Nuero Diag Practice Quiz

``Medial cervical myelopathy is characterized by long tract symptoms and frequently spares the upper limbs as these nerve fibers are usually located further from the midline: True/ False?

False

Myelopathy can be divided into five related syndromes based on the location of the pathology in the cervical spine: True/ False?

True

MRI is the best modality for evaluation of spinal stenosis and damage to the spinal cord: True/ False?

True

A 38 y/o male was examined by a neurologist because of a complaint of severe burning pain over the left shoulder and upper part of the left arm that had started 3 weeks previously. The pain was accentuated by moving his neck and by coughing. After a full clinical examination followed by an MRI a diagnosis of prolapse of the intervertebral disc between C5 and C6 vertebrae was made. There was no evidence of muscle weakness. The following anatomical facts concerning this case are correct except: The posterior root of the C6 nerve was compressed by the prolapsed disc/ When an IVD prolapses the nucleus pulposus moves anteriorly/ The common site for a disc to press on a nerve root is in the IVF/ In the cervical region the spinal nerves emerge above the vertebrae of the same number/ In the cervical region there are eight cervical nerves but only seven cervical vertebrae?

When an IVD prolapses the nucleus pulposus moves anteriorly

The vigilant doctor should evaluate the patient suspected of cervical spondylophytic myelopathy for long tract signs including abnormal plantar response and the presence of Hoffman's reflex in the hands: True/ False?

True

Patients that suffer an acute stroke of the ACA with motor deficits characteristically: Involves the lower extremity contralaterally to the infarct site/ Involves the lower extremity ipsilateral to the infarct side/ Involves the upper extremity contralateral to the infarct side/ Involves the upper extremity ipsilateral to the infarct site?

Involves the lower extremity contralaterally to the infarct site

On the average there are roughly 750000 people in the U.S. that have a stroke each year: True/ False?

True

A 60 y/o female presents to the office with a 4 hour history of diffuse motor weakness on her entire right side. She is unable to move her eyes laterally to the right. Which of the following best describes her stroke: Left medial Pontine Stroke/ Right Medial Pontine Stroke/ Left Lateral Pontine Stroke/ Right Lateral Pontine Stroke?

Left medial Pontine Stroke

A hallmark of posterior circulation stroke is the presence of crossed findings: ipsilateral cranial nerve deficits and contralateral motor deficits: True/ False?

True

Posterior cerebral artery (PCA) occlusions affect vision and thought: True/ False?

True

Brain tissue dies when cerebral blood flow(CBF)<15-20 dl/mg brain/min: True/ False?

True

Although the definitive distinction of ischemic stroke and hemorrhagic stroke require neuroimaging: a meta-analysis found that the following clinical findings increase the probability of hemorrhagic stroke except: Coma/ Seizures/ Neck stiffness/ Diastolic blood pressure < 110mmHg?

Diastolic blood pressure < 110mmHg

Middle cerebral artery (MCA) occlusions commonly produce all of the following symptoms except: Contralateral hemiparesis/ Contralateral hypesthesia/ Contralateral hemianopsia/ Gaze preference toward the side of the lesion?

Gaze preference toward the side of the lesion

Infarcts involving the territory of the ACA are uncommon accounting for a considerably small share of the total number of ischemic strokes: True/ False?

True

In the prehospital and Emergency Department (ED) settings hypoglycemia is a common stroke mimic and is particularly important to consider since it can be readily detected and corrected: True/ False?

True

If a Stroke is suspected the pneumonic FAST relates: Face drooping Arm good speech difficulty time to call 911/ Face drooping arm weakness speech difficulty time to call 911/ Face drooping Alignment good Subluxations Time/ Face drooping Atlas Subluxation Tremors?

Face drooping arm weakness speech difficulty time to call 911

The inability to follow a motor command is termed: Apraxia/ Dyslexia/ Dyskinesia/ Agnosia?

Apraxia

A repetitive vibratory contraction of the muscle that occurs in response to muscle tendon stretch is: Clonus/ Hyper-reflexia/ Dystonia/ Spasticity?

Clonus

While performing a plantar reflex the examiner notes the toes are down going on the right and silent on the left. This is considered a: Abnormal response on the silent side/ Normal response on the silent side/ Normal response on the down going side/ Abnormal response on the down going side?

Abnormal response on the silent side

A normal DTR is registered as: 2+/ 1+/ 4+/ 3+?

2+

Extraocular movements are checked by having the patient look in all directions without moving their head. What nerves are involved with this exam: III IV VI/ III V VI/ II IV VI/ III V VII?

III IV VI

A patient presents with a complaint of low back pain and bilateral lower extremity symptoms consisting of generalized pain and heaviness feelings which were usually preceded by tingling in the feet. What is the differential diagnosis: Lower Cross Syndrome/ T10 Syndrome/ TOS/ Lumbar HNP/ SI joint Dysfunction?

T10 Syndrome

Herpes Zoster is uncommon in patients under 50 years of age: True/ False?

True

Which of the following conditions needs to be considered with a patient that is suffering from T4 Syndrome (choose all that apply): T10 Syndrome/ Carpal Tunnel Syndrome/ Thoracic outlet Syndrome/ Ulnar Neuropathy?

Carpal Tunnel Syndrome/ Thoracic outlet Syndrome/ Ulnar Neuropathy

Cauda equina syndrome is defined by a constellation of symptoms that result from terminal spinal nerve root compression in the lumbosacral region. It is a true medical emergency: True/ False?

True

Radicular pain associated with Herpes Zoster usually occurs __________ days prior to skin manifestations: 1-2/ 2-5/ 5-7/ 7-9?

2-5

A patient presents with upper to mid thoracic discomfort and stiffness associated with pain tingling and numbness of one or both upper extremities headache and a glove-like paresthesia in the hands. This patient is likely suffering from: Abdominal migraine/ Migraine headache/ T4 Syndrome/ T10 Syndrome?

T4 Syndrome

What are the patient's chief complaints: LBP/ Bilateral lower extremity pain/ Bilateral lower extremity weakness/ Morning stiffness/ Headache?

LBP/ Bilateral lower extremity pain/ Morning stiffness

Which of the following areas of the body are commonly involved with Herpes Zoster: Cervical/ Lumbar/ Thoracic/ Hands/ Toes?

Thoracic/ Lumbar/ Cervical

A patient presents with a macular and vesicular rash that follows along the path of the facial nerve to the vestibulocochlear nerve causing hearing loss and vertigo is likely suffering from: Ramsey Hunt Syndrome type II/ Herpes simplex/ HPV/ CMV/ EBV?

Ramsey Hunt Syndrome type II

What are the two most common pathophysiological cause of cauda equina syndrome: Space occupying lesion in the central canal/ Spinal stenosis/ Disc herniation/ Epidural abscess/ Trauma?

Disc herniation/ Spinal stenosis

In patient's with posterior interosseous syndrome (PIN) there will be weakness of (choose all that apply): Partial wrist extensors/ Finger extensors/ Finger flexors/ Wrist flexors?

Finger extensors/ Partial wrist extensors

Median nerve compression or entrapment neuropathies include Supinator Syndrome (choose all that apply): Pronator syndrome/ Supinator syndrome/ Anterior interosseous syndrome/ Carpal tunnel syndrome/ Guyon canal syndrome?

Pronator syndrome/ Anterior interosseous syndrome/ Carpal tunnel syndrome

What are the two common sites for entrapment of the ulnar nerve: Cubital tunnel/ Ulnar tunnel/ Pronator teres/ Spiral groove?

Cubital tunnel/ Ulnar tunnel

Saturday night palsy is entrapment of the radial n. in the spiral groove of the humerus: True/ False?

True

Which of the following conditions are related to entrapment neuropathies of the Radial n. (choose all that apply): Posterior interosseous nerve syndrome/ Radial tunnel syndrome/ Whartenberg's syndrome/ Guyon canal syndrome?

Posterior interosseous nerve syndrome/ Radial tunnel syndrome/ Whartenberg's syndrome

A 35 y/o female presents with lower back pain and left leg pain into the top of the foot and big toe… What is the working diagnosis: L4 HNP with radiculopathy/ L5 HNP with radiculopathy/ S1 HNP with radiculopathy/ L3 HNP with radiculopathy?

L5 HNP with radiculopathy

A 48 year-old right-hand dominant woman shipping manager presented with a 2-month history of severe left arm pain and weakness… What is the working diagnosis: HNP C4/5/ HNP C5/6/ HNP C6/7/ HNP C7/T1?

HNP C6/7

Chronic pain is defined as pain that lasts at least 12 weeks: True/ False?

