Block 5 Neuro Atlas Ch 6 W Expl Part 2
- 1.A 41-year-old man is brought to the emergency department after an accident at a construction site. The examination reveals a weakness(hemiplegia) and a loss of vibratory sensation and discriminative touch all on the left lower extremity, and a loss of pain and thermal sensations on the right lower extremity. CT shows a fracture of the vertebral column adjacent to the T8 level of the spinal cord. Damage to which of the following fiber bundles or tracts would most likely explain the loss of vibratory sensation in this man?
- A.
Anterolateral system on the right
- B.
Cuneate fasciculus on the left
- C.
Cuneate fasciculus on the right
- D.
Gracile fasciculus on the left
- E.
Gracile fasciculus on the right
- 2.A 41-year-old man is brought to the emergency department after an accident at a construction site. The examination reveals a weakness(hemiplegia) and a loss of vibratory sensation and discriminative touch all on the left lower extremity, and a loss of pain and thermal sensations on the right lower extremity. CT shows a fracture of the vertebral column adjacent to the T8 level of the spinal cord. The loss of pain and thermal sensation in this man reflects damage to which of the following fiber bundles or tracts?
- A.
Anterolateral system on the left
- B.
Anterolateral system on the right
- C.
Cuneate fasciculus on the left
- D.
Gracile fasciculus on the left
- E.
Posterior spinocerebellar tract on the left
- 3.Which of the following is the prominent population of melanin-containing cells located immediately internal to the crus cerebri?
- A.
Locus ceruleus
- B.
Pontine nuclei
- C.
Red nucleus
- D.
Reticular formation
- E.
Substantia nigra
- 4.Which of the following structures receives visceral sensory input and is located immediately inferior to the medial and spinal vestibular nuclei at medullary levels?
- A.
Cochlear nuclei
- B.
Inferior salivatory nucleus
- C.
Nucleus ambiguus
- D.
Spinal trigeminal nucleus
- E.
Solitary nucleus
- 5.Which of the following groups of visceromotor (autonomic)cell bodies is located lateral to the abducens nucleus, directly adjacent to the exiting fibers of the facial nerve, and sends its axons out of the brainstem via this cranial nerve?
- A.
Dorsal motor nucleus
- B.
Edinger-Westphal nucleus
- C.
Inferior salivatory nucleus
- D.
Intermediolateral cell column
- E.
Superior salivatory nucleus
- 6.A 56-year-old woman presents to her family physician with persistent headache and nausea. MRI shows a tumor in the fourth ventricle impinging on the facial colliculus. Which of the following nuclei is found immediately internal to this elevation?
- A.
Abducens
- B.
Facial
- C.
Hypoglossal
- D.
Trigeminal
- E.
Vestibular
- 7.An 88-year-old man is brought to the emergency department by his daughter. She indicates that he complained of weakness of his “arm “and “leg”(upper and lower extremities) on the right side and of “seeing two of everything”(double vision—diplopia).CT shows an infarcted area in the medial area of the pons at the pons-medulla junction. The infarcted area is consistent with the vascular territory served by paramecia branches of the basilar artery. Weakness of the extremities on the right can be explained by damage to which of the following structures?
- A.
Corticospinal fibers on the left
- B.
Corticospinal fibers on the right
- C.
Middle cerebellar peduncle on the left
- D.
Rubrospinal fibers on the left
- E.
Rubrospinal fibers on the right
- 8.An 88-year-old man is brought to the emergency department by his daughter. She indicates that he complained of weakness of his “arm “and “leg”(upper and lower extremities) on the right side and of “seeing two of everything”(double vision—diplopia).CT shows an infarcted area in the medial area of the pons at the pons-medulla junction. The infarcted area is consistent with the vascular territory served by paramecia branches of the basilar artery. The diplopia (double vision) this man is having is most likely the result of damage to which of the following structures?
- A.
Abducens nerve root
- B.
Facial nerve root
- C.
Oculomotor nerve root
- D.
Optic nerve
- E.
