front 1 After a hemicord injury, a patient develops ipsilateral weakness
below the lesion with impaired voluntary limb movement. Which tract is
most directly damaged? | back 1 B. Lateral corticospinal tract |
front 2 A patient cannot detect toe vibration or joint position but still
feels pinprick. Which pathway is primarily affected? | back 2 D. Posterior columns |
front 3 A central cord lesion causes loss of pain, temperature, and crude
touch sensation. Which pathway carries these modalities? | back 3 A. Anterolateral pathway |
front 4 A neurosurgeon identifies the sulcus separating frontal from parietal
cortex before resection. Which landmark is this? | back 4 C. Rolandic sulcus |
front 5 A focal seizure arises from Brodmann area 4. Which gyrus contains
this cortex? | back 5 A. Precentral gyrus |
front 6 A cortical lesion involving Brodmann areas 3, 1, and 2 causes primary
sensory loss. Where is the lesion? | back 6 D. Postcentral gyrus |
front 7 A patient has impaired interpretation of sensory input, but basic
strength and basic sensation remain largely intact. Which cortex is
most likely involved? | back 7 B. Association cortex |
front 8 Penfield stimulation studies show an orderly body map across primary
motor and sensory cortices. What is this arrangement called? | back 8 C. Somatotopic organization |
front 9 The distorted body map classically drawn over the precentral gyrus is
called the: | back 9 A. Motor homunculus |
front 10 The distorted body map classically drawn over the postcentral gyrus
is called the: | back 10 C. Sensory homunculus |
front 11 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: | back 11 D. Medial to the arm |
front 12 In the posterior columns, lower-limb fibers are positioned how
relative to upper-limb fibers? | back 12 B. Medial to the arm |
front 13 On cross-section, the spinal cord shows a butterfly-shaped central
region surrounded by funiculi. The butterfly region is: | back 13 A. Gray matter |
front 14 Sensory neurons in the dorsal root ganglia send a central process
into the cord. These axons characteristically: | back 14 D. Bifurcate |
front 15 The dorsal horn of spinal gray matter is involved mainly in: | back 15 B. Sensory processing |
front 16 The ventral horn primarily contains: | back 16 C. Motor neurons |
front 17 The intermediate zone of spinal gray matter contains: | back 17 A. Interneurons and specialized nuclei |
front 18 Lower motor neuron axons leave the spinal cord through the: | back 18 D. Ventral root filaments |
front 19 At which spinal level is white matter thickest? | back 19 B. Cervical cord |
front 20 Which spinal region is composed mostly of gray matter? | back 20 C. Sacral cord |
front 21 The cervical and lumbosacral enlargements are most directly related
to formation of: | back 21 A. Nerve plexuses |
front 22 Compared with thoracic levels, spinal gray matter is greater
at: | back 22 D. Cervical and lumbosacral levels |
front 23 A histologic section from the thoracic cord shows a lateral horn.
Which structure is found there? | back 23 B. Intermediolateral cell column |
front 24 Arterial supply to the spinal cord arises from branches of
the: | back 24 C. Vertebral and spinal radicular |
front 25 The vertebral arteries directly give rise to the: | back 25 A. Anterior spinal artery |
front 26 The anterior spinal artery runs along which surface of the spinal
cord? | back 26 C. Ventral surface |
front 27 A lesion affecting the cord region that gives rise to the upper-limb
plexus most likely involves the: | back 27 C. Cervical enlargement |
front 28 A lesion affecting the cord region that gives rise to the lower-limb
plexus most likely involves the: | back 28 A. Lumbosacral enlargement |
front 29 A posterior spinal artery infarct would most directly compromise
blood flow to which spinal cord region? | back 29 B. Dorsal surface only |
front 30 How many posterior spinal arteries typically supply the cord? | back 30 B. Two |
front 31 The posterior spinal arteries usually arise from which
vessels? | back 31 B. Vertebral or PICA |
front 32 A surgeon ligates the artery of Adamkiewicz during aortic repair.
