Peripheral Nerves Flashcards
A 16-year-old boy presented to the OPD for follow-up after 2 months of brachial plexus injury. Initially, his reflexes were absent. Which maneuver will help you to further support your finding?
● A. Jendrassick maneuver
● B. Hamlick maneuver
● C. tENS
● D. Stimulation
A. Jendrassick maneuver
A 35-year-old female is suffering from wrist drop after getting IM injection from a quack. Her tone is decreased and reflexes are absent. What kind of lesion is this?
● A. Upper motor neuron
● B. Mixed
● C. Myopathic
● D. Lower motor neuron
D. Lower motor neuron
There are three innervations of thumb. Pick up the correct sequence.
● A. Median nerve: opposition; ulnar nerve: adduction; and radial nerve: extension
● B. Median nerve: extension; ulnar nerve: abduction; and radial nerve: extension
● C. Median nerve: flexion; ulnar nerve: abduction; and radial
nerve: extension
● D. None of the above
A. Median nerve: opposition; ulnar nerve: adduction; and radial nerve: extension
A patient suffered from foot drop after peroneal nerve injury during car accident. Which of the following statements is true regarding nerve injury?
● A. After 24 months of denervation, most muscle cannot recover useful function even with reinnervation
● B. The longer the distance from the injury site to the function unit to be innervated, the earlier the surgical intervention should be considered
● C. There is some degree of continuity in > 60% of nerve injury
● D. All of the above
D. All of the above
A 30-year-old weight lifter presented to the OPD with severe back ache which started right after his workout. Since then his right foot is numb, and he cannot move his lower limb without pain. MRI spine shows disk prolapse at L5–S1. Which is best way to test L5 clinically?
● A. Extensor hallucis longus
● B. Plantar flexion of big toe
● C. Tibialis anterior and extensor digitorum
● D. None of the above
A. Extensor hallucis longus
A young patient came to electrophysiology department for NCS/EMG for carpel tunnel syndrome. Despite complete absence of a median nerve evoked compound muscle action potential from the thenar eminence, the patient had significant preservation of function and minimal muscle atrophy. Activation of the ulnar nerve at both the wrist and elbow generated easily obtainable compound muscle action potentials from the thenar eminence with initial negative onset. This observed
preservation of function and electrophysiologic responses are best explained by the presence of what?
● A. Martin Gruber anastomosis
● B. Medial and radial nerve anastomosis
● C. Radial and anterior interosseous nerve anastomosis
● D. Richie–Cannieu anastomosis
D. Richie–Cannieu anastomosis
A young male was referred to the OPD 6 weeks after a fall from the roof. Immediately after the fall he was not able to extend his wrist and unable to extend his fingers, along with weakness of brachioradialis muscle. The most likely radial nerve injury is where?
● A. Axillary area
● B. Spiral groove
● C. At wrist
● D. Forearm
B. Spiral groove
The peripheral nervous system consists of nerve fibers and axons that connect the central nervous system with motor and sensory, somatic, and visceral end organs. Following are included in peripheral nervous system except?
● A. Cranial nerves one and two
● B. Cranial nerves three to twelve
● C. Spinal nerves
● D. Nerves of extremities
● E. Cervical, brachial, and lumbosacral plexus
A. Cranial nerves one and two
Medical Research Council scale (MRC scale) is used for muscle strength grading. A patient presented to neurosurgical OPD with reduced power of right upper limb. The patient can move the limb actively with gravity eliminated. What is MRC grade of this patient?
● A. 1
● B. 2
● C. 3
● D. 4
● E. 5
B. 2
Muscle stretch reflex grading scale is used for deep tendon
reflex. It typically ranges from 0 to 4 + . Which of the following
statements is true regarding these reflexes?
● A. 2 + is normal while 3 + is less brisk than normal
● B. 0.5 + means reflex is elicitable only with reinforcement
● C. In the lower extremities, reinforcement consists of having patients clench their teeth
● D. In the upper extremities, reinforcement consists of hooking tip of fingers of right hand into left hand and pulling (Jendrassik maneuver)
● E. 5 + means hyperreflexic with clonus
B. 0.5 + means reflex is elicitable only with reinforcement
Possible etiologies of upper motor neuron (UMN) paralysis are stroke, spinal cord injury, and cervical spondylotic myelopathy while of lower motor neuron (LMN) paralysis are herniated intervertebral disk, nerve entrapment syndrome, polio, and progressive muscular atrophy. Which of the following statements is incorrect regarding difference between UMN paralysis and LMN paralysis?
● A. Muscle tone in UMN paralysis is initially flaccid then later spastic with clasping resistance while in LMN paralysis it is flaccid
● B. Tendon reflexes are hyperactive in UMN paralysis while these are absent in LMN paralysis
● C. Pathologic reflexes like Babinski and Hoffman are present in UMN paralysis while these are absent in LMN paralysis
● D. Atrophy does not occur in UMN paralysis while it does occur in LMN paralysis
● E. Spontaneous spasms may occur in UMN paralysis while in LMN paralysis fibrillations and fasciculations occur
D. Atrophy does not occur in UMN paralysis while it does occur in LMN paralysis
Fasciculations are coarse muscle contractions that are visible to the naked eye while fibrillations are not visible and require EMG to detect. Fasciculations most often occur in diseases involving anterior horn cells which includes which of the following?
● A. Amyotrophic lateral sclerosis
● B. Spinal muscular atrophy
● C. Polio
● D. Syringomyelia
● E. All of the above
E. All of the above
What is the common root value of deltoid muscle (abducts arm from 30 to 90), biceps brachii (flex forearm and supinate forearm), and brachialis (flex forearm)?
● A. C4, c5
● B. C6, c7
● C. C5, c6
● D. C5, c6, c7
● E. C4, c5, c6
C. C5, c6
C7, C8, and T1 roots collectively supply which muscle in upper extremities?
● A. Flexor pollicis longus (flex distal phalanx of thumb)
● B. Flexor digitorum profundus 1 and 2 (radial part) (flex distal phalanx of digits 2 and 3, also flexes wrist)
● C. Palmaris longus (wrist flexion)
● D. Flexor digitorum superficialis (flexion of middle phalanx of digits 2 to 5, flexes wrist)
● E. All of the above
E. All of the above
Flexion and extension of thumb occurs in the plane of palm while adduction and abduction occur in plane at right angle to the palm and opposition is bringing the thumb across the hand to the little finger. All of the following statements regarding innervation of thumb muscles is correct except?
● A. Median nerve innervates abductor pollicis brevis which causes abduction
● B. Ulnar nerve supplies adductor pollicis which causes adduction of thumb
● C. Radial nerve supplies extensor pollicis brevis and longus which cause extension of thumb
● D. Radial nerve also supplies opponens brevis which causes opposition
● E. Median nerve also supplies flexor pollicis brevis which causes flexion
D. Radial nerve also supplies opponens brevis which causes opposition
