Block 5 Pace Quiz 1

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Block 5 Pace Quiz 1 - Quiz

Questions and Answers
  • 1. 

    Dr Welke You are seeing a patient with a tumor affecting the brainstem.  The disorder has specifically attacked the nerve marked by the arrow.  Name (i) the marked nerve and (ii) the corresponding clinical deficits.

    • A.

      Trigeminal Nerve – Loss of voluntary motor function to the muscles of mastication on the right, loss of sensation to the right face

    • B.

      Trigeminal Nerve – Loss of voluntary motor function to the muscles of mastication on the left, Loss of sensation to the left face

    • C.

      Facial Nerve – Bell’s palsy on the left, loss of taste on the patient’s left

    • D.

      Facial Nerve – Bell’s palsy on the right, loss of taste on the patient’s right

    • E.

      Trochlear Nerve – Trochlear nerve palsy

    Correct Answer
    B. Trigeminal Nerve – Loss of voluntary motor function to the muscles of mastication on the left, Loss of sensation to the left face
    Explanation
    The correct answer is the Trigeminal Nerve. The patient is experiencing a loss of voluntary motor function to the muscles of mastication on the left side, as well as a loss of sensation to the left side of the face.

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  • 2. 

    A patient has a stroke in the branches of the artery marked in the below graphic.  As the physician, you know (i) the name of syndrome the stroke will cause and (ii) the corresponding clinical deficit that the syndrome will produce.

    • A.

      Superior Alternating Syndrome – Right oculomotor nerve palsy

    • B.

      Lateral Medullary Syndrome – Loss of taste on the patient’s left

    • C.

      Superior Alternating Syndrome – Left oculomotor nerve palsy

    • D.

      Lateral Medullary Syndrome – Loss of taste on the patient’s right

    • E.

      Medial Medullary Syndrome – Loss of voluntary motor function on the patient’s left.

    Correct Answer
    C. Superior Alternating Syndrome – Left oculomotor nerve palsy
    Explanation
    The correct answer states that the stroke in the branches of the marked artery will cause Superior Alternating Syndrome, specifically resulting in a left oculomotor nerve palsy. This means that the patient will experience paralysis or weakness of certain eye muscles on the left side of their face, leading to difficulty in moving the eye and potentially causing double vision or drooping eyelids on the left side.

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  • 3. 

    You are in Gross Anatomy Laboratory dissecting the maxillary division of CN V.  You discover the zygomatic nerve and are carefully cleaning this nerve so you can demonstrate it to the other groups.  You know that this nerve carries three type of axons, one which is parasympathetic.  Name (i) the axon modality type for the parasympathetic axon (ii) the cranial nerve that this axon is resident of and (iii) what this nerve innervates.

    • A.

      SVA – CN V – Taste buds on the palate

    • B.

      SVA – CN VII – Taste buds on the palate

    • C.

      GVE – CN V – Lacrimal gland

    • D.

      GSE – CN VII – muscles of facial expression

    • E.

      GVE – CN VII – Lacrimal gland

    Correct Answer
    E. GVE – CN VII – Lacrimal gland
    Explanation
    The correct answer is GVE - CN VII - Lacrimal gland. The axon modality type for the parasympathetic axon is GVE (General Visceral Efferent), which carries autonomic motor fibers to innervate glands and smooth muscles. The cranial nerve that this axon is resident of is CN VII (Facial nerve), which controls the muscles of facial expression and also carries parasympathetic fibers to innervate the lacrimal gland, responsible for tear production.

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  • 4. 

    A research scientist is interested in creating a discrete lesion in the area of the spinal cord marked below.  Name the (i) tract he is interested in affecting and (ii) type of information that tract carries.

    • A.

      Lateral Corticospinal Tract – voluntary motor function to the patient’s left

    • B.

      Lateral Corticospinal Tract – voluntary motor function to the patient’s right

    • C.

      Spinothalamic Tract – pain and temperature from below this level on the patient’s left

    • D.

      Spinothalamic Tract – pain and temperature from the face on the patient’s left.

    • E.

