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A 75-year-old man is involved in a motor vehicle accident Central Cord Syndrome
and strikes his forehead on the windshield. He complains the central cord syndrome involves loss of motor function that is more severe in
of neck pain and severe burning in his shoulders and the upper extremities than in the lower extremities, and is more severe in the
arms. His physical examination reveals weakness of his hands. There is typically hyperesthesia over the shoulders and arms. Anterior cord
upper extremities. What type of spinal cord injury does syndrome presents with paraplegia or quadriplegia, loss of lateral spinothalamic
this patient have? function with preservation of posterior column function. Brown-Séquard
syndrome consists of weakness and loss of posterior column function on one side
A anterior cord syndrome of the body distal to the lesion with contralateral loss of lateral spinothalamic
B central cord syndrome function one to two levels below the lesion. Complete cord transection would
C Brown-Séquard syndrome affect motor and sensory function distal to the lesion. Cauda equina syndrome
D complete cord transection typically presents as low back pain with radiculopathy.
E cauda equina syndrome
ANS: B
,A 37-year-old man fell from a ladder as he finished Epidural Hematoma
hanging the Christmas lights on his house. The right side Epidural hematoma most often results from a traumatic tear of the middle
of his head hit the alley cement, and he lost meningeal artery. Although a lucid interval ranging from minutes to hours
consciousness for about 1 minute; he woke up with a followed by altered mental status and focal deficits is typical for epidural
headache, but he had no other complaints. A few hours hematoma, this clinical picture is only encountered in up to 1/3 of the patients. The
later, the patient is brought to the emergency room by his collection of blood between the skull and dura mater causes an evident mass
neighbor because of an intense headache, confusion, effect with ophthalmic nerve palsy and the contralateral hemiparesis. Surgical
and left hand hemiparesis. On examination, the patient evacuation of the clot via burr holes is the treatment of choice.
has a bruise located over the right temporal region,
mydriasis, and right deviation of the right eye, Subdural hematoma results from a traumatic rupture of the bridging veins that
papilledema, and left extensor plantar response. An connect the cerebrum to the venous sinuses within the dura. This venous
emergency CT scan of the head without contrast reveals hemorrhage will result in a gradual increase of the hematoma, with a progressive
a lens-shaped hyper-density under the right temporal clinical picture over days or weeks. The CT scan will show a concave, crescent-
bone with mass effect and edema. What is the most likely shaped hyper-density compared to the convex, lens-shaped hyper-density in
diagnosis? epidural hematoma.
Answer Choices Subarachnoid hemorrhage is the result of an aneurysm rupture; the most common
1 Epidural hematoma is the congenital berry aneurysm. The clinical picture is of a sudden, severe
2 Subdural hematoma headache with meningeal irritation. A CT scan will show blood in the subarachnoid
3 Subarachnoid hemorrhage space, and a lumbar puncture will reveal xanthochromia CSF.
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis Intracerebral parenchymal hemorrhage is most likely caused by hypertension
ANS: 1 complicated with Charcot-Bouchard aneurysms. The blood accumulates into the
brain substance and most commonly involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal
irritation dominate the clinical picture. Lumbar puncture, indicated if there are no
focal neurological signs on clinical examination, will be the diagnostic procedure.
The CT scan of the patient presented in this case is characteristic for epidural
hematoma, and there is no indication for a lumbar punctu
,A 31-year-old woman presents with a purpural rash Antibiotics
covering her arms, legs, and abdomen. She also has Antibiotics are the treatment of choice for meningococcemia. The preferred drug
fever, chills, nausea, abdominal tenderness, tachycardia, for active infection is penicillin G. For those allergic to penicillin, chloramphenicol
and generalized myalgias. Prior to the development of and cephalosporins (ie, cefotaxime, cefuroxime) may be used as alternatives.
the rash, the patient noted that she had a headache,
cough, and sore throat. Laboratory studies were positive Patients will also receive supportive care, but antibiotic therapy must be initiated
for Gram-negative diplococci in the blood, along with quickly if the patient is to survive. Intensive care placement may be necessary if
thrombocytopenia and an elevation in PMNs. Urinalysis organ failure is imminent. Ventilatory support, inotropic support, and IV fluids are
showed blood, protein, and casts. Vital signs are as necessary in some. If adrenal insufficiency occurs, corticosteroid replacement
follows: PB 92/66, P 96, RR 14, T 39. The patient denies any may be considered. A central venous line helps to provide large amounts of
foreign travel and does not have any sick contacts. volume expanders and inotropic medications for adequate tissue perfusion.
However, she does work part time as a nurse in a local
hospital. Steroids have not been shown to play a major role in the treatment of
Question meningococcemia. However, they have been used in addition to antibiotic
The patient is diagnosed with Meningococcemia; she is therapy. In the case of adrenal insufficiency, for example, steroid replacement has
admitted to the hospital and placed in respiratory been shown to be beneficial.
isolation. What major course of therapy should this
patient receive? Transfusion does not generally play a major role in treatment. If the patient suffers
from a devastating coagulopathy, blood or blood products may be replaced as
Answer Choices necessary.
1 Steroids
2 Supportive care Bactericidal/permeability-increasing protein is a protein stored in the granules of
3 Antibiotics neutrophils. It binds to endotoxin in vitro and neutralizes it. This technique is
4 Transfusion experimental, and it is not used in everyday treatment of meningococcemia.
5 Bacterici
In myasthenia gravis, weakness is a result of insufficient Muscle Fasiculations
acetylcholine transmission at the neuromuscular junction; Signs of cholinergic overdosage include muscle fasciculation, rhinorrhea,
however, weakness can also occur with overdosing of the lacrimation, salivation, increased bronchial secretions, nausea, or diarrhea. The
cholinergic medications used to treat myasthenia. What presence of any of these suggests that the patient's weakness may be due to
symptom helps differentiate a myasthenic crisis from a cholinergic crisis. The other signs are due to weakness and can occur in either
cholinergic crisis? condition.
Answer Choices
1 Respiratory failure
2 Bilateral ptosis
3 Muscle fasciculations
4 Diplopia
5 Normal muscle stretch reflexes
ANS: 3
, A 54-year-old man presents after having a generalized Toxoplasma encephalitis
seizure. The patient is HIV positive, but he has been The patient's symptoms and MRI findings are most consistent with the diagnosis of
unable to afford antiretroviral therapy since losing his job toxoplasma encephalitis. Toxoplasmosis is the most common cerebral mass lesion
2 years ago. Other than cachexia, the physical exam is among HIV-positive patients. Infection with the Toxoplasma gondii parasite is
unremarkable. Upon further inquiry, the patient also notes relatively common and usually asymptomatic. Reactivation occurs in HIV positive
that he has become short-tempered and hypercritical; at patients due to failing cellular immunity, and it causes a multifocal necrotizing
times, he seems confused. An MRI of the brain is encephalitis. Seizures may be the initial manifestation of central nervous system
performed, and it reveals several cortical ring-enhancing (CNS) infection; other common clinical manifestations include focal neurologic
lesions. deficits, such as impaired speech and hemiparesis. Personality change, lethargy,
Question headache, and confusion are also observed. The MRI in patients with toxoplasma
What is the most likely diagnosis? encephalitis characteristically reveals multiple, ring-enhancing lesions with
Answer Choices surrounding edema; these lesions usually occur bilaterally in the frontal and
1 AIDS dementia complex parietal cortices.
2 Cryptococcal meningitis
3 Cytomegalovirus encephalitis AIDS dementia complex describes a constellation of cognitive symptoms seen
4 Progressive multifocal leukoencephalopathy among HIV positive patients. The condition occurs when HIV virus disseminates to
5 Toxoplasma encephalitis the CNS. Within the CNS, the virus tends to concentrate in the basal ganglia and
ANS:5 subcortical regions. Symptoms include a constellation of cognitive, behavioral,
and motor disturbances that cause varying degrees of functional impairment.
Characteristic MRI findings include non-enhancing white matter, cerebral atrophy,
and ventricular enlargement. The diagnosis requires that other central nervous
system infections, carcinoma, as well as general medical conditions and substance
abuse have been excluded.
Cryptococcal meningitis is caused by the encapsulated fungus Cryptococcus
neoformans. Among HIV positive patients, the illness may be the result of new
infection or reactivation of latent infection. Presenting signs are often nonspecific;
they include headache, fev
verified answers (MULTIPLE CHOICES) AND
RATIONALES|GET IT 100% ACCURATE!!
Edit Save
Students also studied
KNOW THIS AND FINISH ALREADY :... NR 603 CEA Midterm NR603 CEA Exam NR667-
150 terms 150 terms 150 terms 460 term
morsburne0318 Preview gatesy17 Preview Amandam118 Preview jmin
A 75-year-old man is involved in a motor vehicle accident Central Cord Syndrome
and strikes his forehead on the windshield. He complains the central cord syndrome involves loss of motor function that is more severe in
of neck pain and severe burning in his shoulders and the upper extremities than in the lower extremities, and is more severe in the
arms. His physical examination reveals weakness of his hands. There is typically hyperesthesia over the shoulders and arms. Anterior cord
upper extremities. What type of spinal cord injury does syndrome presents with paraplegia or quadriplegia, loss of lateral spinothalamic
this patient have? function with preservation of posterior column function. Brown-Séquard
syndrome consists of weakness and loss of posterior column function on one side
A anterior cord syndrome of the body distal to the lesion with contralateral loss of lateral spinothalamic
B central cord syndrome function one to two levels below the lesion. Complete cord transection would
C Brown-Séquard syndrome affect motor and sensory function distal to the lesion. Cauda equina syndrome
D complete cord transection typically presents as low back pain with radiculopathy.
E cauda equina syndrome
ANS: B
,A 37-year-old man fell from a ladder as he finished Epidural Hematoma
hanging the Christmas lights on his house. The right side Epidural hematoma most often results from a traumatic tear of the middle
of his head hit the alley cement, and he lost meningeal artery. Although a lucid interval ranging from minutes to hours
consciousness for about 1 minute; he woke up with a followed by altered mental status and focal deficits is typical for epidural
headache, but he had no other complaints. A few hours hematoma, this clinical picture is only encountered in up to 1/3 of the patients. The
later, the patient is brought to the emergency room by his collection of blood between the skull and dura mater causes an evident mass
neighbor because of an intense headache, confusion, effect with ophthalmic nerve palsy and the contralateral hemiparesis. Surgical
and left hand hemiparesis. On examination, the patient evacuation of the clot via burr holes is the treatment of choice.
has a bruise located over the right temporal region,
mydriasis, and right deviation of the right eye, Subdural hematoma results from a traumatic rupture of the bridging veins that
papilledema, and left extensor plantar response. An connect the cerebrum to the venous sinuses within the dura. This venous
emergency CT scan of the head without contrast reveals hemorrhage will result in a gradual increase of the hematoma, with a progressive
a lens-shaped hyper-density under the right temporal clinical picture over days or weeks. The CT scan will show a concave, crescent-
bone with mass effect and edema. What is the most likely shaped hyper-density compared to the convex, lens-shaped hyper-density in
diagnosis? epidural hematoma.
Answer Choices Subarachnoid hemorrhage is the result of an aneurysm rupture; the most common
1 Epidural hematoma is the congenital berry aneurysm. The clinical picture is of a sudden, severe
2 Subdural hematoma headache with meningeal irritation. A CT scan will show blood in the subarachnoid
3 Subarachnoid hemorrhage space, and a lumbar puncture will reveal xanthochromia CSF.
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis Intracerebral parenchymal hemorrhage is most likely caused by hypertension
ANS: 1 complicated with Charcot-Bouchard aneurysms. The blood accumulates into the
brain substance and most commonly involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal
irritation dominate the clinical picture. Lumbar puncture, indicated if there are no
focal neurological signs on clinical examination, will be the diagnostic procedure.
The CT scan of the patient presented in this case is characteristic for epidural
hematoma, and there is no indication for a lumbar punctu
,A 31-year-old woman presents with a purpural rash Antibiotics
covering her arms, legs, and abdomen. She also has Antibiotics are the treatment of choice for meningococcemia. The preferred drug
fever, chills, nausea, abdominal tenderness, tachycardia, for active infection is penicillin G. For those allergic to penicillin, chloramphenicol
and generalized myalgias. Prior to the development of and cephalosporins (ie, cefotaxime, cefuroxime) may be used as alternatives.
the rash, the patient noted that she had a headache,
cough, and sore throat. Laboratory studies were positive Patients will also receive supportive care, but antibiotic therapy must be initiated
for Gram-negative diplococci in the blood, along with quickly if the patient is to survive. Intensive care placement may be necessary if
thrombocytopenia and an elevation in PMNs. Urinalysis organ failure is imminent. Ventilatory support, inotropic support, and IV fluids are
showed blood, protein, and casts. Vital signs are as necessary in some. If adrenal insufficiency occurs, corticosteroid replacement
follows: PB 92/66, P 96, RR 14, T 39. The patient denies any may be considered. A central venous line helps to provide large amounts of
foreign travel and does not have any sick contacts. volume expanders and inotropic medications for adequate tissue perfusion.
However, she does work part time as a nurse in a local
hospital. Steroids have not been shown to play a major role in the treatment of
Question meningococcemia. However, they have been used in addition to antibiotic
The patient is diagnosed with Meningococcemia; she is therapy. In the case of adrenal insufficiency, for example, steroid replacement has
admitted to the hospital and placed in respiratory been shown to be beneficial.
isolation. What major course of therapy should this
patient receive? Transfusion does not generally play a major role in treatment. If the patient suffers
from a devastating coagulopathy, blood or blood products may be replaced as
Answer Choices necessary.
1 Steroids
2 Supportive care Bactericidal/permeability-increasing protein is a protein stored in the granules of
3 Antibiotics neutrophils. It binds to endotoxin in vitro and neutralizes it. This technique is
4 Transfusion experimental, and it is not used in everyday treatment of meningococcemia.
5 Bacterici
In myasthenia gravis, weakness is a result of insufficient Muscle Fasiculations
acetylcholine transmission at the neuromuscular junction; Signs of cholinergic overdosage include muscle fasciculation, rhinorrhea,
however, weakness can also occur with overdosing of the lacrimation, salivation, increased bronchial secretions, nausea, or diarrhea. The
cholinergic medications used to treat myasthenia. What presence of any of these suggests that the patient's weakness may be due to
symptom helps differentiate a myasthenic crisis from a cholinergic crisis. The other signs are due to weakness and can occur in either
cholinergic crisis? condition.
Answer Choices
1 Respiratory failure
2 Bilateral ptosis
3 Muscle fasciculations
4 Diplopia
5 Normal muscle stretch reflexes
ANS: 3
, A 54-year-old man presents after having a generalized Toxoplasma encephalitis
seizure. The patient is HIV positive, but he has been The patient's symptoms and MRI findings are most consistent with the diagnosis of
unable to afford antiretroviral therapy since losing his job toxoplasma encephalitis. Toxoplasmosis is the most common cerebral mass lesion
2 years ago. Other than cachexia, the physical exam is among HIV-positive patients. Infection with the Toxoplasma gondii parasite is
unremarkable. Upon further inquiry, the patient also notes relatively common and usually asymptomatic. Reactivation occurs in HIV positive
that he has become short-tempered and hypercritical; at patients due to failing cellular immunity, and it causes a multifocal necrotizing
times, he seems confused. An MRI of the brain is encephalitis. Seizures may be the initial manifestation of central nervous system
performed, and it reveals several cortical ring-enhancing (CNS) infection; other common clinical manifestations include focal neurologic
lesions. deficits, such as impaired speech and hemiparesis. Personality change, lethargy,
Question headache, and confusion are also observed. The MRI in patients with toxoplasma
What is the most likely diagnosis? encephalitis characteristically reveals multiple, ring-enhancing lesions with
Answer Choices surrounding edema; these lesions usually occur bilaterally in the frontal and
1 AIDS dementia complex parietal cortices.
2 Cryptococcal meningitis
3 Cytomegalovirus encephalitis AIDS dementia complex describes a constellation of cognitive symptoms seen
4 Progressive multifocal leukoencephalopathy among HIV positive patients. The condition occurs when HIV virus disseminates to
5 Toxoplasma encephalitis the CNS. Within the CNS, the virus tends to concentrate in the basal ganglia and
ANS:5 subcortical regions. Symptoms include a constellation of cognitive, behavioral,
and motor disturbances that cause varying degrees of functional impairment.
Characteristic MRI findings include non-enhancing white matter, cerebral atrophy,
and ventricular enlargement. The diagnosis requires that other central nervous
system infections, carcinoma, as well as general medical conditions and substance
abuse have been excluded.
Cryptococcal meningitis is caused by the encapsulated fungus Cryptococcus
neoformans. Among HIV positive patients, the illness may be the result of new
infection or reactivation of latent infection. Presenting signs are often nonspecific;
they include headache, fev
