BARKLEY 3P EXAM AND PRACTICE EXAM NEWEST 2026/
2027 TEST BANK| COMPLETE 500 REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS WITH RATIONALES) ALREADY
GRADED A+ (MOST RECENT!!)
1. A 72-year-old man with a 3-year history of progressive gait instability and urinary
urgency is referred for cognitive assessment. On the Barkley 3P exam, he requires 45
seconds to complete Trails B with 3 errors and recalls 2 of 5 words on delayed recall.
His Montreal Cognitive Assessment (MoCA) score is 22/30. Which combination of
findings most strongly suggests a specific neurodegenerative etiology rather than
normal pressure hydrocephalus (NPH)?
A. Disproportionate impairment in executive function with intact visuospatial skills and a normal gait
velocity
B. Early and prominent memory consolidation deficit with relative preservation of executive function
and a magnetic gait
C. Severe psychomotor slowing with intact memory and a wide-based, short-stepped gait that
improves with walking aids
D. Prominent language impairment with impaired verbal fluency and a gait that is normal on formal
kinematic analysis
Answer: B. Early and prominent memory consolidation deficit with relative preservation
of executive function and a magnetic gait
2. During a Barkley 3P assessment, a 58-year-old female with suspected frontotemporal
dementia (bvFTD) exhibits marked perseveration on the Wisconsin Card Sorting Test
and severe impairment on the 'Go/No-Go' task. However, her performance on the
Boston Naming Test and the Rey-Osterrieth Complex Figure copy is within normal
limits. Which aspect of her cognitive profile is most incongruent with the expected
pattern for bvFTD?
A. Perseveration is a classic sign of frontal lobe dysfunction and thus expected in bvFTD
B. Impaired response inhibition on Go/No-Go reflects orbitofrontal involvement, which is common in
bvFTD
C. Normal confrontation naming is atypical because bvFTD often features prominent language
deficits early on
D. Intact visuoconstructional skills on the Rey-Osterrieth are typical early in bvFTD
Answer: C. Normal confrontation naming is atypical because bvFTD often features
prominent language deficits early on
3. A 40-year-old nurse sustains a traumatic brain injury (TBI) in a motor vehicle
accident. Three months post-injury, she undergoes a comprehensive Barkley 3P
evaluation. Her cognitive flexibility (Trails B) is in the 2nd percentile, but her sustained
attention (CPT-II omissions) is in the 90th percentile. She also shows impaired social
cognition on the Reading the Mind in the Eyes test. Which executive function
,subdomain is most disproportionately affected, and which neuroanatomical correlate is
most likely?
A. Sustained attention, with damage to the right dorsolateral prefrontal cortex
B. Cognitive flexibility, with damage to the frontostriatal circuits involving the anterior cingulate cortex
C. Social cognition, with damage to the orbitofrontal cortex and temporal pole
D. Response inhibition, with damage to the inferior frontal gyrus
Answer: C. Social cognition, with damage to the orbitofrontal cortex and temporal pole
4. In a reflex testing component of the Barkley 3P exam, a patient with suspected
cervical myelopathy demonstrates hyperreflexia at the biceps and brachioradialis
tendons with a positive Hoffmann's sign. Which additional reflex finding would be
MOST consistent with a lesion at the C5-C6 level, and what does it indicate about the
lesion's laterality?
A. Absent triceps reflex (C7) bilaterally, suggesting a bilateral lesion
B. Inverted radial reflex, suggesting an ipsilateral lesion at C5-C6
C. Brisk knee jerk (L4) and ankle jerk (S1) bilaterally, suggesting a diffuse upper motor neuron lesion
D. Finger flexor reflex (C8) hyperreflexia, suggesting a bilateral lesion above C5
Answer: B. Inverted radial reflex, suggesting an ipsilateral lesion at C5-C6
5. During a deep tendon reflex (DTR) assessment, a patient exhibits an asymmetrically
brisk left patellar reflex (3+ on the left, 2+ on the right). Which additional sign would
MOST reliably indicate an upper motor neuron (UMN) lesion on the left side, and why?
A. Down-going plantar response (flexor) bilaterally, indicating normal corticospinal function
B. Left extensor plantar response (Babinski sign), indicating corticospinal tract dysfunction
C. Left ankle clonus of 5 beats, indicating diffuse UMN involvement
D. Presence of abdominal reflexes bilaterally, suggesting intact UMN pathways
Answer: B. Left extensor plantar response (Babinski sign), indicating corticospinal
tract dysfunction
6. A 65-year-old man with Parkinson's disease is undergoing reflex testing as part of
the Barkley 3P exam. He has mild cogwheel rigidity and bradykinesia. Which reflex
profile is expected in this patient, and what does it indicate about the underlying
pathophysiology?
A. Hyperreflexia with bilateral extensor plantars, indicating concurrent upper motor neuron
involvement
B. Hyporeflexia with areflexia in the lower extremities, indicating peripheral neuropathy
C. Normal or slightly brisk reflexes without pathological reflexes, indicating basal ganglia dysfunction
without pyramidal tract involvement
D. Asymmetric hyperreflexia with a positive Hoffman's sign, suggesting corticospinal tract disease
Answer: C. Normal or slightly brisk reflexes without pathological reflexes, indicating
basal ganglia dysfunction without pyramidal tract involvement
7. In a cognitive and developmental evaluation using the Barkley 3P exam, a 7-year-old
child with suspected ADHD is assessed with a continuous performance test (CPT). He
, shows a high omission rate but a low commission rate, and his reaction time variability
is high. Which aspect of executive function is MOST impaired based on this pattern?
A. Response inhibition, as indicated by high commission rate
B. Sustained attention, as indicated by high omission rate and reaction time variability
C. Working memory, as indicated by reaction time variability
D. Cognitive flexibility, as indicated by low commission rate
Answer: B. Sustained attention, as indicated by high omission rate and reaction time
variability
8. During the cognitive portion of the Barkley 3P exam, a 10-year-old child with a
history of epilepsy and academic struggles is given the Rey-Osterrieth Complex Figure
(ROCF). He copies the figure accurately but performs poorly on the 3-minute delayed
recall. Which cognitive domain is most likely impaired, and what does this suggest
about his cognitive profile?
A. Visuospatial construction, indicating posterior cortical dysfunction
B. Verbal memory, indicating left temporal lobe involvement
C. Nonverbal memory, indicating right temporal lobe or hippocampal dysfunction
D. Executive function, indicating frontal lobe dysfunction
Answer: C. Nonverbal memory, indicating right temporal lobe or hippocampal
dysfunction
9. A 45-year-old woman presents with progressive forgetfulness and behavioral
changes. On the Barkley 3P exam, she has a score of 25/30 on the Montreal Cognitive
Assessment (MoCA), with points lost on delayed recall and verbal fluency. Her
neurological exam is notable for brisk reflexes and a left extensor plantar response.
Which of the following is the most appropriate next step in her evaluation?
A. Initiate donepezil for Alzheimer's disease based on MoCA score
B. Order an MRI of the brain with and without contrast to evaluate for structural lesions
C. Refer for a lumbar puncture to measure amyloid beta and tau levels
D. Order genetic testing for the APOE µ4 allele
Answer: B. Order an MRI of the brain with and without contrast to evaluate for
structural lesions
10. In motor function testing for the Barkley 3P exam, a patient with a suspected
cerebellar lesion is asked to perform the finger-to-nose test. He exhibits dysmetria,
overshooting the target, and intention tremor. Which combination of findings would
BEST localize the lesion to the cerebellar hemisphere rather than the vermis?
A. Truncal ataxia with wide-based gait and normal limb coordination on the finger-to-nose test
B. Unilateral limb dysmetria and hypotonia, with truncal stability
C. Nystagmus with truncal titubation and difficulty with tandem gait
D. Ataxic dysarthria with head tremor and normal limb coordination
Answer: B. Unilateral limb dysmetria and hypotonia, with truncal stability
11. A 30-year-old woman with multiple sclerosis is undergoing the motor function
2027 TEST BANK| COMPLETE 500 REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS WITH RATIONALES) ALREADY
GRADED A+ (MOST RECENT!!)
