1. Regarding the pathophysiology of myasthenia gravis, what is/are the possible mechanisms by which acetylcholine receptor antibodies interfere with neuromuscular transmission?

A. binding to the acetylcholine receptor and blocking the binding of acetylcholine

B. cross-linking acetylcholine receptors, thereby increasing their rate of internalization

C. binding of complement resulting in destruction of the muscle end plate

D. all of the above

E. none of the above

2. All of the following statements are correct regarding the medial lemniscus EXCEPT:

A. Near the sensory decussation, its blood supply comes from the anterior spinal artery.

B. The medial lemniscus can be found in close proximity to the anterolateral tract in the medulla.

C. Its somatotopy in the pons is such that leg fibers are lateral to arm fibers.

D. The fibers of the medial lemniscus arise from the cuneate and gracile nuclei.

E. Brainstem lesions involving medial lemniscus fibers usually include adjacent structures, resulting in motor and sensory losses.

A. 10% formalin

B. 12% glutaraldehyde

C. UV irradiation

D. autoclaving at 121°C

E. sodium hydroxide (2N)

4. Which of the following lines at the craniocervical junction extends from the basion to the opisthion?

A. McRae’s line

B. McGregor’s line

C. Chamberlain’s line

D. Wackenheim’s line

E. Anterior marginal line

5. The somatotopic arrangement in the ventral horn is such that

A. the flexors are dorsal to extensors and limbs are medial to trunk.

B. the extensors are dorsal to flexors and limbs are medial to trunk.

C. the flexors are dorsal to extensors and limbs are lateral to trunk.

D. the extensors are dorsal to flexors and limbs are lateral to trunk.

E. none of the above

6. The oxygen extraction ratio is increased when blood flow decreases in all of the following organs EXCEPT:

A. brain

B. kidney

C. liver

D. heart

E. lungs

A. pathology reveals pleomorphic short and wide septate hyphae

B. treated with Cancidas, Voriconazole, and AmBisome

C. causes hemorrhagic necrosis and ischemic strokes

D. organism originates in the soil

E. may be seen in an immunocompromised patient

8. Somatic motor efferents to the urethral sphincter are located

A. in intermediolateral cell columns of the sacral cord.

B. in Onuf’s nucleus.

C. in Barrington’s nucleus.

D. all of the above

E. none of the above

9. Cerebral ischemia begins when cerebral perfusion pressure (CPP) falls below

A. 100 mm Hg.

B. 75 mm Hg.

C. 50 mm Hg.

D. 23 mm Hg.

E. 8 mm Hg.

10. Regarding the anatomy near the cavernous sinus, the borders of the clinoidal triangle are cranial nerves

A. I and II.

B. II and III.

C. III and IV.

D. IV and V.

E. none of the above

A. The first presentation is usually weakness of the extraocular muscles.

B. Weakness that fluctuates and fatigues over the course of the day.

C. Speech may be hypernasal or hoarse in some patients.

D. It may present with a head drop.

E. Dysphagia is worst at breakfast and improves during the course of the day.

12. All of the following are true of polymyositis EXCEPT:

A. It involves a symmetric weakness of proximal limb and trunk muscles.

B. Its onset is insidious.

C. Ocular muscles are usually spared.

D. Muscles are not tender to palpation.

E. Skin changes typically occur before muscle abnormalities.

13. Protein 14–3-3 is elevated in the CSF in which of the following conditions?

A. Creutzfeldt-Jakob disease

B. demyelinating disease

C. head trauma

D. meningoencephalitis

E. all of the above

14. Which of the following statements is most accurate regarding the nerve supplying the teres minor muscle?

A. It has a contribution from the lateral cord.

B. It is an extension of the posterior cord.

C. Ventral rami C8 and T1 are major contributors to this nerve.

D. It is derived from the same cord as the musculocutaneous nerve.

E. None of the above

15. The pterion is formed by the junction of the all of the following EXCEPT:

A. frontal bone

B. sphenoid bone

C. zygomatic bone

D. temporal bone

E. parietal bone

16. Which of the following increase dead space?

A. PE (pulmonary embolus)

B. PEEP (positive end expiratory pressure)

C. emphysema

D. all of the above

E. none of the above

A. S. aureus.

B. Pseudomonas.

C. Proteus.

D. S. pneumoniae.

E. E. coli.

18. Patients with interstitial cystitis

A. are rarely incontinent.

B. have an overwhelming desire to urinate.

C. have activation of a sensory pathway subserving cortical sensation of the bladder without activation of the afferent reflex pathway.

D. all of the above

E. none of the above

19. Which of the following factors increase ICP?

A. movement

B. pain

C. fever

D. Valsalva

E. all of the above

20. The posterior loop of the internal carotid artery and the origin of the meningo-hypophyseal trunk are exposed in the floor of which triangle?

A. lateral triangle

B. anterior lateral triangle

C. Parkinson’s triangle

D. anterior medial triangle

E. none of the above

A. as synchronous muscle fiber activation between fibers of different motor units.

B. as the difference in timing of muscle fiber activation between two fibers in a single motor unit.

C. as the difference in timing of muscle fiber activation between two fibers of different motor units.

D. as the complete failure of neuromuscular transmission at one muscle fiber in a pair.

E. none of the above

22. Ataxia may be seen in all of the following syndromes EXCEPT:

A. Claude’s syndrome

B. Benedikt’s syndrome

C. Nothnagel’s syndrome

D. Basilar artery syndrome

E. Weber’s syndrome

23. Which one of the following findings is seen with subacute combined degeneration?

A. ataxic gait

B. antalgic gait

C. myopathic gait

D. apraxia gait

E. calcaneus gait

24. A lesion of which of the following structures would MOST significantly impair memory?

A. amygdala

B. fornix

C. dorsomedial nucleus of the thalamus

D. mamillary body

E. area 44

A. weakness of hand

B. Horner’s syndrome

C. Raynaud’s syndrome

D. traction meningocele

E. ulnar paresthesias

26. Which of the following are true of PEEP (postive end expiratory pressure)?

A. it decreases work of breathing

B. it increases cerebral perfusion pressure

C. it decreases physiologic dead space

D. all of the above

E. none of the above

27. Which of the following can decrease the infection rate of venous catheters?

A. changing the line periodically over a guide-wire

B. occlusive dressings

C. masks and gowns

D. all of the above

E. none of the above

28. Which of the following neurotransmitters promotes penile erection?

A. serotonin

B. dopamine

C. noradrenaline

D. all of the above

E. none of the above

A. in about 4 hours.

B. in about 2 hours.

C. in about 1 hour.

D. in about 30 minutes.

E. in about 15 minutes.

30. The borders of Parkinson’s triangle are cranial nerves

A. I and II.

B. II and III.

C. III and IV.

D. IV and V₁

E. none of the above

31. The Tensilon test

A. is not sensitive but very specific for myasthenia gravis (MG).

B. is not particularly useful in ocular MG.

C. when negative, rules out the diagnosis of MG.

D. shows no correlation with subsequent response to pyridostigmine.

E. is not affected by the quantity of acetylcholine receptors.

32. In posterior interosseous syndrome, there is a fingerdrop but no wristdrop because of sparing

A. of the extensor carpi radialis longus.

B. of the extensor carpi radialis brevis.

C. of the extensor digitorum.

D. of the extensor carpi ulnaris.

E. of the brachioradialis.

33. What is the name of the following equation?

E = (RT/zF) ln Q

A. Nernst equation

B. Goldman equation

C. Poiseuille’s equation

D. Henderson-Hasselbalch equation

E. none of the above

34. Interruption of the inferior geniculocalcarine fibers results

A. in an ipsilateral superior quadrantanopsia.

B. in a contralateral superior quadrantanopsia.

C. in an ipsilateral inferior quadrantanopsia.

D. in a contralateral inferior quadrantanopsia.

E. none of the above

A. vertical oscillation of the eyes occurring with movements of the palate

B. hypertrophy of the inferior olivary nucleus

C. prior lesions of the central tegmental tract

D. all of the above

E. none of the above

36. All of the following characterize adult respiratory distress syndrome (ARDS) EXCEPT:

A. late hypoxemia

B. diffuse infiltrate

C. leaky capillaries

D. association with sepsis and trauma

E. protein content of fluid greater than with pulmonary edema

37. In a healing wound, maximum collagen deposition occurs

A. at 2 weeks.

B. at 4 weeks.

C. at 6 weeks.

D. at 8 weeks.

E. at 10 weeks.

38. All of the following are true regarding the condition depicted by the following histopathology EXCEPT:

A. It is histologically characterized by a biphasic pattern.

B. Rosenthal fibers are a prerequisite for this diagnosis.

C. It may mimic oligodendroglioma.

D. It is a CNS neoplasm seen with neurofibromatosis type 1.

E. Recurrence is usually a reformation of the cyst rather than the solid tumor.

A. inverse steal phenomenon

B. decreased CMR (cerebral metabolic rate)

C. decreased oxygen consumption

D. scavenger free radicals

E. all of the above

40. The anterolateral middle fossa triangle is defined by cranial nerves

A. II and III.

B. III and IV.

C. IV and V₁.

D. V₁ and V₂.

E. V₂ and V₃.

41. Which of the following is true of myasthenia gravis?

A. The majority of acetylcholine receptor antibodies are of the M subtype.

B. Cyclosporine is used as a first-line treatment.

C. Corticosteroids may reduce the risk of secondary generalization in the ocular form.

D. Pathologic abnormalities of the thymus are found in less than 5% of patients.

E. Weakness confined to the ocular muscles beyond 3 years is associated with poor prognosis.

42. The border of the foramen lacerum is formed

A. by the sphenoid bone.

B. by the temporal bone.

C. by the sphenoid and temporal bones.

D. by the sphenoid, temporal, and occipital bones.

E. by the occipital bone.

43. Absence of inflammation is typical of the following diseases EXCEPT:

A. neuropathy from diphtheria

B. Creutzfeldt-Jakob disease

C. paraneoplastic necrotizing myelopathy

D. central pontine myelinolysis

E. Tolosa-Hunt syndrome

44. Wernicke’s area is BEST described as including

A. area 39.

B. the supramarginal, area 40, and posterior one third of the superior temporal gyri.

C. the angular and posterior one third of the superior temporal gyri.

D. areas 39 and 40.

E. the supramarginal and posterior one third of the superior temporal gyri.

A. in opsoclonus.

B. in square wave jerks.

C. in downbeat nystagmus.

D. in upbeat nystagmus.

E. none of the above

46. The origin of axons that mediate the swallowing reflex

A. is the solitary nucleus.

B. is the dorsal motor nucleus of X.

C. is the nucleus ambiguus.

D. all of the above

E. none of the above

For the MRI findings in questions 47 to 51, please choose the answer option that is correct.

