Neuro Exam III Clinical Notes Flashcards
What is muscle tone (LMN dysfunction) characterized by?
a) Fluctuating tension in muscles
b) Absence of tension in muscles
c) Steady level of tension in muscles
d) Unpredictable muscle contractions
Steady level of tension in muscles
Reason: Muscle Tone: steady level of tension in muscles – felt as a resistance of the muscle to
passive stretch
Which term describes a condition characterized by decreased tone of skeletal muscles?
a) Hypertonus (LMN dysfunction)
b) Hyperreflexia (LMN dysfunction)
c) Hypotonus (LMN dysfunction)
d) Hyporeflexia (LMN dysfunction)
Hypotonus
Which term describes a condition characterized by increased tone of skeletal muscles?
a) Hypertonus (LMN dysfunction)
b) Hyperreflexia (LMN dysfunction)
c) Hypotonus (LMN dysfunction)
d) Hyporeflexia (LMN dysfunction)
Hypertonus
Which of the following are upper limb reflex areas
Biceps (C5, C6)
Triceps (C6, C7, C8); Brachioradialis (C5, C6)
Finger flexors (C7, C8)
All of the above
All of the above
Name the lower limb reflex area
Patella (L2, L3, L4); Achilles (S1, S2)
Which term refers to a condition where there is an absence of reflex activity?
a) Areflexia (LMN dysfunction)
b) Hyporeflexia (LMN dysfunction)
c) Hyperreflexia (LMN dysfunction)
d) Reflexia (LMN dysfunction)
Areflexia
Areflexia: lack of reflex activity
Your patient presents with reflex activity that is weaker than normal. What reflex activity do you suspect your patient to have?
a) Areflexia (LMN dysfunction)
b) Hyporeflexia (LMN dysfunction)
c) Hyperreflexia (LMN dysfunction)
d) Reflexia (LMN dysfunction)
Hyporeflexia
Your patient presents with reflex activity that is over active/stronger than normal. What reflex activity do you suspect your patient to have?
a) Areflexia (LMN dysfunction)
b) Hyporeflexia (LMN dysfunction)
c) Hyperreflexia (LMN dysfunction)
d) Reflexia (LMN dysfunction)
Hyperreflexia
True or False:
If your patient has damage to the final motor pathway LMN, you would expect to observe weakness, muscle atrophy, fibrillations or fasciculations, hypotonia, and hyporeflexia or areflexia.
True
A patient with upper motor neuron (UMN) damage to CN VII, where would you typically expect to observe weakness suspecting the damage is ABOVE the motor of decussation?
a) Ipsilateral to the lower muscle of the facial expression
b) Contralaterally to the lower muscle of facial expression
c) Bilaterally
d) Unilaterally
b) Contralaterally to the lower muscle of facial expression
UMN Damage Contralateral weakness. Reason: CN VII: lower muscle of facial expression
CN VII: LMN that innervate the lower facial
muscles receive primarily ____ input.
contralateral
CN X: LMN that innervate the muscles of soft palate & uvula receive primarily ______
input
contralateral
CN XI: LMN that innervate the trapezius/SCM
receives primarily ____ input.
ipsilateral
CN XII: LMN that innervate the genioglossus
receives primarily ____ input
contralateral
Which cranial nerve innervates the muscles of the soft palate, leading to a deviation of the uvula toward the side of the lesion when damaged in UMN damage contralateral weakness?
a) CN V
b) CN VII
c) CN X
d) CN XII
c) CN X
Which cranial nerve innervates the trapezius and sternocleidomastoid muscles ipsilaterally in UMN damage contralateral weakness?
a) CN V
b) CN VII
c) CN XI
d) CN XII
c) CN XI
Which cranial nerve, when affected by lower motor neuron damage, geioglossus leads to deviation of the tongue TOWARD the side of the lesion?
a) CN V
b) CN VII
c) CN X
d) CN XII
d) CN XII
In lower motor neuron damage affecting which cranial nerve, do we observe deviation of the uvula away from the side of the lesion?
a) CN V
b) CN VII
c) CN X
d) CN XII
CN X
Which cranial nerve, when damaged at the lower motor neuron level, results in weakness of the trapezius and sternocleidomastoid muscles?
a) CN V
b) CN VII
c) CN XI
d) CN XII
c) CN XI
In lower motor neuron (LMN) damage, which cranial nerve is responsible for innervating all of the muscles of facial expression, leading to ipsilateral weakness?
a) CN V
b) CN VII
c) CN X
d) CN XII
b) CN VII
LMN Unit
A patient has a stroke and has sudden weakness in their contralateral trunk, upper limb, and face regions. Which artery is most likely affected in this case?
a) Anterior cerebral artery
b) Posterior cerebral artery
c) Middle cerebral artery
d) Anterior communicating artery
Middle cerebral artery
A patient is admitted to the emergency room with a stroke. Imaging reveals a lesion affecting the posterior limb and genu of the internal capsule. Which arterial branches are most likely implicated?
a) Anterior cerebral artery
b) Posterior cerebral artery
c) Lenticulostriate branches
d) Middle cerebral artery
c) Lenticulostriate branches
Following a suspected stroke, a patient presents with weakness primarily affecting the lower limb region of primary motor cortex. Which cerebral artery is likely involved in this neurological deficit?
a) Middle cerebral artery
b) Posterior cerebral artery
c) Anterior cerebral artery
d) Anterior communicating artery
c) Anterior cerebral artery
True or False : If your patient has damage to the UMN, you would expect to observe Initial flaccidity (spinal shock), Weakness: graded (paresis) or complete paralysis
(plegia), Mono (single limb), Hemi (one side of the body), Para (only the legs), Tri (three limbs), Tetra or Quadra (all four limbs), Hypertonia & Hyperreflexia
True
Which of the following best defines apraxia (UMN dysfunction)?
a) Impairment in memory recall
b) Difficulty in language comprehension
c) Impairment in the ability to execute actions in absence of paresis or paralysis
d) Difficulty in recognizing familiar objects
c) Impairment in the ability to execute actions in absence of paresis or paralysis
Decorticate rigidity is characterized by:
a) Hyperactivity in the flexor muscles of the upper extremities and the extensor muscles of the lower extremities
b) Hypoactivity in the flexor muscles of the upper extremities and the extensor muscles of the lower extremities
c) Hypoactivity in all muscle groups
d) Hyperactivity in all muscle groups
a) Hyperactivity in the flexor muscles of the upper extremities and the extensor muscles of the lower extremities
Damage to cortical areas leading to the removal of cortical influence on brainstem-spinal systems occurs where with decorticate rigidity ?
a) Below the Red nucleus
b) Below Hypothalamus
c) Above the Red nucleus
d) Above the Thalamus
Above the Red nucleus
Decerebrate rigidity is characterized by:
a) Unopposed hyperactivity in the flexor muscles of the limbs
b) Unopposed hyperactivity in the extensor muscles of the limbs
c) Hypoactivity in the flexor muscles of the limbs
d) Hypoactivity in the extensor muscles of the limbs
b) Unopposed hyperactivity in the extensor muscles of the limbs
Damage to cortical areas leading to the removal of cortical influence on brainstem-spinal systems occurs where with decerebrate rigidity ?
a) Below the Red nucleus
b) Below Hypothalamus
c) Above the Red nucleus
d) Above the Thalamus
a) Below the Red nucleus
Which condition is characterized by absence of fasciculation and fibrillation?
a) Spasticity
b) Clasp-knife phenomenon
c) Clonus
d) Babinski sign
d) Babinski sign (UMN dysfunction)
Which sign involves dorsiflexion of the great toe with fanning of the other toes upon firm stroking of the lateral aspect of the foot?
a) Spasticity (UMN dysfunction)
b) Clasp-knife phenomenon (UMN dysfunction)
c) Clonus (UMN dysfunction)
d) Babinski sign (UMN dysfunction)
d) Babinski sign (UMN dysfunction)
Which phenomenon is described as increased resistance to passive movement followed by a sudden release of the resistance?
a) Spasticity (UMN dysfunction)
b) Clasp-knife phenomenon (UMN dysfunction)
c) Clonus (UMN dysfunction)
d) Babinski sign (UMN dysfunction)
b) Clasp-knife phenomenon (UMN dysfunction)
What is spasticity characterized by?
a) Increased resistance to passive movement followed by sudden release
b) Decreased resistance to passive movement
c) Velocity-dependent resistance to passive movement
d) Rhythmic involuntary muscular contractions and relaxations
c) Velocity-dependent resistance to passive movement
In individuals with hyperkinetic movement disorders, what type of involuntary movements are typically observed?
a) Weak and slow movements
b) Excessive involuntary movements
c) No involuntary movements
d) Rapid voluntary movements
b) Excessive involuntary movements
Movement disorders are characterized by abnormal motor control resulting from:
a) Increased voluntary movements
b) Diminished voluntary movements or presence of involuntary movements
c) Reduced involuntary movements
d) Absence of any motor activity
b) Diminished voluntary movements or presence of involuntary movements
Which term best describes hypokinetic movement disorders?
a) Increased motor activity
b) Diminished or slowed automatic movements
c) Diminished voluntary movements
d) Excessive involuntary movements
b) Diminished or slowed automatic movements
What characterizes hyperkinetic movement disorders?
a) Excessive voluntary movements
b) Diminished voluntary movements
c) Reduced involuntary movements
d) Excessive involuntary movements
d) Excessive involuntary movements
What are brief, abrupt, irregular, and unpredictable movements that flow between muscle groups known as?
a) Chorea
b) Athetosis
c) Ballismus
d) Tics
a) Chorea
Which movement disorder involves uncontrolled co-contraction of agonist and antagonist muscles, leading to abnormal postures?
a) Chorea
b) Dystonia
c) Athetosis
d) Tics
b) Dystonia
What term describes involuntary movements of the tongue, face, arms, and lips?
a) Tics
b) Ballismus
c) Tardive dyskinesia
d) Resting tremors
c) Tardive dyskinesia
Which type of movement disorder is characterized by abnormal, uncontrolled involuntary movements?
a) Chorea
b) Dystonia
c) Dyskinesia
d) Athetosis
c) Dyskinesia
What term describes rapid movements of particular body parts that range from simple motor tics to complex and repetitive movements?
a) Athetosis
b) Chorea
c) Tics
d) Dystonia
c) Tics
Which movement disorder is characterized by involuntary ballistic movements, often seen as wild flinging of a body part?
a) Chorea
b) Dystonia
c) Athetosis
d) Ballismus
Answer: d) Ballismus
How does athetosis differ from chorea?
a) Athetosis involves slower movements primarily in the distal extremities ex hands.
b) Chorea involves slower movements primarily in the distal extremities.
c) Athetosis involves rapid, unpredictable movements involving multiple muscle groups.
d) Chorea involves rapid, unpredictable movements involving multiple muscle groups.
Answer: a) Athetosis involves slower movements primarily in the distal extremities example hands.
Resting tremors are characterized by tremors in a body part when at rest, which stop when the body part engages in active movement.
True or False?
True
Reason: Resting Tremors: when at rest body part tremors and tremor stops when the body part engages in
active movement.
Which disorder is characterized by a selective and progressive loss of medium spiny neurons (MSNs) of the indirect pathway in the Striatum, leading to changes in behavior, cognition, and choreiform movements?
a) Parkinson’s Disease
b) Multiple Sclerosis
c) Huntington’s Disease
d) Amyotrophic Lateral Sclerosis
c) Huntington’s Disease
Which hyperkinetic movement disorder is typically caused by a unilateral lesion to the Subthalamic nucleus, resulting in involuntary ballistic movements on the contralateral side of the body?
a) Parkinson’s Disease
b) Huntington’s Disease
c) Hemiballismus
d) Dystonia
Answer: c) Hemiballismus
Which term describes slowness and poverty of movement?
a) Akinesia
b) Bradykinesia
c) Rigidity
d) Lead-pipe rigidity
Answer: b) Bradykinesia
What is the term for resistance to passive movement that is not dependent on speed and feels like catching and releasing of gears?
a) Akinesia
b) Bradykinesia
c) Rigidity
d) Cogwheel rigidity
Answer: d) Cogwheel rigidity
What is the definition of akinesia?
a) Slowness and poverty of movement
b) Resistance to passive movement
c) Absence or loss of power of voluntary movements
d) Rigidity coupled with tremor
Answer: c) Absence or loss of power of voluntary movements
How is rigidity defined?
a) Slowness and poverty of movement
b) Resistance to passive movement that is not dependent on speed
c) Absence or loss of power of voluntary movements
d) Rigidity coupled with tremor
Answer: b) Resistance to passive movement that is not dependent on speed
What characterizes Parkinson’s Disease, a hypokinetic movement disorder?
a) Increased dopamine input to the striatum
b) Progressive loss of dopaminergic neurons in the Substantia nigra
c) Increased excitation of the direct pathway
d) Increased inhibition of the indirect pathway
Answer: b) Progressive loss of dopaminergic neurons in the Substantia nigra
Which symptom is characteristic of Parkinson’s Disease?
a) Hyperkinesia
b) Resting tremor
c) Increased facial expressions
d) Frenetic gait
Answer: b) Resting tremor
Which artery supplies the entire superior surface of the cerebellum, majority of the deep cerebellar nuclei, superior cerebellar peduncle, and the rostral part of the middle cerebellar peduncle?
a) Anterior cerebral artery
b) Middle cerebral artery
c) Posterior cerebral artery
d) Superior cerebellar artery
Answer: d) Superior cerebellar artery
Which artery supplies the caudolateral parts of the inferior cerebellar surface and the caudal part of the middle cerebellar peduncle?
a) Anterior inferior cerebellar artery
b) Posterior inferior cerebellar artery
c) Superior cerebellar artery
d) Basilar artery
Anterior inferior cerebellar artery
Which artery supplies the caudomedial parts of the inferior cerebellar surface, including the vermis, and the inferior cerebellar peduncle?
