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Neuroscience Fundamentals Rehabilitation 4th Edition By Lundy Ekman – Test Bank 
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Lundy-Ekman: Neuroscience: Fundamentals for Rehabilitation, 4th Edition

 

Chapter 1: Introduction to Neuroscience

 

Test Bank

 

 

  1. Which one of the following studies is an example of systems level neuroscience?
  2. A study investigating the action of the neurotransmitter dopamine in the temporal lobes of rodents
  3. A study investigating the effect of impaired memory on walking performance
  4. A study investigating how autonomic nerves influences baroreceptors in the vasculature
  5. A study investigating the differential effects of vestibular and proprioceptive impairments on balance in those who have had a stroke

 

ANS: C

Rationale: Systems level neuroscience is concerned with groups of cells in the nervous system that perform a common function and how these cells interact with other body systems. Other levels of neuroscience include the molecular level, which investigates the chemistry and physics involved in neural function; the cellular level, which examines the distinctions among different types of cells in the nervous system and how they function and communicate among themselves and among non-neural cells; the behavioral level, which examines the interactions among systems that influence behavior; and the cognitive level, which explores complex neurologic functions such as thinking, language, and memory.

 

  1. Which of the following three systems extend into all regions of the nervous system?
  2. Somatic motor, autonomic, and basal ganglia
  3. Autonomic, somatosensory, and cognitive
  4. Limbic, autonomic, and somatosensory
  5. Somatic, somatosensory, and autonomic

 

ANS: D

Rationale: The three systems extend throughout the entire nervous system. are the somatosensory system, conveying information from the skin and musculoskeletal system to the brain; the autonomic system, providing communication between the brain and smooth muscles, cardiac muscle, and glands; and the somatic motor system, transmitting information from the brain to the skeletal muscles. The basal ganglia, cognitive, and limbic systems are located entirely within the brain, and thus do not extend into the spinal and peripheral regions.

 

  1. The peripheral nervous system includes which of the following?
  2. Brainstem and spinal nerves
  3. Nerves, sensory receptors, and autonomic ganglia
  4. Groups of myelinated axons called capsules or tracts
  5. Only afferent neurons that convey information to the central nervous system

 

ANS: B

Rationale: The peripheral nervous system consists of all nervous system structures outside of the skull and spinal column. Myelinated axons, the white matter of the peripheral nervous system, are grouped together in nerves. Peripheral nerves convey both afferent and efferent information to and from the central nervous system. Collections of autonomic cell bodies, or gray matter, located in the periphery are termed ganglia.

 

  1. The brainstem and cerebellum receive most of their blood supply from which of the following arterial branches?
  2. Internal carotid and posterior cerebral
  3. Vertebral and middle cerebral
  4. Vertebral and basilar
  5. Internal carotid and basilar

 

ANS: C

Rationale: Branches of the vertebral and basilar arteries provide blood supply to the brainstem and cerebellum. These branches include the anterior and posterior spinal arteries (medulla), posterior cerebral arteries (midbrain), posterior inferior cerebellar arteries (medulla and cerebellum), and anterior inferior and superior cerebellar arteries (pons and cerebellum).

 

  1. The purpose of a neurologic evaluation is to:
  2. Establish a definitive diagnosis.
  3. Determine an appropriate plan of care.
  4. Determine the probable cause of the problem.
  5. Determine the probable cause of the problem and the appropriate plan of care.

 

ANS: D

Rationale: The purpose of a neurologic evaluation is to determine the likely cause of the problem and the appropriate course of action so that treatment can be provided. In many instances the evaluation will reveal a definitive diagnosis; however, this is not always the case.

 

  1. A patient reports that she has recently had pain and a loss of coordination in her left leg. These symptoms initially began 5 days earlier, gradually worsened for 3 days, but then did not worsen or improve since that time. The speed of onset and nature of these complaints is most likely which one of the following?
  2. Acute vascular problem
  3. Subacute degenerative disorder
  4. Chronic inflammatory process
  5. Subacute inflammatory process

 

ANS: D

Rationale: The speed of onset of a neurologic complaint can be classified as acute, subacute, or chronic. Acute problems achieve maximal signs and symptoms in minutes to hours and often indicate a vascular problem, whereas subacute problems arise over several days and may indicate an inflammatory process. Chronic problems gradually worsen over a period weeks, months, or years and may suggest either a tumor or degenerative disorder.

