Physio CH 9
T/F Adults spend more time sleeping as they age.
FALSE
T/F All that we learn is put into memory.
FALSE
T/F All voluntary lateral pathways cross- over, or decussate, in the spinal cord.
FALSE
T/F Brain lateralization is absolute.
FALSE
T/F Glial cells are excitable cells.
FALSE
T/F Motor neurons are exclusively excitatory, which means that activity of those motor neurons cannot be modulated.
FALSE
T/F Movement of the right side of the body is controlled by the right side of the cerebral cortex.
FALSE
T/F Somatic reflexes involve somatic neurons transmitting information to smooth and cardiac muscle cells
FALSE
T/F The ascending and descending tracts of the spinal cord are found in the gray matter.
FALSE
T/F The brain runs exclusively on glucose.
FALSE
T/F The composition of cerebrospinal fluid is identical to plasma.
FALSE
T/F The reticulospinal tract is associated with sleep.
FALSE
T/F A stroke is also known as a cerebrovascular accident, or CVA.
TRUE
T/F All spinal nerves are mixed nerves containing both sensory and motor fibers.
TRUE
T/F As the night progresses, w e spend more time in rapid eye movement sleep.
TRUE
T/F Broca's and Wernicke's areas process sign language as well as spoken language.
TRUE
T/F Hydrogen ions cannot permeate the blood- brain barrier.
TRUE
T/F In the somatosensory cortex, the hands have a greater area of representation than the feet.
TRUE
T/F Initiation of a withdrawal reflex also activates the crossed- extensor reflex.
TRUE
T/F Multiple sclerosis is an autoimmune disease, meaning the body attacks itself.
TRUE
T/F Sleeping is an active process.
TRUE
T/F Stress can come in the form of exercise, changes in the environment, and injury.
TRUE
T/F Strokes can be classified as either occlusive or hemorrhagic.
TRUE
T/F The central nervous system is very sensitive to interruptions in blood flow.
TRUE
T/F The cerebral cortex carries out the highest level of neural processing.
TRUE
T/F The facilitated diffusion of molecules across the blood- brain barrier relies on protein carriers that are specific for the movement of particular molecules.
TRUE
T/F The frontal lobes are associated with personality.
TRUE
T/F The hypothalamus is the major link between the endocrine system and the nervous system.
TRUE
T/F The majority of cells in the nervous system are glial cells.
TRUE
T/F The sulci and gyri of the brain provide more surface area and more volume for the cerebral cortex to reside.
TRUE
What type of glial cells plays a critical role in maintaining extracellular potassium levels? A) oligodendrocytes B) Schwann cells C) microglia D) astrocytes E) ependymal cells
D) astrocytes
A new mother is visiting the pediatrician because her baby is sleeping up to 17 hours a day. She jokes with the doctor that her husband, who is quite older than she, sleeps only 5 hours a day and seems fully rested. Which of the following would be the most likely response from the physician? A) "Your baby is fine. It is normal for babies to sleep up to 17 hours a day. By the way, it is also normal for older adults to need less sleep as they age." B) "The normal sleep cycle is 8 hours. We need to hospitalize your baby for observation." C) "Your baby is sleeping too much, but since your husband is up, have him play with the baby." D) "Your baby is fine. It is normal for babies to sleep up to 17 hours a day. However, you probably need to send your husband to a doctor since a person needs to sleep at least 8 hours a day." E) "I will refer you to a sleep center as both your baby and husband need to be evaluated for sleep disorders."
A) "Your baby is fine. It is normal for babies to sleep up to 17 hours a day. By the way, it is also normal for older adults to need less sleep as they age."
Which area of the brain is necessary for language expression? A) Broca's area B) basal nuclei C) primary somatosensory cortex D) primary auditory cortex E) Wernicke's area
A) Broca's area
Physicians administer drugs or do spinal taps in the lumbar region of the spine. Which statement best describes why the lumbar region of the spine is used for such procedures? A) It is due to the anatomical feature known as the cauda equina (Latin "horse tail"), meaning the spinal cord spreads out into individual nerves and the physician is less likely to harm the spinal cord. B) This is where the dorsal and ventral roots are located and drugs administered to the roots are more effective. C) Patients are less sensitive in this area of the back. D) It is because of gravity; the CFS has more pressure in the lumbar region of the spine. E) It is due to the anatomical feature of projection fibers that connect the spinal cord with the brain so the drugs will make it to the brain.
A) It is due to the anatomical feature known as the cauda equina (Latin "horse tail"), meaning the spinal cord spreads out into individual nerves and the physician is less likely to harm the spinal cord.
What anatomical feature of the brain has a similar function to that of the cerebellum? A) basal nuclei B) corpus callosum C) cingulate gyrus D) amygdala E) choroid plexus
A) basal nuclei
When you're awake and alert, an EEG shows a pattern of high- frequency, low- amplitude oscillations known as ________. When you're awake but resting, the EEG shifts to a new pattern of lower- frequency, higher- amplitude waves known as ________. A) beta waves : alpha waves B) sigmoid waves : electromagnetic waves C) delta waves : theta waves D) alpha waves : beta waves E) theta waves : delta waves
A) beta waves : alpha waves
What are the fibers that connect the cortical regions on one side of the brain with the corresponding cortical region on the other side of the brain? A) commissural fibers B) spinothalamic tracts C) projection fibers D) arcuate fasciculi E) association fibers
A) commissural fibers
The transitioning of a memory from short term to long term is called A) consolidation. B) declaration. C) plasticity. D) remembering. E) memorizing.
A) consolidation.
What is the function of the tectospinal tract? A) controls the head so that the eyes can follow and object B) transmits impulses associated with pain C) transmits impulses associated with hearing D) controls the head, neck, and lumbar muscles in order to maintain posture E) controls muscle tone
A) controls the head so that the eyes can follow and object
118) The body surface is mapped into ________, which are regions that receive sensory information from particular spinal nerves. A) dermatomes B) homunculi C) motor programs D) cortexes E) reflex arcs
A) dermatomes
Through physical examination, neurologists can easily determine which spinal nerve has been damaged and at what level in the spinal cord an injury has occurred due to mapping out the various sensory regions called A) dermatomes. B) commissural fibers. C) projection fibers. D) association fibers. E) ganglia.
A) dermatomes.
Afferent and efferent axons travel together in spinal nerves, but they separate into different bundles when they leave and enter the spinal cord. The afferent axons enter the spinal cord via the ________ root and efferent axons leave the spinal cord via the ________ root. A) dorsal : ventral B) canal : spindle C) ventral : dorsal D) ascending : descending E) descending : ascending
A) dorsal : ventral
You go to the library to study for an exam only to find that parts of the library are being remodeled, creating many distracting noises. However, you decide to stay and complete your studies at the library because you have recently learned about ________, or a decrease in response to a repeated stimulus, such as the noises coming from the remodeling process. A) habituation B) sensitization C) consolidation D) plasticity E) declaration
A) habituation
101) Which area of the brain is the integration center for neural and endocrine controls? A) hypothalamus B) thalamus C) basal nuclei D) corpus callosum E) cerebellum
A) hypothalamus
102) Hunger and satiety centers are located in which area of the brain? A) hypothalamus B) thalamus C) basal nuclei D) corpus callosum E) cerebellum
A) hypothalamus
Thermoregulatory centers are located in which area of the brain? A) hypothalamus B) thalamus C) basal nuclei D) corpus callosum E) cerebellum
A) hypothalamus
This area of the brain is often referred to as the "control center" because it plays an important role in regulating homeostasis. It is involved in hunger, thirst, thermoregulation, and many other important homeostatic measures. A) hypothalamus B) thalamus C) cerebral cortex D) limbic system E) cerebellum
A) hypothalamus
The execution of a voluntary motor task involves a series of steps. Which of the following presents those steps in the correct order? A) intent, program, execute, feedback B) program, intent, execute, feedback C) feedback, intent, program, execute D) intent, feedback, program, execute E) program, intent, feedback, execute
A) intent, program, execute, feedback
92) Which of the following is a phagocytic cell that protects the central nervous system from pathogens? A) microglia B) Schwann cell C) astrocyte D) ependymal cell E) oligodendrocyte
A) microglia
A stroke occurring in the basal nuclei could produce which of the following symptoms? A) muscle rigidity B) altered sleep- wake patterns C) loss of language comprehension D) deafness E) blindness or blurred vision
A) muscle rigidity
Which of the following reflexes is a monosynaptic reflex found in the human body? A) muscle spindle stretch B) crossed- flexor C) pupillary light D) withdrawal E) crossed- extensor
A) muscle spindle stretch
The withdrawal reflex is initiated by activation of what type of receptor? A) nociceptor B) taste receptor C) photoreceptor D) muscle spindle stretch receptor E) warm receptor
A) nociceptor
Which cerebral lobe contains the visual cortex? A) occipital B) parietal C) temporal D) medial E) frontal
A) occipital
Which cranial nerve controls eye movements, papillary reflex, accommodation reflex, and proprioception? A) oculomotor B) trochlear C) trigeminal D) abducens E) glossopharyngeal
A) oculomotor
114) Where in the cerebral cortex does the awareness of limb positions and muscle tension occur? A) parietal lobe B) frontal lobe C) temporal lobe D) occipital lobe E) corpus callosum
A) parietal lobe
120) What endocrine gland is attached to the hypothalamus and involved in the regulation of circadian rhythms? A) pineal gland B) cingulate nuclei C) parahippocampal gyri D) fornix E) basal nuclei
A) pineal gland
122) The ability of the nervous system to adapt anatomically and functionally to changes in its activity is called A) plasticity. B) sensitization. C) consolidation. D) parallel processing. E) habituation.
A) plasticity.
What two tracts control skeletal muscle activity? A) pyramidal and rubrospinal tracts B) reticular spinal and corticospinal C) spinocerebellar and spinothalmic D) fasciculus gracilis and fasciculus cuneatus E) tectospinal and spinothalamic
A) pyramidal and rubrospinal tracts
121) Which of the following represents the five components of a reflex arc in the correct sequence? A) sensory receptor, afferent neuron, integration center, efferent neuron, effector organ B) integration center, sensory receptor, afferent neuron, efferent neuron, effector organ C) effector organ, sensory receptor, efferent neuron, afferent neuron, effector organ D) sensory receptor, efferent neuron, integration center, afferent neuron, effector organ E) sensory receptor, integration center, afferent neuron, efferent neuron, effector organ
A) sensory receptor, afferent neuron, integration center, efferent neuron, effector organ
116) The space between the pia mater and the arachnoid mater that contains cerebrospinal fluid is called the A) subarachnoid space. B) central canal. C) choroid plexus. D) ventricle. E) interventricular foramen.
A) subarachnoid space.
How is a reflex that involves signals sent along autonomic sensory nerves classified? A) visceral B) spinal C) cranial D) somatic E) innate
A) visceral
Which of the following characteristics is NOT a specialization of the left side of the cerebrum in most individuals? A) expression of language B) spatial perception C) comprehension of language D) logical reasoning E) analytical reasoning
B) spatial perception
The ________ plays a principle role in establishing the circadian rhythm of the body. A) putamen B) suprachiasmatic nucleus C) globus pallidus D) cingulate gyrus E) caudate nucleus
B) suprachiasmatic nucleus
Which of the following has NOT been proposed as a function of sleep? A) to facilitate long- term memory B) to clear short- term memory C) to enhance immune function D) mental practicing while dreaming E) to conserve energy
B) to clear short- term memory
The maintenance of an uninterrupted delivery of oxygen and glucose to the brain is essential to its function. What is it about the brain and nervous tissue in general that makes them so sensitive to changes in blood flow?
At rest, the central nervous system receives 15% of the blood pumped from the heart, while only accounting for 2% of body weight. This high proportion of blood flowing to the brain is necessary to meet the demands of this metabolically active tissue. At rest, the brain accounts for 20% of the oxygen and 50% of the glucose consumed by the body. Thus, high blood flow is required to ensure continuous delivery of oxygen and glucose to the brain. When those demands are not met, even for short periods of time (on the order of minutes, as would occur during cardiac arrest or during focal blood flow interruptions), the brain can be irreversibly damaged. This maintenance of blood flow is essential because the brain is not able to store glucose in the form of glycogen. At the same time, the brain is reliant on glucose as its primary energy source because neurons are incapable of metabolizing fatty acids. Thus, all of the brain's primary energy substrate, glucose, must be continuously extracted from the blood. The brain's reliance on oxygen derives from its inability to undergo anaerobic metabolism. There is an alternative fuel source, ketones, which can be used by the brain when glucose availability to the cell is reduced (during starvation or diabetes). Ketones in the blood are a byproduct of fatty acid metabolism in the liver. Up to 2/3 of the brain's energy substrate can be supplied by ketones, but the other third must still be derived from glucose. Thus, the brain relies on a continuous supply of glucose and oxygen through the vasculature in order to function.
