1. A person has a pituitary gland tumor. Which of the following brain structures is most likely to become affected as the tumor enlarges?

A. Oculomotor nerve
B. Medial orbitofrontal cortex
C. Mammillary body
D. Optic chiasm

Comment: The pituitary gland is located in the sella turcica. The optic chiasm is located directly above the sella turcica. As the tumor enlarges, because it is located with the bony sella, it can only expand dorsally, thereby impinging on the optic chiasm.

2. Complete the following analogy using the best choice: The parvocellular neurosecretory system is to the magnocellular neurosecretory system, as

A. the anterior pituitary gland is to the posterior pituitary gland.
B. the median eminence is to the adrenal gland.
C. the paraventricular nucleus is to the lateral hypothalamus.
D. the supraoptic nucleus is to the arcuate nucleus.

3. Which of the following statements best describes the median eminence?

A. It contains the neurovascular contacts of magnocellular neurosecretory neurons.
B. It contains the neurovascular contacts of parvocellular neurosecretory neurons.
C. It is where descending hypothalamic pathways course.
D. It is where ascending serotonergic and noradrenergic systems course from the brain stem to the forebrain.

Comment: The descending autonomic pathway from the hypothalamus courses through the medial forebrain bundle, en route to the brain stem.

4. Which of the following statements best describes how the central nervous system innervates smooth muscle and skeletal muscle?

A. Smooth muscle is innervated by autonomic preganglionic neurons, whereas skeletal muscle is innervated by somatic motor neurons.
B. Smooth muscle is innervated by autonomic postganglionic neurons, whereas skeletal muscle is innervated by somatic motor neurons.
C. Preganglionic neurons innervate postganglionic neurons, which innervate smooth muscle; skeletal muscle is innervated only by somatic motor neurons.
D. Preganglionic neurons innervate postganglionic neurons and somatic motor neurons; postganglionic neurons innervate smooth muscle; somatic motor neurons innervate skeletal muscle.

5. The components of the autonomic nervous system in the spinal cord are regulated by which of the following brain structures?

A. Mammillary body
B. Supraoptic nucleus
C. Paraventricular nucleus
D. Arcuate nucleus

6. A man has difficulty staying awake during the day. He often falls asleep during meetings and in social interactions. When he falls asleep, he usually loses all muscle tone. Which of the following neurotransmitters/neuromodulatory agents is affected in this patient?

A. Orexin
B. Histamine
C. GABA
D. 5-HT

Comment: The man likely has narcolepsy. The loss of muscle tone accompanying sleep is cataplexy, which is often associated with narcolepsy. Orexin-containing neurons in the lateral hypothalamus have been found to be diminished in number in the brains of people with narcolepsy.

7. Some antihistamine medications used to treat allergic reactions can cause drowsiness. This is because:

A. they act directly on hypothalamic centers to trigger sleep.
B. they shift the biological clock in the suprachiasmatic nucleus later in the day, so the brain thinks it is night time.  
C. they can block the central action of histamine, which normally activates forebrain neurons.
D. they can block the actions of the retinal projection to the hypothalamus.

Comment: The tuberomammillary nucleus releases histamine, as its neurotransmitter, throughout the forebrain. Histamine activates the target neurons. Antihistamines that cross the blood-brain barrier can block this action of histamine, and make the person drowsy.

8. The hypothalamus receives viscerosensory information to regulate blood pressure and fluid intake. Which of the following statements best describes how this information is transmitted to the hypothalamus?

A. It is relayed by the solitary and parabrachial nuclei.
B. It is transmitted directly by axons in the anterolateral system.
C. It is relayed from the insular and primary somatic sensory cortical areas.
D. It is transmitted from the orbitofrontal and cingulate cortical areas.

9. A person has a stroke that produces the following signs: ipsilateral mild ptosis, dry skin on the ipsilateral face, vertigo, ataxia of the ipsilateral leg, and a hoarse voice. A single occlusion of which artery could produce all of these signs?

A. Internal carotid artery
B. Anterior choroidal artery
C. Superior cerebellar artery
D. Posterior inferior cerebellar artery

10. A person has the following neurological signs: constricted pupil in left eye, decreased sweating on left side of face, and reddening of the left side of the face. Which of the following statements does not describe a site of a single lesion that produces these signs?

A. Dorsolateral midbrain
B. Medial pons
C. Lateral spinal cord white matter
D. Damage to sympathetic postganglionic axons in the neck

Comment: These are signs of loss of sympathetic control of cranial structures on the left side. They can be produced by damage to the left: hypothalamus, descending hypothalamic projection, spinal cord, superior cervical ganglion, or sympathetic fibers in the neck. Localization of the lesion is determined by other signs. For example, if there is also ataxia, the lesion is likely in the dorsolateral medulla, or if there is limb paralysis, it is in the spinal cord.