NPTE-PT Test Neuromuscular and Nervous Systems Questions and Answers — Questions and Answers
Question 1: A physical therapist is evaluating a patient who presents with flaccid paralysis, significant muscle atrophy, and fasciculations in the right lower extremity. Deep tendon reflexes are diminished (1+). Sensation is intact. These signs are MOST indicative of a lesion in which of the following locations?
- Cerebral cortex
- Basal ganglia
- Anterior horn cell (Correct answer)
- Dorsal column
Correct answer: Anterior horn cell
The clinical presentation of flaccid paralysis, significant muscle atrophy, fasciculations, and hyporeflexia are classic signs of a lower motor neuron (LMN) lesion. [2, 8] The anterior horn cell is the location of the cell body for lower motor neurons. A lesion here would produce these findings. Lesions in the cerebral cortex (upper motor neuron) would result in spasticity and hyperreflexia. [10] Basal ganglia lesions are associated with movement disorders like Parkinson's disease, characterized by rigidity and bradykinesia. Dorsal column lesions would primarily affect sensory modalities like vibration and proprioception, not motor function in this manner.
Question 2: A 68-year-old male with a 5-year history of idiopathic Parkinson's disease is referred to physical therapy to address progressive difficulty with walking and frequent freezing episodes. Which of the following interventions would be MOST effective for improving gait initiation and continuity?
- Massed practice of sit-to-stand transfers without cues
- High-amplitude, low-repetition strengthening exercises for the quadriceps
- Use of external visual and auditory cues (Correct answer)
- Prolonged static stretching of the hip flexors and pectorals
Correct answer: Use of external visual and auditory cues
Patients with Parkinson's disease have difficulty with internally generated movements due to basal ganglia dysfunction. [15, 16] External cues, such as rhythmic auditory stimulation (e.g., a metronome beat) or visual cues (e.g., lines on the floor), can bypass the defective basal ganglia circuitry and utilize alternative pathways to facilitate movement, thereby improving gait initiation, stride length, and reducing freezing of gait. [14, 23] While strengthening and stretching are important components of a comprehensive plan, they do not directly address the mechanism of freezing of gait as effectively as external cueing strategies.
Question 3: A patient is in the acute phase of recovery from Guillain-Barré syndrome (GBS) and is currently on a ventilator in the intensive care unit. The patient is medically stable but has profound, symmetrical ascending weakness. Which of the following is the MOST appropriate physical therapy intervention at this stage?
- Active-resistive exercises to prevent deconditioning
- Passive range of motion and positioning to prevent contractures (Correct answer)
- Functional mobility training, including bed-to-chair transfers
- Overground gait training with a body-weight support system
Correct answer: Passive range of motion and positioning to prevent contractures
In the acute, progressive phase of GBS, especially when a patient is ventilator-dependent, the primary goals are to maintain joint integrity, prevent skin breakdown, and manage respiratory complications. [13, 20] Gentle passive range of motion is crucial to prevent contractures, and proper positioning helps prevent pressure injuries. [17] Introducing active or resistive exercise at this stage is contraindicated as it can lead to overwork weakness and delay recovery. Functional mobility and gait training are not appropriate for a patient with profound weakness who requires mechanical ventilation. [13]
Question 4: A physical therapist is examining a patient with a complete C6 spinal cord injury. Which of the following functional abilities would be the MOST realistic expectation for this patient following comprehensive rehabilitation?
- Independent driving of an adapted van
- Independent ambulation with knee-ankle-foot orthoses (KAFOs)
- Independent self-feeding and grooming with adaptive equipment (Correct answer)
- Independent floor-to-wheelchair transfers
Correct answer: Independent self-feeding and grooming with adaptive equipment
A person with a C6 complete SCI has full innervation of the shoulder and elbow flexors, and importantly, wrist extensors (tenodesis grasp). This allows for independent performance of many activities of daily living, such as feeding, grooming, and upper body dressing, often with the use of adaptive equipment. Driving an adapted van is typically possible for individuals with C6-C7 level injuries. Independent ambulation is not a realistic goal. Independent floor-to-wheelchair transfers are very difficult and usually require a lower level of injury (e.g., C7-C8) due to the need for triceps strength.
Question 5: A patient recovering from a right cerebrovascular accident (CVA) exhibits significant left-sided weakness and pushes strongly toward the left side when sitting, walking, or transferring. The patient resists any attempt at passive correction toward midline. This clinical presentation is BEST described as:
- Ataxia
- Pusher Syndrome (Contraversive Pushing) (Correct answer)
- Apraxia
- Unilateral Neglect
Correct answer: Pusher Syndrome (Contraversive Pushing)
Pusher Syndrome, or contraversive pushing, is a disorder of postural control where the patient actively pushes with their non-paretic side toward their paretic side due to a mismatch between their visual vertical and their perceived postural vertical. [19] This results in a loss of lateral balance and resistance to passive correction. Ataxia is uncoordinated movement. Apraxia is the inability to perform purposeful movements despite intact motor and sensory function. Unilateral neglect is the failure to report or respond to stimuli presented on the contralateral side of a brain lesion.
Question 6: Which of the following sets of clinical findings is MOST consistent with a diagnosis of Relapsing-Remitting Multiple Sclerosis (RRMS)?
- A steady, continuous worsening of symptoms from onset without distinct relapses.
- Clearly defined episodes of new or worsening neurologic symptoms followed by periods of partial or complete recovery. (Correct answer)
- A slow, progressive worsening of symptoms from onset, which is later followed by the development of distinct relapses.
- Initial relapsing-remitting course followed by a progressive worsening of disability with or without occasional relapses.
Correct answer: Clearly defined episodes of new or worsening neurologic symptoms followed by periods of partial or complete recovery.
Relapsing-Remitting Multiple Sclerosis (RRMS) is the most common form of MS and is characterized by distinct attacks (relapses) of new or increasing neurologic symptoms. [25] These relapses are followed by periods of partial or complete recovery (remissions). [25] A steady worsening from onset describes Primary-Progressive MS. A progressive course from onset with later relapses describes Progressive-Relapsing MS (a less common term now often included under PPMS). An initial relapsing course that becomes steadily progressive describes Secondary-Progressive MS.
NPTE-PT Test Neuromuscular and Nervous Systems Questions and Answers
A physical therapist is evaluating a patient who presents with flaccid paralysis, significant muscle atrophy, and fasciculations in the right lower extremity.
Deep tendon reflexes are diminished (1+).
Sensation is intact.
These signs are MOST indicative of a lesion in which of the following locations?