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Neurology Exam

Neurology Exam for MSD

QuestionAnswer
A lesion to which one of the following cranial nerves will lead to weakness of the soft palate, pharynx, and the larynx? vagus nerve
The origin of both the direction and indirection activation pathway is the cerebral cortex. T or F? true
Increased resistance to passive movement as seen in rigidity is associated with a lesion to the ______________ control circuit. basal ganglia
The three structures of the cerebellum containing fiber tracts entering and exiting the cerebellum include the inferior, middle, and superior peduncle
Which of the following major structures of the brain is not part of or directly associated with the basal ganglia control circuit? A. spinal nerve B. substantia nigra C. putamen D. subthalamus A. spinal nerve
Spasticity can result from a lesion to the Final Common Pathway. T or F? false
A state of low muscle tone is hypotonia
Abnormal movements of the eyes as a result of neurological disease is nystagamus
Muscular spasms, involving repeated, often rhythmic contractions is the definition of clonus
A neurological exam revealed bilateral facial weakness and increased deep tendon and Babinski reflexes. Are these signs most likely the result of upper or lower motor neuron disease? UMN
Loss of the ability to move a body part is the definition of _________. paralysis
The presence of involuntary movement (i.e. hyperkinesias) is the result of a lesion to the lower motor neuron system. T or F? false
In the evaluation of a patient, a neurologist noted a broad, coarse and low frequency tremor upon initiation of intended movement. This may suggest a lesion to which one of the following major structures of the nervous system? final common pathway
Which of the following dysarthrias is associated with a lesion to the final common pathway? flaccid dysarthria
Which of the following dysarthrias is associated with a lesion to the bilateral motor strip in the cerebral hemispheres? spastic dysarthria
Which of the following dysarthrias is associated with a lesion to the basal ganglia control circuit? hyperkinetic
If you observe spasticity, what structure is impaired and what dysarthria type is it? IAP; spastic dysarthria
If you observe intention tremor, what structure is impaired and what dysarthria type is it? cerebellar circuit; ataxic dysarthria
If you observe paresis, what structure is impaired and what dysarthria type is it? FCP; flaccid dysarthria
If you observe rigidity, what structure is impaired and what dysarthria type is it? Basal ganglia; hypokinetic dysarthria
If you observe hyporeflexia, what structure is impaired and what dysarthria type is it? DAP; spastic dysarthria
Why might right or left lower face weakness, seen as drooping, be more likely to occur than weakness in the right or left vocal cord for a unilateral cerebral hemisphere stroke? The lower face innervation of the UMN is not bilaterally distributed across the motor strip of the cerebral hemisphere for the facial nerve, but it is for the vagus nerve.
What is a disorder of conceptualization? dementia
What is a disorder of motor planning or programming? apraxia of speech (AOS)
What is a disorder of linguistic planning? aphasia
What is a disorder of feedback and performance (execution)? dysarthria
What is atrophy? wasting away of body tissue or an organ; typically due to degeneration of cells - can be a symptom of disease of motor neurons (compared to sensory neurons) - seen more often in flaccid dysarthria.
What are fasciculations? a brief, spontoaneous contraction of a small number of muscle fibers often causing a flicker movement under the skin - can be a symprom of disease of motor neurons (compared to senesory neurons) - seen more often in flaccid dysarthria
What is dystonia and what part of the neurological system might be impaired? state of abnormal muscle tone resulting in muscle spasms and abnormal posture, typically due to neurological disease (often in Basal Ganglia Circuit)
What is cogwheel rigidity? Where does the potential lesion lie? - a form of rigidity which is associated with a jerky resistance to passive movement, typically associated with Parkinsonism (Basal Ganglia Circuit).
Sensation of the mucous membrane of the mouth, side of the head and scalp, the lower jaw, and the anterior two thirds of the tongue are associated with which one of the following cranial nerves? Cranial nerve V
Impairment to which one of the following cranial nerves may result in the inability to elevate ones shoulders? Cranial nerve XI
Which intrinsic laryngeal muscle is not innervated by the recurrent branch of the vagus nerve? cricothyroid muscle
When liquid falls on the surface of the vocal folds and we cough to expel the liquid, what branch of the 10th cranial nerve is responsible for the sensing of the liquid on the vocal fold surface? recurrent branch
What are the four major functional divisions of the motor system? 1. The final common pathway 2. The direct common pathway 3. The indirect common pathway 4. The control circuits
What are the major structures of the FCP? cranial nerves and spinal nerves
What is the final common pathway referred to as? What does this mean? the lower motor neuron system; the peripheral mechanism through which all motor activity is mediated; last link in the chain of neural events that lead to movement
What four cranial nerves are involved in the respiratory system? IX (glossopharyngeal), X (vagus), XI (accessory), XII (hypoglossal)
dorsal respiratory neurons located in the reticular formation of the medulla; produces inhalation and important to maintaining a smooth rhythm of respiration
ventral respiratory neurons ventrolateral portion of the medulla) stimulates exhalation or inhalation but are primary responsible for providing force during exhalation
apneustic center (lower pons) drives inspiration
pneumotaxic center (upper pons) helps regulate inspiratory volume by inhibiting inspiration
What are the three groups of neurons located at the pons and medulla? What is their role in respiration? 1. ponto-medullary respiratory oscillator 2. dorsal respiratory neurons 3. ventral respiratory neurons They are involved in voluntary rhythmic breathing.
