Med Sci Iii - Exam 2

Front 1

You have been treating Mrs. Georgette, a 45 year old female, in your outpatient physical therapy clinic for cervical neck pain. Recently she has reported paroxysmal attacks of severe bi-parietal headache. She has become forgetful, short-tempered and messy in her appearance. During evaluation you noted small irregular pupils that did not respond to light but reacted to accommodation. Upon further questioning she notes treatment for a genital ulcer. Which disease do you suspect and what screening test would be appropriate?
a. Neurosyphilis; BUN and blood glucose
b. Gonorrhea; VDRL and RPR
c. Neurosyphilis; blood culture and pap smear
d. Neurosyphilis; VDRL and RPR
e. Gonorrhea; blood culture and pap smear

Back 1

a. Neurosyphilis; BUN and blood glucose – neurosyphilis is tested using VDRL and RPR
b. Gonorrhea; VDRL and RPR – gonorrhea is tested using blood culture and pap smear, whereas neurosyphilis is tested using VDRL and RPR
c. Neurosyphilis; blood culture and pap smear – gonorrhea is tested using a blood culture or pap smear
d. Neurosyphilis; VDRL and RPR – CORRECT – neurosyphilis can be tested using VDRL and RPR
e. Gonorrhea; blood culture and pap smear – this testing can be used for gonorrhea

Front 2

Mr. Jones, a 63 year old male, presents to your outpatient clinic for BIG Therapy as he has recently been diagnosed with Parkinson’s disease. During a comprehensive history, he reports being diagnosed with Wilson’s disease 2 years ago. This disease is due to impaired ____________ metabolism and leads to deposits in the ______________.
a. Calcium; Thalamus
b. Copper; Basal Ganglia
c. Lead; Cerebellum
d. Copper; Thalamus
e. Lead; Basal Ganglia

Back 2

a. Calcium; Thalamus – calcium metabolism is not impaired in Wilson’s disease and deposits do not occur in the basal ganglia
b. Copper; Basal Ganglia – CORRECT – impaired copper metabolism leads to deposits in the basal ganglia
c. Lead; Cerebellum – lead metabolism is not impaired in Wilson’s disease
d. Copper; Thalamus – deposits do not occur in the Thalamus in Wilson’s disease – THIS IS NOT A CORRECT STATEMENT
e. Lead; Basal Ganglia – lead metabolism is not impaired in Wilson’s disease and deposits do not occur in the basal ganglia
Question has two answers. I’ll modify accordingly.

Front 3

Mr. Parker was admitted to the acute care hospital with a R hip fracture secondary to Wernicke-Korsakoff Syndrome leading to a fall. Wernicke-Korsakoff Syndrome is a combination of Wernicke’s Encephalopathy and Korsakoff’s Psychosis. Wernicke’s Encephalopathy is characterized by _________ and Korsakoff’s Psychosis is characterized by __________.
a. Confusion, nystagmus, ataxia; retrograde and anterograde amnesia, confabulation
b. Retrograde and anterograde amnesia, confabulation; bradykinesia, hyporeflexia
c. Confusion, nystagmus, ataxia; ideomotor and constructional apraxia
d. Retrograde and anterograde amnesia, confabulation; confusion, nystagmus, ataxia
e. Bradykinesia, hyporeflexia; ideomotor and constructional apraxia

Back 3

a. Confusion, nystagmus, ataxia; retrograde and anterograde amnesia, confabulation – CORRECT – these symptoms match appropriately with their respective disease
b. Retrograde and anterograde amnesia; bradykinesia, resting tremor – these symptoms are Kortakoff’s Psychosis and Parkinson’s Disease
c. Confusion, nystagmus, ataxia; ideomotor and constructional apraxia – Wernicke’s Encephalopathy is correct, but Korsakoff’s Psychosis presents with amnesia not apraxia
d. Retrograde and anterograde amnesia, confabulation; confusion, nystagmus, ataxia – these symptoms are reversed therefore they do not match appropriately
e. Bradykinesia, resting tremor; ideomotor and constructional apraxia – these are symptoms of Parkinson’s Disease and Korsakoff’s Psychosis presents with amnesia not apraxia
Good question

Front 4

Mrs. Johnson, a 79 yo female with no PMH of neurological pathology, presents to the NOA clinic for treatment of gait dysfunction. During your evaluation, you notice _______ muscle wasting, ______ reaction to light and accommodation, and mild progressive loss of ­­­­________ and __________ sense, all of which are associated with normal aging.
a. Proximal, increased, vibration and position
b. Distal, decreased, pain and temperature
c. Axial, increased, pain and temperature
d. Intrinsic hand, decreased, vibration and position
e. Intrinsic foot, decreased, vibration and position

Back 4

a. Proximal, increased, vibration and position- normal aging is associated with intrinsic hand wasting and decreased reaction to light & accommodation
b. Distal, decreased, pain and temperature- normal aging is associated with intrinsic hand wasting and progressive loss of vibration and position sense
c. Axial, increased, pain and temperature- normal aging is associated with intrinsic hand weakness and decreased reaction to light & accommodation
d. Intrinsic hand, decreased, vibration and position- CORRECT
e. Intrinsic foot, decreased, vibration and position- normal aging is associated with intrinsic hand muscle wasting

The way the question is written, “E”, could also be a true state as could “A”. Muscle wasting happens in multiple locations but is just most noticeable in the intrinsic hands. I’ll rewrite this question appropriately.

Front 5

Jack A. Tack is on her last rotation and seeing a patient for the first time. The patient is a 38 year old female presenting with a history of falls that have occurred intermittently throughout the last couple years. She recalls falling during bouts of vision disturbances and leg weakness but these symptoms went away after approximately two days. She was referred to PT by her neurologist with a clinical diagnosis of MS. What is the preferred imaging technique to confirm this diagnosis and the one you would like to see in her chart?

a. X-ray
b. CT scan
c. MR arthrogram
d. PET scan
e. MRI with flair

Back 5

a. Xray- incorrect- typically used for imaging of bone, not soft tissue/brain.
b. CT scan- incorrect- not sensitive for detecting plaque formation
c. MR arthrogram- incorrect- usually used to image joint capsules.
d. PET scan- incorrect - typically used to image increased areas of metabolic activity, such as a tumor, which is not typically associated with MS.
e. MRI with flair- CORRECT - this technique is most sensitive to white matter lesions as well as viewing increased blood build up from the inflammatory process surrounding the lesions which show up as hyperdense on the image.

Front 6

You are a physical therapist treating on the neurological floor of Washington Hospital Center. Your next patient, Joe Trader, is a 29 year old white male who was diagnosed with M.S. three years ago, but who has been admitted to the hospital due to an acute relapse. Being the educated PT that you are, even before you begin your thorough chart review, you know to expect he will be treated with ________ because it _______.

a. a short course of high-dose corticosteroids; shortens time to recovery by 1 to 2 weeks
b. a short course of high-dose corticosteroids; enhances extent of recovery and changes the course of the disease
c. prolonged use of low-dose corticosteroids; chronic use has been shown to help prevent subsequent relapses
d. prolonged use of high-dose corticosteroids; chronic use has been shown to have very few side effects and may likely enhance the extent of recovery
e. no corticosteroid use as this has been shown to directly accelerate the demyelination associated with M.S.

Back 6

a. a short course of high-dose corticosteroids; shortens time to recovery by 1 to 2 weeks- CORRECT- an acute relapse of M.S. is often treated with a short course of high-dose corticosteroids, as this shortens the recovery time
b. a short course of high-dose corticosteroids; enhances extent of recovery and changes the course of the disease- incorrect- high-dose corticosteroids do not improve extent of recovery or change the course of the disease
c. prolonged use of low-dose corticosteroids; chronic use has been shown to help prevent subsequent relapses- incorrect- chronic treatment has not been shown to prevent subsequent relapses
d. prolonged use of high-dose corticosteroids; chronic use has been shown to have very few side effects and may likely enhance the extent of recovery- incorrect- corticosteroids do not improve the extent of recovery and have many side effects including mood changes, sleep disturbances, weight gain, and palpitations
e. no corticosteroid use as this has been shown to directly accelerate the demyelination associated with M.S.- incorrect- a short course of high-dose corticosteroids shortens recovery time by 1 to 2 weeks

Front 7

Mary Bidoli, a 35 y.o female, is scheduled for an IE concerning knee pain. Before treatment today you look through her chart from a previous bout of PT two months ago and see the therapist did not get a comprehensive PMH or note anything significant. Today, Ms. Bidoli arrives complaining of double vision and noticed R arm weakness. Upon questioning you realize that she has had these symptoms before with a full recovery, and she just had an MRI that showed two white matter lesions in the brain and large hyperintense area indicating demyelination plaque at C7. Given these findings and the lack of symptoms during her last bout of PT it is likely Ms. Bidoli has _____________ categorized as ______________.

a. NMO, primary progressive
b. multiple sclerosis, primary progressive
c. multiple sclerosis, relapsing remitting
d. multiple sclerosis, progressive relapsing
e. NMO, relapsing remitting

Back 7

a. NMO, primary progressive- incorrect. NMO does not present with brain lesions and given that she experiences periods of full recovery it would not be primary progressive
b. multiple sclerosis, primary progressive- incorrect. Given the MRI findings and clinical symptoms it is likely she has multiple sclerosis, but because she experiences periods of full recovery it is not primary progressive.
c. multiple sclerosis, relapsing remitting- CORRECT- given the MRI findings and clinical symptoms this is likely the diagnosis
d. multiple sclerosis, progressive relapsing- incorrect. given the MRI findings and clinical symptoms it is likely multiple sclerosis, but because she experiences periods of full recovery it is not progressive relapsing.
e. NMO, relapsing remitting- incorrect. NMO does not present with brain lesions, but given the periods of full recovery it is likely she relapsing/remitting

Front 8

You are on the neurologic floor of the hospital visiting your first patient, Riga Marroll, who presents with progressive multifocal leukoencephalopathy (PML). You know that PML is an infectious demyelinating disorder causing focal lesions to the white matter of the brain. Infectious can be attributed to the fact that PML is associated with a low immunity and usually caused by an invading viral component. Infectious is to PML as genetic is best associated with which of the following other demyelinating disorders?

a. Diptheria
b. Charcotte-Marie Tooth
c. Guillain Barré Syndrome
d. MS
e. Chronic Inflammatory Demyelinating

Back 8

a. Diptheria - Incorrect. Diptheria is an acute infectious disease acquired through a toxic bacteria.
b. Charcotte-Marie Tooth - CORRECT. Charcotte-Marie Tooth is known to be a hereditary motor and sensory neuropathy.
c. Guillain Barré Syndrome - Incorrect. Guillain Barré Syndrome is immune-mediated (autoimmune disease).
d. MS - Incorrect. MS is thought to be a multi-factorial disease with an unknown specific cause.
e. Chronic Inflammatory Demyelinating Polyneuropathy - Incorrect. CIDP is generally associated with an abnormal immune response.

Front 9

You are treating a 25 year old female for gait dysfunction with treadmill training. She presents with nystagmus, impaired rapid alternating movements in bilateral upper extremities, absent abdominal reflexes, lower extremity ataxia, sustained clonus, and severe extensor spasms of her left leg provoked when rising from her wheelchair. While on the treadmill you are monitoring her vitals and notice a sudden exacerbation of symptoms as her body temperature increases to 100.6 degrees. You immediately stop treatment because you know this presentation is affected by her increased body temperature and is a common complication of ____________ called _____________.

a. Multiple Sclerosis; Lhermitte’s phenomenon
b. Guillain-Barre Syndrome; fatigue
c. Multiple Sclerosis; Uhthoff’s phenomenon
d. Multiple Sclerosis; La belle indifference
e. Guillain-Barre Syndrome; epilepsy

Back 9

a. Multiple Sclerosis; Lhermitte’s phenomenon- Although this presentation is a common complication of MS, Lhermitte’s phenomenon would present with symptoms of “electric shock” and not symptom exacerbation with elevated temperature as the situation describes
b. Guillain-Barre Syndrome; fatigue- This presentation of symptom exacerbation with elevated temperatures is known as Uhthoff’s phenomenon not fatigue, and is not a common complication of GBS
c. Multiple Sclerosis; Uhthoff’s phenomenon CORRECT- Uhthoff’s phenomenon is thermal sensitivity and is a common complication of MS
d. Multiple Sclerosis; La belle indifference: Although this presentation is associated with MS La belle indifference would present with symptoms such as outward euphoria often with mixed inward depression and not symptom exacerbation with elevated temperature as the situation describes
e. Guillain-Barre Syndrome; epilepsy- This presentation of symptom exacerbation with elevated temperatures is known as Uhthoff’s phenomenon not epilepsy, and is not a common complication of GBS

Front 10

Mary Washington is a 41 year old female, presenting to you in the outpatient setting following a recent decrease in her ability to ambulate with a rolling walker. Mary has a 2 year history of primary progressive Multiple Sclerosis. Because you want to create the best treatment plan you can for Mary, you want to know what Mary’s prognosis might be, as all MS patients are different. As a UDPT student, you recall the good prognostic factors for Multiple Sclerosis include what?

a. female, onset <35 years old, short inter-exacerbation period, presenting symptom of ataxic gait
b. male, onset <35 years old, long inter-exacerbation period, presenting symptom of UE tremor
c. female, onset > 35 years old, long inter-exacerbation period, presenting symptom of optic neuritis
d. male, onset > 35 years old, short inter-exacerbation period, presenting symptom of ataxic gait
e. female, onset < 35 years old, long inter-exacerbation period, presenting symptom of optic neuritis

Back 10

a. female, onset <35 years old, short inter-exacerbation period, presenting symptom of ataxic gait: - Short inter-exacerbation periods and presenting symptoms of motor function involvement are poor prognostic factors for MS.
b. male, onset <35 years old, long inter-exacerbation period, presenting symptom of UE tremor: Being male and having involvement of the cerebellar or motor functions as presenting symptoms as shown by the UE tremor, are poor prognostic factors of MS
c. female, onset > 35 years old, long inter-exacerbation period, presenting symptom of optic neuritis- Older onset of MS at >35 years old is a poor prognostic factor for MS
d. male, onset > 35 years old, short inter-exacerbation period, presenting symptom of ataxic gait- Being male, having age of onset > 35 years old, short inter-exacerbation periods and presenting symptoms of motor origin (ataxic gait), are all poor prognostic factors for MS
e. female, onset < 35 years old, long inter-exacerbation period, presenting symptom of optic neuritis CORRECT- All of these factors are good prognostic factors for MS

Front 11

You have a good rapport with your local neurologist as you often refer patients to each other and maintain a good communication. He has recently referred Tiffany to you, a 38 year old caucasian female, whom your neurologist believes has MS. She arrives to your clinic and you note she appears to be happy and cheerful, and responds appropriately to your questions. As you ask for her subjective, she tells you she experiences increased bouts of severe fatigue, vision disturbances, and gait disturbances. You continue to question her and she eventually tells you she experiences bouts of depression, as well as bowel and bladder problems. As you observe her gait, you begin to suspect cerebellar involvement, due to which of the following observations?

a. Gait imbalance, difficulty performing coordinated actions with the arms, dysmetria, hypotonia, tremor, nystagmus
b. Bilateral facial palsy, weakness and hyporeflexia of all four extremities, diminished sensation to touch and pain
c. Inappropriate behavior, inappropriate mood, compulsive behaviors, increased muscle tone, weakness and apraxia
d. Forgetfulness, trouble reading and writing, delusions, depression, agitation, reports of getting lost on familiar routes
e. Disinhibition, unilateral leg weakness and sensory loss, gait apraxia

Back 11

a. Gait imbalance, difficulty performing coordinated actions with the arms, dysmetria, hypotonia, tremor, nystagmus - CORRECT- Patient’s with cerebellar involvement of MS likely present with these issues.
b. Bilateral facial palsy, weakness and hyporeflexia of all four extremities, diminished sensation to touch and pain - These issues are more likely to be found in peripheral nerve problems, such as GBS.
c. Inappropriate behavior, inappropriate mood, compulsive behaviors, increased muscle tone, weakness and apraxia- Although apraxia may lead you to believe cerebellar involvement, the addition of inappropriate behavior and increased muscle tone are more likely to be present with a pathology such as Pick’s disease.
d. Forgetfulness, trouble reading and writing, delusions, depression, agitation, reports of getting lost on familiar routes- These symptoms are likely associated with Alzheimer’s disease rather than MS with cerebellar involvement.
e. Disinhibition, unilateral leg weakness and sensory loss, gait apraxia- Although gait apraxia can be seen in cerebellar involvement, unilateral leg weakness and sensory loss as well as disinhibition should lead you to favor stroke, particularly ACA involvement.

Front 12

Mary, a 24 year old caucasian female, arrived at your clinic with reports of an alarming "electric shock" down her spine during a game of duck duck goose with her 1st grade class. You perform a Cranial Nerve Screen along with Upper and Lower Quarter screens. The UQS is unremarkable however LQS reveals mild deficits in strength and sensation along L4, L5 distributions on the Right, with a hyperreflexive patellar reflex on the Right. Oculomotor testing reveals nystagmus as well as decreased visual acuity of the Right eye. The patient denies urinary issues or gait disturbances and appears lucid and oriented x3. You decide to refer Mary to her neurologist.

Based on her clinical presentation you expect the neurologist to diagnose what specific disorder? What specific characteristic of the disorder would likely be revealed through what assessment technique?

a. Multiple Sclerosis; Dawson’s Fingers in a T2 FLAIR
b. Anterior Lateral Sclerosis; Dawson’s Fingers in a T2 FLAIR
c. Multiple Sclerosis; IgG Index within the CSF
d. Guillain Barre Disease; Abnormal results of nerve conduction on Nerve Conduction Test following 1 week.
e. Normal Pressure Hydrocephalus; Subependymal flow in a T1 MR

Back 12

a. Multiple Sclerosis; Dawson’s Fingers in a T2 FLAIR: CORRECT- A FLAIR is most sensitive for white matter abnormalities.
b. Anterior Lateral Sclerosis; Dawson’s Fingers in a T2 FLAIR- ALS would present in the spinal cord rather than in brain imaging.
c. Multiple Sclerosis; IgG Index within the CSF- An IgG Index is not necessarily specific to MS but general to all myelinating disorders. The test is an ancillary test for MS.
d. Guillain Barre Disease; Abnormal results of nerve conduction on Nerve Conduction Velocity Test by 1 week- Testing is correct for GBS however the disorder is not indicated by Mary’s clinical presentation of only slight strength involvements with hyperreflexia.
e.Normal Pressure Hydrocephalus; Subependymal flow in a T1 MR- Subependymal flow is a likely indicator of Normal Pressure Hydrocephalus however the patient does not report any urinary issues, nor is she displaying any cognitive or gait disturbances.

Front 13

Mr. Carl is a 75 y.o. male who presents to your rural PT clinic via direct access after having fallen several times over the past year. His wife is bringing him in now because she hurt her back while trying to get him up from the floor and wants him to stop falling. You notice when you go to bring him back from the waiting room that he has a slight tremor in his right hand that disappears when he reaches for his cane. After he stands from the chair, he has extreme difficulty initiating walking from waiting room. Upon cranial nerve screen, all ocular movements are normal. What is at the top of your differential diagnosis and what will you want to evaluate?

a. Essential Tremors - Finger to nose and heel to shin
b. Parkinson’s Disease - gait analysis and balance
c. Huntington’s disease - gait and strength
d. Progressive supranuclear palsy - Modified Ashworth scale
e. Tardive dyskinesia - ROM and strength

Back 13

a. Essential Tremors - Finger to nose and heel to shin - incorrect, essential tremors only appear when the patient is at a certain point in ROM
b. Parkinson’s Disease - gait analysis and balance - CORRECT - Patients with Parkinson’s disease present with resting tremors, freezing episode, festinating gait, rigidity, bradykinesia, etc; you would want to evaluate the patient’s gait and balance as he has had several falls
c. Huntington’s disease - gait and strength - incorrect, patient’s with Huntington’s disease present with chorea, psychiatric and behavioral dysfunction, and bradyphrenia; also, patients with Huntington’s disease are typically diagnosed between ages 40 and 60 and do not live very long
d. Progressive supranuclear palsy - Modified Ashworth scale - incorrect, PSP presents with extensor rigidity in axial muscles, extraocular movement impaired, bradykinesia, and postural instabilities
e. Tardive dyskinesia - ROM and strength -- incorrect, this is a drug-induced disorder causing movements of mouth, tongue, and muscles of mastication

Front 14

Mr. X is a 66 year old male presenting to the acute care clinic secondary to a fall while ambulating from his bedroom to his bathroom this morning. His referring physician has documented suspected Parkinson’s disease. You read this just prior to evaluating Mr. X. Which of the following would you NOT expect to observe while examining your patient?

a. Rigidity and bradykinesia
b. Alterations in righting response
c. Difficulty with visual-spatial perception
d. Progressive decrease in cadence during gait
e. Depression

Back 14

a. Rigidity and bradykinesia- incorrect, these are common signs of PD
b. Alterations in righting response- incorrect, this is a sign of PD which can lead to falls
c. Difficulty with visual-spatial perception- incorrect, this is a sign of PD
d. Progressive decrease in cadence during gait - Correct - Patient’s with PD tend to demonstrate an increase in cadence while walking, which combined with a forward flexed posture and festinating gait, often leads to falls.
e. Depression- incorrect, this is a potential symptom of PD

Front 15

Mr. Carba is an 82 year old gentleman whom you are seeing in your outpatient orthopedic clinic for right hip pain following a fall one week ago. When reviewing his medications, prior to seeing your patient, you notice that he has been taking L-dopa for 15 years due to his diagnosis of Parkinson’s disease. Being a wonderful patient who would like to be conscientious of the medication he is taking, he asks you what side effects he might expect from taking L-dopa. You explain to him some of the many side effects L-dopa can have on a patient following extended periods of time of use. Which of the following would NOT be a potential side effect he could experience?

a. nausea and vomiting
b. confusion and hallucinations
c. anorexia and insomnia
d. dyskinesias
e. urinary incontinence

Back 15

a. nausea and vomiting- incorrect, this is a common side effect of L-dopa
b. confusion and hallucinations- incorrect, this is a potential side effect of L-dopa
c. anorexia and insomnia- incorrect, this is a common side effect of L-dopa
d. dyskinesias- incorrect, this is a common side effect of long term use of L-dopa
e. urinary incontinence- Correct -This may be seen in elderly patients with UTI and NPH, but is not a common side effect for PD medications.

Ok, good question… but one side effect from l-dopa is increased incidence of UTI which may indirectly cause the incontinence. Just something to think about.

Front 16

Mr Blue Hen is a 68 year old male who presents to the NOA clinic for an evaluation. He complains of blurred vision, constipation, and urinary retention. During your Mini Mental State examination, he shows signs of memory impairment, cognitive deterioration and confusion. His wife, who is a nurse at Christiana Hospital, suggests that she has been noticing signs of delirium and hallucinations at home. You decide to review his list of medications and realize that these signs and symptoms can be side effects for ALL of the following medications EXCEPT____.

a. Anticholinergics
b. Antidepressants
c. Antipsychotics
d. Benzodiazepines
e. Statins – these can give all of those side effects but are just less likely to do so… I’ll modify the question.

Back 16

a. Anticholinergics – Incorrect; this medication can cause blurred vision, constipation, urinary retention, memory impairment, cognitive deterioration, confusion, delirium, hallucinations
b. Antidepressants- Incorrect; this medication can cause blurred vision, constipation, urinary retention, memory impairment, cognitive deterioration, confusion, delirium, hallucinations
c. Antihistamines - Incorrect; this medication can cause blurred vision, constipation, urinary retention, memory impairment, cognitive deterioration, confusion, delirium, hallucinations
d. Benzodiazepines - Incorrect: this medication can cause blurred vision, constipation, urinary retention, memory impairment, cognitive deterioration, confusion, delirium, hallucinations
e. Statins – CORRECT-These blood pressure control medications have side effects associated with myalgias, muscle cramps and gastrointestinal problems.

Front 17

You are working as an early post-grad PT in an acute care hospital when a 40 y/o female patient is added to your schedule. You scan her chart before entering the room and see that she has Huntington’s Disease (HD), which was diagnosed when she was 28 y/o. All of the following are characteristics of HD that would apply to this patient, except:

a. Genetic testing revealing a long CAG repeat length
b. Chorea
c. Parkinsonian rigidity
d. Repetitive spontaneous movements
e. Bradyphrenia

Back 17

a. Genetic testing revealing a long CAG repeat length - INCORRECT; This patient had an early onset of HD, which is correlated with a longer CAG length
b. Chorea - INCORRECT; This is a characteristic of HD
c. Parkinsonian rigidity - INCORRECT; This is a characteristic of HD
d. Repetitive spontaneous movements - CORRECT; People with HD tend to exhibit non-repetitive, randomly distributed, spontaneous movements - not repetitive movements
e. Bradyphrenia - INCORRECT; This is a characteristics of HD

Front 18

You are treating a 58-year-old patient with schizophrenia who has been taking
chlorpromazine (Thorazine), a dopamine antagonist. You notice that he has begun to present with involuntary muscle contractions and spasms, slow and twisting in nature, primarily affecting his head and neck. His doctor informed him that these movements may be a side-effect of his medication, but your patient was so embarrassed that he stopped taking them. To his dismay, his symptoms continued and even seemed to worsen. Your patient is likely experiencing the following:

a. Blepharospasm
b. Progressive Supranuclear Palsy
c. Tardive Dystonia
d. Spasmodic Torticollis
e. Essential Tremors

Back 18

a. Blepharospasm - this is a condition where there is sustained, forced, involuntary closing of the eyelids
b. Progressive Supranuclear Palsy - while this is a movement disorder that can result in changes in facial expression, it generally occurs from damage to certain nerve cells in the brain, not from withdrawing from medication
c. Tardive Dystonia - CORRECT - this is a drug-induced secondary dystonia that presents after exposure to dopamine receptor blocking agents. It typically does not present immediately after the introduction of the drug, but rather, later and either continued or worsened after the drug's removal. It is characterized by involuntary muscle contractions, awkward postures, and contorted body movements that can be both painful and embarrassing.
d. Spasmodic Torticollis - AKA - Cervical Dystonia, this neurological disorder does affect the head and neck, but results in the head to be pulled either sideways, downwards or backwards
e. Essential Tremors - results in tremors, usually in the extremities that are most apparent with voluntary movement

Front 19

You are treating 10-year-old Jack Kub in an outpatient PT setting for a recent Grade II left lateral ankle sprain sustained during a soccer game. After evaluating Jack on the first day, you notice that he is a very eccentric child. He constantly makes facial grimaces, jerks his head, and clears his throat. He also becomes preoccupied with what seem like small details, such as counting tiles on the ceiling when he is supposed to be performing his exercises. His mother mentions that his teachers have been pushing her to get him evaluated as they suspect that he may have ADHD. You decide that Jack should be referred to a local pediatric neurologist, because he may have:

a. Huntington’s Disease
b. Torticollis Syndrome
c. Tourette’s Syndrome
d. Obsessive-compulsive personality disorder
e. Seizure disorder

Back 19

a. Huntington’s Disease - Childhood forms rarely appear for HD and would present differently with possible dystonia, parkinsonian rigidity, postural instability, bradykinesia, bradyphrenia, attention and sequencing impairments, impaired recent and remote memories, etc.
b. Torticollis Syndrome - Torticollis is lateral rotation of the head due to muscle spasm.
c. Tourette’s Syndrome: CORRECT - Typical onset of Tourette’s is 5 to 20 years, most often affecting males. These patients often present with motor, vocal, and phonic tics (noises from mouth, throat, and nose). Greater than 50% of these patients may also have OCD and/or ADHD.
d. Obsessive-compulsive personality disorder - Although this patient presents with some OCD-like symptoms, children under the age of 15 are not typically diagnosed with personality disorders. Plus, there are additional signs described above that would not be covered solely by the diagnosis of OCD. I think you meant to put OCPD.
e. Seizure disorder - (aka epilepsy) caused by excessive, abnormal, synchronous
discharges of neurons (usually in the cerebral cortex) and may present in a variety of ways, which may range from simply staring “blankly for a few seconds during a seizure” to having “full-fledged convulsions”

Front 20

You are working at Wilmington Hospital with a 45-year-old male patient presenting with uncontrolled dyskinesias of the arms and legs, as well as progressive difficulties with eating. The patient also reports a family history of Huntington’s disease. You remember that with Huntington’s disease, you will often see “box car” ventricles on the radiograph and remember that this is due to the fact that this disease often causes atrophy of the _________ first, due to progressive degeneration of _________.

a. internal capsule - NMDA receptors
b. head of the caudate - GABAergic neurons
c. head of the caudate - NMDA receptors
d. tail of the caudate - GABAergic neurons
e. putamen - GABAergic neurons

Back 20

a. internal capsule - NMDA receptors: incorrect - Huntington’s disease affects the head of the caudate primarily and causes degeneration of the GABAergic neurons. Due to the close proximity of the caudate to the ventricles, atrophy creates this “box car” appearance.
b. head of the caudate - GABAergic neurons: CORRECT - Huntington’s disease affects the head of the caudate primarily and causes degeneration of the GABAergic neurons. Due to the close proximity of the caudate to the ventricles, atrophy creates this “box car” appearance.
c. head of the caudate - NMDA receptors: incorrect - Although the head of the caudate is affected primarily with Huntington’s disease, the GABAergic neurons are affected, not the NMDA receptors
d. tail of the caudate - GABAergic neurons: incorrect - Although GABAergic neurons are affected in Huntington’s disease, the head of the caudate is primarily affected, not the tail.
e. putamen - GABAergic neurons: incorrect - Although GABAergic neurons are affected in Huntington’s disease, the head of the caudate is primarily affected before the putamen.

Front 21

Question 1

Bob Dole is a 60 year old male you are treating in an outpatient clinic for carpal tunnel syndrome. During the subjective portion of today’s treatment, he reports recently tripping over both of his feet and doesn’t know why. You perform a lower quarter screen and find: 3+/5 strength in his great toe extension and 4/5 strength in dorsiflexion bilaterally, absent patellar tendon and Achilles reflexes, and diminished vibration sense in his left foot. Thinking back to your Neurology class, you faintly remember Fred saying something about quickly progressing distal to proximal LE weakness. What is the correct diagnosis and course of action?

a. Guillain-Barre Syndrome; instruct patient to schedule an appointment with primary care physician in next few weeks
b. Multiple Sclerosis; instruct patient to schedule an appointment with primary care physician in next few weeks
c. Guillain-Barre Syndrome; send patient directly to emergency room and make sure they ventilate him immediately
d. Multiple Sclerosis; send patient directly to emergency room and make sure they ventilate him immediately
e. Guillain-Barre Syndrome; instruct patient to schedule appointment for an EMG to confirm your suspicions

Back 21

a. Guillain-Barre Syndrome; instruct patient to schedule an appointment with primary care physician in next few weeks - You have correctly identified the pathology, but GBS can quickly affect the respiratory muscles and appropriate actions to prepare for this need to be taken immediately
b. Multiple Sclerosis; instruct patient to schedule an appointment with primary care physician in next few weeks - MS typically presents in middle aged females and would likely include visual deficits
c. Guillain-Barre Syndrome; send patient directly to emergency room and make sure they ventilate him immediately - CORRECT - GBS can affect the respiratory muscles and therefore immediate precautionary actions need to be taken
d. Multiple Sclerosis; send patient directly to emergency room and make sure they ventilate him immediately - MS typically presents in middle aged females and would likely include visual deficits
e. Guillain-Barre Syndrome; instruct patient to schedule appointment for an EMG to confirm your suspicions - You have correctly identified the pathology and a positive EMG would likely be seen 2-3 weeks after onset of symptoms, but the potential for respiratory dysfunction is your primary concern currently


Before you would think GBS, in this clinical scenario, you would first think of acute herniated disc. In order to cinch the diagnosis you really need to describe the progression to severe weakness and then respiratory involvement. You would send the patient to the ER if there is acute severe weakness… that part is true… but the clinical pathway is very different. Acute herniation causing weakness goes to neurosurgery… GBS gets an EMG, IVIg, ICU, etc. Also, a patient with GBS is only ventiliated if there is respiratory involvement. You’re not describing SOB or hypoxia in this patient. I’ll revise the question accordingly… But I’m glad to be faintly remembered.

Front 22

Hulk Hogan is a 63 year old male you are treating in an inpatient rehabilitation facility. He developed symptoms consistent with Guillain-Barre Syndrome two weeks ago and EMG studies found positive sharp waves indicating nerve degeneration in his lower extremities. Your CI asks you to explain your reasoning concerning specific interventions for this patient. Which of the following is not an appropriate intervention and reasoning to use for this patient?
a. TENS for short term pain relief only
b. Respiratory therapy to combat dysphagia and facilitate airway clearance
c. Strengthening exercise to hasten the rate of nerve regeneration
d. Repositioning and stretching to prevent decubitus ulcers and contractures
e. Exercise to increase respiratory capacity and maximize function

Back 22

a. TENS for short term pain relief only - Pain is a common complaint in patients with GBS
b. Respiratory therapy to combat dysphagia and facilitate airway clearance - GBS can affect the diaphragm, therefore, respiratory therapy is important in managing a patient with GBS.
c. Strengthening exercise to hasten the rate of nerve regeneration - CORRECT - While exercise will help to maximize their function, it will not influence the rate of nerve regeneration.
d. Repositioning and stretching to prevent decubitus ulcers and contractures - Skin integrity and contractures are common concerns with immobile patients, even if they are only immobile for a few hours.
e. Exercise to increase respiratory capacity and maximize function - Exercise is helpful in maintaining the patient’s musculoskeletal system in a ready state.

Front 23

You are working in an acute care hospital with 44 year old Mr. Jones, originally hospitalized for acute appendicitis and experienced a severe upper respiratory infection post-operatively. During treatment you notice Mr. Jones has a lot of difficulty walking. You question him about his condition and he tells you he felt weakness in his feet and ankles beginning two weeks ago. But recently he feels as if his calves and thighs are also weak and feel like they’re going to give out. He was getting concerned and asked if he would be able to walk normally again. What is his probable long term prognosis and what treatments should he be started on?

a. He will eventually need a wheelchair; Plasma exchange
b. He will eventually need a wheelchair; Interferon
c. He will be able to walk again; Plasma exchange
d. He will be able to walk again; Interferon
e. These symptoms will worsen gradually over time; surgery

Back 23

a. He will eventually need a wheelchair; Plasma exchange - Prognosis is for MS and treatment is for GBS
b. He will eventually need a wheelchair; Interferon - Prognosis is for MS and treatment is for GBS
c. He will be able to walk again; Plasma exchange - CORRECT - Prognosis and treatment are both for GBS
d. He will be able to walk again; Interferon - Prognosis is for GBS but treatment is for MS
e. These symptoms will worsen gradually over time; surgery - Prognosis is for MS and treatment is for neither

You should say, Mr. Jones eventually progressed to full blow GBS… or at least describe progression to diaphragm involvement.

Front 24

Today you are performing an evaluation on Mr. Carrie, a 46 year old male who has recovered from Guillain-Barre Syndrome with a slow onset one month ago. He reports experiencing progressive muscle weakness for two weeks before his strength slowly started returning. At the conclusion of your PT session, Mr. Carrie asks you how Guillain-Barre Syndrome works and what his prognosis might be. Which of the following explanations (in medical language) is correct?

a. Macrophages invade oligodendrocyte basal lamina, leading to demyelination of mostly distal portions of the nerve; patient shows good prognosis due to his slow onset and rapid plateau of symptoms
b. Macrophages invade Schwann cell basal lamina, leading to demyelination of mostly proximal portions of the nerve; patient shows good prognosis due to his slow onset and rapid plateau of symptoms
c. Macrophages invade oligodendrocyte basal lamina, leading to demyelination of mostly distal portions of the nerve; patient shows poor prognosis due to his slow onset and rapid plateau of symptoms
d. Macrophages invade Schwann cell basal lamina, leading to demyelination of mostly proximal portions of the nerve; patient shows poor prognosis due to his slow onset and rapid plateau of symptoms
e. Macrophages invade Schwann cell basal lamina, leading to demyelination of mostly proximal portions of the nerve; patient will likely require respiratory aide

Back 24

a. Macrophages invade oligodendrocyte basal lamina, leading to demyelination of mostly distal portions of the nerve; patient shows good prognosis due to his slow onset and rapid plateau of symptoms - Oligodendrocytes are in the central nervous system only and the proximal portions of the nerve are most affected
b. Macrophages invade Schwann cell basal lamina, leading to demyelination of mostly proximal portions of the nerve; patient shows good prognosis due to his slow onset and rapid plateau of symptoms - CORRECT - poor prognosis is associated with rapid onset and failure to show plateau of symptoms/improvements within 3 weeks
c. Macrophages invade oligodendrocyte basal lamina, leading to demyelination of mostly distal portions of the nerve; patient shows poor prognosis due to his slow onset and rapid plateau of symptoms - Oligodendrocytes are exclusively located in the central nervous system and are not affected by GBS and his plateau in symptoms within 3 weeks of onset is encouraging rather than discouraging
d. Macrophages invade Schwann cell basal lamina, leading to demyelination of mostly proximal portions of the nerve; patient shows poor prognosis due to his slow onset and rapid plateau of symptoms - his plateau in symptoms within 3 weeks is indicative of a good rather than poor prognosis
e. Macrophages invade Schwann cell basal lamina, leading to demyelination of mostly proximal portions of the nerve; patient will likely require respiratory aide - Mr. Carrie’s presentation is indicative of a good prognosis, whereas a respiratory aide is indicative of a poor outcome

Front 25

You are working in a facility that has physical therapy and wellness, catering specifically to Alzheimer’s patients and their families. You are seeing Mr. Forgetmenot, a 72 year old male for what his wife and caregiver describe as “atypical behavior”. Ten years ago his wife noticed he had become forgetful and generally surly, and had an attitude due to his difficulty understanding things he previously had been adept at, such as operating the microwave. He was diagnosed with Alzheimer’s disease and started on some “Alzheimer’s pills” shortly after his diagnosis. His wife noticed that his memory and mood seemed to improve and that his ability to use household items had improved. She reports that he has recently been having difficulty again with things that he has had no trouble with since he “started on the pills,” and that his short term memory has been rapidly degenerating. Upon further questioning, you find that a few months ago, he was assigned a new primary care physician, who discontinued one of his medications. Discontinuation of which of the following medications would explain Mr. Forgetmenot’s current relapse?

a. Lisonopril
b. Atenolol
c. Ciprofloxacin
d. Namenda
e. Levosalbutemol

Back 25

a. Lisonopril –This is a drug used to decrease blood pressure. Discontinuation of this drug would likely not result in any cognition changes or memory loss, albeit without causing a stroke.
b. Atenolol –This drug is a beta blocker, and is generally used in conjunction with a ‘pressor’ drug. This blunts the heart rate response to exercise, and would likely not cause any changes in cognition or memory loss, albeit without having caused a myocardial infarction.
c. Ciprofloxacin –This drug is a fluoroquinolone, generally used to treat infections. Discontinuation of this drug would probably not directly cause memory loss or cognition changes, although it may indirectly, if the infection being treated were not completely eliminated. We would likely see fever, irritation, personality changes before we were to see cognition and memory changes.
d. Namenda – CORRECT This drug is used to treat alzheimers, as it promotes learning and memory. Discontinuation of this drug would likely cause the relapse symptoms his wife and caregiver is describing.
e. Levosalbutemol –This drug is a beta 2 adrenergic agonist, acting on the lungs to relax smooth muscle and cause bronchodilation. Discontinuation of this drug would probably not cause memory loss or cognition changes, albeit in a state of hypoxemia. We would likely see shortness of breath and lightheadedness first.

Front 26

Mr. Kreutzfeldt is a 60-year-old male who comes to your clinic with a history of syncope and
recent falls. You notice he is walking with a slow, shuffling gait, and while taking his history, he seems to almost fall asleep. He has no resting tremor and his memory seems intact. Later, he mentioned seeing a strange dog in his house from time to time. When you talk to his wife, she informs you that he’s been talking about the dog for several weeks, but that there hasn’t been a dog in their house. She also tells you that he has been moving around a lot in his sleep recently and he’s had trouble multitasking, which was never a problem before. His MRI reveals marked atrophy of the putamen and midbrain, substantia innominata, and hypothalamus. You suspect Mr. Kreutzfeldt is suffering from:

A. Parkinson’s disease
B. Lewy body dementia
C. Alzheimer’s disease
D. Fronto temporal dementia
E. Systemic Lupus Erythematosus

Back 26

A. Parkinson’s disease – Although his gait is indicative of Parkinson’s, he has no resting
tremors.
B. Lewy body dementia - CORRECT - This disease is more prominent in men, and one the
hallmark symptom is hallucinations. He is also exhibiting a Parkinsonian gait without resting
tremor, history of falls, preserved memory, fluctuations in consciousness, difficulty multitasking,
and symptoms of REM behavior disorder. Additionally, his MRI findings are symptomtic of LD
and help to exclude AD as the cause of his dementia.
C. Alzheimer’s disease - He is not having problems with his memory or behavioral disturbances,
he is having hallucinations.
D. Fronto-temporal dementia - although he does have a Parkinsonian gait, the typical onset for
FTD is 30-50 years old. Also, he is not exhibiting personality changes, decreased attention to
hygiene, suspicion of others, or pack-rat-type behavior.
E. Systemic Lupus Erythematosus - While Lupus may mimic a lot of these symptoms for various
reasons, his symptoms seem to be mostly neurologic in nature. Generally, Lupus has effects
on multiple systems, including, but not limited to, the dermis (including the classic butterfly
rash), the lungs, the GI tract, hair loss. There just aren’t enough of the signs/symptoms here to
make one think definitively lupus.

Front 27

You are evaluating Mr. Perfectsquare, a 49 year old male, in an outpatient physical therapy
clinic for balance deficits as he recently fell. You notice his gait is short and shuffling and he hesitates with starting and turning. Mr. Perfectsquare claims that nothing is wrong with him; however, his wife tells you privately that he has been accusing her of stealing money from him and has begun stashing
money in his pillow case, has stopped brushing his hair and teeth as much, and has been
irritable and short with their children, ages 1, 4, and 9. You ask if he has always walked with
short shuffling steps, and she tells you this is also new. You ask about his memory and she tells
you his memory has been unaffected, as far as she can tell. He had a nearly perfect score on
the MMSE. You suspect Mr. Perfectsquare is affected by which of the following?

A. Parkinson’s disease
B. Lewy body dementia
C. Alzheimer’s disease
D. Fronto temporal dementia
E. Systemic Lupus Erythematosus

Back 27

A. Parkinson’s disease –While his gait suggests parkinson’s disease, he does not demonstrate
any resting tremors, nor does he demonstrate any memory issues. Also, his decreased
attention to hygiene is not characteristic of Parkinson’s, and Parkinson’s generally does not
onset this early(although it can) in most patients.
B. Lewy body dementia– Many of his symptoms make sense for lewy body dementia, such
as parkinsonian gait without resting tremor, falls, relatively preserved memory, and it is more
prominent in men. However, one of the hallmarks of lewy body dementia are hallucinations.
Additionally, autonomic dysfunction is common in lewy body dementia, and we have no
evidence of that happening in this patient.
C. Alzheimer’s disease – While his personality changes may be characteristic of alzheimer’s
disease, and his recent inattention to hygiene may be explained by alzheimer’s. However, his
memory seems to be fully intact.
D. Fronto-temporal dementia – CORRECT – these symptoms: suspicion of others, squirreling
things away, decreased attention to hygiene, personality changes(especially as evidenced
by social interactions), parkinsonian gait, and no apparent memory or cognition changes are
characteristic of fronto-temporal dementia. Additionally, it typically onsets between 30 and 50
years old.
E. Systemic Lupus Erythematosus – While lupus may mimic a lot of these symptoms for various
reasons, his symptoms seem to be mostly neurologic in nature. Generally, lupus has effects on
multiple systems, including, but not limited to, the dermis (including the classic butterfly rash),
the lungs, the GI tract, hair loss. There just aren’t enough of the signs/symptoms here to make
one think definitively lupus.

Front 28

Mr. Brooks is a 67 year old male who came to your clinic for Left hip OA and has Alzheimer’s Dementia. As a PT, you know there is no way to stop or reverse the process; however, it can be managed with _____________ inhibitors, which may reduce behavioral dyscontrol and produce modest, transient improvements in memory and cognition. An example of one of these medications is __________________.

A. NMDA, Donepezil
B. Cholinesterase, Galantamine
C. NMDA, Rivastigmine
D. Cholinesterase, Memantine
E. NMDA, Memantine

Back 28

a. NMDA, Donepezil - Cholinesterase inhibitors may reduce behavioral dyscontrol and produce
modest, transient improvements in memory and cognition. Donepezil, Galantamine and
Rivastigmine are all examples of this medication.
b. Cholinesterase, Galantamine- CORRECT- Cholinesterase inhibitors may reduce behavioral
dyscontrol and produce modest, transient improvements in memory and cognition. Donepezil,
Galantamine and Rivastigmine are all examples of this medication.
c. NMDA, Rivastigmine- Cholinesterase inhibitors may reduce behavioral dyscontrol and produce
modest, transient improvements in memory and cognition. Donepezil, Galantamine and
Rivastigmine are all examples of this medication.
d. Cholinesterase, Memantine- Cholinesterase inhibitors may reduce behavioral dyscontrol and
produce modest, transient improvements in memory and cognition. Memantine deals with
NMDA receptors.
e. NMDA, Memantine- Cholinesterase inhibitors may reduce behavioral dyscontrol and produce
modest, transient improvements in memory and cognition. Donepezil, Galantamine and
Rivastigmine are all examples of this medication.

Front 29

You are treating at the ELC (pediatric setting) and working with a 3 y/o boy, Mark, who has been diagnosed with CP. You have not received any other information regarding his condition. You remember children with CP present with all of the following EXCEPT:

a. Epilepsy
b. Faster than normal growth
c. Chronic constipation
d. Aphasia
e. Amblyopia

Back 29

a. Epilepsy- occurs in ⅓-1/2 of patients and is more common in spastic quadriplegia and acquired hemiplegia
b. Faster than normal growth- CORRECT- children with CP have growth failure not increased growth.
c. Chronic constipation- Children with CP can present with GI abnormalities swallowing disorders, chronic constipation, regurgitation, chronic aspiration, abdominal pain, and reflux
d. Aphasia- children with CP may have speech and language impairments such as aphasia, dysarthria, hearing impairments, and abnormal function of oropharyngeal muscles
e. Amblyopia- visual disorders are common in children with CP; common disorders include amblyopia, low visual acuity, and visual field defects

Front 30

You are treating in a pediatric school setting and working with a 4 y/o female, Hannah, diagnosed with CP at childbirth for the past 4 weeks. You have been working on ambulation with a head array but in the process you notice she is having difficulty controlling her saliva. When her mother comes in to pick up Hannah you counsel her on the treatment options for her excessive drooling. All of the following are treatment strategies for excessive drooling EXCEPT:

a. Glycopyrrolate
b. Biofeedback
c. Scopolamine
d. Repositioning sublingual gland
e. Unilateral ligation of a parotid duct

Back 30

a. Glycopyrrolate-this is an anticholinergic that is used to treat excessive drooling, other medications used to treat this are Artane, Scopolamine, and botulinum toxin A
b. Biofeedback- biofeedback and behavior modification can be used to make swallowing a conscious action
c. Scopolamine- this is an anticholinergic that is used to treat excessive drooling, other medications used to treat this are Artane, Glycopyrrolate, and botulinum toxin A
d. Repositioning sublingual gland-CORRECT- A treatment to correct excessive drooling in CP is repositioning of the submandibular duct, not the sublingual gland
e. Unilateral ligation of a parotid duct- unilateral ligation of a parotid duct is a surgical intervention to treat excessive drooling. Side effects include dry mouth, difficulty swallowing, and changes in consistency of oral secretions

