COMSAE PHASE 1 NEUROANATOMY
PRACTICE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
Question 1
A 67-year-old man suddenly develops weakness of the right face, arm,
and leg. He also has difficulty producing speech, but his comprehension
is relatively preserved. MRI demonstrates an infarct involving the
posterior portion of the left frontal lobe. Which cortical region is most
directly affected?
A. Primary auditory cortex
B. Broca area
C. Wernicke area
D. Primary visual cortex
E. Somatosensory association cortex
Answer: B. Broca area
Rationale: Broca area, located in the dominant inferior frontal gyrus
(Brodmann areas 44 and 45), is responsible for motor planning and
production of language. Injury causes expressive/nonfluent aphasia,
in which the patient has difficulty generating fluent speech despite
relatively preserved comprehension. The dominant hemisphere is
usually the left hemisphere. The nearby primary motor cortex can also
be involved in a middle cerebral artery infarction, producing
contralateral face and upper-extremity weakness.
1
,Question 2
A patient sustains a penetrating injury to the spinal cord at the T10 level.
Examination demonstrates ipsilateral loss of vibration, proprioception,
and discriminative touch below the lesion, along with contralateral loss
of pain and temperature beginning several segments below the injury.
Which syndrome best explains these findings?
A. Anterior cord syndrome
B. Central cord syndrome
C. Brown-Séquard syndrome
D. Conus medullaris syndrome
E. Cauda equina syndrome
Answer: C. Brown-Séquard syndrome
Rationale: Brown-Séquard syndrome results from hemisection of the
spinal cord. The dorsal columns ascend ipsilaterally and therefore
produce ipsilateral loss of vibration, proprioception, and fine touch
below the lesion. Spinothalamic fibers cross within the spinal cord
through the anterior white commissure, typically producing
contralateral pain and temperature loss beginning approximately 1–2
spinal levels below the lesion. Ipsilateral corticospinal tract damage
causes upper motor neuron weakness below the lesion.
Question 3
A 72-year-old woman develops sudden contralateral hemiparesis
involving the face, arm, and leg. There is no aphasia, visual field deficit,
or cortical sensory loss. MRI reveals a small infarct in the posterior limb
of the internal capsule. Which structure is most directly affected?
A. Corticospinal fibers
B. Medial lemniscus
C. Spinothalamic tract
2
,D. Optic radiation
E. Medial longitudinal fasciculus
Answer: A. Corticospinal fibers
Rationale: The posterior limb of the internal capsule contains densely
packed corticospinal and corticobulbar fibers. A small lacunar
infarction here can produce profound contralateral pure motor
hemiparesis because a large number of descending motor fibers are
concentrated within a very small area. This is a classic example of a
lesion producing major neurological deficits without prominent
cortical signs.
Question 4
A 58-year-old patient has difficulty coordinating voluntary movements
of the right upper extremity. Examination demonstrates intention tremor,
dysmetria, and dysdiadochokinesia on the right. Which cerebellar region
is most likely involved?
A. Left cerebellar hemisphere
B. Right cerebellar hemisphere
C. Left flocculonodular lobe
D. Right vestibular nuclei
E. Vermis exclusively
Answer: B. Right cerebellar hemisphere
Rationale: Cerebellar hemisphere lesions typically produce ipsilateral
limb coordination deficits. The right cerebellar hemisphere
coordinates movements of the right side of the body through cerebellar
connections that ultimately influence ipsilateral motor control.
Dysmetria, intention tremor, and dysdiadochokinesia are classic
manifestations of cerebellar dysfunction.
3
, Question 5
A patient develops ptosis, a dilated pupil, and an eye positioned "down
and out." Which cranial nerve is most likely damaged?
A. CN II
B. CN III
C. CN IV
D. CN VI
E. CN VII
Answer: B. CN III
Rationale: The oculomotor nerve innervates the medial, superior, and
inferior recti; inferior oblique; levator palpebrae superioris; and
carries parasympathetic fibers to the pupil. A complete CN III lesion
causes ptosis, a dilated pupil due to loss of parasympathetic
constriction, and a "down and out" eye due to unopposed lateral
rectus and superior oblique activity.
Question 6
A patient has a lesion affecting the left optic tract. Which visual deficit
is most likely?
A. Left monocular blindness
B. Right monocular blindness
C. Left homonymous hemianopia
D. Right homonymous hemianopia
E. Bitemporal hemianopia
Answer: D. Right homonymous hemianopia
Rationale: The left optic tract contains fibers originating from the left
temporal retina and right nasal retina, both of which carry
information from the right visual field. Therefore, a lesion of the left
4
PRACTICE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
Question 1
A 67-year-old man suddenly develops weakness of the right face, arm,
and leg. He also has difficulty producing speech, but his comprehension
is relatively preserved. MRI demonstrates an infarct involving the
posterior portion of the left frontal lobe. Which cortical region is most
directly affected?
A. Primary auditory cortex
B. Broca area
C. Wernicke area
D. Primary visual cortex
E. Somatosensory association cortex
Answer: B. Broca area
Rationale: Broca area, located in the dominant inferior frontal gyrus
(Brodmann areas 44 and 45), is responsible for motor planning and
production of language. Injury causes expressive/nonfluent aphasia,
in which the patient has difficulty generating fluent speech despite
relatively preserved comprehension. The dominant hemisphere is
usually the left hemisphere. The nearby primary motor cortex can also
be involved in a middle cerebral artery infarction, producing
contralateral face and upper-extremity weakness.
1
,Question 2
A patient sustains a penetrating injury to the spinal cord at the T10 level.
Examination demonstrates ipsilateral loss of vibration, proprioception,
and discriminative touch below the lesion, along with contralateral loss
of pain and temperature beginning several segments below the injury.
Which syndrome best explains these findings?
A. Anterior cord syndrome
B. Central cord syndrome
C. Brown-Séquard syndrome
D. Conus medullaris syndrome
E. Cauda equina syndrome
Answer: C. Brown-Séquard syndrome
Rationale: Brown-Séquard syndrome results from hemisection of the
spinal cord. The dorsal columns ascend ipsilaterally and therefore
produce ipsilateral loss of vibration, proprioception, and fine touch
below the lesion. Spinothalamic fibers cross within the spinal cord
through the anterior white commissure, typically producing
contralateral pain and temperature loss beginning approximately 1–2
spinal levels below the lesion. Ipsilateral corticospinal tract damage
causes upper motor neuron weakness below the lesion.
Question 3
A 72-year-old woman develops sudden contralateral hemiparesis
involving the face, arm, and leg. There is no aphasia, visual field deficit,
or cortical sensory loss. MRI reveals a small infarct in the posterior limb
of the internal capsule. Which structure is most directly affected?
A. Corticospinal fibers
B. Medial lemniscus
C. Spinothalamic tract
2
,D. Optic radiation
E. Medial longitudinal fasciculus
Answer: A. Corticospinal fibers
Rationale: The posterior limb of the internal capsule contains densely
packed corticospinal and corticobulbar fibers. A small lacunar
infarction here can produce profound contralateral pure motor
hemiparesis because a large number of descending motor fibers are
concentrated within a very small area. This is a classic example of a
lesion producing major neurological deficits without prominent
cortical signs.
Question 4
A 58-year-old patient has difficulty coordinating voluntary movements
of the right upper extremity. Examination demonstrates intention tremor,
dysmetria, and dysdiadochokinesia on the right. Which cerebellar region
is most likely involved?
A. Left cerebellar hemisphere
B. Right cerebellar hemisphere
C. Left flocculonodular lobe
D. Right vestibular nuclei
E. Vermis exclusively
Answer: B. Right cerebellar hemisphere
Rationale: Cerebellar hemisphere lesions typically produce ipsilateral
limb coordination deficits. The right cerebellar hemisphere
coordinates movements of the right side of the body through cerebellar
connections that ultimately influence ipsilateral motor control.
Dysmetria, intention tremor, and dysdiadochokinesia are classic
manifestations of cerebellar dysfunction.
3
, Question 5
A patient develops ptosis, a dilated pupil, and an eye positioned "down
and out." Which cranial nerve is most likely damaged?
A. CN II
B. CN III
C. CN IV
D. CN VI
E. CN VII
Answer: B. CN III
Rationale: The oculomotor nerve innervates the medial, superior, and
inferior recti; inferior oblique; levator palpebrae superioris; and
carries parasympathetic fibers to the pupil. A complete CN III lesion
causes ptosis, a dilated pupil due to loss of parasympathetic
constriction, and a "down and out" eye due to unopposed lateral
rectus and superior oblique activity.
Question 6
A patient has a lesion affecting the left optic tract. Which visual deficit
is most likely?
A. Left monocular blindness
B. Right monocular blindness
C. Left homonymous hemianopia
D. Right homonymous hemianopia
E. Bitemporal hemianopia
Answer: D. Right homonymous hemianopia
Rationale: The left optic tract contains fibers originating from the left
temporal retina and right nasal retina, both of which carry
information from the right visual field. Therefore, a lesion of the left
4
