NR 603 Week 1 Exam with Questions and
Verified Answers | 2026 Prep
1.A 75-year-old man is involved in a motor vehicle accident and strikes his
forehead on the windshield. He complains of neck pain and severe burning in
his shoulders and arms. His physical examination reveals weakness of his upper
extremities. What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B - Correct Answer✔✔-Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more severe in
the upper extremities than in the lower extremities, and is more severe in the
hands. There is typically hyperesthesia over the shoulders and arms. Anterior
cord syndrome presents with paraplegia or quadriplegia, loss of lateral
spinothalamic function with preservation of posterior column function. Brown-
Séquard syndrome consists of weakness and loss of posterior column function
on one side of the body distal to the lesion with contralateral loss of lateral
spinothalamic function one to two levels below the lesion. Complete cord
transection would affect motor and sensory function distal to the lesion. Cauda
equina syndrome typically presents as low back pain with radiculopathy.
2.A 37-year-old man fell from a ladder as he finished hanging the Christmas
lights on his house. The right side of his head hit the alley cement, and he lost
consciousness for about 1 minute; he woke up with a headache, but he had no
other complaints. A few hours later, the patient is brought to the emergency
room by his neighbor because of an intense headache, confusion, and left hand
hemiparesis. On examination, the patient has a bruise located over the right
temporal region, mydriasis, and right deviation of the right eye, papilledema,
and left extensor plantar response. An emergency CT scan of the head without
contrast reveals a lens-shaped hyper-density under the right temporal bone with
mass effect and edema. What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
,5 Acute meningitis
ANS: 1 - Correct Answer✔✔-Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the middle
meningeal artery. Although a lucid interval ranging from minutes to hours
followed by altered mental status and focal deficits is typical for epidural
hematoma, this clinical picture is only encountered in up to 1/3 of the patients.
The collection of blood between the skull and dura mater causes an evident
mass effect with ophthalmic nerve palsy and the contralateral hemiparesis.
Surgical evacuation of the clot via burr holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging veins that
connect the cerebrum to the venous sinuses within the dura. This venous
hemorrhage will result in a gradual increase of the hematoma, with a
progressive clinical picture over days or weeks. The CT scan will show a
concave, crescent-shaped hyper-density compared to the convex, lens-shaped
hyper-density in epidural hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most
common is the congenital berry aneurysm. The clinical picture is of a sudden,
severe headache with meningeal irritation. A CT scan will show blood in the
subarachnoid space, and a lumbar puncture will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by hypertension
complicated with Charcot-Bouchard aneurysms. The blood accumulates into the
brain substance and most commonly involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal
irritation dominate the clinical picture. Lumbar puncture, indicated if there are
no focal neurological signs on clinical examination, will be the diagnostic
procedure. The CT scan of the patient presented in this case is characteristic for
epidural hematoma, and there is no indication for a lumbar punctu
3.A 31-year-old woman presents with a purpural rash covering her arms, legs,
and abdomen. She also has fever, chills, nausea, abdominal tenderness,
tachycardia, and generalized myalgias. Prior to the development of the rash, the
patient noted that she had a headache, cough, and sore throat. Laboratory
studies were positive for Gram-negative diplococci in the blood, along with
thrombocytopenia and an elevation in PMNs. Urinalysis showed blood, protein,
and casts. Vital signs are as follows: PB 92/66, P 96, RR 14, T 39. The patient
denies any foreign travel and does not have any sick contacts. However, she
does work part time as a nurse in a local hospital.
Question
,The patient is diagnosed with Meningococcemia; she is admitted to the hospital
and placed in respiratory isolation. What major course of therapy should this
patient receive?
Answer Choices
1 Steroids
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici - Correct Answer✔✔-Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The preferred
drug for active infection is penicillin G. For those allergic to penicillin,
chloramphenicol and cephalosporins (ie, cefotaxime, cefuroxime) may be used
as alternatives.
Patients will also receive supportive care, but antibiotic therapy must be
initiated quickly if the patient is to survive. Intensive care placement may be
necessary if organ failure is imminent. Ventilatory support, inotropic support,
and IV fluids are necessary in some. If adrenal insufficiency occurs,
corticosteroid replacement may be considered. A central venous line helps to
provide large amounts of volume expanders and inotropic medications for
adequate tissue perfusion.
Steroids have not been shown to play a major role in the treatment of
meningococcemia. However, they have been used in addition to antibiotic
therapy. In the case of adrenal insufficiency, for example, steroid replacement
has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the patient
suffers from a devastating coagulopathy, blood or blood products may be
replaced as necessary.
Bactericidal/permeability-increasing protein is a protein stored in the granules
of neutrophils. It binds to endotoxin in vitro and neutralizes it. This technique is
experimental, and it is not used in everyday treatment of meningococcemia.
