OCC OCC Neurological Assessment & Neuromuscular Medicine 2 — Questions and Answers
Question 1: Carpal tunnel syndrome produces paresthesias in which sensory distribution?
- All five digits equally
- Thumb, index, middle, and radial half of ring finger (Correct answer)
- Ring and little finger only
- Entire dorsum and palm of the hand
Correct answer: Thumb, index, middle, and radial half of ring finger
Compression of the median nerve in the carpal tunnel causes sensory symptoms in the lateral 3.5 fingers: thumb, index, middle, and radial half of the ring finger.
Question 2: The Romberg test primarily evaluates the integrity of which sensory pathway?
- Spinothalamic tract (pain/temperature)
- Posterior (dorsal) columns (proprioception/vibration) (Correct answer)
- Lateral corticospinal tract
- Spinocerebellar tract
Correct answer: Posterior (dorsal) columns (proprioception/vibration)
The Romberg test assesses proprioception carried by the posterior columns; removing visual input unmasks deficits in sensory ataxia due to dorsal column dysfunction.
Question 3: Which combination of neurological signs is characteristic of amyotrophic lateral sclerosis (ALS)?
- Upper motor neuron signs only
- Lower motor neuron signs only
- Both upper and lower motor neuron signs with no sensory deficits (Correct answer)
- Both motor and sensory deficits with preserved deep tendon reflexes
Correct answer: Both upper and lower motor neuron signs with no sensory deficits
ALS simultaneously involves upper motor neurons (spasticity, hyperreflexia, Babinski) and lower motor neurons (atrophy, fasciculations) while characteristically sparing sensory pathways.
Question 4: A patient describes the sudden onset of 'the worst headache of my life.' Which diagnosis must be emergently excluded?
- Migraine with aura
- Cluster headache
- Subarachnoid hemorrhage (Correct answer)
- Tension-type headache
Correct answer: Subarachnoid hemorrhage
A thunderclap headache reaching maximal intensity within seconds is the classic presentation of subarachnoid hemorrhage and requires immediate CT and lumbar puncture if CT is negative.
Question 5: When applying OMT for cervicogenic or tension-type headache, which region is most commonly the primary treatment target?
- Thoracic spine (T1-T4)
- Lumbar spine (L1-L5)
- Suboccipital and upper cervical region (Correct answer)
- Sacrum and pelvis only
Correct answer: Suboccipital and upper cervical region
Somatic dysfunction in the suboccipital and upper cervical region contributes to headache via muscular tension, neurovascular compression, and neurological facilitation, making it the primary OMT target.
Question 6: The classic gait of a patient with Parkinson's disease is best described as:
- Wide-based, unsteady gait with lateral deviation
- High-stepping gait with foot drop
- Shuffling gait with small steps and reduced arm swing (Correct answer)
- Scissors gait with bilateral lower extremity spasticity
Correct answer: Shuffling gait with small steps and reduced arm swing
Parkinsonian gait is characterized by shuffling small steps (festination), reduced arm swing, stooped posture, and difficulty initiating or stopping movement due to bradykinesia and rigidity.
Question 7: Which electrophysiological finding best distinguishes a demyelinating neuropathy from an axonal neuropathy on nerve conduction studies?
- Reduced compound motor action potential amplitude
- Markedly slowed nerve conduction velocity (Correct answer)
- Increased insertional activity on needle EMG
- Fibrillation potentials at rest
Correct answer: Markedly slowed nerve conduction velocity
Demyelinating neuropathies show significantly slowed nerve conduction velocity due to impaired saltatory conduction, while axonal neuropathies primarily reduce CMAP amplitude with relatively preserved velocity.
OCC OCC Neurological Assessment & Neuromuscular Medicine 2
Carpal tunnel syndrome produces paresthesias in which sensory distribution?