USMLE Step 1 Qs (9)

50 Questions | Total Attempts: 142

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USMLE Quizzes & Trivia

For those of you who love all things biology and living organisms especially anatomy and how stuff works in the human body then, USMLE Step 1 Qs (9 is for you. If you are prepared to test your knowledge try it out.


Questions and Answers
  • 1. 
    Emma is a 64-year-old woman who has had heart disease for many years. While carrying chemicals down the stairs of the dry-cleaning shop where she worked, she suddenly lost control of her right leg and arm. She fell down the stairs and was able to stand up with some assistance from a coworker. When attempting to walk on her own, she had a very unsteady gait, with a tendency to fall to the right side. Her supervisor asked her if she was all right, and noticed that her speech was very slurred when she tried to answer. He called an ambulance to take her to the nearest hospital. The physician who was called to see Emma in the emergency room noted that her speech was slurred as if she were intoxicated, but the grammar and meaning were intact. Her face appeared symmetric, but when asked to protrude her tongue, it deviated toward the left. She was unable to tell if her right toe was moved up or down by the physician when she closed her eyes, and she couldn't feel the buzz of a tuning fork on her right arm and leg. In addition, her right arm and leg were markedly weak. The physician could find no other abnormalities on the remainder of Emma's general medical examination. Where in the nervous system could a lesion occur that causes arm and leg weakness, but spares the face?
    • A. 

      Right corticospinal tract in the cervical spinal cord

    • B. 

      Left inferior frontal lobe

    • C. 

      Left medullary pyramids

    • D. 

      Occipital lobe

    • E. 

      Both A and C are plausible sites

  • 2. 
    Emma is a 64-year-old woman who has had heart disease for many years. While carrying chemicals down the stairs of the dry-cleaning shop where she worked, she suddenly lost control of her right leg and arm. She fell down the stairs and was able to stand up with some assistance from a coworker. When attempting to walk on her own, she had a very unsteady gait, with a tendency to fall to the right side. Her supervisor asked her if she was all right, and noticed that her speech was very slurred when she tried to answer. He called an ambulance to take her to the nearest hospital. The physician who was called to see Emma in the emergency room noted that her speech was slurred as if she were intoxicated, but the grammar and meaning were intact. Her face appeared symmetric, but when asked to protrude her tongue, it deviated toward the left. She was unable to tell if her right toe was moved up or down by the physician when she closed her eyes, and she couldn't feel the buzz of a tuning fork on her right arm and leg. In addition, her right arm and leg were markedly weak. The physician could find no other abnormalities on the remainder of Emma's general medical examination. Other than the weakness on her right side, what type of deficit could cause Emma's gait problem, and where could a lesion causing this deficit occur?
    • A. 

      Proprioceptive, left medial lemniscus

    • B. 

      Sight, left eye

    • C. 

      Descending component of the medial longitudinal fasciculus

    • D. 

      Pain, left spinothalamic tract

    • E. 

      Proprioceptive, right medial lemniscus

  • 3. 
    Emma is a 64-year-old woman who has had heart disease for many years. While carrying chemicals down the stairs of the dry-cleaning shop where she worked, she suddenly lost control of her right leg and arm. She fell down the stairs and was able to stand up with some assistance from a coworker. When attempting to walk on her own, she had a very unsteady gait, with a tendency to fall to the right side. Her supervisor asked her if she was all right, and noticed that her speech was very slurred when she tried to answer. He called an ambulance to take her to the nearest hospital. The physician who was called to see Emma in the emergency room noted that her speech was slurred as if she were intoxicated, but the grammar and meaning were intact. Her face appeared symmetric, but when asked to protrude her tongue, it deviated toward the left. She was unable to tell if her right toe was moved up or down by the physician when she closed her eyes, and she couldn't feel the buzz of a tuning fork on her right arm and leg. In addition, her right arm and leg were markedly weak. The physician could find no other abnormalities on the remainder of Emma's general medical examination. Deviation of the tongue to the left, away from the right hemiparesis, implies a lesion in which area of the nervous system
    • A. 

      Right hypoglossal nucleus

    • B. 

      Left hypoglossal nucleus

    • C. 

      Right inferior frontal lobe

    • D. 

      Left inferior frontal lobe

    • E. 

