Adult-Gerontology CNS Test Clinical Assessment & Diagnosis 1 — Questions and Answers
Question 1: The Montreal Cognitive Assessment (MoCA) is preferred over the MMSE for detecting mild cognitive impairment because:
- It takes longer and is more detailed
- It has greater sensitivity for MCI due to inclusion of executive function, visuospatial, and memory domains (Correct answer)
- It requires less training to administer correctly
- It is validated only for hospitalized patients
Correct answer: It has greater sensitivity for MCI due to inclusion of executive function, visuospatial, and memory domains
The MoCA detects subtle cognitive changes in MCI by assessing executive function, attention, and memory with greater sensitivity than the MMSE, which is more sensitive for moderate-severe dementia.
Question 2: In assessing a patient with dyspnea, the finding of orthopnea (2-pillow preference) most suggests:
- COPD exacerbation
- Heart failure with increased pulmonary venous congestion in the supine position (Correct answer)
- Pulmonary embolism
- Pleural effusion from malignancy
Correct answer: Heart failure with increased pulmonary venous congestion in the supine position
Orthopnea occurs in heart failure because lying flat redistributes fluid from dependent areas to the lungs, worsening dyspnea, which is relieved by elevating the head.
Question 3: A positive Romberg test indicates impairment of:
- Cerebellar coordination and motor function
- Proprioception and posterior column sensory function (Correct answer)
- Vestibular end-organ alone
- Corticospinal tract integrity
Correct answer: Proprioception and posterior column sensory function
Romberg test isolates proprioceptive input; if a patient sways with eyes closed but not open, it indicates posterior column (proprioceptive) dysfunction rather than cerebellar ataxia.
Question 4: The "Get Up and Go" test primarily assesses:
- Cognitive function and memory recall
- Mobility, balance, and fall risk in older adults (Correct answer)
- Pulmonary function and exercise tolerance
- Peripheral vascular adequacy
Correct answer: Mobility, balance, and fall risk in older adults
The Timed Up and Go (TUG) test measures the time to rise from a chair, walk 3 meters, turn, return, and sit — a practical composite measure of mobility and fall risk.
Question 5: A new S3 heart sound (ventricular gallop) in an adult most commonly indicates:
- Aortic stenosis
- Ventricular volume overload or decreased compliance as seen in heart failure (Correct answer)
- Mitral valve prolapse
- Pericarditis
Correct answer: Ventricular volume overload or decreased compliance as seen in heart failure
An S3 results from rapid ventricular filling against a stiff, dilated, or volume-overloaded ventricle and is a classic physical finding in heart failure.
Question 6: When assessing pain in a patient with moderate dementia who cannot self-report, the CNS should use:
- Assume pain-free status since verbal reports are absent
- An observational pain assessment tool such as PAINAD or ABBEY pain scale (Correct answer)
- Only the numeric rating scale with loud prompting
- Analgesics empirically without any formal assessment
Correct answer: An observational pain assessment tool such as PAINAD or ABBEY pain scale
Observational tools like PAINAD assess behavioral indicators of pain (facial expression, vocalizations, body language, consolability) in those who cannot self-report.
Adult-Gerontology CNS Test Clinical Assessment & Diagnosis 1
The Montreal Cognitive Assessment (MoCA) is preferred over the MMSE for detecting mild cognitive impairment because: