front 1 Spinal cord ends where? A. T11–T12 | back 1 B. L1–L2 |
front 2 On adult spinal MRI, the region below L1/L2 containing only descending nerve roots and no spinal cord is the: A. filum terminale | back 2 D. cauda equina |
front 3 The conus medullaris tapers distally into the: A. filum terminale | back 3 A. filum terminale |
front 4 Within the cauda equina, the most central roots arise from the most: A. rostral segments | back 4 C. caudal segments |
front 5 Which spinal segment is unique in having motor roots without sensory roots? A. C2 | back 5 C. C1 |
front 6 The cervical enlargement giving rise to upper-limb innervation corresponds to: A. C3–C7 | back 6 B. C5–T1 |
front 7 The lumbosacral enlargement spans which root levels? A. L1–S3 | back 7 A. L1–S3 |
front 8 A mixed spinal nerve is formed by the fusion of: A. dorsal and ventral horns | back 8 C. sensory and motor roots |
front 9 In degenerative spinal stenosis, hypertrophy of which structure may compress the cord or nerve roots? A. dentate ligament | back 9 D. ligamentum flavum |
front 10 Disc herniations are most common in which regions? A. cervical and lumbosacral | back 10 A. cervical and lumbosacral |
front 11 Which spinal roots have the most horizontal course as they emerge from the thecal sac? A. lumbar | back 11 C. cervical |
front 12 Cervical disc herniations are usually more lateral than central because the disc is constrained by the: A. ligamentum flavum | back 12 B. posterior longitudinal ligament |
front 13 In the lumbosacral spine, the usual disc herniation pattern is: A. posterolateral; descending roots | back 13 A. posterolateral; descending roots |
front 14 A far-lateral L4–L5 disc herniation most likely compresses which root? A. L5 root | back 14 D. L4 root |
front 15 A large central L2–L3 disc herniation in an adult most likely: A. spares descending roots | back 15 C. compresses lower cauda equina |
front 16 A central disc herniation above the L1 level can directly compress the: A. spinal cord | back 16 A. spinal cord |
front 17 Epidural fat normally contains which important structures? A. dura and ganglia | back 17 B. Batson plexus and arteries |
front 18 A cutaneous territory innervated by a single spinal root is called a: A. dermatome | back 18 A. dermatome |
front 19 Sensation over the posterior scalp near the occiput is supplied mainly by: A. C5 branches | back 19 B. C2 branches |
front 20 Dermatomal maps of the lower back and chest skip C5–T1 mainly because those levels supply the: A. diaphragm | back 20 D. upper limb |
front 21 A set of muscles supplied predominantly by one spinal root defines a: A. dermatome | back 21 B. myotome |
front 22 The site of pathology in a neuropathy may involve: A. axons, myelin, or both | back 22 A. axons, myelin, or both |
front 23 Most peripheral neuropathies affect: A. sensory fibers only | back 23 C. sensory and motor fibers |
front 24 Median nerve compression at the wrist is best classified as a: A. polyneuropathy | back 24 D. mononeuropathy |
front 25 Painful patchy deficits affecting several separate named nerves, as in vasculitis, are most consistent with: A. polyneuropathy | back 25 B. mononeuropathy multiplex |
front 26 Symmetric distal stocking-glove numbness in both feet and hands is the classic pattern of: A. mononeuropathy | back 26 C. polyneuropathy |
front 27 Which group contains only recognized causes of neuropathy? A. asthma, gout, cirrhosis | back 27 B. toxins, infection, malnutrition |
front 28 The most common diabetic neuropathy pattern is: A. mononeuropathy multiplex | back 28 C. distal symmetric polyneuropathy |
front 29 Acute diabetic mononeuropathy most commonly involves which set of nerves? A. radial, ulnar, median | back 29 C. CN III, femoral, sciatic |
front 30 Extrinsic compression, traction, laceration, or entrapment by nearby structures is classified as: A. metabolic neuropathy | back 30 D. mechanical nerve injury |
front 31 A transient conduction block after mild nerve compression, without major axonal disruption, is called: A. axonotmesis | back 31 B. neurapraxia |
front 32 Wallerian degeneration affects axons and myelin ______ to the nerve injury. A. proximal | back 32 C. distal |
front 33 Following a wrist sprain, a patient develops severe limb pain, edema, sweating, and vasomotor skin changes without identifiable named nerve injury. This is: A. CRPS type 2 | back 33 D. CRPS type 1 |
front 34 A patient develops severe burning pain after a documented partial median nerve laceration, with edema and abnormal sweating. This syndrome is: A. CRPS type 2 | back 34 A. CRPS type 2 |
front 35 Which feature is shared by both type 1 and type 2 complex regional pain syndrome? A. isolated numb thumb | back 35 C. burning pain with autonomic changes |
front 36 Painful paresthesias in peripheral neuropathy are commonly treated with: A. beta blockers, SNRIs, or TCAs | back 36 D. anticonvulsants, SNRIs, or TCAs |
front 37 Guillain-Barré syndrome classically begins: A. immediately after trauma | back 37 B. 1–2 weeks post-infection |
front 38 Which antecedent infection is classically associated with Guillain-Barré syndrome? A. Epstein-Barr mononucleosis | back 38 C. Campylobacter jejuni enteritis |
front 39 A patient develops ascending weakness, absent reflexes, and tingling in the hands and feet after a recent diarrheal illness. The most likely diagnosis is: A. myasthenia gravis | back 39 B. Guillain-Barré syndrome |
front 40 Which CSF profile supports Guillain-Barré syndrome? A. high protein, normal WBC | back 40 A. high protein, normal WBC |
front 41 Disease-modifying treatment for Guillain-Barré syndrome includes: A. acetazolamide or phenytoin | back 41 B. plasmapheresis or IVIG |
front 42 Myasthenia gravis most characteristically causes: A. asymmetric sensory ataxia | back 42 D. symmetric fatigable weakness |
front 43 Which combination best fits myasthenia gravis? A. facial weakness, dysphagia, nasal voice | back 43 A. facial weakness, dysphagia, nasal voice |
front 44 Continued use of muscles in myasthenia gravis typically causes: A. improved force generation | back 44 B. increased weakness |
front 45 Ocular myasthenia gravis is defined by deficits limited to the: A. proximal arms and neck | back 45 C. extraocular muscles and eyelids |
front 46 In the bedside ice pack test, improvement of ptosis after two minutes supports: A. Lambert-Eaton syndrome | back 46 C. myasthenia gravis |
front 47 Anti-acetylcholine receptor antibodies are positive in about 85% of patients with: A. ocular myasthenia only | back 47 B. generalized myasthenia |
front 48 A patient with generalized myasthenia is negative for AChR antibodies. Which antibody may still be positive? A. anti-Hu | back 48 C. MuSK antibody |
front 49 A tumor of the thymus associated with myasthenia gravis is called: A. neuroma | back 49 B. thymoma |
front 50 Which medication is a long-acting cholinesterase inhibitor used in myasthenia gravis? A. pyridostigmine | back 50 A. pyridostigmine |
front 51 Which is an appropriate short-term immunotherapy for myasthenia gravis exacerbation? A. levetiracetam | back 51 C. IVIG |
front 52 Which intervention may be considered in myasthenia gravis when indicated by disease context? A. rhizotomy | back 52 B. thymectomy |
front 53 Disorders causing weakness that is usually more severe proximally than distally, without sensory loss, are: A. neuropathies | back 53 B. myopathies |
front 54 Serum creatine phosphokinase is typically elevated in: A. myopathies | back 54 A. myopathies |
front 55 A patient with inflammatory myopathy develops a violaceous rash over the extensor surfaces of the knuckles. This finding is most characteristic of: A. polymyositis | back 55 B. dermatomyositis |
front 56 Which feature best distinguishes dermatomyositis from many other myopathies? A. glove-stocking sensory loss | back 56 C. violet extensor-joint rash |
front 57 A 6-year-old boy has progressive proximal muscle weakness and a family history consistent with X-linked transmission. The most likely diagnosis is: A. Duchenne muscular dystrophy | back 57 A. Duchenne muscular dystrophy |
front 58 Duchenne muscular dystrophy classically affects: A. adult women | back 58 C. male children |
front 59 In a patient whose back pain begins after age 50, which serious cause should be especially suspected? A. migraine | back 59 B. neoplasm |
front 60 In evaluating back pain, failure to assess which group of functions risks missing irreversible neurologic loss? A. speech, vision, hearing | back 60 C. bowel, bladder, sexual |
front 61 Sensory or motor dysfunction caused by pathology of a nerve root is termed: A. neuropathy | back 61 D. radiculopathy |
front 62 Radiculopathy most commonly presents with: A. painless proximal weakness | back 62 B. shooting dermatomal limb pain |
front 63 A patient with chronic nerve root compression may eventually develop: A. hyperreflexia and spasticity | back 63 B. atrophy and fasciculations |
front 64 Cauda equina syndrome refers to involvement of multiple nerve roots: A. above C5 | back 64 C. below L1 |
front 65 The most common cause of radiculopathy is: A. thymoma | back 65 B. disc herniation |
front 66 Disc-herniation radiculopathy most commonly affects which roots? A. C6, C7, L5, S1 | back 66 A. C6, C7, L5, S1 |
front 67 Compared with cervical radiculopathies, lumbosacral radiculopathies are approximately: A. equally common | back 67 C. 2–3 times more common |
front 68 As the spine degenerates over time, which structure commonly forms? A. tophi | back 68 B. osteophytes |
front 69 Osteophytes can produce radiculopathy by: A. weakening neuromuscular junctions | back 69 D. narrowing foramina or canal |
front 70 In the straight-leg raising test, the patient lies: A. prone with knees flexed | back 70 C. supine while one leg lifts |
front 71 A positive straight-leg raising test reproduces typical radicular pain and paresthesias at approximately: A. 10–60 degrees | back 71 A. 10–60 degrees |
front 72 In a crossed straight-leg raising test, elevating the asymptomatic leg causes: A. bilateral arm pain | back 72 D. symptoms in symptomatic leg |
front 73 Pain on percussion of the spine should raise concern for: A. migraine or tension headache | back 73 B. metastatic or infectious vertebral disease |
front 74 Narrowing of the spinal canal is called: A. spondylolysis | back 74 C. spinal stenosis |
front 75 Bilateral leg pain and weakness triggered by walking is most characteristic of: A. neurogenic claudication | back 75 A. neurogenic claudication |
front 76 Reactivation of which virus can cause radiculopathy with shingles? A. Epstein-Barr virus | back 76 B. varicella-zoster virus |
front 77 Which tick-borne illness may cause radiculopathies? A. babesiosis | back 77 C. Lyme disease |
front 78 In a patient with HIV, an important cause of polyradiculopathy is: A. adenovirus | back 78 D. cytomegalovirus |
front 79 Dumbbell-shaped nerve sheath tumors that may cause radiculopathy include: A. ependymomas and meningiomas | back 79 B. schwannomas and neurofibromas |
front 80 The most clinically important nerve roots in the leg are: A. L1, L2, L3 | back 80 C. L4, L5, S1 |
front 81 Sensory loss in an S2–S5 distribution is termed: A. cape anesthesia | back 81 B. saddle anesthesia |
front 82 A patient with severe low back pain reports urinary retention, perineal numbness, and sexual dysfunction. The most urgent diagnosis to exclude is: A. dermatomyositis | back 82 D. cauda equina syndrome |
front 83 A 62-year-old with chronic lumbar degeneration develops root pain from intervertebral foraminal narrowing by bony overgrowth. The offending lesion is most likely: A. epidural hematoma | back 83 B. osteophyte formation |
front 84 A patient with a compressive lesion involving S2–S4 roots would most likely develop which urinary pattern? A. urgency with small voids | back 84 B. distended atonic retention |
front 85 Sacral root involvement at S2–S4 may also cause: A. constipation and fecal incontinence | back 85 A. constipation and fecal incontinence |
front 86 Loss of erections in a patient with cauda equina symptoms most strongly suggests involvement of: A. L1–L2 roots | back 86 C. S2–S4 roots |
front 87 Which condition is an indication for urgent surgery in radiculopathy? A. isolated paresthesias | back 87 C. cord compression |
front 88 Which second condition also warrants urgent surgery for radiculopathy? A. cauda equina syndrome | back 88 A. cauda equina syndrome |
front 89 A foraminotomy is performed to: A. remove dorsal root ganglia | back 89 B. widen the lateral recess |
front 90 The nerve root passes through the lateral recess just before exiting the: A. neural tube | back 90 C. intervertebral foramen |
front 91 A patient has a painful vesicular rash over the lateral shoulder and arm in a dermatomal pattern. Which diagnosis best fits? A. shingles of left C5–C6 | back 91 A. shingles of left C5–C6 |
front 92 In adults, the spinal cord normally ends as the conus medullaris at the level of: A. T11–T12 vertebrae | back 92 B. L1–L2 vertebrae |
front 93 The conus medullaris tapers into the: A. dentate ligament | back 93 C. filum terminale |
front 94 Which structure runs centrally within the cauda equina? A. filum terminale | back 94 A. filum terminale |
front 95 Unlike the cranium, the spinal canal contains a layer of ______ between dura and periosteum. A. CSF | back 95 B. epidural fat |
front 96 Epidural fat in the spinal canal is clinically important because it creates a true: A. subarachnoid cistern | back 96 B. epidural space |
front 97 The ligamentum flavum is most prominent in which regions? A. thoracic and sacral | back 97 B. cervical and lumbar |
front 98 Hypertrophy of ligamentum flavum can contribute to: A. syringomyelia only | back 98 B. spinal stenosis |
front 99 Cervical discs are constrained mainly by the ______ ligament. A. anterior longitudinal | back 99 C. posterior longitudinal |
front 100 Because of that ligamentous constraint, cervical discs usually herniate: A. centrally | back 100 D. laterally |
front 101 In the cervical spine, the affected nerve root from a disc herniation usually corresponds to the ______ vertebral bone of that disc space. A. upper | back 101 B. lower |
front 102 A C5–C6 disc herniation in the cervical spine most commonly causes: A. C5 radiculopathy | back 102 B. C6 radiculopathy |
front 103 A far-lateral L5–S1 disc herniation most likely produces: A. S1 radiculopathy | back 103 C. L5 radiculopathy |
front 104 A far-lateral lumbosacral disc herniation typically impinges: A. the next higher root | back 104 A. the next higher root |
front 105 The greater and lesser occipital nerves derive primarily from: A. C2 | back 105 A. C2 |
front 106 The L4 dermatome extends down the: A. lateral calf | back 106 C. anteromedial shin |
front 107 The L5 dermatome includes the: A. small toe only | back 107 B. anterolateral shin, big toe |
front 108 The S1 dermatome includes the: A. medial knee and thigh | back 108 D. small toes and lateral foot |
front 109 Which exam modality is more sensitive for dermatomal sensory loss? A. vibration | back 109 D. pinprick |
front 110 Pinprick is more sensitive than touch for dermatomal loss because: A. motor fibers overlap less | back 110 C. small fibers overlap less |
front 111 Atrophy, fasciculations, decreased tone, and hyporeflexia suggest damage to the ______ nervous system. A. central | back 111 D. peripheral |
front 112 Paresthesias in a peripheral nerve distribution also support a lesion in the: A. cerebellum | back 112 B. peripheral nervous system |
