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Neuro 7

front 1

Sensory neuron fibers are classified into four major groups primarily by:

A. Neurotransmitter and origin
B. Size and function
C. Color and trajectory
D. Root level and side

back 1

B. Size and function

front 2

Largest diameter, proprioception:

A. A-delta
B. C
C. A-beta
D. A-alpha

back 2

D. A-alpha

front 3

Proprioception, light touch, deep touch

A. A-delta
B. C
C. A-beta
D. A-alpha

back 3

C. A-beta

front 4

Pain, cold temperature, itch

A. A-delta
B. C
C. A-beta
D. A-alpha

back 4

A. A-delta

front 5

Smallest diameter, warm temperature, itch

A. A-delta
B. C
C. A-beta
D. A-alpha

back 5

B. C

front 6

Compared with smaller unmyelinated fibers, larger myelinated fibers generally conduct:

A. More slowly
B. More rapidly
C. Only centrally
D. Intermittently

back 6

B. More rapidly

front 7

The cell bodies of primary sensory neurons are located in the:

A. Ventral horn
B. Dorsal root ganglion
C. Spinothalamic tract
D. Posterior column nucleus

back 7

B. Dorsal root ganglion

front 8

Primary sensory neurons are termed pseudounipolar because they have:

A. Two dendrites, no axon
B. One axon, one dendrite
C. One process splitting in two
D. Many peripheral branches only

back 8

C. One process splitting in two

front 9

In a pseudounipolar sensory neuron, one process extends peripherally while the other projects into the:

A. Cerebellar cortex
B. Spinal cord gray matter
C. Internal capsule
D. Ventral root ganglion

back 9

B. Spinal cord gray matter

front 10

A band of numbness across the chest corresponds to sensory loss from one spinal root level. This region is called a:

A. Myotome
B. Sclerotome
C. Dermatome
D. Neurotome

back 10

C. Dermatome

front 11

The primary axons of the posterior column pathway are best described as:

A. Small, unmyelinated pain fibers
B. Large, myelinated sensory fibers
C. Thin, autonomic postganglionics
D. Medium, motor efferent fibers

back 11

B. Large, myelinated sensory fibers

front 12

Posterior column fibers first enter the spinal cord through the:

A. Ventral root
B. Lateral horn
C. Dorsal root
D. Anterior commissure

back 12

C. Dorsal root

front 13

After entering the spinal cord, first-order posterior column axons ascend in which location before synapsing?

A. Contralateral lateral funiculus
B. Ipsilateral posterior column
C. Ventral corticospinal tract
D. Spinothalamic anterolateral tract

back 13

B. Ipsilateral posterior column

front 14

A lesion interrupts first-order posterior column fibers before they synapse. These axons normally ascend to the:

A. Thalamus in pons
B. Cerebellum in midbrain
C. Medulla nuclei
D. Internal capsule

back 14

C. Medulla nuclei

front 15

Which statement correctly describes the organization of the posterior column pathway?

A. One tract, one nucleus
B. Two tracts, two nuclei
C. Two tracts, one nucleus
D. One tract, two nuclei

back 15

B. Two tracts, two nuclei

front 16

Sensory fibers carrying proprioception from the lower limb ascend in which fasciculus?

A. Fasciculus cuneatus
B. Lateral spinothalamic tract
C. Fasciculus gracilis
D. Anterior spinocerebellar tract

back 16

C. Fasciculus gracilis

front 17

Which part of the posterior column contains fibers from the lower limbs and trunk?

A. Lateral cuneate portion
B. Medial gracile portion
C. Ventral central portion
D. Contralateral dorsal portion

back 17

B. Medial gracile portion

front 18

A lesion damages the nucleus that receives posterior column input from the lower limbs. Which nucleus is affected?

A. Nucleus cuneatus
B. Nucleus ambiguus
C. Nucleus gracilis
D. Red nucleus

back 18

C. Nucleus gracilis

front 19

Fibers from the upper limb, upper trunk above T6, and neck ascend in the:

A. Medial gracile fasciculus
B. Lateral cuneate fasciculus
C. Ventral spinothalamic tract
D. Dorsal spinocerebellar tract

back 19

B. Lateral cuneate fasciculus

front 20

Posterior column fibers from the upper limb ultimately synapse on second-order neurons in the:

A. Nucleus gracilis
B. Nucleus solitarius
C. Nucleus cuneatus
D. Inferior olive

back 20

C. Nucleus cuneatus

front 21

A hemicord lesion damages the lateral portion of the posterior column at a cervical level. Which sensory region is most affected?

A. Lower limb
B. Upper limb and neck
C. Perianal saddle region
D. Contralateral face

back 21

B. Upper limb and neck

front 22

After first-order posterior column fibers synapse in the caudal medulla, the second-order neurons cross the midline as the:

A. External arcuate fibers
B. Spinothalamic commissure
C. Internal arcuate fibers
D. Posterior funicular fibers

back 22

C. Internal arcuate fibers

front 23

Once these second-order neurons decussate in the medulla, they ascend contralaterally as the:

A. Medial lemniscus
B. Lateral lemniscus
C. Spinocerebellar tract
D. Trigeminal tract

back 23

A. Medial lemniscus

front 24

A small lesion selectively damages the ventral portion of the medial lemniscus in the medulla. Which body region’s proprioceptive information is most likely affected?

A. Face
B. Upper limb
C. Neck
D. Foot and lower limb

back 24

D. Foot and lower limb

front 25

A small lesion selectively damages the dorsal portion of the medial lemniscus in the medulla. Which body region’s proprioceptive information is most likely affected?

