Lecture Midterm 1 Review Questions Flashcards
How many intervertebral discs are normally in the human spinal column?
23
Neurological loss from spinal nerve root compression or ischemia with numbness and/or weakness describes ____
radiculopathy
Pain referred to the inferior angle of the scapula due to gallstones is an example of what type of reflex?
viscero-somatic
What is true about radiculopathy? (select all that apply)
A. sensory follows dermatomal distribution
B. may involve muscle weakness
C. is always caused by a disc lesion
D. can be caused by spinal degeneration
E. is not influenced by posture
A, B, D
What does the “P” in the acronym “OPQRST” intend to remind one to ask?
What makes it worse?
What makes the problem better?
The majority of information needed to make a clinical diagnosis comes from ____
patient history
What is the MOST common symptom of vertebral artery dissection?
neck pain & stiffness
What are the 3 MOST IMPORTANT reasons to perform examinations (Homack’s Law)?
- document medical necessity to order tests
- make accurate diagnosis
- establish baselines for outcome measures
After a blow to the head, a 42 year old drummer notices his left hand has difficulty maintaining rhythm. This is an example of ____
dysdiadochokinesia
Upper motor neuron signs may be due to compression of what portion of the spinal cord?
- anterior corticospinal tract
- lateral corticospinal tract
What is true about motor neurons? (choose all that apply)
A. they are in the ventral cord
B. they come from dorsal roots
C. they are afferent
D. they are efferent
E. they carry signals into the cord
A, D
How are normal superficial reflex responses properly recorded in health care records?
present
What is true regarding the dorsal columns? (choose all that apply)
A. they carry sensory information
B. made up of motor neurons
C. they are efferent
D. carry information on proprioception
E. responsible for coordinated movements
A, D
How is pallesthesia assessed?
using a 128 Hz tuning fork
What other symptoms might be seen in a patient demonstrating resting tremors?
- festinating gait
- mask-like face
- choreiform motion
- lead pipe rigidity
- cogwheel rigidity
- hemiballism
- pill rolling
Which muscles of mastication are innervated by cranial nerve V?
internal pterygoid
temporalis
external pterygoid
masseter
(BITEM)
A 22 year old female complains of “double vision” with both eyes open, 2 days after being hit in the head by a kicked soccer ball. Which cranial nerves are likely to be involved?
CN III, IV, VI
A patient’s left eye is exposed to a flashlight and constricts. The right eye is unresponsive. Which structure is most likely damaged?
Right CN III
What cranial nerve carries sensory (taste) from the anterior aspect of the tongue?
CN VII: facial
A patient has tongue deviation to the left. Which cranial nerve and which side are involved?
Left CN XII: Hypoglossal
In a patient with tongue deviation to the left, which side would appear weak when strength testing the tongue (tongue in cheek)?
right
Your patient drifts to the left when walking forward, and left when walking backward. What does this indictate?
Left-sided cerebellar issue
Multiple sclerosis can first present as ____ which can create a ____ loss of vision (blind spot)
Optic neuritis; central
In order to determine if an anterior (ventral) corticospinal tract lesion is due to compression of the cervical cord, you can repeat tendon reflexes with the patient ____, noting and change in your findings
Looking down (provocative position)
The majority of information that leads to an accurate diagnosis is derived from ____
Patient history
Your patient has loss of vision. During your examination you discover your patient has difficulty pointing to a spot without shaking, and identifying objects placed in a closed hand. Which is the most likely cause?
A. cervical cord compression
B. pre-frontal gyrus injury
C. posterior circulation compromise
D. anterior circulation compromise
E. thoracic cord compression
Posterior circulation compromise
Headache, neck pain, and neck stiffness without a fever likely indicates ____
VBAI (vertebral a dissection)
After a sinus infection, your patient states this food “tastes funny”
A. State the condition you suspect
B. State one test to evaluate this
C. Perform the test you stated
D. State the positive findings and what they indicate
A. Damage to olfactory bulb or CN I
B. Olfaction test
D. Inability to recognize scent presented
What is the term given to pupils that are different sizes on each side?
Anisocoria
Strabismus refers to eye ____
Alignment
What term is given to pupils that don’t react to light?
Marcus-Gunn pupil
What does the term “medico-legal” refer to?
Legal stuff to protect doctor & patient
Hypotonia is associated with issues in what area?
Cerebellum
Clonus is associated with issues in what area?
UMN
Your patient reports that they frequently bite their tongue. Which cranial nerves may be involved?
CN V & CN XII (& CN VII)
If sound lateralized to the right ear, what could the problem be?
Nerve damage on left
OR
Air conduction on right
If sound lateralizes to the right ear on Webers test, what would you expect to find on Rinnes?
- If nerve (bone) conduction loss on left: BC and AC will be less time on the left side, or may be heard on right side
- If air conduction loss on right: less than 2:1 AC:BC (will hear less time when held to ear than mastoid)
Name 4 tests for dysmetria
- heel to shin
- toe to dr’s finger
- finger to nose
- finger to dr’s finger
Name 4 tests for hypotonia
- Andre Thomas Test
- Holmes test
- Rag doll appearance
- Myotonic reflexes
Name 3 tests for ataxia
- Romberg’s position
- Babinski Weil
- Tandem Gait
Name 3 tests for deep pressure
- Biernacki’s
- Abadie’s
- Pitres
When testing tone across the elbow, what would you find in a patient with an extra-pyramidal (basal ganglion) lesion?
Rigidity:
- no weakness
- cogwheel rigidity
- lead pipe rigidity
- not velocity dependent
- both directions
When performing deep tendon reflexes, what does a score of +2 J indicate?
Normal
When performing deep tendon reflexes, what does a score of +4 J indicate?
Transient clonus
When performing deep tendon reflexes, what does a score of +5 J indicate?
Sustained clonus
Name 4 pathologic reflexes in the upper extremity
- Gordon’s
- chaddock’s
- tromner’s
- rossolimo’s
Name 5 pathologic reflexes in the lower extremity
- Shaffer’s
- Chaddock’s
- Gordon’s
- Oppenheim Sign
- Rossolimo’s
Name 2 pathologic reflexes in the face
- snout
- glabellar
Name 2 tests for hypocalcemia
- Chvostek Sign
- Trousseau’s Sign
What is the Frontal Release Sign?
The frontal lobe “releases” primitive reflexes
(UMNL)
What are the 3 body types?
- ectomorph (tall, slender)
- mesomorph
- endomorph (short, broad)
Name the neural areas supplied by posterior circulation?
(COBS)
Cerebellum
Occipital lobe (visual)
Brainscape stem (CNs)
Spinal cord
Cerebellar testing should be performed with the patient…
Standing
The anterior cerebellar lobe is in control of the ____ in relation to the ____
Torso
Lower extremities
The posterior cerebellar lobe is in control of the ____ in relation to the ____
Head
Torso
A pressure difference of 15mmHg or more between right and left arms points to an increased likelihood of…
Dying from any cause
Arnold Chiari malformation is a disease of the ____
Cerebellum
(Pushed through foramen magnum)
What part of the suggested VBAI screening protocol protects the doctor and the patient?
Written informed consent
Basal ganglia is involved with ____ movement
Volitional
When concerned about CN III, ask about ____
Photophobia (sensitivity to light because pupils are dilated)
What reflex goes in and out on the same nerve?
Jaw jerk: CN V
