LE: Spina Bifida

Question 1

Upon checking the MRI scan of your patient with myelomeningocele, it was identified that there was definite damage to the fifth lumbar nerve root. As a physical therapist, you deduct that there might be possible weakness to the muscle/s served by that nerve root. The following are the muscular origins of the muscles affected, except:
Interosseous membrane Lower ant. surface of the fibula
Mid. ant. surface of the fibula
None

Answer 1

Lower ant. surface of the fibula

Question 2

This primitive reflex uses pressure stimuli to the ball of foot (under toes). When is this reflex integrated

Answer 2

9 months

Question 3

After suffering from meningomyelocele since birth, Dominique always complained about loss of sensation in her dorsum of the foot, big toe, medial leg, lateral thigh, and medial buttock. Upon performing the sensory assessment you identified the nerve root affected to be

Answer 3

L4

Question 4

While assessing the spasticity of your shoulder flexors, you passively moved the shoulder towards extension. You notice a marked increase in tension at around the 10* mark up until the available range. What grade of spasticity is observed here?

Answer 4

2

Question 5

The following statements about spina bifida occulta are falsely stated, except: Minimal UMN signs maybe observed especially in the lower extremities.
There is a closure defect of the post. vertebral arches and laminae
Protrusion of meningeal structures are observed.
None

Answer 5

There is a closure defect of the post. vertebral arches and laminae

Question 6

While assessing visual tracking, you identified that the child has a problem with the (R) superior rectus and (L) inferior oblique. What bilateral eye motions does he have a hard time performing?

Answer 6

Eyes up and right

Question 7

Which sequence of orthotic needs can properly address mild to mod. spina bifida cases with intact T12 to L3 motor levels?

Answer 7

Toronto A Frame -> Ambulation bracing at 15-24 months -> RGO; thoracic uprights; rollator walker

Question 8

The following structures have CSF within them, except: Choroid Plexus Arachnoid Vili
Cisterna Magna
None

Answer 8

none

Question 9

Kylie is 13 year old teenager with thoracic myelomengingocele. If she has a moderate thoracic levoscoliosis, the following musculoskeletal changes to the spine wont be observed, except:
T6 spinous process will rotate towards the left. Chest bump will be prominent on the left.
T7 vertebral body will rotate towards the right. Rib is pushed anterolaterally on the concave side.

Answer 9

Rib is pushed anterolaterally on the concave side.

Question 10

Use of valproic acid during pregnancy may give a 1-2% risk of the infant acquiring spina bifida. Aside from VA, which medication among the choices can’t be considered as an anticonvulsant? Phenytoin
Diazepam
Gabapentin
Fentanyl

Answer 10

Fentanyl

Question 11

Patient with myelomeningocele presented with weakness of the hip adductors. To test, the patient is positioned in side lying with top leg (non-test side) abducted 25°. The therapist stands behind patient in side lying with support given to the non-test side in abduction. Upon performing adduction the patient was able to achieve full range of motion against gravity. The patient was only able to tolerate nearly moderate manual resistance. What MMT grade is appropriate for this finding.

Answer 11

4-

Question 12

During herniation of meninges, which of the following layers is most adhered to the spinal cord?

Answer 12

Pia mater

Question 13

Squeezing of calf muscles firmly

Answer 13

Gordon’s

Question 14

What age is this milestone achieved? “dada!”

Answer 14

10 months

Question 15

How many spinal nerves are there?

Answer 15

62

Question 16

In communicating syringomyelia, increased fluid build up distends the spinal cord. Cerebrospinal fluid from within the ventricles communicates with the fluid around the spinal cord.

Answer 16

first statement: TRUE, second statement: FALSE

Question 17

The following details are true about neural tube development and its defects, except: Closure begins at both ends and then moves cephalically and caudally.
Failure of closure usually happens on the 28th day.
The process of tube formation is called neurolation.
None

Answer 17

Closure begins at both ends and then moves cephalically and caudally.

Question 18

This type of neural tube defect presents with paralysis & loss of sensation below the level of the lesion. the meninges, the spinal cord & nerve roots protrude through the gap, has higher risk of infection due to presentation. Skeletally, there’s an unfused portion of the vertebral column as well.

Answer 18

Myeloschisis

Question 19

The following details are true about talipes equinovarus, except: The foot is in exaggerated plantarflexion and inversion. In some cases, tightness of tibialis posterior is present.
Peroneal weakness may also present in some cases.
None

Answer 19

None

Question 20

Patients with cerebellar affectation may present with this visual condition. This is called?

Answer 20

Diplopia

Question 21

The spinal cord consists of ascending tracts of axons and descending tracts of axons. Which of the following are correct in reference to those tracts?

• The ascending tracts are found in the white matter and transmit sensory information. The descending tracts are found in the gray matter and transmit motor information.
• Both tracts are found in the white matter. The ascending tract transmits sensory information while the descending tracts transmit motor information.
• The ascending tracts are found in the gray matter and transmit sensory information. The descending tracts are found in the white matter and transmit motor information.
• None

Answer 21

-Both tracts are found in the white matter. The ascending tract transmits sensory information while the descending tracts transmit motor information.

Question 22

Marcus has been suffering from spina bifida cystica since birth. He is now 8 years old. During physical examination, weakness in dorsiflexors are evident especially during ambulation. He presents with a slight crouch and his legs often graze over each other during ambulation. What level of paralysis is he presenting with?

Answer 22

high lumbar

Question 23

Which deep tendon reflex is greatly affected in low lumbar level paralysis spina bifida?

Answer 23

Tibalis posterior

Question 24

Spina bifida patients with thoracic level of paralysis presents decreased ventilatory capacity. The following are secondary muscles of respiration, except: Sternocleidomastoid Pectoralis major Pectoralis minor
Serratus posterior inferior

Answer 24

Serratus posterior inferior

Question 25

Fasciculi are bundles of nerve tracts associated with \_\_\_\_\_\_\_\_\_ 
The white matter of the spinal cord 
The gray matter of the spinal cord 
The gray commissure of the spinal cord 
None

Answer 25

The white matter of the spinal cord

Question 26

What bony structure attaches to the area with a green circle?

Answer 26

Tubercle of the rib

Question 27

The following integumentary markers may indicate spinal problems to the area it presents on, except Cafe-au-lait spots
Hairy tuft
Port wine stains
None

Answer 27

none

Question 28

What is the 4th testing position/procedure for the Berg Balance Scale?

Answer 28

Standing to sit.

Question 29

A thickened ropelike filum terminale persists and anchors the conus at or below the L2 level.

Answer 29

Tethered cord

Question 30

Early onset diastematomyelia often presents as, unilateral foot abnormalities, including talipes equinovalgus, claw toes, atrophy of the gastrocnemius, and loss of pain and temperature sensation, are apparent in a preschool child.

Answer 30

False