I85PREP
⌘ K
ABPTS NCS study materials
ABPTS NCS study resources

ABPTS NCS practice questions

One question at a time. Build your ABPTS NCS understanding.

First 50 of 199 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient reports a sudden, severe occipital headache with neck stiffness and photophobia that began during strenuous lifting. Which finding most increases suspicion for a subarachnoid hemorrhage rather than a benign musculoskeletal headache?

  1. Pain reproduced with active cervical rotation
  2. Headache that is dull and gradually builds over several days
  3. Tenderness to palpation over the suboccipital muscles
  4. Thunderclap onset reaching maximum intensity within seconds to minutes Correct answer.

Explanation

Subarachnoid hemorrhage classically presents with a thunderclap headache that peaks almost immediately, reflecting acute arterial bleeding into the subarachnoid space. Gradual-onset, movement-provoked, or palpation-reproduced pain patterns point toward musculoskeletal or tension-type sources.

Question 2Neuromuscular and Neurologic System Review and Differential Diagnosis

Which cranial nerve is most commonly affected in a patient presenting with acute, unilateral, peripheral facial weakness that also involves the forehead?

  1. Oculomotor nerve
  2. Facial nerve Correct answer.
  3. Hypoglossal nerve
  4. Trigeminal nerve

Explanation

Peripheral facial weakness affecting both the upper and lower face localizes to the facial nerve (CN VII) distal to the facial nucleus. Central lesions spare the forehead because of bilateral cortical innervation of the upper face.

Question 3Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient with acute low back pain and bilateral lower extremity weakness has saddle anesthesia, urinary retention, and decreased rectal tone. What is the most appropriate immediate action?

  1. Perform repeated straight-leg raise testing to confirm radiculopathy
  2. Arrange emergent referral for cauda equina syndrome Correct answer.
  3. Begin an aggressive lumbar stabilization program
  4. Apply lumbar traction and monitor for one week

Explanation

Saddle anesthesia, bowel or bladder dysfunction, and bilateral leg weakness constitute a red-flag constellation for cauda equina syndrome, which requires emergent imaging and surgical evaluation. Any delay risks permanent neurologic deficit.

Question 4Neuromuscular and Neurologic System Review and Differential Diagnosis

Which pattern of sensory loss best distinguishes a peripheral neuropathy from a spinal cord lesion?

  1. Contralateral loss of pain and temperature below the lesion
  2. Suspended sensory level with sacral sparing
  3. Stocking-glove distribution in a length-dependent pattern Correct answer.
  4. Dermatomal loss with a distinct segmental level

Explanation

Length-dependent peripheral neuropathies produce a stocking-glove pattern because the longest axons are affected first. Spinal cord lesions typically produce a sensory level corresponding to the involved segment.

Question 5Neuromuscular and Neurologic System Review and Differential Diagnosis

In a patient with a C5 tetraplegia, which muscle is most likely to remain under volitional control because its innervation arises above the lesion?

  1. Diaphragm Correct answer.
  2. Triceps brachii
  3. Deltoid
  4. Biceps brachii

Explanation

The diaphragm is innervated by the phrenic nerve (C3-C5), with the bulk of its supply above a C5 lesion, so it is typically spared in C5 tetraplegia. Elbow flexors and extensors are supplied by C5-C6 and C7 respectively and are affected.

Question 6Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient with multiple sclerosis reports transient worsening of vision and fatigue when overheated. What phenomenon does this describe?

  1. Uhthoff phenomenon Correct answer.
  2. Romberg sign
  3. Lhermitte sign
  4. Charcot triad

Explanation

Uhthoff phenomenon is the reversible worsening of neurologic symptoms with increased body temperature, reflecting heat-sensitive conduction block in demyelinated fibers. It is not a marker of new disease activity.

Question 7Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient presents with a resting tremor, cogwheel rigidity, and bradykinesia. Which medication class is most directly associated with the pathophysiology of these findings?

  1. Selective serotonin reuptake inhibitors
  2. Proton pump inhibitors
  3. Dopamine antagonists Correct answer.
  4. Beta-adrenergic agonists

Explanation

Parkinsonian signs arise from dopaminergic deficiency in the basal ganglia, and dopamine-blocking drugs can produce a secondary parkinsonism. Recognizing drug-induced parkinsonism is essential because it is potentially reversible.

Question 8Neuromuscular and Neurologic System Review and Differential Diagnosis

Which clinical feature most reliably differentiates a peripheral vestibular disorder from a central vestibular lesion?

  1. Sudden onset of spinning sensation
  2. Direction-changing nystagmus on gaze testing Correct answer.
  3. Vertigo worsened by head movement
  4. Presence of nausea and vomiting

Explanation

Direction-changing nystagmus with gaze fixation failure suggests a central lesion, whereas peripheral lesions typically produce unidirectional horizontal nystagmus that suppresses with fixation. Nausea and positional vertigo occur in both.

Question 9Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient has weakness of the right arm and leg with right-sided facial droop sparing the forehead, plus a left homonymous hemianopia. Where does the lesion most likely localize?

  1. Cervical spinal cord
  2. Peripheral facial nerve
  3. Right cerebral hemisphere
  4. Left cerebral hemisphere Correct answer.

Explanation

Contralateral hemiparesis, a central facial pattern with forehead sparing, and a contralateral visual field deficit localize to the left hemisphere. The corticospinal and corticobulbar tracts cross below the cortex, and the optic radiation carries contralateral field information.

Question 10Neuromuscular and Neurologic System Review and Differential Diagnosis

Which finding is most characteristic of an upper motor neuron lesion?

  1. Fasciculations with muscle atrophy
  2. Flaccid tone with diminished reflexes
  3. Hyperreflexia with a Babinski sign Correct answer.
  4. Fibrillations on needle electromyography

Explanation

Upper motor neuron lesions produce hyperreflexia, spasticity, and an extensor plantar response because descending inhibitory influence is lost. Lower motor neuron lesions cause flaccidity, atrophy, and fasciculations.

Question 11Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient with Guillain-Barré syndrome is being monitored. Which parameter most warrants close serial assessment because of the risk of respiratory failure?

  1. Vital capacity Correct answer.
  2. Ankle deep tendon reflexes
  3. Grip strength
  4. Pain intensity

Explanation

Respiratory muscle weakness is the major cause of morbidity in Guillain-Barré syndrome, so serial vital capacity measurement guides decisions about airway and ventilator support. Peripheral strength and reflex changes do not predict respiratory compromise as directly.

Question 12Neuromuscular and Neurologic System Review and Differential Diagnosis

Which clinical sign is most suggestive of myasthenia gravis rather than a myopathy?

  1. Fatigable weakness that worsens with sustained activity Correct answer.
  2. Proximal weakness with elevated creatine kinase
  3. Muscle pain after exertion
  4. Sensory loss in a stocking distribution

Explanation

Myasthenia gravis is a neuromuscular junction disorder producing fatigable weakness that worsens with use and improves with rest. Myopathies typically cause fixed proximal weakness with enzyme elevation.

Question 13Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient with a suspected cervical radiculopathy at C6 is examined. Which finding best supports this level?

  1. Weakness of elbow flexion and diminished biceps reflex Correct answer.
  2. Weakness of thumb extension and sensory loss over the middle finger
  3. Weakness of shoulder abduction and diminished brachioradialis reflex
  4. Weakness of finger abduction and diminished triceps reflex

Explanation

The C6 root contributes to the biceps and brachialis, so C6 radiculopathy typically produces elbow flexion weakness and a diminished biceps reflex with sensory changes in the thumb and index finger. Adjacent levels have different reflex and motor signatures.

Question 14Neuromuscular and Neurologic System Review and Differential Diagnosis

Which feature most increases the likelihood that a tremor is essential tremor rather than Parkinson disease?

  1. Tremor accompanied by cogwheel rigidity
  2. Tremor that is most prominent at rest and asymmetric
  3. Tremor that is most prominent with action and posture Correct answer.
  4. Tremor that resolves with voluntary movement

Explanation

Essential tremor is an action and postural tremor, often symmetric and improving with alcohol. Parkinsonian tremor is a rest tremor that attenuates with voluntary movement and is typically asymmetric.

Question 15Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient reports a band-like tightness around the trunk and a sensory level at T8 after a fall. What does this finding most suggest?

  1. Lumbar radiculopathy
  2. Peripheral neuropathy
  3. Cerebellar lesion
  4. Thoracic spinal cord injury Correct answer.

Explanation

A truncal band of tightness with a defined sensory level indicates a lesion at the corresponding spinal cord segment. Radiculopathy and neuropathy do not produce a discrete sensory level.

Question 16Neuromuscular and Neurologic System Review and Differential Diagnosis

Which cranial nerve deficit would most likely cause diplopia that worsens on downward and inward gaze?

  1. Vestibulocochlear nerve
  2. Trochlear nerve Correct answer.
  3. Optic nerve
  4. Facial nerve

Explanation

The trochlear nerve (CN IV) supplies the superior oblique, which depresses and intorts the eye, so its palsy causes vertical diplopia that worsens on downward and inward gaze. Other cranial nerves listed serve vision, facial movement, or hearing and balance.

Question 17Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient with a complete T10 spinal cord injury is being evaluated for mobility. Which function is most likely to be preserved?

  1. Upper extremity strength Correct answer.
  2. Volitional bowel and bladder control
  3. Independent ambulation with a walker
  4. Full trunk control without support

Explanation

A T10 lesion spares the cervical and upper thoracic segments, so upper extremity innervation remains intact. Trunk control, bowel and bladder function, and ambulation are variably impaired depending on the level.

Question 18Neuromuscular and Neurologic System Review and Differential Diagnosis

Which sign is most consistent with a cerebellar lesion?

  1. Loss of vibration sense in the feet
  2. Resting tremor of the hands
  3. Dysmetria on finger-to-nose testing Correct answer.
  4. Spasticity with clonus

Explanation

Cerebellar dysfunction produces errors in the rate, range, and force of movement, manifesting as dysmetria, dysdiadochokinesia, and intention tremor. Spasticity and sensory loss localize elsewhere.

Question 19Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient develops new-onset unilateral ptosis, diplopia, and a dilated pupil after a neck manipulation. Which diagnosis should be prioritized?

  1. Trigeminal neuralgia
  2. Vestibular neuritis
  3. Bell palsy
  4. Carotid artery dissection Correct answer.

Explanation

A painful Horner syndrome with ipsilateral cranial nerve deficits after neck trauma or manipulation raises concern for carotid artery dissection. The dilated pupil and ptosis reflect sympathetic and oculomotor involvement.

Question 20Neuromuscular and Neurologic System Review and Differential Diagnosis

Which examination finding best distinguishes a central facial palsy from a peripheral one?

  1. The eye cannot be closed on the affected side
  2. Forehead wrinkling is preserved on the affected side Correct answer.
  3. The mouth droops on the unaffected side
  4. Taste is lost on the anterior tongue

Explanation

Central facial palsy spares the upper face because the forehead receives bilateral cortical innervation, so wrinkling remains intact. Peripheral lesions affect both upper and lower face on the involved side.

Question 21Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient with amyotrophic lateral sclerosis shows a mix of muscle atrophy and hyperreflexia. What does this combination indicate?

  1. Neuromuscular junction blockade
  2. Isolated cerebellar degeneration
  3. Combined upper and lower motor neuron involvement Correct answer.
  4. Pure sensory neuropathy

Explanation

ALS is a motor neuron disease affecting both upper and lower motor neurons, producing atrophy and fasciculations alongside spasticity and hyperreflexia. Pure sensory or cerebellar patterns do not fit this combination.

