Neuroscience and Neuroanatomy

I.1. In which location along the carotid artery would a ruptured

aneurysm result in subarachnoid hemorrhage?

a. Carotid artery bifurcation

b. Extracranial internal carotid segment

c. Petrous carotid segment

d. Carotid cavernous segment

e. Ophthalmic carotid segment

I.2. Which of the following might result from a stroke due to inter-

ruption of the blood supply to the recurrent artery of Heubner?

a. Contralateral hemisensory loss

b. Abulia and executive dysfunction

c. Contralateral hemiataxia

d. Ipsilateral hemiataxia

e. Visuospatial disorientation

I.3. Which of the following arteries is not a component of the circle of Willis?

a. Anterior cerebral artery, A1 segment

b. Anterior communicating artery

c. Posterior communicating artery

d. Posterior cerebral artery, P1 segment

e. Posterior cerebral artery, P2 segment

I.4. A 24-year-old woman presents with pain in the left side of the

neck, numbness on the left side of the face, and numbness of

the right arm and leg, all of which began soon after falling from

a horse. On examination she has dysphonia, left hemiataxia, left

miosis and ptosis, and reduced pinprick sensation on the left

side of the face and the right arm and leg. To which of the fol-

lowing structures does the lesion best localize?

a. Central pons

b. Left lateral medulla

c. Right lateral medulla

d. Left midbrain

e. The findings cannot be localized to a single structure

I.5. Which of the following accurately lists the order of branches

from the internal carotid artery?

a. Anterior choroidal, ophthalmic, posterior communicating

b. Superior cerebellar, ophthalmic, anterior choroidal

c. Ophthalmic, posterior communicating, anterior choroidal

d. Anterior choroidal, posterior communicating, ophthalmic

e. Posterior communicating, ophthalmic, anterior choroidal

I.6. Which of the following structures is supplied by the posterior

spinal arteries?

a. Spinothalamic tract

b. Rubrospinal tract

c. Spinoreticular tract

d. Dorsal column–medial lemniscal pathway

e. Tectospinal tract

I.7. A 72-year-old man with a history of atrial fibrillation has an

abrupt onset of speech arrest and right hemiparesis. He is found

to have a large ischemic cerebral infarction in the distribution of

the left middle cerebral artery. Which of the following would be

the characteristic pathologic finding 3 weeks after onset?

a. Gliosis

b. Cytotoxic edema

c. Mononuclear cell infiltrate

d. Eosinophilic pyknotic (“red dead”) neurons

e. Infiltration of reactive astrocytes

I.8. Which of the following best characterizes the function of cere-

brospinal fluid?

a. It is the primary mechanism of neuronal nutrient delivery

b. It serves as an intracellular transport pathway

c. It is not involved in homeostasis of the central nervous system

d. It provides buoyancy for the brain

e. It is a primary neuroendocrine secretory pathway

I.9. An 83-year-old man with a history of mild dementia fell, hit his

head, and damaged several left-sided bridging veins. On imag-

ing studies, hemorrhage into which of the following spaces or

structures would be most likely?

a. Epidural space

b. Subdural space

c. Subarachnoid space

d. Cerebral parenchyma

e. Intraventricular space

I.10. Which of the following describes the correct sequence of flow for cerebrospinal fluid after it is produced in the choroid plexus of the lateral ventricles?

a. Foramen of Magendie, cerebral aqueduct, fourth ventricle, arach-

noid granulations, superior sagittal sinus

b. Cerebral aqueduct, third ventricle, foramen of Monro, subarach-

noid space, arachnoid granulations

c. Third ventricle, fourth ventricle, cerebral aqueduct, foramen of

Magendie, lateral ventricle

d. Foramen of Monro, third ventricle, cerebral aqueduct, fourth

ventricle, foramina of Luschka

e. Arachnoid granulations, subarachnoid space, fourth ventricle,

third ventricle, lateral ventricle

I.11. An 11-year-old girl with tuberous sclerosis has headaches.

Imaging shows a large tumor near the foramen of Monro, which

is subsequently identified as a subependymal giant cell astrocy-

toma. Which of the following cerebrospinal fluid spaces would

most likely be enlarged on brain imaging?

a. Lateral ventricles

b. Third ventricle and lateral ventricles

c. Cerebral aqueduct, third ventricle, and lateral ventricles

d. Fourth ventricle, cerebral aqueduct, third ventricle, and lateral ventricles

e. Subarachnoid space, fourth ventricle, cerebral aqueduct, third

ventricle, and lateral ventricles

I.12. Which of the following best approximates the volume of cerebrospinal fluid in an adult at any point in time?

a. 50 mL

b. 35 mL

c. 150 mL

d. 500 mL

e. 725 mL

I.13. Which of the following best reflects a typical, normal cerebrospi-

nal fluid opening pressure in a healthy adult?

a. –20 mm H2O

b. 10 mm H2O

c. 150 mm H2O

d. 450 mm H2O

e. 700 mm H2O

I.14. Which of the following is a characteristic feature of sensory

systems?

a. They rarely display topographic representation of receptive fields

b. They rely on stimulus coding for transduction

c. None use cortical control as a component of sensory relay

d. They rely primarily on disconnected pathways for processing

e. They are generally not limited to the properties of their respective receptive fields

I.15. Which of the following associations between sensory organ and modality is most correct?

a. Ruffini end-organ and perception of texture and form

b. Free nerve endings and joint-position sense

c. Merkel disk and proprioception

d. Pacini corpuscle and braille-like stimuli

e. Meissner corpuscle and edge contour

I.16. Which of the following sensory modalities bypasses thalamic

relay nuclei?

a. Olfactory

b. Visual

c. Auditory

d. Gustatory

e. Somatosensory

I.17. Which of the following statements about sensory systems is most correct?

a. Heteromodal processing structures typically project to unimodal sensory pathways

b. Most pathways maintain topographic representations of receptive fields

c. There are no parallel pathways of sensory integration through the ventral and dorsal streams

d. All sensory systems contain at least 3 precortical synapses

e. All sensory systems are mediated through parenchymal sensory ganglia

I.18. Which of the following modalities is primarily carried by the

dorsal column–medial lemniscal system?

a. Pain and temperature from the face

b. Bulbar joint position sense

c. Light touch from the face

d. Pain and temperature from the body

e. Vibration and joint position sense from the body

I.19. The thalamic relay for the sensation of pain includes which of

the following?

a. Mediodorsal, ventral posteromedial, and ventral posterolateral nuclei

b. Pulvinar, ventral posterolateral, and ventral posteromedial nuclei

c. Anterior nucleus

d. Ventral posterolateral and ventral posteromedial nuclei

e. Medial and lateral geniculate bodies

I.20. Unmyelinated C axons terminate in which Rexed laminae of the dorsal horn?

a. I and II

b. II and III

c. III and IV

d. IV and V

e. I through V

I.21. A 24-year-old woman has intermittent pain and redness in the

feet, often precipitated by aerobic exercise. Her father had a

similar syndrome. Mutations in which of the following channels

may be responsible for this disorder?

a. Nav1.7 channel

b. P/Q-type calcium channel

c. TRPV1 channel

d. Nav1.9 channel

e. Kvα11 channel

I.22. Nociception is mediated primarily by which of the following

nerve fiber types?

a. Type 2A

b. Type 2B

c. Aβ

d. Aδ and C

e. Aα

I.23. For which process is the superior olive important?

a. Transmission of sound frequency

b. Transmission of light touch and vibration

c. Sound localization

d. Vestibuloocular coordination

e. Comparison of intended action to actual action

I.24. Activation of the right horizontal semicircular canal stimulates

which muscles as a result of the vestibuloocular reflex?

a. Left superior oblique and right inferior rectus

b. Right superior oblique and left inferior rectus

c. Right lateral rectus and left medial rectus

d. Left lateral rectus and right medial rectus

e. Right and left medial rectus’

I.25. Which of the following cell types has a glial function in the retina?

a. Ganglion

b. Photoreceptor

c. Amacrine

d. Bipolar

e. Müller

I.26. A patient has numbness of the lateral aspect of the left thigh

without weakness or pain. On neurologic examination, lower

extremity strength and reflexes at the knees and ankles are nor-

mal. On sensory examination, the lateral aspect of the thigh has

decreased sensation to a pin. What is the most likely diagnosis?

a. Left lateral femoral cutaneous neuropathy

b. Left L3 radiculopathy

c. Left femoral neuropathy

d. Left obturator neuropathy

e. Left superficial peroneal neuropathy

I.27. A 75-year-old man with prostate cancer has had a gradual onset

of his foot slapping the ground when he walks. On examination,

he has weakness of the right peroneal, right anterior tibial, and

right posterior tibial muscles. His reflexes are normal at the

knees and ankles. What is the most likely localization?

a. Right superficial peroneal neuropathy

b. Right deep peroneal neuropathy

c. Right L4 radiculopathy

d. Right L5 radiculopathy

e. Right sciatic neuropathy

I.28. A 72-year-old man with diabetes mellitus presents with subacute

pain and weakness in the left thigh. On examination, he has

moderate weakness of the left quadriceps muscles and hip

adductors. The stretch reflexes of the quadriceps muscles are

reduced, but the ankle jerks are preserved. To which structure

does the lesion best localize?

a. S1 spinal root

b. Lumbar plexus

c. Femoral nerve

d. Obturator nerve

e. Sciatic nerve

I.29. A 15-year-old boy presents for evaluation of right shoulder pain.

On examination, you find that his right scapula moves posteri-

orly when he leans forward against the wall with both hands. To

which structure does the lesion best localize?

a. Left precentral gyrus

b. Long thoracic nerve

c. Spinal accessory nerve

d. Dorsal scapular nerve

e. Suprascapular nerve

I.30. What lesion is compatible with loss of pain and temperature sen-

sation on the right side below the level of the umbilicus, left leg

weakness, and loss of proprioception in the left leg?

a. Commissural syndrome at the T10 level

b. Occlusion of the anterior spinal artery with ventral cord syn-

drome at the T10 level

c. Central cervical cord syrinx

d. Cauda equina syndrome

e. Left T10 hemicord syndrome (Brown-Séquard syndrome)

I.31. A 64-year-old man with prostate cancer presents with progressive

back pain and gait deterioration over 3 months. On neurologic

examination, he has weakness of the hamstring and anterior tibi-

alis muscles bilaterally, increased knee and ankle reflexes, bilat-

eral Babinski signs, and reduced sensation to vibration and

proprioception but not to pin prick. What other symptom or sign

might you expect in this patient?

a. Fasciculations

b. Urinary retention

c. Tongue weakness

d. Lhermitte sign

e. Decreased temperature sensation

I.32. A 50-year-old man presents with a 1-year history of progressive

weakness and fasciculations of his right lower extremity with

subsequent spasticity, weakness, and fasciculations of his right

upper extremity. Over the past month, he has also had difficulties

with slurred speech and dysphagia. He does not have associated

pain or sensory symptoms. What combination of abnormalities

would be the likely cause of this presentation?

a. Damage to the corticospinal tract and the spinothalamic tract

b. Damage to the anterior horn cells and the cortical motor neurons

c. Damage to the fasciculus gracilis and the fasciculus cuneatus

d. Damage to the anterior horn cells and the fasciculus gracilis

e. Damage to the cortical motor neurons and the spinothalamic

tract

I.33. Which of the following describes cranial nerve IX?

a. Innervates the stylopharyngeus muscle

b. Innervates the sublingual and submandibular glands

c. Innervates the glossopharyngeal muscle

d. Participates in the efferent limb of the baroreceptor reflex

e. Receives touch sensation to the forehead

I.34. Which of the following tracts or pathways does not cross in the

brainstem?

a. Dorsal column–medial lemniscal pathway

b. Trigeminothalamic tract

c. Gustatory tract

d. Corticospinal tract

e. Dentato-rubro-olivary pathway

I.35. Which of the following features may result from a lateral medul-

lary infarction?

a. Contralateral decrease in pain and temperature sensations of the

face, arm, and leg

b. Contralateral hemiataxia

c. Horner syndrome

d. Tongue deviation ipsilateral to the lesion

e. Spastic dysarthria

I.36. Which sensory pathway does not relay in the thalamus?

a. Light touch

b. Olfactory

c. Visual

d. Gustatory

e. Pain and temperature

I.37. Villaret syndrome is a composite of ipsilateral paralysis of the

soft palate, pharynx, and larynx resulting in hoarseness and dys-

phagia, ipsilateral weakness of the sternocleidomastoid and tra-

pezius muscles, and ipsilateral weakness of the tongue with

atrophy. In addition, there is ipsilateral ptosis, miosis, and facial

anhidrosis. Where would these findings localize?

a. Nucleus ambiguus

b. Jugular foramen

c. Pterygopalatine ganglia

d. Retropharyngeal space

e. Hypoglossal foramen

I.38. A patient presents with pulsatile tinnitus, mild proptosis of the

right eye, right sixth nerve palsy, and mild numbness of the right

side of the forehead. Where would this process most likely localize?

a. Jugular foramen

b. Cavernous sinus

c. Rostral pons

d. Meckel cave

e. Cribiform plate

I.39. Which of the following describes the spinal tract and nucleus of

cranial nerve V?

a. Crosses at the pons

b. Carry light touch and unconscious proprioception

c. Ascend to the ventral posterolateral nucleus of the thalamus

d. Part of the afferent limb of the blink reflex

e. Nucleus is within the midbrain

I.40. A petroclival meningioma may result in dysfunction of which cranial nerve?

a. II

b. III

c. IV

d. V

e. VI

I.41. What may result from a unilateral lesion in the rostral midbrain

affecting the inferior colliculus?

a. Difficulty with sound localization

b. Unilateral deafness

c. Pure word deafness

d. Anomia

e. No deficit

I.42. Which of the following would not result from a lesion affecting

cranial nerve VII at the internal acoustic meatus?

a. Unilateral facial weakness sparing the forehead

b. Ipsilateral decrease in taste

c. Ipsilateral increase in sound

d. Ipsilateral change in tear production

e. Difficulty closing the ipsilateral eye

I.43. From which skull foramen does the third sensory division of cra-

nial nerve V enter?

a. Hypoglossal foramen

b. Foramen rotundum

c. Foramen spinosum

d. Foramen ovale

e. Foramen lacerum

I.44. Which finding might you see in a patient with decorticate

posturing?

a. Absent spontaneous respirations

b. Absent corneal reflex

c. Fixed, dilated pupils

d. Absent caloric reflex

e. Decreased level of consciousness

I.45. A patient has skew diplopia that worsens with right head tilt and

improves with left head tilt. Where is the most likely lesion?

a. Right third nerve axon

b. Left third nerve nucleus

c. Right fourth nerve axon

d. Left fourth nerve axon

e. Right third nerve nucleus

I.46. If a patient presents with a right third nerve palsy and contralat-

eral hemiparesis, where is the lesion?

a. Right lateral midbrain

b. Right medial midbrain

c. Left lateral midbrain

d. Left medial midbrain

e. Tectal plate

I.47. What is the result of a right nuclear third nerve palsy?

a. Right third nerve palsy and contralateral pupillary dilatation

b. Right third nerve palsy and left intranuclear ophthalmoplegia

c. Right third nerve palsy, contralateral superior rectus palsy, and

contralateral ptosis

d. Right third nerve palsy and pupillary sparing

e. Right third nerve palsy and ipsilateral facial weakness

I.48. Which extraocular muscles are innervated by cranial nerve III?

a. Superior rectus, superior oblique, inferior rectus, and inferior

oblique

b. Lateral rectus, superior rectus, inferior rectus, and medial rectus

c. Lateral rectus, inferior rectus, inferior oblique, and superior oblique

d. Inferior rectus, superior rectus, medial rectus, and inferior

oblique

e. Superior rectus, lateral rectus, inferior oblique, and superior

oblique

I.49. Which of the following does not describe the third nerve nuclear

complex?

a. The Edinger-Westphal subnucleus is rostral to the general somatic

efferent component of the third nerve

b. The medial rectus subnuclei on the right innervate the left medial

rectus muscle

c. The central caudal nucleus is midline and innervates bilateral

levator palpebrae muscles

d. This complex lies in the medial midbrain at the level of the red

nucleus and superior colliculus

e. The general visceral efferent component of the third nerve inner-

vates the pupillary constricting muscles

I.50. A patient presents with acute right hemiparesis and gaze prefer-

ence toward the left. What will happen if you perform the ves-

tibuloocular reflex?

a. The vestibuloocular reflex will be intact

b. The vestibuloocular reflex will be impaired

c. The vestibuloocular reflex will indicate intranuclear

ophthalmoplegia

d. The vestibuloocular reflex will indicate one-and-a-half syndrome

e. The vestibuloocular reflex will indicate bilateral horizontal gaze

dysfunction

I.51. Which neurotransmitter is secreted by the locus ceruleus?

a. Serotonin

b. Norepinephrine

c. Epinephrine

d. Dopamine

e. Tryptophan

I.52. A patient presents with gradual, progressive difficulty with

upward gaze and headache. Upon attempted upgaze, he has

convergence-retraction nystagmus. His pupils do not react. What

is the most likely cause?

a. Pituitary tumor

b. Multiple sclerosis affecting the pons

c. Pineal tumor

d. Cavernous sinus meningioma

e. Acoustic neuroma

I.53. Which cranial nerves have parasympathetic components?

a. III, V, VI, and X

b. III, IV, V, and VI

c. III, VII, IX, and X

d. V, VII, IX, and X

e. V, VII, IX, and XII

I.54. What innervates the submandibular and sublingual glands?

a. Cranial nerve IX through the otic ganglion

b. Cranial nerve X through the otic ganglion

c. Cranial nerve VII through the sphenopalatine ganglion

d. Cranial nerve V through the submandibular ganglion

e. Cranial nerve VII through the submandibular ganglion

I.55. Where do burst neurons for horizontal saccades originate?

a. Interstitial nucleus of Cajal

b. Nucleus raphe interpositus

c. Vestibular nucleus

d. Paramedian pontine reticular formation

e. Superior olive

I.56. While examining a 35-year-old woman referred for possible multiple

sclerosis, you observe eye movement abnormalities. Although right-

ward gaze is normal and conjugate, during leftward saccades the

right eye adducts slowly and incompletely, and the abducted left eye

shows a few beats of nystagmus. Both eyes adduct normally with

convergence. On the basis of these findings, where is the lesion?

a. Left vestibular nuclei

b. Left medial longitudinal fasciculus (MLF)

c. Left paramedian pontine reticular formation

d. Right MLF

e. Right rostral interstitial nucleus of the MLF

I.57. In the ocular motor system, what is the purpose of a neural

integrator?

a. To prolong the duration of the vestibular system response to sus-

tained rotation

b. To improve the accuracy of saccades

c. To convert a velocity (pulse) to the position (step) command in

order to hold the eyes in an eccentric position and prevent gaze-

holding nystagmus

d. To prevent excitatory burst neurons from unintended firing that

would result in ocular flutter or opsoclonus

e. To relay visual input to the ocular motor system during smooth

pursuit

I.58. A 62-year-old woman is referred to you for slowly progressive gait

impairment. On examination you observe spontaneous downbeat

nystagmus in primary position, gaze-evoked nystagmus, and

choppy pursuit in all directions. What is the most likely diagnosis?

a. Parkinson disease

b. Progressive supranuclear palsy

c. Pontine cavernous angioma

d. Posterior cortical atrophy

e. Cerebellar degeneration

I.59. Through which thalamic nucleus does the olfactory pathway

relay before reaching the olfactory cortex?

a. Pulvinar

b. Medial dorsal

c. Lateral geniculate body

d. Anterior nucleus

e. None

I.60. To which part of the visual pathway would bitemporal visual loss

localize?

a. Optic nerve

b. Optic chiasm

c. Lateral geniculate body

d. Optic radiation to the parietal lobe

e. Occipital cortex

I.61. If a patient reports detecting unusual odors that no one else

perceives, where might a lesion be located?

a. Orbitofrontal cortex

b. Piriform cortex

c. Lingual gyrus

d. Fusiform gyrus

e. Angular gyrus

I.62. What would a patient likely experience with an ischemic stroke

involving the anterior nucleus of the thalamus?

a. Contralateral homonymous hemianopsia

b. Ipsilateral hemiataxia

c. Short-term memory loss

d. Aphasia

e. Disinhibited behavior

I.63. Which of the following thalamic nuclei is involved in executive

function and multitasking?

a. Dorsomedial

b. Lateral geniculate body

c. Ventral lateral

d. Ventral anterior

e. Pulvinar

I.64. Which thalamic nucleus receives blood supply from the anterior

circulation?

a. Dorsomedial

b. Lateral geniculate body

c. Ventral posterior lateral

d. Pulvinar

e. Anterior nucleus

I.65. A 60-year-old woman has clinical signs and symptoms consistent

with a diagnosis of Cushing syndrome. This condition is likely due

to prolonged exposure to high levels of which of the following?

a. Thyrotropin

b. Prolactin

c. Insulinlike growth factor 1

d. Follicle-stimulating hormone

e. Cortisol

I.66. Which of the following inhibits the secretion of growth hormone?

a. Somatostatin

b. Dopamine

c. Cortisol

d. Triiodothyronine

e. Testosterone

I.67. A 45-year-old man has difficulty with food intake and the sleep-

wake cycle. Which nucleus of the hypothalamus is most likely

affected?

a. Paraventricular (magnocellular neurons)

b. Paraventricular (parvocellular neurons)

c. Medial preoptic

d. Posterolateral

e. Dorsomedial

I.68. Which part of the limbic system is most critical for the encoding

and retrieval of declarative (explicit) memory?

a. The posterior limbic circuit, centered in the posterior cingu-

late cortex

b. The anterior limbic circuit, centered in the hippocampus

c. The posterior limbic circuit, centered in the hippocampus

d. The anterior limbic circuit, centered in the amygdala

e. The orbitomedial prefrontal cortex

I.69. Which component of the limbic system is responsible for asso-

ciative memory linking the perception of odors with emotional

and behavioral responses?

a. Basolateral amygdala

b. Basal forebrain

c. Entorhinal cortex

d. Olfactory amygdala

e. Centromedial amygdala

I.70. A 38-year-old man is dismissed from the hospital after receiving

antiviral therapy for herpes simplex virus encephalitis. A few

months later, family members bring him to you for evaluation

because the patient has been displaying inappropriate sexual

behavior and a tendency to explore objects with his mouth, and he

has had memory loss, weight gain due to nearly compulsive eating,

and a submissive, “docile” affect. What syndrome is most likely?

a. Behavioral variant frontotemporal dementia

b. Kleine-Levin syndrome

c. Herpes simplex virus reinfection syndrome

d. Early-onset Alzheimer disease

e. Klüver-Bucy syndrome

I.71. What is the effect of the globus pallidus interna (GPi) on thala-

mocortical outflow?

a. Tonic excitation

b. Oscillatory excitation

c. Tonic inhibition

d. Oscillatory inhibition

e. No direct outflow is present

I.72. For facilitation of movement, which of the following must occur?

a. Facilitation of the subthalamic nucleus

b. Inhibition of the globus pallidus interna (GPi)

c. Inhibition of the supplementary motor area

d. Increased γ-aminobutyric acid (GABA)ergic transmission

e. Inhibition of thalamocortical projections

I.73. Which disease is associated with decreased activity of the direct

pathway dopamine D1 receptors and increased activity of the

indirect pathway dopamine D2 receptors?

a. Hemiballismus

b. Huntington disease

c. Basal ganglia stroke

d. Parkinson disease

e. Fahr disease

I.74. A female patient presents with acute mild weakness of the right

arm and leg. She has superimposed ataxia on the right side with

the finger-to-nose and heel-to-shin tests. She also has reduced

sensation to pain and temperature on the right side. Where is

the most likely localization of this syndrome?

a. Basis pontis

b. Lateral thalamus and internal capsule

c. Medial midbrain

d. Ventral medulla

e. Parietal cortex

I.75. Which artery supplies the dentate nucleus?

a. Vertebral artery

b. Basilar artery

c. Posterior inferior cerebellar artery

d. Anterior inferior cerebellar artery

e. Posterior cerebral artery

I.76. If a patient has gait ataxia without limb ataxia, where might the

lesion be located?

a. Vermis of the cerebellum

b. Flocculus of the cerebellum

c. Anterior lobe of the cerebellum

d. Decussation of the left superior cerebellar peduncle

e. Lateral hemisphere of the cerebellum

I.77. Which of the following describes the output of the dentate nucleus?

a. The fibers travel ipsilaterally in the spinal cord as the reticulospi-

nal tracts

b. The fibers travel to the contralateral spinal cord as the reticulo-

spinal tracts

c. The fibers travel through the superior cerebellar peduncle, cross to

the contralateral side, and synapse in the ventral lateral thalamus

d. The output fibers from the dentate nucleus travel to the contra-

lateral basis pontis, where they synapse

e. The fibers travel to the ipsilateral ventromedial thalamus

I.78. Autoimmune autonomic ganglionopathy (AAG) most often

results from autoantibodies against the ganglionic subtype of

nicotinic acetylcholine receptors. Which of the following would

not be an expected manifestation of AAG?

a. Atonic bladder

b. Early satiety

c. Excessive sweating

d. Impaired night vision

e. Orthostatic hypotension

I.79. Which of the following correctly pairs a lesion with a feature of

the type of neurogenic bladder that would result from that lesion?

a. Aqueductal stenosis and retention of large volumes of urine

b. Cauda equina compression and detrusor-sphincter dyssynergia

c. Diabetic neuropathy and uninhibited bladder

d. Lateral medullary infarction and atonic bladder

e. Transverse myelitis and urinary frequency with urgency

I.80. A patient’s pupils measure OD 2 mm and OS 4 mm in bright light

and OD 3 mm and OS 7 mm in dim light. With instillation of

dilute cocaine drops, the pupils measure OD 8 mm and OS 9 mm.

Which of the following is a possible location of the lesion result-

ing in pupil asymmetry?

a. Right oculomotor nerve

b. Left lateral medulla

c. Right superior cervical ganglion

d. Left oculomotor nuclei

e. Right pupillary dilator muscle

I.81. In which lobe of the brain is the angular gyrus located?

a. Frontal

b. Temporal

c. Parietal

d. Occipital

e. Limbic

I.82. A 34-year-old patient with a history of recent traumatic brain

injury was found urinating on his front lawn. He made inappro-

priate comments when police arrived. In which portion of the

brain is the injury most likely located?

a. Anterior cingulate gyrus

b. Paracentral lobule

c. Cuneus

d. Orbitofrontal cortex

e. Dorsolateral prefrontal cortex

I.83. Where in the cortex are primary visceral sensory, taste, and pain

information projected?

a. Dorsolateral prefrontal cortex

b. Cuneus

c. Inferior temporal lobe

d. Precuneus

e. Insular cortex

I.84. Which statement is false about cortical organization?

a. The number of layers in the cortex varies by cortex type

b. Idiotypic isocortex contains 6 layers

c. Homotypic isocortex contains 6 layers

d. The primary motor cortex is an example of idiotypic isocortex

e. Allocortex has no consistent lamination

I.85. Which is not an example of mesocortex?

a. Parahippocampal gyrus

b. Cingulate gyrus

c. Basal forebrain

d. Insula

e. Temporal pole

I.86. Which term is not related to the neocortex?

a. Isocortex

b. Corticoid

c. Primary cortex

d. Heteromodal association cortex

e. Unimodal association cortex

I.87. Which of the following is true about the default mode net-

work (DMN)?

a. The DMN consists of a series of interconnected unimodal cortices

b. The orbitofrontal cortex is a large component of the DMN

c. Neurodegenerative diseases may impair the DMN, leading to

impairment of autobiographic memory and poor spatial navigation

d. The DMN is active during coma

e. The DMN is associated with lesions in the thalamus

I.88. Which of the following is a function of the anterior limbic circuit?

a. Hunger

b. Autobiographic memory

c. Visual spatial awareness

d. Sensory integration

e. Taste

I.89. Why is the parietal heteromodal cortex important?

a. For identifying and labeling a visual object

b. For identifying the color of a visual object

c. For integrating the location of a visual object to direct motor (eye

and limb) movement toward the object

d. For identifying the texture of an object

e. For initiating a motor response to an emotion

I.90. A 75-year-old patient presents with stroke affecting the left

hemisphere. He has nonfluent speech with poor naming but

intact comprehension and repetition. What would be the best

classification for this type of aphasia?