Trochlear nerve or root
- 9.An 88-year-old man is brought to the emergency department by his daughter. She indicates that he complained of weakness of his “arm “and “leg”(upper and lower extremities) on the right side and of “seeing two of everything”(double vision—diplopia).CT shows an infarcted area in the medial area of the pons at the pons-medulla junction. The infarcted area is consistent with the vascular territory served by paramecia branches of the basilar artery. Recognizing that this patient’s lesion involves the territory served by paramedian branches of the basilar artery, which of the following structures is also most likely included in the area of infarction?
- A.
Anterolateral system
- B.
Facial motor nucleus
- C.
Hypoglossal nucleus
- D.
Medial lemniscus
- E.
Spinal trigeminal tract
- 10.A 77-year-old man presents with a weakness of his right upper and lower extremities and he is unable to abduct his left eye on attempted gaze to the left. Which of the following most specifically describes this deficit?
- A.
Alternating hemianesthesia
- B.
Hemihypesthesia
- C.
Inferior alternating hemiplegia
- D.
Middle alternating hemiplegia
- E.
Superior alternating hemiplegia
- 11.In axial MRI which of the following structures is an important landmark that separates the third ventricle (rostral to this point) from the quadrigeminal cistern (caudal to this point)?
- A.
Lamina terminalis
- B.
Habenular nucleus
- C.
Massa intermedia
- D.
Pulvinar
- E.
Superior colliculu
- 12.A 77-year-old woman presents with deficits that suggest a lesion involving long tracts and a cranial nerve. CT shows an infarct in the region served by the penetrating branches of the basilar bifurcation. Which of the following structures is most likely located in this vascular territory?
- A.
Abducens nerve
- B.
Anterolateral system
- C.
Corticospinal fibers in pyramid
- D.
Medial lemniscus
- E.
Red nucleus
- 13.A 69-year-old man is brought to the emergency department with the complaint of a sudden loss of sensation. The history reveals that the man is overweight, hypertensive ,and does not regularly take medication. When the man speaks his voice is gravely and hoarse. The examination further reveals a loss of pain and thermal sensations on the right side of his body and on the left side of his face. CT shows an infarcted area in the medulla. Damage to which of the following structures would most likely explain the man’s hoarse, gravelly voice?
- A.
Facial nucleus
- B.
Gracile nucleus
- C.
Hypoglossal nucleus
- D.
Nucleus ambiguus
- E.
Spinal trigeminal nucleus
- 14.A 69-year-old man is brought to the emergency department with the complaint of a sudden loss of sensation. The history reveals that the man is overweight, hypertensive ,and does not regularly take medication. When the man speaks his voice is gravely and hoarse. The examination further reveals a loss of pain and thermal sensations on the right side of his body and on the left side of his face. CT shows an infarcted area in the medulla. Injury to which of the following structures in this man is most specifically related to the loss of pain and thermal sensations on the body below the neck?
- A.
Anterolateral system
- B.
Cuneate fasciculus
- C.
Gracile fasciculus
- D.
Medial lemniscus
- E.
Spinal trigeminal tract
- 15.A 69-year-old man is brought to the emergency department with the complaint of a sudden loss of sensation. The history reveals that the man is overweight, hypertensive ,and does not regularly take medication. When the man speaks his voice is gravely and hoarse. The examination further reveals a loss of pain and thermal sensations on the right side of his body and on the left side of his face. CT shows an infarcted area in the medulla. Damage to which of the following structures would most specifically explain the loss of pain and thermal sensations on the man’s face?
- A.
Anterolateral system
- B.
Medial lemniscus
- C.
Medial longitudinal fasciculus
- D.
Solitary tract
- E.
Spinal trigeminal tract
- 16.A 69-year-old man is brought to the emergency department with the complaint of a sudden loss of sensation. The history reveals that the man is overweight, hypertensive ,and does not regularly take medication. When the man speaks his voice is gravely and hoarse. The examination further reveals a loss of pain and thermal sensations on the right side of his body and on the left side of his face. CT shows an infarcted area in the medulla. The CT shows an infarcted area in the medulla in this man. Based on the deficits described, and the corresponding structures involved, which of the following vessels is most likely occluded?
- A.
Anterior spinal artery
- B.
Posterior spinal artery
- C.
Posterior inferior cerebellar artery
- D.
Anterior inferior cerebellar artery
- E.
Penetrating branches of the vertebral artery
- 17.A 77-year-old man presents with an ataxic gait. There are no other deficits. CT shows an infarcted area in the medulla in the territory served by the posterior inferior cerebellar artery. Damage to which of the following structures would most likely explain the symptoms experienced by this man?
