Section 1

Question 1

All of the following are characteristics of Wallenberg’s syndrome, except
A. Ipsilateral Homer’s syndrome
B. Vertebral artery ocdusion
C. lpsilateral decreased pain and temperature in the body
D. Ipsilateral ataxia
E. lpsilateral decreased pain and temperature in the face

Answer 1

C. lpsilateral decreased pain and temperature in
the body

Wallenberg’s (lateral medullary) syndrome is
caused by vertebral a or PICA (posterior inferior
cerebellar artery) occlusion. The clinical picture is
ipsilateral except for pain and temperature in the
body, which is contralateral (ventral and lateral
spinothalamic tracts).

Question 2

Antibodies to presynaptic voltage-gated ca++ channels (VGCC), in patients with oat cell lung carcinoma are associated with
A. Stiff-man syndrome
B. Lambert-Eaton myasthenic syndrome
C. Myasthenia gravis
D. Anti-Hu antibodies
E. Anti-Yo antibodies

Answer 2

B. Lambert-Eaton myasthenic syndrome

Lambert-Eaton myasthenic syndrome is characterized by antibodies to presynaptic voltage-gated Ca++ channels (VGCC). Myasthenia gravis is caused by antibodies to nicotinic AChR (acetylcholine receptors) or MuSK (muscle-specific kinase). Anti-Hu is associated with lung cancer (oat cell carcinoma) and lymphoma. Anti-Yo is associated with ovarian and breast cancer. Stiff-man (Moersch-Woltman) (Stiff-person) syndrome is related to anti-GAD (glutamic add decarboxylase) is non-paraneoplastic, or anti-amphiphysin or anti-gephyrin which are paraneoplastic.

Question 3

Struthers ligament is associated with entrapment of
A. Median n at the elbow
B. Median n at the wrist
C. Ulnar n at the elbow
D. Ulnar n at the wrist
E. Radial n

Answer 3

A. Median n at the elbow

The ligament of Struthers can attach to a medial
supracondylar process of the humerus and cause
entrapment of the median n proximal to the elbow
joint. The arcade of Struthers (controversial) can be
associated with ulnar n entrapment at the elbow
and may cause recurrence after decompression.
The posterior interosseous n (PIN), a branch of the
radial nerve can be entrapped under the arcade of
Frohse.

Question 4

A 65-year-old male had transient aphasia and was found to have 75% ICA stenosis. The ideal treatment is
A. Observation and treatment of risk factors
B. Daily Aspirin 81 mg
C. Daily Aspirin 325 mg
D. IV heparin followed by oral Coumadin
E. Carotid endarterectomy

Answer 4

E. Carotid endarterectomy

According to NASCET (North American Carotid
Endarterectomy Trial), carotid endarterectomy
reduces the risk of stroke for symptomatic carotid
artery stenosis of >70%, from 26% to 9% at 2 years.

Question 5

The yearly risk of rupture of cerebral AVM is
A. 0-1%
B. 1-2%
C. 2-4%
D. 4-6%
E. 6-8%

Answer 5

C. 2-4%

The annual risk of rupture of cavemomas is
0.5-1%, aneurysms 1-2%, and AVMs 2-4%.

Question 6

All of the following statements are true regarding the cerebellar climbing fibers, except
A. They arise in the contralateral inferior olivary nucleus
B. They traverse the inferior cerebellar peduncle
C. They climb to the molecular layer
D. They synapse with the stellate and basket cells
E. They inhibit Purkinje cells

Answer 6

E. They inhibit Purkinje cells

The climbing (olivocerebellar) fibers are excitatory secreting glutamate. Also, mossy fibers and granule cells are excitatory. Purkinje cells are inhibitory.

Question 7

What is the typical location for endoscopic third ventriculostomy (E1V)?
A. Anterior to the optic chiasm
B. Between the chiasm and the pituitary infundibulum
C. Between the median eminence and the mammillary bodies
D. just posterior to the mammillary bodies
E. None of the above

Answer 7

C. Between the median eminence and the mammillary bodies

Endoscopic third ventriculostomy is performed
in the floor of the third ventricle between the
Mammillary bodies and the Median eminence.

