NCS Practice Exam and Case Study
Review (Med-bridge and NCS
Advantage) Questions with Complete
Answers
tPA Administration - for what? when can it be administered? what needs to be done
first? - ANSWER-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? - ANSWER-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? - ANSWER-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 - ANSWER-Sensitivity = true positive rate
Highly sensitive tests are best for RULING OUT conditions with negative test results
Specificity - ANSWER-Specificity = true negative rate
Best for RULING IN conditions with a positive test result
,Spinning sensation after bed mobility- - ANSWER-SPINNING sensation after bed
mobility = BPPV (NOT OH)
High sensitivity and specificity? - ANSWER-78.9% sensitivity and 83.7% specificity
were both considered fairly high sensitivity and specificity
Case Study- - ANSWER-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- - ANSWER-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- - ANSWER-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- - ANSWER-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- - ANSWER-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? - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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? - ANSWER-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.
Pill-rolling tremor - ANSWER-Pill-rolling tremors are resting tremors that appear as if
a person is rolling a pill or other small object between their thumb and index finger.
A pill rolling tremor is the most common tremor associated with Parkinson's disease,
a nervous system disorder that affects movement
Pill-rolling tremor Definition: A type of resting tremor characterized by simultaneous
rubbing movements of thumb and index fingers against eachother
SO THIS IS A RESTING TREMOR
VERY COMMON WITH PD
Essential Tremor - ANSWER-Essential tremor is a nervous system (neurological)
disorder that causes involuntary and rhythmic shaking. It can affect almost any part
of your body, but the trembling occurs most often in your hands — especially when
you do simple tasks, such as drinking from a glass or tying shoelaces.
Review (Med-bridge and NCS
Advantage) Questions with Complete
Answers
tPA Administration - for what? when can it be administered? what needs to be done
first? - ANSWER-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? - ANSWER-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? - ANSWER-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 - ANSWER-Sensitivity = true positive rate
Highly sensitive tests are best for RULING OUT conditions with negative test results
Specificity - ANSWER-Specificity = true negative rate
Best for RULING IN conditions with a positive test result
,Spinning sensation after bed mobility- - ANSWER-SPINNING sensation after bed
mobility = BPPV (NOT OH)
High sensitivity and specificity? - ANSWER-78.9% sensitivity and 83.7% specificity
were both considered fairly high sensitivity and specificity
Case Study- - ANSWER-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- - ANSWER-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- - ANSWER-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- - ANSWER-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- - ANSWER-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? - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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? - ANSWER-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.
Pill-rolling tremor - ANSWER-Pill-rolling tremors are resting tremors that appear as if
a person is rolling a pill or other small object between their thumb and index finger.
A pill rolling tremor is the most common tremor associated with Parkinson's disease,
a nervous system disorder that affects movement
Pill-rolling tremor Definition: A type of resting tremor characterized by simultaneous
rubbing movements of thumb and index fingers against eachother
SO THIS IS A RESTING TREMOR
VERY COMMON WITH PD
Essential Tremor - ANSWER-Essential tremor is a nervous system (neurological)
disorder that causes involuntary and rhythmic shaking. It can affect almost any part
of your body, but the trembling occurs most often in your hands — especially when
you do simple tasks, such as drinking from a glass or tying shoelaces.
