Download Y1. A 42-year-old female complains about a painful and burning

Y1. A 42-year-old female complains about a painful and burning sensation in both hands and
arms. Following a neurological examination, it was determined that the patient is suffering from
a peripheral neuropathy caused by a virus that selectively attacked sensory fibers in the arms
mediating pain and temperature signals. Concerning the distribution and sites of termination of
these sensory fibers in the central nervous system (CNS), their sites of termination include which
of the following regions?
A Laminae I and II of the gray matter of the spinal cord ipsilateral to their site of entry into the
cord
B Laminae III and IV of the gray matter of the spinal cord contralateral to their site of entry into
the cord
C Laminae VIII and IX of the gray matter of the spinal cord ipsilateral to their site of entry into
the cord
D Laminae VIII and IX of the gray matter of the spinal cord contralateral to their site of entry
into the cord
E Lower brain stem nuclei ipsilateral to their site of entry into the cord
Y2. An individual was admitted to the emergency room following loss of consciousness. After the
patient regained consciousness, he was examined by a neurologist and presented with a right
side hemiplegia, loss of sensation on the left side of the face, and his ability to chew. Which of
the following arteries was most likely subjected to an infarct that could account for the deficits
described in this individual?
A Posterior inferior cerebellar artery
B Anterior inferior cerebellar artery
C Circumferential branches of basilar artery
D Paramedian branches of basilar artery
E Anterior spinal artery
Y3. A 38-year-old woman with a body mass index (BMI) of 31 presents with pain to the right side
of the neck, extending laterally to the right clavicle for an hour or two after meals. A careful
physical examination of her neck and shoulder region suggests that the pain may be referred
pain, since manipulation of the right shoulder and neck does not reproduce the vague pain.
Which one of the following nerves is responsible for referred pain in this woman?
A Cervical cardiac accelerator nerves
B Posterior vagal trunk
C Right intercostal nerves
D Right phrenic nerve
E Right recurrent laryngeal nerve
Y4. As the consulting physician to the US Open, you are asked to examine a golfer who complains
of increased pain with right wrist flexion and pronation activities. The patient also reports
discomfort even when simply shaking hands with someone. Examination reveals also decreased
sensation in the territory of the ulnar nerve. Your diagnosis is golfer's elbow, affecting mostly the
superficial flexor muscles of the forearm. This group of muscles has a common origin from which
of the following bony landmarks?
A
B
C
D
E
head of the radius
lateral epicondyle of the humerus
medial epicondyle of the humerus
olecranon process of the ulna
tuberosity of the radius
Y5. A 36-year-old male office worker comes to the clinic complaining of general weakness and
shortness of breath. He also relates a rapid, throbbing pulse after climbing a flight of stairs.
Cardiac auscultation reveals a diastolic rumbling murmur attributable to the mitral valve. The
mitral valve is best heard where?
A
B
C
D
E
Left side adjacent to the sternum in the second intercostal space
Left side adjacent to the sternum in the fifth intercostal space
Left side in the midclavicular line in the fifth intercostal space
Right side adjacent to the sternum in the second intercostal space
Right side adjacent to the sternum in the fourth intercostal space
Y6. You are concerned that your patient may have compromised function of the mitral valve. The
sound of the mitral valve is best heard at which of the following locations?
A at the apex in the left fifth intercostal space in the midclavicular line
B at the xiphisternal junction
C in the fifth intercostal space to the right of the sternum
D in the second intercostal space to the left of the sternum
E in the second intercostal space to the right of the sternum
Y7. Vasa vasorum provide a function analogous to that of which one of the following structures?
A Valves
B Basal lamina
C Coronary arteries
D Endothelial diaphragms
E Arterioles
Y8. A 3-year-old child suspected of aspirating a small, cloth-covered metal button is seen in the
emergency room. Although the child does not complain of pain, there is frequent coughing.
Diminished breath sounds are most likely to be heard in which of the following?
A In both lungs
B In the lingula of the left inferior lobe
C In the right inferior lobe
D In the left superior lobe
E In the right superior lobe
Y9. A 75-year-old male college graduate is brought to a neurologist by his family because he is
having problems with his gait, suffers from urinary incontinence (for the past 6 months) and
recently began to have problems with his short-term memory and paying his bills. The gait
problem manifests itself mainly as difficulty climbing stairs and frequent falls. The patient has no
past medical history other than a subarachnoid hemorrhage resulting from a ruptured cerebral
aneurysm many years earlier. When the neurologist examines him, she finds he cannot
remember three objects 5 minutes after they are shown to him, even when prompted. He is
unable to figure out how many quarters are in $1.75, and he spells the word “world” incorrectly.
A grasp reflex (squeezing the examiner’s hand as a reflex reaction to stroking of the palm) is
present. Although his motor strength is full in all of his extremities, when asked to walk, he takes
many steps in the same place without moving forward, and then starts to fall. His cranial nerve,
sensory, and cerebellar examinations are normal. You are asked to evaluate the patient with the
neurologist. The nurse in the office asks if you would like to order a CT scan, and you request one.
The CT scan shows that all the ventricles are dilated, especially the frontal horns of the lateral
ventricles, without any evidence of obstruction by a tumor. Which of the following is the most
likely mechanism underlying the enlargement of the ventricles?
A Decreased cerebrospinal fluid (CSF) absorption
B Low blood pressure
C Decreased CNS blood flow
D Decreased intracranial pressure
E High blood pressure
Y10. A 19-year-old woman was dancing in clogs in an ethnic street festival when she inverted her
left foot. She presents to the clinic the next day with a swollen foot, but mainly complains about
tenderness on the lateral aspect of the foot along the plantar surface. Her foot is carefully
palpated and it is determined that she has tenderness over the tuberosity of the fifth metatarsal
bone. What muscle has avulsed from its insertion onto the tuberosity of the fifth metatarsal?
A Abductor digiti minimi
B Fibularis (peroneus) brevis
C Fibularis (peroneus) longus
D Tibialis anterior
E Tibialis posterior
Y11. Where would you find the specialized cardiac muscle cells that control the rate of the
heartbeat?
A In the muscular wall of the interventricular septum
B In the arch of the aorta
C In the wall of the left atrium between openings of the pulmonary veins
D In the wall of the right atrium near the opening of the superior vena cava
E On the surface of the heart
Y12. A 27-year-old female was suffering from excruciating pain that could not be reduced or
eliminated through drug treatment. A decision was made by the neurosurgeon to attempt to
alleviate the pain by surgically cutting pathway mediating pain impulses to the thalamus. Which
pathway did the neurosurgeon select to be cut in order to alleviate the pain?
A
B
C
D
E
Fasciculus gracilis
Fasciculus cuneatus
Spinocerebellar tract
Spinothalamic tract
Tectospinal tract
Y13. The neural plate forms directly from which of the following?
A Ectoderm
B Endoderm
C Somatopleuric mesoderm
D Splanchnopleuric mesoderm
E Hypoblast
Y14. Specific neurons supplying the head and neck region have their cell bodies located in ganglia.
Cell bodies that bring about accommodation for near vision are located where?
A Ciliary ganglion
B Geniculate ganglion
C Otic ganglion
D Pterygopalatine (sphenopalatine) ganglion
E Semilunar ganglion
F Submandibular ganglion
Y15. An 86-year-old woman has had difficulty with high blood pressure, high cholesterol,
diabetes, strokes, and blood clots in her legs for many years. One day, her grandson arrived at
her apartment in a senior citizen center for his weekly visit and found her lying unconscious on
the floor. He immediately called an ambulance. The paramedics in the ambulance gave her some
medications, including glucose, but she did not awaken. She was taken to the nearest emergency
room, where a physician was called to evaluate her. She was breathing on her own and had a
pulse, but could not be aroused to any stimulus. Her arms and legs were stiff and would not
move in response to a painful stimulus. Her eyes moved in response to moving her head. Finally,
in response to a very loud shout and pinch on the arm, she briefly opened her eyes; however,
she immediately shut them again. Further attempts to arouse the patient were unsuccessful. She
was taken for a CT scan of her head, and then taken to an intensive care unit. An acute stroke in
which portion of the CNS would most likely cause this scenario?
A Right frontal lobe
B Left frontal lobe
C Right temporal lobe
D Pons and midbrain
E Right occipital lobe
Y16. Following a bicycle accident, a patient exhibits perfuse bleeding from the scalp. Which of
the following arteries is a major supplier to the scalp?
A Maxillary artery
B Ascending pharyngeal artery
C Lingual artery
D Superficial temporal artery
E Middle meningeal artery
Y17. A 36-year-old man was the victim of a superficial knife wound to the lower left abdomen
during a barroom brawl. At 56 he develops a direct inguinal hernia on the left side. Damage to
which one of the following nerves is most likely responsible for the predisposing weakness of the
abdominal wall?
A Genitofemoral nerve
B Ilioinguinal nerve
C The subcostal nerve
D Pelvic splanchnic nerves
E The nerve of the tenth intercostal space (T10)
Y18. A woman is found to have internal (medially directed) strabismus of the left eye, paralysis of
the muscles of facial expression on the left side, hyperacusis (louder perception of sounds) of the
left ear, and loss of taste from the anterior two-thirds of the tongue on the left. Her mouth is
somewhat drier than normal. In addition, there is a lack of tearing in her left eye, and a blink
reflex cannot be elicited from the stimulation of either the right or the left cornea. She has upper
motor neuron paralysis of the right side of her body. Internal strabismus (deviation of the eye
medially) results from paralysis of which of the following cranial nerves?
A Cranial nerve II
B Cranial nerve III
C Cranial nerve IV
D Cranial nerve V
E Cranial nerve VI
Y19. A 17-year-old high school football player is sent to a neurology clinic because his mother
thinks he may have acquired neck problems during a game. A month before, he sustained a
concussion from a blow to his head from another player. Shortly after, she noted that he
intermittently tilted his head to the side. When asked what was the matter, he simply said that
sometimes he had double vision and that the images were situated on top of each other
vertically, making it difficult to go downstairs. When he is examined, there is no neck pain or
limitation of motion. He tends to keep his head tilted to the right side. When asked to follow the
doctor's finger with his head in a straight position, his left eye does not move downward when
his eyes are turned to the right, and they tend to remain slightly deviated toward the left. At this
point, he states that he has double vision and feels better if his head is tilted to the right. The
remainder of his eye movements, as well as the remainder of his examination, are normal. Which
of the following muscles was most likely weakened?
A Superior rectus
B Inferior rectus
C Lateral rectus
D Superior oblique
E Inferior oblique
Y20. Which of the following locations is optimal for fertilization of an ovulated egg by sperm to
occur?
A Ampulla of the oviduct
B Uterus
C Infundibulum of the oviduct
D Isthmus of the oviduct
E Cervical canal of the uterus
Y21. Following hemisection of the spinal cord at the level of approximately T3, a patient
experiences loss of pain and temperature on the left side of the leg. Which of the following tracts
was affected by the hemisection of the cord that could account for this deficit?
A Right fasciculus cuneatus
B Right fasciculus gracilis
C Right spinothalamic tract
D Left spinothalamic tract
E Left corticospinal tract
Y22. A couple comes to your office because they have been unable to conceive a child after 1
year of trying. You examine the man and notice a darkish mass and fullness of the left
scrotum/spermatic cord compared to the smaller right scrotum/spermatic cord. You suggest he
follow up with an urologist because you suspect which of the following?
A Undiagnosed cryptorchidism of the right testicle
B Acquired varicocele
C Acquired left femoral hernia
D Acquired right direct femoral hernia
E Congenital absence of the pampiniform plexus on the right side
Y23. 50-year-old multiparous woman comes to your office to rule out cancer. She reports a
growing mass or fullness on the anterior wall of her vagina. Upon physical examination you
detect a soft, bulging, and a very compressible mass on the anterior surface of the vagina. When
you push on the bulging mass she feels the need to urinate. You order a CT because you suspect
which of the following?
A Rectocele
B Cystocele
C Cervical cancer
D Didelphic uterus
E Indirect inguinal hernia
Y24. A 13-month-old baby boy is brought into your pediatric office by his concerned mother.
The boy is just beginning to talk and seems to have difficulty speaking some sounds. The mother
had also noted that his tongue seems “sort of stuck in his mouth” compared to her two older
children. When you examine the baby and look in his mouth, you agree with the mom that his
tongue seems to be stuck in the floor of his mouth. You correctly explain which of the following
to the mother?
A The hypoglossal nerves that control the tongue must have never developed
B That the problem could likely be corrected by cutting the lingual frenulum
C That the problem could likely be corrected by shortening the posterior belly of the digastric
muscle
D That the problem could likely be corrected by cutting the pterygomandibular raphe
E That the problem could likely not be corrected and the speech therapy is the best option
Y25. A 48-year-old woman underwent a complete mastectomy, including removing several
axillary lymph nodes. The lymph nodes were all negative for evidence of metastasis. However,
the patient is found to have winging of the scapula when her flexed arm is pressed against a fixed
object. This indicates injury to which of the following nerves?
A Axillary
B Long thoracic
C Lower subscapular
D Supraclavicular
E Thoracodorsal
Y26. A patient experiences paralysis in both arms and legs, but is able to control his gaze in a
vertical direction or to blink his eyes. Which of the following pathways would be damaged as a
result of an infarct of a blood vessel in the brain to account for paralysis of the limbs?
A Corticospinal and corticobulbar tracts
B Spinothalamic tract
C Solitary tract
D Superior cerebellar peduncle
E Inferior cerebellar peduncle
Y27. An individual had no prior problems with his hearing but was subsequently struck in the
face by an object, causing him to become extremely sensitive to noise. Assuming that there was
no prior damage to the cochlear nerve or with his ears, damage to the nerve supply of which of
the following muscles could cause the sensitivity to or distortion of noises?
A Digastric
B Platysma
C Buccinator
D Geniohyoid
E Stapedius
Y28. A 49-year-old male began to act in ways that could be described as “antisocial,” coupled
with what appeared to be intellectual deficits. He was sent for a neurological examination, given
an MRI (shown in the given figure), and then sent to a neuropsychologist for further examination.
The patient was given a card-sorting task in which he was asked to sort the cards on the basis of
color, shape, or number. The patient was unable to shift the categorization from shape to
number when requested to do so. The patient also continued to perseverate in the use of
original strategies in other problem-solving tasks even though those strategies were incorrect.
The MRI revealed the presence of a brain tumor. Which of the following regions most likely
contained the tumor?
A Precentral gyrus
B Prefrontal cortex
C Premotor cortex
D Parietal cortex
E Head of caudate nucleus
Y29. A 58-year-old man comes into your emergency room with difficulty breathing. He also
reports some left side chest pain and points to the inferior portion of his ribs. You listen to his
lung sounds and there seems to be reduced breath sounds in the inferior half of his left plural
cavity. Both PA and lateral chest films confirm what is likely fluid in the inferior 1/3 of the left
pleural space. There were no obvious rib fractures. You wish to determine the nature of the fluid
accumulating in the left pleural cavity, since that will dictate the appropriate treatment. What
structures will your 19 g needle penetrate as you pass from skin to fluid at the midaxillary line
below the sixth rib?
A Skin, subcutaneous tissue, external intercostal muscle, internal intercostal muscle, innermost
intercostal muscle, parietal pleura
B Skin, subcutaneous tissue, external intercostal muscle, internal intercostal muscle, parietal
pleura, innermost intercostal muscle
C Skin, subcutaneous tissue, parietal pleura, external intercostal muscle, internal intercostal
muscle, innermost intercostal muscle
D Skin, parietal pleura, external intercostal muscle, internal intercostal muscle, innermost
intercostal muscle, subcutaneous tissue
E Skin, subcutaneous tissue, innermost intercostal muscle, internal intercostal muscle, external
intercostal muscle, parietal pleura
Y30. A 56-year-old female is examined by a neurologist following complaints that she could not
recognize any pain sensation in her arms or legs. A detailed neurological examination suggests
the presence of a viral disorder that selectively affected sensory fibers that enter the spinal cord
and which pass through Lissauer marginal zone. Which of the following statements correctly
characterizes the fibers in this region?
A They mediate unconscious proprioception.
B This zone is composed of coarse, heavily myelinated fibers.
C Fibers within Lissauer marginal zone may ascend or descend several segments.
D These fibers synapse with alpha motor neurons of extensor muscles.
E Cells in this zone typically project to thalamic nuclei.
Y31. During a bar fight a 23-year-old man's chest is punctured to the left of his sternum with an
ice pick. He is brought to the emergency department because he is feeling faint and unable to
walk due to weakness. He is placed on oxygen as he is evaluated. All his heart sounds are distant
and muffled and his blood pressure is low despite a very rapid pulse. His lungs sound normal. His
jugular veins are becoming more and more distended. How would one use a 3 inch, 19 gauge
needle to help the bar fight victim?
A Insert it just under the left tip of the xiphoid process in an effort to remove blood from the
pericardial cavity.
B Insert it at the second intercostal space on the left side of the sternum in an effort to inject
nitroglycerine to increase the strength of cardiac contractions.
C Insert it at the ninth intercostal space at the left midclavicular line in an effort to remove
blood from the pleural cavity.
D Insert it at the fourth intercostal space on the right side in an effort to remove blood from
the right pulmonary artery.
E Insert it just under the left clavicle in an effort to remove blood from the right cephalic vein.
Y32. When examining an AP chest film of a 57-year-old man with a systolic ejection-type
cardiac murmur, you notice that the arch of the aorta forms a typical aortic knob on the left of
the mediastinal border, but also appears as a bulge on the right upper mediastinal border,
suggesting an enlarged ascending aorta. In addition, the left ventricular heart border appears
prominent. There is no evidence of pulmonary hypertension in your patient. Your order an
echocardiogram because you suspect your patient has which of the following?
A Tetralogy of Fallot
B Pulmonary valve stenosis
C Atherosclerosis
D Aortic valve stenosis
E Defective tricuspid valve
Y33.. A 19-year-old man presents in extreme pain holding a handkerchief over his right eye. He
explains that he was accidentally struck in the eye with a pool cue and the he can't see anything
other than a milky white cloud in his right eye. On examination of his right eye, there appears to
be a scratch on the cornea, the anterior chamber of the eye is partially filled with blood, but the
eye has not ruptured. Intraocular pressure as measured with a tonometer is normal. The patient
is told that it is important to avoid any other blows to the head since the retina is at increased
risk for detachment and to return to the office the next day to determine if the intraocular
pressure has risen. There are abnormal red blood cells in the aqueous humor that may plug the
normal site of drainage, leading to excessive intraocular pressure if left untreated. Where in the
anterior chamber of the eye does aqueous humor normally drain?
A Trabecular meshwork that leads to the scleral venous sinus (canal of Schlemm)
B Ciliary muscle which has zonular fibers (suspensory ligament of the lens) attached to it
C Ciliary process
D Lens
E Retina
Y34. An 8-year-old boy presents in your clinic after suffering a straddle injury while riding a
bicycle. You note significant swelling of the penis and perineum. You are concerned that urine
may be leaking into the underlying fascia. Within which structure is the penile urethra located?
A Corpus cavernosum
B
C
D
E
Corpus spongiosum
Crus of the penis
Prepuce
Prostate gland
Y35. A frantic young mother brings her 3-year-old boy to the emergency department. The child
is suspected of aspirating a small (0.6 cm in diameter), cloth-covered metal button since one is
missing from his teddy bear and when asked where it went, he said he ate it. Although the child
does not complain of pain, he has a persistent and frequent coughing. Diminished breath sounds
in this patient are most likely to be heard in which one of the following?
A In both lungs
B In the lingula of the left inferior lobe
C In the right inferior lobe
D In the left superior lobe
E In the right superior lobe
Y36. A 72-year-old woman trips over the edge of the carpet and falls forward onto the floor. A
common reflex reaction to tripping and falling forward is to extend ones hands to ease the
impact of striking the floor. She presents to the ER holding her left arm with her right hand.
There is an obvious posterior displacement of the left distal wrist and hand that looks like a
dinner fork. Which bone(s) is/are likely involved in a classic Colles fracture?
A Always the ulna and sometimes the radius
B Always the radius and sometimes the ulna
C Always the ulna and sometimes the scaphoid
D Always the radius and sometimes the trapezium
E Only the ulna
Y37. An individual is diagnosed by an optometrist as being nearsighted. To correct this person’s
defect, which of the following lenses should the doctor recommend be put into his eyeglasses?
A Cylindrical
B Concave
C Convex
D Neutral
E Rectangular
Y38. A 28-year-old man presents in the emergency room with trauma to the face. History
indicates he was assaulted with a knife and he currently exhibits pulsatile bleeding from the
lateral aspect of his jaw. Which branch of the external carotid artery would be severed by a
laceration in the skin over the jaw, just anterior to the masseter muscle?
A Facial artery
B Lingual artery
C Occipital artery
D Superficial temporal artery
E Transverse facial artery
Y39. A sudden extreme pain that shoots along the left side of the jaw and up anterior to the
ear and along the side of the head is most likely due to which of the following?
A Ménière’s disease
B Horner’s syndrome
C Tic douloureux (trigeminal neuralgia)
D Wry neck
E Craniosynostosis
Y40. A 2-month-old infant from a small rural town is brought to a regional pediatric center by her
mother. Her heart's apical beat is heard on the right side of her chest. What is the name for this
condition and what other congenital condition might one suspect to find associated with this
finding?
A Dextracardia and DiGeorge syndrome
B Dextracardia and Down syndrome
C Dextracardia and situs inversus
D Situs inversus and anencephaly
E Situs inversus and clubfoot
Y41. A routine eye examination reveals the presence of inflammation limited to the left optic
disk, probably due to neuritis of this region. Which of the following is the most likely visual deficit
resulting from this disorder?
A Total blindness of the left eye
B Left homonymous hemianopsia
C Left heteronymous hemianopsia
D Left enlargement of the blind spot
E Left upper quadrantanopia
Y42. A couple comes to the reproductive endocrinology infertility clinic because they have
been unable to conceive a child after 1 year of trying. Physical examination of the man reveals a
darkish mass and fullness of the left scrotum/spermatic cord that feels like a bag of worms. The
physician suggests that he follow up with a urologist because of suspicion of which one of the
following?
A Undiagnosed cryptorchidism of the right testicle
B Acquired varicocele
C Acquired left femoral hernia
D Acquired right direct femoral hernia
E Congenital absence of the pampiniform plexus on the right side
Y43. In testing for motor dysfunctions, a neurologist identifies an upward movement of the
patient’s toe when the plantar surface of his foot is scratched. This response is indicative of a
lesion of a part of the nervous system. Which of the following is linked to this response?
A UMNs
B
C
D
E
LMNs
Peripheral nerves
Skeletal muscles
Autonomic nerves
Y44. A 63-year-old woman presents with lethargy and unremitting epigastric pain. She is 5 ft 6
in tall and weighs 170 lb and has smoked for 44 years. She has lost 5 lb in the last week despite
eating normally. She reports that her skin and eyes have started to yellow. She has midline
epigastric pain, which also radiates to her back. The pain sometimes gets worse with eating but
has become unbearable and interferes with her sleeping. What nerves likely carry her pain and
what diagnosis should she fear the most?
A Greater splanchnic nerves; ascites from cirrhosis
B Greater splanchnic nerves; duodenal ulcer
C Greater splanchnic nerves; pancreatic adenocarcinoma
D Lesser splanchnic nerves; gallstones
E Lesser splanchnic nerves; gastric carcinoma
Y45. You deliver a newborn baby girl that has an umbilical hernia with part of another organ
attached to its inner surface. What portion of the gastrointestinal tract is most likely to be
attached to the inner surface of the umbilical hernia?
A Anal canal
B Appendix
C Cecum
D Ileum
E stomach
Y46. A 19-year-old teenager was dancing in clogs in an ethnic street festival when she inverted
her left foot. She presents to your office the next day with a swollen foot, but mainly complains
about tenderness on the lateral aspect of the foot along the plantar surface. You carefully
palpate her foot and determine that she has tenderness over the tuberosity of the fifth
metatarsal bone. What muscle has avulsed from its insertion on to the tuberosity of the fifth
metatarsal?
A Abductor digiti minimi
B Fibularis (Peroneus) brevis
C Fibularis (Peroneus) longus
D Tibialis anterior
E Tibialis posterior
Y47. A small child is brought into the emergency room after inhaling a large piece of gum which
then gets lodged in the carina. Which of the following best describes where the carina is located?
A A depression between the back of the tongue and epiglottis
B A space between the true and false vocal folds
C The bifurcation of the bronchopulmonary segments
D The bifurcation of the trachea at vertebral level T4-T5
E
A depression in the piriform recess of the oropharynx
Y48. An elderly male who had been living in a nursing home was found unconscious by a nurse.
He was rushed to a hospital and remained unconscious for approximately 24 hours. When he
recovered consciousness, he was examined by a neurologist. The patient was unable to move his
left leg or arm. He also experienced double vision and was unable to move his right eye medially
when requested to follow the movement of the neurologist’s finger, when it was moved into a
medial position. It was concluded that the stroke involved an occlusion of an artery in the brain.
Which of the following structures were most likely affected by the stroke?
A Nucleus of facial nerve and basilar pons
B Nucleus of trochlear nerve and dorsal midbrain tegmentum
C Nucleus of oculomotor nucleus and cerebral peduncle
D Nucleus of trigeminal nucleus and basilar pons
E Internal capsule and optic tract
Y49. A previously healthy 62-year-old man is brought to a neurologist by his daughter because
of increasing difficulty in walking. His daughter noticed that for the past year, he had difficulty
getting out of a chair and took a lot of time to begin to walk. When he did walk, he walked with a
slow, shuffling gait. In addition, she had noticed some changes in his face, and that he had been
drooling excessively. His signature on checks became progressively smaller from the beginning of
his name to the end, and he had developed a new tremor. She brought him in to make sure this
was not just "aging." The neurologist examines the patient and notices immediately that his
facial expression was masklike, with few eyeblinks. When asked to write a sentence, the letters
become progressively smaller toward the end of the sentence. His speech is soft and
monotonous, and he has a slow, resting pill-rolling tremor in both of his hands. He has very little
spontaneous movement, and his arms, legs, and trunk were stiff. When the neurologist tries to
flex his arm, he feels many catches, similar to a cog-wheel. There is no weakness, sensory
problems, or abnormalities in his reflexes. When asked to walk, the patient takes many tries to
rise from his chair. When he finally stands up, his posture is stooped and flexed. His gait is slow,
his feet shuffle when he walks, and his arms do not swing with his steps. The neurologist tells the
patient's daughter that she is correct that this is not just aging and explains to her all of the
details about a new medication that her father needs to take. Damage to which of the following
structures most likely causes this patient's problem with movement?
A Substantia gelatinosa
B Substantia nigra, pars reticularis
C Substantia nigra, pars compacta
D Caudate nucleus
E Thalamus
Y50. A 70-year-old female suffered a stroke affecting parts of the left frontal lobe of the
cerebral cortex. Upon testing, the patient was later unable to move her eyes to the right when
requested to do so. Which of the following pathways disrupted best accounts for this deficit?
A Frontal lobe projections to the ipsilateral superior colliculus
B Frontal lobe projections to the contralateral occipital cortex
C Frontal lobe projections to the ipsilateral trochlear nucleus
D Frontal lobe projections to the contralateral oculomotor complex
E Frontal lobe projections to the contralateral pontine gaze center
Y51. The intercostal neurovascular bundle is particularly vulnerable to injury from fractured ribs
because it is found in which of the following locations?
A Above the superior border of the ribs, anteriorly
B Beneath the inferior border of the ribs
C Between external and internal intercostal muscle layers
D Deep to the posterior intercostal membrane
E Superficial to the ribs, anteriorly
Y52. A 58-year-old patient enters the emergency room suffering from severe chest pain, left
shoulder and arm pain, shortness of breath, and vomiting. The patient’s blood tests indicate
increased levels of creatine kinase and troponin and an electrocardiogram that exhibits an
elevated ST segment. The patient is prepped for percutaneous coronary intervention to alleviate
the blockage in the left anterior descending (LAD) artery. During the initial physical exam, which
valve is best auscultated at the second intercostal space along the right sternal border?
A Mitral valve
B Pulmonary valve
C Tricuspid valve
D Valve of the inferior vena cava
E Aortic valve
Y53 A 78-year-old male with a history of alcohol and drug abuse was admitted to a local
hospital after he was observed to have consistently lost his balance upon attempting to walk. In
his attempt to retain his balance, he would walk with a wide, ataxic gait. In which of the
following structures did an MRI scan identify the locus of the lesion?
A Red nucleus
B Cerebellar vermis
C Substantia nigra
D Internal capsule
E Basilar pons
Y54. A 65-year-old male is informed by his neurologist that he has Parkinson’s disease. Which of
the following neurotransmitters is deficient in this patient?
A Norepinephrine
B Glutamate
C Dopamine
D ACh
E GABA
Y55. After recovery from the surgical removal of the thyroid gland, the quality of the voice in a
patient changed to a monotone. It was discovered that the cricothyroid muscle in this patient
was paralyzed. The cricothyroid muscle is innervated by which of the following?
A accessory nerve
B ansa cervicalis
C external laryngeal nerve
D hypoglossal nerve
E internal laryngeal nerve
Y56. A young couple comes to your urology office because of inability to conceive a wanted
child after 1 year of unprotected sex. The wife had already undergone a gynecological workup,
including testing for 3 months showing a normal ovulation profile as confirmed by an ovulatory
kit. The primary care physician describes the husband’s physical exam as normal and had already
ordered a semen analysis and had forwarded the results to you. The semen volume was 0.5 mL,
pH 6.8, and azospermic without any fructose. The husband has a brother, who has two children,
one of whom has confirmed cystic fibrosis. You order a pelvic MRI of the husband to determine
whether which of the following exist(s)?
A Bilateral abdominal testicles
B Hypospadias
C Congenital absence of ejaculatory ducts and vas deferens
D Congenital hydrocele
E Congenital absence of the prostate gland
Y57. Fructose, a source of energy for spermatozoa, is found primarily in secretions from which of
the following organs?
A Bulbourethral glands
B Epididymis
C Prostate
D Seminal vesicles
E Testis
Y58. A 59-year-old male is admitted to the emergency room following a brief loss of
consciousness. Upon awakening, he is examined by a neurologist who notes a left side
oculomotor nerve paralysis as well as a tremor the limbs on the right side coupled with some
somatosensory loss on the right side of the body. The patient from presents with a dilated pupil
and double vision and receives a diagnosis of an oculomotor paralysis. It is determined that there
is a defect in the neurotransmitter mechanism associated with the postganglionic neuron
supplying the smooth muscle of the eye. Which of the following neurotransmitters is most likely
affected in this case?
A Acetylcholine
B Norepinephrine
C GABA
D Dopamine
E Serotonin
Y59. A patient complains of having constant headaches involving the frontal region. Further
examination reveals increased intraocular pressure, but at the time of examination there is little
evidence of visual deficits. Which of the following is the likely diagnosis?
A Cataracts
B A tumor of the visual cortex or lateral geniculate nucleus
C A tumor at the base of the brain impinging upon the optic chiasm
D Glaucoma
E Color blindness
Y60. It was discovered that a 29-year-old male had a tumor pressing on the base of the brain,
where it impinged upon the optic chiasm. His field of vision was seriously affected. Which of the
following defects was present in this individual?
A Total blindness of both eyes
B Bitemporal hemianopsia
C Right homonymous hemianopsia
D Binasal hemianopsia
E Right lower homonymous quadrantanopia
Y61. A 69-year-old male was admitted to the emergency after losing consciousness. When he
regained consciousness, he was examined by a neurologist who concluded that there was an
occlusion of one of the arteries supplying the brain. In addition, the neurologist recorded that
the patient presented with a marked motor aphasia. Which of the following arteries was most
likely occluded in this patient?
A Anterior cerebral artery
B Posterior cerebral artery
C Anterior inferior cerebellar artery
D Middle cerebral artery
E Basilar artery
Y62. Following an automobile accident, a teenage boy was admitted to the emergency room and
diagnosed as having a subarachnoid hemorrhage. Which of the following CSF findings would be
expected in this individual?
A Increased CSF pressure, bloody appearance of CSF, increased red cells, increased protein,
decreased glucose
B Decreased CSF pressure, bloody appearance of CSF, decreased red cells, decreased protein,
decreased glucose
C Normal pressure, normal red cells, increased protein, increased glucose, normal color of CSF
D Clear CSF, normal pressure, decreased protein, increased red cells, increased glucose
E Cloudy CSF, increased CSF, increased neutrophils, normal protein, normal glucose
Y63. Retinal detachment most commonly results from which of the following?
A Local swelling in specific retinal layers
B Leakage of blood from the inner retinal capillaries
C Fluid accumulation between the retina and the retinal pigment epithelium (RPE)
D Impaired pumping of water toward the photoreceptors by the RPE
E
Increased phagocytosis of outer segments by the RPE cells
Y64. A 42-year-old woman is watching her son play baseball when a stray foul ball from
another field unexpectedly strikes her in the back of the head and neck behind her left ear. A
subcutaneous bulge rapidly appears, but she stays to watch the rest of the game and ices the
bump when she arrives at home. The next day much of the swelling is diminished, but when she
tries to eat an apple, or even when she swallows, it hurts deep behind her left ear. In addition,
the patient reports the sensation of a foreign body in her throat and discomfort when turning
her head. She travels to the urgent care clinic where the physician orders a lateral skull film that
shows no fracture of her mastoid process. Which structure is most likely to cause tension on the
styloid process when opening the jaw widely?
A Stylohyoid ligament
B Stylohyoid muscle
C Styloglossus muscle
D Stylomandibular ligament
E Stylopharyngeus muscle
Y65. A 68-year-old female was admitted to the emergency room following an inability to move
her left eye to the left as well as a failure to show a smile on the left side of her face. However,
she experienced no loss of taste from any part of her tongue. Damage to which of the following
structures would most likely account for these deficits?
A The trigeminal and abducens nerves
B The facial and trigeminal nerves, distal to their exit from the brainstem
C The facial and abducens nerve nuclei within the pons
D The facial nerve, distal to the chorda tympani nerve
E The facial nerve, distal to the geniculate ganglion
Y66. A 58-year-old man presents to the ENT clinic with complaints of headaches and nasal
drainage. He has seasonal allergies, but this year he complains of headaches along with his
allergies. The headache often feels as if it is between his eyes or "on top of his head." Upon
examination of his nose and mouth, a large nasal polyp is seen on the medial aspect of the
superior turbinate of his left nostril. A CT confirms a large nasal polyp in the left sphenoethmoid
recess and sinusitis within an adjacent sinus. The sinusitis is most likely causing the headaches
within which one of the following locations?
A Anterior ethmoid sinuses
B Frontal sinus
C Middle ethmoid sinuses
D Maxillary sinus
E Sphenoid sinus
Y67. A 36-year-old male bartender is brought by ambulance to the emergency department
because a patron jumped over the bar, grabbed an ice pick, and stabbed him in the chest rather
than pay his bar tab at the end of the night. The ice pick entered the chest about 2 cm to the left
of the sternum in between the fourth and fifth rib. Upon examining the bartender, there is very
little blood coming from the puncture wound and normal lung sounds can be heard from both
the right and left lung. However, his heart is beating rapidly at 100 beats per minute, his external
jugular veins are bulging, and his heart sounds are becoming difficult to hear. A stat ultrasound is
ordered because which one of the following conditions is likely present?
A Hemothorax
B Pneumothorax
C Cardiac tamponade
D Aortic valve stenosis
E Deep venous thrombosis
Y68. A person is told that he has astigmatism. To correct this defect, the optometrist prescribes
which of the following lenses and for which reason?
A Cylindrical lens because the cornea or lens is oblong
B Concave lens because the eyeball is too long
C Convex lens because the lens is too short
D Neutral lens because the eyeball is normal but the cornea is too thin
E Concave lens because the cornea is opaque
Y69. A 70-year-old male was brought to the emergency room after experiencing headaches,
nausea, and dizziness. An MRI revealed the presence of a brain tumor, which had produced a
noncommunicating hydrocephalus. Which of the following is the most likely location of the
tumor?
A Cerebral subarachnoid space
B Cistern of the lamina terminalis
C Interventricular foramen
D Pontine cistern
E Cisterna magna
Y80. A 70-year-old male is admitted to the emergency room and a subsequent MRI revealed the
presence of a tumor involving parts of the left temporal lobe. In addition to certain short-term
memory deficits, visual deficits are noted as well. Which of the following visual deficits would
most likely result from this tumor?
A Left homonymous hemianopsia
B Right homonymous hemianopsia
C Left upper quadrantanopia
D Right upper quadrantanopia
E Left lower quadrantanopia
Y71. An elderly woman is brought to see an audiologist after complaining about hearing
difficulties. The audiologist notes that she is suffering from unilateral deafness and refers her to a
neurologist for further examination. On the basis of his examination, damage to which of the
following structures most likely accounts for her present condition?
A The auditory cortex of one side
B The lateral lemniscus of one side
C Cranial nerve VIII on one side
D The medial geniculate
E The medial lemniscus
Y72. After a hemisection of the spinal cord takes place at T3, a patient experiences marked
weakness in the right leg. Which of the following best accounts for this weakness?
A There was muscle damage in the right leg
B There was damage in his left frontal lobe
C There was damage to the right corticospinal tract
D The dorsal root was damaged
E There was damage to the right femoral nerve
Y73. An individual experienced the following constellation of symptoms following a brainstem
lesion associated with a stroke of that region: hoarseness, difficulty in swallowing, diminished
gastric secretions, and loss of some cardiovascular reflex functions. To which of the following
structures can these symptoms be attributed?
A Cranial nerve VII
B Cranial nerve IX
C Cranial nerve X
D Cranial nerve XI
E Pontine reticular formation
Y74. A urologist is teaching her resident to perform a vasectomy. She explains that he has to
inject the anesthetic in the skin of the scrotum, in preparation for incision of its lateral aspect.
This surgical location allows for easy access to the spermatic cord. Which of the following nerves
innervates the skin of the scrotum?
A femoral nerve
B iliohypogastric nerve
C ilioinguinal nerve
D obturator nerve
E subcostal nerve
Y75. A 52-year-old male patient with a history of alcoholism is brought to the emergency room
because of a sudden onset of right upper quadrant pain, nausea, blood in the vomitus, and fever.
Ultrasound diagnosis reveals a portal vein obstruction caused by liver cirrhosis and accompanied
by esophageal varices. Proper portal circulation must be reestablished to alleviate the
esophargeal varices, and the attending surgeon decides on an end-to-side portocaval shunt.
Which of the following describes the chosen procedure?
A anastomosis by communication between the portal vein and the inferior vena cava
B anastomosis by prosthetic vascular graft between the inferior vena cava and the superior
mesenteric vein
C anastomosis by suturing the inferior end of the portal vein to the inferior vena cava
D anastomosis of the splenic vein to the left renal vein
E placement of an expandable stent between a hepatic vein and the portal vein
Y76. A 36-year-old male bartender is brought by ambulance to your emergency room because
a patron jumped over the bar, grabbed an ice pick, and stabbed him in the chest rather than pay
his bar tab at the end of the night. The ice pick entered the chest about 2 cm to the left of the
sternum in between the fourth and fifth rib. Upon examining the bartender, you note very little
blood is coming from the puncture wound and normal lung sounds from both the right and left
lung. However, his heart is beating rapidly at 100 beats per minute, his external jugular veins are
bulging, and you have difficulty hearing his heart sounds. You order a PA and lateral chest film
because you suspect which of the following?
A Hemothorax
B Pneumothorax
C Cardiac tamponade
D Aortic valve stenosis
E Deep venous thrombosis
Y77. A 28-year-old man is treated in the emergency department (ED) for a superficial gash on his
forehead. The wound is bleeding profusely, but examination reveals no fracture. While the
wound is being sutured, he relates that while he was using an electric razor, he remembers
becoming dizzy and then waking up on the floor with "blood everywhere." The physician
suspects a hypersensitive cardiac reflex. The patient's epicranial aponeurosis (galea aponeurotica)
is penetrated, resulting in severe gaping of the wound. The structure overlying the epicranial
aponeurosis is which one of the following?
A A layer containing blood vessels
B Bone
C The dura mater
D The periosteum (pericranium)
E The tendon of the epicranial muscles (occipitofrontalis)
Y78. A 62-year-old man who smoked two packs of cigarettes per day for 35 years was suffering
from a chronic cough that was attributed to his smoking habit by his physician. One day the
patient noticed that his right eyelid drooped slightly and that his right pupil was smaller than the
left. He also noticed that the inner side of his right hand was numb and that he had begun to
drop things from his right hand. He had no other symptoms. He consulted his physician, who
directed him to a neurologist. The neurologist noted that although the right pupil was smaller
than the left, it was still reactive to light. Although the patient's right eyelid drooped slightly, he
could close his eyes tightly when asked to do so. The neurologist noted that the patient did not
sweat on the right side of his face. He was unable to feel a pinprick on the inner surface of his
right hand, and his right triceps and hand muscles were weak. The patient's small pupil was due
to which of the following?
A Unopposed action of the muscles with parasympathetic innervation
B Unopposed action of the muscles with sympathetic innervation
C Both sympathetic and parasympathetic damage
D A lesion in the nucleus of the third nerve
E A lesion in distal branches of the trochlear nerve
Y79. A 57-year-old male patient has always been a very heavy drinker, often consuming two pints
of whiskey per day, for many years. He visited his doctor because he now needs to stand with his
feet far apart in order to maintain his balance and he waddles when he walks. The doctor who
evaluated him tested his memory and speech carefully, as well as his cranial nerves, and was
unable to find any deficits. There was no weakness, sensory loss, or abnormalities in his reflexes.
When asked to touch the doctor’s finger and then his nose, the patient missed his nose slightly,
but rapidly corrected the movement on both sides. When asked to slide his right heel down his
left shin, his heel slid sideways and clumsily across the bone until it reached his ankle. The
response with the left heel was similar. When asked to walk, the patient walked with his feet
very far apart. If he attempted to walk in a tandem fashion, with one heel in front of the other
toe, he began to fall, and the doctor needed to catch him. The doctor ordered an MRI of the
patient’s head. A gait problem of this type could be caused by lesions in which of the following
systems?
A Cerebellar tracts only
B Posterior columns only
C Corticospinal tracts
D Both the cerebellar and the posterior column systems
E Spinothalamic system
Y80. During a bar fight a client was punctured with an ice pick. He is brought to the emergency
room because he can no longer walk due to weakness, and he is feeling faint. You place him on
oxygen as you listen to his heart and lungs. All his heart sounds are distant and muffled and his
blood pressure is low despite a very rapid pulse. His lungs sound normal. Using a 3 in. 19 gauge
needle you do which of the following?
A Insert it just under the left tip of the xiphoid process in an effort to remove blood from the
pericardial cavity
B Insert it at the second intercostal space on the left side of the sternum in an effort to inject
nitroglycerine in an effort to increase the strength of cardiac contractions.
C Insert it at the ninth intercostal space at the left midclavicular line in an effort to remove
blood from the pleural cavity
D Insert it at the fourth intercostal space on the right side in an effort to remove blood from
the right pulmonary artery
E Insert it just under the left clavicle in an effort to remove blood from the right cephalic vein
Y81. A 19-year-old teenager is brought to the emergency department after a single car accident
just 20 minutes earlier in which she lost control of her car on black ice and hit a retaining column
of an overpass at about 45 miles per hour. She was wearing a seat belt but looks pale, has
tachycardia and positional hypotension, is extremely nauseated, and is lying in the fetal position
due to increasingly severe abdominal pain. She has no fractures and a cranial nerve test is
normal. You order an abdominal CT because you suspect which one of the following?
A Lacerated kidney
B
C
D
E
Ruptured spleen
Ruptured gallbladder
Diverticulitis
Hemorrhoids
Y82. A patient presents in her fifth pregnancy with a history of numbness and tingling in her
right thumb and index finger during each of her previous four pregnancies. Currently, the same
symptoms are constant, although worse in the early morning. Symptoms could be somewhat
relieved by vigorous shaking of the wrist. Neurologic examination revealed atrophy and
weakness of the abductor pollicis brevis, the opponens pollicis, and the first two lumbrical
muscles. Sensation was decreased over the lateral palm and the volar aspect of the first three
digits. Numbness and tingling were markedly increased over the first three digits and the lateral
palm when the wrist was held in flexion for 30 seconds. The symptoms suggest damage to which
one of the following?
A The radial artery
B The median nerve
C The ulnar nerve
D Proper digital nerves
E The radial nerve
Y83. A 62-year-old male is found unconscious by his wife in their home. He is admitted to the
emergency room of a local hospital and, when he regains consciousness, is examined by an
emergency room physician and then by a neurologist. The patient presented with a left side
UMN paralysis of the arm and leg. In addition, his right eye was dilated, the pupil of that eye was
unresponsive to light; the eyelid was drooping and the eye deviated downward. Which of the
following is the likely locus of the lesion?
A Dorsomedial pons of right side
B Right frontal eye field of cerebral cortex
C Ventromedial midbrain of right side
D Dorsolateral pons of right side
E Dorsomedial midbrain of right side
Y84. A 58-year-old patient enters the emergency room suffering from severe chest pain, left
shoulder and arm pain, shortness of breath, and vomiting. The patient’s blood tests indicate
increased levels of creatine kinase and troponin and an electrocardiogram that exhibits an
elevated ST segment. The patient is prepped for percutaneous coronary intervention to alleviate
the blockage in the left anterior descending (LAD) artery. Upon auscultation of this patient’s
heart, which event(s) occur(s) at the end of systole?
A Closing of the aortic and pulmonary valves
B Closing of the aortic and mitral valves
C Closing of the mitral and tricuspid valves
D Closing of the pulmonary and tricuspid valves
E First heart sound
Y85. A 19-year-old man comes into your office in extreme pain holding a handkerchief over his
right eye. He explains to you that he was accidentally struck in the eye with a pool cue and the he
can’t see anything other than a milky white cloud in that eye. You carefully exam his right eye
and note that while there appears to be a scratch on the cornea, the anterior chamber of the eye
has partially filled with blood, but the eye has not ruptured. You use a tonometer and determine
that the intraocular pressure is normal. You tell the patient that it is important to avoid any other
blows to the head since the retina is at increased risk for detachment and to return to the office
the next day to redetermine if the intraocular pressure has risen. You explain to the patient that
the anterior chamber of the eye, where his blood is, is normally filled with a clear fluid called
aqueous humor, which is produced at the ciliary process. The abnormal red blood cells in the
aqueous humor may plug the normal site of drainage, leading to excessive intraocular pressure if
left untreated. Where in the anterior chamber of the eye does aqueous humor normally drain?
A Trabecular meshwork that leads to the scleral venous sinus (canal of Schlemm)
B Ciliary muscle which has zonular fibers (suspensory ligament of the lens) attached to it
C Ciliary process
D Lens
Y86. A multiparous mother brings in her second son, an 18-month-old active toddler, because
she has noticed blood (sometimes red, one time “currant jelly”) in his stools. Although the
toddler is trying new foods, she doesn’t think the blood is associated with anything in his diet.
Your physical exam, including a digital rectal exam, is normal. You order an upper GI barium
swallow with small bowel follow through and radiological report describes a 2-inch-long
diverticulum, pointing toward the umbilicus, in the ileum, about 2 ft from the ileocecal valve. You
explain to the mother that the blood is most likely from which of the following sources?
A An appendix that must be removed
B A Meckel’s (ileal) diverticulum
C Active diverticulitis
D Internal hemorrhoids
E A duodenal ulcer
Y87. A 35-year-old married woman comes to the emergency room due to sudden onset of
nausea, vomiting, positional hypotension, and tachycardia. She also complains of sudden
abdominal fullness and generalized pelvic pain. Her period is “late,” with the last menses 55 days
ago. A pregnancy test is positive. Pelvic sonogram suggests extravasated fluid in the peritoneal
cavity and pooling in the rectouterine pouch (of Douglas) and a mass in the left fallopian tube. A
culdocentesis yields fresh blood. You correctly suggest that she be admitted for which of the
following?
A D and C (dilation and curettage)
B Endoscopic exploration to rule out ectopic pregnancy
C Ovariectomy for ovarian cancer
D Hysterectomy for fibroids
E Cystocele repair
Y88. Detection of angular acceleration is accomplished by which of the following structures?
A Maculae of the utricle and saccule
B Hair cells of the organ of Corti
C Cristae ampullaris of the semicircular canals
D Interdental cells
E Pillar cells
Y89. A patient is suffering from a speech deficit coupled with an ipsilateral loss of pain and
temperature from the left side of the face and contralateral loss of pain and temperature from
the body, as well as some autonomic dysfunctions. With reference to speech, the physician who
was called to see the patient in the emergency room noted that his speech was slurred as if he
were intoxicated, but the grammar and meaning were intact. Which of the following types of
speech deficit did the patient encounter?
A Broca’s aphasia
B Wernicke’s aphasia
C Mixed aphasia
D Dysarthria
E Agnosia
Y90. A 75-year-old man who is right-handed was told in the past by his internist that he has an
irregular heartbeat. Unfortunately, the patient decided that he didn’t wish to learn anything
further about this condition, so he didn’t return to this physician, and it remained untreated. One
morning, he awoke to find that his face drooped on the right side and that he couldn’t move his
right arm or right leg. When he tried to call an ambulance for help, he had a great deal of
difficulty communicating with the operator because his speech was slurred, nonfluent, and
missing some pronouns. The call was traced by the police; an ambulance arrived at his house and
took him to an emergency room. A neurologist was called to see him in the emergency room.
When he listened to his heart, he detected an irregular heartbeat. It was very difficult to
understand his speech because it was halting, with a tendency to repeat the same phrases over
and over. He had difficulty repeating specific sentences given to him by the neurologist, but he
was able to follow simple commands such as “Touch your right ear with your left hand.” His
mouth drooped on the right when he attempted to smile, but his forehead remained symmetric
when he wrinkled it. He couldn’t move his right arm at all, but he was able to wiggle his right leg
a little bit. Which of the following language problems does the patient have?
A Dysarthria
B Wernicke’s aphasia
C Broca’s aphasia
D Alexia
E Pure word deafness
Y91. A college student received an injury as a result of being tackled in a football game. After the
game, the student was treated at a local hospital and was found to be unable to abduct and
rotate the left arm at the shoulder, flex the elbow, and extend the wrist of the left side. Further
examination revealed depression of the biceps reflex of this limb, but the reflex activity involving
the other limbs was normal. Which of the following is the most likely site of the injury?
A Precentral gyrus
B Basilar pons
C Ventral horn cells at C1
D Nerve roots of C5–C6
E Triceps muscle
Y92. As a result of a hemisection of the spinal cord, a patient has loss of vibration and position
sense in the right leg. Which of the following pathways was affected by the lesion?
A Right fasciculus cuneatus
B Right fasciculus gracilis
C Left fasciculus cuneatus
D Left fasciculus gracilis
E Right Lissauer’s tract
Y93. A female infant is born approximately 10 weeks prematurely (at 30 weeks) and weighs 1710
g. She has respiratory distress syndrome and is treated with endogenous surfactant. She is
intubated endotracheally with mechanical ventilation immediately after birth. Over the first 4
days after birth the ventilator pressure and the fraction of inspired oxygen are reduced.
Beginning on the fifth day after birth, she has brief desaturations that become more persistent.
She needs increased ventilator and oxygen support on the seventh day after birth. She becomes
cyanotic. Further examination, echocardiogram, and x-rays reveal left atrial enlargement, an
enlarged pulmonary artery, increased pulmonary vasculature, and a continuous machine-like
murmur. Which of the following is the most likely diagnosis?
A Persistent foramen ovale
B Patent ductus arteriosus
C Ventricular septal defect
D Pulmonary stenosis
E Coarctation of the aorta
Y94. A 23-year-old female was exposed to a neurotoxin that selectively destroyed the Purkinje
cell layer of the cerebellum, resulting in loss of balance and coordination. Of the structures or
regions indicated below, which one was most directly affected by the loss of Purkinje cells?
A Red nucleus
B Deep cerebellar nuclei
C Reticular formation
D Ventrolateral (VL) nucleus (thalamus)
E Spinal cord
Y95. A 32-year-old woman gave birth to a healthy 8.5 lb boy. After 2 months, she suddenly
experienced "pins and needles" feeling in the fingers of her right hand, which she normally used
to hold the baby. A neurological examination indicated that she was suffering from carpal tunnel
syndrome. The anatomical site most commonly involved in this disorder is which of the
following?
A
B
C
D
E
White matter of right cervical spinal cord
Right radial nerve
Right median nerve
Gray matter of right cervical spinal cord
Right axillary nerve
Y96. If it were possible to surgically isolate the pathway mediating pain impulses to the thalamus,
which pathway would be most appropriate to isolate and disconnect?
A Fasciculus gracilis
B Fasciculus cuneatus
C Spinocerebellar tract
D Spinothalamic tract
E Tectospinal tract
Y97. Following hemisection of the spinal cord at the level of approximately T3, a patient
experiences loss of pain and temperature on the left side of the leg. Which of the following tracts
was affected by the hemisection of the cord that could account for this deficit?
A Right fasciculus cuneatus
B Right fasciculus gracilis
C Right spinothalamic tract
D Left spinothalamic tract
E Left corticospinal tract
Y98. The scapula has no direct attachment to the axial skeleton. During development, the
scapula is formed by which of the following?
A Splanchnic lateral plate mesoderm
B Neural crest cells
C Axial mesoderm
D Somatic lateral plate mesoderm
E Somitic mesoderm
Y99. An elderly woman is brought to see an audiologist after complaining about hearing
difficulties. The audiologist notes that she is suffering from unilateral deafness and refers her to a
neurologist for further examination. On the basis of his examination, damage to which of the
following structures most likely accounts for her present condition?
A The auditory cortex of one side
B The lateral lemniscus of one side
C Cranial nerve VIII on one side
D The medial geniculate
E The medial lemniscus
Y100. A person is examined by a neurologist after complaining that he keeps having a sensation
of smell that he could not clearly define. A subsequent MRI reveals the presence of a brain tumor
and that the patient is experiencing uncinate hallucinations. The tumor is most likely situated in
which of the following regions?
A Anterior temporal lobe
B Medial dorsal thalamic nucleus
C Parietal cortex
D Hypothalamus
E Midbrain periaqueductal gray
Y101. A 55-year-old woman complained of headaches and was subsequently diagnosed as
having a tumor localized to the left parietal lobe. In addition to a variety of sensory deficits,
further examination also revealed a reduction in her visual fields. Which of the following visual
deficits would most likely result from this tumor?
A Left homonymous hemianopsia
B Right homonymous hemianopsia
C Left upper quadrantanopia
D Right upper quadrantanopia
E Right lower quadrantanopia
Y102. A 38-year-old (gravida 0, para 0) woman is recently married and pregnant. The zygote is
a result of a haploid ovum fertilized by her husband’s sperm. Which of the following is required
for continuation of the second meiotic division to produce the haploid ovum?
A Elevation of progesterone titers
B Expulsion from the mature follicle
C The environment of the oviduct and uterus
D Fertilization by a spermatozoon
E The presence of human chorionic gonadotropin (hCG)
Y103. A patient is admitted to the local hospital for treatment of a vascular occlusion within the
forebrain. A magnetic resonance imaging (MRI) indicates that the damage is limited to the
subthalamic nucleus. As a result of this lesion, which of the following disorders is likely to be
present in the patient?
A Torsion dystonia
B Tremor at rest
C Hemiballism
D Spastic paralysis
E Tardive dyskinesia
Y104. A patient complains of a reduction in his field of vision. A routine magnetic resonance
imaging (MRI) reveals the presence of a tumor situated in the left optic tract proximal to the
lateral geniculate nucleus. Which of the following best characterizes the most likely visual
deficit?
A Total blindness of the left eye
B Bitemporal hemianopsia
C Right homonymous hemianopsia
D Left homonymous hemianopsia
E
Left homonymous quadrantanopia
Y105. A small peripheral nerve injury involving some of the axons that enter the spinal cord at
L1 affected principally fibers that innervate the nucleus dorsalis of Clarke. Which of the following
is the primary dysfunction resulting from this injury?
A Loss of autonomic functions
B Loss of unconscious proprioceptive information
C Loss of pain and temperature sensation
D UMN paralysis
E LMN paralysis
Y106. A neurological examination of a 75-year-old male reveals that when the abdominal wall is
stroked, the muscles of the abdominal wall of the side of the body stimulated fail to contract.
Other neurological tests appear normal. Which of the following is the most likely region of the
injury?
A C1–C5 spinal segments
B C6–T1 spinal segments
C T2–T7 spinal segments
D T8–T12 spinal segments
E L1–L5 spinal segments
Y107. A 13-year-old boy was vacationing with his parents in Mexico on spring break. He
developed nausea, vomiting 4 days into the trip despite caution about what he ate and drank. He
switched to a clear liquid diet. None of the others on the trip were sick. On his flight back to the
United States the next day he developed a fever and increased abdominal pain, especially in the
paraumbilical region. His parents took him to their pediatrician the next day as he was feeling
worse and could barely move. During the physical exam the pediatrician noted tenderness
around the umbilicus and rebound tenderness over McBurney’s point and was sent for an
abdominal CT at a local pediatric hospital. Where is McBurney’s point and what is the likely
diagnosis?
A At the right costal margin at the mid-clavicular line; ruptured gallbladder
B On a line drawn between the anterior superior iliac spine and umbilicus on the right;
appendicitis
C On a line drawn between the anterior superior iliac spine and umbilicus on the left;
appendicitis
D On a line drawn between the anterior superior iliac spine and the pubic tubercle on the right;
kidney stone
E On a line drawn between the anterior superior iliac spine and the pubic tubercle on the left;
kidney stone
Y108. A 43-year-old man presents with left-sided maxillary tooth pain of one week's duration.
Because he thought it might have been one of his maxillary fillings (the newer plastic polymers)
he visited his dentist first, but his dentist was unable to identify any dental problems. His
physician taps on his maxillae and elicits sharp pain when she taps on the left, but not right side
of his face. While he does not think he has any allergies, he admits that his girlfriend has recently
bought a cat that lives inside. A sinus series is ordered because his physician suspects which one
of the following?
A Sphenoid sinusitis
B Anterior ethmoidal sinusitis
C Posterior ethmoidal sinusitis
D Maxillary sinusitis
E Frontal sinusitis
Y109. A patient is told that he has astigmatism. To correct this defect, the optometrist prescribes
which of the following lenses and for which reason?
A Cylindrical lens because the cornea or lens is oblong.
B Concave lens because the eyeball is too long.
C Convex lens because the lens is too short.
D Neutral lens because the eyeball is normal but the cornea is too thin.
E Concave lens because the cornea is opaque.
Y110. An 86-year-old woman has had difficulty with high blood pressure, high cholesterol,
diabetes, strokes, and blood clots in her legs for many years. One day, her grandson arrived at
her apartment in a senior citizen center for his weekly visit and found her lying unconscious on
the floor. He immediately called an ambulance. The paramedics in the ambulance gave her some
medications, including glucose, but she did not awaken. She was taken to the nearest emergency
room, where a physician was called to evaluate her. She was breathing on her own and had a
pulse, but could not be aroused to any stimulus. Her arms and legs were stiff and would not
move in response to a painful stimulus. Her eyes moved in response to moving her head. Finally,
in response to a very loud shout and pinch on the arm, she briefly opened her eyes; however,
she immediately shut them again. Further attempts to arouse the patient were unsuccessful. She
was taken for a CT scan of her head, and then taken to an intensive care unit. An acute stroke in
which portion of the CNS would most likely cause this scenario?
A Right frontal lobe
B Left frontal lobe
C Right temporal lobe
D Pons and midbrain
E Right occipital lobe
Y111. While on a medical mission to rural Haiti a physician sees a 24-year-old mother of one who
is complaining of right lower quadrant pain. Initially the physician examines her for rebound
tenderness over McBurney point; however, the pain is lower and more pelvic. She tells the
physician that she thinks she is about 2 months pregnant. A urine dipstick confirms that she is
pregnant, so a pelvic examination is completed since ultrasound is unavailable. What is the most
likely, potential deadly condition the young mother might have and what procedure will the
physician use during the pelvic examination to support her/his hypothesis?
A Eclampsia; confirmed by vaginally observing that the external os of the cervix is closed
tightly
B Peritoneal ectopic pregnancy; confirmed by placing one hand in the vagina and one hand in
the rectum palpating the rectouterine pouch of Douglas
C Preeclampsia; confirmed by vaginally observing the appearance and nature of the external os
of the cervix
D Tubal ectopic pregnancy; confirmed by placing one hand in her vagina and one hand gently
pressing on her anterior abdominal wall
E Twin pregnancy; confirmed by estimating the size of the uterus with one hand in her vagina
and one hand gently pressing on her anterior abdominal wall in the midline
Y112. One of your patients boxes semiprofessionally. One time he was almost knocked out by a
right “hook” to the head and for about a week he had frequent headaches and a very runny nose,
which finally stopped running by itself. However, he was never able to smell with his left nostril
again. What is the most likely site of injury that explains the symptoms?
A Fracture at the cribriform plate
B Fracture of the lacrimal bones
C Fracture of the nasal bones
D A Le Fort II fracture
E A Le Fort III fracture
Y113. A college student received an injury as a result of being tackled in a football game. After
the game, the student was treated at a local hospital and was found to be unable to abduct and
rotate the left arm at the shoulder, flex the elbow, and extend the wrist of the left side. Further
examination revealed depression of the biceps reflex of this limb, but the reflex activity involving
the other limbs was normal. Which of the following is the most likely site of the injury?
A Precentral gyrus
B Basilar pons
C Ventral horn cells at C1
D Nerve roots of C5 to C6
E Triceps muscle
Y114. An individual lost his sense of smell. After receiving a medical examination, it was
determined that the reason for his loss of sensation was due to degeneration of primary afferent
fibers that enter the olfactory glomerulus. In a healthy individual, upon which of the following
structures do these primary afferent fibers terminate?
A Granule cell dendrites forming axodendritic synapses
B Granule cell axon terminals forming axoaxonic synapses
C Mitral cell dendrites forming axodendritic synapses
D Mitral cell axon terminals forming axoaxonic synapses
E Axon terminals of fibers arising from the olfactory tubercle, forming axoaxonic synapses
Y115. A 62-year-old female diagnosed with ovarian cancer is prepped for surgery. During the
total hysterectomy, the ureter is isolated and protected because it courses in the pelvis posterior
and is inferior to which structure?
A Uterine artery
B
C
D
E
Sacrogenital fold
Round ligament of the uterus
Ovarian artery
Common iliac artery
Y116. A 62-year-old male is found unconscious by his wife in their home. He is admitted to the
emergency room of a local hospital and, when he regains consciousness, is examined by an
emergency room physician and then by a neurologist. The patient presented with a left side
UMN paralysis of the arm and leg. In addition, his right eye was dilated, the pupil of that eye was
unresponsive to light, the eyelid was drooping, and the eye deviated downward. Which
combination of structures described below was most likely damaged by the lesion?
A Red nucleus and superior cerebellar peduncle
B Internal capsule and optic tract
C Substantia nigra and cerebral peduncle
D Third nerve and cerebral peduncle
E MLF and pontine tegmentum
Y117 . In a case involving a patient who experienced hoarseness and dysphagia, it was concluded
that the patient suffered from a lesion affecting selective brainstem neurons. Which of the
following is the most probable nuclei damaged in this case?
A Solitary nucleus
B Deep pontine nuclei
C Nucleus ambiguus
D Ventral horn cells of cervical cord
E Inferior salivatory nuclei
Y118. A 35-year-old man who had optic neuritis (an inflammation of the optic nerve causing
blurred vision) several years before was told that he had a 50% chance of eventually developing
multiple sclerosis (MS). One day he noticed that he had double vision and felt weak on his right
side. Although he noted that the symptoms were becoming steadily worse throughout the day,
he attributed this to stress from his job as a stockbroker, and in order to relax he decided to take
a drive in his car. While he was driving, his vision became steadily worse. As he was about to pull
over to the side of the road, he saw two trees on the right side of the road. Uncertain which was
the actual image, he attempted to place his right foot on the brake pedal. He suddenly realized
that he was unable to lift his right leg, and his car collided with the tree. A pedestrian on the side
of the road called the emergency medical service (EMS), and the patient was brought to a nearby
emergency room.
A neurologist is called to see the patient because the emergency room physicians thought he
might have had a stroke, despite his young age. The neurologist speaks to him, then examines
him. He finds that his left eye was deviated to the left and down. When the patient attempts to
look to his right, his right eye moves normally, but his left eye is unable to move farther to the
right than the midline. His left pupil is dilated and does not contract to light from a penlight. His
left eyelid droops, and he has difficulty raising it. In addition, the right side of his mouth remains
motionless when he attempts to smile, but his forehead is symmetric when he raises his
eyebrows. His right arm and leg are markedly weak. The neurologist tells the patient that he is
not certain that this was necessarily a stroke, but admits him to the hospital for observation and
tests. A lesion in which of the following nerves most likely caused the patient’s double vision?
A Optic nerve
B Oculomotor nerve
C Cervical sympathetic fibers
D Trochlear nerve
E Abducens nerve
Y119. A large vascular infarct involving the posterior limb of the internal capsule on the right
side is likely to produce which of the following deficits?
A deviation of the protruded tongue to the right
B hypertonia and hyperreflexia in the right upper limb
C paralysis of facial expression muscles on the lower left portion of face
D paraplegia involving the lower extremities
E spastic hemiplegia involving the right side of the body
Y120. Paresthesia, hyperesthesia, or even painful sensation in the anterolateral region of the
thigh may occur in obese persons. It results from an abdominal panniculus adiposus that bulges
over the inguinal ligament and compresses which of the following underlying nerves?
A Femoral branch of the genitfemoral nerve
B Femoral nerve
C Iliohypogastric nerve
D Ilioinguinal nerve
E Lateral femoral cutaneous nerve
Y121. During an abortion procedure, a long needle is inserted into the vagina. Instead of entering
the cervix, it pierces the posterior fornix. The patient becomes septic and dies. Which region did
the needle enter incorrectly?
A Bladder
B Ischiorectal fossa
C Rectouterine space
D Retropubic space
E Vesicouterine space
Y122. Vasopressin is released from the posterior pituitary. However, it is synthesized elsewhere.
In which of the following structures is it synthesized?
A Mammillary bodies
B Lateral hypothalamus
C Supraoptic hypothalamic nucleus
D Ventromedial hypothalamic nucleus
E Posterior hypothalamus
Y123. A posteriorly perforating ulcer in the pyloric antrum of the stomach is most likely to
produce an initial localized peritonitis or abscess formation in which of the following?
A Greater sac
B Left subhepatic and hepatorenal spaces (pouch of Morison)
C Omental bursa
D Right subphrenic space
E Right subhepatic space
Y124. After a night of fraternity parties, a 21-year-old college junior came to the ED the following
morning complaining that she could not raise her wrist. There is no history of trauma. On
examination, the patient cannot extend her fingers or wrist but can flex them. She can also both
flex and extend her elbow normally. There are no other motor deficits. The symptoms suggest
damage to which one of the following?
A Median nerve
B Ulnar nerve
C Radial nerve
D Axillary nerve
E Musculocutaneous nerve
Y125. A 55-year-old man, who has been suffering from hypertension for the past 8 years,
experiences attacks of pain in the regions of the pharynx and ear which are usually preceded by
swallowing and coughing spells. These attacks, each of which lasts for an average of 1 minute,
occurred a number of times; ultimately, this condition showed remission. Although the
neurological examination is basically normal, a subsequent magnetic resonance imaging (MRI) is
taken and reveals an abnormality at the base of the skull. Which of the following cranial nerves is
most likely involved in this disorder?
A Nerve V
B Nerve VII
C Nerve IX
D Nerve XI
E Nerve XII
Y126. A 19-year-old teenager is brought to the emergency room after a single-car accident just
20 minutes earlier in which she lost control of her car on black ice and hit a retaining column of
an overpass at about 45 miles per hour. She was wearing a seat belt but looks pale, has
tachycardia and positional hypotension, is extremely nauseated, and is lying in the fetal position
due to increasingly severe abdominal pain. She has no fractures and a cranial nerve test is normal.
You order an abdominal CT because you suspect which of the following?
A Lacerated kidney
B Ruptured spleen
C Ruptured gallbladder
D Diverticulitis
E Hemorrhoids
Y127. A 58-year-old woman underwent open-heart surgery for a mitral valve replacement.
About 3 days after the surgery, her breathing became more labored just before she was about to
be discharged. The surgical resident listened to the heart and lungs and noted a decrease in
breath sounds in the inferior half of the left chest. When they placed a chest tube into her
pleural cavity a milky white fluid was collected. What is the likely source of the fluid and what is
the normal course of the structure damaged?
A The right lymph duct, which normally crosses the midline and carries lymph to the junction of
the left subclavian vein and the internal jugular vein
B The thoracic duct, which normally carries lymph from the cisterna chyli to the junction of the
left subclavian vein with the internal jugular vein in the neck
C The thoracic duct, which normally carries lymph from the junction of the left subclavian vein
with the internal jugular vein in the neck down to the cisterna chyli in the abdomen for
absorption
D Pleural lymph from damage to the intrinsic lymphatic channels of both the right and left
lungs that drain toward the bifurcation of the trachea
E Pleural lymph from damage to the intrinsic lymph channels of the left lung as they move
toward the hilar region
Y128. An 83-year-old female was admitted to the emergency room following a stroke. Sometime
after she regained consciousness, a neurological examination revealed that the application of
mild tactile stimulation on the right arm was extremely painful, while the remainder of the
neurological examination was relatively normal for an individual of her age. Where was the most
likely locus of the stroke?
A Right precentral gyrus
B Left precentral gyrus
C Right ventroposterolateral thalamus
D Left ventroposterolateral thalamus
E Left ventroposteromedial thalamus
Y129. An individual is referred to a neurologist because he is having difficulty moving his eyes
horizontally to one side. The neurologist concludes that the individual has a vascular lesion.
Which of the following structures was most likely affected by this lesion?
A Paramedian pontine reticular formation
B Ventrolateral medulla
C Cranial nerve IV
D Primary motor cortex
E Ventral posterolateral nucleus of thalamus
Y130. A 9-year-old girl is brought to your pediatric office by her mother because the girl has been
complaining about how sore her throat is, and the mother has noticed that she has started to
snore loudly at night. You examine the girl’s mouth and oral pharynx and you immediately
discover the likely source of the problem to be extremely large palatine tonsils. You suggest
surgical removal of the tonsils, but you do explain that there is a small risk of the surgery, which
may result in which of the following?
A Loss in the ability to taste salt in the anterior two-thirds of the tongue
B Loss in the ability to protrude her tongue, thus limiting her ability to lick an ice cream cone
C Weakness in the ability to open her mouth fully when eating an apple due to damage to the
innervation to the lateral pterygoid muscle
D Loss in the ability to taste in the posterior one-third of the tongue and perhaps some
difficulty in swallowing
E Weakened ability to move her jaw from side to side because of loss in innervation of the
medial pterygoid muscle
Y131. A young boy was admitted to the emergency room after having experienced severe nausea,
headache, and fever. The neurologist concluded that he was suffering from a form of bacterial
meningitis. His cerebrospinal fluid (CSF) would most likely indicate which of the following?
A Increased protein, decreased glucose, decreased neutrophils
B Increased protein, decreased glucose, increased neurophils
C Increased protein, normal glucose, normal neutrophils
D Decreased CSF pressure, decreased protein, decreased glucose
E Decreased protein, normal CSF pressure, increased glucose
Y132. Which of the following is the primary regulator of salivary secretion?
