Block 5 Neuro Somatosensory Pain MCQ's

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Block 5 Neuro Somatosensory Pain MCQs - Quiz

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Questions and Answers
  • 1. 

    A 92-year-old woman is brought to the emergency department by her caregiver. The woman had suddenly become drowsy and confused. The examination revealed no cranial nerve deficits and age-normal motor function, but a loss of pain, thermal, vibratory, and discriminative touch sensations on one side of the body excluding the head. CT shows a small infarcted area. (i) Which of the following structures is the most likely location of this lesion?

    • A.

      Anterolateral system

    • B.

      Medial geniculate nucleus

    • C.

      Subthalamic nucleus

    • D.

      Ventral posterolateral nucleus

    • E.

      Ventral posteromedial nucleus

    Correct Answer
    D. Ventral posterolateral nucleus
    Explanation
    The most likely location of the lesion in this case is the ventral posterolateral nucleus. This is because the patient is experiencing a loss of pain, thermal, vibratory, and discriminative touch sensations on one side of the body excluding the head. The ventral posterolateral nucleus is responsible for relaying sensory information from the opposite side of the body to the somatosensory cortex. Damage to this nucleus can result in a loss of sensation on one side of the body.

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  • 2. 

    A 61-year-old man is brought to the emergency department after a fall from his garage roof. The examination reveals a hemiplegia on the left, a loss of vibratory sense on the left, and a loss of pain and thermal sensation on the right side involving the upper and lower extremities. These deficits are characteristically seen in which of the following syndromes?

    • A.

      Benedikt

    • B.

      Brown-Sequard

    • C.

      Claude

    • D.

      Wallenberg

    • E.

      Weber

    Correct Answer
    B. Brown-Sequard
    Explanation
    The patient's symptoms of hemiplegia on the left side, loss of vibratory sense on the left, and loss of pain and thermal sensation on the right side involving both upper and lower extremities are characteristic of Brown-Sequard syndrome. Brown-Sequard syndrome is caused by a hemisection or damage to one side of the spinal cord. This results in ipsilateral motor deficits and loss of vibratory sense on the same side as the lesion, and contralateral loss of pain and thermal sensation due to the crossing of these pathways in the spinal cord.

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  • 3. 

    A 92-year-old woman is brought to the emergency department by her caregiver. The woman had suddenly become drowsy and confused. The examination revealed no cranial nerve deficits and age-normal motor function, but a loss of pain, thermal, vibratory, and discriminative touch sensations on one side of the body excluding the head. CT shows a small infarcted area. (ii) The loss of pain and thermal sensations experienced by this woman would most likely correlate with a lesion involving which of the following structures?

    • A.

      Anterior (ventral) trigeminothalamic tract

    • B.

      Anterolateral system

    • C.

      Lateral lemniscus

    • D.

      Medial lemniscus

    • E.

      Spinal trigeminal tract

    Correct Answer
    B. Anterolateral system
    Explanation
    The loss of pain and thermal sensations on one side of the body, excluding the head, suggests a lesion involving the anterolateral system. The anterolateral system is responsible for transmitting pain and temperature sensations from the body to the brain. Lesions in this system can result in a loss of these sensations on the contralateral side of the body. The other structures listed are not primarily involved in transmitting pain and thermal sensations, making them less likely to be the site of the lesion.

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  • 4. 

    Damage to which of the following fiber bundles or tracts would most likely explain the loss of vibratory sensation of the left lower limb?

    • A.

      Anterolateral system on the right

    • B.

      Cuneate fasciculus on the left

    • C.

      Cuneate fasciculus on the right

    • D.

      Gracile fasciculus on the left

    • E.

      Gracile fasciculus on the right

    Correct Answer
    D. Gracile fasciculus on the left
    Explanation
    Damage to the gracile fasciculus on the left would most likely explain the loss of vibratory sensation in the left lower limb. The gracile fasciculus is responsible for transmitting sensory information related to proprioception, vibration, and fine touch from the lower limbs to the brain. Damage to this pathway would disrupt the transmission of these sensory signals, resulting in a loss of vibratory sensation in the left lower limb.

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  • 5. 

    An 88-year-old man is brought to the emergency department by his daughter. She indicates that he complained of weakness of his "arm" and "leg" (upper and lower extremities) on the right side and of "seeing two of everything" (double vision-diplopia). CT shows an infarcted area in the medial area of the pons at the pons-medulla junction. The infarcted area is consistent with the vascular territory served by paramedian branches of the basilar artery. (i) Weakness of the extremities on the right can be explained by damage to which of the following structures?

