NPTE Exam Neuromuscular Review Questions And Answers
Cranial Nerve I - ANSWER 1. Olfactory- Smell
2. Test sense of smell on each side: use common non irritating odors; close off other
nostrils
3. Anosmia (inability to detect smells), seen with frontal lobe lesions
Cranial Nerve II - ANSWER 1. Optic- Vision
2. Visual acuity testing Central: Snellen chart; test each eye separately by occluding
other eye; test at distance of 20 ft. Visual fields: test peripheral vision by confrontation
3. Blindness, myopia-impaired far vision; presbyopia-impaired near vision. Visual
defects: homonymous hemianopsia and bitemporal hemianopsia
Cranial Nerve III - ANSWER 1. Oculomotor- Pupillary reflex (tests CN II afferent response
and CN III efferent response). Accommodation. Convergence. Extraocular movements:
turns eye up, down, in; constricts pupil and elevates eyelid.
2. Shine light in eye: pupil. Eye accommodates to light.
Pupils move medially when viewing object at close range. Test extra ocular movements:
ask patient to look up, down, medial and lateral
3. Loss of pupillary constriction in both eyes suggests CN II lesion and loss in tested
eyes suggests CN III lesion. Lateral strabismus (Exotropia). Unequal pupils (Anisocoria).
Lateral strabismus: eyeball turns lateral; may cause diplopia or nystagmus. CN III
lesions also cause complete ptosis and dilated pupil.
Cranial Nerve IV - ANSWER 1. Trochlear- Extraocular movements: moves adducted eye
down
2. Ask patient to look in and down
3. Unable to look in and down
Cranial Nerve V - ANSWER 1. Trigeminal- Sensory: face, Sensory: cornea, Motor:
,temporal and master muscles.
2. Test pain, light touch sensations: forehead, cheeks, jaw. Test corneal reflex: touch
lightly with wisp of cotton. Palpate muscles; have patient clench teeth, hold against
resistance
3. Loss of facial sensations, numbest with CN V lesion. Loss of corneal reflex
ipsilaterally. Weakness, wasting of muscles of mastication. Deviation of jaw when
opened to ipsilateral side abnormal findings: Asymmetry of jaw movements, Asymmetry
of jaw strength
Cranial Nerve VI - ANSWER 1. Abducens- Extraocular movements: turns eye out
2. Ask patient to look lateral
3. Medial strabismus: eyeball turns inward; can cause diplopia or nystagmus
Cranial Nerve VII- ANSWER 1. Facial- Facial expression, Sensory function: taste to
anterior ⅓ of tongue
2. Test motor function facial muscles: raise eyebrows, frown, show teeth, smile, close
eyes tightly, puff out both cheeks. Apply sweet, salty, and sour solutions to outer and
lateral portions of anterior tongue using a cotton swab (occlude vision)
3. Paralysis ipsilateral facial muscles: inability to close eye, droop in corner of mouth,
difficulty with speech articulation; PNI: Bell's palsy (CN VII) results in complete
ipsilateral facial paralysis; UMN lesion: above the facial nucleus results in paralysis in
the contralateral lower part of the face. Incorrectly identifies solution. Decreased taste.
Cranial Nerve VIII - ANSWER 1. Acoustic (Vestibulocochlear)- Vestibular function, Test
eye-head coordination: Vestibular Ocular Reflex (VOR), Cochlear function.
2. Balance test: Vestibulospinal function Test eye-head coordination: Vestibular Ocular
Reflex- VOR Test auditory acuity Test for lateralization -Weber's Test: place vibration
tuning fork on top of head, mid position; check if sound heard in one ear, or equally in
both Compare air and bone conduction -Rinne's Test: place vibrating tuning fork on
mastoid bone, then close to ear canal; sound heard longer through air than bone
3. Vertigo, disequilibrium. Gaze instability w/ head rotations, nystagmus (constant,
involuntary cyclical movement of the eyeball). Deafness, impaired hearing, tinnitus.
Unilateral conductive loss: sound lateralized to impaired ear. Sensorineural loss: sound
heard in good ear. Conductive loss: sound heard through bone = or longer than air.
Sensorineural loss: sound heard longer through air.
, Cranial Nerve IX - ANSWER 1. Glossopharyngeal- Sensory function: posterior ⅓ of
tongue, pharynx, middle ear. Phonation. Palatal, pharynx control.
