Which part of the central nervous system is chiefly evaluated by the coordination and gait portions of the neurological exam?
Cerebellum
✓
Cerebrum
Spinal cord
Hypothalamus
Correct Answer
Cerebellum
The cerebellum coordinates complex movements, balance and posture, so the coordination and gait exams test it. The cerebrum is assessed by the mental status exam. The spinal cord is assessed by the sensory and motor exams. The hypothalamus regulates autonomic and endocrine functions and is not the focus of these exams.
Category: Exam Overview
Question 2
The mental status exam is designed mainly to assess the function of which brain region?
Cerebellum
Cerebrum
✓
Medulla oblongata
Thalamus
Correct Answer
Cerebrum
The mental status exam tests higher cognitive functions such as orientation, memory, language and judgment, which depend on the cerebrum. The cerebellum is evaluated by the coordination and gait exams. The medulla oblongata is assessed mostly through the cranial nerve exam. The thalamus relays sensory information but is not the main target of mental status testing.
Category: Exam Overview
Question 3
Neurological deficits caused by reduced blood flow to the brain that resolve completely within 24 hours are classified as which event?
Hemorrhagic stroke
Ischemic stroke
Transient ischemic attack
✓
Cerebral concussion
Correct Answer
Transient ischemic attack
A transient ischemic attack produces stroke-like deficits that clear within 24 hours once blood flow returns. A hemorrhagic stroke is caused by bleeding from a damaged vessel. An ischemic stroke involves blocked flow with effects lasting at least 24 hours. A cerebral concussion results from head trauma rather than reduced blood flow.
Category: Stroke and TIA
Question 4
A patient speaks fluently but cannot understand spoken words. Damage to which brain region is most likely?
Broca's area
Primary motor cortex
Occipital lobe
Wernicke's area
✓
Correct Answer
Wernicke's area
Wernicke's area, near the auditory association cortex in the temporal lobe, is needed for language comprehension, and damage causes receptive aphasia with fluent but poorly understood speech. Broca's area damage causes halting, non-fluent speech. The primary motor cortex controls voluntary movement, not comprehension. The occipital lobe processes vision.
Category: Language and Speech
Question 5
Halting, non-fluent speech with relatively preserved comprehension is called what?
Expressive aphasia
✓
Receptive aphasia
Conduction aphasia
Global aphasia
Correct Answer
Expressive aphasia
Expressive aphasia results from damage to Broca's area in the frontal lobe and makes speech slow and effortful while understanding stays largely intact. Receptive aphasia impairs comprehension while speech remains fluent. Conduction aphasia mainly impairs repetition. Global aphasia affects both comprehension and production.
Category: Language and Speech
Question 6
Which cortical region is responsible for judgment, abstract reasoning and working memory?
Occipital cortex
Prefrontal cortex
✓
Primary somatosensory cortex
Auditory cortex
Correct Answer
Prefrontal cortex
The prefrontal cortex in the anterior frontal lobe supports judgment, abstract reasoning and working memory, which is why proverb and problem-solving questions test it. The occipital cortex processes vision. The primary somatosensory cortex receives touch and body sensation. The auditory cortex processes sound.
Category: Judgment and Reasoning
Question 7
After both of his medial temporal lobes were removed, patient HM could no longer form new episodic memories. What is this deficit called?
Retrograde amnesia
Prosopagnosia
Anterograde amnesia
✓
Apraxia
Correct Answer
Anterograde amnesia
Anterograde amnesia is the inability to form new long-term memories after an injury, and HM's medial temporal lobe removal produced it. Retrograde amnesia is loss of memories formed before the injury. Prosopagnosia is an inability to recognize faces. Apraxia is an inability to carry out learned movements on command.
Category: Memory
Question 8
Identifying a coin by touch alone with the eyes closed tests which ability?
Graphesthesia
Proprioception
Praxis
Stereognosis
✓
Correct Answer
Stereognosis
Stereognosis is the ability to recognize an object by its shape and texture through touch, a function of the parietal cortex. Graphesthesia is recognizing symbols traced on the skin. Proprioception is the sense of body position. Praxis is performing movements on verbal command.
Category: Sensorium
Question 9
Which cranial nerve is tested by having the patient identify coffee or mint while smelling with one nostril at a time?
Olfactory nerve
✓
Trigeminal nerve
Facial nerve
Glossopharyngeal nerve
Correct Answer
Olfactory nerve
The olfactory nerve, cranial nerve I, carries the sense of smell, so each nostril is tested separately with familiar odors. The trigeminal nerve carries general sensation from the face. The facial nerve controls facial expression and carries taste from the anterior tongue. The glossopharyngeal nerve carries taste and sensation from the posterior tongue and pharynx.
Category: Cranial Nerve Exam
Question 10
A Snellen chart is used to assess which function?
Visual fields
Visual acuity
✓
Pupillary response
Eye movement
Correct Answer
Visual acuity
A Snellen chart measures visual acuity, the sharpness of vision, expressed as a ratio such as 20/60. Visual fields are tested by asking when the examiner's fingers disappear from peripheral view. Pupillary response is tested with a light. Eye movement is tested by having the patient follow a moving target.
