Chapter 20: Alterations of Neurologic Function in Children Flashcards
The neural groove closes dorsally during which week of gestational life?
a. Second
c. Eighth
b. Fourth
d. Twelfth
ANS: B
During the fourth gestational week, the neural groove deepens, its folds develop laterally,
and it closes dorsally to form the neural tube, epithelial tissue that ultimately becomes the
central nervous system (CNS). The second week is too early, and the other options
represent times periods after the groove closes
Which defect of neural tube closure is most common?
a. Anterior
c. Lateral
b. Posterior
d. Midline
ANS: B
Posterior defects are most common. The other options are not the most common.
PTS: 1 REF: Page 663
What is the anomaly in which the soft bony component of the skull and much of the brain is missing? a. Anencephaly c. Cranial meningocele b. Myelodysplasia d. Hydrocephaly
ANS: A
Anencephaly is an anomaly in which the soft, bony component of the skull and much of
the brain are missing. The other options do not represent this condition.
The most common cause of obstructive hydrocephalus in infants is:
a. Obstructed arachnoid villi
b. Stenosis of the aqueduct of Sylvius
c. Excessive production of cerebrospinal fluid
d. Impaired cerebrospinal fluid circulation in the subarachnoid space
ANS: B
Congenital aqueduct stenosis most commonly causes obstructive hydrocephalus. The other
options do not represent the most common cause of this condition.
PTS: 1 REF: Page 669
What is the term for a herniation or protrusion of brain and meninges through a defect in the skull? a. Encephalocele c. Arachnoidocele b. Meningocele d. Cephacephalocele
ANS: A
Encephalocele refers to a herniation or protrusion of brain and meninges through a defect
in the skull, resulting in a saclike structure. The other terms are not used to describe an
encephalocele.
PTS: 1 REF: Page 664
What is the result of a Chiari type II malformation associated with a myelomeningocele?
a. Upward displacement of the cerebellum into the diencephalon
b. Motor and sensory lesions below the level of the myelomeningocele
c. Downward displacement of the cerebellum, brainstem, and fourth ventricle
d. Generalized cerebral edema and hydrocephalus
ANS: C
One serious, potentially life-threatening problem associated with myelomeningocele is the
Chiari type II malformation. This deformity involves the downward displacement of the
cerebellum, cerebellar tonsils, brainstem, and fourth ventricle. The other options do not
appropriately describe the pathologic characteristics resulting from a Chiari type II
malformation.
Gait disturbances and instability are characteristic of which form of cerebral palsy?
a. Spastic
c. Ataxic
b. Dyskinetic
d. Biochemical
ANS: C
Ataxic cerebral palsy causes damage to the cerebellum and exhibits gait disturbances and
instability. This description is not accurate of the other options.
PTS: 1 REF: Page 672
What is the most common general symptom of a localized childhood brain tumor?
a. Poor bonding
b. Increased intracranial pressure
c. Delayed extinction of newborn reflexes
d. Failure to thrive
ANS: B
Symptoms of brain tumors may be generalized or localized. The most common general
symptom is increased intracranial pressure, which may cause headaches, irritability,
vomiting, somnolence, and bulging of fontanels. The remaining options are not the most
common symptom of a localized childhood tumor.
PTS: 1 REF: Page 685
What term is used to describe a hernial protrusion of a saclike cyst that contains meninges,
spinal fluid, and a portion of the spinal cord through a defect in a posterior arch of a
vertebra?
a. Encephalocele
c. Spina bifida occulta
b. Meningocele
d. Myelomeningocele
ANS: D
Myelomeningocele is a hernial protrusion of a saclike cyst containing meninges, spinal
fluid, and a portion of the spinal cord with its nerves through a defect in the posterior arch
of a vertebra. The remaining options are not appropriate terms to identity the described
condition.
PTS: 1 REF: Pages 664-665
The clinical manifestations of dyskinetic cerebral palsy include:
a. Increased muscle tone and prolonged primitive reflexes
b. Exaggerated deep tendon reflexes, clonus, and rigidity of extremities
c. Scoliosis, contractures, and stiffness of trunk muscles
d. Jerky uncontrolled and abrupt fine musculoskeletal movements
ANS: D
Dyskinetic cerebral palsy is associated with extreme difficulty in fine motor coordination
and purposeful movements. Movements are jerky, uncontrolled, and abrupt, resulting from
injury to the basal ganglia or thalamus. The symptoms presented by the other options are
not associated with this form of cerebral palsy.
PTS: 1 REF: Page 672
. Which musculoskeletal deformities are associated with myelomeningocele? (Select all that
apply. )
a. Extra digits on feet
b. Clubfoot
c. Dislocation of the hips
d. Scoliosis
e. Kyphosis
ANS: B, C, D, E
Several musculoskeletal deformities are related to myelomeningocele, including clubfoot,
dislocation of hip or hips, and poor spinal alignment. Spinal deformities, such as scoliosis
and kyphosis, are also common. Extra digits are not associated with myelomeningocele.
PTS: 1 REF: Page 665
True microcephaly can be caused by: (Select all that apply.)
a. Autosomal gene alterations
b. Prenatal physical abuse of the mother
c. X-linked gene alterations
d. Toxic-induced chromosomal defects
e. Maternal anorexia
ANS: A, C, D
Genetic alterations, including autosomal dominant, autosomal recessive or X-linked genes,
or various chromosomal abnormalities can cause true (primary) microcephaly (present at
birth). Environmental causes include toxin exposure during the period of induction and
major cell migration. Radiation, intrauterine infection, or chemical exposure may be the
initiating factor. Secondary microcephaly (developing postnatally) is associated with a
variety of causes including infection, trauma, metabolic disorders, maternal anorexia
experienced during the third trimester of pregnancy, and the presence of other genetic
syndromes.
Which statements regarding the term myelodysplasia are true? (Select all that apply.)
a. Myelodysplasia is used to define a defect in the formation of the spinal cord.
b. It can be used to refer to brain anomalies involving missing brain tissue.
c. Myelodysplasia correctly includes encephaloceles.
d. It is used to describe a herniation of brain and meninges through a defect in the
skull.
e. Myelodysplasia can be used to refer to a form of spina bifida
ANS: A, E
Although myelodysplasia is defined as a defect in the formation of the spinal cord, the
term is also used to refer to anomalies of both the vertebral column and the spinal cord.
Birth defects in which the vertebrae fail to close are known as spina bifida (split spine).
Anencephaly is an anomaly in which the soft, bony component of the skull and much of
the brain are missing. Encephalocele refers to a herniation or protrusion of various
amounts of brain and meninges through a defect in the skull, resulting in a saclike
structure.
PTS: 1 REF: Page 663
Match the tumor name with its site of development.
______ A. Medulloblastoma
______ B. Ependymoma
______ C. Cerebellar astrocytoma
______ D. Craniopharyngioma
______ E. Neuroblastoma
22. Originates in the neural crest that normally forms the sympathetic ganglia and adrenal
medulla.
23. Develops in the fourth ventricle.
24. Develops in the vermis of the cerebellum and may extend to the fourth ventricle.
25. Originates from the pituitary or hypothalamus.
26. Causes unilateral symptoms such as nystagmus.
- ANS: E PTS: 1 REF: Page 684
MSC: A neuroblastoma is an embryonal aggressive tumor that originates in the neural crest cells
that normally give rise to the sympathetic nervous system (sympathetic ganglia and the adrenal
medulla). - ANS: B PTS: 1 REF: Page 683
MSC: The ependymoma develops in the fourth ventricle and arises from the ependymal cells that
line the ventricular system. - ANS: A PTS: 1 REF: Page 683
MSC: A medulloblastoma is an embryonal tumor and the most common childhood malignant
tumor. It occurs as an invasive tumor that develops in the vermis of the cerebellum and may extend
into the fourth ventricle. - ANS: D PTS: 1 REF: Page 683
MSC: The area of the sella turcica, the structure containing the pituitary gland, is the site of
several childhood brain tumors, including craniopharyngioma (the most common). These tumors may originate from the pituitary gland or the hypothalamus. - ANS: C PTS: 1 REF: Page 683
MSC: Cerebellar astrocytomas are located on the surface of the right or left cerebellar hemisphere
and cause unilateral symptoms (occurring on the same side of the tumor), such as head tilt, limb
ataxia, and nystagmus when the eyes are turned toward the tumor.