Which cord regions are most threatened? | back 32 C. Lumbar and sacral |
front 33 The great radicular artery of Adamkiewicz most commonly enters
between: | back 33 C. T9 and T12 |
front 34 The artery of Adamkiewicz usually arises from which side? | back 34 B. Left side |
front 35 Across all variants, the artery of Adamkiewicz may arise anywhere
from: | back 35 D. T5 to L3 |
front 36 During prolonged hypotension, which spinal cord region is especially
vulnerable because it lies between major arterial territories? | back 36 B. T4 to T8 |
front 37 Batson’s plexus is clinically important because these epidural
veins: | back 37 A. Lack valves |
front 38 A patient with prostate carcinoma develops vertebral epidural
metastases after repeated Valsalva strain. The route is best explained
by: | back 38 C. Valveless Batson plexus reflux |
front 39 Elevated intra-abdominal pressure can promote reflux through Batson’s
plexus carrying: | back 39 B. Pelvic infection or metastases |
front 40 Cerebellar and basal ganglia output returns to the cerebral cortex
primarily via the: | back 40 C. Thalamus |
front 41 Which statement about cerebellar and basal ganglia motor output is
most accurate? | back 41 D. They do not reach LMNs directly |
front 42 A patient has intact strength but cannot correctly perform a learned
motor task on command. This deficit is called: | back 42 B. Apraxia |
front 43 Apraxia is best defined as impaired: | back 43 C. Higher-order motor planning |
front 44 Which pair constitutes the two lateral motor systems? | back 44 C. Lateral corticospinal and rubrospinal |
front 45 Which tract is most associated with automatic posture and
gait-related movements? | back 45 B. Reticulospinal tracts |
front 46 Coordination of head and eye movements is most closely associated
with the: | back 46 D. Tectospinal tract |
front 47 Which of the following is a medial motor system? | back 47 C. Reticulospinal tract |
front 48 Which tract is the major pathway controlling extremity movement and
is especially useful for clinical localization when injured? | back 48 A. Lateral corticospinal tract |
front 49 Most corticospinal neurons arise from pyramidal cells in which
cortical layer? | back 49 D. Layer 5 |
front 50 Layer 5 pyramidal cell projections can synapse directly onto ventral
horn: | back 50 B. Motor neurons only |
front 51 In addition to direct ventral horn motor neuron synapses,
corticospinal fibers also synapse on: | back 51 C. Spinal interneurons |
front 52 About 3% of corticospinal neurons are giant pyramidal cells
called: | back 52 B. Betz cells |
front 53 The largest neurons in the human nervous system are: | back 53 C. Betz cells |
front 54 Relative to the internal capsule, the thalamus and caudate nucleus
are always: | back 54 D. Medial |
front 55 Relative to the internal capsule, the globus pallidus and putamen are
always: | back 55 B. Lateral |
front 56 Which list correctly names the three parts of the internal
capsule? | back 56 A. Anterior limb, genu, posterior limb |
front 57 The anterior limb of the internal capsule separates the head of the
caudate from the: | back 57 C. Globus pallidus and putamen |
front 58 The posterior limb of the internal capsule separates the thalamus
from the: | back 58 A. Globus pallidus and putamen |
front 59 In the pyramidal decussation, approximately what percentage of fibers
cross to form the lateral corticospinal tract? | back 59 C. 85% |
front 60 After crossing in the pyramidal decussation, lateral corticospinal
fibers descend in the lateral: | back 60 B. White matter columns |
front 61 Axons of the lateral corticospinal tract enter spinal gray matter to
synapse on: | back 61 D. Anterior horn cells |
front 62 Preganglionic sympathetic neurons are located in the: | back 62 C. Intermediolateral cell column |
front 63 Sympathetic preganglionic neurons are found primarily at which spinal
levels? | back 63 B. T1 to L2/L3 |
front 64 The sympathetic trunk extends on each side from: | back 64 B. Cervical to sacral |
front 65 The sympathetic trunk is clinically important because it allows
thoracolumbar sympathetic efferents to: | back 65 A. Reach other body regions |
front 66 Sympathetic supply to the head and neck arises mainly from which
spinal segments? | back 66 C. T1 to T3 |
front 67 Which set of ganglia supplies sympathetic fibers to the head and
neck? | back 67 D. Superior, middle, inferior cervical |
front 68 Which cervical sympathetic ganglion is often absent? | back 68 B. Middle cervical |
front 69 The inferior cervical ganglion is also called the: | back 69 C. Stellate ganglion |
front 70 Unpaired sympathetic ganglia surrounding the aorta are located in
the: | back 70 D. Celiac plexus |
front 71 Which of the following is a prevertebral sympathetic
ganglion? | back 71 A. Celiac ganglion |
