NSG 464- Final Exam Review
Questions With Correct Answers
A |28-year-old |book |editor |comes |to |your |clinic |complaining |of |strange |episodes. |He |states |
that |about |once |a |week |for |the |last |3 |months |his |left |hand |and |arm |will |stiffen |and |then |start |
jerking. |He |says |that |after |a |few |seconds |his |whole |left |arm |and |then |his |left |leg |will |also |start |
to |jerk. |He |denies |any |loss |of |consciousness |or |loss |of |bowel |or |bladder |control. |When |the |
symptoms |resolve, |his |arm |and |leg |feel |tired |but |otherwise |he |feels |fine. |His |past |medical |
history |is |significant |for |a |cyst |in |his |brain |that |was |removed |6 |months |ago. |He |is |married |and |
has |2 |children. |His |parents |are |both |healthy. |On |examination |you |see |a |scar |over |the |right |
side |of |his |head |but |otherwise |his |neurologic |examination |is |unremarkable. |What |type |of |
seizure |disorder |is |he |most |likely |to |have?
A. |Generalized |tonic-clonic |seizure
B. |Generalized |absence |seizure |
C. |Simple |partial |seizure |(Jacksonian)
D. |Complex |partial |seizure |- |CORRECT |ANSWER✔✔-C. |Simple |partial |seizure |(Jacksonian)
Rationale: |Simple |partial |seizures |start |with |a |unilateral |symptom, |involve |no |loss |of |
consciousness, |and |have |a |normal |postictal |state. |In |a |Jacksonian |seizure, |the |symptoms |start |
with |one |body |part |and |"march" |along |the |same |side |of |the |body.
A |37-year-old |insurance |agent |comes |to |your |office, |complaining |of |trembling |hands. |She |says |
that |for |the |past |3 |months |when |she |tries |to |use |her |hands |to |fix |her |hair |or |cook |they |shake |
badly. |She |says |she |doesn't |feel |particularly |nervous |when |this |occurs |but |she |is |worries |that |
other |people |will |think |she |has |anxiety |disorder |or |that |she |is |a |drinker. |She |admits |to |having |
some |recent |fatigue, |trouble |with |vision, |and |difficulty |maintaining |bladder |control. |Her |past |
medical |history |is |remarkable |for |hypothyroidism. |Her |mother |has |lupus |and |her |father |is |
healthy. |She |has |an |older |brother |with |T1DM. |She |is |married |and |has |3 |children. |She |denies |
tobacco, |alcohol, |or |drug |use. |On |examination, |when |she |tries |to |reach |for |a |pencil |to |fill |out |
the |health |form |she |has |obvious |tremors |in |her |dominant |hand. |What |type |of |tremor |is |she |
most |likely |to |have?
,A. |Resting |tremor
B. |Postural |tremor |
C. |Intention |tremor |- |CORRECT |ANSWER✔✔-C. |Intention |tremor |
Rationale: |Intention |tremors |are |absent |at |rest |or |in |a |postural |position |and |occur |only |with |
intentional |movement |of |the |hands. |This |is |seen |in |cerebellar |disease |(stroke |or |alcohol |use) |
or |in |multiple |sclerosis. |This |patient's |tremor, |fatigue, |bladder |problems, |and |visual |problems |
are |suggestive |of |multiple |sclerosis
A |77-year-old |retired |school |superintendent |comes |to |your |office |complaining |of |unsteady |
hands. |He |says |that |for |the |past |6 |months, |when |his |hands |are |resting |in |his |lap |they |shake |
uncontrollably. |He |says |when |he |holds |them |out |in |front |of |his |body |the |shaking |diminishes, |
and |when |he |uses |his |hands |the |shaking |is |also |better. |He |also |complains |of |some |difficulty |
getting |up |out |of |his |chair |and |walking |around. |He |denies |any |recent |illness |or |injuries. |His |
past |medical |history |is |significant |for |HTN |and |CAD, |requiring |a |stent |in |the |past. |He |has |been |
married |for |over |50 |years |and |has |5 |children |and |12 |grandchildren. |He |denies |any |tobacco, |
alcohol, |or |drug |use. |His |mother |died |of |a |stroke |in |her |70s |and |her |father |died |of |a |heart |
attack |in |his |60s. |He |has |a |younger |sister |who |has |arthritis |problems. |His |children |are |all |
essentially |healthy. |On |examination |you |see |a |fine, |pill-rolling |tremor |of |his |left |hand. |His |right
|s |- |CORRECT |ANSWER✔✔-A. |Resting |tremor
Rationale: |Resting |tremors |occur |when |the |hands |are |literally |at |rest, |such |as |sitting |in |the |lap.