      Spinothalamic Tract – pain and temperature from below this level on the patient’s right

    Correct Answer
    E. Spinothalamic Tract – pain and temperature from below this level on the patient’s right
    Explanation
    The correct answer is the Spinothalamic Tract, which carries information related to pain and temperature from below the marked level on the patient's right side. This means that the research scientist is interested in affecting this specific tract to study the effects on the patient's perception of pain and temperature sensations on the right side of their body below the marked level.

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  • 5. 

    Which of the following grouping of nuclei of the hypothalamus all regulate feeding behaviors?

    • A.

      Dorsomedial nucleus, lateral nucleus, ventromedial nucleus

    • B.

      Dorsomedial nucleus, lateral nucleus, anterior nucleus

    • C.

      Arcuate nucleus, lateral nucleus, paraventricular nucleus

    • D.

      Arcuate nucleus, suprachiasmatic nucleus, posterior nucleus

    • E.

      Ventromedial nucleus, posterior nucleus, paraventricular nucleus

    Correct Answer
    A. Dorsomedial nucleus, lateral nucleus, ventromedial nucleus
    Explanation
    The correct answer is Dorsomedial nucleus, lateral nucleus, ventromedial nucleus. These three nuclei of the hypothalamus are known to regulate feeding behaviors. The dorsomedial nucleus is involved in the initiation of feeding, the lateral nucleus is involved in the promotion of feeding, and the ventromedial nucleus is involved in the termination of feeding. Therefore, these three nuclei work together to regulate feeding behaviors.

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  • 6. 

    Your great uncle has a small infarct in a cerebellar artery that affects only the interposed nuclei of the cerebellum.  This nucleus is associated with (i) what lobe of the cerebellum and (ii) helps modulate what motor output?

    • A.

      Anterior lobe - adjusts medial motor systems for balance and posture

    • B.

      Posterior lobe - adjusts medial motor systems for balance and posture

    • C.

      Posterior lobe - adjusts lateral descending systems for extremities

    • D.

      Flocculo-nodular lobe - adjusts medial motor systems for balance and posture

    • E.

      Anterior lobe – adjusts lateral descending systems for extremities

    Correct Answer
    E. Anterior lobe – adjusts lateral descending systems for extremities
    Explanation
    The correct answer is Anterior lobe – adjusts lateral descending systems for extremities. This is because the interposed nuclei, which are affected by the infarct, are associated with the anterior lobe of the cerebellum. The anterior lobe is responsible for adjusting the lateral descending systems, which control movements of the extremities.

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  • 7. 

    Dr Martin A young child is diagnosed with a communicating or non obstructive hydrocephalus.  Which of the following is the most likely cause of this condition?  

    • A.

      Blockage of the foramen of Monroe

    • B.

      Blockage of the aqueduct of sylvius

    • C.

      Blockage of the foramen of magendie in 4th ventricle

    • D.

      Blockage of the arachnoid villi

    Correct Answer
    D. Blockage of the arachnoid villi
    Explanation
    Blockage of the arachnoid villi can lead to a condition called communicating hydrocephalus. Arachnoid villi are small projections of the arachnoid membrane that protrude into the venous sinuses of the brain. They help to absorb cerebrospinal fluid (CSF) and regulate its flow. If the arachnoid villi are blocked or not functioning properly, CSF cannot be absorbed effectively, leading to an accumulation of fluid in the ventricles of the brain and resulting in hydrocephalus.

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  • 8. 

    Dr. O’Donoghue  As a medical student, you are tapping the patellar tendon to activate the knee jerk reflex.  The resulting reflex is within a normal range. Which sensory organ is activated in response to this stimulus?

    • A.

      Golgi tendon organ

    • B.

      Merkel cell

    • C.

      Pacinian corpuscle

    • D.

      Muscle spindle

    • E.

      Ruffini ending

    Correct Answer
    D. Muscle spindle
    Explanation
    The muscle spindle is activated in response to tapping the patellar tendon to activate the knee jerk reflex. The muscle spindle is a sensory organ located within the muscle that detects changes in muscle length and rate of change, allowing for the body to maintain balance and coordination. When the patellar tendon is tapped, it causes a stretch in the muscle, which activates the muscle spindle and initiates the knee jerk reflex.

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  • 9. 

    While recovering from a football game collision, a 27-year-old man complains that everything he eats “tastes funny.” Which of the following specifies the distorted sense of taste experienced by this man?

    • A.

      Ageusia

    • B.

      Dysgeusia

    • C.

      Dysosmia

    • D.

      Anosmia

    • E.

      Hyposmia

    Correct Answer
    B. Dysgeusia
    Explanation
    Dysgeusia refers to a distorted sense of taste, where everything the person eats tastes funny. This condition can occur as a result of various factors, such as certain medications, infections, or underlying health conditions. In this case, the 27-year-old man is experiencing this symptom after a football game collision, indicating that the collision may have caused an injury or trauma that has led to the distorted sense of taste.

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  • 10. 

    A 73-year-old woman is brought to the Emergency Department by her husband. The examination reveals an otherwise healthy trim woman who had a headache that responded to an OTC medication but was followed by a sudden onset of involuntary flinging movements of her right extremities, most pronounced in her right upper extremity. CT reveals a small localized hemorrhagic lesion. This lesion is most likely located in which basal nucleus?

    • A.

      Left caudate and putamen

    • B.

      Left subthalamic nucleus

    • C.

      Left globus pallidus

    • D.

      Right putamen

    • E.

      Right subthalamic nucleus

    Correct Answer
    B. Left subthalamic nucleus
    Explanation
    The patient's symptoms of sudden onset involuntary flinging movements of her right extremities, most pronounced in her right upper extremity, along with the presence of a small localized hemorrhagic lesion on CT, suggest a lesion in the basal ganglia. The basal ganglia is responsible for movement control, and the subthalamic nucleus is a part of the basal ganglia. Therefore, the most likely location of the lesion is the left subthalamic nucleus.

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  • 11. 

    A 3-year-old girl is brought to the Emergency Department (ED) by her mother. The history is well known to the Chief of the ED. The current examination reveals that the girl has burns on both hands from touching a hot burner. She has an unusual neurological disorder (probably inherited) that greatly reduces her sensitivity to pain and temperature. Which fiber type/s is/are not functioning properly in this girl?  

    • A.

    • B.

    • C.

      Aδ only

    • D.

      Aδ and C

    • E.

      C only

    Correct Answer
    D. Aδ and C
    Explanation
    The correct answer is Aδ and C. Aδ and C fibers are responsible for transmitting pain and temperature sensations. In this case, the girl's unusual neurological disorder is likely affecting these fibers, resulting in her reduced sensitivity to pain and temperature. The fact that she has burns on both hands from touching a hot burner without feeling pain supports this explanation.

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  • 12. 

    A 25-year old woman suffers head injuries from an automobile accident.  Her MRI reveals an epidural hematoma.  Between which two structures has blood accumulated?

    • A.

      Between the arachnoid and the pia mater.

    • B.

      Between the dura and the pia mater.

    • C.

      Between the dura and the arachnoid layer.

    • D.

      Between the pia and sub arachnoid layer.

    • E.

      Between the skull and the dura.

    Correct Answer
    E. Between the skull and the dura.
  • 13. 

    A 34-year old man is rushed to the emergency room from the site of a car accident. An MRI reveals a lesion at the level of the midbrain. His upper and lower limbs are extended. Name (i) the type of rigidity and (ii) the tract/tracts involved in the extension of the limbs.

    • A.

      Decorticate; Rubrospinal tract

    • B.

      Decorticate; Medial reticulospinal and lateral vestibulospinal tract

    • C.

      Decerebrate; Rubrospinal and lateral vestibulospinal tract

    • D.

      Decerebrate; Medial reticulospinal and lateral vestibulospinal tract

    • E.

      Decerebrate; Rubrospinal tract

    Correct Answer
    D. Decerebrate; Medial reticulospinal and lateral vestibulospinal tract
    Explanation
    The correct answer is "Decerebrate; Medial reticulospinal and lateral vestibulospinal tract". Decerebrate rigidity is characterized by extension of both the upper and lower limbs. It is caused by damage to the brainstem, specifically at the level of the midbrain. In this case, the lesion at the level of the midbrain is causing the decerebrate rigidity. The extension of the limbs is mediated by the involvement of the medial reticulospinal and lateral vestibulospinal tracts.

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  • 14. 

