FOR MORE EXAMS: De-eagles - Stuvia US
NSG 464- FINAL EXAM REVIEW |
QUESTIONS & ANSWERS (VERIFIED) |
LATEST UPDATE | GRADED A+
A 28-year-old book editor comes to your clinic complaining of strange episodes. He
states that about once a week for the last 3 months his left hand and arm will stiffen and
then start jerking. He says that after a few seconds his whole left arm and then his left
leg will also start to jerk. He denies any loss of consciousness or loss of bowel or
bladder control. When the symptoms resolve, his arm and leg feel tired but otherwise he
feels fine. His past medical history is significant for a cyst in his brain that was removed
6 months ago. He is married and has 2 children. His parents are both healthy. On
examination you see a scar over the right side of his head but otherwise his neurologic
examination is unremarkable. What type of seizure disorder is he most likely to have?
A. Generalized tonic-clonic seizure
B. Generalized absence seizure
C. Simple partial seizure (Jacksonian)
D. Complex partial seizure
ANSWER: C. Simple partial seizure (Jacksonian)
Rationale: Simple partial seizures start with a unilateral symptom, involve no loss of
consciousness, and have a normal postictal state. In a Jacksonian seizure, the
symptoms start with one body part and "march" along the same side of the body.
, FOR MORE EXAMS: De-eagles - Stuvia US
A 37-year-old insurance agent comes to your office, complaining of trembling hands.
She says that for the past 3 months when she tries to use her hands to fix her hair or
cook they shake badly. She says she doesn't feel particularly nervous when this occurs
but she is worries that other people will think she has anxiety disorder or that she is a
drinker. She admits to having some recent fatigue, trouble with vision, and difficulty
maintaining bladder control. Her past medical history is remarkable for hypothyroidism.
Her mother has lupus and her father is healthy. She has an older brother with T1DM.
She is married and has 3 children. She denies tobacco, alcohol, or drug use. On
examination, when she tries to reach for a pencil to fill out the health form she has
obvious tremors in her dominant hand. What type of tremor is she most likely to have?
A. Resting tremor
B. Postural tremor
C. Intention tremor
ANSWER: C. Intention tremor
Rationale: Intention tremors are absent at rest or in a postural position and occur only
with intentional movement of the hands. This is seen in cerebellar disease (stroke or
alcohol use) or in multiple sclerosis. This patient's tremor, fatigue, bladder problems,
and visual problems are suggestive of multiple sclerosis
A 77-year-old retired school superintendent comes to your office complaining of
unsteady hands. He says that for the past 6 months, when his hands are resting in his
, FOR MORE EXAMS: De-eagles - Stuvia US
lap they shake uncontrollably. He says when he holds them out in front of his body the
shaking diminishes, and when he uses his hands the shaking is also better. He also
complains of some difficulty getting up out of his chair and walking around. He denies
any recent illness or injuries. His past medical history is significant for HTN and CAD,
requiring a stent in the past. He has been married for over 50 years and has 5 children
and 12 grandchildren. He denies any tobacco, alcohol, or drug use. His mother died of a
stroke in her 70s and her father died of a heart attack in his 60s. He has a younger
sister who has arthritis problems. His children are all essentially healthy. On
examination you see a fine, pill-rolling tremor of his left hand. His right s
ANSWER: A. Resting tremor
Rationale: Resting tremors occur when the hands are literally at rest, such as sitting in
the lap. These are slow, fine tremors such as the pill-rolling in Parkinson's disease,
which this patient most likely has. Decreased arm swing with emulation is one of the
earliest objective findings of Parkinson's disease
A 48-year-old grocery store manager comes to your clinic complaining of her head
being "stuck" to one side. She says that today she was doing her normal routine when it
suddenly felt like her head was being moved to her left and then it just stuck that way.
She says it is somewhat painful because she cannot get it moved back to normal. She
denies any recent neck trauma. Her past medical history consists of T2DM and
gastroparesis (slow-moving peristalsis in the digestive tract, seen in diabetes). She is on
oral medications for each. She is married and has 3 children. She denies alcohol,
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tobacco, and drug use. Her father has DM and her mother passed away from breast
cancer. Her children are healthy. On examination you see a slightly overweight Hispanic
woman appearing her stated age. Her head is twisted grotesquely to her left but
otherwise her examination is normal. What form of involuntary movement does she
have?
A.
ANSWER: D. Dystonia
Rationale: Dystonia involves large movements of the body, such as with the head or
trunk, leading to grotesque twisted postures. Some medications (such as one commonly
used for gastroparesis) often cause dystonia
A 41-year-old real estate agent comes to your office complaining that he feels like his
face is paralyzed on the left. He states that last week he felt his left eyelid was drowsy
and as the day progressed he was unable to close his eyelid all the way. Later he felt
like his smile became affected also. He denies and recent injuries but had an upper
respiratory viral infection last month. His past medical history is unremarkable. He is
divorced and has 1 child. He smokes 1 pack of cigarettes per day, occasionally drinks
alcohol, and denies any illegal drug use. His mother has HTN and his father has
sarcoidosis. On examination you ask him to close his eyes. He is unable to close his left
eye. You ask him to open his eyes and raise his eyebrows. His right forehead furrows
but his left remains flat. You then ask him to give you a big smile. The right corner of his
mouth raises but the left side of his mouth remains the sa
NSG 464- FINAL EXAM REVIEW |
QUESTIONS & ANSWERS (VERIFIED) |
LATEST UPDATE | GRADED A+
A 28-year-old book editor comes to your clinic complaining of strange episodes. He
states that about once a week for the last 3 months his left hand and arm will stiffen and
then start jerking. He says that after a few seconds his whole left arm and then his left
leg will also start to jerk. He denies any loss of consciousness or loss of bowel or
bladder control. When the symptoms resolve, his arm and leg feel tired but otherwise he
feels fine. His past medical history is significant for a cyst in his brain that was removed
6 months ago. He is married and has 2 children. His parents are both healthy. On
examination you see a scar over the right side of his head but otherwise his neurologic
examination is unremarkable. What type of seizure disorder is he most likely to have?
A. Generalized tonic-clonic seizure
B. Generalized absence seizure
C. Simple partial seizure (Jacksonian)
D. Complex partial seizure
ANSWER: C. Simple partial seizure (Jacksonian)
Rationale: Simple partial seizures start with a unilateral symptom, involve no loss of
consciousness, and have a normal postictal state. In a Jacksonian seizure, the
symptoms start with one body part and "march" along the same side of the body.
, FOR MORE EXAMS: De-eagles - Stuvia US
A 37-year-old insurance agent comes to your office, complaining of trembling hands.
She says that for the past 3 months when she tries to use her hands to fix her hair or
cook they shake badly. She says she doesn't feel particularly nervous when this occurs
but she is worries that other people will think she has anxiety disorder or that she is a
drinker. She admits to having some recent fatigue, trouble with vision, and difficulty
maintaining bladder control. Her past medical history is remarkable for hypothyroidism.
Her mother has lupus and her father is healthy. She has an older brother with T1DM.
She is married and has 3 children. She denies tobacco, alcohol, or drug use. On
examination, when she tries to reach for a pencil to fill out the health form she has
obvious tremors in her dominant hand. What type of tremor is she most likely to have?
A. Resting tremor
B. Postural tremor
C. Intention tremor
ANSWER: C. Intention tremor
Rationale: Intention tremors are absent at rest or in a postural position and occur only
with intentional movement of the hands. This is seen in cerebellar disease (stroke or
alcohol use) or in multiple sclerosis. This patient's tremor, fatigue, bladder problems,
and visual problems are suggestive of multiple sclerosis
A 77-year-old retired school superintendent comes to your office complaining of
unsteady hands. He says that for the past 6 months, when his hands are resting in his
, FOR MORE EXAMS: De-eagles - Stuvia US
lap they shake uncontrollably. He says when he holds them out in front of his body the
shaking diminishes, and when he uses his hands the shaking is also better. He also
complains of some difficulty getting up out of his chair and walking around. He denies
any recent illness or injuries. His past medical history is significant for HTN and CAD,
requiring a stent in the past. He has been married for over 50 years and has 5 children
and 12 grandchildren. He denies any tobacco, alcohol, or drug use. His mother died of a
stroke in her 70s and her father died of a heart attack in his 60s. He has a younger
sister who has arthritis problems. His children are all essentially healthy. On
examination you see a fine, pill-rolling tremor of his left hand. His right s
ANSWER: A. Resting tremor
Rationale: Resting tremors occur when the hands are literally at rest, such as sitting in
the lap. These are slow, fine tremors such as the pill-rolling in Parkinson's disease,
which this patient most likely has. Decreased arm swing with emulation is one of the
earliest objective findings of Parkinson's disease
A 48-year-old grocery store manager comes to your clinic complaining of her head
being "stuck" to one side. She says that today she was doing her normal routine when it
suddenly felt like her head was being moved to her left and then it just stuck that way.
She says it is somewhat painful because she cannot get it moved back to normal. She
denies any recent neck trauma. Her past medical history consists of T2DM and
gastroparesis (slow-moving peristalsis in the digestive tract, seen in diabetes). She is on
oral medications for each. She is married and has 3 children. She denies alcohol,
, FOR MORE EXAMS: De-eagles - Stuvia US
tobacco, and drug use. Her father has DM and her mother passed away from breast
cancer. Her children are healthy. On examination you see a slightly overweight Hispanic
woman appearing her stated age. Her head is twisted grotesquely to her left but
otherwise her examination is normal. What form of involuntary movement does she
have?
A.
ANSWER: D. Dystonia
Rationale: Dystonia involves large movements of the body, such as with the head or
trunk, leading to grotesque twisted postures. Some medications (such as one commonly
used for gastroparesis) often cause dystonia
A 41-year-old real estate agent comes to your office complaining that he feels like his
face is paralyzed on the left. He states that last week he felt his left eyelid was drowsy
and as the day progressed he was unable to close his eyelid all the way. Later he felt
like his smile became affected also. He denies and recent injuries but had an upper
respiratory viral infection last month. His past medical history is unremarkable. He is
divorced and has 1 child. He smokes 1 pack of cigarettes per day, occasionally drinks
alcohol, and denies any illegal drug use. His mother has HTN and his father has
sarcoidosis. On examination you ask him to close his eyes. He is unable to close his left
eye. You ask him to open his eyes and raise his eyebrows. His right forehead furrows
but his left remains flat. You then ask him to give you a big smile. The right corner of his
mouth raises but the left side of his mouth remains the sa
