On the first day after a spinal cord injury at T2, a man has a blood pressure of 78/40 mmHg, a heart rate of 48 per minute and warm, dry skin below the lesion. Which condition explains this?

Spinal shock alone, with no circulatory effect

Hypovolaemic shock from bleeding

What is the principle of LSVT BIG training for Parkinson's disease?

High-effort, large-amplitude movements delivered intensively

Passive stretching by the therapist

Slow, small, careful movements to avoid tremor

Light general fitness classes twice a month

A woman with unilateral vestibular hypofunction sees the world jump when she walks. Which exercise is most suitable?

Gaze stabilisation, keeping the eyes on a target while moving the head

Standing with eyes closed on a firm surface only

Long-term vestibular suppressant drugs

A man with a complete C6 injury has reduced cough strength. Which technique helps clear secretions?

Manually assisted cough, with an abdominal thrust timed with his expiratory effort

Chest percussion alone on the back, without any assistance to the cough

A strong abdominal thrust given at the end of inspiration, before he coughs

A series of rapid shallow breathing exercises without any assisted cough or thrust

A man with acute continuous vertigo, spontaneous horizontal nystagmus and an inability to walk has a normal head impulse test. Which interpretation is correct?

A normal head impulse test here suggests a central cause such as cerebellar stroke

