Chapter 11: Neuro Flashcards
What is Charcot triad
Dysarthria, intentional tremor, nystagmus
- More complex patterns of movements, such as throwing a ball or picking up a fork, are controlled by the cortex in the frontal lobe.
A) premotor
B) primary motor
C) reflexive
D) supplementary
A) premotor
- Disorders of the pyramidal tracts, such as a stroke, are characterized by:
A) paralysis.
B) hypotonia.
C) muscle rigidity.
D) involuntary movements.
A) paralysis.
- Myasthenia gravis is characterized by muscle weakness caused by antibody- mediated destruction of:
A) periorbital muscles.
B) thymus gland cells.
C) skeletal muscle fibers.
D) acetylcholine receptors.
D) acetylcholine receptors.
- A patient has wrist inflammation causing compression of the median nerve in the carpal tunnel. Manifestations of this syndrome include:
A) little finger numbness.
B) forearm paresthesia.
C) loss of tendon reflexes.
D) precision grip weakness.
D) precision grip weakness.
- The cardinal symptoms of Parkinson disease include:
A) hypotonia.
B) bradykinesia.
C) paresthesia.
D) lack of sweating.
B) bradykinesia.
- The patient has a traumatic complete spinal cord transection at the C5 level. Intact motor and somatosensory function will include control.
A) bladder
B) finger flexion
C) diaphragm
D) trunk muscle
C) diaphragm
- Unlike disorders of the motor cortex and corticospinal (pyramidal) tract, lesions of the basal ganglia disrupt movement:
A) without causing paralysis.
B) posture and muscle tone.
C) and cortical responses.
D) of upper motor neurons.
A) without causing paralysis.
- The demyelination and degeneration of nerve fibers characteristic of multiple sclerosis is the result of:
A) decreased oligodendrocytes.
B) corticospinal injuries.
C) atherosclerotic destruction.
D) oligodendrocytic infection.
A) decreased oligodendrocytes.
Oligodendrocytes are glial cells in the central nervous system (CNS) that produce myelin sheaths around axons
- A sudden traumatic complete transection of the spinal cord results in
below the level of injury.
A) flaccid paralysis
B) vasoconstriction
C) deep visceral pain
D) 3+ tendon reflexes
A) flaccid paralysis
10 Autonomic dysreflexia (autonomic hyperreflexia) is characterized by:
.
A) severe spinal shock.
B) tachycardia and pale skin.
C) lack of sweat above injury level.
D) vasospasms and hypertension.
D) vasospasms and hypertension.
11 A clinician is assessing the muscle tone of a patient who has been diagnosed
. with a lower motor neuron (LMN) lesion. Which of the following assessment findings is congruent with the patients diagnosis?
A) Hypotonia
B) Spasticity
C) Tetany
D) Rigidity
A) Hypotonia
12 An elderly patient has been brought to his primary care provider by his wife
. who is concerned about his recent decrease in coordination. Upon assessment, his primary care provider notes that the patients gait is wide- based, unsteady, and lacking in fluidity, although his muscle tone appears normal. This patient requires further assessment for which of the following health problems?
A) Muscle atrophy
B) Cerebellar disorders
C) Impaired spinal reflexes
D) Lower motor neuron lesions
B) Cerebellar disorders
13 Knowing that she is a carrier for Duchene muscular dystrophy (DMD), a
. pregnant woman arranged for prenatal genetic testing, during which her child was diagnosed with DMD. As her son develops, the woman should watch for which of the following early signs that the disease is progressing?
A) Impaired sensory perception and frequent wounds
B) Spasticity and hypertonic reflexes
C) Muscle atrophy with decreased coordination
D) Frequent falls and increased muscle size
D) Frequent falls and increased muscle size
14 A patient with a diagnosis of myasthenia gravis has required a mastectomy
. for the treatment of breast cancer. The surgery has been deemed a success, but the patient has gone into a myasthenic crisis on postoperative day one. Which of the following measures should the care team prioritize in this patients immediate care?
A) Positioning the patient to minimize hypertonia and muscle rigidity
B) Seizure precautions
C) Respiratory support and protection of the patients airway
D) Monitoring the patient for painful dyskinesias
C) Respiratory support and protection of the patients airway
15 Which of the following disorders of neuromuscular function typically has
. the most rapid onset?
A) Duchenne muscular dystrophy (DMD)
B) Guillain-Barr syndrome
C) Parkinson disease
D) Myasthenia gravis
D) Myasthenia gravis
16 A patient who experienced a traumatic head injury from a severe blow to the
. back of his head now lives with numerous function deficits, including an inability to maintain steady posture while he is in a standing position, although he is steadier when walking. Which of the following disorders most likely resulted from his injury?
A) Cerebellar dystaxia
B) Cerebellar tremor
C) A lower motor neuron lesion
D) A vestibulocerebellar disorder
D) A vestibulocerebellar disorder
17 A patients recent diagnosis of Parkinson disease has prompted his care
. provider to promptly begin pharmacologic therapy. The drugs that are selected will likely influence the patients levels of:
A) dopamine.
B) acetylcholine.
C) serotonin.
D) adenosine.
A) dopamine.
18 A patient is devastated to receive a diagnosis of amyotrophic lateral sclerosis
. (ALS). The symptomatology of this disease is a result of its effects on:
A) upper motor neurons.
B) the vestibulocerebellar system.
C) upper and lower motor neurons.
D) neuromuscular junctions.
C) upper and lower motor neurons.
19 Restoration of the integrity of myelin sheaths would likely result in a
. slowing or stopping of the progression of:
A) Amyotrophic lateral sclerosis (ALS)
B) Multiple sclerosis (MS)
C) Duchenne muscular dystrophy (DMD)
D) Paralysis caused by Clostridium botulinum
B) Multiple sclerosis (MS)
20 A patient with a spinal cord injury at T8 would likely retain normal motor
. and somatosensory function of her:
A) arms.
B) bowels.
C) bladder.
D) perineal musculature.
A) arms.
myasthenia gravis
In myasthenia gravis, the immune system makes antibodies that block or destroy many of your muscles’ receptor sites for a neurotransmitter called acetylcholine (as-uh-teel-KOH-leen). With fewer receptor sites available, your muscles receive fewer nerve signals. This causes weakness.
Antibodies also can block a protein called muscle-specific receptor tyrosine kinase (TIE-roh-seen KIE-nays), sometimes referred to as MuSK. This protein helps form the nerve-muscle junction. Antibodies against this protein can lead to myasthenia gravis.
- The intracranial volume that is most capable of compensating for increasing intracranial pressure is the:
A) brain cell tissue.
B) intravascular blood.
C) surface sulci fluid.
D) cerebrospinal fluid.
D) cerebrospinal fluid.
- A late indicator of increased intracranial pressure is:
A) tachycardia.
B) right-sided heart failure.
C) narrow pulse pressure.
D) high mean arterial pressure.
D) high mean arterial pressure.
- Extreme cerebral edema may cause the brain to herniate into another compartment. Upward herniation from the infratentorial compartment against the aqueduct of Sylvius causes:
A) hydrocephalus.
B) cardiac arrest.
C) tissue infarction.
D) intracranial bleeding.
A) hydrocephalus.
- Coup and contrecoup cerebral contusion caused by blunt head trauma against a fixed object results in:
A) diffuse axonal injuries.
B) cerebrovascular infarction.
C) momentary unconsciousness.
D) permanent brain tissue damage.
D) permanent brain tissue damage.
- An intracranial epidural hematoma causes focal symptoms that can include:
A) ipsilateral pupil dilation.
B) ipsilateral hemiparesis.
C) diffuse venous bleeding.
D) commuting hydrocephalus.
A) ipsilateral pupil dilation.
- The earliest signs of decreased level of consciousness include:
A) stupor.
B) lethargy.
C) delirium.
D) inattention.
D) inattention.
- Metabolic factors that increase cerebral blood flow include:
A) increased oxygen saturation.
B) increased carbon dioxide level.
C) decreased serum sodium level.
D) decreased hydrogen ion concentration.
B) increased carbon dioxide level.
- Transient ischemic attacks (TIAs) are characterized by ischemic cerebral neurologic deficits that:
A) indicate aneurysm leakage.
B) cause minor residual deficits.
C) affect diffuse cerebral functions.
D) resolve within one hour of onset.
D) resolve within one hour of onset.
- Common manifestations of acute meningococcal meningitis, a highly contagious and lethal form of meningitis, include:
A) diplopia.
B) petechiae.
C) papilledema.
D) focal paralysis.
B) petechiae.
10 The moderate stage of the progressive degenerative Alzheimer-type
. dementia is manifested by behaviors that include:
A) confusion.
B) incontinence.
C) decreased level of consciousness.
D) social withdrawal.
A) confusion.
11 A patients recent computed tomography (CT) scan has revealed the presence
. of hydrocephalus. Which of the following treatment measures is most likely to resolve this health problem?
A) Aggressive diuresis
B) Placement of a shunt
C) Administration of hypertonic intravenous solution
D) Lumbar puncture
B) Placement of a shunt
12 A high school senior sustained a concussion during a football game. Which
. of the following signs and symptoms would indicate the presence of postconcussion syndrome in the days and weeks following his injury?
A) Headaches and memory lapses
B) Recurrent nosebleeds and hypersomnia
C) Unilateral weakness and decreased coordination
D) Neck pain and decreased neck range of motion
A) Headaches and memory lapses
13 An elderly male patient has been brought to the emergency department after
. experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care teams emphasis on restoring circulation?
A) Failure to restore blood flow creates a severe risk for future transient ischemic attacks.
B) Necrosis will continue unabated throughout the brain unless blood flow is restored.
C) Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored.
D) Unless blood flow is restored, the patient faces the risk of progressing to hemorrhagic stroke.
C) Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored.
14 A patients emergency magnetic resonance imaging (MRI) has been
. examined by the physician and tPA has been administered to the patient.
What was this patients most likely diagnosis?
A) Status epilepticus
B) Subarachnoid hemorrhage
C) Ischemic stroke
D) Encephalitis
C) Ischemic stroke
15 A patient has been diagnosed with a cerebral aneurysm and placed under
. close observation before treatment commences. Which of the following pathophysiologic conditions has contributed to this patients diagnosis?
A) Weakness in the muscular wall of an artery
B) Impaired synthesis of clotting factors
C) Deficits in the autonomic control of blood pressure
D) Increased levels of cerebrospinal fluid
A) Weakness in the muscular wall of an artery
16 Which of the following pathophysiologic processes occurs in cases of
. bacterial meningitis?
A) Infection in the cerebrospinal fluid causes vasoconstriction and cerebral hypoxia.
B) Trauma introduces skin-borne pathogens to the cerebrospinal fluid.
C) Infection in the cerebrospinal fluid causes spinal cord compression and neurologic deficits.
D) Inflammation allows pathogens to cross into the cerebrospinal fluid.
D) Inflammation allows pathogens to cross into the cerebrospinal fluid.
17 Which of the following individuals has the highest chance of having a
. medulloblastoma?
A) An 88-year-old man who has begun displaying signs and symptoms of increased ICP
B) A 60-year-old woman who is soon to begin radiation therapy for the treatment of breast cancer
C) A 4-year-old child who has become uncoordinated in recent months
D) A 68-year-old man who is a smoker and has a family history of cancer
C) A 4-year-old child who has become uncoordinated in recent months
primary brain cancer in children. It originates in the part of the brain that is towards the back and the bottom, on the floor of the skull, in the cerebellum, or posterior fossa
18 A patient with a history of a seizure disorder has been observed suddenly
. and repetitively patting his knee. After stopping this repetitive action, the patient appears confused and is oriented to person and place but not time. What type of seizure did this patient most likely experience?
A) Simple partial seizure
B) Atonic seizure
C) Myoclonic seizure
D) Complex partial seizure
D) Complex partial seizure
19 A patient with a long history of cigarette smoking and poorly controlled
. hypertension has experienced recent psychomotor deficits as a result of hemorrhagic brain damage. The patients psychomotor deficits are likely the result of:
A) Alzheimer disease.
B) frontotemporal dementia (FTD).
C) vascular dementia.
D) Wernicke-Korsakoff syndrome.
C) vascular dementia.
20 Which of the following statements by the husband of a patient with
. Alzheimer disease demonstrates an accurate understanding of his wifes medication regimen?
A) Im really hoping these medications will slow down her mental losses.
B) Were both holding out hope that this medication will cure her Alzheimers.
C) I know that this wont cure her, but we learned that it might prevent a bodily decline while she declines mentally.
D) I learned that if we are vigilant about her medication schedule, she may not experience the physical effects of her disease.
A) Im really hoping these medications will slow down her mental losses.
A 30 year old patient presents to the ED with complaints of “the worst headache of her life.” She has a past medical history including hypertension and tobacco use. What kind of hematoma is most likely to be causing her symptoms?
Epidural
Subarachnoid
Subdural
Intracerebral
Subarachnoid
Which of the following conditions is characterized by inflammation of the brain tissue?
Bacterial Meningitis
Myelitis
Viral Meningitis
Encephalitis
Encephalitis
Which is the initial, prominent feature of Lewy body Dementia?
A. executive and visuospatial functioning
B. Rapidly progressive myoclonus symptoms
C. Progressive changes in personality and behavior
D. Difficulty with working and recent memory
A. executive and visuospatial functioning
) One way to determine level of consciousness when assessing a patient with a traumatic brain injury (TBI) is
MRI
CT
ICP
Glasgow Coma Scale
Glasgow Coma Scale
A patient has recently been involved in an MVA and has sustained head trauma, the pt reports having issues with both smell and memory which lobe do you suspect has been affected?
A. Frontal
B. Occipital
C. Parietal
D. Temporal
D. Temporal
Match each of the following with the appropriate description
1.Thalamus A. Coordinates subconscious movements of skeletal muscles & contributes to tone, posture, balance, and equilibrium
2.Hypothalamus B.relays sensory information to the spinal cord and some parts of brain
3.Cerebellum C. controls various homeostatic functions (temp, respirations, Heart rate)
4.Cerebral cortex D. sends message to move skeletal muscles
1 thalamus = B.relays sensory information to the spinal cord and some parts of brain
2 hypthalamus = C. controls various homeostatic functions (temp, respirations, Heart rate)
3 cerebellum = A. Coordinates subconscious movements of skeletal muscles & contributes to tone, posture, balance, and equilibrium
4 cerebral cortex = D. sends message to move skeletal muscles
What is the most common risk factor for thrombotic and embolic CVA’s?
a. Cerebral aneurysms
b. HTN
c. Atherosclerosis
d. Arteriovenous Malformations (AVMs)
c. Atherosclerosis
A 30-year-old woman comes into the clinic complaining of flu-like symptoms after coming back from a safari trip in Africa 4 days ago. Upon exam she complains of weakness, lethargy, joint pain, and a rash covering her face, trunk, and palms. She also discloses she is newly pregnant. Upon further testing she is diagnosed with Zika virus. What are some educational topics for this patient?
a. Close follow-up for 2 years after the baby is born to watch for neurological complications is key.
b. If the patient has a headache, instruct her about utilizing aspirin for the headache.
c. Unprotected sex is okay to have with partners during recovery of the disease.
d. Do not use mosquito repellent with DEET due to environmental concerns.
a. Close follow-up for 2 years after the baby is born to watch for neurological complications is key.
Pathological characteristics associated with Lewey Body dementia include:
Presence of amyloid plaques
Presence of the proteins ubiquiten and synuclein
Presence of neurofibrillary tangles
Abnormal accumulation of TDP-43 and tau protein
Presence of the proteins ubiquiten and synuclein
Clinical manifestations of this autosomal dominant disorder include choreiform movements, psychiatric problems, and eventual dementia. What is the diagnosis?
Parkinson’s Disease
Alzheimer Disease
Myasthenia Gravis
Huntington’s Disease
Huntington’s Disease
epidural hematoma
bleeding between dura and skull - usually arterial tear
common in adolescent as result of trauma
neuro dysfunction few hours after injury (brief loss of consciousness, short period of alertness, then deterioration - vomiting, headache, confusion, seizures)
subdural hematoma
bleeding between dura and arachnoid
cause by small venous tear
symptoms within 24 hours
acute can be deadly
subarachnoid hemmorrhage
bleeding between arachnoid and pia
rupture of an aneurysm or malformation
severe, sudden headache near back of head/location of bleed
why does MS have exacerbations and remissions
disease is caused by the immune system attacking the protective myelin sheath around nerves in the central nervous system, leading to inflammation and damage that can come and go in waves, with periods of active inflammation causing new symptoms or worsening of existing ones (exacerbation), followed by periods where the inflammation subsides and symptoms partially or fully improve (remission).
what are astrocytes
neuroglial cell that provides frameowrk of the brain and spinal cord. controls neurotransmitter elvels and ion levels. form blood-brain barrier
what are oligendrocytes
produce/develop myelin in CNS
what are microglial cells
phagocytic property neuroglial cell
what are ependymal cells
form the epithelial lining of the CNS, produce CSF
what are schwann cells
produce myelin in the PNS
