Stimulation of periaqueductal gyrus causes

a.   Increase in glutamate release

b.   Increase in Substance P release

c.   Decrease in Endorphin release

d.   Increase in Enkephalin release

e.   Decrease in serotonin release

2. Anterior spinal artery occlusion results in which of the following deficits?

a.   loss of vibration and position sensation below the lesion

b.   areflexia at the level of the lesion

c.   bilateral loss of pain and temperature sensation below the lesion

d.   bilateral spastic paralysis below the lesion

e.   All of the above

f.   A, B, and C

g.   B, C, and D

3. On examining a 66-yr-old male patient, the physician notes that the patient was suffering from bilateral loss of pain and temperature; bilateral loss of crude touch and pressure; bilateral paralysis of muscles; and no loss of vibration, fine touch, and proprioception. He also notes that the muscles supplied by the involved spinal segment are flaccid and those below it are rigid. The possible lesion in this patient is

a.   Complete transection of cord

b.   Anterior cord syndrome

c.   Brown-Sequard syndrome

d.   Posterior compression of cord

e.   Central compression of cord

4. Reflex movement of our bodies with a moving object is mediated by

a.   Superior colliculus

b.   VPL of Thalamus

c.   Lateral vestibular nucleus

d.   Red nucleus

e.   Inferior colliculus

f.   Medial vestibular nucleus

5. A patient suffering from poliomyelitis has which of the following findings

a.   Spastic paralysis of the affected region

b.   Loss of pain and temperature of the affected region

c.   Loss of vibration of the affected region

d.   Decreased muscular tone of the affected region

e.   Increased reflexes on the affected side

6. Use the picture given to answer the question. Which letter represents the tract whose injury causes loss of ipsilateral vibration sense in legs?

a.   A

b.   B

c.   C

d.   D

e.   E

f.   F

7. Use the picture given above to answer the question. Which letter represents the tract whose Injury will result in absence of abdominal muscle contraction on rubbing the skin with a wisp of cotton?

a.   A

b.   B

c.   C

d.   D

e.   E

f.   F

8. Use the picture given above to answer the question. Absence of pin-prick sensation in a patient should make us suspect a problem in which of the tracts shown in the picture (select the corresponding letter)?

a.   A

b.   B

c.   C

d.   D

e.   E

f.   F

9. While examining a patient a physician noted that there is a significant lack of coordination of movements especially of lower limbs. The patient also exhibits high stepping gait. Further investigation revealed that there is a problem in the posterior spinocerebellar tract. All of the following statements concerning the dorsal spinocerebellar tract are FALSE EXCEPT

a.   It is a crossed tract

b.   It enters the cerebellum via the superior

cerebellar peduncle

c.   It mediates conscious proprioception

d.   It shares its 2nd order relay center with anterior spinocerebellar tract

e.   It terminates in cerebellum

10. A 55-year-old known hypertensive male suffers a stroke while trying to replace a flat tire on the road. He had not been taking his hypertensive medications regularly. He is also a heavy smoker, and drinks a six-pack of beer every weekend. On examination, he is conscious and coherent with normal light and corneal reflexes. Cranial nerves appeared normal. He has a dense hemiplegia (-Plegia = paralysis) on the right side, with equal paralysis of the arm and leg. His lesion most likely involves the

a.   C1-C3

b.   C4-C7

c.   T1-T6

d.   T6-T12

e.   L1-L5

f.   S1-S5

11. In the above patient, which of the following symptoms can be expected to be seen?

a.   Paralysis in flexion

b.   Paralysis in extension

c.   Flaccid paralysis of all involved muscles

d.   Spastic paralysis of all involved muscles

e.   Increased reflexes in all muscles

f.   Decreased reflexes in all

muscles

12. Examining a patient with Amyotrophic lateral sclerosis will reveal which of the following clinical features?

a.   UMN paralysis features only

b.   LMN and UMN paralysis features

c.   LMN paralysis features only

d.   Loss of vibration sense in legs

e.   Astereognosis

13. On examining a patient, the physician notes that the patient is suffering bilateral muscle weakness in all extremities, which is more pronounced in the upper limbs compared to lower ones. There is also loss of pain and temperature in both extremities, more pronounced in upper limbs. The possible spinal cord lesion in this patient is

a.   Posterior cord syndrome

b.   Anterior cord syndrome

c.   Syringomyelia

d.   Lateral cord lesion

e.   Tabes dorsalis

f.   Poliomyelitis

g.   Amyotrophic lateral sclerosis

14. A 52-yr-old male patient is brought to the hospital with complaints of inability to move both legs. Examination of lower limbs revealed right-sided paralysis, left-sided loss of pain and temperature, and right-sided loss of vibratory sensations. His muscles were flaccid in some areas and rigid in other areas. What is the most likely diagnosis?

a.   Anterior cord syndrome

b.   Central cord syndrome

c.   Posterior cord syndrome

d.   Syringomyelia

e.   Brown-Sequard syndrome

f.   Poliomyelitis

15. A patient visits a doctor complaining of unilateral deafness in left ear. Basing on this complaint alone the pathology cannot be present in?

a.   Left Ear

b.   Left Cochlear nerve

c.   Left anterior and posterior Cochlear nucleus

d.   Left Trapezoid body

e.   A, B, C

f.   All the above

16. A patient visited the hospital complaining of weakness in upper and lower limbs along with pins and needle sensation in them. Examination revealed that there is spastic paralysis in both right upper and lower limbs and also altered pain and temperature sensation in left upper and lower limbs. Investigations revealed a prolapsed intervertebral disc with the contents entering the vertebral canal compressing the cord laterally from outside to inside. From the data provided, which of the following statements regarding the evolution of symptoms is TRUE?

a.   Weakness in muscles first appear in legs and then hands

b.   Loss of pain sensation first appear in hands and then legs

c.   Loss of temperature sensation first appear in hands and then legs

d.   Increased reflexes appear first in hands and then legs

e.   Inability to write appears before Babinski sign

17. Which of the following conditions best explain the above symptoms?

a.   Complete transection of cord

b.   Hemitransection of cord

c.   Lateral compression of cord

d.   Posterior cord syndrome

e.   Anterior cord syndrome

18. A patient suffered ischemic stroke to a part of the spinal cord, which resulted in destruction of the ventral horn. If the physician does a thorough neurological examination at the level of the lesion, then he will find all the following things except

a.   Loss of deep tendon reflexes (MSRs)

b.   Loss of muscle bulk

c.   Loss of cremasteric reflex

d.   Twitching of muscles on hitting them

e.   Flaccid paralysis

19. On examination of a patient who visited his office with complaints of slurred speech and difficulty swallowing, a physician noted that the patient is having loss of pain and temperature sensation on left side of the body and right side of the face; intention tremors and co-ordination problems; left-sided hemiplegia with increased muscle tone and reflexes; loss of vibration sense, fine touch, & 2-point discrimination on left; problems in taste; alterations in heart rate and blood pressure; and balance problems. From this data we can infer that the patient is having a problem in

a.   Right side of medulla oblongata at pyramidal decussation

b.   Left side of medulla oblongata at pyramidal decussation

c.   Right side of medulla

oblongata at lemniscal decussation

d.   Left side of medulla oblongata at lemniscal decussation

e.   Right side of medulla oblongata at olives

f.   Left side of medulla oblongata at olives

20. What additional clinical feature can be expected in the above patient?

a.   loss of light reflex when light is focused on right eye

b.   loss of light reflex when light is focused on left eye

c.   loss of corneal reflex on touching right cornea

d.   loss of corneal reflex on touching left cornea

e.   loss of accommodation reflex

f.   Hearing loss on left

g.   Hoarseness

21. While performing a detailed neurological examination in a patient, the physician noted that the patient is not able to identify 2 distinct points of tactile stimulus on the left hand. Which of the following pathways is affected?

a.   Right Spinothalamic tract

b.   Left Medial Leminiscus

c.   Left Spinothalamic

tract

d.   Right Medial Leminiscus

e.   Right fasciculus cuneatus

f.   Left fasciculus gracilis

g.   Right fasciculus gracilis

22. The motor nucleus of cranial nerves 9, 10, & 11 is

a.   Nucleus tractus solitarius

b.   Nucleus ambiguus

c.   Dorsal nucleus

d.   Superior salivatory nucleus

e.   Inferior salivatory nucleus

23. Use the picture given above to answer the question. This tract carries proprioception fibers to ipsilateral cerebellum and has its second-order neurons in thoracic nucleus (Select the letter corresponding to the tract)

a.   A

b.   B

c.   C

d.   D

e.   E

f.   F

24. Use the picture given above to answer the question. Injury of this tract causes inability of patient to identify the object placed in their hands.

a.   A

b.   B

c.   C

d.   D

e.   E

f.   F

25. While examining a female patient, a physician noted that the patient has intact bilateral pain and thermal sensations but has bilateral spastic paralysis of muscles along with Babinski sign. She also has problems stating the position of a limb with eyes closed and also has problems with vibratory sense. Which of the following pathologies can cause this?