A. Face
B. Upper limb
C. Neck
D. Foot and lower limb

back 25

B. Upper limb

front 26

A midbrain lesion damages the lateral portion of the medial lemniscus. Which sensory stream is most likely impaired?

A. Facial touch
B. Upper trunk vibration
C. Lower limb proprioception
D. Hand pain sensation

back 26

C. Lower limb proprioception

front 27

In the midbrain, fibers from the upper limb are located in which part of the medial lemniscus?

A. Medial portion
B. Ventral portion
C. Dorsal portion
D. Lateral portion

back 27

A. Medial portion

front 28

The medial-lateral arrangement of body fibers in the pons and midbrain is best described as:

A. Identical to spinal cord
B. Opposite the spinal cord
C. Identical to dorsal columns
D. Opposite the thalamus only

back 28

B. Opposite the spinal cord

front 29

Second-order neurons of the dorsal column-medial lemniscus pathway synapse on third-order neurons in which thalamic nucleus?

A. Ventral posterior medial
B. Lateral geniculate nucleus
C. Ventral posterior lateral
D. Ventral anterior nucleus

back 29

C. Ventral posterior lateral

front 30

After synapsing in the VPL, body sensory fibers reach cortex by passing through the:

A. Posterior limb, internal capsule
B. Anterior limb, internal capsule
C. External capsule only
D. Genu, internal capsule

back 30

A. Posterior limb, internal capsule

front 31

Thalamocortical somatosensory projections from the VPL terminate primarily in the:

A. Precentral gyrus
B. Superior temporal gyrus
C. Cingulate cortex
D. Postcentral gyrus

back 31

D. Postcentral gyrus

front 32

Most thalamocortical sensory fibers terminate in which cortical layer of primary somatosensory cortex?

A. Layer II
B. Layer IV
C. Layer V
D. Layer VI

back 32

D. Layer VI

front 33

Touch sensation from the face reaches the thalamus primarily through the trigeminal lemniscus and then synapses in the:

A. VPL nucleus
B. Pulvinar nucleus
C. Medial geniculate
D. VPM nucleus

back 33

D. VPM nucleus

front 34

A patient loses pain and temperature sensation after injury to the anterolateral pathway. Which tract is primarily involved?

A. Dorsal spinocerebellar tract
B. Medial longitudinal fasciculus
C. Spinothalamic tract
D. Fasciculus cuneatus

back 34

C. Spinothalamic tract

front 35

The primary afferents entering the spinothalamic pathway are best described as:

A. Large, heavily myelinated fibers
B. Small, often unmyelinated fibers
C. Fast motor efferent axons
D. Thick autonomic preganglionics

back 35

B. Small, often unmyelinated fibers

front 36

Which sensory modalities are primarily carried by the spinothalamic tract?

A. Fine touch, vibration, proprioception
B. Pain, temperature, gross touch
C. Smell, taste, visceral stretch
D. Position, stereognosis, graphesthesia

back 36

B. Pain, temperature, gross touch

front 37

First-order spinothalamic fibers enter the spinal cord through the:

A. Ventral root
B. Lateral corticospinal tract
C. Dorsal root
D. Posterior funiculus

back 37

C. Dorsal root

front 38

After entering the spinal cord, spinothalamic primary afferents first synapse mainly in which regions?

A. Lamina I and V
B. Lamina II only
C. Nucleus gracilis only
D. Clarke nucleus and VI

back 38

A. Lamina I and V

front 39

A painful stimulus applied to the foot travels in fibers that may ascend or descend a few spinal segments before synapsing. These fibers are traveling in:

A. Anterior white commissure
B. Lissauer tract
C. Medial lemniscus
D. Posterior column

back 39

B. Lissauer tract

front 40

Which statement best describes the crossing pattern of spinothalamic second-order neurons?

A. They cross in medulla
B. They remain ipsilateral throughout
C. They cross in anterior commissure
D. They cross in internal capsule

back 40

C. They cross in anterior commissure

front 41

A right lateral spinal cord lesion at T8 causes loss of left-sided pain and temperature beginning a few segments below the lesion. This occurs because spinothalamic fibers:

A. Cross immediately at entry
B. Cross after 2–3 segments
C. Ascend ipsilaterally to pons
D. Synapse first in thalamus

back 41

B. Cross after 2–3 segments

front 42

In the spinal cord, lower-limb pain and temperature fibers within the anterolateral white matter are located:

A. Most medially
B. Most dorsally
C. Most ventrally
D. Most laterally

back 42

D. Most laterally

front 43

In the spinothalamic tract, upper-limb fibers are located:

A. Most medially
B. Most laterally
C. Most ventrally
D. Most posteriorly

back 43

A. Most medially

front 44

Most ascending spinothalamic fibers carrying body sensation synapse in which thalamic nucleus?

A. VPM
B. VPL
C. Lateral geniculate
D. Ventral anterior

back 44

B. VPL

front 45

Some spinothalamic fibers terminate in the intralaminar nuclei of the thalamus, contributing especially to:

A. Fine touch discrimination
B. Emotional arousal of pain
C. Facial proprioception
D. Voluntary pain suppression

back 45

B. Emotional arousal of pain

front 46

Besides the intralaminar nuclei, some spinothalamic fibers also project to the:

A. Mediodorsal nucleus
B. Pulvinar nucleus
C. Mammillary nucleus
D. Subthalamic nucleus

back 46

A. Mediodorsal nucleus

front 47

After thalamic processing, spinothalamic sensory information ultimately projects to the:

A. Precentral gyrus
B. Superior temporal gyrus
C. Postcentral gyrus
D. Cingulate gyrus

back 47

C. Postcentral gyrus

front 48

Besides the spinothalamic tract, which tract in the anterolateral column is most associated with the emotional and arousal aspects of pain?