True

The criteria for making a diagnosis of an HNP all of the following symptoms and test(s) need to be applied to the patient. What are the criteria (choose all that apply): Leg pain is the dominant symptom when compared to LBP/ Paresthesia is localized to a dermatome/ Positive SLR (50%decreased)/ positive WLR/ Positive bowstring?

Leg pain is the dominant symptom when compared to LBP/ Paresthesia is localized to a dermatome/ Positive SLR (50%decreased)/ positive WLR/ Positive bowstring

Receiving a diagnosis of a HNP nerve root compression or radiculopathy can be frightening… most of the time these conditions can heal with chiropractic care: True/ False?

True

The neurological examination of a patient with lumbosacral pain radiating into the leg may have hyper or hypo-esthesia/algesia in the dermatome of the affected nerve root: True/ False?

True

A patient presents with low back pain and weakness with dorsiflexion big toe extension foot eversion/inversion. There is hypoesthesia over the dorsum of the foot and big toe. What disc level is involved: L2/L3/ L3/L4/ L4/L5/ L5/S1?

L4/L5

All of the following are considered Red Flags in evaluating a patient with a cervical or lumbar radiculopathy except: Thoracic pain/ Fever/unexplained weight loss/ Bowel/Bladder dysfunction/ Gait ataxia/ No significant medical comorbidities?

No significant medical comorbidities

All back pain patients need to be screened for cauda equina syndrome: True/ False?

True

Compression of an L5/S1 disc usually produces a ______ radiculopathy: L4/ L5/ S1/ S2?

S1

A patient presents with low back pain and weakness in the iliopsoas and quadriceps. She has a +1 patellar reflex and hypoesthesia over the medial lower leg. What nerve root is involved: L3/ L4/ L5/ S1?

L4

A 30 y/o patient presents to you complaining of severe low back pain and right leg pain to the bottom of the foot. She has a flexed antalgic lean to the right. You suspect: L4/L5 Medial HNP/ L5/S1 Lateral HNP/ L4/L5 Lateral HNP/ L5/S1 Medial HNP?

L5/S1 Medial HNP

All of the following are considered neurological deficits in patients with an HNP except: Altered sensation/ Motor weakness/ Altered reflexes/ Good muscle strength/ Atrophy?

Good muscle strength

In evaluating low back pain patients the clinician needs to be aware of signs of cauda equina syndrome. What are the signs of cauda equina syndrome (choose all that apply): Saddle paresthesia/ Sexual dysfunction/ Back & leg pain/weakness/ Bowel/bladder dysfunction/ Neurologic deficits?

Saddle paresthesia/ Sexual dysfunction/ Back & leg pain/weakness/ Bowel/bladder dysfunction/ Neurologic deficits

Neuropathy is a general term meaning nerve disorder: True/ False?

True

What are the subjective complaints (choose all that apply): Left sided low back pain (chronic)/ Pain with sitting/slouching/ Pain with walking/ Pain with standing?

Left sided low back pain (chronic)/ Pain with sitting/slouching

Cervical myelopathy whether treated conservatively or surgically may result in some degree of impairment: True/ False?

True

A patient suspected of having cervical spondylophytic myelopathy should have plain films of the cervical spine for disc space narrowing facet joint arthrosis bone spurs ossification of the PLL and a kyphotic deformity: True/ False?

True

All of the following are types of cervical myelopathy except: Lateral Cervical Myelopathy/ Medial Cervical Myelopathy/ Combination of both lateral and medial/ Vascular Cervical Myelopathy/ Anterior Posterior Cervical Myelopathy?

Anterior Posterior Cervical Myelopathy

Anterior cerebral artery (ACA) occlusions primarily affect frontal lobe function. Findings in ACA stroke may include all of the following except: Disinhibition and speech preservation/ Primitive reflexes/ Impaired judgment/ Ipsilateral weakness greater in legs than arms?

Ipsilateral weakness greater in legs than arms

What are the three causes of ischemic stroke: Embolic/Thrombotic/MI / Embolic/Thrombotic/Lacunar / MI/Lacunar/Embolic / Embolic/Thrombotic/Watershed?

Embolic/Thrombotic/Lacunar

An 81 y/o female presented to the ED because of left foot weakness… Based on the above information where is the lesion: Right ACA brain lesion/ Left ACA brain lesion/ Left sided brainstem lesion/ Right sided brainstem lesion?

Right ACA brain lesion

An 81 y/o female presented to the ED because of left foot weakness… What are the main physical findings: No pronator drift/ Slowing of heel-to-shin left leg/ Weakness left iliopsoas/ Weakness left hamstring/ Weakness left EHL?

Slowing of heel-to-shin left leg/ Weakness left iliopsoas/ Weakness left hamstring/ Weakness left EHL

Myasthenia gravis is an autoimmune disease characterized by a post junctional NMJ pathology with a decrease in the number of acetylcholine receptors (AChR): True/ False?

True

Acoustic neuroma is a usually slow growing benign tumor of the vestibulo-cochlear nerve sheath: True/ False?

True

Cervicogenic oto-ocular syndrome presents with which of the following symptoms (choose all that apply): Cervical spine dysfunction/ Sympathetic NS dysfunction/ Eustachian tube dysfunction/ Hydrops's/Meniere's Disease/ Low salt diet?

Cervical spine dysfunction/ Sympathetic NS dysfunction/ Eustachian tube dysfunction

What imaging modality is preferred in making the diagnosis of acoustic neuroma: MRI/ MRI with gadolineum/ CT/ CT with contrast?

MRI with gadolineum

Patient's with myasthenia gravis are known to have weakness with the following muscles_________/________ resulting in symptoms of __________ and __________ of the upper eyelid: EOM's/ Levator palpebra/ Diplopia/ Ptosis/ Myopia?

EOM's/ Levator palpebra/ Diplopia/ Ptosis

All of the following are symptoms associated with an acoustic neuroma except: High frequency sensorineural hearing loss/ Mild tinnitus/ Aural pressure/ Unsteadiness may be present/ No tinnitus?

No tinnitus

All of the following are general measures in taking care of a patient with Meniere's except: Chiropractic adjustments/ High salt diet/ Stress management/ Reduce /avoid alcohol/ Low salt diet?

High salt diet

The differential diagnosis in a patient suffering from Meniere's disease should include (choose all that apply): Post head trauma/ Migraine/ Benign paroxysmal positional vertigo/ Acoustic neuroma/ Partial seizure?

Post head trauma/ Migraine/ Benign paroxysmal positional vertigo/ Acoustic neuroma

Bilateral acoustic neuromas is diagnostic of neurofibromatosis type 2: True/ False?

True

The mean time of onset of symptoms to diagnosis of patients with an acoustic neuroma is: 2 years/ 2.5 years/ 3 years/ 3.7 years/ 4 years?

3.7 years

Classic Meniere's Disease presents as an inner ear disorder characterized by episodic vertigo attacks. Which of the following symptoms are associated with this condition (choose all that apply): Sensorineural hearing loss/ Tinnitus/ Fullness in the affected ear/ Nausea/vomiting/ No tinnitus?

Sensorineural hearing loss/ Tinnitus/ Fullness in the affected ear/ Nausea/vomiting

The association between influenza vaccine and GBS emerged in the United States in 1976 when 32% of Ohio's population was vaccinated against influenza A… concluded that there is one case of the disease for every 100000 doses administered: True/ False?

True

In evaluating cauda equina syndrome the imaging modality of choice to evaluate neurologic compression is: Diagnostic ultrasound/ Plain films/ CT/ MRI?

MRI

All of the following are key features in a patient suffering from cauda equina syndrome except: Bilateral leg pain/ Saddle anesthesia/ Bowel dysfunction/ Bladder dysfunction/ Normal sensorimotor changes?

Normal sensorimotor changes

It is believed that zoster occurs due to the failure of the immune defense system to control the latent replication of the virus: True/ False?

True

What are the patient's objective finding's: Decreased lumbar lordosis/ Slumped posture while sitting/ Left leg cold/ Left rotation with full flexion limited and painful/ Decreased left rotation at T10-12?

Decreased lumbar lordosis/ Slumped posture while sitting/ Left leg cold/ Left rotation with full flexion limited and painful/ Decreased left rotation at T10-12

Which of the following situations are triggers for Herpes Zoster (choose all that apply): Stress/ Immunosuppressants/ Exposure to the virus/ Presence of malignancy/ Acute/Chronic illness?

Stress/ Immunosuppressants/ Presence of malignancy/ Acute/Chronic illness

The symptoms associated with T4 Syndrome often awaken the patient or are present upon rising: True/ False?

True

Acute Cauda Equina Syndrome is a Medical Emergency that requires timely diagnosis and treatment to reverse or stop the worsening of neurological damage to the spinal nerve roots (the nerves in the low back): True/ False?

True

Sensory and or motor dysfunction caused by a pathology of a spinal nerve root is called Radiculopathy: True/ False?

True

The most common causes of lumbar radiculopathies are (choose all that apply): HNP/ Lateral recess stenosis/ IVF stenosis/ Trauma/ Tumor?

HNP/ Lateral recess stenosis/ IVF stenosis

Patients with a lumbosacral radiculopathy need to be screened for red flags. What are the red flags (choose all that apply): Weight loss/ Fever/ Saddle paresthesia/ Prior history of cancer/ Good appetite?

Weight loss/ Fever/ Saddle paresthesia/ Prior history of cancer

A 48 year-old right-hand dominant woman shipping manager presented with a 2-month history of severe left arm pain and weakness… What is the patients chief complaint (subjective): Severe left arm pain for 2 months/ Left arm weakness/ Weak wrist flexors/ Weak left triceps?

Severe left arm pain for 2 months

What are the chief complaints with this patient (choose all that apply): Low back pain/ Left leg pain to the top of the left foot and big toe/ Posterior left leg pain/ Pain with sitting?

Low back pain/ Left leg pain to the top of the left foot and big toe/ Pain with sitting

The location of paresthesia is often a more accurate representation of the spinal nerve involved: True/ False?

True

The most common lumbosacral radiculopathies are: L5/S1/ L4/L5/ L3/L4/ L2/L3/ L1/L2?

L5/S1/ L4/L5

A patient presents with pain tingling and numbness in the buttocks posterior thigh hip and leg. There is radiating pain into the posterior thigh on the involved side. Tenderness is noted over the sciatic notch. What is the differential diagnosis (choose all that apply): Lumbar plexopathy/ Sciatic neuropathy/ Lumbar radiculopathy/ Gluteus medius spasm/ Piriformis?

Lumbar plexopathy/ Sciatic neuropathy/ Lumbar radiculopathy/ Piriformis

The differential diagnosis for lumbosacral radiculopathy should include (but is not limited to) the following (choose all that apply): Degenerative/ Traumatic/ Tumors(benign/malignant)/ Infection/ Vascular?

Degenerative/ Traumatic/ Tumors(benign/malignant)/ Infection/ Vascular

The vast majority of radiculopathy cases resolve with conservative management. In cases where symptoms fail to resolve which of the following modalities will aid in making a diagnosis (choose all that apply): MRI/ CT/ EMG/ NCV (Nerve Conduction)/ Plain film radiography?

MRI/ CT/ EMG/ NCV (Nerve Conduction)

Patients that present with symptoms of a radiculopathy present with paresthesia in the more distal portion of the extremity: True/ False?

True

The condition cervical myelopathy begins with the deterioration of the IVD which results in a reactive hyperostosis of the vertebra bodies: True/ False?

True

A 55 y/o male presents to the office with a 2 hour history of altered mental status. He was unresponsive on the sofa while watching Lord of the Rings… Which of the following is the type of stroke experienced by this patient: Right ACA/ Left ACA/ Right MCA/ Left MCA/ Right Lateral Medullary Stroke?

Right ACA

Atherosclerosis is a primary cause of ischemic stroke: True/ False?

True

Patient's with posterior inferior cerebellar artery territory infarcts (PICA) have a triad of all of the following at stroke onset except: Vertigo/ Headache/ Gait abnormalities/ Speech abnormalities?

Speech abnormalities

Using the NIH Stroke Scale a score of 5-15 tells the clinician the patient had: Minor stroke/ Moderate to severe stroke/ Severe stroke/ Moderate stroke?

Moderate stroke

The examiner can check for drift by having the patient close their eyes: Either both arms and legs up simultaneously/ Hold both arms up simultaneously/ Hold both legs up simultaneously/ None of the above?

Hold both arms up simultaneously

Hoffman's sign indicates heightened reflexes in: Finger flexors/ Finger extensors/ Finger interdigital muscles/ Toe Extensors?

Finger flexors

The examiner has the patient fixate on an object as it is moved slowly toward a point right between the patient's eyes. This is testing: Convergence/ Saccades/ Nystagmus/ Diplopia?

Convergence

Facial weakness can be caused by lesions in all of the following areas except: Ipsilateral motor cortex/ Contralateral motor cortex/ LMN in ipsilateral CN VII/ Contralateral descending motor pathways?

Ipsilateral motor cortex