Nr 603 Week 1

NR 603 WEEK 1 |2025| complete exam
test questions and verified answers
(MULTIPLE CHOICES) AND
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AA75-year-
oldAmanAisAinvolvedAinAaAmotorAvehicleAaccidentAandAstrikesAhisAforeheadAonAtheAwindshiel
d.AHeAcomplainsAofAneckApainAandAsevereAburningAinAhisAshouldersAandAarms.AHisAphysic
alAexaminationArevealsAweaknessAofAhisAupperAextremities.AWhatAtypeAofAspinalAcordAinjur
yAdoesAthisApatientAhave?

AAanteriorAcordAsyndromeA
BAcentralAcordAsyndromeA
CABrown-SéquardAsyndromeA
DAcompleteAcordAtransectionA
EAcaudaAequinaAsyndrome
ANS:ABA-ACORRECTAANSWER-CentralACordASyndrome
theAcentralAcordAsyndromeAinvolvesAlossAofAmotorAfunctionAthatAisAmoreAsevereAinAtheAupp
erAextremitiesAthanAinAtheAlowerAextremities,AandAisAmoreAsevereAinAtheAhands.AThereAisAty
picallyAhyperesthesiaAoverAtheAshouldersAandAarms.AAnteriorAcordAsyndromeApresentsAwit
hAparaplegiaAorAquadriplegia,AlossAofAlateralAspinothalamicAfunctionAwithApreservationAofAp
osteriorAcolumnAfunction.ABrown-
SéquardAsyndromeAconsistsAofAweaknessAandAlossAofAposteriorAcolumnAfunctionAonAoneAs
ideAofAtheAbodyAdistalAtoAtheAlesionAwithAcontralateralAlossAofAlateralAspinothalamicAfunctio
nAoneAtoAtwoAlevelsAbelowAtheAlesion.ACompleteAcordAtransectionAwouldAaffectAmotorAandA
sensoryAfunctionAdistalAtoAtheAlesion.ACaudaAequinaAsyndromeAtypicallyApresentsAasAlowAb
ackApainAwithAradiculopathy.
AA37-year-
oldAmanAfellAfromAaAladderAasAheAfinishedAhangingAtheAChristmasAlightsAonAhisAhouse.AThe
ArightAsideAofAhisAheadAhitAtheAalleyAcement,AandAheAlostAconsciousnessAforAaboutA1Aminut

e;AheAwokeAupAwithAaAheadache,AbutAheAhadAnoAotherAcomplaints.AAAfewAhoursAlater,AtheAp
atientAisAbroughtAtoAtheAemergencyAroomAbyAhisAneighborAbecauseAofAanAintenseAheadach
e,Aconfusion,AandAleftAhandAhemiparesis.AOnAexamination,AtheApatientAhasAaAbruiseAlocate
dAoverAtheArightAtemporalAregion,Amydriasis,AandArightAdeviationAofAtheArightAeye,Apapillede
ma,AandAleftAextensorAplantarAresponse.AAnAemergencyACTAscanAofAtheAheadAwithoutAcont
rastArevealsAaAlens-shapedAhyper-
densityAunderAtheArightAtemporalAboneAwithAmassAeffectAandAedema.AWhatAisAtheAmostAlik
elyAdiagnosis?

,AnswerAChoices
1AEpiduralAhematoma
2ASubduralAhematoma
3ASubarachnoidAhemorrhage
4AIntracerebralAparenchymalAhemorrhage
5AAcuteAmeningitis
ANS:A1A-ACORRECTAANSWER-EpiduralAHematoma
EpiduralAhematomaAmostAoftenAresultsAfromAaAtraumaticAtearAofAtheAmiddleAmeningealAart
ery.AAlthoughAaAlucidAintervalArangingAfromAminutesAtoAhoursAfollowedAbyAalteredAmentalAs
tatusAandAfocalAdeficitsAisAtypicalAforAepiduralAhematoma,AthisAclinicalApictureAisAonlyAenco
unteredAinAupAtoA1/3AofAtheApatients.ATheAcollectionAofAbloodAbetweenAtheAskullAandAduraA
materAcausesAanAevidentAmassAeffectAwithAophthalmicAnerveApalsyAandAtheAcontralateralA
hemiparesis.ASurgicalAevacuationAofAtheAclotAviaAburrAholesAisAtheAtreatmentAofAchoice.

SubduralAhematomaAresultsAfromAaAtraumaticAruptureAofAtheAbridgingAveinsAthatAconnectAt
heAcerebrumAtoAtheAvenousAsinusesAwithinAtheAdura.AThisAvenousAhemorrhageAwillAresultAi
nAaAgradualAincreaseAofAtheAhematoma,AwithAaAprogressiveAclinicalApictureAoverAdaysAorAw
eeks.ATheACTAscanAwillAshowAaAconcave,Acrescent-shapedAhyper-
densityAcomparedAtoAtheAconvex,Alens-shapedAhyper-densityAinAepiduralAhematoma.

SubarachnoidAhemorrhageAisAtheAresultAofAanAaneurysmArupture;AtheAmostAcommonAisAth
eAcongenitalAberryAaneurysm.ATheAclinicalApictureAisAofAaAsudden,AsevereAheadacheAwithA
meningealAirritation.AAACTAscanAwillAshowAbloodAinAtheAsubarachnoidAspace,AandAaAlumba
rApunctureAwillArevealAxanthochromiaACSF.

IntracerebralAparenchymalAhemorrhageAisAmostAlikelyAcausedAbyAhypertensionAcomplicat
edAwithACharcot-
BouchardAaneurysms.ATheAbloodAaccumulatesAintoAtheAbrainAsubstanceAandAmostAcomm
onlyAinvolvesAtheAbasalAganglia.

AcuteAmeningitisAisAnotAassociatedAwithAtrauma.AFeverAandAsignsAofAmeningealAirritationAd
ominateAtheAclinicalApicture.ALumbarApuncture,AindicatedAifAthereAareAnoAfocalAneurological
AsignsAonAclinicalAexamination,AwillAbeAtheAdiagnosticAprocedure.ATheACTAscanAofAtheApati

entApresentedAinAthisAcaseAisAcharacteristicAforAepiduralAhematoma,AandAthereAisAnoAindica
tionAforAaAlumbarApunctu
AA31-year-
oldAwomanApresentsAwithAaApurpuralArashAcoveringAherAarms,Alegs,AandAabdomen.ASheAal
soAhasAfever,Achills,Anausea,AabdominalAtenderness,Atachycardia,AandAgeneralizedAmyalgi
as.APriorAtoAtheAdevelopmentAofAtheArash,AtheApatientAnotedAthatAsheAhadAaAheadache,Acou
gh,AandAsoreAthroat.ALaboratoryAstudiesAwereApositiveAforAGram-
negativeAdiplococciAinAtheAblood,AalongAwithAthrombocytopeniaAandAanAelevationAinAPMNs
.AUrinalysisAshowedAblood,Aprotein,AandAcasts.AVitalAsignsAareAasAfollows:APBA92/66,APA96,
ARRA14,ATA39.ATheApatientAdeniesAanyAforeignAtravelAandAdoesAnotAhaveAanyAsickAcontacts

.AHowever,AsheAdoesAworkApartAtimeAasAaAnurseAinAaAlocalAhospital.
QuestionA

,TheApatientAisAdiagnosedAwithAMeningococcemia;AsheAisAadmittedAtoAtheAhospitalAandApla
cedAinArespiratoryAisolation.AWhatAmajorAcourseAofAtherapyAshouldAthisApatientAreceive?

AnswerAChoices
1ASteroids
2ASupportiveAcare
3AAntibiotics
4ATransfusion
5ABactericiA-ACORRECTAANSWER-Antibiotics
AntibioticsAareAtheAtreatmentAofAchoiceAforAmeningococcemia.ATheApreferredAdrugAforAacti
veAinfectionAisApenicillinAG.AForAthoseAallergicAtoApenicillin,AchloramphenicolAandAcephalos
porinsA(ie,Acefotaxime,Acefuroxime)AmayAbeAusedAasAalternatives.

PatientsAwillAalsoAreceiveAsupportiveAcare,AbutAantibioticAtherapyAmustAbeAinitiatedAquicklyA
ifAtheApatientAisAtoAsurvive.AIntensiveAcareAplacementAmayAbeAnecessaryAifAorganAfailureAisA
imminent.AVentilatoryAsupport,AinotropicAsupport,AandAIVAfluidsAareAnecessaryAinAsome.AIfA
adrenalAinsufficiencyAoccurs,AcorticosteroidAreplacementAmayAbeAconsidered.AAAcentralAv
enousAlineAhelpsAtoAprovideAlargeAamountsAofAvolumeAexpandersAandAinotropicAmedicatio
nsAforAadequateAtissueAperfusion.

SteroidsAhaveAnotAbeenAshownAtoAplayAaAmajorAroleAinAtheAtreatmentAofAmeningococcemia
.AHowever,AtheyAhaveAbeenAusedAinAadditionAtoAantibioticAtherapy.AInAtheAcaseAofAadrenalAi
nsufficiency,AforAexample,AsteroidAreplacementAhasAbeenAshownAtoAbeAbeneficial.

TransfusionAdoesAnotAgenerallyAplayAaAmajorAroleAinAtreatment.AIfAtheApatientAsuffersAfromA
aAdevastatingAcoagulopathy,AbloodAorAbloodAproductsAmayAbeAreplacedAasAnecessary.

