Sem 2 Neuro, DPS, Week 2 - Spinal Cord

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  • 1/26 Questions

    A patient has an injury that results in damage to the lower motor neurons. Which of the following would you expect to see in the patient?

    • Spastic paralysis
    • Hyperreflexia
    • Increased muscle tone
    • Positive Babinski sign
    • Flaccid paralysis
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About This Quiz

This quiz, titled 'Sem 2 neuro, dps, week 2 - Spinal cord,' assesses knowledge on spinal cord injuries and neurological disorders through clinical scenarios. It covers topics such as hemisection, dorsal column injuries, and spinothalamic tract lesions, focusing on diagnosis and understanding of spinal cord anatomy.

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  • 2. 

    A patient has an injury that results in damage to the ventral horn of the spinal cord. Which of the following would you expect to see in this patient?

    • Flaccid paralysis

    • Spastic paralysis

    • Hyperreflexia

    • Increased muscle tone

    • Positive Babinski sign

    Correct Answer
    A. Flaccid paralysis
    Explanation
    Damage to the ventral horn of the spinal cord would result in flaccid paralysis. Flaccid paralysis is characterized by the loss of muscle tone and voluntary movement in the affected muscles. This occurs because the damage to the ventral horn disrupts the motor neurons that innervate the muscles, leading to a loss of muscle function. In contrast, spastic paralysis is caused by damage to the upper motor neurons and is characterized by increased muscle tone and hyperreflexia. Therefore, in this patient, we would expect to see flaccid paralysis rather than spastic paralysis, hyperreflexia, increased muscle tone, or a positive Babinski sign.

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  • 3. 

    A 19 year old gang member presented in the ER with a stab wound of the neck. Neurological examination revealed left hemiparesis with complete loss of vibratory and joint position sense below C6 on the same side as the weakness. Loss of pain and temperature sensation was elicited on the left at C6 only and on the right below C6. An MRI of the cervical spinal cord will reveal which of these findings?

    • Hemisection of the left spinal cord

    • Lesion of the dorsal column only on the left spinal cord

    • Complete transection of the spinal cord

    • Lesion of the left anterolateral white mater only of the spinal cord

    • Damage to the cervical dorsal roots at C6 on the left side only

    Correct Answer
    A. Hemisection of the left spinal cord
    Explanation
    The given answer, "Hemisection of the left spinal cord," is correct because the patient's symptoms are consistent with Brown-Séquard syndrome, which is characterized by a lesion or injury to one half of the spinal cord. In this case, the left side of the spinal cord is affected, resulting in loss of vibratory and joint position sense below C6 on the same side as the weakness. Additionally, there is loss of pain and temperature sensation on the left at C6 only and on the right below C6. This pattern of findings is indicative of a hemisection or partial damage to the left side of the spinal cord.

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  • 4. 

    A 70 year old male presents to his family physician for a regular checkup. The patient has a history of untreated syphilis when he was 25 years old. He now presents with an unsteady gait, problems with his memory and urinary incontinence. You perform a complete neurological examination which includes the Romberg's test. His Romberg is positive. Which specific task in this test indicates that the patient has suffered posterior column damage?

    • Loss of balance with his eyes closed

    • Inability to understand commands

    • Patient has lost the ability to discriminate two sensations

    • Pupils do not react to light

    • Areflexia

    Correct Answer
    A. Loss of balance with his eyes closed
    Explanation
    Loss of balance with his eyes closed indicates that the patient has suffered posterior column damage. The Romberg's test is used to evaluate proprioception and the patient's ability to maintain balance. When the patient closes their eyes during the test, they rely solely on proprioception to maintain balance. If there is damage to the posterior columns of the spinal cord, which are responsible for proprioception, the patient will have difficulty maintaining balance and will sway or fall. This is why a positive Romberg's test with loss of balance with eyes closed indicates posterior column damage.

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  • 5. 

    45 year painter was rushed to the ER after he fell from a high building and fractured his cervical vertebra and damaged his spinal cord. During examination of his reflexes immediately after the accident, which of the following are most likely to be seen?

    • Increased reflexes

    • Decreased reflexes

    • Clonus

    • Rigidity

    • Fasiculations

    Correct Answer
    A. Decreased reflexes
    Explanation
    After a traumatic injury like a fall from a high building resulting in a fractured cervical vertebra and spinal cord damage, it is expected to see decreased reflexes. This is because the injury affects the communication between the brain and the spinal cord, leading to a disruption in the reflex arc. The damaged nerves are unable to transmit signals properly, resulting in a decrease in reflex responses.

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  • 6. 

    Your great-aunt has pernicious anemia because of a vitamin B12 deficiency. She exhibits spastic paralysis and a loss of touch and pressure perception in both lower limbs, Because of your medical background, which problem do you suspect?

    • Subacute combined degeneration

    • Brown-Sequard syndrome

    • Syringomyelia

    • Amyotrophic lateral sclerosis (ALS)

    • Tabes Dorsalis

    Correct Answer
    A. Subacute combined degeneration
    Explanation
    Based on the symptoms described, it is likely that the great-aunt is experiencing subacute combined degeneration. This condition is typically caused by a deficiency in vitamin B12, which can lead to neurological symptoms such as spastic paralysis and a loss of touch and pressure perception in the lower limbs. The other options, including Brown-Sequard syndrome, syringomyelia, amyotrophic lateral sclerosis (ALS), and tabes dorsalis, do not typically present with the same combination of symptoms seen in this case.

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  • 7. 

    Which of the following would be an iatrogenic cause for a spinal cord injury?

    • Neurosyphilis

    • Meningitis

    • Motor vehicle accident

    • Osteoporosis

    • Lumbar puncture

    Correct Answer
    A. Lumbar puncture
    Explanation
    A lumbar puncture can be an iatrogenic cause for a spinal cord injury because it involves inserting a needle into the spinal canal, which can potentially damage the spinal cord if not performed correctly. While neurosyphilis, meningitis, motor vehicle accidents, and osteoporosis can all lead to spinal cord injuries, they are not iatrogenic causes as they are not caused by medical procedures or interventions.

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  • 8. 

    In which of the following funiculi would you find the dorsal columns?

    • Lateral Funiculus

    • Posterior Funiculus

    • Anterior Funiculus

    • Medial Funiculus

    • Cuneate Funiculus

    Correct Answer
    A. Posterior Funiculus
    Explanation
    The dorsal columns, also known as the posterior columns, are located in the posterior funiculus of the spinal cord. These columns contain sensory nerve fibers that carry information related to touch, vibration, and proprioception from the body to the brain.

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  • 9. 

    Which of the following would you primarily find in the lateral funiculus of the spina cord?

    • Alpha motor neurons

    • Anterior Corticospinal tract

    • Fasciculus cuneatus

    • Medial Lemniscus

    • Lateral Corticospinal tract

    Correct Answer
    A. Lateral Corticospinal tract
    Explanation
    The lateral funiculus of the spinal cord primarily contains the Lateral Corticospinal tract. This tract is responsible for carrying motor signals from the cerebral cortex to the spinal cord, controlling voluntary movements of the limbs and trunk. The other options listed, such as alpha motor neurons, anterior corticospinal tract, fasciculus cuneatus, and medial lemniscus, are found in other regions of the spinal cord and serve different functions.

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  • 10. 

    Which of the following would you find in the dorsal horn of the spinal cord?

    • Alpha motor neuron

    • Gamma motor neuron

    • Substantia gelatinosa

    • Sympathetic cell bodies

    • Clarke's nucleus

    Correct Answer
    A. Substantia gelatinosa
    Explanation
    The dorsal horn of the spinal cord contains the substantia gelatinosa. This is a gel-like substance that is involved in processing pain and temperature sensations. It is responsible for modulating the transmission of pain signals to the brain. The substantia gelatinosa contains interneurons that receive sensory input from peripheral nerves and transmit it to other areas of the spinal cord and brain. It plays a crucial role in the processing and modulation of pain signals.

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  • 11. 

    A 25 year old female accidentally drops of a suitcase that she did not realize was too heavy. Which of the following pathways are most likely to be directly responsible for transmitting unconscious proprioception?

    • Neospinothalamic

    • Spinoreticular

    • Spinocerebellar

    • Dorsal column-medial Lemniscus

    • Spinomesencephalic

    Correct Answer
    A. Spinocerebellar
    Explanation
    The spinocerebellar pathway is most likely to be directly responsible for transmitting unconscious proprioception. This pathway carries information from proprioceptors in the muscles, tendons, and joints to the cerebellum, which is involved in coordinating movement and maintaining balance. This pathway does not involve conscious perception of proprioception, which is why it is referred to as "unconscious" proprioception. The other pathways listed, such as the neospinothalamic, spinoreticular, dorsal column-medial lemniscus, and spinomesencephalic pathways, are not primarily involved in transmitting proprioceptive information.

