Exam 3 - Share Motor, Sensory, Basal Ganglion Questions

Bell's Palsy

A 24 year-old patient comes into the clinic after suffering a viral infection for the past week. On examination, the patient is unable to close their right eyelid and you notice a reduction of muscle tone in the cheeks and drooping of the mouth on the right side. The left side of the face was found to be normal on examination. The patient's blood pressure is within the normal range, no family history of cardiovascular disease, and is currently not on any prescribed medications. There is no trauma noted. What diagnosis would most likely attribute to the following

symptoms?

- Erb's Palsy: 5/6 weakness, waiter deformity, stretch injury

- Stroke: only face and all CN 7 (does not fit)

- Bell's Palsy

- Central Seven Syndrome MCA stroke, or lenticulostriate branches, OO and Frontalis are spared in this

Parkinson's Disease

Phil, a 63 year old male, comes into you clinic today for lower back and neck pain. After he signs in, you notice that he has shuffling gait while he is walking to a chair. As Phil is completing his paperwork, you notice drooping posture. Upon completion of his paperwork, he is sitting in a chair, waiting to be seen. While he is sitting there, you see

his arm rhythmically shaking. You ask him why he is shaking his limbs to figure out if it contributes to and/or helps his neck/ back pain. He indicates that this rhythmic shaking

movement of his limbs, while at rest, is involuntary. Overall, you notice a slowing of Phil's movements. What is the cause of Phil's shuffling gait, drooping posture, and shaking

limbs?

- Huntington's Disease: Hyperkinesia, constant choreiform movements

- Parkinson's Disease

- Syringomyelia: loss of STT in cape and glove only and possible CST

- Large disc herniation at L5-S1

Carpal tunnel syndrome

Brendan Seaweed presents to your office complaining of loss of sensation in his right hand. and first three digits on the volar surface. On examination there is weakness in his hand and first two finger flexors and the opponens pollicis muscle. Brendan has an absence of reflex when testing C7 nerve and a positive

Tinel's test at the wrist. Which of the following is the most likely diagnosis?

- C8 root impingement: Ulnar weakness finger flexors, and sensation loss on digits 4-5, and medial forearm

- Carpal tunnel syndrome

- T1 disc herniation: ab/adductors of the fingers weakness, axillary loss of sensation

- Tunnel of Guyon compression: ulnar claw, tinels at Guyons tunnel

Syringomyelia

A 45-year-old male patient, previously diagnosed with a sprain/ strain in a motor vehicle accident., complains about muscle weakness in his biceps, with a cape and glove loss of sensation extending from the shoulders to the wrists bilaterally,

EMG reveals abnormal recruitment of motor unit in action potentials upon stimuli to the biceps bilaterally. Which is the most likely diagnosis?

- Lambert Eaton Syndrome: generalized weakness from circulating Ca2+ increased

secondary to lung cancer

- Guillain Barre: traveling paralysis following GI illness most common

campylobacter jejunni

- Syringomyelia

- Huntington's Disease (Defined earlier)

Lambert Eaton Syndrome

A 45-year-old male patient, previously diagnosed with small cell lung cancer, complain about muscle weakness in his legs with difficulty climbing stairs.The EMG study shows rapid reduction in action potentials stimuli to the lower extremities bilaterally. Which is the most likely diagnosis?

- Lambert Eaton Syndrome

- Multiple Sclerosis

- Guillain Barre Syndrome

- Huntington's Disease

Cervical Spinal Stenosis

Clinical findings of neck stiffness, weakness of the upper extremities, loss of vibration in the lower extremities, and joint proprioception, hyperreflexia in the

lower extremities in a 75-year-old with no family or previous history of similar conditions are indicative of:

- Lumbar Discopathy: cannot have weakness of the upper extremities from a cervical condition

- Cervical Spinal Stenosis

- ALS: Lou Gehrig's disease, alpha motor neuron disease fatal Amytrophic Lateral Sclerosis

- Diabetic Neuropathy- Sensory neuropathy of the feet and migrate to calves, and include hands

Amyotrophic Lateral Sclerosis

A male patient shows on clinical exam upper and lower motor neuron positive findings of upper motor neuron weakness in the in the lower extremities and lower motor neuron weaknesses in the upper extremities, and has positive findings of weakness in the bulbar region. The lab work shows an elevated protein in the CSF. The EMG/NCV reveals multiple areas of fasciculation and fibrillation potentials. The diagnosis is most likely?

- Amyotrophic Lateral Sclerosis

- Multiple Sclerosis

- Neurosyphilis - Secondary to

- Lambert Eaton Syndrome

Asterixis

A 22-year old man presents to his family physician with motor deficits. The examination reveals that the man has jerky up-down movements of his upper extremities, especially noticeable in his hands when his arms are extended. Which of the

following most specifically designates this abnormal movement?

- Akinesia: abnormal movement

- Asterixis

- Dystonia: tremor of the region, often seen in the head and neck

- Intention tremor: Cerebellar tremor

Spinal shock from cervical cord trauma

A 17-year old boy is brought to the emergency department from a high school swim meet, after a fall from the diving board. Initial examination revealed a paralysis of the right arm, with a loss of reflexes in the biceps and triceps graded 1+. Two days later a follow up examination revealed weakness of the bicep 4/5, reflex 1+ at bicep, all other upper extremity DRTs and myotomes were normal. What diagnosis most clearly explains the findings on the initial exam?

- Internal capsule stroke on the right

- C8 fracture

- Spinal shock from cervical cord trauma

- Brachial plexus stretch to the posterior cord

Erb Duchenne Palsy

A patient presents with weakness in shoulder abduction and external rotation. Inspection of the patient's upper limb reveals an adducted shoulder, medially rotated arm, extended

elbow, and flexed wrist in a waiter tip position. Which of the foolowing is the most likely

diagnosis?

- Lower brachial plexus injury: Klumpke's

- Erb Duchenne Palsy

- Pronator teres syndrome: median nerve

- Ulnar nerve entrapment: ulnar claw

Huntington's

A 39-year-old female has a 6 month history of abnormal movements which are non-purposeful, alternating from upper and lower extremities in a choreiform manner, depression and is exhibiting signs of paranoia. There is a family history of similar complaints, her father and one brother passed away from the same condition. What is her diagnosis?

- Parkinson's

- Huntington's

- Alzheimer's: not motor disease, degeneration of cortex through tau, beta amyloid plaque

- Dementia: happy forgetful old person

Basal ganglia

Hyperkinetic syndrome, such as chorea and athetosis, are usually associated with

pathologic changes in -----

- Motor areas of the cerebral cortex: either MCA stroke like , or ACA, of a region, M lesions

- Pathways for recurrent collateral inhibition in the spinal cord- release of agaonist contraction

- Portions of the reticular formation that control the gamma innervation of muscle spindles control

- Basal ganglia

Wilson's disease: genetic, copper causes oxidide accumulates in tissue, and causes. Urine is collected to examine the Copper levels. Pts are more likely to have kidney stones

A 17-year-old boy is brought to the pediatrician by his mother. The examination reveals that the boy has rigidity, athetoid movements (athetosis), and difficulty speaking. His ophthalmologist reports that the boy has a greenish-brown ring at corneoscleral margin. This boy is most likely suffering from which of the following?

- Parkinson's disease: done

- Pick disease: frontotemporal dementia, this region affected temporal, pats loose track, no filter, early onset, 50-60 8-10 yrs survival

- Sydenham chorea: Chorea of Gravidum during pregnancy, or in

children develop choreiform movements, usually occurs following strep infection

- Wilson's disease: genetic, copper causes oxidide accumulates in tissue, and causes. Urine is collected to examine the Copper levels. Pts are more likely to have kidney stones

Multiple sclerosis

25-year-old male complains of visual loss in the left eye for 2 weeks and now has improved to a central scotoma currently. The Doctor finds that there is a left afferent pupillary defect. The Doctor also notes a left optic disc pallor upon eye exam. The patient was positive for oligoclonal bands in the CSF exam, and the MRI noted multiple white matter lesions

- Guillain-Barre syndrome

- ALS

- Multiple sclerosis

- Myasthenia gravis

Posterior columns fibers

An 84-year old woman presents to her physician with the complaint of difficulty walking. The examination reveals that the woman has an unsteady gait and tends to forcibly slap her feet to the floor as she walks, examination shown a loss of Achilles reflex, and vibration bilaterally. She has no other deficits. The physician concludes that the

woman has sensory ataxia. Degenerative changes in which the following would most likely explain this deficit?

