Neurobehavioral, Psychophysiological, and Endocrine Disorders

Question 1

What is the difference between a closed-head and open-head injury?

Answer 1

A closed-head injury is when the head is hit but there is no penetration, and the open-head injury is when the skull is penetrated.

Question 1

What is a TBI?

Answer 1

TBI stands for Traumatic Brain Injury (or traumatic head injury, cerebral trauma). It refers to an injury to the brain caused by an external force that can cause temporary or permanant impairment in cognitive, behavioral and/or physical functioning.

Question 2

What problems can a closed-head injury cause?

Answer 2

It can cause a blow (at the site of injury) and bruising on the opposite side of the brain, which can also lead to hemorrhage (bleeding) and edema (collection of fluid around the damages tissue). The damage can cause an alteration or loss of consciousness, and some degree of anterograde and retrograde amnesia.

Question 3

What problems can a open-head injury cause?

Answer 3

The skull is penetrated and there is no loss of consciousness, but the injury is localised and the symptoms are very specific to the injury.

Question 4

How is the level of severity of a TBI assessed?

Answer 4

It is assessed based on several factors, including the initial score on the Glasgow Coma Scale (GCS; lower score is more severe), duration of posttraumatic amnesia (PTA; longer duration is worst), and duration of the loss of consciousness (LOC; longer duration is worst).

Question 5

What does posttraumatic amnesia refer to?

Answer 5

It refers to post-injury anterograde amnesia and its duration is a good predictor of recovery.

Question 6

What is retrograde amnesia, and what is the shrinking retrograde amnesia phenomenon?

Answer 6

Loss of recent memories. For patients with retrograde amnesia, recovery of long-term memories usually involves “shrinking retrograde amnesia”, in which the most remote memories return first.

Question 7

What factors can influence (moderate) the recovery from TBI; name 6 ?

Answer 7

1. Severity of injury
2. Age
3. Gender
4. Socioeconomic status
5. Preinjury physical and mental functioning
6. Genes (allele e4 on Apoliproprotein E (ApoE) gene).

Question 8

During what period does the greatest amount of recovery from TBI happens?

Answer 8

The first three months (with considerable additional recovery through the first year).

Question 9

What is the postconcussional syndrome (PCS) ?

Answer 9

it refers to a patterns of somatic and psychological symptoms that occur in up to 50% or more of individuals who have experiences a mild brain injury.

Question 10

What are the common initial symptoms of postconcussional syndrome (PCS); name 5 ?

Answer 10

1. headache
2. dizziness
3. nausea
4. blurred vision
5. drowsiness

Question 11

Name 6 other symptoms that can be present in the postconcussional syndrome (PCS) after the initial phase.

Answer 11

1. insomnia
2. fatigue
3. tinnitus
4. cognitive impairment (memory, attention, concentration, processing speed)
5. irritability
6. depression or anxiety

Question 12

What is the primary organic cause that has been linked to postconcussional syndrome (PCS)?

Answer 12

Diffuse axonal injury

Question 13

What is the recovery time for postconcussional syndrome (PCS)?

Answer 13

The majority recover within one to three months, but some have persisting symptoms. For those whose symptoms last for more than a year, symptoms may be permanant.

Question 14

What is a cerebrovascular accident (CVA) ?

Answer 14

It is also called a stroke, and refers to the onset of neurological symptoms resulting from disruption in the blood supply to the brain.

Question 15

What are the three major causes of cerebrovascular accident (CVA) ?

Answer 15

1. thrombosis (blockage or an artery by blood clot)
2. embolism (sudden blockage of an artery by material from another part of the bloodstream)
3. hemorrhage.

Question 16

Name 2 major risk factors of a cerebrovascular accident (CVA).

Answer 16

1. hypertension
2. atherosclerosis (thickening of the lining of the arterial walls)

Question 17

Name 6 symptoms that can occur when the middle cerebral artery is affected during a stroke.

