Patho quiz 7

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

c. Anticonvulsants

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

c. Greenstick

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

c. Osteomalacia Osteomalacia is inadequate mineralization of bone tissue, most commonly caused by vitamin D deficiency, and it usually causes skeletal pain. Osteopenia, osteomyelitis, and osteoporosis are not caused by vitamin D deficiency.

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.

c. a subjective experience that is difficult to measure objectively Because pain is a subjective experience, defining and assessing it are difficult. Pain is not always associated with a change in vital signs. Pain is whatever the experiencing person says it is, and may vary according to each individual. Most pain begins in the periphery when free nerve endings called nociceptors are stimulated.

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.

c. abnormal muscle contraction Most muscle strains are caused by abnormal muscle contraction. A muscle strain can be caused by a tear in the muscle. A tendon strain can be as a result of a tear in the tendon. Muscle asymmetry is not the cause of muscle strains. Muscle strains are not caused by bleeding into the muscle.

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.

c. other potential causes of dementia must be ruled out All manageable causes for dementia or delirium should be ruled out before diagnosing Alzheimer disease. Neuroimaging may be useful in ruling out other neurologic diagnoses. A brain biopsy is not indicated. Evaluation of blood chemistry does not include the presence of aluminum. Increased protein in a lumbar puncture is not indicative of Alzheimer dementia.

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.

c. sympathetic nervous system activation An extreme increase in ICP can precipitate an intense reaction by the sympathetic nervous system as it attempts to maintain cerebral perfusion through the compressed blood vessels. This has been termed an ischemic response or Cushing reflex. Manifestations of acute brain ischemia are because of sympathetic nervous system activation. The sympathetic nervous system activates to attempt to lower the intracranial pressure accompanied by acute brain ischemia. The Cushing reflex generally is viewed as a "last-ditch" effort by the brain to reestablish cerebral perfusion but is not as a result of loss of brainstem reflexes.

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

a. 3

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

a. 3

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

a. Guillain-Barré syndrome Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis. It usually begins in the legs, spreading often to the arms and face. Symptoms of multiple sclerosis include double vision, weakness, poor coordination, and sensory deficits. Ascending paralysis is not characteristic of myasthenia gravis. Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of the hands, arms, and legs.

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.

a. The age of onset ranges from 20 to 50 years The age of onset of MS ranges from 20 to 50 years. MS is two to three times more common in women than in men. There is a higher incidence of ALS in military veterans, especially those of the Persian Gulf. MS occurs at a higher rate among individuals from Caucasian northern European descent and those who live in northern latitudes.

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

a. acute hypertension Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often longstanding hypertension. Risk factors for stroke are similar to those for other atherosclerotic vascular disease. Cardiac disease complicated by atrial fibrillation is an important risk factor for embolic stroke. Sedentary lifestyle is not a risk factor for hemorrhagic stroke.

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.

a. because of a viral infection in brain cells Encephalitis is an inflammation of the brain which is caused by a variety of agents. Viral causes account for the majority of encephalitis cases. Bacteria can be responsible for the inflammation of the brain associated with encephalitis. Death occurs in 5% to 20% of encephalitis cases. Clinical manifestations of HSV encephalitis typically evolve over several days.

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.

a. demyelination is mediated by immune mechanisms

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.

a. 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.

a. during the night

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

a. early menopause

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.

a. fibromyalgia syndrome. Patients complain of pain that waxes and wanes and that does not follow a dermatomal pattern in fibromyalgia syndrome. The pain tends to be exacerbated by physical exertion. Trigeminal neuralgia is a form of neuropathic pain that can be quite disabling for patients. It is sudden, momentary, but excruciating pains along the second and third divisions of the trigeminal nerve. In the early stages, intermittent claudication is associated with physical activity and alleviated with rest and has a cramping quality. In severe cases, ischemic neuropathy may ensue and cause a more consistent burning, shooting pain in the leg or foot. In pain related to neuropathy, patients complain of burning pain in the distal bilateral lower extremities that is frequently worse at night.

One of the most common causes of acute pain is a. headache. b. fibromyalgia. c. malignancy. d. trigeminal neuralgia.

a. headache Headache is one of the most common causes of acute pain, accounting for approximately 13 million visits each year in the Unites States to physician's offices, urgent care clinics, and emergency departments. Fibromyalgia syndrome is a chronic pain syndrome. Cancer pain is a subcategory of chronic pain, although it may be acute. Trigeminal neuralgia is a form of neuropathic pain.

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

a. hematogenous Hematogenous osteomyelitis is the most common type of osteomyelitis. Contiguous focus osteomyelitis is not the most common type. Brodie abscess is when an infection becomes enclosed by fibrotic tissue. Osteomyelitis may be caused by a direct invasion of organisms into the bone, but this is not the most common cause.

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

a. hypoventilation Hyperventilation, not hypoventilation, is indicated in the management of an acute elevation of intracranial pressure. Elevating the head is aimed at maintaining intracranial pressure and cerebral blood flow. Normal intravascular volume is indicated in the management of intracranial pressure. Bed rest would be indicated for the head trauma patient.

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.

a. intervention It is clinically useful to conceptualize pain physiology according to these four processes, because each stage provides an opportunity for intervention in the pain experience. It is more useful to provide intervention for the patient experiencing pain. Stimulation may actually increase the pain level for the patient. Documentation of findings is appropriate, but taking measures to reduce or stop the pain is more advantageous.

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

a. nicotine use

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

a. nociception

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

a. osteomalacia Osteomalacia is caused by vitamin D deficiency in adults. Rickets is caused by vitamin D deficiency in children. Osteoporosis is related to decreased estrogen. Subluxation refers to a bone displacement.

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.

a. paralysis of the muscles innervated by the facial nerve

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.

a. rest tremor and skeletal muscle rigidity Tremor is often the first symptom of Parkinson disease that prompts patients to seek treatment. The tremor is generally at rest, unilateral affecting distal extremities. Difficulty initiating and controlling movements results in akinesia, tremor, and rigidity. The clinical manifestations of cerebellar disorders primarily include ataxia, hypotonia, intention tremors, and disturbances of gait and balance. Skeletal muscle rigidity and intention tremors are not the classic manifestations of Parkinson disease.

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.

a. stabilization of respiratory and cardiovascular function The primary consideration in the acute phase of stroke is assuring the patient's airway, respiratory, and cardiovascular function. In the acute phase of stroke, risk factor modification is not appropriate. Treatment aimed at preventing bedsores and contractions is not a typical consideration in the acute phase. Neurologic rehabilitation is not the focus of treatment in the acute phase.

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.

a. sudden, severe headache Warning leaks may occur before an aneurysm ruptures and often produce severe headache, which is typically described by the patient as "the worst headache I have ever had." Ringing in the ears is not a symptom associated with rupture of a cerebral aneurysm. Transient episodes of numbness are not indicative of a cerebral aneurysm rupture. Transient episodes of vertigo are not indicative of a cerebral aneurysm rupture.

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

b. Assumes decorticate posture with light touch, no verbal response Decorticate posturing is an abnormal flexor response of the arms and wrists, with legs and feet extended and internally rotated. This occurs as the neurologic functioning deteriorates. Normal response occurs with spontaneous eye opening, movement on command and orientation to self. Eye opening to touch is not indicative of poor neurologic functioning. A lower neurologic functioning is indicated by a patient who is able to withdraw from painful stimulus and localize the source of pain.

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

b. Cytotoxic

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.

c. 8

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.

b. Glasgow Coma Scale (GCS) The Glasgow Coma Scale (GCS) is a standardized tool developed for the purpose of assessing the level of consciousness in acutely brain-injured patients. An MRI is useful in evaluating a patient with an increase in ICP or change in mental status. ICP monitoring is useful in monitoring and treating patients with head trauma or other sources of excessive CSF. Central perfusion pressure is a useful tool in guiding therapy along with ICP.

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

b. Paget disease Paget disease is characterized by excessive bone resorption and formation, causing fractures and deformities. Osteomyelitis, osteoporosis, and rickets do not involve softening and then enlargement of bones.