    A 44-year old man presents with a “cape-like” loss of sensation (pain and temperature) to his back and arms. An MRI reveals a cyst at the cervical level of his spinal cord. Name (i) the disorder and (ii) the tract that is affected.

    • A.

      Brown Séquard syndrome, Spinothalamic tract

    • B.

      Brown Séquard syndrome, Corticospinal tract

    • C.

      Syringomyelia, Spinothalamic tract

    • D.

      Syringomyelia, Corticospinal tract

    • E.

      Syringomyelia, Tectospinal tract

    Correct Answer
    C. Syringomyelia, Spinothalamic tract
    Explanation
    The correct answer is Syringomyelia, Spinothalamic tract. Syringomyelia is a disorder characterized by the formation of a cyst or cavity within the spinal cord. This cyst can compress and damage the surrounding nerve fibers, including the spinothalamic tract. The spinothalamic tract is responsible for transmitting sensory information, such as pain and temperature, from the body to the brain. Therefore, the presence of a cyst in the cervical level of the spinal cord can lead to a "cape-like" loss of sensation to the back and arms, which is consistent with the symptoms described in the question.

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  • 15. 

    Dr Dhiman 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

    Correct Answer
    D. Mandibular nerve
    Explanation
    The contents of this foramen neatly form the mnemonic 'OVALE' (otic ganglion, V3, accessory meningeal artery, lesser petrosal nerve, emissary veins)


    Several nerves, arteries and veins pass through the foramen ovale. They are as follows:
    Mandibular nerve (the third branch (V3) of the trigeminal nerve)
    Accessory meningeal artery (small meningeal or parvidural branch, sometimes derived from the middle meningeal artery)
    Lesser petrosal nerve of (CN IX) (note: the lesser superficial petrosal nerve sometimes passes through a special canal (canaliculus innominatus of Arnold), situated medial to the foramen spinosum)
    Emissary veins (from the cavernous sinus to the pterygoid plexus)
    The otic ganglion is situated directly under the foramen, but is also transmitted through the foramen ovale.

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  • 16. 

    Dr Vigh   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

    Correct Answer
    A. Loose areolar tissue layer
    Explanation
    Loose areolar layer is full of many blood vessels with many anastamoses. Severe Blood Loss can occur if damaged.

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  • 17. 

    A 20-year old man presents double vision after a car accident. The ER resident tests eye muscle functions and find that the patient is unable to elevate the abducted right eye. Which muscle is not functioning properly?

    • A.

      Inferior oblique

    • B.

      Inferior rectus

    • C.

      Superior rectus

    • D.

      Superior oblique

    • E.

      Lateral rectus

    Correct Answer
    C. Superior rectus
    Explanation
    The OBLIQUES only raise and lower pupil when the eye is ADDucted

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  • 18. 

    A patient with a goiter went through a thyroidectomy. When ligating the inferior thyroid artery, a profuse bleeding covered the view and made it difficult to identify structures in the area. The surgeon made every effort to avoid injury of the structure closely related to the inferior thyroid artery. Which is the structure that he was most concerned about?

    • A.

      Recurrent laryngeal nerve

    • B.

      External laryngeal nerve

    • C.

      Internal laryngeal nerve

    • D.

      Superior laryngeal artery

    • E.

      Hypoglossal nerve

    Correct Answer
    A. Recurrent laryngeal nerve
    Explanation
    The recurrent laryngeal nerve passes upward generally behind, but occasionally in front of, the artery. This makes it vulnerable to injury during surgery that involves ligating the inferior thyroid artery, such as excision of the lower pole of the thyroid gland.

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  • 19. 

    Dr Sharma   A 24-year-old graduate student suffers a fall from a ladder and was left paralyzed from his waist down. After initial medical management was unsuccessful for recovery of function of his legs, he was admitted to a spinal cord injury rehabilitation center.  There he worked diligently at the exercises and techniques, aimed at recovery.  After six weeks of intensive work he has shown no improvement in his motor function. He tearfully tells his trainer that he feels that it is not worth the effort anymore and that he would like to have a motorized chair so that he could get out of the place and get back with his studies. The behavior shown by the patient at this time suggests he is in what phase of the grief process?

    • A.

      Denial

    • B.

      Acceptance

    • C.