    • A.

      Corticospinal fibers on the left

    • B.

      Corticospinal fibers on the right

    • C.

      Middle cerebellar peduncle on the left

    • D.

      Rubrospinal fibers on the left

    • E.

      Rubrospinal fibers on the right

    Correct Answer
    A. Corticospinal fibers on the left
    Explanation
    The weakness of the extremities on the right side can be explained by damage to the corticospinal fibers on the left side. The corticospinal fibers are responsible for transmitting motor signals from the brain to the spinal cord, which then control the movement of the extremities. In this case, the infarcted area in the medial area of the pons at the pons-medulla junction, which is supplied by the paramedian branches of the basilar artery, has likely caused damage to the corticospinal fibers on the left side, leading to weakness on the right side of the body.

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  • 6. 

    An 88-year-old man is brought to the emergency department by his daughter. She indicates that he complained of weakness of his "arm" and "leg" (upper and lower extremities) on the right side and of "seeing two of everything" (double vision-diplopia). CT shows an infarcted area in the medial area of the pons at the pons-medulla junction. The infarcted area is consistent with the vascular territory served by paramedian branches of the basilar artery. (ii) Injury to which of the following structures in this man is most specifically related to the loss of pain and thermal sensations on the body below the neck?

    • A.

      Anterolateral system

    • B.

      Cuneate fasciculus

    • C.

      Gracile fasciculus

    • D.

      Medial lemniscus

    • E.

      Spinal trigeminal tract

    Correct Answer
    A. Anterolateral system
    Explanation
    The loss of pain and thermal sensations on the body below the neck is most specifically related to injury to the anterolateral system. The anterolateral system is responsible for transmitting pain and temperature sensations from the body to the brain. In this case, the infarcted area in the medial area of the pons at the pons-medulla junction, which is consistent with the vascular territory served by paramedian branches of the basilar artery, is likely causing damage to the anterolateral system, leading to the loss of pain and thermal sensations.

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  • 7. 

    An 88-year-old man is brought to the emergency department by his daughter. She indicates that he complained of weakness of his "arm" and "leg" (upper and lower extremities) on the right side and of "seeing two of everything" (double vision-diplopia). CT shows an infarcted area in the medial area of the pons at the pons-medulla junction. The infarcted area is consistent with the vascular territory served by paramedian branches of the basilar artery. (iii)  Damage to which of the following structures would most specifically explain the loss of pain and thermal sensations on the man's face?

    • A.

      Anterolateral system

    • B.

      Medial lemniscus

    • C.

      Medial longitudinal fasciculus

    • D.

      Solitary tract

    • E.

      Spinal trigeminal tract

    Correct Answer
    E. Spinal trigeminal tract
    Explanation
    The spinal trigeminal tract is responsible for transmitting pain and thermal sensations from the face to the brain. Damage to this structure would specifically explain the loss of pain and thermal sensations on the man's face.

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  • 8. 

    A 79-year-old woman is brought to the emergency department after a fall in her home from which she was unable to get up. The examination reveals a deviation of the tongue to the left on protrusion, a pronounced weakness of the right upper and lower extremities, and a loss of position and vibratory sense and discriminative touch on the right side of the body below the neck. CT shows an infarcted area in the medulla . (i) Which of the following represents the best localizing sign in this patient?

    • A.

      Deviation of the tongue

    • B.

      Motor loss on lower extremity

    • C.

      Motor loss on upper extremity

    • D.

      Sensory loss on lower extremity

    • E.

      Sensory loss on upper extremity

    Correct Answer
    A. Deviation of the tongue
    Explanation
    The best localizing sign in this patient is the deviation of the tongue to the left on protrusion. This is indicative of a cranial nerve deficit, specifically involvement of the hypoglossal nerve (CN XII), which innervates the muscles of the tongue. The other findings mentioned in the question, such as weakness of the right upper and lower extremities and loss of sensation on the right side of the body, suggest a contralateral (opposite side) involvement, which is consistent with a medullary infarct. However, the deviation of the tongue is a more specific localizing sign that directly points to the affected cranial nerve.

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  • 9. 

    A 79-year-old woman is brought to the emergency department after a fall in her home from which she was unable to get up. The examination reveals a deviation of the tongue to the left on protrusion, a pronounced weakness of the right upper and lower extremities, and a loss of position and vibratory sense and discriminative touch on the right side of the body below the neck. CT shows an infarcted area in the medulla . (ii) Damage to which of the following tracts or fiber bundles would most likely give rise to the sensory deficits experienced by this patient?

    • A.

      Anterolateral system

    • B.

      Medial lemniscus

    • C.

      MediaIlongitudinaIfascicuIus

    • D.

      Solitary tract

    • E.

      SpinaI trigeminaI tract

    Correct Answer
    B. Medial lemniscus
    Explanation
    Damage to the medial lemniscus would most likely give rise to the sensory deficits experienced by this patient. The medial lemniscus is a pathway in the brainstem that carries sensory information, including position and vibratory sense, discriminative touch, and proprioception, from the body to the thalamus and then to the somatosensory cortex. In this case, the patient's loss of position and vibratory sense and discriminative touch on the right side of the body below the neck suggests damage to the medial lemniscus on the right side, which is consistent with the infarcted area in the medulla seen on CT.

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  • 10. 

    A 15-year-old boy is brought to the emergency department after an accident on his father's farm. The examination reveals weakness of the left lower extremity, but no frank paralysis. There is a loss of pinprick sensation on the right side beginning at the T8 dermatome (about half way between the nipple and umbilicus), and dorsiflexion of the great toe in response to plantar stimulation. Based on this examination, which of the following represents the most likely approximate location of this lesion?

    • A.

      T6 on the left side

    • B.

      T6 on the right side

    • C.

      T8 on the left side

    • D.

      T8 on the right side

    • E.

      Tl0 on the left side

    Correct Answer
    A. T6 on the left side
    Explanation
    Based on the examination findings, the weakness of the left lower extremity suggests a lesion on the left side of the spinal cord. The loss of pinprick sensation on the right side beginning at the T8 dermatome indicates that the lesion is located above the T8 level. Since the lesion is on the left side and above T8, the most likely approximate location is T6 on the left side.

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  • 11. 

    An 80-year-old woman is brought to the emergency department from an assisted care facility. The woman, who is in a wheelchair, complains of not feeling well, numbness on her face, and being hoarse, although she claims not to have a cold. The examination reveals a loss of pain and thermal sensations on the right side of her face and the left side of her body. CT shows an infarcted area in the lateral portion of the medulla. A lesion of which of the following structures in this woman would explain the loss of pain and thermal sensations on her body excluding the head?

    • A.

      Anterolateral system on the left

    • B.

      Anterolateral system on the right

    • C.

      Medial lemniscus on the left

    • D.

      Spinal trigeminal nucleus on the left

    • E.

      Spinal trigeminal tract on the left

    Correct Answer
    B. Anterolateral system on the right
    Explanation
    A lesion of the anterolateral system on the right side would explain the loss of pain and thermal sensations on the left side of the body. The anterolateral system is responsible for transmitting pain and temperature sensations from the body to the brain. When this system is damaged on one side, it results in a loss of these sensations on the opposite side of the body. In this case, the woman's symptoms of numbness on her face and left side of the body indicate a lesion in the anterolateral system on the right side.

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  • 12. 

    In the course of a neurological examination of a 23-year-old man, the physician places her index finger on the midline of the mandible and taps it with a percussion hammer stimulating the afferent limb of the jaw (jaw-jerk) reflex. Collateral fibers from which of the following brain stem nuclei enter the trigeminaI motar nueleus to initiate the motor response?

    • A.

      Hypoglossal

    • B.

      Mesencephalic

    • C.

      Principal sensory

    • D.

      Spinal trigeminal, pars caudalis

    • E.

      Spinal trigeminal, pars interpolaris

    Correct Answer
    B. Mesencephalic
    Explanation
    The correct answer is Mesencephalic. The mesencephalic nucleus is responsible for proprioception and deep sensation in the face, including the jaw-jerk reflex. When the physician taps the mandible, the afferent limb of the reflex is stimulated, and the sensory information is transmitted to the mesencephalic nucleus. Collateral fibers from this nucleus then enter the trigeminal motor nucleus to initiate the motor response, causing the jaw to jerk. The other options, such as Hypoglossal, Principal sensory, and Spinal trigeminal nuclei, are not involved in the jaw-jerk reflex.

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  • 13. 

    An 80-year-old woman is brought to the emergency department from an assisted care facility. The woman, who is in a wheelchair, complains of not feeling well, numbness on her face, and being hoarse, although she claims not to have a cold. The examination reveals a loss of pain and thermal sensations on the right side of her face and the left side of her body. CT shows an infarcted area in the lateral portion of the medulla: The facial sensory deficits experienced by this woman are explained by a lesion to the axons of cell bodies located in which of the following structures?

    • A.

      Anterior trigeminothalamic fibers on the left

    • B.

      Left trigeminal ganglion

    • C.

      Principal sensory nucleus on the left

    • D.

      Right trigeminal ganglion

    • E.

      Spinal trigeminal nucleus on the right

    Correct Answer
    B. Left trigeminal ganglion
    Explanation
    The facial sensory deficits experienced by this woman are explained by a lesion to the axons of cell bodies located in the left trigeminal ganglion. The trigeminal ganglion is responsible for relaying sensory information from the face to the brain. A lesion in the left trigeminal ganglion would result in loss of sensation on the right side of the face, which is consistent with the patient's symptoms.

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  • 14. 

    The loss of pain and thermal sensations  on the right side of the body (excluding the face) is most likely the result of damage to which of the following structures?

    • A.

      Anterolateral system fibers on the left

    • B.

      Anterolateral system fibers on the right

    • C.

      Anterior trigeminothalamic fibers on the left

    • D.

      Medial lemniscus on the left

    • E.

      Medial lemniscus on the right

    Correct Answer
    A. Anterolateral system fibers on the left
    Explanation
    The loss of pain and thermal sensations on the right side of the body (excluding the face) suggests damage to the anterolateral system fibers on the left side. The anterolateral system is responsible for transmitting pain and temperature sensations from the body to the brain. Damage to the fibers on the left side would affect the transmission of these sensations from the right side of the body. The other options, such as anterolateral system fibers on the right, anterior trigeminothalamic fibers on the left, medial lemniscus on the left, and medial lemniscus on the right, are not likely to cause this specific pattern of sensory loss.

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  • 15. 

    An 11-year-old girl is brought to the family physician by her mother. The mother explains that the girl has been complaining that her hands and arms "feel funny." In fact, the mother states that the girl cut her little finger, but did not realize it until she saw blood. The examination reveals a bilateral loss of pain and thermal sensation on the upper extremities and shoulder. Which of the following is the most likely cause of this deficit in this girl?

    • A.

      Brawn-Sequard syndrome

    • B.

      Posterior inferior cerebellar artery syndrome

    • C.

      Tabes dorsalis

    • D.

      Syringobulbia

    • E.

      Syringomyelia

    Correct Answer
    E. Syringomyelia
    Explanation
    The most likely cause of the bilateral loss of pain and thermal sensation on the upper extremities and shoulder in this girl is syringomyelia. Syringomyelia is a condition characterized by the formation of a fluid-filled cyst (syrinx) in the spinal cord. This cyst can compress and damage the nerve fibers responsible for transmitting pain and temperature sensations. The girl's symptoms of not feeling pain or realizing she was cut until she saw blood are consistent with the loss of sensation caused by syringomyelia.

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  • 16. 

    You touch the edge of a coin with your right index finger. This tactile information is sent to cortex by a tract that crosses the neuroaxis at which point in the nervous system?

    • A.

      Anterior white commissure

    • B.

      Upper cervical cord

    • C.

      Fvlid-pons

    • D.

      All levels of the spinal cord

    • E.

      Caudal medulla

    Correct Answer
    E. Caudal medulla
    Explanation
    When you touch the edge of a coin with your right index finger, the tactile information is sent to the cortex by a tract that crosses the neuroaxis at the caudal medulla. The caudal medulla is a region located at the lower part of the brainstem, where sensory information from the body crosses over to the opposite side of the brain. This crossing is known as decussation, and it allows for the integration of sensory information from one side of the body to be processed by the opposite side of the brain.

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  • 17. 

    During a neurological examination a 49-year old woman's Romberg's test is positive. Which of the following is the major structure that has been affected?

    • A.

      Spinal nucleus of V

    • B.

      Ventral commissure of spinal cord

    • C.

      Ventral horn of spinal cord

    • D.

      Dorsal columns

    • E.

