Quiz 1 Basic Sciences III Class 22'
Which of the following structures contains the third-order neuron of the posterior column pathway? A. Postcentral Gyrus B. Olivary nuceli C. Thalamus D. Gracile Fasciculus E. Superior colliculus
Thalamus
Which part of the vertebra is located anteriorly to the spinal cord? A. Pedicle of vertebra B. Body of vertebra C. Lamina of vertebral arch D. Superior articular process of vertebra E. Transverse process
*Ans- Body of vertebra
A 60-year-old man notices that the discriminative touch, proprioception, weight discrimination sensation of his left arm is impaired. The doctor thus considers the impairment of which ipsilateral spinal tract? A. Rubrospinal tract B. Gracile fasciculus C. Dorsal spinocerebellar tract D. Cuneate fasciculus E. Dorsolateral tract
*Ans- Cuneate fasciculus
Which of the following are characteristics of cervical vertebrae? A. Transverse foramen B. Bifid spinous process C. Posterior facing superior articular facets D. Costal facets E. Kidney-shaped body F. Hatchet shaped spinous process G. Superior-facing articular facets H. Oblique- facing superior articular facets I. Lateral-facing superior articular facets J. Posterior-facing superior articular facets
*Answer- Transverse foramen, bifid spinous process, posterior facing superior articular facets
An area of the spinal cord that gives rise to anterior rami that form the brachial plexus is: A. cauda equina B. cervical enlargement C. conus medullaris D. lumbosacral enlargement
*Answer- cervical enlargement
Intervertebral disc herniation involves protrusion of the A. anulus fibrosis B. spinal cord C. nucleus pulposus D. sciatic nerve
*Answer- nucleus pulposus
Which structure of the vertebral column limits lateral flexion? A. Intertransverse Ligament B. Ligamentum Flavum C. Supraspinous Ligament D. Intertransverse Ligament E. Iliolumbar Ligament
*Answer: Intertransverse Ligament
What angles for anterior obliques
15 to 20° caudad
What angle for posterior obliques?
15 to 20° cephalad
Which of the following ligaments provides the most tensile strength in the lumbar region? A. Intertransverse Ligament B. Ligamentum Flavum C. Supraspinous Ligament D. Intertransverse Ligament E. Iliolumbar Ligament F. Filum Terminae G. Anterior Longitudinal Ligament
A. Anterior longitudinal ligament
The pars interarticularis is the part of vertebra located between the __________and _________ of the facet joint
ANS- inferior and Superior articular processes
The stretch reflexes are an example of A. Autonomic Regulation B. Automatic Reflexes C. Brainstem Reflexes D. Axial Reflexes
ANS-Spinal Reflexes maintain our posture through Autonomic Regulation
Once the muscle spindle is stretched, the impulse is sent back to the muscle very quickly, and protects it from being pulled forcefully or beyond its normal range of motion.
Ans- Stretch reflex
Which of the following may contribute to a dysfunction of trunk deviation (L) with forward bending? A. Tight erector spinae muscles Right B. Stiff facet joint capsule on (L) C. Poor strength (L) internal and external oblique muscles D. Facet joint osteophyte on Right
ANS: B A tight capsule on the (L) would draw the trunk to the side of the tightness. Tight muscles on the right would cause a (R) deviation. Inadequate anterior muscle strength would not be a factor as they are not active in this motion. An osteophyte on the (R) would cause limits to extension and not flexion.
In the cervical spine, the greatest amount of rotation is available at which of the following motion segments? A. C0 to C1 B. C1 to C2 C. C4 to C5 D. C6 to C7
ANS: B Approximately 55% to 58% of total rotation of the cervical spine occurs at the atlantoaxial joint (C1 to C2).
Which of the following most accurately describes the motion segment anatomical structures that will limit anterior translation of L5 on S1? A. Shape of the intervertebral disc and the anterior annular fibers of the intervertebral disc B. The iliolumbar ligament and posterior annular fibers of the intervertebral disc C. The anterior longitudinal ligament and iliolumbar ligament D. Posterior longitudinal ligament and intertransverse ligament
ANS: B The angle created by the L5 on S1 segment is quite large and requires support from several structures. The iliolumbar ligament and posterior longitudinal ligament play a large role in stabilizing the fifth vertebrae on the sacrum. The intervertebral disc also helps to stabilize this joint through resistance of translation by its posterior fibers
Which of the following is true with regard to the structure of the anulus fibrosis of the normal intervertebral disc? A. Annular lamina are oriented 60° to the horizontal plane of the intervertebral disc. B. It resists tensile forces in all directions. C. The water and proteoglycans content of the anulus is greater than the collagen content. D. Anulus is vascular in the adult.
ANS: B The lamellae in the anulus fibrosis are arranged in concentric rings that totally enclose the nucleus. The collagen fibers in adjacent rings are oriented in opposite directions at 120° to each other. This fiber arrangement would allow resistance to tensile forces in all directions.
Which of the following best describes the function of the sacrotuberous and sacrospinous ligaments? A. They prevent excessive counternutation of the sacrum on the innominates. B. They become most taut with end range of hip extension to effectively lock the sacrum and innominates together. C. They counterbalance the trunk forces that flex the sacral promontory. D. They form the superior border of the lesser sciatic foramen.
ANS: C The strong sacrotuberous and sacrospinous ligaments have a primary role in counterbalancing the trunk forces that flex the sacral promontory.
Which of these features is not found on a singular vertebra? A. Vertebral Arch B. Spinous Process C. Vertebral Foramen D. Intervertebral Foramen
Ans- Intervertebral foramen
What does the AP axial demonstrate?
Ans- Pathology of mid and lower cervical spine C3-T2
Which of the following is true concerning the structure of the temporomandibular joint (TMJ)? A. The lower joint is formed by the articulation of the articular eminence of the mandible with the superior surface of the disc. B. The upper joint is formed by the articulation of the anterior surface of the condyle with the posterior surface of the disc. C. The lower joint is formed by the superior surface of the disc and the posterior surface of the condyle. D. The upper joint is formed by the articulation of the articular eminence of the temporal bone and the superior surface of the disc.
ANS: D = The articular disc separates the TMJ into two separate spaces. The lower joint is formed by the articulation of the anterior surface of the condyle and the inferior surface of the articular disc. This space allows for rotation of the condyle under the disc. The upper joint is formed by the articulation of the articular eminence and the superior surface of the articular disc. The joint space allows for gliding of the disc and condyle along the temporal bone.
Biting down on the left side of the mouth promotes unloading of the right temporomandibular joint (TMJ). True or False?
ANS: F = Biting down on the left side of the mouth would create motion about an anteroposterior axis. This would cause distraction of the left joint space and compression of the right joint space.
In the congenital anomaly of 'sacralization', the lumbar vertebral column consists of only four typical lumbar vertebrae, as the fifth is fused to either one of which two bony structures? (more than 1) A. Coccyx B. Ribs C. Sacrum D. Thoracic Vertebrae E. Ilium
Ans- Sacrum & Ilium
C3 Level is at the what lanmark?
Ans - Gonion
Which of the following accurately describes what happens to the articular surface of the facet joints of the mid/lower cervical spine during cervical extension? A. Distraction of articular surfaces B. Compression of articular surfaces C. No change at the articular surfaces
B
Which of the following force couples is responsible for - contraction of the obliques requires contraction of the adductors to stabilize pelvis? A. Superficial posterior oblique system B. Anterior oblique system C. Lateral system D. Inner system
B. Anterior oblique system - interaction of the internal/external obliques and the adductor muscles
Which of the following is an example of a stretch reflex? A. sneezing, coughing and vomiting B. posture and trunk balance C. heartbeat, breathing D. Eye movement
B. posture and trunk balance
Spinal Cord Cervical Enlargement? A. C2-T1 B. C2-C8 C. C4-T1 D. C6-T1
C. C4-T1 (Brachial Plexus)
Which of the following force couples is responsible for contraction of glut med/min requires contraction of adductors to stabilize pelvis? A. Superficial posterior oblique system B. Anterior oblique system C. Lateral system D. Inner system
C. Lateral system interaction of the glut med/min and adductors
What is the coupled motion for C-spine rotation/lateral flexion?
C0-C2 side flexion and rotation occur in opposite direction C2-C7 side flexion and rotation occur in the same direction
Name the anatomical features found at each section of the Scottie dog Eye- Hindlegs- Nose- Ear- Forelegs-
Eye- Pedicle Hindlegs- Spinous Process Nose- Transverse process Ear- Superior articular facet Forelegs- Inferior articular facet
From conus medullaris until C1 A. Intertransverse Ligament B. Ligamentum Flavum C. Supraspinous Ligament D. Intertransverse Ligament E. Iliolumbar Ligament F. Filum Terminae G. Anterior Longitudinal Ligament
Filum Terminae
Which arteries provide branches for the circle of Willis? A. Internal carotid artery B. Maxillary artery C. Vertebral artery D. External carotid artery E. Anterior deep temporal artery
Internal carotid artery & Vertebral artery
The anterior longitudinal ligament is strongest in which of the following regions? A. Lumbar B. Cervical C. Sacral D. Thoracic
Lumbar
Which part of the brain contains the pyramidal decussation? A. Thalamus B. Pyramids of cerebellum C. Medulla Oblongata D. Dura Mater E. Optic Chiasm
Medulla Oblongata (so does Dorsal Column System)
Where do the axons of the lateral corticospinal tract and the anterior corticospinal tract originate? A. Pons B. Medulla Obolongata C. Motor cortex D. Spinal ganglion E. Gray matter
Motor Cortex
A 32-year-old woman has lost the sensation in her left thumb and fingers. She can not differentiate between hot or cold. After some tests, the attending physician suspects this to be caused by a lesion affecting the primary sensory area. Which gyrus of the cerebrum is most likely affected? A. Long gyrus of insula B. Precentral gyrus C. Inferior temporal gyrus D. Dentate gyrus E. Postcentral gyrus
Postcentral gyrus (where Medial Lemniscus System is found)
A 32-year-old woman goes to her family doctor because she hasn't been able to feel anything when she touches her left arm over the last ten days. The doctor tests the functionality of the posterior column-medial lemniscus (PCML) pathway, that carries sensory information to the brain, with a tuning fork. Where are the cell bodies of the first-order neuron of this pathway located? A. Thalamus B. Medulla Oblongata C. Posterior funiculus of spinal cord D. Posterior horn of spinal cord E. Spinal Ganglion
Spinal Ganglion (or Dorsal Root ganglion)
Which neuronal tract transmits pain stimuli from the periphery to the brain? A. Rubrospinal Tract B. Vestibulospinal tract C. Anterior Spinocerebellar tract D. Spinothalamic tract E. Spinocervical tract
Spinothalamic tract (Lateral spinothalamic is located in the Lateral column and transmits pain, thermal sensation. Anterior ST is in the anterior column & transmits crude tough, vibration, sexual sensation, itch, tickle, pressure)
The medial lemniscus fibers runs from the medulla oblongata to which structure? A. Thalamus B. Cerebral cortex C. Superior colliculus D. Olivary Nuclei E. Cerebellum
Thalamus (Dorsal Column system decussates in Medulla & ascends to 3rd neuron in thalamus)
What is the orientation of the cervical spine facet joints, resting position, and closed-packed position?
The superior facets of the C-spine face upward, backward and slightly medially, and the inferior facets face downward, forward, and slightly laterally. The resting position of the C-spine is slightly extended, and the closed packed position of the facet joints is complete extension of the C-spine.
