NR 509 – Advanced Physical Assessment Final
Exam | 2025/2026 Verified Questions
✅ NEUROLOGICAL EXAM (Q 1-14)
1. A 62-year-old man is unable to identify a key placed in his hand with his eyes
closed. This finding is best described as
A. Astereognosis
B. Stereognosis loss (tactile agnosia)
C. Graphesthesia deficit
D. Extinction phenomenon
Rationale: Inability to recognize objects by touch indicates a lesion in the
contralateral parietal lobe.
2. To best test the function of cranial nerve XI, ask the patient to
A. Shrug shoulders against resistance
B. Shrug shoulders against resistance and turn head against hand
C. Smile and puff cheeks
D. Stick out tongue midline
Rationale: CN XI (spinal accessory) innervates trapezius & sternocleidomastoid.
3. A positive Romberg test indicates pathology in the
A. Cerebellum
B. Dorsal columns / proprioceptive pathways
C. Corticospinal tract
D. Basal ganglia
Rationale: Romberg tests proprioception; patient stands steady with eyes open
but sways when closed.
4. When testing rapid alternating movements, slow & clumsy performance is
termed
A. Dysmetria
B. Dysdiadochokinesia
C. Ataxia
D. Bradykinesia
Rationale: Dysdiadochokinesia is a cerebellar sign.
5. Which reflex grade is considered normal?
A. 0
, B. 2+
C. 3+
D. 4+
Rationale: 2+ is normal; 0 absent, 1+ diminished, 3+ hyperactive, 4+ clonus.
6. The NP strokes the lateral aspect of the foot and observes extension of the big
toe. This is
A. Normal in adults
B. Babinski sign
C. Chvostek sign
D. Kernig sign
Rationale: Upgoing toe = UMN lesion.
7. Which cerebral artery supplies the lateral aspect of the cerebral hemisphere &
Broca’s area?
A. ACA
B. MCA
C. PCA
D. Vertebral
Rationale: Middle cerebral artery (MCA) stroke → aphasia, hemiparesis face/arm.
8. A patient with left homonymous hemianopsia most likely has a lesion in the
A. Left optic nerve
B. Right optic tract / occipital lobe
C. Optic chiasm
D. Right temporal lobe
Rationale: Contralateral visual-field loss posterior to chiasm.
9. Which neurodegenerative disorder presents with resting tremor, masked facies,
and cogwheel rigidity?
A. ALS
B. MS
C. Parkinson disease
D. Huntington disease
Rationale: Classic triad of parkinsonism.
10. Decorticate posturing is characterized by
A. Arms extended, legs flexed
B. Arms flexed to core, legs extended
C. All four limbs extended
D. All four limbs flexed
Rationale: Indicates lesion above brainstem red nucleus.
11. The most sensitive screening tool for cognitive impairment in primary care is
A. GCS
Exam | 2025/2026 Verified Questions
✅ NEUROLOGICAL EXAM (Q 1-14)
1. A 62-year-old man is unable to identify a key placed in his hand with his eyes
closed. This finding is best described as
A. Astereognosis
B. Stereognosis loss (tactile agnosia)
C. Graphesthesia deficit
D. Extinction phenomenon
Rationale: Inability to recognize objects by touch indicates a lesion in the
contralateral parietal lobe.
2. To best test the function of cranial nerve XI, ask the patient to
A. Shrug shoulders against resistance
B. Shrug shoulders against resistance and turn head against hand
C. Smile and puff cheeks
D. Stick out tongue midline
Rationale: CN XI (spinal accessory) innervates trapezius & sternocleidomastoid.
3. A positive Romberg test indicates pathology in the
A. Cerebellum
B. Dorsal columns / proprioceptive pathways
C. Corticospinal tract
D. Basal ganglia
Rationale: Romberg tests proprioception; patient stands steady with eyes open
but sways when closed.
4. When testing rapid alternating movements, slow & clumsy performance is
termed
A. Dysmetria
B. Dysdiadochokinesia
C. Ataxia
D. Bradykinesia
Rationale: Dysdiadochokinesia is a cerebellar sign.
5. Which reflex grade is considered normal?
A. 0
, B. 2+
C. 3+
D. 4+
Rationale: 2+ is normal; 0 absent, 1+ diminished, 3+ hyperactive, 4+ clonus.
6. The NP strokes the lateral aspect of the foot and observes extension of the big
toe. This is
A. Normal in adults
B. Babinski sign
C. Chvostek sign
D. Kernig sign
Rationale: Upgoing toe = UMN lesion.
7. Which cerebral artery supplies the lateral aspect of the cerebral hemisphere &
Broca’s area?
A. ACA
B. MCA
C. PCA
D. Vertebral
Rationale: Middle cerebral artery (MCA) stroke → aphasia, hemiparesis face/arm.
8. A patient with left homonymous hemianopsia most likely has a lesion in the
A. Left optic nerve
B. Right optic tract / occipital lobe
C. Optic chiasm
D. Right temporal lobe
Rationale: Contralateral visual-field loss posterior to chiasm.
9. Which neurodegenerative disorder presents with resting tremor, masked facies,
and cogwheel rigidity?
A. ALS
B. MS
C. Parkinson disease
D. Huntington disease
Rationale: Classic triad of parkinsonism.
10. Decorticate posturing is characterized by
A. Arms extended, legs flexed
B. Arms flexed to core, legs extended
C. All four limbs extended
D. All four limbs flexed
Rationale: Indicates lesion above brainstem red nucleus.
11. The most sensitive screening tool for cognitive impairment in primary care is
A. GCS
