Question 1

A herniation of which disk will 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). L2 to L3 herniation would result in radicular pain in the anterior middle thigh and knee. L3 to L5 would manifest as pain in the knee and the bilateral calf. An S2 to S3 herniation would be characterized with pain on the upper posterior thigh going down to the distal portion of the calf, just proximal to the ankle.

Question 2

A healthcare professional is caring for a patient who has a spinal cord injury at T5. The patient exhibits severe hypertension, a heart rate of 32 beats/min, and sweating above the spinal cord lesion. How does the professional chart this event?

Accepted Answer

Individuals most likely to be affected have lesions at the T6 level or above. Paroxysmal hypertension (up to 300 mmHg 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/min) characterize autonomic hyperreflexia. This does not describe craniosacral dysreflexia, parasympathetic dysreflexia, or retrograde hyperreflexia.

Question 3

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

Accepted Answer

Assessment findings related to only 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 a positive Brudzinski sign, in which passive flexion of the neck produces neck pain and increased rigidity, may appear.

Question 4

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

Accepted Answer

A spinal cord injury 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. The thalamus is not involved in temperature regulation.

Question 5

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. The other options would not result in the complications described.

Question 6

A healthcare professional wants to volunteer for a community education project to help prevent spinal cord injury. What activity would the professional most likely volunteer for?

Accepted Answer

Because of preexisting degenerative vertebral disorders, older adults are particularly at risk for minor trauma, resulting in serious spinal cord injury, especially from falls. Although any of the events listed could help prevent spinal cord injury, the activity targeting older adults would have the biggest impact because the risk to the other groups is less than that of the older adult.

Question 7

A person has been diagnosed with multiple sclerosis and asks the healthcare professional to explain the disease. What description by the professional is most accurate?

Accepted Answer

Multiple sclerosis (MS) is an autoimmune disorder diffusely involving the degeneration of CNS myelin and loss of axons. Myelination in the PNS is not involved. Neurofibrillary tangles in the CNS are characteristic of Alzheimer disease. Neurofibromatosis is an autosomal dominant genetic disorder.

Question 8

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. Hemorrhagic stroke is often the result of hypertension. Thrombotic CVAs develop most often from atherosclerosis and inflammatory disease processes that damage vessel walls. Lacunar strokes are usually caused by perivascular edema.

Question 9

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. The other options are not as indicative as the systolic bruit.

Question 10

In adults, how are most intracranial tumors located?

Accepted Answer

Approximately 70% to 75% of all intracranial tumors diagnosed in adults are located supratentorially (above the tentorium cerebella). The other options are not primary locations for intracranial tumors in adults.

Question 11

What do diffuse axonal injuries (DAIs) of the brain often result in?

Accepted Answer

Diffuse axonal injuries occur from mechanical forces of acceleration, deceleration, and rotation that cause stretching and shearing of axons. The injury can be mild, moderate, or severe. Persons with head injury can experience headaches, nausea and vomiting, confusion, disorientation, attention-deficit, dizziness, and impaired ability to concentrate for days after the injury, contributed to DAI among other processes. DAI can cause permanent or temporary dysfunction. DAI do not cause fine motor tremors or visual disturbances.

Question 12

A patient has a spinal cord injury at C4. What should the healthcare professional assess as the priority in this patient?

Accepted Answer

In the cervical region, the swelling that accompanies an injury to C3 to C5 can be life-threatening because of the possibility of resulting impairment of the diaphragm function (phrenic nerves exit C3 to C5). All vital signs are important, but because of this possibility the priority is to monitor signs of respiratory impairment.

Question 13

What is the most common primary central nervous system (CNS) tumor?

Accepted Answer

Astrocytomas are the most common primary CNS tumors (50% of all brain and spinal cord tumors). The other options do not occur as frequently.

Question 14

A right hemisphere embolic CVA has resulted in left-sided paralysis and reduced sensation of the left foot and leg. Which cerebral artery is most likely affected by the emboli?

Accepted Answer

Symptoms of an embolic stroke in only the right anterior cerebral artery would include left-sided contralateral paralysis or paresis (greater in the foot and thigh). A middle cerebral CVA would result in greater effects in the face and upper extremities. A posterior cerebral artery CVA would manifest with contralateral hemiplegia with possible dysmetria, dyskinesia, hemiballism or choreoathetosis, dystaxia, cerebellar ataxia, and tremor; and contralateral upper motor neuron palsy.

Question 15

A healthcare professional is planning a community event to reduce risk of cerebrovascular accident (CVA) in high risk groups. Which group would the professional target as the priority?

Accepted Answer

Hypertension is the single greatest risk factor for stroke. The other options are recognized risk factors but do not carry the intensity of hypertension.

Question 16

In children, how are most intracranial tumors located?

Accepted Answer

Approximately 70% of all intracranial tumors in children are located infratentorially (below the tentorium cerebelli) and not in the locations provided by the other options.

Question 17

What indicates that spinal shock is terminating?

Accepted Answer

Indications that spinal shock is terminating include the reappearance of reflex activity, hyperreflexia, spasticity, and reflex emptying of the bladder. Termination of spinal shock is not evidenced by voluntary movement, paresthesia, decreased deep tendon reflexes, or paralysis.

Question 18

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

Accepted Answer

In an arteriovenous malformation (AVM), arteries feed directly into veins through a vascular tangle of malformed vessels. A cavernous angioma is a blood vessel abnormality associated with subdural hematomas. Telangiectasia are simple "spider veins" usually found on the skin. An arteriovenous angioma usually is found deep within the brain and often leads to seizures and hemiparesis.

Question 19

Autonomic hyperreflexia-induced bradycardia is a result of stimulation of what?

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. The sympathetic system is damaged and not able to stimulate receptors. Without sympathetic balance, the parasympathetic nervous system dominates. The glossopharyngeal nerve is not involved in heart rate regulation. a-Adrenergic receptors would be stimulated by the sympathetic system.

Question 20

What event is most likely to occur when a person experiences a closed head injury?

Accepted Answer

Transient cessation of respiration can occur with brief periods of bradycardia, and a decrease in blood pressure occurs, lasting 30 sec or less. Vital signs stabilize within a few seconds to within normal limits. Edema does not occur immediately. Disruption of axons in the diencephalon and brainstem may or may not occur.

Quiz 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction