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Which artery is most commonly involved in ischemic stroke?
The most common artery occluded in ischemic stroke is the middle cerebral artery, which supplies a large percentage of the frontal lobe and the lateral surface of the temporal and parietal lobes. Occlusion of this artery affects the motor and sensory areas of the face, throat, arm, hand and the areas for speech.
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Which of the following is the most common etiology of intracerebral hemorrhagic stroke?
Hypertension is a leading etiology in intracerebral hemorrhagic stroke. Chronic hypertension can cause damage and stress to the blood vessel wall, leading to aneurism or increased risk of spontaneous rupture.
AVM, trauma, and medications such as blood thinners are all also responsible for a significant (though lesser) number of hemorrhagic strokes, or may be co-morbidities that increase the risk of a rupture in the presence of prolonged hypertension.
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You are the nurse assessing a 16-year old girl who is the star of her high school's gymanstics team who is admitted to the hospital for fatigue and weakness. You examine her and notice that she appears hypovolemic, her hair appears thin and brittle, her parotid glands appear swollen, her knuckles have excoriations, and her teeth appear slightly yellow. You suspect that she most likely suffers from which of the following?
The correct answer is bulimia nervosa.
Bulimia nervosa is an eating disorder in which a patient classically consumes large amounts of food (binge eating) and then induces vomiting (purge behavior) to expel the food prior to absorption in the gastrointestinal tract. As such, the patient restricts their ability to gain weight. Patients with bulimia nervosa are frequently successful, high-achieving individuals under a great deal of stress, and often may be adolescent athletes, as patients in this population frequently have specific weight cutoffs that they must achieve for their respective sports/activities. Some signs of bulimia nervosa, as exhibited by this patient, are thin, brittle hair, a hypovolemic appearance (due to frequent vomiting), excoriations on the knuckles (from self-inducing vomiting with their hands), yellow discoloration of the teeth (from the acidity of vomitus), and swelling of the parotid glands (colloquially known as "chipmunk cheeks") as a response to the frequent vomiting. Patients with bulimia may also use other methods to purge themselves of food and drinks including diuretic use, and/or laxative use.
A key distinction between bulimia nervosa and anorexia nervosa is that in bulimia the patient exhibits a form of purge behavior following binge eating, whereas in anorexia, classically, the patient simply restricts eating rather than binging and purging.
Hypothyroidism is not a correct answer choice because while this patient is exhibiting lethargy, weakness, and brittle hair, given the constellation of her other symptoms and exam findings, it is less consistent with her presentation than bulimia nervosa. If these symptoms persisted following treatment for bulimia, then hypothyroidism could be considered as a concurrent finding.
Exogenous use of testosterone would not account for the symptoms seen in this patient.
Marfan's syndrome would also not account for the symptoms seen in this patient.
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What is the most common cranial mononeuropathy in diabetic patients?
Third nerve palsy (cranial nerve III, the oculomotor nerve) is the most common cranial mononeuropathy seen in diabetic patients. They will present with ptosis, dilated and fixed pupils, and an outward and slightly downward deviation of the eye. Bell's palsy involves unilateral facial paralysis as a result of damage to the facial nerve (cranial nerve VII). Cranial mononeuropathy VI is caused by damage to the abducens nerve (cranial nerve VI). Signs of damage include inability to laterally rotate the eye and/or double vision. Auditory neuropathy may be a result of damage to the vestibulocochlear nerve (cranial nerve VIII); the most pronounced symptom is loss of audition.
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A 62-year-old male client is admitted to the hospital with acute pancreatitis. The client has a well-established history of alcohol abuse. The nurse caring for this client is aware he may exhibit withdrawal symptoms during the inpatient course.
The nurse's plan of care for this client should include assessment for all the following symptoms of alcohol withdrawal except?
The symptoms of alcohol withdrawal may include confusion, disorientation, and anxiety. Hypersomnolence or excessive sleep is not associated with this condition. Additional symptoms may include agitation, hypervigilance, tremor, rapid and irregular heart beat, hypertension, seizure, and hallucinations (mostly visual).
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What condition is described by the following: A defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis?
Wilson's disease is characterized by a defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis. This results in copper accumulation, primarily in the liver and the brain. Signs and symptoms include liver failure, cognitive deterioration, clumsiness, and changes in behavior. Symptoms often start in adolescence, but can start any time between 6-20 years old. Aceruloplasminemia is a rare condition of iron accumulation in the basal ganglia, retina, and liver. Hereditary hemochromatosis is also a disorder of iron accumulation, often caused by mutations in the HFE gene. Huntington disease is a genetic neurodegenerative disease unrelated to any mineral storage disorders.
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What is the most common cause of meningitis?
All of the answers given are possible causes of meningitis, but the most common (and least severe) etiology is viral. There is no vaccine for viral meningitis, but there are vaccines for three different organisms that cause bacterial meningitis:
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Approximately 80% of strokes are of what type?
Approximately 80% of strokes are ischemic, either caused by thrombus or emboli. Hemorrhagic strokes only account for approximately 15% of all strokes, but are significantly more lethal and account for 30% of all stroke deaths. They involve the rupturing of a weakened blood vessel in the brain and subsequent bleeding in the surrounding areas. Transient ischemic attacks are not considered true strokes, and are often referred to as "mini strokes."
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A client has a history of spinal injury and the nurse is evaluating the client with the onset of new symptoms. The symptoms include hypertension, a throbbing headache, a slow heart rate of 40 beats per minute, and piloerection.
The nurse recognizes these symptoms are consistent with what disorder?
These symptoms are evidence of autonomic dysreflexia, which is a sequela of spinal shock. It is a medical emergency and requires immediate intervention as it may lead to stroke, cardiac arrest, coma or death if untreated.
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A 23-year-old male college student presents to the emergency room after experiencing a high fever, nausea, vomiting, and nuchal rigidity. The nurse recognizes that this combination of symptoms are indicative of bacterial meningitis. The nurse is aware cranial nerve dysfunction is related to the condition.
Which of the following cranial nerves (CN) is correctly matched to its dysfunction?
The trigeminal nerve (CN V) is responsible for both sensory and motor functions of the face, including the corneal reflex which is also mediated by the facial nerve (CN VII).
CN II, optic nerve affects vision, including causing papilledema - swelling of the optic disc. CN III, oculomotor dysfunction may cause ptosis. Cranial nerve VIII, vestibulocochlear is responsible for hearing and cranial nerve VI, abducens is responsible for horizontal eye movements.
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A young woman presents to a clinic complaining of unilateral headaches that she describes as throbbing, "like a hammer was hitting my head." She experiences these headaches 5-10 times per month, and an episode can last up to 24 hours. During the headache she is sensitive to light, sound, and smell. On a few occasions the pain has been severe enough to induce vomiting. She feels better with coffee, and by lying down alone in a dark room. Her headache is most likely which of the following types?
The symptoms this individual describes are most likely due to migraine headache (migraine without aura, also known as common migraine). Migraines are diagnosed by the following criteria:
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A 37 year old man comes into the clinic for chronic headaches. He describes his headaches as in his forehead and temples bilaterally, occasionally wrapping around his head toward his neck. Pain is rated as a 4 out of 10. He has these headaches around 3 times per week. No photophobia with his headaches, no nausea or vomiting. Headache feels better when he presses on his scalp. When asked to describe the sensation of the headache, he replies that it's "like a band" around his head. These headaches are not preventing him from normal activity. These are most likely what type of headache?
The symptoms described by this individual make tension headaches the most likely diagnosis. Tension headaches are defined by the following criteria:
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A 21 year old male presents to clinic for extremely painful headaches. Pain is felt above the left eye and described as a 9 out of 10. Headaches are short; most episodes last for 30-45 minutes, and always on the left side. He notices that during an episode, his left eye will become red and watery, and his nose will run on the left side. He has up to three episodes per day. During a headache he will become agitated and restless, and will pace, groan, and hit the wall or floor with his fist. He is very concerned that he may have a brain tumor, meningitis, or some other serious condition. His headaches are most likely which of the following types?
The presentation of this patient's headaches would make cluster headache the most likely diagnosis. Cluster headaches are defined by the following criteria:
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Which of the following is not a common trigger for migraine headaches?