a. Broca aphasia

b. Wernicke aphasia

c. Pure word deafness

d. Transcortical sensory aphasia

e. Transcortical motor aphasia

I.91. Soon after a patient was involved in a motor vehicle accident,

the patient began to laugh inappropriately during church ser-

vices, interrupt conversations, and make poor financial deci-

sions. Where is the most likely localization of the brain injury?

a. Dorsolateral prefrontal cortex

b. Ventrolateral prefrontal cortex

c. Orbitofrontal cortex

d. Bilateral temporal cortices

e. Bilateral parietal cortices

I.92. A patient with stroke cannot recognize her son visually, but

when he speaks, she recognizes his voice. Where is the stroke

most likely localized?

a. Left prefrontal cortex

b. Right prefrontal cortex

c. Left parietal cortex

d. Right occipitotemporal cortex

e. Left occipital lobe

I.93. A patient has sudden difficulty with adding and subtracting,

identifying his thumb, right-left disorientation, and writing.

Where is this process localized?

a. Left orbitofrontal cortex

b. Left premotor cortex

c. Left anterior thalamus

d. Left angular gyrus

e. Left superior parietal lobule

I.94. Which factor increases the speed of action potential propagation?

a. Sensory nerve rather than motor nerve

b. Cold

c. Location in the central nervous system

d. Absence of myelin

e. Larger axonal diameter

I.95. Which of the following describes the neurotransmitter glutamate?

a. Ondansetron acts on glutamate receptors

b. Glutamate is an inhibitory neurotransmitter

c. α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)

and N-methyl-D-aspartate (NMDA) are receptors for glutamate

d. The locus ceruleus manufactures glutamate

e. Glutamate acts on nicotinic and muscarinic receptors

I.96. Which of the following is produced by the raphe nuclei?

a. Dopamine

b. Acetylcholine

c. Serotonin

d. Adrenaline

e. Oxytocin

I.97. Which of the following statements about neuronal transmem-

brane potentials is most correct?

a. Usually the neuronal resting membrane potential is approxi-

mately +70 mV

b. The resting membrane potential is maintained primarily through

passive membrane ion transport

c. The depolarizing phase of the action potential is mediated primar-

ily by voltage-gated sodium channels that have a fast activation

d. The speed of action potential propagation is entirely indepen-

dent of axonal diameter

e. The equilibrium potential of potassium is highly positive (approx-

imately +90 mV) and therefore does not contribute meaningfully

to the resting membrane potential

I.98. Which of the following is the primary neurotransmitter synthe-

sized by alpha motor neurons in the spinal cord?

a. Dopamine

b. Serotonin

c. Norepinephrine

d. Acetylcholine

e. Glutamate

I.99. Which statement is true about anterograde axonal transport?

a. It is accomplished by the dynein-dynactin complex

b. Anterograde transport shuttles cellular cargo toward the cell body

c. The kinesin family of proteins is involved in this process

d. The rate of transport is approximately 100 mm/d

e. Transport occurs along neurofilaments

I.100. Which cellular component or process is dysfunctional in lyso-

somal storage diseases?

a. Anterograde axonal transport

b. Apoptosis

c. Transcription

d. Mitochondria

e. Protein processing

I.101. Which of the following is required for transport of long-chain

fatty acids into the mitochondria?

a. L-carnitine and carnitine palmitoyltransferases

b. Nicotinamide adenine dinucleotide

c. Adenosine triphosphate

d. Methylmalonic acid

e. Coenzyme Q10

I.102. Which of the following best decribes the cause of necrosis, an

acute process of cellular injury and death?

a. Formation of autophagosomes

b. Energy depletion, ion pump failure, and cellular swelling and lysis

c. Cellular shrinkage and chromatin condensation

d. Self-aggregation of misfolded proteins

e. Release of cytochrome c through mitochondrial pores

I.103. What is the culmination of intrinsic and extrinsic apoptotic

pathways?

a. A profound inflammatory response caused by apoptotic bodies

b. Cellular lysis releasing toxic and proinflammatory intracellular

contents

c. Mitochondrial pore formation, cytochrome c release, and cas-

pase 3 activation, which causes DNA fragmentation

d. Large membrane vesicles fusing with lysosomes

e. Cell membrane pore formation, which accelerates permeability,

swelling, and lysis

I.104. What is the morphologic hallmark of autophagy?

a. Cytoplasmic and mitochondrial swelling

b. Formation of apoptotic bodies

c. Nuclear chromatin rarefaction and karyolysis

d. An abundance of intracellular vesicles, autophagosomes, and

lysosomes

e. Cellular shrinkage, membrane blebs, and nuclear compaction

I.105. In the presynaptic neuron, which vitamin is required for the

conversion of glutamate to γ-aminobutyric acid (GABA)?

a. Vitamin B1

b. Vitamin E

c. Vitamin D

d. Vitamin A

e. Vitamin B6

I.106. Phenytoin is highly protein bound. In which instance would a

patient most likely show signs of toxicity with a normal level of

serum total phenytoin?

a. Chronic kidney disease

b. Concurrent levetiracetam use

c. Obesity

d. Type 2 diabetes mellitus

e. Pregnancy

I.107. How do calcitonin gene–related peptide (CGRP) receptor anti-

body medications exert their action on migraine?

a. By acting as selective agonists of serotonin 1B and 1D receptors

b. By increasing glutamatergic inhibition

c. By decreasing intrasynaptic dopamine reuptake

d. By modulating nociceptive pathways in the trigeminovascu-

lar system

e. By inhibiting norepinephrine production

I.108. How do monoamine oxidase B (MAO-B) inhibitors improve

symptoms of Parkinson disease?

a. By directly activating dopamine receptors

b. By blocking degradation of dopamine

c. By enhancing dopamine release from presynaptic terminals

d. By causing anticholinergic effects

e. By inhibiting dopa decarboxylase

I.109. A patient in the sleep laboratory has low-amplitude, mixed-fre-

quency changes on electroencephalography (EEG) with K com-

plexes and sleep spindles in addition to decreased muscle tone.

The patient is most likely in which of the following stages of sleep?

a. Non–rapid eye movement (NREM) sleep stage N1

b. NREM sleep stage N2

c. NREM sleep stage N3

d. NREM sleep stage N4

e. Rapid eye movement sleep

I.110. Which stage of sleep is represented in the sleep study shown in the figure below?

a. Non–rapid eye movement (NREM) sleep stage N1

b. NREM sleep stage N2

c. NREM sleep stage N3

d. NREM sleep stage N4

e. Rapid eye movement sleep

I.111. Where are hypocretinergic (orexinergic) nuclei located?

a. Basal forebrain

b. Pineal gland

c. Posterolateral hypothalamus

d. Anterior thalamus

e. Supraoptic nucleus of the hypothalamus

I.112. What type of inheritance is most likely represented by the pedigree in the figure below?

a. Autosomal dominant

b. Autosomal recessive

c. Mitochondrial

d. X-linked dominant

e. X-linked recessive

I.113. Which statement is true about mitochondrial DNA or mitochon-

drial inheritance?

a. Mitochondrial DNA contains 48 genes

b. An individual cell contains approximately 5 copies of the mito-

chondrial DNA

c. Transmission of mitochondrial diseases is through maternal

inheritance

d. Mitochondrial diseases are never inherited in a mendelian fashion

e. The phenotype of patients with mitochondrial disease is almost

identical to that of the parent

I.114. Which of the following terms refers to the degree or severity to

which a disease phenotype is expressed among persons with

the same mutation?

a. Allelic heterogeneity

b. Expressivity

c. Locus heterogeneity

d. Penetrance

e. Phenotypic heterogeneity

I.115. Adults with Down syndrome have an increased risk for which of

the following neurologic conditions?

a. Ataxia

b. Parkinson disease

c. Alzheimer dementia

d. Spastic paraparesis

e. Multiple system atrophy

I.116. Which diagnostic test may be helpful in the diagnosis of

Angelman syndrome?

a. Cerebrospinal fluid analysis

b. Electroencephalography

c. Electromyography

d. Magnetic resonance imaging of the brain

e. Auditory evoked potentials

I.117. Which of the following syndromes is the most common single-gene cause of intellectual disability?

a. Prader-Willi syndrome

b. Angelman syndrome

c. Williams syndrome

d. Fragile X syndrome

e. Down syndrome

I.118. Repetitive, stereotypic hand movements are characteristic for

which of the following intellectual disabilities?

a. Rett syndrome

b. Fragile X syndrome

c. Down syndrome

d. Prader-Willi syndrome

e. Angelman syndrome

I.119. What stage of sleep is shown in the electroencephalographic (EEG) epoch in the figure below?

a. N1

b. N2

c. N3

d. Rapid eye movement (REM)

e. Awake

I.120. A 43-year-old man had an episode of confusion. An electroencephalogram (EEG) during drowsiness is shown in the figure

below. What is its clinical importance?

a. It shows a normal variant

b. It indicates an increased risk of seizures

c. It shows a temporal lobe seizure

d. It indicates that a brain injury occurred

e. It is typical after a craniotomy

I.121. From slowest to fastest, what is the correct order of electroen-

cephalographic (EEG) frequencies?

a. Alpha, beta, delta, theta

b. Delta, theta, alpha, beta

c. Beta, alpha, theta, delta

d. Theta, alpha, beta, delta

e. Delta, alpha, theta, beta

I.122. A 17-year-old high school senior presents after having a generalized tonic-clonic seizure. She describes a history of quick jerks that have usually occurred in the morning and have sometimes caused her to drop things. You suspect juvenile myoclonic epilepsy. What

finding might be expected on electroencephalography?

a. Electrodecrement with myoclonic jerks

b. Generalized 3-Hz spike-and-wave pattern

c. Generalized slow spike-and-wave pattern

d. Generalized atypical polyspike-and-wave pattern

e. Focal right temporal sharp waves

I.123. Which of the following is an electroencephalographic (EEG) cri-

terion to evaluate brain death?

a. Interelectrode distance of at least 20 cm

b. Impedance of 10 to 20,000 Ω

c. Recording with a sensitivity of 2 μV/mm for at least 30 minutes

d. Core body temperature less than 36°C

e. A high-frequency filter setting of less than 30 Hz

1.124. A 46-year-old woman presents to the emergency department

after a witnessed seizure. She had progressive confusion for the

day preceding the seizure. In the emergency department, she is

encephalopathic and febrile. With polymerase chain reaction,

her spinal fluid is positive for herpes simplex virus (HSV). Which

of the following would electroencephalography (EEG) most

likely show?

a. Lateralized periodic discharges

b. Normal EEG

c. Generalized atypical spike-and-wave discharges

d. Burst suppression pattern

e. Frontal intermittent rhythmic delta activity (FIRDA)

I.125. Which is not an electromyographic feature of muscle disorders

(myopathy and muscular dystrophy)?

a. Fibrillation potentials

b. Fasciculation potentials

c. Small motor unit action potentials

d. Rapid recruitment of motor units

e. Myotonia

I.126. A 32-year-old man presents with numbness and weakness in the

feet and ankles. The peroneal conduction velocity is 22 m/s; the

tibial motor conduction velocity is 24 m/s. Temporal dispersion

and conduction block are not present. Which is most likely?

