NR509 Week 4 Midterm Exam 2026 – Advanced Physical
Assessment: 100 Actual Exam Questions with Explanations
(PDF Download)
Section 1: Cranial Nerves & Neurologic Assessment (1–15)
1. A patient cannot elevate the left eye, and the left pupil is dilated. Which cranial
nerve is affected?
A. CN II (Optic)
B. CN III (Oculomotor)
C. CN IV (Trochlear)
D. CN VI (Abducens)
CN III controls extraocular muscles (except lateral rectus and superior oblique), pupillary
constriction, and eyelid elevation. A dilated pupil with eye movement deficits is a CN III
palsy until proven otherwise.
2. Which cranial nerve is tested by asking the patient to shrug their shoulders against
resistance?
A. CN X (Vagus)
B. CN XI (Spinal Accessory)
C. CN XII (Hypoglossal)
D. CN IX (Glossopharyngeal)
CN XI innervates the trapezius and sternocleidomastoid. Shoulder shrug tests trapezius
function.
3. A patient has difficulty swallowing and a hoarse voice. Which cranial nerve is most
likely involved?
A. CN V (Trigeminal)
B. CN X (Vagus)
C. CN VII (Facial)
D. CN XII (Hypoglossal)
CN X provides motor innervation to the pharynx and larynx. Dysphagia and hoarseness
suggest vagal injury.
,4. To test CN VIII (Vestibulocochlear), the provider should:
A. Check the gag reflex
B. Perform the Weber and Rinne tests
C. Assess extraocular movements
D. Test facial sensation
CN VIII has cochlear (hearing) and vestibular (balance) components. Weber and Rinne
assess hearing.
5. A patient presents with right eye deviation medially and inability to abduct the right
eye. This is consistent with:
A. Right CN III palsy
B. Right CN VI palsy
C. Right CN IV palsy
D. Internuclear ophthalmoplegia
CN VI (Abducens) innervates the lateral rectus. Loss of abduction with normal adduction
points to CN VI.
6. A patient’s tongue deviates to the left when protruded. This indicates:
A. Left CN XII (Hypoglossal) lesion
B. Right CN XII lesion
C. Left CN X lesion
D. Right CN IX lesion
CN XII innervates intrinsic tongue muscles. The tongue deviates toward the side of the
lesion.
7. Corneal reflex testing involves which two cranial nerves?
A. CN II and CN III
B. CN V (afferent) and CN VII (efferent)
C. CN III and CN VI
D. CN VIII and CN IX
Touch to cornea travels via CN V (trigeminal), and the blink response is via CN VII (facial).
8. A patient cannot frown, raise eyebrows, or close the left eye tightly. The forehead
is also affected. This is:
A. Central facial nerve palsy (stroke)
B. Peripheral facial nerve palsy (Bell’s palsy)
C. Trigeminal neuralgia
D. Myasthenia gravis
Peripheral CN VII lesions paralyze upper and lower face. Central lesions spare the forehead
due to bilateral innervation.
, 9. A patient has double vision when looking downward and inward (e.g., reading).
Which nerve is likely affected?
A. CN III
B. CN IV (Trochlear)
C. CN VI
D. CN VIII
CN IV controls the superior oblique muscle, which depresses the adducted eye. Trochlear
palsy causes vertical diplopia on downward gaze.
10. During the fundoscopic exam, you note sharp optic disc margins and physiologic
cupping. This is:
A. Papilledema
B. Normal finding
C. Glaucomatous change
D. Optic neuritis
*Sharp margins and normal cup-to-disc ratio (<0.5) are normal. Blurred margins suggest
papilledema.*
11. The patient reports “double vision that goes away when I close one eye.” This is:
A. Monocular diplopia (refractive or corneal cause)
B. Binocular diplopia (cranial nerve or muscle cause)
C. Convergence insufficiency
D. Nystagmus
Monocular diplopia persists with one eye closed and usually indicates a problem in that eye
(cornea, lens, retina).
12. A patient with diabetes presents with acute onset of “slightly droopy eyelid” but a
normal pupil. This is most likely:
A. CN III palsy with pupil involvement
B. CN III palsy with pupil sparing (microvascular)
C. Horner syndrome
D. Myasthenia gravis
Microvascular CN III palsy (diabetic) typically spares the pupil. Pupil involvement suggests
compression (aneurysm).