The ability of the nervous system to alter its anatomy and function in response to changes in its activity pattern is called A) declaration. B) Plasticity C) consolidation. D) remembering. E) memorizing.
B) Plasticity
During an initial interview, a patient tells you that he is having intense bizarre nightmares but awakens spontaneously. What phase of sleep would you tell the physician the patient has described to you? A) slow- wave sleep (SWS) or non- REM sleep B) REM sleep C) stage 4 high- frequency sleep D) delta phase sleep E) stage 1 high- frequency sleep
B) REM sleep
94) Which of the following is the only glial cell located in the peripheral nervous system? A) microglia B) Schwann cell C) astrocyte D) ependymal cell E) oligodendrocyte
B) Schwann cell
The primary function of the ventromedial pathways is on the muscles of the A) ears, eyes, and mouth. B) trunk, neck, and proximal portions of the limb. C) stomach, back, and buttocks. D) fingers, wrists, and toes. E) knee, ankle, and foot.
B) trunk, neck, and proximal portions of the limb.
1) What is the function of gray matter in the CNS? A)signals the brain centers to produce dopamine B)neural integration and synaptic communication C)to speed up nerve transmission D)to carry information in tracts from the peripheral nervous system to the CNS E) to communicate between the different lobes of the brain
B)neural integration and synaptic communication
An epileptic patient has undergone a complete corpus callosotomy, a surgical procedure that results in the complete disconnection of the corpus callosum. Which statement best describes the behaviors you would observe in this type of patient? A) This area of the brain determines personality therefore the patient will undergo changes in personality, usually becoming more aggressive. B) Since communication between the hemispheres has been disconnected, the patient cannot name what the right side of the brain is seeing. C) This area of the brain controls the ability to see things in three dimensions; it is likely this patient will always be running into items. D) This area of the brain controls higher- order thinking therefore the patient will have no interest in solving problems. E) Since communication between the hemispheres has been disconnected, the patient will be unable to speak; you must have both sides of the brain working in order to form words.
B) Since communication between the hemispheres has been disconnected, the patient cannot name what the right side of the brain is seeing.
The increased influx of calcium at a postsynaptic terminal with glutamate receptors A) activates the NMDA receptor to increase calcium influx. B) activates a protein kinase that phosphorylates the AMPA receptor, making it more sensitive to glutamate. C) activates the AMPA receptor to increase sodium influx. D) causes a greater release of neurotransmitter from the postsynaptic cell. E) activates a protein kinase that phosphorylates the NMDA receptor, making it more sensitive to glutamate.
B) activates a protein kinase that phosphorylates the AMPA receptor, making it more sensitive to glutamate.
Which region of the limbic system is primarily involved in the emotion of fear? A) hippocampus B) amygdala C) fornix D) thalamus E) cingulate gyrus
B) amygdala
Which of the following is a descending tract? A) spinotectal tract B) anterior pyramidal tract C) lateral spinothalamic tract D) dorsal columns E) anterior spinothalamic tract
B) anterior pyramidal tract
What type of glial cell is necessary for normal development of the blood- brain barrier? A) Schwann cells B) astrocytes C) microglia D) oligodendrocytes E) ependymal cells
B) astrocytes
105) Damage to which area of the brain can result in Huntington's chorea or Parkinson's disease? A) cerebellum B) basal nuclei C) hypothalamus D) thalamus E) corpus callosum
B) basal nuclei
106) Which area of the brain provides feedback control of voluntary movement by comparing accomplished movement to planned movement? A) basal nuclei B) cerebellum C) corpus callosum D) hypothalamus E) thalamus
B) cerebellum
Which of the following is NOT a function of the hypothalamus? A) affects emotions and behaviors in response to emotions B) contains the cardiovascular control centers C) controls thermoregulation D) communication between the nervous and endocrine system E) controls hunger and thirst
B) contains the cardiovascular control centers
The face is innervated by what type of nerves? A) thoracic B) cranial C) lumbar D) sacral E) cervical
B) cranial
Which of the following would consist of white matter? A) basal nuclei B) dorsal columns of the spinal cord C) ventral horn of the spinal cord D) cerebral cortex E) dorsal horn of the spinal cord
B) dorsal columns of the spinal cord
112) Where in the cerebral cortex do thoughts occur? A) parietal lobe B) frontal lobe C) temporal lobe D) occipital lobe E) corpus callosum
B) frontal lobe
113) Where in the cerebral cortex do personality traits reside? A) parietal lobe B) frontal lobe C) temporal lobe D) occipital lobe E) corpus callosum
B) frontal lobe
Voluntary control of fine discrete movement happens in which lobe of the cerebral cortex? A) parietal lobe B) frontal lobe C) temporal lobe D) occipital lobe E) corpus callosum
B) frontal lobe
The ________ lobe contains the primary motor cortex, which initiates ________ movement. A) medial lobe : voluntary B) frontal lobe : voluntary C) occipital lobe : involuntary D) parietal lobe : voluntary E) temporal lobe : involuntary
B) frontal lobe : voluntary
During rapid eye movement sleep, there is a(n) ________ in frequency of the electroencephalogram and a(n) ________ in arousal threshold. A) increase : decrease B) increase : increase C) decrease : decrease D) decrease : increase E) stabilization : decrease
B) increase : increase
A characteristic sign of cerebellar damage which involves a violent shaking motion that becomes worse as the limb gets closer to its target is called a(n) ________ tremor. A) postural B) intention C) rest D) kinetic E) action
B) intention
Which of the following characteristics is NOT a specialization of the right side of the cerebrum in most individuals? A) creativity B) logic C) artistic qualities D) musical E) spatial perception
B) logic
What type of glial cell is a phagocyte? A) astrocyte B) microglia C) Schwann cell D) oligodendrocyte E) ependymal cell
B) microglia
99) The perception of vision begins in which area of the brain? A) primary auditory cortex B) primary visual cortex C) cerebellum D) Broca's area E) basal nuclei
B) primary visual cortex
54) What neural pathway provides for the control of fine, discrete movements of the extremities? A) spinothalamic tract B) pyramidal tract C) tectospinal tract D) rubrospinal tract E) reticularspinal tract
B) pyramidal tract
119) The region of the brainstem important in the sleep- wake cycle, the arousal of the cerebral cortex, and in consciousness is known as the A) medulla oblongata. B) reticular formation. C) pons. D) midbrain. E) corpus callosum.