4.In myasthenia gravis, weakness is a result of insufficient acetylcholine
transmission at the neuromuscular junction; however, weakness can also occur
with overdosing of the cholinergic medications used to treat myasthenia. What
symptom helps differentiate a myasthenic crisis from a cholinergic crisis?
Answer Choices
1 Respiratory failure
, 2 Bilateral ptosis
3 Muscle fasciculations
4 Diplopia
5 Normal muscle stretch reflexes
ANS: 3 - Correct Answer✔✔-Muscle Fasiculations
Signs of cholinergic overdosage include muscle fasciculation, rhinorrhea,
lacrimation, salivation, increased bronchial secretions, nausea, or diarrhea. The
presence of any of these suggests that the patient's weakness may be due to
cholinergic crisis. The other signs are due to weakness and can occur in either
condition.
4.A 54-year-old man presents after having a generalized seizure. The patient is
HIV positive, but he has been unable to afford antiretroviral therapy since
losing his job 2 years ago. Other than cachexia, the physical exam is
unremarkable. Upon further inquiry, the patient also notes that he has become
short-tempered and hypercritical; at times, he seems confused. An MRI of the
brain is performed, and it reveals several cortical ring-enhancing lesions.
Question
What is the most likely diagnosis?
Answer Choices
1 AIDS dementia complex
2 Cryptococcal meningitis
3 Cytomegalovirus encephalitis
4 Progressive multifocal leukoencephalopathy
5 Toxoplasma encephalitis
ANS:5 - Correct Answer✔✔-Toxoplasma encephalitis
The patient's symptoms and MRI findings are most consistent with the
diagnosis of toxoplasma encephalitis. Toxoplasmosis is the most common
cerebral mass lesion among HIV-positive patients. Infection with the
Toxoplasma gondii parasite is relatively common and usually asymptomatic.
Reactivation occurs in HIV positive patients due to failing cellular immunity,
and it causes a multifocal necrotizing encephalitis. Seizures may be the initial
manifestation of central nervous system (CNS) infection; other common clinical
manifestations include focal neurologic deficits, such as impaired speech and
hemiparesis. Personality change, lethargy, headache, and confusion are also
observed. The MRI in patients with toxoplasma encephalitis characteristically
reveals multiple, ring-enhancing lesions with surrounding edema; these lesions
usually occur bilaterally in the frontal and parietal cortices.
AIDS dementia complex describes a constellation of cognitive symptoms seen
among HIV positive patients. The condition occurs when HIV virus
disseminates to the CNS. Within the CNS, the virus tends to concentrate in the
Verified Answers | 2026 Prep
1.A 75-year-old man is involved in a motor vehicle accident and strikes his
forehead on the windshield. He complains of neck pain and severe burning in
his shoulders and arms. His physical examination reveals weakness of his upper
extremities. What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B - Correct Answer✔✔-Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more severe in
the upper extremities than in the lower extremities, and is more severe in the
hands. There is typically hyperesthesia over the shoulders and arms. Anterior
cord syndrome presents with paraplegia or quadriplegia, loss of lateral
spinothalamic function with preservation of posterior column function. Brown-
Séquard syndrome consists of weakness and loss of posterior column function
on one side of the body distal to the lesion with contralateral loss of lateral
spinothalamic function one to two levels below the lesion. Complete cord
transection would affect motor and sensory function distal to the lesion. Cauda
equina syndrome typically presents as low back pain with radiculopathy.
2.A 37-year-old man fell from a ladder as he finished hanging the Christmas
lights on his house. The right side of his head hit the alley cement, and he lost
consciousness for about 1 minute; he woke up with a headache, but he had no
other complaints. A few hours later, the patient is brought to the emergency
room by his neighbor because of an intense headache, confusion, and left hand
hemiparesis. On examination, the patient has a bruise located over the right
temporal region, mydriasis, and right deviation of the right eye, papilledema,
and left extensor plantar response. An emergency CT scan of the head without
contrast reveals a lens-shaped hyper-density under the right temporal bone with
mass effect and edema. What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
,5 Acute meningitis
ANS: 1 - Correct Answer✔✔-Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the middle
meningeal artery. Although a lucid interval ranging from minutes to hours
followed by altered mental status and focal deficits is typical for epidural
hematoma, this clinical picture is only encountered in up to 1/3 of the patients.
The collection of blood between the skull and dura mater causes an evident
mass effect with ophthalmic nerve palsy and the contralateral hemiparesis.
