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NU 673 COMPREHENSIVE ASSESSMENT
MIDTERM EXAM 2025-2026 200+ QUESTIONS
AND ANSWERS GRADED A+
This consists of aggregations of neuro- nal cell bodies. It rims the surfaces of the cerebral hemispheres, forming the cerebral cortex
A. Gray matter
B. White matter
A. Gray matter
- Deep in the brain lie additional clusters of gray matter (Fig. 17-2). These include the basal ganglia, which affect movement, and the thalamus and the hypothala- mus structures in the diencephalon. The thalamus processes sensory impulses and relays them to the cerebral cortex. The hypothalamus maintains homeostasis (Bickley)
- 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 pitu- itary gland. (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
This consists of neuronal axons that are coated with myelin. The myelin sheaths, which create the white color, allow nerve impulses to travel more rapidly.
A. Gray matter
B. White matter
B. White matter
- The internal capsule is a white-matter structure where myelinated fibers converge from all parts of the cerebral cortex and descend into the brainstem. The brainstem, which connects the upper part of the brain with the spinal cord, has three sec- tions: the midbrain, the pons, and the medulla. (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
Consciousness relies on the interaction between intact cerebral hemispheres and a structure in the diencephalon and upper brainstem
A. Reticular activating system
B. Cerebellum
A. Reticular activating system
- Consciousness relies on the interaction between intact cerebral hemispheres and a structure in the diencephalon and upper brainstem, the reticular activating (arousal) system.
- The cerebellum, which lies at the base of the brain, coordinates all movement and helps maintain the body upright in space. (Bickley)
their functions during times of stress and arousal, and the para- sympathetic nervous system, which conserves energy and resources during times of rest and relaxation."5 (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
Determine the pairs of peripheral nerves
A. Cervical
B. Thoracic
C. Lumbar
D. Sacral
E. Coccygeal
A. Cervical- 8
B. Thoracic- 12
C. Lumbar- 5
D. Sacral- 5
E. Coccygeal- 1
- The PNS includes spinal and peripheral nerves that carry impulses to and from the cord. A total of 31 pairs of spinal nerves attach to the spinal cord: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. Each nerve has an anterior (ventral) root containing motor fibers, and a posterior (dorsal) root containing sensory fibers. The anterior and posterior roots merge to form a short spinal nerve, <5 mm long. Spinal nerve fibers commingle with similar fibers from other levels in
plexuses outside the cord, from which peripheral nerves emerge. Most peripheral nerves contain both sensory (afferent) and motor (efferent) fibers. (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
Determine the Cranial Nerve:
Oflactory: sense of smell
A. I
B. Ii
C. III
D. IV
E. V
F. Vi
G. VII
H. VIIi
I. IX
J. X
K. Xi
L. XII
XII Hypoglossal motor tongue
C. Cerebellar system
A. Corticospinal (pyramidal) tract
- The corticospinal (pyramidal) tract. The corticospinal tracts mediate voluntary movement and integrate skilled, complicated, or delicate movements by stim- ulating selected muscular actions and inhibiting others. They also carry impulses that inhibit muscle tone, the slight tension maintained by normal muscle even when it is relaxed. The corticospinal tracts originate in the motor cortex of the brain (Fig. 17-6). Motor fibers travel down into the lower medulla, where they form an anatomical structure resembling a pyramid.
- There, most of these fibers cross to the opposite or contralateral side of the medulla, continue downward, and synapse with anterior horn cells or with intermediate neurons. Tracts synapsing in the brainstem with motor nuclei of the CNs are termed corticobulbar.
● The basal ganglia system. This exceedingly complex system includes motor pathways between the cerebral cortex, basal ganglia, brainstem, and spinal cord. It helps to maintain muscle tone and to control body movements, espe- cially gross automatic movements such as walking.
● The cerebellar system. The cerebellum receives both sensory and motor input and coordinates motor activity, maintains equilibrium, and helps to control posture. (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
When upper motor neuron systems are damaged above their crossover in the medulla, motor impairment develops on and becomes (STA)
A. Ipsilateral
B. Contralateral
C. Exaggerated reflex
D. Lack of reflex
B. Contralateral & C. Exaggerated reflex
- When upper motor neuron systems are dam- aged above their crossover in the medulla, motor impairment develops on the opposite or contralateral side. In damage below the crossover, motor impairment occurs on the same or ipsi- lateral side of the body (Bickley)
- slow- ness or lack of spontaneous and automatic movements termed bradykinesia, and various involuntary movements. (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
Determine the location of the spinal nerve
A. Ankle
B. Knee
C. Brachioradialis
D. Bicep
E. Tricep reflex
Identify the presentation
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
identification
A. Abrupt onset of motor and sensory deficits occurs in
B. Progressive subacute onset of lower extremity weakness
C. Chronic, more gradual, onset of lower extremity weakness occurs in
D. Focal or asymmetric weakness has both central (ischemic, thrombotic, or mass lesions) and peripheral
E. Proximal limb weakness, when sym- metric with intact sensation
F. proximal typically asymmetric weakness that gets worse with effort (fatigability), often with associated bulbar symptoms such as diplopia, ptosis, dysarthria, and dysphagia
G. Bilateral predominantly distal weak- ness, often with sensory loss
A. TIA or Stoke
B. Guillan-Barre
c. metastatic spinal cord tumors. (Bickley)
D. M,yopathies
E. occurs in myopathies from alcohol, drugs like glucocorticoids, and inflammatory muscle disorders like polymyositis and dermatomyositis
F. Myasthenia Gravis
G. Polyneuropathy
Identification
A. Burning pain occurs in painful sensory neuropathies from conditions like
B. A pattern of stocking, then glove, sensory loss occurs in
C. multiple patchy areas of sensory loss in diffe ent limbs suggest
D. The most com- mon cause of syncope, look for the prodrome of nausea, diaphoresis, and pallor triggered by a fearful or unpleasant event, then vagally medi- ated hypotension, often with slow onset and offset. In syncope from arrhythmias, onset and offset are often sudden, reflecting loss and recovery of cerebral perfusion. (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
A. Diabetes
B. Polyneuropathies
C. Monotneuritis multiplex
D. Vasovagal
A. the patient hear external noise or voices throughout the episode, feel light- headed or weak, but fail to actually lose consciousness
B. Patient actually experience complete loss of consciousness, a more serious symptom representing
A. Near synocpe
B. True syncope
- The AHA/ASA report cites the well- validated ABCD2 scoring system for predicting ischemic stroke within 2, 7, and 90 days after TIA: Age ≥60 years, initial Blood pressure ≥140/90 mm Hg, Clinical features of focal weakness or impaired speech without focal weak- ness, Duration 10 to 59 minutes or ≥ minutes, and Diabetes.48 (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
Middle cerebral, Left middle cerebral, right middle cerebral
A. Causes visual field cuts and contralateral hemiparesis and sensory deficits
B. Produces aphasia
C. neglect or inattention to the opposite side of the body.
A. middle cerebral
B. left middle cerebral
C. right middle cerebral
A. This is the most common type of diabetic neuropathy. It is slowly progressive, often asymptomatic, and a risk factor for ulcerations, arthropathy, and amputation. Symptomatic patients report burning electrical pain in the lower extremities, usually at night.
B. which initially causes unilateral thigh pain and proximal lower extremity weakness.
A
Distal symmetric sensorimotor polyneuropathy
B. Autonomic dysfunction, mononeuropathies, polyrediculopathies
A. an acute confusional state marked by sudden onset, fluctuating course, inattention, and at times changing levels of consciousness.
B. is characterized by declines in memory and cogni- tive ability that interfere with activities of daily living. (Bickley)
C. is more common in individuals with significant medical conditions, including several neurologic disorders—dementia, epilepsy, multiple sclerosis, and Parkinson disease—and is also underdiagnosed.
A. Delirium- Confusional Assessment Method (CAM) algorithm, displayed below, is recom- mended for screening at-risk patients. The CAM instrument can quickly and accurately detect delirium at the bedside
B. Dementia- The most common types are Alzheimer disease (affecting 5 million Americans over age 65 years), vascular dementia, Lewy body dementia, and frontotemporal dementia.
C. Depression- Have you been feeling down, depressed, or hopeless (depressed mood)?" and, "Have you felt little inter- est or pleasure in doing things (anhedonia)?" (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
A. is seen in local problems with glasses or contact lenses, cataracts, astigmatism, or pto- sis
B. Occurs in CN III, IV, and VI neuropathy (40% of patients), and eye muscle disorders from myas- thenia gravis, trauma, thyroid ophthal- mopathy, and internuclear ophthalmoplegia
C. an involuntary jerking movement of the eyes with quick and slow components.
D. is seen in 3rd nerve palsy (CN III), Horner syndrome (ptosis, miosis, forehead anhidrosis), or myasthenia gravis
E. is absent in both eyes in CN V lesions and on the side of weakness in lesions of CN VII. Absent blinking and sensorineural hearing loss occur in acoustic neuroma.
A. Mononocular diplopia
B. Binocular diplopia
C. Nystagmus- Nystagmus is seen in cerebellar dis- ease, especially with gait ataxia and dysarthria (increases with retinal fixa- tion), and vestibular disorders (decreases with retinal fixation); and in internuclear ophthalmoplegia.
D. Ptosis
E. Blinking
- Test the corneal reflex. Ask the patient to look up and away from you and approach from the opposite side, out of the pa- tient's line of vision. Avoid- ing the eyelashes, lightly touch the cornea
A. affects both the upper and lower face; a central lesion affects mainly the lower face. Loss of taste, hyperacusis, and increased or decreased tearing also occur
B. air and bone conduction
C. lateraliza- tion
D. is both sen- sitive (>90%) and specific (>80%) when assessing presence or absence of hearing loss
E. Vertigo with hearing loss and nystag- mus typifies
A. Bells Palsy
B. Rinne test
C. Weber
D. Whispered voice test
E. Ménière disease.
- Excess cerumen, otosclerosis, and oti- tis media cause conductive hearing loss; presbyacusis from aging is usu- ally from sensorineural hearing loss.
A. The palate fails to rise with a bilateral lesion of
B. Unilateral absence of this reflex sug- gests a lesion of CN IX, and perhaps CN X.
C. fine flickering irregular movements in small groups of muscle fibers
D. What CN: Observe the contraction of the opposite sternocleido- mastoid (SCM) muscle and note the force of the movement against your hand
A. is velocity-dependent increased tone that worsens at the extremes of range
B. Marked floppiness indicates muscle...
C. Is increased resis- tance throughout the range of move- ment and in both directions; it is not rate-dependent.
D. Impaired strength or weakness is called
E. Absent strength is
A. Spasticity- pasticity, seen in central corticospinal tract diseases, is rate- dependent, increasing with rapid movement.
B. Hypotonia/ flaccidity
C. Rigidity
D. Paresis
E. Palegia
- Impaired strength or weakness is called paresis. Absent strength is paralysis, or plegia. Hemiparesis refers to weakness of one half of the body; hemiplegia refers to paralysis of one half of the body. Paraplegia means paralysis of the legs; quadriplegia means paralysis of all four limbs. (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
Identify the muscle strength:
A. Active movement against gravity
A. 3
- Extensor weakness is seen in periph- eral radial nerve damage, and in the hemiplegia of CNS disease seen in stroke or multiple sclerosis.
- A weak grip is seen in cervical radicu- lopathy, median or ulnar peripheral nerve disease, and pain from de Quer- vain tenosynovitis, carpal tunnel syn- drome, arthritis, and epicondylitis.
- Weak finger abduction occurs in ulnar nerve disorders.
- Inspect for weak opposition of the thumb in median nerve disorders such as carpal tunnel syndrome (Bickley)
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking, 12th Edition. Wolters Kluwer Health, 20160620. VitalBook file.
A. Symmetric weakness of the proximal muscles suggests
B. symmet- ric weakness of distal muscles sug- gests
A. Myopathy
B. Polymyopathy
- ■ The vestibular system, for balance and for coordinating eye, head, and body movements
■ The sensory system, for position sense
- In cerebellar disease, instead of alter- nating quickly, these movements are slow, irregular, and clumsy, an abnor- mality called dysdiadochokinesis. Upper motor neuron weakness and basal ganglia disease can also impair these movements, but not in the same manner.
- Dysdiadochokinesis points to cerebellar disease.
