Neuro Assessment: Coordination, Weakness & Nervous System Functions, Exams of Neurology

Download Neuro Assessment: Coordination, Weakness & Nervous System Functions and more Exams Neurology in PDF only on Docsity! AGNP EXAM NEUROLOGY ASSESSMENT WITH ANSWERS. Question: A 80 year old male visits the nurse practitioner for an annual well exam. History reveals two falls in the prior 12 months and difficulty with balance. The next step the nurse practitioner should take is: reassess the patient in 6 months. obtain cognitive and functional assessment. Correct assess respiratory assessment. assess cardiac function. Explanation: High-risk older adults, namely those with a single fall in the past 12 months with abnormal gait and balance and those with two or more falls in the prior 12 months, an acute fall, and/or difficulties with gait and balance, require further assessment to determine the reasons for the falls. Obtaining relevant medical history, physical exam, cognitive and functional assessment and determining multifactorial fall risks are essential to the preventing future falls. Question: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of: position and vibration. pain and temperature. Correct deep touch. discriminative AGNP EXAM NEUROLOGY ASSESSMENT WITH ANSWERS. sensations. AGNP BOARD EXAM QUESTIONS Neurology Assessment Assessment of a 70-year-old's ability to maintain personal safety would be most adversely affected by declining function in the: cardiovascular system. respiratory system. sensory perception system. Correct gastrointestinal system. Explanation: The sensory system or sensory perception involves vision, touch, taste, smell, and hearing. With the aging process these perceptions are altered and these alterations put the elderly at risk for falls, burns, inability to smell smoke, and the inability to move fast enough to get out of harm's way. These impact personal safety. Changes in the cardiovascular, gastrointestinal, and respiratory systems do not usually lead to safety issues. Question: A patient complains of experiencing symptoms of nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event. These symptoms are most likely associated with: subarachnoid hemorrhage. stroke. neurocardiogenic syncope. vasovagal syncope. Correct Explanation: In vasovagal syncope, a common cause of syncope, a prodrome of nausea, diaphoresis, and pallor are triggered by a fearful or unpleasant event, then vagally mediated hypotension, often with slow onset and offset. In syncope from arrhythmias, onset and offset are often sudden, reflecting loss and recovery of cerebral perfusion. Stroke or subarachnoid hemorrhage are unlikely to cause syncope unless there are focal findings AGNP BOARD EXAM QUESTIONS Neurology Assessment and damage to both hemispheres. Question: An infant presents with an inappropriately increasing head circumference and hydrocephalus confirmed by CT scan. In addition to these findings, which one of the following would also be consistent with hydrocephalus? A soft, low-pitched cry Ability to be comforted easily Tense, bulging fontanels Correct Appropriately increasing weight Explanation: An infant with newly diagnosed hydrocephalus presents with a shrill and high-pitched cry. They are very irritable and do not comfort easily. Additionally, the infant's fontanels are tense and bulging due to the increased amount of cerebral spinal fluid (CSF) being produced or not being absorbed. These infants are very difficult feeders, so they often do not gain weight appropriately. AGNP BOARD EXAM QUESTIONS Neurology Assessment Question: Postural tremors appear when the affected part is: at rest. moving voluntarily. is actively maintaining a posture. Correct getting closer to its target. Explanation: Tremors are rhythmic oscillatory movements. Postural tremors appear when the affected part is actively maintaining a posture. Examples include the fine rapid tremor of hyperthyroidism, the tremors of anxiety and fatigue, and benign essential tremor. The other choices are not consistent with postural tremors. Question: Dysphonia refers to: the inability to produce or understand language. the loss of voice. an impairment in volume of the voice. Correct a defect in the muscular control of the speech apparatus. Explanation: Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Aphasia refers to a disorder in producing or understanding language. Question: Symptoms of a migraine headache can include throbbing, nausea or vomiting, duration of one day, and be unilateral and/or disabling. How many of these symptoms should be present to classify the headache as a migraine? One of the five Two of the five AGNP BOARD EXAM QUESTIONS Neurology Assessment The least invasive, least expensive, most efficient strategy used to detect cognitive and developmental deficits in infants and children is assessing for achievement of developmental milestones. Delay in achievement of developmental milestones is a cardinal sign of deficits/disabilities. The other three choices may be done at a later date as the child gets older and after the child is identified as having delayed or failure to achieve milestones. Question: A term used to describe an increase in muscular bulk with diminished strength is: hypertrophy. muscular atrophy. pseudohypertrophy. Correct muscle weakness. Explanation: An increase in muscular bulk with diminished strength is known as pseudohypertrophy. Hypertrophy refers to an increase in bulk of the muscle with a proportionate increase in AGNP BOARD EXAM QUESTIONS Neurology Assessment strength. A term used to describe muscle wasting or loss of muscle bulk is muscular atrophy. Muscular weakness is a term used to describe a lack of strength or firmness in a muscle. Question: A 40-year-old male presents with complaints of headaches. History reveals headaches that occurred daily for about 4-6 weeks. He had relief for 6 months but now they are recurring. These are most likely: tension headaches. cluster headaches. Correct migraine headaches. sinus headaches. Explanation: Headaches that are episodic with several each day for 4-6 weeks with an extended period of relief for 6-12 months are most likely cluster headaches. Cluster headaches are more common in men than women. Question: It is imperative to assess for suicidality and bipolar disorder in patients suspected of experiencing: delirium. autism spectrum disorder. depression. Correct attention deficit disorder. Explanation: Depression is more common in individuals with significant medical conditions, including several neurologic disorders—dementia, epilepsy, multiple sclerosis, and Parkinson disease. Patients who present with depression may actually have bipolar disorder and so screening should always take place. Patients who are depressed may be suicidal. Consequently, in order for appropriate treatment to occur, appropriate diagnosis must occur. AGNP BOARD EXAM QUESTIONS Neurology Assessment Question: The level of consciousness that refers to the patient that remains unarousable with eyes closed without evidence of response to inner need or external stimuli is said to be in: an obtunded state. a comatose state. Correct a lethargic state. a stuporous state. Explanation: A patient that remains unarousable with eyes closed without evidence of response to inner need or external stimuli is a comatose patient. An obtunded patient opens his eyes, looks at the person speaking to him but responds slowly and appears confused. Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. A stuporous patient arouses from sleep only after painful stimuli. AGNP BOARD EXAM QUESTIONS Neurology Assessment The term used to describe involuntary muscle movements, such as chorea, is: dystonia. bradykinesia. akinesia. dyskinesia. Correct Explanation: Dyskinesia is the presence of involuntary muscle movements such as tics or chorea. These movements can be seen in children who have rheumatic fever. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. The absence or loss of control of voluntary muscle movements is akinesia. Question: While assessing the trigeminal nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a: bilateral hemispheric disease. central nervous system lesions. cranial nerve disorder. Correct brainstem lesion. Explanation: While assessing the trigeminal nerve, cranial nerve V (CN V) for sensory function, the patient reports a pain sensation on the right cheek. This finding could be consistent with a cranial nerve disorder, such as trigeminal neuralgia. Question: A progressive disorder of the nervous system that affects movement is known as: delirium. functional impairment. Parkinson's disease. Correct Alzheimer's disease. AGNP BOARD EXAM QUESTIONS Neurology Assessment Explanation: Parkinson's disease is a progressive disorder of the nervous system that affects movement. Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Alzheimer's disease is a geriatric condition in which normal alertness is present but progressive global deterioration of cognition occurs in multiple domains, including short-term memory, but with sparing of memory for remote events, subtle language errors, visuospatial perceptual difficulties, and changes in executive function, or the ability to perform sequential tasks such as instrumental activities of daily living (IADLs). Question: Physical exam of a well two-week-old infant reveals a little dimple with a small amount of hair just above the sacral area. This could be: an unusual finding but within normal limits. AGNP BOARD EXAM QUESTIONS Neurology Assessment hirsutism. Arnold -Chiari malformation. spina bifida occulta. Correct Explanation: There are four types of spina bifida: occulta, closed neural tube defects, meningocele, and myelomeningocele. Occulta is the mildest and most common form in which one or more vertebrae are malformed. The name “occulta,” which means “hidden,” indicates that a layer of skin covers the malformation, or opening in the vertebrae. This form of spina bifida, present in 10-20 percent of the general population, rarely causes disability or symptoms. Closed neural tube defects are often recognized early in life due to an abnormal tuft or clump of hair or a small dimple or birthmark on the skin at the site of the spinal malformation. Meningocele and myelomeningocele generally involve a fluid- filled sac—visible on the back—protruding from the spinal canal. In meningocele, the sac may be covered by a thin layer of skin. In most cases of myelomeningocele, there is no layer of skin covering the sac and an area of abnormally developed spinal cord tissue is usually exposed. Hirsutism is an excessive amount of hair on the body usually caused by a hormonal imbalance. An Arnold- Chiari malformation is a cyst-like formation in the fourth ventricle, cerebellum or brainstem. Question: The patient experiences a sudden loss of consciousness with falling without movements and injury may occur. This type of a seizure is consistent with: a myoclonic seizure. an absent seizure. a myoclonic atonic seizure. Correct a focal seizure with impairment of consciousness. Explanation: During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. A patient AGNP BOARD EXAM QUESTIONS Neurology Assessment findings are abnormal, is the cause in the central or peripheral nervous system?. The other questions are also important to ask but are not included in the 3 most important ones for the neurological exam. Question: The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as: obtundation. alertness. Correct lethargy. stupor. Explanation: The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as alertness. An obtunded patient opens his eyes, AGNP BOARD EXAM QUESTIONS Neurology Assessment looks at the person speaking to him but responds slowly and appears confused. Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. A stuporous patient arouses from sleep only after painful stimuli. Question: A transient ischemic attack is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemia, without acute infarction. Correct an infarction of the central nervous system tissue that may be silent or symptomatic. the abrupt onset of motor or sensory deficits. focal or asymmetric weaknesses caused by central and peripheral nerve damage. Explanation: TIA is now defined as “a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.” Ischemic stroke is “an infarction of central nervous system tissue” that may be symptomatic or silent. The other terms are not related to the new definitions. Question: A patient is noted as lying supine with the jaws clenched and the neck extended with the arms adducted and stiffly extended at the elbows. His forearms are pronated, wrists and fingers flexed. The legs are extended at the knees and the feet are plantar flexed. This position is consistent with: hemiplegia. decorticate rigidity. decerebrate rigidity. Correct paratonia. Explanation: In decerebrate rigidity, the jaws are clenched and the neck is extended with the arms adducted and stiffly extended at the elbows, with forearms pronated, wrists and fingers flexed. A patient is noted as lying supine in an abnormal posture with the upper arms flexed tight to the sides with elbows, wrists, and fingers flexed. His legs are extended and internally rotated and his feet are plantar flexed. This position is consistent with AGNP BOARD EXAM QUESTIONS Neurology Assessment decorticate rigidity. The legs are extended at the knees and the feet are plantar flexed. Hemiplegia refers to one-sided paralysis. Paratonia refers to a form of hypertonia with an involuntary variable resistance during passive movement. Question: A mother reports to the nurse practitioner that her teenager might be taking drugs because earlier today the teenager had a mild seizure and now has an unstable gait and is beginning to complain of shortness of breath. These symptoms might be consistent with a possible overdose of: barbiturates. amphetamines. Correct marijuana. opioids. Explanation: AGNP BOARD EXAM QUESTIONS Neurology Assessment Explanation: Proximal limb weakness, usually symmetric and without sensory loss, occurs in myopathies from alcohol, glucocorticoids, and inflammatory muscle disorders like myositis and dermatomyositis. Bilateral predominantly distal weakness suggests a polyneuropathy, as in diabetes. In the neuromuscular junction disorder myasthenia gravis, there is proximal, typically asymmetric weakness that gets worse with effort. Question: Which one of the following assesses pain, temperature, and sensation using the distal and proximal areas testing pattern? Test the sensation in the thumbs and little fingers Correct Compare the sensation in the right arm to that in the left arm Test the sensation in the fingers and the toes Stimulate first at an area of reduced sensation and move by progressive steps until the patient detects a change Explanation: When testing pain, temperature, and touch sensation, also compare the distal with the proximal areas of the extremities. Further, scatter the stimuli so as to sample most of the dermatomes and major peripheral nerves. An example would be to test the thumbs and fingers (C6 and C8). Comparing the sensation in the right arm with that in the left arm would be an example of the testing pattern of comparing symmetric areas. Testing the fingers and toes is an example of testing pattern for vibration and position sense. By stimulating an area of reduced sensation and moving by progressive steps until the patient detects a change is an example of the pattern of mapping out the boundaries for sensory loss. Question: When trying to determine the level of consciousness in a patient whose level of consciousness is altered, a lethargic patient: opens the eyes and looks at the examiner, responds slowly, and is somewhat confused. appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. Correct AGNP BOARD EXAM QUESTIONS Neurology Assessment arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state. remains unarousable with eyes closed. Explanation: A lethargic patient appears drowsy but opens his eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. Question: AGNP BOARD EXAM QUESTIONS Neurology Assessment With the adult patient lying supine, the nurse practitioner flexes the patient's neck while observing the hips and knees. Flexion of both hips and knees was noted. This is a positive: Brudzinski's sign. Correct Kernig's sign. nuchal rigidity sign. Babinski's sign. Explanation: To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is positive for Brudzinski's sign. To test for Kernig's sign, flex the patient's leg at both the hip and the knee and then straighten the knee. Pain and increased resistance to extending the knee are positive for Kernig's sign. With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward so that his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is positive for nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. To elicit the Babinski response, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick; plantar flexion is normal. Dorsiflexion of the big toe is a positive Babinski's sign. Question: The part of the brain tissue that consists of neuronal axons that are coated with myelin is the: basal ganglion. white matter. Correct gray matter. thalamus. Explanation: Brain tissue may be gray or white. Gray matter consists of aggregations of neuronal cell bodies. It rims the surfaces of the cerebral hemispheres, forming the cerebral cortex. White matter consists of neuronal axons that are coated with myelin. The myelin sheaths, which create the white color, allow nerve impulses to travel more rapidly. AGNP BOARD EXAM QUESTIONS Neurology Assessment Questio n:Question: Walking on the toes and heels may reveal: distal muscular weakness in the legs. Correct ataxia. a cerebellar dysfunction. proximal weakness of the extensors of the hip. Explanation: Walking on the toes and heels may reveal distal muscular weakness in the legs. Inability to heel-walk is a sensitive test for corticospinal tract weakness. An ataxia would be suspected if the patient was unable to walk heel-to-toe in a straight line. Inability to hop in place on each foot would denote cerebellar dysfunction. Difficulty performing a shallow knee bend would suggest proximal weakness in the extensors of the hip, weakness of the quadriceps, extensors of the knee, or both. AGNP BOARD EXAM QUESTIONS Neurology Assessment Questio n:Involuntary rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue are known as: facial tics. dystonic movements. athetoid movements. oral-facial dyskinesias. Correct Explanation: Oral–facial dyskinesias are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. These are involuntary movements. Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Question: Persistent blinking after glabellar tap and difficulty walking heel-to- toe are common in: Alzheimer's disease. Muscular Dystrophy. Parkinson’s disease. Correct Multiple Sclerosis. Explanation: Glabellar tap is a primitive reflex that is characterized by blinking eyes when a patient is lightly tapped between the eyebrows. In less that 5 taps, a normal individual will stop blinking. In Parkinson's disease, persistent blinking will occur until the examiner stops tapping. Difficulty walking heel-to-toe are common in Parkinson's disease. Question: AGNP BOARD EXAM QUESTIONS Neurology Assessment Questio n:To evaluate a patient's response to light touch sensation, the nurse practitioner would ask the patient to identify: a touch on the skin in response to touching the skin with a cotton wisp. Correct an object as being hot or cold. a vibration sensation on the big toe. pain as sharp or dull when the thumb is touched using the sharp end of a safety pin. Explanation: A light touch on the skin in response to touching the skin with a cotton wisp would be an example of assessing for light touch. To evaluate for pain, a safety pin could be used to determine if the sensation is sharp or dull. To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify an object as being hot or cold. To test for vibration, use a tuning fork over the interphalangeal joint of the big toe and ask the patient if he feels the vibration. AGNP BOARD EXAM QUESTIONS Neurology Assessment absence of touch sensation. decreased sensitivity to touch. increased sensitivity to touch. Correct absence of pain sensation. Explanation: Anesthesia is absence of touch sensation; hypesthesia is decreased sensitivity to touch; hyperesthesia is increased sensitivity to touch; and analgesia refers to absence of pain sensation. Question: A female patient complains of weakness in her hand when opening a jar. This finding could be suggestive of which type of weakness pattern? Proximal Distal Correct Symmetric Asymmetric Explanation: To identify distal weakness, ask about hand movements when opening a jar, can or using scissors or a screwdriver. Another example is a problems like tripping when walking. Question: When trying to determine the level of consciousness in a patient whose level of consciousness is altered, a comatose patient: opens the eyes and looks at the examiner, responds slowly, and is somewhat confused. appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. arouses from sleep after exposure to painful stimuli, exhibits slow verbal response, and easily lapses into an unresponsive state. AGNP BOARD EXAM QUESTIONS Neurology Assessment remains unarousable with eyes closed. Correct Explanation: A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. A lethargic patient appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. An obtunded patient opens the eyes and looks at the examiner, but responds slowly and is somewhat confused. A stuporous patient arouses from sleep after exposure to painful stimuli, verbal responses are slow, and lapses into an unresponsive state. Question: What geriatric condition is characterized by normal alertness but progressive global deterioration of cognition in multiple domains? Delirium Cognitive impairment Parkinson's disease AGNP BOARD EXAM QUESTIONS Neurology Assessment Alzheimer's disease Correct Explanation: Alzheimer's disease is a geriatric condition in which normal alertness is present but progressive global deterioration of cognition occurs in multiple domains, including short- term memory, but with sparing of memory for remote events, subtle language errors, visuospatial perceptual difficulties, and changes in executive function, or the ability to perform sequential tasks such as instrumental activities of daily living (IADLs). Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking. Cognitive impairment is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Parkinson's disease is a progressive disorder of the nervous system that affects movement. Question: Having the patient shrug his shoulders and elicit neck movements would be testing Cranial Nerve: VI. VII . IX. XI. Correct Explanation: Cranial Nerve XI is the spinal accessory nerve and is responsible for proper functioning of the shoulder and neck muscles. When the trapezius is paralyzed, the shoulder droops and the scapula is displaced downward and laterally. Weakness with atrophy and fasciculations indicates a peripheral nerve disorder. CN VI tests extraocular movements; CN VII tests hearing; and CN IX and X test swallowing and the gag reflex. Question: To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify: a light touch on the skin in response to touching the skin with a cotton wisp. AGNP BOARD EXAM QUESTIONS Neurology Assessment These skin lesions may be indicative of: leukemia. meningococcemia. Correct neurofibromatosis. hemorrhagic pancreatitis. Explanation: Skin lesions associated with meningococcemia initially present as pink macules and papules. Within minutes to a few hours, petechiae, hemorrhagic petechiae, hemorrhagic bullae, and purpura fulminans become apparent. With meningococcemia meningitis, the temperature may be 102°F or greater and the patient appears very ill. Skin lesions associated with leukemia may include pallor, exfoliative erythroderma, nodules, petechiae, ecchymoses, pruritus, vasculitis, pyoderma gangrenosum, and bullous diseases. Skin lesions associated with neurofibromatosis may include, neurofibromas, cafe´-au-lait spots, freckling in the axillary and inguinal areas, and plexiform neurofibroma. Hemorrhagic pancreatitis skin lesions include Grey Turner's sign (bruising AGNP BOARD EXAM QUESTIONS Neurology Assessment of the flanks, appearing as a blue discoloration), Cullen's sign (superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus), and panniculitis (a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue). Question: Aphasia refers to: the inability to produce or understand language. Correct the loss of voice. an impairment in volume of the voice. a defect in the muscular control of the speech apparatus. Explanation: Aphasia refers to a disorder in producing or understanding language. Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its nerve supply. Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice. Dysarthria refers to a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Question: The part of the brain that maintains homeostasis is the: basal ganglion. thalamus. hypothalamus. Correct cerebellum. Explanation: The hypothalamus maintains homeostasis and regulates temperature, heart rate, and blood pressure. The hypothalamus affects the endocrine system and governs emotional behaviors such as anger and sexual drive. Hormones secreted in the hypothalamus act directly on the pituitary gland. Question: Sudden, brief, rapid jerks, involving the trunk or limbs may be consistent with: a myoclonic seizure. Correct an absent seizure. AGNP BOARD EXAM QUESTIONS Neurology Assessment a myoclonic atonic seizure. a focal seizure with impairment of consciousness. Explanation: A patient experiencing a myoclonic seizure manifests sudden, brief, rapid jerks, involving the trunk or limbs. A sudden brief lapse of consciousness with momentary blinking, staring, or movements of the lips and hands but no falling is consistent with an absent seizure. During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. Focal seizures with impairment of consciousness the person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Question: AGNP BOARD EXAM QUESTIONS Neurology Assessment With the adult patient lying supine, the nurse practitioner strokes the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick. Dorsiflexion of the big toe was noted. This is a positive: Brudzinski's sign. Kernig's sign. nuchal rigidity sign. Babinski's sign. Correct Explanation: To elicit Babinski sign, stroke the lateral aspect of the sole from the heel to the ball of the foot with the end of an applicator stick. Plantar flexion is normal. Dorsiflexion of the big toe is a positive Babinski's sign. To elicit Brudzinski's sign, flex the neck. Flexion of both the hips and knees is positive for Brudzinski's. To test for Kernig's sign, flex the patient's leg at both the hip and the knee and then straighten the knee. Pain and increased resistance to extending the knee are positive for a Kernig's sign. With the patient lying supine, the nurse practitioner places her hands behind the patient's head while flexing his neck forward until his chin touches his chest. Neck stiffness with resistance to flexion is noted. This is positive nuchal rigidity and suggestive of meningeal inflammation from meningitis or subarachnoid hemorrhage. Question: When assessing the cranial nerves, the nurse practitioner instructs the patient to stick out his tongue and move it from side to side. This maneuver would be used to assess which cranial nerve? Cranial Nerve V (CN V) Cranial Nerve VII (CN VII) Cranial Nerve IX (CN IX) Cranial Nerve XII (CN XII) Correct Explanation: Instructing the patient to stick out his tongue and move it from side to side would be used to assess cranial nerve XII (CN XII)-Hypoglossal nerve. AGNP BOARD EXAM QUESTIONS Neurology Assessment Question: Which of the following neurological assessment findings indicate the need for further evaluation? Lifting one foot and then the other when the infant is held upright with the feet touching a solid surface Fanning and hyperextension of the toes when the sole is stroked upward from the heel Grasping a finger placed in the neonate's palm Weak and ineffective sucking movements Correct Explanation: Weak and ineffective sucking movements would indicate the need for further evaluation since any weak, absent, asymmetrical or fine jumping movements would suggest neurological system disorders. The other choices represent common reflexes found in the normal newborn: Babinski, grasping, and stepping. Question: AGNP BOARD EXAM QUESTIONS Neurology Assessment Which of the following symptoms may be associated with a tumor of the eighth cranial nerve? Dizziness Correct Inability to close the eyes Loss of the sense of smell Inability to taste sour things Explanation: The eighth cranial nerve (CN) is the vestibulocochlear nerve and it is responsible for hearing and balance. The main symptoms of an acoustic neuroma are hearing loss and tinnitus. They are caused by a tumor affecting the auditory nerve. Inability to close the eye would reflect an abnormality of CN VII, the facial nerve. CN I, the olfactory nerve, is responsible for the sense of smell. Two cranial nerves are responsible for the taste, CN VII and X. Question: When assessing the cranial nerves, the nurse practitioner uses the tongue blade to gently stimulate the back of the throat on each side. A unilateral absence of the gag reflex is noted. This finding could be suggestive of a unilateral lesion in which cranial nerve? Cranial Nerve V (CN V) Cranial Nerve VII (CN VII) Cranial Nerve IX (CN IX) Correct Cranial Nerve XII (CN XII) Explanation: Unilateral absence of the gag reflex suggests a lesion of CN IX or CN X. glossopharyngeal and vagus nerves. Question: When assessing abdominal cutaneous reflexes, the nurse practitioner strokes the lower abdomen, the localized twitch is absent. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? AGNP BOARD EXAM QUESTIONS Neurology Assessment Explanation: Tonic and then clonic movements that start unilaterally in the hand, foot, or face and spread to other body parts on the same side with the patient remaining conscious are known as Jacksonian seizures. Focal seizures with impairment of consciousness is characterized when a person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Focal seizures that become generalized are partial seizures that resemble tonic-clonic seizures. The patient may recall the aura and a unilateral neurologic deficit is present during the postictal period. During a grand mal seizure the person loses consciousness suddenly, sometimes with a cry, and the body stiffens into tonic extensor rigidity. Breathing stops, and the person becomes cyanotic. A clonic phase of rhythmic muscular contraction follows. Question: AGNP BOARD EXAM QUESTIONS Neurology Assessment When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates muscle strength? Motor system Correct Cerebellar system Vestibular system Sensory system Explanation: Coordination of muscle movement requires that four areas of the nervous system function in an integrated way: motor system for muscle strength, cerebellar system for rhythmic movements and steady posture, vestibular system for balance and coordinating eye, head, and body movements, and sensory system for position sense. Question: When a two-week-old infant presents with irritability, poor appetite, and rapid head growth with distended scalp veins, one should consider: hydrocephalus. Correct meningitis. cerebral palsy. Reye's syndrome. Explanation: The combination of signs is strongly suggestive of hydrocephalus: shrill with high- pitched cry, irritability, tense and bulging fontanels due to the increased amount of CSF being produced or not being absorbed. Meningitis would include signs of sepsis/infection. The manifestations of cerebral palsy vary but may include: persistence of primitive reflexes, delayed gross motor development, and a lack of progression through developmental milestones. Reye’s syndrome is associated with an antecedent viral infection with symptoms of malaise, nausea, and vomiting, progressive neurological deterioration occurs. Question: AGNP BOARD EXAM QUESTIONS Neurology Assessment When evaluating the sensory system, testing the posterior columns tract would include assessing sensations of: position and vibration. Correct pain and temperature. deep touch. discriminative sensations. Explanation: When evaluating the sensory system, testing the spinothalamic tracts would include assessing sensations of pain and temperature. Assessing position and vibration evaluate the posterior columns. Light touch assesses both the spinothalamic and posterior column tracts. To assess discriminative sensation, both the spinothalamic and posterior columns tracts as well as the cortex would be assessed. Question: A patient experiences difficulty rising from a sitting position without arm support. This would be suggestive of: AGNP BOARD EXAM QUESTIONS Neurology Assessment seizure. Correct Explanation: A seizure is an uncontrolled electrical activity in the brain which may produce minor physical signs, thought disturbances, or disturbed motor activity, or a combination of symptoms. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is a tremor. Question: A term used to describe an increase in muscular bulk with proportionate strength is: hypertrophy. Correct muscular atrophy. pseudohypertrophy. muscle weakness. Explanation: Hypertrophy refers to an increase in bulk of the muscle with a proportionate increase in strength. A term used to describe muscle wasting or loss of muscle bulk is muscular atrophy. An increase in muscular bulk with diminished strength is known as pseudohypertrophy. Muscular weakness is a term used to describe a lack of strength or firmness in a muscle. Question: The part of the brain that controls most functions in the body and is responsible for breathing, heart rate, and articulate speech is the: cerebrum. brainstem. Correct cerebellum. diencephalon. Explanation: AGNP BOARD EXAM QUESTIONS Neurology Assessment The nerve connections of the motor and sensory systems from the main part of the brain to the rest of the body pass through the brainstem. The brainstem controls most functions in the body but mostly responsible for breathing, heart rate, and articulate speech. The cerebrum controls all voluntary actions of the body with the aid of the cerebellum. The diencephalon relays sensory information between brain regions and controls many autonomic functions of the peripheral nervous system. It also connects structures of the endocrine system with the nervous system and works in conjunction with limbic system structures to generate and manage emotions and memories. The cerebellum, which lies at the base of the brain, coordinates all movement and helps maintain the body upright in space. Question: Symptoms indicative of Shaken Baby Syndrome are related to: poor nutrition and lack of parental bonding. vaso-occlusive crisis and cerebral infarction. AGNP BOARD EXAM QUESTIONS Neurology Assessment uncontrollable cerebral edema and hypoxia. Correct microcephaly and premature closures of the cranial sutures. Explanation: Brain damage resulting from shaking of the body and rapid flexing and extension of the head results in hypoxia and cerebral edema leading to symptoms of blindness, inability to perform previously learned milestones, and very flaccid muscle tone. The other choices are not the culprits of this type injury/abuse. It is caused by someone shaking the child and causing irreversible brain damage in most cases. Question: Fasciculations in atrophic muscles suggest: a lower motor neuron disease. Correct rheumatoid arthritis. peripheral nervous system disease. a central nervous system disorder. Explanation: Fasciculations are small muscle twitches and can be found in any muscle of the body. Fasciculations are not usually serious but can be annoying. If they occur in atrophic muscles, this may suggest a lower motor neuron disease. They are not seen in central or peripheral nervous system disease or rheumatoid arthritis. Question: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates a steady posture? Motor system Cerebellar system Correct Vestibular system Sensory system Explanation: AGNP BOARD EXAM QUESTIONS Neurology Assessment would grasp the patient's big toe and move it up or down while the patient has his eyes closed. The patient would identify the correct position of the movement. Question: Which one of the following symptoms is not associated with bulbar symptoms? Diplopia Ptosis Dysphagi a Dysesthesias Correct Explanation: Dysesthesias are a distortion of any sense, especially that of touch and is associated with spinal cord injuries. Characteristics include numbness, tingling, burning, or pain felt below the level of the injury. The pons and medulla form the "bulb", or bulbar area of the brain, which controls the bulbar muscles in the throat, tongue, jaw and face. Bulbar symptoms include diplopia, ptosis, dysphagia, and dysarthria. AGNP BOARD EXAM QUESTIONS Neurology Assessment Question: Bilateral weakness in cranial nerve V (CN V) would be suggestive of a: bilateral hemispheric disease. Correct central nervous system lesions. pontine lesion. brainstem lesion. Explanation: Bilateral weakness in cranial nerve V (CN V), the trigeminal nerve, is suggestive of a bilateral hemispheric disease. Question: To evaluate a patient's response to a vibration sensation, the nurse practitioner would ask the patient to identify: a touch on the skin in response to touching the skin with a cotton wisp. an object as being hot or cold. the sensation when the tuning fork is placed on the big toe. Correct pain as sharp or dull when the thumb is touched using the sharp end of a safety pin. Explanation: To test for vibration, use a tuning fork over the interphalangeal joint of the big toe and ask the patient if he feels the vibration. Touching the skin with a cotton wisp is an example of assessing for light touch. To evaluate a patient's response to temperature sensation, the nurse practitioner would ask the patient to identify an object as being hot or cold. To evaluate for pain, a safety pin could be used to determine if the sensation is sharp or dull. Question: When assessing the patient's sense of position, instruct the patient to first stand with his feet together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses his balance with his eyes closed, this is: considered a normal finding. suggestive of ataxia related to dorsal column disease. Correct suggestive of cerebellar ataxia. AGNP BOARD EXAM QUESTIONS Neurology Assessment corticospinal track damage. Explanation: When assessing the patient's sense of position, instruct the patient to first stand with his feet together and eyes open, then instruct him to close both eyes for 30-60 seconds. If he loses his balance with his eyes closed, this is a positive Romberg test and suggestive of ataxia related to a dorsal column disease. In cerebellar ataxia, the patient has difficulty standing with feet together whether the eyes are open or closed. With corticospinal tract damage, the gait is affected and the patient is unable to heel-walk. Question: Intention tremors appear with movement and: worsen with stress. increase during sleep. are more pronounced when maintaining a posture. AGNP BOARD EXAM QUESTIONS Neurology Assessment Duchenne muscular dystrophy (DMD) is an X-link inherited recessive disorder and is passed from mother to male offspring. DMD is a congenital disorder with symptoms appearing during the 2nd and 3rd year of life. Tremors, hypertonicity and seizures are more consistent with cerebral palsy. Waddling gait, lordosis and Gower's maneuver are signs of DMD. Gower's sign is classic for DMD. The patient has to use his hands and arms to "walk" up his own body from a squatting position due to lack of hip and thigh muscle strength. Question: When eliciting deep tendon reflexes in the biceps, the nurse practitioner notes an abnormal reflex in the right biceps. This abnormality is probably consistent with a pathological lesion in which segmented level of the spine? Cervical 5 and 6 Correct Cervical 6 and 7 Lumbar 2, 3, and 4 Sacral 1 Explanation: The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee: lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6 & 7. Question: The part of the peripheral nervous system that regulates muscle movement and response to the sensations of pain and touch is the: autonomic nervous system. somatic nervous system. Correct sympathetic nervous system. parasympathetic nervous system. Explanation: AGNP BOARD EXAM QUESTIONS Neurology Assessment The part of the peripheral nervous system that regulates muscle movement and response to the sensations of pain and touch is the somatic nervous system. The autonomic nervous system generates autonomic reflex responses and consists of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system mobilizes organs and their functions during times of stress and arousal. The parasympathetic nervous system conserves energy and resources during times of rest and relaxation. Question: The term used to describe low back pain with nerve pain that radiates down the leg is: asterixis. sciatica. Correct dermatome. stereognosis. Explanation: AGNP BOARD EXAM QUESTIONS Neurology Assessment The term used to describe low back pain with nerve pain that radiates down the leg is sciatica. Asterixis refers to an abnormal tremor consisting of involuntary jerking movements, especially in the hands, frequently occurring with impending hepatic coma and other forms of metabolic encephalopathy. This is also called flapping tremor. A dermatome is a band of skin innervated by the sensory root of a single spinal nerve. Stereognosis refers to the ability to identify an object by feeling it. Question: An example of tandem walking is having the patient: walk across the room. walk heel-to-toe. Correct walk on the toes, then on the heels. walk with a shallow knee bend. Explanation: Walking heel-to-toe in a straight line is called tandem walking. If the patient is unable to accomplish this, it may reveal ataxia. The other examples are not examples of tandem walking. Question: The level of consciousness that refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep is known as: obtundation. alertness. lethargy. Correct stupor. Explanation: Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. An obtunded patient opens his eyes, looks at the person speaking to him but responds slowly and appears confused. The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as alertness. A stuporous patient arouses from sleep only after painful stimuli. AGNP BOARD EXAM QUESTIONS Neurology Assessment stereognosis. The patients eyes must be closed. Graphesthesia, or number identification, is the ability to identify a number when drawn in the hand of a patient whose eyes are closed. The ability to identify an object touching 2 areas simultaneously is termed two-point discrimination. Astereognosis is a term used to describe the inability to recognize objects placed in the hand. Question: A band of skin innervated by the sensory root of a single spinal nerve is termed a: peripheral nerve field. dermatome. Correct synapse asterixis. Explanation: AGNP BOARD EXAM QUESTIONS Neurology Assessment A band of skin innervated by the sensory root of a single spinal or dorsal nerve root is termed a dermatome. A peripheral nerve field refers to an area of the skin innervated by a single nerve and is described as cutaneous nerve distribution. A synapse is a structure that permits a neuron to pass an electrical or chemical signal to another cell. Asterixis refers to an abnormal tremor consisting of involuntary jerking movements, especially in the hands, frequently occurring with impending hepatic coma and other forms of metabolic encephalopathy. This is also known as flapping tremor. Question: An example of distal weakness is: the right shoulder. the right hand. Correct both arms. one the right side of the face. Explanation: There are 4 different patterns of weakness: Proximal, distal, symmetric, and asymmetric. An example of proximal weakness is weakness in the shoulder or hip girdle. Distal weakness occurs in the hands or feet. Symmetric weakness occurs in the same areas on both sides of the body. An asymmetric weakness occurs in a portion of the face or extremity - a form of focal weakness. Question: To evaluate a patient's response to pain sensation, the nurse practitioner would ask the patient to identify: a light touch on the skin in response to touching the skin with a cotton wisp. an object as being hot or cold. a vibration sensation on the big toe. pain as sharp or dull when the thumb is touched using the sharp end of a safety pin. Correct Explanation: To evaluate for pain, a safety pin could be used to determine if the sensation is sharp or dull. To evaluate a patient's response to temperature sensation, the nurse practitioner AGNP BOARD EXAM QUESTIONS Neurology Assessment would ask the patient to identify an object as being hot or cold. A light touch on the skin in response to touching the skin with a cotton wisp would be an example of assessing for light touch. To test for vibration, use a tuning fork over the interphalangeal joint of the big toe and ask the patient if he feels the vibration. Question: Ptosis of the left eye would be suggestive of damage to which cranial nerve? Cranial Nerve II (CN II) Cranial Nerve III (CN III) Correct Cranial Nerve IV (CN IV) Cranial Nerve V (CN V) Explanation: Ptosis of the left eye would be suggestive of 3rd nerve palsy (CN III)-Oculomotor nerve. Question: AGNP BOARD EXAM QUESTIONS Neurology Assessment While palpating the temporal and masseter muscles, the patient is asked to clench his teeth and move his jaw from side to side. This maneuver would be assessing which cranial nerve? Cranial Nerve III (CN III) Cranial Nerve IV (CN IV) Cranial Nerve V (CN V) Correct Cranial Nerve VII (CN VII) Explanation: Palpation of the temporal and masseter muscles, when the patient clenches his teeth and moves his jaw from side to side. This maneuver assesses the Trigeminal nerve and cranial nerve (CN V). Question: When observing for thenar atrophy of the hands, a typical observation is: furrowing in the spaces between the metacarpals. Correct thenar eminences appear full. the hypothenar eminences would appear convex. the spaces between the metacarpals would be slightly depressed. Explanation: Flattening of the thenar and hypothenar eminences and furrowing between the metacarpals suggests atrophy. Localized atrophy of the thenar and hypothenar eminences suggests damage to the median and ulnar nerves. Normally, the metacarpal spaces are full and slightly depressed and the thenar and hypothenar appear full and convex. Motor neuron disease, rheumatoid arthritis, and protein-calorie malnutrition can cause atrophy in the hand. Question: A form of aphasia in which the person has difficulty speaking and understanding words and is unable to read or write is termed: Broca's aphasia. AGNP BOARD EXAM QUESTIONS Neurology Assessment anomic aphasia. Wernicke's aphasia. global aphasia. Correct Explanation: With global aphasia, the person has difficulty speaking and understanding words and is unable to read or write. In Broca's aphasia, speech is confluent, slow, with few words and laborious effort. Inflection and articulation are impaired but words are meaningful, with nouns, transitive verbs, and important adjectives. Small grammatical words are often dropped. With anomic aphasia, the person has word-finding difficulties and because of the difficulties, the person struggles to find the right words for speaking and writing. With Wernicke's aphasia, speech is fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible. AGNP BOARD EXAM QUESTIONS Neurology Assessment Question: A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is: dystonia. bradykinesia . a tremor. Correct a seizure. Explanation: A rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups is a tremor. Dystonia is a neurological disorder that causes involuntary muscle spasms and twisting of the limbs. Bradykinesia is the term used to describe the impaired ability to adjust to one's body position. This symptom is noted in patients who have Parkinson's disease. A seizure is an uncontrolled electrical activity in the brain which may produce minor physical signs, thought disturbances, or disturbed motor activity, or a combination of symptoms. Question: The straight leg raise maneuver tests for: peripheral nerve involvement. plantar response. asterixis. sciatica. Correct Explanation: The straight leg raise maneuver tests for sciatica, especially if in the S1 distribution. Question: Most peripheral nerves contain afferent and efferent fibers. The term afferent refers to: the cranial nerve fibers. spinal nerve fibers. sensory nerve fibers. Correct motor nerve fibers. AGNP BOARD EXAM QUESTIONS Neurology Assessment movements of the lips and hands but no falling is consistent with an absent seizure. A patient experiencing a myoclonic seizure manifests sudden, brief, rapid jerks, involving the trunk or limbs. During a myoclonic atonic seizure, the patient experiences a sudden loss of consciousness with falling but no movements. Injury may occur. Focal seizures with impairment of consciousness the person appears confused. Automatisms include automatic motor behaviors such as chewing, smacking the lips, walking about, and unbuttoning clothes. Question: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates head movements? Motor system Cerebellar system Vestibular system Correct Sensory system AGNP BOARD EXAM QUESTIONS Neurology Assessment Explanation: Coordination of muscle movement requires that four areas of the nervous system function in an integrated way: motor system for muscle strength, cerebellar system for rhythmic movements and steady posture, vestibular system for balance and coordinating eye, head, and body movements, and sensory system for position sense. Question: What is an example of a disease or condition that appears in a dermatomal pattern? Fibromyalgia Shingles Correct Diabetic neuropathy Referred pain Explanation: A band of skin innervated by the sensory root of a single spinal nerve is a dermatome. Symptoms that follow a dermatome (e.g. like pain or a rash) may indicate pathology that involves the related nerve root. Viruses that lie dormant in nerve ganglia (e.g. varicella zoster virus, which causes both chickenpox and herpes zoster shingles), often cause either pain, rash or both in a pattern defined by a dermatome. However, the symptoms may not appear across the entire dermatome. Referred pain usually involves a specific "referred" location so is not associated with a dermatome. Diabetic neuropathy results from nerve damage related to high levels of glucose in the body and the resulting pain or absence of pain does not follow a dermatomal pattern. Fibromyalgia appears to result from neuro-chemical imbalances including activation of inflammatory pathways in the brain which results in abnormalities in pain processing. Question: The part of the brain that coordinates all movement and helps maintain the body upright in space is the: cerebrum. brainstem. cerebellum. AGNP BOARD EXAM QUESTIONS Neurology Assessment Correct diencephalon. Explanation: The cerebellum, which lies at the base of the brain, coordinates all movement and helps maintain the body upright in space. The cerebrum controls all voluntary actions of the body with the aid of the cerebellum. The nerve connections of the motor and sensory systems from the main part of the brain to the rest of the body pass through the brainstem. Brainstem controls most functions in the body but mostly responsible for breathing, heart rate, and articulate speech. The diencephalon relays sensory information between brain regions and controls many autonomic functions of the peripheral nervous system. It also connects structures of the endocrine system with the nervous system and works in conjunction with limbic system structures to generate and manage emotions and memories. Question: AGNP BOARD EXAM QUESTIONS Neurology Assessment Explanation: Signs of a basilar skull fracture are battle's sign, raccoon eyes, rhinorrhea, otorrhea and hemotympanum (blood in the tympanic cavity). Intracranial hematoma is associated with a general skull fracture. Pain in the occipital region is associated with occipital fracture. Bilateral retinal hemorrhages are associated with shaken baby syndrome. Question: When assessing plantar reflexes, the nurse practitioner strokes the lateral aspect of the sole from the heel to the ball of the right foot. Absence of movement of the big toe is noted. This finding could be suggestive of a pathologic lesion in which segmented level of the spine? Thoracic 8, 9, and 10 Thoracic 10, 11, and 12 Lumbar 5 and Sacral 1 Correct Sacral 2, 3, and 4 Explanation: Superficial (cutaneous) reflexes and their corresponding spinal segments include the following: Abdominal reflexes: upper thoracic 8, 9, 10 and lower thoracic 10, 11, 12; Plantar: lumbar 5 and sacral 1; and Anal: sacral 2, 3, 4. Question: A female patient complaints of weakness in both arms when transferring the wet clothes from the washer and placing them in the dryer. This finding could be suggestive of which type of weakness pattern? Proxima l Distal Symmetric Correct Asymmetric Explanation: To identify symmetric weakness, ask about experiencing weakness in the same area on both sides of the body. AGNP BOARD EXAM QUESTIONS Neurology Assessment Question: An indication that there is a malfunction of a ventriculoperitoneal (VP) shunt in an older child would be the presence of a: headache upon awakening. Correct temperature greater than 100.8 degrees Fahrenheit. noticeable increase in activity. bulging fontanels. Explanation: Headache and projectile vomiting are associated with shunt malfunction as well as signs of increased intracranial pressure. Fever can be associated with shunt infection. Older children's fontanels and sutures are closed, so they do not present with bulging fontanels. Corre ct Corre ct AGNP BOARD EXAM QUESTIONS Neurology Assessment Question: When assessing coordination of muscle movement, four areas of the nervous system function in an integrated way. These areas include the motor, cerebellar, the vestibular, and the sensory systems. Which system coordinates position sense? Motor system Cerebellar system Vestibular system