Material Covered: Direct and Indirect Motor Systems, Limbic System and
Cerebral Cortical Function
Use the following letters to indicate your answer:
A: Only I is true
B: Only II is true
C: Both are true
D: Both are false
1. I. The superior anastomotic vein is connected to the superior sagittal sinus.
II. The foramen of Magendie connects the 4th ventricle to the cisterna magna.
2. I. Substantia gelatinosa neurons convey temperature sensation to contralateral
neurons in the thalamus, which in turn sends axons to the postcentral gyrus.
II. Reflex proprioception fibers in the ventral spinocerebellar tracts are conveyed
to the cerebellum via the inferior cerebellar peduncle.
3. I. A CVA causing a infarct of the right inferior olivary nucleus could cause a
patient’s tongue to deviate to the left when protruding it.
II. A stroke destroying the right nucleus ambiguus of the glossopharyngeal nerve
would lead to paralysis of the right stylopharyngeus muscle.
4. I. The motor nucleus of the trigeminal nerve is medial to the chief sensory nucleus
of the trigeminal nerve. These nuclei can be found in the pons.
II. A complete ablation of the right geniculate ganglion would lead to paralysis of
the right side of the face, i.e., loss of voluntary control of the muscles of facial expression.
5. I. The right trochlear nucleus innervates the left superior oblique muscle and the right
oculomotor nucleus innervates the right superior rectus muscle.
II. A patient that you are examining presents with right eye palsy (paralysis) and a left
upper and low extremity intention tremor. A diagnosis of Benedikt’s syndrome would
be consistent with these symptoms.
6. I. Bending the stereocilia of the vestibular sensory hair cells towards the kinocilium
will lead to an inhibition of glutamate release.
II. The medial vestibulospinal tracts carry axons that innervate the neck muscles that
help control head position.
7. I. Cold water in the left ear will induce a right beating nystagmus.
II. High frequency sounds are translated into electrical impulses in the area of the
basilar membrane that is narrow and stiff.
8. I. The scala vestibuli contains perilymph, which has an unusually high concentration
of potassium.
II. The nucleus of the inferior colliculus sends axons to both ipsi and contralateral
medial geniculate nuclei.
9. I. When you look into a patient’s retina to find the optic disk, you will need to
look towards the nasal side.
II. Horizontal neurons of the retina use GABA as their neurotransmitter and
send axons to the multiple cones.
10. I. In the presence of light the “off-center” bipolar neurons do not stimulate
retinal ganglion cells.
II. The right lingual gyrus receives visual information from the left inferior visual field.
11. I. The ventral lateral nucleus of the thalamus is anterior to the ventral posterior
nucleus.
II. The medial lemniscus which conveys fine touch carries axons that will synapse
in the ventral posterior nucleus of the thalamus.
12. I. The substantia nigra sends axons to the ventral anterior nucleus of the thalamus.
II. The thalamic fasiculus carries axons from the substantia nigra and red nucleus
but not from the globus pallidus.
13. I. The premotor cortex sends projections to both the caudate and putamen nuclei.
II. The anterior thalamic nucleus has major afferent tracts to both the cingulate gyrus
and frontal cortex.
14. I. The central tegmental tract carries axons from the reticular formation to the
centromedian nucleus of the thalamus.
II. The lateral posterior nucleus of the thalamus sends axons to the parietal and temporal
lobes of the cortex.
15. I. The pulvinar nucleus of the thalamus is involved in language and speech.
II. The medial geniculate body projects to Brodmann’s area’s 41 and 42.
16. I. The reticular nucleus of the thalamus sends axons to both the cerebral cortex and to
other nuclei of the thalamus.
II. The head of the caudate is medial to the anterior limb of the internal capsule.
17. I. The splenium is found in the anterior portion of the corpus callosum.
II. The mass intermedia is a non-neuronal structure that spans the fourth ventricle and
connects the right and left dorsal thalami.