It confirms benign paroxysmal positional vertigo as the cause of his symptoms

It excludes any serious cause and he can be discharged with exercises at home

It confirms vestibular neuritis, which is the usual cause of acute vertigo

Spinal cord injury and neurological disorders

60 Gulf Prometric Physiotherapist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Spinal cord injury and neurological disorders, part of Neurorehabilitation. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
On the first day after a spinal cord injury at T2, a man has a blood pressure of 78/40 mmHg, a heart rate of 48 per minute and warm, dry skin below the lesion. Which condition explains this?
1. ASpinal shock alone, with no circulatory effect
2. BHypovolaemic shock from bleeding
3. CNeurogenic shock
4. DAutonomic dysreflexia
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Answer: C · Neurogenic shock
Injury above about T6 can cut sympathetic outflow, so vascular tone falls and the unopposed vagus slows the heart. The result is hypotension with bradycardia and warm, vasodilated skin. Haemorrhagic shock, by contrast, causes tachycardia and cold, pale skin. Spinal shock describes the temporary loss of reflexes below the lesion.
- A: Spinal shock is loss of reflexes; it does not explain the circulatory picture.
- B: Bleeding causes a fast heart rate and cold, pale skin.
- D: Autonomic dysreflexia causes severe hypertension, not hypotension.
Remember this
Neurogenic shock: hypotension with bradycardia and warm skin after a high cord injury.
Question 2 · Medium
What is the principle of LSVT BIG training for Parkinson's disease?
1. APassive stretching by the therapist
2. BHigh-effort, large-amplitude movements delivered intensively
3. CSlow, small, careful movements to avoid tremor
4. DLight general fitness classes twice a month
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Answer: B · High-effort, large-amplitude movements delivered intensively
Bradykinesia and hypokinesia make movements small, and patients feel they are moving normally. LSVT BIG trains large-amplitude, high-effort movements in an intensive schedule of one hour four times a week for 4 weeks, with calibration of effort. The goal is to recalibrate perceived movement size.
- A: Passive stretching alone does not retrain amplitude.
- C: Small careful movements reinforce hypokinesia.
- D: Infrequent light classes lack the intensity the programme needs.
Remember this
LSVT BIG trains large-amplitude, high-effort movement intensively.
Question 3 · Medium
A woman with unilateral vestibular hypofunction sees the world jump when she walks. Which exercise is most suitable?
1. AComplete bed rest
2. BGaze stabilisation, keeping the eyes on a target while moving the head
3. CStanding with eyes closed on a firm surface only
4. DLong-term vestibular suppressant drugs
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Answer: B · Gaze stabilisation, keeping the eyes on a target while moving the head
Oscillopsia comes from a poor vestibulo-ocular reflex. Gaze stabilisation (VOR x1 and x2 exercises) drive adaptation of the reflex by repeated head movement with the eyes fixed on a target. Rest and suppressants slow central compensation.
- A: Rest prevents compensation.
- C: Standing still with eyes closed does not train the reflex.
- D: Long-term suppressants slow central compensation.
Remember this
Gaze stabilisation exercises adapt the vestibulo-ocular reflex.
Question 4 · Medium
A man with a complete C6 injury has reduced cough strength. Which technique helps clear secretions?
1. AChest percussion alone on the back, without any assistance to the cough
2. BA strong abdominal thrust given at the end of inspiration, before he coughs
3. CA series of rapid shallow breathing exercises without any assisted cough or thrust
4. DManually assisted cough, with an abdominal thrust timed with his expiratory effort
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Answer: D · Manually assisted cough, with an abdominal thrust timed with his expiratory effort
Abdominal and intercostal muscles are paralysed, so an assistant gives an upward and inward abdominal thrust at the start of expiration to raise the expiratory pressure and flow. Timing during inspiration would be ineffective. Percussion and shallow breathing do not provide the expiratory force.
- A: Percussion alone cannot mobilise secretions without an effective cough.
- B: A thrust during inspiration does not help and may cause discomfort.
- C: Shallow breathing does not produce cough flow.
Remember this
Assisted cough: abdominal thrust timed with expiration.
Question 5 · Hard
A man with acute continuous vertigo, spontaneous horizontal nystagmus and an inability to walk has a normal head impulse test. Which interpretation is correct?
1. AIt confirms benign paroxysmal positional vertigo as the cause of his symptoms
2. BIt excludes any serious cause and he can be discharged with exercises at home
3. CA normal head impulse test here suggests a central cause such as cerebellar stroke
4. DIt confirms vestibular neuritis, which is the usual cause of acute vertigo
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Answer: C · A normal head impulse test here suggests a central cause such as cerebellar stroke
In acute vestibular syndrome, an abnormal head impulse test suggests peripheral neuritis, while a normal test despite continuous vertigo and nystagmus raises the possibility of a central lesion. This is the head impulse component of the HINTS examination. Urgent medical assessment and imaging are then needed.
- A: Benign positional vertigo is brief and triggered by head position.
- B: A normal test does not exclude danger and in fact raises concern.
- D: Vestibular neuritis normally shows an abnormal head impulse test.
Remember this
A normal head impulse test in continuous vertigo suggests a central cause.
Question 6 · Easy
During a gym session a man with a T4 injury becomes flushed, with a thumping headache and a very high blood pressure. What should the physiotherapist do first?
1. ASit him upright, lower the legs and loosen tight clothing
2. BLay him flat, raise the legs and keep him warm with blankets
3. CGive a large drink of water and leave him to rest in the gym
4. DContinue the exercise at a lower intensity and monitor him
Answer and explanation in LearnFree account
Question 7 · Medium
Which finding is used to classify a spinal cord injury as incomplete?
1. AAny movement of the toes appearing only after the first 6 months
