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Flashcards in ASIPP Anatomy Questions Deck (205):
1

1. Sacral splanchnics are primarily:
A. Sympathetic postganglionic fi bers
B. Parasympathetic postgangalionic fi bers
C. Sympathetic preganglionic fi bers
D. Parasympathetic preganglionic fi bers
E. Senory preganglionic fi bers

1. Answer: A
Explanation:
Sacral splanchnics refer to sympathetic fi bers traveling to
the hypogastric plexuses. Another name for the superior
hypogastric plexus is the presacral nerve.
Source: Boswell MV, Board Review 2005

2

2. The most common form of inguinal hernia begins
A. At the deep inguinal ring
B. Medial to the epigastric artery
C. Travels through the inguinal triangle
D. Entraps the genitofemoral nerve
E. Rarely enters the scrotum

2. Answer: A
Explanation:
Direct inguinal hernias pass through the inguinal triangle,
which is an area of weak fascia. They almost never go into
the scrotum. Both the superfi cial inguinal ring and the
inherent weakness of abdominal wall lateral to the falx
inguinalis make this area susceptible to hernias. Indirect
inguinal hernias start at deep inguinal ring, pass down
inguinal canal, through superfi cial ring, and, in the male,
usually descend into scrotum along with the spermatic
cord. In the female they travel along the round ligament.
Source: Boswell MV, Board Review 2005

3

3. The obturator nerve innervates which of the following
muscles?
A. Gracilis
B. Sartorius
C. Rectus Femoris
D. Pectineus
E. Vastus Medialis

3. Answer: A
Source: Day MR, Board Review 2005

4

4. What is true about the superfi cial cervical plexus?
A. Blocks of this plexus are useful for upper airway laryngoscopy
B. One branch is the suprascapular nerve
C. One branch is the lesser occipital nerve
D. Needle insertion is between the anterior and middle
scalene muscles
E. There is a very high risk for intrathecal injections

4. Answer: C
Explanation:
(Raj, Pain Medicine Review, 2nd Ed., pages 232-236)
Blocks of the superior laryngeal nerve are useful for upper
airway laryngoscopy (above the vocal cords). Blocks of the
recurrent laryngeal nerve are useful for tracheal
procedures (below the vocal cords). The suprascapular
nerve originates from C5,6 and goes posteriorly to
innervate the supraspinatus and infraspinatus (with
sensory input from the shoulder joint). The lesser
occipital, greater auricular, transverse cervical, and
supraclavicular nerves originate from C2, C3, C4 and
comprise the superfi cial cervical plexus. An interscalene
brachial plexus block is performed through the anterior
and middle scalene muscles. There is a low risk of
intrathecal injections compared to a deep cervical plexus
block.
Source: Shah RV, Board Review 2005

5

5. Which of the following is true about the auriculotemporal
nerve?
A. It is a branch of the mandibular division of trigeminal
ganglion
B. It is anterior to the superfi cial temporal artery
C. It is posterior to the external auditory meatus
D. Blocking it would alleviate pain when the earlobe undergoes
piercing
E. It provides sensation to the cheek

5. Answer: A
Explanation:
(Raj, Pain Review 2nd Ed., page 229)
The auriculotemporal nerve originates from the V3 branch
of the trigeminal ganglion. It travels posterior to the
superfi cial temporal artery and anterior to the external auditory meatus. It receives sensation from the TMJ,
parotid gland, external auditory meatus, tympanic
membrane, tragus (not earlobe), and skin over the
temporal area.
Source: Shah RV, Board Review 2005

6

6. You perform a glossopharyngeal nerve block. Which of the
following is not likely to be related to the block?
A. Torticollis
B. Seizure
C. Hoarseness
D. Dysphagia
E. Diffi culty with smiling

6. Answer: E
Explanation:
(Raj, Pain Medicine Review, 2nd Ed. Page 232)
The glossopharyngeal nerve exits the jugular foramen
along with cranial nerves X and XI. Hence one can develop
dysphagia (IX), hoarseness (X), and torticollis (XI).
Seizures can occur as a consequence of intra-arterial
injection into the carotid. Diffi culty with smiling occurs
with palsy of cranial nerve VII which exits through the
stylo-mastoid foramen.
Source: Shah RV, Board Review 2005

7

7. Blockade of the brachial plexus via the interscalene
approach commonly misses what nerve?
A. Median
B. Axillary
C. Radial
D. Ulnar
E. Musculocutaneous

7. Answer: D
Source: Day MR, Board Review 2005

8

8. Lower esophageal pain can be improved by blocking spinal
nerve roots at which levels?
A. T2 - T3
B. T3 - T5
C. T5 -T9
D. T10 - T11
E. T11 - T12

8. Answer: C
Explanation:
Innervation by lower thoracic splanchnics and vagus
afferents
Raj. Chapter 43. Thoracoabdominal Pain. In: Practical
Management of Pain 3rd Edition, Raj et al, Mosby, 2000
Source: Boswell MV, Board Review 2005

9

9. Of the following nerve block techniques, which one
produces anesthesia of ALL of terminal branches of the
brachial plexus?
A. Interscalene
B. Supraclavicular
C. Axillary
D. Deep cervical
E. Superfi cial cervical

9. Answer: B
Source: Day MR, Board Review 2005

10

10. Structures innervated by the inferior hypogastric plexus
include
A. Uterus
B. Bladder
C. Rectum
D. Scrotum
E. Vagina

10. Answer: A
Explanation:
The uterus is innervated by the sympathetics passing
inferiorly via the inferior hypogastric plexus.The other
organs listed are innervated by the pelvic splanchnics,
arising from the sacral roots or the pudendal nerve.
Source: Boswell MV, Board Review 2005

11

11. Which of the following is the most important center of
sympathetic and parasympathetic distribution to the
pelvis?
A. Superior hypogastric plexus
B. Inferior hypogastric plexus
C. Pelvic splanchnic nerves
D. Pudendal nerve
E. Nervi erigentes

11. Answer: B
Explanation:
The superior hypogastric plexus sends sympathetics to the
inferior hypogastric plexus, the inferior hypogastric
plexus receives parasympathetics from the pelvic
sphlancnics
Source: Boswell MV, Board Review 2005

12

12. The web space between the great toe and the second toe is
innervated by what nerve?
A. Sural
B. Saphenous
C. Superfi cial peroneal
D. Deep peroneal
E. Posterior tibial

12. Answer: D
Explanation:
The deep peroneal nerve innervates the short extensors of
the toes and the skin of the web space between the great
and second toe.
The deep peroneal nerve is blocked at the ankle by
infi ltration between the tendons of the anterior tibial and
extensor hallucis longus muscle.
Source: Day MR, Board Review 2005

13

13. The preganglion cell bodies of the sympathetic nervous
system are located where in the spinal cord?
A. Dorsal columns
B. Lateral spinothalamic tract
C. Intermediolateral cell column
D. Substantia gelatinosa
E. Rexed laminae IV

13. Answer: C
Source: Day MR, Board Review 2005

14

14. Stellate ganglion is:
A. Combination of C7-T1 ganglion
B. Combination of C8-T1 ganglion
C. Combination of C7-C8
D. Sits on C6 transverse process
E. Located under the longus coli muscle

14. Answer: A
Source: Racz G. Board Review 2003

15

15. Anatomically, the celiac plexus is located anterolateral to
the aorta at which level?
A. Above the diaphragm at T10
B. At the crura of the diaphragm at L1
C. At the bifurcation of the aorta at L4
D. Above the crura of the diaphragm at T12
E. Surrounding then superior mesenteric artery

15. Answer: B
Source: Boswell MV, Board Review 2005

16

16. The lateral cord of the brachial plexus is formed by which
of the following divisions?
A. Anterior divisions of the superior and middle trunks
B. Posterior divisions of the superior, middle, and inferior
trunks
C. Anterior division of the inferior trunk
D. Anterior division of the superior trunk and posterior
division of the middle trunk
E. Posterior divisions of the middle and inferior trunks

16. Answer: A
Source: Day MR, Board Review 2005

17

17. T5-T12 sympathetic ganglia transmit nociceptive afferents
from the upper abdominal organs with which of the
following?
A. Renal plexus
B. Celiac plexus
C. Cardiac plexus
D. Pulmonary plexus
E. Hypogastric plexus

17. Answer: B
Source: Boswell MV, Board Review 2005

18

18. In terms of surface anatomy, a line connecting the inferior poles of both scapulae would intersect which vertebral
body?
A. C7
B. T3
C. T7
D. T10
E. T12

18. Answer: C
Explanation:
(Raj, Pain Review 2nd Ed., page 216)
The line connecting the inferior poles of both scapula
would intersect T7.
Source: Shah RV, Board Review 2005

19

19. The purpose of the cavernous nerves of the penis is to
provide:
A. Sympathetics and allow for erection
B. Parasympathetics and allow for ejaculation
C. Parasympathetics and allow for erection
D. Sympathetics and allow for ejaculation
E. Sensory afferent muscular tone

19. Answer: C
Explanation:
Parasympathetic is point and sympathetic is shoot.
Source: Boswell MV, Board Review 2005

20

20. Which of the techniques for blockade of the brachial
plexus has the highest incidence of pneumothorax?
A. Interscalene
B. Supraclavicular
C. Infraclavicular
D. Axillary
E. Deep Cervical

20. Answer: B
Source: Day MR, Board Review 2005

21

21. Motor stimulation of the peroneal nerve elicits what
motions of the foot?
A. Dorsifl exion, inversion
B. Dorsifl exion, eversion
C. Plantar fl exion, inversion
D. Plantar fl exion, eversion
E. Plantar fl exion only

21. Answer: B
Source: Day MR, Board Review 2005

22

22. What is the function of the parasympathetic contribution
to the bladder?
A. Causes the detrusor muscle to relax and the sphincter
to contract
B. Causes the detrusor muscle to contract and the sphincter
to relax
C. Causes the trigone muscle to relax and the sphincter to
relax
D. Causes the detrusor muscle to contract and the sphincter
to contract
E. Causes the trigone muscle to contractd and the detrusor
to contract

22. Answer: B
Explanation:
Cholinergic tone allows for micturation.
Anticholinergics can cause urinary retention.
Source: Boswell MV, Board Review 2005

23

23. Meralgia paresthetica is caused by compression of what
nerve?
A. Obturator
B. Sural
C. Common peroneal
D. Lateral fermoral cutaneous
E. Genitofemoral

23. Answer: D
Source: Day MR, Board Review 2005

24

24. Which of the following most accurately describes the
pelvic splanchnics nerves?
A. S3-S4, preganglionic sympatehtic fi bers
B. S1-S2, postganglionic sympathetic fi bers
C. S2-S4, preganglionic parasympathetic fi bers
D. T1-L2/L3, postganglionic sympathetic fi bers
E. T1-L2/L3, preganglionic parasympathetic fi bers

24. Answer: C
Explanation:
C. The pelvic splanchnics are parasympathetic fi bers
arising from the sacral segments.
Source: Boswell MV, Board Review 2005

25

25. Which of the following nerves is not a branch of the sciatic
nerve?
A. Superfi cial peroneal
B. Saphenous
C. Deep peroneal
D. Posterior tibial
E. Sural

25. Answer: B
Source: Day MR, Board Review 2005

26

26. A patient is going to undergo a gastrectomy. Where would
you like the tip of the epidural catheter to be placed?
A. T3
B. T5
C. T10
D. T12
E. L1

26. Answer: B
Explanation:
(Raj, Pain Review 2nd Ed., page 272)
With a gastrectomy the incision may be extended up to the
xiphoid process. This can be extremely painful if the
catheter is placed to low. Hence T10, T12, L1 catheters may
be able to cover some of the pain but it would be
insuffi cient. Higher concentrations and volumes would be
needed to cover the xiphoid which could put the patient at
undue risk of hypotension, muscle weakness, and sensory
loss. A catheter at T3 may be appropriate for thoracic
surgery but not for upper abdominal surgery.
Source: Shah RV, Board Review 2005

27

27. Which of the following is true of neural tube
development?
A. Closure of the neural tube proceeds in a craniocaudal
sequence
B. The basic organization of the neural tube features
peripheral neuronal cell bodies and centrally located
myelinated processes
C. The primitive neurectoderm cells of the neural tube give
rise to both neuron and all glial components
D. During development, neuronal and glial precursors are
born near the central canal and migrate to the periphery
E. Mature neurons migrate out of the spinal cord to form
the sensory ganglia

27. Answer: D
Explanation:
(Moore, Developing Human, 6/e, pp 452-456.) After
closure of the neural tube, cells proliferate and establish
three primitive layers: (1) the ventricular zone adjoining
the central canal and ventricles; mitoses of neuronal and
glial precursors continue in this zone; (2) a mantle zone
consisting of cell bodies of neurons and glia that have
migrated out of the ventricular zone; and (3) a marginal
zone on the periphery containing the myelinated nerve
processes characteristic of white matter. Closure of the
neural tube begins near the midpoint of its length and
proceeds in both directions simultaneously. The
neurectoderm of the neural tube will give rise to neurons
and some glial cells (astrocytes, oligodendroglia, and
ependymal cells), but the precursors of microglia (the
monocyte-macrophage lineage) migrate into the nervous
system from the blood. The sensory ganglia are formed by
neural crest cells that migrated before the development of
mature neurons.
Source: Klein RM and McKenzie JC 2002.

28

28. Which of the following cranial nerves exists the brain stem
from its dorsal aspects?
A. Oculomotor nerve
B. Facial nerve
C. Trigeminal nerve
D. Glossopharyngeal nerve
E. Trochlear nerve

28. Answer: E
Explanation:
The trochlear nerve is purely a motor nerve and is the only
cranial nerve to exist the brain dorsally. The trochlear
nerve supplies one muscle: the superior oblique. The cell
bodies that originate in the trochlear nerve are located in
the ventral part of the brain stem in the trochlear nucleus.
The trochlear nucleus gives rise to fi bers that cross to the
other side of the brain stem just prior to exiting the pons.
Thus, each superior oblique muscle is supplied by nerve
fi bers from the trochlear nucleus of the opposite side. The
nerve travels in the lateral wall of the cavernous sinus and
then enters the orbit via the superior orbital fi ssure. It
passes medially and diagonally across the levator palpebral
superioris and superior rectus muscles to innervate the
superior oblique. (Parent, 531)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

29

29. The deep peroneal nerve provides cutaneous innervation
to what part of the foot?
A. Lateral aspect
B. The entire dorsum
C. The plantar surface
D. The web space between the Great and 2nd toes
E. The web space between the 3rd and 4th toes

29. Answer: D
Source: Day MR, Board Review 2006

30

30. The sympathetic component of the sphenopalatine
ganglion travel to the ganglion via what nerve?
A. Greater petrosal nerve
B. Palatine nerves
C. Maxillary nerve
D. Deep petrosal nerve
E. Mandibular nerve

30. Answer: D
Source: Day MR, Board Review 2005

31

31. You are asked to insert a needle approximately 2-3 cm
medial to the ASIS and 2-3 cm inferior to this point. The
insertion should be above the inguinal ligament. A ‘pop’
may be felt as you insert your needle to identify the right depth. What nerve are you most likely going to block?
A. Genitofemoral
B. Iliohypogastric
C. Ilioinguinal
D. Lateral femoral cutaneous
E. Obturator nerve block

31. Answer: C
Explanation:
(Raj, Pain Review 2nd Ed.)
A.The genitofemoral nerve is approached by inserting the
needle just lateral to the pubic tubercle. The needle is
advanced through the inguinal ligament.
B.The iliohypogastric lies 3 cm medial to the ASIS, but the
needle is aimed towards the umbilicus.
C.The ilioinguinal nerve is approximately 2-3 cm medial
and 2-3 cm inferior to the ASIS, but above the inguinal
canal.Typically one may feel a ‘pop’ as the needle passes the
internal oblique and lies between the internal oblique and
transverses abdominis.
D.The lateral femoral cutaneous nerve is approached 2cm
medial and inferior to the ASIS but the needle is inserted
below the inguinal ligament. The needle is advanced
through the fascia lata with a pop and loss of resistance.
Note that if you advance the needle further and feel a
second pop, then you have gone through the fascia iliaca.
This is approximately how one would perform a fascia
iliaca block in order to avoid the femoral nerve block.
Source: Shah RV, Board Review 2003

32

32. The portion of the upper extremity that is not innervated
by the brachial plexus is:
A. Posterior medial portion of the arm
B. Anterior and posterior aspects of elbow
C. Lateral portion of the forearm
D. Medial portion of the forearm
E. Anterolateral portion of the arm

32. Answer: A
Explanation:
The arm receives sensory innervation from the brachial
plexus except for the shoulder, which is innervated by the
cervical plexus, and the posterior medial aspect of the arm,
which is supplied by the intercostobrachial nerve.

33

33. The greater occipital nerve is a branch of:
A. Posterior ramus of C2
B. Posterior ramus of C1
C. Anterior ramus of C1
D. Anterior ramus of C2
E. Anterior ramus of C2 and C3

33. Answer: A
Explanation:
The skin over the posterior part of the neck, upper back,
posterior part of the scalp upto the vertex is supplied
segmentally by the posterior rami of the C2 to C5.
A. The Greater occipital nerve is a branch of the posterior
of ramus of C2.
The lesser occipital nerve is a branch of the posterior
ramus of C2 and C3.
Headaches due to occipital neuralgia are characterized
by either continuous pain or paroxysmal lancinating pain
in the distribution of the nerve.
The etiology of occipital neuralgia is compression of
the C2 nerve root, migraine or nerve entrapment.
An occipital nerve block maybe performed as a diagnostic
or therapeutic measure.
Source: Chopra P. 2004

34

34. The muscles of the back receive motor innervation from
A. Dorsal roots
B. Dorsal primary rami
C. Gray rami communicantes
D. Splanchnic nerves
E. Ventral primary rami

34. Answer: B
Explanation:
A.The dorsal roots convey sensation to the spinal cord.
B.The axial musculature of the back receives innervation
from the dorsal primary rami of the spinal nerves.
D.The splanchnic nerves and gray rami communicantes
are components fo the sympathetic division of the
autonomic nervous sytem.
E.The ventral primary rami contribute to the cervical
plexus, brachial plexus, intercostal nerves, and the
lumbosacral plexus.

35

35. Which of the following is the most direct route for spread
of infection from the paranasal sinuses to the cavernous
sinus of the dura mater?
A. Pterygoid venous plexus
B. Parietal emissary vein
C. Frontal emissary vein
D. Basilar venous plexus
E. Superior ophthalmic vein

35. Answer: E
Explanation:
A. The pterygoid venous plexus communicates with the
cavernous sinus via the petrosal sinuses.
B. The parietal emissary vein also communicates with the
superior sagittal sinus.
C. The frontal emissary vein communicates with the
superior sagittal sinus via the foramen cecum.
D. The basilar venous plexus communicates with the
inferior petrosal sinus.
E. The superior ophthalmic vein drains the region of the
paranasal sinuses and is directly connected with the
cavernous sinus although blood fl ow is normally away
from the brain

36

36. Myelination in the central nervous system differs from
myelination in the peripheral nervous system in
A. Its formation only during fetal development
B. The function of myelin
C. Its ultrastructural appearance
D. The involvement of oligodendrocytes
E. The involvement of astrocytes

36. Answer: D
Explanation:
Myelination in the central (CNS) and peripheral (PNS)
nervous systems occurs by similar methods, although
there are differences in the supportive cells responsible.
A. Myelin is similar in both locations but different in the
presence of Schmidt-Lanterman clefts, which only appear
in the PNS and represent the presence of Schwann cell
cytoplasm that is not displaced toward the periphery.
This provides a continuous cytoplasmic pathway from
the exterior to the interior of the myelin sheath.
Myelin is an insulator and also decreases membrane
capacitance.
White matter is high in myelin content and is named by
the presence of tracts of axons that appear white
(myelinated).
Gray matter represents neuron-rich areas low in myelin
(e.g., cell bodies).
B. Myelination occurs in both pre- and postnatal
development.
In the PNS, formation of myelin is initiated by the
invagination of an axon into a Schwann cell. A mesaxon is
formed as the outer leafl ets of the cell membrane fuse.
Subsequently, the mesaxon of the Schwann cell wraps itself
around the fi ber.
D. In the CNS, the oligodendrocytes myelinate axons,
whereas the Schwann cells conduct myelination in the
PNS.
Oligodendrocytes myelinate several axons at one time,
whereas the Schwann cells myelinate only one axon.
In the CNS, oligodendrocytes form myelin around
several axon segments compared with the 1: 1 relationship
between Schwann cells and axon segments in the PNS.

37

37. The stellate ganglion lies in closest proximity to which of
the following vascular structures?
A. Common carotid artery
B. Internal carotid artery
C. Vertebral artery
D. Axillary artery
E. Aorta

37. Answer: C
Explanation:
The stellate ganglion usually lies in front of the neck of the
fi rst rib.
C. The vertebral artery lies anterior to the ganglion as it
has just originated from the subclavian artery.
After passing over the ganglion, it enters the foramen
and lies posterior to the anterior tubercle of C6.

38

38. A cranial fracture through the foramen rotundum that
compresses the enclosed nerve (maxillary nerve) results
in the following clinical symptoms:
A. Inability to clench the jaw fi rmly
B. Regurgitation of fl uids into the nasopharynx during
swallowing
C. Paralysis of the inferior oblique muscle of the orbit
D. Loss of the sneeze refl ex
E. Uncontrolled drooling from the mouth

38. Answer: D
Explanation:
A. The mandibular division of the trigeminal nerve, which
passes through the foramen ovale, innervates the
masticatory muscles responsible for clenching the jaw as
well as the tensor palatini muscle, which assists in the
establishment of the velopharyngeal seal.
B. The other muscles of the soft palate are innervated by
the pharyngeal branch of the vagus nerve, which transits
the jugular foramen.
C. The inferior oblique muscle of the eye is innervated by
the inferior branch of the oculomotor nerve, which enters
the orbit through the superior orbital fi ssure.
D. The maxillary division of the trigeminal nerve, which
passes through the foramen rotundum, is entirely sensory.
Damage to this nerve results in sensory deprivation over
the maxillary region of the face and loss of the sneeze
refl ex.
E. The orbicularis oris and buccinator muscles are
innervated by the facial nerve, which transits the
stylomastoid foramen

39

39. The occipital portion of the skull receives sensory
innervation from
A. Spinal accessory nerve (nerve XI)
B. Facial nerve (nerve VII)
C. Ophthalmic branch of trigeminal nerve (nerve V)
D. Maxillary branch of trigeminal nerve (nerve V)
E. None of the above

39. Answer: E
Explanation:
The occiput receives sensory innervation from the
occipital nerves, which are terminal branches of the
cervical plexus.

40

40. For upper abdominal surgery, optimal epidural catheter
placement would be at which vertebral levels?
A. C7 - T2
B. T4 - T8
C. T8 - T10
D. T10- T12
E. L2- L4

40. Answer: C
Explanation:
Ref: Crews. Chapter 14. Acute Pain Syndromes. In:
Practical Management of Pain. 3rd Edition. Raj et al,
Mosby, 2000, page 178.
Source: Day MR, Board Review 2003

41

41. The muscles of the anterior compartment of the leg are
innervated primarily by which of the following nerves?
A. Deep fi bular
B. Lateral sural cutaneous
C. Saphenous
D. Superfi cial fi bular
E. Sural

41. Answer: A
Explanation:
The common fi bular (peroneal) nerve bifurcates into
superfi cial and deep branches. The deep fi bular nerve
innervates all muscles of the anterior compartment of the
leg. The superfi cial fi bular nerve emerges from the deep
fascia and descends in the lateral compartment, where it
innervates the peroneus longus and brevis muscles before
dividing into median dorsal cutaneous and intermediate
dorsal cutaneous nerves, which supply the distal third of
the leg, dorsum of the foot, and all the toes. The saphenous nerve (the terminal branch of the common femoral nerve)
distributes cutaneous branches to the anterior and medial
aspects of the leg as well as to the dorsomedial aspect of
the foot. The sural nerve follows the course of the lesser
saphenous vein and becomes the lateral sural cutaneous
nerve to supply the anterolateral aspect of the foot.
Source: Klein RM and McKenzie JC 2002.

42

42. The correct order of structures (from cephalad to caudad)
in the intercostal space is:
A. Nerve, artery, vein
B. Vein, nerve, artery
C. Vein, artery, nerve
D. Artery, nerve, vein
E. Artery, vein, nerve

42. Answer: C

43

43. The inner lining of the thoracic cage is also known as the
A. visceral pleura
B. parietal pleura
C. subcostal fascia
D. endothoracic fascia
E. external thoracic fascia

43. Answer: D
Explanation:
D. The rib cage is covered both internally and externally
by thin layers of deep fascia.
The inner layer, consisting of loose areolar tissue called
the endothoracic fascia, lines the internal aspect of the
thoracic cage.
This layer of facia covers the inner surface of the
intercostal muscles and intervening ribs, along with
the subcostal and transversus thoracis muscles andthe
diaphragm.
It lies between the parietal pleura and the thoracic cage.

44

44. Which of the following muscles of the larynx is innervated
by the external branch of the superior laryngeal nerve?
A. Vocalis muscle
B. Thyroarytenoid muscles
C. Posterior cricoarytenoid muscle
D. Oblique arytenoids muscles
E. Cricothyroid muscle

44. Answer: E
Explanation:
All other muscles of the larynx are innervated by the
recurrent laryngeal nerve.

45

45. The saphenous nerve can blocked at the medial thigh in what named canal?
A. Guyon’s
B. Alcock’s
C. Labat’s
D. Kappis’s
E. Hunter’s

45. Answer: E
Source: Day MR, Board Review 2006

46

46. Which of the following has a transverse process but not
vertebral artery foramen?
A. C1
B. C3
C. C5
D. C6
E. C7

46. Answer: E
Explanation:
(Bonica, 3rd Ed., page 970)
C7 has a transverse process but no foramen for
transmitting the vertebral artery. In fact the stellate
ganglion (C7-T1) is posterior to the artery at this level.
C3, C5, C6 all have transverse processes that transmit the
vertebral artery. C1 does have a long transverse process
that is longer than other vertebral bodies. It also has a
vertebral artery foramen. Upon leaving this level, the
vertebral artery migrates posteriorly and medially.
Source: Shah RV, Board Review 2005

47

47. The Greater splanchnic nerve is formed by?
A. T4 - T6 sympathetic nerve fi bers
B. T5 - T7 sympathetic nerve fi bers
C. T5 - T9 sympathetic nerve fi bers
D. T10 - T11 sympathetic nerve fi bers
E. T11 - T12 sympathetic nerve fi bers

47. Answer: C
Source: Boswell MV, Board Review 2005

48

48. The L4-5 facet joint is innervated by the:
A. medial branches of the L3 and L4 spinal nerves
B. medial branches of the L4 and L5 spinal nerves
C. medial branches of the L2, L3, and L4 spinal nerves
D. medial branches of the L3, L4, and L5 spinal nerves
E. medial branches of the L4, L5, and S1 spinal nerve

48. Answer: A
Explanation:
(Raj, Pain Review 2nd Ed., page 292-3)
The medial branch of the exiting spinal nerve sends a
branch to the facet joint at its level and to one level below.
In older studies some have demonstrated and ascending
branch of the dorsal ramus that innervates the level above.
However, this is not true as far as board exams go.
In this case the medial branches of the L3 and L4 nerves innervate the L4-5 zygapophyseal joint. Expect some
permutation of this kind of question
Source: Shah RV, Board Review 2005

49

49. The conus medullaris ends at T12 in which percentage of
patients?
A. 5-10%
B. 15-20%
C. 21-35%
D. Never
E. >50%

49. Answer: A
Explanation:
(Bonica, 3rd Ed., page 1480, fi gure 75-9)
The conus ends at:
T12: 6%
T12-L1: 18%
L1: 30%
L1-L2: 24%
L2: 22%
L3: rarely
Source: Shah RV, Board Review 2005

50

50. The genitofemoral nerve passes through the anterior psoas
fascia at what vertebral body level?
A. L1
B. L2
C. L3
D. L4
E. L5

50. Answer: C
Source: Day MR, Board Review 2005

51

51. Which of the following is not true about the cervical
intervertebral disc?
A. The height of the cervical intervertebral disc is twice
anteriorly as compared to posteriorly
B. The vertebral endplates bounding the intervertebral disc
are fl at
C. The nucleus pulposus is located anteriorly when compared
to those in the lumbar spine
D. The posterior longitudinal ligament is wider when compared
to its size in the lumbar spine
E. The joints of Luschka are not synovial joints.

51. Answer: B
Explanation:
(Bonica, 3rd Ed., page 372)
The vertebral endplates are fl at in the lumbar spine, but
are concave and convex. All of the other statements are
true.
The joints of Luschka or the uncovertebral joints are
degenerative clefts.
Source: Shah RV, Board Review 2005

52

52. The anterior and posterior spinal arteries originate from
the
A. Common carotid and vertebral arteries, respectively
B. Internal carotid and vertebral arteries, respectively
C. Internal carotid and posterior cerebral arteries, respectively
D. Vertebral and anterior cerebellar arteries, respectively
E. Vertebral and posterior inferior cerebellar arteries, respectively

52. Answer: E
Explanation:
The posterior spinal arteries are paired; they arise from the
posterior inferior cerebellar arteries and have 25 to 40
radicular arteries. The anterior spinal artery is a single
midline artery that arises from the union of a branch of
each vertebral artery. It descends in front of the anterior
longitudinal sulcus of the spinal cord. This single artery is
also fed by numerous radicular arteries.

53

53. At which level would you expect the spinal canal to be
narrowest in its sagittal dimension?
A. C1-2
B. C2-3
C. C3-4
D. C4-5
E. C5-6

53. Answer: E
Explanation:
(Bonica, 3rd Ed., page 975)
Canal sagittal dimensions get progressively narrower
from the upper to lower cervical spine; the narrowest
location is at C5-6.
C1-C3: 21 mm (16-30)
C4-C6: 18 mm (14-23)
Source: Shah RV, Board Review 2005

54

54. The deep peroneal nerve innervates the
A. Web space between the third and fourth toes
B. Medial aspect of the dorsum of the foot
C. Web space between the great toe and the second toe
D. Entire dorsum of the foot
E. Lateral aspect of the dorsum of the foot

54. Answer: C
Explanation:
The deep peroneal nerve innervates the short extensors
of the toes and the skin of the web space between the great
and second toe.
The deep peroneal nerve is blocked at the ankle by
infi ltration between the tendons of the anterior tibial and
extensor hallucis longus muscle.

55

55. The medial boundary of the stellate ganglion is?
A. Vertebral artery
B. Dome of the lung
C. Longus colli muscle
D. Scalene muscles
E. Subclavian artery

55. Answer: C
Source: Day MR, Board Review 2005

56

56. The hypogastric plexus is composed of what type of
fi bers?
A. Postganglionic sympathetic
B. Postganglionic parasympathetic
C. Visceral efferent
D. A delta
E. C Fibers

56. Answer: A
Source: Raj P, Pain medicine - A comprehensive Review -
Second Edition

57

57. The odontoid process (dens) is correctly described by
which of the following statements?
A. It articulates with the occipital portion of the skull
B. It is separated from the atlas by an intervertebral disk
C. It projects from the inferior surface of the atlas
D. It represents the vertebral body of the fi rst cervical vertebra
E. None of the above

57. Answer: D
Explanation:
D. The odontoid process (dens) of the axis, the second
cervical vertebra, is the remnant of the body of the fi rst
cervical vertebra (atlas).
Developing from a separate ossifi cation center, it fused
to the body of the axis.
The fact that there is no intervertebral disk between the
atlas and axis probably facilitates the fusion.
The dens, projecting from the superior surface of the
axis, provides a pivot about which rotation occurs at the
atlantoaxial joint.
Fracture and posterior dislocation of the dens may crush
the spinal cord with fatal results.

58

58. What is the rib that articulates with the sternum at the
level of the xiphisternal junction?
A. 6th
B. 7th
C. 8th
D. 9th
E. 10th

58. Answer: B
Explanation:
B.The 7th costal cartilage articulates with the sternum at
the lateral margin of the xiphisternal junction.
The articulation between the xiphoid process and the
inferior border of the sternal body is a cartilaginous
structure that ossifi es later in life.

59

59. The following statement is false regarding the course of the
vertebral artery:
A. The vertebral artery is consistently lateral to the atlantoaxial
joint.
B. The vertebral artery courses through the foramina transversaria
of C7 through C1.
C. The vertebral artery lies posterior to the atlanto-occipital
joint in the suboccipital triangle
D. Intracranial branches from the right and left vertebral
arteries combine to form a single descending anterior
spinal artery.
E. The paired right and left posterior spinal arteries originate
respectively from the right and left vertebral arteries
above C1.

59. Answer: B
Explanation:
Reference: Gray’s Anatomy, Thirteenth American Edition.
Pages 696-699.
The vertebral arteries originate from the subclavian
arteries and ascend anterior to the transverse processes of
the seventh cervical vertebrae. They then ascend through
the foramina transversaria from C6 to C1. The C7
vertebral body does not have a foramen transversarium.
The arteries then exit the C1 foramina transversaria and
turn medial to course through the foramen magnum
where they ascend and combine to form the basilar artery
which perfuses the brain. Just above the foramen magnum,
the vertebral arteries give rise to the paired posterior
spinal arteries. Further cephalad, at the approximate level
of the medulla oblongata, the paired vertebrals give rise to
the descending, single anterior spinal artery.
The vertebral arteries are always lateral to the atlanto-axial
joints since they must pass through the laterally-situated
foramina transversaria at C1 and C2. From the foramen
transversarium of C1 to the foramen magnum, the
vertebral arteries pass posterior to the atlanto-occipital
joints within the suboccipital triangle. There course from
C1 to the foramen magnum may be somewhat tortuous
and unpredictable.
The vertebral arteries are always anterolateral with respect to the cervical neuroforamina since they are coursing
through the foramina transversaria.
Source: Schultz D, Board Review 2004

60

60. The sympathetic component to the sphenopalatine
ganglion originates from which nerve?
A. Deep petrosal
B. Greater petrosal
C. Maxillary
D. Greater palatine
E. Lesser palatine

60. Answer: A
Source: Day MR, Board Review 2006

61

61. At which level is the intervertebral disc height to vertebral
body height the largest?
A. C1-C2
B. C6-C7
C. T12-L1
D. L4-L5
E. C3-C4

61. Answer: B
Explanation:
(Bonica 3rd Ed., page 971)

62

62. A musculocutaneous nerve lesion affects
A. Hand sensation
B. Supination with the forearm extended
C. Supination with the elbow in fl exion
D. Wrist extension
E. Upper arm abduction

62. Answer: C
Explanation:
The musculocutaneous nerve arises from the lateral cord
of the brachial plexus and carries fi bers from the root of
C5, C6, and C7. The nerve proceeds obliquely downward
between the axillary artery and the median nerve. The
nerve pierces the coracobrachialis muscle while giving off
branches to it, and it descends further between the biceps
and brachialis muscles to supply both of them. The lateral
cutaneous nerve of the forearm is the sensor continuation
of the muscular cutaneous nerve innervates the skin from
the elbow to the wrist and covers the entire forearm from
the dorsal to the ventral midline. The coracobrachialis
muscle is a forward elevator of the arm. The biceps is a
forearm supinator, especially if the elbow fl exed at 90
degrees. Isolated lesions of the musculocutaneous nerve
are rare. Such lesion could cause weakness of elbow
fl exion again resistance in a fully supinated hand, possible
arm elevation weakness, arm pain and radial forearm
parasthesia. (Brazis, 9-10; Staal, 31-33)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

63

63. Corneal anesthesia results from blockade of which nerve?
A. Supratrochlear
B. Mandibular
C. Maxillary
D. Opthalmic
E. Meckels

63. Answer: D
Source: Day MR, Board Review 2006

64

64. The styloid process is an important landmark during
blockade of which nerve?
A. phrenic nerve
B. maxillary nerve
C. facial nerve
D. glossopharyngeal nerve
E. trigeminal nerve

64. Answer: D
Explanation:
D. The tip of the styloid process lies approximately
halfway between the angle of the mandible and the
mastoid process and provides a bony landmark for
blockade of the glossopharyngeal nerve.
The glossopharyngeal nerve exits the jugular foramen at
the base of the skull to emerge slightly posterior and
medial to the styloid process. It proceeds inferiorly to
innervate the posterior one-third of the tongue as well as
part of the throat and nasopharynx as far down as the
pharyngoesophageal junction at the level of the cricoid
cartilage.

65

65. There is usually no sympathetic ganglion at:
A. L1
B. L2
C. L3
D. L4
E. L5

65. Answer: A
Source: Racz G. Board Review 2003

66

66. Blood supply to the spinal cord is by:
A. Two posterior spinal arteries and two anterior spinal
arteries
B. Two posterior spinal arteries and one anterior spinal
artery
C. Branches of the lumbar arteries
D. Radicularis Magna (artery of Adamkiewicz) and two
posterior spinal arteries
E. Braches of Aorta

66. Answer: B
Explanation:
The blood supply to the spinal cord is primarily three
longitudinally running arteries – two posterior spinal
arteries and one anterior spinal artery.
The Anterior Spinal artery supplies approximately 80% of
the intrinsic spinal cord vasculature. It is formed by the
union of a branch from the terminal part of each vertebral
artery. It actually consists of longitudinal series of
functionally individual blood vessels with wide variation
in lumen size and anatomic discontinuations.
The spinal cord has three major arterial supply regions:
1. C1 to T3: Cervicothoracic region
2. T3 to T8: Mid thoracic region
3. T8 to the Conus: Thoracolumbar region
There is a poor anastomosis between these three regions.
As a result the blood fl ow at the T3 and T8 levels is
tenuous. In spinal stenosis, especially in the lower cervical
region, the Anterior Spinal artery may be compressed by a
dorsal osteophyte and a herniated nucleus pulposus
leadingto the Anterior Spinal Syndrome (loss of motor
function).
There are two posterior spinal arteries that arise from the
posterior inferior cerebellar arteries.
The three longitudinal arteries are reinforced by ‘feeder’
arteries. They are spinal branches of the cervical, vertebral
posterior intercostal, lumbar and lateral sacral arteries.
Approximately 6 or 7 of these contribute to the anterior
spinal artery and another 6 or 7 to the posterior spinal
arteries, but at different levels. The largest of these arteries
is known as the radicularis magna or the artery of
Adamkiewicz.
Source: Chopra P, 2004

67

67. Which of the following neurological structures does NOT
travel through the cavernous sinus
A. Sympathetic carotid plexus
B. Oculomotor nerve
C. Mandibular branch of the trigeminal nerve
D. Trochlear nerve
E. Abducens nerve

67. Answer: C
Explanation:
The medial wall of the cavernous sinus contains the
abducens nerve, the internal carotid artery and the
sympathetic fi bers of the carotid plexus. The lateral wall
contains the oculomotor and trochlear nerves, and the
ophthalmic and maxillary divisions of the trigeminal
nerve. (Afi fi and Bergman, 240)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

68

68. Which of the following is TRUE about the trigeminal
nerve?
A. The spinal nucleus of the trigeminal nerve subserves
light touch in the ipsilateral side of the face.
B. The motor nucleus of the trigeminal nerve lies in the
pons medial to the sensory nucleus and sends axons to
the maxillary division of the trigeminal nerve
C. The three divisions of the trigeminal nerve converge at
the Gasserian ganglion.
D. The mesencephalic nucleus of the trigeminal nerve
subserves pain and temperature in the ipsilateral side
of the face.
E. The mandibular division of the trigeminal nerve subserves
sensation of the ipsilateral angle of the mandible.

68. Answer: C
Explanation:
The trigeminal nerve is a mixed nerve. It subserves the
sensory innervation of the ipsilateral side of the face and
the ipsilateral muscles of mastication (masseter, temporalis, and pterygoids). The sensory nucleus of the
trigeminal nerve extends from the midbrain to the upper
cervical cord: (a) The mesencephalic nucleus subserves
proprioception and deep sensation from the tendons and
muscles of mastication. (b) The main sensory nucleus
(located in the pons) subserves light touch. (c) The spinal
nucleus (which extends from the pons to the upper
cervical cord and is divided into segments that correspond
to concentric dermatomes around the mouth) subserves
pain and temperature. The trigeminal nerve supplies
sensation to the ipsilateral side of the face via three
branches: the ophthalmic division (which innervates the
frontal, lacrimal, and nasociliary areas), the maxillary
division (which innervates the cheek and lower eyelid),
and the mandibular division (which innervates the lower
lip, the tongue, the mandible, except for the angle of the
mandible). The motor nucleus lies medially to the main
sensory nucleus and sends axons to the mandibular
division of the trigeminal nerve. All division of the
trigeminal nerve converge at the Gasserian ganglion which
lies in Meckel’s cave of the temporal bone. (Afi fi and
Bergman, 173-175)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

69

69. All of the following muscles are innervated by the medial
division of the sciatic nerve EXCEPT the
A. Semimembranosus
B. Long head of the biceps femoris
C. Semitendinosus
D. Short head of the biceps femoris
E. Adductor magnus muscle

69. Answer: D
Explanation:
The sciatic nerve is a mixed nerve that carries fi bers from
L4 to S3 and leaves the pelvis through the sciatic foramen
below the piriform muscle. The nerve then curves laterally
and downward beneath gluteus maximus muscle and runs
on the dorsal side of the femoral bone to terminate at the
proximal part of the popliteal fossa to divide into the tibial
nerve medially and the peroneal nerve laterally. Within
the sciatic nerve, as proximal as the gluteal region, the
fi bers of the tibial and peroneal nerves are arranged into
two separate divisions: The medial and the lateral trunks,
respectively. The medial part of the nerve innervates the
adductor magnus and the hamstring muscles, except for
the short head of the biceps femoris (it is the only thigh
muscle supplied by the lateral peroneal division). The
hamstring muscles are fl exors of the knee joint and include
the semimembranosus muscle, the semitendinous muscle,
and the short and long heads of the biceps femoris. (Staal,
117-118)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

70

70. The thoracic duct ascends from the abdominal cavity to
enter the thorax via the following aperture:
A. Esophageal
B. Central tendon
C. Splanchnic
D. Inferior vena caval
E. Aortic

70. Answer: E
Explanation:
The diaphragm has three large openings (the aortic,
esophageal, and vena caval apertures) and a number of
smaller ones that transmit the superior and middle
splanchnic nerves.
E. The aortic aperture is the lowest and most posterior of
the large openings and approximates the level of the T10
vertebra.
This aperture also transmits the thoracic duct and occasionally the azygous and hemiazygous veins.

71

71. Celiac plexus is located:
A. in front of vena cava at L2
B. in front of aorta at L2
C. in front of aorta at L1
D. behind the vena cava of L1
E. behind the aorta of L1

71. Answer: C
Source: Racz G. Board Review 2003

72

72. Age-related changes which occur in the spine and may be
imaged by MRI fi ndings include:
A. Increase in water content of intervertebral disk
B. Increase in glycoproteins of intervertebral disk
C. Increase in height of vertebral bodies
D. Reduced caliber of spinal canal
E. All of the above

72. Answer: D
Explanation:
With advancing age, there is reduced caliber of the spinal
canal due to arthritic changes. There is decreased water
and glycoprotein content of intervertebral disks, with
decreased height of vertebral bodies. (Ref. 1, pp. 455–456;
Ref. 2, p. 590)
Source: Neurology for the Psychiatry specialty Board
Review By Leon A. Weisberg, MD

73

73. Which of the following structures receives afferents
responsible for taste sensation in the anterior two thirds
of the tongue ?
A. Submaxillary ganglion
B. Pterygopalatine ganglion
C. Superior salivary nucleus
D. Geniculate ganglion
E. Submandibular ganglion

73. Answer: D
Explanation:
The nervus intermedius is the sensory and
parasympathetic division of the facial nerve. It carries
preganglionic parasympathetic fi bers to the submaxillary
ganglion and tothe pterygopalatine ganglion. It receives
sensory fi bers from the geniculate ganglion. This ganglion
receives fi bers that carry taste sensation from the anterior
two-thirds of the tongue and afferents from the mucosae
of the pharynx, nose, and palate.(Afi fi and Bergman, 166-
167)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

74

74. Which of the following cranial nerves is responsible for
eye closure ?
A. Oculomotor nerve
B. Trochlear nerve
C. Abducens nerve
D. Facial nerve
E. Spinal accessory nerve

74. Answer: D
Explanation:
The orbicularis oculi controls eye closure and is
innervated by the facial nerve.Eye opening is controlled by
the levator of the lid, which is innervated by the
oculomotor nerve. (Brazis, Masdeu, and Biller, 271-272)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

75

75. Which statement is false regarding the blood supply of the
spinal cord:
A. The anterior spinal artery originates from the vertebral
arteries above the foramen magnum.
B. Segmental spinal arteries enter the spinal canal by way
of the intervertebral foramina bilaterally at every spinal
level.
C. The blood supply to the spinal cord is most tenuous in
the region from T10 through L1.
D. The Artery of Adamkiewicz is an anterior medullary
feeder artery that contributes blood to the anterior
spinal artery.
E. Arteries that penetrate the cord parenchyma are end
arteries and usually do not anastomose further.

75. Answer: C
Explanation:
Reference: Gray’s Anatomy, Thirteenth American Edition.
Pages 964-971.
The spinal cord receives its’ blood supply from three
longitudinal arteries:
1. a single anterior spinal artery
2. two posterior spinal arteries
The anterior spinal artery forms intracranially anterior to
the medulla oblongata, from the junction of two anterior
spinal branches, one derived from each of the two
vertebral arteries. From its’ origin, it descends anterior
to the spinalcord to the tip of the conus medullaris. The
diameter of the anterior spinal artery is greatest at the
cervical and lower thoracic regions with the smallest
diameter along the midthoracic zone from T3-T9.
This region of the cord is considered the “vulnerable zone”
with respect to circulation.
The branches of the anterior spinal artery that
penetrate the cord parenchyma are end arteries and do not anastomose further.
The spinal cord receives segmental arteries bilaterally at
every level that enter the spinal canal through the
neuroforamina, accompanying the spinal nerve roots.
These segmental arteries supply blood to the dorsal and
ventral nerve roots. In the cervical region these segmental
arteries may originate from the vertebrals or from other
cervical arteries. In the thoracic region, the segmental
arteries originate from the posterior intercostal arteries
which branch directly from the aorta.In the lumbar
region,they branch from the lumbar arteries. In addition,
the anterior spinal artery is reinforced at a number of
segmental levels by feeder arterial branches from these
segmental arteries. These arteries are called anterior
medullary feeder arteries. There is an average total of 8
anterior medullary feeder arteries (inclusive of all spinal
levels bilaterally) the largest of which is the great anterior
medullary artery or artery of Adamkiewicz. The total
number of anterior medullary feeder arteries varies from 2
to 17 in different individuals with an average of 3 in the
cervical region, 3 in the thoracic region and 2 in the
lumbar region. The artery of Adamkiewicz typically enters
the cord on the left side (77% of specimens) anywhere
from T7 to L4 (most commonly at T9 to T12). In the
cervical region, the largest anterior medullary feeder
enters at C4-5 or C5-6.
Source: Schultz D, Board Review 2004

76

76. A 40-year-old man developed chronic pain in the right
forearm that lasted hours each day. Neurological
examination demonstrated normal sensory examination,
mild right forearm pronation weakness, and weak fl exion
of terminal phalanges of right thumb, index, and middle
fi ngers. An attempt to make a full circle by applying the
end phalanx of the thumb to that of the index fi nger with
fi rm pressure showed consistent weakness. Which of the
following structures is affected?
A. Right anterior interosseous nerve
B. Right median nerve at the upper axilla
C. Right ulnar nerve
D. Right radial nerve
E. Right musculocutaneous nerve

76. Answer: A
Explanation:
The patient described in this vignette has a pure motor
defi cit. The right pronator quadratus is weak because of
paresis of forearm pronation. Also there is paresis of the
fl exor digitorum profundus I & II and the fl exor pollicis
longus because of loss of fl exion of the terminal phalanges
of the second and third fi ngers, and the thumb,
respectively. All of these muscles are innervated by an
anterior interosseous nerve. The characteristic feature of a
lesion of this nerve is the inability to make a circle with the
thumb and index fi nger. (Staal 55-56)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

77

77. The mandibular nerve leaves the cranial cavity through
the
A. foramen ovale
B. foramen spinosum
C. foramen rotundum
D. jugular foramen
E. foramen lacerum

77. Answer: A
Explanation:
A. The madibular nerve emerges from the cranial cavity by
way of the foramen ovale to enter the infratemporal fossa.
In the infratemporal fossa the mandibular nerve divides
into its terminal branches.
Madibular nerver supplies the lower jaw, tongue, and
lower teeth, the buccal surface of the cheek, and the
skin overlying the lower jaw, the temporal region, and the
anterosuperior two-thirds of the surface of the external
ear.
C. The maxillary nerve leaves through the foramen
rotundum

78

78. The most frequently involved structure in external
impingement of shoulder is
A. Subacromiodeltoid tendon
B. Subacromiodeltoid bursa
C. Teres minor tendon
D. Infraspinatus tendon
E. Supraspinous tendon

78. Answer: B
Source: Sizer et al - Pain Practice - March & June 2004

79

79. Anatomy of Meckel’s cave is as follows.
A. the location of the glossophraryngeal nerve as it passes
near the tonsillar fossa
B. an intestinal diverticulum that may cause epigastric
pain
C. located between the mastoid process and the angle of the
mandiblethe retrouterine recess in which an abscess or
tumor may compress the hypogastric plexus
D. the recess in which the gasserian ganglion resides before
dividing
E. the recess in which the posteior two thirds of the ganglion
are covered by dura

79. Answer: E
Explanation:
The gasserian ganglion, also known as the trigeminal
ganglion,is formed from many midpontine rootlets as they
pass into the posterior cranial fossa and cross the superior
border of the petrous bone to enter the recess called
Meckel’s cave, or the trigeminal cave.
In this recess (Meckel’s cave or trigeminal cave), the
posterior two thirds of the ganglion are covered by dura.
The anterior one-third is not covered by dura, and it is
from this portion of the ganglion that the three major
divisions of the trigeminal nerve (ophthalmic, maxillary,
and mandibular) exit.
When performing a trigeminal ganglion block, if the
needle has punctured the dura of Meckel’s cave, a very
small amount of local anesthetic may result in rapid loss
of consciousness or cardiac arrest.

80

80. The highest concentration of wide dynamic range neurons
are seen in Rexed lamina
A. I
B. II
C. III
D. V
E. IX

80. Answer: D
Explanation:
The Rexed laminae in the dorsal horn of the spinal
cord are important in the modulation and transmission
of nociceptive stimuli.
A, B. Laminae I and II receive dense projections from the
brainstem nuclei.
Small diameter primary afferents also terminate
primarily in laminae I and II.
Myelinated primary afferent neurons and those from
the brainstem involved in modulation of pain perception
in laminae I and II also project to the deeper laminae such
as V.
D. Lamina V has a high concentration of wide dynamic
range cells, which play an active role in the phenomenon
of central sensitization.

81

81. The L2 ganglion is at the following distance from the
anterior lateral x-ray view- vertebral body border:
A. 5-6 MM
B. 6-8 MM
C. 12-13 MM
D. 15-20 MM
E. 20-22 MM

81. Answer: C
Source: Racz G. Board Review 2003

82

82. Cutaneous innervation of the plantar surface of the foot is
provided by the
A. Sural nerve
B. Posterior tibial nerve
C. Saphenous nerve
D. Deep peroneal nerve
E. Superfi cial peroneal nerve

82. Answer: B
Explanation:
There are 5 nerves that supply the ankle and foot:
1. Posterior tibial nerve
2. Sural nerve
3. Superfi cial nerve
4. Deep peroneal nerve
5. Saphenous nerve
These nerves are superfi cial at the level of the ankle and
are easy to block. The posterior branch of the tibial nerve
gives rise to the medial and lateral plantar nerves, which supply the plantar surface of the foot.

