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Neuro 15

front 1

After resection of a right cerebellar hemisphere metastasis, the patient develops dysmetria and intention tremor during finger-to-nose testing. Which limb would be most affected?

A. Left upper extremity
B. Right upper extremity
C. Both upper extremities
D. Neither upper extremity

back 1

B. Right upper extremity

remember that cerebellum controls activity on same side of the body

front 2

A patient has severe gait instability, cannot maintain upright sitting without swaying, and has abnormal eye movements with vertigo, nausea, and vomiting. The lesion is most likely in the:

A. Dentate nucleus
B. Lateral hemisphere
C. Flocculonodular lobe
D. Midline vermis

back 2

C. Flocculonodular lobe

front 3

A small cerebellar lesion produces limb incoordination with relatively spared truncal stability. Which region is the best match?

A. Lateral vermis
B. Midline vermis
C. Fastigial nucleus
D. Flocculonodular lobe

back 3

A. Lateral vermis

remember that limb incordination with spared truncal ability is the definition for appendicular ataxia

front 4

The flocculonodular lobe has its most direct functional relationship with the:

A. Red nuclei
B. Pontine nuclei
C. Vestibular nuclei
D. Cochlear nuclei

back 4

C. Vestibular nuclei

front 5

Most cerebellar efferent output leaves through the:

A. Superior peduncle
B. Middle peduncle
C. Inferior peduncle
D. All equally

back 5

A. Superior peduncle

front 6

Cerebellar afferent information enters predominantly through which peduncles?

A. Superior and middle
B. Superior and inferior
C. Middle only
D. Middle and inferior

back 6

D. Middle and inferior

front 7

Fibers traveling in the superior cerebellar peduncle decussate at the:

A. Superior colliculus level
B. Inferior colliculus level
C. Pontomedullary junction
D. Pyramidal decussation

back 7

B. Inferior colliculus level

front 8

Selective injury to the cerebellar vermis would most impair:

A. Distal finger individuation
B. Language comprehension
C. Trunk and vestibulo-ocular control
D. Pain and temperature sense

back 8

C. Trunk and vestibulo-ocular control

front 9

From lateral to medial, the deep cerebellar nuclei are arranged as:

A. Dentate, emboliform, globose, fastigial
B. Fastigial, globose, emboliform, dentate
C. Dentate, globose, emboliform, fastigial
D. Emboliform, dentate, fastigial, globose

back 9

C. Dentate, globose, emboliform, fastigial

front 10

Which deep cerebellar nucleus is the largest?

A. Fastigial
B. Globose
C. Emboliform
D. Dentate

back 10

D. Dentate

front 11

In an experiment measuring cerebellar activity just before a planned movement begins, which nucleus would be expected to show the greatest activation?

A. Fastigial nucleus
B. Interposed nuclei
C. Dentate nucleus
D. Vestibular nuclei

back 11

C. Dentate nucleus

front 12

Which nuclei are most associated with activity during or in relation to an ongoing movement?

A. Dentate nucleus
B. Interposed nuclei
C. Fastigial nucleus
D. Inferior olive

back 12

B. Interposed nuclei

front 13

A mossy fiber excites a neuron whose axon ascends, bifurcates into parallel fibers, and then synapses on Purkinje cells. That neuron is a:

A. Golgi cell
B. Basket cell
C. Stellate cell
D. Granule cell

back 13

D. Granule cell

front 14

All output from the cerebellar cortex reaches the cerebellar white matter through axons of:

A. Purkinje cells
B. Granule cells
C. Golgi cells
D. Climbing fibers

back 14

A. Purkinje cells

front 15

Purkinje cell projections to deep cerebellar nuclei and vestibular nuclei are primarily:

A. Glutamatergic excitatory
B. Cholinergic excitatory
C. GABAergic inhibitory
D. Glycinergic inhibitory

back 15

C. GABAergic inhibitory

Purkinje cells are inhibitory, so GABA

front 16

Climbing fibers arise from neurons in the:

A. Ipsilateral red nucleus
B. Contralateral inferior olive
C. Contralateral pontine nuclei
D. Ipsilateral vestibular nuclei

back 16

B. Contralateral inferior olive

front 17

Climbing fibers arise from neurons in the contralateral inferior olive, specifically located in the ______ ______. These axons pass through the inferior cerebellar peduncle to synapse on ______ cells.

