CNRN Practice Samples Exam 235 Questions with Verified Answers
Which of the following tumor types will have a higher incidence in pediatric populations
... [Show More] and have a decreased incidence with age?
A. Glioblastoma
B. Pilocytic astrocytoma
C. Central nervous system lymphoma
D. Metastatic brain tumor - CORRECT ANSWER B
Rationale: Both pilocytic astrocytoma and medulloblastoma brain tumors are more commonly found in the younger population. The incidence of these tumors will decrease with age. Glioblastomas are more frequently found in young adults. CNS lymphoma and metastasis will have an increased incidence with age.
A patient presents with progressive neurological deficits and has a recent history of transient neurological attack. This patient is most likely experiencing which of the following types of stroke?
A. Thrombotic stroke
B. Embolic stroke
C. Subarachnoid hemorrhage
D. Vasospasms - CORRECT ANSWER A
Rationale: Thrombotic strokes frequently present as a worsening neurological status over a short period of time. Patients may have experienced episodes of transient ischemic attacks (TIAs) before the onset of the ischemic strokes. Embolic strokes tend to have a more sudden onset without progression in symptoms. Subarachnoid hemorrhages (SAHs) are a sudden onset of headache without the history of transient neurological deficits. Vasospasms are associated with SAH, and symptoms occur most commonly between 7 and 10 days after the SAH.
Which of the following best describes a coup injury?
A. Injury occurs at the point of impact.
B. Injury occurs on the contralateral side of impact.
C. It is an acceleration injury.
D. It is a deceleration injury. - CORRECT ANSWER A
Rationale: A coup injury occurs at the point of impact, and a contracoup injury occurs on the contralateral side. The mechanism of injury for acceleration injuries is commonly defined as a moving object hitting a stationary head, whereas a deceleration injury involves a moving head hitting a stationary object.
A patient is admitted to the ICU with persistent epileptic seizures lasting beyond 90 minutes. Which of the following best describes the seizure activity?
A. Epileptic seizure
B. Epilepsy
C. Refractory seizure
D. Nonepileptic seizure - CORRECT ANSWER C
Rationale: An epileptic seizure, which persists for greater than 90 minutes despite administration of anticonvulsants is called a refractory seizure. An epileptic seizure indicates the presence of EEG wave changes during the seizure activity. Epilepsy refers to repetitive seizures without a reversible cause such as hyponatremia. Nonepileptic seizure is the presence of seizure activity without the EEG changes.
Which of the following would be the best technique to use to assess for cerebrospinal fluid in bloody drainage from the nose following a traumatic brain injury?
A. Glucose test
B. Halo test
C. Send to lab for hemoglobin level
D. Litmus test - CORRECT ANSWER B
Rationale: Halo test (a positive result produces a yellow ring) is more accurate than a glucose test, especially with the presence of bloody drainage. A glucose test has been used to distinguish between sinus drainage and cerebrospinal fluid (CSF) because CSF has glucose but sinus drainage does not. But in this scenario, the drainage was "bloody," and blood has glucose. Bloody drainage may give a false positive with a glucose test. Testing for hemoglobin in the drainage does not determine the presence of CSF. Litmus test is used to test a pH of a fluid and is not used to distinguish CSF from nasal drainage.
Which of the following is the most common cause of an embolic stroke?
A. Atrial septal defect
B. Atrial fibrillation
C. Calcified lesion
D. Angioplasty - CORRECT ANSWER B
Rationale: Atrial fibrillation (AF) is the most common cause of an embolic stroke. Atrial septic defect (ASD) and calcified lesions can also result in embolic strokes but are significantly less common than AF. A complication of angioplasty can be distal embolization but again is not the most common cause of an embolic stroke.
Cranial nerve (CN) VII (facial nerve) is commonly involved with Bell's palsy. Where does this CN originate?
A. Pons
B. Medulla
C. Midbrain
D. Basal ganglia - CORRECT ANSWER A
Rationale: Cranial nerve (CN) V (trigeminal nerve), VI (abducens nerve), VII (facial nerve), and VIII (acoustic nerve) originate from the pons. CNs IX (hypoglossal nerve), X (vagus), XI (spinal accessory nerve), and XII (hypoglossal nerve) originate from medulla. CNs III (oculomotor nerve) and IV (glossopharyngeal nerve) originate from the midbrain. No cranial nerves originate from the basal ganglia.
Which of the following electrolyte abnormalities is LESS likely to result in a seizure?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
D. Hypomagnesemia - CORRECT ANSWER B
Rationale: Hyponatremia is one of the most common electrolyte abnormalities that can cause a seizure. Hypocalcemia and hypomagnesemia can also cause seizures. Potassium is more likely to affect the myocardial electrical system, resulting in arrhythmias.
A patient in the ICU following a severe traumatic brain injury suddenly demonstrates profuse sweating, sustained tachycardia, hypertension, and fever. Which of the following is the most likely cause?
A. Neurogenic fever
B. Diencephalic seizure
C. Paroxysmal sympathetic hyperactivity
D. Cerebral salt wasting syndrome - CORRECT ANSWER C
Rationale: Traumatic brain injury (TBI) patients can experience "sympathetic storms" called paroxysmal sympathetic hyperactivity. The symptoms include fever, tachycardia, hypertension, profuse sweating, agitation, and increase respiratory rate. The "storm" is thought to be due to intermittent stimulation of the sympathoexcitatory centers located in upper brainstem and diencephalon. Diencephalic seizure is an incorrect term for the symptoms because the EEG is negative. Neurogenic fevers can occur following TBI but is not associated with the other symptoms of hypertension and tachycardia. Cerebral salt wasting syndrome (CSWS) is the loss of sodium through the kidneys and results in hypovolemic hyponatremia.
In severe cases of cerebral palsy, there may be a delay in growth and development. Which of the following conditions can occur in these cases?
A. Coagulopathy
B. Immunocompromise
C. Failure to thrive
D. Locked-in syndrome - CORRECT ANSWER C
Rationale: Failure to thrive is a complication of moderate to severe cerebral palsy (CP). It can result in malnutrition and death. CP is not associated with immunocompromise or coagulopathies. CP involves abnormal motor movements associated with spasticity or flaccidity, but does not develop locked-in syndrome.
Which of the following best describes the penumbra in an ischemic stroke?
A. Irreversibly damaged tissue
B. Normal healthy tissue
C. Presence of vasogenic cerebral edema
D. Reversible ischemic tissue - CORRECT ANSWER D
Rationale: The penumbra is the area surrounding an infarction that is ischemic or reversible ischemic tissue. Irreversibly damaged tissue is the area of tissue infarction and is the core of the infarction. Vasogenic cerebral edema is an increase in interstitial edema or fluid and is typically found surrounding the penumbra. Normal, healthy tissue is the area of brain tissue not affected by the ischemia or injury.
A patient is admitted to the trauma ICU following a traumatic brain injury due to vehicle rollover. The patient is hypotensive and tachycardic. Which of the following is the most accurate statement?
A. Hypotension following traumatic brain injury (TBI) indicates presence of epidural hematoma.
B. Hypotension is sign of blood loss but is not considered a sign of TBI.
C. Scalp lacerations can be easily controlled with direct compression.
D. Neurogenic shock following TBI results in hypotension. - CORRECT ANSWER B
Rationale: Traumatic brain injury (TBI) patients can experience additional systemic injuries. Hypotension indicates hypovolemia from blood loss in trauma patients, but cerebral injury, even epidural hematoma, cannot account for the volume of blood loss. Scalp lacerations bleed profusely and may require sutures or staples to stop the bleeding. Neurogenic shock is associated with spinal cord injuries. Symptoms include hypotension and bradycardia (not tachycardia).
Which of the following has been found to be the most effective in preventing embolic strokes due to atrial fibrillation?
A. Aspirin
B. Low-molecular-weight heparin
C. Warfarin (Coumadin)
D. Clopidogrel (Plavix) - CORRECT ANSWER C
Rationale: Studies have shown warfarin is the best at preventing an embolic stroke but is associated with a greater risk of bleeding. Aspirin is also used in primary prevention of embolic strokes but has less efficacy in preventing embolic strokes. Aspirin has a lower risk of bleeding than anticoagulation therapy. Low-molecular-weight heparin (LMWH) and Plavix are not currently recommended in preventing embolic strokes.
Which of the following scales are used to determine the overall prognosis in patients with a brain tumor?
