Page 1 of 269
NR 603 WEEK 1 EXAM | {LATEST 2026/ 2027
UPDATE} COMPLETE ACTUAL AND AUTHENTIC
EXAM | BRAND NEW!
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
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
,Page 2 of 269
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.
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
,Page 3 of 269
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1
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.
, Page 4 of 269
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
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
NR 603 WEEK 1 EXAM | {LATEST 2026/ 2027
UPDATE} COMPLETE ACTUAL AND AUTHENTIC
EXAM | BRAND NEW!
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
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
,Page 2 of 269
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.
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
,Page 3 of 269
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1
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.
, Page 4 of 269
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
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