front 113 The onset of acute diabetic mononeuropathy is usually: A. congenital | back 113 D. fairly sudden |
front 114 Acute diabetic mononeuropathy may be accompanied by: A. painless pure weakness | back 114 B. painful paresthesias |
front 115 Neurapraxia generally resolves over: A. minutes to hours | back 115 B. hours to weeks |
front 116 Severe nerve injury may cause ______ degeneration distal to the lesion. A. retrograde | back 116 B. wallerian |
front 117 If the nerve’s structural scaffolding remains intact, axonal regeneration proceeds at approximately: A. 1 cm/day | back 117 B. 1 mm/day |
front 118 Which syndrome is a complication of nerve injury due to incomplete or aberrant reinnervation? A. Brown-Séquard syndrome | back 118 B. complex regional pain syndrome |
front 119 Complex regional pain syndrome is characterized by: A. local burning pain with edema | back 119 A. local burning pain with edema |
front 120 Autonomic-type findings in complex regional pain syndrome include: A. aphasia and neglect | back 120 C. sweating and vasomotor changes |
front 121 In Guillain-Barré syndrome, which modality is typically more affected? A. sensory | back 121 C. motor |
front 122 Guillain-Barré syndrome typically presents with: A. fluctuating ptosis after exertion | back 122 B. progressive weakness and areflexia |
front 123 The sensory complaint most often accompanying Guillain-Barré syndrome is: A. complete anesthesia | back 123 B. tingling in hands and feet |
front 124 Symptoms of Guillain-Barré syndrome usually peak: A. within 24 hours | back 124 B. at 1–3 weeks |
front 125 Myasthenia gravis most commonly presents in the 2nd or 3rd decade in: A. males | back 125 B. females |
front 126 Myasthenia gravis more typically presents in the 6th or 7th decade in: A. females | back 126 C. males |
front 127 Deep tendon reflexes in myasthenia gravis are usually: A. absent | back 127 D. normal |
front 128 A patient has generalized myasthenia gravis but is negative for anti-ACh receptor antibodies. Which antibody is often positive? A. anti-GQ1b | back 128 B. MuSK antibody |
front 129 Roughly half of generalized myasthenia patients who are AChR-antibody negative have antibodies against: A. voltage-gated calcium channels | back 129 B. muscle specific tyrosine kinase |
front 130 About 12% of patients with myasthenia gravis have a: A. neuroma | back 130 B. thymoma |
front 131 In myasthenia gravis, many patients without thymoma still have: A. adrenal hyperplasia | back 131 C. thymic hyperplasia |
front 132 The benefit of thymectomy in myasthenia gravis is thought to come from: A. reducing autoimmune response | back 132 A. reducing autoimmune response |
front 133 A patient in myasthenic crisis may benefit short-term from: A. IVIG or plasmapheresis | back 133 A. IVIG or plasmapheresis |
front 134 Disc-herniation radiculopathy most commonly affects which roots in this set? A. C3, C4, L2, L3 | back 134 B. C5, C6, L5, S1 |
front 135 Lumbar stenosis can produce neurogenic claudication, classically causing: A. unilateral arm weakness | back 135 B. bilateral leg pain with walking |
front 136 A diabetic patient develops band-like abdominal pain due to occasional nerve-root involvement. Which level is particularly implicated? A. cervical | back 136 C. thoracic |
front 137 CMV polyradiculopathy in a patient with HIV most commonly affects the: A. cervical roots | back 137 D. lumbosacral roots |
front 138 Impaired function of multiple nerve roots below L1 or L2 is called: A. conus medullaris syndrome | back 138 B. cauda equina syndrome |
front 139 A lesion in the sacral segments of the spinal cord causes: A. conus medullaris syndrome | back 139 A. conus medullaris syndrome |
front 140 Conus medullaris syndrome is most similar to: A. diabetic mononeuropathy | back 140 B. cauda equina syndrome |