Download Exam 1 4-23

BRAIN & BEHAVIOR I
First Exam
April 23, 2001
KEY
For the following questions, indicate the letter that corresponds to the SINGLE MOST
APPROPRIATE ANSWER.
1.
*
A clinical finding of loss of pain and temperature on one side of the body and
weakness and loss of position sense on the opposite side of the body resulting from
a lesion located ipsilateral to the loss of position sense and weakness would suggest
which level of the neuraxis?
A.
B.
C.
D.
Supratentorial level
Posterior fossa level
Spinal level
Peripheral level
2.
Absence of green cones
*
A.
B.
C.
D.
E.
3.
The tegmentum of the brainstem contains all of the following EXCEPT
*`
A.
B.
C.
D
E.
4.
*
does not reduce the range of visible wavelengths.
eliminates the ability to discriminate lights on the basis of wavelengths.
is equally common in men and women.
prevents the detection of wavelengths that are normally perceived as green.
substantially reduces night vision.
cranial nerve nuclei.
nerve roots entering and leaving the brainstem.
the reticular formation.
tracts that transmit pain to higher levels.
the pyramids.
In response to a question asked in a noisy room, you shake your head to answer
“No.” During this response, the vestibular afferent fibers that have the
GREATEST change in firing rate are those from the
A.
B.
C.
D.
E.
left horizontal and right posterior semicircular ducts.
left anterior and right posterior semicircular ducts.
left posterior and right horizontal semicircular ducts.
left anterior and right horizontal semicircular ducts.
left and right horizontal semicircular ducts.
2
5.
*
The muscle end-plate potential (EPP)
A.
B.
C
D.
E.
is a regenerative, propagated potential.
is mediated by voltage-gated Na+ and K+ channels.
is suprathreshold and will normally trigger a muscle action potential.
is a response to the release of one quantum of acetylcholine from the
presynaptic motor nerve terminal.
can be elicited anywhere along the surface of the muscle.
6.
The image below shows a lesion labeled by “A”. This lesion is located in the
*
A.
B.
C.
D.
E.
tectum of the midbrain.
tegmentum of the midbrain.
base of the pons.
diencephalon.
tegmentum of the medulla.
A
3
7.
*
8.
An ophthalmologist examined the fundus of the right eye of a 49-year-old woman.
Features of the fundus which he expected to observe included all of the following
EXCEPT the
A.
B.
C.
D.
E.
macula lutea.
central retinal artery.
optic disk.
ora serrata.
fovea centralis.
A 43-year-old man had a tumor that affected his vision. In clinical tests of the
pupillary light reflex in this patient, the ophthalmologist saw the following:
(Note: Images are views of the patient’s eyes as you look at him)
The above findings suggest that the pathology could involve a tumor of the
*
A.
B.
C.
D.
E.
right optic nerve.
right oculomotor nerve.
left optic tract.
optic chiasm.
left Edinger-Westphal nucleus.
4
9.
*
10.
*
The image labeled “Q” on your image pages shows a high signal mass that is
probably a tumor. If this tumor continues to enlarge it could compress numerous
structures, resulting in any of the following EXCEPT
A.
B.
C.
D.
E.
a decrease in function of neurons involved in pain inhibition.
compression of the abducens nuclei.
abnormal pupillary light reflexes.
increased intracranial pressure.
compression of the superior colliculi.
Activation of NMDA receptors on the surface of projection neurons of the
anterolateral system
A.
B.
C.
D.
E.
blocks the basal firing activities of these cells.
leads to release of gamma butyric acid (GABA) from these cells.
causes production of prostaglandins.
blocks the response of these cells to substance P.
blocks formation of nitric oxide in these cells.
FOR QUESTIONS #11 AND #12, REFER TO THE IMAGE LABELED “P” ON YOUR
IMAGE PAGES:
11.
*
12.
*
A child was brought to The Children’s Hospital with symptoms that suggested a
possible nervous system lesion. He was sent for a head scan. On examining his
scan (Image “P” on your image pages), a pediatrics resident concluded that this child
had a high signal mass (probably a tumor) primarily located in the
A.
B.
C.
D.
E.
tegmentum of the midbrain.
tegmentum of the pons.
tegmentum of the medulla.
base of the pons.
base of the medulla.
The scan shown in Image “P” is a
A.
B.
C.
D.
E.
CT scan
MR T1 weighted image.
MR T2 weighted image.
PET scan.
MR angiogram.
5
13.
*
14.
*
15.
*
16.
*
A 40-year-old woman was reading a newspaper while riding the bus. In order to
read the fine print, she moved the front page of the paper toward her face. During
movement of the paper toward her face, there was a (an)
A.
B.
C.
D.
E.
contraction of the lateral rectus muscles bilaterally.
substantial increase in light rays striking the foveas of her eyeballs.
contraction of the dilator pupillae muscles bilaterally.
contraction of the ciliary muscles bilaterally.
decrease in the thickness of the lens.
Injury to a peripheral nerve that causes prolonged pain results in
A.
B.
C.
D.
decreased sensitivity of nociceptors.
reorganization of the circuitry of the dorsal horn.
degeneration of lamina I neurons.
depletion of substance P from the synapses that contact lamina V neurons.
A 43-year-old man went to the elective MRI center near the Paul Brown stadium to
have a complete serial MRI done “just in case” there was something wrong.
Thorough examination of all of the images showed a mass on the right side of the C5
level of the spinal cord. This mass could directly affect all the following EXCEPT
A.
B.
C.
D.
E.
lower motor neurons to upper limb muscles of the right side.
neurons of the substantia gelatinosa.
axons conducting pain information from the left lower limb.
cell bodies of preganglionic neurons.
axons conducting information from Pacinian corpuscles from the right side of
the chest.
During the third week after conception, a 21-year-old college student went to an
“after-final exams party,” where she drank countless margaritas before dancing on a
table and falling asleep on the floor for the night. Eight months later she delivered a
baby that had incomplete closure of the caudal end of the neural tube with a vertebral
defect at the same level. This pathology is described clinically as
A.
B.
C.
D.
E.
spina bifida with meningocoele.
craniorachischisis.
spina bifida with myelorachischisis.
spina bifida with myelomeningocoele.
meningohydroencephalocoele.
6
17.
The calcium buffering systems in the presynaptic terminal include all the following
EXCEPT
binding of calcium to Ca2+-binding proteins.
uptake of calcium by intracellular organelles.
activation of Ca2+-calmodulin dependent protein kinases.
pumping of calcium outside of the terminal.
a Na+-Ca2+ exchange pump.
*
A.
B.
C.
D.
E.
18.
Which of the following would increase the efficiency of a myelinated axon?
*
A.
B.
C.
D.
E.
19.
*
20.
*
Reducing its space constant
Decreasing the distance between the nodes of Ranvier
Reducing the thickness of the myelin
Increasing the resistance to longitudinal (axial) current
Increasing the diameter of the cytoplasmic core
During drug development at a pharmaceutical company, a chemical was developed
that had as a side effect the selective destruction of neural crest cells at the lumbar
level of the developing neural tube. If the drug was administered in vivo one would
expect to observe a deficiency (partial or complete loss) in all of the following
EXCEPT
A.
B.
C.
D.
E.
pigmentation in the skin.
sympathetic ganglia.
afferent fibers to Clarke’s nucleus.
anterior horn cells.
afferent fibers to the dorsal horn.
A 64-year-old woman was attending an athletic event. At one point she became quite
excited when her team scored the points that tied the game. After jumping up and
down and shouting enthusiastically, she became dizzy and nauseous and fell
unconscious to the floor, striking her head. She was taken to the Emergency
Department at University Hospital and regained consciousness about 12 hours later.
The physician who conducted the neurological examination after she regained
consciousness noted the following deficits: inability to recognize the position of her
upper limbs and lower limbs bilaterally; loss of vibratory sensation over the whole
body except the face. She was able to recognize pinprick sensation in all limbs.
Assuming a SINGLE lesion, the most likely location of the lesion in this patient is
the
A,
B.
C.
D.
E.
caudal midbrain.
caudal medulla.
rostral medulla.
rostral midbrain.
cerebral cortex.
7
21.
*
While interning in the Emergency Department at University Hospital, you were on
call when several people were brought in from a three-car collision. You were
assigned to do clinical tests on a 24-year-old man who had numerous symptoms,
including those associated with his eyes. As you entered the examining room, you
noticed his eyeball position as he waited, apparently thinking to himself. You then
tested his eyeball movements and observed the signs shown below. NOTE:
IMAGES ARE VIEWS OF THE PATIENT’S EYES AS YOU LOOKED AT HIM. This
patient probably had a lesion that affected the
A.
B.
C.
D.
E.
left side of the rostral midbrain.
right side of the rostral midbrain.
left frontal cortex.
right frontal cortex.
right side of the caudal pons.
PATIENT’S EYES AT REST
PATIENT’S EYES ON AN ATTEMPT TO LOOK TO THE RIGHT
PATIENT’S EYES ON AN ATTEMPT TO LOOK TO THE LEFT
PATIENT’S EYES WHEN HE TRIES TO FOCUS ON YOUR FINGER AT 5 INCHES
FROM HIS NOSE
8
QUESTIONS #22 & 23
A 67-year-old pianist visited his family physician, complaining of a gradual increase in
difficulty playing piano compositions by Rachmaninoff that previously he could perform
flawlessly. On physical examination it was noted that he had a decreased response to
pinprick and temperature sensation on the right upper and lower limbs, inability to locate the
position of his right fingers and toes, and decreased sensation of pain, temperature, and
position sense on the right side of the face.
22.
*
Of the following, the most likely location of a small tumor that can account for these
symptoms is the
A.
B.
C.
D.
E.
right thalamus.
left lateral tegmentum of the midbrain.
right ventrolateral vascular zone of the medulla.
left lateral tegmentum of the medulla.
right lateral tegmentum of the medulla.
23.
The artery that perfuses the area where the tumor is located is the
*
A.
B.
C.
D.
E.
24.
*
25.
*
anterior cerebral artery.
basilar artery.
posterior cerebral artery.
middle cerebral artery.
posterior inferior cerebellar artery.
The glial cell that has an inductive role in the development of the non-fenestrated
blood-brain barrier phenotype is the
A.
B.
C.
D.
E.
ependymal cell.
Schwann cell.
microglial cell.
astrocyte.
oligodendrocyte.
A 75-year-old Alzheimer’s patient hit the back of his head when he fell out of bed.
The examining physician was concerned that bridging veins were torn as a result of
this accident. Blood from torn bridging veins usually accumulates in the
A.
B.
C.
D.
E.
ventricles.
space deep to the pia mater.
subdural space.
epidural space.
quadrigeminal cistern.
9
26.
*
27.
*
28.
*
29.
*
All the following are the consequence of energy failure in the neuron resulting from
hypoxia-ischemia EXCEPT
A.
B.
C.
D.
E.
normal brain electrical activity ceases.
an elevation of extracellular K+.
an enhanced lactic acid production.
an increase of intracellular glutamate concentrations.
an elevation of intracellular Na+ and Ca2+ concentrations.
A visceral motor neuron in the mid-thoracic level of the spinal cord receives important
input from all of the following EXCEPT
A.
B.
C.
D.
E.
visceral centers in the brainstem.
the hypothalamus.
nearby interneurons.
afferent fibers from the same visceral structure it supplies.
motor cortex of the paracentral lobule.
