Neuromuscular

Question 1

What is the etiology of Parkinson’s disease?

Answer 1

loss of inhibitory dopamine results in an excessive excitatory output from cholinergic system (acetylcholine) of basal ganglia

Question 2

What are the stages of Parkinson’s disease? (Hoehn and Yahr)

Answer 2

I.) minimal or absent disability, unilateral symptoms

II.) minimal bilateral or midline involvement, no balance involvement

III.) impaired balance, some restrictions in activity

IV.) all symptoms present and severe; stands and walks only with assistance

V.) confinement of bed or wheelchair

Question 3

What is the etiology of Myasthenia gravis?

Answer 3

an autoimmune antibody-mediated attack on acetylcholine receptors at the neuromuscular junction

Question 4

What are the four types of myasthenia gravis?

Answer 4

• ocular myasthenia
• mild generalized myasthenia
• severe generalized myasthenia
• crisis

Question 5

What electrolyte imbalances can cause seizures?

Answer 5

• hyponatremia
• hypernatremia
• hypoglycemia
• hypomagnesia

Question 6

Lesions of the archicerebellum

Answer 6

central vestibular symptoms: ocular dysmetria, poor eye pursuit, dysfunctional vestibular ocular reflex (VOR), impaired eye-hand coordination

gait and trunk ataxia

little change in tone or dyssynergia or extremity movements

Question 7

Lesions of paleocerebellum

Answer 7

hypotonia

truncal ataxia

ataxic gait

Question 8

Lesions of neocerebellum

Answer 8

• intention tremor
• dysdiadochokinesia
• dysmetria
• dyssynergia
• errors in timing related to perceptual tasks

Question 9

What visual changes can occur in patients with vestibular dysfunction?

Answer 9

• nystagmus

- blurred vision: gaze instability secondary to VOR dysfunction

Question 10

Vestibular neuritis, labyrinthitis

Answer 10

an acute infection with prolonged attack of symptoms, persisting for several days or several weeks; caused by viral or bacterial infection

Question 11

Ménière’s disease

Answer 11

recurrent and usually progressive vestibular disease; episodic attacks may last from minutes to several hours with severe symptoms; usually associated with tinnitus, deafness, sensation of pressure/fullness within ear; etiology unknown, edema of membranous labyrinth is a consistent finding

Question 12

Tumors involving the inner ear

Answer 12

• acoustic neuroma
• gliomas/brainstem
• cerebellar medulloblastoma

Question 13

What conditions case bilateral vestibular disorders (BVD)?

Answer 13

• toxicity: ototoxic drugs
• bilateral infection: neuritis, meningitis
• vestibular neuropathy, otosclerosis (Paget’s disease)

Question 14

What is the difference between axonotmesis and neurotmesis?

Answer 14

interruption of the endoneurium

Question 15

Trigeminal neuralgia

Answer 15

results from degeneration or compression (tortuous basilar artery or cerebellopontine tumor)

• brief paroxysms of neurogenic pain; frequently reoccurring
• occurs along the distribution of the trigeminal nerve, mandibular and maxillary divisions; ocular division is rare
• pain restricted to one side of the face
• autonomic instability: exacerbated by stress, cold; relieved by relaxation

Question 16

Bulbar palsy

Answer 16

• weakness or paralysis of the muscles innervated by the motor nuclei of the lower brainstem, affecting the muscles of the face, tongie, larynx, and pharynx

Question 17

(T/F) Amyotrophic lateral sclerosis (ALS) is an autosomal dominant condition

Answer 17

True

Question 18

What are the stages of ALS?

Answer 18

Stage 1: early disease, mild focal weakness, asymmetrical distribution, sx of hand cramping and fasciculations

Stage 2: moderate weakness in groups of muscles, some wasting (atrophy) of muscles; modified independence with assistive devices

Stage 3: severe weakness of specific muscles, increasing fatigue; mild to moderate functional limitations, ambulatory

Stage 4: severe weakness and wasting of LEs, mild weakness of UEs; moderate assistance and assistive devices required; wheelchair user

Stage 5: progressive weakness with deterioration of mobility and endurance, increased fatigue, moderate to severe weakness of whole limbs and trunk; spasticitiy, hyperreflexia; loss of head control; maximal assist

Stage 6: bedridden, dependent ADLs, FMS; progressive respiratory distress

Question 19

Acute Stage of CRPS

Answer 19

diffuse, severe burning or aching pain; increases with emotional stress; allodynia and hyperpathia; vasomotor instability with dusky mottling, cool skin, swelling and edema

Question 20

Dystrophic Stage of CRPS

Answer 20

skin changes with thin, pale, cyanotic skin; cessation of hair and nail growth; hyperhidrosis; muscle atrophy and osteoporosis

Question 21

Atrophic Stage of CRPS

Answer 21

decreased hypersensitivity; normal blood flow and temperature; smooth; glossy skin; severe muscles atrophy; periscapular fibrosis; diffuse osteoporosis; development of claw hand deformity

Question 22

What are the components of the basal ganglia?

