NR 603 Week 2 Quiz – Full Questions,
Answers and Rationales | 2026
Update | Graded A+
1. A 72-year-old male reports a new, severe headache that
began yesterday. He has a history of polymyalgia rheumatica.
On exam, his temporal arteries are tender and pulseless. What
is the most appropriate next step?
A. Order an MRI of the brain
B. Prescribe oral sumatriptan
C. Start high-dose corticosteroids immediately
D. Schedule a temporal artery biopsy in 2 weeks
Answer: C
Rationale: This presentation is classic for giant cell (temporal)
arteritis. Immediate high-dose corticosteroids (e.g., prednisone
40–60 mg/day) are indicated to prevent vision loss. Biopsy can be
done within a few days, but treatment should not be delayed.
2. A 28-year-old woman presents with episodic throbbing
headaches, nausea, photophobia, and an aura of flashing
lights. Each headache lasts 6–8 hours. What is the first-line
acute treatment?
A. Propranolol daily
, B. Sumatriptan orally or intranasally
C. Naproxen 500 mg BID
D. Topiramate 25 mg daily
Answer: B
Rationale: This is migraine with aura. Triptans (e.g., sumatriptan)
are first-line for acute moderate-to-severe migraine. Propranolol
and topiramate are preventive (prophylactic) medications, not
acute.
3. A 45-year-old male has a 2-day history of severe, constant
headache, neck stiffness, and fever. On exam, Kernig’s sign is
positive. What is the priority diagnostic test?
A. Non-contrast head CT
B. Lumbar puncture
C. EEG
D. Cranial MRI with contrast
Answer: B
Rationale: The triad of headache, fever, and nuchal rigidity
suggests meningitis. Lumbar puncture with CSF analysis is
essential for diagnosis. A head CT may be done first if there is
concern for elevated ICP, but LP is the definitive test.
4. A 62-year-old woman complains of dizziness described as
“the room spinning.” It started suddenly 2 hours ago,
,associated with nausea and vomiting. She has no hearing loss
or tinnitus. What is the most likely diagnosis?
A. Benign paroxysmal positional vertigo (BPPV)
B. Vestibular neuritis
C. Ménière’s disease
D. Orthostatic hypotension
Answer: B
Rationale: Acute, continuous, severe rotational vertigo without
auditory symptoms points to vestibular neuritis (often post-
viral). BPPV is brief, triggered by head movement. Ménière’s
includes hearing loss/tinnitus. Orthostatic hypotension causes
lightheadedness, not true vertigo.
5. During a Dix-Hallpike maneuver, a patient develops vertigo
and nystagmus after a 5-second delay, and the nystagmus
fatigues with repetition. Which condition does this confirm?
A. Central vertigo
B. Vestibular neuritis
C. Benign paroxysmal positional vertigo (BPPV)
D. Labyrinthitis
Answer: C
Rationale: A positive Dix-Hallpike with latency, fatigability, and
torsional nystagmus is diagnostic of posterior canal BPPV.
Central vertigo often has no latency, no fatigue, and direction-
changing nystagmus.
, 6. A patient with sudden onset of vertigo, nausea, and
imbalance also has new dysarthria and left arm drift. What is
the most appropriate next step?
A. Epley maneuver
B. Meclizine 25 mg PO
C. Stat non-contrast head CT
D. MRI brain with diffusion
Answer: C
Rationale: Vertigo plus focal neurologic signs (dysarthria, arm
drift) suggests posterior circulation stroke. Immediate non-
contrast head CT is done to rule out hemorrhage; then MRI is
often obtained. The Epley maneuver is for BPPV, not acute stroke.
7. A 55-year-old diabetic presents with acute painful vision
loss in the right eye. Fundoscopy shows a pale, swollen optic
disc with blurred margins. What is the most likely diagnosis?
A. Optic neuritis
B. Anterior ischemic optic neuropathy (AION)
C. Papilledema from increased ICP
D. Central retinal artery occlusion
Answer: B
Rationale: Non-arteritic anterior ischemic optic neuropathy
(NAION) is common in patients with diabetes/hypertension. It
Answers and Rationales | 2026
Update | Graded A+
1. A 72-year-old male reports a new, severe headache that
began yesterday. He has a history of polymyalgia rheumatica.
On exam, his temporal arteries are tender and pulseless. What
is the most appropriate next step?
A. Order an MRI of the brain
B. Prescribe oral sumatriptan
C. Start high-dose corticosteroids immediately
D. Schedule a temporal artery biopsy in 2 weeks
Answer: C
Rationale: This presentation is classic for giant cell (temporal)
arteritis. Immediate high-dose corticosteroids (e.g., prednisone
40–60 mg/day) are indicated to prevent vision loss. Biopsy can be
done within a few days, but treatment should not be delayed.
2. A 28-year-old woman presents with episodic throbbing
headaches, nausea, photophobia, and an aura of flashing
lights. Each headache lasts 6–8 hours. What is the first-line
acute treatment?
A. Propranolol daily
, B. Sumatriptan orally or intranasally
C. Naproxen 500 mg BID
D. Topiramate 25 mg daily
Answer: B
Rationale: This is migraine with aura. Triptans (e.g., sumatriptan)
are first-line for acute moderate-to-severe migraine. Propranolol
and topiramate are preventive (prophylactic) medications, not
acute.
3. A 45-year-old male has a 2-day history of severe, constant
headache, neck stiffness, and fever. On exam, Kernig’s sign is
positive. What is the priority diagnostic test?
A. Non-contrast head CT
B. Lumbar puncture
C. EEG
D. Cranial MRI with contrast
Answer: B
Rationale: The triad of headache, fever, and nuchal rigidity
suggests meningitis. Lumbar puncture with CSF analysis is
essential for diagnosis. A head CT may be done first if there is
concern for elevated ICP, but LP is the definitive test.
4. A 62-year-old woman complains of dizziness described as
“the room spinning.” It started suddenly 2 hours ago,
,associated with nausea and vomiting. She has no hearing loss
or tinnitus. What is the most likely diagnosis?
A. Benign paroxysmal positional vertigo (BPPV)
B. Vestibular neuritis
C. Ménière’s disease
D. Orthostatic hypotension
Answer: B
Rationale: Acute, continuous, severe rotational vertigo without
auditory symptoms points to vestibular neuritis (often post-
viral). BPPV is brief, triggered by head movement. Ménière’s
includes hearing loss/tinnitus. Orthostatic hypotension causes
lightheadedness, not true vertigo.
5. During a Dix-Hallpike maneuver, a patient develops vertigo
and nystagmus after a 5-second delay, and the nystagmus
fatigues with repetition. Which condition does this confirm?
A. Central vertigo
B. Vestibular neuritis
C. Benign paroxysmal positional vertigo (BPPV)
D. Labyrinthitis
Answer: C
Rationale: A positive Dix-Hallpike with latency, fatigability, and
torsional nystagmus is diagnostic of posterior canal BPPV.
Central vertigo often has no latency, no fatigue, and direction-
changing nystagmus.
, 6. A patient with sudden onset of vertigo, nausea, and
imbalance also has new dysarthria and left arm drift. What is
the most appropriate next step?
A. Epley maneuver
B. Meclizine 25 mg PO
C. Stat non-contrast head CT
D. MRI brain with diffusion
Answer: C
Rationale: Vertigo plus focal neurologic signs (dysarthria, arm
drift) suggests posterior circulation stroke. Immediate non-
contrast head CT is done to rule out hemorrhage; then MRI is
often obtained. The Epley maneuver is for BPPV, not acute stroke.
7. A 55-year-old diabetic presents with acute painful vision
loss in the right eye. Fundoscopy shows a pale, swollen optic
disc with blurred margins. What is the most likely diagnosis?
A. Optic neuritis
B. Anterior ischemic optic neuropathy (AION)
C. Papilledema from increased ICP
D. Central retinal artery occlusion
Answer: B
Rationale: Non-arteritic anterior ischemic optic neuropathy
(NAION) is common in patients with diabetes/hypertension. It
