Exam 15: Neurological System

A 77-year-old male is brought into the emergency department accompanied by his daughter.She reports that her father has been complaining of right-handed weakness for 2 to 3 hours and that she has noticed him slurring his speech.On physical examination,the right hand grip strength is 1/ 5 compared to the left hand grip of 5/5.A facial droop is noted on the right side of the face.Cranial nerve dysfunction is noted in the right-sided CNVII,CN V,CNIX,CNX,CNXI,and CNXII.The clinician should request the following diagnostic test immediately:

A 60-year-old female complains of several episodes of dizziness and nausea that started this morning.She denies trauma,falling,or loss of consciousness.She has a 5-year history of hypertension and takes a beta blocker daily.On physical examination,there are no neurologic deficits or any abnormal findings and ECG is normal.Which of the following tests should be performed?

Which of the following microorganisms is a common cause of meningitis?

In order to test abstract thought on the mental status exam,the clinician can ask:

A 44-year-old male presents to the emergency room with the "worst headache of his life." He is holding his head and appears severely distressed.This is a patient symptom that should prompt a clinician to look for signs of a:

A 43-year-old male presents to the emergency department in a stupor accompanied by his wife.She called the ambulance because her husband was difficult to awaken this morning.She reports that for the last 3 days,he has had fever and upper respiratory infection.Yesterday he had a headache.He has had no medical treatment.On physical examination,the patient demonstrates 103 fever,sluggish pupil response,and nuchal rigidity.Which of the following should the clinician attempt to elicit next?

An 85-year-old female patient arrives by ambulance to the emergency department accompanied by her husband.He reports that his wife had been ill with pneumonia and,2 days ago,went to the family physician who prescribed azithromycin twice a day.The husband reports that he is making sure she gets the medicine.His wife has been staying in bed and resting.She awoke from sleep last night and was extremely agitated,left the house,and was walking outside.She did not recognize her husband and wanted to call the police.Which of the following is an appropriate question for the history?

A 41-year-old male patient presents to the emergency department complaining of severe headache pain.He describes it as a piercing,right sided head pain that occurred earlier in day for about 1 hour and now is recurring.You note lacrimation and rhinorrhea on the right side of the face.Which of the following types of headache is the patient describing?

A 65-year-old woman is accompanied by her daughter for a physical examination.She has mild heart failure and takes digitalis and an ACE inhibitor.As you examine the patient,you note flat affect,hand tremor,and slowed movements.The tremor is worsened at rest.There are no neurologic deficits.Hand grip,sensation of face and extremities,and lower extremity muscle strength are within normal limits and bilaterally equal.DTRs are equal bilaterally.CN II to XII are intact.The mental status exam is normal.These are key signs of:

A female patient presents to the clinic with complaints of a severe,throbbing,unilateral headache.She complains of seeing flashes of light prior to the headache.She complains of sound and light sensitivity as well as nausea.The clinician should recognize these as symptoms of:

An 81-year-old patient with heart failure comes into the emergency room accompanied by his daughter.The daughter reports that her father "banged his head" as he was getting out of the car 4 days ago.He did not complain of headache pain,so she did not obtain medical advice.She reports that she noticed a mild facial droop,slurring of speech,and gait disturbance in her father today.She reports that her father takes Coumadin,digoxin,and an ACE inhibitor.On physical examination,there is decreased right hand grip 2/5 strength and decreased right quadriceps strength 2/ 5 compared to the left side 5/5.CT scan shows an intracranial bleed.Which of the following is the most probable diagnosis?

When carrying out a mental status exam on a non-English speaking patient,it is important to have a(n):

Ménière's 'disease presents with the following triad of symptoms:

An 8-year-old child presents to the emergency room with a severe unilateral,throbbing headache.She is lying on the gurney with her eyes closed while holding her head.She denies ever having this kind of headache in the past.She complains of sensitivity to light and noise.An appropriate history question to ask the parent would be:

An 88-year-old female is accompanied by her daughter to the emergency department.The daughter explains that her mother was having her hair washed at the beauty salon,then complained of dizziness and fainted.The 88-year-old patient has a history of hypertension for which she takes a beta blocker.Otherwise she was in her usual state of health until this incident.On examination,she has no neurological deficits.Which of the following conditions should be considered?

In dementia,which of the following cognitive functions is most commonly lost first?

On a history and physical examination of a 34-year-old patient,during the review of systems,he reports occasional episodes of headache.He describes the headache pain as a "band is around his head" and tightness in the neck and shoulders.The clinician should recognize these symptoms as:

A 78-year-old female comes to the clinic for a physical examination.She is accompanied by her daughter and looks to her daughter to answer questions during the interview.She was diagnosed with early Alzheimer's disease 2 years ago,and her daughter would like her current mental status evaluated. You ask the patient her daughter's name,and she answers correctly.You ask her the date and time,and she answers incorrectly.You hand the patient a pencil and ask her if she knows what it is.She replies with,"Is it a stick?" You ask the patient to put on a patient gown,and she does not know how to perform the task.These are examples of disorientation to time and:

You are an emergency room clinician that assisted with CPR on a 20-year-old trauma patient.The CPR was unsuccessful,the patient expired,and you need to explain this to the family in the waiting room.Upon telling the mother about the death of her son,she becomes dizzy and faints.What is the most likely cause for the woman fainting?

When examining the carotid arteries,the clinician should: