ANP652 Midterm Exam – Patients with central nervous system injury

Midterm Exam ANP 652

1 Patients with central nervous system injury may commonly have a specific type of gastric ulcer known as (select the best answer):

 Curling’s ulcer

 Duodenal ulcer

 H. pylori ulcer

 Barrett’s ulcer

2 How do you differentiate a cholinergic crisis from a myasthenia crisis? Select the best answer.

 Perform a Tensilon (edrophonium) test.

 Order a stat plasmapheresis trial.

 Obtain a stat cortisol stimulation test.

 Administer rapid immunomodulating therapies (IVIG).

3 Complications of giant cell arteritis include:

 Uveitis

 Arthritis

 Blindness

 Hemiparesis

4 On the Folstein Mini-Mental State Exam, the maximum score is 30, but a score of 23 or less indicates _____.

 Cognitive impairment

 Mental retardation

 Alzheimer’s dementia

 Parkinson’s dementia

5 Atypical antipsychotics like Seroquel, Zyprexa, and Risperdol are the preferred treatments for dementia-related aggression.

 True 

False

6 A 67-year-old male with a past medical history significant for lung cancer is admitted with sepsis. On assessment, you notice petechiae and bruising. Which of the following statements about DIC is not true?

 Results from activation of the clotting cascade and results in clotting factor consumption.

 Diffuse clothing occurs simultaneously with bleeding.

 Heparin may improve lab parameters, but may aggravate bleeding.

 Lab results indicate increased platelet, increased fibrinogen, and prolonged PT/INR.

7 Rickettsial infections include which of the following:

 Rocky Mountain spotted fever and Q fever

 Malaria and toxoplasmosis

 Histoplasmosis and cryptococcosis

 Epstein-Barr virus and cytomegalovirus

8 A 20-year-old female has periodic episodes that begin with decreased vision that lasts for about 30 minutes and is followed by a throbbing occipital headache. Which of the following is the most likely diagnosis?

 Migraine

 Vertebral-basilar insufficiency

 Tension headache

 Panic attack

9 Conductive hearing loss and sensorineural hearing loss are common in the elderly. What are three differential diagnoses for sensorineural hearing loss to include the most common pattern?

 Barotraumas, viral cochleitis, osteoma

 Acoustic neuroma, ototoxic drugs, presbycusis

 Exostosis, meningioma, vascular disease

 Presbycusis, trauma, Paget’s disease

10 Fever of unknown origin, by definition, is a fever of 101 Fahrenheit or greater rectally persisting over at least how many weeks?

 2 weeks

 3 weeks

 1 week

 6 weeks

11 Brain death criteria vary from state to state and involve the absence of breathing, absence of spontaneous movement, and several other neurological findings. Ancillary tests to prove brain death include all of the following except:

 Transcranial Doppler

 Electroencephalography

 Cerebral blood flow study

 Nerve conduction studies

12 The classic triad of Parkinson’s includes all of the following except:

 Resting tremor

 Rigidity arms, legs, and neck stiffness

 Bradykinesia

 Severe cognitive deficits

13 Focal seizures are often accompanied by automatisms, which are behaviors that include all of the following except:

 Lip smacking

 Picking at clothes

 Chewing

 Scratching

14 Loss of central vision is a hallmark of:

 Macular degeneration

 Glaucoma

 Retinal detachment

 C15 Which of the following diseases cause degeneration or loss of nerve cells in the brain?

 Alzheimer’s, Parkinson’s, and Huntington’s

 Sepsis, chronic kidney disease, and scleroderma

 Rheumatoid Arthritis, Alzheimer’s, and Scleroderma

 Parkinson’s, B12 deficiency, and Myasthenia Gravis

16 Immunologic mediators that play a role in the pathophysiology of fever include all of the following except:

 Interleukin 1 – primary

 Interleukin 2

 Interleukin 6

 Tumor necrosis factor

17 The most common causes of fever in a geriatric patient include all of the following except:

 Malignancies

 Medication effect

 Connective tissue disorders (rheumatoid arthritis, sarcoidosis, temporal arteritis)

 Sexually transmitted infections (chlamydia, herpes)

18 Anemia is the reduction of one or more of the following major red blood cell measurements:

 Hemoglobin, hematocrit, RBC count

 B12, folic acid, hemoglobin

 Hemoglobin, folic acid, fibrinogen

 Hemoglobin, RBC, and B12

19 Areas of occult infection include:

 Sinuses, teeth, central nervous system

 Lung, ear, throat

 Skin, joints, lymph nodes

 Pelvis, abdomen, and chest

20 A 62-year-old African American male with a past medical history significant for diabetes presents with sudden onset of headache on the right side and blurred vision in his right eye. Fundoscopic exam reveals a deeply cupped optic disc. Which of the following disorders is this patient likely experiencing?