2. BA normal bladder habit with no catheter needed and no leakage of urine
3. CPreserved sensation or voluntary contraction at the anal sphincter (S4-S5)
4. DReturn of the knee jerk and the plantar response soon after the end of spinal shock
Answer and explanation in LearnFree account
Question 8 · Medium
A therapist stretches the hands of a man with a C6 complete injury. What advice protects his functional grasp?
1. AStretch the finger flexors fully with the wrist in extension daily
2. BSplint the fingers in extension at night to lengthen the flexors
3. CAvoid stretching the finger flexors with the wrist extended, so the tenodesis effect is kept
4. DStretch the wrist flexors only
Answer and explanation in LearnFree account
Question 9 · Easy
Which key muscle is tested for the C5 myotome in the ISNCSCI examination?
1. AElbow extensors
2. BFinger flexors
3. CWrist extensors
4. DElbow flexors
Answer and explanation in LearnFree account
Question 10 · Hard
A man with multiple sclerosis has had new leg weakness for 3 days. He has no fever, no heat exposure and no other cause found. Which is the most appropriate response?
1. AWait for 3 months before any review
2. BTreat it as a possible relapse and refer promptly to his neurologist
3. CIncrease the intensity of exercise to overcome it
4. DTreat it as Uhthoff's phenomenon and reassure him
Answer and explanation in LearnFree account
Question 11 · Medium
Which is the most appropriate mobility device for a person with a complete C4 injury?
1. AManual wheelchair with push rim projections
2. BWalking with a knee-ankle-foot orthosis
3. CPower wheelchair with chin, head or breath control
4. DManual wheelchair with a sliding board for independent transfers
Answer and explanation in LearnFree account
Question 12 · Hard
A man has a clawed ring and little finger and weak finger abduction, but normal sensation on the dorsum of the ulnar side of the hand and normal flexor carpi ulnaris. Where is the ulnar nerve lesion most likely?
1. AAt the carpal tunnel
2. BAt the medial epicondyle behind the elbow
3. CIn the axilla
4. DAt the wrist (Guyon's canal)
Answer and explanation in LearnFree account
Question 13 · Easy
Which of the following is a cardinal sign of Parkinson's disease?
1. ASpastic paralysis
2. BIntention tremor
3. CResting tremor
4. DAtaxic gait with wide base
Answer and explanation in LearnFree account
Question 14 · Medium
When the examiner gently pulls a patient with Parkinson's disease backward by the shoulders, he takes several backward steps and nearly falls. What does this show?
1. ASpastic hemiparesis
2. BPostural instability with retropulsion
3. CNormal postural reflexes
4. DCerebellar dysmetria
Answer and explanation in LearnFree account
Question 15 · Medium
During the head impulse test, a patient makes a corrective saccade when the head is quickly turned to the right. What does it indicate?
1. AA normal vestibulo-ocular reflex with an intact brain stem
2. BBenign paroxysmal positional vertigo of the horizontal canal
3. CImpaired right vestibulo-ocular reflex, a peripheral lesion
4. DCerebellar stroke affecting the vestibulocerebellum
Answer and explanation in LearnFree account
Question 16 · Medium
A man with Parkinson's disease has great difficulty rising from a chair. Which strategy helps him most?
1. AWait until his medication wears off, when he moves more freely
2. BKeep the trunk upright and push straight up from the armrests
3. CMove to the front of the seat, lean well forward and stand on a counted cue
4. DRock backwards first to build up momentum before standing
Answer and explanation in LearnFree account
Question 17 · Medium
Which advice best manages fatigue in a woman with multiple sclerosis?
1. ATake a long hot bath before each activity to relax the muscles beforehand
2. BExercise vigorously every day until exhausted, to build up stamina
3. CAvoid all exercise and daily tasks in order to save energy for later
4. DPlan activities with pacing, scheduled rests and energy conservation
Answer and explanation in LearnFree account
Question 18 · Easy
Which test is used to diagnose benign paroxysmal positional vertigo of the posterior semicircular canal?
1. ARomberg test
2. BDix-Hallpike test
3. CTinel's test
4. DStraight leg raise
Answer and explanation in LearnFree account
Question 19 · Medium
Which clinical course is the most common at the onset of multiple sclerosis?
1. ASecondary progressive
2. BRelapsing-remitting
3. CPrimary progressive
4. DProgressive-relapsing
Answer and explanation in LearnFree account
Question 20 · Easy
Injury to the radial nerve at the spiral groove of the humerus characteristically produces:
1. AClaw hand
2. BApe hand
3. CFoot drop
4. DWrist drop
Answer and explanation in LearnFree account
Question 21 · Medium
After a humeral shaft fracture, a man has a radial nerve palsy with wrist drop, so he is given a splint. Which splint is right?
1. AA resting splint holding the wrist in flexion
2. BA cock-up wrist splint holding the wrist in extension
3. CA buddy strap for the fingers
4. DA lumbrical bar splint for the ring and little fingers
Answer and explanation in LearnFree account
Question 22 · Medium
A man with a complete C6 injury uses a tenodesis grasp. What is the mechanism?
1. AActive wrist extension closes the fingers passively through the tightness of the finger flexors
2. BActive finger flexors close the hand around the object
3. CWrist flexion opens the hand and lifts the object
4. DElectrical stimulation of the thenar muscles produces the grip
Answer and explanation in LearnFree account
Question 23 · Hard
A man cannot extend his fingers, but he can extend his wrist with radial deviation, has no sensory loss, and triceps is normal. Which nerve lesion fits best?
1. ARadial nerve at the spiral groove
2. BPosterior interosseous nerve
3. CMedian nerve at the wrist
4. DAxillary nerve
Answer and explanation in LearnFree account
Question 24 · Hard
A man with Parkinson's disease can stand and walk unaided but is severely disabled, with marked slowing and postural instability, and needs help with many activities. Which Hoehn and Yahr stage is this?
1. AStage 4
2. BStage 2
3. CStage 3
4. DStage 5
Answer and explanation in LearnFree account
Question 25 · Medium
What does the distal advance of Tinel's sign along the course of an injured nerve indicate?
1. APermanent scar tissue formation
2. BA worsening of the lesion
3. CMuscle reinnervation is complete
4. DThe advancing front of regenerating axons
Answer and explanation in LearnFree account

