,NUR 504 – Advanced Health Assessment
Exam 4: Comprehensive Final
University of St. Thomas
Latest Curriculum (2026/2027)
Instructions: Select the single best answer for each question unless otherwise
specified.
Section I: Multiple Choice
1. A 72-year-old patient presents with a new onset of a resting tremor in their
right hand, cogwheel rigidity in their right arm, and a shuffling gait. Which of the
following findings would be most consistent with a diagnosis of Idiopathic
Parkinson's Disease, rather than a Parkinson-Plus Syndrome?
A. Early onset of postural instability and falls
B. Absence of a resting tremor
C. Asymmetric onset of symptoms
D. Presence of rapid eye movement (REM) sleep behavior disorder
Answer: C. Asymmetric onset of symptoms
Rationale: Idiopathic Parkinson's Disease (PD) typically presents with unilateral or
asymmetric onset of symptoms (e.g., one arm or leg affected first). Parkinson-Plus
Syndromes (like Multiple System Atrophy or Progressive Supranuclear Palsy) are
more likely to present with symmetric findings, early postural instability (A), and
lack of tremor (B). REM sleep behavior disorder (D) can be seen in both but is
more strongly associated with synucleinopathies in general, but asymmetry is a
key differentiator for PD.
2. When performing a mental status examination on an 80-year-old patient,
which finding would be considered a normal age-related change rather than a
pathological one?
A. Inability to recall the names of their grandchildren
B. Difficulty finding the right word during conversation
,C. Getting lost in a familiar neighborhood
D. Inability to manage personal finances
Answer: B. Difficulty finding the right word during conversation
Rationale: Normal age-related cognitive changes include a mild decline in
processing speed, executive function, and word-finding (tip-of-the-tongue
phenomenon). Inability to recall names of close family members (A), getting lost
in familiar places (C), and inability to manage finances (D) are all "red flags" that
suggest a pathological process such as dementia or delirium.
3. A 45-year-old male with a history of alcohol use disorder presents with
confusion, ataxia, and nystagmus. You suspect Wernicke's encephalopathy.
Which of the following physical exam findings would be most specific to this
condition?
A. Abducens nerve (CN VI) palsy
B. Ophthalmoplegia
C. Pupillary light reflex abnormality
D. Ptosis
Answer: B. Ophthalmoplegia
Rationale: The classic triad of Wernicke's encephalopathy is confusion, ataxia, and
ophthalmoplegia (paralysis or weakness of the extraocular muscles). While CN VI
palsy (A) can occur, ophthalmoplegia is the classic finding associated with this
thiamine deficiency. Pupillary reflexes (C) are often spared, and ptosis (D) is not a
primary feature.
4. You are performing a cranial nerve exam on a patient with a suspected
stroke. To assess Cranial Nerve III (Oculomotor), which of the following actions
should the patient be able to perform?
A. Shrug their shoulders against resistance
B. Stick out their tongue midline
C. Look medially and downward with the eye
D. Clench their jaw tightly
, Answer: C. Look medially and downward with the eye
Rationale: CN III (Oculomotor) innervates the medial rectus (adduction), superior
rectus (elevation), inferior rectus (depression), and inferior oblique (elevation).
Looking medially and downward tests the inferior rectus. Shoulder shrug is CN XI
(A), tongue protrusion is CN XII (B), and jaw clenching is CN V (D).
5. A patient presents with a severe headache and photophobia. On exam, you
flex the patient's neck to their chest, and they flex their hips and knees
involuntarily. This positive sign is indicative of:
A. Meningeal irritation
B. Upper motor neuron lesion
C. Lower motor neuron lesion
D. Cerebellar dysfunction
Answer: A. Meningeal irritation
Rationale: This describes a positive Brudzinski's sign. When the neck is flexed, the
patient involuntarily flexes their hips and knees. Along with Kernig's sign, this is a
classic indicator of meningeal irritation, often seen in meningitis or subarachnoid
hemorrhage.
6. A 55-year-old female reports pain and paresthesia in the lateral three digits of
her right hand, which wakes her up at night. She shakes her hand to relieve the
symptoms. What provocative test would you perform to confirm your
suspicion?
A. Phalen's test
B. Spurling's test
C. Tinel's test at the elbow
D. Adson's test
Answer: A. Phalen's test
Rationale: The patient's symptoms (pain/paresthesia in the median nerve
distribution, nocturnal worsening, and the "flick sign") are classic for Carpal
Tunnel Syndrome. Phalen's test (holding the wrists in full flexion for 60 seconds)
Exam 4: Comprehensive Final
University of St. Thomas
Latest Curriculum (2026/2027)
Instructions: Select the single best answer for each question unless otherwise
specified.
