AGNP BOARD EXAM QUESTION AND ANSWERS – NEUROLOGY ASSESSMENT

AGNP BOARD EXAM QUESTIONS Neurology Assessment (Questions 194) Question: When eliciting deep tendon reflexes in the knee, the nurse practitioner notes an abnormal reflex in the right knee. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6 Cervical 6 and 7 Lumbar 2, 3, and 4 Correct Sacral 1 Explanation: The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee: lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6 & 7. Question: A 80 year old male visits the nurse practitioner for an annual well exam. History reveals two falls in the prior 12 months and difficulty with balance. The next step the nurse practitioner should take is: reassess the patient in 6 months. obtain cognitive and functional assessment. Correct assess respiratory assessment. assess cardiac function. Explanation: High-risk older adults, namely those with a single fall in the past 12 months with abnormal gait and balance and those with two or more falls in the prior 12 months, an acute fall, and/or difficulties with gait and balance, require further assessment to determine the reasons for the falls. Obtaining relevant medical history, physical exam, cognitive and functional assessment and determining multifactorial fall risks are essential to the preventing future falls. Question: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of: position and vibration. pain and temperature. Correct deep touch. discriminative sensations. Explanation: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of pain and temperature. Assessing position and vibration evaluate the posterior columns. Light touch assesses both the spinothalamic and posterior column tracts. To assess discriminative sensation, both the spinothalamic and posterior columns tracts as well as the cortex would be assessed. Question: When testing for corneal reflex, an absent blink reflex is noted. This finding may be suggestive of a lesion in which cranial nerve? Cranial Nerve II (CN II) Cranial Nerve IV (CN IV) Cranial Nerve VI (CN V) Cranial Nerve VII (CN VII) Correct Explanation: When testing for corneal reflex, an absent blink reflex would be suggestive of a lesion in cranial nerves V or VII (CN V or CN VII)-Trigeminal or facial nerves. Question: An example of symmetric weakness is: the right shoulder. the right hand. both arms. Correct one the right side of the face. Explanation: There are 4 different patterns of weakness: Proximal, distal, symmetric, and asymmetric. An example of proximal weakness is weakness in the shoulder or hip girdle. Distal weakness occurs in the hands or feet. Symmetric weakness occurs in the same areas on both sides of the body. An asymmetric weakness occurs in a portion of the face or extremity - a form of focal weakness. Question: One maneuver used to assess coordination is to observe the patient: dorsiflexing the ankle. walking heel-to-toe in a straight line. Correct squeezing the examiner's fingers. counting to 10 backwards. Explanation: To assess coordination, observe the patient’s performance in rapid alternating movements, point-to-point movements, gait and other related body movements, standing in specified ways. Walking heel-to-toe would be an example of observing the patient's gait. Dorsiflexion would be assessing the patient's joint function. Squeezing the examiner's fingers would be one way to assess hand grasp. Counting has nothing to do with coordination. Question: Assessment of a 70-year-old's ability to maintain personal safety would be most adversely affected by declining function in the: cardiovascular system. respiratory system. sensory perception system. Correct gastrointestinal system. Explanation: The sensory system or sensory perception involves vision, touch, taste, smell, and hearing. With the aging process these perceptions are altered and these alterations put the elderly at risk for falls, burns, inability to smell smoke, and the inability to move fast enough to get out of harm's way. These impact personal safety. Changes in the cardiovascular, gastrointestinal, and respiratory systems do not usually lead to safety issues. Question: A patient complains of experiencing symptoms of nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event. These symptoms are most likely associated with: subarachnoid hemorrhage. stroke. neurocardiogenic syncope. vasovagal syncope. Correct Explanation: In vasovagal syncope, a common cause of syncope, a prodrome of nausea, diaphoresis, and pallor are triggered by a fearful or unpleasant event, then vagally mediated hypotension, often with slow onset and offset. In syncope from arrhythmias, onset and offset are often sudden, reflecting loss and recovery of cerebral perfusion. Stroke or subarachnoid hemorrhage are unlikely to cause syncope unless there are focal findings and damage to both hemispheres. Question: An infant presents with an inappropriately increasing head circumference and hydrocephalus confirmed by CT scan. In addition to these findings, which one of the following would also be consistent with hydrocephalus? A soft, low-pitched cry Ability to be comforted easily Tense, bulging fontanels Correct Appropriately increasing weight Explanation: An infant with newly diagnosed hydrocephalus presents with a shrill and high-pitched cry. They are very irritable and do not comfort easily. Additionally, the infant's fontanels are tense and bulging due to the increased amount of cerebral spinal fluid (CSF) being produced or not being absorbed. These infants are very difficult feeders, so they often do not gain weight appropriately. Question: Postural tremors appear when the affected part is: at rest. moving voluntarily. is actively maintaining a posture. Correct getting closer to its target. Explanation: Tremors are rhythmic oscillatory movements. Postural tremors appear when the affected part is actively maintaining a posture. Examples include the fine rapid tremor of hyperthyroidism, the tremors of anxiety and fatigue, and benign essential tremor. The other choices are not consistent with postural tremors. Question: Dysphonia refers to: the inability to produce or understand language. the loss of voice. an impairment in volume of the voice. Correct a defect in the muscular control of the speech apparatus. Explanation: Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Aphasia refers to a disorder in producing or understanding language. Question: Symptoms of a migraine headache can include throbbing, nausea or vomiting, duration of one day, and be unilateral and/or disabling. How many of these symptoms should be present to classify the headache as a migraine? One of the five Two of the five Three of the five Correct Four of the five Explanation: A migraine headache is highly likely if three of the five “POUND” features are present: Pulsatile or throbbing; One-day duration, or lasts 4 to 72 hours if untreated; Unilateral; Nausea or vomiting; Disabling or intensity causing interruption of daily