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40 Cards in this Set
- Front
- Back
- 3rd side (hint)
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33 y/o African American patient, presents with worst headache she's ever had. Describes it as pounding, feels like somebody hit her in the head with a baseball bat. Onset about 2 hours ago, unrelieved by ASA, Ibuprofen. C/O photophobia, some blurring of vision on affected side. Which of the following would be in the top three DD.
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Tension headache
inflammatory CVA Cluster Migraine |
CVA
Tension Inflammatory |
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45 y.o. C Male presents for PE. During assessment, you note a disconjugate gaze. Which cranial nerve(s) may be responsible for this finding?
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CN II
CN III CN V CN VI All the above |
II
III VI |
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In an 87 y/o female patient with CVA that left her without function of the glossopharyngeal nerve, what finding would you anticipate?
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a. Intact gag reflex
b. tongue deviation upon extension, and inability to move side to side c. Intact speech d. Difficulty swallowing e. uvula and tongue do not rise to midline with phonation |
CN IX controls swallowing, cough, speech, gag reflex, tongue and uvula midline, uvula and soft palate rise in midline with phonation
D and E: you would anticipate loss or diminished gag reflex, difficulty swallowing, coughing, and speaking. The hypoglossal nerve provides motor control to the tongue enabling it to protrude midline and move side to side. |
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21 week old pt presents for well-baby exam. Which of the following reflexes would you anticipate being extinguished at this age.
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palmar
rooting tonic neck moro a. palmar only b. palmar and rooting c. all the above d. none of the above |
Palmar grasp gone by 3 months
Rooting gone by 4 months Tonic neck gone by 6 months; if persists, R/O Cerebral palsy Moro gone by 6 months Correct response B. palmar and rooting should be extinguished by 5 months of age |
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Next patient is alert, smiling, drooling and sitting up without assistance. She turns towards her caretaker when she hears a toy squeak and reaches her hand up in the direction of the caretaker/toy. Based upon this child achieving normal developmental milestones, what age would you expect this baby to be?
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a. 2 months
b. 4 months c. 6 months d. 9 months 1. b 2. b or c 3. c or d 4. none of the above |
Based upon developmental milestones, this baby could be 6 months or older.
correct response 3 - she could be 6 or 9 months of age |
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Next patient is being brought in by his grandmother who is worried he is "slow for his age". Grandmother is sole guardian, state removed child from home secondary to neglect; parents were involved in drugs and currently both are incarcerated. Child is slim but not thin, fine facial features, eyes clear, dressed neatly, hair is clean and shiny.
His DOB makes him 4 years 3 months and he falls in the 55% for height and weight. How would you assess this child for developmental delays, which of the following would be abnormal for a child of this age? |
a. inability to balance on one foot for 1 second
b. build a tower of blocks 8 cubes high c. Names one picture correctly d. Grandmother dresses him e. Speech mostly clear, unable to name colors; knows mouth, hand, and head body parts. |
All except B are abnormal findings in a child age 4+.
a. at 3 a child should be able to balance for 1 second on one foot b. building 8 block tower anticipated in 4 year old c. at age 4 should be able to define 5 words. d. At age 2-3 a child should be able to apply clothing. e. By age 4 you would anticipate a child being able to name 4 colors, and all speech should be clearly understandable |
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You are asked to see a nursing home patient, the report you are given is that the patient has suffered a CVA, is a DNR, and is exhibiting a frontal release sign.
What do you anticipate finding on exam? |
a. pupil dilatation
b. fixed pupil, unilaterally c. 'dolls eyes' d. disconjugate, fixed gaze e. none of the above |
The correct response is e - none of the above.
The frontal release sign is indicative of a patient who has reverted to primitive reflexes and has an intact rooting reflex. |
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74 y/o AA female brought in by daughter. Pt is well known to you and has been seen in clinic for >30 years.
Daughter expresses concern because "mom, hasn't been herself the last few days". She forgot to turn off the water on Monday and flooded the kitchen sink and floor. She left on Tuesday to go to Bingo and didn't take her purse with her. Then yesterday, well, yesterday took the cake. Pt. had been discovered two streets over by a passerby. She had fallen in the snow and ice and was unable to get herself upright. When found, she was wearing a black sweater over a white cotton shirt, tan denim pants, cotton socks, her walking shoes, and a rain cap. She carried no identification and was unable to give verbal responses. The passerby who found her didn't know what to do and was afraid to try and move her - so she called the police from her cell phone. EMS transported her to the local ED where she was deemed free of any injuries and released. The police returned her and she was able to point out to them which house was hers. Although she gave no verbal responses, she was able to point. The pt has been living independently for >10 years since her husband died. She only recently moved in with her daughter to "help with the kids". The daughter had just arrived home yesterday only to be met by two concerned, and almost hostile, police officers who requested access to inspect the house and explained to her in not so nice terms the charge for neglect and/or elder abuse. Just last week, the pt had picked up the kids and taken them skating and she even baked cupcakes for her grandson's birthday party on Saturday. The daughter asks you what is going on?? The patient today is alert, bright, and says her "daughter is making a mountain out of a mole hill" and "blowing this all up out of proportion". She explains she just took a misstep yesterday and because she was on a hill, she couldn't gain enough purchase to get herself standing again. She doesn't know what all this foolishness is - she most certainly did talk to those nice policemen yesterday. How else does she think they got her home? What is your big-picture DD? |
a. Metabolic disorder
b. Acute infection c. Drug-drug interaction d. Alzheimer's e. all the above |
Any of these situations could cause confusion, although, in this case, this actual patient was diagnosed with primary progressive aphasia as a presenting symptom of Alzheimer's.
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You are seeing a new pt. 34 y/o AA male, reports he has recently had a seizure, maybe two. He says it is crazy, because he started smelling something burning and mentioned it to his wife. Next thing he remembers, she is shaking him and tells him he was "staring off into space and moving his lips funny"
His s/sx are consistent with: |
a. simple partial seizure
b. complex partial seizure c. absence or petit mal seizure d. secondary or generalized partial seizure. |
b. complex partial seizure - altered LOC, aura, staring and automatisms or repetitive non purposeful movements are presenting s/sx of complex partial seizure.
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16 y/o boy comes in with T102 for past 36 hours, he has a severe HA and started throwing up this morning. On exam he exhibits photophobia. Which of the following would support a diagnosis of meningitis?
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a. + Kernig's sign and - Brudzinski's sign
b. + Kernig's sign and + Brudzinski's sign c. - Kernig's sign and - Brudzinski's sign d. - Kernig's sign and - Brudzinski's sign |
The correct answer is B. Findings suggesting meningitis include the presence of positive Kernig and positive Brudzinski sign, increased protein, decreased glucose, and presence of WBC in CSF.
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The use of neuroleptics in migraine headache therapy should be limited to less than 3 times a week due to their:
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a. addictive potential
b. extrapyramidal movement risk c. ability to cause rebound headache d. sedative effect |
b. extrapyramidal movement risk
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A 40 y/o male presents with a four week history of recurrent headaches that awaken him from sleep. The pain is intense, severe and lasts for a little over an hour - it seems focused behind his right eye. He reports his eyes water and it hurts so bad it makes his nose run. What is the most likely diagnosis?
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a. common migraine
b. classic migraine c. cluster headache d. IICP |
c. cluster headache
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Assessing vision and visual fields involves testing cranial nerve:
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a. I
b. II c. III d. IV |
b. II
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A middle-aged man presents for a PE and during the tests for EOM, you note he is unable to move his eyes upward and inward. This indicates a possible paralysis of CN:
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a. II
b. III c. V d. VI |
b. III
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Loss of corneal reflex is seen in dysfunction of CN:
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a. III
b. IV c. V d. VI |
c. V
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New patient, 25 y/o presents with sudden onset facial drooping, she is unable to close her right eye, frown symmetrically, or smile. Which of the following represents the most appropriate diagnostic test?
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a. CBC w/diff
b. CT scan head with and without contrast c. Lyme antibody titer d. BMP |
c. Lyme antibody titer
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Prophylactic treatment of migraine includes:
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a. propranolol
b. ergotamine c. naproxen sodium d. enalapril |
a. propranolol
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You examine a 64 y/o female with history of arthritis, breast cancer with lumpectomy, 2-vessel stenting, onychomycosis, and recurrent post-menopausal symptoms including vaginal drying and thinning making intercourse painful. Which of the following represents the best choice of abortive migraine headache treatment for this patient?
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a. verapamil
b. ergotamine c. ibuprofen d. suatriptan |
c. ibuprofen
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Which of the following is true about migraine headaches?
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a. migraine with aura is the most common form
b. most migraines are in ongoing health care for other conditions c. the condition is equally common in men as women d. pain is typically described as pulsating |
d. pain is typically described as pulsating
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In tension-type headache, which of the following is true?
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a. photophobia is seldom reported
b. pain is pressing in quality c. usually unilateral pain c. headache worsens with activity |
b. pain is pressing in quality
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Fetal TORCH infections can cause microcephaly, mental retardation, and intrauterine growth retardation. Which of the following are TORCH diseases?
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a. toxoplasmosis, ocular infection, rubella, CMV, and herpes
b. toxoplasmosis, other infection, rubella, CMV, and herpes c. toxoplasmosis, otic infection, rubeolla, CMV, and herpes d. toxoplasmosis, other infection, rubeolla, CMV, and herpes |
b. toxoplasmosis, other infection, rubella, CMV, and herpes
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A 70 y/o man presents with CC bright red spot in left eye field of vision x 2 days. He denies pain, changes in other vision, or headache. He is recovering from a mild cold, only occasional coughing, He takes allopurinal, Vitamin D, ASA, and HCTZ. Which of the following is most likely?
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a. corneal detachment
b. acute bacterial conjunctivitis c. retinal mylasia d. subconjunctival hemorrhage |
d. subconjunctival hemorrhage
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A 34 y/o female has been recently diagnosed with multiple sclerosis (MS). When providing primary care, you consider that MS:
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a. has a predictable course of progressive decline in intellectual and motor function
b. presents with a classic pattern of myalgia, blurred vision, and ataxia c. is often seen with variable pattern of exacerbation and remissions d. is accompanied by classic CNS lesions detectable on skull films |
c. is often seen with variable pattern of exacerbation and remissions
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Treatment options in MS to attenuate disease progression include:
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a. interferon B-1b
b. methylprednisone c. ribavirin d. phenytoin |
interferon B-1b
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A patient diagnosed with cluster headaches:
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a. usually has fever
b. can be diagnosed with imagine c. should eliminate triggers like nicotine and alcohol d. will exhibit +Long sign |
c. should eliminate triggers like nicotine and alcohol
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An elderly patient has an audible carotid bruit. He has Hx of HTN, hyperlipidemia, and an MI 5 years ago. The findings of a bruit indicate the patient:
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a. probably will have a stroke
b. has more than triple risk of stroke compared to individuals who do not have a bruit c. is more likely to die of cardiovascular disease than a CVA d. probably has significant carotid artery stenosis |
c. is more likely to die of cardiovascular disease than a CVA
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The daughter of a patient asks how long her mother, recently diagnosed with Alzheimer's, will be on the acetylcholinesterase inhibitor before you can tell if it is going to help. Your best reply is:
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a. 4-8 weeks
b. about 12 weeks c. 6 - 12 months d. about a year |
c. 6 - 12 months
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An elderly patient with organic brain syndrome is at increased risk of elder abuse because:
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a. she lives in a nursing home
b. she has multiple caregivers c. he is incontinent of stool and urine d. he has declining cognitive function |
d. he has declining cognitive function
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A 68 y/o smoker with history of well controlled HTN, describes a syncopal episode which occurred yesterday while cutting the yard. Today he has no complaints, the NP should initially:
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a. perform complete neuro and cardiovascular exam
b. order 12 lead EKG, carotid USG, and perform a PE c. order CT brain, blood clotting studies, and cardiac enzymes d. check blood pressure in 3 positions, order 12 lead EKG, and schedule a stress test. |
a. perform complete neuro and cardiovascular exam
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A 73 y.o patient, with longstanding HTN and CHF comes with CC new onset HA accompanied by visual disturbances. Routine lab is WNL, ESR elevated. You order which of the following diagnostic tests?
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a. MRI
b. angiography c. USG d. biopsy |
d. biopsy
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Your sister calls and asks you what you think is wrong with her? She reports hand and wrist pain and explains she has been at the keyboard nonstop because it is tax time. If she has carpal tunnel syndrome, which finger will not be involved?
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a. thumb
b. second finger c. fourth finger d. fifth finger |
d. fifth finger
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A patient presents with anosmia. Which cranial nerve could be involved?
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a. I
b. II c. V d. X |
a. I - anosmia refers to the inability to smell
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A 72 y.o. patient comes into your office with a headache. When you examine this patient, she has numbness of the right side of her face and her speech is slurred. What is the likely etiology of this event?
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a. migraine headache
b. alcohol intoxication c. stroke d. bell's palsy |
c. stroke
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A patient who is 72 is broght to the clinic. His wife states he was out in the garden today and became disoriented and had slurred speech. She helped him to the house and got him out of the sun, cooled him of with tap water to drink and applied cool compress to his temples and neck. He looks to be in his normal state when you see him. He tells you he just got too hot, and it scared him a little, but he is fine now. How should the NP proceed?
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a. place him on aspirin
b. have him come by the clinic tomorrow for a recheck c. send him to the ED d. order an EKG |
c. send him to the ED
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A patient reports history of a TIA 6 months ago. He takes lisinopril, lovastatin, metformin. You advise him to quit smoking, what is the most important thing for you to now recommend?
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a. get annual EKG
b. take an aspirin daily c. check your Hgb A1c every 3-6 months d. try the nicotine patch for smoking cessation |
b. take an aspirin daily
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A TIA is characterized as an episode of reversible neurological symptoms that may last up to:
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a. 1 hour
b. 6 hours c. 12 hours d. 24 hours |
d. 24 hours
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Swim therapy for a 13 year old boy with cerebral palsy is an example of:
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a. primary prevention
b. secondary prevention c. tertiary prevention d. health prevention |
c. tertiary prevention
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Which of the following is used to screen for color blindness in a 7 year old boy?
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a. Snellen chart
b. Ishihara chart c. Belldon chart d. Coomb chart |
b. Ishihara chart
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A 45 y/o male with a two week history of weakness is brought to the clinic for hospital f/u. He was seen last Thursday and diagnosed with myasthenia gravis. Which of the following is true about myasthenia gravis?
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a. it results from demyelination of peripheral nerves
b. it is classified as an autoimmune disorder c. it presents with ascending muscle weakness and progresses to paralysis d. it occurs do to the deficiency of acetylcholine at the neurotransmitter junction |
b. it is classified as an autoimmune disorder
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MVA with resultant head trauma is the leading cause of morbidity in young adults. How does head trauma affect intracranial pressure?
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a. it increases CSF volume which maintains auto regulation and normalizes ICP
b. It results in an increase in cerebral perfusion pressure which causes a decrease in ICP c. It increases ICP as a compensatory response to the acute volume loss d. it has no effect on ICP unless a mass effect or intracranial hemorrhage occurs |
d. it has no effect on ICP unless a mass effect or intracranial hemorrhage occurs
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