Semester 2 Neuro, Week 2 - BrainSTEM

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Semester 2 Neuro, Week 2 - Brainstem - Quiz

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Questions and Answers
  • 1. 

    A female patient complains of difficulty swallowing, a loss of pain and temperature sensations from the left side of her body below the neck and from the right side of her face, At what level of the brainstem do you suspect the lesion to be?

    • A.

      The right lateral medulla

    • B.

      The upper (rostra!) pons

    • C.

      The lower (caudal) pons

    • D.

      The left lateral medulla

    • E.

      The right midbrain

    Correct Answer
    A. The right lateral medulla
    Explanation
    The patient's symptoms suggest a lesion in the right lateral medulla. The difficulty swallowing indicates involvement of the glossopharyngeal and vagus cranial nerves, which are located in the medulla. The loss of pain and temperature sensations on the left side of the body below the neck suggests involvement of the spinothalamic tract, which also passes through the medulla. Additionally, the loss of pain and temperature sensations on the right side of the face indicates involvement of the trigeminal nerve, which has a nucleus in the medulla. Therefore, the most likely location of the lesion is the right lateral medulla.

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  • 2. 

    You are a pathologist who has sectioned the brain and brainstem and are ready to examine a section of medulla. Which of the following would you expect to see at this level?

    • A.

      Edinger-Westphal nucleus

    • B.

      Inferior olivary nucleus

    • C.

      Olfactory nuclei

    • D.

      Trochlear nucleus

    • E.

      Motor nucleus of

    Correct Answer
    B. Inferior olivary nucleus
    Explanation
    At the level of the medulla, the pathologist would expect to see the Inferior Olivary Nucleus. The Inferior Olivary Nucleus is located in the medulla and is involved in motor coordination and learning. It receives input from the cerebral cortex and sends output to the cerebellum. This nucleus plays a crucial role in the coordination of movements and is involved in the control of balance and coordination.

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  • 3. 

    A 62-year old male has sustained several injuries from a car accident. Upon administering a neurological examination, you suspect that the patient has damage to the right caudal medulla. Why do you think this?

    • A.

      The patient's right eye exhibits hypertropia and he complains of diplopia,

    • B.

      The patient's tongue deviates towards to right when you asked him to stick it out and his uvula deviates towards the left when you ask him to say, "aahhh".

    • C.

      The patient has a loss of taste on the right anterior 2/3rds of his tongue

    • D.

      The patient exhibits anosmia (inability to smell)

    • E.

      The patient complains of excruciating pain on the right side of his face

    Correct Answer
    B. The patient's tongue deviates towards to right when you asked him to stick it out and his uvula deviates towards the left when you ask him to say, "aahhh".
    Explanation
    Based on the symptoms described, it is likely that the patient has damage to the right caudal medulla. The deviation of the tongue towards the right indicates a weakness or paralysis of the left side of the tongue, which is controlled by the hypoglossal nerve (CN XII). The deviation of the uvula towards the left suggests a weakness or paralysis of the right side of the soft palate, which is controlled by the vagus nerve (CN X). These findings are consistent with damage to the right caudal medulla, where the nuclei for CN XII and CN X are located.

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  • 4. 

    A lesion at the level of the cerebral peduncle would affect descending fibers of the corticospinal tract. Disruption of these axons would result in which of the following?

    • A.

      Flaccid paralysis

    • B.

      Areflexia

    • C.

      Hypotonicity

    • D.

      Positive Babinski sign

    • E.

      Absent Babinski sign

    Correct Answer
    D. Positive Babinski sign
    Explanation
    A lesion at the level of the cerebral peduncle would affect the descending fibers of the corticospinal tract. The corticospinal tract is responsible for voluntary movement and carries signals from the motor cortex to the spinal cord. When this tract is disrupted, it can lead to an abnormal response known as the Babinski sign. Normally, when the sole of the foot is stroked, the toes curl downwards. However, in the presence of a lesion affecting the corticospinal tract, the toes instead extend upwards, indicating an abnormal response. This abnormal response is known as a positive Babinski sign. Therefore, a lesion at the level of the cerebral peduncle would result in a positive Babinski sign.

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  • 5. 

    A 23-year-old female suffers a discrete arterial infarct that affects the left spinal tract of V and the left spinal nucleus of V. What deficit would you expect to see in this patient?

    • A.

      A loss of touch and pressure sense on the left side of the face.

    • B.

      A loss of pain and temperature sense on the left side of the face.

    • C.

      A loss of touch and pressure sense on the right side of the face.

    • D.

      A loss of pain and temperature sense on the right side of the face,

    • E.

      A loss of voluntary motor function to the muscles of mastication.

    Correct Answer
    B. A loss of pain and temperature sense on the left side of the face.
    Explanation
    The left spinal tract of V and the left spinal nucleus of V are responsible for transmitting pain and temperature sensation from the face to the brain. Therefore, if these structures are affected by an arterial infarct, it would result in a loss of pain and temperature sense on the left side of the face.

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  • 6. 

    A 49-year old woman suffers a small infarct that affects only the medial lemniscus in the mid-pons on the right. What clinical deficit do you expect to see in this woman?

    • A.

      A loss of pain and temperature perception below the neck on the left below the level of the infarct

    • B.

      A loss of touch and pressure sense on the left face

    • C.

      A loss of touch and pressure sense below the neck on the left

    • D.

      A loss of voluntary motor Function below the neck on the right

    • E.

      A loss of pain and temperature perception below the neck on the right below the level of the infarct

    Correct Answer
    C. A loss of touch and pressure sense below the neck on the left
    Explanation
    The medial lemniscus carries sensory information related to touch and pressure from the opposite side of the body. In this case, the infarct affects the right medial lemniscus, resulting in a loss of touch and pressure sense on the left side of the body below the neck.

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  • 7. 

    You are a pathologist who has sectioned the brain and brainstem and are ready to examine a section of midbrain. Which of the following would you expect to see at this level?

    • A.

      Rostral nucleus solitaries

    • B.

      Accessory nucleus

    • C.

      Edinger-Westphal nucleus

    • D.

      Spinal nucleus of V

    • E.

      Inferior olivary nucleus

    Correct Answer
    C. Edinger-Westphal nucleus
    Explanation
    At the level of the midbrain, the Edinger-Westphal nucleus is expected to be seen. This nucleus is responsible for controlling the pupillary reflex and accommodation reflex, which are important for regulating the size of the pupil and adjusting the shape of the lens for near vision. It is located in the midbrain, specifically in the oculomotor nuclear complex, and receives input from the pretectal area. The other options listed, such as the rostral nucleus solitaries, accessory nucleus, spinal nucleus of V, and inferior olivary nucleus, are not typically found at the level of the midbrain.

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  • 8. 

    A detailed neurological examination of a 52-year old male reveals the following: patient H5 alert to time, date and place and exhibits no disorders of speech or comprehension. Visual system testing, however, reveals a paralysis of upward gaze as well as a loss of the consensual pupillary light reflex. Such a constellation of symptoms could be due to a tumor at which location?

    • A.

      Optic chiasm

    • B.

      Rathke’s pouch (Craniopharingioma)

    • C.

      Pituitary gland

    • D.

      Pineal gland

    • E.

      Caudal pans

    Correct Answer
    D. Pineal gland
    Explanation
    A paralysis of upward gaze and loss of the consensual pupillary light reflex suggests dysfunction in the midbrain. The pineal gland is located in the midbrain and is responsible for regulating sleep-wake cycles. Tumors in the pineal gland can compress nearby structures, leading to neurological symptoms such as those described in the patient. Therefore, a tumor in the pineal gland is a likely explanation for the constellation of symptoms observed in the 52-year old male.

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  • 9. 

    Which of the following 2" order neurons is involved with relaying touch & proprioceptive information to the somatosensory cortex from the face?

    • A.

      Principal (main) sensory nucleus of V

    • B.

      Nucleus gracilis

    • C.

      Motor nucleus of V

    • D.

      Nucleus cuneatus

    • E.

      Ventral horn neurons

    Correct Answer
    A. Principal (main) sensory nucleus of V
    Explanation
    The correct answer is the Principal (main) sensory nucleus of V. This nucleus is responsible for relaying touch and proprioceptive information from the face to the somatosensory cortex. It is a second-order neuron, meaning it receives input from first-order neurons and sends that information to higher processing centers in the brain. The other options listed are not specifically involved in relaying touch and proprioceptive information from the face to the somatosensory cortex.

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  • 10. 

    A 60-year old man suffered from a right sided hemiplegia and right sided cerebellar ataxia. He could not abduct the left eye. Which of the following structures is involved?

    • A.

      Right pons

    • B.

      Left internal capsule

    • C.

      Right internal capsule

    • D.

      Left medulla

    • E.

      Left pons

    Correct Answer
    E. Left pons
    Explanation
    The left pons is involved in this case because it controls the movement of the left eye. The symptoms described, including right-sided hemiplegia and right-sided cerebellar ataxia, indicate a lesion on the opposite side of the brain. Since the left eye is unable to abduct, it suggests that the left abducens nerve, which controls eye abduction, is affected. The abducens nerve originates in the pons, therefore, a lesion in the left pons would explain the patient's inability to abduct the left eye.

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  • 11. 

    During a college football game, a player is "sacked" and carried off the field. A CT scan reveals a bone fragment lodged into the lateral aspect of his dorsal columns in the cervical spinal cord on the left side. Which of the following functions will most likely be affected given this patient's presentation?

    • A.

      Motor control of left leg

    • B.

      Motor control of right leg

    • C.

      Touch, pressure, vibration of left leg

    • D.

      Touch, pressure, vibration of right leg

    • E.

      Touch, pressure, vibration of right arm

    • F.

      Touch, pressure, vibration of left arm

    Correct Answer
    F. Touch, pressure, vibration of left arm
    Explanation
    The bone fragment lodged into the lateral aspect of the dorsal columns in the cervical spinal cord on the left side suggests damage to the sensory pathways responsible for touch, pressure, and vibration. Since the fragment is on the left side, it is likely to affect the sensory input from the left side of the body. Therefore, touch, pressure, and vibration of the left arm will most likely be affected in this patient's presentation.

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  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jan 15, 2012
    Quiz Created by
    BLACKMD
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