      Right cerebral peduncle

  • 4. 
    Emma is a 64-year-old woman who has had heart disease for many years. While carrying chemicals down the stairs of the dry-cleaning shop where she worked, she suddenly lost control of her right leg and arm. She fell down the stairs and was able to stand up with some assistance from a coworker. When attempting to walk on her own, she had a very unsteady gait, with a tendency to fall to the right side. Her supervisor asked her if she was all right, and noticed that her speech was very slurred when she tried to answer. He called an ambulance to take her to the nearest hospital. The physician who was called to see Emma in the emergency room noted that her speech was slurred as if she were intoxicated, but the grammar and meaning were intact. Her face appeared symmetric, but when asked to protrude her tongue, it deviated toward the left. She was unable to tell if her right toe was moved up or down by the physician when she closed her eyes, and she couldn't feel the buzz of a tuning fork on her right arm and leg. In addition, her right arm and leg were markedly weak. The physician could find no other abnormalities on the remainder of Emma's general medical examination. What type of speech problem does Emma have?
    • A. 

      Broca's aphasia

    • B. 

      Wernicke's aphasia

    • C. 

      Mixed aphasia

    • D. 

      Dysarthria

    • E. 

      Agnosia

  • 5. 
    A second-year medical student was asked to see a nursing home patient as a requirement for a physical diagnosis course. The patient was a 79-year-old man who was apparently in a coma. The student wasn't certain of how to approach this case, so he asked the patient's wife, who was sitting at the bedside, why this patient was in a coma. The wife replied: "Oh, Paul isn't in a coma. But he did have a stroke." Slightly confused, the student leaned over and asked Paul to open his eyes. He opened his eyes immediately. However, when asked to lift his arm or speak, Paul did nothing. The student then asked Paul's wife if she was certain that his eye opening was not simply a coincidence, and that he really was in a coma, since he was unable to follow any commands. Paul's wife explained that he was unable to move or speak as a result of his stroke. However, she knew that he was awake, because he could communicate with her by blinking his eyes. The student appeared rather skeptical, so Paul's wife asked her husband to blink once for "yes" and twice for "no." She then asked him if he were at home and he blinked twice. When asked if he were in a nursing home, he blinked once. The student then asked him to move his eyes, and he was able to look in his direction. However, when the student asked him if he could move his arms or legs, he blinked twice. He also blinked twice when asked if he could smile. He did the same when asked if he could feel someone moving his arm. The student thanked Paul and his wife for their time, made notes of his findings, and returned to class. Where in the nervous system could a lesion occur that can cause paralysis of the extremities bilaterally, as well as the face, but not of the eyes?
    • A. 

      High cervical spinal cord bilaterally

    • B. 

      Bilateral thalamus

    • C. 

      Bilateral basal ganglia

    • D. 

      Bilateral pontine tegmentum

    • E. 

      Bilateral frontal lobe

  • 6. 
    A second-year medical student was asked to see a nursing home patient as a requirement for a physical diagnosis course. The patient was a 79-year-old man who was apparently in a coma. The student wasn't certain of how to approach this case, so he asked the patient's wife, who was sitting at the bedside, why this patient was in a coma. The wife replied: "Oh, Paul isn't in a coma. But he did have a stroke." Slightly confused, the student leaned over and asked Paul to open his eyes. He opened his eyes immediately. However, when asked to lift his arm or speak, Paul did nothing. The student then asked Paul's wife if she was certain that his eye opening was not simply a coincidence, and that he really was in a coma, since he was unable to follow any commands. Paul's wife explained that he was unable to move or speak as a result of his stroke. However, she knew that he was awake, because he could communicate with her by blinking his eyes. The student appeared rather skeptical, so Paul's wife asked her husband to blink once for "yes" and twice for "no." She then asked him if he were at home and he blinked twice. When asked if he were in a nursing home, he blinked once. The student then asked him to move his eyes, and he was able to look in his direction. However, when the student asked him if he could move his arms or legs, he blinked twice. He also blinked twice when asked if he could smile. He did the same when asked if he could feel someone moving his arm. The student thanked Paul and his wife for their time, made notes of his findings, and returned to class. An infarct in what vascular distribution could cause this lesion
    • A. 

      Anterior spinal artery

    • B. 

      Vertebral artery

    • C. 

      Basilar artery

    • D. 

      Middle cerebral artery

    • E. 

      Posterior cerebral artery

  • 7. 
    A second-year medical student was asked to see a nursing home patient as a requirement for a physical diagnosis course. The patient was a 79-year-old man who was apparently in a coma. The student wasn't certain of how to approach this case, so he asked the patient's wife, who was sitting at the bedside, why this patient was in a coma. The wife replied: "Oh, Paul isn't in a coma. But he did have a stroke." Slightly confused, the student leaned over and asked Paul to open his eyes. He opened his eyes immediately. However, when asked to lift his arm or speak, Paul did nothing. The student then asked Paul's wife if she was certain that his eye opening was not simply a coincidence, and that he really was in a coma, since he was unable to follow any commands. Paul's wife explained that he was unable to move or speak as a result of his stroke. However, she knew that he was awake, because he could communicate with her by blinking his eyes. The student appeared rather skeptical, so Paul's wife asked her husband to blink once for "yes" and twice for "no." She then asked him if he were at home and he blinked twice. When asked if he were in a nursing home, he blinked once. The student then asked him to move his eyes, and he was able to look in his direction. However, when the student asked him if he could move his arms or legs, he blinked twice. He also blinked twice when asked if he could smile. He did the same when asked if he could feel someone moving his arm. The student thanked Paul and his wife for their time, made notes of his findings, and returned to class. Damage to which tracts caused Paul's inability to move his arms and legs?
    • A. 

      Corticospinal and corticobulbar tracts

    • B. 

      Spinothalamic tract

    • C. 

      Solitary tract

    • D. 

      Superior cerebellar peduncle

    • E. 

      Inferior cerebellar peduncle

  • 8. 
    A second-year medical student was asked to see a nursing home patient as a requirement for a physical diagnosis course. The patient was a 79-year-old man who was apparently in a coma. The student wasn't certain of how to approach this case, so he asked the patient's wife, who was sitting at the bedside, why this patient was in a coma. The wife replied: "Oh, Paul isn't in a coma. But he did have a stroke." Slightly confused, the student leaned over and asked Paul to open his eyes. He opened his eyes immediately. However, when asked to lift his arm or speak, Paul did nothing. The student then asked Paul's wife if she was certain that his eye opening was not simply a coincidence, and that he really was in a coma, since he was unable to follow any commands. Paul's wife explained that he was unable to move or speak as a result of his stroke. However, she knew that he was awake, because he could communicate with her by blinking his eyes. The student appeared rather skeptical, so Paul's wife asked her husband to blink once for "yes" and twice for "no." She then asked him if he were at home and he blinked twice. When asked if he were in a nursing home, he blinked once. The student then asked him to move his eyes, and he was able to look in his direction. However, when the student asked him if he could move his arms or legs, he blinked twice. He also blinked twice when asked if he could smile. He did the same when asked if he could feel someone moving his arm. The student thanked Paul and his wife for their time, made notes of his findings, and returned to class. Damage to which tract caused Paul's lack of perception of someone moving his arm?
    • A. 

      Corticospinal and corticobulbar

    • B. 

      Middle cerebellar peduncle

    • C. 

      Spinothalamic tract

    • D. 

      Rubrospinal tract

    • E. 

      Medial lemniscus

  • 9. 
    A second-year medical student was asked to see a nursing home patient as a requirement for a physical diagnosis course. The patient was a 79-year-old man who was apparently in a coma. The student wasn't certain of how to approach this case, so he asked the patient's wife, who was sitting at the bedside, why this patient was in a coma. The wife replied: "Oh, Paul isn't in a coma. But he did have a stroke." Slightly confused, the student leaned over and asked Paul to open his eyes. He opened his eyes immediately. However, when asked to lift his arm or speak, Paul did nothing. The student then asked Paul's wife if she was certain that his eye opening was not simply a coincidence, and that he really was in a coma, since he was unable to follow any commands. Paul's wife explained that he was unable to move or speak as a result of his stroke. However, she knew that he was awake, because he could communicate with her by blinking his eyes. The student appeared rather skeptical, so Paul's wife asked her husband to blink once for "yes" and twice for "no." She then asked him if he were at home and he blinked twice. When asked if he were in a nursing home, he blinked once. The student then asked him to move his eyes, and he was able to look in his direction. However, when the student asked him if he could move his arms or legs, he blinked twice. He also blinked twice when asked if he could smile. He did the same when asked if he could feel someone moving his arm. The student thanked Paul and his wife for their time, made notes of his findings, and returned to class. What area is spared to preserve consciousness?
    • A. 