83

83. While performing an atlantoaxial joint injection, the
patient has a seizure. Local anesthetic injection into what
structure/space most likely occurred?
A. Carotid artery
B. Epidural space
C. Intrathecal space
D. Spinal nerve root
E. Vertebral artery

83. Answer: E
Source: Day MR, Board Review 2006

84

84. Which anatomic landmark is not used in any of the
standard blocks of the sciatic nerve?
A. Posterior superior iliac spine (PSIS)
B. Anterior superior iliac spine (ASIS)
C. Greater trochanter of the femur
D. Pubic tubercle
E. Lesser trochanter of the femur

84. Answer: E
Source: Shah RV, Board Review 2003

85

85. The nerve located immediately lateral to the trachea is:
A. Vagus
B. Recurrent laryngeal
C. Phrenic
D. Long thoracic
E. Spinal accessory

85. Answer: B
Explanation:
The structures in the neck from medial to lateral are the
recurrent laryngeal nerve, carotid artery, vagus nerve,
internal jugular vein, and phrenic nerve.

86

86. The branches of the spinal artery providing blood supply
to the vertebral body is:
A. Posterior
B. Intermediate
C. Lateral
D. Medial
E. Anterior

86. Answer: E
Explanation:
The spinal artery arises from the posterior branch of the
segmental artery close to the intervertebral foramen and
divides into three terminal branches: posterior,
intermediate, and anterior.
A. The posterior branches help supply the spinal dura and
the tissues of the epidural space.
B. The intermediate (middle) branches supply the dura of
the associated nerve roots.Their radicular branch can
pierce the dura and help supply the spinal cord.
E. The anterior branches supply the vertebral bodies along
with other spinal structures.

87

87. The artery of Adamkiewicz, also known as arteria
radicularis magna, implied in spinal cord damage
following epidural steroid injections, most frequently
arises from the aorta, the following spinal level(s).
A. T1 to T4
B. T5 to T8
C. L1 to L4
D. T9 to T12
E. L5-S1

87. Answer: D
Explanation:
The artery of Adamkiewicz, also known as arteria
radicularis magna, is one of the feeder arteries for the
anterior spinal artery. Damage to this artery by any means
or particular injection can lead to ischemia in the
thoracolumbar region of the spinal cord. The origin of
this artery is variable. In 60% of the cases, it is described to
arise from T9 to T12. In 14% of cases, it is described to
originate from T5 to T8. In 20% of the cases, it is
described to originate below L1.

88

88. The lesser occipital nerve is formed from the ventral root/s
of which cervical spinal nerve/s?
A. C1
B. C2
C. C3
D. C1 and C2
E. C2 and C3

88. Answer: E
Source: Day MR, Board Review 2006

89

89. What other cranial nerve can be blocked while performing
a glossopharyngeal nerve block?
A. Trigeminal
B. Spinal Accessory
C. Vestibulocochlear
D. Oculomotor
E. Facial

89. Answer: B
Source: Day MR, Board Review 2005

90

90. Which of the following is not part of a Horner’s
syndrome?
A. Myopia
B. Facial anhidrosis
C. Myosis
D. Enophthalmus
E. Ptosis

90. Answer: A
Source: Day MR, Board Review 2006

91

91. Which of the following pairs of cranial nerves travel
through the internal auditory canal?
A. Vestibulocochlear and trigeminal
B. Facial and trigeminal
C. Facial and optic
D. Facial and vestibulocochlear
E. Vestibulocochlear and vagus

91. Answer: D
Explanation:
The facial nerve leaves the pons and travels with the
vestibulocochlear nerve through the internal auditory
canal. (Parent, 154-168)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

92

92. Which of the following structures is found in the lateral
wall of the tonsillar fossa?
A. Facial nerve
B. Glossopharyngeal nerve
C. Hypoglossal nerve
D. Lingual nerve
E. Vagus nerve

92. Answer: B
Explanation:
A. The facial nerve lies superfi cial on the face.
B. The location of the glossopharyngeal nerve in the
tonsillar bed places it in jeopardy during tonsillectomy.
C, D. The hypoglossal and lingual nerves pass well
inferior to the tonsillar bed.

93

93. The most medial structures in the antecubital fossa
include:
A. Brachial artery
B. Cephalic vein
C. Tendon of the biceps
D. Median nerve
E. Musculocutaneous nerve

93. Answer: D

94

94. The maxillary nerve leaves the cranial cavity thru the
A. foramen ovale
B. foramen spinosum
C. foramen rotundum
D. jugular foramen
E. foramen lacerum

94. Answer: C
Explanation:
A. The mandibular nerve leaves through the foramen
ovale.
B.The maxillary nerve leaves the cranial cavity through the
foramen rotundum.Following here it traverses the
pterygomaxillary fossa to enter the fl oor of the orbit at the
inferior orbital fi ssure.
The maxillary nerve primarily supplies the upper jaw,
lateral nasal wall, and most of the nasal septum.

95

95. The saphenous nerve at the ankle is blocked where?
A. Anterior to the lateral malleolus
B. Posterior to the lateral malleolus
C. Anterior to the medial malleolus
D. Posterior to medial malleolus
E. Lateral to the extensor hallucis longus muscle

95. Answer: C
Source: Day MR, Board Review 2006

96

96. If a needle is introduced 2 cm inferior and lateral to
the pubic tubercle, to which nerve will it lie in close
proximity?
A. Ilioinguinal nerve
B. Femoral nerve
C. Lateral femoral cutaneous nerve
D. Obturator nerve
E. Sciatic nerve

96. Answer: D
Explanation:
D. An obturator nerve block is achieved by placement of
the needle 1 to 2 cm lateral to and below the pubic
tubercle.
After contact with the pubic bone, the needle is withdrawn
and walked cephalad to identify the obturator canal.

97

97. The L3 ganglion located on lateral view X-ray:
A. inferior anterior border of L3
B. mid body L3
C. posterior body L3
D. near the anterior border of L3
E. none of the above

97. Answer: D
Source: Racz G. Board Review 2003

98

98. In carpal tunnel syndrome, the median nerve is entrapped
A. Beneath the fl exor retinaculum ligament
B. Above the fl exor retinaculum ligament
C. At the hamate bone
D. In Guyon’s canal
E. On the radial side of the wrist at the level of the styloid
process

98. Answer: A
Explanation:
The point of entrapment of the median nerve in carpal
tunnel syndrome lies under the fl exor retinaculum. The
fl exor retinaculum forms the roof of the carpal tunnel,
whereas the carpal bones and their connective tissue
components form the fl oor of the carpal tunnel.In Guyon’s
canal, the hamate, and the pisiform bones are sites of
compression of the ulnar nerve at the wrist. Rarely, radial
nerve compression occurs at the level of the styloid
process, just proximal to the wrist. (Staal, 56-66)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

99

99. The obturator nerve innervates muscles which are
responsible for what movement of the lower extremity?
A. Abduction
B. Flexion
C. Extension
D. Internal rotation
E. Adduction

99. Answer: E
Source: Day MR, Board Review 2006

100

100. Which of the following is a compression site of the radial
nerve?
A. Suprascapular notch
B. Carpal tunnel
C. Spinoglenoid notch
D. The elbow posterior to the medial epicondyle
E. Spiral groove in the posterior aspect of the humerus

100. Answer: E
Explanation:
The radial nerve arises from the posterior cord of the
brachial plexus and comprises fi ber from spinal levels C5
to C8. After descending posterior to the axillary artery, the
nerve courses posterior to the humerus in the spinal
groove. It is at this site that the nerve is more often
damaged by the compression. (Staal, 35)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

101

101. Blockade of the ilioinguinal nerve is accomplished by
depositing local anesthetic between which 2 muscle
groups?
A. External oblique and internal oblique
B. External oblique and transverse abdominus
C. Rectus abdominus and internal oblique
D. Internal oblique and transverse abdominus
E. Transverse abdominus and iliacus

101. Answer: D
Source: Day MR, Board Review 2006

102

102. Which brachial plexus block technique produces the best blockade of all of the terminal branches of the plexus?
A. Axillary
B. Supraclavicular
C. Infraclavicular
D. Interscalene
E. Deep cervical plexus

102. Answer: B
Source: Day MR, Board Review 2006

103

103.Which one of the following statements regarding
zygapophyseal joints is false:
A. Zygapophyseal joints are covered with a fi brous capsule
and contain synovial fl uid
B. The articular surfaces of zygapophyseal joints are covered
with hyaline cartilage.
C. The most cephalad zygapophyseal joint is C1-2.
D. Zygapophyseal joints are always posterior spinal structures.
E. Lumbar zygapophyseal joints are oriented with increasing
alignment to the sagittal plane as one ascends the
spine

103. Answer: C
Explanation:
References:
Waldman, Interventional Pain Management, Second
Edition; Chapter 42, pp. 446-452
Gray’s Anatomy, Thirteenth American Edition, pp. 333-
335.
Zygapophyseal or facet joints are true synovial joints and
share characteristics with other synovial joints including:
1.The contiguous bony surfaces of the joints are covered
with hyaline cartilage
2.The joint is surrounded by a fi brous joint capsule
3.The inner surface of the joint is lined by a synovial
membrane which secretes synovial fl uid to lubricate the
joint
4.The joints contain intra-articular meniscoids (of
uncertain signifi cance) which are attached to the joint
capsule
Zygapophyseal joints are posterior spinal structures with
the nerve root and neuroforamen anterior to the joint. The
most cephalad zyg joint is C2-3 and the most caudal is L5-
S1. The atlanto-axial and atlanto-occipital joints (C1-2
and C0-1 respectively) are unique and fundamentally
different from zyg joints in that they are anterior spinal
structures with the nerve root exiting posterior to the
joint. These two most cephalad spinal joints are therefore
not considered zygapophyseal joints and do not have
sensory innervation from medial branch nerves like the
true zyg joints.
Source: Schultz D, Board Review 2004

104

104. The long thoracic nerve innervates the
A. Serratus anterior muscle
B. Rhomboid muscle
C. Levator scapula
D. Supraspinatus muscle
E. Infraspinatus muscle

104. Answer: A
Explanation:
The long thoracic nerve arises from the motor roots of C5,
C6, and C7. It courses downward through and in front of
the medial scalenus muscle and further descends dorsal to
the brachial plexus along the medial axillary wall to
innervate the serratus anterior muscle. The suprascapular
nerve innervates the supraspinatus and infraspinatus. The
dorsal scapular nerve innervates the rhomboid and levator
scapulae. (Parent, 276; Staal 19)
SOURCE: Souayah, N, and Khella S; Neurology
Examination & Board Review; McGraw-Hill, New York.
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

105

105. Which of the following is a branch of the trigeminal
nerve:
A. Lingual nerve
B. Posterior auricular nerve
C. Spinal accessory nerve
D. Greater Occipital nerve
E. Lesser Occipital nerve

105. Answer: A
Explanation:
The lingual nerve is a branch of the mandibular division.
The posterior auricular is part of the cervical plexus, the
spinal accessory is CN XI, and the occipital is from C2 and
C3
Source: Trescot AM, Board Review 2003

106

106.The arachnoid villi allow cerebrospinal fl uid to pass
between which of the following two spaces?
A. Choroid plexus and subdural space
B. Subarachnoid space and subdural space
C. Superior sagittal sinus and jugular vein
D. Subdural space and cavernous sinus
E. Subarachnoid space and superior sagittal sinus

106. Answer: E
Explanation:
E. Cerebrospinal fl uid formed in the choroid plexus
circulates in the subarachnoid space and is absorbed by the
venous sinuses through the arachnoid villi, some of which
project into the superior sagittal sinus.
Cerebrospinal fl uid protects the nervous system from
concussions and mechanical injuries and is important for
metabolism.
A, B, C, D. It circulates slowly through the ventricles of the
brain and through the meshes of the subarachnoid space.

107

107. The MOST common location of the Dorsal Root Ganglion
is:
A. Medial to the pedicle within the lateral recess
B. Inferolateral to the pedicle
C. Lateral to the superior articular facet of the corresponding
vertebra.
D. Directly below the pedicle
E. Superolateral to the pedicle

107. Answer: D
Explanation:
In approximately 90% of cases the dorsal root ganglion
(DRG) lies in the middle zone of the intervertebral
foramen, directly below the pedicle. In approximately, 8%
of cases it is inferolateral and in 2% of cases it is medial to
the pedicle. The center of the DRG lies over the lateral
portion of the intervertebral disc in some cases. The size of
the DRG increases from L1 to S1 and then progressively
decreases till S4. The DRG at S1 is 6mm in width.
The DRG contains multiple sensory cell bodies. It is the
site for production of neuropeptides: Substance P,
Eukephalin, VIP (Vasoactive Intestinal peptides), and
other neuropeptides.
The DRG is a primary source of pain when it undergoes
mechanical deformity as by an osteophyte, herniated
nucleus pulposus or stenosis. It also produces pain when it
undergoes an infl ammatory process either by infection or
chemical irritation from a herniated nucleus pulposus,
release of local neuropeptides or local vascular
compromise.
Source: Chopra P, 2004

108

108. A pulse in the dorsalis pedis artery may be palpated
A. Between the tendons of the extensor digitorum longus
and peroneus tertius muscles
B. Between the tendons of the extensor hallucis and extensor
digitorum muscles
C. Between the tendons of the tibialis anterior and extensor
hallucis longus muscles
D. Immediately anterior to the lateral malleolus
E. Immediately posterior to the medial malleolus

108. Answer: B
Explanation:
B. The dorsal pedal artery, a continuation of the anterior
tibial artery, passes onto the dorsum of the foot between
the tendons of the extensor hallucis longus and extensor
digitorum longus muscles.
The dorsal pedal pulse may be palpated here before the
artery passes beneath the extensor hallucis brevis muscle.
E. The posterior tibial artery passes behind the medial
malleolus, where the posterior tibial pulse is normally
palpable.
Source: Klein RM and McKenzie JC 2002.

109

109. In the histogenesis of the neural tube, which zone will
become the white matter of the adult CNS?
A. Ventricular zone
B. Marginal zone
C. Mantle zone
D. Ependymal zone
E. Intermediate zone

109. Answer: B
Explanation:
A. From the ventricular zone, astrocytes, oligodendrocytes,
and neurons differentiate.
Ultimately, the cells that remain in the ventricular zone
become the ependymal cells that line the central canal.
B. The white matter of the adult CNS is derived from the
marginal zone of the developing neural tube.
The most peripheral zone is the marginal zone, which
contains the myelinated axons of the developing motor
neurons (adult white matter).
C. The mantle zone forms the grey matter, where cell
bodies of differentiating motor neurons are located.
Source: Klein RM and McKenzie JC 2002.

110

110. Which of the following is INCORRECT about the axillary
nerve?
A. It arises from C5-C6.
B. It innervates the deltoid and teres minor muscles.
C. It is a pure motor never.
D. Its injury may lead to weakness of arm abduction in the
horizontal position.
E. In neuralgic amyotrophy, the axillary nerve may be affected
in isolation in 10% of cases.

110. Answer: C
Explanation:
The axillary nerve originates from the posterior fascicle of
the brachial plexus and carries fi bers from C5 and C6. It
innervates the deltoid muscle and teres minor muscle. The
axillary nerve sends a sensory branch, the lateral brachial
cutaneous nerve, to the skin of the upper outer surface of
the arm mainly in the deltoid region. An axillary nerve
lesion results in weakness of arm abduction in the
horizontal position against resistance.The fi rst 30 degrees
of abduction of the upper arm from the trunk is
performed by the supraspinatus muscle, which is
innervated by the suprascapular nerve, not by the axillary
nerve.
There is also weakness of the horizontal upper arm
retraction against resistance with sensory loss in the skin
area overlying the deltoid muscle.The axillary nerve
is often involved in neuralgic amyotrophy, and in about
ten percentof cases it is affected in isolation. (Parent, 275
– 277; Staal, 27-29)
Source: Neurology Examination and Board Review By
Nizar Souayah, MD and Sami Khella, MD

111

111. The venous sinuses are located in the
A. Periosteum
B. Dura mater
C. Subdural space
D. Arachnoid
E. Pia mater

111. Answer: B
Explanation:
A. The periosteum is an important connective tissue layer
surrounding the bone of the skull. This layer retains
osteogenic potential even in the adult.
B. The dura mater contains the venous sinuses and is
composed of dense connective tissue and possesses very
limited osteogenic potential.
The dura mater is one of the three protective layers that
comprise the meninges surrounding the brain and spinal
cord.
In the spinal cord, the dura is separated from the
periosteum by the epidural space.
C.The thin subdural space lies between the dura mater and
the arachnoid.
D. The arachnoid is composed of a weblike avascular
connective tissue that forms villi for the reabsorption of
cerebrospinal fl uid (CSF) into the venous sinuses found in
the dura.
The subarachnoid space contains the CSF, which is
formed both by ultrafi ltration of the blood and
transport across the epithelial lining of the choroid plexuses.
E. The pia covers the brain and spinal cord as a delicate,
vascular connective tissue.
It lines the perivascular spaces through which blood
vessels penetrate the CNS.

