Book Review And Study Questions For Chapter 1 & 2

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Questions and Answers
  • 1. 

    A 71-year-old man complains to his family physician that his face “feels funny. “The examination reveals numbness on his face and on the same side of his tongue. RI shows a lesion in the cerebral cortex. This man’s lesion is most likely located in which of the following cortical regions?

    • A. 

      Anterior Para central

    • B. 

      Lateral one-third of the post central

    • C. 

      Lateral one-third of the precentral

    • D. 

      Middle one-third of the postcentral

    • E. 

      Posterior paracentral

    Correct Answer
    B. Lateral one-third of the post central
    Explanation
    Numbness on the face, resulting from a lesion in the cerebral cortex, indicates a lesion in the lateral one-third of the postcentral gyrus (face area of the somatosensory cortex).The anterior paracentral gyrus and the precentral gyrus are somatomotor areas of the cerebral cortex. The upper extremity is rep-resented in the middle one-third of the postcentral gyrus and the lower extremity is represented in the posterior paracentralgyrus.(p.14)

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  • 2. 

    The labyrinthine artery is an important source of blood supply to the inner ear. Which of the following arteries represents the major vessel from which this branch usually arises?

    • A. 

      Anterior inferior cerebellar

    • B. 

      Basilar

    • C. 

      Posterior inferior cerebellar

    • D. 

      Superior cerebellar

    • E. 

      Vertebral

    Correct Answer
    A. Anterior inferior cerebellar
    Explanation
    In most cases (85%–100%),the labyrinthine artery, also called the internal auditory (or acoustic) artery, originates from the anterior inferior cerebellar artery. It enters the internal acoustic meatus, serves bone and dura of the canal, the nerves of the canal, and vestibular and cochlear structures. In a few cases (15% or less),this artery originates from the basilarartery. None of the other choices gives rise to vessels that serve the inner ear.(p.25)

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  • 3. 

    The quadrigeminal artery in a 20-year-old man is occluded by a fat embolus originating from a compound fracture of the humerus. Which of the following structures does this occluded vessel most directly affect?

    • A. 

      Superior cerebellar peduncle

    • B. 

      Mammillary bodies

    • C. 

      Medial and lateral geniculate bodies

    • D. 

      Pineal and habenula

    • E. 

      Superior and inferior colliculi

    Correct Answer
    E. Superior and inferior colliculi
    Explanation
    The quadrigeminal artery is the primary blood sup-ply to the superior and inferior colliculi: this vessel originates from P1
    .The geniculate bodies receive their blood supply from the thalamogeniculate arteries, and the pineal and habenula from the posterior medial choroidal artery. The superior cerebellar peduncle receives its blood supply via the medial branch of the superior cerebellar artery, and branches of the cerebral circle (of Willis) serve the mammillary bodies.(p.33,35)

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  • 4. 

    67-year-old man complains to his family physician of severe headaches. The examination reveals visual deficits in both eyes, and MRI shows a lesion in the cerebral cortex. Which of the following cortical structures represents the most likely location of this lesion?

    • A. 

      Angular gyrus

    • B. 

      Cingulate gyrus

    • C. 

      Lingual gyrus

    • D. 

      Para hippocampal gyrus

    • E. 

      Precuneus

    Correct Answer
    C. Lingual gyrus
    Explanation
    The lingual gyrus is the lower bank of the calcarinesulcus; the upper (cuneus) and lower banks of this sulcus are the location of the primary visual cortex. The precuneus is the medial aspect of the parietal lobe, and the angular gyrus is a portion of the inferior parietal lobule on the lateral aspect of the hemisphere. The cingulate and parahippocampal gyri are located on the medial aspect of the hemisphere and are parts of the limbic lobe.(p.14,15,28–30

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  • 5. 

    A sagittal MRI of a 23-year-old woman is located at, or immediately adjacent to, the midline. Which of the following spaces or structures would be in the image and would indicate this particular plane in this woman’s MRI?

    • A. 

      Cerebral aqueduct

    • B. 

      Corpus callosum

    • C. 

      Interpeduncular fossa

    • D. 

      Interventricular foramen

    • E. 

      Superior colliculus

    Correct Answer
    A. Cerebral aqueduct
    Explanation
    The cerebral aqueduct is about 1.5–2.0 mm in diameter, and connects the third ventricle with the fourth ventricle. When this part of the ventricular system appears in a sagittal MRI, the plane of the scan is at the midline. Neither the inter-ventricular foramen nor the superior colliculus are on the mid-line. Both the interpeduncular fossa and the corpus callosumare on the midline, but extend off the midline well beyond the width of the cerebral aqueduct.(p.28,30–31)

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  • 6. 

    A 73-year-old man is brought to the emergency department after being found in his garage in a state of confusion. CT shows an infarct involving much of the superior frontal gyrus. Which of the following vessels is most likely occluded in this patient?

    • A. 

      Angular artery

    • B. 

      Callosomarginal artery

    • C. 

      Lenticulostriate arteries

    • D. 

      Middle cerebral artery,M4 segments

    • E. 

      Posterior cerebral artery,P4 segments

    Correct Answer
    B. Callosomarginal artery
    Explanation
    The callosomarginal artery, a branch of the anterior cerebral artery, serves the medial aspect of the superior frontal gyrus and that portion of this gyrus on the superior and lateral aspects of the hemisphere.M4 segments of the middle cerebral artery serve the lateral aspects of the hemisphere;
    P4 segments of the posterior cerebral artery serve the medial aspects of the hemisphere caudal to the parietoccipital sulcus, and the angular artery (an M4 branch) serves the angular gyrus of the inferior parietal lobule. The lenticulostriate arteries are branches of M1 that serve internal structures of the hemisphere.(p.19,21,25,29,39)

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  • 7. 

    The MRI of a 49-year-old woman shows a tumor in the cerebral cortex located immediately superior to the corpus callosum. This lesion is most likely located in which of the following lobes?

    • A. 

      Frontal

    • B. 

      Limbic

    • C. 

      Occipital

    • D. 

      Parietal

    • E. 

      Temporal

    Correct Answer
    B. Limbic
    Explanation
    The limbic lobe, consisting primarily of the cingulate gyrus and the parahippocampal gyrus, is located on the most medial aspect of the hemisphere; the cingulate gyrus is located immediately adjacent to the corpus callosum. None of the other lobes of the cerebral cortex borders directly on the corpus callosum.(p.28,30)

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  • 8. 

    A 69-year-old woman is brought to the emergency department. The daughter reports that her mother suddenly seemed to be unable to speak. The examination reveals that the woman has a nonfluent (Broca) aphasia. A sagittal MRI shows a lesion in which of the following gyri?

    • A. 

      Angular

    • B. 

      Inferior frontal

    • C. 

      Lateral one-third of the precentral

    • D. 

      Middle frontal

    • E. 

      Supramarginal

    Correct Answer
    B. Inferior frontal
    Explanation
    The inferior frontal gyrus consists of the pars orbital-is (Brodmann area 47),pars triangularis (area 45),and parsopercularis (area 44).A lesion located primarily in areas 44 and45 in the dominant hemisphere will result in a nonfluent(Broca) aphasia. The supramarginal (area 40) and angular (area39) gyri represent what is called the Wernicke area, and the middle frontal gyrus contains areas 6 and 8.The lateral one-third of the precentral gyrus is the face area of the somatomo-tor cortex.(p.14,18)

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  • 9. 

    Which of the following Brodmann areas represents the primary somatosensory cortex?

    • A. 

      Areas 3,1,2

    • B. 

      Area 4

    • C. 

      Area 17

    • D. 

      Area 22

    • E. 

      Area 40

    Correct Answer
    A. Areas 3,1,2
    Explanation
    Areas 3,1,2 collectively represent the primary somatosensory cortex. Area 4 is the primary somatomotor cortex, area 17 the primary visual cortex, and area 22 the primary auditory cortex. Area 40 is in the supramarginal gyrus, a large part of which is called the Wernicke area.(p.14)

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  • 10. 

    A 64-year-old man awakens with a profound weakness of his right hand. The man is transported by ambulance to a major medical center, a distance of 240 miles and taking several hours. About 2.5 hours after his arrival, an MRI shows a small lesion in the cerebral cortex. Which of the following gyri represents the most likely location of this lesion?

    • A. 

      Anterior paracentral

    • B. 

      Medial one-third of precentral

    • C. 

      Middle frontal

    • D. 

      Middle one-third of precentral

    • E. 

      Lateral one-third of precentral

    Correct Answer
    D. Middle one-third of precentral
    Explanation
    The body is represented in the somatomotor cortex(precentral gyrus, anterior paracentral gyrus) in the following pattern: the face in about the lateral one-third of the precentral gyrus above the lateral sulcus; the hand and upper extremity in about its middle third; and the trunk and hip in about its medial third. The lower extremity and foot are represented in the anterior paracentral gyrus. Caudal portions of the middle frontal gyrus are the location of the frontal eye field.(p.14)

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  • 11. 

    A 71-year-old man presents with a Broca (nonfluent) aphasia. RI reveals a lesion in Brodmann area 44.As this lesion expands, due to edema, and impinges on the immediately adjacent cortical areas, which of the following deficits would most likely be seen?

    • A. 

      Loss of hearing in one ear

    • B. 

      Numbness and prickly sensation on the hand

    • C. 

      Visual field deficits in both eyes

    • D. 

      Weakness of facial muscles

    • E. 

      Weakness of the upper extremity

    Correct Answer
    D. Weakness of facial muscles
    Explanation
    A lesion in area 44 (the pars opercularis) that spreads will affect the lower portions of the precentral gyrus in which the face is represented. This will result in weakness offacial muscles, accompanied by other cranial nerve deficits. Thecortical areas for hearing and vision are far separated from area44.Also,a lesion in the primary auditory cortex will not result in a hearing loss in one ear. The hand area of the sensory cortex and the upper extremity area of the motor cortex are not adjacent to Brodmann area 44.(p.14,18)

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  • 12. 

    A 47-year-old woman presents with seizures and ill-defined neurological complaints. The examination reveals a bruit on the lateral aspect of the head immediately rostral and superior to the ear. A CT shows a large arteriovenous malformation in the area of the lateral sulcus. The feeding artery(ies) is M4 branches. Which of the following most likely represents the major draining vein?

    • A. 

      Inferior sagittal sinus

    • B. 

      Deep cerebral vein

    • C. 

      Internal cerebral vein

    • D. 

      Ophthalmic vein

    • E. 

      Superficial middle cerebral vein

    • F. 

      Superior petrosal sinus

    Correct Answer
    E. Superficial middle cerebral vein
    Explanation
    The superficial middle cerebral vein is located on the surface of the cerebral hemisphere in the immediate vicinity of the lateral sulcus and, of the choices, is the most likely candidate. The deep middle cerebral vein is located on the surface of the insular lobe. The inferior sagittal sinus primarily drains the medial aspect of the hemisphere immediately superior to the corpus callosum. The internal cerebral vein (to the great cerebral vein) drains the internal parts of the hemisphere; the ophthalmic vein connects the orbit with the cavernoussinus; and the superior petrosal sinus connects the cavernoussinus with the sigmoid sinus at its junction with the transversesinus.(p.19,29,39)

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  • 13. 

    The collection of posterior and anterior roots that occupy the lumbar cistern are collectively known as which of the following?

    • A. 

      Cauda equine

    • B. 

      Conus medullaris

    • C. 

      Denticulate ligament

    • D. 

      Filum terminale externum

    • E. 

      Filum terminale internum

    Correct Answer
    A. Cauda equine
    Explanation
    As they descend in the dural sac from their origin from the spinal cord to their exit at their respective intervertebral foramen, the anterior and posterior roots form the caudaequina. The conus medullaris is the most caudal end of the spinal cord, and the filum terminale internum is the strand of pia that extends from the conus caudally to attach to the inneraspect of the dural sac at about S2.The denticulate ligament anchors the spinal cord laterally to the inner surface of the Dural sac, and the filum terminale externum anchors the Dural sac caudally to the inner aspect of the coccyx.(p.12,52–53)

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  • 14. 

    Which of the following Brodmann areas represents the primary somatomotor cortex?

    • A. 

      Areas 3,1,2

    • B. 

      Area 4

    • C. 

      Area 5

    • D. 

      Area 6

    • E. 

      Area 7

    Correct Answer
    B. Area 4
    Explanation
    The primary somatomotor cortex consists of the pre-central gyrus and the anterior paracentral gyrus; area 4 is found in these structures. Areas 3,1,and 2 are the primary somatosensory cortex; areas 5 and 7 make up the superior parietal lobule and the precuneus; and area 6 is located rostral to area 4.Portions of area 6 in the caudal region of the middle frontalgyrus are the frontal eye field.(p.14)

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  • 15. 

    A 39-year-old woman complains of weakness in her right lower extremity. The history suggests that this deficit has developed slowly,perhaps over several years. MRI shows a mening iomaimposing on the cerebral cortex. Which of the following gyri is most likely involved in this patient?

    • A. 

      Anterior paracentral

    • B. 

      Lateral part of precentral

    • C. 

      Medial part of precentral

    • D. 

      Medial part of postcentral

    • E. 

      Posterior paracentral

    Correct Answer
    A. Anterior paracentral
    Explanation
    In this patient, the meningioma is located in the falxcerebri and is impinging on the anterior paracentral gyrus correlating with her motor deficit. The lower extremity is represented in the anterior paracentral gyrus (somatomotor) and in the posterior paracentral gyrus (somatosensory).The precentral gyrus contains the motor representation for the face (later-al part) and the trunk and hip (medial part).The postcentralgyrus is part of the somatosensory cortex.(p.14)

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  • 16. 

    A 71-year-old woman presents with motor and sensory deficits affecting her face and upper extremity. CT shows a hemorrhage that is confined largely to the cortex and adjacent subcorticalareas. Which of the following vessels/segments are most likely involved?

    • A. 

      A1

    • B. 

      M2

    • C. 

      M3

    • D. 

      M4

    • E. 

      P4

    Correct Answer
    D. M4
    Explanation
    The M4 segments of the middle cerebral artery serve the lateral aspect of the cerebral hemisphere. The named M4 vessels that serve the pre- and postcentral gyri (hemorrhage into approximately the lower two-thirds of these gyri explain the motor and sensory deficits) are the precentral branches(prerolandic),central branches (Rolandic branches),and anterior parietal branches. The M2 segment serves the insular cortex, and the M3 segment serves the inner surface of the frontal, parietal, and temporal opercula. The A1 segment serves hypo-thalamic structures, the subcallosal and septal areas, and adjacent structures.P4 serves the medial aspect of the occipital lobe(visual cortex).(p.19,25,39)

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  • 17. 

    A 22-year-old man is brought to the emergency department with a gunshot wound to the head. He is decorticate but soon becomes decerebrate. This change in status is due to uncal herniation. Which of the following most specifically describes the position of the uncus prior to this patient’s change in status?

    • A. 

      At the temporal lobe

    • B. 

      Caudal aspect of the cingulate gyrus

    • C. 

      Caudal aspect of the gyrus rectus

    • D. 

      Medial edge of occipitotemporal gyri

    • E. 

      Rostromedial aspect of the parahippocampal gyrus

    Correct Answer
    E. Rostromedial aspect of the parahippocampal gyrus
    Explanation
    The uncus is a small elevation at the rostral and medial aspect of the parahippocampal gyrus adjacent to the crus cerebri of the midbrain. In addition to the catastrophic effect of decerebration, herniation of the uncus may also affectcorticospinal and corticonuclear (corticobulbar) fibers in the crus cerebri and the root of the oculomotor nerve. None of the other areas of the forebrain listed as choices is related to uncalherniation.(p.20,22,24)

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  • 18. 

    A 73-year-old woman presents with visual deficits in both eyes. No other cranial nerve deficits or motor or sensory deficits are seen. CT shows a hemorrhage in the cerebral cortex. Which of the following vessels/segments is most likely involved in this hemorrhage?

    • A. 

      A4 * 5

    • B. 

      M3

    • C. 

      M4

    • D. 

      P2

    • E. 

      P4

    Correct Answer
    E. P4
    Explanation
    The P4 segments of the posterior cerebral artery consist of the parietooccipital and calcarine branches; the latter being located in the calcarine sulcus and a primary blood sup-ply to the primary visual cortex.M3 and M4 segments of the middle cerebral are located, respectively, on the inner aspect of the frontal, parietal, and temporal opercula and on the lateral aspect of the cerebral hemisphere. The P2 segment of the posterior cerebral artery is located just distal to the posterior communicating–posterior cerebral intersection and gives rise to medial and lateral posterior choroidal and to thalamogeniculate arteries. The A1 segment is located between the internal arotid and anterior communicating artery and gives rise to branches that serve anterior hypothalamic structures, septalareas, and the optic chiasm.(p.14,25)

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  • 19. 

    An 81-year-old woman is brought to the emergency department by her son with a complaint of weakness on the same side of her body and face. CT shows a hemorrhage in the territory of the lenticulostriate arteries. Which of the following represents the most likely origin of these vessels?

    • A. 

      A1

    • B. 

      M1

    • C. 

      M2

    • D. 

      P1

    • E. 

      P2

    Correct Answer
    B. M1
    Explanation
    Lenticulostriate arteries, also called the lateral striate arteries, originate from the M1 segment of the middle cerebral artery and serve much of the lenticular nucleus and adjacent parts of the internal capsule.A1 branches serve the anterior hypothalamus and optic chiasm, and M2 branches serve the insular cortex. The P1 and P2 segments give rise to many small perforating branches and to the thalamoperforating and quadrigeminal arteries (P1),medial and lateral posteriorchoroidal arteries, and the thalamogeniculate artery (P2).(p.21,23,25,29)

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  • 20. 

    The MRI of a 27-year-old woman shows a meningioma impinging on the gyrus rectus in axial and coronal MRI. This lesion is located on which of the following lobes of the cerebral hemi-sphere?

    • A. 

      Frontal

    • B. 

      Insular

    • C. 

      Occipital

    • D. 

      Parietal

    • E. 

      Temporal

    Correct Answer
    A. Frontal
    Explanation
    The gyrus rectus is located on the inferior and medial aspect of the frontal lobe. It is separated from the orbital gyriby the olfactory sulcus in which the olfactory bulb and tract islocated. None of the other lobes has a direct relationship to the gyrus rectus.(p.20,22)

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  • 21. 

    A 51-year-old man presents with visual field deficits in both eyes and a right-sided weakness of the upper and lower extremities. MRI shows a lesion in the optic tract that has spread into a structure located immediately adjacent to this tract. Based on its anatomical relationship, which of the following structures is most likely involved in this lesion in this patient?

    • A. 

      Left basilar pons

    • B. 

      Left crus cerebri

    • C. 

      Left pyramid

    • D. 

      Right crus cerebri

    • E. 

      Right optic nerve

    Correct Answer
    B. Left crus cerebri
    Explanation
    The optic tract lies immediately on the surface of the crus cerebri, a relationship frequently seen in MRI. The fact that this patient has a right-sided weakness of the extremities specifies that the lesion is in the left crus cerebri. The bilateral visual deficits correlate with damage to the left optic tract. Lesions of the left basilar pons and pyramid would result in aright-sided weakness but no visual deficits. A lesion in the right optic nerve would result in blindness in that eye but no weak-ness of the extremities.(p.26)

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  • 22. 

    A 19-year-old man presents with significant paralysis of movement in his left eye and a dilated pupil. No other deficits are seen. Suspecting some type of lesion on the root or along the intracranial course of the oculomotor (III) nerve, the neurologist orders T2-weighted MRI. Which of the following describes the appearance of the subarachnoid and ventricular spaces in this image?

    • A. 

      Black (hypointense)

    • B. 

      Dark grey

    • C. 

      Light grey

    • D. 

      Medium grey

    • E. 

      White (hyperintense)

    Correct Answer
    E. White (hyperintense)
    Explanation
    Cerebrospinal fluid in the ventricles, and through-out the subarachnoid space, appears very white in T2-weightedMRI images. Structures located in, or traversing the subarachnoid space (such as vessels or cranial nerve roots, including the oculomotor nerve) appear grey to black against a white back-ground.(p.2–5)

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  • 23. 

    A 49-year-old woman presents with ill-defined neurological deficits that have persisted over several months. As part of the evaluation, the neurologist orders a T1-weighted MRI. Which of the following describes the appearance of CSF in the ventricular spaces, and consequently the outline and shape of the ventricles, in this patient?

    • A. 

      Black (hypointense)

    • B. 

      Dark grey

    • C. 

      Light grey

    • D. 

      Medium grey

    • E. 

      White (hyperintense)

    Correct Answer
    A. Black (hypointense)
    Explanation
    Cerebrospinal fluid and other fluids appear black inT1-weighted MRI images. Consequently, the ventricles, and more obvious parts of the subarachnoid space, appear black. Changes in ventricular shape (i.e., enlargement, midline shift),or obliterated sulci, or even subarachnoid space, most likely represent a potentially serious clinical issue.(p.3–4,63)

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  • 24. 

    . A 71-year-old morbidly obese man is brought to the emergency department by his son. The son reports that the man complained of a sudden excruciating headache and then became stuporous. Suspecting a ruptured aneurysm the physician orders a CT. Which of the following describes the appearance of acute blood in the subarachnoid space in this patient?

    • A. 

      Black (hypodense)

    • B. 

      Black to grey

    • C. 

      Light grey

    • D. 

      Medium grey

    • E. 

      White (hyperdense)

    Correct Answer
    E. White (hyperdense)
    Explanation
    Patients who experience rupture of an intracranial aneurysm frequently complain of an intense, sudden headache(“the most horrible headache I have ever had”).Acute blood in the subarachnoid space will appear white to very white on CT. This will contrast with the medium grey of the brain and the black of cerebrospinal fluid (CSF) in the ventricles. The degree of white may vary somewhat, based on the relative concentration of blood, from very white (concentrated blood) to white(mostly blood, some CSF),to very light grey (mixture of blood and CSF).(p.2–4)

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  • 25. 

    Which of the following cranial nerves exits the brainstem via the preolivary sulcus?

    • A. 

      Abducens (VI)

    • B. 

      Facial (VII)

    • C. 

      Hypoglossal (XII)

    • D. 

      Vagus (X)

    • E. 

      Trigeminal (V)

    Correct Answer
    C. Hypoglossal (XII)
    Explanation
    The hypoglossal nerve exits the medulla via the preolivary sulcus of the medulla immediately (and laterally) adjacent to the pyramid. The abducens nerve exits in line with the preolivary sulcus, but, at the caudal edge of the pons, and the trigeminal nerve exits the lateral aspect of the pons. The vagus nerve exits the lateral aspect of the medulla via the postolivarysulcus, and the facial nerve in line with this sulcus, but at thepons-medulla junction.(p.24,25)

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  • 26. 

    Which of the following cranial nerves exits the posterior (dorsal) aspect of the brainstem?

    • A. 

      Abducens (VI)

    • B. 

      Hypoglossal (XII)

    • C. 

      Trigeminal (V)

    • D. 

      Trochlear (IV)

    • E. 

      Vestibulocochlear (VIII)

    Correct Answer
    D. Trochlear (IV)
    Explanation
    The trochlear nerve exits the posterior (dorsal)aspect of the brainstem just caudal to the inferior colliculus and passes around the lateral aspect of the midbrain in the ambient cistern, en route to its exit from the skull via the superior orbital fissure. The abducens nerve exits at the caudal edge of
    the pons in line with the preolivary fissure, and the hypoglossal exits from the medulla via this fissure. The trigeminal nerve exits the lateral aspect of the pons, and the vestibulocochlear nerve exits at the most lateral aspect of the pons-medulla junction.(p.32–33,44)

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  • 27. 

    The MRI of an 11-year-old boy shows a tumor in the pontine portion of the fourth ventricle. The rostral edge of which of the following structures represents the caudal border of this ventricular space?

    • A. 

      Facial colliculus

    • B. 

      Hypoglossal trigone

    • C. 

      Medial eminence

    • D. 

      Stria medullares

    • E. 

      Vagal trigone

    Correct Answer
    D. Stria medullares
    Explanation
    The rostral edge of the striae medullares (of the fourth ventricle) is regarded as the border between the pontine and medullary portions of the fourth ventricle. These fibers pass from the median fissure in the floor of the ventricle later-ally into the lateral recess, where they arch up into the cerebellum. The facial colliculus and median eminence are located in the floor of the pontine portion of the ventricle, and the vagal and hypoglossal trigones are found in the medial floor of the medullary portion of the fourth ventricle.(p.32,34)

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  • 28. 

    A 61-year-old man presents with a tremor and unsteady gait; these problems are on the same side of his body. Sagittal MRI shows a lesion in the anterior lobe of the cerebellum. This lesion is located immediately rostral to which of the following?

    • A. 

      Horizontal fissure

    • B. 

      Posterior superior fissure

    • C. 

      Posterolateral fissure

    • D. 

      Primary fissure

    • E. 

      Secondary fissure

    Correct Answer
    D. Primary fissure
    Explanation
    The primary fissure is the deepest fissure in the cerebellum and it separates the anterior lobe from the posterior lobe and extends from the vermis to the lateral cerebellar margin. The posterolateral fissure is located between the flocculon-odular lobe and the posterior lobe. The horizontal, secondary, and posterior superior fissures are all located within the posterior lobe.(p.36–37)

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  • 29. 

    The MRI of a 49-year-old woman with a brain tumor shows tonsillar herniation. Based on its anatomical position, which of the following portions of the brainstem would be most adversely affected by this herniation?

    • A. 

      Caudal midbrain

    • B. 

      Caudal pons

    • C. 

      Medulla

    • D. 

      Rostral midbrain

    • E. 

      Rostral pons

    Correct Answer
    C. Medulla
    Explanation
    The tonsil of the cerebellum is found on the caudal and inferior aspect of the cerebellar hemisphere, adjacent to the midline and immediately posterior (dorsal) to the medulla. The cisterna magna is located in this area. Sudden tonsillar herniation may compress the medulla and damage respiratory and cardiac centers resulting in sudden death. The tonsil herniates downward through the foramen magnum. Consequently, another part of the brainstem is directly affected.(p.36–37)

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  • 30. 

    A 4-year-old boy is brought to the emergency department by his mother who explains that the boy fell off a porch onto a concrete sidewalk. The examination reveals that the boy has a large parietal scalp laceration, is stuporous, and has reactive pupils. Which of the following imaging tests would be most immediately (and appropriately) useful in this patient?

    • A. 

      CT

    • B. 

      MRI, gadolinium enhanced

    • C. 

      MRI,T1-weighted

    • D. 

      MRI,T2-weighted

    • E. 

      PET (positron emission tomography)

    Correct Answer
    A. CT
    Explanation
    A CT is a fast method, does not require sedation of young patients, and shows bone fractures and acute intracranial blood in detail. MRI (T1- and T2-weighted) does not show acute blood or bone fracture to advantage, takes much longer to do, and may require sedation in a child. Enhanced MRI is uniquely useful for tumors, and PET is useful in identifying metabolic activity of brain tissue, not anatomic detail.(p.2–4)

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  • 31. 

    A sagittal MRI of a 52-year-old man clearly shows a small tumor in the area of the long and short gyri. These gyri are characteristically found in which of the following lobes?

    • A. 

      Frontal

    • B. 

      Insular

    • C. 

      Limbic

    • D. 

      Occipital

    • E. 

      Parietal

    Correct Answer
    B. Insular
    Explanation
    The long and short gyri (gyri longi et breves) are components of the insular lobe. This lobe is located deep to the lateral sulcus, has a central sulcus that separates the short gyri(rostral to this sulcus) from the long gyri (caudal to this sulcus).The cortex of the insular lobe is separated from the adjacentfrontal, parietal, and temporal opercula by the circular sulcus of the insula. None of the other lobes has gyri that are specifically named long and short gyri.(p.38–39)

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  • 32. 

    Which of the following venous structures is found deep in the lateral sulcus on the surface of the insular cortex?

    • A. 

      Anterior cerebral vein

    • B. 

      Basal vein of Rosenthal

    • C. 

      Deep middle cerebral vein

    • D. 

      Superficial middle cerebral vein

    • E. 

      Vein of Labbé

    Correct Answer
    C. Deep middle cerebral vein
    Explanation
    The deep middle cerebral vein is located on the insular cortex and, by joining with the anterior cerebral vein, forms the basal vein of Rosenthal. The superficial middle cerebral vein is located on the lateral aspect of the hemisphere in the vicinity of the lateral sulcus, arches around the temporal lobe and joins the cavernous sinus. The vein of Labbé drains the lateral aspect of the hemisphere into the transverse sinus.(p.19,21,39)

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  • 33. 

    Which of the following Brodmann areas represents the primary auditory cortex?

    • A. 

      Areas 3,1,2

    • B. 

      Area 17

    • C. 

      Areas 39 * 40

    • D. 

      Area 41

    • E. 

      Area 45

    Correct Answer
    D. Area 41
    Explanation
    The primary auditory cortex is Brodmann area 41.Areas 3,1,and 2 and area 17 are, respectively, the primary somatosensory and visual cortices. Areas 3940 collectively form the inferior parietal lobule; lesions of this portion of the cerebral cortex give rise to a Wernicke (receptive or fluent)aphasia. Area 45 is the pars triangularis of the inferior frontal lobe; lesions in this cortical region give rise to a Broca (expressive or nonfluent) aphasia.(p.14)

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  • 34. 

    A 59-year-old woman complains of a sudden severe headache that did not seen to respond to OTC medications, but cleared after several hours. Upon questioning her physician discovers that she has recently had prior similar episodes and he orders an MRI. This series of images reveals a large fusiform aneurysm of the P3 seg-ment.34.Based on its location, which of the following gyri would most likely be impinged upon by this aneurysm?

    • A. 

      Cuneus

    • B. 

      Lingual

    • C. 

      Orbital

    • D. 

      Parahippocampal

    • E. 

      Superior temporal

    Correct Answer
    D. Parahippocampal
    Explanation
    The P3 segment lies along the orientation of, and adjacent to, the parahippocampal gyrus as this part of the posterior cerebral artery courses around the midbrain. Branches of the P3 segment serve the inferior surface of the temporal lobe, which includes much of the laterally adjacent occipitotemporalgyri. The lingual gyrus and the cuneus are in the territory of the P4 segment and the orbital gyri are served by branches of the anterior and middle cerebral arteries. The superior temporal gyrus is served by M4 branches of the inferior trunk of the middle cerebral artery.(p.21,29)

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  • 35. 

    A 59-year-old woman complains of a sudden severe headache that did not seen to respond to OTC medications, but cleared after several hours. Upon questioning her physician discovers that she has recently had prior similar episodes and he orders an MRI. This series of images reveals a large fusiform aneurysm of the P3 seg-ment.34.  Assuming the neurosurgeon decides that this is a serious lesion that requires clipping, which of the following deficits might this patient experience?

    • A. 

      Blindness in one eye

    • B. 

      Partial bilateral hearing loss

    • C. 

      Partial bilateral visual loss

    • D. 

      Somato motor loss on the body

    • E. 

      Somatosensory loss on the body

    Correct Answer
    C. Partial bilateral visual loss
    Explanation
    Clipping the P3 segment proximal to the aneurysm would block all blood flow to targets distal to this point. Distal portions of the posterior cerebral artery (the P4 segment) serve the primary visual cortex. Somatosensory, somatomotor, and auditory regions of the cerebral cortex are served by terminal branches of the middle cerebral artery (M4 in the case of motor and sensory,M3/M4 in the case of auditory).Blindness in one eye would result from a lesion rostral to the optic chiasm; in the case of a vascular cause, this may relate to damage to the ophthalmic branch of the internal carotid.(p.21,29)

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  • 36. 

    .A 49-year-old man complains of “seeing two of everything” and his wife notices that, in her words “his eyes look funny. “the examination reveals that the man has difficulty making voluntary eye movements in the horizontal plane in one direction. MRI reveals a small convexity meningioma impinging on the frontal eye fields. This lesion is most likely involving which of the following Brodmann areas?

    • A. 

      Areas 3,1,2

    • B. 

      Area 4

    • C. 

      Area 6

    • D. 

      Areas 5 * 7

    • E. 

      Areas 18 * 19

    Correct Answer
    C. Area 6
    Explanation
    Recent studies on humans clearly suggest that the frontal eye field is located primarily in area 6 in the caudal aspect of the middle frontal gyrus. Areas 3,1,2 are collectively the primary somatosensory cortex and area 4 is the primary somatomotor cortex. Areas 5 7 collectively constitute the superior parietal lobule while areas 18 19 represent visual cortical regions that border on the primary visual cortex.(p.14)

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