Question 22Neuromuscular and Neurologic System Review and Differential Diagnosis

Which clinical feature most suggests a diagnosis of normal pressure hydrocephalus rather than Alzheimer disease?

  1. Personality change with preserved gait
  2. Stepwise cognitive decline with focal deficits
  3. Gait apraxia with urinary incontinence and cognitive decline Correct answer.
  4. Early prominent language deficit

Explanation

The classic triad of normal pressure hydrocephalus is gait disturbance, urinary incontinence, and cognitive impairment, with gait often the earliest and most prominent feature. Alzheimer disease typically presents with memory decline and preserved early gait.

Question 23Neuromuscular and Neurologic System Review and Differential Diagnosis

Which clinical finding is most consistent with a lesion of the median nerve at the wrist?

  1. Weakness of thumb abduction with sensory loss over the lateral palm Correct answer.
  2. Weakness of finger abduction with sensory loss over the little finger
  3. Weakness of elbow flexion with sensory loss over the forearm
  4. Weakness of wrist extension with sensory loss over the dorsum of the hand

Explanation

The median nerve supplies the thenar muscles, including the abductor pollicis brevis, and sensation over the lateral palm and first three digits. Compression at the wrist therefore produces thumb abduction weakness and lateral palmar sensory loss.

Question 24Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient reports brief, lancinating facial pain triggered by chewing and light touch over the cheek. Which diagnosis is most likely?

  1. Temporal arteritis
  2. Trigeminal neuralgia Correct answer.
  3. Bell palsy
  4. Cluster headache

Explanation

Trigeminal neuralgia produces paroxysmal, electric-shock-like pain in a trigeminal division distribution, provoked by innocuous stimuli such as chewing or touch. The other options cause different pain patterns or motor deficits.

Question 25Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient with a suspected brachial plexus injury has weakness of shoulder abduction and external rotation, with sensory loss over the lateral deltoid. Which root level is most likely involved?

  1. C5 Correct answer.
  2. T1
  3. C7
  4. C8

Explanation

The C5 root supplies the deltoid and supraspinatus through the axillary and suprascapular nerves, so shoulder abduction and external rotation weakness with lateral deltoid sensory loss localizes to C5. Lower roots supply distal forearm and hand muscles.

Question 26Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient reports episodes of vertigo, hearing loss, and tinnitus lasting hours, with symptom-free intervals between attacks. Which diagnosis best fits this presentation?

  1. Benign paroxysmal positional vertigo
  2. Vestibular schwannoma
  3. Vertebrobasilar insufficiency
  4. Meniere disease Correct answer.

Explanation

The combination of episodic vertigo lasting hours, fluctuating sensorineural hearing loss, and tinnitus with asymptomatic intervals is the classic tetrad of Meniere disease, reflecting endolymphatic hydrops. The episodic, hour-long time course with auditory symptoms separates it from positional and vascular causes.

Question 27Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient has a resting tremor, bradykinesia, and rigidity, and reports that symptoms began asymmetrically in the left hand. Which additional finding would most support a diagnosis of Parkinson disease over an atypical parkinsonian syndrome?

  1. Symmetrical onset with axial rigidity
  2. Sustained improvement with levodopa Correct answer.
  3. Poor response to levodopa from the outset
  4. Early prominent falls and dysautonomia

Explanation

Idiopathic Parkinson disease typically begins asymmetrically and shows a robust, sustained response to levodopa because the deficit is dopaminergic. Atypical parkinsonian syndromes more often present with early falls, symmetry, autonomic failure, and a limited levodopa response.

Question 28Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient has a sudden onset of severe vertigo, nausea, and unsteadiness, and examination shows spontaneous horizontal nystagmus that does not suppress with visual fixation. Which feature most suggests a central rather than peripheral cause?

  1. Nystagmus that changes direction with gaze and persists with fixation Correct answer.
  2. Nystagmus that is unidirectional and suppressed by fixation
  3. Positive head impulse test on the affected side
  4. Improvement of vertigo with positional maneuvers

Explanation

Direction-changing nystagmus and failure of fixation to suppress the nystagmus indicate a central vestibular lesion. Peripheral lesions typically produce unidirectional nystagmus that is suppressed by visual fixation.

Question 29Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient has weakness of the right arm and leg with right-sided facial droop sparing the forehead, plus a left homonymous hemianopia. Which vascular territory is most likely involved?

  1. Right middle cerebral artery
  2. Left middle cerebral artery Correct answer.
  3. Right posterior cerebral artery
  4. Left anterior cerebral artery

Explanation

A left middle cerebral artery lesion affects the left hemisphere, producing right-sided face and limb weakness with a cortical pattern of facial involvement and a contralateral visual field defect. The combination of motor and visual findings localizes to the MCA territory.

Question 30Neuromuscular and Neurologic System Review and Differential Diagnosis

A patient reports a two-week history of progressive symmetric weakness that began in the feet and has ascended to the thighs, with absent ankle reflexes. Cerebrospinal fluid analysis shows an elevated protein level with a normal white blood cell count. Which pattern best describes this presentation?

  1. Ascending areflexic weakness with albuminocytologic dissociation Correct answer.
  2. Proximal fatigable weakness with normal cerebrospinal fluid
  3. Descending spastic weakness with pleocytosis
  4. Asymmetric distal weakness with sensory level and elevated white blood cell count

Explanation

An ascending, symmetric, areflexic pattern of weakness combined with high cerebrospinal fluid protein and a normal cell count (albuminocytologic dissociation) is the classic profile of an acute inflammatory demyelinating polyradiculoneuropathy. The peripheral, areflexic distribution reflects involvement of nerve roots and peripheral nerves rather than the central nervous system.

Question 31Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient's score on the Mini-Mental State Examination is 22/30. Which interpretation is most accurate?

  1. The score suggests cognitive impairment warranting further evaluation. Correct answer.
  2. The score indicates a diagnosis of Alzheimer disease.
  3. The score is within normal limits for all adults.
  4. The score confirms intact executive function.

Explanation

Scores below the conventional cutoff of about 24/30 on the MMSE suggest cognitive impairment and should prompt more detailed assessment. A screening score alone cannot establish a specific dementia diagnosis or confirm domain-specific function.

Question 32Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

Which cranial nerve is tested by asking the patient to shrug the shoulders against resistance?

  1. Cranial nerve XI Correct answer.
  2. Cranial nerve VII
  3. Cranial nerve IX
  4. Cranial nerve XII

Explanation

The spinal accessory nerve (CN XI) innervates the trapezius and sternocleidomastoid, so shoulder shrug and head rotation against resistance test it. The other listed nerves serve different motor or mixed functions.

Question 33Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient demonstrates a score of 3/5 on manual muscle testing of the hip flexors. How is this grade best described?

  1. Palpable contraction without joint motion
  2. Active movement against gravity only
  3. Active movement against gravity with some resistance
  4. Active movement with gravity eliminated Correct answer.

Explanation

A grade of 3/5 indicates the muscle can move the joint through range against gravity; grade 2 indicates movement only with gravity eliminated. A grade of 3 is not against added resistance, which would be 4 or 5.

Question 34Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

During a sensory exam, a patient cannot identify a key placed in the hand without looking. This finding is best documented as a deficit in which modality?

  1. Proprioception
  2. Two-point discrimination
  3. Graphesthesia
  4. Stereognosis Correct answer.

Explanation

Stereognosis is the ability to recognize objects by touch with vision occluded, mediated by parietal cortical processing. Graphesthesia involves identifying numbers traced on the skin, and two-point discrimination measures spatial acuity.

Question 35Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient reports sudden onset of the worst headache of life with neck stiffness. Which action is most appropriate for the physical therapist?

  1. Begin a graded exercise program as planned
  2. Apply traction and reassess in one week
  3. Refer urgently for emergency medical evaluation Correct answer.
  4. Proceed with cervical mobilization to relieve stiffness

Explanation

A thunderclap headache with meningismus raises concern for subarachnoid hemorrhage or other serious pathology and requires urgent medical evaluation. Manual therapy or exercise would be inappropriate before medical clearance.

Question 36Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

The Romberg test is designed primarily to assess which function?

  1. Position sense contributing to standing balance Correct answer.
  2. Lower extremity strength
  3. Vestibular caloric response
  4. Cerebellar coordination of the upper limbs

Explanation

The Romberg test compares standing balance with eyes open versus closed; increased sway with eyes closed suggests impaired proprioceptive input to balance. It does not directly measure limb coordination, caloric responses, or strength.

Question 37Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

Which scale is specifically designed to grade the severity of spasticity by resistance to passive movement?

  1. Functional Independence Measure
  2. Modified Ashworth Scale Correct answer.
  3. Berg Balance Scale
  4. Glasgow Coma Scale

Explanation

The Modified Ashworth Scale grades resistance to passive stretch as a measure of spasticity. The Berg assesses balance, the FIM assesses functional independence, and the Glasgow assesses level of consciousness.

Question 38Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient with a cerebellar lesion is most likely to demonstrate which finding during finger-to-nose testing?

  1. Cogwheel rigidity
  2. Lead-pipe rigidity
  3. Resting tremor that resolves with movement
  4. Dysmetria with overshooting Correct answer.

Explanation

Cerebellar dysfunction produces dysmetria, with the limb overshooting or undershooting the target during goal-directed movement. Rigidity and resting tremor are associated with basal ganglia disorders.

Question 39Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient's deep tendon reflexes are 1+ and symmetric with mild atrophy and fasciculations in the distal legs. These findings are most consistent with which process?

  1. Upper motor neuron involvement
  2. Lower motor neuron involvement Correct answer.
  3. Basal ganglia dysfunction
  4. Cerebellar degeneration

Explanation

Hyporeflexia, atrophy, and fasciculations are hallmarks of lower motor neuron or peripheral nerve disease. Upper motor neuron lesions instead cause hyperreflexia and spasticity.

Question 40Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A therapist suspects a patient has homonymous hemianopia affecting the right visual field. Which bedside screening is most appropriate?

  1. Pupillary light reflex testing
  2. Corneal reflex testing
  3. Testing of extraocular muscle range
  4. Confrontation testing of each visual quadrant Correct answer.

Explanation

Confrontation visual field testing compares the patient's fields with the examiner's in each quadrant and can detect hemianopia. Pupillary, extraocular, and corneal tests assess different functions.

Question 41Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient with a right middle cerebral artery stroke is most likely to show which pattern of deficits?

  1. Left hemiparesis with neglect of the left side Correct answer.
  2. Bilateral lower extremity weakness with incontinence
  3. Isolated cerebellar ataxia without weakness
  4. Right hemiparesis with left-sided neglect

Explanation

A right MCA stroke affects the left hemisphere's contralateral motor pathways and right-hemisphere attentional networks, producing left hemiparesis and left-sided neglect. Bilateral leg weakness with incontinence suggests a different localization.

Question 42Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

Which finding best distinguishes a peripheral vestibular disorder from a central vestibular lesion in an acute dizziness presentation?

  1. Presence of nystagmus
  2. Nausea with vomiting
  3. Vertigo worse with head movement
  4. Nystagmus that is direction-changing on gaze testing Correct answer.

Explanation

Direction-changing or vertical nystagmus that does not suppress with fixation suggests a central lesion. Peripheral vestibular nystagmus is typically unidirectional and suppressed by visual fixation.

Question 43Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient with Parkinson disease is being examined. Which finding is most consistent with the disease?

  1. Spasticity with hyperreflexia
  2. Cogwheel rigidity with bradykinesia Correct answer.
  3. Dysmetria with intention tremor
  4. Chorea with hypotonia

Explanation

Parkinson disease is characterized by rigidity (often cogwheel), bradykinesia, resting tremor, and postural instability. Chorea, intention tremor, and spasticity point to other disorders.

Question 44Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient with a T4 complete spinal cord injury is being examined. Which finding is expected?

  1. Intact sensation to the umbilicus with no motor deficit
  2. Intact sacral sparing with voluntary anal contraction
  3. Preserved triceps reflex with absent lower extremity reflexes Correct answer.
  4. Normal bowel and bladder control

Explanation

A T4 lesion spares cervical-level reflexes such as the triceps while abolishing lower extremity reflexes and sensation below the level. Sacral sparing and normal bowel/bladder function would indicate an incomplete lesion.

Question 45Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

During examination of a patient with suspected carpal tunnel syndrome, which finding would most support the diagnosis?

  1. Absent biceps reflex
  2. Positive Phalen test reproducing median-distribution paresthesias Correct answer.
  3. Weakness of wrist extension with radial nerve distribution
  4. Positive straight leg raise

Explanation

The Phalen test provokes median nerve compression symptoms in the hand, supporting carpal tunnel syndrome. The straight leg raise, radial nerve weakness, and biceps reflex test other regions.

Question 46Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient scores 18/56 on the Berg Balance Scale. How should this result be interpreted?

  1. The patient is at low fall risk and independent in balance.
  2. The patient has normal balance for age.
  3. The score indicates cognitive impairment.
  4. The patient has balance impairment and increased fall risk. Correct answer.

Explanation

Lower Berg scores indicate greater balance impairment; scores in this range are associated with increased fall risk and need for assistive support. High scores near 56 suggest independent balance.

Question 47Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

Which examination finding is most suggestive of a cerebellar lesion affecting the lower extremities?

  1. Spastic scissoring gait
  2. Positive Romberg sign with preserved position sense
  3. Wide-based gait with veering and impaired tandem gait Correct answer.
  4. Steppage gait with foot drop

Explanation

Cerebellar gait ataxia presents as a wide-based, unsteady gait with poor tandem performance. A positive Romberg with preserved proprioception is more typical of vestibular dysfunction, and spastic or steppage gaits reflect other lesions.

Question 48Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient with a suspected C6 radiculopathy is examined. Which finding best supports this level?

  1. Diminished ankle reflex with weakness of plantar flexion
  2. Diminished patellar reflex with weakness of knee extension
  3. Diminished triceps reflex with weakness of elbow extension
  4. Diminished biceps reflex with weakness of elbow flexion Correct answer.

Explanation

The C5-C6 level contributes to the biceps reflex and elbow flexion, so biceps reflex diminution with elbow flexion weakness supports C6 involvement. Triceps, patellar, and ankle reflexes reflect other segments.

Question 49Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient with a left hemispheric stroke is being evaluated for communication. Which pattern is most consistent with Broca aphasia?

  1. Fluent speech with poor comprehension
  2. Intact repetition with fluent meaningless speech
  3. Severely impaired comprehension with fluent speech
  4. Nonfluent speech with relatively preserved comprehension Correct answer.

Explanation

Broca aphasia is nonfluent with effortful speech but relatively preserved comprehension, typically from a left frontal lesion. Fluent aphasias with poor comprehension suggest Wernicke or other posterior involvement.

Question 50Examination, Evaluation, and Diagnosis in Neurologic Physical Therapy

A patient demonstrates impaired proprioception and a positive Romberg sign, but strength and coordination are otherwise normal. Which localization is most likely?

  1. Dorsal column-medial lemniscus pathway Correct answer.
  2. Corticospinal tract
  3. Basal ganglia
  4. Cerebellar vermis

Explanation

Loss of position sense with a positive Romberg and normal strength suggests impaired dorsal column function, which carries proprioceptive input. Cerebellar, corticospinal, and basal ganglia lesions produce different patterns.