Deck 22: Acute Neurological Disorders

Question 1

Which of the following characteristics indicates that the CSF is normal?

A) cloudy and pale yellow color
B) presence of erythrocytes
C) presence of numerous leukocytes
D) clear and colorless fluid

Answer 1

clear and colorless fluid

Question 2

Why are focal or generalized seizures an early indication of a brain tumor?

A) Surrounding inflammation stimulates neurons to discharge spontaneously.
B) Malignant tumors cause alkalosis,exciting the CNS.
C) Systemic effects of the brain tumor may cause seizures.
D) Metabolic effects of cancer change blood chemistry to trigger seizures.

Answer 2

Surrounding inflammation stimulates neurons to discharge spontaneously.

Question 3

What is the effect of an enlarging brain abscess on cardiovascular activity?

A) increased heart rate and systemic vasodilation
B) low blood pressure and irregular heart and respiratory rates
C) systemic vasoconstriction and slower heart rate
D) immediate depression of the cardiac control centers

Answer 3

systemic vasoconstriction and slower heart rate

Question 4

Which of the following statements is TRUE about malignant brain tumors?

A) Most brain tumors arise from malignant neurons.
B) Primary brain tumors rarely metastasize outside the CNS.
C) The blood-brain barrier prevents secondary brain tumors.
D) Brainstem tumors do not manifest signs until they are quite large.

Question 5

Which of the following is the usual location of language centers?

A) left hemisphere
B) right hemisphere
C) brainstem
D) hypothalamus

Question 6

What is the typical change in blood pressure with increased intracranial pressure?

A) increasing diastolic pressure
B) decreasing systolic pressure
C) systolic and diastolic pressures decreasing proportionately
D) increasing pulse pressure

Question 7

A brain tumor causes headache because the tumor:

A) causes ischemic pain in the brain
B) stretches the meninges and blood vessel walls
C) erodes the skull
D) compresses sensory fibers in cranial nerves

Question 8

Where are beta-1 adrenergic receptors located?

A) bronchiolar walls
B) arteriolar walls
C) cardiac muscle
D) glands of the intestinal tract

Question 9

As intracranial pressure rises,the pupil of the eye,ipsilateral to the lesion,becomes dilated and unresponsive to light because of pressure on the:

A) optic nerve
B) PNS fibers in cranial nerve III
C) SNS nerve to the eye
D) occipital lobe

Question 10

What would be the effect of damage to the auditory association area in the left hemisphere?

A) loss of hearing in both ears
B) inability to understand what is heard
C) loss of hearing in the left ear
D) inability to determine the source of the sound

Question 11

Which of the following conditions is NOT part of the criteria for a declaration of "brain death"?

A) no activity on EEG
B) absence of all reflexes
C) no spontaneous respirations
D) presence of any head injury

Question 12

Which of the following causes papilledema?

A) increased pressure of CSF at the optic disc
B) increased intraocular pressure
C) pressure on the oculomotor nerve
D) pressure on the optic chiasm

Question 13

What is the best definition of aphasia?

A) the inability to comprehend or express language appropriately
B) difficulty swallowing
C) loss of the visual field contralateral to the area of damage
D) the inability to articulate words clearly

Question 14

What would be the expected effect of a tumor developing in the inferior part of the left frontal lobe?

A) numbness in the right leg
B) weakness in the right side of the face
C) paralysis in the left leg
D) dizziness and loss of balance

Question 15

What is the rationale for vomiting with increased intracranial pressure?

A) chemoreceptors responding to changes in the blood
B) pressure extending to spinal nerves
C) pressure on the emetic center in the medulla
D) stimuli to the hypothalamic center for hunger and thirst

Question 16

Through what area does the cerebrospinal fluid circulate around the brain and spinal cord?

A) between the double layers of the dura mater
B) in the subdural space
C) in the subarachnoid space
D) through the arachnoid villi

Question 17

Which of the following applies to the corticospinal tract?

A) It is an ascending tract.
B) The nerve fibers conduct sensory impulses.
C) It is an extrapyramidal tract.
D) It is a pyramidal tract for efferent impulses.

Question 18

What is an early indicator of increasing intracranial pressure?

A) papilledema
B) bilateral fixed dilated pupils
C) decreasing responsiveness
D) rapid heart rate

Question 19

What does a vegetative state refer to?

A) depression of the RAS and inability to initiate action
B) loss of awareness and intellectual function but continued brainstem function
C) continuing intellectual function but inability to communicate or move
D) disorientation and confusion with decreased responsiveness

Question 20

What is a major function of the limbic system?