front 72 Compared with postganglionic sympathetic axons, preganglionic
sympathetic axons usually travel a: | back 72 C. Shorter distance |
front 73 Postganglionic sympathetic axons generally travel a: | back 73 B. Long distance |
front 74 Parasympathetic preganglionic fibers must travel a
relatively: | back 74 A. Long distance |
front 75 Parasympathetic preganglionic fibers arise from cranial nerve nuclei
and from sacral nuclei at: | back 75 B. S2 to S4 |
front 76 The sacral parasympathetic nuclei are located in spinal: | back 76 C. Lateral gray matter |
front 77 Upper motor neurons of the corticospinal tract project from
the: | back 77 A. Cerebral cortex |
front 78 Lower motor neurons of the corticospinal system are located in the
spinal: | back 78 C. Anterior horn |
front 79 Lower motor neurons project to skeletal muscle through: | back 79 B. Peripheral nerves |
front 80 Which finding most strongly suggests a lower motor neuron
lesion? | back 80 D. Fasciculations |
front 81 Fasciculations are best defined as: | back 81 C. Twitching from motor unit firing |
front 82 Which combination best fits an upper motor neuron lesion? | back 82 B. Weakness with spasticity |
front 83 Unilateral weakness affecting face, arm, and leg is called: | back 83 D. Hemiparesis |
front 84 During pronator drift testing, in a LMN injury, the abnormal arm
typically shows: | back 84 C. Pronation with slight downward drift |
front 85 Resistance testing of which muscles is especially useful for subtle
corticospinal lesions? | back 85 B. Finger extensors |
front 86 Rapid thumb-finger tapping, coin transfer, and alternating hand
movements primarily assess: | back 86 C. Fine movements |
front 87 One of the most sensitive tests for subtle neurologic dysfunction is
careful examination of: | back 87 B. Gait |
front 88 A patient walks stiff-legged with circumduction, toe-walking, reduced
arm swing, and scissoring. Which gait is most likely? | back 88 D. Spastic gait |
front 89 Which pair are the classic exceptions to the “arms medial to legs”
rule? | back 89 C. Primary sensorimotor cortices and posterior columns |
front 90 In the spinal cord, white matter columns are also called: | back 90 C. funiculi |
front 91 The genu of the internal capsule lies at the level of the: | back 91 B. foramen of Monro |
front 92 The corticospinal tract travels through which part of the internal
capsule? | back 92 D. posterior limb |
front 93 In the internal capsule, motor fibers for the face are located
most: | back 93 A. anterior |
front 94 In the internal capsule, motor fibers for the leg are located
most: | back 94 C. posterior |
front 95 Which sequence best describes internal capsule somatotopy from
anterior to posterior? | back 95 B. face, arm, leg |
front 96 The internal capsule continues into the midbrain as the: | back 96 B. cerebral peduncles |
front 97 The ventral white matter of the cerebral peduncles is called
the: | back 97 C. basis pedunculi |
front 98 The middle one-third of the basis pedunculi contains: | back 98 B. corticobulbar and corticospinal fibers |
front 99 In the basis pedunculi, face, arm, and leg fibers are
arranged: | back 99 D. medial to lateral |
front 100 The transition from medulla to spinal cord is the: | back 100 B. cervicomedullary junction |
front 101 The cervicomedullary junction is located at the: | back 101 C. foramen magnum |
front 102 Which tract is not one of the four medial motor
systems? | back 102 D. rubrospinal |
front 103 The unpaired prevertebral sympathetic ganglia are located around the
aorta in the: | back 103 B. celiac plexus |
front 104 Which set correctly lists the major prevertebral sympathetic
ganglia? | back 104 C. celiac, superior mesenteric, inferior mesenteric |
front 105 Parasympathetic terminal ganglia are usually located: | back 105 B. within or near effector organs |
front 106 Which combination best fits a lower motor neuron lesion? | back 106 A. weakness, atrophy, hyporeflexia |
front 107 Which additional finding strongly supports an upper motor neuron
lesion? | back 107 C. Babinski sign |
front 108 Which finding is another classic upper motor neuron sign? | back 108 A. Hoffmann sign |
front 109 Resistance testing of the finger extensors is sensitive for
corticospinal lesions partly because corticospinal damage tends to
spare: | back 109 B. flexors over extensors |
front 110 Finger extensors are especially useful to test because they are
relatively: | back 110 B. weak and cortically represented |
front 111 In rapid alternating and dexterity tasks, the dominant hand or foot
is normally: | back 111 B. slightly faster |
front 112 A patient has a wide-based, staggering gait and falls toward the side
of worse cerebellar pathology. Which gait is this? | back 112 C. ataxic gait |
