Deck 15: Alterations of Neurologic Function

Question 1

A 25-year-old male was in an automobile accident. At impact, his forehead struck the windshield. In this situation, the coup injury would occur in the:

A) frontal region.
B) temporal region.
C) parietal region.
D) occipital region.

Answer 1

frontal region.

Question 2

A 33-year-old male is brought to the emergency department for treatment of injuries received in a motor vehicle accident. An MRI reveals an injury of the cervical cord. Cord swelling in this region may be life threatening because:

A) increased intracranial pressure may occur.
B) reflexes will be disrupted.
C) diaphragm function may be impaired.
D) bladder emptying will not occur.

Answer 2

diaphragm function may be impaired.

Question 3

A 15-year-old male suffered diffuse brain injury after wrecking an all-terrain vehicle. He had momentary confusion and retrograde amnesia after 5 to 10 minutes. His injury could be categorized as:

A) Grade I.
B) Grade II.
C) Grade III.
D) a mild concussion.

Answer 3

Grade II.

Question 4

Mild concussion is characterized by:

A) a brief loss of consciousness.
B) significant behavioral changes.
C) retrograde amnesia.
D) transient confusion.

Question 5

A 20-year-old female suffered from spinal cord injury that resulted from a motor vehicle accident. She had spinal shock lasting 15 days and is now experiencing an uncompensated cardiovascular response to sympathetic stimulation. This condition may accompany:

A) toxic accumulation of free radicals below the level of the injury.
B) pain stimulation above the level of the spinal cord lesion.
C) a distended bladder or rectum.
D) an abnormal vagal response.

Question 6

The main source of bleeding in extradural (epidural) hematomas is:

A) arterial.
B) venous.
C) capillary.
D) sinus.

Question 7

A 69-year-old male with a history of alcohol abuse presents to the ER after a month-long episode of headaches and confusion. Based on his alcoholism, a likely cause of his neurologic symptoms is:

A) concussion.
B) chronic subdural hematoma.
C) epidural hematoma.
D) subacute subdural hematoma.

Question 8

A 15-year-old male is brought to the emergency department for treatment of injuries received in a motor vehicle accident. An MRI reveals spinal cord injury, and his body temperature fluctuates markedly. The most accurate explanation of this phenomenon is that:

A) he developed pneumonia.
B) his sympathetic nervous system has been damaged and thermal control disturbed.
C) he has a brain injury.
D) he has septicemia from an unknown source.

Question 9

An initial clinical manifestation associated with acute spinal cord injury is:

A) pain below the level of the injury.
B) loss of autonomic reflexes above the injury.
C) loss of voluntary control below the injury.
D) hyperactive spinal reflexes below the injury.

Question 10

A 39-year-old male suffers a severe brain injury when he falls off a building while working. CT scan reveals that he has a basilar skull fractures. One major concern for this patient is:

A) hematoma formation.
B) meningeal infection.
C) increased intracranial pressure.
D) cognitive deficits.

Question 11

_____ are most at risk of spinal cord injury from minor trauma.

A) Infants
B) Men
C) Women
D) The elderly

Question 12

A 17-year-old male is brought to the emergency department for treatment of injuries received in a motor vehicle accident. A spinal cord injury is suspected. The two regions most likely to be damaged are the:

A) cervical and thoracic regions.
B) thoracic and lumbar regions.
C) lumbar and sacral regions.
D) cervical and lumbar regions.

Question 13

A 65-year-old female loses her balance while walking in the woods, causing her to fall and hit her head. She loses consciousness and is in a coma for 5 days. She is diagnosed as having diffuse brain injury. Which of the following would most likely occur in this patient?

A) Complete loss of vision
B) Arrhythmia
C) Blunted affect
D) Meningitis infection

Question 14

A 10-year-old male was climbing on a house and fell. He suffered a severe brain injury. His Glasgow Coma Scale was 5 initially and 7 after 1 day. He remained unconscious for 2 weeks, then was confused and suffered from anterograde amnesia. Which of the following is he most likely experiencing?

A) Mild diffuse brain injury
B) Moderate diffuse brain injury
C) Severe diffuse brain injury
D) Postconcussive syndrome

Question 15

A 50-year-old male presents with low back pain. He denies trauma and says he just woke up and it was hurting. An MRI reveals that the vertebra at L5 slid forward relative to those above and below it. This condition is called:

A) degenerative disk disease.
B) spondylolysis.
C) spondylolisthesis.
D) spinal stenosis.

Question 16

A 15-year-old male was struck by a motor vehicle and suffered a traumatic brain injury. Paramedics found him unconscious at the scene of the accident. During the ambulance ride, he regained consciousness and was able to maintain a conversation with the medical staff. Upon arrival to hospital, he was alert and oriented. Physical exam reveals confusion and impaired responsiveness. What is the probable nature of his brain injury based on this history?

A) Class IV (classic) concussion
B) Subdural hematoma
C) Extradural (epidural) hematoma
D) Diffuse axonal injury

Question 17

The most severe diffuse brain injury caused by rotational acceleration is most likely to be located:

A) more peripheral to the brain stem.
B) in the central portion of the brain stem.
C) throughout the brain stem.
D) distal to the brain stem.

Question 18

Six weeks ago a female patient suffered a T6 spinal cord injury. She then developed a blood pressure of 200/120, a severe headache, blurred vision, and bradycardia. She is likely experiencing:

A) extreme spinal shock.
B) acute anxiety.
C) autonomic hyperreflexia.
D) parasympathetic areflexia.

Question 19

The most common type of traumatic brain injury is:

A) penetrating trauma.
B) diffuse axonal injury.
C) focal brain injury.
D) concussion.

