1. Which of the following in not characteristic of the Brown-Sequard syndrome.

 A. Contralateral paralysis below the lesion level.
 B. Contralateral loss of temperature sensation 2-3 segments below the lesion.
 C. Ipsilateral loss of position and vibratory sense below the lesion level.
 D. An ipsilateral segmental area of atrophy and reflex loss at the segmental lesion region.
 E. Contralateral loss of pain sensation 2-3 segments below the lesion.

2. Which statement is not true in regard to spinal cord morphology?

 A. The most lateral motoneuron columns innervate the distal musculature.
 B. Motoneurons lying in the dorsal position of motoneuron columns innervate extensor muscles.
 C. Motoneuron columns are classified as area IX in Rexed's map.
 D. Motoneurons are the only means by which the central nervous system can direct striated muscle
           movements. 
 E. Substantia gelatinosa represents lamina II in Rexed's map.

3. Which of the following pathways is not found in the lateral funiculus of the spinal cord.

 A. Corticospinal tract.
 B. Vestibulospinal tract.
 C. Rubrospinal tract.
 D. Dorsal spinocerebellar tract.
 E. Ventral spinocerebellar tract.

4. Pernacious anemia is characterized by which of the following spinal cord syndromes.

 A. Syringomyelia.
 B. Friedrich's ataxia.
 C. Combined system disease.
 D. Brown-Sequard syndrome.
 E. Tabes dorsalis.

5. Which of the following is incorrect in regard to the corticospinal pathway.

 A. It inhibits flexor motoneurons and excites extensor motoneurons.
 B. It is both ipsi- and contralateral in the spinal cord.
 C. Damage results in a Babinski reflex.
 D. In the upper medulla, it is contralateral to motoneurons it will innervate.
 E. Damage produces spastic paralysis.

6. Which of the following sensation is not carried in the dorsal columns.

 A. Heat. 
 B. Joint sensation.
 C. Discriminative touch.
 D. Vibration.
 E. Muscle spindle sensations.

7. Which of the following is not indicative of an upper motoneuron lesion.

 A. Spasticity.
 B. Babinsky response.
 C. Complete muscle atrophy.
 D. Hyperreflexia.
 E. None of the above.

8. The disease of the nervous system we call combined system disease is due to.

 A. Aplastic anemia.
 B. Lack of vitamin B6.
 C. Cutting the cord in half.
 D. Lack of intrinsic factor.
 E. A neurotrophic virus.

9. Which of the following statements is incorrect in regard to the spinal cord.

 A. The lateral nucleus is found from T1 through L2.
 B. Clarke's nucleus is found from C8 through L3.
 C. The spinal cord ends opposite vertebrae L1.
 D. The lumbar enlargement is opposite vertebrae T10.

10. The tract that is excitatory to flexor motoneurons is.

 A. The vestibulospinal tract.
 B. The descending MLF tract.
 C. The rubrospinal tract.
 D. The lateral reticulospinal tract.

11. Which of the following is incorrect in regard to the reticulospinal tracts.

 A. It is located in the ventral and lateral funiculus.
 B. The medial tract originates from the pons while the lateral originates from the medulla.
 C. It is monosynaptic to motoneurons.
 D. It is excitatory to extensor motoneurons and inhibitory to flexor motoneurons.

12. Which of the following statements is true regarding a pure lower motoneuron syndrome two weeks after
      the lesion occurred.

 A. Paralysis, hyperreflexia, muscle atrophy.
 B. Paresis, hyperreflexia, muscle atrophy.
 C. Paresis, hypertonia, muscle atrophy.
 D. Paralysis, atonia, muscle atrophy.
 E. Paresis, areflexia, muscle atrophy.

13. The most vulnerable aspect of spinal cord arterial supply due to occlusion is.

 A. Segments C6 and L1.
 B. Segments T4 and L1.
 C. The dorsal root ganglion.
 D. The most ventral portion of the dorsal funiculus.

14. Which of the following would you not find with a lateral quadrant lesion of the spinal cord?          

 A. Paresis, hyperreflexia, hypertonia ipsilaterally.
 B. Ipsilateral hypothermia.
 C. Contralateral hypothermia.
 D. Contralateral anesthesia.
 E. Ipsilateral babinski response.

15. A 46-year-old man had a neurologic operation in which the white matter of the anterior quadrant of the 
      spinal cord was cut at the level of the third cervical segment of the right side.  The operation was 
      successful and there were no complications. The structure that was the target of the surgeon was the:

 A. Dorsal spinocerebellar tract.
 B. Lateral vestibulospinal tract.
 C. Anterior corticospinal tract.
 D. Right spinothalamic tract.
 E. Fasciculus cuneatus.

16. If a patient displayed inability to feel pain or temperature over the thorax and both upper extremities 
      with no disturbance of tactile sensitivity, ataxia, and no disturbance of motor function conclude the 
      patient had.

 A. Multiple sclerosis.
 B. Syringomyelia.
 C. Tabes dorsales.
 D. Combined system disease.
 E. Guillain-Barre syndrome.

17. All are true in relation to the pain gate theory except.

 A. Higher centers.
 B. The lateral division fibers are tonically active which keep the gate open normally.
 C. The large fiber activation by delta fibers results in excitation of the T cells initially.
 D. Small c fiber activation is responsible for excitation of the substantia gelatinosa which inhibits T cells 
           and closes the gate.
 E. Activation of the medial division after initial adaptation of a pain stimulus results in inhibition of pain 
           sensations.

18. The spinothalamic fibers.

 A. Carry the sensations of light touch, temperature, pain and proprioception from the lower joints.
 B. Is an ipsilateral pathway.
 C. First order neurons are within lamina I, II, IV, and V.
 D. Are often damaged initially in syringomyelia before other pathways become involved.
 E. Are often cut to relieve pain in the body, which is the best long-term treatment for a variety of clinical 
           disorders.

19. All of the following are true about the substantia gelatinosa except.

 A. It is represented by lamina I of the spinal cord.
 B. It may be found throughout the spinal cord and lower medulla.
 C. It is characterized by small interneurons.
 D. It is characterized by the highest concentration of enkephalins, endorphins, and substance P of the 
           entire nervous system.
 E. It is related to nociceptive input.

20. The epicratic system.

 A. Refers to the lateral division of spinal nerves.
 B. Refers to the spinothalamic system.
 C. Is the discriminatory, large myelinated axons of the CNS.
 D. Is the phylogenetically older acquisition of the nervous system.
 E. Is best characterized by the localization of burning pain.

21. All of the following are true for the spinal cord except.

 A. There is a well-defined epidural space.
 B. The C3-C5 segments represent the location of the phrenic nucleus.
 C. There is 31 pairs of nerves.
 D. It terminates at the level of the L2 vertebrae.
 E. All preganglionic sympathetic myelinated axons exit between segments C8-L1. 

22. The corticospinal tracts.

 A. Are excitatory to extensor musculature.
 B. Are all in the lateral funiculus of the spinal cord.
 C. When damaged result in atonis, are flexia, and muscle fasciculations.
 D. Termination is bilateral for the lateral pathway and ipsilateral for the anterior pathway.
 E. Terminate in a dorsal ---- ventral pattern for the lateral and a ventral ---- dorsal pattern for the anterior.

23. All of the following spinal cord tracts may be found in the anterior white funiculus except.

 A. Lateral spinothalamic tract.
 B. Anterior spinothalamic tract.
 C. Tectospinal tract.
 D. Anterior corticospinal tract.
 E. Lateral reticulospinal tract.

24. A spinal tract which we would consider as being protopathic in nature is. 

 A. Dorsal spinocerebellar.
 B. Lateral spinothalamic.
 C. Dorsal column.
 D. Spinal vestibular.
 E. Spino-olivary.

25. All of the following symptoms would be seen in the case of an upper motor neuron lesion except.

 A. Babinski response.
 B. Hyperreflexia.
 C. Muscle paresis.
 D. Muscle fasciculations.
 E. Hypertonus.

26. The corticospinal tracts.

 A. Are found ipsilateral in the spinal white matter.
 B. Are referred to as the lovive in the medulla.
 C. Are excitatory to extensor muscles and inhibitory to flexor muscles.
 D. Terminate only on alpha motoneurons.
 E. Are somatotopically arranged with the cervical fibers lying more medially and the sacral lying laterally.

27. The most critical area or vulnerable area of the radicular branches supplying the posterior spinal artery is.

 A. C1-4.
 B. T1-3.
 C. T6-9.
 D. L1-3.
 E. S2-4.

28. Lesions of which of the following tracts will result in a positive Romberg sign.

 A. Corticospinal.
 B. Dorsal column.
 C. Lateral spinothalamic.
 D. Rubrospinal.
 E. Vestibulospinal.

29. The tapping of the biceps tendon results in flexion of the forearm at the elbows.  This reflex involves which 
      of the following segments.

 A. C 1-2.
 B. C 3-4.
 C. C 5-6.
 D. C 7-8.
 E. T 1-2.

30. Horners syndrome includes all of the following symptomology except.

 A. Pupil on affected side is smaller.
 B. Pupil doesn't dilate on affected side when partially shaded.
 C. Ptosis of the affected side due to denervation of superior palpebral muscle.
 D. Face is sweaty, whitish and cold to the touch.
 E. None of the above.

31. According to the pain-gate theory of Wall and Melzack, an open gate means.

 A. The substantia gelatinosa cells are being excited bilaterally by small caliber fibers.
 B. The T cells are firing at an increased level.
 C. The P cells are firing at an increased level.
 D. The sensation of pain is being inhibited by the substantia gelatinosa.
 E. The large caliber fibers are firing in greater quantity than smaller caliber fibers.

32. All of the following symptoms would be seen in the case of a lower motor lesion except.

 A. Hypotonus.
 B. Muscle fasciculations.
 C. Areflexia.
 D. Muscle paralysis.
 E. Babinski response.

33. Small infarcts to spinal radicular arteries are most likely to.

 A. Cause an infarction to the peripheral white matter of the cord.
 B. Cause infarctions primarily at the base of the dorsal column and dorsal horn.
 C. Cause an infarction to the ventral gray matter.
 D. Cause an infarction of the entire dorsal horn bilaterally.
 E. Never cause any problems.

34. The term linea splendens refers to.

 A. The filum terminale pia attachment to the coccyx vertebrae.
 B. Conus medullaris.
 C. Thickened pia in the region of the anterior median fissure.
 D. The epidural space.
 E. The pia attachment's lateral extensions to the vertebral spinal canal.

35. The major blood supply to the motoneurons in spinal cord ventral gray matter is.

 A. The anterior radicular artery.
 B. Sulcal branches of the anterior spinal artery.
 C. Posterior spinal artery.
 D. Circumferential branches of the radicular artery.
 E. Spinal arteries.

36. If one saw specific degeneration of only the dorsal columns, one would expect which of the following 
      diseases to be the culprit.

 A. Syringomyelia.
 B. Brown-Seguard Syndrome.
 C. Friedrich's ataxia.
 D. Poliomyelitis.
 E. Tabes dorsalis.

37. A large infarction of the anterior spinal artery will most likely result in.

 A. Loss of pain. 
 B. Loss of discriminatory touch.
 C. Loss of vibration sense.
 D. Loss of lower motor neurons.
 E. Loss of lateral funiculi fiber tracts

38. All of the following tracts can be found in the anterior funiculus except.

 A. Dorsal spinocerebellar tract.
 B. MLF.
 C. Tectospinal tract.
 D. Anterior corticospinal tract.
 E. Vestibulospinal tract.

39. A normal triceps reflex utilizes which of the spinal cord segments for its integrity.

 A. C3-C4.
 B. C5-6.       
 C. C6-C7.
 D. T1-T2.
 E. C1-C2.

40. Radicular pain refers to.

 A. Pain caused by arthritis.
 B. Pain caused by visceral organs.
 C. Pain caused by central nervous system damage.
 D. Pain caused by irritation of the ventral nerve roots.
 E. Pain caused by irritation of the dorsal nerve roots.

41. All of the following sites of referred pain are correct except.

 A. Heart referred to thorax and inner upper arm.
 B. Gallbladder referred to above umbilicus on right side.
 C. Ovary referred to lateral and below umbilicus.
 D. Pancreas referred to small of the back.
 E. Aortic arch referred right shoulder and neck.

42. If one had paralysis of only the diaphragm muscles, one would expect the spinal cord to be damaged in 
      which of the following regions.

 A. Upper cervical.
 B. Middle cervical.
 C. Lower cervical
 D. Upper thoracic.
 E. Lower thoracic.

43. All of the following are true in regard to Horners Syndrome except.

 A. Damage to superior cervical ganglion can cause it.
 B. Results in ptosis of the eye because of superior palpebral muscle denervation.
 C. Results in the face being red, dry, and warm.
 D. Results in smaller pupil on affected side.
 E. Damage to Edinger-Westphal nucleus can cause it. 

44. All of the following projections are correct for substantia gelatinosa cells except.

 A. They relate to other SG cells in the same segment.
 B. They relate to other SG cells in other segments.
 C. They relate to contralateral SG cells through the posterior spinal commissure.
 D. They synapse with dendrites of motoneurons
 E. They synapse with pain fibers entering the SG by means of axo-axonic contacts.

45. All of the following are true except.

 A.  A lesion of the lateral corticospinal tract results in muscular hypotension. 
 B. Alpha motoneurones supply extrafusal fibers of striated skeletal muscles.
 C. Gamma motoneurones supply intrafusal fibers of neuromuscular spindles.
 D. The Renshaw cell is an important inhibitory interneuron in the spinal cord.
 E. The fasciculus gracilus deals with sensations from the lower limbs while the cuneatus deals with 
           sensations from the upper limbs.

46. The major blood supply to the spinocerebellar tracts are. 

 A. The anterior radicular artery.
 B. Sulcal branches of the anterior spinal artery.
 C. Spinal arteries.
 D. Circumferential branches of the radicular artery.
 E. Posterior spinal artery.

47. In the pain gate theory:

 A. The T cells are not necessary to have pain propagated to higher centers.
 B. The medial division fibers are tonically active which keep the gate open normally.
 C. The large fiber activation by delta fibers results in inactivation of the T cells initially.
 D. Small c fiber activation is responsible for excitation of the substantia gelatinosa which inhibits T cells 
           and opens the gate.
 E. Activation of the lateral division after initial adaptation of a pain stimulus results in inhibition of pain 
           sensations.

48. Bowel and bladder function is controlled by parasympathetic autonomic neurons in which part of the 
      spinal cord?

 A. Cervical.
 B. Thoracic.
 C. Upper Lumbar.
 D. Lower lumbar.
 E. Sacral.

49. All of the following spinal cord tracts can be found in the lateral funiculus except:

 A. Lateral corticospinal tract.
 B. Rubrospinal tract.
 C. Ventral spinocerebellar tract.
 D. Lateral spinothalamic tract.
 E. Lateral reticulospinal tract.

50. A positive Romberg sign would be expected in all of the following clinical disorders except:

 A. Tabes dorsalis.
 B. Charcot-Marie-Tooth disease.
 C. Amyotrophic lateral sclerosis.
 D. Combined system disease.
 E. Friedrich's ataxia.

51. The substantia gelatinosa:

 A. Is represented by lamina I of Rexed's map.
 B. Is related to proprioceptive input.
 C. Is characterized by small Golgi type I neurons.
 D. May be found in all segments of the spinal cord and lower medulla.
 E. Is characterized by having the lowest concentration of substance P, enkephalins and endorphins 
          of the entire nervous system.

52. You place your hand on a hot burner and rapidly jerk it away. The sensory information responsible for this 
      response was conveyed through a (an):

 A. Monosynaptic reflex channel.
 B. Polysynaptic reflex channel.
 C. Spinocerebellar channel.
 D. Protopathic leminiscal channel.
 E. Epicratic leminiscal channel.

53. The protopathic system:

 A. Refers to the medial division of spinal nerves.
 B. Is the discriminatory , large myelinated axons of the CNS.
 C. Is the phylogenetically newest acquisition of the nervous system.
 D. Refers to the dorsal columns.
 E. Is best characterized by the localization of burning pain.

54. The corticospinal tracts:

 A.  Terminate in a dorsal <---- ventral pattern for the lateral and a ventral <---- dorsal pattern for 
            the anterior.
 B.  Are all in the lateral funiculus of the spinal cord.
 C.  Are excitatory to extensor musculature.
 D.  When damaged, result in atonia, areflexia, and muscle fasciculations.
 E.  Termination is ipsilateral for the lateral pathway and bilateral for the anterior pathway.

55. When one thinks of the dorsal column system, all of the following terms come to mind (I hope!) except:

 A. Medial leminiscus. 
 B. Epicratic.
 C. Nucleus gracilis.
 D. Nucleus cuneatus.
 E. External cuneate fibers.

56. Severing a ventral or dorsal root of the lumbar nerve in the spinal cord can result in paralysis of 
      both legs. This would be due to. 

 A.  Motor fibers are multi-segmental.
 B.  Motor fibers can be found in dorsal roots.
 C.  The lumbar segments have major feeder arteries which would cause a bilateral infarct.
 D. You would be damaging the anterior spinal artery
 E.  You would be damaging the posterior spinal artery

57. A patient cuts himself with a rusty nail, doesn't go to the doctor and three days later is admitted to
      the ER with convulsions. What is the neurological explanation? 

 A. The motoneuron have been denervated.
 B. Tetanus prevents the release of Glycine from Renshaw cells. 
 C. Acetylcholine is released in greater quantities from the corticospinal tract synapses.
 D. Gamma motoneurons are destroyed.
 E. Tetanus destroys the large diameter fibers.

58. During a passive muscle stretch, Ia afferent activity should.

 A. Transiently increase.
 B. Transiently decrease.
 C. Remain the same.
 D. Increase during the stretch and remain at an elevated level.
 E. Decrease during the stretch and remain at a reduced level.

59. In humans, which class of peripheral nerve fibers is most likely to carry information interpreted as
      slow pain?

 A. C fibers.
 B. A-delta fibers.
 C. B fibers.
 D. Group I fibers
 E. Group II fibers.

60. A 40 year old woman noted a painless, slowly progressive loss of sensation in an area involving the
      back of her head, neck, shoulders, and both upper extremities. Neurologic examination revealed a
      sensory loss involving only pain and temperature in this area. Specific testing of all other modalities 
      of sensation in the affected areas and elsewhere revealed no abnormalities, and there were no
      changes in motor performance, strength or deep tendon reflexes. Your diagnosis would be. 

 A. Tabes dorsalis.
 B. Combined system disease.
 C. Multiple sclerosis.
 D. An anterior midline tumor mass.
 E. Diabetes.

61. The drug baclofen would be used for.

 A. To prevent convulsions from increased motoneuron excitation.
 B. To prevent spinal shock in spinal trauma.
 C. To stop metabolism of Substance P and prevent pain.
 D. To decrease the mass reflex from occurring in spinal trauma patients.
 E. To increase spinal artery flow in spinal trauma.

62. All of the following are true except. 

 A. The substantia gelatinosa of the spinal cord is homologous with the spinal trigeminal nucleus.
 B. The axial musculature is supplied by the lateral aspect of the ventral horn, while those neurons
           innervating the limbs are in the medial portion of the ventral horn.
 C. Most of the spinothalamic fibers originate from neurons in lamina V of the spinal cord.
 D. Lamina VIII and IX include motoneurones innervating skeletal muscle.
 E. Dorsal root afferents terminate in all laminae, but predominantly in the dorsal horn.

63. All of the following are true except.

 A. The axons of the ventral spinocerebellar tract terminate in the ipsilateral cerebellar cortex.
 B. The axons of the dorsal spinocerebellar tract terminate in the ipsilateral cerebellar cortex.
 C. The rubrospinal tract arises from the ipsilateral red nucleus.
 D. The lateral vestibulospinal tract is an uncrossed tract.
 E. The fasciculus proprius contains spino-spinal fibers. 

64. If a patient displayed lack of epicratic sensation over both lower limbs, deviation of the left lateral rectus 
      muscle, blindness in the right eye, and loss of urinary control with all other sensations being normal, one 
      might first think of which of the following disease entities as being the culprit. 

 A. Guillain-Barre Syndrome.
 B. Tabes Dorsalis.
 C. Poliomyelitis.
 D. Multiple Sclerosis.
 E. Combined system disease.

65. The term  "Ventral Root Nerve Fiber Type Ia" is best matched by the following:

A. Flower spray ending.            
B. Extrafusal fiber.        
C. Isotonic response.                                           
D. Annulospiral ending.                      
E. Static response.                                             

66. All of the following are true except.

 A. The stretch reflex is a monsynaptic reflex.
 B. The flexor reflex is a polysynaptic reflex.
 C. There is extensive sensory loss following the interruption of a single dorsal root of a spinal nerve. 
 D. Transection of the spinal cord between the cervical and lumbar enlargements causes paraplegia.
 E. With a hemisection, position sense and vibration are lost on the ipsilateral side and pain and  
           temperature are lost on the contralateral side.

67. Preganglionic parasympathetic neurons are located in.

 A. The interomedialateral cell column.
 B. In sacral segments S2, S3, and S4.
 C. In lumbar segments L2 through L4.
 D. In all sacral segments.
 E. In ganglia close to the structures they innervate.

68. In the pain gate theory, the gate refers to: 
        
 A. The substantia gelatinosa.
 B. The T cells. 
 C. Epicratic fibers.
 D. Protopathic fibers.
 E. Unipolar neurons.

69. All of the following are treatments for chronic pain syndrome except:

 A. Cutting the spinothalamic tracts.
 B. Dorsal column stimulation.
 C. TENS unit.
 D. Using anti-depressant drugs to increase brain enkephalins.
 E. Surgically produces a Brown-Sequard syndrome.

70. There are various aspects of afferent pain which are important. Which would you consider not to be 
      important.

 A. The ongoing activity which precedes the stimulus.
 B. The balance of activity between large versus small fibers.
 C. When a stimulus is applied peripherally, many fibers may increase their activity.
 D. Selective destruction of large peripheral nerve fibers or dorsal column fibers, as may be seen in 
           alcoholism, diabetes etc., which eliminates the presynaptic inhibition on the T cell and can open the gate.
 E. Two consecutive burns should inhibit all pain.

71. Inhibition of the Renshaw cell by strychnine results in death due to.

 A. Muscle paralysis.
 B. Hyperreflexia.
 C. Bladder infection.
 D. Cardiac arrhythmia.
 E. Convulsions.

72. All of the following provide protection for the spinal cord except.

 A. Vertebrae.
 B. Dentate ligaments.
 C. Meninges.
 D. Linea splendens.
 E. Caudal equina.

73. A bilateral posterior compression of the thoracic spinal cord would result in.                            

 A. Bilateral loss of vibration except perianal region.
 B. Bilateral hemiplegia.
 C. Bilateral anesthesia.
 D. Bilateral hypothermia.
 E. Bilateral hyperreflexia.

74. Descending autonomic fibers in the spinal cord are located in: 
                  
 A. Anterior funiculus.
 B. The posterior funiculus.
 C. The fasciculis proprii.
 D. The ventral part of the lateral funiculus.
 E. The dorsal half of the lateral funiculus.

75. In the Brown-Sequard syndrome:
     
 A. Pain, thermal, and tactile senses are lost contralaterally at slightly different levels below the lesion.
 B. Discriminative tactile and kinesthetic senses are lost ipsilaterally below the level of the lesion.
 C. The endon reflexes become exaggerated after a period of spinal shock.
 D. Atrophy develops in muscles below the level of the lesion.
 E. The superficial abdominal and cremasteric reflexes are lost contralateral to the lesion.

76. A patient comes into your office complaining of being tired and having a loss of strength. You do a 
      neurological on him and find a bilateral loss of strength grip, more on the right, a hyperactive triceps 
      and biceps jerk, a bilateral Babinski with no sensory abnormalities. Your diagnosis is: 

 A. Multiple sclerosis.
 B. Poliomyelitis.
 C. Syphilis.
 D. Amyotrophic lateral sclerosis.
 E. Combined system disease.

77. Spinal neurons classified as root cells are:

 A. Internuncial neurons.
 B. Association neurons.
 C. Commissural neurons.
 D. Somatic and visceral efferent neurons.
 E. Neurons in laminae III and IV.

78. All of the following symptoms would be seen in a lower motor neuron lesion except:

 A. Spasticity in the antigravity muscles.
 B. Muscular atrophy.
 C. Absent deep reflexes.
 D. Muscular atonia.