Motor Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Motor Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Motor Disorders Indian Medical PG Question 1: A 3 year old child is brought to you with history of frequent, violent and rapid swinging movement of the left arm for one week duration. What is the condition described in this scenario called?
- A. Athetosis
- B. Dystonia
- C. Chorea
- D. Hemiballismus (Correct Answer)
Motor Disorders Explanation: ***Hemiballismus***
- **Hemiballismus** is characterized by sudden, involuntary, wild, rapid, and **flailing movements** of one side of the body, primarily affecting the proximal musculature such as the arm and leg.
- The description of "frequent, violent and rapid swinging movement of the left arm" perfectly aligns with the clinical presentation of hemiballismus, often resulting from a lesion in the **subthalamic nucleus**.
*Athetosis*
- **Athetosis** involves slow, writhing, involuntary movements, especially in the distal parts of the limbs (fingers and toes).
- This condition is typically slower and more sustained than the "violent and rapid swinging" described in the scenario.
*Dystonia*
- **Dystonia** is characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements or postures.
- While it can involve forceful movements, it usually results in sustained postures or twisting movements rather than the rapid, flailing motion described.
*Chorea*
- **Chorea** refers to irregular, unpredictable, brief, and jerky movements that flow from one body part to another in a dance-like manner.
- Unlike the violent, large-amplitude movements of hemiballismus, chorea typically involves more distal and less organized movements.
Motor Disorders Indian Medical PG Question 2: A 2-year- old boy presents with progressive clumsiness and difficulty walking. On physical examination, the child has
large calves. He has difficulty walking on his toes and has a waddling gait as shown. Which of the following is the most likely diagnosis?
- A. Myotonic dystrophy
- B. Facioscapulo humeral dystrophy
- C. Becker muscular dystrophy
- D. Duchenne muscular dystrophy (Correct Answer)
- E. Limb-girdle muscular dystrophy
Motor Disorders Explanation: ***Duchenne muscular dystrophy***
- This X-linked recessive disorder is characterized by **progressive muscle weakness** and **atrophy**, typically presenting in early childhood with symptoms like **clumsiness, difficulty walking, and a waddling gait**.
- **Pseudohypertrophy of the calves**, due to fat and connective tissue infiltration, and walking on toes are classic signs, along with a **Gowers' sign** (using hands to push off the floor to stand).
*Myotonic dystrophy*
- This autosomal dominant disorder is frequently characterized by **myotonia** (delayed muscle relaxation), which is not described.
- Clinical features usually include **distal muscle weakness**, **facial weakness**, **cataracts**, and **cardiac conduction abnormalities**, and symptoms typically begin in adolescence or adulthood, though congenital forms exist with more severe weakness.
*Facioscapulohumeral dystrophy*
- This genetic disorder has a primary presentation involving weakness of the **facial muscles**, **shoulder girdle**, and **upper arm**, which is not the predominant symptom set.
- Onset is typically in adolescence or adulthood, with initial symptoms rarely affecting lower limb ambulation as severely in early childhood.
*Becker muscular dystrophy*
- While also an X-linked recessive disorder caused by a dystrophin gene mutation, **Becker muscular dystrophy** typically has a **later onset** and a **milder, slower progression** compared to Duchenne muscular dystrophy.
- Symptoms usually appear in adolescence or early adulthood, and patients often retain the ability to walk into adulthood, unlike the rapid progression seen in this 2-year-old.
*Limb-girdle muscular dystrophy*
- This heterogeneous group of disorders primarily affects **proximal muscles** of the pelvic and shoulder girdles.
- While it can present with proximal weakness, onset is typically **later in childhood or adolescence**, and **calf pseudohypertrophy** is less prominent than in Duchenne muscular dystrophy.
- The age of presentation (2 years) and classic features make Duchenne more likely.
Motor Disorders Indian Medical PG Question 3: Absence of which of the given milestones in a 3 year old child should be called delayed development?
- A. Hopping on one leg
- B. Catching a ball reliably
- C. Drawing a square
- D. Feeding by spoon (Correct Answer)
Motor Disorders Explanation: ***Feeding by spoon***
- The ability to **feed oneself with a spoon** is typically achieved by **15 to 18 months of age**, making its absence in a 3-year-old a sign of delayed development.
- This milestone reflects both **fine motor coordination** and **self-help skills**.
*Hopping on one leg*
- **Hopping on one leg** is a gross motor skill usually developed between **4 and 5 years of age**, so a 3-year-old not yet doing this is within the normal developmental range.
- This skill requires advanced **balance** and **coordination**.
*Catching a ball reliably*
- **Catching a ball reliably** typically emerges around **4 to 5 years of age**, as it requires good **hand-eye coordination** and **anticipation skills**.
- A 3-year-old's inability to catch a ball reliably is not considered delayed.
*Drawing a square*
- The ability to **draw a square** is usually achieved by **4 to 5 years of age**, requiring fine motor precision and visuomotor integration.
- At 3 years, children are more likely to be able to copy a **circle** or **vertical line**.
Motor Disorders Indian Medical PG Question 4: Lesion of globus pallidus causes
- A. Chorea
- B. Athetosis (Correct Answer)
- C. Hemibalismus
- D. Dystonia
Motor Disorders Explanation: ***Athetosis***
- **Athetosis** is the **classic movement disorder** associated with lesions of the **globus pallidus**, often occurring with **putamen** involvement.
- It is characterized by **slow, writhing, involuntary movements**, particularly affecting the **distal extremities** (hands and feet).
- Commonly seen in **kernicterus** (bilirubin-induced damage to basal ganglia), **cerebral palsy**, and **status marmoratus** of the basal ganglia.
- When combined with chorea, it forms **choreoathetosis**.
*Chorea*
- **Chorea** is predominantly associated with dysfunction of the **caudate nucleus** and **putamen**, as seen in **Huntington's disease**.
- It involves brief, irregular, unpredictable, **involuntary movements** that flow from one body part to another.
*Hemibalismus*
- **Hemibalismus** is most commonly caused by a lesion in the **subthalamic nucleus** (nucleus of Luys), often due to a **lacunar stroke**.
- It involves large-amplitude, **involuntary flinging movements** of the limbs on **one side of the body**.
*Dystonia*
- **Dystonia** involves sustained or repetitive muscle contractions leading to twisting movements or abnormal fixed postures.
- It results from dysfunction of **multiple basal ganglia structures** including the globus pallidus internal segment, putamen, and thalamus, but is **not the classic presentation** of isolated globus pallidus lesions.
Motor Disorders Indian Medical PG Question 5: A 7 year old boy with progressive muscle weakness and walking difficulties presented with the following finding. What is the probable diagnosis?
- A. Emery-Dreifuss muscular dystrophy
- B. Duchenne muscular dystrophy (Correct Answer)
- C. Spinal muscular atrophy
- D. Myotonic dystrophy
- E. Becker muscular dystrophy
Motor Disorders Explanation: ***Duchenne muscular dystrophy***
- The image illustrates the **Gower sign**, where the boy uses his hands to "walk up" his legs to stand from a seated position, indicating **proximal muscle weakness**, a classic feature of Duchenne muscular dystrophy (DMD).
- DMD is an X-linked recessive disorder characterized by rapid progressive muscle degeneration, typically presenting in early childhood (3-5 years) with muscle weakness, **waddling gait**, and frequent falls.
- The **age of presentation** (7 years) and **severity of weakness** requiring Gower's maneuver are most consistent with DMD rather than the milder Becker variant.
*Emery-Dreifuss muscular dystrophy*
- This dystrophy primarily affects **skeletal muscles** and the **cardiac muscle**, often presenting with joint contractures, particularly in the elbows, ankles, and neck, which are not explicitly shown or suggested as primary difficulties here.
- While it causes muscle weakness, the **pattern of weakness** and specific movements like the Gower sign are more characteristic of DMD in this age group.
*Spinal muscular atrophy*
- This condition involves the **loss of motor neurons** in the spinal cord, leading to widespread muscle weakness and atrophy, but it typically presents with **floppiness** (hypotonia) in infancy and absence of deep tendon reflexes.
- Patients with SMA would likely have significant difficulty achieving the positions seen in the Gower sign, and the muscle weakness is due to **nerve degeneration**, not directly to muscle pathology.
*Myotonic dystrophy*
- Myotonic dystrophy is characterized by **myotonia** (delayed muscle relaxation), distal muscle weakness, and often involves multiple organ systems.
- It usually presents later in childhood or adulthood with distinctive facial weakness, difficulty releasing grip, and is not typically associated with the classic presentation of **Gower sign** in a 7-year-old child.
*Becker muscular dystrophy*
- Becker muscular dystrophy is an **allelic variant** of DMD with mutations in the same dystrophin gene but producing a partially functional protein.
- It typically has a **later onset** (usually after age 10-12) and **slower progression** compared to DMD, making it less likely in a 7-year-old with significant weakness requiring Gower's maneuver.
- Patients with Becker can often maintain ambulation into their 20s or later, unlike DMD patients who typically lose ambulation by early teens.
Motor Disorders Indian Medical PG Question 6: In a 9-month-old child, which of the following reflexes is considered most abnormal?
- A. Parachute reflex
- B. Righting reflex
- C. Asymmetric tonic neck reflex (ATNR) (Correct Answer)
- D. None of the options
Motor Disorders Explanation: ***Asymmetric tonic neck reflex (ATNR)***
- The **ATNR** (fencing reflex) typically **disappears by 6 months of age**. Persistence beyond this age, especially at 9 months, is a critical indicator of potential neurological dysfunction or developmental delay.
- Its presence can hinder normal development, such as rolling, crawling, and reaching milestones like bringing hands to midline, and is therefore considered the **most abnormal** at this age.
*Parachute reflex*
- The **parachute reflex** (forward protective extension) typically emerges between **6 to 9 months of age** and persists throughout life.
- Its presence at 9 months indicates a normally developing protective mechanism and is therefore **normal**, not abnormal.
*Righting reflex*
- The **righting reflex** (which includes various head and body righting reactions), allows the infant to maintain an upright head position and orient the body relative to the head and gravity.
- These reflexes gradually develop and are often well-established by **6-12 months**, being crucial for independent sitting and balance, making its presence at 9 months **expected and normal**.
*None of the options*
- This option is incorrect because the **Asymmetric Tonic Neck Reflex (ATNR)** is indeed considered abnormal if present at 9 months of age, indicating a potential developmental concern.
Motor Disorders Indian Medical PG Question 7: Which of the following is not seen in a hyperkinetic child?
- A. Left-right disorientation (Correct Answer)
- B. Decreased attention span
- C. Aggressive outbursts
- D. Soft neurological signs
Motor Disorders Explanation: ***Left to right disorientation***
- **Left-right disorientation** is a sign of **developmental coordination disorder** or other specific learning difficulties, not a core symptom of hyperkinesis (ADHD).
- Hyperkinetic children primarily exhibit symptoms related to **inattention**, **hyperactivity**, and **impulsivity**.
*Decreased attention span*
- A **decreased attention span** is a cardinal feature of **Attention-Deficit/Hyperactivity Disorder (ADHD)**, which is synonymous with hyperkinesis in children.
- Children with ADHD often struggle with sustaining focus on tasks, leading to difficulties in academic and social settings.
*Aggressive outbursts*
- **Aggressive outbursts** and **irritability** can be associated features of hyperkinetic disorder, particularly in children who also experience **oppositional defiant disorder** or **conduct disorder** as comorbidities.
- Impulsivity and difficulty with emotional regulation can contribute to these behaviors.
*Soft neurological signs*
- **Soft neurological signs** (e.g., poor coordination, minor motor deficits, abnormal reflexes) are more frequently observed in children with **hyperkinetic disorder** compared to neurotypical children.
- These signs indicate subtle neurological dysfunction that is not localized or severe enough to be classified as a distinct neurological disorder.
Motor Disorders Indian Medical PG Question 8: Absence of which of the given milestones in a 3 year old child should be called delayed development?
- A. Feeding by spoon (Correct Answer)
- B. Hopping on one leg
- C. Drawing square
- D. Catching a ball reliably
Motor Disorders Explanation: ***Feeding by spoon***
- Self-feeding with a spoon is a **fine motor and adaptive skill** typically achieved between **12 to 18 months of age**.
- By 3 years old, children should be able to feed themselves proficiently with both spoon and fork.
- Absence of this skill at age 3 indicates **significant developmental delay** in fine motor and self-care abilities.
- This is a **red flag** requiring developmental assessment.
*Drawing square*
- Drawing a square is a fine motor milestone achieved around **4 to 5 years of age**.
- At age 3, children can typically copy a **circle** but not a square.
- Absence of square-drawing ability at age 3 is **normal** and does not indicate delay.
*Hopping on one leg*
- Hopping on one leg is a **gross motor skill** typically achieved between **4 to 5 years of age**.
- At age 3, children can stand briefly on one foot but hopping is more advanced.
- Absence at age 3 is **within normal developmental range**.
*Catching a ball reliably*
- Reliable ball-catching with good coordination develops between **4 to 5 years of age**.
- 3-year-olds may catch a large ball with two hands inconsistently.
- Absence of reliable catching at age 3 is **not a developmental concern**.
Motor Disorders Indian Medical PG Question 9: A pole vaulter had a fall during pole vaulting and had paralysis of the arm . Which of the following investigations gives the best recovery prognosis -
- A. Electromyography (Correct Answer)
- B. Strength Duration Curve
- C. Creatine phosphokinase levels
- D. Muscle biopsy
Motor Disorders Explanation: Electromyography
- **Electromyography (EMG)** can help assess the extent of nerve damage and reinnervation, providing insights into the potential for recovery [1].
- The presence of **spontaneous activity** (fibrillations, positive sharp waves) indicates denervation, while the appearance of **motor unit action potentials (MUAPs)** suggests reinnervation [1].
*Creatine phosphokinase levels*
- **Creatine phosphokinase (CPK)** levels primarily indicate **muscle damage**, not the extent of nerve injury or recovery potential.
- While muscle damage can occur with nerve injury, CPK does not provide specific prognostic information for nerve regeneration.
*Strength Duration Curve*
- The **strength duration curve** assesses the excitability of a nerve or muscle to electrical stimulation.
- While it can differentiate between **nerve and muscle damage**, it provides less comprehensive prognostic information compared to EMG regarding the status of nerve regeneration.
*Muscle biopsy*
- A **muscle biopsy** would directly evaluate muscle pathology, such as atrophy or regeneration.
- However, it is an **invasive procedure** and provides less direct information about nerve recovery compared to EMG, which directly assesses nerve and muscle electrical activity.
Motor Disorders Indian Medical PG Question 10: Which of the following are tools commonly used in the evaluation of children with cerebral palsy for motor function and spasticity assessment?
I. Gross Motor Function Classification System
II. Medical Research Council System
III. Modified Connors Scale (Connors-II)
IV. Modified Ashworth Scale
Select the correct answer using the code given below:
- A. III and IV
- B. I and IV (Correct Answer)
- C. I and II
- D. II and III
Motor Disorders Explanation: ***Correct: I and IV***
- The **Gross Motor Function Classification System (GMFCS)** is the gold standard tool to classify gross motor function in children with **cerebral palsy** based on self-initiated movement and functional limitations across five levels (I-V).
- The **Modified Ashworth Scale** is the most widely used clinical tool for assessing **spasticity** and muscle tone in cerebral palsy, grading resistance to passive movement on a 0-4 scale.
- These two tools directly address **motor function classification** and **spasticity assessment** as required in the question.
*Incorrect: III and IV*
- While the **Modified Ashworth Scale (IV)** is correctly identified for spasticity assessment, the **Modified Connors Scale (Connors-II)** is used exclusively for evaluating **Attention-Deficit/Hyperactivity Disorder (ADHD)**, not motor function or spasticity in cerebral palsy.
*Incorrect: I and II*
- The **GMFCS (I)** is correctly identified for motor function classification in cerebral palsy.
- However, the **Medical Research Council (MRC) System** is primarily used for **muscle strength grading** (0-5 scale) in conditions like peripheral neuropathy, stroke, or myopathy—not for motor function classification or spasticity assessment specific to cerebral palsy.
*Incorrect: II and III*
- Both tools are inappropriate for the stated purpose: the **MRC System** assesses muscle strength (not CP-specific motor function classification), and the **Modified Connors Scale** evaluates ADHD symptoms.
- Neither tool is standard for evaluating motor function or spasticity in cerebral palsy.
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