ASIPP Anatomy Questions Flashcards
1
Q
1. Sacral splanchnics are primarily: A. Sympathetic postganglionic fi bers B. Parasympathetic postgangalionic fi bers C. Sympathetic preganglionic fi bers D. Parasympathetic preganglionic fi bers E. Senory preganglionic fi bers
A
- Answer: A
Explanation:
Sacral splanchnics refer to sympathetic fi bers traveling to
the hypogastric plexuses. Another name for the superior
hypogastric plexus is the presacral nerve.
Source: Boswell MV, Board Review 2005
2
Q
2. The most common form of inguinal hernia begins A. At the deep inguinal ring B. Medial to the epigastric artery C. Travels through the inguinal triangle D. Entraps the genitofemoral nerve E. Rarely enters the scrotum
A
- Answer: A
Explanation:
Direct inguinal hernias pass through the inguinal triangle,
which is an area of weak fascia. They almost never go into
the scrotum. Both the superfi cial inguinal ring and the
inherent weakness of abdominal wall lateral to the falx
inguinalis make this area susceptible to hernias. Indirect
inguinal hernias start at deep inguinal ring, pass down
inguinal canal, through superfi cial ring, and, in the male,
usually descend into scrotum along with the spermatic
cord. In the female they travel along the round ligament.
Source: Boswell MV, Board Review 2005
3
Q
3. The obturator nerve innervates which of the following muscles? A. Gracilis B. Sartorius C. Rectus Femoris D. Pectineus E. Vastus Medialis
A
- Answer: A
Source: Day MR, Board Review 2005
4
Q
- What is true about the superfi cial cervical plexus?
A. Blocks of this plexus are useful for upper airway laryngoscopy
B. One branch is the suprascapular nerve
C. One branch is the lesser occipital nerve
D. Needle insertion is between the anterior and middle
scalene muscles
E. There is a very high risk for intrathecal injections
A
- Answer: C
Explanation:
(Raj, Pain Medicine Review, 2nd Ed., pages 232-236)
Blocks of the superior laryngeal nerve are useful for upper
airway laryngoscopy (above the vocal cords). Blocks of the
recurrent laryngeal nerve are useful for tracheal
procedures (below the vocal cords). The suprascapular
nerve originates from C5,6 and goes posteriorly to
innervate the supraspinatus and infraspinatus (with
sensory input from the shoulder joint). The lesser
occipital, greater auricular, transverse cervical, and
supraclavicular nerves originate from C2, C3, C4 and
comprise the superfi cial cervical plexus. An interscalene
brachial plexus block is performed through the anterior
and middle scalene muscles. There is a low risk of
intrathecal injections compared to a deep cervical plexus
block.
Source: Shah RV, Board Review 2005
5
Q
- Which of the following is true about the auriculotemporal
nerve?
A. It is a branch of the mandibular division of trigeminal
ganglion
B. It is anterior to the superfi cial temporal artery
C. It is posterior to the external auditory meatus
D. Blocking it would alleviate pain when the earlobe undergoes
piercing
E. It provides sensation to the cheek
A
- Answer: A
Explanation:
(Raj, Pain Review 2nd Ed., page 229)
The auriculotemporal nerve originates from the V3 branch
of the trigeminal ganglion. It travels posterior to the
superfi cial temporal artery and anterior to the external auditory meatus. It receives sensation from the TMJ,
parotid gland, external auditory meatus, tympanic
membrane, tragus (not earlobe), and skin over the
temporal area.
Source: Shah RV, Board Review 2005
6
Q
- You perform a glossopharyngeal nerve block. Which of the
following is not likely to be related to the block?
A. Torticollis
B. Seizure
C. Hoarseness
D. Dysphagia
E. Diffi culty with smiling
A
- Answer: E
Explanation:
(Raj, Pain Medicine Review, 2nd Ed. Page 232)
The glossopharyngeal nerve exits the jugular foramen
along with cranial nerves X and XI. Hence one can develop
dysphagia (IX), hoarseness (X), and torticollis (XI).
Seizures can occur as a consequence of intra-arterial
injection into the carotid. Diffi culty with smiling occurs
with palsy of cranial nerve VII which exits through the
stylo-mastoid foramen.
Source: Shah RV, Board Review 2005
7
Q
7. Blockade of the brachial plexus via the interscalene approach commonly misses what nerve? A. Median B. Axillary C. Radial D. Ulnar E. Musculocutaneous
A
- Answer: D
Source: Day MR, Board Review 2005
8
Q
8. Lower esophageal pain can be improved by blocking spinal nerve roots at which levels? A. T2 - T3 B. T3 - T5 C. T5 -T9 D. T10 - T11 E. T11 - T12
A
- Answer: C
Explanation:
Innervation by lower thoracic splanchnics and vagus
afferents
Raj. Chapter 43. Thoracoabdominal Pain. In: Practical
Management of Pain 3rd Edition, Raj et al, Mosby, 2000
Source: Boswell MV, Board Review 2005
9
Q
9. Of the following nerve block techniques, which one produces anesthesia of ALL of terminal branches of the brachial plexus? A. Interscalene B. Supraclavicular C. Axillary D. Deep cervical E. Superfi cial cervical
A
- Answer: B
Source: Day MR, Board Review 2005
10
Q
10. Structures innervated by the inferior hypogastric plexus include A. Uterus B. Bladder C. Rectum D. Scrotum E. Vagina
A
- Answer: A
Explanation:
The uterus is innervated by the sympathetics passing
inferiorly via the inferior hypogastric plexus.The other
organs listed are innervated by the pelvic splanchnics,
arising from the sacral roots or the pudendal nerve.
Source: Boswell MV, Board Review 2005
11
Q
11. Which of the following is the most important center of sympathetic and parasympathetic distribution to the pelvis? A. Superior hypogastric plexus B. Inferior hypogastric plexus C. Pelvic splanchnic nerves D. Pudendal nerve E. Nervi erigentes
A
- Answer: B
Explanation:
The superior hypogastric plexus sends sympathetics to the
inferior hypogastric plexus, the inferior hypogastric
plexus receives parasympathetics from the pelvic
sphlancnics
Source: Boswell MV, Board Review 2005
12
Q
12. The web space between the great toe and the second toe is innervated by what nerve? A. Sural B. Saphenous C. Superfi cial peroneal D. Deep peroneal E. Posterior tibial
A
- Answer: D
Explanation:
The deep peroneal nerve innervates the short extensors of
the toes and the skin of the web space between the great
and second toe.
The deep peroneal nerve is blocked at the ankle by
infi ltration between the tendons of the anterior tibial and
extensor hallucis longus muscle.
Source: Day MR, Board Review 2005
13
Q
- The preganglion cell bodies of the sympathetic nervous
system are located where in the spinal cord?