A) overall control of fluid balance
B) required for logical thinking,reason,and decision making
C) determines emotional responses
D) responsible for artistic and musical talents

Question 21

What would be the effect of infarction owing to obstruction in the right anterior cerebral artery?

A) some visual loss
B) sensory deficit involving the upper body
C) aphasia
D) contralateral weakness in the leg,impaired spatial relationships

Question 22

Collateral circulation is most likely to be present when a CVA results from:

A) rupture of a cerebral artery
B) an embolus
C) development of an atheroma
D) vasospasm in the cerebral circulation

Question 23

All of the following apply to CVA EXCEPT:

A) the common cause is an atheroma with thrombus
B) maximum necrosis and infarction develop within several hours of onset
C) warning signs may appear with partial obstruction of the artery
D) increasing neurologic deficits usually develop during the first few days

Question 24

Why may secondary damage occur shortly after a spinal cord injury?

A) presence of unstable fractures or dislocations of vertebrae
B) catecholamine release in the area causing local vasoconstriction
C) decreased or labile systemic blood pressure
D) a,b
E) a,b,c

Question 25

In cases of Guillain-Barré syndrome,what does the pathophysiology include?

A) damage and loss of function in the motor neurons of the spinal cord and medulla
B) encephalopathy with disorientation,headache,and coma
C) infection and inflammation of the motor cortex
D) inflammation and demyelination of peripheral nerves,leading to ascending paralysis

Question 26

Which of the following statements about berry aneurysms in the brain is NOT true?

A) They usually develop at points of bifurcation in the circle of Willis.
B) They are usually asymptomatic for many years.
C) Rupture causes signs of circulatory shock.
D) Following rupture,blood appears in the subarachnoid space.

Question 27

An epidural hematoma is located between the:

A) dura mater and the arachnoid mater
B) dura mater and the skull
C) arachnoid mater and the pia mater
D) pia mater and the brain

Question 28

What does the term otorrhea mean?

A) bleeding from the nose
B) CSF leaking from the ear
C) torn meninges but no skull fracture
D) hemorrhage from the ear

Question 29

Following a spinal injury at C5,what is the expected effect during the period of spinal shock?

A) spastic paralysis below the level of the injury
B) urinary incontinence
C) possible periods of apnea
D) normal blood pressure

Question 30

Expressive aphasia is most likely to result from damage to:

A) the left frontal lobe
B) the left temporal lobe
C) the right motor cortex
D) Wernicke's area

Question 31

What is the probable source of an embolus causing a CVA?

A) right ventricle of the heart
B) femoral vein
C) common carotid artery
D) pulmonary artery

Question 32

In a case of bacterial meningitis,where does swelling and purulent exudate form?

A) involving the pia,arachnoid,and surface of the entire brain
B) in the dura mater and epidural space
C) at the site of the injury or entry point of the microbes
D) primarily around the spinal cord

Question 33

All of the following apply to tetanus infection EXCEPT:

A) it is caused by an anaerobic,spore-forming bacillus
B) the exotoxin causes strong skeletal muscle spasms
C) death may result from respiratory failure
D) signs of infection include fever,vomiting,stiff neck,and paralysis

Question 34

What are significant signs of acute bacterial meningitis?

A) severe headache,nuchal rigidity,and photophobia
B) fatigue and lethargy,fever,and anorexia
C) focal signs,such as progressive paralysis in a limb
D) ascending paralysis beginning in the legs

Question 35

Which of the following is a TRUE statement about transient ischemic attacks?

A) They usually cause necrosis and permanent brain damage.
B) Rupture of an aneurysm or damaged artery may cause a TIA.
C) They usually indicate systemic hypertension.
D) They often warn of potential cerebrovascular accidents.

Question 36

Following a head injury,what is the most likely cause of secondary damage to the brain?

A) hematoma or infection
B) laceration by foreign objects
C) hypoxia or acidosis
D) tearing of blood vessels as the brain rotates across the inside of the skull

Question 37

How does a depressed skull fracture cause brain damage?

A) A bone fragment penetrates and tears brain tissue.
B) A section of the skull is missing,leaving the brain unprotected.
C) A section of skull bone is displaced below the level of the skull,causing pressure on the brain.
D) Many fracture lines are present causing instability.
E) The contrecoup injury is the cause of brain damage.

Question 38

What are the signs of autonomic dysreflexia in a person with cervical spinal injury?

A) unexpected drop in blood pressure and apnea
B) sudden marked increase in blood pressure with bradycardia
C) hyperreflexia in the arms and legs
D) urinary and bowel incontinence

Question 39

In many types of encephalitis,such as St.Louis encephalitis,how are the viruses transmitted?

