Health Assessment

Testing the deep tendon reflexes gives the examiner specific information regarding the intactness of the:
A) corticospinal tract.
B) reflex arc at specific levels in the spinal cord.
C) medulla.
D) upper motor and lower motor neuron synaptic junction.

When testing the DTRs of a 74-year-old male with a history of contracting polio at the age of 6, which of the following responses would be expected?
A) Negative reflexes
B) Hyperactive reflexes with clonus
C) Normal reflexes
D) Absent reflexes

Mr. McKnight is a 37-year-old patient who presents to your office with a complaint of unsteady gait. When you are testing the quadriceps reflex, which of the following is an expected response?
A) Extension of the lower leg
B) Relaxation of the quadriceps
C) Plantar flexion
D) Flexion of the knee

Mr. Bryan is a 57-year-old patient who comes to you with his wife. His wife notes that he has had an unsteady gait for the last few days. When you are testing the DTRs of an individual, the concept of reinforcement may become important and is best described by which of the following?
A) When testing the DTRs, you may have to stimulate the tendon a second time to reinforce the initial stimulus.
B) If you are unable to initiate a DTR, have the individual perform an isometric exercise in a muscle group away from the one being tested.
C) When testing for DTRs, you must wait at least one minute between testing the same muscle groups in similar extremities; otherwise the initial stimulus is reinforced in the spinal cord.
D) When initiating a DTR, you need to hit the tendon twice in one second so that the second stimulus reinforces the first.

You are assessing the deep tendon reflex response on a 16-year-old boy. The response is an expected reflex response. Which of the following scores should be documented?
A) 2+
B) 3+
C) 1+
D) 4+

Mrs. Bowers brings her newborn daughter in for her first post-hospital visit. On examination, you note the presence of primitive reflexes. The presence of primitive reflexes in a newborn is indicative of which of the following?
A) Immaturity of the nervous system
B) Mental retardation
C) Spinal cord alterations (e.g., spina bifida)
D) Prematurity of the infant

You are requested to examine a newborn in the nursery unit of the hospital. Your initial observation indicates that the infant prefers to maintain a flexed position. Your impression is that:
A) muscle development in this infant has probably been compromised.
B) this infant needs to be screened for cerebral palsy.
C) the infant may have a developmental growth delay.
D) this is an expected position for a newborn to assume.

Which of the following concepts should guide your assessment of the newborn related to a sensory exam?
A) Infants generally have a reduced ability to perceive sensory stimulus and require a stronger stimulus to initiate a response.
B) Infants generally have no feeling of pain until they are about 1 year old, so a sensory exam is useless.
C) Infants generally have an overreaction to any type of stimulus, so it is noninformative to perform a sensory exam.
D) The sensory component of the nervous system lags behind the motor development, so it is useless to perform a sensory exam until the motor system is well developed.

When observing a toddler get up from a lying position, you note that he positions himself on all four extremities and then climbs up himself until he is upright. Your impression related to this observation is:
A) this is significant for developmental delays, and further testing needs to be initiated.
B) this child may have a problem with balance and needs to be tested for cerebellar dysfunction.
C) this child needs to be screened for muscular dystrophy.
D) this is an expected maneuver until the child is at least 5 years old.

10. Mr. Brooks is a 51-year-old patient who presents to your office for a follow-up examination. Which of the following procedures is specifically associated with testing cerebellar function?
A) Superficial pain and touch
B) Muscle strength
C) Rhomboid maneuver
D) Rapid alternating movements

Use of the Glasgow Coma Scale will provide the health care provider with which of the following pieces of information?
A) The site of brain trauma
B) A measure of the level of consciousness
C) The differentiation between upper motor neuron dysfunction and lower motor neuron dysfunction
D) The degree of neurologic dysfunction

During your examination of a 45-year-old female, she indicates that frequently when she is falling asleep, she will experience sudden jerks of her arm or leg. Your response to her should be based on which of the following?
A) These jerks represent the beginning stages of Parkinson disease, and she needs to be monitored closely for further developments.
B) These are normal experiences of individuals when falling asleep.
C) This is the beginning of Huntington disease, and she should be referred to a specialist for continued monitoring.
D) These jerks represent latent epilepsy and require that the individual be placed on anti-seizure medication.

