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

Question 1

Diffuse axonal injuries (DAIs) of the brain often result in:

a. Reduced levels of consciousness
c. Fine motor tremors
b. Mild but permanent dysfunction
d. Visual disturbances

Answer 1

ANS: A
Focal brain injuries account for more than two-thirds of head injury deaths; DAIs accounts
for less than one third. However, more severely disabled survivors, including those in an
unresponsive state or reduced level of consciousness, have DAIs. The other options do not
appropriately complete the stem.
PTS: 1 REF: Page 582

Question 2

What event is most likely to occur to the brain in a classic cerebral concussion?

a. Brief period of vital sign instability
b. Cerebral edema throughout the cerebral cortex
c. Cerebral edema throughout the diencephalon
d. Disruption of axons extending from the diencephalon and brainstem

Answer 2

ANS: A
Transient cessation of respiration can occur with brief periods of bradycardia, and a
decrease in blood pressure occurs, lasting 30 seconds or less. Vital signs stabilize within a
few seconds to within normal limits. The other options do not accurately describe an event
associated with a classic cerebral concussion.
PTS: 1 REF: Page 588

Question 3

Which disorder has clinical manifestations that include decreased consciousness for up to
6 hours, as well as retrograde and posttraumatic amnesia?
a. Mild concussion
c. Cortical contusion
b. Classic concussion
d. Acute subdural hematoma

Answer 3

ANS: B
Evidence of a classic concussion is the immediate loss of consciousness, which lasts less
than 6 hours. Retrograde and anterograde (posttraumatic) amnesia is also present. The
other options do not apply.
PTS: 1 REF: Page 588

Question 4

The edema of the upper cervical cord after spinal cord injury is considered life threatening
because of which possible outcome?
a. Hypovolemic shock from blood lost during the injury
b. Breathing difficulties from an impairment to the diaphragm
c. Head injury that likely occurred during the injury
d. Spinal shock immediately after the injury

Answer 4

ANS: B
In the cervical region, spinal cord swelling may be life threatening because of the
possibility of resulting impairment of the diaphragm function (phrenic nerves exit C3-C5).
The other options do not appropriately explain the threat.
PTS: 1 REF: Page 591

Question 5

What term is used to describe the complication that can result from a spinal cord injury
above T6 that is producing paroxysmal hypertension, as well as piloerection and sweating
above the spinal cord lesion?
a. Craniosacral dysreflexia
c. Autonomic hyperreflexia
b. Parasympathetic dysreflexia
d. Retrograde hyperreflexia

Answer 5

ANS: C
Individuals most likely to be affected have lesions at the T6 level or above. 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)
characterize autonomic hyperreflexia. No other options appropriately describe this
complication.

Question 6

Why does a person who has a spinal cord injury experience faulty control of sweating?
a. The hypothalamus is unable to regulate body heat as a result of damage to the
sympathetic nervous system.
b. The thalamus is unable to regulate body heat as a result of damage to the
sympathetic nervous system.
c. The hypothalamus is unable to regulate body heat as a result of damage to the parasympathetic nervous system.
d. The thalamus is unable to regulate body heat as a result of damage to spinal nerve
roots

Answer 6

ANS: A
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 other options do not
appropriately describe the process that causes faulty control of sweating

Question 7

Autonomic hyperreflexia–induced bradycardia is a result of stimulation of the:
a. Sympathetic nervous system to ß-adrenergic receptors to the sinoatrial node
b. Carotid sinus to the vagus nerve to the sinoatrial node
c. Parasympathetic nervous system to the glossopharyngeal nerve to the
atrioventricular node
d. Bundle branches to the D-adrenergic receptors to the sinoatrial node

Answer 7

ANS: B
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 process is not appropriately described by the other
options.

