Seidel Ch 23 Neuro question and answer with verified content

Seidel Ch 23 Neuro question and answer with verified content Which is a function of the basal ganglia? A. Facilitate involuntary functions of the brain B. Exert a fine-tuning effect on motor movements C. Control levels of consciousness D. Facilitate balance and coordination B. Exert a fine-tuning effect on motor movements Through its interconnections with the thalamus, motor cortex, reticular formation, and spinal cord, the basal ganglia refine motor movements. Testing for sharp, dull, and light touch on the face at the scalp cheek and chin examines: CN V CN VI CN VII CN VIII ANS: A Rationale: The three divisions of the trigeminal nerve (CN V) are evaluated for sharp, dull, and light touch sensation (see Fig. 22-10). Cerebellar ataxia or vestibular dysfunction is tested by: Testing the acoustic nerve Heel toe walking Finger-to-nose movement Romberg test ANS: D Rationale: The Romberg test is used for cerebellar ataxia or vestibular dysfunction. Hyperactive reflexes indicate: Lower motor neuron disorder Upper motor neuron disorder Lower sensory neuron disorder Upper sensory neuron disorder ANS: B Rationale: Absent reflexes may indicate neuropathy for lower motor neuron disorder; hyperactive reflexes suggest an upper motor neuron disorder. Julie is a 38-year-old patient who presents to the clinic for a concern regarding facial drooping. You suspect a diagnosis of Bell palsy. Which is the etiology of Bell palsy? Bilateral inflammation of CN V Acute inflammation of CN V Acute inflammation of CN VII Chronic inflammation of CN VII ANS: C Rationale: Bell palsy is an acute inflammation of the facial nerve (cranial nerve VII) that is a viral infection with herpes simplex, which leads to ischemia and demyelination. Bell palsy is a(n): Lower motor neuron disorder Upper motor neuron disorder Lower sensory neuron disorder Upper sensory neuron disorder ANS: A Rationale: To distinguish between upper and lower neuron disease that affects the face, inspect the face with an emotional expression. When the upper motor neurons are affected, as in a stroke, voluntary movements are paralyzed but emotional movements are spared. In lower motoneuron disorders, such as Bell palsy, all facial movement on the affected side is paralyzed Julie is a 38-year-old patient who presents to the clinic for a concern regarding facial drooping. You suspect a diagnosis of Bell palsy. On examination, which characteristic would you expect to find? (Select all that apply). Drooping of the eyelid on the affected side Facial creases and nasolabial fold disappear on the affected side Absent facial sensation Absent cranial nerves III, IV, and VI ANS: A, B Rationale: In Bell palsy there is a temporary weakening of one side of the face. This can cause drooping of the eyelid and disappearance of the facial creases and nasolabial fold. Facial sensation remains intact. Primary sensory Superficial touch; superficial pain; temperature and deep pressure; vibration; position of joints Cortical sensory Sterognosis; two-point discrimination; extinction phenomenon; graphesthesia; point location Superficial reflexes Plantar, abdominal, cremasteric Not routinely tested, but need to be when thoracic spinal nerves need to be eval-ed Deep tendon reflexes Biceps, brachioradial, triceps, patellar, Achilles Clonus Protective sensation Monofilament on foot for diabetic/peripheral neuropathy patients Meningeal signs Stiff neck, nuchal rigidity Brudzinski and Kernig signs Brudzinski's sign Sign of meningitis; positive when a patient's legs lift involuntarily when lifting a patient's head Kernig signs + when pt has pain in lower back and resistance to straightening the leg at the knee Jolt accentuation of headache Pt presents with fever and HA, suspect Meningitits - have pt move head horizontally 2-3 rotations/sec + indicated by increased HA over baseline Posturing (in acute care usually) Decorticate, flexor, decerebrate, extensor Neuro physical exam on preggo pts Deep tendon reflexes on initial examination serve as baseline You are obtaining a history on a new patient. A family history of which disorder would be of greatest concern? A. Cardiovascular accident (CVA) B. Meningitis C. Huntington chorea D. Vertigo C. Huntington chorea A family history of Huntington chorea is of the greatest concern because it is a hereditary disorder and therefore the possibility of the patient being affected must be explored. Additional questions need to be asked about specific family members affected, and the patient must be carefully checked for any indications of the disease as part of the physical examination. Testing of cranial nerve ____ is not routinely performed unless a problem is suspected. A. I B. II C. V D. XI A. I Ordinarily, taste and smell are not evaluated unless a problem is suspected. The patient is able to touch each finger to his thumb in rapid sequence. What does this finding signify? A. The patient has intact trochlear and abducens cranial nerves. B. The patient has normal cerebellar function. C. The patient has an intact spinal accessory nerve. D. The patient has appropriate kinesthetic sensation B. The patient has normal cerebellar function As an alternate procedure, have the patient touch the thumb to each finger on the same hand, in sequence from the index finger to the little finger and back. Which question asked by the examiner may help to determine prevention strategies for seizures that a patient is experiencing? A. "Where do your seizures typically begin?" B. "How do you feel after the seizure?" C. "What goes through your mind during the seizure?" D. "Are there any factors or activities that seem to start the seizures?" D. "Are there any factors or activities that seem to start the seizures?" Questions asked of a patient presenting with a seizure relate to history of prior seizure, premonition or aura (headache, mood change, anxiety, irritability, lethargy, changes in appetite, dizziness, and lightheadedness), and any precipitating factors. Identification of precipitating factors can assist in designing prevention strategies. Mr. McKnight is a 48-year-old patient who presents to your office with a complaint of dizziness. He states, "I sometimes feel as if the whole room is spinning." What type of neurologic dysfunction should the examiner suspect? A. Peripheral neuropathy dysfunction B. Increased intracranial pressure from a brain tumor C. Inner ear dysfunction affecting the acoustic nerve D. A lesion affecting the frontal lobe C. Inner ear dysfunction affecting the acoustic nerve The acoustic nerve, or cranial nerve VIII, regulates hearing and equilibrium. The examiner asks the patient to close her eyes, then places a vibrating tuning fork on the patient's ankle and asks her to indicate what is felt. What is being assessed? A. Peripheral nerve sensory function B. Cranial nerve sensory function C. Cortical sensory function D. Level of consciousness A. Peripheral nerve sensory function Sensory loss follows the distribution of dermatomes or peripheral nerves. Jack is a 52-year-old obese man with a history of poorly controlled diabetes. He also smokes. Based on these data, the examiner should recognize that Jack has several risk factors for: A. seizures. B. cerebrovascular accident. C. multiple sclerosis. D. Guillain-Barré syndrome. B. cerebrovascular accident. Risk factors for stroke (brain attack or cerebrovascular accident) include smoking tobacco products and history of diabetes mellitus, cardiovascular disease, hypertension, and increased serum cholesterol levels. The examiner is assessing deep tendon reflexes in a 12-year-old boy. Which score should be documented when the expected reflex response occurs? A. 1+ B. 2+ C. 3+ D. 4+ B. 2+ The notation 2+ represents an active or expected response. Mr. Tucker is a 68-year-old patient who presents to your office for follow-up. He tells you, "I feel numb and I am so slow when I move." On examination, you note postural instability. These assessment data are suggestive of which problem? A. Developing seizure disorder B. Parkinson disease C. Dysfunction of the temporal lobe D. Vestibular tumor B. Parkinson disease Parkinson disease is a slowly progressive, degenerative neurologic disorder in which deficiency of the dopamine neurotransmitter results in poor communication between parts of the brain that coordinate and control movement and balance. Mr. Smith, a 75-year-old, tells you during his physical that he is experiencing tremors in his hands that occur at rest. Which disorder does this finding cause you to suspect? A. Multiple sclerosis B. Myasthenia gravis C. Parkinson disease D. Alzheimer disease C. Parkinson disease With Parkinson disease, tremors (sometimes unilateral) occur initially at rest and with fatigue, disappearing with intended movement and sleep; as the disease progresses, pill-rolling movement of fingers bilaterally and tremor of the head occur. Mrs. Morrison brings in her 5-year-old son in for an examination. What is your best approach to the neurologic assessment of the child? A. Ask the mother or father to perform the examination while you observe the response. B. Ask the mother or father to step out of the room. C. Promise the child a toy or treat if he does what you ask. D. Make various aspects of the neurologic examination a game. D. Make various aspects of the neurologic examination a game. Direct examination of cranial nerves is modified for the age of the child. Often a game is played to elicit the response. Which infant reflex response is considered normal? A. A 13-month-old infant's knee flexes in response to stroking the lateral surface of the infant's sole. B. An 8-month-old infant demonstrates a positive Moro reflex when startled. C. A 3-month-old infant's fingers fan when the examiner's finger is placed in the infant's hand. D. A 2-month-old infant's legs flex up against the body when the infant is held in an upright position, and the dorsal side of the foot touches the table. D. A 2-month-old infant's legs flex up against the body when the infant is held in an upright position, and the dorsal side of the foot touches the table. Hold the infant upright under the arms next to a table or chair; touch the dorsal side of the foot to the table or chair edge; observe flexion of the hips and knees and lifting of the foot as if stepping up on the table; age of disappearance varies. The examiner is interviewing the mother of a 3-month-old infant as part of the infant's neurologic system examination. Which response of the mother may indicate a need for further evaluation of the infant? A. "My baby sometimes falls asleep when I am feeding her." B. "My baby seems to jump when there is a loud noise in the room." C. "I drank a glass of wine about once a week while I was pregnant." D. "I had problems with hypertension the entire time I was pregnant." D. "I had problems with hypertension the entire time I was pregnant." A prenatal/maternal history of intrauterine infections such as toxoplasmosis, syphilis, tuberculosis, rubella, cytomegalovirus, herpes, prior history of hypertension, preeclampsia, bleeding, history of trauma or stress, persistent vomiting, hypertension, or drug or alcohol use alerts the examiner to the need for further evaluation of an infant. Mr. Harrien is a 56-year-old patient who presents to your office. On examination, you note impaired pain sensation. Which additional testing is appropriate to further evaluate this finding? A. Temperature and deep pressure sensation B. Ultrasonic perception C. Deep tendon reflex D. Transillumination of the involved area A. Temperature and deep pressure sensation Temperature and deep pressure sensation tests are performed only if superficial pain sensation is not intact. Mr. Black is a 41-year-old construction worker who comes in to your office. You squeeze the patient's biceps muscle as part of an examination. Which of the following responses verbalized by the patient is considered normal? A. "That makes my arm tingle." B. "That makes a burning sensation go up my arm." C. "That is uncomfortable." D. "My arm is twitching." C. "That is uncomfortable." Deep pressure sensation is tested by squeezing the trapezius, calf, or biceps muscle. The patient should experience discomfort. Which finding is associated with an increased risk of skin breakdown and injury? A. An inability to feel pressure applied by a monofilament B. An inability to identify a familiar object by touch C. An inability to identify a letter drawn in the palm of the hand D. 3+ deep tendon reflexes A. An inability to feel pressure applied by a monofilament Loss of sensation to the touch of the monofilament is an indication of peripheral neuropathy. Skin breakdown and injury can occur as a result of excessive pressure; thus a patient who is unable to feel pressure is at risk for injury secondary to excessive pressure. A patient presents with a bilaterally symmetric intention tremor of the hands that she describes as "worse when I'm stressed and better when I have a cocktail." How would you document this tremor? A. Physiologic tremor B. Essential tremor C. Resting tremor D. Psychological tremor B. Essential tremor Essential tremor may worsen with stress or fatigue; it may improve temporarily with alcohol. The main function of cerebrospinal fluid is to: A. provide nutrients for the brain and spinal cord cells. B. act as a shock absorber. C. cleanse the brain and spinal cord cells and remove debris. D. function as a neurotransmitter. B. act as a shock absorber. Cerebrospinal fluid circulates between an interconnecting system of ventricles in the brain and around the brain and spinal cord, serving as a shock absorber. Which assessment finding is consistent with upper motor neuron disease affecting the face? A. Movement of the affected side occurs with emotion but not volition B. Movement of the affected side occurs only on direct command C. Asynchronized movements of the two sides of the face D. Total paralysis of the affected side of the face A. Movement of the affected side occurs with emotion but not volition When the upper motor neurons are affected, as in a stroke or brain attack, voluntary movements are paralyzed but emotional movements are spared. The cerebellum is primarily responsible for: A. controlling temperature sensation and voluntary skeletal muscle activity. B. processing visual data as they are received. C. controlling the perception and interpretation of sight and sound. D. controlling reflexive control of muscle tone, equilibrium, and posture. D. controlling reflexive control of muscle tone, equilibrium, and posture. In concert with the vestibular system, the cerebellum uses the sensory data for reflexive control of muscle tone, balance, and posture to produce steady and precise movements. Which assessment finding is consistent with lower motor neuron disease affecting the face? A. Movement of the affected side of the face only with emotion B. Movement of the affected side of the face only on direct command C. Asynchronized movements of the two sides of the face D. Total paralysis of the affected side of the face D. Total paralysis of the affected side of the face In a lower motor neuron disorder, such as Bell palsy, all facial movements on the affected side are paralyzed. The upper motor neurons are part of the descending pathways that connect the: A. brainstem with the cranial nerves. B. left hemisphere with the right hemisphere. C. brainstem with the cerebral cortex. D. brain with the spinal cord. D. brain with the spinal cord. Upper motor neurons are nerve cell bodies for the motor pathways that all begin and end within the central nervous system. They comprise the descending pathways from the brain to the spinal cord. Motor maturation in an infant proceeds in which direction? A. Inferosuperior B. Mediolateral C. Cephalocaudal D. Inferoexterior C. Cephalocaudal Motor maturation proceeds in a cephalocaudal direction. Mrs. Green brings her 6-month-old infant in for examination. Which observation is most indicative of a normal timetable of neurologic development? A. The infant grasps your finger when you place it on the palm of the hand. B. The infant takes and holds a spoon in one hand. C. The infant can throw a soft ball. D. The infant can make and hold a fist. B. The infant takes and holds a spoon in one hand. Purposeful movement (e.g., reaching and grasping for objects) begins at about 2 months of age. The infant progresses to taking objects with one hand at 6 months, transferring objects hand to hand at 7 months, and purposefully releasing objects by 10 months of age. A dermatome is that part of the body that: A. is innervated by a particular spinal nerve. B. is governed by a specific cranial nerve. C. is receptive to sensory stimuli. D. responds to motor impulses A. is innervated by a particular spinal nerve. Dermatomes of the body are areas of body surface innervated by particular spinal nerves; C1 usually has no cutaneous distribution. A functioning cranial nerve (CN) I allows an individual to: A. differentiate light from dark. B. differentiate hot from cold. C. differentiate various odors. D. differentiate touch from light pain. C. differentiate various odors. Cranial nerve I (olfactory nerve) is a sensory nerve that allows reception of smell and its interpretation. By asking an individual to make various faces at you, you are testing: A. CN II. B. CN III. C. CN IX. D. CN VII. D. CN VII. Cranial nerve VII (facial nerve) has both motor and sensory components. The motor component is responsible for movement of facial expression muscles except the jaw; it is also responsible for closing the eyelids and for labial speech sounds (b, m, w, and rounded vowels). The sensory component of CN VII is responsible for which function? A. Taste B. Smell C. Balance D. Pain A. Taste The sensory component of cranial nerve VII (facial nerve) mediates taste sensation from the anterior two-thirds of the tongue. The finger-to-nose test is used to test for: A. speed of performance. B. accuracy of movement. C. specificity of position. D. quality of movement. B. accuracy of movement. The finger-to-nose test is performed with the patient's eyes open to test accuracy of movement. Ask the patient to use an index finger and alternately touch his or her nose and your index finger. During the examination of a 49-year-old