Stimulation of periaqueductal gyrus causes

a. Increase in
glutamate release

b. Increase in
Substance P release

c. Decrease in
Endorphin release

d. Increase in
Enkephalin release

e. Decrease in
serotonin release
2. Anterior spinal artery occlusion results in which of the following deficits?


a. loss of vibration
and position
sensation below the
lesion

b. areflexia at the
level of the lesion


c. bilateral loss of
pain and
temperature
sensation below the
lesion


d. bilateral spastic
paralysis below the
lesion


e. All of the above


f. A, B, and C


g. B, C, and D
3. On examining a 66-yr-old male patient, the physician notes that the patient was suffering from
bilateral loss of pain and temperature; bilateral loss of crude touch and pressure; bilateral
paralysis of muscles; and no loss of vibration, fine touch, and proprioception. He also notes that
the muscles supplied by the involved spinal segment are flaccid and those below it are rigid.
The possible lesion in this patient is

a. Complete
transection of cord

b. Anterior cord
syndrome

c. Brown-Sequard
syndrome


d. Posterior
compression of
cord


e. Central
compression of
cord
4. Reflex movement of our bodies with a moving object is mediated by

a. Superior
colliculus


b. VPL of Thalamus

c. Lateral
vestibular nucleus


d. Red nucleus

e. Inferior
colliculus

f. Medial vestibular
nucleus
5. A patient suffering from poliomyelitis has which of the following findings


a. Spastic paralysis
of the affected
region


b. Loss of pain and
temperature of the
affected region


c. Loss of vibration
of the affected
region


d. Decreased
muscular tone of
the affected region


e. Increased
reflexes on the
affected side
6. Use the picture given to answer the question. Which letter represents the tract whose injury
causes loss of ipsilateral vibration sense in legs?




a. A


b. B


c. C


d. D


e. E


f. F
7. Use the picture given above to answer the question. Which letter represents the tract whose
Injury will result in absence of abdominal muscle contraction on rubbing the skin with a wisp of
cotton?


a. A


b. B


c. C


d. D


e. E


f. F
8. Use the picture given above to answer the question. Absence of pin-prick sensation in a patient
should make us suspect a problem in which of the tracts shown in the picture (select the
corresponding letter)?


a. A


b. B


c. C


d. D


e. E


f. F
9. While examining a patient a physician noted that there is a significant lack of coordination of
movements especially of lower limbs. The patient also exhibits high stepping gait. Further
investigation revealed that there is a problem in the posterior spinocerebellar tract. All of the
following statements concerning the dorsal spinocerebellar tract are FALSE EXCEPT

a. It is a crossed
tract


b. It enters the
cerebellum via the
superior cerebellar
peduncle


c. It mediates
conscious
proprioception


d. It shares its 2nd
order relay center
with anterior
spinocerebellar
tract

e. It terminates in
cerebellum
10. A 55-year-old known hypertensive male suffers a stroke while trying to replace a flat tire on the
road. He had not been taking his hypertensive medications regularly. He is also a heavy
smoker, and drinks a six-pack of beer every weekend. On examination, he is conscious and
coherent with normal light and corneal reflexes. Cranial nerves appeared normal. He has a
dense hemiplegia (-Plegia = paralysis) on the right side, with equal paralysis of the arm and leg.
His lesion most likely involves the


a. C1-C3


b. C4-C7


c. T1-T6


d. T6-T12


e. L1-L5


f. S1-S5
11. In the above patient, which of the following symptoms can be expected to be seen?

a. Paralysis in
flexion


b. Paralysis in
extension


c. Flaccid paralysis
of all involved
muscles


d. Spastic paralysis
of all involved
muscles


e. Increased
reflexes in all
muscles


f. Decreased
reflexes in all
muscles
12. Examining a patient with Amyotrophic lateral sclerosis will reveal which of the following clinical
features?

a. UMN paralysis
features only

b. LMN and UMN
paralysis features

c. LMN paralysis
features only

d. Loss of vibration
sense in legs


e. Astereognosis
13. On examining a patient, the physician notes that the patient is suffering bilateral muscle
weakness in all extremities, which is more pronounced in the upper limbs compared to lower
ones. There is also loss of pain and temperature in both extremities, more pronounced in upper
limbs. The possible spinal cord lesion in this patient is

a. Posterior cord
syndrome

b. Anterior cord
syndrome


c. Syringomyelia

d. Lateral cord
lesion


e. Tabes dorsalis


f. Poliomyelitis

g. Amyotrophic
lateral sclerosis
14. A 52-yr-old male patient is brought to the hospital with complaints of inability to move both
legs. Examination of lower limbs revealed right-sided paralysis, left-sided loss of pain and
temperature, and right-sided loss of vibratory sensations. His muscles were flaccid in some
areas and rigid in other areas. What is the most likely diagnosis?