B) reticular formation
When your mind is "racing" at night and you cannot fall asleep what, region of the brain is keeping you awake? A) cerebellum B) reticular formation C) forebrain D) limbic system E) pons
B) reticular formation
Which area of the brain plays an important role in sleep- wake cycles, arousal of the cerebral cortex, and consciousness? A) diencephalon B) reticular formation C) cerebellum D) frontal lobes E) temporal lobe
B) reticular formation
You're interviewing a patient who has recently had a stroke. You ask her to state her name and house address. She appears to understand your question, but when she tries to answer, she stutters and slurs her words, which are not grammatically correct. What type of aphasia is your patient displaying? A) isolation B) global C) Broca's D) anomic E) Wernicke's
C) Broca's
If you tend to remember your dreams, what stage of sleep are you in and what time of the night are the dreams likely occurring? A) REM sleep and early in the sleep cycle, or just as you make your way into REM sleep B) REM sleep during the alternating patterns of REM C) REM sleep and late into the sleep cycle, or prior to waking in the morning D) slow- wave sleep during stage 1, or just as you fall asleep E) slow- wave sleep during stage 4, or in deep sleep just before you go into REM sleep
C) REM sleep and late into the sleep cycle, or prior to waking in the morning
Which area of the brain is necessary for language comprehension? A) basal nuclei B) primary auditory cortex C) Wernicke's area D) Broca's area E) primary somatosensory cortex
C) Wernicke's area
Which of the following is known to cause drowsiness? A) vitamin D B) birth control pills C) antihistamines D) aspirin E) vitamin B12
C) antihistamines
95) Which of the following provides support for development of the blood- brain barrier? A) microglia B) Schwann cell C) astrocyte D) ependymal cell E) oligodendrocyte
C) astrocyte
96) Which of the following degrades certain neurotransmitters? A) microglia B) Schwann cell C) astrocyte D) ependymal cell E) oligodendrocyte
C) astrocyte
How is a reflex that requires communication with the brain classified? A) visceral B) spinal C) cranial D) somatic E) innate
C) cranial
Which of the following is NOT characteristic of slow- wave sleep? A) decreased brain activity B) snoring C) elaborate and intense dreams D) increased parasympathetic activity E) decreased muscle tone
C) elaborate and intense dreams
Which nerves innervate the anterior thigh? A) sacral nerves B) cervical nerves C) lumbar nerves D) thoracic nerves E) cranial nerves
C) lumbar nerves
What emotion is the strongest motivation predictor? A) anger B) fear C) pleasure D) depression E) aggression
C) pleasure
In addition to an increase in sensitivity to glutamate, the binding of large amounts of glutamate to its receptors on the postsynaptic membrane also A) directly causes more NMDA channels to open. B) can overwhelm the synapse. C) stimulates the release of a paracrine messenger that further increases glutamate release. D) affects other synapses that are close to the first. E) stimulates presynaptic autoreceptors and enhances its release.
C) stimulates the release of a paracrine messenger that further increases glutamate release.
What symptom of stroke distinguishes it from other neurological disorders? A) paralysis B) muscleweakness C) sudden onset D) tingling sensations in the extremities E) loss of vision
C) sudden onset
111) Where in the cerebral cortex does auditory perception occur? A) parietal lobe B) frontal lobe C) temporal lobe D) occipital lobe E) corpus callosum
C) temporal lobe
What region of the diencephalon filters and refines sensory information, allowing us to direct our attention to specific external stimuli? A) limbic system B) hypothalamus C) thalamus D) basal nuclei E) putamen
C) thalamus
Which cranial nerve controls the muscles for chewing? A) oculomotor B) trochlear C) trigeminal D) abducens E) glossopharyngeal
C) trigeminal
What type of glucose transporter is located in the endothelial cells of the blood- brain barrier? A) GLUT- 4 B)co transporter with sodium C)GLUT- 1 D)counter transporter with sodium E)GLUT- 2
C)GLUT- 1
Insulin is known to cross the blood- brain barrier and attach to receptors in the brain. Which statement best describes the function of insulin in the brain? A)It causes stroke. B)It increases hunger. C)It assists in glucose metabolism. D) It decreases hunger. E) It signals the brain to release glucagon
D) It decreases hunger.
Which statement best describes why the brain requires an uninterrupted supply of blood? A) TheCNS has very little glycogen to convert to glucose. B) TheCNS does not have access to fatty acids for energy, which increases their demand for glucose. C) The CNS has a limited ability to produce energy anaerobically. D) The CNS has limited glycogen to convert to glucose, it does not have access to fatty acids for energy, and it has limited ability to produce energy anaerobically. E) The CNS has very little glycogen to convert to glucose and has limited ability to produce energy anaerobically.
D) The CNS has limited glycogen to convert to glucose, it does not have access to fatty acids for energy, and it has limited ability to produce energy anaerobically.
If a bilingual person has a stroke in the language centers of the brain, which statement best describes the likely outcome of recovering one of the languages? A) The person is most likely to speak both languages within the same sentence. B) The most recently learned language will suffer the greatest deficit. C) If both languages were learned at about the same time, then the two languages will be equally affected. D) The most recently learned language will suffer the greatest unless both languages were learned at about the same time in which case both languages will be equally affected. E) The most recently learned language will not be affected.
D) The most recently learned language will suffer the greatest unless both languages were learned at about the same time in which case both languages will be equally affected.
You're interviewing a patient who has recently had a stroke. You ask him to state his name and house address. He has no response. You write down your question and have him read it. His reply is "yesterday morrow soon." What type of aphasia is your patient displaying? A) anomic B) global C) Broca's D) Wernicke's E) isolation
D) Wernicke's
What area of the brain controls language comprehension? A) amygdala B) limbic system C) Broca's area D) Wernicke's area E) hypothalamus
D) Wernicke's area
Huntington's disease is one of the few dominant genetic disorders that causes exaggerated involuntary jerking motions and progressive dementia. What area of the brain is primarily responsible for these symptoms? A) cingulate gyrus B) amygdala C) corpus callosum D) basal nuclei E) choroid plexus
D) basal nuclei
Which area of the brain contains the ascending reticular activating system? A) thalamus B) hypothalamus C) brain stem D) basal nuclei E) cerebellum
D) basal nuclei
In order for ions to move across the capillary endothelial cells of the blood-brain barrier,they must A) move through pores between endothelial cells. B) move through the endothelial cell layer by transcytosis. C) belipophobic. D) be transported across endothelial cells. E) be hydrophilic.
