Pathophysiology Week 8 Objectives: Check Your Understanding: CH. 44, 45, 47, 51

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

absent spinal reflexes below the level of injury

A tool used to assess levels of consciousness is a. magnetic resonance imaging (MRI). b. Glasgow Coma Scale (GCS). c. central perfusion pressure (CPP). d. intracranial pressure (ICP) monitoring.

Glasgow Coma Scale (GCS)

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

Greenstick

Ascending paralysis with no loss of sensation is characteristic of a. Guillain-Barré syndrome. b. myasthenia gravis. c. amyotrophic lateral sclerosis. d. multiple sclerosis.

Guillain-Barré syndrome

_________ 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. Myelomeningocele d. Meningocele

Meningocele

________ occurs when a brainstem impaired patient exhibits a persistent rhythmic or jerky movement in one or both eyes a. Doll's eye b. Ocular palsy c. Dysconjugate movement d. Nystagmus

Nystagmus

________ occurs when a brainstem impaired patient exhibits a persistent rhythmic or jerky movement in one or both eyes.

Nystagmus

Which disorder usually causes skeletal pain and involves significant bone demineralization from vitamin D deficiency? a. Osteoporosis b. Osteopenia c. Osteomalacia d. Osteomyelitis

Osteomalacia

The disorders characterized by softening and then enlargement of bones is referred to as a. osteomyelitis. b. Paget disease. c. osteoporosis. d. rickets.

Paget disease

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

Parkinson disease

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

Slower rate of action potential conduction

Which statement is true about the incidence of multiple sclerosis? a. The age of onset ranges from 20 to 50 years. b. There is a higher incidence of MS in military veterans. c. MS is more common in men than women. d. There is a higher rate of MS in African-Americans.

The age of onset ranges from 20 to 50 years

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

a deficiency of dopamine in the substantia nigra

Pain is thought of as a. associated with changes in vital signs reflecting its intensity. b. experienced in the same way by all individuals. c. a subjective experience that is difficult to measure objectively. d. always the result of tissue damage that activates nociceptors.

a subjective experience that is difficult to measure objectively

Most muscle strains are caused by a. a tear in an adjoining tendon. b. muscle asymmetry. c. abnormal muscle contraction. d. bleeding into the muscle.

abnormal muscle contraction

Leakage of CSF from the nose or ears is commonly associated with a. temporal skull fracture. b. cerebral aneurysm. c. epidural hematoma. d. basilar skull fracture.

basilar skull fracture

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

because of a viral infection in brain cells

The most important preventive measure for hemorrhagic stroke is a. management of dysrhythmias. b. blood pressure control. c. anticoagulation. d. thrombolytics.

blood pressure control

People who have osteoporosis are at risk for a. rhabdomyolysis. b. osteomyelitis. c. osteomalacia. d. bone fractures.

bone fractures

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

bone pain

A severe complication of elevated intracranial pressure is a. hydrocephalus. b. brain herniation. c. burr hole. d. Cushing reflex.

brain herniation

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

broken and protruding through the skin

Inflammation of the sacs that overlie bony prominences is called a. epicondylitis. b. tendinitis. c. arthritis. d. bursitis.

bursitis

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

cerebral vasodilation

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. increased intracranial pressure. b. cerebral vasospasm. c. excessive volume loss. d. hypotension.

cerebral vasospasm

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

changes in pain transmission in the spinal cord

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

characterized by a lucid interval immediately after injury

A fracture in which bone breaks into two or more fragments is referred to as a. stress. b. greenstick. c. open. d. comminuted.

comminuted

Following a bone fracture, the most likely event to occur is a. development of a blood clot beneath the periosteum. b. blood vessel growth at the fracture site. c. leukocyte infiltration into bone tissue. d. migration of osteoblasts to the fracture site.

development of a blood clot beneath the periosteum

The pain of nonarticular rheumatism ("growing pain") is worse a. during the night. b. upon awakening. c. following strenuous exercise. d. during activity.

