Clinically Based Questions on morphology of the brain Part 1


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Clinically Based Questions on morphology of the brain Part 1

  1. 1. Clinically based questions Neuroanatomy I 1. A 71-year-old man complains to his family physician that his face “feels funny.” The examination reveals numbness on his face and on the same side of his tongue. MRI shows a lesion in the cerebral cortex. This man’s lesion is most likely located in which of the following cortical regions? _ (A) Anterior paracentral _ (B) lower one-third of the postcentral _ (C) Lateral one-third of the precentral _ (D) Middle one-third of the postcentral _ (E) Posterior paracentral 2. A 41-year-old woman complains to her family physician about recurring episodes of sharp pain that seem to originate from around her mouth and cheek. The pain is so intense that she is unable to eat or brush her teeth. Which of the following cranial nerves is the most likely source of this pain? _ (A) Facial (VII) _ (B) Glossopharyngeal (IX) _ (C) Hypoglossal (XII) _ (D) Trigeminal (V) _ (E) Vagus (X) 3. The labyrinthine artery is an important source of blood supply to the inner ear. Which of the following arteries represents the major vessel from which this branch usually arises? _ (A) Anterior inferior cerebellar _ (B) Basilar _ (C) Posterior inferior cerebellar _ (D) Superior cerebellar _ (E) Vertebral
  2. 2. 4. The quadrigeminal artery in a 20-year-old man is occluded by a fat embolus originating from a compound fracture of the humerus. Which of the following structures does this occluded vessel most directly affect? -(A) Superior cerebellar peduncle _ (B) Mammillary bodies _ (C) Medial and lateral geniculate bodies _ (D) Pineal and habenula _ (E) Superior and inferior colliculi Questions 5 and 6 are based on the following patient. A 63-year-old man has hearing loss, tinnitus (ringing or buzzing sounds in the ear), vertigo, and unsteady gait; all of these have developed over several years. MRI reveals a large tumor (3 cm in diameter) at the cerebellopontine angle, most likely a vestibular schwannoma (sometimes incorrectly called an acoustic neuroma). 5. What additional deficit could this patient also have? _ (A) Anosmia _ (B) Hemianopsia _ (C) Numbness on the face _ (D) Visual field deficits _ (E) Weakness of the tongue 6. In addition to the vestibulocochlear nerve, which of the following structures would most likely also be affected by the tumor in this man? _ (A) Anterior inferior cerebellar artery _ (B) Facial nerve _ (C) Glossopharyngeal nerve _ (D) Posterior inferior cerebellar artery _ (E) Vagus nerve 7. A 67-year-old man complains to his family physician of severe headaches. The examination reveals visual deficits in both eyes, and MRI shows a lesion in the
  3. 3. cerebral cortex. Which of the following cortical structures represents the most likely location of this lesion? _ (A) Angular gyrus _ (B) Cingulate gyrus _ (C) Lingual gyrus _ (D) Parahippocampal gyrus _ (E) Precuneus 8. A sagittal MRI of a 23-year-old woman is located at, or immediately adjacent to, the midline. Which of the following spaces or structures would be in the image and would indicate a midline plane? _ (A) Cerebral aqueduct _ (B) Corpus callosum _ (C) Interpeduncular fossa _ (D) Interventricular foramen _ (E) Superior colliculus 9. Which of the following portions of the ventricular system does not contain choroid plexus? _ (A) Cerebral aqueduct _ (B) Fourth ventricle _ (C) Lateral ventricle _ (D) Interventricular foramen _ (E) Third ventricle 10. A 47-year-old man presents with an intense pain on his face arising from stimulation at the corner of his mouth. This is characteristic of trigeminal neuralgia (tic douloureux). MRI shows a vessel compressing the root of the trigeminal nerve. Which of the following vessels would most likely be involved? _ (A) Anterior inferior cerebellar artery _ (B) Basal vein (of Rosenthal) _ (C) Basilar artery _ (D) Posterior cerebral artery
  4. 4. _ (E) Superior cerebellar artery 11. Which of the following cranial nerves contain the afferent and efferent limbs of the corneal reflex? _ (A) II and III (optic and oculomotor) _ (B) III, IV, VI (oculomotor, trochlear, abducens) _ (C) V and VII (trigeminal, facial) _ (D) VIII and IX (vestibulocochlear, glossopharyngeal) _ (E) IX and X (glossopharyngeal, vagus) 12. A 73-year-old man is brought to the emergency department after being found in his garage in a state of confusion. CT shows an infarct involving much of the superior frontal gyrus. Which of the following vessels is most likely occluded in this patient? _ (A) Angular artery _ (B) Callosomarginal artery _ (C) Lenticulostriate arteries _ (D) Middle cerebral artery _ (E) Posterior cerebral artery 13. The MRI of a 49-year-old woman shows a tumor located immediately superior to the corpus callosum. This lesion is most likely located in which of the following lobes? _ (A) Frontal _ (B) Limbic _ (C) Occipital _ (D) Parietal _ (E) Temporal 14. A 69-year-old woman is brought to the emergency department. The daughter reports that her mother suddenly seemed to be unable to speak. The examination reveals that the woman has a nonfluent (Broca) aphasia. A sagittal MRI shows a lesion in which of the following gyri?
  5. 5. _ (A) Angular _ (B) Inferior frontal _ (C) lower Lateral one-third of the precentral _ (D) Middle frontal _ (E) Supramarginal 15. Which of the following Brodmann areas represents the somatosensory cortex? _ (A) Areas 3, 1, 2 _ (B) Area 4 _ (C) Area 17 _ (D) Area 22 _ (E) Area 40 16. A 64-year-old man awakens with a profound weakness of his right hand. The man is transported by ambulance to a major medical center. MRI shows a small lesion in the cerebral cortex. Which of the following gyri represents the most likely location of this lesion? _ (A) Anterior paracentral _ (B) Middle one-third of precentral _ (C) Middle frontal _ (D) lower one-third of precentral _ (E) upper one-third of precentral 17. A lumbar puncture, commonly called a “lumbar tap,” consists of a needle being inserted through an intervertebral space into the lumbar cistern to retrieve a sample of cerebrospinal fluid. Which of the following is the most likely level for the insertion of the needle? _ (A) L1–L2 _ (B) L2–L3 _ (C) L4–L5 _ (D) S1–S2 _ (E) T12–L1
  6. 6. 18. A 59-year-old man complains of persistent headache. An MRA (Magnetic Resonance Angiography) shows an aneurysm in the interpeduncular fossa (and cistern) arising from the basilar tip. Which of the following cranial nerves would be most directly affected by this aneurysm? _ (A) Abducens (VI) _ (B) Oculomotor (III) _ (C) Optic (II) _ (D) Trigeminal, V1 (V) _ (E) Trochlear (IV) 19. A 71-year-old man presents with a Broca (nonfluent) aphasia. MRI reveals a lesion in Brodmann area 44. As this lesion expands (due to edema) and impinges on the immediately adjacent cortical areas, which of the following deficits would most likely be seen? _ (A) Loss of hearing in one ear _ (B) Numbness and prickly sensation on the hand _ (C) Visual field deficits in both eyes _ (D) Weakness of facial muscles _ (E) Weakness of the upper extremity 20. The collection of posterior and anterior roots that occupy the lumbar cistern are collectively known as which of the following? _ (A) Cauda equina _ (B) Conus medullaris _ (C) Denticulate ligament _ (D) Filum terminale externum _ (E) Filum terminale internum