112

112. Innervation to the rotator cuff muscle that medially
rotates the arm is provided by the
A. Axillary nerve
B. Suprascapular nerve
C. Thoracodorsal nerve
D. Upper and lower subscapular nerves
E. None of the above

112. Answer: D
Explanation:
(Moore, Anatomy, 4/e, pp 698-699.) The upper and lower
subscapular nerves innervate the subscapularis muscle,
which is the only muscle of the rotator cuff group that
medially rotates the arm. The lower subscapular nerve also
innervates the teres major muscle, which is not part of the
rotator cuff group. The suprascapular nerve innervates the
supraspinatus and infraspinatus muscles that abduct and
laterally rotate the arm, respectively. The teres minor
muscle, innervated by the axillary nerve, also laterally
rotates the arm. The thoracodorsal nerve, originating from
the posterior cord between the upper and lower
subscapular nerves, innervates the latissimus dorsi muscle.
Source: Klein RM and McKenzie JC 2002.

113

113. The vertebral arteries are correctly described by which of
the following statements?
A. They arise from the common carotid artery on the left
and the brachiocephalic artery on the right
B. They enter the cranium via the anterior condylar canals
C. They enter the cranium via the posterior condylar canals
D. They pass through the transverse foraminae of several
cervical vertebrae
E. They directly give rise to the posterior cerebral arteries

113. Answer: D
Explanation:
A, D. The vertebral arteries usually arise from the
subclavian arteries and ascend through the transverse
foramina of the sixth to the fi rst cervical vertebrae but not
the seventh.
They enter the cranium through the foramen magnum
after which they join to form the basilar artery.
B. The hypoglossal nerves leave the cranium via the
anterior condylar (hypoglossal) canals,
C. The posterior condylar canals transmit emissary veins.
E. The basilar artery terminates by bifurcating into the
posterior cerebral arteries.

114

114. Areas innervated by glossopharyngeal nerve are all of the following EXCEPT
A. Palatine tonsils
B. Posterior one third of the tongue
C. Pharyngeal wall
D. Epiglottis
E. Auditory Canal

114. Answer: D
Source: Raj P, Pain medicine - A comprehensive Review -
Second Edition

115

115. Nutrition to the lumbar intervertebral disk is from the:
A. Posterior Spinal artery
B. Internal Iliac artery
C. Lumbar artery
D. Anterior spinal artery
E. None of the above

115. Answer: C
Explanation:
The lumbar arteries supply the vertebrae at various levels.
Each lumbar artery passes posteriorly around the related
vertebra and supplies branches into the vertebral body.
The terminal branches form a plexus of capillaries below
each endplate. The disk is a relatively avascular structure.
Nutrition to the disk is by diffusion from the endplate
capillaries and blood vessels in the outer annulus fi brosus.
Passive diffusion of fl uids into the proteoglycan matrix is
further enhanced by repeated compression of the disk by
repeated fl exion-extension of the spine associated with
activities of daily living which pumps fl uid in and out of
the disk.
Source: Chopra P. 2004

116

116. The carotid tubercle (Chaussignac’s tubercle) is located
at:
A. Transverse process of the C5 vertebra
B. Facet joint of the C5-C6 vertebra
C. Facet joint of the C6-C7 vertebra
D. Transverse process of the C7 vertebra
E. Transverse process of the C6 vertebra

116. Answer: E
Explanation:
E. The carotid tubercle (Chaussignac’s tubercle) lies 2.5
cm lateral to the cricoid cartilage.
It is a part of the transverse process of the C6 vertebra
and can be easily palpated anteriorly.
The carotid tubercle is an important landmark for stellate
ganglion blocks.
Source: Chopra P. 2004

117

117. The MOST common origin of the Artery of Adamkiewicz
is:
A. Between T4 and T6
B. At T7
C. Between T8 and L3
D. At L4
E. At L5

117. Answer: C
Explanation:
A, B. It originates in 14% of cases between T5-T8.
In a small percentage of cases (15%) the take off is
higher at T5. In this case the slender contribution from the
iliac artery enlarges to compensate for the increased blood
fl ow to the lumbar portion of the cord and the conus.
C. The artery of Adamkiewicz originates on the left
between the T8 and L3 level in most cases.
This is the largest of the feeder arteries that supplies the
anterior spinal artery.
The artery of Adamkiewicz enters through an
intervertebral foramen between T8 and L3 to supply the
lumbar enlargement. It originates in 60% of cases between
T9-T12.
D, E. It originates below L1 in 20% of cases.
Source: Chopra P, 2004

118

118. The Stellate ganglion is located at the:
A. Anterior to the transverse process of the C6 vertebra
B. Posterior to the subclavian artery
C. Anterior to the transverse process of the C5 vertebra
D. Anterior to the neck of the fi rst rib and the transverse
process of the C7 vertebra
E. Anterior to vertebral artery at C7

118. Answer: D
Explanation:
D. The stellate ganglion is the inferior cervical ganglion.
The cervicothoracic ganglion is frequently formed by
the fusion of the inferior cervical ganglion and the fi rst
thoracic ganglion.
It is located anteriorly on the neck of the fi rst rib and
the transverse process of the C7 vertebra.
It is oval in shape and 1 inch long by 0.5 inch wide.
The ganglion is bound anteriorly by the subclavian
artery, posteriorly by the prevertebral fascia and the
transverse process, medially by the longus colli
muscle and laterally by the scalene muscle.
The classical Stellate ganglion block is done one level
above the location of the Stellate ganglion (it lies at the C7
level and the block is done at the C6 level).
E. The vertebral artery travels anteriorly over the stellate
ganglion at C7 but at C6 the artery moves posteriorly.
Source: Chopra P. 2004

119

119. The blood-brain barrier is formed by
A. Fenestrations between brain capillary endothelial cells
B. Microglial activity
C. Astrocytic foot processes surrounding blood vessels entering
the brain parenchyma
D. The basement membrane associated with the glia limitans
E. Occluding junctions between brain capillary endothelial
cells

119. Answer: E
Explanation:
A. The capillary endothelium is nonfenestrated, which also
adds to the barrier.
B. Microglia function as brain macrophages and are involved in antigen presentation and phagocytosis.
C. Astrocytes form foot processes around the brain
capillaries.
D. Surrounding the CNS is a basement membrane with a
lining of astrocyte foot processes; this forms the glia
limitans, which also contributes to the integrity of the
blood-brain barrier.
E. The blood-brain barrier is formed primarily by
occluding junctions (zonulae occludentes) between
endothelial cells that compose the lining of brain
capillaries.

120

120. Nerves that originate from the sacral plexus include
1. Femoral nerve
2. Obturator nerve
3. Lateral femoral cutaneous nerve
4. Sciatic nerve

120. Answer: D (4 Only)
Explanation:
1. The femoral nerve originates from lumbar plexus.
2. The obturator nerve originates from lumbar plexus.
3. Lateral femoral cutaneous nerves arise from the lumbar
plexus.
4. The sciatic nerve gives multiple branches: the common
peroneal deep and superfi cial peroneal, posterior tibial,
and sural.

121

121. The greater occipital nerve:
1. Is a branch of the posterior ramus of C2
2. Is part of the cervical plexus.
3. Injection can cause a total spinal.
4. Is a mixed motor and sensory nerve.

121. Answer: B (1 & 3)
Explanation:
1. The greater occipital nerve is a branch of the posterior
ramus of C2.
2. The lesser occipital nerve is part of the cervical plexus.
3. Total spinal anesthetics has occurred after occipital
nerve blocks, due to subarachnoid injection.
4. The occipital nerve is a pure sensory nerve.
Source: Trescot AM, Board Review 2003

122

122. Which of the following statements are true regarding
medial branch nerves:
1. The medial branches from C4 through C7 typically lack
any cutaneous distribution.
2. The medial branch of L5 is located in the groove between
the sacral ala and the superior articulating process
of S1.
3. The “third occipital nerve” originates from the C3 dorsal
ramus.
4. The greater occipital nerve is the medial branch of the
dorsal primary ramus of C2.

122. Answer: E (All)
Explanation:
References:
Bogduk, Clinical Anatomy of the Lumbar Spine and
Sacrum, Third Edition, Churchill Livingston 1997 pp.
133-135
Lord, Barnsley, Bogduk; Cervical Zygapophyseal Joint Pain
in Whiplash Injuries in Cervical Extension-Flexion
Whiplash Injuries, George Malanga MD Editor, Hanley
and Belfus Medical Publishers, 1998 pp. 309-310
With respect to the zygapophyseal joint, each joint is
innervated by two medial branch nerves, one originating
from the dorsal ramus of the same segmental level and one
originating from the dorsal ramus above the level. For
example, the C4-5 zygapophyseal joint is innervated by the
C4 and C5 medial branches and the L4-5 zygapophyseal
joint is innervated by the L3 and the L4 medial branches.
With respect to the medial branch nerves, each medial branch originates from the dorsal ramus of the spinal
nerve and sends an ascending branch to innervate the joint
above and a descending branch to innervate the joint
below.
Which medial branch nerves innervate which
zygapophyseal joints can be a source of confusion since
numbering in the cervical spine is different from the
numbering in the thoraco-lumbar spine. The numbering
convention associating spinal nerve roots within
neuroforamina is different above and below C7-T1. The
C4 nerve root (and C4 medial branch) exits the C3-4
neuroforamen whereas the L4 nerve root (and L4 medial
branch) exits the L4-5 neuroforamen. Things change from
a numbering perspective at C7-T1 since the C8 nerve root
exits the C7-T1 foramen Above C7-T1 (from C2-3 to C6-
7)the exiting spinal nerve root has the same number as the
last number of the foramen (i.e. C6 exits the C5-6
foramen).Beginning at the T1-2 neuroforamen, the exiting
nerve root carries the same number as the fi rst number of
the foramen (T1 nerve root exits T1-2 foramen). With
respect to medial branches, the C8 medial branch
innervates the C7-T1 joint and the T1-2 joint. The T1
medial branch innervates the T1-2 and the T2-3 joints.
And the L3 nerve root innervates the L3-4 and L4-5 joints.
1. The medial branches of C4 through C8 typically lack
cutaneous distribution and follow the following course:
The dorsal ramus of the segmental nerve at each level
gives rise to the medial branch with that segmental
number which in turn innervates the zyg joint above and
below i.e. the C4 spinal nerve exits the C3-4 foramen and
gives rise to the C4 medial branch which sends a branch
cephalad to innervate the C3-4 zyg joint and caudad to
innervate the C4-5 zyg joint.
2. The medial branch of L5 is located in the groove
between the sacral ala and the superior articulating process
of S1.
3. The C3 medial branch is the fi rst clinically signifi cant
medial branch with respect to radiofrequency denervation
of the zyg joints. The C3 medial branch is unique in that it
has a large superfi cial, cephalad branch called the “third
occipital nerve”and a smallerdeep and more caudal branch
which is called the medial branch of C3. The third
occipital nerve originates from the C3 dorsal ramus and
courses directly posterior across the lateral aspect of the
C2-3 zyg joint which it innervates. The C3 medial branch
also originates from the C3 dorsal ramus but courses
caudally to cross the lateral waist of the C3
4. The medial branch of C2 is large and is called the
greater occipital nerve. The C2 medial branch (greater
occipital nerve) supplies sensory-motor innervation to the
occiput and may also send a communicating branch
caudally to contribute to the innervation of the C2-3 zyg
joint. articular pillar in similar fashion to the courses
of the C4-C8 medial branches. The C3 medial branch
innervates the superior aspect of the C3-4 zyg joint.
Source: Schultz D, Board Review 2004

123

123. The tibial nerve is responsible for what motion of the foot
and ankle?
1. Plantar fl exion
2. Eversion
3. Inversion
4. Dorsifl exion

123. Answer: B
Source: Day MR, Board Review 2006

124

124. Bony landmarks that need to be identifi ed for a posterior
sciatic nerve block are:
1. Anterior superior iliac spine
2. Posterior superior iliac spine
3. Lesser trochanter
4. Greater trochanter

124. Answer: C
Source: Day MR, Board Review 2006

125

125. All the following are true statements concerning
intervertebral disks.
1. in the lumbar region, the disks constitute 50 percent of
the length of the column
2. the nucleus pulposus is a colloidal gel composed of
mucopolysaccharide
3. at birth, an intervertebral disk contains 50 percent
water
4. the superior and inferior plates of the disk are composed
of hyaline cartilage

125. Answer: C (2 & 4)
Explanation:
1. In the lumbar region the intervertebral disks constitute
about 30 percent of the length of the column as compared
with 20 to 25 percent in the thoracic and cervical regions.
2. Each intervertebral disk is composed of a tough
fi brocartilaginous ring (the annulus fi brosus) and a
pliable intergelatinous mass (the nucleus pulposus).
The colloidal gel of the nucleus pulposus is a
mucopolysaccharide that can imbibe external fl uid and
maintain its intrinsic water balance.
3. At birth the disk contains 88 percent water, but it
dehydrates with age and trauma.
4. The superior and inferior plates of the disks are the end
plates of the vertebral bodies, which are composed of
articular hyaline cartilage in direct contact with and
adherent to the underlying resilient bone of the vertebral
body.

126

126. Except for the fi rst intercostal nerve, all intercostal nerves
differ from other spinal nerves in that
1. each pursues an independent course
2. they only have a sensory modality
3. they do not result in the formation plexus
4. their posterior divisions only supply muscles and skin
of the back

126. Answer: B (1 & 3)
Explanation:
1. Intercostal nerves differ from other spinal nerves in that
each pursues an independent course.
2. The intercostal nerves are distributed chiefl y to the
thorax and abdomen.
3. Except for the fi rst intercostal nerve, they do not enter
into the formation of plexuses.
4. The smaller posterior primary divisions diverge from
their anterior counterparts and run posteriorly to supply
the muscles and skin of the back through medial and
lateral branches.

127

127. The extraocular muscles innervated by the oculomotor
nerve include the
1. lateral rectus
2. medial rectus
3. superior oblique
4. inferior rectus

127. Answer: C (2 & 4)
Explanation:
Six extraocular muscles control the movements of the eye.
The four rectus muscles (superior, medial, inferior, and
lateral) originate from a common tendon ring that
encircles the optic foramen.
1. The lateral rectus muscle is innervated by the abducens
or 6th cranial nerve while the superior oblique muscle
receives innervation from the trochlear or 4 th cranial
nerve.
2. The oculomotor or third cranial nerve innervates the superior, medial, and inferior rectus muscles as well as the
inferior oblique and levator palpebrae superioris muscles.
3. The superior oblique muscle originates above and
medial to the optic foramen, while the inferior oblique
muscle originates medially from the periosteum of the
lacrimal bone.
4. The oculomotor or third cranial nerve innervates the
superior, medial, and inferior rectus muscles as well as the
inferior oblique and levator palpebrae superioris muscles.

128

128. Referred pain to the penis can be caused by which of the following neuralgias?
1. Ilioinguinal
2. Iliohypogastric
3. Genitofemoral
4. Lateral femoral cutaneous

128. Answer: A (1, 2, & 3)
Explanation:
1. Pain referred to the penis may be due to neuralgia of the
ilioinguinal nerve.
2. Pain referred to penis may be due to neuralgia of
iliohypogastric nerve.
3. Pain referred to penis may be due to neuralgia of
genitofemoral nerve.
4. Lateral femoral cutaneous neuralgia (meralgia
paresthetica) usually causes pain in the lateral thigh
without radiation to the penile shaft.
Source: Kahn CH, DeSio JM. PreTest Self Assessment and
Review. Pain Management. New York, McGraw-Hill, Inc.,
1996.

129

129. The musculocutaneous nerve innervates which muscle/s?
1. Biceps brachii
2. Brachialis
3. Coracobrachialis
4. Brachiradialis

129. Answer: A
Source: Day MR, Board Review 2006

130

130. The following are true statements about the sympathetic
nervous system:
1. Most cell bodies of preganglionic fi bers lie in the intermediolateral
cell column of the spinal cord from T1 to
L2.
2. The preganglionic fi bers enter the dorsal root ganglion
through the white rami communicantes.
3. The preganglionic fi bers enter the spinal nerve through
the ventral root.
4. The post ganglionic fi bers exit the sympathetic ganglion
via the gray rami communicantes

130. Answer: E (All)
Explanation:
Reference:
Bonica’s Management of Pain, Third Edition, pp. 210-215
Cell bodies of preganglionic sympathetic fi bers lie
primarily in the intermediolateral cell column of the spinal
cord from T1 to L2. The preganglionic axon fi bers course
out of the spinal cord in the ventral root, course a short
distance within the segmental spinal nerve and then exit
the spinal nerve via the white rami communicantes. The
white rami carries the preganglionic sympathetic fi bers to
the sympathetic ganglia which consist of postganglionic
cell bodies and are located in the prevertebral regions from
the high cervical spine to the sacrum. Preganglionic fi bers
may ascend or descend within the sympathetic chain for
several levels before synapsing in the ganglion with the
cell body of the post-ganglionic fi bers.
The postganglionic sympathetic axons are then
transmitted out of the ganglion by the gray rami
communicantes where these axons travel with the spinal
nerves to their end organs mainly blood vessels, sweat
glands and hair follicles.
Source: Schultz D, Board Review 2004

131

131. Regarding a myelinated nerve fi ber, which of the following
statements are true
1. the action potential is regenerated only at the nodes of
Ranvier
2. the resting potential is about - 90 microvolts (μV)
3. sodium channels are present only at the nodes of Ranvier
4. potassium ions fl ow inward across the cell membrane
during depolarization

131. Answer: A (1, 2, & 3 )
Explanation:
An action potential occurs when an electrical, mechanical,
or chemical stimulus increases neural membrane
permeability to ion infl ux.
1. In myelinated nerves, the action potentials occur at the
nodes of Ranvier and impulses are rapidly conducted by
saltatory conduction.
- In nonmyelinated nerves, the action potentials occur
along the length of the axon. Such continuous conduction
is much slower than the saltatory conduction of
myelinated fi bers.
2. The resting transmembrane potential is around -90μV
with high membrane permeability to potassium (K+) and
limited sodium (Na+) permeability.
3. Sodium channels are present only at the nodes of
Ranvier.
4. Increasing stimuli alter the membrane potential, the
membrane becomes much more permeable to Na+. This
causes sodium to fl ow in and potassium ions to fl ow
outward. Chloride ion diffuses freely through the
membrane in response to changes in polarity.
- The opening and closing of K+ channels in response to
stimuli is responsible for the depolarization and
repolarization phases of the action potential. An ion
channel, for example, enlarges during the depolarization
phase (+60 to 70 μV). After depolarization, the Na+
channels lose their increased permeability to Na+, and K+
is pumped back into the cells during repolarization. The
potential gradually returns to resting transmembrane
potential.
- The resting potential is maintained by diffusion of
intracellular K+ out of the cell through partially open K+
channels.

132

132. The sphenopalatine ganglion:
1. Has sensory input from the trigeminal nerve
2. Is a parasympathetic ganglion
3. Has been injected to treat cluster headaches
4. When injected, causes a Horner’s syndrome

132. Answer: B (1 & 3 )
Explanation:
1. The sphenopalatine ganglion receives sensory input
from a variety of nerves, including the trigeminal nerve.
2. It is a sympathetic ganglion.
3. Has been blocked to treat cluster headache.
4. It has efferents to the stellate ganglion, but does not
cause a Horner’s syndrome.
Source: Trescot AM, Board Review 2003

133

133.The following statements are true concerning
intervertebral discs:
1. The structure of the posterior annulus is similar in lumbar
and cervical discs.
2. The annulus of the intact lumbar disc consists of 10 to
20 lamella made up of vertically and horizontally oriented
collagen fi bers.
3. In the intact lumbar disc, the annulus is thickest in the
posterior portion and thinnest in the anterior portion
4. The gray rami commicantes innervates the outer third
of the anterior and anterolateral annulus.

133. Answer: D (4 Only)
Explanation:
References:
Mercer, The Ligaments and Anulus Fibrosus of Human
Adult Cervical Intervertebral Discs, SPINE 1999;24:619
Bogduk, Clinical Anatomy of the Lumbar Spine and
Sacrum, Third Edition, Churchill Livingston 1997,
Chapter 2, pp. 26-29
1. The lumbar intervertebral discs function as load bearing shock absorbers whereas the cervical discs
accommodate rotational motion of the cervical spine but
do not bear signifi cant weight.
- Therefore the anatomic structure of the lumbar and
cervical discs is very different from each other.
2. The lumbar disc annulus consists of approximately 20
concentric lamellae of collagen fi bers that uniformly
surround the nucleus pulposus with alternating oblique
orientations slanted to approximately 65 degrees.
- These lamellae are thicker in the anterior and lateral
portions of the disc and thinner at the posterior disc
margin.
3. The cervical anulus is crescentic, being thick anteriorly
but tapering in thickness laterally as it approaches the
uncovertebral region. There is no defi nable nucleus in the
adult cervical disc. Posteriorly, the anulus fi brosus is not
multilaminated like the anterior anulus of cervical discs or
the posterior anulus of lumbar discs, nor does it consist of
obliquely orientated fi bers. It is represented only by a thin
set of vertically running fi bers.
4. In the lumbar disc, the gray rami communicantes
innervates the anterior and anterolateral portions of the
disc whereas the sinuvertebral nerve innervates the
posterior disc annulus
Source: Schultz D, Board Review 2004

134

134.Which of the following tendons are considered
intra-articular but extrasynovial in proximity of the
glenohumeral joint?
1. Infraspinatus Tendon
2. Subscapularis Tendon
3. Supraspinatus Tendon
4. Biceps Tendon

134. Answer: D (4 Only)
Source: Sizer Et Al - Pain Practice March & June 2003

135

135. Approaches to the brachial plexus block include:
1. Interscalene
2. Supraclavicular
3. Infraclavicular
4. Cervical transforaminal at C6 level

135. Answer: A (1, 2, & 3)
Explanation:
1. The brachial plexus may be blocked through
interscalene approach.
2. The brachial plexus may be blocked through
supraclavicular approach.
3. The brachial plexus may be blocked through
infraclavicular or axillary approach.
4. Cervical transforaminal is utilized for epidural block –
individual nerves may be blocked, but not the plexus.
Source: Trescot AM, Board Review 2003

136

136. Ankle blocks typically refer to blockade of the distal
branches of which of the following nerves?
1. Common Peroneal
2. Tibial
3. Femoral
4. Obturator

136. Answer: A (1, 2, & 3 )
Explanation:
(Raj, Pain Review 2nd Ed.)
Ankle blocks typically refer to blockade of the deep and
superfi cial peroneal nerves, posterior tibial nerves, sural
nerve, and saphenous nerve.
The superfi cial peroneal, sural, saphenous are superfi cial
to the fascia, whereas the deep peroneal and posterior
tibial are deep to the fascia.
The superfi cial peroneal and deep peroneal nerves are branches of the common peroneal nerve.
The deep peroneal is medial to the dorsalis pedis artery.
The posterior tibial nerve, a branch of the tibial nerve, lies
in the tarsal tunnel, anterior to the posterior tibial artery
and posterior to the fl exor hallicis longus. The saphenous
nerve is a branch of the femoral nerve. The obturator
supplies the hip adductors and sensation to a small area
over the distal medial thigh.
Source: Shah RV, Board Review 2003

137

137.True statements regarding the ligamentum fl avum
include
1. it is thinnest in the cervical region
2. it connects the laminate of adjacent vertebrae
3. it is thickest in the lumbar region
4. its fi bers are arranged parallel to the laminae to which
it is attached

137. Answer: A (1, 2, & 3 )
Explanation:
Each ligamentum fl avum consists of yellow elastic tissue
attached to the anterior and inferior surfaces of the lamina
above and to the posterior superior surface of the lamina
below.
1 & 3. Ligamenta fl ava is thin in the cervical region,
thicker in the thoracic region, and thickest in the lumbar
region.
2. The ligamenta fl ava connect the laminae of adjacent
vertebrae.
4. The fi bers of the ligamenta fl ava are oriented
perpendicularly to the laminae to which they are attached.

138

138. Which of the following are true regarding a Chiari II
malformation?
1. Most common serious posterior fossa malformation
2. Typically associated with myelomeningocele
3. Known as Arnold Chiari malformation
4. Associate with an alpha-fetoprotein marker

138. Answer: E (All)
Explanation:
The Chiari II malformation is a complex anomaly with
skull, dura, brain, spinal, and spinal cord manifestations.
This disorder is almost invariably associated with
myelomeningocele. The Chiari II malformation is the
most common serious malformation of the posterior
fossa. The frequency is approximately 1 case per 1000
population in the United States.
Source: Boswell MV, Board Review 2004

139

139. Ganglion impar is:
1. lowest sympathetic ganglion in the body
2. also named ganglion of Walther
3. located at sacrococcygeal junction
4. has ganglion cells

139. Answer: E (All)
Source: Racz G. Board Review 2003

140

140. Head and neck nerves that are mixed (sensory and motor)
nerves include:
1. Glossopha.ryngeal
2. Occipital
3. Sphenopalatine
4. Spinal accessory

140. Answer: D (4 Only)
Explanation:
The glossopharyngeal and sphenopalatine are mixed
nerves. The spinal accessory is a motor nerve and the
occipital is a sensory nerve.
Source: Trescot AM, Board Review 2003

141

141. The posterior cord gives rise to what nerve/s?
1. Median
2. Axillary
3. Ulnar
4. Radial

141. Answer: C
Source: Day MR, Board Review 2006

142

142. Which of the following are thought to be pain insensitive
structures in the lung?
1. bronchi
2. visceral pleura
3. parietal pleura
4. Lung parenchyma

142. Answer: C (2 & 4)
Explanation:
(Raj, Practical Management of Pain, 3rd Ed., page 618)
1. The trachea and bronchial tree send afferent input
through the vagus and upper thoracic sympathetics (T2-7)
and is pain radiates to the sternum.
2. The visceral pleura has no pain sensation.
3. The parietal pleura transmits pain along somatic nerves,
such as the brachial plexus (C8,T1), intercostal nerves
(T1-12), and phrenic nerves (C3-5).
4. The lung parenchyma is pain insensitive.
Source: Shah RV, Board Review 2005

143

143. The anterior surface of the head of each rib is connected
to the sides of the bodies of two adjacent vertebrae by the
following ligament.
1. Intraarticular
2. Superior costotransverse
3. Lateral costotransverse
4. Radiate

143. Answer: D (4 Only)
Explanation:
1. The intraarticular ligament consists of a short fl at band
of fi bers attached at one end to the crest separating the two
articular facets on the head of the rib and at the other end
tothe intervertebral disk.
2. The superior costotransverse ligament is attached to the
superior border of the neck of the rib and passes laterally
to the lower border of the neck of the transverse process
immediately above.
3.The radiate ligament connects the anterior part of the
head of each rib with the sides of the bodies of two
adjacent vertebrae and the intervertebral disks between
them.
4. The lateral costotransverse ligament passes from the
apex of the transverse process of the vertebra to the rough
and nonarticular portion of the tubercle of the
corresponding rib.

144

144. The superior hypogastric plexus is:
1. a bilateral structure
2. located at the level of the third lumbar vertebra
3. in the proximity of the bifurcation of the common iliac
vessels
4. a purely sympathetic chain

144. Answer: B (1 & 3)
Source: Nader and Candido – Pain Practice. June 2001

145

145. The following statements are true of spinal nerves
1. they exit the spinal canal at the intervertebral foramina
2. cervical spinal nerves form the intercostal nerves
3. they are derived from ventral and dorsal roots of the
spinal cord
4. the dorsal rami combine to form plexuses at the cervical
and lumbosacral levels

145. Answer: B (1 & 3 )
Explanation:
1. They exit the spinal canal through the intervertebral
foramina and immediately split into dorsal and ventral
rami.
- The dorsal rami pass posteriorly to innervate the
paraspinal muscles and skin.
2. Thoracic spinal nerves form intercostal nerves – not
cervical
3. Spinal nerves are derived from the union of the
corresponding ventral and dorsal roots of the spinal
cord.
4. The ventral rami combine to form plexuses at cervical
and lumbosacral levels. The thoracic spinal nerves from
the intercostal nerves.

146

146.The intervertebral disc is composed of all of the following
1. Nucleus pulposus
2. Annulus fi brosis
3. Posterior longitudinal ligament
4. The end plates

146. Answer: A (1, 2, & 3 )
Source: Rozen. Pain Practice: SEP 2001

147

147. Which of the following are innervated by fi bers traversing celiac plexus?
1. Pancreas
2. Kidney
3. Duodenum
4. Descending colon

147. Answer: A (1, 2, & 3)
Source: Boswell MV, Board Review 2005

148

148.Which of the following factors induce pain in visceral
structures?
1. Traction or compression of ligaments, vessels, or mesentery
2. Rapid stretching of the capsule of solid visceral organs
3. Ischemia of visceral musculature
4. Crushing or burning

148. Answer: A (1, 2 & 3)
Explanation:
Raj and Patt. Chapter 11. Visceral Pain. In: Pain Medicine:
A Comprehensive Review, 2nd Edition, Raj, Mosby, 2003
Source: Boswell MV, Board Review 2005

149

149. Which of the following is (are) true regarding the superior hypogastric plexus?
1. Adjacent to the bifurcation of the aorta
2. Located at the lower 1/3 of L5 vertebral body
3. At the upper 1/3 of S1 vertebral body
4. Also named the presacral nerve

149. Answer: C (2 & 4)
Source: Boswell MV, Board Review 2005

150

150.Which of the following are indications for a superior
hypogastric plexus blockade?
1. Bladder pain
2. Ovarian pain
3. Vulvar pain
4. Kidney pain

150. Answer: C (2 & 4)
Explanation:
1. The bladder is innervated by the pelvic splanchnics
(pain afferents with parasympathetics from the sacral
roots).
2. Superior hypogastric plexus block is indicated for
ovarian pain.
3. The vulva is innervated by somatic fi bers that travel
with pudendal nerves.
4. Superior hypogastric plexus block is indicated for
kidney pain.
Source: Boswell MV, Board Review 2005

151

151.The musculocutaneous nerve innervates which of the
following muscles?
1. Brachialis
2. Brachiradialis
3. Biceps brachii
4. Tricep

.151. Answer: B
Source: Day MR, Board Review 2005

152

152. Which of the following are true?
1. Average spinal cord diameter at C4-5 is about 9-11 millimeters
2. With neck extension, the posterior longitudinal ligament
is stretched
3. The ligamentum fl avum reinforces the anterior aspect
the cervical facet joint capsule
4. The lateral atlanto-axial joints are responsible for nodding

152. Answer: B
Explanation:
(Bonica, 3rd Ed., pages 971-976)
The average spinal cord diameter from C2-6 is about 10
millimeters and below C6 it is 7-9 millimeters. With neck
extension, the posterior longitudinal ligament relaxes and
the anterior longitudinal ligament stretches. The
ligamentum fl avum looks like shingles on a roof: they span
the anterior inferior surface of the cephalad lamina to the
posterior superior margin of the caudad lamina. They are
elastic and stretch laterally to reinforce the anterior aspect
of the zygapophyseal joints. The lateral atlanto-axial joints
contribute to rotation (the ‘NO’ joint) and the atlantooccipital
joint contributes to fl exion-extension (nodding,
the ‘YES’ joint).
Source: Shah RV, Board Review 2005

153

153.Which of the following cervical vertebra have three
articulating surfaces?
1. C6
2. C2
3. C3
4. C1

153. Answer: D
Explanation:
(Bonica, 3rd Ed., page 969)
The atlas or C1 vertebra does not have a body. It is a solid
ring of bone with two lateral pillars; the upper and lower
surfaces articulate with the occiput and C2 vertebra
respectively. The short anterior arch of C1 articulates with
the odontoid process of C2 in the vertical plane. The C2
vertebra has four articulating surfaces. Excluding those
two already mentioned, the inferior facet articulates with
the superior facet of C3 and the posterior aspect of the
dens articulates with the transverse alar ligament. The
C3 and C7 vertebral bodies have only two each. The
intervertebral disc and the uncinate processes are not true
articular surfaces.
Source: Shah RV, Board Review 2005

154

154. If you use the external occipital protuberance as a point
of reference and march anteriorly, you will encounter
several nerves innervating the cranium. Which of the
following sequences would be correct?
1. Least occipital nerve, Greater occipital nerve, Lesser occipital
nerve, Greater auricular nerve
2. Lesser occipital nerve, Greater occipital nerve, Least occipital
nerve, Auriculotemporal nerve
3. Least occipital nerve, Lesser occipital nerve, Greater
auricular nerve, Auriculotemporal nerve
4. Greater occipital nerve, Least Occipital Nerve, Auricolotemporal,
Greater auricular nerve

.154. Answer: B (1 & 3)
Explanation:
(Raj, Pain Review 2nd Ed., page 229-231, Netter’s
Anatomy Atlas)
The correct order is least occipital nerve (C3), greater
occipital nerve (C2), lesser occipital (C2-3), greater
auricular nerve (C2-3), auriculotemporal (V3),
supraorbital (V1), and supratrochlear(V1).
Source: Shah RV, Board Review 2005

155

155. True statements regarding the pudendal nerve include
1. it is derived from the S2,S3, and S4 nerves
2. it leaves the pelvic cavity through the greater sciatic
foramen
3. it receives sympathetic fi bers from the sacral portion of
the sympathetic trunk
4. it divides into fi ve main branches

155. Answer: A (1, 2, & 3 )
Explanation:
1. The somatic fi bers of the pudendal nerve are derived
from the anterior primary divisions of the S2, S3 and S4
nerves.
2. The pudendal nerve leaves the pelvic cavity by passing
through the greater sciatic foramen inferior to the
piriformis muscle, between it and the coccygeal muscle.
3. The sympathetic fi bers of pudendal nerve are
contributed by the sacral portion of the sympathetic pain.
4. The pudendal nerve trunk divides into three main
branches: the inferior hemorrhoidal nerve, the perineal
nerve, and the dorsal nerve to the clitoris (or to the penis).

156

156. True Tietze’s syndrome is a condition that includes all of
the following except:
1. may be confused with myocardial ischemia
2. affl icts patients of all ages, but usually patients younger
than 40
3. may be associated with bulbous swelling of the costal
cartilages
4. involves the lower thoracic costo-transverse joints

156. Answer: D (4 only)
Explanation:
(Raj, Practical Management of Pain, 3rd Ed., page 620-
621)
1. Although Tietze’s syndrome is synonymous with
costochondritis (infl ammation of the anterior joints
corresponding to articulation between the
sternum/manubrium and ribs), it is specifi c for a
unilateral anterior chest pain involving the 2nd and 3rd
anterior costal cartilages. A better term would be
costochondral pain. This pain develops following blunt
chest trauma, coughing due to upper respiratory
infections,and overuse (washing windows or painting). It
can be confused with myocardial infarction.
2. It affl icts patients of all ages, but usually those less than
40 years of age.
3. Bulbous swellings may persist for several months and
point tenderness over the costochondral joints are
common. Treatment is conservative: NSAIDS, TENS, local
infi ltration, hot/cold packs, electroacupuncture.
True costochondritis refers to infl ammation and
arthritides of the costochondral joints at multiple
locations. This affl icts elderly patients, but the treatment is
similar to Tietze’s syndrome.
Source: Shah RV, Board Review 2005

157

157. Characteristics of the lumber vertebrae include
1. the body is wider
2. they are the largest of the immovable vertebrae
3. the lumbar vertebral (spinal) canal is larger than cervical
canal
4. the lumbar vertebral (spinal) canal is larger than the thoracic canal

157. Answer: C (2 & 4)
Explanation:
1. The laminae of lumbar vertebrae are broad, short, and
strong.
- The body of the vertebra is large and is wider
transversely than anteroposteriorly and a little thicker anteriorly than posteriorly.
2. The lumbar vertebrae are the largest of the true
immovable vertebrae and are also large in comparison to
their own vertebral canal.
3. The lumbar vertebral (spinal) canal is triangular and is
larger than the thoracic canal but smaller than the cervical
canal.
4. The lumbar vertebral (spinal) canal is triangular and is
larger than the thoracic canal but smaller than the cervical
canal.

