NPTE-PT Neuromuscular and Nervous Systems 4 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
NPTE-PT Neuromuscular and Nervous Systems 4
Which spinal cord tract carries conscious proprioception and vibration sense to the brain?