A. PedsQL
B. Functional Independence Measure
C. CHADS2 score
D. Karnofsky Performance Status Scale - CORRECT ANSWER D
Rationale: Karnofsky Performance Status Scale (KPS) is used to determine overall prognosis in patients with a brain tumor. It is used along with histopathology of the tumor, completeness of resection, presence of necrosis, and tumor size and location. CHADS2 score is used to determine the stroke risk of atrial fibrillation. Functional Independence Measure (FIM) is used to evaluate stroke patients in rehabilitation. PedsQL is a tool used to assess quality of life in pediatric patients with brain tumors but is not used for overall prognosis.
Which of the following best describes a radiculopathy?
A. Compression of the cord with central stenosis
B. Inflammation of bone and cartilage of joint
C. Compression of nerve roots with foraminal stenosis
D. Symptomatic degenerative changes of osteoarthritis - CORRECT ANSWER C
Rationale: Radiculopathy is compression of nerve roots due to the narrowing of foraminal processes. Osteoarthritis is the inflammation of bone and cartilage of the spinal joints. Myelopathy is compression of the spinal cord due to central stenosis. Spondylosis is the symptomatic degenerative change that occurs in osteoarthritis.
Your patient presents with left upper extremity weakness and facial droop. Which of the following vessels is most likely involved in this stroke?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery - CORRECT ANSWER B
Rationale: The middle cerebral artery (MCA) supplies blood to the lateral portion of the cerebral cortex, which is where the motor strip for the upper extremities and face is located. The anterior cerebral artery (ACA) supplies blood to the medial portion of the cerebral cortex, which is where the motor strip for the lower extremities is located (results in lower-extremity weakness). The posterior cerebral artery (PCA) supplies blood to the occipital lobe, which results in visual deficits. The basilar artery is in the posterior circulation (brainstem) and may present with quadriplegia or "locked-in" syndrome.
Your patient has sustained a traumatic brain injury and a basilar skull fracture. The physician has ordered a nasogastric tube (NG) be placed. Which of the following is your best response?
A. Place the NG according to the physician's order.
B. Discuss with the physician the need to place an enteral feeding tube.
C. Insert the gastric tube orally.
D. Ask the physician to place the NG. - CORRECT ANSWER C
Rationale: Never place a gastric tube nasally in a patient with a basilar skull fracture. The nasogastric (NG) tube may go through the cribriform fracture and enter the brain. A gastric tube can be placed orally, just not nasally. An enteral feeding tube may not be indicated at this time. Having the physician place the NG tube is not appropriate because the tube should not be placed nasally.
During a stroke assessment, the patient has been found to have a deviated gaze. Which of the following would be the most correct statement regarding the gaze?
A. Dysconjugate gaze
B. Upward gaze
C. Gaze toward the affected side
D. Gaze away from affected side - CORRECT ANSWER C
Rationale: The gaze abnormality in a middle cerebral artery (MCA) stroke is deviated toward the affected side. Seizures result in gaze away from the affected side. A dysconjugate or upward gaze is frequently associated with cranial nerve abnormalities but not commonly associated with strokes.
What type of seizure is an aura classified as?
A. Simple partial
B. Complex partial
C. Generalized
D. Nonconvulsive - CORRECT ANSWER A
Rationale: An aura is a simple partial seizure typically involving somatosensory symptoms such as hallucinations. People are aware of the aura prior to having a generalized seizure. Complex partial seizures result in a loss of awareness and are frequently manifested as motor or automatism behavior. Generalized seizures occur across both hemispheres at once and are most frequently tonic-clonic. Nonconvulsive seizure patients have epileptic EEGs, but no physical signs of a seizure.
Your patient presents with the diagnosis of Guillain-Barré syndrome. Which of the following is the priority of care for this patient?
A. Assessment of vital capacity
B. Reassurance of the patient
C. Preparing for electromyography testing
D. Obtaining CT scan of the spine - CORRECT ANSWER A
Rationale: Airway and breathing are the priorities of care. The ascending loss of muscle contraction can include the diaphragm and respiratory muscles. Vital capacity is commonly used to assess the effectiveness of ventilation in neuromuscular disorders. Electromyogram (EMG) testing may be ordered; the patient should be reassured, but the priority of care is airway and breathing. A CT of the spine may be ordered to rule out cord compression, but is not a priority over assessment of ventilatory capability.
A patient sustained cervical fractures at the C4 and C5 level from a motor vehicle collision. In the ED, initially he was moving all extremities equally. He suddenly became hemiplegic on the left side. Which of the following is the most likely cause for this neurological change?