activity. Question: The cranial sutures are closed on the head of a 9 month old infant. This indicates: hydrocephalus. craniosynostosis. Correct a normal finding. opisthotonos. Explanation: Craniosynostosis is defined as the premature closing of the sutures in young children. When this occurs, a bony ridge can be felt along the suture line. This is not a normal finding since the sutures usually fuse between 12 and 18 months. Hydrocephalus refers to fluid on the brain and would appear as an enlarged head with sutures remaining open. Opisthotonos is a state of severe hyperextension and spasticity in which an individual's head, neck and spinal column enter into a complete "bridging" or "arching" position. This abnormal posturing is an extrapyramidal effect and is caused by spasm of the axial muscles along the spinal column. Question: When upper motor neuron systems are damaged above the crossover of its tracts in the medulla, motor impairment develops on the opposite side. This term is: ipsilateral. contralateral. Correct superficial. intermediate. Explanation: When upper motor neuron systems are damaged above the crossover of its tracts in the medulla, motor impairment develops on the opposite side. This term is contralateral. In damage below the crossover, motor impairment would occur on the same side or ipsilateral side. Superficial refers to the outer surface of something. Intermediate is a term used to denote something between two other structures. Question: The best method of detecting cognitive impairment or intellectual disability at an early age is by: performing neuropsychological testing of intelligence. administration of an IQ test of cognitive abilities. radiographic evaluation of the brain and brainstem. assessment of the achievement of developmental milestones. Correct Explanation: The least invasive, least expensive, most efficient strategy used to detect cognitive and developmental deficits in infants and children is assessing for achievement of developmental milestones. Delay in achievement of developmental milestones is a cardinal sign of deficits/disabilities. The other three choices may be done at a later date as the child gets older and after the child is identified as having delayed or failure to achieve milestones. Question: A term used to describe an increase in muscular bulk with diminished strength is: hypertrophy. muscular atrophy. pseudohypertrophy. Correct muscle weakness. Explanation: An increase in muscular bulk with diminished strength is known as pseudohypertrophy. Hypertrophy refers to an increase in bulk of the muscle with a proportionate increase in strength. A term used to describe muscle wasting or loss of muscle bulk is muscular atrophy. Muscular weakness is a term used to describe a lack of strength or firmness in a muscle. Question: A 40-year-old male presents with complaints of headaches. History reveals headaches that occurred daily for about 4-6 weeks. He had relief for 6 months but now they are recurring. These are most likely: tension headaches. cluster headaches. Correct migraine headaches. sinus headaches. Explanation: Headaches that are episodic with several each day for 4-6 weeks with an extended period of relief for 6-12 months are most likely cluster headaches. Cluster headaches are more common in men than women. Question: It is imperative to assess for suicidality and bipolar disorder in patients suspected of experiencing: delirium. autism spectrum disorder. depression. Correct attention deficit disorder. Explanation: Depression is more common in individuals with significant medical conditions, including several neurologic disorders—dementia, epilepsy, multiple sclerosis, and Parkinson disease. Patients who present with depression may actually have bipolar disorder and so screening should always take place. Patients who are depressed may be suicidal. Consequently, in order for appropriate treatment to occur, appropriate diagnosis must occur. Question: The level of consciousness that refers to the patient that remains unarousable with eyes closed without evidence of response to inner need or external stimuli is said to be in: an obtunded state. a comatose state. Correct a lethargic state. a stuporous state. Explanation: A patient that remains unarousable with eyes closed without evidence of response to inner need or external stimuli is a comatose patient. An obtunded patient opens his eyes, looks at the person speaking to him but responds slowly and appears confused. Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. A stuporous patient arouses from sleep only after painful stimuli. Question: Brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals are consistent with: facial tics. Correct dystonic movements. athetoid movements. oral-facial dyskinesias. Explanation: Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. Question: On examination of the adult patient, symptoms of flexed posture, tremor, rigidity, and shuffling gait are observed. These findings are consistent with: drug induced reaction. functional impairment. Parkinson's disease. Correct depression. Explanation: Evidence of flexed posture, tremor, rigidity, bradykinesia, micrographia, shuffling gait, and difficulty rising from a chair are symptoms consistent with Parkinson's disease. Question: When a patient complains of severe headaches that have worsened over the last few weeks but she has no other symptoms, a most likely diagnosis would be: sinusitis. a tumor. Correct subarachnoid hemorrhage. an abscess. Explanation: The most important attributes of headaches are chronologic pattern and severity. Changing or progressively severe headaches increase the likelihood of tumor, abscess, or other masses. Extremely severe headaches suggest subarachnoid hemorrhage or meningitis and these headaches require immediate intervention because they worsen rapidly, not over a "few weeks". Sinusitis does cause headache but these headaches are not usually severe. Question: The term used to describe involuntary muscle movements, such as chorea, is: dystonia. bradykinesia. akinesia. dyskinesia. Correct Explanation: Dyskinesia is the presence of involuntary muscle movements such as tics or chorea. These movements can be seen in children who have rheumatic fever. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. The absence or loss of control of voluntary muscle movements is akinesia. Question: While assessing the trigeminal nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a: bilateral hemispheric disease. central nervous system lesions. cranial nerve disorder. Correct brainstem lesion. Explanation: While assessing the trigeminal nerve, cranial nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a cranial nerve disorder, such as trigeminal neuralgia. Question: A progressive disorder of the nervous system that affects movement is known as: delirium. functional impairment. Parkinson's disease. Correct Alzheimer's disease. Explanation: Parkinson's disease is a progressive disorder of the nervous system that affects movement. Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Alzheimer's disease is a geriatric condition in which normal alertness is present but progressive global deterioration of cognition occurs in multiple domains, including short-term memory, but with sparing of memory for remote events, subtle language errors, visuospatial perceptual difficulties, and changes in executive function, or the ability to perform sequential tasks such as instrumental activities of daily living (IADLs). Question: Physical exam of a well two-week-old infant reveals a little dimple with a small amount of hair just above the sacral area. This could be: an unusual finding but within normal limits. hirsutism. Arnold -Chiari malformation. spina bifida occulta. Correct Explanation: There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. Occulta is the mildest and most common form in which one or more vertebrae are malformed. The name “occulta,” which means “hidden,” indicates that a layer of skin covers the malformation, or opening in the vertebrae. This form of spina bifida, present in 10-20 percent of the general population, rarely causes disability or symptoms. Closed neural tube defects are often recognized early in life due to an abnormal tuft or clump of hair or a small dimple or birthmark on the skin at the site of the spinal malformation. Meningocele and myelomeningocele generally involve a fluid- filled sac—visible on the back—protruding from the spinal canal. In meningocele, the sac may be covered by a thin layer of skin. In most cases of myelomeningocele, there is no layer of skin covering the sac and an area of abnormally developed spinal cord tissue is usually exposed. Hirsutism is an excessive amount of hair on the body usually caused by a hormonal imbalance. An Arnold-Chiari malformation is a cyst-like formation in the fourth ventricle, cerebellum or brainstem. Question: The patient experiences a sudden loss of consciousness with falling without movements and injury may occur. This type of a seizure is consistent with: a myoclonic seizure. an absent seizure. a myoclonic atonic seizure. Correct a focal seizure with impairment of consciousness. Explanation: During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. A patient experiencing a myoclonic seizure manifests sudden, brief, rapid jerks, involving the trunk or limbs. A sudden brief lapse of consciousness, with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with an absent seizure. Focal seizures with impairment of consciousness the person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Question: A patient is instructed to stand, close both eyes, and extend both arms forward with the palms facing upward for 20-30 seconds. If the forearm drifts downward, this would indicate: a normal finding. lower motor neuron disease. corticospinal tract lesion . Correct cerebellum lesion. Explanation: A patient is instructed to stand, close both eyes, and extend both arms forward with the palms facing upward for 20-30 seconds. If the forearm drifts downward, this would indicate a corticospinal lesion originating in the contralateral hemisphere. An upward drift would be indicative of a lesion in the cerebellum. This test is called the Test for Pronator Drift and is used to test for upper motor neuron disease. Question: To identify sensory deficits comparing symmetric areas, the nurse practitioner would compare the sensation: in the thumb to that in the little finger. in both arms. Correct by mapping out the area of sensory loss. and vibration in the fingers or toes. Explanation: To identify sensory deficits by comparing symmetric areas, the nurse practitioner would compare the sensation on both sides of the body. For example, the right arm should have the same perception of sensation as the left arm. An example of a comparison of the distal with proximal areas, the sensation in the thumb would be compared to that in the little finger. Mapping an area of sensory loss or hypersensitivity would be assessed by stimulating first the point of reduced sensation and moving by progressive steps until the patient detects the change. When testing vibration and position, first test the fingers and toes. Question: The three important questions that govern the neurological examination include: Is the mental status intact?, Are right-sided and left-sided findings symmetric?, and: Are deep tendon reflexes intact?. Are vital signs stable? If findings are abnormal, is the cause in the central or peripheral nervous system?. Correct Are the cranial nerves intact?. Explanation: The three important questions that govern the neurological examination include: Is the mental status intact?, Are right-sided and left-sided findings symmetric?, and If findings are abnormal, is the cause in the central or peripheral nervous system?. The other questions are also important to ask but are not included in the 3 most important ones for the neurological exam. Question: The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as: obtundation. alertness. Correct lethargy. stupor. Explanation: The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as alertness. An obtunded patient opens his eyes, looks at the person speaking to him but responds slowly and appears confused. Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. A stuporous patient arouses from sleep only after painful stimuli. Question: A transient ischemic attack is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemia, without acute infarction. Correct an infarction of the central nervous system tissue that may be silent or symptomatic. the abrupt onset of motor or sensory deficits. focal or asymmetric weaknesses caused by central and peripheral nerve damage. Explanation: TIA is now defined as “a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.” Ischemic stroke is “an infarction of central nervous system tissue” that may be symptomatic or silent. The other terms are not related to the new definitions. Question: A patient is noted as lying supine with the jaws clenched and the neck extended with the arms adducted and stiffly extended at the elbows. His forearms are pronated, wrists and fingers flexed. The legs are extended at the knees and the feet are plantar flexed. This position is consistent with: hemiplegia. decorticate rigidity. decerebrate rigidity. Correct paratonia. Explanation: In decerebrate rigidity, the jaws are clenched and the neck is extended with the arms adducted and stiffly extended at the elbows, with forearms pronated, wrists and fingers flexed. A patient is noted as lying supine in an abnormal posture with the upper arms flexed tight to the sides with elbows, wrists, and fingers flexed. His legs are extended and internally rotated and his feet are plantar flexed. This position is consistent with decorticate rigidity. The legs are extended at the knees and the feet are plantar flexed. Hemiplegia refers to one-sided