      Anger

    • D.

      Bargaining

    • E.

      Depression

    Correct Answer
    B. Acceptance
    Explanation
    http://youtu.be/cuAzT-StlVI

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  • 20. 

    Dr Meisenberg   y-aminobutyric acid (GABA) is the most important inhibitory neurotransmitter in the brain. GABA suppresses anxiety, and a deficiency of GABA causes anxiety. You work for a secret service that wants to develop an anxiety-inducing drug for interrogations. The best strategy to accomplish this aim would be a drug that:

    • A.

      Inhibits glutamate decarboxylase

    • B.

      Inhibits GABA decarboxylase

    • C.

      Keeps the GABA-operated chloride channel open

    • D.

      Inhibits GABA transaminase

    • E.

      Inhibits the sodium-dependent GABA transporter in the presynaptic terminal

    Correct Answer
    A. Inhibits glutamate decarboxylase
    Explanation
    Inhibiting glutamate decarboxylase would be the best strategy to develop an anxiety-inducing drug for interrogations. Glutamate decarboxylase is the enzyme responsible for converting glutamate into GABA. By inhibiting this enzyme, there would be a decrease in GABA production, leading to a deficiency of GABA in the brain. As mentioned earlier, a deficiency of GABA causes anxiety. Therefore, inhibiting glutamate decarboxylase would effectively induce anxiety, making it the most suitable option for developing an anxiety-inducing drug.

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  • 21. 

    Dr O'Donoghue   When the following cells are activated, REM sleep is turned ON:

    • A.

      Noradrenergic neurons of locus coeruleus, serotoninergic neurons of the Raphe

    • B.

      Noradrenergic neurons of locus coeruleus, GABAergic neurons of the RF

    • C.

      Cholinergic neurons of the pontine RF, noradrenergic neurons of locus coeruleus

    • D.

      GABAergic neurons of the RF, serotoninergic neurons of the Raphe

    • E.

      Cholinergic neurons of the pontine RF, GABAergic neurons of the RF

    Correct Answer
    E. Cholinergic neurons of the pontine RF, GABAergic neurons of the RF
    Explanation
    During REM:
    GABA in the RF of the optic area,
    A-Ch in RF of midbrain (same as when awake)
    No Histamine in REM either
    In Non-REM only A-Ch is turned off.
    in Wakeful, on GABA is off (preoptic are)

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  • 22. 

    What aspect of language would be affected by a lesion of BA 44/45 of the dominant hemisphere?

    • A.

      Language understanding

    • B.

      Language production

    • C.

      Semantic aspects of language

    • D.

      Prosodic aspects of language

    • E.

      Syntactic aspects of language

    Correct Answer
    B. Language production
    Explanation
    Pars opercularis, = 44
    Pars traingularis = 45
    Damage to Brodmann area 39 (ang. gyrus) plays a role in semantic aphasia.

    area 22 On the left side this area helps with generation and understanding of individual words. On the right it helps tell the difference between melody, pitch, and sound intensity, (PROSODY).

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  • 23. 

    You are trying not to fall asleep during a boring lecture. Suddenly, you feel a bug crawling on your skin, which instantly wakes you up. Which part of your reticular formation was initially involved in this increase of your attention?

    • A.

      Raphe

    • B.

      Lateral RF

    • C.

      Parapontine RF

    • D.

      Locus coeruleus

    • E.

      Medial RF

    Correct Answer
    B. Lateral RF
    Explanation
    The lateral reticular formation (RF) is involved in the increase of attention when feeling a bug crawling on your skin during a boring lecture. This region of the reticular formation is responsible for regulating arousal and maintaining wakefulness. It receives sensory input and sends signals to other areas of the brain to enhance alertness and attention. Therefore, when you feel the bug crawling on your skin, the lateral RF is activated, instantly waking you up and increasing your attention.

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  • 24. 

    You may find large pyramidal cells in which cortical layer?

    • A.

      I

    • B.

      II

    • C.

      V

    • D.

      IV

    • E.

      VI

    Correct Answer
    C. V
    Explanation
    L1: Molecular layer (cell-sparse layer)
    L2/3: Supragranular layers (small-to-medium sized pyramidal cells)
    L4: Granular layer (small stellate cells)
    L5/6: Infragranular layers (large pyramidal cells (layer 5) and polymorphic cells (layer 6)

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  • 25. 

