NCS PRACTICE EXAM AND CASE
STUDY REVIEW (MEDBRIDGE AND
NCS ADVANTAGE)
Imaging with stroke presentation- - Correct Answers -After presenting with a stroke, CT
is often the first imaging ordered. It will not show an ischemic stroke but it's quick and it
will rule out a hemorrhagic stroke so that tPA can be ordered quickly if appropriate
tPA Administration - for what? when can it be administered? what needs to be done
first? - Correct Answers -tPA is the gold standard for treating ischemic strokes. It can be
administered up to 3-4.5 hours after first symptom onset. Hemorrhagic stroke must be
ruled out first
NIHSS
Range of scores?
What scores are better?
Severity - mild, mild to moderate, severe, very severe?
Predicting d/c disposition? - Correct Answers -NIHSS scores range from 0-42, with
lower scores being better and meaning a less severe stroke
Severity:
Mild = 1-5
Mild to moderate = 5-14
Severe = 15-24
Very severe > 25
Predicting d/c disposition
Scores < 5 = 80% go home
Scores 6-13 = typically IP rehab
Scores > 14 = frequently require long term care
Postural Assessment Scale for Stroke Patients (PASS)
Is it recommended?
What items does it look at?
Who is it recommended for? - Correct Answers -Highly recommended by the Stroke
EDGE task force
Looks at static maintaining a posture
Looks at dynamic changing postures
Looks at bed mobility, transfers, sitting balance, standing balance
,Sensitivity - Correct Answers -Sensitivity = true positive rate
Highly sensitive tests are best for RULING OUT conditions with negative test results
Specificity - Correct Answers -Specificity = true negative rate
Best for RULING IN conditions with a positive test result
Spinning sensation after bed mobility- - Correct Answers -SPINNING sensation after
bed mobility = BPPV (NOT OH)
High sensitivity and specificity? - Correct Answers -78.9% sensitivity and 83.7%
specificity were both considered fairly high sensitivity and specificity
Case Study- - Correct Answers -Case study - detailed consideration and research
focused on a person, group or situation over a period of time
Analyzed in order to illustrate a thesis or principle
Case Control Study- - Correct Answers -Case Control Study - a study that compares
two groups of people - those with the disease or condition under study (cases) and a
very similar group of people who do not have the disease or condition (controls)
Cohort Study- - Correct Answers -Cohort Study - a research study that compares a
particular outcome (such as lung cancer) in a group of individuals who are alike in many
ways but differ by a certain characteristic (for example, female nurses who smoke
compared to those who do not smoke)
A type of longitudinal study that follows people over many years
An exposure is assessed and then participants are followed prospectively to observe
whether they develop the outcome
Follows a group of people over time
Can be prospective, retrospective or a combo of both types
Cross-Sectional Study- - Correct Answers -Cross-sectional Study - a type of research
design in which you collect data from many different individuals at a single point in time.
You observe variables without influencing them
It's an observational study design
Descriptive research, NOT causal or relational
Measures at one given point in time across a sample population
Liberatory Maneuver- - Correct Answers -The Semont or Liberatory maneuver is used
for treating cupulolithiasis.
Just FYI another name for Semont's Maneuver is Liberatory Maneuver
Outcomes of repositioning maneuvers treatments for posterior canalithiasis? How many
sessions does it usually take? Does it work well? What can the patient expect? Is
recurrence possible? Might they need more treatments? - Correct Answers -Most
patients with your condition have complete resolution of symptoms after one treatment
, and over 90% have no symptoms remaining after two treatments. We will re-test at your
next session to see if further treatment is warranted
Most patients treated for posterior canalithiasis experience complete resolution of
symptoms within 1-2 sessions. We want to convey confidence to the patient to ease her
anxiety while stopping short of promising a "cure." It is not necessary for the patient to
call immediately if her symptoms persist, as she is not reporting other functional/safety
concerns (per DHI) and it would likely increase her anxiety to perceive positional vertigo
as a medically urgent matter.