a. Anterior cord
syndrome

b. Central cord
syndrome

c. Posterior cord
syndrome


d. Syringomyelia

e. Brown-Sequard
syndrome


f. Poliomyelitis
15. A patient visits a doctor complaining of unilateral deafness in left ear. Basing on this complaint
alone the pathology cannot be present in?


a. Left Ear

b. Left Cochlear
nerve


c. Left anterior and
posterior Cochlear
nucleus

d. Left Trapezoid
body


e. A, B, C


f. All the above
16. A patient visited the hospital complaining of weakness in upper and lower limbs along with
pins and needle sensation in them. Examination revealed that there is spastic paralysis in both
right upper and lower limbs and also altered pain and temperature sensation in left upper and
lower limbs. Investigations revealed a prolapsed intervertebral disc with the contents entering
the vertebral canal compressing the cord laterally from outside to inside. From the data
provided, which of the following statements regarding the evolution of symptoms is TRUE?


a. Weakness in
muscles first appear
in legs and then
hands


b. Loss of pain
sensation first
appear in hands
and then legs


c. Loss of
temperature
sensation first
appear in hands
and then legs


d. Increased
reflexes appear first
in hands and then
legs


e. Inability to write
appears before
Babinski sign
17. Which of the following conditions best explain the above symptoms?

a. Complete
transection of cord

b. Hemitransection
of cord


c. Lateral
compression of
cord

d. Posterior cord
syndrome

e. Anterior cord
syndrome
18. A patient suffered ischemic stroke to a part of the spinal cord, which resulted in destruction of
the ventral horn. If the physician does a thorough neurological examination at the level of the
lesion, then he will find all the following things except


a. Loss of deep
tendon reflexes
(MSRs)

b. Loss of muscle
bulk

c. Loss of
cremasteric reflex


d. Twitching of
muscles on hitting
them


e. Flaccid paralysis
19. On examination of a patient who visited his office with complaints of slurred speech and
difficulty swallowing, a physician noted that the patient is having loss of pain and temperature
sensation on left side of the body and right side of the face; intention tremors and co-
ordination problems; left-sided hemiplegia with increased muscle tone and reflexes; loss of
vibration sense, fine touch, & 2-point discrimination on left; problems in taste; alterations in
heart rate and blood pressure; and balance problems. From this data we can infer that the
patient is having a problem in


a. Right side of
medulla oblongata
at pyramidal
decussation


b. Left side of
medulla oblongata
at pyramidal
decussation


c. Right side of
medulla oblongata
at lemniscal
decussation


d. Left side of
medulla oblongata
at lemniscal
decussation


e. Right side of
medulla oblongata
at olives


f. Left side of
medulla oblongata
at olives
20. What additional clinical feature can be expected in the above patient?


a. loss of light
reflex when light is
focused on right
eye


b. loss of light
reflex when light is
focused on left eye


c. loss of corneal
reflex on touching
right cornea


d. loss of corneal
reflex on touching
left cornea


e. loss of
accommodation
reflex

f. Hearing loss on
left


g. Hoarseness
21. While performing a detailed neurological examination in a patient, the physician noted that the
patient is not able to identify 2 distinct points of tactile stimulus on the left hand. Which of the
following pathways is affected?

a. Right
Spinothalamic tract

b. Left Medial
Leminiscus

c. Left
Spinothalamic tract

d. Right Medial
Leminiscus

e. Right fasciculus
cuneatus

f. Left fasciculus
gracilis

g. Right fasciculus
gracilis
22. The motor nucleus of cranial nerves 9, 10, & 11 is

a. Nucleus tractus
solitarius

b. Nucleus
ambiguus


c. Dorsal nucleus

d. Superior
salivatory nucleus

e. Inferior
salivatory nucleus
23. Use the picture given above to answer the question. This tract carries proprioception fibers to
ipsilateral cerebellum and has its second-order neurons in thoracic nucleus (Select the letter
corresponding to the tract)




a. A


b. B


c. C


d. D


e. E


f. F
24. Use the picture given above to answer the question. Injury of this tract causes inability of
patient to identify the object placed in their hands.


a. A


b. B


c. C


d. D


e. E


f. F
25. While examining a female patient, a physician noted that the patient has intact bilateral pain
and thermal sensations but has bilateral spastic paralysis of muscles along with Babinski sign.
She also has problems stating the position of a limb with eyes closed and also has problems
with vibratory sense. Which of the following pathologies can cause this?

