MSN 572 Quiz 6. A 35-year-old reporter presents to your office for evaluation of back pain and weakness in his left leg. He was play-wrestling with his nephew and hurt his back 2 weeks ago. He states that he has noticed
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MSN 572 Quiz 6. A 35-year-old reporter presents to your office for evaluation of back pain and weakness in his left leg. He was play-wrestling with his nephew and hurt his back 2 weeks ago. He states that he has noticed tingling in his left leg as well. He has not noticed incontinence of bowel or bladder function. You perform a physical examination and confirm that he is dragging his left foot when he walks and that his Achilles reflex is diminished. You diagnose him with a herniated disc. Which nerve root are you testing with the Achilles reflex? Question 1 options: C5 C6 L2 L3 L4 S1 L4 L5 Question 2 (1 point) Saved Which part of the brain is associated with personality and intellectual functioning? Question 2 options: Frontal lobe Parietal lobe Occipital lobe Temporal lobe Question 3 (1 point) Saved In which patient would the NP expect to find a palmar grasp reflex and a positive Babinski reflex? Question 3 options: An infant A 4 year old child An adolescent An adult Question 4 (1 point) Saved In long-standing and poorly controlled hypertension, white matter tracts in the brain are subjected to arteriosclerotic affects. Which one of the following is most vulnerable to this process? Question 4 options: Thalamus Basal ganglia Reticular activating system Diencephalon Internal capsule Question 5 (1 point) Saved A new mom brings in her six month old baby for not being able to keep his eyes together when looking to the left. On exam both of his eyes appear in alignment with conjugate gaze, upon looking to the right. However when looking to the left, the baby’s left eye stays in the forward gays position while the right continues on with full adduction to the left. The eyes appear out of alignment. Which cranial nerve is responsible for the dysfunction in looking left? Question 5 options: The left abducens nerve. The right oculomotor nerve The right abducens nerve The left oculomotor nerve The right Trochlear nerve The left Trochlear nerve Question 6 (1 point) Saved Which cranial nerve injury may cause anosmia in the patient? Question 6 options: Cranial nerve I (olfactory nerve) Cranial nerve II (optic nerve) Cranial nerve III (oculomotor nerve) Cranial nerve IV (trochlear nerve) Question 7 (1 point) Saved A 70-year-old retired musician is brought to your clinic for a hospital follow-up visit after sustaining a stroke. He is able to articulate words but they sound slurred or indistinct. As the astute NP student you would document his speech as: Question 7 options: Dysarthria Dysphonia Dysphagia Aphasia Question 8 (1 point) Saved A 22-year-old daycare worker comes to the clinic for evaluation of fever as high as 103.5°F headache and neck pain. She has photophobia and neck stiffness. During the physical examination you flex the patient's leg at both the hip and the knee and then straighten her knee to elicit meningeal irritation. The patient experiences severe pain. The name of this sign is: Question 8 options: Kernig's sign Brudzinski's sign Babinski's sign Lachman's sign Question 9 (1 point) Saved A 25-year-old housewife presents to the clinic for evaluation of paralysis in her face. She has a history of an upper respiratory infection 2 weeks before the onset of these symptoms. She states that her face is drooping and that she is unable to close her eye. On physical examination you note that her forehead is smooth on the right side her palpebral fissure appears widened and her nasolabial fold appears flattened and she is drooling. Based on this information what is the most likely diagnosis? Question 9 options: Cortical stroke Bell's palsy Horner's syndrome Stress reaction Question 10 (1 point) Saved You are evaluating a 55-year-old teacher for altered mental status. You are trying to distinguish between delirium and dementia. All of the following statements are true about delirium EXCEPT: Question 10 options: Delirium has an acute onset. In delirium there is always a disturbed level of consciousness. Orientation is fairly well maintained but becomes impaired in the later stages of illness. Attention fluctuates Question 11 (1 point) Saved Which nerve roots are tested when the patellar reflex is checked? Question 11 options: C3 C4 L2 L3 L4 T10 T11 T12 C5 C6 Question 12 (1 point) Saved Which of the following is a disease-specific risk factor for stroke? Question 12 options: Obstructive Sleep Apnea Epilepsy Smoking Alcohol use Question 13 (1 point) Saved What is the maximum score given to a patient in the Mini-Mental State Examination (MMSE)? Question 13 options: 5 20 25 30 Question 14 (1 point) Saved Which of the following cranial nerves is responsible for lateral deviation of the eye: Question 14 options: CN II CN III CN IV CN VI Question 15 (1 point) Saved What are the components of a reflex arc? Question 15 options: Nucleus Sensory nerve & motor nerve Motor nerve Cranial nerve Sensory nerve Sensory nerve Neuromuscular junction motor nerve Motor nerve and sensory nerve Question 16 (1 point) Saved While assessing a patient the provider finds that the patient is an at-risk drinker. Which statement by the patient led the provider to conclude this? Question 16 options: I drink 5 alcoholic drinks per week. I drink 6 alcoholic drinks per week. I drink 1 alcoholic drink per occasion. I drink 4 alcoholic