Nokea
Mr. Smith's physician suspects that Mr. Smith has an injured pituitary gland because of his
- A. large output of low specific gravity urine
- B. watery nasal discharge positive for glucose
- C. pupils failing to react to light
- D. positive Babinski reflex
Correct Answer: A
Rationale: Diabetes insipidus, indicated by large outputs of low specific gravity urine, can result from pituitary injury.
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A previously healthy 68-year-old male presents with progressive muscle weakness in his right hand, swallowing difficulty and difficulty with walking. He believes these symptoms occurred "out of the blue" and have worsened over the last 2-3 months. His temperature is 98.6 deg F (37 deg C), blood pressure 145/86 mmHg, pulse is 80/min, and respirations are 17/min. Neurologic examination is significant for mild dysarthria. He has atrophy of the thenar muscles of the right hand and forearm, and 2/5 strength on wrist extension and flexion, as well as 3/5 power in intrinsic hand muscles on right. He has some fasciculations in his right thigh, and mild (4+/5) weakness of hip flexors bilaterally. Tone is increased in both legs. Sensory examination is intact. 3+ patellar reflexes are noted on the left lower extremity. On gait testing, the patient has poor balance, and spastic gait. Which of the following is the most likely diagnosis?
- A. Guillain-Barre syndrome
- B. Amyotrophic lateral sclerosis
- C. Myasthenia gravis
- D. Multiple sclerosis
Correct Answer: B
Rationale: The patient's presentation of progressive muscle weakness, atrophy, fasciculations, and spasticity with hyperreflexia is classic for amyotrophic lateral sclerosis (ALS). ALS involves both upper and lower motor neuron degeneration, leading to a combination of weakness, atrophy, and spasticity. The absence of sensory deficits and the presence of bulbar symptoms (dysarthria, swallowing difficulty) further support this diagnosis. Guillain-Barre syndrome typically presents with ascending paralysis and areflexia, while myasthenia gravis is characterized by fatigable weakness without atrophy or fasciculations. Multiple sclerosis and dermatomyositis do not fit the clinical picture.
In the UK, two tests of speed of information processing, verbal memory tests (list learning and story recall), and visual memory tests (design learning and figure recall) is known as:
- A. The Adult Memory and Information Processing Battery (AMIPB).
- B. The Information Processing test (IPT).
- C. The Adult Executive Function Scale (AEFS).
- D. The Memory Battery (MB).
Correct Answer: A
Rationale: The Adult Memory and Information Processing Battery (AMIPB) is a comprehensive neuropsychological test used in the UK to assess memory and information processing abilities. It includes tests of verbal memory (e.g., list learning, story recall) and visual memory (e.g., design learning, figure recall), as well as measures of processing speed. This battery is widely used to evaluate cognitive functioning in individuals with neurological disorders or brain injuries.
The brain stem does NOT include the:
- A. diencephalons
- B. midbrain
- C. medilla oblongata
- D. pons
Correct Answer: A
Rationale: The brainstem consists of the midbrain, pons, and medulla oblongata. The diencephalon, which includes the thalamus and hypothalamus, is part of the forebrain, not the brainstem.
One of the most distressing problems experienced by the patient with ALS is
- A. Painful spasticity of the face and extremities
- B. Retention of cognitive function with total degeneration of motor function
- C. Uncontrollable writhing and twisting movements of the face
- D. limbs
Correct Answer: B
Rationale: Retention of cognitive function while losing motor abilities is emotionally distressing
To assess a patient's recent memory, the nurse should:
- A. Ask the patient to recall recent events or conversations.
- B. Check the patient's ability to recognize familiar faces.
- C. Measure the patient's blood pressure.
- D. Inspect the patient's gait.
Correct Answer: A
Rationale: Recent memory is assessed by asking the patient to recall recent events or conversations. Recognizing faces, blood pressure, and gait are unrelated to memory assessment.