a. Tertiary
infection of syphilis


b. Retrograde
spread of Polio
virus


c. Retrograde
axonal spread of
rabies virus

d. Pernicious
anemia

e. Expansion of
central canal
26. In the above patient, what is the possible cause for the mentioned symptoms?


a. Demyelination
of posterior column
and Corticospinal
tracts


b. Compression of
entire anterior white
column


c. Demyelination
of both
spinothalamic tracts


d. Compression of
entire lateral white
column


e. Demyelination
of only posterior
column tracts
27. While examining the tongue, the physician noted that the tongue deviates to the right on
protrusion. This indicates involvement of which of the following nerves?

a. Right
hypoglossal


b. Left hypoglossal


c. Right vagus


d. Left vagus

e. Left
glossopharyngeal
28. While doing a post-mortem analysis on a recently deceased patient who suffered from chronic
pain syndrome, the pathologist noted that there is an ischemic lesion involving the peripheral
integrating center for pain in the spinal cord. The center the pathologist is referring to is
controlling which of the following areas in spinal cord?


a. Lamina I


b. Clarks nucleus


c. Thoracic nucleus


d. Nucleus gracilis

e. Nucleus
cuneatus


f. Lamina V
29. In the above patient, which of the following neurotransmitters is most probably responsible for
the patients chronic pain?


a. Acetylcholine


b. Dopamine


c. Norepinephrine


d. Substance P


e. GABA
30. In the above patient, which one of the following statements regarding the center is FALSE?


a. Axons arising in
this lamina does not
form the
spinothalamic tract


b. Neurons in this
lamina do not
mediate sharp pain


c. Neurons in this
lamina play a major
role in perception
of dull pain


d. This lamina acts
as the peripheral
integrating center
for sharp pain


e. Axons arising in
this lamina does not
form spinotectal
tract
31. Paralysis of sternocleidomastoid and trapezius indicates a problem in

a. Nuclues
ambiguus


b. Nucleus gracilis

c. Upper Cervical
spinal segments

d. Nucleus tractus
solitarius

e. Hypoglossal
nucleus
32. A man has metastatic carcinoma and enlarged deep cervical lymph nodes. One of his
symptoms is a hoarse voice, barely heard above a whisper and difficulty swallowing &
breathing. Endoscopy revealed presence of a mass in piriform fossa. Subsequently he
succumbs to the disease and at autopsy it is found that the mass is putting a pressure on a
nerve. Presumably this was the reason for the hoarse voice. The involved nerve arises from

a. Nucleus tractus
solitarius

b. Dorsal nucleus
of vagus


c. Cochlear nuclei

d. Hypoglossal
nucleus

e. Nucleus
ambiguus
33. Loss of all taste sensations in a patient makes one suspect

a. Nuclues
ambiguus


b. Nucleus gracilis

c. Nucleus tractus
solitarius

d. Cervical spinal
segments

e. Hypoglossal
nucleus
34. On touching the right side of the posterior part of the tongue, the patient gagged. On
touching the left side of the posterior part of the tongue, there was no gag reflex. This could be
because of the involvement of which of the following nerves?


a. Left vagus

b. Left
Glossopharyngeal

c. Right
Glossopharyngeal


d. Right vagus and
right
Glossopharyngeal


e. Left vagus and
left
glossopharyngeal
35. While studying the nerve supply of tongue, a researcher noted that the taste sensations from a
small area in posterior one-third of the tongue are carried by vagus nerve. The first order
neurons for taste from this area are present in

a. Dorsal root
ganglion

b. Inferior vagal
ganglion


c. Nucleus tractus
solitaries Lower
part


d. Nucleus tractus
solitarius Upper
part


e. Spinal nucleus

f. Superior vagal
ganglion
36. A physician notes that in a patient there is impaired vibration and position sense,
astereognosis, and ataxia. The physician noted loss of all sensations in some areas of the
patient along with diminished reflexes in those same areas. When the patient was asked to
stand with legs close together and hands outstretched, the patient was able to do so easily
with eyes open but with eyes closed, he started swaying. The strength in the muscles is normal.
The patient also has high-stepping gait. The pathology is in


