EXAM 2 PATHO REVIEW QUESTIONS

EXAM 2 PATHO REVIEW QUESTIONS 1. Which statement is accurate? A. Allergy means a hypersensitivity to environmental antigens. Correct B. Immunity means an altered immunologic response. C. Hypersensitivity means the protective response to an antigen. D. Autoimmunity means the normal response to foreign antigens. Allergy - a hypersensitivity to environmental antigens. Immunity - is the protective response to antigens. Hypersensitivity - is the altered immunologic response to an antigen. Autoimmunity - is a disturbance in the immunologic tolerance of self-antigens. 2. An accurate description of a type I reaction would be that it: A. is mediated by IgA. B. is generally allergic in nature. Correct C. most often occurs against medications. D. seldom contributes to autoimmune diseases. Most type I reactions are allergic. They are mediated by IgE. Most occur against environmental antigens and do contribute to some autoimmune diseases. 3. When considering serum sickness, which is correct? Serum sickness is: A. caused by the formation of immune complexes. Correct B. the result of the deposition of complexes in the lungs. C. the result of cytotoxic T-cell reactions to antigens. D. created by the binding of the antigen to the cell surface. Serum sickness reactions are caused by the formation of immune complexes in the blood and their deposition in target tissues. An Arthus reaction deposits complexes into the walls of blood vessels. Type IV mechanisms occur through either cytotoxic T lymphocytes or lymphokine-producing Th1 cells. Antigen is bound to the cell surface in type II reactions. 4. A type IV allergic reaction will: A. be immediate in its action. B. result in an infiltration of B cells. C. create a red, soft-centered lesion. D. be transferred by cells. Correct Type IV hypersensitivity reactions can be transferred by cells (cell-mediated), but not by serum. They are delayed as their onset takes from 24 to 72 hours. The site is infiltrated with T lymphocytes and macrophages. There is a clear hard center with surrounding erythema (redness). 5. A patient who presents with systemic lupus erythematosus (SLE) is likely to: A. be male. B. be white. C. report symptoms of arthritis. Correct D. experience memory loss. SLE is characterized by an autoimmune disease, such as arthritis, and is more common in women and in blacks. Memory loss is not generally associated with this disorder. 6. Which of the following is TRUE regarding organ transplant rejection? A. The rejection is type IV hypersensitivity. Correct B. Hyperacute rejection is common. C. Acute rejection occurs within months to years. D. Without drugs, it takes years for rejection. This is a type IV cell–mediated hypersensitivity reaction. Hyperacute rejection is rare. Acute rejection occurs within days to months. Rejection may occur in 2 weeks if immunosuppressive drugs are not used. 7. Which is true for a patient who is transfused with a unit of unmatched packed RBCs? The unit: A. now has only three different RBC antigens. B. is type AB blood and will have anti-A and anti-B antibodies. C. is type O blood and will have neither A nor B antigens. Correct D. is type A blood and will have anti-O antibodies. Type O blood does not contain A or B antigens. There are 80 major different red cell antigens. A patient with type A blood carries anti-B antibodies. A patient with type B blood carries anti-A antibodies. A patient with type AB blood lacks both anti-A and anti-B antibodies. Those with type O blood have both anti-A and anti-B antibodies. 8. A patient who is a type AB+ blood will: A. not produce anti-D antibodies. Correct B. have one genotype, DD. C. have the dd genotype. D. be among 15% of the population. Positive blood types may be DD or Dd in genotype and do not have any D antibodies. The dd genotype is for negative blood, and 85% of the population is Rh positive. Awarded 0.0 points out of 1.0 possible points. 9. 9.ID: 53 Hypersensitivity reactions include: (select all that apply) A. type I IgE allergic reactions. Correct B. type II tissue-specific reactions. Correct C. type III immune complex reactions. Correct D. type IV cell–mediated reactions. Correct E. type V autoimmune reactions. There are only four distinct types of hypersensitivity reactions. Awarded 0.75 points out of 1.0 possible points. 10. 10.ID: 47 The action of histamine results in the: (select all that apply) A. relaxation of smooth muscle. B. increase of vascular permeability. Correct C. formation of edema. Correct D. increase of blood flow into the affected area. Correct E. constriction of bronchial smooth muscles. Correct Histamine contracts bronchial smooth muscle, and this causes bronchoconstriction. There is also increased vascular permeability, edema, and vasodilation. Awarded 0.5 points out of 1.0 possible points. 11. 11.ID: 65 Urticaria is also known as: (select all that apply) A. rhinitis. B. hives. Correct C. wheal/flare. Correct D. bleb. E. dermal skin reaction. Correct Hives, wheal/flare, and dermal skin reaction are all other names for urticaria. This skin condition is common in type I reactions. Rhinitis is another name for inflammation of the nasal passages. A bleb is a large, serous-filled blister. Awarded -0. points out of 1.0 possible points. 12. 12.ID: 61 The mechanism by which a type II hypersensitivity reaction affects cells includes which of the following? (select all that apply) A. The cell is destroyed by antibody and complement. Correct B. Antibody may cause phagocytosis. Correct C. Components of neutrophils will release their granules. Correct D. Antigen-mediated cytotoxicity. E. Antibody-dependent cell-mediated cytotoxicity. Correct There are five mechanisms by which type II hypersensitivity reactions can affect cells. First, the cell is destroyed by antibody and complement. Second, antibodies may cause damage through phagocytosis. Third, neutrophil granules, as well as several toxic oxygen products, will damage tissue. A fourth mechanism is antibody-dependent cell- mediated cytotoxicity. The fifth mechanism causes cell malfunction, not death. Antigen- mediated cytotoxicity is not a recognized mechanism. Awarded 0.75 points out of 1.0 possible points. 13. 13.ID: 45 An example of type IV sensitivity reactions would include: (select all that apply) A. graft rejection. Correct B. skin test for tuberculosis. Correct C. Arthus reactions. D. autoimmune processes. Correct E. poison ivy blebs. Graft rejection, skin test for tuberculosis, allergic reactions such as those caused by poison ivy and oak, and autoimmune responses may all be type IV reactions. The Arthus reaction is a type III hypersensitivity reaction. 14. The definition of reactive response includes mounting a response: A. in anticipation to a stressor. B. in reaction to a stressor. C. to a learned stressor. D. to a physical stressor. A reactive response is a psychological response to a stressor. An anticipatory response is a psychological response to an anticipated stressor. A learned response is a psychological response to specific stimuli that may be physical and has been negative in the past. Awarded 1.0 points out of 1.0 possible points. 15. 2.ID: 51 When experiencing stress, the effects of the epinephrine circulating in body will result in: A. bradycardia. B. decreased heart contractility. C. increased skeletal muscle blood supply. D. hyperglycemia. Correct Epinephrine will cause transient hyperglycemia. The epinephrine will increase heart rate and contractility. There will be increased venous return to the heart and, thus, increased cardiac output and blood pressure. Epinephrine dilates blood vessels of the muscles. Awarded 0.0 points out of 1.0 possible points. 16. 3.ID: 45 When ACTH activates the release of cortisol, then: A. plasma is bound to corticotropin. B. gluconeogenesis is halted. C. cortisol increases blood glucose. Correct D. cortisol decreases protein synthesis. Cortisol has many actions that include the stimulation of gluconeogenesis, resulting in the increase of glucose production. Plasma will bind to a protein called transcortin, and protein synthesis is increased. Awarded 1.0 points out of 1.0 possible points. 17. 4.ID: 47 It is TRUE that the immune system will respond to stress: A. with an increase in Th1. B. through a shift in Th1. C. with little or no change. D. through the effects of cortisol. Correct Stress can activate an excessive immune response through cortisol. It can cause suppression of Th1 and a Th2 shift. Awarded 1.0 points out of 1.0 possible points. 18. 5.ID: 41 CRH (corticotropin-releasing hormone) influences the immune system through: A. its release from peripheral inflammatory sites. Correct B. vasoconstriction. C. decreased vascular permeability. D. targeting red blood cells at peripheral targets. CRH is released from the hypothalamus and peripherally at inflammatory sites. Because this hormone is proinflammatory, it causes vasodilation and increased vascular permeability. The primary target of peripheral CRH is the mast cell. Awarded 1.0 points out of 1.0 possible points. 19. 6.ID: 53 Which of the following is a TRUE statement regarding stress and the immune system? A. There are no known immune-related conditions. B. Cardiovascular disease is one condition related to stress. Correct C. There is a decreased level of proinflammatory cytokines. D. Negative emotions cause no alterations in the immune system. Cardiovascular disease, aging, cancer, osteoporosis, arthritis, type 2 diabetes mellitus, and COPD are all associated with prolonged presence of proinflammatory cytokines. There is an increase in these proinflammatory cytokines. Negative emotions and stress are directly associated with the increased level of these proinflammatory cytokines and so affect the immune system. Awarded 1.0 points out of 1.0 possible points. 20. 7.ID: 39 The stages in the development of general adaptation syndrome include: (select all that apply) A. alarm. Correct B. resistance. Correct C. termination. D. exhaustion. Correct E. adaptation. Correct The three successive stages in the development of the general adaptation syndrome are alarm, resistance (also referred to as adaptation), and exhaustion. Awarded 1.0 points out of 1.0 possible points. 21. 8.ID: 55 Research has shown that an elderly adult’s mortality is affected when a spouse or partner is hospitalized in the areas of: (select all that apply) A. emotional stress. Correct B. financial stress. Correct C. practical support. Correct D. psychological support. Correct E. self-esteem. For elderly people whose spouse had been hospitalized, the short-term risk of dying approaches that of an elderly person after his or her spouse’s death. The researchers commented that a spouse’s illness or death can increase a partner’s mortality by causing severe stress and removing a primary source of emotional, psychological, practical, and financial support. Self-esteem is not generally seen as affecting mortality. Awarded 0.5 points out of 1.0 possible points. 22. 9.ID: 37 Which age-related change is associated with the stress-age syndrome? (select all that apply) A. Free-radical damage to cells Correct B. Increase in serum thyroxine C. Hypercoagulation of the blood Correct D. Decreased concentrations of testosterone Correct E. Immunodepression Correct With aging, sometimes a set of neurohormonal and immune alterations, as well as tissue and cellular changes, develops. These changes have been defined as stress-age syndrome and include the following: free-radical cell damage, decreases in both testosterone and thyroxine, depression of the immune system, and hypercoagulation of the blood. Awarded 0.25 points out of 1.0 possible points. 23. 10.ID: 43 The effect of stress on inflammatory and immune processes can have an effect on which conditions? (select all that apply) A. Depression Correct B. Coronary artery disease Correct C. Malnutrition D. Autoimmune disorders Correct E. Virally mediated cancers Effects of stress on inflammatory and immune processes influence coronary artery disease, depression, autoimmune disorders, and, possibly, virally mediated cancers. There is no currently accepted connection with malnutrition. 24. 1.ID: 11 A characteristic of a malignant tumor includes that it: A. is encapsulated. B. will not invade local tissues. C. is well differentiated. D. can spread far from the tissue of origin. Correct Malignant tumors have no capsule, which allows them to spread readily. They have rapid growth rates and specific microscopic alterations. They are poorly differentiated and spread to distant tissues. Awarded 1.0 points out of 1.0 possible points. 25. 2.ID: 19 Cancer of the connective tissue is referred to as a: A. sarcoma. Correct B. leukemia. C. lymphoma. D. carcinoma. Sarcoma is a cancer of mesenchymal tissue (including connective tissue, muscle, and bone). Carcinoma is a cancer of epithelial tissue. Leukemia is a cancer of blood-forming cells. Lymphoma is a cancer of lymphatic tissue. Awarded 1.0 points out of 1.0 possible points. 26. 3.ID: 13 A cancerous tumor that is very poorly differentiated is referred to as being: A. pleomorphic. B. anaplastic. Correct C. immortal. D. independent. Anaplastic means the absence of differentiation. Pleomorphic describes anaplastic cells of varying size and shape. Immortal refers to a cancerous cell’s ability to live indefinitely. Independent refers to the cancerous cell’s independence from normal cell controls. Awarded 1.0 points out of 1.0 possible points. 27. 4.ID: 03 The serum marker used to evaluate a tumor of the adrenal gland is: A. PSA. B. AFP. C. catecholamines. Correct D. DNA. Catecholamines are secreted by the adrenal medulla and are found in excess if there is a tumor. PSA is the prostate-specific antigen and is used to detect prostate cancer. AFP is alpha fetoprotein and is used to detect liver and germ cell cancers. DNA is the genetic material in cells, not a serum marker. Awarded 1.0 points out of 1.0 possible points. 28. 5.ID: 01 Which gene in its normal state negatively regulates cell proliferation? A. Oncogenes B. Tumor-suppressor genes Correct C. Proto-oncogenes D. Telomeres Tumor-suppressor genes encode proteins that in their normal state negatively regulate proliferation. Oncogenes are mutant genes that in their normal nonmutant state direct synthesis of protein that positively accelerates proliferation. Telomeres are protective ends, or caps, on each chromosome. Proto-oncogene is an oncogene in its nonmutant state. Awarded 1.0 points out of 1.0 possible points. 29. 6.ID: 15 A mutation that occurs due to changes in nucleotide base-pairs is described as a: A. point mutation. Correct B. translocation. C. gene amplification. D. pleomorphic. Point mutations are small changes in one or a few nucleotides. Translocations occur when a piece of one chromosome translocates to another chromosome. Gene amplification can result in duplication of a small piece of a chromosome over and over again. Pleomorphic describes anaplastic cells. Awarded 1.0 points out of 1.0 possible points. 30. 7.ID: 07 The process whereby tumor cells generate their own blood supply is referred to as: A. carcinogenesis. B. angiogenesis. Correct C. transforming growth factor. D. thrombospondin. Angiogenesis is the generation of new blood vessels. Thrombospondin is a protein that inhibits the growth of new blood cells. Carcinogenesis is the development of cancerous cells. Transforming growth factor is a proangiogenic factor (aids in the development of blood vessels). Awarded 1.0 points out of 1.0 possible points. 31. 8.ID: 09 Genomic instability refers to: A. a decreased ability to mutate during the metaphase of the cell life cycle. B. increased tendency for genome alterations and mutability during cell life cycles Correct C. genetic weaknesses predispose the development of solid tumors. D. absence of tumor suppression cells that result in excessive cell proliferation. Genomic instability refers to an increased tendency of alterations—mutability—in the genome during the life cycle of cells. Inherited and acquired mutations in caretaker genes that protect the integrity of the genome and DNA repair increase the level of genomic instability and risk for developing cancer. Awarded 1.0 points out of 1.0 possible points. 32. 9.ID: 05 When a patient is diagnosed with a benign tumor, it can be assumed that the tumor is: (select all that apply) A. well encapsulated. Correct B. well differentiated. Correct C. absent of normal tissue. D. spreading to regional lymph nodes. E. generally resistant to treatment modalities. Benign tumors are well encapsulated and well differentiated, but actually do retain some normal tissue. They do not spread to regional lymph nodes, nor are they generally resistant to treatment. Awarded 1.0 points out of 1.0 possible points. 33. 10.ID: 17 Research has shown a connection between the development of cancer and the: (select all that apply) A. Epstein-Barr virus. Correct B. hepatitis B virus. Correct C. hepatitis C virus. Correct D. hepatitis A virus. E. human papillomavirus. Correct Hepatitis B and hepatitis C have been linked to the development of liver cancer, usually due to chronic inflammation. Epstein-Barr virus can lead to B-cell lymphomas in those patients who are immunosuppressed. Human papillomavirus has been linked to cervical, anogenital, and penile cancers. Research has not shown a link between cancer and the hepatitis A virus. 34. 1.ID: 38 Childhood cancers generally: A. originate immediately after birth. B. affect the tissues in the brain. C. originate from the mesodermal germ layer. Correct D. result in extensive forms of lung cancer. Most childhood cancers originate from the mesodermal germ layer and give rise to connective tissue cancer. Brain and lung cancers are generally seen as common sites of childhood cancers. Embryonic tumors originate during intrauterine life, not after birth. Awarded 1.0 points out of 1.0 possible points. 35. 2.ID: 42 A TRUE statement regarding a childhood embryonic tumor includes, “The tumor contains: A. mature cells.” B. undifferentiated cells.” Correct C. carcinoma cells.” D. functional cells.” They contain cells that are not well differentiated, immature cells. This means they are unable to mature or differentiate into fully developed functional cells. Carcinoma cells are cancer cells that may or may not be present in such tumors. Awarded 1.0 points out of 1.0 possible points. 36. 3.ID: 30 The most common malignancy in children is: A. leukemia. Correct B. in the nervous system. C. in the kidney. D. in soft tissue. Leukemia is by far the most common malignancy in children. Malignancies occur in the nervous system, kidneys, and soft tissue, but are rare. Awarded 1.0 points out of 1.0 possible points. 37. 4.ID: 44 Which of the following viruses has been linked with the development of cancer? A. Measles B. Epstein-Barr Correct C. Mumps D. Influenza Epstein-Barr has been linked with the development of Burkitt lymphoma, nasopharyngeal carcinoma, and Hodgkin disease. While viruses may play a role in development of cancer, measles, mumps, and influenza are not linked by evidence to known childhood cancers. Awarded 1.0 points out of 1.0 possible points. 38. 5.ID: 36 The current belief is that the survival rates for childhood cancer survivors have improved primarily because: A. screening for such cancers have become more sensitive. B. less toxic treatments have been developed. Correct C. radiology has become a viable treatment modality. D. the general health of children has improved over the last century. Improved survival for children with cancer is because of research aimed at identifying less toxic treatments that will minimize residual effects. While all the options are true, the primary risk to survival lies in the residual effects to the child’s health caused by the treatment modalities used. Awarded 1.0 points out of 1.0 possible points. 39. 6.ID: 40 Which of the following children should be monitored closely for the symptomatology of leukemia? A. 2-year-old diagnosed with Down syndrome Correct B. 18-month-old with a heart valve defect C. 3-year-old with a congenital bone disorder D. 8-month-old with a cleft lip and cleft palate Children with Down syndrome are at increased risk for developing leukemia. Currently there is no research to support a connection between the other conditions and the development of leukemia. Awarded 1.0 points out of 1.0 possible points. 40. 7.ID: 46 The first risk factor to be considered when a child is diagnosed with a carcinoma is: A. a family history of this type of cancer. B. the presence of an autoimmune disorder. C. exposure to an environmental toxin. Correct D. a recent viral illness. Because most carcinomas in children are caused by environmental exposure, assessing for exposure to environmental toxins is the primary focus. While risk factors for other types of cancers include the remaining options, they are not primary risks for carcinomas. Awarded 1.0 points out of 1.0 possible points. 41. 8.ID: 32 A child is receiving immunosuppressive therapy after a lung transplant. Which form of childhood cancer is the child now at risk for developing? A. Leukemia B. Lymphoma Correct C. Hepatocellular carcinoma D. Neuroblastoma Immunosuppressive agents increase the child’s risk for developing lymphoma during childhood. This risk is not associated with the remaining options. Awarded 1.0 points out of 1.0 possible points. 42. 9.ID: 34 Which statement is correct when considering where a childhood tumor is most likely to develop? A. Lungs B. Kidneys C. Brain Correct D. Skin The most common type of childhood cancer is leukemia, and the second most common type of pediatric malignancy is a tumor involving the brain or central nervous system. Awarded 1.0 points out of 1.0 possible points. 43. 10.ID: 28 A survivor of a childhood cancer is at risk for developing a cancer later in life related to factors that include: (select all that apply) A. being under 2 years of age when original cancer occurred. B. receiving chemotherapy for the original cancer. Correct C. having a family history of the original cancer. Correct D. receiving radiation for the original cancer. Correct E. an original cancer being a soft tissue sarcoma. Correct This risk may be associated with a variety of factors, including previous chemotherapy or radiotherapy, genetic factors, and type of primary cancer (e.g., soft tissue sarcoma, neuroblastoma). Currently there is no known risk associated specifically with age. 44. 1.ID: 68 The central nervous system contains the: A. brain. Correct B. somatic nervous system. C. afferent pathways. D. cranial nerves. The brain is part of the central nervous system, while the remaining structures are contained in the peripheral nervous system. Awarded 1.0 points out of 1.0 possible points. 45. 2.ID: 84 Which option is composed of endoplasmic reticulum and ribosomes? A. Nissl substances Correct B. Dendrities C. Microfilaments D. Microtubules The Nissl substances, endoplasmic reticulum and ribosomes, are involved in protein synthesis. Microfilaments are composed of structural proteins and responsible for support. The dendrites are extensions that carry nerve impulses toward the cell body. Microtubules are involved in transport of cellular products. Awarded 1.0 points out of 1.0 possible points. 46. 