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NPTE-PTA practice questions

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Question 1Musculoskeletal System

Which ligament of the knee primarily resists anterior translation of the tibia on the femur?

  1. Anterior cruciate ligament Correct answer.
  2. Lateral collateral ligament
  3. Posterior cruciate ligament
  4. Medial collateral ligament

Explanation

The anterior cruciate ligament checks anterior tibial translation as well as rotational stress on the knee. The other ligaments limit posterior translation or varus/valgus angulation rather than sagittal translation.

Question 2Musculoskeletal System

Normal active knee flexion range of motion in an adult is approximately:

  1. 0 to 135 degrees Correct answer.
  2. 0 to 45 degrees
  3. 0 to 180 degrees
  4. 0 to 90 degrees

Explanation

The knee flexes to roughly 135 degrees, with the exact value varying with body habitus and soft tissue bulk. Values of 90 degrees or less are considered limited, and 180 degrees is well beyond normal knee excursion.

Question 3Musculoskeletal System

A patient moves the elbow through complete active flexion and extension against gravity but cannot tolerate any added manual resistance. This corresponds to which manual muscle test grade?

  1. 3/5 (Fair) Correct answer.
  2. 5/5 (Normal)
  3. 2/5 (Poor)
  4. 4/5 (Good)

Explanation

Grade 3 indicates the muscle can move the joint through the full available range against gravity but cannot overcome added resistance. Grade 2 eliminates gravity, grade 4 tolerates moderate resistance, and grade 5 tolerates maximal resistance.

Question 4Musculoskeletal System

A patient twists the ankle inward during a run and reports mild pain and swelling. There is no joint laxity on stress testing and the patient can bear full weight. This presentation is most consistent with:

  1. A grade I lateral ankle sprain Correct answer.
  2. A syndesmotic (high) ankle sprain
  3. A grade II lateral ankle sprain
  4. A grade III lateral ankle sprain

Explanation

A grade I sprain involves ligament stretching without instability, so the patient can bear weight and stress testing shows no laxity. Grade II involves a partial tear with mild laxity, and grade III involves a complete tear with gross instability.

Question 5Musculoskeletal System

Which precaution set is appropriate after a total hip arthroplasty performed through a posterior approach?

  1. Full weight bearing with a brace locked in extension
  2. Knee flexion limited to 60 degrees with a pillow under the knee
  3. Hip flexion to 90 degrees, no adduction, no internal rotation Correct answer.
  4. Hip flexion to 45 degrees, no abduction, no external rotation

Explanation

Posterior-approach precautions protect the posterior capsule by limiting flexion to about 90 degrees, blocking adduction past midline, and preventing internal rotation. Abduction and external rotation are generally permitted and encouraged with an abduction pillow.

Question 6Musculoskeletal System

Normal active shoulder flexion range of motion in an adult is approximately:

  1. 0 to 180 degrees Correct answer.
  2. 0 to 120 degrees
  3. 0 to 90 degrees
  4. 0 to 60 degrees

Explanation

Shoulder flexion normally reaches about 180 degrees, with roughly two thirds occurring at the glenohumeral joint and the remainder through scapulothoracic motion. Measurements of 90 to 120 degrees would indicate significant limitation.

Question 7Musculoskeletal System

During the first 48 hours after an acute ankle inversion injury, the most appropriate intervention is:

  1. Deep transverse friction massage over the lateral malleolus
  2. Immediate return to sport in a lace-up brace
  3. Vigorous stretching of the lateral ligaments
  4. Rest, ice, compression, and elevation Correct answer.

Explanation

Acute soft tissue injury is managed initially with rest, ice, compression, and elevation to limit bleeding, edema, and pain. Aggressive stretching or massage in this phase may increase tissue damage and swelling.

Question 8Musculoskeletal System

Sensation on the palmar surface of the thumb is supplied primarily by which nerve root?

  1. C5
  2. C7
  3. C8
  4. C6 Correct answer.

Explanation

The C6 dermatome covers the palmar surface of the thumb and the radial forearm. C5 covers the lateral arm, C7 the middle finger, and C8 the little finger.

Question 9Musculoskeletal System

The Lachman test is performed with the knee positioned in:

  1. 45 degrees of flexion in internal rotation
  2. 20 to 30 degrees of flexion Correct answer.
  3. Full extension in external rotation
  4. 90 degrees of flexion

Explanation

The Lachman test is performed near 20 to 30 degrees of knee flexion, where the hamstrings are relatively relaxed and the anterior cruciate ligament is the primary restraint. Placing the knee at 90 degrees assesses the posterior cruciate ligament or the anterior drawer.

Question 10Musculoskeletal System

A patient reports a click and medial knee pain when the examiner flexes, internally rotates, and extends the knee while applying a valgus force. This finding suggests injury to the:

  1. Patellar tendon
  2. Posterior cruciate ligament
  3. Medial meniscus Correct answer.
  4. Anterior cruciate ligament

Explanation

The McMurray test loads the meniscus by combining flexion, rotation, and a valgus or varus force; a click or pain along the joint line suggests a meniscal tear. Medial joint line findings correspond to the medial meniscus.

Question 11Musculoskeletal System

Which test is designed to isolate the supraspinatus tendon?

  1. Speed test
  2. Empty can (Jobe) test Correct answer.
  3. Lift-off (Gerber) test
  4. Belly-press test

Explanation

The empty can test positions the arm in 90 degrees of scaption with internal rotation and applies downward resistance, which preferentially loads the supraspinatus. Pain or weakness suggests tendinopathy or a tear of that tendon.

Question 12Musculoskeletal System

The capsular pattern of the glenohumeral joint is:

  1. External rotation, abduction, internal rotation Correct answer.
  2. Internal rotation, adduction, extension
  3. Flexion, abduction, extension
  4. Abduction, extension, internal rotation

Explanation

In a true capsular restriction of the glenohumeral joint, external rotation is most limited, followed by abduction, then internal rotation. This pattern helps distinguish adhesive capsulitis from focal tendon pathology.

Question 13Musculoskeletal System

A patient reports lateral elbow pain that increases with resisted wrist extension and with gripping. This finding is most consistent with:

  1. Lateral epicondylitis Correct answer.
  2. Cubital tunnel syndrome
  3. Medial epicondylitis
  4. Olecranon bursitis

Explanation

Resisted wrist extension and gripping load the common extensor tendon at the lateral epicondyle, reproducing pain in lateral epicondylitis. Medial epicondylitis is provoked by resisted wrist flexion, and cubital tunnel syndrome produces ulnar nerve symptoms.

Question 14Musculoskeletal System

Which finding is most consistent with carpal tunnel syndrome?

  1. Numbness along the ulnar border of the hand and little finger
  2. Paresthesia over the dorsum of the first web space
  3. Pain reproduced by resisted wrist extension
  4. Numbness of the thumb, index, and middle fingers that awakens the patient at night Correct answer.

Explanation

The median nerve supplies the thumb, index, middle, and radial half of the ring finger, and compression in the carpal tunnel classically causes nocturnal numbness in that distribution. Ulnar border symptoms point to a Guyon canal or cubital tunnel problem.

Question 15Musculoskeletal System

A patient reports sharp heel pain with the first steps out of bed each morning. Which examination finding best supports a diagnosis of plantar fasciitis?

  1. Pain reproduced by a calcaneal squeeze
  2. Pain with toe extension while standing on the affected foot Correct answer.
  3. Pain with resisted plantar flexion with the knee extended
  4. Heel pad numbness that resolves with weight bearing

Explanation

The windlass test places the plantar fascia under tension by extending the toes during weight bearing and reproduces pain at the medial calcaneal tubercle. Morning first-step pain is the hallmark symptom because the fascia shortens overnight.

Question 16Musculoskeletal System

Which measure best prevents a knee flexion contracture after total knee arthroplasty?

  1. Positioning the knee in full extension with a towel roll under the heel Correct answer.
  2. Delaying terminal knee extension exercises until week six
  3. Placing two pillows under the knee during sleep
  4. Encouraging prolonged sitting with the knee flexed

Explanation

A towel roll under the heel uses gravity to encourage full passive extension and prevents the knee from resting in flexion. Pillows under the knee and prolonged sitting promote flexion contracture.

Question 17Musculoskeletal System

In Maitland joint mobilization grading, a grade III oscillation is described as:

  1. A large-amplitude movement that stays before tissue resistance
  2. A small-amplitude movement at the beginning of the range
  3. A small-amplitude movement into tissue resistance
  4. A large-amplitude movement reaching into tissue resistance Correct answer.

Explanation

Grade III is a large-amplitude oscillation that moves from mid-range into tissue resistance, and is used to improve mobility. Grades I and II are small-amplitude oscillations, and grade IV is a small-amplitude movement at the resistance end of range.

Question 18Musculoskeletal System

A grade II muscle strain is best characterized by:

  1. A complete tear that is painless on resisted contraction
  2. A complete rupture with a palpable defect
  3. A partial tear with moderate pain and reduced strength Correct answer.
  4. A microscopic injury with no loss of strength

Explanation

Grade II strains involve partial disruption of the muscle-tendon unit, producing moderate pain, swelling, and measurable strength loss. Grade I injuries are microscopic with minimal strength loss, while grade III injuries are complete ruptures.

Question 19Musculoskeletal System

Which exercise is safest and most appropriate for a patient with diagnosed osteoporosis?

  1. Jumping rope for 10 minutes to stimulate bone density
  2. Seated trunk flexion with rotation using a weighted bar
  3. Resisted hip abduction in standing with light tubing Correct answer.
  4. Ballistic trunk extension stretching at end range

Explanation

Resisted hip abduction in standing loads the hip in a controlled, upright position without spinal flexion or impact, which is appropriate for osteoporotic bone. Flexion with rotation, ballistic end-range motion, and high-impact jumping increase vertebral compression fracture risk.

Question 20Musculoskeletal System

A patient with low back pain reports that symptoms increase with sitting and ease with standing extension. The most appropriate initial intervention is:

  1. Repeated lumbar flexion in supine
  2. Repeated extension exercises in standing Correct answer.
  3. Sustained flexion stretching in sitting
  4. Lumbar traction applied in a flexed position

Explanation

Symptoms that worsen with flexion and improve with extension indicate a directional preference for extension. Repeated extension in standing promotes centralization of symptoms in this pattern.

Question 21Musculoskeletal System

A runner has anterior knee pain that worsens with stairs and squatting, and a single-leg squat shows the knee falling into valgus. The most appropriate intervention is:

  1. Iliopsoas stretching in prone
  2. Gastrocnemius stretching in standing
  3. Hip adductor strengthening
  4. Gluteus medius and external rotator strengthening Correct answer.

Explanation

Dynamic knee valgus during single-leg tasks reflects insufficient hip abductor and external rotator control, which increases patellofemoral stress. Strengthening the gluteus medius and deep external rotators improves frontal plane control of the limb.

Question 22Musculoskeletal System

Which finding is most characteristic of iliotibial band syndrome?

  1. Diffuse anterior knee pain that worsens with prolonged sitting
  2. Posterior knee pain with resisted hamstring contraction
  3. Medial joint line pain with a positive McMurray test
  4. Lateral knee pain that appears after a predictable running distance Correct answer.

Explanation

Iliotibial band syndrome produces lateral knee pain that typically begins at a reproducible distance or time into a run and resolves with rest. The predictable onset distinguishes it from intra-articular or patellofemoral sources of pain.

Question 23Musculoskeletal System

Which exercise is most appropriate to include during the first two weeks after anterior cruciate ligament reconstruction with a patellar tendon graft?

  1. Straight-line jogging on a treadmill
  2. Open-chain resisted knee extension from 0 to 45 degrees
  3. Deep squats to 110 degrees of knee flexion
  4. Quadriceps sets with the knee in full extension Correct answer.

Explanation

Early rehabilitation emphasizes quadriceps activation, full passive extension, and protected weight bearing; quadriceps sets in full extension achieve this without stressing the graft. High graft tension from open-chain resisted extension near full extension and high joint compression from deep squats are introduced later.

Question 24Musculoskeletal System

A patient has medial scapular winging and difficulty raising the arm above shoulder height. Which muscle is most likely involved?

  1. Trapezius
  2. Levator scapulae
  3. Serratus anterior Correct answer.
  4. Rhomboid major

Explanation

The serratus anterior protracts and upwardly rotates the scapula and holds it against the thorax; weakness from long thoracic nerve injury causes medial border winging and impaired overhead elevation. The trapezius, rhomboids, and levator scapulae have different actions and produce different patterns of dysfunction.

Question 25Musculoskeletal System

The Hawkins-Kennedy test is performed by:

  1. Resisted external rotation with the arm at the side
  2. Shoulder flexion to 90 degrees with internal rotation Correct answer.
  3. Hand to opposite shoulder against resistance
  4. Full shoulder elevation with the thumb pointing down

Explanation

The Hawkins-Kennedy test flexes the shoulder to 90 degrees and internally rotates the humerus, driving the greater tuberosity under the coracoacromial arch to reproduce subacromial impingement pain. It differs from Neer's test, which uses full overhead flexion.

Question 26Musculoskeletal System

A patient has weakness with shoulder abduction and elbow flexion, along with a diminished biceps reflex. Which nerve root is most likely involved?

  1. C5 Correct answer.
  2. C8
  3. C7
  4. C6

Explanation

The C5 nerve root supplies the deltoid and biceps brachii and contributes to the biceps reflex. Weakness of shoulder abduction and elbow flexion with a diminished biceps reflex therefore points to a C5 lesion. C6 contributes more to wrist extension and the brachioradialis reflex.

Question 27Musculoskeletal System

Which ligament is assessed by the anterior drawer test of the ankle?

  1. Posterior talofibular ligament
  2. Deltoid ligament
  3. Calcaneofibular ligament
  4. Anterior talofibular ligament Correct answer.

Explanation

The anterior drawer test of the ankle stresses the anterior talofibular ligament by translating the talus anteriorly. Increased excursion or a soft endpoint suggests injury to that ligament. The calcaneofibular and posterior talofibular ligaments are assessed with other tests, such as the talar tilt and posterior drawer.

Question 28Musculoskeletal System

The capsular pattern of the hip joint is most accurately described as limitation of:

  1. flexion, external rotation, and adduction
  2. extension, abduction, and external rotation
  3. abduction, extension, and external rotation
  4. internal rotation, flexion, and abduction Correct answer.

Explanation

The hip capsular pattern is classically described as limitation of internal rotation, flexion, and abduction, with internal rotation typically most restricted. This pattern helps distinguish capsular involvement from isolated muscle or tendon problems. External rotation and extension are relatively less limited in a pure capsular pattern.

Question 29Musculoskeletal System

Following a posterior-approach total hip arthroplasty, which movement should the patient avoid?

  1. Active ankle pumps
  2. Isometric quadriceps setting
  3. Hip flexion beyond 90 degrees Correct answer.
  4. Hip extension past neutral

Explanation

A posterior-approach hip replacement creates a risk of posterior dislocation, so precautions typically limit hip flexion beyond 90 degrees, adduction past midline, and internal rotation. Active ankle pumps and quadriceps setting are safe and encouraged. Hip extension past neutral is not the primary restricted movement after this approach.

Question 30Musculoskeletal System

A patient reports weakness lifting the arm, and when the examiner passively abducts the arm to 90 degrees and releases it, the arm drops suddenly. This finding is most consistent with:

  1. A full-thickness rotator cuff tear Correct answer.
  2. An acromioclavicular joint sprain
  3. Adhesive capsulitis
  4. Suprascapular neuropathy

Explanation

A positive drop arm test occurs when the patient cannot maintain the arm in abduction after it is passively positioned, suggesting a large or full-thickness rotator cuff tear. Adhesive capsulitis causes global loss of motion rather than sudden dropping. AC joint sprain and isolated suprascapular neuropathy do not typically produce this drop-arm response.

Question 31Musculoskeletal System

A valgus stress test performed at 30 degrees of knee flexion primarily assesses the:

  1. Medial collateral ligament Correct answer.
  2. Posterior cruciate ligament
  3. Anterior cruciate ligament
  4. Lateral collateral ligament

Explanation

Valgus stress opens the medial compartment and stresses the medial collateral ligament; testing at 30 degrees of flexion isolates the ligament from secondary restraints. Testing near full extension also involves the capsule and other structures. The lateral collateral ligament is assessed with varus stress.

Question 32Musculoskeletal System

An older adult reports bilateral buttock and leg pain that develops after walking two blocks and is relieved by sitting or leaning forward on a shopping cart. Which condition is most likely?

  1. Lumbar spinal stenosis Correct answer.
  2. Vascular claudication
  3. Lumbar disc herniation
  4. Hip osteoarthritis

Explanation

Lumbar spinal stenosis causes neurogenic claudication, with bilateral leg symptoms provoked by walking or extension and relieved by flexion-based positions such as sitting or leaning forward. Vascular claudication is relieved by simply standing still and is not typically position-dependent in the same way. Disc herniation more often causes unilateral radicular symptoms.

Question 33Musculoskeletal System

Which test is performed by side-bending and rotating the cervical spine toward the symptomatic side while applying axial compression?

  1. Spurling test Correct answer.
  2. Lhermitte sign
  3. Phalen test
  4. Adson test

Explanation

The Spurling test narrows the intervertebral foramen on the symptomatic side and can reproduce radicular symptoms in cervical radiculopathy. The Phalen test assesses the wrist for carpal tunnel syndrome, and the Adson test evaluates thoracic outlet syndrome. Lhermitte sign refers to an electric shock sensation with neck flexion.

Question 34Musculoskeletal System

A patient has sudden posterior ankle pain and cannot perform a heel raise. Which test is most appropriate to confirm an Achilles tendon rupture?

  1. Thompson test Correct answer.
  2. Squeeze test of the leg
  3. Anterior drawer test
  4. Talar tilt test

Explanation

The Thompson test squeezes the calf with the patient prone; absence of plantar flexion indicates a ruptured Achilles tendon. An inability to perform a heel raise after a sudden pop is also highly suggestive. The anterior drawer and talar tilt tests assess ankle ligaments.

Question 35Musculoskeletal System

A patient reports radial-sided wrist pain that worsens when gripping a child or a cup. Which test is most specific for De Quervain tenosynovitis?

  1. Watson test
  2. Tinel sign at the wrist
  3. Phalen test
  4. Finkelstein test Correct answer.

Explanation

The Finkelstein test places the thumb in a fist and ulnar-deviates the wrist, stretching the first dorsal compartment and reproducing pain in De Quervain tenosynovitis. The Phalen test and Tinel sign assess the median nerve at the carpal tunnel. The Watson test assesses scaphoid instability.

Question 36Musculoskeletal System

Which finding is an indication for ankle radiography according to the Ottawa ankle rules?

  1. Pain with active ankle dorsiflexion
  2. Bone tenderness at the posterior edge or tip of the lateral malleolus Correct answer.
  3. Swelling over the dorsum of the foot
  4. Inability to perform a single-leg hop

Explanation

The Ottawa ankle rules recommend radiography when there is pain in the malleolar zone plus bone tenderness at the posterior edge or tip of either malleolus, or inability to bear weight for four steps. Swelling and painful dorsiflexion alone are not criteria. The ability to hop is not part of the rules.

Question 37Musculoskeletal System

A 12-year-old with obesity reports hip and knee pain and walks with an antalgic gait and the affected leg held in external rotation. Which condition is most likely?

  1. Slipped capital femoral epiphysis Correct answer.
  2. Legg-Calve-Perthes disease
  3. Iliotibial band syndrome
  4. Septic arthritis of the hip

Explanation

Slipped capital femoral epiphysis typically affects obese adolescents and presents with hip or referred knee pain, an antalgic gait, and obligate external rotation of the affected leg. Legg-Calve-Perthes disease occurs in younger children, and septic arthritis presents with fever and marked irritability. IT band syndrome causes lateral knee pain rather than a fixed external rotation deformity.

Question 38Musculoskeletal System

A patient reports constant low back pain that awakens them at night, unexplained weight loss, and no relief with rest. What is the most appropriate action?

  1. Refer the patient to a physician for further evaluation Correct answer.
  2. Apply intermittent lumbar traction
  3. Begin a lumbar stabilization program
  4. Progress the patient to strengthening exercises

Explanation

Night pain, unexplained weight loss, and pain unrelieved by rest are red flags that may indicate serious pathology such as malignancy or infection. The appropriate action is medical referral before continuing physical therapy. Exercise and traction are not appropriate until serious pathology has been ruled out.

Question 39Musculoskeletal System

A patient has weak ankle dorsiflexion after a fibular nerve injury. Which gait deviation is most characteristic?

  1. Trendelenburg gait
  2. Festinating gait
  3. Steppage gait Correct answer.
  4. Scissoring gait

Explanation

Foot drop from weak ankle dorsiflexion causes the patient to lift the hip and knee excessively to clear the toes, producing a steppage gait. Trendelenburg gait results from hip abductor weakness, and scissoring is seen with spasticity. Festinating gait is associated with Parkinson disease.

Question 40Musculoskeletal System

Which instruction is most appropriate for joint protection in a patient with rheumatoid arthritis?

  1. Use larger joints for tasks and avoid prolonged tight gripping Correct answer.
  2. Rest all joints completely until inflammation resolves
  3. Apply superficial heat during an acute flare
  4. Exercise through joint pain to maintain range of motion

Explanation

Joint protection principles include using larger, stronger joints for tasks, avoiding prolonged gripping, and balancing activity with rest. Exercising through pain can increase inflammation and joint damage. Complete rest of all joints leads to stiffness and weakness.

Question 41Neuromuscular and Nervous Systems

A patient has a right middle cerebral artery stroke, and the therapist documents a left homonymous hemianopsia. Which statement best explains this finding?

  1. It is on the same side as the lesion.
  2. It indicates bilateral occipital damage.
  3. It is contralateral to the cerebral lesion. Correct answer.
  4. It reflects right optic nerve damage.

Explanation

The optic radiations and visual cortex receive input from the contralateral visual field, so a lesion behind the optic chiasm produces a homonymous deficit on the opposite side. A right hemisphere stroke therefore yields a left homonymous hemianopsia.

Question 42Neuromuscular and Nervous Systems

Which clinical pattern is most characteristic of Guillain-Barré syndrome?

  1. Weakness confined to a single limb
  2. Descending spastic paralysis with hyperreflexia
  3. Proximal weakness that spares distal muscles
  4. Ascending symmetric weakness with areflexia Correct answer.

Explanation

Guillain-Barré syndrome is an acute inflammatory demyelinating polyneuropathy that produces flaccid, symmetric weakness beginning distally and progressing proximally, with diminished or absent reflexes.

Question 43Neuromuscular and Nervous Systems

A patient with Parkinson's disease takes progressively shorter, faster steps and reports difficulty stopping once walking begins. Which gait pattern is this?

  1. Antalgic gait
  2. Festinating gait Correct answer.
  3. Ataxic gait
  4. Steppage gait

Explanation

Festination consists of small, accelerating steps with a forward trunk lean and impaired ability to stop, reflecting the basal ganglia dysfunction of Parkinson's disease.

