Neurophysiology and Regional Brain Syndromes

Question 1

The blood–brain barrier is present in which of the following areas?
● A. Choroid plexus
● B. Hypophysis
● C. Tuber cinereum
● D. Area postrema
● E. Brain stem

Answer 1

E. Brain stem

Question 2

According to classical model of language and speech function, conduction aphasia is caused by a damage to which of the following?
● A. Brodmann’s area 39
● B. Brodmann’s area 40
● C. Broca’s area
● D. Wernicke’s area
● E. Arcuate fasciculus

Answer 2

E. Arcuate fasciculus

Question 2

In head injury, the blood–brain barrier is closed; therefore, there is no protein extravasation and no enhancement on CT or MRI. The cells swell and then shrink. What kind of cerebral edema is this?
● A. Cytotoxic
● B. Vasogenic
● C. Vasospastic
● D. Ischemic
● E. Mixed

Answer 2

A. Cytotoxic

Question 3

The afferent limb of the plantar reflex originates in cutaneous receptors restricted to which dermatome?
● A. L1
● B. L4
● C. L5
● D. S1
● E. S2

Answer 3

D. S1

Question 4

In a patient with suspected stroke, the plantar reflex could not be elicited by stimulation of the lateral plantar surface and transverse arch in a single movement, so the examiner pinched the Achilles tendon to elicit the plantar response. What is this
maneuver called?
● A. Chaddok
● B. Schaeffer
● C. Oppenheim
● D. Gordon
● E. Bing

Answer 4

B. Schaeffer

Question 5

Where does the primary coordinating center for bladder function reside within the pons?
● A. Nucleus locus coeruleus
● B. Nucleus V
● C. Area postrema
● D. Lateral medullary nucleus
● E. Medial medullary nucleus

Answer 5

A. Nucleus locus coeruleus

Question 6

Hoffman’s sign is elicited by flicking downward on the nail of the middle or ring finger: a positive (pathologic) response consists of involuntary flexion of the adjacent fingers and/or thumb. It is monosynaptic (synapse in Rexed lamina IX) and indicates a lesion above what?
● A. C3
● B. C5
● C. C8
● D. T1
● E. T3

Answer 6

C. C8

Question 7

The detrusor muscle of the bladder contracts and the internal sphincter relaxes under parasympathetic stimulation; the
preganglionic cell bodies reside in the intermediolateral gray of which spinal cord segments?
● A. T2–T10
● B. T10–T12
● C. L1–L3
● D. L2–L4
● E. S2–S4

Answer 7

E. S2–S4

Question 8

Regarding bladder physiology, sympathetic cell bodies lie within the intermediolateral gray column of lumbar spinal cord segments T12–L2. Preganglionic axons pass through the sympathetic chain (without synapsing) to the inferior mesenteric ganglion. Detrusor smooth muscle relaxation during bladder filling and storage is carried out by stimulation of which of the following?
● A. Alpha 1
● B. Alpha 2
● C. Beta 1
● D. Beta 2
● E. Beta 3

Answer 8

E. Beta 3

Question 9

A patient presented with urinary frequency, urgency, incontinence, and nocturia. Urodynamic findings showed detrusor overactivity (DO) without detrusor sphincter dyssynergia (DSD). What is the level of lesion?
● A. Supraspinal
● B. Suprasacral during spinal shock
● C. Suprasacral after resolution of spinal shock
● D. Infrasacral
● E. Systemic, e.g., diabetes

Answer 9

A. Supraspinal

Question 10

What is the cut off value of bladder pressure for safe storage?
● A. < 40 cm H2O
● B. < 60 cm H2O
● C. < 80 cm H2O
● D. < 100 cm H2O
● E. < 120 cm H2O

Answer 10

A. < 40 cm H2O

Question 11

Tamsulosin is a prostate alpha1A adrenoreceptor antagonist. What is the initial usual adult daily dose?
● A. 0.1 mg
● B. 0.4 mg
● C. 1 mg
● D. 2 mg
● E. 4 mg

Answer 11

B. 0.4 mg

Question 12

Which of the following is a parietal lobe syndrome with a unilateral asomatognosia, anosognosia, apathy, allocheiria, dressing apraxia, and extinction and inattention to an entire visual field?
● A. Anton Babinski syndrome
● B. Foster Kennedy syndrome
● C. Parinaud’s syndrome
● D. Weber syndrome
● E. Gertsmann’s syndrome

Answer 12

A. Anton Babinski syndrome

Question 13

A patient presented with agraphia without alexia, left–right
confusion, digit agnosia and acalculia. This is typical for which
syndrome?
● A. Anton Babinski syndrome
● B. Foster Kennedy syndrome
● C. Parinaud’s syndrome
● D. Weber syndrome
● E. Gertsmann’s syndrome

Answer 13

E. Gertsmann’s syndrome

Question 14

Which of the following is cranial nerve III palsy with contralateral hemiparesis?
● A. Anton Babinski syndrome
● B. Foster Kennedy syndrome
● C. Parinaud’s syndrome
● D. Weber syndrome
● E. Gertsmann’s syndrome

Answer 14

D. Weber syndrome

Question 15

Which syndrome is usually associated with olfactory groove or medial third sphenoid wing tumor and presents with the classic triad of ipsilateral anosmia, ipsilateral central scotoma, and contralateral papilledema?
● A. Anton Babinski syndrome
● B. Foster Kennedy syndrome
● C. Parinaud’s syndrome
● D. Weber syndrome
● E. Benedikt’s syndrome

Answer 15

B. Foster Kennedy syndrome

Question 16

Pars vascularis is the larger posterolateral compartment of jugular foramen and it contains which of the following?
● A. Vagus nerve
● B. Glossopharyngeal nerve
● C. Branching Jacobson’s nerve
● D. Inferior petrosal sinus
● E. Meningeal branch of the ascending pharyngeal artery

Answer 16

A. Vagus nerve

Question 16

After resection of a posterior fossa brain tumor, a child presented with speechlessness, ataxia, hypotonia, and irritability along with cranial nerve deficits, neurobehavioral changes, and urinary incontinence. What syndrome is this?
● A. Cerebellar mutism syndrome
● B. Posterior fossa syndrome
● C. Jugular foramen syndrome
● D. Cerebellar syndrome
● E. Fourth ventricle syndrome

Answer 16

B. Posterior fossa syndrome

Question 17

Which of the following is a jugular foramen syndrome with palsies of cranial nerves IX, X, XI, and XII without sympathetic involvement?
● A. Collet-Sicard syndrome
● B. Villaret’s syndrome
● C. Tapia syndrome
● D. (Hughlings) Jackson’s syndrome
● E. Schmidt’s syndrome

Answer 17

A. Collet-Sicard syndrome

Question 17

Which of the following is a jugular foramen syndrome with palsies of cranial nerves IX, X, XI, and XII with sympathetic involvement?
● A. Collet-Sicard syndrome
● B. Villaret’s syndrome
● C. Tapia syndrome
● D. (Hughlings) Jackson’s syndrome
● E. Schmidt’s syndrome

Answer 17

B. Villaret’s syndrome

Question 18

Blood–brain barrier (BBB) which is formed by the tight junctions (zona occludens) between cerebral capillary endothelial cells is absent in following areas of brain except?
● A. Area postrema and posterior eminence of hypothalamus
● B. Pineal gland and choroid plexus
● C. Tuber cinereum and preoptic recess
● D. Anterior pituitary (adenohypophysis)
● E. Posterior pituitary (neurohypophysis)

Answer 18

D. Anterior pituitary (adenohypophysis)

Question 19

A patient presented in OPD with tumor on brain MRI which showed marked perilesional edema. This edema is due to extravasation of protein because of blood–brain barrier disruption. What is this type of edema in this case of brain tumor called?
● A. Cytotoxic edema
● B. Vascular edema
● C. Vasogenic edema
● D. Ischemic edema
● E. Both B and C

Answer 19

C. Vasogenic edema

Question 20

A patient presents in neurosurgical OPD with complaint of fluent speech, and he/she is unable to understand speech of other people. This phenomenon is known as receptive aphasia. In which brain area this patient most likely has a lesion?
● A. Broca’s area
● B. Wernicke’s area
● C. At arcuate fasciculus
● D. Primary auditory area
● E. Areas of ventral and dorsal stream flow

Answer 20

B. Wernicke’s area

Question 21

Planter reflex also known as Babinski sign is a primitive reflex present in infancy usually up to 10 months. This reflex consists of extension of great toe in response to noxious stimulus applied to the planter aspect of foot. It is not present in adults in which one of the following conditions?
● A. Tumor in left frontal brain region
● B. Cervical spinal cord compression by prolapsed disk
● C. Tumor at L4–L5 spinal cord level
● D. Compression of thoracic spinal cord due to traumatic vertebral fracture
● E. L4–L5 spinal vertebral level disk

Answer 21

E. L4–L5 spinal vertebral level disk

Question 22

Hoffmann’s sign consists of involuntary flexion of adjacent finger and/or thumb on flicking downward on the nail of middle or ring finger. This sign is positive if lesion is found at which cord level?
● A. Above C5
● B. At or above C3
● C. Only at C8
● D. Only at C5 level
● E. Above C8 level

Answer 22

E. Above C8 level

Question 23

Primary coordinating center for bladder function resides within nucleus locus coeruleus. This area is supplied by inhibitory signals for voluntary cortical control of micturition from where?
● A. Anteromedial portion of frontal lobe
● B. Genu of corpus callosum
● C. Gyrus rectus
● D. Frontal lobe of brain
● E. Both A and B

Answer 23

E. Both A and B

Question 24

Gerstmann’s syndrome is because of lesion in the dominant parietal lobe. It consists of which of the following?
● A. Agraphia without alexia
● B. Left–right confusion
● C. Digit agnosia
● D. Acalculia
● E. All of the above

Answer 24

E. All of the above

Question 25

A patient presented in emergency with traumatic large herniated lumbar disk at L4–L5 vertebral level. This lesion can result in which of the following conditions?
● A. Detrusor overactivity (DO) without detrusor sphincter dysnergy (DSD)
● B. DO with DSD
● C. Only detrusor overactivity
● D. Detrusor areflexia with overflow incontinence
● E. None of the above

Answer 25

D. Detrusor areflexia with overflow incontinence

Question 26

Frontal eye field is located in the posterior frontal lobe and is Brodmann’s area 8. Destructive lesion in this area causes which of the following conditions?
● A. Impaired gaze to the contralateral side
● B. Causing gaze toward contralateral side
● C. Patient looks toward the side of lesion
● D. Patient looks away from the side of lesion
● E. Both A and C
● F. Both C and D

Answer 26

E. Both A and C

Question 27

Olfactory groove meningioma or medial sphenoid wing meningioma can cause “Foster Kennedy syndrome.” All of the following are the features of this syndrome except?
● A. Contralateral optic atrophy
● B. Ipsilateral anosmia
● C. Ipsilateral central scotoma
● D. Contralateral papilledema
● E. All of the above

Answer 27

A. Contralateral optic atrophy

Question 28

Speechlessness that develops following cerebellar injury is called as mutism with subsequent dysarthria. It is also known as what?
● A. Cerebellar mutism
● B. Cerebellar mutism syndrome
● C. Posterior fossa syndrome
● D. Cerebellar dysfunction
● E. Both A and B

Answer 28

A. Cerebellar mutism