Neuromuscular 2 2010

1 All of the following are appropriate treatment interventions for a patient with multiple
sclerosis except for:
a) utilize a distributed practice schedule
b) cool environment
c) exercise time is less than the rest time
d) switch the patient to a pool therapy program

Rationale: Common problems in multiple sclerosis include fatigue and heat

intolerance. Exercise intensity should be reduced and a distributed practice schedule
used in which rest times equal or exceed exercise times. A massed practice schedule in
which the exercise time exceeds the rest time is contraindicated. A cool environment can
reduce heat intolerance and fatigue that commonly accompanies exercise. A warm
environment or warm pools are contraindicated as both can increase fatigue. Neuro:
Intervention

2 A diagnostic EMG was performed with evidence of spontaneous fibrillation potentials.

What does this mean?
a) reinnervation is complete
b) axonotmesis is occurring
c) denervation atrophy has occurred
d) reinnervation is in process

Rationale: Spontaneous fibrillation potentials present on EMG are evidence of

denervation atrophy. Polyphasic motor units of low amplitude and short duration are
evidence of reinnervation. Neuro : App

3 Your patient is a complete T10 paraplegia. Which initial gait pattern would you teach
him?
a) swing to
b) swing through
c) 2 point
d) 4 point

Rationale: A swing-to gait pattern is indicated for individuals with limited use of both
lower extremities and trunk instability. It is slower and more stable than a swing-through
gait pattern . This patient is unable to perform a reciprocal gait. Neuro: Intervention

4 Your patient was diagnosed with Bell's Palsy. She exhibits facial drooping and
decreased ability to move the face. What are other recognized symptoms ?
a) Sensitivity to sound on affected side of the face
b) Blurred vision
c) Insomnia
d) Problems eating

Rationale: Bell's palsy is a dysfunction of cranial nerve VII (the facial nerve) that
results in inability to control facial muscles on the affected side. Several conditions can
cause a facial paralysis, e.g., brain tumor, stroke, and Lyme disease. However, if no
specific cause can be identified, the condition is known as Bell's palsy. Named after
Scottish anatomist Charles Bell, who first described it, Bell's palsy is the most common
acute mononeuropathy (disease involving only one nerve) and is the most common
cause of acute facial nerve paralysis.

5 Your patient was stabbed in the leg. He was diagnosed with neurotmesis of the
superficial peroneal nerve. What does this mean?
a) A more severe grade of injury to a peripheral nerve
b) Reversible injury to damaged fibers
c) Irreversible injury; no possibility of regeneration
d) Distal wallerian degeneration can occur

Rationale: The most severe grade of injury to a peripheral nerve , axon, myelin,
connective tissue components, are all damaged or transacted , irreversible injury ; no
possibility of regeneration, all motor and sensory loss distal to lesion becomes
permanently impaired.

6 Which task developmentally appropriate for an 8-9 month-old?

a) climb the stairs
b) fine pincer grasp
c) transfer objects from one hand to another
d) rolling to left and right

Rationale: Transferring objects from one hand to another is a task developmentally

appropriate for an 8-9 month-old. Neuro: Clinical App

7 Posterior cerebral arteries supplies oxygenated blood to the posterior aspect of the?
a) Occipital lobe
b) Putamen
c) Pallidum
d) Pons

Rationale: The posterior cerebral artery supplies the oxygenated blood to the
posterior aspect of the occipital lobe.

8 Your patient who is a 50-year old female suffers a left cerebral hemisphere stroke.
Which deficits will your patient manifest?
a) loss of motor skill impairment on the left side
b) loss of speech left side
c) loss of motor skill impairment on the right side
d) full immobility on both sides

Rationale: A left cerebral hemisphere stroke, controls movement of the right side.
The stroke may result in functional loss or motor skill impairment of the right side of the
body. also loss of speech.

9 Your patient is states that she feels dull, aching pain. Discriminative fast pain and
discriminative touch are absent. Which pathways are impaired?
a) proprioceptive pathways and lateral spinothalamic tract
b) anterior and lateral spinothalamic tract
c) anterior spinothalamic tract and proprioceptive pathways
d) fasciculus gracilis/cuneatus and medial lemniscus
 Rationale: Sensations interpreted as dull, aching pain travel in the anterior (paleo)
spinothalamic tract. Discriminative fast pain is carried in the lateral (neo) spinothalamic
tract. Discriminative touch is carried in the proprioceptive pathways (fasciculus
gracilis/cuneatus, medial lemniscus). Nervous : Examination

10 A patient was referred for assessment of the vestibulocular reflex. What action does
this reflex support ?
a) Head and neck balance
b) Gaze stabilization
c) Controlling posture
d) Coordination of the trunk

Rationale: Vestibuloocular reflex (VOR) allows for head/eye movement coordination.

