Chapter 14: Neurological Disorders
Signs and symptoms of a stroke depend upon: a. location of obstruction, size of artery, and area affected. b. duration of the blockage, distance from the heart, and type of obstruction. c. health of the victim, area affected, and collateral circulation. d. size of the obstruction, condition of the heart, and duration of blockage.
A
The largest category of primary malignant brain tumors that arise from cells in the central nervous system (CNS) are called: a. gliomas. b. sarcomas. c. lymphomas. d. myelomas.
A
The stroke scale used to rapidly diagnose a stroke includes: a. capacity for speech, level of consciousness, motor skills, eye movements. b. motor skills, spatial awareness, time awareness, facial recognition. c. short-term memory, cognitive skills, speech, name recognition. d. hand-eye coordination, problem solving, ability to stand or walk, consciousness.
A
Vertebral fractures are classified as: a. simple, compression, wedge, dislocation. b. compound, open, closed, shattered. c. complex, torsion, open, multiple. d. pressure, complex, simple, variable.
A
What is the best definition of aphasia? a. The inability to comprehend or express language appropriately b. Difficulty swallowing c. Loss of the visual field contralateral to the area of damage d. The inability to articulate words clearly
A
Which of the following applies to Parkinson's disease? a. Usually develops in men and women over 60 years of age. b. There is no apparent genetic component. c. The majority of cases are predisposed by intake of antipsychotic medications. d. It rarely develops in women.
A
Which of the following does NOT apply to Reye's syndrome? a. There is no permanent damage in the body. b. It is precipitated by a combination of viral infection and administration of acetylsalicylic acid (ASA). c. Cerebral edema develops. d. Liver damage is common.
A
Which of the following statements is TRUE about malignant brain tumors? a. Most brain tumors arise from malignant neurons. b. Primary brain tumors rarely metastasize outside the CNS. c. The blood-brain barrier prevents secondary brain tumors. d. Brainstem tumors do not manifest signs until they are quite large.
B
What is the pathophysiological change in Parkinson's disease? a. Degeneration of motor fibers in the pyramidal tracts b. Excess secretion of stimulatory neurotransmitters in the CNS c. Degeneration of the basal nuclei with a deficit of dopamine d. Deficit of acetylcholine and degeneration of the motor cortex in the frontal lobe
C
What is the typical initial effect of a herniated intervertebral disc at the L4 to L5 level? a. Back pain and weakness at waist level b. Muscle weakness in both legs c. Lower back pain radiating down the leg d. Urinary incontinence
C
Which of the following is the most common cause of brain damage in children with cerebral palsy? a. Hyperbilirubinemia b. Hypoglycemia c. Hypoxia d. Trauma
C
Which of the following is used to confirm the diagnosis of, and classify, seizures? a. Characteristics of the aura b. Presence of precipitating factors c. Electroencephalogram d. Changes in the characteristics of cerebrospinal fluid
C
What characteristic is common to all individuals with cerebral palsy? a. Some loss of cognitive function b. One or more types of seizure c. Serious multiple communication difficulties d. Some degree of motor disability
D
What are the significant early signs of a ruptured cerebral aneurysm? a. Impaired speech and muscle weakness b. Severe headache, nuchal rigidity, and photophobia c. Abnormal sensations and tremors d. Vomiting and visual abnormalities
B
What are the signs of autonomic dysreflexia in a person with cervical spinal injury? a. Unexpected drop in blood pressure and apnea b. Sudden marked increase in blood pressure with bradycardia c. Hyperreflexia in the arms and legs d. Urinary and bowel incontinence
B
What causes a herniated intervertebral disc? a. A tear in the nucleus pulposus b. A protrusion of the nucleus pulposus through the annulus fibrosis c. Displacement of the annulus fibrosis between the laminae d. Failure of the spinous processes to restrict movement of the intervertebral disc
B
What does a vegetative state refer to? a. Depression of the reticular activating system (RAS) and inability to initiate action b. Loss of awareness and intellectual function but continued brainstem function c. Continuing intellectual function but inability to communicate or move d. Disorientation and confusion with decreased responsiveness
B
What does the term otorrhea mean? a. Bleeding from the nose. b. CSF leaking from the ear. c. Torn meninges but no skull fracture. d. Hemorrhage from the ear.
