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Flashcards in Pain Review Questions Deck (767):
1

1. Structures of the rhinencephalon include the:
a. olfactory receptor cells
b. olfactory epithelium
c. olfactory bulbs
d. olfactory tracts and areas
e. all of the above

1. E

2

2. Which of the following structures is not a cranial nerve?
a. trigeminal
b. olfactory
c. obturator
d. vagus
e. spinal accessory

2. C

3

3. Which of the following statements regarding the optic
nerve are true?
a. It is the second cranial nerve.
b. It contains special afferent sensory fibers.
c. Fibers from each optic nerve cross the midline to exit
the chiasm together at the opposite optic tract.
d. Via the optic tract and optic radiations, visual information
carried by the optic nerve is projected onto
the occipital lobes.
e. all of the above

3. E

4

4. Systemic diseases that can cause visual impairment
include:
a. diabetes mellitus
b. hypertension
c. vitamin A deficiency
d. vitamin B12 deficiency
e. all of the above

4. E

5

5. Diseases that may affect the oculomotor (cranial nerve III)
are:
a. brain tumors
b. aneurysms
c. increased intracranial pressure
d. low cerebrospinal fluid pressure
e. all of the above

5. E

6

6. Clinical symptoms associated with disorders of the oculomotor
nerve include:
a. severe facial pain
b. inactive pupil
c. palsy of the medial rectus muscle with weak adduction
d. b and c
e. all of the above

6. D

7

7. Cranial nerve IV is the:
a. spinal accessory nerve
b. trochlear nerve
c. trigeminal nerve
d. glossopharyngeal nerve
e. supraorbital nerve

7. B

8

8. Palsy of the trochlear nerve will present clinically
as the:
a. inability to look downward
b. inability to look upward
c. inability to look inward
d. b and c
e. a and c

8. E

9

9. The most common disorder affecting the trigeminal
nerve is:
a. peripheral neuropathy
b. wallerian degeneration
c. moya moya disease
d. trigeminal neuralgia
e. none of the above

9. D

10

10. Trigeminal neuralgia is:
a. characterized by paroxysms of shocklike pain
b. characterized by an association with multiple sclerosis
in 2% to 3% of patients
c. often caused by tortuous cranial blood vessels
d. severe in intensity
e. all of the above

10. E

11

11. The most common cause of isolated abducens
(cranial nerve VI) palsy is:
a. microvascular disease associated with diabetes
b. Rift Valley fever
c. open-angle glaucoma
d. closed-angle glaucoma
e. none of the above

11. A

12

12. The patient suffering from abducens (cranial nerve VI)
palsy will be unable to:
a. abduct the eye on the affected side
b. smell strong odors
c. constrict the pupil
d. elevate the scapula
e. none of the above

12. A

13

13. The facial nerve is made up of the following types
of nerve fibers:
a. branchial motor special visceral efferent fibers
b. visceral motor general visceral efferent fibers
c. special sensory special afferent fibers
d. general sensory general somatic afferent
e. all of the above

13. E

14

14. The most common disorder affecting the facial
nerve is:
a. trigeminal neuralgia
b. Dercum’s disease
c. Ramsay Hunt syndrome
d. Bell’s palsy
e. none of the above

14. D

15

15. Abnormalities of the vestibulocochlear nerve can manifest
themselves clinically as:
a. pain in the posterior third of the tongue
b. vertigo
c. hearing loss
d. b and c
e. none of the above

15. D

16

16. The most common disorder affecting the glossopharyngeal
nerve is:
a. trigeminal neuralgia
b. glossopharyngeal neuralgia
c. Ramsay Hunt syndrome
d. Bell’s palsy
e. none of the above

16. B

17

17. Functions related to the glossopharyngeal nerve include:
a. the ‘‘dry mouth’’ associated with fear
b. the salivation reflex associated with the smell of food
c. taste on the posterior two-thirds of the tongue
d. sensation of the external ear
e. all of the above

17. E

18

18. The vagus nerve provides innervation to:
a. the posterior skin of the ear, the external surface of
the tympanic membrane, the pharynx, and the external
auditory meatus
b. sensory information from the larynx, esophagus, trachea,
and abdominal and thoracic viscera
c. information from the stretch receptors of the aortic
arch and chemoreceptors of the aortic bodies
d. innervation to the intrinsic muscles of the larynx
e. all of the above

18. E

19

19. Clinical findings suggestive of compromise of the vagus
nerve include:
a. hoarseness
b. anisocoria
c. difficulty swallowing
d. a and b
e. a and c

19. E

20

20. Disorders of the spinal accessory nerve will present clinically
as:
a. weakness of the sternocleidomastoid muscle on the
affected side
b. weakness of the intercostal muscles on the affected
side
c. weakness of the trapezius muscle on the affected side
d. a and c
e. a and b

20. D

21

21. Which of the following is not a clinical sign of damage to
the hypoglossal nerve?
a. weakness of the intrinsic muscles of the tongue
b. deviation of the extended tongue to the
affected side.
c. atrophy of the intrinsic muscles of the tongue on the
affected side when the compromise of the hypoglossal
nerve has been of long-standing
d. weakness of elevation of the contralateral shoulder
e. all of the above

21. D

22

22. The greater occipital nerve:
a. is a peripheral branch of the second and third cervical
nerves
b. supplies the medial portion of the posterior scalp as
far anterior as the vertex
c. has been implicated as one of the nerves subserving
the pain of occipital neuralgia
d. all of the above
e. none of the above

22. D

23

23. The sphenopalatine ganglion sends major branches to the:
a. gasserian ganglion and trigeminal nerves
b. carotid plexus
c. facial nerve
d. superior cervical ganglion
e. all of the above

23. E

24

24. The superficial cervical plexus:
a. controls closure of the true vocal cords
b. arises from fibers of the primary ventral rami of
the first, second, third, and fourth cervical nerves
c. provides only motor innervation
d. provides innervation of the exocrine pancreas
e. all of the above

24. B

25

25. The deep cervical plexus:
a. controls closure of the true vocal cords
b. arises from fibers of the primary ventral rami of the
first, second, third, and fourth cervical nerves
c. provides only motor innervation
d. contributes fibers to the phrenic nerve
e. b and d

25. E

26

26. The stellate ganglion is:
a. located in the retrocrural space
b. made up primarily of special efferent motor fibers
c. formed by the fusion of the inferior cervical and the
first thoracic ganglion as they meet anterior to the
vertebral body of C7
d. inferior to the celiac plexus
e. all of the above

26. C

27

27. The following structures are anterior to the stellate
ganglion:
a. skin
b. subcutaneous tissue
c. sternocleidomastoid muscle
d. carotid sheath
e. all of the above

27. E

28

28. The following are true statements about the structure and
function of the cervical vertebrae:
a. There are seven cervical vertebrae.
b. The first cervical vertebra is called atlas.
c. The second cervical vertebra is called axis.
d. The transverse foramen protects and allows passage
of the vertebral artery and vein.
e. all of the above

28. E

29

29. Rudimentary structures found on the seventh cervical
vertebra in a small number of patients are called:
a. chorionic villi
b. cervical ribs
c. Schmorl’s nodes
d. sesamoid bones
e. none of the above

29. B

30

30. Which of the following statements are true about the
cervical intervertebral disc?
a. It serves as the major shock absorbing structure of the
cervical spine.
b. It prevents impingement of the adjacent neural
structures.
c. It helps facilitate the synchronized movement of the
cervical spine.
d. It prevents impingement of the vasculature that traverse
the cervical spine.
e. all of the above

30. E

31

31. The top and bottom of the cervical intervertebral discs
are called the:
a. syndesmotic junction
b. nucleus pulposus
c. end plates
d. vomer
e. none of the above

31. C

32

32. The outside of the cervical intervertebral disc is made up
of a woven crisscrossing matrix of fibroelastic fibers
called the:
a. annulus
b. nucleus pulposus
c. end plates
d. vomer
e. none of the above

32. A

33

33. The center of the disc is the water-containing mucopolysaccharide
gel-like substance called the:
a. annulus
b. nucleus pulposus
c. end plates
d. vomer
e. none of the above

33. B

34

34. The meninges are made up of three layers that include the:
a. pia mater
b. arachnoid mater
c. dura mater
d. tunica alba
e. a, b, and c

34. E

35

35. The cerebrospinal fluid is absorbed by the:
a. tunica alba
b. pineal gland
c. arachnoid granulations
d. lacrimal glands
e. all of the above

35. C

36

36. The cervical epidural space is bounded by the:
a. fusion of the periosteal and spinal layers of dura at the
foramen magnum superiorly
b. posterior longitudinal ligament anteriorly
c. vertebral laminae and the ligamentum flavum
posteriorly
d. vertebral pedicles and intervertebral foramina laterally
e. all of the above

36. E

37

37. The cervical epidural space contains:
a. fat
b. veins and arteries
c. lymphatics
d. connective tissue
e. all of the above

37. E

38

38. Which of the following statements regarding the cervical
facet joints is false?
a. The lower cervical facet joints receive innervation
from one vertebral level.
b. The atlanto-occipital and atlantoaxial joints are
unique relative to the other cervical facet joints.
c. The lower cervical facet joints receive innervation
from two vertebral levels.
d. The lower cervical facet joints are true joints as they
are lined with synovium.
e. All of the statements are false.

38. A

39

39. Which of the following structures aid in stabilizing the
cervical spine?
a. ligamentum nuchae
b. interspinous ligament
c. supraspinous ligament
d. ligamentum flavum
e. all of the above

39. E

40

40. The smaller upper four thoracic vertebrae share characteristics
in common with the:
a. cervical vertebrae
b. thoracic vertebrae
c. lumbar vertebrae
d. sacrum
e. none of the above

40. A

41

41. The larger lower four thoracic vertebrae share characteristics
in common with the:
a. cervical vertebrae
b. thoracic vertebrae
c. lumbar vertebrae
d. sacrum
e. none of the above

41. C

42

42. A distinguishing characteristic of the first 10 thoracic vertebrae
is the presence of:
a. intervertebral foramen
b. articular facets for the ribs
c. arachnoid granulations
d. no end plates
e. all of the above

42. B

43

43. The following structure is found at the T4 dermatome in
most patients:
a. nipple
b. jugular notch
c. stellate ganglion
d. umbilicus
e. none of the above

43. A

44

44. The following structure is found at the T10 dermatome in
most patients:
a. nipple
b. jugular notch
c. stellate ganglion
d. umbilicus
e. none of the above

44. D

45

45. The following structure is found at the L4 dermatome in
most patients:
a. nipple
b. jugular notch
c. iliac crest
d. umbilicus
e. none of the above

45. C

46

46. The brachial plexus is formed by the fusion of the
anterior (ventral) rami of the:
a. C5 spinal nerve
b. C6 spinal nerve
c. C7 spinal nerve
d. C8 and T1 spinal nerves
e. all of the above

46. E

47

47. The brachial plexus occasionally receives contributions
from the anterior (ventral) rami of the:
a. C2 spinal nerve
b. C4 spinal nerve
c. T2 spinal nerve
d. b and c
e. all of the above

47. D

48

48. The brachial plexus is subdivided into:
a. roots
b. trunks
c. divisions and cords
d. terminal branches
e. all of the above

48. E

49

49. Injuries that are isolated to the musculocutaneous nerve
present clinically as:
a. painless weakness of elbow flexion
b. painless weakness of elbow supination
c. localized sensory deficit on the radial side of the forearm
d. all of the above
e. none of the above

49. D

50

50. The musculocutaneous nerve arises from the:
a. lateral cord of the brachial plexus
b. posterior cord of the brachial plexus
c. medial cord of the brachial plexus
d. all of the above
e. none of the above

50. A

51

51. The ulnar nerve provides sensory innervation to the:
a. ulnar aspect of the dorsum of the hand
b. dorsal aspect of the little finger and the ulnar half
of the ring
c. palmar aspect of the little finger and the ulnar half
of the ring finger.
d. all of the above
e. none of the above

51. D

52

52. The ulnar nerve:
a. arises from the medial cord of the brachial plexus
b. is made up of fibers from C8-T1 spinal roots
c. lies medial and inferior to the axillary artery
d. all of the above
e. none of the above

52. D

53

53. The median nerve provides sensory innervation to:
a. a portion of the palmar surface of the hand
b. the palmar surface of the thumb, index and middle
fingers, and the radial portion of the ring finger
c. distal dorsal surface of the index and middle fingers
and the radial portion of the ring finger
d. all of the above
e. none of the above

53. D

54

54. The median nerve:
a. arises from the medial and lateral cords of the brachial
plexus
b. is made up of fibers from C5-T1 spinal roots
c. lies anterior and superior to the axillary artery
d. all of the above
e. none of the above

54. D

55

55. Entrapment of the median nerve:
a. occurs most commonly at the wrist
b. occurs most commonly at the elbow
c. is known as carpal tunnel syndrome
d. all of the above
e. a and c

55. E

56

56. The radial nerve:
a. arises from the posterior cord of the brachial plexus
b. is made up of fibers from C5-T1 spinal roots
c. lies posterior and inferior to the axillary artery
d. all of the above
e. none of the above

56. D

57

57. Damage to the radial nerve as it winds around the shaft
of the humerus is characterized by:
a. palsy or paralysis of all extensors of the wrist and digits
b. palsy or paralysis of the forearm supinators
c. numbness over the dorsoradial aspect of the hand and
the dorsal aspect of the radial 31=2 digits
d. all of the above
e. none of the above

57. D

58

58. Which of the following statements is true regarding the
glenohumeral joint?
a. The humeral head articulates with the glenoid fossa.
b. It is a true joint.
c. It is the most commonly dislocated joint in humans.
d. all of the above
e. none of the above

58. D

59

59. The acromioclavicular joint is formed by the:
a. distal end of the clavicle and the anterior and medial
aspect of the acromion
b. head of the humerus and the glenoid fossa
c. sternoclavicular space
d. articulation of the first rib and the vertebra
e. none of the above

59. A

60

60. The subdeltoid bursa lies primarily under the:
a. acromion extending laterally between the deltoid
muscle and joint capsule
b. scapula
c. suprascapular notch
d. all of the above
e. none of the above

60. A

61

61. The biceps muscle:
a. supinates the forearm
b. flexes the elbow joint
c. is innervated by the musculocutaneous nerve
d. has a long and a short head
e. all of the above

61. E

62

62. The muscles that comprise the rotator cuff include the:
a. supraspinatus muscle
b. infraspinatus muscle
c. teres minor muscle
d. subscapularis muscle
e. all of the above

62. E

63

63. The muscles and their associated fascia and tendons of
the rotator cuff:
a. work in concert to maintain the stability of the shoulder
joint throughout a wide and varied range of
motion
b. assist in deglutition
c. are subject to tears from overuse or misuse
d. a and c
e. none of the above

63. D

64

64. The supraspinatus muscle:
a. is the most important muscle of the rotator cuff
b. provides shoulder joint stability
c. along with the deltoid muscle abducts the arm at the
shoulder by fixing the head of the humerus firmly
against the glenoid fossa.
d. is innervated by the suprascapular nerve
e. all of the above

64. E

65

65. The infraspinatus muscle:
a. provides shoulder joint stability
b. along with the teres minor muscle externally rotates
the arm at the shoulder
c. is innervated by the suprascapular nerve
d. all of the above
e. none of the above

65. D

66

66. The subcoracoid bursa lies:
a. between the joint capsule and the coracoid process
b. just inferior to the jugular notch
c. at the costosternal junction
d. at the costovertebral angle
e. none of the above

66. A

67

67. The intercostal nerves arise from the:
a. stellate ganglion
b. anterior division of the thoracic paravertebral nerves
c. celiac plexus
d. all of the above
e. none of the above

67. B

68

68. The four branches of a typical intercostal nerve include the:
a. unmyelinated postganglionic fibers of the gray rami
communicantes
b. posterior cutaneous branch
c. lateral cutaneous division
d. anterior cutaneous branch
e. all of the above

68. E

69

69. The 12th intercostal nerve is commonly known as the:
a. subcostal nerve
b. posterior cutaneous branch
c. lateral cutaneous division
d. anterior cutaneous branch
e. all of the above

69. A

70

70. The first thoracic ganglion is fused with the lower cervical
ganglion to help make up the:
a. gasserian ganglion
b. ganglion of Impar
c. stellate ganglion
d. all of the above
e. none of the above

70. C

71

71. The major preganglionic contribution to the celiac plexus
is provided by the:
a. greater splanchnic nerves
b. lesser splanchnic nerves
c. least splanchnic nerves
d. all of the above
e. none of the above

71. D

72

72. The ganglia usually lie approximately at the level of:
a. the fifth intercostal vein
b. T6
c. the first lumbar vertebra
d. the third lumbar vertebra
e. none of the above

72. C

73

73. The celiac plexus is:
a. anterior to the crus of the diaphragm
b. posterior to the crus of the diaphragm
c. superior to the crus of the diaphragm
d. intrathoracic
e. none of the above

73. A

74

74. The superior hypogastric plexus lies in front of:
a. L1
b. L4
c. T12
d. the greater curvature of the stomach
e. none of the above

74. B

75

75. The hypogastric nerves provide sympathetic innervation
to the:
a. pelvic viscera
b. esophagus
c. pelvic viscera
d. a and c
e. b and c

75. C

76

76. The lumbar sympathetic chain and ganglia lie:
a. at the anterolateral margin of the lumbar vertebral
bodies
b. in the peritoneal cavity
c. within the spinal canal
d. within the corresponding spinal nerve roots
e. none of the above

76. A

77

77. The peritoneal cavity lies lateral and anterior to the:
a. small intestine
b. lumbar sympathetic chain
c. colon
d. all of the above
e. none of the above

77. B

78

78. The greater splanchnic nerve has its origin from the:
a. T5-10 spinal roots
b. C7-T2 spinal roots
c. stellate ganglion
d. all of the above
e. none of the above

78. A

79

79. The lesser splanchnic nerve arises from the:
a. T10-11 roots
b. C7-T2 spinal roots
c. stellate ganglion
d. all of the above
e. none of the above

79. A

80

80. The least splanchnic nerve has its origin from the:
a. T11-12 spinal roots
b. C7-T2 spinal roots
c. stellate ganglion
d. all of the above
e. none of the above

80. A

81

81. The elbow joint is composed of the following bones:
a. humerus
b. ulna
c. radius
d. all of the above
e. none of the above

81. D

82

82. The bursae most commonly inflamed by overuse or
misuse of the elbow include the:
a. olecranon bursa
b. cubital bursa
c. pes anserine bursa
d. b and c
e. a and b

82. E

83

83. The olecranon bursa lies:
a. in the posterior aspect of the elbow joint between the
olecranon process of the ulna and the overlying skin
b. in the antecubital fossa lateral to the artery
c. in the antecubital fossa medial to the artery
d. under the biceps brachii muscle
e. none of the above

83. A

84

84. The cubital bursa:
a. lies in the anterior aspect of the elbow
b. is subject to inflammation from overuse or misuse of
the elbow
c. may become infected
d. may become calcified if the inflammation becomes
chronic
e. all of the above

84. E

85

85. The radial nerve at the elbow lies between the:
a. lateral epicondyle of the humerus and the musculospiral
groove
b. the fascia of the triceps muscle and the muscle
substance
c. fascia of the biceps muscle and the muscle substance
d. none of the above
e. all of the above

85. A

86

86. The cubital tunnel:
a. contains the axillary artery and nerve
b. is made up of the olecranon process and medial epicondyle
of the humerus
c. contains the radial artery and nerve
d. a and b
e. b and c

86. B

87

87. The anterior interosseous nerve:
a. provides motor innervation to the flexor muscles of
the forearm
b. is susceptible to nerve entrapment by aberrant ligaments,
muscle hypertrophy, and direct trauma
c. is a branch of the median nerve
d. all of the above
e. none of the above

87. D

88

88. The lateral antebrachial cutaneous nerve:
a. is a continuation of the musculocutaneous nerve
b. is susceptible to entrapment as the nerve passes lateral
to the fascia of the biceps tendon
c. passes behind the cephalic vein, where it divides into a
volar branch that continues along the radial border of
the forearm
d. provides sensory innervation to the skin over the lateral
half of the volar surface of the forearm
e. all of the above

88. E

89

89. The wrist allows which of the following movements?
a. flexion/extension
b. radial/ulnar deviation
c. pronation/supination
d. all of the above
e. none of the above

89. D

90

90. The wrist is made up of the following joints:
a. distal radioulnar joint
b. radiocarpal joint and the ulnar carpal joint
c. proximal carpal joints
d. midcarpal joints
e. all of the above

90. E

91

91. The triangular fibroelastic cartilage:
a. is located primarily between the distal ulna and the
lunate and triquetrum
b. is made up of very strong fibroelastic fibers
c. acts like an intervertebral disc in that it serves as the
primary shock absorber of the wrist and acts like a
ligament in that it serves as the primarily stabilizer for
the distal radioulnar joint
d. has a poor vascular supply and heals poorly
e. all of the above

91. E

92

92. The ulnar tunnel is:
a. the space between the pisiform and hamate bones of
the wrist through which the ulnar nerve and artery
pass
b. also known as the cubital tunnel
c. also known as Guyon’s canal
d. a and b
e. a and c

92. E

93

93. The carpal tunnel:
a. is bounded on three sides by the carpal bones and is
covered by the transverse carpal ligament
b. contains the radial nerve
c. contains the median nerve
d. a and b
e. a and c

93. E

94

94. In addition to the median nerve, the carpal tunnel also
contains:
a. a number of flexor tendon sheaths
b. blood vessels
c. lymphatics
d. all of the above
e. none of the above

94. D

95

95. The carpometacarpal joint:
a. is a synovial, saddle-shaped joint
b. is a synovial hinge type joint
c. serves as the articulation between the trapezium and
the base of the first metacarpal
d. a and b
e. a and c

95. E

96

96. The carpometacarpal joints of the fingers:
a. are synovial plane joints that serve as the articulation
between the carpals and the metacarpals
b. also allow articulation of the bases of the metacarpal
bones with one another
c. is a synovial hinge-type joint
d. a and b
e. a and c

96. D

97

97. The metacarpophalangeal joint:
a. is a synovial, ellipsoid-shaped joint
b. serves as the articulation between the base of the
proximal phalanges and the head of its respective
metacarpal
c. is a synovial hinge-type joint
d. a and b
e. a and c

97. D

98

98. The interphalangeal joints:
a. are synovial hinge-shaped joints
b. are synovial plane joints
c. serve as the articulation between the phalanges
d. a and b
e. a and c

98. E

99

99. The sciatic nerve:
a. innervates the distal lower extremity and foot
with the exception of the medial aspect of the
calf and foot, which are subserved by the saphenous
nerve
b. is the largest nerve in the body
c. is derived from the L4, L5, and S1-3 nerve roots
d. all of the above
e. none of the above

99. D

100

100. Branches of the sciatic nerve include the:
a. tibial
b. common peroneal nerves
c. ganglion of Impar
d. a and b
e. a and c

100. D

101

101. The lumbar plexus:
a. lies within the substance of the psoas muscle
b. is made up of the ventral roots of the first four
lumbar nerves and, in some patients, a contribution
from the 12th thoracic nerve
c. consists of nerves that lie in front of the transverse
processes of their respective vertebrae as they course
inferolaterally
d. consists of nerves that divide into a number of
peripheral nerves
e. all of the above

101. E

102

102. The femoral nerve:
a. innervates the anterior portion of the thigh and
medial calf
b. is derived from the posterior branches of the L2, L3,
and L4 nerve roots
c. roots fuse together in the psoas muscle and descend
laterally between the psoas and iliacus muscles to
enter the iliac fossa
d. gives off motor fibers to the iliac, sartorius, quadriceps
femoris, and pectineus muscles
e. all of the above

102. E

103

103. The femoral nerve:
a. passes beneath the inguinal ligament to enter the
thigh
b. is just lateral to the femoral artery as it passes
beneath the inguinal ligament
c. is enclosed with the femoral artery and vein within
the femoral sheath
d. provides sensory fibers to the knee joint as well as
the skin overlying the anterior thigh
e. all of the above

103. E

104

104. The lateral femoral cutaneous nerve:
a. is formed from the posterior divisions of the L2 and
L3 nerves
b. leaves the psoas muscle and courses laterally
and inferiorly to pass just beneath the ilioinguinal
nerve at the level of the anterior superior iliac
spine and then divides into an anterior and a posterior
branch
c. provides limited cutaneous sensory innervation over
the anterolateral thigh through its anterior branch
d. provides cutaneous sensory innervation to the lateral
thigh from just above the greater trochanter to the
knee through its posterior branch
e. all of the above