158

158. Which of the following is true about nervus intermedius:
1. neuralgia of this structure is also known as the otalgic
type of geniculate neuralgia
2. it causes pain originating in the ear but radiating to deep
facial structures
3. it can be lesioned alone or in conjunction with the following
cranial nerves: VI, XI, XII.
4. surgical exposure to section this nerve is easier than that
for trigeminal or glossopharyngeal structures

158. Answer: A (1,2, & 3)
Explanation:
(Raj. Pain Review 2nd Ed., page 313, Bonica 3rd Ed., page
938)
Ramsay-Hunt syndrome is the reactivation of herpes
zoster in the geniculate ganglion and can lead to ear and
facial pain, rash over the face, hearing loss, and balance
diffi culties.
1. The otalgic variety of geniculate neuralgia is known.
2. Pain can occur in the ear and radiate to the face.
3. It can be lesioned alone or in conjunction with the
following cranial nerves: VI, XI, XII.
4. Surgical exposure of the nervus intermedius is more
diffi cult than performing trigeminal or glossopharyngeal
nerve sectioning. Additional cranial nerves that may be
sectioned include VII, VIII, IX, and X.
Source: Shah RV, Board Review 2005

159

159.Which of the following do not share a common
innervation with the temporomandibular joint?
1. masseter
2. lateral pterygoid
3. temporalis
4. buccinator

159. Answer: D (4 only)
Explanation:
(Raj, Practical Management of Pain 3rd Ed., page 580)
1, 2, 3. The trigeminal ganglion is commonly thought of as
only a sensory neural structure, but in reality it provides
motor innervation to the muscles of mastication: masseter,
medial and lateral pterygoids, temporalis, mylohyoid and
anterior belly of the digastric muscles. The temporomandibular
joint is innervated by the maxillary nerve.
4. The facial nerve provides muscle innervation to the
muscles of the face and taste sensation vis a vis chorda
tympani. Recall the pneumonic:’To Zanzibar By Motor
Car’, which describes the branches of the facial nerve. The
buccinator is innervated by the buccal nerve.
Temporalis
Zygomatic
Buccal
Marginal Mandibular
Chorda Tympani
Source: Shah RV, Board Review 2005

160

160. True statements regarding the epidural space include that
it is
1. bound anteriorly by the posterior longitudinal ligament
2. triangular in the cervical region
3. bound posteriorly by the ligamentum fl avum
4. most narrow posteriorly

160. Answer: B (1 & 3)
Explanation:
1. The epidural space is bound anteriorly by the posterior
longitudinal ligament and the vertebral bodies, and laterally by the pedicles and intervertebral foramina.
2. In the lumbar region, the epidural space is triangular
with the apex of the triangle corresponding to the
posterior midline of the vertebral canal.
3. Posterior boundaries of the epidural space include the
laminae and ligamenta fl ava, while its inferior boundary is
its continuation with the sacral canal.
4. The size of the epidural space varies greatly. The
anterior portion is the narrowest (approximately 1 mm).

161

161. Landmarks used in performing a deep cervical plexus
block include the
1. mastoid process
2. cricoid cartilage
3. Chassaignac’s tubercle (C6)
4. posterior border of sternocleidomastoid muscle

161. Answer: A (1, 2, & 3 )
Explanation:
1, 2 & 3. Insertion sites are located by reference to a line
that joins the tip of the mastoid process with Chassaignac’s
tubercle of C6, which is palpated at the level of the cricoid
cartilage.
- The deep cervical plexus is composed of the C2-C4
spinal nerves as they emerge from the foramina in the
cervical vertebrae.
4. The posterior border of the sternocleidomastoid muscle
is the major point of reference used in performing
blockade of the superfi cial cervical plexus.

162

162.Which of the following brain structures contain high
concentrations of adrenergic neurons?
1. Dorsal raphe
2. Locus ceruleus
3. Striatum
4. Pons

162. Answer: C (2 & 4)

163

163. The inferior hypogastric Plexus:
1. Is a unilateral structure
2. Is situated on either side of the rectum
3. Provides innervation to the perineum
4. Provides afferent information from the prostrate

163. Answer: C (2 & 4)
Source: Nader and Candido – Pain Practice. June 2001

164

164. The muscles of anterior abdominal wall include all the
following :
1. cremaster
2. internal oblique
3. pyramidalis
4. external oblique

164. Answer: E (All)
Explanation:
The muscles of the abdomen are divided into an
anterolateral group and a posterior group.
The anterolateral group is composed of four fl at muscular
sheets that form the anterior abdominal wall. These
muscles include the internal and external obliques; the
transversus and rectus abdominis; and the cremaster and
pyramidalis muscles, which are involved in suspending the
testes and tensing the midline tendinous raphe of the
abdominal wall, respectively.

165

165.Which of the statements regarding spinal structures is
correct:
1. The anterior column consists of vertebral bodies and
intervertebral discs.
2. The pars interarticularis connects the posterior spinal
elements to the vertebral body
3. The posterior spinal elements include the spinous processes, zygapophysial or facet joints, and the lamina.
4. The dens is part of the atlas

165. Answer: B (1 & 3)
Explanation:
Reference:
Gray’s Anatomy, Thirteenth American Edition. Page 127-
130.
1. The anterior spinal column consists of vertebral bodies
and intervertebral discs.
2. The spinal canal lies between the anterior column and
the posterior elements and transmits the spinal cord and
below L2, the cauda equina.
- The pedicle connects the lamina to the vertebral body,
thus connecting the posterior and anterior spinal
structures.
- The pars interarticularis is part of the lamina between the superior and inferior articular processes.
3. The posterior elements consist of spinous processes,
lamina, zygapophysial (facet) joints and posterior spinal
ligaments (supraspinous, infraspinous and ligamentum
fl avum).
4. The dens (odontoid process) is the tooth-like
projection of the C2 vertebral body (the axis) that juts
upward into the anterior arch of C1 (the atlas).
Source: Schultz D, Board Review 2004

166

166. Which of the following nerve entrapments is a potential
cause of eye pain?
1. Supraorbital
2. Occipital
3. Infraorbital
4. Mandibular

166. Answer: A (1, 2, & 3 )
Explanation:
1. The supraorbital nerve innervates the eye.
2. The occipital nerve transmits the referred pain.
3. Infraorbital nerve innervates the eye.
4. The mandibular nerve innervates the lower jaw.
Source: Trescot AM, Board Review 2003

167

167. True statements with regard to the celiac plexus include
1. it lies anterior to the crura of the diaphragm
2. the entire plexus lies anterior to the stomach and omental
bursa
3. it is composed of parasympathetic and sympathetic
fi bers
4. it lies posterior to the vertebral body of L1

167. Answer: A ( 1, 2, & 3)
Explanation:
1. The plexus is situated in the epigastrium just anterior to
the crura of the diaphragm.
2. The entire plexus lies posterior to the stomach and the
omental bursa not anterior.
3. The celiac plexus is composed of two or more large
aggregates of ganglion cells, the right and left celiac
ganglia, a number of smaller ganglia, and a dense network
of parasympathetic and sympathetic efferent and afferent
fi bers that enmesh these ganglia.
4. The plexus is situated anterior to the body of fi rst
lumbar vertebra not posterior.

168

168.The following are true statements about the pars
interarticularis:
1. It is a part of the pedicle which attaches to the vertebral
body.
2. Spondylolisthesis is the term used to describe a bilateral
pars defect
3. A pars defect is present in approximately 1% of asymptomatic
individuals
4. It is represented by the “neck” of the Scotty dog on
oblique fluoroscopic imaging.

168. Answer: D (4 Only)
Explanation:
Bogduk, Clinical Anatomy of the Lumbar Spine and
Sacrum, Third Edition
1. The pars interarticularis is a part of the lamina which
connects the superior and inferior articular processes.
2. Spondylolysis is the term used to describe a pars defect.
- Spondylolysis was originally thought to be a defect
caused by failure of union between two ossifi cation centers
in the vertebral lamina.
- Recent evidence however clearly shows that
spondylolysis is an acquired defect caused by a fatigue
fracture of the pars interarticularis.
3. Pars defects are not necessarily painful and are present
in approximately 10% of asymptomatic individuals.
- Nonetheless, in the presence of a pars defect, the
posterior spinal elements are disconnected from the
anterior spinal column and constitute a “fl ail segment”.
- This may cause motion instability and the forward movement of one vertebral body on another known as
spondylolisthesis.
- The pars defect itself is innervated with free nociceptive
nerve endings and certainly has the potential to be painful.
- It has been suggested that infi ltration of the pars defect
may help to determine whether or not it is involved in
pain generation.
- However, no studies have established how often a pars
defect is the cause for back pain.
4. Fluoroscopically, the pars interarticularis is represented
by the neck of the “Scotty dog” and a pars defect appears
as a “collar” on the dog’s neck.
Source: Schultz D, Board Review 2004

169

169. The innervaton of the diaphragm includes
1. Vagus nerves
2. Intercostal nerves
3. Lumbar plexus
4. Cervical plexus

169. Answer: C (2 & 4)
Explanation:
1. Vagus nerves do not innervate the diaphragm.
2. The diaphragm’s peripheral muscular fi bers are
supplied by the 6th to the 11th or 12th intercostal nerves.
3. Lumbar plexus does not innervate the diaphragm.
4.The most central portion of the diaphragm is innervated
by the phrenic nerves, which arise from the two cervical
plexuses (C3-C5).

170

170. Afferent fi bers from the heart enter the central nervous
system via the:
1. vagus nerve
2. greater splanchnic nerve
3. middle cervical ganglion
4. superior cervical ganglion

170. Answer: B (1 & 3)
Explanation:
(Raj, Practical Management of Pain 3rd Ed., page 618)
The visceral afferent fi bers of the heart are transmitted
through the vagus, cervical ganglia (middle and inferior
cervical nerves), and the upper fi ve thoracic ganglia
(thoracic cardiac nerves)…all of which send input to the
central nervous system via T1-5.
Source: Shah RV, Board Review 2005

171

171. Choose the correct statement(s) with respect to sensory
innervation of the posterior primary division of a spinal
nerve:
1. periosteum
2. Cutaneous and muscular structures
3. Facet or zygapophysial joints
4. Posterior longitudinal ligament

171. Answer: A (1, 2, & 3 )
Explanation:
1. The posterior primary division provides sensory fi bers
to periosteum.
2. The posterior primary division provides sensory fi bers
to cutaneous and muscular structures.
3. The posterior primary division provides sensory fi bers
to facet joints.
4. The sinuvertebral nerves supply posterior longitudinal
ligament and other structures within the spinal canal.

172

172. Which of the following are branches of the ophthalmic
division of the trigeminal ganglion?
1. Supratrochlear nerve
2. Infraorbital nerve
3. Frontal nerve
4. Auriculotemporal nerve

172. Answer: B (1 & 3)
Explanation:
1. Supratrochlear nerve is a branch of ophthalmic division
of trigeminal nerve.
2. Infratrochlear nerve is a branch of maxillary nerve (DR
M CHECK)
3. Frontal nerve is a branch of ophthalmic division of
trigeminal nerve.
4. Auriculotemporal nerve is a branch of mandibular
nerve.
Source: Shah RV, Board Review 2003

173

173. Ilioinguinal nerve entrapment:
1. courses in an L1-L2 nerve distribution
2. Has an S2-S4 nerve distribution
3. May be noticed postoperatively
4. Is usually of a cyclical nature

173. Answer: B (1 & 3)
Source: Nader and Candido – Pain Practice. June 2001

174

174. Scenario:A needle is placed into the spinal canal of a
cadaver. The needle enters the skin in the mid-sagittal
plane of the spine and travels through the spinal canal
from the midline posterior to the midline anterior.The
following statements are true:
1. With regards to ligaments, the needle would cross the
interspinous ligament fi rst, the supraspinous ligament
second and the ligamentum fl avum third.
2. The needle would encounter the posterior longitudinal
ligament only after penetrating the entire thickness of
spinal cord.
3. The needle tip would encounter cerebrospinal fl uid
immediately after penetrating the dura mater and just
prior to penetrating the arachnoid membrane.
4. The needle would enter the dorsal epidural space immediately
after exiting the ligamentum fl avum

174. Answer: C (2 & 4)
Explanation:
Reference:
Gray’s Anatomy, Thirteenth American Edition. Pages 345-
350.
1. The posterior spinal ligaments consist of the
supraspinous, the interspinous and the ligamentum
fl avum. The supraspinous is the most superfi cial and
connects the apices of the spinous processes from the
C7 to the sacrum. The interspinous ligament connects
adjacent spinous processes with one another and is
interposed between the supraspinous and the ligamentum
fl avum. The ligamentum fl avum is markedly elastic and
connects the lamina of one segment to the adjacent
lamina. The ligamentum fl avum is the roof of the dorsal
epidural space.
2. The posterior longitudinal ligament runs the length of
the spinal column from the axis to the sacrum. This
ligament is within the spinal canal and is just anterior to
the spinal cord and anterior epidural space. The posterior
longitudinal ligament separates the intervertebral disc
annulus from the spinal canal.
- The anterior longitudinal ligament lies on the ventral
surface of the vertebral bodies extending from the axis to
the sacrum.
3. The layers of the spinal canal consist of the dura mater,
the arachnoid and the pia mater. The dura is a substantial
fi brous tissue that is the inner boarder of the epidural
space.
- Once the dura is penetrated the needle tip enters a
potential space called the subdural space. This space is
fi lled with a small amount of serosanguinous fl uid. The
subdural space is often transcended entirely with quick
penetration of the thin and closely apposed arachnoid
membrane which allows access to the cerebrospinal fl uid
compartment. The pia mater is closely adherent to the
spinal cord and the CSF fl ows between the pia and the
arachnoid.
4. The epidural space is a circular space which surrounds
the spinal canal and its contents.Posteriorly in the midline,
the dura is the fl oor of the epidural space and the
ligamentum fl avum is the roof.
Source: Schultz D, Board Review 2004

175

175. The following nerve(s) are branch or branches of the
maxillary nerve contained within the pterygopalatine
fossa:
1. Greater Palatine
2. Nasopalatine
3. Superior Alveolar
4. Inferior Alveolar

175. Answer: A (1, 2, & 3 )
Explanation:
1, 2 & 3. Branches of the maxillary nerve within the
pterygopalatine fossa include the pharyngeal branch to the
mucosa of the pharynx, the greater palatine branch to the mucosa of the posterior palate, the nasopalatine branch to
the septal mucosa through the incisive canal to the
anterior hard palate, and the superior alveolar branch to
the second and third maxillary molars.
4. The inferior alveolar nerve is a sensory branch of the
mandibular nerve that supplies the mandibular teeth,body
of the mandible, and labial gingiva anterior to the bicuspid
teeth

176

176. The visceral pleura receives innervation from
1. intercostal nerves
2. sympathetic fi bers with vasomotor function
3. primary nociceptive afferent fi bers
4. parasympathetic fi bers via the pulmonary plexus

176. Answer: C (2 & 4)
Explanation:
1. The parietal pleura is supplied by the intercostal nerves
at its lateral aspects, by the T1 spinal nerve at its apex, and
by the phrenic nerves on the diaphragmatic surface.
2. The visceral pleura is supplied by sympathetic fi bers that
have a vasomotor function.
3. It has afferent fi bers that do not have a nociceptive
function, making it insensitive to noxious stimuli.
4. Visceral pleura receives parasympathetic fi bers through
the pulmonary plexuses.

177

177. A mandibular nerve block at the coronoid notch may
result in the following:
1. Anesthesia of the cornea
2. Loss of sensation to the tongue
3. A subarachnoid injection
4. Anesthesia to the chin

177. Answer: C (2 & 4)
Explanation:
1. A trigeminal nerve block at the foramen ovale can result
in anesthesia to the eye.
2. The mandibular nerve block at the coronoid will
include the lingular nerve which gives sensation to the
tongue resulting in loss of sensation.
3. A trigeminal nerve block at foramen ovale can result in
subarachnoid injection.
4. The mandibular nerve block at coronoid notch will
block the mental nerve which innervates the chin.
Source: Trescot AM, Board Review 2003

178

178. Choose all items that correctly match anatomic structures with their level of termination in adults.
1. Spinal cord, L1-L2
2. Preganglionic sympathetic nerves, L2
3. Spinal canal, sacral hiatus
4. Dural sac, S4

178. Answer: A (1, 2, & 3)
Explanation:
1. In adults the spinal cord ends at L1-L2.
2. The sympathetic nerve fi ber originates in the
intermediolateral grey column of the T1-L2 spinal
segments.
3. The spinal canal originates at the foramen magnum and
terminates at the sacral hiatus.
4. The dural sac terminates at S2 in adults – not S4.