during the night

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

deposits of urate crystals in tissues

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

early menopause

Modulation of pain signals is thought to be mediated by the release of a. glutamine. b. histamine. c. endorphins. d. cholecystokinin.

endorphins

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

estrogen deficiency

Most sensory afferent pain fibers enter the spinal cord by way of the ________ nerve roots. a. anterior b. posterior c. C fiber d. anterolateral

posterior

The classic manifestations of Parkinson disease include a. rest tremor and skeletal muscle rigidity. b. intention tremor and akinesia. c. skeletal muscle rigidity and intention tremor. d. ataxia and intention tremor.

rest tremor and skeletal muscle rigidity

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

rickets

The first indication of brain compression from increasing intracranial pressure (ICP) may be a. absence of verbalization. b. Glasgow Coma Scale score of 13. c. decorticate posturing. d. sluggish pupil response to light.

sluggish pupil response to light

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

soft-tissue damage

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

stabilization of respiratory and cardiovascular function

Cerebral aneurysm is most frequently the result of a. embolic stroke. b. subarachnoid hemorrhage. c. subdural hemorrhage. d. meningitis.

subarachnoid hemorrhage

The displacement of two bones in which the articular surfaces partially lose contact with each other is called a. sublimation. b. subjugation c. dislocation. d. subluxation.

subluxation

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

unmyelinated C fibers

Rickets is characterized by soft, weak bones resulting from a deficiency of

vitamin D

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

within the same dermatome

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

myasthenia gravis

Healing of a fractured bone with a poor alignment is called a. nonunion. b. disunion. c. delayed union. d. malunion.

malunion

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. skull fracture. b. cerebral ischemia. c. meningitis. d. encephalitis.

meningitis

A patient presenting with a severe, pounding headache accompanied by nausea and photophobia is likely experiencing a ________ headache a. tension b. chronic c. migraine d. sinus

migraine

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

Anticonvulsants

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

Assumes decorticate posture with light touch, no verbal response

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

Cytotoxic

Intracranial pressure normally ranges from ______ mm Hg. a. 15 to 25 b. 10 to 20 c. 20 to 30 d. 0 to 15

0 to 15

A level of ____ on the Glasgow Coma Scale indicates likely fatal damage a. 3 b. 12 c. 8 d. 15

3

A level of ____ on the Glasgow Coma Scale indicates likely fatal damage. a. 3 b. 15 c. 12 d. 8

3

The person at highest risk of a greenstick fracture from falling off a tall ladder is age a. 23. b. 44. c. 8. d. 68.

8

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

Absence

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

Amyotrophic lateral sclerosis

Myasthenia gravis is an autoimmune disease in which a. neuronal demyelination disrupts nerve transmission. b. muscles become increasingly bulky but weakened. c. acetylcholine receptors are destroyed or dysfunctional. d. acetylcholine release from motor neurons is disrupted.

acetylcholine receptors are destroyed or dysfunctional

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

acute hypertension

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

air embolus

A patient who experiences early symptoms of muscle twitching, cramping, and stiffness of the hands may be demonstrating signs of a. hydrocephalus. b. amyotrophic lateral sclerosis. c. Parkinson disease. d. Guillain-Barré syndrome.

amyotrophic lateral sclerosis

Upper extremity weakness in association with degeneration of CNS neurons is characteristic of a. Guillain-Barré syndrome. b. amyotrophic lateral sclerosis. c. myasthenia gravis. d. multiple sclerosis.

amyotrophic lateral sclerosis

The most common source of osteomyelitis is a. surgical contamination. b. a joint prosthesis. c. direct invasion from a fracture. d. an infection that migrates via the bloodstream.

an infection that migrates via the bloodstream

The gate control theory of pain transmission predicts that activity in touch receptors will a. enhance perception of pain. b. activate opioid receptors in the CNS. c. decrease pain signal transmission in the spinal cord. d. increase secretion of substance P in the spinal cord.

decrease pain signal transmission in the spinal cord

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. delayed healing. c. dysunion. d. nonunion.

delayed healing

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

demyelination is mediated by immune mechanisms

The dementia of Alzheimer disease is associated with structural changes in the brain, including a. significant aluminum deposits in the brain. b. deposition of amyloid plaques in the brain. c. degeneration of basal ganglia. d. hypertrophy of frontal lobe neurons.

deposition of amyloid plaques in the brain

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

excessive bone resorption followed by excessive formation of fragile bone

Pain that waxes and wanes and is exacerbated by physical exertion is likely related to a. fibromyalgia syndrome. b. neuralgia. c. intermittent claudication. d. neuropathy.

fibromyalgia syndrome.