104. E

105

105. Entrapment of the lateral femoral cutaneous nerve is
known as:
a. meralgia paresthetica
b. ilioinguinal neuralgia
c. genitofemoral neuralgia
d. femoral neuralgia
e. none of the above

105. A

106

106. The ilioinguinal nerve:
a. is a branch of the L1 nerve root with a contribution
from T12 in some patients
b. follows a curvilinear course that takes it from its
origin of the L1 and occasionally T12 somatic
nerves to inside the concavity of the ilium
c. continues anteriorly to perforate the transverse
abdominal muscle at the level of the anterior superior
iliac spine.
d. may interconnect with the iliohypogastric nerve as
it continues to pass along its course medially
and inferiorly, where it accompanies the spermatic
cord through the inguinal ring and into the inguinal
canal
e. all of the above

106. E

107

107. Entrapment of the ilioinguinal nerve is known as:
a. meralgia paresthetica
b. ilioinguinal neuralgia
c. genitofemoral neuralgia
d. femoral neuralgia
e. none of the above

107. B

108

108. Entrapment of the iliohypogastric nerve is known as:
a. meralgia paresthetica
b. iliohypogastric neuralgia
c. genitofemoral neuralgia
d. femoral neuralgia
e. none of the above

108. B

109

109. Entrapment of the genitofemoral nerve is known as:
a. meralgia paresthetica
b. ilioinguinal neuralgia
c. genitofemoral neuralgia
d. femoral neuralgia
e. none of the above

109. C

110

110. The iliohypogastric nerve:
a. is a branch of the L1 nerve root with a contribution
from T12 in some patients
b. follows a curvilinear course that takes it from its
origin of the L1 and occasionally T12 somatic
nerves to inside the concavity of the ilium
c. continues anteriorly to perforate the transverse
abdominal muscle to lie between it and the external
oblique muscle where it divides into an anterior and
a lateral branch
d. all of the above
e. none of the above

110. D

111

111. The ilioinguinal nerve:
a. provides cutaneous sensory innervation to the posterolateral
gluteal region via its lateral branch
b. pierces the external oblique muscle just beyond the
anterior superior iliac spine to provide cutaneous
sensory innervation to the abdominal skin above
the pubis via its anterior branch
c. may interconnect with the ilioinguinal nerve along
its course, resulting in variation of the distribution of the sensory innervation of the iliohypogastric and
ilioinguinal nerves
d. all of the above
e. none of the above

111. D

112

112. The genitofemoral nerve:
a. is a branch of the L1 nerve root with a contribution
from T12 in some patients
b. follows a curvilinear course that takes it from its
origin of the L1 and occasionally T12 and L2 somatic
nerves to inside the concavity of the ilium
c. descends obliquely in an anterior course through the
psoas major muscle to emerge on the abdominal
surface opposite L3 or L4
d. all of the above
e. none of the above

112. D

113

113. The genitofemoral nerve:
a. divides into a genital and femoral branch just above
the inguinal ligament
b. in males, the genital branch travels through the
inguinal canal passing inside the deep inguinal ring
to innervate the cremaster muscle and skin of the
scrotum
c. in females, the genital branch follows the course of
the round ligament and provides innervation to the
ipsilateral mons pubis and labia majora
d. in males and females, the femoral branch
descends lateral to the external iliac artery to pass
behind the inguinal ligament to enter the femoral
sheath lateral to the femoral artery to
innervate the skin of the anterior superior femoral
triangle
e. all of the above

113. E

114

114. The obturator nerve:
a. provides the majority of innervation to the hip joint
b. is derived from the posterior divisions of the L2, L3,
and L4 nerves
c. leaves the medial border psoas muscle and courses
inferiorly to pass the pelvis, where it joins the obturator
vessels to travel via the obturator canal to enter
the thigh where it then divides into an anterior and
posterior branch
d. all of the above
e. none of the above

114. D

115

115. The anterior branch of the obturator nerve supplies:
a. an articular branch to provide sensory innervation to
the hip joint
b. motor branches to the superficial hip adductors
c. a cutaneous branch to the medial aspect of the distal
thigh
d. all of the above
e. none of the above

115. D

116

116. The posterior branch of the obturator nerve provides:
a. motor innervation to the deep hip adductors
b. an articular branch to the posterior knee joint.
c. motor innervation to the superficial hip abductors
d. a and b
e. a and c

116. D

117

117. The ganglion of Impar:
a. lies in front of the coccyx just below the sacrococcygeal
junction
b. is the terminal coalescence of the sympathetic chains
c. receives fibers from the lumbar and sacral portions
of the sympathetic and parasympathetic nervous
system
d. all of the above
e. none of the above

117. E

118

118. The tibial nerve:
a. is one of the two major continuations of the sciatic
nerve
b. provides sensory innervation to the posterior
portion of the calf, the heel, and the medial plantar
surface
c. splits from the sciatic nerve at the superior margin of
the popliteal fossa and descends in a slightly medial
course through the popliteal fossa
d. continues its downward course, running between the
two heads of the gastrocnemius muscle, passing deep
to the soleus muscle
e. all of the above

118. E

119

119. The tibial nerve:
a. courses medially between the Achilles tendon and
the medial malleolus, where it divides into the
medial and lateral plantar nerves
b. provides sensory innervation to the heel and medial
plantar surface
c. provides motor innervation to the extensor hallucis
longus
d. a and b
e. a and c

119. D

120

120. Entrapment of the tibial nerve as it courses medially
between the Achilles tendon and the medial malleolus
is known as:
a. anterior tarsal tunnel syndrome
b. posterior tarsal tunnel syndrome
c. hallux rigidus
d. meralgia paresthetica
e. none of the above

120. B

121

121. The common peroneal nerve:
a. is one of the two major continuations of the sciatic
nerve
b. provides sensory innervation to the inferior portion
of the knee joint and the posterior and lateral skin of
the upper calf
c. is derived from the posterior branches of the L4, the
L5, and the S1 and S2 nerve roots
d. splits from the sciatic nerve at the superior margin of
the popliteal fossa and descends laterally behind the
head of the fibula
e. all of the above

121. E

122

122. The ischial bursa:
a. lies between the gluteus maximus muscle and the
ischial tuberosity
b. lies between the inguinal ligament and the
acetabulum
c. lies between the tensor fascia lata and the greater
trochanter
d. all of the above
e. none of the above

122. A

123

123. The hip:
a. is a ball-and-socket type joint
b. is composed of the femoral head and the cup-shaped
acetabulum
c. has a femoral head that is completely covered with
hyaline cartilage except for a central area called
the fovea, which is the point of attachment for the
ligamentum teres
d. all of the above
e. none of the above

123. E

124

124. The gluteal bursae:
a. lie between the gluteal maximus, medius, and minimus
muscles as well as between these muscles and
the underlying bone
b. lie between the inguinal ligament and the
acetabulum
c. lie between the tensor fascia lata and the greater
trochanter
d. all of the above
e. none of the above

124. A

125

125. The trochanteric bursa:
a. lies between the greater trochanter and the tendon
of the gluteus medius and the iliotibial tract
b. lies between the inguinal ligament and the
acetabulum
c. lies between the tensor fascia lata and the greater
trochanter
d. all of the above
e. none of the above

125. A

126

126. The SI joint:
a. is a synovial (diarthrodial) joint
b. is more mobile in youth than later in life
c. becomes more fibrotic in adulthood in the upper
two-thirds of the joint
d. of the female pelvis is also more mobile to accommodate
pregnancy and parturition
e. all of the above

126. E

127

127. The SI joint:
a. is densely innervated by several levels of spinal
nerves (L3-S1)
b. may produce lumbar disc–like symptoms when
stimulated
c. has muscle insertions near the joint such as the gluteus
maximus and hamstrings, which may refer pain
to the hip and ischial area, respectively, when
stressed
d. all of the above
e. none of the above

127. D

128

128. The femoral-tibial joint:
a. is made up of the articulation of the femur and the
tibia
b. is a synarthrodial joint
c. is not a true joint
d. all of the above
e. none of the above

128. A

129

129. The main extensor of the knee is:
a. the extensor hallucis longus
b. the quadriceps muscle that attaches to the patella via
the quadriceps tendon
c. the extensor hallucis brevis
d. all of the above
e. none of the above

129. B

130

130. The main flexors of the knee joint are the:
a. hamstrings
b. gastrocnemius
c. sartorius
d. gracilis
e. all of the above

130. E

131

131. The prepatellar bursa:
a. lies between the subcutaneous tissues and the patella
b. lies deep to the inguinal ligament
c. is superficial to the inguinal ligament
d. is deep to the pes anserine bursa
e. none of the above

131. A

132

132. The suprapatellar bursa:
a. extends superiorly from beneath the patella under
the quadriceps femoris muscle and its tendon.
b. lies deep to the inguinal ligament
c. is superficial to the inguinal ligament
d. is deep to the pes anserine bursa
e. none of the above

132. A

133

133. The deep infrapatellar bursa:
a. lies between the ligamentum patellae and the tibia
b. lies deep to the inguinal ligament
c. is superficial to the inguinal ligament
d. is deep to the infrapatellar fossa
e. none of the above

133. A

134

134. The superficial infrapatellar bursa:
a. lies between the subcutaneous tissues and the ligamentum
patellae
b. lies deep to the inguinal ligament
c. is superficial to the inguinal ligament
d. is deep to the infrapatellar fossa
e. none of the above

134. A

135

135. The pes anserine bursa:
a. lies between the combined tendinous insertion of the
sartorius, gracilis, and semitendinosus muscles and
the medial tibia
b. lies deep to the inguinal ligament
c. is superficial to the inguinal ligament
d. is deep to the infrapatellar fossa
e. none of the above

135. A

136

136. The iliotibial band bursa:
a. lies between the iliotibial band and the lateral condyle
of the femur
b. lies deep to the inguinal ligament
c. is superficial to the inguinal ligament
d. is deep to the infrapatellar fossa
e. none of the above

136. A

137

137. The iliotibial band:
a. is an extension of the fascia lata that inserts at the
lateral condyle of the tibia
b. can rub backward and forward over the lateral
epicondyle of the femur
c. can irritate the iliotibial bursa beneath it
d. all of the above
e. none of the above

137. D

138

138. The distal joint between the tibia and fibula:
a. allows very little movement with the hinge joint
formed by the distal ends of the tibia and fibula
and the talus providing dorsiflexion and plantar flexion
needed for ambulation
b. is stabilized by the medial and lateral malleoli, which
extend along the sides of the talus to form a mortise
and prevents ankle rotation
c. is further strengthened by the deltoid ligament medially
and the anterior talofibular, posterior talofibular,
and calcaneofibular ligaments laterally
d. all of the above
e. none of the above

138. D

139

139. The talocalcaneal joint:
a. lies between the talus and calcaneus
b. allows for additional range of motion of the ankle
joint and makes up for the limitations of motions
placed on the joint by the mortise structure of the
talus and medial and lateral malleoli
c. permits approximately 30 degrees of foot inversion
d. permits 15 to 20 degrees of foot eversion, which
allows walking on uneven surfaces
e. all of the above

139. E

140

140. The deltoid ligament:
a. has two layers
b. attaches above to the medial malleolus
c. has a deep layer that attaches below to the medial
body of the talus
d. superficial fibers attach to the medial talus and the
sustentaculum tali of the calcaneus and the navicular
tuberosity
e. all of the above

140. E

141

141. The anterior talofibular ligament:
a. runs from the anterior border of the lateral malleolus
to the lateral surface of the talus
b. attaches above to the medial malleolus
c. has a deep layer that attaches below to the medial
body of the talus
d. superficial fibers attach to the medial talus and the
sustentaculum tali of the calcaneus and the navicular
tuberosity
e. all of the above

141. A

142

142. The posterior tarsal tunnel:
a. is made up of the flexor retinaculum, the bones of
the ankle, and the lacunate ligament
b. is the site of compression of the tibial nerve
c. contains the posterior tibial artery and a number of
flexor tendons
d. all of the above
e. none of the above

142. D

143

143. The deep branch of the peroneal nerve:
a. continues down the leg in conjunction with the tibial
artery and vein to provide sensory innervation to the
web space of the first and second toes and adjacent
dorsum of the foot
b. provides motor innervation to all of the toe
extensors
c. passes beneath the dense superficial fascia of the
ankle where it is subject to entrapment called anterior
tarsal tunnel syndrome
d. all of the above
e. none of the above

143. D

144

144. The Achilles tendon:
a. is the thickest and strongest tendon in the body,
yet also very susceptible to rupture
b. is the common tendon of the gastrocnemius muscle
c. begins at mid-calf and continues downward to attach
to the posterior calcaneus, where it may become
inflamed
d. narrows during its downward course, becoming
most narrow approximately 5 cm above its calcaneal
insertion
e. all of the above

144. E

145

145. The Achilles bursa:
a. lies between the Achilles tendon and the base of the
tibia and the posterior calcaneus
b. is rarely inflamed
c. lies superficial to the Achilles tendon and the base of
the tibia and the posterior calcaneus
d. all of the above
e. none of the above

145. A

146

146. The Achilles bursa:
a. may become inflamed with overuse or misuse
b. is located in the anterior tarsal tunnel
c. may become inflamed in association with Achilles
tendonitis
d. a and b
e. a and c

146. E

147

147. The shallow longitudinal indentation along the length of
the dorsal surface of the spinal cord is called the:
a. anterior median fissure
b. posterior median sulcus
c. central canal
d. filum terminale
e. none of the above

147. B

148

148. The deep longitudinal indentation along the ventral surface
of the spinal cord is called the:
a. anterior median fissure
b. posterior median sulcus
c. central canal
d. filum terminale
e. none of the above

148. A

149

149. The cervical enlargement:
a. contains interneurons for the nerves that supply the
upper extremities and pectoral girdle as well as
fibers from regions inferior to the cervical region,
e.g., thoracic, lumbar, and sacral
b. contains the geniculate ganglion
c. contains the ganglion of Gasser
d. all of the above
e. none of the above

149. A

150

150. The lumbar enlargement contains:
a. interneurons for the nerves that supply the lower
extremities and pelvis as well as fibers from the
more inferior sacral region
b. the geniculate ganglion
c. the ganglion of Gasser
d. all of the above
e. none of the above

150. A

151

151. The end of the spinal cord tapers to a point that is
called the:
a. cervical enlargement
b. lumbar enlargement
c. hypogastric plexus
d. conus medullaris

151. D

152

152. The conus medullaris is at the:
a. third segment of the sacrum
b. sacral hiatus
c. level of the first lumbar vertebra
d. foramen ovale
e. none of the above

152. C

153

153. The distal spinal cord is tethered distally by the:
a. filum terminale
b. sacral hiatus
c. first lumbar vertebra
d. foramen ovale
e. none of the above

153. A

154

154. The dorsal root ganglia:
a. contain the nerve cell bodies of the corresponding
sensory neurons
b. contain the nerve cell bodies of the corresponding
motor neurons
c. contain the origins of the ganglion of Gasser
d. all of the above
e. none of the above

154. A

155

155. The ventral nerve root carries primarily:
a. sensory neurons
b. motor neurons
c. parasympathetic ganglia
d. all of the above
e. none of the above

155. B

156

156. The spinal nerve root:
a. is a mixed nerve that carries both motor and sensory
information
b. is formed from the coalescence of the dorsal and
ventral nerve roots
c. exits via the intervertebral foramen
d. all of the above
e. none of the above

156. D

157

157. In the center of the spinal cord is an H-shaped structure
made up primarily of:
a. gray matter consisting of nerve cell bodies and glial
cells
b. white matter consisting of nerve cell bodies and glial
cells
c. connective tissue
d. veins and lymphatics
e. all of the above

157. A

158

158. The concept that dorsal roots carry sensory information
and the ventral roots carry motor information is known
as the:
a. Herring-Brewer law
b. Mason-Dixon law
c. Bell-Magendie law
d. Marbury-Madison law
e. none of the above

158. C

159

159. The first pair of spinal nerves is designated C1 and they:
a. exit between the skull and the first cervical
vertebra
b. exit between the first and second cervical vertebrae
c. exit via the jugular foramen
d. exit via the foramen magnum
e. none of the above

159. A

160

160. The last pair of cervical nerves exit between the seventh
cervical vertebra and the first thoracic vertebra and are
designated:
a. C7
b. C8
c. the cervical plexus
d. the stellate ganglion
e. none of the above

160. B

161

161. The first thoracic spinal nerve T1 exits:
a. just beneath the seventh cervical vertebra
b. just beneath the first thoracic vertebra
c. via the jugular foramen
d. via the foramen magnum
e. none of the above

161. B

162

162. Each spinal nerve is invested with three layers of connective
tissue, which include the:
a. outermost epineurium
b. central perineurium
c. innermost endoneurium
d. all of the above
e. none of the above

162. D

163

*163. The white ramus:
a. carries visceral motor fibers to the nearby
autonomic ganglia associated with the sympathetic
chain
b. carries special sensory fibers
c. is made up of myelinated fibers
d. a and c
e. b and c

163. D

164

164. Reflexes:
a. are immediate involuntary motor responses to a specific
stimulus that are designed to help maintain
homeostasis across a wide range of conditions
b. can be modulated at the spinal cord level
c. can be modulated by the brain
d. all of the above
e. none of the above

164. D

165

165. The posterior column pathway carries:
a. fine touch information
b. pressure information
c. vibratory information
d. proprioceptive information
e. all of the above

165. E

166

166. First-order neurons carrying fine touch, pressure, vibratory,
and proprioceptive information from the upper
extremities enter the central nervous system via the
dorsal roots and ascend via the:
a. stellate ganglion
b. fasciculus cuneatus
c. ganglion of Gasser
d. fasciculus gracilis
e. none of the above

166. B

167

167. First-order neurons carrying fine touch, pressure, vibratory,
and proprioceptive information from the lower
extremities enter the central nervous system via the
dorsal roots and ascend via the:
a. stellate ganglion
b. fasciculus cuneatus
c. ganglion of Gasser
d. fasciculus gracilis
e. none of the above

167. D

168

*168. Second-order neurons of the posterior column pathway
leave the medulla oblongata and immediately cross to
the opposite side of the brainstem to relay transmitted
information via the:
a. ribbon-like medial lemniscus
b. ribbon-like lateral lemniscus
c. stellate ganglion
d. trigeminal nucleus
e. none of the above

168. A

169

169. Fine touch information that comes from stimulus of the
left great toe is projected onto the:
a. ipsilateral primary sensory cortex
b. contralateral primary sensory cortex
c. ipsilateral frontal lobe
d. contralateral frontal lobe
e. none of the above

169. B

170

*170. The tract cells of the spinothalamic pathway:
a. decussate at the brainstem level to the contralateral
thalamus via the anterior white tract
b. decussate to the opposite side of the spinal cord via
the anterior white commissure to the contralateral
anterolateral spinal cord
c. travel up the ipsilateral side of the spinal cord in the
ventral region of the spinal cord
d. travel up the ipsilateral side of the spinal cord in the
dorsal region of the spinal cord
e. none of the above

170. B

171

171. The anterior spinothalamic tract carries:
a. pain and temperature information
b. vibratory information
c. crude touch
d. proprioception
e. none of the above

171. C

172

172. The lateral spinothalamic tract carries:
a. pain and temperature information
b. vibratory information
c. crude touch
d. proprioception
e. none of the above

172. A

173

173. The pyramidal system is made up of the:
a. corticobulbar tracts
b. lateral corticospinal tracts
c. anterior corticospinal tracts
d. all of the above
e. none of the above

173. D

174

*174. Approximately 85% of these primary motor axons
decussate at the level of the medulla to cross to the
contralateral spinal cord to enter the:
a. lateral corticospinal tracts
b. anterior corticospinal tracts
c. medial lemniscal tract
d. anterior lemniscal tract
e. none of the above

174. A

175

*175. Approximately 15% of these primary motor axons do
not decussate at the level of the medulla to remain on
the ipsilateral side of the spinal cord to enter the:
a. lateral corticospinal tracts
b. anterior corticospinal tracts
c. medial lemniscal tract
d. anterior lemniscal tract
e. none of the above

175. B

176

176. The extrapyramidal system is the name used to describe
a number of centers and their associated tracts whose
primary function is to coordinate and process:
a. motor commands performed at a subconscious level
b. sudomotor responses
c. vasomotor responses
d. all of the above
e. none of the above

176. A

177

177. The extrapyramidal processing centers produce output
to a variety of targets including:
a. the primary motor cortex to modulate the activities
of the pyramidal system
b. the cranial nerve nuclei to coordinate reflex
activities in response to visual, auditory, and equilibrium
input
c. descending pathways into the spinal cord including
the vestibulospinal tracts, the tectospinal tracts, the
rubrospinal tracts, and the reticulospinal tracts
d. all of the above
e. none of the above

177. D

178

178. Functions of the cerebellum include the:
a. processing and integration of the functioning of the
pyramidal and extrapyramidal systems
b. maintenance of motor tone for the muscles of
posture
c. processing of proprioceptive information
d. all of the above
e. none of the above

178. D

179

179. The sympathetic chain ganglia:
a. are responsible for the sympathetic activity of the
thoracic cavity, chest and abdominal wall, the head,
neck, and the extremities
b. are located on each side of the vertebral columns
c. on each side average 3 cervical, 11 or 12 thoracic, 3
to 5 lumbar, and 4 or 5 sacral ganglia
d. of the coccyx from each sympathetic chain are fused
to form a single terminal ganglion known as the ganglion
of Impar
e. all of the above

179. E

180

180. The myelinated sympathetic fibers from the spinal nerve
roots:
a. may synapse within the sympathetic chain ganglion
at the same level at which the fibers entered the
ganglion
b. may ascend or descend within the sympathetic chain
and then synapse with a sympathetic ganglion at a
level different from the level of fiber entry
c. may simply pass through the sympathetic chain
without synapsing with any sympathetic chain ganglion
to ultimately synapse with a collateral ganglion
or the adrenal medulla
d. all of the above
e. none of the above

180. D

181

*181. The sympathetic division of the autonomic nervous
system is best characterized by the concept of:
a. convergence
b. divergence
c. reverberating circuitry
d. ultra-short axons
e. none of the above

181. B

182

182. The sympathetic collateral ganglia:
a. most often lie anterolateral to the descending aorta
b. include the celiac ganglion
c. include the superior and inferior mesenteric ganglia
d. give off postganglionic fibers that provide sympathetic
innervation to the abdominopelvic viscera
e. all of the above

182. E

183

183. The sympathetic nerves located in the center of the
adrenal medulla:
a. release epinephrine and norepinephrine into the
capillary bed of the adrenal medulla
b. allow tissues not innervated by postganglionic
sympathetic fibers to receive stimulation by the sympathetic nervous system providing they have
receptors sensitive to epinephrine and norepinephrine
c. are stimulated by preganglionic sympathetic nerves
that do not synapse in the ganglia of the sympathetic
chain
d. all of the above
e. none of the above

183. D

184

184. The parasympathetic division of the autonomic nervous
system has:
a. preganglionic neurons and nuclei that are located in
the brain, mesencephalon, pons, and medulla
oblongata
b. autonomic nuclei that reside in the lateral gray horns
of spinal segments S2-4
c. preganglionic fibers that travel within cranial nerves
III, VII, IX, and X to synapse at the ciliary, sphenopalatine,
otic, and submandibular ganglia
d. short postganglion fibers that carry parasympathetic
commands to their respective target organs
e. all of the above

184. E

185

185. Stimulation of these parasympathetic nerves results in:
a. the release of acetylcholine by all preganglionic parasympathetic
neurons, which causes stimulation of all
nicotinic receptors
b. stimulation of muscarinic receptors
c. inhibition of muscarinic receptors
d. all of the above
e. none of the above

185. D

186

186. The autonomic nervous system is characterized by:
a. one nerve–one fiber innervation
b. discrete innervation
c. an antagonistic dual innervation system
d. an all-sort axon configuration
e. all of the above

186. C

187

187. Nociceptors are freely distributed in the:
a. outer layers of the skin
b. walls of blood vessels
c. periosteum of bone
d. joint capsules
e. all of the above

187. E

188

188. When nociceptors are initially stimulated, the first
response is the firing of the receptors to produce an
immediate message to the central nervous system that
results in the perception known as:
a. dull pain
b. slow pain
c. fast pain
d. internuncial pain
e. none of the above

188. C

189

189. Fast pain information is carried by:
a. C fibers
b. A delta fibers
c. the white communicantes
d. the gray communicantes
e. all of the above

189. B

190

190. Slow pain information is carried by:
a. C fibers
b. A delta fibers
c. the white communicantes
d. the gray communicantes
e. all of the above

190. A

191

191. C fibers are:
a. heavily myelinated
b. pure sympathetic fibers
c. unmyelinated
d. only found in the pelvis
e. none of the above

191. C

192

192. Pain and temperature impulses are carried to the central
nervous system via the:
a. lateral spinothalamic tract
b. anterior spinothalamic tract
c. Meissner corpuscles
d. all of the above
e. none of the above

192. A

193

193. Mechanoreceptors include:
a. tactile receptors
b. baroreceptors
c. proprioceptors
d. all of the above
e. none of the above

193. D

194

194. Baroreceptors are commonly found in the:
a. aorta and carotid arteries
b. urinary bladder and ureters
c. respiratory system
d. digestive system
e. all of the above

194. E

195

195. Encapsulated tactile receptors include:
a. Meissner’s corpuscles
b. Pacinian corpuscles
c. Ruffinian corpuscles
d. all of the above
e. none of the above

195. D

196

196. Unencapsulated receptors include:
a. Merkel’s discs
b. free nerve endings
c. root hair plexuses
d. the digestive system
e. all of the above

196. E

197

197. Proprioceptors are located in:
a. muscle spindles
b. the Golgi tendon apparatus
c. joint capsules
d. ligaments
e. all of the above

197. E

198

198. Examples of specialized proprioceptors include:
a. the muscle spindle apparatus
b. Meissner’s corpuscles
c. the Golgi tendon apparatus
d. a and b
e. a and c

198. E

199

199. The major chemoreceptors are located in the:
a. medulla oblongata
b. carotid bodies
c. aortic bodies
d. all of the above
e. none of the above

199. D

200

200. Chemoreceptors located in the medulla oblongata
respond to changes in the:
a. hydrogen ion concentrations in the cerebrospinal
fluid
b. protein concentration in the cerebrospinal fluid
c. carbon dioxide concentrations in the cerebrospinal
fluid
d. a and b
e. a and c

200. E

201

201. The phenomenon of wind-up:
a. is modulated in large part by modulatory
neurotransmitter peptides
b. is an example of how modulatory neurotransmitter
peptides can result in increased transmission of
nociceptive information
c. occurs primarily at the spinal cord level
d. often results in increased perception of pain
e. all of the above

201. E

202

202. Examples of modulatory neurotransmitter peptides
include:
a. substance P
b. somatostatin
c. vasoactive intestinal polypeptide
d. calcitonin gene–related peptide
e. all of the above

202. E

203

203. The two cerebral hemispheres are divided by the:
a. medial longitudinal fissure
b. Sylvian fissure
c. postcentral gyrus
d. precentral gyrus
e. putamen

203. A

204

204. The primary area for afferent sensory processing of the
cerebrum is:
a. medial longitudinal fissure
b. Sylvian fissure
c. postcentral gyrus
d. precentral gyrus
e. putamen

204. C

205

205. The primary area for efferent motor processing of the
cerebrum is:
a. medial longitudinal fissure
b. Sylvian fissure
c. postcentral gyrus
d. precentral gyrus
e. putamen

205. D

206

206. The central white matter is made up of:
a. unmyelinated fibers
b. myelinated fibers
c. ganglionic cell bodies
d. small-diameter sympathetic fibers
e. all of the above

206. B

207

207. Efferent motor impulses originating in the precentral
gyrus of the left cerebral hemisphere control the:
a. right side of the body
b. left side of the body
c. both sides of the body
d. all of the above
e. none of the above

207. A

208

208. The functions of the limbic system are complex and
include:
a. the establishment of baseline emotional states
b. behavior drives
c. facilitation of storage and retrieval of memories
d. the coordination and linkage of the complex conscious
functions of the cerebral cortex with the
unconscious and autonomic functions
e. all of the above

208. E

209

209. Afferent sensory impulses originating on the left side of
the body are perceived by the:
a. right postcentral gyrus
b. left postcentral gyrus
c. postcentral gyri of both cerebral hemispheres
d. all of the above
e. none of the above

209. A

210

210. Inhibition of pain impulses may also occur by
stimulation of:
a. periaqueductal gray matter that surrounds the third
ventricle and cerebral aqueduct
b. trigone of the bladder
c. pulmonary vasculature
d. all of the above
e. none of the above

210. A

211

211. The ventral posterior portion of the ventral nuclei of the thalamus is the primary relay station for the transmission of:
a. fine touch
b. pain
c. temperature
d. pressure and proprioception
e. all of the above

211. E

212

212. The posterior nuclei is made up of the:
a. pulvinar
b. lateral geniculate nuclei
c. medial geniculate nuclei
d. all of the above
e. none of the above

212. D

213

213. The thalamic nuclei include the:
a. lateral nuclei and medial nuclei
b. anterior nuclei
c. ventral nuclei
d. posterior nuclei
e. all of the above

213. E

214

214. The thalamus is located in the:
a. rhinencephalon
b. norencephalon
c. mesencephalon
d. diencephalons
e. none of the above

214. D

215

215. Functions of the hypothalamus include:
a. raising or lowering of body temperature
b. causing the release of antidiuretic hormone to signal
the kidneys to restrict water loss
c. causing the release of oxytocin to stimulate contractions
of the uterus and prostate as well as the myoepithelial
cells of the breasts
d. coordination of circadian rhythms
e. all of the above

215. E

216

216. Functions of the hypothalamus include the:
a. coordination and modulation of autonomic functions
including blood pressure, heart rate, blood
pressure, and respiration
b. coordination and modulation of involuntary somatic
motor activities associated with pain, pleasure, rage,
and sexual arousal
c. coordination of the complex interactions between
the neuroendocrine system and the pituitary gland
d. coordination and modulation of voluntary and involuntary
behavioral patterns including thirst and
hunger
e. all of the above

216. E

217

217. Structures of the mesencephalon include the:
a. red nuclei
b. substantia nigra
c. superior and inferior colliculus
d. reticular activating system
e. all of the above

217. E

218

218. The pons contains the following structures:
a. the apneustic center and the pneumotaxic centers
b. the sensory and motor nuclei of cranial nerves V, VI,
VII, and VIII
c. the nuclei that process and relay afferent information
from the cerebellum that arrives in the pons via
the middle cerebral peduncles
d. tracts of ascending, descending, and transverse fibers
that carry information from the spinal cord to the
brain and from the brain to the spinal cord and the
information from opposite cerebral hemispheres
e. all of the above

218. E

219

219. The apneustic center and the pneumotaxic centers
control:
a. voluntary respiration
b. involuntary respiration
c. heart rate
d. all of the above
e. none of the above

219. B

220

220. Important nuclei and centers that sort, relay, and modulate
a variety of activities necessary for the maintenance
of homeostasis which are located in the medulla
oblongata include the:
a. respiratory rhythmicity center
b. cardiovascular center
c. olivary nuclei
d. nucleus gracilis and cuneatus
e. all of the above

220. E

221

221. Clinical characteristics include:
a. bilateral or occasionally unilateral pain involving
the frontal, temporal, and occipital regions
b. bandlike nonpulsatile ache or tightness
c. associated neck symptomatology
d. pain that evolves over a period of hours or days and
then tends to remain constant without progressive
symptomatology
e. all of the above

221. E

222

222. The following statements are true about tension-type
headache.
a. There is no aura associated with tension-type
headache.
b. Significant sleep disturbance is usually present.
c. It affects females more than males.
d. all of the above
e. none of the above

222. D

223

223. Effective treatments for tension-type headache include:
a. tricyclic antidepressants
b. cervical steroid epidural nerve blocks
c. biofeedback
d. all of the above
e. none of the above

223. D

224

224. Effective prophylactic treatments for migraine headaches
include:
a. beta-blockers
b. calcium channel blockers
c. nonsteroidal anti-inflammatory agents
d. valproic acid
e. all of the above

224. E

225

225. The main risk of the use of abortive therapies in the
treatment of migraine headache includes:
a. analgesic rebound headache
b. peripheral vascular ischemia
c. coronary artery ischemia
d. all of the above
e. none of the above

225. D

226

226. Clinical signs and symptoms of migraine headache
include:
a. unilateral pounding headache
b. nausea and vomiting
c. pallor
d. photophobia and sonophobia
e. all of the above

226. E

227

227. The painless neurologic phenomenon associated with
migraine with aura includes:
a. Braxton-Hicks contractions
b. Cullen’s sign
c. aura
d. all of the above
e. none of the above

227. C

228

228. Clinical signs and symptoms of cluster headache
include:
a. severe retro-orbital and temporal headache
b. deep, boring quality
c. unilateral
d. Horner’s syndrome and rhinorrhea
e. all of the above

228. E

229

229. Effective treatments for cluster headaches include:
a. prednisone
b. sphenopalatine ganglion blocks
c. lithium carbonate
d. methysergide
e. all of the above

229. E

230

230. In contradistinction to migraine and tension-type headache,
cluster headache is unique in its:
a. female predominance
b. association with sickle cell disease
c. male predominance
d. long onset-to-peak
e. none of the above

230. C

231

231. The headache with the shortest onset-to-peak is:
a. migraine headache
b. cluster headache
c. tension-type headache
d. analgesic rebound headache
e. none of the above

231. B

232

232. The diagnostic criteria for pseudotumor cerebri include:
a. signs and symptoms suggestive of increased intracranial
pressure including papilledema
b. normal magnetic resonance imaging (MRI) or computed
tomography (CT) of the brain performed with
and without contrast media
c. increased cerebrospinal fluid pressure documented
by lumbar puncture
d. normal cerebrospinal fluid chemistry, cultures, and
cytology
e. all of the above

232. E

233

233. The typical patient suffering from papilledema is:
a. female
b. obese
c. between 20 and 45 years old
d. complaining of headache
e. all of the above

233. E

234

234. Drugs implicated in the evolution of pseudotumor
cerebri include:
a. vitamin A
b. tetracyclines
c. nalidixic acid
d. corticosteroids
e. all of the above

234. E

235

235. Clinical disorders associated with pseudotumor cerebri
include:
a. anemias
b. endocrinopathies
c. blood dyscrasias
d. chronic respiratory insufficiency
e. all of the above

235. E

236

236. Common causes of ocular pain include:
a. conjunctivitis
b. corneal abrasions
c. glaucoma
d. uveitis
e. all of the above

236. E

237

237. The sine qua non of post-dural puncture headache is:
a. postural headache
b. fever
c. unilateral nature
d. all of the above
e. none of the above

237. A

238

238. Causes of trigeminal neuralgia include:
a. acoustic neuromas
b. cholesteatomas and bony abnormalities
c. aneurysms and angiomas
d. compression by aberrant or tortuous blood vessels
e. all of the above

238. E

239

239. Medication treatment options for trigeminal neuralgia
include:
a. carbamazepine
b. baclofen
c. gabapentin
d. all of the above
e. none of the above

239. D

240

240. Surgical treatment options for trigeminal neuralgia
include:
a. trigeminal nerve block
b. retrogasserian injection of glycerol
c. radiofrequency lesioning of the gasserian ganglion
d. microvascular decompression of the trigeminal
root
e. all of the above

240. E

241

241. The following symptom is pathognomonic for temporal
arteritis:
a. tinnitus
b. papilledema
c. jaw claudication
d. areflexia
e. none of the above

241. C

242

242. Temporal arteritis is a:
a. disease of the sixth decade
b. disease associated with polymyalgia rheumatica in
approximately 50% of patients
c. disease that affects females three times more often
than males
d. disease that affects almost exclusively whites
e. all of the above

242. E

243

243. Over 90% of patients with temporal arteritis have a
significantly elevated:
a. hemoglobin
b. erythrocyte sedimentation rate
c. uric acid
d. all of the above
e. none of the above

243. B

244

244. Common causes of otalgia include:
a. cellulitis and/or abscess of the auricle
b. otitis externa
c. otitis media
d. meningitis
e. all of the above

244. E

245

245. Herpes zoster infection involving the geniculate ganglion
and external auditory canal and auricle is called:
a. Boerhaave’s syndrome
b. zoster sine herpes
c. zoster ophthalmicus dura
d. zoster polio juvenalis
e. none of the above

245. E

246

246. The ear receives innervation from the:
a. facial nerve
b. glossopharyngeal nerve
c. auriculotemporal branch of the mandibular nerve
d. superficial petrosal nerve
e. all of the above

246. E

247

247. Nose pain is commonly caused by:
a. infections including folliculitis
b. foreign bodies
c. malignancies
d. all of the above
e. none of the above

247. D

248

248. Midface pain may be caused by:
a. sinusitis
b. osteomyelitis of the facial bones
c. squamous cell carcinomas
d. nasopharyngiomas
e. all of the above

248. E

249

249. Referred pain to the ear, midface, and throat can be
caused by:
a. tumors of the nasopharynx
b. deep infections of the pharynx including retropharyngeal
abscess
c. dental infections
d. Eagle’s syndrome
e. all of the above

249. E

250

250. The greater occipital nerve:
a. arises from fibers of the dorsal primary ramus of the
second cervical nerve
b. arises, to a lesser extent, from fibers from the third
cervical nerve
c. pierces the fascia just below the superior nuchal
ridge along with the occipital artery
d. supplies the medial portion of the posterior scalp as
far anterior as the vertex
e. all of the above

250. E

251

251. The lesser occipital nerve:
a. arises from the ventral primary rami of the second
and third cervical nerves
b. passes superiorly along the posterior border of the
sternocleidomastoid muscle, dividing into cutaneous branches that innervate the lateral portion of the
posterior scalp and the cranial surface of the pinna
of the ear
c. is relatively easy to block with local anesthetic and
steroid
d. all of the above
e. none of the above

251. D

252

252. Cervical radiculopathy is best treated with a multimodality
approach including:
a. physical therapy including heat modalities and deep
sedative massage
b. nonsteroidal anti-inflammatory agents
c. skeletal muscle relaxants
d. cervical steroid epidural nerve blocks with local
anesthetic and steroid
e. all of the above

252. E

253

253. Pain syndromes that may mimic cervical radiculopathy
include:
a. cervicalgia
b. cervical bursitis and cervical fibromyositis
c. inflammatory arthritis
d. disorders of the cervical spinal cord, roots, plexus,
and nerves
e. all of the above

253. E

254

254. The causes of cervical radiculopathy include:
a. herniated disc
b. foraminal stenosis and osteophyte formation
c. tumor
d. infection
e. all of the above

254. E

255

255. The patient suffering from cervical radiculopathy may
experience:
a. pain in a dermatomal distribution
b. numbness
c. weakness
d. loss of reflexes
e. all of the above

255. E

256

256. Patients will commonly place the hand of the affected
extremity on the top of the head in order to obtain relief
when suffering from compromise of which of the
following cervical nerve roots?
a. C5
b. C6
c. C7
d. C8
e. none of the above

256. C

257

257. The clinical hallmark of cervical strain is:
a. neck pain
b. pain in a dermatomal distribution
c. myelopathy
d. all of the above
e. none of the above

257. A

258

258. The pain of cervical strain:
a. often begins in the occipital region
b. radiates in a nondermatomal pattern into the
shoulders and intrascapular region
c. is often exacerbated by movement of the cervical
spine and shoulders
d. is often accompanied by headaches and sleep
disturbance
e. all of the above

258. E

259

259. Physical examination results of the patient suffering
from cervical strain may include:
a. tenderness on palpation of the paraspinous musculature
and trapezius
b. spasm of the paraspinous musculature and trapezius
c. decreased range of motion of the cervical spine
d. normal neurologic examination of the upper
extremities
e. all of the above

259. E

260

260. Cervical strain is best treated with a multimodality
approach including:
a. physical therapy with heat modalities and deep sedative
massage
b. nonsteroidal anti-inflammatory agents
c. skeletal muscle relaxants
d. cervical facet blocks with local anesthetic and steroid
e. all of the above

260. E

261

261. The patient suffering from cervicothoracic bursitis will
present with:
a. the complaint of dull, poorly localized pain in the
lower cervical and upper thoracic region
b. nonradicular pain that spreads from the midline to
the adjacent paraspinous area
c. the patient holding the cervical spine rigid with the
head thrust forward to splint the affected ligament
and bursae
d. pain that is exacerbated by flexion and extension of
the lower cervical spine and upper thoracic spine
e. all of the above

261. E

262

262. The pathognomonic lesion of fibromyalgia pain is the:
a. goblet cell
b. trigger point
c. delta cell
d. beta cell
e. none of the above

262. B

263

263. Cervicothoracic bursitis is best treated with a multimodality
approach including:
a. physical therapy with heat modalities and deep sedative
massage
b. nonsteroidal anti-inflammatory agents
c. skeletal muscle relaxants
d. injection of the cervicothoracic bursae with local
anesthetic and steroid
e. all of the above

263. E

264

264. Fibromyalgia of the cervical spine is best treated with a
multimodality approach including:
a. techniques that will help eliminate the trigger point
b. tricyclic antidepressant compounds
c. trigger point injections
d. all of the above
e. none of the above

264. D

265

265. Each facet joint receives fibers from the:
a. dorsal ramus at the same level as the vertebra
b. ventral ramus at the same level as the vertebra
c. dorsal ramus of the vertebra above
d. a and b
e. a and c

265. E

266

266. Cervical facet syndrome is a constellation of symptoms
consisting of:
a. neck, head, shoulder, and proximal upper extremity
pain that radiates in a nondermatomal pattern
b. pain that is dull and ill defined in character
c. pain that may be unilateral or bilateral
d. pain that is exacerbated by flexion, extension, and
lateral bending of the cervical spine
e. all of the above

266. E

267

267. Cervical facet syndrome is best treated with a multimodality
approach including:
a. physical therapy with heat modalities
b. nonsteroidal anti-inflammatory agents
c. skeletal muscle relaxants
d. injection of the cervical facet joints with local anesthetic
and steroid
e. all of the above

267. E

268

268. Common causes of thoracic radiculopathy include:
a. herniated disc
b. foraminal stenosis and osteophyte formation
c. tumor and infection
d. vertebral compression fractures
e. all of the above

268. E

269

269. The patient suffering from thoracic radiculopathy may
experience:
a. pain in a dermatomal distribution
b. numbness and paresthesias
c. weakness
d. loss of superficial abdominal reflexes
e. all of the above

269. E

270

270. Thoracic myelopathy is most commonly due to:
a. midline herniated thoracic disc
b. spinal stenosis
c. demyelinating disease
d. tumor or, rarely, infection
e. all of the above

270. E

271

271. Intercostal neuralgia is best treated with a multimodality
approach including:
a. tricyclic antidepressant compounds
b. nonsteroidal anti-inflammatory agents
c. gabapentin
d. injection of the intercostal nerves with local anesthetic
and steroid
e. all of the above

271. E

272

*272. Physical examination of the patient suffering from costosternal
syndrome will reveal that:
a. the patient will vigorously attempt to splint the joints
by keeping the shoulders stiffly in neutral position
b. pain is reproduced with active protraction or retraction
of the shoulder, deep inspiration, as well as full
elevation of the arm
c. the costosternal joints and adjacent intercostal
muscles may be tender to palpation
d. the patient may also complain of a clicking sensation
with movement of the joint
e. all of the above

272. E

273

*273. Physical examination of the patient suffering from
manubriosternal joint syndrome will reveal that:
a. the patient will vigorously attempt to splint the
joints by keeping the shoulders stiffly in neutral
position
b. pain is reproduced with active protraction or retraction
of the shoulder, deep inspiration, and full
elevation of the arm
c. the manubriosternal joint may feel hot and inflamed
d. shrugging of the shoulder may also reproduce the
pain
e. all of the above

273. E

274

274. Symptoms associated with compression fractures of the
thoracic vertebra include:
a. pain that is aggravated by deep inspiration, coughing,
and any movement of the dorsal spine
b. pain and spasm of the paraspinous muscles elicited
by palpation of the affected vertebra
c. hematoma and ecchymosis overlying the fracture
site if trauma has occurred
d. abdominal ileus and severe pain with resulting
splinting of the paraspinous muscles of the dorsal
spine further compromising the patient’s ability to
walk and their pulmonary status
e. all of the above

274. E

275

275. Initial treatment of pain secondary to compression
fracture of the thoracic spine should include:
a. combination of simple analgesics and the nonsteroidal
anti-inflammatory drugs or opioids if the pain is
uncontrolled
b. the local application of heat and cold, which may
also be beneficial to provide symptomatic relief of
the pain of vertebral compression fracture
c. the use of an orthotic, such as the CASH brace
d. thoracic epidural block using local anesthetic and
steroid
e. all of the above

275. E

276

276. The patient suffering from lumbar radiculopathy will
complain of:
a. pain, numbness, tingling, and paresthesias in the
distribution of the affected nerve root or roots
b. weakness and lack of coordination in the affected
extremity
c. muscle spasms and back pain as well as pain referred
into the buttocks
d. reflex changes are demonstrated on physical examination
and a reflex shifting of the trunk to one side
called a list
e. all of the above

276. E

277

277. Lumbar radiculopathy is best treated with a multimodality
approach including:
a. physical therapy with heat modalities
b. nonsteroidal anti-inflammatory agents
c. skeletal muscle relaxants
d. lumbar epidural or caudal injection of the affected
nerve roots with local anesthetic and steroid
e. all of the above

277. E

278

278. Lumbar myelopathy is most commonly due to:
a. midline herniated lumbar disc
b. spinal stenosis
c. tumor or, rarely, infection
d. all of the above
e. none of the above

278. D

279

279. Patients suffering from lumbar myelopathy or cauda
equina syndrome will experience:
a. varying degrees of lower extremity weakness
b. bowel symptomatology
c. bladder symptomatology
d. all of the above
e. none of the above

279. D

280

280. The patient suffering from coccydynia will exhibit:
a. point tenderness over the coccyx with the pain being
increased with movement of the coccyx
b. movement of the coccyx may cause sharp paresthesias
into the rectum
c. on rectal exam, the levator ani, piriformis, and
coccygeus muscles may feel indurated and palpation
of these muscles may induce severe spasm
d. sitting may exacerbate the pain of coccydynia, and
the patient may attempt to sit on one buttock to
avoid pressure on the coccyx
e. all of the above

280. E

281

281. The following pathologic conditions may mimic the
pain of coccydynia:
a. primary pathology of the rectum and anus
b. primary tumors or metastatic lesions of the sacrum
and/or coccyx
c. proctalgia fugax
d. insufficiency fractures of the pelvis and sacrum
e. all of the above

281. E

282

282. Proctalgia fugax can be distinguished from coccydynia
in that patients suffering from proctalgia fugax will
exhibit:
a. no increase in pain with movement of the coccyx
b. an increase in pain with movement of the coccyx
c. blood in stool
d. a and c
e. none of the above

282. A

283

283. Reflex sympathetic dystrophy is characterized by:
a. burning facial pain
b. sudomotor changes
c. vasomotor changes
d. trophic skin changes
e. all of the above

283. E

284

284. The clinical symptomatology of reflex sympathetic
dystrophy of the face may often be confused with:
a. pain of dental origin
b. pain of sinus origin
c. atypical facial pain
d. trigeminal neuralgia
e. all of the above

284. E

285

285. Characteristic symptoms of a typical post-dural
puncture headache include:
a. rapid onset of headache when the patient moves
from the horizontal to the upright position
b. constant holocranial headache when the patient is
supine
c. headache that abates when the patient resumes a
horizontal position
d. a and b
e. a and c

285. E

286

286. Untreated post-dural puncture headache may
result in:
a. glossopharyngeal neuralgia
b. persistent cranial nerve palsies
c. increased serum potassium
d. increased serum sodium
e. none of the above

286. B

287

287. Medication treatment options for glossopharyngeal
neuralgia include:
a. carbamazepine
b. baclofen
c. gabapentin
d. all of the above
e. none of the above

287. D

288

288. Surgical treatment options for glossopharyngeal neuralgia
include:
a. glossopharyngeal nerve block
b. radiofrequency lesioning of the glossopharyngeal
nerve
c. microvascular decompression of the trigeminal
root
d. all of the above
e. none of the above