|These |are |slow, |fine |tremors |such |as |the |pill-rolling |in |Parkinson's |disease, |which |this |patient |
most |likely |has. |Decreased |arm |swing |with |emulation |is |one |of |the |earliest |objective |findings |
of |Parkinson's |disease
A |48-year-old |grocery |store |manager |comes |to |your |clinic |complaining |of |her |head |being
|"stuck" |to |one |side. |She |says |that |today |she |was |doing |her |normal |routine |when |it |suddenly |
felt |like |her |head |was |being |moved |to |her |left |and |then |it |just |stuck |that |way. |She |says |it |is |
somewhat |painful |because |she |cannot |get |it |moved |back |to |normal. |She |denies |any |recent |
neck |trauma. |Her |past |medical |history |consists |of |T2DM |and |gastroparesis |(slow-moving |
peristalsis |in |the |digestive |tract, |seen |in |diabetes). |She |is |on |oral |medications |for |each. |She |is |
married |and |has |3 |children. |She |denies |alcohol, |tobacco, |and |drug |use. |Her |father |has |DM |and
,her |mother |passed |away |from |breast |cancer. |Her |children |are |healthy. |On |examination |you |
|
see |a |slightly |overweight |Hispanic |woman |appearing |her |stated |age. |Her |head |is |twisted |
grotesquely |to |her |left |but |otherwise |her |examination |is |normal. |What |form |of |involuntary |
movement |does |she |have?
A. |- |CORRECT |ANSWER✔✔-D. |Dystonia |
Rationale: |Dystonia |involves |large |movements |of |the |body, |such |as |with |the |head |or |trunk, |
leading |to |grotesque |twisted |postures. |Some |medications |(such |as |one |commonly |used |for |
gastroparesis) |often |cause |dystonia
A |41-year-old |real |estate |agent |comes |to |your |office |complaining |that |he |feels |like |his |face |is |
paralyzed |on |the |left. |He |states |that |last |week |he |felt |his |left |eyelid |was |drowsy |and |as |the |
day |progressed |he |was |unable |to |close |his |eyelid |all |the |way. |Later |he |felt |like |his |smile |
became |affected |also. |He |denies |and |recent |injuries |but |had |an |upper |respiratory |viral |
infection |last |month. |His |past |medical |history |is |unremarkable. |He |is |divorced |and |has |1 |child. |
He |smokes |1 |pack |of |cigarettes |per |day, |occasionally |drinks |alcohol, |and |denies |any |illegal |
drug |use. |His |mother |has |HTN |and |his |father |has |sarcoidosis. |On |examination |you |ask |him |to |
close |his |eyes. |He |is |unable |to |close |his |left |eye. |You |ask |him |to |open |his |eyes |and |raise |his |
eyebrows. |His |right |forehead |furrows |but |his |left |remains |flat. |You |then |ask |him |to |give |you |a |
big |smile. |The |right |corner |of |his |mouth |raises |but |the |left |side |of |his |mouth |remains |the |sa |- |
CORRECT |ANSWER✔✔-A. |Peripheral |CN |VII |paralysis |
Rationale: |In |a |peripheral |lesion |the |entire |side |of |the |face |will |be |involved. |This |causes |the |
inability |to |close |the |eye, |raise |the |eyebrow, |wrinkle |the |forehead, |and |smile |on |the |affected |
side. |Bell's |palsy |is |an |example |of |this |type |of |paralysis |and |is |probably |what |is |affecting |this |
patient.