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

focal injuries occur in two places at opposite poles

Seizures that involve both hemispheres at the outset are termed a. complex. b. partial. c. generalized d. focal.

generalized

Muscular dystrophy includes a number of muscle disorders that are a. easily prevented and managed. b. autoimmune in nature. c. demyelinating focused. d. genetically transmitted.

genetically transmitted

One of the most common causes of acute pain is

headache

The most common type of osteomyelitis is a. hematogenous. b. direct invasion. c. contiguous focus. d. Brodie abscess.

hematogenous

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

hypertension and bradycardia

An example of inappropriate treatment for head trauma would be a. hypoventilation. b. bed rest. c. free water restriction. d. head elevation.

hypoventilation

The pathophysiology of osteomalacia involves a. crowding of cells in the osteoid. b. collagen breakdown in the bone matrix. c. inadequate mineralization in the osteoid. d. increased osteoclast activity.

inadequate mineralization in the osteoid

Dopamine precursors and anticholinergics are all used in the management of Parkinson disease, because they a. prevent progression of the disease. b. produce excitation of basal ganglia structures. c. induce regeneration of neurons in the basal ganglia. d. increase dopamine activity in the basal ganglia.

increase dopamine activity in the basal ganglia

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

initiate action to have the cast split or removed

It is useful to conceptualize pain physiology according to the four stages because each stage provides an opportunity for a. intervention. b. education. c. documentation. d. stimulation.

intervention

The stroke etiology with the highest morbidity and mortality is a. intracranial thrombosis. b. intracranial embolization. c. intracranial hemorrhage. d. cardiac arrest.

intracranial hemorrhage

The most important determinant for prescribing therapy for acute stroke is a. thrombotic versus embolic cause. b. ischemic versus hemorrhagic cause. c. location of ischemia. d. age of the patient.

ischemic versus hemorrhagic cause

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

left-sided muscle weakness and neglect

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

lower spine

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

maintaining an airway

It is recommended that women of childbearing age take folic acid daily for prevention of a. seizure disorders. b. neural tube defects resulting in spina Bifida c. cerebral palsy. d. hydrocephalus.

neural tube defects resulting in spina bifida

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

nicotine use

The physiologic mechanisms involved in the pain phenomenon are termed a. nociception. b. neurotransmission. c. proprioception. d. sensitization.

nociception

Pain with passive stretching of a muscle is indicative of a. skeletal muscle damage. b. noncontractile tissue injury. c. vascular insufficiency. d. contractile tissue injury.

noncontractile tissue injury

A bone disorder that results from insufficient vitamin D is referred to as a. osteomalacia. b. rickets. c. subluxation. d. osteoporosis.

osteomalacia

A malignant bone-forming tumor is referred to as a(n) a. rhabdosarcoma. b. liposarcoma. c. osteosarcoma. d. chondrosarcoma.

osteosarcoma

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

other potential causes of dementia must be ruled out

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

paralysis of the muscles innervated by the facial nerve

Rupture of a cerebral aneurysm should be suspected if the patient reports a. sudden, severe headache. b. transient episodes of numbness. c. transient episodes of vertigo. d. ringing in the ears.

sudden, severe headache

Manifestations of acute brain ischemia (Cushing reflex) are due primarily to a. loss of brainstem reflexes. b. autoregulation of body systems. c. sympathetic nervous system activation. d. parasympathetic nervous system activation.

sympathetic nervous system activation

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

tender point pain

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

the callus has been completely replaced with mature bone

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

the lack of airway maintenance can lead to hypoxia

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

threshold