What is the significance of the vertebral artery?
The vertebral artery passes through the transverse processes of the cervical vertebrae usually starting at C6. It supplies 20% of the blood to the brain, & 80% to the internal carotid artery. The vertebral artery lies close to the facet joints and vertebral bodies, and pathologies with these structures can cut off the supply of the vertebral artery.
During a routine examination in the hospital, a 40-year-old patient's big toe dorsiflexes when the lateral side of his foot is rubbed with a blunt object, which is a classic presentation of a pathological reflex called the Babinski reflex. Presence of this reflex suggests an injury of the pyramidal system. An injury of which of the following tracts has to be considered? A. Anterior spinocerebellar tract B. Dorsolateral tract C. Spinocervical tract D. Lateral corticospinal tract E. Vestibulospinal tract
lateral corticospinal tract
negative psychological condition related to belief that experienced pain will inevitably result in worst possible outcome A. somatogenic pain B. viscerogenic pain C. pain catastrophizing
pain catastrophizing
contractile and non contractile cause pain A. somatogenic pain B. viscerogenic pain C. pain catastrophizing
somatogenic pain
a failure of the vertebral arch to close, exposing the spinal cord.
spina bifida
Annulus fibrosis is the _______ fibrous portion of the intervertebral disk
· Outer
Which structure of the vertebral column resists forward flexion and the separation of laminae? A. Intertransverse Ligament B. Ligamentum Flavum C. Supraspinous Ligament D. Intertransverse Ligament E. Iliolumbar Ligament F. Filum Terminae G. Anterior Longitudinal Ligament
*Answer- Ligamentum Flavum
Which of the following are not a boundary of the vertebral foramen? A. Pedicle B. Body C. Lamina D. Spinous processes E. Transverse process
*Answer- Spinous processes, Transverse process Pedicle- lateral boundary Body- anterior boundary Lamina- posterior-lateral boundary Spinous Process- posterior boundary
Which of the following statements is true concerning the functions of the posterior bilaminar retrodiscal pad during normal temporomandibular joint (TMJ) osteokinematics? A. The elastic superior lamina allows disc translation anteriorly along the articular eminence during mandibular depression. B. The elastic inferior lamina serves to enhance disc motion during mandibular depression. C. The superior lamina is inelastic and serves to tether the disc from forward translation.
*Ans = A The bilaminar retrodiscal pad is highly innervated with an ample blood supply and is often the source of pain at the TMJ. The two bands of the retrodiscal pad each serve a different purpose. The superior lamina is very elastic and allows the superior band to stretch with forward translation of the disc. Its elastic properties help to reposition the disc posteriorly during mouth closing. The inferior lamina is inelastic and serves to tether the disc, limiting anterior translation, but does not assist with repositioning of the disc upon mouth closing.
The neurons of which spinal tract originate in Rexed laminae 5-7? A. Spinoolivary tract B. Dorsal spinocerebellar tract C. Anterior spinocerebellar tract D. Spinothalamic tract
*Ans- Dorsal spinocerebellar tract & Anterior spinocerebellar tract
Which of the following tracts of the spinal cord is an ascending tract? A. Vestibulospinal tract B. Rubrospinal Tract C. Anterior corticospinal tract D. Lissauer's tract
*Ans- Dorsolateral tract (Lissauer's tract)
Which structure corresponds to Rexed lamina 2? A. White Matter B. Periaqueductal gray substance C. Gelatinous substance of spinal cord D. Secondary viscera; gray matter of spinal cord E. Substantia nigra
*Ans- Gelatinous substance of spinal cord
Which fascicle in the posterior funiculus transmits discriminative touch, proprioception, weight discrimination information from the lower limb to the brain? A. Cuneate fasciculus B. Lateral corticospinal tract C. Medial longitudinal fasciculus D. Gracile fasciculus E. Anterior proper fasciculus
*Ans- Gracile fasciculus
Which part of the spinal cord contains cell bodies of neurons and glial cells? A. Anterior root of spinal nerve B. White matter C. Posterior root of spinal nerve D. Gray matter E. Central canal of spinal cord
*Ans- Gray Matter = : A major component of the central nervous system consisting of neuronal cell bodies, neuropil (dendrites and unmyelinated axons), glial cells (astroglia and oligodendrocytes), and capillaries (White Matter = A region of the central nervous system containing myelinated nerve fibers and no dendrites.)
The grey matter of the spinal cord can be histologically divided into ten different cell layers (Rexed laminae). Which two laminae define the ventral horn? A. Lamina VIII B. Lamina X C. Lamina I D. Lamina IX E. Lamina II
*Ans- IX & VIII
The grey commissure links the two halves of the spinal cord's grey matter and surrounds the central canal. Which Rexed lamina does it project to? A. Lamina VIII B. Lamina X C. Lamina I D. Lamina V E. Lamina III
*Ans- Lamina X
Which part of the vertebra is located laterally to the spinal cord? A. Pedicle of vertebra B. Body of vertebra C. Lamina of vertebral arch D. Spinous processes E. Transverse process
*Ans- Pedicle of vertebra
Which of the following neural tracts enter the cerebellum via the inferior cerebellar peduncle? A. Posterior Spinocerebellar tract B. Pyramidal tract C. Spinoolivary tract D. Solitary tract E. Olivocerebellar tract
*Ans- Posterior Spinocerebellar tract & Olivocerebellar tract
Proprioceptive information of the locomotor system and the skin, as well as the sensation of pain and temperature, is mainly processed in the nucleus proprius of spinal cord. In which structure of the spinal cord is this nucleus located? A. Anterior horn of spinal cord B. Anterior funiculus of spinal cord C. Posterior funiculus of spinal cord D. Posterior horn of spinal cord E. Posterior root
*Ans- Posterior horn of spinal cord (nucleus proprius found in gray matter in all levels of the spinal cord first synapse of the spinothalamic tract) (Substantia gelatinosa (SG) - located at the top of the dorsal horn, the SG is important for relaying pain, temperature and light touch sensation to the brain. Nucleus proprius (NP) - located in the 'neck' of the dorsal horn, the NP relays mechanical and temperature sensation to the brain).
Which of the following tracts of the spinal cord is a descending tract? A. Spinocervical tract B. Rubrospinal Tract C. Tectospinal tract D. Dorsolateral tract E. Spinocerebellar Tract
*Ans- Rubrospinal Tract (Located in Lateral column involuntary control of limbs, hand and feet) & Tectospinal tract (located in Anterior Column muscles of head & eyes in response to visual stimuli). Extrapyramidal tracts have cell bodies in Brain Stem/ Cerebral Cortex & axons remain in CNS. Responsible for automatic movements.
Which of the following structures lies laterally to the spinal cord and contains sensory neurons that relay sensory signals from the body to the posterior horn of the spinal cord? A. Anterior root of spinal nerve B. Spinal Ganglion C. Posterior root of spinal nerve D. Gray matter E. Central canal of spinal cord
*Ans- Spinal Ganglion
Which of the following ligaments primarily stabilize Atlanto-occipital joint? A. Alar ligaments B. tectorial membrane C. Transverse ligament D. ligament nuchae E. Ligamentum Flavum
*Ans-The atlanto-occipital membranes, tectorial membrane, and alar ligaments all work to stabilize the joint.
Which reflex is monosynaptic? A. Crossed Extensor Reflex B. Withdrawal reflex C. Stretch reflex
*Ans= Stretch reflex (Monosynaptic reflex is a type of reflex in which reflex arc provides direct communication between sensory and motor neurons innervating the muscle. Muscle stretch reflex is an example for Monosynaptic reflex.)
Excessive anterior pelvic tilt is usually associated with weakness / inhibition of which two muscles? A. Thoracolumbar extensors and hamstrings B. Glutes and abdominals C. Hamstrings and Hip flexors D. Quadriceps and calves
*Answer = Glutes and abdominals
Which of the following are characteristics of Lumbar vertebrae? A. Transverse foramen B. Bifid spinous process C. Posterior facing superior articular facets D. Costal facets E. Kidney-shaped body F. Hatchet shaped spinous process G. Superior-facing articular facets H. Oblique- facing superior articular facets I. Lateral-facing superior articular facets J. Posterior-facing superior articular facets
*Answer- Hatchet shaped spinous process, medial facing superior articular facet, kidney shaped body
Which of the following structures is a Dynamic restraint (resists) of anterior shearing forces in the lumbar spine?
A. Deep Erector Spinae
What is the orientation of the Zygapophyseal joints in the lumbar region?
A. Inferior facets are vertical and convex, face slightly anterior & lateral, Superior facets are vertical & concave, facing posteriorly, superiorly and laterally
Mammillary processes found on the posterior edge of the superior facets, serves as an attachment site for what structure?
A. Multifidus and medial transverse muscles
Change in response to change in length A. Muscle Spindle Reflex B. Golgi tendon reflex C. Scratch reflex D. Crossed Extensor Reflex
A. Muscle Spindle Reflex
Which of the following force couples is responsible for contraction of the glut max requires contraction of the lat to stabilize pelvis? A. Superficial posterior oblique system B. Anterior oblique system C. Lateral system D. Inner system
A. Superficial posterior oblique system - interaction of the latissimus dorsi, thoracolumbar fascia, and gluteus maximus
What aspect of the sacrum articulates with the coccyx? A. Ala of sacrum B. Superior Articular process of sacrum C. Apex of sacrum D. Base of Sacrum E. Median Sacral Crest
Ans- Apex of sacrum
Name of zygapophyseal joint between C1 and C2 is called what?
Ans- Atlantoaxial
Which structure plays an important role in maintaining the lumbopelvic rhythm?
A. Thoracolumbar fascia- forms a hoop around abdomen and acts as a stabilizing corset, increasing spinal stiffness. Helps the spinal extensors resist an applied load
Which of the following structures is a static restraint (resists) of anterior shearing forces in the lumbar spine?
A. Zygapophyseal joints
Which of the following structures limits rotation in the lumbar spine?
A. Zygapophyseal joints
Vertebrae that do not have a body is called what?
Ans- Atlas
Which of the following accurately describes what happens to the intervertebral foramen during extension? A. Intervertebral foramen becomes smaller. B. Intervertebral foramen remains the same size. C. Intervertebral foramen becomes larger. D. Intervertebral foramen becomes square in shape.
ANS: A During extension of the spine, the intervertebral foramen is narrowed, and the spinous processes move closer together.
Which of the following statements best fits the description of the sacroiliac ligaments? A. The sacroiliac ligaments are reinforced by fibrous expansions from the erector spinae and gluteus maximus. B. The fascial support is greater anteriorly than posteriorly. C. The sacrotuberous and sacrospinous ligaments are not part of the sacroiliac ligaments. The short posterior sacroiliac ligament is considered by some just a capsular reinforcement
ANS: A The sacroiliac ligaments include all of the named sacroiliac ligaments and the sacrotuberous and sacrospinous ligaments. The system is well reinforced posteriorly by fascia and by several fibrous expansions from posterior muscles (including the gluteus maximus and erector spinae). The anterior sacroiliac ligament is considered by some to be a capsular ligament, and the interosseous sacroiliac ligament (including its short posterior portion) is considered the most important ligament of the complex.
Which of the following muscles flexes the mid/lower cervical spine and extends the upper cervical spine? A. Sternocleidomastoid muscles B. Anterior scalene muscles C. Rectus capitus muscles D. Oblique capitus muscles
ANS: A The sternocleidomastoid (SCM) muscle has a unique function as it produces cervical flexion and suboccipital extension at the Atlanto-Occipital (AO) joint. It also can produce rotation to the same side when contracted unilaterally
Which of the following factors is the primary contributor to the vertebral body's decreased ability to withstand compressive forces as it ages? A. Loss of horizontal trabeculae B. Loss of vertical trabeculae C. Loss of osteophyte formation D. Loss of cortical bone
ANS: A The vertical trabeculae help the vertebral body to withstand shear force, and the horizontal trabeculae are primarily responsible in supporting compressive forces.
With which of the following pathological conditions will the patient experience joint noise at two different intervals during mandibular depression and elevation? A. Disc displacement B. Capsulitis C. Joint hypermobility D. Capsular fibrosis
ANS: A = Advanced disc displacement will result in a reciprocal click during mandibular depression and elevation.
Retrusion of the temporomandibular joint (TMJ) is primarily limited by the: A. Horizontal portion of the temporomandibular ligament B. Stylomandibular ligament C. Anterior portion of the temporomandibular joint capsule
ANS: A = Both the horizontal and oblique portion of the temporomandibular ligament are positioned to resist posterior translation of the condyles.
Which of the following muscles is considered to be a prime mover for mandibular depression against resistance? A. Digastric B. Bilateral medial pterygoid C. Masseter D. Temporalis
ANS: A = The primary muscle responsible for mandibular depression is the digastric muscle. Gravity has a great effect on this motion as well.
The bony structures the vertebral pedicles are directly posterior two are called what?
Ans- Body
What is the significance of a "reciprocal click"?
ANS: A person with an anteriorly displaced disc will have an audible click on opening and a second when the mouth closes. On mouth opening, the condyle slips forward and under the disc to obtain normal relationship with the disc. When the condyle slips under the disc, an audible click is often present. The reverse relationship occurs upon closure of the mouth. When the click occurs early in opening and late in closing, the displacement is relatively limited. The later the click occurs in the opening phase, the more severe the disc dislocation.
Which muscle serves as an important frontal and horizontal plane stabilizer of the trunk? A. Longissimus thoracis B. Quadratus lumborum C. Rectus abdominus Iliocostalis lumborum
ANS: B The quadratus lumborum serves an important role in both frontal plane and horizontal plane stabilization by "fixing" the pelvis.
The (R) alar ligament limits ____________________ of C1 on C2. A. (R) rotation B. (L) rotation C. Extension D. Both (R) and (L) lateral flexion
ANS: B The two alar ligaments arise from the axis on either side of the dens and extend laterally and superiorly to attach to the medial sides of the occipital condyles. The left alar ligament will resist right rotation, and the right alar ligament resists left rotation.
The orientation of the uncinate processes in the cervical spine function to limit which of the following motions? * A. Vertebral body anterior shear B. Vertebral body lateral translation C. Vertebral body superior translation D. Vertebral body posterior shear
ANS: B The uncinate processes are seen along the lateral margins of the vertebral bodies from C3 to C7. These structures are the primary limiter of lateral translation of the cervical spine during motion.
The first phase of mandibular depression occurs in the ____________________ joint and consists of anterior ____________________ of the condylar head. A. upper, rotation B. lower, rotation C. upper, translation D. lower, translation
ANS: B = Mandibular depression or mouth opening occurs in two phases: rotation and glide (translation). In the rotation phase, there is pure anterior rotation of the condyle on the disc occurring in the lower joint space. The second phase involves translation of the disc-condyle complex anteriorly and inferiorly along the articular eminence. There are some newer models of motion that indicate these two activities may occur more simultaneously, but rotation still appears to initiate the process.
Contraction of which muscle will pull the articular disc anteriorly during mouth opening? A. Medial pterygoid B. Lateral pterygoid C. Digastric D. Temporalis
ANS: B = The articular disc is controlled both actively and passively. Active control of the disc may be exerted through the attachments to the lateral pterygoid muscle.
The physical therapy evaluation of a patient's cervical spine determines that compression of the (R) C5/C6 facet joint reproduces the patient's symptoms. Which of the following osteokinematic movements would be primarily responsible for reproducing the patient's symptoms? A. Flexion B. (R) rotation C. (L) rotation and (R) lateral flexion D. (R) rotation and (L) lateral flexion
ANS: C Due to the coupled motion pattern seen in the spine, compression of the (R) facet would occur primarily with rotation to the (L) and with (R) lateral flexion. The compression occurs with (R) lateral flexion as a coupled rotation to the (L) would occur.
Which of the following structures would be best suited to resist the tensile forces produced during spinal extension? A. Posterior vertebral body B. Posterior longitudinal ligament C. Anterior longitudinal ligament D. Facet capsule
ANS: C During extension of the spine, the posterior vertebral body and facet joint surfaces would have a compressive force placed on them. This compressive force would not affect the facet joint capsule. The posterior longitudinal ligament would become slack, and the anterior longitudinal ligament would be the only structure listed above to resist the tensile force being produced by an extension motion.
Which of the following describes the lumbar spine facet joint arthrokinematic motion during (L) lateral flexion in the neutral position? A. Ipsilateral facet moves caudal and anterior; contralateral facet moves caudal and lateral. B. Ipsilateral facet moves cephalic and posterior; contralateral facet moves caudal and posterior. C. Ipsilateral facet moves caudal and anterior; contralateral facet moves cephalic and posterior. D. Ipsilateral facet moves cephalic and medial; contralateral facet moves cephalic and medial.
ANS: C During lateral flexion to the left, the ipsilateral facet would travel in a caudal direction. Due to the coupled motion of the spine, there would also be slight rotation of the segment in the opposite direction; therefore, the ipsilateral facet would move slightly anterior. On the contralateral side, the facet would move in a general cephalic direction with a slight posterior rotation due to the coupled motion.