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  • 12. 

    A 24-year-old graduate student suffers a fall from a ladder and was left paralyzed from his waist down. After initial medical management was unsuccessful for recovery of function of his legs, he was admitted to a spinal cord injury rehabilitation center. There he worked diligently at the exercises and techniques, aimed at recovery. After six weeks of intensive work he has shown no improvement in his motor function. He tearfully tells his trainer that he feels that it is not worth the effort anymore and that he would like to have a motorized chair so that he could get out of the place and get back with his studies. The behavior shown by the patient at this time suggests he is in what phase of the grief process?

    • Denial

    • Acceptance

    • Anger

    • Bargaining

    • Depression

    Correct Answer
    A. Acceptance
    Explanation
    The behavior shown by the patient, expressing a desire for a motorized chair to resume his studies, suggests that he has accepted his condition and is ready to adapt to his new circumstances. This indicates that he has moved past the initial stages of denial, anger, bargaining, and depression, and has come to terms with his paralysis.

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  • 13. 

    Which of the following tracts is affected with syringomyelia?

    • Lateral Corticospinal

    • Dorsal Column fibers

    • Anterior Corticospinal

    • Spinothalamic Tract

    • Dorsal Spinocerebellar fibers

    Correct Answer
    A. Spinothalamic Tract
    Explanation
    Syringomyelia is a condition characterized by the formation of a fluid-filled cyst or syrinx within the spinal cord. This cyst can disrupt the normal functioning of the spinal cord and affect different tracts. In syringomyelia, the spinothalamic tract is commonly affected. The spinothalamic tract is responsible for transmitting pain and temperature sensations from the body to the brain. Damage to this tract can lead to sensory disturbances, such as loss of pain and temperature sensation, in the affected areas of the body.

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  • 14. 

    During a college football game, a player is "sacked" and carried off the field. A CT scan reveals a bone fragment lodged into the medial aspect of his dorsal columns in the cervical spinal cord on the left side. Which of the following functions will most likely be affected given this patient's presentation?

    • Motor control of left leg

    • Proprioception of right leg

    • Pain from left face

    • Touch, pressure, vibration of right arm

    • Touch, pressure, vibration of left leg

    Correct Answer
    A. Touch, pressure, vibration of left leg
    Explanation
    The bone fragment lodged into the medial aspect of the dorsal columns in the cervical spinal cord on the left side will most likely affect the touch, pressure, and vibration sensations of the left leg. The dorsal columns are responsible for transmitting sensory information such as touch, pressure, and vibration from the body to the brain. Since the bone fragment is affecting the dorsal columns on the left side, it will disrupt the transmission of sensory signals from the left leg, leading to a loss or impairment of touch, pressure, and vibration sensations in that leg.

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  • 15. 

    An occlusion of the anterior spinal artery at the T10 spinal cord level would result in which of the following?

    • Ipsilateral loss of touch and pressure sense below the level of occlusion

    • Ipsilateral loss of pain and temperature sense below the level of occlusion

    • Loss of voluntary motor function to muscles of the tongue

    • Ipsilateral loss of voluntary motor function below the level of occlusion

    • Bilateral loss of voluntary motor function below the level of occlusion

    Correct Answer
    A. Bilateral loss of voluntary motor function below the level of occlusion
    Explanation
    An occlusion of the anterior spinal artery at the T10 spinal cord level would result in bilateral loss of voluntary motor function below the level of occlusion. This is because the anterior spinal artery supplies blood to the anterior portion of the spinal cord, which contains the motor pathways. When this artery is occluded, it leads to a lack of blood supply and subsequent damage to the motor pathways, resulting in a loss of voluntary motor function on both sides of the body below the level of the occlusion.

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  • 16. 

    A pain researcher wants to make a lesion to the Spinothalamic tract so that his subjects feel no pain and temperature sensation from the right leg, but leaves pain and temperature sensation rostral to the arm. Where would you advise this researcher to make his lesion?

    • Lesion the right spinal tract of V

    • Lesion the most lateral aspect of the left spinothalamic tract

    • Lesion the most medial aspect of the left spinothalamic tract

    • Lesion the most lateral aspect of the right spinothalamic tract

    • Lesion the most medial aspect of the right spinothalamic tract

    Correct Answer
    A. Lesion the most lateral aspect of the left spinothalamic tract
    Explanation
    The most lateral aspect of the left spinothalamic tract should be lesioned in order to achieve the desired result. This is because the spinothalamic tract carries pain and temperature sensations from the contralateral side of the body. By lesioning the most lateral aspect of the left spinothalamic tract, the researcher can selectively block pain and temperature sensations from the right leg while leaving the sensations rostral to the arm unaffected.

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  • 17. 

    During a play-off game, a college hockey player is struck hard on the back of his neck with a hockey stick. A CT scar reveals a bone fragment lodged into the medial aspect of his dorsal columns in the cervical spinal cord. Which of the following functions will most likely be affected given this patient's presentation?

    • Touch, pressure, vibratory sense from ipsilateral leg

    • Pain and temperature sense from contralateral leg

    • Pain from ipsilateral face

    • Pain and temperature sense from contralateral arm

    • Touch, pressure, vibration of ipsilateral arm

    Correct Answer
    A. Touch, pressure, vibratory sense from ipsilateral leg
    Explanation
    The bone fragment lodged into the medial aspect of the dorsal columns in the cervical spinal cord is likely to affect the sensory pathways that transmit touch, pressure, and vibratory sense from the ipsilateral leg. This is because the dorsal columns are responsible for transmitting these sensory modalities from the lower body to the brain. The fact that the injury is on the medial aspect of the dorsal columns suggests that it will specifically affect the sensory pathways that are closer to the midline of the body, which includes the ipsilateral leg.

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  • 18. 

    As a principal investigator, you are researching the morphology and functionality of alpha motor neurons in the spinal cord. Today you are ready to examine alpha motor neurons located very medially at the lumbar spinal cord level. You know that these neurons provide voluntary motor innervation to which of the following?

    • Hard

    • Trunk

    • Knee

    • Thigh

    • Foot

    Correct Answer
    A. Thigh
    Explanation
    Alpha motor neurons in the lumbar spinal cord are involved in innervating muscles of the lower limbs, including those of the thigh. These neurons control voluntary movements by sending signals to the muscles. Specifically, at the lumbar level, they are crucial for the motor control of muscles in the thigh, which include the quadriceps and hamstrings.

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  • 19. 

    Which of the following 2nd order neurons is involved with relaying pain and temperature information to the VPM from the face?

    • Principal (main) sensory nucleus of V

    • Spinal nucleus of V

    • Motor nucleus of V

    • Nucleus cuneatus

    • Ventral horn neurons

    Correct Answer
    A. Spinal nucleus of V
    Explanation
    The correct answer is the Spinal nucleus of V. This is because the Spinal nucleus of V is responsible for relaying pain and temperature information from the face to the VPM (ventral posterior medial) nucleus of the thalamus. The other options listed are not specifically involved in relaying pain and temperature information from the face.

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  • 20. 

    As a principal investigator in a spinal cord regeneration laboratory, you decide to prepare a feline subject with a Brown-Sequard syndrome to illustrate the deficits to your graduate students and technicians. Which of the following would this subject exhibit with a Brown­Sequard syndrome on the left side?

    • A loss of voluntary motor function on the right side below the level of the lesion

    • A loss of pain and temperature sense on the left side below the level of the lesion

    • A loss of touch and pressure sense on the left side below the level of the lesion

    • A loss of touch and pressure sense on the right side below the level of the lesion

    • A loss of pain and temperature sense on the right side of the face.

    Correct Answer
    A. A loss of touch and pressure sense on the left side below the level of the lesion
    Explanation
    A Brown-Sequard syndrome is a neurological condition caused by damage to one side of the spinal cord. The syndrome is characterized by a loss of motor function and proprioception (sense of body position) on the same side as the lesion, and a loss of pain and temperature sensation on the opposite side. In this case, the subject would exhibit a loss of touch and pressure sense on the left side below the level of the lesion, which is consistent with the characteristics of Brown-Sequard syndrome.

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  • 21. 

    A 36 year old male is observed to have difficulty in walking during a clinic visit. Testing indicates that his joint position sense is intact. However, his reflexes in his lower limbs are diminished. Based on the findings in this patient, which of the following pathways most likely have been damaged?

    • Lateral spinothalamic

    • Ventral spinothalamic

    • Dorsal spinocerebellar

    • Cuneocerebellar

    • Dorsal column

    Correct Answer
    A. Dorsal spinocerebellar
    Explanation
    The patient's intact joint position sense suggests that the dorsal column pathway, which carries proprioceptive information, is intact. The diminished reflexes in the lower limbs indicate damage to the pathway responsible for transmitting this information to the cerebellum, which is the dorsal spinocerebellar pathway.

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  • 22. 

    A 22-year old athlete is complaining of a loss of 'touch and pressure sense from his left lower limb. You know that axons carrying this type of information are found in which of the following spinal cord regions?

    • Dorsal funiculus of the spinal cord

    • Ventral horn of the spinal cord

    • Lateral funiculus of the spinal cord

    • Dorsal horn of the spinal cord

    • Anterior funiculus of the spinal cord

    Correct Answer
    A. Dorsal funiculus of the spinal cord
    Explanation
    Axons carrying touch and pressure sensation information are found in the dorsal funiculus of the spinal cord. The dorsal funiculus is responsible for transmitting sensory information from the body to the brain. In this case, the loss of touch and pressure sense in the left lower limb suggests a problem with the axons in the dorsal funiculus on the same side of the body.

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  • 23. 

    The incidence of spinal cord injuries in the USA is

    • 10% of the population

    • Approximately 250,00 cases at any point in time in the population

    • About 12,000 new cases per year

    • Prevalent among young males

    • Mostly caused by motor vehicle accidents

    Correct Answer
    A. About 12,000 new cases per year
    Explanation
    The correct answer is "About 12,000 new cases per year." This answer is supported by the information provided in the question, which states that there are approximately 12,000 new cases of spinal cord injuries per year. The other statements in the question provide additional information about the incidence and prevalence of spinal cord injuries in the USA, but the statement about 12,000 new cases per year specifically addresses the question being asked.

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  • 24. 

    A patient was brought to the ER after "blacking out and falling down in the kitchen. A CT scan revealed damage to the brainstem. During neurological testing the patient displayed no obvious cranial nerve signs. Sensory testing, pinprick sensitivity and vibration testing was normal. Motor testing revealed no problems with gait and the patient was able to rise from a chair easily - however, when asked to pick up a pencil and write the patient's hand appeared clumsy. Such distal weakness is associated most commonly with?

    • Vestibulospinal tract lesions

    • Lower motor neuron lesions

    • Guillain barre syndrome

    • Corticospinal tract lesions

    • Flaccid paralysis

    • Anterior corticospinal tract lesions

    Correct Answer
    A. Corticospinal tract lesions
    Explanation
    The patient's presentation of distal weakness and clumsiness in the hand during fine motor tasks suggests a lesion in the corticospinal tract. The corticospinal tract is responsible for carrying motor signals from the cerebral cortex to the spinal cord, controlling voluntary movements. Damage to this tract can result in weakness and loss of fine motor control, especially in the distal extremities. The absence of cranial nerve signs and normal sensory testing suggest that the lesion is specific to the corticospinal tract rather than involving other neurological structures.

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  • 25. 

    The gait in a patient with established neuro syphilis with damage to the spinal cord is which of the following?

    • Staggering

    • Shuffling

    • Drags one feet

    • High stepping

    • Scissors like

    Correct Answer
    A. High stepping
    Explanation
    In patients with established neuro syphilis and damage to the spinal cord, the gait is typically characterized by high stepping. This refers to a gait pattern where the patient lifts their legs higher than normal while walking, often resulting in exaggerated knee and hip flexion. This gait abnormality is caused by the damage to the nerves in the spinal cord, leading to weakness or paralysis of the lower limbs and a loss of coordination. The high stepping gait is a result of the patient's attempt to compensate for the muscle weakness and maintain balance while walking.

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  • 26. 

    A 28-year old man presents with (I) loss of joint position and vibration of his right lower limb, (ii) loss of pain and temperature on his left lower limb and (iii) upper motor neuron weakness of his right lower limb. Name the tracts that are damaged (in order from (0 to OW and the side of the spinal cord the lesion was sustained.

    • The corticospinal tract, the spinothalamic tract, the fasciculus gracilis, right side

    • The fasciculus gracilis, the spinothalamic tract, the corticospinal tract, left side.

    • The spinothalamic tract, fasciculus gracilis, the corticospinal tract, left side

    • The fasciculus gracilis, the corticospinal tract, the spinothalamic tract, right side

    • None of the above

    Correct Answer
    A. None of the above

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  • Aug 10, 2024
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  • Jan 15, 2012
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