A Antidiuretic hormone
B Autonomic nervous system
C Aldosterone
D Cholecystokinin
E Secretin
Y133. A 62-year-old man is brought by ambulance to the emergency department. He collapsed
with severe tearing chest pain while trying to carry two bags of groceries in from his car. He is
given oxygen and electrocardiogram (ECG) leads are applied in the ambulance. The ECG appears
relatively normal. In the emergency department, he is alert, but breathing rapidly and has severe
chest pain that radiates to his back. The pain does not radiate to his left arm. The heart sounds
are all normal, but his lung sounds are diminished on the left side. A CT is ordered immediately
because of fear that he may have which one of the following conditions?
A Development of a patent foramen ovale
B Dissection of the thoracic aorta
C Rib fracture on the left side
D Blockage of the left anterior descending artery
E A diaphragmatic hernia on the left side
Y134. A 17-year-old high school football player is sent to a neurology clinic because his mother
thinks he may have acquired neck problems during a game. A month before, he sustained a
concussion from a blow to his head from another player. Shortly after, she noted that he
intermittently tilted his head to the side. When asked what was the matter, he simply said that
sometimes he had double vision and that the images were situated on top of each other
vertically, making it difficult to go downstairs. When he is examined, there is no neck pain or
limitation of motion. He tends to keep his head tilted to the right side. When asked to follow the
doctor’s finger with his head in a straight position, his left eye does not move downward when
his eyes are turned to the right, and they tend to remain slightly deviated toward the left. At this
point, he states that he has double vision and feels better if his head is tilted to the right. The
remainder of his eye movements, as well as the remainder of his exam, are normal. Where did
the damage most likely occur?
A The oculomotor nerve
B The abducens nerve
C The trochlear nerve
D The trigeminal nerve
E The facial nerve
Y135. A previously healthy 68-year-old woman experienced twitching of her left finger that
soon extended to her hand, arm, shoulder, and then to her leg. At this point, she became
unconscious. Her legs and arms began to jerk for several minutes and her neck extended
backward. She did not respond to comments or requests by people who were near her. She was
admitted to a hospital, at which time, she regained consciousness but was able to answer some
questions such as identifying the present month. She had better movement of her right side of
her body than her left but was somewhat ineffective in following commands given by her
physician. From which area of the brain did the seizure most likely begin?
A Left precentral gyrus
B Right precentral gyrus
C Right temporal lobe
D Left temporal lobe
E Thalamus
Y136. A 47-year-old radiology professor suddenly notices that he can no longer hit his normal
three-point shot in basketball on his driveway. He also notes a diminished ability to do his usual
pushup regimen. He presents to his family physician's office where it is learned that he has been
suffering some mild neck pain of 6 weeks' duration. In addition, he describes right arm pain
down the back of his right arm and extending to the dorsal surface of his hand, including his
middle finger. A diminished triceps tendon reflex is noted on the right side only. His physician
orders which of the following because of concern that his patient has herniated which
intervertebral disk?
A Lateral x-ray; C6 to C7
B Cervical MRI; C6 to C7
C Cervical MRI; C8 to T1
D CT; C5 to C6
E CT; C8 to T1
Y137. A 63-year-old woman was brought into the emergency room by her son, who suspected
she had suffered a stroke the previous night. Subsequent examination revealed spastic
hemiplegia on the left side with hyperreflexia and a positive Babinski’s sign. The left side of the
patient’s face was paralyzed below the eye, and the right eye was turned out and down. The
right pupil made direct and consensual responses to light, but the left pupil was fixed and
unresponsive. There were no apparent sensory deficits. Which is the most likely location of the
lesion?
A Left motor cortex
B Right sensory cortex
C Right midbrain
D Left thalamus
E Right thalamus
Y138. During surgery to repair a strangulated inguinal hernia, it is discovered that the left
testicular vein is thrombosed and must be repaired. The left testicular vein normally drains into
which of the following?
A inferior vena cava
B left renal vein
C right common iliac vein
D right femoral vein
E right renal vein
Y139. A 79-year-old man was brought to the emergency room because his family was worried
that he suddenly was not using his right arm and leg and seemed to have a simultaneous
behavior change. He was unable to write a reminder note to himself, even with his left hand, and
he put his shoes on the wrong feet. A neurologist was called to the emergency room to examine
the patient. A loud bruit was heard with a stethoscope over the left carotid artery in his neck.
When asked to show the neurologist his left hand, he pointed to his right hand, since it could not
move. The neurologist asked him to add numbers, and he was unable to do this, despite having
spent his life as a bookkeeper. The patient was unable to name the fingers on either hand, and
he could not form any semblance of a letter using his left hand. The patient’s eyes did not blink
when the neurologist waved his hands close to them in the left temporal and right nasal visual
fields. The right lower two-thirds of his face drooped. There was some asymmetry of his reflexes
between the right and left sides, and there was a positive Babinski’s response of his right toe.
Assuming that the patient had a stroke, which of the following arteries has become occluded?
A Left anterior cerebral
B Right anterior cerebral
C Right middle cerebral
D Left middle cerebral
E Left posterior cerebral
Y140. A 67-year-old man is found on rectal examination to have a single, hard, irregular nodule
within his prostate. A biopsy of this lesion reveals the presence of small glands lined by a single
layer of cells with enlarged, prominent nucleoli. From what portion of the prostate did this lesion
most likely originate?
A Anterior zone
B Central zone
C Peripheral zone
D Periurethral glands
E
Transition zone
Y141. A mammogram of a woman, age 48, reveals macrocalcification within the right breast,
indicating the need for biopsy. The surgeon visually and manually examines the breast with
negative results. The surgeon closely examines the nipple for indications of ductal carcinoma. At
surgery for the biopsy, a locator needle is inserted into the region of macrocalcification and the
position confirmed by mammography. The surgeon incises the skin and dissects a block of tissue.
The pathology report indicates ductal carcinoma with microinvasion necessitating surgery. Both
patient and surgeon agree that a modified radical mastectomy offers the best prognosis in her
case. At surgery for mastectomy, the surgeon carries the dissection along the major pathway of
lymphatic drainage from the mammary gland. The major lymphatic channels parallel which of
the following?
A Subcutaneous venous networks to the contralateral breast and abdominal wall
B Tributaries of the axillary vessels to the axillary nodes
C Tributaries of the intercostal vessels to the parasternal nodes
D Tributaries of the internal thoracic (mammary) vessels to the parasternal nodes
E Tributaries of the thoracoacromial vessels to the apical (subscapular) nodes
Y142. An 18-year-old male is shot in the back and is taken to the emergency room. A
neurological examination reveals that there was a hemisection of the right half of the spinal cord
that extended from T8 to T12. Which of the following deficits will most likely result from this
injury?
A Loss of pain and temperature sensation from the right leg; loss of conscious proprioception
from the left leg; UMN paralysis of the left leg
B Loss of pain and temperature sensation from the left leg; loss of conscious proprioception
from the right leg; UMN paralysis of the left leg
C Loss of pain and temperature sensation from the left arm and leg; loss of conscious
proprioception from the right leg and arm; flaccid paralysis of the right leg
D Loss of pain and temperature sensation from the left leg; loss of conscious proprioception
from the right leg; UMN paralysis of the right leg
E Bilateral loss of pain and temperature sensation and conscious proprioception, both from the
lower half of the body; UMN paralysis of the left leg and flaccid paralysis of the right leg
Y143. An investigator sought to determine the primary neuronal target structure in the brain
which receives inputs from the inferior olivary nucleus. In order to complete this study, the
investigator microinjected a tracer substance into the inferior olivary nucleus which was then
transported from the cell bodies in the inferior olivary nucleus down the axons to their target
structures. Which of the following structures would contain the tracer substance indicating that
it constitutes a principal projection target of the inferior olivary nucleus?
A Cerebral cortex
B Midbrain periaqueductal gray
C Vestibular nuclei
D Dorsal column nuclei
E Cerebellar cortex
Y144. When examining a 48-year-old woman for the first time at a free clinic her physician notes
that she is quite slender with prominent veins both on her anterior abdominal wall and her nose.
Abdominal palpation reveals a fairly large firm organ that extends well below the right costal
margin during both inspiration and expiration. There is no abdominal tenderness. Which one of
the following is the most likely explanation for your physical findings?
A Splenomegaly
B Hepatomegaly
C Appendicitis
D Cholecystitis
E Abdominal aortic aneurysm
Y145. A 42-year-old slightly overweight woman presents to her primary care physician
complaining of recent blood in her stool. She has no fever and feels well otherwise. She generally
has one or two bowel movements daily with no change in frequency or consistency. She
describes an absence of painful hemorrhoids and no pain on defecation. Prior to examining the
patient what should be her physician's list of potential causes of blood in the stool?
A Diverticulitis and colorectal cancer
B Diverticulitis and internal hemorrhoids
C Diverticulosis and external hemorrhoids
D External hemorrhoids and fissures, and diverticulitis
E Diverticulosis, internal hemorrhoids, and colorectal cancer
KEY:
1.A 2.D 3.D 4.C 5.C 6.A 7.C 8.C 9.A 10.B 11.D 12.D 13.A 14.A
15.D 16.D 17.B 18.E 19.D 20.A 21.C 22.B 23.B 24.B 25.B 26.A 27.E 28.B
29.A 30.C 31.A 32.D 33.A 34.B 35.C 36.B 37.B 38.A 39.C 40.C 41.D 42.B
43.A 44.C 45.D 46.B 47.D 48.C 49.C 50.E 51.B 52.E 53.B 54.C 55.C 56.C
57.D 58.A 59.D 60.B 61.D 62.A 63.C 64.D 65.C 66.E 67.C 68.A 69.C 70.D
71.C 72.C 73.C 74.C 75.C 76.C 77.A 78.A 79.D 80.A 81.B 82.B 83.C 84.A
85.A 86.B 87.B 88.C 89.D 90.C 91.D 92.B 93.B 94.B 95.C 96.D 97.C 98.D
99.C 100.A 101.E 102.D 103.C 104.C 105.B 106.D 107.B 108.D 109.A 110.D
111.D 112.A 113.D 114.C
115.A 116.D 117.C 118.B 119.C 120.E 121.C 122.C
123.C 124.C 125.C 126.B 127.C 128.D 129.A 130.D 131.B 132.B 133.B 134.C
135.B 136.B 137.C 138.B 139.D 140.C
141.B 142.D 143.E 144.B 145.E