Lecture Midterm 2 Review Questions

Question 1

A patient walks into your office holding her neck soon after a car accident. What sign is this and what does it indicate?

Answer 1

Rust sign
instability

Question 2

Which of the following tests (if positive) would indicate a space occupying lesion? (choose all that apply)
A) Libman’s
B) Triad of Dejerine
C) Valsalva’s
D) Milgram’s
E) Cervical distraction

Answer 2

B) Triad of Dejerine
C) Valsalva’s
D) Milgram’s

Question 3

Which of the following tests is least invasive and therefore should be done first?
A) Jackson’s lateral flexion compression
B) maximal foraminal compression
C) neutral compression
D) rotary compression
E) extension compression

Answer 3

neutral compression

Question 4

When concerned about CN III, ask about ____

Answer 4

Photophobia (sensitivity to light because pupils are dilated)

Question 5

The corticobulbar tract begins in the ____ and ends in the ____

Answer 5

motor cortex
brainstem

Question 6

Why is cranial nerve testing part of the vertebrobasilar artery insufficiency screening protocol?

Answer 6

vertebral aa supply the brainstem

Question 7

Damage to the cerebellar vermis could result in ____

Answer 7

truncal ataxia

Question 8

Which cranial nerves are involved in biting the tongue?

Answer 8

V: trigeminal
XII: hypoglossal

Question 9

Pathologic reflexes are associated with damage to the ____

Answer 9

corticospinal tract

Question 10

What is the MOST common symptom of vertebral artery dissection?
A) neck pain & stiffness
B) headache relieved by NSAIDS
C) difficulty swallowing
D) vertebral subluxation
E) balance issues

Answer 10

neck pain & stiffness

Question 11

Which test differentiates vestibular cause vs. a cerebellar cause of “dizziness”?
A) Mittlemeyer marching
B) Romberg’s test
C) Swivel chair test
D) Babinski-Weil
E) Weber-Rinne test

Answer 11

Babinski-Weil

Question 12

Your patient has drooping on the right side of the face with sparing of the ability to raise both eyebrows. Which diagnosis is most likely?
A) acoustic neuroma
B) Bell’s palsy
C) vertebral artery insufficiency
D) stroke

Answer 12

stroke

Question 13

What is the correct reflex for the C6 nerve root?
A) biceps brachii
B) brachioradialis
C) triceps brachii
D) there is no reflex

Answer 13

brachioradialis

Question 14

Your patient is able to raise their arm into abduction, but cannot resist any over pressure. What is the correct grading for this finding?
A) 0/5
B) 1/5
C) 2/5
D) 3/5
E) 4/5

Answer 14

3/5

Question 15

Tapping the triceps tendon produces a reflex that has several beats but then stops. What is true for this finding? (Choose all that apply)
A) grade of +3/5
B) grade of +4/5
C) grade of +5/5
D) may be a normal finding
E) indicates an upper motor neuron lesion

Answer 15

+4/5
UMNL (clonus)

Question 16

Which is the most likely diagnosis for a patient that has pain into the right arm when turning the head to the left?
A) medial scalene TOS
B) middle scalene TOS
C) posterior scalene TOS
D) pec minor TOS
E) hyperextension TOS

Answer 16

middle scalene TOS

Question 17

What is the most likely cause of popping, clicking and pain in the anterior shoulder with motion?
A) gleno-humeral capsulitis
B) sub-acromial bursitis
C) fractured humeral neck
D) supraspinatus tear
E) transverse humeral ligament tear

Answer 17

transverse humeral ligament tear (or bicipital tendinitis

Question 18

Which of the following tests would be positive or present for a patient with a partial supraspinatus tear? (choose all that apply)
A) Codman’s test
B) Yergason’s test
C) Dawburn’s pushbutton test
D) Supraspinatus press test

Answer 18

A) Codman’s
D) Supraspinatus press test

Question 19

Nerve entrapment in the cubital fossa will cause symptoms into what part of the upper extremity?
A) dorsal surface of medial hand & fingers
B) dorsal surface of lateral hand & fingers
C) volar surface of middle hand into the 3rd digit
D) volar surface of lateral hand & fingers
E) volar surface of medial hand & fingers

Answer 19

D) volar surface of lateral hand & fingers

Question 20

What is the most common site of radial nerve entrapment?

Answer 20

posterior interosseous n. at arcade of frohse
(proximal to supinator in proximal forearm)

Question 21

The tip of the little finger is the sensory pure patch for what peripheral nerve?

Answer 21

ulnar

Question 22

What does a 4+J bicep reflex suggest?
A) C5 nerve root compression
B) axillary nerve entrapment
C) corticospinal tract lesion
D) corticobulbar tract lesion

Answer 22

C) corticospinal tract lesion

Question 23

What reflex corresponds to the nerve that shares the sensory pure patch over the tip of the pinky?
A) there isn’t one
B) there is no primary, but secondary is brachioradialis
C) brachioradialis
D) bicipital
E) triceps

Answer 23

A) there isn’t one (ulnar n)

Question 24

A finding for cervical capsulitis during the cervical distraction test is:
A) decreased posterio-lateral cervical pain
B) increased pain radiating down the upper extremity
C) increased localized posterio-lateral cervical pain
D) decreased pain radiating down the upper extremity

Answer 24

C) increased localized posterio-lateral cervical pain

Question 25

If a patient’s tongue deviates left when they stick it out, where is the lesion?
A) CN X on the right
B) CN X on the left
C) CN XII on the right
D) CN XII on the left

Answer 25

D) CN XII on the left

Question 26

Your patient has sharp pain going down the left leg when she sneezes. What could cause this?

Answer 26

space occupying lesion

Question 27

What are the tests for a space occupying lesion in order from least to most invasive?

Answer 27

1. triad of dejerine
2. valsalva
3. milgram’s

Question 28

Interosseous wasting may be a sign of:
A) median nerve damage
B) an apical lung tumor
C) radial nerve damage
D) D5 nerve root impingement
E) carpal tunnel syndrome

Answer 28

B) an apical lung tumor

Question 29

Your patient has right medial forearm pain when turning her head to the right. What muscle test is most appropriate?

Answer 29

C8: finger flexors

Question 30

Your patient has right arm pain extending into the index finger when turning his head to the left. Name two tests most useful to evaluate this patient.

Answer 30

• Reverse Adson’s (middle scalene TOS)
• Rotary compression test (IVF encroachment)

Question 31

Your patient has intense pain over the lateral wrist. Name an appropriate test and the condition you suspect.

Answer 31

Finkelstein’s test for DeQuervain’s tenosynovitis

Question 32

Your patient has difficulty opening a jar after falling and hitting their head due to weakness. Name the area you suspect is involved and name a test to evaluate that area.

Answer 32

UMNL
- patho. reflexes
- myotonic reflexes
- superficial reflexes

Question 33

Define hypesthesia

Answer 33

nerve root or peripheral nerve compression

Question 34

Define hyperesthesia

Answer 34

early nerve root compression

Question 35

Which digit receives sensory innervation from median, ulnar, and radial nerves?

Answer 35

ring finger (4th)

Question 36

What nerve root and peripheral nerves may be involved in a patient who can’t crush apples with their right hand anymore?

Answer 36

C8
median n
ulnar n

Question 37

What nerve root and peripheral nerve may be involved in a patient who can’t disco (ABduct) with their right arm anymore?

Answer 37

C5
axillary n

Question 38

What nerve root and peripheral nerve may be involved in a patient who can’t turn the throttle on their little jet anymore?

Answer 38

C6
radial n