1. A 30-year-old man was driving a motorcycle when he swerved off the road and suffered a severe spinal cord injury. When he was being treated at an emergency room, on neurological examination he was noted to have lost the sense of touch on his right leg and lower trunk, to the level of the umbilicus. He also had lost pain sensation. Which of the following statements best describes the side and lowest dermatomal level of remaining pain sensation?

A. Left side of spinal cord at the 10th thoracic segment (T10)
B. Left, L1
C. Right, L1
D. Right, T10

Comment: Because the anterolateral system decussates in the spinal cord, pain will be lost on the left side, opposite the side for touch. Because the pain pathway ascends as it decussates, as well as afferent fibers ascending within Lissauer’s tract, pain sense is preserved for a segment or two below the level of the lesion.

2. Which of the following best describes a nociceptor?

A. Pacinian corpuscle
B. Ruffini’s corpuscle
C. Meissner’s corpuscle
D. Unencapsulated receptor

3. Small-diameter afferent fibers terminate within which listed region of the spinal cord gray matter?

A. Superficial laminae of the dorsal horn
B. Deep layers of the dorsal horn
C. Intermediate zone
D. Ventral horn

4. Pain signals from caudal visceral structures ascend within which spinal pathway?

A. Cuneate fascicle
B. Gracile fascicle
C. Anterolateral column
D. Ventral column

5. Occlusion of the posterior inferior cerebellar artery results in which of the following patterns of analgesia?

A. Loss of pain on the ipsilateral arms and legs
B. Loss of pain on the contralateral arms and legs
C. Bilateral loss of pain on the arms and legs
D. There would be no change in pain

6. A soldier was injured in battle. Despite the injury, and the tissue damage that the injury caused, the soldier was able to continue to engage the enemy. Which of the following best explains why the soldier was able to continue engaging the enemy?

A. Brain stem noradrenergic and serotonergic descending tracts that inhibit dorsal horn pain transmission can be activated by areas of the brain engaged in emotions.
B. Brain stem cholinergic and serotonergic descending tracts that inhibit dorsal horn pain transmission can be activated by areas of the brain engaged in emotions.
C. Spinal nociceptive circuits engage local feedback inhibitory mechanisms to limit nociceptive transmission in the dorsal horn.
D. Cognitive systems of the brain can directly inhibit spinal pain circuits.

7. The raphe nuclei are to the periaqueductal gray matter, as

A. the spinoreticular tract is to the spinothalamic tract
B. 5-HT is to glutamate
C. pain suppression is to pain arousal
D. burning pain is to sharp pain

8. Which thalamic nucleus does not play a key role in pain and thermal sensations?

A. Ventral posterior nucleus
B. Ventral medial posterior nucleus
C. Medial dorsal nucleus
D. Lateral geniculate nucleus

9. Which of the following statements best describes how pain signals from the spinal cord reach the amygdala?

A. Spinoreticular tract, to the parabrachial nucleus, to the amygdala
B. Spinothalamic tract, to the thalamic reticular nucleus, to the amygdala
C. Spinothalamic tract, to the ventral posterior lateral nucleus, to the amygdala
D. Spinomesencephalic tract, to the superior colliculus, to the periaqueductal gray matter, to the amygdala

10. The anterior cingulate gyrus is not important for which of the following pain functions and pain pathway connections?

A. Localizing a painful stimulus
B. Emotional aspects of pain
C. Emotional hurt
D. Receives input from the medial dorsal nucleus