a) Anterior inferior cerebellar artery
b) Posterior inferior cerebellar artery
c) Superior cerebellar artery
d) Basilar artery
Answer: b) Posterior inferior cerebellar artery
Which term describes the inability to perform rapid alternating movements, such as rapid supination or pronation, opening/closing hand, or finger tapping?
a) Ataxia (cerebellum dysfunction)
b) Dysdiadochokinesia (cerebellum dysfunction)
c) Dysarthria (cerebellum dysfunction)
d) Titubation (cerebellum dysfunction)
Answer: b) Dysdiadochokinesia (cerebellum dysfunction)
What is characterized by inappropriate force and distance of targeted movements, often resulting in hypometria or hypermetria?
a) Dysarthria (cerebellum dysfunction)
b) Dysmetria (cerebellum dysfunction)
c) Intention tremor (cerebellum dysfunction)
d) Dysdiadochokinesia (cerebellum dysfunction)
Answer: b) Dysmetria (cerebellum dysfunction)
Which term describes the impairment in coordination and accuracy of movements that accompanies cerebellar damage, with deficits predominantly seen ipsilateral to the lesion?
a) Dysmetria (cerebellum dysfunction)
b) Dysdiadochokinesia (cerebellum dysfunction)
c) Ataxia (cerebellum dysfunction)
d) Dysarthria (cerebellum dysfunction)
Answer: c) Ataxia (cerebellum dysfunction)
What is characterized by a wide base stance, staggering gait pattern, and frequent loss of balance toward the side of the lesion?
a) Dysmetria (cerebellum dysfunction)
b) Dysdiadochokinesia (cerebellum dysfunction)
c) Ataxia (cerebellum dysfunction)
d) Postural/gait disturbance (cerebellum dysfunction)
Answer: d) Postural/gait disturbance (cerebellum dysfunction)
What term refers to a type of essential tremor that causes uncontrollable, rhythmic shaking?
a) Intention tremor (cerebellum dysfunction)
b) Titubation (cerebellum dysfunction)
c) Dysarthria (cerebellum dysfunction)
d) Dysmetria (cerebellum dysfunction)
Answer: b) Titubation (cerebellum dysfunction)
Which term describes a type of tremor characterized by an oscillatory trajectory during target-directed movements, pronounced at the end point of the movement, and absent at rest?
a) Intention tremor (cerebellum dysfunction)
b) Titubation (cerebellum dysfunction)
c) Dysmetria (cerebellum dysfunction)
d) Dysdiadochokinesia (cerebellum dysfunction)
a) Intention tremor (cerebellum dysfunction)
What is the result of damage to the abducens nerve?
a) Loss of ability to abduct the contralateral eye
b) Loss of ability to abduct the ipsilateral eye
c) Inability to adduct the ipsilateral eye
d) Inability to adduct the contralateral eye
Answer: b) Loss of ability to abduct the ipsilateral eye
What occurs with damage to the abducens nuclei or horizontal gaze center?
a) Loss of ability to abduct the contralateral eye
b) Loss of ability to abduct the ipsilateral eye
c) Inability to adduct the ipsilateral eye
d) Horizontal gaze palsy - inability to adduct the contralateral eye during horizontal saccade
Answer: d) Horizontal gaze palsy - inability to adduct the contralateral eye during horizontal saccade
What is the result of damage to the frontal eye fields (FEF)?
a) Loss of ability to abduct the ipsilateral eye
b) Inability to adduct the contralateral eye
c) Decreased ability to voluntarily direct the eyes to/from a visual target
d) Loss of ability to make short-reflex-like saccade movements
Answer: c) Decreased ability to voluntarily direct the eyes to/from a visual target
What is the result of damage to the medial longitudinal fasciculus (MLF)?
a) Inability to abduct the ipsilateral eye
b) Inability to adduct the contralateral eye
c) Inability to converge the eyes
d) Loss of ability to make short-reflex-like saccade movements
Answer: b) Inability to adduct the contralateral eye
What occurs with damage to the superior colliculus (SC)?
a) Loss of ability to abduct the ipsilateral eye
b) Inability to adduct the contralateral eye
c) Loss of ability to make short-reflex-like saccade movements
d) Decreased ability to voluntarily direct the eyes to/from a visual target
Answer: c) Loss of ability to make short-reflex-like saccade movements
Following damage to the frontal eye fields (FEF), which structure compensates for the loss of function over time?
a) Abducens nerve
b) Medial longitudinal fasciculus (MLF)
c) Superior colliculus (SC)
d) Oculomotor nerve
Answer: c) Superior colliculus (SC)
You are assessing a patient who had a stroke that affected the lateral zone of the left cerebellum. You would expect to see motor deficits on the right side? True or False
TRUE: contralateral deficits
