NR511 Week 8 Final Exam
1. A 45-year-old patient presents with a "curtain coming down" over their vision in the right
eye, lasting 5 minutes, followed by a severe unilateral headache. Which type of headache is
this?
A. Tension headache
B. Cluster headache
C. Migraine with aura
D. Sinus headache
Correct Answer: C
Rationale: A visual disturbance (scotoma, fortification spectrum) preceding a headache is a
classic aura, indicative of a migraine with aura. Tension headaches are bilateral and lack aura.
Cluster headaches present with severe orbital pain and autonomic symptoms (tearing,
rhinorrhea) without visual auras.
2. A patient presents with a fixed, dilated pupil and ptosis on the left side. This clinical
presentation is most consistent with:
A. Horner's syndrome
B. CN III (Oculomotor) palsy
C. CN IV (Trochlear) palsy
D. CN VI (Abducens) palsy
Correct Answer: B
Rationale: CN III palsy typically presents with a "down and out" eye, ptosis, and a dilated,
non-reactive pupil (due to parasympathetic fibers on the outside of the nerve). Horner's
syndrome presents with ptosis, miosis (constricted pupil), and anhidrosis.
3. Which of the following are risk factors for the development of open-angle glaucoma?
(Select All That Apply)
A. African American descent
B. Advanced age
C. History of migraines
D. Myopia
Correct Answers: A, B, C
Rationale: Risk factors for open-angle glaucoma include age >40, African American ancestry,
family history, diabetes, myopia, and migraines. Myopia is a risk factor, but the most common
triad tested is age, race, and family history.
,4. A 65-year-old patient reports a sudden onset of severe, deep, boring pain in the right eye
radiating to the temple. The eye is red, and the pupil is mid-dilated and fixed. What is the
priority diagnosis?
A. Acute angle-closure glaucoma
B. Conjunctivitis
C. Scleritis
D. Corneal abrasion
Correct Answer: A
Rationale: Acute angle-closure glaucoma presents with severe unilateral eye pain,
headache, nausea/vomiting, a mid-dilated fixed pupil, and a red eye. It is an ophthalmologic
emergency.
5. The "Snellen chart" is used to assess:
A. Color vision
B. Visual acuity
C. Visual fields
D. Extraocular movements
Correct Answer: B
Rationale: The Snellen chart measures central visual acuity (distance vision).
6. A patient presents with a "cherry red" spot in the macula and sudden painless loss of
vision. What is the likely diagnosis?
A. Macular degeneration
B. Central retinal artery occlusion (CRAO)
C. Retinal detachment
D. Vitreous hemorrhage
Correct Answer: B
Rationale: CRAO presents with sudden, painless, unilateral vision loss. Fundoscopy reveals a
pale retina with a "cherry-red spot" at the macula.
7. Which cranial nerve is assessed by asking the patient to shrug their shoulders against
resistance?
A. CN IX (Glossopharyngeal)
B. CN X (Vagus)
C. CN XI (Spinal Accessory)
D. CN XII (Hypoglossal)
Correct Answer: C
Rationale: CN XI innervates the sternocleidomastoid and trapezius muscles. Shrugging
shoulders tests the trapezius.
,8. A patient has a positive "Romberg test." This indicates:
A. Cerebellar dysfunction
B. Proprioceptive dysfunction or vestibular loss
C. Corticospinal tract lesion
D. Peripheral neuropathy
Correct Answer: B
Rationale: A positive Romberg (increased sway/fall with eyes closed) indicates a loss of
proprioception or vestibular function. If the patient falls with eyes open, it suggests cerebellar
ataxia.
9. Which of the following are signs of Parkinson's disease? (Select All That Apply)
A. Cogwheel rigidity
B. Resting tremor
C. Bradykinesia
D. Hyperreflexia
Correct Answers: A, B, C
Rationale: The cardinal signs of Parkinson's are tremor (resting), rigidity (cogwheel),
bradykinesia/akinesia, and postural instability. Hyperreflexia is more indicative of an upper
motor neuron lesion (e.g., stroke, MS).
10. A patient presents with a "mask-like" facies, shuffling gait, and a pill-rolling tremor. This is
characteristic of:
A. Parkinson's disease
B. Multiple sclerosis
C. Myasthenia gravis
D. Huntington's disease
Correct Answer: A
Rationale: These are classic motor symptoms of Parkinson's disease.
