Mosby Review - Section 2 Spinal Anatomy

1. Which of the following forms the posterior border of a typical intervertebral foramen? a. Pedicle b. zygapophyseal joint c. uncinate process d. lamina

1. b. The borders of a typical intervertebral Foramen arc as rollows: superior, pedicle of the vertebra above; anterior (from superior to inferior), vertebral body of the vertebra above; intervertebral disc, vertebral body of the vertebra below; inferior, pedicle of the vertebra below; posterior, zygapophyseal (facet) joint (formed by the superior articular facet of the vertebra below, the inferior articular facet of the vertebra above, and lined by the ligamentum flavum anteriorly).

1. When cerebrospinal fluid is withdrawn by lumbar puncture, which structure will NOT be penetrated by the needle? a. dura mater b. subdural space c. pia mater d. subarachnoid space

1. c. The pia mater is adherent to the spinal cord, which ends at the L2 spinal level in the adult. Inferior to the termination of the spinal cord (conus medularis), the pia mater continues as the filum terminate. Because lumbar punctures are administered below the L2 spine, it is unlikely to puncture pia mater.

1. What kind of cartilage covers the articulating surfaces of each superior and inferior articular process of the vertebrae? a. Annular b. Reticular c. Elastic d. hyaline

1. d. Hyaline cartilage is flexible and somewhat elastic. Elastic or reticular cartilages do not cover the articular processes. The annular cartilage is located in the trachea.

1. Which of the following muscles does NOT attach to the mastoid process of the temporal bone? a. digastric muscle b. longissimus capitis muscle c. splenius capitis muscle d. semispinalis capitis muscle

1. d. The mastoid process of the temporal bone serves as an attachment for several muscles, including the sternocleidomastoid, the longissimus capitis, the digastricus, and the splenius capitis muscles. The semispinalis capitis muscle attaches to the transverse processes of C4-T6 vertebrae and to the superior nuchal line of occipital bone but not to the mastoid process of the temporal bone.

10. Which of the following muscles does NOT attach to transverse processes of vertebrae? a. Semispinalis b. Multifidus c. Spinalis d. Intertransversarii

10. c. Spinalis muscle: originate from spinous processes and insert into spinous processes. The semispinalis and muitifidus are two muscles of the fifth laver of back muscles that are also known as the transversospinalis muscles. They originate from transverse processes and insert into spinous processes. The intertransversarii muscles are located between transverse processes of successive vertebrae.

10. Which of the following ligaments limits hyperextension of the vertebral column? a. Interspinous b. Intertransverse c. ligamentum flavum d. anterior longitudinal

10. d. The anterior longitudinal ligament is quite wide and covers the anterior aspect of the vertebral bodies from the level of C 1 to the sacrum. Generally speaking, this ligament has rather strong attachments to the vertebral bodies but rather weak attachments to the intervertebral discs. However, the precise attachments are somewhat more complex than this. The anterior longitudinal ligament functions to limit extension of the spine. The interspinous ligament, supraspinous ligament, and ligamentum flavum all function to limit hyperflexion of the vertebral column.

10. The basal ganglia do NOT include which of the following structures? a. putamen b. caudate nucleus c. globes pallidus d. red nucleus

10. d. The basal ganglia are groups of neurons related to the diencephalon but separated from it by the internal capsule. They include caudate nucleus, putamen, globes pallidus, subthalamic nuclei, and substantia nigra (in the midbrain). They help to control movement. The red nucleus is located in the midbrain.

10. What is the normal minimum dimension of the anteroposterior canal in an adult lumbar vertebra? a. 5 mm b. 9 mm c. 11 mm d. 15 mm

10. d. Values regarding the vertebral canal dimensions are important because of their clinical significance (i.e., canal stenosis). An adult anteroposterior canal measurement of less than 15 mm indicates stenosis.

11. Which of the following is NOT a feature of the atlas vertebra? a. anterior tubercle b. bifid spinous process c. posterior arch d. fovea dentalis

11. b. Bifid spinous processes are features of C2-C6 cervical vertebrae. The atlas has no spinous process; instead it has a posterior tubercle. All the other structures listed are features of the atlas.

11. Which of the following muscles is attached to mamillary processes of lumbar vertebrae? a. longissimus thoracis b. multifidus c. rotatores d. spinalis

11. b. Multifidus muscles originate partially from mamillary processes of lumbar vertebrae. Longissimus thoracis originate partially from accessory processes of lumbar vertebrae.

11. Whiplash injury from a rear-end collision would tear which of the following ligaments? a. posterior longitudinal ligament (PLL) b. anterior longitudinal ligament (ALL) c. ligamentum nuchae d. ligamentum flavum

11. b. Whiplash injury includes hyperextension of cervical vertebrae that may tear the anterior longitudinal ligament that limits extension of cervical spine. All of the other ligaments limit flexion of the cervical spine; accordingly, they may be torn in hyperflexion injuries.

11. Which of the following is a function of the hippocampus? a. Smell b. Taste c. Memory d. vision

11. c. The hippocampus, which is part of the limbic system, is important in the processing, but not storage of, declarative (cognitive) memory. It is formed by the gray and white matter of two gyri rolled together and is located in the medial temporal lobe.

12. The trapezius muscle is innervated by which nerve? a. spinal accessory nerve b. thoracodorsal nerve c. dorsal scapular nerve d. dorsal primary rani of spinal nerves

12. a. The spinal part of the accessory nerve innervates the trapezius and sternocleidomastoid muscles. The thoracodorsal nerve innervates the latissmus dorsi muscle. The dorsal scapular nerve innervates the levator scapulae and the rhomboid major and minor muscles (second layer of back muscles). The dorsal primary rami of spinal nerves innervate deep back muscles.

12. Uncinate processes are characteristic of what area of the vertebral column? a. cervical vertebrae b. thoracic vertebrae c. lumbar vertebrae d. sacrum

12. a. Uncinate processes are unique features of the C3-C7 cervical vertebrae. They form uncovertebral joints of Luschka that are found only in the cervical region of the vertebral column.

12. Which of the following is NOT an ascending tract in the spinal cord? a. ventral spinothalamic b. corticospinal c. spinotectal d. spino-olivary

12. b. The major ascending tracts of the spinal cord include the ventral and dorsal spinothalamic tracts, the spinotectal tract, the ventral and dorsal spinocerebellar tracts, and the spinoreticular tract. Other ascending tracts are spino-olivary and spinovestibular tracts. The corticospinal tract is a descending motor tract.

12. Which of the following is a symphysis type of joint? a. facet joints b. atlanto-occipital joints c. intervertebral discs d. sternoclavicular joints

12. c. IVDs are fibrocartilaginous joints (symphysis = secondary cartilaginous joints). Facet joints are plane synovial joints. The atlanto-occipital joint is a condylar synovial joint, and the sternoclavicular joint is a saddle type of synovial joint.

13. Contraction of which muscle produces extension of the head? a. spinalis cervices b. longus capitis c. longus colli d. sternocleidomastoid

13. a. The longus capitis, longus colli, and sternocleidomastoid muscles are all associated with the anterior aspect of the cervical vertebrae and thus produce flexion of the head.

13. Which lamina of the dorsal horn of the spinal cord is known as the substantia gelatinosa of Rolando? a. I b. II c. IV d. VI

13. b. Lamina I is known as the marginal zone of Waldeyer; laminae III and IV are known as the nucleus proprius; and laminae VI to X are not named.

13. Which of the following foramina is NOT located in the middle cranial fossa? a. foramen ovale b. foramen rotundum c. foramen spinosum d. foramen cecum

13. d. The foramen cecum is located in the anterior cranial fossa, between the crista galls and frontal crest. It transmits emissary veins between the superior sagittal sinus and nasal veins. All other foramina are located on the greater wing of the sphenoid bone that forms part of the floor of the middle cranial fossa.

13. Which of the following ligaments is anterior to the spinal cord? a. ligamentum flavum b. interspinous ligament c. supraspinous ligament d. posterior longitudinal ligament (PLL)

13. d. The posterior longitudinal ligament connects the back of vertebra bodies and forms an anterior boundary to the vertebral canal; accordingly, it is anterior to the spinal cord. All other ligaments ai posterior to the spinal cord.

14. The fasciculus cuneatus conveys information from the: a. ipsilateral upper extremity b. contralateral upper extremity c. ipsilateral lower extremity d. contralateral lower extremity

14. a. The fasciculus cuneatus conveys information from the ipsilateral upper extremity. The fasciculus gracilis conveys information from the ipsilateral lower extremity.

14. What is the main motion at the atlantoaxial joints? a. Rotation b. Flexion c. Extension d. lateral flexion

14. a. There are three atlantoaxial joints. The median atlantoaxial joint is a pivot (trochoid) type of synovial joint where the main motion is rotation. The two lateral atlantoaxial joints are plane (gliding) types of synovial joints where the main motion is also rotation.

14. Which of the following is NOT transmitted through foramen magnum? a. spinal cord b. internal carotid artery c. vertebral artery d. spinal part of accessory nerve

14. b. The internal carotid artery enters the cranial cavity through the carotid canal, which is located in the petrous part of temporal bone in the base of the skull.

14. In the lumbar spine, the multifudus lumborum muscle originates from which structure? a. spinous processes of the lumbar vertebrae b. sacrotuberous ligament c. posteromedial iliac crest d. mamillary processes of the lumbar vertebrae

14. d. The multifudus lumborum inserts on the spinous processes of vertebrae located two to four segments above; the sacrotuberous ligament and the posteromedial iliac crest represent the location of some of the insertions of the iliocostalis lumborum.

15. What type of joint are synchondroses? a. fibrous joint b. synovial joint c. cartilaginous joint d. suture

15. c. A synchondrosis is a cartilaginous joint such as the epiphyseal plates between the diaphysis and epiphyses of long bones, and costosternal joints. Fibrous joints include syndesmoses and sutures. Synovial joints are enclosed by a joint capsule and contain synovial fluid.

15. Which muscles constitute the deepest muscle fasciculi located in the groove between the spinous and transverse processes? a. Multifudus b. Semispinalis c. Rotatores d. longissimus

15. c. The longissimus muscle is part of the fifth layer of the back muscles. All others are part of the sixth layer, but the rotators are the deepest.

15. The paleospinothalamic tract conveys: a. light touch b. proprioception c. vibration d. pain and temperature

15. d. Light touch, proprioception, and vibration are carried mainly by the dorsal columns. The ventral spinothalamic tract conveys some light touch and pressure. The paleospinothalamic tract is the subdivision of the lateral spinothalamic tract that carries slow (C-type) pain fibers.

15. Which of the following is NOT a part of the ethmoid bone? a. crista galli b. cribriform plate c. superior nasal concha d. inferior nasal concha

15. d. The inferior nasal concha is a separate skull bone. The superior and middle nasal conchae are parts of the ethmoid bone. All other structures listed are parts of the ethmoid bone.

16. At the caudal level of the medulla, what percentage of the fibers of the corticospinal tract cross at the pyramidal decussation? a. 90% to 100% b. 80% to 90% c. 70% to 80% d. 60% to 70%

16. b. Most anatomists agree that 80% to 90% of the fibers of the corticospinal tract cross over.

16. Which muscle originates on the spinous process of the axis and inserts onto the transverse process of the atlas? a. rectus capitis posterior major b. obliquus capitis inferior c. rectus capitis posterior minor d. obliquus capitis superior

16. b. The rectus capitis posterior major begins at the spinous process of C2 and terminates at the occiput. The rectus capitis posterior minor begins at the posterior tubercle of the atlas and terminates at the occiput. The obliquus capitis superior arises from the transverse process of the atlas and inserts on the occiput.

16. Which bony structure does NOT border the intervertebral foramen? a. intervertebral disc b. superior facet c. lamina d. inferior facet

16. c. The pedicle of the vertebra above forms the roof of the IVF, the two vertebral bodies and the disc between them forms the anterior border of the IVF, the pedicle of the vertebra below forms the floor of the IVF, and the zygapophyseal joint forms the posterior border of the IVF. The lamina is posterior to the IVF and does not border it.

16. Select the FALSE statement concerning the atlantoaxial joint a. it is a synovial joint b. it has two plane joints between the superior and inferior articular facets of the atlas and axis c. it has one pivot joint between the dens of the axis and the anterior arch of the atlas d. it permits flexion and extension of the head

16. d. The principal motion seen in the atlantoaxial joint is rotation. The dens blocks flexion and extension at this joint.

17. Which of the following portions of the multi-fides muscle group is the most highly developed in humans? a. Lumborum b. Thoracis c. Cervices d. Capitis

17. A. The multifidus lumborum is much more substantial than any of the other regions of this muscle (thoracic and cervicis regions). The other contributors to the transversospinalis muscle group (sixth layer of back muscles) also are most highly developed in a specific region of the spine. More specifically, the semispinalis capitis and rotatores thoracis muscles are the most highly developed portions of the other transversospinalis muscles.

17. This descending tract originates in the superior colliculus and is involved with the orientation toward a stimulus in the environment by reflex turning of the head. a. rubrospinal b. reticulospinal c. tectospinal d. vestibulospinal

17. c. The rubrospinal tract originates in the red nucleus; the reticulospinal tract originates in the medullary and pontine reticular formation; and the vestibulospinal tract originates in the lateral vestibular nucleus.

17. Which of the following is NOT part of the axial skeleton? a. Coccyx b. Sternum c. Rib d. Ilium

17. d. The axial skeleton includes the skull, hyoid bone, vertebral column, and the thoracic cage. The ilium is part of the appendicular skeleton.

17. Which bone is NOT part of the cranial vault? a. Frontal b. Parietal c. Ethmoid d. maxilla

17. d. The cranial vault is made of bones that form the cavity for the brain. This includes the frontal, parietal, ethmoid, sphenoid, temporal, and occipital bones. The maxillary bone is considered a facial bone.

18. The os coxae is composed of what structures? a. fused vertebra of the coccyx b. fused vertebra of the sacrum c. ilium, ischium, and pubic bones d. facial bones of the skull

18. c. The os coxa, or hip bone, is composed of three bones before puberty. These are the ilium, ischium, and pubis. They fuse at the acetabulum following puberty, and fusion is complete by the early 20s.

18. The lateral division fibers of the dorsal root utilize the dorsolateral tract of to enter the spinal cord. a. Lisfranc b. Lister c. Lissauer d. Lichten

18. c. The tract of Lissauer receives small dorsal root fibers and axons originating from dorsal horn neurons (primary afferent nociceptive axons, pain-carrying fibers).

18. What is a secondary curve of the vertebral column? a. Scoliosis b. curve that developed during the fetal period c. kyphosis d. curve that develops after birth

18. d. At birth, the spine is "C" shaped with a posterior apex. This is the primary curve. As the infant lifts the head and later begins to stand and walk, the cervical and lumbar curves reverse, forming secondary curves. Even though secondary curves are kyphotic, a "kyphosis" refers to a pathologic curve. A scoliosis is an abnormal lateral curve of the spine.

18. Which of the following muscles is innervated by a posterior Primary division (dorsal ramus)? a. Trapezius b. rhomboid major c. serratus posterior superior d. obliques capitis superior

18. d. The first three layers of back muscles are either innervated by interior primary divisions (ventral rami) or in the case of the trapezius muscles by cranial nerve IX (spinal accessory nerve). The deep back muscles (layers 4 through 6, i.e., splenius capitis and cervicis muscles, erector spinae muscle group, and the transversospinalis muscle group), suboccipital muscles, intertransversarii muscles, and interspinales muscles are all innervated by posterior primary divisions (dorsal rami). The obliques capitis superior muscle is one of the suboccipital muscles and is therefore innervated by a posterior primary division (specifically the suboccipital nerve, which is the posterior primary division of the first cervical spinal cord segment).