Question 8

The most common location for a saccular brain aneurysm is
A. Anterior communicating a (ACOM)
B. Posterior communicating a (PCOM)
C. Middle cerebral a (MCA)
D. Basilar a tip
E. Posterior inferior cerebellar a (PICA)

Answer 8

A. Anterior communicating a (ACOM)

Incidence of saccular aneurysms of the brain:
ACOM:40%
PCOM:30%
MCA: 20%
Basilar: 8%
PICA: 2%

Question 9

A 25-year-old male presents with daily unilateral headache associated with rhinorrhea, lacrimation, and conjunctival injection. The most likely diagnosis is
A. Classic migraine
B. Migraine variant
C. Tension headache
D. Cluster headache
E. Pseudotumor cerebri

Answer 9

D. Cluster headache

Typical description of cluster headache: young adult male, unilateral headache, parasympathetic discharge causing lacrimation, rhinorrhea, and conjunctival injection. It occurs every day for weeks to months.

Question 10

In the following diagram the thalamostriate v is labeled
A. 1
B. 2
c. 3
D. 4
E. 5

Answer 10

B. 2

1. Septal v, 2. thalamostriate v, 3. internal
   cerebral v, 4. basal v of Rosenthal, 5. v of Galen, 6. straight sinus, 7. inferior sagittal sinus

Question 11

In the above diagram, the basal v of Rosenthal is labeled
A. 3
B. 4
c. 5
D. 6
E. 7

Answer 11

B. 4

1. Septal v, 2. thalamostriate v, 3. internal
   cerebral v, 4. basal v of Rosenthal, 5. v of Galen, 6. straight sinus, 7. inferior sagittal sinus

Question 12

The yearly ri5k of rupture of cavernous malformations of the brain is
A. 0.5- 1%
B. 1-2%
c. 2-4%
D. 4-6%
E. 6-8%

Answer 12

**A. 0.5- 1% **

The annual risk of rupture of cavernous malformations is 0.5-1%, aneurysms 1-2%, and AVMs 2-4%.

Question 13

Venous hypertension (Foix-Alajouanine syndrome) is found in which type( s) of spinal AVMs?
A. Type I
B. Type II
C. Type III
D. Type II and III
E. Type I and IV

Answer 13

Spinal AVMs types I and IV are high flow, low pressure, they present with venous hypertension;
while types II and III are high flow, high pressure,
they present with hemorrhage.

Question 14

Neurofibrillary tangles and neuritic plaques are histolagic reatures of
A. Huntington’s chorea
B. Pick’s disease
C. Alzheimer’s disease
D. Wilson’s disease
E. Parkinson’s disease

Answer 14

C. Alzheimer’s disease

Histologic characteristics of neurodegenerative diseases. Alzheimer’s: neurofibrillary tangles and neuritic plaques; Huntington’s: caudate atrophy; Pick’s: Pick bodies; Wilson’s: Opalski cells; and Parkinson’s: Lewy bodies.

Question 15

Which cranial nerves are involved in Collet-Sicard syndrome?
A. III and IV
B. V and VI
C. VII and VIII
D. IX, X, XI, and XII
E. None of the above combinations

Answer 15

D. IX, X, XI, and XII

Collet-Sicard syndrome is a unilateral lower
cranial nerves palsy (IX, X, XI, and XII) usually
caused by trauma or tumors.

Question 16

Parkinson’s disease is primarily caused by degeneration of cells in
A. Subthalamic nucleus
B. Substantia nigra
C. Corpus striatum
D. Globus pallidus externus
E. Globus pallidus internus

Answer 16

B. Substantia nigra

Parkinson’s disease is caused by failure of dopaminergic output from the substantia nigra pars
compacta to the corpus striatum. Hemiballismus is caused by lesions of the subthalamic nucleus.
Huntington’s chorea, manganese, and methanol
toxicity affect the striatum. Athetosis has involvement of the globus pallidus externus, while carbon monoxide and manganese affect the globus pallidus internus.

Question 17

Meralgia paresthetica causes pain and numbness in the
A. Medial thigh
B. Anterolateral thigh
C. Medial leg
D. Anterolateral leg
E. Sole of foot

Answer 17

B. Anterolateral thigh

Meralgia paresthetica is caused by entrapment or injury of the lateral femoral cutaneous n; it causes pain and numbness in the anterolateral thigh. The medial thigh is supplied by the ilioinguinal n, femoral n, and obturator n, medial leg by the saphenous n (a branch of the femoral n), anterolateral leg by the peroneal n, and the sole of the foot by the medial and lateral plantar nn (branches of the tibial).

