Question 1

Which clinical finding is considered a diagnostic indicator for an arteriovenous malformation (AVM)?

Accepted Answer

A systolic bruit over the carotid in the neck, the mastoid process, or (in a young person) the eyeball is almost always diagnostic of an AVM.

Question 2

Which clinical manifestation is characteristic of cluster headaches?

Accepted Answer

The headache attack usually begins without warning and is characterized by severe, unilateral tearing, burning, periorbital, and retrobulbar or temporal pain lasting 30 minutes to 2 hours.

Question 3

In adults most intracranial tumors are located:

Accepted Answer

Approximately 70%-75% of all intracranial tumors diagnosed in adults are located supratentorially (above the tentorium cerebella).

Question 4

A right hemisphere embolic cerebrovascular accident has resulted in left-sided paralysis and reduced sensation of the left foot and leg.The vessel most likely affected by the emboli is the right _____ artery.

Accepted Answer

Symptomatology of an embolic stroke in the right anterior cerebral artery would include left-sided contralateral paralysis or paresis (greater in foot and thigh) and mild upper extremity weakness with mild contralateral lower extremity sensory deficiency with loss of vibratory and/or position sense and loss of two-point discrimination.

Question 5

What complication is occurring for a person who has a spinal cord injury above T6 and is experiencing paroxysmal hypertension as well as piloerection and sweating above the spinal cord lesion?

Accepted Answer

Individuals most likely to be affected have lesions at the T6 level or above. Autonomic hyperreflexia is characterized by paroxysmal hypertension (up to 300 mm Hg systolic), a pounding headache, blurred vision, sweating above the level of the lesion with flushing of the skin, nasal congestion, nausea, piloerection caused by pilomotor spasm, and bradycardia (30 to 40 beats/minute).

Question 6

What is the central component of the pathogenic model of multiple sclerosis?

Accepted Answer

Multiple sclerosis (MS) is an autoimmune disorder diffusely involving degeneration of CNS myelin and loss of axons.

Question 7

Which cerebral vascular disorder causes meningeal irritation, photophobia, and positive Kernig and Brudzinski signs?

Accepted Answer

Assessment findings related to a subarachnoid hemorrhage include meningeal irritation and inflammation causing neck stiffness (nuchal rigidity), photophobia, blurred vision, irritability, restlessness, and low-grade fever. A positive Kernig sign (in which straightening the knee with the hip and knee in a flexed position produces pain in the back and neck regions) and Brudzinski sign (in which passive flexion of the neck produces neck pain and increased rigidity) may appear.

Question 8

A blunt force injury to the forehead would result in a contrecoup injury to the _____ region.

Accepted Answer

The focal injury may be coup (directly below the point of impact) or contrecoup (on the pole opposite the site of impact). Objects striking the back of the head usually result in both coup and contrecoup injuries because of the irregularity of the inner surface of the frontal bones.

Question 9

Meningiomas characteristically compress:

Accepted Answer

Extramedullary spinal cord tumors produce dysfunction by compression of adjacent tissue, not by direct invasion.

Question 10

A herniation of which disk would likely result in motor and sensory changes of the lateral lower legs and soles of the feet?

Accepted Answer

Clinical manifestations of posterolateral protrusions include radicular pain exacerbated by movement and straining (medial calf suggests L5, lateral calf suggests S1 root compression). Refer to Figure 17-14.

Question 11

What sequence causes autonomic hyperreflexia-induced bradycardia?

Accepted Answer

The intact autonomic nervous system reflexively responds with an arteriolar spasm that increases blood pressure. Baroreceptors in the cerebral vessels, the carotid sinus, and the aorta sense the hypertension and stimulate the parasympathetic system. The heart rate decreases, but the visceral and peripheral vessels do not dilate because efferent impulses cannot pass through the cord. Refer to Figure 17-13.

Question 12

Microinfarcts resulting in pure motor or pure sensory deficits are the result of which type of stroke?

Accepted Answer

A lacunar stroke (lacunar infarct) is a microinfarct smaller than 1 cm in diameter. Because of the subcortical location and small area of infarction, these strokes may have pure motor and sensory deficits.

Question 13

In children most intracranial tumors are located:

Accepted Answer

Approximately 70% of all intracranial tumors in children are located infratentorially (below the tentorium cerebelli).

Question 14

Which vascular malformation is characterized by arteries that feed directly into veins through vascular tangles of abnormal vessels?

Accepted Answer

In an arteriovenous malformation, arteries feed directly into veins through a vascular tangle of malformed vessels.

Question 15

Why does a person who has a spinal cord injury experience faulty control of sweating?

Accepted Answer

The condition also results in disturbed thermal control because the hypothalamus is unable to regulate a damaged sympathetic nervous system. This damage causes faulty control of sweating and radiation through capillary dilation.

Question 16

The most common primary central nervous system tumor is the:

Accepted Answer

Astrocytomas are the most common primary CNS tumors (50% of all brain and spinal cord tumors).

Question 17

Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke?

Accepted Answer

High-risk sources for the onset of embolic stroke are atrial fibrillation (15% to 25% of strokes), left ventricular aneurysm or thrombus, left atrial thrombus, recent myocardial infarction, rheumatic valvular disease, mechanical prosthetic valve, nonbacterial thrombotic endocarditis, bacterial endocarditis, patent foramen ovale, and primary intracardiac tumors.

Question 18

A man was in an automobile accident in which his forehead struck the windshield.A blunt force injury to the forehead would result in a coup injury to the _____ region.

Accepted Answer

The focal injury may be coup (directly below the point of impact). Objects striking the front of the head usually produce only coup injuries (contusions and fractures) because the inner skull in the occipital area is smooth.

Question 19

Spinal cord injuries are most likely to occur in which of the following regions?

Accepted Answer

Vertebral injuries occur mostly at vertebrae C1-C2 (cervical), C4-C7, and T1-L2 (thoracic lumbar).

Question 20

Of the following people, who is at highest risk for a cerebrovascular accident (CVA)?

Accepted Answer

Fifty percent of CVAs occur in persons older than 70 years. Strokes, however, do occur in a 3:10 ratio (28%) in individuals younger than 65 years. Stroke tends to run in families. The incidence of stroke is 2.5 times higher in blacks than whites. Stroke prevalence in 2005 for black men was 2.3 million compared to 3.4 million in black women. The risk of first ever stroke in blacks is almost twice that of whites.

Quiz 17: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction

Which clinical finding is considered a diagnostic indicator for an arteriovenous malformation (AVM) ?