NPTE-PT Neuromuscular and Nervous Systems — Questions and Answers
Question 1: A patient presents with foot drop, weakness of ankle dorsiflexion, and sensory loss over the dorsum of the foot. Which nerve is most likely injured?
- Tibial nerve
- Common peroneal nerve (Correct answer)
- Sural nerve
- Saphenous nerve
Correct answer: Common peroneal nerve
The common peroneal nerve innervates the muscles responsible for ankle dorsiflexion and eversion, and provides sensation to the dorsum of the foot.
Question 2: Which reflex arc component is responsible for detecting changes in muscle length?
- Golgi tendon organ
- Muscle spindle (Correct answer)
- Pacinian corpuscle
- Ruffini ending
Correct answer: Muscle spindle
Muscle spindles (intrafusal fibers) are stretch-sensitive receptors that detect changes in muscle length and rate of length change.
Question 3: A patient recovering from a stroke demonstrates hyperreflexia and increased muscle tone in the right upper extremity. Which descending pathway is most likely damaged?
- Rubrospinal tract
- Vestibulospinal tract
- Corticospinal tract (Correct answer)
- Reticulospinal tract
Correct answer: Corticospinal tract
Damage to the corticospinal (pyramidal) tract causes upper motor neuron signs including hyperreflexia, spasticity, and increased muscle tone.
Question 4: Which cranial nerve is tested when a patient is asked to shrug their shoulders against resistance?
- CN IX
- CN X
- CN XI (Correct answer)
- CN XII
Correct answer: CN XI
The accessory nerve (CN XI) innervates the trapezius and sternocleidomastoid muscles, which are tested with shoulder shrugging and head rotation.
Question 5: During gait analysis, a patient shows excessive lateral trunk lean toward the stance leg. This compensatory strategy is most likely due to weakness of which muscle?
- Gluteus maximus
- Gluteus medius (Correct answer)
- Tensor fascia latae
- Piriformis
Correct answer: Gluteus medius
Gluteus medius weakness causes the Trendelenburg gait, where the trunk leans toward the weak side to shift the center of mass and reduce the hip abductor moment demand.
Question 6: A patient with a C6 spinal cord injury would retain which of the following motor functions?
- Finger flexion
- Elbow extension
- Wrist extension (Correct answer)
- Hand intrinsic muscle control
Correct answer: Wrist extension
The C6 myotome includes wrist extensors (extensor carpi radialis), which remain intact in a C6 complete spinal cord injury.
Question 7: Which term describes the phenomenon where repeated stimulation of a reflex leads to a diminished response over time?
- Sensitization
- Facilitation
- Habituation (Correct answer)
- Irradiation
Correct answer: Habituation
Habituation is the progressive decrease in reflex response amplitude with repeated, non-noxious stimulation of the same pathway.
Question 8: A patient demonstrates an inability to oppose the thumb and has wasting of the thenar eminence. Which nerve is most likely compressed?
- Ulnar nerve at the wrist
- Median nerve at the wrist (Correct answer)
- Radial nerve at the elbow
- Anterior interosseous nerve
Correct answer: Median nerve at the wrist
Carpal tunnel syndrome involves median nerve compression at the wrist, causing thenar wasting and loss of thumb opposition due to opponens pollicis weakness.
Question 9: Which area of the brain is primarily responsible for the learning and coordination of skilled, sequential movements?
- Basal ganglia
- Cerebellum (Correct answer)
- Thalamus
- Prefrontal cortex
Correct answer: Cerebellum
The cerebellum coordinates the timing, sequencing, and precision of skilled voluntary movements and is critical for motor learning.
Question 10: A patient presents with a positive Romberg test. What does this finding indicate?
- Cerebellar dysfunction
- Vestibular dysfunction only
- Proprioceptive deficit with visual compensation (Correct answer)
- Upper motor neuron lesion
Correct answer: Proprioceptive deficit with visual compensation
A positive Romberg test indicates that the patient can maintain balance with eyes open (using vision) but loses balance with eyes closed, suggesting proprioceptive or dorsal column impairment.
Question 11: Which type of motor neuron disease is characterized by both upper and lower motor neuron signs occurring simultaneously?
- Multiple sclerosis
- Amyotrophic lateral sclerosis (Correct answer)
- Guillain-Barré syndrome
- Poliomyelitis
Correct answer: Amyotrophic lateral sclerosis
ALS (amyotrophic lateral sclerosis) is characterized by simultaneous degeneration of both upper motor neurons (corticospinal tract) and lower motor neurons (anterior horn cells).
