SLP 481B Exam 2

Two people have areas of brain damage that are the same size. Person 1 has a major communication problem; Person 2 has only a mild change. Which additional fact would best explain the difference?

Person 1 has more severe damage in a site important for communication, while Person 2 has less severe damage in a different site.

The materials state that the site and severity of nervous-system damage help determine the resulting deficit. Apply that idea to two areas of brain damage that are the same size but produce different communication and cognitive problems.

Size alone does not determine the deficit. Damage in a particular site may affect communication, cognition, motor movement, or another function, while damage of the same size in another site may have a different effect. Greater severity at a site can also produce a more serious deficit.

Two people with the same acute etiology can have different deficits when the site or severity of their nervous-system damage differs.

True or False

True

A patient has an ischemic stroke. The tissue around the infarct is not functioning normally but is still receiving enough blood from other vessels to stay alive. This tissue is the ischemic __________.

Penumbra

A patient has a hemorrhagic stroke. Which sequence best accounts for the combination of a sudden deficit, blood entering tissue, and increased intracranial pressure?

Blood supply is interrupted; blood spills into brain tissue; continued bleeding can increase pressure within the skull.

Fatty materials such as cholesterol accumulate slowly on an artery wall, narrowing the artery and restricting blood flow.

Atherosclerosis

A clot develops slowly in an artery and interrupts blood flow to the brain.

Thrombotic stroke

A mass travels through the bloodstream and lodges in a blood vessel that is too small for it to pass through.

Embolic stroke

A small ischemia resolves within 24 hours, but repeated episodes can eventually produce lasting cognitive problems.

Transient ischemic attack

The tissue cannot function normally because blood flow is too low, but collateral blood flow keeps the tissue alive.

Ischemic penumbra

Cells in the affected area have died because the blood supply necessary for survival was not restored.

Ischemic core

A hemorrhagic stroke produces a sudden deficit. Explain how one ruptured blood vessel can produce three different sources of brain damage described in the materials.

The rupture can interrupt blood supply to part of the brain, causing ischemic damage. Blood can spill into brain tissue and damage the tissue it contacts. Continued bleeding can increase intracranial pressure, making it harder for blood to enter the brain and potentially causing death.

A sudden and very severe headache can be a sign of hemorrhagic stroke, while the distinction still depends on whether the vessel ruptured or became blocked.

True or False

True

A clot blocks a blood vessel in the brain, but it did not form at the site where it became lodged. Which additional finding would best support that explanation?

A clot formed in another part of the body and traveled through the bloodstream.

A clot that forms slowly in an artery and interrupts blood flow is a __________. If a piece breaks off, travels through the bloodstream, and lodges in another blood vessel, it is an __________.

thrombus; embolus

A person has two brief episodes of weakness. Each episode resolves within 24 hours, but the second occurs a week after the first. Explain why the repeated episodes are more concerning than one isolated episode, even though neither leaves a permanent deficit at the time.

Each episode is consistent with a transient ischemic attack, in which a small ischemia resolves. Repeated TIAs can produce lasting cognitive and language deficits over time and may warn of a larger, more destructive stroke. Symptom resolution does not remove that risk.

Saving the ischemic penumbra can improve the prognosis, but tissue in the ischemic core has already experienced irreversible cell death.

True or False

True

A person has mild weakness and a cognitive change that disappear after the blood clot is resolved. Which interpretation best fits the materials?

The event may be a transient ischemic attack, which can warn of a larger stroke.

A patient has an obstructing clot that is being treated with a clot-busting medication.

tPA

An open operation places a metal clip across the base of an aneurysm to close the aneurysm.

Aneurysm clipping

A catheter places a platinum-wire coil inside an aneurysm to prevent blood from flowing into it.

Endovascular coiling

A larger aneurysm needs a coil and a wire-mesh tube to hold the coil in place and seal the opening.

Stent-assisted coiling or flow diversion

A drain is used to monitor intracranial pressure and treat brain swelling or hydrocephalus.

External ventricular drain

Two patients have similar sudden deficits. One has a blocked artery, and the other has a ruptured aneurysm. Explain why a treatment that may help the first patient could be dangerous for the second patient.

The blocked artery may require treatment directed at the clot and the ischemic penumbra. A ruptured aneurysm requires treatment to stop the bleeding and control intracranial pressure. A medication intended to dissolve a clot could increase bleeding in the patient with the ruptured aneurysm.

In a hemorrhagic stroke, the blood that spills from the ruptured vessel is itself a source of brain damage, in addition to the interruption of blood supply and increased intracranial pressure.

True or False

True

A hemorrhage is described as occurring between the arachnoid mater and pia mater rather than within the brain itself. Which term and location fit together?

Subarachnoid hemorrhage; blood enters the space between the arachnoid mater and pia mater.

When the brain receives no oxygen, the condition is called __________. When the brain receives only part of the oxygen it needs, the condition is called __________.

anoxia; hypoxia

A cerebral aneurysm may be present without symptoms; rupture can turn it into a hemorrhagic stroke.

True or False

True

A patient has blood within brain tissue. Another has blood between the arachnoid mater and pia mater. Compare the first source of damage in each case and explain why both can increase intracranial pressure.

Blood within brain tissue directly damages the tissue it contacts. Blood between the arachnoid mater and pia mater surrounds the brain and can affect the brain's surface and pressure. Continued bleeding in either location can increase intracranial pressure.

A woman reports confusion, nausea, and a sudden behavioral change but no weakness. Which explanation best accounts for why treatment might be delayed?

The symptoms are different from common stroke symptoms and may not be recognized as a stroke.

A woman with sudden confusion and nausea is not recognized as having a stroke until four hours after the symptoms begin. Use the materials to explain why the delay could affect treatment, but do not treat the three-hour time point as a guarantee of recovery.

The materials state that the most effective stroke treatments are available only when the stroke is recognized and diagnosed within the first three hours. A delay can therefore remove some treatment options. Reaching treatment within that time does not guarantee recovery because the result depends on the type and severity of brain damage.

A woman smokes, has high blood pressure, and uses birth control pills. Explain why focusing only on the birth control pills would give an incomplete account of her stroke risk.

Birth control pills are one unique risk factor in women, but the materials also identify smoking and high blood pressure as general risk factors. The risks can occur together, so the complete pattern matters.

A woman who is pregnant or has migraine headaches with aura has risk factors that replace general factors such as smoking, high blood pressure, and diabetes when stroke risk is assessed.

True or False

False. The materials identify both general risk factors and unique risk factors in women. Smoking, high blood pressure, diabetes, high cholesterol, lack of exercise, and being overweight remain relevant

Which statement applies the materials' discussion of general and unique risk factors in women most accurately?

A woman may have both general risk factors and unique risk factors, and the presence of one does not remove the importance of the others.

A unique risk factor in a woman identifies whether a future stroke will be ischemic or hemorrhagic.

True or False

False. A risk factor can increase the likelihood of stroke, but it does not identify the specific type of stroke that will occur.

A patient has several risk factors for stroke, but the available information does not show whether a blood vessel was blocked or ruptured. Explain why the risk factors cannot answer that question.

Risk factors increase the likelihood of stroke but do not identify the event that occurred. The type of stroke depends on whether the blood vessel was blocked or ruptured and how the brain tissue was affected.

A person has a brief episode of weakness that resolves within 24 hours. Two weeks later, the person has a more serious and lasting deficit. Which explanation best connects the two episodes?

The first episode may have been a transient ischemic attack that warned of the later stroke.

A woman whose stroke symptoms are not recognized promptly may lose access to the most effective treatments because recognition and diagnosis are needed within the first __________ hours.

Three

A forceful fall damages the brain, and the damage cannot be explained by a stroke or seizure.

Traumatic brain injury

A person stops breathing during an overdose, and oxygen deprivation affects the entire brain.

Hypoxic or anoxic brain injury

A person survives an overdose but has brain damage from high levels of poisonous substances in the body.

Toxic brain injury

A clot blocks a blood vessel and damages the area of brain tissue supplied by that vessel.

Ischemic stroke

Brain tissue is damaged while an operation is being performed to reach a tumor or repair a bleed.

Surgical trauma

A blood vessel ruptures, interrupting blood supply and allowing blood to enter tissue where it does not belong.

Hemorrhagic stroke

When a stroke causes a fall, the resulting brain damage is classified as traumatic brain injury because the patient struck the ground.

True or False

False. Traumatic brain injury requires brain damage caused by an external and forceful event. A stroke that causes a fall remains a stroke unless the fall also causes separate brain damage.

After an opioid overdose, a person has both respiratory failure and direct exposure to a poisonous substance. Explain why the person can have both hypoxic or anoxic brain injury and toxic brain injury, and why the damage may be spread across the brain.

Respiratory failure can deprive the brain of oxygen, causing hypoxic or anoxic brain injury. The opioid can also produce toxic brain injury. Unlike a stroke that affects a localized and specific area, oxygen deprivation can affect the entire brain, producing nonlocalized and diffused damage.

After an opioid overdose, a person shows problems with visual attention, working memory, and decision making. The problems do not fit one small area supplied by one artery. Which explanation best fits the materials?

The pattern can result from hypoxic or anoxic brain injury, toxic brain injury, or both.

A person who survives an opioid overdose performs poorly on tasks involving visuomotor skills, visual attention, executive function, working memory, impulsivity, and decision making. Explain why the materials describe this as a possible pattern rather than as one single deficit.

The overdose can produce hypoxic or anoxic brain injury, toxic brain injury, or both. Oxygen deprivation can affect the entire brain, and the resulting nonlocalized and diffused damage can affect several cognitive domains rather than one single function.

After an opioid overdose, hypoxic or anoxic injury follows the same localized pattern as the injury from a stroke.

True or False

False. A stroke can produce anoxic or hypoxic conditions in localized and specific areas, whereas an overdose can deprive the entire brain of oxygen and produce nonlocalized and diffused damage.

A patient with an ischemic stroke receives medical care soon after symptoms begin. Explain why early care may save some brain tissue but cannot restore tissue that has already died.

The ischemic penumbra has lost enough blood flow to stop functioning but is still receiving enough blood to stay alive, so prompt treatment may save it. The ischemic core has permanent tissue damage and irreversible cell death, so treatment cannot restore it.

A speech, cognitive, and swallowing deficit appears after surgery to repair a hemorrhagic stroke. Which finding most strongly points to a secondary complication rather than damage caused directly by the surgical maneuver?

A seizure begins after the patient has recovered from the operation.

A later deficit after brain surgery should be assigned to the original stroke or tumor before seizures, infection, another stroke, or increased intracranial pressure are considered.

True or False

False. The materials identify seizures, additional strokes, infections, and increased intracranial pressure as secondary risks of brain surgery.

Retraction is used to reach a surgical target. Trace one possible sequence from retraction to a later deficit, using at least two of the following terms: brain edema, neuroinflammation, cellular death, hemorrhage, seizure, infection, increased intracranial pressure.

Retraction can damage brain tissue at the perisurgical site. That damage can be followed by brain edema, neuroinflammation, cellular death, or hemorrhage. A later seizure, infection, or increased intracranial pressure can add further damage and produce a deficit.

The operation enters the brain through a cut in tissue.

Incision

Brain tissue is moved or held aside so the surgeon can reach the target.

Retraction

Heat used during the operation damages nearby brain tissue.

Thermal damage from electrocautery

Bleeding during the operation produces immediate and long-term brain injury.

Intraoperative hemorrhage

Damage at the surgical site is followed by swelling, inflammation, and death of cells.

Brain edema, neuroinflammation, and cellular death

A seizure, additional stroke, infection, or increased intracranial pressure occurs after the operation.

Secondary complications

A deficit that appears after brain surgery may result from the original disease, surgical trauma, or a secondary risk of surgery.

True or False

True.

A patient has a new deficit after brain surgery. Compare three possible explanations: direct surgical trauma, a secondary seizure, and increased intracranial pressure. What makes each explanation different?

