Pathophys 7: CH 44, 45, 47, 51, 52

What effect do demyelinating disorders such as multiple sclerosis have on neurotransmission? a. Slower rate of action potential conduction b. Increased rate of action potential conduction c. Faster rate of repolarization d. Facilitation of action potential initiation

a

What type of seizure usually occurs in children and is characterized by brief staring spells? a. Absence b. Idiopathic c. Partial d. Epileptic

a

The physiologic change most likely to lead to an increase in intracranial pressure is a. cerebral vasodilation. b. hypernatremia. c. respiratory hyperventilation. d. REM sleep.

a. cerebral vasodilation.

A risk factor for osteoporosis is a. late menopause. b. endometriosis. c. early menopause. d. ovarian cysts.

c

Before making a diagnosis of Alzheimer disease a. increased protein is found in a lumbar puncture. b. a brain biopsy demonstrating organic changes is necessary. c. other potential causes of dementia must be ruled out. d. biochemical tests for aluminum toxicity must be positive.

c

It is true that epidural bleeding is a. located between the arachnoid and the dura mater. b. usually because of venous leakage. c. characterized by a lucid interval immediately after injury. d. associated with widespread vascular disruption.

c

Orthostatic hypotension may be a manifestation of a. multiple sclerosis. b. Alzheimer disease. c. Parkinson disease. d. amyotrophic lateral sclerosis.

c

Prosthetic joint infection is most often because of a. injury to the joint. b. arthritis. c. hematogenous transfer. d. defective replacement material.

c

Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to a. unknown etiologic factors. b. septic joint inflammation and necrosis. c. autoimmune mechanisms. d. wear and tear on weight-bearing joints.

c

Tophi are a. painful edematous joints. b. spots that coalesce in a malar rash. c. deposits of urate crystals in tissues. d. renal calculi composed of uric acid.

c

What type of fracture generally occurs in children? a. Stress b. Nightstick c. Greenstick d. Colles

c

_________ is a form of spina bifida in which a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. a. Spina bifida occulta b. Meningomyelocele c. Meningocele d. Myelomeningocele

c

Which treatment is helpful in neuropathic pain but not used for acute pain? a. Narcotic analgesics b. Nonsteroidal anti-inflammatory drugs and aspirin c. Anticonvulsants d. Nonnarcotic analgesics

c. Anticonvulsants

It is true that epidural bleeding is a. associated with widespread vascular disruption. b. located between the arachnoid and the dura mater. c. usually because of venous leakage. d. characterized by a lucid interval immediately after injury.

d. characterized by a lucid interval immediately after injury.

Clinical manifestations of a stroke within the right cerebral hemisphere include a. cortical blindness. b. right visual field blindness. c. expressive and receptive aphasia. d. left-sided muscle weakness and neglect.

d. left-sided muscle weakness and neglect.

Systemic disorders include a. adhesive capsulitis. b. verrucae. c. osteoarthritis. d. rheumatoid arthritis.

d. rheumatoid arthritis.

The ________ is the level of painful stimulation required to be perceived. a. perception b. tolerance c. expression d. threshold

d. threshold

A level of ____ on the Glasgow Coma Scale indicates likely fatal damage. A. 3 B. 8 C. 12 D. 15

A. 3

The most common source of osteomyelitis is A. an infection that migrates via the bloodstream. B. direct invasion from a fracture. C. surgical contamination. D. A joint prosthesis

A. An injection that migrates via the blood stream

A fracture in which bone breaks into two or more fragments is referred to as A. comminuted. B. open. C. greenstick. D. stress.

A. Comminuted

The dementia of Alzheimer disease is associated with structural changes in the brain, including A. deposition of amyloid plaques in the brain. B. degeneration of basal ganglia. C. hypertrophy of frontal lobe neurons. D. significant aluminum deposits in the brain.

A. Deposition of amyloid plaques in the brain

________ occurs when a brainstem impaired patient exhibits a persistent rhythmic or jerky movement in one or both eyes. A. Nystagmus B. Dysconjugate movement C. Ocular palsy D. Doll's eye

A. Nystagmus

Which disorder usually causes skeletal pain and involves significant bone demineralization from vitamin D deficiency? A.Osteomalacia B. Osteopenia C. Osteomyelitis D. Osteoporosis

A. Osteomalacia

Subarachnoid hemorrhage is usually managed with volume expansion and blood pressure support to enhance cerebral perfusion. This is necessary because subarachnoid hemorrhage predisposes to A. cerebral vasospasm. B. hypotension. C. excessive volume loss. D. increased intracranial pressure.

