CHAPTER REVIEW

QUESTIONS
End of chapter questions in Snell’s clinical Neuroanatomy. 7th edition

Anatomy and physiology of CNS

Okurut Steven
BSMR
21/U/22255
CHAPTER 1 6. The following statements concern the peripheral
nervous
Directions: Each of the incomplete statements in this system:
section is (a) There are ten pairs of cranial nerves.
followed by completions of the statement. Select the (b) There are eight pairs of cervical spinal nerves.
ONE lettered
completion that is BEST in each case. REVIEW QUESTIONS
1. The spinal cord has (c) The posterior root of a spinal nerve contains many
(a) an outer covering of gray matter and an inner core efferent motor nerve fibers.
of white matter. (d) A spinal nerve is formed by the union of an anterior
(b) an enlargement below that forms the conus and a posterior ramus in an intervertebral
medullaris. foramen.
(c) anterior and posterior roots of a single spinal nerve (e) A posterior root ganglion contains the cell bodies
attached to a single segment. of autonomic nerve fibers leaving the spinal cord.
(d) cells in the posterior gray horn that give rise to 7. The following statements concern the central nervous
efferent system:
fibers that supply skeletal muscles. (a) A CT brain scan cannot distinguish between white
(e) a central canal that is situated in the white matter and gray matter.
commissure. (b) The lateral ventricles are in direct communication
2. The medulla oblongata has with the fourth ventricle.
(a) a tubular shape. (c) An MRI of the brain uses the magnetic properties of
(b) the fourth ventricle lying posterior to its lower part. the hydrogen nucleus excited by radiofrequency
(c) the midbrain directly continuous with its upper radiation transmitted by a coil surrounding the
border. patient’s head.
(d) no central canal in its lower part. (d) Following trauma and sudden movement of the
(e) the spinal cord directly continuous with its lower brain within the skull, the large arteries at the base
end in the foramen magnum. of the brain are commonly torn.
3. The midbrain has (e) The movement of the brain at the time of head
(a) a cavity called the cerebral aqueduct. injuries is unlikely to damage the small sixth cranial
(b) a large size. nerve.
(c) no cerebrospinal fluid around it. 8. The following statements concern the cerebrospinal
(d) a cavity that opens above into the lateral ventricle. fluid:
(e) a location in the middle cranial fossa of the skull. (a) The cerebrospinal fluid in the central canal of the
Directions: Each of the numbered items in this section is spinal cord is unable to enter the fourth ventricle.
followed (b) With the patient in the recumbent position,the
by answers. Select the ONE lettered answer that is normal
CORRECT. pressure is about 60 to 150 mm of water.
4. The following statements concern the cerebellum: (c) It plays only a minor role in the protection of the
(a) It lies within the middle cranial fossa. brain and spinal cord from traumatic injury.
(b) The cerebellar cortex is composed of white matter. (d) Compression of the internal jugular veins in the
(c) The vermis is the name given to that part joining the neck lowers the cerebrospinal fluid pressure.
cerebellar hemispheres together. (e) The subdural space is filled with cerebrospinal
(d) The cerebellum lies anterior to the fourth ventricle. fluid.
(e) The dentate nucleus is a mass of white matter 9. The following statements concern the vertebral levels
found in each cerebellar hemisphere. and the spinal cord segmental levels:
5. The following statements concern the cerebrum: (a) The first lumbar vertebra lies opposite the L3-4
(a) The cerebral hemispheres are separated by a segments
fibrous septum called the tentorium cerebelli. of the cord.
(b) The bones of the vault of the skull are named for (b) The third thoracic vertebra lies opposite the third
the lobes of the cerebral hemisphere over which thoracic spinal cord segment.
they lie. (c) The fifth cervical vertebra lies opposite the seventh
(c) The corpus callosum is a mass of gray matter lying cervical spinal cord segment.
within each cerebral hemisphere. (d) The eighth thoracic vertebra lies opposite the ninth
(d) The internal capsule is an important collection of thoracic spinal cord segment.
nerve fibers, which has the caudate nucleus and (e) The third cervical vertebra lies opposite the fourth
the thalamus on its medial side and the lentiform cervical spinal cord segment.
nucleus on its lateral side. Directions: Each case history is followed by questions.
(e) The cavity present within each cerebral hemisphere Select the
is called the cerebral ventricle. ONE BEST lettered answer.
A 23-year-old woman was unconscious when admitted the muscles of the left leg. Radiologic examination
to showed
the emergency department.While crossing the road,she that the osteoarthritic changes had spread to involve the
had boundaries of many of the lumbar intervertebral
been hit on the side of the head by a bus.Within an foramina.
hour,she 13. Explain the change in the symptoms and signs found
was found to have a large doughlike swelling over the in
right this patient.
temporal region.She also had signs of muscular (a) The sciatic nerve was compressed in the pelvis by
paralysis on a spreading rectal cancer.
the left side of the body. A lateral radiograph of the (b) The patient had developed advanced atherosclerosis
skull of the arteries of the right lower limb.
showed a fracture line running downward and forward (c) The osteoarthritic process had produced osteophytes
across the anterior inferior angle of the right parietal that encroached on the intervertebral foramina,
bone. Her coma deepened, and she died 5 hours after the compressing the segmental spinal nerve roots.
accident. (d) Neuritis had developed in the sciatic nerve trunk.
10. Select the most likely cause of the swelling over the (e) The patient was experiencing psychiatric problems
right
temporal region in this patient.
(a) Superficial bruising of the skin
(b) Hemorrhage from a blood vessel in the temporalis
muscle
(c) Rupture of the right middle meningeal vessels
(d) Edema of the skin
(e) Hemorrhage from a blood vessel in the superficial
fascia
11. Select the most likely cause of the muscular
paralysis of
the left side of the body in this patient.
(a) Laceration of the right side of the cerebral
hemisphere
(b) Right-sided epidural hemorrhage
(c) Left-sided epidural hemorrhage
(d) Injury to the cerebral cortex on the left side of the
brain
(e) Injury to the right cerebellar hemisphere
A 69-year-old man was admitted to the neurology unit
complaining
of severe discomfort of the lower back. Radiologic
examination of the lumbar region of the vertebral
column
revealed significant narrowing of the spinal canal
caused
by advanced osteoarthritis.
12. Explain the discomfort in the lower back
experienced
by this patient.
(a) Muscle fatigue
(b) Prolapsed intervertebral disc
(c) Torn ligament in the joints of the lumbar region of
the spine
(d) Compression of the cauda equina
(e) Bad posture
Later, in this same patient, the back pain became more
severe and now radiated down the back of the left leg;
the
patient was also experiencing difficulty walking.
Examination
of the patient revealed weakness and some wasting of
CHAPTER 2 (c) Inhibitory stimuli are believed to produce their
effect by causing an influx of K" ions through the
Directions: Each of the numbered items in this section is plasma membrane of the neuron.
followed (d) Hyperpolarization can be produced by causing an
by answers. Select the ONE lettered answer that is influx of K" ions through the plasma membrane.
CORRECT. (e) The axolemma is the site of nerve conduction.
1. The following statements concern the cytology of a 5. The following statements concern the structure of a
neuron: synapse:
(a) A unipolar neuron is one that gives rise to a single (a) Synapses may be axodendritic, axosomatic, or
neurite that divides a short distance from the cell axoaxonic.
body into two branches, one proceeding to some (b) The synaptic cleft is the space between the
peripheral structure and the other entering the central presynaptic
nervous system. and postsynaptic membranes and measures
(b) A bipolar neuron is one that has two neurites that about 200 nm.
emerge together from the cell body. (c) The subsynaptic web lies beneath the presynaptic
(c) Nissl substance is found in the axon of a neuron. membrane.
(d) The Golgi complex does not synthesize cell (d) Presynaptic vesicles do not contain the
membranes. neurotransmitter
REVIEW QUESTIONS substance.
(e) Melanin granules are not found in the neurons of (e) All neurons produce and release several types of
the substantia nigra. transmitter substances at all their nerve endings.
2. The following statements concern the cytology of a 6. The following statements concern a neuron:
neuron: (a) Nerve fibers are the dendrites and axons of a
(a) The protein molecules projecting from the surface neuron.
of the microtubules take no part in rapid transport (b) The volume of cytoplasm within the nerve cell
in axoplasm. body always far exceeds that found in the neurites.
(b) The protein molecules that extend through the full (c) Golgi type I neurons have very short axons.
thickness of the plasma membrane of a neuron (d) Golgi type II neurons have very long axons.
serve as sodium and potassium channels. (e) Golgi type II neurons form the Purkinje cells of the
(c) There is strong experimental evidence to suggest cerebellar cortex.
that the gates of the sodium and potassium channels 7. The following statements concern the neuron
are formed by actin molecules. organelles
(d) The size of the nucleolus in a neuron is unrelated to and inclusions:
the volume of cytoplasm possessed by neurons. (a) Centrioles are not found in mature nerve cells.
(e) A synapse is the site where two neurons come (b) Lipofuscin granules tend to disappear with age.
together and their membranes are in contact; (c) The Nissl substance fills the axon hillock but is
interneuronal communication occurs. absent from other areas of the cytoplasm.
3. The following statements concern the axon: (d) Microfilaments contain actin and do not assist in
(a) The initial segment of the axon is the first 500 !m cell transport.
after it leaves the axon hillock. (e) Mitochondria are found in the dendrites and
(b) The nerve impulse generated by a neuron does not axons.
originate at the initial segment of an axon but on 8. The following statements concern dendrites:
the dendrite. (a) A dendrite conveys a nerve impulse away from the
(c) The action potential is produced by the sudden nerve cell body.
influx of Na" ions into the cytoplasm. (b) Dendritic spines are small projections of the
(d) Following the influx of Na" ions in the production plasma membrane that increase the receptor surface
of the action potential, the permeability for Na" area of the dendrite.
ions increases further, and the permeability for K" (c) The cytoplasm of dendrites does not contain
ions ceases. ribosomes
(e) The spread of the action potential along the and agranular endoplasmic reticulum.
microtubules (d) Most dendrites expand in width as they extend
of the axon constitutes the nerve impulse. from the nerve cell body.
