pg. 1 Week 8 NR 509 Advanced Health Assessment Final 2024 Newest/ Complete 100 Actual Exam Questions with Correct Detailed Answers (Verified Answers) Graded A+
CHAPTER 20: Male Genitalia
A 67-year-old electronics technician with a history of hypertension and type 2 diabetes presents for his yearly physical examination and complains of progressively worsening erectile dysfunction (ED). While counseling him, the clinician mentions that multiple processes must take place to achieve an erection. Which of the following structures would be most affected by vascular deficiencies related to his preexisting medical conditions and is likely contributing to his symptoms? - Correct Answer - Corpora cavernosa Rationale: The corpora cavernosa are two structures within the shaft of the penis that become engorged with venous blood during erection. Patients with a history of cardiovascular disease such as hypertension and other diseases, such as diabetes, that cause limitations of blood flow are common causes of ED. Ejaculatory duct is incorrect.It is a conduit for seminal fluid from the seminal vesicle and terminal vas deferens to the urethra and is not involved in the process of an erection. Epididymis is incorrect. It is a structure on top of each of the testicles that provides a reservoir for storage, saturation, and transport of sperm from the testes and is also not involved in the process of an erection. Seminal vesicle is incorrect. It produces secretions that contribute to the seminal fluid and is also not involved in the process of an erection. Vas deferens is incorrect. It is a cord-like structure that transports sperm from the tail of the epididymis to the urethra and also is not involved in the process of an erection.
CHAPTER 20: Male Genitalia
A 29-year-old graduate student states that he is able to achieve an erection and ejaculate during sexual intercourse; however, he does not experience any pleasurable sensation of orgasm. He is otherwise healthy and is not on any medications. What is the most likely cause of his problem? - Correct Answer - Psychogenic 1 / 4
pg. 2 Rationale: Lack of orgasm with ejaculation is usually not a physiological or structural issue, rather psychogenic in nature. It is fairly uncommon but does occur, and clinicians should be aware of the problem and take a thorough history to ascertain the roots of this disorder. Androgen insufficiency is incorrect as it is more likely to cause a decrease in libido and problems with erectile dysfunction (ED) rather than lack of orgasm. Endocrine dysfunction is incorrect as it may also cause ED and decreased libido as well as reduced or absent ejaculation among others; however, it should not cause the symptoms described above. Peyronie disease is incorrect as it is the development of fibrous scar tissue within the penis that causes disfigured and painful erections. STI is incorrect. STIs can cause a constellation of symptoms such as urethral discharge, fever, and pain to name a few; however, they should not cause the symptoms described above.
CHAPTER 24: Nervous System
A 35-year-old female patient has had migraines for much of her adult life. Ather regular checkup, she is healthy, takes no medications except oral contraceptive pills (OCPs), exercises, and has a steady job. Her only complaint is that her migraines seem to have become worse, and, for the past few weeks, she has been waking up at night with headache and also nausea. Which of the following is the best course of action? - Correct Answer - Take a further history and perform a very careful neurological examination.
Rationale: The history of nightly awakening and nausea is concerning for increased intracranial pressure from a tumor or other mass. (Brain tumor is not common in a 35- year-old.) A careful neurological examination may uncover deficits. Reassure her that this is a common pattern with migraines is incorrect. The new symptoms are not typical of migraines. Order studies to evaluate potential TIAs because she is on OCPs is incorrect. Despite her being on OCPs, the new symptoms are not typical of TIAs or strokes. Treat her for sinusitis is incorrect. Headaches from sinusitis are typically frontal, worse when leaning forward, and do not typically cause such nighttime nausea.Prescribe a strong medication for her migraines is incorrect. Treatment without further workup is not prudent, particularly since these symptoms are not typical of migraines.
CHAPTER 24: Nervous System
An 82-year-old grandmother presents to the Emergency Department in the care of her extended family with new-onset speech impairment. According to family members, the 2 / 4
pg. 3 patient awoke with this symptom as well as difficulty in understanding questions or following commands. Her past medical history is remarkable for atrial fibrillation but no other notable conditions. On examination, her speech is verbose but poorly comprehensible and lacks meaning. She is unable to follow simple commands. Which of the following best describes her speech disorder? - Correct Answer - c. Wernicke aphasia
Rationale: The combination of both receptive and expressive aphasia is a characteristic of Wernicke aphasia, which is usually due to a lesion of the posterior superior temporal lobe. Dysphonia with expressive deficit is incorrect because it is an impairment of the voice due to dysfunction of vocal cords and related structures but does not affect the ability to understand or express oneself. Dysarthria is incorrect because it is an impairment of the voice due to dysfunction of the muscles that allow speech but does not affect the ability to understand or express oneself. Global aphasia is incorrect because it is a condition in which all communicative capacity is impaired, resulting in a complete inability to communicate with others. Broca aphasia (usually due to a lesion in the posterior inferior frontal lobe) is incorrect because it results in verbose, meaningless verbal expression but with sparing of language interpretation.
CHAPTER 24: Nervous System
A 74-year-old bus driver is delivered to the hospital via emergency transport after an astute passenger noted that the patient exhibited drooping facial features and slurred speech. The patient was diagnosed rapidly with ischemic (nonhemorrhagic) stroke, and urgent intervention lead to a near complete recovery from his symptoms. The astute passenger was thanked and congratulated for recognizing the signs of acute stroke; this individual credited this recognition to a public safety awareness campaign that outlined the critical public health need to recognize strokes early. Which of the following statements is true for risks and rapid recognition of suspected strokes? - Correct Answer - b. Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke.
Rationale: Hypertension is the leading risk factor for both ischemic and hemorrhagic stroke. Although many risk factors for stroke have been recognized, hypertension remains the greatest risk after smoking, high cholesterol, diabetes, elevated weight, and low exercise levels. Atrial fibrillation is not a risk factor for ischemic stroke in individuals age ≥75 years is incorrect because atrial fibrillation that is not recognized or not treated with anticoagulation confers a significant risk of stroke. Obesity with normal glucose tolerance is not a risk factor for stroke is incorrect because obesity doubles the risk of 3 / 4
pg. 4 stroke even without associated glucose intolerance. TIAs that resolve within in 1 hour confer a 5% risk of death from stroke within the next 12 months is incorrect because TIAs are a significant predictor for risk of stroke, with 1-year mortality of ~12% associated with them, regardless of the time it takes a TIA to resolve. Due to increasing public awareness, the median time for arrival to care for suspected stroke is <3 hours is incorrect because, unfortunately, most patients present after the third hour of symptoms with a median time for arrival of 3-6 hours. This is often outside of the window for intervention with thrombolytic therapy.
CHAPTER 24: Nervous System
A 70-year-old male presents to the Emergency Department accompanied by his wife, who is concerned that he has experienced a stroke. She states that he awoke with drooping of the right side of his mouth. He has a history of hypertension and diet- controlled diabetes, but no history of prior transient ischemic attacks (TIAs), strokes, or neurologic deficits. Physical examination reveals a well-nourished, right-handed male, who has an obvious flattening of the right nasolabial fold at rest. He is unable to close his right eye, wrinkle his forehead, or raise his eyebrows. The remainder of the neurologic examination is symmetric with intact strength and normal deep tendon reflexes. Based on this history and physical examination, which of the following statements is true? - Correct Answer - d. The patient most likely has an isolated peripheral lower motor neuron (LMN) lesion involving cranial nerve (CN) VII, the facial nerve.
Rationale: This patient most likely has an isolated peripheral LMN lesion involving CNVII, the facial nerve. Facial paralysis is a concerning finding in any patient, and it is critical to make the clinical distinction between Bell palsy (a facial nerve weakness due to primarily benign causes) and central lesions of the contralateral motor cortex (such as stroke or tumor). A peripheral (or LMN) lesion involves the entire affected side, whereas a central (UMN) lesion spares the upper face and selectively paralyzes the lower face. The patient most likely has a central UMN lesion involving CN VII (the facial nerve); the patient most likely has a central process of unclear location; an acute ischemic event must be ruled out with an emergent CT scan; and the patient most likely has had an embolic affecting a UMN are incorrect. All of these answers include a UMN lesion, while this patient has examination findings consistent with an LMN lesion. The patient most likely has an isolated peripheral LMN lesion involving CN V, the trigeminal nerve is incorrect because this nerve supplies sensory (not motor) innervation to the face, although it does innervate muscles of mastication.
- / 4