Question 1

Why does demyelination occur in Guillain-Barr&#233; syndrome?&#10;A) Schwann cells die too fast for the body to replenish them.&#10;B) Macrophages strip myelin from the nerves.&#10;C) There is a lack of acetylcholine at the presynaptic junction.&#10;D) There is a lack of blood flow to the outermost covering of nerves.

Accepted Answer

Demyelination, initiated at the known node of Ranvier, occurs because macrophages, responding to inflammatory signals, strip myelin from the nerves. After the initial demyelination, the body initiates a repair process.

Question 2

Which of the following is a common clinical manifestation of ulnar nerve palsy?&#10;A) flattening of the thenar eminence&#10;B) claw hand deformity&#10;C) ulnar deviation of the hand when the wrist is flexed&#10;D) impaired sensation along the thumb and first digit

Accepted Answer

Flattening of the hypothenar eminence along with abduction of the little finger coincides with weakness of the palmaris brevis and abductor digiti minimi. Paralysis of the flexor carpi ulnaris produces a radial deviation of the hand when wrist flexion is attempted. Impaired sensation may be expected along the fifth digit and the ulnar aspect of the ring finger.

Question 3

Which of the following peripheral neuropathies involves the motor endplate?&#10;A) neurapraxia&#10;B) diabetes mellitus&#10;C) Guillain-Barr&#233; syndrome&#10;D) botulism

Accepted Answer

Botulism disrupts transfer of acetylcholine at the motor endplate. The other choices involve axonal degeneration and demyelination.

Question 4

Which of the following is a true statement regarding neuropathy?&#10;A) There is hypertonia of muscles involved.&#10;B) Motor symptoms tend to occur first distally.&#10;C) Deep tendon reflexes are increased.&#10;D) The most proximal deep tendon reflexes will be affected first.

Accepted Answer

The most common symptoms of motor nerve involvement include distal weakness and hypotonicity. Deep tendon reflexes are diminished or absent, and distal most deep tendon reflexes will be affected first. In neuropathy, motor symptoms tend to occur first distally, while in myopathy the weakness tends to be proximal.

Question 5

Which of the following is the least common symptom of a paraneoplastic neuropathy?&#10;A) weakness&#10;B) burning and aching&#10;C) numbness&#10;D) paresthesia

Accepted Answer

Although individuals exhibit symptoms of areflexia, weakness is not common and when it occurs, generally it is related to an inability to sustain the contractions secondary to impair proprioceptive feedback.

Question 6

Which of the following sensations has the slowest nerve conduction velocity?&#10;A) proprioception&#10;B) pressure&#10;C) temperature&#10;D) pain

Accepted Answer

As a general rule, the thicker the myelin sheath, the faster the conduction velocity of a nerve. Proprioception has the fastest conduction velocity with pain the slowest.

Question 7

Prolonged compression of a nerve that produces an area of infarction and necrosis is defined as which of the following?&#10;A) neurapraxia&#10;B) myelinopathy&#10;C) axonotmesis&#10;D) neurotmesis

Accepted Answer

Axonotmesis occurs when the axon has been damaged, but connective tissue coverings that support and protect the nerve remain intact. Prolonged compression that produces an area of infarction and necrosis causes an axonotmesis.

Question 8

Which of the following is correct advice for a PTA to give a patient with a diagnosis of post-polio syndrome that is beginning an outpatient physical therapy intervention program?&#10;A) The patient should exercise to the point of fatigue at the first visit.&#10;B) The patient should stop exercise if pain or weakness increases.&#10;C) The patient should focus on lower extremity aggressive exercise.&#10;D) Functional exercises should be of maximal intensity.

Accepted Answer

Partially denervated muscle does not have the physiologic capacity to respond to a conventional strengthening program. Instead, programs aimed at nonexhaustive exercise and general body conditioning are preferable. The client should never exercise to the point of fatigue. Caution the client to stop if pain or weakness persists.

Question 9

Which of the following is not a normal aging effect on the peripheral nervous system?&#10;A) The perineurium will thicken.&#10;B) The epineurium will thicken.&#10;C) The size and number of fascicles will decrease.&#10;D) The endoneurium will become fibrosed.

Accepted Answer

Age does not affect the size or number of fascicles, but the perineurium and epineurium do thicken with age and the endoneurium often becomes fibrosed with increased collagen.

Question 10

Which of the following diabetic neuropathies is considered rapidly reversible?&#10;A) acute sensory neuropathy&#10;B) chronic sensorimotor&#10;C) autonomic&#10;D) hyperglycemic neuropathy

Accepted Answer

Hyperglycemic neuropathy occurs in an individual with poorly controlled diabetes, and in those who have been newly diagnosed, rapidly reversible nerve conduction abnormalities have been reported. Symptoms disappear when the individual's blood sugar is controlled, although abnormalities in nerve conduction may persist. The other choices are considered generalized symmetric polyneuropathies.

Question 11

Lower motor neuron involvement occurs with trauma to several sites.Damage to which of the following sites will not produce lower motor neuron symptoms?&#10;A) cerebellum&#10;B) cell body of alpha motor neuron located in the spinal cord or brainstem&#10;C) motor endplate of the axon&#10;D) muscle fibers innervated by the motor nerve axon

Accepted Answer

The answer of Lower motor neuron involvement occurs with trauma...

Question 12

Which of the following disorders is not common with Charcot-Marie-Tooth (CMT)disease?&#10;A) distally symmetric muscle weakness&#10;B) increased deep tendon reflexes&#10;C) high arch deformities&#10;D) hammer toes

Accepted Answer

The answer of Which of the following disorders is not...

Question 13

Which layer of connective tissue surrounding peripheral nerves is responsible for maintaining the blood-nerve barrier?&#10;A) endoneurium&#10;B) perineurium&#10;C) epineurium&#10;D) axolemma

Accepted Answer

The answer of Which layer of connective tissue surrounding peripheral...

Question 14

Which test is considered the gold standard for carpal tunnel syndrome?&#10;A) Phalen's test&#10;B) Tinel's test&#10;C) nerve conduction velocity testing&#10;D) carpal compression test

Accepted Answer

The answer of Which test is considered the gold standard...

Question 15

Disruption of which cranial nerve will result in Bell's palsy?&#10;A) trochlear&#10;B) trigeminal&#10;C) facial&#10;D) vagus

Accepted Answer

The answer of Disruption of which cranial nerve will result...

Question 16

What is the prognosis for reinnervation of muscle after a neurotmesis injury where there has been no return of function for 1 year?&#10;A) poor&#10;B) fair&#10;C) good&#10;D) excellent

Accepted Answer

The answer of What is the prognosis for reinnervation of...

Question 17

Which of the following will show a complete interference pattern with maximal contraction on electromyogram (EMG)?&#10;A) normal innervation&#10;B) segmental demyelination&#10;C) axonal degeneration&#10;D) myopathy

Accepted Answer

The answer of Which of the following will show a...

Question 18

At what stage of the complex regional pain syndrome (CRPS)is the skin thin,shiny,cyanotic,and dry?&#10;A) acute&#10;B) dystrophic&#10;C) atrophic&#10;D) subacute

Accepted Answer

The answer of At what stage of the complex regional...

Question 19

The medication amiodarone is toxic to peripheral nerves.What is this medication prescribed for?&#10;A) cancer&#10;B) irregular heartbeat&#10;C) skin diseases&#10;D) seizures and pain

Accepted Answer

The answer of The medication amiodarone is toxic to peripheral...

Question 20

A patient presents to outpatient physical therapy with a diagnosis of thoracic outlet syndrome (TOS).Which of the following treatments would be inappropriate for this individual?&#10;A) forceful stretching to mobilize the first rib&#10;B) postural and breathing exercises&#10;C) strengthening exercises for the shoulder girdle musculature&#10;D) moist heat to the upper trapezius

Accepted Answer

The answer of A patient presents to outpatient physical therapy...

Deck 25: The Peripheral Nervous System