NR 603 WEEK 1 | FROM QUESTION TO PERFECTION|
STUDY WITH CONFIDENCE!
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 - 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.
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
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1
,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 - 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.
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,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
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 - 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.
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, 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.
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
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4
STUDY WITH CONFIDENCE!
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 - 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.
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
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1
,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 - 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.
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,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
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 - 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.
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, 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.
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
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