Front 31

You are working in a pediatric clinic and Little Squirt, a 6 month old male, presents with poor head balance. No matter what you do, he cannot keep his head upright for more than a few seconds. He demonstrates ability to maintain focus, based on his ability to follow your gaze for extended periods of time. You know that poor prognosis for walking is correlated with all of the following EXCEPT:

a. If head balance/control not achieved by 20 months
b. Postural reactions not achieved by 24 months
c. Crawling not achieved by 5 years
d. Primitive reflexes (Babinski, moro, Hoffman reflexes) retained
e. If he can sit by 2 years and crawl before 30 months of age

Back 31

a. If head balance/control not achieved by 20 months- Prognosis for walking poor if head balance not achieved by 20 months
b. Postural reactions not achieved by 24 months-Prognosis for walking poor if postural reactions not achieved by 24 months
c. Crawling not achieved by 5 years- Prognosis for walking poor if crawling not achieved by 5 years
d. Primitive reflexes (Babinski, moro, Hoffman reflexes) retained- Prognosis for walking poor if Primitive reflexes (Babinski, moro, Hoffman reflexes) retained
e. If he can sit by 2 years and crawl before 30 months of age- CORRECT- This is a good prognosis for motor function

Front 32

You are working in the NOA clinic and you have an initial evaluation with Sarah, a 30 y/o female with Myasthenia Gravis. She is 4 months pregnant and feels her symptoms have gotten worse and is coming to PT in hopes some of her symptoms can be managed. She could present with all of the following symptoms EXCEPT:

a. Difficulty chewing
b. Abnormal reflexes & sensory exam
c. Axial muscle weakness > neck flexors
d. Ptosis
e. Diplopia

Back 32

a. Difficulty chewing- This is a potential symptom of Myasthenia Gravis.
b. Abnormal reflexes & sensory exam- CORRECT- A person with Myasthenia gravis will have normal reflexes and sensory exam.
c. Axial muscle weakness > neck flexors-This is a potential symptom of Myasthenia Gravis.
d. Ptosis -This is a potential symptom of Myasthenia Gravis.
e. Diplopia -This is a potential symptom of Myasthenia Gravis.

Front 33

You are to perform a PT consult for a 67-year-old gentleman, Mr. Fellows, at YouDee Hospital. Prior to reviewing his chart, you speak with a nurse who is familiar with his case to get a quick synopsis of his hospital course. She mentions he has been extremely weak and bedridden for the last several days with terminal brain cancer, among other issues. The most common cause of a brain malignancy is _______.

a. Meningioma
b. Glioblastoma multiforme (GBM)
c. Brain Abscess
d. Pituitary adenoma
e. Metastatic disease

Back 33

a. Meningioma - incorrect; accounts for about 24% of primary brain tumors; typically benign
b. Glioblastoma multiforme (GBM) - incorrect; accounts for about 23% of adult brain tumors; typically malignant
c. Brain Abscess - incorrect; this is a mass infection within the brain parenchyma, most commonly resulting from bacteria
d. Pituitary adenoma - incorrect; this is a non-cancerous tumor that occurs in the pituitary gland
e. Metastatic disease - CORRECT; secondary tumors typically spread to the brain through the arterial circulation from a primary systemic cancer site elsewhere in the body in 20-30% of people with systemic cancer; most commonly affects the frontal lobe

Front 34

You are working in acute care with a 55 year old female status post brain tumor resection. The chart does not say whether the tumor is a primary or secondary tumor. However, you remember that most brain tumors are secondary. You suspect metastasis from another area of the body, which of the following would be the LEAST LIKELY types of cancer to appear on her PMH?

a. lungs
b. breast
c. kidney
d. melanoma
e. gynecologic

Back 34

a. lungs - incorrect; you would expect to see PMH of lung cancer because the most common sources of metastatic brain tumors are lungs, breast, kidneys, and melanoma.
b. breast - incorrect; you would expect to see PMH of breast cancer because the most common sources of metastatic brain tumors are lungs, breast, kidneys, and melanoma.
c. kidney - incorrect; you would expect to see PMH of kidney cancer because the most common sources of metastatic brain tumors are lungs, breast, kidneys, and melanoma.
d. melanoma - incorrect; you would expect to see PMH of melanoma because the most common sources of metastatic brain tumors are lungs, breast, kidneys, and melanoma.
e. gynecologic - CORRECT; You would NOT expect to see a PMH of liver cancer because it is not a common source of metastatic brain cancer. Tumors of this origin RARELY cause metastases to the brain in only 1-10% of cases. The common sources of metastatic brain cancer are: lung, breast, kidney, and melanoma.

Front 35

You are treating a patient in the acute care setting, and after performing a chart review, you see that he has been diagnosed with HIV. As a well-educated UDPT student, you know that all of the following can develop in a patient with HIV, except:

a. Headache
b. Seizures
c. Pseudohypertrophy in calves
d. Impaired cognitive function
e. Focal neurological signs and symptoms

Back 35

a. Headache - incorrect; this is a clinical symptom of HIV
b. Seizures - incorrect; this is a clinical symptom of HIV
c. Pseudohypertrophy - CORRECT; this is a clinical symptom of Duchenne Muscular Dystrophy
d. Impaired cognitive function -incorrect; this is a clinical symptom of HIV
e. Focal neurological signs and symptoms -incorrect; this is a clinical symptom of HIV

Front 36

Your patient presents with confusion, decreased responsiveness and arousal, irritability, and slow thought processing. His imaging shows that he has developed a brain abscess. Based on the most common origin of a brain abscess, you know that all of the following will put a patient at an increased risk of developing a brain abscess, EXCEPT:

a. AVM in the lungs
b. Currently receiving chemotherapy treatment for cancer
c. Corticosteroid use
d. Congenital heart defect
e. Family history of an abscess

Back 36

a. AVM in the lungs - incorrect - A pulmonary arteriovenous malformation allows infections to reach the brain from the intestines, teeth, or other body areas
b. Currently receiving chemotherapy treatment for cancer - incorrect - chemotherapy can also suppress the immune system, which can increase the risk of developing a brain abscess
c. Corticosteroid use - incorrect - these drugs suppress the immune system, which can increase the risk of developing a brain abscess
d. Congenital heart defect - incorrect - heart defects, such as right-to-left heart shunts, allow infections to reach the brain from the intestines, teeth, or other body areas
e. Family history of an abscess - CORRECT - This will not necessarily increase risk of developing a brain abscess

Front 37

You are treating a 23 year old male, Zason Jhao, who is 1 year status post onset of traumatic brain injury secondary to a motor vehicle accident. He was discharged from rehab 6 months ago and has been attending outpatient PT at your neuro outpatient clinic. His mom is his primary caregiver and she tells you that her son has had seizures that cause impairments of consciousness and motor symptoms on both sides of his body. She wants to know why the doctor has prescribed her son valproic acid and what side effects or risk factors she should know about. You could tell her:


a. Your son most likely has generalized epilepsy, which is the most common type of epilepsy. Patients with traumatic brain injuries are at a higher risk for development of seizures and valproic acid is prescribed to help treat generalized seizures.
b. Your son most likely has generalized epilepsy and valproic acid is prescribed to treat the epilepsy. This drug is processed by the liver. Your son should avoid alcohol and/or tylenol consumption while taking this drug as both alcohol and tylenol are processed by the liver. Taking all those substances could cause fatal liver toxicity.
c. Your son most likely has partial epilepsy, which is responsible for his motor seizures. Valproic acid is a medication prescribed to treat partial epilepsy. Make sure that your son only takes the proper dose, as taking too much of this medication could cause liver toxicity.
d. Your son most likely has partial epilepsy, the most common type of epilepsy. Your MD may want him to consider a high protein and carbohydrate diet to help suppress his seizure frequency.
e. Your son most likely has generalized epilepsy and valproic acid is prescribed to treat the epilepsy. One of the side effects of this drug is decreased white blood count, so your doctor will most likely be tracking your son’s white blood cell count.

Back 37

a. Your son most likely has generalized epilepsy, which is the most common type of epilepsy. Patients with traumatic brain injuries are at a higher risk for development of seizures and valproic acid is prescribed to treat generalized seizures - Partial seizures are the most common type of epilepsy. The rest is true.
b. Your son most likely has generalized epilepsy and valproic acid is prescribed to treat the epilepsy. This drug is processed by the liver. Your son should avoid alcohol and/or tylenol consumption while taking this drug as both alcohol and tylenol are processed by the liver. Taking all those substances could cause fatal liver toxicity – CORRECT - Generalized epilepsy is generally treated with Valproic acid. Valproic acid is processed by the liver and patient is at risk for developing fatal hepatotoxicity, as tylenol and alcohol are also processed by the liver, patient should avoid consumption of these substances.
c. Your son most likely has partial epilepsy, which is responsible for his motor seizures. Valproic acid is a medication prescribed to treat partial epilepsy. Make sure that your son only takes the proper dose, as taking too much of this medication could cause liver toxicity - Valproic acid is prescribed for generalized epilepsy.
d. Your son most likely has partial epilepsy, the most common type of epilepsy. Your MD may want him to consider a high protein and carbohydrate diet to help suppress his seizure frequency - Valproic acid is prescribed for generalized epilepsy. The ketogenic diet associated with suppression of seizures in some patients involves 3-4 parts fat to one part protein and carbohydrate.
e. Your son most likely has generalized epilepsy and valproic acid is prescribed to treat the epilepsy. One of the side effects of this drug is decreased white blood count, so your doctor will most likely be tracking your son’s white blood cell count - Decreased white blood cell count associated with Carbamazepine.


I did a little more research and actually, Valproic acid can also be used for partial seizures… in fact, now a days, mostly its used for that indication. This is not your fault. Learning these anti-seizure medications is a moving target and I taught off of what Dr. Hooker used. I will modify the question accordingly. This is a well written question. Good job.

Front 38

You are currently treating Mary Christy Mas, a 46 year old female teacher with low back pain. You are having trouble getting a good subjective from her as she seems to have selective attention, and only pays attention to certain subjective questions. She often responds, “I don’t know,” to your questions with regards to her back pain. On the fourth visit you become concerned because you have not been able to change her low back pain and you have noted significant memory deficits. You decide to refer her to a neurologist because you suspect an underlying neurological disorder that is grossly affecting your ability to treat her low back pain. However, basic neurological exam and MRI comes back normal. What do you suspect may be leading to your patient’s selective attention and long term verbal memory deficits?

a. NPH
b. Frontotemporal Dementia
c. Depression
d. Bilateral Temporal Lobe Contusion
e. Wernicke-Korsakoff

Back 38

a. NPH - you would likely notice a gait disturbance and patient report of urinary incontinence as disinhibited urinary detrusor reflex is associated with NPH (As an educated UDPT alumni you know you should always ask your low back patients if they have bowel or bladder changes!) The MRI may also have enlarged ventricles.
b. Frontotemporal Dementia - While she fits the typical age range, you would likely see more inappropriate behaviors, emotional blunting, decreased personal hygiene, speech and language impairments, trouble making decisions, etc, and less problems with memory (still, patients have issues with memory).
c. Depression – CORRECT - depression can cause problems with selective attention, working memory, verbal long term memory, and verbal fluency. Patients often say “I don’t know,” and basic neurological exam is often normal, along with normal MRI or MRI with increased white matter hyperintensities/decreased blood flow (this has only been shown in women so far)
d. Bilateral Temporal Lobe Contusion - The mechanism of injury is head trauma and thus contusion would cause severe memory loss, not the minor verbal biased memory deficits.
e. Wernicke-Korsakoff - you would likely see more severe memory loss or abnormalities, such as anterograde amnesia, retrograde amnesia, confabulation, hallucinations and other symptoms such as confusion, nystagmus, ataxia, and pupillary changes.

Good question!

Front 39

Ebaneezer Scrooge, a 68 year old accountant, presents to Newark Memorial Hospital with altered mental status s/p multiple falls at home over the past few weeks. Currently, his son lives two blocks away from his house and visits his father two times per week to make sure he is in good spirits. When his son, Jeremiah, comes in to visit his father at the hospital, you ask the son questions about his father’s recent physical and mental status changes. Jeremiah tells you that his father was fired from his job 3 months ago as he forgot to go to work multiple times. He has also observed that his father has experienced difficulties lifting his feet from the floor while walking and issues with urinary incontinence over the past 4-6 months. Knowing that Mr. Scrooge did not have any of these symptoms 6 months ago, what condition do you suspect he is presenting with, and what confirmatory test should be performed?

a. Alzheimer’s Disease and PET SCAN
b. Normal Pressure Hydrocephalus and large volume CSF drainage testing
c. UTI and Urinalysis
d. Hepatic Encephalopathy and lumbar puncture
e. Huntington’s Disease and genetic testing

Back 39

a. Alzheimer’s Disease and PET SCAN - While progression of Alzheimer’s Disease can be monitored by PET scan, Alzheimer’s disease would present with more gradual onset of symptoms.
b. Normal Pressure Hydrocephalus and large volume CSF drainage test – CORRECT - Normal pressure hydrocephalus can be associated with urinary incontinence, increased incidence of falls, and cognitive decline. NPH is indicated with gait changes that are seen within 24 hours after large volume CSF drainage testing. CSF shunting is used to treat NPH after positive test results on large volume CSF drainage testing.
c. UTI and Urinalysis - Urinalysis can be used to look for white blood cell count and other bacteria that may have caused a UTI. A UTI would also present more acutely than NPH. You should know that a UA would also be performed in this case to rule out a UTI as the cause.
d. Hepatic Encephalopathy and lumbar puncture - A person with hepatic encephalopathy may present with gait disturbances and increased forgetfulness, but lumbar puncture would not be used to rule in hepatic encephalopathy.
e. Huntington’s Disease and genetic testing - HD is accurately diagnosed by genetic testing, however, urinary incontinence is not a common symptom of early Huntington’s Disease

Good job!

Front 40

You are currently treating two neurologic patients during your rehab affiliation. Both patients demonstrate classic neurologic movement disorders; however, you notice subtle differences between their symptoms as you work with each of them. Patient A demonstrates twisting wrist movements that are sustained up to 15 minutes without relaxation and are often quite painful (8/10 pain on the Numeric Pain Rating Scale). Patient B also demonstrates twisting wrist movements; however, you notice that these symptoms tend to be brief in duration (only a few seconds), seem to be random movement patterns, and appear to be more “jerky” than Patient A. Given your understanding of neurological movement disorders, you hypothesize that Patient A exhibits signs of _________, while Patient B exhibits signs of _________.

a. Ballismus; Chorea
b. Chorea; Dystonia
c. Dystonia; Ballismus
d. Tics, Chorea
e. Dystonia; Chorea

Back 40

a. Ballismus; Chorea - Ballismus would be characterized by a flinging movement of the entire limb, likely not just the wrist; Chorea is the correct answer for Patient B, as it is characterized by brief, non-repetitive, jerking movements.
b. Chorea; Dystonia - These are the correct disorders; however, they are matched with the incorrect patients. Patient A demonstrates signs of dystonia and Patient B demonstrates signs of chorea.
c. Dystonia; Ballismus - Dystonia is the correct answer for Patient A, as it is characterized by sustained, twisting movements that may be painful. Ballismus would not be the correct answer for Patient B as it is characterized by a flinging movement of the entire limb, likely not just the wrist.
d. Tics, Chorea - Tics would not be the correct answer for Patient A, as tics are associated with brief, repetitive, stereotypical movements, short duration, random movements. Chorea is the correct answer for Patient B, as it is characterized by brief, non-repetitive, jerking movements.
e. Dystonia; Chorea - CORRECT - Dystonia is the correct answer for Patient A, as it is characterized by sustained, twisting movements that may be painful. Chorea is the correct answer for Patient B, as it is characterized by brief, non-repetitive, jerking movements.

Good question.

Front 41

Wil Myers is a 58 y/o male you are evaluating in the NOA clinic. During the subjective you learn the patient has come to therapy with difficulty gripping keys to unlock doors and start his car. You observe your patient appears fatigued and mildly short of breath after only a short walk from the waiting room to the treatment plinth. You suspect your patient presents with ALS and you expect to see all of the following symptoms except:

a. Foot drop
b. Urinary incontinence
c. Fasciculations of the tongue
d. Easily altered emotions
e. More extensive weakness than patient reports

Back 41

a. Foot drop - a very common sign of distal weakness in ALS patients
b. Urinary incontinence - CORRECT - bowel and bladder function is usually spared in ALS along with extraocular muscles and the sensory system
c. Fasciculations of the tongue - fasciculations are one of the earliest clinical markers of ALS, particularly of the tongue
d. Easily altered emotions - this is a common presentation of ALS patients
e. More extensive weakness than patient reports - ALS patients have often lost 80% of motor neurons in areas of weakness before they complain

Front 42

Mr. Jon Johnson is 30 year old man who has recently been diagnosed with myotonic dystrophy 1 whom you are about to evaluate for a sprained ankle in your outpatient physical therapy clinic. He is quite concerned about his recent diagnosis and asks you many questions about what he might experience in coming years. You choose to discuss with him some of the more probable signs/symptoms he may begin to experience. Which of the following would you not discuss with him during your patient education.


a. Atrophy of facial muscles
b. Atrophy of forearm and hand musculature
c. Cognitive impairments
d. Insomnia
e. Difficulty swallowing

Back 42

a. Atrophy of facial muscles - Facial, forearm and hand muscle atrophy is common with DM1
b. Atrophy of forearm and hand musculature - Facial, forearm and hand muscle atrophy is common with DM1
c. Cognitive impairments - Cognitive impairments are associated with the disease DM1
d. Insomnia- CORRECT - a patient diagnosed with DM1 is likely to experience hypersomnia rather than insomnia
e. Difficulty swallowing - Difficulty swallowing is an impairment associated with DM1

Front 43

You have been treating Mr. Buddy, a 28 y/o male, in the NOA clinic for generalized proximal weakness for the past 2 months. His PMH is significant for severe asthma requiring repeated hospitalizations over the years. He comes to PT after having canceled his previous two appointments. When he comes in, you find out that he had gotten food poisoning and was unable to get out of bed or keep anything down for four days. Once you start exercising, you see that his function has regressed to where he was one month ago due to weakness and atrophy. He also complains that his muscle pain has significantly increased in the past week. What type of myopathy would you suspect he has?

a. Critical illness myopathy
b. Myotonic Dystrophy
c. Corticosteroid myopathy
d. Alcohol-Induced myopathy
e. ALS

Back 43

a. Critical illness myopathy - often occurs with multi-organ failure
b. Myotonic Dystrophy - presents with atrophy of facial atrophy, hand grip affected, frontal balding, and temporal wasting
c. Corticosteroid myopathy - CORRECT - effects often get worse with fasting and inactivity
d. Alcohol-Induced myopathy - with chronic heavy alcohol use presenting with myoedema and myonecrosis
e. ALS - presents with muscle cramps, fasciculations, weight loss, fatigue, and monomelic weakness

Front 44

This is your tenth visit working with Mrs. Mavis who was diagnosed with myasthenia gravis ten years ago. Lately you have been noticing that she has an abnormal amount of proximal muscle weakness and unexplained myalgias in her arms and legs. She reports that these symptoms worsen with long times between meals and when she has to sit at her desk for long periods of time. You are concerned because…

a. Proximal muscle weakness is not associated with myasthenia gravis and you think it is likely that this patient could have ALS.
b. The corticosteroids on her medication list that she has be taking for a long period of time since her initial diagnosis (10 years) and suspect a possibility for corticosteroid myopathy.
c. She reported consuming a glass of wine last night with her dinner during the subjective and are concerned that she may have acute alcohol induced myopathy.
d. The long time she spends between meals indicates loss of appetite and you suspect she may have acquired HIV.
e. The atypical signs and symptoms this patient presents likely indicates a brain tumor and she should be sent to the MD for an MRI immediately.

Back 44

a. Proximal muscle weakness is not associated with myasthenia gravis and you think it is likely that this patient could have ALS - Proximal muscle weakness is not associated with MG
b. The corticosteroids on her medication list that she has been taking for a long period of time since her initial diagnosis (10 years) could put her at risk for corticosteroid myopathy - CORRECT -Long term use of corticosteroids can cause proximal muscle weakness and myalgias that worsen during fasting and inactivity.
c. She reported consuming a glass of wine last night with her dinner during the subjective and are concerned that she may have acute alcohol induced myopathy - This type of myopathy is associated with chronic heavy alcohol use; one glass of wine will not induce this onset.
d. The long time she spends between meals indicates loss of appetite and you suspect she may have acquired HIV - HIV will not present with neurologic complications during the later stages.
e. The atypical signs and symptoms this patient presents likely indicates a brain tumor and she should be sent to the MD for an MRI immediately - Although brain tumors can present with a variety of signs and symptoms that mimics other CNS diseases, a patient with a brain tumor will not likely experience myalgias.

Front 45

Jorge Mariva is a 45 year-old male runner who reports to your PT clinic with complaints of frequent episodes of tripping; he has been tripping over his feet during his runs for the past few weeks and thinks he may have ankle instability. Upon examination, you observe weakness of dorsiflexor muscles bilaterally (3/5) and fasciculations in the tibialis anterior muscle. Additionally, you observe marked weakness bilaterally for all lower extremity muscles, especially his hip flexors and knee flexors bilaterally. Sensation is normal bilaterally. You decide to perform a quick cranial nerve screen and upon examination of CNXII, you notice that fasciculations are also present on the tongue, with marked atrophy. Based on the patient’s complaints and these objective findings, you are concerned enough to contact the patient’s doctor because you suspect:

a. Brain tumor
b. ALS
c. Progressive Bulbar Palsy
d. Encephalitis
e. Postinfectious Transverse Myelitis

Back 45

a. Brain tumor - Brain tumors may present with variable symptoms based on location, but it is unlikely that fasciculations will be observed.
b. ALS - CORRECT - This patient is of typical age and sex of a patient who may present with early ALS, as the disease presents with muscle weakness (distal>proximal), atrophy, and fasciculations.
c. Progressive Bulbar Palsy - Although this can present with tongue atrophy and fasciculations, this affects the bulbar region first, then the limbs. The patient would not present with symptoms of tripping and distal muscle weakness during these early stages.
d. Encephalitis - The patient will likely present with fever, headaches, nausea, vomiting and hyperreflexia in the early stages.
e. Postinfectious Transverse Myelitis - Although the legs are affected more in this disease, the patient will also present with numbness, dysesthesias or paresthesias.

Front 46

1. This drug is injected locally. It is a muscle paralytic that inhibits the ACH release at the skeletal neuromuscular junction.
2. Works on the CNS by increasing inhibitory effects of GABA. It is used for muscle spasms and spasticity. Can cause sedation.
3. This drug stimulates the alpha-2 receptors on the spinal interneurons leading to inhibition of the interneurons and decreased excitatory input onto the alpha motor neurons.
4. Inhibits the release of calcium from skeletal muscle SR. It is the only direct acting muscle relaxant.
5. Originally developed as an anti-seizure medication. Enhances GABA effects in the spinal cord.
6. A synthetic form of GABA. Works by stimulating GABA receptors in the cord and decreasing the excitation of alpha motor neurons.
7. This drug is used to treat severe spasticity. It can be administered via spinal injection (intrathecally).

a. Diazepam
b. Baclofen
c. Alpha 2 agonists
d. Gabapentin (Neurontin)
e. Dantrolene
f. Botulinum toxin

Back 46

6B, 5D, 4E, 1F, 3C, 2A, 7B

Front 47

Put the following four general stages of anesthesia in order:
1. Surgical anesthesia
2. Excitement/delirium
3. Medullary paralysis
4. Analgesia

Back 47

Correct order: 4, 2, 1, 3

Front 48

Match the definition/description to the appropriate type of block:
12. Local anesthetic injected into the venous system of affected arm or leg. Used for some surgical procedures or to treat CRPS/RSDS


13. Small catheter is implanted near peripheral nerve(s) to a specific region. Local anesthetic dripped onto nerve. Excellent post-op pain control.