A 35-year-old female mail carrier visited her physician complaining of difficulty in
walking her route. Additionally, she had back pain that was progressively becoming
worse. Her physician conducted a neurological examination. In addition to motor
symptoms that are not described here, she had a decrease in discriminatory touch
and vibration sensation on her left ankle and a decrease in pinprick sensation on her
right foot. All other sensory testing was normal. Her physician decided to order
neuroimaging because he suspected the most likely cause of her signs and
symptoms is
A.
B.
C.
D.
E.
an obstruction of the blood supply to the median vascular zone of the medulla.
ischemia of tissue supplied by the great artery of Adamkewicz.
an obstruction of the left anterior inferior cerebellar artery.
syringomyelia.
a tumor of the left side of the spinal cord.
The fact that regeneration in the adult mammalian central nervous system is virtually
absent is, in part, due to
A.
B.
C.
D.
E.
interleukin-1 released from macrophages.
laminin.
reactive gliosis.
GAPs (growth-associated polypeptides).
neurotropic factors.
30.
*
31.
*
32.
*
33.
*
10
A neurologist was developing a protocol for placement of electrodes in specific
nuclei of the thalamus as a palliative measure in a patient with Parkinson’s disease.
The neurologist knew that the thalamus
A.
B.
C.
D.
E.
develops from the telencephalon.
serves as a relay and integrator of only sensory modalities.
has the third ventricle as its medial boundary.
is divided into medial and lateral parts by the external medullary lamina.
is located lateral to the internal capsule.
Mannitol was injected into the carotid circulation along with an alkylating agent that
has shown efficacy in the treatment of brain-sequestered tumors. If the subsequent
osmotic opening of the blood-brain barrier persists for too long a period of time, the
increase in the blood-brain permeability could directly result in an acute
A.
B.
C.
D.
E.
ischemia.
intracellular edema.
cytotoxic edema.
ischemic cell change.
vasogenic edema.
A 74-year-old woman was diagnosed with glaucoma in her right eye. Her
ophthalmologist knew that the increased pressure of the aqueous humor could
have resulted from all of the following conditions EXCEPT for
A.
B.
C.
D.
E.
a blockage of flow in the canal of Schlemm.
an increase of production of aqueous humor by the ciliary processes.
a blockage of flow through the pupil.
an increase of production of aqueous humor in the anterior chamber.
a blockage of flow through the spaces of Fontana.
A 46-year-old surgeon collapsed while in the operating room of University
Hospital. She was rushed to the Emergency Department. After clinical testing and a
CT head scan that was taken within ten minutes of her collapse, a diagnosis of a
ruptured aneurysm of the basilar artery was made. The diagnosis was based on
findings that included, in the CT scan, the presence of a large amount of blood in the
region where the vessel ruptured. The space that contains the ruptured aneurysm is
called the
A.
B.
C.
D.
E.
fourth ventricle.
mid-sagittal (longitudinal) fissure.
pontine cistern.
interpenduncular cistern.
lumbar cistern.
11
34.
The dark areas in these cross sections of spinal cord are the location of lesions.
Which one best illustrates multiple sclerosis?
A.
*
B.
C.
D.
E.
35.
A patient has a sensory loss in both lower extremities which also extends up the
torso to the level of the umbilicus. This type of sensory loss best fits with a lesion
involving
A.
B.
C.
D.
E.
multiple small fiber nerves.
the lumbosacral enlargement.
the spinal cord at the level of L3.
the spinal cord at the level of T10. *
bilateral anterolateral systems at the level of the medulla.
12
36.
*
37.
A four-year-old girl walked through the park holding a helium balloon on a string.
While being distracted by a pair of squirrels playing in the grass, she let go of the
string. Without moving her head, she then watched the balloon slowly rise to the
clouds using her
A.
B.
C.
D.
E.
vestibuloocular reflexes.
paramedian pontine reticular formation.
tracking (smooth pursuit) pathways.
horizontal saccades.
accommodation reflexes.