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.

b. a deficiency of dopamine in the substantia nigra

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.

b. amyotrophic lateral sclerosis

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.

b. amyotrophic lateral sclerosis Most patients with ALS demonstrate muscle weakness and atrophy. The earliest symptoms may be muscle twitching, cramping, and stiffness. Often the hands or upper extremities are affected first. Guillain-Barré syndrome is characterized by ascending weakness that usually begins in the legs. Tremors at rest are usually the earliest symptoms of Parkinson disease. Hydrocephalus is characterized by abnormal accumulation of CSF in the cerebral ventricular system.

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

b. blood pressure control Hemorrhagic stroke is a hemorrhage that is usually the result of longstanding hypertension. Blood pressure control is the most important preventive measure. Anticoagulation would be useful for preventing embolic stroke. Risk reduction strategies for thrombotic stroke are aimed at reducing atherosclerosis. Dysrhythmias are not related to a risk of hemorrhagic stroke.

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

b. bone pain

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

b. brain herniation

Secondary injury after head trauma refers to a. injury as a result of medical therapy. b. brain injury resulting from the body's response to tissue damage. c. focal areas of bleeding. d. brain injury resulting from the initial trauma.

b. brain injury resulting from the body's response to tissue damage

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.

b. broken and protruding through the skin The type of fracture described is broken and protruding through the skin. A comminuted fracture is one that is broken in two or more pieces. An incomplete fracture is cracked but not completely separated. A longitudinal fracture is broken along the long axis.

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.

b. cerebral vasospasm In patients experiencing subarachnoid hemorrhage as a consequence of ruptured aneurysm, the complications of cerebral vasospasm and hydrocephalus must be monitored and managed. Vasospasm can be managed by keeping blood volume and blood pressure at normal to high levels. Vasospasm is managed by keeping blood volume and blood pressure at normal to high levels. Subarachnoid hemorrhage does not predispose to excessive volume loss. Subarachnoid hemorrhage is not associated with predisposition to increases in intracranial pressure.

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.

b. delayed healing

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.

b. deposition of amyloid plaques in the brain The hallmark pathophysiologic changes associated with Alzheimer disease include intracellular neurofibrillary tangles and extracellular amyloid plaques. Degeneration of the basal ganglia is not associated with dementia of Alzheimer disease. Brain atrophy occurs as a result of the amyloid plaques in the brain. Aluminum deposits in the brain are not responsible for dementia of Alzheimer disease.

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.

b. initiate action to have the cast split or removed

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.

b. ischemic versus hemorrhagic cause Treatment pathways differ between ischemic and hemorrhagic stroke. The goals of therapy for ischemic stroke are to minimize infarct size and preserve neurologic function. Secondary prevention for thrombotic stroke includes lifestyle modification to address risk factors. It is critical to prevent further hypoxia or ischemia after ischemic stroke regardless of the age of the patient.

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

b. lower spine The lower spine is the most common site affected in Paget's disease. The skull and pelvis are affected, but are not the most common sites. Joints are not affected in Paget's disease.

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.

b. maintaining an airway Treatment of an individual experiencing a seizure is concentrated on maintaining an airway and protecting the individual from injury. If the seizures are because of irreversible or unidentifiable factors, anticonvulsant medications specific to the type of seizure are the best management. Recording the course of the seizure episode is useful, but is not the initial focus of care. EEG studies may be useful in determining abnormalities which elicit the pathologic mechanism.

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

b. myasthenia gravis Anticholinesterase inhibitors may be used to manage myasthenia gravis. Anticholinesterase agents are not used to manage muscular dystrophy, fibromyalgia, or rheumatoid arthritis.

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

b. neural tube defects

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.

b. noncontractile tissue injury Pain with passive stretching of a muscle is indicative of noncontractile tissue injury. Pain with passive stretching of a muscle is not an indication of a contractile tissue injury, vascular insufficiency, or skeletal muscle damage.

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

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

b. rickets Rickets is similar to osteomalacia in that it is caused by vitamin D deficiency and leads to soft, deformable bones. Rickets occurs in growing children. Osteosarcoma, Paget disease, and osteopenia are not similar to osteomalacia.

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

b. subarachnoid hemorrhage Although trauma is an important cause of subarachnoid hemorrhage, it is more commonly associated with rupture of cerebral aneurysms. Embolic stroke is usually from a cardiac source. Subdural hematomas are related to trauma. Meningitis is caused by microbial invasion of the CNS.

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

b. threshold

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.

c. acetylcholine receptors are destroyed or dysfunctional Myasthenia gravis is an autoimmune disease in which acetylcholine receptors are destroyed or dysfunctional. Multiple sclerosis is an autoimmune disease in which neuronal demyelination disrupts nerve transmission. Muscles become weak, but not bulky, in myasthenia gravis. Acetylcholine receptors are destroyed or dysfunction in myasthenia gravis.

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.

c. cerebral vasodilation Cerebral edema starts a cyclic process whereby fluid collection in the brain leads to compression of vessels, which results in inadequate blood and oxygen perfusion into the cells. This results in ischemia, which triggers vasodilation, increased capillary pressure, and increased edema. An increase in intracranial pressure is not associated with hypernatremia nor caused by respiratory hyperventilation. The physiologic change most likely to lead to increased intracranial pressure is not related to sleep.

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.

c. changes in pain transmission in the spinal cord Pain in fibromyalgia involves changes in pain transmission in the spinal cord that are called central sensitization. Muscle inflammation, nerve inflammation, and autoimmune destruction of muscle tissue do not cause the pain in fibromyalgia.

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.

c. decrease pain signal transmission in the spinal cord The gate control theory is used to explain how stimulation of large "touch" neurons could inhibit the transmission of nociceptor impulses. Central to the gate control theory is the capacity for interneurons in the spinal cord to modify the transmission of nociceptor impulses. The gate control theory is not based on a theory that activity in touch receptors will enhance perception of pain. Opioid receptors are thought to be the mediators of presynaptic inhibition. One way to inhibit synaptic transmission is through presynaptic inhibition of substance P release from nociceptor neurons.

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.

c. deposits of urate crystals in tissues

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

c. endorphins Pain modulation occurs not only at the cord level but also in the brain itself. Opioids such as endorphins produced in the brain are thought to be important modulators of pain perception. Histamine is a chemical mediator of pain which is involved in the transduction phase. Cholecystokinin is a substance involved in synaptic transmission in the spinal cord. The excitatory neurotransmitter glutamate is involved in carrying the nociceptive message from primary afferent fibers to secondary neurons.

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

c. estrogen deficiency In older women, osteoporosis is thought to be primarily because of estrogen deficiency. Although dietary inadequacies and inactivity play roles, the primary cause of osteoporosis in older women is thought to be because of estrogen deficiency. Malabsorption is not the primary cause of osteoporosis in older women.

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

c. generalized Episodes in which the entire brain is involved from the onset of the seizure are referred to as generalized seizures. Partial seizures are those in which activity is restricted to one brain hemisphere. Complex partial seizures are restricted to one area of the brain. Focal seizures are classified as partial.

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.

c. inadequate mineralization in the osteoid Osteomalacia is characterized by inadequate or delayed mineralization in the osteoid. Osteomalacia does not involve increased osteoclast activity, collagen breakdown in the bone matrix, or crowding of cells in the osteoid.

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

c. intracranial hemorrhage Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs in the context of severe and often longstanding hypertension. It carries a 38% mortality, with death usually occurring within minutes to hours. Ischemic strokes are the most common and include thrombotic and embolic types. Embolic and ischemic strokes are the most common type. Stroke is the third leading cause of death in the United States. Cardiac arrest is not the stroke etiology with the highest morbidity and mortality.

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.

c. 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

c. migraine Typical signs of a migraine headache include severe unilateral pounding or throbbing pain that may be accompanied by nausea, vomiting, photophobia, phonophobia, and lacrimation. A severe, pounding headache with nausea and photophobia is likely to be a migraine headache. A sinus headache is not typically associated with nausea and photophobia. Pain is considered chronic when it lasts more than several months beyond the expected healing time.

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

c. osteosarcoma An osteosarcoma is a malignant bone-forming tumor. Rhabdo- refers to skeletal muscle. Lipo- refers to fat. Chondro- refers to cartilage.

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

c. unmyelinated C fibers The majority of pain sensations travel via C fibers and project to areas of the brain that evoke emotional responses such as displeasure and anxiety. Unmyelinated C fibers transmit pain more slowly. Pain transmitted by C fibers is poorly localized and has a dull or aching quality that lingers long after the initial sharp pain abates. Group Ia afferents are not the source of slow pain sensation. Slow pain sensation is not transmitted by α motor neurons. The nature of the pain carried by the fast-traveling Aδ fibers is characterized as sharp, stinging, and highly localized.

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

d. 0 to 15 ICP is the pressure exerted by the contents of the cranium, and it normally ranges from 0 to 15 mm Hg. Normal ICP ranges from 0 to 15 mm Hg. Fifteen to 25 mm Hg is considered to be high. Elevated ICP may occur in most types of acute brain injury. ICP of 20 to 30 mm Hg is high and is associated with impaired neurologic function because of compression of brain structures.

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

d. 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

d. Amyotrophic lateral sclerosis ALS is also known as Lou Gehrig disease, after the famed "Iron Man" of the New York Yankees, who died from the disease. Multiple sclerosis, Parkinson disease, and Alzheimer disease are not named after Lou Gehrig.

_________ 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

d. Meningocele In the meningocele form of spina bifida cystica, a saclike cyst filled with CSF protrudes through the spinal defect but does not involve the spinal cord. In spina bifida occulta, the posterior vertebral laminae have failed to fuse. A myelomeningocele or meningomyelocele deformity contains meninges, CSF, and a portion of the spinal cord that protrudes from the vertebral defect in a cystlike sac.

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.

d. within the same dermatome

________ 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

d. Nystagmus Nystagmus is a persistent rhythmic or jerky movement in one or both eyes. Dysconjugate movements occur when the eyes do not move together in the same direction. Ocular palsies occur when one or more cranial nerves are dysfunctional such that motor paralysis of the eye muscles impairs movements in one or more directions. The doll's-eyes test is performed by holding open the patient's eyelids and rotating the head from one side to the other. If the brainstem is intact, the eyes will turn in a direction opposite to the direction of head rotation.

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

d. Parkinson disease In patients with Parkinson disease, involvement of the autonomic nervous system may result in orthostatic hypotension. Alzheimer disease is not typically associated with orthostatic hypotension. Orthostatic hypotension is not associated with multiple sclerosis. Amyotrophic lateral sclerosis is not manifested by orthostatic hypotension.

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

d. Slower rate of action potential conduction The inflammation and scarring that occur with MS slow or interrupt the conduction of nerve impulses. Multiple sclerosis does not have an increased rate of action potential conduction on neurotransmission. Action potential initiation is not facilitated in demyelinating disorders. There is not a faster rate of repolarization in demyelinating disorders such as MS.

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.

d. absent spinal reflexes below the level of injury Spinal shock may occur after injury to the spinal cord, and can last from a few hours to a few weeks. Symptoms below the level of injury include flaccid paralysis of all skeletal muscles; loss of all spinal reflexes; loss of pain, proprioception, and other sensations; bowel and bladder dysfunction with paralytic ileus; and loss of thermoregulation. Bowel and bladder dysfunction may occur with spinal shock. Spinal shock is not characterized by autonomic dysreflexia. Spinal shock is generally associated with flaccid paralysis and loss of spinal reflexes.

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.

d. air embolus

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.

d. an infection that migrates via the bloodstream Hematogenous osteomyelitis (via the blood stream) is the most common type of osteomyelitis. Direct invasion of infection from a fracture, infection of a bone resulting from surgical contamination, and a joint prosthesis are not the most common sources of osteomyelitis.

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.

d. basilar skull fracture Sometimes fractures at the base of the skull are not visible on the routine CT scan, but allow drainage of CSF into the nasal sinuses. Head-injured patients who have drainage of clear fluid from the ears or nose should be evaluated for basilar skull fracture. Epidural hematomas are not associated with leakage of CSF from the nose or ears. Fracture of the temporal bone commonly results in an acute epidural hemorrhage. Cerebral aneurysm is not associated with leakage of cerebrospinal fluid.

