1
NR 547 CEA Exam 2 2026 – Pre-Clinical
Diagnostic Exam Questions with 100%
Correct Answers| Graded A – Chamberlain.
A 28-year-old man presents following a motor vehicle accident 20 minutes prior. He states
that it was just a "fender bender," but he feels he might have whiplash. His neck is stiff and
sore, and he has developed numbness and tingling on the medial surface of his right arm and
into his right fourth and fifth digits. On physical examination, his bicep strength is +5/5 on the
left and +5/5 on the right. His biceps tendon reflex is 2+ on the left and 2+ on the right. In
addition, his triceps tendon reflex is 2+ on the left and 2+ on the right. His grip strength on the
right is diminished as compared to the left. The remainder of the physical exam is normal.
Question
Based on the above presentation, what is the cervical nerve root most likely affected?
, 2
Answer Choices
1 C4
2 C5
3 C6
4 C7
5 C8
ANS:5 - Correct Answer :C8
The most likely nerve affected in this case is the C8 nerve root.
Impingement of C8 may cause numbness and tingling primarily on the medial surface of the
arm and into the lateral hand into the fourth and fifth digits. Impingement may also cause
dysfunction of the hand, as it innervates the small hand muscles.
Impingement of the C4 nerve root may cause neck and upper shoulder numbness and pain.
Impingement of C5 nerve root may cause deltoid and shoulder numbness and pain, and
biceps tendon reflex may be diminished.
Impingement of the C6 nerve root can cause numbness and tingling down the arm into the
thumb, with weakness in the bicep muscle and diminished brachioradialis tendon reflex in the
affected extremity.
Impingement of C7 also causes numbness and pain down the affected arm but into the
middle finger, and the triceps reflex may be diminished on exam.
, 3
A 32-year-old woman starts to notice that she is having difficulty brushing her hair. She also
notices that her eyes are extremely tired after reading the evening newspaper. One night, her
husband comments that she has droopy eyelids. She is relieved the next morning when her
eyelids appear normal. Her condition deteriorates, and she has weakness and fatigability to
the point that she finally sees her family doctor.
On history, she denies pain. Her physical exam demonstrates weakness in her limbs. Her deep
tendon reflexes are within normal limits. Her doctor wants to run a diagnostic test by injecting
a drug. What is the most likely diagnosis?
Answer Choices
1 Myasthenia gravis
2 Duchenne's dystrophy
3 Polymyositis
4 Familial periodic paralysis
5 Botulism
ANS:1 - Correct Answer :myasthenia gravis
This patient's symptoms indicate myasthenia gravis. Ocular muscle weakness and ptosis are
common. Muscular weakness and fatigue are consistent with this condition. Myasthenia
gravis occurs due to the presence of antibodies to the acetylcholine receptor. A diagnostic aid
is the Tensilon test. The Tensilon test entails the administration of a rapid acting
anticholinesterase, edrophonium. By administering an anticholinesterase, any acetylcholine
released will be present longer and will have a longer period of time to act at the
neuromuscular junction.
Duchenne's dystrophy would present at a very young age. It is X-linked.
, 4
Polymyositis can present with weakness. However, the weakness is proximal; it is usually of
the hips and thigh, but sometimes it is of the shoulder girdles. Polymyositis would spare the
ocular muscles.
Familial periodic paralysis can present with weakness. However, the weakness would be in the
extremities and the trunk. It would also spare the ocular muscles.
Botulism can present with weakness. In addition, the ocular muscles can be involved.
However, botulism would present with a progressive weakness, rather than an intermittent
weakness. There would also be a loss of deep tendon reflexes. Furthermore, there is nothing
in her history to suggest ingestion of botulism toxin.
A 32-year-old man presents with a 2-day history of high fever and progressive, severe,
headaches. It is associated with blurred vision and increasing confusion. The patient is
normally healthy, and he does not have a remarkable past medical history. He is married. He
does not drink alcohol, smoke, or use illicit drugs. He has not had any blood transfusions, and
he takes no medications.
On physical examination, he appears ill and disorientated to time, place, and person. His pulse
is 110/minute, temperature 39 degrees Celsius (102 degrees Fahrenheit), respirations
22/minute and blood pressure is 115/70 mmHg. He is well-hydrated. He has no scleral icterus or
oral candidal infection. Pupils are equal and reactive. There are no palpable adenopathy or
rashes. His cranial nerve examination is intact. His fundi are normal. He can move all of his
limbs. Deep tendon reflexes are normal; plantar reflexes are equivocal. His ne –
Correct Answer :HSV encephalitis
The patient has a fever, severe headache, altered mental status and has abnormal levels of
lymphocytes in the CSF. These findings, along with the results of the MRI scan, suggest
herpes simplex virus, encephalitis. HSV encephalitis occurs in 10% of all cases of encephalitis in
the United States. There is a high mortality rate and morbidity rate. The latter is normal in the
form of neurological damage. Herpes simplex type 1 is the most common cause and type 2
NR 547 CEA Exam 2 2026 – Pre-Clinical
Diagnostic Exam Questions with 100%
Correct Answers| Graded A – Chamberlain.
A 28-year-old man presents following a motor vehicle accident 20 minutes prior. He states
that it was just a "fender bender," but he feels he might have whiplash. His neck is stiff and
sore, and he has developed numbness and tingling on the medial surface of his right arm and
into his right fourth and fifth digits. On physical examination, his bicep strength is +5/5 on the
left and +5/5 on the right. His biceps tendon reflex is 2+ on the left and 2+ on the right. In
addition, his triceps tendon reflex is 2+ on the left and 2+ on the right. His grip strength on the
right is diminished as compared to the left. The remainder of the physical exam is normal.
Question
Based on the above presentation, what is the cervical nerve root most likely affected?
, 2
Answer Choices
1 C4
2 C5
3 C6
4 C7
5 C8
ANS:5 - Correct Answer :C8
The most likely nerve affected in this case is the C8 nerve root.
Impingement of C8 may cause numbness and tingling primarily on the medial surface of the
arm and into the lateral hand into the fourth and fifth digits. Impingement may also cause
dysfunction of the hand, as it innervates the small hand muscles.
Impingement of the C4 nerve root may cause neck and upper shoulder numbness and pain.
Impingement of C5 nerve root may cause deltoid and shoulder numbness and pain, and
biceps tendon reflex may be diminished.
Impingement of the C6 nerve root can cause numbness and tingling down the arm into the
thumb, with weakness in the bicep muscle and diminished brachioradialis tendon reflex in the
affected extremity.
Impingement of C7 also causes numbness and pain down the affected arm but into the
middle finger, and the triceps reflex may be diminished on exam.
, 3
A 32-year-old woman starts to notice that she is having difficulty brushing her hair. She also
notices that her eyes are extremely tired after reading the evening newspaper. One night, her
husband comments that she has droopy eyelids. She is relieved the next morning when her
eyelids appear normal. Her condition deteriorates, and she has weakness and fatigability to
the point that she finally sees her family doctor.
On history, she denies pain. Her physical exam demonstrates weakness in her limbs. Her deep
tendon reflexes are within normal limits. Her doctor wants to run a diagnostic test by injecting
a drug. What is the most likely diagnosis?
Answer Choices
1 Myasthenia gravis
2 Duchenne's dystrophy
3 Polymyositis
4 Familial periodic paralysis
5 Botulism
ANS:1 - Correct Answer :myasthenia gravis
This patient's symptoms indicate myasthenia gravis. Ocular muscle weakness and ptosis are
common. Muscular weakness and fatigue are consistent with this condition. Myasthenia
gravis occurs due to the presence of antibodies to the acetylcholine receptor. A diagnostic aid
is the Tensilon test. The Tensilon test entails the administration of a rapid acting
anticholinesterase, edrophonium. By administering an anticholinesterase, any acetylcholine
released will be present longer and will have a longer period of time to act at the
neuromuscular junction.
Duchenne's dystrophy would present at a very young age. It is X-linked.
, 4
Polymyositis can present with weakness. However, the weakness is proximal; it is usually of
the hips and thigh, but sometimes it is of the shoulder girdles. Polymyositis would spare the
ocular muscles.
Familial periodic paralysis can present with weakness. However, the weakness would be in the
extremities and the trunk. It would also spare the ocular muscles.
Botulism can present with weakness. In addition, the ocular muscles can be involved.
However, botulism would present with a progressive weakness, rather than an intermittent
weakness. There would also be a loss of deep tendon reflexes. Furthermore, there is nothing
in her history to suggest ingestion of botulism toxin.
A 32-year-old man presents with a 2-day history of high fever and progressive, severe,
headaches. It is associated with blurred vision and increasing confusion. The patient is
normally healthy, and he does not have a remarkable past medical history. He is married. He
does not drink alcohol, smoke, or use illicit drugs. He has not had any blood transfusions, and
he takes no medications.
On physical examination, he appears ill and disorientated to time, place, and person. His pulse
is 110/minute, temperature 39 degrees Celsius (102 degrees Fahrenheit), respirations
22/minute and blood pressure is 115/70 mmHg. He is well-hydrated. He has no scleral icterus or
oral candidal infection. Pupils are equal and reactive. There are no palpable adenopathy or
rashes. His cranial nerve examination is intact. His fundi are normal. He can move all of his
limbs. Deep tendon reflexes are normal; plantar reflexes are equivocal. His ne –
Correct Answer :HSV encephalitis
The patient has a fever, severe headache, altered mental status and has abnormal levels of
lymphocytes in the CSF. These findings, along with the results of the MRI scan, suggest
herpes simplex virus, encephalitis. HSV encephalitis occurs in 10% of all cases of encephalitis in
the United States. There is a high mortality rate and morbidity rate. The latter is normal in the
form of neurological damage. Herpes simplex type 1 is the most common cause and type 2
