Neuroanatomy — MCQs

A 73-year-old man presents to your office accompanied by his wife. He has been experiencing a tremor in his right hand for the last several months that seems to be worsening. He does not have any other complaints and says he’s “fine.” His wife thinks that he has also had more difficulty walking. His history is significant for hypertension and an ischemic stroke of the right middle cerebral artery 2 years ago. His medications include hydrochlorothiazide and daily aspirin. On physical exam you note that the patient speaks with a soft voice and has decreased facial expressions. He has a resting tremor that is worse on the right side. He has increased resistance to passive movement when you flex and extend his relaxed wrist. He has 5/5 strength bilaterally. Neuronal degeneration in which of the following locations is most likely responsible for the progression of this disease?

A 27-year-old man is brought to the emergency department because of a knife wound to his back. His pulse is 110/min, respirations are 14/min, and blood pressure is 125/78 mm Hg. Examination shows a 5-cm deep stab wound at the level of T9. He withdraws the right foot to pain but is unable to sense vibration or whether his right toe is flexed or extended. Sensation in the left leg is normal. Motor strength is 5/5 in all extremities. Rectal tone is normal. Which of the following spinal column structures was most likely affected?

A 60-year-old man is brought to the emergency department because of a 1-hour history of disorientation and slurred speech. He has a 10-year history of hypertension and hypercholesterolemia. His blood pressure is 210/110 mm Hg, and pulse is 90/min. Once the patient is stabilized, an MRI of the brain is performed, which shows an infarct of the left precentral gyrus involving the facial motor cortex. Given the MRI findings, which of the following neurological findings would most be expected?

A 23-year-old woman comes to the physician because of an 8-month history of weakness and intermittent burning pain in her neck, shoulders, and arms. She was involved in a motor vehicle collision 1 year ago. Examination of the upper extremities shows absent reflexes, muscle weakness, and fasciculations bilaterally. Sensation to temperature and pain is absent; vibration and proprioception are preserved. The pupils are equal and reactive to light. Which of the following is the most likely diagnosis?

A 47-year-old man comes to the emergency department because of urinary and fecal incontinence for 6 hours. Earlier in the day, he suffered a fall at a construction site and sustained injuries to his back and thighs but did not seek medical attention. He took ibuprofen for lower back pain. His temperature is 36.9°C (98.4°F), pulse is 80/min, and blood pressure is 132/84 mm Hg. Examination shows tenderness over the lumbar spine, bilateral lower extremity weakness, absent ankle jerk reflexes, and preserved patellar reflexes. There is decreased rectal tone. An ultrasound of the bladder shows a full bladder. Which of the following is the most likely diagnosis?

You are called to see a chemotherapy patient who is complaining of severe nausea. This patient is a 52-year-old male with acute lymphoblastic leukemia (ALL) who began his first cycle of chemotherapy 2 days ago. Which of the following structures is involved in the pathway responsible for this patient's nausea?

A 58-year-old woman presents to her primary care doctor with her husband. The patient's husband reports that his wife has been acting "funny" ever since she was in a motor vehicle accident 2 months ago. She's been very rude to him, their children, and her friends, often saying inappropriate things. She is not interested in her previous hobbies and will not watch her favorite television shows or play cards. Which of the following regions is suspicious for injury?

A 65-year-old woman presents to her physician with the complaint of ringing in her right ear. She says it started about 3 months ago with associated progressive difficulty in hearing on the same side. Past medical history is significant for a hysterectomy 5 years ago due to dysfunctional uterine bleeding. She is currently not taking any medications. She is a non-smoker and drinks socially. On otoscopic examination, a red-blue pulsatile mass is observed behind the right tympanic membrane. A noncontrast CT scan of the head shows significant bone destruction resulting in a larger jugular foramen highly suggestive of a tumor derived from neural crest cells. Which of the cranial nerves are most likely to be involved in this type of lesion?

A 68-year-old man is brought to the emergency department by ambulance after he was found to be altered at home. Specifically, his wife says that he fell and was unable to get back up while walking to bed. When she approached him, she found that he was unable to move his left leg. His past medical history is significant for hypertension, atrial fibrillation, and diabetes. In addition, he has a 20-pack-year smoking history. On presentation, he is found to still have difficulty moving his left leg though motor function in his left arm is completely intact. The cause of this patient's symptoms most likely occurred in an artery supplying which of the following brain regions?

A 42-year-old woman presents with loss of sensation in her left arm and hand. A rapid evaluation is performed to rule out stroke. No other focal neurologic deficits are found except for a loss of fine touch sensation in a C6 dermatome pattern. Further evaluation reveals that the patient was recently sick with an upper respiratory infection. A biopsy is performed and shows destruction of the cell bodies of sensory nerves. Which of the following structures has most likely been damaged?