Review Questions

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1. Which of the following cells are found in the white matter of the spinal cord?

2. A 50-year-old man begins to have problems typing on his computer keyboard and holding a hammer in his right hand In the next month he realizes that his right hand and right arm are weaker than the left, but a few weeks later the left arm and hand also become weak Two months later, his right hand can be held only in a claw like position, there is atrophy of the hypothenar eminence, and the right thumb is held in a position of extension. The patient also notices that he has trouble getting up from a chair and that he walks stiffly. Tendon reflexes in both lower limbs are elevated, and there are bilateral Babinski responses in both feet. The biceps and triceps tendon reflexes are virtually absent. Upon examination you note that he has nasal and slurred speech, there are wormlike fascicula-tions on the tongue, and there is visible twitching of muscle fibers beneath the skin of both forearms and chest. The patient has no pain or loss of sensation, and he maintains that bladder function is normal. The patient demonstrates signs consistent with

Schwann cells Ependymal cells O ligo dendrocytes Pyramidal cells Alpha motor neurons

Guillain Barré syndrome subacute combined degeneration multiple sclerosis myasthenia gravis amyotrophic lateral sclerosis

Cutting a ventral root of a spinal nerve may result in

(A) atrophy of skeletal muscle innervated by that nerve as a result of disuse

(B) increased activity of the muscle stretch reflexes involving denervated muscles

(C) a Babinski sign

(D) degeneration of dorsal root ganglion cells at the same segmental spinal cord level

(E) regeneration of the cut axons because their myelin sheaths are formed by Schwann cells

Your patient has fallen off of a ladder. A neurological exam conducted 2 weeks after the accident reveals that the individual has a complete hemisection of the right side of the spinal cord at the level of the TIO segment. In this case, the patient is most likely to exhibit

(A) a pain and temperature loss to in both the upper and lower limb on the left

(B) altered touch sensations from the right lower limb

(C) hyperactive stretch reflexes in the lower limb on the left

(D) absent stretch reflexes in the right upper limb

(E) Horner syndrome

A 55-year-old man develops pain in both legs, altered sensation of touch in the soles of both feet, and increased tendencies to urinate, particularly at night. When he walks to the bus stop in the morning, his gait is unsteady. What else might you expect to observe in the patient?

(A) Pupils that accommodate but do not react to light

(B) Amyotrophic lateral sclerosis

(C) Hyperactive stretch reflexes

(D) Subacute combined degeneration

(E) Horner syndrome

Your patient, a 25-year-old woman, tells you that 6 months ago she had balance problems and numbness in her right hand, but die numbness subsided after a week or so. She is a secretary and thinks that she may have carpal tunnel syndrome. Today, you note that she has decreased vibratory sense in both the right hand and right leg, decreased pinprick sensation in the right lower limb, and that both of her right Limbs are weak. Analysis of cerebrospinal fluid following lumbar tap reveals heterogeneous immunoglobulin G staining with oligoclonal banding. Which of the following might also be seen in die patient?

(A) Bilateral ptosis

(B) Blurry vision

(D) Tic douloureux

Your patient complains that he cannot tell "the difference between hot or cold water when he washes his hands, and he also notes that both upper limbs tire easily. You note that the thenar eminences of both hands of the patient appear wasted. You suspect that the patient

has

(A)

amyotrophic lateral sclerosis

(B)

tabes dorsalis

(C)

poliomyelitis

(D)

syringomyelia

(E)

a Pancoast tumor

Your patient has lost the ability to discriminate between two points presented simultaneously to the skin of the left hand. Your neurological evaluation is most likely to reveai a lesion in the

(A) fasciculus cuneatus on the right side of the spinal cord at C2

(B) medial lemniscus on the right side of the pons

(C) dorsal columns on the right side of the spinal cord at T5

(D) fasciculus gracilis on the right side of the medulla

(E) spinothalamic tract left side of the spinal cord at C2

In a section through the T10 segment of the spinal cord, which of the following will not be present?

(A) Preganglionic sympathetic neurons

(B) Fasciculus gracilis

(C) Lower motor neurons

(D) Fasciculus cuneatus

(E) Dorsal spinocerebellar tract

A patient presents with muscle weakness, fasciculations, and suppressed reflexes. The most likely location of the lesion is in the

(A) dorsal horn

(B) ventral horn

(C) lateral horn

(D) dorsal column

(E) ventral white commissure

Contraction of the quadriceps femoris muscle and extension of the leg at the knee in the patellar tendon reflex is initiated by stimulation of

(A) Golgi tendon organs

(B) muscle spindles

(C) upper motor neurons

(D) la dorsal root fibers

(E) brain stem neurons

12. During repair of an aortic aneurysm, a patient awakes with neurological signs, which the neurologist attributed to temporary occlusion of the feeder arteries to the anterior spinal artery. Which of the following neurologic signs would you be least likely to observe in the patient?

(A) Bilateral loss of pain and temperature below the site of the occlusion

(B) Bilateral weakness below the site of the occlusion

(C) Bilateral loss of vibratory sense below the site of the occlusion

(D) Increased urinary frequency

(E) Bilateral Babinski signs

Questions 13 and 14 are based on the following figure.

13. The figure above indicates several labeled structures in a section through the spinal cord. Which letter indicates a neural structure that would be affected in poliomyelitis?

(A)

A

(B)

B

(C)

C

(D)

D

(E)

E

(F)

F

(G)

G

(H)

H

(I)

I

14. The figure above indicates several labeled structures in a section through the spinal cord. Which of the following labeled structures carries pain and temperature sensations from the right leg?

15. In the same figure from question 14, if the structure at "G" were cut, where would you expect to find degenerating neuronal cell bodies as a result of retrograde cbromatolysis?

(A) Nucleus cuneatus

(B) Dorsal root ganglia

(C) Ventral posterior lateral nucleus of the thalamus

(D) Postcentral gyrus

(E) Dorsal horn of the spinal cord gray matter

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