NAME



NAME _____________________________

BRAIN AND BEHAVIOR I

THIRD EXAM

Monday, June 6, 2000

For all the following questions, indicate the letter that corresponds to the SINGLE MOST APPROPRIATE ANSWER.

1. All of the following are correct statements concerning the EEG EXCEPT that

A. it is generated by the flow of synaptic currents through the extracellular space.

B. it is recorded noninvasively with scalp electrodes.

C. the EEG component related to a specific sensory stimulus is called a sensory evoked

potential.

D. EEG recordings represent the summed activity of a large number of neurons.

* E. non-pyramidal cells contribute more to the EEG than pyramidal cells.

2. The conscious perception of emotional states (feelings) is mediated by connections from the

amygdala to the

* A. cingulate cortex.

B. periaqueductal gray matter.

C. thalamus.

D. substantia nigra.

E. habenula.

3. A 63-year-old hypertensive, diabetic male had a gradual onset of symptoms that included "tingling" of the right side of his face and right limbs and difficulty in walking. On neurological

examination, he had: ptosis of the left upper eyelid; a left eyeball that was depressed and laterally

deviated (down and out); dysdiadochokinesis and dysmetria of the right upper limb; and, decreased pain, temperature, and discriminative touch in the right upper and lower limbs and the right side of his face. The neurologic signs and symptoms of this patient could MOST LIKELY be explained by a tumor in the

* A. left side of the midbrain tegmentum.

B. left side of the basis pontis.

C. right side of the midbrain tegmentum.

D. right side of the basis pontis.

E. left cerebral cortex.

4. Narcolepsy can be described as having all of the following clinical characteristics EXCEPT for

A. sleep paralysis.

B. hypnagogic hallucinations.

* C. nocturnal myoclonus.

D. excessive daytime sleep.

E. cataplexy.

5. A patient with the pathology observed in the Image "Q" in the Image Collection Page could

probably have all of the following clinical signs EXCEPT

A. decerebrate rigidity.

B. an abnormal pupillary light response.

* C. an absence of spontaneous respirations.

D. a loss of consciousness.

E. a decreased transmission of cortical input to the micturition center.

6. MR imaging revealed that a patient with focal onset seizures has an arteriovenous malformation that is inoperable. Consequently, this patient's epilepsy must be managed pharmacologically. An antiepileptic drug that inhibits the enzyme that metabolizes GABA is

A. gabapentin.

B. tiagabine.

* C. vigabatrin.

D. lamotrigine.

E. carbidopa.

7. A defect in development of the diencephalon could result in abnormal morphology of all of the

following diencephalic structures except the

A. habenula.

B. subthalamus.

C. pineal gland.

* D. globus pallidus.

E. hypothalamus.

8. Individuals with deficits in the nigrostriatal dopaminergic system

A. can initiate but have difficulty completing motivated behaviors.

B. cannot copulate.

* C. have difficulty initiating motivated behaviors.

D. behave as if they have schizophrenia.

E. have normal motor function.

9. A 60-year-old man had a cardiorespiratory arrest. After resuscitation his EEG showed persistent

epileptic (convulsive) brain activity. The neurochemical system MOST LIKELY to cause this

enhanced neuronal activity is the

A. serotonergic system.

B. glycinergic system.

C. histaminergic system.

* D. glutamatergic system.

E. cholinergic system.

10. A 50-year-old Gross Anatomy course director at the U.C. College of Medicine has a history of

memory loss and impaired cognitive capacity from running one too many marathons for a man

of his age. The best drug to treat this condition would be a

A. histamine antagonist.

* B. cholinesterase inhibitor.

C. beta-adrenergic blocking agent.

D. dopamine precursor (L-DOPA).

E. serotonin antagonist.

11. Sexual dimorphism in the central nervous system has been described for all the following structures EXCEPT the

A. hypothalamus.

B. corpus callosum.

C. spinal cord.

D. cerebral cortex.

* E. pons.

12. A form of nonassociative learning that enables a novel stimulus to alert us to potentially

harmful stimuli is called

* A. sensitization.

B. classical conditioning.

C. habituation.

D. instrumental conditioning.

E. Pavlovian conditioning.

13. The nucleus solitarius receives sensory input from neurons associated with all of the following EXCEPT

A. taste buds from the anterior 2/3 of the tongue.

B. receptors in the lining of the digestive tract.

C. chemoreceptors in the carotid body.

* D. the epithelium on the outer surface of the tympanic membrane.

14. A possible role for the calcium ion in the induction of LTP (long-term potentiation) includes all

of the following EXCEPT activation of

A. PKC via the protease calpain.

B. autophosphorylation of CamKinase II.

C. nitric oxide synthase.

D. protein kinases that activate transcription factors.

* E. protein kinases that phosphorylate S-potassium channels.

15. Which of the following is an example of an appetitive behavior?

A. Copulating

B. Swallowing a drink of water

* C. Pressing a lever to obtain food

D. Ejaculating

E. Chewing a bite of food

16. Characteristics of non-fluent aphasia include

A. impaired auditory comprehension.

* B. damage anterior to the central sulcus.

C. frequent verbal paraphasias.

D. long phrase length.

E. normal prosody.

17. A 42-year-old woman is incontinent. After a thorough neurological examination, it is concluded

that the woman has an upper motor neuron lesion causing an automatic reflex bladder.

This problem is also referred to as a spinal or spastic bladder. What are the characteristics of

bladder function associated with this problem?

A. The bladder empties fully.

B. There is severe urinary retention in the bladder.

* C. The bladder does not empty fully.

D. The bladder is paralyzed.

E. There is no awareness of fullness.

18. A 28-year-old man is brought to you by his family. Two months ago he had a head injury (went

over the handle bars of his mountain bike) with a half-hour loss of consciousness. Ever since he

was released from the hospital, he has been irresponsible, argumentative, and socially

inappropriate. You suspect that he has sustained an injury to

A. Wernicke's area.

B. Broca's area.

C. dorsolateral frontal cortex.

* D. orbitofrontal cortex.

E. right parietal cortex.

19. A patient with impairment of episodic and semantic memory systems would MOST LIKELY

have a lesion affecting the

* A. medial portions of the temporal lobes.

B. frontal lobes.

C. supramarginal gyri.

D. inferior prefrontal cortices.

E. inferotemporal cortices.

20. A 64-year-old woman had a hemorrhage that was restricted to the thalamus. The resultant "thalamic syndrome" would include all of the following EXCEPT

A. contralateral homonymous hemianopsia.

B. contralateral hemianesthesia

C. dysesthesia.

D. contralateral intention tremor.

* E. contralateral hemiparesis.

(Questions #21 and 22):

A meningeal tumor (meningioma) lesioned the superficial structures blackened in the diagram below.

[pic]

21. The structures affected by the tumor include the

A. abducens nucleus.

B. facial motor nucleus.

C. hypoglossal nucleus.

* D. vestibular nuclei.

E. nucleus gracilis.

22. As a consequence of the damage shown in the drawing above, one would expect axonal

degeneration in the

A. left abducens nerve.

B. left vagus nerve.

C. left hypoglossal nerve.

D. left ventral trigeminothalamic tract.

* E. right medial lemniscus.

23. Following a head injury resulting from a motor vehicle accident, a 16-year-old was tested

for eyeball movement. Her eyeballs looked as shown below during testing.

[pic]

This patient probably had an injury of the

A. right paramedian pontine reticular formation (PPRF).

B. left paramedian pontine reticular formation (PPRF).

C. right frontal cortex.

* D. left oculomotor nerve.

E. left abducens nerve.

24. The amygdala has projections to all of the following structures EXCEPT the

A. bed nucleus of the stria terminalis.

B. orbitofrontal cortex.

C. brainstem nuclei.

D. hypothalamus.

* E. anterior nucleus of the thalamus.

25. A patient with body neglect and tactile agnosia MOST LIKELY has a lesion of the

* A. posterior parietal cortex.

B. temporal association cortex.

C. prefrontal cortex.

D. primary motor cortex.

E. cingulum.

(Questions #26-27):

A 38-year-old man had a stroke that caused tissue damage ON THE LEFT SIDE in the area shown by the hatching in the drawing below:

[pic]

26. Structures DIRECTLY affected by this lesion include

A. axons from cells in the nucleus cuneatus.

B. axons from cells in the main sensory nucleus of the trigeminal nerve.

C. corticobulbar fibers.

D. rubrospinal fibers.

* E. axons from cells in the ventral posterior lateral (VPL) nucleus.

27. Enduring (long term) symptoms expected from this lesion include

A. spastic paralysis of the muscle that closes the left eyelids.

* B. spastic paralysis of the right upper limb.

C. flaccid paralysis of the left upper limb.

D. decreased perception of painful stimuli of the left side of the face.

E. decreased perception of painful stimuli of the left side of the body.

28. All the following are correct statements concerning the effects of an injury of the peripheral nervous system EXCEPT

A. chromatolysis.

B. transsynaptic loss of synapses.

C. degeneration of axonal segments distal to the injury site.

* D. astrogliosis and microglial activation.