A. Carotid artery dissection
B. Spinal cord injury
C. Spinal epidural hematoma
D. Cerebral edema - CORRECT ANSWER A
Rationale: Carotid artery dissections are associated with traumatic injuries at the cervical level. The flexion/extension mechanism of injury that causes vertebral fractures and spinal cord injuries can also cause carotid and vertebral dissections. Carotid dissections can cause cerebral infarctions with symptoms of contralateral motor loss of upper and lower extremities. Spinal cord injury and epidural hematoma would result in paralysis bilateral. There is no justification within the scenario to suspect cerebral edema as the cause of the symptoms.
Which of the following therapeutic interventions is frequently recommended to manage a cerebrospinal fluid (CSF) leak?
A. Drain CSF with a lumbar drain.
B. Administer mannitol.
C. Limit fluid intake.
D. Maintain head-of-the-bed elevation greater than 30 degrees. - CORRECT ANSWER A
Rationale: Cerebrospinal fluid (CSF) leak is frequently managed by placing a lumbar drain to remove CSF. This lowers the CSF pressure and decreases the drainage. Mannitol is used to manage cerebral edema and increased intracranial pressure (ICP). Limiting fluid intake does not affect the CSF leak and is not recommended; head of the bed (HOB) is maintained flat, not elevated, to decrease the CSF leak.
The mother of a 6-year-old girl just diagnosed with pilocytic astrocytoma asks the nurse what her child's prognosis is. Which of the following would be the best response by the nurse?
A. This type of tumor has a good prognosis and can usually be managed with surgery.
B. The tumor is malignant and frequently metastasizes to the spine.
C. This tumor is associated with poor prognosis. I would encourage you to speak with a palliative care physician.
D. The prognosis is not well known. She will probably require long-term chemotherapy. - CORRECT ANSWER A
Rationale: The prognosis of pilocytic astrocytoma is good, with over a 90% survival rate in 10 years. It is commonly located in the cerebellum and can be surgically resected. It may not require follow-up radiotherapy if resection is complete. The tumor is not typically malignant.
Which of the following cerebral arteries is most likely involved in the presentation of "locked-in" syndrome during a stroke?
A. Anterior cerebral artery
B. Posterior communicating artery
C. Internal carotid artery
D. Basilar artery - CORRECT ANSWER D
Rationale: The basilar artery provides blood to the ventral portion of the pons. The basilar artery is involved in the stroke, resulting in locked-in syndrome. The internal carotid artery typically presents with unilateral paresis or paralysis. The posterior communicating artery or anterior cerebral artery does not present with quadriplegia.
Following a minor brain injury (concussion), the patient may experience which of the following symptoms over the next 6 months?
A. Periods of aphasia
B. Swallowing deficits
C. Difficulty concentrating
D. Ataxia - CORRECT ANSWER C
Rationale: Following a minor brain injury (concussion), patients may experience postconcussion syndrome. This is self-limiting, with neurological deficits that may last 6 months to a year after injury. Symptoms of postconcussion syndrome include (but not limited to) memory deficits, emotional outbursts, and difficulty concentrating. Periods of aphasia would be more likely transient ischemia attack. Swallowing deficit and ataxia are not associated with postconcussion syndrome and may indicate another neurological issue.
A patient presents with signs of occipital headache and abnormal motor strength. The MRI found herniation of the cerebellar tonsils, vermis, and fourth ventricle. How would this Chiari malformation be classified?
A. Type I
B. Type II
C. Type III
D. Type IV - CORRECT ANSWER B
Rationale: A type II Chiari malformation is the downward displacement of cerebellar tonsils and inferior vermis, fourth ventricle, choroid plexus, and medulla.
The patient presents in the ED with expressive aphasia and paralysis of the right arm and leg. He has a decreased level of consciousness and rapid respiration. Which of the following is your priority of care?
A. Obtain a STAT CT scan.
B. Administer alteplase immediately.
C. Perform a baseline National Institutes of Health Stroke Scale (NIHSS).
D. Secure an airway and ensure ventilation. - CORRECT ANSWER D
Rationale: Priority of care is always airway and breathing. Patients presenting with a decreased level of consciousness (LOC) may be unable to maintain an airway, requiring the airway to be secured. The patient will need a CT scan and a National Institutes of Health Stroke Scale (NIHSS) assessment and may be a candidate for thrombolytic therapy, but airway and breathing are the priorities of care.
A patient presents with low-back pain. Upon review of the spinal radiographs, multiple levels of osteophytes are noted. Which of the following best describes an osteophyte?
