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How many different diseases do you think there are? There are so many diseases globally, and some are even rare and unheeded. Some are common and occur in over sixty percent of the world’s population, according to research conducted in 2015. The deadliest disease is said to be coronary artery disease. This quiz will help you to learn about various diseases.
Questions and Answers
1.
Based on their relative locations in the spinal cord, which of the following tracts or fiber bundles would most likely be involved In a lesion located in the immediate vicinity of the lateral corticospinal tract?
A.
Anterolateral system
B.
Anterior spinocerebellar tract
C.
Gracile fasciculus
D.
Medial longitudinal fasciculus
E.
Rubrospinal tract
Correct Answer
E. Rubrospinal tract
Explanation A lesion located in the immediate vicinity of the lateral corticospinal tract would most likely involve the Rubrospinal tract. The Rubrospinal tract is located adjacent to the lateral corticospinal tract in the spinal cord. Lesions in this area could affect both tracts, as they are in close proximity to each other. The other options listed are not in the immediate vicinity of the lateral corticospinal tract and would therefore be less likely to be involved in a lesion in this area.
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2.
A 70-year old woman is brought to the emergency department by members of the volunteer fire department of a small town. She primarily complains of weakness. The examination reveals hemiplegia involving the left upper and lower extremities, sensory losses (pain, thermal sensations, and proprioception) on the left side of the body and face, and a visual deficit in both eyes. MRI shows an area of infarction consistent with the territory served by the anterior choroidal artery. The weakness of the extremities in this woman is most likely due to damage to which of the following?
A.
Corticospinal fibers on the left
B.
Corticospinal fibers on the right
C.
Somatomotor cortex on the right
D.
Thalamocortical fibers to motor cortex on the right
E.
Thalamocortical fibers to sensory cortex on the right
Correct Answer
B. Corticospinal fibers on the right
Explanation The weakness and sensory losses on the left side of the body and face indicate damage to the right side of the brain. The corticospinal fibers are responsible for motor control, so damage to the corticospinal fibers on the right side would result in weakness of the left upper and lower extremities. Therefore, the weakness in this woman is most likely due to damage to the corticospinal fibers on the right side.
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3.
A 57-year-old woman presents with the main complaint of difficulty speaking. The examination reveals that the woman's tongue deviates to the right on the attempted protrusion. When she says \\Ah" her soft palate elevates slightly on the left and the uvula deviates to the same side. This combination of deficits most likely indicates a small lesion in which of the following?
A.
Crus cerebri on the right
B.
Genu of the internal capsule on the left
C.
Genu of the internal capsule on the right
D.
Lateral medulla on the right
E.
Medial medulla on the right
Correct Answer
B. Genu of the internal capsule on the left
Explanation The combination of the woman's tongue deviation to the right on attempted protrusion and the elevation of the soft palate and uvula to the left when saying "Ah" suggests a lesion affecting the left side of the brain. The genu of the internal capsule is a white matter pathway that carries motor fibers from the cerebral cortex to the brainstem. Lesions in this area can result in contralateral motor deficits, including tongue deviation. Therefore, a small lesion in the genu of the internal capsule on the left is the most likely explanation for the patient's symptoms.
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4.
A 47-year-old man is transported to the emergency department from the site of an automobile collision. The examination reveals a paralysis of both lower extremities. Which of the following most specifically identifies this clinical picture?
A.
Alternating hemiplegia
B.
Hemiplegia
C.
Monoplegia
D.
Quadriplegia
E.
Paraplegia
Correct Answer
E. Paraplegia
Explanation Paraplegia is the most specific term that identifies the clinical picture described in the question. Paraplegia refers to paralysis of both lower extremities, which is consistent with the examination findings of the 47-year-old man who was involved in an automobile collision. This term specifically indicates the paralysis is limited to the lower limbs and does not involve the upper limbs or any other body parts. Alternating hemiplegia refers to episodes of paralysis that alternate between the left and right sides of the body, hemiplegia refers to paralysis of one side of the body, monoplegia refers to paralysis of a single limb, and quadriplegia refers to paralysis of all four limbs.
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5.
A 37-year-old man is brought to the emergency department with a severe head injury. Within a few hours he is decerebrate (upper and lower extremities extended) and comatose. The extension of his extremities indicates a dominant input to extensor motor neurons through reticulospinal fibers/tracts. Which of the following most specifically describes the position of these activated fibers within the spinal cord?
A.
Anterolateral area (area of anterolateral system)
B.
Posterolateral area (area of lateral corticospinal tract)
C.
Posteriorcolumns
D.
Posterolateral (dorsolateraI)tract
E.
Intermediatezone
Correct Answer
A. Anterolateral area (area of anterolateral system)
Explanation The correct answer is "Anterolateral area (area of anterolateral system)". In this scenario, the decerebrate posture and extension of the extremities indicate a dominant input to extensor motor neurons through reticulospinal fibers/tracts. The anterolateral area of the spinal cord, specifically the area of the anterolateral system, is responsible for transmitting pain and temperature sensations as well as controlling motor functions related to the maintenance of posture and movement.
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6.
Following a motor bike accident, a 22-year old man presents with paraplegia. Name
(i) the tract affected (ii) the site of injury and
(iii) the type of lesion
A.
Corticobulbar tract, genu of internal capsule, bilateral
B.
Spinothalamic, thoracic, unilateral
C.
Corticospinal tract, rostral to the decussation of pyramids, bilateral
D.
Corticospinal tract, thoracic, bilateral
E.
Corticospinal tract, posterior limb, unilateral
Correct Answer
D. Corticospinal tract, thoracic, bilateral
Explanation The correct answer is corticospinal tract, thoracic, bilateral. In this case, the corticospinal tract, which is responsible for voluntary motor control, is affected. The site of injury is in the thoracic region, and the lesion is bilateral, meaning that both sides of the body are affected. This would result in paralysis or weakness in the lower limbs due to damage to the motor fibers in the corticospinal tract at the thoracic level.
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7.
Your elderly neighbor has difficulties in picking up his newspaper properly from his porch
and you have also noticed that he exhibits issues with correctly grasping his brandy glass
when he invites you over for a drink. He told you that he has problems controlling the
distance of his movements. You know this to be which of the following?
A.
Akinesia
B.
Dysdiadochokinesia
C.
Bradykinesia
D.
Dysphagia
E.
Dysmetria
Correct Answer
E. Dysmetria
Explanation Based on the given information, the elderly neighbor's difficulty in controlling the distance of his movements, as evidenced by his struggles in picking up the newspaper and grasping the brandy glass, suggests that he is experiencing dysmetria. Dysmetria is a condition characterized by inaccurate or poorly coordinated movements, often resulting in overshooting or undershooting a target. This aligns with the neighbor's description of having problems with controlling the distance of his movements.
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8.
Which of the following statements about the choroid of the eye is INCORRECT?
A.
There are many melanocytes in the choroid
B.
There are many venous plexuses in the choroid
C.
The anterior rim of the choroid becomes the ciliary body
D.
The choroid touches the neural retina
E.
The choroid is mostly loose connective tissue
Correct Answer
D. The choroid touches the neural retina
Explanation The choroid does not directly touch the neural retina. The choroid is located between the retina and the sclera, providing nourishment to the outer layers of the retina. The choroid is mostly composed of loose connective tissue and contains many melanocytes and venous plexuses. The anterior rim of the choroid becomes the ciliary body, which is responsible for producing aqueous humor and controlling the shape of the lens.
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9.
A 52-year-old woman has difficulty reading small print in newspapers and magazines. Her ophthalmologist explains to her that she is suffering from a condition due to a loss of her ability to accommodate and focus on near objects. She most likely has which of the following?
A.
Astigmatism
B.
Cataracts
C.
Optic atrophy
D.
Macular degeneration
E.
Presbyopia
Correct Answer
E. Presbyopia
Explanation The woman's difficulty in reading small print in newspapers and magazines is due to a loss of her ability to accommodate and focus on near objects. This is a common age-related condition called presbyopia, which is characterized by a gradual loss of the eye's ability to change focus from distant to near objects. Astigmatism, cataracts, optic atrophy, and macular degeneration are all different conditions that can affect vision, but they do not specifically cause a loss of accommodation and focus on near objects like presbyopia does.
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10.
A 26-year old woman presented with diplopia. The abduction of both eyes were normal. The adduction of both eyes were quite limited in each eye. MRI revealed a multifocal lesion in the pons bilaterally next to the midline. Which structure is most probably affected?
A.
Medial lernruscus
B.
Lateral lemniscus
C.
Abducent nucleus
D.
PPRF
E.
Medial longitudinal fascicle
Correct Answer
E. Medial longitudinal fascicle
Explanation The Medial Longitudinal Fasciculus carries information about the direction that the eyes should move. It yokes the cranial nerve nuclei III (Oculomotor nerve), IV (Trochlear nerve), and VI (Abducens nerve) together, and integrates movements directed by the gaze centers (frontal eye field) and information about head movement (from cranial nerve VIII, Vestibulocochlear nerve). It is an integral component of saccadic eye movements as well as vestibular-ocular and optokinetic reflexes. It also carries the descending tectospinal tract and medial vestibulospinal tracts into the cervical spinal cord and innervates some muscles of the neck and upper limbs. These bundles of axons are situated near the midline of the brainstem and are composed of both ascending and descending fibers that arise from a number of sources and terminate in different areas.
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11.
Your 82-year old patient is in very good overall health. He does have, however, some deficits in hearing. He cannot hear the full l range of sounds that a young person can normally hear. You explain to him that this loss of hearing is common with aging and that he shouldn't worry about it. The hearing loss he is experiencing is most likely?
A.
The result of damage to hair cells that respond maximally to low frequency sounds
B.
The result of damage to hair cells that respond maximally to mid frequency sounds
C.
The result of damage to hair cells at base of basilar membrane
D.
The result of damage to hair cells at apex of basilar membrane
Correct Answer
C. The result of damage to hair cells at base of basilar membrane
Explanation As a person ages, they may experience a loss of hearing due to damage to the hair cells in the inner ear. The hair cells at the base of the basilar membrane are responsible for detecting high frequency sounds, while the hair cells at the apex of the basilar membrane detect low frequency sounds. Since the patient cannot hear the full range of sounds, it suggests that the damage is occurring at the base of the basilar membrane, affecting the hair cells that respond to high frequency sounds.
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12.
What is the main function of the outer hair cells?
A.
Production of endolymph
B.
Cochlear amplification
C.
Production of perilymph
D.
Emission of sound
E.
Inhibition of inner hair cells
Correct Answer
B. Cochlear amplification
Explanation The main function of the outer hair cells is cochlear amplification. These cells are responsible for amplifying sound waves and enhancing the sensitivity and selectivity of the inner ear. They act as tiny motors, which can change their length and stiffness in response to electrical signals from the brain. This amplification helps in improving the overall hearing ability and discrimination of different sounds.
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13.
The opening of ion channels in stereocilia results in inner hair cell depolarization. If we were to take the ions responsible for this depolarization of hair cells and add these ions to the extracellular solution surrounding a cerebellar Purkinje cell, what would happen to the resting membrane potential of the cerebellar Purkinje cell?
A.
Nothing
B.
Hyperpolarization
C.
Depolarization
D.
Repolarization
Correct Answer
C. Depolarization
Explanation When the ions responsible for depolarization of hair cells are added to the extracellular solution surrounding a cerebellar Purkinje cell, it would result in depolarization of the resting membrane potential of the Purkinje cell. This means that the membrane potential of the cell would become less negative, bringing it closer to the threshold for generating an action potential.
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14.
Damage to the efferent portion of the muscle spindle would involve which of the following fiber types?
A.
B fibers
B.
Aa fibers
C.
C fibers
D.
Ay fibers
E.
AB fibers
Correct Answer
D. Ay fibers
Explanation Damage to the efferent portion of the muscle spindle would involve Ay fibers. The muscle spindle is responsible for detecting changes in muscle length and relaying this information to the central nervous system. The efferent portion of the muscle spindle consists of motor fibers that innervate the intrafusal muscle fibers within the spindle. Ay fibers are the motor fibers that specifically innervate the nuclear bag fibers, which are one of the two types of intrafusal muscle fibers found in the muscle spindle. Therefore, damage to the efferent portion of the muscle spindle would affect the Ay fibers.
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15.
A 22-year-old woman n is suffering from bilateral weakness of her lower limbs. Which of the following represents the most likely location of this lesion?
A.
A lesion rostral to the pyramidal decussation
B.
The left genu of the internal capsule
C.
The right posterior limb of the internal capsule
D.
A lesion caudal to the pyramidal decussation
E.
The right genu of the internal capsule
Correct Answer
D. A lesion caudal to the pyramidal decussation
Explanation The most likely location of the lesion causing bilateral weakness of the lower limbs in a 22-year-old woman is a lesion caudal to the pyramidal decussation. The pyramidal decussation is the point where the fibers of the corticospinal tract cross over to the opposite side of the spinal cord. A lesion caudal to this decussation would affect the descending motor fibers that control the lower limbs, resulting in bilateral weakness.
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16.
A 52-year-old woman who is unable to move her left leg visits your office. Sensory modalities in all of her limbs are retained and there appears to be no sign of weakness in any of her other limbs. In which of the following structures are the cell bodies of lower motor neurons innervating the lower limb located?
A.
Lamina I-VI
B.
Lamina VIII, IX
C.
Lamina X
D.
Lamina III, IV
E.
Lamina I, II
Correct Answer
B. Lamina VIII, IX
Explanation The cell bodies of lower motor neurons innervating the lower limb are located in Lamina VIII, IX. This is supported by the fact that the patient is unable to move her left leg, indicating a dysfunction in the lower motor neurons specifically innervating that limb. The sensory modalities in all of her limbs are retained, suggesting that the issue is not with the sensory pathways. Additionally, there is no sign of weakness in her other limbs, further indicating a localized problem in the lower motor neurons innervating the lower limb.
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17.
A 74-year-old woman was residing in a rehabilitation facility while recovering from an infection. She was doing well until one morning she suddenly developed slurred speech and right sided weakness. An emergency neurologist was consulted. Medical history was notable for hypertension, coronary artery disease and a recent onset of atrial fibrillation. Examination revealed weak movements of the right face with only mild forehead involvement. Decreased palate movement on the right, and rightward tongue deviation. The neurologist suspected lacunar infarction, which was confirmed by MRI. Where is the most possible localization?
A.
Left prefrontal gyrus medial part of the hemisphere
B.
Right Broca area with involvement of lower part of Broadmann area 4.
C.
Left posterior limb of internal capsule
D.
Left genu of internal capsule
E.
Right posterior limb and genu of internal capsule
Correct Answer
D. Left genu of internal capsule
Explanation The patient's symptoms of slurred speech and right-sided weakness are consistent with a lacunar infarction. Lacunar infarctions are small, localized areas of stroke caused by occlusion of a single penetrating artery. The most common location for lacunar infarctions is the internal capsule, which is a white matter tract that carries motor fibers. The left genu of the internal capsule is the most likely localization because it supplies motor fibers to the contralateral face and tongue. This explains the patient's right-sided weakness and deviation of the tongue to the right.
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18.
A57-year-old man presents with hoarseness. The neurological examination reveals a deviation of the uvula to the left on phonation, deviation of the tongue to the right on the protrusion, and weakness of the facial muscles around the mouth on the right. Which of the following would most likely also be seen in this man?
A.
Inability to turn his head to the left against resistance
B.
Inability to turn his head to the right against resistance
C.
Inability to shrug the right shoulder against resistance
D.
Weakness of the masticatory muscles on the left
E.
Weakness of the masticatory muscles on the right
Correct Answer
A. Inability to turn his head to the left against resistance
Explanation Based on the given symptoms of deviation of the uvula to the left, deviation of the tongue to the right, and weakness of the facial muscles around the mouth on the right, it suggests a lesion of the right hypoglossal nerve (CN XII) and right facial nerve (CN VII). These nerves control the movement of the tongue, facial muscles, and uvula. The head turning is controlled by the sternocleidomastoid muscle, which is innervated by the spinal accessory nerve (CN XI). Therefore, the most likely additional symptom seen in this man would be an inability to turn his head to the left against resistance.
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19.
A 57-year-old obese man is brought to the emergency department by his wife. The examination reveals that cranial nerve function is normal but the man has the bilateral weakness of his lower extremities. He has no sensory deficits. MRI shows a small infarcted area in the general region of the cervical spinal cord-medulla junction. Which of the following represents the most likely location of this lesion?
A.
Caudal part of the pyramidal decussation
B.
Lateral corticospinal tract on the left
C.
Pyramids bilaterally
D.
Pyramid on the right
E.
Rostral part of the pyramidal decussation
Correct Answer
A. Caudal part of the pyramidal decussation
Explanation The most likely location of the lesion in this case is the caudal part of the pyramidal decussation. The patient's symptoms of bilateral weakness of the lower extremities without sensory deficits indicate a problem with the motor pathways. The pyramidal decussation is the site where the fibers of the corticospinal tracts cross over from one side of the brain to the opposite side of the spinal cord. Lesions in this area can lead to bilateral motor deficits, which is consistent with the patient's symptoms. The other options, such as the lateral corticospinal tract on the left or the pyramid on the right, do not account for the bilateral nature of the symptoms.
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20.
Which of the following would produce maximum excitation of the hair cells in the right horizontal semicircular canal?
A.
Hyperpolarization of the hair cells
B.
Bending the stereocilia away from the kinocilia
C.
Rapid ascent in an elevator
D.
Rotating the head to the right
Correct Answer
D. Rotating the head to the right
Explanation The semicircular canals are involved in angular acceleration or rotation. Hair cells of the right semicircular canal are excited (depolarized) when there is a rotation to the right. This rotation causes bending of the stereocilia toward the kinocilia, and this bending produces depolarization of the hair cell. The ascent in an elevator would activate the saccules, which detect linear acceleration.
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