NR 603 WEEK 1 |2025|
COMPLETE EXAM TEST
QUESTIONS AND VERIFIED
ANSWERS (MULTIPLE
CHOICES) AND
RATIONALES|GET IT 100%
ACCURATE!!
A75-year-
oldmanisinvolvedinamotorvehicleaccidentandstrikeshisforeheadonthewindshield.Hecomplai
nsofneckpainandsevereburninginhisshouldersandarms.Hisphysicalexaminationrevealsweakn
essofhisupperextremities.Whattypeofspinalcordinjurydoesthispatienthave?
Aanteriorcordsyndrome
Bcentralcordsyndrome
CBrown-Séquardsyndrome
Dcompletecordtransection
Ecaudaequinasyndrome
ANS:B-Correctanswer~CentralCordSyndrome
thecentralcordsyndromeinvolveslossofmotorfunctionthatismoresevereintheupperextremitie
sthaninthelowerextremities,andismoresevereinthehands.Thereistypicallyhyperesthesiaovert
heshouldersandarms.Anteriorcordsyndromepresentswithparaplegiaorquadriplegia,lossoflate
ralspinothalamicfunctionwithpreservationofposteriorcolumnfunction.Brown-
,Séquardsyndromeconsistsofweaknessandlossofposteriorcolumnfunctionononesideofthebod
ydistaltothelesionwithcontralaterallossoflateralspinothalamicfunctiononetotwolevelsbelowt
helesion.Completecordtransectionwouldaffectmotorandsensoryfunctiondistaltothelesion.Ca
udaequinasyndrometypicallypresentsaslowbackpainwithradiculopathy.
A37-year-
oldmanfellfromaladderashefinishedhangingtheChristmaslightsonhishouse.Therightsideofhis
headhitthealleycement,andhelostconsciousnessforabout1minute;hewokeupwithaheadache,
buthehadnoothercomplaints.Afewhourslater,thepatientisbroughttotheemergencyroombyhis
neighborbecauseofanintenseheadache,confusion,andlefthandhemiparesis.Onexamination,th
epatienthasabruiselocatedovertherighttemporalregion,mydriasis,andrightdeviationoftherigh
teye,papilledema,andleftextensorplantarresponse.AnemergencyCTscanoftheheadwithoutco
ntrastrevealsalens-shapedhyper-
densityundertherighttemporalbonewithmasseffectandedema.Whatisthemostlikelydiagnosis?
AnswerChoices
1Epiduralhematoma
2Subduralhematoma
3Subarachnoidhemorrhage
4Intracerebralparenchymalhemorrhage
5Acutemeningitis
ANS:1-Correctanswer~EpiduralHematoma
Epiduralhematomamostoftenresultsfromatraumatictearofthemiddlemeningealartery.Althou
ghalucidintervalrangingfromminutestohoursfollowedbyalteredmentalstatusandfocaldeficitsis
typicalforepiduralhematoma,thisclinicalpictureisonlyencounteredinupto1/3ofthepatients.Th
ecollectionofbloodbetweentheskullandduramatercausesanevidentmasseffectwithophthalmi
cnervepalsyandthecontralateralhemiparesis.Surgicalevacuationoftheclotviaburrholesisthetre
atmentofchoice.
Subduralhematomaresultsfromatraumaticruptureofthebridgingveinsthatconnectthecerebru
mtothevenoussinuseswithinthedura.Thisvenoushemorrhagewillresultinagradualincreaseofth
ehematoma,withaprogressiveclinicalpictureoverdaysorweeks.TheCTscanwillshowaconcave,cr
escent-shapedhyper-densitycomparedtotheconvex,lens-shapedhyper-
densityinepiduralhematoma.
,Subarachnoidhemorrhageistheresultofananeurysmrupture;themostcommonisthecongenital
berryaneurysm.Theclinicalpictureisofasudden,severeheadachewithmeningealirritation.ACTsc
anwillshowbloodinthesubarachnoidspace,andalumbarpuncturewillrevealxanthochromiaCSF.
IntracerebralparenchymalhemorrhageismostlikelycausedbyhypertensioncomplicatedwithCh
arcot-
Bouchardaneurysms.Thebloodaccumulatesintothebrainsubstanceandmostcommonlyinvolves
thebasalganglia.
Acutemeningitisisnotassociatedwithtrauma.Feverandsignsofmeningealirritationdominatethe
clinicalpicture.Lumbarpuncture,indicatediftherearenofocalneurologicalsignsonclinicalexamin
ation,willbethediagnosticprocedure.TheCTscanofthepatientpresentedinthiscaseischaracterist
icforepiduralhematoma,andthereisnoindicationforalumbarpunctu
A31-year-
oldwomanpresentswithapurpuralrashcoveringherarms,legs,andabdomen.Shealsohasfever,ch
ills,nausea,abdominaltenderness,tachycardia,andgeneralizedmyalgias.Priortothedevelopmen
toftherash,thepatientnotedthatshehadaheadache,cough,andsorethroat.Laboratorystudiesw
erepositiveforGram-
negativediplococciintheblood,alongwiththrombocytopeniaandanelevationinPMNs.Urinalysis
showedblood,protein,andcasts.Vitalsignsareasfollows:PB92/66,P96,RR14,T39.Thepatientdeni
esanyforeigntravelanddoesnothaveanysickcontacts.However,shedoesworkparttimeasanursei
nalocalhospital.
Question
ThepatientisdiagnosedwithMeningococcemia;sheisadmittedtothehospitalandplacedinrespira
toryisolation.Whatmajorcourseoftherapyshouldthispatientreceive?
AnswerChoices
1Steroids
2Supportivecare
3Antibiotics
4Transfusion
, 5Bacterici-Correctanswer~Antibiotics
Antibioticsarethetreatmentofchoiceformeningococcemia.Thepreferreddrugforactiveinfection
ispenicillinG.Forthoseallergictopenicillin,chloramphenicolandcephalosporins(ie,cefotaxime,c
efuroxime)maybeusedasalternatives.
Patientswillalsoreceivesupportivecare,butantibiotictherapymustbeinitiatedquicklyifthepatien
tistosurvive.Intensivecareplacementmaybenecessaryiforganfailureisimminent.Ventilatorysup
port,inotropicsupport,andIVfluidsarenecessaryinsome.Ifadrenalinsufficiencyoccurs,corticost
eroidreplacementmaybeconsidered.Acentralvenouslinehelpstoprovidelargeamountsofvolum
eexpandersandinotropicmedicationsforadequatetissueperfusion.
Steroidshavenotbeenshowntoplayamajorroleinthetreatmentofmeningococcemia.However,th
eyhavebeenusedinadditiontoantibiotictherapy.Inthecaseofadrenalinsufficiency,forexample,st
eroidreplacementhasbeenshowntobebeneficial.
Transfusiondoesnotgenerallyplayamajorroleintreatment.Ifthepatientsuffersfromadevastating
coagulopathy,bloodorbloodproductsmaybereplacedasnecessary.
Bactericidal/permeability-
increasingproteinisaproteinstoredinthegranulesofneutrophils.Itbindstoendotoxininvitroandn
eutralizesit.Thistechniqueisexperimental,anditisnotusedineverydaytreatmentofmeningococc
emia.
Inmyastheniagravis,weaknessisaresultofinsufficientacetylcholinetransmissionattheneuromus
cularjunction;however,weaknesscanalsooccurwithoverdosingofthecholinergicmedicationsus
edtotreatmyasthenia.Whatsymptomhelpsdifferentiateamyastheniccrisisfromacholinergiccrisi
s?
