@1. The ability to recognize an unseen familiar object placed in the hand depends on the integrity of which pathway?

(A) Spinospinal tract (B) Dorsal column (C) Dorsal spinocerebellar tract (D) Spino-olivary tract B. The ability to recognize the form and texture of an unseen familiar object is called stereognosis. This is an important function of the dorsal columnmedial lemniscus system. @2. The spinal tract involved with the control of trunk muscles is the (A) cuneocerebellar (B) vestibulospinal (C) ventral corticospinal (D) lateral corticospinal 2C. The ventral corticospinal tract is concerned with the control of axial muscles, including the muscles of the trunk and head. @3. The sensation produced by a wisp of cotton on ones fingertip is mediated by the (A) cuneocerebellar tract (B) dorsal columnmedial lemniscus pathway (C) ventral spinocerebellar tract (d) ventral spinothalamic tract 3d. The ventral spinothalamic tract is concerned with light touch, the sensation produced by stroking glabrous skin with a wisp of cotton. @4. First-order neurons of the ventral spinocere- bellar tract (A) are found in dorsal root ganglia at all levels (B) provide the afferent limb for muscle stretch reflexes (C) project axons into the medial root entry zone (D) give rise to the fasciculus cuneatus B. First-order neurons of the ventral spinocerebellar tract provide the afferent limb for muscle stretch reflexes. They are found in the dorsal root ganglia from L1 to S2 and synapse on spinal border cell. First-order neurons of the ventral spinothalamic and dorsal spinocerebellar tracts project axons into the medial root entry zone; first-order neurons of the dorsal columnmedial lemniscus pathway give rise to the fasciculus gracilis and cuneatus; and first-order neurons of the lateral spinothalamic tract project axons via the dorsolateral tract of Lissauer. @5. Acute-stage upper motor neuron lesions result in (A) hypertonia (B) spastic paresis (C) flaccid paralysis (D) extensor toe response Ans C. Acute-stage upper motor neuron lesions result in transient spinal shock, which

includes flaccid paralysis, areflexia, and hypotonia. Chronic-stage lesions result in spastic paresis, hyper- tonia, reduction or loss of superficial abdominal and cremasteric reflexes and extensor toe response, and clonus. @6. Which of the following tracts Contains axons from the giant cells of Deiters . (A) Cuneocerebellar tract . (B) Vestibulospinal tract . (C) Dorsal spinocerebellar tract . (D) Lissauer tract . Ans B The vestibulospinal tract arises from the giant cells of Deiters found in the ipsilateral lateral vestibular nucleus of the pons. The vestibulospinal tract facilitates extensor muscle tone.

@7. Which of the following tracts Is the upper extremity equivalent of a tract that arises from the cells of Clarke column . (A) Cuneocerebellar tract . (B) Cuneate fasciculus . (C) Dorsal spinocerebellar tract . (D) Lateral corticospinal tract . 7A. The cuneocerebellar tract is the upper extremity equivalent of the dorsal spinocerebellar tract, which arises from the cells of the Clarke column. The cuneocerebellar tract arises from cells of the accessory cuneate nucleus, a homolog of the nucleus of Clarke.

@8. Which of the following tracts Conveys nociceptive input from the contralateral side of the body . (A) Cuneocerebellar tract . (B) Lateral spinothalamic tract . (C) Dorsal spinocerebellar tract . (D) Lateral corticospinal tract . . Ans B The lateral spinothalamic tract conveys nociceptive input from the contralateral side of the body.

. @9. Which of the following tracts Contains axons from the giant cells of Betz (A) Cuneocerebellar tract . (B) Cuneate fasciculus . (C) Dorsal spinocerebellar tract . (D) Lateral corticospinal tract . 9D. The lateral corticospinal tract contains axons from the giant cells of Betz. The giant pyram- idal cells of Betz are found in the precentral gyrus and in the anterior paracentral lobule

@10. Which of the following tracts Contains ipsilateral pain fibers that have their second-order neurons in the dorsal horn . (A) Cuneocerebellar tract . (B Lissauer tract . (C) Dorsal spinocerebellar tract . (D) Vestibulospinal tract 10b. The dorsolateral tract of Lissauer contains ipsilateral pain fibers that have their second- order neurons in the dorsal horn. @11. Which of the following tracts Projects to the cerebellum via the inferior cerebellar peduncle . (A) Cuneocerebellar tract . (B) Cuneate fasciculus . (C) Dorsal spinocerebellar tract . (D) Lateral corticospinal tract Ans C The dorsal spinocerebellar tract projects unconscious proprioceptive information (muscle spindles and GTOs) to the cerebellum via the inferior cerebellar peduncle.

12. Which of the following tracts Mediates pain and temperature sensation a) Dorsal spinocerebellar tract b) Lateral corticospinal tract

c) Lateral spinothalamic tract d) Lissauer tract Ans C The lateral spinothalamic tract lies between the ventral spinocerebellar tract and the ventral horn. It mediates pain and temperature sensation. @13. Cells of origin are found in the precentral gyrus . (A) Cuneocerebellar tract . (B) Cuneate fasciculus . (C) Dorsal spinocerebellar tract . (D) Lateral corticospinal tract . . Ans D The lateral corticospinal tract has its cells of origin in the premotor, motor, and sensory cortices. The precentral gyrus and the anterior paracentral lobule are motor cortices and contain the motor homunculus. The lateral corticospinal gives rise to one-third of the fibers of the corti- cospinal (pyramidal) tract.