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Spinal cord injury and neurological disorders

On the first day after a spinal cord injury at T2, a man has a blood pressure of 78/40 mmHg, a heart rate of 48 per minute and warm, dry skin below the lesion. Which condition explains this?

What is the principle of LSVT BIG training for Parkinson's disease?

A woman with unilateral vestibular hypofunction sees the world jump when she walks. Which exercise is most suitable?

A man with a complete C6 injury has reduced cough strength. Which technique helps clear secretions?

A man with acute continuous vertigo, spontaneous horizontal nystagmus and an inability to walk has a normal head impulse test. Which interpretation is correct?

During a gym session a man with a T4 injury becomes flushed, with a thumping headache and a very high blood pressure. What should the physiotherapist do first?

Which finding is used to classify a spinal cord injury as incomplete?

A therapist stretches the hands of a man with a C6 complete injury. What advice protects his functional grasp?

Which key muscle is tested for the C5 myotome in the ISNCSCI examination?

A man with multiple sclerosis has had new leg weakness for 3 days. He has no fever, no heat exposure and no other cause found. Which is the most appropriate response?

Which is the most appropriate mobility device for a person with a complete C4 injury?

A man has a clawed ring and little finger and weak finger abduction, but normal sensation on the dorsum of the ulnar side of the hand and normal flexor carpi ulnaris. Where is the ulnar nerve lesion most likely?

Which of the following is a cardinal sign of Parkinson's disease?

When the examiner gently pulls a patient with Parkinson's disease backward by the shoulders, he takes several backward steps and nearly falls. What does this show?

During the head impulse test, a patient makes a corrective saccade when the head is quickly turned to the right. What does it indicate?

A man with Parkinson's disease has great difficulty rising from a chair. Which strategy helps him most?

Which advice best manages fatigue in a woman with multiple sclerosis?

Which test is used to diagnose benign paroxysmal positional vertigo of the posterior semicircular canal?

Which clinical course is the most common at the onset of multiple sclerosis?

Injury to the radial nerve at the spiral groove of the humerus characteristically produces:

After a humeral shaft fracture, a man has a radial nerve palsy with wrist drop, so he is given a splint. Which splint is right?

A man with a complete C6 injury uses a tenodesis grasp. What is the mechanism?

A man cannot extend his fingers, but he can extend his wrist with radial deviation, has no sensory loss, and triceps is normal. Which nerve lesion fits best?

A man with Parkinson's disease can stand and walk unaided but is severely disabled, with marked slowing and postural instability, and needs help with many activities. Which Hoehn and Yahr stage is this?

What does the distal advance of Tinel's sign along the course of an injured nerve indicate?