A. scan 1

B. scan 2

C. both scans 1 and 2

D. neither scan 1 nor scan 2

47. Hypertension

48. Early facial nerve involvement

49. Hypotension and bronchoconstriction during resection

50. Diarrhea

51. Early hearing loss and tinnitus

A. increased fibrinogen level

B. prolonged PT

C. prolonged PTT

D. thrombocytopenia

E. fragmented RBCs

53. The mastoid air cells are innervated

A. by V₁.

B. by V₂.

C. by V₃.

D. by IX.

E. by X.

54. Which of the following statements is most accurate regarding the band of Gennari?

A. It divides the third layer of the cortex of areas 17 and 18.

B. It divides the third layer of the cortex of area 17.

C. It divides the fourth layer of the cortex of areas 17 and 18.

D. It divides the fourth layer of the cortex of area 17.

E. It divides the fourth layer of the cortex of areas 17, 18, and 19.

55. The following are prenuclear structures for vertical gaze EXCEPT:

A. nucleus of Darkshevich

B. posterior commissure

C. interstitial nucleus of Cajal

D. rostral interstitial nucleus of the medial longitudinal fasciculus (MLF)

E. nucleus prepositus hypoglossi

56. Which of the following neurons or nerve cell processes is/are particularly involved with new, novel movements?

A. mossy fibers

B. Betz cell

C. climbing fibers

D. all of the above

E. none of the above

57. Which of the following disease states is characterized by high trophic hormone and low target hormone?

A. Cushing’s disease

B. Graves’ disease

C. Adrenal tumors

D. Addison’s disease

E. None of the above

A. adductor pollicis

B. abductor pollicis brevis

C. flexor pollicis brevis

D. opponens pollicis

E. extensor pollicis brevis

59. Resolution of brain edema occurs primarily

A. through bulk flow.

B. through vascular clearance.

C. through unknown mechanisms at the blood–brain barrier.

D. all of the above

E. none of the above

For the brachial plexus structures in questions 60 to 64, choose the appropriate letter in the diagram below:

60. Medial brachial cutaneous nerve

61. Long thoracic nerve

62. Medial antebrachial cutaneous nerve

63. Suprascapular nerve

64. Median pectoral nerve

A. lateral

B. vertical

C. vergence

D. oblique

E. horizontal

66. Which of the following is a distinguishing factor between Apert’s and Crouzon’s syndrome?

A. pattern of inheritance

B. association with bilateral coronal synostosis

C. severity of mental retardation

D. all of the above

E. none of the above

67. Thyrotropin-releasing hormone (TRH) is a secretagogue

A. for prolactin.

B. for adrenocorticotropic hormone (ACTH).

C. for growth hormone (GH).

D. for thyroid-stimulating hormone (TSH).

E. all of the above

68. Which of the following pairs of nerves is responsible for movement of the ring finger?

A. radial only

B. radial and median

C. radial, median, and ulnar

D. radial, median, and axillary

E. musculocutaneous, median, and ulnar

69. Which of the following types of edema is a feature of hydrocephalus?

A. Vasogenic edema

B. Cytotoxic edema

C. Interstitial edema

D. All of the above

E. None of the above

A. lateral triangle

B. paramedial triangle

C. Glasscock’s triangle

D. Kawase’s triangle

E. Parkinson’s triangle

71. Which is FALSE regarding the hormone prolactin (PRL)?

A. Its releasing hormone is located in the arcuate nucleus.

B. Normal levels are 5 to 25 ng per mL.

C. Levels may be increased after syncope.

D. Levels are increased after tonic clonic seizure activity.

E. Levels are increased after nonepileptic seizures.

72. Which of the following circumventricular organs is a central receptor site for angiotensin II?

A. organum vasculosum of the lamina terminalis

B. median eminence of the tuber cinereum

C. subcommissural organ

D. subfornical organ

E. area postrema

73. All of the following are true of the sinuvertebral nerve EXCEPT:

A. It is a branch from the posterior division of the spinal nerve proximal to the dorsal root ganglion.

B. It may enter the intervertebral foramen.

C. It supplies most of the innervation to the posterior aspect of the disk.

D. It may have a proprioceptive and/or nociceptive function.

E. It has been shown to consist of two roots at cervical levels.

74. All of the following are true of conduction aphasia EXCEPT:

A. It is caused by a lesion of the arcuate fasciculus.

B. There is fluent paraphasic speech with intact repetition.

C. It may be caused by occlusion of an MCA posterior temporal branch.

D. Patients may mimic Wernicke’s, but are able to understand.

E. Patients are aware of the problem.

A. It arises from the cavernous internal carotid artery.

B. It measures about 6 to 8 mm.

C. It usually presents with pituitary dysfunction.

D. All of the above are true.

E. None of the above are true.

76. During surgery for craniosynostosis, the MOST common event associated with poor outcome is

A. poor sterile technique and infection.

B. excessive blood loss and hypothermia.

C. inexperienced surgeon and need for reoperation.

D. all of the above are equally associated with poor outcome.

E. none of the above

77. Which of the following disorders is due to a defect in neural cell adhesion molecules (N-CAM) that guide the migration of the gonadotropin-releasing hormone (GnRH) neurons?

A. Laron-type dwarfism

B. Kallmann’s syndrome

C. Letterer-Siwe disease

D. Wolfram’s syndrome

E. none of the above

A. in the dorsal root ganglia only.

B. in the anterior horn only.

C. in the sympathetic chain ganglia and dorsal root ganglia.

D. in the lateral horn and sympathetic chain ganglia.

E. none of the above

79. The perforant path is the main

A. inhibitory pathway of the hippocampus.

B. excitatory pathway of the hippocampus.

C. inhibitory pathway of the hypothalamus.

D. excitatory pathway of the hypothalamus.

E. none of the above

80. Which triangle contains the foramen spinosum?

A. Parkinson’s triangle

B. Kawase’s triangle

C. Glasscock’s triangle

D. Inferior medial triangle

E. Paramedial triangle

81. The most common type of headache is

A. cluster.

B. tension.

C. migraine.

D. postconcussive.

E. due to temporal arteritis.

82. The trochlear nerve can be found in which cistern?

A. cerebellomedullary

B. interpeduncular

C. ambient

D. chiasmatic

E. pontine

A. anterior scalene

B. anterior and medial

C. medial and posterior

D. anterior and posterior

E. anterior, medial, and posterior

84. A lesion of the left geniculocalcarine tract and the corpus callosum is most likely to cause

A. pure word blindness.

B. pure word deafness.

C. mutism.

D. anomic aphasia.

E. global aphasia.

85. All of the following are true regarding hemispherectomy EXCEPT:

A. Improvement in IQ is often seen postoperatively.

B. Behavior is improved after surgery.

C. It is not necessary to preserve the septum pellucidum.

D. Plugging the foramen of Monro with a piece of temporalis muscle is often performed.

E. Patients are usually mute for about a week after surgery.

86. The principle behind multiple subpial transection for epilepsy is that

A. horizontal fibers have a limited functional role.

B. vertical fibers have a limited functional role.

C. the pia has a limited functional role.

D. all of the above

E. none of the above

87. The presenting symptom of a hypothalamic hamartoma is most commonly

A. headache.

B. vomiting.

C. visual field disturbance.

D. sexual precocity.

E. seizures.

A. It is found in superficial brain regions.

B. It shows intracellular accumulation of lipids.

C. It corresponds to World Health Organization (WHO) grade II.

D. It carries a dismal prognosis.

E. It presents in patients with a long history of seizures.

89. Schaffer collaterals carry

A. excitatory input from CA1.

B. excitatory input from CA3.

C. inhibitory input from CA1.

D. inhibitory input from CA3.

E. none of the above

90. The size of the medial group of lenticulostriate arteries from M1 is__________ related to the size of the ipsilateral recurrent artery of Heubner.

A. directly

B. inversely

C. not at all

D. exponentially

E. logarithmically

91. Which amino acids are precursors for catecholamines?

A. phenylalanine and tyrosine

B. phenylalanine and tryptophan

C. tyrosine and tryptophan

D. arginine and tyrosine

E. phenylalanine and arginine

A. pyramids

B. medial lemniscus

C. fibers of cranial nerve XII

D. gracile and cuneate nuclei

E. anterior two thirds of the spinal cord

93. During a clinic appointment, patients are asked to sit with their arms dependent, hold their breath, and tilt their head back and turn it to the side. Meanwhile the doctor is checking for the presence or absence of a radial pulse. What is being described?

A. Allen’s test

B. Ayer’s test

C. Adson’s test

D. Addis test

E. Dix-Hallpike maneuver

94. The corticobulbar tract is located in which area of the internal capsule?

A. anterior limb

B. posterior limb

C. retrolenticular limb

D. sublenticular limb

E. genu

95. The medial forebrain bundle interconnects the following areas EXCEPT:

A. septal nuclei

B. raphe nuclei

C. locus ceruleus

D. medulla

E. hypothalamus

96. Cerebellar tonsillar displacement is seen

A. in Chiari I.

B. in Chiari II.

C. in Crouzon’s syndrome.

D. all of the above

E. none of the above

97. The most severe forms of hypothalamic cachexia are seen in lesions

A. of the lateral hypothalamus.

B. of the anterior hypothalamus.

C. of the posterior hypothalamus.

D. of the ventromedial hypothalamus.

E. of the suprachiasmatic hypothalamus.

A. the temporal.

B. the cingulate.

C. the prefrontal.

D. the posterior parietal.

E. the anterior parietal.

99. The most prominent inhibitor to apoptosis is

A. Bax.

B. Bcl-2.

C. PAX.

D. HSP-90.

E. none of the above

100. Which of the following pathologic diagnosis is most likely associated with this hemorrhagic lesion?

A. melanoma

B. choriocarcinoma

C. breast carcinoma

D. renal cell carcinoma

E. choroid plexus papilloma

101. The highest incidence of phenylketonuria (PKU) is in which country?

A. Ireland

B. Japan

C. Australia

D. Sweden

E. Mexico

A. of the internal cerebral vein and basal vein.

B. of the inferior sagittal sinus and vein of Galen.

C. of the basal vein and great cerebral vein.

D. of the inferior sagittal vein and basal vein.

E. of the precentral cerebellar vein and internal cerebral vein.

103. A lesion of the vestibular labyrinth that causes images in the visual fields to move back and forth is best described

