1.6

Question 1

Paralysis vs. paresis

Answer 1

Paralysis - complete loss of muscular action
Paresis - muscle weakness or partial paralysis

Question 2

3 sets of muscle groups regulated by motor regulation

Answer 2

1. Distal musculature
   - fingers and toes
2. Proximal musculature
   - elbow and shoulder and lower extremity equivalent
3. Axial musculature
   - spine

Question 3

CNS area involved in planning

Answer 3

cerebral cortex

Question 4

CNS area involved in command

Answer 4

motor cortex (motor strip)

Question 5

CNS area involved in organizing muscle groups

Answer 5

basal nuclei

Question 6

CNS area involved in adjustment

Answer 6

cerebellum

Question 7

CNS area involved in associations

Answer 7

brainstem

Question 8

CNS area involved in pathways

Answer 8

spinal cord

Question 9

CNS area involved in final transmission

Answer 9

peripheral nerves

Question 10

7 aspects of motor exam

Answer 10

1. Muscle inspection and palpation
2. Passive movement
3. Rapid fine movement
4. Muscle strength
5. Deep tendon reflexes
6. Coordination
7. Balance and gait

Question 11

Spasticity vs. rigidity

Answer 11

Spasticity: velocity related increase in tone
- hypereflexia
Rigidity: increased constant resistance to passive movement
- normal reflexes

Question 12

Somatosensory modalities: 2 major sensory modalities

Answer 12

1. Vibration, proprioception, fine touch (discriminative touch)
2. Pain and temperature

Question 13

Higher mental function neurological exam

Answer 13

1. Mental status
2. Executive function
3. Attention
4. Language
5. Memory
6. Visuospatial function
7. Emotionality

Question 14

3 questions of neurologic exam

Answer 14

1. Is this a neurologic problem?
   - organic vs. psychogenic
2. Where is the lesion?
3. What is the pathophysiology? What is the etiology?

Question 15

Tools for recording the neurologic H & P

Answer 15

History matrix
Localization matrix
Motor scales, strength, and DTRs

Question 16

History matrix

Answer 16

Symptom timeline
Collateral factors/descriptors

Question 17

Localization matrix

Answer 17

Enter a circle (◯) if the structure could be involved

Question 18

Localization tips: muscle

Answer 18

weakness, atrophy

Question 19

Localization tips: NMJ

Answer 19

weakness increases with exam

Question 20

Localization tips: peripheral nerve

Answer 20

multiple modalities in area of one nerve

Question 21

Localization tips: spinal cord

Answer 21

regional symptoms/signs (s/s), fit the distribution of a tract

Question 22

Localization tips: brainstem

Answer 22

cranial nerve, consciousness, motor + sensory signs

Question 23

Localization tips: deep white matter and lateral thalamus

Answer 23

hemimotor/hemisensory s/s

Question 24

Localization tips: cortical lesions

Answer 24

complex processing

Question 25

Localization tips: cerebellum

Answer 25

balance and coordination

Question 26

Localization tips: basal nuclei

Answer 26

hemibody or bilateral, postural or voluntary control impaired

Question 27

Fail safe

Answer 27

makes sure certain diagnoses are rules out

Question 28

Muscle power grading scale

Answer 28

Grade 5 - normal strength
Grade 4 - relative to normal, but reduced muscle strength against resistance
Grade 3 - difficulty contracting against resistance
Grade 2 - visible movement gravity minimized
Grade 1 - visible muscle contraction but no movement
Grade 0 - no muscle contraction

Question 29

Reflex response grading system

Answer 29

0+ no reflex
1+ decreased reflex
2+ normal reflex
3+ increased reflex
4+ abnormally brisk reflex with sustain clonus

Question 30

The text uses the term “organic basis.” This means there is an identifiable anatomic or functional reason for the patient’s complaints. What are the features that would make a clinician suspect that there is no organic basis for the symptoms?

Answer 30

The features that would make one suspect that the symptoms are not organically based would be neurological symptoms, which, as the history taking progresses, shift from side to side, and a lack of consistent hard neurological findings.