NSG500 / NSG 500 Exam 3: Advanced Health
Assessment – Wilkes University Actual Exam Complete
Questions & Rationales | Differential Diagnosis | Pass
Guaranteed - A+ Graded
[Neurologic Assessment]
Q1: A 58-year-old patient presents with sudden-onset facial asymmetry. Upon
examination, you note that the patient cannot close their right eye, their right forehead is
completely smooth, and the corner of their mouth droops on the right when asked to
smile. The differential here is guided by the involvement of the forehead, which helps
you localize the lesion to which cranial nerve?
A. Cranial nerve V (Trigeminal nerve) - specifically the ophthalmic division
B. Cranial nerve VII (Facial nerve) - peripheral lesion
C. Cranial nerve VII (Facial nerve) - central lesion (upper motor neuron)
D. Cranial nerve XII (Hypoglossal nerve) - ipsilateral lower lesion
Correct Answer: B [CORRECT]
Correct Answer: B
Rationale: The best answer is a peripheral CN VII lesion because the upper face
receives bilateral motor cortex input, so a central stroke would spare the forehead. What
you'd want to do in practice is recognize that a forehead involved with the lower face
droop points straight to a peripheral issue like Bell's palsy.
Q2: A 45-year-old patient is undergoing a neurological assessment. You note increased
muscle tone in both upper and lower extremities, hyperreflexia, and the presence of a
positive Babinski sign. There is no muscle fasciculation or atrophy. How do you classify
these findings?
A. Lower motor neuron lesion
B. Upper motor neuron lesion
C. Cerebellar dysfunction
D. Extrapyramidal tract involvement
Correct Answer: B [CORRECT]
Correct Answer: B
Rationale: The best answer is an upper motor neuron lesion because spasticity,
hyperreflexia, and a positive Babinski are the classic triad indicating damage above the
anterior horn cell. Remember the key distinguishing feature between upper and lower
,motor neuron lesions is that lower motor neuron lesions present with flaccidity,
hyporeflexia, and fasciculations.
Q3: You are screening a 72-year-old patient for cognitive impairment using the Montreal
Cognitive Assessment (MoCA). The patient scores a 24 out of 30. What is the most
accurate interpretation of this result?
A. The patient has severe dementia and requires immediate institutionalization
B. The score is normal for a patient of this age and requires no further action
C. The score indicates mild cognitive impairment (MCI) and warrants further clinical
evaluation
D. The test is invalid because the MoCA cannot be used in patients over the age of 70
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: What you'd want to do in practice is recognize that a score of 26 or above is
considered normal on the MoCA. This aligns with the physical exam finding that a score
in the 20s, while not severe dementia, strongly suggests mild cognitive impairment that
needs a deeper workup.
Q4: A patient is asked to stand with their feet together and arms at their sides. They are
steady with their eyes open, but as soon as they close their eyes, they begin to sway
significantly and nearly lose their balance. What does this positive Romberg test
indicate?
A. Cerebellar ataxia
B. Vestibular dysfunction
C. Proprioceptive or dorsal column deficit
D. Parkinsonian rigidity
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: The best answer is a dorsal column deficit because the Romberg test
specifically isolates proprioception. When the patient loses visual input, they can't
compensate for the lack of joint position sense, whereas a patient with cerebellar ataxia
would be unsteady even with their eyes open.
Q5: When assessing a 65-year-old patient's deep tendon reflexes, you note that the
biceps reflex is 2+ bilaterally, but the patellar and Achilles reflexes are 1+ and trace,
respectively. The patient also reports numbness in their feet. What is the most likely
underlying cause for these findings?
A. Hyperthyroidism
B. A cervical spinal cord lesion
C. Peripheral neuropathy
D. Acute intracranial hypertension
, Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: This aligns with the physical exam finding of diminished distal reflexes paired
with sensory loss in the feet, which is the hallmark presentation of peripheral
neuropathy. The differential here is guided by the fact that a spinal cord lesion would
usually cause hyperreflexia below the level of injury, not hyporeflexia.
Q6: You are testing the sensory system of a patient who reports numbness in their
lateral thigh. To accurately assess this specific complaint, which dermatome should you
focus on during your light touch and pinprick testing?
A. L2
B. L4
C. L5
D. S1
Correct Answer: A [CORRECT]
Correct Answer: A
Rationale: The best answer is L2 because this dermatome wraps around the lateral
aspect of the upper thigh. What you'd want to do in practice is avoid testing L4 (medial
leg) or L5/S1 (lateral leg and foot) when the complaint is strictly isolated to the lateral
thigh, as that points to something like meralgia paresthetica.
Q7: A patient walks into the exam room and you immediately notice a wide-based,
staggering gait. They look like they are drunk, though they deny alcohol use. When they
try to walk heel-to-toe, they are highly unsteady. Which part of the nervous system is
most likely compromised?
A. Corticospinal tract
B. Spinothalamic tract
C. Cerebellum
D. Peripheral nerves
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: The best answer is the cerebellum because a wide-based, unsteady gait with
a positive tandem walk is the textbook presentation of cerebellar ataxia. Remember the
key distinguishing feature between cerebellar and cortical issues is that cerebellar
problems cause incoordination without true weakness.
Q8: A 22-year-old college student presents to the clinic with a severe headache, fever,
and photophobia. As part of your neurological assessment, you ask the patient to flex
their neck forward, which elicits severe pain and neck stiffness. What is the name of this
maneuver, and what condition are you highly suspicious of?
A. Kernig sign, suspected lumbar disc herniation
Assessment – Wilkes University Actual Exam Complete
Questions & Rationales | Differential Diagnosis | Pass
Guaranteed - A+ Graded
[Neurologic Assessment]
Q1: A 58-year-old patient presents with sudden-onset facial asymmetry. Upon
examination, you note that the patient cannot close their right eye, their right forehead is
completely smooth, and the corner of their mouth droops on the right when asked to
smile. The differential here is guided by the involvement of the forehead, which helps
you localize the lesion to which cranial nerve?
A. Cranial nerve V (Trigeminal nerve) - specifically the ophthalmic division
B. Cranial nerve VII (Facial nerve) - peripheral lesion
C. Cranial nerve VII (Facial nerve) - central lesion (upper motor neuron)
D. Cranial nerve XII (Hypoglossal nerve) - ipsilateral lower lesion
Correct Answer: B [CORRECT]
Correct Answer: B
Rationale: The best answer is a peripheral CN VII lesion because the upper face
receives bilateral motor cortex input, so a central stroke would spare the forehead. What
you'd want to do in practice is recognize that a forehead involved with the lower face
droop points straight to a peripheral issue like Bell's palsy.
Q2: A 45-year-old patient is undergoing a neurological assessment. You note increased
muscle tone in both upper and lower extremities, hyperreflexia, and the presence of a
positive Babinski sign. There is no muscle fasciculation or atrophy. How do you classify
these findings?
A. Lower motor neuron lesion
B. Upper motor neuron lesion
C. Cerebellar dysfunction
D. Extrapyramidal tract involvement
Correct Answer: B [CORRECT]
Correct Answer: B
Rationale: The best answer is an upper motor neuron lesion because spasticity,
hyperreflexia, and a positive Babinski are the classic triad indicating damage above the
anterior horn cell. Remember the key distinguishing feature between upper and lower
,motor neuron lesions is that lower motor neuron lesions present with flaccidity,
hyporeflexia, and fasciculations.
Q3: You are screening a 72-year-old patient for cognitive impairment using the Montreal
Cognitive Assessment (MoCA). The patient scores a 24 out of 30. What is the most
accurate interpretation of this result?
A. The patient has severe dementia and requires immediate institutionalization
B. The score is normal for a patient of this age and requires no further action
C. The score indicates mild cognitive impairment (MCI) and warrants further clinical
evaluation
D. The test is invalid because the MoCA cannot be used in patients over the age of 70
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: What you'd want to do in practice is recognize that a score of 26 or above is
considered normal on the MoCA. This aligns with the physical exam finding that a score
in the 20s, while not severe dementia, strongly suggests mild cognitive impairment that
needs a deeper workup.
Q4: A patient is asked to stand with their feet together and arms at their sides. They are
steady with their eyes open, but as soon as they close their eyes, they begin to sway
significantly and nearly lose their balance. What does this positive Romberg test
indicate?
A. Cerebellar ataxia
B. Vestibular dysfunction
C. Proprioceptive or dorsal column deficit
D. Parkinsonian rigidity
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: The best answer is a dorsal column deficit because the Romberg test
specifically isolates proprioception. When the patient loses visual input, they can't
compensate for the lack of joint position sense, whereas a patient with cerebellar ataxia
would be unsteady even with their eyes open.
Q5: When assessing a 65-year-old patient's deep tendon reflexes, you note that the
biceps reflex is 2+ bilaterally, but the patellar and Achilles reflexes are 1+ and trace,
respectively. The patient also reports numbness in their feet. What is the most likely
underlying cause for these findings?
A. Hyperthyroidism
B. A cervical spinal cord lesion
C. Peripheral neuropathy
D. Acute intracranial hypertension
, Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: This aligns with the physical exam finding of diminished distal reflexes paired
with sensory loss in the feet, which is the hallmark presentation of peripheral
neuropathy. The differential here is guided by the fact that a spinal cord lesion would
usually cause hyperreflexia below the level of injury, not hyporeflexia.
Q6: You are testing the sensory system of a patient who reports numbness in their
lateral thigh. To accurately assess this specific complaint, which dermatome should you
focus on during your light touch and pinprick testing?
A. L2
B. L4
C. L5
D. S1
Correct Answer: A [CORRECT]
Correct Answer: A
Rationale: The best answer is L2 because this dermatome wraps around the lateral
aspect of the upper thigh. What you'd want to do in practice is avoid testing L4 (medial
leg) or L5/S1 (lateral leg and foot) when the complaint is strictly isolated to the lateral
thigh, as that points to something like meralgia paresthetica.
Q7: A patient walks into the exam room and you immediately notice a wide-based,
staggering gait. They look like they are drunk, though they deny alcohol use. When they
try to walk heel-to-toe, they are highly unsteady. Which part of the nervous system is
most likely compromised?
A. Corticospinal tract
B. Spinothalamic tract
C. Cerebellum
D. Peripheral nerves
Correct Answer: C [CORRECT]
Correct Answer: C
Rationale: The best answer is the cerebellum because a wide-based, unsteady gait with
a positive tandem walk is the textbook presentation of cerebellar ataxia. Remember the
key distinguishing feature between cerebellar and cortical issues is that cerebellar
problems cause incoordination without true weakness.
Q8: A 22-year-old college student presents to the clinic with a severe headache, fever,
and photophobia. As part of your neurological assessment, you ask the patient to flex
their neck forward, which elicits severe pain and neck stiffness. What is the name of this
maneuver, and what condition are you highly suspicious of?
A. Kernig sign, suspected lumbar disc herniation