19. Which of the following structures separates the primary motor cortex from the primary sensory cortex? a. central sulcus b. longitudinal fissure c. cingulate sulcus d. lateral fissure

19. a. The central sulcus separates the precentral gyrus, which is the primary motor cortex, from the postcentral gyms, which is the primary sensory cortex. The longitudinal fissure separates the two hemispheres. The cingulate sulcus is seen on a medial view and separates the superior frontal gyrus from the cingulate gyrus. The lateral fissure separates the frontal lobe from the temporal lobe.

19. Which of the following is a feature of the sphenoid bone? a. sella turcica b. mastoid process c. cribriform plate d. external occipital protuberance

19. a. The sella turcica is the bony structure that houses the pituitary gland, and it is part of the sphenoid bone. The mastoid process is part of the temporal bone, the cribriform plate is part of the ethmoid bone, and the external occipital protuberance is part of the occipital bone.

19. Which of the following muscles is located most laterally? a. longissimus thoracis b. iliocostalis thoracis c. semispinalis thoracis d. spinalis thoracis

19. b. From lateral to medial, the erector spinae muscles are composed of the iliocostalis, longissimus, and spinalis muscles. The transversospinalis muscle group (semispinalis, multifidus, and rotatores muscles) is located medial to the iliocostalis and longissimus muscles.

19. The tectorial membrane is the superior continuation OF what structure? a. ligamentum nuchae b. anterior longitudinal ligament c. ligamentum flavum d. posterior longitudinal ligament

19. d. The superior continuation of the posterior longitudinal ligament is called the membranatectoria, occipitoaxial ligament, or tectorial membrane. It attaches to the occipital bone medial to the hypoglossal canal and is closely adherent to the cranial dura once inside the cranial vault.

2. The vertebral foramina and sacral canal are circular (as viewed from above) and are the smallest in which of the following regions? a. Cervical b. Thoracic c. Lumbar d. sacral

2. b. The vertebral foramina in the cervical region are the largest of the spine and are trefoil in shape. The thoracic vertebral foramina are the smallest of the spine (the spinal cord is also smaller in this region) and are rounded in shape. The vertebral foramina in the lumbar region are of intermediate size between the cervical, which are larger, and the thoracic, which are smaller. The lumbar vertebral foramina are trefoil in shape. The sacral canal, which is also trefoil in shape, is slightly smaller than the lumbar vertebral canal.

2. Choose the INCORRECT statement. a. the iliocostalis lumborum muscle attaches to the ilium and the inferior six ribs b. the longissimus muscles form the middle column of the erector spinae group and extends from the ilium to the skull c. the erector spinae muscles will extend the spine, laterally flex the spine, and rotate the spine d. the iliocostalis thoracis muscle attaches from the transverse processes of T12-L4 and to ribs 8 through 12

2. d. The iliocostalis thoracic muscle attaches from the inferior six ribs to the superior six ribs, the rest of the statements are correct.

2. Which structure acts as a relay station in the central nervous system? a. occipital lobe b. temporalis c. pituitary gland d. thalamus

2. d. The thalamus is composed of several nuclei, many of which serve as important relay centers for the sensory pathways.

20. What type of ribs are the first seven ribs? a. real ribs b. true ribs c. floating ribs d. false ribs

20. b. Ribs 1 through 7 are true or vertebrosternal ribs because they articulate with both the vertebrae and to the sternum by their own costal cartilage. False ribs are the 8th to 12th ribs, of which the 11th and 12th are considered floating ribs.

20. The ligamentum nuchae extends from what structure to what structure? a. atlas to T12 b. inion and median nuchal crest to the spinous process of C7 c. lateral masses of the axis to the transverse processes of T1 d. external occipital protuberance and occipital crest to the spinous process of T12

20. b. The ligamentum nuchae is the superior continuation of the supraspinous ligament and attaches to the external occipital protuberance (anion), the median nuchal line, the posterior tubercle of the atlas, and the spinous processes of the cervical vertebrae down to C7.

20. Which of the following muscles is considered to be an accessory muscle of respiration? a. latissimus dorsi b. rhomboid major c. serratus posterior superior d. iliocostalis thoracis

20. c. The third layer of back muscles, which are composed of the serratus posterior superior and serratus posterior inferior muscles, are considered to be accessory muscle of respiration. They are thought to help with forced inspiration and expiration, respectively. The latissimus dorsi muscle functions to adduct, internally rotate, and extend the upper extremity by acting on the humerus; the rhomboid major (muscle) retracts the scapula; and the iliocostalis thoracic muscle laterally flexes the thoracic region to the same side.

20. Which of the following innervates the meninges located within the supratentorial region of the cranial cavity? a. C1-C3 spinal nerves b. vagus nerve c. suboccipital nerve d. trigeminal nerve

20. d. Branches of the trigeminal nerve innervate the meninges superior to the tentorium cerebelli (supratentorial cranial cavity). Branches of C 1 -C3 spinal nerves innervate the meninges in the infratentoriai cranial cavity.

21. Which ligament attaches the transverse ligament of the atlas to the anterior margin of the foramen magnum? a. cranial crus of the cruciate ligament b. anterior atlanto-occipital membrane c. alar ligament d. apical ligament

21. a. The transverse ligament of the atlas attaches on the two lateral masses of the atlas and serves to hold the odontoid process of the axis tight against the anterior arch of the atlas. The transverse ligament of the atlas is stabilized by two fibrous cords, one superior and one inferior. These are known as the cranial and caudal crus, respectively, and the entire complex is called the cruciate ligament. Other names include the superior longitudinal band and inferior longitudinal band, respectively.

21. Choose the INCORRECT statement. a. the anterior fontanel closes at 18 to 24 months of age and becomes the bregma b. the posterolateral fontanel is located at the intersection of the squamous and lambdoidal sutures c. the posterior fontanel closes by 2 months of age and becomes the lambda d. the metopic suture is usually obliterated by age 6 and connects the glabella to the pterion

21. d. The metopic suture is typically "closed" by age 6, but it connects the bregma to the glabella and not to the pterion, which is the adult equivalent of the anterolateral or sphenoidal fontanel.

22. Which of the following classifications does NOT describe the zygapophyseal joints? a. Syndesmosis b. Gliding c. Plane d. diarthrodial

22. a. The zygapophyseal joint, or the Z joint, facet joints, interlaminar joints, or apophyseal joints are synovial, diarthrodial, plane (shape of the articular surfaces), gliding (surfaces glide on each other), uniaxial joints formed by the prezygapophysis (superior articular facets) and the postzygapophysis (inferior articular facets) of two adjacent vertebrae. A syndesmosis is a type of fibrous joint involving an interosseous ligament.

22. Which two bones form the structure called the clivus? a. occipital bone, temporal bone b. temporal bone, zygomatic bone c. vomer bone, occipital bone d. sphenoid bone, occipital bone

22. d. The clivus is the area of the skull located in the posterior fossa that slopes from the foramen magnum to the dorsum sellae. It is formed by part of the basilar portion of the occipital bone and part of the body of the sphenoid bone.

23. The inferior articular facets of T12 face in which direction? a. Anterolateral b. Anteromedial c. Posterolateral d. posteromedial

23. a. The inferior articular facets located on the articular process of the thoracic vertebrae face in an anterior direction, but those on T12 have turned slightly lateral to articulate with the superior articular facets of L 1.

23. Which ligament is found within the confines of the neural canal? a. anterior longitudinal ligament b. posterior longitudinal ligament c. interspinous ligament d. supraspinous ligament

23. b. The posterior longitudinal ligament lies within the neural canal posterior to the vertebral bodies.

24. Which one of the following structures does NOT pass through the foramen magnum of the occipital bone? a. spinal cord b. meninges c. cranial nerve XII d. vertebral artery

24. C. The structures that pass through the foramen magnum include the spinal cord, the meninges, the spinal components of cranial nerve XI, and the vertebral arteries. Cranial nerve XII exits the skull through the hypoglossal canals.

24. What type of cartilage directly covers the articular surfaces of the bodies of adjacent vertebrae? a. Fibrous b. Hyaline c. Elastic d. they are not covered with cartilage

24. b. The intervertebral joint is classified as a secondary cartilaginous joint. The surfaces of the vertebral bodies are covered with a thin plate of hyaline cartilage.

25. In the growing infant, which fontanel typically closes first? a. Anterior b. Posterior c. Anterolateral d. Posterolateral

25. b. The fontanels "close" in a predictable pattern. The first to close or ossify is the posterior or occipital fontanel. This fontanel closes by 2 months of age and becomes the anatomic structure called the lambda.

25. Which of the following structures attaches from the tip of the odontoid process to the anterior margin of the foramen magnum? a. transverse ligament of the atlas b. alar ligament c. apical ligament d. tectorial membrane

25. c. The apical ligament (suspensory ligament) is a single ligament that attaches from the tip of dens (odontoid process) of the axis to the anterior margin of foramen magnum. It may be the remains of the embryonic notochord as there is no disc there.

26. Which of the following is the list of ATYPICAL vertebrae? a. C1, T1, L1, S1 b. C1, C2, T10, T12, L5 c. C2, C7, T2, T8, L2, S5 d. C1, C2, C7, T1, T12, L3 e. C1, C7, T8, T9, T10, L2, L5, S3

26. b. Vertebrae are listed as typical or atypical. The atypical vertebrae are those that do not look like or possess the same attributes as other vertebrae in its group. The atypical vertebrae in the cervical region are Cl, C2, and C7; thoracic region, Ti, T9, T10, T11, and T12; and lumbar region, L5.

26. Choose the INCORRECT statement regarding the intervertebral discs. a. there are 23 of them in the adult b. they account for approximately 25% of the height of the vertebral column c. they form part of the anterior wall of the IVF d. in regions of the anterior spinal curves, the disc is thicker on its posterior margin

26. d. In regions of the spinal column where the spinal curve is anterior (lordosis), the intervertebral discs are thicker on their anterior margin, thus forcing the anterior curvature to the spinal column.

27. Choose the INCORRECT statement concerning vertebral ossification centers. a. a typical vertebra has five ossification centers that develop during puberty b. typical vertebrae have three initial ossification centers c. the three ossification centers of a typical vertebra are the two transverse processes and the centrum d. fusion of the vertebral arch is complete by age 6 in the lumbar vertebrae e. secondary ossification centers unite with the vertebrae by age 25

27. c. The primary ossification centers of a typical vertebra are the centrum and the two halves of the neural arch.

28. The anterior curve present in the normal adult cervical spine would be classified as what type of curve? a. Primary b. Secondary c. Tertiary d. quaternary

28. b. The spinal column has basically a "C-shape" at birth and begins to take on more of a sigmoid shape as the child begins to stand erect. Those spinal curves that are present at birth (posterior) and that remain into adult life are considered primary curves. Those spinal curves that change and become anterior are considered secondary curves.

29. The first intervertebral foramen is located between which two bones? a. occiput, atlas b. atlas, axis c. axis, third cervical vertebra d. third cervical vertebra, fourth cervical vertebra

29. c. The first intervertebral foramen is the exit for Cl spinal nerve and is located between the occiput and Cl. Intervertebral discs, however, are present, starting between the vertebral bodies of C2 and C3 vertebrae and ending between the vertebral bodies of L5 and S1.

3. The nucleus pulposus is thickest in which region of the spine? a. lumbar spine b. inferior half of the thoracic spine c. superior half of the thoracic spine d. cervical spine

3. a. The nucleus pulposus is thickest in the lumbar spine, followed by the cervical region; it is thinnest in the thoracic spine.

3. Which structure is immediately external to the myelin sheath of a nerve? a. Endoneurium b. Schwann cytoplasm c. basement membrane d. axolemma

3. b. The myelin sheath is composed of the membrane of Schwann cells that is wrapped around axons for insulation. Most of the cytoplasm is excluded from this part of the membrane and therefore it is external to the sheath itself.

3. Which of the following muscles does NOT attach to the atlas? a. levator scapulae b. rectus capitis posterior minor c. rectus capitis posterior major d. obliquus capitis superior

3. c. The rectus capitis posterior major muscles attache from the spinous process of the axis to the inferior nuchal line of the occipital bone and has no attachments to the atlas. The other muscles listed do attach to the atlas (C 1 vertebra). The levator scapulae muscle attaches to the transverse process of the atlas, the rectus capitis posterior minor attaches to the posterior tubercle of the atlas, and the obliquus capitis superior attaches to the transverse process of the atlas.

3. The atlas (C1) has which of the following features? a. superior articular processes that are concave inferiorly b. an articulation with the occiput that is categorized as a planar joint c. inferior articular processes that are oval d. prominent anterior and posterior tubercles on the transverse processes

3. c. The right and left superior articular processes of the atlas are very irregular in shape and are concave superiorly in order to accommodate the convex occipital condyle of the corresponding side. The joint between the occiput and the atlas is categorized as a condyloid (ellipsoid), synovial (diarthrodial) joint. The left and right transverse processes are each large and possess a single lateral process (not an anterior and posterior tubercle as is the case with typical cervical vertebrae).

30. The neural canal is smallest and circular in shape in the region of the vertebral canal. a. Cervical b. Thoracic c. Lumbar d. Sacral

30. b. The neural canal (vertebral canal) is largest and most triangular in the cervical region and smallest and most circular in the thoracic region.

4. The sacral elements of the spinal cord may be crushed by a fracture of which vertebrae? a. LI b. L3 c. L5 d. S1 and S2

4. a. The inferior end of the spinal cord is at the L2 spinal level, which corresponds to the sacral cord. Inferior to L2 is the location of the cauda equina. Therefore, a fracture of L 1 would potentially crush the spinal cord.

4. Which statement is FALSE concerning the intervertebral foramen (IVF)? a. a pair (left and right) of IVFs are located between all of the adjacent vertebrae from C2 to the sacrum b. the pedicles of adjacent vertebrae form the roof and the floor of the IVF c. IVFs become smaller in spinal flexion and larger in spinal extension d. the IVFs are smaller in the cervical region

4. c. Flexion of the spine creates a separation of the zygapophyseal joints, creating an augmentation of the size of the IVF.

4. Choose the INCORRECT statement. a. the multifidus muscles attach from the transverse process of one vertebra to the spinous processes of the 2 to 4 superior vertebrae b. the short rotator muscles in the lumbar region attach to the transverse muscle of one vertebra and insert on the spinous process of the vertebra directly superior to its origin c. the interspinalis muscles attach from spinous process to spinous process d. the long rotator muscles in the cervical region attach from the transverse muscle of one vertebra and insert on the spinous process of the vertebra directly above it up to the level of C2

4. d. The long rotator muscles attach from the transverse process of one vertebra to the spinous process of the second vertebra superior to its origin as opposed to short rotator muscles, which attach from the transverse process of one vertebra and insert on the spinous process of the vertebra above its origin.

4. Each typical thoracic vertebra (T2 to T9) has which of the following features? a. a prominent superior vertebral notch b. rectangular vertebral bodies (when viewed from above) c. superior articular processes that face posteriorly and medially and lie within a vertical plane d. a transverse costal facet on the transverse process that articulates with the rib with the same number

4. d. The typical thoracic vertebrae include T2 through T9. The 1st, 10th, 11th, and 12th thoracic vertebrae can best be described as unique rather than the term "atypical," which is best used to describe Cl and C2. The vertebral bodies of the thoracic spine are larger than those of the cervical region. The bodies are more or less heart-shaped as seen from above (concave posteriorly). The pedicles of the thoracic spine are quite stout. They attach very high up on their respective vertebral bodies and, as a result, there is no superior vertebral notch associated with typical thoracic vertebrae. The transverse processes of typical thoracic vertebrae have a facet for articulation with the articular tubercle of the corresponding rib (e.g., the transverse process of T6 articulates with the sixth rib. This facet is appropriately named the transverse costal facet or costal facet of the transverse process. The superior articulating facets of the thoracic spine are oriented in a plane that lies approximately 30 degrees to a vertical plane. They face posteriorly, superiorly, and laterally.