 

  1. An individual is admitted to the hospital to investigate a recently discovered abdominal mass. To determine the metabolic rate of the mass, an imaging study is ordered, during which a radioisotope is injected into the patient’s bloodstream. This study is an example of which one of the following?
  2. Computed tomographic (CT) scan
  3. Functional magnetic resonance image (fMRI)
  4. Diffusion tensor image (DTI)
  5. PET scan

 

ANS: D

Rationale: A PET scan is a nuclear imaging study in which emissions from a radioactive compound are examined to assess blood flow, oxygenation, glucose metabolism, and/or receptor location. Techniques such as CT, DTI, and fMRI rely on the use of x-ray images, radio waves, or magnetic fields.

 

  1. An individual suffers a cerebrovascular accident (CVA) or stroke, which disrupts the blood supply to the medial area of the frontal lobe. This disruption is most likely due to blockage of which one of the following?
  2. Anterior communicating artery
  3. Anterior cerebral artery
  4. Middle cerebral artery
  5. Posterior cerebral artery

 

ANS: B

Rationale: The anterior cerebral arteries provide blood flow to the medial aspects of the frontal and parietal lobes. The anterior communicating artery joins these arteries. In addition, the middle cerebral artery supplies much of the lateral hemispheres, and the posterior cerebral artery supplies the occipital lobe and medial and inferior temporal lobe.

 

  1. A patient visits the emergency department after a motor vehicle accident. He has suffered multiple blunt force head traumas. This patient’s injury would be described as:
  2. Focal.
  3. Multifocal.
  4. Diffuse.
  5. Both B and C

 

ANS: B

Rationale: Damage or injuries to the central nervous system are categorized as being focal, multifocal, or diffuse lesions. Focal lesions are limited to a single location, multifocal lesions are limited to several nonsymmetric locations, and diffuse lesions affect bilateral structures symmetrically but do not cross the midline as a single lesion.

 

  1. The incidence of a disease is:
  2. The proportion of the population that develops a new case of the disorder in a defined period.
  3. The current proportion of the population with the condition.
  4. The cumulative sum of past years’ prevalence rates.
  5. Typically reported as being per 1000 people.

 

ANS: A

Rationale: The incidence of a disease refers to the proportion of the population that develops a new case of the disorder in a defined period. The prevalence of a disease is the current proportion of the population with the condition, including both old and new cases. Thus the prevalence of a disease is the cumulative sum of past years’ incidence rates. Disease incidence is typically reported as per 100,000 people, whereas prevalence is typically reported per 1000 people.

 

  1. Blood supply to the deep structures of the brain is provided by which of the following?
  2. Deep branches of the posterior cerebral arteries
  3. Anterior choroidal arteries
  4. Posterior choroidal arteries
  5. Both B and C
  6. A, B, and C

 

ANS: E

Rationale: The deep branches of each of the major cerebral arteries (e.g., anterior, middle, posterior) provide the blood supply to the deep structures of the brain. The anterior and posterior choroidal arteries provide additional blood flow to the deep structures of the brain.

 

  1. The middle cerebral arteries arise from the ________ and supply the _________.
  2. Basilar artery; medial surfaces of the frontal and parietal lobes
  3. Internal carotid arteries; lateral cerebral hemispheres
  4. Anterior communicating artery; lateral cerebral hemispheres
  5. Internal carotid arteries; internal capsule, putamen, and caudate nucleus
  6. Internal carotid arteries; lateral cerebral hemispheres and internal capsule, putamen, and caudate nucleus

 

ANS: E

Rationale: The middle cerebral arteries arise as branches from the internal carotid arteries and provide blood supply to a majority of the lateral cerebral hemispheres, as well as to the internal capsule, globus pallidus, putamen, and caudate nucleus.

 

  1. Which of the following arteries are part of the circle of Willis?
  2. Internal carotid and vertebral arteries
  3. Anterior and lateral cerebral arteries
  4. Anterior and posterior cerebral arteries
  5. Medial and lateral communicating arteries

 

ANS: C

Rationale: The circle of Willis is a ring of nine anastomotic arteries: the left and right anterior cerebral arteries, the left and right internal carotid arteries, the left and right posterior cerebral arteries, posterior communicating arteries (left and right), and the anterior communicating artery. The basilar artery and middle cerebral arteries are sometimes also included in the circle.

 

  1. The function of the meninges includes which one of the following?
  2. Regulation of extracellular fluid content
  3. Protection of the brain and spinal cord
  4. Circulation of cerebrospinal fluid
  5. All of the above

 

ANS: D

Rationale: The cerebrospinal fluid system consists of both the cerebrospinal fluid and the meninges. The meninges contain spaces called dural sinuses, which contribute to the return of blood and cerebrospinal fluid to the venous blood system. The meninges also provide buoyancy and protection to the brain and spinal cord, as well as regulate extracellular fluid content.

 

  1. Cerebrospinal fluid is secreted by the _______ and reabsorbed into the ________.
  2. Choroid plexus; lymphatic system
  3. Lymphatic system; choroid plexus
  4. Venous system; lymphatic system
  5. Choroid plexus; venous system

 

ANS: D

Rationale: Cerebrospinal fluid, a modified plasma filtrate, is secreted by the choroid plexus in the ventricles of the central nervous system and is reabsorbed into the venous blood system.

 

  1. Which of the following correctly pairs a cerebral structure with its function?
  2. Corpus striatum; memory formation
  3. Internal capsule; cortical and subcortical communication
  4. Amygdala; somatosensory integration and processing
  5. Epithalamus; regulation of metabolic rate

 

ANS: B

Rationale: Composed of the caudate nucleus and putamen, the corpus striatum is an important structure in the basal ganglia circuit, which is critical to the control of movement. The internal capsule consists of projections between the cerebral cortex and subcortical structures, thus facilitating communication between these areas. The amygdale, a component of the limbic system, plays an important role in emotion and some aspects of memory formation. The epithalamus consists primarily of the pineal gland and influences secretion of the endocrine glands.

 

  1. The cerebral hemispheres are:
  2. Divided by the central sulcus.
  3. Subdivided into four lobes per hemisphere.
  4. Composed primarily of gray matter, with an outer layer of white matter.
  5. Connected by the corpus callosum and anterior commissure.

 

ANS: D

Rationale: The longitudinal fissure divides the two cerebral hemispheres, and each hemisphere can be subdivided into a total of six lobes: frontal, parietal, temporal, occipital, limbic, and insular. The surface of the cerebrum is composed of gray matter, with underlying white matter deep to this. The corpus callosum connects the majority of the left and right cerebral hemispheres, with the anterior commissure connecting the left and right temporal cortices.

 

  1. Each cranial nerve:
  2. Emerges from the spinal cord.
  3. Is numbered according to its place of attachment.
  4. Innervates the head, neck, and face.
  5. Carries motor and sensory information.

 

ANS: B

Rationale: The cranial nerves are a series of 12 nerve pairs that emerge from the surface of the brain and are numbered according to their sites of attachment to the brain, from anterior to posterior. Cranial nerves I, II, and VIII carry only sensory information, whereas nerves III, IV, VI, X, and XII carry primarily motor information. The remaining cranial nerves (V, VII, IX, and XI) are mixed, carrying both motor and sensory signals. Although most cranial nerves innervate structures of the head, neck, and face, the vagus nerve (X) also innervates abdominal and thoracic structures.

 

  1. Which one of the following functions is regulated by the structures of the diencephalon?
  2. Processing of emotion and memory information
  3. Integration of information for equilibrium
  4. Coordination of movement
  5. Orientation to visual and auditory stimuli

 

ANS: A

Rationale: The diencephalon consists of the thalamus, hypothalamus, epithalamus, and subthalamus. These structures process emotion and some forms of memory. They also regulate consciousness and attention; maintain body temperature, metabolic rate, and chemical composition of the tissues; regulate eating, defensive, and reproductive behavior; and influence the secretion of endocrine glands.

 

  1. Which one of the following statements about the nervous system is incorrect?
  2. Areas of white matter of the spinal cord are divided into anterior, lateral, and dorsal areas and are called columns.
  3. The two primary functions of the spinal cord are to process information and to mediate reflex pathways.
  4. The pyramidal decussation is a prominent feature on the anterior surface of the pons.
  5. Both A and B
  6. All of the above

 

ANS: C

Rationale: A cross-section of the spinal cord reveals a centrally located area of gray matter shaped similar to the letter H. Surrounding this area of gray matter are areas of white matter, which can be divided into the anterior, lateral, and dorsal columns, or funiculi. The two primary functions of the spinal cord are to convey information between the periphery and the brain and to process information. The medulla is continuous with the spinal cord as it enters the skull. This area of the brain contains the pyramidal decussation, a prominent feature on the anterior medulla, composed of crossing axons traveling from the cerebral cortex into the spinal cord.

