Practice Quiz - Deep Back & Spinal Cord
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  1. The part of a spinal nerve that supplies the true back muscles and the skin overlying them is the:
    dorsal primary ramus
    dorsal root
    ventral primary ramus
    ventral root
  2. Which is a source of axons found in the dorsal primary ramus of the 4th thoracic spinal nerve?
    Afferent neurons arising from the skin overlying the trapezius muscle
    Somatic motor neurons supplying the levator scapulae muscle
    Somatic motor neurons supplying the rhomboid muscles
    Somatic motor neurons supplying the trapezius muscle
  3. A football player suffers a herniated (ruptured) intervertebral disk in his neck. The disk compresses the spinal nerve exiting through the intevertebral foramen between the 5th and 6th cervical vertebrae. Which spinal nerve is affected?
    C 4
    C 5
    C 6
    C 7
    C 8
  4. A man has a herniated intervertebral disk between the fourth and fifth lumbar vertebrae. If this disk compresses the spinal nerve in the intervertebral foramen immediately posterior to this disk, which spinal nerve would be affected?
    L 3
    L 4
    L 5
    S 1
    S 2
  5. Kyphosis is an accentuated or abnormal curvature of which region of the spine?
    cervical
    thoracic
    lumbar
    sacral
    coccygeal
  6. Both the dural sac and the subarachnoid space end at which vertebral level?
    L 4
    L 5
    S 2
    S 1
    S 4
  7. It is decided to image the spinal cord and spinal nerve rootlets by doing a myelogram (injection of a radio-opaque dye into the subarachnoid space followed by a radiograph). In order to inject the dye without injury to the spinal cord, the injection is usually done below what vertebral level?
    L 1
    L 2
    L 3
    L 4
    L 5
  8. The myelogram revealed that the dye had leaked out along the spinal nerves in the mid cervical region on the right side. For the dye to leak out, what layer must have been torn or ruptured?
    arachnoid
    denticulate ligament
    periosteum
    pia
    perineurium
  9. The myelogram also revealed that the dorsal and ventral rootlets of the 5th and 6th cervical nerves had been avulsed (torn or pulled out) from the spinal cord on the right side. Which nerve fibers would not be damaged by the avulsion?
    general somatic afferent
    general somatic efferent
    preganglionic sympathetic
    postganglionic sympathetic
  10. It was noted that after the injury the patient's face on the right side was flushed due to dilation of the blood vessels. The lack of vasoconstriction was due to interruption of what fibers somewhere along their course?
    somatic afferent
    somatic efferent
    parasympathetic
    sympathetic
  11. The intervertebral disk
    is found between all adjacent vertebrae
    adds about 1/4th to entire length of vertebral column
    is a type of synovial joint within the vertebral column
    contains a compressible liquid center
    is perforated by the needle when performing a spinal tap
  12. The conus medullaris:
    exhibits both a cervical and lumbar enlargement
    has a modification of neural tissue extending from its termination to the coccygeal ligament
    gives origin to most of the cauda equina
    is found at its lowest extent at S2
    is normally anesthetized to perform a spinal tap
  13. A neuron with a cell body in the dorsal root ganglia could convey what type of fibers?
    motor to the deep back muscles
    motor to the pectoralis major muscle
    sensory from the skin overlying the trapezius
    sympathetic preganglionics to the suprarenal medulla
    visceral efferents to the stomach
  14. The denticulate ligament:
    is a modification of pia mater
    is found between all dorsal and ventral roots
    attaches to the dural sac continuously
    has its terminal attachment at S2
    holds the radicular arteries in place
  15. A patient is suspected of having bacterial meningitis. As part of the diagnostic procedure, a lumbar puncture is to be performed. The attending physician asks you where she should insert the spinal needle to withdraw CSF. You answer, "just below the spine of the 4th lumbar vertebra." What reference point would you use to identify the spine?
    Crest of the ilium
    Ischial tuberosity
    Pubic symphysis
    Umbilicus
    Xiphoid process
  16. As the spinal needle in the above question is being inserted, which ligament would it pass through on its way to the subarachnoid space?
    Anterior longitudinal
    Denticulate
    Ligamentum nuchae
    Posterior longitudinal
    Supraspinous
  17. Because of their structure and interconnections, which veins are especially important in the metastatic spread of cancer?
    Basilic
    Cephalic
    Dorsal scapular
    Internal vertebral venous plexus
    Transverse cervical
  18. The number of vertebrae and number of spinal cord segments are the same in each region except:
    Cervical
    Thoracic
    Lumbar
    Sacral
  19. The subtrapezial plexus of nerves includes:
    C3, C4 and the dorsal scapular nerve
    C3, C4 and the accessory nerve
    C3, C4 and nerve to levator scapulae
    Accessory and dorsal scapular nerves
    Accessory nerve and nerve to levator scapulae
  20. If in the process of doing a lumbar puncture a spinal needle was inserted posteriorly in the midline until it had just penetrated the posterior longitudinal ligament, would the needle have entered the subarachnoid space?
    Yes
    No
  21. While moving into a new apartment a student lifting a heavy box of books experiences a sharp pain in his back, radiating down the anterior thigh and medial side of his leg. After several days of misery, he finally goes for treatment and is told that he has a herniated intervertebral disk at the L 4 level which is compressing a spinal nerve where it exits the vertebral column. The point of compression is the:
    Central canal
    Foramen magnum
    Hiatus of the sacral canal
    Intervertebral foramen
    Vertebral foramen
  22. Which muscle is innervated by posterior primary rami?
    Latissimus dorsi
    Levator scapulae
    Rhomboideus major
    Erector spinae
    Trapezius
  23. The spinal cord is segmented like the vertebral column, but in contrast to the vertebrae, there are only _____ cord segments
    28
    29
    30
    31
    32
  24. A patient is suspected of having bacterial meningitis. A lumbar puncture is performed to remove cerebrospinal fluid (CSF) for analysis. If done properly, the needle used for the tap would penetrate all layers except:
    Arachnoid mater
    Epidural fat
    Dura mater
    Pia mater
    Supraspinous ligament
  25. Quasimoto, the "Hunchback of Notre Dame," suffered from an abnormal thoracic curvature called kyphosis. In this condition the accentuated convexity of the curvature is:
    Anterior
    Caudal
    Lateral
    Medial
    Posterior
  26. A patient is suspected of having bacterial meningitis. A lumbar puncture is performed to remove cerebrospinal fluid (CSF) for analysis. The fluid would be removed from the:
    Epidural space at the level of L3
    Intervertebral foramen at the level of L2
    Spinal canal at level of L 3
    Subdural space at the level of L4
    Subarachnoid space at the level of L4
  27. A 60-year-old male presented with a number of unusual signs and symptoms in the facial region. Among others, it was found that the right side of his face was flushed (red). Further testing revealed a lack of ability to sweat in the same cutaneous region. Which nervous structures were most likely implicated in this set of clinical abnormalities?
    Cranial outflow of the ANS
    Dorsal roots of cervical nerves
    Gray rami communicantes of T 5
    Sympathetic nerve fibers
    Vagus nerves
  28. In the lumbar spine, the L4 nerve root sleeve exits:
    above the pedicle of L4 and at the top of the intervertebral foramen
    above the pedicle of L4 and at the bottom of the intervertebral foramen
    below the pedicle of L4 and at the top of the intervertebral foramen
    below the pedicle of L4 and at the bottom of the intervertebral foramen
  29. Which structure does NOT contain efferent autonomic nerve fibers?
    Dorsal ramus of C4
    Dorsal root of T6
    Ventral root of T3
    Ventral ramus of L2
  30. In order to expose the spinal cord from the posterior side, it is necessary to remove the:
    Laminae, pedicles and ligamenta flavum
    Laminae, spinous processes and ligamenta flavum
    Pedicles, spinous processes and posterior longitudinal ligament
    Transverse processes, pedicles and ligamenta flavum
  31. In an adult, the conus medullaris of the spinal cord is normally positioned at which vertebral body levels:
    T10-T12
    T12-L2
    L2-L4
    L5-S1
  32. Inserting a spinal tap needle in the lumbar region, in the midline, you hear and feel a 'pop' at the needle tip. What structure was perforated to cause the 'pop?'
    intervertebral disk
    anterior longitudinal ligament
    ligamentum flavum
    dura mater
    arachnoid mater
  33. Prostate cancer is diagnosed in an 82 year old male. Thereafter a malignant brain tumor of prostatic origin is found. He subsequently dies. An autopsy reveals tumor sites in the prostate, vertebral column, and brain, but no other organs. By what vascular pathway did the cancerous cells get to the brain:
    anterior spinal artery
    vertebral venous plexus
    azygos venous system
    vertebral artery
    thoracic duct
  34. Which of the following statements about the artery of Adamkiewicz is not correct?
    It is also known as the artery of the lumbar enlargement
    It is a radicular (or radiculomedullary) artery in the lower thoracic or upper lumbar region
    It is most frequently found on the left side
    It has extensive collateralization (anastomoses) on the surface of the thoracic spinal cord
    It passes along the surface of a ventral root of a spinal nerve to reach the cord
  35. A 45-year-old man complained to his physician that the muscles of his upper limb were weak and he felt clumsy while walking. Tests revealed that he had amyotrophic lateral sclerosis (Lou Gehrig's disease), a disease which attacks the neurons of the voluntary motor system. Where would one expect to see atrophic or degenerated nerve cell bodies?
    Dorsal horn of the spinal cord
    Dorsal root ganglion
    Lateral horn of the spinal cord
    Sympathetic chain ganglia
    Ventral horn of the spinal cord
  36. A patient is diagnosed as having a venous anomaly of the posterior spinal veins which have enlarged, putting pressure on the spinal cord. In order to expose the veins, the surgeon will have to pass through the skin, subcutaneous tissue, deep back muscles and then, in order, the:
    Laminae and ligamenta flava, posterior longitudinal ligament, epidural space, dura, subdural space, arachnoid, subarachnoid space, pia
    Pedicles and ligamenta flava, epidural space, dura, subdural space, arachnoid, subarachnoid space, pia.
    Laminae and ligamenta flava, epidural space, dura, subdural space, arachnoid, subarachnoid space, pia.
    Pedicles, posterior longitudinal ligament, epidural space, dura, subdural space, arachnoid, subarachnoid space, pia.
    Laminae and ligamenta flava, epidural space, pia.
  37. A University student comes to the Emergency Room with a high fever, lethargy and a stiff neck. After further examination, meningitis is suspected and a lumbar puncture is ordered. What landmark could be used to insert the spinal needle between the 4th and 5th lumbar vertebral spines?
    Anterior superior iliac spine
    Costal margin
    Iliac crest
    Transpyloric plane
    Umbilicus
  38. If one does a laminectomy (removing the laminae of two adjacent vertebrae) to expose the spinal cord, which ligament must be removed?
    anterior longitudinal
    denticulate
    ligamentum flavum
    ligamentum nuchae
    posterior longitudinal
  39. In the final stages of labor a caudal anesthetic is sometimes given via a needle inserted into the sacral hiatus. The anesthetic is thus placed around the outside of the sacral spinal nerve roots and into the:
    Central canal
    Dural sinus
    Epidural space
    Subarachnoid space
    Subdural space