A. Inflammation of synovial joints
B. Degeneration of vertebral body with increased bone formation
C. Stenosis of the nerve root as exits lateral foramen
D. Compression of lumbar disc - CORRECT ANSWER B
Rationale: The degeneration of the vertebral body includes increased bone formation of the subchondral bone adjacent to endplate and is called sclerosis. It is less able to absorb loads and causes formation of osteophytes, bony projections also known as spurs. These may compress on neurological structures and cause symptoms. Synovitis is inflammation of synovial joints. Foraminal stenosis causes the compression of exiting nerve roots. Lumbar disc compression can cause symptoms but is not an osteophyte.
Anticholinesterase agents are used to improve myasthenia gravis muscle function through which of the following actions?
A. Increase secretion of acetylcholine.
B. Prevent breakdown of acetylcholine.
C. Increase sensitization postsynaptic receptors.
D. Increase number of postsynaptic muscle receptors. - CORRECT ANSWER B
Rationale: Anticholinesterase agents prevent the breakdown of acetylcholine by acetylcholinesterase. The effect of the anticholinesterase agents is to prolong the effect of the neurotransmitter acetylcholine. The agents do not increase secretion of the neurotransmitter acetylcholine or sensitize the receptors of acetylcholine. The postsynaptic muscle receptors are destroyed and cannot be regenerated.
Which of the following diagnostic studies is considered the most reliable to identify spinal cord and soft-tissue injuries?
A. Lateral cervical spine radiographs
B. CT scan
C. MRI
D. Flexion/extension radiographs - CORRECT ANSWER C
Rationale: The benefits of MRI in evaluating acute spinal cord injury (SCI) are its ability to identify cord compression, soft-tissue injuries such as herniated disc and epidural hematoma, ligament instability, and intramedullary hematomas. Lateral C-spine radiographic studies can identify vertebral fractures and can assess for misalignment of the cervical spine but cannot identify cord or soft-tissue injuries. CT scans are not considered as beneficial as MRI in identifying injury to the spinal cord, soft tissue, or ligaments. Flexion/extension radiographs are used in certain patients to identify misalignment of the spine (ligament injury) but are not able to identify actual injury to the cord, soft tissues, or ligaments.
A patient reports he or she experiences irritability and mood changes days prior to a seizure. What is this period called?
A. Preictal
B. Aura
C. Intraictal
D. Postictal - CORRECT ANSWER A
Rationale: The preictal state is the "warning" sign of an impending seizure that may occur days prior to the seizure. This may include feelings of general irritability or depression, mood changes, anxiety, headaches, lethargy, change in appetite, and light-headedness. An aura is the actual start of the seizure. Intraictal is the period of time during the seizure. Postictal is after the seizure.
Which of the following secondary injuries would be the most important determinants of outcomes in patients following traumatic brain injuries?
A. Hyponatremia and tachycardia
B. Hypoxia and hypotension
C. Hyperglycemia and hypothermia
D. Hyperthermia and metabolic acidosis - CORRECT ANSWER B
Rationale: Current research has found the two most important determinants of outcome following a traumatic brain injury are hypoxia and hypotension. They both are considered secondary injuries and determine cerebral perfusion. Hyperglycemia, hyperthermia, hyponatremia, and metabolic acidosis are secondary injuries and can affect outcomes but are not as severe as secondary injuries affecting cerebral perfusion.
Which of the following would be a contraindication for administering a thrombolytic?
A. Patient's home medications include Eliquis
B. National Institutes of Health Stroke Scale score of 10
C. Patient on a daily aspirin
D. Negative CT scan - CORRECT ANSWER A
Rationale: Eliquis is classified as a novel anticoagulant. A National Institutes of Health Stroke Scale (NIHSS) score of 10 is not a contraindication for alteplase. Depending upon other criteria, it would be an indication. Antiplatelet agents, such as aspirin, are not a contraindication to alteplase in acute stroke. An acute ischemic stroke will have a negative CT scan initially.
Your patient has a sudden loss of consciousness. An emergency CT is obtained and an intracerebral hemorrhage (ICH) is seen. Which of the following would be the LEAST common cause of an ICH?
A. Anticoagulation therapy
B. Hypertensive crisis
C. Aneurysm rupture
D. Vascular tumor - CORRECT ANSWER C
Rationale: Aneurysm rupture results in subarachnoid hemorrhages (SAH) and intraventricular hemorrhage (IVH), not primarily intracerebral bleeds. Anticoagulated patients, hypertensive crisis, and vascular tumors will typically cause bleeding into the parenchyma and are called intracerebral hemorrhage (ICH).
