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An 18 year-old college freshman presents to the emergency room 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. He has no rashes. During the physical examination, you flex the patient's neck and his hips and knees flex in response, indicating a meningeal irritation. The name of this positive sign is:
- A. Kernig's sign
- B. Brudzinski sign
- C. Babinski's sign
- D. Lachman's sign
Correct Answer: B
Rationale: Brudzinski's sign is a physical finding associated with meningeal irritation. When the neck is flexed, it causes involuntary flexion of the hips and knees. This sign, along with Kernig's sign, is used to diagnose meningitis. Babinski's sign and Lachman's sign are unrelated to meningeal irritation.
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A 30-year-old female presents with muscle weakness in the lower extremities and palpitations. Her symptoms have been progressively worse over the course of a 2 weeks. She reports to be in great health, but had a period of abdominal pain and diarrhea approximately 5 weeks ago. Her temperature is 98.9 deg F (37.2 deg C), blood pressure 117/82 mmHg, pulse is 102/min, and respirations are 16/min. On physical exam, there is 4-/5 muscle strength throughout the lower extremities. Bilateral patellar reflexes are 1+ and ankle reflexes are absent. Lumbar puncture was performed, and results are pending. Part 1: What is the most likely diagnosis?
- A. Polymyositis
- B. Guillain-Barre syndrome
- C. Hypokalemia
- D. Myasthenia gravis
Correct Answer: B
Rationale: The patient's presentation of progressive weakness, areflexia, and a history of recent gastrointestinal infection is classic for Guillain-Barre syndrome (GBS). GBS is an autoimmune disorder that often follows an infection and leads to demyelination of peripheral nerves. Polymyositis and myasthenia gravis do not typically cause areflexia, and hypokalemia would present with generalized weakness rather than a ascending paralysis.
What are the two branches of the autonomic nervous system?
- A. endocrine and exocrine
- B. upper and lower
- C. sympathetic and parasympathetic
- D. central and peripheral
Correct Answer: C
Rationale: The autonomic nervous system (ANS) regulates involuntary bodily functions and is divided into the sympathetic nervous system, which activates the 'fight or flight' response, and the parasympathetic nervous system, which promotes 'rest and digest' activities. These two branches work in opposition to maintain homeostasis.
A drug that affects both divisions of the autonomic system is going to bind to, or block, which type of neurotransmitter receptor?
- A. nicotinic
- B. muscarinic
- C. α-adrenergic
- D. β-adrenergic
Correct Answer: A
Rationale: Rationale for Correct Answer (A):
1. Nicotinic receptors are present in both sympathetic and parasympathetic divisions of the autonomic system.
2. Drugs affecting both divisions target nicotinic receptors to modulate autonomic functions.
3. Binding or blocking nicotinic receptors can impact both sympathetic and parasympathetic activities.
Summary of Incorrect Choices:
B. Muscarinic receptors are specific to the parasympathetic division, not affecting the sympathetic division.
C. α-adrenergic receptors are specific to the sympathetic division, not influencing parasympathetic functions.
D. β-adrenergic receptors are also specific to the sympathetic division, not impacting the parasympathetic division.
What should the nurse teach the patient recovering from an episode of acute low back pain?
- A. Perform daily exercise as a lifelong routine.
- B. Sit in a chair with the hips higher than the knees.
- C. Avoid occupations in which the use of the body is required.
- D. Sleep on the abdomen or on the back with the legs extended.
Correct Answer: A
Rationale: Regular exercise strengthens the back muscles.
Which number represents the medulla oblongata? (Figure 3)
- A. 1
- B. 2
- C. 5
- D. 8
Correct Answer: D
Rationale: The number 8 represents the medulla oblongata because it is the lower part of the brainstem that controls vital autonomic functions such as heart rate, breathing, and blood pressure. The medulla oblongata is essential for maintaining life and ensuring the proper functioning of the cardiovascular and respiratory systems.