Formative

Question 1

Telencephalic dysgenesis is an extremely rare congenital disorder characterised by abnormal development of the telencephalon. Which brain structure might be affected?

• Cerebral cortex
• Hypothalamus
• Medulla
• Midbrain
• Thalamus

Answer 1

cerebral cortex

Question 2

While examining a patient who is awaiting resection of a brain tumour, you notice that they have a left homonymous superior quadrantanopia. You speak to the consultant looking after the patient who informs you that this has been caused by the tumour. Where is the tumour?

• Left parietal lobe
• Left temporal lobe
• Right occipital lobe
• Right parietal lobe
• Right temporal lobe

Answer 2

Right temporal lobe

think: PITS

PI= parietal and inferior radiation

TS= temporal and superior radiation

Question 3

Internuclear ophthalmoplegia is a disorder caused by damage to the medial longitudinal fasciculus. Which symptom are patients with this condition most likely to experience?

• Blurred vision
• Diplopia
• Eye pain
• Glare
• Monocular blindness

Answer 3

diplopia

is an ocular movement disorder caused by a lesion of the medial longitudinal fasciculus. It is characterized by impaired adduction of the ipsilateral eye with nystagmus of the abducting eye

Question 4

is an ocular movement disorder caused by a lesion of the medial longitudinal fasciculus. [1] It is characterized by impaired adduction of the ipsilateral eye with nystagmus of the abducting eye

Which part of the ventricular system is the pointer indicating?

• Cerebral aqueduct
• Foramen of Magendie (median aperture)
• Fourth ventricle
• Interventricular foramen
• Lateral ventricle

Answer 4

fourth ventricle

Question 5

Look at the image, which is a superior view of the cerebral circulation, with anterior towards the top and posterior towards the bottom.

Occlusion of which vessel might lead to damage to the medial portion of the frontal lobe?

A
B
C

D

E

Answer 5

A

Question 6

Which vessel would supply blood to a tumour that was growing in the occipital lobe?

A

B

C

D

E

Answer 6

D

Question 7

Occlusion of the branches of which vessel might lead to damage to the internal capsule?

A

B

C

D

E

Answer 7

B

MCA- Lentriculostriatal arteries

Question 8

Occlusion of which vessel could lead to damage to the cerebral peduncles?

A

B

C

D

E

Answer 8

PCA supplies the midbrain

Question 10

Occlusion of which vessel might lead to anterior (spinal) cord syndrome?

A

B

C

D

E

Answer 10

E- Vertebral

Question 11

Which of the following is not important in the maintenance of balance?

Cranial nerve VIII

Dorsal columns

Semicircular canals

Spinothalamic tracts

Visual cues

Answer 11

D- Spinothalamic tracts

Question 12

Mrs RS is a 68 year old woman who has a widely dilated pupil on one side. In which one of the following is the problem likely to be?

The carotid sheath

The cervical sympathetic chain

The oculomotor nerve

The ophthalmic division of the trigeminal nerve

The upper thoracic dorsal roots

Answer 12

The oculomotor nerve

Question 13

Through which one of the following do nerve fibres conveying the sense of smell from the nose, pass into the skull?

Cribriformplate

Foramenmagnum

Foramen ovale

Fossa ovalis

Jugular foramen

Answer 13

Cribriformplate

Question 14

Which one of the following is true of the facial nerve?

A. Supplies the anterior belly of the digastric muscle

B. Contains taste fibres from the posterior third of the tongue x

C. Is purely sensory in the face

D. Leaves the skull through the stylomastoid foramen

E. Contains parasympathetic nerve fibres which innervate the dilator pupillae

Answer 14

D

Leaves the skull through the stylomastoid foramen

Question 15

Mrs T W is an 82 year old woman who has been admitted with a bed sore on her buttocks. Curiously she seems to have had no pain from this and on testing you find absent sensation on both buttocks and lower limb weakness. Where is the most likely site of the problem?

Caudaequina

Precentralgyrus

Sacral nerves

Spinothalamic tracts

Thalamus

Answer 15

Caudaequina

Question 16

Mr K P is a 76 year old man who presents with difficulty in speech articulation. On examination the muscles on the right side of the tongue are wasted and he is unable to move the tongue on that side. Where is the lesion most likely to lie?

Right facial nerve

Right hypoglossal nerve

Right trigeminal nerve

Right vagus nerve nucleus

The left cerebral cortex

Answer 16

Right hypoglossal nerve

LICK YOUR WOUND

Question 17

16.Mrs R F aged 55 has subacute combined degeneration of the cord, a condition caused by vitamin B12 deficiency and involving, amongst other parts, the dorsal columns of the cord. What physical findings would you expect as a consequence of this damage?