13. The patient is unable to identify a number drawn on the palm with eyes closed.
This tests:
A. Graphesthesia
B. Stereognosis
C. Extinction
D. Two-point discrimination
Assessment: 100 Actual Exam Questions with Explanations
(PDF Download)
Section 1: Cranial Nerves & Neurologic Assessment (1–15)
1. A patient cannot elevate the left eye, and the left pupil is dilated. Which cranial
nerve is affected?
A. CN II (Optic)
B. CN III (Oculomotor)
C. CN IV (Trochlear)
D. CN VI (Abducens)
CN III controls extraocular muscles (except lateral rectus and superior oblique), pupillary
constriction, and eyelid elevation. A dilated pupil with eye movement deficits is a CN III
palsy until proven otherwise.
2. Which cranial nerve is tested by asking the patient to shrug their shoulders against
resistance?
A. CN X (Vagus)
B. CN XI (Spinal Accessory)
C. CN XII (Hypoglossal)
D. CN IX (Glossopharyngeal)
CN XI innervates the trapezius and sternocleidomastoid. Shoulder shrug tests trapezius
function.
3. A patient has difficulty swallowing and a hoarse voice. Which cranial nerve is most
likely involved?
A. CN V (Trigeminal)
B. CN X (Vagus)
C. CN VII (Facial)
D. CN XII (Hypoglossal)
CN X provides motor innervation to the pharynx and larynx. Dysphagia and hoarseness
suggest vagal injury.
,4. To test CN VIII (Vestibulocochlear), the provider should:
A. Check the gag reflex
B. Perform the Weber and Rinne tests
C. Assess extraocular movements
D. Test facial sensation
CN VIII has cochlear (hearing) and vestibular (balance) components. Weber and Rinne
assess hearing.
5. A patient presents with right eye deviation medially and inability to abduct the right
eye. This is consistent with:
A. Right CN III palsy
B. Right CN VI palsy
C. Right CN IV palsy
D. Internuclear ophthalmoplegia
CN VI (Abducens) innervates the lateral rectus. Loss of abduction with normal adduction
points to CN VI.
6. A patient’s tongue deviates to the left when protruded. This indicates:
A. Left CN XII (Hypoglossal) lesion
B. Right CN XII lesion
C. Left CN X lesion
D. Right CN IX lesion
CN XII innervates intrinsic tongue muscles. The tongue deviates toward the side of the
lesion.
7. Corneal reflex testing involves which two cranial nerves?
A. CN II and CN III
B. CN V (afferent) and CN VII (efferent)
C. CN III and CN VI
D. CN VIII and CN IX
Touch to cornea travels via CN V (trigeminal), and the blink response is via CN VII (facial).
8. A patient cannot frown, raise eyebrows, or close the left eye tightly. The forehead
is also affected. This is:
A. Central facial nerve palsy (stroke)
B. Peripheral facial nerve palsy (Bell’s palsy)
C. Trigeminal neuralgia
D. Myasthenia gravis
Peripheral CN VII lesions paralyze upper and lower face. Central lesions spare the forehead
due to bilateral innervation.
, 9. A patient has double vision when looking downward and inward (e.g., reading).
Which nerve is likely affected?
A. CN III
B. CN IV (Trochlear)
C. CN VI
D. CN VIII
CN IV controls the superior oblique muscle, which depresses the adducted eye. Trochlear
palsy causes vertical diplopia on downward gaze.
10. During the fundoscopic exam, you note sharp optic disc margins and physiologic
cupping. This is:
A. Papilledema
B. Normal finding
C. Glaucomatous change
D. Optic neuritis
*Sharp margins and normal cup-to-disc ratio (<0.5) are normal. Blurred margins suggest
papilledema.*
11. The patient reports “double vision that goes away when I close one eye.” This is:
A. Monocular diplopia (refractive or corneal cause)
B. Binocular diplopia (cranial nerve or muscle cause)
C. Convergence insufficiency
D. Nystagmus
Monocular diplopia persists with one eye closed and usually indicates a problem in that eye
(cornea, lens, retina).
12. A patient with diabetes presents with acute onset of “slightly droopy eyelid” but a
normal pupil. This is most likely:
A. CN III palsy with pupil involvement
B. CN III palsy with pupil sparing (microvascular)
C. Horner syndrome
D. Myasthenia gravis
Microvascular CN III palsy (diabetic) typically spares the pupil. Pupil involvement suggests
compression (aneurysm).
13. The patient is unable to identify a number drawn on the palm with eyes closed.
This tests:
A. Graphesthesia
B. Stereognosis
C. Extinction
D. Two-point discrimination
