Neurology, MBBS Second Year. This chapter is split into 3 topics and has
147 practice questions. The topics covered are listed below, followed by
10 free sample questions from the chapter.
Topics in this chapter
Clinical Scenarium: Meningitis and Lumbar Puncture47 questions
Meningeal Coverings and Spaces50 questions
Pia Mater Extensions and Vertebral Ligaments50 questions
Sample questions: NN 32. Spinal cord meninges
10 sample questions with the correct answer and an explanation. Try to answer each one before reading the explanation.
Q1. During a midline lumbar puncture, which three ligaments must the needle traverse in order from superficial to deep?
A. Supraspinous → ligamentum flavum → interspinous
B. Ligamentum flavum → interspinous → supraspinous
C. Supraspinous → interspinous → ligamentum flavum(correct answer)
D. Interspinous → supraspinous → ligamentum flavum
Answer: C.Approaching from the skin, the needle passes the supraspinous ligament (tips of spinous processes), then the interspinous ligament (between spinous processes), then the ligamentum flavum (connecting the laminae).
Q2. A patient with fever and a stiff neck cannot tolerate bright rooms or loud noises. What are these two complaints called?
A. Diplopia and tinnitus, features of brainstem infarction
B. Hyperosmia and hyperacusis, features of temporal lobe seizures
C. Anosmia and ageusia, features of olfactory nerve injury
D. Photophobia and phonophobia, features of meningeal irritation(correct answer)
Answer: D.Photophobia and phonophobia accompany meningeal irritation along with headache, fever, neck stiffness and confusion in the note's scenario. Standard knowledge (beyond the note): the terms photophobia and phonophobia.
Q3. Kernig's sign, used to support the diagnosis of meningitis, is best described as:
A. Resistance and pain on extending the knee while the hip is flexed(correct answer)
B. Dorsiflexion of the big toe on stroking the sole of the foot
C. Flexion of the hips when the patient's neck is passively flexed
D. Involuntary jerking of the foot on tapping the Achilles tendon
Answer: A.Kernig's sign is pain and resistance on knee extension with the hip flexed to 90 degrees. Standard knowledge (beyond the note): Kernig and Brudzinski signs are classic bedside tests of meningeal irritation.
Q4. A lumbar puncture in a young adult yields cloudy CSF. Which pattern of results is most typical of bacterial meningitis?
A. Many red cells only, with normal protein and glucose
B. Many lymphocytes, normal protein and normal glucose
C. Few cells, low protein and raised glucose
D. Many neutrophils, raised protein and low glucose(correct answer)
Answer: D.Bacterial infection causes a neutrophilic pleocytosis with high protein and low CSF glucose because bacteria and cells consume glucose. Standard knowledge (beyond the note): CSF interpretation; the note itself only names lumbar puncture as the definitive step.
Q5. A drowsy patient with fever and neck stiffness has a papilloedema suggestive of raised intracranial pressure. What is the safest approach before lumbar puncture?
A. Perform the puncture at once at a higher interspace to relieve pressure
B. Perform the puncture in the upright sitting posture with no imaging
C. Cancel the puncture permanently and treat as a tension headache
D. Obtain brain imaging first to exclude a mass lesion or obstruction(correct answer)
Answer: D.Removing CSF below a mass lesion or with obstructed flow risks herniation, so imaging is done first when raised pressure is suspected. Standard knowledge (beyond the note): contraindication to immediate lumbar puncture.
Q6. A patient has fever, neck stiffness and photophobia, but CSF shows mainly lymphocytes with normal glucose and mildly raised protein. Which cause is most likely?
A. A subarachnoid bleed from a ruptured aneurysm
B. A pyogenic bacterial infection of the meninges
C. A traumatic tap with blood from the epidural veins
D. A viral infection of the meninges(correct answer)
Answer: D.Viral meningitis typically gives a lymphocytic CSF with normal glucose, unlike the neutrophilic, low-glucose picture of bacterial meningitis. Standard knowledge (beyond the note): CSF patterns in meningitis.
Q7. Below the end of the cord at L1-L2, what mainly floats in the CSF at the L3-L4 level where the needle is placed?
A. The nerve roots of the cauda equina(correct answer)
B. The posterior columns of the cord
C. The conus medullaris of the cord
D. The denticulate ligaments of the cord
Answer: A.Below the conus the CSF sac contains the cauda equina; the roots tend to be displaced by the needle rather than pierced. Standard knowledge (beyond the note): lumbar cistern contents; the note gives the cord end and the cauda equina.
Q8. An anaesthetist injects a drug into the fat- and vein-filled space of the vertebral canal outside the dura. Which space is this?
A. The epidural space(correct answer)
B. The subdural space
C. The space between pia and arachnoid
D. The subarachnoid space
Answer: A.The epidural space is a real space in the spinal canal filled with fat and veins; the subarachnoid space is the CSF-filled space. Standard knowledge (beyond the note): epidural anaesthesia targets this space.
Q9. Which ligament is yellow and elastic and is felt as a 'give' when a needle passes through it?
A. The supraspinous ligament
B. The ligamentum flavum(correct answer)
C. The interspinous ligament
D. The denticulate ligament
Answer: B.Standard knowledge (beyond the note): the ligamentum flavum (flavum means yellow) is rich in elastic fibres and gives a characteristic loss of resistance on needle passage; the note states only that it connects the laminae.
Q10. The 'internal' part of the filum terminale lies inside the dural sac and ends at which level?
A. About L1, where the cord ends
B. About S2, where the dural sac ends(correct answer)
C. About T12, at the diaphragm
D. About the coccyx tip, outside the sac
Answer: B.The filum terminale internum runs within the CSF sac down to about S2, after which the externum continues to the coccyx. Standard knowledge (beyond the note): parts of the filum terminale; the note describes the extension as reaching the coccyx.