Action Tremor - Correct Answers -Action tremor
Action tremor occurs with the voluntary movement of a muscle. Most types of tremor are
considered action tremor. There are several sub-classifications of action tremor, many
of which overlap. Postural tremor occurs when you are holding a position against
gravity, such as keeping your arms outstretched.
Is action tremor the same as intention tremor?
An action tremor (kinetic or intention tremor) occurs during movement of the affected
body part from one point to another. A task-specific tremor occurs only when the patient
begins to perform a highly skilled activity, such as writing or speaking.
Intention Tremor - Correct Answers -Intention tremor
Intention tremor is produced with purposeful movement toward a target, such as lifting a
finger to touch the nose. Typically the tremor will become worse as an individual gets
closer to their target. Task-specific tremor only appears when performing highly-skilled,
goal-oriented tasks such as handwriting or speaking.
The most common causes are multiple sclerosis, midbrain trauma, and stroke.
Intention tremor is defined as a rhythmic, oscillatory, and high amplitude tremor during a
directed and purposeful motor movement
Same as action tremor
Resting Tremor - Correct Answers -Resting tremor - resting tremor is common with PD.
It's present at rest but reduces when you actively use your arm to do something
The main difference between Parkinson's tremor and most other types of tremor is that
in PD resting tremor is most common. Other conditions are usually characterized by
"action tremor," which tends to lessen at rest and increase when you're doing
something, like trying to make a phone call or take a drink. Tremors of the head and
voice are also common in essential tremor but rare in PD.
Resting tremor occurs when the muscle is relaxed, such as when the hands are resting
on the lap.
It will dampen or subside entirely with action.
What is the difference between resting and intention tremor? - Correct Answers -For
example, when bringing a spoon to the mouth, the hand will begin to shake as the
person brings the spoon to their mouth. Conversely, a person who has a resting tremor
would have involuntary movement when they are not trying to move, but when they
begin an intentional movement the tremors typically stop.
STUDY REVIEW (MEDBRIDGE AND
NCS ADVANTAGE)
Imaging with stroke presentation- - Correct Answers -After presenting with a stroke, CT
is often the first imaging ordered. It will not show an ischemic stroke but it's quick and it
will rule out a hemorrhagic stroke so that tPA can be ordered quickly if appropriate
tPA Administration - for what? when can it be administered? what needs to be done
first? - Correct Answers -tPA is the gold standard for treating ischemic strokes. It can be
administered up to 3-4.5 hours after first symptom onset. Hemorrhagic stroke must be
ruled out first
NIHSS
Range of scores?
What scores are better?
Severity - mild, mild to moderate, severe, very severe?
Predicting d/c disposition? - Correct Answers -NIHSS scores range from 0-42, with
lower scores being better and meaning a less severe stroke
Severity:
Mild = 1-5
Mild to moderate = 5-14
Severe = 15-24
Very severe > 25
Predicting d/c disposition
Scores < 5 = 80% go home
Scores 6-13 = typically IP rehab
Scores > 14 = frequently require long term care
Postural Assessment Scale for Stroke Patients (PASS)
Is it recommended?
What items does it look at?
Who is it recommended for? - Correct Answers -Highly recommended by the Stroke
EDGE task force
Looks at static maintaining a posture
Looks at dynamic changing postures
Looks at bed mobility, transfers, sitting balance, standing balance
,Sensitivity - Correct Answers -Sensitivity = true positive rate
Highly sensitive tests are best for RULING OUT conditions with negative test results
Specificity - Correct Answers -Specificity = true negative rate
Best for RULING IN conditions with a positive test result
Spinning sensation after bed mobility- - Correct Answers -SPINNING sensation after
bed mobility = BPPV (NOT OH)
High sensitivity and specificity? - Correct Answers -78.9% sensitivity and 83.7%
specificity were both considered fairly high sensitivity and specificity
Case Study- - Correct Answers -Case study - detailed consideration and research
focused on a person, group or situation over a period of time
Analyzed in order to illustrate a thesis or principle
Case Control Study- - Correct Answers -Case Control Study - a study that compares
two groups of people - those with the disease or condition under study (cases) and a
very similar group of people who do not have the disease or condition (controls)
Cohort Study- - Correct Answers -Cohort Study - a research study that compares a
particular outcome (such as lung cancer) in a group of individuals who are alike in many
ways but differ by a certain characteristic (for example, female nurses who smoke
compared to those who do not smoke)
A type of longitudinal study that follows people over many years
An exposure is assessed and then participants are followed prospectively to observe
whether they develop the outcome
Follows a group of people over time
Can be prospective, retrospective or a combo of both types
Cross-Sectional Study- - Correct Answers -Cross-sectional Study - a type of research
design in which you collect data from many different individuals at a single point in time.
You observe variables without influencing them
It's an observational study design
Descriptive research, NOT causal or relational
Measures at one given point in time across a sample population
Liberatory Maneuver- - Correct Answers -The Semont or Liberatory maneuver is used
for treating cupulolithiasis.
Just FYI another name for Semont's Maneuver is Liberatory Maneuver
Outcomes of repositioning maneuvers treatments for posterior canalithiasis? How many
sessions does it usually take? Does it work well? What can the patient expect? Is
recurrence possible? Might they need more treatments? - Correct Answers -Most
patients with your condition have complete resolution of symptoms after one treatment
, and over 90% have no symptoms remaining after two treatments. We will re-test at your
next session to see if further treatment is warranted
Most patients treated for posterior canalithiasis experience complete resolution of
symptoms within 1-2 sessions. We want to convey confidence to the patient to ease her
anxiety while stopping short of promising a "cure." It is not necessary for the patient to
call immediately if her symptoms persist, as she is not reporting other functional/safety
concerns (per DHI) and it would likely increase her anxiety to perceive positional vertigo
as a medically urgent matter.
Action Tremor - Correct Answers -Action tremor
Action tremor occurs with the voluntary movement of a muscle. Most types of tremor are
considered action tremor. There are several sub-classifications of action tremor, many
of which overlap. Postural tremor occurs when you are holding a position against
gravity, such as keeping your arms outstretched.
Is action tremor the same as intention tremor?
An action tremor (kinetic or intention tremor) occurs during movement of the affected
body part from one point to another. A task-specific tremor occurs only when the patient
begins to perform a highly skilled activity, such as writing or speaking.
Intention Tremor - Correct Answers -Intention tremor
Intention tremor is produced with purposeful movement toward a target, such as lifting a
finger to touch the nose. Typically the tremor will become worse as an individual gets
closer to their target. Task-specific tremor only appears when performing highly-skilled,
goal-oriented tasks such as handwriting or speaking.
The most common causes are multiple sclerosis, midbrain trauma, and stroke.
Intention tremor is defined as a rhythmic, oscillatory, and high amplitude tremor during a
directed and purposeful motor movement
Same as action tremor
Resting Tremor - Correct Answers -Resting tremor - resting tremor is common with PD.
It's present at rest but reduces when you actively use your arm to do something
The main difference between Parkinson's tremor and most other types of tremor is that
in PD resting tremor is most common. Other conditions are usually characterized by
"action tremor," which tends to lessen at rest and increase when you're doing
something, like trying to make a phone call or take a drink. Tremors of the head and
voice are also common in essential tremor but rare in PD.
Resting tremor occurs when the muscle is relaxed, such as when the hands are resting
on the lap.
It will dampen or subside entirely with action.
What is the difference between resting and intention tremor? - Correct Answers -For
example, when bringing a spoon to the mouth, the hand will begin to shake as the
person brings the spoon to their mouth. Conversely, a person who has a resting tremor
would have involuntary movement when they are not trying to move, but when they
begin an intentional movement the tremors typically stop.