D) be transported across endothelial cells.
Which of the following areas of the brain is involved in coordinated movement? A) pineal gland B) brainstem nuclei C) thalamus D) cerebellum E) cortex
D) cerebellum
Which spinal nerves originate in the neck region? A) lumbar nerves B) coccygeal nerve C) thoracic nerves D) cervical nerves E) sacral nerves
D) cervical nerves
Alzheimer's disease is caused by the loss of ________ neurons in certain brain areas and replacement of the lost neurons with scar tissue called ________. A) adrenergic:plaques B) muscarinic : myelin C) adrenergic : myelin D) cholinergic : plaques E) cholinergic:myelin
D) cholinergic : plaques
117) What area of the brain connects the left and right sides of the brain? A) association fibers B) astrocytes C) projection fibers D) corpus callosum E) blood- brain barrier
D) corpus callosum
The euphoria that is perceived when one ingests drugs such as opioids or amphetamines results from the activation of the ________ system. A) sympathetic B) adrenergic C) nitridergic D) dopaminergic E) cholinergic
D) dopaminergic
Where is the thermoregulatory center? A) hippocampus B) pons C) medulla oblongata D) hypothalamus E) amygdala
D) hypothalamus
Which of the following is NOT characteristic of rapid eye movement (REM) sleep? A) increased brain activity B) decreased limbic system activity C) illogical and bizarre thoughts D) increased parasympathetic activity E) loss of postural muscle tone
D) increased parasympathetic activity
An ascending or descending pathway that is located on the same side of the central nervous system integration center is called A) contralateral. B) longitudinal. C) commissural. D) ipsilateral. E) lateralized.
D) ipsilateral.
What area of the brain is often referred to as the "primitive brain" due to its association with very basic human drives such as aggression, fear, and the sense of smell? A) cerebral cortex B) thalamus C) cerebellum D) limbic system E) hypothalamus
D) limbic system
The crossed- extensor reflex is initiated by activation of what type of receptor? A) taste receptor B) muscle spindle stretch receptor C) photoreceptor D) nociceptor E) warm receptor
D) nociceptor
In studying for this exam you acquired new knowledge and hopefully retained it. If you used a repetitive approach such as studying from note cards, this type of learning is referred to as ________. If you studied using, for example, the same information but linked to a case study, this type of learning is referred to as ________. A) nonprocedural : procedural B) declarative : procedural C) associative : nonassociative D) nonassociative : associative E) procedural : nonprocedural
D) nonassociative : associative
110) Where in the cerebral cortex does visual perception occur? A) parietal lobe B) frontal lobe C) temporal lobe D) occipital lobe E) corpus callosum
D) occipital lobe
Rapid eye movement (REM) is called paradoxical sleep because A) electroencephalogram activity can change quite extensively during REM sleep. B) electroencephalogram activity reverts toward that observed in an awake, alert person. C) electroencephalogram activity is quite different from slow- wave sleep. D) people are more likely to awaken spontaneously during REM sleep when arousal threshold is highest. E) people are less likely to awaken spontaneously during REM sleep when arousal threshold is lowest.
D) people are more likely to awaken spontaneously during REM sleep when arousal threshold is highest.
115) The three meninges from neural tissue to bone are A) arachnoid mater, pia mater, and dura mater. B) dura mater, arachnoid mater, and pia mater. C) pia mater, dura mater, and arachnoid mater. D) pia mater, arachnoid mater, and dura mater. E) dura mater, pia mater, and arachnoid mater.
D) pia mater, arachnoid mater, and dura mater.
Threading a needle or a fishing hook would involve which of the following tracts? A) spinocerebellar B) vestibulospinal C) tectospinal D) pyramidal E) reticulospinal
D) pyramidal
100) Which area of the brain relays sensory information to the cerebral cortex? A) cerebellum B) corpus callosum C) basal nuclei D) thalamus E) hypothalamus
D) thalamus
Damage to the cerebellum will lead to which of the following symptoms? A) the generation of slow, fine movements only B) the generation of movement of large muscle groups only C) a complete inability to move (lack of execution) D) the generation of clumsy, poorly directed movements E) an inability to accurately plan a movement
D) the generation of clumsy, poorly directed movements
The lower motor neurons that innervate skeletal muscle, and induce them to contract, originate from the A) dorsal horn of the spinal cord. B) pyramidal tract. C) basal nuclei. D) ventral horn of the spinal cord. E) motor cortex.
D) ventral horn of the spinal cord.
Which statement best describes why nicotine should be avoided before going to bed? A) It binds to receptors in the corpus callosum, which stimulates both sides of the brain. B) It binds to receptors in the cerebral cortex, which is involved in wake/sleep cycles. C) Nicotine should not be avoided before bed; it will help relax you before going to sleep. D) Nicotine is a depressant and, therefore, negative feedback speeds up your heart and respiratory systems, which keep you from relaxing. E) Nicotine mimics acetylcholine, which is associated with the ascending reticular activating system.
E) Nicotine mimics acetylcholine, which is associated with the ascending reticular activating system.
In the motor and sensory homunculi, each body part is shown next to the area of cerebral cortex devoted to it. Which statement best describes what these homunculi represent? A) The homunculi map out the dermatomes of the body. B) The relative size of the body part distinguishes which part is primarily on the right side of the brain versus the left. C) The relative size of the body parts corresponds to the ascending and descending tracts that control that body part. D) The homunculi are open to interpretation by neurologists, based upon his or her area of specialty. E) The relative size of the body part represents the relative size of the cortical area devoted to that body part.
E) The relative size of the body part represents the relative size of the cortical area devoted to that body part.
Which of thefollowing protectsthesoft tissuesof thebrain? A) cerebrospinal fluid (CSF) B) themeninges C) thecranium D) cerebrospinal fluid (CSF) and the cranium E) cerebrospinal fluid (CSF), the meninges, and the cranium
E) cerebrospinal fluid (CSF), the meninges, and the cranium
Tight junctions between capillary endothelial cells in the central nervous system create the blood - brain barrier, there by restricting what type of movement of molecules into the brain ? A) active transport of B) diffusion of lipophilic C) facilitated diffusion of hydrophobic D) transcytosisof E) diffusion of hydrophilic
E) diffusion of hydrophilic
Parkinson's disease appears to target ________ cells within the ________. A) adrenergic : substantia nigra B) adrenergic : red nuclei C) cholinergic : substantia nigra D) cholinergic : red nuclei E) dopaminergic : substantia nigra
E) dopaminergic : substantia nigra
In response to stepping on a nail, the crossed- extensor reflex causes A) flexion of the leg opposite the side of receptor activation. B) extension of the leg on the side of receptor activation. C) flexion of the leg on the side of receptor activation. D) extension of the arm on the side of receptor activation. E) extension of the leg opposite the side of receptor activation.
E) extension of the leg opposite the side of receptor activation.
Which cranial nerve controls the motor control of swallowing and salivary glands and taste? A) oculomotor B) trochlear C) trigeminal D) abducens E) glossopharyngeal
E) glossopharyngeal
Which of the following substances requires mediated transport to cross the blood-brain barrier? A) carbon dioxide B) oxygen C) hydrogen ions D) ethanol E) glucose
E) glucose
How is a reflex with which we are born classified? A) visceral B) spinal C) cranial D) somatic E) innate
E) innate
How is a reflex that requires only a single synapse between two neurons classified? A) bineuronal B) polysynaptic C) bisynaptic D) polyneuronal E) monosynaptic
E) monosynaptic
93) Which of the following forms myelin in the central nervous system? A) microglia B) Schwann cell C) astrocyte D) ependymal cell E) oligodendrocyte
E) oligodendrocyte
97) Which of the following enhances the conduction velocity of neurons in the central nervous system? A) microglia B) Schwann cell C) astrocyte D) ependymal cell E) oligodendrocyte
E) oligodendrocyte
What emotion drives addiction? A) depression B) aggression C) fear D) anger E) pleasure
E) pleasure
98) The perception of touch sensations begins in which area of the brain? A) limbic system B) basal nuclei C) cerebellum D) primary somatosensory cortex E) primary motor cortex
E) primary motor cortex
In long- term potentiation, the enhanced possibility that an activated postsynaptic membrane will generate an action potential is associated with a(n) A) increased number of EPSPs. B) increase in its threshold. C) increased strength of the EPSPs. D) decrease in its threshold. E) reduction in the number of IPSPs.
E) reduction in the number of IPSPs.
Your roommate not only talks in her sleep but also sleepwalks. Which statement best describe what sleep phase she is in? A) delta phase sleep B) REM sleep C) stage 1 high- frequency sleep D) stage 4 high- frequency sleep E) slow- wave sleep (SWS) or non- REM sleep
E) slow- wave sleep (SWS) or non- REM sleep
Which of the following does NOT describe a type of reflex that occurred when Pavlov's dogs salivated in response to the ringing of a bell? A) conditioned B) visceral C) polysynaptic D) cranial E) spinal
E) spinal
Which cerebral lobe contains the auditory cortex? A) parietal B) frontal C) occipital D) medial E) temporal
E) temporal
Describe the receptor- mediated events that appear to play a role in long- term potentiation and learning plasticity within the central nervous system.
Learning and memory are able to occur within the brain because of its plasticity, which can be defined as the brain's ability to alter its anatomy and function in response to changes in its activity pattern. This plasticity derives from the fact that the function of existing synapses can be altered for short or long periods of time. Long- term potentiation is one form of plasticity. Repetitive stimulation of a particular synapse eventually leads to an increase in the strength of the synaptic connection. (The synapse is more likely to develop an action potential when stimulated.) This enhanced ability to generate an action potential is mediated by an increase in the strength of the excitatory postsynaptic potential (EPSP) generated. The EPSP can be increased by 1) increasing the sensitivity of a postsynaptic receptor to a neurotransmitter, or 2) increasing the amount of neurotransmitter released, or 3) both. Long- term potentiation is thought to be important in the consolidation of long- term memory. One type of potentiation occurs in synapses with the neurotransmitter glutamate. There are two receptors for glutamate that are present on the postsynaptic membrane: NMDA and AMPA receptors. NMDA receptors initiate the opening of calcium channels, whereas AMPA receptors cause sodium channels to open. When glutamate is released into the synapse, both receptors are activated. The amount of glutamate released is dependent upon the frequency of action potentials within the presynaptic membrane. When glutamate release is low to moderate, some AMPA receptors and NMDA receptors are activated, opening sodium and calcium channels, respectively. Even though the NMDA channels are open, the movement of calcium through these channels is blocked by magnesium. Thus, the extent of the depolarization is reduced by the blockade of NMDA receptors by magnesium when glutamate levels are low to moderate. However, if the frequency of action potentials is increased, large amounts of glutamate are released. This produces a stronger depolarization that prevents the magnesium- induced blockade of the NMDA, thereby increasing the extent of depolarization. At the same time, this increased calcium influx triggers the activation of protein kinases. These protein kinases can 1) phosphorylate AMPA receptors, making them more sensitive to glutamate (which further enhances the depolarization), and 2) stimulate the postsynaptic membrane to release a paracrine messenger that triggers presynaptic release of glutamate. All of these changes increase the likelihood that the glutamate released across the synapse will initiate an action potential in the postsynaptic membrane.
Describe memory and learning, including the different types of learning and memory.
Learning is described as the acquisition of new information or skills. Memory is the retention of information, skills, or thoughts. There are two major types of learning that take place: associative and nonassociative. Associative learning requires making connections between two or more stimuli. We learn to associate one thing with another (Pavlov's dog is an example). Nonassociative learning occurs in response to repetition of the same stimulus and includes the process of habituation and sensitization. Habituation is a decrease in the response to a repeated stimulus. Sensitization is an increase in response to a repetitive stimulus. Memory can be classified as either procedural or declarative. Procedural memory is the memory of learned motor skills and behaviors. This type of memory is thought to reside in the cerebellum. Declarative memory is the memory of learned experiences such as facts or events that can be stated verbally. Memory occurs at two levels: long term and short term. Short- term memory is temporary storage that lasts only a few seconds. That memory will be lost if it is not consolidated into long- term memory. The methods by which consolidation occur are not well understood.
Characterize the four types of reflexes, including the essential components of a reflex arc, and describe the details of the withdrawal reflex.
Reflexes describe automatic, patterned responses to a sensory stimulus. As such, reflexes can be distributed into four categories: spinal vs. cranial (depending upon the region of the nervous system where responses are integrated), somatic vs. autonomic (depending upon the efferent pathway that is activated), conditioned vs. innate (depending upon whether they are learned or not), and monosynaptic vs. polysynaptic (the number of synapses in the pathway). A reflex arc is composed of a sensory receptor, an afferent neuron, an integration center, an efferent neuron, and an effector organ. The reflex arc is initiated by a sensory receptor that detects a stimulus, which is then communicated to the integration center via an action potential, thereby resulting in an efferent response. For the withdrawal reflex, the sensory receptor originating the response is a nociceptor, which detects an intense stimulus that is potentially damaging. The action potential generated by the afferent neuron travels to the spinal cord and synapses with a number of interneurons. One of the interneurons excites the efferent neurons that innervate the flexor muscle of the limb affected (the flexor muscles of the leg is the hamstring), causing that limb to withdraw. In order for this to work effectively, the antagonistic muscles (the extensor muscles of the leg are the quadriceps) must be simultaneously relaxed. Thus, at the same time the excitatory interneuron is activated, an inhibitory interneuron is activated that reduces frequency of action potentials along the efferent neuron, causing the quadriceps muscle to relax. If we were standing at the time, the movement of one leg only would result in a loss of balance. So, the withdrawal reflex also activates the crossed- extensor reflex. This reflex is mediated by other interneurons within the spinal cord that synapse with the nociceptor that originated the reflex. Those interneurons synapse with efferent neurons that innervate the flexor and extensor muscle of the opposite leg. In the opposite leg, the response initiated is the opposite of what occurs in the leg where the reflex was originated: the extensor contracts while the flexor relaxes. This crossed- extensor reflex allows us to rapidly withdraw from a painful stimulus (like stepping on a tack) without losing our balance.
Define sleep, listing the theories that have been developed to explain our need for sleep. Include in this discussion the two types of sleep and the characteristics of each type of sleep.
Sleep is an active process that requires energy and is defined as a state of depressed motor activity and perception that occurs on a cyclical basis. Note that activity is decreased but is not completely absent during sleep. Several theories have been developed to explain our need for sleep. Sleep may 1) play a restorative role, allowing us to recover from our daily activity, 2) provide us an opportunity to conserve energy, 3) allow us to dream, providing time for mental practicing, 4) facilitate long- term memory storage, and 5) provide a time for the immune system to function optimally. From measurement of brain waves via electroencephalogram (EEG), sleep has been divided into two types: 1) slow- wave sleep (SWS), characterized by multiple stages of low- frequency EEG waves, and 2) rapid eye movement sleep (REM), characterized by high- frequency brain waves and periodic rapid eye movement. In SWS, muscle tone is decreased, but occasional bursts of involuntary activity occur every 10- 20 minutes. In the brain, activity decreases in most regions except the parasympathetic nervous system, where activity is increased. During SWS, a person may dream but the dreams are less detailed than during REM sleep, and are more logical and less emotional. In REM sleep, postural muscles lose their tone and become paralyzed and the jaw muscles relax (causing the mouth to open). Snoring usually occurs within SWS sleep. In REM sleep, the muscles controlling face, eyes, and distal limbs frequently twitch. REM sleep demonstrates an overall increase in brain activity compared to SWS sleep, except for the limbic system, where activity decreases during REM sleep. Periodically, breathing is stimulated and sympathetic activity is increased. Heart rate and blood pressure may rise while body temperature control is lost. During REM sleep, dreams are more elaborate and intense and are usually more narrative. In SWS, dreams are more like feelings or apparitions, whereas in REM sleep, thoughts are more illogical and bizarre.
The cortex is not the only functional portion of the cerebrum; subcortical structures are important to a number of systems. Describe the subcortical structures of the cerebrum and their various functions.
Subcortical structures are nuclei (clusters of neuron cell bodies) located deep within the cerebrum that include the basal nuclei, thalamus, hypothalamus, and the limbic system. The basal nuclei include the caudate nucleus, the globus pallidus, and the putamen. These structures are involved in modifying movement. The thalamus is a cluster of nuclei located within the diencephalon. All sensory information has a direct relay through the thalamus (with the exception of smell). Thus, the thalamus is involved in filtering and refining sensory information, directing attention to specific sensory information, and in the control of movement. The hypothalamus, located below the thalamus, is primarily involved in the maintenance of body homeostasis. The hypothalamus is an important link between the endocrine and nervous system via its release of tropic hormones (which are neurohormones). These tropic hormones stimulate the release of hormones from the anterior pituitary as well as stimulate the release of hormones from the posterior pituitary (antidiuretic hormone and oxytocin). The hypothalamus is also involved in the regulation of behaviors through centers like the satiety and hunger center (eating behavior) as well as the thirst center (drinking). Many of the responses produced by the hypothalamus are ultimately regulated by the autonomic nervous system, including emotions that can affect digestive, cardiovascular, and respiratory function through inputs to the brainstem and body temperature. Finally, the hypothalamus is responsible for the generation of circadian rhythms originating from the suprachiasmatic nucleus. The limbic system is a collection of closely associated cortical, subcortical, and forebrain regions that function in learning and emotion. This system includes the amygdala, hippocampus, fornix, and cingulate gyrus of the cerebral cortex as well as portions of the thalamus and hypothalamus. The limbic system is the primitive region of the brain involved in basic drives. The hippocampus is a major component in the regulation of learning and memory.
The development of the cerebral cortex is what appears to set humans apart from other species. Identify the structures and general functions of the cortex.
