USMLE Step 1 Qs (10)

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  • 1/50 Questions
    A lesion at which site in the diagram below could produce weakness of muscles that mediate swallowing, chewing, breathing, and speaking? - ProProfs

    A lesion at which site in the diagram below could produce weakness of muscles that mediate swallowing, chewing, breathing, and speaking?

    • D
    • E
    • F
    • G
    • H
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USMLE Step 1 Qs (10) - Quiz
About This Quiz

This USMLE Step 1 quiz assesses knowledge in key medical areas including anatomy, physiology, and pathology. Questions focus on clinical scenarios and fundamental medical concepts, crucial for future medical professionals.

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  • 2. 

    The cerebellum is derived from which of the following?

    • Neural crest cells

    • Rhombic lips

    • Mesencephalon

    • Sulcus limitans

    • Telencephalon

    Correct Answer
    A. Rhombic lips
    Explanation
    The cerebellum is formed from the dorsolateral aspects of the alar plates, which bend medially and posteriorly to form the rhombic lips.

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  • 3. 

    The anterior pituitary is derived from which of the following?

    • Neural crest cells

    • Rhombic lips

    • Myelencephalon

    • Floor plate

    • Rathke's pouch

    Correct Answer
    A. Rathke's pouch
    Explanation
    The anterior lobe of the pituitary is formed as an in-pocket derivative of the ectodermal stomodeum, called Rathke's pouch.

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  • 4. 

    young child is brought into the hospital emergency room because he has episodes of vomiting, headaches, problems in acquisition of motor skills, cranial nerve dysfunction, and problems in breathing. This combination of syndromes most closely relates to which of the following disorders?

    • Cleft palate

    • Hydrocephalus

    • Anencephaly

    • Syringomyelia

    • Congenital aneurysm

    Correct Answer
    A. Hydrocephalus
    Explanation
    The symptoms described are characteristic of hydrocephalus. Hydrocephalus may come about as a result of defects such as the failure of formation of the cerebellar vermis, foramens of Magendie and Luschka, or of the corpus callosum. There is an enlarged cranium as a result of the buildup of cerebrospinal fluid (CSF), causing brain damage. Several of the symptoms may also be caused by a compression of the posterior fossa and the absence of a cerebellar vermis. Cleft palate is a fissure of the medial aspect of the lip and would not result in the symptoms described previously. Anencephaly is the complete or partial absence of the brain and is not compatible with life. Syringomyelia is associated with bilateral segmental loss of pain and temperature. A congenital aneurysm can occur in a variety of places within the CNS and is typically associated with stroke in the adult.

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  • 5. 

    Apoptosis is likely to occur following which of the following events?

    • Stimulation of an afferent nerve fiber

    • Severing of an afferent nerve fiber

    • The beginning of myelin formation

    • Elimination of nerve growth factor

    • Reduction in brain serotonin levels

    Correct Answer
    A. Elimination of nerve growth factor
    Explanation
    When nerve growth factor is eliminated, cell death results and involves fragmentation, shrinkage, and ultimate phagocytosis of the cell. Apoptosis is believed to be triggered by a biochemical process that causes transcription of a variety of genes. Nerve growth factor blocks the activation of this process. It should also be noted that this form of cell death differs from that occurring after nerve injury or trauma to the nerve. The other choices listed are unrelated to the process of apoptosis.

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  • 6. 

    The methods involving microinjections of Fluoro-Gold or horseradish peroxidase (HRP) have been employed over the past few decades by many investigators. These methods have been used to identify which of the following

    • Cell bodies

    • Metabolic activity of neurons

    • Sensory endings of nerve fibers

    • Central nervous system receptors

    • Degenerating axons

    Correct Answer
    A. Cell bodies
    Explanation
    With HRP histochemistry, the glycoprotein enzyme HRP is injected into the region of the terminal endings of the neuronal pathway under examination and is incorporated into the axons through a process of micropinocytosis. Horseradish peroxidase is then retrogradely transported back to the cell bodies of origin of that pathway, where it is then degraded. By reacting the tissue with an appropriate substrate, the labeled cells can be visualized under light microscopy.

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  • 7. 

    Substances such as tritiated amino acids and phaseolus vulgaris agglutinin microinjected into specific regions of the brain have also been employed by many investigators for the study of the nervous system. These methods are specific in that they label which of the following?

    • Cell bodies

    • Glial cells

    • Sensory receptors

    • Motor end plates

    • Axons and axon preterminals

    Correct Answer
    A. Axons and axon preterminals
    Explanation
    The mapping of pathways utilizing anterograde tracing of fibers depends upon the process of axonal transport. For example, if a tritiated amino acid such as 3H-leucine is microinjected into a region of the brain, it gets synthesized into protein in the cell bodies and transported down the respective axons to their terminals. By utilizing autoradiographic methods, one can identify the loci of the label contained in the protein that has been transported to the axon terminals. The application of phaseolus vulgaris agglutinin also utilizes the principle of anterograde transport to map the distribution of pathways from cell bodies injected with this substance.

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  • 8. 

    Which of the following procedures would be utilized in order to show positive staining of groups of serotonin neurons

    • Electrical brain stimulation

    • Glutamate stimulation of the brain

    • HRP staining of neurons

    • Immunocytochemical labeling

    • Metabolic staining of neurons

    Correct Answer
    A. Immunocytochemical labeling
    Explanation
    Immunocytochemical methods, including in situ hybridization, have been used to identify the presence and localization of specific neurotransmitters and receptors, such as serotonin.

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  • 9. 

    An individual sustained a severe knife wound, damaging a spinal nerve adjoining its entry to the spinal cord. If one could examine this peripheral nerve and its cell body, which of the following events would he or she most likely observe?

    • A displacement of the nucleus toward the periphery of the cell

    • A mitotic division of the neuronal cell body

    • A more intense staining of the cell body

    • Degeneration of processes along the axon proximal but not distal to the lesion

    • An initial loss of mitochondria in the axoplasm at Ranvier's node

    Correct Answer
    A. A displacement of the nucleus toward the periphery of the cell
    Explanation
    Damage to a nerve fiber proximal to its cell body will cause, among other changes, retrograde degeneration of the cell body. A number of changes occur in the neuron during the process of retrograde degeneration. The cell body initially shows some swelling and becomes distended. At the beginning of the degenerative process, there is an accumulation of mitochondria in the axoplasm at Ranvier's nodes. The nucleus is then displaced toward the periphery of the cell. The Nissl granules break down, first in the center of the cell; later, the breakdown spreads outward. In addition, the axonal process distal to the site of the lesion will undergo degeneration. It should be noted that retrograde degeneration procedures were used experimentally prior to the advent of histochemical methods for identifying cell bodies of origin of given pathways in the CNS.