- A.
Anterolateral system
- B.
Corticospinal tract
- C.
Nucleus ambiguus
- D.
Rest form body
- E.
Vestibular nuclei
- 18.Which of the following cranial nerve nuclei is located in the anterior (ventral or inferior) and medial portion of the periaqueductal grey at the cross-sectional level of the superior colliculus?
- A.
Abducens
- B.
Mesencephalic
- C.
Oculomotor
- D.
Trigeminal motor
- E.
Trochlear
- 19.A 53-year-old woman presents with motor deficits that the examining neurologist describes as a superior alternating hemiplegia. Which of the following cranial nerve roots is most likely involved in this lesion?
- A.
Abducens
- B.
Hypoglossal
- C.
Oculomotor
- D.
Trigeminal
- E.
Trochlear
- 20.An 82-year-old woman presents to the emergency department with difficulty swallowing (dysphagia).Which of the following nuclei of the medulla contain motor neurons that innervate muscles involved in swallowing?
- A.
Dorsal motor vagal
- B.
Hypoglossal
- C.
Inferior salivatory
- D.
Medial vestibular
- E.
Nucleus ambiguus
- 21.A 73-year-old man is brought to the emergency department after losing consciousness at his home. CT shows a hemorrhage into the right hemisphere. The man regains consciousness, but is not fully alert. After 3 to 4 days the man begins to rapidly deteriorate. His pupils are large (dilated) and respond slowly to light, eye movement becomes restricted, there is weakness in the extremities on the left side, and the man becomes comatose. Repeat CT shows an uncalherniation. Based on its location, which of the following parts of the brain-stem is most likely to be directly affected by uncal herniation, especially in the early stages?
- A.
Diencephalon/thalamus
- B.
Mesencephalon/midbrain
- C.
Myelencephalon/medulla
- D.
Pons and cerebellum
- E.
Pons only
- 22.A 73-year-old man is brought to the emergency department after losing consciousness at his home. CT shows a hemorrhage into the right hemisphere. The man regains consciousness, but is not fully alert. After 3 to 4 days the man begins to rapidly deteriorate. His pupils are large (dilated) and respond slowly to light, eye movement becomes restricted, there is weakness in the extremities on the left side, and the man becomes comatose. Repeat CT shows an uncalherniation. Damage to corticospinal fibers in which of the following locations would most likely explain the weakness in his extremities?
- A.
Left basilar pons
- B.
Left crus cerebri
- C.
Right basilar pons
- D.
Right crus cerebri
- E.
Right posterior limb of the internal capsule
- 23.A 73-year-old man is brought to the emergency department after losing consciousness at his home. CT shows a hemorrhage into the right hemisphere. The man regains consciousness, but is not fully alert. After 3 to 4 days the man begins to rapidly deteriorate. His pupils are large (dilated) and respond slowly to light, eye movement becomes restricted, there is weakness in the extremities on the left side, and the man becomes comatose. Repeat CT shows an uncalherniation. The dilated, and slowly responsive, pupils in this man are most likely explained by damage to fibers in which of the following?
- A.
Abducens nerve
- B.
Corticonuclear fibers in the crus
- C.
Oculomotor nerve
- D.
Optic nerve
- E.
Sympathetic fibers on cerebral vessels
- 24.The sagittal MRI of a 26-year-old man shows a dark shadow in the midbrain tegmentum on the midline at the cross-sectional level of the inferior colliculus. Which of the following structures does this dark area represent?
- A.
Central portions of the red nucleus
- B.
Compact and reticular parts of the substantia nigra
- C.
Decussation of the superior cerebellar peduncle
- D.
Decussation of trigeminothalamic fibers
- E.
Motor (pyramidal) decussation
- 25.The CT of a 39-year-old man with untreated hypertension shows a small hemorrhage in the brainstem. This lesion encompasses the brachium of the inferior colliculus and the brain sub-stance immediately internal to this structure. Which of the following structures is also most likely involved in this lesion?
- A.
Anterolateral system
- B.
Central tegmental tract
- C.
Corticospinal fibers
- D.
Mesencephalic tract
- E.
Oculomotor nerve
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