patient, you test rapid rhythmic alternating movements. This tests an individual's: A. sense of balance. B. gross motor movements. C. coordination and fine motor skills. D. CN XII C. coordination and fine motor skills. Evaluate coordination and fine motor skills by testing rapid rhythmic alternating movements. Mr. Treven is a 48-year-old patient who presents to your office with a complaint of poor balance. In assessing this complaint, which test do you perform first? A. Tandem gait test B. Heel to shin test C. Romberg test D. Weber test C. Romberg test Evaluate balance using the Romberg test. Which condition is required when testing discriminatory sensory function of an individual? A. Quiet room B. Darkened environment C. Quiet voice D. Individual's eyes closed D. Individual's eyes closed Each sensory discrimination procedure is tested with the patient's eyes closed. Mrs. Bowers is a 63-year-old patient. On examination, you need to test joint position sensation. In testing position sensation, the examiner moves the individual's: A. head back and forth. B. finger and toe up or down. C. arm away from and toward the body. D. leg up or down. B. finger and toe up or down. To test joint position sensation, assess the great toe of each foot and a finger on each hand. Hold the joint to be tested (e.g., great toe or finger) by the lateral aspects to avoid giving a clue about the direction moved. Beginning with the joint in neutral position, raise or lower the digit and ask the patient which way the joint was moved. Expect patients to identify the joint position. A pill-rolling tremor is an expected finding in patients with which disorder? A. Multiple sclerosis B. Parkinson disease C. Hyperthyroidism D. Hypoglycemia B. Parkinson disease Parkinson disease is characterized by slow supination-pronation (pill-rolling) movements when the limb is at rest. By simultaneously touching the individual in two distinct areas of the body and asking the number and location of stimuli, you are testing: A. two-point discrimination. B. superficial pain. C. extinction phenomenon. D. dermatome function. C. extinction phenomenon. The extinction phenomenon is tested by simultaneously touching two areas on each side of the body (e.g., cheek, hand, or other area) with the sharp edge of a broken tongue blade and asking the patient to tell you the number of stimuli and where they are felt. Similar sensations should be felt bilaterally. When stroking the inner thigh of a male patient, which of the following is expected to occur? A. The individual will experience an erection. B. The scrotum and testicle on the stroked side will rise. C. The penis will rotate toward the nonstroked side. D. The urethral meatus will wink at you. B. The scrotum and testicle on the stroked side will rise. Stroking the inner thigh of the male patient (proximal to distal) elicits the cremasteric reflex. The testicle and scrotum rise on the stroked side. The Babinski response of the plantar reflex is normally seen in individuals who: A. have hyperreflexive deep tendon reflexes. B. demonstrate clonus. C. also demonstrate a cremasteric reflex. D. are younger than 24 months of age. D. are younger than 24 months of age. The plantar reflex is routinely performed as described in the adult examination. A positive Babinski sign, fanning of the toes and dorsiflexion of the great toe, is expected until the infant is 16 to 24 months of age. Pronation of the forearm and flexion of the elbow is an expected response of the: A. biceps deep tendon reflex. B. triceps deep tendon reflex. C. brachioradial deep tendon reflex. D. patellar deep tendon reflex. C. brachioradial deep tendon reflex. The brachioradial reflex results in pronation of the forearm and flexion of the elbow when the brachioradial tendon is struck with the reflex hammer. A deep tendon reflex that is more brisk than expected and slightly hyperactive would be graded as: A. 1+. B. 2+. C. 3+. D. 4+. C. 3+. Reflexes that are more brisk than expected and slightly hyperactive are graded 3+. Clonus is associated with reflexes that are: A. hyperactive. B. sluggish. C. superficial. D. flaccid. A. hyperactive. Grade IV reflexes are brisk, hyperactive, and with intermittent or transient clonus. Mr. Arena is a 64-year-old patient. On examination, you note positive Brudzinski and Kernig signs. The Brudzinski and Kernig signs are indicators of: A. mental retardation. B. peripheral neuropathy. C. meningeal irritation. D. facial nerve paralysis. C. meningeal irritation. The presence of Brudzinski and Kernig signs may indicate meningeal irritation.