Motor Systems

Question 1

Which of the following signs is characteristic of lower motor neuron (LMN) lesions?
A) Increased tone
B) Hyperactive tendon reflexes
C) Absent plantar response
D) Proximal weakness

Answer 1

C
i.e absent of Babisnki sign

Question 2

Which of the following is NOT a feature of lower motor neuron (LMN) lesions?
A) Wasting
B) Reduced tone
C) Brisk tendon reflexes
D) Fasciculations

Answer 2

C

Question 3

A patient presents with weakness, wasting, and reduced tone in their right leg. The tendon reflexes are absent in the affected leg. Which of the following is the most likely site of the lesion?
A) Neuromuscular junction
B) Peripheral nerve
C) Anterior horn cell
D) Muscle

Answer 3

C

Question 4

In which of the following conditions can both upper motor neuron (UMN) and lower motor neuron (LMN) signs be present?
A) Myasthenia gravis
B) Cervical spondylosis
C) Amyotrophic lateral sclerosis (ALS)
D) Myopathy

Answer 4

C
ALS is a progressive neurodegenerative disease that affects both the upper motor neurons (in the brain) and the lower motor neurons (in the spinal cord). As a result, it can present with a combination of UMN and LMN signs. UMN signs include spasticity, hyperreflexia, and a positive Babinski sign. LMN signs include muscle weakness, wasting, and absent reflexes. ALS is characterized by the degeneration of motor neurons, leading to a wide range of symptoms involving both UMN and LMN pathways.

Question 5

Which of the following disorders typically results in weakness that fatigues with use or repeated testing?
A) Myasthenia gravis
B) Cervical spondylosis
C) Amyotrophic lateral sclerosis (ALS)
D) Myopathy

Answer 5

A) Myasthenia gravis

Question 6

A patient presents with weakness in their arms and legs. The weakness is primarily located in the proximal muscles. Which type of disorder is most likely responsible?
A) Myasthenia gravis
B) Cervical spondylosis
C) Amyotrophic lateral sclerosis (ALS)
D) Myopathy

Answer 6

D) Myopathy

Question 7

Which of the following is NOT a feature of lower motor neuron (LMN) lesions?
A) Fasciculations
B) Reduced tendon reflexes
C) Absent plantar response
D) Increased muscle tone

Answer 7

D) Increased muscle tone

Question 8

A patient presents with weakness and wasting in their left arm. They also have brisk tendon reflexes and fasciculating muscles in the affected limb. Which type of disorder is most likely responsible?
A) Myasthenia gravis
B) Cervical spondylosis
C) Amyotrophic lateral sclerosis (ALS)
D) Myopathy

Answer 8

C

Question 9

A patient has a lesion at the level of C5/6. Which signs would you expect to find?
A) Lower motor neuron (LMN) signs at C5/6 and upper motor neuron (UMN) signs below C6
B) Lower motor neuron (LMN) signs below C6 and upper motor neuron (UMN) signs at C5/6
C) Upper motor neuron (UMN) signs at C5/6 and lower motor neuron (LMN) signs below C6
D) Upper motor neuron (UMN) signs at C5/6 and lower motor neuron (LMN) signs at C5/6

Answer 9

A) Lower motor neuron (LMN) signs at C5/6 and upper motor neuron (UMN) signs below C6

Question 10

Which of the following is NOT a feature of lower motor neuron (LMN) lesions?
A) Wasting (prominent and early in disease process)
B) Weakness
C) Absent tendon reflexes
D) Hyperactive plantar response

Answer 10

D

Question 11

Which of the following signs is characteristic of upper motor neuron (UMN) lesions?
A) Wasting and weakness
B) Hyporeflexia
C) Hypotonia
D) Extensor plantar response

Answer 11

D) Extensor plantar response

Question 12

A patient presents with weakness primarily in the extensors of the arms and flexors of the legs. Which of the following is the most likely site of the lesion?
A) Anterior horn cell
B) Motor cortex
C) Peripheral nerve
D) Neuromuscular junction

Answer 12

B) Motor cortex

Question 13

A patient has weakness in their arms and legs, with the weakness being more pronounced in the extensors of the arms and flexors of the legs. Which type of disorder is most likely responsible?
A) Lower motor neuron (LMN) lesion
B) Myasthenia gravis
C) Upper motor neuron (UMN) lesion
D) Myopathy

