neuroanatomy 3rd Comprehensive Examination 145 - 189

Question 1

145. Thalamus

Answer 1

145-D. The thalamus.

Question 2

146. Internal capsule

Answer 2

146-E. The anterior limb of the internal capsule

Question 3

147. Putamen

Answer 3

147-B. The putamen.

Question 4

148. Caudate nucleus

Answer 4

148-A. The head of the caudate nucleus.

Question 5

149. Splenium

Answer 5

149-C. The splenium of the corpus callosum.

Question 6

Questions 150-154
Match the descriptions in items 150-154 with the appropriate lettered structure shown in the
magnetic resonance image (MRI) of the axial section of the brain.

150. Medial geniculate body

Answer 6

150-C. The medial geniculate body.

Question 7

Questions 150-154
Match the descriptions in items 150-154 with the appropriate lettered structure shown in the
magnetic resonance image (MRI) of the axial section of the brain.

151. Mesencephalon

Answer 7

151-B. The mesencephalon.

Question 8

Questions 150-154
Match the descriptions in items 150-154 with the appropriate lettered structure shown in the
magnetic resonance image (MRI) of the axial section of the brain.

152. Mamillary body

Answer 8

152-D. The mamillary body.

Question 9

Questions 150-154
Match the descriptions in items 150-154 with the appropriate lettered structure shown in the
magnetic resonance image (MRI) of the axial section of the brain.

153. Optic tract

Answer 9

153-E. The optic tract.

Question 10

Questions 150-154
Match the descriptions in items 150-154 with the appropriate lettered structure shown in the
magnetic resonance image (MRI) of the axial section of the brain.

154. Amygdala

Answer 10

154-A. The amygdala (amygdaloid nuclear complex).

Question 11

Questions 155-159
Match the descriptions in items 155-159 with the appropriate letter shown in the magnetic res-
onance image (MRI) of the midsagittal section of the brain.

155. Pineal gland

Answer 11

155-C. The pineal gland (epiphysis).

Question 12

Questions 155-159
Match the descriptions in items 155-159 with the appropriate letter shown in the magnetic res-
onance image (MRI) of the midsagittal section of the brain.

156. Hypophysis

Answer 12

156-E. The hypophysis (pituitary gland).

Question 13

Questions 155-159
Match the descriptions in items 155-159 with the appropriate letter shown in the magnetic res-
onance image (MRI) of the midsagittal section of the brain.

157. Mesencephalon

Answer 13

157-D. The mesencephalon (midbrain).

Question 14

Questions 155-159
Match the descriptions in items 155-159 with the appropriate letter shown in the magnetic res-
onance image (MRI) of the midsagittal section of the brain.

158. Thalamus

Answer 14

158-B. The thalamus.

Question 15

Questions 155-159
Match the descriptions in items 155-159 with the appropriate letter shown in the magnetic res-
onance image (MRI) of the midsagittal section of the brain.

159. Fornix

Answer 15

159-A. The fornix.

Question 16

Questions 160-169
Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure

160. right third-nerve palsy

Answer 16

160-J. A right third-nerve palsy with complete ptosis. The ptosis results from paralysis of the
levator palpebrae muscle.

Question 17

Questions 160-169
Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure.

161. Destructive lesion of the right frontal
     lobe

Answer 17

161-1. A destructive lesion of the frontal eye fields results in a deviation of the eyes toward the
lesion. An irritative lesion results in deviation of the eyes away from the lesion

Question 18

Questions 160-169
Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure.

162. Argyll Robertson pupil

Answer 18

162-H. The Argyll Robertson pupil is characterized by irregular miotic pupils that do not re-
spond to light, but do converge in response to accommodation. It is a sign of tertiary syphilis.

Question 19

Questions 160-169
Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure.

163. Right fourth-nerve palsy

Answer 19

163-G. Aright fourth-nerve palsy is characterized by the inability of the patient to depress the
glove from the adducted position.

Question 20

Questions 160-169
Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure.

164. Parinaud syndrome

Answer 20

164-F. Parinaud syndrome is characterized by the inability to perform upward or downward
conjugate gaze and may be associated with ptosis and pupillary abnormalities.

Question 21

Questions 160-169
Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure.

165. Right sixth-nerve palsy

Answer 21

165-E. Aright sixth-nerve palsy is characterized by the inability to abduct the eye.

Question 22

Questions 160-169
Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure.

