BIOD 102 Portage Learning - Lab 3 Exam (Reflexes)
(2026/2027)
Section 1: Reflex Testing Techniques
Q1: According to current 2026/2027 neurological exam standards, what is the most appropriate
technique for holding a percussion hammer when testing deep tendon reflexes?
A. Gripping the handle tightly near the hammer head to maximize downward force
B. Holding the handle loosely at the distal end, allowing it to swing freely via wrist
movement [CORRECT]
C. Using a pencil grip at the midpoint of the handle for precise, slow targeting
D. Grasping the flat metal head directly between the thumb and forefinger to tap
Correct Answer: B
Rationale: The hammer should be held loosely at the distal end to allow gravity and a relaxed
wrist snap to generate the force, ensuring a consistent, elastic strike. Tight grips or holding near
the head restrict the swing and deliver a blunt, inconsistent blow.
Q2: In a Portage Learning lab simulation video, a student is observed eliciting the Achilles
tendon reflex. The patient is seated on the exam table with their legs dangling freely. What is the
primary error in this technique?
A. The patient should be lying supine with the hip internally rotated
B. The patient should be prone with the foot hanging over the edge of the table to put the
tendon on stretch [CORRECT]
C. The patient's knee must be fully extended to put the Achilles tendon on maximal stretch
D. Dangling legs provide optimal stretch, but the hammer must strike the calcaneus instead of
the tendon
Correct Answer: B
.
,Rationale: To properly put the Achilles tendon on stretch for accurate testing, the patient should
be prone with the foot dangling off the edge, or kneeling. A seated position with dangling legs
does not provide adequate tension on the gastrocnemius-soleus complex.
Q3: A lab video demonstrates a student performing the Jendrassik maneuver while testing the
patellar reflex. The patient is instructed to hook their fingers together and pull them apart right as
the tendon is struck. What is the physiological purpose of this reinforcement technique?
A. To distract the patient's higher brain centers from feeling the percussion hammer strike
B. To voluntarily contract the quadriceps to compensate for a suspected lower motor neuron
lesion
C. To increase gamma motor neuron activation, thereby increasing muscle spindle
sensitivity [CORRECT]
D. To inhibit the Golgi tendon organ so that the reflex arc is not prematurely terminated
Correct Answer: C
Rationale: The Jendrassik maneuver causes an isometric contraction in the upper body that
activates gamma motor neurons in the lower body, pre-tensioning the muscle spindles and
amplifying the reflex response. It does not directly inhibit the Golgi tendon organ or simply act
as a mental distraction.
Q4: When targeting the patellar tendon to elicit the knee-jerk reflex, where exactly should the
percussion hammer make contact?
A. The superior aspect of the patella
B. The distal tendon insertion on the tibial tuberosity
C. The indentation just distal to the patellar border [CORRECT]
D. The belly of the quadriceps femoris muscle
Correct Answer: C
Rationale: The hammer must strike the patellar tendon precisely in the soft tissue indentation
just below the patella to properly stretch the muscle spindle fibers. Striking the bone or the
muscle belly yields inaccurate or absent reflexes.
.
, Q5: During a simulated lab practical, a student accidentally strikes the tibial tuberosity instead of
the patellar tendon. The patient's leg does not move. How should this finding be documented?
A. 0 (Absent)
B. 1+ (Hypoactive)
C. 2+ (Normal)
D. Indeterminate due to improper technique [CORRECT]
Correct Answer: D
Rationale: Reflex findings cannot be accurately graded if the incorrect anatomical structure is
struck. Striking bone does not stretch the muscle spindle, so grading it as a pathological absence
(0) would be a clinical error.
Q6: On the standard 0 to 4+ deep tendon reflex grading scale established in modern neurological
assessments, what does a grade of 2+ indicate?
A. A brisk, exaggerated response without clonus
B. A normal, expected physiological response [CORRECT]
C. A diminished, low-normal response
D. A completely absent response requiring reinforcement
Correct Answer: B
Rationale: A 2+ grade represents a normal, baseline reflex response in a healthy adult. 1+ is
hypoactive, 3+ is brisk without clonus, and 0 is absent.
Q7: A digital Portage Learning simulation shows a patient's biceps reflex. Upon percussion, there
is a visible contraction of the biceps muscle, but the forearm does not visibly flex at the elbow.
How should this response be graded?
A. 1+ [CORRECT]
B. 2+
C. 3+
D. 4+
Correct Answer: A
.