1. A 72-year-old man with a 3-year history of progressive gait instability and urinary
urgency is referred for cognitive assessment. On the Barkley 3P exam, he requires 45
seconds to complete Trails B with 3 errors and recalls 2 of 5 words on delayed recall.
His Montreal Cognitive Assessment (MoCA) score is 22/30. Which combination of
findings most strongly suggests a specific neurodegenerative etiology rather than
normal pressure hydrocephalus (NPH)?
A. Disproportionate impairment in executive function with intact visuospatial skills and a normal gait
velocity
B. Early and prominent memory consolidation deficit with relative preservation of executive function
and a magnetic gait
C. Severe psychomotor slowing with intact memory and a wide-based, short-stepped gait that
improves with walking aids
D. Prominent language impairment with impaired verbal fluency and a gait that is normal on formal
kinematic analysis
Answer: B. Early and prominent memory consolidation deficit with relative preservation
of executive function and a magnetic gait
2. During a Barkley 3P assessment, a 58-year-old female with suspected frontotemporal
dementia (bvFTD) exhibits marked perseveration on the Wisconsin Card Sorting Test
and severe impairment on the 'Go/No-Go' task. However, her performance on the
Boston Naming Test and the Rey-Osterrieth Complex Figure copy is within normal
limits. Which aspect of her cognitive profile is most incongruent with the expected
pattern for bvFTD?
A. Perseveration is a classic sign of frontal lobe dysfunction and thus expected in bvFTD
B. Impaired response inhibition on Go/No-Go reflects orbitofrontal involvement, which is common in
bvFTD
C. Normal confrontation naming is atypical because bvFTD often features prominent language
deficits early on
D. Intact visuoconstructional skills on the Rey-Osterrieth are typical early in bvFTD
Answer: C. Normal confrontation naming is atypical because bvFTD often features
prominent language deficits early on
3. A 40-year-old nurse sustains a traumatic brain injury (TBI) in a motor vehicle
accident. Three months post-injury, she undergoes a comprehensive Barkley 3P
evaluation. Her cognitive flexibility (Trails B) is in the 2nd percentile, but her sustained
attention (CPT-II omissions) is in the 90th percentile. She also shows impaired social
cognition on the Reading the Mind in the Eyes test. Which executive function
,subdomain is most disproportionately affected, and which neuroanatomical correlate is
most likely?
A. Sustained attention, with damage to the right dorsolateral prefrontal cortex
B. Cognitive flexibility, with damage to the frontostriatal circuits involving the anterior cingulate cortex
C. Social cognition, with damage to the orbitofrontal cortex and temporal pole
D. Response inhibition, with damage to the inferior frontal gyrus
Answer: C. Social cognition, with damage to the orbitofrontal cortex and temporal pole
4. In a reflex testing component of the Barkley 3P exam, a patient with suspected
cervical myelopathy demonstrates hyperreflexia at the biceps and brachioradialis
tendons with a positive Hoffmann's sign. Which additional reflex finding would be
MOST consistent with a lesion at the C5-C6 level, and what does it indicate about the
lesion's laterality?
A. Absent triceps reflex (C7) bilaterally, suggesting a bilateral lesion
B. Inverted radial reflex, suggesting an ipsilateral lesion at C5-C6
C. Brisk knee jerk (L4) and ankle jerk (S1) bilaterally, suggesting a diffuse upper motor neuron lesion
D. Finger flexor reflex (C8) hyperreflexia, suggesting a bilateral lesion above C5
Answer: B. Inverted radial reflex, suggesting an ipsilateral lesion at C5-C6
5. During a deep tendon reflex (DTR) assessment, a patient exhibits an asymmetrically
brisk left patellar reflex (3+ on the left, 2+ on the right). Which additional sign would
MOST reliably indicate an upper motor neuron (UMN) lesion on the left side, and why?
A. Down-going plantar response (flexor) bilaterally, indicating normal corticospinal function
B. Left extensor plantar response (Babinski sign), indicating corticospinal tract dysfunction
C. Left ankle clonus of 5 beats, indicating diffuse UMN involvement
D. Presence of abdominal reflexes bilaterally, suggesting intact UMN pathways
Answer: B. Left extensor plantar response (Babinski sign), indicating corticospinal
tract dysfunction
6. A 65-year-old man with Parkinson's disease is undergoing reflex testing as part of
the Barkley 3P exam. He has mild cogwheel rigidity and bradykinesia. Which reflex
profile is expected in this patient, and what does it indicate about the underlying
pathophysiology?
A. Hyperreflexia with bilateral extensor plantars, indicating concurrent upper motor neuron
involvement
B. Hyporeflexia with areflexia in the lower extremities, indicating peripheral neuropathy
C. Normal or slightly brisk reflexes without pathological reflexes, indicating basal ganglia dysfunction
without pyramidal tract involvement
D. Asymmetric hyperreflexia with a positive Hoffman's sign, suggesting corticospinal tract disease
Answer: C. Normal or slightly brisk reflexes without pathological reflexes, indicating
basal ganglia dysfunction without pyramidal tract involvement
7. In a cognitive and developmental evaluation using the Barkley 3P exam, a 7-year-old
child with suspected ADHD is assessed with a continuous performance test (CPT). He
, shows a high omission rate but a low commission rate, and his reaction time variability
is high. Which aspect of executive function is MOST impaired based on this pattern?
A. Response inhibition, as indicated by high commission rate
B. Sustained attention, as indicated by high omission rate and reaction time variability
C. Working memory, as indicated by reaction time variability
D. Cognitive flexibility, as indicated by low commission rate
Answer: B. Sustained attention, as indicated by high omission rate and reaction time
variability
8. During the cognitive portion of the Barkley 3P exam, a 10-year-old child with a
history of epilepsy and academic struggles is given the Rey-Osterrieth Complex Figure
(ROCF). He copies the figure accurately but performs poorly on the 3-minute delayed
recall. Which cognitive domain is most likely impaired, and what does this suggest
about his cognitive profile?
A. Visuospatial construction, indicating posterior cortical dysfunction
B. Verbal memory, indicating left temporal lobe involvement
C. Nonverbal memory, indicating right temporal lobe or hippocampal dysfunction
D. Executive function, indicating frontal lobe dysfunction
Answer: C. Nonverbal memory, indicating right temporal lobe or hippocampal
dysfunction
9. A 45-year-old woman presents with progressive forgetfulness and behavioral
changes. On the Barkley 3P exam, she has a score of 25/30 on the Montreal Cognitive
Assessment (MoCA), with points lost on delayed recall and verbal fluency. Her
neurological exam is notable for brisk reflexes and a left extensor plantar response.
Which of the following is the most appropriate next step in her evaluation?
A. Initiate donepezil for Alzheimer's disease based on MoCA score
B. Order an MRI of the brain with and without contrast to evaluate for structural lesions
C. Refer for a lumbar puncture to measure amyloid beta and tau levels
D. Order genetic testing for the APOE µ4 allele
Answer: B. Order an MRI of the brain with and without contrast to evaluate for
structural lesions
10. In motor function testing for the Barkley 3P exam, a patient with a suspected
cerebellar lesion is asked to perform the finger-to-nose test. He exhibits dysmetria,
overshooting the target, and intention tremor. Which combination of findings would
BEST localize the lesion to the cerebellar hemisphere rather than the vermis?
A. Truncal ataxia with wide-based gait and normal limb coordination on the finger-to-nose test
B. Unilateral limb dysmetria and hypotonia, with truncal stability
C. Nystagmus with truncal titubation and difficulty with tandem gait
D. Ataxic dysarthria with head tremor and normal limb coordination
Answer: B. Unilateral limb dysmetria and hypotonia, with truncal stability
11. A 30-year-old woman with multiple sclerosis is undergoing the motor function