A |60-year-old |retired |seamstress |comes |to |your |office |complaining |of |decreased |sensation |in |
her |hands |and |feet. |She |states |that |she |began |to |have |the |problems |in |her |feet |a |year |ago |but
|now |it |has |started |in |her |hands |also. |She |also |complains |of |some |weakness |in |her |grip. |She |
has |had |no |recent |illness |or |injuries. |Her |past |medical |history |consists |of |having |T2DM |for |20 |
years. |She |now |takes |insulin |and |oral |medications |for |her |diabetes. |She |has |been |married |for |
for |40 |years. |She |has |2 |healthy |children. |Her |mother |has |Alzheimer's |disease |and |CAD. |Her |
father |died |of |a |stroke |and |also |had |diabetes. |She |denies |any |tobacco, |alcohol, |or |drug |use. |
, On |examination |she |has |decreased |deep |tendon |reflexes |in |the |patellar |and |Achilles |tendons. |
She |has |decreased |sensation |of |fine |touch, |pressure, |and |vibration |of |both |feet. |She |has |
decreased |two-point |discrimination |on |her |hands. |Her |grip |strength |is |decreased |and |her |
plantar |and |d |- |CORRECT |ANSWER✔✔-C. |Peripheral |polyneuropathy |
Rationale: |With |peripheral |neuropathy |there |will |be |distal |extremity |symptoms |before |
proximal |symptoms. |There |will |be |weakness |and |atrophy |and |decreased |sensory |sensations. |
There |is |often |the |classic |glove-stocking |distribution |pattern |of |the |lower |legs |and |hands. |
Causes |include: |diabetic |neuropathy, |as |in |this |case, |alcoholism, |and |vitamin |deficiencies
A |21-year-old |engineering |student |comes |to |your |office |complaining |of |leg |and |back |pain |and |
of |tripping |when |he |walks. |He |states |this |started |3 |months |ago |with |back |and |buttock |pain |
but |has |since |progressed |to |feeling |weak |in |his |left |leg. |He |denies |any |bowel |or |bladder |
symptoms. |He |can |think |of |no |specific |traumatic |incidences |but |he |was |a |defensive |lineman |in
|high-school |and |junior |college. |He |past |medical |history |is |unremarkable. |He |denies |tobacco |
use |or |alcohol |use |or |drug |abuse. |His |parents |are |both |healthy. |On |examination |he |is |tender |
over |the |lumbar |spine |and |has |a |positive |straight-leg |raise |on |the |left. |His |Achilles |tendon |
deep |reflex |is |decreased |on |the |left. |While |watching |his |gait |you |notice |he |has |to |pick |his |left |
foot |up |high |in |order |not |to |trip. |What |abnormality |of |gait |does |he |most |likely |have?