A. Dorsal spinocerebellar tract
B. Spinoreticular tract
C. Fasciculus gracilis
D. Corticobulbar tract

back 48

B. Spinoreticular tract

front 49

Fibers in the spinoreticular tract terminate primarily in the:

A. Ventral posterior nucleus
B. Periaqueductal gray
C. Superior parietal lobule
D. Medullary-pontine reticular formation

back 49

D. Medullary-pontine reticular formation

front 50

The medullary-pontine reticular formation projects mainly to which thalamic nuclei in this pain pathway?

A. Geniculate nuclei
B. Intralaminar nuclei
C. Ventral anterior nuclei
D. Pulvinar nuclei

back 50

B. Intralaminar nuclei

front 51

Unlike the spinothalamic tract, the spinoreticular tract does not project to cortex in a:

A. Bilateral pattern
B. Somatotopic pattern
C. Descending pattern
D. Monosynaptic pattern

back 51

B. Somatotopic pattern

front 52

Diffuse cortical projections from the spinoreticular system are thought to promote:

A. Behavioral arousal
B. Fine discrimination
C. Motor inhibition
D. Visual tracking

back 52

A. Behavioral arousal

front 53

Which anterolateral tract projects to the periaqueductal gray matter and superior colliculus?

A. Spinocerebellar tract
B. Spinoreticular tract
C. Spinomesencephalic tract
D. Medial lemniscus

back 53

C. Spinomesencephalic tract

front 54

The spinomesencephalic tract is most directly involved in:

A. Position sense
B. Central pain modulation
C. Facial motor control
D. Stereognosis

back 54

B. Central pain modulation

front 55

In the notes, the spinomesencephalic tract is summarized as helping to:

A. Localize pain
B. Trigger arousal
C. Resolve pain
D. Intensify pain

back 55

C. Resolve pain

front 56

Somatosensory information from primary cortex is conveyed next to the secondary somatosensory association cortex located in the:

A. Sylvian fissure region
B. Calcarine cortex
C. Cingulate gyrus
D. Internal capsule

back 56

A. Sylvian fissure region

front 57

The secondary somatosensory association cortex lies in the region called the:

A. Uncus
B. Precuneus
C. Parietal operculum
D. Insular pole

back 57

C. Parietal operculum

front 58

Further higher-order processing of somatosensory information occurs in the superior parietal lobule, which includes Brodmann areas:

A. 9 and 10
B. 5 and 7
C. 22 and 24
D. 41 and 42

back 58

B. 5 and 7

front 59

Cortical sensory loss is most likely caused by lesions of the:

A. Basal ganglia and association areas
B. Spinal roots and association areas
C. Somatosensory cortex and association areas
D. Cerebellar vermis and association areas

back 59

C. Somatosensory cortex and association areas

front 60

Gate control theory proposes that activation of which fibers can reduce pain at the dorsal horn?

A. A-delta fibers
B. C fibers
C. Sympathetic fibers
D. A-beta fibers

back 60

A. A-delta fibers

front 61

Rubbing or flicking an injured area may lessen pain because nonpain sensory input can:

A. Amplify spinothalamic firing
B. Reduce pain in dorsal horn
C. Block thalamic relay neurons
D. Silence primary motor cortex

back 61

B. Reduce pain in dorsal horn

front 62

The periaqueductal gray receives input from the hypothalamus, amygdala, and cortex in order to:

A. Initiate voluntary movement
B. Modulate pain
C. Produce REM sleep
D. Generate vestibular reflexes

back 62

B. Modulate pain

front 63

Descending pain inhibition from the periaqueductal gray reaches the dorsal horn through a relay in the:

A. Red nucleus
B. Ventral posterior nucleus
C. Rostral ventral medulla
D. Inferior olivary nucleus

back 63

C. Rostral ventral medulla

front 64

In this descending pain-modulating system, the rostral ventral medulla uses which neurotransmitter to influence the dorsal horn?

A. Serotonin
B. Dopamine
C. Acetylcholine
D. GABA

back 64

A. Serotonin

front 65

The notes also state that the rostral ventral medulla responds to substance P by projecting which transmitter into the dorsal horn?

A. Glycine
B. Histamine
C. Norepinephrine
D. Glutamate

back 65

C. Norepinephrine

front 66

An opioid analgesic reduces pain by acting on receptors distributed throughout which system?

A. Corticospinal motor pathway
B. Pain modulation pathway
C. Visual relay pathway
D. Vestibular pathway

back 66

B. Pain modulation pathway

front 67

Opiate receptors are present in many locations, but their highest concentrations are found on the:

A. Thalamus and cortex
B. Basal ganglia and cerebellum
C. Midbrain and medulla only
D. Peripheral nerves and dorsal horn

back 67

D. Peripheral nerves and dorsal horn

front 68

Which set contains only endogenous opiates?

A. Serotonin, dynorphin, glutamate
B. Endorphin, GABA, enkephalin
C. Enkephalin, endorphin, dynorphin
D. Dopamine, norepinephrine, endorphin

back 68

C. Enkephalin, endorphin, dynorphin

front 69

Enkephalins and dynorphins are specifically noted to be present in the dorsal horn and also in the:

A. RVM and periaqueductal gray
B. Thalamus and cortex
C. Hypothalamus and cerebellum
D. Basal ganglia and pons

back 69

A. RVM and periaqueductal gray

front 70

Which endogenous opioid is specifically associated with the hypothalamus rather than being listed directly in the dorsal horn?

