NRMS 5190 Advanced Pathophysiology — Exam 3 Comprehensive Review | Questions and Answers
with Rationales | 2026/27 Update | 100% Correct -SUNY Downstate Medical Center
Section I — Neurologic, Pain, Neurodegenerative,
Cerebrovascular & Psychiatric Pathophysiology
1. A patient loses the ability to perceive pain and temperature below a spinal cord lesion
while fine touch remains intact. Which pathway is most directly affected?
A. Dorsal column-medial lemniscal pathway
B. Anterolateral pathway
C. Corticospinal tract
D. Vestibulospinal tract
Answer: B — Anterolateral pathway.
Rationale: The anterolateral/spinothalamic system carries pain, temperature, crude touch, and
pressure. Discriminative touch and proprioception travel predominantly through the dorsal-
column system.
2. A patient can feel an object placed in the hand but cannot identify it with the eyes closed.
What deficit is present?
A. Aphasia
B. Astereognosis
C. Ataxia
D. Dysmetria
Answer: B — Astereognosis.
Rationale: Stereognosis requires intact peripheral sensation, discriminative sensory pathways,
and higher-order parietal association cortex. Loss of this ability is astereognosis.
3. Which nerve fibers are primarily responsible for the initial sharp, well-localized
component of pain?
A. C fibers
B. A-delta fibers
C. B fibers
D. Autonomic postganglionic fibers
Answer: B — A-delta fibers.
Rationale: Myelinated A-delta fibers conduct relatively rapid, sharp pain. Small unmyelinated C
fibers conduct slower, diffuse, burning or aching pain.
4. A patient with diabetes describes burning feet, paresthesias, and electric-shock
sensations even though there is no new tissue injury. Which mechanism best explains the
pain?
A. Nociceptive pain
,B. Neuropathic pain
C. Referred pain
D. Visceral pain
Answer: B — Neuropathic pain.
Rationale: Neuropathic pain results from a lesion or disease affecting the somatosensory
nervous system rather than activation of otherwise normal nociceptors by damaged tissue.
5. A patient reports intense pain when a bedsheet lightly touches the leg. This phenomenon
is called:
A. Hyperreflexia
B. Allodynia
C. Anesthesia
D. Dysesthesia only
Answer: B — Allodynia.
Rationale: Allodynia is pain produced by a stimulus that normally would not cause pain, such as
light touch.
6. Why can myocardial ischemia be perceived as discomfort in areas distant from the
heart?
A. Peripheral motor neurons become hyperexcitable
B. Visceral and somatic afferents converge on shared spinal neurons
C. The vagus nerve becomes completely blocked
D. Cerebellar neurons misinterpret proprioception
Answer: B.
Rationale: Referred pain occurs partly because visceral and somatic sensory afferents converge
at similar spinal cord levels, causing the CNS to mislocalize the source.
7. Which duration best fits the contemporary definition of chronic pain?
A. Longer than 1 week
B. Longer than 1 month
C. Persistent or recurrent for longer than 3 months
D. Longer than 12 months
Answer: C.
Rationale: Current IASP classification generally defines chronic pain as pain persisting or
recurring for more than three months, rather than the older six-month threshold in the guide.
(IASP)
8. Which presentation is most characteristic of migraine without aura in an adult?
A. Bilateral pressure lasting 15 minutes without associated symptoms
B. Recurrent pulsating headache lasting 4–72 hours with nausea and/or light and sound
sensitivity
, C. Seconds of facial pain triggered by touching the cheek
D. Constant headache with fever and nuchal rigidity
Answer: B.
Rationale: Migraine without aura usually produces moderate-to-severe pulsating headache,
often unilateral and aggravated by routine activity, with nausea/vomiting or photophobia and
phonophobia. Adult attacks typically last 4–72 hours. (ICHD)
9. Which finding most strongly supports migraine with typical aura?
A. Permanent monocular blindness
B. Gradually developing, fully reversible visual or sensory symptoms
C. Persistent paralysis for several days
D. Continuous fever
Answer: B.
Rationale: Typical aura consists of fully reversible visual, sensory, and/or speech-language
symptoms that develop gradually and generally resolve within an hour. (ICHD)
10. Which description best fits a tension-type headache?
A. Severe unilateral orbital pain with autonomic findings
B. Dull pressure or “band-like” discomfort that is not usually aggravated by routine activity
C. Sudden explosive headache with meningismus
D. Recurrent electric-shock facial pain
Answer: B.
Rationale: Tension-type headache is typically pressing/tightening rather than pulsating and is
often described as a band around the head.
11. A patient has repeated attacks of excruciating unilateral periorbital pain associated
with tearing and nasal congestion. Which headache is most likely?
A. Tension headache
B. Cluster headache
C. Medication-overuse headache
D. Postconcussion headache
Answer: B — Cluster headache.
Rationale: Cluster headache is a trigeminal autonomic cephalalgia characterized by severe
unilateral orbital/temporal pain with ipsilateral autonomic manifestations.
