BECOM 2 Exam 1 – 2020

1. CNS Development

1. Which of the following correctly pairs chemical signal with area of development?

  1. Sonic hedgehog: Alar pole (sensory)

  2. Sonic hedgehog: Basal pole (motor)

  3. Sonic hedgehog: Alar pole (motor)

  4. Sonic hedgehog: sulcus limitans

  5. 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?

  1. Pons

  2. Cerebellum

  3. Cerebrum

  4. Medulla

  5. Midbrain

3. Paige was born without vertebral arches and a cystic mass containing meninges and CSF. What condition does she have?

  1. Spina bifida occulta

  2. Spina bifida cystica menigocele

  3. Spina bifida cystica meninigomyelocele

  4. Encephalocele meningocele

  5. Encephalocele meningomyelocele

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?

  1. Corpus Callosum

  2. Pineal gland

  3. Gyrus rectus

  4. Superior colliculus

  5. Inferior colliculus

5. Which of the following symptoms would you expect to see in Bradley if he is missing the structure in the answer above?

  1. Regulation of body temperature, appetite, sexual behavior and emotional responses

  2. Consolidation of information from short-term memory to long-term memory

  3. Deficits in attention, lower intellectual function, issues being able to read, learn and with verbal memory, problems with executive and psychosocial functions

  4. Production of melatonin, irregular sleep patterns

  5. 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.

  1. Christiansen Reflex

  2. Flexor Reflex

  3. Monosynaptic Stretch Reflex

  4. Crossed Extensor Reflex

  5. B and D

 

7. Which structure carries proprioception and discriminative touch from spinal levels T7 and below to the medulla?

  1. Fasciculus gracilis

  2. Fasciculus cuneatus

  3. Nucleus gracilis

  4. Nucleus cuneatus

  5. Substantia gelatinosa

 

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?

  1. Subacute combined degeneration

  2. Multiple sclerosis

  3. Tabes Dorsalis

  4. Osteogenesis Imperfecta

  5. Syringomyelia

9. Which descending spinal tract is responsible for controlling limb flexor muscles?

  1. Spinothalamic Tract

  2. Vestibulospinal Tract

  3. Rubrospinal Tract

  4. Reticulospinal Tract

  5. Corticospinal Tract

 

10. Where does the corticospinal tract originate?

  1. Inferior Frontal Lobe

  2. Parahippocampal Gyrus

  3. Postcentral Gyrus

  4. Cingulate Gyrus

  5. Precentral Gyrus

3. Brain Topography

 

11. In which location are the cell bodies located for the rubrospinal tract?

  1. Cerebral cortex

  2. Thalamus

  3. Red Nucleus

  4. Nucleus Gracilis 

  5. Dorsal Horn of the associated spinal level

 

12. The cingulate sulcus separates which two lobes?

  1. Frontal and Parietal 

  2. Frontal and Limbic

  3. Parietal and Temporal

  4. Parietal and Occipital

  5. Occipital and Limbic

 

13. In which of the following areas would you find the frontal eye field?

  1. Precental gyrus

  2. Superior frontal gyrus

  3. Middle frontal gyrus

  4. Inferior frontal gyrus

  5. Gyrus rectus

 

14. A patient suffers a stroke which selectively damages the inferior frontal gyri. Which of the following would most drastically affected?

  1. Primary motor cortex

  2. Supplementary motor area

  3. Frontal eye field

  4. Broca’s area

  5. Prefrontal cortex

 

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?

  1. Prefrontal cortex

  2. Inferior frontal gyri

  3. Inferior parietal lobule

  4. Inferior temporal gyri

  5. Lingual gyrus

 

16. The primary visual cortex is situated around which of the following sulci?

  1. Lateral

  2. Central

  3. Pareitoocipital 

  4. Cingulate

  5. Calcarine

 

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?

  1. Frontal

  2. Parietal

  3. Temporal

  4. Occipital

  5. Limbic

 

18. A blockage develops in the right callosomarginal artery. Which limb is most likely affected?

  1. Right arm

  2. Right leg

  3. Left arm

  4. Left leg

  5. Both lower extremities

 

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?

  1. Pericallosal 

  2. Anterior cerebral

  3. Posterior cerebral 

  4. Lenticulostriate 

  5. Basilar

 

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?

  1. Pericallosal

  2. Posterior Cerebral

  3. Lenticulostriate 

  4. Internal auditory

  5. Posterior Inferior Cerebellar

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?

  1. Eye Movement

  2. Planned Movement

  3. Visual Association

  4. Personality

  5. Hearing

 

22. Using the same image, the blue circle most likely indicates function associated to which body part?

  1. Foot

  2. Hip

  3. Hand

  4. Tongue

  5. Larynx

 

23. Area 17 is correctly matched with the following lobe and function?

  1. Temporal – Auditory

  2. Temporal – Visual

  3. Parietal – Auditory

  4. Occipital – Auditory

  5. Occipital – Visual

 

24. A patient was born without areas 18 and 19, which of the following senses would be most affected?

  1. Smell

  2. Taste

  3. Touch

  4. Hearing

  5. Seeing Dead People

 

25. “Identify the tagged structure (24)” – DMC?

  1. Cingulate Gyrus

  2. Corpus Callosum

  3. Straight Gyrus

  4. Postcentral Gyrus

  5. Supramarginal Gyrus

26. Identify Number 2?

  1. Olfactory Bulb

  2. Olfactory Tract

  3. Orbital Gyri

  4. Gyrus Rectus

  5. Optic Tract

 

27. If the entirety of the structure labeled “4” was removed, what aspect of the brain would be lost?

  1. Olfactory Processing

  2. Connection of the Cerebral Hemispheres 

  3. Visual Processing

  4. CSF Production 

  5. Basic Personality

5. Medulla Oblongata

 

28. At what level of the Medulla does the restiform body begin to form

  1. Pons – Medullary Junction

  2. Motor Decussation level

  3. Sensory Decussation level

  4. Mid-Medullary level

  5. Rostral Medulla

     

 

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?

  1. Right Spinal Trigeminal Tract

  2. Left Spinal Trigeminal Tract

  3. Left Anterolateral Tract

  4. Right Anterolateral Tract

  5. Left Spinothalamic Tract

30. A lesion in which artery could account for the deficits found in the previous question?

 

  1. Basilar Artery

  2. AICA

  3. Anterior Spinal Artery

  4. PICA

  5. Vertebral Artery

 

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?

  1. Lateral reticular nucleus

  2. Parvocellular nucleus

  3. Ventrolateral reticular area

  4. Raphespinal fibers

  5. Nucleus Raphes Magnus

 

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?

  1. Level of the Obex

  2. Mid-Medullary Level

  3. Pons-Medulla junction

  4. Rostral Medulla

  5. Sensory Decussation Level

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?

  1. Loss of vision and/or Double vision

  2. Seizures 

  3. Loss of balance

  4. Sudden change in heart rate and respiration

  5. Inability to distinguish objects placed in your hand (Astrogenesis)

6. Pons

 

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?

 

  1. Foramen of Luschka

  2. Pontomesencephalic junction

  3. Inferior collicular aperture

  4. Medullarypontine recess

  5. Pontomedullary junction

 

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.

  1. Cerebral cortex → pontocerebellar fibers → pontine nuclei → contralateral inferior cerebellar peduncle → cerebellar hemisphere

  2. Cerebral cortex → corticopontine fibers → pontine nuclei → pontocerebellar fibers → ipsilateral middle cerebellar peduncle → cerebellar hemisphere

  3. Cerebral cortex → corticopontine fibers → pontine nuclei → pontocerebellar fibers → contralateral middle cerebellar peduncle → cerebellar hemisphere

  4. Cerebral cortex → pontocerebellar fibers → pontine nuclei → corticopontine fibers → contralateral superior cerebellar peduncle → cerebellar hemisphere

  5. 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?

  1. Right lateral rectus muscle; left Abducens

  2. Right lateral rectus muscle; right Trochlear

  3. Right medial rectus muscle; right Abducens

  4. Right medial rectus muscle; left Trochlear

  5. 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?

  1. Right basal pons

  2. Right pontine tegmentum

  3. Left basal pons

  4. Medial Lemniscus

  5. 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?

  1. Middle cerebellar peduncles; CN VI

  2. Superior cerebellar peduncles; CN IV

  3. Middle cerebellar peduncles; CN IV

  4. Superior cerebellar peduncles; CN VI

  5. Superior cerebellar peduncles; CN V

 

7. Cerebellum

 

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?

  1. Inferior cerebellar peduncle

  2. Middle cerebellar peduncle

  3. Superior cerebellar peduncle

  4. Flocculus

  5. Vermis

 

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?

  1. Superior cerebellar artery

  2. Posterior Inferior cerebellar artery

  3. Anterior Inferior cerebellar artery

  4. Basilar artery

  5. Labyrinth artery

 

41. Which of the following is the most medial of the deep cerebellar nuclei?

  1. Globose nucleus

  2. Dentate nucleus

  3. Fastigial nucleus

  4. Emboliform nucleus

  5. Interposed nucleus

 

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?

  1. Climbing fibers→Granule Cell→Purkinje fibers→Deep Nuclei→Brainstem→Thalamus

  2. Thalamus→Brainstem→Deep Nuclei→Granule Cell→Climbing fibers→Purkinje fibers

  3. Brainstem→Climbing fibers→Granule cell→Deep nuclei→purkinje fibers→Thalamus

  4. Mossy fibers→climbing fibers→Purkinje fibers→Deep nuclei→Granule cell→Brainstem→Thalamus

  5. Olivary nucleus→Mossy fibers→Granule cell→Purkinje fibers→Deep nuclei→ Brainstem→Thalamus

 

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?

  1. Broad based, staggering gait

  2. Incoordination of arm movements on the ipsilateral side

  3. Incoordination of leg movements on the contralateral side

  4. Festinating gait

  5. Positive Romberg’s Test

8. Midbrain

 

44. Which of the following cranial nerves exit the midbrain?

  1. Olfactory – CN I

  2. Oculomotor – CN III

  3. Trigeminal – CN V

  4. Facial – CN VII

  5. Glossopharyngeal – CN IX

 

45. Which of the following marks the posterior rostral boundary for the midbrain?

  1. Crura Cerebri

  2. Interpeduncular fossa

  3. Mammillary bodies

  4. Posterior commissure 

  5. Trochlear Nerve

 

46. A patient with damage to their inferior colliculi would have trouble with which of the following?

  1. Hand coordination

  2. Vision

  3. Hearing

  4. Temperature sensation

  5. Discriminatory touch

 

47. Damage to the Edinger-Westphal nucleus would present with which of the following symptoms?

  1. Constricted pupil 

  2. Hearing loss

  3. Facial sensation 

  4. Increased pain

  5. Dilated pupil

 

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?

  1. Red nucleus 

  2. Periaqueductal grey

  3. Substantia nigra 

  4. Medial longitudinal fasciculus 

  5. Crus cerebri

 

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?

  1. Red nucleus

  2. Periaqueductal grey

  3. Substantia nigra

  4. Medial longitudinal fasciculus

  5. Crus cerebri

 

50. Which of the following symptoms would you to believe that a patient is suffering from Weber syndrome rather than Claude syndrome?

  1. Ipsilateral paralysis of various eye movements

  2. Dysfunction in contralateral extremities 

  3. Ipsilateral pupil dilation

  4. Tongue deviation

  5. Contralateral ataxia

 

52. Which of the following herniations can lead to hydrocephalus?

  1. Central herniation

  2. Upward cerebellar herniation

  3. Lateral herniation

  4. Downward cerebellar herniation

  5. Uncal herniation

9. Cranial Nerve Nuclei

 

53. Which of the following is correct in describing cranial nerve nuclei in the brainstem?

  1. Motor tracts are more lateral

  2. Sensory nuclei are more lateral

  3. Higher number Cranial Nerves are more rostral

  4. Lower number Cranial Nerves are more dorsal

  5. The trigeminal nucleus is minor

 

54. Which Cranial Nerve Motor Nuclei is found in the Pons?

  1. X

  2. VIII

  3. VII

  4. IV

  5. XI

 

55. Which nerve fiber is the most lateral?

  1. Pharyngeal Motor

  2. Autonomic

  3. Visceral Sensory

  4. Somatic Sensory

  5. Somatic Motor

 

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?

  1. Trigeminal (V)

  2. Abducens (VI)

  3. Facial (VII)

  4. Glossopharyngeal (IX)

  5. Vagus (X)

 

57. Occlusion of the posterior inferior cerebellar artery (PICA) is most likely associated with which of the following?

  1. Ischemia of the medial medulla

  2. Ischemia of the lateral pons

  3. Contralateral face sensory deficit

  4. Ipsilateral body sensory deficit

  5. Wallenberg’s

 

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?

  1. CN II

  2. CN IV

  3. CN IX

  4. CN X

  5. CN XII

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…

  1. Reflexively turn the head to the Left in response to visual stimuli on the Left

  2. Reflexively turn the head to the Left in response to visual stimuli on the Right

  3. Reflexively turn the head to the Right in response to visual stimuli on the Left

  4. Reflexively turn the head to the Right in response to visual stimuli on the Right

  5. Reflexively turn the head to the 360 degrees in response to Pazuzu possession

 

60. What Cranial Nerve is the only one to project directly into the forebrain?

  1. CN III

  2. CN IV

  3. CN I

  4. CN II

  5. CN VI

 

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?

  1. Hypoglossal Trigone

  2. Facial Colliculus

  3. A lesion

  4. Vagal Trigone

  5. Vestibular Area

 

62. Damage occurring to the structure surrounding the cerebral aqueduct would result in a disruption of what function?

  1. Mydriasis

  2. Diaphoresis

  3. Analgesia

  4. Emesis

  5. Deglutition

 

63. One would expect to see this area of the cerebral peduncle severely impacted in a patient with Parkinson’s Disease.   What is….

  1. Red Nuclei

  2. Edinger-Westphal Nucleus

  3. Periaqueductal Gray

  4. Inferior Olivary Nucleus

  5. Substantia Nigra

 

11. Diencephalon

 

64. What endocrine function does the pineal gland initiate?

  1. Insulin Secretion

  2. Glucagon Secretion

  3. Somatostatin Secretion

  4. A and C

  5. None of the Above

 

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?

  1. Amygdala

  2. Thalamus

  3. Hypothalamus

  4. Red Nucleus

  5. Hippocampus

 

66. Which structure in the brain works has a functional redundancy of the carotid body and the carotid sinus?

  1. Posterior Inferior Cerebellar Artery

  2. Thalamus

  3. Prefrontal Gyrus

  4. Hypothalamus

  5. Insula

 

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?

  1. Dorsomedial Nucleus

  2. Suprachiasmatic Nucleus

  3. Mammillary nucleus

  4. Red Nucleus

  5. Amygdala

 

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?

  1. Parkinson’s disease is caused by the decrease in dopamine from the substantia nigra.

  2. Parkinson’s and Huntington’s are congenital diseases and Alzheimer’s is not.

  3. 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.

  4. Alzheimer’s does not affect subcortical structures.

  5. Both B and C

12. Cerebrum

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?

  1. Somatosensory loss to the right side of face

  2. Motor loss to the left foot.

  3. Motor loss to the right side of face.

  4. Somatosensory loss to the right foot.

  5. 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?

  1. Somatosensory loss to the right side of the face.

  2. Motor loss to the left foot.

  3. Motor loss to the right side of the face.

  4. Somatosensory loss to the right foot.

  5. 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?

  1. Cognition

  2. Emotional processing of sensation

  3. Planning

  4. Learning

  5. 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?

  1. Anterior association area

  2. Limbic association area

  3. Auditory unimodal association area

  4. Posterior association area

  5. Premotor cortex

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?

