NR 603 Advanced Clinical Diagnosis
and Practice Across the Lifespan
(FNP)
Domain 1: Neurological & Spinal Cord Injuries (Q 1–12)
Question 1: A 75-year-old man is involved in a motor vehicle accident and strikes
his forehead on the windshield. He complains of neck pain and severe burning in
his shoulders and arms. His physical examination reveals weakness of his upper
extremities. What type of spinal cord injury does this patient have?
• A) Anterior cord syndrome
• B) Central cord syndrome
• C) Brown-Séquard syndrome
• D) Complete cord transection
• E) Cauda equina syndrome
,,,ANSWER,,,: B
Rationale: Central cord syndrome involves loss of motor function that is more
severe in the upper extremities than in the lower extremities, and is more severe in
the hands. There is typically hyperesthesia over the shoulders and arms. This injury
commonly occurs in older adults from hyperextension injuries. Anterior cord
syndrome presents with paraplegia or quadriplegia, loss of lateral spinothalamic
function with preservation of posterior column function. Brown-Séquard syndrome
consists of weakness and loss of posterior column function on one side with
,contralateral loss of lateral spinothalamic function. Complete cord transection
affects motor and sensory function distal to the lesion. Cauda equina syndrome
typically presents as low back pain with radiculopathy .
Question 2: A 37-year-old man fell from a ladder and struck his head. He lost
consciousness for 1 minute, then woke up with a headache. A few hours later, he is
brought to the emergency room with intense headache, confusion, and left hand
hemiparesis. CT head shows a lens-shaped hyper-density under the right temporal
bone with mass effect. What is the most likely diagnosis?
• A) Subdural hematoma
• B) Epidural hematoma
• C) Subarachnoid hemorrhage
• D) Intracerebral hemorrhage
,,,ANSWER,,,: B
Rationale: Epidural hematoma most often results from a traumatic tear of the
middle meningeal artery. Although a lucid interval ranging from minutes to hours
followed by altered mental status and focal deficits is classic for epidural
hematoma, this clinical picture is only encountered in up to one-third of patients.
The lens-shaped (biconvex) hyper-density on CT is characteristic. Surgical
evacuation is the treatment of choice. Subdural hematoma results from rupture of
bridging veins and appears crescent-shaped on CT .
Question 3: A patient involved in a rear-impact motor vehicle collision now
experiences severe neck pain and decreased upper extremity motor function, but
,normal motor function in the lower extremities. The patient complains of
paresthesias greater in the arms than legs. This is most consistent with:
• A) Cauda equina syndrome
• B) Brown-Séquard syndrome
• C) Anterior cord syndrome
• D) Central cord syndrome
,,,ANSWER,,,: D
Rationale: Central cord syndrome is characterized by greater motor impairment in
the upper extremities compared to the lower extremities, with varying degrees of
sensory loss. This pattern occurs because the centrally located corticospinal tracts
that serve the upper extremities are affected. This injury is commonly seen in older
adults with pre-existing cervical stenosis following hyperextension injuries (e.g.,
rear-end collisions) .
Question 4: Which finding on physical examination is most consistent with
Brown-Séquard syndrome (spinal cord hemisection)?
• A) Bilateral lower extremity weakness with bladder dysfunction
• B) Ipsilateral weakness and contralateral loss of pain/temperature sensation
• C) Greater upper extremity weakness than lower extremity weakness
• D) Complete loss of all sensation below the level of injury
,,,ANSWER,,,: B
Rationale: Brown-Séquard syndrome (spinal cord hemisection) produces a classic
pattern: ipsilateral weakness (corticospinal tract) and loss of
proprioception/vibration (posterior column) with contralateral loss of pain and
temperature sensation (spinothalamic tract) beginning 1-2 levels below the lesion.
, Central cord syndrome causes greater upper extremity weakness. Complete cord
transection causes complete loss of function below the lesion .
Question 5: A patient with a spinal cord injury at T6 presents with sudden
hypertension (BP 210/110), severe headache, bradycardia, and diaphoresis above
the level of injury. What is the priority intervention?
• A) Administer IV nitroglycerin
• B) Place the patient in Trendelenburg position
• C) Sit the patient upright and check for bladder distention
• D) Administer IV fluids
,,,ANSWER,,,: C
Rationale: This presentation describes autonomic dysreflexia, a medical
emergency in patients with spinal cord injuries at T6 or above. The most common
triggers are bladder distention or fecal impaction. The priority is to sit the patient
upright (to lower blood pressure) and identify/remove the noxious stimulus—
starting with checking for bladder distention. Never place the patient in
Trendelenburg position, as this would increase intracranial pressure .
Question 6: A 1-year-old boy presents with increasing lethargy and is barely
responsive. His parents deny any trauma or injury. What is the most common cause
of nontraumatic altered levels of consciousness in a child?
