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Flashcards in LESION SPINAL TRACT Deck (15)
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4. Neurologic examination reveals an extensor plantar reflex on the left side, hyperreflexia on the left side, a loss of pain and temperature sensation on the right side, and ptosis and miosis on the left side. A lesion that cause this constellation of deficits would most likely be found in the
(A). Paracentral lobule, left side
(B). Crus cerebri, right side
(C). Dorsolateral medulla, left side
(D). Cervical spinal cord
(E). Lumbar spinal cord

4.-D. A lesion of the cervical spinal cord could result in ipsilateral Horner syndrome, ipsilateral spastic paresis, and contralateral loss of pain and temperature sensation . Horner syndrome is always manifested on the ipsilateral side. This lesions represents a classic Brown-sequard syndrome.

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5. A 50 years old woman complains of clumsiness in her hands while working in the kitchen; she recently burnt her hands on the stove without experiencing any pain. Neurologic examination reveals bilateral weakness of the shoulder girdles, arms and hands, as well as a loss of pain and temperature sensation covering the shoulder and upper extremity in a cape-like distribution. Severe atrophy is present in the intrinsic muscles of the hands. The most likely diagnosis is
(A). Amyotrophic lateral sclerosis (ALS)
(B). Subacute combined degeneration
(C). Werdnig-Hoffmann disease
(D). Syringomyelia
(E). Tabes dorsalis

5.-D. Syringomyelia is a cavitation of the spinal cord most commonly seen in the cervicothoracic segments. This condition results in bilateral loss of pain and temperature sensation in a capelike distribution as well as wasting of the intrinsic muscles of the hands. Amyotrphic lateral sclerosis (ALS) is a pure motor syndrome, subacute combined degeneration includes both sensory and motor deficits. Werdnig-Hoffmann disease is a pure motor disease, and tabes dorsalis is a pure sensory syndrome (neurosyphilis).

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6. A 50 years old man has a 2 years history of progressive muscle weakness in all extremities, with severe muscle atrophy and reduced muscle stretch reflexes (MSRs) in both legs. In his arms, the muscle atrophy is less pronounced and the MSRs are exaggerated. Post mortem examination would most likely show which of the following areas of neuronal degeneration?
(A). Loss of purkinje cells
(B). Loss of neurons from the globus pallidus
(C). Loss of neurons from the paracentral lobule and from the anterior horns of the spinal cord.
(D). Demyelination of axons in the posterior and lateral columns
(E). Demyelination of axons in the posterior limb of the internal capsule

6.-C. Amyotrophic lateral sclerosis (ALS) affects both the upper and lower motor neurons. It is also referred to as motor systems disease. A loss of purkinje cells as seen in cerebellar cortical atrophy (cerebello-olivary atrophy)results in cerebellar signs. Cell loss in the globus pallidus and putamen is seen in wilson disease (hepatolenticular degeneration). Demyelination of axons in the poaterior and lateral column is seen in subacute combined degeneration. Demyelination of axons in the posterior limb of the internal capsule result in contralateral spastic hemiparesis.

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7. All of the following statements concerning syringomyelia are correct EXCEPT
(A). It is a central cavitation of the spinal cord
(B). It is usually found at lumbosacral levels
(C). It usually includes a lower motor neuron (LMN) lesion
(D). It usually results in a bilateral loss of pain and temperature sensation
(E). It may result in horner syndrome

7.-B. Syringomyelia is a central cavitation of the cervical spinal cord and is of unknown etiology expansion of the syrinx typically affects the ventral white commisure, interupting decussating fiber of the spinothalamic tract and resulting in a bilateral loss of pain and temperature sensation at the level of involvement. Lateral extension involves one or both of the ventral horns and results in a lower motor neuron (LMN) lesion with muscle wasting and flaccid paralysis. Caudal extension to (C8) T1-T2 may involve the lateral horn (ciliospinal center of Budge) and produce aaaaaaaahorner Syndrome.

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8. Hemisection of the spinal cord at T1 on the left side results in all of the following signsor symptoms EXCEPT
(A). Plantar response flexor on the left side
(B). Loss of vibration sensation in the left leg
(C). Leg dystaxia on the right side
(D). Exaggerated knee jerk reflex on the left side
(E). Normal pain and temperature sensation on the left side

8.-A. Hemisection of the spinal cord is known as brown sequard syndrome. Transection of the left lateral corticospinal tract would result in an extensor plantar response on the left side (Babinskin sign). Leg dystaxia on the right side results from interruption of the crossed ventral spinocerebellar tract.

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9. Lower motor neuron (LMN) lesions result in all of the following deficits or signs EXCEPT
(A). Loss of muscle stretch reflexes (MSRs)
(B). Loss of superficial reflexes
(C). Fascivulations
(D). Muscle wasting
(E). Plantar reflex extensor

9.-E. Lower motor neuron (LMN) lesions result from destruction of ventral horn (or cranial nerve) motor neurons or transection of their axons. LMN lesions interrupt the final common pathway to skeletal muscle, they result in flaccid paralysis and atrophy (muscle wasting) and a loss of all reflex action (areflexia). Fasciculations (visible muscle twitching) and fibrillation (seen on an electromyogram (EMG) afe signs of LMN disease. The babinski sign, an extensor plantar reflex,is not seen in LMN lesions.

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10. All of the following statements concerning upper motor neuron (UMN) lesions are correct EXCEPT
(A). They are found above the pyramidal decussation
(B).They result in the presence of the babinski sign
(C). They result in the absence of the knee jerk reflex
(D). They are commonly caused by cerebrovascular accidents
(E). They frequently involve the internal capsule

10.-C. Upper motor neuron (UMN) lesions result from destruction of cortical neurons (or their axons) that give rise to the corticospinal and corticobulbar tract. UMN are founds in the cerebral cortex and in the brain stem. UMN lesions result in dpastic paralysis (hyperreflexia, hypertonia, clasp-knife phenomenon, clonus, muscle weakness, and the babinsky sign). UMN lesions are commonly caused by cerebrovasculer accidents and frequently damage the internal capsule.

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11. all of the following statements concerning horner syndrome are correct EXCEPT
(A). It is Seen in spinal cord lesions above T1
(B). It is ipsilateral to the lesions
(C). It is results from interruption of descending autonomic pathways
(D). It results in mydriasis and mild ptosis
(E). It results in facial hemianhidrosis

D

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12. All of the following statements concerning intervertebral disk herniation are correct EXCEPT
(A). It results from prolapse of the nucleus pulposus through a defective annulus fibrosus into the vertebral canal
(B). It may involve the cauda equina
(C). It usually involves a single nerve root
(D). It most frequently appears in the L4-L5 interspace
(E). It usually results in urinary incontinence

E

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(A). Amyotrophic lateral sclerosis (ALS)
(B). Cauda Equina syndrome
(C). Cervical spondylosis
(D). Friedreich ataxia
(E). Guillan Barre syndrome
(F). Multipel sclerosis
(G). Subacute combined degeneration
(H). Tabes dorsalis
(I). Werdnig-Hoffmann disease

13. A pure lower motor neuron disease

I

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(A). Amyotrophic lateral sclerosis (ALS)
(B). Cauda Equina syndrome
(C). Cervical spondylosis
(D). Friedreich ataxia
(E). Guillan Barre syndrome
(F). Multipel sclerosis
(G). Subacute combined degeneration
(H). Tabes dorsalis
(I). Werdnig-Hoffmann disease

14. Elevated cerebrospinal fluid (CSF) protein with a normal CSF cell count

E

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(A). Amyotrophic lateral sclerosis (ALS)
(B). Cauda Equina syndrome
(C). Cervical spondylosis
(D). Friedreich ataxia
(E). Guillan Barre syndrome
(F). Multipel sclerosis
(G). Subacute combined degeneration
(H). Tabes dorsalis
(I). Werdnig-Hoffmann disease

15. Characterized by asymmetric lesions found in the white matter of cervical segments

F

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(A). Amyotrophic lateral sclerosis (ALS)
(B). Cauda Equina syndrome
(C). Cervical spondylosis
(D). Friedreich ataxia
(E). Guillan Barre syndrome
(F). Multipel sclerosis
(G). Subacute combined degeneration
(H). Tabes dorsalis
(I). Werdnig-Hoffmann disease

16. May result from intervertebral disk herniation

B

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(A). Amyotrophic lateral sclerosis (ALS)
(B). Cauda Equina syndrome
(C). Cervical spondylosis
(D). Friedreich ataxia
(E). Guillan Barre syndrome
(F). Multipel sclerosis
(G). Subacute combined degeneration
(H). Tabes dorsalis
(I). Werdnig-Hoffmann disease

17.Symptoms include a painfull stiff neck arm pain and weakness, spastic leg weakness with dystaxia;sensory disorders are frequent

C

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(A). Amyotrophic lateral sclerosis (ALS)
(B). Cauda Equina syndrome
(C). Cervical spondylosis
(D). Friedreich ataxia
(E). Guillan Barre syndrome
(F). Multipel sclerosis
(G). Subacute combined degeneration
(H). Tabes dorsalis
(I). Werdnig-Hoffmann disease

18.Associated with a loss of purkinje cells

D