Neuro 6 Flashcards

After a hemicord injury, a patient develops ipsilateral weakness below the lesion with impaired voluntary limb movement. Which tract is most directly damaged?
A. Posterior columns
B. Lateral corticospinal tract
C. Ventral spinocerebellar tract
D. Anterolateral pathway

A patient cannot detect toe vibration or joint position but still feels pinprick. Which pathway is primarily affected?
A. Corticospinal tract
B. Rubrospinal tract
C. Spinoreticular tract
D. Posterior columns

A central cord lesion causes loss of pain, temperature, and crude touch sensation. Which pathway carries these modalities?
A. Anterolateral pathway
B. Posterior columns
C. Dorsal spinocerebellar tract
D. Lateral corticospinal tract

A neurosurgeon identifies the sulcus separating frontal from parietal cortex before resection. Which landmark is this?
A. Calcarine sulcus
B. Lateral sulcus
C. Rolandic sulcus
D. Parieto-occipital sulcus

A focal seizure arises from Brodmann area 4. Which gyrus contains this cortex?
A. Precentral gyrus
B. Postcentral gyrus
C. Superior frontal gyrus
D. Cingulate gyrus

A cortical lesion involving Brodmann areas 3, 1, and 2 causes primary sensory loss. Where is the lesion?
A. Precentral gyrus
B. Inferior parietal lobule
C. Superior temporal gyrus
D. Postcentral gyrus

A patient has impaired interpretation of sensory input, but basic strength and basic sensation remain largely intact. Which cortex is most likely involved?
A. Primary motor cortex
B. Association cortex
C. Primary visual cortex
D. Ventral horn cortex

Penfield stimulation studies show an orderly body map across primary motor and sensory cortices. What is this arrangement called?
A. Laminar organization
B. Columnar organization
C. Somatotopic organization
D. Retinotopic organization

The distorted body map classically drawn over the precentral gyrus is called the:
A. Motor homunculus
B. Sensory homunculus
C. Cerebellar homunculus
D. Basal homunculus

The distorted body map classically drawn over the postcentral gyrus is called the:
A. Motor homunculus
B. Cortical unculus
C. Sensory homunculus
D. Visual homunculus

A parasagittal cortical infarct affects the leg area more than the arm area in primary sensorimotor cortex. Relative to the arm, the leg representation lies:
A. Inferior to the arm
B. Lateral to the arm
C. Posterior to the arm
D. Medial to the arm

In the posterior columns, lower-limb fibers are positioned how relative to upper-limb fibers?
A. Lateral to the arm
B. Medial to the arm
C. Anterior to the arm
D. Ventral to the arm

On cross-section, the spinal cord shows a butterfly-shaped central region surrounded by funiculi. The butterfly region is:
A. Gray matter
B. White matter
C. Pia mater
D. Central canal

Sensory neurons in the dorsal root ganglia send a central process into the cord. These axons characteristically:
A. Decussate immediately
B. Terminate ipsilaterally
C. Remain unbranched
D. Bifurcate

The dorsal horn of spinal gray matter is involved mainly in:
A. Motor planning
B. Sensory processing
C. Endocrine output
D. Visceral efferents

The ventral horn primarily contains:
A. Interneurons
B. Radicular arteries
C. Motor neurons
D. Sensory ganglia

The intermediate zone of spinal gray matter contains:
A. Interneurons and specialized nuclei
B. Lower motor neurons and specialized nuclei
C. Only sensory relay cells and specialized nuclei
D. Ascending fasciculi and specialized nuclei

Lower motor neuron axons leave the spinal cord through the:
A. Dorsal horn
B. Dorsal root ganglion
C. Lateral funiculus
D. Ventral root filaments

At which spinal level is white matter thickest?
A. Sacral cord
B. Cervical cord
C. Lumbar cord
D. Thoracic cord

Which spinal region is composed mostly of gray matter?
A. Cervical cord
B. Thoracic cord
C. Sacral cord
D. Medullary cord

The cervical and lumbosacral enlargements are most directly related to formation of:
A. Nerve plexuses
B. Meningeal folds
C. Denticulate ligaments
D. Dorsal columns

Compared with thoracic levels, spinal gray matter is greater at:
A. Only cervical levels
B. Only lumbar levels
C. Thoracic and sacral levels
D. Cervical and lumbosacral levels