Which of the following statements is a true regarding cerebral palsy (CP)?
A. CP is not preventable.
B. CP is a disease found in children but can be cured.
C. Most children with CP will die by the age of 10 years.
D. CP has no cure. - CORRECT ANSWER D
Rationale: There is no cure for cerebral palsy (CP). It is preventable in some cases such as those due to maternal infections (vaccinations) or Rh incompatibility (use of Rhogam). CP can be at birth or acquired at a very young age. CP may shorten life expectancy, but many children with CP live into adult ages.
Plasmapheresis is treatment commonly used in managing Guillain-Barré. It involves the:
A. Complete exchange of red blood cells
B. Removal of antibodies with plasma exchange
C. Washing of the white blood cells to clear allergens
D. Filtering of the immunoglobulins - CORRECT ANSWER B
Rationale: Guillain-Barré is an autoimmune disorder. Plasmapheresis involves the exchange of serum plasma to remove the antibodies. Plasmapheresis does not exchange red blood cells, wash white blood cells, or filter immunoglobulins.
Which of the following best describes Moyamoya disease?
A. Small, multiple aneurysms in the microcirculation
B. Arteriovenous malformations
C. Hyperlipidemia deposits of fat in the cerebral vessel wall
D. Progressive occlusion of the intracranial internal carotid artery with collateral flow - CORRECT ANSWER D
Rationale: Moyamoya disease is the progressive narrowing or occlusion of the internal carotid artery with the development of collateral circulation called Moyamoya vessels. Presence of multiple, small aneurysms in the microcirculation is called Charcot-Bouchard. Hyperlipidemia results in the formation of plaque and the narrowing of the vessel but is not called Moyamoya vessels. Arteriovenous malformations (AVMs) are congenital vascular anomalies in which the arteries feed directly into draining veins.
When clearing a cervical spine injury in the acute period following a traumatic event, which of the following is NOT required?
A. Maintain cervical immobilization until cleared of ligament injury
B. Flexion/extension evaluation in an awake, asymptomatic patient
C. Visualization of C1 through T1 on lateral cervical radiographs
D. MRI of cervical spine - CORRECT ANSWER D
Rationale: MRI of cervical spine can be used to clear a cervical spine injury (C-spine) in certain circumstances but is not required. Maintaining cervical immobilization until ligament injuries can be cleared is required to prevent subluxation and cord compression if an injury is present. Awake, asymptomatic patients require evaluation (radiographs or physical assessment) of flexion and extension capability to determine if potential ligament injury since plain radiographs cannot identify ligament unless some degree of subluxation is noted. Lateral C-spines require visualization of C1-C7 and the tip of T1 to clear the C-spine of bony fractures.
Which of the following is a known risk factor for a brain tumor?
A. Use of cellular phones
B. Exposure to ionized radiation
C. Consumption of fish with high mercury levels
D. Use of microwaves - CORRECT ANSWER B
Rationale: Overall, causes of brain tumors are unknown. Exposure to ionized radiation is a known risk factor, which can be modified. Cell phones produce a very low magnetic radiation and have not been found to increase the risk of brain tumor. Environmental risks such as ingestion of high mercury and food cooked in microwave have not been found to increase risk of brain tumors.
Lobar intracerebral hemorrhage frequently presents with which neurological symptom?
A. Cranial nerve deficits
B. Decreased level of consciousness
C. Pinpoint pupils
D. Horner's syndrome - CORRECT ANSWER B
Rationale: A decrease in level of consciousness is frequently associated with lobar intracerebral hemorrhage. A bleed within the brainstem frequently presents with cranial nerve deficits, pinpoint pupils, and Horner's syndrome.
Patients with Mèniére's disease often complain of feelings of aural fullness accompanied by which of the following other symptoms?
A. Worst headache of their lives
B. Urinary incontinence
C. Roaring sound in ears
D. Frequent ear infections - CORRECT ANSWER C
Rationale: A common complaint by patients is a "roaring" sound in their ears as well as aural fullness. Urinary incontinence is associated with normal-pressure hydrocephalus (NPH). Subarachnoid hemorrhage (SAH) presents with the "worst headache of their life." M`eniére's disease is not associated with frequent ear infections but can have hearing losses. [Show Less]