Semester 2 Neuro, Quiz 6 - Motor Systems

24 Questions | By BLACKMD | Last updated: Mar 22, 2022 | Total Attempts: 2198

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1.

A 74-year-old woman was residing in a rehabilitation facility while recovering from an infection. She was doing well until one morning she suddenly developed slurred speech and right sided weakness. An emergency neurologist was consulted. Medical history was notable for hypertension, coronary artery disease and a recent onset of atrial fibrillation. Examination revealed weak movements of the right face with only mild forehead involvement. Decreased palate movement on the right, and rightward tongue deviation. The neurologist suspected lacunar infarction, which was confirmed by MRI. Where is the most possible localization?
- A.
  
  Left prefrontal gyrus medial part of the hemisphere
- B.
  
  Right Broca area with involvement of lower part of Broadmann area 4.
- C.
  
  Left posterior limb of internal capsule
- D.
  
  Left genu of internal capsule
- E.
  
  Right posterior limb and genu of internal capsule
2.

Following a motor bike accident, a 22-year old man presents with paraplegia. Name (i) the tract affected (ii) the site of injury and (iii) the type of lesion.
- A.
  
  Corticobulbar tract, genu of internal capsule, bilateral.
- B.
  
  Spinothalamic, thoracic, unilateral.
- C.
  
  Corticospinal tract, rostral to the decussation of pyramids, bilateral.
- D.
  
  Corticospinal tract, thoracic, bilateral.
- E.
  
  Corticospinal tract, posterior limb, unilateral.
3.

A 28-year old women experiences drooping in her left lower facial muscles (below the eye). Her forehead remains unaffected. Given her symptoms name (i) the type of lesion (ii) the site of the lesion and (iii) the side of lesion.
- A.
  
  Upper motor neuron lesion, genu of internal capsule, right.
- B.
  
  Lower motor neuron lesion, facial nerve, left.
- C.
  
  Upper motor neuron lesion, trigeminal nerve, right.
- D.
  
  Lower motor neuron lesion, posterior limb of internal capsule, right.
- E.
  
  Upper motor neuron lesion, posterior limb of internal capsule, left.
4.

Your elderly neighbor has difficulties in picking up his newspaper properly from his porch and you have also noticed that he exhibits issues with correctly grasping his brandy glass when he invites you over for a drink. He told you that he has problems controlling the distance of his movements. You know this to be which of the following?
- A.
  
  Akinesia
- B.
  
  Dysdiadochokinesia
- C.
  
  Bradykinesia
- D.
  
  Dysphagia
- E.
  
  Dysmetria
5.

A 52-year-old woman who is unable to move her left leg visits your office. Sensory modalities in all of her limbs are retained and there appears to be no sign of weakness in any of her other limbs. In which of the following structures are the cell bodies of lower motor neurons innervating the lower limb located?
- A.
  
  Lamina I-VI
- B.
  
  Lamina VIII, IX
- C.
  
  Lamina X
- D.
  
  Lamina I, II
- E.
  
  Lamina III, IV
6.

A 24-year-old woman is rushed to the hospital following severe head injuries. She is displaying a specific rigidity that is a result of lesions rostral to the red nucleus. What symptoms is she displaying?
- A.
  
  Lower extremity weakness
- B.
  
  Weakness of the masticatory muscles
- C.
  
  Upper and lower limb extension
- D.
  
  Upper limb flexion and lower limb extension
- E.
  
  Deviation of the tongue on protrusion
7.

A 34-year old man is rushed to the emergency room from the site of a car accident. An MRI reveals a lesion at the level of the midbrain. His upper and lower limbs are extended. Name (i) the type of rigidity and (ii) the tract/tracts involved in the extension of the limbs.
- A.
  
  Decorticate; Rubrospinal tract
- B.
  
  Decorticate; Medial reticulospinal and lateral vestibulospinal tract
- C.
  
  Decerebrate; Rubrospinal and lateral vestibulospinal tract
- D.
  
  Decerebrate; Rubrospinal tract
- E.
  
  Decerebrate; Medial reticulospinal and lateral vestibulospinal tract
8.

A 22-year-old woman n is suffering from bilateral weakness of her lower limbs. Which of the following represents the most likely location of this lesion?
- A.
  
  A lesion rostral to the pyramidal decussation
- B.
  
  The left genu of the internal capsule
- C.
  
  The right posterior limb of the internal capsule
- D.
  
  A lesion caudal to the pyramidal decussation
- E.
  
  The right genu of the internal capsule
9.

A 64-year old woman presents with headache, lethargy and occasional vomiting, all suggestive of increased intracranial pressure. She also has marked weakness on the left side of her body. An MRI is performed which reveals a glioma invading the white matter between the lenticular nucleus and the thalamus on the right side of her brain. Which of the following is being compressed by this tumor?
- A.
  
  Corticopontine tract
- B.
  
  Anterior commissure
- C.
  
  Anterior limb of internal capsule
- D.
  
  Posterior limb of internal capsule
- E.
  
  Posterior commissure
10.

Which of the following represents the fibers that fan out from the internal capsule into the white matter of the hemisphere?
- A.
  
  Cingulum
- B.
  
  Corona radiata
- C.
  
  Genu of the corpus callosum
- D.
  
  Superior longitudinal fasciculus
- E.
  
  Uncinate fasciculus
11.

Damage to the efferent portion of the muscle spindle would involve which of the following fiber types?
- A.
  
  B fibers
- B.
  
  Aa fibers
- C.
  
  C fibers
- D.
  
  Ay fibers
- E.
  
  AB fibers
12.

A 44-year old man presents with a "cape-like" loss of sensation (pain and temperature) to his back and arms. An MRI reveals a cyst at the cervical level of his spinal cord. Name (i) the disorder and (ii) the tract that is affected.
- A.
  
  Brown Sequard syndrome, Spinothalamic tract
- B.
  
  Brown Sequard syndrome, Corticospinal tract
- C.
  
  Syringomyelia, Spinothalamrc tract
- D.
  
  Syringomyelia, Corticospinal tract
- E.
  
  Syringomyelia, Tectospinal tract
13.

A 54-year-old morbidly obese and hypertensive man is brought to the emergency department after experiencing sudden onset of weakness of his left upper and lower extremities. CT shows an infarcted area in the medulla. Damage to which of the following tracts or fiber bundles of the medulla would most likely explain this deficit?
- A.
  
  Anterolateral system
- B.
  
  Corticospinal fibers
- C.
  
  Medial Lemniscus
- D.
  
  Rubrospinal tract
- E.
  
  Vestibulospinal fibers
14.

A 23 year old man is brought to the emeregency room from the site of an automobile collision. The neurological examination reveals weakness of the right lower extremity and a loss of pain and thermal sensations on the left side beginning at the level of the umbilicus. CT shows a fracture of the vertebral column with displacement of bone fragments into the vertebral canal. Damage to which of the following tracts would correlate with weakness of the lower extremity in this man?
- A.
  
  Left lateral corticospinal tract
- B.
  
  Reticulospinal fibers on the right
- C.
  
  Right lateral corticospinal tract
- D.
  
  Right rubrospinal tract
- E.
  
  Vestibulospinal fibers on the right
15.

Which of the following represents the most likely level of damage to the spinal cord resulting from the fracture to the vertebral column in this man?
- A.
  
  T6 on the left
- B.
  
  T8 on the left
- C.
  
  T8 on the right
- D.
  
  T10 on the left
- E.
  
  T10 on the right
16.

Based on their relative locations in the spinal cord, which of the following tracts or fiber bundles would most likely be involved In a lesion located in the immediate vicinity of the lateral corticospinal tract?
- A.
  
  Anterolateral system
- B.
  
  Anterior spinocerebellar tract
- C.
  
  Gracile fasciculus
- D.
  
  Medial longitudinal fasciculus
- E.
  
  Rubrospinal tract
17.

A 37-year-old man is brought to the emergency department with a severe head injury. Within a few hours he is decerebrate (upper and lower extremities extended) and comatose. The extension of his extremities indicates a dominant input to extensor motor neurons through reticulospinal fibers/tracts. Which of the following most specifically describes the position of these activated fibers within the spinal cord?
- A.
  
  Anterolateral area (area of anterolateral system)
- B.
  
  Posterolateral area (area of lateral corticospinal tract)
- C.
  
  Posteriorcolumns
- D.
  
  Posterolateral (dorsolateraI)tract
- E.
  
  Intermediatezone
18.

A 47-year-old man is transported to the emergency department from the site of an automobile collision. The examination reveals a paralysis of both lower extremities. Which of the following most specifically identifies this clinical picture?
- A.
  
  Alternating hemiplegia
- B.
  
  Hemiplegia
- C.
  
  Monoplegia
- D.
  
  Quadriplegia
- E.
  
  Paraplegia
19.

A 57-year-old woman presents with the main complaint of difficulty speaking. The examination reveals that the woman's tongue deviates to the right on attempted protrusion. When she says \\Ah" her soft palate elevates slightly on the left and the uvula deviates to the same side . This combination of deficits most likely indicates a small lesion in which of the following?
- A.
  
  Crus cerebri on the right
- B.
  
  Genu of the internal capsule on the left
- C.
  
  Genu of the internal capsule on the right
- D.
  
  Lateral medulla on the right
- E.
  
  Medial medulla on the right
20.

A 70-year old woman is brought to the emergency department by members of the volunteer fire department of a small town. She primarily complains of weakness. The examination reveals a hemiplegia involving the left upper and lower extremities, sensory losses (pain, thermal sensations, and proprioception) on the left side of the body and face, and a visual deficit in both eyes. MRI shows an area of infarction consistent with the territory served by the anterior choroidal artery. The weakness of the extremities in this woman is most likely due to damage to which of the following?
- A.
  
  Corticospinal fibers on the left
- B.
  
  Corticospinal fibers on the right
- C.
  
  Somatomotor cortex on the right
- D.
  
  Thalamocortical fibers to motor cortex on the right
- E.
  
  Thalamocortical fibers to sensory cortex on the right
21.

A57-year-old man presents with hoarseness. The neurological examination reveals a deviation of the uvula to the left on phonation, deviation of the tongue to the right on protrusion, and weakness of the facial muscles around the mouth on the right. Which of the following would most likely also be seen in this man?
- A.
  
  Inability to turn his head to the left against resistance
- B.
  
  Inability to turn his head to the right against resistance
- C.
  
  Inability to shrug the right shoulder against resistance
- D.
  
  Weakness of the masticatory muscles on the left
- E.
  
  Weakness of the masticatory muscles on the right
22.

A 57-year-old obese man is brought to the emergency department by his wife. The examination reveals that cranial nerve function is normal but the man has bilateral weakness of his lower extremities. He has no sensory deficits. MRI shows a small infarcted area in the general region of the cervical spinal cord-medulla junction. Which of the following represents the most likely location of this lesion?
- A.
  
  Caudal part of the pyramidal decussation
- B.
  
  Lateral corticospinal tract on the left
- C.
  
  Pyramids bilaterally
- D.
  
  Pyramid on the right
- E.
  
  Rostral part of the pyramidal decussation
23.

As a medical student, you are tapping the patellar tendon to activate the knee jerk reflex. The resulting reflex is within a normal range. Which sensory organ is activated in response to this stimulus?
- A.
  
  Golgi tendon organ
- B.
  
  Merkel cell
- C.
  
  Pacinian corpuscle
- D.
  
  Muscle spindle
- E.
  
  Ruffini ending
24.

A 79~year old man is experiencing peripheral nerve damage of his lower right limb. Which of the following is characteristic of lower motor neuron damage?
- A.
  
  Hyperreflexia
- B.
  
  Increased tone
- C.
  
  Hyporeflexia
- D.
  
  Spastic paralysis
- E.
  
  Increased muscle mass