est Bank - Neuroanatomy through Clinical Cases 3rd
Edition by Blumenfeld |All Chapters (1-19) |2025 | A+
1. A patient presents with acute-onset left-sided hemiparesis and left-sided neglect. MRI shows a
right middle cerebral artery (MCA) territory infarct. Which of the following additional deficits is
most likely to be present?
A. Left homonymous hemianopia
B. Right homonymous hemianopia
C. Left-sided apraxia
D. Right-sided hyperreflexia
Answer: A
Rationale: The right MCA supplies the optic radiation, causing left homonymous hemianopia. Left
neglect is typical of right parietal lesions. Right-sided deficits would be contralateral to the lesion.
2. Which of the following best describes the difference between the direct and indirect pathways of
the basal ganglia?
A. The direct pathway facilitates movement via disinhibition of the thalamus; the indirect pathway inhibits
movement via increased inhibition of the thalamus.
B. The direct pathway inhibits movement via the substantia nigra pars compacta; the indirect pathway facilitates
movement via the subthalamic nucleus.
C. Both pathways converge on the internal globus pallidus to regulate cortical activity.
D. The direct pathway uses GABA as its primary neurotransmitter; the indirect pathway uses glutamate
exclusively.
Answer: A
Rationale: The direct pathway (cortex !’ striatum !’ GPi/SNr !’ thalamus) disinhibits thalamus to facilitate
movement. The indirect pathway (cortex -> striatum -> GPe -> STN -> GPi/SNr) increases inhibition of
thalamus, suppressing movement. Option B is reversed; C is partially true but not the best description;
D is incorrect because both use GABA and glutamate at different synapses.
3. A patient with a lesion in the left lateral medulla presents with hoarseness, dysphagia, and loss of
pain and temperature sensation on the right side of the body and left side of the face. Which artery
is most likely occluded?
A. Posterior inferior cerebellar artery (PICA)
B. Anterior inferior cerebellar artery (AICA)
C. Superior cerebellar artery (SCA)
D. Vertebral artery
Answer: A
Rationale: Lateral medullary syndrome (Wallenberg) is typically due to PICA occlusion. It affects the
spinothalamic tract (contralateral body pain/temp loss), spinal trigeminal nucleus (ipsilateral face
pain/temp loss), and nucleus ambiguus (hoarseness, dysphagia). AICA affects lateral pons; SCA affects
Page 1
,cerebellar; vertebral can cause lateral medullary but PICA is classic.
4. Which of the following correctly pairs a cranial nerve with its primary function and the location
of its nucleus?
A. CN III - eye adduction - oculomotor nucleus in midbrain
B. CN VI - lateral gaze - abducens nucleus in pons
C. CN IV - downward gaze - trochlear nucleus in pons
D. CN XII - tongue protrusion - hypoglossal nucleus in medulla
Answer: B
Rationale: CN VI (abducens) innervates lateral rectus for abduction, nucleus in pons. CN III adducts eye,
but nucleus is in midbrain (correct). CN IV (trochlear) nucleus is in midbrain, not pons. CN XII nucleus
is in medulla, correct function but B is the only fully correct pair.
5. A patient with a lesion in the left optic tract would most likely exhibit which visual field defect?
A. Left homonymous hemianopia
B. Right homonymous hemianopia
C. Bitemporal hemianopia
D. Left homonymous quadrantanopia
Answer: B
Rationale: The left optic tract carries information from the right visual field (temporal retina of left eye
and nasal retina of right eye). A lesion causes contralateral homonymous hemianopia, i.e., right
homonymous hemianopia. Bitemporal hemianopia is from chiasm; quadrantanopia from optic radiation.
6. Which of the following is a characteristic finding in a patient with a lesion of the left cerebellar
hemisphere?
A. Intention tremor on the right side
B. Ataxia of gait with wide base
C. Dysdiadochokinesia on the left side
D. Nystagmus with fast component to the left
Answer: A
Rationale: Cerebellar hemispheres control ipsilateral limb coordination. Left hemisphere lesion causes
ipsilateral (left) limb ataxia, intention tremor, dysdiadochokinesia. Option A says right side, which
would be contralateral, so incorrect. Option C says left side, which is ipsilateral and correct, but the
question asks for characteristic finding; intention tremor is classic. Option B is more typical of vermal
lesions; D is brainstem/cerebellar but not specific.
7. In the spinal cord, which of the following tracts is located in the dorsal column and carries
proprioception and vibration sense?
A. Fasciculus gracilis
B. Spinothalamic tract
C. Corticospinal tract
D. Spinocerebellar tract
Page 2
,Answer: A
Rationale: Fasciculus gracilis (medial) and cuneatus (lateral) form the dorsal columns, carrying
proprioception, vibration, and fine touch. Spinothalamic carries pain/temp; corticospinal is motor;
spinocerebellar carries proprioception to cerebellum but is not in dorsal column.
8. A patient with a lesion at the level of the foramen magnum would most likely present with which
combination of deficits?
A. Quadriparesis with preserved sensation in the face
B. Hemiparesis with ipsilateral loss of pain and temperature on the face
C. Paraplegia with sensory level at the umbilicus
D. Crossed sensory loss with ipsilateral facial numbness and contralateral body pain/temp loss
Answer: A
Rationale: Foramen magnum lesions can compress the corticospinal tracts bilaterally (quadriparesis)
and the medial lemniscus, but often spare the spinal trigeminal nucleus (face sensation preserved)
because it is higher. Option D describes lateral medullary syndrome; B is typical of brainstem lesion at
pontine level; C is spinal cord lesion at thoracic level.
9. Which of the following neurotransmitters is primarily associated with the raphe nuclei and their
projections?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
Answer: C
Rationale: Raphe nuclei are the main source of serotonin in the brain. Dopamine is from substantia
nigra/VTA; norepinephrine from locus coeruleus; acetylcholine from basal forebrain and brainstem
nuclei.
10. A patient with a lesion in the left primary motor cortex (precentral gyrus) would most likely
exhibit:
A. Contralateral hemiparesis with spasticity and hyperreflexia
B. Ipsilateral hemiparesis with flaccidity and hyporeflexia
C. Contralateral loss of proprioception and vibration
D. Ipsilateral loss of pain and temperature
Answer: A
Rationale: Primary motor cortex controls voluntary movement contralaterally. Lesion causes
contralateral hemiparesis (upper motor neuron type) with spasticity and hyperreflexia due to loss of
descending inhibition. Ipsilateral deficits are not seen. Sensory loss would involve parietal cortex.
11. A patient presents with a lesion that selectively abolishes the direct pathway of the basal
ganglia while sparing the indirect pathway. Which of the following motor symptoms would most
likely predominate?
Page 3
, A. Chorea and hemiballismus
B. Bradykinesia and rigidity
C. Athetosis and dystonia
D. Myoclonus and tremor
Answer: B
Rationale: The direct pathway facilitates movement by disinhibiting thalamocortical projections. Loss of
the direct pathway leads to decreased movement initiation, resulting in bradykinesia and rigidity.
Chorea (A) results from overactivity of the direct pathway or underactivity of the indirect pathway.
Athetosis (C) is associated with striatal lesions affecting both pathways. Myoclonus (D) is not a typical
basal ganglia sign.
12. In a patient with a right hemispheric stroke, which of the following deficits would be most
consistent with damage to the right superior longitudinal fasciculus (SLF)?
A. Transcortical sensory aphasia
B. Conduction aphasia
C. Apraxia of speech
D. Neglect of left hemispace
Answer: B
Rationale: The SLF connects Wernicke's and Broca's areas. Damage to the left SLF causes conduction
aphasia with impaired repetition and phonemic paraphasias. The right SLF is involved in prosody and
emotional aspects of language, but conduction aphasia is typically associated with left hemisphere
damage. Neglect (D) results from right parietal lesions, not specifically SLF. Apraxia of speech (C) is
from left frontal opercular lesions.
13. A patient has a lesion that destroys the entire left optic tract. Which of the following visual field
deficits would be expected?
A. Left homonymous hemianopia
B. Right homonymous hemianopia
C. Bitemporal heteronymous hemianopia
D. Left homonymous superior quadrantanopia
Answer: B
Rationale: The left optic tract carries information from the left temporal retina (right visual field) and
right nasal retina (right visual field). A complete left optic tract lesion produces a right homonymous
hemianopia. Option A would result from a right optic tract lesion. Bitemporal hemianopia (C) is from
chiasmal lesions. Quadrantanopia (D) is from optic radiation lesions.
14. Which of the following best explains why a lesion in the ventrolateral nucleus of the thalamus
can cause tremor that is present at rest but diminishes with voluntary movement?
A. Loss of inhibitory input from the cerebellum to the thalamus
B. Disruption of the cerebello-thalamo-cortical pathway affecting the rubral circuit
C. Damage to the thalamic reticular nucleus causing disinhibition of the motor cortex
D. Interruption of the pallidothalamic tract leading to increased thalamocortical drive
Page 4
Edition by Blumenfeld |All Chapters (1-19) |2025 | A+
1. A patient presents with acute-onset left-sided hemiparesis and left-sided neglect. MRI shows a
right middle cerebral artery (MCA) territory infarct. Which of the following additional deficits is
most likely to be present?
A. Left homonymous hemianopia
B. Right homonymous hemianopia
C. Left-sided apraxia
D. Right-sided hyperreflexia
Answer: A
Rationale: The right MCA supplies the optic radiation, causing left homonymous hemianopia. Left
neglect is typical of right parietal lesions. Right-sided deficits would be contralateral to the lesion.
2. Which of the following best describes the difference between the direct and indirect pathways of
the basal ganglia?
A. The direct pathway facilitates movement via disinhibition of the thalamus; the indirect pathway inhibits
movement via increased inhibition of the thalamus.
B. The direct pathway inhibits movement via the substantia nigra pars compacta; the indirect pathway facilitates
movement via the subthalamic nucleus.
C. Both pathways converge on the internal globus pallidus to regulate cortical activity.
D. The direct pathway uses GABA as its primary neurotransmitter; the indirect pathway uses glutamate
exclusively.
Answer: A
Rationale: The direct pathway (cortex !’ striatum !’ GPi/SNr !’ thalamus) disinhibits thalamus to facilitate
movement. The indirect pathway (cortex -> striatum -> GPe -> STN -> GPi/SNr) increases inhibition of
thalamus, suppressing movement. Option B is reversed; C is partially true but not the best description;
D is incorrect because both use GABA and glutamate at different synapses.
3. A patient with a lesion in the left lateral medulla presents with hoarseness, dysphagia, and loss of
pain and temperature sensation on the right side of the body and left side of the face. Which artery
is most likely occluded?
A. Posterior inferior cerebellar artery (PICA)
B. Anterior inferior cerebellar artery (AICA)
C. Superior cerebellar artery (SCA)
D. Vertebral artery
Answer: A
Rationale: Lateral medullary syndrome (Wallenberg) is typically due to PICA occlusion. It affects the
spinothalamic tract (contralateral body pain/temp loss), spinal trigeminal nucleus (ipsilateral face
pain/temp loss), and nucleus ambiguus (hoarseness, dysphagia). AICA affects lateral pons; SCA affects
Page 1
,cerebellar; vertebral can cause lateral medullary but PICA is classic.
4. Which of the following correctly pairs a cranial nerve with its primary function and the location
of its nucleus?
A. CN III - eye adduction - oculomotor nucleus in midbrain
B. CN VI - lateral gaze - abducens nucleus in pons
C. CN IV - downward gaze - trochlear nucleus in pons
D. CN XII - tongue protrusion - hypoglossal nucleus in medulla
Answer: B
Rationale: CN VI (abducens) innervates lateral rectus for abduction, nucleus in pons. CN III adducts eye,
but nucleus is in midbrain (correct). CN IV (trochlear) nucleus is in midbrain, not pons. CN XII nucleus
is in medulla, correct function but B is the only fully correct pair.
5. A patient with a lesion in the left optic tract would most likely exhibit which visual field defect?
A. Left homonymous hemianopia
B. Right homonymous hemianopia
C. Bitemporal hemianopia
D. Left homonymous quadrantanopia
Answer: B
Rationale: The left optic tract carries information from the right visual field (temporal retina of left eye
and nasal retina of right eye). A lesion causes contralateral homonymous hemianopia, i.e., right
homonymous hemianopia. Bitemporal hemianopia is from chiasm; quadrantanopia from optic radiation.
6. Which of the following is a characteristic finding in a patient with a lesion of the left cerebellar
hemisphere?
A. Intention tremor on the right side
B. Ataxia of gait with wide base
C. Dysdiadochokinesia on the left side
D. Nystagmus with fast component to the left
Answer: A
Rationale: Cerebellar hemispheres control ipsilateral limb coordination. Left hemisphere lesion causes
ipsilateral (left) limb ataxia, intention tremor, dysdiadochokinesia. Option A says right side, which
would be contralateral, so incorrect. Option C says left side, which is ipsilateral and correct, but the
question asks for characteristic finding; intention tremor is classic. Option B is more typical of vermal
lesions; D is brainstem/cerebellar but not specific.
7. In the spinal cord, which of the following tracts is located in the dorsal column and carries
proprioception and vibration sense?