This reflex supports gaze stabilization where the eyes can move while the head is fixed,
visual tracking can also occur when both the eyes and head are moving.

11 The parent of your pediatric patient states that his son vomited several times, was
irritable and is now lethargic. The patient has an atrio-ventricular shunt for
hydrocephalus. What do you suspect?
a) increased cerebral edema
b) child abuse
c) drug overdose
d) flu

Rationale: These signs could be the result of increased cerebral edema due to a
clogged or infected shunt. Medical attention should be obtained immediately to avoid
damage to the brain. Neuro: Eval

12 You are practicing balancing in the physical therapy unit with a patient. The name for
this type of balancing is called suspensory strategy. What does it focus on ?
a) To elevate the center of gravity during standing or ambulation in order to better
control the center of gravity
b) To move the centre of gravity forward during standing or ambulation in order to
better control the center of gravity
c) To lower the center of gravity during standing or ambulation in order to
better control the center of gravity
d) To move the center of gravity backward during standing or ambulation in order to
better control the center of gravity

Rationale: Suspensory strategy is used to lower the centre of gravity to better

control the centre of gravity. Examples of this strategy include knee flexion, crouching or
squatting. this strategy is often used when both mobility and stability are required during
a task ( such as surfing )

13 Your patient has amyotrophic lateral sclerosis. An important early goal of physical
therapy is to maintain the patient's level of conditioning while preventing what?
a) Myalgia
b) overwork damage
c) radicular pain
d) Ataxia
 Rationale: Amyotrophic lateral sclerosis is a progressive degenerative disease that
affects both upper and lower motor neurons. An important early goal of physical therapy
is to maintain the patient's level of conditioning while preventing overwork damage in
denervated muscle (lower motor neuron injury). Myalgia is common in LMN lesions. It
can be ameliorated but not prevented. Ataxia and radicular pain are not associated with
ALS. Neuro: Eval

14 You are treating an 18-month old child with Down Syndrome. What is the best
intervention?
a) rhythmic stabilization
b) proprioceptive exercises
c) weight-bearing activities in antigravity postures
d) verbal cueing

Rationale: Children with Down syndrome typically present with generalized

hypotonicity. The low tone is best managed by weight-bearing activities in antigravity
postures. Typical responses include widened base-of-support and co-contraction to gain
stability. Proprioceptors are not in a high state of readiness and the child may be slow to
respond to proprioceptive facilitation techniques (i.e., stretch, resistance, rhythmic
stabilization). Verbal cueing for redirection is generally the best form of feedback to use
along with visually guided postural control. Neuro: Intervention

15 Your patient's daughter tells you that her mom suffered from brain attack 2 days ago.
How would you position the upper extremity when in supine?
a) shoulder abducted and externally rotated
b) shoulder adducted and externally rotated
c) shoulder abducted and internally rotated
d) shoulder adducted and internally rotated

Rationale:

16 Your patient was diagnosed with embolic type CVA. This is caused by an embolus
and can originate in any part of the body. Which artery is most commonly occluded by
an embolus?
a) Carotid artery
b) The middle cerebral artery
c) Anterior cerebral artery
d) Posterior artery

Rationale: The middle cerebral artery, is most commonly affected by an embolus

from internal carotid arteries. Due to the sudden onset of occlusion , tissues distal to the
infarct can sustain higher permanent damage than those of thrombotic infarcts.

17 Your patient sustained a head injury after a fall from the horse. MRI reveals
hemorrhagic stroke. What is the survival rate of patients with this condition in the first 48
hours ?
a) 25%
b) 40%
c) 50%
d) 60%
 Rationale: Hemorrhage usually occurs during the day with symptoms resolving in
relation to the speed of the bleed. Approximately 50% of deaths from hemorrhagic stroke
occur within the first 48 hours.

18 Your patient receives chronic treatment of systemic corticosteroids for her Multiple
Sclerosis. You expect to find:
a) Spontaneous fractures
b) hypoglycemia
c) muscle wasting
d) weight gain

Rationale: Systemic corticosteroids are used to suppress inflammation and the

normal immune system response during an MS attack. Chronic treatment leads to
adrenal suppression. There are numerous adverse reactions and side effects that can
occur. Those affecting the patient's capacity to exercise include muscle wasting and
pain, weakness, and osteoporosis, Weight loss is common with nausea and vomiting.
Adrenal suppression produces hyperglycemia not hypoglycemia. Spontaneous fractures
are not typical. Neuro: App

19 Your patient suffers a secondary cerebral vascular accident while at home alone.
What are the risk factors for secondary cerebral vascular accidents ?
a) Poor diet
b) Physical inactivity
c) Insomnia
d) Drug abuse

Rationale: The risk factors for cerebral vascular accident , includes primary and
secondary, they include; hypertension, heart disease, diabetes mellitus cigarette
smoking, transient ischemic attacks, obesity, high cholesterol, behaviors related to
hypertension, physical inactivity, increased alcohol consumption.

20 You are treating a patient with a basal ganglia disorder. What is the best strategy?
a) progressive resistive exercises
b) balance platform training
c) task-specific training
d) modalities to decrease pain

Rationale: The basal ganglia functions to convert general motor activity into specific,
goal-directed action plans. Dysfunction results in problems with motor planning and
scaling of movements and postures (e.g., bradykinesia). Patients benefit from initial
guided movement and task-specific training. Proprioceptive, tactile, and verbal cues can
also be used prior to and during a task to enhance movement. Neuro: App

21 You suspect your patient has vagus nerve damage. Which findings are consistent
with this?
a) problems with breathing
b) deviation of the uvula to one side when saying "AH"
c) increased gag reflex
d) dryness of the mouth
 Rationale: These findings suggest involvement of the vagus nerve- Problems with
swallowing, Tests for phonation by having the patient say "AH" with the mouth open,
there is deviation of the uvula to one side. Tests for function of the gag reflex shows
decreased response to stimulation. Neuro: Exam

22 Your patient was referred to physical therapy for movement therapy in relation to
hemiplegia. This technique was developed by Signe Brownstones based on hierarchical
model by Hughlings Jackson. What is the main purpose of using this technique?
a) Reflex inhibiting posture
b) Increased ability for postural adjustment
c) Increased coordination
d) Decreased frustration

Rationale: Movement therapy, this approach has created and defined the term
synergy and initially encouraged the use of reflex inhibiting posture.

23 Kabat, knott, and voss, introduced proprioceptive neuromuscular facilitation (PNF),

the original goal of treatment was to lay down gross motor patterns within the central
nervous system. What is the focus on ?
a) Utilizing stronger parts of the body to stimulate and strengthen weaker
parts.
b) The involved lower extremity will abduct and adduct
c) Mobility is restored to the normal expectations
d) Increased awareness and judgement

Rationale: The PNF approach utilizes methods that promote or hasten the response
of neuromuscular mechanism through stimulation of the proprioceptors.

24 Kabat, Knott, and Voss, introduced proprioceptive neuromuscular facilitation (PNF),

the original goal of treatment was to lay down gross motor patterns within the central
nervous system. Which principle does this technique follow?
a) Utilizing stronger parts of the body to stimulate and strengthen weaker
parts.
b) The involved lower extremity will abduct and adduct
c) Mobility is restored to the normal expectations
d) Increased awareness and judgment

Rationale: The PNF approach utilizes methods that promote or hasten the response
of neuromuscular mechanism through stimulation of the proprioceptors.

25 You are teaching Diagonal patterns -upper extremity responses to your patient. You
want the patient to perform D1 flexion pattern. What are the components of this pattern
for the scapula?
a) Flexion ,adduction, lateral rotation
b) Flexion or extension
c) Elevation , abduction, upward rotation
d) Supination

Rationale: The scapula in D1flexion pattern is indicated in the sequence of

elevation, abduction, upward rotation. It also includes D1 extension pattern, D2 flexion
pattern, D2 extension pattern.
26 Your patient with Parkinson's disease developed elbow flexion, shoulder adduction
contractures of the upper extremities along with a flexed, stooped posture. Which PNF
technique will best help this patient?
a) Bilateral symmetrical upper extremity PNF D2 Extension patterns
b) Bilateral symmetrical upper extremity PNF D2 Flexion patterns
c) Bilateral symmetrical upper extremity PNF D1 extension patterns
d) Bilateral symmetrical upper extremity PNF D1 flexion patterns

Rationale: The patient with Parkinson's disease typically develops elbow flexion,
shoulder adduction contractures of the upper extremities along with a flexed, stooped
posture. Bilateral symmetrical upper extremity PNF D2F patterns encourage shoulder
flexion and abduction with elbow extension, and upper trunk extension (all needed
motions). Neuro: Intervention

27 Your patient suffered from CVA affecting the anterior cerebral artery. Which findings
do you expect?
a) decreased pain and temperature to the face and ipsilateral ataxia with
contralateral pain and thermal loss of the body
b) contralateral hemiparesis and hemi sensory deficits with greater involvement of
the arm than the leg
c) contralateral hemiparesis and sensory deficits, leg more involved than the
arm
d) contralateral hemiplegia with thalamic sensory syndrome and involuntary
movements

Rationale: A CVA affecting the middle cerebral artery will result in symptoms of
contralateral hemiparesis and hemi sensory deficits with greater involvement of the arm
than the leg. Contralateral hemiplegia with thalamic sensory syndrome and involuntary
movements are characteristic of a CVA affecting the posterior cerebral artery syndrome
(central territory). Decreased pain and temperature to the face and ipsilateral ataxia with
contralateral pain and thermal loss of the bodyare characteristic of a CVA affecting the
vertebral artery, posterior inferior cerebellar artery (lateral medullary syndrome).
Contralateral hemiparesis and sensory deficits, leg more involved than the arm are
characteristic of a CVA affecting the anterior cerebral artery. Neuro: Diff Diag

28 Your patient is very ataxic. You decided to use “slow reversal” as one of the
therapeutic exercises. When would you use this technique?
a) Controlled mobility
b) Initiate movement
c) Proximal dynamic stability
d) Increased ROM

Rationale: Slow reversal is indicated with the following : stability, controlled mobility,
distal functional movement.

29 What type of lesion can result in locked-in syndrome leaving the patient with an
inability to move or speak but with full cognitive function?
a) Pontine lesion
b) Basal ganglia lesion
c) Hypothalamic lesion
 d) Frontal Lobe lesion

Rationale: Pontine lesions that result in locked-in syndrome leave the patient with an
inability to move or speak but with full cognitive function. By taping one eye open, the
patient's ability to receive sensory inputs is increased (sensory deprivation is lessened)
and eye movements can be used for communication. Neuro: Eval

30 A patient recovering from a stroke is having difficulty with stair climbing. During
ascent, the patient is able to position the more involved foot on the step above but is
unable to transfer the weight up to the next stair level. The BEST intervention to solve
this problem is:
a) hooklying, bridging.
b) standing, partial wall squats.
c) plantigrade, knee flexion with hip extension.
d) standing, side steps.

Rationale: Rationale: The appropriate task would include the six month gross
developmental level activity of working on unsupported sitting (standing and supine are
not appropriate choices). The use of a multicolored object is more appropriate than a
black and white object for a three year cognitive level.

31 The term ‘Rood” is based on Sherrington and the reflex stimulus model. When would
you utilize this technique?
a) The ability to perform a movement as a result of internal processes
b) The ability to modify or change at the synapse level either temporarily or
permanently in order to perform a particular function
c) Obtain homeostasis in motor output and to activate and perform a task
independently of a stimulus.
d) The ability of the motor and sensory systems to stabilize position and control
movement

Rationale: A goal of this approach is to obtain homeostasis in motor output and to

activate muscles and perform a task independently of a stimulus. Exercise is seen as a
treatment technique only if the response is correct and if it provides sensory feedback
that enhances the motor learning of that response.

32 A 6 year-old boy has a diagnosis of Duchenne muscular dystrophy who is still able to
walk. What is your best course of treatment?
a) wheelchair sports
b) circuit training
c) progressive resistance strength training
d) recreational physical activities

Rationale: Recreational exercise will be both fun and helpful in maintaining

functional level as long as possible. Neuro: Intervention

33 Your patient has astereognosis. What will you expect on your assessment?
a) The inability to write due to a lesion within the brain
b) The inability to recognize symbols letters or numbers traced on the skin
c) The inability to interpret information
d) The inability to recognize objects by sense of touch
 Rationale: Astereognosis, the inability to recognise objects by sense of touch, the
terminology also includes e.g. the inability to interpret information, the inability to write
due to a lesion within the brain.