A. |Sensory |ataxia
B. |Parkinsonian |gait |
C. |Steppage |gait |
D. |Spastic |hemiparesis |- |CORRECT |ANSWER✔✔-C. |Steppage |gait |
Rationale: |This |gait |is |associated |with |foot |drop, |usually |secondary |to |a |lower |motor |neuron |
disease. |This |is |often |seen |with |a |herniated |disc, |such |as |in |this |patient
A |17-year-old |high |school |student |is |brought |to |your |ER |in |a |comatose |state. |His |friends |have |
accompanied |him |and |tell |you |that |they |have |been |shooting |up |heroin |tonight |and |they |think |
their |friend |might |have |had |too |much. |The |patient |is |unconscious |and |cannot |protect |his |
airway, |so |he |is |intubated. |His |HR |is |60 |and |he |is |breathing |through |the |ventilator. |He |is |not |
posturing |and |he |does |not |respond |to |sternal |rub. |Preparing |to |finish |the |neurologic |
Questions With Correct Answers
A |28-year-old |book |editor |comes |to |your |clinic |complaining |of |strange |episodes. |He |states |
that |about |once |a |week |for |the |last |3 |months |his |left |hand |and |arm |will |stiffen |and |then |start |
jerking. |He |says |that |after |a |few |seconds |his |whole |left |arm |and |then |his |left |leg |will |also |start |
to |jerk. |He |denies |any |loss |of |consciousness |or |loss |of |bowel |or |bladder |control. |When |the |
symptoms |resolve, |his |arm |and |leg |feel |tired |but |otherwise |he |feels |fine. |His |past |medical |
history |is |significant |for |a |cyst |in |his |brain |that |was |removed |6 |months |ago. |He |is |married |and |
has |2 |children. |His |parents |are |both |healthy. |On |examination |you |see |a |scar |over |the |right |
side |of |his |head |but |otherwise |his |neurologic |examination |is |unremarkable. |What |type |of |
seizure |disorder |is |he |most |likely |to |have?
A. |Generalized |tonic-clonic |seizure
B. |Generalized |absence |seizure |
C. |Simple |partial |seizure |(Jacksonian)
D. |Complex |partial |seizure |- |CORRECT |ANSWER✔✔-C. |Simple |partial |seizure |(Jacksonian)
Rationale: |Simple |partial |seizures |start |with |a |unilateral |symptom, |involve |no |loss |of |
consciousness, |and |have |a |normal |postictal |state. |In |a |Jacksonian |seizure, |the |symptoms |start |
with |one |body |part |and |"march" |along |the |same |side |of |the |body.
A |37-year-old |insurance |agent |comes |to |your |office, |complaining |of |trembling |hands. |She |says |
that |for |the |past |3 |months |when |she |tries |to |use |her |hands |to |fix |her |hair |or |cook |they |shake |
badly. |She |says |she |doesn't |feel |particularly |nervous |when |this |occurs |but |she |is |worries |that |
other |people |will |think |she |has |anxiety |disorder |or |that |she |is |a |drinker. |She |admits |to |having |
some |recent |fatigue, |trouble |with |vision, |and |difficulty |maintaining |bladder |control. |Her |past |
medical |history |is |remarkable |for |hypothyroidism. |Her |mother |has |lupus |and |her |father |is |
healthy. |She |has |an |older |brother |with |T1DM. |She |is |married |and |has |3 |children. |She |denies |
tobacco, |alcohol, |or |drug |use. |On |examination, |when |she |tries |to |reach |for |a |pencil |to |fill |out |
the |health |form |she |has |obvious |tremors |in |her |dominant |hand. |What |type |of |tremor |is |she |
most |likely |to |have?
,A. |Resting |tremor
B. |Postural |tremor |
C. |Intention |tremor |- |CORRECT |ANSWER✔✔-C. |Intention |tremor |
Rationale: |Intention |tremors |are |absent |at |rest |or |in |a |postural |position |and |occur |only |with |
intentional |movement |of |the |hands. |This |is |seen |in |cerebellar |disease |(stroke |or |alcohol |use) |
or |in |multiple |sclerosis. |This |patient's |tremor, |fatigue, |bladder |problems, |and |visual |problems |
are |suggestive |of |multiple |sclerosis
A |77-year-old |retired |school |superintendent |comes |to |your |office |complaining |of |unsteady |
hands. |He |says |that |for |the |past |6 |months, |when |his |hands |are |resting |in |his |lap |they |shake |
uncontrollably. |He |says |when |he |holds |them |out |in |front |of |his |body |the |shaking |diminishes, |
and |when |he |uses |his |hands |the |shaking |is |also |better. |He |also |complains |of |some |difficulty |
getting |up |out |of |his |chair |and |walking |around. |He |denies |any |recent |illness |or |injuries. |His |
past |medical |history |is |significant |for |HTN |and |CAD, |requiring |a |stent |in |the |past. |He |has |been |
married |for |over |50 |years |and |has |5 |children |and |12 |grandchildren. |He |denies |any |tobacco, |
alcohol, |or |drug |use. |His |mother |died |of |a |stroke |in |her |70s |and |her |father |died |of |a |heart |
attack |in |his |60s. |He |has |a |younger |sister |who |has |arthritis |problems. |His |children |are |all |
essentially |healthy. |On |examination |you |see |a |fine, |pill-rolling |tremor |of |his |left |hand. |His |right
|s |- |CORRECT |ANSWER✔✔-A. |Resting |tremor
Rationale: |Resting |tremors |occur |when |the |hands |are |literally |at |rest, |such |as |sitting |in |the |lap.
|These |are |slow, |fine |tremors |such |as |the |pill-rolling |in |Parkinson's |disease, |which |this |patient |
most |likely |has. |Decreased |arm |swing |with |emulation |is |one |of |the |earliest |objective |findings |
of |Parkinson's |disease
A |48-year-old |grocery |store |manager |comes |to |your |clinic |complaining |of |her |head |being
|"stuck" |to |one |side. |She |says |that |today |she |was |doing |her |normal |routine |when |it |suddenly |
felt |like |her |head |was |being |moved |to |her |left |and |then |it |just |stuck |that |way. |She |says |it |is |
somewhat |painful |because |she |cannot |get |it |moved |back |to |normal. |She |denies |any |recent |
neck |trauma. |Her |past |medical |history |consists |of |T2DM |and |gastroparesis |(slow-moving |
peristalsis |in |the |digestive |tract, |seen |in |diabetes). |She |is |on |oral |medications |for |each. |She |is |
married |and |has |3 |children. |She |denies |alcohol, |tobacco, |and |drug |use. |Her |father |has |DM |and
,her |mother |passed |away |from |breast |cancer. |Her |children |are |healthy. |On |examination |you |
|
see |a |slightly |overweight |Hispanic |woman |appearing |her |stated |age. |Her |head |is |twisted |
grotesquely |to |her |left |but |otherwise |her |examination |is |normal. |What |form |of |involuntary |
movement |does |she |have?
A. |- |CORRECT |ANSWER✔✔-D. |Dystonia |
Rationale: |Dystonia |involves |large |movements |of |the |body, |such |as |with |the |head |or |trunk, |
leading |to |grotesque |twisted |postures. |Some |medications |(such |as |one |commonly |used |for |
gastroparesis) |often |cause |dystonia
A |41-year-old |real |estate |agent |comes |to |your |office |complaining |that |he |feels |like |his |face |is |
paralyzed |on |the |left. |He |states |that |last |week |he |felt |his |left |eyelid |was |drowsy |and |as |the |
day |progressed |he |was |unable |to |close |his |eyelid |all |the |way. |Later |he |felt |like |his |smile |
became |affected |also. |He |denies |and |recent |injuries |but |had |an |upper |respiratory |viral |
infection |last |month. |His |past |medical |history |is |unremarkable. |He |is |divorced |and |has |1 |child. |
He |smokes |1 |pack |of |cigarettes |per |day, |occasionally |drinks |alcohol, |and |denies |any |illegal |
drug |use. |His |mother |has |HTN |and |his |father |has |sarcoidosis. |On |examination |you |ask |him |to |
close |his |eyes. |He |is |unable |to |close |his |left |eye. |You |ask |him |to |open |his |eyes |and |raise |his |
eyebrows. |His |right |forehead |furrows |but |his |left |remains |flat. |You |then |ask |him |to |give |you |a |
big |smile. |The |right |corner |of |his |mouth |raises |but |the |left |side |of |his |mouth |remains |the |sa |- |
CORRECT |ANSWER✔✔-A. |Peripheral |CN |VII |paralysis |
Rationale: |In |a |peripheral |lesion |the |entire |side |of |the |face |will |be |involved. |This |causes |the |
inability |to |close |the |eye, |raise |the |eyebrow, |wrinkle |the |forehead, |and |smile |on |the |affected |
side. |Bell's |palsy |is |an |example |of |this |type |of |paralysis |and |is |probably |what |is |affecting |this |
patient.
