Shadow Health Neurological Assessment – Samuel Green: Comprehensive Question & Answer Study Guide with Clinical Rationales (2026)

Shadow Health Neurological
Assessment – Samuel Green:
Comprehensive Question & Answer
Study Guide with Clinical Rationales
(2026)

Question 1
A 68-year-old male presents with a 14-month history of right-hand tremor. Which
additional finding from the HPI is most characteristic of Parkinson's disease (PD)?

 A) Tremor that worsens with reaching for an object
 B) Tremor that is present at rest and decreases with voluntary movement
 C) Bilateral head tremor
 D) Tremor that is present only during sleep

Correct Answer: B

Rationale: A classic feature of Parkinson's disease is a resting tremor (typically 4–6 Hz)
that is present when the limb is at rest and suppressed during voluntary movement.
Samuel's right-hand tremor that improves when he uses the hand points to PD rather
than essential tremor, which worsens with action.

,Question 2
Samuel's wife reports he has a "masked face" and looks worried even when he isn't. This
clinical finding is termed:

 A) Emotional lability
 B) Hypomimia (masked facies)
 C) Flat affect
 D) Psychomotor retardation

Correct Answer: B

Rationale: Hypomimia, or masked facies, refers to reduced facial expression and is a
common feature of Parkinson's disease due to bradykinesia affecting facial muscles.




Question 3
Samuel's wife reports he has difficulty typing emails and buttoning his shirts. This is best
attributed to:

 A) Cognitive decline
 B) Bradykinesia and resting tremor
 C) Visual impairment
 D) Peripheral neuropathy

Correct Answer: B

Rationale: Difficulty with fine motor tasks such as typing and buttoning in Parkinson's
disease results from bradykinesia (slowness of movement) and resting tremor. These
motor symptoms impair dexterity and precision.

,Question 4
Samuel's MoCA (Montreal Cognitive Assessment) score is 24/30. This indicates:

 A) Normal cognition for age
 B) Mild cognitive impairment (PD-MCI)
 C) Moderate dementia
 D) Severe dementia

Correct Answer: B

Rationale: Standard MoCA scoring: 26–30 is normal, 18–25 indicates mild cognitive
impairment, 10–17 moderate dementia, and <10 severe dementia. Samuel's score of
24/30 indicates PD-MCI, which affects executive function and recall.




Question 5
Samuel's chronic constipation for two years before motor symptoms is best explained
by:

 A) An unrelated gastrointestinal condition
 B) A side effect of lisinopril
 C) Lewy body pathology in the enteric nervous system (Braak stage 1)
 D) Poor dietary habits

Correct Answer: C

Rationale: According to Braak's hypothesis, Lewy body pathology begins in the dorsal
motor nucleus of the vagus and the enteric nervous system (stages 1–2) years before
ascending to the brainstem and cortex. Constipation represents early GI involvement
and is a prodromal feature of PD.

, Question 6
Samuel's wife reports he "freezes" when trying to walk through doorways. This
phenomenon is most accurately described as:

 A) Claustrophobia
 B) Freezing of gait (FOG)
 C) Akathisia
 D) Dystonia

Correct Answer: B

Rationale: Freezing of gait (FOG) is a paroxysmal, transient inability to generate
effective stepping, often triggered by narrow spaces (doorways, elevators), turning, or
gait initiation. It is common in mid-stage PD and significantly increases fall risk.




Question 7
On general survey, Samuel appears older than his stated age due to:

 A) Poor grooming and hygiene
 B) Masked facies and seborrheic dermatitis
 C) Significant weight loss
 D) Pallor and fatigue

Correct Answer: B

Rationale: Masked facies (hypomimia) reduces emotional expression, and seborrheic
dermatitis (oily, scaly skin on the forehead and nasolabial folds) is common in PD due to
autonomic dysfunction. Both contribute to an aged appearance.