3.ID: 60 Which is an insulating substance for the neuron? A. Schwann cells B. Myelin Correct C. Neuroglial cells D. Nodes of Ranvier Myelin is an insulating substance. Schwann and neuroglial cells provide structural support and nutrition for the neurons. The nodes of Ranvier are interruptions at regular intervals that occur in the myelin. Awarded 1.0 points out of 1.0 possible points. 47. 4.ID: 72 Successive, rapid impulses received from a single neuron on the same synapse best describes: A. temporal summation. Correct B. spatial summation. C. actuation. D. facilitation. Temporal summation refers to the effects of successive, rapid impulses received from a single neuron on the same synapse. Spatial summation refers to the combined effect of impulses from a number of neurons on a single synapse at the same time. Facilitation refers to the effects of excitatory postsynaptic potentials (EPSPs) on the plasma membrane potential. Actuation is not a process that relates to neural impulse transmission. Awarded 1.0 points out of 1.0 possible points. 48. 5.ID: 89 The midbrain contains the: A. cerebral hemisphere. B. tegmentum. Correct C. cerebellum. D. medulla oblongata. The tegmentum, corpora quadrigemina, and basis pedunculi are all part of the midbrain. The cerebral hemispheres are part of the forebrain. The brainstem is composed of the midbrain, medulla oblongata, and pons. The cerebellum is located in the hindbrain. Awarded 1.0 points out of 1.0 possible points. 49. 6.ID: 62 Which part of the brain contains all cell bodies and dendrites of neurons? A. Gyri B. Sulci C. White matter D. Gray matter Correct The gray matter contains cell bodies and dendrites of neurons. The white matter contains myelinated nerve fibers. The gyri are the convolutions of the cerebrum. The sulci are the grooves between adjacent gyri. Awarded 1.0 points out of 1.0 possible points. 50. 7.ID: 82 It is true that the brain’s Broca speech area: A. makes receptive responses possible. B. is responsible for motor speech. Correct C. when traumatized results in the inability to hear. D. is found in the right cerebral hemisphere. The Broca area is found on the left and is responsible for motor speech. Deficits in this area result in the inability to form words, also called expressive or motor aphasia. Hearing and receptive responding are not influenced by the Broca area. Awarded 1.0 points out of 1.0 possible points. 51. 8.ID: 76 Which is a function of the thalamus? A. Major integrating center for afferent impulseCorrect B. Maintenance of internal environment C. Voluntary visual motor movements D. Movements of the auditory system The thalamus is a major integrating center for afferent impulses. Maintenance of the internal environment is a function of the hypothalamus. Voluntary visual motor movements are controlled by the superior colliculi. Movements of the auditory system are accomplished by the inferior colliculi. Awarded 1.0 points out of 1.0 possible points. 52. 9.ID: 64 It is true that the cerebellum: A. makes up fibers of the corticospinal tract. B. maintains balance or posture. Correct C. controls respiration. D. contains cranial nerves V through VIII. The cerebellum is responsible for balance and posture and conscious and unconscious muscle synergy. The pons controls respirations and is the location of cranial nerves V through VIII. The fibers of the corticospinal tract are made up in the basis pedunculi. Awarded 1.0 points out of 1.0 possible points. 53. 10.ID: 74 Which structure is involved in pain transmission? A. Posterior horn B. Substantia gelatinosa Correct C. Anterior horn D. Dorsal root ganglia The substantia gelatinosa is a structure involved in pain transmission. The anterior or ventral horn contains nerve cell bodies for efferent pathways leaving the spinal cord. The posterior horn (dorsal horn) is composed primarily of interneurons and axons from sensory neurons. The dorsal root ganglion is part of the sensory ganglion. Awarded 1.0 points out of 1.0 possible points. 54. 11.ID: 80 The neurotransmitter released from the postganglionic parasympathetic axon terminal is: A. acetylcholine. Correct B. epinephrine. C. norepinephrine. D. dopamine. Both the pre- and postganglionic neurons of the parasympathetic nervous system release acetylcholine. The preganglionic neurons of the sympathetic nervous system release acetylcholine, while the postganglionic neurons release norepinephrine. Dopamine is produced by the hypothalamus. Preganglionic sympathetic fibers cause the rapid release of epinephrine. Awarded 1.0 points out of 1.0 possible points. 55. 12.ID: 78 Which is a characteristic of Wallerian degeneration? (select all that apply) A. Swelling Correct B. Neurofilamental atrophy C. Myelin sheath shrinkage Correct D. Axon portion degeneration Correct E. Overproduction of axons The neurofilaments actually hypertrophy, and there is degeneration of axons distal to an injury. The other choices are all characteristic of Wallerian degeneration. Awarded 1.0 points out of 1.0 possible points. 56. 13.ID: 87 The major divisions of the brain include: (select all that apply) A. forebrain. Correct B. cerebrum. C. midbrain. Correct D. hindbrain. Correct E. brainstem. The three main divisions of the brain are forebrain, midbrain, and hindbrain. The cerebral hemispheres are a portion of the forebrain. The brainstem is a component of the midbrain. Awarded 1.0 points out of 1.0 possible points. 57. 14.ID: 70 When a patient experiences a brain injury and the medulla oblongata is affected, it is reasonable to expect the client will experience: (select all that apply) A. heart rate changes. Correct B. alterations in respirations. Correct C. altered blood pressure. Correct D. alterations in balance and posture. E. problems in swallowing. Correct The medulla is responsible for heart rate, respiration, blood pressure, coughing, sneezing, swallowing, and vomiting. The cerebellum is responsible for balance and posture. Awarded 1.0 points out of 1.0 possible points. 58. 15.ID: 66 The meninges surrounding the brain comprise the: (select all that apply) A. dura mater. Correct B. anterior fossa. C. pia mater. Correct D. endosteal layer. E. anterior horn. The meninges are the dura mater, arachnoid, and the pia mater. The endosteal layer is part of the dura mater. The anterior fossa is the location where the frontal lobe lies. The anterior or ventral horn contains nerve cell bodies for efferent pathways leaving the spinal cord. 59. 1.ID: 02 It is TRUE that the specificity theory of pain: A. focuses on the attention of pain. B. focuses on previous experience of pain. C. relates the amount of pain to the amount of soft tissue injury.Correct D. relates to the emotions exhibited toward pain. The specificity theory of pain postulates that the intensity of pain is directly related to the amount of associated tissue injury. It does not take into account previous experience, emotions, or attention to pain. Awarded 1.0 points out of 1.0 possible points. 60. 2.ID: 34 Which pair of structures regulates the complex emotional responses to pain? A. Frontal and cerebellar lobes B. Limbic and reticular system Correct C. Thalamus and brainstem D. Midbrain and nuclei of thalamus The reticular and limbic systems regulate what we feel about pain. The remaining structures are not involved. Awarded 1.0 points out of 1.0 possible points. 61. 3.ID: 58 Which activity has been documented to increase the levels of circulating endogenous endorphins? A. Cough B. Stress Correct C. Sleep D. Pain Stress, sexual intercourse, acupuncture, and excessive physical exertion have all been linked to increased levels of circulating endorphins. Drinking behavior and cough are actually moderated by endorphins. Sleep and pain are not linked with excessive amounts of endorphins. Awarded 1.0 points out of 1.0 possible points. 62. 