43.

A 22-year-old woman presents to her physician with amenorrhea, weight loss, anxiety, tremor, heat intolerance, and palpitations. Laboratory examination is consistent with hyperthyroidism, and the physician prescribes propylthiouracil. The patient's response to propylthiouracil is disappointing, and the symptoms recur, then worsen. Subtotal thyroidectomy is successfully performed, but following the surgery, the woman is extremely hoarse, and can barely speak above a whisper. This hoarseness is most probably related to damage to a branch which of the following cranial nerves? (A) Facial (B) Glossopharyngeal (C) Hypoglossal (D) Trigeminal (E) Vagus

45. A 67-year-old man is evaluated for persistent shooting pains, lower limb ataxia, and bladder dysfunction. Physical examination demonstrates small irregular pupils that constrict with accommodation but not in response to light. A VDRL test is positive. A CT scan of the spinal cord would most likely demonstrate atrophy of which of the following structures?

(A) Dorsal column (B) Dorsal horn (C) Lateral column (D) Ventral column (E) Ventral horn 49. During a fight, a 32-year-old man is hit on the back of the neck with a chair. A CT scan reveals a bony fragment that penetrated the lateral portion of the dorsal columns. Which of the following functions would most likely be affected by a lesion at this site?

(A) Fine motor control of the ipsilateral fingers (B) Motor control of the contralateral foot (C) Proprioception from the ipsilateral leg (D) Sweating of the ipsilateral face

(E) Vibratory sense from the ipsilateral arm Correlated letters and numbers: A=1+2+3, B=1+3, C=2+4, D=4, E=all Solution: 1. Vertigo is a sign of: 1. Mniere syndrome 2. Foster-Kennedy syndrome 3. cerebellar infarct of neoplasm 4. central pontine myelinolysis ABCDE 2. Vertical gaze paralysis results from a damage to the: 1. Westphal-Edinger nucleus 2. nucleus interstitialis Cajal 3. nucleus ambiguus 4. nucleus commissurae posterioris ABCDE 3. The medial longitudinal fasciculus is an association tract linking the: 1. nuclei of the ocular muscles 2. vestibular nuclei 3. cervical spinal cord 4. pontine and mesencaphalic subcortical gaze centres ABCDE 4. Hearing loss may be associated with: 1. inner ear concussion 2. long term furosemide therapy 3. acustics neurinoma 4. frontobasal neoplasms ABCDE 5. Inputs to the thalamus include: 1. visual pathway 2. spinothalamic tract 3. medial lemniscus 4. olfactory pathway ABCDE 6. Ptosis or proptosis is a common sign of: 1. Horner syndrome 2. sinus cavernous thrombosis 3. myasthenia gravis 4. tegmental lesion of the midbrain ABCDE 7. Which of the following statements are true regarding the Gradenigo's syndrome: 1. the underlying disorder is generally otitis media

2. it occurs due to abscess formation in petrous apex 3. one of the characteristic sign is: ipsilateral sixth nerve palsy 4. one of the characteristic sign is: ipsilateral facial pain ABCDE 8. The majority of intervertebral disk herniations occur between: 1. L4-L5 2. C5-C6 3. L5-S1 4. C6-C7 ABCDE 9. Anosmia may associate with: 1. head trauma 2. leukodystrophy 3. olfactory groove meningioma 4. parasagittal meningoma ABCDE 10. Muscular rigidity is a common sign of: 1. malignant hyperthermia 2. Parkinson disease 3. stiff-man syndrome 4. Guillain-Barr syndrome ABCDE 11. Which of the following statements is/are true regarding the pupillary light reflex: 1. the pretectal area projects to the contralateral Edinger-Westphal nucleus 2. the fibers bypass the lateral geniculate body 3. the fibers does not reach the posterior commissure 4. the fibers run through the brachium of the superior colliculus to synapse in the pretectal region ABCDE 12. The visual system receives its blood supply from the: 1. anterior choroidal artery 2. middle cerebral artery 3. posterior cerebral artery 4. pericallosal artery ABCDE 13. The most common causes of aquired diplopia include: 1. meningitis tuberculosa 2. multiple sclerosis 3. Wernicke encephalopathy 4. herpes zoster ABCDE 14. The nuclei of the trigeminal nerve can be found in the: 1. pons