      Red nucleus

    Correct Answer
    D. Dorsal columns
    Explanation
    The Romberg's test is used to assess a patient's ability to maintain balance and coordination while standing with their eyes closed. A positive Romberg's test indicates a loss of proprioception, which is the sense of the body's position in space. The major structure that is responsible for proprioception is the dorsal columns of the spinal cord. Therefore, if the Romberg's test is positive, it suggests that the dorsal columns have been affected.

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  • 18. 

    A 26-year old woman is in an automobile accident. A neurological exam reveals loss of touch, vibration and proprioception in her lower right limb. What is the adaptation rate and receptive field size of Meissner's corpuscles in response to touch under normal conditions?

    • A.

      Adapt rapidly to stimuli and have a small receptive field

    • B.

      Adapt rapidly to stimuli and have a large receptive field

    • C.

      Adapt slowly to stimuli and have a large receptive field

    • D.

      Adapt slowly to stimuli and have a small receptive field

    • E.

      None of the above

    Correct Answer
    A. Adapt rapidly to stimuli and have a small receptive field
    Explanation
    Meissner's corpuscles are sensory receptors located in the skin that are responsible for detecting light touch and vibration. They adapt rapidly to stimuli, meaning they quickly respond to changes in touch sensation. Additionally, Meissner's corpuscles have a small receptive field, which means they are sensitive to stimuli in a specific localized area. This allows for precise detection of touch and vibration in the skin. Therefore, the correct answer is that Meissner's corpuscles adapt rapidly to stimuli and have a small receptive field.

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  • 19. 

    A patient presents with weakness in the limbs on the left side of the body as well as loss of pain and temperature sensitivity on the left side of the body. Damage to which fibers types could elicit such pain/temperature symptoms?  

    • A.

      Type Ap fibers

    • B.

      Type C fibers

    • C.

      Type 1a fibers

    • D.

      Type lb fibers

    • E.

      Type Ay fibers

    Correct Answer
    B. Type C fibers
    Explanation
    Damage to type C fibers could elicit loss of pain and temperature sensitivity on the left side of the body. Type C fibers are unmyelinated and transmit slow, dull, and poorly localized pain sensations. They are responsible for transmitting pain and temperature information from the periphery to the central nervous system. Therefore, damage to these fibers would result in a loss of pain and temperature sensitivity on the affected side of the body.

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  • 20. 

    Following a series of strokes a 76~year old woman complains of Hypogeusia . In the pathway that is affected where are the cell bodies of the third order sensory neurons located?

    • A.

      Insula

    • B.

      Solitary nucleus

    • C.

      VPM (Ventral posteromedial nucleus; of the thalamus)

    • D.

      Cranial nerve ganglia

    • E.

      Taste buds

    Correct Answer
    C. VPM (Ventral posteromedial nucleus; of the thalamus)
    Explanation
    After a series of strokes, the woman is experiencing Hypogeusia, which is a reduced ability to taste. The question is asking about the location of the cell bodies of the third-order sensory neurons in the pathway that is affected. The VPM (Ventral posteromedial nucleus) of the thalamus is responsible for relaying sensory information, including taste, to the cerebral cortex. Therefore, the correct answer is VPM (Ventral posteromedial nucleus; of the thalamus).

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  • 21. 

    A 26-year footballer collides with a member of the opposition during a soccer match. A couple of days later he meets with his physician and complains of hyposmia. Which of the following statements is correct in relation to normal olfaction?

    • A.

      Primary olfactory neurons are multipolar

    • B.

      The main output cell of the olfactory bulb is the mitral cell

    • C.

      Primary olfactory neurons synapse in specific glomeruli within the olfactory epithelium

    • D.

      Sustentacular cells are also known as Basal cells

    • E.

      Olfactory epithelium is located in the inferior nasal cavity

    Correct Answer
    B. The main output cell of the olfactory bulb is the mitral cell
    Explanation
    The main output cell of the olfactory bulb is the mitral cell. This means that the mitral cells transmit signals from the olfactory bulb to other parts of the brain, allowing for the perception and interpretation of smells. The other statements are not correct in relation to normal olfaction. Primary olfactory neurons are bipolar, not multipolar. Primary olfactory neurons do synapse in specific glomeruli within the olfactory epithelium, but sustentacular cells are not known as basal cells. The olfactory epithelium is located in the superior nasal cavity, not the inferior nasal cavity.

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  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jan 24, 2012
    Quiz Created by
    Chachelly
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