of the reinforcement and reward mechanism. The mesocorticolimbic dopamine system arises from the ventral tegmental area, which lies dorsal to the substantia nigra.
28. The human circadian pacemaker is located in the:
A. reticular activating system
B. thalamus
C. suprachiasmatic nucleus
D. pons
29. Which of the following statements is not true regarding serotonin?
A. Cell bodies lie in the substantia nigra and innervate the cortex and limbic system.
B. It is increased by monoamine oxidase inhibitors and tricyclics.
C. It is likely decreased in impulsive individuals.
D. It is kept in synaptic cleft longer by fluoxetine.
E. It is produced in raphe nuclei.
View Answer
29. Answer: A. The substantia nigra houses dopamine and GABA. The raphe nucleus is the primary serotonin producer in the brain.
30. The tuberomammillary nucleus is the only location in the brain that produces histamine.
A. True
B. False
31. The severe short-term (explicit) memory deficits characteristic of Alzheimer’s disease would most likely be due to:
A. plaques and tangles in the hippocampal regions
B. neurofilaments and tau protein in basal ganglia
C. degeneration of the ventral tegmental area
D. loss of norepinephrine in the amygdala
View Answer
31. Answer: A. Plaques and tangles in the hippocampus are the pathologic hallmark of Alzheimer’s disease.
32. A 65-year-old female presents with headache, fever, and occasional jaw claudication. What is the most likely cause?
A. Left MCA stroke
B. Tension headache
C. Trigeminal neuralgia
D. Temporal arteritis
View Answer
32. Answer: D. Temporal arteritis or giant cell arteritis is a chronic inflammatory disease of large blood vessels, and untreated patients are at risk for blindness.
33. Which cranial nerve is affected in the syndrome known as tic douloureux?
A. CN II
B. CN V
C. CN VII
D. CN X
E. CN IV
View Answer
33. Answer: B. CN V. It is also known as trigeminal neuralgia and is typically seen in older adults. Its etiology is not well understood, however, microvascular compression is thought to be one possible cause.
34. Horner’s syndrome is often associated with which one of the following?
A. Cluster headache
B. Multiple sclerosis
C. Lyme disease
D. Anton’s syndrome
View Answer
34. Answer: A. Cluster headaches are severe, brief, nonthrobbing unilateral headaches that recur. Horner’s syndrome (ptosis, miosis, anhidrosis) and ipsilateral nasal congestion, rhinorrhea, and tearing are often associated with it. Treatment includes oxygen therapy, ergots, and triptans.
35. A 73-year-old female presents with symptoms consistent with amaurosis fugax. Which vessel is most likely involved?
A. Vertebral artery
B. PCA
C. Ophthalmic artery
D. Central retinal vein
E. Lenticulostriate artery
View Answer
35. Answer: C. Ophthalmic artery. Occlusion of this artery temporarily would lead to brief, ipsilateral blindness.
36. A 93-year-old male presents with left leg weakness, irritability, and mood disturbance that occurred suddenly this morning. Which artery is most likely involved?
A. Right anterior choroidal artery
B. Left anterior cerebral artery
C. Left middle cerebral artery (MCA)
D. Right posterior cerebral artery
E. None of the above
View Answer
36. Answer: E. The anterior cerebral artery would affect the contralateral leg, which in this case would have to be the right anterior cerebral artery. Behavioral changes are often seen as well.
37. A 67-year-old right-handed male presents to the emergency department (ED) with decreased consciousness, ophthalmoplegia, pupillary constriction, and bilateral paralysis. Which artery or arteries would most likely be involved?
A. Left posterior cerebral artery
B. Basilar artery
C. Bilateral anterior cerebral arteries
D. Bilateral external carotid arteries
E. All of the arteries above could cause these symptoms.
View Answer
37. Answer: B. Basilar artery occlusion would lead to these symptoms. Vertebrobasilar artery involvement is often fatal. Dysphagia and dysarthria may also be common symptoms.
38. A 36-year-old female with a congenital berry aneurysm of the circle of Willis may also have one of the following?
A. Ulcerative colitis
B. Polycystic ovarian syndrome
C. Turner’s syndrome
D. Polycystic kidney disease
E. Abdominal aortic aneurysm
View Answer
38. Answer: D. Congenital berry aneurysms occurring around the circle of Willis are common and are sometimes associated with polycystic kidney disease and aortic coarctation. Typically, these aneurysms are asymptomatic until they bleed.
39. A 54-year-old male with a history of hypertension presents with sudden onset of hemiballistic movements of his right upper extremity. If these symptoms were due to a stroke, the most likely location and artery involved would be?
A. Thalamus; MCA
B. Subthalamic nucleus; posterior cerebral artery
C. Genu of the internal capsule; anterior choroidal artery
D. Caudate; MCA
E. None of the above
View Answer
39. Answer: B. Occlusion of the posterior cerebral artery may lead to hemiballistic movement disorder, contralateral homonymous hemianopsia, sensory loss, and spontaneous thalamic pain.
40. A 28-year-old right-handed male presents to the ED with confusion and headache. A computed tomography (CT) scan of the head is performed and reveals hydrocephalus. This condition may be associated with an overproduction of cerebrospinal fluid (CSF), which would be associated with which structure?
A. Meninges
B. Choroid plexus
C. Foramen of Luschka
D. Foramen of Magendie
View Answer
40. Answer: B. The walls of each ventricle contain a specialized structure called the choroid plexus, which secretes the clear CSF.
41. A 35-year-old male presents to the ED after a motor vehicle accident with decreased consciousness. On CT scan of his head, an epidural hemorrhage is noted. What is the most likely vessel involved?
A. External carotid artery
B. Middle meningeal artery
C. Anterior choroidal artery
D. Bridging vein
View Answer
41. Answer: B. The middle meningeal artery, which lies outside the dura (hence, epidural) and forms a groove in the cranial bone. Epidural bleeds generally coincide with skull fracture.
42. An 84-year-old male with a history of a right MCA territory stroke about 6 months ago presents to your office. The hallmark features on his examination could include all of the following except?
A. Spastic paralysis
B. Fasciculations
C. Hyperreflexia
D. No significant muscle atrophy
View Answer
42. Answer: B. Fasciculations and fibrillations are a sign of a lower motor neuron deficit. All the rest are often seen with upper motor neuron lesions.
43. A 78-year-old female presents with a history of polio and has residual lower extremity weakness, atrophy, fasciculations, and hyporeflexia. Where did the polio virus cause the damage?
A. Dorsal root ganglion
B. Anterior horn cells
C. C2 spinal root
D. Lumbosacral plexus
E. None of the above
44. An 18-year-old male presented to the ED after a recent MVA and hemisection of his spinal cord at T2. At what level would he have pain and temperature loss?
A. T1
B. T2
C. T4
D. C7
E. None of the above; pain and temperature would be preserved.
View Answer
44. Answer: C. T4. Pain and temperature fibers do not all cross over immediately. Many ascend one or two segments before crossing over.
45. A 54-year-old male presented to the clinic with recent damage to his S2 and S3 nerve root. What is the most likely autonomic system that is involved?
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