A. Dynorphin
B. Enkephalin
C. Substance P
D. Endorphin

back 70

D. Endorphin

front 71

The hypothalamic location of endorphin is relevant because the hypothalamus is connected to the:

A. Ventral posterior nucleus
B. Periaqueductal gray matter
C. Internal capsule
D. Postcentral gyrus

back 71

B. Periaqueductal gray matter

front 72

The thalamus is part of which major brain division?

A. Mesencephalon
B. Telencephalon
C. Myelencephalon
D. Diencephalon

back 72

D. Diencephalon

front 73

Relative to the midbrain, the thalamus is located:

A. Rostral
B. Caudal
C. Dorsal only
D. Lateral only

back 73

A. Rostral

front 74

Which structure lies ventral to the thalamus?

A. Epithalamus
B. Hypothalamus
C. Midbrain
D. Cerebellum

back 74

B. Hypothalamus

front 75

Nearly all pathways that project to the cerebral cortex do so by first synapsing in the:

A. Thalamus
B. Midbrain
C. Medulla
D. Basal ganglia

back 75

A. Thalamus

front 76

In addition to sensory pathways, which motor-related systems relay information to the cerebrum through the thalamus?

A. Corticospinal and spinothalamic systems
B. Cerebellum and basal ganglia
C. Vestibular nuclei and retina
D. Amygdala and hippocampus

back 76

B. Cerebellum and basal ganglia

front 77

Thalamic nuclei generally receive strong feedback from the:

A. Cortical areas they supply
B. Spinal cord dorsal horn
C. Peripheral sensory nerves
D. Contralateral cerebellum

back 77

A. Cortical areas they supply

front 78

Thalamic nuclei involved in motor and sensory projection are most often:

A. Bilateral and diffuse
B. Localized
C. Unmyelinated
D. Inhibitory only

back 78

B. Localized

front 79

_____ Nuclei= relays inputs from many pathways to the cortex in reciporical fashion. includes medial, lateral, and anteiror nuclear groups

back 79

Relay

front 80

_____ Nuclei= within the internal medullary lamina of the thalamus and is involved with relay of inputs from the basal ganglia to widespread cortical locations and is involved in relay of ARAS which promotes alertness

back 80

Intralaminar

front 81

_____ Nucleus= located in sheet lateral to thalamus within its capsule and has a mainly inihibitory role within the thalamus relaying thalamic inputs back to the thalamus and
modulating other inputs. Also plays role in modulating attention/alertness

back 81

Reticular

front 82

A patient with a lesion in a major somatosensory pathway reports abnormal tingling despite objective sensory loss. This symptom is best described as:

A. Dysarthria
B. Paresthesia
C. Hyperreflexia
D. Ataxia

back 82

B. Paresthesia

front 83

A patient reports numbness, tingling, and a tight band-like sensation around the limb. Which lesion location best matches this symptom pattern?

A. Posterior column
B. Thalamus
C. Anterolateral column
D. Peripheral motor nerve

back 83

A. Posterior column

front 84

A lesion of the anterolateral column is most likely to produce which abnormal sensory complaint?

A. Tight band-like numbness
B. Loss of graphesthesia only
C. Sharp, burning pain
D. Isolated proprioceptive loss

back 84

C. Sharp, burning pain

front 85

A patient develops severe contralateral pain after a thalamic stroke. This syndrome is called:

A. Brown-Séquard syndrome
B. Lhermitte syndrome
C. Wallenberg syndrome
D. Dejerine-Roussy syndrome

back 85

D. Dejerine-Roussy syndrome

front 86

Flexing the neck causes an electric shock-like sensation running down the back and into both arms. This finding is called:

A. Romberg sign
B. Hoffman's sign
C. Lhermitte sign
D. Babinski sign

back 86

C. Lhermitte sign

front 87

A patient has pain and numbness radiating down the lateral leg in a dermatomal pattern, and the pain worsens when the nerve root is stretched. This is most consistent with:

A. Mononeuropathy
B. Radiculopathy
C. Polyneuropathy
D. Myelopathy

back 87

B. Radiculopathy

front 88

Which statement best describes symptoms from a peripheral nerve lesion compared with radiculopathy?

A. They never cause numbness
B. They affect the opposite limb
C. They produce symptoms in the nerve’s region
D. They always involve the spinal cord

back 88

C. They produce symptoms in the nerve’s region

front 89

An unpleasant, abnormal sensory experience that is not simply decreased sensation is termed:

A. Dysesthesia
B. Hypesthesia
C. Paresthesia
D. Anesthesia

back 89

A. Dysesthesia

front 90

Pain produced by a stimulus that is normally not painful is called:

A. Hyperpathia
B. Allodynia
C. Hypesthesia
D. Radiculopathy

back 90

B. Allodynia

front 91

A pinprick that is mildly painful in most people causes an exaggerated painful response in a patient with central sensitization. This is best termed:

A. Hyperpathia or hyperalgesia
B. Dysesthesia or paresthesia
C. Anesthesia dolorosa
D. Allodynia only

back 91

A. Hyperpathia or hyperalgesia

front 92

Decreased sensation on neurologic examination is termed:

A. Hypalgesia
B. Hypesthesia
C. Hyperesthesia
D. Dysesthesia

back 92

B. Hypesthesia

front 93

The most common cause of spinal cord dysfunction is:

A. Intrinsic demyelination
B. Vascular malformation
C. Extrinsic compression
D. Congenital syrinx

back 93

C. Extrinsic compression

front 94

A patient with spinal cord dysfunction is expected to develop both motor and sensory deficits beginning:

A. At unrelated random levels
B. At the same general level
C. Only below the sacral cord
D. Only on one side initially

back 94

B. At the same general level

front 95

Immediately after a traumatic spinal cord injury, a patient has flaccid paralysis, absent deep tendon reflexes, hypotension, and loss of sphincter tone. This phase is called:

A. Neuroleptic rigidity
B. Spinal shock
C. Cauda equina syndrome
D. Autonomic dysreflexia

back 95

B. Spinal shock

front 96

As spinal shock resolves over time, which pattern is most likely to emerge?

