Neuroanatomy can be tough.  But with time, and effort, it is a very logical and rewarding system that can make you seem like a pro. “Where’s the lesion?” isn’t the only thing you’ll be tested on in this series however.  Best of luck! 

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Clinical Neuroanatomy: Part One

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Question 1
A patient with degloving down to (but not including) the subcutaneous hypodermis, of glabrous skin, will retain which of the following regional afferent modalities?
Select all that apply ...
A
Vibrational sense
B
Discriminative touch
C
Shear stress
D
Light touch
E
Deep pressure
Question 1 Explanation: 
With loss of Ruffini endings, Merkel complexes and Meissner's corpuscles, the only remaining integument afferent receptor of note above is the Pacinian corpuscle within the subcutaneous hypodermis. Its function is the sensation of deep pressure acutely.
Question 2
Which of the following utilise rapid conductivity to alert the central nervous system of sudden modality change to the integumentary system?
Select all that apply ... 
A
Free nerve endings with C-fibres
B
Meissner's corpuscles
C
Merkel's discs
D
Ruffini endings
E
Pacinian corpuscles
Question 2 Explanation: 
Meissner and Pacinian are the fastest conduction available above. They convey discriminative epicritic touch, vibration for the former, and deep pressure for the latter.
Question 3
The anterolateral spinothalamic tract and dorsal column medial lemniscus system converge distally at which common structure?
A
V1
B
M1
C
S1
D
A1
E
FEF
Question 3 Explanation: 
V = visual cortex ; M = motor cortex ; S = sensory cortex ; A = auditory cortex ; FEF = frontal eye field (Brodmann area 8 of the frontal lobe) ;
Question 4
The sensory homunculus is mapped to the primary somatosensory cortex dorsal to which sulcus?
A
Lateral
B
Common
C
Parietooccipital
D
Sensory
E
Central
Question 4 Explanation: 
Central is also classically termed Rolanderic with the lateral also termed Sylvian.
Question 5

Stem 1 of 4

A patient presents with altered level of consciousness and further neurological signs. There is acute-onset paralysis/paraesthesia of the genitals and distal lower limb bilaterally.
Given the presentation, which of the following signs is most likely to be present?
A
Areflexia
B
Diminution of the L2, 3 deep tendon reflex
C
Localised lower limb flaccidity
D
Fibrillation of the soleus muscle bilaterally
E
Spastic catch
Question 5 Explanation: 
The bilateral, acute nature would most likely indicate a cerebrovascular incident in the cranium. This is highly suggestive of an upper motor neuron lesion, of which the only classical sign above is the spastic.
Question 6

Stem 2 of 4

CT-angiography of the head demonstrates an aneurysm. Which structure is most likely enlarged?
A
Optic chasim
B
Ophthalmic artery
C
Arachnoid granulations
D
Pericallosal artery
E
M3 superior arcade
Question 7

Stem 3 of 4

Given the probable site of lesion, which portion of the internal capsule does its upper motor neuron fibres descend through?
A
Anterior limb
B
Genu
C
Posterior limb
D
Retrolentiform complex
E
All of the above
Question 8

Stem 4 of 4

The patient states a decreased sensation in the S1 dermatome. As the afferent limb ascends from this location, which thalamic nuclei forms the third-order neuronal cell soma location?
A
Anterior thalamic nuclei
B
Dorsomedial thalamic nuceli
C
Ventroposterior lateral
D
Ventroposterior medial
E
Posterior
Question 8 Explanation: 
The VPL is the site of the dorsal column-medial lemnscus system third order neuron cell bodies, forming a thalamocortical tract complex.
Question 9
Which of the following Rexed lamina contain a cell soma that project axons to the femoral nerve?
A
Marginal zone
B
Substantia gelatinosa
C
Tract of Lissauer
D
IX
E
II
Question 9 Explanation: 
VIII and IX traditionally are found to have the soma of lower motor neurons. There is, naturally, interpersonal variety.
Question 10
Free nerve endings of the dermis are involved in the bulk of receptive input in which of the below tracts?
A
Conveyor of epicritic touch
B
Conveyor of fine vibrational sensation
C
Conveyor of conscious proprioception
D
Protopathic (crude) touch
E
Conveyor of unconscious proprioception
Question 10 Explanation: 
We are describing the spinothalamic (anterior) system that conveys the protopathic crude touch sensory modality.
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