Pathophysiology: 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
b. Mild but permanent dysfunction
c. Fine motor tremors
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.

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.

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
b. Classic concussion
c. Cortical contusion
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.

Question 4

What group is most at risk of spinal cord injury from minor trauma?

a. Children
b. Adolescents
c. Adults
d. Older adults

Answer 4

ANS: D
Because of preexisting degenerative vertebral disorders, older adults are particularly at risk
for minor trauma, resulting in serious spinal cord injury, especially from falls. The risk to
the other age groups is less than that of the older adult.

Question 5

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 5

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.

Question 6

What indicates that spinal shock is terminating?

a. Voluntary movement below the level of injury
b. Reflex emptying of the bladder
c. Paresthesia below the level of injury
d. Decreased deep tendon reflexes and flaccid paralysis

Answer 6

ANS: B
Indications that spinal shock is terminating include the reappearance of reflex activity,
hyperreflexia, spasticity, and reflex emptying of the bladder. Termination of a spinal cord
injury is not evidenced by any of the other options.

Question 7

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
b. Parasympathetic dysreflexia
c. Autonomic hyperreflexia
d. Retrograde hyperreflexia

Answer 7

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 8

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 theparasympathetic nervous system.
d. The thalamus is unable to regulate body heat as a result of damage to spinal nerve
roots.

Answer 8

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 9

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 -adrenergic receptors to the sinoatrial node

Answer 9

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 10

A herniation of which disk will likely result in motor and sensory changes of the lateral
lower legs and soles of the feet?
a. L2-L3 
b. L3-L5
c. L5-S1 
d. S2-S3

Answer 10

ANS: C
Clinical manifestations of posterolateral protrusions include radicular pain exacerbated by
movement and straining (medial calf suggests L5; lateral calf suggests S1 root
compression). Herniation of any of the other vertebrae will not result in the described
symptoms.

Question 11

Which condition poses the highest risk for a cerebrovascular accident (CVA)?

a. Insulin-resistant diabetes mellitus
b. Hypertension
c. Polycythemia
d. Smoking

Answer 11

ANS: B
Hypertension is the single greatest risk factor for stroke. The other options are recognized
risk factors but do not carry the intensity of hypertension.

Question 12

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
b. Vertebral
c. Posterior cerebral
d. Anterior cerebral

Answer 12

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 13

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

Answer 13

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.

Question 14

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

Answer 14

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 15

Which vascular malformation is characterized by arteries that feed directly into veins
through vascular tangles of abnormal vessels?
a. Cavernous angioma
b. Capillary telangiectasia
c. Arteriovenous angioma
d. Arteriovenous malformation

Answer 15

ANS: D
In only an arteriovenous malformation (AVM), do arteries feed directly into veins through
a vascular tangle of malformed vessels.

Question 16

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 16

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.

Question 17

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

Answer 17

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 18

In adults, most intracranial tumors are located:

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

Answer 18

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 19

In children, most intracranial tumors are located:

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

Answer 19

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.

Question 20

The most common primary central nervous system (CNS) tumor is the:

a. Microglioma
b. Neuroblastoma
c. Astrocytoma
d. Neuroma

Answer 20

ANS: C
Astrocytomas are the most common primary CNS tumors (50% of all brain and spinal
cord tumors). The other options do not occur as frequently.

Question 21

Meningiomas characteristically compress from:

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

Answer 21

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.

Question 22

What is the central component of the pathogenic model of multiple sclerosis?

a. Myelination of nerve fibers in the peripheral nervous system (PNS)
b. Demyelination of nerve fibers in the CNS
c. Development of neurofibrillary tangles in the CNS
d. Inherited autosomal dominant trait with high penetrance

Answer 22

ANS: B
Multiple sclerosis (MS) is an autoimmune disorder diffusely involving the degeneration of
CNS myelin and loss of axons. The other options are not central components of the
pathogenic model of MS.