4. The following statements concern a nerve impulse: (e) Dendrites rarely branch.
(a) The refractory period is the duration of the 9. The following statements concern neuromodulators:
nonexcitable (a) Neuromodulators may coexist with the principal
state of the plasma membrane following the (classic) transmitter at a single synapse.
passage of a wave of repolarization. (b) They often diminish and shorten the effect of the
(b) Subthreshold stimuli, when applied to the surface principal transmitter.
of a neuron, cannot be summated. (c) They never act through a second messenger.
(d) They have a brief effect on the postsynaptic possess microvilli and cilia.
membrane. (e) Ependymal cells are incapable of absorbing
(e) Acetylcholine (muscarinic) is not a good example substances
of a neuromodulator. from the cerebrospinal fluid.
10. The following statements concern the neurobiology 14. The following statements concern the extracellular
of space:
neuron structures: (a) The space is formed by the gaps between the neurons
(a) A lysosome is a membrane-bound vesicle covered and not the gaps between the neuroglial cells.
with ribosomes. (b) The space surrounds the lymphatic capillaries
(b) A terminal bouton is the postsynaptic part of an present
axon. in the brain and spinal cord.
(c) A receptor is a protein molecule on the postsynaptic (c) The space is not in continuity with the subarachnoid
membrane. space.
(d) Nissl substance is formed of the smooth surfaced (d) The space is filled with tissue fluid.
endoplasmic reticulum. (e) The space is not continuous with the synaptic cleft
(e) Microtubules provide a mobile track that allows between two neurons.
specific organelles to move by molecular motors. 15. The following statements concern tumors of
11. The following statements concern neuroglia: neuroglia:
(a) Fibrous astrocytes are located mainly in the gray (a) They form about 5% of all intracranial tumors.
matter of the central nervous system. (b) Apart from the ependymomas, tumors of neuroglia
(b) Replacement gliosis follows the death of neurons grow slowly and are not highly invasive.
in the central nervous system and is due to the (c) They commonly infiltrate between neurons, causing
proliferation the minimum disturbance of function.
of astrocytes. (d) They are nonmalignant and easily removed
(c) Astrocytes are not involved in the absorption of surgically.
gamma-aminobutyric acid (GABA)GABA secreted (e) As they expand,they raise the intracranial pressure.
by the nerve terminals. 16. The following statements concern neuroglial cells:
(d) Oligodendrocytes are responsible for the formation (a) They tend to be larger than nerve cell bodies.
of the myelin of nerve fibers in the peripheral nervous (b) Heat increases the action potential in an axon
system. and reduces the signs and symptoms in multiple
(e) A single oligodendrocyte can form,by means of its sclerosis.
processes, only one internodal segment of myelin (c) Oligodendrocytes are found some distance away
on the same axon. from nerve cell bodies and their neurites.
12. The following statements concern the microglial (d) Multiple sclerosis is a disease involving the
cells: oligodendrocyte.
(a) Microglial cells resemble connective tissue mast (e) Like Schwann cells, oligodendrocytes are
cells. surrounded
(b) Microglial cells are larger than astrocytes or by a basement membrane.
oligodendrocytes. 17. The following general statements concern the
(c) Microglial cells migrate into the central nervous neuroglial
system during adult life. cells:
(d) In the presence of damaged neurons, microglial (a) The microglial cells have straight processes with
cells become branched. spinelike projections.
(e) In degenerative lesions of the central nervous (b) The astrocytes form a scaffold for developing
system, neurons.
the circulating blood contributes cells to the (c) Oligodendrocyte processes are not continuous
population of microglial cells. with the myelin sheaths.
13. The following statements concern the ependymal (d) The ependymal cells have no cilia on their free
cells: borders.
(a) Choroidal epithelial cells do not secrete (e) Macroglia is the term used to distinguish the larger
cerebrospinal oligodendrocytes from the smaller astrocyte.
fluid.
(b) The ependymocytes line the ventricular system but
do not permit the cerebrospinal fluid to enter the
extracellular spaces of the nervous tissue.
(c) Tanycytes have short, unbranched basal processes,
many of which have end feet placed on the capillaries CHAPTER 3
of the median eminence. Directions: Each of the numbered items in this section is
(d) The ependymal cells form a single layer, and many followed
by answers. Select the ONE lettered answer that is branch.
CORRECT. (c) The plexuses at the roots of the limbs are formed
1. The following statements concern nerves: from posterior rami of spinal nerves.
(a) A nerve tract is the name given to a nerve fiber in (d) The plexuses of the autonomic nervous system
the peripheral and central nervous systems. possess a network of efferent nerve fibers and no
(b) The supporting cell of a myelinated nerve fiber in nerve cells.
the (e) A plexus situated at the root of a limb permits nerve
central nervous system is called an oligodendrocyte. fibers from different segments of the spinal cord to
(c) A node of Ranvier in peripheral nerves is where become rearranged so that they more easily travel
two Schwann cells come together and cover the to different parts of the limb.
exposed part of the plasma membrane of the axon. 6. The following statements concern nerve conduction:
(d) Nodes of Ranvier are absent from myelinated nerve (a) An adequate stimulus decreases the permeability
fibers in the central nervous system. of the axolemma to Na$ ions at the point of stimulation.
(e) The major dense line of myelin consists of two (b) During the absolute refractory period, a very strong
inner lipid layers of the plasma membrane that are stimulus will excite the nerve fiber.
fused together. (c) As the action potential moves along the axon, the
2. The following statements concern nerves: entry of Na$ ions into the axon increases and the
(a) The minor dense line of myelin is made up of permeability to K$ ions decreases.
protein. (d) A typical action potential is about $40 mV.
(b) The incisures of Schmidt-Lanterman are caused by (e) In the resting unstimulated nerve fiber, the interior
the mesaxons of the Schwann cells. of the axolemma is positive to the exterior.
(c) Only five or six unmyelinated axons may share a 7. The following statements concern the propagation of
single Schwann cell in the peripheral nervous a
system. nerve impulse:
(d) The node of Ranvier is the site of nerve activity. (a) The conduction velocity is smallest in nerve fibers
(e) Chromatolysis is the term used to describe the having a large cross-sectional diameter.
changes in the arrangement of Nissl material within (b) In nonmyelinated nerve fibers, the action potential
the axon following injury. occurs along the length of the fiber.
3. The following statements concern an (c) A myelinated nerve fiber can be stimulated only
oligodendrocyte: between the nodes of Ranvier.
(a) A single oligodendrocyte may be associated with (d) Saltatory conduction occurs only in the central
one segment of myelin on a single axon. nervous system.
(b) The incisures of Schmidt-Lanterman are not present (e) At the node of Ranvier, the action potential has no
in the myelinated fibers of the central nervous effect on the surrounding tissue fluid.
system. 8. The following statements concern wallerian
REVIEW QUESTIONS degeneration:
(c) Myelination in the central nervous system occurs (a) The myelin breaks down into droplets that are
by the rotation of the axon within the oligodendrocytic phagocytosed by the Schwann cells.
process and the wrapping of it around the (b) The axon rapidly disappears.
axon. (c) The Schwann cells round off and do not multiply.
(d) A nonmyelinated axon in the central nervous system (d) In the central nervous system,the debris is removed
has a special relationship with the oligodendrocyte. by the astrocyte cells.
(e) A single oligodendrocyte may be associated with (e) In the peripheral nervous system, the tissue
the myelin sheaths of as many as 60 axons. macrophages play no part in the digestion of the
4. The following statements concern spinal nerves: nerve fragments.
(a) There are 26 pairs. 9. The following statements concern the failure of
(b) They are formed by the union of anterior and regeneration
posterior of nerve fibers in the central nervous system:
nerve roots. (a) Endoneurial tubes are present.
(c) The posterior ramus contains only sensory axons. (b) Oligodendrocytes have a basement membrane.
(d) The anterior root contains only sensory axons. (c) Oligodendrocytes fail to multiply and form a band
(e) The posterior root ganglion contains bipolar neurons fiber,as do Schwann cells in the peripheral nervous
enveloped in capsular cells. system.
5. The following statements concern peripheral nerve (d) The blood supply is not usually adequate.
plexuses: (e) There are nerve growth factors present.
(a) They are formed by a network of connective tissue 10. The following factor may explain the partial return
fibers. of
(b) Bundles of nerve fibers do not branch, and in most function following injury to the spinal cord:
instances, the individual nerve fibers do not (a) The edema fluid persists at the site of injury.
(b) Nonfunctional neurons never take over the function 15. The following statements concern the
of damaged neurons. neurotendinous
(c) A reduction in the number of receptor sites may spindles:
occur on the postsynaptic membranes. (a) They are situated in tendons some distance away
(d) Some of the axons completely regenerate. from the musculotendinous junction.
(e) With training, the patient may use other muscles to (b) The nerve terminates in a single club-shaped ending.
compensate for the loss of paralyzed muscles. (c) Each has a fibrous capsule, loosely arranged
11. The following statements concern receptor endings: collagen
(a) The rods and cones of the eyes are chemoreceptors. fibers, and tendon cells.