166. Left third-nerve palsy

Answer 22

166-D. A third-nerve palsy is characterized by a down-and-out eye, a complete ptosis, and a di-
lated (blown) pupil. The lid was retracted to view the pupil.

Question 23

• Questions 160-169

Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure.

167. Internuclear ophthalmoplegia (INO)

Answer 23

167-C. Internuclear ophthalmoplegia (INO) results from a lesion of one or both medial longitu-
 dinal fasciculi (MLFs). Transection of the right MLF results in a medial rectus palsy on attempted
 lateral gaze to the left. Convergence is normal, and nystagmus is seen in the abducting eye.

Question 24

Questions 160-169
Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure.

168. Horner syndrome

Answer 24

168-B. Horner syndrome consists of miosis, mild ptosis, hemianhidrosis, and enophthalmos. It
results from a loss of sympathetic input to the head

Question 25

Questions 160-169 Match the descriptions in items 160-169 with the appropriate diagnoses shown in the figure. 169. Retrobulbar neuritis

Answer 25

169-A. Retrobulbar neuritis is an inflammation of the optic nerve that reduces the light-carrying ability of the nerve. This condition can be diagnosed by the swinging flashlight test. Light shown into the normal eye results in constriction of both pupils. Swinging the flashlight to the affected eye results in a dilated pupil in both eyes. This pupil is called an afferent, or Marcus Gunn, pupil.

Question 26

Questions 170-174 The response options for items 170—174 are the same. You will be required to select one answer for each item in the set. (A) Diabetes insipidus (B) Hyperthermia (C) Hyperphagia and savage behavior (D) Inability to thermoregulate (E) Anorexia Match each defect below with the condition it best describes. 170. Bilateral lesions of the ventromedial hy- pothalamic nucleus

Answer 26

170-C. A bilateral lesion of the ventromedial hypothalamic nucleus results in hyperphagia and savage behavior.

Question 27

Questions 170-174 The response options for items 170—174 are the same. You will be required to select one answer for each item in the set. (A) Diabetes insipidus (B) Hyperthermia (C) Hyperphagia and savage behavior (D) Inability to thermoregulate (E) Anorexia Match each defect below with the condition it best describes 171. Bilateral lesions of the posterior hypothal- amic nuclei

Answer 27

171-D. A bilateral lesion of the posterior hypothalamic nucleus results in the inability to ther- moregulate (poikilothermia). Bilateral destruction of only the posterior aspect of the lateral hy- pothalamic nucleus results in anorexia and emaciation.

Question 28

Questions 170-174 The response options for items 170—174 are the same. You will be required to select one answer for each item in the set. (A) Diabetes insipidus (B) Hyperthermia (C) Hyperphagia and savage behavior (D) Inability to thermoregulate (E) Anorexia Match each defect below with the condition it best describes. 172. Lesions involving the supraoptic and para- ventricular nuclei

Answer 28

172-A. Lesions involving the supraoptic and paraventricular nuclei or the supraopticohy- pophyseal tract result in diabetes insipidus with polydipsia and polyuria.

Question 29

Questions 170-174 The response options for items 170—174 are the same. You will be required to select one answer for each item in the set. (A) Diabetes insipidus (B) Hyperthermia (C) Hyperphagia and savage behavior (D) Inability to thermoregulate (E) Anorexia Match each defect below with the condition it best describes. 173. Destruction of the anterior hypothalamic nuclei

Answer 29

173-B. Destruction of the anterior hypothalamic nuclei results in hyperthermia.

Question 30

Questions 170-174 The response options for items 170—174 are the same. You will be required to select one answer for each item in the set. (A) Diabetes insipidus (B) Hyperthermia (C) Hyperphagia and savage behavior (D) Inability to thermoregulate (E) Anorexia Match each defect below with the condition it best describes. 174. Stimulation of the ventromedial nuclei

Answer 30

174-E. Stimulation of the ventromedial nuclei (VMNs) inhibits the urge to eat, resulting in ema- ciation (cachexia). Destruction of the VMNs results in hyperphagia and savage behavior.

Question 31

Questions 175-182 Match the descriptions in items 175-182 with the appropriate lettered structure in the figure 175. Stimulation of this area results in turn- ing the eyes and head to the contralateral side

Answer 31

175-H. Stimulation of the frontal eye field (Brodmann area 8) results in turning of the eyes and head to the contralateral side.

