Neurology - Impairment of Motor Control - Clinical Signs and Patterns Flashcards
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
a.primary motor cortex
which part of the frontal lobe organises and sequences movements
a.primary motor cortex
b.premotor cortex
c.prefrontal and orbitofrontal
b.premotor cortex
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
c.prefrontal and orbitofrontal
descending motor pathway
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
the cell body of lower motor neurons is located within which structure
a.dorsal horn
b.ventral horn
b.ventral horn
which type of motor neurons are responsible for voluntary muscle contraction and the myostatic stretch reflex
a.a motor neurons
b.y motor neurons
a.a motor neurons
which type of motor neurons are responsible for regulating muscle tone and maintaining proprioception
a.a motor neurons
b.y motor neurons
b.y motor neurons
the cortex exerts …………. signals over both the spinal neurons and brainstem motor areas
a.exitatory
b.inhibitory
b.inhibitory
to ensure postural stability when pulling on a handle contraction of the gastrocnmius happens ……………….. contraction of the biceps
a.before
b.after
a.before
weakness of the legs
a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis
a.paraparesis
complete weakness of the legs
a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis
b.paraplegia
abnormal sensation
a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis
c.paraesthesia
weakness of the arms and legs
a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis
d.quadraparesis
weakness of half of the body
a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.hemiparesis
e.hemiparesis
myelo -
of the spinal cord
radiculo -
of the nerve roots
lack of coordination of limb movements and or gait
a.paraparesis
b.paraplegia
c.paraesthesia
d.quadraparesis
e.ataxia
e.ataxia
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
a.above medulla
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
a.cervical
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
b.thoracic or c,lumbar
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
e.brown sequard
in brown sequard syndrome weakness /paralysis occurs ………….. to the lesion
a.contralaterally
b.ipsilaterally
b.ipsilaterally
in brown sequard syndrome loss of pai and temperature sensation occurs ………….. to the lesion
a.contralaterally
b.ipsilaterally
a.contralaterally
UMN lesion results in …………… of the stretch reflex
a.hyperexcitability
b.hypoexcitability
a.hyperexcitability
loss of inhibitory control
eg clasp knife
increased tone, clonus , hyperreflexia and the babinski sign indicate what
a.UMN lesion
b.LMN lesion
c.cerebellar damage
d.basal ganglia damage
a.UMN lesion
spastic paraparesis of all 4 limbs indicates the lesion must be above..
a.c6
b.c5
c.c4
d.c3
e.c2
b.c5
what does a complete lesion cause
complete paralysis below lesion
loss of sensory modalities below lesion
loss of bowel, bladder and sexual function
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
d.t1
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
b.incomplete
conditions with UMN signs
brain tumour
ischaemic stroke
intracranial haemorrhage
MS
spinal cord stenosis
prolapsed disc
damage to the motor neuron in the anterior horn of the spinal cord is classed as a
a.UMN lesion
b.LMN lesions
b.LMN lesions
muscle wasting, flaccid tone, fasciculations and waddling gait indicate which type of lesion
a.UMN
b.LMN
c.cerebellar lesion
d. basal ganglia lesion
b.LMN
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
a.guillian barre
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
a.guillian barre
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
c.plexopathy, radiculopathy , muscular dystrophies
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
d.focal/widespread neuropathy
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
e.myasthenia gravis
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
a.tibialis anterior
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
d.L5 nerve root
a lesion in which of these nerve root can cause foot drop
a.L1
b.L2
c.L3
d.L4
e.L5
e.L5
if wrist drop is chronic is may be due to wasting of which muscle
a.biceps brachii
b.brachioradialis
c.triceps
c.triceps
wrist drop may be due to a lesion on which nerve
a. median
b.musculocutaneous
c.axillary
d.radial
e. ulnar
d.radial
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
c. Motor neurone disease
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
c. Motor neurone disease
damage to anterior horn in spinal cord
what do the basal ganglia do
(striatum - caudate and putamen, globus pallidus , subthalmic nucleus, substantia nigra)
give fluidity to movement
sequencing and control of movement
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
d.parkinsons
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
f.huntingtons
what is the role of the cerebellum
coordinates agonist and antagonist muscle activity in learned movements
nystagmus , dysarthia , intention tremor and a wide based unsteady gait indicates dysfunction where?
a/UMN
b.LMN
c. basal ganglia
d.cerebellum
d.cerebellum
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
b) MRI of spine
brisk reflexes = UMN
brain or spinal cord?
both legs involved, urinary dysfunction, sensory level
is myasthenia gravis upper or lower motor neurone syndrome
a.upper
b.lower
b.lower
droopy eyelids
double vision
difficulty making facial expressions
difficulty swallowing
slurred speech
SOB
fatiguiable weakness
what is the first line drug for myasthenia gravis
a.pyridostigmine
b.prednisolone
c. nimodipine
d.immunosurpressants
a.pyridostigmine
only works to reduce muscle weakness for few hours so has to be taken multiple times daily
what is the main side effect of pyridostigmine
a.GI upset (diarrhoea and stomach pain)
b.agranulocytosis
c. itching skin
d.nightmares
a.GI upset (diarrhoea and stomach pain)
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
b.prednisolone
what is a side effect of prednisolone (steroid)
a.weight gain
b.weight loss
c. Gi upset
d.pupil constriction
a.weight gain