Surgical evacuation of the clot via burr holes is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging veins that
connect the cerebrum to the venous sinuses within the dura. This venous
hemorrhage will result in a gradual increase of the hematoma, with a
progressive clinical picture over days or weeks. The CT scan will show a
concave, crescent-shaped hyper-density compared to the convex, lens-shaped
hyper-density in epidural hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most
common is the congenital berry aneurysm. The clinical picture is of a sudden,
severe headache with meningeal irritation. A CT scan will show blood in the
subarachnoid space, and a lumbar puncture will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by hypertension
complicated with Charcot-Bouchard aneurysms. The blood accumulates into the
brain substance and most commonly involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal
irritation dominate the clinical picture. Lumbar puncture, indicated if there are
no focal neurological signs on clinical examination, will be the diagnostic
procedure. The CT scan of the patient presented in this case is characteristic for
epidural hematoma, and there is no indication for a lumbar punctu
3.A 31-year-old woman presents with a purpural rash covering her arms, legs,
and abdomen. She also has fever, chills, nausea, abdominal tenderness,
tachycardia, and generalized myalgias. Prior to the development of the rash, the
patient noted that she had a headache, cough, and sore throat. Laboratory
studies were positive for Gram-negative diplococci in the blood, along with
thrombocytopenia and an elevation in PMNs. Urinalysis showed blood, protein,
and casts. Vital signs are as follows: PB 92/66, P 96, RR 14, T 39. The patient
denies any foreign travel and does not have any sick contacts. However, she
does work part time as a nurse in a local hospital.
Question
,The patient is diagnosed with Meningococcemia; she is admitted to the hospital
and placed in respiratory isolation. What major course of therapy should this
patient receive?
Answer Choices
1 Steroids
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici - Correct Answer✔✔-Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The preferred
drug for active infection is penicillin G. For those allergic to penicillin,
chloramphenicol and cephalosporins (ie, cefotaxime, cefuroxime) may be used
as alternatives.
Patients will also receive supportive care, but antibiotic therapy must be
initiated quickly if the patient is to survive. Intensive care placement may be
necessary if organ failure is imminent. Ventilatory support, inotropic support,
and IV fluids are necessary in some. If adrenal insufficiency occurs,
corticosteroid replacement may be considered. A central venous line helps to
provide large amounts of volume expanders and inotropic medications for
adequate tissue perfusion.
Steroids have not been shown to play a major role in the treatment of
meningococcemia. However, they have been used in addition to antibiotic
therapy. In the case of adrenal insufficiency, for example, steroid replacement
has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the patient
suffers from a devastating coagulopathy, blood or blood products may be
replaced as necessary.
Bactericidal/permeability-increasing protein is a protein stored in the granules
of neutrophils. It binds to endotoxin in vitro and neutralizes it. This technique is
experimental, and it is not used in everyday treatment of meningococcemia.
4.In myasthenia gravis, weakness is a result of insufficient acetylcholine
transmission at the neuromuscular junction; however, weakness can also occur
with overdosing of the cholinergic medications used to treat myasthenia. What
symptom helps differentiate a myasthenic crisis from a cholinergic crisis?
Answer Choices
1 Respiratory failure
, 2 Bilateral ptosis
3 Muscle fasciculations
4 Diplopia
5 Normal muscle stretch reflexes
ANS: 3 - Correct Answer✔✔-Muscle Fasiculations
Signs of cholinergic overdosage include muscle fasciculation, rhinorrhea,
lacrimation, salivation, increased bronchial secretions, nausea, or diarrhea. The
presence of any of these suggests that the patient's weakness may be due to
cholinergic crisis. The other signs are due to weakness and can occur in either
condition.
4.A 54-year-old man presents after having a generalized seizure. The patient is
HIV positive, but he has been unable to afford antiretroviral therapy since
losing his job 2 years ago. Other than cachexia, the physical exam is
unremarkable. Upon further inquiry, the patient also notes that he has become
short-tempered and hypercritical; at times, he seems confused. An MRI of the
brain is performed, and it reveals several cortical ring-enhancing lesions.
Question
What is the most likely diagnosis?
Answer Choices
1 AIDS dementia complex
2 Cryptococcal meningitis
3 Cytomegalovirus encephalitis
4 Progressive multifocal leukoencephalopathy
5 Toxoplasma encephalitis
ANS:5 - Correct Answer✔✔-Toxoplasma encephalitis
The patient's symptoms and MRI findings are most consistent with the
diagnosis of toxoplasma encephalitis. Toxoplasmosis is the most common
cerebral mass lesion among HIV-positive patients. Infection with the
Toxoplasma gondii parasite is relatively common and usually asymptomatic.
Reactivation occurs in HIV positive patients due to failing cellular immunity,
and it causes a multifocal necrotizing encephalitis. Seizures may be the initial
manifestation of central nervous system (CNS) infection; other common clinical
manifestations include focal neurologic deficits, such as impaired speech and
hemiparesis. Personality change, lethargy, headache, and confusion are also
observed. The MRI in patients with toxoplasma encephalitis characteristically
reveals multiple, ring-enhancing lesions with surrounding edema; these lesions
usually occur bilaterally in the frontal and parietal cortices.
AIDS dementia complex describes a constellation of cognitive symptoms seen
among HIV positive patients. The condition occurs when HIV virus
disseminates to the CNS. Within the CNS, the virus tends to concentrate in the
