Neurology Multiple choice questions

Abnormal findings in which would indicate possible neurological dysfunction?

(1) level of consciousness (LOC), (2) pattern of breathing, (3) size and reactivity of pupils, (4) eye position and reflexive response, and (5) skeletal muscle motor responses. Although heart rate is a vital sign, it is not always indicative of neurologic status.

Criteria for determining brain death include:

1. Completion of all appropriate therapeutic procedures. 2. Unresponsive coma. 3. No spontaneous respiration (apnea). 4. Absent cephalic reflexes. 5. Isoelectric EEG. 6. Persistence of these signs for 30 minutes to 1 hour and for 6 hours after onset of coma and apnea.

Which type of hearing loss is a result of foreign body obstruction of the inner ear?

Conductive. Conductive hearing loss occurs when a change in the outer or middle ear, such as a foreign body lodged in the ear canal, impairs conduction of the sound from the outer to inner ear.

A young child presents with redness of the eyes. The parents indicate that this condition seems to be 'going around' the daycare. Which is the most likely diagnosis?

Conjunctivitis. Acute bacterial conjunctivitis, or pinkeye, is a highly contagious bacterial infection.

A patient who fell and hit his head 2 days ago is now restless and irritable. This scenario is characteristic of:

Delirium. Delirium is an acute state of confusion. It is abrupt in its onset. The patient may have difficulty in concentration, restlessness, irritability, tremulousness, insomnia, and poor appetite

is a more chronic problem in which there is progressive failure of many cerebral functions.

Dementia

not endogenous opioids are

Denkephalins are not endogenous opioids

is a loss of consciousness

A coma

is also called a wedge. This occurs when there is a crush type of injury and the vertebrae loses height.

A compressed fracture

is when two bones at a joint are no longer in alignment.

A dislocation

would result in pain beginning a point lower than that described.

A herniated coccyx vertebrate

is a single break usually affecting the transverse or spinous process.

A simple fracture

arises from cutaneous, deep somatic, or visceral structures and is a protective mechanism.

Acute pain

A patient who is experiencing difficulty in recognizing a pattern's form and the nature of objects is exhibiting characteristics of:

Agnosia. Agnosia is a defect of pattern recognition.

_____ _____ AND ______ _____ represents the clonic phase.

Alternating contraction and muscle relaxation // _____ _____ immediately follows the seizure. \\. The postictal phase

is a disease of dementia.

Alzheimer disease

is a type of dementia

Alzheimer disease

it is TRUE that Alzheimer disease is

Alzheimer disease is characterized with short-term memory loss, increased irritability and agitation, as well as anxiety and depression. Its onset of symptoms is gradual, and there are no remissions that allow for cognitive clarity.

is reduced vision in an eye secondary to uncorrected strabismus.

Amblyopia

is a type of occlusive stroke.

An infarct

is a complete loss of smell.

Anosmia

is complete inability to speak. .

Aphasia

is the complete absence of speech.

Aphasia

is the inability to perform purposeful or skilled motor acts in the absence of paralysis, sensory loss, abnormal posture, or tone.

Apraxia

A cause of a cerebral aneurysm includes:

Arteriosclerosis, congenital anomalies, and trauma are all considered causes of an aneurysm. Cocaine has been linked to aneurysm formation; heroin has not.

is a wide-based gait in which the person walks with small steps and decreased arm swing.

Basal ganglion gait

is inflammation of the eyelids.

Blepharitis

occurs when the upper extremities are flexed at the elbows and held close to the body while the lower extremities are externally rotated and extended

Decorticate posture

It is true that an acute cerebrovascular accident (CVA) is

CVAs are the leading cause of disability and the third leading cause of death. There are 500,000 stroke victims a year, and 5% to 14% have a second stroke within 1 year.

is usually prolonged, lasting at least 3 months.

Chronic pain

is a state of neurobehavioral unresponsiveness.

Coma

is the paralysis of both upper or both lower extremities as a result of cerebral hemisphere injuries.

Diplegia

is impairment of comprehension or production of language.

Dysphasia

A patient who is experiencing a loss of comprehension or the production of language is described as having:

Dysphasia Dysphasia is impairment in comprehension or production of language

Endogenous opioids include:

Enkephalins, endorphins, dynorphins, endomorphins. The four types of endogenous opioids include enkephalins, endorphins, dynorphins, and endomorphins.

A 23-year-old patient is hit in the temporal portion of his skull during an altercation. Although he initially loses consciousness, he soon awakens and is conversant. Three hours later he is experiencing vomiting, drowsiness, and confusion. Type of brain injury?

Epidural hematoma is a person hit in the temporal area with damage to the middle meningeal artery. The patient will lose consciousness at the time of injury, but there may be a period where consciousness is regained. The patient will then become more confused and drowsy.

is the inability to maintain sustained attention, inability to set goals and recognize when an object meets a goal, and a deficit in working memory.

Executive attention deficit

A patient is brought to the emergency room following a motor vehicle accident in which he sustained diffuse brain injury. Which of the following symptoms would be expected to accompany his injury?

Memory deficits, Swallowing disorders, Agitation, Short attention span Diffuse brain injury can produce, memory deficits, dysphagia, agitation, and short attention span. Fatigue is not part of diffuse brain injury.

is characterized primarily by deficits in expression, but comprehension may be present.

Expressive dysphasia

A trauma patient diagnosed with a brain contusion experiences changes in attention, memory, affect, and emotion. In which region of the brain is the contusion most likely located?

Frontal Contusions are most commonly found in the frontal lobes, particularly at the poles and along the inferior orbital surfaces. They result in changes in attention, memory, and executive attentional functioning.

is increased intraocular pressure.

Glaucoma

What is TRUE regarding grading of the astrocytoma?

Grades III and IV are treated with surgery Grade I is treated with surgery and then follow-up CT scans for recurrence. Grade II is treated surgically if accessible and then with radiation. Grade III is well circumscribed.

A patient who was outside on a summer day and is now experiencing increased sweating and thirst, weakness, and dizziness is exhibiting signs of:

Heat exhaustion is the result of prolonged high core temperatures. There is often dehydration, feelings of weakness, dizziness, nausea, and fainting.

The term used to describe a patient who sustains a cerebrovascular accident and is paralyzed on the left side is

Hemiplegia Hemiplegia means loss of motor function on one side of the body.

refers to loss of motor function of the lower extremities.

Paraplegia

is resistance to passive movement that is proportional to the force applied.

Paratonia

is increased muscle tone.

Hypertonia

is a decrease in taste sensation.

Hypogeusia

is an impaired sense of smell.

Hyposmia

The appropriate definition of perceptual dominance is:

Perceptual dominance is pain at one location that may cause an increase in threshold at another location. For example, when a patient has severe pain in his leg, he may not feel neck pain.

is an infection of the cornea.

Keratitis

Which pair of structures regulates the complex emotional responses to pain?

Limbic and reticular system. The reticular and limbic systems regulate what we feel about pain.

describes an individual who has both the content of thought and the level of arousal intact. The efferent pathways are disrupted, which means the individual cannot communicate through speech or body movement.

Locked-in syndrome

A patient has sustained a traumatic brain injury but is able to follow simple commands and can manipulate objects. The term used to describe this state is:

minimally conscious which refers to severely altered consciousness in which the person demonstrates minimal but defined behavioral evidence of self or environmental awareness.

A 55-year-old obese male presents to a sleep clinic complaining of difficulty sleeping. He reports that he wakes gasping for air and his wife is ready to divorce him because his snoring keeps her up at night. Which is the most likely diagnosis for this patient?

Obstructive sleep apnea. Obstructive sleep apnea is due to upper airway obstruction and is accompanied by excessive snoring and episodic apnea.

_____ ______ is described in terms of pulmonary function, not in general classification of pain

Pleuritic pain

is a form of sensorineural hearing loss usually seen in elderly people.

Presbycusis

refers to paralysis of all four extremities.

Quadriplegia

is the ability to select specific information to be processed from environmental and internal stimuli.

Selective attention deficit

is caused by impairment of the organ of Corti or its central connections.

Sensorineural hearing loss

arises from connective tissue, muscle, bone, and skin. It is may be sharp and well organized or dull, aching, and poorly localized.

Somatic pain

results from hyperexcitability of the stretch reflexes.

Spasticity

is when one eye deviates from the other when a person is looking at an object.

Strabismus

Which activity has been documented to increase the levels of circulating endogenous endorphins?

Stress. Stress, sexual intercourse, acupuncture, and excessive physical exertion have all been linked to increased levels of circulating endorphins. Drinking behavior and cough are actually moderated by endorphins. Sleep and pain are not linked with excessive amounts of endorphins.

The most common cause of TBI is:

motor vehicle accidents Motor vehicle accidents account for 50%. Falls account for 21%. Sports-related events and violence account for 10% and 12%, respectively.

A patient experiencing the tonic phase of a seizure exhibits:

muscle contraction with increased muscle tone. The phase of muscle contraction with increased muscle tone is the tonic phase.

Involuntary unilateral or bilateral rhythmic movement of the eyes is referred to as:

nystagmus. Nystagmus may be present when at rest or when the eyes move.

Risk factors for a CVA includes

The risk factors for CVAs include arterial hypertension, smoking, diabetes, insulin resistance, polycythemia, increased lipoprotein A, impaired cardiac function, hyperhomocysteinemia, and atrial fibrillation. Obesity may indirectly cause other risk factors but is not a direct risk factor for CVA.

It is correct to assume that Grade III and Grade IV astrocytomas are

They are commonly found in the frontal lobe and cerebral hemisphere and are found twice as often in men as in women. They are often large and well circumscribed with a variegated pattern. The rim is pinkish gray and solid with a soft, yellow, necrotic center. There is vascular proliferation.

involves the ability to repeat and to recite.

Transcortical dysphasia

Pinhole-sized pupils can be a result of an overdose of

opiates. Opiates = heroin and morphine cause pinhole or constricted pupils.

A patient experiences no nausea but significant vomiting with a CNS injury when the trauma

Vomiting associated with CNS injuries involves the vestibular nuclei. It can also be caused by impingement on the fourth ventricle or an increase in intracranial pressure. Vomiting with no associated nausea indicates direct involvement of the central neural mechanisms regardless of abdominal trauma.

A means of classifying a seizure includes:

The following are ways to classify seizures: (1) clinical manifestations, (2) site of origin, (3) EEG correlates, and (4) response to therapy

It is correct to assume that Cheyne-Stokes respirations (CSR)

The pathophysiology of CSR includes an increased ventilatory response to carbon dioxide stimulation. This causes hypercapnia and diminished ventilatory stimulus. Changes in PaCO2 produce irregular breathing, not changes in PaO2. The PaCO2 level decreases to below normal when overbreathing occurs

is a wakeful unconscious state.

Vegetative state

It is correct to assume that a subarachnoid hemorrhage is

a risk for individuals with an intracranial aneurysm. Individuals with intracranial aneurysms are at risk for subarachnoid hemorrhage. Hypertension and trauma are also risk factors. The mortality is over 50%.

Functional hearing loss is believed to be caused by

emotional or psychologic factors.

A patient diagnosed with Parkinson disease initially experiences:

fine tremors. Tremor is often the first symptom to appear. The symptoms are often unilateral and then become bilateral, progressing to affect gait and include postural instability and the inability to walk.

The classification of acute pain includes

acute visceral, referred, acute somatic, cutaneous. Acute pain arises from cutaneous, deep somatic, or visceral structures; these include acute visceral, acute somatic, and referred.

The person at highest risk for traumatic brain injury (TBI) is:

are children 0 to 4 years of age, older adolescents aged 15 to 19 years, and adults aged 65 years and older. Males have the highest incidence in every age group. TBI is highest among African Americans and in lower- and median-income families.

A basic neural system to cognitive function would include

attentional systems, memory systems, affective or emotive systems, language systems. sensory systems are NOT related to cognitive function.

A patient is diagnosed with Huntington disease. Which of the following is a TRUE statement? Huntington's disease is: A. a commonly diagnosed neurological disorder. B. a nonhereditary disease. C. also known as chorea. D. asymptomatic until the 2nd decade of life.

c. also known as chorea. Huntington disease is also called chorea. It is relatively rare and is a hereditary degenerative disorder. It most commonly affects those between the ages of 30 and 50.

t is correct to assume that a saccular aneurysm

can be due to a combination of congenital and degenerative changes. Saccular (berry) aneurysms can be due to a combination of congenital and degenerative changes. They affect approximately 2% of the general population. They grow slowly over time and are rare in childhood.

A patient presents with a wide-based gait in which the feet were turned outward. She staggers when walking and holds her pelvis stiff. These characteristics are representative of:

cerebellar gait. Cerebellar dysfunction results in a wide-based gait in which the feet are turned inward or outward.

Both a ____ and ____ injury would indicate pain that originated higher on the body.

cervical and thoracic injury

A patient experiences a vertebral fracture in which the C1 vertebra is fractured into several fragments. This type of fracture can be described as:

comminuted. A comminuted fracture is also called a burst fracture, in which the vertebral body is shattered into several fragments.

A benefit of fever to human blood includes:

decreases serum levels of iron, zinc, and copper, for bacterial replication. It switches from burning glucose to lipolysis and proteolysis, thus depriving bacteria of a food source. Increased lymphocytic transformation, increasing the immune response. Increased phagocytosis

A patient who reports that 'everything tastes unpleasant' is exhibiting symptoms of:

dysgeusia. Dysgeusia is a perversion of taste in which everything has an unpleasant flavor.

A patient who exhibits involuntary twisting movements caused by slow muscle contraction on the right side of the body is experiencing:

hemidystonia. Injury to the putamen or its outflow tracts would result in hemidystonia.

It is TRUE that spinal shock

involves all skeletal muscles. Spinal shock does involve function of skeletal muscles resulting in paralysis and flaccidity. Such an injury is characterized by a complete loss of reflex function below the level of the lesion, and impairment of control of thermal regulation is observed.

It is TRUE that a hemorrhagic stroke

is commonly caused by hypertension Chronic, untreated hypertension is generally the cause of hemorrhagic stroke. Hemorrhagic stroke is the third most common cause of CVA. It accounts for 10% to 15% of strokes in whites and 30% in blacks and Asians.

A patient is experiencing pain that courses over the buttocks and into the calf and ankle. This is suggestive of a herniated disc at which vertebral level?

lumbar A herniated disc in the lumbosacral area is associated with pain that radiates along the sciatic nerve and courses over the buttock and into the calf and ankle.

It is TRUE that an oligodendroglioma

rarely includes cysts or calcifications. They often have cysts and calcifications but are slow growing, well-differentiated tumors that comprise 2% of all brain tumors.

What is TRUE regarding metastatic tumors that are located in the brain?

rcinomas are disseminated to the brain from the circulation. Carcinomas disseminate to the brain from the circulation. Two-thirds of metastatic tumors are located within the brain, and one-third are located in the extradural spaces

the appropriate term for pain that is present in an area distant from its point of origin is:

referred pain. Referred pain is pain that is present in an area removed or distant from its point of origin

It is TRUE that the specificity theory of pain:

relates the amount of pain to the amount of soft tissue injury. The specificity theory of pain postulates that the intensity of pain is directly related to the amount of associated tissue injury. It does not take into account previous experience, emotions, or attention to pain.

A patient who reports a loss of childhood memories is describing a characteristic of:

retrograde amnesia. Retrograde amnesia is the loss of past memories, whereas anterograde amnesia is the inability to form new memories.

A patient is diagnosed with a meningioma. The most likely site of the tumor is the:

sella turcica, olfactory groove, tuberculum sellae, sphenoidal wing, cerebellopontine angle.

An elderly alcoholic man falls and experiences a hematoma that is on the top of his brain. The hematoma is most likely a:

subdural. Subdural hematomas are commonly found in the elderly and persons who abuse alcohol.

A mechanism that does not result in heat loss is

vasoconstriction. Vasoconstriction is a mechanism of heat conservation. Increased respiration, conduction, and convection are all mechanisms of heat loss.