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• Descending tracts in the posterior white column
• The difference between anatomy, function and clinical correlate of the
pyramidal and EPS
• Complete spinal cord transection
• Further tracts: ascending – spinotectal, spinoreticular, spino-olivary and
gating theory
• Descending: lateral reticulospinal tract, descending autonomics, lateral
olivospinal tract, tectospinal and rubrospinal tract
• Definitions: spasticity vs rigidity, tremor, spasms, athetosis, chorea,
dystonia, myoclonus
• Clinical correlates: BSS, syringomyelia
• Arterial supply of the spinal cord, roots and rootlets
• Veins of the spinal cord
• Acute SCI and compression
• Posterior intersegmental tract, lateral intersegmental tract, anterior
intersegmental tract
• Define hemiballismus, tabes dorsalis, pernicious anaemia related to MS
• Outline how pain relief is undertaken by rhizotomy or cordotomy

Spinal Cord NUNC

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Question 1
A patient with history of neurosyphillis undergoes MR of the spine.  Which of the following signs would you expect?
A
A normal spinothalamic system
B
Atrophy of the fasciculus cuneatus
C
Atrophy of the fasciculus gracilis
D
Presence of the septomarginal tract
E
None of the above
Question 2
Select all that may apply. Which of the following lesions could cause hyperreflexia?
A
Cerebral peduncle lesion
B
Basalis pontis lesion
C
Pyramidal lesion
D
Internal capsule lesion
E
Corona radiata lesion
Question 3
A patient presents with mask facies, tremor at rest and cog-wheel rigidity on examination.  Which of the following pathways may be implicated in the symptoms?
A
Tectospinal pathway
B
Rubrospinal pathway
C
Nigrostriatal pathway
D
Vestibulocerebellar pathway
E
Lateral vestibulospinal pathway
Question 4
A classical antipsychotic is given, resulting in bradykinesia and postural instability.   Which further sign is expected?
A
Hypertonia
B
Hyperreflexia
C
Flaccid paralysis
D
Cogwheel rigidity
E
Babinski sign
Question 5
Which of the following would be seen in a crush injury that had cause a hemi-cord lesion?
A
Ipsilateral motor paralysis
B
Contralateral motor paralysis
C
Ipsilateral vibration sense loss
D
Contralateral vibration sense loss
E
Ipsilateral unconscious proprioception loss
Question 6
A patient has flaccid paralysis of the distal limbs, that appears progressive with obvious guttering. On examination there is hyperreflexia and clasp-knife sign at the elbow.  What is the best matched differential?
A
Tabes dorsalis
B
Pernicious anaemia
C
Multiple sclerosis
D
Amyotrophic lateral sclerosis
E
Anterior spinal artery infarct
Question 7
Where is the lesion in a patient with the classic “cape-like distribution” of nociception/thermoreception loss?
A
Extradural space
B
Subdural space
C
Subarachnoid space
D
Subpial space
E
Intraparenchymal space
Question 8
The tract that unconcsiously arouses the central nervous system in response to noxious stimuli is termed the
A
Vestibulospinal tract
B
Spinoreticular tract
C
Spinocerebellar tract
D
Spinocerebral tract
E
Spinoolivary tract
Question 9
The inferior olivary nucleus projects which fibres to the cerebellar cortex?
A
Purkinje cells
B
Mossy fibres
C
Climbing fibres
D
Basket cells
E
Stellate cells
Question 10
A conscious awareness of pain is under the remit of which tract(s)?
A
Archispinothalamic tract
B
Anterior spinothalamic tract
C
Neospinothalamic tract
D
Paleospinothalamic tract
E
Lateral spinocerebellar tract
Question 11
A-delta fibres convey which sensory modality in the most part?
A
Pain
B
Touch
C
Temperature
D
Pressure
E
Vibration
Question 12
A patient falls and hurts their knee. Their mum tells them to “rub it better” and the pain is improved.  They ask their GP the following week why this was the case. Which fibres are involved in the activation of GABAergic inhibtory interneurons in this pathway classically?
A
C-fibres
B
A-alpha
C
A-beta
D
A-gamma
E
A-delta
Question 13
A velocity dependent paralysis would be seen in which of the following circumstances ...
A
Cerebellar stroke
B
Subthalamic infarct
C
Bicaudate atrophy
D
Nigrostriatal defect
E
Corona radiata space occupying lesion
Question 14
Which artery supplies the region of the cell body for an A-delta fibre?
A
Anterior radicular artery
B
Posterior radicular artery
C
Anterior spinal artery
D
Posterior spinal artery
E
Vertebral artery
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