4.ID: 94 The appropriate definition of perceptual dominance is: A. the duration of time or intensity of pain before overt pain responses are initiated. B. pain at one location that may cause an increase in threshold at another location. Correct C. repeated exposure to a pain stimulus. D. the point at which pain is perceived. Perceptual dominance is pain at one location that may cause an increase in threshold at another location. For example, when a patient has severe pain in his leg, he may not feel neck pain. Pain tolerance is the duration of time or intensity of pain before overt pain responses are initiated. Repeated exposure to pain usually decreases pain tolerance. The pain threshold is the point at which pain is perceived. Awarded 1.0 points out of 1.0 possible points. 63. 5.ID: 26 The appropriate term for pain that is present in an area distant from its point of origin is: A. acute pain. B. chronic pain. C. referred pain. Correct D. somatic pain. Referred pain is pain that is present in an area removed or distant from its point of origin. Chronic pain is usually prolonged, lasting at least 3 months. Somatic pain arises from connective tissue, muscle, bone, and skin. It is may be sharp and well organized or dull, aching, and poorly localized. Acute pain arises from cutaneous, deep somatic, or visceral structures and is a protective mechanism. Awarded 1.0 points out of 1.0 possible points. 64. 6.ID: 63 Which mechanism does not result in heat loss? A. Increased respiration B. Conduction C. Convection D. Vasoconstriction Correct Vasoconstriction is a mechanism of heat conservation. Increased respiration, conduction, and convection are all mechanisms of heat loss. Awarded 1.0 points out of 1.0 possible points. 65. 7.ID: 81 A benefit of fever to human blood includes: A. decreased lymphocytic transformation. B. diminished phagocytosis. C. increased iron concentration. D. a switch to lipolysis and proteolysis. Correct Fever has benefits. The higher body temperature decreases serum levels of iron, zinc, and copper, all of which are need for bacterial replication. It switches from burning glucose to lipolysis and proteolysis, thus depriving bacteria of a food source. There is increased lymphocytic transformation, increasing the immune response. Increased phagocytosis also occurs. Awarded 1.0 points out of 1.0 possible points. 66. 8.ID: 61 A patient who was outside on a summer day and is now experiencing increased sweating and thirst, weakness, and dizziness is exhibiting signs of: A. heat cramps. B. heat exhaustion. Correct C. hyperthermic stroke. D. malignant hyperthermia. Heat exhaustion is the result of prolonged high core temperatures. There is often dehydration, feelings of weakness, dizziness, nausea, and fainting. Heat cramps are severe, spasmodic cramps in the abdomen and the extremities that follow prolonged sweating and associated sodium loss. Heat stroke may be lethal and is caused by exposure to excessive heat and loss of the body’s protective mechanisms for cooling. Malignant hyperthermia is a lethal complication of a rare inherited muscle disorder. Awarded 1.0 points out of 1.0 possible points. 67. 9.ID: 50 An obese male presents to a sleep clinic complaining of difficulty sleeping. He reports that he wakes gasping for air. Which is the most likely diagnosis for this patient? A. Primary hypersomnia B. Parasomnia C. Somnambulism D. Obstructive sleep apnea Correct Obstructive sleep apnea is due to upper airway obstruction and is accompanied by excessive snoring and episodic apnea. Primary hypersomnia is excessive daytime sleepiness. Parasomnia is unusual behavior during sleep. Somnambulism is sleepwalking. Awarded 1.0 points out of 1.0 possible points. 68. 10.ID: 86 Involuntary unilateral or bilateral rhythmic movement of the eyes is referred to as: A. nystagmus. Correct B. amblyopia. C. glaucoma. D. strabismus. Nystagmus may be present when at rest or when the eyes move. Amblyopia is reduced vision in an eye secondary to uncorrected strabismus. Strabismus is when one eye deviates from the other when a person is looking at an object. Glaucoma is increased intraocular pressure. Awarded 1.0 points out of 1.0 possible points. 69. 11.ID: 42 A young child presents with redness of the eyes. The parents indicate that this condition seems to be “going around” the daycare. Which is the most likely diagnosis? A. Blepharitis B. Keratitis C. Trachoma D. Conjunctivitis Correct Acute bacterial conjunctivitis, or pinkeye, is a highly contagious bacterial infection. Blepharitis is inflammation of the eyelids. Keratitis is an infection of the cornea. Trachoma is a bacterial infection caused by poor hygiene and is the leading cause of preventable blindness. Awarded 1.0 points out of 1.0 possible points. 70. 12.ID: 10 Which type of hearing loss is a result of foreign body obstruction of the middle ear? A. Conductive Correct B. Sensorineural C. Functional D. Presbycusis Conductive hearing loss occurs when a change in the outer or middle ear, such as a foreign body lodged in the ear canal, impairs conduction of the sound from the outer to inner ear. Sensorineural hearing loss is caused by impairment of the organ of Corti or its central connections. Presbycusis is a form of sensorineural hearing loss usually seen in elderly people. Functional hearing loss is believed to be caused by emotional or psychological factors. Awarded 1.0 points out of 1.0 possible points. 71. 13.ID: 69 A patient who reports that “everything tastes unpleasant” is exhibiting symptoms of: A. hyposmia. B. anosmia. C. hypogeusia. D. dysgeusia. Correct Dysgeusia is a perversion of taste in which everything has an unpleasant flavor. Hyposmia is an impaired sense of smell. Anosmia is a complete loss of smell. Hypogeusia is a decrease in taste sensation. Awarded 1.0 points out of 1.0 possible points. 72. 14.ID: 50 Endogenous opioids include: (select all that apply) A. enkephalins. Correct B. endorphins. Correct C. dynorphins. Correct D. endomorphins. Correct E. denkephalins. The four types of endogenous opioids include enkephalins, endorphins, dynorphins, and endomorphins. Denkephalins are not endogenous opioids. Awarded 1.0 points out of 1.0 possible points. 73. 15.ID: 18 The classification of acute pain includes: (select all that apply) A. acute visceral. Correct B. pleuritic. C. referred. Correct D. acute somatic. Correct E. cutaneous. Correct Pleuritic pain is described in terms of pulmonary function, not in general classification of pain. Acute pain arises from cutaneous, deep somatic, or visceral structures; these include acute visceral, acute somatic, and referred. 74. 1.ID: 63 It is correct to assume that Cheyne-Stokes respirations (CSR): A. involve a pathological pattern of crescendo-decrescendo. Correct B. result in hypocapnia and increased ventilatory stimulus. C. cause changes in PaO2 that produce irregular breathing. D. increase PaCO2 level when overbreathing occurs. Increases in PaCO2 levels lead to tachypnea. The PaCO2 level then decreases to below normal and breathing stops (apnea) until the carbon dioxide reaccumulates and again stimulates tachypnea. Changes in PaCO2 produce irregular breathing, not changes in PaO2. The PaCO2 level decreases to below normal when overbreathing occurs. Awarded 1.0 points out of 1.0 possible points. 75. 2.ID: 45 A patient often experiences vomiting with a central nervous system (CNS) injury when the trauma: A. impinges directly on the floor of the third ventricle. B. causes a decrease in intracranial pressure. C. involves the vestibular nuclei. Correct D. also involves the abdominal area. Vomiting associated with CNS injuries involves the vestibular nuclei. It can also be caused by impingement on the fourth ventricle or an increase in intracranial pressure. Vomiting with no associated nausea indicates direct involvement of the central neural mechanisms regardless of abdominal trauma. Awarded 1.0 points out of 1.0 possible points. 76. 3.ID: 75 Pinhole-sized pupils can be a result of an overdose of: A. atropine. B. scopolamine. C. opiates. Correct D. amphetamines. Opiates (heroin and morphine) cause pinhole or constricted pupils. The other choices cause large dilated pupils. Awarded 1.0 points out of 1.0 possible points. 77. 4.ID: 51 A patient has sustained a traumatic brain injury but is able to follow simple commands and can manipulate objects. The term used to describe this state is: A. coma B. vegetative C. minimally conscious Correct D. locked-in syndrome The term minimally conscious refers to severely altered consciousness in which the person demonstrates minimal but defined behavioral evidence of self or environmental awareness. The clinical features include following simple commands, manipulation of objects, gestural or verbal yes/no responses, intelligible verbalization, and stereotypical movements. Locked-in syndrome describes an individual who has both the content of thought and the level of arousal intact. The efferent pathways are disrupted, which means the individual cannot communicate through speech or body movement. Coma is a state of neurobehavioral unresponsiveness. Vegetative state is a wakeful unconscious state. Awarded 1.0 points out of 1.0 possible points. 78. 5.ID: 55 A patient experiencing the tonic phase of a seizure exhibits: A. muscle contraction with increased muscle tone. Correct B. alternating contraction and relaxation of muscle. C. muscle contraction alternating with placidity. D. complete paralysis. The phase of muscle contraction with increased muscle tone is the tonic phase. Alternating contraction and muscle relaxation represent the clonic phase. The postictal phase immediately follows the seizure. There is no phase that is characterized with muscle contraction alternating with placidity. Awarded 1.0 points out of 1.0 possible points. 79. 6.ID: 65 A patient who reports a loss of childhood memories is describing a characteristic of: A. selective attention deficit. B. retrograde amnesia. Correct C. anterograde amnesia. D. executive attention deficits. Retrograde amnesia is the loss of past memories, whereas anterograde amnesia is the inability to form new memories. Selective attention deficit is the ability to select specific information to be processed from environmental and internal stimuli. Executive attention deficit is the inability to maintain sustained attention, inability to set goals and recognize when an object meets a goal, and a deficit in working memory. Awarded 1.0 points out of 1.0 possible points. 80. 7.ID: 49 A patient who is experiencing difficulty in recognizing a pattern’s form and the nature of objects is exhibiting characteristics of: A. agnosia. Correct B. aphasia. C. dysphasia. D. Alzheimer disease. Agnosia is a defect of pattern recognition. Aphasia is the complete absence of speech. Dysphasia is impairment of comprehension or production of language. Alzheimer disease is a disease of dementia. Awarded 1.0 points out of 1.0 possible points. 81. 8.ID: 61 A patient who is experiencing a loss of comprehension or the production of language is described as having: A. dysphasia. Correct B. aphasia. C. expressive dysphasia. D. transcortical dysphasia. Aphasia is complete inability to speak. Dysphasia is impairment in comprehension or production of language. Expressive dysphasia is characterized primarily by deficits in expression, but comprehension may be present. Transcortical dysphasia involves the ability to repeat and to recite. Awarded 0.0 points out of 1.0 possible points. 82. 9.ID: 39 A patient who was admitted to a postsurgical unit 2 days ago is now demonstrating progressive restlessness and is uncharacteristically irritable. This scenario is characteristic of: A. Alzheimer disease. B. dementia. C. delirium. Correct D. coma. Delirium is an acute state of confusion. It is abrupt in its onset. The patient may have difficulty in concentration, restlessness, irritability, tremulousness, insomnia, and poor appetite. Delirium is associated with autonomic nervous system overactivity and typically develops over 2-3 days. It most commonly occurs in critical care units, following surgery, or during withdrawal from central nervous system depressants (i.e., alcohol or narcotic agents). Dementia is a more chronic problem in which there is progressive failure of many cerebral functions. Alzheimer disease is a type of dementia. A coma is a loss of consciousness. Awarded 1.0 points out of 1.0 possible points. 83. 10.ID: 67 It is TRUE that Alzheimer disease is: A. an uncommon neurologic disorder. B. not believed to have a genetic relationship. C. a result of neuronal proteins becoming distorted and tangled. Correct D. the cause of plaques increasing nerve impulse transmission. Neurofibrillary tangles occur when the proteins in neurons become tangled and distorted. There is a genetic relationship in late-onset familial Alzheimer dementia. It is a common neurologic disorder; nearly 6 million Americans had the disease in 2000. With the formation of plaques, there is decreased nerve impulse transmission. Awarded 1.0 points out of 1.0 possible points. 84. 11.ID: 71 The term used to describe a patient who sustains a cerebrovascular accident and the limbs are paralyzed on an entire side is: A. hemiplegia. Correct B. paraplegia. C. diplegia. D. quadriplegia. Hemiplegia means loss of motor function on one side of the body. Paraplegia refers to loss of motor function of the lower extremities. Diplegia is the paralysis of both upper and lower extremities as a result of cerebral hemisphere injuries. Quadriplegia refers to paralysis of all four extremities. Awarded 1.0 points out of 1.0 possible points. 85. 12.ID: 43 A patient who exhibits positioning that includes both arms being held close to the body with flexion at the elbows while legs are extended and rotated externally is demonstrating: A. decerebrate posture. B. spastic posture. C. decorticate posture. Correct D. basal ganglion posture. Decorticate posture (also referred to as antigravity posture or hemiplegic posture) is characterized by upper extremities flexed at the elbows and held close to the body and by lower extremities that are externally rotated and extended. A spastic gait or posturemanifests by a shuffling gait with the leg extended and held stiff, causing a scraping over the floor surface. The leg swings improperly around the body rather than being appropriately lifted and placed. The foot may drag on the ground, and the person tends to fall to the affected side. Decerebrate posture refers to increased tone in extensor muscles and trunk muscles, with active tonic neck reflexes. When the head is in a neutral position, all four limbs are rigidly extended. Basal ganglion posture refers to a stooped, hyperflexed posture with a narrow-based, short-stepped gait. Awarded 1.0 points out of 1.0 possible points. 86. 13.ID: 77 A patient is diagnosed with Huntington disease. Which of the following is a TRUE statement? Huntington’s disease is: A. a commonly diagnosed neurological disorder. B. a nonhereditary disease. C. also known as chorea. Correct D. asymptomatic until the sixth decade of life. Huntington disease is also called chorea. It is relatively rare and is a hereditary degenerative disorder. It most commonly affects those between the ages of 25 and 45. Awarded 1.0 points out of 1.0 possible points. 87. 14.ID: 53 A patient diagnosed with Parkinson disease initially experiences: A. difficulty walking. B. resting tremors. Correct C. postural instability. D. rigidity of leg muscles. The classic manifestations of Parkinson disease are resting tremors, rigidity, bradykinesia/akinesia, postural disturbance, dysarthria, and dysphagia. Tremor is often the first symptom to appear. The symptoms are often unilateral and then become bilateral, progressing to affect gait and include postural instability and the inability to walk. Awarded 1.0 points out of 1.0 possible points. 88. 15.ID: 41 A patient presents with a wide-based gait in which the feet are turned outward. Staggering is noted when walking and the pelvis is held stiff. These characteristics are representative of: A. cerebellar gait. Correct B. basal ganglion gait. C. decorticate posture. D. apraxia. Cerebellar dysfunction results in a wide-based gait in which the feet are turned inward or outward. Basal ganglion gait is a wide-based gait in which the person walks with small steps and decreased arm swing. Decorticate posture occurs when the upper extremities are flexed at the elbows and held close to the body while the lower extremities are externally rotated and extended. Apraxia is the inability to perform purposeful or skilled motor acts in the absence of paralysis, sensory loss, abnormal posture, or tone. Awarded 1.0 points out of 1.0 possible points. 89. 16.ID: 69 A basic neural system essential to cognitive function would include: (select all that apply) A. attentional systems. Correct B. memory systems. Correct C. affective or emotive systems. Correct D. sensory systems. E. language systems. Correct In this case, sensory systems are not related to cognitive function. Awarded 1.0 points out of 1.0 possible points. 90. 17.ID: 59 Abnormal findings in which of the following evaluations would indicate possible neurologic dysfunction? (select all that apply) A. Level of consciousness Correct B. Pattern of breathing Correct C. Decreased gastrointestinal motility D. Eye response Correct E. Motor responses Correct The five categories that are critical for the evaluation process for neurologic function include: (1) level of consciousness (LOC), (2) pattern of breathing, (3) size and reactivity of pupils, (4) eye position and reflexive response, and (5) muscle motor responses. Gastrointestinal motility is not indicative of neurologic status. 91. Criteria for determining brain death include: (select all that apply) A. unresponsive coma. Correct B. no spontaneous respiration. Correct C. isoelectric EEG. Correct D. pupils are reactive but unequal. E. ocular response to head turning. The following criteria determine brain death: 1. Completion of all appropriate diagnostic and therapeutic procedures with no possibility of brain function recovery 2. Unresponsive coma (no motor or reflex movements) 3. No spontaneous respiration (apnea) 4. No brainstem functions (ocular responses to head turning or caloric stimulation; dilated, fixed pupils; no gag or corneal reflex [see Figures 15-3 and 15-4]) 5. Isoelectric (flat) EEG (electrocerebral silence) 6. Persistence of these signs for an appropriate observation period 92. A means of classifying a seizure includes: (select all that apply) A. clinical manifestations. Correct B. site of origin. Correct C. response to therapy. Correct D. length of activity. E. EEG correlates. Correct The following are ways to classify seizures: (1) clinical manifestations, (2) site of origin, (3) EEG correlates, and (4) response to therapy. The length of the seizure activity is not a classifying characteristic. 93. A characteristic of Alzheimer disease includes: (select all that apply) A. rapid onset of symptomatology. B. short-term memory loss. Correct C. increased irritability and agitation. Correct D. anxiety and depression. Correct E. remissions resulting in cognitive clarity. Alzheimer disease is characterized with short-term memory loss, increased irritability and agitation, as well as anxiety and depression. Its onset of symptoms is gradual, and there are no remissions that allow for cognitive clarity. 94. The person at highest risk for traumatic brain injury (TBI) is: A. black and economically disadvantaged. Correct B. male and disabled. C. female and 20 years of age. D. an economically advantaged young adult. Those at highest risk for TBI are children 0-4 years of age, older adolescents aged 15-19 years, and adults aged 65 years and older. Males have the highest incidence in every age group. TBI is highest among blacks and in lower- and median-income families. 95. The most common cause of TBI is: E. motor vehicle accidents. Correct F. falls. G. sports-related events. H. violence. Motor vehicle accidents account for 50%. Falls account for 21%. Sports-related events and violence account for 10% and 12%, respectively. A trauma patient diagnosed with a brain contusion experiences changes in attention, memory, affect, and emotion. In which region of the brain is the contusion most likely located? A. Cerebral B. Frontal Correct C. Cerebellum D. Midbrain Contusions are most commonly found in the frontal lobes, particularly at the poles and along the inferior orbital surfaces. They result in changes in attention, memory, and executive attentional functioning. 97. After a fall at home, an elderly patient experiences a hematoma located on the top of the brain. The hematoma is most likely: A. subdural. Correct B. epidural. C. extradural. D. intracerebral. Subdural hematomas (bleeding between the dura mater and the brain) arise in 10-20% of persons with traumatic brain injury. Acute subdural hematomas develop rapidly, commonly within hours, and usually are located at the top of the skull (the cerebral convexities). Chronic subdural hematomas are commonly found in the elderly and persons who abuse alcohol. Epidural hematomas develop from bleeding between the dura mater and the skull in all age groups (most commonly in 20-40-year-olds). The temporal fossa is the most common site of extradural hematomas. Intracerebral hematomas are a result of bleeding within the brain. A patient is hit in the temporal portion of his skull. Although initial loss of consciousness occurs, the patient soon awakens and is conversant. Three hours later vomiting, drowsiness, and confusion are noted. These symptoms are most likely related to which type of brain injury? A. Diffuse axonal B. Intracerebral C. Subdural D. Epidural Correct The classic presentation of an epidural hematoma is a person hit in the temporal area with damage to the middle meningeal artery. The patient will lose consciousness at the time of injury, but there may be a period where consciousness is regained. The patient will then become more confused and drowsy. This scenario is not typical with the other types of brain injuries. A patient experiences a vertebral fracture in which the C1 vertebra is fractured into several fragments. This type of fracture can be described as: A. simple. B. compressed. C. comminuted. Correct D. dislocation. A comminuted fracture is also called a burst fracture, in which the vertebral body is shattered into several fragments. A simple fracture is a single break usually affecting the transverse or spinous process. A compressed fracture is also called a wedge. This occurs when there is a crush type of injury and the vertebrae lose height. A dislocation is when two bones at a joint are no longer in alignment. 100. It is TRUE that spinal shock: A. is characterized by an incomplete loss of reflex function. B. involves all skeletal muscles below the level of injury. Correct C. causes increased muscle tone below the lesion. D. results in no disruption of thermal control. Spinal shock does involve function of skeletal muscles resulting in paralysis and flaccidity. Such an injury is characterized by a complete loss of reflex function below the level of the lesion, and impairment of control of thermal regulation is observed. 