Mr. Williams presents for evaluation after sustaining an injury to Wernicke's area. On examination you determine that the patient may hear sound, but is unable to make any meaning out of it. This is identified as _______ aphasia.
A) receptive
B) nociceptive
C) recessive
D) expressive

Which of the following areas in the frontal lobe is responsible for mediating motor speech?
A) Broca's area
B) Basal ganglion
C) Wernicke's area
D) Brocade's area

The extrapyramidal system is located in which of the following parts of the brain?
A) The cerebellum
B) The medulla
C) The basal ganglia
D) The hypothalamus

The three component structures of the brain that compose the brain stem are the:
A) thalamus, midbrain, and medulla.
B) thalamus, hypothalamus, and basal ganglia.
C) midbrain, pons, and medulla.
D) hypothalamus, pons, and cerebellum.

Along with serving as the main pathway for ascending and descending fiber tracts that connect the spinal nerves to the brain, the spinal cord specifically:
A) mediates reflexes.
B) is a major control center with many vital functions.
C) directs sensory input for transmission to specialized brain compartments.
D) coordinates movement, maintains equilibrium, and helps maintain posture.

The concept of the left cerebral cortex controlling the right side of the body and vice versa is known as:
A) decussate domination.
B) crossover control.
C) crossed representation.
D) oppositional direction.

The sensory pathways in the spinal cord consist of which two tracts?
A) Anterior and posterior columns
B) Pyramidal and extrapyramidal
C) Corticospinal and cerebellar
D) Spinothalamic and posterior columns

The complex motor system that coordinates movement, maintains equilibrium, and helps maintain posture is identified as the: A) extrapyramidal system.
B) cerebellum.
C) upper and lower motor neurons.
D) basal ganglia.

The vagus cranial nerve differs from the other cranial nerves in which of the following ways?
A) It also has a spinal nerve component to its origin and structure.
B) It innervates organs outside the head and neck.
C) It is the only motor cranial nerve.
D) It is the only mixed cranial nerve.

A dermatome is characterized by which of the following?
A) A specific location on the body that mediates nerve impulse transmission to the spinal cord
B) A circumscribed area of skin that is supplied by a particular spinal cord segment via a spinal nerve
C) A precise portion of the body that corresponds to a specific section of the spinal cord and its derived spinal nerve roots
D) A circumscribed cutaneous segment that moderates nerve impulse transmission via the spinal nerve to the corresponding brain segment

Dermatomes overlap in order to do which of the following?
A) Moderate nerve impulse transmission so that one nerve is not overloaded
B) Allow for sensations to be felt when a nerve that innervates the dermatome is severed
C) Mediate the degree of nerve impulse sensation so that transmission is equalized between fibers
D) Maximize the nerve impulse transmission to the spinal cord

Of the following paired terms, which one states a type of reflex arc followed by its corresponding response?
A) Superficial-abdominal
B) Deep tendon-Babinski
C) Visceral-corneal light reflex
D) Pathologic-knee jerk

In the newborn infant, motor activity is under the control of the:
A) cerebellum and brain stem.
B) cranial and spinal nerve roots.
C) spinal cord and medulla.
D) spinothalamic and corticospinal spinal cord pathways.

Which of the following sequences best describes the order in which the myelinization process occurs in the motor and sensory development of an infant?
A) Extremities, trunk, neck, head
B) Trunk, extremities, head, neck
C) Head, neck, trunk, extremities
D) Neck, head, trunk, extremities

The loss of neurons in the brain and spinal cord of older adults results in which of the following?
A) Numbness and tingling in the extremities
B) A decrease in cognitive abilities
C) A decrease in weight and volume of the affected structures
D) The gradual development of migraine headaches

Mrs. Black presents to your office with a complaint of fatigue and vertigo. True vertigo is characterized by which of the following?
A) A sudden loss of strength or temporary loss of consciousness
B) Diminished cerebral blood flow and diminished vestibular response
C) Involuntary contraction of opposing muscle groups
D) A rotational spinning sensation experienced as if the room were spinning around the individual

An abnormal sensation of burning and/or tingling is best described as:
A) paresis.
B) paresthesia.
C) paralysis.
D) dysmetria.