(2026/2027)
Section 1: Reflex Testing Techniques
Q1: According to current 2026/2027 neurological exam standards, what is the most appropriate
technique for holding a percussion hammer when testing deep tendon reflexes?
A. Gripping the handle tightly near the hammer head to maximize downward force
B. Holding the handle loosely at the distal end, allowing it to swing freely via wrist
movement [CORRECT]
C. Using a pencil grip at the midpoint of the handle for precise, slow targeting
D. Grasping the flat metal head directly between the thumb and forefinger to tap
Correct Answer: B
Rationale: The hammer should be held loosely at the distal end to allow gravity and a relaxed
wrist snap to generate the force, ensuring a consistent, elastic strike. Tight grips or holding near
the head restrict the swing and deliver a blunt, inconsistent blow.
Q2: In a Portage Learning lab simulation video, a student is observed eliciting the Achilles
tendon reflex. The patient is seated on the exam table with their legs dangling freely. What is the
primary error in this technique?
A. The patient should be lying supine with the hip internally rotated
B. The patient should be prone with the foot hanging over the edge of the table to put the
tendon on stretch [CORRECT]
C. The patient's knee must be fully extended to put the Achilles tendon on maximal stretch
D. Dangling legs provide optimal stretch, but the hammer must strike the calcaneus instead of
the tendon
Correct Answer: B
.
,Rationale: To properly put the Achilles tendon on stretch for accurate testing, the patient should
be prone with the foot dangling off the edge, or kneeling. A seated position with dangling legs
does not provide adequate tension on the gastrocnemius-soleus complex.
Q3: A lab video demonstrates a student performing the Jendrassik maneuver while testing the
patellar reflex. The patient is instructed to hook their fingers together and pull them apart right as
the tendon is struck. What is the physiological purpose of this reinforcement technique?
A. To distract the patient's higher brain centers from feeling the percussion hammer strike
B. To voluntarily contract the quadriceps to compensate for a suspected lower motor neuron
lesion
C. To increase gamma motor neuron activation, thereby increasing muscle spindle
sensitivity [CORRECT]
D. To inhibit the Golgi tendon organ so that the reflex arc is not prematurely terminated
Correct Answer: C
Rationale: The Jendrassik maneuver causes an isometric contraction in the upper body that
activates gamma motor neurons in the lower body, pre-tensioning the muscle spindles and
amplifying the reflex response. It does not directly inhibit the Golgi tendon organ or simply act
as a mental distraction.
Q4: When targeting the patellar tendon to elicit the knee-jerk reflex, where exactly should the
percussion hammer make contact?
A. The superior aspect of the patella
B. The distal tendon insertion on the tibial tuberosity
C. The indentation just distal to the patellar border [CORRECT]
D. The belly of the quadriceps femoris muscle
Correct Answer: C
Rationale: The hammer must strike the patellar tendon precisely in the soft tissue indentation
just below the patella to properly stretch the muscle spindle fibers. Striking the bone or the
muscle belly yields inaccurate or absent reflexes.
.
, Q5: During a simulated lab practical, a student accidentally strikes the tibial tuberosity instead of
the patellar tendon. The patient's leg does not move. How should this finding be documented?
A. 0 (Absent)
B. 1+ (Hypoactive)
C. 2+ (Normal)
D. Indeterminate due to improper technique [CORRECT]
Correct Answer: D
Rationale: Reflex findings cannot be accurately graded if the incorrect anatomical structure is
struck. Striking bone does not stretch the muscle spindle, so grading it as a pathological absence
(0) would be a clinical error.
Q6: On the standard 0 to 4+ deep tendon reflex grading scale established in modern neurological
assessments, what does a grade of 2+ indicate?
A. A brisk, exaggerated response without clonus
B. A normal, expected physiological response [CORRECT]
C. A diminished, low-normal response
D. A completely absent response requiring reinforcement
Correct Answer: B
Rationale: A 2+ grade represents a normal, baseline reflex response in a healthy adult. 1+ is
hypoactive, 3+ is brisk without clonus, and 0 is absent.
Q7: A digital Portage Learning simulation shows a patient's biceps reflex. Upon percussion, there
is a visible contraction of the biceps muscle, but the forearm does not visibly flex at the elbow.
How should this response be graded?
A. 1+ [CORRECT]
B. 2+
C. 3+
D. 4+
Correct Answer: A
.