18. I. The pineal gland is considered part of the epithalamus.
II. The septum pellucidum forms the medial wall of the third ventricle.
19. I. The stria medullaris connect the septal area with the amygdala.
II. If the pineal gland does not produce melatonin puberty will be delayed.
20. I. The supraoptic nucleus of the hypothalamus sends axons to the adenohypophysis.
II. The ventromedial nucleus is considered the “feeding center” of the hypothalamus.
21. I. The posterior hypothalamic area is part of the sympathetic nervous system.
II. The median eminence of the hypothalamus is very involved with control of sexual behavior
and maternal instinct.
22. I. The suprachiasmatic nucleus of the hypothalamus receives axons from the retina.
II. The paraventricular nucleus of the hypothalamus synthesizes oxytocin.
23. I. The posterior choroidal artery branches from the middle cerebral artery.
II. The anterior choroidal artery branches from the internal carotid artery.
24. I. The major role of posterior lobes of the cerebellum is regulation of balance and muscle tone.
II. The flocculonodular lobe of the cerebellum is considered part of the archicerebellum.
25. I. The paleocerebellum regulates muscle tone.
II. Reflex proprioception fibers go mainly to the paleocerebellum.
26. I. Neurons in the inferior olivary nucleus send axons to the contralateral cerebellum and
synapse on the granule cells.
II. Climbing fibers in the cerebellum contain axons from the spinocerebellar tracts.
27. I. The molecular layer of the cerebellum is the most superficial layer and is where the dendritic
trees of the Purkinje neurons are found.
II. All Purkinje neuron efferent projections synapse on cerebellar nuclei.
28. I. The main neurotransmitter used by the stellate neurons of the cerebellum is GABA.
II. Axons from granule neurons form the parallel fibers which synapse on the golgi neuron dendrites.
The neurotransmitter used at this synapse is glutamate.
29. I. The flocculonodular lobe sends axons to the fastigial nucleus as well as the vestibular nucleus.
II. The fastigial, interposed and dentate nuclei of the cerebellum receives afferent projections
from the olivary nucleus complex.
30. I. The main pontine nucleus/cerebellum connection is the pontine efferents to the interposed
nucleus.
II. Dysmetria is the condition of muscle flaccidity with decrease in resistance to passive
movement of the joints.
31. I. About one third of the corticospinal tracts are made of efferent fibers from Brodmann’s
areas 5 and 7.
II. Four major inputs into the cerebellum are vestibular, thalamic, olivary complex
(which includes the inferior olive) and spinocerebellar afferent fibers.
32. I. The globus pallidus sends inhibitory axons to the subthalamic nucleus. Those axons
synapse on neurons that stimulate neurons in the globus pallidus, which project to the
lateral ventral nucleus of the thalamus.
II. The substantia nigra sends both stimulatory and inhibitory projections to the putamen.
When both of these inputs are active, the result is stimulation of the inhibitory neurons
that project to the thalamus.
33. I. The genu of the internal capsule contains the corticospinal tracts.
II. Decerebrate rigidity occurs with a lesion inferior to the superior colliculus but above
the reticular formation. The result is hyperextension of all four extremities and head.
This is caused by stimulation of the inhibitory input of the reticular formation by dorsal
root ganglion.
34. I. Hippocampal efferent fibers to the frontal cortex septal area can be found in the fornix.
II. The Papez circuit involves tracts from the mammillary bodies to the anterior nucleus of
the thalamus. That nucleus projects to the cingulate gyrus, which in turn project to the
amygdala. To complete the circuit, the amygdala project back to the mammillary bodies.
35. I. The hypothalamus projects to the amygdala via the stria terminalis.
II. The habenula sends major projections to various nuclei of the cranial nerves.
36. I. The most direct way for sensory information to travel from the olfactory bulb to the
hippocampus is via the lateral olfactory stria.
II. The major commissural pathway for hippocampal fibers is the anterior commissure.
37. I. The major commissural pathway for the amygdala is the corpus callosum.
II. The septal nucleus is medial to the nucleus accumbens in the septal area of the forebrain.
38. I. The basal nucleus of Meynert is a major source of acetylcholine synapses in the cortex.
II. The ansa lenticularis carries fibers from the globus pallidus and passes inferiorly to the
subthalamic nucleus.
39. I. The globus pallidus is part of the neostriatum.
II. Athetosis (Greek for “without position”) is characterized by slow, writhing continuos
wormlike movements of the distal parts of the extremities, chiefly the fingers, which
show bizarre posturing. Often time’s patients will have a mix of chorea and athetosis
(choreoathetosis)
40. I. The supplementary motor area is found in Brodmann’s areas 5 and 7.
II. A lesion in the premoter cortex could lead to apraxia.
41. I. Diadochokinesis is the inability to do rapidly alternating movement such as supination/pronation
of the hand.
II. One of the major efferent pathways from the fastigial nucleus goes to the red nucleus.
42. I. Betz cells, which are large pyramidal cells are typically found in layer 6 of the neocortex.
II. The internal pyramidal layer of the neocortex gives rise to the cortical spinal tracts.
43. I. Cells of Martinotti, which are inhibitory, can be found in all 6 cortical layers.
II. The internal pyramidal layer is part of the infragranular layer of the neocortex.
44. I. The horizontal cells, which use GABA as their neurotransmitter, are mostly found in the
molecular layer of the neocortex.
II. Pulvinar projections to the cortex are an example of nonspecific afferent projections.
45. I. The typical person uses only between 25 – 50% of their brain.
II. One typically looses about 50% of their neurons during normal aging process.
46. I. Area 1 of the precentral gyrus receives general tactile sensation information.
II. Broca’s area is found in Brodmann’s areas 45 and 46.
47. I. Wernicke’s aphasia means that the patient has difficulty comprehending language in
either written or spoken form.
II. The uncinate fasciculus connects Broca’s area with Wernicke’s area.
48. I. Destruction of the angular gyrus may lead to alexia.
II. Prosody is the inability to manifest rhythm and feeling into speech.
49. I. The right brain in most left handed people contains the primary language center.
II. Brodmann’s areas 9, 10, 11 and 12 are found in the frontal lobe.
50. I. Kanji, the ideogram part of Japanese, can be comprehended even following destruction
of the angular gyrus.
II. Stimulation of Brodmann’s area 17 leads to the patients “seeing” objects, indicating
that this cortical region may play a role in visual memory.
Case Study
A 60-year-old dock worker was brought to the emergency room unconscious after he had
collapsed while loading a truck. After regaining consciousness, an examination was performed
with the following result:
1. paralysis of right upper and lower extremities
2. hypertonicity in upper and lower extremities
3. increased deep tendon reflexes on the right side
4. dysarthria
5. deviation of the tongue to the left when protruded
6. loss of conscious proprioception, pressure and fine touch on the right side of the body
What is your preliminary diagnosis?
Key:
| 1 C | 26 D |
| 2 A | 27 A |
| 3 B | 28 B |
| 4 C | 29 C |
| 5 C | 30 D |
| 6 B | 31 A |
| 7 C | 32 A |
| 8 D | 33 D |
| 9 C | 34 A |
| 10 A | 35 C |
| 11 C | 36 D |
| 12 A | 37 B |
| 13 A | 38 C |
| 14 C | 39 B |
| 15 C | 40 B |
| 16 C | 41 D |
| 17 D | 42 B |
| 18 A | 43 B |
| 19 D | 44 C |
| 20 D | 45 D |
| 21 A | 46 D |
| 22 B | 47 A |
| 23 B | 48 A |
| 24 B | 49 B |
| 25 C | 50 A |
Case Study:
There is a likely stroke involving the left side midmedulla causing damage to the left
pyramid (corticospinal fibers), left medial lemniscus and hypoglossal nerve.