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AAPMR questions review > Neurological disorders > Flashcards

Neurological disorders Flashcards

1
Q

A needle electrode examination with fibrillations in the teres minor, anconeus, and supinator muscles and normal findings in the brachialis, flexor carpi ulnaris, and pronator teres muscles would localize a lesion to which part of the brachial plexus?

A

Posterior cord

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2
Q

In an acute myopathic process the number of motor units is functionally ___. The muscle fiber content of each motor unit is classically ___. In an end stage myopathic process the number of motor units is functionally ___. The muscle fiber content of each motor unit is classically ___.

A

Unchanged, decreased; decreased, decreased

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3
Q

A 45-year-old male patient presents to the hospital with an acute onset of generalized weakness, impaired balance, coordination, difficulty walking and lazy eyes worsening over past 3 days. On further history he reports a history of flu like symptoms a week prior to the onset of these symptoms. He denies any difficulty breathing, numbness, or bowel and bladder symptoms. On exam, he is mildly tachycardic with elevated BP, and is noted to have bilateral 3rd,4th,6th nerve palsy, strength of 4/5 in bilateral upper and lower extremities, areflexia and ataxic gait. He has no sensory abnormalities. Labs are positive for Anti-GQ1b antibodies. CSF shows elevated protein with normal WBC count. EMG shows prolongation of F wave latencies. What subtype of Guillain-Barré syndrome (GBS) does this patient likely have?

A

Miller Fisher variant of GBS

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4
Q

What is the leading cause of post-stroke disability among nursing home residents?

A

Urinary incontinence

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5
Q

What is the most common mode of inheritance of spinal muscular atrophy?

A

autosomal recessive

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6
Q

Which of the following is the natural history of pediatric Guillain-Barré Syndrome (GBS), as compared with adult GBS?

A

more benign course

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7
Q

When considering the upper extremities of a SCI patient, the rear axle should be positioned so that the hand is placed at the top center position on the push rim, and the angle between the upper arm and the forearm is between:

A

100-120 degrees

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8
Q

A 53-year-old right-handed male presents with alexia without agraphia following a stroke. The most common blood vessel infarcted is:

A

Left posterior cerebral artery

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9
Q

Which of the following mechanisms of injury can result in cervical cord neuropraxia?

A

hyperflexion, hyperextension, and axial compression forces.

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10
Q

Patients with which type of brain injury are most likely to have deep vein thromboses?

A

Intraparenchymal hemorrhage

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11
Q

Which is true of Hereditary Inclusion Body Myopathy?

A

Relatively spares function of the quadriceps

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12
Q

Treadmill training in Parkinson’s Disease patients improves:

A

gait speed

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13
Q

The most common sites and organism for epidural abscesses are:

A

Thoracic spine and Staphylococcus aureus

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14
Q

The most common form of spinal cord dysfunction in individuals over the age of 55 in the USA is:

A

Cervical spondylotic myelopathy

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15
Q

An elderly patient is evaluated following surgical repair of pelvic and femoral fractures sustained in a motor vehicle crash. He suffered femoral nerve damage due to the trauma. Which of the following areas will have decreased sensation?

A

Medial aspect of the calf

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16
Q

Following an acute ischemic stroke, an individual is admitted to acute rehabilitation with the following deficits: partial right hemianopsia, fluent speech with paraphasic errors, poor comprehension of spoken/written language, and preserved motor/somatosensory function. What is the most likely location of the stroke?

A

Inferior division of the dominant middle cerebral artery

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17
Q

According to the international standards for neurological classification of SCI, when testing for a grade 4 or 5 strength, the following specific positions should be used:

A

C7: shoulder is neutral rotation, abducted and in 90 degrees of forward flexion and elbow in 45 degrees of flexion, L2: hip is flexed to 90 degrees.C5: elbow flexed at 90 degrees, arm at the patient’s side and forearm supinated. C6: wrist is full extension.

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18
Q

What is the most commonly injured nerve in total hip arthroplasty performed from a posterior surgical approach?

A

Sciatic

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19
Q

45-year-old concert violinist presents to your clinic for evaluation of 8 months of left elbow pain and impaired function. She has been diagnosed with “lateral epicondylitis”. She has treated her symptoms with relative rest, occupational therapy and alternative therapies, such as acupuncture and massage, without improvement in her symptoms. What other diagnosis should you consider in this patient?

A

Posterior interosseous neuropathy

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20
Q

The cerebral perfusion pressure is the driving force behind cerebral blood flow. How is cerebral perfusion pressure calculated?

A

Mean arterial blood pressure minus intracranial pressure

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21
Q

Which microscopic skin changes occurs following spinal cord injury?

A

There is decreased Type I collagen and increased Type III collagen below the level of injury.

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22
Q

What is a common clinical manifestation of myotonic muscular dystrophy?

A

cataracts

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23
Q

The subtype of dermatomyositis/polymyositis most often associated with neoplasia is

A

type 3

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24
Q

The most common form of primary spinal cord tumor is a(n):

A

schwannoma

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25
Q

Which of the following factors increases the likelihood of employment after spinal cord injury?

A

greater for women, paraplegia compared with tetraplegia neurologic level of injury, incomplete compared with complete AIS impairment scale

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26
Q

Which of the following is the preferred method of ventilator weaning in tetraplegics?

A

Progressive ventilator-free breathing (PVFB)

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27
Q

An individual with a functional level of C5 motor-complete tetraplegia, with no zone of partial preservation below this level, asks you for information regarding a rehabilitation strategy to maximize upper limb function. You suggest a(n):

A

Long-opponens splint with a universal cuff

28
Q

What has been shown to prolong survival for patients with amyotrophic lateral sclerosis (ALS)?

A

Early enteral feeding tube placement

29
Q

In accordance to the International Standards for Neurological and Functional Classification, at post-injury, the earliest reliable neurological evaluation may be performed to predict neurological recovery is:

A

72 hours to 7 days

30
Q

Which of the following is the mobility outcome for Myotonic muscular dystrophy?

A

preserved ambulation

31
Q

Increased intracranial pressure that displaces the medial edge of the temporal lobe through the tentorial foramen is called:

A

uncle herniation

32
Q

What is it called when the innermost part of the frontal lobe is pushed under part of the falx cerebri.

A

Falcine herniation

33
Q

Which strengthening exercises result in greatest force generation and mobility in those with Parkinson’s disease?

A

eccentric

34
Q

The function of which commonly affected nerve should be assessed when considering post-mastectomy pain syndrome (PMPS) as a diagnosis?

A

1) intercostobrachial nerve (axillary paresthesia); 2) thoracodorsal nerve (latissimus weakness); 3) long thoracic nerve (serratus anterior weakness); 4) medial/lateral pectoral nerve (pectoralis weakness).

35
Q

What is the earliest recommended age for initiating intermittent catheterization training in the pediatric SCI population?

A

3 years

36
Q

Which is the most common symptom of tethered cord in a patient with myelomeningocele?

A

weakness

37
Q

Tracheal tube placement for long-term ventilator support in spinal cord injured individuals is associated with:

A

granulation formation, stomal infection, tracheomalacia, tracheal perforation, stenosis, fistula formation, decreased voice volume, and inability to perform glossopharyngeal breathing.

38
Q

Your patient has a tremor of 5-8Hz, which is made worse with activity, and there is little or no tremor at rest. This finding best describes which type of tremor?

A

essential

39
Q

Medulloblastoma is associated with

A

high incidence of neurocognitive deficits (Over 85% of children with this type of tumor have long-term learning and memory deficits.)

40
Q

Which of the following is most useful in determining the prognosis of patients with Guillain-Barré syndrome (GBS)?

A

CMAP amplitudes of < 20% of the lower limit of normal on nerve conduction studies, the magnitude of increase in serum IgG levels 2 weeks after IVIG treatment, nerve root enhancement on MRI, and elevated CSF levels of axonal neurofilament (NfH).

41
Q

Among patients with Asia Impairment Scale (AIS) A, which level of injury are usually good candidates for phrenic nerve pacer placement:

A

C2

42
Q

Musculocutaneous neuropathy may be associated with loss of sensation over the:

A

lateral forearm

43
Q

Which level of cervical radiculopathy has the highest incidence?

A

C7

44
Q

What type of mobility would be anticipated in a teenager with cerebral palsy who has a gross motor functional classification level of IV?

A

Wheelchair use in the community

45
Q

Which factor is associated with the best prognosis in multiple sclerosis?

A

female sex, younger age at onset, > 5 years between attacks, < 2 relapses in the first 5 years, initial attack of optic neuritis, and complete recovery after the first attack.

46
Q

Which of the following is most commonly present in the Miller Fisher variant of Guillain-Barré syndrome?

A

Areflexia, external ophthalmoparesis, and ataxia

47
Q

A 21-year-old man is treated for testicular cancer with a protocol that includes radical orchiectomy, retroperitoneal lymph node dissection (RPLND), and cisplatin. Three months following completion of therapy, he develops progressive lower extremity pain and gait dysfunction. What is the most likely cause of his symptoms?

A

coasting effect

48
Q

what is the term for Damage to the dorsal root ganglion by platinum-based chemotherapeutics causes progressive dysfunction of the dorsal root ganglion as cellular activities are disrupted. This leads to the progressive development of sensory neuropathy that can start weeks to months after the discontinuation of chemotherapy and continue for as long as a year

A

coasting effect

49
Q

With an anterior dislocation of the hip, which nerve palsy is most likely to present?

A

femoral

50
Q

What is the underlying pathophysiology in mucopolysaccharidoses?

A

Degradation of glycosaminoglycans

51
Q

The gold standard imaging study for demonstrating fracture pattern and spinal canal compromise in spinal injuries is:

A

CT scan

52
Q

Which is an absolute contraindication for using recombinant tissue plasminogen activator (t-PA) in an acute stroke?

A

intracranial hemorrhage (acute or history of), uncontrolled hypertension, thrombocytopenia or coagulopathy, serious head trauma or stroke in the last 3 months; frank hypodensity on CT more than one-third of the affected cerebral hemisphere, sever hypo- or hyperglycemia.

53
Q

Which of the following muscles will be spared in an upper trunk brachial plexopathy (proximal to the origin of the suprascapular nerve) but affected in a C5/6 radiculopathy?

A

Rhomboids and serratus anterior

54
Q

Which of the following is a primary manifestation of anterior spinal cord syndrome?

A

Motor weakness

55
Q

Which of the following characteristics is featured in Myotonic Dystrophy?

A

multiple psychological disorders, including obsessive compulsive disorder, depression, and avoidant personality disorder. Testicular atrophy and cardiac abnormalities are common in DM.

56
Q

The MOST common clinical presentation of those with expanding post traumatic syringomyelia is:

A

pain

57
Q

Which of the following is most likely to be present in both Multifocal Motor Neuropathy (MMN) and Amyotrophic Lateral Sclerosis (ALS)?

A

Asymmetric, progressive weakness without sensory loss

58
Q

Which stroke syndrome has ipsilateral ptosis, external strabismus, a dilated pupil, and contralateral weakness of the lower face, tongue, arm, and leg?

A

weber

59
Q

Which imaging method is the preferred initial study to detect brain tumors?

A

MRI

60
Q

Which of the following increases risk of respiratory failure in spinal cord injury?

A

Signs of impending respiratory failure in spinal cord injury include neurological level C3 or higher, forced vital capacity <1L, and arterial blood gas shows increased PCO2 or decreased PO2 levels.

61
Q

What is the most common fracture site for chronic SCI patients?

A

femur fracture

62
Q

Which of the following is the largest contributor to formation of joint contractures in neuromuscular disease?

A

immobility

63
Q

Which neurologic deficit showed improvement with slow repetitive transcranial magnetic stimulation to the un-injured hemisphere in stroke patients?

A

aphasia

64
Q

What is the highest level of spinal cord injury where independence in all aspects of bowel management can be attained?

A

c7

65
Q

Which of the following is the primary mechanism of acute traumatic injuries to the spinal cord?

A

deformation of the spinal cord

66
Q

what are some secondary mechanisms of injury for SCI

A

ischemia, axonal degeneration, and inflammation.

AAPMR questions review (9 decks)

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