A train (series) of 10 EPSPs, each 5 msec in duration, was generated by stimulating
a presynaptic neuron at 10 msec intervals. The amplitude of the first EPSP recorded
from the postsynaptic neuron was 1 mV and increased by 0.1 mV for each
succeeding EPSP. This observation can be best explained as
*
A.
B.
C.
D.
E.
38.
Who can focus sharply on an object ten inches from the eye?
*
A.
B.
C.
D.
39.
While reading in bed, your eyes move from one line of text to the next. This involves
*
A.
B.
C.
D.
E.
post-tetanic potentiation.
spatial summation.
long-term potentiation.
disinhibition.
facilitation.
A myopic subject with no prescription lenses.
A young adult with normal vision who has relaxed the ciliary muscles.
A 60-year-old with average vision and no prescription lenses
A hyperopic subject wearing diverging (-) lenses
contraction of the ciliary muscles.
voluntary saccades.
the vestibuloocular reflex.
smooth pursuit (tracking).
reflex saccades.
40.
All of the following chemicals activate nociceptors EXCEPT
*
A.
B.
C.
D.
E.
K+.
prostaglandins.
NaCl.
histamine.
substance P.
13
41.
*
All the following statements concerning the generator potential are correct
EXCEPT that
A.
B.
C.
D.
E.
it is produced by opening of both K+ and Na+ channels.
it has a relatively long refractory period.
it is a graded response.
its magnitude depends on the strength of the stimulus.
it shows temporal and spatial summation.
42.
A photoreceptor will release more neurotransmitter when
*
A.
B.
C.
D.
E.
43.
the level of illumination is high.
its cGMP-gated channels are mostly closed.
the concentration of cGMP in the outer segment is high.
it is producing many action potentials.
it is hyperpolarized.
A 86-year-old woman had a stroke in the branches of her left middle cerebral
artery supplying the cortex. A visual field test revealed the visual field defect shown
below. The structure which was damaged by the stroke, producing this visual field
defect, is the
LEFT EYE RIGHT EYE
Visual Field Defect
*
A.
B.
C.
D.
E.
44.
The membrane potential of a neuron
*
A.
B.
C.
D.
E.
left optic tract.
left occipital pole.
left lateral geniculate nucleus.
right optic tract.
left optic radiations.
is 0 mV at rest.
is proportional to the amount of charge separated across the membrane
capacitance.
becomes more positive when gated K+ channels open.
is usually determined by the gated channels at rest.
is independent of current crossing the membrane.
14
45.
All of the following statements concerning the analgesia system (descending
pain inhibition) system are correct EXCEPT that
A.
B.
C.
*
D.
E.
46.
the periaqueductal gray is a major component of the descending pain
inhibitory pathway.
serotonin is a major transmitter between the fibers from the nucleus raphe
magnus and the dorsal horn.
the descending pain inhibitory system can be activated by neurons in the
prefrontal cortex.
the descending inhibitory system inhibits the inhibitory neurons of the
substantia gelatinosa.
the descending inhibitory system is involved in motivational aspects of pain
perception.
The scan labeled “B” below is from a patient admitted to the emergency room with
acute bleeding into the thalamus (H). The bright signal of the hemorrhage results
from
A.
B.
C.
D.
E.
the use of gadolinium for contrast enhancement.
high attenuation due to fresh blood. *
T1-weighting of the image.
T2-weighting of the image.
vasogenic and cytotoxic edema resulting from the breakdown of the bloodbrain barrier.
15
47.
*
A specific loss of cone photoreceptors would
A.
B.
C.
D.
E.
particularly reduce peripheral vision.
produce night blindness.
have only minor effects on visual acuity.
make it difficult to see in normal daylight.
spare the center of the visual field.
48.
While rotating through a Radiology Department, you examined an MRI scan that
was associated with the Radiology “Question of the Week.” The scan showed a
lesion (at the tip of the arrow) as shown in the neuroanatomically-oriented slice
below. In response to the “Question” of clinical signs expected in this patient, you
shouted, for all to hear,
*
A.