E. denervation-induced synaptogenesis and collateral sprouting.

29. An 18-year-old boy does not appear to have undergone puberty and has been diagnosed with

Kallman's syndrome. All of the following statements would be correct about this syndrome

EXCEPT that

A. it is an X-chromosome linked disorder.

B. he is unable to appreciate subtle taste differences in food.

* C. he has an acute sense of smell and can differentiate perfumes.

D. he has reduced production of LHRH.

E. his gonads are underdeveloped.

30. A 33-year-old woman with a history of multiple chronic stressors presents with a three-month

history of a loss of interest and pleasure in life. She also reports decreased sleep and appetite,

fatigue, difficulty thinking and making decisions, feelings of helplessness, and hopelessness.

The pathophysiology of her illness might include

* A. a decreased level of norepinephrine in the brain.

B. increased mesolimbic dopamine activity.

C. diminished neuronal activity in the amygdala.

D. disruption of the pathway from the raphe nuclei to the cerebellar cortex.

E. increased serotonin receptor binding in the limbic-thalamo-cortical circuit.

31. A patient with a history of chronic alcoholism and diagnosed with severe memory impairment

would MOST LIKELY have a

A. Wallenberg's syndrome.

* B. Korsakoff's syndrome.

C. Kluver-Bucy syndrome.

D. anterior lobe syndrome.

E. Brown-Sequard syndrome.

32. All of the following statements regarding REM sleep are correct EXCEPT that it

A. usually occurs 70-90 minutes after sleep onset.

B. is characterized by fast frequency, low amplitude waves.

* C. increases with old age.

D. is paradoxical sleep.

E. is accompanied by relaxation of skeletal muscles.

33. A 55-year-old woman in a psychiatric ward received antipsychotic drug treatment for her bizarre

behavior and hallucinations. After six months of treatment, stereotyped repetitive involuntary

movements of the tongue, mouth, and face developed. Other findings on neurological

examination were normal. The neurochemical system MOST LIKELY altered in this patient is

the

* A. dopaminergic system.

B. cholinergic system.

C. histaminergic system.

D. adrenergeric system.

E. glutamatergic system.

34. After two episodes of "muscle weakness", a 24-year-old woman was seen by a neurologist.

During the physical examination, she was asked to look to the right and then to the left. Her

eyeballs looked as follows:

[pic]

This patient probably suffered an injury to

A. the left frontal cortex.

B. the right frontal cortex.

C. the left parieto-occipital cortex.

* D. both the left and the right medial longitudinal fasciculi (MLF).

E. the right paramedian pontine reticular formation (PPRF).

35. A 58-year-old woman consulted her physician with the complaint of a right-sided headache that has been increasing in frequency and intensity, "numbness" over her right cheekbone and right forehead, blurred vision, and paralysis of her right eye. A neurological examination revealed ptosis of the right upper eyelid, loss of pupillary reflexes in the right eye, and a total right eye ophthalmoplegia (paralysis of eye muscles). Also, a visual field deficit was detected and is shown below:

[pic]

In addition, there was loss of sensation over the right side of her face, except for the mandibular

area. The MOST LIKELY diagnosis is

A. an occlusion of the right central artery of the retina.

B. a pituitary tumor.

C. a right optic tract lesion.

D. a right uncal herniation.

* E. a large aneurysm of the right internal carotid artery.

36. Inhibition of the hypothalamo-pituitary adrenal axis occurs via

A. increased activation of the sympathetic nervous system.

B. negative feedback mechanisms associated with increases in plasma glucose

concentration, decreases in blood oxygen concentration and increased plasma osmolarity.

C. increased blood volume associated with drinking a beer to relax.

* D. feedback by CRH, ACTH and cortisol at their various receptors to inhibit further release

of these identical agents.

E. no feedback mechanism for the hypothalamo-pituitary axis.

37. Cells in layer V of the cerebral cortex

A. project primarily to other areas of the cerebral cortex.

* B. project to many subcortical structures.

C. use acetylcholine as their neurotransmitter.

D. are mostly fusiform cells.

E. receive a direct input from the intralaminar thalamic nuclei.

38. A woman was found lying in the street. On admission into the Emergency Department she had

numerous clinical signs including:

- bilateral Babinski signs

- no responses to verbal requests

- no responses to severely painful stimuli

- normal pupillary light reflexes bilaterally

Of the following, the most likely cause of her clinical signs is

A. an obstruction of the cortical branches of the left middle cerebral artery.

B. a left uncal herniation.

C. a central transtentorial herniation.

* D. an obstruction of paramedian branches of the basilar artery.

E. narcolepsy.

39. All of the following are correct statements about Cajal-Retzius cells except that

A. they originate in the ventricular zone.

* B. they must migrate through all the other cortical layers to reach layer I.

C. some eventually differentiate into horizontal cells.

D. they are among the first neurons to be generated.

E. they occupy the most superficial part of the developing neocortex.

40. Groups of neurons that are considered a part of the reticular formation are involved in all of the

following EXCEPT

A. breathing.

B. standing up straight.

C. looking for a piece of paper on your desk.

* D. recognizing the Dean.

E. staying awake during a lecture.

41. The increased susceptibility to major depression in women may be because

A. estrogen dampens the body's stress response in women.

* B. the female brain has a lower average rate of serotonin synthesis than the male brain.

C. the limbic system is suppressed in women compared with men during self-induced

sadness experiments.

D. tryptophan-free diets alleviate depression more frequently in women than in men.

E. life stress is experienced by more male than female patients with depression.

42. A 63-year-old man, shivering on a hot August day, was brought to the emergency department.

His body temperature was 105º F, he was not perspiring, and it was concluded that he was

suffering from hyperthermia. All other neurological tests were within normal ranges. Assuming he is not delusional, where would you localize the lesion responsible for his current problem?

* A. Anterior region of the hypothalamus (preoptic area)

B. Tuberal region of the hypothalamus.

C. Posterior region of the hypothalamus (mammillary region)

D. Median eminence

E. Neurohypophysis

43. An event such as diving into an ice-cold mountain lake after a hot five hour hike produces

A. acute activation of the parasympathetic nervous system followed by the activation of the

hypothalamo-pituitary adrenal axis.

B. acute inactivation of the sympathetic nervous system followed by the activation of the

hypothalamo-pituitary adrenal axis.

* C. acute activation of the sympathetic nervous system followed by the activation of the

hypothalamo-pituitary adrenal axis.

D. acute inactivation of the sympathetic nervous system followed by the inactivation of the

hypothalamo-pituitary adrenal axis.

E. acute activation of the parasympathetic nervous system followed by the inactivation of

the hypothalamo-pituitary adrenal axis.

44. A 5-year-old girl presents with normal intelligence and sudden onset of seizures. An MRI

reveals bilateral ribbons of grey matter located beneath the cerebral cortex, separated by a thin

band of white matter. A genetic screen reveals loss of heterozygosity at the doublecortin locus.

The most likely diagnosis is

A. classical lissencephaly.

B. bilateral periventricular nodular heterotopia.

* C. X-linked lissencephaly/subcortical band heterotopia.

D. subcortical band heterotopia.

E. pachygyria.

45. The hippocampal formation has projections to all of the following structures EXCEPT to the

A. nucleus accumbens.

* B. olfactory bulbs.

C. amygdala.

D. septal nuclei.

E. mammillary bodies.

(Questions #46-48):

46. The scan labeled "A" in the above figure is of a normal patient. In the scan labeled "B", the patient had sustained a right cerebral hemorrhage, indicated by the white area (arrow). This cerebrovascular accident MOST LIKELY resulted in

A. a left hemianesthesia.

B. a left homonymous hemianopsia. *

C. loss of intellectual and emotional responses.

D. aphasia.

E. hemiparesis of the right side of the body.

47. The blood vessel(s) MOST LIKELY responsible for this hemorrhage is (are) the

A. anterior cerebral artery.

B. middle cerebral artery.

* C. posterior cerebral artery.

D. superior cerebellar artery.

E. lenticulostriate arteries.

48. The imaging technique used to produce the scan labeled "A"

A. uses ionizing radiation.

* B. is T2-weighted.

C. detects single photon radiation.

D. readily detects calcification.

E.. is the method of choice for the detection of an acute hemorrhage.

49. The Kluver-Bucy syndrome is typically associated with lesions of the

A. septal area.

B. cingulate gyrus.

C. medial hypothalamus.

* D. amygdala.

E. lateral hypothalamus.

50. A 70-year-old retired accountant comes to see you complaining of difficulty talking and

problems using his right upper and lower extremities. These symptoms developed over

the last six months. On neurological examination, he had: weakness of the right upper

and lower limbs; deviation of the tongue to the left on attempted protrusion; decreased

position and vibratory sensations on the right fingers and toes; hyperreflexia and

hypertonia in both right limbs; and a Babinski sign on the right. The MOST LIKELY

location of this patient's pathology is the

* A. left side of the rostral medulla.

B. right side of the rostral medulla.

C. left side of the rostral pons.

D. right side of the rostral pons.

E. left side of the caudal midbrain.

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[pic]

B

A

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