NCS Neurological Assessment 2 — Questions and Answers
Question 1: Which cranial nerve is assessed by testing the patient's ability to shrug their shoulders against resistance?
- CN IX (Glossopharyngeal)
- CN X (Vagus)
- CN XI (Spinal Accessory) (Correct answer)
- CN XII (Hypoglossal)
Correct answer: CN XI (Spinal Accessory)
CN XI (Spinal Accessory) innervates the trapezius and sternocleidomastoid muscles, tested by shoulder shrug and head rotation against resistance.
Question 2: A patient presents with loss of pain and temperature sensation on the contralateral side with ipsilateral motor weakness below the lesion. Which spinal cord syndrome is most consistent?
- Central cord syndrome
- Brown-Séquard syndrome (Correct answer)
- Anterior cord syndrome
- Posterior cord syndrome
Correct answer: Brown-Séquard syndrome
Brown-Séquard syndrome results from hemisection of the spinal cord, causing ipsilateral motor loss and contralateral loss of pain/temperature.
Question 3: When assessing the H-reflex in clinical practice, which muscle-nerve pair is most commonly tested?
- Quadriceps via femoral nerve
- Soleus via tibial nerve (Correct answer)
- Biceps via musculocutaneous nerve
- Deltoid via axillary nerve
Correct answer: Soleus via tibial nerve
The H-reflex is most reliably elicited from the soleus via tibial nerve stimulation and reflects the S1 reflex arc.
Question 4: Which assessment tool uses a 15-point scale measuring eye opening, verbal response, and motor response to quantify level of consciousness?
- Rancho Los Amigos Scale
- Glasgow Coma Scale (Correct answer)
- Functional Independence Measure
- NIH Stroke Scale
Correct answer: Glasgow Coma Scale
The Glasgow Coma Scale (GCS) scores eye opening (1-4), verbal response (1-5), and motor response (1-6) for a total of 3-15.
Question 5: During two-point discrimination testing of the fingertip, what is the approximate normal threshold in a healthy adult?
- 1-2 mm
- 2-5 mm (Correct answer)
- 6-10 mm
- 10-15 mm
Correct answer: 2-5 mm
Normal two-point discrimination at the fingertip is approximately 2-5 mm, reflecting high receptor density in the hand.
Question 6: A patient with a complete T10 spinal cord injury would be expected to retain which function?
- Hip flexion
- Ankle dorsiflexion
- Voluntary bladder control
- Diaphragmatic breathing (Correct answer)
Correct answer: Diaphragmatic breathing
The diaphragm is innervated by C3-C5 via the phrenic nerve, which is well above a T10 lesion, so breathing is preserved.
Question 7: Which special test is used to assess the integrity of the dorsal columns by having the patient identify a number traced on their palm?
- Stereognosis
- Graphesthesia (Correct answer)
- Kinesthesia
- Pallesthesia
Correct answer: Graphesthesia
Graphesthesia tests the ability to identify numbers or letters traced on the skin and relies on intact dorsal column-medial lemniscal pathways.
NCS Neurological Assessment 2
Which cranial nerve is assessed by testing the patient's ability to shrug their shoulders against resistance?