A. cerebral vasospasm.

Autonomic dysreflexia is characterized by A. hypertension and bradycardia. B. hypotension and shock. C. pallor and vasoconstriction above the level of injury. D. extreme pain below the level of injury.

A. hypertension and bradycardia.

It is true that scleroderma involves A. inflammation and fibrosis of connective tissue. B. autoantibodies against acetylcholine receptors. C. infection by beta-hemolytic streptococcus. D. inflammation caused by antigenic fragments of dead organisms.

A. inflammation and fibrosis of connective tissue.

The stroke etiology with the highest morbidity and mortality is A. intracranial hemorrhage. B. intracranial thrombosis. C. intracranial embolization. D. cardiac arrest.

A. intracranial hemorrhage.

The most common site affected in Paget's disease is the A. lower spine. B. skull. C. pelvis. D. joints.

A. lower spine.

A clinical finding consistent with a diagnosis of rheumatoid arthritis would be A. systemic manifestations of inflammation. B. localized pain in weight-bearing joints. C. reduced excretion of uric acid by the kidney. D. firm, crystallized nodules or "tophi" at the affected joints.

A. systemic manifestations of inflammation.

Most muscle strains are caused by A. a tear in an adjoining tendon. B. abnormal muscle contraction. C. muscle asymmetry. D. bleeding into the muscle.

B. Abnormal muscle contraction

Ascending paralysis with no loss of sensation is characteristic of A. multiple sclerosis. B. Guillain-Barré syndrome. C. myasthenia gravis. D. amyotrophic lateral sclerosis.

B. Guillain-Barré syndrome.

The classic manifestations of Parkinson disease include A. intention tremor and akinesia. B. rest tremor and skeletal muscle rigidity. C. ataxia and intention tremor. D. skeletal muscle rigidity and intention tremor.

B. rest tremor and skeletal muscle rigidity

A patient presenting with a severe, pounding headache accompanied by nausea and photophobia is likely experiencing a ________ headache. A. tension B. migraine C. sinus D. Chronic

B. Migraine

Most sensory afferent pain fibers enter the spinal cord by way of the ________ nerve roots. A. anterior B. posterior C. C fiber D. Anterolateral

B. Posterior

Most muscle strains are caused by A. a tear in an adjoining tendon. B. abnormal muscle contraction. C. muscle asymmetry. D. bleeding into the muscle.

B. abnormal muscle contraction.

Steroids may be used in the management of acute exacerbation of symptoms in patients with multiple sclerosis, because A. viral damage can be inhibited. B. demyelination is mediated by immune mechanisms. C. steroids reverse the progression of the disease. D. steroids inhibit synaptic degradation of neurotransmitters.

B. demyelination is mediated by immune mechanisms

Paget's disease is characterized by A. overactivity of osteoblasts leading to multiple bone tumors. B. excessive bone resorption followed by excessive formation of fragile bone. C. inflammatory disorder resulting in fusion of spine joints. D. failure of resorption by osteoclasts resulting in hard bones.

B. excessive bone resorption followed by excessive formation of fragile bone.

Assessment of an extremity six hours after surgical alignment and casting demonstrates pulselessness and pallor. The priority action to take is to A. increase the administration his pain medication. B. initiate action to have the cast split or removed. C. note the increase in pain in his chart, and recheck the extremity in 30 minutes. D. elevate the extremity to relieve swelling.

B. initiate action to have the cast split or removed.

Bone healing may be impaired by A. excessive vitamin C. B. nicotine use. C. a high-protein diet. D. immobilization.

B. nicotine use.

Pain that waxes and wanes and is exacerbated by physical exertion is likely related to A. neuralgia. B. intermittent claudication. C. fibromyalgia syndrome. D. neuropathy.

C. Fibromyalgia syndrome

A malignant bone-forming tumor is referred to as a(n) A. rhabdosarcoma. B. liposarcoma. C. osteosarcoma. D.chondrosarcoma.

C. Osteosarcoma

The complication which is not likely to result from a compound, transverse fracture of the tibia and fibula is A. bone infection. B. fat emboli. C. air embolus. D. compartment syndrome.

C. air embolus.

Prosthetic joint infection is most often because of A. defective replacement material. B. injury to the joint. C. hematogenous transfer. D. arthritis.

C. hematogenous transfer.

It is useful to conceptualize pain physiology according to the four stages because each stage provides an opportunity for A. education. B. stimulation. C. intervention. D. documentation.

C. intervention.

The disorders characterized by softening and then enlargement of bones is referred to as A. osteomyelitis. B. osteoporosis. C.Paget disease. D. Rickets

C.Paget disease.

Upper extremity weakness in association with degeneration of CNS neurons is characteristic of A.multiple sclerosis. B. Guillain-Barré syndrome. C. myasthenia gravis. D. amyotrophic lateral sclerosis.

D. Amyotrophic lateral sclerosis

People who have osteoporosis are at risk for A. rhabdomyolysis. B. osteomyelitis. C. osteomalacia. D. bone fractures.

D. Bone fractures

A compound, transverse fracture is best described as a bone that is A. broken in two or more pieces. B. cracked but not completely separated. C. broken along the long axis. D. broken and protruding through the skin.

D. Broken and protruding through the skin

Although skin manifestations may occur in numerous locations, the classic presentation of systemic lupus erythematosus (SLE) includes A. lesions affecting the palms of hands and the soles of feet. B. dry, scaly patches in the antecubital area and behind the knees. C. cracked, scaly areas in the webs of fingers. D. a butterfly pattern rash on the face across the bridge of the nose.

D. a butterfly pattern rash on the face across the bridge of the nose.

Systemic lupus erythematosus (SLE) is a rheumatic disease attributed to A. wear and tear on weight-bearing joints. B. septic joint inflammation and necrosis. C. unknown etiologic factors. D. autoimmune mechanisms.

D. autoimmune mechanisms.

Pain in fibromyalgia involves A. muscle inflammation. B, autoimmune destruction of muscle tissue. C. nerve inflammation. D. changes in pain transmission in the spinal cord.

D. changes in pain transmission in the spinal cord.

Gouty arthritis is a complication of A. group A streptococcal infection. B. autoimmune destruction of joint collagen. C. excessive production of urea. D. inadequate renal excretion of uric acid.

D. inadequate renal excretion of uric acid.

In contrast to osteoarthritis, rheumatoid arthritis may be associated with A. debilitating joint pain and stiffness. B. improvement in symptoms with aspirin therapy. C. changes in activities of daily living. D. systemic aching in the musculoskeletal system.

D. systemic aching in the musculoskeletal system.

Inflammation of the sacs that overlie bony prominences is called A. epicondylitis. B. arthritis. C.tendinitis. D. Bursitis

D.Bursitis

Ankylosing spondylitis causes a. intervertebral joint fusion. b. instability of synovial joints. c. costal cartilage degeneration. d. temporomandibular joint degeneration.

a

Assessment of an extremity six hours after surgical alignment and casting demonstrates pulselessness and pallor. The priority action to take is to a. initiate action to have the cast split or removed. b. note the increase in pain in his chart, and recheck the extremity in 30 minutes. c. increase the administration his pain medication. d. elevate the extremity to relieve swelling.

a

Autonomic dysreflexia is characterized by a. hypertension and bradycardia. b. hypotension and shock. c. extreme pain below the level of injury. d. pallor and vasoconstriction above the level of injury.

a

Bone healing may be impaired by a. nicotine use. b. excessive vitamin C. c. immobilization. d. a high-protein diet.

a

It is true that Bell palsy is a a. paralysis of the muscles innervated by the facial nerve. b. painful neuropathic pain affecting the trigeminal nerve. c. herpetic outbreak in a facial dermatome. d. permanent facial paralysis after stroke.

a

Referred pain may be perceived at some distance from the area of tissue injury, but generally felt a. within the same dermatome. b. with slightly less intensity. c. within 10 to 15 cm area. d. on the same side of the body.

a

Rheumatoid arthritis is commonly associated with the presence of rheumatoid factor autoantibodies in the bloodstream. This indicates that rheumatoid arthritis is likely to be a. an autoimmune process. b. because of an enzymatic defect. c. an infective process. d. caused by bacterial infection.