Question 23

A blunt force injury to the forehead would result in a coup injury to which region of the
brain?
a. Frontal 
b. Temporal
c. Parietal 
d. Occipital

Answer 23

ANS: A
Coup injuries occur directly below the point of impact. Objects striking the front of the
head usually produce only coup injuries (contusions and fractures) because the inner skull
in the occipital area is smooth. A coup injury is not nearly as likely when other portions of
the brain are affected.

Question 24

A blunt force injury to the forehead would result in a contrecoup injury to which region of
the brain?
a. Frontal 
b. Tempora
c. Parietall
d. Occipital

Answer 24

ANS: A
The focal injury produces a contrecoup (on the pole opposite the site of impact) injury.
The frontal portion of the brain is opposite of the site of impact. Objects striking the back
of the head usually result in both coup and contrecoup injuries because of the irregularity
of the inner surface of the frontal bones. A contrecoup injury is not nearly as likely when
other portions of the brain are affected.

Question 25

Spinal cord injuries most likely occur in which region?

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

Answer 25

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 26

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 26

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.

Question 27

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 27

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).

Question 28

The type of vascular malformation that most often results in hemorrhage is:

a. Cavernous angioma
b. Venous angioma
c. Capillary telangiectasia
d. Arteriovenous malformation

Answer 28

ANS: D
In an arteriovenous malformation (AVM), arteries feed directly into veins through a
vascular tangle of malformed vessels, causing venous hemorrhaging. The other options are
not as likely to result in a hemorrhage.

Question 29

Atheromatous plaques are most commonly found:

a. In larger veins
b. Near capillary sphincters
c. At branches of arteries
d. On the venous sinuses

Answer 29

ANS: C
Over 20 to 30 years, atheromatous plaques (stenotic lesions) tend to form at branchings
and curves in the cerebral circulation, not at any of the other options provided.

Question 30

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 30

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.

Question 31

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

Answer 31

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.

Question 32

It is true that Guillain-Barré syndrome (GBS):

a. Is preceded by a viral illness.
b. Involves a deficit in acetylcholine.
c. Results in asymmetric paralysis.
d. Is an outcome of HIV.

Answer 32

ANS: A
GBS is considered to be an autoimmune disease triggered by a preceding bacterial or viral
infection. None of the other options are true of GBS.

Question 33

It is true that myasthenia gravis:

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

Answer 33

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.

Question 34

In which disorder are acetylcholine receptor antibodies (IgG antibodies) produced against
acetylcholine receptors?
a. Guillain-Barré syndrome 
b. Multiple sclerosis
c. Myasthenia gravis 
d. Parkinson disease

Answer 34

ANS: C
The main defect of myasthenia gravis is the formation of autoantibodies (an
immunoglobulin G [IgG] antibody) against receptors at the Ach-binding site on the
postsynaptic membrane. This defect is not found in any of the other options.

Question 35

Multiple sclerosis and Guillain-Barré syndrome are similar in that they both:

a. Result from demyelination by an immune reaction.
b. Cause permanent destruction of peripheral nerves.
c. Result from inadequate production of neurotransmitters.
d. Block acetylcholine receptor sites at the myoneuronal junction.

Answer 35

ANS: A
Acute inflammatory demyelinating polyneuropathy (AIDP) accounts for most occurrences
of Guillain- Barré syndrome (GBS). Multiple sclerosis (MS) is an autoimmune disorder
diffusely involving degeneration of CNS myelin and loss of axons. Only the correct option
accurately describes the similarity between MS and GBS

Question 36

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 36

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.

Question 37

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 37

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.

Question 38

CNS manifestation of tuberculosis

Answer 38

Meningitis

Question 39

Mosquito-borne viral infection

Answer 39

Encephalitis

Question 40

Opportunistic infection

Answer 40

Cryptococcus neoformans

Question 41

Complication of mastoiditis

Answer 41

Brain abscess

Question 42

Tick-borne bacterial infection

Answer 42

Lyme disease