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McGraw-Hill Specialty Board Review Pain Medicine

Salahadin Abdi, Pradeep Chopra, Howard Smith

Chapter 1

Anatomy - all with Video Answers

Educators

Chapter Questions

Problem 1

A 66-year-old woman presents with pain in the posterior cervical region for the last 1 year. It radiates to the right shoulder, lateral upper arm, and right index finger. She also complains in the medial part of the right scapula and anterior shoulder. On physical examination, she has numbness to the index and middle fingers of the right hand and weakness of the triceps muscle. The most likely cause of her pain is
(A) herniated nucleus pulposus of the $\mathrm{C} 5$ to C6 disc causing compression of the $C_5$ nerve root
(B) herniated nucleus pulposus of the $\mathrm{C} 5$ to C6 disc causing compression of the $\mathrm{C} 6$ nerve root
(C) herniated nucleus pulposus of the $\mathrm{C} 6$ to $C 7$ disc causing compression of the $C 7$ nerve root
(D) herniated nucleus pulposus of the $\mathrm{C} 6$ to $\mathrm{C} 7$ disc causing compression of the $\mathrm{C} 6$ nerve root
(E) muscle spasm

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01:14

Problem 1

Nutrition to the lumbar intervertebral disc is from the
(A) posterior spinal artery
(B) internal iliac artery
(C) lumbar artery
(D) anterior spinal artery
(E) abdominal aorta

Qudsiya Anis
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Problem 2

A 65-year-old man presents with symptoms of pain in the cervical region. He also complains of radiation of his pain along the lateral part of his right forearm. He has a magnetic resonance imaging (MRI) of the cervical region with evidence of a herniated disc between the fifth and the sixth cervical vertebra. The nerve root that is most likely compressed is
(A) fourth cervical nerve root
(B) fifth cervical nerve root
(C) sixth cervical nerve root
(D) seventh cervical nerve root
(E) first thoracic nerve root

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04:13

Problem 3

The most common presenting symptom of rheumatoid arthritis is
(A) pain in the small joints of the hand
(B) neck pain
(C) knee pain
(D) low back pain
(E) hip pain

Mariana Roldan
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00:37

Problem 4

The usual site of herniation of a cervical intervertebral disc is
(A) posterior
(B) lateral
(C) posterolateral
(D) anterior
(E) anterolateral

Andrei Demkov
Andrei Demkov
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00:40

Problem 5

The carotid tubercle (Chassaignac tubercle) is located at the
(A) transverse process of the C6 vertebra
(B) facet joint of the $\mathrm{C} 5$ and $\mathrm{C} 6$ vertebra
(C) facet joint of the $\mathrm{C} 6$ and $\mathrm{C} 7$ vertebra
(D) transverse process of the $\mathrm{C} 7$ vertebra
(E) transverse process of the $\mathrm{C} 5$ vertebra

Andrei Demkov
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00:25

Problem 6

The stellate ganglion is located
(A) anterior to the transverse process of the C6 vertebra
(B) posterior to the subclavian artery
(C) anterior to the transverse process of the C5 vertebra
(D) anterior to the neck of the first rib and the transverse process of the $C 7$ vertebra
(E) anterior to the transverse process of the first thoracic vertbra

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02:00

Problem 7

Features of Horner syndrome consist of the following, EXCEPT
(A) ptosis
(B) anhydrosis
(C) miosis
(D) enophthalmos
(E) mydriasis

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Problem 8

A 35-year-old woman with Complex Regional Pain Syndrome type I of the right upper extremity develops miosis, ptosis, and enophthalmos after undergoing a stellate ganglion block. She does not notice any significant pain relief. No significant rise in skin temperature was reconded in the right upper extremity. What is the most likely cause?
(A) Inadequate concentration of the local anesthetic
(B) Intravascular injection
(C) Subarachnoid block
(D) Anomalous Kuntz nerves
(E) Inadvertent injection of normal saline

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01:08

Problem 9

The greater occipital nerve is a branch of
(A) posterior ramus of $\mathrm{C} 2$
(B) posterior ramus of $\mathrm{C} 1$
(C) anterior ramus of $\mathrm{C1}$
(D) anterior ramus of $\mathrm{C} 2$
(E) trigeminal nerve

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Problem 12

The most common origin of the artery of Adamkiewicz is
(A) between T4 and T6
(B) at $\mathrm{T7}$
(C) between T8 and L3
(D) at LA
(E) at L5

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00:25

Problem 13

The most common location of the dorsal root ganglion is
(A) medial to the pedicle within the lateral recess
(B) inferolateral to the pedicle
(C) lateral to the superior articular facet of the corresponding vertebra
(D) directly below the pedicle
(E) medial to the superior articular facet of the corresponding vertebra

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01:42

Problem 14

Absolute central lumbar spinal stenosis is defined as
(A) less than $8 \mathrm{~mm}$ diameter
(B) less than $10 \mathrm{~mm}$ diameter
(C) less than $12 \mathrm{~mm}$ diameter
(D) pain at rest
(E) pain with ambulation

Joanna Quigley
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00:17

Problem 15

The principal action of the quadratus lumborum muscle is
(A) lateral flexion of the lumbar spine
(B) axial rotation of the lumbar spine
(C) extension of the lumbar spine
(D) fixation of the 12th rib during respiration
(E) forward flexion of the lumbar spine

Alexander Burbelo
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01:48

Problem 16

The following structure passes under the inguinal ligament:
(A) Inferior epigastric artery
(B) Lateral femoral cutaneous nerve
(C) Obturator nerve
(D) Intra-articular nerve of the hip joint
(E) Sciatic nerve

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Problem 17

The structure that passes under the flexor reticulum of the wrist is
(A) median nerve
(B) radial nerve
(C) ulnar nerve
(D) anterior interosseous nerve
(E) extensor digitorum longus

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00:28

Problem 18

A boxer complains of pain in his hand after punching a bag. What is the most likely cause?
(A) Avulsed ulnar ligament
(B) Scaphoid fracture
(C) Fracture of distal radius
(D) Metacarpal fracture
(E) Dislocation of the fifth proximal interphalangeal joint

Tate Hilken
Tate Hilken
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01:57

Problem 19

In the dorsal horn of the spinal cond:
(A) Cells from lamina I and II project to the hypothalamus
(B) Stimulation of lamina I and II produces pain
(C) Lamina 1 and 11 are found in the thoracic segment of the spinal cord only
(D) Discharge from lamina I and II decreases as a noxious stimulus increases
(E) Wide dynamic range (WDR) neurons are located predominantly in lamina I and II

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01:04

Problem 20

In case of an injury of a peripheral nerve:
(A) Wallerian degeneration of the proximal nerve occurs
(B) The rate of regeneration is $1 \mathrm{~mm} / \mathrm{d}$
.(C) Sensory nerves regenerate faster than motor nerves
(D) An inflammatory response occurs
(E) Regeneration of the nerves is faster in the central nervous system than the peripheral nervous system

Rikhil Makwana
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Problem 21

Neuropraxia is
(A) anatomical disruption of a nerve
(B) loss of conduction of a nerve
(C) pain due to peripheral nerve injury
(D) muscle tremor
(E) increased conduction of a nerve

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01:14

Problem 22

The following are true about pain, EXCEPT
(A) transmitted faster through $\mathrm{C}$ fibers
(B) some pain may travel through the dorsal column
(C) $\mu$-receptors when stimulated in the brain produce analgesia
(D) intractable pain due to cancer cannot be effectively treated by hypophysectomy
(E) transmitted slower through $\mathrm{C}$ fibers

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01:16

Problem 23

A- $\delta$ fibers:-
(A) Are unmyelinated
(B) Are low-threshold mechanoreceptors
(C) Increase their firing as the intensity of the stimulus increases
(D) Do not respond to noxious stimuli
(E) Are thick nerves

Josee Pacheco
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Problem 24

All of the following statements are true regarding fentanyl as a good agent for transdermal use, EXCEIT
(A) low molecular weight
(B) adequate lipid solubility
(C) high analgesic potency
(D) low abuse potential
(E) high molecular weight

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Problem 25

All of the following agents are $\alpha_2$-agonists, EXCEPT
(A) clonidine
(B) antipamezole
(C) tizanidine
(D) dexmedetomidine
(E) baclofen

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Problem 26

The antidepressant with the lowest sedation side effect is
(A) desipramine
(B) trazodone
(C) nortriptyline
(D) maprotiline
(E) amitriptyline

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00:41

Problem 27

Methadone in addition to being a $\mu$-receptor agonist has been proposed to also act as a
(A) cyclooxygenase 2 (COX-2) inhibitor
(B) sodium-channel blocker
(C) N-methyl-D-aspartate (NMDA) receptor antagonist
(D) $\delta$-receptor agonist
(E) $\alpha_2$-agonist

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02:38

Problem 28

The beneficial effects of epidural administration of steroids have been attributed to all of the following, EXCEPT
(A) inhibit phospholipase A2
(B) improve microcirculation around the nerve root
(C) NMDA antagonist
(D) block conduction of nociceptive $\mathrm{C}$ nerve fibers
(E) $\mu$-receptor agonist

AR
Adnan Radwan
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Problem 29

A22-year-old healthy woman with a history for migraine headaches develops an intense frontal headache after eating ice cream at a party. The pain is sharp and intense. What is the most likely diagnosis?
(A) Frontal sinusitis
(B) Cold stimulus headache
(C) Conversion headache
(D) Chronic paroxysmal hemicranias
(E) Aneurysm

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Problem 30

An 18-year-old woman presents with frequent headaches, each lasting for several days. She has to take time off from school. She describes them as throbbing, localized to the temporal region. They are associated with nausea and vomiting, sensitivity to sound and light. A recent MRI was normal. A diagnostic lumbar puncture done was normal. The most probable cause of her headaches is
(A) migraine without aura
(B) postdural puncture headache
(C) tension-type headache
(D) temporal arteritis
(E) malingering

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02:55

Problem 31

The cricoid cartilage corresponds with the following vertebra:
(A) $\mathrm{C3}$
(B) $\mathrm{CA}$
(C) $\mathrm{C5}$
(D) $\mathrm{C} 6$
(E) $\mathrm{C} 7$

Briana De La Torre
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01:27

Problem 32

Rotation of the cervical spine occurs at
(A) atlantooccipital joint
(B) atlantoaxial joint
(C) atlantofacet joint
(D) cervical-facet joints at $\mathrm{C}_2-\mathrm{C}_3$
(E) cervical-facet joints at $\mathrm{C3}-\mathrm{C} 4$

Qudsiya Anis
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01:55

Problem 33

The nucleus pulposus in the cervical spine is absent after the age of
(A) 20 years
(B) 40 years
(C) 50 years
(D) 60 years
(E) 70 years

Bryan Lynn
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00:38

Problem 34

Kuntz nerves are a contribution from
(A) the C5 sympathetic fibers to the upper extremity
(B) the C6 sympathetic fibers to the upper extremity
(C) the T1 sympathetic fibers to the upper extremity
(D) the T2 sympathetic fibers to the upper extremity
(E) the C7 sympathetic fibers to the upper extremity

Joanna Quigley
Joanna Quigley
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00:41

Problem 35

Achilles reflex is diminished when the following nerve root is affected:
(A) $\mathrm{L} 3$
(B) L4
(C) $\mathrm{L5}$
(D) $\mathrm{S} 1$
(E) L2

Joanna Quigley
Joanna Quigley
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00:20

Problem 36

The dermatome corresponding to the area over the medial malleolus is
(A) LA
(B) $\mathrm{L} 5$
(C) 51
(D) 52
(E) 1.3

Alexander Burbelo
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01:19

Problem 37

The medial branch of the dorsal rami innervates the following
(A) multifidus muscle
(B) subarachnoid mater
(C) ligamentum flavum
(D) quadratus lumborum muscle
(E) piriformis muscle

Willis James
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00:19

Problem 38

The psoas major muscle is
(A) flexor of the spine
(B) flexor of the hip
(C) inserts into the greater trochanter of the femur
(D) axial rotator of the lumbar spine
(E) extensor of the spine

Andrei Demkov
Andrei Demkov
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Problem 39

The principal action of the piriformis muscle is
(A) lateral flexion of the hip
(B) external rotation of the femur
(C) extension of the hip
(D) internal rotation of the femur
(E) knee flexion

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00:25

Problem 40

The lumbar facet joint is innervated by
(A) branches from the dorsal ramus at the same level and level above
(B) branches from the dorsal ramus at the same level and level below
(C) branches from the dorsal ramus at the same level
(D) branches from the dorsal ramus at the level below and level above
(E) corresponding spinal nerve root

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Problem 41

The lumbar facet joints are oriented:
(A) In coronal plane
(B) In a sagittal plane
(C) $45^{\circ}$ off the saggital plane
(D) $20^{\circ}$ off the coronal plane
(E) $20^{\circ}$ off the saggital plane

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Problem 42

The nerve involved in meralgia paresthetica is
(A) lateral femoral cutaneous nerve
(B) medial femoral cutancous nerve
(C) femoral nerve
(D) obturator nerve
(E) Inguinal nerve

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01:42

Problem 43

The lumbar sympathetic chain lies
(A) anterior to the transverse process of the lumbar vertebra
(B) anterolateral border of the lumbar vertebral bodies
(C) anteriorly over the lumbar vertebral bodies
(D) posteriorly to the abdominal aorta
(E) posteriorly to the inferior vena cava

Joanna Quigley
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Problem 44

A 56-year-old man presents with pain in the left flank. He gives a history of a rash for 1 week. The pain is burning in character and is sensitive to touch. He most likely has
(A) costochondritis
(B) herpes zoster
(C) fractured left rib
(D) postherpetic neuralgia
(E) angina pectoris

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05:42

Problem 45

Pain in the gluteal region produced by hip flexion, adduction, and internal rotation is caused by
(A) sacroiliac joint
(B) obturator muscle
(C) hip joint
(D) piriformis muscle
(E) gluteus medius

Noah Boudrie
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01:57

Problem 2111

Blood supply to the spinal cord is by
(A) two posterior spinal arteries and two anterior spinal arteries
(B) two posterior spinal arteries and one anterior spinal artery
(C) branches of the lumbar arteries
(D) radicularis magna (artery of Adamkiewicz) and two posterior spinal arteries
(E) internal iliac arteries

Asma Venkitta
Asma Venkitta
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