Mock Exam # 1

1. A 27 year old scuba diver was diving with his girlfriend when she accidentally
shot him with her spear gun. The patient presented with weakness in the left leg
from belly button down. The patient complained of altered sensation on the Right
leg. Where is the lesion?

a.

b.

c.

d.
2. A 53 year old man collapsed on the pier in Santa Monica. Paramedics rushed him
to the hospital where he regained consciousness. Neurological exam revealed that
he was weak and had lost light touch sensation from his left foot and leg. Where
was his lesion and what blood vessel was injured to produce the lesion?
a. Left ACA
b. Right ACA
c. Left MCA
d. Right MCA
3. A 61-year old referee collapsed at a high school wrestling tournament. He
regained consciousness in the emergency room and was given a neurological
examination. The attending observed these symptoms: positive Babinski sign in
his left footleft sided spastic paralysis (left spastic hemiplegia) and increased
tendon reflexes in left UE and LEloss of fine touch, 2-point discrimination and
proprioception (anesthesia) on theside of his bodysignificant decrease in pain and
temperature sensation on the entire left side of his body. The acute onset of the
deficit suggests a vascular lesion what is the most likely location of the lesion;
and branches of what artery are involved?

a. Middle cerebral artery

b. Anterior cerebral artery
c. Internal Carotid artery
d. Anterior communicating artery
4. A successful 48-year old attorney was told he was hypertensive but did not take
his blood pressure medications. He was apparently well until 4 days after his
birthday, when he developed weakness in his right hand that impaired his writing.
The attack lasted less than an hour, and he was referred for neurological
evaluation. Because of a busy schedule, he canceled the appointment. Several
weeks later, he complained to his wife of a left-sided headache. She found him an
hour later, slumped in a chair apparently confused and paralyzed on the right side.
Neurological examination in the hospital revealed spastic paralysis of the right
arm and a flattened nasolabial fold on his right face. He was able to resist the
physicians attempt to force open his right eyelid. His right leg motor function
was unaffected, as it was on his entire left side. Touch sensation was absent in his
entire right face and right hand. Deep tendon reflexes were hyperreflexic only in
his right wrist. The patient was aphasic and unable to produce any intelligible
speech beyond very simple phrases. Where was the lesion, what was affected, and
explain the symptoms present?
a. Left ACA
b. Left MCA
c. Right ACA
d. Right MCA
5. A man brought his 68 year-old wife to the hospital because she had awoken that
morning with a limp right arm, and, according to her husband, she couldn't seem
to be able to get a sentence out straight. Examination revealed that the strength in
her right hand was less than on the left, and her right biceps tendon reflex was
increased. Her response to stroking the sole of the foot was plantarflexion in both
feet. She presented no sensory deficits, and was able to understand spoken
questions and directions, but she responded with frustrating, halting, one-word
answers and could not read aloud. There was no gait asymmetry, but there was a
slight droop to the right corner of her mouth. Paresis in the upper right limb and
facial palsy of the lower face on the right. The physician diagnosed a vascular
lesion. Where was the lesion, which vessel was likely involved, and what
systems/structures were affected?
a. Left ACA
b. Left MCA
c. Right ACA
d. Right MCA
6. A 74-year-old woman was brought to the clinic by her granddaughter because she
had problems walking. Recently she had experienced a tendency to sway or
stagger (ataxia) to the right and had fallen on her right side that morning. The
physician took a detailed history and ascertained that the current conditions were
continuations of a long series of events beginning about 5 years previously. At
that time, the patient had experienced a number of dizzy spells and complained to
her granddaughter of ringing in her right ear (tinnitus). After about one year,

however, the ringing stopped. Several months earlier, she experienced some
intermittent facial pain, but since then, the right side of her face became numb.
Later, she noted difficulty in closing her right eyelid tightly and sagging of the
right corner of her mouth. In the past few weeks, she developed increasing
difficulty walking. During the examination, the doctor noted that her voice was
hoarse and she reported having difficulty swallowing. Closer examination
revealed pronounced hearing loss in the right ear, loss of taste on the right side of
her tongue, and absence of corneal reflexes on her right eye. Where is the lesion
and what structures were involved? (Select all of the appropriate answer
Multiple choice, Multiple answer)
a. CN III
b. CN IV
c. CN V
d. CN VI
e. CN VII
f. CN VIII
g. CN IX
h. CN X
i. Cerebellum
j. L Cerebral Hemisphere
k. R Cerebral Hemisphere
l. Midbrain
m. Pons
n. Ponto-Medullary Junction
o. Medulla
7. A 40-year old prostitute was brought to the ER after collapsing on the street.
Blood pressure was dangerously high, and blood drawn while she was still
unconscious revealed moderate levels of alcohol and barbiturates, as well as
sexually transmitted disease. Upon regaining consciousness, a detailed history
was taken, and a neurological examination was conducted and the following was
found:
bilateral anesthesia and loss of vibratory sensation of lower limbs without
impairment of pain sensation, and a positive Romberg's sign
a diminished gag reflex was considered an unreliable result due to the patient's
history, however she demonstrated difficulty swallowing and choked when
drinking water, and her voice was hoarse and quiet
loss of pain and temperature from her right face and left upper and lower
limbs and trunk
Describe the system(s) and/or nerve(s) and/or nuclei involved. (Select all of the
appropriate answerMultiple choice, Multiple answer)
a. CN III
b. CN IV
c. CN V
d. CN VI
e. CN VII
f. CN VIII

g. CN IX
h. CN X
i. Cerebellum
j. L Cerebral Hemisphere
k. R Cerebral Hemisphere
l. Midbrain
m. Pons
n. Ponto-Medullary Junction
o. Medulla
p. Cervical spinal cord
q. Thoracic spinal cord
r. Lumbar spinal cord
s. Sacral spinal cord
8. A 21-year old rock climber was trying to scale El Capitan in Yosemite National
Park when she slipped and fell 150 feet before her rope caught her, leaving a
severe horizontal rope burn on her back. She was air lifted to a nearby trauma
center. Both of her legs showed flaccid paralysis, and her lower abdomen bulged.
She had no fine tactile sensation from her umbilicus down both of her legs, and no
pain sensation in a strip of skin across her navel nor below her inguinal ligaments.
One week later, she was found to have hyperreflexic patellar and Achilles tendon
responses in both LEs and bilateral Babinski signs. She developed an automatic
reflex bladder, which produced incontinence and did not empty fully. Her sensory
deficits resolved. Where was the lesion and what was affected? If a vasculature is
affected, which one would be the one with a clot? (Select all of the appropriate
answerMultiple choice, Multiple answer)
a. Anterior spinal artery
b. Posterior spinal artery
c. Vasocorona

d.

e.

f.

g.
9. 9. 6 months previously, a 31 year old woman visited her physician she had noticed
that she was easily fatigued when walking. The physician suggested more
exercise and a daily multivitamin. Presently, she was brought to the hospital by
her husband because she was no longer able to walk. Tests of her deep tendon
reflexes revealed elevated responses in both lower limbs and a bilateral Babinski
sign (positive). Her upper limb responses were normal and symmetrical. Sensory
testing demonstrated that she had no fine touch sensation in either lower limb, and
she couldnt tell when the physician dorsiflexed or plantarflexed either great toe.
MRI revealed a 3 cm brain tumor. Where is the tumor and what structures were
damaged to produce the symptoms? (Select all of the appropriate answer
Multiple choice, Multiple answer)
a. Superior frontal gyrus
b. Superior parietal lobule
c. Longitudinal fissure
d. Central sulcus
e. Primary motor cortex
f. Primary somatosensory cortex
g. Premotor cortex
10. A 65 year old hypertensive man suddenly collapsed while playing poker with
friends. He awoke in the hospital and was examined by a neurologist. He had
spastic hemiplegia on the right side of his body. His deep tendon reflexes on the
right were elevated and resistance to passive movements in both right extremities
was increased. His right lower face was also weak and he was unable to show his
teeth on that side. Pinprick sensation on the right side of his body and face was
not sharp and was poorly localized, and he had a loss of tactile and proprioceptive
sensibility on the complete right side of his body and face. Where is the lesion?
a. Left ACA
b. Left MCA
c. Right ACA
d. Right MCA

11. An elderly gentleman suffered a stroke. When he recovered consciousness, he

was unable to move his left arm and leg, and his mouth on the left side drooped.
He complained about double vision. Eye movements in his right eye were
compromised; lateral gaze was intact, but there was little other movement
possible. His right pupil was fixed and dilated. Where was the lesion?

a.

b.

c.

d.
12. 7. The neurologist who examined the woman noticed that her speech was slurred,
but she made sense and was able to convey some details of the recent fall and trip
to the hospital. During the motor section of the neurological exam, she was asked
to stick out her tongue. She did this and it deviated to the left. She demonstrated
weakness of the right arm and leg. Sensory examination revealed a loss of
position sense for her right thumb and right toe and loss of vibration perception,
measured using a tuning fork placed on her right elbow and right knee. The
remainder of the neurological examination was essentially within normal limits.
Review of her medical history revealed that she had a long history of heart
disease. Where was the lesion?

a.

b.

c.

d.
13. Anna was traveling to Paris (where it is extremely HOT) for addressing a
complication with her thymus. Doctors discovered:
ptosis,
diplopia,
difficulty swallowing,
shortness of breath,
impaired speech,
weakness of arms
To address these signs and symptoms, the doctors would give Anna:
a. Gabapentin
b. Acetylcholine Esterase inhibitor
c. Prednisone
d. Dexamethasone

14. One day, CSF was happily flowing in the ventricular system when it came across
a nasty clot. To see where the clot is, the doctors decided to stick a camera
through the Right Internal Jugular Vein. They believed that with this tiny camera,
a clot in the lateral ventricle would be visible! Assuming their belief is accurate,
what path would the camera take?
15. True/ False: Thalamus is ventro-caudal to the corpus callosum, but lateral
ventricle is dorso-raustral to the thalamus.