12. Which feature most clearly distinguishes heatstroke from an uncomplicated fever?
A. Increase in body temperature
B. CNS dysfunction associated with uncontrolled hyperthermia
C. Sweating
D. Tachycardia
with Rationales | 2026/27 Update | 100% Correct -SUNY Downstate Medical Center
Section I — Neurologic, Pain, Neurodegenerative,
Cerebrovascular & Psychiatric Pathophysiology
1. A patient loses the ability to perceive pain and temperature below a spinal cord lesion
while fine touch remains intact. Which pathway is most directly affected?
A. Dorsal column-medial lemniscal pathway
B. Anterolateral pathway
C. Corticospinal tract
D. Vestibulospinal tract
Answer: B — Anterolateral pathway.
Rationale: The anterolateral/spinothalamic system carries pain, temperature, crude touch, and
pressure. Discriminative touch and proprioception travel predominantly through the dorsal-
column system.
2. A patient can feel an object placed in the hand but cannot identify it with the eyes closed.
What deficit is present?
A. Aphasia
B. Astereognosis
C. Ataxia
D. Dysmetria
Answer: B — Astereognosis.
Rationale: Stereognosis requires intact peripheral sensation, discriminative sensory pathways,
and higher-order parietal association cortex. Loss of this ability is astereognosis.
3. Which nerve fibers are primarily responsible for the initial sharp, well-localized
component of pain?
A. C fibers
B. A-delta fibers
C. B fibers
D. Autonomic postganglionic fibers
Answer: B — A-delta fibers.
Rationale: Myelinated A-delta fibers conduct relatively rapid, sharp pain. Small unmyelinated C
fibers conduct slower, diffuse, burning or aching pain.
4. A patient with diabetes describes burning feet, paresthesias, and electric-shock
sensations even though there is no new tissue injury. Which mechanism best explains the
pain?
A. Nociceptive pain
,B. Neuropathic pain
C. Referred pain
D. Visceral pain
Answer: B — Neuropathic pain.
Rationale: Neuropathic pain results from a lesion or disease affecting the somatosensory
nervous system rather than activation of otherwise normal nociceptors by damaged tissue.
5. A patient reports intense pain when a bedsheet lightly touches the leg. This phenomenon
is called:
A. Hyperreflexia
B. Allodynia
C. Anesthesia
D. Dysesthesia only
Answer: B — Allodynia.
Rationale: Allodynia is pain produced by a stimulus that normally would not cause pain, such as
light touch.
6. Why can myocardial ischemia be perceived as discomfort in areas distant from the
heart?
A. Peripheral motor neurons become hyperexcitable
B. Visceral and somatic afferents converge on shared spinal neurons
C. The vagus nerve becomes completely blocked
D. Cerebellar neurons misinterpret proprioception
Answer: B.
Rationale: Referred pain occurs partly because visceral and somatic sensory afferents converge
at similar spinal cord levels, causing the CNS to mislocalize the source.
7. Which duration best fits the contemporary definition of chronic pain?
A. Longer than 1 week
B. Longer than 1 month
C. Persistent or recurrent for longer than 3 months
D. Longer than 12 months
Answer: C.
Rationale: Current IASP classification generally defines chronic pain as pain persisting or
recurring for more than three months, rather than the older six-month threshold in the guide.
(IASP)
8. Which presentation is most characteristic of migraine without aura in an adult?
A. Bilateral pressure lasting 15 minutes without associated symptoms
B. Recurrent pulsating headache lasting 4–72 hours with nausea and/or light and sound
sensitivity
, C. Seconds of facial pain triggered by touching the cheek
D. Constant headache with fever and nuchal rigidity
Answer: B.
Rationale: Migraine without aura usually produces moderate-to-severe pulsating headache,
often unilateral and aggravated by routine activity, with nausea/vomiting or photophobia and
phonophobia. Adult attacks typically last 4–72 hours. (ICHD)
9. Which finding most strongly supports migraine with typical aura?
A. Permanent monocular blindness
B. Gradually developing, fully reversible visual or sensory symptoms
C. Persistent paralysis for several days
D. Continuous fever
Answer: B.
Rationale: Typical aura consists of fully reversible visual, sensory, and/or speech-language
symptoms that develop gradually and generally resolve within an hour. (ICHD)
10. Which description best fits a tension-type headache?
A. Severe unilateral orbital pain with autonomic findings
B. Dull pressure or “band-like” discomfort that is not usually aggravated by routine activity
C. Sudden explosive headache with meningismus
D. Recurrent electric-shock facial pain
Answer: B.
Rationale: Tension-type headache is typically pressing/tightening rather than pulsating and is
often described as a band around the head.
11. A patient has repeated attacks of excruciating unilateral periorbital pain associated
with tearing and nasal congestion. Which headache is most likely?
A. Tension headache
B. Cluster headache
C. Medication-overuse headache
D. Postconcussion headache
Answer: B — Cluster headache.
Rationale: Cluster headache is a trigeminal autonomic cephalalgia characterized by severe
unilateral orbital/temporal pain with ipsilateral autonomic manifestations.
12. Which feature most clearly distinguishes heatstroke from an uncomplicated fever?
A. Increase in body temperature
B. CNS dysfunction associated with uncontrolled hyperthermia
C. Sweating
D. Tachycardia
