Neurological Problem Quiz
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Which of the following is an arterial branch of the vertebral system supplying the brain?
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Anterior cerebral artery
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Posterior inferior cerebellar artery (PICA)
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Posterior communicating artery
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Middle cerebral artery
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Anterior communicating artery
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Neurological disorders are diseases of the central and peripheral nervous system and are undoubtedly one of the most frightening illnesses. The quiz below is designed to test out how much you know about neurological problems. Give it a try and increase your knowledge along the way. All the best as you do!
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- 2.
A 50-year old man was admitted to the hospital complaining of a loss of hearing. The patient also reported unsteadiness in balance. Examination further revealed a facial palsy on the side of the face ipsilateral to the hearing loss. The most likely cause of this disorder is:
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Acoustic neuroma of the cerebellopontine angle
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Tumor in the external ear
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Tumor in the middle ear
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Tumor affecting the midline region of the cerebellum
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Vascular lesion affecting the medial two third of the basilar pons
Correct Answer
A. Acoustic neuroma of the cerebellopontine angleExplanation
The most likely cause of the patient's symptoms of hearing loss, unsteadiness in balance, and facial palsy on the same side is an acoustic neuroma of the cerebellopontine angle. Acoustic neuromas are benign tumors that arise from the Schwann cells of the vestibulocochlear nerve (cranial nerve VIII) and typically present with symptoms related to compression of adjacent structures. In this case, the tumor is likely compressing the vestibulocochlear nerve, leading to hearing loss, as well as affecting the facial nerve, resulting in facial palsy. The location of the tumor in the cerebellopontine angle is consistent with the patient's symptoms.Rate this question:
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- 3.
A neurological examination of a 51-year old woman indicated that she had a loss of pain and temperature sense on the right side of her body, a decreased sense of taste on the left side and hoarseness of voice when speaking. She also complained of dizziness and nausea. Which of the following arteries may be occluded in this patient?
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Posterior Cerebral Artery
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Anterior Inferior Cerebellar Artery (AlCA)
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Posterior Inferior Cerebellar Artery (PICA)
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Anterior Spinal Artery
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Anterior Cerebral Artery
Correct Answer
A. Posterior Inferior Cerebellar Artery (PICA)Explanation
Lateral medullary syndrome (Wallenberg) is a disease in which the patient has a constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis. This syndrome is characterized by sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side with the infarct. Specifically, there is a loss of pain and temperature sensation on the contralateral (opposite) side of the body and ipsilateral (same) side of the face. Clinical symptoms include swallowing difficulty, or dysphagia,[1] slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner syndrome, diplopia, and possibly palatal myoclonus. Affected persons have difficulty in swallowing (dysphagia) resulting from involvement of the nucleus ambiguus, as well as slurred speech (dysarthria) and disordered vocal quality (dysphonia) . Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex. The spinothalamic tract is damaged, resulting in loss of pain and temperature sensation to the opposite side of the body. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia. Damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay and gives symptoms analogous to Horner syndrome.Rate this question:
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- 4.
Which thalamic nucleus would be primarily responsible for processing input associated with activation of pacinian corpuscles in your left hand?
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Left dorsomedial nucleus of the thalamus
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Left pulvinar nucleus of the thalamus
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Left ventroposteromedial (VPM) nucleus of the thalamus
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Right lateral geniculate nucleus of the thalamus
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Right ventroposterolateral (VPL) nucleus of the thalamus
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Right ventral anterior nucleus of the thalamus
Correct Answer
A. Right ventroposterolateral (VPL) nucleus of the thalamusExplanation
The pacinian corpuscles are responsible for detecting vibrations and deep pressure in the skin. The VPL nucleus of the thalamus receives sensory input from the body, including proprioceptive and tactile information. Since the activation of pacinian corpuscles in the left hand is a tactile sensation, the VPL nucleus on the right side of the thalamus would be primarily responsible for processing this input.Rate this question:
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- 5.
A 55-year old male was admitted to the hospital after suffering from a stroke. He later succumbed. The diagram below represents a cross section from his lower pons obtained at autopsy. The dark shaded area presents a lesion resulting from an embolus in which artery?
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Anterior cerebral artery
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Middle cerebral artery
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Posterior inferior cerebellar artery
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Anterior inferior cerebellar artery
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Paramedian branch of basilar artery
Correct Answer
A. Paramedian branch of basilar arteryExplanation
The dark shaded area in the diagram represents a lesion resulting from an embolus. The paramedian branch of the basilar artery supplies blood to the lower pons. Therefore, the embolus must have occluded this artery, leading to the stroke and ultimately the patient's death.Rate this question:
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- 6.
Your 27-year old patient displays ataxia when asked to walk across the examination room. You ask him to stand still with his eyes closed and note marked swaying back and forth. When he opens his eyes the swaying persists. Vibration sense is normal on all four limbs. Given the clinical picture in this case, such ataxia is likely due to damage to which of the following structures?
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Dorsal columns
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Cerebral peduncles
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Posterior limb of the internal capsule
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Ventral horns of the spinal cord
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Cerebellum
Correct Answer
A. CerebellumExplanation
The patient's symptoms of ataxia, marked swaying back and forth with eyes closed, and persistence of swaying even when eyes are open, suggest dysfunction of the cerebellum. The cerebellum is responsible for coordinating voluntary movements, maintaining balance, and proprioception. Damage to the cerebellum can result in impaired coordination and balance, leading to ataxia. The other structures listed, such as the dorsal columns and cerebral peduncles, are not typically associated with these specific symptoms of ataxia.Rate this question:
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- 7.
A 52-year old man reported feeling unsteady while walking. History taking revealed that this balance problem developed after a hearing loss associated with the left ear. The patient's muscles of facial expression on the left exhibited marked weakness. In addition, the patient's corneal reflex was absent on the left side. The most likely explanation of these symptoms is?
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Lesion to the medial longitudinal fasciculus
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Vascular occlusion affecting the medial region of the basilar pons
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Acoustic schwannoma of cerebellopontine angle
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Middle ear infection
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Tumor affecting cerebellar vermis
Correct Answer
A. Acoustic schwannoma of cerebellopontine angleExplanation
The most likely explanation for the presented symptoms is an acoustic schwannoma of the cerebellopontine angle. The patient's balance problem, hearing loss, facial muscle weakness, and absent corneal reflex on the left side are all consistent with the characteristic symptoms of an acoustic schwannoma. This type of tumor originates from the Schwann cells of the vestibulocochlear nerve (CN VIII) and can cause compression of surrounding structures, leading to a variety of neurological symptoms.Rate this question:
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- 8.
Which of the following ascending pathways enters the cerebellum through the superior cerebellar peduncle?
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Dorsal spinocerebellar tract
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Cuneo cerebellar tract
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Anterior spinocerebellar tract
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Ponto cerebellar fibers
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Climbing fibers
Correct Answer
A. Anterior spinocerebellar tractExplanation
The correct answer is the anterior spinocerebellar tract. This ascending pathway carries proprioceptive information from the lower limbs to the cerebellum. It enters the cerebellum through the superior cerebellar peduncle, which is one of the three major tracts connecting the cerebellum to the brainstem. The other options listed are not associated with the superior cerebellar peduncle.Rate this question:
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- 9.
Efferent axons from the dentate nucleus terminate in what thalamic nucleus and travel through what peduncle?
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Ventral anterior nucleus of the thalamus (VA) ---superior cerebellar peduncle
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Ventral anterior nucleus of the thalamus (VA) ---middle cerebellar peduncle
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Ventral lateral nucleus of the thalamus (VL) ---superior cerebellar peduncle
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Ventral lateral nucleus of the thalamus (VL) ---middle cerebellar peduncle
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Ventral posterolateral nucleus of the thalamus (VPL) ---superior cerebellar peduncle
Correct Answer
A. Ventral lateral nucleus of the thalamus (VL) ---superior cerebellar peduncleExplanation
The efferent axons from the dentate nucleus terminate in the ventral lateral nucleus of the thalamus (VL) and travel through the superior cerebellar peduncle.Rate this question:
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- 10.
As a principal investigator with a team of scientists, you are determined to create a method by which individuals could elect to surgically alter their hypothalamus to control their weight. Which hypothalamic nucleus would cause starvation if it was lesioned or destroyed?
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Paraventricular nucleus
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Mammillary body
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Ventromedial nucleus
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Lateral nucleus
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Posterior nucleus
Correct Answer
A. Lateral nucleusExplanation
Lesioning or destroying the lateral nucleus of the hypothalamus would cause starvation. The lateral nucleus is responsible for stimulating appetite and regulating food intake. When the lateral nucleus is damaged, it disrupts the normal feeding behavior and leads to a decrease in appetite, resulting in starvation.Rate this question:
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- 11.
An infarct involving the hypothalamus would most likely result from occlusion of the?
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Anterior spinal artery
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Vertebral artery
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Anterior cerebral artery
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Perforating arteries associated with the Circle of Willis
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Posterior cerebral artery
Correct Answer
A. Anterior cerebral arteryExplanation
An infarct involving the hypothalamus would most likely result from occlusion of the Anterior cerebral artery. The hypothalamus is a region of the brain that plays a crucial role in regulating various bodily functions, including temperature control, hormone production, and sleep. The Anterior cerebral artery supplies blood to the frontal lobes of the brain, which includes the hypothalamus. Therefore, if this artery becomes occluded, it can lead to a lack of blood supply to the hypothalamus, resulting in an infarct or tissue death in that area.Rate this question:
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- 12.
As a researcher you are doing axonal tracing studies in the thalamus. You decide to inject an anterograde tracer into the VL (ventral lateral) and VA (ventral anterior) nuclei of the thalamus. What is the major output of these nuclei?
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Primary somatosensory cortex (3,1,2)
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Primary motor cortex (4)
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Primary visual cortex (17)
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Cingulate gyrus and other limbic regions
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Primary auditory cortex (41,42)
Correct Answer
A. Primary motor cortex (4)Explanation
The ventral anterior nucleus receives neuronal inputs from the basal ganglia which includes the substantia nigra and the globus pallidus. It also has inputs from the cerebellum it sends out neuronal input to the supplementary motor cortex AND to primary motor cortex.Rate this question:
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- 13.
A 34-year old man reported episodes of dizziness and vertigo to his physician. Two weeks later he reported hearing loss and a slight tinnitus in his right ear. These symptoms started to get worse with time. A neurological examination revealed no other signs of neurological dysfunction. The most likely site of the lesion/dysfunction in this patient is?
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A lesion of the medial longitudinal fasciculus
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A tumor of the cerebellar vermis
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Damage to the spiral ganglion
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A tumor affecting cranial VIII and VII at the cerebellopontine angle
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Abnormal volume of endolymph in the inner ear
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Tumor in pons compressing lateral lemniscus
Correct Answer
A. Abnormal volume of endolymph in the inner earExplanation
The patient's symptoms of dizziness, vertigo, hearing loss, and tinnitus, which worsened over time, suggest a dysfunction in the inner ear. The abnormal volume of endolymph in the inner ear is a characteristic feature of Ménière's disease, a disorder that affects the balance and hearing. This condition can cause fluid buildup in the inner ear, leading to the symptoms experienced by the patient. A lesion of the medial longitudinal fasciculus, a tumor of the cerebellar vermis, damage to the spiral ganglion, a tumor affecting cranial VIII and VII at the cerebellopontine angle, or a tumor in the pons compressing the lateral lemniscus would not explain the patient's specific symptoms.Rate this question:
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- 14.
Your friend in your advanced genetics class is always falling asleep during lecture. At first you thought that she just wasn't sleeping at night or that the lecture had to be extremely boring for her. However! you then notice that she sometimes she falls asleep during group activities as well. Which hypothalamic nucleus may be related to her problem?
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Dorsomedial nucleus
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Paraventricular nucleus
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Anterior nucleus
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Arcuate nucleus
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Ventromedial nucleus
Correct Answer
A. Dorsomedial nucleusExplanation
The Dorsomedial nucleus of the hypothalamus may be related to her problem. The hypothalamus plays a crucial role in regulating sleep and wakefulness, and the Dorsomedial nucleus is involved in the regulation of sleep-wake cycles. If this nucleus is not functioning properly, it could lead to excessive sleepiness and falling asleep during lectures and group activities.Rate this question:
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- 15.
Concerning the circuitry between mossy fibers, climbing fibers and cells of the cerebellar cortex, which of the following pairs both provide excitatory input?
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Mossy fibers & Purkinje cells
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Purkinje cells & Golgi cells
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Granule cell parallel fibers & Mossy fibers
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Golgi cells & Climbing fibers
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Climbing fibers & Basket cells
Correct Answer
A. Granule cell parallel fibers & Mossy fibersExplanation
Purkinje cells send inhibitory projections to the deep cerebellar nuclei, and constitute the sole output of all motor coordination in the cerebellar cortex.Rate this question:
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- 16.
A 47-year old female is referred to a local clinic because of polyuria linked to excessive thirst/drinking. She denies any family history of diabetes. A CT (computed tomography) scan reveals an infarcted area in a region of the diencephalon. You suspect a lesion in which structure?
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Posterior nucleus of hypothalamus
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Anterior nucleus of thalamus
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Ventro-postero lateral nucleus of thalamus
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Habenular nucleus of epithalamus
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Arcuate nucleus of thalamus
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Paraventricular nucleus of hypothalamus
Correct Answer
A. Paraventricular nucleus of hypothalamusExplanation
The paraventricular nucleus of the hypothalamus is responsible for regulating water balance in the body. Damage to this region can lead to polyuria (excessive urination) and excessive thirst. In this case, the patient's symptoms of polyuria and excessive thirst are likely caused by the infarcted area in the diencephalon, specifically the paraventricular nucleus of the hypothalamus.Rate this question:
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- 17.
A resident is attempting her first placement of central line into the right internal jugular vein. To correctly locate the point of insertion, she should place the needle at the:
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Between the two heads of the right sternocleidomastoid muscle
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Jugular notch
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At the sternal angle on the right side
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Lateral to the sternocleidomastoid muscle on the right side
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Between the bellies of the anterior and middle scalene muscles on the right side
Correct Answer
A. Between the two heads of the right sternocleidomastoid muscleExplanation
The correct answer is "Between the two heads of the right sternocleidomastoid muscle." The internal jugular vein is located between the two heads of the sternocleidomastoid muscle, making it the correct point of insertion for a central line. Placing the needle at this location ensures proper access to the vein for the procedure.Rate this question:
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- 18.
Your patient had a stroke affecting the thalamus. After an MRI, the neurologist advised you that the "limbic" thalamus had been affected. Which of the following thalamic nuclei has both afferent and efferent limbic connections?
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Anterior nucleus
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Pulvinar
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Ventral posterolateral nucleus
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Ventral lateral nucleus
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Medial geniculate nucleus
Correct Answer
A. Anterior nucleusExplanation
The anterior nucleus of the thalamus has both afferent and efferent limbic connections. It receives inputs from the mammillary bodies and the cingulate gyrus, which are part of the limbic system, and sends outputs to the cingulate gyrus and the hippocampus, which are also part of the limbic system. This makes the anterior nucleus an important relay station for limbic system function and contributes to emotional and memory processes.Rate this question:
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- 19.
Which of the following regions of the hypothalamus contains nuclei important for learning and memory circuits?
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Preoptic Area
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Posterior Area
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Tuberal Region
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Anterior Area
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Lateral Area
Correct Answer
A. Posterior AreaExplanation
The posterior area of the hypothalamus contains nuclei that are important for learning and memory circuits. These nuclei play a role in the consolidation and retrieval of memories.Rate this question:
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- 20.
Your 30-year-old patient has a lower neck injury. During the physical examination you realize that the wound is in the omoclavicular triangle. You know that this injury might be dangerous because important structures are passing through this area. Which of the following structures might be in danger?
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Common carotid artery
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Ansa cervicalis
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Vagus nerve
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Hypoglossal nerve
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Trunks of the brachial plexus
Correct Answer
A. Ansa cervicalisExplanation
The ansa cervicalis is a nerve that innervates the infrahyoid muscles of the neck. It runs through the omoclavicular triangle, which is an area where important structures pass through. Therefore, if there is an injury in this area, the ansa cervicalis might be in danger. The other structures listed (common carotid artery, vagus nerve, hypoglossal nerve, trunks of the brachial plexus) are not specifically mentioned as passing through the omoclavicular triangle.Rate this question:
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- 21.
The anterior scaIene muscle is an important accessory muscle of respiration. Its innervation is:
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Ventral rami of spinal nerves C1-C2
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Ventral rami of spinal nerves C4-C6
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Dorsal rami of spinal nerves C2-C4
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Brachial plexus
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Phrenic nerve
Correct Answer
A. Brachial plexusExplanation
The anterior scalene muscle is innervated by the brachial plexus. The brachial plexus is a network of nerves that originates from the ventral rami of spinal nerves C5-T1. It provides motor and sensory innervation to the upper limb and shoulder region. Since the anterior scalene muscle is located in the neck and helps with respiration, it makes sense that its innervation would come from the brachial plexus, which supplies the muscles of the upper limb.Rate this question:
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- 22.
A victim of a motor vehicle accident suffers a cranial base fracture that extends through the jugular foramen and damages the nerves that exit here. Motor deficits in the neck that this patient will evince include weakness or paralysis of
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Muscles enclosed in the deep investing fascia of the neck
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Muscles enclosed in the visceral layer of pretracheal fascia
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Muscles enclosed in prevertebral fascia
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Muscles enclosed in deep investing fascia and pretracheal visceral fascia
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All of the above
Correct Answer
A. Muscles enclosed in the visceral layer of pretracheal fasciaExplanation
The cranial base fracture in this scenario extends through the jugular foramen, which is the opening in the base of the skull where several important nerves exit. The nerves that are damaged in this case are likely the ones that innervate the muscles enclosed in the visceral layer of pretracheal fascia. Therefore, the patient will evince motor deficits specifically in these muscles.Rate this question:
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.JPG "A 55-year old male was admitted to the hospital after suffering from a stroke. He later succumbed. The diagram below represents a cross section from his lower pons obtained at autopsy. The dark shaded area presents a lesion resulting from an embolus in which artery?")
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Aug 29, 2024Quiz Edited by
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