B
Which of the following are common early signs of multiple sclerosis? a. Paralysis of the lower body, impaired cognitive function b. Areas of numbness, weakness in the legs, visual problems c. Sensory deficit in the legs and trunk, memory loss, urinary incontinence d. Tremors, speech impairment, hearing loss
B
Which of the following conditions is marked by focal signs? a. Meningitis b. Brain abscess c. Encephalitis d. Intracerebral hemorrhage
B
Which of the following dietary supplements has reduced the incidence of spina bifida in recent years? a. Vitamin B6 b. Folic acid c. Vitamins A and D d. Zinc and magnesium
B
Which of the following is NOT considered to be a common contributing factor to AIDS dementia? a. Invasion of the central nervous system by HIV b. Development of arteriosclerosis c. Secondary toxoplasmosis infection d. Development of cerebral lymphoma
B
Which of the following is characteristic of generalized seizures? a. The localization of the seizure activity b. The uncontrolled discharge of neurons in both hemispheres c. Seizures that persist for several hours d. Loss of consciousness and all motor function
B
Which statement is TRUE about tetanus infection? a. It is caused by a virus. b. Infection usually develops in deep puncture wounds. c. It causes flaccid skeletal muscles, impairing mobility. d. It affects peripheral nerves initially in the legs and feet.
B
Which type of cerebrovascular accident (CVA) has the poorest prognosis? a. CVA caused by thrombus b. Hemorrhagic CVA c. Embolic CVA d. No difference among types
B
What is a major function of the limbic system? a. Overall control of fluid balance b. Required for logical thinking, reason, and decision making c. Determines emotional responses d. Responsible for artistic and musical talents
C
What is an early indicator of increased intracranial pressure? a. Papilledema b. Bilateral fixed dilated pupils c. Decreasing responsiveness d. Rapid heart rate
C
Brain injury where the brain is injured when it bounces off of the skull due to sudden acceleration or deceleration is referred to as a/an: a. linear fracture b. contusion c. basilar injury d. contrecoup injury
D
What is the usual result of damage to the right occipital lobe? a. Left eye is blind b. Loss of left visual field c. Right eye is blind d. Visual loss in the medial half of each eye
B
What would be the effect of damage to the auditory association area in the left hemisphere? a. Loss of hearing in both ears b. Inability to understand what is heard c. Loss of hearing in the left ear d. Inability to determine the source of the sound
B
Which disease is associated with excessive dopamine secretion, decreased gray matter in the temporal lobes, and abnormal hippocampal cells in the brain? a. Creutzfeldt-Jakob disease b. Schizophrenia c. Panic disorder d. Depression
B
How does a depressed skull fracture cause brain damage? a. A bone fragment penetrates and tears brain tissue. b. A section of the skull is missing, leaving the brain unprotected. c. A section of skull bone is displaced below the level of the skull, causing pressure on the brain. d. Many fracture lines are present, causing instability. e. The contrecoup injury is the cause of brain damage.
E
In the weeks following CVA, why might some neurological function return? 1. Presence of collateral circulation 2. Immediate therapy to dissolve thrombi and maintain perfusion 3. Reduced inflammation in the area 4. Development of alternative neuronal pathways a. 1 only b. 2 only c. 1, 3 d. 2, 3, 4 e. 1, 2, 3, 4
E
Which of the following is NOT a typical effect of advanced Parkinson's disease? a. Difficulty chewing and swallowing b. Urinary retention c. Loss of vision d. Orthostatic hypotension
C
. Failure of the spinous processes to fuse, but without herniation of the meninges, is called: a. spina bifida occulta. b. meningocele. c. myelomeningocele. d. encephalocele.
