Pre-test 2b

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Pretest 2b

Pretest #2b

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Which of the following statements concerning the somatic sensory pathways is (are) 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 thalamus.
d. all of the above are correct
e. only a and c are correct
A patient presents with an inability to identify a common object (eg, key) placed in his right hand with his eyes closed (stereoagnosia). He also has difficulty determining the static position of the fingers of his right hand with his eyes closed (statoagnosia). Where was the lesion producing these signs located?
a. left inferior parietal lobule (areas 39, 40)
b. left cuneus (areas 18, 19)
c. left supramarginal gyrus (area 40)
d. right nucleus cuneatus
e. right nucleus gracilis

Nociceptive information is transmitted by which nerve fibers?
a. Aβ
b. Aδ
c. C
d. All of the above are correct
e. Only b and c are correct

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

Characteristics of a "lower motor neuron lesion" include:
a. weakness
b. muscular atrophy
c. hyperreflexia
d. fasciculations
e. only a, b, and d are correct

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

A patient presents with weakness of the right upper and lower limbs. On examination, he exhibits absent biceps and brachioradialis deep tendon reflexes (DTRs) on the right, but his right triceps, knee, and ankle jerks (DTRs) are hyperactive. Which of the following statements is (are) true?
a. He also exhibits weakness of the lower facial muscles on the right.
b. Muscle tone in his right lower limb is increased.
c. The lesion is in the posterior limb of the internal capsule on the left.
d. The lesion involves the C5-C6 segments of the spinal cord on the right.
e. only b and d are correct

Concerning the concept of an "upper motor neuron lesion":
a. signs and symptoms include weakness, hyporeflexia, muscular atrophy, and fasciculations
b. damage to the putamen can produce the syndrome
c. damage to the corticospinal tract PLUS other descending motor pathways results in the syndrome
d. all of the above are correct
e. only a and c are correct

A lower motor neuron facial weakness:
a. consists of a weakness mainly of the lower facial muscles contralateral to a lesion in the brain
b. consists of a weakness of all of the facial muscles ipsilateral to a lesion in the brain
c. is due to the fact that the part of the facial nucleus supplying the lower facial muscles receives a direct (monosynaptic) input from upper motor neuron axons; whereas the part of the nucleus supplying the upper facial muscles receives a less direct (polysynaptic) input from upper motor neurons
d. all of the above are correct
e. only a and c are correct

Damage to the right frontal eye field (areas 8, 6) results in which of the following?
a. Both eyes are deviated horizontally to the left at rest.
b. Both eyes are deviated to the right at rest.
c. The patient cannot voluntarily look to the right.
d. The patient cannot voluntarily look to the left.
e. When the patient looks to the left, the right eye does not adduct.
f. The patient cannot look upward.
g. only a and c are correct
h. only b and d are correct
i. only e and f are correct

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 left, neither eye moves past the midline. When she 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 left.
b. The lesion involves the left abducent nucleus.
c. The lesion includes the left medial longitudinal fasciculus (MLF).
d. This condition is known as a “one-and-a-half syndrome”. It consists of a left horizontal gaze palsy, plus a left internuclear ophthalmoplegia (INO).
e. all of the above are correct

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 medially (esotropia) in primary gaze and an inability to abduct the right eye
d. increased deep tendon reflexes in the left upper and lower limbs
e. none of the above are correct

Which of the following statements concerning Parinaud’s syndrome are true?
a. Signs include conjugate upgaze paresis and convergence-retraction nystagmus.
b. Pupillary reflexes are usually normal.
c. Common causes include pineal tumors or hydrocephalus compressing the tectum of the midbrain.
d. all of the above are correct
e. only a and c are correct

The neocerebellum (posterior lobe, lateral cerebellar hemispheres):

e. only a and c are correct

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 fastigial nucleus to the brain stem
d. all of the above are correct
e. only a and c are correct

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 posterior lobe (neocerebellum)
c. carries information concerning pain and temperature
d. all of the above are correct
e. only a and c are correct

Which statement(s) concerning the cerebellum is (are) true?
a. It functions below the level of conscious awareness.
b. Its functions include the voluntary control of rapid, finely coordinated, skilled movements.
c. One side of the cerebellum is related to the contralateral side of the body.
d. all of the above are correct
e. only a and c are correct

The dentatorubrothalamic tract:
a. synapses on neurons primarily in the ventral lateral nucleus of the thalamus
b. crosses the midline in the decussation of the middle cerebellar peduncle in the middle third of the pons
c. is part of the cortical-pontine-cerebellar (neocerebellar) feedback loop, which terminates in the primary motor cortex (precentral gyrus, area 4)
d. all of the above are correct
e. only a and c are correct

Granule cells in the granule cell layer of the cerebellar cortex:
a. send their axons into the molecular layer of the cerebellar cortex as the parallel fibers
b. project primarily to the dentate nucleus
c. synapse with many Purkinje cell dendrites via an excitatory (glutamatergic) connection
d. all of the above are correct
e. only a and c are correct

Which of the following areas or structures receive major direct efferent output from the basal nuclei (mainly from the medial globus pallidus [or pars interna; GPi] and the substantia nigra, pars reticularis [SNpr])?
a. lower motor neuron pool in the anterior horn of the spinal cord
b. thalamus (ventral lateral and ventral anterior nuclei)
c. limbic system
d. all of the above are correct
e. only a and c are correct

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 ipsilateral side of the body.
e. all of the above are correct

Major afferent input into the striatum (caudate nucleus and putamen) is:
a. from the substantia nigra, pars reticularis (SNpr)
b. inhibitory using acetylcholine as a neurotransmitter
c. from the cerebral cortex
d. excitatory using GABA as a neurotransmitter
e. only a and c are correct

The substantia nigra, pars compacta (SNpc):
a. projects directly to the globus pallidus
b. consists of neurons containing a dark pigment (melanin) which is a byproduct of dopamine synthesis
c. has direct connections with the subthalamic nucleus via the subthalamic fasciculus
d. projects directly to the striatum via both inhibitory and excitatory dopaminergic pathways
e. only b and d are correct

Extended Matching Set

Synapses in the left spinal nucleus of V.
a. Right postcentral gyrus
b. Right pontine nucleus of V
c. Mesencephalic nucleus of V
d. Left spinal tract of V
e. Left trigeminal lemniscus
f. Right spinal nucleus of V

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

Carries pain and temperature from the left side of the face.
a. Right postcentral gyrus
b. Right pontine nucleus of V
c. Mesencephalic nucleus of V
d. Left spinal tract of V
e. Left trigeminal lemniscus
f. Right spinal nucleus of V

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

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