      Deep frontal white matter

    • B. 

      Pontine reticular formation

    • C. 

      Temporal lobes

    • D. 

      Prefrontal cortex

    • E. 

      Occipital lobe

  • 10. 
    Norma is a 75-year-old woman who had a stroke several months ago, manifested by numbness on her right side, including her arm, face, trunk, and leg. The numbness had improved somewhat over time, but did not completely disappear. One day, she noticed that brushing her right arm against a door was very painful. Thinking that perhaps this was "in her mind," she tried touching the right arm with her left hand, and this, too, was painful. Fearful that she may be having another stroke, she went immediately to see her neurologist at her local hospital. Norma's neurologist examined her and found that sensation for a pin, temperature, and vibration were diminished on the entire right side of her body. The degree of sensory loss was unchanged from an examination several months before. However, she had a large amount of discomfort with any type of stimulus, accompanied by some emotional disturbance. The discomfort was far out of proportion to the degree of the stimulus (e.g., a light touch to her right arm would engender a scream similar to that elicited by a knife). The remainder of her examination was normal. The neurologist told Norma that he didn't think that she had had a new stroke, but would order a head CT to be sure that there was no tumor or bleeding. In addition, he told her that if the head CT showed nothing new, she could begin a new medication that would help with the pain. Which of the following is the most likely location of the old stroke? Norma is a 75-year-old woman who had a stroke several months ago, manifested by numbness on her right side, including her arm, face, trunk, and leg. The numbness had improved somewhat over time, but did not completely disappear. One day, she noticed that brushing her right arm against a door was very painful. Thinking that perhaps this was "in her mind," she tried touching the right arm with her left hand, and this, too, was painful. Fearful that she may be having another stroke, she went immediately to see her neurologist at her local hospital. Norma's neurologist examined her and found that sensation for a pin, temperature, and vibration were diminished on the entire right side of her body. The degree of sensory loss was unchanged from an examination several months before. However, she had a large amount of discomfort with any type of stimulus, accompanied by some emotional disturbance. The discomfort was far out of proportion to the degree of the stimulus (e.g., a light touch to her right arm would engender a scream similar to that elicited by a knife). The remainder of her examination was normal. The neurologist told Norma that he didn't think that she had had a new stroke, but would order a head CT to be sure that there was no tumor or bleeding. In addition, he told her that if the head CT showed nothing new, she could begin a new medication that would help with the pain. Which of the following is the most likely location of the old stroke?
    • A. 

      Right precentral gyrus

    • B. 

      Left precentral gyrus

    • C. 

      Right ventral thalamus

    • D. 

      Left ventral thalamus

    • E. 

      Left cerebral peduncle

  • 11. 
    Norma is a 75-year-old woman who had a stroke several months ago, manifested by numbness on her right side, including her arm, face, trunk, and leg. The numbness had improved somewhat over time, but did not completely disappear. One day, she noticed that brushing her right arm against a door was very painful. Thinking that perhaps this was "in her mind," she tried touching the right arm with her left hand, and this, too, was painful. Fearful that she may be having another stroke, she went immediately to see her neurologist at her local hospital. Norma's neurologist examined her and found that sensation for a pin, temperature, and vibration were diminished on the entire right side of her body. The degree of sensory loss was unchanged from an examination several months before. However, she had a large amount of discomfort with any type of stimulus, accompanied by some emotional disturbance. The discomfort was far out of proportion to the degree of the stimulus (e.g., a light touch to her right arm would engender a scream similar to that elicited by a knife). The remainder of her examination was normal. The neurologist told Norma that he didn't think that she had had a new stroke, but would order a head CT to be sure that there was no tumor or bleeding. In addition, he told her that if the head CT showed nothing new, she could begin a new medication that would help with the pain. Which two nuclei mediating sensation of the arms, face, legs, and trunk may have sustained damage from the original stroke?
    • A. 

      Lateral and medial geniculate nuclei of the thalamus

    • B. 

      Ventral posterior lateral and ventral posterior medial nuclei of the thalamus

    • C. 

      Putamen and globus pallidus

    • D. 

      Caudate and putamen

    • E. 