a.   Tertiary infection of syphilis

b.   Retrograde spread of Polio virus

c.   Retrograde axonal spread of rabies virus

d.   Pernicious anemia

e.   Expansion of central canal

26. In the above patient, what is the possible cause for the mentioned symptoms?

a.   Demyelination of posterior column and Corticospinal tracts

b.   Compression of entire anterior white column

c.   Demyelination of both spinothalamic tracts

d.   Compression of entire lateral white column

e.   Demyelination of only posterior column tracts

27. While examining the tongue, the physician noted that the tongue deviates to the right on protrusion. This indicates involvement of which of the following nerves?

a.   Right hypoglossal

b.   Left hypoglossal

c.   Right vagus

d.   Left vagus

e.   Left glossopharyngeal

28. While doing a post-mortem analysis on a recently deceased patient who suffered from chronic pain syndrome, the pathologist noted that there is an ischemic lesion involving the peripheral integrating center for pain in the spinal cord. The center the pathologist is referring to is controlling which of the following areas in spinal cord?

a.   Lamina I

b.   Clark�s nucleus

c.   Thoracic nucleus

d.   Nucleus gracilis

e.   Nucleus cuneatus

f.   Lamina V

29. In the above patient, which of the following neurotransmitters is most probably responsible for the patient’s chronic pain?

a.   Acetylcholine

b.   Dopamine

c.   Norepinephrine

d.   Substance P

e.   GABA

30. In the above patient, which one of the following statements regarding the center is FALSE?

a.   Axons arising in this lamina does not form the spinothalamic tract

b.   Neurons in this lamina do not mediate sharp

pain

c.   Neurons in this lamina play a major role in perception of dull pain

d.   This lamina acts as the peripheral integrating center for sharp pain

e.   Axons arising in this lamina does not form spinotectal tract

31. Paralysis of sternocleidomastoid and trapezius indicates a problem in

a.   Nuclues ambiguus

b.   Nucleus gracilis

c.   Upper Cervical spinal segments

d.   Nucleus tractus solitarius

e.   Hypoglossal nucleus

32. A man has metastatic carcinoma and enlarged deep cervical lymph nodes. One of his symptoms is a hoarse voice, barely heard above a whisper and difficulty swallowing & breathing. Endoscopy revealed presence of a mass in piriform fossa. Subsequently he succumbs to the disease and at autopsy it is found that the mass is putting a pressure on a nerve. Presumably this was the reason for the hoarse voice. The involved nerve arises from

a.   Nucleus tractus solitarius

b.   Dorsal nucleus of vagus

c.   Cochlear nuclei

d.   Hypoglossal nucleus

e.   Nucleus ambiguus

33. Loss of all taste sensations in a patient makes one suspect

a.   Nuclues

ambiguus

b.   Nucleus gracilis

c.   Nucleus tractus solitarius

d.   Cervical spinal segments

e.   Hypoglossal nucleus

34. On touching the right side of the posterior part of the tongue, the patient gagged. On touching the left side of the posterior part of the tongue, there was no gag reflex. This could be because of the involvement of which of the following nerves?

a.   Left vagus

b.   Left Glossopharyngeal

c.   Right Glossopharyngeal

d.   Right vagus and right Glossopharyngeal

e.   Left vagus and left glossopharyngeal

35. While studying the nerve supply of tongue, a researcher noted that the taste sensations from a small area in posterior one-third of the tongue are carried by vagus nerve. The first order neurons for taste from this area are present in

a.   Dorsal root ganglion

b.   Inferior vagal ganglion

c.   Nucleus tractus solitaries � Lower part

d.   Nucleus tractus solitarius � Upper part

e.   Spinal nucleus

f.   Superior vagal ganglion

36. A physician notes that in a patient there is impaired vibration and position sense, astereognosis, and ataxia. The physician noted loss of all sensations in some areas of the patient along with diminished reflexes in those same areas. When the patient was asked to stand with legs close together and hands outstretched, the patient was able to do so easily with eyes open but with eyes closed, he started swaying. The strength in the muscles is normal. The patient also has high-stepping gait. The