While caffeine may be a migraine trigger for certain individuals, in the majority of people who experience migraine headaches, caffeine provides significant relief of pain. This may be due to it's antagonizing adenosine receptors, which has the effect of cerebral vasoconstriction. Caffeine withdrawal, however, is a common cause of headaches and may trigger migraine is susceptible individuals. Other common migraine triggers include food allergies, medications, bright lights, stress, lack of sleep, hormone fluctuations, strong odors, alcohol, and certain types of exercise.
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A 27 year old female presents complaining of an inability to "smile normally" or close her left eye. She states that she woke up and noticed that the left side of her face was "not responding" when she tried to blink, smile, or speak. She also feels a pain in her left ear. She has never experienced this before. The nurse does a physical exam, which is notable for left sided upper eyelid retraction, general left sided facial muscle weakness, and left sided brow droop. There are no cognitive or sensory defects noted. What is the most likely cause?
The symptoms and physical exam of this patient are consistent with a diagnosis of Bell's palsy, a rapid onset cranial nerve disorder that results in unilateral facial paralysis or weakness. Symptoms usually come on within 24-72 hours and may include facial tingling, ear pain, taste disturbance, headache, issues with balance, cognitive changes, and clumsiness.
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Which of the following is not a type of seizure?
Currently there are over 40 distinct types of seizures recognized by the medical community. Some of the most common seizure types are generalized tonic-clonic, absence, myoclonic, clonic, tonic, febrile, and atonic. Some other less common types include refractory seizures, gelastic seizures, and dacrystic seizures.
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A seven year old girl is having issues in school due to lack of attention. Her teacher states that she will "space out" frequently for a period of 10-20 seconds. During these times she will stare straight ahead and will not respond to questions, even if she is called on directly. She does not have any tics or facial movements during these episodes, other than a slight fluttering of the eyelids. Her teacher states she does this several times during the school day, and that it is impacting her performance in school because she is unable to remember what the teacher was talking about during the spell.
This child is most likely experiencing which of the following types of seizures?
Absence seizures are typified by a brief, 2-30 second loss of consciousness in the absence of other symptoms. Individuals with this condition generally will not experience muscle rigidity (as in a tonic seizure) or jerking (as in clonic or myoclonic seizures), nor do they experience a loss of muscle tone, as seen in atonic seizures. Absence seizures present frequently in young children as "staring spells" and may cause issues with learning or appear as inattentive behavior in school until correctly diagnosed by a medical professional.
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A seven year old girl is having issues in school due to lack of attention. Her teacher states that she will "space out" frequently for a period of 10-20 seconds. During these times she will stare straight ahead and will not respond to questions, even if she is called on directly. She does not have any tics or facial movements during these episodes, other than a slight fluttering of the eyelids. Her teacher states she does this several times during the school day, and that it is impacting her performance in school because she is unable to remember what the teacher was talking about during the spell.
Which of the following diagnostic tool would help this child's provider identify her "spells" as absence seizures?
While CT and MRI may aid in discovering structural abnormalities associated with certain seizure disorders, the correct tool for diagnosis of seizures is electroencephalography (EEG). An EEG can show abnormal surges in brain activity responsible for temporary loss of consciousness in absence seizures.
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Which of the following seizure types is characterized by a brief loss in muscle control, often resulting in a fall or collapse, in the absence of spasm or rigidity?
Atonic seizures are characterized by brief (2-15 second) loss or lapses in muscle control, resulting in sudden relaxation of the neck, legs, or whole body. This seizure type frequently causes injury due to falls or head trauma. There may be spasm or twitching at some point during an atonic seizure, but they generally present without any form of rigidity or clonus, unlike tonic-clonic and myoclonic seizures. Atonic seizures differ from absence seizures in that an individual experiencing absence seizures will generally only experience a loss of consciousness, without an accompanying loss of muscle control.
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A three year old patient presents for a seizure that occurred at home. To her father's knowledge, she has never had a seizure in the past. She was not ill at the time of the seizure, and she is not on any type of medication. There was no head trauma before the incident. Her father states that her older brother was diagnosed with epilepsy at age seven, and that his grandmother was also epileptic. Is it safe to assume that this child is also epileptic?
While epilepsy may certainly be hereditary, the diagnosis of epilepsy requires the occurrence of at least two seizures during two separate incidents, regardless of positive family history. These must occur in the absence of provocative factors such as fever, head trauma, or medication.
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