South University – NSG 6020 Advanced Physical
Assessment Final Review (2025–2026) Focus:
Advanced assessment skills, diagnostic reasoning,
evidence-based differential diagnosis, and system
integration.
1. A patient presents with a unilateral, drooping lower face that includes the forehead. This
finding is most consistent with:
a) Central lesion (e.g., CVA) ✓
b) Bell's Palsy (peripheral CN VII lesion)
c) Parkinson's disease
d) Myasthenia Gravis
Rationale: In a central lesion (like a stroke), the upper face is spared (patient can raise eyebrows)
due to bilateral innervation. A peripheral lesion affects the entire side of the face.
2. The Romberg test is primarily used to assess:
a) Cerebellar function
b) Motor strength
c) Proprioception and vestibular function ✓
d) Cortical sensory integration
Rationale: Romberg tests the patient's ability to maintain balance using proprioception and
vestibular input when visual input is removed. A positive test suggests a sensory ataxia.
3. When testing stereognosis, you are assessing the integrity of the:
a) Spinal thalamic tract
b) Dorsal Columns ✓
c) Corticospinal tract
d) Spinocerebellar tract
Rationale: Stereognosis (identifying an object by touch) is a cortical sensory function that relies
on the dorsal column-medial lemniscus pathway for fine touch and proprioception.
4. A patient with early Alzheimer's disease would most likely exhibit deficits in:
a) Immediate recall
b) Short-term memory ✓
c) Long-term memory
,d) Procedural memory
Rationale: Short-term (recent) memory impairment is a hallmark early sign of Alzheimer's, while
long-term memory is often preserved until later stages.
5. The Glasgow Coma Scale (GCS) assesses which three components?
a) Pupillary Response, Motor Response, Verbal Response
b) Eye Opening, Motor Response, Verbal Response ✓
c) Orientation, Memory, Concentration
d) Cranial Nerves, Sensory, Motor
*Rationale: The GCS is a standardized tool for level of consciousness based on Eye (1-4), Verbal
(1-5), and Motor (1-6) responses.*
6. A positive Babinski sign in an adult is characterized by:
a) Flexion of the toes
b) Fanning and dorsiflexion of the great toe ✓
c) Inversion of the foot
d) No response to plantar stimulation
Rationale: Dorsiflexion of the great toe with fanning of the others is an upper motor neuron sign
(e.g., corticospinal tract lesion). Normal response is plantar flexion.
7. A patient with a lesion to the Cerebellum would most likely demonstrate:
a) Spasticity
b) Flaccidity
c) Intention tremor and ataxia ✓
d) Resting tremor
Rationale: The cerebellum coordinates voluntary movement. Lesions cause ipsilateral ataxia,
intention tremor, dysdiadochokinesia, and nystagmus.
8. The most sensitive clinical indicator of an altered mental status is:
a) Disorientation to person
b) A change in the level of consciousness ✓
c) Abnormal vital signs
d) Inappropriate affect
Rationale: A change in LOC is the earliest and most critical sign of neurological compromise.
9. When assessing deep tendon reflexes, a grade of 2+ indicates:
a) Absent response
b) Diminished response
c) Normal response ✓
d) Brisk response
,*Rationale: Reflex grading: 0=absent, 1+=diminished, 2+=normal, 3+=brisker than average,
4+=clonus.*
10. A key differential between delirium and dementia is:
a) The presence of memory loss
b) The acuity of onset and fluctuating course ✓
c) The patient's age
d) The irreversibility of the condition
Rationale: Delirium is acute, with a fluctuating course and inattention. Dementia is chronic and
progressive.
11. To test the function of Cranial Nerve XII (Hypoglossal), you would ask the patient to:
a) Stick out their tongue ✓
b) Say "ah" to observe the uvula
c) Clench their teeth
d) Follow your finger with their eyes
Rationale: CN XII is a motor nerve controlling tongue movement. Deviation to one side indicates
a lesion on that side.
12. A patient with Parkinson's disease would most likely exhibit:
a) Intention tremor
b) A unilateral, "pill-rolling" resting tremor ✓
c) Choreiform movements
d) Asterixis
*Rationale: The classic tremor of Parkinson's is a 4-6 Hz "pill-rolling" resting tremor that
improves with intentional movement.*
13. Kernig's sign, used to assess for meningeal irritation, is positive when:
a) Neck flexion causes hip and knee flexion
b) Pain is elicited with hip flexion and knee extension ✓
c) The great toe dorsiflexes upon plantar stimulation
d) There is resistance to passive neck rotation
Rationale: Kernig's sign: pain/resistance with passive knee extension while the hip is flexed.