A. Fasciculus gracilis
B. Spinothalamic tract
C. Corticospinal tract
D. Spinocerebellar tract
Page 2
,Answer: A
Rationale: Fasciculus gracilis (medial) and cuneatus (lateral) form the dorsal columns, carrying
proprioception, vibration, and fine touch. Spinothalamic carries pain/temp; corticospinal is motor;
spinocerebellar carries proprioception to cerebellum but is not in dorsal column.
8. A patient with a lesion at the level of the foramen magnum would most likely present with which
combination of deficits?
A. Quadriparesis with preserved sensation in the face
B. Hemiparesis with ipsilateral loss of pain and temperature on the face
C. Paraplegia with sensory level at the umbilicus
D. Crossed sensory loss with ipsilateral facial numbness and contralateral body pain/temp loss
Answer: A
Rationale: Foramen magnum lesions can compress the corticospinal tracts bilaterally (quadriparesis)
and the medial lemniscus, but often spare the spinal trigeminal nucleus (face sensation preserved)
because it is higher. Option D describes lateral medullary syndrome; B is typical of brainstem lesion at
pontine level; C is spinal cord lesion at thoracic level.
9. Which of the following neurotransmitters is primarily associated with the raphe nuclei and their
projections?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
Answer: C
Rationale: Raphe nuclei are the main source of serotonin in the brain. Dopamine is from substantia
nigra/VTA; norepinephrine from locus coeruleus; acetylcholine from basal forebrain and brainstem
nuclei.
10. A patient with a lesion in the left primary motor cortex (precentral gyrus) would most likely
exhibit:
A. Contralateral hemiparesis with spasticity and hyperreflexia
B. Ipsilateral hemiparesis with flaccidity and hyporeflexia
C. Contralateral loss of proprioception and vibration
D. Ipsilateral loss of pain and temperature
Answer: A
Rationale: Primary motor cortex controls voluntary movement contralaterally. Lesion causes
contralateral hemiparesis (upper motor neuron type) with spasticity and hyperreflexia due to loss of
descending inhibition. Ipsilateral deficits are not seen. Sensory loss would involve parietal cortex.
11. A patient presents with a lesion that selectively abolishes the direct pathway of the basal
ganglia while sparing the indirect pathway. Which of the following motor symptoms would most
likely predominate?
Page 3
, A. Chorea and hemiballismus
B. Bradykinesia and rigidity
C. Athetosis and dystonia
D. Myoclonus and tremor
Answer: B
Rationale: The direct pathway facilitates movement by disinhibiting thalamocortical projections. Loss of
the direct pathway leads to decreased movement initiation, resulting in bradykinesia and rigidity.
Chorea (A) results from overactivity of the direct pathway or underactivity of the indirect pathway.
Athetosis (C) is associated with striatal lesions affecting both pathways. Myoclonus (D) is not a typical
basal ganglia sign.
12. In a patient with a right hemispheric stroke, which of the following deficits would be most
consistent with damage to the right superior longitudinal fasciculus (SLF)?
A. Transcortical sensory aphasia
B. Conduction aphasia
C. Apraxia of speech
D. Neglect of left hemispace
Answer: B
Rationale: The SLF connects Wernicke's and Broca's areas. Damage to the left SLF causes conduction
aphasia with impaired repetition and phonemic paraphasias. The right SLF is involved in prosody and
emotional aspects of language, but conduction aphasia is typically associated with left hemisphere
damage. Neglect (D) results from right parietal lesions, not specifically SLF. Apraxia of speech (C) is
from left frontal opercular lesions.
13. A patient has a lesion that destroys the entire left optic tract. Which of the following visual field
deficits would be expected?
A. Left homonymous hemianopia
B. Right homonymous hemianopia
C. Bitemporal heteronymous hemianopia
D. Left homonymous superior quadrantanopia
Answer: B
Rationale: The left optic tract carries information from the left temporal retina (right visual field) and
right nasal retina (right visual field). A complete left optic tract lesion produces a right homonymous
hemianopia. Option A would result from a right optic tract lesion. Bitemporal hemianopia (C) is from
chiasmal lesions. Quadrantanopia (D) is from optic radiation lesions.
14. Which of the following best explains why a lesion in the ventrolateral nucleus of the thalamus
can cause tremor that is present at rest but diminishes with voluntary movement?
A. Loss of inhibitory input from the cerebellum to the thalamus
B. Disruption of the cerebello-thalamo-cortical pathway affecting the rubral circuit
C. Damage to the thalamic reticular nucleus causing disinhibition of the motor cortex
D. Interruption of the pallidothalamic tract leading to increased thalamocortical drive
Page 4
