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The cauda equina, from the Latin for “a horse’s tail”, is a slender series of lumbar, sacral and coccygeal nerves eminating from the lumbar-enlarged caudal spinal cord. ¬†Implicated in the medical emergency cauda equina syndrome (CES), its anatomy is touched upon in this quiz. ¬†Best of luck!¬†

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Clinical Neuroanatomy: Part Five

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Question 1
A key distinguishing feature between the 1) rubrospinal and 2) lateral vestibulospinal tracts are ...
A
1) is involved in flexor muscle control, 2) in extensor muscle control
B
1) is involved in extensor muscle control, 2) in flexor muscle control
C
1) is involved in flexor muscle control, 2) in flexor muscle control
D
1) is involved in extensor muscle control, 2) in extensor muscle control
E
1) and 2) are involved in neither flexor or extensor muscle control
Question 2
The anterior corticospinal tract, responsible for minor motor movements, receives the preponderance of its upper motor neurons from which cortical domain?
A
The primary motor cortex
B
The premotor cortex
C
The supplementary motor cortex
D
The primary somatosensory cortex
E
The prefrontal cortex
Question 3

Stem 1 of 4

Study the image below to answer the following questions
 
Region "A" contains axons with which best-fitting function?
A
Extensor muscle control
B
Anti-gravity muscle control
C
Flexor muscle control
D
Minor motor movement
E
Major, voluntary and skilled motor movemenrt
Question 3 Explanation: 
The is the region of the lateral corticospinal tract with the above function.
Question 4

Stem 2 of 4

The tract at region "B" would risk an infarct in which of the following cases selectively?
A
Occlusion of the anterior spinal artery
B
Occlusion of the right posterior spinal artery
C
Occlusion fo the left posterior spinal artery
D
All of the above
E
None of the above
Question 5

Stem 3 of 4

What is the name of the tract at position "B"?
A
Ventral corticospinal trsct
B
Ventral spinocerebellar tract
C
Anterior spinothalamic tract
D
Lissauer's tract
E
None of the above
Question 6

Stem 4 of 4

Which clinical sign would manifest with a selective lesion (eg abscess) to position "C"?
A
Contralateral flexor weakness
B
Ipsilateral flexor weakness
C
Contralateral extensor weakness
D
Ipsilateral extensor weakness
E
Loss of fine touch sensation
Question 6 Explanation: 
The region "C" corresponds to the lateral vestibulospinal tract aka the "anti-gravity" extensor muscle regulatory domain.
Question 7
A cauda equina lesion would manifest which symptom subset?
A
Increased stretch reflex
B
Severe muscular atrophy
C
Spastic paralysis
D
Clonus
E
Babinski reflex
Question 8
Read the below definition:
"A rhythmic oscillation as a result of alternate stretch and unloading of muscle spindles within a spastic muscle belly"
A patient with a history of cerebral infarct has this clinical sign.  How is it best elicited?
A
Periumbilical stroking with a cotton wool piece
B
Patellar tendon hammer swing
C
Lightly stroking the superomedial thigh
D
A firm arc on the sole of the foot
E
Rapid dorsiflexion about the supported ankle
Question 8 Explanation: 
Each of the above describe a reflex. The first, the superficial abdominal reflex. The second a patellar deep tendon reflex. The third the cremasteric reflex. The fourth, Babinski reflex (sign). The fifth ankle clonus.
Question 9
Which of the following does not show clinical importance of Renshaw cells?
A
Interneurons involved in regulation of synaptic output
B
Interneurons affiliated with the reticulospinal tract neurons
C
Glycine-rich interneurons controlling lower motor neurons
D
Implicated in partial gain of function in some spinal cord lesions
E
A causes of flaccid paralysis when tonic inhibition is added
Question 9 Explanation: 
A reduction of the glyceine-mediated tonic inhibition of Renshaw interneurons causes spastic paralysis as the antigravity muscles they regulate fire in a hyper-excitable way.
Question 10
The withdrawal reflex type utilises
A
Meissner's corpuscles
B
Meckel's discs
C
Pacinian's corpuscles
D
Ruffini endings
E
Free nerve endings
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With thanks to: 

  • Mysid. (2010). Diagrammatic transverse section of the medulla spinalis and its membranes.¬†Available: https://commons.wikimedia.org/wiki/File:Gray770-en.svg. Last accessed 27th October 2019.