EXERCISE PHYSIOLOGY LABORATORY
MANUAL
9TH EDITION
• AUTHOR(S)WILLIAM BEAM, GENE
ADAMS
TEST BANK
1) Corticospinal tract localization
Reference: Ch. 1 — General Organization — Descending Motor
Pathways
Clinical/Applied Stem:
A 68-year-old man suddenly develops dense weakness of the
left face, arm, and leg after a small subcortical stroke. Sensation
is intact, and speech is only mildly slurred. The pattern suggests
disruption of a compact bundle of descending motor fibers
before they reach the brainstem.
Which structure is most likely damaged?
,A. Right dorsal column in the spinal cord
B. Left posterior limb of the internal capsule
C. Right spinothalamic tract in the spinal cord
D. Left anterior horn cells at multiple levels
Correct Answer: B. Left posterior limb of the internal capsule
Rationale — Correct Answer:
The posterior limb of the internal capsule contains densely
packed corticospinal fibers, so a small lesion can cause pure
contralateral motor deficits involving face, arm, and leg. The
lack of sensory loss supports a lesion in the motor pathway
rather than a mixed tract or peripheral nerve.
Rationale — Incorrect Options:
A. Dorsal column injury causes ipsilateral loss of vibration and
proprioception, not isolated weakness.
C. Spinothalamic tract injury would produce pain and
temperature deficits, not pure motor loss.
D. Anterior horn cell disease is a lower motor neuron process
and would not cause this sudden supranuclear pattern.
Teaching Point:
Dense unilateral weakness with intact sensation suggests a
compact corticospinal lesion.
Citation:
Goldberg, S. (2022). Clinical Neuroanatomy Made Ridiculously
Simple (6th ed.). Ch. 1.
,2) Upper motor neuron syndrome
Reference: Ch. 1 — General Organization — Motor System
Hierarchy
Clinical/Applied Stem:
A 74-year-old woman has right-sided weakness after a left
hemispheric stroke. On exam, tone is increased, deep tendon
reflexes are brisk, and the plantar response is extensor. There is
no muscle fasciculation or marked early atrophy.
Which type of lesion best explains these findings?
A. Upper motor neuron lesion
B. Lower motor neuron lesion
C. Neuromuscular junction lesion
D. Myopathy
Correct Answer: A. Upper motor neuron lesion
Rationale — Correct Answer:
Spasticity, hyperreflexia, and an extensor plantar response are
classic upper motor neuron signs. The lesion is above the
anterior horn cell and disrupts descending inhibition.
Rationale — Incorrect Options:
B. Lower motor neuron lesions cause flaccidity, hyporeflexia,
fasciculations, and atrophy.
C. Neuromuscular junction disorders cause fatigable weakness,
not brisk reflexes.
D. Myopathies cause proximal weakness but usually preserve
reflexes until later.
, Teaching Point:
Hyperreflexia and Babinski sign localize to the upper motor
neuron system.
Citation:
Goldberg, S. (2022). Clinical Neuroanatomy Made Ridiculously
Simple (6th ed.). Ch. 1.
3) Lower motor neuron syndrome
Reference: Ch. 1 — General Organization — Motor Neuron
Anatomy
Clinical/Applied Stem:
A 59-year-old man develops progressive weakness in one hand.
The muscles are visibly wasting, tone is reduced, reflexes are
decreased, and fine twitching is seen under the skin. Sensation
remains normal.
Which lesion site is most consistent with this pattern?
A. Primary motor cortex
B. Corticospinal tract in the brainstem
C. Anterior horn cell
D. Spinothalamic tract
Correct Answer: C. Anterior horn cell
Rationale — Correct Answer:
Atrophy, fasciculations, hypotonia, and hyporeflexia are lower
motor neuron signs. An anterior horn cell lesion produces
MANUAL
9TH EDITION
• AUTHOR(S)WILLIAM BEAM, GENE
ADAMS
TEST BANK
1) Corticospinal tract localization
Reference: Ch. 1 — General Organization — Descending Motor
Pathways
Clinical/Applied Stem:
A 68-year-old man suddenly develops dense weakness of the
left face, arm, and leg after a small subcortical stroke. Sensation
is intact, and speech is only mildly slurred. The pattern suggests
disruption of a compact bundle of descending motor fibers
before they reach the brainstem.
Which structure is most likely damaged?
,A. Right dorsal column in the spinal cord
B. Left posterior limb of the internal capsule
C. Right spinothalamic tract in the spinal cord
D. Left anterior horn cells at multiple levels
Correct Answer: B. Left posterior limb of the internal capsule
Rationale — Correct Answer:
The posterior limb of the internal capsule contains densely
packed corticospinal fibers, so a small lesion can cause pure
contralateral motor deficits involving face, arm, and leg. The
lack of sensory loss supports a lesion in the motor pathway
rather than a mixed tract or peripheral nerve.
Rationale — Incorrect Options:
A. Dorsal column injury causes ipsilateral loss of vibration and
proprioception, not isolated weakness.
C. Spinothalamic tract injury would produce pain and
temperature deficits, not pure motor loss.
D. Anterior horn cell disease is a lower motor neuron process
and would not cause this sudden supranuclear pattern.
Teaching Point:
Dense unilateral weakness with intact sensation suggests a
compact corticospinal lesion.
Citation:
Goldberg, S. (2022). Clinical Neuroanatomy Made Ridiculously
Simple (6th ed.). Ch. 1.
,2) Upper motor neuron syndrome
Reference: Ch. 1 — General Organization — Motor System
Hierarchy
Clinical/Applied Stem:
A 74-year-old woman has right-sided weakness after a left
hemispheric stroke. On exam, tone is increased, deep tendon
reflexes are brisk, and the plantar response is extensor. There is
no muscle fasciculation or marked early atrophy.
Which type of lesion best explains these findings?
A. Upper motor neuron lesion
B. Lower motor neuron lesion
C. Neuromuscular junction lesion
D. Myopathy
Correct Answer: A. Upper motor neuron lesion
Rationale — Correct Answer:
Spasticity, hyperreflexia, and an extensor plantar response are
classic upper motor neuron signs. The lesion is above the
anterior horn cell and disrupts descending inhibition.
Rationale — Incorrect Options:
B. Lower motor neuron lesions cause flaccidity, hyporeflexia,
fasciculations, and atrophy.
C. Neuromuscular junction disorders cause fatigable weakness,
not brisk reflexes.
D. Myopathies cause proximal weakness but usually preserve
reflexes until later.
, Teaching Point:
Hyperreflexia and Babinski sign localize to the upper motor
neuron system.
Citation:
Goldberg, S. (2022). Clinical Neuroanatomy Made Ridiculously
Simple (6th ed.). Ch. 1.
3) Lower motor neuron syndrome
Reference: Ch. 1 — General Organization — Motor Neuron
Anatomy
Clinical/Applied Stem:
A 59-year-old man develops progressive weakness in one hand.
The muscles are visibly wasting, tone is reduced, reflexes are
decreased, and fine twitching is seen under the skin. Sensation
remains normal.
Which lesion site is most consistent with this pattern?
A. Primary motor cortex
B. Corticospinal tract in the brainstem
C. Anterior horn cell
D. Spinothalamic tract
Correct Answer: C. Anterior horn cell
Rationale — Correct Answer:
Atrophy, fasciculations, hypotonia, and hyporeflexia are lower
motor neuron signs. An anterior horn cell lesion produces
