NU 518 Exam 2: Questions With Expert Solutions
A 38-year-old accountant comes to your clinic for evaluation of a headache.
The throbbing sensation is located in the right temporal region and is an 8 on
a scale of 1 to 10. It started a few hours ago, and she has noted nausea with
sensitivity to light; she has had headaches like this in the past, usually less
than one per week, but not as severe. She does not know of any inciting
factors. There has been no change in the frequency of her headaches. She
usually takes an over the-counter analgesic, and this results in resolution of
the headache. Based on this description, what is the most likely diagnosis of
the type of headache?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound Correct Answer - B
A 29-year-old computer programmer comes to your office for evaluation of a
headache. The tightening sensation is located all over the head and is of
moderate intensity. It used to last minutes, but this time it has lasted for 5
days. He denies photophobia and nausea. He spends several hours each day at
a computer monitor/keyboard. He has tried over-the-counter medication; it
has dulled the pain but not taken it away. Based on this description, what is
your
most likely diagnosis?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound Correct Answer - A
Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea Correct Answer - A
A 49-year-old administrative assistant comes to your office for evaluation of
dizziness. You elicit the information that the dizziness is a spinning sensation
of sudden onset, worse with head position changes. The episodes last a few
seconds and then go away, and they are accompanied by intense nausea. She
,has vomited one time. She denies tinnitus. You perform a physical
examination of the head and neck and note that the patient's hearing is intact
to Weber and Rinne and that there is nystagmus. Her gait is normal. Based on
this description, what is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma Correct Answer - A
A 55-year-old bank teller comes to your office for persistent episodes of
dizziness. The first episode started suddenly and lasted 3 to 4 hours. He
experienced a lot of nausea with vomiting; the episode resolved
spontaneously. He has had five episodes in the past 1½ weeks. He does note
some tinnitus that comes and goes. Upon physical examination, you note that
he has a normal gait. The Weber localizes to the right side and the air
conduction is equal to the bone conduction in the right ear. Nystagmus is
present. Based on this description, what is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma Correct Answer - C
A 73-year-old nurse comes to your office for evaluation of new onset of
tremors. She is not on any medications and does not take herbs or
supplements. She has no chronic medical conditions. She does not smoke or
drink alcohol. She walks into the examination room with slow movements and
shuffling steps. She has decreased facial mobility and a blunt expression,
without any changes in hair distribution on her face. Based on this
description, what is the most likely reason for the patient's symptoms?
A) Cushing's syndrome
B) Nephrotic syndrome
C) Myxedema
D) Parkinson's disease Correct Answer - D
A 29-year-old physical therapist presents for evaluation of an eyelid problem.
On observation, the right eyeball appears to be protruding forward. Based on
this description, what is the most likely diagnosis?
A) Ptosis
B) Exophthalmos
,C) Ectropion
D) Epicanthus Correct Answer - B
A 12-year-old presents to the clinic with his father for evaluation of a painful
lump in the left eye. It started this morning. He denies any trauma or injury.
There is no visual disturbance. Upon physical examination, there is a red
raised area at the margin of the eyelid that is tender to palpation; no tearing
occurs with palpation of the lesion. Based on this description, what is the
most likely diagnosis?
A) Dacryocystitis
B) Chalazion
C) Hordeolum
D) Xanthelasma Correct Answer - C
A 15-year-old high school sophomore presents to the emergency room with
his mother for evaluation of an area of blood in the left eye. He denies trauma
or injury but has been coughing forcefully with a recent cold. He denies visual
disturbances, eye pain, or discharge from the eye. On physical examination,
the pupils are equal, round, and reactive to light, with a visual acuity of
20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply
demarcated area at the lateral aspect of the base of the left eye. The cornea is
clear. Based on this description, what is the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage Correct Answer - D
A 67-year-old lawyer comes to your clinic for an annual examination. He
denies any history of eye trauma. He denies any visual changes. You inspect
his eyes and find a triangular thickening of the bulbar conjunctiva across the
outer surface of the cornea. He has a normal pupillary reaction to light and
accommodation. Based on this description, what is the most likely diagnosis?
A) Corneal arcus
B) Cataracts
C) Corneal scar
D) Pterygium Correct Answer - D
Which of the following is a "red flag" regarding patients presenting with
headache?
, A) Unilateral headache
B) Pain over the sinuses
C) Age over 50
D) Phonophobia and photophobia Correct Answer - C
A sudden, painless unilateral vision loss may be caused by which of the
following?
A) Retinal detachment
B) Corneal ulcer
C) Acute glaucoma
D) Uveitis Correct Answer - A
Sudden, painful unilateral loss of vision may be caused by which of the
following conditions?
A) Vitreous hemorrhage
B) Central retinal artery occlusion
C) Macular degeneration
D) Optic neuritis Correct Answer - D
Diplopia, which is present with one eye covered, can be caused by which of
the following problems?
A) Weakness of CN III
B) Weakness of CN IV
C) A lesion of the brainstem
D) An irregularity in the cornea or lens Correct Answer - D
A patient complains of epistaxis. Which other cause should be considered?
A) Intracranial hemorrhage
B) Hematemesis
C) Intestinal hemorrhage
D) Hematoma of the nasal septum Correct Answer - B
Glaucoma is the leading cause of blindness in African Americans and the
second leading cause of blindness overall. What features would be noted on
funduscopic examination?
A) Increased cup-to-disc ratio
B) AV nicking
C) Cotton wool spots
D) Microaneurysms Correct Answer - A
A 38-year-old accountant comes to your clinic for evaluation of a headache.
The throbbing sensation is located in the right temporal region and is an 8 on
a scale of 1 to 10. It started a few hours ago, and she has noted nausea with
sensitivity to light; she has had headaches like this in the past, usually less
than one per week, but not as severe. She does not know of any inciting
factors. There has been no change in the frequency of her headaches. She
usually takes an over the-counter analgesic, and this results in resolution of
the headache. Based on this description, what is the most likely diagnosis of
the type of headache?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound Correct Answer - B
A 29-year-old computer programmer comes to your office for evaluation of a
headache. The tightening sensation is located all over the head and is of
moderate intensity. It used to last minutes, but this time it has lasted for 5
days. He denies photophobia and nausea. He spends several hours each day at
a computer monitor/keyboard. He has tried over-the-counter medication; it
has dulled the pain but not taken it away. Based on this description, what is
your
most likely diagnosis?
A) Tension
B) Migraine
C) Cluster
D) Analgesic rebound Correct Answer - A
Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea Correct Answer - A
A 49-year-old administrative assistant comes to your office for evaluation of
dizziness. You elicit the information that the dizziness is a spinning sensation
of sudden onset, worse with head position changes. The episodes last a few
seconds and then go away, and they are accompanied by intense nausea. She
,has vomited one time. She denies tinnitus. You perform a physical
examination of the head and neck and note that the patient's hearing is intact
to Weber and Rinne and that there is nystagmus. Her gait is normal. Based on
this description, what is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma Correct Answer - A
A 55-year-old bank teller comes to your office for persistent episodes of
dizziness. The first episode started suddenly and lasted 3 to 4 hours. He
experienced a lot of nausea with vomiting; the episode resolved
spontaneously. He has had five episodes in the past 1½ weeks. He does note
some tinnitus that comes and goes. Upon physical examination, you note that
he has a normal gait. The Weber localizes to the right side and the air
conduction is equal to the bone conduction in the right ear. Nystagmus is
present. Based on this description, what is the most likely diagnosis?
A) Benign positional vertigo
B) Vestibular neuronitis
C) Ménière's disease
D) Acoustic neuroma Correct Answer - C
A 73-year-old nurse comes to your office for evaluation of new onset of
tremors. She is not on any medications and does not take herbs or
supplements. She has no chronic medical conditions. She does not smoke or
drink alcohol. She walks into the examination room with slow movements and
shuffling steps. She has decreased facial mobility and a blunt expression,
without any changes in hair distribution on her face. Based on this
description, what is the most likely reason for the patient's symptoms?
A) Cushing's syndrome
B) Nephrotic syndrome
C) Myxedema
D) Parkinson's disease Correct Answer - D
A 29-year-old physical therapist presents for evaluation of an eyelid problem.
On observation, the right eyeball appears to be protruding forward. Based on
this description, what is the most likely diagnosis?
A) Ptosis
B) Exophthalmos
,C) Ectropion
D) Epicanthus Correct Answer - B
A 12-year-old presents to the clinic with his father for evaluation of a painful
lump in the left eye. It started this morning. He denies any trauma or injury.
There is no visual disturbance. Upon physical examination, there is a red
raised area at the margin of the eyelid that is tender to palpation; no tearing
occurs with palpation of the lesion. Based on this description, what is the
most likely diagnosis?
A) Dacryocystitis
B) Chalazion
C) Hordeolum
D) Xanthelasma Correct Answer - C
A 15-year-old high school sophomore presents to the emergency room with
his mother for evaluation of an area of blood in the left eye. He denies trauma
or injury but has been coughing forcefully with a recent cold. He denies visual
disturbances, eye pain, or discharge from the eye. On physical examination,
the pupils are equal, round, and reactive to light, with a visual acuity of
20/20 in each eye and 20/20 bilaterally. There is a homogeneous, sharply
demarcated area at the lateral aspect of the base of the left eye. The cornea is
clear. Based on this description, what is the most likely diagnosis?
A) Conjunctivitis
B) Acute iritis
C) Corneal abrasion
D) Subconjunctival hemorrhage Correct Answer - D
A 67-year-old lawyer comes to your clinic for an annual examination. He
denies any history of eye trauma. He denies any visual changes. You inspect
his eyes and find a triangular thickening of the bulbar conjunctiva across the
outer surface of the cornea. He has a normal pupillary reaction to light and
accommodation. Based on this description, what is the most likely diagnosis?
A) Corneal arcus
B) Cataracts
C) Corneal scar
D) Pterygium Correct Answer - D
Which of the following is a "red flag" regarding patients presenting with
headache?
, A) Unilateral headache
B) Pain over the sinuses
C) Age over 50
D) Phonophobia and photophobia Correct Answer - C
A sudden, painless unilateral vision loss may be caused by which of the
following?
A) Retinal detachment
B) Corneal ulcer
C) Acute glaucoma
D) Uveitis Correct Answer - A
Sudden, painful unilateral loss of vision may be caused by which of the
following conditions?
A) Vitreous hemorrhage
B) Central retinal artery occlusion
C) Macular degeneration
D) Optic neuritis Correct Answer - D
Diplopia, which is present with one eye covered, can be caused by which of
the following problems?
A) Weakness of CN III
B) Weakness of CN IV
C) A lesion of the brainstem
D) An irregularity in the cornea or lens Correct Answer - D
A patient complains of epistaxis. Which other cause should be considered?
A) Intracranial hemorrhage
B) Hematemesis
C) Intestinal hemorrhage
D) Hematoma of the nasal septum Correct Answer - B
Glaucoma is the leading cause of blindness in African Americans and the
second leading cause of blindness overall. What features would be noted on
funduscopic examination?
A) Increased cup-to-disc ratio
B) AV nicking
C) Cotton wool spots
D) Microaneurysms Correct Answer - A