- Anterolateral system fibers

- Corticospinal fibers

- Posterior columns fibers

- Posterior root fibers

Contraction of the orbicularis oculi muscle: Myerson's

During a screening neurological examination of a 39-year old man, the physician taps the supraorbital ridge, stimulating the supraorbital nerve, and elicits a motor response. Which of the following most likely represents the motor response in this man in a normal response?

- Contraction of the masticatory muscles

- Contraction of the orbicularis oculi muscle: Myerson's

- Constriction of the pupil

- Dilation of the pupil

Right Substantia Nigra: early signs reveal a contralateral loss of function

A 59-year old man, who is a family physician, confides in a neurology colleague that he believes he has early-stage Parkinson disease. The neurological examination reveals a

slight resting tremor of the left hand, slow gait, and lack of the normal range of facial expression. Which of the following is the most likely location of the degenerative changes at this stage of the physician's disease?

- Left Globus Pallidus

- Left Substantia Nigra

- Right Glubus Pallidus

- Right Substantia Nigra: early signs reveal a contralateral loss of function

Diabetic neuropathy

A patient that complains of burning of the feet bilaterally with paresthesia has a history Of type 2 diabetes for 20 years and admits to an uncontrolled diet stating he has a sweet tooth. On exam the following are noted: loss of vibration in the

feet, and loss of proprioception bilaterally. Romberg's is positive with eyes closed and the achilles reflexes grade 1+ bilaterally. Which of the following is the most correct neurologic diagnosis?

- Sensory neuropathy with demyelinating disease: MS,

- Alcoholic neuropathy: similar symptoms with alcohol

- Diabetic neuropathy

- L5 Radiculopathy

Acetylcholine

A 34-year old woman presents with the complaint of seeing two of everything. The history reveals that the woman becomes tired during the work day to the point where she frequently must leave her work place early. She reported that her vision problems appeared first, and later she noticed that when she had difficulty swallowing later in the afternoon. The examination reveals weakness of the upper extremities. Sensation is normal. Which of the following represents the neurotransmitter most likely affected in this woman?

- Acetylcholine

- Dopamine

- Glutamate

- GABA

At the neuromuscular junction

A 34-year old woman presents with the complaint of seeing "two of

everything"(diplopia). The history reveals that the woman becomes tired during the work day to the point where she frequently must leave her work place early. The woman said that her vision problems appeared first, and later she noticed

that, when she drank, it would "go down the wrong pipe". The examination reveals weakness of the upper extremities. Sensation is normal. Which of the following represents the most likely location of the neurotransmitter dysfunction this woman?

- At the termination of the corticonuclear fibers

- At the termination of the corticospinal fibers

- At the neuromuscular junction

- Within the basal nuclei

Myasthenia gravis

A 34-year old woman presents with the complaint of seeing two of

everything(diplopia) The history reveals that the woman becomes tired during the work day to the point where she frequently must leave her work place early.

woman said that her vision problems appeared first, and later she noticed that, when she drank, it would go down the wrong pipe. The examination reveals weakness of the upper extremities Further laboratory tests indicate that the woman has a neurotransmitter disease. Based on the history and symptoms experienced by this woman, which of the following is the most likely cause of her medical condition?

- Amyotrophic lateral sclerosis

- Huntington disease

- Myasthenia gravis

- Multiple sclerosis

T8-T9 on the right

A 17-year old boy is brought to the emergency department from a high school football game. The examination reveals a loss of vibratory sensation on the right

leg and loss of discriminate touch/ pain and temperature on the left lower extremity to the level of the umbilicus, a vertebral fracture with bone displacement into the

vertebral canal is evident on CT. Which of the following indicates the most likely level of damage to the spinal cord in this boy?

- T10 on the left: vibration lost on R lesion on R

- T7-T8 on the left: wrong side lesion on the right

- T12 on the right: pain/temperature loss marks the first loss of the STT: lesion is 1-2 levels higher

- T8-T9 on the right