34 Spasticity is typically strong in antigravity muscles. In the lower extremities, this is

usually the:
a) the hip and knee flexors, adductors, and plantarflexors
b) the hip and knee extensors, adductors, and plantarflexors
c) the hip and knee extensors, abductors, and plantarflexors
d) the hip and knee extensors, adductors, and dorsiflexors

Rationale: Spasticity is typically strong in antigravity muscles. In the lower

extremities this is usually the hip and knee extensors, adductors, and plantar flexors.
Strong extensor tone results in sacral sitting with the pelvis tilted posteriorly. Neuro: Eval

35 The therapist using sensory stimulation techniques for a patient who is very flaccid.
He decides to use facilitation. Which intervention is the therapist using?
a) Deep pressure
b) Joint compression
c) Prolonged stretch
d) Carotid reflex

Rationale: Faciltitation, includes approximation , joint compression, icing, light

touch , quick stretch, resistance, tapping, traction

36 This thrombolytic agent is the most appropriate drug to use for anticoagulation ?
a) Clopidogrel
b) Warfarin
c) Amiodorone
d) Atenolol

Rationale: Thrombolytic agents which produces anticoagulation effects , destroys

thrombus / emboli, include heparin, ximelagatran, alteplase ( activase ), warfarin
( coumadin ) tissue type plasminogen activator( TPA ).

37 Your patient exhibits episodic vertigo, nausea, blurred vision, and autonomic changes
that occur with head movement and typically stop within 30 seconds once the head is
static. What does your patient have?
a) Acoustic Neuroma
b) Oscillopsia
c) unilateral vestibular dysfunction
d) benign paroxysmal positional vertigo

Rationale: Unilateral vestibular dysfunction patients exhibit vertigo, lateral tilt of the
head toward the side of the lesion, conjugate eye torsion and skew deviation toward the
side of the lesion due to otolithic hypofunction. An abnormal vestibular ocular reflex
(VOR) produces nystagmus (involuntary cyclical movements of the eye). Oscillopsia
refers to oscillating vision (an illusion the environment is moving). Benign paroxysmal
positional vertigo (BPPV) is associated with episodic vertigo, nausea, blurred vision, and
autonomic changes that occur with head movement and typically stop within 30 seconds
once the head is static. Acoustic neuroma is a benign tumor affecting CN VIII and is
associated with progressive hearing loss, tinnitus, and disequilibrium. Meniere's disease
is associated with symptoms of nausea and vomiting, episodic vertigo, and fullness in
the ear with low frequency hearing loss. Nervous: Differential Diagnosis

38 The gastrocnemius-soleus moves the body backward while the anterior tibialis moves
the body forward. Action of which muscles would result in a backward lean with the
center of motion occurring at the hip (hip strategy)?
a) hip flexors
b) hip extensors
c) hip internal rotators
d) hip external rotators

Rationale: The muscles of the foot and ankle move the long lever of the body
forward and backward (ankle strategy). The gastrocnemius-soleus moves the body
backward while the anterior tibialis moves the body forward. Action of the hip extensors
would result in a backward lean with the center of motion occurring at the hip (hip
strategy). Neuromuscular: App

39 Your patient with Parkinson's disease has constructional apraxia. What will you
expect to find on your assessment?
a) The inability to perform purposeful learned movements, although there is no
sensory or motor impairment
b) The inability to reproduce geometric figures and designs. This person is
visually unable to analyze how to perform a task.
c) The inability to comprehend sentences and form words
d) The inability to understand the meaning of conversations

Rationale: Constructional paraxial, is terminology used for, the inability to reproduce

geometric figures and designs. This person is visually unable to analyze how to perform
a task.