Mr. Cole is a 46-year-old patient who presents for a routine examination. During your taking his history, he tells you he has allergic rhinitis. Which of the following abnormalities would you expect?
A) Anotropia
B) Aphasia
C) Anosmia
D) Aposia

The corneal reflex is a test of which two cranial nerves?
A) Trigeminal and oculomotor
B) Trigeminal and facial
C) Trochlear and abducens
D) Facial and abducens

Muscle tone is best described as which of the following?
A) The inability to control range of motion of muscles
B) The normal degree of tension (contraction) in a voluntarily relaxed muscle C) Muscle shows a full resistance to passive stretch.
D) Myoclonus of the diaphragm demonstrates the normal degree of muscle tone.

Ms. Parsons is a 43-year-old patient with multiple sclerosis. On examination you note involuntary muscle movements. In your documentation this would be described by which of the following terms?
A) Ataxia
B) Athetosis
C) Vestibular
D) Flaccidity

An individual with cerebellar disease may demonstrate dysdiadochokinesia, which is characterized by:
A) the inability to walk heel to toe for more than three steps.
B) misses the nose when performing the finger-to-nose test.
C) slow, clumsy, and sloppy movements when performing rapid alternating hand movements.
D) pain when performing deep knee bends.

Mr. Sanchez is a 62-year-old patient who presents for a follow-up examination. Which of the following maneuvers will test the spinothalamic tract for pain perception?
A) Asking the individual to rate the degree of pain when the skin is pinched
B) Asking the individual to identify when the skin is being touched with the sharp or dull end of a pin/broken tongue blade
C) Gradually decreasing the pressure that is applied when touching the skin and having the individual identify when the skin is no longer being touched by the pin
D) Asking the individual to differentiate between being touched with the sharp end of a pin and the sharp end of a broken tongue blade

Ms. Wilson is a 46-year-old patient who presents for a neurologic examination. During the examination you note clonus when testing deep tendon reflexes. This is characterized by a(n):
A) contraction of the muscle that appears after hitting the tendon the second time.
B) slow, twisting, writhing, continuous movement.
C) set of short, jerking contractions of the same muscle.
D) involuntary contraction of opposing muscle groups.

Which of the following is a true statement regarding superficial reflexes?
A) The cremasteric reflex disappears in females after 18 months.
B) The receptors are in the skin rather than the muscles.
C) Their absence generally indicates developmental delays.
D) They are graded on a 3+ scale.

You are examining a 2-month-old male infant for his routine examination. Which of the following manifestations may indicate potential developmental alterations in infants?
A) Premature achievement of skills and/or exhibition of reflex behaviors
B) Increased sleep time in the first two to three days after birth
C) The presence of the Babinski response in infants
D) Persistence of reflex behavior beyond its expected time frame

Which of the following considerations should the examiner keep in mind when testing the neurologic system of the aging adult?
A) The motor pathways deteriorate more rapidly than the sensory neurons, so more attention should be placed on assessing functions of the motor pathways.
B) The aging individual may need stronger stimuli to elicit appropriate responses.
C) By the time an individual reaches 65, the nervous system begins to shut down; therefore, all results are somewhat tenuous and unreliable.
D) As the muscle mass of the individual diminishes, the ability to elicit appropriate DTRs also diminishes.

An individual who sustains an injury to Broca's area in the frontal lobe will experience which of the following?
A) Secondary aphasia
B) Primary aphasia
C) Receptive aphasia
D) Expressive aphasia

Automatic associated movements of the body are under the control and regulation of:
A) the hypothalamus.
B) the basal ganglia.
C) Wernicke's area.
D) the thalamus.

The area of the brain that contains all the ascending and descending fiber tracts that connect the brain and the spinal cord is the:
A) midbrain.
B) basal ganglia.
C) hypothalamus.
D) medulla.

Which of the following statements is correct regarding the concept of crossed representation of the CNS?
A) The left cerebral cortex receives input from and controls activities of the anterior part of the body.
B) The right cerebellar hemisphere receives input from and controls activities of the dorsal part of the body.
C) The right cerebral cortex receives input from and controls activities of the left side of the body.
D) The left cerebellar hemisphere receives input from and controls activities of the right side of the body.