(b) The taste and smell endings are electromagnetic (d) Neurotendinous spindles are found only in
receptors. slowacting
(c) Free nerve endings have no Schwann cells covering muscles.
their tips. (e) The neurotendinous spindle is activated by
(d) Merkel discs are fast-adapting touch receptors. changes in muscle tension and stimulates muscle
(e) Meissner’s corpuscles are absent from the skin of contraction.
the palm of the hand and the sole of the foot. 16. The following statements concern the
12. The following statements concern receptor endings: neuromuscular
(a) The pacinian corpuscle is a slowly adapting junctions in skeletal muscle:
mechanoreceptor. (a) Each terminal branch of the motor nerve ends as
(b) Ruffini corpuscles are fast-adapting stretch receptors an axon covered with fine connective tissue.
found in the dermis of hairy skin. (b) Each axon lies in a groove on the surface of the
(c) Each pacinian corpuscle has no capsule but has a muscle fiber formed by the infolding of the muscle
central core containing the nerve ending. plasma membrane (sarcolemma).
(d) The annulospiral endings in skeletal muscle do not (c) Having caused depolarization of the postsynaptic
possess intrafusal muscle fibers. membrane, acetylcholine is reabsorbed into the
(e) There is a considerable reduction in the number of axon terminal.
Meissner’s corpuscles between birth and old age. (d) Acetylcholine is released from the axon terminal
13. The following statements concern cutaneous when the nerve impulse leaves the initial segment
receptors: of the axon.
(a) The different histologic types of receptors transmit (e) The Schwann cells form the floor for the groove on
different types of nerve impulses. the surface of the muscle fiber.
(b) The type of sensation felt is determined by the 17. The following statements concern the
specific neuromuscular
area of the central nervous system to which junctions on smooth and cardiac muscle:
the sensory nerve fiber passes. (a) In smooth muscle,the autonomic nerve fiber exerts
(c) Transduction at the receptor is the process by control over a single muscle fiber.
which the stimulus is changed into the mechanical (b) In smooth muscle,the wave of contraction does not
energy of the nerve impulse. pass from one muscle fiber to another.
(d) When applied to the receptor, the stimulus brings (c) In cardiac muscle, the wave of contraction spreads
about a change in the potential of the plasma slowly from one muscle fiber to another by way of
membranes desmosomes and gap junctions.
of the capsule cells and not the nerve (d) The autonomic nerve fibers terminate on smooth
ending. muscle as unmyelinated fibers.
(e) If small enough,the receptor potential will generate (e) At the site of the neuromuscular junction, the axon
an action potential in the afferent sensory nerve is completely surrounded by Schwann cells.
fiber. 18. The following statements concern skin sensations
14. The following statements concern the function of a and
neuromuscular dermatomes:
spindle: (a) To produce a region of complete anesthesia on the
(a) It gives rise to intermittent afferent nerve impulses. trunk, at least three segments of the spinal cord
(b) Only active muscle movement causes an increase have to be damaged.
in the rate of passage of nerve impulses in the afferent (b) When contiguous spinal nerves are sectioned, it is
nerve fiber. noted that the area of tactile loss is always smaller
(c) The neuromuscular spindle keeps the central nervous than the area of loss of painful and thermal sensations.
system informed about muscle activity. (c) The dermatome present on the medial side of the
(d) The neuromuscular spindle directly influences the wrist is C5.
control of voluntary movement. (d) The dermatome present on the point of the shoulder
(e) The flower-spray endings are situated mainly on the is C2.
nuclear bag fibers close to the equatorial region.
(e) The dermatomes for the limbs run almost (b) Posture depends on the strength of the joint
horizontally. ligaments
19. The following statements concern muscle reflexes: and not on the degree and distribution of
(a) The biceps brachii tendon reflex involves the C5-6 muscle tone.
segments of the spinal cord. (c) A particular posture can often be maintained for
(b) The triceps tendon reflex involves the T1 segment long periods by groups of muscle fibers in a muscle
of the spinal cord. contracting together continuously.
(c) The patellar tendon reflex (knee jerk) involves L5- (d) The cerebral cortex has no role in the maintenance
S1 segments of the spinal cord. of normal posture.
(d) A tumor pressing on the second, third, and fourth (e) Nerve impulses arising in the eyes and ears cannot
lumbar segments of the spinal cord is likely to interfere influence posture.
with the ankle jerk. 24. The following clinical observation on muscle
(e) The abdominal superficial reflexes involve T3-5 activity
segments can be made:
of the spinal cord. (a) Muscle contracture is a condition in which the
20. The following statements concern the dermatomes muscle contracts for a long period of time.
of (b) Muscle fasciculation is seen with chronic disease
the trunk and lower limbs: that affects sensory nerves supplying muscles.
(a) The T8 dermatome includes the skin of the (c) Muscle atrophy does not take place when a limb is
umbilicus. immobilized in a splint.
(b) The L5 dermatome lies over the lateral side of the (d) Muscle wasting can occur if only the efferent motor
knee joint. nerve fibers to a muscle are sectioned.
(c) The L2 dermatome lies over the medial side of the (e) Wasting does not occur in the muscles acting on
knee joint. the shoulder joint in patients with painful pericapsulitis
(d) The S2 dermatome runs along the lateral side of the involving that joint.
foot.
(e) The L1 dermatome lies over the inguinal ligament.
21. The following statements concern muscle
innervation:
(a) A motor unit consists of the posterior root ganglion
and all the neuromuscular spindles to which it is
connected. CHAPTER 4
(b) In the small muscles of the hand, one nerve fiber Directions: Each of the numbered items in this section is
supplies large numbers of muscle fibers. followed
(c) Neurotendinous spindles are innervated by by answers. Select the ONE lettered answer that is
nonmyelinated CORRECT.
nerve fibers. 1. The following statements concern the spinal cord:
(d) Muscle tone is dependent on the integrity of a simple (a) The anterior and posterior gray columns on the two
monosynaptic reflex arc. sides are united by a white commissure.
(e) The gamma motor efferent fibers innervate the (b) The terminal ventricle is the expanded lower end of
extrafusal fibers of a muscle spindle. the fourth ventricle.
22. The following statements concern skeletal muscle (c) The larger nerve cell bodies in the anterior gray
action: horns give rise to the alpha efferent nerve fibers in
(a) When a muscle begins to contract, the larger motor the anterior roots.
units are stimulated first. (d) The substantia gelatinosa groups of cells are
(b) Muscle fatigue is caused by an exhaustion of the located at the base of each posterior gray column.
presynaptic vesicles at the neuromuscular junction. (e) The nucleus dorsalis (Clarke’s column) is a group of
(c) When a prime mover contracts, the antagonistic nerve cells found in the posterior gray column and
muscles are inhibited. restricted to the lumbar segments of the cord.
(d) When a muscle is paralyzed, it does not immediately 2. The following statements concern the white columns
lose its normal tone. of
(e) To paralyze a muscle completely, it is not necessary the spinal cord:
to destroy several adjacent segments of the spinal (a) The posterior spinocerebellar tract is situated in the
cord or their nerve roots. posterior white column.
23. The following statements concern posture: (b) The anterior spinothalamic tract is found in the
(a) In the standing position, the line of gravity passes anterior white column.
through the odontoid process of the axis, behind (c) The lateral spinothalamic tract is found in the
the centers of the hip joints,and in front of the knee anterior
and ankle joints. white column.
(d) The fasciculus gracilis is found in the lateral white 10. The following statements concern the cell of origin
column. of
(e) The rubrospinal tract is found in the anterior white the tracts listed below:
column. (a) The fasciculus cuneatus arises from the cells in the
3. The following statements concern the spinal cord: substantia gelatinosa.
(a) The spinal cord has a cervical enlargement for the (b) The anterior spinal thalamic arises from the cells in
brachial plexus. posterior root ganglion.
(b) The spinal cord possesses spinal nerves that are (c) The fasciculus gracilis arises from the cells in the
attached to the cord by anterior and posterior rami. nucleus dorsalis (Clarke’s column).
(c) In the adult, the spinal cord usually ends inferiorly (d) The anterior spinocerebellar arises from the cells in
at the lower border of the fourth lumbar vertebra. the posterior root ganglion.
(d) The ligamentum denticulatum anchors the spinal (e) The lateral spinothalamic arises from the cells in
cord to the pedicles of the vertebra along each side. the substantia gelatinosa.
(e) The central canal does not communicate with the 11. The following statements concern the courses taken
fourth ventricle of the brain. by
Directions: Matching Questions. Questions 4 through 9 the tracts listed below:
apply to the (a) The fasciculus gracilis does not cross to the opposite
following figure. Match the numbers listed on the left side of the neural axis.
with the (b) The spinotectal tract does not cross to the opposite
side of the spinal cord.
(c) The lateral spinothalamic tract does not cross to
the opposite side of the spinal cord.
(d) The posterior spinocerebellar tract does cross to
the opposite side of the neural axis.
(e) The anterior spinothalamic tract immediately
crosses to the opposite side of the spinal cord.
12. The following statements concern the nucleus of
termination
of the tracts listed below:
(a) The posterior white column tracts terminate in the
inferior colliculus.
(b) The spinoreticular tract terminates on the neurons
of the hippocampus.
(c) The spinotectal tract terminates in the inferior
colliculus.
(d) The anterior spinothalamic tract terminates in the
ventral posterolateral nucleus of the thalamus.
(e) The anterior spinocerebellar tract terminates in the
dentate nucleus of the cerebellum.
13. The following statements relate sensations with the
appropriate nervous pathways:
(a) Two-point tactile discrimination travels in the lateral
spinothalamic tract.
REVIEW QUESTIONS (b) Pain travels in the anterior spinothalamic tract.
appropriate lettered structure listed on the right. Each (c) Unconscious muscle joint sens
lettered (d) Pressure travels in the posterior spinothalamic
option may be selected once, more than once, or not at tract.
all. (e) Vibration travels in the posterior spinocerebellar
4. Number 1 (a) Nucleus proprius tract.
5. Number 2 (b) Preganglionic sympathetic outflow 14. The following statements concern the gating theory
6. Number 3 (c) Nucleus dorsalis of
7. Number 4 (d) Substantia gelatinosa pain:
8. Number 5 (e) None of the above (a) Stimulation of small non-pain-conducting fibers in
9. Number 6 a peripheral nerve may reduce pain sensitivity.
Directions: Each of the numbered items in this section is (b) Massage applied to the skin over a painful joint may
followed reduce pain sensitivity.
by answers. Select the ONE lettered answer that is (c) Stimulation of delta A- and C-type fibers in a
CORRECT. posterior
root of a spinal nerve may decrease pain sensitivity.
(d) Degeneration of large non-pain-conducting fibers inferior colliculus.
in a peripheral nerve decreases pain sensitivity. (c) The lateral corticospinal tract originates from cells
(e) Inhibition of pain conduction in the spinal cord in area 4 of the cerebral cortex.
does not involve connector neurons. (d) The rubrospinal tract originates from cells in the
15. The following statements concern the reception of reticular nucleus.
pain: (e) The reticulospinal tract originates from cells in the
(a) Serotonin is not a transmitter substance in the reticular formation that is confined to the midbrain.
analgesic 19. The following statements concern muscle
system. movement:
(b) Substance P, a protein, is thought to be the (a) Muscular fasciculation is seen only when there is
neurotransmitter rapid destruction of the lower motor neurons.
at the synapses where the first-order (b) Muscle spindle afferent nerve fibers send
neuron terminates on the cells in the posterior gray information
column of the spinal cord. only to the spinal cord.
(c) The enkephalins and endorphins may serve to (c) In Parkinson disease, there is a degeneration of
stimulate dopamine-secreting neurons that originate in the
the release of substance P in the posterior vestibular nucleus.
gray column of the spinal cord. (d) Brain neuronal activity preceding a voluntary
(d) Many of the tracts conducting the initial, sharp, movement is limited to the precentral gyrus
pricking pain terminate in the dorsal anterolateral (area 4).
nucleus of the thalamus. (e) Hyperactive ankle-jerk reflexes and ankle clonus
(e) The slow-conducting C-type fibers are responsible indicate a release of the lower motor neurons from
for prolonged,burning pain. supraspinal inhibition.
16. The following statements concern the corticospinal 20. After a hemorrhage into the left internal capsule in a
tracts: right-handed person, the following sign or symptom
(a) They occupy the posterior limb of the internal might be present:
capsule. (a) Left homonymous hemianopia
(b) They are mainly responsible for controlling the (b) Right astereognosis
voluntary (c) Left hemiplegia
movements in the proximal muscles of the (d) Normal speech.
limbs. (e) Left-sided positive Babinski response
(c) They arise as axons of the pyramidal cells in the 21. A patient with a traumatic lesion of the left half of
fourth layer of the cerebral cortex. the spinal cord at the level of the eighth cervical
(d) Those that control the movements of the upper segment
limb originate in the precentral gyrus on the medial might present the following sign(s) and symptom(
side of the cerebral hemisphere. s):
(e) Those that are concerned with the movements of (a) Loss of pain and temperature sensations on the left
the lower limb are located in the medial area of the side below the level of the lesion
middle three-fifths of the basis pedunculi. (b) Loss of position sense of the right leg
17. The following statements concern the course taken (c) Right hemiplegia
by (d) Left positive Babinski sign
the tracts listed below: (e) Right-sided lower motor paralysis in the segment of
(a) The rubrospinal tract crosses the midline of the the lesion and muscular atrophy
neuroaxis in the medulla oblongata. Directions: Each of the numbered items in this section is
(b) The tectospinal tract (most of the nerve fibers) followed
crosses the midline in the posterior commissure. by answers. Select the ONE lettered answer that is
(c) The vestibulospinal tract crosses the midline in the BEST in each
midbrain. case.
(d) The lateral corticospinal tract has crossed the 22. Which of the signs and symptoms listed below is
midline indicative
in the medulla oblongata. of a cerebellar lesion?
(e) The anterior corticospinal tract crosses the midline (a) Cogwheel rigidity
in the midbrain. (b) Hemiballismus
18. The following statements concern the nerve cells of (c) Chorea
origin (d) Intention tremor
for the tracts listed below: (e) Athetosis
(a) The vestibulospinal tract originates from cells of the 23. Which of the following regions of white matter
medial vestibular nucleus situated in the pons. would
(b) The tectospinal tract originates from cells in the not contain corticospinal fibers?
(a) Pyramid of medulla oblongata spinothalamic tract.
(b) Lateral white column of the spinal cord 26. The severe intractable pain in the back in this patient
(c) Cerebral peduncle of the midbrain could be treated by the following methods except:
(d) Anterior limb of the internal capsule (a) The prescription of salicylates in large doses.
(e) Corona radiata (b) The intramuscular injection of morphine or even
Directions: Each case history is followed by questions. the direct injection of the opiate into the spinal
Read the cord.
case history, then select the ONE BEST lettered answer. (c) The operation of posterior rhizotomy.
A 59-year-old woman was experiencing pain in the back (d) The operation of cordotomy.
and showed evidence of loss of pain and temperature (e) The injection of opiates into the subarachnoid
sensations space.
down the back of her left leg.Three years previously,
she underwent a radical mastectomy followed by
radiation
and chemotherapy for advanced carcinoma of her right
breast.
On examination, it was found that she was experiencing
pain over the lower part of the back, with loss of the CHAPTER 5
skin Directions: Each of the numbered items in this section is
sensations of pain and temperature down the back of her followed
left leg in the area of the S1-3 dermatomes. No other by answers. Select the ONE lettered answer that is
neurologic CORRECT.
deficits were identified. Radiographic examination of 1. The following statements concern the anterior surface
the vertebral column showed evidence of metastases in of the medulla oblongata:
the (a) The pyramids taper inferiorly and give rise to the
bodies of the 9th and 10th thoracic vertebrae. An MRI decussation of the pyramids.
revealed an extension of one of the metastases into the (b) On each side of the midline, there is an ovoid
vertebral swelling called the olive, which contains the
canal,with slight indentation of the spinal cord on the corticospinal
right side. fibers.
24. The pain in the back could be explained in this (c) The hypoglossal nerve emerges between the olive
patient and the inferior cerebellar peduncle.
by the following facts except: (d) The vagus nerve emerges between the pyramid and
(a) Osteoarthritis of the joints of the vertebral column. the olive.
(b) The presence of metastases in the bodies of the 9th (e) The abducent nerve emerges between the pons
and 10th thoracic vertebrae. and the midbrain.
(c) The pressure of the tumor on the posterior roots of 2. The following general statements concern the medulla
the spinal nerves. oblongata:
(d) A prolapsed intervertebral disc pressing on the (a) The caudal half of the floor of the fourth ventricle
spinal nerves. is formed by the rostral half of the medulla.
(e) Spasm of the postvertebral muscles following (b) The central canal extends throughout the length of
pressure the medulla oblongata.
of the tumor on the posterior white columns of (c) The nucleus gracilis is situated beneath the gracile
the spinal cord. tubercle on the anterior surface of the medulla.
25. The loss of pain and temperature sensations down (d) The decussation of the medial lemnisci takes place
the in the rostral half of the medulla.
back of the patient’s left leg in the area of the S1-3 (e) The cerebellum lies anterior to the medulla.
dermatomes 3. The following statements concern the interior of the
could be explained by the following factual lower part of the medulla:
statements except: (a) The decussation of the pyramids represents the
(a) The lateral spinothalamic tracts in the spinal cord crossing over from one side of the medulla to the
conduct the sensations of pain. other of one-quarter of the corticospinal fibers.
(b) The lateral spinothalamic tracts are laminated,with (b) The central canal of the spinal cord is not continuous
the sacral segments of the body located most laterally. upward into the medulla.
(c) The sacral segments of the tracts are the most (c) The substantia gelatinosa is not continuous with the
exposed to external cord pressure from a metastasizing nucleus of the spinal tract of the trigeminal nerve.
tumor. (d) The medial lemniscus is formed by the anterior
(d) The loss of temperature sensations in the leg could spinothalamic tract and the spinotectal tract.
be explained by pressure of the tumor on the anterior (e) The internal arcuate fibers emerge from the
nucleus gracilis and nucleus cuneatus. 12. Number 5 (e) None of the above
4. The following statements concern the interior of the 13. Number 6
upper part of the medulla: Directions: Each of the numbered items in this section is
(a) The reticular formation consists of nerve fibers,and followed
there are no nerve cells. by answers. Select the ONE lettered answer that is
(b) The nucleus ambiguus constitutes the motor CORRECT.
nucleus of the vagus, cranial part of the accessory, 14. The following statements concern the pons:
and hypoglossal nerves. (a) The trigeminal nerve emerges on the lateral aspect
(c) Beneath the floor of the fourth ventricle are located of the pons.
the dorsal nucleus of the vagus and the vestibular (b) The glossopharyngeal nerve emerges on the anterior
nuclei. aspect of the brainstem in the groove between
(d) The medial longitudinal fasciculus is a bundle of the pons and the medulla oblongata.
ascending fibers on each side of the midline. (c) The basilar artery lies in a centrally placed groove
(e) The inferior cerebellar peduncle connects the pons on the anterior aspect of the pons.
to the cerebellum. (d) Many nerve fibers present on the posterior aspect
5. The following statements concern the Arnold-Chiari of the pons converge laterally to form the middle
phenomenon: cerebellar peduncle.
(a) It is an acquired anomaly. (e) The pons forms the lower half of the floor of the
REVIEW QUESTIONS fourth ventricle.
15. The following important structures are located in the
(b) The exits in the roof of the fourth ventricle may be
brainstem at the level stated:
blocked.
(a) The red nucleus lies within the midbrain.
(c) The cerebellum never herniates through the foramen
magnum.
(d) It is not associated with various forms of spina
bifida.
(e) It is safe to perform a spinal tap in this condition.
6. The following statements concern the medial
medullary
syndrome:
(a) The tongue is paralyzed on the contralateral side.
(b) There is ipsilateral hemiplegia.
(c) There are ipsilateral impaired sensations of position
and movement.
(d) It is commonly caused by thrombosis of a branch
of the vertebral artery to the medulla oblongata.
(e) There is contralateral facial paralysis.
7. The following statements concern the lateral
medullary
syndrome:
(a) The condition may be caused by a thrombosis of
the anterior inferior cerebellar artery. (b) The facial colliculus lies in the cranial part of the
(b) The nucleus ambiguus of the same side may be pons.
damaged. (c) The motor nucleus of the trigeminal nerve lies
(c) There may be analgesia and thermoanesthesia on within the caudal part of the pons.
the contralateral side of the face. (d) The abducent nucleus lies within the cranial part of
(d) Contralateral trunk and extremity hypalgesia and the pons.
thermoanesthesia may occur. (e) The trochlear nucleus lies within the midbrain at
(e) There may be evidence of seizures. the level of the superior colliculus.
Directions: Matching Questions. The following 16. The following statements concern the posterior
questions apply to surface
Figure 5-34. Match the numbers listed on the left with of the pons:
the appropriate (a) Lateral to the median sulcus is an elongated
lettered structure listed on the right. Each lettered swelling called the lateral eminence.
option (b) The facial colliculus is produced by the root of the
may be selected once, more than once, or not at all. facial nerve winding around the nucleus of the
8. Number 1 (a) Inferior cerebellar peduncle abducent nerve.
9. Number 2 (b) Medial lemniscus (c) The floor of the inferior part of the sulcus limitans
10. Number 3 (c) Hypoglossal nucleus is pigmented and is called the substantia ferruginea.
11. Number 4 (d) Reticular formation (d) The vestibular area lies medial to the sulcus limitans.
(e) The cerebellum lies anterior to the pons.
17. The following statements concern a transverse
section
through the caudal part of the pons:
(a) The pontine nuclei lie between the transverse pontine
fibers.
(b) The vestibular nuclei lie medial to the abducent
nucleus.
(c) The trapezoid body is made up of fibers derived
from the facial nerve nuclei.
(d) The tegmentum is the part of the pons lying anterior
to the trapezoid body.
(e) The medial longitudinal fasciculus lies above the
floor of the fourth ventricle on either side of the
midline.
18. The following statements concern a transverse
section
through the cranial part of the pons: 20. Number 1 (a) Basilar groove
(a) The motor nucleus of the trigeminal nerve lies lateral 21. Number 2 (b) Medial longitudinal fasciculus
to the main sensory nucleus in the tegmentum. 22. Number 3 (c) Superior cerebellar peduncle
(b) The medial lemniscus has rotated so that its long 23. Number 4 (d) Superior medullary velum
axis lies vertically. 24. Number 5 (e) None of the above
(c) Bundles of corticospinal fibers lie among the 25. Number 6
transverse Directions: Each of the numbered items in this section is
pontine fibers. followed
(d) The medial longitudinal fasciculus joins the by answers. Select the ONE lettered answer that is
thalamus CORRECT.
to the spinal nucleus of the trigeminal nerve. 26. The following statements concern the midbrain:
(e) The motor root of the trigeminal nerve is much (a) It passes superiorly between the fixed
larger than the sensory root. b) The oculomotor nerve emerges from the posterior
19. The following statements concern the pons: surface below the inferior colliculi.
(a) It is related superiorly to the dorsum sellae of the (c) The superior brachium passes from the superior
sphenoid bone. colliculus to the medial geniculate body.
(b) It lies in the middle cranial fossa. (d) The cavity of the midbrain is called the cerebral
(c) Glial tumors of the pons are rare. aqueduct
(d) The corticopontine fibers terminate in the pontine (e) The interpeduncular fossa is bounded laterally by
nuclei. the cerebellar peduncles.
(e) The pons receives its blood supply from the internal 27. The following statements concern the midbrain:
carotid artery. (a) The oculomotor nucleus is found within it at the
Directions: Matching Questions. The following level of the inferior colliculus.
questions apply to (b) The trochlear nerve emerges on the anterior surface
Figure 5-35. Match the numbers listed on the left with of the midbrain and decussates completely in
the appropriate the superior medullary velum.
lettered structure listed on the right. Each lettered
(c) The trochlear nucleus is situated in the central gray
option
matter at the level of the inferior colliculus.
may be selected once, more than once, or not at all.
(d) The lemnisci are situated medial to the central gray
matter.
(e) The trigeminal lemniscus lies anterior to the medial
lemniscus.
28. The following statements concern the internal
structures
of the midbrain:
(a) The tectum is the part situated posterior to the
cerebral
aqueduct.
(b) The crus cerebri on each side lies posterior to the
substantia nigra.
(c) The tegmentum lies anterior to the substantia nigra.
(d) The central gray matter encircles the red nuclei.
(e) The reticular formation is limited to the lower part (c) Medial medullary syndrome on the left side
of the midbrain. (d) Lateral medullary syndrome on the right side
29. The following statements concern the colliculi of the (e) Medial medullary syndrome on the right side
midbrain: A 7-year-old girl was seen by a neurologist because she
(a) They are located in the tegmentum. complained to her mother that she was seeing double.
(b) The superior colliculi are concerned with sight Careful physical examination revealed that the double
reflexes. vision became worse when she looked toward the left.
(c) The inferior colliculi lie at the level of the The patient also had evidence of a mild motor paralysis
oculomotor of her right lower limb without spasticity. There was
nerve nuclei. also
(d) The inferior colliculi are concerned with reflexes of a slight facial paralysis involving the whole left side of
smell. the
(e) The superior colliculi lie at the level of the trochlear face.
nuclei. 38. Based on the clinical history and the clinical
30. The following statements concern the third cranial examination,
nerve nuclei: the following neurologic deficits could have been
(a) The oculomotor nucleus is situated lateral to the present except:
central gray matter. (a) The double vision caused by weakness of the left
(b) The sympathetic part of the oculomotor nucleus is lateral rectus muscle.
called the Edinger-Westphal nucleus. (b) The complete left-sided facial paralysis caused by
(c) The oculomotor nucleus lies posterior to the cerebral involvement of the left seventh cranial nerve
aqueduct. nucleus or its nerve.
(d) The nerve fibers from the oculomotor nucleus pass (c) The mild right hemiparesis produced by damage to
through the red nucleus. the corticospinal tract on the right side.
(e) The oculomotor nucleus lies close to the lateral (d) An MRI revealed the presence of a tumor of the
longitudinal fasciculus. lower part of the pons on the left side.
Directions: Matching Questions. The following (e) There was damage to the left sixth cranial nerve
questions apply to nucleus.
Figure 5-36. Match the numbers listed on the left with A 42-year-old woman complaining of a severe,
the appropriate persistent
lettered structure listed on the right. Each lettered headache visited her physician. At first, the headache
option was
may be selected once, more than once, or not at all. not continuous and tended to occur during the
31. Number 1 (a) Medial longitudinal fasciculus night.Now,
32. Number 2 (b) Inferior colliculus the headache was present all the time and was felt over
33. Number 3 (c) Medial lemniscus the
34. Number 4 (d) Trochlear nucleus whole head. Recently, she has begun to feel nauseous,
35. Number 5 (e) None of the above and
36. Number 6 this has resulted in several episodes of vomiting. Last
Directions: Each case history is followed by questions.
week,
Read the
on looking in the mirror, she noted that her right pupil
case history, then select the ONE BEST lettered answer.
looked much larger than the left. Her right upper lid
A 63-year-old man complaining of difficulty in
appeared to droop.
swallowing,
39. The physical examination revealed the following
some hoarseness of his voice, and giddiness was seen by
most
a
likely findings except:
neurologist.All these symptoms started suddenly 4 days
(a) There was weakness in raising the right eyelid
previously.
upward.
On physical examination, he was found to have a
(b) There was severe ptosis of the right eye.
loss of the pharyngeal gagging reflex on the left side,
(c) There was obvious dilatation of the right pupil.
leftsided
(d) Ophthalmoscopic examination revealed bilateral
facial analgesia, and left-sided paralysis of the vocal
papilledema.
cord.
(e) There was no evidence of paralysis of either superior
37. Based on the clinical history and the results of
oblique muscle.
the physical examination, select the most likely
(f) Examination of the lower limbs revealed a mild
diagnosis.
spasticity of the left lower limb muscles.
(a) A meningeal tumor in the posterior cranial fossa on
(g) Ataxia of the right upper limb was also present.
the right side
(h) There was a loss of taste sensation on the posterior
(b) Lateral medullary syndrome on the left side
one-third of the tongue on the left side.
40. The combination of the clinical history and the (e) The gray matter of folia of the dentate nucleus has
findings a branched appearance on the cut surface, called
in the physical examination enabled the physician to the arbor vitae.
make the following most likely diagnosis. 4. The following statements concern the structure of the
(a) A tumor involving the left cerebral hemisphere cerebellar cortex:
(b) A tumor involving the right side of the midbrain at (a) The cortex is folded by many vertical fissures into
the level of the superior colliculi folia.
(c) Severe migraine (b) The structure of the cortex differs widely in different
(d) A cerebral hemorrhage involving the left cerebral parts of the cerebellum.
hemisphere (c) The Purkinje cells are found in the most superficial
(e) A tumor of the left side of the midbrain layer of the cortex.
(d) The Golgi cells are found in the most superficial
layer of the cerebellar cortex.
(e) The axons of the Purkinje cells form the efferent
fibers from the cerebellar cortex.
5. The following statements concern the intracerebellar
CHAPTER 6 nuclei:
(a) The nuclei are found within the superficial layers of
Directions: Each of the numbered items in this section is the white matter.
followed (b) The nuclei are located in the walls of the fourth
by answers. Select the ONE lettered answer that is ventricle.
CORRECT. (c) The nuclei are composed of many small unipolar
1. The following statements concern the gross neurons.
appearance (d) The axons of the nuclei form the main cerebellar
of the cerebellum: outflow.
(a) It is separated from the occipital lobes of the cerebral (e) From medial to lateral, the nuclei are named as
hemispheres by the tentorium cerebelli. follows:
(b) It lies anterior to the medulla oblongata and the dentate, emboliform,globose, and fastigial.
pons. 6. The following statements concern the cerebellar
(c) The anterior lobe is separated from the middle peduncles:
(posterior) lobe by the uvulonodular fissure. (a) In the superior cerebellar peduncle, most of the
(d) The flocculonodular lobe is separated from the fibers are afferent and arise from the neurons of the
middle (posterior) lobe by the horizontal fissure. spinal cord.
(e) The third ventricle lies anterior to the cerebellum. (b) The anterior spinocerebellar tract enters the
2. The following general statements concern the cerebellum
cerebellum: through the superior cerebellar peduncle.
(a) The cerebellum greatly influences the activity of (c) The inferior cerebellar peduncle is made up
smooth muscle. exclusively
(b) The cerebellum has no influence on the skeletal of fibers that pass from the inferior olivary
muscles supplied by the cranial nerves. uclei to the middle lobe of the cerebellar hemisphere.
(c) Each cerebellar hemisphere controls the tone of (d) The middle cerebellar peduncle is formed of fibers
skeletal muscle supplied by spinal nerves on the that arise from the dentate nuclei.
same side of the body. (e) The cerebellar peduncles are surface structures
(d) The important Purkinje cells are Golgi type II that are difficult to see even by brain dissection.
neurons. 7. The following statements concern the afferent fibers
(e) The Purkinje cells exert a stimulatory influence on entering the cerebellum:
the intracerebellar nuclei. (a) The mossy fibers end by making synaptic contacts
3. The following statements concern the structure of the with the dendrites of the Purkinje cells.
cerebellum: (b) The fibers enter the cerebellum mainly through the
(a) The cerebellum consists of two cerebellar internal and external arcuate fibers.
hemispheres (c) The climbing and mossy fibers constitute the two
joined by a narrow median vermis. main lines of input to the cerebellar cortex.
(b) The inferior surface of the cerebellum shows a (d) The afferent fibers are inhibitory to the Purkinje
deep groove formed by the superior surface of the cells.
vermis. (e) The afferent fibers to the cerebellum are
(c) The inferior cerebellar peduncles join the cerebellum nonmyelinated.
to the pons. 8. The following statements concern the functions of the
(d) The gray matter is confined to the cerebellar cortex. cerebellum:
REVIEW QUESTIONS (a) The cerebellum influences the actions of muscle
tendons. Each lettered option may be selected once, more than
(b) The cerebellum controls voluntary movement by once, or
coordinating the force and extent of contraction of not at all.
different muscles. 14. Corticopontocerebellar (a) Superior cerebellar
(c) The cerebellum stimulates the contraction of 15. Cuneocerebellar peduncle
antagonistic muscles. 16. Cerebellar reticular (b) Corpus callosum
(d) The cerebellum directly influences skeletal muscle 17. Cerebellar rubral (c) Striae medullaris
activity without the assistance of the cerebral cortex. (d) Inferior cerebellar
(e) The cerebellum coordinates the peristaltic waves peduncle
seen in intestinal muscle. (e) Middle cerebellar
9. The following statements concern the cerebellum: peduncle
(a) The afferent climbing fibers make single synaptic (f) None of the above
contacts with individual Purkinje cells. Directions: Each case history is followed by questions.
(b) The afferent mossy fibers may stimulate many Read the
Purkinje case history, then select the ONE BEST lettered answer.
cells by first stimulating the stellate cells. A 45-year-old man,who was an alcoholic, started to
(c) The neurons of the intracerebellar nuclei send develop
axons without interruption to the opposite cerebral a lurching, staggering gait even when he was not
hemisphere. intoxicated.
(d) The output of the cerebellar nuclei influences muscle The condition became slowly worse over a period of
activity so that movements can progress in an several weeks and then appeared to stabilize. Friends
orderly sequence from one movement to the next. noticed that he had difficulty in walking in tandem with
(e) Past pointing is caused by the failure of the cerebral another person and tended to become unsteady on
cortex to inhibit the cerebellum after the movement turning
has begun. quickly.
10. The following statements concern the cerebellum: 18. A thorough physical examination of this patient
(a) The cerebellar cortex has a different microscopic revealed the following findings except:
structure in different individuals. (a) The patient exhibited instability of trunk movements
(b) The axons of the Purkinje cells exert an inhibitory and incoordination of leg movements.
influence on the neurons of the deep cerebellar (b) While standing still, the patient stood with his feet
nuclei. together.
(c) Each cerebellar hemisphere principally influences (c) He had no evidence of polyneuropathy.
movement on the opposite hand. (d) The ataxia of the legs was confirmed by performing
(d) The part of the cerebellum that lies in the midline the heel-to-shin test.
is called the flocculus. (e) Magnetic resonance imaging showed evidence of
(e) Intention tremor is a sign of cerebellar disease. atrophy of the cerebellar vermis.
Directions: Matching Questions. Following thrombosis 19. The following additional abnormal signs might have
of the been observed in this patient except:
posterior inferior cerebellar artery, a patient presents (a) Nystagmus in both eyes
the numbered (b) Dysarthria
signs and symptoms listed below; match the signs and (c) Tremor of the left hand when reaching for a cup
symptoms with the appropriate lettered structures (d) Paralysis of the right upper arm muscles
involved. (e) Dysdiadochokinesia
Each lettered option may be selected once, more than
once, or
not at all.
11. Loss of pain and temperature on the left side of the
body
12. Nystagmus
13. Hypotonicity of the muscles on the right with a CHAPTER 7
tendency Directions: Each of the numbered items in this section is
to fall to the right followed
(a) Right reticulospinal tract by answers. Select the ONE lettered answer that is
(b) Right inferior cerebellar peduncle CORRECT.
(c) None of the above 1. The following statements concern the diencephalon:
Directions: Match the numbered nerve tracts listed (a) It extends anteriorly as far as the optic chiasma.
below with (b) It is bounded laterally by the internal capsule.
the lettered pathways by which they leave the (c) The thalamus is located in the medial wall of the
cerebellum. third ventricle.
(d) The epithalamus is formed by the cranial end of the to form the choroid plexus.
substantia nigra and the red nuclei. (d) Lying in the floor of the ventricle, from posterior to
(e) It extends posteriorly as far as the interthalamic anterior, are the optic chiasma, the tuber cinereum,
connection. and the mammillary bodies.
2. The following statements concern the pineal gland: (e) The wall of the ventricle is not lined with ependyma.
(a) It produces a secretion that is opaque to x-rays. Matching Questions. Directions: The following
(b) It contains high concentrations of melatonin. questions apply to
(c) Melatonin stimulates the release of the Figure 7-30. Match the numbers listed on the left with
gonadotrophic the appropriate
hormone from the anterior lobe of the pituitary lettered structure listed on the right. Each lettered
gland. option
(d) There is a decrease in the production of secretions may be selected once, more than once, or not at all.
of the pineal gland during darkness. 7. Number 1 (a) Genu of corpus callosum
(e) The pinealocytes are inhibited by the sympathetic 8. Number 2 (b) Interventricular foramen
nerve endings. 9. Number 3 (c) Body of fornix
3. The following statements concern the thalamus: 10. Number 4 (d) Anterior commissure
(a) It is the largest part of the diencephalon and serves 11. Number 5 (e) None of the above
as a relay station to all the main sensory tracts 12. Number 6
(except the olfactory pathway). 13. Number 7
Directions: Each of the numbered items in this section is
(b) It is separated from the lentiform nucleus by the
followed
external capsule.
by answers. Select the ONE lettered answer that is
(c) It forms the anterior boundary of the interventricular CORRECT.
foramen. 14. The following statements concern the longitudinal
(d) It is completely separate from the thalamus on the cerebral
opposite side. fissure:
(e) The thalamus is a small rectangular mass of gray (a) The fissure contains the fold of dura mater, the falx
matter. cerebelli.
4. The following statements concern the hypothalamus: (b) The fissure contains the middle cerebral arteries.
(a) It is formed by the upper part of the lateral wall and (c) The superior sagittal sinus lies below it.
roof of the third ventricle. (d) In the depths of the fissure, the corpus callosum
(b) Caudally,the hypothalamus merges with the tectum crosses the midline.
of the midbrain. (e) The inferior sagittal sinus lies above it.
(c) The nuclei are composed of groups of large nerve 15. The following statements concern the central sulcus:
cells. (a) The central sulcus extends onto the medial surface
(d) Functionally,it plays a role in the release of pituitary of the cerebral hemisphere.
hormones. (b) The frontal lobe lies posterior to it.
(e) The mammillary bodies are not part of the (c) The parietal lobe lies anterior to it.
hypothalamus. (d) The central sulcus is continuous inferiorly with the
5. The following statements concern the hypothalamus: lateral sulcus.
(a) The hypothalamus has no influence on the activities (e) The arachnoid mater extends into the central sulcus.
of the autonomic and endocrine systems. 16. The following statements concern the lateral
(b) It receives few afferent visceral and somatic sensory ventricle:
fibers. (a) Each ventricle is J shaped and filled with
(c) It gives off efferent fibers that pass to the cerebrospinal
sympathetic fluid.
and parasympathetic outflows in the brain (b) It communicates with the third ventricle through
and spinal cord. the interventricular foramen.
(d) It does not assist in the regulation of water (c) The body of the ventricle occupies the frontal lobe.
metabolism. (d) The lateral ventricle does not possess a choroid
(e) The hypothalamus plays no role in controlling plexus.
emotional states. (e) The anterior horn occupies the parietal lobe.
REVIEW QUESTIONS 17. The following statements concern the corpus
6. The following statements concern the third ventricle: callosum:
(a) The posterior wall is formed by the opening into (a) It is connected to the fornix by the lamina terminalis.
the cerebral aqueduct and the pineal recess. (b) The rostrum connects the genu to the septum
(b) It does not communicate directly with the lateral pellucidum.
ventricles. (c) Most of the fibers within the corpus callosum
(c) The vascular tela choroidea projects from the floor interconnect
symmetrical areas of the cerebral cortex. 28. Number 3 (c) Superior temporal gyrus
(d) The fibers of the genu curve forward into the frontal 29. Number 4 (d) Superior parietal lobule
lobes as the forceps major. 30. Number 5 (e) None of the above
(e) The corpus callosum is related inferiorly to the falx 31. Number 6
cerebri. Directions: The case histories below are followed by
18. The following statements concern the anterior questions.
commissure: Select the ONE BEST lettered answer.
(a) It is embedded in the superior part of the septum A 70-year-old man with hypertension was admitted to
pellucidum. an
(b) When traced laterally, an anterior bundle of fibers emergency department, having suddenly developed
curves forward to join the olfactory tract. hemiparesis
(c) Some of the fibers are concerned with the sensations on the right side and numbness of the right leg.Axial
of taste. CT and MRI were undertaken. MRI revealed a small
(d) It forms the anterior boundary of the interventricular hemorrhage
foramen. in the left thalamus, which passed horizontally
(e) It is formed by a large bundle of nerve fibers. through the lateral ventricles. After careful observation,
19. The following statements concerning the internal 2
capsule days later the paresis was much improved, and the
are correct except: patient
(a) It is continuous below with the tectum of the reported that his numbness had disappeared. The patient
midbrain. uneventful recovery. His hypertension was brought
(b) It has an anterior limb and a posterior limb,which under
are in a straight line. control with suitable medication.
(c) The genu and the anterior part of the posterior limb 32. Using your knowledge of the relationships of the left
contain the corticobulbar and corticospinal fibers. thalamus, select the statement that explains the transient
(d) It is related medially to the lentiform nucleus. right hemiparesis and numbness.
(e) It is continuous below with the corona radiata. (a) The hemorrhage occurred into the third ventricle.
20. The following statements concern the basal ganglia: (b) The hemorrhage into the thalamus extended laterally
(a) The caudate nucleus is not attached to the into the posterior limb of the left internal capsule.
lentiform nucleus. (c) The hemorrhage was small and confined to the
(b) The corpus striatum is concerned with muscular thalamus on the left side.
movement. (d) The hemorrhage was small and occurred in the
(c) The lentiform nucleus is related medially to the lateral
external capsule. part of the left thalamus, producing transient
(d) The lentiform nucleus is oval shaped, as seen on edema in the left internal capsule.
horizontal section. (e) The hemorrhage extended laterally into the left
(e) The amygdaloid nucleus does not form one of the lateral
basal ganglia. ventricle.
Matching Questions. Directions: The following 33. This hypertensive patient had a small thalamic
questions apply to hemorrhage.
Figure 7-31. Match the numbers listed on the left with Select the most likely cause for the hemorrhage:
the appropriate (a) One of the small diseased thalamic arteries may
lettered structure listed on the right. Each lettered have ruptured.
option (b) One of the small veins draining the thalamus may
may be selected once, more than once, or not at all. have ruptured.
21. Number 1 (a) Optic radiation (c) Vasoconstriction of the thalamic arteries could
22. Number 2 (b) Lateral sulcus have occurred.
23. Number 3 (c) Lentiform nucleus (d) Softening of the neuronal tissue around the thalamic
24. Number 4 (d) Anterior horn of lateral ventricle arteries might have taken place.
25. Number 5 (e) None of the above (e) There is no relation between hypertension and the
The following questions apply to Figure 7-32. Match the thalamic hemorrhage in this patient.
numbers An 8-year-old boy with a severe earache on the right
listed on the left with the appropriate lettered structure side
listed on
was taken to a pediatrician. The symptoms had started 7
the right. Each lettered option may be selected once,
days ago, and the pain had progressively worsened. On
more than
once, or not at all. examination, the boy was found to have severe right-
26. Number 1 (a) Central sulcus sided
27. Number 2 (b) Postcentral gyrus otitis media with acute mastoiditis. On being
questioned,
the boy admitted that his head hurt badly all over and (a) In most individuals,this area is important on the left
that or dominant hemisphere.
he felt sick.While he was being examined, he vomited. (b) The Broca speech area brings about the formation
His of words by its connections with the secondary
body temperature was slightly elevated. In view of the motor area.
severity of the headache and the presence of nausea and (c) It is not connected to the sensory speech area of
vomiting, the pediatrician decided to have an MRI Wernicke.
performed. (d) It is located in the superior frontal gyrus between
The result showed a small,well-defined, right cerebral the anterior and ascending rami and the ascending
abscess. and posterior rami of the lateral fissure.
34. The cerebral abscess in this patient was most likely (e) Brodmann areas 34 and 35 represent the motor
located at which site in the right cerebral hemisphere: speech area.
(a) Frontal lobe 4. The following statements concern the primary
(b) Thalamus somesthetic
(c) Occipital lobe area:
(d) Temporal lobe (a) It occupies the lower part of the precentral gyrus.
(e) Cuneus (b) Histologically, it contains large numbers of
pyramidal
cells and few granular cells.
(c) The opposite half of the body is represented
inverted.
(d) Although most sensations reach the cortex from the
contralateral side of the body, sensations from the
CHAPTER 8 hand go to both sides.
(e) The area extends onto the anterior part of the
Directions: Each of the numbered items in this section is paracentral
followed lobule.
by answers. Select the ONE lettered answer that is 5. The following statements concern the visual areas of
CORRECT. the
1. The following statements concern the cerebral cortex:
cortex: (a) The primary visual area is located in the walls of
(a) The cerebral cortex is thinnest over the crest of a the parieto-occipital sulcus.
gyrus and thickest in the depth of a sulcus. (b) The visual cortex receives afferent fibers from the
(b) The largest giant pyramidal cells are found in the medial geniculate body.
postcentral gyrus. (c) The right half of the visual field is represented in
(c) In the visual cortex, the outer band of Baillarger is the visual cortex of the right cerebral hemisphere.
thin and can only be seen under a microscope. (d) The superior retinal quadrants pass to the inferior
(d) The molecular layer is the most superficial layer of portion of the visual cortex.
the cerebral cortex and is composed of the small (e) The secondary visual area (Brodmann areas 18 and
cell bodies of the granular cells. 19) is surrounded by the primary visual area on the
(e) From a functional point of view, the cerebral cortex medial and lateral surfaces of the hemisphere.
is organized into vertical units of activity. 6. The following statements concern the superior
2. The following statements concern the precentral area temporal
of gyrus:
the frontal lobe of the cerebral cortex: (a) The primary auditory area is situated in the inferior
(a) The anterior region is known as the primary motor wall of the lateral sulcus.
area. (b) The main projection fibers to the primary auditory
(b) The primary motor area is responsible for skilled area arise from the thalamus.
movements on the opposite side of the body. (c) The sensory speech area of Wernicke is localized in
(c) The function of the primary motor area is to store the inferior temporal gyrus in the dominant hemisphere.
programs of motor activity, which are conveyed to (d) A unilateral lesion of the auditory area produces
the premotor area for the execution of movements. complete deafness in both ears.
(d) Individual skeletal muscles are represented in the (e) The secondary auditory area is sometimes referred
primary motor area. to as Brodmann areas 41 and 42.
REVIEW QUESTIONS 7. The following statements concern the association
(e) The area of cortex controlling a particular movement areas
is not proportional to the skill involved. of the cerebral cortex:
3. The following statements concern the motor speech (a) They form a small area of the cortical surface.
area of Broca: (b) The prefrontal area is concerned with the makeup
of the individual’s personality. Directions: Each case history is followed by questions.
(c) They are concerned with the interpretation of Read the
motor experiences. case history, then select the ONE BEST lettered answer.
(d) An appreciation of the body image is assembled in A 54-year-old woman was seen by a neurologist
the anterior parietal cortex,and the right side of the because her
body is represented in the left hemisphere. sister had noticed a sudden change in her behavior. On
(e) The association areas have only four layers of cortex. questioning, the patient stated that after waking up from
8. The following statements concern cerebral a
dominance: deep sleep about a week ago, she noticed that the left
(a) The cortical gyri of the dominant and nondominant side
hemispheres are arranged differently. of her body did not feel as if it belonged to her. Later,
(b) More than 90% of the adult population is the
righthanded feeling worsened, and she became unaware
and,therefore,is left hemisphere dominant.
(c) About 96% of the adult population is right tence of her left side. Her sister told the neurologist that
hemisphere the
dominant for speech. patient now neglects to wash the left side of her body.