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  • 10. 

    A 65-year-old man is diagnosed with a form of a peripheral neuropathy. This individual will likely display which of the following

    • A loss in motor function, but sensory functions will remain largely intact

    • A reduction in conduction velocity of the affected nerve

    • An increase in the number of Ranvier's nodes

    • Degeneration of myelin but the axon will typically remain intact

    • Signs of an upper motor neuron (UMN) paralysis

    Correct Answer
    A. A reduction in conduction velocity of the affected nerve
    Explanation
    In a peripheral neuropathy, there may be damage to either the myelin or the axon directly, although, more often, there is damage to the myelin. Because of myelin (or axonal) damage, there is a reduction (or loss) of conduction velocity. The disorder may affect both sensory and motor components of the peripheral nerve, thereby causing dysfunction in both the sensory and the motor processes associated with that nerve. Because there is peripheral neuronal damage, the motor loss will be reflected in a weakness, paralysis, or reflex activity associated with the affected muscle, as well as impairment of sensation.

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  • 11. 

    During an in vitro experiment, the membrane potential of a nerve cell is hyperpolarized to –120 mV. At that time, a transmitter, known to be inhibitory in function, is applied to the preparation and results in a depolarization of the membrane. Which of the following is the most likely reason for this occurrence?

    • Inhibitory transmitters normally depolarize the postsynaptic membrane

    • The normal response of the postsynaptic membrane to any transmitter is depolarization

    • The inhibitory transmitter activates ligand-gated potassium channels

    • Sodium channels become inactivated

    • Calcium channels become activated

    Correct Answer
    A. The inhibitory transmitter activates ligand-gated potassium channels
    Explanation
    To understand how an inhibitory transmitter can actually cause a partial depolarization of the membrane, refer to the Goldman equation. The release (or application) of an inhibitory transmitter will serve to open specific ion channels, notably those of potassium. If the membrane is artificially hyperpolarized to –120 mV, the opening of the potassium channel will lead to a redistribution of the ions across the membrane to a normal level. If the normal equilibrium potential for potassium is approximately –75 mV, then, application of an inhibitory transmitter (that typically functions by opening potassium channels) will result in a redistribution of potassium ions toward the potassium equilibrium potential (i.e., –75 mV). Consequently, the membrane potential will be reduced (i.e., depolarized) from –120 mV to a value close to –75 mV. Other possible answers are clearly incorrect. Inhibitory transmitters normally function to hyperpolarize the membrane. Postsynaptic membranes may either be depolarized or hyperpolarized, depending upon the nature of the transmitter and receptor complex present at the synapse. Since the influx of calcium during the depolarization phase of the action potential leads to opposing effects, activation of this channel cannot account for the observed effects. Inactivation of sodium channels would not result in a depolarization of the membrane, but, instead, may contribute to the hyperpolarization of the membrane

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  • 12. 

    The passive spread of a presynaptic current acorss a gap junction that is activated by changes in voltage, pH, or calcium ion levels is most closely associated with which of the following

    • The resting potential

    • The action potential

    • Electrical presynaptic potentials

    • Electrical postsynaptic potentials

    • Receptor potentials

    Correct Answer
    A. Electrical postsynaptic potentials
    Explanation
    Electrical postsynaptic potentials involve the passive spread of current across a gap junction that is permeable to a variety of small ions. The stimulus for such activation may be a change in either voltage, pH, or intracellular calcium.

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  • 13. 

    Which of the following characterizes a principal feature of axosomatic synapses

    • It is referred to as a type I synapse

    • They have an electrical continuity linking the pre- and postsynaptic cells

    • They are typically inhibitory

    • Synaptic transmission is mediated by glutamate

    • They form the predominant synapse of cortical projections to the neostriatum

    Correct Answer
    A. They are typically inhibitory
    Explanation
    Axon terminals that make synaptic contact with the soma of postsynaptic cells are frequently observed to be inhibitory and are referred to as a type II synapse. A classic example of this is in the cerebellar cortex, where an interneuron (basket cell) makes synaptic contact with the soma of the Purkinje cell. These are chemical and not electrical synapses, and their actions are frequently mediated by GABA. Activation of the basket cell results in subsequent inhibition of the Purkinje cell. The overwhelming number of excitatory synapses are observed to be axodendritic. They are referred to as a type I synapse and are frequently characterized by specialized extensions of the dendrites called spines. These synapses also display a dense basement membrane and a prominent presynaptic density. Cortical projections to the neostriatum have been shown to be excitatory and their functions mediated by glutamate.

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  • 14. 

    Which of the following is a second messenger system directly activated by the binding of norepinephrine to a beta-adrenergic receptor

    • Inositol 1,4,5-triphosphate (IP3)

    • Adenosine 3',5'-cyclic phosphate (cAMP)

    • Diacylglycerol (DAG)

    • Arachidonic acid

    • Prostaglandins

    Correct Answer
    A. Adenosine 3',5'-cyclic phosphate (cAMP)
    Explanation
    When norepinephrine reaches a beta -adrenergic receptor, a G protein activates adenyl cyclase, which generates a second messenger, cAMP, from ATP. cAMP activates a cAMP-dependent kinase that alters the conformation of regulatory subunits of other kinases. This frees catalytic subunits to phosphorylate specific proteins, which, in turn, leads to the cellular response. IP3 and DAG are associated with the transmitter acetylcholine, which binds to muscarinic receptors, and arachidonic acid is linked to histamine, which binds to histamine receptors.
    Prostaglandins are metabolites of arachidonic acid.

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  • 15. 

    Hyperpolarization of the neuron is governed by which of the following

    • Chloride and sodium

    • Chloride and potassium

    • Potassium and sodium

    • Sodium and calcium

    • Sodium only

    Correct Answer
    A. Chloride and potassium
    Explanation
    In neurons within the CNS, an inhibitory transmitter will open chloride channels. In addition, second messengers may also mediate inhibition. It is likely that they do so by opening potassium channels. When a chloride channel is opened, it will lead to movement of this ion down its concentration gradient and into the cell. This will make the cell more negative (i.e., hyperpolarized). At the same time, there will be an efflux of potassium, which will also produce hyperpolarization of the cell because positive charges are now being removed. On the other hand, sodium and calcium influx are associated with depolarization of the cell.

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  • 16. 

    The release of the transmitter is directly governed by which of the following

    • Sodium influx

    • Sodium efflux

    • Potassium influx

    • Potassium efflux

    • Calcium influx

    Correct Answer
    A. Calcium influx
    Explanation
    Experimental methods permit evaluation of the relative contributions of different ions in the regulation of transmitter release. Neither tetrodotoxin, which blocks voltage-gated sodium channels, nor tetraethylammonium, which blocks voltage-gated potassium channels, will block the generation of a postsynaptic potential when the presynaptic cell is artificially depolarized. In contrast, presynaptic calcium influx triggers the release of the transmitter and results in a postsynaptic potential. Moreover, when presynaptic calcium influx is blocked, no postsynaptic potential is produced. Action potentials at the presynaptic axon terminals open up calcium channels, permitting calcium influx. This event helps move synaptic vesicles to active sites as actin filaments (which anchor the vesicles) are dissolved.

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  • 17. 

    N-methyl-D-aspartate (NMDA), kainate, and quisqualate all act on which of the following receptors

    • GABA receptors

    • Excitatory amino acid receptors

    • Adrenergic receptors

    • Opioid receptors

    • Dopamine receptors

    Correct Answer
    A. Excitatory amino acid receptors
    Explanation
    NMDA, kainate, and quisqualate act upon excitatory amino acid receptors. The NMDA receptor differs from the other types of receptors in that it is blocked by Mg2+ and controls a cation channel permeable to calcium, sodium, and potassium. Pharmacologically, NMDA receptors can be blocked by 2-amino-5-phosphonovaleric acid. The quisqualate receptor is activated by quisqualic acid; it has a high affinity for L-glutamate and alpha-amino-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA). The kainate receptor is activated by kainic acid. It regulates a channel that is permeable to sodium and potassium, binds AMPA, and is important in the process of excitotoxicity

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  • 18. 

    In the biosynthesis of dopamine, which of the following is the immediate precursor of dopamine?

    • Tyrosine

    • Tyrosine hydroxylase

    • Tryptophan

    • L-Dihydroxyphenylalanine (L-DOPA)

    • Dopamine beta-hydroxylase

    Correct Answer
    A. L-Dihydroxyphenylalanine (L-DOPA)
    Explanation
    The biosynthesis of catecholamines includes the following steps: tyrosine is converted into L-dihydroxyphenylalanine (L-DOPA) by tyrosine hydroxylase. L-DOPA is then decarboxylated by a decarboxylase to form dopamine (and CO2). The conversion of dopamine to norepinephrine comes about by the action of the enzyme dopamine beta-hydroxylase. The rate-limiting enzyme in the biosynthesis of serotonin is tryptophan hydroxylase. In this process, tryptophan is converted to 5-hydroxytryptophan by tryptophan hydroxylase and by 5-hydroxytryptophan decarboxylase into serotonin.

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  • 19. 

    A baby is born with an inherited autosomal recessive trait in which there is a delay in development, resulting in the occurrence of seizures and mental retardation. The child was diagnosed as having phenylketonuria (PKU). Which of the following is the likely neurochemical locus of this genetic defect?

    • Tyrosine

    • Tryptophan

    • Tryptophan hydroxylase

    • Dopamine

    • Phenylalanine (Phe) hydroxylase

    Correct Answer
    A. Phenylalanine (Phe) hydroxylase
    Explanation
    Phenylketonuria results in severe mental retardation and is caused by a defect in the gene that provides the code for Phe hydroxylase, the enzyme that converts Phe to tyrosine. As a result of this defective gene, there is an abundance of Phe in the brain, which produces a toxic metabolite, thus interfering in brain development and maturation.

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  • 20. 

    After an individual is admitted to the hospital, it is determined that he displays a variable weakness of cranial nerve and limb muscles but shows no clinical signs of denervation from tests, which include electromyogram (EMG) recordings. This disorder was partially reversed by the administration of drugs that inhibit acetylcholinesterase. Which of the following is the likely basis for this disorder?

    • The production of excessive quantities of acetylcholine (ACh)

    • The production of antibodies that act against nicotinic ACh receptors

    • A minor stroke involving the motor strip of the cerebral cortex

    • A vitamin B deficiency

    • Viral encephalitis

    Correct Answer
    A. The production of antibodies that act against nicotinic ACh receptors
    Explanation
    Myasthenia gravis is an autoimmune disease that causes cranial nerve and limb muscle weakness by producing antibodies that act against the nicotinic receptor at the neuromuscular junction. The result is that the action of nerve fibers that innervate skeletal muscle are affected, producing loss of the effects of ACh at the neuromuscular junction. The net result is a reduction of the size of the action potential in the muscle, producing a weakness in the affected muscle. This disorder is reversed by administration of drugs that inhibit the enzyme, acetylcholinesterase, that degrades ACh. Multiple sclerosis, ALS, and combined system disease (see the chapter entitled "The Spinal Cord") involve damage to axons and/or nerve cells within the CNS, producing much more profound damage to motor functions and, in the case of combined system disease, damage to both motor and sensory systems. Muscular dystrophy is typically characterized, in part, by progressive weakness of muscles and degeneration of the muscle fibers. The other disorders listed all involve disorders affecting the CNS, and thus, the symptoms associated with these disorders differ significantly from those described in this case. Excessive release of ACh is not a realistic event that is likely to occur (except from the bite of a black widow spider). In theory, if it were to occur, there is no reason to believe that muscular weakness would be a symptom. Instead, there would be some rigidity and muscle spasms.

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  • 21. 
    The neurotoxin, -bungarotoxin, has been utilized as a valuable experimental tool because it binds to which of the following? - ProProfs

    The neurotoxin, -bungarotoxin, has been utilized as a valuable experimental tool because it binds to which of the following?

    • GABAA receptor

    • GABAB receptor

    • Nicotinic receptor

    • NMDA receptor

    • Histamine receptor

    Correct Answer
    A. Nicotinic receptor
    Explanation
    The alpha-toxins, including alpha-bungarotoxin, can produce postsynaptic effects similar to that observed with curare, by binding specifically to the alpha-subunits of the nicotinic ACh receptor. In the case of the neuromuscular junction, the binding is to alpha-subunit of the nicotinic ACh receptor. Because of the selective actions of alpha-bungarotoxin upon the ACh receptor, it has been used effectively as an experimental tool to study the properties and actions of ACh and its associated receptors.

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  • 22. 

    A 60-year-old male has high blood pressure and the diagnosis indicates that it is due in part to retention of water. Which of the following compounds would most likely relate to this process

    • Oxytocin

    • Serotonin

    • Histamine

    • Vasopressin

    • Somatostatin

    Correct Answer
    A. Vasopressin
    Explanation
    Vasopressin is produced mainly from the magnocellular neurons of the hypothalamus. The hormone is released into the capillaries of the posterior pituitary. When it is released into the vascular system, it stimulates the kidneys to conserve water. The action of oxytocin is related to functions of the uterus and breasts. This hormone plays a role in the expulsion of the fetus at birth and in the milk ejection reflex following suckling. Substance P, histamine, and somatostatin are not known to relate specifically to this process.

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  • 23. 

    A 65-year-old man has been experiencing considerable pain due to a chronic back problem. If the patient is administered morphine to alleviate the problem, which of the following is a possible mechanism by which morphine would provide effective action

    • Release of somatostatin

    • Release of histamine

    • Release of vasopressin

    • Release of ACh

    • Release of substance P

    Correct Answer
    A. Release of histamine
    Explanation
    When an opioid compound, especially a mu-receptor agonist (such as morphine), is administered in response to chronic pain, this causes the release of histamine in neurons. This leads to the activation of histamine H2 receptors, which play a role in the relief of pain. In fact, there are ongoing attempts now to develop drugs, such as histamine H3-receptor compounds, which have been shown to mediate antinociception and have anti-inflammatory properties as well. The other choices listed in this question are not known to relate to the alleviation of pain, in particular, with respect to morphine administration. In fact, substance P is associated with the elicitation of pain impulses.

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  • 24. 

    Which of the following receptors requires the simultaneous binding of two different agonists for activation?

    • L-AP4 receptor

    • Kainate receptor

    • NMDA receptor

    • AMPA receptor

    • GABAA receptor

    Correct Answer
    A. NMDA receptor
    Explanation
    their activation. NMDA ion channels are opened after such compounds as glutamate and glycine are applied to the membranes that include NMDA receptors. Recent evidence has shown that a metabotropic glutamate receptor, L-AP4, is present in the retina. Activation of this receptor may serve to hyperpolarize bipolar neurons within the retina. Glutamate activation (of this receptor) constitutes an unusual action because most neurons in the CNS are depolarized by glutamate. AMPA is one of several classes of ionotropic glutamate receptors and functions as a synaptic receptor for fast excitatory synaptic transmission mediated through glutamate. The other choices, kainate and GABA receptors, do not have this property.

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  • 25. 

    A 16-year-old boy takes phencyclidine (PCP). The deleterious effects of the drug are due in part to which of the following

    • Blockade of NMDA receptors

    • Blockade of AMPA receptors

    • Blockade of cholinergic receptors

    • Blockade of GABAA receptors

    • Blockade of GABAB receptors

    Correct Answer
    A. Blockade of NMDA receptors
    Explanation
    NMDA ion channels are opened by both glutamate and glycine. On the other hand, Mg2 generates a voltage-dependent block of this ion channel. The drug of abuse, phencyclidine (PCP), also utilizes a similar mechanism to block NMDA-receptor channels. The other choices do not relate to this mechanism with respect to PCP

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  • 26. 

    A 50-year-old woman has been treated over the past 6 months with lithium for an ongoing disorder. Which of the following is the most likely diagnosis?

    • Panic attacks

    • Schizophrenia

    • Epilepsy

    • Bipolar disorder

    • Anxiety

    Correct Answer
    A. Bipolar disorder
    Explanation
    Lithium has been used for a number of years as an effective drug for the treatment of bipolar disorders. It has been shown to decrease the length, severity, and recurrence of manic states as well as the depressive components of this disorder. The mechanism of action of lithium in effectively combating bipolar disorder is not absolutely clear since it has a wide variety of biological effects. In part, these include: changes in the expression of some G proteins and subtypes of adenyl cyclase, alteration of the coupling of G proteins to neurotransmitter receptors, alterations of monoamine levels and receptors, and effects upon ion channels. Monoaminergic drugs are generally used for the treatment of panic disorders and, to some extent, to treat anxiety. Anxiety attacks are also treated with benzodiazepine drugs. Drugs for the treatment of epilepsy generally include those that increase or maintain GABA levels or decrease glutamate levels. For schizophrenia, a wide range of drugs has been used; these include those which affect monoaminergic, cholinergic, and GABAergic systems.

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  • 27. 

     long-lasting depletion of norepinephrine can be produced by administration of which of the following?

    • Amphetamine

    • Apomorphine

    • Clonidine

    • Reserpine

    • Yohimbine

    Correct Answer
    A. Reserpine
    Explanation
    Reserpine interferes with the uptake-storage mechanism associated with amine granules, which results in destruction of these granules. Administration of this drug will produce long-lasting depletion of norepinephrine. Amphetamine blocks the reuptake mechanism and, thus, produces a net increase in the release of norepinephrine. Apomorphine is a nonspecific dopamine agonist; clonidine is an alpha2-receptor agonist, and yohimbine is an alpha2-receptor antagonist.

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  • 28. 

    Removal of norepinephrine from the region of the synaptic cleft may be achieved by which of the following mechanisms

    • Reuptake

    • Enzymatic degradation

    • Diffusion

    • A combination of enzymatic degradation and diffusion

    • A combination of enzymatic degradation, diffusion, and reuptake

    Correct Answer
    A. A combination of enzymatic degradation, diffusion, and reuptake
    Explanation
    There are three mechanisms by which a transmitter is removed from the region of the synaptic cleft. The most common one is reuptake, in which transporter molecules mediate high-affinity reuptake that is specific for the transmitter in question. Other mechanisms include diffusion, which removes some components of the transmitter substance, and enzymatic degradation of the amine achieved by the enzymes monoamine oxidase and catechol-O-methyltransferase.

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  • 29. 

    A college student received an injury as a result of being tackled in a football game. After the game, the student was treated at a local hospital and was found to be unable to abduct and rotate the left arm at the shoulder, flex the elbow, and extend the wrist of the left side. Upon further examination, testing revealed depression of the biceps reflex of this limb, but the reflex activity involving the other limbs was normal. Which of the following is the most likely site of the injury?

    • Precentral gyrus

    • Basilar pons

    • Ventral horn cells at C1

    • Nerve roots of C5-C6

    • Triceps muscle

    Correct Answer
    A. Nerve roots of C5-C6
    Explanation
    In this case, disruption of the root fibers of C5–C6 involve components of the brachial plexus and affect muscle groups such as the deltoid, supraspinatus, intraspinatus, biceps, and flexor carpi radialis. These muscles govern abduction of the arm, rotation of the arm at the shoulder, flexion of the elbow and wrist. Reflex activity would also be affected due to disturbance of both alpha and gamma motor neurons serving the biceps muscle. Lesions involving the cerebral cortex or pons, especially the region of the pyramidal tracts, would produce a UMN paralysis, which would include hyperreflexia and hypertonia. An LMN paralysis involving the ventral horn cells at C1 would not affect the brachial plexus and the muscle groups indicated in this question. The triceps muscle is not involved in producing the movements affected by the injury.

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  • 30. 

    A neurological examination of a 75-year-old male reveals that when the abdominal wall is stroked, the muscles of the abdominal wall of the side of the body stimulated failed to contract. Other neurological tests appeared normal. Which of the following region is most likely affected

    • C1–C5 spinal segments

    • C6–T1 spinal segments

    • T2–T7 spinal segments

    • T8–T12 spinal segments

    • L1–L5 spinal segments

    Correct Answer
    A. T8–T12 spinal segments
    Explanation
    In this case, there is a loss of superficial abdominal reflexes, which require that spinal segments T8–T12 are intact. The test for these reflexes is to stroke a quadrant of the abdominal wall with an object such as a wooden stick. The normal response is for the muscle of the quadrant stimulated to contract and for movement of the umbilicus in the direction of the stimulus

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  • 31. 

    A 65-year-old female finds that she has weakness in attempting to flex her left knee and extend the hip. Neurophysiological analysis of the affected regions revealed a reduced number of motor units firing with fasciculations and slowed conduction velocity. There was no depression of tendon reflexes or muscle wasting. Likewise, plantar and abdominal reflexes were normal, and there was little sensory loss nor any signs of sphincter disturbances. The disturbances experienced by this woman are probably due to which of the following

    • Peripheral neuropathy of nerves on the left side of the body that exit the spinal cord at L4–S1

    • Damage of the neuromuscular junctions associated with nerves that exit the left side of spinal cord between T8–L3

    • Degeneration of nerve cells in the ventral horn of the left side of the spinal cord between T8–T12

    • Degeneration of fibers contained in the lateral funiculus of the left side of the thoracic spinal cord

    • Damage to the dorsal horn of the spinal cord of the left side between L1–L4

    Correct Answer
    A. Peripheral neuropathy of nerves on the left side of the body that exit the spinal cord at L4–S1
    Explanation
    The nerves innervating the knee and hip exit the spinal cord between L4–S1. Typical characteristics of a peripheral neuropathy include muscle weakness directed in a more pronounced manner upon the proximal muscles. Depression of tendon reflexes is generally not seen, and muscle wasting might occur only at a very late stage of the disease. Damage to the neuromuscular junction, such as myasthenia gravis, produces a different constellation of deficits. These include muscle fatigue and weakness that is fluctuating. This disorder also typically affects cranial nerves. In addition, the spinal segments indicated (T8–L3) are not associated with the muscle groups in question. Damage to the ventral horn would produce an LMN (flaccid) paralysis, which is not characteristic of the muscle weakness of this patient. Likewise, damage to the lateral funiculus would produce a UMN (spastic) paralysis, and dorsal horn damage would produce sensory deficits as well as affect muscle tone. In addition, the spinal segments indicated in this last choice (e) do not relate to the muscle groups affected in the patient.

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  • 32. 

    A 55-year-old man discovered that he had pain in the neck and right arm and weakness in extending his fingers of his right hand with loss of sensation in the right thumb and middle fingers. A neurological examination further revealed a weakness of the right biceps reflex, but other neurological signs could not be detected. Which of the following is the most likely diagnosis

    • Syringomyelia involving the cervical cord

    • A knife wound of the right arm completely severing nerves innervating the biceps muscle

    • Prolapse of a cervical disk

    • Poliomyelitis involving the cervical cord

    • AIDS

    Correct Answer
    A. Prolapse of a cervical disk
    Explanation
    The most likely cause of the condition in this patient is a cervical disk prolapse. This disorder would produce pain in the neck and arm, which increases with movement of the head. It would also cause loss of some sensation in the thumb and other fingers, as well as weakness in both finger extension and of the biceps reflex. Syringomyelia would produce bilateral segmental loss of pain and temperature. A knife wound completely severing the nerve would result in a functional loss similar to that experienced with an LMN paralysis. Polio results in loss of LMNs, thus also producing an LMN paralysis. One of the effects of AIDS is that it produces damage to the lateral and dorsal columns, resulting in the appearance of a UMN disorder.

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  • 33. 

    A 60-year-old woman was hospitalized with a severe respiratory infection for several weeks. Afterward, she displayed symptoms of myalgia and weakness of the lower limbs. In addition, she also showed loss of muscle tone and some flaccidity with loss of tendon reflexes. Examination also revealed a weakness of facial muscles. This constellation of symptoms progressed for approximately 2 weeks and persisted for more than a year, at which time, recovery took place at a slow rate. There was also some demyelination coupled with lymphatic inflammation at the site of demyelination. Which of the following is the most likely cause of this patient's condition?

    • Myasthenia gravis

    • Muscular dystrophy (MD)

    • Multiple sclerosis (MS)

    • Guillain-Barré syndrome

    • Lumbar disk prolapse

    Correct Answer
    A. Guillain-Barré syndrome
    Explanation
    Guillain-Barré syndrome is an acute polyneuropathy whose occurrence frequently follows a respiratory infection. It results in myalgia of the lower limbs, loss of muscle tone and tendon reflexes, and some flaccidity. The disorder can also affect the seventh cranial nerve. The disorder can produce diffuse demyelination of the peripheral nerves with an increase in lymphocytes present at the sites of demyelination. The other disorders listed are generally progressive where eventual recovery without intervention is not known to occur. Myasthenia gravis and lumbar disk prolapse would not show demyelination and lymphocyte increases near the sites of demyelination. Multiple sclerosis involves central nervous system (CNS) structures; therefore, the constellation of symptoms would be different. As indicated earlier, MD is progressive with effects upon both proximal muscles and later in distal muscles.

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  • 34. 

    A 38-year-old woman is referred to a neurologist because she complained of visual loss and muscle weakness. Subsequent examination revealed additional signs: impairment of other sensations, which included tingling and burning sensations; weakness of the lower limbs; paralysis of the upper limbs; progressive impairment of gait; signs of UMN involvement (i.e., spasticity and increased tendon reflexes); and bladder disturbances. No signs of infection were detected as measured by blood analysis, cultures, and chest x-ray. However, elevations in CSF protein were noted as well an abnormal IgG synthesis. Which of the following is the most likely diagnosis?

    • Diffuse cerebellar degeneration

    • ALS

    • Multiple sclerosis MS

    • A peripheral neuropathy

    • A prefrontal cortical brain tumor

    Correct Answer
    A. Multiple sclerosis MS
    Explanation
    Multiple sclerosis is a demyelinating autoimmune disease that affects CNS function. This disorder produces a wide variety of symptoms, including sudden sensory dysfunction and loss, which affect vision and the somatosensory system, causing tingling, pain, and hypesthesia. Broad functional motor disturbances also occur, including weakness of the upper or lower limbs, UMN signs, and gait impairment. There is also bladder dysfunction as well as an increase in CSF protein and IgG synthesis. Diffuse cerebellar degeneration would produce gait ataxia and deficits in the accuracy of intentional movements. As noted earlier, ALS would produce both a UMN and an LMN paralysis, which typically does not extend to sensory functions. Likewise, a peripheral neuropathy would not produce UMN signs, visual deficits, and extensive motor disturbances as described in this case. A tumor of the prefrontal cortex would affect some cognitive and emotional functions, but it would not affect sensory processes such as vision and somatosensation, nor would it produce signs of a UMN disorder or muscle weakness.

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  • 35. 

    The polar regions of the muscle spindle are excited by which of the following

    • Unmyelinated C fibers

    • 1A fibers

    • Gamma motor neurons

    • Alpha motor neurons

    • General visceral efferent fibers

    Correct Answer
    A. Gamma motor neurons
    Explanation
    Gamma motor neurons innervate the polar regions of the muscle spindle and, when excited, cause resetting of the spindle by stretching it, resulting in a lowering of the threshold for activation of that receptor by an external force. Unmyelinated C fibers mediate nociceptive sensations from the periphery to the spinal cord and thus do not relate to this question. 1A fibers arise from the nuclear region of the spindle and mediate spindle activity to the spinal cord and thus form the afferent limb of the monosynaptic stretch reflex. Alpha motor neurons arise in the ventral horn of spinal cord and innervate extrafusal muscle fibers, causing movement of the limb when excited. It does not innervate the polar regions of the spindle. General visceral afferent fibers exit from the intermediolateral cell columns (at T1–L3 for sympathetics and S2–S4 for parasympathetics) of the spinal cord and innervate postganglionic neurons for these respective autonomic systems. Such fibers, therefore, do not relate to muscle spindles, including their polar regions.

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  • 36. 

    Which of the following pathways all cross in the spinal cord

    • Lateral spinothalamic tract, anterior spinothalamic tract, posterior spinocerebellar tract

    • Anterior spinothalamic tract, lateral spinothalamic tract, anterior corticospinal tract

    • Anterior spinocerebellar tract, posterior spinocerebellar tract, lateral vestibulospinal tract

    • Anterior corticospinal tract, lateral spinothalamic tract, dorsal columns

    • Medial vestibulospinal tract, lateral spinothalamic tract, anterior spinothalamic tract

    Correct Answer
    A. Anterior spinothalamic tract, lateral spinothalamic tract, anterior corticospinal tract
    Explanation
    Both the lateral and anterior spinothalamic tracts cross over to the contralateral white matter of the cord relatively close to their cell bodies of origin and ascend to the thalamus. Similarly, the ventral spinocerebellar tract crosses over to the contralateral side and ascends as a distinct fiber pathway in the far lateral aspect of the white matter immediately below the position occupied by the dorsal spinocerebellar tract. The anterior corticospinal tract represents approximately 10 percent of the fibers descending from the cortex as corticospinal fibers. These fibers pass ipsilaterally through the brainstem to the spinal cord, reaching the anterior funiculus of the cord. Near the level at which these fibers terminate, most anterior corticospinal fibers cross over in the commissure of the spinal cord to supply the intermediate gray of the ventral horn. Posterior spinocerebellar fibers, which arise from Clarke's nucleus dorsalis, do not cross in the spinal cord. Instead, they pass laterally from their cell of origin and ascend within the dorsal half of the far lateral aspect of the white matter to the cerebellum. Lateral vestibulospinal fibers arise from the lateral vestibular nucleus and descend ipsilaterally within the ventral funiculus to all levels of the spinal cord, where they terminate upon neurons in the ventral horn. Dorsal column fibers are first-order neurons that arise from the periphery and enter the spinal cord at all levels. They ascend ipsilaterally in the fasciculus gracilis and cuneatus to the level of the dorsal column nuclei of the medulla, where they terminate.

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  • 37. 

    An injury to a patient results in a hemisection of the right half of the spinal cord that extends from T8 to T12. It is probable that the patient will experience which of the following

    • Loss of pain and temperature sensation from the right leg; loss of conscious proprioception from the left leg; UMN paralysis of the left leg

    • Loss of pain and temperature sensation from the left leg; loss of conscious proprioception from the right leg; UMN paralysis of the left leg

    • Loss of pain and temperature sensation from the left arm and leg; loss of conscious proprioception from the right leg and arm; flaccid paralysis of the right leg

    • Loss of pain and temperature sensation from the left leg and loss of conscious proprioception from the right leg; UMN paralysis of the right leg

    • Bilateral loss of pain and temperature sensation and conscious proprioception, both from the lower half of the body; UMN paralysis of the left leg and flaccid paralysis of the right leg

    Correct Answer
    A. Loss of pain and temperature sensation from the left leg and loss of conscious proprioception from the right leg; UMN paralysis of the right leg
    Explanation
    Hemisection of the right side of the spinal cord that involves segments T8 to T12 will result in contralateral loss of pain and temperature sensation below the level of the lesion and ipsilateral loss of conscious proprioception below the level of the lesion. Thus, this patient will experience loss of pain and temperature in the left leg and loss of conscious proprioception in the right leg. In addition, there will be damage to the descending corticospinal fibers that normally are essential for activation of the LMNs that control muscles of the right leg (i.e., UMN paralysis of the right leg). However, since the lesion is situated below the entry of sensory fibers as well as the origin of anterior horn cells that innervate the upper limbs, no loss of sensation to the upper limbs will ensue, nor will there be an LMN or UMN paralysis of the upper limbs. The pain and temperature fibers ipsilateral to the site of the lesion are unaffected because the second-order neurons decussate at the approximate level of their cell bodies of origin and ascend on the side contralateral to the lesion, leaving this system intact.

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  • 38. 

    . The hypothalamus and amygdala are able to modulate the output of the autonomic nervous system by virtue of their connections with which of the following

    • Ventrolateral nucleus of the thalamus

    • Nucleus accumbens

    • Solitary nucleus

    • Red nucleus

    • Ventral horn cells at the level of C8–T12 of the spinal cord

    Correct Answer
    A. Solitary nucleus
    Explanation
    The solitary nucleus of the medulla plays a significant role in the neural control of autonomic functions because it receives input from several different regions of the brain that regulate such functions. These inputs include fibers that arise from the hypothalamus, central nucleus of the amygdala, midbrain periaqueductal gray, and sensory processes (i.e., visceral afferents) of the glossopharyngeal and vagus nerves. The last signal changes in blood pressure and levels of oxygen and carbon dioxide in the blood. The ventrolateral nucleus of the thalamus, red nucleus of the midbrain, and ventral horn cells of the spinal cord are associated with somatomotor rather than autonomic function. The nucleus accumbens is believed to be associated with motivational processes.

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  • 39. 

    The following test is administered to a patient: A cotton applicator is gently applied to the cornea of the eye as the patient is asked to look upward. The patient did not blink in response to stimulation of the cornea. Which of the following cranial nerves are normally involved in this reflex?

    • Nerves II and III

    • Nerves III and IV

    • Nerves III and V

    • Nerves V and VII

    • Nerves VII and IX

    Correct Answer
    A. Nerves V and VII
    Explanation
    The reflex described in this question is the corneal reflex. It involves the reflex activation of the ophthalmic division of the sensory component of cranial nerve V in response to touching of the cornea and the motor division of the facial (cranial nerve VII), which produces the motor component (i.e., the blinking response). The sensory component of cranial nerve V is classified as a general somatic afferent fiber and the somatic motor component of cranial nerve VII is classified as a special visceral efferent fiber.

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  • 40. 

    An individual has difficulty in adjusting his head, especially after he changes his posture. Which of the following is the most likely pathway affected

    • Lateral vestibulospinal tract

    • Medial vestibulospinal tract

    • Medial reticulospinal tract

    • Lateral reticulospinal tract

    • Rubrospinal tract

    Correct Answer
    A. Medial vestibulospinal tract
    Explanation
    The medial vestibulospinal tract arises from the medial vestibular nucleus and descends in the medial longitudinal fasciculus to cervical levels where it controls LMNs, which innervate (flexor) muscles controlling the position of the head. The lateral vestibulospinal tract facilitates extensor motor neurons of the limbs; the rubrospinal tract facilitates flexor motor neurons of the limbs; and the reticulospinal tracts modulate muscle tone of the limbs.

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  • 41. 

    A patient complains that he cannot move his right eye to the right and that the right side of his face is expressionless. Which of the following is the likely locus of the lesion

    • Dorsal aspect of the medulla

    • Ventromedial medulla

    • Dorsal pons

    • Ventromedial pons

    • Medial midbrain

    Correct Answer
    A. Dorsal pons
    Explanation
    The combined deficit in which the patient loses ability to (use his lateral rectus muscle) abduct his right eye and display facial expression on the right side of the face means that the lesion is located in the dorsal pons at the site where the facial nerve curves around (just above) the motor nucleus of cranial nerve VI. Thus, a lesion at this site will affect both cranial nerves, causing the combined deficits described previously.

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  • 42. 

    Which of the following is the principal projection target of the inferior olivary nucleus?

    • Cerebral cortex

    • Midbrain periaqueductal gray

    • Vestibular nuclei

    • Dorsal column nuclei

    • Cerebellar cortex

    Correct Answer
    A. Cerebellar cortex
    Explanation
    The primary projection pathway of the inferior olivary nucleus exits this nucleus, enters the inferior cerebellar peduncle of the contralateral side of the brain, and passes into the cerebellar cortex, terminating on apical dendrites of Purkinje cells throughout the cerebellar cortex in a somatotopic manner. As indicated previously in the explanation of the previous question, this pathway represents an important source of input to the cerebellum from significant regions mediating sensory and motor information (via the inferior olivary nucleus). Other suggested answers do not include known projection targets of the inferior olivary nucleus.

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  • 43. 

    The vagus nerve (cranial nerve X) includes which of the following components

    • General somatic afferent, special visceral afferent, general visceral afferent, and general visceral efferent

    • Special visceral afferent, special sensory afferent, general visceral afferent, and general visceral efferent

    • General visceral afferent and general visceral efferent only

    • General visceral efferent and special visceral efferent only

    • Special visceral efferent, general visceral efferent, and general visceral afferent only

    Correct Answer
    A. General somatic afferent, special visceral afferent, general visceral afferent, and general visceral efferent
    Explanation
    Cranial nerve X is a highly complex nerve. It contains a few general somatic afferents from the back of the ear that enter the brain as cranial nerve X but terminate in the trigeminal complex. Special visceral afferents include fibers from chemoreceptors for taste associated with the epiglottis and chemoreceptors in the aortic bodies that sense changes in O2-CO2 levels in the blood. General visceral afferent fibers arise from the trachea, pharynx, larynx, and esophagus and signal changes in blood pressure to the brainstem. Special visceral efferent fibers innervate the constrictor muscles of the pharynx and the intrinsic muscles of the larynx. General visceral efferent fibers constitute part of the cranial aspect of the parasympathetic nervous system; thus, they are preganglionic parasympathetic fibers that innervate the heart, lung, esophagus, and stomach.

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  • 44. 

    Lesions involving the dorsolateral medulla can produce which of the following

    • Loss of pain and thermal sensation on the contralateral half of the face

    • Loss of pain and temperature sensation on the ipsilateral side of the body

    • Dysphonia

    • Hemiparesis

    • Intention tremor

    Correct Answer
    A. Dysphonia
    Explanation
    A primary characteristic of a lesion of the dorsolateral medulla is loss of pain and temperature sensation on the contralateral side of the body and ipsilateral half of the face. Damage to the descending tract of the trigeminal nerve and to the spinal nucleus of cranial nerve V will produce loss of sensation on the ipsilateral side of the face. There also will be damage to the lateral spinothalamic tract, which has already crossed at the level of the spinal cord and which conveys pain and temperature sensation from the contralateral side of the body. In addition, fibers arising from the nucleus ambiguus exit laterally from the medulla, and these fibers, which innervate the larynx and pharynx, would also be affected, causing dysphonia. Hemiparesis would not result from this lesion since the pyramidal tract would remain intact. The cerebellum would also be spared and intention tremor associated with cerebellar damage would not occur.

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  • 45. 

     Which of the following contains first-order sensory neurons with their cell bodies located within the CNS?

    • Geniculate ganglion

    • Spiral ganglion

    • Mesencephalic nucleus of cranial nerve V

    • Solitary nucleus

    • Scarpa's ganglia

    Correct Answer
    A. Mesencephalic nucleus of cranial nerve V
    Explanation
    In general, first-order sensory neurons form ganglia outside the CNS. There is one exception, the mesencephalic nucleus of cranial nerve V, which transmits unconscious proprioception (i.e., muscle spindle activity) from jaw muscles. These inputs serve as the first-order neurons for a disynaptic pathway to the cerebellum, as well as for a monosynaptic pathway with the motor nucleus of cranial nerve V for the jaw-closing reflex

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  • 46. 

    In a lateral gaze paralysis, both eyes are conjugatively directed to the side opposite the lesion. In this condition, which of the following is the locus of the lesion

    • Root fibers of cranial nerve III

    • Nucleus of cranial nerve III

    • Root fibers of cranial nerve VI

    • Nucleus of cranial nerve VI

    • Nucleus and root fibers of cranial nerve IV

    Correct Answer
    A. Nucleus of cranial nerve VI
    Explanation
    Conjugate lateral gaze requires the simultaneous contractions of the lateral rectus muscle of one eye and the medial rectus of the other eye. Recent studies have indicated that there is a region that integrates and coordinates such movements and that the site is part of the nucleus of cranial nerve VI. It is likely that it accomplishes this phenomenon, in part, because ascending axons from the abducens nucleus pass through the medial longitudinal fasciculus to the contralateral nuclei of cranial nerve III. Thus, the abducens nucleus serves not only to innervate the lateral rectus muscle but also to integrate signals necessary for conjugate deviation of the eyes. The abducens nucleus appears to be the only cranial nerve structure where lesions of the root fibers and nucleus fail to display identical effects.

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  • 47. 

    A patient displays an ipsilateral paralysis of lateral gaze coupled with a contralateral hemiplegia. A lesion is most likely situated in which of the following

    • Ventromedial medulla

    • Dorsomedial medulla

    • Ventrocaudal pons

    • Dorsorostral pons

    • Ventromedial midbrain

    Correct Answer
    A. Ventrocaudal pons
    Explanation
    For a lesion to produce both an ipsilateral gaze paralysis and contralateral hemiplegia, it must be situated in a location where fibers regulating both lateral gaze and movements of the contralateral limbs lie close to each other. The only such location is the ventrocaudal aspect of the pons, where fibers of cranial nerve VI descend toward the ventral surface of the brainstem and where corticospinal fibers are descending toward the spinal cord. The other regions listed in the question do not meet this condition.

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  • 48. 

    Which of the following cranial nerves all carry special visceral afferent fibers

    • V, VII, and IX

    • III, VI, and XII

    • IX, X, and XI

    • II, VII, and VIII

    • I, VII, and IX

    Correct Answer
    A. I, VII, and IX
    Explanation
    The group called special visceral afferent fibers is limited to those cranial nerves that convey impulses to the brain associated with olfaction (I) and taste (VII, IX, and X). Since olfaction and taste involve chemical senses, some authors also include cranial nerves IX and X in the group because these nerves contain components involved in signaling changes in O2 and CO2 levels in the blood.

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  • 49. 

    . A patient displays the following constellation of symptoms: UMN paralysis of the left leg, paralysis of the lower half of the left side of the face, and a left homonymous hemianopsia. The lesion is most likely located in which of the following

    • Medulla

    • Basilar pons

    • Pontine tegmentum

    • Midbrain

    • Forebrain

    Correct Answer
    A. Forebrain
    Explanation
    Because the deficit includes a homonymous hemianopsia, the lesion has to be located somewhere in the forebrain, such as in the region that includes the optic tract and internal capsule on the right side of the brain. The motor neurons of cranial nerve VII, as well as spinal cord motor neurons, receive cortical fibers that are crossed, which accounts for the fact that motor dysfunctions of the lower face and body involve lesions on the same side.

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  • Mar 21, 2023
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