Shadow Health Neurological
Assessment – Samuel Green: 300
Practice Questions with Answers &
Rationales[2026]/Instant Download
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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) Dysarthria
B) Hypomimia
C) Apraxia
D) Anhedonia
Correct Answer: B
Rationale: Hypomimia refers to reduced facial expression and is a
common motor manifestation of Parkinson's disease due to bradykinesia
affecting facial muscles. It is often described as "masked facies."
Question 3
Samuel reports difficulty typing and buttoning his shirts. This functional
impairment is primarily due to:
A) Cognitive decline affecting fine motor planning
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 wife reports he has fallen while turning. This is most consistent
with:
,A) Orthostatic hypotension
B) Cerebellar ataxia
C) Postural instability and impaired righting reflex
D) Vestibular dysfunction
Correct Answer: C
Rationale: Falls while turning are characteristic of postural instability, a
feature that typically develops in moderate to advanced PD. Patients
with PD lose their ability to make rapid postural adjustments (righting
reflex), especially during rotational movements, significantly increasing
fall risk.
Question 5
Which medication from Samuel's current home list is appropriate for
managing his chronic constipation, a non-motor symptom of PD?
A) Lisinopril
B) Atorvastatin
C) Senna-Docusate
D) Carbidopa-Levodopa
Correct Answer: C
Rationale: Senna is a stimulant laxative and docusate is a stool softener.
This combination is appropriate for managing chronic constipation,
which is a common non-motor symptom of PD due to Lewy body
pathology in the enteric nervous system.
, Question 6
Samuel reports a subjective decline in sense of smell over the past
several years. This symptom is clinically known as:
A) Anosmia
B) Hyposmia
C) Dysgeusia
D) Ageusia
Correct Answer: B
Rationale: Hyposmia refers to a reduced ability to detect odors. It is a
highly prevalent non-motor symptom in early Parkinson's disease, often
preceding motor signs by years. Anosmia is complete loss of smell, while
hyposmia is partial reduction.
Question 7
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.
Assessment – Samuel Green: 300
Practice Questions with Answers &
Rationales[2026]/Instant Download
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) Dysarthria
B) Hypomimia
C) Apraxia
D) Anhedonia
Correct Answer: B
Rationale: Hypomimia refers to reduced facial expression and is a
common motor manifestation of Parkinson's disease due to bradykinesia
affecting facial muscles. It is often described as "masked facies."
Question 3
Samuel reports difficulty typing and buttoning his shirts. This functional
impairment is primarily due to:
A) Cognitive decline affecting fine motor planning
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 wife reports he has fallen while turning. This is most consistent
with:
,A) Orthostatic hypotension
B) Cerebellar ataxia
C) Postural instability and impaired righting reflex
D) Vestibular dysfunction
Correct Answer: C
Rationale: Falls while turning are characteristic of postural instability, a
feature that typically develops in moderate to advanced PD. Patients
with PD lose their ability to make rapid postural adjustments (righting
reflex), especially during rotational movements, significantly increasing
fall risk.
Question 5
Which medication from Samuel's current home list is appropriate for
managing his chronic constipation, a non-motor symptom of PD?
A) Lisinopril
B) Atorvastatin
C) Senna-Docusate
D) Carbidopa-Levodopa
Correct Answer: C
Rationale: Senna is a stimulant laxative and docusate is a stool softener.
This combination is appropriate for managing chronic constipation,
which is a common non-motor symptom of PD due to Lewy body
pathology in the enteric nervous system.
, Question 6
Samuel reports a subjective decline in sense of smell over the past
several years. This symptom is clinically known as:
A) Anosmia
B) Hyposmia
C) Dysgeusia
D) Ageusia
Correct Answer: B
Rationale: Hyposmia refers to a reduced ability to detect odors. It is a
highly prevalent non-motor symptom in early Parkinson's disease, often
preceding motor signs by years. Anosmia is complete loss of smell, while
hyposmia is partial reduction.
Question 7
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.