Which of the following describes biochemical changes that occur in the intervertebral disc with aging? A. Increased proteoglycan concentration in the nucleus pulposus B. Increased water-binding capacity C. Increased collagen content in nucleus pulposus D. Increased elastin content in the anulus fibrosis
ANS: C During maturation and aging, there is a change in the type and amount of collagen content in the nucleus pulposus. The total amount of collagen increases steadily from about 6% to 25% of the dry weight of the center of the nucleus pulposus to 70% in the outer anulus.
Which of the following most accurately describes the primary tissue biomechanics that occur during lumbar rotation in a neutral position? A. Shear force on the vertebral body; ipsilateral facet compressed B. Compression on the vertebral body; ipsilateral joint capsule on slack C. Shear force on the vertebral body; ipsilateral joint capsule stretched Compression on the vertebral body; ipsilateral facet compressed
ANS: C During rotation of the lumbar spine, a shear force would be applied to the vertebral body as translation occurs. At the facet surfaces, there would be a compressive force on the side to which the rotation occurred (ipsilateral side) and a distractive force on the facet capsule on the contralateral side.
During normal mandibular lateral deviation to the left, the left condylar head moves in this manner. A. Gliding posteriorly and superiorly B. Gliding anteriorly and inferiorly C. Spinning posteriorly D. Spinning anteriorly
ANS: C = During lateral deviation, the condyle on the ipsilateral side will spin or rotate in a posterior direction while the contralateral condyle glides anterior and medial.
Which of the following muscles is considered to be a prime mover for mandibular lateral deviation to the right? A. Right masseter B. Right medial and lateral pterygoid C. Left medial and lateral pterygoid D. Left temporalis
ANS: C = Lateral deviation is caused by unilateral action of various muscles. The prime mover appears to be both the medial and lateral pterygoid muscles causing deviation of the mandible to the opposite side. At times, lateral deviation can also be accomplished by the combined action of the lateral pterygoid and temporalis muscle of the same side.
Upon examination of your patient's temporomandibular joint (TMJs), you observe the following amount of active range of motion (AROM): opening 55 mm; (L) lateral deviation 8 mm; (R) lateral deviation 8 mm; and protrusion 12 mm. Based on your knowledge of normal values of AROM of the TMJ, you would conclude that there is: A. Less than expected opening and protrusion B. Less than expected lateral deviation bilaterally C. Greater than expected opening and protrusion D. Excessive motion in all directions
ANS: C = Normal mouth opening is 40 to 50 mm; lateral deviation is 8 mm; protrusion is 6 to 9 mm. In the case above, this would mean that the patient is demonstrating greater than normal opening and protrusion.
The articular disc of the TMJ is attached laterally to the ____________________ and anteriorly to the ____________________. A. fibrous capsule, mandibular condyle B. articular eminence, mandibular condyle C. mandibular condyle, fibrous capsule D. fibrous capsule, articular eminence
ANS: C = The articular disc is firmly attached to the medial and lateral poles of the condyle of the mandible but not to the joint capsule. Anteriorly, the disc is attached to the joint capsule and to the tendon of the lateral pterygoid muscle.
If a person stands and bends forward while attempting to touch his or her toes (keeping knees extended), this produces ____________________ at the innominates, ____________________ at the sacrum and flexion of the lumbar spine. A. posterior rotation, nutation B. anterior rotation, counternutation C. posterior rotation, counternutation D. anterior rotation, nutation
ANS: D Forward flexion caused an anterior rotation of the pelvis accompanied by nutation of the sacrum. Nutation is the commonly used term for sacral motion when the sacral promontory moves anteriorly and inferiorly while the coccyx moves posteriorly in relation to the ilium.
Which of the following abdominal muscles would be active during trunk rotation to the right? A. Right internal oblique, right external oblique B. Left internal oblique, left external oblique C. Right internal oblique, left external oblique D. Left internal oblique, right external oblique
ANS: D Rotation of the trunk occurs when the ipsilateral external oblique muscle and contralateral internal oblique muscle contract at the same time. For rotation to the right, this would mean contraction of the right external oblique and left internal oblique.
Which of the following statements is true concerning the surface of the sacroiliac joints? A. The sacral surface is formed from the fused bodies of S1 to S4. B. Both the sacral and innominate articular surfaces are covered with fibrocartilage. C. There is a pattern of elevations and ridges only on the sacral surfaces. D. The innominate articular surface is "C" shaped.
ANS: D The articular surface of the sacrum is "C" shaped and covered with hyaline cartilage. The corresponding surface of the ilia is also "C" shaped but is covered with fibrocartilage. After puberty, grooves and ridges appear on both surfaces to restrict excessive motion.
During normal mandibular lateral deviation to the left, the left condylar head ____________________, and the right condylar head and disc A. glides posteriorly and superiorly, spins B. glides anteriorly and inferiorly, spins C. spins, glides posteriorly and superiorly D. spins, glides anteriorly and inferiorly
ANS: D = In lateral deviation of the chin to one side, one condyle spins around a vertical axis while the other condyle translates forward. Lateral deviation to the left would involve the left condyle spinning while the right condyle translates anteriorly and inferiorly.
Which of the following muscles may become shortened when the posterior suboccipital muscles become tight as a result of a forward head posture? A. Medial pterygoid B. Lateral pterygoid C. Temporalis D. Posterior belly of the digastric
ANS: D = Posterior rotation of the occiput places many muscles into a shortened position. In addition to the obvious suboccipital and larger posterior neck muscles, this position places the posterior belly of the digastric muscle and stylohyoid muscles into shortened positions.
What is the relationship of the temporomandibular joint (TMJ) with the cervical spine?
ANS: Muscles that attach to the mandible also attach to the head, hyoid bone, and clavicle. Consequently, these muscles may act on the atlanto-occipital joint and cervical spine as well as the TMJ. Conversely, head and neck position may affect the length-tension relationship of these muscles and indirectly affect the function of the TMJ.