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

d. bone fractures Osteoporosis weakens the bone structure and increases the risk of bone fractures. Rhabdomyolysis, osteomyelitis, and osteomalacia are completely different conditions.

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

d. bursitis Bursitis is inflammation of the bursal sacs that protect the skin over bony protuberances. Epicondylitis is inflammation of an epicondyle. Arthritis is inflammation of one or more joints. Tendinitis is inflammation of a tendon.

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.

d. characterized by a lucid interval immediately after injury The source of bleeding in most epidural hematomas is arterial. The patient may suffer only a brief period of disturbed consciousness followed by a period of normal cognition (lucid interval). Then consciousness rapidly deteriorates as the epidural hematoma expands and compresses brain structures. As the epidural hematoma expands, pressure is placed on the brain structures. The bleeding associated with an epidural hematoma occurs between the inner surface of the skull and the dura mater. The source of bleeding in most epidural hematomas is arterial.

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

d. comminuted

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.

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

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.

d. focal injuries occur in two places at opposite poles Polar injuries occur as a consequence of the brain shifting within the skull and meninges during the course of an acceleration-deceleration movement resulting in local injury at two opposite poles of the brain. Focal injuries are those that are localized to the site of impact to the skull. Diffuse injuries occur when movement of the brain causes widespread neuronal damage. An intracranial hematoma is a localized collection of blood within the cranium.

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.

d. genetically transmitted

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.

d. hypertension and bradycardia

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.

d. increase dopamine activity in the basal ganglia

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.

d. left-sided muscle weakness and neglect Manifestations of ischemic stroke are related to the cerebral vasculature involved and the area of brain tissue the vessel supplies. Contralateral hemiplegia is a usual finding. Contralateral hemiplegia , hemisensory loss, and contralateral visual field blindness are usual manifestations of stroke. Left visual blindness would be more indicative of a stroke affecting the right cerebral hemisphere. Aphasia is an integrative language disorder that occurs with brain damage to the dominant cerebral hemisphere (usually left) and involves all language modalities.

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

d. malunion

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.

d. sluggish pupil response to light Careful monitoring of the pupillary response to light during the acute phase is critical, as a failing response may be the first indication of brain compression from increasing ICP. Mild dilation of a pupil with sluggish or absent light response is ominous. Decorticate posturing is related to a deteriorating motor status. Absence of verbalization is not the first indication of brain compression. A GCS score of 13 is not the first indication of brain compression. Although, acute changes in level of consciousness should be further investigated.

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

d. soft-tissue damage Compartment syndrome occurs because of severe soft-tissue damage. Bone infarction and the breakdown of RBCs do not cause compartment syndrome. Muscle necrosis does not cause compartment syndrome, but can result from it.

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.

d. subluxation Subluxation is partial dislocation of a joint. Subjugation, sublimation, and dislocation are not the terms for partial loss of contact of articular surfaces.

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

d. tender point pain Tender point pain is a unique characteristic feature of fibromyalgia. Headache, contractures, and muscle atrophy are not unique characteristic features of fibromyalgia.

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.

d. the callus has been completely replaced with mature bone Complete healing of a bone fracture occurs when the callus has been completely replaced with mature bone. A lack of detectable movement of the break does not indicate that the fracture is healed. Even when a bone fracture is healed, pain at the fracture site and surrounding soft tissue may be present. The patient may progress from a cast to a splint, sling, or brace as the bone fracture continues to heal.

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.

d. the lack of airway maintenance can lead to hypoxia Status epilepticus is a continuing series of seizures without a period of recovery between seizure episodes. Irreversible brain damage and possible death from hypoxia, cardiac arrhythmias, or lactic acidosis can occur if the airway is not maintained and seizure activity is not halted. Prolonged seizure activity is unrelated to glucose transportation by neurons. Status epilepticus can cause cardiac arrhythmias, but the primary concern of prolonged seizure activity is maintaining a proper airway. Brainstem depression is not the primary reason that prolonged seizure activity causes ischemic brain damage.

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

d. vitamin D Rickets is characterized by soft, weak bones resulting from vitamin D deficiency. Rickets is not caused by poor calcium intake or phosphate deficiency. Estrogen deficiency is related to osteoporosis, not rickets.