What is the direct activation pathway? It originates in the cerebral cortex and its destination is the cranial and spinal nerve nuclei. It is involved in the direct voluntary, skilled movements. Known as the pyramidal tract or direct motor system.
What structures are involved in the direct activation pathway? corticobulbar tract and corticospinal tract; form UMN system
What is the result of lesions along the DAP? Lesions along this can cause a loss of skilled movement, hyporeflexia, babinski sign, and decreased muscle tone.
What is unilateral UMN dysarthria? A dysarthria that involves unilateral UMN lesions and seems to reflect weakness and loss of skilled movement.
What is the indirect activation pathway? It originates in the cerebral cortex and its destination is the cranial and spinal nerve nuclei. It is involved in controlling posture, tone, and movements supportive of voluntary movement. Known as the extrapyamidal tract or indirect motor system.
What is the basal ganglia control circuit? The major structures associated with this are the basal ganglia, substantia nigra, subthalamus, and cerebral cortex. known as the extrapyramidal system, it is involved in the planning and programming of postural and supportive components of motor activity
Which nuclei in the cerebellum appears to be most crucial for speech motor control? What aspects of speech motor control is it responsible for? The dentate nucleus may be particularly important for speech control, because it seems to be active in initiating movement, executing pre-planned motor tasks, and regulating posture.
What is motor planning? It represents the highest level of the motor system and "entails formulating the strategy of action by specifying motor goals."
What is motor programming? It is at a "lower level" of the motor system than planning, because it depends on a plan to guide its substance.
What results in flaccid dysarthria? Damage at the lower motor neuron system in the brainstem results in this.
What results in spastic dysarthria? Damage that involves at bilateral upper motor neuron lesion in both the direct and indirect activation pathways in the cerebral cortex results in this.
What consists of the control circuits? What is there role? Basal ganglia and cerebellum; They are involved in the integration or coordination of sensory information and activities of direct and indirect activation pathways to control movement.
What areas of the cerebellum are involved in speech control? vermis and cerebellar hemispheres
What is neurological basis for speech and what nerves are involved? Cranial nerves V, VII, IX, X, XI, and XII, as well as the phrenic nerves from the cervical level of the spinal cord, are the nerves of the final common pathway are most important for speech production.
What constitutes in apraxia of speech? The disturbance of speech motor planning or programming associated with dominant hemisphere abnormalities is called this.
ipsilateral weakness on the same side as the site of lesion
contralateral weakness on the opposite side from the site of lesion
unilateral on one side of the body, one side of the body affected
bilateral on both sides of the body, both sides of the body affected
spasticity increased muscle tone; referred to as an unusual "tightness," stiffness, or "pull" of muscles
flaccidity a clinical manifestation characterization by weakness or paralysis and reduced muscle tone with other obvious cause
clonus a series of involuntary, rhythmic, muscular contractions and relaxations; associated with upper motor neuron lesions along the IAP, accompanied by spasticity
hyperactive stretch reflex same as hyperreflexia
hypotonia a state of low muscle tone (the amount of tension or resistance to stretch in a muscle), often involving reduced muscle strength; result of lower motor neuron lesion or flaccidity
hypertonia a term sometimes used synonymously with spasticity in the literature surrounding damage to the central nervous system, namely upper motor lesions; a condition marked by an abnormal increase in muscle tension and a reduced ability of a muscle to stretch
babinski sign (reflex) a reflex action in which the big toe remains extended or extends itself when the sole of the foot is stimulated, abnormal except in young infants
hyperreflexia defined as overactive or over responsive reflexes.
paresis this results in muscles is deprived of input from all of its LMNs.
rigidity a condition that has an increase in muscle tone, with subsequent increased resistance to passive movements
hypokinesia reduced mobility; characterized by a parietal or complete loss of muscle movement due to a disruption in the basal ganglia; patients with hypokinetic disorders like parkinson's disease experience muscle rigidity and inability to produce movement
hyperkinesia involuntary movements; also known as hyperkinesis, refers to an increase in muscular activity that can result in excessive abnormal movements, excessive normal movements, or a combination of both
truncal ataxia inability to stand or sit without swaying or falling
tremor an untintentional, rhythmic muscle movement involving to-and-fro movements (oscillations) of one or more parts of the body
intention tremor a slow tremor of the extremities that occurs at the end of a purposeful movement, such as trying to press a button or touching a finger to the tip of one's nose
nystagmus abnormal eye movements
atrophy a loss of muscle tone or bulk
fasciculations motor unit discharges shown as twitches on the surfaces of the skin
fibrillation the rapid, irregular, and unsynchronized contraction of muscle fibers
Which of the following subdivision of the nervous system "influence consciously controlled, skilled voluntary movement?" A. Basal ganglia circuit B. Final common pathway C. Cerebellar circuit D. Direct activation pathway E. Indirect activation pathway D. direct activation pathway
Paralysis occurs when a muscle is deprived of input from all the lower motor neurons? T or F True
The destination (not the origin) of the direction activation pathway includes the ________________ and _______________ nerve nuclei. cranial nerves; spinal nerves
Created by: ryanriggs_90