A. as ocular flutter.

B. as ocular dysmetria.

C. as ocular bobbing.

D. as oscillopsia.

E. as opsoclonus.

104. Atropine mainly affects which type of synapses?

A. parasympathetic preganglionic

B. parasympathetic postganglionic

C. sympathetic postganglionic

D. all of the above

E. none of the above

105. Wernicke’s encephalopathy is due to deficiency

A. of vitamin B₁.

B. of vitamin B₂.

C. of vitamin B₆.

D. of vitamin B₁₂.

E. none of the above

106. The solitary pathways are concerned

A. with taste.

B. with thoracic viscera.

C. with sudden changes in blood pressure.

D. all of the above

E. none of the above

107. The greatest difference between diffuse astrocytomas (WHO grade II) and anaplastic astrocytomas (WHO grade III) is

A. the MIB-1 fraction.

B. the presence of mitotic activity.

C. the presence of necrosis.

D. angiogenesis.

E. the presence of gemistocytes.

A. the neurilemmoma.

B. the fibrous histiocytoma.

C. the hemangiopericytoma.

D. the cavernous hemangioma.

E. none of the above

109. Which abnormality does the following EKG show?

A. Hypokalemia

B. Quinidine toxicity

C. Hypothermia

D. Myocardial infarction

E. None of the above

110. The location of the apex in most arteriovenous malformations is

A. cortical.

B. insular.

C. parietal.

D. occipital.

E. periventricular.

111. In catecholamine biosynthesis, the rate-limiting step during conditions of neuronal activation is

A. dopamine β-hydroxylase.

B. tyrosine hydroxylase.

C. aromatic amino acid decarboxylase.

D. monoamine oxidase.

E. phenylethanolamine N-methyltransferase.

A. septal and caudate

B. septal and terminal

C. terminal and caudate

D. internal cerebral and terminal

E. basal and internal cerebral

113. Ocular bobbing may be seen in which of the following?

A. hydrocephalus

B. pontine infarct

C. hepatic encephalopathy

D. trauma

E. all of the above

114. The most likely diagnosis for the following lesion seen on CT is

A. aneurysmal bone cyst.

B. epidermoid granuloma.

C. osteosarcoma.

D. hemangioma.

E. osteoid osteoma.

115. The striae medullares (rhombencephali) arise

A. from the septal nuclei.

B. from the habenular trigone.

C. from the arcuate nuclei.

D. from the amygdala.

E. none of the above

A. on arterioles and venules.

B. on capillaries penetrating the disc.

C. on diffusion.

D. all of the above

E. none of the above

117. Which of the following statements is true of the olivocochlear bundle?

A. It is part of the ascending auditory pathway to the dorsal cochlear nucleus.

B. It can be seen readily in brainstem sections of the upper pons.

C. It communicates directly with the medial lemniscus.

D. Stimulation of it inhibits acoustic fiber responses to auditory stimuli.

E. It arises from the inferior olivary nucleus and projects to the cochlea.

118. Which of the following orbital tumors is at highest risk of tumor seeding and recurrence during removal?

A. cavernous hemangioma

B. pleomorphic adenoma of the lacrimal gland

C. neurilemmoma

D. hemangiopericytoma

E. fibrous histiocytoma

119. The pterygoid plates are composed of which bones?

A. sphenoid and temporal

B. sphenoid and vomer

C. palatine and sphenoid

D. palatine

E. none of the above

120. Brodmann area 44 comprises

A. Wernicke’s area.

B. the visual cortex.

C. Broca’s area

D. the prefrontal area.

E. the frontal eye field.

121. The genetic defect in a particular movement disorder called dopa-responsive dystonia is due to a mutation affecting

A. dopa β-hydroxylase formation.

B. the synthesis of a tyrosine hydroxylase cofactor.

C. the norepinephrine transporter.

D. vesicle formation in the catecholamine neuron.

E. the breakdown of catecholamines.

A. posterior inferior cerebellar artery

B. superior cerebellar artery

C. thalamogeniculate branches

D. posterior choroidal artery

E. none of the above

123. In the comatose patient, extensor movements of the arms and weak flexor movements of the legs are most likely to occur with a lesion

A. above the red nucleus.

B. at the red nucleus.

C. between the red nucleus and above the vestibular nuclei.

D. at the vestibular nuclei.

E. below the vestibular nuclei.

124. “Crocodile tears” or lacrimation from gustatory stimulation is classically described as the result of aberrant regeneration of fibers

A. from cranial nerve III reaching the ciliary ganglion.

B. from cranial nerve V reaching the ciliary ganglion.

C. from cranial nerve VII reaching the ciliary ganglion.

D. from cranial nerve III reaching the sphenopalatine ganglion.

E. from cranial nerve VII reaching the sphenopalatine ganglion.

125. Syringomyelia affecting the lower cervical area may result in attenuation or abolition of which of the following somatosensory evoked potentials?

A. N13

B. N20

C. P40

D. N22

E. None of the above

126. If an instrumentation system is too stiff, disuse osteoporosis can occur around the instrumentation. This statement is related

A. to Sherrington’s law.

B. to Flouren’s law.

C. to Wolff’s law.

D. to Delpech’s principle.

E. to Jackson’s law.

127. In comparison to chordomas, chondrosarcomas

A. arise more laterally.

B. result in more neurologic deficits at presentation.

C. are nearly always S-100 positive.

D. display all of the above features.

E. display none of the above features.

A. medically refractory essential tremor

B. rigidity associated with Parkinson’s disease

C. intention tremor from cerebellar stroke

D. bradykinesia associated with progressive supranuclear palsy (PSP)

E. dyskinesia associated with striatonigral degeneration

129. Which of the following is the best measure of the “equator” of the spinal cord when performing a cordotomy for pain management?

A. just ventral to the dentate ligament

B. just dorsal to the dentate ligament

C. at the attachment of the dentate ligament

D. the midway point between the exit of the dorsal and ventral rootlets

E. ~5 mm from the anterior spinal artery

130. When is the earliest time one would expect to observe after radiation therapy the following changes on a T2-weighted MRI taken in a patient who under-went a tumor resection?

A. 1 month

B. 3 months

C. 14 months

D. 48 months

E. 72 months

A. because the activity of tyrosine hydroxylase is low.

B. because L-dopa is localized in vesicles.

C. because the activity of aromatic amino acid decarboxylase is high.

D. because dopamine ?-hydroxylase is localized in the vesicles.

E. because the activity of tyrosine hydroxylase is high.

132. The facial nucleus and the spinal trigeminal nucleus and tract are supplied by which artery?

A. PICA

B. AICA

C. SCA

D. Basilar

E. Anterior choroidal

133. Which of the following statements regarding the length constant of a nerve fiber is true?

A. The length constant is directly proportional to the membrane resistance.

B. It is the distance along a fiber where a change in the membrane potential by a given current decays to half its original value.

C. The length constant is directly proportional to the axial resistance.

D. The length constant is greater in unmyelinated than myelinated fibers.

E. none of the above

134. Dysfunction of which cell is the main problem in Raynaud’s phenomenon?

A. red blood cell

B. sympathetic neuron

C. platelet

D. mast cell

E. fibroblast

135. Epidural hematomas in children are the result

A. of an arterial injury.

B. of bone oozing.

C. of bleeding from the periosteal surface.

D. all of the above

E. none of the above

136. Spondylolysis most often occurs

A. at L1.

B. at L2.

C. at L3.

D. at L4.

E. at L5.

A. to a nerve arising from the upper trunk of the brachial plexus.

B. to a nerve arising from the roots of the brachial plexus.

C. to the dorsal scapular nerve.

D. to the thoracodorsal nerve.

E. none of the above

138. The typical target in thalamotomy for reduction of tremor is

A. Vim

B. Vop

C. Voa

D. VC

E. none of the above

139. Which of the following structures are derived from the telencephalon?

A. caudate

B. putamen

C. amygdala

D. all of the above

E. none of the above

140. The precuneus (Brodmann areas 7 and 31) is located

A. on the medial surface of the frontal lobe.

B. in the secondary visual cortex.

C. within the occipital lobe.

D. on the medial surface of the parietal lobe.

E. on the medial surface of the occipital lobe.

A. Dopamine β-hydroxylase (DBH) is a copper containing glycoprotein.

B. Phenylethanolamine N-methyltransferase (PNMT) methylates norepinephrine (NE) to form epinephrine.

C. Tyrosine hydroxylase is released from cells when its product, norepinephrine, is released.

D. The final enzyme in the dopamine pathway is amino acid decarboxylase (AADC).

E. The final enzyme in the NE pathway is DBH.

142. Neural crest derivatives include all of the following EXCEPT:

A. Schwann cells

B. bipolar cells

C. leptomeninges

D. chromaffin cells of the suprarenal medulla

E. parafollicular cells

143. Which of the following is located in the bony modiolus of the cochlea?

A. scala vestibuli

B. cochlear duct

C. organ of Corti

D. spiral ganglion

E. basilar membrane

144. Damage to this area leaves the patient transiently mute, with complete recovery in a few weeks.

A. Broca’s area

B. Wernicke’s area

C. Arcuate fasciculus

D. Uncinate fasciculus

E. Supplementary motor area

145. The foramen spinosum is located

A. in the sphenoid bone anterior to the greater and lesser superficial petrosal nerves.

B. in the sphenoid bone between to the greater and lesser superficial petrosal nerves.

C. in the temporal bone posterior to the greater and lesser superficial petrosal nerves.

D. in the temporal bone between the greater and lesser superficial petrosal nerves.

E. in none of the above locations

A. I.

B. II.

C. III.

D. IV.

E. V.

147. Golgi tendon organs are

A. sensitive to stretch.

B. in series with extrafusal fibers.

C. encapsulated.

D. all of the above

E. none of the above

148. During a thalamotomy procedure, what are the indications that the electrode is in the correct location?

A. Low-frequency (2 Hz) stimulation causes driving of the tremor.

B. The patient reports contralateral paresthesias.

C. High-frequency (50 Hz) stimulation results in tremor suppression.

D. All of the above

E. None of the above

149. Olfactory glomeruli are made up

A. of granule and tufted cells.

B. of granule and mitral cells.

C. of tufted and mitral cells.

D. of granule cells only.

E. none of the above

150. The sylvian triangle is defined by points along which artery/arteries?

A. MCA only

B. MCA and ACA

C. ACA, MCA, and PCA

D. MCA and PCA

E. ACA, MCA, and PCA

A. MAO_A has high affinity for norepinephrine and serotonin.

B. MAO_A is selectively inhibited by clorgyline.

C. MAO_B has high affinity for o-phenylethylamines.

D. MAO_A and MAO_B are associated with the inner mitochondrial membrane.

E. MAO_B is selectively inhibited by deprenyl.

152. The superior part of the fourth ventricle is derived from which of the following vesicles?

A. metencephalon

B. myelencephalon

C. mesencephalon

D. prosencephalon

E. none of the above

153. This structure is a projection of the spiral limbus that overlies the hair cells of the organ of Corti.

A. tectorial membrane

B. basilar membrane

C. vestibular membrane

D. Reissner’s membrane

E. None of the above

154. Which fibers are associated with the gag reflex?

A. spinal trigeminal nucleus projections to the nucleus ambiguus

B. solitary projections to the nucleus ambiguus

C. solitary projections to the salivatory nucleus

D. salivatory nucleus projections to the dorsal motor nucleus of the vagus

E. none of the above

A. Lumbar laminectomy of L4-S1

B. Lumbar hemilaminectomy at L4 on left side

C. Pedicle screw fusion of L4-L5

D. Pedicle screw fusion of L3-S1

E. Pedicle screw fusion of L3-L4

156. Which of the following receptors is activated by baclofen and is insensitive to bicuculline?

A. GABA-A

B. GABA-B

C. GABA-C

D. All of the above

E. None of the above

157. All of the following structures pass through the anulus of Zinn (tendinousring) EXCEPT:

A. cranial nerve III, superior division

B. nasociliary nerve

C. cranial nerve IV

D. cranial nerve III, inferior division

E. cranial nerve VI

A. Proteus

B. Streptococcus

C. Staphylococcus

D. Pseudomonas

158. A 16-year-old boy who sustained a parietal skull fracture after a motorcycle accident

159. A 60-year-old woman with chronic ear infection

160. A 3-month-old baby with irritability and decreased oral intake

161. Tranylcypromine is

A. an inhibitor of MAO_A.

B. an inhibitor of MAO_B.

C. an inhibitor of catechol methyltransferase (COMT).

D. a reuptake inhibitor of serotonin.

E. an inhibitor of acetylcholinesterase.

162. Which is the embryologic structure that becomes the ventral white commissure in the adult?

A. basal plate

B. floor plate

C. alar plate

D. sulcus limitans

E. None of the above

A. There is involvement of the upper eyelid.

B. Radiotherapy is not effective.

C. Hemiparesis is contralateral to the facial lesion.

D. The triad classically consists of nevus flammeus, venous malformation, and glaucoma.

E. Abnormalities of chromosome 9 are seen.

164. Cerebrospinal fluid (CSF) is produced

A. by the choroid plexus.

B. by the ependymal surface.

C. by the brain parenchyma.

D. by bulk flow from the brain.

E. all of the above

165. In patients with known systemic cancer, what percentage of single brain lesions are cerebral abscesses or primary brain tumors?

