8- Neuro MSQs Only Flashcards
1 of 73
A 19 year old female is admitted with suspected meningitis. The House Officer is due to perform a lumbar puncture. What is the most likely structure first encountered when the needle is inserted?
Supraspinous ligament
13 of 73
A 22 year old man is undergoing a wedge excision of his great toenail. As the surgeon passes a needle into the area to administer local anaesthetic, the patient notices a sharp pain. By which pathway will this sensation be conveyed to the central nervous system?
Spinothalamic tract
Spinothalamic tract- Pain and temperature
Vestibulospinal tract- Motor neuronal signals relating to posture
Cuneate fasciculus- Fine touch, pressure and proprioception
Posterior spinocerebellar tract- Proprioceptive signals to cerebellum
Anterior corticospinal tract- Conveys motor signals from precentral gyrus to motor cells within the cord
Pain impulses are transmitted via the spinothalamic tract
16 of 73
In which space is a lumbar puncture performed?
Subarachnoid space
Samples of CSF are normally obtained by inserting a needle between the third and fourth lumbar vertebrae. The tip of the needle lies in the sub arachnoid space, the spinal cord terminates at L1 and is not at risk of injury. Clinical evidence of raised intracranial pressure is a contraindication to lumbar puncture.
17 of 73
Where does the spinal cord terminate in neonates?
L3
At the 3rd month the foetus’s spinal cord occupies the entire length of the vertebral canal. The vertebral column then grows longer exceeding the growth rate of the spinal cord. This results with the cord being at L3 at birth and L1-2 by adulthood.
18 of 73
A 10 year old child has a grommet inserted for a glue ear. What type of epithelium is present on the external aspect of the tympanic membrane?
Stratified squamous
The external aspect of the tympanic membrane is lined by stratified squamous epithelium. This is significant clinically in the development of middle ear infections when this type of epithelium may migrate inside the middle ear.
20 of 73
Which of the following structures suspends the spinal cord in the dural sheath?
Denticulate ligaments
The spinal cord is approximately 45cm in men and 43cm in women. The denticulate ligament is a continuation of the pia mater (innermost covering of the spinal cord) which has intermittent lateral projections attaching the spinal cord to the dura mater.
23 of 73
A 20 year old man is hit with a hammer on the right side of the head. He dies on arrival in the emergency department. Which of these features is most likely to be found at post mortem?
Laceration of the middle meningeal artery
This will account for the scenario given where there is a brief delay prior to death. The other options are less acute and a supratentorial herniation would not occur in this setting.
22 of 73
A 45 year old lady develops severe back pain and on examination is found to have clinical evidence of an L5/ S1 radiculopathy. Her symptoms deteriorate and eventually a laminectomy is performed. During a posterior surgical approach the surgeons encounter a tough ligamentous structure lying anterior to the spinous processes. This structure is most likely to be the
Ligamentum flavum
39 of 73
A man with lung cancer and bone metastasis in the thoracic spinal vertebral bodies, sustains a pathological fracture at the level of T4. The fracture is unstable and the spinal cord is severely compressed at this level. Which of the findings below will not be present 6 weeks after injury?
Extensor plantar reflexes
Urinary incontinence
Sensory ataxia
Spasticity of the lower limbs
Diminished patellar tendon reflex ( Right)
A thoracic cord lesion causes spastic paraperesis, hyperrflexia and extensor plantar responses (UMN lesion), incontinence, sensory loss below the lesion and ‘sensory’ ataxia. These features typically manifest several weeks later, once spinal shock (in which areflexia predominates) has resolved.
47 of 73
Which of the following structures separates the intervertebral disks from the spinal cord?
Posterior longitudinal ligament
The posterior longitudinal ligament overlies the posterior aspect of the vertebral bodies. It also overlies the posterior aspect of the intervertebral disks.
54 of 73
A 62 year old male complains of back pain. He has had a recent fall. Walking causes pain of the left lower leg. On examination, he is noted to have reduced sensation over the knee. Which of the spinal levels listed below is most likely to have been affected?
L3
Sensation over the knee is equivalent to the L3 dermatome. The four nerves involved include the infrapatellar branch of the saphenous nerve, the lateral cutaneous nerve of the thigh, anterior cutaneous nerve of the thigh (both lateral and medial branches).
42 of 73
Which of the following statements relating to the vertebral column is false?
- There are 7 cervical vertebrae
- The cervical and lumbar lordosis are secondary curves developing after birth due to change in shape of the intervertebral discs
- The lumbar vertebrae do not have a transverse process foramina
- The lumbar vertebrae receive blood directly from the aorta
- The spinous process is formed by the junction of the pedicles posteriorly ( Right)
The spinous process is formed by 2 laminae posteriorly.
57 of 73
A 56 year old man suddenly develops severe back pain. His pain has a radicular pattern. On examination, he is unable to extend his great toe. Which of the spinal levels listed below is most likely to have been affected?
L5
Extensor hallucis longus is derived from L5 and loss of EHL function is a useful test to determine whether this level is involved.
61 of 73
Which of the following structures attaches periosteum to bone?
Sharpeys fibres
Periosteum is attached to bone by strong collagenous fibers called Sharpey’s fibres, which extend to the outer circumferential and interstitial lamellae. It also provides an attachment for muscles and tendons.
63 of 73
A builder falls off a ladder whilst laying roof tiles. He sustains a burst fracture of L3. The MRI scan shows complete nerve transection at this level, as a result of the injury. Which clinical sign will not be present initially?
Flaccid paralysis of the legs
Extensor plantar response( Right)
Sensory loss in the legs
Incontinence
Areflexia
In lower motor neuron lesions everything is reduced
The main purpose of this question is to differentiate the features of an UMN lesion and a LMN lesion. The features of a LMN lesion include:
· Flaccid paralysis of muscles supplied
. Atrophy of muscles supplied.
. Loss of reflexes of muscles supplied.
.Muscles fasciculation
For lesions below L1 LMN signs will occur. Hence in an L3 lesion, there will be loss of the patella reflex but there will be no extensor plantar reflex.
