Pathophysiology Chapter 22

16. 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. PNS fibers in cranial nerve III c. SNS nerve to the eye d. occipital lobe

PNS fibers in cranial nerve III

30. In many types of encephalitis, such as St. Louis encephalitis, how are the viruses transmitted? a. carriers b. bites of mosquitoes and ticks c. respiratory droplet d. septic emboli in the circulation

bites of mosquitoes and ticks

6. Where are beta-1 adrenergic receptors located? a. bronchiolar walls b. arteriolar walls c. cardiac muscle d. glands of the intestinal tract

cardiac muscle

17. 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

clear and colorless fluid

22. What is the probable source of an embolus causing a CVA? a. right ventricle of the heart b. femoral vein c. common carotid artery d. pulmonary artery

common carotid artery

25. What would be the effect of infarction owing to obstruction in the right anterior cerebral artery? a. some visual loss b. sensory deficit involving the upper body c. aphasia d. contralateral weakness in the leg, impaired spatial relationships

contralateral weakness in the leg, impaired spatial relationships

20. Why are focal or generalized seizures 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.

surrounding inflammation stimulates neurons to discharge spontaneously

15. 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

systemic vasoconstriction and slower heart rate

9. 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

the inability to comprehend or express language appropriately

41. 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

the left frontal lobe

21. Which of the following is a TRUE statement about transient ischemic attacks? a. They usually cause necrosis and permanent brain damage. b. Rupture of an aneurysm or damaged artery may cause a TIA. c. They usually indicate systemic hypertension. d. They often warn of potential cerebrovascular accidents.

they often warn of potential cerebrovascular accidents

19. What would be the expected effect of a tumor developing in the inferior part of the left frontal lobe? a. numbness in the right leg b. weakness in the right side of the face c. paralysis in the left leg d. dizziness and loss of balance

weakness in the right side of the face

10. What is an early indicator of increasing intracranial pressure? a. papilledema b. bilateral fixed dilated pupils c. decreasing responsiveness d. rapid heart rate

decreasing responsiveness

5. 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

determines emotional responses

23. Collateral circulation is most likely to be present when a CVA results from: a. rupture of a cerebral artery b. an embolus c. development of an atheroma d. vasospasm in the cerebral circulation

development of an atheroma

44. 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

displacement of brain tissue downward toward the spinal cord

35. 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

dura matter and the skull

2. Which of the following is the usual location of language centers? a. left hemisphere b. right hemisphere c. brainstem d. hypothalamus

left hemisphere

7. What does a vegetative state refer to? a. depression of the 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

loss of awareness and intellectual function but continued brainstem function

42. 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

loss of left visual field

24. 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 neurologic deficits usually develop during the first few days

maximum necrosis and infarction develop within several hours of onset

48. Which term refers to a stiff hyperextended neck associated with irritation of spinal nerve roots? a. nystagmus b. ptosis c. nuchal rigidity d. spastic quadriplegia

nuchal rigidity

38. 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

possible periods of apnea

8. 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

presence of any head injury

11. What is the rationale for vomiting with 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

pressure on the emetic center in the medulla

18. 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.

primary brain tumors rarely metastasize outside the CNS

43. How does the heart rate change as intracranial pressure increases? a. rate decreases b. rate increases c. no change in rate

rate decreases

27. 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. Rupture causes signs of circulatory shock. d. Following rupture, blood appears in the subarachnoid space.

rupture causes signs of circulatory shock

29. 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

severe headache, nuchal rigidity, and photophobia

47. 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

severe headache, nuchal rigidity, and photophobia

31. 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 may result from respiratory failure d. signs of infection include fever, vomiting, stiff neck, and paralysis

signs of infection include fever, vomiting, stiff neck, and paralysis

39. 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

spastic paraplegia

13. A brain tumor causes headache because the tumor: a. causes ischemic pain in the brain b. stretches the meninges and blood vessel walls c. erodes the skull d. compresses sensory fibers in cranial nerves

stretches the meninges and blood vessel walls

40. 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

sudden marked increase in blood pressure with bradycardia

52. 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 ASA. c. Cerebral edema develops. d. Liver damage is common.

A

54. 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

57. 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

60. 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

51. 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

55. An accurate assessment of the extent of permanent spinal cord damage can usually be completed: a. immediately following admission to hospital b. approximately 48 hours after injury c. approximately 10 days to 2 weeks following injury if no complications arise d. 6-12 months later

C

56. 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

62. 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

26. In the weeks following CVA, why might some neurologic 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

1,2,3,4

46. Which of the following factors predispose(s) an individual to a cerebrovascular accident? 1. hypertension 2. hypocholesteremia 3. smoking cigarettes 4. history of coronary artery disease 5. diabetes mellitus a. 1, 3 b. 1, 2, 4 c. 2, 4, 5 d. 1, 2, 3, 5 e. 1, 3, 4, 5

1,3,4,5

58. 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

61. Which of the following conditions is marked by focal signs? a. meningitis b. brain abscess c. encephalitis d. intracerebral hemorrhage

B

36. 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`

CSF leaking from the ear

53. Which type of fracture typically occurs at the base of the skull? a. depressed b. contrecoup c. comminuted d. basilar

D

59. 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

49. With regard to meningitis, choose the correct combination of microbe and the age group commonly affected. a. E. coli: elderly b. H. influenza: neonate c. N. meningitides: children and youth d. S. pneumoniae: young children

N. meningitiedes: children and youth

33. 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.

a section of skull bone is displaced below the level of the skull, causing pressure on the brain

37. Why may secondary damage occur shortly after a spinal cord injury? a. presence of unstable fractures or dislocations of vertebrae b. catecholamine release in the area causing local vasoconstriction c. decreased or labile systemic blood pressure d. a, b e. a, b, c

a,b,c

34. 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

hematoma or infection

45. Which type of cerebrovascular accident has the poorest prognosis? a. CVA caused by thrombus b. hemorrhagic CVA c. embolic CVA d. no difference among types

hemorrhagic CVA

1. 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

in the subarachnoid space

3. 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

inability to understand what is heard

14. Which of the following causes papilledema? a. increased pressure of CSF at the optic disc b. increased intraocular pressure c. pressure on the oculomotor nerve d. pressure on the optic chiasm

increased pressure of CSF at the optic disc

12. What is the typical change in blood pressure with increased intracranial pressure? a. increasing diastolic pressure b. decreasing systolic pressure c. systolic and diastolic pressures decreasing proportionately d. increasing pulse pressure

increasing pule pressure

32. 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

inflammation and demyelination of peripheral nerves, leading to ascending paralysis

28. In a case of bacterial meningitis, where does swelling and purulent exudate form? a. involving the pia, 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

involving the pia, arachnoid, and surface of the entire brain

4. 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.

it is a pyramidal tract for efferent impulses

50. 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.

it is usually performed at L3-L4