Question 20

The transient nature of spinal shock is directly related to which of the following mechanisms?

A) Incomplete transection of the spinal cord
B) Accumulation of edema within the spinal cord
C) Partial necrosis of the spinal cord
D) Free radical injury and scarring of the glial cells

Question 21

A 23-year-old female begins having problems with tiredness, weakness, and visual changes. Her diagnosis is multiple sclerosis (MS). The pathogenic model of multiple sclerosis includes:

A) depletion of dopamine in the central nervous system.
B) demyelination of nerve fibers in the CNS.
C) the development of neurofibril webs in the CNS.
D) reduced amounts of acetylcholine at the neuromuscular junction.

Question 22

Myasthenia gravis results from:

A) viral infection of skeletal muscle.
B) atrophy of motor neurons in the spinal cord.
C) demyelination of skeletal motor neurons.
D) autoimmune injury at the neuromuscular junction.

Question 23

A 30-year-old white male recently suffered a cerebrovascular accident. Which of the following is the most likely factor that contributed to his stroke?

A) Age
B) Gender
C) Diabetes
D) Race

Question 24

A 15-month-old child from Pennsylvania was brought to the ER for fever, seizure activity, cranial palsies, and paralysis. Which of the following is the most likely cause?

A) Eastern equine encephalitis
B) Venezuelan encephalitis
C) St. Louis encephalitis
D) West Nile encephalitis

Question 25

A 65-year-old male suffers a subarachnoid hemorrhage secondary to uncontrolled hypertension. He appears drowsy and confused with pronounced focal neurologic deficits. This condition is a grade:

A) I.
B) II.
C) III.
D) IV.

Question 26

One risk factor for thrombotic stroke is:

A) hyperthyroidism.
B) fat embolus.
C) anemia.
D) dehydration.

Question 27

A cause of hydrocephalus in subarachnoid hemorrhage is:

A) scarring of meninges and impairment of CSF resorption.
B) choroid plexus injury.
C) impairment of CSF flow through the ventricles.
D) vasoconstriction related to CO₂ changes in the cerebral circulation.

Question 28

Classic amyotrophic lateral sclerosis (ALS) presents with:

A) progressive dementia.
B) muscle weakness and atrophy.
C) severe paresthesias.
D) autonomic dysfunction.

Question 29

A 72-year-old male demonstrates left-sided weakness of upper and lower extremities. The symptoms disappear in 24 hours. He most likely experienced a(n):

A) stroke-in-evolution.
B) arteriovenous malformation.
C) transient ischemic attack.
D) cerebral hemorrhage.

Question 30

A 60-year-old female with a recent history of head trauma and a long-term history of hypertension presents to the ER for changes in mental status. MRI reveals that she had a hemorrhage stoke. This type of stroke is often caused by:

A) rheumatic heart disease.
B) thrombi.
C) aneurysms.
D) hypotension.

Question 31

The majority of intervertebral disk herniations occur between vertebral levels (cervical, C; thoracic, T; lumbar, L; sacral, S):

A) C1 to C3.
B) T1 to T4.
C) T12 to L3.
D) L4 to S1.

Question 32

Most causes of encephalitis are:

A) bacterial.
B) viral.
C) fungal.
D) toxoid.

Question 33

A 25-year-old female presents to her physician complaining of fever, headache, nuchal rigidity, and decreased consciousness. She was previously treated for sinusitis. Which of the following is the most likely diagnosis?

A) Aseptic meningitis
B) Bacterial meningitis
C) Fungal meningitis
D) Nonpurulent meningitis

Question 34

In meningitis, the infection is thought to enter the CNS through the:

A) blood-brain barrier.
B) sinuses.
C) choroid plexus.
D) cerebral capillaries.

Question 35

A 75-year-old male experienced a lacunar stroke. This type of stroke is most often associated with:

A) an embolus.
B) hypertension.
C) a hemorrhage.
D) an aneurysm.

Question 36

A major contributing process in cerebrovascular accidents (CVA) is the development of atheromatous plaques in cerebral circulation. These most commonly form:

A) in the larger veins.
B) near capillary sphincters.
C) in cerebral arteries.
D) in the venous sinuses.

Question 37

A 48-year-old female presents at the emergency department complaining of an acute severe headache, nausea, photophobia, and nuchal rigidity. These signs and symptoms are probably caused by:

A) diffuse brain injury.
B) subarachnoid hemorrhage.
C) epidural hematoma.
D) classic concussion.

Question 38

Of the following groups, who are at highest risk for a cerebrovascular accident?

A) Blacks over 65 years of age
B) Whites over 65 years of age
C) Blacks under 65 years of age
D) Whites under 65 years of age

Question 39

The cause of multiple sclerosis (MS) seems to be an interaction between:

A) vascular and metabolic factors.
B) bacterial infection and the inflammatory response.
C) autoimmunity and genetic susceptibility.
D) neurotransmitters and inherited genes.

Question 40

A 25-year-old male died from a gunshot wound to the heart. Upon autopsy, abnormalities in the media of the arterial wall and degenerative changes were detected. Which of the following most likely accompanied this finding?

A) Fusiform aneurysm
B) Saccular aneurysm
C) Arteriovenous malformation
D) Thrombotic stroke

Question 41

The most common primary CNS tumors in adults are:

A) meningiomas.
B) medulloblastomas.
C) astrocytomas.
D) angiomas.

Question 42

Patients with myasthenia gravis often have tumors or pathologic changes in the:

A) brain.
B) pancreas.
C) thymus.
D) lungs.

Question 43

A 45-year-old male presents with seizures. An MRI reveals a meningioma most likely originating from the:

A) dura mater and arachnoid membrane.
B) astrocytes.
C) pia mater.
D) CNS neurons.