Section I: Multiple Choice
1. A 72-year-old patient presents with a new onset of a resting tremor in their
right hand, cogwheel rigidity in their right arm, and a shuffling gait. Which of the
following findings would be most consistent with a diagnosis of Idiopathic
Parkinson's Disease, rather than a Parkinson-Plus Syndrome?
A. Early onset of postural instability and falls
B. Absence of a resting tremor
C. Asymmetric onset of symptoms
D. Presence of rapid eye movement (REM) sleep behavior disorder
Answer: C. Asymmetric onset of symptoms
Rationale: Idiopathic Parkinson's Disease (PD) typically presents with unilateral or
asymmetric onset of symptoms (e.g., one arm or leg affected first). Parkinson-Plus
Syndromes (like Multiple System Atrophy or Progressive Supranuclear Palsy) are
more likely to present with symmetric findings, early postural instability (A), and
lack of tremor (B). REM sleep behavior disorder (D) can be seen in both but is
more strongly associated with synucleinopathies in general, but asymmetry is a
key differentiator for PD.
2. When performing a mental status examination on an 80-year-old patient,
which finding would be considered a normal age-related change rather than a
pathological one?
A. Inability to recall the names of their grandchildren
B. Difficulty finding the right word during conversation
,C. Getting lost in a familiar neighborhood
D. Inability to manage personal finances
Answer: B. Difficulty finding the right word during conversation
Rationale: Normal age-related cognitive changes include a mild decline in
processing speed, executive function, and word-finding (tip-of-the-tongue
phenomenon). Inability to recall names of close family members (A), getting lost
in familiar places (C), and inability to manage finances (D) are all "red flags" that
suggest a pathological process such as dementia or delirium.
3. A 45-year-old male with a history of alcohol use disorder presents with
confusion, ataxia, and nystagmus. You suspect Wernicke's encephalopathy.
Which of the following physical exam findings would be most specific to this
condition?
A. Abducens nerve (CN VI) palsy
B. Ophthalmoplegia
C. Pupillary light reflex abnormality
D. Ptosis
Answer: B. Ophthalmoplegia
Rationale: The classic triad of Wernicke's encephalopathy is confusion, ataxia, and
ophthalmoplegia (paralysis or weakness of the extraocular muscles). While CN VI
palsy (A) can occur, ophthalmoplegia is the classic finding associated with this
thiamine deficiency. Pupillary reflexes (C) are often spared, and ptosis (D) is not a
primary feature.
4. You are performing a cranial nerve exam on a patient with a suspected
stroke. To assess Cranial Nerve III (Oculomotor), which of the following actions
should the patient be able to perform?
A. Shrug their shoulders against resistance
B. Stick out their tongue midline
C. Look medially and downward with the eye
D. Clench their jaw tightly
, Answer: C. Look medially and downward with the eye
Rationale: CN III (Oculomotor) innervates the medial rectus (adduction), superior
rectus (elevation), inferior rectus (depression), and inferior oblique (elevation).
Looking medially and downward tests the inferior rectus. Shoulder shrug is CN XI
(A), tongue protrusion is CN XII (B), and jaw clenching is CN V (D).
5. A patient presents with a severe headache and photophobia. On exam, you
flex the patient's neck to their chest, and they flex their hips and knees
involuntarily. This positive sign is indicative of:
A. Meningeal irritation
B. Upper motor neuron lesion
C. Lower motor neuron lesion
D. Cerebellar dysfunction
Answer: A. Meningeal irritation
Rationale: This describes a positive Brudzinski's sign. When the neck is flexed, the
patient involuntarily flexes their hips and knees. Along with Kernig's sign, this is a
classic indicator of meningeal irritation, often seen in meningitis or subarachnoid
hemorrhage.
6. A 55-year-old female reports pain and paresthesia in the lateral three digits of
her right hand, which wakes her up at night. She shakes her hand to relieve the
symptoms. What provocative test would you perform to confirm your
suspicion?
A. Phalen's test
B. Spurling's test
C. Tinel's test at the elbow
D. Adson's test
Answer: A. Phalen's test
Rationale: The patient's symptoms (pain/paresthesia in the median nerve
distribution, nocturnal worsening, and the "flick sign") are classic for Carpal
Tunnel Syndrome. Phalen's test (holding the wrists in full flexion for 60 seconds)
