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

B. Right upper extremity

remember that cerebellum controls activity on same side of the body

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

C. Flocculonodular lobe

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

A. Lateral vermis

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

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

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

C. Vestibular nuclei

Most cerebellar efferent output leaves through the:

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

A. Superior peduncle

Cerebellar afferent information enters predominantly through which peduncles?

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

D. Middle and inferior

Fibers traveling in the superior cerebellar peduncle decussate at the:

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

B. Inferior colliculus level

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

C. Trunk and vestibulo-ocular control

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

C. Dentate, globose, emboliform, fastigial

Which deep cerebellar nucleus is the largest?

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

D. Dentate

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

C. Dentate nucleus

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

B. Interposed nuclei

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

D. Granule cell

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

A. Purkinje cells

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

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

C. GABAergic inhibitory

Purkinje cells are inhibitory, so GABA

Climbing fibers arise from neurons in the:

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

B. Contralateral inferior olive

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.

medulla oblongata

Purkinje

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

D. Strong excitation

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

A. Negative feedback

The cerebellar glomerulus is located in the:

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

B. Granule cell layer

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

C. Mossy → granule → Purkinje

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

C. Mossy, climbing, parallel

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

A. Purkinje, stellate, basket, Golgi

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

D. Superior cerebellar peduncle

Fibers from the dentate nucleus decussate at which level?

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

B. Inferior colliculus

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

A. Contralateral posterior VLN

Cerebellar output to the thalamus terminates mainly in the:

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

D. Posterior VLN

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

C. Parvocellular

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

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

B. Magnocellular

Most cerebellar afferent input is carried by:

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

D. Mossy fibers

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

A. Middle cerebellar peduncle

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

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

B. Mossy fibers

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

C. Dorsal spinocerebellar tract

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

A. Cuneocerebellar tract

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

D. Ventral spinocerebellar tract

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

B. Rostral spinocerebellar tract

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

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

C. Dorsal spinocerebellar

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

A. PICA

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

B. AICA

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

C. SCA

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

D. AICA

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

B. Cerebellar vermis

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

C. Intermediate/lateral hemisphere

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

D. Right cerebellar lesion

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

A. Vertebral artery

The SCA usually arises from the:

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

D. Top of the basilar

The AICA most commonly arises from the:

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

B. Lower basilar artery

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

PICA

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

AICA

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

SCA