drinks per occasion. Question 17 (1 point) Saved A 63-year-old gardener makes an appointment with the office for a pain in his right leg for three days. Since working in the garden moving heavy bags over the weekend, he has begun having intermittent but excruciating pain shooting down the posterior aspect of his right leg. On examination, sensory loss to light touch in the right leg posteriorly corresponding to the S1 (sacral 1) dermatome is noted. Which reflex would be expected to be decreased compared to the other side? Question 17 options: Right plantar Left knee Left ankle Right ankle Left plantar Right knee Question 18 (1 point) Saved The FNP asks the patient to close the eyes and then traces the number 5 on the patient's palm. The patient is unable to identify the number even after repeated attempts. This finding could indicate damage to what part of the patient's brain? Question 18 options: Cerebellum Sensory cortex Cranial nerve XII Dorsal spinothalamic tract Question 19 (1 point) Saved How would an adult patient normally respond to the plantar reflex? Question 19 options: By flexing the toes By flexing the elbow By extending the great toe By extending the lower leg Question 20 (1 point) Saved A 68-year-old male presents to the ER accompanied by his wife who is concerned he is experiencing a stroke. She states that he awoke with drooping of the right side of his mouth. He has a history of high blood pressure and diet controlled diabetes, but no history or prior symptoms of TIA, stroke or neurological deficits. Physical exam reveals a well nourished, right handed male who has an obvious flattening of the right nasolabial fold at rest. He is unable to close his right eye, wrinkle his forehead or raise his eyebrows. The remainder of the Neuro exam is symmetric with intact strength and normal DTRs. Based on the history and physical which of the following statements is most likely to be true? Question 20 options: The patient most likely has an isolated peripheral lower motor neuron lesion involving cranial nerve seven, the facial nerve. The patient most likely has a central process of unclear location, and therefore it must be ruled out with an emergent CT scan. Patient most likely has had an embolic event affecting an upper motor neuron. The patient most likely has an isolated peripheral lower motor neuron lesion involving cranial nerve five, the trigeminal nerve. The patient most likely has a central upper motor neuron lesion involving cranial nerve seven, the facial nerve. Question 21 (1 point) Saved Which conditions may cause peripheral neuropathy in a patient? Question 21 options: Diabetes mellitus Cervical spondylosis Shoulder dislocation Horner's syndrome Question 22 (1 point) Saved During a mental status assessment the NP asks about the patient's first job. What is the NP trying to test? Question 22 options: Orientation Attention span Recent memory Remote memory Question 23 (1 point) Saved The NP flashes a light into the eyes of a 4-year-old child and observes ocular misalignment and a deviated gaze. What condition does the NP chart as the finding? Question 23 options: Nystagmus Horner Syndrome Exophthalmos Strabismus Question 24 (1 point) Saved While assessing the deep tendon reflexes in a patient the NP finds that the responses are very brisk and hyperactive with clonus. Which grade should the NP enter in the patient's medical record? Question 24 options: 1+ 2+ 3+ 4+ Question 25 (1 point) Saved What is the major function of the glossopharyngeal nerve? Question 25 options: Tasting of food Swallowing and gagging Lateral movement of the eye Muscular movement of the tongue Question 26 (1 point) Saved Which of the following reflexes is not a cutaneous stimulation reflex? Question 26 options: Abdominal reflexes Cremasteric reflex Supinator (brachoiradialis reflex) Plantar responses Anal reflex Question 27 (1 point) Saved Which lobe of the brain is associated with language comprehension? Question 27 options: Frontal lobe Parietal lobe Occipital lobe Temporal lobe Question 28 (1 point) Saved A 14-year-old female comes with her family to the urgent care clinic, after having been hit in the right eye with a plastic baseball bat during a game. She complains of a painful, watery, red right eye and sensitivity to light. She has normal vision acuity in both eyes and no diplopia and can open and close her eyes normally. The pupils are unequal and size 3 mm on the left 5 mm on the right. Which cranial nerve would be implicated as the cause of photosensitivity and the pupillary asymmetry? Question 28 options: CN V CN III CN II CN VI CN VII Question 29 (1 point) Saved An 18-year-old college freshman presents to the urgent care center for evaluation of fever headache and neck stiffness. On physical examination the patient is resting quietly and has a flushed face. His vital signs are as follows: temperature 104°F; pulse 110 bpm; and BP 105/70 mm Hg. He has no rashes. During the physical examination you flex the patient's neck and his hips and knees flex in response indicating meningeal irritation. The name of this positive sign is: Question 29 options: Kernig's sign Brudzinski's sign Babinski's sign Lachman's sign Question 30 (1 point) Saved How would an NP test a patient's superficial reflex? Question 30 options: Test the elevation of the ipsilateral testicle Test the reactions elicited by stroking the skin. Test the rhythmic contractions of the calf muscle Test the deep tendon reflexes of the lower extremities
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