The cerebral cortex is the outer layer of the cerebrum that is composed of highly convoluted layers of gray matter. These convolutions consist of grooves (sulci) and ridges (gyri) that allow for a greater surface area of the cortex. This thin outer layer is comprised of six functionally distinct layers. The cerebral cortex carries out the higher neural functions, including perception, formulating ideas, experiencing emotion, recalling past events, and coordinating body movements. Each of the cerebral hemispheres can be divided into four distinct lobes: the frontal, parietal, occipital, and temporal lobes. The frontal lobe is the foremost portion of the cerebrum and is separated from the parietal lobe by the central sulcus. Behind the parietal lobe is the occipital lobe, while the temporal lobe is located beneath the frontal andparietal lobes on the side of the brain and is separated from the frontal lobe by the lateral sulcus (Sylvian fissure). The occipital lobe contains the visual cortex, which is involved in the processing of visual information. The auditory cortex is located within the superior temporal lobe. The primary somatosensory cortex is located within the parietal lobe and is involved in processing somatic sensory information from the surface of the skin (somesthetic) as well as an awareness of muscle tension and joint and limb position (proprioception). The frontal lobe contains the primary motor cortex that initiates voluntary movement, and is also important in language, planning, and personality development. Several regions of the cortex are topographically organized, the best examples of which are the primary motor cortex and the primary somatosensory cortex. Their somatotopic organization can be mapped into motor and sensory homunculi that indicate which regions of the cortex are devoted to a particular region of the body. Both the primary visual cortex and primary auditory cortex are mapped similarly. This is not to say that the regions of the cortex are isolated from one another. There are association areas within the cortex that provide for integration of information between the lobes of the cortex. There are two cerebral hemispheres whose divisions appear to be both anatomical and functional. There appears to be specialization of the right and left sides of the brain. The right side of the brain receives sensory information from the left side of the body and controls the motor system on this side of the body. The right hemisphere appears to be involved in creative and artistic endeavors, whereas the left hemisphere appears to be involved in the performance of logical, analytical tasks.
Describe the structure of the spinal cord and how the spinal cord is organized.
The spinal cord is a cylinder of nervous tissue, continuous with the lower portion of the brain. The spinal cord is surrounded by the vertebral column. At each intersection of the vertebral column, a pair of spinal nerves exits the spinal cord for a total of 31 pairs of spinal nerves. The spinal nerves are classified by the vertebral column from which they emerge (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and the coccygeal nerve). However, the spinal cord does not travel the entire length of the vertebral column. The spinal cord only travels 2/3 of the length of the vertebral column with the remainder containing spinal nerves. This bundle of spinal nerve is called the cauda equina. The nerve fibers that leave the spinal cord within the spinal nerves travel to adjacent tissues, making it possible to map the body into sensory regions called dermatomes, which are associated with specific spinal nerves. The spinal cord is composed of both gray and white matter, with the gray matter assuming a butterfly- like arrangement when viewed in cross- section. The gray matter contains interneurons, efferent neurons (dendrites and cell bodies), and axon terminals of afferent neurons. The gray matter is organized into the dorsal and ventral horn, with the dorsal horn containing the terminal axon of afferent neurons (the cell bodies of those neurons are located within the dorsal root ganglia). The ventral horn contains the cell bodies of the efferent neurons that travel to the periphery and synapse with skeletal muscle. In the thoracic and upper lumbar regions of the spinal cord, there is also a lateral horn (intermediolateral cell column) from which the efferent neurons of the autonomic nervous system originate. Both afferent and efferent neurons travel in spinal nerve bundles, but they separate before entering the spinal cord. Afferent fibers enter through the dorsal root, whereas efferent fibers exit through the ventral root. The white matter of the spinal cord provides tracts that communicate with other levels of the spinal cord or with the brain. Ascending tracts carry information to the brain, whereas descending tracts carry information from the brain to the spinal cord.
Researchers have developed a "bionic arm." This technology is possible primarily because of two facts of amputation. First, the motor cortex still sends out control signals even if certain voluntary muscles are no longer there to innervate. Second, when doctors amputate a limb, they do not remove all the nerves that once carried signals to the muscles in that limb. If those nerve endings can be redirected to a working muscle group, and the person thinks "grab the handle and turn," then the brain will send out corresponding signals to the nerves and communicate with the new limb. Based on your knowledge of voluntary motor tasks, explain how this technology is possible.
There are four main steps involved in the successful execution of a voluntary motor control of a muscle. First, there must be intention or in this case the thought of "grab the handle and turn." Then, a program of motor commands must be generated in the primary motor cortex which sends information to be "executed" by afferent motor tracts (primarily the pyramidal and rubrospinal tracts). Finally, feedback must be sent back to the CNS, this time no doubt by some electrode in the "bionic arm" to ensure the original program is being followed. This "bionic arm" must work very similarly to the example given in the textbook where mission controllers program a trajectory but a computer on board the spacecraft can always make adjustments to the program based on feedback. This means the cerebellum must also be involved in controlling the bionic arm keeping track of its position and movements.
Liz is a seventy- year- old woman who is both a wife and a mother. She is moderately obese (BMI 32), and has smoked a half a pack to a pack of cigarettes a day since she was 16 years old. Liz awakes one morning with weakness on her right side. She is confused, sees double, and has slurred speech. She stumbles and has an awkward gait trying to get to the restroom, where she collapses. Her husband calls 911 and Liz is transported to the hospital. Upon physical examination, Liz is found to have partial paralysis (hemiparesis) on her right side and diminished sensitivity to a pin prick on her arm and right side of her face. She has difficulty answering questions, speaking only a few words which are slurred and grammatically incorrect. Her ability to respond to verbal commands, whether spoken or written, is not impaired. In addition, her blood pressure is high (148/and a serum lipid profile that was ordered when she first arrived at the hospital has come back with a high LDL and total cholesterol level. Based on this case answer the following questions: a) What is a stroke? b) Describe the mechanisms by which strokes can occur. c) List the risk factors that predispose an individual to suffer a stroke. d) List at least three classical signs of stroke e) What type of aphasia does Liz display? Explain how you came to this conclusion. f) Based on the historical and physical exam findings, what is the possible cause for Liz's stroke and what specific areas of the brain have been damaged as a result of her stroke?
a) Cerebrovascular accidents (CVA), commonly called strokes, are the third leading cause of death in the U.S. b) Strokes occur when either there is an obstruction of blood flow to a region of the brain or by hemorrhage. c) Risk factors include hypertension, cigarette smoking, high cholesterol, diabetes mellitus, obesity, and a sedentary lifestyle. d) Classical signs of stroke are: sudden numbness or weakness of the face, arm, or leg, especially on one side of the body; confusion; trouble speaking or understanding speech; trouble seeing; sudden dizziness or loss of balance or coordination; and, finally severe headache with no known cause. e) Liz has Broca's aphasia because she can comprehend both oral and written language which she would not be able to do if she had Wernicke's aphasia. Her speech is slurred and is not grammatically correct, which are usually signs of Broca's aphasia. f) Based on her historical and physical examination, Liz has had a stroke on the left side of her brain, probably in the primary motor cortex. Her inability to articulate words indicates a deficit involving Broca's area of the brain. Her stroke was probably caused by a plaque due to high cholesterol as well as hypertension and the fact that she has smoked most of her life.