Ch.12 Diagnostic Testing In Neurology Complete Test Bank

Chapter 12: Diagnostic Testing in Neurology: Lab Tests, Imaging, and Nerve/Muscle Studies with Implications for Therapists

Dennis W. Fell, PT, MD Wesley Blake Denny, PhD, MT (ASCP)

Brad Steffler, MD John R. Jefferson, PT, PhD, OCS, COMT

Bassam A. Bassam, MD, FAAN Jonathan B. Mullins, MD

Multiple Choice

1. Reference ranges for clinical laboratory tests are established by:

A. A national database compiled from clinical labs in the United States

B. Each laboratory based on a local population of healthy individuals

C. Each laboratory based on a local database compiled from all patients tested

D. The manufacturer of the equipment or kit used to perform the test

2. Which of the following neuromuscular disorders is NOT associated with autoantibodies?

A. Myasthenia gravis

B. Amyotrophic lateral sclerosis

C. Multiple sclerosis

D. Myotonia congenita

3. Cerebrovascular accidents (CVAs) caused by clotting disorders are frequently associated with abnormal values for:

A. Blood urea nitrogen

B. Platelet counts

C. Serum chloride

D. White blood cell counts

4. Due to the clinical overlap between different types of muscular dystrophy, myopathies, and congenital myasthenic syndromes, a patient under your care was recently given a neuromuscular disorders genetic screening panel to help the physician diagnose their specific condition. Which area of the clinical laboratory would be responsible for handling this analysis?

A. Molecular diagnostics

B. Immunohematology

C. Flow cytometry

D. Chemistry

5. The most useful assessment of peripheral nerve axonal loss is…

A. Slow nerve conduction velocity

B. Increased distal latency

C. Reduced compound muscle action potential amplitude

D. Dispersed compound muscle action potential

6. What effect does temperature have on nerve conduction study?

A. None, the findings are fine

B. The potential amplitude is reduced

C. The latency is faster, with no change in amplitude

D. The latency is longer, and the amplitude is larger

7. F-wave latency and tibial H-reflex are most useful in evaluation of?

A. Length dependent axonal polyneuropathy

B. Entrapment neuropathy

C. Compressive and inflammatory radiculopathy

D. Nerve lesion proximal versus distal to dorsal root ganglion

8. Abnormal sensory nerve studies would most likely be seen with:

A. Disorders of the neuromuscular junction

B. Myopathic disorders

C. Nerve root lesions distal to the dorsal root ganglion

D. Nerve root lesions proximal to the dorsal root ganglion

E. Upper motor neuron lesions

9. Your patient presents with the following nerve conduction study (NCS) and electromyography (EMG) findings: Decreased CMAP and SNAP amplitudes, motor, and sensory NCV values greater than 75%, no insertional activity, no spontaneous EMG activity but polyphasic waveforms. This is suggestive of which of the following neuropathic conditions?

A. Acute axonal loss

B. Demyelination with conduction block

C. Demyelination without conduction block

D. Disease of the anterior horn cells

E. Long-term axonal loss

10. Which of the following EMG/NCS findings would be most indicative of muscle denervation at 3 weeks post trauma?

A. Decreased CMAP amplitude

B. Decreased insertional activity

C. Decreased motor nerve conduction velocity

D. Fibrillations and positive sharp waves

E. Large amplitude polyphasic motor unit potentials

11. Which of the following EMG/NCS findings would be most indicative of muscle reinnervation at 10 months post-trauma?

A. Decreased CMAP amplitude

B. Decreased insertional activity

C. Decreased motor nerve conduction velocity

D. Fibrillations and positive sharp waves

E. Large amplitude polyphasic motor unit potentials

12. Which of the following indicates abnormal motor unit firing:

A. Fibrillations and positive sharp waves

B. Myotonic discharges

C. Myokymic discharges

D. Complex repetitive discharges (CRDs)

13. Your patient presents with the following NCS and EMG findings: Decreased CMAP but normal SNAP amplitudes, normal motor and sensory nerve conduction velocity (NCV) values, repetitive motor nerve stimulation (RMNS) shows decreased response post exercise, no insertional activity, few spontaneous fibrillations, and some decreased amplitude polyphasic waveforms. This is suggestive of which of the following myopathic conditions?

A. Myopathy with denervation or polymyositis

B. Myotonia

C. Presynaptic neuromuscular junction (NMJ) disorder

D. Postsynaptic neuromuscular junction (NMJ) disorder

14. When looking at EMG interference patterns, a “picket fence” appearance suggests a neuropathic lesion. The “space between the pickets” helps determine whether the neuropathy is due to an upper motor neuron lesion (UMNL) or a lower motor neuron lesion (LMNL), because:

A. With a LMNL, the problem is one of motor unit Activation, resulting in a larger space between pickets

B. With a LMNL, the problem is one of motor unit Recruitment, resulting in a larger space between pickets

C. With an UMNL, the problem is one of motor unit Activation, resulting in a larger space between pickets

D. With a UMNL, the problem is one of motor unit Recruitment, resulting in a larger space between pickets

15. Which of the following diagnostic imaging techniques reflects the current metabolic rate of the tissue?

A. Ultrasound (US)

B. Computed tomography (CT)

C. Magnetic resonance imaging (MRI)

D. Positron emission tomography (PET)

16. In a CT scan…

A. Water appears as light gray

B. Blood appears as black

C. Cerebrospinal fluid (CSF) appears at bright white

D. Acute CNS bleeding appears as bright white areas

17. Which of the following has been shown to be superior in identifying acute brain infarction, within 12 hours of onset?

A. Diffusion-weighted MRI

B. CT with contrast

C. Conventional MRI

D. CT