5. Which is TRUE of the zygapophysial joints (also known as Z joints, or facet joints)? a. they are classified as condylar joints b. they are surrounded by a fibrous joint capsule along both their anterior and posterior surfaces c. they are oriented in approximately the same plane of articulation throughout the spine d. they are innervated by posterior primary divisions (dorsal rami) of spinal nerves

5. d. The junction between a superior articular facet and inferior articular facet of two adjacent vertebrae is known as a zygapophyseal joint (Z joint). These joints are also known as facet joints, apophyseal joints, and interlaminar joints. The Z joints are classified as diarthrodial, planar joints. Each Z joint is surrounded by a capsule, which in turn is internally lined by a synovial membrane. Anteriorly, the ligamentum flavum takes the place of the joint capsule. The joint side of the ligamentum flavum is also lined by a synovial membrane. Each Z joint of a typical vertebra receives innervation from posterior primary divisions, or dorsal rami (more specifically, the medial branches of these nerves). The shape and plane of articulation of each of these joints are very important in determining the direction of movement and the range of motion that can occur between adjacent vertebrae. These variables (shape and plane of articulation) change in each region of the vertebral column (cervical, thoracic, and lumbar regions).

5. Which is TRUE regarding the sacrum and the coccyx? a. There are typically five pairs of pelvic sacral foramina b. The anteriormost aspect of the body of Si is known as the ala c. The transverse processes of the coccyx line up with (are in register with) the sacral cornua d. The superior aspect of the coccyx is known as its base

5. d. The sacrum is made of five fused segments. It is triangular in shape, and therefore the superior surface of the sacrum is known as the base (same with the coccyx), and the inferior surface is known as the apex. The most anterior portion of the sacral base is known as the sacral promontory. The anterior portions of the sacral base located on both the left and right sides (lateral to) the body of the first sacral segment are known as the sacral ala. The ventral surface of the sacrum displays four pair of ventral (pelvic, anterior) sacral foramina. The coccyx is formed by three to five fused segments. It, too, is triangular in shape with the superior surface being the base and the inferior surface forming the apex. The transverse process projects laterally from the first coccygeal segment. The coccygeal cornua are found on the posterior (dorsal) surface of the first coccygeal segment and are in register with the sacral cornua.

5. The cerebellum is an outgrowth of which embryonic brain vesicle? a. Diencephalon b. Mesencephalon c. Prosencephalon d. Metencephalon

5. d. The telencephalon forms the cerebral hemispheres, the diencephalon forms the thalamus and hypothalamus, the mesencephalon forms the midbrain, the metencephalon forms the pons and cerebellum, and the myelencephalon forms the medulla oblongata.

5. Which of the following is TRUE of the latissimus dorsi muscle? a. it originates from the vertebra of the thoracic spine, thoracolumbar fascia, and ilium b. it inserts into the intertubercular sulcus of the humerus c. it adducts and medially rotates the arm d. all of the above

5. d. This superficial muscle covers the inferior portion of the back. The origin of the latissimus dorsi is the spinous processes of T6-T12, the thoracolumbar fascia, iliac crest, and ribs 10 through 12. This muscle inserts in the floor of the intertubercular groove of the humerus. The actions of this muscle include extension, adduction, and medial rotation of the shoulder joint.

6. Which structure of a typical vertebra does NOT arise from the pediculolaminar junction? a. spinous process b. transverse process c. superior articular process d. inferior articular process

6. a. The spinous processes arise from the laminae only.

6. Which is TRUE of the transverse ligament of the atlas (transverse portion of the cruciform ligament)? a. it is the weakest part of the cruciform ligament b. it prevents the atlas from rotating upon the axis c. it forms a synovial joint with the odontoid process d. it has broad attachments to the medial aspect of the left and right occipital condyles

6. c. The transverse ligament of the atlas (transverse portion of the cruciform ligament) courses from one lateral mass (medial aspect) of the atlas to the other and is very strong. It passes posterior to the odontoid process and forms a diarthrodial (synovial) trochoid joint with that structure. This ligament allows the atlas to pivot on the axis and also holds the atlas in its proper position. This latter function protects the spinal cord. It also prevents the atlas from gliding anteriorly during forward flexion.

6. Which of the following is the most lateral portion of the erector spinae muscle group? a. Multifidus b. Spinalis c. Semispinalis d. iliocostalis

6. d. The three muscles of the erector spinae are the iliocostalis, longissimus, and spinalis in order from lateral to medial. The semispinalis, multifidus, and rotatores are parts of the deeper transversospinalis group.

7. Where does the semispinalis capitis muscle have its superior attachment? a. between the superior and inferior nuchal lines of the occiput b. mastoid process of the temporal bone c. spinous processes of the first three cervical vertebrae d. transverse processes of the first three cervical vertebrae

7. a. The semispinalis muscle extends has three parts: the semispinalis thoracis, cervicis, and capitis, each named according to their superior attachment.

7. Which of the following areas does the middle cerebral artery NOT supply? a. motor area b. primary visual area c. premotor area d. auditory projection area

7. b. The middle cerebral artery supplies the motor and premotor areas and the auditory projection areas. The posterior cerebral artery supplies the primary visual area.

7. The tectorial membrane lies most directly between the cruciform ligament and which of the following? a. ligamentum flavum b. Dura mater c. anterior atlanto-occipital membrane d. posterior atlanto-occipital membrane

7. b. The tectorial membrane is the superior extension of the posterior longitudinal ligament. It begins by attaching to the posterior aspect of the vertebral body of C2, crosses over the odontoid process, and inserts onto the anterior rim of the foramen magnum (clivus). This ligament limits both flexion and extension of the atlas and occiput. It is located between the cruciform ligament, which is anterior, and the anterior aspect of the spinal dura mater, which is posterior.

7. Which structure does NOT participate in the formation of the boundaries of the intervertebral foramen (IVF)? a. the pedicle of the vertebra above b. the vertebral body of the vertebra above c. the transverse process of the vertebra above d. the pedicle of the vertebra below

7. c. The boundaries of the IVF include the following: (1) pedicle of the vertebra above, (2) vertebral body of the vertebra above, (3) the intervertebral disc, (4) the vertebral body of the vertebra below, (5) the pedicle of the vertebra below, and (6) the Z joints form the posterior wall of the IVF.

8. In a typical cervical vertebra, which structures arise as elevations of the lateral and posterior rim on the top surface of the vertebral body? a. uncinate processes b. intertubercular lamellae c. pedicles d. anterior tubercles

8. a. The intertubercular lamella and the anterior tubercle are part of the transverse process. Pedicles attach to the posterior and lateral aspects of the vertebral bodies.

8. Which of the following ligaments courses from the crest of the head of a rib to the intervertebral disc, dividing the costovertebral (costocorporeal) synovial articulation into two halves? a. articular capsule b. intra-articular ligament c. radiate ligament d. superior costocorporeal ligament

8. b. There are three types of ligaments associated with the costocorporeal (costovertebral) articulation: (1) the joint capsules (for both the superior and inferior parts of these joint), (2) the infra-articular ligaments (which course from the crest of the head of the rib directly to the adjacent and medially located intervertebral disc), and (3) the radiate ligaments (which cover the other two ligaments and course from the head of a rib to the two vertebral bodies and the intervertebral disc in between). Note: There is no superior costocorporeal ligament. The superior costotransverse ligament is associated with the costotransverse joint and passes from a transverse process to the neck of the rib below.

8. Broca's area is located in which of the following areas? a. superior temporal gyrus b. superior frontal gyrus c. inferior frontal gyrus d. precentral gyrus

8. c. Broca's area occupies the opercular and triangular parts of the inferior frontal gyrus. This area is involved with speech. Damage to this area results in motor or expressive aphasia. The patients are unable to express themselves using language; however, they are capable of understanding language. The control of muscles used in speech is not affected.

9. Which of the following joints is a syndesmosis? a. axial-occipital b. lateral atlantoaxial c. sacroiliac d. costotransverse

9. a. A syndesmosis is a joint consisting of two bones connected by one or more ligaments. The spine is unique in that it has several examples of such joints. The unique syndesmoses include (listed from posterosuperior to anteroinferior): (1) axial-occipital syndesmosis (located between the axis and the occiput, ligaments includes the tectorial membrane, cruciform, apical-odontoid, and alar ligaments); (2) ligamentum nuchae (syndesmosis between occiput and Cl-C7); (3) supraspinous syndesmosis (supraspinous ligament); (4) interspinous syndesmosis (interspinous ligament); (5) laminar syndesmosis (ligamentum flavum); and (6) intertransverse syndesmosis (intertransverse ligament).

9. The cerebral aqueduct is located within which brain region? a. Mesencephalon b. Telencephalon c. Metencephalon d. diencephalons

9. a. The mesencephalon or midbrain contains a narrow cavity called the cerebral aqueduct of Sylvius. It transmits the cerebrospinal fluid from the third to the fourth ventricle.

9. Which of the following back muscles is innervated by dorsal primary rami of spinal nerves? a. latissmus dorsi b. rhomboid major c. serratus posterior superior d. splenius capitis

9. d. The splenius capitis is a deep back muscle. All deep back muscles arc innervated by the dorsal primary rami of spinal nerves. The latissimus dorsi is innervated by the thoracodorsal nerve, the rhomboid major by the dorsal scapular nerve, and the serratus posterior superior by the ventral rami of upper thoracic nerves.

9. Which thoracic vertebra contains only a single facet on each side for articulation with the ribs? a. 4 b. 6 c. 8 d. 10

9. d. Thoracic vertebrae 4, 6, and 8 are typical thoracic vertebrae that contain two facets on each side.

Anatomy of the Central Nervous System and Related Structures

Anatomy of the Central Nervous System and Related Structures

Arthrology and Syndesmology of the Axial Skeleton

Arthrology and Syndesmology of the Axial Skeleton

2. Which component has been found to be the primary load-bearing structure of the intervertebral disc? a. annulus fibrosus b. nucleus pulposus c. vertebral end-plate d. Sharpey's fibers

2. a. The annulus fibrosus can maintain its function (e.g., load bearing) even when the nucleus has been removed.

6. Which of the following is a cerebral commissure? a. corpus callosum b. crus cerebri c. internal capsule d. external capsule

6. a. Commissures are white matter tracts that communicate between hemispheres of the brain, and thus cross the midline. They include the corpus callosum, anterior commissure, and posterior commissure. The crus cerebri, internal capsule, and external capsule carry information ipsilaterally.

8. Which muscle of the transversospinalis group crosses only one vertebral joint? a. Spinalis b. Semispinalis c. Rotatores d. multifidus

8. c. The rotators are short muscles that arise from the transverse process of one vertebra and insert into the spinous process of the vertebra above.

Myology of the Axial Skeleton

Myology of the Axial Skeleton

Organs of Special Senses

Organs of Special Senses

Osteology of the Axial Skeleton

Osteology of the Axial Skeleton

1. Which of the following is NOT part of the auditory pathway? a. spiral ganglion b. medial longitudinal fasciculus c. lateral lemniscus d. medial geniculate body

1. b. The medial longitudinal fasciculus consists of fibers that extend to the midbrain and are involved in vestibular functions and eye movements. All of the other structures listed are part of the peripheral and central connections of the auditory pathway.

1. Which of the following structures does NOT transmit any visceral efferent information? a. parabrachial nucleus b. central gray matter c. thalamus d. amygdala

1. c. The thalamus receives information from the periphery and transmits it to the cerebral cortex. It does not send information back to the periphery. Other structures listed in the question do.

10. What part of the inner ear's vestibular system would be stimulated as one ascends in an elevator that stops at every floor? a. utricle b. semicircular ducts c. saccule d. cochlear duct

10. c. The saccule is part of the static membranous labyrinth of the vestibule of the inner car. Fluid in the saccule of the inner car moves in response to vertical linear acceleration or deceleration and causes the macula to shift and stimulate the hair cells. The utricle is similar but is involved with horizontal linear acceleration or deceleration. The semicircular ducts are sensitive to rotatory movements. The cochlear duct is involved with audition.

10. Which of the following conditions result from severance of the abducens nerve proximal to its entrance into the orbit? a. ptosis of the upper eyelid b. loss of the pupil's ability to dilate c. external strabismus (lateral deviation) d. internal strabismus (medial deviation)

10. d. The abducens nerve innervates the lateral rectos muscle of the eye. Paralysis of this muscle causes medial deviation of the eye.

25. The spinal cord ends at what vertebral level? a. T1O b. L1 c. L6 d. S1

25. b. In the human, the spinal cord terminates in the neural canal of L 1 (sometimes L2) vertebra as the conus medullaris.

11. Which of the following is NOT a branch originating from a spinal nerve? a. ventral primary rami b. dorsal primary rami c. white rami communicans d. gray rami communicans

11. d. Gray rami communicans (31 pairs) are branches from sympathetic trunk carry postganglionic ganglia to spinal nerves. They sympathetic fibers. AII of the other listed branches, as well as the recurrent meningeal nerve (sinovertebral nerve), are branches of' spinal nerves.

12. Preganglionic neurons of the sympathetic nervous system originate from which area? a. dorsal horns of the gray matter of the spinal cord b. lateral horns of the gray matter of the spinal cord c. ventral horns of the gray matter of the spinal cord d. dorsal root ganglia

12. b. Preganglionic neurons of the sympathetic nervous system originate in the lateral horns of T1-L2 spinal cord segments (thoracolumbar). They innervate smooth muscle, cardiac muscles, sweat glands, and adrenal medulla (GVF). Dorsal horns contain sensory neurons. Ventral horns contain motor neurons (GSE) and dorsal root ganglia contain sensory neurons (GSA).

13. Which of the following cranial nerves does NOT contain parasympathetic fibers? a. Oculomotor b. Facial c. Trigeminal d. vagus

13. c. The four cranial nerves that contain parasympathetic fibers are oculomotor, facial, glossopharyngeal, and vagus nerves.

14. Which of the following does NOT give rise to secretomotor fibers? a. submandibular ganglion b. otic ganglion c. pterygopalatine ganglion d. trigeminal ganglion

14. d. Trigeminal ganglion is the sensory ganglion of cranial nerve V and is involved with all sensory functions of the trigeminal nerve. All of the other ganglia listed are involved with the autonomic secretomotor innervation of glands.

15. Which of the following cranial nerves contains preganglionic parasympathetic fibers to the parotid gland? a. Oculomotor b. Facial c. Glossopharyngeal d. vagus

15. c. The parotid gland is stimulated to secrete saliva by the glossopharyngeal nerve. The preganglionic parasympathetic fibers from this nerve travel through the lesser petrosal nerve to the otic ganglion. The postganglionic parasympathetic fibers are carried through the auriculotemporal nerve to the parotid gland.

16. A 28-year-old woman sustains an injury to the left arm during a fall off of her bicycle. Radiographs done at your clinic show an oblique fracture through the mid-shaft of the humerus. Which nerve is most likely to be injured by the mid-shaft fracture of the humerus? a. radial nerve b. median nerve c. musculocutaneous nerve d. ulnar nerve

16. a. The radial nerve travels in the radial groove of the humerus and is subject to injury during midshaft fractures.

17. A 24-year-old man is thrown from a pick-up truck during an accident and sustains an injury to the left neck, shoulder, and upper limb. Examination in the emergency department does not reveal any cuts, fractures, or dislocations, and he is sent home. The following day, he is experiencing several maladies and seeks help from you at your clinic You perform your examination and find that the patient has sustained a lateral traction injury to the superior roots of the brachial plexus. Which of the following signs would you NOT expect to find in this patient? a. dropped left shoulder b. left scapula that falls laterally c. inability to rotate the humerus medially d. paresis of muscles of the anterior aspect of left arm

17. c. Lateral traction injuries resulting from excessive displacement of the head to the opposite side and depression of the shoulder on the same side produce signs and symptoms associated with damage to C5 and C6 nerve roots. This condition is also known as Erb-Duchenne palsy. The clinical picture involves the dorsal scapular nerves—dropped shoulder and scapula falls laterally; the suprascapular nerve—loss of lateral rotators, the axillary nerve—humerus rotates medially due to loss of lateral rotators and unopposed pectoralis major muscle, and the musculocutaneous nerve—paresis of muscles of the anterior arm and the muscles that pronate the forearm due to loss of biceps brachii muscle producing a sign called "waiter's tip." There is no loss of medial rotation of the humerus.