A. Hyperreflexia and spasticity
B. Fasciculations and atrophy
C. Flaccidity with areflexia
D. Progressive sensory extinction

back 96

A. Hyperreflexia and spasticity

front 97

An older patient with long-standing cervical spondylosis develops progressive spinal cord dysfunction over months. This presentation is most consistent with:

A. Acute myelitis
B. Chronic myelopathy
C. Anterior cord infarct
D. Spinal shock

back 97

B. Chronic myelopathy

front 98

Degenerative disorders of the spine can produce both upper and lower motor neuron signs because they may compress both the:

A. Cerebellum and brainstem
B. Cord and thalamus
C. Cortex and cerebellum
D. Nerve roots and cord

back 98

D. Nerve roots and cord

front 99

A patient has metastatic spinal cord compression but is still walking. What is the most important management principle from the notes?

A. Decompress immediately
B. Wait for biopsy first
C. Start rehab only
D. Observe for progression

back 99

A. Decompress immediately

front 100

When a compressive spinal tumor is detected and removed before the patient loses ambulation, the expected outcome is best summarized as:

A. Most still lose walking
B. Most keep walking ability
C. Recovery is unpredictable
D. Paralysis becomes permanent

back 100

B. Most keep walking ability

front 101

The most common site of metastatic tumor causing spinal cord compression is the:

A. Epidural space
B. Subarachnoid space
C. Central canal
D. Intramedullary cord

back 101

A. Epidural space

front 102

Spinal cord infarction most commonly results from occlusion of which vessel?

A. Posterior spinal artery
B. Radicular artery only
C. Vertebral artery
D. Anterior spinal artery

back 102

D. Anterior spinal artery

front 103

Occlusion of the anterior spinal artery most classically produces:

A. Brown-Séquard syndrome
B. Central cord syndrome
C. Anterior cord syndrome
D. Posterior cord syndrome

back 103

C. Anterior cord syndrome

front 104

Watershed infarcts are infarcts occurring in tissue located:

A. Between arterial territories
B. Within venous sinuses
C. Inside the central canal
D. Beneath the pia only

back 104

A. Between arterial territories

front 105

Which region is specifically identified as a vulnerable watershed zone in the spinal cord?

A. Cervicomedullary junction
B. Sacral enlargement
C. Mid-thoracic cord
D. Conus medullaris

back 105

C. Mid-thoracic cord

front 106

A vascular defect that can be difficult to diagnose yet may cause transient episodes of spinal cord dysfunction is:

A. Cavernous malformation
B. Berry aneurysm
C. Epidural hematoma
D. Spinal dural AVM

back 106

D. Spinal dural AVM

front 107

Myelitis is best defined as:

A. Inflammation of spinal cord
B. Degeneration of dorsal roots
C. Compression of cauda equina
D. Ischemia of anterior horn

back 107

A. Inflammation of spinal cord

front 108

A patient develops rapidly progressive spinal cord dysfunction with fever, elevated WBC count, and bright T2 signal abnormalities on spinal MRI. Which cause is specifically listed in the material?

A. Epidural lipomatosis
B. Dural tear
C. Epidural abscess
D. Chronic spondylosis

back 108

C. Epidural abscess

front 109

If myelitis is not treated immediately, the major feared consequence is:

A. Only transient numbness
B. Irreversible spinal damage
C. Isolated facial weakness
D. Benign spontaneous recovery

back 109

B. Irreversible spinal damage

front 110

A 61-year-old man cannot identify a key placed in his left hand with eyes closed, but pinprick, vibration, and crude touch are largely preserved. The lesion is most likely in the:

A. Right primary somatosensory cortex
B. Left primary somatosensory cortex
C. Left lateral pons
D. Left VPL nucleus

back 110

A. Right primary somatosensory cortex

front 111

A patient with a right parietal cortical lesion is most likely to have which sensory deficit pattern?

A. Ipsilateral pain and temperature loss
B. Contralateral sensory deficit predominance
C. Bilateral glove-stocking numbness
D. Contralateral facial pain only

back 111

B. Contralateral sensory deficit predominance

front 112

Which sensory modalities are often most affected by a lesion of the primary somatosensory cortex?

A. Pain and temperature
B. Crude touch and pain
C. Discriminatory touch and proprioception
D. Olfaction and vibration

back 112

C. Discriminatory touch and proprioception

front 113

A patient has intact primary sensation but cannot recognize numbers traced on the palm and ignores simultaneous stimulation on the affected side. This pattern is most consistent with:

A. Cortical sensory loss
B. Spinothalamic tract syndrome
C. Peripheral neuropathy
D. Transverse cord lesion

back 113

A. Cortical sensory loss

front 114

A small infarct of the left VPL nucleus would most likely cause:

A. Ipsilateral body sensory loss
B. Contralateral body sensory loss
C. Bilateral vibration loss
D. Contralateral facial weakness only

back 114

B. Contralateral body sensory loss

front 115

A thalamic lesion extends beyond the VPL/VPM into adjacent structures. Which additional finding may occur?

A. Aphasia or neglect
B. Ptosis or miosis
C. Hemiplegia or hemianopia
D. Ataxia or tremor

back 115

C. Hemiplegia or hemianopia

front 116

A lesion of the thalamic somatosensory radiation is most likely to produce sensory loss plus:

A. Hemiparesis from corticospinal involvement
B. Ipsilateral facial paralysis
C. Bilateral lower motor weakness
D. Contralateral cerebellar signs

back 116

A. Hemiparesis from corticospinal involvement

front 117

Sensory deficits from lesions of the VPL/VPM nuclei are most often noticed by patients in the:

A. Trunk and proximal legs
B. Hands and face
C. Neck and shoulders
D. Feet and occiput

back 117

B. Hands and face

front 118

A dorsolateral brainstem infarct causes loss of pain and temperature on the left face and right body. The lesion is most likely in the:

A. Right medial medulla
B. Left medial pons
C. Left lateral pons or medulla
D. Right primary sensory cortex

back 118

C. Left lateral pons or medulla

front 119

The crossed sensory findings in a lateral pontine or lateral medullary lesion are due to involvement of the:

A. Medial lemniscus and VPL
B. Trigeminal nucleus and spinothalamic tract
C. Posterior columns and corticospinal tract
D. VPM and internal capsule

back 119

B. Trigeminal nucleus and spinothalamic tract

front 120

A lesion of the medial medulla involving the medial lemniscus would most likely cause:

A. Contralateral vibration and proprioception loss
B. Ipsilateral facial pain loss
C. Contralateral pain and temperature loss
D. Bilateral distal numbness

back 120

A. Contralateral vibration and proprioception loss

front 121

A diabetic patient reports gradually progressive numbness in both feet that later involves the hands, in a symmetric distal pattern. This is most characteristic of:

A. Brown-Sequard syndrome
B. Medial medullary syndrome
C. Thalamic radiation lesion
D. Distal symmetrical polyneuropathy

back 121

D. Distal symmetrical polyneuropathy

front 122

“Glove and stocking” sensory loss most strongly localizes to the:

A. Primary sensory cortex
B. Nerve roots or peripheral nerves
C. Lateral medulla
D. Posterior thalamus

back 122

B. Nerve roots or peripheral nerves

front 123

A complete transverse lesion of the thoracic spinal cord would interrupt:

A. Only sensory pathways below lesion
B. Only motor pathways below lesion
C. All sensory and motor pathways below lesion
D. Ipsilateral dorsal column modalities only

back 123

C. All sensory and motor pathways below lesion

front 124

Which of the following is a recognized cause of a transverse cord lesion?

A. Migraine aura
B. Myasthenia gravis
C. Transverse myelitis
D. Myotonic dystrophy

back 124

C. Transverse myelitis

front 125

del

back 125

del

front 126

In Brown-Sequard syndrome, ipsilateral upper motor neuron weakness results from damage to the:

A. Lateral corticospinal tract
B. Anterior horn cells
C. Spinocerebellar tract
D. Medial longitudinal fasciculus

back 126

A. Lateral corticospinal tract

front 127

In Brown-Sequard syndrome, contralateral pain loss is caused by damage to the:

A. Posterior column
B. Medial lemniscus
C. Anterolateral column
D. Ventral corticospinal tract

back 127

C. Anterolateral column

front 128

A patient with spinal cord hemisection has ipsilateral loss of vibration, light touch, and proprioception below the lesion. The damaged structure is the:

A. Anterolateral system
B. Posterior column
C. Spinoreticular pathway
D. Ventral horn

back 128

B. Posterior column

front 129

Which of the following is a recognized cause of Brown-Sequard syndrome?

A. Penetrating injury
B. Basilar migraine
C. Temporal arteritis
D. Hydrocephalus

back 129

A. Penetrating injury

front 130

A 29-year-old man develops a spinal cord injury in the cervical region. He loses pain and temperature sensation over both shoulders and arms in a “cape-like” pattern, but other sensory findings are initially limited. Which spinal cord syndrome best explains this pattern?

A. Anterior cord syndrome
B. Posterior cord syndrome
C. Central cord syndrome
D. Brown-Sequard syndrome

back 130

C. Central cord syndrome

front 131

Which of the following is a common cause of central cord syndrome?

A. B12 deficiency
B. Anterior spinal infarct
C. Spinal contusion
D. Tabes dorsalis

back 131

C. Spinal contusion

front 132

A 55-year-old man has loss of vibration sense and proprioception below a spinal cord lesion. Pain and temperature are preserved. Which syndrome is most likely?

A. Posterior cord syndrome
B. Central cord syndrome
C. Anterior cord syndrome
D. Cauda equina syndrome

back 132

A. Posterior cord syndrome

front 133

A patient with untreated vitamin deficiency develops progressive loss of vibration and joint position sense. A large lesion later produces upper motor neuron signs. Which syndrome best matches this presentation?

A. Central cord syndrome
B. Posterior cord syndrome
C. Anterior cord syndrome
D. Syringobulbia syndrome

back 133

B. Posterior cord syndrome

front 134

A patient cannot feel pain or temperature below a spinal cord lesion, but vibration and proprioception remain intact. He also develops bowel and bladder incontinence. Which syndrome is most likely?

A. Posterior cord syndrome
B. Central cord syndrome
C. Anterior cord syndrome
D. Lateral medullary syndrome

back 134

C. Anterior cord syndrome

front 135

Which cause is classically associated with anterior cord syndrome?

A. Tertiary syphilis
B. B12 deficiency
C. Anterior spinal artery infarct
D. Diabetic neuropathy

back 135

C. Anterior spinal artery infarct

front 136

Sensory information from the rectum, bladder, and genitals enters the spinal cord through which roots?

A. T11-L1
B. L1-L2
C. S2-S4
D. S4-Co1

back 136

C. S2-S4

front 137

Sensory signals from the rectum, bladder, and genitals reach higher centers through:

A. Dorsal columns only
B. Spinothalamic tract
C. Cerebellar pathways
D. Both somatosensory pathways

back 137

D. Both somatosensory pathways

front 138

Voluntary somatic motor fibers that control the pelvic floor arise primarily from:

A. Anterior horn at S2-S4
B. Intermediolateral column at T1-T4
C. Dorsal horn at S2-S4
D. Onuf nucleus at T11-L2

back 138

A. Anterior horn at S2-S4

front 139

The sphincteromotor nucleus of Onuf primarily controls the:

A. Detrusor and trigone
B. Urethral and anal sphincters
C. Internal and bladder neck
D. Pelvic splanchnic ganglia

back 139

B. Urethral and anal sphincters

front 140

Parasympathetic outflow to the pelvis arises from the:

A. Intermediolateral column T11-L2
B. Pontine micturition center
C. Frontal micturition cortex
D. Sacral nuclei at S2-S4

back 140

D. Sacral nuclei at S2-S4

front 141

Sympathetic outflow to the pelvis arises mainly from the:

A. Intermediolateral column T11-S2
B. Sacral nuclei at S2-S4
C. Anterior horn at S2-S4
D. Posterior horn at T11-S2

back 141

A. Intermediolateral column T11-S2

front 142

For a central nervous system lesion to reliably impair bowel, bladder, or sexual function, it usually must be:

A. Unilateral and cortical
B. Limited to one root
C. Bilateral
D. Restricted to dorsal columns

back 142

C. Bilateral

front 143

Normal bladder emptying is best described as being under:

A. Reflex control only
B. Voluntary control
C. Sympathetic control only
D. Sacral control only

back 143

B. Voluntary control

front 144

During normal filling, conscious awareness of bladder fullness depends on sensation reaching the:

A. Sensory cortex
B. Cerebellar cortex
C. Pontine tegmentum
D. Basal ganglia

back 144

A. Sensory cortex

front 145

The conscious initiation of voiding begins with activation of the:

A. Lateral hypothalamus
B. Sacral parasympathetic nuclei
C. Primary motor cortex
D. Medial frontal micturition centers

back 145

D. Medial frontal micturition centers

front 146

Which structure is the main regulator coordinating the voiding program once micturition is initiated?

A. Onuf nucleus
B. Anterior horn
C. Pontine micturition center
D. Dorsal root ganglion

back 146

C. Pontine micturition center

front 147

Voluntary relaxation of the external sphincter during urination first helps by:

A. Activating sympathetics
B. Inhibiting internal sphincter sympathetics
C. Silencing sacral afferents
D. Contracting pelvic floor muscles

back 147

B. Inhibiting internal sphincter sympathetics

front 148

During normal voiding, parasympathetic activation causes the:

A. Detrusor to contract
B. Internal sphincter to contract
C. Pelvic floor to contract
D. Urethra to shorten

back 148

A. Detrusor to contract

front 149

Once urination begins, continued sensation of urine flow mainly:

A. Inhibits detrusor contraction
B. Activates Onuf nucleus
C. Closes the internal sphincter
D. Maintains the voiding reflex

back 149

D. Maintains the voiding reflex

front 150

When urine flow stops, bladder emptying normally ends because the:

A. Pontine center is destroyed
B. Detrusor relaxes via urethral reflex
C. Parasympathetics permanently stop
D. External sphincter paralyzes

back 150

B. Detrusor relaxes via urethral reflex

front 151

A patient with bilateral frontal lobe damage urinates automatically when the bladder fills and is unaware of fullness. The damaged area most likely is the:

A. Sacral parasympathetic nuclei
B. Pontine micturition center
C. Medial frontal micturition centers
D. Sphincteromotor nucleus of Onuf

back 151

C. Medial frontal micturition centers

front 152

Bilateral lesions of the medial frontal micturition centers typically cause:

A. Overflow retention only
B. Loss of detrusor muscle
C. Anal sphincter spasm
D. Reflex incontinence without awareness

back 152

D. Reflex incontinence without awareness

front 153

Which condition is a recognized cause of bilateral medial frontal micturition center damage?

A. Hydrocephalus
B. Pernicious anemia
C. Tabes dorsalis
D. Anterior spinal infarct

back 153

A. Hydrocephalus

front 154

A spinal cord lesion below the pontine micturition center but above the conus medullaris first produces which bladder state?

A. Spastic bladder
B. Neurogenic sphincter spasm
C. Atonic bladder
D. Normal reflex bladder

back 154

C. Atonic bladder

front 155

Weeks after a spinal cord lesion below the pontine micturition center and above the conus medullaris, the bladder most often becomes:

A. Permanently areflexic
B. Hyperreflexive and spastic
C. Fully normal
D. Sensory only impaired

back 155

B. Hyperreflexive and spastic

front 156

A patient with an early flaccid neurogenic bladder has marked urinary retention. Which additional finding is most expected in the more severe form?

A. Sacral anesthesia only
B. Complete spontaneous drainage
C. Bladder distention
D. Fecal urgency alone

back 156

C. Bladder distention

front 157

In a less severe atonic bladder, the patient voids incompletely. Which measurement would be increased?

A. Bladder compliance
B. Post-void residual volume
C. Anal resting pressure
D. Detrusor reflex latency

back 157

B. Post-void residual volume

front 158

A patient with a spastic neurogenic bladder feels sudden urgency even when the bladder contains only a small amount of urine. What is the main problem?

