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1. One of the following statements concerning the somatic sensory pathways is NOT true:
   a. The axons of the second-order neurons cross the midline
   b.  First-order neuron cell bodies are located in spinal (dorsal root) ganglia and the trigeminal ganglia
   c.  Third-order neuron cell bodies are located in the nuclei gracilis and cuneatus
   d. The primary somatic sensory cortex is on the postcentral gyrus (areas 3,1,2)
   e. The superior parietal lobule (areas 5,7) is important for interpretation and integration of somatic sensory information
   
    
2. At the C2-3 level of the spinal cord, what structures are intermingling?
   a. the spinal tract of V with the dorsolateral tract (Lissauer)
   b. the (spinal) accessory nucleus with the intermediolateral cell column (lateral horn)
   c.  the spinal nucleus of V with laminae I to V (including the substantia gelatinosa) of the posterior horn of the spinal cord
   d. all of the above are correct
   e. only a and c are correct



3. Nociceptive information from the periphery is transmitted by which neurotransmitters?
   a. Glutamate
   b. Substance P
   c.  GABA
   d. CGRP
   e. All of the above are correct, except c



4. A patient presents with weakness and numbness of the left upper and lower limbs and a drooping of the left side of the mouth.  On examination, she is surprised to discover that she cannot see objects in the left half of her visual field in either eye.  She is able to wrinkle her forehead and close her eyes symmetrically on both sides, but the left side of her mouth does not move when she smiles or grimaces.  Sensory testing reveals decreased appreciation of pain, vibration, touch, and conscious proprioception (joint position sense) in the left face, upper limb, and lower limb.  A left hemiparesis is noted.  Which of the following statements is (are) true?
   a. The left facial weakness is of "lower motor neuron" type
   b. The lesion involves the crus cerebri and tegmentum of the midbrain on the right
   c.  The lesion involves structures in and near the posterior limb of the internal capsule on the right
   d. The plantar reflexes are extensor (abnormal) bilaterally
   e. only a, c, and d are correct



5. The corticospinal tract:
   a. is concerned with the voluntary control of rapid, finely coordinated, skilled movements (especially of the hands)
   b. is the only descending motor pathway controlling movements of the limbs
   c.  passes through the posterior limb of the internal capsule, the crus cerebri of the midbrain, and crosses the midline in the lower medulla
   d. arises only from large pyramidal cells (Betz) in the precentral gyrus
   e. only a and c are correct



6. The corticonuclear (corticobulbar) fibers of the pyramidal system:
   a. supply the motor nuclei of cranial nerves V, VII, IX, X, XI, and XII
   b. all cross the midline before entering the cranial nerve nuclei
   c.  originate from the lower part of the precentral gyrus
   d. all of the above are correct
   e. only a and c are correct



7. Characteristics of a "lower motor neuron lesion" include:
   a. weakness on one side of the body (hemiparesis)
   b. muscular atrophy
   c.  hyperreflexia
   d. fasciculations
   e. only b and d are correct 



8. Concerning the concept of an "upper motor neuron lesion":
   a. signs and symptoms include weakness, hyperreflexia, increased muscle tone (spasticity), and an extensor plantar reflex
   b. damage to the pyramidal system (i.e., corticospinal and corticonuclear tracts) ALONE results in the syndrome
   c.  damage to the reticulospinal, vestibulospinal, and rubrospinal tracts contributes to the syndrome
   d. all of the above are correct
   e. only a and c are correct



9. Which of the following structures contain “lower motor neuron” cell bodies?
   a. substantia gelatinosa
   b. precentral gyrus (area 4)
   c.   nucleus ambiguus
   d. spinal nucleus of V
   e. none of the above



10. A patient comes to the emergency room with weakness of the right upper and lower limbs and is unable to move any of the muscles of facial expression on the left.  Which of the following statements is (are) true?
    a. The lesion involves a large area of the left frontal lobe
    b. The patient probably also has a left horizontal gaze palsy
    c.    The patient also has a Broca’s aphasia
    d.  The lesion involves the lower pons on the left side
    e.  only b and d are correct



11. A patient presents with a left hemiparesis.  Which of the following findings on examination allows you to "localize the lesion" (i.e., reach an anatomic diagnosis)?
    a. Decreased perception of pain (hypalgesia) on the left side of the body
    b. Dysarthria
    c.  Deviation of the right eye downward and laterally with inability to adduct, elevate, or depress the eye
    d.  Increased deep tendon reflexes in the left upper and lower limbs
    e.  None of the above are correct



12. A patient presents with the acute onset of horizontal (side-by-side) diplopia when looking to the right.  Examination is normal except for the following.  When the patient looks toward the right, the right eye abducts normally, but the left eye fails to adduct.  Which of the following statements concerning this patient’s findings is (are) true?
    a. The lesion is in the lower third of the pons on the right
    b. The lesion involves the left medial longitudinal fasciculus (MLF)
    c.   The lesion involves the right abducent nucleus
    d. This condition is known as a left internuclear ophthalmoplegia (INO)
    e.  only a and c are correct
    f.  only b and d are correct



13. Upper motor neurons originating from the right frontal eye field (areas 8, 6) and destined to produce conjugate horizontal gaze to the left:
    a. pass through the right anterior limb of the internal capsule
    b. cross the midline in the upper pons and enter the left paramedian pontine reticular formation (PPRF)
    c.  ultimately filter their way down through the PPRF to the left abducent nucleus, which serves as the pontine horizontal gaze center
    d.  all of the above are correct
    e. only a and c are correct