14. Administered outside of dura

15. Administered into subarachnoid space

Choices:
a. Epidural block
b. Intravenous regional (Bier) block
c. Spinal block
d. Continuous nerve block

Back 48

Answers: 12B, 13D, 14A, 15C

Front 49

You are working at the early learning center and helping a five year old child, Jimmy, change his pants because he had an accident. He is a little temperamental, so you have to lay him down on the changing table to change his pants. While changing him, you notice that he has pseudohypertrophy of his calves. You therefore ask him to perform a sit up to get up. He is unable to do so and begins to cry and asks you to help him up. You pick him up, put him on the ground, and see that he uses his arms to climb up his leg. As he begins to walk away, you notice _________ which suggests that he may have ________. (Choose the best answer).

a. He has a scissoring gait, Cerebral Palsy.
b. Toe Walking, Duchenne’s Muscular Dystrophy
c. Ataxia, Cerebellar lesion
d. Spasticity of the lower extremities, Cerebral Palsy
e. Scissoring gait, Duchenne’s Muscular Dystrophy

Back 49

a. Has a scissoring gait, Cerebral Palsy; Scissoring gait is associated with cerebral palsy. However, pseudohypertrophy of the calf is most commonly associated with Duchenne’s Muscular Dystrophy.
b. Toe Walking, Duchenne’s Muscular Dystrophy -CORRECT- Pseudohypertrophy is associated with Duchenne’s Muscular Dystrophy, Gower’s sign, proximal weakness, and toe walking.
c. Ataxia, Cerebellar lesion; Not associated with pseudohypertrophy of calves
d. Spasticity of the lower extremities, Cerebral Palsy; Diplegic cerebral palsy is associated with spasticity of the lower extremities. However, pseudohypertrophy of the calf is most commonly associated with Duchenne’s Muscular Dystrophy (along with Gower’s sign and proximal weakness).
e. Scissoring gait, Duchenne’s Muscular Dystrophy; Toe walking is more commonly associated with Duchenne’s Muscular Dystrophy and consistent with proximal weakness, Gower’s sign, and pseudohypertrophy of the calves.

Front 50

You recently began working with Helga Pataki, a 19 year old college student at your outpatient clinic. Her primary complaint is unilateral facial weakness that began insidiously and has been getting progressively worse. She is not able to close her eye and has trouble smiling. As you go through your tests and measures, you find weakness in Helga’s upper extremities. You begin to suspect _________, because you found sparing of the __________ muscle.

a. Duchenne Muscular Dystrophy, Deltoid
b. Fascioscapulohumeral Muscular Dystrophy, Triceps
c. Myotonic Dystrophy, Triceps
d. Fascioscapulohumeral Muscular Dystrophy, Deltoid
e. Duchenne Muscular Dystrophy, Biceps

Back 50

a. Duchenne Muscular Dystrophy, Deltoid; DMD is usually seen earlier in life with marked delayed motor developments at ages 3-5, the deltoid is however spared.
b. Fascioscapulohumeral Muscular Dystrophy, Triceps; While FSH is the likely diagnosis as seen by the facial and proximal UE muscular weakness, the triceps are not spared.
c. Myotonic Dystrophy, Triceps; the onset of of myotonic dystrophy is typically later in life (~29 yo), the triceps are not spared
d. Fascioscapulohumeral Muscular Dystrophy, Deltoid -CORRECT- FSH is usually seen in people over 18 y/o and have an insidious onset of slowly progressive, asymmetric weakness of facial musculature first, followed by scapular and proximal UE muscles and peroneal muscles, but the deltoid muscle is spared. Facial weakness can cause incomplete eye closure, defective puckering and a flattened smile
e. Duchenne Muscular Dystrophy, Biceps; DMD is usually seen earlier in life with marked delayed motor developments at ages 3-5, the biceps are not spared

Front 51

Last week Mrs. Frizzle brought her cute little boy 3 year old boy, Ralphie Frizzle, to the pediatrician’s office because he has been walking on his toes over the last couple months and he is having trouble getting up off the floor after play time. The Pediatrician diagnosed Ralphie with Duchenne’s Muscular Dystrophy (DMD) and prescribed physical therapy for young Ralphie at his school, The Building Block Learning Center. Which of the following goals would NOT be appropriate for young Ralphie currently and in the future?

a. Prevent contractures that can lead to further disability and pain
b. Promote maximal strength and endurance gains and prevent disuse atrophy through minimal patient pain and fatigue
c. Promote maximal strength gains and prevent disuse atrophy without pain or fatigue
d. Facilitate maximal functional abilities using appropriate adaptive equipment
e. Maintain maximal respiratory strength and movement of secretions

Back 51

a. Prevent contractures that can lead to further disability and pain; maintaining range of motion would be one of the most important therapeutic goals for a child with DMD
b. Promote maximal strength gains while minimizing disuse atrophy, allowing increased fatigue to increase endurance -CORRECT- Pushing the patient through pain and fatigue may cause more muscle breakdown and thus would not be indicated as a therapeutic goal for a child with DMD
c. Promote maximal strength gains and prevent atrophy without increase in fatigue or pain; Pushing the patient through pain and fatigue may cause more muscle breakdown and thus the therapist would want to stop play or exercise as soon as the child demonstrates signs of pain or fatigue
d. Facilitate maximal functional abilities using appropriate adaptive equipment; As Ralphie gets older and his proximal weakness progresses, he may need assistive device training to stay independent with ambulation.
e. Maintain maximal respiratory strength and movement of secretions; It is important to maintain movement of secretions as one of the major causes of death in this population is pneumonia.

Front 52

You are treating Mr. Fischer, a 22 year old skateboarder at your outpatient clinic for a right wrist sprain after a fall during one of his practices. You had previously seen him 3 years prior for treatment of a right Colles fracture, also due to a fall. During your exam, you notice that he is behaving somewhat differently than when you last saw him; for instance, he has a more flattened affect and does not completely close his eyes while blinking. Suspicious, you decide to manual muscle test his elbow, shoulder, and periscapular muscles bilaterally. His biceps, triceps, rotator cuff muscles, and rhomboids are weak bilaterally; although his deltoids are very strong bilaterally. He demonstrates difficulty scrunching up his face when you ask him to. You decide to refer Mr. Fischer to a neurologist for an additional consult. What do you suspect Mr. Fischer may present with and what might the neurologist find?

a. Duchenne’s Muscular Dystrophy; contractures in his knee and ankle joints characterized by an abnormally high amount of scar tissue
b. Duchenne’s Muscular Dystrophy; Pseudohypertrophy in the calves characterized by increased fat content in the muscles on MRI
c. Becker’s Muscular Dystrophy; Severe scoliosis
d. Fascioscapulohumeral Muscular Dystrophy; mild muscle necrosis with a moth eaten appearance on biopsy
e. Fascioscapulohumeral Muscular Dystrophy; anterior horn neuronal loss in the cervical nerve roots on MRI

Back 52

a. Duchenne’s Muscular Dystrophy; contractures in his knee and ankle joints characterized by an abnormally high amount of scar tissue - While contractures are common with Duchenne’s MD, this disease usually becomes apparent between the ages of 3 and 5 years old, not 22 years. Further, Duchenne’s MD would present with deltoid weakness.
b. Duchenne’s Muscular Dystrophy; Pseudohypertrophy in the calves characterized by increased fat content in the muscles on MRI - While calf pseudohypertrophy is common with Duchenne’s MD, this disease usually becomes apparent between the ages of 3 and 5 years old, not 22 years. Further, Duchenne’s MD would present with deltoid weakness.
c. Becker’s Muscular Dystrophy; Severe scoliosis - While scoliosis is common with Becker’s MD, this disease usually becomes apparent between the ages of 5 and 15 years old, not 22 years. Further, Becker’s MD would present with deltoid weakness.
d. Fascioscapulohumeral Muscular Dystrophy; mild muscle necrosis with a moth eaten appearance on biopsy - CORRECT: this pattern of weakness (weak facial, scapular, and upper arm musclulature) is characteristic of Fascioscapulohumeral MD. Often, muscles assume a moth eaten appearance due to muscle necrosis.
e. Fascioscapulohumeral Muscular Dystrophy; anterior horn neuronal loss in the cervical nerve roots on MRI - while the pathology is correct, this mechanism is associated with ALS, and is incorrect.

Front 53

A 70 y/o female is admitted to your outpatient clinic with a chief complaint of back pain. She
asks you to write down her HEP because lately she “has trouble remembering things.” Given
her age and presentation you think she may have Alzheimer's. Alzheimer’s is characterized by___________, which are central β-amyloid core surrounded by a ring of astrocytes, microglia and dystrophic neuritis and ____________, which are normal accumulations of paired helical filaments of abnormally hyper phosphorylated tau protein in the neuronal cell body and dendrites and they are located
primarily in the ________ areas.

A. Plaques: tangles: hippocampal, limbic, and frontal
B: Tangles: Plaques: hippocampal, limbic, and frontal
C: Nodules: Plaques: Occipital, Temporal, and frontal
D: Tangles: Nodules: Occipital, hippocampal, parietal
E: Plaques: Tangles: Occipital, limbic, frontal

Back 53

A. Plaques: tangles: hippocampal, limbic, and frontal CORRECT- Plaques and tangles are
matched with the correct definitions and the hippocampal, limbic, and frontal areas are the most
common regions for these
B: Tangles: Plaques: hippocampal, limbic, and frontal incorrect plaques and tangles are
interchanged, hippocampal, limbic, and frontal areas are correct
C: Nodules: Plaques: Occipital, Temporal, and frontal incorrect a nodule is not a
characterization on Alzheimer’s and the definition for the second blank is tangles and not
plaque, the hippocampal, limbic, and frontal areas are most affected by plaques and tangles not
the occipital and temporal
D: Tangles: Nodules: Occipital, hippocampal, parietal incorrect: The correct word for the
definition in the first blank is plaques, a nodule is not a characterization of Alzheimer's,
hippocampal, limbic, and frontal areas are most affected by plaques and tangles not the
occipital and parietal areas.
E: Plaques: Tangles: Occipital, limbic, frontal incorrect the first two blanks are correct but the
occipital lobe is not a primary location for plaques and tangles

I remember distinctly saying in lecture that you do not need to know the specific definitions of plaques and tangles, but rather that those are the pathologic terms associated with Alzheimer’s… so why would you write a question that specifically makes you know the difference. And on top of that, I specifically said I wanted you to associate the Temporal and Parietal lobes with Alzheimer’s and Frontal with FTLD… so why include the smaller font/de-emphasized lobe in the question as part of the correct answer. That makes no sense.

Front 54

1. Benzodiazepine
2. Antipsychotics
3. MAO inhibitors
4. Azapirones
5. Tricyclics

a) Mechanism of action is stimulating Serotonin receptors in CNS
b) Mechanism of action is decreasing amine neurotransmitter breakdown
c) Mechanism of action is increasing action of GABA in brain and spinal cord by facilitating binding to receptors but discontinuation may cause rebounding insomnia
d) Mechanism of action is blocking CNS dopamine receptors
e) Mechanism of action is inhibiting amine neurotransmitter reuptake

Back 54

1 – C
2 – D
3 – B
4 – A
5 – E

Front 55

6. Side effects of antidepressant medications
7. Side effects of benzodiazepine
8. Side effects of atypical (newer) antipsychotics
9. Side effects of Tricyclics
10. Side effects of Lithium toxicity

a) Orthostatic hypotension, sedation and anti-cholinergic effects
b) HR/BP, confusion, hallucinations, agitation, sweating, shivering, dystonia, dyskinesia, muscle pain, GI problems
c) Sedation
d) Nystagmus, metallic taste, fasciculations
e) Weight gain, disturbed lipid/glucose metabolism

Back 55

6 – B
7 – C
8 – E
9 – A
10 – D

Front 56

Ms. Smith is a 23 year old PT student referred to your neurologic clinic with complaints of headaches. She experiences bilateral symptoms and reports her pain is alleviated when her classmate performs the sub-occipital release. Which of the following conditions seem most likely?

a. Migraine without aura
b. Migraine with aura
c. Cluster headache
d. Tension type headache
e. Brain Freeze

Back 56

a. Migraine without aura - bilateral symptoms are not usually consistent with a migraine
b. Migraine with aura - bilateral symptoms are not usually consistent with a migraine
c. Cluster headache - bilateral symptoms are not consistent with a cluster headache
d. Tension type headache - CORRECT - bilateral symptoms responding to soft tissue techniques are consistent with a tension type headache
e. Brain Freeze - headaches resulting from ‘brain freeze’ or sphenopalatine ganglioneuralgia are associated with cold foods contacting the roof of the mouth. These symptoms would not be resolved with a sub-occipital release.