paralysis. Paratonia refers to a form of hypertonia with an involuntary variable resistance during passive movement. Question: A mother reports to the nurse practitioner that her teenager might be taking drugs because earlier today the teenager had a mild seizure and now has an unstable gait and is beginning to complain of shortness of breath. These symptoms might be consistent with a possible overdose of: barbiturates. amphetamines. Correct marijuana. opioids. Explanation: Amphetamines are central nervous system (CNS) stimulants. The teenager could exhibit signs of ataxia, respiratory distress, seizures, coma, myocardial infarction, death if he/she consumed this substance. Impaired memory, judgment, and attention, slurred speech, drowsiness, and irritability are suggestive of central nervous system depressants (CNS). Barbiturates, alcohol and benzodiazepines fall in this class. Opioids may cause euphoria, drowsiness, constricted pupils and some of the same symptoms as CNS depressants. Marijuana intoxication would present with relaxation, euphoria, detachment, talkativeness, slowed perception of time, and possible anxiety or paranoia. Question: Hypesthesia refers to: absence of touch sensation. decreased sensitivity to touch. Correct increased sensitivity to touch. absence of pain sensation. Explanation: Anesthesia is absence of touch sensation; hypesthesia is decreased sensitivity to touch; hyperesthesia is increased sensitivity to touch; and analgesia refers to absence of pain sensation. Question: With the adult patient lying supine, the nurse practitioner flexes the patient's leg at both the hip and the knee and then straightens the knee. Pain and increased resistance to extending the knee is noted. This is a positive: Brudzinski's sign. Kernig's sign. Correct nuchal rigidity sign. Babinski's sign. Explanation: To test for Kernig's sign, flex the patient's leg at both the hip and the knee and then straighten the knee. Pain and increased resistance to extending the knee are positive for Kernig's sign. To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is positive for Brudzinski's. With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward so that his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is positive for nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. To elicit the Babinski response, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick; plantar flexion is normal. Dorsiflexion of the big toe is Babinski's sign. Question: When evaluating a patient for weakness of the upper extremities, bilateral proximal limb weakness without sensory loss is noted. This finding could be suggestive of: alcohol myopathy. Correct polyneuropathy. myositis. neuromuscular junction disorders. Explanation: Proximal limb weakness, usually symmetric and without sensory loss, occurs in myopathies from alcohol, glucocorticoids, and inflammatory muscle disorders like myositis and dermatomyositis. Bilateral predominantly distal weakness suggests a polyneuropathy, as in diabetes. In the neuromuscular junction disorder myasthenia gravis, there is proximal, typically asymmetric weakness that gets worse with effort. Question: Which one of the following assesses pain, temperature, and sensation using the distal and proximal areas testing pattern? Test the sensation in the thumbs and little fingers Correct Compare the sensation in the right arm to that in the left arm Test the sensation in the fingers and the toes Stimulate first at an area of reduced sensation and move by progressive steps until the patient detects a change Explanation: When testing pain, temperature, and touch sensation, also compare the distal with the proximal areas of the extremities. Further, scatter the stimuli so as to sample most of the dermatomes and major peripheral nerves. An example would be to test the thumbs and fingers (C6 and C8). Comparing the sensation in the right arm with that in the left arm would be an example of the testing pattern of comparing symmetric areas. Testing the fingers and toes is an example of testing pattern for vibration and position sense. By stimulating an area of reduced sensation and moving by progressive steps until the patient detects a change is an example of the pattern of mapping out the boundaries for sensory loss. Question: When trying to determine the level of consciousness in a patient whose level of consciousness is altered, a lethargic patient: opens the eyes and looks at the examiner, responds slowly, and is somewhat confused. appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. Correct arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state. remains unarousable with eyes closed. Explanation: A lethargic patient appears drowsy but opens his eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. Question: With the adult patient lying supine, the nurse practitioner flexes the patient's neck while observing the hips and knees. Flexion of both hips and knees was noted. This is a positive: Brudzinski's sign. Correct Kernig's sign. nuchal rigidity sign. Babinski's sign. Explanation: To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is positive for Brudzinski's sign. To test for Kernig's sign, flex the patient's leg at both the hip and the knee and then straighten the knee. Pain and increased resistance to extending the knee are positive for Kernig's sign. With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward so that his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is positive for nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. To elicit the Babinski response, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick; plantar flexion is normal. Dorsiflexion of the big toe is a positive Babinski's sign. Question: The part of the brain tissue that consists of neuronal axons that are coated with myelin is the: basal ganglion. white matter. Correct gray matter. thalamus. Explanation: Brain tissue may be gray or white. Gray matter consists of aggregations of neuronal cell bodies. It rims the surfaces of the cerebral hemispheres, forming the cerebral cortex. White matter consists of neuronal axons that are coated with myelin. The myelin sheaths, which create the white color, allow nerve impulses to travel more rapidly. Question: The inability to hop in place on each foot, could be suggestive of a: cerebellar dysfunction. Correct corticospinal tract weakness. proximal tract weakness. weakness of the quadriceps. Explanation: Inability to hop in place on each foot could denote cerebellar dysfunction, weakness, or lack of position sense. Hopping involves the proximal muscles of the legs as well as the distal ones and requires both good position sense and normal cerebellar function. Walking on the toes and heels may reveal distal muscular weakness in the legs. Inability to heel-walk is a sensitive test for corticospinal tract weakness. Difficulty performing a shallow knee bend would suggest proximal weakness in the extensors of the hip, weakness