288. D

289

289. Varieties of spasmodic torticollis include:
a. tonic spasmodic torticollis
b. clonic spasmodic torticollis
c. tonic/clonic spasmodic torticollis
d. all of the above
e. none of the above

289. D

290

290. Patients suffering from brachial plexopathy will complain
of:
a. pain radiating to the supraclavicular region and
upper extremity
b. neuritic pain that may take on a deep, boring quality
with invasion of the plexus by tumor
c. movement of the neck and shoulder that exacerbates
the pain
d. all of the above
e. none of the above

290. D

291

291. Common causes of brachial plexopathy include:
a. compression of the plexus by cervical ribs or abnormal
muscles
b. invasion of the plexus by tumor, e.g., Pancoast’s
syndrome
c. direct trauma to the plexus, e.g., stretch injuries and
avulsions
d. inflammatory causes, e.g., Parsonage-Turner syndrome
and postradiation plexopathy
e. all of the above

291. E

292

292. Adson’s maneuver is helpful in the diagnosis of thoracic
outlet syndrome and is performed by:
a. palpating the radial pulse on the affected side with
the patient’s neck extended and the head turned
toward the affected side
b. occluding both the ulnar and radial arteries at the
wrist
c. forcibly flexing the cervical spine
d. active pronation of the affected extremity
e. none of the above

292. A

293

293. Signs and symptoms of thoracic outlet syndrome include:
a. paresthesias of the upper extremity radiating into the
distribution of the ulnar nerve
b. aching and incoordination of the affected extremity
c. edema or discoloration of the arm
d. in rare instances venous or arterial thrombosis
e. all of the above

293. E

294

294. Provocation of the symptoms of thoracic outlet
syndrome may be elicited by a variety of maneuvers
including the:
a. Adson test
b. elevated arm stress test
c. Allen test
d. a and b
e. a and c

294. D

295

295. Invasive treatments useful in the palliation of the pain
associated with Pancoast’s tumor include:
a. brachial plexus block
b. dorsal root entry zone lesioning
c. radiofrequency lesioning of the brachial plexus
d. cordotomy
e. all of the above

295. E

296

296. Pharmacologic treatment useful in the palliation of the
pain associated with Pancoast’s tumor includes:
a. gabapentin
b. carbamazepine
c. baclofen
d. opioid analgesics
e. all of the above

296. E

297

297. Patients suffering from Pancoast’s tumor syndrome will
complain of:
a. neuritic pain radiating to the supraclavicular region
and upper extremity.
b. initial pain in the upper thoracic and lower cervical
dermatomes as the lower portion of the brachial
plexus is involved as the tumor grows from below
c. exacerbation of pain with movement of the neck and
shoulder
d. Horner’s syndrome in some patients
e. all of the above

297. E

298

298. Pancoast’s tumor syndrome:
a. is the result of local growth of tumor from the apex
of the lung directly into the brachial plexus
b. usually involves the first and second thoracic nerves
as well as the eighth cervical nerve producing a
classic clinical syndrome consisting of severe arm
pain and, in some patients, Horner’s syndrome
c. often results in destruction of the first and second
ribs
d. all of the above
e. none of the above

298. D

299

299. Tennis elbow is also known as:
a. medial epicondylitis
b. lateral epicondylitis
c. radial tunnel syndrome
d. pronator syndrome
e. none of the above

299. B

300

300. Which of the following painful conditions may be
misdiagnosed as tennis elbow?
a. radial tunnel syndrome
b. pronator syndrome
c. C6-7 radiculopathy
d. a and b
e. a and c

300. E

301

301. Treatments effective in the management of tennis elbow
include:
a. nonsteroidal anti-inflammatory agents
b. local application of heat and cold
c. physical therapy
d. injection of the lateral epicondyle with local
anesthetic and steroid
e. all of the above

301. E

302

302. Patients suffering from tennis elbow will complain of:
a. pain that is localized to the region of the lateral
epicondyle
b. pain that is constant and is made worse with active
contraction of the wrist
c. the inability to hold a coffee cup or hammer with
weakened grip strength
d. pain when undergoing a tennis elbow test
e. all of the above

302. E

303

303. Golfer’s elbow is also known as:
a. medial epicondylitis
b. lateral epicondylitis
c. radial tunnel syndrome
d. pronator syndrome
e. none of the above

303. A

304

304. Which of the following painful conditions can be
misdiagnosed as golfer’s elbow?
a. radial tunnel syndrome
b. gout, arthritis, and bursitis
c. C6-7 radiculopathy
d. a and b
e. b and c

304. E

305

305. Treatments effective in the management of golfer’s
elbow include:
a. nonsteroidal anti-inflammatory agents
b. local application of heat and cold
c. physical therapy
d. injection of the medial epicondyle with local
anesthetic and steroid
e. all of the above

305. E

306

306. Patients suffering from golfer’s elbow will complain of:
a. pain that is localized to the region of the medial
epicondyle
b. pain that is constant and is made worse with active
contraction of the wrist
c. the inability to hold a coffee cup or hammer with
weakened grip strength
d. pain when undergoing a Golfer’s elbow test
e. all of the above

306. E

307

307. In radial tunnel syndrome, the:
a. posterior interosseous branch of the radial nerve
is entrapped
b. anterior interosseous branch of the radial nerve is
entrapped
c. lateral interosseous branch of the radial nerve
is entrapped
d. medial interosseous branch of the radial nerve is
entrapped
e. none of the above

307. A

308

308. Mechanisms implicated in the compression of the radial
nerve in radial tunnel syndrome include:
a. aberrant fibrous bands in front of the radial head
b. anomalous blood vessels that compress the nerve
c. a sharp tendinous margin of the extensor carpi
radialis brevis
d. all of the above
e. none of the above

308. D

309

309. Clinical features of radial tunnel syndrome include:
a. aching lateral elbow pain
b. pain that is localized to the deep extensor muscle
mass
c. pain that may radiate proximally and distally into the
upper arm and forearm
d. all of the above
e. none of the above

309. D

310

310. Which of the following painful conditions can be
misdiagnosed as radial tunnel syndrome?
a. tennis elbow
b. pronator syndrome
c. C5-6 radiculopathy
d. a and b
e. a and c

310. A

311

311. Ulnar nerve entrapment at the elbow is also called:
a. tardy ulnar palsy
b. cubital tunnel syndrome
c. ulnar nerve neuritis.
d. all of the above
e. none of the above

311. D

312

312. Physical findings of ulnar nerve entrapment at the elbow
may include:
a. tenderness over the ulnar nerve at the elbow
b. positive Tinel’s sign over the ulnar nerve as it passes
beneath the aponeuroses
c. weakness of the intrinsic muscles of the forearm and
hand that are innervated by the ulnar nerve
d. loss of sensation on the ulnar side of the little finger
e. all of the above

312. E

313

313. The pain and muscle weakness of anterior interosseous
syndrome can be caused by:
a. median nerve compression of the nerve just below
the elbow by the tendinous origins of the pronator
teres muscle and flexor digitorum superficialis
muscle of the long finger
b. aberrant blood vessels
c. inflammatory causes
d. all of the above
e. none of the above

313. D

314

314. Clinically, anterior interosseous syndrome presents as:
a. acute pain in the proximal forearm and deep in the
wrist
b. heavy sensation in the forearm with minimal activity
c. inability to pinch items between the thumb and
index finger due to paralysis of the flexor pollicis
longis and the flexor digitorum profundus
d. all of the above
e. none of the above

314. D

315

315. The following statement(s) regarding olecranon bursitis
is (are) true.
a. Olecranon bursitis may develop gradually due to
repetitive irritation of the olecranon bursa or acutely
due to trauma or infection.
b. The olecranon bursa lies in the posterior aspect of
the elbow between the olecranon process of the ulna
and the overlying skin.
c. The olecranon bursa may exist as a single bursal sac
or, in some patients, as a multisegmented series of
sacs that may be loculated in nature.
d. With overuse or misuse, these bursae may
become inflamed, enlarged, and, on rare occasions,
infected.
e. all of the above

315. E

316

316. The following statement(s) regarding olecranon bursitis
is(are) true.
a. The patient suffering from olecranon bursitis will
frequently complain of pain and swelling with any
movement of the elbow, but especially with
extension.
b. The pain of olecranon bursitis is localized to the
olecranon area with referred pain often noted
above the elbow joint.
c. Physical examination will reveal point tenderness
over the olecranon and swelling of the bursa,
which at times can be quite extensive.
d. Passive extension and resisted flexion shoulder will
reproduce the pain, as will any pressure over the
bursa.
e. all of the above

316. E

317

317. Carpal tunnel syndrome is the most common entrapment
neuropathy encountered in clinical practice and is
caused by compression of the:
a. median nerve as it passes through the carpal canal at
the wrist
b. radial nerve as it passes through the carpal canal
at the wrist
c. ulnar nerve as it passes through the carpal canal at
the wrist
d. median nerve as it passes through the Vesuvian canal
at the wrist
e. none of the above

317. A

318

318. The most common causes of carpal tunnel syndrome
include:
a. flexor tenosynovitis
b. rheumatoid arthritis
c. pregnancy
d. amyloidosis and other space-occupying lesions that
compromise the median nerve as it passes though
this closed space
e. all of the above

318. E

319

319. Carpal tunnel syndrome presents as:
a. pain, numbness, paresthesias, and associated weakness
in the hand and wrist
b. pain, numbness, paresthesias, and associated weakness
that radiates to the thumb, index, middle, and
radial half of the ring fingers
c. pain, numbness, and paresthesias that radiate
proximal to the entrapment into the forearm
d. all of the above
e. none of the above

319. D

320

320. Signs and symptoms of carpal tunnel syndrome include:
a. a positive Tinel’s sign over the median nerve at the
wrist
b. a positive Phalen’s sign
c. weakness of thumb opposition
d. wasting of the thenar eminence
e. all of the above

320. E

321

321. Cheiralgia paresthetica is caused by compression
of the:
a. sensory branch of the radial nerve at the wrist
b. sensory branch of the median nerve at the wrist
c. sensory branch of the ulnar nerve at the wrist
d. motor branch of the radial nerve at the wrist
e. none of the above

321. A

322

322. de Quervain’s tenosynovitis is caused by an:
a. inflammation and swelling of the tendons of the
adductor pollicis longus and flexor pollicis longus
at the level of the radial styloid process
b. inflammation and swelling of the tendons of the
abductor pollicis longus and extensor pollicis brevis
at the level of the radial styloid process
c. inflammation and swelling of the tendons of the
abductor pollicis brevis and extensor pollicis longus
at the level of the radial styloid process
d. all of the above
e. none of the above

322. B

323

323. Signs and symptoms associated with Dupuytren’s contracture
include:
a. hard fibrotic nodules along the path of the flexor
tendons
b. taut fibrous bands that may cross the metacarpophalangeal
joint and ultimately the proximal interphalangeal
joint
c. limitation of finger extension
d. relatively normal finger flexion
e. all of the above

323. E

324

324. Dupuytren’s contracture:
a. is thought to have a genetic basis
b. occurs most frequently in males of northern
Scandinavian descent
c. may be associated with trauma to the palm
d. may be associated with diabetes, alcoholism, and
chronic barbiturate use
e. all of the above

324. E

325

325. The nonsurgical treatment of the pain and functional
disability associated with Dupuytren’s contracture
should include:
a. nonsteroidal anti-inflammatory drugs
b. the use of physical modalities including local heat as
well as gentle range-of-motion exercises
c. a nighttime splint to protect the fingers, which may
help relieve symptoms
d. injection of Dupuytren’s contracture with local anesthetic
and steroid, which may also be effective in
the management of the symptoms associated with
Dupuytren’s contracture
e. all of the above

325. E

326

326. Disorders that may mimic the symptoms of diabetic
truncal neuropathies include:
a. Hansen’s disease
b. Lyme disease
c. HIV
d. toxic neuropathies
e. all of the above

326. E

327

327. Disorders that may mimic the symptoms of diabetic
truncal neuropathies include:
a. heavy metal poisoning
b. neuropathy secondary to chemotherapy
c. heritable neuropathies including Charcot-Marie-
Tooth disease
d. vitamin deficiencies
e. all of the above

327. E

328

328. Disorders that may mimic the symptoms of diabetic
truncal neuropathies include:
a. sarcoidosis
b. amyloidosis
c. intercostal neuralgia
d. intra-abdominal and intrathoracic pathology
e. all of the above

328. E

329

329. Medical treatment of diabetic truncal neuropathy
should include:
a. anticonvulsants
b. antidepressants
c. antiarrhythmics
d. tight control of blood sugars
e. all of the above

329. E

330

330. Topical agents shown to be useful in the palliation of
pain secondary to the pain of diabetic truncal neuropathy
include:
a. capsaicin
b. topical lidocaine creme
c. lidocaine transdermal patch
d. all of the above
e. none of the above

330. D

331

331. Signs and symptoms associated with Tietze’s syndrome
include:
a. tenderness and swelling of the second and third
costosternal joints
b. tenderness of intercostal muscles adjacent to the
second and third costosternal joints
c. increased pain with retraction of the shoulders
d. a clicking sensation with movement of the affected
costosternal joints
e. all of the above

331. E

332

332. Treatment of the pain and functional disability
associated with Tietze’s syndrome should include:
a. nonsteroidal anti-inflammatory drugs
b. the local application of heat and cold
c. the use of an elastic rib belt
d. injection of the costosternal joints using local
anesthetic and steroid
e. all of the above

332. E

333

333. Causes of post-thoracotomy syndrome include:
a. direct surgical trauma to the intercostal nerves and/
or cutaneous neuroma formation
b. fractured ribs due to the rib spreader
c. compressive neuropathy of the intercostal nerves
due to direct compression to the intercostal nerves
by retractors
d. stretch injuries to the intercostal nerves at the
costovertebral junction
e. all of the above

333. E

334

334. Treatment of post-thoracotomy syndrome includes:
a. nonsteroidal anti-inflammatory agents and simple
analgesics
b. anticonvulsants and antidepressant compounds
c. application of local heat and cold
d. injection of the structures causing the pain with local
anesthetic and steroid
e. all of the above

334. E

335

335. Treatment of post-mastectomy syndrome includes:
a. nonsteroidal anti-inflammatory agents and simple
analgesics
b. anticonvulsants and antidepressant compounds
c. application of local heat and cold
d. injection of the intercostal nerves and/or thoracic
epidural nerves with local anesthetic and steroid
e. all of the above

335. E

336

336. The following statement(s) regarding herpes zoster is
(are) true.
a. Herpes zoster is an infectious disease that is caused
by the varicella-zoster virus.
b. The thoracic nerve roots are the most common site
for the development of acute herpes zoster.
c. Primary infection with the varicella-zoster virus in
the nonimmune host manifests itself clinically as
chickenpox.
d. During the course of primary infection with varicellazoster
virus, the virus migrates to the dorsal root of
the thoracic nerves where it remains dormant.
e. all of the above

336. E

337

337. Patients with the following diseases are more likely than
the general population to develop acute herpes zoster:
a. patients with lymphoma
b. patients on steroids
c. patients undergoing chemotherapy or receiving
immunosuppressive drugs
d. patients undergoing radiation therapy
e. all of the above

337. E

338

338. The initial treatment of acute herpes zoster should
include:
a. sympathetic nerve blocks
b. antiviral agents
c. opioid analgesics
d. adjuvant analgesics including gabapentin and
antidepressant compounds
e. all of the above

338. E

339

339. The initial treatment of postherpetic neuralgia should
include:
a. sympathetic and somatic nerve blocks
b. gabapentin
c. opioid analgesics
d. adjuvant analgesics including antidepressants and
antidepressant compounds
e. all of the above

339. E

340

340. The initial evaluation of epidural abscess should include:
a. stat blood and urine cultures
b. immediate CT and/or MRI
c. myelography if CT or MRI is equivocal or
unavailable
d. all of the above
e. none of the above

340. D

341

341. Spondylolisthesis:
a. is a degenerative disease of the lumbar spine
b. occurs more commonly in women
c. is most often seen after the age of 40
d. is caused by the slippage of one vertebral body onto
another due to degeneration of the facet joints and
intervertebral disc
e. all of the above

341. E

342

342. In spondylolisthesis:
a. the upper vertebral body moves anteriorly relative to
the vertebral body below it
b. the slippage of one vertebra onto another usually
causes narrowing of the spinal canal
c. there is often a relative spinal stenosis and back pain
d. occasionally, the upper vertebral body slides posteriorly
relative to the vertebral body below it, which
compromises the neural foramina
e. all of the above

342. E

343

343. Ankylosing spondylitis is also known as:
a. Osgood-Schlatter disease
b. Marie-Stru¨mpell disease
c. Osgood-Weber-Rendu disease
d. Dubin-Johnson-Sprint disease
e. none of the above

343. B

344

344. Ankylosing spondylitis:
a. is associated with an approximately 90% presence of
histocompatibility antigen HLA-B27 compared with
7% of the general population
b. occurs three times more frequently in men
c. symptoms usually appear by the third decade of life
d. rarely has its onset beyond 40 years of age
e. all of the above

344. E

345

345. Ankylosing spondylitis is best treated with a multimodality
approach including:
a. physical therapy including exercises to maintain
function, heat modalities, and deep sedative massage
b. nonsteroidal anti-inflammatory agents and skeletal
muscle relaxants
c. sulfasalazine
d. the addition of caudal or lumbar epidural blocks with
a local anesthetic and steroid
e. all of the above

345. E

346

346. Acute pancreatitis is characterized by:
a. mild to severe abdominal pain
b. steady, boring epigastric pain that radiates to the
flanks and chest
c. pain that is worse with the supine position
d. nausea, vomiting, and anorexia
e. all of the above

346. E

347

347. The patient with acute pancreatitis will exhibit the
following signs and symptoms:
a. tachycardia and hypotension due to hypovolemia
and low-grade fever
b. saponification of subcutaneous fat
c. pulmonary complications including pleural effusions
and pleuritic pain that may compromise
respiration
d. diffuse abdominal tenderness with peritoneal signs
are invariably present
e. all of the above

347. E

348

348. Findings of hemorrhagic pancreatitis include:
a. periumbilical ecchymosis (Cullen’s sign)
b. flank ecchymosis (Turner’s sign)
c. absent startle reflex
d. a and b
e. a and c

348. D

349

349. The abnormal laboratory finding that is the sine qua non
of acute pancreatitis is:
a. elevated SGOT
b. lowered SGOT
c. elevated serum amylase
d. elevated serum calcium
e. none of the above

349. C

350

350. Common causes of acute pancreatitis include:
a. alcohol
b. gallstones
c. viral infections
d. medications
e. all of the above

350. E

351

351. Common causes of acute pancreatitis include:
a. metabolic causes
b. connective tissue diseases
c. obstruction of the ampulla of Vater by tumor
d. heredity
e. all of the above

351. E

352

352. Chronic pancreatitis is commonly caused by:
a. alcohol
b. cystic fibrosis
c. pancreatic malignancies
d. hereditary causes such as alpha1-antitrypsin deficiency
e. all of the above

352. E

353

353. Which of the following can mimic the signs and
symptoms of ilioinguinal neuralgia?
a. lesions of the lumbar plexus
b. tumors involving the lumbar plexus
c. diabetic neuropathy
d. inflammation of the ilioinguinal nerve
e. all of the above

353. E

354

354. Signs and symptoms associated with ilioinguinal neuralgia
include:
a. paresthesias, burning pain, and occasionally numbness
over the lower abdomen that radiates into the
scrotum or labia and occasionally into the inner
upper thigh
b. pain that does not radiate below the knee
c. pain that is made worse by extension of the lumbar
spine
d. a bent-forward ‘‘novice skier’s’’ position
e. all of the above

354. E

355

355. Physical findings of genitofemoral neuralgia include:
a. sensory deficit in the inner thigh, base of the scrotum,
or labia majora in the distribution of the genitofemoral
nerve
b. weakness of the anterior abdominal wall
musculature
c. Tinel’s sign that may be elicited by tapping over the
genitofemoral nerve at the point it passes beneath
the inguinal ligament
d. a bent-forward ‘‘novice skier’s’’ position
d. all of the above

355. E

356

356. Meralgia paresthetica is caused by compression of the:
a. lateral femoral cutaneous nerve
b. femoral nerve
c. sciatic nerve
d. iliohypogastric nerve
e. none of the above

356. A

357

357. Signs and symptoms associated with meralgia paresthetica
include:
a. tenderness over the lateral femoral cutaneous nerve
at the origin of the inguinal ligament at the anterior
superior iliac spine
b. a positive Tinel’s sign over the lateral femoral cutaneous
nerve as it passes beneath the inguinal ligament
c. a sensory deficit in the distribution of the lateral
femoral cutaneous nerve
d. all of the above
e. none of the above

357. D

358

358. The pain of spinal stenosis usually presents in a characteristic
manner as pain and weakness in the legs and
calves when walking that is known as:
a. pseudoclaudication
b. neurogenic claudication
c. vascular claudication
d. a and b
e. none of the above

358. D

359

359. The patient suffering from spinal stenosis:
a. will complain of calf and leg pain and fatigue with
walking, standing, or lying supine
b. will note that the calf and leg pain and fatigue will
disappear if the patient flexes the lumbar spine or
assumes the sitting position
c. will note that extension of the spine may also cause
and increase the symptoms
d. may experience weakness and reflex changes in the
affected dermatomes
e. all of the above

359. E

360

360. Occasionally, patients suffering from spinal stenosis may
suffer from myelopathy or cauda equina syndrome. In
this setting, the:
a. onset of symptoms may be insidious
b. patient may experience bladder symptomatology
c. patient may experience bowel sympatomatology
d. findings of myelopathy or cauda equina syndrome
should be considered a neurosurgical emergency
e. all of the above

360. E

361

361. Pain syndromes that may mimic spinal stenosis include:
a. low back strain
b. lumbar bursitis and lumbar fibromyositis
c. inflammatory arthritis of the lumbosacral spine
d. disorders of the lumbar spinal cord, roots, plexus,
and nerves including diabetic femoral neuropathy
e. all of the above

361. E

362

362. Pain syndromes that may mimic arachnoiditis include:
a. tumors of the spinal cord
b. infection involving the meninges or contents of the
spinal canal
c. disorders of the lumbar spinal cord and nerve roots
d. disorders of the cervical or lumbar plexi
e. all of the above

362. E

363

363. Patients suffering from arachnoiditis will complain of:
a. pain in the distribution of the affected nerve root or
roots
b. numbness, tingling, and paresthesias in the distribution
of the affected nerve root or roots
c. weakness and lack of coordination in the affected
extremity/extremities
d. reflex changes
e. all of the above

363. E

364

364. Common extrascrotal causes of chronic orchialgia
include:
a. ureteral calculi
b. inguinal hernia
c. ilioinguinal and genitofemoral nerve entrapment
d. diseases of the lumbar spine and roots
e. all of the above

364. E

365

365. Common intrascrotal causes of chronic orchialgia
include:
a. tumor
b. chronic epididymitis
c. hydrocele
d. varicocele
e. all of the above

365. E

366

366. Common extravulva pathologic processes that can
mimic vulvadynia include:
a. malignancy involving the pelvic contents other than
the vulva
b. tumors involving the lumbar plexus, cauda equina,
and/or the hypogastric plexus
c. ilioinguinal and genitofemoral neuralgia
d. postradiation neuropathy
e. all of the above

366. E

367

367. Treatment of vulvadynia should include:
a. nonsteroidal anti-inflammatory agents
b. antidepressant compounds
c. empiric treatment of occult urinary tract and yeast
infections
d. psychological evaluations
e. all of the above

367. E

368

368. Diseases that may mimic proctalgia fugax include:
a. proctitis
b. inflammatory bowel disease
c. prostatitis and prostadynia
d. hemorrhoids
e. all of the above

368. E

369

369. Proctalgia fugax is:
a. a disease of unknown etiology
b. characterized by paroxysms of rectal pain with
pain-free periods between attacks
c. characterized, like cluster headache, by spontaneous
remissions of the disease that may last weeks to years
d. more common in females
e. all of the above

369. E

370

370. The signs and symptoms of osteitis pubis include:
a. localized tenderness over the symphysis pubis
b. pain radiating into the inner thigh
c. waddling gait
d. characteristic radiographic changes consisting of
erosion, sclerosis, and widening of the symphysis
pubis
e. all of the above

370. E

371

371. Osteitis pubis:
a. occurs more commonly in females
b. is a disease of the second to fourth decade
c. most commonly follows bladder, inguinal, or prostate
surgery and is thought to be due to hematogenous
spread of infection to the relatively avascular
symphysis pubis
d. can appear without an obvious inciting factor or
infection
e. all of the above

