questions from class

Question 1

What is the cutoff score on the MoCA to be considered normal?

Answer 1

26/30

The cutoff score for the MMSE is 24/30.

Question 2

What structures of the nervous system could contribute to abnormal findings on the MoCA or MMSE?

Answer 2

Main structures:
* DLPFC in frontal lobe
* Basal ganglia
* Cerebellum
* Hippocampus
* Amygdala

Question 3

What are the expected abnormal findings with damage to the LEFT trigeminal nerve?

Answer 3

Impaired/absent sensation of LEFT side of face, LMN signs of the muscles of mastication (atrophy, weakness, fasciculations) on the LEFT side of face

Question 4

Which cranial nerves would you test if your patient complains of dysarthria, dysphagia, and dizziness?

Answer 4

Primarily:
* 8
* 9
* 10

May also want to do 11 and 12 if suspecting medulla/PICA lesion; maybe 5 if swallowing issues are due to difficulty chewing; maybe 7 if weakness of mouth muscles contributes to difficulty speaking.

Question 5

What clinical tests would you perform if your patient had a lesion of the left anterior inferior cerebellar artery?

Answer 5

Primarily:
* Cognition and language (MoCA, MMSE)
* Cranial nerves 5-8 bilaterally
* Coordination tests of upper and lower extremities bilaterally
* Rapid alternating movements of upper and lower extremities bilaterally
* Saccades
* Smooth pursuit
* VOR cancellation
* Proprioception/kinesthesia of upper and lower extremities bilaterally

Question 6

What lesion location(s) could lead to areflexia of the right plantarflexor/Achilles tendon?

Answer 6

G

Question 7

What lesion location(s) could lead to non-fractionated movement of the left elbow?

Answer 7

A, C, F

Question 8

What lesion location(s) could lead to weakness of the right L4 myotome?

Answer 8

B, D, E, G

Question 9

What lesion location(s) could lead to hypertonicity of the right knee extensors?

Answer 9

B, D, E

Question 10

What sensory signs would you expect from a lesion in the RIGHT dorsal column of C7 spinal cord?

Answer 10

Loss of light touch, proprioception, kinesthesia, vibration, two-point discrimination, stereognosis at and below C7 on the RIGHT. Remains intact on the left and bilaterally.

Question 11

What sensory signs would you expect from a lesion to the RIGHT, MEDIAL postcentral gyrus?

Answer 11

Loss of all sensation (light touch, proprioception, kinesthesia, pain, temperature etc.) to the LEFT side of the body UE>LE.

Question 12

Which sensory and motor test(s) would you prioritize if there were an anterior spinal artery lesion at C7 spinal cord level? Why?

Answer 12

Bilateral Pin Prick/Temperature testing: Spinothalamic pathway involvement
Bilateral triceps myotome testing/strength testing: anterior horn involvement
Bilateral reflex or strength testing in UE/LE: detect extent of lateral corticospinal tract involvement