 

Lundy-Ekman: Neuroscience: Fundamentals for Rehabilitation, 4th Edition

 

Chapter 3: Synapses and Synaptic Transmission

 

Test Bank

 

 

  1. The second messenger in a second messenger system is a(n):
  2. G-protein
  3. α chain of the G-protein
  4. Enzyme inside the neuron that can trigger responses within the neuron
  5. Neurotransmitter
  6. Gene

 

ANS: C

Rationale: The G-protein–mediated second-messenger system involves: (1) binding of a neurotransmitter (first messenger) to a G-protein–associated membrane receptor; (2) activation of an effector enzyme (second messenger); (3) increased levels of the second messenger that elicits responses within the neuron.

 

  1. Second messengers may initiate the:
  2. Opening of membrane ion channels
  3. Activation of genes, causing increased synthesis of specific cellular products
  4. Modulation of Ca+2 levels inside the cell
  5. A, B, and C
  6. None of the above

 

ANS: D

Rationale: Second messengers activate responses inside the cell. In these cases, a single neurotransmitter might turn on a molecular pathway that ends with a change in gene expression, the opening of ion channels, and/or phosphorylation of a structural protein.

 

  1. Which one of the following can serve as the postsynaptic cell of a synapse?
  2. Smooth muscle cell in an artery
  3. Hepatocyte in the liver
  4. Neuron in the thalamus
  5. Muscle cell in the triceps
  6. All of the above

 

ANS: E

Rationale: A postsynaptic cell is any cell of an organ, gland, blood vessel, neuron, or muscle cell that synapses with a neuron.

 

  1. ACh receptor subtypes include:
  2. Adrenergic and noradrenergic
  3. Nicotinic and muscarinic
  4. Alpha and beta
  5. Alpha and gamma
  6. None of the above

 

ANS: B

Rationale: Receptors that bind ACh fall into two categories: nicotinic and muscarinic. These receptors are distinguished by their ability to bind certain drugs. Nicotine, derived from tobacco, selectively activates the nicotinic receptors. Muscarine, a poison derived from mushrooms, activates only the muscarinic receptors.

 

  1. How does onabotulinumtoxinA (BOTOX) therapeutically produce paresis in overactive muscles?
  2. Acts as an antagonist by binding to the ACh receptor on the postsynaptic membrane.
  3. Rapidly degrades ACh in the synaptic cleft.
  4. Facilitates the reuptake and sequestration of ACh into the presynaptic cell.
  5. Disrupts the protein structure of the muscle cell receptor, thus preventing ACh from binding.
  6. Inhibits the release of ACh from the presynaptic terminal at the neuromuscular junction.

 

ANS: E

Rationale: Botulinum toxin is naturally produced by a family of bacteria and, when ingested, causes widespread paralysis by inhibiting the release of ACh at the neuromuscular junction. When small doses of BOTOX are therapeutically injected directly into an overactive muscle, the inhibition of ACh release reduces or prevents contraction of the injected muscle.

 

  1. N-methyl-D-aspartate (NMDA) receptors:
  2. Are involved in long-term potentiation.
  3. Bind glutamate.
  4. Have been implicated in pathologic changes in the nervous system.
  5. A, B, and C
  6. None of the above

 

ANS: D

Rationale: The ligand-gated ion channels that bind glutamate are alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), kainate, and NMDA receptors. The NMDA receptor is unique because glutamate must be bound to the receptor and, simultaneously, the membrane must depolarize to open the ion channel. Thus the NMDA receptor is both voltage- and ligand-gated. Activation of an NMDA receptor causes the associated channel to open and close very slowly, resulting in prolonged ionic changes inside the postsynaptic neuron. This produces long-term potentiation (LTP), a prolonged increase in the size of the postsynaptic response to a given stimulus. Abnormal NMDA receptor activity has been implicated in epilepsy, chronic pain, Parkinson’s disease, stroke, and schizophrenia

 

  1. Myasthenia gravis:
  2. Is caused by the destruction of gamma-aminobutyric acid (GABA) receptors on the postsynaptic membrane of muscles.
  3. Results in the decreased release of ACh at the neuromuscular junction.
  4. Is an autoimmune disease that destroys ACh receptors on the postsynaptic membrane of muscles, thus interferes with ACh binding for repetitive muscle contractions.
  5. Is successfully treated with removal of the pituitary gland.
  6. All of the above

 

ANS: C

Rationale: Myasthenia gravis is an autoimmune disease during which antibodies attack and destroy nicotinic receptors on muscle cells. Normal amounts of ACh are released into the cleft, but few receptors are available for binding, resulting in increasing weakness with repetitive muscle contractions.

 

  1. Which of the following is a type of synaptic connection between neurons?
  2. Axosomatic
  3. Axoaxonic
  4. Axodendritic
  5. All of the above

 

ANS: D

Rationale: Synapses can exist between (1) the axon of a presynaptic neuron and the cell body of a postsynaptic neuron (axosomatic); (2) the axon of a presynaptic neuron and the dendrites of a postsynaptic neuron (axodendritic); and (3) the axon of a presynaptic neuron and the axon of a postsynaptic neuron (axoaxonic).

 

  1. Which one of the following is the first step in the sequence of actions in the G-protein receptor activity cycle?
  2. α chain activates a target protein.
  3. Neurotransmitter binds with receptor.
  4. Membrane channels open, or intracellular target proteins are activated.
  5. Receptor protein changes shape.

 

ANS: B

Rationale: The G-protein receptor activation cycle consists of the following steps: (1) neurotransmitter binds to the G-protein; (2) receptor protein changes shape; (3) G-protein subunits break free as cytoplasmic shuttling units; (4) subunits bind to the membrane ion channel; (5) ion channel changes shape; and 6) subunits deactivate and reassociate with the G-protein receptor.

 

  1. When an action potential arrives at the presynaptic terminal:
  2. Voltage-gated calcium channels are activated.
  3. Intracellular calcium stores are released.
  4. Synaptic vesicles fuse to the membrane of the soma.
  5. Calcium is actively transported out of the neuron terminal.
  6. A, B, and D

 

ANS: B

Rationale: Arrival of an action potential at the presynaptic terminal triggers the opening of voltage-gated calcium channels. This results in an influx of calcium into the neuron terminal and triggers the movement of synaptic vesicles toward release sites. The synaptic vesicles fuse with the presynaptic membrane and release neurotransmitters into the synaptic cleft.

 

  1. The binding of ACh at the neuromuscular junction results in:
  2. An inhibitory postsynaptic potential.
  3. Presynaptic facilitation.
  4. Presynaptic inhibition.
  5. An excitatory postsynaptic potential.

 

ANS: D

Rationale: The binding of ACh at the neuromuscular junction results in the opening of Na+ channels and depolarization of the postsynaptic cell membrane. This is an example of an excitatory postsynaptic potential. In contrast, an inhibitory postsynaptic potential results in the opening of potassium and chloride ion channels and hyperpolarization of the postsynaptic cell membrane. Presynaptic facilitation and inhibition refer to the amount of neurotransmitter released into the synapse.

 

  1. Neurotransmitters that act ________ are classified as ________, whereas neurotransmitters that act ________are classified as ________.
  2. Directly; slow-acting; indirectly; fast-acting
  3. Directly; inhibitory; indirectly; excitatory
  4. Directly; fast-acting; indirectly; slow-acting
  5. Directly; excitatory; indirectly; inhibitory

 

ANS: C

Rationale: Neurotransmitters act either directly, by activating ion channels (ionotropic); or indirectly, by activating postsynaptic neuron proteins (metabotropic). Direct-acting neurotransmitters are classified as fast-acting, because their effects last less than 1/1000 of a second. Indirect acting neurotransmitters are classified as slow-acting, because their effects require 1/10 of a second to several minutes.

 

  1. Which of the following neurotransmitters is paired with its correct description?
  2. Glutamate; excitatory transmitter, is important in learning and development.
  3. Dopamine; inhibitory transmitter, increases attention to sensory information.
  4. GABA; excitatory transmitter, modulates neural activity in the CNS.
  5. Acetylcholine; excitatory transmitter, affects mood, arousal, and pain perception.
  6. Both A and C

 

ANS: A

Rationale: Glutamate is the principle excitatory transmitter of the CNS and is important in eliciting the neural changes associated with learning and development. Dopamine is an excitatory neurotransmitter that affects motor activity, cognition, pleasure, and reward behavior. GABA is the principle inhibitory transmitter in the CNS, preventing neural overactivity, particularly in the spinal cord. Acetylcholine is the major neurotransmitter in the peripheral nervous system (PNS), regulating the control of movement and autonomic function. In the CNS, ACh is involved in the selection of objects for attention.

 

  1. Substance P is an example of a(n):
  2. Amino acid transmitter.
  3. Amine transmitter.
  4. Peptide transmitter.
  5. Histamine transmitter.

 

ANS: C

Rationale: Substance P, calcitonin gene–related peptide, galanin, and opioids, are examples of neuroactive peptide transmitters. Examples of amino acid transmitters include glutamate, glycine, and GABA. Dopamine, norepinephrine, serotonin, and histamine are examples of amine transmitters.

 

  1. Which of the following is associated with post-traumatic stress disorder?
  2. Elevated serotonin levels
  3. Reduced dopamine reuptake
  4. Hyperactivity of the norepinephrine system
  5. All of the above

 

ANS: C

Rationale: Norepinephrine is a critical mediator of attention and arousal. Overactivity of the norepinephrine system contributes to panic and post-traumatic stress disorder.

 

  1. Which of the following neurotransmitters and modulators are implicated in pain perception?
  2. Opioid peptides
  3. Substance P
  4. Dopamine
  5. Both A and B
  6. All of the above

 

ANS: D

Rationale: Opioid peptides and substance P are linked to pain perception and modulation.

 

  1. Receptor tyrosine kinases:
  2. Act through second messenger systems.
  3. Are usually activated by neuropeptides or hormones.
  4. Function through phosphorylation of tyrosine.
  5. Both A and C
  6. All of the above

 

ANS: E

Rationale: Tyrosine kinsase receptors act through second messenger systems and are typically activated by neuropeptides or hormones. These receptors are named for an intracellular site that alters its properties by adding phosphate groups to tyrosine when extracellular ligand binding occurs. This phosphorylation activates downstream molecules, initiating a signalling cascade.

 

  1. Receptor activity is regulated by:
  2. Decreasing the number of receptors through internalization.
  3. Decreasing the number of available receptors through inactivation.
  4. Increasing the number of active receptors.
  5. Both A and B
  6. All of the above

 

ANS: E

Rationale: Cells can regulate receptor activity by decreasing the number of receptors through internalization, decreasing the number of functional receptors through inactivation, or increasing the number of active receptors in response to low neurotransmitter levels or infrequent receptor activation.

 

  1. Which one of the following is used to treat myasthenia gravis?
  2. Medications that inhibit the breakdown of acetylcholine
  3. Medications that activate the immune system
  4. Removal of the pancreas, which contributes to receptor damage
  5. Frequent blood transfusions to prevent anemia
  6. All of the above

 

ANS: A

Rationale: Treatment of myasthenia gravis commonly involves medications that inhibit the breakdown of acetylcholine, immunosuppressant medications, removal of the thymus gland, and/or plasmapheresis to filter and replace plasma.

 

  1. An antagonist drug acts by:
  2. Preventing the release of a neurotransmitter.
  3. Binding to a receptor to facilitate the effect of a neurotransmitter.
  4. Elevating neurotransmitter levels in the synaptic cleft.
  5. Increasing the number of active receptors on a cell membrane.

 

ANS: A

Rationale: Antagonist drugs act by preventing neurotransmitter release or by binding to a receptor and impeding the effects of a naturally occurring transmitter.

Lundy-Ekman: Neuroscience: Fundamentals for Rehabilitation, 4th Edition

 

Chapter 11: Basal Ganglia, Cerebellum, and Movement

 

Test Bank

 

 

  1. How does motor information from the basal ganglia reach spinal lower motor neurons?
  2. Neurons in the basal ganglia that have axonal connections directly to spinal lower motor neurons.
  3. Neural connections with the cerebellum.
  4. Output to the thalamus and pedunculopontine nucleus (PPN), which synapse with cortical and brainstem motor neurons that project to the spinal lower motor neurons.
  5. Direct connections from the striatum to lower motor neurons.
  6. Neurons from the subthalamic nucleus directly synapse with spinal lower motor neurons.

 

ANS: C

Rationale: The motor output from the basal ganglia inhibits three structures: pedunculopontine nucleus, the midbrain locomotor region, and motor areas of the thalamus. Neurons from these three structures project to the reticulospinal tracts and motor areas of the cerebral cortex. So motor information from the basal ganglia reaches lower motor neurons via multisynaptic routes involving corticospinal and reticulospinal tracts and stepping pattern generators. There are no direct connections from the basal ganglia to spinal lower motor neurons. A direct connection would be a neuron that directly synapses with the lower motor neuron. Corticospinal neurons have direct connections with lower motor neurons.