Front 57

Joseph is a 42 year old male who reports to your clinic with a unilateral pulsating feeling in his head beginning last night and increasing with exercise. He asks if you could bring a trash can close to the table because he is feeling nauseous and also requests you turn off the lights. When asked, he tells you the symptoms have been occurring for six hours and this is at least the tenth time this happened. Which of the following conditions seem most likely?
a. Migraine without aura
b. Migraine with aura
c. Cluster headache
d. Tension type headache
e. Hemorrhagic stroke

Back 57

a. Migraine without aura - CORRECT - patient’s symptom fulfills the diagnostic criteria for migraine without aura: headache attack lasting 4-72 hrs, unilateral location, aggravated by routine physical activity, and nausea
b. Migraine with aura - although the unilateral headache symptoms are consistent with a migraine, there are no reports of visual, verbal, or sensory disturbances supporting the presence of aura
c. Cluster headache - Nausea is not commonly associated with cluster headaches
d. Tension type headache - tension type headaches are most often associated with poor posture and although it is possible for symptoms to be exacerbated with exercise, it is more common for exacerbation with prolonged periods of sitting in a stooped position
e. Hemorrhagic stroke - although a ‘worst headache of my life’ complaint is a concern for hemorrhagic stroke, the patient’s complaints do not seem to fit that description and he has a previous history of these symptoms

Front 58

Mary Jane is a 64 year old female status post TKA and your first patient of the day in an outpatient clinic. When you greet her, you notice she appears restless and sniffling. When you ask her if she is okay, she tells you she has a really bad headache right here (points to area directly above her left eye). Upon closer examination, you see her left eye is drooping and her face is sweaty and pale. Which of the following conditions seem most likely?

a. Migraine without aura
b. Migraine with aura
c. Cluster headache
d. Tension type headache
e. Brain Freeze

Back 58

a. Migraine without aura - ptosis and a lack of complaints of nausea make this unlikely
b. Migraine with aura - there are no reports of visual or verbal disturbances
c. Cluster headache - CORRECT - unilateral symptoms in the supraorbital region with associated ptosis and pallor are consistent with a cluster headache
d. Tension type headache - more likely to present with bilateral symptoms
e. Brain Freeze - no cold foods have been consumed in this scenario and therefore this is an unlikely culprit

Front 59

You are treating 39 year old Aretha Franklin for lateral epicondylitis and during the session she complains of a headache on her left side. She also reports seeing bright spots and tells you to turn down the music because it is so loud. You tell her to sit down, take her BP and HR which are within normal limits. While waiting for emergency services within 20 minutes of onset of symptoms she tells you she feels much better and remarks “It’s no big deal. I get headaches like this all the time.” You still suggest she go to the hospital for observation, but what is the most likely diagnosis?

a. Migraine without aura
b. Migraine with aura
c. Cluster headache
d. Tension type headache
e. Brain Freeze

Back 59

a. Migraine without aura - unilateral headache symptoms are consistent with a migraine; however, subjective reports of bright spots suggest presence of aura
b. Migraine with aura - CORRECT - unilateral headache symptoms are consistent with a migraine and reports of bright spots and symptoms lasting < 20 minutes are consistent with an aura
c. Cluster headache - restlessness or agitation not present, lack of sweating, eye lid edema, and nasal congestion make this an unlikely diagnosis
d. Tension type headache - bilateral symptoms would be present
e. Brain Freeze - cold food was not explicitly mentioned and therefore this is an unlikely diagnosis

Front 60

You are preparing for an evaluation of a 6 month old child with cerebral palsy in your outpatient clinic. You remember from your medical science class that cerebral palsy presents in many ways. When reviewing her medical history you see she has Spastic Quadriplegia, the most severe form of spastic cerebral palsy. You remember that the _______ muscles are affected by spasticity in these patients, and the muscle groups affected include ______________.

a. Antigravity; hip adductors and knee flexors
b. Antigravity; hip abductors and knee extensors
c. Power; hip adductors and knee flexors
d. Power; hip abductors and knee extensors
e. Antigravity; hip adductors and knee extensors

Back 60

a. Antigravity; hip adductors and knee flexors – CORRECT - the antigravity muscles are affected and these are examples of antigravity muscles
b. Antigravity; hip abductors and knee extensors - the antigravity muscles are affected however these are not examples of antigravity muscles
c. Power; hip adductors and knee flexors - the power muscles are not the muscles affected the antigravity muscles are, however these are examples of antigravity muscles.
d. Power; hip abductors and knee extensors - the power muscles are not the muscles affected the antigravity muscles are affected, and these are not examples of antigravity muscles.
e. Antigravity; hip adductors and knee extensors - the antigravity muscles are affected however knee extensors are not antigravity muscles

Front 61

You are working in an outpatient pediatrics clinic and treating a 2 year old girl with cerebral palsy. This patient has significant postural abnormalities specific to a certain type of cerebral palsy. What type of cerebral palsy do you expect this patient to have and what postural abnormalities?

a. Spastic Hemiplegia; abducted shoulder, clawing toes, and knee and ankles flexed
b. Spastic Diplegia; abducted shoulder, clawing toes, and knee and ankles flexed
c. Spastic Hemiplegia; adducted shoulder, flaring toes, knee and ankles extended
d. Spastic Diplegia; adducted shoulder, flaring toes, knee and ankles extended
e. Spastic Quadriplegia; abducted shoulder, clawing toes, and knee and ankles flexed

Back 61

a. Spastic Hemiplegia; adducted shoulder, flaring toes, knee and ankles extended - this is the correct type of CP however these postures are the opposite of the postures that are specific to this spastic hemiplegia
b. Spastic Diplegia; abducted shoulder, clawing toes, and knee and ankles flexed - this is the incorrect type of CP and these postures are specific to spastic hemiplegia.
c. Spastic Hemiplegia; abducted shoulder, clawing toes, and knee and ankles flexed- CORRECT - this is the correct type of cerebral palsy and these postures are specific to this type of CP
d. Spastic Diplegia; adducted shoulder, flaring toes, knee and ankles extended - this is the incorrect type of CP associated with specific postural abnormalities and these postural abnormalities are the opposite of those associated with spastic hemiplegia
e. Spastic Quadriplegia; abducted shoulder, clawing toes, and knee and ankles flexed - the type of CP that are associated with these postures is spastic hemiplegia not quadriplegia however these are the postures associated with spastic hemiplegia.

Front 62

You are evaluating Matthew, a 5 year old boy, at the Delaware Early Learning Center for Cerebral Palsy. You recall that the incidence of CP increases with ________ birth weight and gestational age. Upon evaluation you observe he has spastic CP. Name two important risk factors for spastic CP.

a. Decreasing; Mother between ages 20-40 and Caucasian
b. Increasing; Intrauterine Infection and Coagulation
c. Increasing; First Pregnancy and Mother Over 40 yo
d. Increasing; Multiple Birth and Breech Birth
e. Decreasing; Intrauterine Infection and Coagulation

Back 62

a. Decreasing; Mother between ages 20-40 and Caucasian – increased incidence in African Americans and mothers ages <20 and >40
b. Increasing; Intrauterine Infection and Coagulation – the incidence of CP increases with decreased birth weight and gestational age; these are risk factors
c. Increasing; First Pregnancy and Mother Over 40 yo – the incidence of CP increases with decreased birth weight and gestational age; these are risk factors
d. Increasing; Multiple Birth and Breech Birth – the incidence of CP increases with decreased birth weight and gestational age; these are risk factors
e. Decreasing; Intrauterine Infection and Coagulation – CORRECT – the incidence of CP increases with decreased birth weight and gestational age; these are the most important risk factors for spastic CP

Front 63

You are sitting on your porch when you notice Billy, your neighbor’s 2 year old son, playing next door. You suspect he has CP due to poor truncal balance and persistent primitive reflexes. In children with CP, _______ is evident after 6 months of age and _________is evident after 18 months of age.

a. Loss of developmental milestones; muscle atrophy
b. Spasticity; a dyskinetic pattern
c. Dyskinetic pattern; flaccidity
d. Loss of developmental milestones; muscle hypertrophy
e. Dyskinetic pattern; spasticity

Back 63

a. Loss of developmental milestones; muscle atrophy- Spasticity is evident after 6 months and a dyskinetic pattern is event after 18 months
b. Spasticity; a dyskinetic pattern- CORRECT- these are evident after their respective times
c. Dyskinetic pattern; flaccidity- Spasticity is evident after 6 months and a dyskinetic pattern is event after 18 months
d. Loss of developmental milestones; muscle hypertrophy- Spasticity is evident after 6 months and a dyskinetic pattern is event after 18 months
e. Dyskinetic pattern; spasticity- Spasticity is evident after 6 months and a dyskinetic pattern is event after 18 months

Front 64

1. Levidopa
2. Carbidopa
3. COMT inhibitors
4. Anticholinergic agents
5. Dopamine agonist
6. Amantadine
7. Selegiline

a. Stimulates Dopamine receptors directly
b. Precursor to dopamine
c. Inhibits dopa decarboxylase, preventing premature conversion of dopa to dopamine before crossing blood brain barrier
d. Allows increased amount of L-dopa to reach the brain, by preventing an enzyme that breaks down L-dopa in peripheral tissues
e. Inhibits monoamine oxidase, preventing dopamine from breaking down in the brain
f. Decreases acetylcholine influence
g. Decreases influence of excitatory amino acids by blocking NMDA receptors in the brain (anti-viral agent)

Back 64

1. Levidopa
2. Carbidopa
3. COMT inhibitors
4. Anticholinergic agents
5. Dopamine agonist
6. Amantadine
7. Selegiline

a. Stimulates Dopamine receptors directly
b. Precursor to dopamine
c. Inhibits dopa decarboxylase, preventing premature conversion of dopa to dopamine before crossing blood brain barrier
d. Allows increased amount of L-dopa to reach the brain, by preventing an enzyme that breaks down L-dopa in peripheral tissues
e. Inhibits monoamine oxidase, preventing dopamine from breaking down in the brain
f. Decreases acetylcholine influence
g. Decreases influence of excitatory amino acids by blocking NMDA receptors in the brain (anti-viral agent)


BCDFAGE

Front 65

PT implications of Parkinson’s

1. Optimal treatment time after PD medications
2. In PD there is an abnormal balance of dopamine and _______________ in the basal ganglia.
3. A possible side effect of Parkinson’s medications is what?

a. Epinephrine
b. Acetylcholine
c. 30-60 minutes
d. Manic episodes
e. Dyskinesia
f. 2-3 hours
g. Norepinephrine

Back 65

PT implications of Parkinson’s

1. Optimal treatment time after PD medications
2. In PD there is an abnormal balance of dopamine and _______________ in the basal ganglia.
3. A possible side effect of Parkinson’s medications is what?

a. Epinephrine
b. Acetylcholine
c. 30-60 minutes
d. Manic episodes
e. Dyskinesia
f. 2-3 hours
g. Norepinephrine

CBE

Front 66

Anti-Seizures Medications

1. This primary anti-seizure medication decreases sodium entry into rapidly firing neurons
2. This primary anti-seizure medication decreases calcium entry into thalamic neurons
3. This primary anti-seizure medication increases GABA inhibition
4. This second generation anti-seizure drug can also be used to treat neuropathic pain
5. This anti-seizure drug tends to have milder side effects as well as may allow more possible drug combinations to treat seizures

Answer Choices

A. Phenytoin (Dilantin)
B. Ethosuximide (Zarontin)
C. Benzodiazepine
D. Gabapentin (Neurontin)
E. Levodopa (Dopar)

Back 66

Anti-Seizures Medications

1. This primary anti-seizure medication decreases sodium entry into rapidly firing neurons
2. This primary anti-seizure medication decreases calcium entry into thalamic neurons
3. This primary anti-seizure medication increases GABA inhibition
4. This second generation anti-seizure drug can also be used to treat neuropathic pain
5. This anti-seizure drug tends to have milder side effects as well as may allow more possible drug combinations to treat seizures

Answer Choices

A. Phenytoin (Dilantin)
B. Ethosuximide (Zarontin)
C. Benzodiazepine
D. Gabapentin (Neurontin)
E. Levodopa (Dopar)

ABCDD