Test Bank for Neuroscience Fundamentals for Rehabilitation 4th Edition by Lundy Ekman

Test Bank for Neuroscience Fundamentals for

Rehabilitation 4th Edition by Lundy Ekman

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Lundy-Ekman: Neuroscience: Fundamentals for Rehabilitation, 4th Edition
Chapter 7: Somatosensation: Clinical Application

Test Bank

1. Sensory extinction is the:

A. Inability to recognize any sensations consciously.
B. Loss of conscious proprioception.
C. Same as astereognosis.
D. Awareness of stimuli on only one side of the body when both sides of the body are
simultaneously stimulated.
E. Inability to localize a pinprick on one side of the body.

ANS: D
Rationale: In cases of sensory extinction (also called sensory inattention), the loss of sensation
is only evident when symmetrical body parts are tested bilaterally.

2. The role of enkephalins in the spinal cord is:

A. To decrease release of substance P from the primary afferent.
B. To hyperpolarize spinal interneurons in the pain pathway.
C. To stimulate non-nociceptive interneurons of the dorsal horn.
D. A and B
E. A, B, and C

ANS: D
Rationale: Enkephalins bind with receptor sites on both the primary afferents and interneurons
of the pain system. Enkephalin binding depresses the release of substance P and
hyperpolarizes the interneurons, thus inhibiting the transmission of nociceptive signals.

3. When the raphespinal tract is active, which neurotransmitter is released at the axon terminal in
the dorsal horn of the spinal cord?
A. Norepinephrine
B. Gamma-aminobutyric acid (GABA)
C. Dopamine
D. Substance P
E. Serotonin

ANS: E
Rationale: When the rostral ventromedial medulla is electrically stimulated, the raphespinal
tracts (i.e., the axons projecting to the spinal cord) release the neurotransmitter, serotonin, in
the dorsal horn, inhibiting the tract neurons via enkephalin interneurons and thus interfering
with the transmission of nociceptive messages.

4. Which of the following is(are) part of the fast-descending neuronal system for pain inhibition?

Copyright © 2013 by Saunders, an imprint of Elsevier Inc.

Test bank 7-2

A. Rostral ventromedial medulla

B. Periaqueductal gray
C. Locus coeruleus
D. A, B, and C
E. None of the above

ANS: D
Rationale: The brainstem areas that provide intrinsic antinociception form a neuronal
descending system, arising in the following: rostral ventromedial medulla, periaqueductal
gray (PAG) in the midbrain, and locus coeruleus in the pons.

5. The locus coeruleus is located in which one of the following?

A. Spinal cord dorsal horn
B. Medulla
C. Pons
D. Midbrain
E. Cerebral cortex

ANS: C
Rationale: The locus coeruleus is located in the pons.

6. The periaqueductal gray is located in which one of the following?

A. Spinal cord dorsal horn
B. Medulla
C. Pons
D. Midbrain
E. Cerebral cortex

ANS: D
Rationale: The periaqueductal gray is located in the midbrain.

7. Which of the following guidelines will improve the reliability of sensory testing?
A. Explain the purpose of the testing.
B. Administer the test in a loud environment.
C. Apply stimuli near the center of the dermatomes being tested.
D. A and C

ANS: D
Rationale: The following guidelines serve to improve the reliability of sensory testing: (1)
administer the tests in a quiet, distraction-free setting; (2) position the patient seated or lying
and supported by a firm, stable surface to avoid challenging balance during the test; (3)
explain the purpose of the test; (4) demonstrate each test before administering it; during the
demonstration, allow the patient to see the stimulus; (5) during testing, block the patient’s
vision by having the patient close the eyes or wear a blindfold or by placing a barrier between
the part being tested and the patient’s eyes; and (6) apply stimuli near the center of the
dermatomes being tested.

Copyright © 2013 by Saunders, an imprint of Elsevier Inc.

 Test bank 7-3

8. Which of the following is not measured during a complete sensory evaluation?

A. Proprioceptive thresholds
B. Conscious touch sensitivity
C. Thresholds for stimulation
D. All of the above

ANS: A
Rationale: A complete sensory evaluation includes measuring sensitivity and thresholds for
stimulation of each conscious sensation, except proprioceptive thresholds, which are not
measured. For example, a measure of conscious touch sensitivity is the ability to distinguish
between two closely applied points on the skin; threshold is the lowest intensity of a stimulus
that can be perceived, similar to when the person barely perceives being touched.

9. If only one sensory root is severed, does a complete loss of sensation result in that area?
A. Yes. Sensation does not depend on multiple dermatomes.
B. No. Overlapping dermatomes ensure not all sensation is lost.
C. No. Multiple sensory roots must be severed for complete sensory loss to occur.
D. Yes. Overlapping dermatomes will not prevent complete sensation loss.

ANS: B
Rationale: The results of somatosensory testing procedures can be used to map a person's
pattern of sensory loss. The resulting map can be compared with standardized maps of
peripheral nerve distribution and of dermatome distributions to determine whether the person's
pattern of sensory loss is consistent with a peripheral nerve or a spinal region pattern. Because
every individual is unique and adjacent dermatomes overlap one another, the maps presented
represent common but not definitive nerve distributions. The overlap of adjacent dermatomes
also ensures that if only one sensory root is severed, then a complete loss of sensation does
not occur in any area.