Answer 22

• striatum (caudate nucleus, nucleus accumbens, putamen)
• putamen and globus palladus (lenticular nucleus)
• substantia nigra (compact and reticular aspects)
• subthalamic nucleus

Question 23

What are the functions of the hypothalamus?

Answer 23

• maintains body homeostasis
• regulates body temperature
• eating
• water balance
• anterior pituitary function/sexual behavior
• emotions

Question 24

Pineal gland

Answer 24

secretes hormones that influence the pituitary gland and several other organs; influences circadian rhythm

Question 25

Medial longitudinal fasciculus

Answer 25

originates from the vestibular nuclei and extends throughout the brainstem and upper cervical spinal cord; important for control of head movements and gaze stabilization (VOR reflex)

Question 26

Nerve fiber types

Answer 26

- A-alpha: proprioception, somatic motor - A-beta: touch, pressure - A-gamma: motor to muscle spindles - A-delta: pain, temperature, touch - B fibers: small, myelinated, conduct less rapidly, preganglionic autonomic - C fibers: smallest, unmyelinated, slowest conducting (dorsal root: pain, reflex responses; sympathetic: postganglionic sympathetic)

Question 27

Persistent vegetative state

Answer 27

a period lasting >1 year for traumatic brain injury and >3 months for anoxic brain injury

Question 28

Glasgow Coma Scale

Answer 28

relates consciousness to three elements: eye-opening, motor response, and verbal response severe brain injury - 1-8 moderate brain injury - 9-12 minor brain injury - 13-15

Question 29

Mini-Mental State Examination

Answer 29

maximum score is 30; 21-24 indicates mild cognitive impairment; 16-20 indicated moderate impairment; 15 or less indicates severe impairment

Question 30

Rancho Los Amigos Levels of Cognitive Funcion

Answer 30

- No response (I) - Decreased response levels (II and III) - Confused levels (IV, V, and VI) - Appropriate (automatic, purposeful) levels (VII and VIII)

Question 31

Broca's aphasia is also known as...

Answer 31

nonfluent aphasia; expressive aphasia; results from a lesion involving the third frontal convolution of the left hemisphere

Question 32

Verbal apraxia

Answer 32

impairment of volitional articulatory control secondary to a cortical, dominant, hemisphere lesion

Question 33

Wernicke's aphasia is also known as...

Answer 33

fluent aphasia; receptive aphasia; results from a lesion in the posterior first temporal gyrus of the left hemisphere

Question 34

Kernig's sign

Answer 34

patient is positioned in supine; flex hip and knee fully to chest and then extend knee; postive when extending the knees due to spasm of the hamstring, suggesting meningeal irritation

Question 35

Brudzinski's sign

Answer 35

patient is positioned in supine; flex neck to chest; positive when causes flexion of the hip and knees, suggesting meningeal irritation

Question 36

Superficial sensation

Answer 36

- pain - temperature - touch

Question 37

Deep sensation

Answer 37

- proprioception - kinesthesia - vibration

Question 38

Cortical sensation

Answer 38

- stereognosis - barognosis - graphesthesia - two-point discrimination - tactile localization - bilateral simultaneous stimulation

Question 39

Ideomotor apraxia

Answer 39

a patient cannot perform the task on command but can do the task when left on own

Question 40

Ideational apraxia

Answer 40

the patient cannot perform the task at all, either on command or on own

Question 41

Modified Ashworth Scale

Answer 41

0 - no increase in muscle tone 1 - a slight increase in muscle tone, minimal resistance at the end range 1+ - a slight increase in muscle tone, minimal resistance through less than half of ROM 2 - more marked increase in muscle tone, through most of ROM, affected part easily moved 3 - a considerable increase in muscle tone, passive movement difficult 4 - affected part rigid in flexion or extension

Question 42

In which patients is decerebrate posturing observed?

Answer 42

in comatose patients with brainstem lesions between the superior colliculus and the vestibular nucleus

Question 43

In which patients is decorticate posturing observed?

Answer 43

in comatose patients with lesions above the superior colliculus

Question 44

Opisthotonos

Answer 44

prolonged, severe spasm of muscles, causing the head, back, and heels to arch backward; arms and hands are held rigidly flexed seen in severe meningitis, tetanus, epilepsy, and strychnine poisoning