S1_L1: Neurological Examination in PT Practice

Question 1

TRUE OR FALSE: Coma (Deep coma) has a sleep-wake cycle and can determine day from night.

Answer 1

False

Vegetative state has a sleep-wake cycle. In a coma, the eyes are closed with absence of sleep-wake cycles and no evidence of a contingent relationship between the patient’s behavior and the environment (Braddom).

Question 2

Level of consciousness where the individual responds to loud shaking voices and painful stimuli. They need constant, repeated stimulation to cooperate and maintain consciousness.

Answer 2

Obtunded

Question 3

Level of consciousness where the individual sleeps (easily falls asleep) when not stimulated but is easily aroused. They are drowsy and inattentive. The patient may have difficulty in focusing or maintaining attention on a question or task.

Answer 3

Lethargic

Question 4

Individuals in a stupor respond to painful stimuli, such as rubbing what 2 body structures using the tip of the thumb, IP joint or PIP joint of index finger or other fingers?

Answer 4

1. glabella
2. sternum

Question 5

TRUE OR FALSE: Coma and vegetative states are both lacking in response to any kind of stimulus.

Answer 5

True

Question 6

Musical quality / component of speech and the ability to differentiate declarative from interrogative statements

Answer 6

Prosody

Question 7

The quality of speech
and the ability to express or answer without hesitation; when a question is given, pt can answer properly.

Answer 7

Fluency

Question 8

Denial & lack of awareness of the presence or severity of one’s paralysis; pt still uses the affected side because they think that there’s no problem with that side.

Answer 8

Anosognosia

Question 9

Neglect in your environment / surroundings

Answer 9

Hemispace

Question 10

Lack of awareness of the body structure and relationship of body parts to oneself or to others. A lack of proprioception may underlie or compound this disorder.

Answer 10

Somatoagnosia / Autotopagnosia / Body Agnosia

(Other two names source: O’Sullivan, 6th ed)

Question 11

TRUE OR FALSE: Right and Left Discrimination must be assessed prior to Somatoagnosia Testing.

Answer 11

False

Somatoagnosia is assessed first.

Question 12

The inability to register & integrate stimuli & perceptions from one side of the body, which is not due to sensory loss.

Answer 12

Unilateral neglect / Unilateral spatial neglect / Hemi-inattention / Hemineglect / Unilateral visual inattention

Additional: The pt is aware that they have a problem on one side of the body, and they sometimes forget but does not deny that they have a problem on one side of the body.

Question 13

TRUE OR FALSE: A left sided hemispheric stroke (or the affected hemiplegic side) commonly has a perceptual deficit or problem in body scheme.

Answer 13

False, it’s the R. If L sided, aphasic problem (language affectation).

Question 14

A language examination is not complete without each of the 7 components of language. Enumerate all 7.

Answer 14

1. Fluency
2. Prosody
3. Repetition
4. Naming
5. Comprehension
6. Reading
7. Writing

Question 15

Enumerate the components of language assessed by PTs to determine the type of aphasia

Answer 15

1. Fluency
2. Comprehension
3. Repetition

Question 16

Asking the patient to subtract the following consecutively: 30-5, 25-6, 19-4, 15-5

A. Attention span
B. Concentration span

Answer 16

B. Concentration span

The above test is known as serial subtraction.

Question 17

Asking the patient to count from 20 backwards until reaching 0.

A. Attention span
B. Concentration span

Answer 17

B. Concentration span

Question 18

Asking the patient to spell the word “money” backwards

A. Attention span
B. Concentration span

Answer 18

B. Concentration span

Note: When the 1st try is wrong, try once more to determine if it was an honest mistake or impaired. Also, let the patient spell the word correctly first then backwards.

Question 19

The amount of time it took for the patient to finish a task

A. Attention span
B. Concentration span

Answer 19

A. Attention span

Question 20

The number of times the patient reached for the pencil

A. Attention span
B. Concentration span

Answer 20

A. Attention span

Question 21

Which of the following disorders is a result from oculomotor damage?
A. Myopia
B. Anosmia
C. Exotropia
D. Esotropia
E. Wasting of the temporalis muscle

Answer 21

C. Exotropia

Question 22

How far should the Snellen chart be placed away from the patient in assessing visual acuity? (for far vision)

Answer 22

6 feet

Question 23

How far should the Snellen chart be placed away from the patient in assessing visual acuity? (for near vision)

Answer 23

14 inches

Question 24

The corneal reflex is a sensitive test for what cranial nerve damage?

Answer 24

Trigeminal nerve (CN V; ophthalmic division)

Additional: The corneal reflex is actually the most sensitive test for CN V

Question 25

It is the afferent arm of the gag reflex

Answer 25

Glossopharyngeal nerve (CN IX)

Question 26

It is the efferent arm of the gag reflex

Answer 26

Vagus nerve (CN X)

Question 27

If you have ® hypoglossal nerve injury, the tongue will deviate towards what side?

Answer 27

Right side

Question 28

If you have (L) vagus nerve injury, the uvula will deviate towards what side?

Answer 28

Right side

Question 29

If these tests are intact, all other combined cortical sensations are intact. What are those tests?

Answer 29

1. 2-point discrimination 2. Stereognosis

Question 30

If you have (R) vagus nerve injury, the uvula will deviate towards what side?

Answer 30

Left

Question 31

TRUE OR FALSE: Atrophy of the trapezius can be observed by a loss of the C-shaped contour with more of an L-shaped contour.

Answer 31

True Source: Braddom, 6th ed

Question 32

Normal values for 2-point discrimination on the fingertips

Answer 32

3-5 mm

Question 33

Normal values for 2-point discrimination on the dorsum of the hand

Answer 33

20-30 mm

Question 34

Normal values for 2-point discrimination on the palms

Answer 34

8-15 mm

Question 35

In 2-point discrimination, the normal values of the fingertips compared to the palms is smaller. What topographic representation is the reason for this?

Answer 35

Sensory homunculus Note: According to the drawing of the homunculus, the representation of the hand is larger than the fingertips, therefore it has more sensory receptors.

Question 36

During double simultaneous stimulation, there is an absence of the distal extremity sensation while simultaneously applying proximal and distal sensations. This abnormality is known as the?

Answer 36

Extinction phenomenon Additional: Even if you stimulate higher areas, the pt still cannot feel the distal stimulus

Question 37

Determine the corresponding nerve roots of the following superficial reflexes 1. Lower abdominal reflex 2. Anal reflex 3. Plantar scratch/reflex 4. Upper abdominal reflex A. T8-T10 B. T10-T12 C. L2-S1 D. S2-S4

Answer 37

1. B 2. D 3. C 4. A

Question 38

Determine the corresponding nerve roots of the following superficial reflexes 1. Brachioradialis Reflex 2. Patellar Reflex 3. Biceps, Brachialis Reflex 4. Ankle (Achilles) Reflex 5. Triceps Reflex A. C5-C6 B. C5-C6 / C6-C7 C. C6-C7 / C7-C8 D. L2-L4 E. S1

Answer 38

1. B 2. D 3. A 4. E 5. C

Question 39

The most important sensory test when the patient has a stroke or brain problem.

Answer 39

Combined cortical

Question 40

Pt has L hearing loss based on the hearing assessment before the Weber’s & Rinne’s Tests. During the Rinne’s test, pt reported they heard more vibration sounds when PT placed the tip of the tuning fork on the mastoid process. A. Normal hearing B. Conductive hearing loss C. Sensorineural hearing loss

Answer 40

B. Conductive hearing loss

Question 41

Pt has L hearing loss based on the hearing assessment before the Weber’s & Rinne’s Tests. During the Weber’s test, pt reported that the sound is louder on the L than the R. A. Normal hearing B. Conductive hearing loss C. Sensorineural hearing loss

Answer 41

B. Conductive hearing loss

Question 42

Pt has L hearing loss based on the hearing assessment before the Weber’s & Rinne’s Tests. During the Rinne’s test, pt reported they heard vibration sounds when PT placed the tip of the tuning fork on the mastoid process. When PT placed the tip near the ear, pt said that they heard vibration sounds but the sound immediately disappeared. A. Normal hearing B. Conductive hearing loss C. Sensorineural hearing loss

Answer 42

C. Sensorineural hearing loss

Question 43

Pt has L hearing loss based on the hearing assessment before the Weber’s & Rinne’s Tests. During the Weber’s test, pt reported that they heard sounds in the R ear, while nothing was heard in the L ear. A. Normal hearing B. Conductive hearing loss C. Sensorineural hearing loss

Answer 43

C. Sensorineural hearing loss

Question 44

___ hearing loss is associated with affectation of the outer or middle ear.

Answer 44

Conductive

Question 45

___ hearing loss is associated with affectation of the inner ear to the nerves, up to the brain. A problem with the transition of sound results.

Answer 45

Sensorineural

Question 45

What is the landmark/structure where the base of the tuning fork is placed while inquiring whether sound remains central or referred to one side in the Weber’s test?

Answer 45

Vertex of the skull

Question 46

The efferent arm of the corneal reflex

Answer 46

Facial nerve (CN VII)

Question 47

Determine the corresponding nerve affectation of the following conditions 1. Myopia 2. Horizontal diplopia 3. Vertical diplopia 4. Esotropia 5. Exotropia A. Optic nerve (CN II) B. Oculomotor nerve (CN III) C. Trochlear nerve (CN IV) D. Abducens nerve (CN VI)

Answer 47

1. A 2. D 3. C 4. D 5. B

Question 48

Determine the corresponding description of the following conditions 1. Double vision 2. External strabismus 3. Near-sightedness 4. Internal strabismus 5. Dilation of pupils A. Myopia B. Diplopia C. Mydriasis D. Esotropia E. Exotropia

Answer 48

1. B 2. E 3. A 4. D 5. C

Question 49

Determine the corresponding description of the following conditions 1. Affectation of lateral rectus 2. Constriction of pupil 3. Affectation of medial rectus 4. Far-sightedness 5. Unequal pupils A. Esotropia B. Anisocoria C. Presbyopia D. Miosis E. Exotropia

Answer 49

1. A 2. D 3. E 4. C 5. B

Question 49

Direct pupillary light reflex was performed. The L eye was in contact with the light. The L and R eyes did not constrict. This observation is due to a problem in which structure/s? A. L oculomotor nerve B. R oculomotor nerve C. L optic nerve or (B) oculomotor nerves D. R optic nerve or (B) oculomotor nerves E. No affectation

Answer 49

C. L optic nerve or (B) oculomotor nerves

Question 50

Direct pupillary light reflex was performed. The L eye was in contact with the light. The L and R eyes both constricted. This observation is due to a problem in which structure/s? A. L oculomotor nerve B. R oculomotor nerve C. L optic nerve or (B) oculomotor nerves D. R optic nerve or (B) oculomotor nerves E. No affectation

Answer 50

E. No affectation

Question 51

Direct pupillary light reflex was performed. The L eye was in contact with the light. The L eye did not constrict, while the R eye constricted. This observation is due to a problem in which structure/s? A. L oculomotor nerve B. R oculomotor nerve C. L optic nerve or (B) oculomotor nerves D. R optic nerve or (B) oculomotor nerves E. No affectation

Answer 51

A. L oculomotor nerve

Question 52

Direct pupillary light reflex was performed. The L eye was in contact with the light. The L eye constricted, while the R eye did not constrict. This observation is due to a problem in which structure/s? A. L oculomotor nerve B. R oculomotor nerve C. L optic nerve or (B) oculomotor nerves D. R optic nerve or (B) oculomotor nerves E. No affectation

Answer 52

B. R oculomotor nerve

Question 53

Direct pupillary light reflex was performed. The R eye was in contact with the light. The L and R eyes did not constrict. This observation is due to a problem in which structure/s? A. L oculomotor nerve B. R oculomotor nerve C. L optic nerve or (B) oculomotor nerves D. R optic nerve or (B) oculomotor nerves E. No affectation