Category: Vision Testing
Question 11
Which extraocular muscle is controlled by the abducens nerve?
Medial rectus
Superior oblique
Lateral rectus
✓
Inferior rectus
Correct Answer
Lateral rectus
The abducens nerve, cranial nerve VI, innervates the lateral rectus, which abducts the eye. The medial rectus is supplied by the oculomotor nerve and adducts the eye. The superior oblique is supplied by the trochlear nerve. The inferior rectus is supplied by the oculomotor nerve and depresses the eye.
Category: Eye Movements
Question 12
Which cranial nerve innervates the superior oblique muscle of the eye?
Oculomotor nerve
Abducens nerve
Optic nerve
Trochlear nerve
✓
Correct Answer
Trochlear nerve
The trochlear nerve, cranial nerve IV, controls only the superior oblique muscle. The oculomotor nerve controls most of the other extraocular muscles and the upper eyelid. The abducens nerve controls the lateral rectus. The optic nerve is purely sensory and carries vision.
Category: Eye Movements
Question 13
When a light is shined into one eye, the pupil of the opposite eye also constricts. What is this response called?
Consensual reflex
✓
Direct reflex
Corneal reflex
Accommodation reflex
Correct Answer
Consensual reflex
The consensual reflex is constriction of the pupil in the eye that was not illuminated, which happens because the light signal reaches the oculomotor pathways on both sides. The direct reflex is constriction of the illuminated eye. The corneal reflex is blinking when the cornea is touched. The accommodation reflex adjusts the lens and pupil for near vision.
Category: Pupillary Reflex
Question 14
In the Rinne test, where is the base of the vibrating tuning fork placed first?
On the top of the skull
On the mastoid process
✓
On the cheekbone
On the chin
Correct Answer
On the mastoid process
The Rinne test starts with the tuning fork on the mastoid process to test bone conduction, then moves it beside the ear canal to test air conduction. The top of the skull is where the fork is placed for the Weber test. The cheekbone and the chin are not the standard starting points for the Rinne test.
Category: Hearing Tests
Question 15
If one hypoglossal nerve is damaged, which way does the tongue deviate when the patient sticks it out?
Toward the healthy side
Upward toward the palate
Toward the damaged side
✓
Back toward the pharynx
Correct Answer
Toward the damaged side
The genioglossus on the healthy side still pushes the tongue forward while the weakened side does not, so the tongue points toward the damaged side. Toward the healthy side is the opposite of what happens. Upward toward the palate and back toward the pharynx are not typical findings of hypoglossal damage.
Category: Cranial Nerve Exam
Question 16
Shrugging the shoulders against resistance tests which cranial nerve?
Vagus nerve
Hypoglossal nerve
Facial nerve
Accessory nerve
✓
Correct Answer
Accessory nerve
The accessory nerve, cranial nerve XI, controls the trapezius, which elevates the shoulders, and the sternocleidomastoid. The vagus nerve controls the pharynx and larynx. The hypoglossal nerve controls the tongue. The facial nerve controls the muscles of facial expression.
Category: Cranial Nerve Exam
Question 17
Pain and temperature sensations are carried to the brain by which ascending pathway?
Spinothalamic tract
✓
Dorsal column pathway
Corticospinal tract
Spinocerebellar tract
Correct Answer
Spinothalamic tract
The spinothalamic tract carries pain and temperature, crossing to the opposite side at its level of entry into the spinal cord. The dorsal column pathway carries fine touch, vibration and proprioception. The corticospinal tract is a descending motor pathway. The spinocerebellar tract carries proprioceptive input to the cerebellum.
Category: Sensory Exam
Question 18
Which finding points to a lower motor neuron lesion?
Spasticity
Fasciculations
✓
Positive Babinski sign
Clasp-knife response
Correct Answer
Fasciculations
Fasciculations, visible twitches of denervated muscle, are a sign of lower motor neuron damage along with flaccid weakness and reduced reflexes. Spasticity is an upper motor neuron sign. A positive Babinski sign in an adult indicates upper motor neuron damage. A clasp-knife response is also an upper motor neuron sign.
Category: Motor Exam
Question 19
Which cerebellar peduncle carries the main cerebellar output to the red nucleus and thalamus?
Middle cerebellar peduncle
Inferior cerebellar peduncle
Superior cerebellar peduncle
✓
Cerebral peduncle
Correct Answer
Superior cerebellar peduncle
The superior cerebellar peduncle connects the cerebellum to the midbrain and carries its major output to the red nucleus and thalamus. The middle cerebellar peduncle brings input from the pons. The inferior cerebellar peduncle brings input from the medulla, including the inferior olive. The cerebral peduncle is part of the midbrain carrying descending cortical fibers, not a cerebellar connection.
Category: Cerebellum
Question 20
Walking in a straight line while placing the heel of one foot against the toes of the other is called what?
Station
Romberg test
Heel-to-shin test
Tandem gait
✓
Correct Answer
Tandem gait
Tandem gait narrows the base of support and exposes balance problems from cerebellar dysfunction. Station is standing with the feet in a normal position and the eyes open. The Romberg test is standing still with the eyes closed. The heel-to-shin test slides one heel down the opposite shin.
Category: Gait Exam