Question 18

Hypsarrhythmiaon EEG occurs in which syndrome?
A. LeMax-Gastaut syndrome
B. Absence seizures
C. Grand mat epilepsy
D. Night terrors
E. West syndrome

Answer 18

E. West syndrome

West syndrome is characterized by hypsarrhythmia on EEG: large bilateral slow waves with multifocal spikes; Lennox-Gastaut: spike-dome 1-2 Hz; absence: spike-dome 3 Hz; juvenile myodonic epilepsy: spike-dome 4-6 Hz; grand mat: repetitive spikes up to 100 pV. Night terrors occur in stages 3 and 4 of non-REM sleep

Question 19

The main neurotransmitter of the climbing fibers is
A. Glutamate
B. GABA
C. Acetylcholine
D. 5-HT
E. Substance P

Answer 19

A. Glutamate

Climbing fibers consist of the olivocerebellar tract, which travels within the inferior cerebellar peduncle. Together with the granule cells, they synapse with Purkinje cell dendrites in the molecular cell layer, are excitatory, and secrete glutamate. Mossy fibers are also excitatory but end in the granular layer

Question 20

The proatlantal a
A. Is located between the occiput and Cl
B. Is located between Cl and C2
C. Passes through the hypoglossal canal
D. Is found in the internal auditory canal
E. Connects ICA to ECA

Answer 20

A. Is located between the occiput and Cl

The proatlantal a is an anastomosis between the vertebral a and either the internal or external carotid a (ICA or ECA); it travels between the occiput and Cl. The hypoglossal a connects the ICA to the basilar a and travels through the hypoglossal canal. The acoustic (otic) a connects the ICA to the basilar a through the internal auditory canal.

Question 21

Based on the ISUIA (International Study of Unruptured Intracranial Aneurysms), asymptomatic anterior circulation aneurysms should be treated if equal to or greater than
A. 2 mm
B. 3 mm
C. 5 mm
D. 7 mm
E. 10 mm

Answer 21

D. 7 mm

Based on the ISUIA study, the risk of rupture
of asymptomatic anterior circulation aneurysms,
excluding PCOM, <7 mm is very low.

Question 22

The risk of stroke after a TIA over 2 years, in patients with >70% carotid artery stenosis, is
A. 6%
B. 11%
C. 26%
D. 50%
E. 60%

Answer 22

C. 26%

Based on NASCET (North American Symptomatic Carotid Endarterectomy Trial), carotid endarterectomy reduces the risk of stroke from 26% to 9% over 2 years in symptomatic patients with
70-99% stenosis, or 50-69% in high risk patients.

Question 23

All of the following vessels contribute to the blood supply of the internal capsule, except
A. Anterior choroidal a
B. PCA
C. PCOM
D. Recurrent a of Heubner
E. Lateral lenticulostriate aa

Answer 23

B. PCA

The internal capsule is supplied by the anterior
choroidal, PCOM, Heubner, and lateral lenticulostriate aa. The PCA does not contribute to the blood supply of the internal capsule.

Question 24

Normal cerebral blood flow is
A. <8 mL/100 g/min
B. 8-23 mL/100 g/min
C. 24-49 mL/100 g/min
D. 50 mL/100 g/min
E. 51-100 mL/100 g/min

Answer 24

D. 50 mL/100 g/min

The normal cerebral blood flow is 50 mL/100 g/ min, with higher flow in the gray matter than the white matter. In the ischemic penumbra. it is 8-23 mL/100 g/min. The normal Oxygen consumption is 3.5 mL/100 g/min.

Question 25

Internudear ophthalmoplegia (INO) is associated with all of the following, except
A. Can be caused by multiple sderosis (MS)
B. ls caused by lesion of the ipsilateral medial longitudinal fasdculus (MLF)
C. Causes failure of adduction of the ipsilateral eye
D. Causes failure of abduction of the contralateral eye
E. Can be bilateral

Answer 25

D. Causes failure of abduction of the contralateral eye

INO causes failure of the ipsilateral eye to adduct due to a lesion of the MLF {medial longitudinal fasciculus). Failure to abduct is caused by VI n palsy and not INO.

Question 26

Incremental response of compound musde action potential (CMAP) is observed in
A. Myasthenia gravis
B. Lambert-Eaton myasthenic syndrome (LEMS)
C. Amyotrophic lateral sclerosis (ALS)
D. Myotonia congenita
E. Anti-Hu antibodies

Answer 26

B. Lambert-Eaton myasthenic syndrome (LEMS)

LEMS is caused by antibodies against presynaptic VGCC. It is associated with oat cell pulmonary
carcinoma and is characterized by incremental
response of CMAP.

Question 27

The daily production of cerebrospinal fluid (CSF) is about
A. 75 mL
B. 150 mL
C. 300 mL
D. 450 mL
E. 600 mL

Answer 27

D. 450 mL

The normal adult CSF volume is 150 mL, of which 30 mL is intraventricular, 40 ml spinal subarachnoid space, and 80 mL cranial subarachnoid space. The body produces 3 times the CSF volume per day { 450 mL).

Question 28

At the ischemic penumbra, the cerebral blood flow is
A. <8 mL/100 g/min
B. 8-23 mL/100 g/min
C. 24-49 mL/100 g/min
D. 50 mL/100 g/min
E. 51-100 mL/100 g/min

Answer 28

B. 8-23 mL/100 g/min

The ischemic penumbra is at 8-23 mL/100 g/ min of cerebral blood flow. EEG is isoelectric <18 mL/100 g/min. At.12 ml/100 g/min, there is failure of Na+/K- ATPase. Irreversible damage occurs <8 mL/100 g/min.

Question 29

The blood-brain barrier (BBB) is intact within which structure?
A. Neurohypophysis
B. Pineal gland
C. Area postrema
D. Subfornical organ
E. Subcommissural organ

Answer 29

B. Pineal gland

The subcommissural organ is the only circumventricular organ with intact BBB.

Question 30

The tentorial a is a branch of which segment of the ICA?
A. Cervical
B. Petrous
C. Lacerum
D. lntracavernous
E. Supraclinoid

Answer 30

D. lntracavernous

The tentorial artery ofBernasconi and cassinari
is a branch of the meningohypophyseal trunk of
the intracavernous carotid a. The meningohypophyseal trunk also gives the dorsal meningeal and inferior hypophyseal. The intracavernous carotid a also gives the McConnell’s capsular a and the inferior cavernous a.

Question 31

An autosomal recessive disorder characterized by accumulation of phytanic acid is
A. Refsum’s disease
B. Niemann-Pick’s disease
C. Hurler’s disease
D. Morqulo’s syndrome
E. Krabbe’s disease

Answer 31

A. Refsum’s disease

Refsum’s disease is autosomal recessive, caused
by phytanic acid oxidase deficiency, characterized
by retinitis pigrnentosum, deafness, cardiomyopathy, and peripheral neuropathy (sensory-motor, symmetric, predominantly in the lower extremities).

Question 32

Early subacute blood appears hyperintense on Tl- and hypointense on T2-weighted MRI due to
A. Oxyhemoglobin
B. Deoxyhemoglobin
C. Intracellular methemoglobin
D. Extracellular methemoglobin
E. Hemosiderin

Answer 32

C. Intracellular methemoglobin

In the early subacute stage (3-14 ds), intracellular metHb appears bright (hyperintense) on Tl- and dark (hypointense) on T2-weighted MRI.

Question 33

Wave V of the brains tern auditory evoked responses (BAERs) represents activation of
A. Cochlear nuclei
B. Superior olivary nucleus
C. Lateral lemniscus
D. Inferior colliculus
E. Auditory radiation

Answer 33

D. Inferior colliculus

BAERs waves: I: cochlear n; II: cochlear nuclei;
III: superior olivary nucleus; IV: lateral lemniscus;
V: inferior colliculus; VI: medial geniculate body;
VII: auditory radiation.

Question 34

After a subarachnoid hemorrhage, when a patient is lethargic and confused with no focal deficits, the Hunt and Hess grade is
A. I
B. II
C. III
D. IV
E. v

Answer 34

C. III

Based on the main features of the Hunt and Hess grading system for subarachnoid hemorrhage: grade I: mild headache, II: severe headache or cranial nerve deficits, III: lethargy, IV: hemiparesis, V: extensor posturing.

Question 35

A cerebral AVM of 3.5 an in diameter, in the dominant temporal lobe, and with deep venous drainage, corresponds to which Spetzler-Martin grade?
A. I
B. II
C. III
D. IV
E. V

Answer 35

D. IV

Based on the Spetzler-Martin grading system,
the presented AVM is 3-6 cm (2), in an eloquent
cortex (1), and with deep venous drainage (1).
Therefore, this patient’s AVM is grade IV. The higher the grade, the higher the surgical morbidity.

Question 36

The lesion marked by the arrows in the following MRI will most likely cause
A. Subarachnoid hemorrhage
B. Gelastic seizures
C. Absence seizures
D. Panhypopituitarism
E. Metastasis

Answer 36

B. Gelastic seizures

Hypothalamic hamartomas (arrows) cause gelastic seizures.

Question 37

Which of the following is true about the anatomy of the spinal cord?
A. In the topographic representation of the posterior columns, the legs are medial
B. In the lateral corticospinal tract, the legs are medial.
C. In the lateral spinothalamic tract, the legs are medial.
D. Fine touch and proprioception travel in the lateral funiculus.
E. In the anterior horn, the appendicular muscles are medial.

Answer 37

A. In the topographic representation of the posterior

In the spinal cord, the arms are lateral in the
posterior columns (cuneate tract}; these transmit fine touch and proprioception. The arms are
medial in the spinothalamic and lateral corticospinal tracts. In the anterior horn, the axial muscles are medial while the appendicular muscles are lateral and the extensor muscles are ventral while the flexor muscles are dorsal.

Question 38

The main neurotransmitter in the substantia gelatinosa of Rolando is
A. Glutamate
B. GABA
C. Acetylcholine
D. Dopamine
E. Substance P

Answer 38

E. Substance P

The substantia gelatinosa of Rolando is represented by layer II of the Rexed laminae in the posterior horn of the spinal cord. It transmits pain and utilizes substance P as its neurotransmitte.

Question 39

The pterion is located at the junction of all of the following bones, except
A. Frontal
B. Zygoma
C. Greater wing of sphenoid
D. Squamous temporal
E. Parietal

Answer 39

B. Zygoma

The pterion is H-shaped and Is made of: frontal,
parietal, squamous part of temporal bone, and the
greater wing of the sphenoid bone.

Question 40

Bill’s bar separates
A. Facial n from superior vestibular n
B. Facial n from cochlear n
C. Superior from inferior vestibular nerves
D. Cochlear n from inferior vestibular n
E. Facial n from inferior vestibular n

Answer 40

A. Facial n from superior vestibular n

In the internal acoustic meatus, the facial n is above the cochlear n (7-up, coke down), the superior vestibular n is above the inferior vestibular n. and the facial n is medial to the superior vestibular n and separated from it by the Bill’s bar.

Question 41

Somnambulism occurs in which stage of sleep 7
A. REM (rapid alternating eye movements)
B. 1
C. 2
D. 4

Answer 41

D. 4

Somnambulism, night terrors, and enuresis are
associated with stages 3 and 4 of sleep.

Question 42

Nightmares occur in which stage of sleep?
A. 1
B. 2
c. 3
D. 4
E. REM (rapid alternating eye movements)

Answer 42

E. REM (rapid alternating eye movements)

Nightmares and sleep apnea occur during REM
sleep. Nocturnal epilepsy occurs during stage 4 or
REM sleep.

Question 43

A 41-year-old female was involved in a motor vehicle accident. She was positive for alcohol, amphetamines, and tricyclic antidepressants. Her injuries included closed head injury (CT head below, see
a), minor rib fractures, and liver laceration. Initial examination revealed that she was neurologically intact. Five days later, she developed confusion and right hemiparesis. Angiogram is shown below. The most likely cause of her symptoms is
A. Blossomed contusion
B. Fat embolism
C. Cardio-embolic
D. Carotid dissection
E. Carotid atherosclerosis

Answer 43

D. Carotid dissection

The patient suffered a Jeft carotid dissection as evidenced by the smooth tapering of the left ICA (arrow) and the pseudoaneurysm (arrow-head). She did not respond to therapeutic anticoagulation. She then underwent successful stenting under barbiturate burst suppression.

Question 44

Thoracic disc herniation patients are least likely to improve after which surgical approach?
A. Endoscopic transthoracic
B. Open transthoracic
C. Laminectomy
D. Transpedicular
E. Costotransversectomy

Answer 44

C. Laminectomy

Thoracic disc herniation can be successfully
treated by a transpedicular, transfacet, costotransversectomy, lateral extracavitary, or transthoracic approaches. Laminectomy has a high risk of worsening.

Question 45

A trauma that leads to Chance fracture, usually involves
A. Flexion only
B. Flexion and distraction
C. Extension and distraction
D. Axial load
E. Axial rotation

Answer 45

B. Flexion and distraction

Chance fracture is usually caused by a flexion and distraction (seat-belt) iajury.

Question 46

Froment’s test is used to depict
A. Median neuropathy
B. Ulnar neuropathy
C. Radial neuropathy
D. Tenosynovitis
E. Rheumatoid arthritis

Answer 46

B. Ulnar neuropathy

Froment’s test is performed by asking the patient to hold on to a piece of paper between the thumb and index fingers using adductor pollicis which is supplied by the ulnar n. In case of ulnar n palsy, as the examiner tries to pull on the paper, the patient flexes the distal phalanx of the thumb using flexor pollicis longus supplied by the AIN (median n).

Question 47

All of the following structures enter the orbit through the annulus of Zinn, except
A. Oculomotor n, superior division
B. Oculomotor n, inferior division
C. Trochlear n
D. Nasociliary n
E. Abducens n

Answer 47

C. Trochlear n

Structures entering the orbit outside the annulus of Zinn are: LFf: Lacrimal n (from V 1 ), Frontal n (from V1 ), Trochlear n (IV), in addition to the superior ophthalmic vein.

Question 48

Nervi erigentes provides
A. Somatic supply to the genitals
B. Sympathetic supply to the genitals
C. Parasympathetic supply to the genitals
D. Somatic supply to the inner thigh
E. None of the above

Answer 48

C. Parasympathetic supply to the genitals

Nervi erigentes (pelvic splanchnic nn; S2,3,4) provide parasympathetic supply to the pelvis and perineum.

Question 49

The parasympathetic component of the third cranial nerve arises from
A. Edinger-Westphal nucleus
B. Central nucleus
C. Medial nucleus
D. Lateral nucleus
E. Superior salivary nucleus

Answer 49

A. Edinger-Westphal nucleus

Edinger-Westphal nucleus provides parasympathetic component of the oculomotor n (III) (general visceral efferent). The general somatic efferents arise from the central nucleus supplying levator palpebrae superioris bilaterally, medial nucleus supplying contralateral superior rectus, and lateral nucleus supplying ipsilateral inferior rectus, inferior oblique, and medial rectus. The superior division supplies levator palpebrae superioris and superior rectus. The parasympathetic fibers occupy the outside of III and are more vulnerable to compressive lesions, like PCOM aneurysms.

Question 50

Taste sensation of the anterior 2/3 of tongue is carried by
A. Trigeminal n
B. Chorda tympani n
C. Glossopharyngeal n
D. Vagus n
E. None of the above

Answer 50

B. Chorda tympani n

While somatic sensation of the anterior 2/3 of the tongue (general somatic afferents) is supplied by V, taste sensation (special visceral afferents) is provided by the chorda tympani branch of VII. The posterior 1/3 of the tongue is supplied by IX for both somatic and taste sensations.

Question 51

The thalamic nucleus that receives input from the globus pallidus and projects to the premotor and supplementary motor cortices is
A. Medial dorsal (MD)
B. Lateral dorsal (W)
C. Ventral Anterior (VA)
D. Ventrolateral pars caudalis (VLc)
E. Ventrolateral pars oralis (VLo)

Answer 51

E. Ventrolateral pars oralis (VLo)

VLo (Voa) receives afferents from GP and projects to premotor cortex. VLc and VPLo receive afferents from the dentate nucleus and projects to motor area 4. VA receives input from SN, areas 6 and 8 and projects to premotor cortex. MD receives input from prefrontal cortex. temporal cortex, amygdala, SN, and GP and projects to prefrontal cortex. LD sends projections to the cingulate gyros.