 

  1. The cortico-basal ganglia-thalamus motor loop contributes to:
  2. Regulation of muscle force
  3. Sequencing of movements
  4. Regulation of muscle tone
  5. Selection and inhibition of specific motor synergies
  6. All of the above

 

ANS: E

Rationale: The cortico-basal ganglia-thalamus motor loop regulates muscle contraction, muscle force, multijoint movements, and sequencing of movements.

 

  1. Major roles of the cerebellum are to:
  2. Compare actual movement to intended movement.
  3. Adjust movements to existing conditions.
  4. Provide conscious awareness of proprioceptive information.
  5. Both A and B
  6. A, B, and C

 

ANS: D

Rationale: The cerebellum compares actual movement to intended movement and adjusts movements to existing conditions. However, all cerebellar activity is subconscious.

 

  1. Dyskinesia is a side effect caused by prolonged use of which one of the following chemical agents for treatment of Parkinson’s disease?
  2. Acetylcholinesterase
  3. L-dopa
  4. Botulinum
  5. Baclofen
  6. Gamma-aminobutyric acid (GABA) agonists

 

ANS: B

Rationale: Prolonged use of L-dopa for treatment of Parkinson’s disease can cause dyskinesia because the drug L-dopa is converted to dopamine is converted to dopamine in the brain and an excess of dopamine in the striatal output pathway disinhibits the motor thalamus. In turn the motor thalamus overstimulates the motor areas of the cerebral cortex, producing involuntary movements.

 

  1. Deep brain stimulation of which structure is safe and effective for reducing tremors in Parkinson’s disease?
  2. Putamen
  3. Caudate
  4. Thalamus
  5. Substantia nigra
  6. Red nucleus

 

ANS: C

Rationale: Deep brain stimulation of the thalamus is safe and effective for reducing Parkinson’s disease tremors.

 

  1. Which of the following is (are) associated with the emergence of focal hand dystonia?
  2. Excessive repetition or overuse
  3. Somatotopic degradation of somatosensory cortex
  4. Central impairment of proprioception
  5. Both A and B
  6. A, B, and C

 

ANS: E

Rationale: Excessive repetition or overuse of the hand causes somatotopic degradation of somatosensory cortex and central impairment of proprioception, leading to focal hand dystonia in genetically susceptible people.

 

  1. Which one of the following brain structures is part of the basal ganglia motor circuit?
  2. Primary motor cortex and premotor cortical areas
  3. Putamen
  4. Thalamus
  5. All of the above

 

ANS: D

Rationale: The basal ganglia motor circuit includes the cerebral cortex motor areas, putamen, subthalamic nucleus, globus pallidus internus, and motor areas of the thalamus.

 

  1. The basal ganglia are important for influencing motor movements but is also involved in other types of behavior. Which of the following additional loops involves the basal ganglia?
  2. Oculomotor loop
  3. Executive loop
  4. Behavioral flexibility and control loop
  5. All of the above

 

ANS: D

Rationale: The basal ganglia are critical parts of four additional and separate, parallel cortico-basal ganglia-thalamic loops: oculomotor, executive, behavioral flexibility and control, and limbic.

 

  1. Which one of the following basal ganglia loops is involved in goal-directed behavior, planning, and choosing actions in context?
  2. Motor loop
  3. Executive loop
  4. Behavioral flexibility and control loop
  5. Limbic loop

 

ANS: B

Rationale: The execute loop of the basal ganglia participates in goal-directed behavior, including evaluating information for making perceptual decisions, planning, and choosing actions in context.

 

  1. Which one of the following basal ganglia loops is involved in recognizing it is socially inappropriate to burp out loud in the middle of lecture?
  2. Motor loop
  3. Executive loop
  4. Behavioral flexibility and control loop
  5. Limbic loop

 

ANS: C

Rationale: The behavioral flexibility and control loop of the basal ganglia is involved in the recognition of social disapproval, self-regulatory control, selecting relevant knowledge from irrelevant knowledge, maintaining attention, and stimulus-response learning.

 

  1. Which one of the following basal ganglia loops motivates a pediatric patient to participate in therapy for stickers?
  2. Motor loop
  3. Executive loop
  4. Behavioral flexibility and control loop
  5. Limbic loop

 

ANS: D

Rationale: The limbic loop of the basal ganglia links limbic, cognitive, and motor systems; identifies value of stimuli; is involved in reward-guided behaviors; monitors errors in predictions; and is concerned with seeking pleasure.

 

  1. Which one of the following are distinctive signs of akinetic-rigid Parkinson’s disease?
  2. Hypokinesia
  3. Freezing during movement
  4. Resting tremor
  5. All of the above

 

ANS: D

Rationale: The distinctive signs of akinetic-rigid Parkinson’s disease include rigidity; hypokinesia (decreased movement); freezing during movement; visuoperceptive impairments; postural instability; resting tremor; and nonmotor signs including depression, psychosis, Parkinson’s dementia, and autonomic dysfunction.

 

  1. Postural instability in individuals with akinetic-rigid Parkinson’s disease is caused by which of the following?
  2. Rigidity of postural flexor and extensor musculature
  3. Disinhibition of the reticulospinal tracts
  4. Loss of pedunculopontine cells
  5. All of the above

 

ANS: D

Rationale: Postural instability occurs secondary to the extreme rigidity of postural flexors and extensors. The loss of pedunculopontine cells, combined with increased inhibition of the PPN, disinhibits the reticulospinal tracts, producing excessive contraction of postural and proximal limb muscles.

 

  1. Which of the following is a potential treatment option for individuals with Parkinson’s disease?
  2. L-3,4-dihydroxyphenylalanine (l-DOPA)
  3. Deep-brain stimulation
  4. Physical and occupational therapy
  5. All of the above

 

ANS: D

Rationale: Drugs, invasive procedures, and physical and occupational therapy are used to treat Parkinson’s disease. Because Parkinson’s disease involves the loss of dopamine-producing cells in the substantia nigra, drug therapy that replaces dopamine (l-DOPA) is initially effective in reducing the signs of the disease. Invasive procedures, including deep-brain stimulation, neuronal transplantation, and destructive surgery, are sometimes used to treat the dyskinesia, tremors, and akinesia associated with Parkinson’s disease. Physical and occupational therapy are reported to improve mobility and functional status in those with Parkinson’s disease.

 

  1. Parkinson-plus syndromes are the collective name for primary neurodegenerative diseases that cause signs similar to Parkinson’s disease and include which one of the following diseases?
  2. Progressive supranuclear palsy
  3. Alzheimer disease
  4. Chronic traumatic encephalopathy
  5. Huntington’s disease

 

ANS: A

Rationale: Parkinson-plus syndromes include progressive supranuclear palsy, dementia with Lewy bodies, and multiple system atrophy (MSA).

 

  1. MSA is characterized by which one of the following?
  2. Akinetic-rigid syndrome
  3. Cerebellar signs
  4. Autonomic dysfunction
  5. All of the above

 

ANS: D

Rationale: MSA is characterized by akinetic-rigid syndrome, cerebellar signs, autonomic dysfunction, and corticospinal tract dysfunction.

 

  1. Huntington’s disease is characterized by which one of the following?
  2. Chorea
  3. Dementia
  4. Hypokinesia
  5. Both A and B

 

ANS: D

Rationale: Chorea, consisting of involuntary, jerky, rapid movements, and dementia are signs of Huntington’s disease.

 

  1. Which one of the following is an example of focal dystonia?
  2. Segawa’s dystonic
  3. Tourette’s disorder
  4. Spasmodic torticollis
  5. None of the above

 

ANS: C

Rationale: Focal dystonias are the most common and are limited to one part of the body. An example of focal dystonia is spasmodic torticollis (also known as cervical dystonia).

 

  1. The return of motor control after treatment of focal dystonia is likely the result of which one of the following?
  2. Stretching of tight muscles
  3. Application of heat to relieve spasms
  4. Improvement in the organization of somatosensory cortex
  5. None of the above

 

ANS: C

Rationale: A treatment protocol for musician’s dystonia developed by Byl consists of the cessation of abnormal movements, avoidance of heavy gripping of instruments (e.g., pens, musical instruments), sensory retraining, and mental rehearsal of the target movement without overt body movement. After completing the protocol, all participants in Byl’s study showed improvement in strength, stereognosis, motor control, and other clinical measures. Improvement in motor control was accompanied by improvement in the organization of somatosensory cortex. Because the muscle contractions are caused by basal ganglia dysfunction, attempts at treating the disorder by stretching the muscles are ineffective. Heat, cold, and exercise may be helpful to relieve pain and/or spasms.

 

  1. The functions of the cerebrocerebellum and dentate nuclei include which one of the following?
  2. Coordination of voluntary movements
  3. Planning of movements
  4. Timing
  5. All of the above

 

ANS: D

Rationale: The functions of the cerebrocerebellum and dentate include coordination of voluntary movements via influence on corticofugal tracts, planning of movements, and timing.