Describe the attachments of the articular disc of the temporomandibular joint (TMJ).
ANS: The articular disc of the temporomandibular joint is a biconcave structure. Both its superior and inferior surfaces are concave, giving its peanut shape. The disc is firmly attached to the medial and lateral poles of the condyle of the mandible but not to the capsule medially or laterally. Anteriorly, the disc is attached to the joint capsule and to the tendon of the lateral pterygoid muscle. Posteriorly, the disc is attached to the bilaminar retrodiscal pad, which consists of two bands separated by loose areolar connective tissue with a rich arterial and neural supply.
Through what opening does Cerebral Spinal Fluid pass to the brain? A. Vertebral foramen B. Vertebral Arch C. Transverse foramen D. Intervertebral foramen E. Central Canal
Ans - Central Canal
Which of the following are intersegmental? A. Flexor (withdrawal) reflex and the patellar reflex B. Muscle tension reflex and the stretch reflex C. Crossed Extensor reflex and the flexor (withdrawal) reflex D. The stretch reflex and the flexor (withdrawal) reflex E. Crossed extensor reflex and tendon reflex
Ans = Muscle tension reflex and the stretch reflex. Polysynaptic reflex include crossed extensor reflex and withdrawal reflex. Any reflex with more than one synapse is known as polysynaptic reflex
The intervertebral joints are classified as
Ans- Amphiarthrodial
Which of the following spinal tracts carry unconscious proprioceptive information? A. Anterior spinocerebellar tract B. Posterior spinocerebellar tract C. Tectospinal Tract D. Spinothalamic Tract E. Rubrospinal Tract
Ans- Anterior spinocerebellar tract & Dorsal spinocerebellar tract
Eye movements are an example of which of the following? A. Autonomic Regulation B. Automatic Reflexes C. Brainstem Reflexes D. Axial Reflexes E. Spinal Reflexes
Ans- Brainstem Reflexes. (Automatic reflexes - swallowing, sneezing, coughing and vomiting. Spinal Reflexes- maintain our posture and trunk balance. Autonomic reflexes - maintain homeostasis with heartbeat, breathing, BP)
Degenerative spondylolisthesis (DS), as opposed to spondylolytic spondylolisthesis results from age-related degeneration of _________ and _________
Ans- Facet Joints and Intervertebral discs
__________ are receptors present where the muscle is connected to the tendon, and which regulate the tension within the muscle A. Muscle Spindles B. Muscle Fibers C. Golgi Tendons D. Golgi Tendon Organs
Ans- Golgi Tendon Organs. Muscle spindles are composed of a few intrafusal fibres, which in fact lack the contractile proteins of normal muscle (actin and myosin), they are non-contractile, and they serve as receptive surfaces.
Spinal nerves run to and from the spinal cord within what structure? a. foramen magnum b. vertebral arch c. vertebral foramen d. intervertebral foramina
Ans- Intervertebral Foramina
Lumbarization refers to the spinal anomaly defined by the non-fusion of the first and second segments of which bony structure? A. Lumbar Vertebrae B. Sacrum C. Coccyx D. Thoracic Vertebrae E. Cervical Vertebrae
Ans- Sacrum
Kyphosis is the term for an exaggerated curvature physiologically found in which vertebral regions? (more than 1) A. Sacrum B. Coccyx C. Lumbar Vertebrae D. Thoracic Vertebrae E. Cervical Vertebrae
Ans- Sacrum, coccyx, thoracic
What structure do the inferior articular facets of the fifth lumbar vertebra articulate with to form the lumbosacral joint? A. Ala of sacrum B. Superior Articular process of sacrum C. Apex of sacrum D. Base of Sacrum E. Median Sacral Crest
Ans- Superior Articular process of sacrum
Once a stretch reflex occurs, the impulse is sent from the stretched muscle spindle, to the alpha motor neuron. The alpha motor neuron is split. This is how it is able to contraction in the ______ group, and relaxation in the ________ group.
Ans- Synergist, Antagonist
Process that extends laterally from junction of pedicles and laminae is called what?
Ans- Transverse Process
Hyper extension and hyperflexion lateral projections of the C-spine help to diagnose a what type of injury?
Ans- Whiplash
Which structure is formed by the fused spinous processes on the dorsal side of the sacrum, building a jagged bony ridge? A. Ala of sacrum B. Promontory of sacrum C. Lateral sacral crest D. Apex of sacrum E. Median sacral crest
Ans-Median Sacral Crest
What pathology is described by an anterior shifting of a vertebral body in relation to the vertebra located immediately inferior to it
Ans-Spondylolisthesis
What ligament provides the most stability at the atlanto-axial joint? A. Transverse ligament B. alar ligaments C. ligament nuchae D. Ligamentum Flavum
Ans-The transverse ligament provides the most stability at this joint as it holds the dens of the axis against the anterior arch of the atlas.
Which of the following is INCORRECT pertaining to the sacrum? A. It articulates with the L5 vertebra at the lumbosacral angle B. Its sacral hiatus leads to the sacral canal C. Its cornua are found on the sacral promontory D. It articulates with the ilium at the auricular surface
Answer - Its cornua are found on the sacral promontory
The semispinalis capitis: A. is part of the erector spinae group of muscles. B. when acting unilaterally, rotates the head so that the face points to the ipsilateral side C. when acting bilaterally, flexes the neck. D. is innervated by posterior rami of spinal nerves.
Answer - is innervated by posterior rami of spinal nerves.
The articular eminence contains a major area of A. Spongy Bone B. Trabeculae Bone C. Blood vessels D. Hyaline cartilage
Answer Trabeculae Bone
Which structure of the vertebral column resists distraction, translation and rotation of vertebral bodies? A. Intertransverse Ligament B. Ligamentum Flavum C. Annulus Fibrosus D. Supraspinous Ligament E. Intertransverse Ligament F. Iliolumbar Ligament
Answer- Annulus Fibrosus
Which structure of the vertebral column resists anterior sliding of the 5th Lumbar vertebrae on the 1st sacral vertebra? A. Intertransverse Ligament B. Ligamentum Flavum C. Supraspinous Ligament D. Intertransverse Ligament E. Iliolumbar Ligament
Answer- Iliolumbar Ligament
Which of the following is INCORRECT pertaining to typical cervical vertebrae? A. Sharply downward-slopping spinous processes B. Most mobile region of the vertebral column C. Presence of transverse foramina D. Prescence of uncinate processes
Answer- Sharply downward-slopping spinous processes
What type of joint is the tempo mandibular? A. Synovial B. Diarthrodial
Answer- Synovial
How are the superficial collagen fibers aligned in TMJ? Perpendicular, to withstand stresses Parallel to facilitate gliding of the joint
Answer: Parallel to facilitate gliding of the joint
How are the deep collagen fibers aligned in TMJ? Perpendicular, to withstand stresses Parallel to facilitate gliding of the joint
Answer: Perpendicular, to withstand stresses
Which of the following spinal tracts crosses to the opposite side at the level of each spinal segment? A. Vestibulospinal tract B. Rubrospinal tract C. Anterior corticospinal tract D. Gracile fasciculus E. Lateral corticospinal tract
Anterior corticospinal tract
Which structure runs downwards directly next to the anterior median fissured carries voluntary motor control to racial muscles of the contralateral side? A. Lateral Corticospinal tract B. Anterior corticospinal tract C. Spinocervical tract D. Spinothalamic tract E. Lamina I
Anterior corticospinal tract
The right "dorsal ganglia" at the level of C5 is damaged. Which of the following will occur? A. Impaired tactile (non-noxious) sensory processing on the right side. B. Impaired pain sensory processing on the right side. C. Impaired tactile (non-noxious) sensory processing on the left side D. Impaired pain sensory on the left side.
B- impaired pain sensory on the R side. (damage to the fasciculus cuneate, hasn't Decussated yet ((since it Decussates at medulla)) so issue will be ipsilateral, if it occurred above medulla, issue would be contralateral)
Spinal Cord Lumbar Enlargement? A. (T12-L5) B. (T11-S1) C. (T8-S2) D. (L1-S4)
B. (T11-S1) Lumbosacral Plexus
Which of the following force couples is responsible for - work together to prevent excessive anterior/posterior rotation? A. Superficial posterior oblique system B. Anterior oblique system C. Lateral system D. Inner system
D. Inner system interaction of multifidus, diaphragm, transverse abdominis, and pelvic floor muscles
____________ is an example of a circuit that skips the brain, and follows the simple neural loop connecting the muscle to the spinal cord and back. A. Autonomic Regulation B. Automatic Reflexes C. Axial Reflexes D. Spinal Reflexes
D. Spinal Reflexes
The ____ orientation of the Zygapophyseal joints in the lumbar region allow them to resist ____ forces?
Frontal Plane resists anterior shear. Sagittal Plane, resists rotation
Which of the following structures occupy the posterior funiculus of the spinal cord? A. Cuneate fasciculus B. Lateral corticospinal tract C. Anterior proper fasciculus D. Gracile fasciculus E. Medial longitudinal fasciculus
Gracile fasciculus & Cuneate fasciculus (The dorsal column is formed by two large fasciculi (bundles of nerve fibers) running through the posterior spinal cord)
A 7-year-old girl presenting with headache, vomiting, irritability and neck stiffness is suspected to have meningitis. To confirm the diagnosis, the doctor needs to perform a lumbar puncture to extract the cerebrospinal fluid (CSF) from the subarachnoid space of the spinal canal. In order to avoid damaging the spinal cord, the doctor must insert the needle below the termination of the spinal cord and above the termination of the dura mater. Between which of the following vertebra should the needle be inserted? (more than 1) A. Vertebra L3 B. Vertebra S4 C. Vertebra S2 D. Vertebra L1 E. Vertebra S5
L3- S2
Which Lumbar Vertebrae can be found at the following landmarks? -height of iliac crest -level of 12th rib -origin of 12th rib -greater trochanter, ischial tuberosities
L4/L5 vertebrae: height of iliac crest L2 IVD: level of 12th rib T12: origin of 12th rib apex of coccyx: greater trochanter, ischial tuberosities
Which of the following arteries usually gives off the posterior spinal artery to supply the spinal cord? A. Basilar artery B. Posterior inferior cerebellar artery C. Posterior cerebral artery D. Anterior inferior cerebellar artery E. Superior cerebellar artery
Posterior inferior cerebellar artery
Which gyrus of the cerebrum contains the primary motor cortex? A. Long gyrus of insula B. Precentral gyrus C. Inferior temporal gyrus D. Dentate gyrus E. Postcentral gyrus
Precentral gyrus
A lesion in which isolated part of the cortex can cause flaccid paralysis on the contralateral side of the body? A. Cingulate gyrus B. Postcentral Gyrus C. Medial Frontal gyrus D. Angular Gyrus E. Precentral gyrus
Precentral gyrus (where Motor Cortex is found in the frontal lobe)
Which of the following arteries give off branches that supply the cerebellum, brainstem and occipital lobes? (more than 1) A. Vertebral artery B. Maxillary artery C. Basilar artery D. External carotid artery E. Internal carotid artery
Vertebral (branches ASA, PSA, PICA, MB, MA (M-meningeal)(vertebral artery terminates at basilar artery) & Basilar artery
What with AP open mouth demonstrate?
Zygapophyseal joints between C1 & C2, and odontoid
organ causing pain in the low back A. somatogenic pain B. viscerogenic pain C. pain catastrophizing
viscerogenic pain (referred pain)
