NR 603 WEEK 1 APEA PREDICTOR EXAM REVIEW QUESTIONS AND VERIFIED ANSWERS WITH RATIONALES 2024 LATEST UPDATE// ALREADRY GRADED A+

NR 603 WEEK 1 APEA PREDICTOR EXAM REVIEW
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES 2024 LATEST UPDATE// ALREADRY
GRADED A+
A 75-year-old man is involved in a motor vehicle accident and strikes his forehead on the windshield. He
complains of neck pain and severe burning in his shoulders and arms. His physical examination reveals
weakness of his upper extremities. What type of spinal cord injury does this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome ANS: B
Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more severe in the upper extremities
than in the lower extremities, and is more severe in the hands. There is typically hyperesthesia over the
shoulders and arms. Anterior cord syndrome presents with paraplegia or quadriplegia, loss of lateral
spinothalamic function with preservation of posterior column function. Brown-Séquard syndrome
consists of weakness and loss of posterior column function on one side of the body distal to the lesion
with contralateral loss of lateral spinothalamic function one to two levels below the lesion. Complete
cord transection would affect motor and sensory function distal to the lesion. Cauda equina syndrome
typically presents as low back pain with radiculopathy.
A 37-year-old man fell from a ladder as he finished hanging the Christmas lights on his house. The right
side of his head hit the alley cement, and he lost consciousness for about 1 minute; he woke up with a
headache, but he had no other complaints. A few hours later, the patient is brought to the emergency
room by his neighbor because of an intense headache, confusion, and left hand hemiparesis. On
examination, the patient has a bruise located over the right temporal region, mydriasis, and right
deviation of the right eye, papilledema, and left extensor plantar response. An emergency CT scan of the
head without contrast reveals a lens-shaped hyper-density under the right temporal bone with mass
effect and edema. What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
NR 603 Week 1 APEA Predictor Exam Review Questions &
Answers
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis ANS: 1
Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the middle meningeal artery. Although a
lucid interval ranging from minutes to hours followed by altered mental status and focal deficits is
typical for epidural hematoma, this clinical picture is only encountered in up to 1/3 of the patients. The
collection of blood between the skull and dura mater causes an evident mass effect with ophthalmic
nerve palsy and the contralateral hemiparesis. Surgical evacuation of the clot via burr holes is the
treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging veins that connect the cerebrum to
the venous sinuses within the dura. This venous hemorrhage will result in a gradual increase of the
hematoma, with a progressive clinical picture over days or weeks. The CT scan will show a concave,
crescent-shaped hyper-density compared to the convex, lens-shaped hyper-density in epidural
hematoma.
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most common is the congenital
berry aneurysm. The clinical picture is of a sudden, severe headache with meningeal irritation. A CT scan
will show blood in the subarachnoid space, and a lumbar puncture will reveal xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by hypertension complicated with
CharcotBouchard aneurysms. The blood accumulates into the brain substance and most commonly
involves the basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of meningeal irritation dominate the
clinical picture. Lumbar puncture, indicated if there are no focal neurological signs on clinical
examination, will be the diagnostic procedure. The CT scan of the patient presented in this case is
characteristic for epidural hematoma, a