a. Ventral column
and dorsal root of
spinal nerve


b. Dorsal column
and ventral root of
spinal nerve


c. Lateral column
and dorsal root of
spinal nerve


d. Lateral column
and ventral root of
spinal nerve


e. Dorsal column
and dorsal root of
spinal nerve


f. Ventral column
and ventral root of
spinal nerve

g. Anterior gray
matter only
37. The condition in the above patient is

a. Amyotrophic
lateral sclerosis


b. Poliomyelitis


c. Tabes dorsalis


d. Syringomyelia

e. None of the
above
38. On examining a 66-yr-old male patient, the physician notes that the patient was suffering from
bilateral loss of pain and temperature; bilateral loss of crude touch and pressure; bilateral
paralysis of muscles; and bilateral loss of vibration, fine touch, and proprioception. The possible
lesion in this patient is

a. Complete
transection of cord

b. Anterior cord
syndrome


c. Brown-Sequard
syndrome


d. Posterior
compression of
cord


e. Central
compression of
cord
39. A 67-yr-old patient was brought to the hospital with hemiplegia. Examination revealed the
involvement of corticospinal tract at medulla oblongata. Which of the following features will be
seen in this patient?


a. Flaccid paralysis
on the same side as
the lesion


b. Flaccid paralysis
on the opposite
side as the lesion


c. Paralysis with
rigidity on the
opposite side as the
lesion


d. Paralysis with
rigidity on the same
side as the lesion


e. Flaccid paralysis
on the both sides of
the body


f. Paralysis with
rigidity on the both
sides of the body
40. On performing a CT scan in the above patient, an anomaly will be noted in which of the
following areas?


a. Olives


b. Pyramid


c. Gracile tubercle

d. Cuneate
tubercle

e. Inferior
cerebellar peduncle
41. Inability to identify a known object placed in the right hand indicates a problem in

a. Right fasciculus
gracilis

b. Left fasciculus
gracilis

c. Left Gracili
tubercle

d. Left Cuneate
tubercle

e. Right VPL of
Thalamus

f. Left VPL of
thalamus
42. A patient presents to the hospital with complaints of tingling, numbness, and needle-prick
sensations. X-ray revealed a prolapsed intervertebral disc with lateral compression of cervical
spinal cord. The pain and temperature loss in this patient will appear in which of the following
orders?

a. Arms --> trunk -
-> legs

b. Trunk --> legs -
-> arms

c. Legs --> arms --
> trunk

d. Legs --> trunk -
-> arms

e. Arms --> legs --
> trunk
43. On examining a patient, the physician noted that the patient had diminished muscle strength in
lower extremities along with diminished tone and reflexes. He also exhibited saddle anesthesia
and diminished sensations in the areas supplied by lower lumbar and entire sacral nerves.
There is also loss of bulbocavernous reflexes. Anal and vesicular sphincters are patulous
(relaxed). MRI revealed a prolapsed disc in the region of L4-L5 vertebrae. The condition is most
likely


a. Conus
medullaris
syndrome

b. Cauda equine
syndrome


c. Syringomyelia


d. Tabes Dorsalis

e. Amyotrophic
lateral sclerosis
44. Medial medullary syndrome doesn't involve which of the following structures?

a. Hypoglossal
nuclei


b. MLF system

c. Nucleus
ambiguus

d. Medial
leminiscus

e. Tectospinal
tracts
45. The CT scan of a patient revealed that the structure present immediately posterolateral to the
left pyramid is injured. Which of the following clinical features will be seen in this patient?

a. Contralateral
Intention tremors

b. Ipsilateral clasp-
knife rigidity

c. Contralateral
clasp-knife rigidity


d. Ipsilateral co-
ordination
problems

e. Contralateral
Astereognosis

f. Ipsilateral
Astereognosis
46. Use the picture given to answer the question. Identify the tract with one-third of the fibers
arising from Pre-central gyrus (Select the letter corresponding to the tract)




a. A


b. B


c. C


d. D


e. E


f. F
47. Use the picture given above to answer the question. Fibers arise from lamina 7 of spinal cord


a. A


b. B


c. C


d. D


e. E


f. F
48. Use the picture given above to answer the question. Fibers arise from first order sensory
neurons


a. A


b. B


c. C


d. D


e. E
49. Deviation of tongue to the right on protrusion of the tongue can be due to lesion to

a. Right vagal
nerve

b. Right chorda-
tympani nerve

c. Right
hypoglossal nerve


d. Left vagal nerve

e. Left hypoglossal
nerve

f. Left chorda-
tympani nerve
50. Inferior colliculus forms the relay center for which of the following structures?

a. Visuo-spinal
reflex pathway

b. Medial
vestibular nucleus

c. Superior
vestibular nucleus

d. Inferior
vestibular nucleus

e. Lateral
vestibular nucleus

f. Dorsal cochlear
nucleus

g. Light reflex
pathway
51. A neurologist evaluates a 54-year-old man with a gait disorder. When the physician passively
moves the patient's right thumb upward or downward, the patient cannot accurately report the
direction of motion or the position of the toe. His perception of light touch and painful stimuli
is unimpaired. A lesion of which of the following structures can best explain this finding?

a. Right fasciculus
cuneatus

b. Right fasciculus
gracilis

c. Left fasciculus
gracilis

d. Left fasciculus
cuneatus

e. Right Lateral
leminiscus

f. Right medial
lemniscus


g. Right
ventroposterolateral
nucleus of the
thalamus
52. A 52-yr-old male patient came to a neurologist complaining of problems in both lower limbs.
Detailed neurological examination of the lower limbs revealed loss of all sensations at the level
of the lesion and inability to the object touching but still able to tell which area of the body is
touched. Patient also had problems with vibration, sterognosis and 2-point discrimination.
Strength of all the leg muscles appeared normal. No problems with pain and temperature.
Neurological examination of rest of the body appeared normal. Examination of remaining
systems revealed no significant anomalies. Which of the following conditions can explain all the
above symptoms?

a. Anterior cord
syndrome

b. Posterior cord
syndrome

c. Central cord
syndrome


d. Complete
transection of spinal
cord

e. Hemitransection
of spinal cord
53. In the above patient, which of the following arteries is involved?


a. Vertebral artery

b. Anterior spinal
artery

c. Posterior spinal
artery


d. Radicular artery


e. Thoracic aorta
54. In the above patient, the second order neurons for the affected tract/tracts are present in

a. Lamina 2 of
spinal cord

b. Lamina 5 of
spinal cord

c. Lamina 9 of
spinal cord

d. Medulla
oblongata


e. Lamina 8 of
spinal cord
55. A 35-yr-old man sustains a knife wound to the neck that completely destroyed the left C6
dorsal root ganglion. Two months later, the axons, dendrites, and nerve cell bodies of this
damaged structure have completely degenerated. Which of the following centers ARE NOT
directly affected due to the above-mentioned damage & injury?

a. Nucleus gracilis
& cuneatus

b. Lamina I of
spinal cord


c. Thoracic nucleus

d. Lamina 5 of
spinal cord


e. alpha motor
neurons of agonist
muscles


f. alpha motor
neurons of
antagonist muscles

g. Interneurons of
spinal cord
56. Loss of all bilateral ascending tracts and variable portion of bilateral corticospinal tracts in a
spinal cord should make one suspect a problem in

a. Posterior spinal
arteries

b. Vertebral
arteries

c. Internal carotid
arteries

d. Anterior spinal
arteries

e. Radicular
arteries
57. On examining the CT scan of a patient who recently suffered from a stroke, the neurologist
noted that there is an ischemic lesion affecting one-half of medulla. He further noted that the
posture of the patient is paralysis in extension. Which of the following tract/tracts could have
been injured?


a. Reticulospinal
tract and
rubrospinal tract

b. Corticospinal
tract


c. Vestibulospinal
tract & tectospinal
tract


d. Tectospinal tract


e. Rubrospinal
tract and
vestibulospinal tract


f. Corticospinal
tract & Tectospinal
tract


g. Corticospinal
tract & rubrospinal
tract
58. In the above patient, lesion of the tract responsible for the abnormal posture caused


a. Increased
activity of flexors on
the same side of
lesion


b. Increased
activity of extensors
on the same side of
lesion


c. Decreased
activity of flexors on
the opposite side of
lesion


d. Decreased
activity of extensors
on the opposite
side of the lesion


e. Has no effect on
flexors or extensors
on either side
59. On examination of a patient who visited his office with complaints of slurred speech, a
physician noted that the patient is having loss of pain and temperature sensation on right side
of the body; right-sided hemiplegia (arms & leg) with increased muscle tone and reflexes; no
loss of taste or salivation; normal eye functions; lack of hoarseness; no nausea, vomiting, or
hearing loss. From this data we can infer that the patient is having a problem in


a. Right side of
medulla oblongata
at pyramidal
decussation


b. Left side of
medulla oblongata
at pyramidal
decussation

c. Left side of
caudal pons


d. Left side of
medulla oblongata
at olives


e. Right side of
medulla oblongata
at olives


f. Left side of
medulla oblongata
at lemniscal
(sensory)
decussation


g. Right side of
medulla oblongata
at lemniscal
(sensory)
decussation
60. The neurons of the nucleus in thalamus in which the spinothalamic tract synapses will be

a. First-order
neurons

b. Second-order
neurons

c. Third-order
neurons

d. Fourth-order
neurons

e. Fifth-order
neurons