Mock Exam – Example Question & Score

The following is an example of a vignette style question. Students are presented with the vignette, the question, and the answer choices. After you choose the answer, you will click on the “see answer” button. The right/wrong result will show, together with the feedback for that specific question.

Vignette: Your 40-year-old female patient has recently been diagnosed with Amyotrophic Lateral Sclerosis (ALS). She initially saw her doctor because of progressive weakness in her hands, as well as mild swallowing issues. Her past medical history is otherwise unremarkable. You perform an initial assessment on your patient.

Which of the following statements is false regarding ALS and your assessment findings?

Correct Answer: C

1. Normal sensation is noted throughout testing as ALS does not affect the sensory system.
   • This is a TRUE statement.
   • the sensory system is NOT affected with ALS. The sensory tracts of the spinal cord are not damaged, only the motor tracts.
2. Muscle atrophy is observed in the patient’s hands and shoulder girdles due to anterior horn cell damage.
   • This is a TRUE statement
   • Muscle atrophy is a result of lower motor neuron damage.
   • ALS results in the progressive loss of both upper AND lower motor nerves:
     • Upper Motor Nerves: Corticospinal tract (motor tract)
     • Lower Motor Nerves: Anterior horn cells (contains cell bodies of motor neurons)
3. Muscle fasciculations are observed throughout the trunk and arms due to upper motor neuron damage.
   • This is the correct answer as it is a FALSE statement.
   • Fasciculations are brief, spontaneous contractions affecting a small number of muscle fibers, often causing a flicker of movement under the skin. They can be an early sign of motor neuron diseases such as ALS and are due to lower motor nerve injury NOT upper motor neuron injury.
4. Hyperreflexia is present with reflex testing in the upper and lower limbs bilaterally due to corticospinal tract damage.
   • The corticospinal tract contains upper motor neurons and damage here results in spasticity, hyperreflexia and motor impairments.

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