Question 44Neuromuscular and Nervous Systems

A patient has unilateral facial weakness with an inability to close the eye and loss of forehead wrinkling on the same side. Which cranial nerve is involved?

  1. Trigeminal (CN V)
  2. Hypoglossal (CN XII)
  3. Glossopharyngeal (CN IX)
  4. Facial (CN VII) Correct answer.

Explanation

The facial nerve supplies the muscles of facial expression, including the orbicularis oculi and frontalis. Involvement of the forehead indicates a peripheral lesion of CN VII rather than a central lesion, which spares the upper face.

Question 45Neuromuscular and Nervous Systems

A patient responds to stimuli with nonpurposeful, generalized movements and shows no localized response. Which Rancho Los Amigos level does this describe?

  1. Confused-agitated
  2. Generalized response Correct answer.
  3. Purposeful-appropriate
  4. Localized response

Explanation

Rancho Los Amigos level II is the generalized response stage, in which reactions are nonpurposeful and inconsistent. Localized responses appear at level III, agitation at level IV, and purposeful appropriate behavior at level VIII.

Question 46Neuromuscular and Nervous Systems

A patient loses balance only when standing with feet together and eyes closed but stands steady with the eyes open. What does this finding most suggest?

  1. Cerebellar hemisphere lesion
  2. Lower extremity muscle weakness
  3. Impaired proprioceptive input Correct answer.
  4. Benign paroxysmal positional vertigo

Explanation

A positive Romberg test indicates that balance depends on vision because proprioceptive input is impaired. Removing visual input leaves the patient without adequate postural information.

Question 47Neuromuscular and Nervous Systems

Which finding best distinguishes myasthenia gravis from a central demyelinating disease?

  1. Sensory loss in a stocking distribution
  2. Fatigable weakness that improves with rest Correct answer.
  3. Hyperreflexia with clonus
  4. Weakness that is worse in the morning

Explanation

Myasthenia gravis is a neuromuscular junction disorder producing weakness that worsens with activity and improves with rest. Central demyelination causes upper motor neuron signs and sensory changes that do not fluctuate with use.

Question 48Neuromuscular and Nervous Systems

A patient with a severe traumatic brain injury shows arm flexion, adduction, and internal rotation together with leg extension. Which posturing is this?

  1. Opisthotonic posturing
  2. Decorticate posturing Correct answer.
  3. Flaccid posturing
  4. Decerebrate posturing

Explanation

Decorticate posturing reflects a lesion above the level of the red nucleus and is characterized by upper extremity flexion with lower extremity extension. Decerebrate posturing instead shows extension of all four limbs.

Question 49Neuromuscular and Nervous Systems

A patient with a T4 spinal cord injury suddenly develops a blood pressure of 190/110 mmHg, a pounding headache, and profuse sweating. What is the most appropriate first action?

  1. Place the patient supine and apply ice to the neck
  2. Begin passive range of motion to the lower extremities
  3. Document the finding and continue the session
  4. Sit the patient upright and identify the noxious stimulus Correct answer.

Explanation

These signs indicate autonomic dysreflexia, a medical emergency in lesions at T6 or above. The immediate response is to raise the head of the bed to reduce blood pressure and search for the triggering noxious stimulus, most often bladder distention.

Question 50Neuromuscular and Nervous Systems

A patient with multiple sclerosis reports blurred vision and increased leg weakness after 20 minutes of exercise in a warm therapy pool. What is the best interpretation?

  1. The patient is having an acute relapse requiring hospitalization
  2. Heat transiently impairs conduction in demyelinated axons Correct answer.
  3. The symptoms indicate a peripheral neuropathy
  4. The patient has developed a permanent new lesion

Explanation

This is the Uhthoff phenomenon: elevated core temperature further slows conduction in already demyelinated fibers, producing transient visual and motor worsening. Symptoms resolve with cooling and do not represent a new lesion.