Systems T4 - 4b
Test 1 and 2
- 1.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. Her forearm pronation is:
- A.
Paralyzed.
- B.
Paretic.
- C.
Neurologically normal.
- D.
Unopposed.
- E.
Weakly opposed.
- 2.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. Her hand will have the _______ presentation.
- A.
Clawhand
- B.
Apehand
- C.
Wrist drop
- D.
A & B
- E.
None of the above.
- 3.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. Which of the following statements is TRUE regarding the edema in this case?
- A.
The ulnar side of the forearm and hand distal to the injury site will be severely edematous.
- B.
Her entire forearm and hand distal to the injury site will show signs of vasomotor paralysis.
- C.
The palmar aspect of her hand will be severely edematous.
- D.
It is unlikely that there will be vasomotor dysfunction in this case.
- E.
None of the above.
- 4.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. Her wrist adduction is ___________ and her wrist abduction is ___________.
- A.
Effectively eliminated; neurologically normal.
- B.
Neurologically normal; paretic and deviates posteriorly.
- C.
Paralyzed; effectively eliminated.
- D.
Paretic and deviates posteriorly; neurologically normal.
- E.
Neurologically normal; effectively eliminated.
- 5.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. Her thumb adduction is __________ and her thumb flexion is ____________.
- A.
Neurologically normal; paretic.
- B.
Paretic; paretic.
- C.
Paralyzed; paretic.
- D.
Paralyzed; paralyzed.
- E.
Neurologically normal; neurologically normal.
- 6.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. Her wrist flexion is:
- A.
Mildly paretic and deviates medially.
- B.
Mildly paretic and deviates laterally.
- C.
Neurologically normal.
- D.
Limited by the edema in the hand.
- E.
None of the above.
- 7.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. True or False: Before beginning to treat her, it will be important to assess how the medial side of her had reacts to stimuli, since it is an area that may generate irritable firing phenomenon.
- A.
True
- B.
False
- 8.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. True or False: Even against mild resistance, it is unlikely that she will be able to open (spread) her fingers apart.
- A.
True
- B.
False
- 9.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. True or False: This client will need to be cautious about how she uses her wrist since it will be quite susceptible to medial wrist sprains.
- A.
True
- B.
False
- 10.A 28 year old woman, who is a regular client of yours, fell on the ice over a month ago as she ran to catch her bus to work. She landed heavily on her left elbow and sustained a complete ulnar nerve lesion. The elbow swelling and bruising are now well on the way to subsiding, although her ulna is still very tender to pressure. She was on an analgesic and an anti-inflammatory for 10 days following the injury, but is not taking anything now. Her neurologist has said that while there should be good recovery, a full return to function is not guaranteed. He has given her a neutral wrist brace to wear at night. Please assume that the injury eliminated ALL ulnar nerve functions and at this time, no signs of recovery have begun. True or False: With a severe ulnar nerve injury such as in this case, there will be a significant amount of true atrophy, especially in the muscles of the thenar eminence.
- A.
True
- B.
False
- 11.In Wallerian degeneration, the damaged axon:
- A.
Experiences transient disruption of conduction but remains in continuity with the nerve.
- B.
Completely degenerates back to the cell body.
- C.
Degenerates distally from the injury site, as well as proximately to the nearest node of Ranvier.
- D.
Degenerates to the nearest node of Ranvier distal to the injury site.
- E.
Degenerates from the cell body to the nearest node of Ranvier proximal to the injury site.
- 12.Of the axonal lesions studied, which is LEAST likely to resolve with full recovery of the affected nerve's functions?
- A.
Axonotmesis
- B.
Neurotmesis
- C.
Neuritis
- D.
Neurapraxia
- E.
Saturday Night Palsy
- 13.Which of the following conditions can lead to peripheral nerve damage?
- A.
Alcoholism
- B.
Birth trauma
- C.
Prolonged cane use
- D.
Leprosy
- E.
All of the above
- 14.In the early stages of nerve healing, neuritis can occur. Which of the following statements is FALSE regarding neuritis?
- A.
The most common type of nerve inflammation is interstitial neuritis.
- B.
A red streak can often be observed on the skin overlying the inflamed nerve.
- C.
Modified hydrotherapy applications such as warm towels are used to encourage local blood supply and healing
- D.
Complications include adhesions and compensatory problems.
- E.
All the statements are true.
- 15.Which of the following is FALSE about nerve injuries involving vasomotor paralysis?
- A.
There is maximal hydrostatic pressure in the affected capillary bed.
- B.
The body part would be quite warm at first, but in time is likely to become cool.
- C.
There is high likelihood that causalgia will be a co-finding in a complete ulnar nerve lesion.
- D.
Despite the edema, tissue health is maintained fairly well because of the large volume of blood in the area.
- E.
C & D
- 16.Which of the following actions will be completely paralyzed in a complete median nerve lesion at the proximal humerus?
- A.
Thumb opposition and forearm pronation.
- B.
Thumb flexion and forearm pronation.
- C.
Thumb adduction and forearm pronation.
- D.
Thumb opposition and forearm supination.
- E.
Thumb flexion and forearm supination.
- 17.Your client has permanent complete radial nerve damage from an old injury to the dorsal hand an inch or so distal to the wrist joint. You expect to observe that:
- A.
There is no motor dysfunction, only sensory.
- B.
There is no sensory dysfunction, only motor.
- C.
Finger extension is paralyzed but thumb extension is spared.
- D.
The posterior aspect of the wrist joint is proprioceptively blind.
- E.
B & C
- 18.Select the TRUE statement about true atrophy.
- A.
It begins to reverse once normal profusion is re-established to the tissue.
- B.
It occurs when nutritional processes inside the muscle cell are disabled.
- C.
It is only present when there is flaccid paralysis of all the motor units in the affected muscle.
- D.
There is no cause relationship between vasomotor paralysis and true atrophy.
- E.
B & D
- 19.Which of the following is a requirement for successful regeneration of a peripheral nerve?
- A.
Cell body must be healthy and intact.
- B.
The myelin sheath must be intact. This provides a framework into which the endoneurium can grow.
- C.
Adequate numbers of Schwann cells.
- D.
A & C
- E.
All of the above.
- 20.The median nerve is most commonly injured:
- A.
In the palmar aspect of the hand.
- B.
At the wrist.
- C.
In the forearm.
- D.
In the distal arm.
- E.
At the shoulder.
- 21.Which of the following is TRUE regarding neuromas?
- A.
Neuromas are temporary structures that are resorbed by the body relatively soon after the injury.
- B.
Sensory irritable firing caused by stimulation of the neuroma can be felt in the cutaneous supply of the nerve.
- C.
Once full regeneration has taken place, it is important to address the neuroma with cyriax frictions.
- D.
A neuroma only forms when Schwann cell supply is inadequate and axons are left unmyelinated.
- E.
None of the above are true.
- 22.In order to have flaccid paralysis of thumb abduction, complete loss of _______ function is required.
- A.
Radial
- B.
Median
- C.
Ulnar and median
- D.
Radial and ulnar
- E.
Radial and median
- 23.Flaccidity occurs motor unit by motor unit - a muscle can contain flaccid motor units alongside normal motor units.
- A.
True
- B.
False
- 24.Causalgia is a specific type of irritable firing associated with injuries involving nerves carrying sympathetic fibres.
- A.
True
- B.
False
- 25.Full loss of holding position due to a complete median nerve lesion is know as Ape Hand. The forearm is fully pronated and the thumb is adducted.
- A.
True
- B.
False
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