front 113 A patient has a slow, shuffling, narrow-based gait with stooped
posture, decreased arm swing, and en bloc turning. What gait is
this? | back 113 D. Parkinsonian gait |
front 114 On pull testing, a patient takes several rapid backward steps to
regain balance. This finding is called: | back 114 B. Retropulsion |
front 115 Multiple sclerosis is best described as: | back 115 A. Autoimmune CNS demyelination |
front 116 The neurologic deficits of demyelination are most directly explained
by: | back 116 C. Slowed, dispersed conduction |
front 117 The classic clinical definition of multiple sclerosis
requires: | back 117 B. Deficits separated in space/time |
front 118 Oligoclonal bands in CSF most strongly indicate: | back 118 D. Intrathecal immunoglobulin synthesis |
front 119 About what fraction of patients with isolated optic neuritis or
transverse myelitis later develop multiple sclerosis? | back 119 A. About 50% |
front 120 Which pair is first-line for relapsing-remitting multiple
sclerosis? | back 120 C. Beta-interferon and glatiramer |
front 121 ALS is characterized by degeneration of: | back 121 B. Upper and lower motor neurons |
front 122 Which exam pattern most strongly supports ALS? | back 122 D. Brisk reflexes with atrophy |
front 123 Which pair should be excluded in suspected ALS because they can mimic
the syndrome? | back 123 A. Lead toxicity, B12 deficiency |
front 124 Primary Lateral Sclerosis (PLS): UMN or LMN Spinal Muscular Atrophy (SMA): UMN or LMN | back 124 UMN LMN |
front 125 Infantile spinal muscular atrophy is called: | back 125 D. Werdnig-Hoffmann disease |
front 126 The somatosensory association cortex is located in the: | back 126 A. Parietal lobe |
front 127 The cervical enlargement for the arm plexus spans: | back 127 C. C3-T1 |
front 128 The lumbosacral enlargement for the leg plexus spans: | back 128 A. L1-S2 |
front 129 Rexed lamina I is the: | back 129 D. Marginal zone |
front 130 Rexed lamina II corresponds to the: | back 130 B. Substantia gelatinosa |
front 131 Rexed laminae III and IV form the: | back 131 A. Nucleus proprius |
front 132 Rexed lamina V is the: | back 132 C. Neck of dorsal horn |
front 133 Rexed lamina VI is the: | back 133 B. Base of dorsal horn |
front 134 Rexed lamina VII contains the: | back 134 D. Clarke and IML nuclei |
front 135 Rexed lamina VIII corresponds to the: | back 135 C. Commissural nucleus |
front 136 Rexed lamina IX contains the: | back 136 A. Motor nuclei |
front 137 Rexed lamina X is the: | back 137 D. Grisea centralis |
front 138 Which spinal cord region is predominantly gray matter? | back 138 B. Sacral region |
front 139 Which arteries arise from the aorta and supply the spinal meninges
along the cord? | back 139 C. Segmental arteries |
front 140 How many segmental arteries supply the spinal meninges? | back 140 A. 31 |
front 141 Parkinsonian gait can occur in Parkinson disease and also
with: | back 141 B. Progressive supranuclear palsy |
front 142 A man with prostate cancer develops epidural metastases after tumor
cells spread through a valveless spinal venous network. Which plexus
is involved? | back 142 C. Batson's plexus |
front 143 Batson's plexus is clinically important primarily because it: | back 143 B. lacks venous valves |
front 144 Which pair of descending tracts primarily controls extremity
movement? | back 144 A. Lateral corticospinal and rubrospinal |
front 145 Which descending tract is especially important for rapid, dexterous
movement of individual digits and joints? | back 145 C. Lateral corticospinal tract |
front 146 Both the lateral corticospinal and rubrospinal tracts descend in
which part of the spinal cord? | back 146 B. Contralateral lateral columns |
front 147 Because the lateral corticospinal and rubrospinal tracts have already
crossed, they control: | back 147 B. contralateral extremities |
front 148 Which descending motor system primarily controls proximal axial and
girdle muscles used for posture, balance, orienting, and automatic
gait? | back 148 D. Medial motor system |
front 149 Which tract belongs to the medial motor system? | back 149 C. Vestibulospinal tract |
front 150 Which list correctly names the four medial motor system
tracts? | back 150 A. Anterior corticospinal, vestibulospinal, reticulospinal, tectospinal |
front 151 Medial motor system tracts primarily terminate on: | back 151 D. spinal interneurons |
front 152 Why does a unilateral lesion of the medial motor system often cause
only modest deficits? | back 152 C. it acts through bilateral interneurons |
front 153 Which medial motor tract is the only one that decussates? | back 153 B. Tectospinal tract |
front 154 The tectospinal tract decussates in the: | back 154 D. dorsal tegmentum |
front 155 The tectospinal tract originates in the: | back 155 B. superior colliculus |