B.
C.
D.
E.
“blurred vision while voluntarily looking to the right or left.”
“spontaneous pain on movement of the hands.”
“blurred vision while trying to look at his shoes while walking.”
“convergence of the eyes to look at a booklet handed to him in an airport.”
“loss of awareness of his feet while walking.”
49.
*
50.
16
While writing exam questions for a Brain & Behavior I, Dr. Giffin took a short “fun”
break by dragging his office chair (on wheels) into the main hallway of the MSB and
getting a big push (lots of force) from Dr. Drake to the back of the chair. When Dr.
Giffin began coasting at a rather high speed down the hallway, he probably had an
increase in firing rate of afferent nerve fibers from the
A.
B.
C.
D.
E.
The endplate potential (EPP) is small in
A.
B.
C.
D.
51.
*
52.
*
left and right horizontal semicircular ducts.
left and right posterior semicircular ducts.
left posterior and right anterior semicircular ducts.
left and right utricles.
left and right cochleas.
Lambert-Eaton myasthenic syndrome.
Myasthenia gravis.
both A and B. *
neither A or B.
A 19-year-old Duke University basketball player fell to the court during the NCAA
tournament, hitting the back of his head on the floor. He complained of “seeing stars”
to the team physician. The physician knew that the primary visual cortex was located
in the region of the impact and that all of the following statements about this cortex
are correct EXCEPT that
A.
B.
C.
D.
E.
it receives its primary arterial supply from the calcarine artery.
it is located above the tentorium cerebelli.
it contains a Line of Gennari in layer 4.
it is found in both the lingual gyrus and the cuneus.
the macula is represented in only the medial surface of the occipital cortex.
To identify an abnormal pattern of eye movement, a systematic approach to the
evaluation of eye movements is essential. The term that describes the extent of eye
movements when each eye is tested individually is
A.
B.
C.
D.
E.
vergence.
duction.
pursuit.
saccades.
versions.
17
53.
*
A 55-year-old man with a history of episodic vertigo, tinnitus, and a low frequency
hearing loss has the typical clinical signs and symptoms of
A.
B.
C.
D.
E.
idiopathic dizziness.
benign paroxysmal positional vertigo (BPPV).
Meniere’s disease.
cupulolithiasis.
a central vestibular lesion.
18
GROSS ANATOMY EXAMINATION
54.
*
55.
*
56.
*
57.
*
A young man came into the emergency department with a deep laceration in front of his right
ear. The laceration extended from the zygomatic arch inferiorly two inches towards the angle
of the mandible. Through the gaping wound, muscle fibers of the masseter could be seen. The
patient could show all of the following signs EXCEPT
A.
B.
C.
D.
E.
a crooked smile (an asymmetrical smile).
drooping of the right corner of his mouth.
loss of feeling to the tip of his nose.
a reduced amount of saliva.
a tendency to have food accumulate in his right cheek when eating.
A patient was admitted into the hospital with thrombophlebitis of the cavernous sinus. The
resident noticed that there was an open sore on the upper lip. The area around the sore was red
and inflamed. The infection from the lip had spread directly into the cavernous sinus through
which of the following veins.
A.
B.
C.
D.
E.
Superficial temporal
Supratrochlear
Superior labial
Ophthalmic
Maxillary
An elderly, bald man tripped and banged the top of his head against the edge of a chair.
Later, he noticed a large swelling and bruise where he had hurt himself. Most likely he had a
subgaleal hematoma. In which layer of the scalp is the accumulation of blood?
A.
B.
C.
D.
E.
Dense connective tissue layer
Skin
Loose connective tissue layer
Epicranial aponeurosis
Pericranium
The pulsations of a blood vessel could be seen and felt just above the zygomatic arch,
immediately anterior to the ear, of a runner who had just finished running in the Flying Pig
Marathon. This vessel is the
A.