A
Common manifestations of rabies infection include: a. headache, foaming at the mouth, and difficulty swallowing. b. difficulty walking and coordinating movements. c. decreased sensitivity to sound and touch. d. vomiting, liver and kidney damage.
A
Expressive aphasia is most likely to result from damage to: a. the left frontal lobe. b. the left temporal lobe. c. the right motor cortex. d. Wernicke's area.
A
Following a head injury, what is the most likely cause of secondary damage to the brain? a. Hematoma or infection b. Laceration by foreign objects c. Hypoxia or acidosis d. Tearing of blood vessels as the brain rotates across the inside of the skull
A
Following an injury at L2 to L3, what would indicate recovery from spinal shock? a. Spastic paraplegia b. Urinary retention c. Labile body temperature d. Increased sensation in the legs
A
Herpes zoster can be identified by a typical: a. unilateral rash and pain along a cranial nerve or dermatome. b. weakness and muscle atrophy in the legs. c. ascending paralysis commencing in the legs. d. skeletal muscle spasms in the face and neck.
A
How does the heart rate change as intracranial pressure increases? a. Rate decreases b. Rate increases c. No change in rate d. Irregular heart rate
A
How is the presence of spina bifida diagnosed? a. Prenatally by ultrasound or detection of alpha-fetoprotein (AFP) in maternal blood or amniotic fluid b. Only after birth by direct observation of the sac c. After birth when the sac herniates as CSF builds up d. Only with a spinal X-ray
A
In a case of bacterial meningitis, where does swelling and purulent exudate form? a. In the pia mater, arachnoid, and surface of the entire brain b. In the dura mater and epidural space c. At the site of the injury or entry point of the microbes d. Primarily around the spinal cord
A
The ataxic form of cerebral palsy results from damage to the: a. cerebellum. b. motor cortex. c. basal nuclei. d. pyramidal tracts.
A
The primary reason for seizures frequently occurring with head injuries is: a. presence of blood irritates the neurons. b. otorrhea or rhinorrhea changes intracranial pressure. c. inflammatory response causes general hypoxia. d. CNS is depressed.
A
What are significant signs of acute bacterial meningitis? a. Severe headache, nuchal rigidity, and photophobia b. Fatigue and lethargy, fever, and anorexia c. Focal signs, such as progressive paralysis in a limb d. Ascending paralysis beginning in the legs
A
What are the characteristic changes in the brain of a patient with Alzheimer's disease? a. Cortical atrophy with plaques and neurofibrillary tangles, impairing conduction b. Increased acetylcholine (ACh) and decreased GABA and serotonin levels c. Obstruction of many small arteries and arterioles throughout the cerebral cortex d. Vacuoles forming in the neurons, rapidly destroying them
A
Which of the following applies to cerebral palsy? a. Nonprogressive brain damage to the fetus or neonate b. A genetic defect affecting metabolism and causing degeneration in the neurons c. A developmental error during early growth of the peripheral nervous system d. A chromosomal defect resulting in abnormalities in many body structures
A
Which of the following are common early manifestations of Parkinson's disease? a. Tremors at rest in the hands and repetitive motion of the hands b. Extreme weakness in the legs and spastic movements in the arms c. Visual deficits and speech impairment d. Loss of facial expressions and altered posture and gait
A
Which of the following are typical characteristics associated with schizophrenia? a. Disorganized thought processes, short attention span, delusions b. Lack of energy and motivation, poor concentration, insomnia c. Hyperventilation, tachycardia, intense anxiety d. Memory loss, mood swings, hostile behavior
A
Which of the following are typical early signs of Alzheimer's disease? 1. Behavioral changes 2. Reduced ability to reason and problem solve 3. Decreased verbal responses 4. Urinary incontinence a. 1, 2 b. 1, 4 c. 2, 3 d. 1, 3, 4
A
Which of the following causes papilledema? a. Increased pressure of cerebrospinal fluid (CSF) at the optic disc b. Increased intraocular pressure c. Pressure on the oculomotor nerve d. Pressure on the optic chiasm
A
Which of the following is characteristic of multiple sclerosis? a. Remissions and exacerbations b. Predictable pattern of progression in all patients c. Onset in men and women more than 60 years of age d. Full recovery of function during remissions
A
Which of the following is the usual location of language centers? a. Left hemisphere b. Right hemisphere c. Brainstem d. Hypothalamus
A
Which of the following statements applies to a lumbar puncture? a. It is usually performed at L3-L4. b. Fluid is withdrawn from the epidural space. c. It can be used to confirm any diagnosis. d. The tissue seals up immediately after puncture.
A
Which statement is TRUE about amyotrophic lateral sclerosis (ALS)? a. Cognitive function remains normal. b. ALS affects primarily young women. c. Sensory neurons are damaged initially. d. Cause of death is usually a cardiac arrhythmia.
A
Which statement is TRUE about depression? a. It is classified as a mood disorder. b. Episodes of intense fear are recurrent. c. It is marked by increased appetite and libido. d. It is not a common condition.
A
Which type of seizure commonly occurs in children? a. Absence b. Tonic-clonic c. Focal d. Complex partial
A
Why are focal or generalized seizures sometimes an early indication of a brain tumor? a. Surrounding inflammation stimulates neurons to discharge spontaneously. b. Malignant tumors cause alkalosis, exciting the CNS. c. Systemic effects of the brain tumor may cause seizures. d. Metabolic effects of cancer change blood chemistry to trigger seizures.
A
. Secondary brain tumors usually arise from: a. severe head trauma. b. metastasized breast or lung tumors. c. exposure to carcinogenic agents. d. exposure to radiation.
B
All of the following apply to CVA EXCEPT: a. the common cause is an atheroma with thrombus. b. maximum necrosis and infarction develop within several hours of onset. c. warning signs may appear with partial obstruction of the artery. d. increasing neurological deficits usually develop during the first few days.
B
All of the following are typical signs of hydrocephalus in the neonate EXCEPT: a. enlarged head with bulging fontanels. b. vomiting, headache, and paralysis. c. irritability and feeding difficulties. d. eyes turned downward with sclerae showing above the pupils.
B
All of the following may precipitate a seizure EXCEPT: a. hypoglycemia. b. hypoventilation. c. brain abscess. d. high fever in young child.
B
An epidural hematoma is located between the: a. dura mater and the arachnoid mater. b. dura mater and the skull. c. arachnoid mater and the pia mater. d. pia mater and the brain.
B
As intracranial pressure rises, the pupil of the eye, ipsilateral to the lesion, becomes dilated and unresponsive to light because of pressure on the: a. optic nerve. b. peripheral nervous system (PNS) fibers in cranial nerve III. c. sympathetic nervous system (SNS) nerve to the eye. d. occipital lobe.
B
Communicating hydrocephalus causes increased intracranial pressure because of: a. atresia at the foramen magnum. b. failure of the subarachnoid to absorb CSF. c. obstruction in the lumbar area of the spinal cord. d. scar tissue from encephalitis blocking flow of CSF.
B
How would a seizure consisting of bizarre or inappropriate activity be classified? a. Absence seizure b. Psychomotor seizure c. Focal seizure d. Jacksonian seizure
B
In many types of encephalitis, such as St. Louis encephalitis, how are the viruses transmitted? a. Carriers b. Mosquito and tick bites c. Respiratory droplet d. Septic emboli in the circulation
B
In which type of neuron is progressive degeneration occurring with amyotrophic lateral sclerosis (ALS)? a. Upper motor neurons b. Upper and lower motor neurons c. Motor and sensory neurons d. Motor, sensory, and autonomic system neurons
B
Collateral circulation is most likely to be present when a CVA results from: a. rupture of a cerebral artery. b. an embolus. c. atherosclerosis. d. vasospasm in the cerebral circulation.
