Neurology - Impairment of Motor Control - Clinical Signs and Patterns

Question 1

which part of the frontal lobe is made up of large pyrimidal neurons that travel down the spinal cord and synapse with motor neurons

a.primary motor cortex
b.premotor cortex
c.prefrontal and orbitofrontal

Answer 1

a.primary motor cortex

Question 2

which part of the frontal lobe organises and sequences movements

a.primary motor cortex
b.premotor cortex
c.prefrontal and orbitofrontal

Answer 2

b.premotor cortex

Question 3

which part of the frontal lobe is responsible for abstract planning and telling the premotor cortex the steps required to reach a goal

a.primary motor cortex
b.premotor cortex
c.prefrontal and orbitofrontal

Answer 3

c.prefrontal and orbitofrontal

Question 4

descending motor pathway

Answer 4

primary motor cortex
internal capsule
cerebellar peduncles in pons
cross at level of medulla to form lateral corticospinal tracts
synapse with lower motor neurons
neuromuscular junction
muscle

primary motor cortex
internal capsulse
cerebellar peduncles in pons
cross over at level of medulla to form corticospinal tracts
synapse with lower motor neurons
neuromuscular junction
muscle

primary motor cortex
internal capsule
cerebellar peduncles in pons
cross over at level of medulla to form corticospinal tracts
synapse with lower motor neurons
neuromuscular junction
muscle

Question 5

the cell body of lower motor neurons is located within which structure

a.dorsal horn
b.ventral horn

Answer 5

b.ventral horn

Question 6

which type of motor neurons are responsible for voluntary muscle contraction and the myostatic stretch reflex

a.a motor neurons
b.y motor neurons

Answer 6

a.a motor neurons

Question 7

which type of motor neurons are responsible for regulating muscle tone and maintaining proprioception

a.a motor neurons
b.y motor neurons

Answer 7

b.y motor neurons

Question 8

the cortex exerts …………. signals over both the spinal neurons and brainstem motor areas

a.exitatory
b.inhibitory

Answer 8

b.inhibitory

Question 9

to ensure postural stability when pulling on a handle contraction of the gastrocnmius happens ……………….. contraction of the biceps

a.before
b.after

Answer 9

a.before

Question 10

weakness of the legs

a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis

Answer 10

a.paraparesis

Question 11

complete weakness of the legs

a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis

Answer 11

b.paraplegia

Question 12

abnormal sensation

a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis

Answer 12

c.paraesthesia

Question 13

weakness of the arms and legs

a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis

Answer 13

d.quadraparesis

Question 14

weakness of half of the body

a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis

Answer 14

e.hemiparesis

Question 15

myelo -

Answer 15

of the spinal cord

Question 16

radiculo -

Answer 16

of the nerve roots

Question 17

lack of coordination of limb movements and or gait

a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.ataxia

Answer 17

e.ataxia

Question 18

contralateral (to the lesion) hemiplegia (paralysis of one side of the body ) and pattern of flexed upper limbs and extended lower limbs indicates brain damage where ?

a.above medulla
b.below medulla
c.peripheral nervous system
d.basal ganglia
e.cerebellum

Answer 18

a.above medulla

Question 19

damage below the medulla results in a spinal cord syndrome. quadriplegia suggests damage to which part of the spinal cord

a.cervical
b.thoracic
c.lumbar
d.sacral

Answer 19

a.cervical

Question 20

paraplegia (paralysis of the legs) indicates damage below the medulla to which section of the spinal cord

a.cervical
b.thoracic
c.lumbar
d.sacral

Answer 20

b.thoracic or c,lumbar

Question 21

hemisection of the spinal cord results in which spinal cord syndrome

a.guillian barre
b.eaton lambert
c.cushings
d,waterhouse friedrickson
e.brown sequard