A. Detrusor-sphincter dyssynergia
B. Pudendal nerve transection
C. Loss of cortical sensation
D. Complete sphincter paralysis

back 158

A. Detrusor-sphincter dyssynergia

front 159

In a hyperreflexive bladder, the abnormal urgency is mainly caused by:

A. Internal sphincter fibrosis
B. Detrusor spasms at low volume
C. Bladder outlet obstruction
D. Loss of urethral sensation

back 159

B. Detrusor spasms at low volume

front 160

A hyperreflexive bladder is also called a:

A. Atonic bladder
B. Flaccid bladder
C. Spastic bladder
D. Overflow bladder

back 160

C. Spastic bladder

front 161

Which of the following can cause either an atonic bladder or a hyperreflexive bladder?

A. Cataracts
B. Spinal tumors
C. Otitis media
D. Myasthenia gravis

back 161

B. Spinal tumors

front 162

Multiple sclerosis can cause which bladder problem?

A. Only stress incontinence
B. Only normal voiding
C. Only overflow retention
D. Atonic or hyperreflexive bladder

back 162

D. Atonic or hyperreflexive bladder

front 163

Trauma involving the nervous system can lead to:

A. Only spastic bladder
B. Only flaccid bowel
C. Atonic or spastic bladder
D. Only sensory urgency

back 163

C. Atonic or spastic bladder

front 164

Peripheral neuropathies usually cause which bladder pattern?

A. Flaccid more than spastic
B. Spastic more than flaccid
C. Normal detrusor function
D. Isolated sphincter hypertonia

back 164

A. Flaccid more than spastic

front 165

In peripheral neuropathy, flaccid bladder commonly occurs because of loss of:

A. Sympathetic flow to trigone
B. Parasympathetic flow to detrusor
C. Cortical input to pons
D. Sensory flow to cerebellum

back 165

B. Parasympathetic flow to detrusor

front 166

A patient with diabetic neuropathy develops urinary dribbling from an overfilled bladder. Which diagnosis best fits?

A. Stress incontinence
B. Reflex incontinence
C. Overflow incontinence
D. Urge suppression

back 166

C. Overflow incontinence

front 167

Which condition is classically associated with flaccid neurogenic bladder from peripheral nerve involvement?

A. Hydrocephalus
B. Diabetic neuropathy
C. Frontal meningioma
D. Pontine stroke

back 167

B. Diabetic neuropathy

front 168

Which lower spinal condition can cause a flaccid bladder?

A. Temporal lobe seizure
B. Basal ganglia infarct
C. Cauda equina syndrome
D. Cerebellar hemorrhage

back 168

C. Cauda equina syndrome

front 169

A large lumbar disc herniation most commonly causes which bladder pattern if sacral pathways are affected?

A. Spastic bladder
B. Flaccid bladder
C. Normal bladder
D. Painful bladder only

back 169

B. Flaccid bladder

front 170

Parasympathetic stimulation of GI motility proximal to the descending colon is supplied mainly by:

A. CN III
B. CN VII
C. CN IX
D. CN X

back 170

D. CN X

front 171

Bowel dysfunction of neurological origin can result from damage to which locations?

A. Only frontal cortex
B. Only sacral roots
C. Only thoracic cord
D. Brain, cord, or sacral roots

back 171

D. Brain, cord, or sacral roots

front 172

Sensation from the genitals is carried mainly by the:

A. Obturator nerve
B. Pudendal nerve
C. Femoral nerve
D. Genitofemoral nerve

back 172

B. Pudendal nerve

front 173

Genital sensory fibers enter the spinal cord primarily at:

A. L1-L2
B. T11-L1
C. S2-S4
D. S4-Co1

back 173

C. S2-S4

front 174

del

back 174

del

front 175

In females, parasympathetic stimulation causes Bartholin glands to:

A. Stop secreting mucus
B. Secrete mucus
C. Contract skeletal muscle
D. Produce estrogen

back 175

B. Secrete mucus

front 176

In females, vaginal secretions are stimulated mainly by:

A. Sympathetics
B. Parasympathetics
C. Pudendal motor fibers
D. Somatic reflex arcs

back 176

A. Sympathetics

front 177

In both sexes, erection is primarily mediated by:

A. Sympathetics
B. Parasympathetics
C. Corticospinal fibers
D. Dorsal column pathways

back 177

B. Parasympathetics

front 178

In males, ejaculation is primarily mediated by a:

A. Parasympathetic skin reflex
B. Sympathetic reflex
C. Pudendal sensory reflex
D. Cerebellar reflex

back 178

B. Sympathetic reflex

front 179

During male ejaculation, which muscle type contracts along the reproductive tract?

A. Cardiac muscle
B. Skeletal muscle only
C. Smooth muscle
D. Extraocular muscle

back 179

C. Smooth muscle

front 180

Which of the following can also contribute to sexual dysfunction besides spinal cord disease?

A. Peripheral nerve disease
B. Corneal abrasion
C. Otosclerosis
D. Nephrolithiasis

back 180

A. Peripheral nerve disease

front 181

Syringomyelia is best defined as a:

A. Brainstem aneurysm
B. Fluid-filled spinal cavity
C. Tumor of dorsal roots
D. Peripheral nerve cyst

back 181

B. Fluid-filled spinal cavity

front 182

Which of the following is a recognized cause of syringomyelia?

A. Congenital abnormalities
B. Hyperthyroidism
C. Meningococcal rash
D. Temporal arteritis

back 182

A. Congenital abnormalities

front 183

Posttraumatic syringomyelia is best described as:

A. Immediate spinal hemorrhage
B. Delayed sequela of SCI
C. Congenital sacral cyst
D. Acute viral myelitis

back 183

B. Delayed sequela of SCI