Question 52

The cortical area that connects mostly with the lateral posterior (LP) nucleus of thalamus is
A. Frontal lobe
B. Parietal lobe
C. Occipital lobe
D. Temporal lobe
E. Cingulate gyrus

Answer 52

B. Parietal lobe

LP nucleus of thalamus has sensory projections to the parietal lobe, areas 5 and 7.

Question 53

The large pyramidal cells occupy which layer of the cerebral cortex?
A. I
B. II
C. III
D. IV
E. V

Answer 53

E. V

In a 6-layer cortex model, the main output from the internal pyramidal layer (V) is to the brain stem and spinal cord, and from the multiform layer (VI) to the thalamus. The main afferents connect to the internal granular layer (IV). The molecular (I), external granular (II), and external pyramidal (III) layers connect to other cortical areas, while III connects the 2 hemispheres.

Question 54

The uncinate fasciculus connects
A. Orbito-frontal gyri to anterior temporal lobe
B. Anterior temporal lobe to occipital lobe
C. Orbito-frontal gyri to parietal lobe
D. Parietal to occipital lobe
E. Frontal, parietal, parahippocampal. and temporal

Answer 54

A. Orbito-frontal gyri to anterior temporal lobe

The uncinate fasciculus connects orbito-frontal gyri to anterior temporal lobe. The arcuate fasciculus connects the superior and middle frontal gyri to the temporal lobe. The superior longitudinal fasciculus: frontal to parietal and occipital. The inferior longitudinal fasciculus: temporal to occipital.

Question 55

The corticobulbar fibers occupy which part of the internal capsule?
A. Anterior limb
B. Genu
C. Posterior limb
D. Retrolenticular
E. Sublenticular

Answer 55

B. Genu

The corticobulbar fibers occupy the genu of the
internal capsule, corticospinal the posterior half of the posterior limb with the legs represented posteriorly, auditory projections in sublenticular, visual in retrolenticular. The anterior limb contains the anterior thalamic peduncle.

Question 56

In the following figure, the subiculum, is represented by number
A. 1
B. 2
C. 3
D. 4
E. 5

Answer 56

C. 3

1. Dentate gyros; 2. Comu Ammonis (hippocampus): 3. subiculum; 4. entorhinal cortex; 5. optic tract; 6. temporal horn oflateral ventricle; 7. fimbria of fornix; 8. tail of caudate nucleus; 9. alveus; 10. choroid plexus.

Question 57

In the above figure, the fimbria is represented by number
A. 1
B. 2
C. 3
D. 5
E. 7

Answer 57

E. 7

1. Dentate gyros; 2. Comu Ammonis (hippocampus): 3. subiculum; 4. entorhinal cortex; 5. optic tract; 6. temporal horn oflateral ventricle; 7. fimbria of fornix; 8. tail of caudate nucleus; 9. alveus; 10. choroid plexus.

Question 58

What is a contraindication to an anterior odontoid screw?
A. Age >50
B. Fracture line horizontal
C. Fracture line oblique downward and posteriorly
D. Very large barrel chest
E. Inability to open the mouth >2 cm

Answer 58

D. Very large barrel chest

Barrel chest will preclude the ability to get the appropriate trajectory for an odontoid screw. A fracture line oblique downward and anteriorly will not allow purchase in the broken fragment. Inability to open the mouth is a contraindication for a transoral approach for odontoidectomy.

Question 59

The superior salivary nucleus provides parasympathetic supply that travels through the
A. Facial n
B. Glossopharyngeal n
C. Vagus n
D. All of the above
E. None of the above

Answer 59

A. Facial n

The superior salivary nucleus provides parasympathetic efferents (general visceral efferents) through the chorda tympani branch of the facial n to the submandibular and sublingual salivary
glands, through the greater superficial petrosal n to the lacrimal gland. The inferior salivary nucleus
provides parasympathetic efferents to the glossopharyngeal n (parotid gland) and the dorsal vagal nucleus to the vagus n.

Question 60

The stria terminalis connects
A. The substantia nigra to the caudate nucleus
B. The amygdala to the hypothalamus
C. The hypothalamus to the salivary nuclei
D. The amygdala to the nucleus accumbens septi
E. The lateral hypothalamus to the hippocampus

Answer 60

B. The amygdala to the hypothalamus

The stria tennlnalis connects the hypothalamus and septal nuclei to the amygdala. The stria medulIaris provides efferents from the septa! nuclei to the habenular nuclei.