 Acute angle-closure glaucoma

 Strabismus

 Bacterial conjunctivitis

 Cataracts

21 Dementia is characterized by many things, except:

 General decrease in level of cognition

 Behavioral disturbance

 Interference with daily function and independence

 Focused attention to detail and obsession with dates and numbers

22 Although the etiology of Guillain-Barre syndrome is largely unknown, which of the following possible triggers for this disease are most likely:

 Campylobacter jejuni enteritis, cytomegalovirus, Epstein-Barr, HIV, or mycoplasma infection

 Streptococcus pneumonia, Staph aureus, and E. coli

 Cytomegalovirus, Epstein Barr, strep throat, or thrush

 Any bacterial pneumonia or herpes zoster

23 Parasitic infections include which of the following:

 Rocky Mountain spotted fever and Q fever

 Malaria and toxoplasmosis

 Histoplasmosis and cryptococcosis

 Epstein-Barr virus and cytomegalovirus

24 A 65-year-old patient complains of recurrent temporal headaches, malaise, muscle aches, and low grade fever. The headache is described as superficial tenderness rather than deep pain. Temporal arteritis is suspected. Appropriate treatment is:

 Aspirin or acetaminophen every 4 hours as needed for pain and fever

 Refer for a temporal artery biopsy and initiation of oral prednisone

 CT scan of the head and lumbar puncture for CSF evaluation

 A daily three-blocker such as propranolol

25 Which of the following lists of medications is generally contraindicated in geriatric patients?

 Beers list

 Anticholinergic list

 Universal list

 Alzheimer’s list

26 Myasthenia gravis is a disorder of the neuromuscular junction, a pure motor syndrome, caused by an autoimmune attack on the acetylcholine receptor complex at the postsynaptic membrane of the neuromuscular junction. All of the following are true about this disease except (select the best answer):

 Ptosis occurs in up to 40% of these patients initially, and eventually in 80% of these patients with disease progression.

 Dysphagia

 Proximal limb weakness with upper limbs more noticeable than lower

 Loss of sensation with weakened or absent reflexes

27 The most common causes of fever in a geriatric patient include all of the following except:

 Malignancies

 Medication effect

 Connective tissue disorders (rheumatoid arthritis , sarcoidosis, temporal arteritis)

 Sexually transmitted infections (chlamydia, herpes)

28 Epidural hematomas are most often associated with the following findings (select the best answer):

 Seen in the frontal/temporal region, with an initial loss of consciousness followed by a brief lucid period.

 Seen mostly in occipital area, with complete loss of consciousness, and coma-like presentation.

 Seen mostly in frontal region with no loss of consciousness and subtle, stable neurologic deficits.

 None of the above

29 Robert is a 72-year-old male with a past medical history significant for CHF, hypertension, and diabetes, who presents to the ER with a family member who states that Robert has been acting strange lately. Which of the following is an assessment tool most commonly used to screen for dementia?

 MMSE

 Tinetti

 Romberg

 GDS

30 All of the following are correct except:

 It is acceptable to treat mild to moderate dementia with Aricept (donepezil) and Exelon (rivastigmine).

 It is acceptable to treat moderate to severe dementia with Namenda.

 It is acceptable to treat mild dementia with Razadyne (galantamine hydrobromide)

 It is acceptable to treat severe dementia with Exelon.

31 A 27-year-old female presents with facial congestion, left-side facial pressure, and purulent nasal discharge for 11 days. Fever began 2 days ago. She has been trying OTC medications, but does not seem to be able to get any better. Which of the following is the best treatment option?

 Amoxicillin/Clavulanate

 Ciprofloxacin

 Erythromycin

 Doxycycline

32 Viral infections include which of the following:

 Rocky Mountain spotted fever and Q fever

 Malaria and toxoplasmosis

 Histoplasmosis and cryptococcosis

 Epstein-Barr virus and cytomegalovirus

33 A 32-year-old man presents with a 3-day history of fever, headache, and skin rash. Exam reveals positive Kernig and Brudzinski signs, as well as diffuse, erythematous, maculopapular rash. This presentation is most consistent with:

 Subarachnoid hemorrhage

 Viral encephalitis

 Epidural hematoma

 Bacterial meningitis

34 A spinal injury involving C2-C3 usually results in the following (select the best answer):

 Respiratory paralysis and loss of sensation below the mandible

 Quadriplegia and priapism

 Paralysis from the nipple line down with sparing of ventilation and reflexes 

 None of the above

35 John is a 55-year-old male with a past medical history significant for IBS who presented to ER with knee pain after trauma. He is now POD #2 for knee replacement. His labs this morning indicated a platelet count of 15,000, but CMP and anticoagulation labs are within defined limits. What is the most likely diagnosis?