      Anterior and lateral dorsal nuclei of the thalamus

  • 12. 
    Norma is a 75-year-old woman who had a stroke several months ago, manifested by numbness on her right side, including her arm, face, trunk, and leg. The numbness had improved somewhat over time, but did not completely disappear. One day, she noticed that brushing her right arm against a door was very painful. Thinking that perhaps this was "in her mind," she tried touching the right arm with her left hand, and this, too, was painful. Fearful that she may be having another stroke, she went immediately to see her neurologist at her local hospital. Norma's neurologist examined her and found that sensation for a pin, temperature, and vibration were diminished on the entire right side of her body. The degree of sensory loss was unchanged from an examination several months before. However, she had a large amount of discomfort with any type of stimulus, accompanied by some emotional disturbance. The discomfort was far out of proportion to the degree of the stimulus (e.g., a light touch to her right arm would engender a scream similar to that elicited by a knife). The remainder of her examination was normal. The neurologist told Norma that he didn't think that she had had a new stroke, but would order a head CT to be sure that there was no tumor or bleeding. In addition, he told her that if the head CT showed nothing new, she could begin a new medication that would help with the pain. Which pathway mediating pain is the afferent input into the infarcted area?
    • A. 

      Fasciculus gracilis

    • B. 

      Fasciculus cuneatus

    • C. 

      Spinocerebellar tract

    • D. 

      Spinothalamic tract

    • E. 

      Corticospinal tract

  • 13. 
    Norma is a 75-year-old woman who had a stroke several months ago, manifested by numbness on her right side, including her arm, face, trunk, and leg. The numbness had improved somewhat over time, but did not completely disappear. One day, she noticed that brushing her right arm against a door was very painful. Thinking that perhaps this was "in her mind," she tried touching the right arm with her left hand, and this, too, was painful. Fearful that she may be having another stroke, she went immediately to see her neurologist at her local hospital. Norma's neurologist examined her and found that sensation for a pin, temperature, and vibration were diminished on the entire right side of her body. The degree of sensory loss was unchanged from an examination several months before. However, she had a large amount of discomfort with any type of stimulus, accompanied by some emotional disturbance. The discomfort was far out of proportion to the degree of the stimulus (e.g., a light touch to her right arm would engender a scream similar to that elicited by a knife). The remainder of her examination was normal. The neurologist told Norma that he didn't think that she had had a new stroke, but would order a head CT to be sure that there was no tumor or bleeding. In addition, he told her that if the head CT showed nothing new, she could begin a new medication that would help with the pain. Surgical stimulation of various regions of the central nervous system (CNS) has been shown to alleviate pain. What is the location of one of these areas producing analgesia?
    • A. 

      Anterior nucleus of the thalamus

    • B. 

      Caudate nucleus

    • C. 

      Anterior horn of the spinal cord

    • D. 

      Globus pallidus

    • E. 

      Periaqueductal gray

  • 14. 
    Norma is a 75-year-old woman who had a stroke several months ago, manifested by numbness on her right side, including her arm, face, trunk, and leg. The numbness had improved somewhat over time, but did not completely disappear. One day, she noticed that brushing her right arm against a door was very painful. Thinking that perhaps this was "in her mind," she tried touching the right arm with her left hand, and this, too, was painful. Fearful that she may be having another stroke, she went immediately to see her neurologist at her local hospital. Norma's neurologist examined her and found that sensation for a pin, temperature, and vibration were diminished on the entire right side of her body. The degree of sensory loss was unchanged from an examination several months before. However, she had a large amount of discomfort with any type of stimulus, accompanied by some emotional disturbance. The discomfort was far out of proportion to the degree of the stimulus (e.g., a light touch to her right arm would engender a scream similar to that elicited by a knife). The remainder of her examination was normal. The neurologist told Norma that he didn't think that she had had a new stroke, but would order a head CT to be sure that there was no tumor or bleeding. In addition, he told her that if the head CT showed nothing new, she could begin a new medication that would help with the pain. Neurotransmitters implicated in pain modulation, which may be the targets of pain-alleviating drugs, include which of the following
    • A. 

      Aspartate

    • B. 

      Glutamate

    • C. 

      Epinephrine

    • D. 

      Dopamine and norepinephrine

    • E. 

      Opiates and serotonin

  • 15. 
    Louise is an 86-year-old woman who has had difficulty with high blood pressure, high cholesterol, diabetes, strokes, and blood clots in her legs for many years. One day, her grandson arrived at her apartment in a senior citizen center for his weekly visit, only to find her lying unconscious on the floor. He immediately called an ambulance to bring her to the nearest emergency room. The paramedics in the ambulance gave Louise some medications, including glucose, but she did not awaken. She was brought to the nearest emergency room, where a physician was called to evaluate her. She was breathing on her own and had a pulse, but could not be aroused to any stimulus. Her arms and legs were stiff, and would not move in response to a painful stimulus. Her eyes moved in response to moving her head. Finally, in response to a very loud shout and pinch on the arm, she briefly opened her eyes; however, she immediately shut them again. Further attempts to arouse Louise were unsuccessful. She was taken for a CT scan of her head, and then brought to an intensive care unit. An acute stroke in which portion of the CNS could cause this picture?
    • A. 

      Right frontal lobe

    • B. 

      Left frontal lobe

    • C. 

      Right temporal lobe

    • D. 

      Pons and midbrain

    • E. 

      Right occipital lobe

  • 16. 
    Louise is an 86-year-old woman who has had difficulty with high blood pressure, high cholesterol, diabetes, strokes, and blood clots in her legs for many years. One day, her grandson arrived at her apartment in a senior citizen center for his weekly visit, only to find her lying unconscious on the floor. He immediately called an ambulance to bring her to the nearest emergency room. The paramedics in the ambulance gave Louise some medications, including glucose, but she did not awaken. She was brought to the nearest emergency room, where a physician was called to evaluate her. She was breathing on her own and had a pulse, but could not be aroused to any stimulus. Her arms and legs were stiff, and would not move in response to a painful stimulus. Her eyes moved in response to moving her head. Finally, in response to a very loud shout and pinch on the arm, she briefly opened her eyes; however, she immediately shut them again. Further attempts to arouse Louise were unsuccessful. She was taken for a CT scan of her head, and then brought to an intensive care unit. Which of the following is the most likely cause of the stiffness in Louise's arms and legs?
    • A. 

      Infarction of the corticospinal tracts bilaterally in the pons

    • B. 

      Damage to the basal ganglia

    • C. 

      Infarction of the precentral gyrus

    • D. 

      Infarction of the internal capsules bilaterally

    • E. 

      Thalamic infarction

  • 17. 
    Louise is an 86-year-old woman who has had difficulty with high blood pressure, high cholesterol, diabetes, strokes, and blood clots in her legs for many years. One day, her grandson arrived at her apartment in a senior citizen center for his weekly visit, only to find her lying unconscious on the floor. He immediately called an ambulance to bring her to the nearest emergency room. The paramedics in the ambulance gave Louise some medications, including glucose, but she did not awaken. She was brought to the nearest emergency room, where a physician was called to evaluate her. She was breathing on her own and had a pulse, but could not be aroused to any stimulus. Her arms and legs were stiff, and would not move in response to a painful stimulus. Her eyes moved in response to moving her head. Finally, in response to a very loud shout and pinch on the arm, she briefly opened her eyes; however, she immediately shut them again. Further attempts to arouse Louise were unsuccessful. She was taken for a CT scan of her head, and then brought to an intensive care unit. Infarction of which artery may cause this picture
    • A. 

      Anterior cerebral artery

    • B. 

      Middle cerebral artery

    • C. 

      Anterior choroidal artery

    • D. 

      Basilar artery

    • E. 

      Lenticulostriate branches of the middle cerebral artery

  • 18. 
    Louise is an 86-year-old woman who has had difficulty with high blood pressure, high cholesterol, diabetes, strokes, and blood clots in her legs for many years. One day, her grandson arrived at her apartment in a senior citizen center for his weekly visit, only to find her lying unconscious on the floor. He immediately called an ambulance to bring her to the nearest emergency room. The paramedics in the ambulance gave Louise some medications, including glucose, but she did not awaken. She was brought to the nearest emergency room, where a physician was called to evaluate her. She was breathing on her own and had a pulse, but could not be aroused to any stimulus. Her arms and legs were stiff, and would not move in response to a painful stimulus. Her eyes moved in response to moving her head. Finally, in response to a very loud shout and pinch on the arm, she briefly opened her eyes; however, she immediately shut them again. Further attempts to arouse Louise were unsuccessful. She was taken for a CT scan of her head, and then brought to an intensive care unit. If the stroke occurred in the brainstem, which of the following regions is most likely affected
    • A. 

      Facial nerve nucleus

    • B. 

      Trochlear nerve nucleus

    • C. 

      Reticular formation

    • D. 

      Trigeminal system

    • E. 

      Medial longitudinal fasciculus

  • 19. 
    Louise is an 86-year-old woman who has had difficulty with high blood pressure, high cholesterol, diabetes, strokes, and blood clots in her legs for many years. One day, her grandson arrived at her apartment in a senior citizen center for his weekly visit, only to find her lying unconscious on the floor. He immediately called an ambulance to bring her to the nearest emergency room. The paramedics in the ambulance gave Louise some medications, including glucose, but she did not awaken. She was brought to the nearest emergency room, where a physician was called to evaluate her. She was breathing on her own and had a pulse, but could not be aroused to any stimulus. Her arms and legs were stiff, and would not move in response to a painful stimulus. Her eyes moved in response to moving her head. Finally, in response to a very loud shout and pinch on the arm, she briefly opened her eyes; however, she immediately shut them again. Further attempts to arouse Louise were unsuccessful. She was taken for a CT scan of her head, and then brought to an intensive care unit. Which of the following are the main monoaminergic systems of the region infarcted?
    • A. 

      Dopamine

    • B. 

      Norepinephrine

    • C. 

      Serotonin

    • D. 

      GABA

    • E. 

      Norepinephrine and serotonin

  • 20. 
    A 67-year-old man suffers an infarct of the geniculothalamic branch of the posterior cerebral artery. In particular, there is involvement of nuclei of the posterior thalamus. Which of the following is the most likely effect of such an infarct
    • A. 

      Emotional volatility in response to an innocuous statement

    • B. 

      Short-term memory loss that occurs about 1 week following the infarct

    • C. 

      Long-term memory loss that occurs about 1 month following the infarct

    • D. 

      Severe pain triggered by cutaneous stimuli applied to the patient

    • E. 

      Spastic paralysis of the contralateral limbs

  • 21. 
    A 67-year-old man suffers an infarct of the geniculothalamic branch of the posterior cerebral artery. In particular, there is involvement of nuclei of the posterior thalamus. The neurons affected by this infarction project primarily to which of the following?
    • A. 

      Hypothalamus and midbrain

    • B. 

      Parietal and occipital cortices

    • C. 

      Precentral and postcentral gyri

    • D. 

      Basal ganglia and premotor cortex

    • E. 

      Prefrontal cortex and medial aspect of the frontal lobe

  • 22. 
    A 52-year-old woman has an infarct involving a branch of the posterior communicating artery, causing damage to the ventral anterior (VA), ventrolateral (VL), dorsomedial, and anterior thalamic nuclei. Which of the following is the most likely clinical manifestations of this infarct
    • A. 

      Hemiparesis and neuropsychological impairment

    • B. 

      Loss of sleep and apnea

    • C. 

      Loss of appetite and thermoregulation

    • D. 

      Total blindness of the contralateral eye

    • E. 

      Marked endocrine dysfunction

  • 23. 
    A 52-year-old woman has an infarct involving a branch of the posterior communicating artery, causing damage to the ventral anterior (VA), ventrolateral (VL), dorsomedial, and anterior thalamic nuclei. The VA nucleus receives inputs primarily from structures associated with which of the following?
    • A. 

      Somatosensory functions

    • B. 

      Motor functions

    • C. 

      Autonomic functions

    • D. 

      Auditory and taste functions

    • E. 

      The regulation of sleep

  • 24. 
    A 52-year-old woman has an infarct involving a branch of the posterior communicating artery, causing damage to the ventral anterior (VA), ventrolateral (VL), dorsomedial, and anterior thalamic nuclei. The primary outputs of the VA nucleus include which of the following?
    • A. 

      Prefrontal and premotor cortices

    • B. 

      Precentral and postcentral gyri

    • C. 

      Posterior parietal lobe

    • D. 

      Middle temporal gyrus

    • E. 

      Wernicke's area

  • 25. 
    A patient is confused and displays localized jerks in his right hand, which progress to jerks of the entire arm with a brief loss of consciousness. This disorder can best be characterized as which type of seizure?
    • A. 

      Generalized seizure

    • B. 

      Absence seizure

    • C. 

      Simple partial seizure

    • D. 

      Complex partial seizure

    • E. 

      Petit mal seizure

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