@ Which of the following tracts Mediates two-point tactile discrimination from the hand . (A) Lissauer tract . (B) Cuneate fasciculus . (C) Dorsal spinocerebellar tract . (D) Lateral corticospinal tract

Ans B The fasciculus cuneatus mediates two-point tactile discrimination from the hand.

@15. Which of the following tracts Myelination is not fully achieved until the end of the second year . (A) Cuneocerebellar tract . (B) Cuneate fasciculus . (C) Dorsal spinocerebellar tract

. (D) Lateral corticospinal tract

Ans D The corticospinal (pyramidal) tracts are not fully myelinated until the end of the second year. For this reason, the Babinski sign may be elicited in young children.

@16. Which of the following tracts Transection results in spasticity . (A) Cuneocerebellar tract . (B) Cuneate fasciculus . (C) Dorsal spinocerebellar tract . (D) Lateral corticospinal tract

Ans d Transection of the lateral corticospinal tract results in spastic paresis (exaggerated MSRs and clonus).

@17. Which of the following tracts Plays a role in regulating extensor tone . (A) Cuneocerebellar tract . (B) Cuneate fasciculus . (C) Dorsal spinocerebellar tract . D) Vestibulospinal tract

17D. The vestibulospinal (lateral) tract, found ventral to the ventral horn, plays a role in regu- lating extensor tone.

@18. Which of the following tracts Transmits vibration sensation from the ankle . (A) Cuneocerebellar tract . (B) Cuneate fasciculus . (C) fasciculus gracilis

. (D) Lateral corticospinal tract

18C. The fasciculus gracilis transmits vibratory sensation (pallesthesia) from the lower extremi- ties.

@1. Which of the following reflexes is monosynaptic? (A) Achilles reflex (B) Babinski reflex (C) Corneal reflex (D) Extensor plantar reflex 1A. The Achilles reflex, or ankle jerk reflex, is a myotatic monosynaptic reflex that is mediated by cord segment S1. @2. The spinal cord of a newborn baby terminates at (A) VL1 (B) VL3 (C) VS1 (D) VS3 2B. In the newborn, the spinal cord ends at the level of the third lumbar vertebra (VL3). In the adult, the spinal cord ends at the lower border of the first lumbar vertebra (VL1), and the dural cul-de-sac ends at the level of the second sacral vertebra (VS2). The pia mater is the innermost meningeal layer of the spinal cord; spinal cord, pia mater, arachnoid, dura mater, ligamenta flava, periosteum. @3. Which spinal nerve rami contain unmyeli- nated postganglionic sympathetic nerve fibers? (A) White communicating (B) Dorsal primary (C) Gray communicating (D) Ventral primary 3D. Gray communicating rami contain unmyelinated preganglionic sympathetic fibers, where- as white communicating rami contain myelinated preganglionic sympathetic fibers and myeli- nated GVA fibers. The meningeal ramus innervates the meninges and vertebral column; the dor- sal primary ramus innervates the skin and muscles of the back; and the ventral primary ramus innervates the ventral lateral muscles and skin of the trunk, extremities, and visceral organs. @4. The efferent limb of a myotatic reflex includes a (A) ventral horn motor neuron (B) muscle spindle (C) dorsal root ganglion neuron (D) lateral horn visceromotor nucleus 4A. The myotatic reflex is a monosynaptic and ipsilateral MSR (incorrectly called a deep tendon reflex). The efferent limb consists of the axon of a ventral horn alpha motor neuron that inner- vates striated muscle fibers (effector); the afferent limb consists of a muscle spindle (receptor) and an Ia fiber (axon) of a dorsal root ganglion neuron. The quadriceps (patellar) and triceps surae (ankle) MSRs are myotatic reflexes.

@5. Which of the following spinal cord levels Contains preganglionic parasympathetic neu- rons (A) Cervical cord ( B) Upper thoracic cord (C) Lumbar cord (D) Sacral cord 5d. The sacral cord contains the sacral parasympathetic nucleus (S2S4); this gives rise to pre- ganglionic fibers that synapse in the intramural ganglia of the pelvic viscera. @6. Which of the following spinal cord levels Contains the brachial plexus (A) Cervical cord B) Upper thoracic cord (C) Lumbar cord (D) Lower thoracic cord (E) Coccygeal cord 6A. The cervical cord contains massive ventral horns, which give rise to the brachial plexus (C5C8) @7. Which of the following spinal cord levels Has a ciliospinal center of Budge (A) Cervical cord ( B) Upper thoracic cord (C) Lumbar cord (D) Lower thoracic cord 7B. The ciliospinal center of Budge is found in the lateral horn at T1. This sympathetic nucleus innervates the radial muscle of the iris (dilator pupillae) and the nonstriated superior and inferi- or tarsal (Mller) muscles.

@8. Which of the following spinal cord levels Contains the spinal accessory nucleus (CN XI) (A) Cervical cord B) Upper thoracic cord

(C) Lumbar cord (D) Lower thoracic cord 8A. The spinal accessory nucleus extends from C1 to C6 and gives rise to the spinal root of the spinal accessory nerve; it innervates the sternocleidomastoid and trapezius muscles.

@9. Which of the following spinal cord levels Contains the phrenic nucleus (A) Cervical cord B) Upper thoracic cord (C) Lumbar cord (D) Lower thoracic cord 9A. The phrenic nucleus extends from C3 to C6 and innervates the diaphragm.