Neuro Cerebellum MCQ's

1.

A 70-year old man with a history of hypertension went to work and had sudden onset of nausea and vomiting. He was taken to ER, where his exam was notable for slurred speech, dysmetria on finger-to-nose testing on the left side. His gait was normal. Where is the lesion?

A.

Cerebellar vermis
B.

Right cerebellar hemisphere
C.

Left cerebellar hemisphere
D.

Fastigial nucleus
E.

Vestibular nuclei

Correct Answer
C. Left cerebellar hemispHere

Explanation
The patient's symptoms of slurred speech and dysmetria on the left side indicate a lesion in the left cerebellar hemisphere. The cerebellum is responsible for coordinating voluntary movements, including speech and limb movements. Lesions in the cerebellar hemisphere can result in ipsilateral (same side) symptoms, such as the ones seen in this patient. The other options, such as the cerebellar vermis, right cerebellar hemisphere, fastigial nucleus, and vestibular nuclei, are not consistent with the patient's symptoms.

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2.

A 45-year-old man was admitted to the hospital with a cerebellar hemorrhage. The patient exhibited an unsteady "drunk like" gait and the physician noted that he swayed while entering the examination room. Which region of the cerebellum was most likely affected by the bleed?

A.

Hemispheres of the anterior lobe
B.

Hemisphere of the posterior lobe
C.

Interposed nuclei
D.

Dentate nucleus
E.

Flocculonodular lobe

Correct Answer
E. Flocculonodular lobe

Explanation
The patient's symptoms of an unsteady "drunk like" gait and swaying suggest that the cerebellar hemorrhage affected the flocculonodular lobe. The flocculonodular lobe is responsible for coordinating balance and posture, and damage to this region can result in ataxia and unsteady movements.

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3.

Dysdiadokinesia refers to which of the following?

A.

Inability to perform the Tandem-Gait test
B.

Inability to stand without swaying with eyes open
C.

Inability to control distance, power or speed of a movement
D.

Inability to control vestibulo-ocular reflexes
E.

Inability to perform rapid alternating movements with the hands

Correct Answer
E. Inability to perform rapid alternating movements with the hands

Explanation
Dysdiadokinesia refers to the inability to perform rapid alternating movements with the hands. This condition is characterized by difficulty in coordinating and executing movements that require rapid and alternating actions, such as rapidly pronating and supinating the hands. It is often seen in neurological disorders such as cerebellar dysfunction or damage.

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4.

Concerning the circuitry between mossy fibers, climbing fibers and cells of the cerebellar cortex, which of the following pairs both provide excitatory input?

A.

Mossy fibers & Purkinje cells
B.

Purkinje cells & Golgi cells
C.

Granule cell parallel fibers & Mossy fibers
D.

Golgi cells & Climbing fibers
E.

Climbing fibers & Basket cells

Correct Answer
C. Granule cell parallel fibers & Mossy fibers

Explanation
Granule cell parallel fibers and mossy fibers both provide excitatory input.

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5.

As a researcher studying the circuitry of the cerebellum, which of the following nuclei do you wish to lesion if you are focusing mainly on the flocculo-nodular lobe circuitry of the cerebellum?

A.

Fastigial nucleus
B.

Dentate nucleus
C.

Clarkes nucleus
D.

Spinal border cells
E.

Globose nucleus

Correct Answer
A. Fastigial nucleus

Explanation
The correct answer is Fastigial nucleus. The flocculo-nodular lobe circuitry of the cerebellum is primarily involved in coordinating eye movements and balance. The Fastigial nucleus is responsible for receiving input from the flocculo-nodular lobe and sending output to the vestibular nuclei, which are important for balance control. Therefore, lesioning the Fastigial nucleus would specifically target the circuitry related to the flocculo-nodular lobe.

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6.

Your 27-year old patient displays ataxia when asked to walk across the examination room. You ask him to stand still with his eyes closed and note marked swaying back and forth. When he opens his eyes the swaying persists. Vibration sense is normal on all four limbs. Given the clinical picture in this case, such ataxia is likely due to damage to which of the following structures?

A.

Dorsal columns
B.

Cerebral peduncles
C.

Posterior limb of the internal capsule
D.

Ventral horns of the spinal cord
E.

Cerebellum

Correct Answer
E. Cerebellum

Explanation
The patient's ataxia and swaying, which persist even when his eyes are open, suggest a problem with the cerebellum. The cerebellum is responsible for coordinating movement and maintaining balance. Damage to the cerebellum can result in unsteady and uncoordinated movements, leading to ataxia. The normal vibration sense on all four limbs indicates that the dorsal columns, which transmit sensory information such as vibration sense, are intact. The cerebral peduncles, posterior limb of the internal capsule, and ventral horns of the spinal cord are not directly involved in coordinating movement and balance, making them less likely to be the cause of the patient's symptoms.

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7.

Efferent axons from the dentate nucleus terminate in what thalamic nucleus and travel through what peduncle?

A.

Ventral anterior nucleus of the thalamus (VA) ---superior cerebellar peduncle
B.

Ventral anterior nucleus of the thalamus (VA) ---middle cerebellar peduncle
C.

Ventral lateral nucleus of the thalamus (VL) ---superior cerebellar peduncle
D.

Ventral lateral nucleus of the thalamus (VL) ---middle cerebellar peduncle
E.

Ventral posterolateral nucleus of the thalamus (VPL) ---superior cerebellar peduncle

Correct Answer
C. Ventral lateral nucleus of the thalamus (VL) ---superior cerebellar peduncle

Explanation
Efferent axons from the dentate nucleus terminate in the ventral lateral nucleus of the thalamus (VL) and travel through the superior cerebellar peduncle.

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8.

As a researcher studying the circuitry of the cerebellum, which of the following nuclei do you know to be the major output neuron of the cerebellar cortex?

A.

Purkinje cells
B.

Dentate nucleus
C.

Fastigial nucleus
D.

Clarke's nucleus
E.

Spinal border cells

Correct Answer
A. Purkinje cells

Explanation
Purkinje cells are the major output neurons of the cerebellar cortex. They receive inputs from various sources within the cerebellum and send their axons to different targets outside the cerebellum. These cells play a crucial role in motor coordination and learning. They are characterized by their distinctive morphology, with a large, flat dendritic tree that receives inputs from parallel fibers and a single axon that projects to the deep cerebellar nuclei. Purkinje cells are critical for the integration and modulation of motor signals, making them the major output neurons of the cerebellar cortex.

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9.

Which of the following ascending pathways enters the cerebellum through the peduncle marked in the picture?

A.

Dorsal spinocerebellar tract
B.

Cuneo cerebellar tract
C.

Anterior spinocerebellar tract
D.

Ponto cerebellar fibers
E.

Climbing fibers

Correct Answer
C. Anterior spinocerebellar tract

Explanation
The correct answer is the Anterior spinocerebellar tract. This ascending pathway enters the cerebellum through the peduncle marked in the picture. The other options listed are not associated with this specific peduncle.

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