2. spinal cord 3. midbrain 4. medulla oblongata ABCDE 15. Which of the following structures play(s) a role in the initiation of the optokinetic nystagmus: 1. occipital lobe 2. frontal lobe 3. superior colliculus 4. inferior colliculus ABCDE 16. The amnesic syndrome results from lesion in: 1. prefrontal area 2. hippocampus 3. red nucleus 4. medial thalamus ABCDE 17. A lesion involving the nucleus ambiguous could produce: 1. double vision 2. dysphagia 3. myoclonus 4. dysarthria ABCDE 18. Which nuclei are located in the medulla oblongata: 1. nucleus hypoglossus 2. nucleus of Perlia 3. inferior and superior salivatory nuclei 4. Westphal-Edinger nucleus ABCDE 19. Which of the following allows accomodation of near vision: 1. contraction of ciliary muscles 2. relaxation of the ciliary muscles 3. thickening of the lens 4. flattening of the lens ABCDE 20. Which of the following statements are true regarding the sympathetic innervation of ocular muscles: 1. the ocular sympathetic innervation is a three-neuron pathway 2. the ciliospinal center is located in the intermediolateral column of the spinal cord at the levels of C8 and Th1-2 3. it supplies the pupillary dilator and the superior tarsal muscles 4. its lesion results in Horner triad ABCDE 21. Trismus ("lockjaw"= spasms of the masseter muscle) may associate with: 1. tetanus

2. pontine encephalitis 3. peritonsillar abscess 4. hypertensive encephalopathy ABCDE 22. Branches from the basilar artery are the: 1. superior cerebellar artery 2. anterior inferior cerebellar artery 3. pontine branches 4. labyrinthine artery ABCDE 23. Which is a part of the auditory system the: 1. ganglion oticum 2. ganglion geniculi 3. ganglion stellatum 4. ganglion spirale ABCDE 24. Vestibular nuclei include: 1. nucleus lateralis Deiters 2. nucleus medialis Schwalbe 3. nucleus superior Bechterew 4. nucleus descendes spinalis Roller ABCDE 25. Which of the following corresponds to the primary auditory cortex: 1. Brodman 38 2. Brodman 39 3. Brodman 40 4. Brodman 41 ABCDE 26. Nucleus ambiguus belongs to the: 1. nervus glossopharyngeus 2. nervus vagus 3. nervus accessorius 4. nervus hypoglossus ABCDE 27. Which of the following ganglions belong(s) to the vagal nerve: 1. ganglion jugulare (superius) 2. ganglion superius (intracraniale) 3. ganglion nodosum (inferius) 4. ganglion inferius (extracraniale) ABCDE 28. The fibers of the superior cerebellar peduncles decussate in the: 1. tectum

2. base of pons 3. pontine tegmentum 4. tegmentum of the midbrain ABCDE 29. Which of the following nuclei are affected in Wallenberg syndrome: 1. nucleus vestibularis inferior 2. nucleus dorsalis vagi 3. nucleus tractus solitarii 4. nucelus ambiguus ABCDE 30. Which of the following tracts/structures are involved in Wallenberg syndrome: 1. tractus spinocerebellaris anterior 2. tractus tegmentalis centralis 3. tractus spinothalamicus 4. pedunculus cerebellaris inferior ABCDE 31. Signs of Wallenberg syndrome include: 1. Horner triad 2. ipsilateral nystagmus 3. ipsilateral ataxia 4. contralateral sensory disturbance ABCDE 32. Medulla oblongata is/are supplied by the: 1. posterior inferior cerebellar artery 2. anterior inferior cerebellar artery 3. anterior spinal artery 4. posterior cerebral artery ABCDE 33. Pons is/are supplied by the: 1. posterior cerebral artery 2. anterior spinal artery 3. posterior choroidal artery 4. basilar artery ABCDE 34. Midbrain is/are supplied by the: 1. superior cerebellar artery 2. posterior cerebral artery 3. rami interpedunculares 4. posterior choroidal artery ABCDE 35. Which if the following statements are true concerning the Parinaud syndrome: 1. it may associate with refractory nystagmus on convergence

2. it is characterized by a paralyis of upward gaze 3. it is usually caused by a tumor of the pineal gland 4. it is usually caused by hypophyseal tumor ABCDE 36. Cerebellar nuclei include: 1. nucleus emboliformis 2. nucleus globosus 3. nucleus dentatus 4. nucleus fastigii ABCDE 37. Which of the following statements are true regarding inferior olive: 1. it lies in the ventral medulla 2. it receives its afferentation via central tegmental tract 3. its cells project to the contralateral cerebellar cortex via the inferior cerebellar peduncle 4. it receives afferent fibers from red nucleus ABCDE 38. Cerebellum is important for: 1. maintaining balance 2. regulating muscle tone 3. performing rapid, precise, coordinated movement patterns 4. regulating muscle power ABCDE 39. Which of the following statements are true of thalamus:

1. it is the gateway to the cortex 2. it integrates outflow from cerebellum and basal nuclei and transmit this information to the motor cortex 3. appart from olfaction sensory stimuli pass through the thalamus and are relayed to the cortex for conscious processi 4. it regulates consciousness, arousal and attention ABCDE 40. The limbic system consist of the: 1. gyrus cinguli 2. amygdala 3. fornix 4. corpus mamillare ABCDE

41. Nucleus solitarius receives impulses from taste receptors of the tongue through the sensory ganglia of which crania 1. n. intermedius 2. n. glossopharyngeus 3. n. vagus 4. n. hypoglossus ABCDE 42. Components of vestibular system are:

1. utricle 2. saccule 3. semicircular canals 4. organ of Corti ABCDE 43. Dizziness may be associated with: 1. zoster oticus 2. panic attacks 3. drug intoxication 4. neuronitis vestibularis ABCDE 44. The sixth nerve palsy is a part of the: 1. Gradenigo syndrome 2. Benedikt syndrome 3. Foville syndrome 4. Weber syndrome ABCDE 45. Combined unilateral lesion of the III., IV., and VI. cranial nerves is associated with: 1. Foville syndrome 2. superior orbital fissure syndrome 3. Millard-Gubler syndrome 4. Tolosa-Hunt syndrome ABCDE 46. Oculomotor palsy is the common sign of: 1. Nothnagel syndrome 2. Benedikt syndrome 3. Weber syndrome 4. Foville syndrome ABCDE 47. In which syndrome is the facial nerve affected: 1. Melkersson -Rosenthal 2. Avellis 3. Millard-Gubler 4. Parinaud ABCDE 48. Effects of acetylcholin receptor activation may include: 1. increased sweating 2. miosis 3. rapid depolarization, contraction of skeletal muscle 4. release of nitric oxide ABCDE 49. What deficit would occur if thalamus were destroyed:

1. contralateral hemianesthesia 2. contralateral pain 3. disorders of the emotions 4. movement disorder ABCDE 50. Characteristic CSF findings in meningitis basilaris: 1. mild pleocytosis 2. high glucose level 3. low glucose level 4. cell count about 20000/3 ABCDE 51. The signs and symptoms of vertebrobasilar stroke may include: 1. dizziness 2. numbness around the mouth 3. drop attacks 4. unsteadiness ABCDE 52. Which of the following drugs are use for treatment of tuberculosis: 1. Isoniazid 2. Rifampin 3. Pyrazinamide 4. Ethambutol ABCDE 53. Which of the following drugs are used for treatment of multiple sclerotis: 1. Interferon Beta-1b (Betaseron) 2. Pramipexole (Mirapex) 3. Glatiramer Acetate (Copaxone) 4. Ticlopidine hydrochloride (Ticlid) ABCDE 54. Which of the following diseases are muscular in origin: 1. progressive muscular dystrophy 2. Werdnig-Hoffmann disease 3. myotonia congenita 4. amyotrophic lateral sclerosis ABCDE 55. Which of the following structures are affected in poliomyelitis: 1. posterior horns of the spinal cord 2. motoneurons of the ventral horns in the spinal cord 3. pontine tegmentum 4. nuclei of the caudal cranial nerves ABCDE 56. Which of the following is a low motoneuron disease:

1. bulbar paresis 2. Heine-Medin disease 3. Werdnig-Hoffmann disease 4. pseudobulbar paresis ABCDE 57. Which of the following is/are the sign(s) of an injury to the common peroneal nerve: 1. inability to evert foot 2. loss of plantar flexion 3. loss of sensation on dorsum of foot and lateral aspect of leg 4. loss of sensation on sole of foot ABCDE 58. What lies below the inferior olive: 1. central tegmental tract 2. spinocerebellar tract 3. spinothalamic tract 4. pyramidal tract ABCDE 59. Which of the following statements are true regarding Krabbe disease: 1. it is an X-linked disorder 2. it is inherited in an autosomal recessive manner 3. the galactocerebrosidase enzyme activity is elevated 4. the galactocerebrosidase enzyme activity is very low ABCDE 60. Which of the following nerves may be involved in Mbius syndrome: 1.olfactory 2. facial 3. optic 4. abducent ABCDE 61. Epileptic seizure often associates with: 1. intracranial tumors 2. chronic alcoholism 3. fhead injury 4. multiple sclerosis ABCDE 62. Which of the following statements are true reagarding Leber hereditary optic neuropathy: 1. males are more commonly affected than females 2. it is characterized by subacute bilateral visual loss 3. visual evoked potentials may confirm the diagnosis 4. MRI is often normal ABCDE 63. Which of the following can be found in the cytoplasm of the neurons:

1. neurofibrillary tangle 2. Negri body 3. Lewy body 4. Pick body ABCDE 64. Spastic paraparesis may be associated with: 1. multiple sclerosis 2. transverse myelitis 3. anterior spinal artery thrombosis 4. cercical myelopathy ABCDE 65. Plasmapheresis is accepted for the treatment of: 1. myasthenia gravis 2. polymyositis 3. Guillain-Barr syndrome 4. Foster-Kennedy syndrome ABCDE 66. Which of the following are characteristic of progressive muscular dystrophy: 1. EMG: polyphasic motor unit potentials with small amplitude 2. the transaminase values are normal 3. serum CPK is markedly elevated 4. muscle biopsy reveals angular atrophic fibers with fiber type grouping ABCDE 67. Common signs of myotonic dystrophy are: 1. alopecia 2. weakness and wasting in the distal limb muscles 3. cataracts 4. testicular atrophy ABCDE 68. Which of the following statements are true concerning Emery-Dreifuss dystrophy: 1. its inheritance is X-linked 2. its inheritance is autosomal dominant 3. ankle and elbow contractures are common 4. atrial arrhythmias may be noted on cardiac examination ABCDE 69. Phakomatoses include: 1. Arnold-Chiari malformation 2. sclerosis tuberosa 3. Dandy-Walker syndrome 4. neurofibromatosis generalisata ABCDE 70. Characteristic of Sturge-Weber syndrome are:

1. naevus flammeus on the face 2. late onset of symptoms 3. epileptic seizures 4. adenoma sebaceum on the face ABCDE 71. Characteristics of Hippel-Lindau disease include: 1. multiple caf au lait spots 2. cerebellar hemangioblastoma 3. naevus flammeus on the face 4. retinal hemangioblastoma ABCDE 72. Types of spinal muscular atrophies are: 1. Werdnig-Hoffmann - infantile, proximal, severe form 2. Kugelberg-Welander - juvenile, proximal, intermediate form 3. Vulpian-Bernhard - adult, proximal, mild form 4. Aran-Duchenne - adult, distal ABCDE 73. Which of the following statements are true regardin subacute combined degeneration of the spinal cord: 1. it is a disorder caused by vitamin B12 deficiency 2. it is characterized by a demyelination affecting the dorsal columns 3. it often associated with pernicious anemia 4. the firs symptom is generally urinary incontinence ABCDE 74. The most common signs of encephalitis include: 1. altered consciousness 2. taste disturbance 3. epileptic seizures 4. peripheral paresis ABCDE 75. Cerebral edema may be associated with: 1. brain abscess 2. leukodystrophy 3. glioblastoma multiforme 4. Huntington disease ABCDE 76. Senile plaques are composed of: 1. -amyloid protein 2. intranuclear inclusions 3. dystrophic neurites 4. paired helical filaments ABCDE 77. Most common signs of Jakob-Creutzfeldt's disease are:

1. progressive dementia 2. myoclonus 3. epileptic seizures 4. papilledema ABCDE 78. Neurological complications of AIDS include: 1. opportunistic infections 2. dementia 3. malignant intracranial tumors 4. peripheral neuropathy ABCDE 79. Characteristics of malignant hyperthermia are: 1. myoglobinuria 2. triggers: inhalational anesthetic agents 3. fever 4. muscle rigidity ABCDE 80. Which of the following statements is/are true regarding the structure of the intracranial arteries: 1. the have an external elastic lamina 2. they have an internal elastic lamina 3. their tunica media is rich in elastic fibers 4. under normal conditions, they have no vasa vasorum ABCDE 81. Which of the following statements ar true concerning " ischemic penumbra" : 1. it occurs in the area surrounding the ischemic core 2. in the area of penumbra, the nerve cells undergo necrosis 3. it is a term which refers to the reversible loss of neuronal cell function related to cerebral hypoperfusion 4. after restoration of circulations, the cells does not regain their functionality ABCDE 82. Which of the following statements is/are true concerning the so-called luxury perfusion: 1. it is generally caused by lactic acidosis 2. vasoparalysis is present 3. in the affected site, the metabolism is damaged 4. in the affected site, the neurons regain rapidly their function ABCDE 83. Which of the following statements is/are true regarding cavernous hemangioma: 1. it may be inherited in an autosomal dominant mode 2. the angiography is the best imaging modality to make an accurate diagnosis 3. it contains sinusoidal vascular spaces lined with endothelium and an adventitial layer 4. functional neural tissue exists between the sinusoidal vessels ABCDE 84. Which of the following statements is/are true regarding the fat embolism syndrome:

1. it generally follows long bone fractures 2. an asymptomatic period of about 12-48 hours precedes the clinical manifestations 3. petechial rashes appear on the upper anterior portion of the body 4. altered level of consciousness is not uncommon ABCDE 85. Conditions which predispose to intracranial hemorrhage in neonates include: 1. diabetes 2. immaturity 3. hypotension 4. hypoxia ABCDE 86. The outlet(s) of the fourth ventricle is/are: 1. foramen of Magendie 2. foramen of Monroe 3. foramen of Luschka 4. foramen jugulare ABCDE 87. The most common complications of SAH are: 1. vasospasm 2. rebleeding 3. hydrocephalus 4. meningitis ABCDE 88. Diagnostic criteria for clinical diagnosis of brain death: 1. coma 2. abscence of brainstem reflexes 3. negative apnea test 4. exclusion of drug intoxication or poisoning ABCDE 89. Characteristic signs of Binswanger's disease: 1. gait disturbances 2. progressive dementia 3. urinary incontinence 4. double vision ABCDE 90. Causes of hydrocephalus may include: 1. excessive secretion of CSF 2. blockage to CSF circulation 3. Dandy Walker syndrome 4. posterior fossa tumors ABCDE 91. Which of the following are characteristic of Hallervorden-Spatz disease:

1. muscle rigidity 2. autosomal recessive inheritance 3. dementia 4. choreoathetosis ABCDE 92. Treatment of Wilson disease: 1. use of D-Penicillinamin 2. low-copper diet 3. use of zinc acetate 4. copper-rich diet ABCDE 93. Local injections of botulinum toxin are effective in the treatment of: 1. athetosis 2. blepharospasm 3. chorea 4. spasmodic torticollis ABCDE 94. Indications of beta blockers include: 1. migrain prophylaxis 2. epilepsy 3. essential tremor 4. Guillain-Barr syndrome ABCDE 95. The most widely used agent(s) for reduction of spasticity is/are: 1. Baclofen 2. Tizanidine 3. Diazepam 4. Madopar ABCDE 96. Drug(s) that may exacerbate weakness in myasthenia gravis is/are: 1. beta blockers 2. aminoglycosides 3. procainamide hydrochloride 4. dopamine agonists ABCDE 97. Which of the following is/are recommended for the tretament of the cholinergic crisis: 1. neostigmine methylsulfate 2. pyridostigmine bromide (Mestinon) 3. edrophonium chloride (Tensilon) 4. atropine ABCDE 98. Which of the followings are characteristic of the myasthenic crisis:

1. miosis 2. mydriasis 3. bradycardia 4. tachycardia ABCDE 99. Nonsteroidal anti-inflammatory drugs (NSAIDs) include: 1. diclofenac 2. haloperidol 3. indomethacin 4. valium ABCDE 100. Paraneoplastic syndromes include: 1. cerebellar atrophy 2. progressive multifocal leukoencephalopathy 3. polyneuropathy 4. dermatomyositis ABCDE

Solution: 1B, 2C, 3E, 4A, 5A, 6E, 7E, 8B, 9B, 10A, 11C, 12A, 13E, 14A, 15B, 16C, 17C, 18B, 19B, 20E, 21A, 22E, 23D, 24E, 25 57B, 58D, 59C, 60C, 61A, 62E, 63E, 64E, 65A, 66B, 67E, 68E, 69C, 70B, 71C, 72E, 73A, 74B, 75B, 76B, 77A, 78E, 79

A 73-year-old woman comes to the physician because of a 2-month history of diffuse weakness and tingling of her arms and legs. Neurologic examination shows weakness of the extensor and flexor muscles of the lower extremities. Knee and ankle deep tendon reflexes are exaggerated. Sensation to vibration and position is decreased in all extremities, but the decrease is more prominent in the lower extremities than in the upper extremities. This patient most likely has a deficiency of which of the following vitamins?
. (A) Niacin . (B) Vitamin B1 (thiamine) . (C) Vitamin B2 (riboflavin) . (D) Vitamin B6 (pyridoxine) . (E) Vitamin B12 (cyanocobalamin)

A 68-year-old woman has the sudden onset of weakness in her right arm and leg. She can speak, but her words are not enunciated clearly. Neurologic examination 6 weeks later shows an extensor plantar reflex on the right. When she is asked to protrude her tongue, it deviates to the left, and the muscle in the left side of the tongue shows considerable atrophy. Which of the following labeled areas in the transverse sections of the brain stem is most likely damaged?

A 48-year-old woman has loss of pain and temperature sensation in the left upper and lower limbs. Which of the following labeled areas in the medulla is the most likely site of the causal lesion?