Question 8

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?
a. Middle cerebral
c. Posterior cerebral
b. Vertebral
d. Anterior cerebral

Answer 8

ANS: D
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) 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 9

. Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for
which type of stroke?
a. Hemorrhagic 
c. Embolic
b. Thrombotic 
d. Lacunar

Answer 9

ANS: C
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. These are not risk factors for the other options provided.
PTS: 1 REF: Page 599

Question 10

Microinfarcts resulting in pure motor or pure sensory deficits are the result of which type
of stroke?
a. Embolic 
c. Lacunar
b. Hemorrhagic 
d. Thrombotic

Answer 10

ANS: C
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 11

Which clinical finding is considered a diagnostic indicator for an arteriovenous
malformation (AVM)?
a. Systolic bruit over the carotid artery
b. Decreased level of consciousness
c. Hypertension with bradycardia
d. Diastolic bruit over the temporal artery

Answer 11

ANS: A
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.
PTS: 1 REF: Page 605

Question 12

Which cerebral vascular hemorrhage causes meningeal irritation, photophobia, and
positive Kernig and Brudzinski signs?
a. Intracranial 
c. Epidural
b. Subarachnoid 
d. Subdural

Answer 12

ANS: B
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 13

In adults, most intracranial tumors are located:

a. Infratentorially
c. Laterally
b. Supratentiorially
d. Posterolaterally

Answer 13

ANS: A
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 14

In children, most intracranial tumors are located:

a. Infratentorially
c. Laterally
b. Supratentiorially
d. Posterolaterally

Answer 14

ANS: B
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.
PTS: 1 REF: Page 626

Question 15

Meningiomas characteristically compress from:

a. Within neural tissues
c. Outside the spinal cord
b. Outside spinal nerve roots d. Within the subarachnoid space

Answer 15

ANS: C
Extramedullary spinal cord tumors produce dysfunction by compression of adjacent tissue,
not by direct invasion. The pathologic characteristic of meningiomas is not appropriately
described by the other options.
PTS: 1 REF: Page 633

Question 16

Spinal cord injuries most likely occur in which region?

a. Cervical and thoracic
c. Lumbar and sacral
b. Thoracic and lumbar
d. Cervical and thoracic-lumbar

Answer 16

ANS: D
Vertebral injuries most often occur at vertebrae C1-C2 (cervical), C4-C7, and T1-L2
(thoracic lumbar). None of the other options are applicable

Question 17

The most likely rationale for body temperature fluctuations after cervical spinal cord
injury is that the person has:
a. Developed bilateral pneumonia or a urinary tract infection.
b. Sustain sympathetic nervous system damage resulting in disturbed thermal control.
c. Sustained a head injury that damaged the hypothalamus’s ability to regulate
temperature.
d. Developed septicemia from posttrauma infection.

Answer 17

ANS: B
Spinal cord injuries result in disturbed thermal control because the sympathetic nervous
system is damaged. None of the remaining options explain this complication.
PTS: 1 REF: Page 592

Question 18

A man who sustained a cervical spinal cord injury 2 days ago suddenly develops severe
hypertension and bradycardia. He reports severe head pain and blurred vision. The most
likely explanation for these clinical manifestations is that he is:
a. Experiencing acute anxiety
b. Developing spinal shock
c. Developing autonomic hyperreflexia
d. Experiencing parasympathetic areflexia

Answer 18

ANS: C
Autonomic hyperreflexia is the only option that 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 per minute).
PTS: 1 REF: Pages 593-594

Question 19

Multiple sclerosis is best described as a(an):
a. Central nervous system demyelination, possibly from an immunogenetic virus
b. Inadequate supply of acetylcholine at the neurotransmitter junction as a result of an
autoimmune disorder
c. Depletion of dopamine in the central nervous system as a result of a virus
d. Degenerative disorder of lower and upper motor neurons caused by viral-immune
factors

Answer 19

ANS: A
Multiple sclerosis (MS) is an autoimmune disorder diffusely involving the degeneration of
central nervous system (CNS) myelin and loss of axons. MS is described as occurring
when a previous infectious insult to the CNS has occurred in a genetically susceptible
individual with a subsequent abnormal immune response in the CNS. The other options do
not adequately describe MS.
PTS: 1 REF: Pages 618-619