Direct surgical trauma results from damage at the perisurgical site during the operation. A secondary seizure is abnormal electrical activity that occurs after surgery and can produce additional brain damage. Increased intracranial pressure is pressure within the skull that can make it difficult for blood to enter the brain and can cause further damage

A deficit develops gradually as a mass grows, but the patient later has a sudden worsening. Which conclusion best respects both parts of the time course?

The mass may explain the gradual problems, but the sudden worsening does not establish whether increased intracranial pressure, another acute etiology, or a change in the tumor caused it.

A tumor that originates within the brain is a __________ tumor. A tumor that spreads from another part of the body to the brain is a __________ tumor.

primary; secondary

The lack of spread from a benign tumor means that a mass effect is not part of its risk.

True or False

False. A benign tumor can grow inside the skull, crush nearby brain tissue, and create a mass effect even though it does not spread to other parts of the body.

The tumor develops in glial cells, and the types range from slow growing to aggressive and cancerous.

Glioma

The tumor develops in the meninges and is usually benign, but it can press on brain tissue.

Meningioma

The tumor develops on the vestibular and cochlear nerves and can affect hearing and balance.

Vestibular schwannoma

A large tumor at the base of the skull can cause vision changes and hormonal changes.

Pituitary adenoma

This grade-four glial tumor is aggressive and has a poor prognosis.

Glioblastoma

The tumor began in another part of the body and spread to the brain.

Metastatic tumor

A benign tumor is growing inside the skull near tissue that controls an important function. Explain why the tumor can be dangerous and why the surgery to remove it can produce additional deficits.

A benign tumor cannot spread to other parts of the body, but it can grow uncontrollably inside the skull, crush healthy brain tissue, and create a mass effect. Surgery can damage nearby brain tissue and create additional complications and deficits.

A patient has progressive hearing and balance problems but no visual or hormonal changes. The mass is located on the nerves that connect the inner ear with the brain. Which tumor best fits the complete pattern?

Vestibular schwannoma

A surgeon removes a small piece of a tumor to determine whether it is benign or malignant. This procedure is a __________. Radiation therapy can damage healthy and cancerous cells __________.

biopsy; indiscriminately

Primary and secondary describe whether a tumor is benign or malignant, while benign and malignant describe where it began.

True or False

False. Primary and secondary describe where a tumor began. Benign and malignant describe how a tumor behaves.

Compare the time course expected from a growing brain tumor with the time course often seen in ischemic stroke. Then explain why a change from gradual to sudden does not automatically identify the cause.

A tumor usually produces symptoms that develop and worsen gradually as it grows. Ischemic stroke symptoms often begin suddenly when a blood vessel becomes blocked. A tumor can produce sudden symptoms if bleeding or swelling occurs, so time course alone does not establish the cause.

A large mass at the base of the skull is followed by vision changes, headaches, and hormonal changes. Which explanation best fits both the location and the combination of findings?

A pituitary adenoma can press on nearby brain tissue or nerves and disrupt hormones.

Radiation therapy can damage healthy tissue near a tumor because it destroys healthy and cancerous cells indiscriminately.

True or False

True

Fever, confusion, or seizures occur because an acute infection or inflammation affects the brain or spinal cord.

Encephalitis

HIV/AIDS is followed by slowed processing, impaired recall, reduced attention, and difficulty learning new information.

NeuroAIDS or HAND

A prion disease causes rapidly progressive dementia and involuntary movements and is usually fatal within a year of onset.

Creutzfeldt-Jakob disease

A nervous-system form of syphilis produces meningitis, visual changes, facial weakness, cognitive deficits, or motor problems

Neurosyphilis

A virus attacks motor nerve tracks of the peripheral nervous system, producing nonsymmetrical paralysis and diminished or absent reflexes.

Poliomyelitis

Pus, immune cells, and other material collect in the brain and can cause permanent brain damage if untreated.

Brain abscess

Damage to subcortical structures produces sleep-wake, heart-rate, breathing, movement, and Parkinsonian problems.