11. A patient has a blood pressure of 160/94 mmHg. According to the ACC/AHA guidelines,
this is classified as:
A. Elevated
B. Stage 1 Hypertension
C. Stage 2 Hypertension
D. Hypertensive Crisis
Correct Answer: C
Rationale: Stage 2 hypertension is defined as a systolic BP ≥140 mmHg or a diastolic BP ≥90
mmHg. (Note: The 2017 ACC/AHA guidelines define Stage 2 as ≥140/90, whereas the old JNC7
, defined it as ≥160/100. Current NP programs typically follow ACC/AHA: Normal <120/80,
Elevated 120-129/<80, Stage 1 130-139 or 80-89, Stage 2 ≥140 or ≥90).
12. The "PMI" (Point of Maximal Impulse) is normally located at:
A. The 2nd intercostal space, left sternal border
B. The 5th intercostal space, midclavicular line
C. The 4th intercostal space, left sternal border
D. The apex of the heart
Correct Answer: B
Rationale: The PMI (apex) is located at the 5th intercostal space at the midclavicular line in
most adults.
13. A patient has a loud, harsh, systolic murmur heard best at the right 2nd intercostal space.
This is most likely:
A. Aortic stenosis
B. Mitral regurgitation
C. Pulmonic stenosis
D. Tricuspid regurgitation
Correct Answer: A
Rationale: Aortic stenosis is a systolic ejection murmur heard best at the right 2nd
intercostal space (aortic area) and radiates to the carotids.
14. Which of the following are symptoms of left-sided heart failure? (Select All That Apply)
A. Dyspnea
B. Orthopnea
C. Peripheral edema
D. Paroxysmal nocturnal dyspnea
Correct Answers: A, B, D
Rationale: Left-sided heart failure causes pulmonary congestion (dyspnea, orthopnea, PND).
Right-sided heart failure causes systemic congestion (peripheral edema, JVD, hepatomegaly).
15. A patient presents with a "water-hammer" pulse and a wide pulse pressure. This is
associated with:
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Cardiac tamponade
Correct Answer: B
1. A 45-year-old patient presents with a "curtain coming down" over their vision in the right
eye, lasting 5 minutes, followed by a severe unilateral headache. Which type of headache is
this?
A. Tension headache
B. Cluster headache
C. Migraine with aura
D. Sinus headache
Correct Answer: C
Rationale: A visual disturbance (scotoma, fortification spectrum) preceding a headache is a
classic aura, indicative of a migraine with aura. Tension headaches are bilateral and lack aura.
Cluster headaches present with severe orbital pain and autonomic symptoms (tearing,
rhinorrhea) without visual auras.
2. A patient presents with a fixed, dilated pupil and ptosis on the left side. This clinical
presentation is most consistent with:
A. Horner's syndrome
B. CN III (Oculomotor) palsy
C. CN IV (Trochlear) palsy
D. CN VI (Abducens) palsy
Correct Answer: B
Rationale: CN III palsy typically presents with a "down and out" eye, ptosis, and a dilated,
non-reactive pupil (due to parasympathetic fibers on the outside of the nerve). Horner's
syndrome presents with ptosis, miosis (constricted pupil), and anhidrosis.
3. Which of the following are risk factors for the development of open-angle glaucoma?
(Select All That Apply)
A. African American descent
B. Advanced age
C. History of migraines
D. Myopia
Correct Answers: A, B, C
Rationale: Risk factors for open-angle glaucoma include age >40, African American ancestry,
family history, diabetes, myopia, and migraines. Myopia is a risk factor, but the most common
triad tested is age, race, and family history.
,4. A 65-year-old patient reports a sudden onset of severe, deep, boring pain in the right eye
radiating to the temple. The eye is red, and the pupil is mid-dilated and fixed. What is the
priority diagnosis?
A. Acute angle-closure glaucoma
B. Conjunctivitis
C. Scleritis
D. Corneal abrasion
Correct Answer: A
Rationale: Acute angle-closure glaucoma presents with severe unilateral eye pain,
headache, nausea/vomiting, a mid-dilated fixed pupil, and a red eye. It is an ophthalmologic
emergency.
5. The "Snellen chart" is used to assess:
A. Color vision
B. Visual acuity
C. Visual fields
D. Extraocular movements
Correct Answer: B
Rationale: The Snellen chart measures central visual acuity (distance vision).
6. A patient presents with a "cherry red" spot in the macula and sudden painless loss of
vision. What is the likely diagnosis?
A. Macular degeneration
B. Central retinal artery occlusion (CRAO)
C. Retinal detachment
D. Vitreous hemorrhage
Correct Answer: B
Rationale: CRAO presents with sudden, painless, unilateral vision loss. Fundoscopy reveals a
pale retina with a "cherry-red spot" at the macula.
7. Which cranial nerve is assessed by asking the patient to shrug their shoulders against
resistance?
A. CN IX (Glossopharyngeal)
B. CN X (Vagus)
C. CN XI (Spinal Accessory)
D. CN XII (Hypoglossal)
Correct Answer: C
Rationale: CN XI innervates the sternocleidomastoid and trapezius muscles. Shrugging
shoulders tests the trapezius.
,8. A patient has a positive "Romberg test." This indicates:
A. Cerebellar dysfunction
B. Proprioceptive dysfunction or vestibular loss
C. Corticospinal tract lesion
D. Peripheral neuropathy
Correct Answer: B
Rationale: A positive Romberg (increased sway/fall with eyes closed) indicates a loss of
proprioception or vestibular function. If the patient falls with eyes open, it suggests cerebellar
ataxia.
9. Which of the following are signs of Parkinson's disease? (Select All That Apply)
A. Cogwheel rigidity
B. Resting tremor
C. Bradykinesia
D. Hyperreflexia
Correct Answers: A, B, C
Rationale: The cardinal signs of Parkinson's are tremor (resting), rigidity (cogwheel),
bradykinesia/akinesia, and postural instability. Hyperreflexia is more indicative of an upper
motor neuron lesion (e.g., stroke, MS).
10. A patient presents with a "mask-like" facies, shuffling gait, and a pill-rolling tremor. This is
characteristic of:
A. Parkinson's disease
B. Multiple sclerosis
C. Myasthenia gravis
D. Huntington's disease
Correct Answer: A
Rationale: These are classic motor symptoms of Parkinson's disease.
11. A patient has a blood pressure of 160/94 mmHg. According to the ACC/AHA guidelines,
this is classified as:
A. Elevated
B. Stage 1 Hypertension
C. Stage 2 Hypertension
D. Hypertensive Crisis
Correct Answer: C
Rationale: Stage 2 hypertension is defined as a systolic BP ≥140 mmHg or a diastolic BP ≥90
mmHg. (Note: The 2017 ACC/AHA guidelines define Stage 2 as ≥140/90, whereas the old JNC7
, defined it as ≥160/100. Current NP programs typically follow ACC/AHA: Normal <120/80,
Elevated 120-129/<80, Stage 1 130-139 or 80-89, Stage 2 ≥140 or ≥90).
12. The "PMI" (Point of Maximal Impulse) is normally located at:
A. The 2nd intercostal space, left sternal border
B. The 5th intercostal space, midclavicular line
C. The 4th intercostal space, left sternal border
D. The apex of the heart
Correct Answer: B
Rationale: The PMI (apex) is located at the 5th intercostal space at the midclavicular line in
most adults.
13. A patient has a loud, harsh, systolic murmur heard best at the right 2nd intercostal space.
This is most likely:
A. Aortic stenosis
B. Mitral regurgitation
C. Pulmonic stenosis
D. Tricuspid regurgitation
Correct Answer: A
Rationale: Aortic stenosis is a systolic ejection murmur heard best at the right 2nd
intercostal space (aortic area) and radiates to the carotids.
14. Which of the following are symptoms of left-sided heart failure? (Select All That Apply)
A. Dyspnea
B. Orthopnea
C. Peripheral edema
D. Paroxysmal nocturnal dyspnea
Correct Answers: A, B, D
Rationale: Left-sided heart failure causes pulmonary congestion (dyspnea, orthopnea, PND).
Right-sided heart failure causes systemic congestion (peripheral edema, JVD, hepatomegaly).
15. A patient presents with a "water-hammer" pulse and a wide pulse pressure. This is
associated with:
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Cardiac tamponade
Correct Answer: B
