NRMS 5190 Advanced
Pathophysiology — Full Exam with
correct answers and rationale
updated 2026 graded A+
SECTION A: NEUROLOGICAL PATHOPHYSIOLOGY
AND PAIN (Questions 1–25)
1. Which pathway transmits signals for pain, thermal sensation, crude touch,
and pressure?
A) Discriminative pathway
B) Anterolateral pathway
C) Dorsal column-medial lemniscus pathway
D) Spinocerebellar pathway
Answer: B) Anterolateral pathway
Rationale: The anterolateral pathway sends signals for pain, thermal sensation, crude
touch, and pressure -1 . The discriminative pathway relays precise spatial information
and is used for perception and arousal -1 .
2. A-delta fibers are responsible for which type of pain transmission?
A) Slow, dull aching pain
B) Fast pain
C) Visceral pain only
D) Referred pain
Answer: B) Fast pain
Rationale: A-delta fibers are associated with fast pain, while C fibers are smaller and
transmit slower wave pain -1 .
3. The neospinothalamic tract is primarily associated with which type of pain?
A) Dull, aching pain
B) Sharp, stabbing pain
C) Chronic visceral pain
D) Referred pain
Answer: B) Sharp, stabbing pain
Rationale: The neospinothalamic tract transmits sharp stabbing pain, whereas the
,paleospinothalamic tract is associated with dull aching pain commonly seen in
chronic and visceral pain -1 .
4. Which type of pain occurs when nociceptors are activated in response to
actual or impending tissue injury?
A) Neuropathic pain
B) Nociceptive pain
C) Referred pain
D) Phantom pain
Answer: B) Nociceptive pain
Rationale: Nociceptive pain occurs when nociceptors (pain receptors) are activated
in response to actual or impending tissue injury. When this occurs in internal organs,
it is known as visceral pain -1-5 .
5. Neuropathic pain can be caused by all of the following EXCEPT:
A) Diabetes
B) Long-term alcohol use
C) Hypothyroidism
D) Acute muscle strain
Answer: D) Acute muscle strain
Rationale: Neuropathic pain can be caused by diabetes, long-term alcohol use,
hypothyroidism, rash, or trauma -1-5 . Acute muscle strain would produce
nociceptive pain, not neuropathic pain.
6. Allodynia is best defined as:
A) Loss of pain sensation
B) Extreme sensitivity to touch
C) Pain originating in visceral organs
D) Pain perceived at a site distant from its origin
Answer: B) Extreme sensitivity to touch
Rationale: Allodynia is extreme sensitivity to touch, such as wind, sheets, or water.
Patients cannot let sheets touch the affected area -1 .
7. Which type of pain originates at a visceral site but is perceived as originating
in part of the body wall innervated by neurons entering the same segment of
the nervous system?
A) Cutaneous pain
B) Deep somatic pain
C) Referred pain
D) Visceral pain
, Answer: C) Referred pain
Rationale: Referred pain originates at a visceral site but is perceived as originating in
part of the body wall that is innervated by neurons entering the same segment of the
nervous system -1 .
8. Acute pain is defined as pain that lasts:
A) Less than 3 months
B) Less than 6 months
C) More than 6 months
D) More than 12 months
Answer: B) Less than 6 months
Rationale: Acute pain is self-limiting pain that lasts less than 6 months. Chronic pain
is persistent pain lasting longer than 6 months -1 .
9. Trigeminal neuralgia affects which cranial nerve?
A) Cranial Nerve VII
B) Cranial Nerve V
C) Cranial Nerve IX
D) Cranial Nerve X
Answer: B) Cranial Nerve V
Rationale: Trigeminal neuralgia affects Cranial Nerve V and is characterized by sharp,
stabbing pain without numbness. There is demyelination of axons in the ganglion,
root, and nerve -1 .
10. Complex regional pain syndrome is characterized by:
A) Pain that is proportionate to the injury
B) Chronic arm or leg pain after injury, surgery, or heart attack with pain greater than
expected
C) Pain limited to the skin only
D) Pain that resolves spontaneously within weeks
Answer: B) Chronic arm or leg pain after injury, surgery, or heart attack with
pain greater than expected
Rationale: Complex regional pain syndrome is characterized by chronic arm or leg
pain after an injury, surgery, or heart attack. Pain is greater than would be expected
from the injury that causes it -5 .