of the quadriceps, extensors of the knee, or both. Question: The term used to describe an abnormal tremor consisting of involuntary jerking movements, especially in the hands is: asterixis. Correct sciatica. dermatome. stereognosis. Explanation: Asterixis refers to an abnormal tremor consisting of involuntary jerking movements, especially in the hands, frequently occurring with impending hepatic coma and other forms of metabolic encephalopathy. This is also called flapping tremor. The term used to describe low back pain with nerve pain that radiates down the leg is sciatica. A dermatome is a band of skin innervated by the sensory root of a single spinal nerve. Stereognosis refers to the ability to identify an object by feeling it. Question: When assessing an elderly patient for delirium, the recommended instrument with the best supportive data is the: Delirium Rating Scale (DRS). Confusion Assessment Method (CAM). Correct Mini Mental State Examination (MMSE). Delirium Superimposed on Dementia Algorithm (DSDA). Explanation: Confusion Assessment Method (CAM), a screening tool specifically designed to detect delirium, is the most recommended because it provides the best supportive data for bedside use and takes 5 minutes to complete. The Delirium Rating Scale (DRS) covers a range of symptoms relating to delirium, and is useful for diagnostic purposes and for assessing severity and distinguishing delirium from other disorders. It is very complex and requires advanced training to administer. The MMSE is the most widely used instrument to test cognitive function. The Delirium Superimposed on Dementia Algorithm recommends a process to assess for delirium for people with a pre-existing dementia. Question: Walking on the toes and heels may reveal: distal muscular weakness in the legs. Correct ataxia. a cerebellar dysfunction. proximal weakness of the extensors of the hip. Explanation: Walking on the toes and heels may reveal distal muscular weakness in the legs. Inability to heel-walk is a sensitive test for corticospinal tract weakness. An ataxia would be suspected if the patient was unable to walk heel-to-toe in a straight line. Inability to hop in place on each foot would denote cerebellar dysfunction. Difficulty performing a shallow knee bend would suggest proximal weakness in the extensors of the hip, weakness of the quadriceps, extensors of the knee, or both. Question: Involuntary rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue are known as: facial tics. dystonic movements. athetoid movements. oral-facial dyskinesias. Correct Explanation: Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Question: Persistent blinking after glabellar tap and difficulty walking heel-to- toe are common in: Alzheimer's disease. Muscular Dystrophy. Parkinson’s disease. Correct Multiple Sclerosis. Explanation: Glabellar tap is a primitive reflex that is characterized by blinking eyes when a patient is lightly tapped between the eyebrows. In less that 5 taps, a normal individual will stop blinking. In Parkinson's disease, persistent blinking will occur until the examiner stops tapping. Difficulty walking heel-to-toe are common in Parkinson's disease. Question: To evaluate a patient's response to light touch sensation, the nurse practitioner would ask the patient to identify: a touch on the skin in response to touching the skin with a cotton wisp. Correct an object as being hot or cold. a vibration sensation on the big toe. pain as sharp or dull when the thumb is touched using the sharp end of a safety pin. Explanation: A light touch on the skin in response to touching the skin with a cotton wisp would be an example of assessing for light touch. To evaluate for pain, a safety pin could be used to determine if the sensation is sharp or dull. To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify an object as being hot or cold. To test for vibration, use a tuning fork over the interphalangeal joint of the big toe and ask the patient if he feels the vibration. Question: A form of aphasia where articulation is good but sentences lack meaning is referred to as: Broca's aphasia. anomic aphasia. Wernicke's aphasia. Correct global aphasia. Explanation: With Wernicke's aphasia, speech is fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible. In Broca's aphasia, speech is confluent, slow, with few words and laborious effort. Inflection and articulation are impaired but words are meaningful, with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped. With anomic aphasia, the person has word-finding difficulties and because of the difficulties, the person struggles to find the right words for speaking and writing. With global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. Question: While assessing the cranial nerves, the nurse practitioner touches the cornea lightly with a wisp of cotton. This maneuver assesses which cranial nerve? Cranial Nerve II (CN II) Cranial Nerve IV (CN IV) Cranial Nerve V (CN V) Correct Cranial Nerve X (CN X) Explanation: Touching the cornea and assessing for a reflex assesses cranial nerve V. Question: By placing the patient in the supine position, the nurse practitioner raises the patient's relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is known as: Kernig's sign. the straight-leg raise. Correct the plantar response. the ankle reflex. Explanation: By placing the patient in the supine position, the nurse practitioner raises the patient's relaxed and straightened leg while flexing the leg at the hip, then dorsiflexes the foot. This maneuver is known as the straight leg raise and is used to evaluate sciatica. It is positive if there is pain down the back of the leg below the knee. Ipsilateral calf wasting and weak ankle dorsiflexion may be present. Question: Hyperesthesia refers to: absence of touch sensation. decreased sensitivity to touch. increased sensitivity to touch. Correct absence of pain sensation. Explanation: Anesthesia is absence of touch sensation; hypesthesia is decreased sensitivity to touch; hyperesthesia is increased sensitivity to touch; and analgesia refers to absence of pain sensation. Question: A female patient complains of weakness in her hand when opening a jar. This finding could be suggestive of which type of weakness pattern? Proximal Distal Correct Symmetric Asymmetric Explanation: To identify distal weakness, ask about hand movements when opening a jar, can or using scissors or a screwdriver. Another example is a problems like tripping when walking. Question: When trying to determine the level of consciousness in a patient whose level of consciousness is altered, a comatose patient: opens the eyes and looks at the examiner, responds slowly, and is somewhat confused. appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. arouses from sleep after exposure to painful stimuli, exhibits slow verbal response, and easily lapses into an unresponsive state. remains unarousable with eyes closed. Correct Explanation: A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. Question: What geriatric condition is characterized by normal alertness but progressive global deterioration of cognition in multiple domains? Delirium Cognitive impairment Parkinson's disease Alzheimer's disease Correct Explanation: Alzheimer's disease is a geriatric condition in which normal alertness is present but progressive global deterioration of cognition occurs in multiple domains, including short- term memory, but with sparing of memory for remote events, subtle language errors, visuospatial perceptual difficulties, and changes in executive function, or the ability to perform sequential tasks such as instrumental activities of daily living (IADLs). Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Parkinson's disease is a progressive disorder of the nervous system that affects movement. Question: Having the patient shrug his shoulders and elicit neck movements would be testing Cranial Nerve: VI. VII. IX. XI. Correct Explanation: Cranial Nerve XI is the spinal accessory nerve and is responsible for proper functioning of the shoulder and neck muscles. When the trapezius is paralyzed, the shoulder droops and the scapula is displaced downward and laterally. Weakness with atrophy and fasciculations indicates a peripheral nerve disorder. CN VI tests extraocular movements; CN VII tests hearing; and CN IX and X test swallowing and the gag reflex. Question: To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify: a light touch on the skin in response to touching the skin with a cotton wisp. an object as being hot or cold. Correct a vibration sensation on the big toe. pain as sharp or dull when the thumb is touched using the sharp end of a safety pin. Explanation: To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify an object as being hot or cold. A light touch on the skin in response to touching the skin with a cotton wisp would be an example of assessing for light touch. To evaluate for pain, a safety pin could be used to determine if the sensation is sharp or dull. To test for vibration, use a tuning fork over the interphalangeal joint of the big toe and ask the patient if he feels the vibration. Question: During this type of seizure activity, the patient experiences partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurologic deficit is present during the postictal period. This type of seizure activity is referred to as a: focal seizure with impairment of consciousness. Jacksonian seizure. focal seizure that becomes generalized. Correct grand mal seizure. Explanation: Focal seizures that become generalized are partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurologic deficit is present during the postictal period. Focal seizures with impairment of consciousness the person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Tonic and then clonic movements that start unilaterally in the hand, foot, or face and spread to other body parts on the same side with the patient remaining conscious are known as Jacksonian seizures. During a grand mal seizure the person loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. Question: The principal muscles involved when closing the mouth are innervated by which Cranial nerve? Cranial nerve III (CN III) Cranial nerve V (CN V) Correct Cranial nerve VII (CN VII) Cranial nerve XII (CN XII) Explanation: The muscles responsible for closing the mouth are innervated by Cranial nerve V (trigeminal nerve). Cranial nerve V innervates the masseter, the temporalis, and the internal pterygoids. Question: A patient presents with history of temperature of 102°F, headache, and pink papules on the upper chest several hours ago. Petechiae and ecchymosis are noted on the trunk. These skin lesions may be indicative of: leukemia. meningococcemia. Correct neurofibromatosis. hemorrhagic pancreatitis. Explanation: Skin lesions associated with meningococcemia initially present as pink macules and papules. Within minutes to a few hours, petechiae, hemorrhagic petechiae, hemorrhagic bullae, and purpura fulminans become apparent. With meningococcemia meningitis, the temperature may be 102°F or greater and the patient appears very ill. Skin lesions associated with leukemia may include pallor, exfoliative erythroderma, nodules, petechiae, ecchymoses, pruritus, vasculitis, pyoderma gangrenosum, and bullous diseases. Skin lesions associated with neurofibromatosis may include, neurofibromas, cafe´-au-lait spots, freckling in the axillary and inguinal areas, and plexiform neurofibroma. Hemorrhagic pancreatitis skin lesions include Grey Turner's sign (bruising of the flanks, appearing as a blue discoloration), Cullen's sign (superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus), and panniculitis (a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue). Question: Aphasia refers to: the inability to produce or understand language. Correct the loss of voice. an impairment in volume of the voice. a defect in the muscular control of the speech apparatus. Explanation: Aphasia refers to a disorder in producing or understanding language. Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Question: The part of the brain that maintains homeostasis is the: basal ganglion. thalamus. hypothalamus. Correct cerebellum. Explanation: The hypothalamus maintains homeostasis and regulates temperature, heart rate, and blood pressure. The hypothalamus affects the endocrine system and governs emotional behaviors such as anger and sexual drive. Hormones secreted in the hypothalamus act directly on the pituitary gland. Question: Sudden, brief, rapid jerks, involving the trunk or limbs may be consistent with: a myoclonic seizure. Correct an absent seizure. a myoclonic atonic seizure. a focal seizure with impairment of consciousness. Explanation: A patient experiencing a myoclonic seizure manifests sudden, brief, rapid jerks, involving the trunk or limbs. A sudden brief lapse of consciousness with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with an absent seizure. During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. Focal seizures with impairment of consciousness the person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Question: Involuntary movements of the body that involve larger portions of the body, including the trunk resulting in grotesque, twisted postures are suggestive of: facial tics. dystonic movements. Correct athetoid movements. oral-facial dyskinesias. Explanation: Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. Question: On examination of an eighteen-year-old which one of the following neurological signs would not be helpful if meningitis is suspected? Pain in the neck and resistance to flexion. A positive Brudzinski's sign. A positive Kernig's sign. Loss of the anal reflex. Correct Explanation: If meningitis is suspected, nuchal rigidity, positive Brudzinski sign, and Kernig's sign should all be assessed. If these meningeal signs are positive, meningitis is suspected. A loss of anal reflex would suggest a lesion in the S2, 3, and 4 reflex arc. Therefore, it would not be helpful with the differential diagnosis. Question: The term used to describe the impaired ability to adjust to one's body position is: dystonia. bradykinesia. Correct akinesia. dyskinesia. Explanation: Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. The absence or loss of control of voluntary muscle movements is akinesia. Dyskinesia is the presence of involuntary muscle movements such as tics or chorea. These movements can be seen in children who have rheumatic fever. Question: With the adult patient lying supine, the nurse practitioner strokes the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick. Dorsiflexion of the big toe was noted. This is a positive: Brudzinski's sign. Kernig's sign. nuchal rigidity sign. Babinski's sign. Correct Explanation: To elicit Babinski sign, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick. Plantar flexion is normal. Dorsiflexion of the big toe is a positive Babinski's sign. To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is positive for Brudzinski's. To test for Kernig's sign, flex the patient's leg at both the hip and the knee and then straighten the knee. Pain and increased resistance to extending the knee are positive for a Kernig's sign. With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward until his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is positive nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. Question: When assessing the cranial nerves, the nurse practitioner instructs the patient to stick out his tongue and move it from side to side. This maneuver would be used to assess which cranial nerve? Cranial Nerve V (CN V) Cranial Nerve VII (CN VII) Cranial Nerve IX (CN IX) Cranial Nerve XII (CN XII) Correct Explanation: Instructing the patient to stick out his tongue and move it from side to side would be used to assess cranial nerve XII (CN XII)-Hypoglossal nerve. Question: Which of the following neurological assessment findings indicate the need for further evaluation? Lifting one foot and then the other when the infant is held upright with the feet touching a solid surface Fanning and hyperextension of the toes when the sole is stroked upward from the heel Grasping a finger placed in the neonate's palm Weak and ineffective sucking movements Correct Explanation: Weak and ineffective sucking movements would indicate the need for further evaluation since any weak, absent, asymmetrical or fine jumping movements would suggest neurological system disorders. The other choices represent common reflexes found in the normal newborn: Babinski, grasping, and stepping. Question: Which of the following symptoms may be associated with a tumor of the eighth cranial nerve? Dizziness Correct Inability to close the eyes Loss of the sense of smell Inability to taste sour things Explanation: The eighth cranial nerve (CN) is the vestibulocochlear nerve and it is responsible for hearing and balance. The main symptoms of an acoustic neuroma are hearing loss and tinnitus. They are caused by a tumor affecting the auditory nerve. Inability to close the eye would reflect an abnormality of CN VII, the facial nerve. CN I, the olfactory nerve, is responsible for the sense of smell. Two cranial nerves are responsible for the taste, CN VII and X. Question: When assessing the cranial nerves, the nurse practitioner uses the tongue blade to gently stimulate the back of the throat on each side. A unilateral absence of the gag reflex is noted. This finding could be suggestive of a unilateral lesion in which cranial nerve? Cranial Nerve V (CN V) Cranial Nerve VII (CN VII) Cranial Nerve IX (CN IX) Correct Cranial Nerve XII (CN XII) Explanation: Unilateral absence of the gag reflex suggests a lesion of CN IX or CN X. glossopharyngeal and vagus nerves. Question: When assessing abdominal cutaneous reflexes, the nurse practitioner strokes the lower abdomen, the localized twitch is absent. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Thoracic 8, 9, and 10 Thoracic 10, 11, and 12 Correct Lumbar 5 and Sacral 1 Sacral 2, 3, and 4 Explanation: Superficial (cutaneous) reflexes and their corresponding spinal segments include the following: Abdominal reflexes: upper thoracic 8, 9, 10 and lower thoracic 10, 11, 12; Plantar: lumbar 5 and sacral 1; and Anal: sacral 2, 3, 4. Question: One way to assess cerebellar function would be to have the patient: hop on one foot. Correct read out loud. shrug the shoulders. discriminate between light and sharp pain. Explanation: The cerebellar function tests are used to monitor the patient's sense of equilibrium, which includes the patient's gait (walk), ability to stand upright with eyes closed (Romberg test), touch finger to nose, and move the heel to opposite knee while lying down. Other examples also include: hopping on one foot, walking heel-to-toe, and touching the examiner's finger and the examinees' nose. Reading out loud tests visual acuity; shrugging shoulders assesses the spinal accessory nerve and discriminating pain between light and sharp assesses the sensory system. Question: The term used to describe the absence or loss of control of voluntary muscle movements is: dystonia. bradykinesia. akinesia. Correct dyskinesia. Explanation: The absence or loss of control of voluntary muscle movements is akinesia. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. Dyskinesia is the presence of involuntary muscle movements such as tics or chorea. These movements can be seen in children who have rheumatic fever. Question: A type of seizure activity that includes tonic and then clonic movements and usually starts in the hand, foot or face then spreads to other parts of the body is known as a: focal seizure with impairment of consciousness. Jacksonian seizure. Correct focal seizure that become generalized. grand mal seizure. Explanation: Tonic and then clonic movements that start unilaterally in the hand, foot, or face and spread to other body parts on the same side with the patient remaining conscious are known as Jacksonian seizures. Focal seizures with impairment of consciousness is characterized when a person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Focal seizures that become generalized are partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurologic deficit is present during the postictal period. During a grand mal seizure the person loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. Question: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates muscle strength? Motor system Correct Cerebellar system Vestibular system Sensory system Explanation: Coordination of muscle movement requires that four areas of the nervous system function in an integrated way: motor system for muscle strength, cerebellar system for rhythmic movements and steady posture, vestibular system for balance and coordinating eye, head, and body movements, and sensory system for position sense. Question: When a two-week-old infant presents with irritability, poor appetite, and rapid head growth with distended scalp veins, one should consider: hydrocephalus. Correct meningitis. cerebral palsy. Reye's syndrome. Explanation: The combination of signs is strongly suggestive of hydrocephalus: shrill with high- pitched cry, irritability, tense and bulging fontanels due to the increased amount of CSF being produced or not being absorbed. Meningitis would include signs of sepsis/infection. The manifestations of cerebral palsy vary but may include: persistence of primitive reflexes, delayed gross motor development, and a lack of progression through developmental milestones. Reye’s syndrome is associated with an antecedent viral infection with symptoms of malaise, nausea, and vomiting, progressive neurological deterioration occurs. Question: When evaluating the sensory system, testing the posterior columns tract would include assessing sensations of: position and vibration. Correct pain and temperature. deep touch. discriminative sensations. Explanation: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of pain and temperature. Assessing position and vibration evaluate the posterior columns. Light touch assesses both the spinothalamic and posterior column tracts. To assess discriminative sensation, both the spinothalamic and posterior columns tracts as well as the cortex would be assessed. Question: A patient experiences difficulty rising from a sitting position without arm support. This would be suggestive of: distal muscle weakness of the pelvic girdle and legs. poor muscle coordination. proximal muscle weakness of the pelvic girdle and legs. Correct a weak vestibular system. Explanation: A patient who experiences difficulty rising from a sitting position without arm support or is unable to step up on a sturdy stool without support suggests proximal muscle weakness of the pelvic girdle and legs. Question: An 8-month-old with a significant head lag would suggest the need for: exercises that strengthen the neck muscles. a follow-up visit in 2 months. a neurological evaluation. Correct an orthopedic referral. Explanation: A baby typically should be able to control the neck muscles by around 4 months of age, so that when pulling from a lying to a sitting position the head should remain in line with the torso and not flop back. Delays in reaching this developmental milestone have been observed in premature babies and in those with cerebral palsy; all others should be referred to a pediatric neurologist for further evaluation. The other choices do not address the issue or the cause. Early interventions result in better outcomes. Question: The most widely used tool available to assess for dementia in an elderly patient is the: Delirium Rating Scale (DRS). Confusion Assessment Method (CAM). Mini Mental State Examination (MMSE). Correct Delirium Superimposed on Dementia Algorithm (DSDA). Explanation: The Mini Mental State Examination (MMSE)is the most widely used instrument to test cognitive function and is considered the best tool for assessing most elderly patients suspected of experiencing dementia. Confusion Assessment Method (CAM), a screening tool specifically designed to detect delirium, is the most recommended because it provides the best supportive data for bedside use and takes 5 minutes to complete. The Delirium Rating Scale (DRS) covers a range of symptoms relating to delirium, and is useful for diagnostic purposes and for assessing severity and distinguishing delirium from other disorders. It is very complex and requires advanced training to administer. The Delirium Superimposed on Dementia Algorithm recommends a process to assess for delirium for people with a pre-existing dementia. Question: Uncontrolled electrical activity in the brain, which may produce minor physical signs, thought disturbances, or disturbed motor activity is: dystonia. bradykinesia. tremor. seizure. Correct Explanation: A seizure is an uncontrolled electrical activity in the brain which may produce minor physical signs, thought disturbances, or disturbed motor activity, or a combination of symptoms. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is a tremor. Question: A term used to describe an increase in muscular bulk with proportionate strength is: hypertrophy. Correct muscular atrophy. pseudohypertrophy. muscle weakness. Explanation: Hypertrophy refers to an increase in bulk of the muscle with a proportionate increase in strength. A term used to describe muscle wasting or loss of muscle bulk is muscular atrophy. An increase in muscular bulk with diminished strength is known as pseudohypertrophy. Muscular weakness is a term used to describe a lack of strength or firmness in a muscle. Question: The part of the brain that controls most functions in the body and is responsible for breathing, heart rate, and articulate speech is the: cerebrum. brainstem. Correct cerebellum. diencephalon. Explanation: The nerve connections of the motor and sensory systems from the main part of the brain to the rest of the body pass through the brainstem. The brainstem controls most functions in the body but mostly responsible for breathing, heart rate, and articulate speech. The cerebrum controls all voluntary actions of the body with the aid of the cerebellum. The diencephalon relays sensory information between brain regions and controls many autonomic functions of the peripheral nervous system. It also connects structures of the endocrine system with the nervous system and works in conjunction with limbic system structures to generate and manage emotions and memories. The cerebellum, which lies at the base of the brain, coordinates all movement and helps maintain the body upright in space. Question: Symptoms indicative of Shaken Baby Syndrome are related to: poor nutrition and lack of parental bonding. vaso-occlusive crisis and cerebral infarction. uncontrollable cerebral edema and hypoxia. Correct microcephaly and premature closures of the cranial sutures. Explanation: Brain damage resulting from shaking of the body and rapid flexing and extension of the head results in hypoxia and cerebral edema leading to symptoms of blindness, inability to perform previously learned milestones, and very flaccid muscle tone. The other choices are not the culprits of this type injury/abuse. It is caused by someone shaking the child and causing irreversible brain damage in most cases. Question: Fasciculations in atrophic muscles suggest: a lower motor neuron disease. Correct rheumatoid arthritis. peripheral nervous system disease. a central nervous system disorder. Explanation: Fasciculations are small muscle twitches and can be found in any muscle of the body. Fasciculations are not usually serious but can be annoying. If they occur in atrophic muscles, this may suggest a lower motor neuron disease. They are not seen in central or peripheral nervous system disease or rheumatoid arthritis. Question: When assessing coord