    Dr Coffin L-DOPA is always given with a decarboxylase inhibitor to increase the peripheral plasma half life or duration of what neurochemical?

    • A.

      Dopamine

    • B.

      L-DOPA

    • C.

      Serotonin

    • D.

      Adenosine

    • E.

      Carbidopa

    Correct Answer
    B. L-DOPA
    Explanation
    this prevents the break down of L-DOPA in the periphery which give it more time to cross the BBB and be converted to Dopamine.

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  • 26. 

    A 70 year-old man has Parkinson's disease that is characterized by bradykinesia, muscle stiffness, dyskinesias and freezing.  If all the drug pharmacotherapy is exhausted and there are still issues with movement then there are FDA approved alternatives which can restore movements and a good quality of life, one of which may be:

    • A.

      Deep brain stimulation in the globus pallidus

    • B.

      Lesion of the thalamus

    • C.

      Implantation of fetal cells that deliver dopamine

    • D.

      Cognitive behavioral therapy

    • E.

      Lesion of the substantia nigra

    Correct Answer
    A. Deep brain stimulation in the globus pallidus
    Explanation
    This is SHOCKING! ;)

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  • 27. 

    A 52 year-old woman has had posterior spinal fusion with instrumentation and is recovering in the critical care unit.  She has severe pain that has not been relieved with high doses of meperidine IM.  What is a viable alternative?  She is put on patient controlled analgesia using IV

    • A.

      Codeine

    • B.

      Morphine

    • C.

      Meperidine

    • D.

      Dextromethorphan

    • E.

      Tramadol

    Correct Answer
    B. Morphine
    Explanation
    Dextromethorphan is the DM in Robitussin DM
    IM and IV meperidine would achieve the same bioavailability, so it makes no sense to give it IV.
    Codeine is not as strong nor is Tramadol.
    OF the choices, Morphine is best option.

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  • 28. 

    A 37-year-old man is brought to the emergency department with a severe head injury. Within a few hours he is decerebrate (upper and lower extremities extended) and comatose. The extension of his extremities indicates involvement of which tract/s?

    • A.

      Medial reticulospinal and lateral vestibulospinal tracts

    • B.

      Medial vestibulospinal and lateral reticulospinal tracts

    • C.

      Rubrospinal tract

    • D.

      Dorsal column/medial lemniscus pathway

    • E.

      Spinothalamic tract

    Correct Answer
    A. Medial reticulospinal and lateral vestibulospinal tracts
    Explanation
    MR. LV

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  • 29. 

    Based on their relative locations in the spinal cord, which of the following tracts or fiber bundles would most likely be involved in a lesion located in the immediate vicinity of the lateral corticospinal tract?

    • A.

      Anterolateral system

    • B.

      Anterior spinocerebellar tract

    • C.

      Gracile fasciculus

    • D.

      Gracile cuneatus

    • E.

      Rubrospinal tract

    Correct Answer
    E. Rubrospinal tract
    Explanation
    A lesion located in the immediate vicinity of the lateral corticospinal tract would most likely involve the rubrospinal tract. The rubrospinal tract is located adjacent to the lateral corticospinal tract in the spinal cord. Lesions in this area can affect the rubrospinal tract, which is involved in motor control and movement coordination.

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  • 30. 

    A  92-year-old woman is brought to the emergency department by her caregiver. The woman had suddenly become drowsy and confused. The examination revealed no cranial nerve deficits and age-normal motor function, but a loss of pain, thermal, vibratory, and discriminative touch sensations on one side of the body excluding the head. CT shows a small infarcted area. Which of the following structures is the most likely location of this lesion?

    • A.

      Anterolateral system

    • B.

      Corticospinal tract

    • C.

      Subthalamic nucleus

    • D.

      Ventral posterolateral nucleus

    • E.

      Ventral posteromedial nucleus

    Correct Answer
    D. Ventral posterolateral nucleus
    Explanation
    VPL is end point for spinothalamic tract

    VPM is end point for Trigeminalthalamic tract (face)
    CSP is a descending pathway (motor)

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