The posterior dorsal columns are responsible for transmitting the sensations of:
A) pain, temperature, and crude touch.
B) position, vibration, and superficial pain.
C) vibration, position, and fine touch.
D) crude touch, deep pain, and position.

Which of the following statements is correct in regard to upper and lower motor neurons?
A) Upper motor neurons are controlled by impulses sent to them by lower motor neurons.
B) The spinothalamic pathway is a lower motor neuron path, and the corticospinal pathway is an upper motor neuron pathway. D) All nuclei of the upper motor neurons originate in the cerebellum.
C) Amyotrophic lateral sclerosis is an example of a lower motor neuron disorder.

An area of the body that is supplied mainly from one spinal segment through a particular spinal nerve is identified as a:
A) dermatome.
B) dermoblast.
C) dermatomee.
D) dermatophyte.

Which of the following statements is true regarding the reflex arc?
A) The corneal reflex is an example of a pathologic reflex.
B) The reflex arc operates below the level of conscious control to allow for a quick response to potentially dangerous or damaging situations.
C) It is a basic defense mechanism of the nervous system that is under voluntary control.
D) The fibers that mediate the reflex are carried by a specific cranial nerve.

Which of the following processes is necessary for adequate development of the neurologic system to occur in the infant?
A) Movements are directed by primary reflexes.
B) Myelinization of nerves
C) The process of myelinization must follow a proximodistal and cephalocaudal order (extremities, trunk, neck, and head).
D) Motor activity in the newborn must be under the control of the spinal cord and pons.

Mrs. Walker is a 69-year-old female patient who presents for a follow-up examination. Which of the following processes is considered an expected age-related change associated with older adults?
A) A decrease in weight and volume of the brain and spinal cord
B) The velocity of nerve conduction decreases between 15% and 20% with aging.
C) Impaired gross coordination and agility, loss of vibratory sense at the ankle, and decreased or absent Achilles reflexes are common.
D) The aging process causes a general atrophy with an acute loss of neurons in the brain and spinal cord.

Mr. Walker is a 45-year-old diabetic patient. During the course of your obtaining a neurologic history, the individual indicates experiencing some numbness and tingling in the extremities. This would be documented as:
A) paraphrasia.
B) paresis.
C) paranesia.
D) paresthesia.

Mr. Shea is a 50-year-old patient with chronic obstructive pulmonary disease and a history of smoking two packs per day. On examination, which of the following alterations related to cranial nerve function would you expect to be a response?
A) No pupillary consensual response bilaterally
B) Loss of smell bilaterally
C) Unilateral anosmia.
D) Decreased sensation of touch bilaterally

You are examining extraocular movement of a 45-year-old female patient. During your assessment, you note that there are some back-and-forth oscillations of the eyes in the extreme lateral gaze. Your impression of this response is:
A) the individual needs to be referred for a more complete eye examination.
B) this is indicative of a disease of the vestibular system and needs further evaluation.
C) this exam should be repeated in about 15 minutes after the eyes have had time to rest to determine if the same phenomenon occurs.
D) this is an expected response during this exam and the movement of the eyes during this procedure.

Cranial nerve V is composed of which of the following three divisions?
A) Ophthalmic, maxillary, and mandibular
B) Maxillary, mandibular, and temporal
C) Ophthalmic, nasovestibular, and mandibular
D) Temporal, vestibular, and oculomotorius

Mrs. Stephens is a 37-year-old patient who presents for a follow-up examination. The sensory component of cranial nerve VII is tested in which of the following ways?
A) Palpating the temporal and masseter muscles as the person clenches the teeth
B) Touching the individual's face at various points with a cotton wisp
C) Having the individual identify specific tastes on the tongue
D) Touching the cornea with a wisp of cotton to elicit the corneal blink reflex

Mrs. Bowers is a 63-year-old patient. On examination you need to test position sensation. In testing position sensation, the examiner moves the individual's:
A) leg up or down.
B) head back and forth.
C) finger/toe up or down.
D) arm away from and toward the body.

Mrs. Garvin is a 55-year-old patient who presents for a follow-up examination. During your examination you simultaneously touch the individual in two distinct areas of the body and ask how many stimuli are present. You are testing:
A) superficial pain.
B) two-point discrimination.
C) dermatome function.
D) extinction phenomenon.