Shadow Health Neurological Assessment - Samuel Green Case
Study | Full Documentation, Assessment Findings & Clinical
Analysis (2026). - 220 Questions
This exam assesses mastery in eliciting and interpreting health history and subjective data for neurological
assessments, using the Samuel Green case study. Questions require synthesis of subjective findings, risk
stratification, and clinical reasoning at a graduate level. It contains 220 multiple-choice questions, each with four
distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized into
10 focused sections: Health History & Subjective Data, Mental Status & Level of Consciousness, Cranial Nerve
Assessment, Motor System: Strength, Tone, and Coordination, Sensory System: Light Touch, Pain, and
Proprioception, Reflexes: Deep Tendon and Superficial, Coordination and Gait, Diagnostic Tests & Imaging,
Documentation & Clinical Analysis, Patient Education & Follow-Up. Targeted learning outcomes include:
Differentiate between central and peripheral nervous system symptoms using subjective descriptors; Analyze the
impact of social determinants on neurological symptom reporting; Apply PQRST framework to characterize
complex neurological complaints; Evaluate the reliability and consistency of subjective data in neurological
assessments. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 80%. Aligned with Accredited
Section 1: Health History & Subjective Data (Questions 1-24)
1 A patient reports brief episodes of 'pins and needles' in both hands lasting 30
seconds, occurring 4-5 times daily, without weakness. Which subjective data
best suggests a central rather than peripheral cause?
A) Sensation is 'like static on TV' and bilateral from onset
B) Sensation is 'sharp and stabbing' radiating from wrist to fingers
C) Symptoms are aggravated by prolonged typing
D) Symptoms are relieved by shaking the hands
Answer: A
Rationale: Bilateral, simultaneous onset of paresthesia suggests a central
process (e.g., cortical or thalamic) rather than a peripheral mononeuropathy.
Option B describes radicular or peripheral distribution; C and D implicate
peripheral nerve compression from repetitive motion.
2 When documenting a patient's history of headaches, which subjective detail
most strongly indicates need for urgent neuroimaging?
A) Headache frequency increased from monthly to weekly over 6 months
B) Headache described as 'worst ever' with acute onset
C) Headache accompanied by nausea and photophobia
D) Headache preceded by visual aura lasting 20 minutes
,Answer: B
Rationale: A sudden, severe 'worst ever' headache (thunderclap) is a red flag for
subarachnoid hemorrhage, requiring immediate imaging. Options A and D
suggest chronic migraine evolution; C is typical migraine without red flags.
3 A patient with hypertension reports 'dizziness when standing up quickly.'
Which follow-up subjective question is most critical to differentiate between
orthostatic hypotension and vertigo?
A) Do you feel like you or the room is spinning?
B) Does the dizziness improve when you lie down?
C) How long does the dizziness last?
D) Do you have any hearing loss or tinnitus?
Answer: A
Rationale: The sensation of 'spinning' (vertigo) is specific to vestibular
dysfunction, while lightheadedness without spinning is typical of orthostatic
hypotension. Option A directly differentiates central from peripheral causes; B,
C, and D are useful but not as discriminating.
4 In a patient with new-onset seizures, which social history element is most
likely to reveal a reversible cause?
A) Occupational exposure to heavy metals
B) Recent international travel
C) Current use of over-the-counter stimulant supplements
D) Family history of epilepsy
Answer: C
Rationale: Stimulants (caffeine, ephedra) lower seizure threshold and are
modifiable. While A and B are possible, stimulant use is a common reversible
precipitant. Family history (D) suggests genetic predisposition, not reversible.
5 A patient with memory complaints reports difficulty managing finances but
can still cook independently. Which subjective assessment best characterizes
functional decline?
A) Instrumental activities of daily living (IADLs) are impaired
B) Basic activities of daily living (BADLs) are impaired
C) Cognitive reserve is depleted but adaptive strategies are intact
D) Executive function is preserved during structured tasks
,Answer: A
Rationale: IADLs (managing finances, cooking) are complex tasks often first
affected in cognitive decline. BADLs (bathing, dressing) are preserved later.
Option C describes alternative explanation; D is contradicted by financial
difficulty.
6 When a patient says their muscle weakness is 'intermittent and worse in the
afternoon,' which clinical reasoning step must be taken next to assess for a
neuromuscular junction disorder?
A) Ask about double vision and difficulty swallowing
B) Inquire about recent viral illness
C) Check for presence of sensory symptoms
D) Determine if weakness is proximal or distal
Answer: A
Rationale: Myasthenia gravis symptoms fluctuate, worsening with fatigue (later
in day). Ocular and bulbar symptoms (ptosis, diplopia, dysphagia) are
hallmark. Option B is more relevant for Guillain-Barré; C and D are general
but less specific to neuromuscular junction.
7 A patient reports loss of smell and taste after a mild respiratory infection,
now resolved. Which subjective detail would most suggest a neurological
rather than sinonasal cause?
A) Loss of taste is complete and includes salty and sweet
B) Loss of smell occurred suddenly and was not associated with congestion
C) Loss of smell persisted for more than four weeks
D) Loss of taste is partial and fluctuates daily
Answer: B
Rationale: Sudden anosmia without congestion suggests olfactory nerve
damage (post-viral or traumatic), not obstructive sinonasal disease. Option A is
common in sinonasal; C and D can occur in both but lack specificity.
8 When evaluating a patient's headache history, which pattern of triggers is
most concerning for secondary headache?
A) Headaches triggered by red wine and aged cheese
B) Headaches triggered by bending forward or coughing
C) Headaches triggered by skipped meals
, D) Headaches triggered by bright lights
Answer: B
Rationale: Headache worsened by Valsalva maneuver (coughing, bending) may
indicate increased intracranial pressure or Chiari malformation. Options A, C,
D are common migraine triggers and typically benign.
9 A patient reports 'numbness' in the right foot that started after a long car ride.
Which subjective question is most important to distinguish between
peripheral nerve compression and early myelopathy?
A) Where exactly on the foot is the numbness located?
B) Do you have any back pain?
C) Is there any weakness in the leg?
D) Are both feet affected at any time?
Answer: D
Rationale: Bilateral symptoms may indicate spinal cord involvement
(myelopathy), while unilateral common peroneal compression is unilateral.
Location (A) helps identify peripheral nerve, but bilaterality is key for
myelopathy. Back pain (B) is nonspecific; weakness (C) can occur in both.
10 In a patient with chronic low back pain radiating to the left leg, which
subjective response most reliably indicates nerve root irritation rather than
referred pain from the sacroiliac joint?
A) Pain is described as 'burning and sharp'
B) Pain is aggravated by coughing or sneezing
C) Pain is partially relieved by walking
D) Pain is associated with numbness in the thigh
Answer: B
Rationale: Coughing and sneezing increase intrathecal pressure, exacerbating
radicular pain from disc herniation. Option A is associated with neuropathic
pain but can also occur in referred pain; C and D are less specific.
11 In the context of Samuel Green's neurological assessment, which subjective
finding would most strongly suggest a need to evaluate for cerebrovascular
accident, even if other symptoms are mild?
A) Intermittent tingling in the left foot upon standing
B) Sudden-onset difficulty finding words during conversation
Study | Full Documentation, Assessment Findings & Clinical
Analysis (2026). - 220 Questions
This exam assesses mastery in eliciting and interpreting health history and subjective data for neurological
assessments, using the Samuel Green case study. Questions require synthesis of subjective findings, risk
stratification, and clinical reasoning at a graduate level. It contains 220 multiple-choice questions, each with four
distractors and a fully worked rationale that explains why the keyed answer is correct. Content is organized into
10 focused sections: Health History & Subjective Data, Mental Status & Level of Consciousness, Cranial Nerve
Assessment, Motor System: Strength, Tone, and Coordination, Sensory System: Light Touch, Pain, and
Proprioception, Reflexes: Deep Tendon and Superficial, Coordination and Gait, Diagnostic Tests & Imaging,
Documentation & Clinical Analysis, Patient Education & Follow-Up. Targeted learning outcomes include:
Differentiate between central and peripheral nervous system symptoms using subjective descriptors; Analyze the
impact of social determinants on neurological symptom reporting; Apply PQRST framework to characterize
complex neurological complaints; Evaluate the reliability and consistency of subjective data in neurological
assessments. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that students
can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 80%. Aligned with Accredited
Section 1: Health History & Subjective Data (Questions 1-24)
1 A patient reports brief episodes of 'pins and needles' in both hands lasting 30
seconds, occurring 4-5 times daily, without weakness. Which subjective data
best suggests a central rather than peripheral cause?
A) Sensation is 'like static on TV' and bilateral from onset
B) Sensation is 'sharp and stabbing' radiating from wrist to fingers
C) Symptoms are aggravated by prolonged typing
D) Symptoms are relieved by shaking the hands
Answer: A
Rationale: Bilateral, simultaneous onset of paresthesia suggests a central
process (e.g., cortical or thalamic) rather than a peripheral mononeuropathy.
Option B describes radicular or peripheral distribution; C and D implicate
peripheral nerve compression from repetitive motion.
2 When documenting a patient's history of headaches, which subjective detail
most strongly indicates need for urgent neuroimaging?
A) Headache frequency increased from monthly to weekly over 6 months
B) Headache described as 'worst ever' with acute onset
C) Headache accompanied by nausea and photophobia
D) Headache preceded by visual aura lasting 20 minutes
,Answer: B
Rationale: A sudden, severe 'worst ever' headache (thunderclap) is a red flag for
subarachnoid hemorrhage, requiring immediate imaging. Options A and D
suggest chronic migraine evolution; C is typical migraine without red flags.
3 A patient with hypertension reports 'dizziness when standing up quickly.'
Which follow-up subjective question is most critical to differentiate between
orthostatic hypotension and vertigo?
A) Do you feel like you or the room is spinning?
B) Does the dizziness improve when you lie down?
C) How long does the dizziness last?
D) Do you have any hearing loss or tinnitus?
Answer: A
Rationale: The sensation of 'spinning' (vertigo) is specific to vestibular
dysfunction, while lightheadedness without spinning is typical of orthostatic
hypotension. Option A directly differentiates central from peripheral causes; B,
C, and D are useful but not as discriminating.
4 In a patient with new-onset seizures, which social history element is most
likely to reveal a reversible cause?
A) Occupational exposure to heavy metals
B) Recent international travel
C) Current use of over-the-counter stimulant supplements
D) Family history of epilepsy
Answer: C
Rationale: Stimulants (caffeine, ephedra) lower seizure threshold and are
modifiable. While A and B are possible, stimulant use is a common reversible
precipitant. Family history (D) suggests genetic predisposition, not reversible.
5 A patient with memory complaints reports difficulty managing finances but
can still cook independently. Which subjective assessment best characterizes
functional decline?
A) Instrumental activities of daily living (IADLs) are impaired
B) Basic activities of daily living (BADLs) are impaired
C) Cognitive reserve is depleted but adaptive strategies are intact
D) Executive function is preserved during structured tasks
,Answer: A
Rationale: IADLs (managing finances, cooking) are complex tasks often first
affected in cognitive decline. BADLs (bathing, dressing) are preserved later.
Option C describes alternative explanation; D is contradicted by financial
difficulty.
6 When a patient says their muscle weakness is 'intermittent and worse in the
afternoon,' which clinical reasoning step must be taken next to assess for a
neuromuscular junction disorder?
A) Ask about double vision and difficulty swallowing
B) Inquire about recent viral illness
C) Check for presence of sensory symptoms
D) Determine if weakness is proximal or distal
Answer: A
Rationale: Myasthenia gravis symptoms fluctuate, worsening with fatigue (later
in day). Ocular and bulbar symptoms (ptosis, diplopia, dysphagia) are
hallmark. Option B is more relevant for Guillain-Barré; C and D are general
but less specific to neuromuscular junction.
7 A patient reports loss of smell and taste after a mild respiratory infection,
now resolved. Which subjective detail would most suggest a neurological
rather than sinonasal cause?
A) Loss of taste is complete and includes salty and sweet
B) Loss of smell occurred suddenly and was not associated with congestion
C) Loss of smell persisted for more than four weeks
D) Loss of taste is partial and fluctuates daily
Answer: B
Rationale: Sudden anosmia without congestion suggests olfactory nerve
damage (post-viral or traumatic), not obstructive sinonasal disease. Option A is
common in sinonasal; C and D can occur in both but lack specificity.
8 When evaluating a patient's headache history, which pattern of triggers is
most concerning for secondary headache?
A) Headaches triggered by red wine and aged cheese
B) Headaches triggered by bending forward or coughing
C) Headaches triggered by skipped meals
, D) Headaches triggered by bright lights
Answer: B
Rationale: Headache worsened by Valsalva maneuver (coughing, bending) may
indicate increased intracranial pressure or Chiari malformation. Options A, C,
D are common migraine triggers and typically benign.
9 A patient reports 'numbness' in the right foot that started after a long car ride.
Which subjective question is most important to distinguish between
peripheral nerve compression and early myelopathy?
A) Where exactly on the foot is the numbness located?
B) Do you have any back pain?
C) Is there any weakness in the leg?
D) Are both feet affected at any time?
Answer: D
Rationale: Bilateral symptoms may indicate spinal cord involvement
(myelopathy), while unilateral common peroneal compression is unilateral.
Location (A) helps identify peripheral nerve, but bilaterality is key for
myelopathy. Back pain (B) is nonspecific; weakness (C) can occur in both.
10 In a patient with chronic low back pain radiating to the left leg, which
subjective response most reliably indicates nerve root irritation rather than
referred pain from the sacroiliac joint?
A) Pain is described as 'burning and sharp'
B) Pain is aggravated by coughing or sneezing
C) Pain is partially relieved by walking
D) Pain is associated with numbness in the thigh
Answer: B
Rationale: Coughing and sneezing increase intrathecal pressure, exacerbating
radicular pain from disc herniation. Option A is associated with neuropathic
pain but can also occur in referred pain; C and D are less specific.
11 In the context of Samuel Green's neurological assessment, which subjective
finding would most strongly suggest a need to evaluate for cerebrovascular
accident, even if other symptoms are mild?
A) Intermittent tingling in the left foot upon standing
B) Sudden-onset difficulty finding words during conversation