back 17

medulla oblongata

Purkinje

front 18

The immediate synaptic effect of a climbing fiber on a Purkinje cell is:

A. Strong inhibition
B. Weak inhibition
C. Weak excitation
D. Strong excitation

back 18

D. Strong excitation

front 19

Granule cells excite Golgi cells. The net circuit consequence of this arrangement is:

A. Negative feedback
B. Positive feedback
C. Feedforward excitation
D. Recurrent inhibition

back 19

A. Negative feedback

front 20

The cerebellar glomerulus is located in the:

A. Molecular layer
B. Granule cell layer
C. Purkinje layer
D. White matter

back 20

B. Granule cell layer

front 21

Which sequence best explains how a mossy fiber can indirectly increase inhibition from cerebellar cortex onto deep nuclei?

A. Mossy → Purkinje → granule
B. Mossy → Golgi → Purkinje
C. Mossy → granule → Purkinje
D. Mossy → olive → Purkinje

back 21

C. Mossy → granule → Purkinje

front 22

A neurophysiology experiment records the major excitatory fibers that ascend into and within the cerebellar cortex. Which set is correct?

A. Mossy, Purkinje, basket
B. Climbing, Golgi, stellate
C. Mossy, climbing, parallel
D. Parallel, basket, Golgi

back 22

C. Mossy, climbing, parallel

front 23

Which group consists entirely of inhibitory neurons projecting downward within or from the cerebellar cortex?

A. Purkinje, stellate, basket, Golgi
B. Mossy, climbing, Purkinje, Golgi
C. Granule, basket, stellate, Golgi
D. Purkinje, granule, basket, stellate

back 23

A. Purkinje, stellate, basket, Golgi

front 24

A lesion interrupts the main efferent pathway leaving the dentate nucleus before it reaches the thalamus. Which structure was most likely damaged first?

A. Middle cerebellar peduncle
B. Inferior cerebellar peduncle
C. Corticospinal tract
D. Superior cerebellar peduncle

back 24

D. Superior cerebellar peduncle

front 25

Fibers from the dentate nucleus decussate at which level?

A. Caudal medulla
B. Inferior colliculus
C. Superior colliculus
D. Pontomedullary junction

back 25

B. Inferior colliculus

front 26

After decussating, dentatothalamic fibers project primarily to which thalamic nucleus?

A. Contralateral posterior VLN
B. Ipsilateral posterior VLN
C. Contralateral anterior VLN
D. Ipsilateral anterior VLN

back 26

A. Contralateral posterior VLN

front 27

Cerebellar output to the thalamus terminates mainly in the:

A. Anterior VAN
B. Posterior VAN
C. Anterior VLN
D. Posterior VLN

back 27

D. Posterior VLN

front 28

Which red nucleus division is more closely tied to cerebellar circuitry rather than the rubrospinal tract?

A. Ipsilateral magnocellular
B. Contralateral magnocellular
C. Parvocellular
D. Reticular division

back 28

C. Parvocellular

front 29

The rubrospinal tract arises from which division of the red nucleus?

A. Parvocellular
B. Magnocellular
C. Dorsomedial
D. Ventrolateral

back 29

B. Magnocellular

front 30

Most cerebellar afferent input is carried by:

A. Climbing fibers
B. Purkinje axons
C. Granule fibers
D. Mossy fibers

back 30

D. Mossy fibers

front 31

Pontocerebellar fibers from one side of the pons enter which peduncle on the opposite side?

A. Middle cerebellar peduncle
B. Superior cerebellar peduncle
C. Inferior cerebellar peduncle
D. Cerebral peduncle

back 31

A. Middle cerebellar peduncle

front 32

Pontine afferents ultimately contribute to which fiber type in the cerebellar cortex?

A. Climbing fibers
B. Mossy fibers
C. Purkinje fibers
D. Basket fibers

back 32

B. Mossy fibers

front 33

Unconscious proprioceptive information from the lower extremity reaches the cerebellum mainly through the:

A. Ventral spinocerebellar tract
B. Rostral spinocerebellar tract
C. Dorsal spinocerebellar tract
D. Cuneocerebellar tract

back 33

C. Dorsal spinocerebellar tract

front 34

Unconscious proprioceptive input from the upper extremity and neck reaches the cerebellum mainly via the:

A. Cuneocerebellar tract
B. Dorsal spinocerebellar tract
C. Ventral spinocerebellar tract
D. Spinothalamic tract

back 34

A. Cuneocerebellar tract

front 35

Information about spinal interneuron activity from the lower extremity is conveyed by the:

A. Dorsal spinocerebellar tract
B. Cuneocerebellar tract
C. Rostral spinocerebellar tract
D. Ventral spinocerebellar tract

back 35

D. Ventral spinocerebellar tract

front 36

Information about spinal interneuron activity from the upper extremity reaches the cerebellum through the:

A. Ventral spinocerebellar tract
B. Rostral spinocerebellar tract
C. Dorsal spinocerebellar tract
D. Cuneocerebellar tract

back 36

B. Rostral spinocerebellar tract

front 37

Neurons in Clarke’s nucleus send axons into which tract?

A. Ventral spinocerebellar
B. Rostral spinocerebellar
C. Dorsal spinocerebellar
D. Cuneocerebellar

back 37

C. Dorsal spinocerebellar

front 38

A patient develops lateral medullary syndrome after vertebral artery disease. Which artery most classically supplies the injured territory?

A. PICA
B. AICA
C. SCA
D. ASA

back 38

A. PICA

front 39

A stroke involves the inferolateral pons and the middle cerebellar peduncle. Which artery is most likely occluded?

A. PICA
B. AICA
C. SCA
D. Basilar apex

back 39

B. AICA

front 40

A cerebellar infarct causes marked ipsilateral limb ataxia with little or no obvious brainstem involvement. Which artery is the best match?

A. AICA
B. PICA
C. SCA
D. Basilar perforator

back 40

C. SCA

front 41

A patient with an acute cerebellopontine region infarct has vertigo, facial weakness, and new unilateral hearing loss. Which artery is most likely involved?

A. PICA
B. SCA
C. Labyrinthine branch alone
D. AICA

back 41

D. AICA

front 42

A midline cerebellar lesion causes a wide-based, “drunk-like” gait without prominent limb dysmetria. Which structure is most likely affected?

A. Dentate nucleus
B. Cerebellar vermis
C. Lateral hemisphere
D. Inferior olive

back 42

B. Cerebellar vermis

front 43

A patient has dysmetria on finger-to-nose testing but relatively preserved truncal stability. The lesion is most likely in the:

A. Flocculonodular lobe
B. Vermis only
C. Intermediate/lateral hemisphere
D. Fastigial nucleus

back 43

C. Intermediate/lateral hemisphere

front 44

A patient with truncal ataxia repeatedly topples to the right while sitting unsupported. This most strongly suggests:

A. Left vestibular lesion
B. Midline frontal lesion
C. Left cerebellar lesion
D. Right cerebellar lesion

back 44

D. Right cerebellar lesion

front 45

Angiography shows occlusion of the artery that most commonly gives rise to the PICA. Which vessel is it?

A. Vertebral artery
B. Lower basilar artery
C. Upper basilar artery
D. Posterior cerebral artery

back 45

A. Vertebral artery

front 46

The SCA usually arises from the:

A. Distal vertebral artery
B. Lower basilar artery
C. Proximal posterior cerebral artery
D. Top of the basilar

back 46

D. Top of the basilar

front 47

The AICA most commonly arises from the:

A. Vertebral artery
B. Lower basilar artery
C. Top basilar artery
D. Posterior cerebral artery

back 47

B. Lower basilar artery

front 48

what supplies the lateral medulla, most of the inferior half of the cerebellum, and the inferior vermis

back 48

PICA

front 49

What supplies the inferior lateral pons, the middle cerebellar peduncle, and a strip of ventral (anterior) cerebellum between the territories of the PICA and SCA, including the flocculus

back 49

AICA

front 50

the upper lateral pons, the superior cerebellar peduncle, most of the superior half of the cerebellar hemisphere, including the deep cerebellar nuclei, and the superior vermis

back 50

SCA