 DIC

 ITP

 TTP

 Cancer

36 Tamara is a 68-year-old female with a past medical history significant for CHF and recently found to have DIC in the intensive care unit. Which one of the following is not a therapeutic option?

 Heparin

 Amicar or EACA

 Vitamin K

 Platelet transfusion

37 Which of the following medications would be most appropriate for the patient who is suffering from neuropathic pain?

 NSAID

 Acetaminophen

 Gabapentin

 Morphine

38 Patients with central nervous system injuries and paralysis suffer from venous pooling in the legs and orthostatic hypotension. Which of the following represent etiologies for this hypotension?

 Increased of skeletal muscle pump

 Impaired sympathetic nervous system

 Impaired parasympathetic nervous system

 Impaired absorption of antihypertensive medications

39 Sarah is a 25-year-old female with no significant past medical history who presented to the ER with headache and loss of consciousness. Sarah was playing on a co-ed soccer team. She was doing a diving header to score a goal and accidentally hit her head on the goal post. What is the first diagnostic test to perform on the patient?

 Skull x-ray

 EEG

 CBC, PT/INR

 CT head

40 A 22-year-old female presents with left ear pain that increases with external ear palpation. She also noticed discharge on her pillow this morning. On physical exam, patient is afebrile and mildly ill-appearing. Otoscopic examination reveals an erythematous and edematous left ear canal with purulent exudates. Which of the following is not the likely causative organism for the patient’s ear pain?

 Staphylococcus aureus

 H. influenzae

 Candida albicans

 Pseudomonas aeruginosa

41 The diagnostic approach to fever of unknown origin includes a thorough history of all of the following except:

 Travel

 Diet

 Animal or insect bites

 Type of birth control, if any

42 A differential diagnosis for a patient who presents with a severe headache of recent onset, neck stiffness, and fever is:

 Subdural hematoma

 Migraines

 Tension headaches

 Meningitis

43 Which of the following ethnic groups is at particularly high risk for diabetes?

 Hispanic

 Caucasian

 African American

 Native American

44 Which of the following has an association with AIDS dementia complex?

 “Wet, Wobbly, Whacky”

 CD4 count less than 200

 Exaggerated response to neuroleptics

 Multiple lacunar infarcts

45 Chronic complications of diabetes include all of the following except:

 Neuropathy

 Retinopathy

 Gastroparesis

 Alopecia

46 To assess the cerebellar functioning in the geriatric patient related to fall risk, the family nurse practitioner would evaluate:

 Close eyes and distinguish common odors

 Range of motion of all extremities

 Ability to recall name, year, and place

 Ability to balance on one foot, then the other

47 A 60-year-old female patient complains of sudden onset unilateral, stabbing, surface pain in the lower part of her face lasting a few minutes, subsiding, and then returning. The pain is triggered by touch or temperature extremes. Physical examination is normal. Which of the following is the most likely diagnosis?

 Bell’s palsy

 Parotiditis

 Trigeminal neuralgia

 Temporal arteritis

48 A transient ischemic attack is:

 A sudden or rapid onset of neurologic deficit caused by focal ischemia that lasts for a few minutes and resolves completely within 24 hours.

 A sudden or rapid onset of neurologic deficit caused by focal ischemia that lasts for a few minutes and resolves completely within 48 hours.

 A sudden or rapid onset of neurologic deficit caused by focal ischemia that lasts for a few minutes and resolves completely within 72 hours.

 Any stroke-type symptoms that resolve within 1 hour.

49 Jugular venous oxygen saturation is one way of monitoring brain oxygenation for traumatic brain injuries. The normal values for jugular venous saturation is (select the best answer):

 55-70%

 80-100%

 80-90%

 35-55%

50 Bone resorption of postmenopausal women can be a key cause in a higher incidence of fractures. A primary cause could be due to:

 Prolactin deficiency

 Progesterone deficiency

 Estrogen deficiency

 Dental extractions

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