BRS Back

Question 1

1. During an outbreak of meningitis at a local college, a 20-year-old student presents to a hospital emergency department complain- ing of headache, fever, chills, and stiff neck. On examination, it appears that he may have meningitis and needs a lumbar puncture or
   a spinal tap. Cerebrospinal fluid (CSF) is nor- mally withdrawn from which of the following spaces?
   (A) Epidural space
   (B) Subdural space
   (C) Space between the spinal cord and the pia
   mater
   (D) Subarachnoid space
   (E) Space between the arachnoid and dura maters

Answer 1

1. The Answer is D- Subarachnoid space

Cerebrospinal fluid (CSF) is found in the subarachnoid space, which is a wide interval between the arachnoid layer and the pia mater. The epidural space contains the inter- nal vertebral venous plexus and epidural fat. The subdural space between the arachnoid and the dura contains a little fluid to moisten the meningeal surface. The pia mater closely covers the spinal cord and enmeshes blood vessels on the surfaces of the spinal cord. Thus, the space between the spinal cord and the pia is a potential space.

Question 2

2. A 23-year-old jockey falls from her horse and complains of headache, backache, and weak- ness. Radiologic examination would reveal blood in which of the following spaces if the internal vertebral venous plexus was ruptured?
(A) Space deep to the piamater
(B) Space between the arachnoid and dura
maters
(C) Subdural space
(D) Epidural space
(E) Subarachnoid space

Answer 2

The Answer is D-Epidural space

The space between the vertebral canal and the dura mater is the epidural space, which contains the internal vertebral venous plexus. The spinal cord and blood vessels lie deep to the pia mater. The space between the arachnoid and dura maters is the subdural space, which contains a film of fluid. The subarachnoid space contains cerebrospinal fluid (CSF).

Question 3

3. A 42-year-old woman with metastatic breast cancer is known to have tumors in the inter- vertebral foramina between the fourth and fifth cervical vertebrae and between the fourth and fifth thoracic vertebrae. Which of the following spinal nerves may be damaged?
   (A) Fourth cervical and fourth thoracic nerves
   (B) Fifth cervical and fifth thoracic nerves
   (C) Fourth cervical and fifth thoracic nerves
   (D) Fifth cervical and fourth thoracic nerves
   (E) Third cervical and fourth thoracic nerves

Answer 3

The Answer is D- Fifth cervical and fourth thoracic nerves

All cervical spinal nerves exit through the intervertebral foramina above the corresponding vertebrae, except the eighth cervical nerves, which run inferior to the seventh cervical vertebra. All other spinal nerves exit the intervertebral foramina below the correspond- ing vertebrae. Therefore, the fifth cervical nerve passes between the fourth and fifth cervical vertebrae, and the fourth thoracic nerve runs between the fourth and fifth thoracic vertebrae.

Question 4

4. A 39-year-old woman with headaches presents to her primary care physician with a possible herniated disk. Her magnetic resonance imaging (MRI) scan reveals that the postero- lateral protrusion of the intervertebral disk between L4 and L5 vertebrae would most likely affect nerve roots of which of the following spinal nerves?
(A) Third lumbar nerve 
(B) Fourth lumbar nerve 
(C) Fifth lumbar nerve 
(D) First sacral nerve
(E) Second sacral nerve

Answer 4

4. The Answer is C- ) Fifth lumbar nerve

A posterolateral herniation of the intervertebral disk at disk level L4 to L5 affects the fifth lumbar nerve root but rarely affects the fourth lumbar nerve root because of
a progressive descending obliquity of the fourth and fifth lumbar nerve roots. The first seven cervical nerves exit above the corresponding vertebra, and the eighth cervical nerve exits below the seventh cervical vertebra because there are eight cervical nerves but only seven cervical vertebrae. The rest of the spinal nerves exit below their corresponding vertebrae.

Question 5

5. A 57-year-old woman comes into her physician’s office complaining of fever, nausea, vomiting, and the worst headache of her
   life. Tests and physical examination suggest hydrocephalus (widening ventricles) resulting from a decrease in the absorption of cerebro- spinal fluid (CSF). A decrease of flow in the CSF through which of the following structures would be responsible for these findings?
   (A) Choroid plexus
   (B) Vertebral venous plexus (C) Arachnoid villi
   (D) Internal jugular vein
   (E) Subarachnoid trabeculae

Answer 5

The Answer is C- Arachnoid villi

Cerebrospinal fluid (CSF) is absorbed into the venous system primarily through the arachnoid villi projecting into the cranial dural venous sinuses, particularly the superior sagittal sinus. CSF is produced by the choroid plexuses of the ventricles of the brain and is circulated in the subarachnoid space, in which subarachnoid trabeculae are also found. The vertebral venous plexus and internal jugular vein are not involved in the absorption of CS