A. Dorsal columns
B. Lateral spinothalamic tract
C. Intermediolateral cell column
D. Substantia gelatinosa
E. Rexed laminae IV
A
- Answer: C
Source: Day MR, Board Review 2005
14
Q
14. Stellate ganglion is: A. Combination of C7-T1 ganglion B. Combination of C8-T1 ganglion C. Combination of C7-C8 D. Sits on C6 transverse process E. Located under the longus coli muscle
A
- Answer: A
Source: Racz G. Board Review 2003
15
Q
- Anatomically, the celiac plexus is located anterolateral to
the aorta at which level?
A. Above the diaphragm at T10
B. At the crura of the diaphragm at L1
C. At the bifurcation of the aorta at L4
D. Above the crura of the diaphragm at T12
E. Surrounding then superior mesenteric artery
A
- Answer: B
Source: Boswell MV, Board Review 2005
16
Q
- The lateral cord of the brachial plexus is formed by which
of the following divisions?
A. Anterior divisions of the superior and middle trunks
B. Posterior divisions of the superior, middle, and inferior
trunks
C. Anterior division of the inferior trunk
D. Anterior division of the superior trunk and posterior
division of the middle trunk
E. Posterior divisions of the middle and inferior trunks
A
- Answer: A
Source: Day MR, Board Review 2005
17
Q
17. T5-T12 sympathetic ganglia transmit nociceptive afferents from the upper abdominal organs with which of the following? A. Renal plexus B. Celiac plexus C. Cardiac plexus D. Pulmonary plexus E. Hypogastric plexus
A
- Answer: B
Source: Boswell MV, Board Review 2005
18
Q
18. In terms of surface anatomy, a line connecting the inferior poles of both scapulae would intersect which vertebral body? A. C7 B. T3 C. T7 D. T10 E. T12
A
18. Answer: C Explanation: (Raj, Pain Review 2nd Ed., page 216) The line connecting the inferior poles of both scapula would intersect T7. Source: Shah RV, Board Review 2005
19
Q
- The purpose of the cavernous nerves of the penis is to
provide:
A. Sympathetics and allow for erection
B. Parasympathetics and allow for ejaculation
C. Parasympathetics and allow for erection
D. Sympathetics and allow for ejaculation
E. Sensory afferent muscular tone
A
- Answer: C
Explanation:
Parasympathetic is point and sympathetic is shoot.
Source: Boswell MV, Board Review 2005
20
Q
- Which of the techniques for blockade of the brachial
plexus has the highest incidence of pneumothorax?
A. Interscalene
B. Supraclavicular
C. Infraclavicular
D. Axillary
E. Deep Cervical
A
- Answer: B
Source: Day MR, Board Review 2005
21
Q
21. Motor stimulation of the peroneal nerve elicits what motions of the foot? A. Dorsifl exion, inversion B. Dorsifl exion, eversion C. Plantar fl exion, inversion D. Plantar fl exion, eversion E. Plantar fl exion only
A
- Answer: B
Source: Day MR, Board Review 2005
22
Q
- What is the function of the parasympathetic contribution
to the bladder?
A. Causes the detrusor muscle to relax and the sphincter
to contract
B. Causes the detrusor muscle to contract and the sphincter
to relax
C. Causes the trigone muscle to relax and the sphincter to
relax
D. Causes the detrusor muscle to contract and the sphincter
to contract
E. Causes the trigone muscle to contractd and the detrusor
to contract
A
22. Answer: B Explanation: Cholinergic tone allows for micturation. Anticholinergics can cause urinary retention. Source: Boswell MV, Board Review 2005
23
Q
23. Meralgia paresthetica is caused by compression of what nerve? A. Obturator B. Sural C. Common peroneal D. Lateral fermoral cutaneous E. Genitofemoral
A
- Answer: D
Source: Day MR, Board Review 2005
24
Q
- Which of the following most accurately describes the
pelvic splanchnics nerves?
A. S3-S4, preganglionic sympatehtic fi bers
B. S1-S2, postganglionic sympathetic fi bers
C. S2-S4, preganglionic parasympathetic fi bers
D. T1-L2/L3, postganglionic sympathetic fi bers
E. T1-L2/L3, preganglionic parasympathetic fi bers
A
24. Answer: C Explanation: C. The pelvic splanchnics are parasympathetic fi bers arising from the sacral segments. Source: Boswell MV, Board Review 2005
25
Q
25. Which of the following nerves is not a branch of the sciatic nerve? A. Superfi cial peroneal B. Saphenous C. Deep peroneal D. Posterior tibial E. Sural
A
- Answer: B
Source: Day MR, Board Review 2005
26
Q
- A patient is going to undergo a gastrectomy. Where would
you like the tip of the epidural catheter to be placed?
A. T3
B. T5
C. T10
D. T12
E. L1
A
- Answer: B
Explanation:
(Raj, Pain Review 2nd Ed., page 272)
With a gastrectomy the incision may be extended up to the
xiphoid process. This can be extremely painful if the
catheter is placed to low. Hence T10, T12, L1 catheters may
be able to cover some of the pain but it would be
insuffi cient. Higher concentrations and volumes would be
needed to cover the xiphoid which could put the patient at
undue risk of hypotension, muscle weakness, and sensory
loss. A catheter at T3 may be appropriate for thoracic
surgery but not for upper abdominal surgery.
Source: Shah RV, Board Review 2005
27
Q
- Which of the following is true of neural tube
development?
A. Closure of the neural tube proceeds in a craniocaudal
sequence
B. The basic organization of the neural tube features
peripheral neuronal cell bodies and centrally located
myelinated processes
C. The primitive neurectoderm cells of the neural tube give
rise to both neuron and all glial components
D. During development, neuronal and glial precursors are
born near the central canal and migrate to the periphery
E. Mature neurons migrate out of the spinal cord to form
the sensory ganglia
A
- Answer: D
Explanation:
(Moore, Developing Human, 6/e, pp 452-456.) After
closure of the neural tube, cells proliferate and establish
three primitive layers: (1) the ventricular zone adjoining
the central canal and ventricles; mitoses of neuronal and
glial precursors continue in this zone; (2) a mantle zone
consisting of cell bodies of neurons and glia that have
migrated out of the ventricular zone; and (3) a marginal
zone on the periphery containing the myelinated nerve
processes characteristic of white matter. Closure of the
neural tube begins near the midpoint of its length and
proceeds in both directions simultaneously. The
neurectoderm of the neural tube will give rise to neurons
and some glial cells (astrocytes, oligodendroglia, and
ependymal cells), but the precursors of microglia (the
monocyte-macrophage lineage) migrate into the nervous
system from the blood. The sensory ganglia are formed by
neural crest cells that migrated before the development of
mature neurons.