11. In a neurological exam, a patient holds both arms straight forward with
palms up and eyes closed for 30 seconds. The right arm slowly drifts downward
and rotates internally. This finding indicates:
A) Cerebellar dysfunction
B) Contralateral corticospinal tract/upper motor neuron dysfunction
Pathophysiology — Full Exam with
correct answers and rationale
updated 2026 graded A+
SECTION A: NEUROLOGICAL PATHOPHYSIOLOGY
AND PAIN (Questions 1–25)
1. Which pathway transmits signals for pain, thermal sensation, crude touch,
and pressure?
A) Discriminative pathway
B) Anterolateral pathway
C) Dorsal column-medial lemniscus pathway
D) Spinocerebellar pathway
Answer: B) Anterolateral pathway
Rationale: The anterolateral pathway sends signals for pain, thermal sensation, crude
touch, and pressure -1 . The discriminative pathway relays precise spatial information
and is used for perception and arousal -1 .
2. A-delta fibers are responsible for which type of pain transmission?
A) Slow, dull aching pain
B) Fast pain
C) Visceral pain only
D) Referred pain
Answer: B) Fast pain
Rationale: A-delta fibers are associated with fast pain, while C fibers are smaller and
transmit slower wave pain -1 .
3. The neospinothalamic tract is primarily associated with which type of pain?
A) Dull, aching pain
B) Sharp, stabbing pain
C) Chronic visceral pain
D) Referred pain
Answer: B) Sharp, stabbing pain
Rationale: The neospinothalamic tract transmits sharp stabbing pain, whereas the
,paleospinothalamic tract is associated with dull aching pain commonly seen in
chronic and visceral pain -1 .
4. Which type of pain occurs when nociceptors are activated in response to
actual or impending tissue injury?
A) Neuropathic pain
B) Nociceptive pain
C) Referred pain
D) Phantom pain
Answer: B) Nociceptive pain
Rationale: Nociceptive pain occurs when nociceptors (pain receptors) are activated
in response to actual or impending tissue injury. When this occurs in internal organs,
it is known as visceral pain -1-5 .
5. Neuropathic pain can be caused by all of the following EXCEPT:
A) Diabetes
B) Long-term alcohol use
C) Hypothyroidism
D) Acute muscle strain
Answer: D) Acute muscle strain
Rationale: Neuropathic pain can be caused by diabetes, long-term alcohol use,
hypothyroidism, rash, or trauma -1-5 . Acute muscle strain would produce
nociceptive pain, not neuropathic pain.
6. Allodynia is best defined as:
A) Loss of pain sensation
B) Extreme sensitivity to touch
C) Pain originating in visceral organs
D) Pain perceived at a site distant from its origin
Answer: B) Extreme sensitivity to touch
Rationale: Allodynia is extreme sensitivity to touch, such as wind, sheets, or water.
Patients cannot let sheets touch the affected area -1 .
7. Which type of pain originates at a visceral site but is perceived as originating
in part of the body wall innervated by neurons entering the same segment of
the nervous system?
A) Cutaneous pain
B) Deep somatic pain
C) Referred pain
D) Visceral pain
, Answer: C) Referred pain
Rationale: Referred pain originates at a visceral site but is perceived as originating in
part of the body wall that is innervated by neurons entering the same segment of the
nervous system -1 .
8. Acute pain is defined as pain that lasts:
A) Less than 3 months
B) Less than 6 months
C) More than 6 months
D) More than 12 months
Answer: B) Less than 6 months
Rationale: Acute pain is self-limiting pain that lasts less than 6 months. Chronic pain
is persistent pain lasting longer than 6 months -1 .
9. Trigeminal neuralgia affects which cranial nerve?
A) Cranial Nerve VII
B) Cranial Nerve V
C) Cranial Nerve IX
D) Cranial Nerve X
Answer: B) Cranial Nerve V
Rationale: Trigeminal neuralgia affects Cranial Nerve V and is characterized by sharp,
stabbing pain without numbness. There is demyelination of axons in the ganglion,
root, and nerve -1 .
10. Complex regional pain syndrome is characterized by:
A) Pain that is proportionate to the injury
B) Chronic arm or leg pain after injury, surgery, or heart attack with pain greater than
expected
C) Pain limited to the skin only
D) Pain that resolves spontaneously within weeks
Answer: B) Chronic arm or leg pain after injury, surgery, or heart attack with
pain greater than expected
Rationale: Complex regional pain syndrome is characterized by chronic arm or leg
pain after an injury, surgery, or heart attack. Pain is greater than would be expected
from the injury that causes it -5 .
11. In a neurological exam, a patient holds both arms straight forward with
palms up and eyes closed for 30 seconds. The right arm slowly drifts downward
and rotates internally. This finding indicates:
A) Cerebellar dysfunction
B) Contralateral corticospinal tract/upper motor neuron dysfunction