C
Following a spinal injury at C5, what is the expected effect during the period of spinal shock? a. Spastic paralysis below the level of the injury b. Urinary incontinence c. Possible periods of apnea d. Normal blood pressure
C
From the following, choose the two events (in correct sequence) that immediately follow the aura during a tonic-clonic event: a. Prodromal signs, then the clonic stage b. Clonic stage, then the tonic stage c. Loss of consciousness, then the tonic stage d. Loss of consciousness and cessation of respiration
C
Huntington's disease is diagnosed by: a. urinalysis. b. motor skills tests. c. DNA analysis. d. antibody agglutination test.
C
In cases of noncommunicating hydrocephalus, why does excess cerebrospinal fluid (CSF) accumulate? a. Absorption of CSF through the arachnoid villi is impaired. b. Excessive amounts of CSF are produced in the ventricles. c. An obstruction is present in the aqueduct of Sylvius or other channel. d. Flow around the spinal cord is blocked.
C
In which disorders do biochemical abnormalities involving the neurotransmitters in the brain occur? 1. Bipolar disorder 2. Schizophrenia 3. Huntington's disease 4. AIDS dementia a. 1, 3 b. 1, 4 c. 1, 2, 3 d. 2, 3, 4
C
The best description of a myelomeningocele is: a. asymptomatic failure of the posterior spinous processes of the vertebrae to fuse. b. herniation of the meninges through a vertebral defect. c. herniation of the meninges, CSF, and spinal cord or nerves through a vertebral defect. d. herniation of brain tissue through a defect in the cranium.
C
The rabies virus is usually transmitted by: a. respiratory droplets. b. insects such as mosquitoes. c. bites from infected animals. d. the fecal-oral route.
C
Through what area does the cerebrospinal fluid circulate around the brain and spinal cord? a. Between the double layers of the dura mater b. In the subdural space c. In the subarachnoid space d. Through the arachnoid villi
C
Typical signs of a TIA include: a. rapidly increasing intracranial pressure. b. loss of consciousness. c. transient muscle weakness in a hand or leg. d. headache, photophobia, and nuchal rigidity.
C
What does the clonic stage of a seizure consist of? a. A sudden strong skeletal muscle contraction and rigidity of trunk and limbs b. A cry and contraction of abdominal and thoracic muscles c. Alternating contractions and relaxation of skeletal muscles d. Cessation of all skeletal muscle activity
C
What is the effect of an enlarging brain abscess on cardiovascular activity? a. Increased heart rate and systemic vasodilation b. Low blood pressure and irregular heart and respiratory rates c. Systemic vasoconstriction and slower heart rate d. Immediate depression of the cardiac control centers
C
What is the probable source of an embolus causing a cerebrovascular accident (CVA)? a. Right ventricle of the heart b. Femoral vein c. Common carotid artery d. Pulmonary artery
C
What is the rationale for vomiting in a patient who has increased intracranial pressure? a. Chemoreceptors responding to changes in the blood b. Pressure extending to spinal nerves c. Pressure on the emetic center in the medulla d. Stimuli to the hypothalamic center for hunger and thirst
C
Where are β1-adrenergic receptors located? a. Bronchiolar walls b. Arteriolar walls c. Cardiac muscle d. Glands of the intestinal tract
C
Which of the following classes of drugs may provide temporary improvement in cases of myasthenia gravis? a. Skeletal muscle relaxants b. Dopamine replacement drugs c. Anticholinesterase agents d. GABA replacement drugs
C
Which of the following statements about berry aneurysms in the brain is NOT true? a. They usually develop at points of bifurcation in the circle of Willis. b. They are usually asymptomatic for many years. c. CSF remains free of blood. d. Following rupture, blood appears in the subarachnoid space.
C
Which signs are indicative of post-polio syndrome? a. Progressive spastic paralysis b. Ascending flaccid paralysis c. Progressive fatigue and weakness d. Increasing numbness and paresthesias
C
Which statement applies to Huntington's disease? a. It is inherited as an autosomal recessive trait. b. It is manifested in individuals by age 20 years. c. It presents with choreiform movements in the upper body and decreased ability to concentrate. d. It causes decreased levels of all neurotransmitters in the CNS.
C
Which statement does NOT apply to status epilepticus? a. Seizures are recurrent or continuous without full recovery between episodes. b. Severe hypoxia and acidosis develop. c. Person does not lose consciousness during seizure. d. If the episode persists, there may be additional brain damage.
C
With regard to meningitis, choose the correct combination of microbe and the age group commonly affected. a. E. coli: elderly b. H. influenzae: neonate c. N. meningitides: children and youth d. S. pneumoniae: young children
C
All of the following apply to tetanus infection EXCEPT: a. it is caused by an anaerobic, spore-forming bacillus. b. the exotoxin causes strong skeletal muscle spasms. c. death usually results from respiratory failure. d. signs of fever, vomiting, stiff neck, and paralysis.
D
Creutzfeldt-Jakob disease is caused by: a. inheritance of an autosomal dominant trait. b. infection in the brain by HIV. c. an autoimmune reaction that damages nerve receptors. d. infection in the brain by a prion.
D
In cases of Guillain-Barré syndrome, what does the pathophysiology include? a. Damage and loss of function in the motor neurons of the spinal cord and medulla b. Encephalopathy, with disorientation, headache, and coma c. Infection and inflammation of the motor cortex d. Inflammation and demyelination of peripheral nerves, leading to ascending paralysis
D
What is the typical change in blood pressure in a patient who has increased intracranial pressure? a. Erratic diastolic pressure b. Decreasing systolic pressure c. Systolic and diastolic pressures decreasing proportionately d. Increasing pulse pressure
D
Which of the following applies to the corticospinal tract? a. It is an ascending tract. b. The nerve fibers conduct sensory impulses. c. It is an extrapyramidal tract. d. It is a pyramidal tract for efferent impulses.
D
Which of the following characteristics indicates that the CSF is normal? a. Cloudy and pale yellow color b. Presence of erythrocytes c. Presence of numerous leukocytes d. Clear and colorless fluid
D
Which of the following conditions is NOT part of the criteria for a declaration of "brain death"? a. No activity on EEG b. Absence of all reflexes c. No spontaneous respirations d. Presence of any head injury
D
Which of the following factors predispose(s) an individual to a CVA? 1. Hypertension 2. Smoking cigarettes 3. History of coronary artery disease 4. Diabetes mellitus a. 1, 3 b. 1, 2, 4 c. 2, 4 d. 1, 2, 3, 4
D
Which of the following impairments results from infection by the polio virus? a. Pain and paresthesia in a cranial nerve or dermatome b. Loss of motor and sensory function in the peripheral nerves c. Inflammation and increased intracranial pressure d. Loss of function of motor neurons of the spinal cord and medulla
D
Which of the following is a TRUE statement about transient ischemic attacks (TIAs)? a. They usually cause necrosis and permanent brain damage. b. They may be caused by rupture of an aneurysm or a damaged artery. c. They usually indicate systemic hypertension. d. They can warn of potential cerebrovascular accidents.
D
Which of the following is a typical early sign of amyotrophic lateral sclerosis (ALS)? a. Impaired ventilation b. Cognitive impairment c. Poor control of eye movement d. Weakness and muscle atrophy in upper limbs
D
Which of the following statements does NOT apply to myasthenia gravis? a. The cholinergic receptors at the neuromuscular junctions are damaged. b. It is an autoimmune disorder. c. Muscle weakness and fatigue occur in the face and neck. d. Dementia develops in the later stage.
D
Which statement best describes herniation resulting from increased intracranial pressure? a. Movement of brain tissue into ventricles b. Movement of brain stem upward c. Pushing of excess CSF and blood down around the spinal cord d. Displacement of brain tissue downward toward the spinal cord
D
Which statement does NOT apply to the pathophysiology of multiple sclerosis? a. Demyelination of axons b. It affects the brain, spinal cord, and cranial nerves c. It affects motor, sensory, and autonomic fibers d. Progressive random degeneration of peripheral nerves
D
Which type of fracture typically occurs at the base of the skull? a. Depressed b. Contrecoup c. Comminuted d. Basilar
D