A histologic section from the thoracic cord shows a lateral horn. Which structure is found there?
A. Clarke nucleus only
B. Intermediolateral cell column
C. Gracile nucleus
D. Substantia gelatinosa

Arterial supply to the spinal cord arises from branches of the:
A. Carotid and basilar arteries
B. Internal thoracic arteries
C. Vertebral and spinal radicular
D. Middle meningeal arteries

The vertebral arteries directly give rise to the:
A. Anterior spinal artery
B. Posterior communicating artery
C. Great radicular artery
D. Internal thoracic artery

The anterior spinal artery runs along which surface of the spinal cord?
A. Dorsal surface
B. Lateral surface
C. Ventral surface
D. Posterolateral sulcus

A lesion affecting the cord region that gives rise to the upper-limb plexus most likely involves the:
A. Sacral cord
B. Thoracic cord
C. Cervical enlargement
D. Conus medullaris

A lesion affecting the cord region that gives rise to the lower-limb plexus most likely involves the:
A. Lumbosacral enlargement
B. Cervical enlargement
C. Thoracic cord
D. Dorsal horn

A posterior spinal artery infarct would most directly compromise blood flow to which spinal cord region?
A. Ventral surface only
B. Dorsal surface only
C. Central canal only
D. Lateral horn only

How many posterior spinal arteries typically supply the cord?
A. One
B. Two
C. Three
D. Four

The posterior spinal arteries usually arise from which vessels?
A. Basilar or superior cerebellar
B. Vertebral or PICA
C. Internal carotid or ACA
D. Aorta or radicular trunks

A surgeon ligates the artery of Adamkiewicz during aortic repair. Which cord regions are most threatened?
A. Cervical and upper thoracic
B. Upper thoracic and cervical
C. Lumbar and sacral
D. Midbrain and pons

The great radicular artery of Adamkiewicz most commonly enters between:
A. T1 and T4
B. T4 and T8
C. T9 and T12
D. L2 and L5

The artery of Adamkiewicz usually arises from which side?
A. Right side
B. Left side
C. Either side equally
D. Midline branch

Across all variants, the artery of Adamkiewicz may arise anywhere from:
A. C5 to T4
B. T1 to T6
C. T3 to T9
D. T5 to L3

During prolonged hypotension, which spinal cord region is especially vulnerable because it lies between major arterial territories?
A. C1 to C4
B. T4 to T8
C. T10 to L2
D. S1 to S4

Batson’s plexus is clinically important because these epidural veins:
A. Lack valves
B. Drain into azygos only
C. Supply dorsal columns
D. Traverse posterior roots

A patient with prostate carcinoma develops vertebral epidural metastases after repeated Valsalva strain. The route is best explained by:
A. Vertebral artery embolization
B. Lymphatic retrograde spread
C. Valveless Batson plexus reflux
D. Subarachnoid venous stasis

Elevated intra-abdominal pressure can promote reflux through Batson’s plexus carrying:
A. Pulmonary emboli or metastases
B. Pelvic infection or metastases
C. Carotid thrombi or metastases
D. CSF into veins or metastases

Cerebellar and basal ganglia output returns to the cerebral cortex primarily via the:
A. Hypothalamus
B. Red nucleus
C. Thalamus
D. Superior colliculus

Which statement about cerebellar and basal ganglia motor output is most accurate?
A. They directly innervate LMNs
B. They bypass the thalamus
C. They project to dorsal roots
D. They do not reach LMNs directly

A patient has intact strength but cannot correctly perform a learned motor task on command. This deficit is called:
A. Ataxia
B. Apraxia
C. Dysmetria
D. Agraphesthesia

Apraxia is best defined as impaired:
A. Primary sensation with weakness
B. Reflexes despite paralysis
C. Higher-order motor planning
D. Tone with hyperreflexia

Which pair constitutes the two lateral motor systems?
A. Tectospinal and vestibulospinal
B. Reticulospinal and rubrospinal
C. Lateral corticospinal and rubrospinal
D. Anterior corticospinal and tectospinal

Which tract is most associated with automatic posture and gait-related movements?
A. Tectospinal tract
B. Reticulospinal tracts
C. Rubrospinal tract
D. Fasciculus gracilis

Coordination of head and eye movements is most closely associated with the:
A. Vestibulospinal tract
B. Corticobulbar tract
C. Reticulospinal tract
D. Tectospinal tract

Which of the following is a medial motor system?
A. Rubrospinal tract
B. Lateral corticospinal tract
C. Reticulospinal tract
D. Spinothalamic tract

Which tract is the major pathway controlling extremity movement and is especially useful for clinical localization when injured?
A. Lateral corticospinal tract
B. Anterior corticospinal tract
C. Vestibulospinal tract
D. Tectospinal tract

Most corticospinal neurons arise from pyramidal cells in which cortical layer?
A. Layer 2
B. Layer 3
C. Layer 4
D. Layer 5

Layer 5 pyramidal cell projections can synapse directly onto ventral horn:
A. Sensory neurons only
B. Motor neurons only
C. Autonomic ganglia only
D. Dorsal root cells only

In addition to direct ventral horn motor neuron synapses, corticospinal fibers also synapse on:
A. Purkinje cells
B. Thalamic relay cells
C. Spinal interneurons
D. Dorsal column nuclei

About 3% of corticospinal neurons are giant pyramidal cells called:
A. Golgi cells
B. Betz cells
C. Renshaw cells
D. Basket cells

The largest neurons in the human nervous system are:
A. Purkinje neurons
B. Alpha motor neurons
C. Betz cells
D. Mitral cells

Relative to the internal capsule, the thalamus and caudate nucleus are always:
A. Lateral
B. Superior
C. Inferior
D. Medial

Relative to the internal capsule, the globus pallidus and putamen are always:
A. Medial
B. Lateral
C. Inferior
D. Posterior

Which list correctly names the three parts of the internal capsule?
A. Anterior limb, genu, posterior limb
B. Head, body, tail
C. Crus, tegmentum, tectum
D. Medial, central, lateral

The anterior limb of the internal capsule separates the head of the caudate from the:
A. Thalamus only
B. Claustrum and insula
C. Globus pallidus and putamen
D. Amygdala and uncus

The posterior limb of the internal capsule separates the thalamus from the:
A. Globus pallidus and putamen
B. Head of caudate only
C. Subthalamic nucleus only
D. Hippocampus and amygdala

In the pyramidal decussation, approximately what percentage of fibers cross to form the lateral corticospinal tract?
A. 60%
B. 70%
C. 85%
D. 95%

After crossing in the pyramidal decussation, lateral corticospinal fibers descend in the lateral:
A. Gray matter columns
B. White matter columns
C. Ventral roots
D. Dorsal horns

Axons of the lateral corticospinal tract enter spinal gray matter to synapse on:
A. Posterior horn cells
B. Intermediolateral neurons
C. Dorsal root neurons
D. Anterior horn cells

Preganglionic sympathetic neurons are located in the:
A. Substantia gelatinosa
B. Nucleus ambiguus
C. Intermediolateral cell column
D. Clarke nucleus

Sympathetic preganglionic neurons are found primarily at which spinal levels?
A. C1 to C8
B. T1 to L2/L3
C. L4 to S4
D. S2 to S4

The sympathetic trunk extends on each side from:
A. Thoracic to lumbar
B. Cervical to sacral
C. Cervical to thoracic
D. Lumbar to coccygeal

The sympathetic trunk is clinically important because it allows thoracolumbar sympathetic efferents to:
A. Reach other body regions
B. Enter dorsal roots
C. Synapse in cortex
D. Bypass all ganglia

Sympathetic supply to the head and neck arises mainly from which spinal segments?
A. C1 to C3
B. C5 to T1
C. T1 to T3
D. T4 to T6

Which set of ganglia supplies sympathetic fibers to the head and neck?
A. Otic, pterygopalatine, ciliary
B. Celiac, mesenteric, hypogastric
C. Dorsal root, nodose, geniculate
D. Superior, middle, inferior cervical

Which cervical sympathetic ganglion is often absent?
A. Superior cervical
B. Middle cervical
C. Inferior cervical
D. Stellate ganglion

The inferior cervical ganglion is also called the:
A. Otic ganglion
B. Submandibular ganglion
C. Stellate ganglion
D. Celiac ganglion

Unpaired sympathetic ganglia surrounding the aorta are located in the:
A. Carotid sheath
B. Cavernous sinus
C. Epidural space
D. Celiac plexus

Which of the following is a prevertebral sympathetic ganglion?
A. Celiac ganglion
B. Ciliary ganglion
C. Geniculate ganglion
D. Trigeminal ganglion

Compared with postganglionic sympathetic axons, preganglionic sympathetic axons usually travel a:
A. More variable course
B. Longer distance
C. Shorter distance
D. More peripheral route

Postganglionic sympathetic axons generally travel a:
A. Short distance
B. Long distance
C. Segmental loop
D. Midline route

Parasympathetic preganglionic fibers must travel a relatively:
A. Long distance
B. Short distance
C. Unmyelinated route
D. Thoracolumbar path

Parasympathetic preganglionic fibers arise from cranial nerve nuclei and from sacral nuclei at:
A. S1 to S2
B. S2 to S4
C. L5 to S2
D. T12 to L2

The sacral parasympathetic nuclei are located in spinal:
A. Dorsal columns
B. Ventral white matter
C. Lateral gray matter
D. Posterior root ganglia

Upper motor neurons of the corticospinal tract project from the:
A. Cerebral cortex
B. Basal ganglia
C. Cerebellar cortex
D. Brainstem reticular formation

Lower motor neurons of the corticospinal system are located in the spinal:
A. Dorsal horn
B. Intermediate zone
C. Anterior horn
D. Lateral funiculus

Lower motor neurons project to skeletal muscle through:
A. Corticobulbar fibers
B. Peripheral nerves
C. Dorsal columns
D. Spinocerebellar tracts

Which finding most strongly suggests a lower motor neuron lesion?
A. Hyperreflexia
B. Babinski sign
C. Increased tone
D. Fasciculations

Fasciculations are best defined as:
A. Rhythmic intention tremors
B. Spasms of flexor muscles
C. Twitching from motor unit firing
D. Repetitive clonic jerks

Which combination best fits an upper motor neuron lesion?
A. Atrophy and hyporeflexia
B. Weakness with spasticity
C. Fasciculations and flaccidity
D. Sensory loss and areflexia

Unilateral weakness affecting face, arm, and leg is called:
A. Diplegia
B. Monoplegia
C. Paraplegia
D. Hemiparesis

During pronator drift testing, in a LMN injury, the abnormal arm typically shows:
A. Finger abduction only
B. Elbow extension only
C. Pronation with slight downward drift
D. Sudden ballistic supination

Resistance testing of which muscles is especially useful for subtle corticospinal lesions?
A. Finger flexors
B. Finger extensors
C. Thenar muscles
D. Interossei only

Rapid thumb-finger tapping, coin transfer, and alternating hand movements primarily assess:
A. Visual fields
B. Muscle bulk
C. Fine movements
D. Primary sensation

One of the most sensitive tests for subtle neurologic dysfunction is careful examination of:
A. Speech
B. Gait
C. Pupils
D. Smell

A patient walks stiff-legged with circumduction, toe-walking, reduced arm swing, and scissoring. Which gait is most likely?
A. Ataxic gait
B. Steppage gait
C. Parkinsonian gait
D. Spastic gait

Which pair are the classic exceptions to the “arms medial to legs” rule?
A. Cerebellum and thalamus
B. Internal capsule and pons
C. Primary sensorimotor cortices and posterior columns
D. Basal ganglia and medulla

In the spinal cord, white matter columns are also called:
A. gyri
B. peduncles
C. funiculi
D. laminae

The genu of the internal capsule lies at the level of the:
A. optic chiasm
B. foramen of Monro
C. mammillary bodies
D. superior colliculus

The corticospinal tract travels through which part of the internal capsule?
A. anterior limb
B. genu
C. retrolenticular limb
D. posterior limb

In the internal capsule, motor fibers for the face are located most:
A. anterior
B. posterior
C. lateral
D. medial

In the internal capsule, motor fibers for the leg are located most:
A. anterior
B. medial
C. posterior
D. superior

Which sequence best describes internal capsule somatotopy from anterior to posterior?
A. leg, arm, face
B. face, arm, leg
C. arm, face, leg
D. face, leg, arm

The internal capsule continues into the midbrain as the:
A. superior cerebellar peduncles
B. cerebral peduncles
C. middle cerebellar peduncles
D. inferior olives

The ventral white matter of the cerebral peduncles is called the:
A. crus cerebelli
B. tegmentum
C. basis pedunculi
D. tectal plate

The middle one-third of the basis pedunculi contains:
A. spinothalamic fibers
B. corticobulbar and corticospinal fibers
C. medial lemniscus fibers
D. vestibulocerebellar fibers

In the basis pedunculi, face, arm, and leg fibers are arranged:
A. lateral to medial
B. posterior to anterior
C. superficial to deep
D. medial to lateral

The transition from medulla to spinal cord is the:
A. pontomedullary junction
B. cervicomedullary junction
C. spinomesencephalic junction
D. thalamocortical junction

The cervicomedullary junction is located at the:
A. jugular foramen
B. foramen ovale
C. foramen magnum
D. stylomastoid foramen

Which tract is not one of the four medial motor systems?
A. anterior corticospinal
B. vestibulospinal
C. reticulospinal
D. rubrospinal

The unpaired prevertebral sympathetic ganglia are located around the aorta in the:
A. carotid sinus
B. celiac plexus
C. epidural space
D. cavernous sinus

Which set correctly lists the major prevertebral sympathetic ganglia?
A. ciliary, otic, submandibular
B. superior cervical, middle cervical, stellate
C. celiac, superior mesenteric, inferior mesenteric
D. dorsal root, nodose, geniculate

Parasympathetic terminal ganglia are usually located:
A. in dorsal roots
B. within or near effector organs
C. along the sympathetic trunk
D. inside vertebral foramina

Which combination best fits a lower motor neuron lesion?
A. weakness, atrophy, hyporeflexia
B. weakness, hyperreflexia, Babinski
C. rigidity, tremor, bradykinesia
D. sensory loss, neglect, aphasia

Which additional finding strongly supports an upper motor neuron lesion?
A. fasciculations
B. hyporeflexia
C. Babinski sign
D. muscle atrophy

Which finding is another classic upper motor neuron sign?
A. Hoffmann sign
B. Romberg sign
C. Kernig sign
D. Lhermitte sign

Resistance testing of the finger extensors is sensitive for corticospinal lesions partly because corticospinal damage tends to spare:
A. extensors over flexors
B. flexors over extensors
C. proximal muscles only
D. axial muscles only

Finger extensors are especially useful to test because they are relatively:
A. strong and brainstem-driven
B. weak and cortically represented
C. fast and autonomic
D. proximal and reflex-dominant

In rapid alternating and dexterity tasks, the dominant hand or foot is normally:
A. dramatically faster
B. slightly faster
C. slightly weaker
D. markedly slower

A patient has a wide-based, staggering gait and falls toward the side of worse cerebellar pathology. Which gait is this?
A. spastic gait
B. steppage gait
C. ataxic gait
D. waddling gait

A patient has a slow, shuffling, narrow-based gait with stooped posture, decreased arm swing, and en bloc turning. What gait is this?
A. Ataxic gait
B. Spastic gait
C. Steppage gait
D. Parkinsonian gait

On pull testing, a patient takes several rapid backward steps to regain balance. This finding is called:
A. Dysmetria
B. Retropulsion
C. Intention tremor
D. Pronator drift

Multiple sclerosis is best described as:
A. Autoimmune CNS demyelination
B. Peripheral axonal degeneration
C. Basal ganglia degeneration
D. Neuromuscular junction failure

The neurologic deficits of demyelination are most directly explained by:
A. Loss of acetylcholine synthesis
B. Increased neuromuscular transmission
C. Slowed, dispersed conduction
D. Excess cortical inhibition

The classic clinical definition of multiple sclerosis requires:
A. One deficit with fever
B. Deficits separated in space/time
C. Sensory loss plus weakness
D. MRI lesions without symptoms

Oligoclonal bands in CSF most strongly indicate:
A. Blood contamination
B. Albumin loss
C. Neutrophilic meningitis
D. Intrathecal immunoglobulin synthesis

About what fraction of patients with isolated optic neuritis or transverse myelitis later develop multiple sclerosis?
A. About 50%
B. About 10%
C. About 25%
D. About 75%

Which pair is first-line for relapsing-remitting multiple sclerosis?
A. Levodopa and amantadine
B. Pyridostigmine and prednisone
C. Beta-interferon and glatiramer
D. Phenytoin and acetazolamide

ALS is characterized by degeneration of:
A. Sensory and autonomic neurons
B. Upper and lower motor neurons
C. Cerebellar and vestibular neurons
D. Basal ganglia and cortex

