NU 518 Exam 2
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 ANS: 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 ANS: A
Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: A
Sudden, painful unilateral loss of vision may be caused by which of the following conditions?
A) Vitreous hemorrhage
B) Central retinal artery occlusion
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 ANS: 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 ANS: A
Which of the following is a symptom involving the eye?
A) Scotomas
B) Tinnitus
C) Dysphagia
D) Rhinorrhea ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: 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 ANS: A
Sudden, painful unilateral loss of vision may be caused by which of the following conditions?
A) Vitreous hemorrhage
B) Central retinal artery occlusion