14. Damage to the lateral hemisphere of the cerebellum:
a. results in impairment of coordination of limb movements and speech
b. results in difficulty maintaining balance and equilibrium when walking or sitting
c.  interrupts cerebellar efferent pathways (output) from the dentate nucleus to the thalamus
d.  all of the above are correct
e.   only a and c are correct



15. Damage to the flocculonodular lobe and/or vermis of the cerebellum:  
    a. results in impairment of balance when sitting (truncal ataxia)
    b. results in difficulty maintaining balance and equilibrium when walking
    c.  interrupts cerebellar efferent pathways (output) from the dentate nucleus to the brain stem
    d. all of the above are correct
    e. only a and b are correct
    
    


16. The posterior spinocerebellar tract:
    a.  has its cell bodies of origin in the ipsilateral thoracic nucleus (nucleus dorsalis, Clarke’s column)
    b. enters the cerebellum through the inferior cerebellar peduncle and ends in the cortex of the lateral hemisphere (neocerebellum)
    c.   carries information concerning vibration and pain
    d.  all of the above are correct
    e. only a and c are correct



17. Which statement(s) concerning the cerebellum is (are) true?
    a. it is involved in stereotyped, postural, and associated movements (e.g., arm swinging while walking).
    b. one side of the cerebellum is related to the contralateral side of the body
    c.  it functions below the level of conscious awareness
    d. all of the above are correct
    e. only a and c are correct
    
    


18. Climbing fibers in the cerebellar cortex:
    a. originate in the contralateral inferior olivary nucleus of the medulla
    b. enter the cerebellum via the middle cerebellar peduncle
    c.  synapse on the dendrites of a single Purkinje cell (piriform neuron) in an all-or-none excitatory (glutamate) connection
    d. all of the above are correct
    e. only a and c are correct
    
    


19. Decerebrate (extensor) posturing:
    a. is due to a lesion between the red nucleus of the midbrain and the vestibular nuclei in the upper medulla
    b. results, in part, from preserved function of the lateral vestibular nucleus and the (lateral) vestibulospinal tract, which is excitatory to extensor muscle groups and inhibitory to flexor muscle groups
    c.  results, in part, from impaired function of the corticospinal, rubrospinal, and corticoreticular (especially those to the medullary reticular formation) fibers, which are excitatory to flexor muscle groups and inhibitory to extensor muscle groups
    d. all of the above are correct
    e. only a and c are correct
    
    


20. Which of the following statements concerning the function of the basal nuclei is(are) true?
    a. The basal nuclei integrate input from the hypothalamus, spinal cord, cerebellum, brain stem cranial nerve nuclei, and limbic system
    b. The basal nuclei function in parallel with the neocerebellum by exerting their influence on the cerebral cortex rather than directly on the brain stem or spinal cord lower motor neurons.
    c.  The basal nuclei are important in regulating the timing and precision of discrete limb movements, eye movements, and vocalization
    d. The basal nuclei act on or affect motor activity on the contralateral side of the body
    e. only b and d are correct



21. Which of the following areas or structures have direct afferent input into the lateral globus pallidus (or pars externa; GPe)?
    a. subthalamic nucleus
    b. substantia nigra
    c.  putamen
    d. all of the above are correct
    e. only a and c are correct
    
    


22. The medial globus pallidus (or pars interna; GPi)
    a. receives input from the putamen
    b. receives input from the subthalamic nucleus
    c.  projects to the ventral lateral and ventral anterior nuclei of the thalamus
    d. projects to the subthalamic nucleus
    e. all of the above are correct
    f.  only a, b, and c are correct


23. The substantia nigra, pars reticularis (SNpr):
    a. projects directly to the ventral anterior and ventral lateral nuclei of the thalamus
    b. consists of neurons containing a dark pigment (melanin) which is a byproduct of GABA synthesis
    c.  has direct connections with the globus pallidus via the subthalamic fasciculus
    d. projects directly to the striatum via an inhibitory dopaminergic pathway
    e. only b and d are correct 



24. Which of the following structures are part of the “indirect pathway” of basal nuclei (ganglia) connections?
    a. lateral globus pallidus (or pars externa; GPe)
    b.  medial globus pallidus (or pars interna; GPi)
    c.  subthalamic nucleus
    d. striatum (caudate and putamen)
    e. all of the above are correct
    f.  only a and c are correct
    g. only b and d are correct
      
Extended Matching Set - For each of the 4 questions below, indicate the letter of the most closely related item from the list. Each option may be correct for more than one question.


25. Involved in mediating the jaw jerk.
    a. Left postcentral gyrus
    b. Left pontine nucleus of V
    c.  Mesencephalic nucleus of V
    d. Left spinal tract of V
    e.  Right trigeminal lemniscus
    f.  Right spinal nucleus of V
    
    


26. Receives discriminative (fine) touch fibers from the left side of the face.
    a. Left postcentral gyrus
    b. Left pontine nucleus of V
    c.  Mesencephalic nucleus of V
    d. Left spinal tract of V
    e. Right trigeminal lemniscus
    f.  Right spinal nucleus of V
    
    


27. Brodmann areas 3, 1, 2.
    a. Left postcentral gyrus
    b. Left pontine nucleus of V
    c.  Mesencephalic nucleus of V
    d. Left spinal tract of V
    e. Right trigeminal lemniscus
    f.  Right spinal nucleus of V



28. Projects its axons to the left ventral posteromedial (VPM) nucleus of the thalamus.
    a. Left postcentral gyrus
    b. Left pontine nucleus of V
    c.  Mesencephalic nucleus of V
    d. Left spinal tract of V
    e. Right trigeminal lemniscus
    f.  Right spinal nucleus of V
    
    

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