pathology is in

a.   Ventral column and dorsal root of spinal nerve

b.   Dorsal column and ventral root of spinal nerve

c.   Lateral column and dorsal root of spinal nerve

d.   Lateral column and ventral root of spinal nerve

e.   Dorsal column and dorsal root of spinal nerve

f.   Ventral column and ventral root of spinal nerve

g.   Anterior gray matter only

37. The condition in the above patient is

a.   Amyotrophic lateral sclerosis

b.   Poliomyelitis

c.   Tabes dorsalis

d.   Syringomyelia

e.   None of the above

38. On examining a 66-yr-old male patient, the physician notes that the patient was suffering from bilateral loss of pain and temperature; bilateral loss of crude touch and pressure; bilateral paralysis of muscles; and bilateral loss of vibration, fine touch, and proprioception. The possible lesion in this patient is

a.   Complete transection of cord

b.   Anterior cord syndrome

c.   Brown-Sequard

syndrome

d.   Posterior compression of cord

e.   Central compression of cord

39. A 67-yr-old patient was brought to the hospital with hemiplegia. Examination revealed the involvement of corticospinal tract at medulla oblongata. Which of the following features will be seen in this patient?

a.   Flaccid paralysis on the same side as the lesion

b.   Flaccid paralysis on the opposite side as the lesion

c.   Paralysis with rigidity on the opposite side as the lesion

d.   Paralysis with rigidity on the same side as the lesion

e.   Flaccid paralysis on the both sides of the body

f.   Paralysis with rigidity on the both sides of the body

40. On performing a CT scan in the above patient, an anomaly will be noted in which of the following areas?

a.   Olives

b.   Pyramid

c.   Gracile tubercle

d.   Cuneate tubercle

e.   Inferior cerebellar peduncle

41. Inability to identify a known object placed in the right hand indicates a problem in

a.   Right fasciculus gracilis

b.   Left fasciculus gracilis

c.   Left Gracili tubercle

d.   Left Cuneate tubercle

e.   Right VPL of Thalamus

f.   Left VPL of thalamus

42. A patient presents to the hospital with complaints of tingling, numbness, and needle-prick sensations. X-ray revealed a prolapsed intervertebral disc with lateral compression of cervical spinal cord. The pain and temperature loss in this patient will appear in which of the following orders?

a.   Arms --> trunk --> legs

b.   Trunk --> legs --> arms

c.   Legs --> arms --> trunk

d.   Legs --> trunk --> arms

e.   Arms --> legs --> trunk

43. On examining a patient, the physician noted that the patient had diminished muscle strength in lower extremities along with diminished tone and reflexes. He also exhibited saddle anesthesia and diminished sensations in the areas supplied by lower lumbar and entire sacral nerves. There is also loss of bulbocavernous reflexes. Anal and vesicular sphincters are patulous (relaxed). MRI revealed a prolapsed disc in the region of L4-L5 vertebrae. The condition is most likely

a.   Conus medullaris syndrome

b.   Cauda equine syndrome

c.   Syringomyelia

d.   Tabes Dorsalis

e.   Amyotrophic lateral sclerosis

44. Medial medullary syndrome doesn't involve which of the following structures?

a.   Hypoglossal nuclei

b.   MLF system

c.   Nucleus ambiguus

d.   Medial leminiscus

e.   Tectospinal tracts

45. The CT scan of a patient revealed that the structure present immediately posterolateral to the left pyramid is injured. Which of the following clinical features will be seen in this patient?

a.   Contralateral Intention tremors

b.   Ipsilateral clasp-knife rigidity

c.   Contralateral clasp-knife rigidity

d.   Ipsilateral co-ordination problems

e.   Contralateral Astereognosis

f.   Ipsilateral Astereognosis

46. Use the picture given to answer the question. Identify the tract with one-third of the fibers arising from Pre-central gyrus (Select the letter corresponding to the tract)

a.   A

b.   B

c.   C

d.   D

e.   E

f.   F

47. Use the picture given above to answer the question. Fibers arise from lamina 7 of

spinal cord

a.   A

b.   B

c.   C

d.   D

e.   E

f.   F

48. Use the picture given above to answer the question. Fibers arise from first order sensory neurons

a.   A

b.   B

c.   C

d.   D

e.   E

49. Deviation of tongue to the right on protrusion of the tongue can be due to lesion to

a.   Right vagal nerve

b.   Right chorda-tympani nerve

c.   Right hypoglossal nerve

d.   Left vagal nerve

e.   Left hypoglossal nerve

f.   Left chorda-tympani nerve

50. Inferior colliculus forms the relay center for which of the following structures?

a.   Visuo-spinal reflex pathway

b.   Medial vestibular nucleus

c.   Superior vestibular nucleus

d.   Inferior vestibular nucleus

e.   Lateral vestibular nucleus

f.   Dorsal cochlear nucleus

g.   Light reflex pathway

51. A neurologist evaluates a 54-year-old man with a gait disorder. When the physician passively moves the patient's right thumb upward or downward, the patient cannot accurately report the direction of motion or the position of the toe. His perception of light touch and painful stimuli is unimpaired. A lesion of which of the following structures can best explain this finding?

a.   Right fasciculus cuneatus

b.   Right fasciculus gracilis

c.   Left fasciculus gracilis

d.   Left fasciculus cuneatus

e.   Right Lateral leminiscus

f.   Right medial lemniscus

g.   Right ventroposterolateral nucleus of the thalamus

52. A 52-yr-old male patient came to a neurologist complaining of problems in both lower limbs. Detailed neurological examination of the lower limbs revealed loss of all sensations at the level of the lesion and inability to the object touching but still able to tell which area of the body is touched. Patient also had problems with vibration, sterognosis and 2-point discrimination. Strength of all the leg muscles appeared normal. No problems with pain and temperature. Neurological examination of rest of the body appeared normal. Examination of remaining systems revealed no significant anomalies. Which of the following conditions can explain all the above symptoms?

a.   Anterior cord syndrome

b.   Posterior cord syndrome

c.   Central cord syndrome

d.   Complete

transection of spinal cord

e.   Hemitransection of spinal cord

53. In the above patient, which of the following arteries is involved?

a.   Vertebral artery

b.   Anterior spinal artery

c.   Posterior spinal artery

d.   Radicular artery

e.   Thoracic aorta

54. In the above patient, the second order neurons for the affected tract/tracts are present in

a.   Lamina 2 of spinal cord

b.   Lamina 5 of spinal cord

c.   Lamina 9 of spinal cord

d.   Medulla oblongata

e.   Lamina 8 of spinal cord

55. A 35-yr-old man sustains a knife wound to the neck that completely destroyed the left C6 dorsal root ganglion. Two months later, the axons, dendrites, and nerve cell bodies of this damaged structure have completely degenerated. Which of the following centers ARE NOT directly affected due to the above-mentioned damage & injury?

a.   Nucleus gracilis & cuneatus

b.   Lamina I of spinal cord

c.   Thoracic nucleus

d.   Lamina 5 of spinal cord

e.   alpha motor neurons of agonist muscles

f.   alpha motor neurons of antagonist muscles

g.   Interneurons of spinal cord

56. Loss of all bilateral ascending tracts and variable portion of bilateral corticospinal tracts in a spinal cord should make one suspect a problem in

a.   Posterior spinal arteries

b.   Vertebral arteries

c.   Internal carotid arteries

d.   Anterior spinal arteries

e.   Radicular arteries

57. On examining the CT scan of a patient who recently suffered from a stroke, the neurologist noted that there is an ischemic lesion affecting one-half of medulla. He further noted that the posture of the patient is paralysis in extension. Which of the following tract/tracts could have been injured?

a.   Reticulospinal tract and rubrospinal tract

b.   Corticospinal tract

c.   Vestibulospinal tract & tectospinal tract

d.   Tectospinal tract

e.   Rubrospinal tract and vestibulospinal tract

f.   Corticospinal tract & Tectospinal tract

g.   Corticospinal tract & rubrospinal tract

58. In the above patient, lesion of the tract responsible for the abnormal posture caused

a.   Increased

activity of flexors on the same side of lesion

b.   Increased activity of extensors on the same side of lesion

c.   Decreased activity of flexors on the opposite side of lesion

d.   Decreased activity of extensors on the opposite side of the lesion

e.   Has no effect on flexors or extensors on either side

59. On examination of a patient who visited his office with complaints of slurred speech, a physician noted that the patient is having loss of pain and temperature sensation on right side of the body; right-sided hemiplegia (arms & leg) with increased muscle tone and reflexes; no loss of taste or salivation; normal eye functions; lack of hoarseness; no nausea, vomiting, or hearing loss. From this data we can infer that the patient is having a problem in

a.   Right side of medulla oblongata at pyramidal decussation

b.   Left side of medulla oblongata at pyramidal decussation

c.   Left side of caudal pons

d.   Left side of medulla oblongata at olives

e.   Right side of medulla oblongata at olives

f.   Left side of medulla oblongata at

lemniscal (sensory) decussation

g.   Right side of medulla oblongata at lemniscal (sensory) decussation

60. The neurons of the nucleus in thalamus in which the spinothalamic tract synapses will be

a.   First-order neurons

b.   Second-order neurons

c.   Third-order neurons

d.   Fourth-order neurons

e.   Fifth-order neurons