AnswerChoices
1Respiratoryfailure
2Bilateralptosis
3Musclefasciculations
4Diplopia
COMPLETE EXAM TEST
QUESTIONS AND VERIFIED
ANSWERS (MULTIPLE
CHOICES) AND
RATIONALES|GET IT 100%
ACCURATE!!
A75-year-
oldmanisinvolvedinamotorvehicleaccidentandstrikeshisforeheadonthewindshield.Hecomplai
nsofneckpainandsevereburninginhisshouldersandarms.Hisphysicalexaminationrevealsweakn
essofhisupperextremities.Whattypeofspinalcordinjurydoesthispatienthave?
Aanteriorcordsyndrome
Bcentralcordsyndrome
CBrown-Séquardsyndrome
Dcompletecordtransection
Ecaudaequinasyndrome
ANS:B-Correctanswer~CentralCordSyndrome
thecentralcordsyndromeinvolveslossofmotorfunctionthatismoresevereintheupperextremitie
sthaninthelowerextremities,andismoresevereinthehands.Thereistypicallyhyperesthesiaovert
heshouldersandarms.Anteriorcordsyndromepresentswithparaplegiaorquadriplegia,lossoflate
ralspinothalamicfunctionwithpreservationofposteriorcolumnfunction.Brown-
,Séquardsyndromeconsistsofweaknessandlossofposteriorcolumnfunctionononesideofthebod
ydistaltothelesionwithcontralaterallossoflateralspinothalamicfunctiononetotwolevelsbelowt
helesion.Completecordtransectionwouldaffectmotorandsensoryfunctiondistaltothelesion.Ca
udaequinasyndrometypicallypresentsaslowbackpainwithradiculopathy.
A37-year-
oldmanfellfromaladderashefinishedhangingtheChristmaslightsonhishouse.Therightsideofhis
headhitthealleycement,andhelostconsciousnessforabout1minute;hewokeupwithaheadache,
buthehadnoothercomplaints.Afewhourslater,thepatientisbroughttotheemergencyroombyhis
neighborbecauseofanintenseheadache,confusion,andlefthandhemiparesis.Onexamination,th
epatienthasabruiselocatedovertherighttemporalregion,mydriasis,andrightdeviationoftherigh
teye,papilledema,andleftextensorplantarresponse.AnemergencyCTscanoftheheadwithoutco
ntrastrevealsalens-shapedhyper-
densityundertherighttemporalbonewithmasseffectandedema.Whatisthemostlikelydiagnosis?
AnswerChoices
1Epiduralhematoma
2Subduralhematoma
3Subarachnoidhemorrhage
4Intracerebralparenchymalhemorrhage
5Acutemeningitis
ANS:1-Correctanswer~EpiduralHematoma
Epiduralhematomamostoftenresultsfromatraumatictearofthemiddlemeningealartery.Althou
ghalucidintervalrangingfromminutestohoursfollowedbyalteredmentalstatusandfocaldeficitsis
typicalforepiduralhematoma,thisclinicalpictureisonlyencounteredinupto1/3ofthepatients.Th
ecollectionofbloodbetweentheskullandduramatercausesanevidentmasseffectwithophthalmi
cnervepalsyandthecontralateralhemiparesis.Surgicalevacuationoftheclotviaburrholesisthetre
atmentofchoice.
Subduralhematomaresultsfromatraumaticruptureofthebridgingveinsthatconnectthecerebru
mtothevenoussinuseswithinthedura.Thisvenoushemorrhagewillresultinagradualincreaseofth
ehematoma,withaprogressiveclinicalpictureoverdaysorweeks.TheCTscanwillshowaconcave,cr
escent-shapedhyper-densitycomparedtotheconvex,lens-shapedhyper-
densityinepiduralhematoma.
,Subarachnoidhemorrhageistheresultofananeurysmrupture;themostcommonisthecongenital
berryaneurysm.Theclinicalpictureisofasudden,severeheadachewithmeningealirritation.ACTsc
anwillshowbloodinthesubarachnoidspace,andalumbarpuncturewillrevealxanthochromiaCSF.