Brudzinski's sign: hip/knee flexion with neck flexion.
14. A patient with a history of TIA presents with amaurosis fugax. This describes:
a) Transient aphasia
b) Transient unilateral blindness ✓
c) Transient hemiparesis
d) Transient vertigo
, Rationale: Amaurosis fugax is a transient monocular blindness, often described as a "shade
coming down," and is a classic symptom of retinal TIA.
15. Pronator drift is a test used to screen for:
a) Cerebellar disease
b) Subtle upper motor neuron weakness ✓
c) Peripheral neuropathy
d) Carpal tunnel syndrome
Rationale: With eyes closed and arms supinated, a patient with subtle UMN weakness will
pronate and drift downward on the affected side.
Cardiovascular & Peripheral Vascular (Questions 16-30)
16. The S1 heart sound is best heard at the apex and corresponds to:
a) Aortic and pulmonic valve closure
b) Mitral and tricuspid valve closure ✓
c) Atrial contraction
d) Ventricular filling
Rationale: S1 is the sound of the AV valves (mitral and tricuspid) closing at the beginning of
systole.
17. A grade 3/6 midsystolic murmur is described as:
a) Very faint, heard only with special effort
b) Loud, with a palpable thrill
c) Moderately loud ✓
d) Loud, can be heard with stethoscope partially off chest
*Rationale: Murmur Grading: 1/6=faint, 2/6=quiet, 3/6=moderately loud, 4/6=loud with thrill,
5/6=very loud with thrill, 6/6=heard with stethoscope off chest.*
18. A murmur that increases in intensity with the Valsalva maneuver is characteristic of:
a) Aortic stenosis
b) Mitral regurgitation
c) Hypertrophic cardiomyopathy ✓
d) Mitral stenosis
Rationale: Valsalva decreases venous return and left ventricular volume, which exacerbates the
obstruction and murmur in HCM.
19. The "a" wave in the jugular venous pulse represents:
a) Ventricular contraction forcing the tricuspid valve upward
Assessment Final Review (2025–2026) Focus:
Advanced assessment skills, diagnostic reasoning,
evidence-based differential diagnosis, and system
integration.
1. A patient presents with a unilateral, drooping lower face that includes the forehead. This
finding is most consistent with:
a) Central lesion (e.g., CVA) ✓
b) Bell's Palsy (peripheral CN VII lesion)
c) Parkinson's disease
d) Myasthenia Gravis
Rationale: In a central lesion (like a stroke), the upper face is spared (patient can raise eyebrows)
due to bilateral innervation. A peripheral lesion affects the entire side of the face.
2. The Romberg test is primarily used to assess:
a) Cerebellar function
b) Motor strength
c) Proprioception and vestibular function ✓
d) Cortical sensory integration
Rationale: Romberg tests the patient's ability to maintain balance using proprioception and
vestibular input when visual input is removed. A positive test suggests a sensory ataxia.
3. When testing stereognosis, you are assessing the integrity of the:
a) Spinal thalamic tract
b) Dorsal Columns ✓
c) Corticospinal tract
d) Spinocerebellar tract
Rationale: Stereognosis (identifying an object by touch) is a cortical sensory function that relies
on the dorsal column-medial lemniscus pathway for fine touch and proprioception.
4. A patient with early Alzheimer's disease would most likely exhibit deficits in:
a) Immediate recall
b) Short-term memory ✓
c) Long-term memory
,d) Procedural memory
Rationale: Short-term (recent) memory impairment is a hallmark early sign of Alzheimer's, while
long-term memory is often preserved until later stages.
5. The Glasgow Coma Scale (GCS) assesses which three components?
a) Pupillary Response, Motor Response, Verbal Response
b) Eye Opening, Motor Response, Verbal Response ✓
c) Orientation, Memory, Concentration
d) Cranial Nerves, Sensory, Motor
*Rationale: The GCS is a standardized tool for level of consciousness based on Eye (1-4), Verbal
(1-5), and Motor (1-6) responses.*
6. A positive Babinski sign in an adult is characterized by:
a) Flexion of the toes
b) Fanning and dorsiflexion of the great toe ✓
c) Inversion of the foot
d) No response to plantar stimulation
Rationale: Dorsiflexion of the great toe with fanning of the others is an upper motor neuron sign
(e.g., corticospinal tract lesion). Normal response is plantar flexion.
7. A patient with a lesion to the Cerebellum would most likely demonstrate:
a) Spasticity
b) Flaccidity
c) Intention tremor and ataxia ✓
d) Resting tremor
Rationale: The cerebellum coordinates voluntary movement. Lesions cause ipsilateral ataxia,
intention tremor, dysdiadochokinesia, and nystagmus.
8. The most sensitive clinical indicator of an altered mental status is:
a) Disorientation to person
b) A change in the level of consciousness ✓
c) Abnormal vital signs
d) Inappropriate affect
Rationale: A change in LOC is the earliest and most critical sign of neurological compromise.
9. When assessing deep tendon reflexes, a grade of 2+ indicates:
a) Absent response
b) Diminished response
c) Normal response ✓
d) Brisk response
,*Rationale: Reflex grading: 0=absent, 1+=diminished, 2+=normal, 3+=brisker than average,
4+=clonus.*
10. A key differential between delirium and dementia is:
a) The presence of memory loss
b) The acuity of onset and fluctuating course ✓
c) The patient's age
d) The irreversibility of the condition
Rationale: Delirium is acute, with a fluctuating course and inattention. Dementia is chronic and
progressive.
11. To test the function of Cranial Nerve XII (Hypoglossal), you would ask the patient to:
a) Stick out their tongue ✓
b) Say "ah" to observe the uvula
c) Clench their teeth
d) Follow your finger with their eyes
Rationale: CN XII is a motor nerve controlling tongue movement. Deviation to one side indicates
a lesion on that side.
12. A patient with Parkinson's disease would most likely exhibit:
a) Intention tremor
b) A unilateral, "pill-rolling" resting tremor ✓
c) Choreiform movements
d) Asterixis
*Rationale: The classic tremor of Parkinson's is a 4-6 Hz "pill-rolling" resting tremor that
improves with intentional movement.*
13. Kernig's sign, used to assess for meningeal irritation, is positive when:
a) Neck flexion causes hip and knee flexion
b) Pain is elicited with hip flexion and knee extension ✓
c) The great toe dorsiflexes upon plantar stimulation
d) There is resistance to passive neck rotation
Rationale: Kernig's sign: pain/resistance with passive knee extension while the hip is flexed.
Brudzinski's sign: hip/knee flexion with neck flexion.
14. A patient with a history of TIA presents with amaurosis fugax. This describes:
a) Transient aphasia
b) Transient unilateral blindness ✓
c) Transient hemiparesis
d) Transient vertigo
, Rationale: Amaurosis fugax is a transient monocular blindness, often described as a "shade
coming down," and is a classic symptom of retinal TIA.
15. Pronator drift is a test used to screen for:
a) Cerebellar disease
b) Subtle upper motor neuron weakness ✓
c) Peripheral neuropathy
d) Carpal tunnel syndrome
Rationale: With eyes closed and arms supinated, a patient with subtle UMN weakness will
pronate and drift downward on the affected side.
Cardiovascular & Peripheral Vascular (Questions 16-30)
16. The S1 heart sound is best heard at the apex and corresponds to:
a) Aortic and pulmonic valve closure
b) Mitral and tricuspid valve closure ✓
c) Atrial contraction
d) Ventricular filling
Rationale: S1 is the sound of the AV valves (mitral and tricuspid) closing at the beginning of
systole.
17. A grade 3/6 midsystolic murmur is described as:
a) Very faint, heard only with special effort
b) Loud, with a palpable thrill
c) Moderately loud ✓
d) Loud, can be heard with stethoscope partially off chest
*Rationale: Murmur Grading: 1/6=faint, 2/6=quiet, 3/6=moderately loud, 4/6=loud with thrill,
5/6=very loud with thrill, 6/6=heard with stethoscope off chest.*
18. A murmur that increases in intensity with the Valsalva maneuver is characteristic of:
a) Aortic stenosis
b) Mitral regurgitation
c) Hypertrophic cardiomyopathy ✓
d) Mitral stenosis
Rationale: Valsalva decreases venous return and left ventricular volume, which exacerbates the
obstruction and murmur in HCM.
19. The "a" wave in the jugular venous pulse represents:
a) Ventricular contraction forcing the tricuspid valve upward