Answer 13

C

Question 14

A patient presents with weakness and hyperreflexia in their limbs. They also exhibit an extensor plantar response. Which type of disorder is most likely responsible?
A) Lower motor neuron (LMN) lesion
B) Myasthenia gravis
C) Upper motor neuron (UMN) lesion
D) Myopathy

Answer 14

C) Upper motor neuron (UMN) lesion

Question 15

A patient exhibits clonus and flexor/extensor spasms. Which type of disorder is most likely responsible?
A) Lower motor neuron (LMN) lesion
B) Myasthenia gravis
C) Upper motor neuron (UMN) lesion
D) Myopathy

Answer 15

C

Question 16

Which of the following is a characteristic feature of upper motor neuron (UMN) lesions?
A) Absent clonus
B) Hypotonia
C) Decreased tendon reflexes
D) Extensor weakness in the arms

Answer 16

D

Question 17

During the examination, a patient’s arms show a drift with slow pronation of the wrist and flexion of fingers and elbow. Which of the following terms is used to describe this sign?
a) Fasciculation
b) Atrophy
c) Arm drift
d) Pyramidal drift

Answer 17

c) Arm drift

Question 18

A 45-year-old patient presents with muscle wasting in the intrinsic muscles of the hand. There is no history of trauma or surgery. Which of the following is the most likely cause of this finding?
a) Disuse wasting
b) Neurogenic wasting
c) UMN lesion
d) LMN disorder

Answer 18

b) Neurogenic wasting- T1
Neurogenic wasting refers to muscle atrophy resulting from damage or dysfunction of the nerves that innervate the muscles. In the case of intrinsic hand muscle wasting, it suggests involvement of the nerves responsible for innervating those muscles. This can occur due to various causes such as peripheral neuropathies, nerve compression, or nerve damage.

Question 19

During a physical examination, a patient is found to have asymmetry in muscle bulk and proportions between the left and right sides of their body. Which of the following should be considered in the differential diagnosis?
a) Disuse wasting
b) Neurogenic wasting
c) UMN lesion
d) LMN disorder

Answer 19

d) LMN disorder

Question 20

A 60-year-old patient has a history of poliomyelitis. On inspection, you notice atrophy of the left calf muscle. Which type of muscle wasting is most likely responsible for this finding?
a) Disuse wasting
b) Neurogenic wasting
c) UMN lesion
d) LMN disorder

Answer 20

b) Neurogenic wasting

Question 21

A patient presents with abnormal postures and movements. On examination, you notice fasciculations and tremors in their muscles. Which of the following conditions is the most likely cause?
a) Disuse wasting
b) Neurogenic wasting
c) UMN lesion
d) LMN disorder

Answer 21

d) LMN disorder

Question 22

During the examination, you palpate thickened nerves in a patient. Which of the following conditions should be considered in the differential diagnosis?
a) Disuse wasting
b) Neurogenic wasting
c) UMN lesion
d) Entrapment neuropathy

Answer 22

d) Entrapment neuropathy

Question 23

While performing the arm drift test, a patient’s arm deviates from the starting position and shows slow pronation of the wrist and flexion of fingers and elbow. Which of the following conditions is most likely responsible for this finding?
a) Disuse wasting
b) Neurogenic wasting
c) UMN lesion
d) LMN disorder

Answer 23

c) UMN lesion

Question 24

A patient presents with muscle tenderness during palpation. Which of the following conditions should be considered in the differential diagnosis?
a) Disuse wasting
b) Neurogenic wasting
c) UMN lesion
d) Inflammatory myopathy

Answer 24

d) Inflammatory myopathy

Question 25

During inspection, you notice ulcers and skin lesions in a patient's arms and legs. Which of the following conditions should be considered in the differential diagnosis? a) Disuse wasting b) Neurogenic wasting c) UMN lesion d) Vasculitis

Answer 25

d) Vasculitis

Question 26

A 50-year-old patient has abnormal postures and movements. On examination, you notice muscle hypertrophy. Which of the following conditions is the most likely cause? a) Disuse wasting b) Neurogenic wasting c) UMN lesion d) Hypothyroidism

Answer 26

d) Hypothyroidism

Question 27

Which of the following conditions is associated with increased muscle tone? A) Cerebral palsy B) Poliomyelitis C) Parkinson's disease D) Lower motor neuron lesion

Answer 27

A) Cerebral palsy DO NOT confuse with RIGIDITY--> Parkinson's

Question 28

A patient with Parkinson's disease is assessed for muscle tone in the upper extremities. Which of the following tone abnormalities would you expect to find? A) Increased tone B) Decreased tone C) Normal tone D) Rigidity

Answer 28

D

Question 29

During the assessment of muscle tone, the examiner should: A) Squeeze the limb firmly to elicit a response B) Distract the patient by playing loud music C) Hold the limb lightly and unobtrusively D) Encourage the patient to actively resist movement

Answer 29

C) Hold the limb lightly and unobtrusively

Question 30

A patient with cerebral palsy presents with increased muscle tone in the right forearm. Which of the following movements would best demonstrate this increased tone? A) Forearm flexion/extension B) Forearm supination/pronation C) Elbow flexion/extension D) Leg abduction/adduction

Answer 30

Forearm flexion/extension

Question 31

A patient with lower motor neuron lesion presents with flaccidity in the left leg. Which of the following movements would best demonstrate this decreased tone? A) Leg abduction/adduction B) Forearm flexion/extension C) Forearm supination/pronation D) Knee flexion/extension

Answer 31

D) Knee flexion/extension

Question 32

A 65-year-old female patient presents with weakness in her right arm. Upon examination, you decide to assess the muscle power of her elbow joint. You ask the patient to attempt to move her arm against your resistance. Which of the following Muscle Strength Grading scores would indicate normal muscle power in this joint? A) 1 - Trace B) 2 - Poor C) 3 - Fair D) 4 - Good E) 5 - Normal

Answer 32

D) 4 - Good. This score indicates that the patient's muscle power is weaker than normal but she can still move her arm against the examiner's resistance. It suggests a relatively good level of muscle strength despite being below the normal range.

Question 33

A 20-year-old male patient has intact muscle strength in both arms. During the examination, you ask the patient to flex his elbow joint against resistance and he is able to move it normally. Which muscle power grade would you assign to this patient's arms? a) 5 - Normal b) 4 - Good c) 3 - Fair d) 2 - Poor e) 1 - Trace

Answer 33

a) 5 - Normal

Question 34

A 55-year-old female patient has weakness in her right arm and is unable to move the joint against gravity. However, she can move the joint if gravity is removed. Which muscle power grade would you assign to this patient's right arm? a) 5 - Normal b) 4 - Good c) 3 - Fair d) 2 - Poor e) 1 - Trace

Answer 34

d) 2 - Poor

Question 35

A 30-year-old male patient presents with paralysis in his right arm. He is unable to contract the muscle or move the joint. Which muscle power grade would you assign to this patient's right arm? a) 5 - Normal b) 4 - Good c) 3 - Fair d) 2 - Poor e) 0 - Zero

Answer 35

e) 0 - Zero

Question 36

A 70-year-old female patient complains of difficulty lifting objects with her left arm. During the examination, you observe that she can move the joint against gravity but is unable to move it against resistance. Which muscle power grade would you assign to this patient's left arm? a) 5 - Normal b) 4 - Good c) 3 - Fair d) 2 - Poor e) 1 - Trace

Answer 36

C According to the Muscle Strength Grading or MRC scale, a grade of 3 indicates that the patient can move the joint or muscle group against gravity as resistance. In this case, the patient is able to move the joint when gravity is acting on it, but she cannot overcome resistance from the examiner. This suggests a moderate level of weakness in the left arm, which may explain her difficulty in lifting objects.

Question 37

A 45-year-old male patient presents with weakness in his right arm. Upon examination, you ask the patient to flex his elbow joint against resistance. He is able to move the joint, but it is weaker than normal. Which muscle power grade would you assign to this patient's right arm? a) 5 - Normal b) 4 - Good c) 3 - Fair d) 2 - Poor e) 1 - Trace

Answer 37

B

Question 38

Which type of reflex is involved in the monosynaptic proprioceptive reflex? a) Autonomic reflex b) Somatic reflex c) Stretch reflex d) Withdrawal reflex

Answer 38

C

Question 39

What is the cause of hyperreflexia in UMN lesions? a) Decreased inhibitory interneuron activity b) Increased inhibitory interneuron activity c) Decreased gamma motor neuron activity d) Increased gamma motor neuron activity

Answer 39

A

Question 40

Which structures are affected in LMN lesions causing hyporeflexia? a) Anterior horn cells, motor nerve root(s), and/or peripheral nerves b) Inhibitory interneurons c) Gamma motor neurons d) Stretch receptors within the muscle

Answer 40

A