A. less than 0.1%

B. 1%

C. 15%

D. 30%

E. 50%

166. Vigabatrin has anticonvulsant properties related to its interference

A. of GABA breakdown.

B. of GABA synthesis.

C. of GABA reuptake.

D. all of the above

E. none of the above

A. of the habenula.

B. of the hippocampus.

C. of the hypothalamus.

D. of the gyrus of Heschl.

E. none of the above

168. A patient who had a thalamotomy for parkinsonian tremor earlier in the month has noticed weakness of the arm. The most likely explanation for this is that the lesion placed during the thalamotomy was too

A. medial.

B. lateral.

C. anterior.

D. posterior.

E. mild.

169. Which immunosuppressive agent works at the level of the T cell by inhibiting expression of interleukin-2 (IL-2)?

A. azathioprine

B. cyclosporine

C. methotrexate

D. all of the above

E. none of the above

170. Posterior thalamoperforating arteries are the perforators that arise from which artery?

A. Pcom

B. Pcom and P1

C. P1 and P2

D. P2

E. P1.

171. Which nucleus of the hypothalamus gives rise to dopamine innervation of the median eminence?

A. supraoptic

B. dorsomedial

C. lateral

D. arcuate

E. ventromedial

172. The alar plate gives rise to all of the following EXCEPT:

A. gracile and cuneate nuclei

B. inferior olivary nuclei

C. solitary nucleus

D. spinal trigeminal nucleus

E. nucleus ambiguus

A. It is related to abnormalities in the endoglin gene.

B. Neurologic symptoms are common and may be related to associated pulmonary AVMs.

C. Presentation may be with GI bleeding, hemoptysis, or epistaxis.

D. It is autosomal recessive.

E. Pulmonary and cerebral AVMs are associated with the 9q gene.

174. In preparation for placement of a ventriculostomy catheter, a resident measures a point 2.5 cm from the midline and 1 cm anterior to the coronal suture. The point that is being measured is

A. Keen’s point.

B. Kocher’s point.

C. McEwen’s point.

D. Barker’s point.

E. the sylvian point.

175. A 60-year-old man with the following MRI finding is most likely to present with the following signs on examination:

A. bilateral limb ataxia

B. ipsilateral Horner’s syndrome

C. contralateral abducens palsy

D. ipsilateral tongue paralysis

E. none of the above

A. carbamazepine

B. phenytoin

C. clonazepam

D. primidone

E. phenobarbitone

177. The interposed nuclei project

A. to the contralateral red nucleus.

B. to the ipsilateral red nucleus.

C. to the contralateral thalamus.

D. to the ipsilateral thalamus.

E. none of the above

178. All of the following symptoms may improve after pallidotomy EXCEPT:

A. drug-induced dyskinesias

B. painful dystonias

C. on/off fluctuations

D. bradykinesia

E. postural instability

179. Which of the following is FALSE regarding the femoral triangle?

A. The femoral nerve lies outside the femoral sheath.

B. The femoral nerve is lateral to the femoral artery.

C. It is bounded superiorly by the inguinal ligament.

D. It is covered superficially by the fascia lata.

E. It is bounded laterally by the adductor longus.

180. The anterior inferior cerebellar artery (AICA) originates

A. from the vertebral artery.

B. from the distal one third of the vertebral artery.

C. from the proximal two thirds of the basilar artery.

D. from the posterior cerebral artery.

E. from the distal two thirds of the basilar artery.

181. Which is FALSE regarding serotonin?

A. It is metabolized to melatonin in the pineal gland.

B. The majority of body stores of serotonin are found in the CNS.

C. Two critical enzymes take part in its synthesis.

D. Tryptophan is the precursor amino acid.

E. It has an indole structure.

A. oculomotor nucleus

B. trochlear nucleus

C. substantia nigra

D. red nucleus

E. superior colliculus

183. Livedo reticularis, subendothelial smooth muscle cell proliferation, and presentation with multiple ischemic strokes are features

A. of Sneddon’s syndrome.

B. of Seddon’s syndrome.

C. of Scheie’s syndrome.

D. of Schmidt’s syndrome.

E. of Schanz’s syndrome.

184. During the abdominal portion of the operation for a ventriculoperitoneal (VP) shunt, if the surgeon is below the arcuate line, which structures would lie behind the rectus abdominus?

A. external oblique aponeurosis

B. internal oblique aponeurosis

C. transversus abdominis aponeurosis

D. transversalis fascia

E. none of the above

185. Which of the following posterior fossa tumors has the tendency to arise from the floor of the fourth ventricle?

A. medulloblastoma

B. ependymoma

C. astrocytoma

D. hemangioblastoma

E. none of the above

186. Which of the following is true of Lissauer’s tract?

A. fibers are derived from the lateral division of the dorsal roots

B. contains Aδ fibers

C. contains C fibers

D. all of the above

E. none of the above

187. The limen insula can be found

A. in the occipital lobe.

B. at the junction of the insula and frontal lobe.

C. within the third ventricle.

D. in cross sections through the pons.

E. in none of the above.

A. to the thalamus.

B. to the internal capsule.

C. to the optic tract.

D. to the amygdala.

E. to the putamen.

189. Which of the following structures is NOT within the adductor canal?

A. femoral artery

B. femoral vein

C. great saphenous vein

D. nerve to vastus medialis

E. saphenous nerve

190. An important landmark for identifying the junction of the tegmentum and the cerebral peduncle is

A. the anterior pontomesencephalic vein.

B. the lateral mesencephalic vein.

C. the precentral cerebellar vein.

D. the vein of Galen.

E. the superior vermian vein.

191. This amino acid is not only a precursor to GABA but is also a neurotransmitter.

A. glycine

B. glutamate

C. arginine

D. tyrosine

E. tryptophan

For the actions and metabolisms in questions 192 to 195, choose the correct medications.

A. hydralazine

B. phentolamine

C. nitroglycerine

D. nitroprusside

192. Metabolized by the kidneys, equal effects on arterial and venous vasodilatation

193. Metabolized by the liver, more potent venous vasodilatation

194. Metabolized by the kidneys, more potent arterial vasodilatation

195. Metabolized by the liver, more potent arterial vasodilatation

A. elevated serum angiotensin converting enzyme

B. eosinophilic granuloma

C. meningitis

D. elevated adrenocorticotrophic hormone

E. sarcoidosis

197. A central facial palsy would only involve

A. the ipsilateral upper face.

B. the ipsilateral lower face.

C. the contralateral upper face.

D. the contralateral lower face.

E. none of the above

198. Palatal nystagmus is most likely due to a lesion

A. of the dorsal spinocerebellar tract.

B. of the corticospinal tract.

C. of the cerebral peduncle.

D. of the central tegmental tract.

E. of the frontal eye field.

199. The single best predictor for patients with esthesioneuroblastoma is

A. completeness of primary tumor excision.

B. TP53 overexpression.

C. the presence of Homer-Wright rosettes on pathology.

D. neuron-specific enolase expression.

E. the destruction of the cribriform plate.

A. increased latency in wave 3.

B. decreased latency in wave 4.

C. decreased latency in wave 5.

D. increased latency in wave 4.

E. increased latency in wave 5.

201. The best characterized glutamate-containing neurons are found

A. in the Purkinje cells of the cerebellum.

B. in the pyramidal cells of the cerebral cortex.

C. in the pyramidal cells of the hippocampus.

D. in the septal region.

E. in the lateral entorhinal cortex.

202. All of the following statements are true of nuclear chain fibers EXCEPT:

A. They receive group Ia primary afferent fibers.

B. They receive group II secondary afferent fibers.

C. They are associated with flower spray endings.

D. They are associated with static gamma efferent fibers.

E. They respond to muscle tension.

203. Patients who continue to display mental status changes after correction of diabetic ketoacidosis should be investigated

A. for cysticercosis.

B. for histoplasmosis.

C. for lyme disease.

D. for mucormycosis.

E. for hydatid disease.

204. Which of the following is FALSE with regard to shunt nephritis?

A. It is a well-described complication of VP shunts.

B. It is due to deposition of immune complexes in the glomeruli of kidneys.

C. The diagnosis is suspected with hematuria, elevated erythrocyte sedimentation rate (ESR), and decreased complement levels.

D. Proper treatment entails removing the entire shunt.

E. There is an elevated peripheral WBC count.

205. Regarding dysembryoplastic neuroepithelial tumor (DNET), which of the following is FALSE?

A. Male predominance has been noted.

B. It is a surgically curable cause of partial seizures.

C. There is an abundance of mitoses with no necrosis.

D. It is a mixed glial and neuronal neoplasm.

E. Shows on CT as a hypodense pseudocystic lesion.

A. transsphenoidal resection

B. bromocriptine

C. angiography

D. ophthalmologic evaluation

E. transcranial resection

207. The saccule sends fibers to the______vestibular ganglion that project to the______vestibular nucleus.

A. superior, superior

B. superior, inferior

C. inferior, superior

D. inferior, inferior

E. none of the above

208. Which of the following tracts traverse the restiform body?

A. olivocerebellar

B. reticulocerebellar

C. dorsal spinocerebellar

D. all of the above

E. none of the above

209. A favorable prognosis in neuroblastomas is related

A. to n-Myc amplification.

B. to 1p deletion.

C. to TrkA expression.

D. to older age.

E. none of the above

A. at the mastoid tip.

B. at the keyhole.

C. at the asterion.

D. at the bregma.

E. at the lambda.

211. The definitive marker for cholinergic neurons is

A. acetyl CoA.

B. acetylcholinesterase.

C. choline acetyltransferase.

D. choline.

E. sensitivity to hemicholinium-3.

212. Tanycytes are most likely to be found

A. in the wall of the third ventricle.

B. in a high-grade glioma.

C. in a low-grade glioma.

D. in the cauda equina.

E. none of the above

For the statements in questions 213 to 216, choose the appropriate structure on the diagram:

214. Innervates the sartorius muscle

215. Enables leg abduction

216. Meralgia paraesthetica

217. The vagus nerve leaves the medulla

A. between the pyramid and the olive.

B. between the olive and the inferior cerebellar peduncle.

C. from the same sulcus as CN XII.

D. from the dorsomedial sulcus.

E. from none of the above.

218. Bilateral damage to the medial basal occipitotemporal cortex results

A. in astereognosis.

B. in prosopagnosia.

C. in alexia without agraphia.

D. in auditory agnosia.

E. in autotopagnosia.

219. Neuroblastomas may present

A. with spinal cord compression.

B. with Ondine’s curse.

C. with opsoclonus syndrome.

D. with diarrhea.

E. all of the above

220. One of the most significant prognostic indicators for successful prolactinoma surgery is

A. results of the Goldman perimetry field.

B. being male.

C. the preoperative prolactin level.

D. age of the patient.

E. being female.

221. Nitric oxide synthase is responsible

A. for conversion of R-arginine into NO.

B. for conversion of citrulline into NO.

C. for production of NO and L-arginine.

D. for production of NO and citrulline.

E. none of the above

A. I

B. II

C. III and IV

D. VII

E. IX

223. The most common presentation of vein of Galen malformation in the neonate is

A. an intracranial bruit with heart failure.

B. subarachnoid hemorrhage.

C. hydrocephalus.

D. developmental delay.

E. ocular symptoms.

224. Which of the following associations based on this MRI scan is FALSE?

A. subarachnoid hemorrhage

B. progressive ascending paraplegic syndrome

C. the definitive therapy is microsurgical elimination

D. tend to bleed in elderly patients

E. it may represent a vascular anomaly

225. The arcuate eminence is the bony landmark of the

A. superior petrosal sinus.

B. superior semicircular canal.

C. middle meningeal artery.

D. vein of Labbe.

E. none of the above

A. It is a branch of the posterior cerebral artery.

B. It supplies the choroid plexus of the third ventricle.

C. It supplies the choroid plexus of the lateral ventricles.

D. all of the above

E. none of the above

227. The calamus scriptorius can be found

A. in the third ventricle.

B. in the fourth ventricle.

C. in the lateral ventricle.

D. at the cauda equina.

E. none of the above

228. Brain waves that are characteristic for deep sleep and have a frequency of 1 to per second are

A. α waves.

B. β waves.

C. theta waves.

D. delta waves.

E. none of the above

229. Which cranial nerves innervate muscles that attach to the styloid process?

A. VII, IX, X

B. IX, X

C. IX, X, XII

D. VII, X

E. VII, IX, XII

230. All of the following are true regarding hyperbaric oxygen therapy in postoperative neurosurgical infection, EXCEPT:

A. It increases the oxygen tension in the infected tissues.

B. It results in a direct bactericidal effect on anaerobic organisms.

C. It results in improved phagocytosis of Staphylococcus.

D. It should be used as an adjunct to surgery and antibiotics.

E. It is a temporizing measure until definitive therapy can be instituted.

231. Allodynia is a condition

A. where a painful response is produced by an innocuous mechanical stimulus.

B. where a painful response is felt in an amputated limb.

C. where a painful response is felt on the opposite side of the body.

D. where there is sensitization of spinocerebellar neurons.

E. all of the above

A. I

B. II

C. III and IV

D. VII

E. IX

233. All of the following are true of encephaloceles EXCEPT:

A. Occipital encephaloceles are the most common type.

B. Frontoethmoidal (sincipital) are the most common type in Southeast Asia and among Australian aborigines.

C. Parietal encephaloceles are associated with Chiari II malformation in up to one third of cases.

D. Basal encephaloceles are associated with defects along the sphenoid bone.

E. Children with basal encephaloceles have a low risk of developing meningitis.

234. On a horizontal section of the brain, the anterior limb of the internal capsule can be found

A. between the thalamus and the globus pallidus.

B. between the caudate and the corpus striatum.

C. between the caudate and the thalamus.

D. between the thalamus and putamen.

E. none of the above

For the structures in questions 235 to 238, choose their appropriate location on the following MRI:

235. Supplementary motor cortex

237. Premotor cortex

238. Heschl’s gyrus

239. Which of the following are true of the greater occipital nerve?

A. It emerges inferior to the inferior obliquus capitis muscle.

B. It is accompanied by the occipital artery.

C. It is a sensory nerve.

D. All of the above

E. None of the above

240. Which of the following statements is FALSE regarding arachidonic acid metabolism?

A. Aspirin inhibits both cyclooxygenase (COX) isoforms.

B. Arachidonic acid is a substrate for production of ceramide.

C. Thromboxane synthesis inhibitors lead to depletion of arachidonic acid.

D. Arachidonic acid is a substrate for COX I.

E. Prostaglandin H₂ (PGH₂) is a product of the COX enzyme.

241. The basal ganglia output for eye movements is

A. the subthalamic nucleus.

B. the substantia nigra pars compacta.

C. the substantia nigra pars reticulata.

D. the globus pallidus interna.

E. the globus pallidus externa.

242. Which area receives dorsal roots?

A. dorsal lateral sulcus

B. dorsal intermediate sulcus

C. ventral lateral sulcus

D. dorsal median sulcus

E. ventral intermediate sulcus

243. Which statement is true in a 4-year-old with the following MRI findings?

A. Biopsy is usually indicated to confirm the diagnosis.

B. Hyperfractionated radiation therapy has not been shown to improve sur vival.

C. Comprise 30% of pediatric CNS tumors.

D. No proven chemotherapeutic regimen.

E. Most lesions will regress spontaneously.

For the medications in questions 244 to 247, choose their correct effects on the cardiovascular system:

A. Increases refractory period, decreases contractility, increases preload (or left ventricular end diastolic pressure)

B. Decreases refractory period, decreases contractility, decreases preload

C. Decreases refractory period, decreases contractility, increases preload

D. Decreases refractory period, increases contractility, increases preload

244. Procainamide

245. Propranolol

246. Phenytoin

247. Lidocaine

248. All of the following are true of Lhermitte-Duclos disease EXCEPT:

A. It is also called dysplastic gangliocytoma of the cerebellum.

B. There is demyelination of the granular cell layer of the cerebellum.

C. There is thickening of one or more cerebellar folia.

D. Calcification and hydrocephalus may occur in this disorder.

E. A laminated pattern of folia on T2-weighted MRI is suggestive.

249. Which of the following is consistent with the diagnosis of typical trigeminal neuralgia?

A. unilateral symptoms

B. sensory deficit

C. decreased corneal reflex

D. all of the above

E. none of the above

250. N-Butylcyanoacrylate is used

A. for cranioplasty.

B. for endovascular procedures.

C. for topical wound dressings.

D. for vasospasm in the ICU.

E. none of the above

251. A 24-year-old man is brought into the emergency room after having a motor cycle accident. He has a scalp wound that is bleeding profusely. His eyes open only after his name is loudly called; however, he is confused when asked about the details of the accident. He obeys commands in all extremities. In this case, the Glasgow Coma Scale (GCS) score is

A. 15.

B. 14.

C. 13.

D. 12.

E. 11.

252. The ciliospinal center of Budge can be found at which spinal cord level?

A. midcervical

B. upper thoracic

C. lower thoracic

D. lumbar

E. sacral

253. The serum level of phenytoin is increased by all of the following EXCEPT:

A. cimetidine

B. chloramphenicol

C. valproic acid

D. uremia

E. aspirin

A. pain and temperature of the body

B. pain and temperature of the face

C. Horner’s syndrome

D. falling

E. none of the above

255. Which of the following fractures is most commonly associated with anterior cord syndrome?

A. clay shoveler’s fracture

B. wedge fracture

C. teardrop fracture

D. Chance fracture

E. transverse process fracture

256. What are the similarities between thrombotic thrombocytopenia purpura (TTP) and idiopathic thrombocytopenic purpura (ITP)?

A. decreased numbers of platelets

B. immune-mediated

C. treated with platelet replacement

D. all of the above

E. none of the above

257. All of the following structures are derived from ectoderm EXCEPT:

A. pia

B. dura

C. arachnoid

D. glia

E. ependyma

258. The most common primary tumor of the septum pellucidum is

A. meningioma.

B. oligodendroglioma.

C. astrocytoma.

D. ependymoma.

E. none of the above

259. The most common conflicting vessel in trigeminal neuralgia is

A. the AICA.

B. the PICA.

C. the SCA.

D. the satellite veins.

E. none of the above

A. in vertebrobasilar ischemia.

B. in controlling ICP.

C. in vasospasm.

D. in tumor biology.

E. in spinal fusion.

261. This cervical spine MRI demonstrates

A. metastatic disease.

B. a jumped facet.

C. a burst fracture.

D. a teardrop fracture.

E. an epidural abscess.

262. A 64-year-old woman presents to a clinic with a left thalamic arteriovenous malformation (AVM). The lesion appears to be ~5 cm in its greatest dimension. The AVM drains exclusively to the deep venous system via several stenotic veins. How would one best grade this AVM?

A. Spetzler-Martin grade 3

B. Spetzler-Martin grade 3A

C. Spetzler-Martin grade 4

D. Spetzler-Martin grade 4A

E. Spetzler-Martin grade 5

A. apneustic

B. Biot

C. central neurogenic hyperventilation

D. Kussmaul

E. Cheyne-Stokes

264. Which of the following structures is supplied mainly by the anterior choroidal artery?

A. globus pallidus externa, posterior limb of the internal capsule

B. globus pallidus interna, posterior limb of the internal capsule

C. globus pallidus externa, anterior limb of the internal capsule

D. globus pallidus interna, anterior limb of the internal capsule

E. none of the above

265. A feature that distinguishes pronator teres syndrome from carpal tunnel syndrome is that the former

A. is due to repetitive usage.

B. causes aching and fatiguing of the muscles involved.

C. causes nocturnal exacerbations.

D. exhibits numbness in the palm area.

E. is a better candidate for surgery.

266. Bleeding time is increased by all of the following EXCEPT:

A. thrombocytopenia

B. uremia

C. factor XIII deficiency

D. vWF deficiency

E. NSAIDs

267. Which of the following is a paired structure?

A. subforniceal organ

B. subcommissural organ

C. area postrema

D. all of the above

E. none of the above

268. Which of the following taste sensations is coupled to G-proteins when activated?

A. sweet and sour

B. sweet and bitter

C. bitter and salty

D. sour only

E. salty only

A. V₁ only

B. V₂ only

C. V₃ only

D. V₂ and V₃

E. V₁, V₂, and V₃

270. Gerstmann’s syndrome classically includes all the following EXCEPT:

A. dysgraphia

B. left-right confusion

C. finger agnosia

D. dyscalculia

E. astereognosis

271. A 50-year-old man is seen in a clinic 6 months after being involved in a motor vehicle accident. He has noticed a palpable lump growing on the left side of his head (see x-ray). On examination, the lesion is painless when palpated. Which of the following lesions is most likely?

A. fibrous dysplasia

B. osteoma

C. eosinophilic granuloma

D. giant cell tumor

E. epidermoid

A. cochlear

B. glossopharyngeal

C. vagus

D. accessory

E. hypoglossal

273. All of the following regarding stage 4 sleep are true EXCEPT:

A. Dreaming occurs.

B. Nightmares occur.

C. It is of decreased duration with hypothyroidism.

D. Somnambulism occurs.

E. It is of increased duration after sleep deprivation.

274. Increased risk of hemorrhage from warfarin is seen

A. with phenobarbital.

B. with carbamazepine.

C. with cephalosporins.

D. with penicillin.

E. with all of the above

275. Which of the following muscles are typically involved in anterior interosseous syndrome?

A. flexor digitorum profundus

B. flexor pollicis longus

C. pronator quadratus

D. all of the above

E. none of the above

A. inferior petrosal sinus

B. jugular bulb

C. sigmoid sinus

D. transverse sinus

E. PICA

277. Which of the following has an intact blood–brain barrier (BBB)?

A. subforniceal organ

B. subcommissural organ

C. area postrema

D. all of the above

E. none of the above

278. Dysgeusia is often associated with the use of

A. penicillin.

B. captopril.

C. steroids.

D. all of the above

E. none of the above

A. observation

B. surgical excision

C. gamma knife

D. partial surgical treatment

E. embolization

280. Which of the following is NOT associated with chronic alcoholism?

A. cerebral atrophy

B. Wernicke encephalopathy

C. central pontine myelinolysis

D. Foster-Kennedy syndrome

E. Marchiafava-Bignami disease

A. early Alzheimer’s disease

B. Pick’s disease

C. Creutzfeldt-Jakob disease

D. Huntington’s disease

E. diffuse Lewy body dementia

282. All of the following statements about fibrillation potentials are true EXCEPT:

A. They are a triphasic potential.

B. They typically last 5 to 15 milliseconds.

C. They are caused by denervation.

D. They are seen with poliomyelitis, ALS, and peripheral nerve injury.

E. They may be associated with positive sharp waves.

283. Bursts of 13 Hz lasting from half a second to 2 seconds are characteristic

A. of stage 1 sleep.

B. of stage 2 sleep.

C. of stage 3 sleep.

D. of stage 4 sleep.

E. of REM sleep.

A. petrous bone

B. hyperostosis

C. anterior clinoid process

D. posterior clinoid process

E. petrous bone

285. The transverse scapular ligament may be the cause of an entrapment syndrome that results in shoulder pain and muscle atrophy. The nerve that is trapped is

A. a direct branch of the C5 root.

B. a branch from the middle trunk.

C. a branch from the posterior cord.

D. a branch from the superior trunk.

E. none of the above

286. Which of the following cranial nerves travel through medial lemniscal fibers on exiting the brainstem?

A. III

B. IV

C. VI

D. VII

E. XII

287. Normal cerebral blood flow is

A. 50 mL/100 mg/min.

B. 50 mL/100 g/min.

C. 50 mL/mg/min.

D. 50 mL/g/min.

E. 50 mL/kg/min.

A. Bell’s palsy

B. familial dysautonomia

C. Raeder’s paratrigeminal syndrome

D. all of the above

E. none of the above

289. Total excision of the lesion shown in the imaging is most likely to improve

A. attention.

B. memory.

C. visuoconstructive ability.

D. executive function.

E. cognitive function.

290. Which of the following is caused by the JC virus?

A. central pontine myelinolysis (CPM)

B. progressive multifocal leukoencephalopathy (PML)

C. bovine spongiform encephalitis (BSE)

D. Creutzfeldt-Jakob disease (CJD)

E. none of the above

291. During saccadic movement of the eyes

A. there is increased activity of STN (subthalamic) neurons.

B. there is increased activity of SNpr (pars reticulata) neurons.

C. there is decreased activity of SNpr neurons.

D. there is increased activity of GPe (globus pallidus pars externa) neurons.

E. none of the above

A. They have three to five phases.

B. They last from 5 to 15 milliseconds.

C. They are associated with nerve fiber irritability.

D. They are not visible through the skin.

E. They may be associated with hypocalcemia, hypothermia, and nerve entrapments.

293. Calexcitin is a signaling molecule that amplifies calcium elevation in response to learning-associated synaptic transmitters in a model system of learning and memory (marine snail Hermissenda). Which of the following is FALSE regarding calexcitin?

