Neuromuscular and Degenerative Disorders Practice Questions

30 multiple-choice questions on Neuromuscular and degenerative disorders for paramedic and EMT students, from Chapter 19 (Neurologic Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A 24-year-old man woke after a large pasta dinner and a night of drinking unable to lift his arms or legs. He is alert with normal sensation and speech. His potassium is 2.1 mEq/L. What is the most likely diagnosis?

   1. A. Hypokalemic periodic paralysis
   2. B. Early Guillain-Barre syndrome
   3. C. An acute spinal cord compression
   4. D. A sudden myasthenic crisis
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   Answer: A. Hypokalemic periodic paralysis

   Hypokalemic periodic paralysis causes attacks of flaccid limb weakness with low potassium, often after a carbohydrate-rich meal, alcohol, or rest after exercise. Some cases are linked to an overactive thyroid, especially in young Asian men. Low potassium can cause dangerous dysrhythmias, so monitor the ECG. Guillain-Barre develops over days, spinal cord compression causes sensory loss and usually back pain, and myasthenic crisis causes fatigable eye, throat and breathing weakness.

2. A 31-year-old woman has had episodes of blurred vision in one eye and limb numbness that resolved over weeks. This pattern most suggests:

   1. A. Multiple sclerosis
   2. B. Guillain-Barré syndrome
   3. C. Myasthenia gravis
   4. D. Parkinson disease
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   Answer: A. Multiple sclerosis

   MS commonly affects young adults, more often women, with episodes of optic neuritis, sensory changes, and weakness separated in time and location.

3. An MS patient's symptoms worsen after a hot shower. This phenomenon is related to:

   1. A. A new inflammatory MS relapse
   2. B. Dehydration from showering
   3. C. Heat-slowed nerve conduction
   4. D. Heat damage to the myelin
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   Answer: C. Heat-slowed nerve conduction

   Heat impairs conduction in demyelinated nerves (Uhthoff phenomenon), temporarily worsening symptoms; cooling usually improves them. This is a pseudo-relapse rather than a new inflammatory attack, the heat does not damage the myelin itself, and a shower does not usually cause meaningful dehydration.

4. The classic triad of Parkinson disease is:

   1. A. Ptosis, diplopia, dysphagia
   2. B. Ataxia, nystagmus, confusion
   3. C. Tremor, rigidity, slowness
   4. D. Fever, rash, neck stiffness
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   Answer: C. Tremor, rigidity, slowness

   Parkinson disease causes resting tremor, cogwheel rigidity, and slow movement, along with postural instability and a shuffling gait.

5. A 68-year-old has a shaking of both hands when he holds a cup or writes, but not when his hands rest in his lap. It improves after a glass of wine, and his father had the same problem. What is the most likely cause?

   1. A. Parkinson disease
   2. B. Essential tremor
   3. C. Alcohol withdrawal
   4. D. A cerebellar stroke
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   Answer: B. Essential tremor

   Essential tremor is a common, often inherited tremor that appears when the hands are used or held out and often improves briefly with alcohol. Parkinson disease typically causes a tremor at rest with slowness and stiffness. Alcohol withdrawal tremor comes with anxiety, sweating and tachycardia after stopping drinking, and a cerebellar stroke begins suddenly with ataxia rather than as a long-standing tremor.

6. A Parkinson patient who abruptly stopped his levodopa now has fever, severe rigidity, and confusion. You should suspect:

   1. A. A typical Parkinson flare
   2. B. Malignant hyperthermia
   3. C. Serotonin syndrome
   4. D. Parkinsonism-hyperpyrexia
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   Answer: D. Parkinsonism-hyperpyrexia

   Abrupt withdrawal of dopaminergic drugs can cause a life-threatening syndrome resembling neuroleptic malignant syndrome with hyperthermia and rigidity. A typical Parkinson flare does not cause fever and confusion. Malignant hyperthermia is triggered by volatile anesthetics or succinylcholine, which he has not had, and serotonin syndrome follows serotonergic drugs and causes clonus and hyperreflexia rather than following levodopa withdrawal.

7. Which complication is a leading cause of death in advanced Parkinson disease?

   1. A. Status epilepticus
   2. B. Hypertensive crisis
   3. C. Liver failure from levodopa
   4. D. Aspiration pneumonia
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   Answer: D. Aspiration pneumonia

   Dysphagia in advanced Parkinson disease leads to aspiration pneumonia; falls are another major cause of injury. Seizures are not a feature of Parkinson disease, levodopa does not cause liver failure, and a hypertensive crisis is rare and mainly a drug-interaction risk with MAO inhibitors.

8. Amyotrophic lateral sclerosis affects which cells?

   1. A. Peripheral sensory neurons only
   2. B. Myelin in the brain only
   3. C. Upper and lower motor neurons
   4. D. The neuromuscular junction
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   Answer: C. Upper and lower motor neurons

   ALS progressively destroys upper and lower motor neurons, causing weakness, atrophy, fasciculations, and eventually respiratory failure, with cognition and sensation usually spared.

9. A patient with advanced ALS has increasing respiratory distress. Which issue should you clarify early?

   1. A. His preferred hospital
   2. B. Advance directives
   3. C. Recent sick contacts at home
   4. D. When his symptoms began
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   Answer: B. Advance directives

   Patients with advanced ALS often have made decisions about intubation and long-term ventilation, so clarify any advance directive, POLST or stated wishes early while preparing to support breathing. His preferred hospital, recent sick contacts and when the ALS first began may be worth noting later, but they do not change the immediate decision about airway support.

10. A 66-year-old's wife says he punches and kicks in his sleep, seeming to act out violent dreams, and once hit her by accident. Which disorder is most likely?

    1. A. REM sleep behavior disorder
    2. B. Sleepwalking (somnambulism)
    3. C. Adult night terrors
    4. D. Nocturnal frontal seizures
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    Answer: A. REM sleep behavior disorder

    In REM sleep behavior disorder, the normal muscle paralysis of dreaming sleep is lost, so people act out vivid dreams, often violent ones, and can injure themselves or a bed partner. It frequently precedes Parkinson disease or Lewy body dementia by years. Sleepwalking and night terrors occur mainly in children during deep non-dream sleep without dream recall, and nocturnal seizures cause stereotyped movements rather than acted-out dreams.

11. A 35-year-old woman has drooping eyelids and double vision that worsen as the day progresses. This most suggests:

    1. A. Bell palsy
    2. B. Multiple sclerosis
    3. C. Parkinson disease
    4. D. Myasthenia gravis
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    Answer: D. Myasthenia gravis

    Fatigable weakness affecting ocular muscles, worse with use and later in the day, is characteristic of myasthenia gravis.

12. Whenever a 19-year-old laughs hard, his knees buckle and he slumps to the floor for a few seconds, fully aware. He also falls asleep during class most days. What is the most likely cause?

    1. A. Atonic seizures from epilepsy
    2. B. Cataplexy from narcolepsy
    3. C. Vasovagal syncope from laughing
    4. D. Myasthenia gravis with fatigue
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    Answer: B. Cataplexy from narcolepsy

    Cataplexy is a sudden, brief loss of muscle tone triggered by strong emotion such as laughter, with full awareness throughout, and with excessive daytime sleepiness it is typical of narcolepsy type 1. Atonic seizures are not triggered by emotion and cause a brief loss of awareness, vasovagal syncope causes loss of consciousness, and myasthenia causes weakness that worsens with repeated use.

13. A myasthenic patient in respiratory distress has an SpO2 of 96%. Why should you not be reassured?

    1. A. Pulse oximetry reads too low
    2. B. Myasthenia falsely raises SpO2
    3. C. Oxygen worsens myasthenia
    4. D. CO2 rises before SpO2 falls
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    Answer: D. CO2 rises before SpO2 falls

    Neuromuscular respiratory failure causes CO2 retention before desaturation, especially on oxygen; watch for weak cough, inability to count in one breath, and rising ETCO2. The oximeter reads accurately in myasthenia rather than too high or too low; it simply falls late, and oxygen does not worsen the disease.

14. A myasthenia patient who took extra pyridostigmine has increased salivation, sweating, cramping, and weakness. You should suspect:

    1. A. Cholinergic crisis
    2. B. Myasthenic crisis
    3. C. Anticholinergic toxicity
    4. D. Serotonin syndrome
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    Answer: A. Cholinergic crisis

    Excess cholinesterase inhibitor causes cholinergic crisis with SLUDGE-type muscarinic signs and weakness. Both crises can cause respiratory failure.

15. A 35-year-old with myotonic dystrophy, who has trouble letting go after a handshake, fainted at home. What cause should be your main concern?

