Block 5 Neuro Brainstem Orbit,Face,Skull MCQ's
- 1.A female patient complains of difficulty swallowing, a loss of pain and temperature sensations from the left side of her body below the neck and from the right side of her face, At what level of the brainstem do you suspect the lesion to be?
- A.
The right lateral medulla
- B.
The upper (rostra!) pons
- C.
The lower (caudal) pons
- D.
The left lateral medulla
- E.
The right midbrain
- 2.You are a pathologist who has sectioned the brain and brainstem and are ready to examine a section of medulla. Which of the following would you expect to see at this level?
- A.
Edinger-Westphal nucleus
- B.
Inferior olivary nucleus
- C.
Olfactory nuclei
- D.
Trochlear nucleus
- E.
Motor nucleus of
- 3.A 62-year old male has sustained several injuries from a car accident. Upon administering a neurological examination, you suspect that the patient has damage to the right caudal medulla. Why do you think this?
- A.
The patient's right eye exhibits hypertropia and he complains of diplopia,
- B.
The patient's tongue deviates towards to right when you asked him to stick it out and his uvula deviates towards the left when you ask him to say, "aahhh".
- C.
The patient has a loss of taste on the right anterior 2/3rds of his tongue
- D.
The patient exhibits anosmia (inability to smell)
- E.
The patient complains of excruciating pain on the right side of his face
- 4.A lesion at the level of the cerebral peduncle would affect descending fibers of the corticospinal tract. Disruption of these axons would result in which of the following?
- A.
Flaccid paralysis
- B.
Areflexia
- C.
Hypotonicity
- D.
Positive Babinski sign
- E.
Absent Babinski sign
- 5.A 23-year-old female suffers a discrete arterial infarct that affects the left spinal tract of V and the left spinal nucleus of V. What deficit would you expect to see in this patient?
- A.
A loss of touch and pressure sense on the left side of the face.
- B.
A loss of pain and temperature sense on the left side of the face.
- C.
A loss of touch and pressure sense on the right side of the face.
- D.
A loss of pain and temperature sense on the right side of the face,
- E.
A loss of voluntary motor function to the muscles of mastication.
- 6.A 49-year old woman suffers a small infarct that affects only the medial lemniscus in the mid-pons on the right. What clinical deficit do you expect to see in this woman?
- A.
A loss of pain and temperature perception below the neck on the left below the level of the infarct
- B.
A loss of touch and pressure sense on the left face
- C.
A loss of touch and pressure sense below the neck on the left
- D.
A loss of voluntary motor Function below the neck on the right
- E.
A loss of pain and temperature perception below the neck on the right below the level of the infarct
- 7.You are a pathologist who has sectioned the brain and brainstem and are ready to examine a section of midbrain. Which of the following would you expect to see at this level?
- A.
Rostral nucleus solitaries
- B.
Accessory nucleus
- C.
Edinger-Westphal nucleus
- D.
Spinal nucleus of V
- E.
Inferior olivary nucleus
- 8.A detailed neurological examination of a 52-year old male reveals the following: patient H5 alert to time, date and place and exhibits no disorders of speech or comprehension. Visual system testing, however, reveals a paralysis of upward gaze as well as a loss of the consensual pupillary light reflex. Such a constellation of symptoms could be due to a tumor at which location?
- A.
Optic chiasm
- B.
Rathke’s pouch (Craniopharingioma)
- C.
Pituitary gland
- D.
Pineal gland
- E.
Caudal pans
- 9.Which of the following 2" order neurons is involved with relaying touch & proprioceptive information to the somatosensory cortex from the face?
- A.
Principal (main) sensory nucleus of V
- B.
Nucleus gracilis
- C.
Motor nucleus of V
- D.
Nucleus cuneatus
- E.
Ventral horn neurons
- 10.A 60-year old man suffered from a right sided hemiplegia and right sided cerebellar ataxia. He could not abduct the left eye. Which of the following structures is involved?
- A.
Right pons
- B.
Left internal capsule
- C.
Right internal capsule
- D.
Left medulla
- E.
Left pons
- 11.During a college football game, a player is "sacked" and carried off the field. A CT scan reveals a bone fragment lodged into the lateral aspect of his dorsal columns in the cervical spinal cord on the left side. Which of the following functions will most likely be affected given this patient's presentation?
- A.
Motor control of left leg
- B.
Motor control of right leg
- C.
Touch, pressure, vibration of left leg
- D.
Touch, pressure, vibration of right leg
- E.
Touch, pressure, vibration of right arm
- F.
Touch, pressure, vibration of left arm
- 12.A 50-year old man present with complaint of double vision. While testing the patient's right eye movement during a cranial nerve test, the physician noted that the patient cannot elevate the adducted eye. Which of the following muscles is involved?
- A.
Superior rectus
- B.
Inferior rectus
- C.
Lateral rectus
- D.
Superior oblique
- E.
Inferior oblique
- 13.A patient is found to be unable to dilate his pupil and has drooping left eyelid ptosis). Ptosis disappears when he looks up. What structure is damaged?
- A.
Vagus nerve
- B.
Oculomotor nerve
- C.
Superior cervical ganglion
- D.
Optic nerve
- E.
Superior rectus muscle
- 14.In a blow-out fracture of the orbit, the floor of the orbit is fractured. Which of the following movements of the eyeball is lost?
- A.
Lateral
- B.
Upward
- C.
Medial
- D.
Downward
- E.
Downward and lateral
- 15.A 16-year-old teenager presents with complaint of double vision. The chief resident asked you to assess the functions of the extrinsic eye muscles. While testing the patient's left eye movement, you noted that the patient cannot depress the adducted eye. Which of the following muscles is involved?
- A.
Superior rectus
- B.
Superior oblique
- C.
Inferior rectus
- D.
Lateral rectus
- E.
Inferior oblique
- 16.A 20-year old man presents with double vision after a car accident. The ER resident tests the eye muscle functions and finds that the patient is unable to elevate the adducted right eye. Which muscle is not functioning properly?
- A.
Inferior rectus
- B.
Superior oblique
- C.
Superior rectus
- D.
Lateral rectus
- E.
Inferior oblique
- 17.Which of the following layers of the scalp constitute the "danger" layer?
- A.
Loose areolar tissue layer
- B.
Skin
- C.
Pericranium
- D.
Subcutaneous layer
- E.
Epicranial aponeurosis
- 18.At Pterion, which of the following bones does not articulate?
- A.
Parietal
- B.
Frontal
- C.
Zygomatic
- D.
Temporal
- E.
Sphenoid
- 19.An elderly patient developed fever and worsening headache a few days after sustaining a scalp laceration and subsequent infection due to a car accident. At the hospital the case was diagnosed as meningitis and superior sagittal sinus thrombosis. The attending physician suggested that infection to the sinus initially spread through one of the scalp layers. The scalp layer involved is:
- A.
Connective tissue (dense)
- B.
Areolar tissue
- C.
Epicranial aponeurosis
- D.
Periosteum
- E.
Skin
- 20.A 25-year-old woman sustains a head injury. A radiograph of the skull shows a fracture of the foramen ovale. Which of the following nerves would most likely be damaged by this event?
- A.
Ophthalmic nerve
- B.
Maxillary nerve
- C.
Optic nerve
- D.
Mandibular nerve
- E.
Trochlear nerve
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