• A) Seizure disorder
• B) Diabetic ketoacidosis
• C) Inborn errors of metabolism
and Practice Across the Lifespan
(FNP)
Domain 1: Neurological & Spinal Cord Injuries (Q 1–12)
Question 1: A 75-year-old man is involved in a motor vehicle accident and strikes
his forehead on the windshield. He complains of neck pain and severe burning in
his shoulders and arms. His physical examination reveals weakness of his upper
extremities. What type of spinal cord injury does this patient have?
• A) Anterior cord syndrome
• B) Central cord syndrome
• C) Brown-Séquard syndrome
• D) Complete cord transection
• E) Cauda equina syndrome
,,,ANSWER,,,: B
Rationale: Central cord syndrome involves loss of motor function that is more
severe in the upper extremities than in the lower extremities, and is more severe in
the hands. There is typically hyperesthesia over the shoulders and arms. This injury
commonly occurs in older adults from hyperextension injuries. Anterior cord
syndrome presents with paraplegia or quadriplegia, loss of lateral spinothalamic
function with preservation of posterior column function. Brown-Séquard syndrome
consists of weakness and loss of posterior column function on one side with
,contralateral loss of lateral spinothalamic function. Complete cord transection
affects motor and sensory function distal to the lesion. Cauda equina syndrome
typically presents as low back pain with radiculopathy .
Question 2: A 37-year-old man fell from a ladder and struck his head. He lost
consciousness for 1 minute, then woke up with a headache. A few hours later, he is
brought to the emergency room with intense headache, confusion, and left hand
hemiparesis. CT head shows a lens-shaped hyper-density under the right temporal
bone with mass effect. What is the most likely diagnosis?
• A) Subdural hematoma
• B) Epidural hematoma
• C) Subarachnoid hemorrhage
• D) Intracerebral hemorrhage
,,,ANSWER,,,: B
Rationale: Epidural hematoma most often results from a traumatic tear of the
middle meningeal artery. Although a lucid interval ranging from minutes to hours
followed by altered mental status and focal deficits is classic for epidural
hematoma, this clinical picture is only encountered in up to one-third of patients.
The lens-shaped (biconvex) hyper-density on CT is characteristic. Surgical
evacuation is the treatment of choice. Subdural hematoma results from rupture of
bridging veins and appears crescent-shaped on CT .
Question 3: A patient involved in a rear-impact motor vehicle collision now
experiences severe neck pain and decreased upper extremity motor function, but
,normal motor function in the lower extremities. The patient complains of
paresthesias greater in the arms than legs. This is most consistent with:
• A) Cauda equina syndrome
• B) Brown-Séquard syndrome
• C) Anterior cord syndrome
• D) Central cord syndrome
,,,ANSWER,,,: D
Rationale: Central cord syndrome is characterized by greater motor impairment in
the upper extremities compared to the lower extremities, with varying degrees of
sensory loss. This pattern occurs because the centrally located corticospinal tracts
that serve the upper extremities are affected. This injury is commonly seen in older
adults with pre-existing cervical stenosis following hyperextension injuries (e.g.,
rear-end collisions) .
Question 4: Which finding on physical examination is most consistent with
Brown-Séquard syndrome (spinal cord hemisection)?
• A) Bilateral lower extremity weakness with bladder dysfunction
• B) Ipsilateral weakness and contralateral loss of pain/temperature sensation
• C) Greater upper extremity weakness than lower extremity weakness
• D) Complete loss of all sensation below the level of injury
,,,ANSWER,,,: B
Rationale: Brown-Séquard syndrome (spinal cord hemisection) produces a classic
pattern: ipsilateral weakness (corticospinal tract) and loss of
proprioception/vibration (posterior column) with contralateral loss of pain and
temperature sensation (spinothalamic tract) beginning 1-2 levels below the lesion.
, Central cord syndrome causes greater upper extremity weakness. Complete cord
transection causes complete loss of function below the lesion .
Question 5: A patient with a spinal cord injury at T6 presents with sudden
hypertension (BP 210/110), severe headache, bradycardia, and diaphoresis above
the level of injury. What is the priority intervention?
• A) Administer IV nitroglycerin
• B) Place the patient in Trendelenburg position
• C) Sit the patient upright and check for bladder distention
• D) Administer IV fluids
,,,ANSWER,,,: C
Rationale: This presentation describes autonomic dysreflexia, a medical
emergency in patients with spinal cord injuries at T6 or above. The most common
triggers are bladder distention or fecal impaction. The priority is to sit the patient
upright (to lower blood pressure) and identify/remove the noxious stimulus—
starting with checking for bladder distention. Never place the patient in
Trendelenburg position, as this would increase intracranial pressure .
Question 6: A 1-year-old boy presents with increasing lethargy and is barely
responsive. His parents deny any trauma or injury. What is the most common cause
of nontraumatic altered levels of consciousness in a child?
• A) Seizure disorder
• B) Diabetic ketoacidosis
• C) Inborn errors of metabolism
