NBCE Neurology and Neurological Assessment 2 — Questions and Answers
Question 1: The biceps brachii reflex tests which nerve roots?
- C4-C5
- C5-C6 (Correct answer)
- C6-C7
- C7-C8
Correct answer: C5-C6
The biceps reflex is mediated by C5-C6 nerve roots via the musculocutaneous nerve, making it useful for diagnosing mid-cervical radiculopathy.
Question 2: A positive Babinski sign (upgoing plantar response) in an adult indicates:
- Normal plantar reflex
- Lower motor neuron lesion
- Upper motor neuron lesion involving the corticospinal tract (Correct answer)
- Peripheral neuropathy
Correct answer: Upper motor neuron lesion involving the corticospinal tract
An upgoing plantar response (Babinski sign) in adults signifies upper motor neuron pathology affecting the corticospinal tract, such as spinal cord compression or stroke.
Question 3: Phalen's test is performed by:
- Tapping over the carpal tunnel to elicit paresthesias
- Holding both wrists in sustained flexion for 60 seconds (Correct answer)
- Applying a tourniquet to assess radial artery patency
- Passively extending the wrist while palpating the tunnel
Correct answer: Holding both wrists in sustained flexion for 60 seconds
Phalen's test involves sustained bilateral wrist flexion for 60 seconds; reproduction of median nerve paresthesias constitutes a positive result for carpal tunnel syndrome.
Question 4: The triceps reflex is primarily mediated by which nerve root?
- C5
- C6
- C7 (Correct answer)
- C8
Correct answer: C7
The triceps reflex is mediated by C7 via the radial nerve, and diminished response suggests C7 nerve root compression.
Question 5: The Romberg test is primarily used to assess:
- Cerebellar coordination via tandem gait
- Proprioception and dorsal column (posterior column) integrity (Correct answer)
- Motor strength in the lower extremities
- Vestibular function during rapid head movement
Correct answer: Proprioception and dorsal column (posterior column) integrity
The Romberg test assesses posterior column integrity; increased sway or falls with eyes closed (positive Romberg) indicates impaired proprioception rather than cerebellar dysfunction.
Question 6: Which cranial nerve is tested by asking a patient to clench their teeth while the examiner palpates the masseter?
- CN VII (facial nerve)
- CN V (trigeminal nerve) (Correct answer)
- CN IX (glossopharyngeal nerve)
- CN XII (hypoglossal nerve)
Correct answer: CN V (trigeminal nerve)
The motor division of CN V (trigeminal nerve) innervates the muscles of mastication, including the masseter, temporalis, and pterygoids.
Question 7: Loss of sensation over the medial forearm, hypothenar eminence, and medial 1.5 fingers most likely indicates compromise of which nerve?
- Median nerve
- Radial nerve
- Ulnar nerve (Correct answer)
- Musculocutaneous nerve
Correct answer: Ulnar nerve
The ulnar nerve supplies the medial forearm, little finger, and medial half of the ring finger; compression commonly occurs at the cubital tunnel (medial elbow).
NBCE Neurology and Neurological Assessment 2
The biceps brachii reflex tests which nerve roots?