IntracerebralparenchymalhemorrhageismostlikelycausedbyhypertensioncomplicatedwithCh
arcot-
Bouchardaneurysms.Thebloodaccumulatesintothebrainsubstanceandmostcommonlyinvolves
thebasalganglia.
Acutemeningitisisnotassociatedwithtrauma.Feverandsignsofmeningealirritationdominatethe
clinicalpicture.Lumbarpuncture,indicatediftherearenofocalneurologicalsignsonclinicalexamin
ation,willbethediagnosticprocedure.TheCTscanofthepatientpresentedinthiscaseischaracterist
icforepiduralhematoma,andthereisnoindicationforalumbarpunctu
A31-year-
oldwomanpresentswithapurpuralrashcoveringherarms,legs,andabdomen.Shealsohasfever,ch
ills,nausea,abdominaltenderness,tachycardia,andgeneralizedmyalgias.Priortothedevelopmen
toftherash,thepatientnotedthatshehadaheadache,cough,andsorethroat.Laboratorystudiesw
erepositiveforGram-
negativediplococciintheblood,alongwiththrombocytopeniaandanelevationinPMNs.Urinalysis
showedblood,protein,andcasts.Vitalsignsareasfollows:PB92/66,P96,RR14,T39.Thepatientdeni
esanyforeigntravelanddoesnothaveanysickcontacts.However,shedoesworkparttimeasanursei
nalocalhospital.
Question
ThepatientisdiagnosedwithMeningococcemia;sheisadmittedtothehospitalandplacedinrespira
toryisolation.Whatmajorcourseoftherapyshouldthispatientreceive?
AnswerChoices
1Steroids
2Supportivecare
3Antibiotics
4Transfusion
, 5Bacterici-Correctanswer~Antibiotics
Antibioticsarethetreatmentofchoiceformeningococcemia.Thepreferreddrugforactiveinfection
ispenicillinG.Forthoseallergictopenicillin,chloramphenicolandcephalosporins(ie,cefotaxime,c
efuroxime)maybeusedasalternatives.
Patientswillalsoreceivesupportivecare,butantibiotictherapymustbeinitiatedquicklyifthepatien
tistosurvive.Intensivecareplacementmaybenecessaryiforganfailureisimminent.Ventilatorysup
port,inotropicsupport,andIVfluidsarenecessaryinsome.Ifadrenalinsufficiencyoccurs,corticost
eroidreplacementmaybeconsidered.Acentralvenouslinehelpstoprovidelargeamountsofvolum
eexpandersandinotropicmedicationsforadequatetissueperfusion.
Steroidshavenotbeenshowntoplayamajorroleinthetreatmentofmeningococcemia.However,th
eyhavebeenusedinadditiontoantibiotictherapy.Inthecaseofadrenalinsufficiency,forexample,st
eroidreplacementhasbeenshowntobebeneficial.
Transfusiondoesnotgenerallyplayamajorroleintreatment.Ifthepatientsuffersfromadevastating
coagulopathy,bloodorbloodproductsmaybereplacedasnecessary.
Bactericidal/permeability-
increasingproteinisaproteinstoredinthegranulesofneutrophils.Itbindstoendotoxininvitroandn
eutralizesit.Thistechniqueisexperimental,anditisnotusedineverydaytreatmentofmeningococc
emia.
Inmyastheniagravis,weaknessisaresultofinsufficientacetylcholinetransmissionattheneuromus
cularjunction;however,weaknesscanalsooccurwithoverdosingofthecholinergicmedicationsus
edtotreatmyasthenia.Whatsymptomhelpsdifferentiateamyastheniccrisisfromacholinergiccrisi
s?
AnswerChoices
1Respiratoryfailure
2Bilateralptosis
3Musclefasciculations
4Diplopia