• Disturbance of bladder function
• Impaired vibration sense in the feet
• Muscle wasting of the legs
• Postural hypotension
• Reduced pain sensation in the legs

Answer 17

Impaired vibration sense in the feet- dorsal column modality

Question 18

Mr X presents to the emergency department after presenting with headaches and weight loss. He undergoes a CT scan of his head which reveals a small tumour compressing the primary sensory cortex representing the lower limbs. Where is the tumour most likely to be found?

a. Lateral aspect of frontal lobe
b. Medial aspect of frontal lobe
c. Occipital lobe
d. Lateral aspect of parietal lobe
e. Medial aspect of parietal lobe

Answer 18

e. Medial aspect of parietal lobe

Question 19

Which of the following connects the lateral ventricles to the third ventricle?

a. Interventricular foramen
b. Foramen of Magendie
c. Foramen of Luschka
d. Aqueduct of Sylvius
e. Central canal

Answer 19

interventricular foramen (also known as Monroe)

CSF drainage into subarachnoid space:

• foramen of magendie - medial
• foramen of luschka- lateral

Question 20

Which of the following cells play an important role in the brains’ immune response?

a. Astrocytes
b. Oligodendrocytes
c. Schwann cells
d. Microglia
e. Melanocytes

Answer 20

d. Microglia

Question 21

Mr Y has knocked his arm on the side of a table. It is immediately painful. Mrs Y suggests that he rubs his arm to reduce the pain. Using the gate theory of pain, which of the following is the best explanation for why this reduces pain?

a. Rubbing the painful area inhibits unmyelinated A fibres that carry nociceptive impulses
b. Rubbing the painful area activates mechanoreceptors that inhibits inhibitory interneurones in the spinal cord
c. Rubbing the painful area activates mechanoreceptors that excites inhibitory interneurones in the spinal cord
d. Rubbing the painful area stimulates the release of central endorphins that reduce pain
e. Rubbing the painful area reduces the inflammatory response to the local area

Answer 21

c. Rubbing the painful area activates mechanoreceptors that excites inhibitory interneurones in the spinal cord

Question 22

A 56 year old woman with metastatic breast cancer presents to her GP with ‘numbness’ affecting her legs. Examination of the lower limbs reveals that she has normal perception of light touch, two point discrimination and vibration sense down to the level of the mid thigh on the left side, however pain and temperature sensation are absent from all of her foot and the anterolateral leg on the right side. The GP suspects that she has a metastasis in her spinal cord.

In terms of spinal cord segments, what is the neural level (i.e. lowest level of normal function) with respect to dorsal column and spinothalamic tract modalities? (2 marks)

Answer 22

DL- L2

ST- L5

Question 23

A 56 year old woman with metastatic breast cancer presents to her GP with ‘numbness’ affecting her legs. Examination of the lower limbs reveals that she has normal perception of light touch, two point discrimination and vibration sense down to the level of the mid thigh on the left side, however pain and temperature sensation are absent from all of her foot and the anterolateral leg on the right side. The GP suspects that she has a metastasis in her spinal cord.

Explain why she has dissociated sensory loss in her lower limbs (i.e. different modalities affected in each lower limb)

Answer 23

Question 24

A 56 year old woman with metastatic breast cancer presents to her GP with ‘numbness’ affecting her legs. Examination of the lower limbs reveals that she has normal perception of light touch, two point discrimination and vibration sense down to the level of the mid thigh on the left side, however pain and temperature sensation are absent from all of her foot and the anterolateral leg on the right side. The GP suspects that she has a metastasis in her spinal cord.

Explain why there is a difference in the neural levels relating to each set of modalities (2 marks)

Answer 24

Question 25

A 56 year old woman with metastatic breast cancer presents to her GP with ‘numbness’ affecting her legs. Examination of the lower limbs reveals that she has normal perception of light touch, two point discrimination and vibration sense down to the level of the mid thigh on the left side, however pain and temperature sensation are absent from all of her foot and the anterolateral leg on the right side. The GP suspects that she has a metastasis in her spinal cord.

Examination of the motor system reveals that the patient has upper motor neurone signs in the distal portion of one of her legs.

Which leg will display upper motor neurone signs? (1 mark)

Answer 25

left leg

Question 26

A 56 year old woman with metastatic breast cancer presents to her GP with ‘numbness’ affecting her legs. Examination of the lower limbs reveals that she has normal perception of light touch, two point discrimination and vibration sense down to the level of the mid thigh on the left side, however pain and temperature sensation are absent from all of her foot and the anterolateral leg on the right side. The GP suspects that she has a metastasis in her spinal cord.

Examination of the motor system reveals that the patient has upper motor neurone signs in the distal portion of one of her legs.

Which pathway in the spinal cord has been interrupted to cause these UMN signs in the distal limb (1 mark)?

Answer 26

Lateral corticospinal tract

Question 27

Following a stroke, an 84 year old man has developed explosive involuntary movements of his right upper limb.

What is the clinical term for this hyperkinetic movement disorder? (1 mark)

Answer 27

hemiballismus

Question 28

Following a stroke, an 84 year old man has developed explosive involuntary movements of his right upper limb.

This condition can be caused by damage to the subthalamic nucleus. Use the highlighted portion of the diagram below to explain why damage to the subthalamic nucleus can lead to increased movement. (4 marks)

Answer 28

Question 29

Following a stroke, an 84 year old man has developed explosive involuntary movements of his right upper limb.

There is a subthalamic nucleus on each side, communicating with the motor cortex in the same way as the rest of the basal ganglia. Which subthalamic nucleus was destroyed by the man’s stroke? Explain your answer (3 marks)

Answer 29

Question 30

Following a stroke, an 84 year old man has developed explosive involuntary movements of his right upper limb.

After seeing a neurologist, the man is recruited into a clinical trial looking at the use of deep brain stimulation (DBS) for his movement disorder. Referring to the highlighted region of the diagram above, increasing the activity of which nucleus by deep brain stimulation might improve his symptoms? Explain your answer. (2 marks)

Answer 30