Answer 53

D. R optic nerve or (B) oculomotor nerves

Question 54

Direct pupillary light reflex was performed. The R eye was in contact with the light. The L eye constricted, while the R eye did not constrict. This observation is due to a problem in which structure/s? A. L oculomotor nerve B. R oculomotor nerve C. L optic nerve or (B) oculomotor nerves D. R optic nerve or (B) oculomotor nerves E. No affectation

Answer 54

B. R oculomotor nerve

Question 55

Direct pupillary light reflex was performed. The R eye was in contact with the light. The L eye did not constrict, while the R eye constricted. This observation is due to a problem in which structure/s? A. L oculomotor nerve B. R oculomotor nerve C. L optic nerve or (B) oculomotor nerves D. R optic nerve or (B) oculomotor nerves E. No affectation

Answer 55

A. L oculomotor nerve

Question 56

The afferent arm of pupillary light reflex

Answer 56

Optic nerve (CN II)

Question 57

The efferent arm of pupillary light reflex

Answer 57

Oculomotor nerve (CN III)

Question 58

The pupillary light reflex is the pupillary constriction of the ipsilateral eye when exposed to light. Ipsilateral pupillary constriction is d/t what structure?

Answer 58

Edinger-Westphal nucleus of the oculomotor nerve

Question 59

The pupillary light reflex is the pupillary constriction of the ipsilateral eye when exposed to light. Contralateral pupillary constriction is d/t the Consensual Light Reflex via what pathway?

Answer 59

Optic-Oculomotor Pathway

Question 60

Determine the corresponding descriptions of the following conditions 1. absent sense of smell 2. distorted sense of smell 3. perception of smell without any stimulus 4. decreased sense of smell 5. perception of bad smell 6. increased sense of smell A. Dysosmia B. Cacosmia C. Hyperosmia D. Hyposmia E. Parosmia F. Anosmia

Answer 60

1. F 2. A 3. E 4. D 5. B 6. C

Question 61

Enumerate all cranial nerves involved in the parasympathetic system

Answer 61

1. Oculomotor nerve (CN III) 2. Facial nerve (CN VII) 3. Glossopharyngeal nerve (CN IX) 4. Vagus nerve (CN X)

Question 62

Enumerate all cranial nerves that are mixed (sensory and motor)

Answer 62

1. Trigeminal nerve (CN V) 2. Facial nerve (CN VII) 3. Glossopharyngeal nerve (CN IX) 4. Vagus (CN X)

Question 63

The ability to visually distinguish a figure from the background in which it is embedded. It interferes with the patient’s ability to locate important objects that are not prominent in a visual array.

Answer 63

Figure-Ground Discrimination Source: O’Sullivan, 6th ed

Question 64

TRUE OR FALSE: Body scheme refers to a postural model of the body including the relationship of the body parts to each other and the relationship of the body to the environment.

Answer 64

True Source: O’Sullivan, 6th ed

Question 65

Automatic response that helps maintain balance when the body’s center of mass is displaced to restore and maintain balance. For example, an individual was hit and they are moving towards their right. Their body will automatically move towards the left to avoid falling.

Answer 65

Equilibrium Reflex

Question 66

TRUE OR FALSE: Physiologic Reflexes are normal reflexes in adults and should exist even when you get older.

Answer 66

True

Question 67

Automatic response to protect the body from potential harm or injury. It causes extension of the limbs to break the fall and minimize injury.

Answer 67

Protective Extension Reflex

Question 68

Pt is fluent, but comprehension and repetition are impaired. A. Anomia B. Conduction C. Transcortical sensory D. Wernicke's

Answer 68

D. Wernicke's

Question 69

Passively flexing the shoulder will elicit extension of the fingers. This is the treatment used for flexor synergy. A. Sterling's Phenomenon B. Raimiste's Phenomenon C. Marie-Foix Phenomenon (Bechterev’s) D. Soque’s Phenomenon E. Homolateral Synkinesis

Answer 69

D. Soque’s Phenomenon

Question 70

PT will resist shoulder abduction on the unaffected side, then there will be an associated abduction on the affected side. A. Sterling's Phenomenon B. Raimiste's Phenomenon C. Marie-Foix Phenomenon (Bechterev’s) D. Soque’s Phenomenon E. Homolateral Synkinesis

Answer 70

A. Sterling's Phenomenon

Question 71

Passively flexing the toes on the affected side will elicit massive flexion of the entire lower extremity on the affected side. A. Sterling's Phenomenon B. Raimiste's Phenomenon C. Marie-Foix Phenomenon (Bechterev’s) D. Soque’s Phenomenon E. Homolateral Synkinesis

Answer 71

C. Marie-Foix Phenomenon (Bechterev’s)

Question 72

PT will resist hip abduction of the unaffected side, then there will be an associated hip abduction on the affected side. This can be done in sitting or supine. A. Sterling's Phenomenon B. Raimiste's Phenomenon C. Marie-Foix Phenomenon (Bechterev’s) D. Soque’s Phenomenon E. Homolateral Synkinesis

Answer 72

B. Raimiste's Phenomenon

Question 73

Passively flexing / extending the UE on the affected side will elicit flexion / extension of the LE ipsilaterally. A. Sterling's Phenomenon B. Raimiste's Phenomenon C. Marie-Foix Phenomenon (Bechterev’s) D. Soque’s Phenomenon E. Homolateral Synkinesis

Answer 73

E. Homolateral Synkinesis

Question 74

TRUE OR FALSE: The stimulus for homolateral synkinesis may be done on the affected LE.

Answer 74

False, it's always done on the UE

Question 75

Non-equilibrium testing grade described as: Minimal impairment: Able to accomplish activity, slightly less than normal control, speed, and steadiness A. 4 B. 3 C. 2 D. 1 E. 0

Answer 75

B. 3

Question 76

Non-equilibrium testing grade described as: Moderate impairment: Able to accomplish activity; movements are slow, awkward, and unsteady A. 4 B. 3 C. 2 D. 1 E. 0

Answer 76

C. 2

Question 77

Non-equilibrium testing grade described as: Severe impairment: able to only initiate activity without completion; movements are slow with significant unsteadiness, oscillation and/or extraneous movements A. 4 B. 3 C. 2 D. 1 E. 0

Answer 77

D. 1

Question 78

Stimulus is stroking of lateral aspect of sole of foot (from little toe to great toe, brisk and firm) A. Babinski B. Chaddock C. Oppenheim D. Gordon E. Piotrowski F. Brudzinski

Answer 78

A. Babinski

Question 79

Stimulus is stroking of lateral side of foot beneath lateral malleolus A. Babinski B. Chaddock C. Oppenheim D. Gordon E. Piotrowski F. Brudzinski

Answer 79

B. Chaddock

Question 80

Stimulus is stroking of anteromedial surface of tibia/ shin in a downward direction, stopping at the ankle area A. Babinski B. Chaddock C. Oppenheim D. Gordon E. Piotrowski F. Brudzinski

Answer 80

C. Oppenheim

Question 81

Stimulus is squeezing of calf muscles firmly but only once A. Babinski B. Chaddock C. Oppenheim D. Gordon E. Piotrowski F. Brudzinski

Answer 81

D. Gordon

Question 82

Stimulus is percussion / tapping of the tibialis anterior muscle A. Babinski B. Chaddock C. Oppenheim D. Gordon E. Piotrowski F. Brudzinski

Answer 82

E. Piotrowski

Question 83

Stimulus is passive flexion of one lower limb (the unaffected side first) A. Babinski B. Chaddock C. Oppenheim D. Gordon E. Piotrowski F. Brudzinski

Answer 83

F. Brudzinski

Question 84

Positive response: dorsiflexion and supination of foot A. Babinski B. Chaddock C. Oppenheim D. Gordon E. Piotrowski F. Brudzinski

Answer 84

E. Piotrowski

Question 85

Positive response is flexion of opposite affected lower limb A. Babinski B. Chaddock C. Oppenheim D. Gordon E. Piotrowski F. Brudzinski

Answer 85

F. Brudzinski

Question 86

Stimulus is tapping of plantar surface of toes A. Piotrowski B. Brudzinski C. Hoffman D. Rossolimo E. Schaeffer

Answer 86

D. Rossolimo

Question 87

Stimulus is pinching of Achilles tendon in middle third A. Piotrowski B. Brudzinski C. Hoffman D. Rossolimo E. Schaeffer

Answer 87

E. Schaeffer

Question 88

Stimulus is tapping of nail bed of index, middle or ring finger (distal phalanx) A. Piotrowski B. Brudzinski C. Hoffman D. Rossolimo E. Schaeffer

Answer 88

C. Hoffman

Question 89

Positive response is flexion of the distal phalanx of thumb A. Piotrowski B. Brudzinski C. Hoffman D. Rossolimo E. Schaeffer

Answer 89

C. Hoffman

Question 90

Positive response is flexion of foot and toes A. Piotrowski B. Brudzinski C. Hoffman D. Rossolimo E. Schaeffer

Answer 90

E. Schaeffer

Question 91

Positive response is plantarflexion of toes A. Piotrowski B. Brudzinski C. Hoffman D. Rossolimo E. Schaeffer

Answer 91

D. Rossolimo

Question 92

Modified Ashworth Scale grade described as: More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved. A. 0 B. 1 C. 1+ D. 2 E. 3 F. 4

Answer 92

D. 2

Question 93

Modified Ashworth Scale grade described as: Considerable increase in muscle tone, passive movement difficult A. 0 B. 1 C. 1+ D. 2 E. 3 F. 4

Answer 93

E. 3

Question 94

Modified Ashworth Scale grade described as: Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM A. 0 B. 1 C. 1+ D. 2 E. 3 F. 4

Answer 94

C. 1+

Question 95

Modified Ashworth Scale grade described as: Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of ROM when the affected part(s) is moved in flexion or extension A. 0 B. 1 C. 1+ D. 2 E. 3 F. 4

Answer 95

B. 1

Question 96

Modified Ashworth Scale grade described as: Affected part(s) rigid in flexion or extension A. 0 B. 1 C. 1+ D. 2 E. 3 F. 4

Answer 96

F. 4

Question 97

Enumerate the characteristics of movement that PTs should take note of in functional muscle testing

Answer 97

1. Body part being assessed 2. Quality of the movement 3. Quantity or number of trials 4. Speed of the movement 5. Duration of the movement

Question 98

Action with the strongest spasticity in UE flexion synergy

Answer 98

Elbow flexion

Question 99

Action with the strongest spasticity in LE flexion synergy

Answer 99

Hip flexion

Question 100

Action with the strongest spasticity in UE extension synergy

Answer 100

Forearm pronation

Question 101

Action with the strongest spasticity in LE extension synergy

Answer 101

Hip adduction, knee extension, ankle plantarflexion

Question 102

TRUE OR FALSE: Cauda equina syndrome will manifest with LMNL features.

Answer 102

True

Question 103

Pt is fluent and has comprehension, but has impaired repetition. A. Anomia B. Conduction C. Transcortical sensory D. Wernicke's

Answer 103

B. Conduction

Question 104

Pt is fluent and has repetition, but has impaired comprehension. A. Anomia B. Conduction C. Transcortical sensory D. Wernicke's

Answer 104

C. Transcortical sensory

Question 105

Pt is fluent, with intact repetition and comprehension. A. Anomia B. Conduction C. Transcortical sensory D. Wernicke's

Answer 105

A. Anomia

Question 106

Pt has intact comprehension and repetition, but has impaired fluency. A. Broca's B. Mixed transcortical C. Global D. Transcortical motor

Answer 106

D. Transcortical motor

Question 107

Pt has intact comprehension, but has impaired fluency and repetition. A. Broca's B. Mixed transcortical C. Global D. Transcortical motor

Answer 107

A. Broca's

Question 108

Pt has intact repetition, but impaired fluency and comprehension. A. Broca's B. Mixed transcortical C. Global D. Transcortical motor

Answer 108

B. Mixed transcortical

Question 109

Pt has impaired fluency, comprehension, and repetition. A. Broca's B. Mixed transcortical C. Global D. Transcortical motor

Answer 109

C. Global