179

179.When performing an interlaminar epidural injection,
each of the following structures is traversed
1. supraspinous ligament
2. ligamentum fl avum
3. interspinous ligament
4. posterior longitudinal ligament

179. Answer: A (1, 2, & 3 )
Explanation:
The supraspinous ligament, interspinous ligament, and
ligamentum fl avum are traversed, after which continued
advancement places the needle in the epidural space.
1. The supraspinous ligament is a strong, fi brous cord that
connects the spinous processes from the C7 vertebra to
the sacrum. The needle passes through this ligament
during an interlaminar epidural injection.
2. The ligamentum fl avum connects the laminae of
adjacent vertebrae. The needle passes through this
ligament during an interlaminar epidural injection.
3. The interspinous ligaments are thin and membranous
and connect adjoining spinous processes, extending from
the root to the apex of each process. The needle passes
through this ligament during an interlaminar epidural
injection.
4. The posterior longitudinal ligament extends from the
axis to the sacrum and passes over the dorsal surface of the
bodies of the vertebrae and the intervertebral disks.
- Although the posterior longitudinal ligament is the
anterior boundary for the epidural space,it is not traversed
when an epidural injection is performed.
- It will only be traversed if the needle went through the
spinal cord.

180

180. All the following nerves pass in front of the ear to provide
innervation of the scalp
1. supraorbital nerve
2. auriculotemporal nerve
3. supratrochlear nerve
4. zygomaticotemporal nerve

180. Answer: E (All)
Explanation:
- There are eight nerves involved in processing sensory
information to the scalp.
- Four sensory nerves pass in front of the ear to the scalp:
the supratrochlear and supraorbital nerve from V1
(ophthalmic branch of trigeminal); the
zygomaticotemporal nerve from V2 (maxillary branch of
trigeminal); and the auriculotemporal nerve from V3
(mandibular branch of trigeminal).
-Four nerves pass behind the ear: the great auricular nerve
and the greater, lesser, and least occipital nerves from the
cervical plexus.
- All eight nerves converge toward the vertex of the
scalp.
1. Supraorbital nerve from ophthalmic branch of
trigeminal also passes in front of ear.
2. Auriculotemporal nerve, a branch of mandibular branch
of trigeminal nerve also passes in front of the ear.
3. Supratrochlear nerve from ophthalmic branch of
trigeminal passes in front of the ear.
4. Zygomatico temporal nerve from maxillary branch of
trigeminal also passes in front of the ear.

181

181. The following statements regarding the sacral canal are
true
1. it communicates laterally with the sacral foramina
2. the volume of sacral canal exceeds 100 mL
3. it contains the cauda equina
4. its superior border is the sacral hiatus

181. Answer: B (1 & 3)
Explanation:
1. The sacral canal is the continuation of the lumbar spinal
canal. It communicates laterally with the anterior and
posterior sacral foramina.
2. The volume of the sacral canal, including the sacral
foraminal extensions, varies between 12 and 65 mL with a
mean of about 30 to 34 mL.
3. The canal contains the fi ve sacral nerve roots and the
coccygeal nerve, which constitute the cauda equina. Sacral
canal also contains the fi lum terminale, which exits
through the sacral hiatus to attach to the back of the
coccyx.
4. Inferiorly, the sacral canal terminates at the sacral

182

182. Abdominal autonomic plexuses include all the following:
1. celiac plexus
2. inferior hypogastric plexus
3. superior hypogastric plexus
4. esophageal plexus

182. Answer: A (1, 2, & 3 )
Explanation:
The abdomen contains three large plexuses composed of
prevertebral sympathetic ganglia, parasympathetic fi bers
from the vagus or sacral parasympathetics, and visceral
afferent fi bers.
1 The celiac plexus innervates the abdominal viscera.
2. The inferior hypogastric plexus also supplies the pelvic
viscera.
3. The superior hypogastric plexuses supply the pelvic
viscera.
4. Esophageal plexus is not (T-T5) abdominal autonomic
plexus

183

183. Which of the following statements are ture regarding the brainstem?
1. It is made up of the medulla, pons and midbrain
2. It is roofed by the fourth ventricle
3. It is bounded rostrally by the thalamus
4. It is bounded ventrally by the clivus

183. Answer: E (All)
Explanation:
1. The brainstem is the most caudal portion of the brain
and consists of the medulla (myelencephalon), pons
(metencephalon), and midbrain (mesencephalon).
2. The brainstem is roofed by the fourth ventricle.
3. The brain stem is bounded rostrally by the thalamus.
4. The brain stem is bounded ventrally by a fl at bone called
the clivus.
- It is bounded dorsally by the fourth ventricle and
cerebellum caudally by the spinal cord.

184

184. Blockade of the sympathetic efferent activity can be
accomplished by which of the following?
1. Intravenous regional anesthesia
2. Intraspinal local anesthetic
3. Perivascular infi ltration
4. Somatic nerve block

184. Answer: E (All)
Explanation:
Sympathetic fi bers can be blocked at all locations. Raj,
Practical Management of Pain, 3rd edition, page 655

185

185. Correct statements regarding the sympathetic nervous
system include the following.
1. It has cell bodies of preganglionic neurons in the anterolateral
quadrant of the spinal cord
2. It has lumbar ganglia that lie on the posterolateral surface
of the respective vertebrae
3. It has axons that pass via posterior spinal roots to reach
paravertebral ganglia
4. It has paravertebral ganglia that extend from the second
cervical vertebra to the coccyx

185. Answer: D (4 Only)
Explanation:
1. Cell bodies of preganglionic sympathetic neurons lie
within the intermediolateral gray of spinal cord segments
(T1-L2).
2. Lumbar ganglia lie on the anterolateral surface of the
respective vertebrae.
3. Axons from these preganglionic neurons pass by way of
anterior spinal roots and rami communicantes to reach
paravertebral ganglia of the sympathetic chain.
4. Paravertebral ganglia are segmentally arrayed in
bilateral vertical rows extending from the second cervical
vertebra to the coccyx.

186

186.The true statements with regard to the superior
hypogastric plexus include the following
1. is located at the level of the aortic bifurcation
2. often lies to the right of the midline
3. contains parasympathetic fi bers derived from the pelvic
splanchnic nerves
4. receives contributions from the L5 and S1 splanchnic
nerves

186. Answer: B (1 & 3 )
Explanation:
1. The superior hypogastric plexus is situated in front of
the bifurcation of the abdominal aorta,the body of the
fi fth lumbar vertebra, and the promontory of the sacrum.
2. Superior hypogastric plexus often lies in the
extraperitoneal connective tissue, often to the left of the
midline - not to the right.
3. In addition to the sympathetic fi bers that descend to
form the superior hypogastric plexus, the superior
hypogastric plexus contains parasympathetic fi bers
derived from the pelvic splanchnic nerves, which ascend
from the inferior hypogastric plexus.
4. The superior hypogastric plexus is formed by the union
of branches from the aortic plexus with contributions by
the L3 and L4 splanchnic nerves.

187

187. Landmarks used in performing a superior laryngeal nerve
block include the
1. Transverse process of C6
2. Cricoid cartilage
3. Angle of the mandible
4. Greater cornu of the hyoid cartilage

187. Answer: C (2 & 4)

188

188. Serotonergic neurons are found predominately in the
1. Dorsal raphe
2. Locus ceruleus
3. Limbic system
4. Substantia nigra

188. Answer: B (1 & 3)

189

189. Landmarks for the caudal block include the
1. Sciatic notch
2. Posterior-superior iliac spines
3. Iliac crests
4. Sacral cornu

189. Answer: C (2 & 4)

190

190. What are the requirements for single system physical
examination?
1. For musculoskeletal system examination primary system
is musculoskeletal
2. For neurological system examination primary system is
nervous system
3. Other systems to be examined for musculoskeletal system/
single system examination include lymphatic and
psychiatric systems
4. Other systems for neurological examination include
psychiatric and cardiovascular systems

190. Answer: A (1, 2, & 3)
Explanation:
SINGLE SYSTEM EXAMINATION
MUSCULOSKELETAL
* Primary
- Musculoskeletal
* Other
- Constitutional
- Neurological
- Cardiovascular – Peripheral
- Lymphatic
- Skin
- Psychiatric
NEUROLOGICAL
* Primary
- Neurological
* Other
- Constitutional
- Musculoskeletal
- Cardiovascular
- Eyes

191

191. The following nerves usually blocked at the ankle do not contain motor fi bers?
1. Posterior tibial nerve
2. Saphenous nerve
3. Deep peroneal nerve
4. Sural nerve

191. Answer: C (2 & 4)
Explanation:
Five nerves are blocked when performing an ankle block.
The saphenous, superfi cial peroneal, and sural nerves are
all sensory below the ankle.
1. The posterior tibial nerve causes fl exion of the toes by
stimulating the fl exor digitorium brevis muscles and
abduction of the fi rst toe by stimulating the abductor
hallucis muscles.
- The posterior tibial nerve is sensory to most of the
plantar part of the foot.
2. Saphenous nerve below ankle does not contain motor
fi bers.
3. Stimulation of the deep peroneal nerve causes extension
of the toes by stimulating the extensor digitorum brevis
muscles.
- The deep peroneal nerve has a small sensory branch for
the fi rst interdigital cleft.
4. Sural nerve below ankle does not contain motor fi bers.

192

192. True statements regarding epidural veins include
1. They communicate with abdominal veins via the intervertebral foramina
2. They lie in the anterolateral part of the epidural space
3. They are large and valveless
4. They are small and valveless

192. Answer: A (1, 2, & 3 )
Explanation:
1. By way of the intervertebral foramina at each level, the
vertebral plexus communicates with thoracic and
abdominal veins.
- Marked increases in intraabdominal pressure may
compress the inferior vena cava while distending the
epidural veins and increasing fl ow up the vertebrobasilar
plexus.
2. The major portion of this plexus lies in the anterolateral
part of the epidural space, out of reach of a correctly
placed epidural needle.
3. Epidural veins are large and valveless. They are part of
the internal vertebral venous plexus, which drains the
neural tissue of the spinal cord, CSF, and the bony spinal
canal.
4. Epidural veins are large and valveless. They are part of
the internal vertebral venous plexus, which drains the
neural tissue of the spinal cord, CSF, and the bony spinal
canal.

193

193. Sensory innervation to the larynx is derived from
1. Internal branch of the superior laryngeal nerve
2. External branch of the superior laryngeal nerve
3. Recurrent laryngeal nerve
4. Glossopharyngeal nerve

193. Answer: A (1, 2, & 3)
Explanation:
1. The internal branch of the superior laryngeal nerve
provides sensory innervation to the larynx above the vocal
cords.
2. The external branch of the superior laryngeal nerve
provides sensory innervation to the anterior subglottic
mucosa.
3. The recurrent laryngeal nerve provides sensory
innervation to the larynx below the vocal cords.
4. Glossopharyngeal nerve does not provide sensory
innervation to the larynx. It provides sensory innervation
to tongue and pharynx. (DR M NEED TO CHECK FOR
ACCURACY)

194

194. The skin of the penis is supplied by:
1. the two dorsal nerves of the penis
2. the pudendal nerve (S2-S4)
3. the ilioinguinal nerve (base of the penis)
4. the iliohypogastric nerve (L 1-L2)

194. Answer: A (1, 2, & 3 )
Source: Nader and Candido – Pain Practice. June 2001

195

195. Branches of the sciatic nerve include
1. Posterior tibial
2. Common peroneal
3. Sural
4. Saphenous

195. Answer: A (1, 2, & 3)
Explanation:
There are four main nerves in the lower extremity: the
sciatic, femoral, obturator, and lateral femoral cutaneous.
1, 2. The sciatic nerve is the largest of the four and divides
into the posterior tibial nerve and common peroneal nerve
at the popliteal fossa.
3. The common peroneal nerve divides further into the
deep and superfi cial peroneal nerves. The tibial nerve
divides into the posterior tibial and sural nerves.
- Thus, four of the fi ve nerves that provide sensory
innervation to the ankle arise from the sciatic nerve: deep
peroneal, superfi cial peroneal, posterior tibial and sural.
4. The saphenous nerve is a branch of the femoral nerve

196

196. The true statements about cricothyroid muscle include:
1. Is an extrinsic muscle of the larynx
2. Receives innervation from the recurrent laryngeal
nerve
3. Receives innervation from the internal branch of the
superior laryngeal nerve
4. It tenses the vocal cords

196. Answer: D (4 Only)
Explanation:
1. The cricothyroid muscle is an intrinsic muscle of the
larynx.
2. The cricothyroid is innervated by the external branch of
the superior laryngeal nerve of the vagus.
3. The cricothyroid is innervated by the external branch of
the superior laryngeal nerve of the vagus.
4. The cricothyroid muscle is the only intrinsic muscle of
the larynx that tenses the vocal cords.
- All other intrinsic muscles of the larynx receive motor
innervation from the recurrent laryngeal nerve.

197

197. Landmarks for the sciatic nerve via a posterior approach
include the
1. Posterior superior iliac spine
2. Coccyx
3. Greater trochanter of the femur
4. Iliac crest

197. Answer: B (1 & 3)

198

198.Recurrent laryngeal nerve paralysis is a recognized
complication of which of the following procedures?
1. Ligation of a patent ductus arteriosus
2. Stellate ganglion block
3. Mediastinoscopy
4. Use of a topical ice slush during hear surgery

198. Answer: A (1, 2, & 3)

199

199. Which of the following anatomic landmarks are needed in
order to perform a trigeminal ganglion block?
1. External auditory meatus
2. Pupil
3. Lips
4. Mandibular notch

199. Answer: A (1, 2, & 3 )
Explanation:
1. Needle trajectory should aim superiorly toward the
anterior aspect of the external auditory meatus (in a lateral
view).
2. In the coronal plane the needle should be in the
directionof the mid-pupillary line.
3. The needle is inserted 2 – 2.5 cm lateral to lips.
4. The mandibular notch is used for the infrazygomatic
sphenopalatine ganglion block
Source: Shah RV, Board Review 2003

200

200. Which of the following are true regarding sympathetic
fi bers that exit the spinal cord and connect with the
sympathetic chain?
1. Are preganglionic fi bers
2. Connect with ventral root fi bers
3. Travel in white communicating rami
4. Synapse with up to 30 postsynaptic nerves

200. Answer: E (All)
Source: Raj P, Practical Management of Pain, 3rd Ed.

201

201. Innervation of the discs include all of the following
1. Sinuvertebral nerve
2. Lateral branch
3. L2 roots
4. Rami communicantes

201. Answer: D (4 Only)
Source: Rozen. Pain Practice: SEP 2001

202

202. True statements about the intervertebral disc include the following.
1. It receives blood supply from vessels in the bodies of
adjacent vertebrae
2. It receives nutrients by diffusion after its blood supply
diminishes
3. It receives nutrients by alternating compression and
relaxation of the annulus fi brosus
4. It becomes avascular after the sixth decade of life

202. Answer: A (1, 2, & 3 )
Explanation:
1. Early in life, the blood supply to the disk is from the
periphery as well as from vessels in the bodies of adjacent
vertebrae, which grow through the cartilaginous plates and
run toward but do not reach the nucleus pulposus.
2. After 3rd decade intervertebral disk receives nutrients
by diffusion of solutes, lymph and other fl uids through the
cervical portion, the vertebral end plate, and the annulus
fibrosus.
3. Intervertebral disk receives nutrition by alternating
compression and relaxation of the elastic container.
4. Shortly after birth, the vascular supply begins to
diminish and by the third decade of life, the disk is almost
avascular.
Source: Kahn and Desio

203

203. The term fl oating applies to the following ribs.
1. 1st
2. 11th
3. 2nd
4. 12th

203. Answer: C (2 & 4)
Explanation:
- The fi rst seven pairs of the 12 ribs are known as the
vertebrosternal ribs. They connect dorsally with the
vertebral column and ventrally with the sternum by means
of costal cartilages.
- The remaining fi ve pairs are “false” ribs and consists of
two types. The 8th to 10th ribs have their cartilages
attached to the cartilage of the rib above
(vertebrochondral).
2 & 4. The 11th and 12th ribs are free at their anterior
extremities and are referred to as fl oating or vertebral ribs
because they do not attach to the sternum.

204

204. Characteristics of the posterior longitudinal ligament
(PLL) include the following:
1. It begins to progressively widen below the L1 vertebral
level
2. It extends along the posterior surface of the body of the
vertebra
3. It is composed of fi bers that are less compact than those
of the anterior longitudinal ligament
4. It contributes to the anterior wall of the vertebral canal

204. Answer: C (2 & 4)
Explanation:
1. The PLL is broad throughout the length of the vertebral
column until it reaches the L1 vertebral level, where it
begins to narrow progressively so that at the L5-S1
interspace it is one half its original width.
2. The posterior longitudinal ligament (PLL) extends
along the posterior surface of the body of the vertebra
from the cervical axis to the sacrum.
3. The PLL is composed of longitudinal fi bers that are
denser and more compact than those of the anterior
longitudinal ligament.
4. It contributes to the anterior wall of the vertebral canal.

205

205. Which of the following joints includes an intra-articular
disc that creates two joint compartments?
1. Acromioclavicular joint
2. Glenohumeral joint
3. Scapulothoracic joint
4. Sternoclavicular joint

205. Answer: D (4 Only)
Source: Sizer Et Al - Pain Practice March & June 2003