Practice Questions

2002 Exam II Case 06

Chief Complaint: A 59 year-old, right-handed male with uncontrolled movement of the right extremities.

History of Chief Complaint:
Two-years ago he suffered the rapid onset of right-sided paralysis, clonus and a Babinski sign. Over the next two months much of the paralysis resolved and the patient began experiencing wild, involuntary flinging motions involving the right upper and lower extremities.

Medical History:
Significant risk factors for artherosclerotic disease

Family History:

Physical Examination:

Neurologic Examination
Mental Status:
He is awake and oriented to person, place and time. His fund of knowledge and memory are intact. Speech is fluent and meaningful. He gave an accurate history.

Cranial Nerves:
Visual fields are full to confrontation. Eye movements are intact in all fields, eyelids elevate fully and pupils are reactive to light. Response to touch and pin-prick are present throughout his face bilaterally. Facial expressions are symmetric and appropriate. Corneal, jaw-jerk and gag reflexes are intact. Hearing is intact to finger rub. His palate elevates symmetrically and his tongue protrudes on the midline.

Motor Systems:
He has normal strength on the left, deep tendon reflexes are 2/4 at the elbow, wrist, knee and ankle on the left. Strength and reflexes could not be tested on the right due to the adventitious motion. These involuntary movements consisted of wild, flinging motions about the proximal joints of the extremity and more jerky motions present about the distal joints. These unwanted motions ameliorate with sleep and return upon awakening. The degree of motion present in the lower extremity makes gait difficult for him and he has a tendency to fall occasionally while walking. The motions continue throughout the day and he complains of exhaustion especially in the evening.

Sensory systems:
All sensory systems are intact on the left and none could be reliably tested on the right.

Questions

INSTRUCTIONS: Provide the BEST or MOST LIKELY answer to the following multiple choice questions.

Question 01:

The motor defect initially expressed in this patient is best termed:

a) Spastic paralysis

b) Hemiballism

c) Hemichorea

d) Athetosis

e) Apraxia

ANSWER

Question 02:

The motor defect initially expressed in this patient is most likely due to a lesion of the:

a) Motor cortex

b) Corona radiata

c) Internal capsule

d) Crus cerebri

e) Subthalamic nucleus

ANSWER

Question 03:

The motor defect expressed by the patient one year post stroke is best termed:

a) Flaccid paralysis

b) Hemiballism

c) Hemichorea

d) Athetosis

e) Apraxia

ANSWER

Question 04:

The motor defect expressed by the patient one year post stroke is most likely due to a lesion of the:

a) Premotor cortex

b) Corpus callosum

c) Putamen

d) Subthalamic nucleus

e) Ventrolateral nucleus

ANSWER

Question 05:

In this patient the most likely location to find degenerating fibers would be the:

a) corticostriatal fibers

b) striatopallidal fibers

c) nigrostriatal fibers

d) Subthalamo-pallidal fibers

e) Thalamocortical fibers

ANSWER

Question 06:

The best description of the temporal profile of this lesion is:

a) Acute and stable

b) Acute and progressive

c) Chronic and stable

d)Chronic and progressive

ANSWER

Question 07:

The best description of the distribution of this lesion is:

a) Focal and on the left

b) Focal and on the right

c) Multifocal

d) Diffuse

ANSWER

Question 08:

The best description of the pathophysiology of this patient’s neurologic lesion would be:

a) Inflammatory

b) Degenerative

c) Vascular - infarction

d) Vascular - hemorrhagic

e) Neoplasm

ANSWER

Question 09:

The most likely location for this lesion on the neuraxis is:

a) Supplementary motor cortex

b) Thalamic-midbrain border

c) Ventral thalamus

d) Thalamus

e) Premotor cortex

ANSWER