1. The principal area of telencephalon supplied with blood by the end branches of the vetebral-basilar 
     system is: 

 A. Frontal cortex
 B. Parietal cortex
 C. Anterior temporal cortex
 D. Occipital cortex
 E. Basal ganglia.

2. The cingulate gyrus receives most of its arterial supply from branches of the.

 A. Anterior cerebral artery
 B. Middle cerebral artery.
 C. Posterior cerebral artery
 D. Superior cerebellar artery
 E. Anterior choroidal artery

3. All of the following are true in regard to brain edema except. 

 A. The brain is edematous when it's parenchymal percentage of water is above normal and that 
           susceptibility is inversely related to the water content
 B. It could be due to increased secretory activity at the choroid plexus and capillaries.
 C. It could be due to increased hydrostatic pressure within blood capillaries
 D. There could be a decreased osmolarity between plasma and brain extracellular fluid
 E. In almost all cases it is due to a breakdown in the astroglia cell

4. Acute occlusion of the left internal carotid at the bifurcation would possibly result in all of the 
    following except. 

 A. Total ischemia of the left hemisphere.
 B. Artheromatous emboli into cerebral vasculature.
 C. Recirculation immediately via anastomatic vessels of the opthalamic artery.
 D. Cerebral edema.
 E. Thrombic emboli via the middle cerebral artery.

5. The chief external autoregulatory mechanism of cerebral blood vessels is.

 A. The parasympathetic innervation of arterioles.
 B. Rising H+ concentration in the perivascular space inhibits vascular muscle.
 C. Intracranial pressure determines vascular dilation.
 D. Normal blood pressure
 E. Serotonergic innervation of cerebral capillaries.

6. All of the following are branches of the middle cerebral artery except:

 A. Artery of cerebral hemorrhage of Charcot
 B. Anterior choroidal artery    
 C. Anterior temporal          
 D. Orbiofrontal
 E. Rolandic and prerolandic

7. Normal blood flow to the brain represents which of the following percentages of total resting cardiac 
    output.

 A. 5%
 B. 10%
 C. 15%
 D. 20%
 E. 25%

8. All of the following can result in decreased cerebral blood flow except.

 A. Cardiac arrhythmia's
 B. Artherosclerosis
 C. Venous septicemia
 D. Hyperventilation
 E. Lactic acid increase

9. Neurogenenic control of vasodilation could include all of the following except.

 A. Acetycholine
 B. Neuropeptide Y
 C. Vasoactive intestinal peptide
 D. Substance P
 E. Adenosine

10. The brain utilizes what percentage of the total body glucose to maintain normal functions.

 A. 10%
 B. 15%
 C. 20%
 D. 40%
 E. 50%

11. To study glucose metabolism and functional activity of the brain in human, one would use which of 
       the following techniques. 

 A. Angiography
 B. CAT scans
 C. Ventriculography
 D. MRI
 E. PET scans

12. An elderly man hit his head getting out of his car, but did not complain of any immediate problems. 
      Two weeks later he had difficulty moving his left leg. He seemed confused, and his family brought 
      him to the emergency room. Skull x-rays revealed no fractures. Which of the following would most 
      likely explain his problems?

 A. Psychiatric problems related to senile dementia.
 B. Subarachnoid hemorrhage
 C. Intracranial bleeding
 D. Chronic subdural hematoma
 E. Epidural hematoma

13. The name of the small artery which branches off the anterior cerebral or anterior communicating artery 
       which distributes to part of the head of the caudate nucleus, internal capsule, and septal nuclei.

 A. Anterior choroidal artery
 B. Artery of cerebral hemorrhage of Charcot
 C. Posterior choroidal artery
 D. Recurrent artery of Huebner
 E. Thalamoperforating artery

14. All of the following are correct in regard to the blood-brain-barrier except.

 A. Glucose is actively transported by a specific carrier protein. 
 B. Active transport systems exist in choroidal epithelium and CNS capillaries for transport of K+ in both 
           directions.
 C. Epinephrine, acetylcholine and dopamine all pass readily through the B-B-B.
 D. The more lipid soluble a substance is, the more readily it passes through the B-B-B.
 E. The blood-brain barrier is incomplete at birth.

15. All of the following may result in herniation of the brain causing brainstem compression except.

 A. Subdural hematoma
 B. Cerebral edema
 C. Subarachnoid hemorrhage
 D. Extradural hematoma
 E. Arteriovenous malformation.

16. Cerebral vascular accident (CVA) is synonymous with cerebral stroke. Which of the following is most 
      appropriate regarding this phenomenon. 

 A. Most often affects the distribution of the anterior cerebral artery.
 B. Is due to emboli occluding vascular distributions.
 C. Is due to ruptured aneurysms.
 D. Is due to skull fractures
 E. Is easily pre-diagnosed with the CAT scan and angiography.

17. Normal blood flow for the entire brain is.

 A. 250 ml./min.
 B. 500 ml./min.
 C. 750 ml./min.
 D. 1000 ml./min.
 E. 1500 ml./min.

18. A hemorrhage of the cortical arteries would result in a hematoma in which of the following spaces.

 A. Epi-dural
 B. Sub-dural
 C. Epi-arachnoid
 D. Subarachnoid
 E. Interventricular

19. Increased breakdown in the blood brain barrier would be expected in all of the following circumstances 
      except.

 A. Tumors
 B. Multiple sclerosis
 C. AIDS
 D. Bacterial meningitis
 E. Malnutrition

20. Which is not considered a cerebral ganglionic branch.

 A. Medial striate artery
 B. Artery of cerebral hemorrhage of Charcot
 C. Thalamoperforating
 D. Posterior meningeal artery
 E. Anterior choroidal artery

21. The major difference between cerebral arteries and peripheral arteries is.

 A. There are many more arterial branches
 B. The brain is the only place anastomosis occurs.
 C. The arterial walls of cerebral vessels are thinner in comparison to their lumen and have decreased 
           muscularis 
 D. Cerebral arterial walls are covered by meninges to give them strength.
 E. The cerebral arteries have valves.

22. The primary cause of a subdural hematoma would be.

 A. AV malformation
 B. Increased intracranial pressure
 C. Cerebral contusion
 D. Venous sinus damage
 E. Meningeal artery rupture

23. All of the following are true in regard to arteriosclerosis. 

 A. Arteriosclerotic plaques can become visibly see morphological changes in the age group of 20' and 
           30's
 B. Plaques major problem is they cause turbulence in blood flow leading to thrombosis.
 C. By the age of 50, the smallest arterioles are effected.
 D. Plaques can reduce blood flow 80-90%
 E. It is the major cause of stroke as it can result in emboli occluding cerebral vessels.

24. The term  "Ventral Root Nerve Fiber Type Ia" is best matched by the following:

 A. Flower spray ending            
 B. Extrafusal fiber        
 C. Isotonic response                                           
 D. Annulospiral ending                      
 E. Static response                                             

25. One of the most paralytic diseases of the peripheral nervous system is autoimmune disease. Which is 
       not correct in regard to it. 

 A. Results in degeneration of myelin.
 B. Demyelination is due to Schwann cells which become phagocytic.
 C. Can be caused by accidental injection of myelin antibodies, i.e. anti-rabies vaccine.
 D. Often occurs after acute viral infections.
 E. Guillain-Barre syndrome is the best example of it.

26. All of the following are true in regard to cerebral metabolism during ischemia except.

 A. Anaerobic glycolysis is an inefficient system.
 B. During ischemia, there is an increased utilization of glucose so it is depleted within one minute.
 C. Krebs cycle produces pyruvate which results in a mole of lactate plus 38 moles of ATP.
 D. Creatine phosphate is depleted more rapidly than ATP and glucose.
 E. Cellular dysfunction results from increased leakage of potassium from neurons due to ATP breakdown.

27. The emissary veins:

 A. Can serve as root for external infections to propagate into the sinuses of the brain, resulting in 
           thrombophlebitis.
 B. Belong to the anterolateral branch of cerebral arteries.
 C. Connect to the superior sagittal and occipital sinuses.
 D. Help to maintain high venous pressure within the skull.
 E. Are small blood vessels containing valves.

28. Which of the following is not true about the venous system of the brain?

 A. The major drainage of the brain eventually is the internal jugular vein.
 B. Emissary veins are small vessels which connect the superior sagittal sinus with the veins outside the 
           skull.
 C. The flow of blood in veins can go in either direction which helps to decrease venous pressure within 
           the skull in pathological cases.
 D. The venous sinus system contains no valves which aid in controlling cerebral blood flow.
 E. The superior sagittal sinus has a positive pressure which allows flow of CSF into it under conditions of 
           increased intracranial pressure.

29.  The anterior and posterior spinal arteries are branches of the:

 A. Middle cerebral artery
 B. Basilar artery
 C. Vertebral artery
 D. Posterior inferior cerebellar artery
 E. Brachiocephalic artery

30. All of the following decrease cerebral blood flow except:

 A. Increased intracranial pressure
 B. Increased sympathetic stimulation
 C. Increased carbon dioxide
 D. Polycythemia
 E. Arteriosclerosis

31. All of the following can result in stroke except:

 A. Decreased glucose
 B. Decreased Oxygen
 C. Hemorrhage of an internal artery.
 D. Arteriosclerosis
 E. Subdural hematoma.

32. All of the following are true in regard to cerebral edema except.

 A. Type I (vasogenic) results from an increase in permeability of brain capillaries with an increase in 
           extracellular fluid volume often seen after focal brain lesions.
 B. Type II (Cytotoxic) results from an increase in intracellular fluid volume often seen in hypoxia.
 C. Might be due to increased brain osmolarity.
 D. Might be due to increased secretory activity at the choroid plexuses and blood capillaries.
 E. Occurs primarily in brain structures having the lowest percentage of brain water.

33. All of the following characterize the venous system except.

 A. Superior group veins all drain into the superior longitudinal sinus.
 B. Cerebral veins drain into sinus's in a direction opposite to that of the sinus blood flow
 C. The jugular artery is the final destination of all cerebral blood drainage.
 D. All cerebral veins have no valves.
 E. All spinal veins contain valves.

34. Cerebral ganglionic (central) arteries:

 A. Are divided into 11 major groups
 B. May include the middle cerebral artery
 C. May include the choroidal arteries
 D. A and C are correct
 E. All are correct

35. All of the following neuroactive substances have been related to vasodilation except.         

 A. Calcitonin gene related peptide
 B. Substance P             
 C. Neuropeptide Y          
 D. Vasoactive intestinal polypeptide
 E. Acetylcholine        

36. The dura splits into two layers in some sites, such as the midline of the hemispheres, and forms dural 
       sinuses. These sinuses contain.

 A. Cerebrospinal fluid
 B. Venous blood
 C. Arterial blood
 D. Neural tissue.
 E. This space is normally empty.

37. The major blood supply to the ventral gray matter is. 

 A. The anterior radicular artery
 B. Sulcal branches of the anterior spinal artery.
 C. Spinal arteries.
 D. Circumferential branches of the radicular artery.
 E. Posterior spinal artery.

38. When arterial blood pressure falls below a certain level, cerebral blood flow suffers. This minimal
       arterial pressure is.

 A. 100 mm Hg
 B. 80 mm Hg
 C. 60 mm Hg
 D. 40 mm Hg
 E. 20 mm Hg

39. Epidural hematomas (hemorrhages) are usually due to damage of.

 A. The cerebral blood vessels
 B. The arachnoid
 C. The parenchyma of the brain
 D. The meningeal arteries
 E. Venous sinuses

40. If one compares the cranial bones and sutures to the middle meningeal artery and cortical gyri, which 
      of the following  relationships would be most correct.

 A. The anterior branch of the middle meningeal artery distributes frontal branches overlying the orbital 
           frontal gyri.
 B. The anterior branch of the middle meningeal artery lies posterior to and parallel to the coronal suture.
 C. The posterior branch of the middle meningeal artery lies above and parallel to the central sulcus.
 D. There is no relationship between the Sylvian fissure and the temporal suture.
 E. The posterior branch of the middle meningeal artery distributes extensively to regions posterior to the
           limbed suture.

41. An example of the blood-brain barrier would be.

 A. The increased bilirubin seen in children with Rh negative incompatibility.
 B. The ease at which brain infections are treated with antibiotics.
 C. The lack of diffusion into the brain parenchyma after injection of tryphan blue dye intraventricularly.
 D. The lack of diffusion into the choroid plexus after injection of tryphan blue I.V.
 E. The lack of diffusion into the brain parenchyma after injection of tryphan blue dye I.V.

42. The most vulnerable aspect of spinal cord arterial supply is:

 A. Segments C6 and Ll.
 B. Segments T4 and Ll.
 C. The dorsal root ganglion.
 D. The most ventral portion of the dorsal funiculus.

43. If a lesion occurred in the posterior medullary region due to an occlusion of the anterior spinal artery, 
      which anatomical structure would you not expect to be affected.

 A. Medial leminiscus
 B. Hypoglossal nuclei
 C. Dorsal motor nucleus of the vagus
 D. Spinal trigeminal nucleus
 E. Medial longitudinal fasciculus

44. The blood-brain barrier is exemplified best by:

 A. The ability of tryphan blue to stain the brain when injected I.V.
 B. The inability of large proteins to pass into the CSF
 C. The interposed astroglia between the blood capillary and the neuron
 D. The inability for leukocytes to pass from the CSF to the venous drainage system.

45. 0cclusion of the calcarine artery frequently produces contralateral hemianopsia but frequently spares
      macular vision because: 

 A. It does not distribute to visual cortex.
 B. The artery is too large for total occlusion to occur. 
 C. There is anastomosis with the anterior cerebral artery. 
 D. There is an anastomosis with the middle cerebral artery.

46. Which is incorrect regarding the cerebral circulation:

 A. Normal blood flow is 50-55 ml- per 100 grams of brain tissue
 B. 15% of total cardiac output goes to the brain
 C. Glucose is stored in great quantities and metabolism is anaerobic
 D. Rate of flow is regulated by tissue carbon dioxide content

47. Which of the following statements is true in regard to cerebral circulation:

 A. Increased CO2 or H+ concentration causes vasoconstriction
 B. The middle cerebral artery supplies the vascular supply of the mid portion of the cerebral cortex
 C. The medial striate artery is also called the "recurrent artery of Huebner" and is of clinical importance
 D. The normal cerebral blood flow accounts for 30% of the total resting cardiac output

48. An example of the control over cerebral blood flow is:

 A. An increase in C02 results in vascular vasoconstriction
 B. A decrease to areas of the brain involved in heavy metabolic activity
 C. An increase in H+ concentration results in vasodilation
 D. An increase in arterial pressure results in vasodilation
 E. An increase in arterial pressure results in increased flow through the opthalamic artery anastomosis

49. A fellow medical student decides to study cerebral hematomas by striking his lab partner with a blunt
      hammer on the back of the head with enough force to just fracture the bone. With your knowledge of the
      vasculature and meninges, what would you expect to find if you opened up the skull?

 A. A subdural hematoma due to damage to the middle meningeal artery
 B. A subdural, hematoma due to damage to the posterior meningeal artery
 C. A subarachnoid hematoma although the dura is intact
 D. No hematoma at all because there is no extradural space
 E. No hematoma at all because there is no blood supply underlying the occipital bone

50. Which is not correct in regard to cerebral blood flow control?

 A. Increased blood pressure causes vasoconstriction
 B. Increased CO2 or H+ concentration causes vasoconstriction
 C. Autonomic nerves can regulate blood flow
 D. Small intraparenchymal vessels may be supplied by noradrenergic nerves from the locus coeruleus
 E. All of the above

51. A ganglionic artery refers to:

 A. A terminal branch of a cerebral artery
 B. An artery which supplies dorsal root ganglion
 C. Small branches of the arteries composing the circle of Willis that supplies internal gray matter 
           of the brain
 D. None of the above

52. Cerebral Vascular occlusions:

 A. Are often related indirectly to arteriosclerotic Plaques
 B. Are most frequently related to the middle cerebral artery
 C. Are due to a weakening of the arterial tunica media
 D. A and B only
 E. All of the above