40 A patient suffered a severe traumatic brain injury and multiple fractures following a
motor vehicle accident. He has positive Kernig's sign with developing nuchal rigidity.
What is the probable cause?
a) cerebral edema
b) brain herniation
c) meningeal irritation
d) CNS infection

Rationale: Signs of increased intracranial pressure secondary to cerebral edema

and brain herniation include decreasing consciousness with slowing of pulse and
Cheyne-Stokes respirations. Cranial nerve dysfunction is typically noted in C.N. II
(papilledema) and C.N.III (dilation of pupils). A positive Kernig's sign with developing
nuchal rigidity is indicative of CNS infection. Neuro: Eval

41 The ventricular system is designed to protect and nourish the brain. How many
ventricles can be found in the brain?
a) Five
b) Three
c) Four
 d) Six

Rationale: The ventricular system consists of four ventricles and multiple foramen
that allow the passage of cerebrospinal fluid.

42 Your patient with cerebral palsy is manifesting athetosis. This condition is best
described as:
a) The inability to perceive the direction and extent of movement of a joint or body
part.
b) A condition that presents with involuntary movements combined with
instability of posture.
c) An involuntary an violent movement of a large body part
d) The inability to perform rapidly alternating movements

Rationale: A condition that presents wit involuntary movements combined with

instability of posture.

43 Your patient was involved in motor vehicle accident. He sustained an anterior cord
syndrome, an incomplete lesion that results from compression and damage to the
anterior part of the spinal cord or anterior spinal artery. Which action could have caused
this condition?
a) Cervical extension
b) Thoracic extension
c) Cervical flexion
d) Thoracic flexion

Rationale: The mechanism of injury usually is cervical flexion, there is a loss of

motor function and pain and temperature sense below the lesion due to damage of the
corticospinal and spin thalamic tracts.

44 Your patient was diagnosed with cauda equina injury. What are the characteristics of
cauda equina injury ?
a) Spasms
b) Rigidity
c) Flaccidity
d) Involuntary movements

Rationale: An injury that occurs below the spinal level L1, where the nerve roots
transcends. The characteristics include: flaccidity, areflexia, and impairment of the bowel
and bladder function.

45 Neurapraxia is a mild peripheral nerve injury (conduction block ischemia) that causes
transient loss of function. Nerve dysfunction is rapidly reversed, generally within:
a) 1-2 days
b) 7-10 days
c) 2-3 weeks
d) 1 month

Rationale: Neurapraxia is a mild peripheral nerve injury (conduction block ischemia)

that causes transient loss of function. Nerve dysfunction is rapidly reversed, generally
within 2-3 weeks. An example is a compression injury to the radial nerve from falling
asleep with the arm over the back of a chair (Saturday night palsy). Neuro: eval

46 Your patient s/p radial head fracture is complaining of pain in the elbow area. You
suspect myossitis ossificans. What other signs will help you confirm your diagnosis?
a) Decreased range of motion
b) Rigidity
c) Deformity
d) Pain

Rationale: Ectopic bone, it typically occurs adjacent to larger joints such as the
knees or the hips. Theories regarding etiology range from tissue hypoxia to abnormal
calcium metabolism

47 Your patient s/p hip fracture has been on bed rest for 3 days. She has been
complaining of pain on the (R) calf area. Which test would you perform to rule out deep
vein thrombosis?
a) Skellinton sign
b) Homan’s sign
c) Moore’s sign
d) Knott sign

Rationale: Homan’s sign is a special test to confirm the presence of a DVT.

48 Your patient who is morbidly obese came to the clinic. She states that it has been
days since she stood up. She is unable to roll and requires maximum assistance to
stand. You suspect that your patient might have developed pressure ulcers. Which areas
are most prone?
a) Buttocks
b) Calf
c) Femur
d) Ulna

Rationale: The most common areas susceptible to pressure ulcers are, buttocks ,
shoulders, elbows , sacrum, malleoli, scapula and prominent vertebrae.

49 A physical therapist examines a patient with a C7 spinal cord injury. Which muscle
would NOT be innervated based on the patient's level of injury?
a) triceps
b) biceps
c) brachioradialis
d) lumbricals

Rationale: The lumbricals will not be innervated with a C7 spinal cord injury.
Neuromuscular: Exam

50 The Rinne test is performed by placing the stem of the tuning fork on the mastoid
process. The test is designed to compare bone conduction hearing with:
a) air conduction hearing
b) liquid conduction hearing
c) bone conduction hearing
 d) propagating conduction hearing

Rationale: The Rinne test is performed by placing the stem of the tuning fork on the
mastoid process. The test is designed to compare bone conduction hearing with air
conduction hearing. Neuro: Exam