NCS Neurological Assessment 3 — Questions and Answers
Question 1: During the Romberg test, a patient is stable with eyes open but sways significantly with eyes closed. This finding most likely implicates which system?
- Cerebellar pathology
- Vestibular or proprioceptive pathology (Correct answer)
- Visual pathway lesion
- Corticospinal tract dysfunction
Correct answer: Vestibular or proprioceptive pathology
A positive Romberg (worsening with eye closure) indicates the patient is compensating visually for a proprioceptive or vestibular deficit.
Question 2: A patient demonstrates dysdiadochokinesia on neurological examination. Which cerebellar function does this deficit represent?
- Coordination of eye movements
- Rapid alternating movements of the hands (Correct answer)
- Balance during single-leg stance
- Smooth pursuit of visual targets
Correct answer: Rapid alternating movements of the hands
Dysdiadochokinesia is the inability to perform rapid alternating movements and is a hallmark sign of cerebellar dysfunction.
Question 3: Which gait deviation is most characteristic of a patient with bilateral spastic lower extremity involvement from cerebral palsy?
- Trendelenburg gait
- Scissor gait (Correct answer)
- Steppage gait
- Antalgic gait
Correct answer: Scissor gait
Scissor gait results from bilateral adductor spasticity causing the legs to cross midline during swing phase.
Question 4: The Timed Up and Go (TUG) test assesses functional mobility by measuring the time to complete which task sequence?
- Walk 10 meters, turn, and walk back
- Rise from a chair, walk 3 meters, turn, return, and sit (Correct answer)
- Stand from floor and walk 6 meters
- Tandem walk 10 steps forward and backward
Correct answer: Rise from a chair, walk 3 meters, turn, return, and sit
The TUG requires rising from a standard chair, walking 3 meters, turning, returning, and sitting, with >12 seconds indicating fall risk.
Question 5: When assessing coordination using the heel-shin test, a patient demonstrates worsening accuracy with increased speed of movement. This pattern is most consistent with:
- Peripheral neuropathy
- Posterior column dysfunction
- Cerebellar ataxia (Correct answer)
- Spastic hemiplegia
Correct answer: Cerebellar ataxia
Cerebellar ataxia worsens with increasing speed of intentional movement, distinguishing it from sensory ataxia which worsens more with eye closure.
Question 6: A patient with Parkinson's disease is assessed using the Pull Test (retropulsion test). What does a positive finding indicate?
- Impaired righting reflex and postural instability (Correct answer)
- Decreased lower extremity strength
- Vestibular hypofunction
- Spinal cord compression
Correct answer: Impaired righting reflex and postural instability
A positive Pull Test, where the patient takes more than 2 steps backward or cannot recover without assistance, indicates impaired postural reflexes.
Question 7: Which component of the neurological examination would best differentiate an upper motor neuron lesion from a lower motor neuron lesion?
- Testing vibration sense with a 128 Hz tuning fork
- Assessment of deep tendon reflexes and muscle tone (Correct answer)
- Two-point discrimination threshold measurement
- Assessing stereognosis with common objects
Correct answer: Assessment of deep tendon reflexes and muscle tone
UMN lesions produce hyperreflexia and spasticity, while LMN lesions cause hyporeflexia or areflexia with flaccidity, making DTRs and tone the key differentiating assessment.
NCS Neurological Assessment 3
During the Romberg test, a patient is stable with eyes open but sways significantly with eyes closed.
This finding most likely implicates which system?