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Clinical Neurology > Motor system > Flashcards

Motor system Flashcards

1
Q

Swinging your neurohammer at the patellar tendon activates a reflex arc at dermatome:

A. L3
B. L4
C. L5
D. S1

A

B

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2
Q

Stroking the sole or lateral aspect of the foot to elicit extensor toe sign stimulates:

A. L3
B. L4
C. L5
D. S1

A

D

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3
Q

Which of the following manifestations is not expected in a disorder of the corticospinal tract?

A. Spastic paralysis 
B. Enhanced tendon reflexes 
C. Denervation atrophy of muscles 
D. Babinski sign 
E. Weakness of muscle groups rather than individual muscles
A

C

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4
Q

Which of the following anatomical structures is not part of the upper motor neuron?

A. Neuronal body in the precentral gyrus
B. Alpha motor neurons in the anterior horn of the spinal cord
C. Corticospinal axons in the lateral funiculus of the spinal cord
D. Axons from the primary motor cortex that decussate at the medullary pyramids
E. Axons from the primary motor cortex that do not decussate at the medullary pyramids

A

B

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5
Q

Which of the following statements is incorrect with regards to the motor system?

A. The corticospinal tract is a direct pathway from the motor cortex to the spinal cord.
B. The corticobulbar tract is a direct pathway from the motor cortex to the brainstem.
C. The corticospinal fibers are located in the lateral funiculus of the spinal cord.
D. The undecussated fibers of the corticopsinal tract are located in the anterior funiculus of the spinal cord.
E. A great majority of the corticobulbar fibers decussate in the medullary pyramids.

A

E

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6
Q

In the lamellation of the corticospinal tract fibers in the thoracic spinal cord, which axons occupy the most medial position?

A. Cervical motor axons 
B. Thoracic motor axons 
C. Lumbar motor axons 
D. Sacral motor axons 
E. Autonomic axons
A

B

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7
Q

Which of the following manifestations is not expected in a left brachial plexus injury?

A. Enhanced left biceps and triceps tendon reflexes
B. Flaccid paralysis of the left arm
C. Atrophy of the left arm and hand muscles
D. Fasciculation and fibrillations of the left arm muscles
E. Abnormal ECG-NCV findings in the left arm

A

A

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8
Q

What is the neurotransmitter used by the corticospinal tract for transmission of impulse?

A. Serotonin
B. Acetylcholine
C. GABA 
D. Glutamate 
E. Dopamine
A

D

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9
Q

What is the classical presentation of a patient with an infarction of the right middle cerebral artery?

A. Dense hemiplegia of the left arm and left leg
B. Dense hemiplegia of the right arm and right leg
C. Left arm weakness that is more severe than the left leg weakness
D. Right arm weakness that is more severe than the right leg weakness
E. Left leg weakness that is more severe than the left arm weakness

A

C

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10
Q

Motor tests to be done while the patient is in the erect position EXCEPT:

A. Romberg test
B. Gait testing
C. Walking on toes and heels
D. Tandem walk

A

A

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11
Q

The first thing that you would do in somatomotor examination

A. Check for pronator drift 
B. Check for atrophy and asymmetry 
C. Check for spasticity
D. Check for motor strength 
E. Check for rigidity
A

B

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12
Q

TRUE about motor strength testing in a seemingly normal patient

A. Start with asking the patient to abduct both arms as the examiner pushes them down
B. Start with doing the pronator drift test
C. If a patient can move the muscle being tested against gravity, his MRS is at least 2/5
D. Finger abduction and adduction are innervated by C8
E. Thigh flexors are innervated by L2-L4

A

B

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13
Q

TRUE regarding tone during motor examination

A. Myotonia is due to contraction of both agonist and antagonist muscles
B. Dystonia is the slow relaxation of muscle
C. Percussion myotonia is when a muscle dimples following percussion with a hammer
D. AOTA
E. A & B only

A

C

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14
Q

Signs of lower motor neuron lesion EXCEPT

A. Presence of fasciculation
B. Reflexes are decreased
C. Mild atrophy due to disuse
D. Presence of weakness

A

C

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15
Q

TRUE about a finding of weakness in neurologic examination

A. In general, proximal weakness is suggestive of myopathy or diseases of muscles
B. In general, distal weakness is suggestive of neuropathy or disease involving nerves
C. The muscles are strongest when acting from their shortest position and have relatively little strength when acting from the longest position
D. AOTA
E. A & B only

A

D

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16
Q

The reflex grading of a patient with hyperactive reflexes accompanied by unsustained clonus

A. +2
B. +3
C. +4
D. +5

A

C

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17
Q

What are the two components of the pyramidal tract?

A

Corticubulbar tract and corticospinal tract

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18
Q

What is hemiplegia?

A

Complete paralysis of one side of the body

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19
Q

What is hemiparesis?

A

Incomplete paralysis of one side of the body

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20
Q

Interruption of a pyramidal tract rostral to its decussation causes hemiplegia (ipsilateral/contralateral) to the lesion

A

Contralateral

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21
Q

Interruption of a pyramidal tract just caudal to its decussation causes hemiplegia (ipsilateral/contralateral) to the lesion.

A

Ipsilateral

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22
Q

Pyramidal tract interruption in the cerebrum affects which component/s of the pyramidal tract?

A

Corticospinal and corticobulbar

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23
Q

Pyramidal tract interruption caudal to its decussation affects only which tract?

A

Corticospinal

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24
Q

No UMN axons leave the neuraxis. T/F

A

T

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25
Q

If the patient has paresis or paralysis of one muscle or a restricted set of muscles, with normal movements otherwise, the lesion involves the ❒ UMNs/ ❒ LMNs.

A

LMNs

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26
Q

If the patient has paresis or paralysis of movements of one side of the body, sparing the other side, the lesion most likely affects the ❒ UMNs/❒ LMNs.

A

UMNs

27
Q

Taking some poetic license, in general, UMN lesions paralyze ❒ movements/❒ muscles, whereas LMN lesions paralyze ❒ movements/❒ muscles.

A

Movement, muscles

28
Q

Complete paralysis of one side of the body is called what?

A

Hemiplegia

29
Q

Incomplete paralysis of one side of the body is called what?

A

Hemiparesis

30
Q

What is cerebellar ataxia?

A

Uncoordinated contractions of the muscles during volitional activation

31
Q

A Pt with cerebellar ataxia displays a tremor (during volitional movements/ at rest) but not (during volitional movements/at rest).

A

During volitional movements, at rest

32
Q

Damage to which of the anatomical structures leads to a lower motor neuron paralysis?

A. Neuron of the primary motor center
B. Axons of the internal capsule
C. Decussating axons of the medullary pyramid
D. Corticospinal tract
E. Cells of the anterior horn of the spine

A

E

33
Q

This indirect pathway reaches as far as the cervical spinal cord, where it innervates predominantly alpha motor neurons that innervate flexors of the upper limb

A. Tectospinal pathway 
B. Vestibulospinal pathway 
C. Pontine Reticulospinal pathway 
D. Medullary Reticulospinal pathway 
E. Rubrospinal pathway
A

E

34
Q

In the homunculus of the primary motor cortex, the area of the brain responsible for leg movement is at the sides of the interhemispheric fissure. This area is supplied by what artery?

A. Anterior Cerebral Artery 
B. Middle Cerebral Artery 
C. Posterior Cerebral Artery 
D. Superior Cerebellar Artery 
E. Inferior Cerebellar Artery
A

A

35
Q

The corticospinal tract passes through what part of the internal capsule?

A. Anterior Limb 
B. Genu 
C. Posterior Limb 
D. Upper Part 
E. Lower Part
A

C

36
Q

Which of the following statements is not true regarding the corticospinal tract?

A. The crossed fibers occupy the lateral funiculus of the spinal cord
B. The uncrossed fibers occupy the anteromedial portion of the spinal cord
C. In the lamellation at the level of the upper cervical spinal cord, the fibers for the legs are located medial to the fibers for the arms
D. The descending fibers decussate before going down to the spinal cord
E. The corticospinal tract is part of the upper

motor neuron system

A

C

37
Q

Which of the following manifestations is not consistent with upper motor neuron damage?