10. What numerical value(s) is (are) involved in determining whether the results of a nerve
conduction study are normal?
A. Conduction velocity
B. Distal latency
C. Amplitude of the evoked potential
D. All of the above

ANS: D
Rationale: To determine whether a nerve conduction study is normal, three numerical values
are compared: (1) distal latency, (2) amplitude of the evoked potential, and (3) conduction
velocity.

11. If sitting with the legs crossed, sensory loss will eventually occur. (Part of the limb will “fall
asleep.”) In what order will this loss occur? (Hint: compression of a nerve affects function in
order according to axon diameter and myelination; largest diameter myelinated axons are
affected first)

Copyright © 2013 by Saunders, an imprint of Elsevier Inc.

Test bank 7-4

A. 1. Slow pain; 2. heat; 3. fast pain; 4. cold; 5. conscious proprioception and discriminative
touch
B. 1. Conscious proprioception and discriminative touch; 2. heat; 3. fast pain; 4. cold; 5. slow
pain
C. 1. Conscious proprioception and discriminative touch; 2. cold; 3. fast pain; 4. heat; 5. slow
pain
D. 1. Slow pain; 2. cold; 3. fast pain; 4. heat; 5. conscious proprioception and discriminative
touch

ANS: C
Rationale: When a person stands up after prolonged sitting with the legs crossed, occasionally,
the person finds that part of the limb has “fallen asleep.” The sensory loss proceeds in the
following order: 1. conscious proprioception and discriminative touch; 2. cold; 3. fast pain; 4.
heat; and 5. slow pain.

12. Loss of pain and temperature information from the left lower limb below the L4 dermatome,
complete loss of discriminative touch and conscious proprioception information from the right
lower limb below the L2 dermatome, and loss of voluntary control of the right lower limb
below the L2 dermatome indicates which one of the following?
A. Brown-Séquard syndrome produced by a hemisection of the cord at L4 on the right side
B. Brown-Séquard syndrome produced by a hemisection of the cord at L4 on the left side
C. Brown-Séquard syndrome produced by a complete transection of the cord
D. Brown-Séquard syndrome produced by a hemisection of the cord at L2 on the right side
E. Brown-Séquard syndrome produced by a hemisection of the cord at L2 on the left side

ANS: D
Rationale: A hemisection (i.e., damage to the right or left half of the cord) interrupts pain and
temperature sensation from the contralateral body because the axons transmitting nociceptive
and temperature information cross to the opposite side of the cord soon after entering the cord.
As a result of collateral branching of nociceptive axons in the dorsolateral tract, the complete
loss of pain sensation occurs two to three dermatomes below the level of the lesion. Because
discriminative touch and conscious proprioception information ascends on the same side of
the cord as it entered, these sensations are lost ipsilateral to the lesion. Paralysis also occurs
ipsilaterally. The pattern of loss is called Brown-Séquard syndrome.

13. Lesions in what location(s) will result in decreased or lost sensation from the contralateral
body or face?
A. Ventral posterolateral (VPL) nucleus of the thalamus
B. Ventral posteromedial (VPM) nucleus of the thalamus
C. A and B
D. None of the above

ANS: C
Rationale: Lesions in the VPL or VPM nucleus of the thalamus result in decreased or lost
sensation from the contralateral body or face because all somatosensory information has

Copyright © 2013 by Saunders, an imprint of Elsevier Inc.

Test bank 7-5

crossed the midline before reaching the thalamus. Rarely, people who have strokes that affect
the VPL or VPM nucleus have severe pain in the contralateral body or face.

14. Which of the following is(are) part of the pain matrix?

A. Amygdala
B. Thalamus
C. Hypothalamus
D. All of the above

ANS: D
Rationale: The pain matrix includes parts of the brainstem, amygdala, hypothalamus,
thalamus, and cerebral cortex.

15. What does the counterirritant theory hypothesizes a mechanism affecting:

A. Pain transmission
B. Pain treatment
C. Pain amplification
D. None of the above

ANS: A
Rationale: A theory that has incorporated findings from research stimulated by the gate theory
is the counterirritant theory. According to the counterirritant theory, inhibition of nociceptive
signals by stimulation of non-nociceptive receptors occurs in the dorsal horn of the spinal
cord.

16. Which of the following are not endorphins?

A. Dynorphins
B. -Endorphins
C. Enkephalins
D. All of the above are types of endorphins.

ANS: D
Rationale: Antinociception is the suppression of pain in response to stimulation that would
normally be painful. The endogenous or natural-occurring substances that activate
antinociceptive mechanisms are called endorphins. Endorphins include enkephalins,
dynorphins, and -endorphins.

17. Which of the following is a site in the nervous system where the transmission of nociceptive
information can be altered?
A. Hormonal system
B. Dorsal horn
C. Cortical level
D. All of the above
ANS: D
Rationale: The transmission of nociceptive information can be altered at several locations in
the nervous system. The phenomenon of antinociception is summarized with a five-level

Copyright © 2013 by Saunders, an imprint of Elsevier Inc.

Test Bank for Neuroscience Fundamentals for Rehabilitation 4th Edition by Lundy Ekman

Test bank 7-6

model: Level 1 occurs in the periphery; level II occurs in the dorsal horn; level III is the fast-
acting neuronal descending system; level IV is the hormonal system; and level V is the
cortical level.

18. Which of the following are NOT characteristics of acute pain?

A. Threat of or actual tissue damage
B. Dysfunction of endogenous pain control systems
C. Clear description of the location of the pain
D. Excessive autonomic activity

ANS: B
Rationale: See Table 7-4.

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