Neurologic System Flashcards
(38 cards)
Select the answer below that best characterizes the pathophysiology of Parkinson Disease.
A. degeneration of basal ganglia and loss of dopaminergic pigmented nuerons in the substantia nigra
B. degeneration of upper and lower motor neurons
C.GABA depletion in the basal ganglia and frontal cortex
D. Neuroimmune inflammation and destruction of myelin
degeneration of basal ganglia and loss of dopaminergic pigmented neurons in the substantia nigra
The pathophysiology of Parkinson Disease involves genetic predisposition, basal ganglia degeneration within the corpus striatum, globus pallidus, subthalamic nucleus, and the substantia nigra, as well as the loss of dopaminergic-pigmented neurons in the substantia nigra (Rogers, 2022, p. 547).
Which answer best defines what is considered a moderate traumatic brain injury (Moderate TBI)?
A. GCS score between 9 and 12, abnormal brain imaging, LOC lasting 1 hour
B. GCS score between 3 and 8, abnormal findings in brain imaging, decerebrate posturing
C. GCS Score 13-15, LOC lasting nearly half hour, retrograde amnesia
D. GCS Score between3 and 8, abnormal findings in brain imaging, decorticate posturing.
A Moderate TBI is characterized by GCS score between 9 and 12, possible loss of consciousness lasting between 30 minutes and 6 hours, potential for abnormal brain imaging, transient decortication or decerebration is possible, confusion is typical, and posttraumatic amnesia can last over 24 hours (Rogers, 2022, p.578).
Which of the following statements correctly compares Multiple Sclerosis (MS) and Guillain-Barre Syndrome (GBS)?
a. MS affects the central nervous system, while GBS affects the peripheral nervous system.
b. MS has been associated with surgery, immunizations, and immune checkpoint inhibitors, as well as infections such as Campylobacter jejuni, the Zika virus, and SARS-CoV-2.
c. GBS usually has a course of remissions and relapses, with a steadily worsening condition while MS recovery occurs within weeks to months or up to 2 years, with 20 % of individuals having residual weakness.
d. The most common initial symptoms of GBS are paresthesia of the face, trunk, or limbs, impaired gait, or urinary incontinence, indicating central nervous system involvement. In contrast, MS symptoms can range from tingling to severe paralysis and autonomic nervous system instability issues such as blood pressure or arrhythmias.
a. MS affects the central nervous system, while GBS affects the peripheral nervous system.
A 45-year-old man was involved in a vehicular accident on the highway and sustained a spinal cord injury (SCI). Which of the following statements accurately describes the clinical manifestations and complications associated with acute SCI?
a. Spinal shock is a temporary loss of spinal cord functions below the lesion and can develop over 1-2 days.
b. Initial clinical manifestations include rapid development of flaccid paralysis below the level of injury, loss of sensations in the lower extremities and possibly lower trunk, and loss of spinal and autonomic reflexes below the level of injury.
c. Motor, sensory, reflex, and autonomic functions will not be returned.
d. First return of spinal neuron excitability occurs slowly and first to return is the deep tendon reflex
b. Initial clinical manifestations include rapid development of flaccid paralysis below the level of injury, loss of sensations in the lower extremities and possibly lower trunk, and loss of spinal and autonomic reflexes below the level of injury.
Meningitis is an infection of the meninges and subarachnoid space of the brain and spinal cord. Which of the following statements about meningitis among children is correct?
a. Pathogens cross the blood-brain barrier, enter the cerebrospinal fluid, and multiply, increasing cerebrovascular permeability and causing alterations in blood flow and edema, leading to increased intracranial pressure.
b. The hallmark of bacterial meningitis is a mononuclear response in the cerebrospinal fluid and the presence of normal glucose levels.
c. Empirical antibiotic therapy effectively reduces infection and inflammation in the meninges and subarachnoid space of the brain and spinal cord.
d. No side effects develop as long as early detection and proper treatment are implemented.
a. Pathogens cross the blood-brain barrier, enter the cerebrospinal fluid, and multiply, increasing cerebrovascular permeability and causing alterations in blood flow and edema, leading to increased intracranial pressure.
A patient presents to the ED with a concern for stroke-like symptoms. The patient is a 75 year old female with a past medical history of hypertension, hyperlipidemia, atrial fibrillation on Eliquis, and peripheral vascular disease. The patient presents with a right sided facial droop, and when asked what is a pen used for she states, “on the paper, marks on the paper.” This is an example of?
Anomic Aphasia
Global Aphasia
Nonfluent Aphasia
Neologism Aphasia
Anomic Aphasia
Anomic aphasia occurs in CVAs and occurs when auditory comprehension is present but speech is fluent. The patient often is able to describe the object but unable to name the specific item or person. Damage to the brain usually consists of the left hemisphere between the broca and wernicke’s area of the brain. (McCance & Huethers, 2023, pp. 523)
An 80 year old male patient presents to the clinic with a family member. The family member states, “He has not been the same this week. He wakes in the middle of the night and is banging on doors and doesn’t recognize me when I try to stop him. He’s also been sleeping more often and is seeing hallucinations. He is talking to people when sitting at the breakfast table when no one else is there. I don’t know what to do with him”. The patient’s other symptoms include bladder incontinence, disorientation and poor PO intake. Standard labs are ordered and it is found that the patient has a urinary tract infection. What would the patient’s altered mental status be diagnosed as?
Alzheimer’s dementia
Parkinson’s
Mixed delirium
Terminal delirium
Mixed delirium
This patient is likely experiencing mixed delirium related to the UTI. Mixed delirium is described as a combination of hyperactive and hypoactive delirium. This is marked by the acute onset of the altered mentation with hallucination and frequent rest periods, he is also having periods of agitation with altered sleep cycles. This patient is likely to recover with proper treatment of the UTI and other deficiencies caused by the associated symptoms like dehydration caused by the poor PO intake. (McCance & Huethers, 2023, pp. 526)
A mother brings her 7 week old infant to the outpatient clinic for complaints of poor feeding, irritability and fever. The mother did not receive prenatal treatment or testing due to lack of transportation available during the prenatal period. The birth of the child was a vaginal delivery and uneventful other than the patient and mother being discharged AMA due to the mothers worry of being hospitalized because of having multiple children at home to take care of. This resulted in the mother and child being discharged home after 24 hrs in the hospital. Upon assessment the infant is seen to be lethargic, with dry mucous membranes. Assessment also shows nuchal rigidity and opisthotonic posturing. What is the likely cause of these symptoms?
Bacterial meningitis
Febrile Seizure
Hemorrhagic Stroke
Medulloblastoma
Bacterial meningitis
Correct: it is likely that this patient is experiencing symptoms of bacterial meningitis with a group B streptococcus as the infectious agent. This is likely due to the mothers lack of prenatal testing and care. If the mother was infected with group B streptococcus it is possible that the infant contracted the bacteria during the vaginal delivery. Meningitis presents with symptoms of fever, headache, vomiting, irritability, nuchal rigidity and severe meningeal irritation can cause opisthotonic posturing or rigid arching of the back with the head extended. (McCance & Huethers, 2023, pp. 653)
A 40-year-old male arrives by EMS after falling from a second story balcony. He is alert to painful stimuli, moaning and localizes pain. The head CT report is pending, as the APRN you know all the following medications are appropriate to consider except:
Ondansetron
Mannitol
Dexamethasone
Levetiracetam
Dexamethasone – is not an appropriate choice as it is a corticosteroid. According to Rogers (2023), “corticosteroids increase mortality with acute TBI and, consequently, should not be used” (p. 579).
Which of the following statements regarding hydrocephalus is correct:
A. Hydrocephalus is caused by increased reabsorption of CSF.
B. Non communicating hydrocephalus is most common in adults.
C. Communicating hydrocephalus is caused by impaired reabsorption of CSF.
D. Acute hydrocephalus results in slowly increasing ICP.
communicating hydrocephalus “results from impaired reabsorption of CSF in the absence of obstruction between the ventricles and subarachnoid space” (Rogers, 2023, p. 538).
You are seeing a new to your practice 15-month-old with a known history of a sacral myleomeningocele which was surgically repaired at birth. Which statement by the patients’ mother is the most concerning?
A. “She has a shunt that was placed when she was 2 months old.”
B. “She was walking around the room holding onto the walls for the past month, but for the last week minimally crawls and won’t stand.”
C. “She eats most veggies, and drinks cow milk from a bottle.”
D. “She had a few episodes where she dazed off for about a minute, but we have a neurology referral pending after an ER visit.”
This statement is most concerning as there is a decline/change in the patients motor function from previous, and while motor and sensory functions can be altered below the level of the lesion, “these problems should not worsen as the child grows” (Rogers, 2023, p. 642).
Which is the inability to name objects, people, or qualities?
A. Aphasia
B. Global aphasia
C. Transcortical aphasia
D. Anomic sensory aphasia
Anomic sensory aphasia
Which type of memory is remembering personal history, events, experiences, facts, and information?
A. Emotional memory
B. Non declarative memory
C. Declarative memory
D. Memory
declarative memory is remembrance of personal history, events, experiences, facts, and information. Memory is the recording, retention, and retrieval of information. Nondeclarative memory is a motor memory for actions, behaviors, skills, and outcomes. Emotional memory attaches positive or negative qualities to a memory
Which of the following is a risk factor for neural tube defects?
A. Mother older than 35 years old
B. Folic acid deficiency
C. Premature birth
D. Use of hypertensive medications before pregnancy
Folic acid deficiency
Jane, a 30-year-old female, presents to your clinic for a wellness check. She reports that she has been experiencing episodes of numbness in her hands and feet and had an episode of urinary incontinence a few weeks ago when these symptoms occurred. She denies any recent fevers or infections. Which test would be most appropriate to schedule for follow up with Jane?
X-ray of her chest
Ultrasound of her limbs
MRI of her head
A cardiac stress test
mri of her head
Dan, a 25-year-old soldier arrives from his military base complaining of headaches, fever and general malaise. He also notes that he’s been unable to lay in bed and watch television, as each time he lifts his head his knees also rise. What assessment would be most appropriate for the provider to perform next?
Have Dan lay on his back, bend his knees and attempt to straighten them.
Ask Dan to close his eyes and identify different sensations on his hands.
Complete a vision test using a Snellen chart.
Conduct a swallow evaluation for different textures of food
Have Dan lay on his back, bend his knees and attempt to straighten them. –Kernigs sign for meningitis
Which statement made by parents would cause the provider to further assess for a possible brain tumor in a 4-year-old pediatric patient?
He’s become such a picky eater; it’s been difficult having him try new foods.
We try to help him get dressed, but he’s insistent on doing everything himself.
It’s been a struggle to get him to focus, he loves jumping from one topic to the next
He’s been waking up with terrible headaches, but luckily those go away as the day goes on
Waking up with headaches that get better as the day progresses are a common symptom of a brain tumor, as young children don’t typically suffer from headaches
A ten-year-old girl is brought to an urgent care clinic by his family with symptoms that have been progressing over the past several weeks. The girl has been having trouble concentrating at school, mainly due to persistent headaches that are worse in the mornings. She has also been reporting nausea and vomiting that, again, is worse in the mornings. Her family brought her in today for urgent evaluation due to her having coordination issues and being unsteady while walking. Which of the following are symptoms generally associated with having a brain tumor?
Vision loss, numbness, and aphasia
Joint pain, muscle weakness, and generalized fatigue
Nausea with vomiting, progressive neurological deficits, and morning headaches
Neck stiffness, fever, and seizures
Nausea with vomiting, progressive neurological deficits, and morning headaches
An 85-year-old male has been brought to the emergency department with his family, as he has been demonstrating confusion over the past several days. He was diagnosed by his primary care physician with a UTI three days ago and has been placed on oral antibiotics as a course of treatment. Since seeing his doctor, he has been experiencing visual hallucinations, is unable to perform his ADLs independently, and has been agitated easily. Per his family, he has some mild cognitive decline, but it has not interfered with his ability to be independent. During his examination in the emergency department, it was noted that his vitals were normal, but he was disoriented to time, place, and situation. What medical condition is the patient likely experiencing currently?
Sepsis
Stroke
Delirium
Dementia
Delirium
A 50-year-old male is brought into his primary care physician’s office, presenting with lower back pain. The pain is chronic, radiating down his legs, creating difficulty for him to ambulate. He is also reporting numbness and tingling in his lower back and legs. On exam, he has a reduced range of motion in his lumbar spine with weakness, and his MRI shows that there is a narrowing within the lumbar spinal canal. Which of the following medical conditions is the patient likely experiencing?
Spinal Stenosis
Herniated Disk
Spondylolisthesis
Degenerative Disk Disease
Spinal Stenosis
Allie is a doctoral student in her first inpatient hospital clinical rotation. She was assigned to take care of a 56 year old female who had just undergone a right total hip replacement. On assessment, Allie noted that the patient’s pupils were pinpoint. Which post-op medication may have caused this pupillary change?
Scopolamine
Oxycodone
Baclofen
Flexeril
Oxycodone
Christopher is an emergency department nurse practitioner. A 45 year old patient who sustained a 10 foot fall off his roof has just gotten dropped off by emergency medical services. Christopher began examining this patient for a brain injury. On assessment, the patient began to regained consciousness (an estimated 35 minutes following the fall). The patient presented as confused. He was unable to recall the falling event or process what he is being told. The patient began to rapidly become anxious, struggling to response to what is being said or communicate how he feels. Glasgow Coma Scale is a 9. What category brain injury does this patient have?
Mild
Moderate
Severe
None of the above
Moderate
A 62-year-old male patient is brought to the emergency department by his family after they noticed a sudden change in his behavior and mental state. He was confused, lethargic, and intermittently unresponsive. The patient has a history of type 2 diabetes and hypertension. On examination, his vital signs are stable, but he appears drowsy and responds minimally to stimuli. Lab results reveal that blood glucose levels are critically low at 35 mg/dL, and serum electrolytes show a mild sodium imbalance. The patient is also noted to have elevated liver enzymes. Which of the following metabolic alterations is most likely contributing to the patient’s decreased level of arousal?
Hypoxia causing a decrease in oxygen delivery to the brain.
Hypoglycemia leading to inadequate energy substrates for neuronal function.
Hyperglycemia causing osmotic shifts and electrolyte disturbances.
Liver failure leading to the accumulation of toxins affecting neuronal excitability.
Hypoglycemia leading to inadequate energy substrates for neuronal function.
Which of the following newborn infant characteristics does not prompt further investigation?
Spinal midline hair turf
Sacral dimples
Hemangioma lesion
None of the above
none of the above– any midline skin abnormality requires further investigation