    1. A. A simple vasovagal faint
    2. B. A myasthenic crisis with fainting
    3. C. A low blood sugar episode
    4. D. A heart conduction problem
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    Answer: D. A heart conduction problem

    Myotonic dystrophy affects the heart's conduction system as well as the muscles, so conduction block and dangerous arrhythmias are common causes of syncope and sudden death. These patients need an ECG and monitoring, and they are also very sensitive to sedatives. A vasovagal faint should not be assumed, myasthenic crisis is a different disease, and a low blood sugar episode should be checked for but is not the main concern.

16. An hour after eating mussels harvested during a red tide warning, a man has tingling and numbness of his lips and face, feels like he is floating, and his arms are getting weak. What is the main danger?

    1. A. Shock from severe vomiting
    2. B. Kidney failure within the hour
    3. C. Anaphylaxis from a shellfish allergy
    4. D. Paralysis of the breathing muscles
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    Answer: D. Paralysis of the breathing muscles

    Paralytic shellfish poisoning comes from a toxin made by algae blooms (red tides) that blocks nerve conduction. Within minutes to hours it causes numbness of the mouth and face, then weakness that can progress to respiratory failure. There is no antidote, so care focuses on monitoring and supporting breathing. Vomiting can occur but is not the main danger, anaphylaxis would bring hives, wheezing or swelling rather than numbness and spreading weakness, and the toxin does not cause early kidney failure.

17. Besides respiratory failure, which complication of Guillain-Barré syndrome requires close monitoring?

    1. A. Severe hyperglycemia
    2. B. Autonomic instability
    3. C. Sudden visual loss
    4. D. Recurrent seizures
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    Answer: B. Autonomic instability

    GBS can affect autonomic nerves, causing labile blood pressure and dangerous arrhythmias; cardiac monitoring is recommended.

18. A 72-year-old with Parkinson disease has fallen several times when getting up. His BP falls from 136/80 to 96/58 mm Hg on standing. What is the most likely cause of his falls?

    1. A. Peak-dose dyskinesia from levodopa
    2. B. A cerebellar stroke
    3. C. A normal finding with aging
    4. D. Orthostatic hypotension
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    Answer: D. Orthostatic hypotension

    Parkinson disease damages the autonomic nervous system, and levodopa and dopamine agonists also lower BP, so orthostatic hypotension is a common cause of lightheadedness and falls. A BP drop of 40 mm Hg on standing confirms it. Dyskinesias are writhing movements, a cerebellar stroke causes sudden ataxia, and a drop this large is not normal aging.

19. A child must push on his thighs with his hands to stand up from the floor. This Gowers sign suggests:

    1. A. Spinal cord transection
    2. B. Cerebellar truncal ataxia
    3. C. Normal motor development
    4. D. Proximal muscle weakness
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    Answer: D. Proximal muscle weakness

    The Gowers sign indicates proximal hip and thigh weakness, classically seen in Duchenne muscular dystrophy.

20. Huntington disease is characterized by:

    1. A. Fatigable eye weakness
    2. B. Ascending paralysis
    3. C. Chorea and dementia
    4. D. Resting pill-rolling tremor
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    Answer: C. Chorea and dementia

    Huntington disease is an inherited, autosomal dominant disorder causing involuntary jerky movements (chorea), psychiatric changes, and dementia.

21. After a vacation meal of barracuda, a woman has vomiting and diarrhea, tingling around her mouth, and says cold drinks feel hot. What is the most likely cause?

    1. A. Scombroid fish poisoning
    2. B. A shellfish allergy
    3. C. Ciguatera fish poisoning
    4. D. Foodborne botulism
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    Answer: C. Ciguatera fish poisoning

    Ciguatera comes from a toxin that builds up in large reef fish such as barracuda, grouper and snapper. It causes stomach symptoms and then numbness and tingling, and the classic reversal of hot and cold sensation, sometimes with slow heart rate and low BP. Scombroid causes flushing and a peppery taste like an allergic reaction, a shellfish allergy would need shellfish, and botulism causes descending weakness without temperature reversal.

22. Why is protecting the eye important in a patient with Bell palsy?

    1. A. The pupil cannot react
    2. B. The eye cannot move outward
    3. C. The cornea is anesthetic
    4. D. The eyelid may not close
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    Answer: D. The eyelid may not close

    Inability to close the eyelid can lead to corneal drying and injury; patients often need lubrication and eye protection. The facial nerve does not move the eye, so outward gaze (sixth nerve) is normal, the pupil (third nerve) still reacts, and corneal sensation (fifth nerve) is preserved.

23. A 50-year-old woman has had weeks of trouble climbing stairs and lifting her arms above her head. She has a purple rash on her eyelids and red, scaly patches over her knuckles. What is the most likely diagnosis?

    1. A. Dermatomyositis
    2. B. Myasthenia gravis
    3. C. Polymyalgia rheumatica
    4. D. Guillain-Barre syndrome
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    Answer: A. Dermatomyositis

    Dermatomyositis is an inflammatory muscle disease that causes weakness of the hips and shoulders with a purplish eyelid rash and scaly patches over the knuckles. It can weaken swallowing and breathing muscles and is linked to cancer in older adults. Myasthenia causes fatigable eye and throat weakness without a rash, polymyalgia rheumatica causes pain and stiffness rather than true weakness, and Guillain-Barre develops over days with lost reflexes.

24. Patients with spina bifida have an increased risk of which allergy relevant to EMS care?

    1. A. Penicillin
    2. B. Shellfish
    3. C. Latex
    4. D. Egg protein
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    Answer: C. Latex

    Repeated exposure to latex during surgeries leads to a high rate of latex allergy in spina bifida patients; use latex-free equipment.

25. Cerebral palsy is best described as:

    1. A. A progressive muscle disease
    2. B. A nonprogressive motor disorder
    3. C. A form of dementia
    4. D. An infection of the spinal cord
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    Answer: B. A nonprogressive motor disorder

    Cerebral palsy results from injury to the developing brain and causes nonprogressive motor impairment; intellect varies widely and should not be assumed impaired.

26. A patient with a deep brain stimulator for Parkinson disease needs defibrillation. Which approach is appropriate?

    1. A. Delay shocks until it is turned off
    2. B. Defibrillate as indicated
    3. C. Remove the device first
    4. D. Use half the usual energy
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    Answer: B. Defibrillate as indicated

    Life-saving defibrillation should not be delayed because of an implanted stimulator; place the pads away from the generator if possible and shock at the usual energy. The device may need to be checked afterward. Waiting to turn it off delays care, the device cannot be removed in the field, and reducing the energy lowers the chance of success.

27. Which statement about patients with ALS is most accurate?

    1. A. Sensation is lost very early
    2. B. It improves with rest
    3. C. It affects only the eye muscles
    4. D. Cognition is often spared
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    Answer: D. Cognition is often spared

    Most ALS patients retain sensation and intellect while losing motor function, so speak directly to the patient and involve them in decisions.

28. A few weeks after a sore throat, a 9-year-old has jerky, purposeless movements of his arms and face, and his handwriting has become messy. What is the most likely cause?

    1. A. A simple motor tic disorder of childhood
    2. B. Absence seizures with automatisms
    3. C. Sydenham chorea (rheumatic fever)
    4. D. Huntington disease
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    Answer: C. Sydenham chorea (rheumatic fever)

    Sydenham chorea is a feature of rheumatic fever that appears weeks to months after a strep throat infection. It causes irregular, flowing, purposeless movements, clumsiness and emotional changes, and the child also needs a heart evaluation for rheumatic carditis. A simple motor tic disorder causes brief, repetitive movements that can be briefly suppressed, absence seizures cause staring, and Huntington disease begins in adulthood.

29. A 45-year-old wakes at night with numbness of the thumb, index and middle fingers of her right hand that improves when she shakes the hand. Her face, speech and arm strength are normal. What is the most likely cause?

    1. A. A transient ischemic attack (TIA)
    2. B. Cervical nerve root compression
    3. C. Median nerve pressure at the wrist
    4. D. Ulnar nerve compression at the elbow
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    Answer: C. Median nerve pressure at the wrist

    Carpal tunnel syndrome compresses the median nerve at the wrist, causing numbness of the thumb, index and middle fingers, typically at night and relieved by shaking the hand. A transient ischemic attack (TIA) comes on suddenly and is not relieved by shaking the hand. A cervical root problem usually brings neck pain that spreads down the arm, and ulnar nerve compression causes numbness of the little and ring fingers.

30. Post-polio syndrome typically presents as:

    1. A. New weakness years after polio
    2. B. Acute paralysis from new polio
    3. C. Seizures in childhood
    4. D. Ascending paralysis after diarrhea
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    Answer: A. New weakness years after polio

    Post-polio syndrome causes new fatigue, weakness, and sometimes breathing or swallowing problems decades after the original polio infection.