Chapter 9: The Neurologic Examination, Radiologic and other Dx Studies

Question 1

Afferent

Answer 1

Carrying neural impulses to the CNS

Question 2

Anterior (ventral) spinal column

Answer 2

The source of neurons that comprise the anterior horn of the spinal cord. Diseases involving the anterior column include:

• amyotrophic lateral sclerosis (ALS)
• spinal muscular atrophy
• poliomyelitis

Question 3

Babinski Sign

Answer 3

Fanning of the toes and upward flexion of the big toe. Also referred to as the “extensor plantar response.”

Question 4

Blown Pupil

Answer 4

A pupil that is dilated and unresponsive to changes in light

Question 5

Clonus

Answer 5

Repetitive, involuntary vibratory movements

Question 6

Deep Tendon Reflex

Answer 6

Muscular contraction that occurs in response to the stretching of a muscle

Question 7

Diplopia

Answer 7

The experience of double vision

Question 8

Dysdiadochokinesia

Answer 8

Impaired ability to smoothly alternate hand movements

Question 9

Dyskinesia

Answer 9

Impaired voluntary movement

Question 10

Dysmetria

Answer 10

Inaccurate range of movement during motion-based activities

Question 11

Efferent

Answer 11

Carrying neural impulses AWAY from the nervous system

Question 12

Graphesthesia

Answer 12

The ability to identify letters or numbers traced on the skin

Question 13

Hemianopsia

Answer 13

The loss of a visual hemifield

Question 14

Homonymous

Answer 14

On the same side (e.g., homonymous hemianopsia)

Question 15

Long-tract signs

Answer 15

Neurologic signs related to upper neuron lesions, including hyperactive deep tendon reflexes, clonus, and spasticity

Question 16

Lower Motor Neuron (LMN)

Answer 16

Motor neurons that originate in the anterior horn of the spinal cord. The motor cranial nerve nuclei are also classified as lower motor neurons.

Question 17

Mental Status

Answer 17

A broad term used in clinical neurology to refer to general cognitive functions such as attention, orientation, memory, spatial abilities, abstraction, and certain aspects of language.

Question 18

Nystagmus

Answer 18

Rapid involuntary eye movements, which may be lateral, vertical, rotational, or mixed.

Question 19

Posterior (dorsal) column

Answer 19

The spinal pathway involved in localized fine touch and conscious proprioception.

Question 20

Proprioception

Answer 20

Perception of one’s body position in space, based on sensory input from the muscles and tendons.

Question 21

Quadrantanopsia

Answer 21

Loss of one quadrant of the visual field

Question 22

Reflexes

Answer 22

an involuntary response to a stimulus

Question 23

Spasticity

Answer 23

Increased muscle tone or increased resistance to stretching

Question 24

Suppression

Answer 24

The unilateral diminution of sensory input perception in the presence of bilateral stimulation

Question 25

Upper Motor Neuron (UMN)

Answer 25

Neurons that originate from the cerebral primary motor cortex (i.e., the precentral gyrus) or from certain brainstem nuclei (e.g., the rubrospinal tract from the red nucleus)

Question 26

Vestibular

Answer 26

Referring to the sense of balance

Question 27

which cranial nerves are involved in eye movement?

A) CN II, III, IV, VI
B) CN III, IV, VI
C) CN VIII, IX, X
D) CN II and III only

Answer 27

B - CN III, IV, VI

Each of these nerves projects to extraocular muscles involved in eye movement.

CN II only carries visual information.
CN VIII can be involved in nystagmus but IX and X have no role in eye movement.

Question 28

Field cuts occurring within the temporal visual hemifield of each eye suggests ____.

A) a lesion of the optic chiasm
B) Bilateral temporal lobe lesions
C) bilateral retinal detachment
D) an implausible visual defect

Answer 28

A - chiasmatic lesion of the optic nerve

Axons from the temporal fields pass through the optic chiasm. Temporal lobe lesions are more likely to produce quadrant–rather than hemifield—defects.

Question 29

A fixed and dilated (“blown”) pupil is typically associated with dysfunction or injury to which cranial nerve?

A) II
B) III
C) IV
D) VI

Answer 29

B - CN III

CN III (oculomotor) specifically mediates the parasympathetic (constricting) ciliary response in the eye. Mechanical damage to CN III interferes with pupil constriction, but the sympathetic function remains and the dilation function remains

Question 30

The trigeminal nerve is involved in ____.

A) only sensory functions of the face and jaw
B) only motor functions of the face and jaw
C) both sensory and motor functions of the face and jaw
D) neither sensory nor motor functions of the face and jaw

Answer 30

C - both sensory and motor functions

The trigeminal is a mixed cranial nerve and has both sensory and motor capacities

Question 31

When performing the Dix-Hallpike maneuver, elicitation of vertigo and nystagmus suggest ____ dysfunction that is ____ to the side of the downward ear.

A) oculomotor; Ipsilateral
B) vestibular; contralateral
C) vestibular; Ipsilateral
D) oculomotor; contralateral

Answer 31

C - Vestibular; ipsilateral

Although nystagmus presents as eye movement, it is a vestibular function mediated by dysfunction involving the vestibular branch of CN VIII, and effects are observed ipsilaterally.

Question 32

Which pairs of these nerves are tested together when eliciting a gag reflex?

A) CN V, VI
B) CN IX, X
C) CN VII, X
D) CN VII, IX

Answer 32

B - CN IX, X

The glossopharyngeal and vagus nerves co-mediate the gag reflex.

CN VII is involved in swallowing and coughing, but only at the level of the neck muscles, not the pharynx

CN V mediates face and jaw sensorimotor functions

CN VI is ocular

Question 33

A patient presents with decreased shoulder shrug on the left and an inability to resist pressure from an examiner’s hand against the right jaw. These findings could suggest _____.

A) left spinal accessory nerve dysfunction
B) right spinal accessory nerve XI dysfunction
C) bilateral spinal accessory nerve XI dysfunction
D) feigned neurologic impairment

Answer 33

A - left spinal accessory nerve dysfunction

Sternocleidomastoid strength and trapezius muscle lift are innervated by the ipsilateral CN XI

Question 34

When asked to stand with feet together and arms held palms up and extended at shoulder level, a patient is unable to maintain the position and her left arm slowly turns toward a palm-down position. She is exhibiting a _____, which suggests ______ dysfunction.

A) Hoffman reflex; contralateral pyramidal tract
B) Romberg sign; ipsilateral cerebellar
C) pronator drift; contralateral pyramidal tract
D) Wartenberg sign; ipsilateral cerebellar

Answer 34

C - pronator drift; contralateral pyramidal tract

The example described is classic pronator drift, which localizes to contralateral pyramidal tracts

Wartenberg and Hoffman signs DO NOT involve standing.

A Romberg sign refers to sway when standing, but no upper extremity signs.

Question 35

Impairment in the ability to perform alternating hand movements is referred to as ____ and suggests cerebellar dysfunction ____ to the more affected side.

A) dysmetria; ipsilateral
B) dysdiadochokinesis; ipsilateral
C) dysmetria; contralateral
D) dysdiadochokinesis; contralateral

Answer 35

B - dysdiadochokinesis; ipsilateral

Dysdiadochokinesis refers to an impairment in alternating motor coordination.

Dysmetria refers to unilateral movement.

Cerebellar output is always ipsilateral, thus contralateral dysfunction is not a feasible option.

Question 36

Which of the following does NOT involve patient exposure to ionizing radiation?

A) computed tomography
B) magnetic resonance imaging
C) single-photon emission tomography
D) positron emission tomography

Answer 36

B - magnetic resonance imaging

MRI –> uses high field magnetization and radiowave pulses

The rest using ionizing radiation in the form of radioactively tagged binding agents.

Question 37

Which imaging technique is most likely to be used in case of acute head trauma?

A) MRI
B) SPECT
C) CT
D) DTI

Answer 37

C - Computed tomography (CT)

MRI is not good because it is unsafe during acute injury due to cardiac leads and external stabilizers

SPECT and DTI are investigational techniques in head trauma

Question 38

The primary dependent variable that is measured using diffusion tensor imaging is ____.

A) diffuse axonal injury (DAI)
B) blood oxygen level dependent response (BOLD)
C) cerebral metabolic rate of glucose metabolism (CMRGlu)
D) fractional anisotrophy (FA)

Answer 38

D - Fractional anisotropy

FA is the primary dependent variable in DTI

DTI may be used to characterize DAI, but is not a specific DTI index

BOLD and fMRI are blood-flow dependent

CMRGlu is only measured with PET

Question 39

Which of the following is accurate about the radioisotope used in neuroimaging technologies such as SPECT and PET?

A) They are absorbed by glia and provide an indirect index of regional activity.
B) They are absorbed by neurons and provide a direct index of neural activity.
C) They remain in the bloodstream and provide an indirect index of neural activity.
D) They cross the blood-brain barrier and provide an indirect index of regional activity

Answer 39

A - They are absorbed by glia and provide an indirect index of regional activity

They are absorbed by glia but do NOT cross the blood-brain barrier. They decay at the level of the glia and emit photons or positrons.

Question 40

Electroencephalographic alpha activity is _____ during relaxation and _____ during mental activity.

A) decreased; increased
B) increased; disappears
C) never present; increased
D) none of the above; it is only present during sleep

Answer 40

B - increased; disappears

EEG alpha activity has been consistently demonstrated to increase with relaxation and disappear when a person engages in mental activity (e.g., mental arithmetic). It is not specific to sleep.

Question 41

The EEG signal represents _____.

A) real-time activity of individual neurons
B) the summation of activity from thousands to millions of neurons
C) normal background activity and epileptiform spikes
D) activity from only those neurons immediately beneath each electrode

Answer 41

B - the summation of activity from thousands to millions of neurons

Although it is time-linked, it does not equate to single-neuron recording, nor is it specific to epileptiform activity.