2. Apply sweat, slaty, and sour solutions to posterior tongue. Listen to voice quality.
Have patient say "ah"; observe motion of soft palate-elevates and position of uvula
-remains midline
3. Mistakes solution, loss of taste on posterior tongue. Dysphonia: hoarseness indicates
vocal cord paralysis; nasal quality indicates palatal weakness. Dysarthria: difficulty in
articulating words clearly, slur words.
Cranial Nerve X - ANSWER 1. Vagus- Swallowing, Gag reflex
2. Observe for dysphagia or difficulty swallowing. Lightly stimulate the back of the
throat on each side.
3. Dysphagia difficulty swallowing; loss of swallowing reflexes. Paralysis: palate fails to
elevate-lesion of CN X; asymmetrical elevation: unilateral paralysis. Absent reflex: lesion
of CN IX; possibly CN X
Cranial Nerve XI - ANSWER 1. AccessoryMuscle function: Trapezius muscle,
Sternocleidomastoid-involvement raises concern of brainstem involvement secondary
to proximal innervation.
2. Observe mass, tone. Weakness to lift shoulder girdle or to bring shoulder to ear. In
supine, request patient to flex head anterolaterally and rotate head to opposite side;
resistance is applied in an obliquely posterior direction.
3. Atrophy, fasciculation's, weakness (PNI): Inability to shrug ipsilateral shoulder;
shoulder droops; + scapular flip test (scapular winging). Weakness inability to flex head
laterally and forward, rotate head to contralateral side. Contracture produces torticollis
(wry neck), a dystonic condition that produces a fixed abnormal head position (tilted,
rotted, with flexion or extension)
Cranial Nerve XII - ANSWER 1. Hypoglossal- Tongue movements
2. Listen to patient's articulation. Observe resting position of tongue. Observe
movement of tongue-move lateral to lateral, protrude
3. Dysarthria (lesions of CN X or CN XII). UMN (supra nuclear) lesion: produces mild to
moderate contralateral weakness; may be transient. LMN (nuclear or infra nuclear)
lesion: produces paralysis, atrophy, and fasciculations of the tongue on involved side;
Cranial Nerve I - ANSWER 1. Olfactory- Smell
2. Test sense of smell on each side: use common non irritating odors; close off other
nostrils
3. Anosmia (inability to detect smells), seen with frontal lobe lesions
Cranial Nerve II - ANSWER 1. Optic- Vision
2. Visual acuity testing Central: Snellen chart; test each eye separately by occluding
other eye; test at distance of 20 ft. Visual fields: test peripheral vision by confrontation
3. Blindness, myopia-impaired far vision; presbyopia-impaired near vision. Visual
defects: homonymous hemianopsia and bitemporal hemianopsia
Cranial Nerve III - ANSWER 1. Oculomotor- Pupillary reflex (tests CN II afferent response
and CN III efferent response). Accommodation. Convergence. Extraocular movements:
turns eye up, down, in; constricts pupil and elevates eyelid.
2. Shine light in eye: pupil. Eye accommodates to light.
Pupils move medially when viewing object at close range. Test extra ocular movements:
ask patient to look up, down, medial and lateral
3. Loss of pupillary constriction in both eyes suggests CN II lesion and loss in tested
eyes suggests CN III lesion. Lateral strabismus (Exotropia). Unequal pupils (Anisocoria).
Lateral strabismus: eyeball turns lateral; may cause diplopia or nystagmus. CN III
lesions also cause complete ptosis and dilated pupil.
Cranial Nerve IV - ANSWER 1. Trochlear- Extraocular movements: moves adducted eye
down
2. Ask patient to look in and down
3. Unable to look in and down
Cranial Nerve V - ANSWER 1. Trigeminal- Sensory: face, Sensory: cornea, Motor:
,temporal and master muscles.
2. Test pain, light touch sensations: forehead, cheeks, jaw. Test corneal reflex: touch
lightly with wisp of cotton. Palpate muscles; have patient clench teeth, hold against
resistance
3. Loss of facial sensations, numbest with CN V lesion. Loss of corneal reflex
ipsilaterally. Weakness, wasting of muscles of mastication. Deviation of jaw when
opened to ipsilateral side abnormal findings: Asymmetry of jaw movements, Asymmetry
of jaw strength
Cranial Nerve VI - ANSWER 1. Abducens- Extraocular movements: turns eye out
2. Ask patient to look lateral
3. Medial strabismus: eyeball turns inward; can cause diplopia or nystagmus
Cranial Nerve VII- ANSWER 1. Facial- Facial expression, Sensory function: taste to
anterior ⅓ of tongue
2. Test motor function facial muscles: raise eyebrows, frown, show teeth, smile, close
eyes tightly, puff out both cheeks. Apply sweet, salty, and sour solutions to outer and
lateral portions of anterior tongue using a cotton swab (occlude vision)
3. Paralysis ipsilateral facial muscles: inability to close eye, droop in corner of mouth,
difficulty with speech articulation; PNI: Bell's palsy (CN VII) results in complete
ipsilateral facial paralysis; UMN lesion: above the facial nucleus results in paralysis in
the contralateral lower part of the face. Incorrectly identifies solution. Decreased taste.
Cranial Nerve VIII - ANSWER 1. Acoustic (Vestibulocochlear)- Vestibular function, Test
eye-head coordination: Vestibular Ocular Reflex (VOR), Cochlear function.
2. Balance test: Vestibulospinal function Test eye-head coordination: Vestibular Ocular
Reflex- VOR Test auditory acuity Test for lateralization -Weber's Test: place vibration
tuning fork on top of head, mid position; check if sound heard in one ear, or equally in
both Compare air and bone conduction -Rinne's Test: place vibrating tuning fork on
mastoid bone, then close to ear canal; sound heard longer through air than bone
3. Vertigo, disequilibrium. Gaze instability w/ head rotations, nystagmus (constant,
involuntary cyclical movement of the eyeball). Deafness, impaired hearing, tinnitus.
Unilateral conductive loss: sound lateralized to impaired ear. Sensorineural loss: sound
heard in good ear. Conductive loss: sound heard through bone = or longer than air.
Sensorineural loss: sound heard longer through air.
, Cranial Nerve IX - ANSWER 1. Glossopharyngeal- Sensory function: posterior ⅓ of
tongue, pharynx, middle ear. Phonation. Palatal, pharynx control.
2. Apply sweat, slaty, and sour solutions to posterior tongue. Listen to voice quality.
Have patient say "ah"; observe motion of soft palate-elevates and position of uvula
-remains midline
3. Mistakes solution, loss of taste on posterior tongue. Dysphonia: hoarseness indicates
vocal cord paralysis; nasal quality indicates palatal weakness. Dysarthria: difficulty in
articulating words clearly, slur words.
Cranial Nerve X - ANSWER 1. Vagus- Swallowing, Gag reflex
2. Observe for dysphagia or difficulty swallowing. Lightly stimulate the back of the
throat on each side.
3. Dysphagia difficulty swallowing; loss of swallowing reflexes. Paralysis: palate fails to
elevate-lesion of CN X; asymmetrical elevation: unilateral paralysis. Absent reflex: lesion
of CN IX; possibly CN X
Cranial Nerve XI - ANSWER 1. AccessoryMuscle function: Trapezius muscle,
Sternocleidomastoid-involvement raises concern of brainstem involvement secondary
to proximal innervation.
2. Observe mass, tone. Weakness to lift shoulder girdle or to bring shoulder to ear. In
supine, request patient to flex head anterolaterally and rotate head to opposite side;
resistance is applied in an obliquely posterior direction.
3. Atrophy, fasciculation's, weakness (PNI): Inability to shrug ipsilateral shoulder;
shoulder droops; + scapular flip test (scapular winging). Weakness inability to flex head
laterally and forward, rotate head to contralateral side. Contracture produces torticollis
(wry neck), a dystonic condition that produces a fixed abnormal head position (tilted,
rotted, with flexion or extension)
Cranial Nerve XII - ANSWER 1. Hypoglossal- Tongue movements
2. Listen to patient's articulation. Observe resting position of tongue. Observe
movement of tongue-move lateral to lateral, protrude
3. Dysarthria (lesions of CN X or CN XII). UMN (supra nuclear) lesion: produces mild to
moderate contralateral weakness; may be transient. LMN (nuclear or infra nuclear)
lesion: produces paralysis, atrophy, and fasciculations of the tongue on involved side;