a

Rickets is characterized by soft, weak bones resulting from a deficiency of a. vitamin D. b. calcium. c. estrogen. d. phosphate.

a

Systemic disorders include a. rheumatoid arthritis. b. verrucae. c. osteoarthritis. d. adhesive capsulitis.

a

The initial treatment of an individual experiencing a seizure is concentrated on a. maintaining an airway. b. documenting the seizure pattern. c. administering anticonvulsant medication. d. obtaining an EEG.

a

Acceleration-deceleration movements of the head often result in polar injuries in which a. injury is localized to the site of initial impact. b. focal injuries occur in two places at opposite poles. c. bleeding from venules fills the subdural space. d. widespread neuronal damage is incurred.

b

Compartment syndrome occurs secondary to a. muscle necrosis. b. soft-tissue damage. c. bone infarction. d. breakdown of RBCs.

b

In contrast to osteoarthritis, rheumatoid arthritis may be associated with a. debilitating joint pain and stiffness. b. systemic aching in the musculoskeletal system. c. changes in activities of daily living. d. improvement in symptoms with aspirin therapy.

b

Risk factors for hemorrhagic stroke include a. dysrhythmias. b. acute hypertension. c. atherosclerosis. d. sedentary lifestyle.

b

The disease that is similar to osteomalacia and occurs in growing children is a. osteopenia. b. rickets. c. Paget disease. d. osteosarcoma.

b

The most common site affected in Paget's disease is the a. skull. b. lower spine. c. joints. d. pelvis.

b

The primary reason that prolonged seizure activity predisposes to ischemic brain damage is that a. cardiovascular regulation is impaired. b. the lack of airway maintenance can lead to hypoxia. c. the brainstem is depressed. d. neurons are unable to transport glucose.

b

Which group of clinical findings indicates the poorest neurologic functioning? a. Eyes open to light touch on shoulder, pupils briskly reactive to light bilaterally b. Assumes decorticate posture with light touch, no verbal response c. No eye opening, responds to painful stimulus by withdrawing d. Spontaneous eye opening, movement to command, oriented to self only

b

In older women, osteoporosis is thought to be primarily because of a. dietary inadequacies. b. estrogen deficiency. c. malabsorption syndrome. d. inactivity.

b. estrogen deficiency.

A college student living in a dormitory reports a stiff neck and headache and is found to have a fever of 102°F. This information is most consistent with a. encephalitis. b. meningitis. c. skull fracture. d. cerebral ischemia.

b. meningitis.

Anticholinesterase inhibitors may be used to manage a. muscular dystrophy. b. myasthenia gravis. c. fibromyalgia. d. rheumatoid arthritis.

b. myasthenia gravis.

The most common presenting sign/symptom with rheumatic fever is a. cardiac murmur. b. polyarthritis. c. rash. d, painless nodules.

b. polyarthritis.

Complete healing of a bone fracture occurs when a. no movement of the break is detectable. b. the callus has been completely replaced with mature bone. c. the fracture site and surrounding soft tissue are pain free. d. a cast is no longer required to stabilize the break.

b. the callus has been completely replaced with mature bone.

Which group of clinical findings indicates the poorest neurologic functioning? a. Spontaneous eye opening, movement to command, oriented to self only b. Eyes open to light touch on shoulder, pupils briskly reactive to light bilaterally c. Assumes decorticate posture with light touch, no verbal response d. No eye opening, responds to painful stimulus by withdrawing

c. Assumes decorticate posture with light touch, no verbal response

Risk factors for hemorrhagic stroke include a, atherosclerosis. b. dysrhythmias. c. acute hypertension. d. sedentary lifestyle.

c. acute hypertension.

Rheumatoid arthritis involves joint inflammation caused by a. bacterial infection. b. trauma. c. autoimmune injury. d. congenital hypermobility.

c. autoimmune injury.

The most common symptom of multiple myeloma is a. pathologic fracture. b. fever. c. bone pain. d. osteomyelitis.

c. bone pain.

Individuals diagnosed with systemic lupus erythematosus (SLE) are at risk for developing numerous complications of various organs because of a. excessive production of connective tissue. b. formation of osteophytes in tissues. c. immune injury to basement membranes. d. impaired tissue oxygen transport.

c. immune injury to basement membranes.

