Nokea
Babinsky response usually develops with damage in:
- A. upper motor neuron
- B. lower motor neuron
- C. cerebellar
- D. thalamus
Correct Answer: A
Rationale: Upper motor neuron is the correct answer because the Babinski sign is a pathological reflex indicative of damage to the corticospinal tract. It is characterized by the extension of the big toe and fanning of the other toes upon stimulation of the sole, which is abnormal in adults and suggests a loss of inhibitory control from the brain.
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In obtaining the history for the patient with carpal tunnel syndrome, you would expect to note a history of
- A. Pain and numbness or tingling sensation in the hand (over the palmar surface of the thumb, index finger, middle finger, and lateral aspect of the ring finger) that is worse at night.
- B. Crepitus (grating feeling on palpation over joint during range of motion) due to loss of articular cartilage and bony overgrowth in joint.
- C. Excessive forward curvature of the thoracic spine (kyphosis) owing to pathologic vertebral fractures, and collapsing of the anterior portion of the vertebral bodies in the thoracic area.
- D. Acute onset of excruciating pain in joint because of accumulation of uric acid within the joint.
Correct Answer: A
Rationale: Carpal tunnel syndrome symptoms include nocturnal pain and paresthesia in the median nerve distribution.
Which finding may suggest a problem with the patient's proprioception?
- A. Difficulty standing with eyes closed or swaying when standing still.
- B. Steady gait and normal balance.
- C. Clear, intact sensation in all extremities.
- D. Normal muscle strength and coordination.
Correct Answer: A
Rationale: Proprioception issues are indicated by difficulty standing with eyes closed or swaying. Steady gait, intact sensation, and normal strength are normal findings.
Nerve impulses are picked up by a neuron's (nerve cell):
- A. dendrites
- B. axon
- C. neuron cell body
- D. synapse
Correct Answer: A
Rationale: Dendrites are the part of a neuron responsible for receiving nerve impulses from other neurons or sensory receptors. They are branched structures that extend from the cell body and contain receptors for neurotransmitters. When neurotransmitters bind to these receptors, they generate electrical signals that travel toward the cell body, initiating communication between neurons. Dendrites play a crucial role in integrating incoming signals and determining whether the neuron will fire an action potential.
An elderly patient presents with a right-sided headache and acute loss of vision on the same side. Tenderness is noted to the right temporal region as well as to the scalp. To obtain a definitive diagnosis, the nurse practitioner will order:
- A. Erythrocyte sedimentation rate (ESR)
- B. C-reactive protein (CRP)
- C. Temporal artery biopsy
- D. CT scan of the head
Correct Answer: C
Rationale: The correct answer is C: Temporal artery biopsy. This is the gold standard for diagnosing giant cell arteritis, which presents with symptoms such as headache, vision loss, and tenderness to the temporal region and scalp. The biopsy will show characteristic inflammatory changes in the artery wall.
A: ESR and B: CRP are nonspecific markers of inflammation and can be elevated in various conditions, including giant cell arteritis, but they do not provide a definitive diagnosis.
D: CT scan of the head may show signs of inflammation in the temporal artery, but it is less sensitive than a biopsy for diagnosing giant cell arteritis.
When an edrophonium (Tensilon) test is carried out, which of the following drugs must be available as an antidote?
- A. Atropine sulfate
- B. Diazepam (Valium)
- C. Ephedrine
- D. Corticosteroids
Correct Answer: A
Rationale: Atropine sulfate is used as an antidote for cholinergic crisis.