Seidel's chapter 23

Question 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

Answer 1

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 with the cerebral cortex, whose function consists of determining intelligence, personality, and motor function.

Question 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.

Answer 2

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.

Question 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.

Answer 3

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

Question 4

Cerebrospinal fluid serves as a

a. motor nerve impulse transmitter.
b. red blood cell conveyer.
c. shock absorber.
d. mediator of voluntary skeletal movement.
e. sensory nerve impulse transmitter.

Answer 4

ANS: C
Cerebrospinal fluid circulates between an interconnecting system of ventricles in the brain and
around the brain and spinal cord, serving as a shock absorber. Neurotransmitters are chemicals
that transmit nerve impulses from one nerve cell to another. The cerebrospinal fluid does not
play a role in red blood cells or in voluntary skeletal movement.

Question 5

The motor cortex of the brain is in the

a. corpus callosum.
b. frontal lobe.

c. limbic system.
d. occipital lobe.
e. parietal lobe.

Answer 5

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 cerebrum’s 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.

Question 6

The thalamus is the major integration center for perception of

a. speech.
b. olfaction.
c. pain.
d. thoughts.
e. visceral responses to emotions.

Answer 6

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.

Question 7

The awareness of body position is known as

a. extrapyramidal.
b. graphesthesia.
c. stereognosis.
d. two-point discrimination.
e. proprioception.

Answer 7

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

Question 8

Which area of the brain is responsible for perceiving sounds and for determining their source?

a. Frontal lobe
b. Occipital lobe
c. Parietal lobe
d. Temporal lobe
e. Brainstem

Answer 8

ANS: D
The temporal lobe is responsible for the perception and interpretation of sounds and determination of their source. The frontal lobe contains the motor cortex associated with voluntary skeletal movement. The occipital lobe contains the primary vision center. The parietal lobe is primarily responsible for processing received sensory data. The brainstem is the pathway between the cerebral cortex and the spinal cord, and it controls many involuntary functions.

Question 9

Nerves that arise from the brain rather than the spinal cord are called

a. sympathetic.
b. parasympathetic.
c. cranial.
d. autonomic.
e. lower motor neurons.

Answer 9

ANS: C
Cranial nerves are peripheral nerves that arise from the brain rather than the spinal cord. Sympathetic, parasympathetic, and autonomic refer to the autonomic nervous system. Lower motor neurons arise in the spinal cord.

Question 10

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

a. CN I, olfactory
b. CN V, trigeminal

c. CN IX, glossopharyngeal
d. CN XI, spinal accessory
e. CN XII, hypoglossal

Answer 10

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.

Question 11

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

a. birth and 1
b. 2 and 3
c. 4 and 7
d. 11 and 14
e. 16 and 21

Answer 11

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

Question 12

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.

Answer 12

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.

Question 13

Normal changes of the aging brain include

a. increased velocity of nerve conduction.
b. diminished perception of touch.
c. increased total number of neurons.
d. decreased dermatomes.
e. diminished intelligence quotient.

Answer 13

ANS: B
Sensory perceptions of touch and pain are diminished by aging. The velocity of nerve impulse conduction declines, so response to stimuli takes longer. The number of cerebral neurons is thought to decrease by 1% a year beginning at 50 years of age; however, the vast number of reserve cells inhibits the appearance of clinical signs. Dermatomal patterns do not change. Acquired knowledge is maintained throughout life.

Question 14

The area of body surface innervated by a particular spinal nerve is called a

a. dermatome.
b. nerve pathway.
c. spinal accessory area.
d. cutaneous zone.
e. spinal tract.

Answer 14

ANS: A
The sensory and motor fibers of each spinal nerve supply and receive information to a segment of skin known as a dermatome. Nerve pathway and spinal accessory area refer to nerve routes; cutaneous zone refers to a skin area that transmits fine mechanical information and normal exogenous thermal information at the same time. Spinal tracts are located in the spinal cord.

Question 15

Environmental hazards and cognitive function are data needed for the personal and social history

section of a neurologic assessment for

a. adolescents.
b. every patient.

c. persons with seizures.
d. pregnant women.
e. infants.

Answer 15

ANS: B
Exposure to lead, arsenic, insecticides, organic solvents, dangerous equipment, and work at heights or in water are important factors to consider in the personal and social history of all patients.

Question 16

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.

Answer 16

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.

Question 17

When assessing superficial pain, touch, vibration, and position perceptions, you are testing

a. motor function.
b. cerebellar function.
c. sensory function.
d. tendon reflexes.
e. emotional status.

Answer 17

ANS: C
Superficial pain, touch, vibration, and position perceptions are sensory functions. Cerebellar function and tendon reflexes are neuromuscular functions, and emotional status is regulated in the amygdala within the temporal lobe.

Question 18

You are examining a patient in the emergency department who has recently sustained head trauma. To initially assess this patient’s neurologic status, you would

a. ask him to discriminate between the smell of orange and peppermint.
b. test the six cardinal points of gaze.
c. palpate the jaw muscles as the patient clenches teeth.

d. observe for swallowing and test the gag reflex.
e. test the patient’s tongue movements.

Answer 18

ANS: B
The sixth cranial nerve is commonly one of the first to lose function in the presence of increased intracranial pressure. Testing of the six cardinal points of gaze involves CN VI, which would be a priority.

Question 19

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.

Answer 19

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.

Question 20

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.

Answer 20

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.

Question 21

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.

Answer 21

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).

Question 22

As Mr. B enters the room, you observe that his gait is wide based and he staggers from side to side while swaying his trunk. You would document Mr. B’s pattern as

a. dystonic ataxia.
b. cerebellar ataxia.
c. steppage gait.
d. tabetic stamping.
e. Parkinsonian gait.

Answer 22

ANS: B
A cerebellar gait (cerebellar ataxia) occurs when the patient’s feet are wide 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, the patient’s posture is stooped, and the body is held rigid; steps are short and shuffling, with hesitation on starting and difficulty stopping.

Question 23

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.

Answer 23

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

Question 24

To assess a cremasteric reflex, the examiner strokes the

a. skin around the anus and observes for the anal wink.

b. abdomen and observes whether the umbilicus moves away from the stimulus.
c. inner thigh and observes whether the testicle and scrotum rise on the stroked

d. palm and observes whether the fingers attempt to grasp.
e. sole of the foot and observes whether the toes fan down and out.

Answer 24

ANS: C
Stroking the inner thigh of a male patient (proximal to distal) will elicit the cremasteric reflex. The testicle and scrotum rise on the stroked side. Stoking the skin around the anus produces reflexive contracture of the external anal sphincter referred to as the anal wink. Stroking the sole of the foot elicits a Babinski sign, stroking the abdomen elicits an abdominal reflex, and stroking the palm elicits a palmar grasp.

Question 25

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.

Answer 25

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. Graphesthesia tests the patient’s ability to identify the figure being drawn 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.

Question 26

The ability to recognize a number traced on the skin is called

a. stereognosis.
b. graphesthesia.
c. extinction phenomenon.
d. two-point discrimination.
e. proprioception.

Answer 26

ANS: B
The ability to recognize a number traced on the skin is called graphesthesia. Stereognosis is the ability to recognize an object through touch and manipulation. The extinction phenomenon test and two-point discrimination assess the person’s ability to discern the number of pinpoints and their location. Proprioception is the sensation of position and muscular activity originating from within the body.

Question 27

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

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

Answer 27

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.

Question 28

To assess spinal levels L2, L3, and L4, which deep tendon reflex should be tested?

a. Triceps
b. Patellar
c. Biceps
d. Achilles
e. Brachioradial

Answer 28

ANS: B
To assess spinal levels L2 to L4, the patellar reflex should be tested. The patellar tendon is the only deep tendon that assesses the lumbar spinal level. The triceps, biceps, and brachioradial deep tendon reflexes are tested to assess the cervical spine, and the Achilles tendon is tested to assess the sacral spine.

Question 29

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. assesses only the dorsal surface of the foot with the patient’s eyes open.

Answer 29

ANS: C
The monofilament is placed on several smooth spots of the patient’s plantar foot for 1 seconds. Adequate pressure applied by the monofilament is measured by the bend of the monofilament.

Question 30

Visible or palpable extension of the elbow is caused by reflex contraction of which muscle?

a. Serratus anterior
b. Biceps
c. Pectoralis major
d. Triceps
e. Deltoid

Answer 30

ANS: D
The triceps tendon, when directly hit with the reflex hammer just above the elbow, will cause contraction of the triceps muscle and extension of the elbow.

Question 31

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.

Answer 31

ANS: A
Test the ankle clonus when reflexes are hyperactive. Support the patient’s knee in a flexed 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.

Question 32

Which sign is associated with meningitis and intracranial hemorrhage?

a. Babinski sign
b. Asymmetric tonic neck reflex
c. Doll’s eye movement
d. Nuchal rigidity
e. Moro reflex

Answer 32

ANS: D
A stiff neck or nuchal rigidity is a sign associated with meningitis and intracranial hemorrhage. Test this by lifting the head of the patient to touch the chin while the patient lies in a supine position. Pain and resistance to neck motion are associated with nuchal rigidity. All of the other options are expected findings in infants and are not related to meningitis in adults.

Question 33

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.

a. Kernig

b. Babinski
c. obturator
d. Brudzinski
e. Murphy

Answer 33

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.

Question 34

On a scale of 0 to 4+, which deep tendon reflex score is appropriate for a finding of clonus in a patient?

a. 0
b. 1+
c. 2+
d. 3+
e. 4+

Answer 34

ANS: E
0 indicates absent reflexes; 1+ indicates sluggish or diminished reflex; 2+ indicates active or expected response; 3+ indicates more brisk than expected, slightly hyperactive; and 4+ indicates brisk, hyperactive, with intermittent or transient clonus.

Question 35

Cranial nerve XII may be assessed in an infant by

a. watching the infant’s facial expressions when crying.

b. observing the infant suck and swallow.
c. clapping hands and watching the infant blink.

d. observing the infant’s rooting reflex.
e. checking the infant’s gag reflex.

Answer 35

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 rise in a midline position. Watching the infant’s facial expressions when crying assesses 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.

Question 36

At what age should an infant begin to transfer objects from hand to hand?

a. 2 months
b. 4 months
c. 7 months
d. 10 months
e. 12 months

Answer 36

ANS: C

Transferring objects hand to hand begins at 7 months. Purposeful release of objects is noted as a normal finding by 10 months. Purposeful movements, such as reaching and grasping for objects, begin at about 2 months of age. The progress of taking objects with one hand begins at 6 months. There should be no tremors or constant overshooting of movements.

Question 37

A positive Babinski sign is normal until what age?

a. 3 to 6 months
b. 9 to 15 months
c. 16 to 24 months
d. 3 years
e. 5 years

Answer 37

ANS: C
A positive Babinski sign, fanning of the toes and dorsiflexion of the great toe, is a normal finding until the infant is 16 to 24 months old.

Question 38

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

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

Answer 38

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

Question 39

Ipsilateral Horner syndrome 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 portion of the pons.

Answer 39

ANS: C
The posterior inferior cerebellar artery supplies the lateral and posterior portion of the medulla. A CVA involving this artery can produce a neurologic sign of ipsilateral Horner syndrome in the eye.

Question 40

An acute polyneuropathy that commonly follows a nonspecific infection occurring 10 to 14 days earlier and that primarily affects the motor and autonomic peripheral nerves in an ascending pattern is

a. cerebral palsy.
b. HIV encephalopathy.
c. Guillain-Barré syndrome.
d. Rett syndrome.
e. myasthenia gravis.

Answer 40

ANS: C
Guillain-Barré syndrome (acute idiopathic polyneuritis) is an acute polyradiculoneuropathy that commonly follows a nonspecific infection that occurred 10 to 14 days earlier. It is characterized by ascending symmetrical weakness with sensation preserved. An increase in the severity occurs over days or weeks. A decrease or absent strength and sensory loss may result along with motor paralysis and respiratory muscle failure.

Question 41

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.

Answer 41

ANS: A
Myasthenia gravis is a chronic autoimmune neuromuscular disease involving the lower motor neurons and muscle fibers. The immune system of infected individuals produces antibodies that destroy acetylcholine receptor sites at the neuromuscular junction. This blocks the nerve impulse from reaching the muscle and produces muscle fatigue.

Question 42

Diabetic peripheral neuropathy will likely produce

a. hyperactive ankle reflexes.
b. diminished pain sensation.
c. exaggerated vibratory sense.
d. hypersensitive temperature perception.
e. exaggerated sharp touch sensation.

Answer 42

ANS: B
Peripheral neuropathy is a disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves, more commonly in the hands and feet. Patients may have sensation of numbness, tingling, burning, and cramping. In moderate to severe diabetic neuropathy, the patient has wasting of the foot muscles, absent ankle and knee reflexes, decreased or no vibratory sensation below the knees, or loss of pain or sharp touch sensation to the mid-calf level.

Question 43

Persons with Parkinson disease have an altered gait that is characterized by

a. short shuffling steps.
b. the trunk in a backward position.
c. exaggerated swinging of the arms.
d. lifting the legs in a high-step fashion.
e. wide-based, staggering, and lurching steps.

Answer 43

ANS: A
The altered gait of Parkinson disease has short shuffling steps, the posture is stooped forward, and the arms have limited swing.

Question 44

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.

Answer 44

ANS: D
Pseudotumor cerebri is a clinical syndrome of intracranial hypertension that mimics brain tumors. Its cause is unknown, but one theory is that an impaired venous outflow leads to increased cerebral blood volume; it may also be idiopathic.