Answer 21

e.brown sequard

Question 22

in brown sequard syndrome weakness /paralysis occurs ………….. to the lesion

a.contralaterally
b.ipsilaterally

Answer 22

b.ipsilaterally

Question 23

in brown sequard syndrome loss of pai and temperature sensation occurs ………….. to the lesion

a.contralaterally
b.ipsilaterally

Answer 23

a.contralaterally

Question 24

UMN lesion results in …………… of the stretch reflex

a.hyperexcitability
b.hypoexcitability

Answer 24

a.hyperexcitability

loss of inhibitory control
eg clasp knife

Question 25

increased tone, clonus , hyperreflexia and the babinski sign indicate what a.UMN lesion b.LMN lesion c.cerebellar damage d.basal ganglia damage

Answer 25

a.UMN lesion

Question 26

spastic paraparesis of all 4 limbs indicates the lesion must be above.. a.c6 b.c5 c.c4 d.c3 e.c2

Answer 26

b.c5

Question 27

what does a complete lesion cause

Answer 27

complete paralysis below lesion loss of sensory modalities below lesion loss of bowel, bladder and sexual function

Question 28

if there is spastic paraparesis in legs but arms are normal the lesion must be below a.c5 b.c6 c.c7 d.t1 e.t2

Answer 28

d.t1

Question 29

lesions of the thoracic / lumbar spinal cord are often ............ causing bilateral leg weakness , impaired sensory function and defective bowel, bladder and sexual function a.complete b.incomplete

Answer 29

b.incomplete

Question 30

conditions with UMN signs

Answer 30

brain tumour ischaemic stroke intracranial haemorrhage MS spinal cord stenosis prolapsed disc

Question 31

damage to the motor neuron in the anterior horn of the spinal cord is classed as a a.UMN lesion b.LMN lesions

Answer 31

b.LMN lesions

Question 32

muscle wasting, flaccid tone, fasciculations and waddling gait indicate which type of lesion a.UMN b.LMN c.cerebellar lesion d. basal ganglia lesion

Answer 32

b.LMN

Question 33

distal and ascending (from legs to torso to arms ) flaccid areflexic paraplegia is seen in which syndrome a.guillian barre b.eaton lambert c.cushings d,waterhouse friedrickson e.brown sequard

Answer 33

a.guillian barre

Question 34

in which syndrome does the immune syste attack nerve cells leading to ascending flassid areflexic paraplegia a.guillian barre b.eaton lambert c.cushings d,waterhouse friedrickson e.brown sequard

Answer 34

a.guillian barre

Question 35

proximal weakness leading to difficulty rising, walking up stairs and washing hair can be caused by what a.brown sequard syndrome b.guillian barre syndrome c.plexopathy, radiculopathy , muscular dystrophies d.focal/widespread neuropathy e.myasthenia gravis

Answer 35

c.plexopathy, radiculopathy , muscular dystrophies

Question 36

distal weakness eg difficulty with fine tasks eg writing and phone can be caused by a.brown sequard syndrome b.guillian barre syndrome c.plexopathy, radiculopathy , muscular dystrophies d.focal/widespread neuropathy e.myasthenia gravis

Answer 36

d.focal/widespread neuropathy

Question 37

fatiguable weakness (worse with repeated effort/ at the end of the day more so in neck and eyes indicates what a.brown sequard syndrome b.guillian barre syndrome c.plexopathy, radiculopathy , muscular dystrophies d.focal/widespread neuropathy e.myasthenia gravis

Answer 37

e.myasthenia gravis

Question 38

patient with foot drop ( unable to dorsiflex the foot and floppy at ankle ) may be due to wasting of which muscle if long standing a.tibialis anterior b.fibularis anterior c.fibularis posterior d. tibialis posterior

Answer 38

a.tibialis anterior

Question 39

which of these is NOT a lesion location indicated in foot drop a.deep/ common peroneal nerve b.sciatic nerve c.lumbosacral plexus d.L5 nerve root e,T1 nerve root

Answer 39

d.L5 nerve root

Question 40

a lesion in which of these nerve root can cause foot drop a.L1 b.L2 c.L3 d.L4 e.L5

Answer 40

e.L5

Question 41

if wrist drop is chronic is may be due to wasting of which muscle a.biceps brachii b.brachioradialis c.triceps

Answer 41

c.triceps

Question 42

wrist drop may be due to a lesion on which nerve a. median b.musculocutaneous c.axillary d.radial e. ulnar

Answer 42

d.radial

Question 43

wrist drop can be seen in which of these conditions a.brown sequard syndrome b.guillian barre syndrome c. Motor neurone disease d.focal/widespread neuropathy e.myasthenia gravis

Answer 43

c. Motor neurone disease

Question 44

combination of upper and lower motor neurone signs eg fasciculations, atrophy , brisk reflexes and extensor plantar response indicates which condition a.brown sequard syndrome b.guillian barre syndrome c. Motor neurone disease d.focal/widespread neuropathy e.myasthenia gravis

Answer 44

c. Motor neurone disease damage to anterior horn in spinal cord

Question 45

what do the basal ganglia do (striatum - caudate and putamen, globus pallidus , subthalmic nucleus, substantia nigra)

Answer 45

give fluidity to movement sequencing and control of movement

Question 46

hypokinesis, bradykinesia, lead pipe stiffness and resting tremor indicate which condition a.brown sequard syndrome b.guillian barre syndrome c. Motor neurone disease d.parkinsons e.myasthenia gravis

Answer 46

d.parkinsons

Question 47

in which of these conditions is there gradual degeneration of the striatum leading to chorea, tremor most obvious in hands when doing tasks eg writing , ballism , dystonia a.brown sequard syndrome b.guillian barre syndrome c. Motor neurone disease d.parkinsons e.myasthenia gravis f.huntingtons

Answer 47

f.huntingtons

Question 48

what is the role of the cerebellum

Answer 48

coordinates agonist and antagonist muscle activity in learned movements

Question 49

nystagmus , dysarthia , intention tremor and a wide based unsteady gait indicates dysfunction where? a/UMN b.LMN c. basal ganglia d.cerebellum

Answer 49

d.cerebellum

Question 50

A 36 year old man attends the Emergency Department with a 10 day history of progressive patchy loss of sensation over his legs and lower abdomen. He reports difficulty passing urine. He has acute urinary retention, mild weakness in his legs, a mid-thoracic sensory level and brisk reflexes in his legs. * What investigation will be the most helpful? a) Electromyography of lower limbs b) MRI of spine c) Nerve conduction studies of lower limbs d) Urinalysis e) Visual evoked potentials

Answer 50

b) MRI of spine brisk reflexes = UMN brain or spinal cord? both legs involved, urinary dysfunction, sensory level

Question 51

is myasthenia gravis upper or lower motor neurone syndrome a.upper b.lower

Answer 51

b.lower droopy eyelids double vision difficulty making facial expressions difficulty swallowing slurred speech SOB fatiguiable weakness

Question 52

what is the first line drug for myasthenia gravis a.pyridostigmine b.prednisolone c. nimodipine d.immunosurpressants

Answer 52

a.pyridostigmine only works to reduce muscle weakness for few hours so has to be taken multiple times daily

Question 53

what is the main side effect of pyridostigmine a.GI upset (diarrhoea and stomach pain) b.agranulocytosis c. itching skin d.nightmares

Answer 53

a.GI upset (diarrhoea and stomach pain)

Question 54

what is given in hospital if a person with myasthenia gravis is having difficulty swallowing or breathing a.pyridostigmine b.prednisolone c. nimodipine d.immunosurpressants

Answer 54

b.prednisolone

Question 55

what is a side effect of prednisolone (steroid) a.weight gain b.weight loss c. Gi upset d.pupil constriction

Answer 55

a.weight gain