Before making a diagnosis of Alzheimer disease a. a brain biopsy demonstrating organic changes is necessary. b. biochemical tests for aluminum toxicity must be positive. c. other potential causes of dementia must be ruled out. d. increased protein is found in a lumbar puncture.

c. other potential causes of dementia must be ruled out.

It is true that Bell palsy is a a. permanent facial paralysis after stroke. b. painful neuropathic pain affecting the trigeminal nerve. c. paralysis of the muscles innervated by the facial nerve. d. herpetic outbreak in a facial dermatome.

c. paralysis of the muscles innervated by the facial nerve.

Slow pain sensation is transmitted primarily by a. group Ia afferents. b. α motor neurons. c. unmyelinated C fibers. d. Aδ fibers.

c. unmyelinated C fibers.

Parkinson disease is associated with a. demyelination of CNS neurons. b. pyramidal nerve tract lesion. c. insufficient production of acetylcholine in the basal ganglia. d. a deficiency of dopamine in the substantia nigra.

d. a deficiency of dopamine in the substantia nigra.

"Please explain the pathophysiology of osteoarthritis to me," says another nurse. "Is it just wear and tear so that the cartilage wears out?" Your best response is a. "Yes; with increasing age, the inflammation from repeated joint use accumulates and causes the cartilage to get thin and ragged until it disappears." b. "Yes; repeated use just wears out the cartilage, until it becomes thin and denuded. That causes pain and will eventually cause joint inflammation." c. "No; autoimmune cells infiltrate the joint and collect on the cartilage in a mass called 'pannus' that eventually thins and destroys the cartilage." d. "No; cells in bone, cartilage, and the synovial membrane all get activated and secrete inflammatory mediators that destroy cartilage and damage bone."

d

A patient diagnosed with diabetes, smokes a pack of cigarettes daily and eats very few green leafy vegetables. After experiencing a fractured toe, this patient is at risk for a. malunion. b. nonunion. c. dysunion. d. delayed healing.

d

A unique characteristic feature of fibromyalgia is the presence of a. muscle atrophy. b. contractures. c. head pain. d. tender point pain.

d

Ankylosing spondylitis is characterized by a. immune mechanisms leading to widespread joint inflammation. b. loss of articular cartilage in weight-bearing joints. c. excessive bone remodeling leading to soft bone. d. inflammation, stiffness, and fusion of spinal joints.

d

Enteropathic arthritis is associated with a. chronic diarrhea. b. irritable bowel syndrome. c. chronic constipation. d. inflammatory bowel disease.

d

In the acute phase of stroke, treatment is focused on a. risk factor modification. b. neurologic rehabilitation. c. prevention of bedsores and contractures. d. stabilization of respiratory and cardiovascular function.

d

It is true that encephalitis is usually a. because of a bacterial infection in the CNS. b. fatal. c. asymptomatic. d. because of a viral infection in brain cells.

d

It is true that scleroderma involves a. autoantibodies against acetylcholine receptors. b. inflammation caused by antigenic fragments of dead organisms. c. infection by beta-hemolytic streptococcus. d. inflammation and fibrosis of connective tissue.

d

Pain in fibromyalgia involves a. autoimmune destruction of muscle tissue. b. muscle inflammation. c. nerve inflammation. d. changes in pain transmission in the spinal cord.

d

The stage of spinal shock that follows spinal cord injury is characterized by a. motor spasticity and hyperreflexia below the level of injury. b. reflex urination and defecation. c. autonomic dysreflexia. d. absent spinal reflexes below the level of injury.

d

To avoid the progression of cutaneous lesions, a patient diagnosed with systemic lupus erythematosus (SLE) should a. refrain from washing the affected areas. b. avoid excessive use of moisturizers. c. apply warm, wet compresses daily. d. avoid sun exposure.

d

Which neurologic disorder is commonly referred to as Lou Gehrig disease? a. Multiple sclerosis b. Parkinson disease c. Alzheimer disease d. Amyotrophic lateral sclerosis

d. Amyotrophic lateral sclerosis

________ edema occurs when ischemic tissue swells because of cellular energy failure. a. Interstitial b. Osmotic c. Vasogenic d. Cytotoxic

d. Cytotoxic

The earliest manifestation of scleroderma is a. thick, tight, shiny skin. b. skin hyper/hypopigmentation. c. renal impairment. d. Raynaud phenomenon.

d. Raynaud phenomenon.