Answer 17

1. contralateral hemiplegia and hemianesthesia
2. contralateral homonymous hemianopia
3. dysarthia
4. aphasia
5. apraxia
6. sensory neglect

Question 18

Question ID #14133: Normally damage to the subthalamus causes involuntary jerking and twitching movements. However, in individuals with __________, damage to this region brings motor activity back to normal.

Select one:

A.Amyotrophic lateral sclerosis (ALS)

B.Alzheimer’s disease

C.Huntington’s disease

D.Parkinson’s disease

Answer 18

The correct answer is D.

Parkinson’s disease is a brain disorder that leads to shaking, stiffness, and difficulty with walking, balance, and coordination. Parkinson’s symptoms usually begin gradually and get worse over time. Lesioning or stimulating the subthalamic nucleus in Parkinson’s disease alleviates many of the movement symptoms associated with Parkinson’s disease.

Answer A: Amyotrophic lateral sclerosis (ALS) is a disease of the parts of the nervous system that control voluntary muscle movement. In ALS, motor neurons are gradually lost, the muscles they control become weak and then nonfunctional, thus leading to muscle weakness, disability, and eventually death.

Answer B: Alzheimer’s disease is a progressive disease, where dementia symptoms gradually worsen over several years and are the most common form of dementia.

Answer C: Huntington’s disease is a rare, inherited disease that causes the progressive breakdown of nerve cells in the brain. It has a broad impact on a person’s functional abilities and usually results in movement, thinking, and cognitive disorders.

Question 19

Question ID #14134: For many patients with mild traumatic brain injury, the greatest amount of recovery occurs during the first ______ following the injury.

Select one:

A.3 weeks

B.3 months

C.6 months

D.9 months

Answer 19

The correct answer is B.

Recovery from a mild traumatic brain injury depends on several factors and, therefore, varies from person to person. But for the majority of individuals with mild TBI, the greatest amount of recovery occurs during the first three months following the injury.

Answers A, C, and D: These answers are incorrect. See rationale for Answer B.

Question 20

Question ID #14135: What type of seizure affects movement and sensation on one side of the body without a loss of consciousness?

Select one:

A.Absence

B.Tonic-clonic

C.Complex partial

D.Simple partial

Answer 20

The correct answer is D.

Simple partial seizures affect one side of the body (at least initially) and do not involve a loss of consciousness.

Answer A: Absence (petit mal) seizures are brief attacks involving a loss of consciousness and without obvious motor symptoms.

Answer B: Tonic-clonic (grand mal) seizures involve the body stiffening following by a stage of rhythmic shaking of the limbs and resolves with confusion or amnesia about the event.

Answer C: Complex partial seizures entail some alteration in consciousness.

Question 21

Question ID #14136: A young woman says that she always feels cold, is frequently depressed and has trouble concentrating, is lethargic, has lost interest in sex, and has gained weight even though her eating habits have not changed. These symptoms are most suggestive of which of the following endocrine disorders?
Select one:

A.Diabetes insipidus

B.Hypothyroidism

C.Hypoglycemia

D.Hyperthyroidism

Answer 21

The correct answer is B.

Hypothyroidism is caused by hyposecretion of thyroxine and is associated with the symptoms listed in this question.

Answer A: Diabetes insipidus is caused by hyposecretion of antidiuretic hormone and produces excessive urination.

Answer C: Hypoglycemia is caused by excessive insulin which produces low blood glucose leading to hunger, dizziness, blurred vision, anxiety, and depression.

Answer D: Grave’s disease is another name for hyperthyroidism, which is caused by hypersecretion of thyroxin and is associated with an elevated body temperature, increased appetite with weight loss, emotional liability, and reduced attention span.

Question 22

Question ID #14137: Which of the following is not a recommended treatment for migraine headaches?
Select one:

A.Nonsteroidal anti-inflammatory drugs

B.SSRIs

C.Thermal biofeedback

D.Gentle exercise

Answer 22

The correct answer is D.

Although gentle exercise may help some migraine sufferers, it is not included in the recommended treatment options for migraine headaches.

Answers A, B, and C: All of these are recommended treatments for migraine headaches.

Question 23

Question ID #14138: A 36-year-old man presents with symptoms of apathy, muscle problems, fidgeting, and forgetfulness. These symptoms seem to progress in intensity and frequency as time goes on. He is most likely suffering from which disease?
Select one:

A.Dementia

B.Huntington’s disease

C.Parkinson’s disease

D.Amyotrophic lateral sclerosis (ALS)

Answer 23

The correct answer is B.

Huntington’s disease is a rare, genetic disease that causes the progressive breakdown of nerve cells in the brain. It results in disordered movement, thinking, and cognition.

Answer A: Dementia involves a progressive loss of cognitive functioning. There are many subtypes of dementia including, but not limited to, Alzheimer’s disease.

Answer C: Parkinson’s is a brain disorder that leads to stiffness, shaking, and difficulty with walking, balance, and coordination. Parkinson’s symptoms usually start off gradually and become more intense as time progresses.

Answer D: ALS is a fatal disease of the nervous system. Characteristic symptoms of ALS include muscle weakness, loss of voluntary movement, and progressing overall disability.

Question 24

Traumatic brain injury (TBI) may be the result of either a closed- or open-head injury. A closed-head injury usually causes an alteration or loss of (1)________ and some degree of anterograde and retrograde amnesia.

Answer 24

(1) consciousness

Question 25

Level of severity of a TBI is often determined by considering the person’s initial score on the (2) ________, duration of (3) ________, and duration of loss of consciousness.

Answer 25

(2) Glasgow Coma Scale
(3) posttraumatic amnesia

Question 26

The term posttraumatic amnesia is usually used to refer to (4) ________ amnesia.

Answer 26

(4) anterograde

Question 27

When retrograde amnesia occurs, (5) ________ memories return first.

Answer 27

(5) remote

Question 28

Recovery from TBI is moderated by a number of factors but, in general, the greatest amount of recovery occurs during the first (6) ________ months.

Answer 28

(6) three

Question 29

As described in the DSM-5, the diagnosis of Neurocognitive Disorder Due to Traumatic Brain Injury requires that symptoms meet the criteria for Major or Mild Neurocognitive Disorder plus evidence of a traumatic brain injury with loss of (7) ________, (8)________, disorientation and confusion, and/or neurological signs.

Answer 29

(7) consciousness
(8) posttraumatic amnesia

Question 30

Common symptoms of a stroke (cerebrovascular accident) include contralateral hemiplegia, contralateral (9) ________, and contralateral visual field loss.

Answer 30

(9) hemianesthesia

Question 31

When the stroke involves the (10) ________ cerebral artery, symptoms may include dysarthia, aphasia, or apraxia.

Answer 31

(10) middle

Question 32

Huntington’s disease is due to an (11) ________ dominant gene and is characterized by a combination of psychiatric, cognitive, and motor symptoms. It has been linked to degeneration of (12)________-secreting cells and glutamate excitotoxicity in certain structures of the basal ganglia.

Answer 32

(11) autosomal
(12) GABA

Question 33

Parkinson’s disease is due to the degeneration of (13)________- containing cells in the substantia nigra and involves tremor at rest, (14)________ (“cruel restlessness”), muscle rigidity, and (15) ________ (a reduction or absence of spontaneous movement).

Answer 33

(13) dopamine
(14) akathisia
(15) akinesia

Question 34

(16) _______ (grand mal) seizures involve stiffening of the body followed by rhythmic shaking of the limbs, while (17)________ (petit mal) seizures are characterized by loss of consciousness without prominent motor symptoms.

Answer 34

(16) tonic-clonic
(17) absence

Question 35

(18) ________ seizures begin in one side of the brain and affect one side of the body, at least initially.

Answer 35

(18) partial

Question 36

Multiple sclerosis is a progressive disease of the nervous system that involves degeneration of the (19)________ that surrounds nerve fibers in the brain and spinal cord. Initial symptoms include optic neuritis, fatigue, motor impairments, and (20) ________ abnormalities.

Answer 36

(19) myelin
(20) sensory