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Advanced Health Assessment Test 2
Ms. Pammy is a 36-year-old woman who presents to your office with a complaint of depression. She is experiencing anger, fear, and sorrow. Which of the following regulates feelings of anger, fear, and sorrow? A. Limbic system B. Corpus callosum C. Temporal lobes Caudate nucleus - correct answer A. Limbic system The limbic system mediates certain patterns of behavior that determine survival (e.g., mating, aggression, fear, and affection). Reactions to emotions such as anger, love, hostility, and envy originate here, but the expression of emotion and behavior is mediated by connections between the limbic system and the frontal lobe. Answers b, c, and d are incorrect because they are responsible for other functions. Mrs. Hilliard brings her 9-year-old daughter to your office. She has been diagnosed with autistic disorder. Which of the following statements best describes this disorder? A. Pervasive neurodevelopmental disorder B. Global intellectual deficit C. Social impairment syndrome D. Right brain dysfunction - correct answer A. Pervasive neurodevelopmental disorder Autism is a pervasive neurodevelopmental disorder of unknown etiology that includes a wide spectrum of disorders typically identified before 3 years of age and is more common in boys than girls. Mr. Edwards presents to the emergency department after an auto accident. Which of the following scales would be used to evaluate the mental status of a patient after head trauma? A. Mini-Mental State Examination B. Perceptual distortion assessment C. Glasgow Coma Scale D. Functional assessment - correct answer C. Glasgow Coma Scale
The Glasgow Coma Scale is used to quantify level of consciousness after an acute brain injury or medical condition. The Mini-Mental State Examination (MMSE) is a standardized tool to assess cognitive function changes over time. Perceptual distortion assessment evaluates the variation between a reported perception of a stimulus and the normal response. Functional assessment is an objective measure of a person's ability to perform the activities of daily living. Disordered perceptions, decreased attention span, suspiciousness, and fear with motor and sensory excitement are characteristics of which disorder? A. Delirium B. Dementia C. Schizophrenia D. Depression - correct answer A. Delirium Delirium is impaired cognition and consciousness and mood and behavioral dysfunction of acute onset. Disordered perceptions, decreased attention span, suspiciousness, and fear with motor and sensory excitement are objective characteristics found in delirium. Mr. Yates is a 67-year-old patient who presents to your office with his son. Which of the following would best test Mr. Yates's comprehension? A. Ask him to count backward by 7s from 100. B. Ask him to follow one- and two-step commands. C. Ask him the meaning of "a stitch in time saves nine." D. Ask him his name, the date, and the season. - correct answer B. Ask him to follow one- and two-step commands. Asking simple one- and two-step directions measures a patient's comprehension. Patients should be able to follow instructions of this type. Answers a, c, and d measure other cognitive abilities, like abstract reasoning. Mrs. Tucker presents to your office today for a follow-up appointment. She appears to fidget in her seat and with her hands. Which of the following would assess her attention span? A. Are you usually this anxious?
Mrs. Karon is a 46-year-old female patient who presents to your office for a physical. When you enter the room, her arms are folded tight and she will not look up to address you. Into which category of examination findings do these observations belong? A. Cognitive abilities B. Speech/language C. Emotional stability D. Appearance and behavior - correct answer D. Appearance and behavior Body language, grooming, and emotional status comprise the patient's appearance and behavior. A lack of concern with appearance or inappropriate dress for season or occasion in a previously well-groomed individual may indicate depression, a psychiatric disorder, or dementia, which are indicative of the patient's emotional status. Answer b is inappropriate because the patient did not verbalize anything. Mrs. Horter brings her 14-year-old son in with a complaint that he has a poor attention span. Which of the following examination categories is most reflective of attention span? A. Cognitive abilities B. Speech/language C. Emotional stability D. Appearance and behavior - correct answer A. Cognitive abilities Attention span, state of consciousness, responses to analogies, abstract reasoning, arithmetic calculation, and memory are assessed to evaluate cognitive abilities. Signs of possible cognitive impairment are poor attention span, significant memory loss, confusion (impaired cognitive function with disorientation, attention and memory deficits, and difficulty answering questions or following commands), impaired communication, inappropriate affect, personal care difficulties, hazardous behavior, agitation, and suspiciousness. Which is a major difference between Alzheimer's disease and vascular dementia? A. Etiology B. Degree of memory loss C. Functional ability D. Extent of personality disintegration - correct answer A. Etiology
Dementia is a chronic, slowly progressive disorder of failing memory, cognitive impairment, behavioral abnormalities, and personality changes that often begin after age 60 years and is usually related to structural diseases. Vascular dementia is a type of dementia-related to acute or embolic strokes or cerebral hemorrhages caused by hypertension. Up to 70% of Alzheimer's dementia is caused by the presence of senile plaques and neurofibrillary tangles with abnormal amyloid processing or deposits. Which of the following actions would best evaluate the patient's judgment? A. Ask the patient the meaning of the statement "A stitch in time saves nine." B. Provide the patient with four unrelated words and ask the patient to remember them. C. Ask the patient, "What do you plan to do after you are discharged from the hospital?" D. Give the patient pencil and paper and ask him to write a paragraph about judgment. - correct answer C. Ask the patient, "What do you plan to do after you are discharged from the hospital?" Questions that focus on the patient's plan for the future are used to assess the patient's judgment, as well as questions to elicit how the patient meets his or her social and familial obligations and those based on hypothetical situations. Answers a, b, and d measure other categories of mental functioning. Mr. Gates is a 68-year-old man who is brought to your office by his daughter. Which of the following would demonstrate an evaluation of thought process and content? A. Observing the person's patterns of thinking, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed B. Observing congruence of effect and speech C. Inquiring about visual, auditory, or tactile hallucinations D. Asking the patient a question such as "What would you do if you were in a theater and saw a fire starting?" - correct answer A. Observing the person's patterns of thinking, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed Thought process and content are evaluated by observing the patient's thought patterns, especially the appropriateness of sequence, logic, coherence, and relevance to the topics discussed. The patient's thought process should be easy to follow, with logical and goal-directed ideas expressed. Illogical, disorganized, or unrealistic thought processes, a flight of ideas (rapid disconnected thoughts), blocking (i.e., an inappropriate pause in the middle of a thought, phrase, or sentence), or impaired stream of thinking (e.g., repetition of a word, phrase, or behavior) indicates an emotional disturbance or a psychiatric disorder. Answers b, c, and d evaluate other components of mental function.
Broca area (frontal lobe) contains the motor cortex, which is associated with speech formation, as well as decision making, problem-solving, the ability to concentrate, and short-term memory. Answers b, c, and d are associated with different areas of the brain and other characteristics. Mr. Reasoner brings his son in for a routine physical examination. On examination, you note impaired attention for his age, impulsivity, and hyperactivity. Your impression is attention-deficit/hyperactivity disorder. You know that this occurs in children before they are: A. 5 years old. B. 7 years old. C. 9 years old. D. 11 years old. - correct answer B. 7 years old. Attention-deficit/hyperactivity disorder is a neurobehavioral problem of impaired attention and hyperactive behavior affecting 5% to 10% of school-age children, with onset before 7 years of age. A review of related history includes detailed inquiry about: A. disorientation and confusion. B. depression. C. medication use. D. all of the above. - correct answer D. all of the above. Responses to questions about these topics provide clues for focusing the physical examination and the development of an appropriate diagnostic evaluation. Questions regarding medication use (prescription and over-the-counter preparations), as well as complementary/alternative therapies, are relevant for each area. Schizophrenia affects which of the following? A. A person's perceptions B. A person's mood C. Attention span D. Only older adults - correct answer A. A person's perceptions
Schizophrenia is a severe, persistent, psychotic syndrome with impaired reality that relapses throughout life. Other disorders may affect a person's mood, attention span, and the older adult. Mr. Jared is a 68-year-old patient who presents to your office with his daughter. During the interview, you note that he has a slumped posture in the chair and lack of facial expression. These observations are most suggestive of which of the following conditions? A. Endocrine disorder B. Concussion C. Parkinson disease D. Vascular dementia - correct answer C. Parkinson disease Slumped posture and a lack of facial expression may indicate depression or a neurologic condition such as Parkinson's disease. The limbic system mediates: A. vomiting. B. emotions. C. speech. D. balance. - correct answer B. emotions. The limbic system mediates certain patterns of behavior that determine survival (e.g., mating, aggression, fear, and affection). Reactions to emotions such as anger, love, hostility, and envy originate here, but the expression of emotion and behavior is mediated by connections between the limbic system and the frontal lobe. Answers a, c, and d are not a part of the anatomy and physiology of the brain. Mrs. Gerrard is a 72-year-old patient who presents to your office. After your examination, you suspect she is depressed. Which of the following findings could indicate depression in an adult patient? A. Unable to demonstrate abstract reasoning B. Unable to correctly write his or her name C. Unable to comb his or her hair D. Demonstrates impaired math skills - correct answer D. Demonstrates impaired math skills
An analogy is a comparison of two things based on their being alike in some way. Analogies are used to investigate cognitive abilities. An inability to describe similarities or differences between common objects such as carrots and green beans is suggestive of which problem? A. A left cerebral hemisphere lesion B. Depression C. An eating disorder D. Aphasia - correct answer A. A left cerebral hemisphere lesion Patients with average intelligence should be able to describe the similarities and differences between common objects. An inability to describe similarities or differences may indicate a lesion of the left or dominant cerebral hemisphere. A 65-year-old woman is brought to the clinic by her family, who report that they have noticed a change in her mental abilities over the past 2 weeks. Normally she is independent, intelligent, and socially oriented. Her medical history is unremarkable except for congestive heart failure, which is controlled with digoxin. She has had no major changes in her health. What question would be the most important for the examiner to ask the family? A. "Is there a family history of Alzheimer's disease?" B. "How much alcohol does she drink in an average week?" C. "When was her digoxin blood level last checked?" D. "Did you know that mental function begins to decline after the age of 60?" - correct answer C. "When was her digoxin blood level last checked?" Digoxin may cause disorientation and confusion. Responses to questions regarding medication use are important for evaluating present illness. A patient who has difficulty writing or drawing is most likely to have which condition? A. Temporal lobe damage B. Peripheral neuropathy C. Wernicke paralysis
D. Psychiatric hallucinations - correct answer B. Peripheral neuropathy Uncoordinated writing or drawing may indicate dementia, parietal lobe damage, a cerebellar lesion, or peripheral neuropathy. Which is a classical indication of Alzheimer's disease? A. Use of clang associations B. Occurrence of visual hallucinations C. Disintegration of personality D. Flat affect and mood - correct answer C. Disintegration of personality Eventual profound disintegration of personality and complete disorientation occur in a majority of Alzheimer's cases (dementia). In babies, babbling and cooing usually occur around: A. 2 to 3 months. B. 3 to 4 months. C. 4 to 6 months. D. 6 to 8 months. - correct answer B. 3 to 4 months. Cooing and babbling are expected after 3 and 4 months of age, respectively. At what age do babies usually say one or two words, such as "Mama" and "Dada"? A. 4 to 6 months B. 6 to 8 months C. 8 to 10 months D. 10 to 12 months - correct answer D. 10 to 12 months Expressive language milestones for this age include words such as "Mama," "Dada," and "Bye-Bye."
A. True B. False - correct answer A. True The MMSE is a standardized tool to assess cognitive function changes over time. There are 11 items measuring orientation, registration, attention and calculation, recall, and language, and it takes approximately 5 to 10 minutes to administer. Screening for depression should be a routine part of care for all new mothers. A. True B. False - correct answer A. True An estimated 39% of women who have depression during pregnancy have postpartum depression. An estimated 13% of women have postpartum depression (Underwood, Waldie, D'Souza, et al., 2016). Postpartum psychosis occurs in 0.1% to 0.2% of women (Berrisford, Lambert, and Heron, 2015). Because depression may interfere with the mother's health, ability to work, and attachment to the newborn and the infant's subsequent development, all new mothers should be screened for depressive symptoms. Problem-solving and short-term recall memory are associated with which section of the brain? A. Frontal lobe B. Parietal lobe C. Temporal lobe D. Limbic system - correct answer A. Frontal lobe The frontal lobe, containing the motor cortex, is associated with speech formation, decision making, problem-solving, the ability to concentrate, and short-term memory. The parietal lobe is primarily responsible for receiving and processing sensory data. The temporal lobe is responsible for the perception and interpretation of sounds as well as localizing their source. The limbic system is responsible for emotions. Which area in the brain regulates the level of arousal? A. Limbic system B. Reticular activating system
C. Temporal lobe D. Occipital lobe - correct answer B. Reticular activating system The reticular activating system (RAS) in the brainstem regulates awareness and arousal. Answers a, c, and d regulate other areas of the brain. Which part of the brain contains the Wernicke speech area, which permits speech and comprehension of written language? A. Frontal lobe B. Parietal lobe C. Temporal lobe D. Limbic system - correct answer C. Temporal lobe The temporal lobe is responsible for perception and interpretation of sounds as well as localizing their source. It contains the Wernicke speech area, which allows a person to understand spoken and written language. It is also involved in the integration of behavior, emotion, and personality, as well as long-term memory. Answers a, b, and d regulate other characterisitics. Long-term memory is associated with which area of the brain? A. Frontal lobe B. Parietal lobe C. Temporal lobe D. Limbic system - correct answer C. Temporal lobe The temporal lobe not only contains the Wernicke speech area, but it is also involved in the integration of behavior, emotion, and personality, as well as long-term memory. Answers a, b, and d regulate other characteristics. You are obtaining a history of a new patient. A family history of which disorder would be of greatest concern? A. Cardiovascular accident (CVA)
C. "What goes through your mind during the seizure?" D. "Are there any factors or activities that seem to start the seizures?" - correct answer D. "Are there any factors or activities that seem to start the seizures?" Questions asked of a patient presenting with a seizure relate to history of prior seizure, premonition or aura (headache, mood change, anxiety, irritability, lethargy, changes in appetite, dizziness, and lightheadedness), and any precipitating factors. Identification of precipitating factors can assist in designing prevention strategies. Mr. McKnight is a 48-year-old patient who presents to your office with a complaint of dizziness. He states, "I sometimes feel as if the whole room is spinning." What type of neurologic dysfunction should the examiner suspect? A. Peripheral neuropathy dysfunction B. Increased intracranial pressure from a brain tumor C. Inner ear dysfunction affecting the acoustic nerve D. A lesion affecting the frontal lobe - correct answer C. Inner ear dysfunction affecting the acoustic nerve The acoustic nerve, or cranial nerve VIII, regulates hearing and equilibrium. The examiner asks the patient to close her eyes, then places a vibrating tuning fork on the patient's ankle and asks her to indicate what is felt. What is being assessed? A. Peripheral nerve sensory function B. Cranial nerve sensory function C. Cortical sensory function D. Level of consciousness - correct answer A. Peripheral nerve sensory function Sensory loss follows the distribution of dermatomes or peripheral nerves. Jack is a 52-year-old obese man with a history of poorly controlled diabetes. He also smokes. Based on these data, the examiner should recognize that Jack has several risk factors for: A. seizures.
