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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 the spinal cord or brain stem
   c.  Third-order neuron cell bodies are located in the thalamus
   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. 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. left superior parietal lobule (areas 5, 7)
   e. right nucleus gracilis


3. Which of the following transmitters is involved in descending modulatory nociceptive pathways?
   a. Substance P
   b. Norepinephrine
   c.  CGRP
   d. Acetylcholine
   e. Somatostatin


4. Characteristics of a "lower motor neuron lesion" include:
   a. weakness
   b. muscular atrophy
   c.  hyporeflexia
   d. fasciculations
   e. all of the above are correct


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


6. The corticospinal tract:
   a. is concerned with the voluntary control of rapid, finely coordinated, skilled movements (especially of the hands)
   b. passes through the anterior limb of the internal capsule, the tegmentum of the pons and midbrain, and crosses the midline in the upper 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. all of the above are correct


7. A "pure motor hemiplegia" (i.e., paralysis of an upper and lower limb on one side of the body without any sensory impairment) could be caused by a unilateral lesion in which of the following structures?
   a. pyramid of the medulla
   b. basal part of the pons
   c.  posterior limb of the internal capsule (3rd quarter)
   d. crus cerebri of the midbrain
   e. all of the above are correct 


8. An upper 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


9. The corticonuclear (corticobulbar) fibers of the pyramidal system:
   a. supply the motor nuclei of cranial nerves II, III, V, VI, VII, and VIII in the brain stem
   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


10. A patient comes to the emergency room with weakness of the right upper and lower limbs and is unable to move either eye to the left (and therefore both eyes are deviated to the right).  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 weakness of all of the facial muscles on the left side
    c.   The lesion involves the upper midbrain on the left side
    d. The lesion involves the lower pons on the left side
    e. only b and d are correct


11. Vertical conjugate eye movements:
    a. are mediated by simultaneous activity of both frontal eye fields (areas 8, 6)
    b. require an intact medial longitudinal fasciculus (MLF)
    c.  utilize a “vertical gaze center” in the lower third of the pons
    d. all of the above are correct
    e. only a and c are correct


12. In the oculosympathetic pathway mediating the signs and symptoms of the Horner’s syndrome (ptosis, miosis, and facial anhidrosis):
    a. the 3rd order (postganglionic) neuron cell bodies are located in the superior cervical sympathetic ganglion and send their axons onto the external carotid artery (for innervation of sweat glands of the face, except for a small area in the supraorbital region) and onto the internal carotid artery (for innervation of the dilator pupillae muscle, smooth muscle portion of the levator palpebrae superioris, and the sweat glands in the supraorbital region)
    b. the 2nd order (preganglionic) neuron cell bodies are located in the upper 1-3 thoracic sympathetic chain ganglia and send their axons upward through the cervical sympathetic chain to synapse with the postganglionic cell bodies in the superior cervical sympathetic ganglion on the anterolateral surface of the upper cervical vertebral column
    c.   the 1st order (central) neuron cell bodies are located in the ipsilateral hypothalamus and send their axons down through the lateral brain stem fields (in a multisynaptic fashion)
    d. all of the above are correct
    e. only a and c are correct


13. When testing eye movements, which are the predominant extraocular muscles utilized when a patient looks down and to the left?
    a. right superior oblique muscle
    b. left inferior oblique muscle
    c.  left inferior rectus muscle
    d. right inferior rectus muscle
    e. a and c are correct
    f.  b and d are correct


14. The neocerebellum (posterior lobe, lateral cerebellar hemispheres):
a. is related to the fastigial nucleus of the cerebellum
b. functions to maintain equilibrium and regulate posture and balance of the trunk
c.  functions by projecting back up to the motor cortex (precentral gyrus) of the cerebrum, and thereby exerts its control of motor activity by influencing the activity of the pyramidal system (corticospinal and corticonuclear tracts)
d.  receives its afferent input mainly from the vestibular nuclei via the inferior cerebellar peduncle
e. all of the above are correct


15. Damage to the flocculonodular lobe and/or vermis of the cerebellum:  
    a. results in impairment of limb movements and coordination
    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
    
    
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 anterior lobe (paleocerebellum)
    c.  carries information concerning muscle tone and unconscious proprioception
    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 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 ipsilateral side of the body
    d. all of the above are correct
    e. only a and c are correct
    
    


18. Oculopalatal tremor (or palatal myoclonus) can be caused by a lesion involving which of the following structures?
    a. red nucleus
    b. central tegmental tract
    c.  dentate nucleus of the cerebellum
    d. inferior olivary nucleus
    e. all of the above are correct
    f.  none of the above are correct


19. Mossy fibers in the cerebellar cortex:
    a. originate in the contralateral pontine nuclei of the basilar part of the pons
    b. originate in the ipsilateral thoracic nucleus (nucleus dorsalis, Clarke’s column) of the T1-L3 spinal cord
    c.  synapse on the dendrites of many granule cells in the granule cell layer of the cerebellar cortex via an excitatory (glutamatergic) connection
    d. originate in the ipsilateral vestibular nuclei of the upper medulla and lower pons
    e. all of the above are correct
    f.  only a and c are correct


20. Which of the following areas or structures receive major direct efferent output from the medial globus pallidus (or pars interna; GPi) and substantia nigra, pars reticularis (SNpr)?
    a. substantia nigra, pars compacta (SNpc)
    b. thalamus (ventral lateral and ventral anterior nuclei)
    c.  subthalamic nucleus
    d. all of the above are correct
    e. only a and c are correct


21. Which of the following statements concerning the function of the basal nuclei is(are) true?
    a. The basal nuclei receive input from a wide variety of areas of the brain and therefore are probably important in modulating and integrating that information
    b. The basal nuclei function in parallel with the neocerebellum by exerting their influence on the cerebral cortex rather than directly on the brainstem or spinal cord lower motor neurons.
    c. The basal nuclei are important in controlling complex, stereotyped motor activities such as postural adjustments, balance, and locomotion
    d. The basal nuclei act on or affect motor activity on the contralateral side of the body
    e. all of the above are correct
    
    
22. Which of the following areas or structures have direct afferent input into the basal nuclei (especially the caudate and putamen)?
    a. substantia nigra, pars compacta (SNpc)
    b. thalamus (centromedian nucleus)
    c.  cerebral cortex
    d. all of the above are correct
    e. only a and c are correct


23. The subthalamic nucleus:
    a. projects directly to the medial globus pallidus (or pars interna; GPi) via the
        subthalamic fasciculus (excitatory)
    b. consists of neurons containing a dark pigment (melanin) which is a byproduct of dopamine synthesis
    c.  receives direct projections from the lateral globus pallidus (or pars externa; GPe) via the subthalamic fasciculus (inhibitory)
    d. projects directly to the thalamus via an excitatory glutaminergic pathway
    e. only a and c 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.


24. Carries conscious proprioception (joint position sense) from the left upper limb and left lower limb
    a. Right medial lemniscus
    b. Dorsal roots of right C5-T1 spinal nerves
    c. Right fasciculus gracilis
    d. Right spinothalamic tract at the level of the T10 spinal cord
    e. Left ventral posterior medial (VPM) nucleus of the thalamus
    f.  Right spinal lemniscus in the medulla
    g. Left fasciculus cuneatus
    h. Left spinal lemniscus in the midbrain  


25. Carries pain and temperature from the left upper limb.
    a. Right medial lemniscus
    b. Dorsal roots of right C5-T1 spinal nerves
    c. Right fasciculus gracilis
    d. Right spinothalamic tract at the level of the T10 spinal cord
    e.  Left ventral posterior medial (VPM) nucleus of the thalamus
    f.  Right spinal lemniscus in the medulla
    g. Left fasciculus cuneatus
    h. Left spinal lemniscus in the midbrain


26. Carries pain and temperature from the left lower limb only.
    a. Right medial lemniscus
    b. Dorsal roots of right C5-T1 spinal nerves
    c. Right fasciculus gracilis
    d. Right spinothalamic tract at the level of the T10 spinal cord
    e. Left ventral posterior medial (VPM) nucleus of the thalamus
    f.  Right spinal lemniscus in the medulla
    g. Left fasciculus cuneatus
    h. Left spinal lemniscus in the midbrain
    
    


27. Carries vibratory sensation from the right upper limb.
    a. Right medial lemniscus
    b. Dorsal roots of right C5-T1 spinal nerves
    c. Right fasciculus gracilis
    d. Right spinothalamic tract at the level of the T10 spinal cord
    e. Left ventral posterior medial (VPM) nucleus of the thalamus
    f.  Right spinal lemniscus in the medulla
    g. Left fasciculus cuneatus
    h. Left spinal lemniscus in the midbrain
    
    

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