A) carriers
B) bites of mosquitoes and ticks
C) respiratory droplet
D) septic emboli in the circulation

Question 40

Following an injury at L2 to L3,what would indicate recovery from spinal shock?

A) spastic paraplegia
B) urinary retention
C) labile body temperature
D) increased sensation in the legs

Question 41

Which of the following does NOT apply to Reye's syndrome?

A) There is no permanent damage in the body.
B) It is precipitated by a combination of viral infection and administration of ASA.
C) Cerebral edema develops.
D) Liver damage is common.

Question 42

How does the heart rate change as intracranial pressure increases?

A) rate decreases
B) rate increases
C) no change in rate

Question 43

Common manifestations of rabies infection include:

A) headache,foaming at the mouth,and difficulty swallowing
B) difficulty walking and coordinating movements
C) decreased sensitivity to sound and touch
D) vomiting,liver and kidney damage

Question 44

The rabies virus is usually transmitted by:

A) respiratory droplets
B) insects such as mosquitoes
C) bites from infected animals
D) the fecal-oral route

Question 45

Herpes zoster can be identified by a typical:

A) unilateral rash and pain along a cranial nerve or dermatome
B) weakness and muscle atrophy in the legs
C) ascending paralysis commencing in the legs
D) skeletal muscle spasms in the face and neck

Question 46

Which statement best describes herniation resulting from increased intracranial pressure?

A) movement of brain tissue into ventricles
B) movement of brain stem upward
C) pushing of excess CSF and blood down around the spinal cord
D) displacement of brain tissue downward toward the spinal cord

Question 47

Which signs are indicative of post-polio syndrome?

A) progressive spastic paralysis
B) ascending flaccid paralysis
C) progressive fatigue and weakness
D) increasing numbness and paresthesias

Question 48

Which of the following impairments results from infection by the polio virus?

A) pain and paresthesia in a cranial nerve or dermatome
B) loss of motor and sensory function in the peripheral nerves
C) inflammation and increased intracranial pressure
D) loss of function of motor neurons of the spinal cord and medulla

Question 49

Which of the following conditions is marked by focal signs?

A) meningitis
B) brain abscess
C) encephalitis
D) intracerebral hemorrhage

Question 50

What are the significant early signs of a ruptured cerebral aneurysm?

A) impaired speech and muscle weakness
B) severe headache,nuchal rigidity,and photophobia
C) abnormal sensations and tremors
D) vomiting and visual abnormalities

Question 51

What is the usual result of damage to the right occipital lobe?

A) left eye is blind
B) loss of left visual field
C) right eye is blind
D) visual loss in the medial half of each eye

Question 52

Which type of fracture typically occurs at the base of the skull?

A) depressed
B) contrecoup
C) comminuted
D) basilar

Question 53

An accurate assessment of the extent of permanent spinal cord damage can usually be completed:

A) immediately following admission to hospital
B) approximately 48 hours after injury
C) approximately 10 days to 2 weeks following injury if no complications arise
D) 6-12 months later

Question 54

Which term refers to a stiff hyperextended neck associated with irritation of spinal nerve roots?

A) nystagmus
B) ptosis
C) nuchal rigidity
D) spastic quadriplegia

Question 55

Which of the following statements applies to a lumbar puncture?

A) It is usually performed at L3-L4.
B) Fluid is withdrawn from the epidural space.
C) It can be used to confirm any diagnosis.
D) The tissue seals up immediately after puncture.

Question 56

The primary reason for seizures frequently occurring with head injuries is:

A) presence of blood irritates the neurons
B) otorrhea or rhinorrhea changes intracranial pressure
C) inflammatory response causes general hypoxia
D) CNS is depressed

Question 57

Which statement is TRUE about tetanus infection?

A) It is caused by a virus.
B) Infection usually develops in deep puncture wounds.
C) It causes flaccid skeletal muscles,impairing mobility.
D) It affects peripheral nerves initially in the legs and feet.

Question 58

Which type of cerebrovascular accident has the poorest prognosis?

A) CVA caused by thrombus
B) hemorrhagic CVA
C) embolic CVA
D) no difference among types

Question 59

With regard to meningitis,choose the correct combination of microbe and the age group commonly affected.

A) E.coli: elderly
B) H.influenza: neonate
C) N.meningitides: children and youth
D) S.pneumoniae: young children

Question 60

Typical signs of a TIA include:

A) rapidly increasing intracranial pressure
B) loss of consciousness
C) transient muscle weakness in a hand or leg
D) headache,photophobia,and nuchal rigidity