101. A patient is experiencing pain that courses over the buttocks and into the calf and ankle. This is suggestive of a herniated disk at which vertebral level? A. Cervical B. Thoracic C. Lumbar Correct D. Coccyx A herniated disk in the lumbosacral area is associated with pain that radiates along the sciatic nerve and courses over the buttock and into the calf and ankle. Both a cervical and thoracic injury would indicate pain that originated higher on the body. A herniated coccyx vertebrate would result in pain beginning a point lower than that described. 102. It is true that an acute cerebrovascular accident (CVA) is: A. the leading cause of disability in the United States. Correct B. the fifth most common cause of death in the United States. C. very likely to be followed by a second stroke within 1 year. D. experienced by 2 million individuals each year. CVAs are the leading cause of disability and the third leading cause of death. There are 500,000 stroke victims a year, and only 5-14% have a second stroke within 1 year. 103. Which is correct regarding hemorrhagic strokes? They: A. are the most common cause of CVA. B. account for 50% of all CVAs. C. are commonly caused by hypertension. Correct D. are often the result of a microinfarct. Chronic, untreated hypertension is generally the cause of hemorrhagic stroke. Hemorrhagic stroke is the third most common cause of CVA. It accounts for 10-15% of strokes in whites and 30% in blacks and Asians. An infarct is a type of occlusive stroke. 104. Which is accurate regarding subarachnoid hemorrhages? They are: A. a particular risk for individuals with an intracranial aneurysms. Correct B. seldom experienced in individuals with hypertension. C. a result of vasospasms not caused by trauma to the head. D. rarely fatal and result in minor cognitive impairments. Individuals with intracranial aneurysms are at risk for subarachnoid hemorrhage. Hypertension and trauma are also risk factors. The mortality is over 50%. 105. Which of the following statements is TRUE regarding grading of the astrocytoma? A. Grade I is not treated. B. Grade II is treated with radiation only. C. Grades III and IV are treated with surgery. Correct D. Grade III is not well circumscribed. Grade I is treated with surgery and then follow-up CT scans for recurrence. Grade II is treated surgically if accessible and then with radiation. Grades III and IV are treated with surgery. Grade III is well circumscribed. 106. It is correct to assume that Grade III and Grade IV astrocytomas are: A. commonly found in the frontal lobe and cerebral hemisphere. Correct B. generally seen more in women than in men. C. usually necrotic as a result of an absence of vascularity. D. bluish gray in color with a hard purplish center. Grades III and Grade IV astrocytomas are commonly found in the frontal lobe and cerebral hemisphere and are found twice as often in men as in women. They are often large and well circumscribed with a variegated pattern. The rim is pinkish gray and solid with a soft, yellow, necrotic center. There is vascular proliferation. 107. Which is TRUE regarding metastatic brain tumors? A. Carcinomas are disseminated to the brain from the circulation. Correct B. One-third of metastatic tumors are located within the brain. C. Two-thirds of metastatic tumors are located in the extradural spaces. D. Tumors of the pelvis tend to involve the frontal lobe. Carcinomas disseminate to the brain from the circulation. Two-thirds of metastatic tumors are located within the brain, and one-third are located in the extradural spaces. Tumors of the pelvis tend to metastasize to the cerebellum and pons. 108. Which is TRUE regarding meningitis? A. Bacterial meningitis is a primary infection of the gray matter. B. Aseptic meningitis is most commonly caused by a fungus. C. Fungal meningitis is the most common form worldwide. D. Tubercular meningitis has a 90% recovery rate, if diagnosed early. Correct Tubercular meningitis has a 90% recovery rate with early diagnosis and treatment. Fungal meningitis is uncommon. Aseptic meningitis is most commonly caused by a virus. Bacterial meningitis is caused by primary infection of the pia mater and arachnoid. 109. A patient has a brain abscess with a decreased necrotic center and mature collagen. This is most consistent with which stage? A. Early cerebritis B. Late cerebritis C. Early capsule formation Correct D. Late capsule formation Early capsule formation occurs on days 10-13. The necrotic center decreases in size and inflammatory infiltrate changes in character. Mature collagen evolves, forming a capsule. Early cerebritis occurs on days 1-3 and is a localized inflammatory process. There are marked cerebral edema and a central core of necrosis. Late cerebritis occurs on days 4-9, and there is a necrotic center surrounded by inflammatory infiltrate of macrophages and fibroblasts. There is rapid new blood vessel formation. Late capsule formation occurs on day 14 and later. There is a well-formed necrotic center surrounded by a dense collagenous capsule. 110. It is TRUE that encephalitis is: A. an afebrile illness lasting 1 week. B. caused by bacteria transmission. C. a result of arthropod-borne viruses. Correct D. caused exclusively by herpes simplex II. It is caused by a virus, often arthropod borne (tick/mosquito borne). Herpes simplex I can also causes the illness; type I is more common than type II. Encephalitis is an acute febrile illness. 111. A patient experiences demyelination of the peripheral nerves with sparing of the axons. This is characteristic of: A. Alzheimer disease. B. Guillain-Barré. Correct C. myasthenia gravis. D. amyotrophic lateral sclerosis (ALS). Guillain-Barré is an idiopathic polyneuritis with acute inflammatory demyelinating characteristics. There is demyelination of the peripheral nerves with relative sparing of the axons. Alzheimer disease is a form of dementia caused by tangles. Myasthenia gravis is due to anti-acetylcholine-receptor antibodies. ALS is a degenerative disorder diffusely involving lower and upper motor neurons, resulting in progressive muscle weakness. 112. A patient is brought to the emergency room following a motor vehicle accident in which a diffuse brain injury is sustained. Which symptoms would be expected to accompany the injury? (select all that apply) A. Memory deficits Correct B. Swallowing disorders Correct C. Agitation Correct D. Fatigue E. Short attention span Correct Diffuse brain injury can produce memory deficits, dysphagia, agitation, and short attention span. Fatigue is not part of diffuse brain injury. 113. Risk factors for a CVA include: (select all that apply) A. obesity. B. smoking. Correct C. diabetes. Correct D. arterial hypertension. Correct E. atrial fibrillation. Correct Obesity may indirectly cause other risk factors but is not a direct risk factor for CVA. The other risk factors for CVAs include arterial hypertension, smoking, diabetes, insulin resistance, polycythemia, increased lipoprotein-a, impaired cardiac function, hyperhomocysteinemia, and atrial fibrillation. 114. A patient is diagnosed with a meningioma. The most likely site of the tumor is the: (select all that apply) A. sella turcica. Correct B. olfactory groove. Correct C. tuberculum sellae. Correct D. sphenoidal wing. Correct E. cerebellopontine angle. Correct Meningiomas are located most commonly in the olfactory grooves, on the wings of the sphenoid bone (at the base of the skull), in the tuberculum sellae (a structure next to the sella turcica), on the superior surface of the cerebellum, and in the cerebellopontine angle and spinal cord. 115. A cause of a cerebral aneurysm includes: (select all that apply) A. arteriosclerosis. Correct B. heroin abuse. C. congenital anomaly. Correct D. trauma. Correct E. cocaine abuse. Correct Arteriosclerosis, congenital anomalies, and trauma are all considered causes of an aneurysm. Cocaine has been linked to aneurysm formation; heroin has not.