371. E

372

372. Piriformis syndrome is caused by compression of the:
a. sciatic nerve by the piriformis muscle
b. piriformis nerve by the piriformis muscle
c. common peroneal nerve by the piriformis muscle
d. tibial nerve by the piriformis muscle
e. none of the above

372. A

373

373. Physical findings of piriformis syndrome include:
a. tenderness over the sciatic notch
b. positive Tinel’s sign over the sciatic nerve as it passes
beneath the piriformis muscle
c. tender and swollen, indurated piriformis muscle
belly
d. weakness of affected gluteal muscles and lower
extremity and ultimately muscle wasting
e. all of the above

373. E

374

374. Initial treatment of the pain and functional disability
associated with piriformis syndrome should include:
a. a combination of nonsteroidal anti-inflammatory
drugs and physical therapy
b. the local application of heat and cold, which may
also be beneficial
c. avoidance of any repetitive activity that may exacerbate
the patient’s symptomatology
d. injection with local anesthetic and steroid in the
region of the sciatic nerve at the level of the piriformis
muscle
e. all of the above

374. E

375

375. Common causes of arthritis of the hip include:
a. osteoarthritis
b. rheumatoid arthritis
c. post-traumatic arthritis
d. all of the above
e. none of the above

375. D

376

376. Less common causes of arthritis of the hip include:
a. villonodular synovitis
b. collagen vascular diseases
c. Lyme disease
d. infections
e. all of the above

376. E

377

377. Arthritis of the hip should be treated with a multimodality
approach including:
a. nonsteroidal anti-inflammatory drugs
b. physical therapy
c. the local application of heat and cold
d. intra-articular injection of local anesthetic and steroid
e. all of the above

377. E

378

378. Femoral neuropathy may be due to compression of the
femoral nerve by a(n):
a. tumor
b. retroperitoneal hemorrhage
c. abscess
d. all of the above
e. none of the above

378. D

379

379. Other causes of femoral neuropathy include:
a. stretch injuries to the femoral nerve as it passes
under the inguinal ligament from extreme extension
or flexion at the hip
b. direct trauma to the nerve from surgery or during
cardiac catheterization
c. diabetes
d. all of the above
e. none of the above

379. D

380

380. Treatment of phantom limb pain should include:
a. nerve blocks
b. adjuvant analgesics including anticonvulsants
c. adjuvant analgesics including antidepressants
d. application of ice packs and/or transcutaneous
stimulation
e. all of the above

380. E

381

381. The patient suffering from trochanteric bursitis:
a. will frequently complain of pain in the lateral hip
that can radiate down the leg mimicking sciatica
b. will complain of pain that is localized to the area
over the greater trochanter
c. will frequently complain of sleep disturbance
d. may complain of a sharp, catching sensation with
range of motion of the hip, especially on first arising
e. all of the above

381. E

382

382. The treatment of trochanteric bursitis should include:
a. nonsteroidal anti-inflammatory drugs
b. physical therapy
c. the local application of heat and cold
d. injection of local anesthetic and steroid around the
trochanteric bursa
e. all of the above

382. E

383

383. Common causes of arthritis of the knee include:
a. osteoarthritis
b. rheumatoid arthritis
c. post-traumatic arthritis
d. all of the above
e. none of the above

383. D

384

384. Less common causes of arthritis of the knee include:
a. villonodular synovitis
b. collagen vascular diseases
c. Lyme disease
d. infections
e. all of the above

384. E

385

385. Arthritis of the knee should be treated with a multimodal
approach including:
a. nonsteroidal anti-inflammatory drugs
b. physical therapy
c. the local application of heat and cold
d. intra-articular injection of local anesthetic and steroid
e. all of the above

385. E

386

386. On physical examination, the patient suffering from
Baker’s cyst:
a. will have a cystic swelling in the medial aspect of the
popliteal fossa (Baker’s cysts can become quite large)
b. will experience an increase in symptoms when
squatting or walking
c. will experience pain that is constant and characterized
as aching in nature
d. may experience a spontaneous rupture and there
may be rubor and color in the calf that may mimic
thrombophlebitis
e. all of the above

386. E

387

*387. The incidence of Baker’s cyst is greater in patients
suffering from:
a. thyrotoxicosis
b. rheumatoid arthritis
c. prepatellar bursitis
d. all of the above
e. none of the above

387. B

388

388. The bursae of the knee are vulnerable to:
a. injury from both acute trauma and repeated
microtrauma
b. may exist as single bursal sacs or as a multisegmented
series of loculated sacs
c. acute injuries in the form of direct trauma to the
bursa via falls or blows directly to the knee or from
patellar, tibial plateau, and proximal fibular trauma
d. calcification process in chronic inflammatory disease
e. all of the above

388. E

389

389. The patient suffering from suprapatellar bursitis will
frequently complain of:
a. pain in the anterior knee above the patella
b. pain that can radiate superiorly into the distal
anterior thigh
c. the inability to kneel or walk down stairs
d. a sharp, catching sensation with range of motion of
the knee, especially on first arising
e. all of the above

389. E

390

390. Prepatellar bursitis is also known as:
a. housemaid’s knee
b. Marie-Stru¨mpell disease
c. a joint mouse
d. Dubin-Johnson-Sprint disease
e. none of the above

390. A

391

391. Treatment of bursitis of the knee should include:
a. nonsteroidal anti-inflammatory drugs
b. physical therapy
c. the local application of heat and cold
d. injection of the inflamed bursa with local anesthetic
and steroid
e. all of the above

391. E

392

392. Patients with pes anserine bursitis:
a. will present with pain over the medial knee joint
b. have increased pain on passive valgus and external
rotation of the knee
c. will complain that activity, especially involving flexion
and external rotation of the knee will make the
pain worse
d. will note that rest and heat provide some relief
e. all of the above

392. E

393

393. Anterior tarsal tunnel syndrome presents with:
a. pain, numbness, and paresthesias of the dorsum of
the foot
b. pain that radiates into the first dorsal web space
c. pain that may also radiate proximal to the entrapment
into the anterior ankle
d. nighttime foot pain analogous to the nocturnal pain
of carpal tunnel syndrome
e. all of the above

393. E

394

394. Anterior tarsal tunnel syndrome is caused by compression
of the:
a. deep peroneal nerve as it passes beneath the superficial
fascia of the ankle
b. tibial nerve as it passes beneath the superficial fascia
of the ankle
c. superficial peroneal nerve as it passes beneath the
superficial fascia of the ankle
d. sural nerve as it passes beneath the superficial fascia
of the ankle
e. none of the above

394. A

395

395. Common causes of anterior tarsal tunnel syndrome
include:
a. direct trauma to the deep peroneal nerve as it passes
beneath the superficial fascia of the ankle
b. severe, acute plantar flexion of the ankle
c. the wearing of overly tight shoes
d. squatting and bending forward
e. all of the above

395. E

396

396. Posterior tarsal tunnel syndrome presents with:
a. pain, numbness, and paresthesias of the sole of the foot
b. weakness of the toe flexors and instability of the foot
due to weakness of the lumbrical muscles
c. nighttime foot pain analogous to the nocturnal pain
of carpal tunnel syndrome
d. all of the above
e. none of the above

396. D

397

397. Posterior tarsal tunnel syndrome is caused by compression
of the:
a. deep peroneal nerve as it passes beneath the superficial
fascia of the ankle
b. posterior tibial nerve as it passes through the posterior
tarsal tunnel
c. superficial peroneal nerve as it passes beneath the
superficial fascia of the ankle
d. sural nerve as it passes beneath the superficial fascia
of the ankle
e. none of the above

397. B

398

398. Common causes of posterior tarsal tunnel syndrome
include:
a. direct trauma to the posterior nerve as it passes
through the posterior tarsal tunnel
b. thrombophlebitis involving the posterior tibial
artery
c. rheumatoid arthritis
d. all of the above
e. none of the above

398. D

399

399. Treatment of Achilles tendinitis should include:
a. nonsteroidal anti-inflammatory agents
b. injection of the tendon with local anesthetic and
steroid
c. use of heat and cold
d. avoidance of repetitive activities responsible for the
evolution of the tendinitis
e. all of the above

399. E

400

400. Causes of Achilles tendinitis include:
a. overuse or misuse of the ankle
b. activities with sudden stopping and starting
c. improper stretching of the tendon
d. all of the above
e. none of the above

400. D

401

401. The signs and symptoms associated with Achilles
tendonitis include:
a. pain in the posterior ankle
b. sleep disturbance
c. creaking or catching with movement of the tendon
d. pain with resisted plantar flexion of the foot
e. all of the above

401. E

402

402. The signs and symptoms of metarsalgia include:
a. pain that can be reproduced by pressure on the
metatarsal heads
b. callus formation over the heads of the second and
third metatarsal heads
c. an antalgic gait
d. ligamentous laxity and flattening of the transverse
arch giving the foot a splayed-out appearance
e. all of the above

402. E

403

403. Other pathologic processes that may mimic metatarsalgia
include:
a. gout
b. occult fractures of the metatarsals
c. tumors of the metatarsals
d. sesamoiditis
e. all of the above

403. E

404

404. The signs and symptoms of plantar fasciitis include:
a. foot pain that is most severe upon first walking after
non–weight bearing
b. pain that is made worse by prolonged standing or
walking
c. point tenderness over the plantar medial calcaneal
tuberosity
d. pain that is increased by dorsiflexing the toes, which
pulls the plantar fascia taut, and then palpating along
the fascia from the heel to the forefoot
e. all of the above

404. E

405

405. Plantar fasciitis:
a. is characterized by pain and tenderness over the
plantar surface of the calcaneus
b. occurs twice as commonly in women
c. can be part of a systemic inflammatory condition such
as rheumatoid arthritis, Reiter’s syndrome, or gout
d. can be associated with obesity and/or going barefoot
or wearing house shoes
e. all of the above

405. E

406

406. Treatment of plantar fasciitis should include:
a. nonsteroidal anti-inflammatory drugs
b. wearing shoes that provide good support
c. the local application of heat and cold
d. injection of the inflamed fascia with local anesthetic
and steroid
e. all of the above

406. E

407

407. Complex regional pain syndrome (CRPS):
a. is divided into two types: CRPS I and CRPS II
b. occurs more commonly in females
c. has a peak occurrence in the fourth and fifth decades
d. all of the above
e. none of the above

407. D

408

408. Both CRPS type I and type II share a unique constellation
of signs and symptoms including:
a. allodynia and hyperalgesia
b. spontaneous pain hyperalgesia
c. autonomic dysfunction including sudomotor and
vasomotor changes
d. edema and trophic changes
e. all of the above

408. E

409

409. Treatments useful in the management of CRPS include:
a. sympathetic nerve blocks
b. spinal cord stimulation
c. gabapentin
d. antidepressants
e. all of the above

409. E

410

410. Abnormalities on three-phase radionuclide bone scanning
include:
a. a homogeneous unilateral hyperperfusion in the
affected body part at 30 seconds post-injection
during the perfusion phase
b. a homogeneous unilateral hyperperfusion in the affected
body part at 2 minutes during the blood pool phase
c. most often unilateral periarticular isotope uptake
during the mineralization phase that is scanned at
3 hours post-injection
d. all of the above
e. none of the above

410. D

411

411. Rheumatoid arthritis:
a. is the most common of the connective tissue
diseases
b. has a cause that is unknown
c. can occur at any age, with the juvenile variant
termed Still’s disease
d. affects women 2.5 times more often than men
e. all of the above

411. E

412

412. The first symptoms of rheumatoid arthritis include:
a. easy fatigability
b. malaise
c. myalgias
d. anorexia and generalized weakness
e. all of the above

412. E

413

413. Other early symptoms of rheumatoid arthritis include:
a. ill-defined morning stiffness
b. symmetrical joint pain with color
c. tenosynovitis
d. fusiform joint effusions
e. all of the above

413. E

414

414. The most common joints affected in patients suffering
from rheumatoid arthritis include the:
a. wrists
b. knees
c. fingers
d. bones of the feet
e. all of the above

414. E

415

415. The classic joint deformity associated with rheumatoid
arthritis is:
a. ulnar drift
b. radial drift
c. gibbus formation
d. Legg-Perthes deformity
e. none of the above

415. A

416

416. Extra-articular manifestations associated with rheumatoid
arthritis include:
a. carpal tunnel syndrome
b. Baker’s cysts
c. uveitis and iritis
d. rheumatoid nodules
e. all of the above

416. E

417

417. Treatment of rheumatoid arthritis should include:
a. nonsteroidal anti-inflammatory agents
b. corticosteroids
c. nighttime splinting
d. joint protection
e. all of the above

417. E

418

418. Disease-modifying drugs that are useful in the treatment
of rheumatoid arthritis include:
a. methotrexate
b. gold
c. penicillamine
d. sulfasalazine
e. all of the above

418. E

419

419. Laboratory findings commonly seen in patients suffering
from rheumatoid arthritis include a(n):
a. normocytic normochromic anemia
b. elevated erythrocyte sedimentation rate
c. elevated RF agglutination factor
d. elevated C-reactive protein
e. all of the above

419. E

420

420. The signs and symptoms of systemic lupus erythematosus
include:
a. polyarthritis
b. butterfly rash
c. focal alopecia
d. mouth ulcers
e. all of the above

420. E

421

421. Common extra-articular manifestations of systemic
lupus erythematosus include:
a. vasculitis
b. pleuritis and pneumonitis
c. myocarditis, endocarditis, and pericarditis
d. glomerulonephritis and hepatitis
e. all of the above

421. E

422

422. Hematologic side effects of systemic lupus erythematosus
include
a. pancytopenia
b. thrombocytopenia
c. leukopenia
d. hypercoagulable state
e. all of the above

422. E

423

423. The laboratory test that is highly diagnostic for systemic
lupus erythematosus is:
a. highly elevated C-reactive protein
b. presence of high levels of antinuclear antibody
c. inversion of the SGOT/SGPT ratio
d. all of the above
e. none of the above

423. B

424

424. Scleroderma–systemic sclerosis is a disease of unknown
etiology that is characterized by:
a. diffuse fibrosis of the skin and connective tissue
b. vascular damage
c. arthritis
d. abnormalities of the esophagus, gastrointestinal
tract, kidneys, heart, and lungs
e. all of the above

424. E

425

425. Facts about scleroderma–systemic sclerosis include
that:
a. the severity and course of the disease varies widely
from patient to patient
b. scleroderma is 4 times more common in women
than in men
c. its onset is rare before the age of 30 or after the age
of 50
d. exposure to contaminated cooking oils, polyvinyl
chloride, and silica has also been implicated as a
risk factor for the development of scleroderma
e. all of the above

425. E

426

426. The initial complaints of patients suffering from
scleroderma include:
a. pain or deformity associated with swelling and loss
of range of motion of the digits (sclerodactyly)
b. associated Raynaud’s phenomenon
c. polyarthralgias and dysphagia
d. cutaneous fibrosis
e. all of the above

426. E

427

CREST syndrome, a variant of scleroderma–systemic
sclerosis, is characterized by:
a. calcinosis
b. Raynaud’s phenomenon
c. esophageal dysfunction
d. sclerodactyly and telangiectasia
e. all of the above

427. E

428

428. Facts about polymyositis include:
a. polymyositis is less common than rheumatoid arthritis,
systemic lupus erythematosus, or scleroderma
b. the disease is characterized by muscle inflammation
that progresses to degenerative muscle disease and
atrophy
c. there are many variants of polymyositis, including
dermatomyositis, which is, from a clinical viewpoint,
simply polymyositis with significant cutaneous
manifestations
d. polymyositis affects women twice as frequently as men
e. all of the above

428. E

429

429. Polymyositis is associated with an increased incidence of:
a. occult malignancy
b. childhood febrile exanthema
c. exposure tomercury-containing vaccines in childhood
d. all of the above
e. none of the above

429. A

430

430. Signs and symptoms associated with the onset of
polymyositis include:
a. rash
b. muscle weakness, which is generally the presenting
symptom with the proximal muscle groups generally
affected initially more commonly that the distal
muscle groups
c. myalgias and polyarthralgias
d. febrile illness resembling a viral infection
e. all of the above

430. E

431

431. The following sign is pathognomonic for dermatomyositis:
a. Schacher’s lines
b. butterfly rash
c. heliotrope periorbital blush
d. Cullen’s sign
e. none of the above

431. C

432

432. Immunosuppressive drugs useful in treatment of
polymyositis include:
a. methotrexate
b. cyclosporine
c. azathioprine
d. cyclophosphamide
e. all of the above

432. E

433

433. Polymyalgia rheumatica is connective tissue disease of
unknown etiology that:
a. occurs primarily in patients over 60 years of age
b. occurs in females twice as commonly as males
c. may be associated with temporal arteritis
d. is associated with little proximal muscle weakness
e. all of the above

433. E

434

434. Polymyalgia rheumatica is characterized by a constellation
of musculoskeletal symptoms that include:
a. deep, aching pain of the cervical, pectoral and
pelvic regions
b. morning stiffness
c. arthralgias
d. stiffness after inactivity (gelling phenomenon)
e. all of the above

434. E

435

435. Constitutional symptoms associated with polymyalgia
rheumatica include:
a. malaise
b. fever
c. anorexia
d. weight loss and depression
e. all of the above

435. E

436

436. Common causes of central pain include:
a. thalamic infarcts and hemorrhage
b. vascular malformations, infarcts, and hemorrhage of
the brain and brainstem
c. traumatic brain injury
d. brain tumors
e. all of the above

436. E

437

437. The portion of the thalamus that is most often
associated with central pain is the:
a. ventroposterior portion
b. ventroanterior portion
c. lateroposterior portion
d. anteriocaudal portion
e. all of the above

437. A

438

438. Common causes of central pain include:
a. multiple sclerosis
b. infections and inflammation of the spinal cord
c. syringomyelia
d. spinal cord tumors
e. all of the above

438. E

439

439. Generally accepted pharmacologic treatments for
central pain include:
a. antidepressants and neuroleptics
b. anticonvulsants
c. analgesics
d. local anesthetics and antiarrhythmics
e. all of the above

439. E

440

440. Generally accepted invasive treatments for central pain
include:
a. spinal cord stimulations
b. deep brain stimulation and surface motor area
cortex stimulation
c. cordotomy
d. dorsal root entry lesioning
e. all of the above

440. E

441

441. Signs and symptoms frequently associated with conversion
disorder include:
a. weakness
b. involuntary motor movements
c. sensory disturbances
d. pseudoseizures
e. all of the above

441. E

442

442. Signs and symptoms frequently associated with conversion
disorder include:
a. blindness
b. deafness
c. aphonia
d. la belle indiffe´rence
e. all of the above

442. E

443

443. La belle indifference:
a. is an inappropriate lack of concern for the impact
and severity of somatic symptomatology associated
with conversion disorder
b. is associated with the complete denial of any psychological
problems associated with the somatic difficulties
of a conversion disorder
c. can occur with organic based neurologic disorders
d. all of the above
e. none of the above

443. D

444

444. Conversion disorder is classified as a(n):
a. somatiform disorder
b. anxiety neurosis
c. depressive neurosis
d. all of the above
e. none of the above

444. A

445

445. The somatic symptoms associated with a conversion
disorder are:
a. under the voluntary control of the patient
b. under the involuntary control of the patient
c. due to an organic lesion or disease
d. all of the above
e. none of the above

445. B

446

446. Patients suffering from Munchausen syndrome:
a. are conscious of their confabulations
b. are not conscious of their confabulations
c. often have associated personality disorders
d. a and b
e. a and c

446. E

447

447. Patients suffering from Munchausen syndrome:
a. receive no obvious primary gain
b. receive no obvious secondary gain
c. often create fictitious illness to produce real signs
and symptoms
d. know they are lying
e. all of the above

447. E

448

448. Management of thermal injuries should include:
a. an assessment of the classification of thermal injury
b. an assessment of the amount of body surface
affected by second-degree burns
c. cleansing of the wound
d. de´bridement of nonviable tissue
e. all of the above

448. E

449

449. Fluid replacement is required with more serious burns
and is guided by:
a. the Parkland formula
b. urine output
c. vital signs
d. all of the above
e. none of the above

449. D

450

450. Types of electrical injuries include:
a. low-voltage injuries
b. high-voltage injuries
c. lightning injuries
d. all of the above
e. a and b

450. D

451

451. The pathognomonic cutaneous sign associated with
lightning injuries is known as the:
a. Lichtenberg figure
b. Sturge-Weber sign
c. vericolor rubor sign
d. dermatographia sign
e. none of the above

451. A

452

452. Tissues that have a high degree of electrical conductivity
include:
a. nerves
b. arteries
c. veins
d. all of the above
e. none of the above

452. D

453

453. Signs and symptoms associated with post-polio syndrome
include:
a. new asymmetrical muscle weakness in muscles that
were not affected by the original infection
b. new muscle atrophy
c. myalgias
d. arthralgias
e. all of the above

453. E

454

454. Signs and symptoms associated with post-polio syndrome
include:
a. generalized fatigue
b. difficulty breathing and swallowing
c. centrally mediated sleep disorders
d. decreased tolerance to cold ambient temperatures
e. all of the above

454. E

455

455. Diseases that may mimic post-polio syndrome include:
a. amyotrophic lateral sclerosis
b. cervical myelopathy
c. inflammatory myopathies
d. hypothyroidism
e. all of the above

455. E

456

456. Multiple sclerosis:
a. is more common in women
b. rarely occurs before the age of 20
c. occurs more commonly in Caucasians
d. all of the above
e. none of the above

456. D

457

457. Multiple sclerosis occurs more commonly in:
a. tropical climates
b. temperate climates
c. the Western Hemisphere
d. a and b
e. b and c

457. E

458

458. The classic pathologic lesion associated with multiple
sclerosis is the:
a. bullous pemphigoid
b. plaque
c. Golgi body
d. Charcot-Leyden crystal
e. None of the above

458. B

459

459. The following will exacerbate the symptoms of multiple
sclerosis:
a. a hot meal
b. vigorous exercise
c. a hot bath
d. all of the above
e. none of the above

459. D

460

460. The most common clinical presentations of multiple
sclerosis include:
a. optic neuritis
b. transverse myelitis
c. internuclear ophthalmoplegia
d. pain and paresthesias
e. all of the above

460. E

461

461. Tissues commonly affected by multiple sclerosis include
the:
a. optic nerve
b. periventricular white matter of the cerebellum
c. brainstem and the basal ganglia
d. spinal cord
e. all of the above

461. E

462

462. A hallmark physical finding of acute classic Guillain-
Barre´ syndrome is:
a. areflexia
b. hyperreflexia
c. increased cremasteric reflex
d. increased light reflex
e. none of the above

462. A

463

463. Diseases that may mimic acute classic Guillain-Barre´
syndrome include:
a. multiple sclerosis
b. heavy metal poisoning
c. organophosphate poisoning
d. inflammatory muscle disease
e. all of the above

463. E

464

464. Diagnostic tests that may help confirm acute classic
Guillain-Barre´ syndrome include:
a. spinal fluid protein
b. spinal fluid cell count
c. gadolinium-enhanced MRI of the spinal nerves
d. all of the above
e. none of the above

464. D

465

465. Complications associated with acute classic Guillain-
Barre´ syndrome include:
a. thrombophlebitis
b. respiratory insufficiency
c. cardiac arrhythmias
d. autonomic dysfunction
e. all of the above

465. E

466

466. Sickle cell disease is most common in people whose
ancestors hail from:
a. sub-Saharan Africa
b. the Mediterranean
c. India
d. the Middle East
e. all of the above

466. E

467

467. Sickle cell disease is caused by:
a. a hemoglobinopathy
b. renal abnormalities
c. a disorder of porphyrin metabolism
d. all of the above
e. none of the above

467. A

468

468. Complications associated with sickle cell disease
include:
a. vaso-occlusive crises
b. splenic sequestration syndrome
c. aplastic crises
d. autosplenectomy
e. all of the above

468. E

469

469. Treatment of sickle cell disease includes:
a. palliation of mild to moderate pain with nonsteroidal
anti-inflammatory agents
b. palliation of severe pain with opioid analgesics
c. oxygen
d. zinc and hydroxyurea
e. all of the above

469. E

470

470. Dependence:
a. is defined as a physiologic state where continued
intake of a substance is required to maintain
homeostasis
b. is frequently confused with addiction
c. can be caused by drugs that are not traditionally associated
with addiction, e.g., antihypertensives, antidepressants,
beta-blockers, etc.
d. can be divided into physiologic and psychological
subsets
e. all of the above

470. E

471

471. Tolerance:
a. is a physiologic phenomenon in which the organism
adapts to the effects of the drug and over time
there is a diminution of one or more of the drug’s
actions
b. of the drug’s actions can be limited to its beneficial
therapeutic effects
c. can affect only the side effects of a drug
d. can affect both the beneficial therapeutic effects and
the side effects of a drug
e. all of the above

471. E

472

472. Centers thought to involved in the phenomenon of
addiction include the:
a. mesolimbic pathway
b. ventral trigeminal area of the midbrain
c. prefrontal cortex
d. nucleus accumbens
e. all of the above

472. E

473

473. The neurotransmitter(s) thought to be most involved in
the phenomenon of addiction include(s):
a. dopamine
b. MDMA
c. acetylcholine
d. all of the above
e. none of the above

473. A

474

474. The placebo response is:
a. the patient’s psychological and behavioral response
of analgesia following the administration of the sham
treatment
b. patient’s psychological and behavioral response
of pain following administration of the sham
treatment
c. present in 75% of patients given a sham treatment
d. a and c
e. b and c

474. A

475

475. The placebo response may be influenced by the:
a. normal waxing and waning of the patient’s perception
of pain
b. patient’s interaction with the practitioner administering
the placebo
c. patient’s expectancy of pain relief
d. all of the above
e. none of the above

475. D

476

476. The nocebo response is the term applied to the:
a. patient’s psychological and behavioral response of
analgesia following the administration of the sham
treatment
b. patient’s psychological and behavioral response of
pain following the administration of the sham
treatment
c. patient’s expectancy of pain relief
d. all of the above
e. none of the above

476. B

477

477. The x-ray cassette is made up of:
a. a light tight structure
b. a radiolucent panel that admits x-ray photons
c. two image-intensifying panels that lie against each
side of the film
d. a Mylar sheet coated on each side with a silver halide
emulsion
e. all of the above

477. E

478

478. The major form of energy conversion in the typical x-ray
vacuum tube is:
a. x-ray photons
b. heat
c. gamma rays
d. visible light on the blue end of the spectrum
e. none of the above

478. B

479

479. The tissue with the highest density to x-ray photons is:
a. bone
b. muscle
c. fat
d. arteries
e. none of the above

479. A

480

480. Commonly used intravenous radionuclides include:
a. gallium-67
b. iodine-123
c. indium-111
d. iodine-131
e. all of the above

480. E

481

481. The substance that carries a radionuclide to a specific
tissue is called a:
a. SPECT scan
b. gamma particle
c. tracer
d. beta particle
e. none of the above

481. C

482

482. Routes of administration of radiopharmaceuticals commonly
used in clinical medicine include:
a. intravenous
b. inhalation
c. oral
d. all of the above
e. none of the above

482. D

483

483. The radiodensities of body tissues are assigned a
number representing their relative x-ray photon attenuation
value known as:
a. pixels
b. Hounsfield units
c. voxels
d. gray scale atomic number
e. none of the above

483. B

484

484. Processing of the data acquired during a CT scan is
accomplished in part by dividing each area of a given
CT slice into small volumetric areas known as:
a. pixels
b. Hounsfield units
c. voxels
d. gray scale atomic number
e. none of the above

484. C

485

485. Tissues that are more radiodense such as bone are by
convention represented on a digital CT image as:
a. white
b. black
c. gray
d. all of the above
e. none of the above

485. A

486

486. The paramagnetic contrast agent gadolinium should be
used with caution in patients with:
a. brain tumors
b. seizures
c. renal failure
d. malignancies of the hemopoietic system
e. none of the above

486. E

487

487. MRI relies on _____________ to produce clinically useful
images.
a. x-ray photons
b. the release of energy from hydrogen protons
c. gamma rays
d. ionizing radiation
e. none of the above

487. B

488

488. Complications of discography include:
a. discitis
b. epidural abscess
c. trauma to neural structures
d. pneumothorax
e. all of the above

488. E

489

489. Indications for discography include:
a. the diagnosis of discogenic pain
b. the identification of the disc responsible for a
patient’s pain in the setting of normal or equivocal
imaging studies
c. an aid to help determine which spinal levels need to
be fused
d. all of the above
e. none of the above

489. D

490

490. Symptoms associated with myopathy include:
a. symmetrical proximal muscle weakness
b. fever
c. muscle aches
d. a normal sensory examination
e. all of the above

490. E

491

491. Diseases associated with myopathy include:
a. polymyositis
b. acute alcohol intoxication
c. hypothyroidism
d. Cushing disease
e. all of the above

491. E

492

492. Diseases associated with peripheral neuropathy
include:
a. diabetes
b. renal disease
c. autoimmune diseases
d. HIV/AIDS
e. all of the above

492. E

493

493. The classic finding on nerve conduction studies in
patients suffering from moderately severe peripheral
neuropathy is:
a. slowing of the nerve conduction velocity
b. enhancement of the nerve conduction velocity
c. a Kondrake phenomenon with repetitive stimulation
d. all of the above
e. none of the above

493. A

494

494. Causes of plexopathy include:
a. idiopathic inflammatory plexitis
b. tumor
c. hematoma and abscess
d. trauma
e. all of the above

494. E

495

495. Visual evoked potentials are useful in the diagnosis of:
a. multiple sclerosis
b. abnormalities of the optic nerve
c. inflammatory conditions of the eye and ocular
pathways
d. tumors involving the eye and ocular pathways
e. all of the above

495. E

496

496. Brainstem auditory evoked potentials are useful in the
diagnosis of:
a. multiple sclerosis
b. acoustic neuromas
c. cerebellopontine angle tumors
d. strokes involving the auditory pathways
e. all of the above

496. E

497

497. Somatosensory evoked potentials are useful in the
diagnosis of:
a. syringomyelia
b. spinal cord tumors
c. multiple sclerosis
d. Huntington’s chorea
e. all of the above

497. E

498

498. Evoked potential testing:
a. is a neurophysiologic test similar to electromyography
b. uses a recording electrode placed on the scalp in a
manner analogous to electroencephalography
c. uses a computer to average ‘‘time-locked’’ signals and
cancel out noise
d. all of the above
e. none of the above

498. D

499

499. The peak of greatest interest in visual evoked potential
testing is called the:
a. P100 peak
b. P200 peak
c. P300 peak
d. peak of inverse latency
e. a and d

499. A

500

500. Examples of unidimensional pain assessment tools that
are useful in the evaluation of adult patients in pain
include the:
a. visual analog scale
b. numerical pain intensity scale
c. verbal descriptor scale
d. all of the above
e. none of the above

500. D

501

501. Examples of multidimensional pain assessment tools
that are useful in the evaluation of adult patients in
pain include the:
a. McGill Pain Questionnaire
b. Brief Pain Inventory
c. Memorial Pain Assessment Card
d. Multidimensional Affect and Pain Survey
e. all of the above

501. E

502

502. Examples of pain assessment tools that are useful in the
evaluation of pain in children include:
a. CRIES
b. COMFORT
c. Wong-Baker Faces Scale
d. Oucher Scale
e. all of the above

502. E

503

503. The atlanto-occipital joint:
a. is not a true joint
b. allows the head to nod forward and backward with an
isolated range of motion of approximately 35 degrees
c. is located anterior to the posterolateral columns of
the spinal cord
d. all of the above
e. none of the above

503. D

504

504. Complications associated with atlanto-occipital block
include:
a. needle-induced trauma to the brainstem
b. ataxia due to vascular absorption
c. seizures secondary to intravascular injection
d. all of the above
e. none of the above

504. D

505

505. The atlantoaxial joint:
a. is not a true joint
b. allows the head to flex and extend approximately
10 degrees, but it allows more than 60 degrees of
rotation in the horizontal plane
c. relies almost entirely on ligaments for its integrity
d. all of the above
e. none of the above

505. D

506

506. Complications associated with atlantoaxial block
include:
a. needle-induced trauma to the brainstem
b. ataxia due to vascular absorption
c. seizures secondary to intravascular injection
d. all of the above
e. none of the above

506. D

507

507. Complications associated with sphenopalatine ganglion
block include:
a. epistaxis
b. orthostatic hypotension
c. intravascular injection
d. inadvertent blockade of the maxillary nerve when
performing the lateral approach
e. all of the above

507. E

508

508. Other names for the sphenopalatine ganglion include:
a. Meckel’s ganglion
b. gasserian ganglion
c. pterygopalatine ganglion
d. a and c
e. all of the above

508. D

509

509. Complications associated with greater and lesser
occipital nerve block include:
a. trauma to the occipital artery
b. needle placement into the foramen magnum
c. intravascular injection
d. all of the above
e. none of the above

509. D

510

510. Useful landmarks for the performance of greater and
lesser occipital nerve block include the:
a. nuchal ridge
b. supraorbital foramen
c. occipital artery
d. a and c
e. all of the above

510. D

511

511. The sensory branches of the gasserian ganglion include the:
a. ophthalmic branch
b. maxillary branch
c. mandibular branch
d. all of the above
e. none of the above

511. D

512

512. Access to the gasserian ganglion is via the:
a. foramen ovale
b. foramen rotundum
c. maxillary foramen
d. pterygopalatine foramen
e. none of the above

512. A

513

513. Complications and side effects of gasserian ganglion
block include:
a. corneal anesthesia
b. subscleral hematoma formation
c. subarachnoid injection
d. damage to arteries
e. all of the above

513. E

514

514. A dreaded complication of destruction of the gasserian
ganglion is:
a. anesthesia phlegmosa
b. prolonged anesthesia
c. anesthesia dolorosa
d. all of the above
e. none of the above

514. C

515

515. Methods that can be used to destroy the gasserian
ganglion include:
a. neurolytic injections with phenol
b. neurolytic injections with glycerol
c. balloon compression of the ganglion
d. radiofrequency lesioning
e. all of the above

515. E

516

516. Complications and side effects of trigeminal nerve
block via the coronoid include:
a. intravascular uptake of local anesthetic
b. hematoma formation
c. weakness of the masseter muscles
d. facial asymmetry due to loss of proprioception
e. all of the above

516. E

517

517. The following branches of the trigeminal nerve have
motor and sensory function:
a. ophthalmic nerve
b. maxillary nerve
c. mandibular nerve
d. b and c
e. none of the above

517. C

518

518. The supraorbital nerve:
a. arises from fibers of the frontal nerve
b. is a terminal branch of the ophthalmic division of the
trigeminal nerve
c. sends fibers all the way to the vertex of the scalp and
provides sensory innervation to the forehead, upper
eyelid, and anterior scalp
d. all of the above
e. none of the above

518. D

519

519. The supraorbital nerve:
a. arises from fibers of the frontal nerve
b. is a terminal branch of the ophthalmic division of the
trigeminal nerve
c. provides sensory innervation to the inferomedial
section of the forehead, the bridge of the nose, and
the medial portion of the upper eyelid
d. all of the above
e. none of the above

519. E

520

520. Complications of infraorbital nerve block include:
a. compression or trauma of the infraorbital nerve
if the needle enters the infraorbital foramen
b. hematoma
c. intravascular injection
d. all of the above
e. none of the above

520. D

521

521. The mental nerve:
a. arises from fibers of the mandibular nerve
b. exits the mandible via the mental foramen at the
level of the second premolar, where it makes a
sharp turn superiorly
c. provides cutaneous branches that innervate the
lower lip, chin, and corresponding oral mucosa
d. all of the above
e. none of the above

521. D

522

522. The muscles involved in temporomandibular joint
dysfunction often include the:
a. temporalis
b. masseter
c. external pterygoid
d. internal pterygoid
e. all of the above

522. E

523

523. When injecting the temporomandibular joint, if the
needle is placed through the joint, the following nerve
may be blocked:
a. trigeminal nerve
b. facial nerve
c. spinal accessory nerve
d. hypoglossal nerve
e. none of the above

523. B

524

524. The key landmark for extraoral glossopharyngeal nerve
block is the:
a. coronoid notch
b. vomer
c. styloid process of the temporal bone
d. temporomandibular joint
e. none of the above

524. C

525

525. Complications of glossopharyngeal nerve block include:
a. intravascular injection
b. trauma to the internal jugular vein
c. trauma to the carotid artery
d. inadvertent vagal nerve block
e. all of the above

525. E

526

526. The vagus nerve:
a. contains both motor and sensory fibers
b. contains motor fibers that innervate the pharyngeal
muscle and provide fibers for the superior and
recurrent laryngeal nerves
c. contains sensory fibers that innervate the dura mater
of the posterior fossa, the posterior aspect of the external auditory meatus, the inferior aspect of the
tympanic membrane, and the mucosa of the larynx
below the vocal cords
d. provides fibers to the intrathoracic contents, including
the heart, lungs, and major vasculature
e. all of the above

526. E

527

527. The major complication associated with vagus nerve
block:
a. is related to trauma to the internal jugular vein and
carotid artery including hematoma formation
b. includes intravascular injection of local anesthetic
c. includes blockade of the motor portion of the vagus
nerve that can result in dysphonia and difficulty
coughing due to blockade of the superior and recurrent
laryngeal nerves
d. includes a reflex tachycardia secondary to vagal
nerve block
e. all of the above

527. E

528

528. The spinal accessory nerve:
a. arises from the nucleus ambiguus
b. has two roots, which leave the cranium together
along with the vagus nerve via the jugular
foramen
c. has fibers of the spinal root pass inferiorly and posteriorly
to provide motor innervation to the superior
portion of the sternocleidomastoid muscle
d. provides, in combination with the cervical plexus,
innervation to the trapezius muscle
e. all of the above

528. E

529

529. Complications of spinal accessory nerve block include:
a. inadvertent subdural, epidural, or surbarachnoid
block
b. inadvertent block of the recurrent laryngeal nerve
c. inadvertent block of the glossopharyngeal nerve
d. hematoma and ecchymosis
e. all of the above

529. E

530

530. The phrenic nerve:
a. arises from fibers of the primary ventral ramus of the
fourth cervical nerve, with contributions from the
third and fifth cervical nerves
b. exits the root of the neck between the subclavian
artery and vein to enter the mediastinum
c. on the right follows the course of the vena cava to
provide motor innervation to the right hemidiaphragm
d. on the left descends to provide motor innervation to
the left hemidiaphragm in a course parallel to that of
the vagus nerve
e. all of the above

530. E

531

531. Complications of phrenic nerve block include:
a. inadvertent subdural, epidural, or surbarachnoid
block
b. inadvertent block of the recurrent laryngeal nerve
c. respiratory embarrassment in the presence of respiratory
disease
d. hematoma and ecchymosis
e. all of the above

531. E

532

532. The facial nerve:
a. provides both motor and sensory fibers to the head
b. arises from the brainstem at the inferior margin of
the pons with the sensory portion of the facial nerve
c. exits the base of the skull via the stylomastoid
foramen
d. passes downward and then turns forward to pass
through the parotid gland, where it divides into
fibers that provide innervation to the muscles of
facial expression
e. all of the above

532. E

533

533. As it leaves the pons, the nervus intermedius is susceptible
to compression producing a ‘‘trigeminal neuralgia–
like’’ syndrome called:
a. geniculate neuralgia
b. vidian neuralgia
c. Sluder’s neuralgia
d. Morton’s neuralgia
e. none of the above

533. A

534

534. The superficial cervical plexus:
a. arises from fibers of the primary ventral rami of the
first, second, third, and fourth cervical nerves with
each nerve dividing into an ascending and a descending
branch providing fibers to the nerves
above and below, respectively
b. provides both sensory and motor innervation
c. has as its most important motor branch the phrenic
nerve, with the plexus also providing motor fibers to
the spinal accessory nerve and to the paravertebral
and deep muscles of the neck
d. provides, with the exception of the first cervical
nerve, significant cutaneous sensory innervation to
the skin of the lower mandible, neck, and supraclavicular
fossa
e. all of the above

534. E

535

535. Complications of superficial cervical plexus block include:
a. inadvertent subdural, epidural, or subarachnoid
block
b. inadvertent block of the recurrent laryngeal nerve
c. respiratory embarrassment in the presence of respiratory
disease
d. hematoma and ecchymosis
e. all of the above

535. E

536

536. The deep cervical plexus:
a. arises from fibers of the primary ventral rami of the
first, second, third, and fourth cervical nerves with
each nerve dividing into an ascending and a descending
branch providing fibers to the nerves
above and below, respectively
b. provides both sensory and motor innervation, with
its most important motor branch being the phrenic
nerve
c. also provides motor fibers to the spinal accessory
nerve and to the paravertebral and deep muscles of
the neck
d. provides significant cutaneous sensory innervation
with the terminal sensory fibers of the deep cervical plexus contributing fibers to the greater auricular
and lesser occipital nerves
e. all of the above

536. E

537

537. Complications of superficial cervical plexus block include:
a. inadvertent subdural, epidural, or subarachnoid
block
b. inadvertent block of the recurrent laryngeal nerve
c. respiratory embarrassment in the presence of respiratory
disease
d. hematoma and ecchymosis
e. all of the above

537. E

538

538. The right and left recurrent laryngeal nerves:
a. arise from the vagus nerve and follow different paths
to reach the larynx and trachea
b. on the right loops underneath the innominate artery
and then ascends in the lateral groove between the
trachea and esophagus to enter the inferior portion
of the larynx
c. on the left loops below the arch of the aorta and then
ascends in the lateral groove between the trachea and
esophagus to enter the inferior portion of the larynx
d. provide the innervation to all the intrinsic muscles of
the larynx except the cricothyroid muscle as well as
providing the sensory innervation for the mucosa
below the vocal cords
e. all of the above

538. E

539

539. Bilateral blockade of the recurrent laryngeal nerves will
result in:
a. numbness of the posterior two-thirds of the tongue
b. bilateral vocal cord paralysis
c. numbness of the larynx above the vocal cords
d. all of the above
e. none of the above

539. B

540

540. Complications and side effects of stellate ganglion block
include:
a. the development of Horner’s syndrome
b. difficulty swallowing and a feeling like there is a
lump in one’s throat
c. pneumothorax
d. intravascular injection
e. all of the above

540. E

541

541. Inadvertent block of the recurrent laryngeal nerve when
performing stellate ganglion block may cause:
a. hoarseness
b. difficulty swallowing
c. difficulty coughing
d. all of the above
e. none of the above

541. D

542

542. Inadvertent blockade of the superior cervical sympathetic
ganglion when performing stellate ganglion
block may result in:
a. contralateral vocal cord paralysis
b. ipsilateral vocal cord paralysis
c. Horner’s syndrome
d. all of the above
e. none of the above

542. C

543

543. The stellate ganglion:
a. is located on the anterior surface of the longus colli
muscle
b. lies just anterior to the transverse processes of the
seventh cervical and first thoracic vertebrae
c. is made up of the fused portion of the seventh
cervical and first thoracic sympathetic ganglia
d. all of the above
e. none of the above

543. D

544

544. The stellate ganglion:
a. lies anteromedial to the vertebral artery
b. is medial to the common carotid artery and jugular
vein
c. is lateral to the trachea and esophagus
d. all of the above
e. none of the above

544. D

545

545. Improper needle placement during stellate ganglion
block can result in:
a. inadvertent epidural injection
b. inadvertent subdural injection
c. inadvertent subarachnoid injection
d. intravascular injection
e. all of the above

545. E

546

546. Complications of radiofrequency lesioning of the stellate
ganglion include:
a. permanent damage to neuroaxial structures
b. permanent recurrent laryngeal nerve paralysis
c. pneumothorax
d. damage to the carotid artery or internal jugular vein
e. all of the above

546. E

547

547. Each facet joint:
a. receives innervation from two spinal levels
b. receives fibers from the dorsal ramus at the same
level as the vertebra as well as fibers from the
dorsal ramus of the vertebra above
c. has a dorsal ramus that provides a medial branch
that wraps around the convexity of the articular
pillar of its respective vertebra
d. has a medial branch whose location is constant for
the C4-7 nerves
e. all of the above

547. E

548

548. Complications of facet joint block include:
a. damage to the spinal cord
b. damage to the vertebral artery
c. intravascular injection
d. inadvertent subdural, epidural, or subarachnoid
block
e. all of the above

548. E

549

549. Ligamentous structures that an epidural needle will traverse
prior to entering the cervical epidural space
include the:
a. ligamentum nuchae
b. interspinous ligament
c. ligamentum flavum
d. all of the above
e. none of the above

549. D

550

550. Complications of cervical epidural nerve block include:
a. damage to the spinal cord
b. infection
c. intravascular injection
d. inadvertent subdural or subarachnoid block
e. all of the above

550. E

551

551. Cervical selective nerve root block is:
a. performed by placing the needle just outside the
neural foramina of the nerve root being blocked
b. performed in a manner analogous to the transforaminal
approach to the cervical epidural space
c. often associated with a paresthesia if the needle
impinges on the cervical nerve root being blocked
d. all of the above
e. none of the above

551. D

552

552. The brachial plexus:
a. is formed by the fusion of the anterior rami of the
C5, C6, C7, C8, and T1 spinal nerves
b. may also have a contribution of fibers from C4 and
T2 spinal nerves
c. is formed by nerves that exit the lateral aspect of the
cervical spine and pass downward and laterally in
conjunction with the subclavian artery
d. nerves and the subclavian artery run between the
anterior scalene and middle scalene muscles, passing
inferiorly behind the middle of the clavicle and above
the top of the first rib to reach the axilla
e. all of the above

552. E

553

553. Nerves from the brachial plexus that surround the axillary
artery that can be blocked when performing brachial
plexus block using the axillary approach include the:
a. median nerve
b. radial nerve
c. ulnar nerve
d. musculocutaneous nerve
e. all of the above

553. E

554

554. The suprascapular nerve:
a. is formed from fibers originating from the C5 and
C6 nerve roots of the brachial plexus with some
contribution of fibers from the C4 root in most
patients
b. passes inferiorly and posteriorly from the brachial
plexus to pass underneath the coracoclavicular ligament
through the suprascapular notch
c. is accompanied by the suprascapular artery and vein
through the suprascapular notch
d. provides much of the sensory innervation to the
shoulder joint and provides innervation to two of
the muscles of the rotator cuff, the supraspinatus
and infraspinatus muscles
e. all of the above

554. E

555

555. Complications of suprascapular nerve block include:
a. trauma to the suprascapular nerve
b. intravascular injection
c. pneumothorax
d. all of the above
e. none of the above

555. D

556

556. The radial nerve:
a. is made up of fibers from C5-T1 spinal roots
b. exits the axilla and passes between the medial and
long heads of the triceps muscle supplying a motor
branch to the triceps and gives off a number of sensory
branches to the upper arm
c. at a point between the lateral epicondyle of the
humerus and the musculospiral groove divides into
its two terminal branches with the superficial branch
continuing down the arm along with the radial artery
and provides sensory innervation to the dorsum of
the wrist and the dorsal aspects of a portion of the
thumb and index and middle fingers
d. has a deep branch that provides the majority of the
motor innervation to the extensors of the forearm
e. all of the above

556. E

557

557. The median nerve:
a. is made up of fibers from C5-T1 spinal roots
b. exits the axilla and descends into the upper arm
along with the brachial artery
c. is, at the level of the elbow, just medial to the biceps
muscle and brachial artery
d. proceeds downward into the forearm giving off
numerous branches that provide motor innervation
to the flexor muscles of the forearm
e. all of the above

557. E

558

558. The terminal branches of the median nerve provide sensory
innervation to:
a. a portion of the palmar surface of the hand
b. the palmar surface of the thumb, index and middle
fingers, and the radial portion of the ring finger
c. the distal dorsal surface of the index and middle
fingers and the radial portion of the ring finger.
d. all of the above
e. none of the above

558. D

559

559. The ulnar nerve:
a. is made up of fibers from C6-T1 spinal roots
b. exits the axilla and descends into the upper arm
along with the brachial artery.
c. courses medially at mid-arm to pass between the
olecranon process and medial epicondyle of the
humerus
d. passes between the heads of the flexor carpi ulnaris
muscle continuing downward, moving radially along
with the ulnar artery
e. all of the above

559. E

560

560. The ulnar nerve:
a. at a point approximately 1 inch proximal to the
crease of the wrist divides into the dorsal and
palmar branches
b. dorsal branch provides sensation to the ulnar aspect
of the dorsum of the hand and the dorsal aspect of
the little finger and the ulnar half of the ring finger
c. palmar branch provides sensory innervation to the
ulnar aspect of the palm of the hand and the palmar
aspect of the little finger and the ulnar half of the
ring finger
d. all of the above
e. none of the above

560. D

561

561. Ulnar nerve block at the elbow must be performed with
caution:
a. to avoid persistent paresthesia
b. because the nerve is enclosed by a dense fibrous
band as it passes through the ulnar nerve sulcus
c. because the nerve passes through a closed space and
is susceptible to compression
d. all of the above
e. none of the above

561. D

562

562. When performing radial nerve block at the wrist:
a. the needle is inserted in a perpendicular trajectory
just lateral to the flexor carpi radialis tendon
b. the needle is inserted in a perpendicular trajectory
just medial to the radial artery at the level of the
distal radial prominence
c. the needle is advanced slowly to avoid trauma to the
radial nerve
d. careful aspiration is mandatory to avoid inadvertent
intravascular injection
e. all of the above

562. E

563

563. When performing median nerve block at the wrist:
a. the needle is inserted in a perpendicular trajectory
just medial to the palmaris longus tendon
b. the needle is inserted in a perpendicular trajectory at
the crease of the wrist
c. the needle is advanced slowly to avoid trauma to the
median nerve
d. careful aspiration is mandatory to avoid inadvertent
intravascular injection
e. all of the above

563. E

564

564. When performing ulnar nerve block at the wrist:
a. the needle is inserted in a slightly caudad trajectory
on the radial side of the flexor carpi ulnaris tendon
b. the needle is inserted at the level of the styloid process
c. the needle is advanced slowly to avoid trauma to the
ulnar nerve
d. careful aspiration is mandatory to avoid inadvertent
intravascular injection
e. all of the above

564. E

565

565. The common digital nerves:
a. arise from fibers of the median and ulnar nerves with
the thumb also having a contribution from superficial
branches of the radial nerve
b. pass along the metacarpal bones and divide into the
palmar and dorsal as they reach the distal palm
c. divide as they pass along the metacarpal bones with
the palmar digital nerves supplying the majority of
sensory innervation to the fingers and running along
the ventrolateral aspect of the finger beside the digital
vein and artery
d. divide as they pass along the metacarpal bones, with
the smaller dorsal digital nerves containing fibers
from the ulnar and radial nerves and supplying the
dorsum of the fingers as far as the proximal joints
e. all of the above

565. E

566

566. Diseases that may mimic multiple sclerosis include:
a. amyotrophic lateral sclerosis
b. Guillain-Barre´ syndrome
c. small vessel cerebrovascular disease
d. central nervous system infections
e. all of the above

566. E

567

567. Side effects of intravenous regional anesthesia include:
a. phlebitis at the injection site especially with estertype
local anesthetics
b. petechial hemorrhages distal to the tourniquet in
patients taking aspirin
c. inadvertent release of large volumes of local
anesthetics due to tourniquet failure
d. all of the above
e. none of the above

567. D

568

568. Limiting factors when performing intravenous regional
anesthesia include the:
a. total amount of local anesthetic that can be safely
administered
b. size of the tourniquet utilized
c. length of time that the circulation of the extremity
can be occluded by the tourniquet
d. a and c
e. b and c

568. D

569

569. The major ligaments of the shoulder joint are the:
a. glenohumeral ligaments in front of the capsule
b. transverse humeral ligament between the humeral
tuberosities
c. coracohumeral ligament which stretches from the
coracoid process to the greater tuberosity of the
humerus
d. all of the above
e. none of the above

569. D

570

570. The cubital fossa:
a. lies in the anterior aspect of the elbow joint
b. is bounded laterally by the brachioradialis muscle
c. is bounded medially by the pronator teres
d. contains the median nerve
e. all of the above

570. E

571

571. Complications of injection of the cubital bursa
include:
a. damage to the median nerve
b. infection
c. inadvertent intravascular injection
d. all of the above
e. none of the above

571. D

572

572. The wrist joint allows:
a. flexion
b. extension
c. abduction and adduction
d. circumduction
e. all of the above

572. E

573

573. Complications of injection of the wrist joint include:
a. damage to the ulnar nerve
b. infection
c. inadvertent intravascular injection
d. all of the above
e. none of the above

573. D

574

574. The inferior radioulnar joint
a. is a synovial, pivot-type joint
b. serves as the articulation between the rounded head
of the ulna and the ulnar notch of the radius
c. allows pronation and supination of the forearm
d. is innervated primarily by the anterior and posterior
interosseous nerves
e. all of the above

574. E

575

575. The carpometacarpal joints of the fingers:
a. are synovial plane joints that serve as the articulation
between the carpals and the metacarpals
b. allow articulation of the bases of the metacarpal
bones with one another
c. have movement limited to a slight gliding motion,
with the carpometacarpal joint of the little finger
possessing the greatest range of motion
d. function primarily to optimize the grip function of
the hand
e. all of the above

575. E

576

576. The metacarpophalangeal joint:
a. is a synovial, ellipsoid-shaped joint that serves as the
articulation between the base of the proximal
phalanges and the head of its respective metacarpal
b. has as its primary role to optimize the gripping
function of the hand
c. allows flexion, extension, abduction, and adduction
d. is covered by a capsule that surrounds the entire
joint and is susceptible to trauma if the joint is
subluxed
e. all of the above

576. E

577

577. The median nerve:
a. passes beneath the flexor retinaculum
b. passes through the carpal tunnel
c. has its terminal branches providing sensory
innervation to a portion of the palmar surface of
the hand as well as the palmar surface of the
thumb, index, middle, and the radial portion of the
ring finger
d. provides sensory innervation to the distal dorsal surface
of the index and middle finger and the radial
portion of the ring finger
e. all of the above

577. E

578

578. The carpal tunnel is:
a. bounded on three sides by the carpal bones
b. covered by the transverse carpal ligament
c. the most common site of entrapment neuropathy
d. all of the above
e. none of the above

578. D

579

579. The carpal tunnel contains:
a. the median nerve
b. a number of flexor tendon sheaths
c. blood vessels
d. lymphatics
e. all of the above

579. E

580

580. Complications of injection of the carpal tunnel include:
a. infection
b. a transient increase in pain
c. trauma to the median nerve
d. inadvertent intravascular injection
e. all of the above

580. E

581

581. The ulnar tunnel is:
a. a closed space
b. bounded on one side by the pisiform and the other
side by the hook of the hamate
c. a site that is associated with entrapment neuropathy
of the ulnar nerve
d. all of the above
e. none of the above

581. D

582

582. The ulnar tunnel contains:
a. the ulnar nerve
b. the ulnar artery
c. flexor tendon sheaths
d. a and b
e. all of the above

582. D

583

583. Complications of thoracic epidural nerve block include:
a. damage to the spinal cord
b. infection
c. intravascular injection
d. inadvertent subdural or surbarachnoid block
e. all of the above

583. E

584

584. The following approach is best suited for performing
thoracic epidural block in the middle thoracic
interspaces:
a. midline approach
b. paramedian approach
c. the no-man’s land approach
d. the anterior approach
e. none of the above

584. B

585

585. Absolute contraindications to thoracic epidural block
include:
a. local infection
b. sepsis
c. anticoagulation
d. all of the above
e. none of the above

585. D

586

586. The thoracic paravertebral nerves:
a. exit their respective intervertebral foramina just
beneath the transverse process of the vertebra
b. exit the intervertebral foramen, the thoracic paravertebral
nerve gives off a recurrent branch that loops
back through the foramen to provide innervation to
the spinal ligaments, meninges, and its respective
vertebra
c. interface with the thoracic sympathetic chain via the
myelinated preganglionic fibers of the white rami
communicantes as well as the unmyelinated postganglionic
fibers of the gray rami communicantes
d. divide into a posterior and an anterior primary
division.
e. all of the above

586. E

587

587. The thoracic paravertebral nerve:
a. gives off a posterior division, courses posteriorly and,
along with its branches, provides innervation to the
facet joints and the muscles and skin of the back
b. gives off a larger, anterior division, courses laterally
to pass into the subcostal groove beneath the rib to
become the respective intercostal nerves
c. runs beneath the 12th thoracic nerve and is called
the subcostal nerve
d. all of the above
e. none of the above

587. D

588

588. When performing thoracic paravertebral block, the
following structures will be blocked:
a. the anterior division of the paravertebral nerve
b. the posterior division of the paravertebral nerve
c. the recurrent branch that loops back through the
foramen to provide innervation to the spinal
ligaments, meninges, and its respective vertebra
d. the sympathetic components of each respective
thoracic paravertebral nerve
e. all of the above

588. E

589

589. Complications of thoracic paravertebral nerve block
include:
a. pneumothorax
b. infection
c. trauma to spinal nerve roots
d. trauma to the spinal cord
e. all of the above

589. E

590

590. The thoracic facet joints are:
a. formed by the articulations of the superior and
inferior articular facets of adjacent vertebrae
b. true joints in that they are lined with synovium and
possess a true joint capsule
c. richly innervated and support the notion of the facet
joint as a pain generator
d. susceptible to arthritic changes and trauma secondary
to acceleration-deceleration injuries
e. all of the above

590. E

591

591. Each thoracic facet joint receives:
a. innervation from two spinal levels
b. fibers from the dorsal ramus at the same level as the
vertebra
c. fibers from the dorsal ramus of the vertebra above
d. all of the above
e. none of the above

591. D

592

592. Complications of thoracic paravertebral nerve block
include:
a. pneumothorax
b. infection
c. trauma to spinal nerve roots and spinal cord
d. inadvertent epidural, subdural, or subarachnoid block
e. all of the above

592. E

593

593. The preganglionic fibers of the thoracic sympathetics:
a. exit the intervertebral foramen along with the
respective thoracic paravertebral nerves
b. give off a recurrent branch that loops back
through the foramen to provide innervation to the spinal ligaments, meninges, and its respective
vertebra
c. interface with the thoracic sympathetic chain via the
myelinated preganglionic fibers of the white rami
communicantes
d. interface with the thoracic sympathetic chain via the
gray rami communicantes
e. all of the above

593. E

594

594. The preganglionic fibers of the thoracic sympathetics
provide sympathetic innervation to the:
a. vasculature
b. sweat glands
c. pilomotor muscles of the skin
d. to the cardiac plexus
e. all of the above

594. E

595

595. A typical intercostal nerve has four major branches that
include the:
a. first branch, which is the unmyelinated postganglionic
fibers of the gray rami communicantes, which
interface with the sympathetic chain
b. second branch, which is the posterior cutaneous
branch, which innervates the muscles and skin of
the paraspinal area
c. third branch, which is the lateral cutaneous division,
which arises in the anterior axillary line which provides
the majority of the cutaneous innervation of
the chest and abdominal wall
d. fourth branch, which is the anterior cutaneous
branch supplying innervation to the midline of the
chest and abdominal wall
e. all of the above

595. E

596

596. Complications of intercostal nerve block include:
a. intravascular injection
b. infection
c. pneumothorax
d. all of the above
e. none of the above

596. D

597

597. Complications of interpleural nerve block include:
a. intravascular injection
b. infection
c. pneumothorax
d. all of the above
e. none of the above

597. D

598

598. Complications of injection of the sternoclavicular joint
include:
a. intravascular injection
b. infection
c. pneumothorax
d. trauma to the great vessels
e. all of the above

598. E

599

599. The sternoclavicular joint:
a. is a double gliding joint with an actual synovial
cavity
b. provides articulation occurs between the sternal end
of the clavicle, the sternal manubrium, and the cartilage
of the first rib
c. is reinforced in front and back by the sternoclavicular
ligaments and by the costoclavicular ligament
d. is dually innervated by both the supraclavicular
nerve and the nerve supplying the subclavius muscle
e. all of the above

599. E

600

600. Posterior to the sternoclavicular joint are a number of
large arteries and veins including the:
a. left common carotid
b. brachiocephalic vein
c. right brachiocephalic artery
d. all of the above
e. none of the above

600. D

601

601. Movement at the sternoclavicular joint is provided by
the:
a. serratus anterior muscle, which produces forward
movement of the clavicle
b. rhomboid and trapezius muscles, which produce
backward movement
c. sternocleidomastoid, rhomboid, and levator scapulae,
which produce elevation of the clavicle
d. pectoralis minor and subclavius muscles, which
produce depression of the clavicle
e. all of the above

601. E

602

602. The suprascapular nerve:
a. is formed from fibers originating from the C5 and C6
nerve roots of the brachial plexus, with some contribution
of fibers from the C4 root in most patients
b. passes inferiorly and posteriorly from the brachial
plexus to pass underneath the coricoclavicular ligament
through the suprascapular notch
c. is accompanied through the notch by the suprascapular
artery
d. provides much of the sensory innervation to the
shoulder joint and provides innervation to two of
the muscles of the rotator cuff, the supraspinatus
and infraspinatus
e. all of the above

602. E

603

603. Complications of injection of the sternoclavicular joint
include:
a. intravascular injection
b. infection
c. pneumothorax
d. local anesthetic toxicity
e. all of the above

603. E

604

604. Complications associated with injection of the costosternal
joints include trauma to the:
a. lung
b. esophagus
c. trachea
d. heart
e. all of the above

604. E

605

605. The anterior cutaneous branch of the intercostal nerve:
a. pierces the fascia of the abdominal wall at the lateral
border of the rectus abdominis muscle
b. turns sharply in an anterior direction to provide
innervation to the anterior wall
c. passes through a firm fibrous ring as it pierces the
fascia, and it is at this point that the nerve is subject
to entrapment
d. is accompanied through the fascia by an epigastric
artery and vein
e. all of the above

605. E

606

606. Complications of injection of the costosternal joint
include:
a. intravascular injection
b. infection
c. pneumothorax
d. damage to the abdominal viscera
e. all of the above

606. E

607

607. Complications of splanchnic nerve block include:
a. trauma to the thoracic duct
b. trauma to the great vessels
c. pneumothorax
d. trauma to abdominal viscera
e. all of the above

607. E

608

608. Complications of splanchnic nerve block include
inadvertent:
a. epidural injection
b. subdural injection
c. subarachnoid injection
d. intravascular injection
e. all of the above

608. E

609

609. Complications of splanchnic nerve block include:
a. trauma to abdominal viscera
b. inadvertent injection into intravertebral disc
c. discitis
d. damage to the kidney and ureter
e. all of the above

609. E

610

610. If the needle is placed too anterior when performing
splanchnic nerve block:
a. the tip may rest in the precrural space
b. the splanchnic nerves may not be blocked
c. trauma to the abdominal viscera may occur
d. all of the above
e. none of the above

610. D

611

611. Contraindications to celiac plexus block include:
a. coagulopathy
b. patients on anticoagulants
c. local infection
d. all of the above
e. none of the above

611. D

612

612. Side effects of celiac plexus block include:
a. hypotension
b. increased bowel motility
c. diarrhea
d. all of the above
e. none of the above

612. D

613

613. The major preganglionic innervation of the celiac plexus
arises from the:
a. lesser splanchnic nerve
b. least splanchnic nerve
c. greater splanchnic nerve
d. all of the above
e. none of the above

613. D

614

614. The celiac ganglia:
a. vary from one to five and range in diameter from 0.5
to 4.5 cm
b. lie anterior and anterolateral to the aorta.
c. located on the left are uniformly more inferior than
their right-sided counterparts by as much as a vertebral
level
d. on both the left and right lie below the level of the
celiac artery at the level of the first lumbar vertebra
e. all of the above

614. E

615

615. The celiac plexus provides innervation to the:
a. distal esophagus
b. stomach and duodenum
c. small intestine
d. ascending and proximal transverse colon
e. all of the above

615. E

616

616. The celiac plexus provides innervation to the:
a. adrenal glands
b. pancreas
c. spleen and liver
d. biliary system
e. all of the above

616. E

617

617. When performing celiac plexus block, if the needle is
placed in the retrocrural space:
a. it is more likely that the splanchnic nerves will be
blocked
b. the needle tip will be preaortic
c. it is more likely that the upper lumbar spinal nerves
will be blocked
d. a and b
e. a and c

617. E

618

618. Complications of ilioinguinal nerve block include:
a. perforation of the abdominal viscera
b. ecchymosis
c. hematoma formation
d. infection
e. all of the above

618. E

619

619. Landmarks utilized in performing ilioinguinal nerve
block include:
a. the anterior superior iliac spine
b. a point 2 inches medial from the anterior superior
iliac spine
c. a point 2 inches below a point 2 inches medial to the
anterior superior iliac spine
d. all of the above
e. none of the above

619. D

620

620. The ilioinguinal nerve provides sensory innervation to
the:
a. upper portion of the skin of the inner thigh
b. root of the penis
c. upper scrotum in men
d. mons pubis and lateral labia in women
e. all of the above

620. E

621

621. The iliohyogastric nerve provides sensory innervation to
the:
a. posterolateral gluteal region
b. the skin above the pubis
c. lower scrotum in men
d. a and b
e. b and c

621. D

622

622. The genitofemoral nerve provides innervation to the:
a. cremaster muscle
b. skin of the anterior superior femoral triangle
c. ipsilateral labia majora
d. ipsilateral mons pubis
e. all of the above

622. E

623

623. Complications associated with lumbar sympathetic ganglion
block include:
a. infection
b. discitis
c. trauma to the abdominal viscera
d. intravascular injection
e. all of the above

623. E

624

624. Placement of the needle medially when performing
lumbar sympathetic ganglion block may result in
inadvertent:
a. subarachnoid injection
b. subdural injection
c. epidural injection
d. all of the above
e. none of the above

624. D

625

625. The lumbar paravertebral nerves:
a. exit their respective intervertebral foramina just
beneath the transverse process of the vertebra
b. give off a recurrent branch that loops back
through the foramen to provide innervation to the
spinal ligaments, meninges, and its respective
vertebra
c. divide into posterior and anterior primary
divisions with the posterior division coursing posteriorly
and, along with its branches, provide innervation
to the facet joints and the muscles and skin of
the back
d. divide into a posterior and larger anterior division,
which courses laterally and inferiorly to enter the
body of the psoas muscle
e. all of the above

625. E

626

626. The lumbar plexus receives contributions from the:
a. first four lumbar paravertebral nerves
b. third through fifth sacral nerves
c. twelfth thoracic paravertebral nerve
d. a and b
e. a and c

626. E

627

627. The lumbar plexus provides innervation to the:
a. lower abdominal wall
b. groin
c. portions of the external genitalia
d. portions of the lower extremity
e. all of the above

627. E

628

628. Complications associated with lumbar facet medial
branch block include:
a. infection
b. inadvertent subdural injection
c. inadvertent subarachnoid injection
d. inadvertent epidural injection
e. all of the above

628. E

629

629. The lumbar facet joints are:
a. formed by the articulations of the superior and
inferior articular facets of adjacent vertebrae
b. true joints in that they are lined with synovium and
possess a true joint capsule
c. susceptible to arthritic changes and trauma secondary
to acceleration-deceleration injuries
d. all of the above
e. none of the above

629. D

630

630. Each lumbar facet joint:
a. receives innervation from two spinal levels
b. receives fibers from the dorsal ramus at the same
level as the vertebra as well as fibers from the
dorsal ramus of the vertebra above
c. may be blocked by either the medial branch or
intra-articular technique
d. all of the above
e. none of the above

630. D

631

631. Complications associated with the transforaminal
approach to the lumbar epidural space include:
a. trauma to the spinal cord
b. trauma to the exiting nerve root
c. inadvertent injection into a segmental artery
d. all of the above
e. none of the above

631. D

632

632. Complications associated with lumbar epidural block
include:
a. inadvertent intravascular injection
b. infection
c. trauma to the spinal cord
d. inadvertent dural puncture
e. all of the above

632. E

633

633. Complications associated with lumbar epidural block
include inadvertent:
a. subdural injection
b. epidural injection
c. subarachnoid injection
d. all of the above
e. none of the above

633. D

634

634. The spinal cord:
a. ends at L2 in adults
b. ends at L4 in infants
c. is surrounded by cerebrospinal fluid
d. all of the above
e. none of the above

634. D

635

635. Common reasons for the failure to place a needle into
the subarachnoid space include:
a. failure to identify the midline
b. underestimating the added depth of needle insertion
necessary to reach the subarachnoid space
c. allowing the needle to cross the midline by using too
lateral a trajectory
d. all of the above
e. none of the above

635. D

636

636. Complications associated with subarachnoid block
include:
a. infection
b. trauma to the spinal cord
c. trauma to the nerve roots
d. hypotension
e. all of the above

636. E

637

636. Complications associated with subarachnoid block
include:
a. infection
b. trauma to the spinal cord
c. trauma to the nerve roots
d. hypotension
e. all of the above

637. E

638

638. The sacral canal contains:
a. blood vessels and fat
b. the filum terminale
c. the sacral nerve roots
d. the coccygeal nerves
e. all of the above

638. E

639

639. Caudal epidural nerve block is performed by placing the
needle through the:
a. foramen rotundum
b. sacral hiatus
c. foramen ovale
d. hiatus of Munro
e. none of the above

639. B

640

640. Complications associated with caudal epidural block
include:
a. inadvertent subarachnoid injection
b. infection
c. inadvertent vascular injection
d. trauma to structures surrounding the sacrum and
coccyx
e. all of the above

640. E

641

641. Incorrect needle placement during caudal epidural block
can include placement of the needle:
a. outside the sacrum into the subcutaneous tissues
b. under the periostium of the sacrum
c. into the substance of the sacrococcygeal ligament
d. through the sacrum into the pelvis
e. all of the above

641. E

642

642. Indications for lysis of adhesions include:
a. perineural fibrosis
b. epidural scarring after infection
c. herniated disc
d. vertebral body compression fracture
e. all of the above

642. E

643

643. Complications associated with epidural lysis of adhesions
include:
a. persistent sensory deficits
b. bowel and bladder difficulties
c. sexual dysfunction
d. infection
e. all of the above

643. E

644

644. The sacral nerve roots provide:
a. motor innervation to the external anal sphincter and
levator ani muscles
b. sensory innervation to the anorectal region
c. visceral innervation to the bladder and urethra
d. sensory innervation to the external genitalia
e. all of the above

644. E

645

645. Side effects and complications associated with blockade
of the sacral nerve roots include:
a. inadvertent intravascular injection
b. trauma to the vasculature
c. infection
d. bladder and bowel dysfunction
e. all of the above

645. E

646

646. Complications associated with hypogastric plexus block
include:
a. trauma to the iliac vessels
b. trauma to the pelvic viscera
c. trauma to the cauda equina
d. infection
e. all of the above

646. E

647

647. Complications associated with hypogastric plexus block
include inadvertent:
a. subdural injection
b. epidural injection
c. subarachnoid injection
d. all of the above
e. none of the above

647. D

648

648. Complications of blockade of the ganglion of Walther
(Impar) include:
a. rectal fistula formation
b. infection
c. trauma to the cauda equina
d. all of the above
e. none of the above

648. D

649

649. Complications of blockade of the pudendal nerve
include:
a. rectal fistula formation
b. infection
c. trauma to the pudendal nerve and artery
d. intravascular injection into the pudendal nerve and
artery
e. all of the above

649. E

650

650. The pudendal nerve:
a. is made up of fibers from the S2, S3, and S4 nerves
b. passes inferiorly between the piriformis and coccygeal
muscles
c. leaves the pelvis via the greater sciatic foramen along
with the pudendal artery and nerve
d. passes around the medial portion of the ischial spine
to reenter the pelvis through the lesser sciatic
foramen
e. all of the above

650. E

651

651. The pudendal nerve branches into the:
a. inferior rectal nerve, which provides innervation to
the anal sphincter and perianal region
b. perineal nerve, which supplies the posterior two
thirds of the scrotum or labia majora and muscles
of the urogenital triangle
c. dorsal nerve of the penis or clitoris, which supplies sensory
innervation to the dorsum of the penis or clitoris
d. all of the above
e. none of the above

651. D

652

652. The sacroiliac joint:
a. is formed by the articular surfaces of the sacrum and
iliac bones
b. bears the weight of the trunk and are thus subject to
the development of strain and arthritis
c. receives its innervation from L3 to S3 nerve roots,
with L4 and L5 providing the greatest contribution
to the innervation of the joint
d. has a very limited range of motion and that motion is
induced by changes in the forces placed on the joint
by shifts in posture and joint loading
e. all of the above

652. E

653

653. Complications and side effects of injection of the
sacroiliac joint include:
a. infection
b. trauma to the sciatic nerve
c. increased pain following injection
d. all of the above
e. none of the above

653. D

654

654. The hip joint is innervated by the:
a. femoral nerve
b. obturator nerve
c. sciatic nerves
d. all of the above
e. none of the above

654. D

655

655. The major ligaments of the hip joint include the:
a. iliofemoral ligament
b. pubofemoral ligament
c. ischiofemoral ligament
d. transverse acetabular ligament
e. all of the above

655. E

656

656. Complications and side effects of injection of the ischial
bursa include:
a. infection
b. trauma to the sciatic nerve
c. increased pain following injection
d. all of the above
e. none of the above

656. D

657

657. Causes of ischial bursitis include:
a. direct trauma to the bursa
b. overuse syndromes
c. prolonged sitting
d. running on sand or uneven surfaces
e. all of the above

657. E

658

658. The gluteal bursae lie between the:
a. gluteus maximus muscle
b. gluteus medius muscle
c. gluteus minimus muscle
d. all of the above
e. none of the above

658. D

659

659. Complications associated with injection of the psoas
bursa include:
a. trauma to the femoral nerve
b. trauma to the femoral vein
c. trauma to femoral artery
d. infection
e. all of the above

659. E

660

660. Physical examination of patients suffering from psoas
bursitis will reveal:
a. point tenderness in the upper thigh just below the
crease of the groin
b. reproduction of the pain with passive flexion of the
affected lower extremity at the hip
c. reproduction of the pain with passive adduction of
the affected lower extremity at the hip
d. reproduction of the pain with passive abduction of
the affected lower extremity at the hip
e. all of the above

660. E

661

661. The iliopectinate bursa lies between the:
a. psoas muscle
b. iliacus muscle
c. iliopectinate eminence
d. all of the above
e. none of the above

661. D

662

662. When performing injection of the iliopectinate bursa, a
paresthesia is occasionally elicited when the needle
impinges on the:
a. femoral nerve
b. sciatic nerve
c. iliac nerve
d. the common peroneal nerve
e. none of the above

662. A

663

663. Patients suffering from trochanteric bursitis will
frequently complain of:
a. pain in the hip region radiating down the affected
extremity
b. a catching sensation when walking
c. an inability to sleep on the affected side
d. difficulty walking up stairs
e. all of the above

663. E

664

664. When performing injection of the trochanteric bursa, a
paresthesia is occasionally elicited when the needle
impinges on the:
a. femoral nerve
b. sciatic nerve
c. iliac nerve
d. the common peroneal nerve
e. none of the above

664. B

665

665. Physical examination of the patient suffering from
trochanteric bursitis will reveal:
a. point tenderness in the lateral thigh
b. no sensory deficit
c. pain on active resisted abduction of the affected
extremity
d. all of the above
e. none of the above

665. D

666

666. Meralgia paresthetica is caused by entrapment of the:
a. femoral nerve
b. sciatic nerve
c. lateral femoral cutaneous nerve
d. common peroneal nerve
e. none of the above

666. C

667

667. Physical findings of meralgia paresthetica include:
a. tenderness over the lateral femoral cutaneous nerve
at the origin of the inguinal ligament at the anterior
superior iliac spine
b. a positive Tinel’s sign may be present over the lateral
femoral cutaneous nerve as it passes beneath the
inguinal ligament
c. a sensory deficit in the distribution of the lateral
femoral cutaneous nerve
d. no motor deficit should be present
e. all of the above

667. E

668

668. The following have been implicated in the evolution of
meralgia paresthetica:
a. wearing of wide belts
b. sitting for long periods
c. squatting for long periods
d. tight waistbands
e. all of the above

668. E

669

669. Piriformis syndrome presents as:
a. pain in the distribution of the sciatic nerve
b. numbness in the distribution of the sciatic nerve
c. weakness in the distribution of the sciatic nerve
d. paresthesias in the distribution of the sciatic nerve
e. none of the above

669. E

670

670. Piriformis syndrome is caused by compression of the
______ nerve by the piriformis muscle:
a. femoral
b. sciatic
c. lateral femoral cutaneous
d. common peroneal
e. none of the above

670. B

671

671. Complications and side effects of blockade of the
lumbar plexus using the Winnie 3-in-1 technique
include:
a. trauma to the femoral nerve
b. trauma to the femoral vein
c. trauma to femoral artery
d. infection
e. all of the above

671. E

672

672. Complications and side effects of blockade of the lumbar
plexus using the psoas technique include
inadvertent:
a. subdural injection
b. epidural injection
c. subarachnoid injection
d. all of the above
e. none of the above

672. D

673

673. Complications and side effects of blockade of the
femoral nerve include:
a. trauma to the femoral nerve
b. trauma to the femoral vein
c. trauma to the femoral artery
d. infection
e. all of the above

673. E

674

674. The femoral nerve provides motor innervation to the:
a. sartorius muscle
b. quadriceps femoris muscle
c. pectineus muscle
d. all of the above
e. none of the above

674. D

675

675. The femoral nerve provides sensory innervation to
the:
a. knee joint
b. skin overlying the anterior thigh
c. skin of the medial thigh
d. all of the above
e. none of the above

675. D

676

676. Indications for obturator nerve block include:
a. obturator nerve entrapment
b. hip pain
c. relief of adductor spasm to facilitate perineal care
d. an aid to physical therapy following hip surgery
e. all of the above

676. E

677

677. Complications and side effects of blockade of the
obturator nerve include:
a. trauma to the obturator nerve
b. trauma to the obturator vein
c. trauma to the obturator artery
d. infection
e. all of the above

677. E

678

678. The sciatic nerve:
a. is the largest nerve in the body
b. roots fuse together in front of the anterior surface
of the lateral sacrum on the anterior surface of the
piriform muscle
c. travels inferiorly and leaves the pelvis just below the
piriform muscle via the sciatic notch
d. courses downward past the lesser trochanter to lie
posterior and medial to the femur
e. all of the above

678. E

679

679. The femoral nerve divides into the:
a. tibial nerve
b. common peroneal nerve
c. quadriceps minor nerve
d. a and b
e. b and c

679. D

680

680. The tibial nerve provides sensory innervation to the:
a. posterior portion of the calf
b. heel
c. medial plantar surface
d. all of the above
e. none of the above

680. D

681

681. The tibial nerve:
a. splits from the sciatic nerve at the superior margin of
the popliteal fossa
b. descends in a slightly medial course through the
popliteal fossa
c. at the knee lies just beneath the popliteal fascia and
is readily accessible for neural blockade
d. runs between the two heads of the gastrocnemius
muscle, passing deep to the soleus muscle
e. all of the above

681. E

682

682. The saphenous nerve:
a. is the largest sensory branch of the femoral nerve
b. is derived primarily from the fibers of the L3 and L4
nerve roots
c. travels along with the femoral artery through
Hunter’s canal
d. passes over the medial condyle of the femur, splitting
into terminal sensory branches
e. all of the above

682. E

683

683. The saphenous nerve provides sensory innervation to
the:
a. medial malleolus
b. medial calf
c. medial arch of the foot
d. all of the above
e. none of the above

683. D

684

684. The common peroneal nerve:
a. is a continuation of the sciatic nerve
b. is derived from the posterior branches of the L4, the
L5, and the S1 and S2 nerve roots
c. splits from the sciatic nerve at the superior margin of
the popliteal fossa
d. descends laterally behind the head of the fibula
e. all of the above

684. E

685

685. The common peroneal nerve is:
a. subject to entrapment as it descends laterally behind
the head of the fibula
b. on occasion compressed by casts
c. on occasion compressed by tourniquets
d. all of the above
e. none of the above

685. D

686

686. When performing deep peroneal nerve block at the
ankle, a paresthesia is often elicited:
a. in the skin between the great and second toe
b. over the lateral malleolus
c. over the medial malleolus
d. over the distal little toe
e. none of the above

686. A

687

687. The superficial branch of the superficial peroneal nerve:
a. continues down the leg in conjunction with the
extensor digitorum longus muscle
b. divides into terminal branches at a point just above
the ankle
c. has fibers of the terminal branches that provide sensory
innervation to most of the dorsum of the foot
except for the area adjacent to the web space of the first and second toes, which is supplied by the deep
peroneal nerve
d. provides sensory innervation to the toes except for
the area between the first and second toe, which is
supplied by the deep peroneal nerve
e. all of the above

687. E

688

688. The sural nerve:
a. is a branch of the posterior tibial nerve
b. passes from the posterior calf around the lateral malleolus
to provide sensor innervation of the posterior
lateral aspect of the calf and the lateral surface of the
foot and fifth toe and the plantar surface of the heel
c. is subject to compression at the ankle and is known
as boot syndrome
d. all of the above
e. none of the above

688. D

689

689. Complications associated with metatarsal and digital
nerve block include:
a. infection
b. vascular compromise caused by injection of large
volumes of local anesthetic into a closed space
c. vascular compromise caused by the use of epinephrine
containing local anesthetics
d. all of the above
e. none of the above

689. D

690

690. The knee joint is susceptible to the development of:
a. arthritis
b. bursitis
c. disruption of the ligaments
d. disruption of the cartilage
e. all of the above

690. E

691

691. The suprapatellar tendon is subject to inflammation
from:
a. misuse
b. overuse
c. direct trauma
d. all of the above
e. none of the above

691. D

692

692. Findings of suprapatellar bursitis include:
a. swelling in the suprapatellar region
b. tenderness to palpation of the suprapatellar region
c. increased pain on passive flexion of the knee
d. pain on active resisted extension of the knee
e. all of the above

692. E

693

693. Patients suffering from suprapatellar bursitis will
frequently complain of:
a. anterior knee pain
b. pain that radiates into the anterior distal thigh
c. an inability to walk stairs
d. an inability to kneel
e. all of the above

693. E

694

694. Symptoms of infection of the prepatellar bursitis
include:
a. fever
b. malaise
c. rubor
d. color
e. all of the above

694. E

695

695. The prepatellar bursa:
a. is subject to the development of bursitis from
misuse, overuse, or direct trauma
b. lies beneath the subcutaneous tissues
c. lies above the patella
d. is held in place by the ligamentum patellae
e. all of the above

695. E

696

696. Physical examination of patients suffering from superficial
infrapatellar bursitis will reveal:
a. pain to palpation of the infrapatellar region
b. swelling and fluid accumulation around the bursa
c. pain on passive flexion
d. pain of active resisted extension
e. all of the above

696. E

697

697. Symptoms of infection of the superficial infrapatellar
bursitis include:
a. fever
b. malaise
c. rubor
d. color
e. all of the above

697. E

698

698. The ligamentum patellae is made of a continuation of
fibers of the:
a. femoral tuberosity
b. quadriceps tendon
c. prepatellar bursa
d. all of the above
e. none of the above

698. B

699

699. The major ligaments of the ankle joint include the:
a. deltoid ligament
b. anterior talofibular ligament
c. calcaneofibular ligament
d. posterior talofibular ligament
e. all of the above

699. E

700

700. Neurologic complications associated with subarachnoid
neurolytic block include:
a. needle-induced trauma to the spinal cord
b. needle-induced trauma to the nerve roots
c. chemical irritation of the meninges
d. chemical irritation of the spinal cord and nerve roots
e. all of the above

700. E

701

701. Complications associated with subarachnoid neurolytic
block include:
a. unexpected motor deficits
b. unexpected sensory deficits
c. infection
d. bowel and bladder dysfunction
e. all of the above

701. E

702

702. Side effects and complications associated with subarachnoid
neurolytic block include:
a. hypotension
b. inadvertent epidural injection
c. inadvertent subdural injection
d. all of the above
e. none of the above

702. D

703

703. When performing hyperbaric subarachnoid neurolytic
block, the patient is positioned:
a. with the affected side up
b. with the affected side down
c. in the jackknife position
d. a and b
e. b and c

703. B

704

704. When performing hyperbaric subarachnoid neurolytic
block, the patient is positioned:
a. with the affected side up
b. with the affected side down
c. in the supine position
d. a and b
e. b and c

704. A

705

705. Contraindications to discography include:
a. presence of anticoagulation
b. coagulopathy
c. sepsis
d. local infection at the injection site
e. all of the above

705. E

706

706. Complications of lumbar discography include:
a. discitis
b. epidural abscess
c. trauma to the spinal cord
d. trauma to the nerve roots
e. all of the above

706. E

707

707. Complications of lumbar discography include:
a. infection
b. pneumothorax
c. trauma to the kidney
d. trauma to the great vessels
e. all of the above

707. E

708

708. Indications for vertebroplasty include:
a. osteoporosis-induced vertebral compression fractures
b. tumors of the vertebral body
c. hemangiomas of the vertebral body
d. traumatic vertebral compression fractures
e. all of the above

708. E

709

709. The best results from vertebroplasty can be expected
when:
a. there is limited compression of the vertebral body
b. the fracture is less than 12 months old
c. if the lesion is greater than 12 months old, the radionuclide
bone scan is still ‘‘hot,’’ indicating continued
active disease
d. all of the above
e. none of the above

709. D

710

710. Complications associated with vertebroplasty include:
a. intravascular injection of cement
b. spread of cement into the spinal canal
c. spread of cement into the neural foramina
d. fracture of the pedicle during the procedure
e. all of the above

710. E

711

711. Indications supporting a trial of spinal cord stimulation
include:
a. reflex sympathetic dystrophy and causalgia
b. ischemic pain secondary to peripheral vascular
insufficiency
c. radiculopathies
d. failed back syndrome
e. all of the above

711. E

712

712. Indications supporting a trial of spinal cord stimulation
include:
a. arachnoiditis
b. postherpetic neuralgia
c. phantom limb pain
d. intractable angina
e. all of the above

712. E

713

713. Contraindications to a trial of spinal cord stimulation
include:
a. sepsis
b. local infection at needle entry site
c. presence of anticoagulation
d. coagulopathy
e. all of the above

713. E

714

714. Complications associated with spinal cord stimulation
include:
a. infection
b. trauma to the spinal cord
c. trauma to the nerve roots
d. epidural hematoma formation
e. all of the above

714. E

715

715. Indications for implantation of a totally implantable
infusion pump include:
a. the administration of epidural drugs for the palliation
of pain in cancer patients with a life expectancy
of months to years
b. carefully selected patients who suffer from chronic
benign pain who have experienced palliation of their
pain with trial doses of spinal opioids and who have
failed to respond to other more conservative treatments
c. those patients suffering from spasticity who have
experienced decreased spasms after trial doses of
subarachnoid administration of baclofen
d. all of the above
e. none of the above

715. D

716

716. Indications for therapeutic ultrasound include:
a. tendinitis
b. bursitis
c. nonacutely inflamed arthritis
d. frozen joints
e. all of the above

716. E

717

717. Indications for therapeutic ultrasound include:
a. contractures
b. degenerative arthritis
c. fractures
d. plantar fasciitis
e. all of the above

717. E

718

718. Contraindications to subarachnoid neurolytic block
include:
a. presence of anticoagulation
b. coagulopathy
c. sepsis
d. local infection at the injection site
e. all of the above

718. E

719

719. Indications for therapeutic heat include:
a. pain
b. muscle spasm
c. bursitis
d. tenosynovitis
e. all of the above

719. E

720

720. Indications for therapeutic heat include:
a. collagen vascular diseases
b. contracture
c. fibromyalgia
d. induction of hyperemia
e. all of the above

720. E

721

721. Indications for therapeutic heat include:
a. hematoma resolution
b. superficial thrombophlebitis
c. reflex sympathetic dystrophy
d. all of the above
e. none of the above

721. D

722

722. Heat modalities that rely on conduction include:
a. hydrocollator packs
b. circulating water heating pads
c. chemical heating pads
d. paraffin baths
e. all of the above

722. E

723

723. Heat modalities that rely on conversion include:
a. ultrasound
b. short wave diathermy
c. microwave diathermy
d. all of the above
e. none of the above

723. D

724

724. Relative contraindications to therapeutic heat include:
a. scar tissue
b. lack of or reduced sensation
c. demyelinating diseases
d. acute inflammation
e. all of the above

724. E

725

725. Relative contraindications to therapeutic heat include:
a. bleeding disorders
b. hemorrhage
c. malignancy
d. inability to communicate or respond to pain
e. all of the above

725. E

726

726. Physiologic effects of therapeutic heat include:
a. increased blood flow
b. decreased muscle spasm
c. increased extensibility of connective tissues
d. all of the above
e. none of the above

726. D

727

727. Physiologic effects of therapeutic heat include:
a. decreased joint stiffness
b. reduction of edema
c. analgesia
d. all of the above
e. none of the above

727. D

728

728. Precautions and contraindications to the use of
therapeutic cold include:
a. ischemia
b. lack of or reduced sensation
c. cold intolerance
d. Raynaud’s disease
e. all of the above

728. E

729

729. Indications for therapeutic cold include:
a. pain
b. muscle spasm
c. bursitis
d. tendinitis
e. all of the above

729. E

730

730. Contraindications to the use of transcutaneous electrical
nerve stimulators include:
a. pacemakers
b. spinal cord stimulators
c. insensate patients
d. pregnancy
e. all of the above

730. E

731

731. Indications for the use of transcutaneous nerve stimulators
include:
a. acute post-traumatic pain
b. acute postoperative pain
c. peripheral vascular insufficiency
d. all of the above
e. none of the above

731. D

732

732. Indications for the use of transcutaneous nerve stimulators
include:
a. functional abdominal pain
b. musculoskeletal pain
c. neuropathic pain
d. all of the above
e. none of the above

732. D

733

733. Types of biofeedback devices include:
a. heart rate monitors
b. electromyographic monitors
c. galvanic skin response monitors
d. thermostat temperature monitors
e. all of the above

733. E

734

734. Factors affecting the clinical properties of local
anesthetics include:
a. percentage of ionization at physiologic pH
b. lipid solubility
c. affinity for protein binding
d. all of the above
e. none of the above

734. D

735

735. Factors affecting the clinical properties of local
anesthetics include the:
a. pH of the tissue being blocked
b. drug’s ability to produce vasodilatation
c. drug’s diffusibility
d. all of the above
e. none of the above

735. D

736

736. Common to the structure of all local anesthetics
is a(n):
a. terminal amine
b. intermediate chain
c. aromatic end
d. all of the above
e. none of the above

736. D

737

737. Neurolytic agents commonly used in clinical practice
include:
a. ethyl alcohol
b. phenol
c. ammonium compounds
d. hypertonic and hypotonic solutions
e. all of the above

737. E

738

738. A dreaded complication of alcohol block of the trigeminal
nerve is:
a. anesthesia dolorosa
b. anesthesia phlegmosa
c. anesthesia albicans
d. all of the above
e. none of the above

738. A

739

739. When alcohol is administered onto a nerve, which of the
following occurs?
a. denaturation of cerebrosides
b. denaturation of phospholipids
c. denaturation of lipoproteins
d. denaturation of mucoproteins
e. all of the above

739. E

740

740. When administered into the subarachnoid space, relative
to cerebrospinal fluid, ethyl alcohol is:
a. isobaric
b. hyperbaric
c. hypobaric
d. radiopaque
e. none of the above

740. C

741

741. The nonsteroidal anti-inflammatory drug’s primary
mechanism of action is the inhibition of:
a. cyclooxygenase enzymes
b. centrally mediated cytokines
c. C-reactive protein type 1
d. C-reactive protein type 2
e. all of the above

741. A

742

742. Actions of aspirin include:
a. inhibition of platelet aggregation
b. antipyretic activity
c. analgesic activity
d. anti-inflammatory activity
e. all of the above

742. E

743

743. The following class of analgesics has recently been
associated with a higher incidence of cardiovascular
side effects compared with other classes of analgesics:
a. opioids
b. aspirin
c. COX-2 inhibitors
d. nonsalicylated aspirin-like drugs
e. none of the above

743. C

744

744. Commonly used skeletal muscle relaxants include:
a. methocarbamol
b. cyclobenzaprine
c. orphenadrine
d. tizanidine
e. all of the above

744. E

745

745. Meprobamate dependence has been associated with the
prolonged use of which of the following muscle relaxants?
a. methocarbamol
b. cyclobenzaprine
c. carisoprodol
d. tizanidine
e. all of the above

745. C

746

746. Drugs that must be avoided when taking monoamine
oxidase inhibitors include:
a. meperidine
b. antihistamines
c. cocaine
d. many antipsychotic medications
e. all of the above

746. E

747

747. Foods that should be avoided when taking monoamine
oxidase inhibitors include:
a. aged cheeses
b. Chianti wine
c. figs
d. overripe fruit
e. all of the above

747. E

748

748. Foods that should be avoided when taking monoamine
oxidase inhibitors include:
a. smoked meats
b. chicken liver
c. soy sauce
d. aged meats
e. all of the above

748. E

749

749. Foods that should be avoided when taking monoamine
oxidase inhibitors include:
a. caviar
b. meat extracts
c. bananas
d. raisins
e. all of the above

749. E

750

750. Side effects of the tricyclic antidepressants include:
a. sedation
b. cardiac arrhythmias
c. xerostomia
d. xeroophthalmia
e. all of the above

750. E

751

751. Side effects of the tricyclic antidepressants include:
a. constipation
b. urinary retention
c. anorgasmia
d. impotence
e. all of the above

751. E

752

752. Category 1 anticonvulsants, drugs that modulate the
voltage-dependent sodium channel, include:
a. phenytoin
b. carbamazepine
c. lamotrigine
d. topiramate
e. all of the above

752. E

753

753. Category 2 anticonvulsants, drugs whose primary
mechanism of action is unrelated to modulation of the
voltage-dependent sodium channel, include:
a. gabapentin
b. tiagabine
c. valproic acid
d. all of the above

753. D

754

754. Side effects associated with phenytoin include:
a. nystagmus
b. liver dysfunction
c. rash
d. Stevens-Johnson syndrome
e. all of the above

754. E

755

755. Side effects associated with phenytoin include:
a. liver dysfunction
b. gum hyperplasia
c. peripheral neuropathy
d. osteomalacia
e. all of the above

755. E

756

756. The anticonvulsant compound that has been associated
with a pseudolymphoma indistinguishable from
Hodgkin’s lymphoma is:
a. carbamazepine
b. phenytoin
c. gabapentin
d. phenobarbital
e. all of the above

756. B

757

757. Alternative routes of administration of opioid analgesics
include:
a. rectal
b. buccal
c. sublingual
d. transdermal
e. all of the above

757. E

758

758. Side effects of opioid analgesics include:
a. nausea
b. constipation
c. psychotomimetic effects
d. itching
e. all of the above

758. E

759

759. Factors that facilitate transplacental transfer of drugs
include:
a. high lipid solubility
b. lower molecular weight
c. low protein binding
d. an active moiety that exists in an unionized state
e. all of the above

759. E

760

760. Factors that facilitate transfer of drugs into breast milk
include:
a. high lipid solubility
b. lower molecular weight
c. low protein binding
d. an active moiety that exists in an unionized state
e. all of the above

760. E

761

761. Phenytoin has been associated with fetal abnormalities:
a. that may be associated with impaired folate
absorption
b. that are known as the hydantoin syndrome
c. including microcephaly, micrognathia, and
dysmorphism
d. all of the above
e. none of the above

761. D

762

762. Common signs of depression in the elderly include:
a. insomnia
b. anger and irritability
c. unexplained weight loss
d. unexplained weight gain
e. all of the above

762. E

763

763. Common signs of depression in the elderly include:
a. fatigue
b. frequent awakening
c. difficulty concentrating
d. loss of pleasure in daily activities
e. all of the above

763. E

764

764. Unique physiologic abnormalities in the newborn
that may affect how narcotic analgesics are used
include:
a. immature liver enzyme system
b. decreased glomerular filtration rates
c. immature central respiratory receptor system
d. all of the above
e. none of the above

764. D

765

765. The following analgesics are generally considered safe in
the pediatric population:
a. acetaminophen
b. morphine
c. codeine
d. ketorolac
e. all of the above

765. E

766

766. The following clinical syndromes are considered
migraine equivalents:
a. cyclical vomiting syndrome
b. benign paroxysmal vertigo
c. acute confusional state disorder
d. all of the above
e. none of the above

766. D

767

767. The following are considered factors that cause concern
when evaluating a patient with headache:
a. first or worst headache
b. headache made worse with the Valsalva maneuver
c. headache associated with fever
d. headache associated with neurologic dysfunction
e. all of the above

767. E