Sensory system Explanation: Coordination of muscle movement requires that four areas of the nervous system function in an integrated way: motor system for muscle strength, cerebellar system for rhythmic movements and steady posture, vestibular system for balance and coordinating eye, head, and body movements, and sensory system for position sense. Question: Involuntary movements of the body that are slower and more twisting and writhing than choreiform movements, and have a larger amplitude are suggestive of: facial tics. dystonic movements. athetoid movements. oral-facial dyskinesias. Explanation: Athetoid movements are slower and more twisting and writhing than choreiform movements, and have a larger amplitude. They most commonly involve the face and the distal extremities. Facial tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Dystonic movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result. Oral–facial dyskinesias are rhythmic, AGNP BOARD EXAM QUESTIONS Neurology Assessment Explanation: The diencephalon relays sensory information between brain regions and controls many autonomic functions of the peripheral nervous system. It also connects structures of the endocrine system with the nervous system and works in conjunction with limbic system structures to generate and manage emotions and memories. The cerebrum controls all voluntary actions of the body with the aid of the cerebellum. The nerve connections of the motor and sensory systems from the main part of the brain to the rest of the body pass through the brainstem. The brainstem controls most functions in the body but is mostly responsible for breathing, heart rate, and articulate speech. The cerebellum, which lies at the base of the brain, coordinates all movement and helps maintain the body upright in space. Question: An example of proximal weakness is: the right shoulder. Correct the right hand. AGNP BOARD EXAM QUESTIONS Neurology Assessment both arms. on the right side of the face. Explanation: There are 4 different patterns of weakness: Proximal, distal, symmetric, and asymmetric. An example of proximal weakness is weakness in the shoulder or hip girdle. Distal weakness occurs in the hands or feet. Symmetric weakness occurs in the same areas on both sides of the body. An asymmetric weakness occurs in a portion of the face or extremity - a form of focal weakness. Question: Common physical findings in a young child with cerebral palsy include which one of the following? Walks by placing the heels of the feet down first Moves about by crawling on the abdomen or all four extremities Generally meets motor developmental milestones on schedule Presence of crossed or touching knees Correct Explanation: Cerebral palsy (CP) is a group of disorders that can involve the brain and nervous system functions, such as movement, learning, hearing, seeing, and thinking. There are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed. Symptoms usually depend on the type and can be seen before a child is 2 years old, and sometimes as early as 3 months. Symptoms may include delays in reaching and in developmental stages such as sitting, rolling, crawling, or walking, or abnormal gait. Arms may be tucked in toward the sides, knees may be crossed or touching, legs may make "scissor" movements, and child may walk on toes. Additionally, newborn reflexes may persist beyond the expected time frame for their disappearance. Question: Which of the following procedures should NOT be performed in a comatose patient? Check corneal response Check pupillary response Flex the neck AGNP BOARD EXAM QUESTIONS Neurology Assessment Correct Inspect the posterior pharynx Explanation: The neck of a comatose patient should not be flexed if there is any question of trauma to the head or neck. The other procedures can be performed on a comatose patient. Question: A patient presents with an altered level of consciousness. He/she is considered in a stuporous state if he/she: appears drowsy but opens the eyes, looks at the examiners, answers the questions, and then falls asleep. arouses from sleep after exposure to painful stimuli, exhibits slow verbal responses, and easily lapses into an unresponsive state. Correct remains unarousable with eyes closed. There is no evident response to inner need or external stimuli. AGNP BOARD EXAM QUESTIONS Neurology Assessment lethargy. stupor. Explanation: An obtunded patient opens his eyes, looks at the person speaking to him but responds slowly and appears confused. The level of consciousness that refers to the ability of the patient to respond fully and appropriately to stimuli is known as alertness. Lethargy refers to the patient that appears drowsy but can open his eyes, respond to questions, then fall back to sleep. A stuporous patient arouses from sleep only after painful stimuli. Question: On physical exam, the soft palate does not rise, there is an absent gag reflex, and the patient complains of taste abnormalities. This requires further evaluation of the: hypoglossal nerve (CN XII). facial nerve (CN VII). glossopharyngeal nerve (IX). Correct trigeminal nerve (CN V). Explanation: The glossopharyngeal and vagus nerves assess swallowing, salivation, taste perception and voice quality. The hypoglossal nerve assesses tongue movement and swallowing. The facial nerve assesses taste on the anterior portion of the tongue and facial muscles. The trigeminal nerve assesses the corneas, nasal and oral mucosa, facial skin, the jaw and chewing muscles. Question: An infant with fetal alcohol syndrome would: appear calm, happy and cooing in the hospital crib. be irritable, hyperactive and exhibit a high-pitched cry. Correct perspire, vomit and have diarrhea. appear shaky, hypoactive, and in respiratory distress. Explanation: AGNP BOARD EXAM QUESTIONS Neurology Assessment A baby with fetal alcohol syndrome may have the following symptoms: poor intrauterine growth, delayed growth after birth, decreased muscle tone and poor coordination, delayed development and problems in three or more major areas: thinking, speech, movement, or social skills; heart defects; structural problems of the face; irritability, hyperactive and a high-pitched cry. The other symptoms are not consistent with fetal alcohol syndrome. Question: The thalamus and the basal ganglion are located in the: spinal cord. peripheral nervous system. white matter. gray matter. Correct Explanation: AGNP BOARD EXAM QUESTIONS Neurology Assessment Deep in the brain lie additional clusters of gray matter. These include the basal ganglia, which affect movement, and the thalamus and the hypothalamus structures in the diencephalon. The thalamus processes sensory impulses and relays them to the cerebral cortex. Question: An ischemic stroke is: a transient episode of neurologic dysfunction by focal brain, spinal cord, or retinal ischemia, without acute infarction. an infarction of the central nervous system tissue that may be silent or symptomatic. Correct the abrupt onset of motor or sensory deficits. focal or asymmetric weaknesses caused by central and peripheral nerve damage. Explanation: Ischemic stroke is “an infarction of central nervous system tissue” that may be symptomatic or silent. TIA is now defined as “a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.” The other terms are not related to the new definitions. Question: Assessment findings in an infant with increased intracranial pressure would include: increased hunger. drowsiness. Correct papilledema. blurred vision. Explanation: Symptoms of increased intracranial pressure in an infant include: drowsiness, separated sutures on the skull, bulging fontanel, and vomiting. Papilledema can be observed in people of any age, but is relatively uncommon in infants because the bones of the skull are not fully fused together at this age. Question: