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Neuromuscular Junction
MULTIPLE CHOICE
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
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
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
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
3. Which disorder has clinical manifestations that include decreased consciousness for up to 6
a. Mild concussion
b. Classic concussion
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
4. What group is most at risk of spinal cord injury from minor trauma?
a. Children
c. Adults
b. Adolescents
d. Older adults
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.
PTS: 1
5. The edema of the upper cervical cord after spinal cord injury is considered life threatening
a.
b.
c.
d.
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
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.
PTS: 1
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
c. Autonomic hyperreflexia
b. Parasympathetic dysreflexia
d. Retrograde hyperreflexia
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.
PTS: 1
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
d. The thalamus is unable to regulate body heat as a result of damage to spinal nerve
roots.
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.
PTS: 1
atrioventricular node
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.
PTS: 1
10. A herniation of which disk will likely result in motor and sensory changes of the lateral lower
c. L5-S1
d. S2-S3
ANS: C
11. Which condition poses the highest risk for a cerebrovascular accident (CVA)?
a. Insulin-resistant diabetes mellitus
c. Polycythemia
b. Hypertension
d. Smoking
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.
PTS: 1
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?
c. Posterior cerebral
a. Middle cerebral
b. Vertebral
d. Anterior cerebral
ANS: D
Symptoms of an embolic stroke in only the right anterior cerebral artery would include leftsided 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.
PTS: 1
13. Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which
type of stroke?
a. Hemorrhagic
b. Thrombotic
c. Embolic
d. Lacunar
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
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
ANS: C
15. Which vascular malformation is characterized by arteries that feed directly into veins through
c. Arteriovenous angioma
d. Arteriovenous malformation
ANS: D
In only an arteriovenous malformation (AVM), do arteries feed directly into veins through a
vascular tangle of malformed vessels.
PTS: 1
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
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
17. Which cerebral vascular hemorrhage causes meningeal irritation, photophobia, and positive
c. Epidural
d. Subdural
ANS: B
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.
PTS: 1
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
20. The most common primary central nervous system (CNS) tumor is the:
a. Microglioma
c. Astrocytoma
b. Neuroblastoma
d. Neuroma
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.
PTS: 1
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
ANS: B
23. A blunt force injury to the forehead would result in a coup injury to which region of the brain?
a. Frontal
c. Parietal
b. Temporal
d. Occipital
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.
PTS: 1
24. A blunt force injury to the forehead would result in a contrecoup injury to which region of the
brain?
a. Frontal
b. Temporal
c. Parietal
d. Occipital
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.
PTS: 1
Vertebral injuries most often occur at vertebrae C1-C2 (cervical), C4-C7, and T1-L2 (thoracic
lumbar). None of the other options are applicable.
PTS: 1
26. The most likely rationale for body temperature fluctuations after cervical spinal cord injury is
temperature.
d. Developed septicemia from posttrauma infection.
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
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
ANS: C
28. The type of vascular malformation that most often results in hemorrhage is:
a. Cavernous angioma
c. Capillary telangiectasia
b. Venous angioma
d. Arteriovenous malformation
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.
PTS: 1
a. In larger veins
b. Near capillary sphincters
c. At branches of arteries
d. On the venous sinuses
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.
PTS: 1
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
ANS: A
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
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
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
34. In which disorder are acetylcholine receptor antibodies (IgG antibodies) produced against
acetylcholine receptors?
a. Guillain-Barr syndrome
b. Multiple sclerosis
c. Myasthenia gravis
d. Parkinson disease
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.
PTS: 1
35. Multiple sclerosis and Guillain-Barr 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.
ANS: A
MULTIPLE RESPONSE
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
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
37. What are the initial clinical manifestations immediately noted after a spinal cord injury?
a.
b.
c.
d.
e.
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
MATCHING
Meningitis
Encephalitis
Cryptococcus neoformans
Brain abscess
Lyme disease
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.