front 156 The tectospinal tract terminates primarily in the: | back 156 C. cervical spinal cord |
front 157 The rubrospinal tract originates from the magnocellular division of
the: | back 157 A. red nucleus |
front 158 The rubrospinal tract decussates in the: | back 158 C. ventral tegmentum |
front 159 The rubrospinal tract terminates primarily in the: | back 159 A. cervical spinal cord |
front 160 Reticulospinal fibers arise from the: | back 160 B. pontine and medullary reticular formation |
front 161 Which descending tract helps position the head and neck and also
contributes to balance? | back 161 B. Vestibulospinal tract |
front 162 The medial vestibulospinal tract arises from which nuclei? | back 162 A. medial and inferior vestibular nuclei |
front 163 The medial vestibulospinal tract terminates mainly in the: | back 163 C. cervical and upper thoracic cord |
front 164 The lateral vestibulospinal tract arises from the: | back 164 D. lateral vestibular nucleus |
front 165 The lateral vestibulospinal tract descends to the: | back 165 C. entire spinal cord |
front 166 Which vestibulospinal tract is most closely associated with
maintaining balance through projections throughout the cord? | back 166 B. Lateral vestibulospinal tract |
front 167 A patient has intact strength but cannot properly plan or execute a
learned motor act. A lesion in which area can cause this
apraxia? | back 167 A. Supplementary motor area |
front 168 Which vestibulospinal tract is primarily associated with positioning
of the head and neck? | back 168 B. Medial vestibulspinal tract |
front 169 Which vestibulospinal tract is most associated with balance? | back 169 C. Lateral vestibulospinal tract |
front 170 Which medial motor system tract is most responsible for controlling
bilateral axial and girdle muscles? | back 170 D. Anterior corticospinal tract |
front 171 Fibers of the lateral corticospinal tract are most abundant at which
spinal cord levels? | back 171 B. Cervical and lumbosacral enlargements |
front 172 As descending axons leave the cerebral cortex and enter the upper
cerebral white matter on their way to the internal capsule, they form
the: | back 172 A. corona radiata |
front 173 Motor fibers that project from the cortex to brainstem motor nuclei
for face movement are called: | back 173 B. corticobulbar fibers |
front 174 A small lacunar infarct in the internal capsule can cause dense
weakness because fibers there are: | back 174 C. highly compact |
front 175 A lesion of the internal capsule most classically causes: | back 175 B. contralateral hemiparesis |
front 176 In the basis pedunculi, corticobulbar and corticospinal fibers are
located in the: | back 176 B. middle one-third |
front 177 In the basis pedunculi somatotopic map, face fibers lie _____ leg
fibers. | back 177 C. medial to |
front 178 The transition from medulla to spinal cord at the foramen magnum is
called the: | back 178 B. cervicomedullary junction |
front 179 About 15% of corticospinal fibers remain uncrossed and descend
ipsilaterally in the: | back 179 C. anterior white column |
front 180 The rubrospinal tract most directly modulates muscle tone by: | back 180 B. exciting flexors, inhibiting extensors |
front 181 The rubrospinal tract has its strongest influence on which limb
region? | back 181 B. Upper limbs |
front 182 The rubrospinal tract crosses in the: | back 182 C. ventral tegmental decussation |
front 183 Sympathetic preganglionic neurons arise from which spinal
levels? | back 183 B. T1-L2/3 |
front 184 In the spinal cord, sympathetic preganglionic neurons are
specifically located in: | back 184 C. Lamina VII |
front 185 Which sympathetic ganglia are paired and form a chain from cervical
to sacral levels? | back 185 C. Paravertebral ganglia |
front 186 Which sympathetic ganglia are unpaired and lie in the celiac plexus
around the aorta? | back 186 B. Prevertebral ganglia |
front 187 A positive Hoffmann sign most strongly indicates a: | back 187 D. upper motor neuron lesion |
front 188 Flicking the middle fingernail and seeing involuntary thumb or index
finger flexion is the: | back 188 B. Hoffmann sign |
front 189 Which pair is most associated with upper motor neuron
dysfunction? | back 189 B. Babinski and posturing |
front 190 The term for partial paralysis or weakness is: | back 190 B. paresis |
front 191 The term for complete absence of movement is: | back 191 C. plegia |
front 192 The most common cause of acute unilateral face and arm weakness in
clinical practice is: | back 192 B. middle cerebral artery infarct |
front 193 Dysarthria is best defined as: | back 193 C. motor speech impairment |
front 194 Which bedside pair is especially useful for detecting subtle
hemiparesis from corticospinal tract involvement? | back 194 B. Pronator drift and finger extensor testing |