Question 1

The condition of a patient with a severe closed head injury is deteriorating.His pupils are dilated and sluggish,pulse pressure is widening,and the pulse is bradycardic.These clinical findings are evidence of what stage of intracranial hypertension?

Accepted Answer

These symptoms indicate Stage 3 of intracranial hypertension, where there is significant increase in intracranial pressure leading to Cushing's triad: bradycardia, hypertension with widening pulse pressure, and irregular respirations.

Question 2

Diagnostic criteria for vegetative states include:

Accepted Answer

Vegetative states are characterized by the return of autonomic functions, such as gastrointestinal function, despite the absence of awareness and higher cognitive functions.

Question 3

Since his cerebrovascular accident,a patient has been denying his left hemiplegia.What term is used to describe this finding?

Accepted Answer

Anosognosia is a condition where a patient is unaware or denies their illness, in this case denying their hemiplegia.

Question 4

Which clinical manifestations are produced by damage to the frontal lobes and frontolimbic tracts that impair the normal influence of the limbic system?

Accepted Answer

Damage to the frontal lobes and frontolimbic tracts can result in disinhibition, impulsivity, and mood changes due to impaired regulation by the limbic system. Irritability, mood swings, loss of control, and impulsiveness are examples of such clinical manifestations.

B, C, and D are incorrect because deficits in attention and coherence of thought, loss of motor movement and coordination on the side opposite the damage, and change in level of consciousness and pupillary reaction are more characteristic of damage to other areas of the brain, such as the parietal or occipital lobes, basal ganglia or brainstem, or the reticular activating system, respectively.

Question 5

What causes stage 1 of intracranial hypertension?

Accepted Answer

Stage 1 of intracranial hypertension is characterized by the displacement of cerebrospinal fluid and compression of the cerebral venous system to compensate for increased intracranial pressure.

Question 6

After a cerebrovascular accident,a patient is unable to feel and identify a comb with his eyes closed.This is an example of:

Accepted Answer

Tactile agnosia is the inability to recognize objects by touch, even though sensation is intact. This can occur after a cerebrovascular accident (stroke). Agraphia is the inability to write, anosognosia is the lack of awareness of one's own illness, and prosopagnosia is the inability to recognize familiar faces.

Question 7

Tactile agnosia is related to injury of the:

Accepted Answer

Tactile agnosia is a type of agnosia that affects the ability to recognize objects by touch, despite intact sensory function. It is associated with injury to the parietal lobe, which is involved in sensory processing and perception.

Question 8

Which are characteristics of primary motor neuron amyotrophies?

Accepted Answer

Primary motor neuron amyotrophies are characterized by lower motor neuron signs such as fasciculations and muscle cramps, typically without sensory loss or spasticity.

Question 9

Most dysphasias are associated with cerebrovascular accidents involving which artery?

Accepted Answer

The middle cerebral artery is the most common site of ischemic stroke, which is often associated with dysphasias.

Question 10

Which assessment finding marks the end of spinal shock?

Accepted Answer

The end of spinal shock is marked by the return of deep tendon reflexes and the presence of spastic paralysis, indicating that the spinal cord is beginning to recover from the initial shock phase.

Question 11

What are characteristics of dementia?

Accepted Answer

Loss of recent and remote memory is a common characteristic of dementia. While deficits in attention and coherence of thought may be present, they are not always definitive indicators of the condition. Likewise, while mood changes and irritability can be part of the behavioral symptoms of dementia, they do not necessarily occur in all cases.

Question 12

Why does the ipsilateral pupil dilate following uncal herniation?

Accepted Answer

Uncal herniation occurs when the uncus (part of the temporal lobe) shifts and compresses the oculomotor nerve (CN III). This results in ipsilateral dilation of the pupil.

Question 13

In amyotrophies,the paresis and paralysis are segmental.Why is the segmental character of weakness difficult to recognize?

Accepted Answer

The segmental character of weakness in amyotrophies is difficult to recognize because each muscle is supplied by two or more nerve roots. As a result, weakness affecting one nerve root may be compensated for by the innervation from adjacent roots, making it difficult to detect isolated weakness in a specific segment or muscle group.

Question 14

A patient is admitted to the intensive care unit with a severe closed head injury.He develops regular,deep,and rapid respirations.This is indicative of what level of neurologic injury?

Accepted Answer

The pattern described is consistent with central neurogenic hyperventilation, which is often associated with injury to the midbrain and upper pons.

Question 15

How does the body compensate first when there is a rise in intracranial pressure?

Accepted Answer

The body first compensates for increased intracranial pressure by displacing cerebrospinal fluid (CSF) to maintain normal pressure levels.

Question 16

The nurse notes that a patient with a severe closed head injury has all four extremities in rigid extension and forearm hyperpronation and legs with plantar extension.This finding is documented as __________ posturing.

Accepted Answer

The described posturing is characteristic of decerebrate posturing, which is a more severe form of posturing than decorticate posturing. Decerebrate posturing indicates damage to the brainstem, while decorticate posturing indicates damage to the cerebral hemispheres. Spastic posturing and cerebellar posturing have different characteristics and are not indicated by the described findings.

Question 17

When does uncal herniation occur?

Accepted Answer

Uncal herniation occurs when the uncus, part of the hippocampal gyrus, shifts from the middle fossa through the tentorial notch into the posterior fossa.

Question 18

Which of the following is the most critical index of nervous system dysfunction?

Accepted Answer

Level of consciousness is the most critical index of nervous system dysfunction because it reflects the overall function of the brain, including the cerebral cortex and the brainstem. A decrease in level of consciousness may indicate a wide range of neurological problems, from mild concussion to severe traumatic brain injury or stroke. The size and reactivity of pupils, pattern of breathing, and motor response, while also important, are more specific to certain conditions and may not always reflect the overall function of the nervous system.

Question 19

Damage to tracts from the _____ lobe to the limbic system may also result in alterations in emotional control.

Accepted Answer

The frontal lobe is responsible for emotional control and damage to the tracts from the frontal lobe to the limbic system can result in alterations in emotional control.

Question 20

Which neurologic disorder is characterized by a protein detaching from neurons causing the cortical nerve cell processes that become twisted and dilated?

Accepted Answer

Alzheimer disease is characterized by the accumulation of beta-amyloid protein on the surface of neurons, leading to the detachment of tau protein from the neurons. As a result, cortical nerve cell processes become twisted and dilated, leading to memory impairment, cognitive decline, and behavioral changes.

Quiz 16: Concepts of Neurologic Dysfunction