Question 20

What is the most common opportunistic infection associated with acquired
immunodeficiency syndrome (AIDS)?
a. Non-Hodgkin lymphoma 
c. Toxoplasmosis
b. Kaposi sarcoma 
d. Cytomegalovirus

Answer 20

ANS: C
Toxoplasmosis is the most common opportunistic infection and occurs in approximately
one third of individuals with AIDS. Cytomegalovirus encephalitis is common in those with
AIDS but is often not diagnosed while the person is alive. Other neoplasms associated
with human immunodeficiency virus (HIV) include systemic non-Hodgkin lymphoma and
metastatic Kaposi sarcoma.
PTS: 1 REF: Page 617

Question 21

It is true that myasthenia gravis:

a. Is an acute autoimmune disease.
c. May result in adrenergic crisis.
b. Affects the nerve roots.
d. Causes muscle weakness.

Answer 21

ANS: D
Exertional fatigue and weakness that worsens with activity, improves with rest, and recurs
with resumption of activity characterizes myasthenia gravis. None of the other options are
true of myasthenia gravis.
PTS: 1 REF: Page 626

Question 22

Which clinical manifestation is characteristic of cluster headaches? (Select all that apply.)

a. Preheadache aura
b. Severe unilateral tearing
c. Gradual onset of a tight band around the head
d. Significant unilateral, temporal pain
e. Pain lasting from 30 to 120 minutes

Answer 22

ANS: B, C, E
The cluster 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. Neither preheadache aura nor significant unilateral, temporal pain is clinical
manifestation characteristic of cluster headaches.
PTS: 1 REF: Pages 608-609

Question 23

What are the initial clinical manifestations immediately noted after a spinal cord injury?
(Select all that apply.)
a. Headache
b. Bladder incontinence
c. Loss of deep tendon reflexes
d. Hypertension
e. Flaccid paralysis

Answer 23

ANS: B, C, E
A complete loss of reflex function in all segments below the level of the lesion
characterizes a spinal cord injury. Severe impairment below the level of the lesion is
obvious; it includes paralysis and flaccidity in muscles, absence of sensation, loss of
bladder and rectal control, transient drop in blood pressure, and poor venous circulation.
Neither headache nor hypertension is an initial clinical manifestation related to a spinal
cord injury.
PTS: 1 REF: Page 592

Question 24

Match the terms with the corresponding descriptions.
\_\_\_\_\_\_ A. Complication of mastoiditis
\_\_\_\_\_\_ B. Opportunistic infection
\_\_\_\_\_\_ C. CNS manifestation of tuberculosis
\_\_\_\_\_\_ D. Mosquito-borne viral infection
\_\_\_\_\_\_ E. Tick-borne bacterial infection
38. Meningitis
39. Encephalitis
40. Cryptococcus neoformans
41. Brain abscess
42. Lyme disease

Answer 24

38. ANS: C PTS: 1 REF: Pages 611-612
    MSC: Tubercular meningitis is the most common and serious form of central nervous system
    (CNS) tuberculosis.
39. ANS: D PTS: 1 REF: Page 614
    MSC: Encephalitis is an acute febrile illness, usually of viral origin, with nervous system
    involvement. Arthropod-borne (mosquito-borne) viruses and herpes simplex cause the most
    common encephalitides.
40. ANS: B PTS: 1 REF: Page 617
    MSC: Opportunistic infections may be bacterial, fungal, protozoal, or viral in origin and produce
    nervous system disease. Cryptococcus neoformans is an example of such an infection
41. ANS: A PTS: 1 REF: Page 613
    MSC: Abscesses may occur in association with a contiguous spread of infection, such as the
    middle ear, mastoid cells, nasal cavity, and nasal sinuses.
42. ANS: E PTS: 1 REF: Page 617
    MSC: Lyme disease, a tick-borne spirochete bacterial infection, is a common arthropod-borne
    infection in the United States