  1. Mother: Associative agnosia, Son: Apperceptive agnosia

  2. Both suffer from different extremes of Associative agnosia

  3. Son: Associative agnosia, Mother: Apperceptive agnosia

  4. Both suffer from different extremes of Apperceptive agnosia

  5. Son: Apperceptive agnosia, Mother: Associative agnosia

13. Cerebral Hemispheres Lab

 

74. “Identify the tagged structure labeled A” -DMC

  1. Insular cortex

  2. Extreme capsule

  3. Claustrum

  4. External capsule

  5. Internal capsule

75. “Identify the tagged structure labeled B” -DMC

  1. Fourth ventricle

  2. Third ventricle

  3. Second ventricle

  4. Lateral ventricle

  5. Aqueduct

76. “Identify the tagged structure labeled C” -DMC

  1. Anterior tubercle of thalamus

  2. Head of caudate nucleus

  3. Internal capsule

  4. Hypothalamus 

  5. Pineal gland

77. “Identify the tagged structure labeled D” -DMC

  1. Insula

  2. Putaman 

  3. Globus pallidus

  4. External capsule

  5. Hypothalamus

78. “Identify the tagged structure labeled A” -DMC

  1. Caudate nucleus

  2. Globus pallidus medial segment

  3. Globus pallidus lateral segment

  4. Anterior limb of the internal capsule

  5. Posterior limb of the internal capsule

79. “Identify the tagged structure labeled B” -DMC

  1. Caudate nucleus

  2. Globus pallidus medial segment

  3. Globus pallidus lateral segment

  4. Anterior limb of the internal capsule

  5. Posterior limb of the internal capsule

80. “Identify the tagged structure labeled C -DMC

  1. Insula

  2. Claustrum

  3. Internal capsule

  4. External capsule

  5. Extreme capsule

81. “Identify the tagged structure labeled D” -DMC

  1. Retrolenticular limb of the internal capsule

  2. Posterior limb of the internal capsule

  3. Internal capsule

  4. Anterior limb of the internal capsule

  5. Dorsomedial limb of the internal capsule

 

82. What is the function of the caudate nucleus

  1. Movement

  2. Hearing

  3. Seeing

  4. Cognitive functions

Language comprehension

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?

  1. Your back actually doesn’t have tactile receptors and can only make positioning based on the vibratory patterns

  2. Nociceptors in your fingers carry fast pain sensations while your back carry slow pain making it easier to identify the location

  3. The tactile receptors on your back need a larger stimulus to encite an action potential than those on your fingers

  4. The tactile receptors on your fingers have a smaller receptive field than those on your back

  5. Your back is not meant for the fine motor skill that your hands are so pinpointing locations is less important.

 

84. Which of the following sensation receptors have short axons?

  1. Discrete touch

  2. Proprioception

  3. Taste

  4. Smell

  5. Pain

 

85. Which of the following cranial nerves does NOT carry special sensations?

  1. CN I

  2. CN II

  3. CN V

  4. CN VII

  5. CN VIII

 

86. Which mechanoreceptor is essential in responding to vibrations?

  1. Meissner’s Corpuscles 

  2. Merkel Discs 

  3. Hair Follicle Receptors 

  4. Ruffini Endings 

  5. Pacinian Corpuscles 

  6. Muscle Spindles

 

87. Which of the following receptors has a layered capsule?

  1. Meissner corpuscle 

  2. Ruffini ending

  3. Hair follicle receptors

  4. Merkel discs

  5. Free nerve endings

 

88. In which of the following locations would you expect to find Merkel discs?

  1. Back

  2. Lips

  3. Soles

  4. Nipples

  5. Middle thigh

 

89. Proprioception sensations from the lower limbs are likely to be carried through which of the following?

  1. Spinothalamic 

  2. Fasciculus gracilis

  3. Fasciculus cuneatus 

  4. Corticospinal

  5. Neospinalthalamic

 

90. The patellar tendon reflex is a response caused by stimulating what type of receptor?

  1. Muscle Spindle

  2. Golgi tendon organ

  3. Meissner’s corpuscles 

  4. Ruffini endings

  5. Free nerve endings

 

91. Presence of a biceps tendon reflex and absence of a triceps tendon reflex would indicate a lesion in which spinal cord segment?

  1. C6

  2. C8

  3. T1

  4. L4

  5. S1

 

92. Which of the following pathways conveys ipsilateral information yet still decussates along its route?

  1. Posterior column-medial lemniscus

  2. Spinothalamic

  3. Posterior spinocerebellar 

  4. Anterior spinocerebellar

  5. Trigeminal

 

93. At which level does the neospinothalamic tract decussate?

  1. At the spinal level they enter

  2. In the medulla

  3. In the pons

  4. In the thalamus

  5. It does not decussate

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?

  1. Periaqueductal Gray Matter

  2. Nucleus Raphe Magnus

  3. Cerebral Cortex

  4. Enkephalin-containing Neurons

  5. Dorsal Horn

 

95. Enkephalin-containing interneurons release enkephalins, it is in the name, but how do they function?

  1. Inhibit dopamine release from substantia nigra

  2. Enhance dopamine release from substantia nigra

  3. Competitive inhibitor of neurotransmitter uptake

  4. Inhibit neurotransmitter release from central processes

  5. Acts as an Acetylcholinesterase in synaptic junctions

 

96. A patient presents with a rare, non-existent disease that specifically destroys unmyelinated C fibers. Which sensation is lost in the patient?

  1. Cold

  2. Heat

  3. Touch

  4. Pain

  5. “What does warm mean”

 

97. This condition is caused by repetitive but typically non-painful stimulation, such as sore throat or sunburns:

  1. Causalgia

  2. Neuralgia

  3. Hyperalgesia

  4. Paresthesia

  5. Allodynia

 

98. This condition results as higher centers of pain perception mistake the sensation of nociceptors:

  1. Two point discrimination

  2. Referred pain

  3. Thalamic pain syndrome

  4. Meralgia paresthetica

  5. Phantom limb pain

 

99. What condition is characterized by pricking, tingling, burning sensations with etiologies such as PVD or nerve compression?

  1. Allodynia

  2. Causalgia

  3. Paresthesia

  4. Thalamic pain syndrome

  5. Neuralgia

 

100. A patient presents with an injury to the Neospinothalamic tract, which two senses are altered or lost?

  1. Auditory and Pain

  2. Auditory and Thermal

  3. Pain and Thermal

  4. Visual and Auditory

  5. Visual and Balance

16. Introduction to Sensory Systems

 

101. Sensory Receptors have the lowest thresholds for which type of stimulus?

  1. Thermal

  2. Adequate

  3. Addictive

  4. Inappropriate

  5. Mechanical

 

102. The threshold mentioned in the above question can be lowered by what type of structures?

  1. Helper

  2. Adequate

  3. Accessory 

  4. Tertiary

  5. Vestigial

 

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?

  1. “Hot” receptors

  2. “Cold” receptors

  3. Nociceptors

  4. Mechanoreceptors

  5. “Lukewarm” receptors

 

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…

  1. The Subliminal zone

  2. The Facilitated zone

  3. The Subthreshold zone

  4. The Zap zone

  5. The Liminal zone

 

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. 

  1. Spatial Inhibition

  2. Discriminatory Inhibition

  3. Mid-Point Inhibition

  4. Lateral Inhibition

  5. Adjacent Inhibition

 

17. Pain

 

106. What by definition is the point at which nociceptive stimulus is perceived as painful?

  1. Nociceptive Origin

  2. Pain Tolerance

  3. Fast Pain

  4. Pain Threshold

  5. Neuropathic Origin

 

107. True or False: Fast Pain is associated with deep tissue destruction.

  1. True

  2. False

 

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?

  1. Substance P agonist

  2. L-DOPA and carbidopa

  3. Glutamate antagonist

  4. AMPA agonist

  5. NMDA antagonist

 

109. Enkephalin and serotonin are involved in the analgesia system. Which type of fibers do they inhibit?

  1. Pre-synaptic type C fibers

  2. Pre-synaptic type Aδ fibers

  3. Post-synaptic type C fibers

  4. Post-synaptic type Aδ fibers

  5. All of the above

 

110. Which of the following would cause true visceral pain?

  1. Ischemia

  2. A clean transection of a part of bowel

  3. Ulcers

  4. A and C

  5. A, B, and C

 

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?

  1. Phantom Limb Syndrome; Left side

  2. Brown-Sequard Syndrome; Left side

  3. Hyperalgesia; Left side

  4. Brown-Sequard Syndrome; Right side

  5. Headache; the entire spinal cord

 

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.

  1. A decrease in aqueous humor production from the ciliary processes in the posterior chamber of the eye..

  2. A blockage of Schlemm’s canal in the anterior corneal epithelium of the limbus.

  3. An overproduction of aqueous humor from the ciliary processes in the anterior chamber of the eye. 

  4. A blockage of Schlemm’s canal in the stroma of the limbus.

  5. Calcification of the descemet membrane resulting in of the cornea resulting in decreased elasticity and increased intraocular pressure.

 

113. This epithelium of the ciliary processes is responsible for the creation of aqueous humor; parasympathetic activity causes zonule fibers to become _____.

  1. Outer non-pigmented ciliary epithelium; loose

  2. Inner pigmented epithelial layer; taut

  3. Glassy membrane; taut

  4. Choriocapillary layer; loose

  5. Episclera; loose

 

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. 

  1. Ciliary muscle contraction; increased zonule fiber tension; flattening of the lens

  2. Ciliary muscle relaxation; zonule fiber loosening; rounding of the lens

  3. Ciliary muscle contraction; zonule fiber loosening; rounding of the lens

  4. Ciliary muscle relaxation; zonule fiber tension; flattening of the lens

  5. Ciliary muscle contraction; zonule fiber tension; rounding of the lens

 

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?

  1. Constrictor muscles contract (sympathetic); Dilator muscles contract (parasympathetic)

  2. Constrictor muscles relax (parasympathetic); Dilator muscles contract (sympathetic)

  3. Constrictor muscles contract (parasympathetic); Dilator muscles relax (sympathetic)

  4. Constrictor muscles relax (sympathetic); Dilator muscles contract (parasympathetic)

  5. Constrictor muscles contract (parasympathetic); Dilator muscles relax (sympathetic)

 

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:

  1. Small cataracts, where small opacifications of their lens has occurred resulting in blurring vision.

  2. Presbyopia, where focal opacifications of the vitreous humor has results in blurry and floating clumps.

  3. Vitreous opacities, where the liquification of the vitreous body has caused the debris within it to clump.

  4. Retinitis pigmentosa, where opaque clumps in the pigmented layer of epithelium has cast shadow-like clumps over the optical retina.

  5. Presbyopia, where debris has accumulated within the vitreous humor faster than it can be cleared by the resident phagocytic hyalocytes.

117. Which of the following conditions could indicate retinal detachment in your patient?

  1. Loss of accommodation due to hardening of the lens.

  2. Accumulation of debris from photoreceptor cells that accumulates on the pigmented epithelial layer.

  3. Blurred vision resulting from opacification of the lens.

  4. Fuzzy vision that accompanies eye floaters in the vitreous humor.

  5. 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.

  1. Rods; rhodopsin; retinal; Vitamin A

  2. Rods; iodopsin, retinal Vitamin A

  3. Rods; retinal; rhodopsin, Vitamin D

  4. Rods; retinal; iodopsin; Vitamin D

  5. 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 ______.

  1. Foveola

  2. Stye

  3. Chalazion

  4. Palpebrae

  5. Conjunctivitis 

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.

  1. Fovea Centralis; retinitis pigmentosa

  2. Zonula fovea; macular degeneration

  3. Foveola; retinitis pigmentosa

  4. Optic papilla; macular degeneration

  5. 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?

  1. Ciliary body

  2. Non-pigmented ciliary epithelium

  3. Pigmented simple columnar ciliary epithelium

  4. Schlemm’s Canal

  5. Ciliary zonule

 

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?

  1. Right Nasal hemianopia

  2. Left Nasal hemianopsia

  3. Left homonymous hemianopia

  4. Bitemporal hemianopsia

  5. Right homonymous hemianopia

 

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?

  1. Left oculomotor nerve palsy

  2. Left optic nerve lesion

  3. Left optic tract lesion

  4. Lesion on the Right angle of optic chiasm

  5. Lesion on the Left angle of optic chiasm

 

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?

  1. 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. 

  2. 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. 

  3. 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). 

  4. 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). 

  5. 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).

 

125. When shining a light into the patient’s eye, the opposite eye also constricts, this is known as which of the following?

  1. Near Triad reflex

  2. Direct light reflex

  3. Consensual light reflex

  4. Pupillary Dilation reflex

  5. Accommodation reflex

 

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?

  1. Night blindness

  2. Tunnel vision

  3. Pigmentation on the retina

  4. Eye floaters

  5. Loss of peripheral vision

20. Special Sense I – Vision

 

127. Which of the following has the greatest refractive power?

  1. Cornea

  2. Sclera

  3. Aqueous humor

  4. Lens

  5. Vitreous Humor

 

128. Which of the following structures are avascular?

  1. Sclera

  2. Cornea

  3. Iris

  4. Optic Disk

  5. Retina

 

129. In which of the following locations would you expect to find the enzyme Carbonic Anhydrase?

  1. Pigmented Epithelium of the ciliary body

  2. Erythrocytes 

  3. Cells of the renal tubule

  4. Gastric mucosa

  5. All of the above

 

130. Through which of the following mechanisms are chloride ions allowed to leave the pigmented epithelium without affecting the membrane potential?

  1. The sodium potassium pump allows more sodium out than potassium in thus making the charge difference negligible 

  2. Chloride is exchanged with bicarbonate ions so the charges cancel out

  3. Bicarbonate ions are produced by the carbonic anhydrase enzyme thus equalizing the charge

  4. Since the eye is not an excitable cell we are not worried about the membrane potential

  5. Chloride must go anywhere sodium does because according to chefs, “salt is the essence of life”

 

131. Which of the following conditions is characterized by an increased intraocular pressure caused by either increased production or decreased removal of aqueous humor?

  1. Cataracts

  2. Macular degeneration

  3. Conjunctivitis 

  4. Glaucoma

  5. Keratoconic cornea

 

132. Which of the following is an effect of the parasympathetic nervous system on the eye?

  1. Relaxation of the ciliary muscle

  2. Dilation of the pupil

  3. Relaxation of the zonular ligaments

  4. Ocular convergence 

  5. Lens flattening

 

133. Which of the following junctions are the connections the weakest and thus more likely to separate from one another?

  1. Ganglion cell and bipolar cell

  2. Ganglion cell and Amacrine cell

  3. Horizontal cell and photoreceptor

  4. Bipolar cell and photoreceptor 

  5. Photoreceptor and pigmented epithelium

 

134. Which of the following is a characteristic of the fovea centralis?

  1. High neuronal convergence 

  2. Highly vascularized 

  3. High receptor density 

  4. High concentration of rods

  5. Low visual acuity

 

135. Which breakdown product stimulates transducin when a photoreceptor has been exposed to light?

  1. Bathorhodopsin

  2. Lumirhodopsin

  3. Metarhodopsin I

  4. Metarhodopsin II

  5. Scotopsin

 

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?

  1. They inhibit the formation of bicarb, which does not allow for more chloride to flow into the stroma thus lowering the pressure

  2. They inhibit the formation of bicarb, which allows for more chloride to flow into the stroma thus lowering the pressure

  3. They inhibit the formation of bicarb, which does not allow for more chloride to flow into the aqueous humor thus lowering the pressure

  4. They inhibit the formation of bicarb, which allows for more chloride to flow out of the aqueous humor thus lowering the pressure

  5. 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 pressure

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?

  1. HCO3–

  2. Na+

  3. Cl–

  4. K+

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?

  1. 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

  2. Decreased parasympathetic innervation to the ciliary muscle causes contraction of the zonular fibers, thinning the lens and inhibiting accommodation.

  3. A & B

  4. Neither A or 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?

  1. Left optic nerve

  2. Optic chiasm

  3.  Right optic tract

  4.  Right inferior optic radiations (Meyer loop)

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?

  1. Eye deviates superiorly and medially

  2. Eye deviates inferiorly and medially

  3. Eye deviates inferiorly and laterally

  4. Eye deviates superiorly and laterally

  5. Diplopia of the eye

 

141. Damage to the paramedian pontine reticular formation would complicate vision in which of the following visual movements?

  1. Vertical gaze

  2. Horizontal gaze 

  3. Vergence

  4. Saccadic

  5. Smooth Pursuit

 

142. A patient presents with a pineal gland tumor, which physical sign of the eye can help with diagnosis?

  1. Upward gaze paralysis

  2. Downward gaze paralysis

  3. Lateral gaze paralysis

  4. Medial gaze paralysis

  5. Paralysis of divergence

 

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?

  1. Saccadic Movements

  2. Smooth Pursuit

  3. Convergence

  4. Optokinetic movements

  5. Vestibulo-ocular movements

 

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?

  1. Saccadic movement

  2. Smooth pursuit

  3. Convergence

  4. Divergence

  5. Vestibulo-ocular movements

22. Histology of the Ear


145. The histology slide above is from the external auditory meatus, identify the structures denoted as “A”

  1. Dermis

  2. Sweat Ducts

  3. Hair Cells

  4. Ceruminous Glands

  5. Stratified Squamous Epithelium

 

146. The histology slide above is from the external auditory meatus, identify the structures denoted as “B”

  1. Dermis

  2. Sweat Ducts

  3. Hair Cells

  4. Ceruminous Glands

  5. Stratified Squamous Epithelium

 

147. If a patient sustains sufficient blunt trauma to the petrous part of the temporal bone, what is he/she in danger of damaging?

  1. Cochlea

  2. Semicircular Canals

  3. Ossicles

  4. Chordae Tympani

  5. Both A and B

 

148. If the Organ of Corti becomes damaged in any way, what function will most likely be impaired?

  1. Sight

  2. Hearing

  3. Angular orientation

  4. Head position

  5. Visual acuity

 

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?

  1. The army veterans sustained blunt trauma to their ears causing damage to their cochleas

  2. The middle ear reflexes are too slow to react to sudden loud noises such as gunshots

  3. The middle ear muscles have hypertrophied due to excess use causing all sounds to become dampened

  4. The ossicles have become damaged from the muscles pulling on them so frequently

  5. The tensor tympani muscle has caused a tear in the tympanic membrane through excessive use of normal reflexes

 

23. Auditory System

 

150. What is the main function of the hair cells in the inner ear?

  1. To convert electrical signals into waves in the perilymph

  2. To convert waves in the perilymph into electrical signals

  3. To convert electrical signals into waves of the endolymph

  4. To convert waves in the endolymph into electrical signals

  5. To protect the organ of Corti from otoconia

 

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?

  1. It destroys the basilar membrane, preventing electrical signals from being produced from sound waves.

  2. It coagulates the endolymph disrupting sound waves entering the cochlea.

  3. It kills outer hair cells that are used to amplify sound wave propagation in the inner ear.

  4. 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.

  5. It binds Potassium in the endolymph to the extent that there is not enough to propagate an electrical signal in the cell.

 

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?

  1. Superior Olivary Nucleus

  2. Medial Lemniscus

  3. Lateral Lemniscus

  4. Inferior Colliculus

  5. Superior Colliculus

 

153. The lateral olivocochlear efferents from the superior olivary nucleus are sent to to:

  1. Outer Hair Cells

  2. Tympanic Membrane

  3. Middle Hair Cells

  4. Inner Hair Cells

  5. Inferior Olivary Nucleus

 

154. What cranial nerves are activated by hearing reflexes?

  1. CN V

  2. CN VII

  3. CN VIII

  4. All of the above

  5. B and C

 

24. Special Sense II – Auditory

155. Which of the following results in the excitation of hair cells:

  1. Bending of the hair cells away from the kinocilium

  2. K+ efflux on the apical side

  3. Bending the of the hair cells toward the kinocilium

  4. K+ efflux on the basolateral side

  5. 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:

  1. Longer basilar fibers towards the base; shorter diameter towards the apex

  2. Shorter basilar fibers towards the base; shorter diameter towards the apex

  3. Longer basilar fibers towards the apex; shorter diameter towards the base

  4. Longer basilar fibers towards the apex; longer diameter towards the apex

  5. 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:

  1. LOF tensor tympani muscle; increased sound dampening

  2. LOF stapedius muscle; decreased sound dampening

  3. LOF tensor tympani muscle; decreased sound dampening

  4. LOF stapedius muscle; increased sound dampening

  5. 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?

  1. Malleus

  2. Incus

  3. Stapes (tee hee)

  4. Tympanic membrane

  5. Oval window

 

159. Which area of the scala media best responds to high frequency vibrations:

  1. Towards the apex

  2. Towards the base

  3. Tip of the Cochlea

  4. Helicotrema

  5. Towards the middle

 

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?

  1. Left Anterior semicircular duct

  2. Left Posterior semicircular duct

  3. Right Horizontal semicircular duct

  4. Right Utricle

  5. Left Saccula

 

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?

  1. The cupulae moves the hair more readily so you feel like you are moving more than you are

  2. The cupulae moves the hair more readily so you feel like you are moving less than you are

  3. The cupulae moves the hair less readily so you feel like you are moving more than you are

  4. The cupulae moves the hair less readily so you feel like you are moving less than you are

  5. Alcohol dampens sound conduction so the room begins to spin.

 

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?

  1. Calcium carbonate crystals are in their utricle

  2. Calcium bicarbonate crystals are in their utricle

  3. Calcium carbonate crystals are in their semicircular canals

  4. Calcium bicarbonate crystals are in their semicircular canals

  5. Calcium bicarbonate crystals are in their saccule

 

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?

  1. Dorsal column medial lemniscus

  2. Vestibuloocular 

  3. Dorsal cerebellar

  4. Corticospinal

  5. Descending vestibular

 

164. Which of the following is not a component of your vestibular system?

  1. Vision 

  2. Inner ears

  3. Hearing

  4. Proprioception 

  5. Vestibulocochlear Nerve

 

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?

  1. Blunt trauma to the head 

  2. Blurry vision

  3. Dizziness when looking down

  4. Ability to duplicate symptoms in clinic

  5. Tinnitus

26. Vestibular Function

 

166. Damage within the vestibule would result in the loss of which sensation?

  1. Linear acceleration

  2. Rotational acceleration

  3. Hearing

  4. Angular acceleration

  5. Taste

 

167. Movement of which of the following are responsible for causing the sensation of gravity or linear acceleration?

  1. Endolymph

  2. Perilymph

  3. Basilar membrane

  4. Otoliths

  5. Tectorial membrane

 

168. Movement of the stereocilia away from the kinocilia would cause which of the following?

  1. No change in membrane potential 

  2. Depolarization 

  3. Repolarization

  4. Hyperpolarization 

  5. Muscle contraction

 

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?

  1. 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

  2. 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

  3. Your ear is starting to undergo degenerative changes and unfortunately there is nothing you can do and you will eventually become deaf. 

  4. 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

  5. You’re broken. Here’s drugs.

 

170. In which way are the semicircular ducts and vestibule different?

  1. The semicircular ducts sense linear acceleration while the vestibule senses gravity

  2. The semicircular ducts have hair cells as receptors while the vestibule has free nerve endings 

  3. The semicircular ducts have cupulas while the vestibule has otoliths 

  4. The semicircular ducts participate in eye reflex movements while the vestibule does not

  5. The semicircular ducts undergo adaptation while the vestibule does not

 

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?

  1. Vestibulo-ocular reflex

  2. Optokinetic reflex

  3. Vestibulo-collic reflex

  4. Vestibulosympathetic reflex

  5. Vestibuloparasympathetic reflex

 

172. Which of the following is characterized by abnormalities in the volume or regulation of endolymph fluid resulting in increased endolymphatic pressure?

  1. Benign paroxysmal positional vertigo

  2. Labyrinthitis 

  3. Meniere’s disease 

  4. Gentamycin use

  5. Otitis media

27. Basal Ganglia Function

 

173. The Basal ganglia, being the ancient part of the brain, is important in which basic function?

  1. Touch Perception

  2. Movement Selection

  3. Auditory Processing

  4. Emotional Cognition

  5. Vocal filtration to avoid SPC

 

174. The Basal Ganglion medium spiny neurons output is associated with which neurotransmitter?

  1. ACh

  2. Glutamate

  3. Dopamine

  4. GABA

  5. Serotonin

 

175. There are three intrinsic connections within the basal ganglia, which pathway is the most critical to multitasking?

  1. Direct pathway

  2. Indirect Pathway

  3. Hyperdirect Pathway

  4. Hyperindirect Pathway

  5. Hypodirect Pathway

 

176. Lesion of this basal ganglia pathway results in excessive movements syndromes such as Huntingtons?

  1. Direct pathway

  2. Indirect Pathway

  3. Hyperdirect Pathway

  4. Hyperindirect Pathway

  5. Hypodirect Pathway

 

177. Which of the following conditions relates to dysfunction of all 4 functions of Basal Ganglia?

  1. Parkinsons

  2. Parkinsonians 

  3. Huntingtons 

  4. Hemiballismus

  5. Bilateral Gangliatitis

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?

  1. Dorsal spinocerebellar tract

  2. Rubrospinal tract

  3. Reticulospinal tract

  4. Tectospinal tract

179. Which of the following structures serves as the primary output from the basal ganglia?

  1. Substantia nigra pars reticulata

  2. Globus pallidus interna

  3. Subthalamic nucleus

  4. Globus pallidus externa

  5. A & B

180. On rotation, you notice a bedridden 65 y.o. male patient exhibiting uncontrolled, wide, rotating motions of their extremities. Your preceptor asks you what particular movement disorder they may be suffering from. What do you answer?

  1. Chorea

  2. Dystonia

  3. Hemiballismus

  4. Myoclonus

181. Because they just love making your life easier, your preceptor asks where the most likely location of the causative lesion within the basal ganglia is for the patient in the previous question. What do you answer?

  1. Globus pallidus externa

  2. Subthalamic nucleus

  3. Substantia nigra pars compacta

  4. Putamen

182. You encounter a 70 y.o. female patient who presents with a resting tremor, rigidity, slow and jerky motions, and most tellingly a shuffling, festinating gait. You quickly discern that she is suffering from Parkinson’s disease, and that she has never been placed on medication for it as she does not have a PCP. What is the most common initial medication for her disease?

  1. Pramipexole

  2. Selegiline

  3. L-DOPA

Entacapone


 

28. Motor Control I

 

183.     Which afferent fibers detect tension in a muscle?

A.   Gamma neurons

B.   1a Fibers

C.    2 Fibers

D.   Bag Fibers

E.    1b fibers

 

184.    Which pathway is engaged with the patellar reflex?

A.   Monosynaptic

B.   Disynaptic

C.    Polysynaptic

D.   Inverse Myotatic

E.    Flexor Withdrawal

 

185. In what muscles will you find the highest concentration of muscle spindles? Muscles performing…

  1. Crude Movements

  2. Reflexive Movements

  3. Fine Movements

  4. Repetitive Movements

  5. Slow Movements

 

186. Of the two sensory endings that relay information from muscle spindles, which has faster conduction and why?

  1. Primary afferent; 1a fibers are smaller in diameter

  2. Primary afferent; 1a fibers are larger in diameter

  3. Secondary afferent; II fibers are larger in diameter

  4. Secondary afferent; II fibers are smaller in diameter

  5. Both; both are myelinated so they will each carry information at the same rate

 

187. What is the purpose of muscle “damping”?

  1. To prevent overexertion of the muscle

  2. To prevent the over-contraction of the muscle

  3. To prevent overstretch of the muscle

  4. To ensure the smoothness of movement of the muscle

  5. To ensure the muscle stays hydrated

 

188. While at the gym you decide you want to try to impress your friends by showing them you can lift the most. You go and overload the bench press station with 600lbs of weight. When you attempt to push the weight up the bar almost immediately drops on you as your arms feel like they have given up. What reflex did you just demonstrate for your friends?

  1. Postural Reflex

  2. Crossed Extension Reflex

  3. Golgi Tendon Reflex

  4. Dynamic Stretch Reflex

  5. Coactivation Reflex

 

189. After stepping on a lego, what allows you to keep your balance long after you have recoiled your foot in pain?

  1. Golgi Tendon Reflex

  2. Postural Reflex

  3. Flexor withdrawal and Crossed Extension Reflex

  4. Polysynaptic Reflexes

  5. Afterdischarge

 

29. Motor Control II

190. What are the roles of the premotor area and the supplementary motor area?

  1. Vision

  2. Sensory interpretation

  3. Sequence movement

  4. Gatekeepers

  5. Predicting future movement

 

191. What component of the corticospinal tract is associated with movement of extremities?

  1. Medial

  2. Anterior

  3. Ventral

  4. Lateral

  5. Dorsal

 

192. Sally came to the clinic complaining of not being able to swallow, and you notice that she also has a slack expression and muddled speech. You order an MRI that shows a lesion in the internal capsule. What would be affected by this lesion.

  1. Broca’s Area

  2. Corticobulbar Tract

  3. Glossopharyngeal Nerve

  4. Rubrospinal Tract

  5. Edinger Westphal Nucleus

 

193. Pontine reticulospinal neurons are primarily _______ and medullary reticulospinal neurons are primarily ______.

  1. Excitatory; Inhibitory

  2. Inhibitory; Inhibitory

  3. Inhibitory; Excitatory

  4. Excitatory; Excitatory

  5. None of the above

 

194. Lesions in the Lower Motor Neurons typically cause?

  1. ALS

  2. Spastic Paralysis

  3. Hyporeflexia

  4. Hyperreflexia

  5. Prader-Willi

 

30. Posture, Locomotion, and Cerebellar Function

195. Which of the following does not relate to the major function(s) of the cerebellum?

  1. Regulating a sequence of motor activity

  2. Coordination

  3. Initiation of command motor movement

  4. Motor correction during execution

  5. Playing the piano

196. Which of the following correctly relates cerebellar anatomy with its correct corresponding function?

  1. Intermediate zone; control of axial body 

  2. Lateral zone; control of distal portions of limbs

  3. Vermis; overall planning of movements

  4. Vermis; control of hips

  5. Intermediate zone; control of shoulders

197. An MRI scan shows a diffuse lesion across your patient’s cerebellum with varying degrees of abnormal densities. Your patient experiences abnormal facial and distal limb functions with regards to their smooth execution of movement. Which functional division of the cerebellum seems to be most affected by the diffuse lesion?

  1. Intermediate zone

  2. Vermis

  3. Lateral zone

  4. Anterior lobe

  5. Flocculonodular lobe

198. After suffering from a recent stroke, medical imaging displays an infarct to a patient’s cerebellum. Your attending withholds the imaging results from your view to test your knowledge of functional anatomy. You know after the stroke that the patient is extremely deficient in equilibrium movements and has trouble balancing. Both the coordination of distal limb structures and the ability to perform sequential movements remain intact. Based on the patient’s presentation, which region of the cerebellum was most likely affected by the stroke?

  1. Cerebrocerebellum

  2. Lateral zone

  3. Anterior lobe

  4. Flocculonodular lobe

  5. Vermis

199. Mr. Wright Good is a court stenographer who has recently suffered from a stroke affecting the cerebellum. He is no longer able to rapidly type and produce transcripts of courtroom hearings after the CVA. Which correct pair of deep cerebellar nuclei and their corresponding function are most likely affected and result in Mr. Good’s inability to perform the consecutive act of rapidly typing?

  1. Interposed; reciprocal coordination of peripheral limb muscles

  2. Fastigial; coordination of sequential motor activities

  3. Dentate; reciprocal coordination of peripheral limb muscles

  4. Interposed; coordination of sequential motor activities

  5. Dentate; coordination of sequential motor activities

200. Which pair of cells both have their cell bodies located in the molecular layer and are responsible for the lateral inhibition of Purkinje cells that result in the sharpening of the output signal from the cerebellum?

  1. Granule cells & Basket cells

  2. Basket cells & Mossy cells

  3. Mossy cells & Stellate cells

  4. Stellate cells & Basket cells

  5. Basket cells & Climbing cells 

201. After the BECOM exam, you and your friends decide to go Axe-throwing in downtown Fort Smith. To your dismay, your first few throws with the hatchet are both off center and not sticking to the board. Determined to silence your snickering cohorts, you continuously make small adjustments to your technique until you awaken your inner lumberjack and land a bulls-eye on the middle of the board. You all shotgun a beer to celebrate your victory! What cerebellar fibers were essential in your progressive attempts to become more precise and are fundamental in motor error and learning?

  1. Granule cell fibers

  2. Climbing fibers

  3. Mossy fibers

  4. Basket cell fibers

  5. Lumberjack fibers

 

202. Which of these nuclei is most likely responsible for trunk stability based upon its location in the cerebellum?

A. Fastigial

B. Globose

C. Emboliform

D. Dentate

E. Facial

 

203. Which of the following fibers originates from the inferior olivary nucleus?

A.   Granule Cell

B.   Basket Cells

C.    Stellate Cells

D.   Deep Nucleur Cells

E.    Climbing Fibers

 

204. If you have a lesion to the vestibulocerebellum, which symptoms are you most likely to experience?

A.   Diplopia

B.   Positive Rhombergs test

C.    Inability to coordinate planned movements

D.   Unable to sharply change direction

E.    Flaccid paralysis

 

31. Special Sense III – Taste and Olfaction

 

205. OR62A is a gene that makes some people perceive cilantro as tasting like soap. This is because of how the brain detects the aldehyde plant secondary compound contained in colliander. Which of the following is not a way humans perceive the sensation of gustation?

  1. Mechanoreceptors

  2. Nociceptors

  3. Olfactory receptor

  4. Pacinian corpuscles 

  5. Gustatory hairs

 

206. Which of the following papillae helps to move food around the mouth?

  1. Lingual papillae

  2. Filiform papillae

  3. Fungiform papillae

  4. Circumvallate papillae

  5. Foliate papillae

 

207. A lesion in which of the following would not affect the transduction of taste to the brain to be sensed?

  1. Salivary Glands

  2. Facial Nerve

  3. Glossopharyngeal nerve

  4. Vagus Nerve

  5. Hypoglossal nerve

 

208. Josephine comes into your office claiming that every time she eats, her mouth tingles and burns and she gets a foul, rancid taste, no matter what she eats. She has lost 10 pounds in the last month because she absolutely loathes eating. Which of the following symptoms is she experiencing?

  1. Ageusia

  2. Anosia

  3. Dysgeusia

  4. Hypogeusia

  5. Phantogeusia

 

209. Karen was cleaning her floors when she mixed ammonia with bleach creating a chloramine gas, an inhaled toxic gas. Which of the following is the pathway that the gas would take to reach her brain?

  1. Olfactory Tract→ Dendrite→ Olfactory neuron→ Olfactory axon→ Olfactory Cilia 

  2. Olfactory Cilia→ Olfactory axon→ Olfactory neuron→ Dendrite→ Olfactory tract

  3. Dendrite→ Olfactory neuron→Olfactory axon→ Olfactory cilia→ Olfactory tract

  4. Olfactory cilia→ Dendrite→ Olfactory neuron→ Olfactory axon→Olfactory tract 

  5. Olfactory Axon→ Olfactory neuron→  Dendrite→ Olfactory cilia→ Olfactory tract

 

210. Ava is a very picky eater who claims she is allergic to vegetables. This is because she has trained her brain that all veggies are bad and now that idea is ingrained into her lateral olfactory area and everytime she smells carrots cooking, she cries and gags. What other olfactory signal/ response is located in this area?

  1. Sending a signal to the cortex that tells her that her brothers diaper is stinky

  2. Her mouth watering when she eats sour gummy worms

  3. Subconsciously licking her lips when she walks past the bakery display case in the grocery store

  4. Her stomach releasing ghrelin to her hypothalamus in response to smelling dinner being made in the kitchen

  5. Perception of taste based on the olfactory receptor

 

211. Larry has been undergoing radiation therapy for Stage III glioblastoma. He says that recently he has been smelling a strong tire odor in random places even when there are no tires around him. This symptom can be described as:

  1. Ageusia

  2. Anosia

  3. Parosmia 

  4. Phantosmia 

  5. Phantogeusia

 

212. Which chemical is responsible for the umami taste on your tongue?

A. Glutamate

B. Sodium concentrations

C. Alkaloids

D. Hydrogen acidity

E. Ketones

 

213. According to a specific taste index, which taste are we most sensitive to detecting?

A. Umami

B. Bitter

C. Salty

D. Sweet

E. Sour

 

214. Which nucleus receives signals for taste before synapsing and proceeding towards the cortex?

  1. Nucleus Ambiguus

  2. Hypoglossal nucleus

  3. DRG

  4. Nucleus Solitaris

  5. Medial Laminiscus

32. Visceral Sensory and Viscromotore Regulation

 

215. Visceral nociceptors will NOT respond to which of the following stimuli?

  1. Overdistention

  2. Crushing

  3. Traction

  4. Ischemia

  5. Endogenous compounds

 

216. Which of the following events is most likely to be sensed by a rapidly adapting physiologic mechanoreceptor?

  1. Movement 

  2. Stretch 

  3. Osmolarity 

  4. Tension 

  5. Temperature

 

217. Visceral pain in which of the following locations would be carried by parasympathetic afferent fibers?

  1. Stomach

  2. Gall bladder

  3. Small intestine 

  4. Appendix 

  5. Lower Sigmoid Colon

 

218. In which of the following locations would you inject an anesthetic for a woman in labor who still wants to be able to push and sense her contractions?

  1. Celiac Plexus

  2. Lesser splanchnic nerve

  3. Lumbar splanchnic nerve

  4. Lumbar epidural space

  5. Caudal epidural block via the sacral hiatus

 

219. The collaterals of visceral afferent fibers are primarily responsible for which of the following?

  1. Deep pain

  2. Referred pain

  3. Muscle cramps 

  4. Somatovisceral reflexes 

  5. Witchcraft and wizardry

 

220. In which of the following cerebral locations would you most accurately perceive a full bladder ot bowel?

  1. Prefrontal Cortex 

  2. Medial Postcentral Gyri 

  3. Lingual Gyrus

  4. Parietal opercular cortex

  5. Occipitotemporal gyrus

 

221. Which cranial nerve is responsible for sensations from the carotid body and sinus?

  1. Oculomotor 

  2. Trigeminal 

  3. Facial 

  4. Glossopharyngeal 

  5. Vagus

 

222. Where would you find the cell bodies for primary afferent viscerosensory neurons from the cranial nerves?

  1. Dorsal root ganglion 

  2. Inferior ganglion 

  3. Superior ganglion 

  4. Dorsal grey horn 

  5. Solitary nucleus

 

223. Damage to which of the following areas would almost certainly result in a persistent coma?

  1. Posterior thalamus 

  2. Medulla 

  3. Anterior thalamus 

  4. Basal Pons

  5. Lateral Hemispheres of Cerebellum

33. Hypothalamus and Neuroendocrine Systems

 

224. A patient presents to the clinic with a damaged hypothalamus, which of the following is most likely to still function?

  1. Reflexes

  2. Hormone Response of Pituitary

  3. Motor Control

  4. Homeostasis

  5. Sleep Cycle 

 

225. Paraventricular nuclei are found in which zone of the Hypothalamus?

  1. Lateral

  2. Periventricular

  3. Paraventricular

  4. Medial

  5. Median

 

226. A lesion in this zone causes me to have issues regarding feeding?

  1. Lateral

  2. Periventricular

  3. Paraventricular 

  4. Medial

  5. Median

 

227. This is the only nucleus in the lateral zone that does not start with the term ‘lateral’?

  1. Suprachiasmatic 

  2. Tuberomammillary 

  3. Supraoptic

  4. Arcuate

  5. Preoptic

 

228. A lesion to which of the following areas of the brain would least likely alter input to the hypothalamus from the forebrain?

  1. Fornix

  2. Medial forebrain bundle

  3. Dorsal longitudinal fasciculus

  4. Ventral amygdalofugal pathway

  5. Suprachiasmatic nuclei

 

229. Prader-Willi syndrome babies are chubby, which nucleus is likely altered involving satiety?

  1. Posterior nuclei

  2. Septal Nuclues

  3. Medial Preoptic nucleus 

  4. Ventromedial nucleus

  5. Ventrolateral nucleus

 

34. Thalamus and Cerebral Cortex

 

230. Which part of the Ventral Anterior nucleus receives afferent information from the pars reticulata of the substantia nigra?

  1. VApc

  2. VAmc

  3. VLo

  4. VLm

  5. VLc

 

231. Jeremy has complained that he has not been able to enjoy food because he has lost his ability to taste. You note that his olfaction is still working fine, but he is unable to distinguish different taste stimuli. Which part of his thalamus is most likely damaged?

  1. Lateral Geniculate Nucleus

  2. Ventral Anterior Nucleus

  3. Ventral Posteromedial Nucleus

  4. Medial Geniculate Nucleus

  5. Ventral Posterolateral Nucleus

 

232. Evelyn has had excessive trouble moving since she fell down a few stairs and struck her head. Upon physical exam there seems to be no musculoskeletal injuries, and her reflexes are intact, but she is unable to start moving without excessive trouble and she is unable to perform sequential movements. Where might there be a lesion in her brain?

  1. Primary motor cortex

  2. Somatosensory cortex

  3. Premotor cortical area

  4. Supplementary Motor Cortex

  5. Both C and D

 

233. Which of the following part of the cortex indicates the location of the primary auditory cortex?

  1. Insula

  2. Heschel’s convolutions

  3. Parieto-occipital sulcus

  4. Middle Temporal gyrus

  5. Temporal Pole

 

234. A patient comes in complaining of decreased vision in their right eye. They say that anything above midline is blurry and you note that they have complete visual loss in their upper visual field by testing their peripheral vision. Which eye field is affected in this patient.

  1. Right Frontal Eye Field

  2. Left Occipital Eye Field

  3. Right Occipital Eye Field

  4. Left Temporal Eye Field

  5. Left Frontal Eye Field

 

235. A patient is unable to carry out intentional movement without a tremor.  You believe there is a lesion in the thalamus that communicates with the dentate nucleus of the cerebellum.  Which part of the thalamus is effected?

  1. A. Anterior

  2. B. Ventral Posterior Lateral

  3. C. Ventral Lateral

  4. D. Ventral Posterior Medial

  5. E. Dorsomedial

 

236. Patient visits the clinic post stroke.  You believe the occluded artery is the one supplying the thalamus.  Which artery supplies the thalamus?