Which exam pattern most strongly supports ALS?
A. Areflexia with sensory loss
B. Rest tremor with rigidity
C. Ophthalmoplegia with ptosis
D. Brisk reflexes with atrophy

Which pair should be excluded in suspected ALS because they can mimic the syndrome?
A. Lead toxicity, B12 deficiency
B. Diabetes, hypercalcemia
C. Myasthenia, epilepsy
D. Lyme disease, porphyria

Primary Lateral Sclerosis (PLS): UMN or LMN

Spinal Muscular Atrophy (SMA): UMN or LMN

Infantile spinal muscular atrophy is called:
A. Friedreich disease
B. Charcot-Marie-Tooth disease
C. Krabbe disease
D. Werdnig-Hoffmann disease

The somatosensory association cortex is located in the:
A. Parietal lobe
B. Frontal lobe
C. Temporal lobe
D. Occipital lobe

The cervical enlargement for the arm plexus spans:
A. C1-T1
B. C5-T5
C. C3-T1
D. T1-L1

The lumbosacral enlargement for the leg plexus spans:
A. L1-S2
B. T10-L2
C. L3-S4
D. S1-S5

Rexed lamina I is the:
A. Nucleus proprius
B. Base of dorsal horn
C. Commissural nucleus
D. Marginal zone

Rexed lamina II corresponds to the:
A. Clarke nucleus
B. Substantia gelatinosa
C. Grisea centralis
D. Motor nuclei

Rexed laminae III and IV form the:
A. Nucleus proprius
B. Marginal zone
C. Neck of dorsal horn
D. Intermediolateral column

Rexed lamina V is the:
A. Base of dorsal horn
B. Motor nuclei
C. Neck of dorsal horn
D. Grisea centralis

Rexed lamina VI is the:
A. Marginal zone
B. Base of dorsal horn
C. Commissural nucleus
D. Nucleus proprius

Rexed lamina VII contains the:
A. Substantia gelatinosa
B. Grisea centralis
C. Motor nuclei
D. Clarke and IML nuclei

Rexed lamina VIII corresponds to the:
A. Marginal zone
B. Base of dorsal horn
C. Commissural nucleus
D. Nucleus proprius

Rexed lamina IX contains the:
A. Motor nuclei
B. Clarke nucleus
C. Neck of dorsal horn
D. Grisea centralis

Rexed lamina X is the:
A. Intermediolateral column
B. Substantia gelatinosa
C. Commissural nucleus
D. Grisea centralis

Which spinal cord region is predominantly gray matter?
A. Cervical region
B. Sacral region
C. Thoracic region
D. Upper lumbar region

Which arteries arise from the aorta and supply the spinal meninges along the cord?
A. Radicular arteries
B. Posterior spinal arteries
C. Segmental arteries
D. Vertebral arteries

How many segmental arteries supply the spinal meninges?
A. 31
B. 24
C. 12
D. 40

Parkinsonian gait can occur in Parkinson disease and also with:
A. Cerebellar vermis lesions
B. Progressive supranuclear palsy
C. Dorsal column lesions
D. Tabes dorsalis

A man with prostate cancer develops epidural metastases after tumor cells spread through a valveless spinal venous network. Which plexus is involved?
A. Pampiniform plexus
B. Internal vertebral plexus
C. Batson's plexus
D. Cavernous plexus

Batson's plexus is clinically important primarily because it:
A. drains CSF directly
B. lacks venous valves
C. supplies spinal arteries
D. surrounds dorsal roots

Which pair of descending tracts primarily controls extremity movement?
A. Lateral corticospinal and rubrospinal
B. Vestibulospinal and tectospinal
C. Reticulospinal and anterior corticospinal
D. Spinothalamic and corticobulbar

Which descending tract is especially important for rapid, dexterous movement of individual digits and joints?
A. Rubrospinal tract
B. Tectospinal tract
C. Lateral corticospinal tract
D. Vestibulospinal tract

Both the lateral corticospinal and rubrospinal tracts descend in which part of the spinal cord?
A. Ipsilateral dorsal columns
B. Contralateral lateral columns
C. Bilateral anterior columns
D. Ipsilateral posterior horns

Because the lateral corticospinal and rubrospinal tracts have already crossed, they control:
A. ipsilateral trunk muscles
B. contralateral extremities
C. bilateral neck muscles
D. ipsilateral facial muscles

Which descending motor system primarily controls proximal axial and girdle muscles used for posture, balance, orienting, and automatic gait?
A. Lateral motor system
B. Dorsal column system
C. Spinocerebellar system
D. Medial motor system

Which tract belongs to the medial motor system?
A. Rubrospinal tract
B. Lateral corticospinal tract
C. Vestibulospinal tract
D. Fasciculus cuneatus

Which list correctly names the four medial motor system tracts?
A. Anterior corticospinal, vestibulospinal, reticulospinal, tectospinal
B. Lateral corticospinal, rubrospinal, spinothalamic, tectospinal
C. Vestibulospinal, spinocerebellar, reticulospinal, gracile
D. Corticobulbar, rubrospinal, anterior spinothalamic, tectospinal

Medial motor system tracts primarily terminate on:
A. anterior horn alpha motor neurons
B. posterior horn projection neurons
C. Clarke nucleus neurons
D. spinal interneurons

Why does a unilateral lesion of the medial motor system often cause only modest deficits?
A. it innervates sensory ganglia
B. it bypasses the spinal cord
C. it acts through bilateral interneurons
D. it reaches only lumbar segments

Which medial motor tract is the only one that decussates?
A. Vestibulospinal tract
B. Tectospinal tract
C. Reticulospinal tract
D. Anterior corticospinal tract

The tectospinal tract decussates in the:
A. pyramidal decussation
B. posterior commissure
C. ventral tegmentum
D. dorsal tegmentum

The tectospinal tract originates in the:
A. red nucleus
B. superior colliculus
C. pontine reticular formation
D. lateral vestibular nucleus

The tectospinal tract terminates primarily in the:
A. lumbar spinal cord
B. sacral spinal cord
C. cervical spinal cord
D. entire spinal cord

The rubrospinal tract originates from the magnocellular division of the:
A. red nucleus
B. inferior olive
C. superior colliculus
D. medial vestibular nucleus

The rubrospinal tract decussates in the:
A. dorsal tegmentum
B. pyramidal decussation
C. ventral tegmentum
D. internal capsule

The rubrospinal tract terminates primarily in the:
A. cervical spinal cord
B. thoracic spinal cord
C. lumbar spinal cord
D. sacral spinal cord

Reticulospinal fibers arise from the:
A. superior and inferior colliculi
B. pontine and medullary reticular formation
C. medial and lateral vestibular nuclei
D. caudate and putamen

Which descending tract helps position the head and neck and also contributes to balance?
A. Rubrospinal tract
B. Vestibulospinal tract
C. Tectospinal tract
D. Lateral corticospinal tract

The medial vestibulospinal tract arises from which nuclei?
A. medial and inferior vestibular nuclei
B. lateral and superior vestibular nuclei
C. dorsal motor and ambiguus nuclei
D. red and vestibular nuclei

The medial vestibulospinal tract terminates mainly in the:
A. sacral cord only
B. entire spinal cord
C. cervical and upper thoracic cord
D. lumbar enlargement only

The lateral vestibulospinal tract arises from the:
A. medial vestibular nucleus
B. inferior vestibular nucleus
C. superior vestibular nucleus
D. lateral vestibular nucleus

The lateral vestibulospinal tract descends to the:
A. cervical cord only
B. thoracic cord only
C. entire spinal cord
D. sacral cord only

Which vestibulospinal tract is most closely associated with maintaining balance through projections throughout the cord?
A. Medial vestibulospinal tract
B. Lateral vestibulospinal tract
C. Tectospinal tract
D. Rubrospinal tract

A patient has intact strength but cannot properly plan or execute a learned motor act. A lesion in which area can cause this apraxia?
A. Supplementary motor area
B. Primary visual cortex
C. Nucleus gracilis
D. Cerebellar flocculus

Which vestibulospinal tract is primarily associated with positioning of the head and neck?
A. Lateral vestibulospinal tract
B. Medial vestibulspinal tract
C. Reticulospinal tract
D. Tectospinal tract

Which vestibulospinal tract is most associated with balance?
A. Medial vestibulospinal tract
B. Rubrospinal tract
C. Lateral vestibulospinal tract
D. Anterior corticospinal tract

Which medial motor system tract is most responsible for controlling bilateral axial and girdle muscles?
A. Vestibulospinal tract
B. Tectospinal tract
C. Reticulospinal tract
D. Anterior corticospinal tract

Fibers of the lateral corticospinal tract are most abundant at which spinal cord levels?
A. Thoracic and sacral only
B. Cervical and lumbosacral enlargements
C. Mid-thoracic levels only
D. Lumbar and coccygeal only

As descending axons leave the cerebral cortex and enter the upper cerebral white matter on their way to the internal capsule, they form the:
A. corona radiata
B. basis pedunculi
C. medial lemniscus
D. posterior limb

Motor fibers that project from the cortex to brainstem motor nuclei for face movement are called:
A. corticoreticular fibers
B. corticobulbar fibers
C. corticorubral fibers
D. corticospinal fibers

A small lacunar infarct in the internal capsule can cause dense weakness because fibers there are:
A. poorly myelinated
B. arranged somatotopically
C. highly compact
D. mostly uncrossed

A lesion of the internal capsule most classically causes:
A. ipsilateral facial numbness
B. contralateral hemiparesis
C. bilateral leg ataxia
D. isolated tongue fasciculations

In the basis pedunculi, corticobulbar and corticospinal fibers are located in the:
A. medial one-third
B. middle one-third
C. lateral one-third
D. dorsal one-third

In the basis pedunculi somatotopic map, face fibers lie _____ leg fibers.
A. lateral to
B. posterior to
C. medial to
D. inferior to

The transition from medulla to spinal cord at the foramen magnum is called the:
A. pontomedullary junction
B. cervicomedullary junction
C. spinomesencephalic junction
D. cervicothalamic junction

About 15% of corticospinal fibers remain uncrossed and descend ipsilaterally in the:
A. lateral white column
B. posterior white column
C. anterior white column
D. central gray matter

The rubrospinal tract most directly modulates muscle tone by:
A. exciting extensors, inhibiting flexors
B. exciting flexors, inhibiting extensors
C. inhibiting all axial muscles
D. activating alpha-gamma co-contraction

The rubrospinal tract has its strongest influence on which limb region?
A. Lower limbs
B. Upper limbs
C. Neck only
D. Trunk only

The rubrospinal tract crosses in the:
A. pyramidal decussation
B. dorsal tegmentum
C. ventral tegmental decussation
D. posterior commissure

Sympathetic preganglionic neurons arise from which spinal levels?
A. C1-C8
B. T1-L2/3
C. L4-S4
D. S2-S4

In the spinal cord, sympathetic preganglionic neurons are specifically located in:
A. Lamina II
B. Lamina V
C. Lamina VII
D. Lamina IX

Which sympathetic ganglia are paired and form a chain from cervical to sacral levels?
A. Prevertebral ganglia
B. Terminal ganglia
C. Paravertebral ganglia
D. Intramural ganglia

Which sympathetic ganglia are unpaired and lie in the celiac plexus around the aorta?
A. Paravertebral ganglia
B. Prevertebral ganglia
C. Dorsal root ganglia
D. Cranial ganglia

A positive Hoffmann sign most strongly indicates a:
A. lower motor neuron lesion
B. cerebellar lesion
C. peripheral neuropathy
D. upper motor neuron lesion

Flicking the middle fingernail and seeing involuntary thumb or index finger flexion is the:
A. Babinski sign
B. Hoffmann sign
C. Romberg sign
D. Tinel sign

Which pair is most associated with upper motor neuron dysfunction?
A. Atrophy and fasciculations
B. Babinski and posturing
C. Hyporeflexia and weakness
D. Ptosis and diplopia

The term for partial paralysis or weakness is:
A. plegia
B. paresis
C. dystonia
D. apraxia

The term for complete absence of movement is:
A. paresis
B. dysarthria
C. plegia
D. ataxia

The most common cause of acute unilateral face and arm weakness in clinical practice is:
A. anterior cerebral artery infarct
B. middle cerebral artery infarct
C. posterior cerebral artery infarct
D. basilar artery infarct

Dysarthria is best defined as:
A. impaired language comprehension
B. inability to plan speech
C. motor speech impairment
D. loss of written expression

Which bedside pair is especially useful for detecting subtle hemiparesis from corticospinal tract involvement?
A. Romberg and tandem gait
B. Pronator drift and finger extensor testing
C. Heel-knee-shin and toe walk
D. Jaw jerk and corneal reflex