Question 12: A therapist observes fasciculations and muscle atrophy in a patient's right quadriceps. These findings are most consistent with a lesion of which structure?
- Upper motor neuron
- Lower motor neuron (Correct answer)
- Corticospinal tract
- Sensory cortex
Correct answer: Lower motor neuron
Fasciculations and muscle atrophy are classic lower motor neuron signs resulting from denervation of the muscle.
Question 13: A patient with Parkinson's disease demonstrates difficulty initiating movements. This symptom is referred to as:
- Ataxia
- Akinesia (Correct answer)
- Dysmetria
- Dyskinesia
Correct answer: Akinesia
Akinesia refers to difficulty or absence of voluntary movement initiation, a hallmark motor symptom of Parkinson's disease due to dopamine depletion in the basal ganglia.
Question 14: The Tinel's sign at the medial elbow (cubital tunnel) tests for entrapment of which nerve?
- Median nerve
- Radial nerve
- Ulnar nerve (Correct answer)
- Musculocutaneous nerve
Correct answer: Ulnar nerve
Tinel's sign at the cubital tunnel (medial elbow) reproduces paresthesias in the ulnar nerve distribution when the nerve is tapped at the site of entrapment.
Question 15: Which spinal cord tract carries conscious proprioception and vibration sense to the brain?
- Spinothalamic tract
- Dorsal columns (posterior funiculus) (Correct answer)
- Spinocerebellar tract
- Corticospinal tract
Correct answer: Dorsal columns (posterior funiculus)
The dorsal columns (medial lemniscal pathway) carry fine touch, vibration, and conscious proprioception to the sensory cortex via the thalamus.
Question 16: A patient who had a right middle cerebral artery stroke now has left-sided hemiplegia and left homonymous hemianopia. The hemianopia is caused by damage to which structure?
- Optic chiasm
- Left optic tract
- Right optic radiation (Correct answer)
- Right optic nerve
Correct answer: Right optic radiation
The right optic radiation carries visual information from the left visual field; damage causes left homonymous hemianopia contralateral to the side of the MCA stroke.
Question 17: Which finding would differentiate a peripheral vestibular disorder from a central vestibular disorder in a patient with dizziness?
- Nystagmus that is purely horizontal and suppressed by visual fixation
- Nystagmus that changes direction with gaze (Correct answer)
- Unilateral hearing loss
- Tinnitus
Correct answer: Nystagmus that changes direction with gaze
Direction-changing nystagmus with gaze is a hallmark of central vestibular pathology; peripheral vestibular nystagmus is unidirectional and suppressed by visual fixation.
Question 18: A patient with a T10 complete spinal cord injury would be expected to have intact function at which level?
- Hip flexors (iliopsoas)
- Knee extensors (quadriceps)
- Ankle dorsiflexors
- Both A and B (Correct answer)
Correct answer: Both A and B
T10 is above the lumbar plexus, so hip flexors (L1-L3) and knee extensors (L2-L4) would both be paralyzed; however, T10 and above innervated trunk muscles are intact.
Question 19: Which assessment tool is most appropriate for measuring functional mobility and fall risk in a patient with neurological deficits?
- Berg Balance Scale (Correct answer)
- Fugl-Meyer Assessment
- Modified Ashworth Scale
- Manual Muscle Testing
Correct answer: Berg Balance Scale
The Berg Balance Scale is a validated 14-item functional balance assessment widely used to quantify balance ability and predict fall risk in neurological populations.
Question 20: A patient demonstrates athetosis. Which structure is most likely damaged?
- Cerebellum
- Basal ganglia (putamen) (Correct answer)
- Prefrontal cortex
- Brainstem
Correct answer: Basal ganglia (putamen)
Athetosis (slow, writhing, involuntary movements) results from damage to the putamen component of the basal ganglia and is commonly seen in cerebral palsy.
Question 21: In a patient with Brown-Séquard syndrome (right-sided hemisection of cord at T6), which deficits would be expected?
- Right-sided loss of pain/temperature, left-sided motor weakness
- Left-sided loss of pain/temperature, right-sided motor weakness (Correct answer)
- Bilateral motor weakness with preserved sensation
- Bilateral loss of pain and temperature below T6
Correct answer: Left-sided loss of pain/temperature, right-sided motor weakness
In Brown-Séquard syndrome, ipsilateral motor loss and proprioception loss occur with contralateral pain and temperature loss because the spinothalamic tract decussates at the level of entry.