  1. A. ACA

  2. B. MCA

  3. C. Basilar

  4. D. Superior Cerebellar

  5. E. PCA

 

35. Cortical Function

 

237. Which pair correctly matches a cerebral lobe with its inherent function?

  1. Parietal lobe; language production and voluntary conjugate deviation of eyes

  2. Frontal lobe; visual semantic and number processing

  3. Temporal lobe; emotions and comprehension of language

  4. Occipital lobe; consolidation of memory and fear

  5. Temporal lobe; interpretation of visual images

 

238. Following a CVA, you patient has suffered significant damage to Wernicke’s area. Which cerebral blood supply was most likely compromised causing the inability of your patient to _____?

  1. ACA; name his favorite band.

  2. MCA; repeat words they have heard.

  3. PCA; interpret visual images

  4. MCA; describe their fondest memory with their dog.

  5. ACA; call out to their dog to come back inside.

 

239. Your patient enters the clinic stating that after a syncopal episode last week they are having extreme difficulty diverting their attention to focus on multiple tasks, computing simple math in their head, telling their left from their right, and making out the meaning of street signs as they drive down the road. You order medical imaging, but are already leaning towards some type of deficit in the _______ based on the connected presentation of symptoms?

  1. Supplementary motor area

  2. Angular gyrus

  3. Amygdala

  4. Hippocampus

  5. Lewy body

 

240. Your patient and close friend calls you at work as he is anxious to speak with you about his new onset of symptoms post stroke. He recounts to you that he was unable to perceive the angry tone in his wife’s voice when she told him to clean the gutters last weekend. Normally his terror of heights undermines his ability to swiftly perform this chore, but his new lack of fear allowed him to strut across the rooftop with ease. Waiting for a pause in the conversation you say to your friend, “I know… You called me yesterday and told me the exact same thing. Don’t you remember?” Based on these presentations, the stroke likely damaged your friend’s  ______.

  1. Frontal lobe

  2. Parietal lobe

  3. Temporal lobe

  4. Limbic lobe

  5. Occipital lobe

 

241. Speaking (repeating) a heard word versus speaking a written word have similar interconnected cerebellar cortical pathways. How do these two similar functions differ in regards to their cortical connections to produce a verbal output?

  1. Speaking a written word involves the angular gyrus, whereas the other does not.

  2. Speaking a heard word involves Wernicke’s area, whereas the other does not

  3. Broca’s area relays planned motor speech to the motor cortex when speaking a written word only.

  4. Speaking a written word involves Wernicke’s area, whereas the other does not.

  5. Speaking a heard word involves the angular gyrus, whereas the other does not.

 

242. Rick and Morty need to incept a memory of Morty getting an A in math. They need it to be committed to long term memory without the teacher noticing a trigger.  The teacher will associate an apple with Morty getting an A in class. Which answer choice best represents this long-term memory strategy?

A.   Episodic memory 

B.   Habituation

C.    Procedural

D.   Priming

E.    Non-associative

 

36. Limbic System Function

 

243. When visiting your grandma, she bakes you a warm batch of cookies, as grandmas generally do. The smell of gooey chocolate chip cookies goes through your olfactory tract into the primary olfactory cortex. It is then processed in the piriform cortex and projected to the _______ which allows it to be recognized as a pleasant odor.

  1. Orbitofrontal cortex

  2. Amygdala

  3. Hypothalamus

  4. Entorhinal cortex

  5. Hippocampus

 

244. Which of the following is not directly regulated by the hypothalamus?

  1. Cardiovascular system

  2. Body temperature

  3. Hunger

  4. Lactation 

  5. Metabolism

 

245. The descending pain modulation pathway runs through the Central Gray matter (AKA Periaqueductal Gray). This area is known as a punishment center. Which of the following explains the mechanism by which a punishment center works? 

  1. Strong stimulation of a punishment center enhances reward and pleasure so you don’t want to remove the noxious stimulus

  2. Weak stimulation of a punishment center enhances reward and pleasure so you don’t want to remove the noxious stimulus

  3. Stimulation of a punishment center inhibits reward and pleasure so that you want to remove the noxious stimulus. 

  4. Stimulation of a punishment center enhances reward and pleasure so that you want to remove the noxious stimulus

  5. Weak stimulation of a punishment center enhances reward and pleasure followed by inhibition causing pain to feel pleasurable

 

246. Jordan has epilepsy that causes him to have seizures with very strong hallucinations involving sight, sound, and smell. Which of the following areas of his brain is most likely hyperexcited?

  1. Amygdala

  2. Hippocampus

  3. Hypothalamus

  4. Thalamus

  5. Basal Ganglia

 

247. The hypothalamus is referred to as the headquarters for the limbic system because of its involvement in many other systems. Which of the following systems is the hypothalamus involved in?

  1. Central nervous system

  2. Autonomic nervous system

  3. Peripheral nervous system

  4. Vestibular system

  5. Visual system

 

248. After attending Dr. Kispert’s lecture on the limbic system, Katie got an idea for research. Based on the process of learning and memory, she wants to look at the best way to convert short-term memory to long-term memory that is done by the hippocampus. She is going to administer the same test to students three times: once as a pre-test, once after studying for a week with different study methods and once 3 months later to see how much was retained Which of the following study methods would you expect to have the best results 3 months down the line?

  1. Reading the material 3 times while snacking on your favorite candy

  2. Listening to the material 3 times while chewing gum

  3. Repeating the material out loud after you read/listen and eating a piece of candy if you get it right

  4. Read/listen to the material then answer practice questions until you get them right

  5. Go through the material passively. Then have someone quiz you. When you get it right, you get a high five, when you get it wrong, you get smacked

 

249. Drugs and sex both stimulate the areas of the brain that satisfy the animal. This causes pleasure and experiments have shown that animals would choose this stimulus over food or other desirable rewards. These experiments have been the basis for addiction having a biological component. Which of the following, if strongly stimulated, would elicit a sense of satisfaction?

  1. Central Gray matter

  2. Amygdala

  3. Septal area

  4. Hippocampus

  5. Basal ganglia

 

250.    Rick from Rick and Morty needs to go through interdimensional customs.  The officer needs to repress his rage center with a tranquilizer. Which part of his hypothalamus is effected by the tranquilizer?

A.   Suprachiasmatic Nucleus

B.   Ventromedial nucleus

C.    Posterior nucleus

D.   Ventral tuberal nucleus

E.    Periventricular

 

251.     A 68 year old patient recently had a pituitary tumor removed. As a result of the surgery, the fornix was mildly damaged. Which part of Papez circuit is most likely effected by this surgery?

A.   Hippocampus

B.   Hypothalamus

C.    Anterior Thalamus

D.   Cingulate Cortex

E.    Prefrontal Cortex

37. Sleep

 

252. During a nightmare you are literally running from your worst fears until suddenly you awake in your bed. What characteristic of REM sleep keeps your body from acting out what you are doing while dreaming?

  1. Heart rate irregularity

  2. Muscle tone depression

  3. Sleep paralysis

  4. Spontaneous Quadraparesis

  5. Paradoxical sleep

 

253. Timmy has a big test coming up and has spent close to no time sleeping in order to get more studying done. When it comes time for him to take the exam, he finds he is having trouble remembering what he has spent all those sleepless nights studying. What stage of sleep did Timmy likely not enter and is now suffering the effects on his memory for it. 

  1. REM

  2. NREM stage 1

  3. NREM stage 2

  4. NREM stage 3

  5. NREM stage 4

 

254. Your friend Jimmy has been sleeping for almost an hour now and you need to ask him something. You try to jostle him, but to no avail. You decide he is just a heavy sleeper and will ask him when he wakes up. What is the real reason you couldn’t wake Jimmy?

  1. He is in NREM stage 2 

  2. He has entered the matrix

  3. He is in NREM stage 3 

  4. He is in NREM stage 4

  5. You didn’t jostle him hard enough

 

255. In the mornings you notice that no matter how low you set your thermostat the night before you always wake up hot. What could be causing this?

  1. Your body will raise its temp to promote sleep onset 

  2. You have too many blankets 

  3. Heat is your body’s way to promote waking

  4. Sleep and thermoregulation are not related

  5. Your body induced a nightmare to wake you up in sweat

 

256. An individual with narcolepsy suffers from sudden attacks of sleep even when they are active. What is the main cause of this disorder?

  1. Loss of VLPO signaling

  2. Loss of Orexin signaling

  3. Disruption of Bmal1 and Clock binding

  4. Increase of Orexin signaling

Overstimulation of the Suprachiasmatic nucleus