Question 32

Questions 175-182 Match the descriptions in items 175-182 with the appropriate lettered structure in the figure 176. A lesion here results in nonfluent, effort- ful, telegraphic speech

Answer 32

176-G. A lesion of the Broca speech area (Brodmann areas 44, 45) results in nonfluent, effort- ful, and telegraphic speech, as well as Broca aphasia.

Question 33

177. Ablation in this area results in a con- tralateral upper homonymous quadrantanopia

Answer 33

177-F. Ablation of the anterior one-third of the temporal lobe interrupts the loop of Meyer, which projects to the lingual gyrus (the lower bank of the calcarine fissure). The lower bank of the cal- carine fissure represents the upper visual field. This lesion results in a contralateral upper homonymous quadrantanopia—"pie in the sky."

Question 34

178. A lesion here results in fluent speech with paraphrasic errors (e.g., non sequiturs, neolo- gisms, driveling speech)

Answer 34

178-E. A lesion destroying the Wernicke area (Brodmann 22) is called Wernicke aphasia, which is characterized by poor comprehension, fluent speech, poor repetition, and paraphasic errors [non sequiturs, neologisms, and driveling speech (meaningless double talk)].

Question 35

179. A lesion of this area is characterized by finger agnosia, dyscalculia, dysgraphia, and dyslexia

Answer 35

179-D. This constellation of dominant hemispheric deficits results from destruction of the an- gular gyrus (Brodmann area 39). Called Gerstmann syndrome, it is characterized by left-right confusion, finger agnosia, dyslexia, dysgraphia, dyscalculia, and a homonymous contralateral lower quadrantanopia.

Question 36

180. Destruction of this area results in an aphasia characterized by fluent speech, good comprehension, and poor repetition

Answer 36

180-C. A lesion of the supramarginal gyrus (Brodmann area 40) or of the arcuate fasciculus re- sults in a conduction aphasia characterized by fluent speech, good comprehension, poor repeti- tion, and paraphrasic speech (fluently spoken jargon-like Wernicke aphasia) and writing.

Question 37

181. Lesions in this gyrus result in contralat- eral astereognosis

Answer 37

181-B. Lesions of the postcentral gyrus, sensory strip, Brodmann area 3, 1, 2) result in con- tralateral astereognosia, hemihypesthesia, and agraphesthesia.

Question 38

182. Lesions in this gyrus result in contralat- eral spasticity

Answer 38

182-A. Lesions of the precentral gyrus, motor strip, (Brodmann area 4) result in contralateral spastic hemiparesis with pyramidal signs.

Question 39

183. In thiamine (vitamin B^) deficiency, hem orrhagic lesions are found in this structure

Answer 39

183-G. In thiamine (vitamin Bt) deficiency, hemorrhagic lesions are found in the mamillary bodies.

Question 40

184. Bilateral lesions in this structure result in hyperphagia, hypersexuality, and psychic blindness (visual agnosia)

Answer 40

184-F. Bilateral lesions of the amygdala result in Kliiver-Bucy syndrome, with hyperphagia, hy- persexuality, and psychic blindness (visual agnosia).

Question 41

185. Infarction (due to cardiac arrest) of this area results in short-term memory loss

Answer 41

185-E. Bilateral damage to the parahippocampal gyri and the underlying hippocampal forma- tion results in severe loss of short term memory (e.g., hypoxia, hypoxemia, and herpes simplex virus encephalitis).

Question 42

186. Lesions of this area result in a lower homonymous quadrantanopia

Answer 42

186-D. Lesions of the cuneus interrupt the visual radiations en route to the upper bank of the calcarine fissure, which represents the inferior visual field quadrants.

Question 43

187. Bilateral transection of this structure may result in the acute amnestic syndrome

Answer 43

187-C. The fornix (a limbic structure) interconnects the septal area and the hippocampal for- mation. Bilateral transection of this structure may result in an acute amnestic syndrome.

Question 44

188. Lesion of this area results in a contralat- eral extensor plantar reflex and ankle clonus

Answer 44

188-B. The motor strip for the foot is in the anterior paracentral lobule on the medial aspect of the hemisphere. A lesion here results in a contralateral hemiparesis of the foot and leg with pyra- midal signs.

Question 45

189. Ablation of this area may result in akine- sia, mutism, apathy, and indifference to pain

Answer 45

189-A. Ablation of the cingulate gyrus (cingulectomies) has been used to treat psychotic and neurotic patients.