B. cerebrovascular accident. C. multiple sclerosis. D. Guillain-Barré syndrome. - correct answer B. cerebrovascular accident. Risk factors for stroke (brain attack or cerebrovascular accident) include smoking tobacco products and history of diabetes mellitus, cardiovascular disease, hypertension, and increased serum cholesterol levels. The examiner is assessing deep tendon reflexes in a 12-year-old boy. Which score should be documented when the expected reflex response occurs? A. 1+ B. 2+ C. 3+ D. 4+ - correct answer B. 2+ The notation 2+ represents an active or expected response.
- Mr. Tucker is a 68-year-old patient who presents to your office for follow-up. He tells you, "I feel numb and I am so slow when I move." On examination, you note postural instability. These assessment data are suggestive of which problem? A. Developing seizure disorder B. Parkinson disease C. Dysfunction of the temporal lobe D. Vestibular tumor - correct answer B. Parkinson disease Parkinson's disease is a slowly progressive, degenerative neurologic disorder in which deficiency of the dopamine neurotransmitter results in poor communication between parts of the brain that coordinate and control movement and balance. Mr. Smith, a 75-year-old, tells you during his physical that he is experiencing tremors in his hands that occur at rest. Which disorder does this finding cause you to suspect? A. Multiple sclerosis
The examiner is interviewing the mother of a 3-month-old infant as part of the infant's neurologic system examination. Which response of the mother may indicate a need for further evaluation of the infant? A. "My baby sometimes falls asleep when I am feeding her." B. "My baby seems to jump when there is a loud noise in the room." C. "I drank a glass of wine about once a week while I was pregnant." D. "I had problems with hypertension the entire time I was pregnant." - correct answer D. "I had problems with hypertension the entire time I was pregnant." A prenatal/maternal history of intrauterine infections such as toxoplasmosis, syphilis, tuberculosis, rubella, cytomegalovirus, herpes, prior history of hypertension, preeclampsia, bleeding, history of trauma or stress, persistent vomiting, hypertension, or drug or alcohol use alerts the examiner to the need for further evaluation of an infant. Mr. Harrien is a 56-year-old patient who presents to your office. On examination, you note impaired pain sensation. Which additional testing is appropriate to further evaluate this finding? A. Temperature and deep pressure sensation B. Ultrasonic perception C. Deep tendon reflex D. Transillumination of the involved area - correct answer A. Temperature and deep pressure sensation Temperature and deep pressure sensation tests are performed only if superficial pain sensation is not intact. Mr. Black is a 41-year-old construction worker who comes into your office. You squeeze the patient's biceps muscle as part of an examination. Which of the following responses verbalized by the patient is considered normal? A. "That makes my arm tingle." B. "That makes a burning sensation go up my arm." C. "That is uncomfortable." D. "My arm is twitching." - correct answer C. "That is uncomfortable."
Deep pressure sensation is tested by squeezing the trapezius, calf, or biceps muscle. The patient should experience discomfort. Which finding is associated with an increased risk of skin breakdown and injury? A. An inability to feel pressure applied by a monofilament B. An inability to identify a familiar object by touch C. An inability to identify a letter drawn in the palm of the hand D. 3+ deep tendon reflexes - correct answer A. An inability to feel pressure applied by a monofilament Loss of sensation to the touch of the monofilament is an indication of peripheral neuropathy. Skin breakdown and injury can occur as a result of excessive pressure; thus a patient who is unable to feel pressure is at risk for injury secondary to excessive pressure. A patient presents with a bilaterally symmetric intention tremor of the hands that she describes as "worse when I'm stressed and better when I have a cocktail." How would you document this tremor? A. Physiologic tremor B. Essential tremor C. Resting tremor D. Psychological tremor - correct answer B. Essential tremor Essential tremor may worsen with stress or fatigue; it may improve temporarily with alcohol. The main function of cerebrospinal fluid is to: A. provide nutrients for the brain and spinal cord cells. B. act as a shock absorber. C. cleanse the brain and spinal cord cells and remove debris. D. function as a neurotransmitter. - correct answer B. act as a shock absorber. Cerebrospinal fluid circulates between an interconnecting system of ventricles in the brain and around the brain and spinal cord, serving as a shock absorber.