B.
C.
D.
E.
facial artery.
transverse facial vein.
superficial temporal artery.
internal jugular vein.
maxillary artery.
19
58.
*
59.
A 14-year-old boy with acne arrives at his primary care physician’s office complaining of
pain behind the eye. The physician, noticing that the skin in the area around the boy’s eyes
and nose are infected, suspects that the pain behind his eye is due to a growing infection
within the cavernous sinuses. He warns the boy and his parents that he eventually may
experience loss of all of the following EXCEPT
A.
B.
C.
D.
E.
A fracture of the petrous part of the temporal bone is likely to damage all of the following
structures EXCEPT the
* A.
B.
C.
D.
E.
60.
*
sensation in the area of the upper lip.
contraction motion of the masseter muscles.
the ability to accommodate for near vision.
the ability to completely open his eyelids.
corneal reflex.
hypoglossal nerve.
greater petrosal nerve.
vestibulocochlear nerve.
facial nerve.
superior petrosal sinus.
During removal of a small tumor in the orbit of a 67-year-old man, the physician found it
necessary to remove the ciliary ganglion. She knew that she was removing cell bodies of
neurons that were involved in
A.
B.
C.
D.
E.
movement of the lateral rectus muscle.
accommodation for near vision.
dilation of the pupil.
elevation of the upper eyelid.
secretion from the lacrimal gland.
61.
Pain from a tumor in the tentorium cerebelli would be transmitted along the
*
A.
B.
C.
D.
E.
ophthalmic division of the trigeminal nerve (V1).
maxillary division of the trigeminal nerve (V2).
mandibular division of the trigeminal nerve (V3).
greater occipital nerve.
lesser occipital nerve.
20
62.
*
63.
*
64.
*
The lacrimal gland receives its preganglionic parasympathetic innervation from nerve
fibers which travel in the
A.
B.
C.
D.
E.
supraorbital nerve.
nasociliary nerve.
lesser petrosal nerve.
deep petrosal nerve.
greater petrosal nerve.
A 40-year-old man comes into your office complaining of a droopy upper eyelid. Upon
examination, you observe that when you elevate the lid forcefully, the pupil is directed down
and laterally with no superior or medial movement possible. The pupil is dilated and
unresponsive to light. You suspect a lesion involving the
A.
B.
C.
D.
E.
trochlear and abducens nerves.
abducens nerve.
oculomotor nerve.
trochlear nerve.
trochlear and oculomotor nerve.
A 20-year-old man had a small tumor removed from the area marked “TUMOR” below.
During this procedure, his surgeon was aware of structures in this region which include all
of the following EXCEPT
A.
B.
C.
D.
E.
the frontalis muscle.
branches of the supraorbital nerve.
veins that connect (directly or indirectly) with the cavernous sinus.
dense subcutaneous tissue.
the levator palpebrae superioris muscle.
65.
*
66.
*
21
A 16-year-old man was cut in the cheek with a knife blade by a four-year-old having a
tantrum. The wound caused a sizeable surface laceration in the area marked below. The man
was brought to the Emergency Department, where the wound was sutured. One week later,
after the sutures were removed, the young man noticed that a patch of skin around the wound
“felt funny and tingled.” His doctor explained that the cutaneous nerves supplying the skin
near the wound were probably cut. These nerves were probably branches of the
A.
B.
C.
D.
E.
zygomatic branch of the facial nerve.
buccal branch of the facial nerve.
auriculotemporal branch of the trigeminal nerve.
buccal branch of the trigeminal nerve.
mental branch of the trigeminal nerve.
A 17-year-old fell while skate boarding and hit his face on a window ledge. It resulted in a
laceration in the area marked below. He put a large bandage on the wound in an attempt to
keep it closed. Two days later, the wound area was very swollen and he had a high
temperature. He saw a family physician, who examined him for evidence of spread of
infection from the wound. This included palpation (tactile examination) for swollen lymph
nodes that drain the area of the laceration. Of the following, the lymph nodes that would
MOST LIKELY be swollen are labeled
A. A
B.
C. C
D. D
E. E
B
Laceration
67.
*
22
During removal of a malignant tumor of the parotid gland, it was necessary to section a
nerve traveling through it, deep to the skin area marked “Nerve Section” below. The surgeon
reminded her residents that, after the surgery, the patient would probably have muscle
paralysis that would cause difficulty in
A.
raising his right eyebrow.
B. lowering the corner of his mouth on the right side.
C. closing his right eye (lowering his right upper eyelid).
D.
opening his right eye (elevating his right upper eyelid).
E.
showing his teeth on the right side.
68.
A tumor in the jugular foramen is likely to compress the
*
A.
B.
C.
D.
E.
69.
*
facial (VII) nerve.
inferior sagittal sinus.
middle meningeal artery.
straight sinus
vagus (X) nerve.
An anteroposterior blow to the head, occurring in an automobile accident, can cause a
fracture of the cribriform plate and a tearing of the meninges, resulting in
A.
B.
C.
D.
E.
a rupture of the nasolacrimal duct.
leakage of cerebrospinal fluid into the nasal cavity.
injury to the maxillary division of the trigeminal (V) nerve.
swelling of the optic disc.
blood oozing from the external auditory meatus.
70.
*
23
A 47-year-old woman visits your office and complains that she has double vision diplopia).
During an examination of her eyes, you ask her to look in various directions to test
the function of the eye muscles. Select from the options below the location of the pupil (the
direction you would ask her to look) if you were interested in testing for a functional right
superior rectus muscle.
A.
B.
C.
D.
E.
A
B
C
D
E
A
B
Nose
C
D
E
71.
*
72.
*
A 13-year-old boy was hit in the side of the head with a rock, resulting in a fractured skull.
The radiologist was concerned that the middle meningeal artery may have been lacerated. He
knew that the most useful guide to the position of the anterior branch of the middle
meningeal artery is the
A.
B.
C.
D.
E.
inion.
asterion.
pterion.
temporomandibular joint.
pulsation of the superficial temporal artery.
A 43-year-old woman fell ten feet from a balcony onto the pavement of a motel parking lot.
She sustained a fracture of the walls of the posterior cranial fossa of her skull. Her
neurologist knew that openings in this fossa include the
A.
B.
C.
D.
E.
optic canal.
foramen spinosum.
cribriform plate.
internal auditory (acoustic) meatus.
foramen lacerum.
73.
*
74
*
24
A 56-year-old female was diagnosed with a tumor in her falx cerebri. Her neurologist was
aware that this tumor could directly compress venous sinuses which border it, resulting in
impedance of venous return from the brain. He knew that all of the following venous sinuses
border the falx cerebri EXCEPT the
A.
B.
C.
D.
E.
inferior sagittal sinus.
confluence of sinuses.
occipital sinus.
superior sagittal sinus.
straight sinus.
A pattern of developmental anomalies that include a deformed auricle of the external ear, a
preauricular appendage, a defect in the cheek between the auricle and the mouth, hypoplasia
of the mandible, and macrostomia (large mouth) can result from insufficient migration of
neural crest cells into the structure(s) labeled (in the drawing above)
A.
B.
C.
D.
E.
A
B
C
A and B
B and C
75.
A baby born to a woman who contracts the rubella virus between the 4th and 7th weeks of her
pregnancy is at risk for
*
A.
B.
C.
D.
E.
cataracts.
ptosis of the eyelid.
retinal detachment.
cyclopia.
anophthalmia.
25
76.
*
A drug that disrupts the migration of neural crest cells into the first and second pharyngeal
arches could affect the development and/or function of all the following EXCEPT the
A.
B.
C.
D.
E.
middle ear.
stapedial artery.
mucous membrane of the tongue.
anterior fontanelle.
face.