(d) The nondominant hemisphere interprets handedness, 17. The neurologist examined the patient and found the
perception of language, and speech. following
(e) After puberty, the dominance of the cerebral most likely signs except:
hemispheres (a) It was noted that the patient did not look toward
becomes fixed. her left side.
Matching Questions. Directions: The following (b) She readily reacted to sensory stimulation of her
questions apply to skin on the left side.
Figure 8-9. Match the numbers listed on the left with (c) On being asked to move her left leg, she promptly
the most did so.
likely words designating lettered functional areas of the (d) There was definite evidence of muscular weakness
cerebral of the upper and lower limbs on the left side.
cortex listed on the right. Each lettered option may be (e) On being asked to walk across the examining
selected room, she tended not to use her left leg as much as
once, more than once, or not at all. her right leg.
9. Number 1 (a) Primary motor area 18. The neurologist made the following likely
10. Number 2 (b) Secondary auditory area conclusions
11. Number 3 (c) Frontal eye field except:
12. Number 4 (d) Primary somesthetic area (a) The diagnosis of left hemiasomatognosia (loss of
(e) None of the above appreciation of the left side of the body) was made.
The following questions apply to Figure 8-10. Match the (b) This condition probably resulted from a lesion of
numbers the left parietal lobe.
listed on the left with the most likely lettered words (c) In addition, the patient exhibited left hemiakinesia
designating (unilateral motor neglect).
functional areas of the cerebral cortex listed on the (d) There was probably a lesion in areas 6 and 8 of the
right. Each lettered
medial and lateral premotor regions of the right
option may be selected once, more than once, or not at
frontal lobe.
all.
13. Number 1 (a) Premotor area (e) The failure to look toward the left side (visual
14. Number 2 (b) Primary somesthetic area extinction) suggested a lesion existed in the right
15. Number 3 (c) Primary visual area parieto-occipital lobes.
16. Number 4 (d) Primary motor area
(e) None of the above
4
1
2
3 Figure 8-9 Lateral view of
the left cerebral hemisphere.
4
1
Central sulcus
2
3
Figure 8-10 Medial view of the left cerebral
hemisphere.
CHAPTER 9 (c) The superior cerebellar veins drain only into the
straight sinus.
(d) The spinal veins drain into the external vertebral
venous plexus.
Directions: Each of the numbered items in this section is (e) The inferior sagittal sinus drains into the straight
followed sinus.
by answers. Select the ONE lettered answer that is
5. The following statements concern the cerebral blood
CORRECT.
flow:
1. The following statements concern the blood supply to
the brain: REVIEW QUESTIONS
(a) The brain receives its blood supply directly from (a) The sympathetic postganglionic fibers exert great
the two external carotid arteries. control over the diameter of the cerebral blood vessels.
(b) The circle of Willis is formed by the anterior (b) It varies greatly with changes in the general blood
cerebral, pressure.
the internal carotid, the posterior cerebral, the (c) Oxygen tension in the cerebral blood has no effect
basilar, and the anterior and posterior communicating on the diameter of the cerebral blood vessels.
arteries. (d) One of the most powerful vasodilators of cerebral
(c) The cerebral arteries do not anastomose on the blood vessels is carbon dioxide.
surface (e) The blood flow for a particular area of nervous tissue
of the brain. following occlusion of a cerebral artery does
(d) There are numerous anastomoses between the not depend on the collateral circulation.
branches of the cerebral arteries once they have 6. The following statements concern cerebral ischemia:
entered the substance of the brain. (a) Atheromatous degeneration of a cerebral artery
(e) The main blood supply to the internal capsule is does not cause degeneration of the nerve cells in
from the central branches of the anterior cerebral the avascular area due to the presence of cerebrospinal
artery. fluid.
2. The areas of the cerebral cortex listed below receive (b) Neuronal function ceases after the blood flow has
their arterial supply as indicated: stopped for about 10 seconds.
(a) The precentral gyrus (face area) is supplied by the (c) Irreversible cerebral damage starts to occur after
middle cerebral artery. the blood flow has ceased for about 4 minutes.
(b) The postcentral gyrus (face area) is supplied by the (d) Shock occurring as the result of severe physical
anterior cerebral artery. trauma does not result in cerebral ischemia.
(c) The cuneus is supplied by the anterior cerebral (e) Cooling of the patient’s body following a
artery. cerebrovascular
(d) The inferior temporal gyrus is supplied by the accident speeds up cerebral degeneration.
middle Matching Questions. Directions: The following
cerebral artery. questions apply to
(e) The Wernicke area is supplied by the posterior Figure 17-17. Match the numbered arteries listed below
with the
cerebral
appropriate lettered arteries. Each lettered option may
artery.
be
3. The arteries listed below arise from the main stem selected once, more than once, or not at all.
arteries 7. Number 1 (a) Middle cerebral artery
as indicated: 8. Number 2 (b) Anterior communicating artery
(a) The ophthalmic artery is a branch of the middle 9. Number 3 (c) Posterior cerebral artery
cerebral artery. 10. Number 4 (d) Basilar artery
(b) The pontine arteries are branches of the internal 11. Number 5 (e) None of the above
carotid artery. 12. Number 6
(c) The posterior communicating artery is a branch of Directions: In the next item, select the ONE lettered
the middle cerebral artery. answer that is
(d) The posterior spinal artery arises from the vertebral CORRECT.
artery. 13. The following statements concern the blood supply
(e) The posterior inferior cerebellar artery is a branch to
of the basilar artery. the spinal cord:
4. The veins listed below drain into the venous sinuses (a) The posterior spinal arteries supply the posterior
indicated: third of the spinal cord.
(a) The superior cerebral veins drain into the inferior (b) The veins do not communicate with the veins of
sagittal sinus. the brain and the venous sinuses.
(b) The great cerebral vein drains into the superior (c) The arteria radicularis magna (artery of
sagittal sinus. Adamkiewicz) arises in the upper thoracic region
from the arch of the aorta. (d) The patient’s head and eyes were turned to the left
(d) The anterior spinal artery is double but usually (i.e., to the side of the lesion).
arises from one vertebral artery. (e) The loss of right-sided abdominal reflexes indicated
(e) The spinal arteries are not reinforced by branches the presence of a lesion on the left side of the brain.
of local arteries. 18. The following physical signs and known anatomical
Directions: Each case history is followed by questions. data strongly suggested the involvement of the left
Read the middle
case history, then select the ONE BEST lettered answer. cerebral artery except:
A 58-year-old man,while eating his evening meal, (a) Paralysis of the right side of the face and the right
suddenly arm was more severe than that of the right leg.
complained of a severe headache. Moments later, he (b) The presence of aphasia.
slumped forward and lost consciousness. (c) The central branches of the middle cerebral artery
do not supply the lentiform nucleus, the caudate
14. On being admitted to the hospital, the examining nucleus, and the internal capsule.
physician (d) The left middle cerebral artery supplies the entire
could have found the following physical signs lateral surface of the cerebral hemisphere, except
except: for the narrow strip supplied by the anterior cerebral
(a) He was in a deep coma,and his breathing was deep artery.
and slow.
(b) The patient’s head was turned to the left. (e) The left posterior cerebral artery supplies the
(c) The right side of his face was flattened, and saliva occipital pole and the inferolateral surface of the
was drooling out of the right corner of his mouth. cerebral hemisphere.
(d) The muscle tone of the limbs was less on the right A 60-year-old man was admitted to the emergency
side than on the left. department,
(e) The right abdominal reflexes were absent, and complaining of the sudden onset of excruciating,
there was a positive Babinski response on the left sharp,tearing pain localized to the back of the chest and
side. the
15. Three days later, the patient regained consciousness, back.After a thorough physical and radiologic
and the following additional signs could have become examination,
apparent except: a diagnosis of dissection of the descending thoracic
(a) The right arm and, to a lesser extent, the right leg aorta
were paralyzed. was made.Within a few hours, the patient started to
(b) Movements of the left arm and leg and the left side experience
of the face were normal. “girdle” pain involving the fourth thoracic dermatome
(c) The upper and lower parts of the right side of his on both sides. Later, he was found to have bilateral
face were paralyzed. thermoanesthesia
(d) The patient had difficulty in swallowing. and analgesia below the level of the fourth
(e) The patient was unable to speak. thoracic dermatome. Position sense, vibration, and light
16. During the next 2 weeks, the following signs could touch remained normal. Complete spastic paralysis of
have both
developed except: legs quickly developed.
(a) The muscles of the limbs on the right side became 19. The sudden onset of “girdle” pain in this patient was
hypertonic. most likely caused by:
(b) The tendon reflexes on the right side became (a) Pressure on the fourth thoracic spinal nerves
hyperactive. (b) Blockage of the origins of the posterior intercostal
(c) The patient had some sensory loss on the right side. arteries that give rise to the segmental spinal arteries
(d) The patient was suffering from urinary incontinence. by the aortic dissection
(e) The muscles on the left side exhibited hypotonia. (c) Discomfort caused by the expanding aneurysm
17. The neurologist in charge of this patient interpreted (d) Osteoarthritis of the vertebral column
the 20. The development of bilateral thermoanesthesia and
findings as follows. All his interpretations were likely to analgesia below the level of the fourth thoracic segment
be correct except: of the cord and the later development of paraplegia
(a) The sudden onset of a severe headache followed could be caused by:
by loss of consciousness is a common finding in (a) Absent circulation in the posterior spinal arteries
patients with a blockage of a cerebral artery. (b) Cerebral hemorrhage
(b) The depth of coma is unrelated to the extent of the (c) Absent circulation in the anterior spinal artery
arterial blockage. (d) Collapse of the fourth thoracic vertebral body
(c) Paralysis of the face on the right side indicated the
presence of a lesion on the left side of the brain.