NR509 Week 4 Midterm Exam | Latest Update 2026/2027 | Questions and
Verified Answers with Rationales | 100% Correct | Advanced Physical
Assessment
Questions 1‑20: Cranial Nerves & Neurologic Assessment
1. A patient cannot elevate the left eye, and the left pupil is dilated. Which cranial nerve is most likely
affected?
A) CN II (Optic)
B) CN III (Oculomotor)
C) CN IV (Trochlear)
D) CN VI (Abducens)
Correct Answer: B – CN III (Oculomotor)
- Rationale: Cranial nerve III controls the majority of extraocular muscles (excluding lateral rectus and
superior oblique), pupillary constriction, and eyelid elevation. A dilated pupil with an eye that cannot
elevate suggests a CN III palsy until proven otherwise. CN IV controls the superior oblique muscle
(downward and inward gaze), and CN VI controls the lateral rectus (abduction), neither of which would
explain this presentation.
2. Which cranial nerve is tested by asking the patient to shrug their shoulders against resistance?
A) CN X (Vagus)
B) CN XI (Spinal Accessory)
C) CN XII (Hypoglossal)
D) CN IX (Glossopharyngeal)
Correct Answer: B – CN XI (Spinal Accessory)
,- Rationale: Cranial nerve XI innervates the trapezius and sternocleidomastoid muscles. Asking the
patient to shrug the shoulders against resistance specifically tests the trapezius muscle, providing a
functional assessment of the spinal accessory nerve.
3. A patient has difficulty swallowing and a hoarse voice. Which cranial nerve is most likely involved?
A) CN V (Trigeminal)
B) CN X (Vagus)
C) CN VII (Facial)
D) CN XII (Hypoglossal)
Correct Answer: B – CN X (Vagus)
- Rationale: The vagus nerve (CN X) provides motor innervation to the pharynx (swallowing) and larynx
(vocal cord movement). Dysphagia (difficulty swallowing) and hoarseness are classic signs of vagal nerve
injury. CN V is responsible for facial sensation and mastication; CN VII controls facial expression; CN XII
controls tongue movement.
4. Which cranial nerve is assessed by evaluating facial symmetry during smiling and frowning?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN X (Vagus)
Correct Answer: B – CN VII (Facial)
- Rationale: Cranial nerve VII controls the muscles of facial expression. Asking the patient to smile,
frown, raise eyebrows, and close the eyes tightly tests the motor function of CN VII. Asymmetry may
indicate peripheral or central facial nerve palsy.
5. A patient with a head injury exhibits a dilated and fixed pupil on the right. This finding most likely
indicates:
,A) Damage to CN II
B) Damage to CN III
C) Damage to CN IV
D) Damage to CN VI
Correct Answer: B – Damage to CN III
- Rationale: The oculomotor nerve (CN III) carries parasympathetic fibers that constrict the pupil. A
dilated and non-reactive (fixed) pupil is a hallmark sign of CN III compression, often due to increased
intracranial pressure, uncal herniation, or aneurysms. CN II controls afferent vision, not pupillary
constriction. CN IV and VI control eye movement but not pupil size.
6. Which of the following is the primary center for sensation in the brain?
A) Precentral gyrus of the frontal lobe
B) Postcentral gyrus of the parietal lobe
C) Temporal lobe
D) Occipital lobe
Correct Answer: B – Postcentral gyrus of the parietal lobe
- Rationale: The postcentral gyrus, located in the parietal lobe, is the primary somatosensory cortex. It
receives and processes sensory information from the body, including touch, pressure, pain, and
temperature. The precentral gyrus in the frontal lobe is the primary motor cortex.
7. A patient who has suffered a stroke cannot speak but appears to understand what is being said. The
patient tries to speak but only produces garbled sounds. This is most consistent with:
A) Receptive aphasia
B) Expressive aphasia
C) Global aphasia
D) Conduction aphasia
, Correct Answer: B – Expressive aphasia
- Rationale: Broca's area in the frontal lobe mediates motor speech. Damage to Broca's area in the
dominant hemisphere results in expressive (non-fluent) aphasia: the patient understands language but
cannot produce fluent speech. In contrast, receptive aphasia (Wernicke's area) impairs comprehension,
and the patient speaks fluently but with meaningless words.
8. A patient hears sound but says it has no meaning, "like hearing a foreign language." This is most
consistent with:
A) Receptive aphasia
B) Expressive aphasia
C) Global aphasia
D) Conduction aphasia
Correct Answer: A – Receptive aphasia
- Rationale: Wernicke's area, located in the temporal lobe, is associated with language comprehension.
Damage to this area in the dominant hemisphere results in receptive (fluent) aphasia: the patient can
hear sound but cannot assign meaning to it, leading to speech that is fluent but nonsensical and poor
comprehension.
9. The Romberg test is used to assess:
A) Motor strength of the lower extremities
B) Cerebellar function and proprioception
C) Cranial nerve II function
D) Reflex arc integrity
Correct Answer: B – Cerebellar function and proprioception
- Rationale: The Romberg test assesses the patient's ability to maintain standing balance with eyes
closed. It tests the dorsal columns (proprioception) and cerebellar function. A positive Romberg sign
(loss of balance with eyes closed) suggests proprioceptive loss (e.g., from posterior column disease)
rather than cerebellar ataxia (which is evident even with eyes open).
Verified Answers with Rationales | 100% Correct | Advanced Physical
Assessment
Questions 1‑20: Cranial Nerves & Neurologic Assessment
1. A patient cannot elevate the left eye, and the left pupil is dilated. Which cranial nerve is most likely
affected?
A) CN II (Optic)
B) CN III (Oculomotor)
C) CN IV (Trochlear)
D) CN VI (Abducens)
Correct Answer: B – CN III (Oculomotor)
- Rationale: Cranial nerve III controls the majority of extraocular muscles (excluding lateral rectus and
superior oblique), pupillary constriction, and eyelid elevation. A dilated pupil with an eye that cannot
elevate suggests a CN III palsy until proven otherwise. CN IV controls the superior oblique muscle
(downward and inward gaze), and CN VI controls the lateral rectus (abduction), neither of which would
explain this presentation.
2. Which cranial nerve is tested by asking the patient to shrug their shoulders against resistance?
A) CN X (Vagus)
B) CN XI (Spinal Accessory)
C) CN XII (Hypoglossal)
D) CN IX (Glossopharyngeal)
Correct Answer: B – CN XI (Spinal Accessory)
,- Rationale: Cranial nerve XI innervates the trapezius and sternocleidomastoid muscles. Asking the
patient to shrug the shoulders against resistance specifically tests the trapezius muscle, providing a
functional assessment of the spinal accessory nerve.
3. A patient has difficulty swallowing and a hoarse voice. Which cranial nerve is most likely involved?
A) CN V (Trigeminal)
B) CN X (Vagus)
C) CN VII (Facial)
D) CN XII (Hypoglossal)
Correct Answer: B – CN X (Vagus)
- Rationale: The vagus nerve (CN X) provides motor innervation to the pharynx (swallowing) and larynx
(vocal cord movement). Dysphagia (difficulty swallowing) and hoarseness are classic signs of vagal nerve
injury. CN V is responsible for facial sensation and mastication; CN VII controls facial expression; CN XII
controls tongue movement.
4. Which cranial nerve is assessed by evaluating facial symmetry during smiling and frowning?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN X (Vagus)
Correct Answer: B – CN VII (Facial)
- Rationale: Cranial nerve VII controls the muscles of facial expression. Asking the patient to smile,
frown, raise eyebrows, and close the eyes tightly tests the motor function of CN VII. Asymmetry may
indicate peripheral or central facial nerve palsy.
5. A patient with a head injury exhibits a dilated and fixed pupil on the right. This finding most likely
indicates:
,A) Damage to CN II
B) Damage to CN III
C) Damage to CN IV
D) Damage to CN VI
Correct Answer: B – Damage to CN III
- Rationale: The oculomotor nerve (CN III) carries parasympathetic fibers that constrict the pupil. A
dilated and non-reactive (fixed) pupil is a hallmark sign of CN III compression, often due to increased
intracranial pressure, uncal herniation, or aneurysms. CN II controls afferent vision, not pupillary
constriction. CN IV and VI control eye movement but not pupil size.
6. Which of the following is the primary center for sensation in the brain?
A) Precentral gyrus of the frontal lobe
B) Postcentral gyrus of the parietal lobe
C) Temporal lobe
D) Occipital lobe
Correct Answer: B – Postcentral gyrus of the parietal lobe
- Rationale: The postcentral gyrus, located in the parietal lobe, is the primary somatosensory cortex. It
receives and processes sensory information from the body, including touch, pressure, pain, and
temperature. The precentral gyrus in the frontal lobe is the primary motor cortex.
7. A patient who has suffered a stroke cannot speak but appears to understand what is being said. The
patient tries to speak but only produces garbled sounds. This is most consistent with:
A) Receptive aphasia
B) Expressive aphasia
C) Global aphasia
D) Conduction aphasia
, Correct Answer: B – Expressive aphasia
- Rationale: Broca's area in the frontal lobe mediates motor speech. Damage to Broca's area in the
dominant hemisphere results in expressive (non-fluent) aphasia: the patient understands language but
cannot produce fluent speech. In contrast, receptive aphasia (Wernicke's area) impairs comprehension,
and the patient speaks fluently but with meaningless words.
8. A patient hears sound but says it has no meaning, "like hearing a foreign language." This is most
consistent with:
A) Receptive aphasia
B) Expressive aphasia
C) Global aphasia
D) Conduction aphasia
Correct Answer: A – Receptive aphasia
- Rationale: Wernicke's area, located in the temporal lobe, is associated with language comprehension.
Damage to this area in the dominant hemisphere results in receptive (fluent) aphasia: the patient can
hear sound but cannot assign meaning to it, leading to speech that is fluent but nonsensical and poor
comprehension.
9. The Romberg test is used to assess:
A) Motor strength of the lower extremities
B) Cerebellar function and proprioception
C) Cranial nerve II function
D) Reflex arc integrity
Correct Answer: B – Cerebellar function and proprioception
- Rationale: The Romberg test assesses the patient's ability to maintain standing balance with eyes
closed. It tests the dorsal columns (proprioception) and cerebellar function. A positive Romberg sign
(loss of balance with eyes closed) suggests proprioceptive loss (e.g., from posterior column disease)
rather than cerebellar ataxia (which is evident even with eyes open).
