2. Upon neurological testing, a 55-year-old male who had recovered from a stroke was unable to make smooth, purposeful movements involving mainly his right arm. The movements were jerky and lacked coordination. Which lettered option on the illustration most closely corresponds to the affected region?
3. A patient admitted to a local hospital presented with difficulties in swallowing, chewing, breathing, and speaking. Further examination revealed significant weakness of the muscles that mediate these functions. Which lettered option on the illustration most closely corresponds to the affected region?
4. A 25-year-old man was involved in a serious automobile accident that resulted in a major head injury. One week following the accident, the patient exhibited significant short-term memory deficit as well as heightened irritability and aggressiveness. Which structure on the illustration is most closely associated with the affected region?
5. A 42-year-old woman was diagnosed as having a movement disorder. Further examination suggested that she was suffering from Huntington's disease. Which structure on the illustration is most likely associated with this disorder?
6. The rostral aspect of the frontal lobe, including the prefrontal cortex, plays a major role in higher-order cognitive functions, and damage to this region of the cortex produces major intellectual impairment. Which structure on the illustration serves as a major afferent source to the frontal region of the cortex?
7. A 68-year-old man presented with a tremor at rest, slowness of voluntary movement, and upon further examination, increased resistance to passive movement of the limbs. This disorder is associated with a loss of dopamine to which specific region of the forebrain on the illustration?
8. A 38-year-old male reported a loss of the ability to smell. Further examination revealed that this patient was suffering from a peripheral neuropathy of the olfactory nerve. Which of the structures shown in the illustration would be most affected in terms of loss of neural transmission?
9. A 67-year-old female was admitted to a hospital after she reported to her primary care physician that she had been having very painful headaches. Further examination revealed the presence of significant increases in intracranial pressure. After viewing an magnetic resonance imaging (MRI), the neurologist concluded that the woman's condition was due to the presence of a developing tumor along the rostral aspect of the medial wall of the lateral ventricle. Which of the structures in the illustration would be most likely to contain this tumor?
10. A 47-year-old male who had a reputation as a very friendly and quiet individual suddenly displayed marked changes in his personality. In particular, he became shorttempered, impulsive, and threatening to his colleagues in response to what most people would consider innocuous statements. He was referred to the psychiatric ward of the community hospital, and an MRI revealed a cortical tumor. Which of the structures in the illustration is most likely to contain this tumor?
11. An 83-year-old woman was brought to the hospital after having received a routine eye examination, which revealed that she could not see out of the lower half of her left visual field. An MRI revealed evidence that she had experienced a cerebrovascular accident. Which of the regions in the illustration was most likely affected by the stroke?
12. An investigator wishes to determine the effects of stimulation of the output neurons of the hippocampal formation upon excitability levels of the target neurons in the diencephalon. In which of the structures shown in the illustration should he place the stimulating electrode?
13. A 69-year-old woman was admitted to the hospital after being diagnosed with a stroke. After a few days, she presented with difficulty in performing voluntary movements, she lacked coordination, and her movements were clearly jerky in appearance. Which location on the illustration is the most likely locus of the lesion?
14. An elderly man complained of having some difficulty seeing. An oph-thalmological examination revealed that he had an upper quadrantanopia. Which location on the illustration is the most likely locus of the lesion?
15. A 48-year-old man had been suffering from epilepsy for a number of years. Drug treatment for this disorder had not been successful and, moreover, in recent months, seizure activity had begun to spread to other regions of the brain, including the opposite side of the brain. For this condition, surgery was indicated in order to reduce the spread of the seizures. Which of the structures on the illustration would most likely be targeted by the neurosurgeon?
16. A patient brought into surgery for localization of a brain tumor was given an MRI and asked to move the fingers of his right hand. Which is the most likely site on the illustration where the MRI would display a population response of neuronal activation?
17. A patient presented with loss of capacity to experience the feeling of a tuning fork when applied to the right leg. Which region on the illustration is most likely to be affected by a cortical lesion?
18. A patient experienced great difficulty in appreciating the meaning of spoken or written words. Which place on the illustration is the most likely locus of a lesion that would cause such a deficit?
19. After having received a head injury, a 23-year-old male complained of a partial loss of hearing. An MRI revealed evidence of brain injury. Which place on the illustration is the most likely locus of such damage?
20. An elderly patient who had been diagnosed with a brain tumor found that he was unable to verbally express his thoughts in a meaningful way. Which place on the illustration is the most likely location of such a lesion?
21. Following an automobile accident in which a 23-year-old male received severe injuries to his head and parts of his body, he was admitted to the emergency room and then transferred to a rehabilitation center. Approximately a week after the accident, the patient became quite irritable and scored poorly on card sorting, delayed alternation, and measures of intellectual skills. Which region of the brain in the illustration was most clearly affected by the accident and whose injury could most readily account for these deficits?
22. A patient was unable to voluntarily move his eyes to the right. An MRI revealed a small tumor located in the cerebral cortex. Which region of the illustration is the most likely location of this tumor?
23. A 66-year-old male suffered a stroke of the right cerebral cortex that produced a marked negligence of the opposite body half and visual space. Which of the regions on the illustration is most closely associated with this deficit? (Note that this illustration depicts the left cerebral cortex. To answer this question, assume that this illustration depicts the right cerebral cortex).
24. A 78-year-old man is found on the ground unconscious one morning and taken to the emergency room of a nearby hospital. After regaining consciousness, he is unable to move his right hand or leg. Which of the regions shown on the illustration was most likely directly affected by the stroke?
25. A 48-year-old woman complained of stomach pains. The diagnosis revealed an ulceration of the stomach wall due to overactivity of the parasym-pathetic input to the stomach. It was recommended that the patient have the cranial nerve which innervates the stomach wall, partially severed. On the illustration, which is the affected cranial nerve on the figure in Question 25?
26. An MRI administered to a patient revealed the presence of a tumor situated in the region of the cerebellopontine angle. The patient noted considerable weakness when attempting to bite. On the illustration in Question 25, which is the affected cranial nerve?
27. Damage to which region(s) shown in the illustration will likely affect the integrity of the Papez circuit, causing disruption of memory and emotional processes?
28. A 28-year-old man was exposed to very cold temperatures for several days and noted sometime afterward that he was unable to smile and display other aspects of facial expression on one side of his face. Which is the affected cranial nerve on the illustration in Question 25?
29. A 78-year-old woman was admitted to a local hospital after finding that she was unable to move her right arm and leg. In addition, she displayed diminution in strength of chewing, facial expression, and speech. An MRI revealed the presence of a tumor situated in the brainstem. Which structures shown on the illustration in Question 25, would most likely be affected by the tumor?
30. A 63-year-old man was admitted to the emergency room and received an MRI, which indicated the presence of a vascular occlusion of a part of the brainstem. The patient was unable to feel any sensation on the left side of his face, chin, and forehead. Which of the cranial nerves shown on the illustration was most closely affected by the stroke?
31. A 30-year-old man complained that he was having difficulty seeing properly and, in particular, was experiencing double vision. The ophthalmologist noted that the patient's right eye was normally abducted downward and the pupil was dilated. A subsequent MRI indicated the presence of a tumor impinging upon a cranial nerve. On the illustration in Question 25, which is the affected cranial nerve?
32. A neurological examination was given to a 60-year-old female because she was experiencing double vision and was unable to abduct the left eye. The examination revealed the likely presence of a small lesion of the brainstem. Which of the cranial nerves shown on the illustration was affected by this lesion?
33. An individual complained about having headaches and experiencing partial blindness, which were later identified as a bitemporal hemianopsia. A neurological examination, including an MRI, indicated that the patient had a brain tumor. Which of the structures shown on the illustration is affected by the tumor?
34. A 43-year-old female experienced dizziness, loss of balance, some nystagmus, and ringing in the ear. A neurological exam suggested damage to a cranial nerve, perhaps associated with a small peripheral tumor. On the illustration in Question 25, which is the affected cranial nerve?
35. Following her admission to the emergency room of a local hospital, a 71-year-old female received a diagnosis of having had a small brainstem stroke. After two weeks, the patient appeared normal, with the exception that her tongue deviated to the left side when she was asked to protrude it. Which structure shown on the illustration was most clearly affected by the stroke?
DIRECTIONS: Each item below contains a question followed by suggested responses. Select the one best response.
36. A young boy was admitted to the emergency room after having experienced severe nausea, headache, and fever. The neurologist concluded that he was suffering from a form of bacterial meningitis. His cerebrospinal fluid (CSF) would most likely indicate which of the following?
a. Increased protein, decreased glucose, decreased neutrophils b. Increased protein, decreased glucose, increased neurophils c. Increased protein, normal glucose, normal neutrophils d. Decreased CSF pressure, decreased protein, decreased glucose e. Decreased protein, normal CSF pressure, increased glucose
37. Following an automobile accident, a teenage boy was admitted to the emergency room and diagnosed as having a subarachnoid hemorrhage. Which of the following CSF findings would be expected in this individual?
a. Increased CSF pressure, bloody appearance of CSF, increased red cells, increased protein, decreased glucose b. Decreased CSF pressure, bloody appearance of CSF, decreased red cells, decreased protein, decreased glucose c. Normal pressure, normal red cells, increased protein, increased glucose, normal color of CSF
d. Clear CSF, normal pressure, decreased protein, increased red cells, increased glucose e. Cloudy CSF, increased CSF, increased neutrophils, normal protein, normal glucose
38. A 70-year-old male was brought to the emergency room after experiencing headaches, nausea, and dizziness. An MRI revealed the presence of a brain tumor, which had produced a noncommunicating hydrocephalus. Which of the following is the most likely location of the tumor?
a. Cerebral subarachnoid space b. Cistern of the lamina terminalis c. Interventricular foramen d. Pontine cistern e. Cisterna magna
39. A fundamental basis underlying the application of drugs for the treatment of emotional and related disorders includes which of the following properties associated with the blood-brain barrier?
a. It has well-developed capillary pores that allow for selective diffusion of substances b. It is selectively permeable to certain compounds such as biogenic amines c. It is found within all structures enclosed by the meninges, including the pineal gland d. It contains junctions associated with the blood-brain barrier are formed exclusively by neuronal or glial processes e. It is restricted to highly vascular regions of the brain, such as those present at the level of the ventromedial hypothalamus
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