Chapter 23: Neurologic System

Multiple Choice

1. The autonomic nervous system coordinates which of the following?

a. High-level cognitive function b. Balance and affect c. Internal organs of the body d. Balance and equilibrium e. Emotions and behavior

ANS: C

The autonomic nervous system coordinates the internal organs of the body by the sympathetic and parasympathetic nervous systems. The other options are associated wi th the cerebral cortex, whose function consists of determining intelligence, personality, and motor function.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

2. The major function of the sympathetic nervous system is to: a. orchestrate the stress response. b. coordinate fine motor movement. c. determine proprioception. d. contribute input from visual, labyrinthine, and proprioceptive sources. e. perceive stereognosis.

ANS: A

Stimulation of the sympathetic branch of the autonomic nervous system prepares the body for emergencies for fight or flight (stress response). The cerebellum plays a key role in the coordination of fine motor movements. Recognition of body parts and awareness of body position (proprioception) are dependent on the parietal lobe. The basal ganglia contribute input from visual, labyrinthine, and proprioceptive sources. Stereognosis is the ability to perceive weight and form of solid objects by touch and is not under sympathetic control.

TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

3. The parasympathetic nervous system maintains the day-to-day function of: a. digestion. b. response to stress. c. lymphatic supply to the brain. d. lymphatic drainage of the brain. e. coordinating fine motor movements.

ANS: A

The parasympathetic division functions in a complementary and counterbalancing manner to conserve body resources and maintain day-to-day body functions such as digestion and elimination.

TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

4. The motor cortex of the brain is in the: a. corpus callosum. b. frontal lobe. c. limbic system. d. occipital lobe. e. parietal lobe.

ANS: B

The frontal lobe contains the motor cortex associated with voluntary skeletal movement and fine repetitive motor movements, as well as the control of eye movements. The corpus callosum interconnects the counterpart areas in each hemisphere, unifying the ce eb m higher sensory and motor functions. The limbic system mediates the sense of smell and certain patterns of behavior that determine survival, such as mating, aggression, fear, and affection. The occipital lobe contains the primary vision center and provides interpretation of visual data. The parietal lobe is primarily responsible for processing sensory data as they are received.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

5. The thalamus is the major integration center for perception of: a. speech. b. olfaction. c. pain. d. thoughts. e. visceral responses to emotions.

ANS: C

The thalamus is the major integrating center for perception of various sensations such as pain and temperature, serving as the relay center between the basal ganglia and cerebellum. The reception of speech and interpretation of speech is located in the Wernicke area. The olfactory sense is processed in the parietal lobe. The cerebrum holds memories, allows you to plan, and enables you to imagine and think. The limbic system mediates the sense of smell and certain patterns of behavior (primitive behaviors, visceral response to emotional and biologic rhythms) that determine survival, such as mating, aggression, fear, and affection.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

6. The awareness of body position is known as: a. extrapyramidal. b. graphesthesia. c. stereognosis. d. two-point discrimination. e. proprioception.

ANS: E

Recognition of body parts and awareness of body position is known as proprioception. This is dependent on the parietal lobe.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. CN I, olfactory b. CN V, trigeminal c. CN IX, glossopharyngeal d. CN XI, spinal accessory e. CN XII, hypoglossal

7. If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation?

ANS: D

CN XI is responsible for the motor ability to shrug the shoulders. CN I is associated with smell reception and interpretation. CN V is associated with opening of the jaw; chewing; and sensation of the cornea, iris, conjunctiva, eyelids, forehead, nose, teeth, tongue, ear, and facial skin. CN IX is associated with swallowing function, sensation of the nasopharynx, gag reflex, taste, secretion of salivary glands, carotid reflex, and swallowing. CN XII is associated with movement of the tongue.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. birth and 1 b. 2 and 3 c. 4 and 7 d. 11 and 14 e. 16 and 21

8. The major portion of brain growth and myelinization occurs between ____ year(s) of age.

ANS: A

The major portion of brain growth occurs in the first year of life along with myelinization of the brain and nervous system.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

9. Motor maturation proceeds in an orderly progression from: a. peripheral to central. b. head to toe. c. lateral to medial. d. pedal to cephalic. e. toe to head.

ANS: B

Motor maturation proceeds in a cephalocaudal direction. Motor control of the head and neck develops first followed by the trunk and extremities. The other choices are incorrect because they relate maturation sequence inappropriately.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

10. A neurologic past medical history should include data about: a. family patterns of dexterity and dominance. b. circulatory problems. c. educational level. d. immunizations. e. allergies.

ANS: B

The neurologic past medical history should include data concerning neurovascular problems such as stroke, aneurysm, and brain surgery. The other answers are not pertinent medical information for the neurologic past medical history.

TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

11. You are initially evaluating the equilibrium of Ms. Q You ask her to stand with her feet together and arms at her sides. She loses her balance. Ms. Q has a positive: a. Kernig sign. b. Homan sign. c. McMurray test. d. Romberg sign. e. Murphy sign.

ANS: D

The Romberg test has the patient stand with his or her eyes closed, feet together, and arms at the sides. Slight swaying movement of the body is expected but not to the extent of falling. Loss of balance results in a positive Romberg test. Kernig sign tests for meningeal irritation, Homan sign tests for venous thrombosis, and McMurray test is a rotation test for demonstrating a torn meniscus. A positive Murphy sign is usually a sign of gallbladder disease.

TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

12. The finger-to-nose test allows assessment of: a. coordination and fine motor function. b. point location. c. sensory function. d. two-point discrimination. e. stereognosis.

ANS: A

To perform the finger-to-nose test, the patient closes both eyes, and touches his or her nose with the index finger, alternating hands while gradually increasing the speed. This tests coordination and fine motor skills. All of the other choices test sensory function without motor function.

TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

13. You are performing a two-point discrimination test as part of a well physical examination. The area with the ability to discern two points in the shortest distance is the: a. back. b. palms. c. fingertips. d. upper arms. e. chest.

ANS: C

On the fingertips and toes, two points are commonly felt when 2 to 8 mm apart. A greater distance is expected for discrimination of two points on other body parts, such as the back (40 to 70 mm) or chest and forearms (40 mm).

TOP: Discipline: Neuroscience

MSC: Organ System: Nervous

14. As Mr. B enters the room, you observe that his gait is wide based and he staggers from side to ide hile a ing hi nk. Yo o ld doc men M . B pa e n a : a. dystonic ataxia. b. cerebellar ataxia. c. steppage gait. d. tabetic stamping. e. Parkinsonian gait.

ANS: B

A ce ebella gai (ce ebella a a ia) occ hen he pa ien fee a e ide based with a staggering gait, lurching from side to side, often accompanied by swaying of the trunk. Dystonic ataxia is jerky dancing movements that appear nondirectional. Steppage gait is noted when the hip and knee are elevated excessively high to lift the plantar flexed foot off the ground. The foot is brought down with a slap, and the patient is unable to walk on the heels. Tabetic stamping occurs when the legs are positioned far apart, lifted high, and forcibly brought down with each step; in this case, the heel stamps on the ground. In Parkinsonian gait, he pa ien po e i ooped, and he bod i held igid; ep a e ho and h ffling, i h hesitation on starting and difficulty stopping.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

15. Deep pressure tests are used mostly for patients who are experiencing: a. absent superficial pain sensation. b. gait and stepping disturbances. c. lordosis, osteoporosis, or arthritis. d. brisk reflexes. e. tonic neck or torso spasms.

ANS: A

Deep pressure sensation is tested by squeezing the trapezius, calf, or biceps mu scle, thus causing discomfort. When superficial pain sensation is not intact, then further assessments of temperature and deep pressure sensation are performed.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

16. You have asked a patient to close his eyes and identify an object placed in his hand. You are evaluating: a. stereognosis. b. graphesthesia. c. vibratory sense. d. two-point discrimination. e. extinction phenomenon.

ANS: A

Stereognosis is the ability to recognize an object through touch and manipulation. Tactile agnosia, an inability to recognize objects by touch, suggests a parietal lobe lesion.

G aphe he ia e he pa ien abili o iden if he fig e being d a n on his or her palm. The vibratory sense uses a tuning fork placed on a bony prominence. Two -point discrimination uses two sharp objects to determine the distance at which the patient can no longer distinguish the two points. The extinction phenomenon tests sensation by simultaneously touching bilateral sides of the body with a sterile needle.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. Central sensory loss that is generalized b. Motor paralysis on lesion side of the body c. Multiple peripheral neuropathy of the joints d. Spinal root paralysis below the umbilicus e. Pain and temperature loss on lesion side of body

17. Which one of the following conditions is consistent with Brown-Séquard syndrome?

ANS: B

Partial spinal sensory syndrome (Brown-Séquard syndrome) is noted when pain and temperature sensation loss occur one to two dermatomes below the lesion on the opposite side of the body from the lesion. Proprioceptive loss and motor paralysis occur on the lesion side of the body.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

18. When using a monofilament to assess sensory function, the examiner: a. uses two simultaneous monofilaments on similar bilateral points and then compares results. b. applies both a monofilament and a pin on similar bilateral points and then compares results. c. applies pressure to the monofilament until the filament bends. d. strokes the monofilament along the skin from proximal to distal areas. e. a e e onl he do al face of he foo i h he pa ien e e open.

ANS: C

The monofilamen i placed on e e al moo h po of he pa ien plan a foo fo seconds. Adequate pressure applied by the monofilament is measured by the bend of the monofilament.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

19. It is especially important to test for ankle clonus if: a. deep tendon reflexes are hyperactive. b. the patient has a positive Kernig sign. c. the Romberg sign is positive. d. the patient has peripheral neuropathy. e. deep tendon reflexes are hypoactive.

ANS: A

Te he ankle clon hen efle e a e h pe ac i e. S ppo he pa ien knee in a fle ed position and briskly dorsiflex the foot with your other hand. If clonus is present, there is recurrent ankle plantar flexion movement as long as the examiner retains the foot in dorsiflexion. Sustained clonus signifies the hypertonia of an upper motor neuron lesion.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. Kernig b. Babinski c. obturator d. Brudzinski e. Murphy

20. When assessing a 17-year-old patient for nuchal rigidity, you gently raise his head off the examination table. He involuntarily flexes his hips and knees. To confirm your suspicions associated with this positive test result, you would also perform a test for the _____ sign.

ANS: A

The first action elicited the Brudzinski sign. This sign is an indicator of meningeal irritation. To confirm meningeal irritation, you would test for the Kerning sign, also a meningeal sign.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

21. Cranial nerve XII may be assessed in an infant by: a. a ching he infan facial e p e ion hen c ing. b. observing the infant suck and swallow. c. clapping hands and watching the infant blink. d. ob e ing he infan oo ing efle . e. checking he infan gag efle .

ANS: B

Cranial nerve (CN) XII may be assessed in an infant by observing the infant suck and swallow and by pinching the nose and then observing for the mouth to open and the tip of the tongue to i e in a midline po i ion. Wa ching he infan facial e p e ion hen c ing a e e CN VII, clapping hands and watching the infant blink tests CN VIII, and observing the rooting reflex assesses CN V. A gag reflex assesses CN IX and X.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous a. Reduced ability to differentiate colors b. Bilateral pillrolling of the fingers c. Absent plantar reflex d. Diminished senses of smell and taste e. Reduced gag reflex

22. Which of the following is a concern, rather than an expected finding, in older adults?

ANS: B

Bilateral pillrolling is indicative of Parkinson disease; the other choices are expected findings with aging.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

23. Emotional lability, personality changes, and contralateral hemiplegia greater in the lower than upper extremities indicates a cerebrovascular accident (CVA) occurring in the: a. anterior spinal artery. b. internal or middle cerebral artery. c. posterior inferior cerebellar artery. d. vertebral or basilar arteries. e. anterior cerebral artery.

ANS: E

The anterior cerebral artery supplies superior surfaces of frontal and parietal lobes and medial surface of cerebral hemispheres (includes motor and somesthetic cortex serving the legs), basal ganglia, corpus callosum.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

24. A postinfectious disorder following a nonspecific gastrointestinal or respiratory infection that causes an acute neuromuscular paralysis is: a. cerebral palsy. b. HIV encephalopathy. c. Guillain-Barré syndrome. d. Rett syndrome. e. myasthenia gravis.

ANS: C

Guillain-Barré syndrome is an autoimmune disorder triggered by a bacterial or viral infection that damages the peripheral nerves, leading to denervation and atrophy.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

25. The immune system attacks the synaptic junction between the nerve and muscle fibers blocking acetylcholine receptor sites in: a. myasthenia gravis. b. encephalitis. c. multiple sclerosis. d. cerebral palsy. e. trigeminal neuralgia.

ANS: A

Myasthenia gravis is an autoimmune disorder of neuromuscular junction involved with muscle activation; autoantibodies directed against the acetylcholine receptors in the neuromuscular junction cause destruction and inflammatory changes in the postsynaptic membranes that lead to muscle dysfunction.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous

26. A clinical syndrome of intracranial hypertension that mimics brain tumors is: a. meningitis. b. myasthenia gravis. c. Guillain-Barré syndrome. d. pseudotumor cerebri. e. Bell palsy.

ANS: D

Pseudotumor cerebri is a clinical syndrome of intracranial hypertension that mimics brain tumors. Etiology is unknown, but proposed causes are excess cerebrospinal fluid (CSF) production or malabsorption. Obstructed venous drainage of CSF is also a potential cause. Obesity is considered a contributing factor.

TOP: Discipline: Neuroscience MSC: Organ System: Nervous