18. A 29-year-old man sustains a severe nerve compression injury to his left upper leg as a result of a fall from a motorcycle. Examination of this patient at your office reveals a contusion surrounding the head and neck of the fibula. Which nerve is susceptible to direct injury by a severe compression force applied to the lateral aspect of the head and neck of the fibula? a. common peroneal nerve b. tibial nerve c. obturator nerve d. saphenous nerve

18. a. The common peroneal nerve travels around the proximal head of the fibula and is susceptible to injury. Damage to the common peroneal at the head of the fibula could result in a loss of innervation of the muscles that dorsiflex the foot and evert the foot.

19. Gray rami communicans leave the paravertebral ganglia and carry postganglionic GVE neurons to what nerves? a. T1 through L2 spinal nerves b. C1 through T12 spinal nerves c. all spinal nerves d. only those spinal nerves below the diaphragm

19. c. White rami communicans carry the preganglionic axon from the spinal nerve to the paravertebral ganglia from spinal segments T1 to L2. Gray rami carry the ganglionic axon from the paravertebral chain back to the spinal nerve and connect to all spinal nerves.

2. The axons that form the optic nerve arise from which neurons of the retina? a. bipolar cells b. rods and cones c. amacrine cells d. ganglion cells

2. d. The ganglion cell layer contains the cell bodies of neurons whose axons leave the eyeball as the optic nerve at the area of the optic disc (blind spot of the eye).

2. From which cranial nuclei do parasympathetic efferent signals emerge? a. II, III, and X b. III, V, IX, and X c. V, VII, and X d. III, VII, IX, and X

2. d. There are no II and V cranial parasympathetic nuclei.

20. Choose the incorrect statement with regard to the brachial plexus. a. the anterior division of brachial plexus trunks innervates muscles that are flexors b. the cords of the brachial plexus are named according to their relationship to the axillary artery c. the brachial plexus is derived from dorsal rami of C5, C6, C7, C8, and T1 d. the posterior cord is formed by the posterior divisions of all three trunks

20. c. All of the peripheral nerve plexi are derived from the ventral rami of the spinal nerves, not the dorsal rami.

21. Cerebrospinal fluid courses between which layers of the meninges? a. dura mater and pia mater b. arachnoid mater and pia mater c. dura mater and arachnoid mater d. pia mater and the cortex

21. b. Cerebrospinal fluid flows in the subarachnoid space, which is between the arachnoid mater and pia mater.

21. For the nervous system to detect stimuli, what must be present? a. Neurotransmitters b. Receptors c. Myofibrils d. Neurofibrils

21. b. The nervous system is a stimulus response system; for stimuli to be detected, there must be a receptor designed to detect that stimulus.

25. How would axons that release, and receptors that respond to norepinephrine andior epinephrine, be classified? a. Adrenergic b. Cholinergic c. Muscarinic d. nicotinic

25. a. Adrenergic refers to those axons that release and those receptors that are activated by epinephrine or related substances (norepinephrine). The term particularly refers to the sympathetic nerve fibers that release norepinephrine.

22. Which of the following structures directly contributes to the formation of the spina nerve? a. ventral rami, dorsal rami b. ventral root, dorsal root c. recurrent meningeal, dorsal rami d. dorsal root, dorsal rami

22. b. The spinal nerve is formed by the union of the dorsal (posterior) root and the ventral (anterior) root as they come together at the intervertebral foramen.

22. Which of the following is the group of crossing fibers that convey information to perform voluntary, purposeful movements? a. internal arcuate fibers b. ventral white commissural fibers c. dorsal tegmental decussation fibers d. pyramidal decussation fibers

22. d. Information concerning voluntary, purposeful movements is conveyed in the corticospinal or pyramidal tract. These fibers cross in the pyramidal decussation at the junction of the cord and medulla. The dorsal columns, conveying information concerning proprioception, vibration, and touch, cross as internal arcuate fibers in the caudal medulla. The spinothalamic tracts conveying pain and temperature information cross in the ventral white commissure of the spinal cord. The tectospinal tract fibers cross in the midbrain as the dorsal tegmental decussation.

23. An occlusion of the posterior cerebral artery would result in a deficit of which of the following? a. motor speech b. general sensation from the knee, leg, and foot c. vision d. voluntary, purposeful movements of muscles located in the region of the head to the hip

23. C. The posterior cerebral artery supplies the occipital lobe as well as the inferior aspect of the temporal lobe. The primary visual cortex is located in the occipital lobe; therefore, part of the visual field would be affected if this artery were occluded. The middle cerebral artery supplies the lateral aspect of the frontal, temporal, and parietal lobes, and an occlusion would therefore affect motor speech and voluntary purposeful movements from the head to the hip, as well as other functions in these areas. The anterior cerebral artery supplies the medial aspect of the frontal and parietal lobes, and an occlusion would therefore affect general sensation from the knee, leg, and foot.

23. Spinal nerve C7 exits the intervertebral foramen located between which two of the following vertebrae? a. C4, C5 b. C5, C6 c. C6, C7 d. C7, C8

23. c. Spinal nerves exit the vertebral column through the intervertebral foramen located between two adjacent vertebrae. In the cervical region, the nerve is numbered according to the vertebra it exits above. So C7 spinal nerve would exit superior to C7, or between C6 and C7 vertebrae.

24. The cell bodies of the oculomotor nerve are located within what part of the central nervous system? a. Midbrain b. frontal lobe c. rostral pons d. floor of the fourth ventricle

24. a. The cell bodies of the oculomotor nuclear complex are located in the midbrain of the brainstem. The oculomotor nerve emerges from the ventral side of the midbrain.

24. Which branch of the spinal nerve carries GSE information to the muscles of the anterior and lateral trunk and all of the muscles of the limbs? a. recurrent meningeal nerve b. ventral ramus c. dorsal ramus d. rami communicans

24. b. The ventral ramus (anterior primary ramus) supplies all motor, sensory, and sympathetic fibers to the anterior and lateral muscles and skin of the neck and trunk and all of the muscles and skin of the limbs, including the superficial back muscles. GSE is general somatic efferent information supplying motor input to skeletal muscles in these regions.

26. Preganglionic sympathetic fibers that will influence effector tissues in the orbit will synapse in which of the following structures? a. stellate ganglion b. celiac ganglion c. superior cervical ganglion d. middle cervical ganglion

26. c. The cell bodies of preganglionic sympathetic fibers, which will influence effector tissues in the orbit, are in the intermediolateral cell column (lateral horn) of the upper thoracic cord segments. After coursing superiorly through the sympathetic chain, the fibers will synapse in the superior cervical ganglion. Postganglionic fibers then course along the internal carotid artery to the effector tissues in the orbit.

26. What are cells that produce myelin in the peripheral nervous system called? a. Microglia b. Oligodendrocytes c. Astrocytes d. neurolemmocytes (Schwann) cells

26. d. Neurolemmocytes, sometimes called Schwann cells, produce the myelin sheath in the peripheral nervous system.

27. Ascending tracts in the white matter of the spinal cord carry what kind of information? a. Sensory b. Motor c. both sensory and motor d. autonomic

27. a. The white matter of the spinal cord carries ascending (sensory) tracts and descending (motor) tracts.

27. Through what structure will preganglionic sympathetic fibers leave the spinal nerve in order to enter the sympathetic chain? a. ventral ramus b. dorsal ramus c. gray ramus communicans d. white ramus communicans

27. d. The myelinated white rami communicans carry preganglionic sympathetic fibers. Gray rami contain postganglionic sympathetic fibers.

28. To say that most organs served by the autonomic nervous system (ANS) have "dual innervation- means what? a. it takes two postganglionic neurons to achieve the desired response b. the organs are innervated by both sympathetic and parasympathetic neurons c. both a preganglionic and a postganglionic neuron go to the organ d. it must receive innervation from at least two or the splanchnic nerves

28. b. Most organs receive both sympathetic and parasympathetic innervations that operate in conjunction with each other. A balance in the firing of the two helps to maintain an internal stable environment in the face of changing external conditions.

28. At what vertebral level would the spinal segment that gives rise to the L5 spinal nerve be located? a. between L4 and L5 vertebrae b. between L5 and S1 vertebrae c. between T5 and T6 vertebrae d. between T11 and T12 vertebrae

28. d. A spinal segment is the cross-sectional area of the spinal cord that gives rise to a pair of spinal nerves. There are 31 pairs of spinal nerves and therefore 31 spinal segments. The spinal segment that gives rise to spinal nerves L5 is located toward the inferior aspect of the spinal cord in the region of T11-T12 vertebrae.

29. What kind of information is found in the ventral root of a spinal nerve? a. GSE, GVE b. GSA, GVA c. GVE, GVA d. GSE, GSA

29. a. Spinal nerves carry both sensory and motor information. Bell-Magendie's law says that the dorsal root of the spinal nerve carries sensory information and the ventral root carries motor information. Information carried in the neuron is classified as to GVE (motor), GSE (motor), GSA (sensory), and GVA (sensory). There are other functional components of neurons, but none of these are carried in spinal nerves (i.e., SVA, SSA, SVE).

29. General visceral afferent (GVA) fibers conveying pain information from viscera that converge in the dorsal horn with general somatic afferent (GSA) fibers and manifest as referred pain provide an example of which of the following? a. viscerosomatic pain b. somatovisceral pain c. viscerovisceral pain d. somatosomatic pain

29. a. The convergence of visceral afferent information with somatic afferent information in the dorsal horn of the cord can be interpreted by higher centers as being of somatic origin rather than visceral. As a result, pain from viscera can be referred to somatic structures.

3. Which nerve roots unite to form the ansa cervicalis of the cervical plexus? a. C1 and C5 b. C2 and C3 c. C3 and C4 d. C4 and C5

3. b. C1 forms the superior root of the ansa cervicalis; parts of C3, C4, and C5 nerve roots form the phrenic nerve.

3. Hair cells in the cochlea are stimulated by the shearing motion between the organ of Corti and what structure? a. tegmental membrane b. tentorial membrane c. basilar membrane d. tectorial membrane

3. d. Hair cells are located inside the organ of Corti, which lies upon the basilar membrane. Hair bundles are in close contact with the tectorial membrane, which is located just above.

30. The thalamus and hypothalamus are part of what brain region? a. Prosencephalon b. Diencephalon c. Mesencephalon d. Telencephalon

30. b. The caudal portion of the prosencephalon is called the diencephalons and consists of the thalamus and hypothalamus.

30. Ventral rami contain which of the following fibers? a. only sensory b. only motor c. both sensory and motor d. both sympathetic and parasympathetic

30. c. Ventral rami are branches of spinal nerves and therefore contain both sensory and motor fibers. Dorsal roots contain only sensory fibers and ventral roots contain only motor fibers. The spinal nerve and nerves distal to it contain both sensory and motor fibers.

4. These taste papillae predominate in the anterior part of the tongue. a. Circumvallate b. Foliate c. Fungiform d. fusiform

4. c. Circumvallate and foliate taste papillae predominate in the posterior part of the tongue. There is no fusiform taste papillae.

4. This nerve provides articular branches to the elbow and wrist joints and motor innervation to the majority of the muscles of the anterior forearm. a. Ulnar b. Radial c. Median d. Axillary

4. c. The ulnar nerve provides motor innervation to the majority of the intrinsic muscles of the palm and the radial nerve to the posterior arm and forearm. The axillary nerve goes to the teres minor and deltoid muscles.

5. If a patient's pupil remains small when room lighting is subdued, this may indicate damage to which structure? a. trochlear nerve b. superior cervical ganglion c. oculomotor nerve d. ophthalmic nerve

5. b. Sympathetic innervation to the intrinsic eye muscles comes from the superior cervical ganglion. Damage to this structure would prevent normal papillary dilation, and therefore the pupil would stay constricted. Damage to the oculomotor nerve (parasympathetic) would lead to ptosis, lateral strabismus, pupillary dilation, loss of accommodation, and diplopia.

5. These nerves innervate the structures located on the anterior aspect the vertebral canal. a. lateral branches of the posterior primary divisions b. recurrent meningeal nerves c. anterior primary divisions d. medial branches of the posterior primary divisions

5. b. The anterior primary divisions form the lumbar plexus; the medial branches of the posterior primary divisions innervate those fibers that supply the spinous process; and the lateral branches of the posterior primary divisions supply motor innervation to the erector spinae muscles.

6. Which of the following contains the cell bodies of preganglionic neurons of the parasympathetic nervous system? a. cranial nerve nuclei and sacral spinal cord b. cervical and thoracic spinal cord c. cranial nerve nuclei and cervical spinal cord d. thoracic and lumbar spinal cord

6. a. The cell bodies of the preganglionic parasympathetic nervous system are located in the nuclei associated with cranial nerves III, VII, IX and X and the sacral cord. The sympathetic preganglionic neuron CCII bodies are located in the spinal cord segments T1-L2.

6. What is the name of the structure where axons or the ganglion cells leave the retina to form the optic nerve? a. fovea centralis b. opaque column c. fovea capitis d. optic disc

6. d. The optic disc (blind spot) is the structural point of exit for the optic nerve.

7. Following radical resection of a primary tongue tumor, a patient has lost general sensation on the anterior two thirds of the tongue. This is probably due to injuries of which of the following nerves? a. trigeminal nerve b. facial nerve c. glossopharyngeal nerve d. vagus nerve

7. a. Although the facial nerve innervates the anterior two thirds of the tongue, its innervation is for taste sensation rather than general sensation. The trigeminal nerve is associated with general sensation of the anterior two thirds of the tongue.

7. Which cranial nerve carries SSA information? a. CN II b. CN III c. CN VI d. CN V

7. a. Functional classifications of information carried in spinal and cranial nerves is denoted by the letters GSA, GVE, SSA, etc. SSA information is special somatic afferent information. This type of information deals with special sensory information carrying sight, sound, and equilibrium that is carried in cranial nerves II and VIII.

8. The dendrites of which cranial nerve occupy the holes of the cribriform plate? a. CN I b. CN II c. CN V d. CN VIII

8. a. The cribriform plate in located in the ethmoid bone, and the dendrites of cranial nerve I occupy these holes as they innervate the nasal mucosa.

8. Which of the following statements concerning the phrenic nerve is TRUE? a. contains only efferent fibers b. injury could cause difficulty in expiration c. supplies the pericardium, mediastinal pleura, and diaphragm d. enters the thorax by passing in front of the subclavian vein

8. c. The phrenic nerve arises from the ventral rami of C3 through C5 nerves and is the sole source of motor innervation to the diaphragm. The phrenic nerve also supplies sensory innervation to the diaphragm, pericardium, and mediastinal pleura.

9. Bilateral severance of which of the following nerves would be most life threatening? a. trigeminal nerve b. facial nerve c. vagus nerve d. spinal accessory nerve

9. c. Because the vagus nerve is responsible for about 75% of parasympathetic activity of the body, which regulates thoracic and abdominal visceral function, death is more likely to ensue following bilateral vagotomy. Bilateral section of the other nerves mild have serious, but not hic-threatening, consequences.

9. Where is the location of a lesion that results in the visual deficit known as a bitemporal hemianopia? a. right optic tract b. left optic tract c. occipital lobe d. optic chiasm

9. d. Bitemporal hemianopia is a loss of vision in the temporal or lateral aspect of each eye's visual field. Axons conveying information from the temporal visual field of each eye cross in the optic chiasm. Therefore, a lesion there would cause a deficit in the temporal visual." fields bilaterally.

Anatomy of the Peripheral and Autonomic Nervous Systems

Anatomy of the Peripheral and Autonomic Nervous Systems