A. Neural mechanisms regarding associative learning rarely are conserved between different species.

B. Calexcitin binds guanosine triphosphate (GTP), which is important in cell signaling.

C. At the endoplasmic reticulum membrane, it has been shown to bind to the ryanodine receptor with high affinity.

D. Calexcitin directly inactives voltage-dependent potassium currents.

E. It is a high-affinity substrate for the α-isozyme of protein kinase C (PKC).

294. Which of the following has been described with oat cell carcinoma of the lung?

A. anti-Hu antibodies

B. Eaton-Lambert syndrome and limbic encephalitis

C. ectopic ACTH secretion

D. syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

E. all of the above

295. On an EKG, a J-point elevation is characteristic of

A. hypocalcemia.

B. hypokalemia.

C. hypothermia.

D. hypothyroidism.

E. subendocardial ischemia.

296. Which of the following encephaloceles have the greatest chance of normal intellectual development and are least likely to develop hydrocephalus?

A. anterior encephaloceles

B. parietal encephaloceles

C. basal encephaloceles

D. occipital encephaloceles

E. encephaloceles of the clivus

A. TP53

B. PTEN

C. EGFR

D. all of the above

E. none of the above

298. Which of the following may be features of anaplastic oligodendroglioma?

A. microvascular proliferation

B. necrosis

C. pseudopalisading

D. all of the above

E. none of the above

299. Which structure straddles the posterior reach of the sylvian fissure?

A. angular gyrus

B. supramarginal gyrus

C. middle temporal gyrus

D. superior parietal lobule

E. none of the above

300. Avellis’ syndrome is most likely caused by a lesion in which area?

A. medulla

B. pons

C. hypothalamus

D. thalamus

E. midbrain

A. a glutamate agonist.

B. a glutamate antagonist.

C. a dopamine agonist.

D. a GABA agonist.

E. a GABA antagonist.

302. All of the following statements regarding Charcot-Marie-Tooth (CMT) disease are true EXCEPT:

A. It may be associated with a footdrop.

B. It is a condition of disordered myelination from decreased production of PMP22 (peripheral myelin protein).

C. It is the most common inherited peripheral neuropathy.

D. It is associated with a mutation on chromosome 17.

E. It is characterized by peroneal muscle atrophy.

303. Neurons that give rise to the ventral trigeminothalamic tract arise

A. from the trigeminal motor nucleus and the spinal trigeminal tract.

B. from the dorsal aspect of the principle sensory nucleus and the spinal trigeminal tract.

C. from the ventral aspect of the principle sensory nucleus and the spinal trigeminal tract.

D. from the ventral aspect of the principle sensory nucleus and the mesencephalic tract.

E. from the dorsal aspect of the principle sensory nucleus and the mesencephalic tract.

304. All of the following regarding motion perception is true EXCEPT:

A. Motion is perceived by an object’s change of position on the retina.

B. The sensation of movement is known as the phi phenomenon.

C. Images that change positions more than 15 times per second are indistinguishable from continuous motion.

D. The motion system is disabled at rates above 50 Hz.

E. There is no physical process occurring on the retina that corresponds to the perceived sensation of motion.

305. Which tract decussates in the dorsal tegmental decussation?

A. rubrospinal tract

B. medial vestibulospinal tract

C. tectospinal tract

D. all of the above

E. none of the above

A. is the major predictor of later tumor recurrence.

B. demands use of special instruments.

C. will more likely result in anosmia postoperatively.

D. all of the above

E. none of the above

307. Which of the following is a distinct interneuron between receptor and ganglion cell?

A. rods

B. cones

C. horizontal cells

D. amacrine cells

E. bipolar cells

308. Ependymoma is immunoreactive

A. for GFAP.

B. for S-100.

C. for vimentin.

D. for all of the above

E. for none of the above

309. The caudal remnant of the median prosencephalic vein unites with the developing internal cerebral veins to form

A. the straight sinus.

B. the vein of Galen.

C. the confluence of sinuses.

D. the inferior sagittal sinus.

E. none of the above

310. Which of the following statements is NOT true of Pelizaeus-Merzbacher disease (PMD)?

A. It has been linked to severe deficiency of myelin specific lipids.

B. It is X-linked recessive in the classical form.

C. The connatal form (type II) is milder than the classical form.

D. It manifests as a “tigroid” pattern of perivascular myelin preservation on MRI.

E. Rare female cases have been described.

311. Which afferent cerebellar tract does NOT pass through the inferior cerebellar peduncle?

A. reticulocerebellar

B. vestibulocerebellar

C. trigeminocerebellar

D. pontocerebellar tract

E. olivocerebellar tract

A. The floccular-nodular lobe receives input from the vestibular nuclei.

B. The anterior lobe receives input from the spinocerebellar tracts.

C. The vermis sends fibers to the VL thalamus and motor cortex.

D. The intermediate zone functions with posture, tone, and ipsilateral limb movements.

E. A lesion of the interposed nuclei causes intention tremor.

313. Which of the following inhibitory synaptic connections is found exclusively in the olfactory bulb?

A. dendrodendritic

B. axodendritic

C. axoaxonic

D. axosomatic

E. dendroaxonic

314. Which of the following statements is FALSE regarding the parvocellular sys tem of the lateral geniculate nucleus?

A. It is a small cell with a compact dendritic tree.

B. It represents a minority of the total ganglion cell number.

C. It projects to layer 4Cβ in the striate cortex.

D. It is involved with color processing.

E. It has low contrast sensitivity and high acuity.

315. All the following are true regarding venous air embolism EXCEPT:

A. It manifests as a decrease in end tidal CO₂.

B. Air should be aspirated from the right atrium if it occurs.

C. The patient should be placed in the left lateral decubitus position.

D. The head should be lowered if possible.

E. End tidal CO₂ changes cannot precede precordial Doppler changes.

316. The stria terminalis is a fiber tract that parallels

A. the caudate vein.

B. the septal vein.

C. the basal vein of Rosenthal.

D. the internal cerebral vein.

E. the thalamostriate vein.

317. What are the major contents of the proximal portion of the cubital fossa, in order from medial to lateral?

A. median nerve, brachial artery, biceps brachii tendon, radial nerve

B. median nerve, biceps brachii tendon, radial nerve, brachial artery

C. biceps brachii tendon, median nerve, radial nerve, brachial artery

D. brachial artery, biceps brachii tendon, radial nerve, median nerve

E. none of the above

A. the pectoralis major

B. the subscapularis

C. the teres major

D. the teres minor

E. the latissimus dorsi

319. The medial posterior choroidal artery when viewed on an angiogram occupies the same location as this structure seen on the venous phase of the angiogram.

A. vein of Galen

B. basal vein of Rosenthal

C. internal cerebral vein

D. thalamostriate vein

E. caudate vein

320. Occlusion of which of the following arteries is most likely to result in ipsilateral hypoglossal palsy?

A. basilar

B. anterior spinal

C. vertebral

D. PICA

E. AICA

321. The Botzinger complex is a cluster of cells that is involved in

A. excitatory control of cardiac function.

B. inhibitory control of cardiac function.

C. excitatory control of respiratory function.

D. inhibitory control of respiratory function.

E. none of the above

322. The upper subscapular nerve arises from which segment of the brachial plexus?

A. superior trunk

B. medial trunk

C. lateral cord

D. posterior cord

E. medial cord

323. All of the following are true of Moyamoya syndrome EXCEPT:

A. The majority of adults with this disease present with ischemia.

B. The age of onset of symptoms displays a bimodal distribution.

C. It is of unknown etiology.

D. Involves progressive stenosis of the supraclinoid carotid arteries with the concomitant formation of rich collaterals at the skull base.

E. It is associated with Down syndrome and neurofibromatosis.

A. It is effective in generalized tonic clonic seizures.

B. It is ~90% protein bound.

C. It has a long half-life.

D. It may be associated with platelet dysfunction.

E. It may result in liver dysfunction.

325. Which of the following anesthetics allows patients to emerge faster from anesthesia and has the least effect on metabolism of antiepileptic drugs?

A. enflurane

B. isoflurane

C. nitrous oxide

D. halothane

E. ketamine

326. The glomus is a prominent tuft of choroid plexus found

A. in the frontal horn.

B. in the temporal horn.

C. in the atrium.

D. in the occipital horn.

E. in none of the above

327. Which of the following groups of nerves is most likely to be affected by fractures of the humerus?

A. axillary, musculocutaneous

B. median, musculocutaneous

C. axillary, radial, ulnar

D. median, radial, ulnar

E. median, radial

328. Apraxia usually results from a lesion

A. of the precentral gyrus.

B. of the postcentral gyrus.

C. of the premotor cortex.

D. of the prefrontal cortex.

E. of the cingulate gyrus.

329. On an angiogram, the colliculocentral point is halfway between the tuberculum sellae and the sinus confluence. This point is closest to which structure?

A. vein of Galen

B. basal vein of Rosenthal

C. internal cerebral vein

D. straight sinus

E. precentral cerebellar vein

A. 5 Hz

B. 10 Hz

C. 15 Hz

D. 20 Hz

E. 25 Hz

331. Cells of which area have true unipolar neurons?

A. motor nucleus of V (trigeminal)

B. mesencephalic nucleus of V

C. sensory nucleus of V

D. red nucleus

E. locus ceruleus

332. The spinal border cells found in the ventral horns at L1-S2 give rise

A. to first-order neurons of the ventral spinocerebellar tract.

B. to second-order neurons of the ventral spinocerebellar tract.

C. to first-order neurons of the dorsal spinocerebellar tract.

D. to second-order neurons of the dorsal spinocerebellar tract.

E. none of the above

333. Narcolepsy is associated with

A. HLA-B27.

B. HLA-A24.

C. HLA-B40.

D. HLA-B54.

E. HLA-DR2.

334. Both retrospective and prospective studies of anterior temporal lobectomy have shown that seizure control in medial temporal lobe epilepsy is related to the extent of

A. anterior resection.

B. posterior resection.

C. lateral resection.

D. medial resection.

E. none of the above

335. Overall, the most common cause of chorea is

A. Huntington’s chorea.

B. chorea gravidarum.

C. senile chorea.

D. Hysterical chorea.

E. Sydenham’s chorea.

A. myopathy.

B. susceptibility to infection.

C. posterior subcapsular cataracts.

D. all of the above

E. none of the above

337. Which of the following is true concerning relationships to the flexor retinaculum?

A. The ulnar artery is superficial to it.

B. The median nerve is deep to it.

C. The ulnar nerve is superficial to it.

D. all of the above

E. none of the above

338. If a patient has already had a thalamotomy for tremor and now seeks treatment for tremor of the other hand, which deep brain stimulation (DBS) procedure should be done?

A. thalamotomy

B. Vim stimulation

C. GPi stimulation

D. any of the above is a reasonable choice

E. none of the above

339. Temozolomide is a novel chemotherapeutic agent approved for use in treating

A. meningioma.

B. glioblastoma multiforme.

C. anaplastic astrocytoma.

D. ependymomas.

E. choroid plexus carcinoma

A. polyneuropathy.

B. cervical radiculopathy.

C. myopathy.

D. S1 radiculopathy.

E. median nerve compression.

341. Which of the following is NOT a normal phenomenon in the aging neuron?

A. lipofuscin accumulation

B. Lewy bodies

C. Marinesco bodies

D. Alzheimer changes

E. colloid inclusions

342. A patient is asked to close his or her eyes during the neurologic exam and the doctor places a key in the patient’s hand. The ability of the patient to tell what the object is depends on the integrity of which pathway?

A. dorsal column

B. spinospinal

C. ventral spinocerebellar

D. dorsal spinocerebellar

E. spinothalamic

343. All of the following are true regarding intracranial pressure monitoring EXCEPT:

A. Pressure gradients between left and right sides of the brain and supra- and infratentorial compartments may be present.

B. The incidence of hemorrhage after insertion is about 1%.

C. Irrigating the tubing decreases the contamination rate of ventricular catheters.

D. Decreased intracranial compliance is suggested when the “b wavelet” is greater than the “a wavelet.”

E. There is no clear consensus as to whether to use prophylactic antibiotics.

A. In the pyramidal decussation, arm areas of cortex cross rostral to those that arise from leg areas.

B. It receives contributions from somatomotor cortex, prefrontal regions, and parietal areas.

C. Glutamate is present in cortical efferent fibers that project to the spinal cord.

D. Leg fibers are lateral to arm fibers at most levels of this particular tract.

E. Area 4 and postcentral gyrus fibers terminate in the same spinal cord lamina.

345. The middle cerebral artery supplies all of the following structures EXCEPT:

A. inferior parietal lobule

B. Broca’s area

C. Wernicke’s area

D. primary auditory cortex

E. paracentral lobule

346. During a transcallosal approach to a tumor, the risk of left hemialexia is minimized by preserving

A. the genu of the corpus callosum.

B. the cingulate gyrus.

C. the pericallosal artery.

D. the splenium of the corpus callosum.

E. none of the above

347. The clivoaxial angle is normally about

A. 13 degrees.

B. 30 degrees.

C. 100 degrees.

D. 130 degrees.

E. 180 degrees.

348. The sensorimotor region is located in which part of the GPi?

A. anteromedial

B. anterolateral

C. posteromedial

D. posterolateral

E. none of the above

A. The majority of these lesions arise from a ventral nerve root.

B. Ten to 15% extend through the dural root sleeve.

C. The fourth through sixth decades represent the peak incidence of occur rence.

D. These masses are typically described as smooth, globoid, and do not pro duce enlargement of the nerve.

E. They are suspended eccentrically from the nerve root with a discrete attachment.

350. Which of the following is particular to type I muscle fibers?

A. anaerobic

B. fast

C. stain dark with ATPase at pH 9.4

D. found in red muscle

E. have few mitochondria

351. Which of the following pathologic inclusions is intranuclear?

A. Pick bodies

B. Lewy bodies

C. Cowdry type B bodies

D. Bunina bodies

E. Lafora bodies

A. lateral spinothalamic

B. ventral spinocerebellar

C. ventral corticospinal

D. dorsal spinocerebellar

E. ventral spinothalamic

353. Which of the following is most accurate about Meniere’s disease?

A. Nystagmus is horizontal and ipsilateral to the affected side.

B. Nystagmus is vertical.

C. Falling and past-pointing are contralateral.

D. Nystagmus is contralateral to the affected side.

E. none of the above

354. Which of the following thalamic nuclei has reciprocal connections with the inferior parietal lobule?

A. pulvinar

B. anterior nucleus

C. centromedian nucleus

D. VA nucleus

E. VL nucleus

355. Visual-verbal disconnection syndrome is most likely to be seen with sectioning

A. of the anterior commissure.

B. of the hippocampal commissure.

C. of the body of the corpus callosum.

D. of the genu of the corpus callosum.

E. of the splenium of the corpus callosum.

356. Pineal tumors usually displace the precentral cerebellar vein

A. anterosuperiorly.

B. posterosuperiorly.

C. anteroinferiorly.

D. posteroinferiorly.

E. none of the above

357. Which of the following structures can be found two thirds of the way from the vomer to the foramen magnum?

A. occipital condyle

B. inion

C. pharyngeal tubercle

D. pituitary gland

E. sphenoid sinus

A. posterior inferior cerebellar artery

B. posterior cerebral artery

C. anterior choroidal artery

D. all of the above

E. none of the above

359. Platelet activation results in an increased affinity of the glycoprotein IIb/IIIa receptor for binding

A. of fibrinogen.

B. of thrombin.

C. of factor V.

D. of factor VIII.

E. of factor X.

360. Which statement regarding hepatolenticular degeneration disease is FALSE?

A. Serum ceruloplasmin is low.

B. Urinary copper is increased.

C. The gene locus is on chromosome 13.

D. Inheritance is autosomal dominant.

E. Early in the course of the disease, liver biopsy shows a high copper content.

361. Which of the following is FALSE regarding Bergmann glia?

A. They serve as guides for migrating granular cell neurons during development.

B. They have cell bodies located in the molecular layer of the cerebellar cortex.

C. They undergo reactive gliosis adjacent to infarcts.

D. They extend long cytoplasmic processes through the molecular layer to the subpial surface.

E. They are inconspicuous until stimulated by local damage.

362. A 62-year-old male presents with cauda equina syndrome from a herniated disc. All of the following statements are true EXCEPT:

A. signs are frequently unilateral

B. classically involves spinal roots inferior to L3

C. may result in profound motor defects

D. may result in urinary or fecal incontinence

E. usually results in a Babinski sign

363. The vestibule contains

A. the kinetic labyrinth.

B. the ampullae.

C. the static labyrinth.

D. the cochlear duct.

E. none of the above

A. VA

B. VL

C. VPL

D. VPM

E. none of the above

365. A meningioma located at the lateral tentorial notch with major extension infratentorially would be best managed

A. with a lateral suboccipital retrosigmoid approach.

B. with a combined subtemporal presigmoid approach.

C. with a infratentorial supracerebellar approach.

D. with a suboccipital transtentorial approach.

E. with none of the above approaches

366. Pineal calcifications are considered abnormal if encountered in patients younger than

A. 6 years.

B. 12 years.

C. 18 years.

D. 26 years.

E. 30 years.

367. Which of the following ligaments is found between the anterior tubercle of the atlas and the dens?

A. anterior longitudinal ligament

B. posterior longitudinal ligament

C. alar ligament

D. transverse ligament

E. none of the above

368. The most frequent site for a subependymoma is

A. the third ventricle.

B. the fourth ventricle.

C. the left lateral ventricle.

D. the right lateral ventricle.

E. the septum pellucidum.

369. The lamina terminalis is continuous

A. with the anterior commissure.

B. with the fornix.

C. with the splenium of the corpus callosum.

D. with the mammillary body.

E. with the pineal gland

A. in both eyes being deviated to the right at rest.

B. in both eyes being deviated to the left at rest.

C. in the right eye being “down-and-out.”

D. in the patient being unable to look upward.

E. in both eyes being deviated upward.

371. Immunoreactivity to transthyretin and S-100 would most likely be seen

A. in oligodendroglioma.

B. in low-grade astrocytoma.

C. in pleomorphic xanthoastrocytoma.

D. in choroid plexus papilloma.

E. in schwannoma.

372. EEG activity becomes isoelectric at a cerebral blood flow

A. of 7 mL/100 g/min.

B. of 16 mL/100 g/min.

C. of 30 mL/100 g/min.

D. of 35 mL/100 g/min.

E. of 45 mL/100 g/min.

373. All of the following are true regarding the lateral vestibulospinal tract EXCEPT:

A. It arises from the ipsilateral Deiter’s nucleus.

B. It is located in the lateral pontine tegmentum.

C. It crosses the midline with medial longitudinal fasciculus (MLF) fibers.

D. It facilitates extensor muscle tone in the antigravity muscles.

E. It is found at all spinal cord levels.

374. Lesions of this thalamic nucleus are found in patients with Korsakoff’s amnestic state.

A. anterior nucleus

B. centromedian nucleus

C. pulvinar

D. VA

E. mediodorsal nucleus

375. Before one transects the tentorium, which cranial nerve must be identified?

A. III

B. IV

C. V

D. VI

E. VII

A. They are the most common pineal region neoplasm.

B. They occur predominantly in males.

C. They commonly occur at around age 40 and above.

D. They are 5 to 10 times more likely in Japan.

E. They are infiltrated by T-cell lymphocytes.

377. All of the following regarding CNS sarcoid are true EXCEPT:

A. It is sensitive to steroids.

B. It may mimic multiple sclerosis.

C. It can involve cranial nerves.

D. It is characterized pathologically by caseating granulomas.

E. Leptomeningeal involvement is common.

378. Which of the following is the most frequent brain tumor in the first year of life?

A. choroid plexus tumor

B. gliosarcoma

C. cystic astrocytoma

D. oligodendroglioma

E. glioblastoma multiforme

379. A “square” anterior cerebral artery (ACA) shift on a cerebral angiogram suggests that there may most likely be a mass in which area?

A. frontal lobe

B. temporal lobe

C. parietal lobe

D. occipital lobe

E. basal ganglia

380. The motor nucleus of the trigeminal nerve is located

A. in the upper midbrain.

B. in the lower midbrain.

C. in the upper pons.

D. in the middle pons.

E. in the lower pons.

381. Circumventricular organs include all of the following EXCEPT:

A. obex

B. subcommissural organ

C. median eminence

D. organum vasculosum of the lamina terminalis

E. area postrema

A. pericallosal

B. anterior communicating

C. posterior communicating

D. middle cerebral

E. superior hypophyseal

383. All of the following are true statements of the posterior inferior cerebellar artery (PICA) EXCEPT:

A. It is a branch of the vertebral artery.

B. It supplies the vestibular nuclei in the medulla.

C. It supplies the medial lemniscus in the medulla.

D. It supplies the inferior cerebellar peduncle.

E. It supplies the lateral spinothalamic tract.

384. The optic disk

A. is located lateral to the fovea.

B. contains myelinated axons from the retinal ganglion cell layer of the retina.

C. contains only cones.

D. all of the above

E. none of the above

385. Which muscle is the border of the superior and inferior suboccipital triangles?

A. rectus capitis posterior major

B. superior obliquus capitis

C. inferior obliquus capitis

D. longissimus capitis

E. none of the above

386. The key to translabyrinthine dissection is anatomic identification

A. of the trigeminal nerve.

B. of the abducens nerve.

C. of the facial nerve.

D. all of the above

E. none of the above

387. All of the following are true of thoracic spine meningiomas EXCEPT:

A. The great majority of spinal meningiomas occur in females.

B. The most common presenting symptom is pain.

C. Plain film calcification is often seen.

D. Inversion recovery sequences and use of gadolinium increase detection sensitivity.

E. Calcospheres may be seen.

A. teres minor

B. teres major

C. latissimus dorsi

D. subscapularis

E. infraspinatus

389. Which of the following statements is NOT TRUE regarding radiation injury after stereotactic radiosurgery?

A. Time of development is directly related to the rate of turnover of the cells.

B. Cell loss after radiation occurs in connection with the cell division.

C. Time of development is directly dependent on the radiation dose.

D. Slowly proliferating tissue like CNS may take years to show the effects.

E. It can be minimized with careful dose planning.

390. Inherited mitochondrial disorders include all of the following EXCEPT:

A. Leigh’s disease

B. MERFF

C. MELAS

D. Kearns-Sayre syndrome

E. Kawasaki disease

391. Chromosomal alterations that are known to occur in tumors include all of the following EXCEPT:

A. Loss of heterozygosity (LOH) at 1p and 19q in oligodendrogliomas

B. LOH at 22 in ependymomas

C. LOH at 17 in astrocytomas

D. Monosomy of 22 in ATRT

E. Amplification of N-myc in glioblastoma

392. During routine preoperative screening for meningioma excision, the single greatest contraindication to surgery would be

A. myocardial infarction within the last 6 months.

B. age greater than 75.

C. greater than five ventricular ectopic beats per minute.

D. smoking more than one pack of cigarettes a day.

E. being hepatitis C positive.

393. All of the following tracts pass through the inferior cerebellar peduncle EXCEPT:

A. dorsal spinocerebellar

B. cuneocerebellar

C. fastigiovestibular

D. olivocerebellar

E. vestibulocerebellar

A. of unilateral destruction of the cuneus.

B. of bilateral destruction of both cunei.

C. of unilateral destruction of the lingual gyrus.

D. of bilateral destruction of both lingual gyri.

E. none of the above

395. During clipping of the following unruptured aneurysm, what is the best maneuver to minimize rupture?

A. temporary clipping of the carotid in the neck

B. lumbar drainage

C. preoperative use of steroids

D. keeping the patient intubated until surgery

E. minimal retraction

396. The reasons for monitoring wave 5 during acoustic neuroma surgery include:

A. It is an indication of the activity peripheral to the tumor.

B. It is easier to detect than the other waves.

C. Wave 5 is an accurate predictor of hearing postoperatively regardless of N1.

D. all of the above

E. none of the above

397. All of the following are true of multiple sclerosis EXCEPT:

A. Axons are intact.

B. Unidentified bright objects (UBOs) may be seen on MRI.

C. Active lesions show contrast enhancement.

D. Initial symptoms are referable to motor function.

E. About 10% have a positive family history.

A. anterior thalamus

B. cingulated gyrus

C. fornix

D. hippocampus

E. dorsomedial thalamus

399. The neurosurgeon accredited with developing modern-day stereotactic radiosurgery is

A. M. Gazi Yasargil.

B. Harvey Cushing.

C. Lars Leksell.

D. Walter Dandy.

E. Wilder Penfield.

400. A nonfluent, expressive aphasia can result from damage to

A. Brodmann area 40.

B. Brodmann area 41.

C. Brodmann area 42.

D. Brodmann area 43.

E. Brodmann area 44.

401. Elevated levels of N-acetyl aspartic acid in the urine and CSF is seen

A. in adrenoleukodystrophy.

B. in Canavan’s disease.

C. in Alexander’s disease.

D. in Krabbe’s disease.

E. in metachromatic leukodystrophy.

402. The most commonly observed platelet dysfunction encountered in surgical patients

A. is due to hemophilia A.

B. is due to factor V deficiency.

C. is due to aspirin.

D. is due to heparin.

E. is due to vitamin K deficiency.

403. All of the following are RNA viruses EXCEPT:

A. poxvirus

B. picornavirus

C. paramyxovirus

D. reovirus

E. rhabdovirus

A. in radiotherapy.

B. in chemotherapy.

C. in gene therapy.

D. in photochemotherapy.

E. none of the above

405. The most sensitive cranial nerve to radiation is

A. I

B. II

C. III

D. IV

E. V

406. The mastoid emissary vein is a useful guide to approximate the location

A. of the junction of the transverse and sigmoid sinuses.

B. of the jugular bulb.

C. of the AICA.

D. all of the above

E. none of the above

407. In the spinal cord, lamina 3 and 4 are also known as

A. the substantia gelatinosa.

B. the nucleus proprius.

C. the zona intermedia.

D. all of the above

E. none of the above

408. The cerebellar glomerulus includes all of the following EXCEPT:

A. mossy fiber terminal

B. Golgi cell dendrite

C. granule cell dendrite

D. Purkinje cell

E. Golgi cell axon terminal

409. The most common histologic feature detected as a late sign of radiation injury is

A. cellular apoptosis.

B. endothelial cell proliferation.

C. demyelination of the nerve fibers.

D. diffuse vasculitis.

E. focal white matter necrosis.

A. cervical

B. thoracic

C. lumbar

D. sacral

E. none of the above

411. This disorder, resulting from a mutation of a signaling molecule (Notch3 on chromosome 19), leads to subcortical white matter ischemic damage.

A. MERRF

B. CADASIL

C. MPS IV

D. HHT

E. VHL

412. The most common side effect of high-dose dexamethasone is

A. hyperglycemia.

B. psychosis.

C. exacerbation of peptic ulcer.

D. aseptic necrosis.

E. skin rash.

413. All of the following regarding cryptococcal meningitis is true EXCEPT:

A. Patients rarely complain of headache.

B. Nausea, vomiting, mental status changes, and cranial nerve palsies are features.

C. It is caused by an encapsulated budding yeast.

D. In some communities, it is more common than toxoplasmosis as a cause of presenting neurologic illness associated with HIV infection.

E. Infection occurs by the inhalation of organisms resulting in a primary pulmonary focus of infection.

414. What percentage of cerebrospinal fluid leaks from basilar skull fractures will resolve spontaneously?

A. 5%

B. 25%

C. 45%

D. 65%

E. 85%

A. PRL.

B. ACTH.

C. TSH.

D. all of the above

E. none of the above

416. During the caloric test, the superior vestibular nerve constitutes the main afferent

A. from the superior semicircular canal.

B. from the lateral semicircular canal.

C. from the posterior semicircular canal.

D. all of the above

E. none of the above

417. The inferior orbital fissure is mainly formed

A. by the sphenoid bone only.

B. by the sphenoid and ethmoid bones.

C. by the zygomatic and palatine bones.

D. by the sphenoid and maxilla.

E. none of the above

418. Many spinocerebellar fibers are distributed

A. to the medial vermal region of the anterior lobe.

B. to the lateral region of anterior lobe.

C. to the medial vermal region of posterior lobe.

D. to the lateral region of posterior lobe.

E. none of the above

419. Which of the following is NOT an indication for stereotactic radiosurgery?

A. cerebral arteriovenous malformation

B. metastatic tumor from non–small-cell lung carcinoma

C. 1.0 cm acoustic schwannoma limited to the IAC

D. 1.5 cm petrous apex meningioma not distorting the brainstem

E. 1.0 cm aneurysm at the top of basilar artery

A. Initial symptoms present between the ages of 20 and 40 years.

B. It may cause longstanding ventriculitis.

C. It is associated with midline fusion defect.

D. It demonstrates linear growth.

E. The surgeon must avoid spillage of tumor contents in the subarachnoid space.

421. All of the following disorders are autosomal recessive EXCEPT:

A. maple syrup urine disease

B. adrenoleukodystrophy

C. Wilson’s disease

D. Refsum’s disease

E. homocystinuria

422. In cerebral salt wasting syndrome, patients are usually

A. hypervolemic and hypernatremic.

B. hypervolemic and hyponatremic.

C. hypovolemic and hypernatremic.

D. hypovolemic and hyponatremic.

E. none of the above

423. All of the following are true of toxoplasmosis EXCEPT:

A. It is the most common cause of intracerebral mass associated with HIV infection when CD4 counts fall below 100/mm³.

B. Chorea in a patient with AIDS may be pathognomonic of toxoplasmosis.

C. Radiographic images show an asymmetric target sign.

D. The presenting neurologic symptom is nonfocal and superimposed on a global encephalopathy.

E. Therapy includes pyrimethamine and sulfadiazine.

A. the frontal bone.

B. the sphenoid bone.

C. the temporal bone.

D. the parietal bone.

E. the occipital bone.

425. Which of the following medical therapies for pituitary tumors is known for its side effect of gallstone formation?

A. bromocriptine

B. GnRH agonists

C. octreotide

D. all of the above

E. none of the above

426. Which of the following are reasonable criteria for recommending patients for stereotactic surgery for acoustic neuroma?

A. The patient is elderly with a medium-sized tumor.

B. The patient has recently been hospitalized and is on two heart medications and a water pill.

C. The tumor is on the side of the patient’s only hearing ear.

D. all of the above

E. none of the above

427. Bill’s bar is a bony protuberance that separates

A. the facial and superior vestibular nerves.

B. the facial and inferior vestibular nerves.

C. the acoustic and superior vestibular nerves.

D. the acoustic and inferior vestibular nerves.

E. none of the above

428. Which of the following persistent circulations is the most common?

A. trigeminal artery

B. otic artery

C. hypoglossal artery

D. proatlantal intersegmental artery

E. fetal posterior communicating artery

A. audiogram with pure tones and speech reception

B. counseling regarding the options of surgery or radiosurgery.

C. workup for a planned craniotomy

D. consent for angiography and possible embolization

E. observation

430. An upper homonymous quadrantanopsia is most likely to arise from a lesion

A. to the ipsilateral parietal lobe.

B. to the contralateral parietal lobe.

C. to the ipsilateral temporal lobe.

D. to the contralateral temporal lobe.

E. to the occipital cortex.

431. The following neurogenetic diseases display trinucleotide repeat EXCEPT:

A. fragile X syndrome

B. myotonic dystrophy

C. olivopontocerebellar atrophy

D. Huntington’s disease

E. Machado-Joseph disease

432. A patient approaching local anesthetic overdose will typically complain

A. of chest tightening.

B. of lightheadedness.

C. of tingling around the mouth.

D. of shortness of breath.

E. of nothing.

A. There is progressive attenuation of the cerebellar and premotor areas, but no change of activity in the primary motor cortex.

B. There is progressive attenuation of the cerebellar, but no change in the premotor and primary motor cortices.

C. There is no change in the cerebellar, but progressive attenuation of the premotor and primary motor cortices.

D. There is no change in the cerebellar and premotor cortices, but progressive attenuation of the primary motor cortex.

E. There is no change in activity of the cerebellar, premotor, or primary motor cortex.

434. All of the following are true of extradural hematomas EXCEPT:

A. They can appear crescentic.

B. The lucid interval is seen in ~80% of patients.

C. A dry eye postoperatively is from traction injury of a nerve.

D. Outcome correlates well with the clinical state prior to surgery.

E. Poor outcome is correlated with delay in surgery.

435. Major indications for craniotomy for pituitary tumors is/are

A. tumor extension into the middle fossae.

B. a dumbbell-shaped tumor with constriction in the middle.

C. a tumor claimed to be fibrous on previous transphenoidal resection.

D. all of the above

E. none of the above

436. An Auditory Brainstem Implant (ABI) is most useful during tumor removal when placed

A. in the third ventricle.

B. in the jugular vein.

C. in the lateral recess of the fourth ventricle.

D. in the lumbar cistern.

E. none of the above