A |60-year-old |retired |seamstress |comes |to |your |office |complaining |of |decreased |sensation |in |
her |hands |and |feet. |She |states |that |she |began |to |have |the |problems |in |her |feet |a |year |ago |but
|now |it |has |started |in |her |hands |also. |She |also |complains |of |some |weakness |in |her |grip. |She |
has |had |no |recent |illness |or |injuries. |Her |past |medical |history |consists |of |having |T2DM |for |20 |
years. |She |now |takes |insulin |and |oral |medications |for |her |diabetes. |She |has |been |married |for |
for |40 |years. |She |has |2 |healthy |children. |Her |mother |has |Alzheimer's |disease |and |CAD. |Her |
father |died |of |a |stroke |and |also |had |diabetes. |She |denies |any |tobacco, |alcohol, |or |drug |use. |
, On |examination |she |has |decreased |deep |tendon |reflexes |in |the |patellar |and |Achilles |tendons. |
She |has |decreased |sensation |of |fine |touch, |pressure, |and |vibration |of |both |feet. |She |has |
decreased |two-point |discrimination |on |her |hands. |Her |grip |strength |is |decreased |and |her |
plantar |and |d |- |CORRECT |ANSWER✔✔-C. |Peripheral |polyneuropathy |
Rationale: |With |peripheral |neuropathy |there |will |be |distal |extremity |symptoms |before |
proximal |symptoms. |There |will |be |weakness |and |atrophy |and |decreased |sensory |sensations. |
There |is |often |the |classic |glove-stocking |distribution |pattern |of |the |lower |legs |and |hands. |
Causes |include: |diabetic |neuropathy, |as |in |this |case, |alcoholism, |and |vitamin |deficiencies
A |21-year-old |engineering |student |comes |to |your |office |complaining |of |leg |and |back |pain |and |
of |tripping |when |he |walks. |He |states |this |started |3 |months |ago |with |back |and |buttock |pain |
but |has |since |progressed |to |feeling |weak |in |his |left |leg. |He |denies |any |bowel |or |bladder |
symptoms. |He |can |think |of |no |specific |traumatic |incidences |but |he |was |a |defensive |lineman |in
|high-school |and |junior |college. |He |past |medical |history |is |unremarkable. |He |denies |tobacco |
use |or |alcohol |use |or |drug |abuse. |His |parents |are |both |healthy. |On |examination |he |is |tender |
over |the |lumbar |spine |and |has |a |positive |straight-leg |raise |on |the |left. |His |Achilles |tendon |
deep |reflex |is |decreased |on |the |left. |While |watching |his |gait |you |notice |he |has |to |pick |his |left |
foot |up |high |in |order |not |to |trip. |What |abnormality |of |gait |does |he |most |likely |have?
A. |Sensory |ataxia
B. |Parkinsonian |gait |
C. |Steppage |gait |
D. |Spastic |hemiparesis |- |CORRECT |ANSWER✔✔-C. |Steppage |gait |
Rationale: |This |gait |is |associated |with |foot |drop, |usually |secondary |to |a |lower |motor |neuron |
disease. |This |is |often |seen |with |a |herniated |disc, |such |as |in |this |patient
A |17-year-old |high |school |student |is |brought |to |your |ER |in |a |comatose |state. |His |friends |have |
accompanied |him |and |tell |you |that |they |have |been |shooting |up |heroin |tonight |and |they |think |
their |friend |might |have |had |too |much. |The |patient |is |unconscious |and |cannot |protect |his |
airway, |so |he |is |intubated. |His |HR |is |60 |and |he |is |breathing |through |the |ventilator. |He |is |not |
posturing |and |he |does |not |respond |to |sternal |rub. |Preparing |to |finish |the |neurologic |
