1. A 22-year-old woman has noticed blurry vision
A 22-year-old woman has noticed blurry vision. On examination her pupils are equal in size. As the flashlight is shined from eye to eye, you see the pupil dilate when you shine the flashlight in the right eye. What is the most likely explanation for her blurry vision?

2. A. She has myopia and needs glasses
.B. She has a sympathetic denervation (Horner's syndrome) of her left eye.
C. She has anisocoria
D. She has a right optic nerve lesion.
E. She has compression of the right oculomotor nerve.

3. A 55-year-old diabetic male complains of double vision
A 55-year-old diabetic male complains of double vision. On examination of his extraocular movements, you notice limited adduction, elevation, and depression of his right eye. The pupils are equal and reactive. The patient most likely has a lesion of which one of the following cranial nerves?

4. A. Left 6th nerve.
B. Right 6th nerve.
C. Left 3rd nerve.
D. Right 3rd nerve.
E. Left 4th nerve.

5. A 60-year-old man has decreased sensation to pin prick over the left cheek but the forehead and jaw area are normal. This finding is most consistent with a sensory loss of which one of the following?

6. A. Left ophthalmic division of the 5th cranial nerve.
B. Left mandibular division of the 5th cranial nerve.
C. Left maxillary division of the 5th cranial nerve.
D. Left descending tract of the 5th cranial nerve.

7. A 38-year-old woman has noticed asymmetry of her smile and drooling from the left side of her mouth. On examination, she can wrinkle her forehead bilaterally. She most likely has which one of the following?

8. A. Right 5th cranial nerve palsy.
B. Left 7th cranial nerve palsy.
C. Right central 7th paresis.
D. Left central 7th paresis.
E. Right 7th cranial nerve palsy.
F. Left 5th cranial nerve palsy

9. When the patient sticks out her tongue, it deviates to the right
When the patient sticks out her tongue, it deviates to the right. This finding is most likely secondary to which one of the following?

10. A. Left 12th cranial nerve palsy.
B. Right 12th cranial nerve palsy.
C. Bilateral 12th cranial nerve palsies.
D. Right 10th cranial nerve palsy.
E. Left 10th cranial nerve palsy

11. A lesion of the right medial longitudinal fasciculus (MLF) would cause which one of the following?

12. A. Incomplete abduction of the left eye.
B. Incomplete adduction of the right eye.
C. Incomplete adduction of the left eye.
D. Incomplete abduction of the right eye.
E. Incomplete adduction of both eyes

13. Which of the following answers best describes the level of crossing of the axons from the second order neurons for the spinothalamic tracts and the dorsal column – medial lemniscus system?

14. A. Level of crossing is immediate for both systems.
B. Both cross at the level of the medulla.
C. Spinothalamic crosses at the level of medulla and the DC-ML cross almost immediately.
D. DC-ML cross at the level of the medulla while the spinothalamic crosses almost immediately.
E. There is continuous crossing as both tracts ascend to the thalamus.

15. A patient has loss of pain and temperature sensation below the level of the umbilicus on the right side. Vibratory and position sense are normal on the right and left sides. Which one of the answers best describes where the lesion is?

16. A. The right half of the thoracic spinal cord.
B. The anterior quadrant of the left side of the thoracic spinal cord.
C. The left half of the thoracic spinal cord.
D. The anterior quadrant of the right side of the thoracic spinal cord

17. An 80-year-old patient has loss of pain and temperature on the right side of her face and the left side of her body. Vibratory and position sense are normal. Which answer best describes the location of her lesion?

18. A. Right lateral medulla.
B. Left lateral medulla
.C. Right medial medulla.
D. Left medial medulla.
E. Left upper pons

19. A patient has loss of pain and temperature sensation on the right side of his body up to the level of the nipple. There is also loss of tactile direction and position sense in the left lower extremity but not the left upper extremity. Which of the following answers best describes the location of his lesion?

20. A. The right half of the thoracic spinal cord.
B. The left half of the thoracic spinal cord.
C. The right half of the lumbar spinal cord.
D. The left half of the lumbar spinal cord.
E. The right half of the cervical spinal cord.
F. The left half of the cervical spinal cord

21. A 42-year-old man complains of burning sensation of both lower legs and both hands. The best explanation for his complaint is which one of the following?

