CHAPTER 1 - Book Review Questions Flashcards
The spinal cord has
(a) an outer covering of gray matter and an inner
core of white matter.
(b) an enlargement below that forms the conus medullaris.
(c) anterior and posterior roots of a single spinal nerve attached to a single segment.
(d) cells In the posterior gray horn that give rise to efferent fibers that supply skeletal muscles.
(e) a central canal that ls situated In the white commlssure.
C is correct.
- Anterior and posterior roots of a single spinal nerve are attached to a single spinal cord segment. A. The spinal cord has an outer covering of white matter and an Inner core of gray matter (see Fig. 1-5). B. The spinal cord tapers off below to form the conus medullaris. D. The cells in the posterior gray horn of the spinal cord are associated with sensory function (seep. 139). E. The central canal of the spinal cord Is situated in the gray commissure (see Fig. 1-6).
The medulla oblongata has
(a) a tubular shape.
(b) the fourth ventricle lying posterior to its lower
part.
(c) the midbrain directly continuous with its upper
border.
(d) no central canal in its lower part.
(e) the spinal cord directly continuous with its
lower end in the foramen magnum.
E is correct.
- The lower end of the medulla oblongata is directly continuous with the spinal cord in the foramen magnum (see Fig. 1-4). A. The medulla oblongata is conical in shape (see Fig. 1-8). B. The medulla oblongata has the fourth ventricle lying posterior to its upper part. C. The medulla oblongata has the pons directly continuous with its upper border. D. The medulla oblongata has a central canal in its lower part that is continuous with that of the spinal cord.
The midbrain has
(a) a cavity called the cerebral aqueduct.
(b) a large size.
(c) no cerebrospinal fluid (CSF) around it.
(d) a cavity that opens above into the lateral ventricle.
(e) a location in the middle cranial fossa of the skull.
A is correct.
- The midbrain has a cavity called the cerebral aqueduct. B. The midbrain is of small size (see Fig. 1-1). C. The midbrain is completely surrounded with CSF ln the subarachnoid space (see Fig. l-2A). D. The mtdbrain has a cavity called the cerebral aqueduct, which opens above into the third ventricle (see Fig. 1-10). E. The midbrain is located in the posterior cranial fossa.
The following statements concern the cerebellum:
(a) It lies within the middle cranial fossa.
(b) The cerebellar cortex is composed of white
matter.
(c) The vermis is the name given to that part joining the cerebellar hemispheres together.
(d) The cerebellum lies anterior to the fourth ventricle.
(e) The dentate nucleus is a mass of white matter
found in each cerebellar hemisphere.
C is correct.
- The vermis is the name given to that part of the cerebellum joining the cerebellar hemispheres together (see Fig. 6-2). A. The cerebellum lies in the posterior cranial fossa (see Fig.1-7). B. The cerebellar cortex is composed of gray matter (see Fig. 1-10). D. The cerebellum lies posterior to the fourth ventricle (see Fig. 1-10). E. The dentate nucleus is a mass of gray matter found in each cerebellar hemisphere (see Fig. 6-7).
The following statements concern the cerebrum:
(a) The cerebral hemispheres are separated by a fibrous septum called the tentorium cerebelli.
(b) The bones of the vault of the skull are named for the lobes of the cerebral hemisphere they lie over.
(c) The corpus callosum is a mass of gray matter lying within each cerebral hemisphere.
(d) The internal capsule is an important collection of nerve fibers, which has the caudate nucleus and the thalamus on its medial side and the lentiform nucleus on its lateral side.
(e) The cavity present within each cerebral hemisphere is called the cerebral ventricle.
D is correct.
- The internal capsule is an important collection of ascending and descending nerve fibers, which has the caudate nucleus and the thalamus on its medial side and the lentiform nucleus on its lateral side (see Fig. 1-13). A. The cerebral hemispheres are separated by a vertical, sagittally placed fibrous septum called the falx cerebri. The tentorium cerebelli ls horizontally placed and roofs over the posterior cranial fossa and separates the cerebellum from the occipital lobes of the cerebrum (see Fig. 15-1). B. The lobes of the cerebral hemisphere are named for the skull bones they lie under. C. The corpus callosum is a mass of white matter lying within each cerebral hemisphere (see Fig. 1-10). E. The cavity present within each cerebral hemisphere is called the lateral ventricle.
The following statements concern the peripheral nervous system:
(a) There are 10 pairs of cranial nerves.
(b) There are 8 pairs of cervical spinal nerves.
(c) The posterior root of a spinal nerve contains many efferent motor nerve fibers.
(d) A spinal nerve is formed by the union of an anterior and a posterior ramus in an intervertebral foramen.
(e) A posterior root ganglion contains the cell bodies of autonomic nerve fibers leaving the spinal cord.
B is correct.
- There are 8 pairs of cervical spinal nerves (only 7 cervical vertebrae). A. There are 12 pairs of cranial nerves. C. The posterior root of a spinal nerve contains afferent nerve fibers. D. A spinal nerve ls formed by the union of an anterior and a posterior root in an intervertebral foramen. E. A posterior root ganglion contains the cell bodies of sensory nerve fibers entering the spinal cord.
The following statements concern the central nervous system:
(a) A computed tomography (CT) brain scan cannot distinguish between white matter and gray matter.
(b) The lateral ventricles are in direct communication with the fourth ventricle.
(c) A magnetic resonance imaging (MRI) of the brain uses the magnetic properties of the hydrogen nucleus excited by radiofrequency radiation transmitted by a coil surrounding the patient’s head.
(d) Following trauma and sudden movement of the brain within the skull, the large arteries at the base of the brain are commonly torn.
(e) The movement of the brain at the time of head injuries is unlikely to damage the small 6th cranial nerve.
C is correct.
- An MRI of the brain uses the magnetic properties of the hydrogen nucleus excited by radiofrequency radiation transmitted by a coil surrounding the patient’s head (seep. 23). A. A CT brain scan can distinguish between white and gray matter (see Fig. 1-22). B. The lateral ventricles communicate indirectly with the fourth ventricle through the interventricular foramen, the third ventricle, and the cerebral aqueduct of the midbrain (see Fig. 1-10). D. Following trauma and sudden movement of the brain within the skull, the large arteries at the base of the brain are rarely torn. E. The movement of the brain at the time of head injuries may stretch and damage the small delicate 6th cranial nerve (the small 4th cranial nerve may also be injured).
The following statements concern the cerebrospinal fluid (CSF):
(a) The CSF in the central canal of the spinal cord is
unable to enter the fourth ventricle.
(b) With the patient in the recumbent position, the normal pressure is about 60 to 150 mm of water.
(c) It plays only a minor role in the protection of the brain and spinal cord from traumatic injury.
(d) Compression of the internal jugular veins in the
neck lowers the CSF pressure.
(e) The subdural space is filled with CSF.
B is correct.
- With the patient in the recumbent position, the normal pressure of CSF is 60 to 150 mm of water. A. The CSF in the central canal of the spinal cord is able to enter the fourth ventricle through the central canal of the lower part of the medulla oblongata (see Fig. 1-2A). C. The CSF is important in protecting the brain and spinal cord from traumatic injury by dissipating the force (compare with the role of the amniotic fluid in protecting the fetus in the pregnant uterus). D. Compression of the internal jugular vein in the neck raises the CSF pressure by inhibiting its absorption into the venous system. E. The subarachnold space is filled with CSF; the potential subdural space contains only tissue fluid.
The following statements concern the vertebral levels and the spinal cord segmental levels:
(a) The1st lumbar vertebra lies opposite the L3-L4
segments of the cord.
(b) The 3rd thoracic vertebra lies opposite the 3rd
thoracic spinal cord segment.
(c) The 5th cervical vertebra lies opposite the 7th
cervical spinal cord segment.
(d) The 8th thoracic vertebra lies opposite the 9th
thoracic spinal cord segment.
(e) The 3rd cervical vertebra lies opposite the 4th
cervical spinal cord segment.
E is correct.
- The 3rd cervical vertebra lies opposite the 4th cervical spinal cord segment (see Table 1-3, p. 16). A. The 1st lumbar vertebra lies opposite the sacral and coccygeal spinal cord segments. B. The 3rd thoracic vertebra lies opposite the 5th thoracic spinal cord segment. C. The 5th cervical vertebra lies opposite the 6th cervical spinal cord segment. D. The 8th thoracic vertebra lies opposite the 11th thoracic spinal cord segment.
A 23-year-old woman was unconscious when admitted to the emergency department. While crossing the road, she had been hit on the side of the head by a bus. Within an hour, she was found to have a large, dough-like swelling over the right temporal region. She also had signs of muscular paralysis on the left side of the body. Alateral radiograph of the skull showed a fracture line running downward and forward across the anterior-inferior angle of the right parietal bone. Her coma deepened, and she died 5 hours after the accident.
Select the most likely cause of the swelling over the right temporal region in this patient.
(a) Superficial bruising of the skin
(b) Hemorrhage from a blood vessel In the temporalis muscle
(c) Rupture of the right middle meningeal vessels
(d) Edema of the skin
(e) Hemorrhage from a blood vessel in the superficial fascia
C is correct.
- The swelling over the right temporal region and the radiologic finding of a linear fracture over the anterior-inferior angle of the right parietal bone would strongly suggest that the right middle meningeal artery had been damaged and an epidural (extradural) hemorrhage had occurred. Blood had spread through the fracture line into the overlying temporalis muscle and soft tissue.
A 23-year-old woman was unconscious when admitted to the emergency department. While crossing the road, she had been hit on the side of the head by a bus. Within an hour, she was found to have a large, dough-like swelling over the right temporal region. She also had signs of muscular paralysis on the left side of the body. Alateral radiograph of the skull showed a fracture line running downward and forward across the anterior-inferior angle of the right parietal bone. Her coma deepened, and she died 5 hours after the accident.
Select the most likely cause of the muscular paralysis of the left side of the body In this patient.
(a) Laceration of the right side of the cerebral
hemisphere
(b) Right-sided epidural hemorrhage
(c) Left-sided epidural hemorrhage
(d) Injury to the cerebral cortex on the left side of
the brain
(e) Injury to the right cerebellar hemisphere
B is correct.
- The left-sided paralysis (left hemiplegia) was due to pressure exerted by the right-sided epidural hemorrhage on the precentral gyrus of the right cerebral hemisphere.
A 69-year-old man was admitted to the neurology unit complaining of severe discomfort of the lower back. Radiologic examination of the lumbar region of the vertebral column revealed significant narrowing of the spinal canal caused by advanced osteoarthritis.
Explain the discomfort in the lower back experienced by this patient.
(a) Muscle fatigue
(b) Prolapsed lntervertebral disc
(c) Tom ligament In the joints of the lumbar region of the spine
(d) Compression of the cauda equina
(e) Bad posture
D is correct.
- In persons in whom the spinal canal was originally small, significant narrowing of the canal in the lumbar region can lead to neurologic compression of the cauda equina with pain radiating to the back, as in this patient.
Later, in this same patient, the back pain became more severe and now radiated down the back of the left leg; the patient was also experiencing difficulty walking. Examination of the patient revealed weakness and some wasting of the muscles of the left leg. Radiologic examination showed that the osteoarthritic changes had spread to involve the boundaries of many of the lumbar intervertebral foramina.
Explain the change in the symptoms and signs found in this patient.
(a) The sciatic nerve was compressed in the pelvis
by a spreading rectal cancer.
(b) The patient had developed advanced atherosclerosis of the arteries of the right lower limb.
(c) The osteoarthritic process had produced osteophytes that encroached on the intervertebral foramina, compressing the segmental spinal
nerve roots.
(d) Neuritis had developed in the sciatic nerve
trunk.
(e) The patient was experiencing psychiatric problems.
C is correct.
- One of the complications of osteoarthritis of the vertebral column is the growth of osteophytes, which commonly encroach on the intervertebral foramina, causing pain along the distribution of the segmental nerve. In this patient, the segmental nerves L4-L5 and S1-S3, which form the important sciatic nerve, were involved. This would explain the pain radiating down the left leg and the atrophy of the leg muscles.
