1. CNS Development
1. Which of the following correctly pairs chemical signal with area of development?
Sonic hedgehog: Alar pole (sensory)
Sonic hedgehog: Basal pole (motor)
Sonic hedgehog: Alar pole (motor)
Sonic hedgehog: sulcus limitans
Sonic hedgehog: Basal pole (sensory)
2. Incomplete maturation of the primary ventricle into the secondary ventricles is incompatible with life. If the rhombencephalon was unable to differentiate into the myelencephalon, which of the following structures would not form?
3. Paige was born without vertebral arches and a cystic mass containing meninges and CSF. What condition does she have?
Spina bifida occulta
Spina bifida cystica menigocele
Spina bifida cystica meninigomyelocele
4. Diane is an alcoholic who unfortunately did not quit drinking while pregnant with Bradley, who was subsequently born with Fetal alcohol syndrome. Which of the following structures is most likely missing in Bradley’s brain?
5. Which of the following symptoms would you expect to see in Bradley if he is missing the structure in the answer above?
Regulation of body temperature, appetite, sexual behavior and emotional responses
Consolidation of information from short-term memory to long-term memory
Deficits in attention, lower intellectual function, issues being able to read, learn and with verbal memory, problems with executive and psychosocial functions
Production of melatonin, irregular sleep patterns
Relaying motor and sensory signals to the cerebral cortex
2. Internal Spinal Cord
6. Ricky was walking through his house in the dark and stepped on a lego with his right foot. He reflexively jerked his right leg up and stood firmly on his left leg. Which reflex/reflexes did Ricky experience.
Monosynaptic Stretch Reflex
Crossed Extensor Reflex
B and DAnswer E. Flexor Reflex and Crossed Extensor Reflex are both Polysynaptic flexor reflexes. Polysynaptic flexor reflex is what causes limb withdrawal from a noxious stimuli, which in this case is the lego. The flexor reflex causes the limb flexor muscles to contract, and simultaneously the crossed extensor reflex causes the extension of the contralateral limb to take the weight of the body. Answer choice A refers to Ole Kirk Christiansen who created the lego, and unfortunately does not have a reflex named for him. Answer Choice C is incorrect because it mediates muscle contraction in response to stretch of muscle spindles.
7. Which structure carries proprioception and discriminative touch from spinal levels T7 and below to the medulla?
Substantia gelatinosaAnswer A. Fasciculus cuneatus carries that information from spinal levels T6 and above. Nucleus gracilis is where the fasciculus gracilis conveys the information to in the medulla, whereas the nucleus cuneatus is where the fasciculus cuneatus carries its information to. The substantia gelatinosa conveys nociceptive information to the brain.
8. James is a 48 year old male who recently went to the local clinic with a chief complaint of loss of proprioception in his lower extremities. He claims this has only started about 6 months ago. The physician notes that he has an unsteady gait as he walks around. A standard neuro test was performed and a positive Romberg’s test was elicited. X-rays and MRI’s ruled out a herniated disc or compression fracture that might be impinging his nerve roots. A blood panel was run and B12 levels were normal, but a more extensive analysis showed his splenocytes were abnormally high. The physician concludes that James has a lesion of his dorsal column. What condition is associated with his findings?
Subacute combined degeneration
SyringomyeliaAnswer C. Subacute combined degeneration is caused by a deficiency of vitamin B12 and since the blood panel showed his levels were normal, this cannot have been the case. Multiple Sclerosis results in damage to the fasciculus cuneatus of the cervical spinal cord which carries information of proprioception and discriminative touch from spinal levels T6 and above, and does not include the levels causing loss of proprioception to the lower extremities. Osteogenesis Imperfecta is a lifelong disorder and even if bones were not broken in this case, it would have started 48 years ago, not 6 months. Syringomyelia is the selective loss of pain and temperature awareness in the upper limbs from damaged to the spinothalamic tracts. The correct answer is Tabes Dorsalis because it causes damage to the dorsal column causing high steppage and an unsteady gait (sensory ataxia), a positive Romberg’s sign, and a high splenocyte count because it is a syphilitic infection.
9. Which descending spinal tract is responsible for controlling limb flexor muscles?
Corticospinal TractAnswer C. Spinothalamic tract is ascending. The Vestibulospinal tract is responsible for postural adjustments and head movements. The reticulospinal tract is responsible for reflexes, muscle tone, and vital functions. Corticospinal tract is responsible for discrete, skilled movements. Rubospinal tract is the correct answer because it controls limb flexor muscles and is a descending spinal tract.
10. Where does the corticospinal tract originate?
Inferior Frontal Lobe
Precentral GyrusAnswer E.
3. Brain Topography
11. In which location are the cell bodies located for the rubrospinal tract?
Dorsal Horn of the associated spinal levelAnswer C.
12. The cingulate sulcus separates which two lobes?
Frontal and Parietal
Frontal and Limbic
Parietal and Temporal
Parietal and Occipital
Occipital and LimbicAnswer B.
13. In which of the following areas would you find the frontal eye field?
Superior frontal gyrus
Middle frontal gyrus
Inferior frontal gyrus
Gyrus rectusAnswer C.
14. A patient suffers a stroke which selectively damages the inferior frontal gyri. Which of the following would most drastically affected?
Primary motor cortex
Supplementary motor area
Frontal eye field
Prefrontal cortexAnswer D.
15. On a neurology rotation you encounter a patient who is able to speak and write but somehow unable to understand what you are saying. Which of the following are they most likely to have damage in?
Inferior frontal gyri
Inferior parietal lobule
Inferior temporal gyri
Lingual gyrusAnswer C.
16. The primary visual cortex is situated around which of the following sulci?
17. Your girlfriend becomes very emotional when you like another girls instagram post. You, being an insensitive prick and soon to be single man, mention that which lobe of hers is probably malfunctioning?
18. A blockage develops in the right callosomarginal artery. Which limb is most likely affected?
Both lower extremitiesAnswer D.
19. After obtaining an MRI from a stroke patient you see that there is a large infarct in the area of the thalamus. Which artery was most likely occluded?
20. A patient presents with vertigo and difficulty hearing on one side. After exhausting all other options you send them for an MRI which reveals a small stroke caused by an occlusion in which artery?
Posterior Inferior CerebellarAnswer D.
4. Brain Topography Lab
21. An ischemic attack in the red circled area (image above) would most likely result in a dysfunction of which of the following function?
22. Using the same image, the blue circle most likely indicates function associated to which body part?
23. Area 17 is correctly matched with the following lobe and function?
Temporal – Auditory
Temporal – Visual
Parietal – Auditory
Occipital – Auditory
Occipital – VisualAnswer E.
24. A patient was born without areas 18 and 19, which of the following senses would be most affected?
Seeing Dead PeopleAnswer E.
25. “Identify the tagged structure (24)” – DMC?
Supramarginal GyrusAnswer A.
26. Identify Number 2?
Optic TractAnswer B.
27. If the entirety of the structure labeled “4” was removed, what aspect of the brain would be lost?
Connection of the Cerebral Hemispheres
Basic PersonalityAnswer B.
5. Medulla Oblongata
28. At what level of the Medulla does the restiform body begin to form
Pons – Medullary Junction
Motor Decussation level
Sensory Decussation level
Rostral MedullaAnswer C.
29. A 4o yr old female patient presents to the ED with a severe burn on the left side of her face. When questions how she received the burn, the patient states she was from her curling iron. The patient states she did not feel any pain or heat from the iron while it burned her. What sensory tract could be affected?
Right Spinal Trigeminal Tract
Left Spinal Trigeminal Tract
Left Anterolateral Tract
Right Anterolateral Tract
Left Spinothalamic TractAnswer B. The Spinal Trigeminal Tract conveys pain and temperature sensory information from the ipsilateral face. Since the burn is on the left side of the face, it must be the Left Spinal Trigeminal Tract.
30. A lesion in which artery could account for the deficits found in the previous question?
Anterior Spinal Artery
Vertebral ArteryAnswer D. The Posterior Inferior Cerebellar Artery supplies the Spinal Trigeminal Tract
31. A patient presents to the clinic with complaints of a “racing heart” and difficulty with catching their breath. You notice that their breathing resembles Cheyne-Stokes and become increasingly concerned that they may have an acute herniation of the cerebellar tonsil. If you are correct, what part of the Medulla do you expect to be damaged?
Lateral reticular nucleus
Ventrolateral reticular area
Nucleus Raphes MagnusAnswer C.
32. A lesion on the area postrema will prevent vomiting in the presence of emetic toxins in the blood or CSF. When looking for this lesion for removal, what level of the medulla would you check?
Level of the Obex
Sensory Decussation LevelAnswer A.
33. Chiari malformation I is a brain condition in which the part of the skull that houses the cerebellum is deformed. Many times this condition is asymptomatic until there is a strain or injury causing the tonsils of the cerebellum to become displaced through the foramen magnum and into the ventrolateral reticular area of the medulla causing damage. What symptoms related to the medulla would you expect to see in a patient who suffers from Chiari?
Loss of vision and/or Double vision
Loss of balance
Sudden change in heart rate and respiration
Inability to distinguish objects placed in your hand (Astrogenesis)Answer D. Although symptoms of Chiari include A B and C, only D is due to the compression on the medullary structure
34. A newborn presents with an abnormal tumor in their brainstem that is obstructing the flow of CSF precisely where the 4th ventricle becomes continuous with the cerebral aqueduct. With respect to brainstem anatomy, which of the following areas most accurately describes the location of this tumor?
Foramen of Luschka
Inferior collicular aperture
35. The relationship and communication between the cerebral cortex, cerebellum, and pons is essential in the execution of smooth, coordinated movements. Which of the following correctly displays the order in which a signal passes from the motor cortex down its neuronal tract for execution.
Cerebral cortex → pontocerebellar fibers → pontine nuclei → contralateral inferior cerebellar peduncle → cerebellar hemisphere
Cerebral cortex → corticopontine fibers → pontine nuclei → pontocerebellar fibers → ipsilateral middle cerebellar peduncle → cerebellar hemisphere
Cerebral cortex → corticopontine fibers → pontine nuclei → pontocerebellar fibers → contralateral middle cerebellar peduncle → cerebellar hemisphere
Cerebral cortex → pontocerebellar fibers → pontine nuclei → corticopontine fibers → contralateral superior cerebellar peduncle → cerebellar hemisphere
Cerebral cortex → cerebralpondular tract → pontocerebellar bodies → ipsilateral superior cerebellar peduncle → cerebellar hemisphere
36. Your patient presents to the clinic complaining of distorted vision. Her right eye is medially oriented compared to the left during normal, forward gaze. She is also unable to laterally rotate the right eye from a neutral gaze position when performing the “H” test. Which muscle isn’t being utilized by the patient’s right eye due to a damaged _____ cranial nerve nucleus?
Right lateral rectus muscle; left Abducens
Right lateral rectus muscle; right Trochlear
Right medial rectus muscle; right Abducens
Right medial rectus muscle; left Trochlear
Right lateral rectus muscle: right Abducens
37. Your patient presents to the clinic complaining of distorted vision. Her right eye is medially oriented compared to the left during normal, forward gaze. She is also unable to laterally rotate the right eye from a neutral gaze position when performing the “H” test. Where in the brainstem is the affected nuclei located?
Right basal pons
Right pontine tegmentum
Left basal pons
Left pontine tegmentum
38. Your attending informs you that your next patient has been diagnosed with an unknown tumor on their superior medullary velum of the 4th ventricle. From what structures does the superior medullary velum span and what cranial nerve might possibly be compromised due to the tumorous growth?
Middle cerebellar peduncles; CN VI
Superior cerebellar peduncles; CN IV
Middle cerebellar peduncles; CN IV
Superior cerebellar peduncles; CN VI
Superior cerebellar peduncles; CN V
39. Bethany has been complaining of numbness and tingling in her arm, having blurry vision, and a loss of balance. A CT of her head indicates a mass pushing on which area that would be blocking afferent fibers?
Inferior cerebellar peduncle
Middle cerebellar peduncle
Superior cerebellar peduncle
40. Chad presents to the ER following a seizure. In his history he tells you that he has been suffering from a migraine for the past three weeks that has been so severe that it has caused impairments in his vision. A CT reveals that he has hydrocephalus caused by a mass protruding into his third ventricle. His CT also reveals that the fluid buildup has caused a tonsillar herniation. Which artery is most likely to be affected by this herniation?
Superior cerebellar artery
Posterior Inferior cerebellar artery
Anterior Inferior cerebellar artery
Labyrinth arteryAnswer B.
41. Which of the following is the most medial of the deep cerebellar nuclei?
Interposed nucleusAnswer C.
42. Gymnastics is a difficult sport in which a lot of grace, poise, and mostly balance is needed to make gravity-defying moves look effortless. Studies have shown that gymnasts typically have a more well-developed cerebellum due to repetitive practice and in forcing their body to reorient itself after a particularly difficult routine on the uneven bars. Which of the following correctly identifies the order in which the message that helps a gymnast stay balanced on the beam arrives to the cerebellum?
Climbing fibers→Granule Cell→Purkinje fibers→Deep Nuclei→Brainstem→Thalamus
Thalamus→Brainstem→Deep Nuclei→Granule Cell→Climbing fibers→Purkinje fibers
Brainstem→Climbing fibers→Granule cell→Deep nuclei→purkinje fibers→Thalamus
Mossy fibers→climbing fibers→Purkinje fibers→Deep nuclei→Granule cell→Brainstem→Thalamus
Olivary nucleus→Mossy fibers→Granule cell→Purkinje fibers→Deep nuclei→ Brainstem→ThalamusAnswer E.
43. Damage to the lateral hemispheres of the cerebellum cause there to be an interruption to the dentate nucleus. This condition, known as Neocerebellar syndrome, is associated with which of the following symptoms?
Broad based, staggering gait
Incoordination of arm movements on the ipsilateral side
Incoordination of leg movements on the contralateral side
Positive Romberg’s TestAnswer B.
44. Which of the following cranial nerves exit the midbrain?
Olfactory – CN I
Oculomotor – CN III
Trigeminal – CN V
Facial – CN VII
Glossopharyngeal – CN IXAnswer B.
45. Which of the following marks the posterior rostral boundary for the midbrain?
Trochlear NerveAnswer D.
46. A patient with damage to their inferior colliculi would have trouble with which of the following?
Discriminatory touchAnswer C.
47. Damage to the Edinger-Westphal nucleus would present with which of the following symptoms?
Dilated pupilAnswer E.
48. A patient presents with difficulty flexing his arm but doesn’t appear to have any issues with extension. Which area would you expect to see a dysfunction or lesion?
Medial longitudinal fasciculus
Crus cerebriAnswer A.
49. During an anatomy dissection your professor stops by your table and remarks that it looks like your donor had parkinson’s disease Which area would he be looking at to make this assessment?
Medial longitudinal fasciculus
Crus cerebriAnswer C.
50. Which of the following symptoms would you to believe that a patient is suffering from Weber syndrome rather than Claude syndrome?
Ipsilateral paralysis of various eye movements
Dysfunction in contralateral extremities
Ipsilateral pupil dilation
Contralateral ataxiaAnswer D.
52. Which of the following herniations can lead to hydrocephalus?
Upward cerebellar herniation
Downward cerebellar herniation
Uncal herniationAnswer B.
9. Cranial Nerve Nuclei
53. Which of the following is correct in describing cranial nerve nuclei in the brainstem?
Motor tracts are more lateral
Sensory nuclei are more lateral
Higher number Cranial Nerves are more rostral
Lower number Cranial Nerves are more dorsal
The trigeminal nucleus is minorAnswer B.
54. Which Cranial Nerve Motor Nuclei is found in the Pons?
55. Which nerve fiber is the most lateral?
Somatic MotorAnswer D.
56. A patient presents to the clinic with a lesion to the spinal trigeminal nucleus, which Cranial Nerve’s CNS component is most likely to remain intact?
Vagus (X)Answer B.
57. Occlusion of the posterior inferior cerebellar artery (PICA) is most likely associated with which of the following?
Ischemia of the medial medulla
Ischemia of the lateral pons
Contralateral face sensory deficit
Ipsilateral body sensory deficit
58. Dr. Throckmorton STRESSED the importance of recognizing patterns in charts, that being said which of the following nerves is associated with a petrous fracture?
CN XIIAnswer B.
10. Hindbrain and Brainstem Lab
59. If a patient suffers from a lesion of the Left Superior Colliculus, then you would expect him/her to be unable to…
Reflexively turn the head to the Left in response to visual stimuli on the Left
Reflexively turn the head to the Left in response to visual stimuli on the Right
Reflexively turn the head to the Right in response to visual stimuli on the Left
Reflexively turn the head to the Right in response to visual stimuli on the Right
Reflexively turn the head to the 360 degrees in response to Pazuzu possessionAnswer D. Superior colliculus is thought to play a role in integrating sensory information (visual, auditory, somatosensory) into motor signals that help orient the head toward various stimuli. The LEFT superior colliculus tells the RIGHT cervical cord motor neurons (splenius capitis) to turn the head to the right.
60. What Cranial Nerve is the only one to project directly into the forebrain?
CN VIAnswer C.
61. While studying the posterior brainstem, you are able to identify a faint dividing line as the sulcus limitans. As you follow it rostrally you notice a bump in the caudal pontine region that is just medial to your line. What could this be?
Vestibular AreaAnswer B.
62. Damage occurring to the structure surrounding the cerebral aqueduct would result in a disruption of what function?
DeglutitionAnswer C. The Periaqueductal Gray surrounding the cerebral aqueduct is responsible for the suppression and modulation of pain (analgesia)
63. One would expect to see this area of the cerebral peduncle severely impacted in a patient with Parkinson’s Disease. What is….
Inferior Olivary Nucleus
Substantia NigraAnswer E. Cells in the substantia nigra use dopamine as their transmitter and they project to many areas in the forebrain.
64. What endocrine function does the pineal gland initiate?
A and C
None of the AboveAnswer E. There are no known neural outputs for endocrine function
65. Dr. Throckmorton’s doesn’t remember much about his first girlfriend, but he does remember the perfume that she used to wear. Like most first relationships, it ended with a very emotional separation. Which part of his brain allows Dr. Throckmorton to still be able to remember the smell of her perfume when he wanders past the women’s fragrance aisle in Walmart?
HippocampusAnswer A . The amygdala is a part of the limbic system that is responsible for emotional responses and emotional learning. Since they were in a relationship we can assume that emotions were involved and that he could pick out her scent (because of her perfume) when he was with or around her. Emotional learning is much more effective in retaining information, so that is why he is still able to recognize the scent and make the association with the perfume she used to wear.
66. Which structure in the brain works has a functional redundancy of the carotid body and the carotid sinus?
Posterior Inferior Cerebellar Artery
InsulaAnswer D. Remember that the carotid body and the carotid sinus are important because they act as a chemoreceptor and baroreceptor respectively. One of the roles of the hypothalamus is to monitor and control blood glucose, blood pressure, blood temperature, and blood osmolarity. It helps keep the body in homeostasis.
67. Bobby hasn’t been sleeping well the past couple weeks and it is starting to take a serious toll on his mental and physical health. He has tried lots of different oils, synthetic melatonin rubs, and “calming” vapors, but nothing seems to work. He goes to the local clinic and gets referred to a neurologist for a sleep study. After a work up the neurologist suspects that Bobby has a lesion in a part of his hypothalamus. Where would this lesion be located?
AmygdalaAnswer B. The suprachiasmatic nucleus is responsible for the circadian rhythms, which are driven by light. If this area is affected by a lesion, the patient would have a disrupted circadian rhythm and thus have trouble sleeping normally. Without diving too deep into sleep supplements, you can read the following article about melatonin and sleep and how it is not quite as effective as most of the population believes: https://www.ncbi.nlm.nih.gov/books/NBK11941/ .
68. Why are learned patterns of repetitive movements like shooting free throws or playing an instrument affected by Parkinson’s and Huntington’s diseases but not Alzheimer’s?
Parkinson’s disease is caused by the decrease in dopamine from the substantia nigra.
Parkinson’s and Huntington’s are congenital diseases and Alzheimer’s is not.
Parkinson’s and Huntington’s diseases do not affect subcortical structures because they start in the frontal lobe while Alzheimer’s starts in the brainstem.
Alzheimer’s does not affect subcortical structures.
Both B and CAnswer C. Parkinson’s and Huntington’s diseases affect the basal nuclei which are involved in the improvement of motor function with practice and learning patterns of repetitive movements. Since Alzheimer’s does not affect the basal nuclei those affected by it can still perform the functions asked about in the question.
69. Your patient has a lesion in the left cerebral hemisphere that affects the primary cortex in the gyrus just rostral to the central sulcus. This lesion is located in the most medial portion of this gyrus. Which deficit is most likely to be seen?
Somatosensory loss to the right side of face
Motor loss to the left foot.
Motor loss to the right side of face.
Somatosensory loss to the right foot.
Motor loss to the right foot.
70. Your patient has a lesion in the left cerebral hemisphere that affects the primary cortex in the gyrus just caudal to the central sulcus. This lesion is located in close proximity to the most lateral portion of the gyrus. Which deficit is most likely to be seen?
Somatosensory loss to the right side of the face.
Motor loss to the left foot.
Motor loss to the right side of the face.
Somatosensory loss to the right foot.
Motor loss to the left side of the face.
71. An OMS-I student frustratingly pounds their forehead on the table after hours of drawing neuro spinal tracts in preparation for the BECOM exam. This unwise action not only leaves a bruise, but subsequently damages their anterior association area of the cerebral cortex. Which associative function is most likely to be affected?
Emotional processing of sensation
All of the above
72. Your patient’s MRI displays a benign tumor which impairs their ability to learn and emotionally process sensation. Which association area is most likely affected by the tumor?
Anterior association area
Limbic association area
Auditory unimodal association area
Posterior association area
73. A mother and her son survive a horrifying elevator accident and nearly make a full recovery. Upon impact of the elevator freefall, they both obtained severe cranial injuries that damage their posterior association areas. During the recovery process, both the mother and the son were asked to name and copy a picture of cartoon puppy. The mother can name the picture, but is unable to copy it. The son reproduces the picture well, but is unable to name the animal he drew. What condition(s) do the mother and son suffer from?
Mother: Associative agnosia, Son: Apperceptive agnosia
Both suffer from different extremes of Associative agnosia
Son: Associative agnosia, Mother: Apperceptive agnosia
Both suffer from different extremes of Apperceptive agnosia
Son: Apperceptive agnosia, Mother: Associative agnosia
13. Cerebral Hemispheres Lab
74. “Identify the tagged structure labeled A” -DMC
Internal capsuleAnswer C.
75. “Identify the tagged structure labeled B” -DMC
76. “Identify the tagged structure labeled C” -DMC
Anterior tubercle of thalamus
Head of caudate nucleus
Pineal glandAnswer A.
77. “Identify the tagged structure labeled D” -DMC
78. “Identify the tagged structure labeled A” -DMC
Globus pallidus medial segment
Globus pallidus lateral segment
Anterior limb of the internal capsule
Posterior limb of the internal capsuleAnswer D.
79. “Identify the tagged structure labeled B” -DMC
Globus pallidus medial segment
Globus pallidus lateral segment
Anterior limb of the internal capsule
Posterior limb of the internal capsuleAnswer E.
80. “Identify the tagged structure labeled C -DMC
Extreme capsuleAnswer B.
81. “Identify the tagged structure labeled D” -DMC
Retrolenticular limb of the internal capsule
Posterior limb of the internal capsule
Anterior limb of the internal capsule
Dorsomedial limb of the internal capsuleAnswer A.
82. What is the function of the caudate nucleus
14. Somatosensory System I
83. Why is it possible for you to pinpoint the exact spot of a needle on your hand or finger but almost impossible to do so on your back?
Your back actually doesn’t have tactile receptors and can only make positioning based on the vibratory patterns
Nociceptors in your fingers carry fast pain sensations while your back carry slow pain making it easier to identify the location
The tactile receptors on your back need a larger stimulus to encite an action potential than those on your fingers
The tactile receptors on your fingers have a smaller receptive field than those on your back
Your back is not meant for the fine motor skill that your hands are so pinpointing locations is less important.Answer D.
84. Which of the following sensation receptors have short axons?
85. Which of the following cranial nerves does NOT carry special sensations?
CN VIIIAnswer C.
86. Which mechanoreceptor is essential in responding to vibrations?
Hair Follicle Receptors
Muscle SpindlesAnswer E.
87. Which of the following receptors has a layered capsule?
Hair follicle receptors
Free nerve endingsAnswer A.
88. In which of the following locations would you expect to find Merkel discs?
Middle thighAnswer B.
89. Proprioception sensations from the lower limbs are likely to be carried through which of the following?
90. The patellar tendon reflex is a response caused by stimulating what type of receptor?
Golgi tendon organ
Free nerve endingsAnswer A.
91. Presence of a biceps tendon reflex and absence of a triceps tendon reflex would indicate a lesion in which spinal cord segment?
92. Which of the following pathways conveys ipsilateral information yet still decussates along its route?
Posterior column-medial lemniscus
93. At which level does the neospinothalamic tract decussate?
At the spinal level they enter
In the medulla
In the pons
In the thalamus
It does not decussateAnswer A.
15. Somatosensory System II
94. A patient presents to the clinic with the inability to perceive pain. You, being a doctor, want to test the descending pain modulation pathway. Where does the pathway begin?
Periaqueductal Gray Matter
Nucleus Raphe Magnus
Dorsal HornAnswer A.
95. Enkephalin-containing interneurons release enkephalins, it is in the name, but how do they function?
Inhibit dopamine release from substantia nigra
Enhance dopamine release from substantia nigra
Competitive inhibitor of neurotransmitter uptake
Inhibit neurotransmitter release from central processes
Acts as an Acetylcholinesterase in synaptic junctionsAnswer D.
96. A patient presents with a rare, non-existent disease that specifically destroys unmyelinated C fibers. Which sensation is lost in the patient?
“What does warm mean”Answer B.
97. This condition is caused by repetitive but typically non-painful stimulation, such as sore throat or sunburns:
98. This condition results as higher centers of pain perception mistake the sensation of nociceptors:
Two point discrimination
Thalamic pain syndrome
Phantom limb painAnswer B.
99. What condition is characterized by pricking, tingling, burning sensations with etiologies such as PVD or nerve compression?
Thalamic pain syndrome
100. A patient presents with an injury to the Neospinothalamic tract, which two senses are altered or lost?
Auditory and Pain
Auditory and Thermal
Pain and Thermal
Visual and Auditory
Visual and BalanceAnswer C.
16. Introduction to Sensory Systems
101. Sensory Receptors have the lowest thresholds for which type of stimulus?
102. The threshold mentioned in the above question can be lowered by what type of structures?
103. Pat has seen YouTube videos of people doing experiments with dry ice and decides to go out and buy some of his own. While conducting one of his own “experiments” Pat picks up a piece with his bare hands. What type of receptors will respond as he holds the dry ice?
“Lukewarm” receptorsAnswer C. Cold receptors only respond to temperatures between 10 and 40 degrees C, below 10 C nociceptors begin to respond instead of Cold receptors. Dry ice usually runs around -78.5 C.
104. In a neuronal pool, there exists a zone where a given input nerve fiber has the ability to stimulate other neurons. This zone is called…
The Subliminal zone
The Facilitated zone
The Subthreshold zone
The Zap zone
The Liminal zoneAnswer E.
105. During a two point discrimination test, what is occuring physiologically to allow you to feel both points at such a short distance between them.
Adjacent InhibitionAnswer D.
106. What by definition is the point at which nociceptive stimulus is perceived as painful?
Neuropathic OriginAnswer D. Nociceptive Origin is initiated by nociceptors that are activated by injury to peripheral tissue. Pain Tolerance is the maximum intensity of pain that one can endure before doing something about it. Fast Pain is feeling pain very fast and sharp. Neuropathic Origin arises from direct injury or dysfunction of sensory axons of peripheral/central nerves.
107. True or False: Fast Pain is associated with deep tissue destruction.
FalseAnswer B. Fast pain is not felt in most deep tissues of the body, and slow pain is usually associated with tissue destruction.
108. Carl is a 70 year old man who has a history of osteomyelitis. This has left him with lower back pain for the past 10 years that seems to just be getting progressively worse. He learns that you are an osteopathic medical student and asks if you think HVLA would help with his pain. You remember that osteomyelitis is a contraindication for HVLA so you tell him that that approach would be a bad idea. What drug would you recommend might help with the progression of his back pain?
Substance P agonist
L-DOPA and carbidopa
NMDA antagonistAnswer E. While there might be some other side effects such as decreased Long Term Potentiation, from the scope of just pain management NMDA receptors that are activated by glutamate increase calcium levels that cause hyperexcitability of nociceptive nerve endings. These receptors are associated with chronic pain. Substance P would increase the pain response by activating the ascending pathways that transmit nociceptive pathways. AMPA receptors facilitate fast pain and transduction of the pain signals to higher centers. Choice B is not relevant to the question.
109. Enkephalin and serotonin are involved in the analgesia system. Which type of fibers do they inhibit?
Pre-synaptic type C fibers
Pre-synaptic type Aδ fibers
Post-synaptic type C fibers
Post-synaptic type Aδ fibers
All of the aboveAnswer E.
110. Which of the following would cause true visceral pain?
A clean transection of a part of bowel
A and C
A, B, and CAnswer D. Highly localized types of damage to the viscera seldom cause severe pain, so most severe pain in the viscera are pathological in nature. Ischemia and Ulcers cause true visceral pain because they are causing death of tissue in the organ and are from a chemical stimulus respectively. Cutting through the bowel should not cause true visceral pain because of the low density of nociceptors.
111. Brenda started to have weakness and loss of vibratory sense below her right hip, and loss of sensation of pain and temperature below her left hip. An MRI shows a lesion that has developed on a single side of her spinal cord at the level of T8. What disease/syndrome is she most likely to be diagnosed with and which side of her spinal cord is the lesion?
Phantom Limb Syndrome; Left side
Brown-Sequard Syndrome; Left side
Hyperalgesia; Left side
Brown-Sequard Syndrome; Right side
Headache; the entire spinal cordAnswer D. Phantom Limb Syndrome would include loss of everything below a certain point and is not directly associated with a type of lesion. Hyperalgesia is a hypersensitivity to pain. I’m sure that if the entire spinal cord was affected a headache could be present, but this is a throwaway answer choice. Brown-Sequard Syndrome is caused by a hemisection of the spinal cord. This disrupts the spinothalamic tract and the dorsal column medial lemniscus pathway dealing with the sensations of pain and temperature, and proprioception and vibratory sense respectively. This would cause ipsilateral disruption of proprioception and vibratory sense, and contralateral disruption of pain and temperature.
18. Histology of the Eye
112. A recent increase in intraocular pressure has caused the condition of glaucoma in your patient. Which of the following situations would result in this condition.
A decrease in aqueous humor production from the ciliary processes in the posterior chamber of the eye..
A blockage of Schlemm’s canal in the anterior corneal epithelium of the limbus.
An overproduction of aqueous humor from the ciliary processes in the anterior chamber of the eye.
A blockage of Schlemm’s canal in the stroma of the limbus.
Calcification of the descemet membrane resulting in of the cornea resulting in decreased elasticity and increased intraocular pressure.Answer D.
113. This epithelium of the ciliary processes is responsible for the creation of aqueous humor; parasympathetic activity causes zonule fibers to become _____.
Outer non-pigmented ciliary epithelium; loose
Inner pigmented epithelial layer; taut
Glassy membrane; taut
Choriocapillary layer; loose
Episclera; looseAnswer A.
114. As you are studying outside and reading from your medical book, you suddenly hear a distant rustling and look to the treeline far away from whence the noise came. Which physiological events took place as your vision changed from looking at the pages in your book to the distant treeline far away.
Ciliary muscle contraction; increased zonule fiber tension; flattening of the lens
Ciliary muscle relaxation; zonule fiber loosening; rounding of the lens
Ciliary muscle contraction; zonule fiber loosening; rounding of the lens
Ciliary muscle relaxation; zonule fiber tension; flattening of the lens
Ciliary muscle contraction; zonule fiber tension; rounding of the lensAnswer D.
115. A standard medical test during a patient check-up to check whether a patient’s exhibits PERRL (pupils are equal, round, and reactive to light). Which choice corresponds to the correct events and their autonomic association when shining a light into a patient’s eye?
Constrictor muscles contract (sympathetic); Dilator muscles contract (parasympathetic)
Constrictor muscles relax (parasympathetic); Dilator muscles contract (sympathetic)
Constrictor muscles contract (parasympathetic); Dilator muscles relax (sympathetic)
Constrictor muscles relax (sympathetic); Dilator muscles contract (parasympathetic)
Constrictor muscles contract (parasympathetic); Dilator muscles relax (sympathetic)Answer E.
116. Your patient complains randomly seeing “eye floaters” in their field of vision and inquires as to what they are. You kindly explain to them that what they are experiencing is/are called:
Small cataracts, where small opacifications of their lens has occurred resulting in blurring vision.
Presbyopia, where focal opacifications of the vitreous humor has results in blurry and floating clumps.
Vitreous opacities, where the liquification of the vitreous body has caused the debris within it to clump.
Retinitis pigmentosa, where opaque clumps in the pigmented layer of epithelium has cast shadow-like clumps over the optical retina.
Presbyopia, where debris has accumulated within the vitreous humor faster than it can be cleared by the resident phagocytic hyalocytes.Answer C.
117. Which of the following conditions could indicate retinal detachment in your patient?
Loss of accommodation due to hardening of the lens.
Accumulation of debris from photoreceptor cells that accumulates on the pigmented epithelial layer.
Blurred vision resulting from opacification of the lens.
Fuzzy vision that accompanies eye floaters in the vitreous humor.
Erythematous conjunctiva that fails to clear.
118. These photoreceptor cells are extremely sensitive to light; use _____ as their light absorption molecule; (which is broken down from the photopigment, _____); and rely on _____ for photopigment restoration where a deficiency can lead to light blindness.
Rods; rhodopsin; retinal; Vitamin A
Rods; iodopsin, retinal Vitamin A
Rods; retinal; rhodopsin, Vitamin D
Rods; retinal; iodopsin; Vitamin D
Rods; retinal; rhodopsin; Vitamin A
119. After studying all night for the BECOM exam, you notice red bump on your eyelid. You remember seeing something similar on your infant nephew when you saw him over winter break and remember that it is called a ______.
120. The ______ lies within the center of Macula lutea where the highest concentration of cone density occurs. Depigmentation of the posterior epithelium within this area leads to this leading age-related cause of blindness.
Fovea Centralis; retinitis pigmentosa
Zonula fovea; macular degeneration
Foveola; retinitis pigmentosa
Optic papilla; macular degeneration
Foveola; macular degeneration
121. Glaucoma can cause irreversible blindness due to an increase in intraocular pressure. This ocular pressure is caused by a buildup of aqueous humor that is secreted by which of the following structures?
Non-pigmented ciliary epithelium
Pigmented simple columnar ciliary epithelium
Ciliary zonuleAnswer B.
19. Visual System
122. Jacob came into your office complaining of headaches, changes in mood, and changes in his vision. As these symptoms are consistent with a lot of problems, you decide to get a full workup including a CT. The CT revealed an enlargement of his pituitary gland that could potentially be cancerous. Which of the following patterns would be consistent with his visual field deficits?
Right Nasal hemianopia
Left Nasal hemianopsia
Left homonymous hemianopia
Right homonymous hemianopiaAnswer D. A pituitary gland tumor would compress on his optic chiasm.
123. Kayla comes in saying that she is unable to see straight ahead out of her left eye. To perform a physical examination, you have her cover her right eye and move a pen in all directions. She is able to follow the pen and see if from her periphery. However, when you move it to the right side of her body, she is unable to see it out of her left eye until you move the pen past her nose. Physical examination of the right eye and pupillary reflex was normal. Which of the following is the most likely cause of her problem?
Left oculomotor nerve palsy
Left optic nerve lesion
Left optic tract lesion
Lesion on the Right angle of optic chiasm
Lesion on the Left angle of optic chiasmAnswer E. Physical examination revealed a deficit in her left nasal visual field.
124. Your friend showed you the above image of last night’s sunset. Because you are a nerd and you no longer have the social skills to interact with people who are not in medical school, you decide to tell them where the water part of the image was processed in the occipital lobe and the pathway that it took to get to the orientation that you are now viewing it. Which of the following is the correct explanation that got you (deservedly) slapped upside the head by your annoyed friend?
The image was sensed by the photoreceptors in the retina that flopped the right and left sides of the image, it then traveled to the medial geniculate in the thalamus, then the lake portion of the image was sent around Myer’s loop to the calcarine gyrus of the occipital lobe.
The image was sensed by the photoreceptors in the retina that flopped the right and left sides of the image, it then traveled to the lateral geniculate in the thalamus, then the lake portion of the image was sent around Myer’s loop to the lingual gyrus of the occipital lobe.
The image was sensed by the photoreceptors in the retina that flopped the right and left sides of the image, it then traveled to the lateral geniculate in the thalamus, then the lake portion of the image was sent to the calcarine gyrus of the occipital lobe (without going around Myer’s loop).
The image was sensed by the photoreceptors in the retina that flopped the right and left sides of the image, it then traveled to the lateral geniculate in the thalamus, then the lake portion of the image was sent to the lingual gyrus of the occipital lobe (without going around Myer’s loop).
The image was sensed by the photoreceptors in the retina that flopped the right and left sides of the image, it then traveled to the medial geniculate in the thalamus, then the lake portion of the image was sent to the calcarine gyrus of the occipital lobe (without going around Myer’s loop).Answer C.
125. When shining a light into the patient’s eye, the opposite eye also constricts, this is known as which of the following?
Near Triad reflex
Direct light reflex
Consensual light reflex
Pupillary Dilation reflex
Accommodation reflexAnswer C.
126. Retinitis pigmentosa is an inherited metabolic disorder that affects the photoreceptors and retinal pigment epithelial cells. Which of the following is not a symptom of Retinitis pigmentosa?
Pigmentation on the retina
Loss of peripheral visionAnswer D.
20. Special Sense I – Vision
127. Which of the following has the greatest refractive power?
Vitreous HumorAnswer A.
128. Which of the following structures are avascular?
129. In which of the following locations would you expect to find the enzyme Carbonic Anhydrase?
Pigmented Epithelium of the ciliary body
Cells of the renal tubule
All of the aboveAnswer E.
130. Through which of the following mechanisms are chloride ions allowed to leave the pigmented epithelium without affecting the membrane potential?
The sodium potassium pump allows more sodium out than potassium in thus making the charge difference negligible
Chloride is exchanged with bicarbonate ions so the charges cancel out
Bicarbonate ions are produced by the carbonic anhydrase enzyme thus equalizing the charge
Since the eye is not an excitable cell we are not worried about the membrane potential
Chloride must go anywhere sodium does because according to chefs, “salt is the essence of life”Answer C.
131. Which of the following conditions is characterized by an increased intraocular pressure caused by either increased production or decreased removal of aqueous humor?
Keratoconic corneaAnswer D.
132. Which of the following is an effect of the parasympathetic nervous system on the eye?
Relaxation of the ciliary muscle
Dilation of the pupil
Relaxation of the zonular ligaments
Lens flatteningAnswer C.
133. Which of the following junctions are the connections the weakest and thus more likely to separate from one another?
Ganglion cell and bipolar cell
Ganglion cell and Amacrine cell
Horizontal cell and photoreceptor
Bipolar cell and photoreceptor
Photoreceptor and pigmented epitheliumAnswer E.
134. Which of the following is a characteristic of the fovea centralis?
High neuronal convergence
High receptor density
High concentration of rods
Low visual acuityAnswer C.
135. Which breakdown product stimulates transducin when a photoreceptor has been exposed to light?
136. Glaucoma is a disease in which the intraocular pressure increases. Carbonic anhydrase inhibitors can help alleviate symptoms caused by this disease. Which of the following explains the mechanism of action of these types of medications?
They inhibit the formation of bicarb, which does not allow for more chloride to flow into the stroma thus lowering the pressure
They inhibit the formation of bicarb, which allows for more chloride to flow into the stroma thus lowering the pressure
They inhibit the formation of bicarb, which does not allow for more chloride to flow into the aqueous humor thus lowering the pressure
They inhibit the formation of bicarb, which allows for more chloride to flow out of the aqueous humor thus lowering the pressure
They inhibit the formation of bicarb, which does not allow for more chloride to flow into the aqueous humor and the stroma thus lowering the pressureAnswer C.
137. Dorzolamide is a topical medication often given to patients with open angle glaucoma. It acts as a carbonic anhydrase inhibitor in the pigmented epithelium of the ciliary body to decrease secretion of aqueous humor in the non-pigmented epithelium. What is the main ion implicated in this process?
K+Answer C. Inhibition of carbonic anhydrase leads to decreased formation of HCO3– from carbonic acid, leading to less secondary transport of Cl– and subsequent diffusion of H2O into the aqueous humor.
138. ARCOM’s class of 2023 collectively had their day messed up when they applied tropicamide solution to their eyes while learning how to conduct an ophthalmic examination, leading to cycloplegic vision in one eye for the rest of the day. Tropicamide acts as a muscarinic acetylcholine receptor antagonist. How would this have lead to cycloplegia?
Decreased parasympathetic innervation to the ciliary muscle causes pupillary dilation, allowing more light to hit the retina and decreasing depth of focus in the lens
Decreased parasympathetic innervation to the ciliary muscle causes contraction of the zonular fibers, thinning the lens and inhibiting accommodation.
A & B
Neither A or BAnswer B.
139. A 43 y.o. female patient presents to your clinic complaining of vision loss. The visit is prompted by an auto accident where she pulled out in front of a car approaching from the left that she claims she never saw. On complete visual field testing you find that this woman has a left homonymous hemianopsia. You perform an MRI and find a tumor impinging on part of her visual pathway. Based on her visual field defect, which of the following is the most likely location of her tumor?
Left optic nerve
Right optic tract
Right inferior optic radiations (Meyer loop)Answer C.
21. Movement of the Eye
140. A patient presents with a lesion in the oculomotor nerve, which of the following signs does the patient present with?
Eye deviates superiorly and medially
Eye deviates inferiorly and medially
Eye deviates inferiorly and laterally
Eye deviates superiorly and laterally
Diplopia of the eyeAnswer C.
141. Damage to the paramedian pontine reticular formation would complicate vision in which of the following visual movements?
Smooth PursuitAnswer B.
142. A patient presents with a pineal gland tumor, which physical sign of the eye can help with diagnosis?
Upward gaze paralysis
Downward gaze paralysis
Lateral gaze paralysis
Medial gaze paralysis
Paralysis of divergenceAnswer A.
143. A lesion to the reticular formation of the rostral midbrain near the oculomotor nuclei would result in complications of which movement aspect to vision?
Vestibulo-ocular movementsAnswer C.
144. In a bizarre series of events, a patient presents after receiving a botched neurosurgery from a back alley surgeon in Mexico. In addition to missing a kidney, the patient had their temporal eye field removed, which aspect of eye movement is most likely to be dysfunctional?
Vestibulo-ocular movementsAnswer B.
22. Histology of the Ear
145. The histology slide above is from the external auditory meatus, identify the structures denoted as “A”
Stratified Squamous EpitheliumAnswer C.
146. The histology slide above is from the external auditory meatus, identify the structures denoted as “B”
Stratified Squamous EpitheliumAnswer D.
147. If a patient sustains sufficient blunt trauma to the petrous part of the temporal bone, what is he/she in danger of damaging?
Both A and BAnswer E.
148. If the Organ of Corti becomes damaged in any way, what function will most likely be impaired?
Visual acuityAnswer B.
149. Hearing loss is the leading disability found amongst army veterans. Although you are pretty sure they all have functional stapedius and tensor tympani muscles, what is the most likely reason they still developed hearing loss?
The army veterans sustained blunt trauma to their ears causing damage to their cochleas
The middle ear reflexes are too slow to react to sudden loud noises such as gunshots
The middle ear muscles have hypertrophied due to excess use causing all sounds to become dampened
The ossicles have become damaged from the muscles pulling on them so frequently
The tensor tympani muscle has caused a tear in the tympanic membrane through excessive use of normal reflexesAnswer B.
23. Auditory System
150. What is the main function of the hair cells in the inner ear?
To convert electrical signals into waves in the perilymph
To convert waves in the perilymph into electrical signals
To convert electrical signals into waves of the endolymph
To convert waves in the endolymph into electrical signals
To protect the organ of Corti from otoconiaAnswer D. Remember that inner ear hair cells are located in the membranous labyrinth that is filled with endolymph, and the membranous labyrinth is suspended in the bony labyrinth by perilymph. Hair cells take the waves that were funneled from the outer ear to the middle ear to the inner ear and converts that into an electrical signal which gets sent to the thalamus for processing.
151. A woman comes to your clinic having a previous diagnosis of Meniere’s Disease that has been exacerbated by a serious bacterial infection. You decide that gentamicin injection into the cochlea is the best treatment option, but it has some unwanted side effects such as hearing loss. Why is this the case?
It destroys the basilar membrane, preventing electrical signals from being produced from sound waves.
It coagulates the endolymph disrupting sound waves entering the cochlea.
It kills outer hair cells that are used to amplify sound wave propagation in the inner ear.
It increases the amount of inner hair cells on the basilar membrane, making it more crowded and the hair cells less likely to be displaced by the sound waves.
It binds Potassium in the endolymph to the extent that there is not enough to propagate an electrical signal in the cell.Answer C. Gentamicin kills outer hair cells which can result in hearing loss due to raising the auditory threshold. Since outer hair cells amplify sound wave propagation through the endolymph, a more intense level of sound is needed to displace the inner hair cells if the outer hair cells die.
152. A 50 year old patient comes to the clinic complaining of hearing problems. Upon examination you find nothing blocking his hearing, and further examination shows negative Weber and Rhinne tests. When you ask him to close his eyes and point to where you are standing, he is unable to locate where you are. An audiogram is ordered and shows normal conduction, but poor sound localization. MRI shows a small lesion in his brainstem. Where is this lesion located?
Superior Olivary Nucleus
Superior ColliculusAnswer A. Signals from the inner hair cells travel to the spiral ganglion in the inner ear, and to the brainstem via CN VIII. Cochlear nuclei synapse and go through ascending fibers through the pontomedullary junction, where some fibers decussate at the superior olivary nucleus, and the rest travel through the medial lemniscus to the lateral lemniscus and eventually to the primary auditory cortex. The decussation of fibers travels to the contralateral auditory cortex to be compared with signals from it’s ipsilateral side. This is how the brain is able to determine the origin of the location of a sound.
153. The lateral olivocochlear efferents from the superior olivary nucleus are sent to to:
Outer Hair Cells
Middle Hair Cells
Inner Hair Cells
Inferior Olivary NucleusAnswer D.
154. What cranial nerves are activated by hearing reflexes?
All of the above
B and CAnswer D. CN VIII is the primary afferent nerve for hearing and CN V and VII are the efferents that innervate the stapedius and tensor tympani muscles if the middle ear. These contract to limit the volume of outside noises and limit the volume of your own mastication and conversation.
24. Special Sense II – Auditory
155. Which of the following results in the excitation of hair cells:
Bending of the hair cells away from the kinocilium
K+ efflux on the apical side
Bending the of the hair cells toward the kinocilium
K+ efflux on the basolateral side
Closing of Cation channels
156. In regarding the anatomical structure of the basilar membrane in the scala vestibuli, which answer choice correctly describes its anatomical layout:
Longer basilar fibers towards the base; shorter diameter towards the apex
Shorter basilar fibers towards the base; shorter diameter towards the apex
Longer basilar fibers towards the apex; shorter diameter towards the base
Longer basilar fibers towards the apex; longer diameter towards the apex
Shorter basilar fibers towards the apex; longer diameter towards the base
157. Damage to the mandibular branch of the trigeminal nerve would result in which of the following deficits:
LOF tensor tympani muscle; increased sound dampening
LOF stapedius muscle; decreased sound dampening
LOF tensor tympani muscle; decreased sound dampening
LOF stapedius muscle; increased sound dampening
LOF stapedius muscle; increased acoustic impedance
158. Which of the following middle ear ossicles is “All Powerful” and rules our audio perception with its iron foot plate?
Stapes (tee hee)
Oval windowAnswer C.
159. Which area of the scala media best responds to high frequency vibrations:
Towards the apex
Towards the base
Tip of the Cochlea
Towards the middleAnswer B.
25. Cortical Function – Vestibular System
160. Ricky Bobby grew up watching NASCAR and wanted nothing more in life than to go fast. In fact, he was tested for autism because of his delayed speech– He just kept repeating: “I wanna go fast” until about age 6. Unfortunately, his dreams came crashing down, as he couldn’t even look left without becoming extremely dizzy to the point of nausea. So, constant left turns around that glorious racetrack were not feasible for his future. He went to an otolaryngologist who suspected the problem lies in his inner ear. Which of the following structures is most likely responsible for his symptoms?
Left Anterior semicircular duct
Left Posterior semicircular duct
Right Horizontal semicircular duct
Left SacculaAnswer A. When looking forward and to the left the reciprocal motion of the endolymph is to move backwards and to the right. In order for this to occur from a physiological standpoint, the flow of the endolymph must be in line with the orientation of the semicircular duct. This alignment occurs in the left anterior semicircular duct and the right posterior semicircular duct. See below image.
161. After your BECOM exam you went to the Electric Cowboy and had quite a few fruity drinks lowering more than your inhibitions. Ethanol is less dense than endolymph so as it begins to replace the endolymph in your cupulae, suddenly the room keeps spinning even when your partner isn’t spinning you anymore. Which of the following explains this phenomenon?
The cupulae moves the hair more readily so you feel like you are moving more than you are
The cupulae moves the hair more readily so you feel like you are moving less than you are
The cupulae moves the hair less readily so you feel like you are moving more than you are
The cupulae moves the hair less readily so you feel like you are moving less than you are
Alcohol dampens sound conduction so the room begins to spin.Answer A.
162. Your patient comes to you saying that they get dizzy where it feels like the room is spinning and sometimes they even fall over. You believe they are suffering from vertigo, which of the following is true?
Calcium carbonate crystals are in their utricle
Calcium bicarbonate crystals are in their utricle
Calcium carbonate crystals are in their semicircular canals
Calcium bicarbonate crystals are in their semicircular canals
Calcium bicarbonate crystals are in their sacculeAnswer C.
163. Yolanda comes to you concerned about her father, Rolando, who has been experiencing a lot of falls in his old age. You decide to perform a Romberg’s test to see where the problem may lie. Upon examination you have him stand with feet together and before he can even close his eyes he is falling over. This is likely a problem with which of the following pathways?
Dorsal column medial lemniscus
Descending vestibularAnswer C.
164. Which of the following is not a component of your vestibular system?
Vestibulocochlear NerveAnswer C.
165. Hank comes to you with a suspected concussion sustained by a tough left-sided tackle that caused his helmet to fly off. He claims that he feels dizzy, had blurry, double vision that has since cleared up, tinnitus, and has been experiencing nausea and vomiting with motion. After physical examination, you suspect that he has benign paroxysmal positional vertigo. Which of the following parts of his history and physical confirms this diagnosis?
Blunt trauma to the head
Dizziness when looking down
Ability to duplicate symptoms in clinic
TinnitusAnswer D. Although A occurred and caused his concussion, thus causing B, C, and E, the ability to replicate when he gets dizzy (from looking down) in office is what confirms the diagnosis and differentiates it from other causes of vertigo.
26. Vestibular Function
166. Damage within the vestibule would result in the loss of which sensation?
167. Movement of which of the following are responsible for causing the sensation of gravity or linear acceleration?
Tectorial membraneAnswer D.
168. Movement of the stereocilia away from the kinocilia would cause which of the following?
No change in membrane potential
Muscle contractionAnswer D.
169. A patient presents to your clinic with the complaint of motion sickness when she rides in a car. She states its worse when she sits in the back and unbearable when she tries to read while in the car. Being the good doctor you were trained to be, what do you explain is happening to the patient before you prescribe her Dramamine and send her on her merry way?
There is a problem with the nerve that connects your ear to your brain and it is sending signals saying that you are moving when you’re just sitting in the car
Your brain becomes confused because your ears are telling it that you are moving when your eyes are telling it that you are staying still
Your ear is starting to undergo degenerative changes and unfortunately there is nothing you can do and you will eventually become deaf.
Your brain becomes confused because your eyes are telling it that you are moving when your ears are telling it that you are staying still
You’re broken. Here’s drugs.Answer B.
170. In which way are the semicircular ducts and vestibule different?
The semicircular ducts sense linear acceleration while the vestibule senses gravity
The semicircular ducts have hair cells as receptors while the vestibule has free nerve endings
The semicircular ducts have cupulas while the vestibule has otoliths
The semicircular ducts participate in eye reflex movements while the vestibule does not
The semicircular ducts undergo adaptation while the vestibule does notAnswer C.
171. Which of the following reflexes is responsible for causing eye movements in response to objects moving in the periphery of the visual field while the head is stationary?
Vestibuloparasympathetic reflexAnswer B.
172. Which of the following is characterized by abnormalities in the volume or regulation of endolymph fluid resulting in increased endolymphatic pressure?
Benign paroxysmal positional vertigo
Otitis mediaAnswer C.
27. Basal Ganglia Function
173. The Basal ganglia, being the ancient part of the brain, is important in which basic function?
Vocal filtration to avoid SPCAnswer B.
174. The Basal Ganglion medium spiny neurons output is associated with which neurotransmitter?
175. There are three intrinsic connections within the basal ganglia, which pathway is the most critical to multitasking?
Hypodirect PathwayAnswer A.
176. Lesion of this basal ganglia pathway results in excessive movements syndromes such as Huntingtons?
Hypodirect PathwayAnswer B.
177. Which of the following conditions relates to dysfunction of all 4 functions of Basal Ganglia?
Bilateral GangliatitisAnswer C.
178. Which of the following tracts, upon receiving decreased input from the basal ganglia, would be responsible for the characteristic gait found in patients with Parkinson’s disease?
Dorsal spinocerebellar tract
Tectospinal tractAnswer C.
179. Which of the following structures serves as the primary output from the basal ganglia?
Substantia nigra pars reticulata
Globus pallidus interna