22. A. He has a disease affecting axons of his peripheral nerves.
B. He has a spinal cord lesion at the cervical level.
C. He has a disease affecting the thalamus bilaterally.
D. He has a disease affecting the somatosensory cortex of both parietal lobes.

23. The patient has difficulty identifying numbers written on the palm of his left hand. Which one of the following answers best explains this finding?

24. A. A lesion of the left spinothalamic tract.
B. A lesion of the right parietal lobe.
C. A lesion of the right dorsal column.
D. A lesion of the left medial pons.

25. A 12-year-old boy complains of side by side or horizontal double vision when looking to the left. When he looks to the left and the left eye is covered, the most peripheral image disappears. The cause of his diplopia is paralysis of which one of the following cranial nerves?

26. A. Right 6th nerve.
B. Left 6th nerve.
C. Right 3rd nerve.
D. Left 3rd nerve.
E. Right 4th nerve

27. A 55-year-old patient can stand with his eyes open but becomes unsteady with his eyes closed. Which one of the following answers is the best explanation for this finding?

28. A. A lesion of the dorsal columns.
B. A lesion of the spinothalamic tracts.
C. A lesion of the midline of the cerebellum.
D. A lesion of the vestibular system.

29. A patient with Wernicke's aphasia would have which one of the following findings on examination?

30. A. Slow, nonfluent speech
B. Can understand a sentence but cannot repeat it.
C. Has telegraphic speech.
D. Cannot follow a command

31. An example of apraxia would be which one of the following?

32. A. Patient cannot name colors.
B. Patient has difficulty saying words.
C. Patient has inability to show he can cut with imaginary scissors.
D. Patient has difficulty with understanding the emotional and affective component of what is said to them.

33. A 71-year-old man has a six month history of being apathetic, unmotivated with poor judgment and inappropriate social behavior. These symptoms suggest dysfunction of what part of the brain?

34. A. Parietal lobes.
B. Frontal lobes.
C. Limbic system.
D. Amygdala and its connections.
E. Occipital parietal association cortex

35. A. Parietal lobes.
B. Frontal lobes.
C. Limbic system.
D. Amygdala and its connections.
E. Occipital parietal association cortex

36. A patient cannot recognize familiar objects placed in her right hand when her eyes are closed but she has no trouble with her left hand. This is called _______ which is from a lesion in the _______ of the brain.

37. A. Prosopagnosia; inferior temporal cortex.
B. Agraphesthesia; somatosensory cortex.
C. Astereognosia; parietal cortex.
D. Visual agnosia; occipital parietal cortex.
E. Sensory neglect; frontal cortex

38. A 55-year-old man has weakness of the right lower extremity with spasticity and hyperreflexia and a Babinski sign. There is also decreased pain sensation in the left lower extremity. Which of the following answers would best describe where this man's lesion is?

39. A. Parasagittal area of the left precentral gyrus.
B. The right side of the thoracic spinal cord.
C. The left internal capsule.
D. The right side of the cervical spinal cord.
E. The right side of the medulla.
    

40. A patient is noticed to have pronation and downward drift of the right upper extremity when the arm is held out in front of her with the palm up and eyes closed. What other findings would you expect to see in this patient?

41. A. Absent position sense in the right upper extremity.
B. Absent pain and temperature on the left side of the body.
C. Right-sided ataxia.
D. Right upper extremity fasciculations.
E. Right Babinski sign.

42. When you are examining a patient, you find several beats of ankle clonus. Given this finding, you are likely to also find which one of the following?

43. A. Hyperreflexia.
B. Plantar reflex.
C. Rigidity.
D. Muscle atrophy

44. The vestibulocerebellar system consists of connections between the vestibular system and which one of the following?

45. A. Vermis and paravermis of the cerebellum
B. Cerebellar hemispheres
C. Flocculonodular lobe of the cerebellum
D. Pontine nuclei

46. The left cerebellar hemisphere receives input from the ________ cerebral hemisphere and clinical findings of disease in this cerebellar hemisphere would cause symptoms on the _______ side of the body.

47. A. right; right
B. right; left
C. left; left
D. left; right