NR 603 WEEK 1 |2025| complete exam test questions and verified answers HIGH-STAKES EXIT EXAM: UPDATED QUESTION POOL & VERIFIED KEYS ACE THE FINAL: COMPLETE 3VERSION TEST BANK WITH 100% ACCURACY

1. Essential Tremor A 52-year-old woman presents with a 1-year history of bilateral hand tremors that worsen with activity and improve after drinking alcohol. Her mother has similar symptoms. What is the most likely diagnosis? A. Alcohol withdrawal B. Parkinson’s disease C. Essential tremor D. Huntington’s disease E. Multiple sclerosis Correct Answer: C. Essential tremor Rationale: Essential tremor is an action tremor that improves with alcohol and often has a familial pattern. Parkinson’s disease causes a resting tremor, and Huntington’s disease presents with chorea and early death. Alcohol withdrawal is acute and transient, not chronic. 2. Huntington Disease – Diagnostic Test A 32-year-old woman presents with involuntary movements, cognitive decline, and speech difficulty. Family history is unknown due to adoption. What test best confirms the diagnosis? A. MRI brain B. CT brain C. AFB smear D. Genetic testing E. EEG Correct Answer: D. Genetic testing Rationale: Huntington disease is an autosomal dominant trinucleotide repeat disorder (chromosome 4). Diagnosis is confirmed by genetic testing, not imaging. MRI/CT may show caudate atrophy but are not diagnostic. 3. Post-Concussion Syndrome A 16-year-old boy has headaches, dizziness, and difficulty concentrating 3 weeks after a mild concussion with normal CT. What is the most likely diagnosis? A. Traumatic brain injury B. Dysthymia C. Complex partial seizures D. Post-concussion syndrome E. Subdural hemorrhage Correct Answer: D. Post-concussion syndrome Rationale: Post-concussion syndrome includes headache, dizziness, cognitive impairment, and fatigue after head injury with normal imaging. Symptoms persist despite normal neurologic exam. 4. Epidural Hematoma – Next Step A 22-year-old man becomes comatose after head trauma with fixed dilated pupil. What is the most appropriate next step? A. MRI brain B. Lumbar puncture C. Burr hole craniotomy D. CT brain E. Observation Correct Answer: D. CT brain Rationale: Epidural hematoma is diagnosed with non-contrast CT scan, which shows biconvex hematoma. MRI is too slow, and burr hole is treatment, not diagnostic confirmation. 5. Visual Field Defect Localization A 74-year-old woman has right inferior homonymous quadrantanopsia after a stroke. Where is the lesion located? A. Left optic tract B. Optic chiasm C. Left optic nerve D. Left parietal lobe E. Right optic tract Correct Answer: D. Left parietal lobe Rationale: Inferior homonymous quadrantanopsia (“pie on the floor”) results from damage to superior optic radiations in the contralateral parietal lobe. 6. Absence Seizures – Treatment Ethosuximide is primarily used to treat: A. Febrile seizures B. Absence seizures C. Generalized tonic-clonic seizures D. Status epilepticus E. Simple partial seizures Correct Answer: B. Absence seizures Rationale: Ethosuximide blocks T-type calcium channels in thalamus, making it first-line for absence seizures only. 7. Bell’s Palsy A 33-year-old woman has complete unilateral facial paralysis including forehead involvement. What is the cause? A. Stroke B. Bell’s palsy C. Tumor D. Myasthenia gravis E. Multiple sclerosis Correct Answer: B. Bell’s palsy Rationale: Bell’s palsy causes LMN facial nerve palsy affecting upper + lower face, often linked to HSV-1 reactivation. 8. Angiogram – Berry Aneurysm A patient with polycystic kidney disease is being evaluated for cerebral aneurysms. Gold standard test? A. MRI B. Angiogram C. PET scan D. CT scan E. EEG Correct Answer: B. Angiogram Rationale: Cerebral angiography is the gold standard for detecting berry aneurysms. 9. Status Epilepticus – Initial Treatment A patient is unconscious after a seizure lasting 30 minutes. Best initial treatment? A. Glucose B. Lorazepam C. Phenytoin D. Phenobarbital E. Surgery Correct Answer: B. Lorazepam Rationale: First-line treatment for status epilepticus is IV benzodiazepine (lorazepam) for rapid seizure control. 10. Biofeedback Therapy A patient with stress-related migraines failed standard therapy. Best next treatment? A. Aversion therapy B. Biofeedback C. Flooding D. Systematic desensitization E. Token economy Correct Answer: B. Biofeedback Rationale: Biofeedback helps patients control physiological stress responses and is effective for migraine, hypertension, and chronic pain. 11. Postural Tremor Improvement with Alcohol A patient has bilateral hand tremor that improves with alcohol and runs in the family. What is the diagnosis? A. Parkinson’s disease B. Essential tremor C. Multiple sclerosis D. Huntington disease E. Alcohol withdrawal Correct Answer: B. Essential tremor Rationale: Essential tremor is a familial action tremor that improves temporarily with alcohol. Parkinson’s disease causes a resting tremor, not action tremor. 12. Stroke with Diplopia and Ataxia A young adult has choreiform movements, cognitive decline, and behavioral changes. Family history is unknown. Best diagnostic test? A. MRI brain B. CT brain C. AFB smear D. Genetic testing E. Lumbar puncture Correct Answer: D. Genetic testing Rationale: Huntington disease is confirmed by genetic testing (chromosome 4 CAG repeat expansion). Imaging is supportive only. 13. Post-Concussion Symptoms A teenager has headaches and poor concentration weeks after head trauma with normal CT. Diagnosis? A. Traumatic brain injury B. Post-concussion syndrome C. Depression D. Seizure disorder E. Subdural hematoma Correct Answer: B. Post-concussion syndrome Rationale: Post-concussion syndrome presents with headache, dizziness, cognitive difficulty, and fatigue after mild head injury, despite normal imaging. 14. Epidural Hematoma Diagnosis A young man becomes comatose with unilateral fixed dilated pupil after head trauma. Next best step? A. MRI brain B. Lumbar puncture C. Burr hole surgery D. CT brain E. Observation Correct Answer: D. CT brain Rationale: Epidural hematoma is a neurosurgical emergency diagnosed by non-contrast CT showing biconvex hematoma. 15. Visual Field Defect Localization Right inferior homonymous quadrantanopsia localizes to: A. Optic chiasm B. Optic nerve C. Left parietal lobe D. Right temporal lobe E. Optic tract Correct Answer: C. Left parietal lobe Rationale: Inferior quadrantanopsia = lesion in contralateral parietal lobe (superior optic radiations). 16. Ethosuximide Indication Ethosuximide is used to treat: A. Febrile seizures B. Absence seizures C. Tonic-clonic seizures D. Status epilepticus E. Partial seizures Correct Answer: B. Absence seizures Rationale: Ethosuximide blocks T-type Ca²⁺ channels in thalamus, treating absence seizures only. 17. Bell’s Palsy Mechanism A patient has unilateral facial paralysis including forehead. Cause? A. Stroke B. Bell’s palsy C. Tumor D. Myasthenia gravis E. MS Correct Answer: B. Bell’s palsy Rationale: Bell’s palsy is LMN facial nerve palsy, often linked to HSV-1 reactivation.