A. Spasticity 
B. Hyperreflexia 
C. Fibrillations 
D. Babinski Sign 
E. Clonus
A

C

38
Q

Which of the following is not true with regard to the reflex arc of a muscle stretch reflex?

A. Monosynaptic
B. Can be facilitated by the Jendrassik Maneuver
C. The synapse is outside the spinal cord because it is a lower motor neuron function
D. Enhanced by a damaged corticospinal tract
E. The reflex is reduced if the peripheral nerve is injured

A

C

39
Q

If a golgi tendon organ is stimulated, what will happen to the muscle?

A. The muscle contracts 
B. The muscle relaxes 
C. The muscle fibrillates 
D. The muscle fasciculates 
E. The muscle shortens
A

B

40
Q

What is the neurotransmitter in the final common pathway?

A. Serotonin 
B. Epinephrine 
C. Dopamine 
D. Acetylcholine 
E. Glutamate
A

D

41
Q

Which of the following neurotransmitters is particularly important to attention to novel and potentially challenging stimuli?

A. Serotonin
B. Dopamine
C. Acetylcholine
D. Norepinephrine

A

D

42
Q

Which of the following conditions will produce hypotonic muscles?

A. Decreased firing of the alpha motor neurons
B. Increased firing of the gamma motor neurons
C. Increased firing of the IB fibers from the tendon organs
D. All of the above

A

D

43
Q

Before doing the somatic motor strength testing, you should first INSPECT for the following EXCEPT:

A. Observe body position
B. Look for atrophy
C. Check for muscle tone
D. Check for involuntary muscle movements

A

C

44
Q

A movement disorder characterized by wild flinging movement of a part of the body

A. Chorea
B. Hemiballismus
C. Athetosis
D. Dystonia

A

B

45
Q

In checking for tone, the least effective way to make a patient relax is to:

A. Ask the patient to relax
B. Ask patient to count down from 100
C. Converse with patient with irrelevant topic
D. Ask the patient to spell WORLD backward

A

A

46
Q

TRUE about terms used in reporting the tone of muscles EXCEPT:

A. Gegenhalten or Paratonia is a condition when tremor is aggravated or increased when one checks for tone
B. When the heel easily leaves the bed when the knee is lifted quickly, this is called spasticity
C. Lead pipe rigidity is characterized by increased resistance throughout the whole range of movement of joint
D. If there is regular intermittent break in tone throughout the whole range: cogwheel rigidity

A

A

47
Q

TRUE about spasticity and rigidity

A. Spasticity suggests extrapyramidal involvement
B. In rigidity, clonus is expected to be present
C. To check for rigidity, the examiner must do a quick jerk of the extremity
D. None of the above

A

D

48
Q

The suggested sequence for the orderly testing of motor strength of upper extremities

A. Arm abductors, elbow flexors, elbow extensors, flexing the forearm while in semiprone position, wrist flexors, wrist extensors

B. Arm abductors, elbow flexors, elbow extensors, wrist flexors, wrist extensors, flexing the forearm while in semiprone position

C. Elbow flexors, arm abductors, elbow extensors, flexing the forearm while in semiprone position, wrist flexors, wrist extensors

D. Arm abductors, elbow flexors, wrist extensors, elbow extensors, wrist flexors, flexion of the forearm while in semiprone position

A

A

49
Q

TRUE about doing the pronator test

A. Ask patient to extend the arms with palms facing downwards

B. The patient can do this test with eyes opened or eyes closed

C. A pronator drift suggests a lower motor neuron lesions

D. None of the above

A

D

50
Q

TRUE about grading of motor strength

A. If movement can be elicited when gravity is eliminated, this is graded 2/5

B. If patient can flicker or move a little the muscle being tested, this is graded as 1/5

C. In the MRC grading of motor strength, MRC stands for Medical Royal College (of London) and not Motor Rating Coding

D. A, B and C

A

D

51
Q

Regarding nerve innervations of the upper extremity:

A. The C5 is involved in arm abduction
B. The musculocutaneous nerve is the nerve involved for elbow flexion
C. The small muscles of the hand is innervated by C7
D. A, B and C

A

A

52
Q

TRUE about S1

A. Involved with plantar flexion, hip extension and knee flexion

B. S1 innervates the foot muscles. If vertebral S1 is affected, one will elicit a positive Babinski sign

C. The knee reflex involves S1, and not just L3-L4

D. In doing the ankle reflex, one should tap on a finger place on top of the Achilles tendon

A

*

53
Q

Things you can examine when you observe the patient during walking

A. You can check for strength of plantar flexors by asking the patient to walk on heels

B. You can check for strength of foot dorsiflexors by asking the patient to walk on toes

C. In Parkinson’s Disease, you can appreciate the poor arm swing and the shuffling gait

D. Tandem walk is a test for posterior column tract and patient should be asked to close their eyes while walking a straight line

A

C

54
Q

TRUE about performing the motor strength examination:

A. Matching principle: Select movements that just about match the examiner’s own strength

B. The Length Strength principle: the muscles are strongest when acting from their shortest position

C. The Length Strength principle: the muscles are weakest when acting from the longest position

D. A and B only

E. A, B and C

A

E

55
Q

TRUE about eliciting reflexes:

A. In doing the biceps (C5) and brachioradialis (C6) reflex, you tap on your finger placed on the top of the tendon, and not directly on the patient’s tendon

B. Tromner reflex is performed by quickly flicking the middle finger down

C. Hoffman reflex is performed by quickly flicking the middle finger up

D. All are true

A

A

56
Q

Assuming that everyone can daw the stick figure in the correct way, all are part of the standardized way of reporting muscle strength reflexes (MSR) EXCEPT:

A. ++ or +2 is given for normal MSR
B. +4 is given for hyperactive reflex with unsustained clonus
C. 0 is hyporeflexia
D. +3 is for hyperreflexia without clonus

A

C

57
Q

The spinal nucleus of the trigeminal nerve is analogous to which structure?

A. Dorsal horn of the spinal cord
B. Lissauer’s tract
C. Substantia Gelatinosa
D. Intermediate horn of the spinal cord

A

A

58
Q

Case: An elderly female was brought in by her son to the PGH-ER after she was found unconscious on the bathroom floor.

In your history taking, which of the following information should you elicit to make your clinical impression?

A. Time when the patient was last seen well 
B. History of recent trauma 
C. Associated systemic illnesses 
D. List of medications 
E. All of the above
A

E

59
Q

On physical examination, which of the following vitals sign/s should you initially note?

A. Temperature 
B. Respiratory rate 
C. Blood pressure 
D. Pulse rate/heart rate 
E. All of the above
A

E

60
Q

On neurologic examination, the patient responded only to pain by withdrawal of the right upper extremity. Which of the following levels of consciousness best describe the patient’s condition?

A. Awake 
B. Drowsy 
C. Stuporous 
D. Comatose 
E. Acute confusional state
A

C

61
Q

On testing the pupillary light and direct light reflex, which of the following cranial nerve/s are involved?

A. Cranial nerve II 
B. Cranial nerve III 
C. Cranial nerve IV 
D. A and B 
E. B and C
A

D

62
Q

In general, which of the following respiratory pattern/s would suggest the level of brain dysfunction/lesion?

A. Cheyne-Stokes 
B. Central Neurogenic Hyperventilation 
C. Apneustic 
D. Ataxic 
E. All of the above
A

D

63
Q

The following are components of sensorium EXCEPT:

A. Consciousness 
B. Orientation 
C. Memory 
D. Insight, judgment and planning 
E. Motor response
A

E

64
Q

After an hour, the level of consciousness of the patient deteriorated. She was noted to assume a decorticate posturing. Which of the following best describe this condition?

A. Arms flexed and legs extended
B. Arms and legs flexed
C. Arms hyperextended on the side and legs extended
D. Arms and legs appropriately withdrawing to pain
E. None of the above

A

A

Clinical Neurology (10 decks)

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