Source: Klein RM and McKenzie JC 2002.
28
Q
28. Which of the following cranial nerves exists the brain stem from its dorsal aspects? A. Oculomotor nerve B. Facial nerve C. Trigeminal nerve D. Glossopharyngeal nerve E. Trochlear nerve
A
- Answer: E
Explanation:
The trochlear nerve is purely a motor nerve and is the only
cranial nerve to exist the brain dorsally. The trochlear
nerve supplies one muscle: the superior oblique. The cell
bodies that originate in the trochlear nerve are located in
the ventral part of the brain stem in the trochlear nucleus.
The trochlear nucleus gives rise to fi bers that cross to the
other side of the brain stem just prior to exiting the pons.
Thus, each superior oblique muscle is supplied by nerve
fi bers from the trochlear nucleus of the opposite side. The
nerve travels in the lateral wall of the cavernous sinus and
then enters the orbit via the superior orbital fi ssure. It
passes medially and diagonally across the levator palpebral
superioris and superior rectus muscles to innervate the
superior oblique. (Parent, 531)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD
29
Q
- The deep peroneal nerve provides cutaneous innervation
to what part of the foot?
A. Lateral aspect
B. The entire dorsum
C. The plantar surface
D. The web space between the Great and 2nd toes
E. The web space between the 3rd and 4th toes
A
- Answer: D
Source: Day MR, Board Review 2006
30
Q
- The sympathetic component of the sphenopalatine
ganglion travel to the ganglion via what nerve?
A. Greater petrosal nerve
B. Palatine nerves
C. Maxillary nerve
D. Deep petrosal nerve
E. Mandibular nerve
A
- Answer: D
Source: Day MR, Board Review 2005
31
Q
- You are asked to insert a needle approximately 2-3 cm
medial to the ASIS and 2-3 cm inferior to this point. The
insertion should be above the inguinal ligament. A ‘pop’
may be felt as you insert your needle to identify the right depth. What nerve are you most likely going to block?
A. Genitofemoral
B. Iliohypogastric
C. Ilioinguinal
D. Lateral femoral cutaneous
E. Obturator nerve block
A
- Answer: C
Explanation:
(Raj, Pain Review 2nd Ed.)
A.The genitofemoral nerve is approached by inserting the
needle just lateral to the pubic tubercle. The needle is
advanced through the inguinal ligament.
B.The iliohypogastric lies 3 cm medial to the ASIS, but the
needle is aimed towards the umbilicus.
C.The ilioinguinal nerve is approximately 2-3 cm medial
and 2-3 cm inferior to the ASIS, but above the inguinal
canal.Typically one may feel a ‘pop’ as the needle passes the
internal oblique and lies between the internal oblique and
transverses abdominis.
D.The lateral femoral cutaneous nerve is approached 2cm
medial and inferior to the ASIS but the needle is inserted
below the inguinal ligament. The needle is advanced
through the fascia lata with a pop and loss of resistance.
Note that if you advance the needle further and feel a
second pop, then you have gone through the fascia iliaca.
This is approximately how one would perform a fascia
iliaca block in order to avoid the femoral nerve block.
Source: Shah RV, Board Review 2003
32
Q
- The portion of the upper extremity that is not innervated
by the brachial plexus is:
A. Posterior medial portion of the arm
B. Anterior and posterior aspects of elbow
C. Lateral portion of the forearm
D. Medial portion of the forearm
E. Anterolateral portion of the arm
A
- Answer: A
Explanation:
The arm receives sensory innervation from the brachial
plexus except for the shoulder, which is innervated by the
cervical plexus, and the posterior medial aspect of the arm,
which is supplied by the intercostobrachial nerve.
33
Q
33. The greater occipital nerve is a branch of: A. Posterior ramus of C2 B. Posterior ramus of C1 C. Anterior ramus of C1 D. Anterior ramus of C2 E. Anterior ramus of C2 and C3
A
- Answer: A
Explanation:
The skin over the posterior part of the neck, upper back,
posterior part of the scalp upto the vertex is supplied
segmentally by the posterior rami of the C2 to C5.
A. The Greater occipital nerve is a branch of the posterior
of ramus of C2.
The lesser occipital nerve is a branch of the posterior
ramus of C2 and C3.
Headaches due to occipital neuralgia are characterized
by either continuous pain or paroxysmal lancinating pain
in the distribution of the nerve.
The etiology of occipital neuralgia is compression of
the C2 nerve root, migraine or nerve entrapment.
An occipital nerve block maybe performed as a diagnostic
or therapeutic measure.
Source: Chopra P. 2004
34
Q
34. The muscles of the back receive motor innervation from A. Dorsal roots B. Dorsal primary rami C. Gray rami communicantes D. Splanchnic nerves E. Ventral primary rami
A
- Answer: B
Explanation:
A.The dorsal roots convey sensation to the spinal cord.
B.The axial musculature of the back receives innervation
from the dorsal primary rami of the spinal nerves.
D.The splanchnic nerves and gray rami communicantes
are components fo the sympathetic division of the
autonomic nervous sytem.
E.The ventral primary rami contribute to the cervical
plexus, brachial plexus, intercostal nerves, and the
lumbosacral plexus.
35
Q
35. Which of the following is the most direct route for spread of infection from the paranasal sinuses to the cavernous sinus of the dura mater? A. Pterygoid venous plexus B. Parietal emissary vein C. Frontal emissary vein D. Basilar venous plexus E. Superior ophthalmic vein
A
- Answer: E
Explanation:
A. The pterygoid venous plexus communicates with the
cavernous sinus via the petrosal sinuses.
B. The parietal emissary vein also communicates with the
superior sagittal sinus.
C. The frontal emissary vein communicates with the
superior sagittal sinus via the foramen cecum.
D. The basilar venous plexus communicates with the
inferior petrosal sinus.
E. The superior ophthalmic vein drains the region of the
paranasal sinuses and is directly connected with the
cavernous sinus although blood fl ow is normally away
from the brain
36
Q
- Myelination in the central nervous system differs from
myelination in the peripheral nervous system in
A. Its formation only during fetal development
B. The function of myelin
C. Its ultrastructural appearance
D. The involvement of oligodendrocytes
E. The involvement of astrocytes
A
- Answer: D
Explanation:
Myelination in the central (CNS) and peripheral (PNS)
nervous systems occurs by similar methods, although
there are differences in the supportive cells responsible.
A. Myelin is similar in both locations but different in the
presence of Schmidt-Lanterman clefts, which only appear
in the PNS and represent the presence of Schwann cell
cytoplasm that is not displaced toward the periphery.
This provides a continuous cytoplasmic pathway from
the exterior to the interior of the myelin sheath.
Myelin is an insulator and also decreases membrane
capacitance.
White matter is high in myelin content and is named by
the presence of tracts of axons that appear white
(myelinated).
Gray matter represents neuron-rich areas low in myelin
(e.g., cell bodies).
B. Myelination occurs in both pre- and postnatal
development.
In the PNS, formation of myelin is initiated by the
invagination of an axon into a Schwann cell. A mesaxon is
formed as the outer leafl ets of the cell membrane fuse.
Subsequently, the mesaxon of the Schwann cell wraps itself
around the fi ber.
D. In the CNS, the oligodendrocytes myelinate axons,
whereas the Schwann cells conduct myelination in the
PNS.
Oligodendrocytes myelinate several axons at one time,
whereas the Schwann cells myelinate only one axon.
In the CNS, oligodendrocytes form myelin around
several axon segments compared with the 1: 1 relationship
between Schwann cells and axon segments in the PNS.
37
Q
37. The stellate ganglion lies in closest proximity to which of the following vascular structures? A. Common carotid artery B. Internal carotid artery C. Vertebral artery D. Axillary artery E. Aorta
A
- Answer: C
Explanation:
The stellate ganglion usually lies in front of the neck of the
fi rst rib.
C. The vertebral artery lies anterior to the ganglion as it
has just originated from the subclavian artery.
After passing over the ganglion, it enters the foramen
and lies posterior to the anterior tubercle of C6.
38
Q
- A cranial fracture through the foramen rotundum that
compresses the enclosed nerve (maxillary nerve) results
in the following clinical symptoms:
A. Inability to clench the jaw fi rmly
B. Regurgitation of fl uids into the nasopharynx during
swallowing
C. Paralysis of the inferior oblique muscle of the orbit
D. Loss of the sneeze refl ex
E. Uncontrolled drooling from the mouth
A
- Answer: D
Explanation:
A. The mandibular division of the trigeminal nerve, which
passes through the foramen ovale, innervates the
masticatory muscles responsible for clenching the jaw as
well as the tensor palatini muscle, which assists in the
establishment of the velopharyngeal seal.
B. The other muscles of the soft palate are innervated by
the pharyngeal branch of the vagus nerve, which transits
the jugular foramen.
C. The inferior oblique muscle of the eye is innervated by
the inferior branch of the oculomotor nerve, which enters
the orbit through the superior orbital fi ssure.
D. The maxillary division of the trigeminal nerve, which
passes through the foramen rotundum, is entirely sensory.
Damage to this nerve results in sensory deprivation over
the maxillary region of the face and loss of the sneeze
refl ex.
E. The orbicularis oris and buccinator muscles are
innervated by the facial nerve, which transits the
stylomastoid foramen
39
Q
- The occipital portion of the skull receives sensory
innervation from
A. Spinal accessory nerve (nerve XI)
B. Facial nerve (nerve VII)
C. Ophthalmic branch of trigeminal nerve (nerve V)
D. Maxillary branch of trigeminal nerve (nerve V)
E. None of the above
A
- Answer: E
Explanation:
The occiput receives sensory innervation from the
occipital nerves, which are terminal branches of the
cervical plexus.
40
Q
- For upper abdominal surgery, optimal epidural catheter
placement would be at which vertebral levels?
A. C7 - T2
B. T4 - T8
C. T8 - T10
D. T10- T12
E. L2- L4
A
- Answer: C
Explanation:
Ref: Crews. Chapter 14. Acute Pain Syndromes. In:
Practical Management of Pain. 3rd Edition. Raj et al,
Mosby, 2000, page 178.
Source: Day MR, Board Review 2003
41
Q
- The muscles of the anterior compartment of the leg are
innervated primarily by which of the following nerves?
A. Deep fi bular
B. Lateral sural cutaneous
C. Saphenous
D. Superfi cial fi bular
E. Sural
A
- Answer: A
Explanation:
The common fi bular (peroneal) nerve bifurcates into
superfi cial and deep branches. The deep fi bular nerve
innervates all muscles of the anterior compartment of the
leg. The superfi cial fi bular nerve emerges from the deep
fascia and descends in the lateral compartment, where it
innervates the peroneus longus and brevis muscles before
dividing into median dorsal cutaneous and intermediate
dorsal cutaneous nerves, which supply the distal third of
the leg, dorsum of the foot, and all the toes. The saphenous nerve (the terminal branch of the common femoral nerve)
distributes cutaneous branches to the anterior and medial
aspects of the leg as well as to the dorsomedial aspect of
the foot. The sural nerve follows the course of the lesser
saphenous vein and becomes the lateral sural cutaneous
nerve to supply the anterolateral aspect of the foot.
Source: Klein RM and McKenzie JC 2002.
42
Q
42. The correct order of structures (from cephalad to caudad) in the intercostal space is: A. Nerve, artery, vein B. Vein, nerve, artery C. Vein, artery, nerve D. Artery, nerve, vein E. Artery, vein, nerve
A
- Answer: C
43
Q
43. The inner lining of the thoracic cage is also known as the A. visceral pleura B. parietal pleura C. subcostal fascia D. endothoracic fascia E. external thoracic fascia
A
- Answer: D
Explanation:
D. The rib cage is covered both internally and externally
by thin layers of deep fascia.
The inner layer, consisting of loose areolar tissue called
the endothoracic fascia, lines the internal aspect of the
thoracic cage.
This layer of facia covers the inner surface of the
intercostal muscles and intervening ribs, along with
the subcostal and transversus thoracis muscles andthe
diaphragm.
It lies between the parietal pleura and the thoracic cage.
44
Q
- Which of the following muscles of the larynx is innervated
by the external branch of the superior laryngeal nerve?
A. Vocalis muscle
B. Thyroarytenoid muscles
C. Posterior cricoarytenoid muscle
D. Oblique arytenoids muscles
E. Cricothyroid muscle
A
- Answer: E
Explanation:
All other muscles of the larynx are innervated by the
recurrent laryngeal nerve.
45
Q
45. The saphenous nerve can blocked at the medial thigh in what named canal? A. Guyon’s B. Alcock’s C. Labat’s D. Kappis’s E. Hunter’s
A
- Answer: E
Source: Day MR, Board Review 2006
46
Q
46. Which of the following has a transverse process but not vertebral artery foramen? A. C1 B. C3 C. C5 D. C6 E. C7
A
- Answer: E
Explanation:
(Bonica, 3rd Ed., page 970)
C7 has a transverse process but no foramen for
transmitting the vertebral artery. In fact the stellate
ganglion (C7-T1) is posterior to the artery at this level.
C3, C5, C6 all have transverse processes that transmit the
vertebral artery. C1 does have a long transverse process
that is longer than other vertebral bodies. It also has a
vertebral artery foramen. Upon leaving this level, the
vertebral artery migrates posteriorly and medially.
Source: Shah RV, Board Review 2005
47
Q
47. The Greater splanchnic nerve is formed by? A. T4 - T6 sympathetic nerve fi bers B. T5 - T7 sympathetic nerve fi bers C. T5 - T9 sympathetic nerve fi bers D. T10 - T11 sympathetic nerve fi bers E. T11 - T12 sympathetic nerve fi bers
A
- Answer: C
Source: Boswell MV, Board Review 2005
48
Q
- The L4-5 facet joint is innervated by the:
A. medial branches of the L3 and L4 spinal nerves
B. medial branches of the L4 and L5 spinal nerves
C. medial branches of the L2, L3, and L4 spinal nerves
D. medial branches of the L3, L4, and L5 spinal nerves
E. medial branches of the L4, L5, and S1 spinal nerve
A
- Answer: A
Explanation:
(Raj, Pain Review 2nd Ed., page 292-3)
The medial branch of the exiting spinal nerve sends a
branch to the facet joint at its level and to one level below.
In older studies some have demonstrated and ascending
branch of the dorsal ramus that innervates the level above.
However, this is not true as far as board exams go.
In this case the medial branches of the L3 and L4 nerves innervate the L4-5 zygapophyseal joint. Expect some
permutation of this kind of question
Source: Shah RV, Board Review 2005
49
Q
49. The conus medullaris ends at T12 in which percentage of patients? A. 5-10% B. 15-20% C. 21-35% D. Never E. >50%
A
49. Answer: A Explanation: (Bonica, 3rd Ed., page 1480, fi gure 75-9) The conus ends at: T12: 6% T12-L1: 18% L1: 30% L1-L2: 24% L2: 22% L3: rarely Source: Shah RV, Board Review 2005
50
Q
50. The genitofemoral nerve passes through the anterior psoas fascia at what vertebral body level? A. L1 B. L2 C. L3 D. L4 E. L5
A
- Answer: C
Source: Day MR, Board Review 2005
51
Q
- Which of the following is not true about the cervical
intervertebral disc?
A. The height of the cervical intervertebral disc is twice
anteriorly as compared to posteriorly
B. The vertebral endplates bounding the intervertebral disc
are fl at
C. The nucleus pulposus is located anteriorly when compared
to those in the lumbar spine
D. The posterior longitudinal ligament is wider when compared
to its size in the lumbar spine
E. The joints of Luschka are not synovial joints.
A
- Answer: B
Explanation:
(Bonica, 3rd Ed., page 372)
The vertebral endplates are fl at in the lumbar spine, but
are concave and convex. All of the other statements are
true.
The joints of Luschka or the uncovertebral joints are
degenerative clefts.
Source: Shah RV, Board Review 2005
52
Q
- The anterior and posterior spinal arteries originate from
the
A. Common carotid and vertebral arteries, respectively
B. Internal carotid and vertebral arteries, respectively
C. Internal carotid and posterior cerebral arteries, respectively
D. Vertebral and anterior cerebellar arteries, respectively
E. Vertebral and posterior inferior cerebellar arteries, respectively
A
- Answer: E
Explanation:
The posterior spinal arteries are paired; they arise from the
posterior inferior cerebellar arteries and have 25 to 40
radicular arteries. The anterior spinal artery is a single
midline artery that arises from the union of a branch of
each vertebral artery. It descends in front of the anterior
longitudinal sulcus of the spinal cord. This single artery is
also fed by numerous radicular arteries.
53
Q
53. At which level would you expect the spinal canal to be narrowest in its sagittal dimension? A. C1-2 B. C2-3 C. C3-4 D. C4-5 E. C5-6
A
53. Answer: E Explanation: (Bonica, 3rd Ed., page 975) Canal sagittal dimensions get progressively narrower from the upper to lower cervical spine; the narrowest location is at C5-6. C1-C3: 21 mm (16-30) C4-C6: 18 mm (14-23) Source: Shah RV, Board Review 2005
54
Q
- The deep peroneal nerve innervates the
A. Web space between the third and fourth toes
B. Medial aspect of the dorsum of the foot
C. Web space between the great toe and the second toe
D. Entire dorsum of the foot
E. Lateral aspect of the dorsum of the foot
A
- Answer: C
Explanation:
The deep peroneal nerve innervates the short extensors
of the toes and the skin of the web space between the great
and second toe.
The deep peroneal nerve is blocked at the ankle by
infi ltration between the tendons of the anterior tibial and
extensor hallucis longus muscle.
55
Q
55. The medial boundary of the stellate ganglion is? A. Vertebral artery B. Dome of the lung C. Longus colli muscle D. Scalene muscles E. Subclavian artery
A
- Answer: C
Source: Day MR, Board Review 2005
56
Q
56. The hypogastric plexus is composed of what type of fi bers? A. Postganglionic sympathetic B. Postganglionic parasympathetic C. Visceral efferent D. A delta E. C Fibers
A
- Answer: A
Source: Raj P, Pain medicine - A comprehensive Review -
Second Edition
57
Q
- The odontoid process (dens) is correctly described by
which of the following statements?
A. It articulates with the occipital portion of the skull
B. It is separated from the atlas by an intervertebral disk
C. It projects from the inferior surface of the atlas
D. It represents the vertebral body of the fi rst cervical vertebra
E. None of the above
A
- Answer: D
Explanation:
D. The odontoid process (dens) of the axis, the second
cervical vertebra, is the remnant of the body of the fi rst
cervical vertebra (atlas).
Developing from a separate ossifi cation center, it fused
to the body of the axis.
The fact that there is no intervertebral disk between the
atlas and axis probably facilitates the fusion.
The dens, projecting from the superior surface of the
axis, provides a pivot about which rotation occurs at the
atlantoaxial joint.
Fracture and posterior dislocation of the dens may crush
the spinal cord with fatal results.
58
Q
58. What is the rib that articulates with the sternum at the level of the xiphisternal junction? A. 6th B. 7th C. 8th D. 9th E. 10th
A
- Answer: B
Explanation:
B.The 7th costal cartilage articulates with the sternum at
the lateral margin of the xiphisternal junction.
The articulation between the xiphoid process and the
inferior border of the sternal body is a cartilaginous
structure that ossifi es later in life.
59
Q
- The following statement is false regarding the course of the
vertebral artery:
A. The vertebral artery is consistently lateral to the atlantoaxial
joint.
B. The vertebral artery courses through the foramina transversaria
of C7 through C1.
C. The vertebral artery lies posterior to the atlanto-occipital
joint in the suboccipital triangle
D. Intracranial branches from the right and left vertebral
arteries combine to form a single descending anterior
spinal artery.
E. The paired right and left posterior spinal arteries originate
respectively from the right and left vertebral arteries
above C1.
A
- Answer: B
Explanation:
Reference: Gray’s Anatomy, Thirteenth American Edition.
Pages 696-699.
The vertebral arteries originate from the subclavian
arteries and ascend anterior to the transverse processes of
the seventh cervical vertebrae. They then ascend through
the foramina transversaria from C6 to C1. The C7
vertebral body does not have a foramen transversarium.
The arteries then exit the C1 foramina transversaria and
turn medial to course through the foramen magnum
where they ascend and combine to form the basilar artery
which perfuses the brain. Just above the foramen magnum,
the vertebral arteries give rise to the paired posterior
spinal arteries. Further cephalad, at the approximate level
of the medulla oblongata, the paired vertebrals give rise to
the descending, single anterior spinal artery.
The vertebral arteries are always lateral to the atlanto-axial
joints since they must pass through the laterally-situated
foramina transversaria at C1 and C2. From the foramen
transversarium of C1 to the foramen magnum, the
vertebral arteries pass posterior to the atlanto-occipital
joints within the suboccipital triangle. There course from
C1 to the foramen magnum may be somewhat tortuous
and unpredictable.
The vertebral arteries are always anterolateral with respect to the cervical neuroforamina since they are coursing
through the foramina transversaria.
Source: Schultz D, Board Review 2004
60
Q
60. The sympathetic component to the sphenopalatine ganglion originates from which nerve? A. Deep petrosal B. Greater petrosal C. Maxillary D. Greater palatine E. Lesser palatine
A
- Answer: A
Source: Day MR, Board Review 2006
61
Q
61. At which level is the intervertebral disc height to vertebral body height the largest? A. C1-C2 B. C6-C7 C. T12-L1 D. L4-L5 E. C3-C4
A
- Answer: B
Explanation:
(Bonica 3rd Ed., page 971)
62
Q
62. A musculocutaneous nerve lesion affects A. Hand sensation B. Supination with the forearm extended C. Supination with the elbow in fl exion D. Wrist extension E. Upper arm abduction
A
- Answer: C
Explanation:
The musculocutaneous nerve arises from the lateral cord
of the brachial plexus and carries fi bers from the root of
C5, C6, and C7. The nerve proceeds obliquely downward
between the axillary artery and the median nerve. The
nerve pierces the coracobrachialis muscle while giving off
branches to it, and it descends further between the biceps
and brachialis muscles to supply both of them. The lateral
cutaneous nerve of the forearm is the sensor continuation
of the muscular cutaneous nerve innervates the skin from
the elbow to the wrist and covers the entire forearm from
the dorsal to the ventral midline. The coracobrachialis
muscle is a forward elevator of the arm. The biceps is a
forearm supinator, especially if the elbow fl exed at 90
degrees. Isolated lesions of the musculocutaneous nerve
are rare. Such lesion could cause weakness of elbow
fl exion again resistance in a fully supinated hand, possible
arm elevation weakness, arm pain and radial forearm
parasthesia. (Brazis, 9-10; Staal, 31-33)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD
63
Q
63. Corneal anesthesia results from blockade of which nerve? A. Supratrochlear B. Mandibular C. Maxillary D. Opthalmic E. Meckels
A
- Answer: D
Source: Day MR, Board Review 2006
64
Q
64. The styloid process is an important landmark during blockade of which nerve? A. phrenic nerve B. maxillary nerve C. facial nerve D. glossopharyngeal nerve E. trigeminal nerve
A
- Answer: D
Explanation:
D. The tip of the styloid process lies approximately
halfway between the angle of the mandible and the
mastoid process and provides a bony landmark for
blockade of the glossopharyngeal nerve.
The glossopharyngeal nerve exits the jugular foramen at
the base of the skull to emerge slightly posterior and
medial to the styloid process. It proceeds inferiorly to
innervate the posterior one-third of the tongue as well as
part of the throat and nasopharynx as far down as the
pharyngoesophageal junction at the level of the cricoid
cartilage.
65
Q
65. There is usually no sympathetic ganglion at: A. L1 B. L2 C. L3 D. L4 E. L5
A
- Answer: A
Source: Racz G. Board Review 2003
66
Q
- Blood supply to the spinal cord is by:
A. Two posterior spinal arteries and two anterior spinal
arteries
B. Two posterior spinal arteries and one anterior spinal
artery
C. Branches of the lumbar arteries
D. Radicularis Magna (artery of Adamkiewicz) and two
posterior spinal arteries
E. Braches of Aorta
A
- Answer: B
Explanation:
The blood supply to the spinal cord is primarily three
longitudinally running arteries – two posterior spinal
arteries and one anterior spinal artery.
The Anterior Spinal artery supplies approximately 80% of
the intrinsic spinal cord vasculature. It is formed by the
union of a branch from the terminal part of each vertebral
artery. It actually consists of longitudinal series of
functionally individual blood vessels with wide variation
in lumen size and anatomic discontinuations.
The spinal cord has three major arterial supply regions: - C1 to T3: Cervicothoracic region
- T3 to T8: Mid thoracic region
- T8 to the Conus: Thoracolumbar region
There is a poor anastomosis between these three regions.
As a result the blood fl ow at the T3 and T8 levels is
tenuous. In spinal stenosis, especially in the lower cervical
region, the Anterior Spinal artery may be compressed by a
dorsal osteophyte and a herniated nucleus pulposus
leadingto the Anterior Spinal Syndrome (loss of motor
function).
There are two posterior spinal arteries that arise from the
posterior inferior cerebellar arteries.
The three longitudinal arteries are reinforced by ‘feeder’
arteries. They are spinal branches of the cervical, vertebral
posterior intercostal, lumbar and lateral sacral arteries.
Approximately 6 or 7 of these contribute to the anterior
spinal artery and another 6 or 7 to the posterior spinal
arteries, but at different levels. The largest of these arteries
is known as the radicularis magna or the artery of
Adamkiewicz.
Source: Chopra P, 2004
67
Q
- Which of the following neurological structures does NOT
travel through the cavernous sinus
A. Sympathetic carotid plexus
B. Oculomotor nerve
C. Mandibular branch of the trigeminal nerve
D. Trochlear nerve
E. Abducens nerve
A
- Answer: C
Explanation:
The medial wall of the cavernous sinus contains the
abducens nerve, the internal carotid artery and the
sympathetic fi bers of the carotid plexus. The lateral wall
contains the oculomotor and trochlear nerves, and the
ophthalmic and maxillary divisions of the trigeminal
nerve. (Afi fi and Bergman, 240)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD
68
Q
- Which of the following is TRUE about the trigeminal
nerve?
A. The spinal nucleus of the trigeminal nerve subserves
light touch in the ipsilateral side of the face.
B. The motor nucleus of the trigeminal nerve lies in the
pons medial to the sensory nucleus and sends axons to
the maxillary division of the trigeminal nerve
C. The three divisions of the trigeminal nerve converge at
the Gasserian ganglion.
D. The mesencephalic nucleus of the trigeminal nerve
subserves pain and temperature in the ipsilateral side
of the face.
E. The mandibular division of the trigeminal nerve subserves
sensation of the ipsilateral angle of the mandible.
A
- Answer: C
Explanation:
The trigeminal nerve is a mixed nerve. It subserves the
sensory innervation of the ipsilateral side of the face and
the ipsilateral muscles of mastication (masseter, temporalis, and pterygoids). The sensory nucleus of the
trigeminal nerve extends from the midbrain to the upper
cervical cord: (a) The mesencephalic nucleus subserves
proprioception and deep sensation from the tendons and
muscles of mastication. (b) The main sensory nucleus
(located in the pons) subserves light touch. (c) The spinal
nucleus (which extends from the pons to the upper
cervical cord and is divided into segments that correspond
to concentric dermatomes around the mouth) subserves
pain and temperature. The trigeminal nerve supplies
sensation to the ipsilateral side of the face via three
branches: the ophthalmic division (which innervates the
frontal, lacrimal, and nasociliary areas), the maxillary
division (which innervates the cheek and lower eyelid),
and the mandibular division (which innervates the lower
lip, the tongue, the mandible, except for the angle of the
mandible). The motor nucleus lies medially to the main
sensory nucleus and sends axons to the mandibular
division of the trigeminal nerve. All division of the
trigeminal nerve converge at the Gasserian ganglion which
lies in Meckel’s cave of the temporal bone. (Afi fi and
Bergman, 173-175)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD
69
Q
69. All of the following muscles are innervated by the medial division of the sciatic nerve EXCEPT the A. Semimembranosus B. Long head of the biceps femoris C. Semitendinosus D. Short head of the biceps femoris E. Adductor magnus muscle
A
- Answer: D
Explanation:
The sciatic nerve is a mixed nerve that carries fi bers from
L4 to S3 and leaves the pelvis through the sciatic foramen
below the piriform muscle. The nerve then curves laterally
and downward beneath gluteus maximus muscle and runs
on the dorsal side of the femoral bone to terminate at the
proximal part of the popliteal fossa to divide into the tibial
nerve medially and the peroneal nerve laterally. Within
the sciatic nerve, as proximal as the gluteal region, the
fi bers of the tibial and peroneal nerves are arranged into
two separate divisions: The medial and the lateral trunks,
respectively. The medial part of the nerve innervates the
adductor magnus and the hamstring muscles, except for
the short head of the biceps femoris (it is the only thigh
muscle supplied by the lateral peroneal division). The
hamstring muscles are fl exors of the knee joint and include
the semimembranosus muscle, the semitendinous muscle,
and the short and long heads of the biceps femoris. (Staal,
117-118)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD
70
Q
- The thoracic duct ascends from the abdominal cavity to
enter the thorax via the following aperture:
A. Esophageal
B. Central tendon
C. Splanchnic
D. Inferior vena caval
E. Aortic
A
- Answer: E
Explanation:
The diaphragm has three large openings (the aortic,
esophageal, and vena caval apertures) and a number of
smaller ones that transmit the superior and middle
splanchnic nerves.
E. The aortic aperture is the lowest and most posterior of
the large openings and approximates the level of the T10
vertebra.
This aperture also transmits the thoracic duct and occasionally the azygous and hemiazygous veins.
71
Q
71. Celiac plexus is located: A. in front of vena cava at L2 B. in front of aorta at L2 C. in front of aorta at L1 D. behind the vena cava of L1 E. behind the aorta of L1
A
- Answer: C
Source: Racz G. Board Review 2003
72
Q
- Age-related changes which occur in the spine and may be
imaged by MRI fi ndings include:
A. Increase in water content of intervertebral disk
B. Increase in glycoproteins of intervertebral disk
C. Increase in height of vertebral bodies
D. Reduced caliber of spinal canal
E. All of the above
A
- Answer: D
Explanation:
With advancing age, there is reduced caliber of the spinal
canal due to arthritic changes. There is decreased water
and glycoprotein content of intervertebral disks, with
decreased height of vertebral bodies. (Ref. 1, pp. 455–456;
Ref. 2, p. 590)
Source: Neurology for the Psychiatry specialty Board
Review By Leon A. Weisberg, MD
73
Q
73. Which of the following structures receives afferents responsible for taste sensation in the anterior two thirds of the tongue ? A. Submaxillary ganglion B. Pterygopalatine ganglion C. Superior salivary nucleus D. Geniculate ganglion E. Submandibular ganglion
A
- Answer: D
Explanation:
The nervus intermedius is the sensory and
parasympathetic division of the facial nerve. It carries
preganglionic parasympathetic fi bers to the submaxillary
ganglion and tothe pterygopalatine ganglion. It receives
sensory fi bers from the geniculate ganglion. This ganglion
receives fi bers that carry taste sensation from the anterior
two-thirds of the tongue and afferents from the mucosae
of the pharynx, nose, and palate.(Afi fi and Bergman, 166-
167)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD
74
Q
74. Which of the following cranial nerves is responsible for eye closure ? A. Oculomotor nerve B. Trochlear nerve C. Abducens nerve D. Facial nerve E. Spinal accessory nerve
A
- Answer: D
Explanation:
The orbicularis oculi controls eye closure and is
innervated by the facial nerve.Eye opening is controlled by
the levator of the lid, which is innervated by the
oculomotor nerve. (Brazis, Masdeu, and Biller, 271-272)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD
75
Q
- Which statement is false regarding the blood supply of the
spinal cord:
A. The anterior spinal artery originates from the vertebral
arteries above the foramen magnum.
B. Segmental spinal arteries enter the spinal canal by way
of the intervertebral foramina bilaterally at every spinal
level.
C. The blood supply to the spinal cord is most tenuous in
the region from T10 through L1.
D. The Artery of Adamkiewicz is an anterior medullary
feeder artery that contributes blood to the anterior
spinal artery.
E. Arteries that penetrate the cord parenchyma are end
arteries and usually do not anastomose further.
A
- Answer: C
Explanation:
Reference: Gray’s Anatomy, Thirteenth American Edition.
Pages 964-971.
The spinal cord receives its’ blood supply from three
longitudinal arteries: - a single anterior spinal artery
- two posterior spinal arteries
The anterior spinal artery forms intracranially anterior to
the medulla oblongata, from the junction of two anterior
spinal branches, one derived from each of the two
vertebral arteries. From its’ origin, it descends anterior
to the spinalcord to the tip of the conus medullaris. The
diameter of the anterior spinal artery is greatest at the
cervical and lower thoracic regions with the smallest
diameter along the midthoracic zone from T3-T9.
This region of the cord is considered the “vulnerable zone”
with respect to circulation.
The branches of the anterior spinal artery that
penetrate the cord parenchyma are end arteries and do not anastomose further.
The spinal cord receives segmental arteries bilaterally at
every level that enter the spinal canal through the
neuroforamina, accompanying the spinal nerve roots.
These segmental arteries supply blood to the dorsal and
ventral nerve roots. In the cervical region these segmental
arteries may originate from the vertebrals or from other
cervical arteries. In the thoracic region, the segmental
arteries originate from the posterior intercostal arteries
which branch directly from the aorta.In the lumbar
region,they branch from the lumbar arteries. In addition,
the anterior spinal artery is reinforced at a number of
segmental levels by feeder arterial branches from these
segmental arteries. These arteries are called anterior
medullary feeder arteries. There is an average total of 8
anterior medullary feeder arteries (inclusive of all spinal
levels bilaterally) the largest of which is the great anterior
medullary artery or artery of Adamkiewicz. The total
number of anterior medullary feeder arteries varies from 2
to 17 in different individuals with an average of 3 in the
cervical region, 3 in the thoracic region and 2 in the
lumbar region. The artery of Adamkiewicz typically enters
the cord on the left side (77% of specimens) anywhere
from T7 to L4 (most commonly at T9 to T12). In the
cervical region, the largest anterior medullary feeder
enters at C4-5 or C5-6.
Source: Schultz D, Board Review 2004
76
Q
- A 40-year-old man developed chronic pain in the right
forearm that lasted hours each day. Neurological
examination demonstrated normal sensory examination,
mild right forearm pronation weakness, and weak fl exion
of terminal phalanges of right thumb, index, and middle
fi ngers. An attempt to make a full circle by applying the
end phalanx of the thumb to that of the index fi nger with
fi rm pressure showed consistent weakness. Which of the
following structures is affected?
A. Right anterior interosseous nerve
B. Right median nerve at the upper axilla
C. Right ulnar nerve
D. Right radial nerve
E. Right musculocutaneous nerve
A
- Answer: A
Explanation:
The patient described in this vignette has a pure motor
defi cit. The right pronator quadratus is weak because of
paresis of forearm pronation. Also there is paresis of the
fl exor digitorum profundus I & II and the fl exor pollicis
longus because of loss of fl exion of the terminal phalanges
of the second and third fi ngers, and the thumb,
respectively. All of these muscles are innervated by an
anterior interosseous nerve. The characteristic feature of a
lesion of this nerve is the inability to make a circle with the
thumb and index fi nger. (Staal 55-56)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD
77
Q
77. The mandibular nerve leaves the cranial cavity through the A. foramen ovale B. foramen spinosum C. foramen rotundum D. jugular foramen E. foramen lacerum
A
- Answer: A
Explanation:
A. The madibular nerve emerges from the cranial cavity by
way of the foramen ovale to enter the infratemporal fossa.
In the infratemporal fossa the mandibular nerve divides
into its terminal branches.
Madibular nerver supplies the lower jaw, tongue, and
lower teeth, the buccal surface of the cheek, and the
skin overlying the lower jaw, the temporal region, and the
anterosuperior two-thirds of the surface of the external
ear.
C. The maxillary nerve leaves through the foramen
rotundum
78
Q
78. The most frequently involved structure in external impingement of shoulder is A. Subacromiodeltoid tendon B. Subacromiodeltoid bursa C. Teres minor tendon D. Infraspinatus tendon E. Supraspinous tendon
A
- Answer: B
Source: Sizer et al - Pain Practice - March & June 2004
79
Q
- Anatomy of Meckel’s cave is as follows.
A. the location of the glossophraryngeal nerve as it passes
near the tonsillar fossa
B. an intestinal diverticulum that may cause epigastric
pain
C. located between the mastoid process and the angle of the
mandiblethe retrouterine recess in which an abscess or
tumor may compress the hypogastric plexus
D. the recess in which the gasserian ganglion resides before
dividing
E. the recess in which the posteior two thirds of the ganglion
are covered by dura
A
- Answer: E
Explanation:
The gasserian ganglion, also known as the trigeminal
ganglion,is formed from many midpontine rootlets as they
pass into the posterior cranial fossa and cross the superior
border of the petrous bone to enter the recess called
Meckel’s cave, or the trigeminal cave.
In this recess (Meckel’s cave or trigeminal cave), the
posterior two thirds of the ganglion are covered by dura.
The anterior one-third is not covered by dura, and it is
from this portion of the ganglion that the three major
divisions of the trigeminal nerve (ophthalmic, maxillary,
and mandibular) exit.
When performing a trigeminal ganglion block, if the
needle has punctured the dura of Meckel’s cave, a very
small amount of local anesthetic may result in rapid loss
of consciousness or cardiac arrest.
80
Q
80. The highest concentration of wide dynamic range neurons are seen in Rexed lamina A. I B. II C. III D. V E. IX
A
- Answer: D
Explanation:
The Rexed laminae in the dorsal horn of the spinal
cord are important in the modulation and transmission
of nociceptive stimuli.
A, B. Laminae I and II receive dense projections from the
brainstem nuclei.
Small diameter primary afferents also terminate
primarily in laminae I and II.
Myelinated primary afferent neurons and those from
the brainstem involved in modulation of pain perception
in laminae I and II also project to the deeper laminae such
as V.
D. Lamina V has a high concentration of wide dynamic
range cells, which play an active role in the phenomenon
of central sensitization.
81
Q
- The L2 ganglion is at the following distance from the
anterior lateral x-ray view- vertebral body border:
A. 5-6 MM
B. 6-8 MM
C. 12-13 MM
D. 15-20 MM
E. 20-22 MM
A
- Answer: C
Source: Racz G. Board Review 2003
82
Q
82. Cutaneous innervation of the plantar surface of the foot is provided by the A. Sural nerve B. Posterior tibial nerve C. Saphenous nerve D. Deep peroneal nerve E. Superfi cial peroneal nerve
A
- Answer: B
Explanation:
There are 5 nerves that supply the ankle and foot: - Posterior tibial nerve
- Sural nerve
- Superfi cial nerve
- Deep peroneal nerve
- Saphenous nerve
These nerves are superfi cial at the level of the ankle and
are easy to block. The posterior branch of the tibial nerve
gives rise to the medial and lateral plantar nerves, which supply the plantar surface of the foot.