a. A myopathy

b. A neuromuscular junction disorder

c. An axonal peripheral neuropathy (likely acquired)

d. A demyelinating peripheral neuropathy (likely acquired)

e. A demyelinating peripheral neuropathy (likely hereditary)

I.127. A patient presents with numbness and tingling of the right

fourth and fifth fingers. The intrinsic muscles of the hand are

slightly weak. Which of the following electromyographic (EMG)

findings would not fit with the diagnosis?

a. Low-amplitude ulnar motor compound muscle action poten-

tial (CMAP)

b. Low-amplitude ulnar sensory CMAP

c. Decreased amplitude with an inching study of the ulnar nerve

across the elbow

d. Needle EMG changes in the abductor pollicis brevis muscle

e. Needle EMG changes in the first dorsal interosseous muscle

I.128. A patient is evaluated in the electromyography laboratory for fatigue. What finding would help support a diagnosis of myas-

thenia gravis?

a. Low-amplitude motor compound muscle action potential (CMAP)

b. Slowed sensory conduction velocities

c. A decrement immediately after exercise that improves with time

d. A decrement at rest that improves after exercise

e. A decrement of 5% at all times

I.129. A low-amplitude motor compound muscle action potential (CMAP)

is least likely to be seen in which of the following disorders?

a. Motor neuropathy

b. Proximal myopathy

c. Lambert-Eaton syndrome

d. Amyotrophic lateral sclerosis

e. Sensory motor axonal neuropathy

I.130. Which of the following would not be expected to increase the

protein level in cerebrospinal fluid (CSF) to more than 500 mg/dL?

a. Tuberculous meningitis

b. Spinal block (Froin syndrome)

c. Subarachnoid hemorrhage

d. Meningeal involvement by a malignancy

e. Viral meningitis

I.131. Which of the following would be most helpful for reducing the

likelihood of headache after lumbar puncture (LP)?

a. Have the patient premedicate with caffeine before the procedure

b. Use a smaller LP needle

c. Have the patient rest supine for 30 minutes after the procedure

d. Remove less than 10 mL of fluid

e. Withdraw the spinal needle when the cerebrospinal fluid pres-

sure reaches 10 mm Hg

I.132. Which of the following conditions most commonly cause a low

glucose level in cerebrospinal fluid (CSF)?

a. Meningeal carcinomatosis

b. West Nile viral meningitis

c. Aseptic meningitis

d. Isolated central nervous system vasculitis

e. Diabetes mellitus

I.133. What is the ideal time frame for detection of xanthochromia in

a patient with suspected subarachnoid hemorrhage?

a. 1 hour to 2 weeks

b. 1 hour to 12 weeks

c. 6 hours to 2 weeks

d. 6 hours to 12 weeks

e. 24 hours to 12 weeks

I.134. A patient presents with headache and fever for 2 days.

Computed tomography of the head does not show any abnor-

malities. The cerebrospinal fluid (CSF) has a white blood cell

count of 100 cells/mcL (mostly lymphocytes), a protein level of

60 mg/dL, and a glucose level that is 50% of the serum glucose

level. What is the most likely diagnosis?

a. Sarcoidosis

b. Viral meningitis

c. Streptococcus pneumoniae meningitis

d. Cytomegalovirus ventriculitis

e. Blastomyces fungal meningitis

I.135. Which of the following structures is not assessed with somato-

sensory evoked potentials (SSEPs)?

a. Medial lemniscus

b. Arcuate fasciculus

c. Cuneate fasciculus

d. Ventral posterolateral nucleus of the thalamus

e. A-beta primary afferent peripheral axons

I.136. Which structure correlates with wave V of the brainstem audi-

tory evoked potential?

a. Cochlea

b. Proximal auditory nerve

c. Dorsal cochlear nucleus

d. Midbrain tectum

e. Primary auditory cortex

I.137. If a patient had visual evoked potential (VEP) P100 prolonga-

tion with full-field pattern reversal stimulation from both eyes,

where would demyelination be localized?

a. Bilateral optic nerves anterior to the optic chiasm

b. The optic chiasm

c. Bilateral optic tracts posterior to the optic chiasm

d. Bilateral temporoparietal optic radiations

e. Bilateral P100 prolongation is not localizable

I.138. Which of the following is not a contraindication to magnetic

resonance imaging (MRI) of the brain with and without a con-

trast agent?

a. Patient’s creatinine level is 3.4 mg/dL

b. Patient is pregnant

c. Patient has a pacemaker but is not pacemaker dependent

d. Patient had an aneurysm clip placed in 1975

e. Patient has a history of metal lodged in his eye

I.139. Which of the following is true regarding diffusion-weighted

imaging (DWI)?

a. DWI is sensitive and specific for acute cerebral ischemia

b. If patients have cerebral ischemia, MRI shows increased attenu-

ation on DWI and the apparent diffusion coefficient (ADC) map

c. DWI will be abnormal for up to 6 weeks after cerebral ischemia

d. DWI cannot be used to distinguish between cytotoxic and vaso-

genic edema

e. DWI is helpful in distinguishing acute cerebral ischemia from

chronic cerebral infarction

I.140. Which of the following imaging sequences best demonstrates

cerebral microhemorrhage?

a. T2-weighted magnetic resonance imaging (MRI)

b. Short tau inversion recovery (STIR) MRI

c. Susceptibility-weighted imaging (SWI) MRI

d. Gradient-recalled echo (GRE) MRI

e. Computed tomography of the head

I.141. Which imaging is most useful for a patient who presents with

right hemiplegia and aphasia 12 hours after the patient was

last observed to be acting normally?

a. Computed tomography (CT) of the head without a contrast agent

b. CT and CT angiography (CTA) of the head

c. CT and CTA of the head and neck

d. CT and CTA of the head and neck and CT perfusion

e. Cerebral angiography