Bactericidal/permeability-
increasingAproteinAisAaAproteinAstoredAinAtheAgranulesAofAneutrophils.AItAbindsAtoAendotoxin
AinAvitroAandAneutralizesAit.AThisAtechniqueAisAexperimental,AandAitAisAnotAusedAinAeverydayA

treatmentAofAmeningococcemia.
InAmyastheniaAgravis,AweaknessAisAaAresultAofAinsufficientAacetylcholineAtransmissionAatAt
heAneuromuscularAjunction;Ahowever,AweaknessAcanAalsoAoccurAwithAoverdosingAofAtheAc
holinergicAmedicationsAusedAtoAtreatAmyasthenia.AWhatAsymptomAhelpsAdifferentiateAaAmy
asthenicAcrisisAfromAaAcholinergicAcrisis?

AnswerAChoices
1ARespiratoryAfailure
2ABilateralAptosis
3AMuscleAfasciculations
4ADiplopia
5ANormalAmuscleAstretchAreflexes

ANS:A3A-ACORRECTAANSWER-MuscleAFasiculations
SignsAofAcholinergicAoverdosageAincludeAmuscleAfasciculation,Arhinorrhea,Alacrimation,Asa
livation,AincreasedAbronchialAsecretions,Anausea,AorAdiarrhea.ATheApresenceAofAanyAofAthe

, seAsuggestsAthatAtheApatient'sAweaknessAmayAbeAdueAtoAcholinergicAcrisis.ATheAotherAsign
sAareAdueAtoAweaknessAandAcanAoccurAinAeitherAcondition.
AA54-year-
oldAmanApresentsAafterAhavingAaAgeneralizedAseizure.ATheApatientAisAHIVApositive,AbutAheA
hasAbeenAunableAtoAaffordAantiretroviralAtherapyAsinceAlosingAhisAjobA2AyearsAago.AOtherAt
hanAcachexia,AtheAphysicalAexamAisAunremarkable.AUponAfurtherAinquiry,AtheApatientAalsoA
notesAthatAheAhasAbecomeAshort-
temperedAandAhypercritical;AatAtimes,AheAseemsAconfused.AAnAMRIAofAtheAbrainAisAperform
ed,AandAitArevealsAseveralAcorticalAring-enhancingAlesions.
QuestionA
WhatAisAtheAmostAlikelyAdiagnosis?
AnswerAChoices
1AAIDSAdementiaAcomplex
2ACryptococcalAmeningitis
3ACytomegalovirusAencephalitis
4AProgressiveAmultifocalAleukoencephalopathy
5AToxoplasmaAencephalitis
ANS:5A-ACORRECTAANSWER-ToxoplasmaAencephalitis
TheApatient'sAsymptomsAandAMRIAfindingsAareAmostAconsistentAwithAtheAdiagnosisAofAtoxo
plasmaAencephalitis.AToxoplasmosisAisAtheAmostAcommonAcerebralAmassAlesionAamongA
HIV-
positiveApatients.AInfectionAwithAtheAToxoplasmaAgondiiAparasiteAisArelativelyAcommonAan
dAusuallyAasymptomatic.AReactivationAoccursAinAHIVApositiveApatientsAdueAtoAfailingAcellul
arAimmunity,AandAitAcausesAaAmultifocalAnecrotizingAencephalitis.ASeizuresAmayAbeAtheAinit
ialAmanifestationAofAcentralAnervousAsystemA(CNS)Ainfection;AotherAcommonAclinicalAmanif
estationsAincludeAfocalAneurologicAdeficits,AsuchAasAimpairedAspeechAandAhemiparesis.AP
ersonalityAchange,Alethargy,Aheadache,AandAconfusionAareAalsoAobserved.ATheAMRIAinApa
tientsAwithAtoxoplasmaAencephalitisAcharacteristicallyArevealsAmultiple,Aring-
enhancingAlesionsAwithAsurroundingAedema;AtheseAlesionsAusuallyAoccurAbilaterallyAinAtheA
frontalAandAparietalAcortices.

AIDSAdementiaAcomplexAdescribesAaAconstellationAofAcognitiveAsymptomsAseenAamongAH
IVApositiveApatients.ATheAconditionAoccursAwhenAHIVAvirusAdisseminatesAtoAtheACNS.AWit
hinAtheACNS,AtheAvirusAtendsAtoAconcentrateAinAtheAbasalAgangliaAandAsubcorticalAregions.
ASymptomsAincludeAaAconstellationAofAcognitive,Abehavioral,AandAmotorAdisturbancesAthatA

causeAvaryingAdegreesAofAfunctionalAimpairment.ACharacteristicAMRIAfindingsAincludeAnon
-
enhancingAwhiteAmatter,AcerebralAatrophy,AandAventricularAenlargement.ATheAdiagnosisAr
equiresAthatAotherAcentralAnervousAsystemAinfections,Acarcinoma,AasAwellAasAgeneralAmed
icalAconditionsAandAsubstanceAabuseAhaveAbeenAexcluded.

CryptococcalAmeningitisAisAcausedAbyAtheAencapsulatedAfungusACryptococcusAneoforman
s.AAmongAHIVApositiveApatients,AtheAillnessAmayAbeAtheAresultAofAnewAinfectionAorAreactiva
tionAofAlatentAinfection.APresentingAsignsAareAoftenAnonspecific;AtheyAincludeAheadache,Afe
v