Encephalitis lethargica

Encephalitis, poliomyelitis, and a brain abscess are all infections, but the expected deficits differ. Compare two of them by identifying the site, nature, or extent of the infection that explains the difference.

Encephalitis affects the brain or spinal cord and can produce cognitive, motor, or speech effects. Poliomyelitis attacks motor nerve tracks of the peripheral nervous system and can produce paralysis and absent reflexes. A brain abscess produces focal brain damage and a mass effect because pus and other material collect in the brain.

A person with HIV/AIDS has slowed processing, impaired recall, reduced attention, and difficulty learning new information. Which interpretation best fits the materials?

The pattern is consistent with HIV/AIDS dementia or HIV-associated neurocognitive disorder.

The materials state that language is often unaffected in HIV/AIDS, but they also report language deficits. Explain how both statements can be true and why the first statement should not be used as an absolute rule.

Many people with HIV/AIDS show learning, attention, processing-speed, recall, and motor problems while language is relatively preserved. The materials also report mild language deficits and severe problems with functional language use, so language can be affected even though it is often less affected.

When penicillin removes a neurosyphilis infection, brain damage that occurred before treatment returns to normal.

True or False

False. Treatment can remove the infection, but it cannot guarantee reversal of brain damage that has already occurred.

Syphilis may be treated early, but nervous-system involvement may appear years after the original infection and treatment. Explain why the term neurosyphilis changes the interpretation of visual, cognitive, motor, or cranial-nerve problems.

Neurosyphilis means that syphilis has affected the nervous system. It can produce meningitis, visual changes, facial weakness, cognitive deficits, motor problems, and involvement of individual cranial nerves. The term therefore identifies nervous-system involvement rather than only the infection.

A patient develops rapidly progressive dementia and involuntary rapid muscle twitching and is expected to die within about a year of symptom onset. Which condition best fits the entire pattern?

Creutzfeldt-Jakob disease

In Creutzfeldt-Jakob disease, rapidly twitching muscles are described as __________. When a person cannot speak because the person cannot move, the condition is called __________ mutism.

myoclonus; akinetic

Neurosyphilis usually occurs years after the initial infection and treatment, but infection of the central nervous system can also begin within days or weeks.

True or False

True

Poliomyelitis can affect spinal nerves, cranial nerves, or both. Explain how the three forms differ and why post-polio syndrome can produce problems years after the original infection.

Spinal polio affects the spinal nerves and the muscles they supply. Bulbar polio affects the cranial nerves and the muscles they supply. Bulbospinal polio affects both. Post-polio syndrome can later produce weakness, pain, fatigue, voice problems, and swallowing problems in areas affected by the earlier infection.

After a viral infection, a patient cannot send normal voluntary and nonvoluntary movement commands from the central nervous system to the muscles. Reflexes are diminished. Which condition best fits?

Poliomyelitis

An epidural abscess is between the __________ and the dura mater. A subdural empyema is between the dura mater and the __________ mater. Early cerebritis is not yet a discrete __________.

skull; arachnoid; mass

Cerebritis is a discrete brain abscess, and a mature abscess is treated with medication without a need for surgery.

True or False

False. Cerebritis is an early microscopic form of cerebral abscess that is not yet a discrete mass. A mature abscess may require medication, surgery, or both.

A brain abscess is not treated, and the patient becomes more confused as swelling increases. Explain how the contents of the abscess and pressure within the skull can together produce permanent brain damage or death.

The abscess contains pus, immune cells, and other material that can damage nearby brain tissue. The abscess and swelling can create a mass effect and increase intracranial pressure. Pressure can affect other parts of the brain, and the infection can cause permanent damage or death if untreated.

A patient has a focal brain problem and a mass. Treatment includes antibiotics or antifungal medication and may also include surgery. Which condition best fits?

Brain abscess

The resulting deficit can differ when the sites, natures, or amounts of damage differ, even when two infections are described in similar terms.

True or False

True

The effect of an infection depends on its __________, the __________ of the infection, and the extent of the tissue __________ it creates.

site; nature; damage