Maybe this is the real one patho final

Complete healing of a bone fracture occurs when

a. no movement of the break is detectable.

b. the callus has been completely replaced with mature bone.

c. the fracture site and surrounding soft tissue are pain free.

d. a cast is no longer required to stabilize the break.

ANS: B

Complete healing of a bone fracture occurs when the callus has been completely replaced

with mature bone. A lack of detectable movement of the break does not indicate that the

fracture is healed. Even when a bone fracture is healed, pain at the fracture site and

surrounding soft tissue may be present. The patient may progress from a cast to a splint,

sling, or brace as the bone fracture continues to heal.

Rickets is characterized by soft, weak bones resulting from a deficiency of

a. calcium.

b. estrogen.

c. phosphate.

d. vitamin D

ANS: D

Rickets is characterized by soft, weak bones resulting from vitamin D deficiency. Rickets is

not caused by poor calcium intake or phosphate deficiency. Estrogen deficiency is related to

osteoporosis, not rickets.

n older women, osteoporosis is thought to be primarily because of

a. dietary inadequacies.

b. estrogen deficiency.

c. malabsorption syndrome.

d. inactivity

ANS: B

In older women, osteoporosis is thought to be primarily because of estrogen deficiency.

Although dietary inadequacies and inactivity play roles, the primary cause of osteoporosis in

older women is thought to be because of estrogen deficiency. Malabsorption is not the

primary cause of osteoporosis in older women.

Pain with passive stretching of a muscle is indicative of

a. noncontractile tissue injury.

b. contractile tissue injury.

c. vascular insufficiency.

d. skeletal muscle damage.

ANS: A

Pain with passive stretching of a muscle is indicative of noncontractile tissue injury. Pain

with passive stretching of a muscle is not an indication of a contractile tissue injury,

vascular insufficiency, or skeletal muscle damage.

Muscular dystrophy includes a number of muscle disorders that are

a. genetically transmitted.

b. easily prevented and managed.

c. autoimmune in nature.

d. demyelinating focused

ANS: A

Muscular dystrophy includes a number of muscle disorders that are genetically transmitted.

Muscular dystrophy is not easily prevented or managed. It is not an autoimmune disease or a

demyelinating disease.

Myasthenia gravis is an autoimmune disease in which

a. neuronal demyelination disrupts nerve transmission.

b. muscles become increasingly bulky but weakened.

c. acetylcholine receptors are destroyed or dysfunctional.

d. acetylcholine release from motor neurons is disrupted

ANS: C

Myasthenia gravis is an autoimmune disease in which acetylcholine receptors are destroyed

or dysfunctional. Multiple sclerosis is an autoimmune disease in which neuronal

demyelination disrupts nerve transmission. Muscles become weak, but not bulky, in

myasthenia gravis. Acetylcholine receptors are destroyed or dysfunction in myasthenia

gravis

. Anticholinesterase inhibitors may be used to manage

a. muscular dystrophy.

b. myasthenia gravis.

c. fibromyalgia.

d. rheumatoid arthritis

ANS: B

Anticholinesterase inhibitors may be used to manage myasthenia gravis. Anticholinesterase

agents are not used to manage muscular dystrophy, fibromyalgia, or rheumatoid arthritis.

A compound, transverse fracture is best described as a bone that is

a. broken in two or more pieces.

b. cracked but not completely separated.

c. broken along the long axis.

d. broken and protruding through the skin

ANS: D

The type of fracture described is broken and protruding through the skin. A comminuted

fracture is one that is broken in two or more pieces. An incomplete fracture is cracked but

not completely separated. A longitudinal fracture is broken along the long axis.

The complication which is not likely to result from a compound, transverse fracture of the

tibia and fibula is

a. bone infection.

b. fat emboli.

c. air embolus.

d. compartment syndrome.

ANS: C

Air embolus is not likely to occur secondary to this fracture. Bone infection is likely,

because it is an open fracture. Fat emboli are likely because the fracture is in a long bone.

Compartment syndrome is likely because of the extent of soft-tissue injury

. Assessment of an extremity six hours after surgical alignment and casting demonstrates

pulselessness and pallor. The priority action to take is to

a. increase the administration his pain medication.

b. initiate action to have the cast split or removed.

c. note the increase in pain in his chart, and recheck the extremity in 30 minutes.

d. elevate the extremity to relieve swelling.

ANS: B

The priority action is to have the cast split or removed because these are signs of

compartment syndrome and emergent decompression is needed. While increasing pain

medication may be appropriate, it is not the priority action. It is not the priority action to

note pain increases in the chart. In compartment syndrome, extremity is not to be elevated

above the heart, as that may lower venous pressure and slow arterial perfusion.

Following a bone fracture, the most likely event to occur is

a. development of a blood clot beneath the periosteum.

b. leukocyte infiltration into bone tissue.

c. blood vessel growth at the fracture site.

d. migration of osteoblasts to the fracture site.

ANS: A

The first step in bone healing is hematoma formation. Leukocyte infiltration into bone

tissue, blood vessel growth at the fracture site, and migration of osteoblasts to the fracture

site are not the first steps in bone healing.

Bone healing may be impaired by

a. excessive vitamin C.

b. nicotine use.

c. a high-protein diet.

d. immobilization.

ANS: B

Nicotine can delay bone healing. Vitamin C, protein, and immobilization are necessary for

bone healing

A unique characteristic feature of fibromyalgia is the presence of

a. tender point pain.

b. head pain.

c. contractures.

d. muscle atrophy

ANS: A

Tender point pain is a unique characteristic feature of fibromyalgia. Headache, contractures,

and muscle atrophy are not unique characteristic features of fibromyalgia

A fracture in which bone breaks into two or more fragments is referred to as

a. comminuted.

b. open.

c. greenstick.

d. stress.

ANS: A

A fracture in which the bone breaks into two or more fragments is called a comminuted

fracture. Open fractures, greenstick fractures, and stress fractures do not involve two or

more bone fragments.

. What type of fracture generally occurs in children?

a. Greenstick

b. Stress

c. Nightstick

d. Colles

ANS: A

Greenstick fractures occur most often in the growing bones of children. Stress fractures can

occur at any age. Nightstick and Colles fractures occur most often in adults.

Most muscle strains are caused by

a. a tear in an adjoining tendon.

b. abnormal muscle contraction.

c. muscle asymmetry.

d. bleeding into the muscle.

ANS: B

Most muscle strains are caused by abnormal muscle contraction. A muscle strain can be

caused by a tear in the muscle. A tendon strain can be as a result of a tear in the tendon.

Muscle asymmetry is not the cause of muscle strains. Muscle strains are not caused by

bleeding into the muscle.

People who have osteoporosis are at risk for

a. rhabdomyolysis.

b. osteomyelitis.

c. osteomalacia.

d. bone fractures.

ANS: D

Osteoporosis weakens the bone structure and increases the risk of bone fractures.

Rhabdomyolysis, osteomyelitis, and osteomalacia are completely different conditions.

A risk factor for osteoporosis is

a. endometriosis.

b. early menopause.

c. late menopause.

d. ovarian cysts.

ANS: B

Early menopause and late menarche are risk factors for osteoporosis. Endometriosis, late

menopause, and ovarian cysts are not risk factors for osteoporosis

Which disorder usually causes skeletal pain and involves significant bone demineralization

from vitamin D deficiency?

a. Osteomalacia

b. Osteopenia

c. Osteomyelitis

d. Osteoporosis

ANS: A

Osteomalacia is inadequate mineralization of bone tissue, most commonly caused by

vitamin D deficiency, and it usually causes skeletal pain. Osteopenia, osteomyelitis, and

osteoporosis are not caused by vitamin D deficiency.

Healing of a fractured bone with a poor alignment is called

a. malunion.

b. nonunion.

c. disunion.

d. delayed union.

ANS: A

Malunion is a complication that occurs when the bone fails to align correctly during the

healing process. Nonunion and delayed union are different complications of bone healing.

Disunion is not the term used for fracture healing with poor alignment

The displacement of two bones in which the articular surfaces partially lose contact with

each other is called

a. subluxation.

b. subjugation

c. sublimation.

d. dislocation

ANS: A

Subluxation is partial dislocation of a joint. Subjugation, sublimation, and dislocation are

not the terms for partial loss of contact of articular surfaces.

The pathophysiology of osteomalacia involves

a. increased osteoclast activity.

b. collagen breakdown in the bone matrix.

c. crowding of cells in the osteoid.

d. inadequate mineralization in the osteoid

ANS: D

Osteomalacia is characterized by inadequate or delayed mineralization in the osteoid.

Osteomalacia does not involve increased osteoclast activity, collagen breakdown in the bone

matrix, or crowding of cells in the osteoid.

The disease that is similar to osteomalacia and occurs in growing children is

a. rickets.

b. osteosarcoma.

c. Paget disease.

d. osteopenia.

ANS: A

Rickets is similar to osteomalacia in that it is caused by vitamin D deficiency and leads to

soft, deformable bones. Rickets occurs in growing children. Osteosarcoma, Paget disease,

and osteopenia are not similar to osteomalacia

Pain in fibromyalgia involves

a. muscle inflammation.

b. autoimmune destruction of muscle tissue.

c. nerve inflammation.

d. changes in pain transmission in the spinal cord.

ANS: D

Pain in fibromyalgia involves changes in pain transmission in the spinal cord that are called

central sensitization. Muscle inflammation, nerve inflammation, and autoimmune

destruction of muscle tissue do not cause the pain in fibromyalgia

A malignant bone-forming tumor is referred to as a(n)

a. rhabdosarcoma.

b. liposarcoma.

c. osteosarcoma.

d. chondrosarcoma.

ANS: C

An osteosarcoma is a malignant bone-forming tumor. Rhabdo- refers to skeletal muscle.

Lipo- refers to fat. Chondro- refers to cartilage

Inflammation of the sacs that overlie bony prominences is called

a. epicondylitis.

b. arthritis.

c. tendinitis.

d. bursitis.

ANS: D

Bursitis is inflammation of the bursal sacs that protect the skin over bony protuberances.

Epicondylitis is inflammation of an epicondyle. Arthritis is inflammation of one or more

joints. Tendinitis is inflammation of a tendon.

. The disorders characterized by softening and then enlargement of bones is referred to as

a. osteomyelitis.

b. osteoporosis.

c. Paget disease.

d. rickets.

ANS: C

Paget disease is characterized by excessive bone resorption and formation, causing fractures

and deformities. Osteomyelitis, osteoporosis, and rickets do not involve softening and then

enlargement of bones

The person at highest risk of a greenstick fracture from falling off a tall ladder is age

a. 68.

b. 44.

c. 8.

d. 23.

ANS: C Greenstick fractures occur primarily in children. The adults are not at high risk for greenstick fracture.

A bone disorder that results from insufficient vitamin D is referred to as

a. rickets.

b. osteoporosis.

c. osteomalacia.

d. subluxation.

ANS: C

Osteomalacia is caused by vitamin D deficiency in adults. Rickets is caused by vitamin D

deficiency in children. Osteoporosis is related to decreased estrogen. Subluxation refers to a

bone displacement.

The most common source of osteomyelitis is

a. an infection that migrates via the bloodstream.

b. direct invasion from a fracture.

c. surgical contamination.

d. a joint prosthesis.

ANS: A

Hematogenous osteomyelitis (via the blood stream) is the most common type of

osteomyelitis. Direct invasion of infection from a fracture, infection of a bone resulting from

surgical contamination, and a joint prosthesis are not the most common sources of

osteomyelitis

A patient diagnosed with diabetes, smokes a pack of cigarettes daily and eats very few green

leafy vegetables. After experiencing a fractured toe, this patient is at risk for

a. delayed healing.

b. malunion.

c. nonunion.

d. dysunion.

ANS: A

Fracture healing that does occur but takes longer than expected is called delayed healing.

The situation is not an example of malunion or nonunion. Dysunion is not a term used to

describe healing complications.

Paget's disease is characterized by

a. overactivity of osteoblasts leading to multiple bone tumors.

b. excessive bone resorption followed by excessive formation of fragile bone.

c. inflammatory disorder resulting in fusion of spine joints.

d. failure of resorption by osteoclasts resulting in hard bones.

ANS: B

Paget's disease is characterized by excessive bone resorption followed by excessive

formation of fragile bone. Overactivity of osteoblasts that lead to multiple bone tumors is

not the cause of Paget's disease. Paget's disease is not characterized by the fusion of spine

joints. Fragile bone, not hard bone, is a characteristic of Paget's disease.

. The most common site affected in Paget's disease is the

a. lower spine.

b. skull.

c. pelvis.

d. joints.

ANS: A

The lower spine is the most common site affected in Paget's disease. The skull and pelvis

are affected, but are not the most common sites. Joints are not affected in Paget's disease.

The most common type of osteomyelitis is

a. hematogenous.

b. contiguous focus.

c. Brodie abscess.

d. direct invasion.

ANS: A

Hematogenous osteomyelitis is the most common type of osteomyelitis. Contiguous focus

osteomyelitis is not the most common type. Brodie abscess is when an infection becomes

enclosed by fibrotic tissue. Osteomyelitis may be caused by a direct invasion of organisms

into the bone, but this is not the most common cause

Compartment syndrome occurs secondary to

a. bone infarction.

b. soft-tissue damage.

c. muscle necrosis.

d. breakdown of RBCs.

ANS: B

Compartment syndrome occurs because of severe soft-tissue damage. Bone infarction and

the breakdown of RBCs do not cause compartment syndrome. Muscle necrosis does not

cause compartment syndrome, but can result from it.

The most common symptom of multiple myeloma is

a. pathologic fracture.

b. fever.

c. bone pain.

d. osteomyelitis.

ANS: C

The most common symptom of multiple myeloma is bone pain. Although pathologic

fractures occur in multiple myeloma, bone pain is the most common symptom. Fever and

osteomyelitis are not common in multiple myeloma.

Manifestations of fibromyalgia often include (Select all that apply.)

a. generalized pain.

b. sensitivity to heat.

c. headaches.

d. fatigue.

e. sleep disturbance.

ANS: A, C, D, E

Common manifestations of fibromyalgia include generalized pain, headaches, fatigue, and

difficulty sleeping. Sensitivity to cold (not heat) is common.

Characteristics of scoliosis include (Select all that apply.)

a. involvement of lateral curvature of the spine.

b. increase during periods of rapid growth.

c. more common in boys.

d. identifiable by uneven shoulders or scapular prominence.

e. possibility of leading to respiratory complications.

ANS: A, B, D, E

Scoliosis involves a lateral curvature of the spine that increases during times of rapid

growth. It is evidenced by uneven shoulders or scapular prominence. If severe and

untreated, it can lead to respiratory and other complications in later age. Scoliosis is more

common in girls.

Pain is thought of as a. a subjective experience that is difficult to measure objectively. b. associated with changes in vital signs reflecting its intensity. c. experienced in the same way by all individuals. d. always the result of tissue damage that activates nociceptors.

ANS: A

Because pain is a subjective experience, defining and assessing it are difficult. Pain is not

always associated with a change in vital signs. Pain is whatever the experiencing person

says it is, and may vary according to each individual. Most pain begins in the periphery

when free nerve endings called nociceptors are stimulated.

The gate control theory of pain transmission predicts that activity in touch receptors will

a. enhance perception of pain.

b. decrease pain signal transmission in the spinal cord.

c. activate opioid receptors in the CNS.

d. increase secretion of substance P in the spinal cord.

ANS: B

The gate control theory is used to explain how stimulation of large "touch" neurons could

inhibit the transmission of nociceptor impulses. Central to the gate control theory is the

capacity for interneurons in the spinal cord to modify the transmission of nociceptor

impulses. The gate control theory is not based on a theory that activity in touch receptors

will enhance perception of pain. Opioid receptors are thought to be the mediators of

presynaptic inhibition. One way to inhibit synaptic transmission is through presynaptic

inhibition of substance P release from nociceptor neurons

Referred pain may be perceived at some distance from the area of tissue injury, but

generally felt

a. on the same side of the body.

b. with slightly less intensity.

c. within the same dermatome.

d. within 10 to 15 cm area.

ANS: C

Referred pain is perceived in an area other than the site of the injury. It is often felt at some

distance from the point of nociceptor activation. Pain is generally referred to other structures

in the same sensory dermatome. The brain cannot differentiate the two sources of pain

signals and tends to attribute the visceral pain to a body surface location regardless of on

which side of the body the injury occurs and on which side of the body the referred pain is

felt. Referred pain is not felt with less intensity. Referred pain is not perceived at a distance

that is within 10 to 15 cm

Slow pain sensation is transmitted primarily by

a. group Ia afferents.

b. motor neurons.

c. unmyelinated C fibers.

d. A fibers.

ANS: C

The majority of pain sensations travel via C fibers and project to areas of the brain that

evoke emotional responses such as displeasure and anxiety. Unmyelinated C fibers transmit

pain more slowly. Pain transmitted by C fibers is poorly localized and has a dull or aching

quality that lingers long after the initial sharp pain abates. Group Ia afferents are not the

source of slow pain sensation. Slow pain sensation is not transmitted by motor neurons.

The nature of the pain carried by the fast-traveling A fibers is characterized as sharp,

stinging, and highly localized

Which treatment is helpful in neuropathic pain but not used for acute pain?

a. Narcotic analgesics

b. Nonsteroidal anti-inflammatory drugs and aspirin

c. Anticonvulsants

d. Nonnarcotic analgesics

ANS: C

Management of pain associated with neuralgia includes antiseizure medications. Narcotic

analgesics are discouraged for long-term therapy. NSAIDs and aspirin are not indicated for

treatment of neuropathic pain. Management of neuralgia includes topical and systemic

therapies.

The physiologic mechanisms involved in the pain phenomenon are termed

a. nociception.

b. sensitization.

c. neurotransmission.

d. proprioception.

ANS: A

The physiologic mechanisms involved in the pain phenomenon are termed nociception.

Sensitization is not the physiologic mechanism of pain phenomena. Neurotransmission is

not related to the physiologic pain mechanism. The physiologic mechanisms involved in the

pain phenomenon are not known as proprioception.

It is useful to conceptualize pain physiology according to the four stages because each stage

provides an opportunity for

a. education.

b. stimulation.

c. intervention.

d. documentation.

ANS: C

It is clinically useful to conceptualize pain physiology according to these four processes,

because each stage provides an opportunity for intervention in the pain experience. It is

more useful to provide intervention for the patient experiencing pain. Stimulation may

actually increase the pain level for the patient. Documentation of findings is appropriate, but

taking measures to reduce or stop the pain is more advantageous.

Most sensory afferent pain fibers enter the spinal cord by way of the ________ nerve roots.

a. anterior

b. posterior

c. C fiber

d. anterolateral

ANS: B

Most sensory afferent pain fibers enter the spinal cord by way of the posterior nerve roots.

The cell bodies of pain neurons are located in the dorsal root ganglion. Sensory afferent pain

fibers do not enter the spinal cord by way of anterior nerve roots. Pain transmitted by C

fibers is poorly localized and transmitted slowly. Many neurons originating in lamina I cross

the spinal cord to activate neurons in the anterolateral tract.

The ________ is the level of painful stimulation required to be perceived.

a. perception

b. tolerance

c. expression

d. threshold

ANS: D

Pain threshold is the level of painful stimulation required to be perceived and is remarkably

similar from one individual to another. Perception includes an awareness and interpretation

of the meaning of the sensation. Pain perception is influenced by attention, distraction,

anxiety, fear, fatigue, and previous experience and expectations. Pain tolerance is the degree

of pain that one is willing to bear before seeking relief. Pain tolerance varies widely among

individuals and within the same individual under differing conditions. Pain expression is the

way in which the pain experience is communicated to others. Pacing, writhing, jaw

clenching, facial grimacing, muscle guarding, crying, moaning, groaning, and verbal

descriptions may be used to express pain.

Modulation of pain signals is thought to be mediated by the release of

a. histamine.

b. endorphins.

c. cholecystokinin.

d. glutamine

ANS: B

Pain modulation occurs not only at the cord level but also in the brain itself. Opioids such as

endorphins produced in the brain are thought to be important modulators of pain perception.

Histamine is a chemical mediator of pain which is involved in the transduction phase.

Cholecystokinin is a substance involved in synaptic transmission in the spinal cord. The

excitatory neurotransmitter glutamate is involved in carrying the nociceptive message from

primary afferent fibers to secondary neurons.

One of the most common causes of acute pain is

a. headache.

b. fibromyalgia.

c. malignancy.

d. trigeminal neuralgia

ANS: A

Headache is one of the most common causes of acute pain, accounting for approximately 13

million visits each year in the Unites States to physician's offices, urgent care clinics, and

emergency departments. Fibromyalgia syndrome is a chronic pain syndrome. Cancer pain is

a subcategory of chronic pain, although it may be acute. Trigeminal neuralgia is a form of

neuropathic pain.

A patient presenting with a severe, pounding headache accompanied by nausea and

photophobia is likely experiencing a ________ headache.

a. tension

b. migraine

c. sinus

d. chronic

ANS: B

Typical signs of a migraine headache include severe unilateral pounding or throbbing pain

that may be accompanied by nausea, vomiting, photophobia, phonophobia, and lacrimation.

A severe, pounding headache with nausea and photophobia is likely to be a migraine

headache. A sinus headache is not typically associated with nausea and photophobia. Pain is

considered chronic when it lasts more than several months beyond the expected healing

time

Pain that waxes and wanes and is exacerbated by physical exertion is likely related to

a. neuralgia.

b. intermittent claudication.

c. fibromyalgia syndrome.

d. neuropathy.

ANS: C

Patients complain of pain that waxes and wanes and that does not follow a dermatomal

pattern in fibromyalgia syndrome. The pain tends to be exacerbated by physical exertion.

Trigeminal neuralgia is a form of neuropathic pain that can be quite disabling for patients. It

is sudden, momentary, but excruciating pains along the second and third divisions of the

trigeminal nerve. In the early stages, intermittent claudication is associated with physical

activity and alleviated with rest and has a cramping quality. In severe cases, ischemic

neuropathy may ensue and cause a more consistent burning, shooting pain in the leg or foot.

In pain related to neuropathy, patients complain of burning pain in the distal bilateral lower

extremities that is frequently worse at night.

Seizures that involve both hemispheres at the outset are termed

a. partial.

b. complex.

c. focal.

d. generalized

ANS: D

Episodes in which the entire brain is involved from the onset of the seizure are referred to as

generalized seizures. Partial seizures are those in which activity is restricted to one brain

hemisphere. Complex partial seizures are restricted to one area of the brain. Focal seizures

are classified as partial.

The primary reason that prolonged seizure activity predisposes to ischemic brain damage is

that

a. neurons are unable to transport glucose.

b. cardiovascular regulation is impaired.

c. the brainstem is depressed.

d. the lack of airway maintenance can lead to hypoxia

ANS: D

Status epilepticus is a continuing series of seizures without a period of recovery between

seizure episodes. Irreversible brain damage and possible death from hypoxia, cardiac

arrhythmias, or lactic acidosis can occur if the airway is not maintained and seizure activity

is not halted. Prolonged seizure activity is unrelated to glucose transportation by neurons.

Status epilepticus can cause cardiac arrhythmias, but the primary concern of prolonged

seizure activity is maintaining a proper airway. Brainstem depression is not the primary

reason that prolonged seizure activity causes ischemic brain damage.

The dementia of Alzheimer disease is associated with structural changes in the brain,

including

a. deposition of amyloid plaques in the brain.

b. degeneration of basal ganglia.

c. hypertrophy of frontal lobe neurons.

d. significant aluminum deposits in the brain.

ANS: A

The hallmark pathophysiologic changes associated with Alzheimer disease include

intracellular neurofibrillary tangles and extracellular amyloid plaques. Degeneration of the

basal ganglia is not associated with dementia of Alzheimer disease. Brain atrophy occurs as

a result of the amyloid plaques in the brain. Aluminum deposits in the brain are not

responsible for dementia of Alzheimer disease.

Before making a diagnosis of Alzheimer disease

a. a brain biopsy demonstrating organic changes is necessary.

b. biochemical tests for aluminum toxicity must be positive.

c. other potential causes of dementia must be ruled out.

d. increased protein is found in a lumbar puncture.

ANS: C

All manageable causes for dementia or delirium should be ruled out before diagnosing

Alzheimer disease. Neuroimaging may be useful in ruling out other neurologic diagnoses. A

brain biopsy is not indicated. Evaluation of blood chemistry does not include the presence of

aluminum. Increased protein in a lumbar puncture is not indicative of Alzheimer dementia.

Parkinson disease is associated with

a. demyelination of CNS neurons.

b. a pyramidal nerve tract lesion.

c. insufficient production of acetylcholine in the basal ganglia.

d. a deficiency of dopamine in the substantia nigra

ANS: D

Parkinson disease results from degeneration of the pigmented dopaminergic neurons found

in the substantia nigra. Demyelination of CNS neurons is not associated with Parkinson

disease. Parkinson disease is not associated with a pyramidal nerve tract lesion. Decreased

acetylcholine synthesis has been found in some studies related to Alzheimer disease

Dopamine precursors and anticholinergics are all used in the management of Parkinson

disease, because they

a. increase dopamine activity in the basal ganglia.

b. induce regeneration of neurons in the basal ganglia.

c. prevent progression of the disease.

d. produce excitation of basal ganglia structures.

ANS: A

The mainstay of Parkinson therapy has been aimed at increasing the level of dopamine in

the CNS. Anticholinergics and dopamine precursors are not related to regeneration of

neurons. Preventing the progression of Parkinson disease is not the mechanism of action in

medications used to treat the disease. Excitation of basal ganglia structures is not produced

with dopamine precursors and anticholinergics

The classic manifestations of Parkinson disease include

a. intention tremor and akinesia.

b. rest tremor and skeletal muscle rigidity.

c. ataxia and intention tremor.

d. skeletal muscle rigidity and intention tremor.

ANS: B

Tremor is often the first symptom of Parkinson disease that prompts patients to seek

treatment. The tremor is generally at rest, unilateral affecting distal extremities. Difficulty

initiating and controlling movements results in akinesia, tremor, and rigidity. The clinical

manifestations of cerebellar disorders primarily include ataxia, hypotonia, intention tremors,

and disturbances of gait and balance. Skeletal muscle rigidity and intention tremors are not

the classic manifestations of Parkinson disease.

What effect do demyelinating disorders such as multiple sclerosis have on

neurotransmission?

a. Slower rate of action potential conduction

b. Increased rate of action potential conduction

c. Facilitation of action potential initiation

d. Faster rate of repolarization

ANS: A

The inflammation and scarring that occur with MS slow or interrupt the conduction of nerve

impulses. Multiple sclerosis does not have an increased rate of action potential conduction

on neurotransmission. Action potential initiation is not facilitated in demyelinating

disorders. There is not a faster rate of repolarization in demyelinating disorders such as MS.

Steroids may be used in the management of acute exacerbation of symptoms in patients with

multiple sclerosis, because

a. viral damage can be inhibited.

b. demyelination is mediated by immune mechanisms.

c. steroids reverse the progression of the disease.

d. steroids inhibit synaptic degradation of neurotransmitters.

ANS: B

In the treatment of MS, corticosteroids such as prednisone are used to reduce edema and the

inflammatory response in acute exacerbations. Steroids are not used to inhibit viral damage

in patients with MS. Recovery may be hastened by the use of steroids, but the extent of

recovery is unchanged. Steroids are not utilized as synaptic degradation inhibitors.

Upper extremity weakness in association with degeneration of CNS neurons is characteristic

of

a. multiple sclerosis.

b. Guillain-Barré syndrome.

c. myasthenia gravis.

d. amyotrophic lateral sclerosis

ANS: D Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease affecting both the upper and lower motor neurons characterized by muscle wasting and atrophy of the hands, arms, and legs. Symptoms of multiple sclerosis include double vision, weakness, poor coordination, and sensory deficits. Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis that usually begins in the legs. Upper extremity weakness associated with degeneration of CNS neurons is not characteristic of myasthenia gravis.

Ascending paralysis with no loss of sensation is characteristic of

a. multiple sclerosis.

b. Guillain-Barré syndrome.

c. myasthenia gravis.

d. amyotrophic lateral sclerosis.

ANS: B

Patients with Guillain-Barré syndrome have progressive ascending weakness or paralysis. It

usually begins in the legs, spreading often to the arms and face. Symptoms of multiple

sclerosis include double vision, weakness, poor coordination, and sensory deficits.

Ascending paralysis is not characteristic of myasthenia gravis. Amyotrophic lateral sclerosis

(ALS) is a progressive degenerative disease affecting both the upper and lower motor

neurons characterized by muscle wasting and atrophy of the hands, arms, and legs

The stage of spinal shock that follows spinal cord injury is characterized by

a. reflex urination and defecation.

b. autonomic dysreflexia.

c. absent spinal reflexes below the level of injury.

d. motor spasticity and hyperreflexia below the level of injury

ANS: C

Spinal shock may occur after injury to the spinal cord, and can last from a few hours to a

few weeks. Symptoms below the level of injury include flaccid paralysis of all skeletal

muscles; loss of all spinal reflexes; loss of pain, proprioception, and other sensations; bowel

and bladder dysfunction with paralytic ileus; and loss of thermoregulation. Bowel and

bladder dysfunction may occur with spinal shock. Spinal shock is not characterized by

autonomic dysreflexia. Spinal shock is generally associated with flaccid paralysis and loss

of spinal reflexes.

Autonomic dysreflexia is characterized by

a. hypertension and bradycardia.

b. hypotension and shock.

c. pallor and vasoconstriction above the level of injury.

d. extreme pain below the level of injury

ANS: A

Autonomic dysreflexia is a potentially life-threatening complication that may occur any

time after spinal shock has resolved. It is characterized by a sudden episode of hypertension,

headache, bradycardia, upper-body flushing and lower body vasoconstriction, piloerection,

and sweating. Autonomic dysreflexia is associated with hypertension and lower body

vasoconstriction. Extreme pain below the level of injury is not characteristic of autonomic

dysreflexia.

It is true that Bell palsy is a

a. permanent facial paralysis after stroke.

b. painful neuropathic pain affecting the trigeminal nerve.

c. paralysis of the muscles innervated by the facial nerve.

d. herpetic outbreak in a facial dermatome.

ANS: C

Bell palsy is an acute idiopathic paresis or paralysis of the facial nerve involving an

inflammatory reaction. Bell palsy patients generally recover facial nerve function

spontaneously within 3 weeks. Patients with Bell palsy may complain of a heavy sensation

in their face. Bell palsy is not related to a herpetic outbreak

A patient who experiences early symptoms of muscle twitching, cramping, and stiffness of

the hands may be demonstrating signs of

a. Guillain-Barré syndrome.

b. amyotrophic lateral sclerosis.

c. Parkinson disease.

d. hydrocephalus

ANS: B

Most patients with ALS demonstrate muscle weakness and atrophy. The earliest symptoms

may be muscle twitching, cramping, and stiffness. Often the hands or upper extremities are

affected first. Guillain-Barré syndrome is characterized by ascending weakness that usually

begins in the legs. Tremors at rest are usually the earliest symptoms of Parkinson disease.

Hydrocephalus is characterized by abnormal accumulation of CSF in the cerebral ventricular

system

What type of seizure usually occurs in children and is characterized by brief staring spells?

a. Epileptic

b. Idiopathic

c. Partial

d. Absence

ANS: D

Absence or petite mal seizures usually occur only in children. They are very brief (2 to 10

seconds), and episodes are characterized by staring spells that last only seconds. Epilepsy

refers to recurrent seizures. Idiopathic seizures are those that have no explanation for the

disorder. Partial seizures are those in which activity is restricted to one brain hemisphere.

The initial treatment of an individual experiencing a seizure is concentrated on

a. maintaining an airway.

b. administering anticonvulsant medication.

c. documenting the seizure pattern.

d. obtaining an EEG

ANS: A

Treatment of an individual experiencing a seizure is concentrated on maintaining an airway

and protecting the individual from injury. If the seizures are because of irreversible or

unidentifiable factors, anticonvulsant medications specific to the type of seizure are the best

management. Recording the course of the seizure episode is useful, but is not the initial

focus of care. EEG studies may be useful in determining abnormalities which elicit the

pathologic mechanism.

_________ is a form of spina bifida in which a saclike cyst filled with CSF protrudes

through the spinal defect but does not involve the spinal cord.

a. Spina bifida occulta

b. Meningocele

c. Myelomeningocele

d. Meningomyelocele

ANS: B

In the meningocele form of spina bifida cystica, a saclike cyst filled with CSF protrudes

through the spinal defect but does not involve the spinal cord. In spina bifida occulta, the

posterior vertebral laminae have failed to fuse. A myelomeningocele or meningomyelocele

deformity contains meninges, CSF, and a portion of the spinal cord that protrudes from the

vertebral defect in a cystlike sac

It is recommended that women of childbearing age take folic acid daily for prevention of

a. neural tube defects.

b. seizure disorders.

c. cerebral palsy.

d. hydrocephalus

ANS: A

The use of folic acid during the period prior to conception has been shown to significantly

decrease the risk of having a child with a neural tube defect. Folic acid does not prevent

seizure disorders. An etiologic factor in the development of cerebral palsy is mechanical

trauma before, during, or after birth. Hydrocephalus is not prevented with the use of folic

acid

Which neurologic disorder is commonly referred to as Lou Gehrig disease?

a. Multiple sclerosis

b. Parkinson disease

c. Alzheimer disease

d. Amyotrophic lateral sclerosis

ANS: D

ALS is also known as Lou Gehrig disease, after the famed "Iron Man" of the New York

Yankees, who died from the disease. Multiple sclerosis, Parkinson disease, and Alzheimer

disease are not named after Lou Gehrig

Which statement is true about the incidence of multiple sclerosis?

a. The age of onset ranges from 20 to 50 years.

b. MS is more common in men than women.

c. There is a higher incidence of MS in military veterans.

d. There is a higher rate of MS in African-Americans.

ANS: A

The age of onset of MS ranges from 20 to 50 years. MS is two to three times more common

in women than in men. There is a higher incidence of ALS in military veterans, especially

those of the Persian Gulf. MS occurs at a higher rate among individuals from Caucasian

northern European descent and those who live in northern latitudes.

Orthostatic hypotension may be a manifestation of

a. Alzheimer disease.

b. multiple sclerosis.

c. Parkinson disease.

d. amyotrophic lateral sclerosis.

ANS: C

In patients with Parkinson disease, involvement of the autonomic nervous system may result

in orthostatic hypotension. Alzheimer disease is not typically associated with orthostatic

hypotension. Orthostatic hypotension is not associated with multiple sclerosis. Amyotrophic

lateral sclerosis is not manifested by orthostatic hypotension

Which conditions are risk factors for the development of cerebral palsy? (Select all that

apply.)

a. Birth trauma

b. Seizure disorder

c. Kernicterus

d. Prenatal maternal infection

e. Scoliosis

ANS: A, C, D

Mechanical trauma to the head before, during, or after birth is a factor in cerebral palsy.

Kernicterus is an etiologic factor associated with cerebral palsy. Etiologic factors associated

with cerebral palsy include prenatal infections or diseases of the mother. Seizure disorder is

not associated with the development of cerebral palsy. Scoliosis may contribute to health

decline in older individuals with cerebral palsy.

Which are common causes of acquired parkinsonism? (Select all that apply.)

a. Degeneration of dopaminergic neurons

b. History of infection

c. History of intoxication

d. History of trauma

e. Seizure disorder

ANS: B, C, D

Common causes of acquired parkinsonism include infection, intoxication, and trauma.

Typically, parkinsonism caused by drug toxicity evolves rapidly, unlike the slow, insidious

onset of the idiopathic disease. Parkinson disease results from degeneration of the

pigmented dopaminergic neurons found in the substantia nigra. Acquired parkinsonism is

not related to seizure disorder.

The physiologic change most likely to lead to an increase in intracranial pressure is

a. cerebral vasodilation.

b. hypernatremia.

c. respiratory hyperventilation.

d. REM sleep

ANS: A

Cerebral edema starts a cyclic process whereby fluid collection in the brain leads to

compression of vessels, which results in inadequate blood and oxygen perfusion into the

cells. This results in ischemia, which triggers vasodilation, increased capillary pressure, and

increased edema. An increase in intracranial pressure is not associated with hypernatremia

nor caused by respiratory hyperventilation. The physiologic change most likely to lead to

increased intracranial pressure is not related to sleep.

Manifestations of acute brain ischemia (Cushing reflex) are due primarily to

a. parasympathetic nervous system activation.

b. sympathetic nervous system activation.

c. autoregulation of body systems.

d. loss of brainstem reflexes.

ANS: B

An extreme increase in ICP can precipitate an intense reaction by the sympathetic nervous

system as it attempts to maintain cerebral perfusion through the compressed blood vessels.

This has been termed an ischemic response or Cushing reflex. Manifestations of acute brain

ischemia are because of sympathetic nervous system activation. The sympathetic nervous

system activates to attempt to lower the intracranial pressure accompanied by acute brain

ischemia. The Cushing reflex generally is viewed as a "last-ditch" effort by the brain to

reestablish cerebral perfusion but is not as a result of loss of brainstem reflexes.

Which group of clinical findings indicates the poorest neurologic functioning?

a. Spontaneous eye opening, movement to command, oriented to self only

b. Eyes open to light touch on shoulder, pupils briskly reactive to light bilaterally

c. Assumes decorticate posture with light touch, no verbal response

d. No eye opening, responds to painful stimulus by withdrawing

ANS: C

Decorticate posturing is an abnormal flexor response of the arms and wrists, with legs and

feet extended and internally rotated. This occurs as the neurologic functioning deteriorates.

Normal response occurs with spontaneous eye opening, movement on command and

orientation to self. Eye opening to touch is not indicative of poor neurologic functioning. A

lower neurologic functioning is indicated by a patient who is able to withdraw from painful

stimulus and localize the source of pain.

Acceleration-deceleration movements of the head often result in polar injuries in which

a. injury is localized to the site of initial impact.

b. widespread neuronal damage is incurred.

c. bleeding from venules fills the subdural space.

d. focal injuries occur in two places at opposite poles

ANS: D

Polar injuries occur as a consequence of the brain shifting within the skull and meninges

during the course of an acceleration-deceleration movement resulting in local injury at two

opposite poles of the brain. Focal injuries are those that are localized to the site of impact to

the skull. Diffuse injuries occur when movement of the brain causes widespread neuronal

damage. An intracranial hematoma is a localized collection of blood within the cranium.

Secondary injury after head trauma refers to

a. brain injury resulting from the initial trauma.

b. focal areas of bleeding.

c. brain injury resulting from the body's response to tissue damage.

d. injury as a result of medical therapy.

ANS: C

Secondary injury is a consequence of the body's response to the primary injury. Injury that

is directly related to the initial impact is primary injury. A focal area of bleeding is related to

primary injury. Injury that results from medical therapy is not known as secondary injury.

An example of inappropriate treatment for head trauma would be

a. head elevation.

b. free water restriction.

c. hypoventilation.

d. bed rest.

ANS: C

Hyperventilation, not hypoventilation, is indicated in the management of an acute elevation

of intracranial pressure. Elevating the head is aimed at maintaining intracranial pressure and

cerebral blood flow. Normal intravascular volume is indicated in the management of

intracranial pressure. Bed rest would be indicated for the head trauma patient

Risk factors for hemorrhagic stroke include

a. atherosclerosis.

b. dysrhythmias.

c. acute hypertension.

d. sedentary lifestyle.

ANS: C

Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs

in the context of severe and often longstanding hypertension. Risk factors for stroke are

similar to those for other atherosclerotic vascular disease. Cardiac disease complicated by

atrial fibrillation is an important risk factor for embolic stroke. Sedentary lifestyle is not a

risk factor for hemorrhagic stroke

The stroke etiology with the highest morbidity and mortality is

a. intracranial hemorrhage.

b. intracranial thrombosis.

c. intracranial embolization.

d. cardiac arrest.

ANS: A

Intracerebral hemorrhage is a hemorrhage within the brain parenchyma and usually occurs

in the context of severe and often longstanding hypertension. It carries a 38% mortality,

with death usually occurring within minutes to hours. Ischemic strokes are the most

common and include thrombotic and embolic types. Embolic and ischemic strokes are the

most common type. Stroke is the third leading cause of death in the United States. Cardiac

arrest is not the stroke etiology with the highest morbidity and mortality.

Clinical manifestations of a stroke within the right cerebral hemisphere include

a. cortical blindness.

b. right visual field blindness.

c. expressive and receptive aphasia.

d. left-sided muscle weakness and neglect.

ANS: D

Manifestations of ischemic stroke are related to the cerebral vasculature involved and the

area of brain tissue the vessel supplies. Contralateral hemiplegia is a usual finding.

Contralateral hemiplegia, hemisensory loss, and contralateral visual field blindness are usual

manifestations of stroke. Left visual blindness would be more indicative of a stroke

affecting the right cerebral hemisphere. Aphasia is an integrative language disorder that

occurs with brain damage to the dominant cerebral hemisphere (usually left) and involves

all language modalities.

The most important preventive measure for hemorrhagic stroke is

a. anticoagulation.

b. blood pressure control.

c. thrombolytics.

d. management of dysrhythmias.

ANS: B

Hemorrhagic stroke is a hemorrhage that is usually the result of longstanding hypertension.

Blood pressure control is the most important preventive measure. Anticoagulation would be

useful for preventing embolic stroke. Risk reduction strategies for thrombotic stroke are

aimed at reducing atherosclerosis. Dysrhythmias are not related to a risk of hemorrhagic

stroke.

In the acute phase of stroke, treatment is focused on

a. stabilization of respiratory and cardiovascular function.

b. risk factor modification.

c. prevention of bedsores and contractures.

d. neurologic rehabilitation

ANS: A

The primary consideration in the acute phase of stroke is assuring the patient's airway,

respiratory, and cardiovascular function. In the acute phase of stroke, risk factor

modification is not appropriate. Treatment aimed at preventing bedsores and contractions is

not a typical consideration in the acute phase. Neurologic rehabilitation is not the focus of

treatment in the acute phase.

Cerebral aneurysm is most frequently the result of

a. embolic stroke.

b. subarachnoid hemorrhage.

c. subdural hemorrhage.

d. meningitis.

ANS: B

Although trauma is an important cause of subarachnoid hemorrhage, it is more commonly

associated with rupture of cerebral aneurysms. Embolic stroke is usually from a cardiac

source. Subdural hematomas are related to trauma. Meningitis is caused by microbial

invasion of the CNS.

Leakage of CSF from the nose or ears is commonly associated with

a. epidural hematoma.

b. temporal skull fracture.

c. basilar skull fracture.

d. cerebral aneurysm.

ANS: C

Sometimes fractures at the base of the skull are not visible on the routine CT scan, but allow

drainage of CSF into the nasal sinuses. Head-injured patients who have drainage of clear

fluid from the ears or nose should be evaluated for basilar skull fracture. Epidural

hematomas are not associated with leakage of CSF from the nose or ears. Fracture of the

temporal bone commonly results in an acute epidural hemorrhage. Cerebral aneurysm is not

associated with leakage of cerebrospinal fluid.

Rupture of a cerebral aneurysm should be suspected if the patient reports

a. ringing in the ears.

b. transient episodes of numbness.

c. transient episodes of vertigo.

d. sudden, severe headache

ANS: D

Warning leaks may occur before an aneurysm ruptures and often produce severe headache,

which is typically described by the patient as "the worst headache I have ever had." Ringing

in the ears is not a symptom associated with rupture of a cerebral aneurysm. Transient

episodes of numbness are not indicative of a cerebral aneurysm rupture. Transient episodes

of vertigo are not indicative of a cerebral aneurysm rupture.

Subarachnoid hemorrhage is usually managed with volume expansion and blood pressure

support to enhance cerebral perfusion. This is necessary because subarachnoid hemorrhage

predisposes to

a. cerebral vasospasm.

b. hypotension.

c. excessive volume loss.

d. increased intracranial pressure.

ANS: A

In patients experiencing subarachnoid hemorrhage as a consequence of ruptured aneurysm,

the complications of cerebral vasospasm and hydrocephalus must be monitored and

managed. Vasospasm can be managed by keeping blood volume and blood pressure at

normal to high levels. Vasospasm is managed by keeping blood volume and blood pressure

at normal to high levels. Subarachnoid hemorrhage does not predispose to excessive volume

loss. Subarachnoid hemorrhage is not associated with predisposition to increases in

intracranial pressure

A college student living in a dormitory reports a stiff neck and headache and is found to

have a fever of 102F. This information is most consistent with

a. encephalitis.

b. meningitis.

c. skull fracture.

d. cerebral ischemia

ANS: B

The combination of headache, fever, stiff neck, and signs of confusion are classic symptoms

of meningitis. Clinical manifestations of encephalitis include fever, headache, and confusion

that evolve over several days. Symptoms of a skull fracture are unrelated to fever and

headache. Fever is not associated with cerebral ischemia.

. It is true that encephalitis is usually

a. because of a bacterial infection in the CNS.

b. fatal.

c. because of a viral infection in brain cells.

d. asymptomatic.

ANS: C

Encephalitis is an inflammation of the brain which is caused by a variety of agents. Viral

causes account for the majority of encephalitis cases. Bacteria can be responsible for the

inflammation of the brain associated with encephalitis. Death occurs in 5% to 20% of

encephalitis cases. Clinical manifestations of HSV encephalitis typically evolve over several

days.

It is true that epidural bleeding is

a. associated with widespread vascular disruption.

b. located between the arachnoid and the dura mater.

c. usually because of venous leakage.

d. characterized by a lucid interval immediately after injury

ANS: D

The source of bleeding in most epidural hematomas is arterial. The patient may suffer only a

brief period of disturbed consciousness followed by a period of normal cognition (lucid

interval). Then consciousness rapidly deteriorates as the epidural hematoma expands and

compresses brain structures. As the epidural hematoma expands, pressure is placed on the

brain structures. The bleeding associated with an epidural hematoma occurs between the

inner surface of the skull and the dura mater. The source of bleeding in most epidural

hematomas is arterial

The most important determinant for prescribing therapy for acute stroke is

a. location of ischemia.

b. thrombotic versus embolic cause.

c. ischemic versus hemorrhagic cause.

d. age of the patient.

ANS: C

Treatment pathways differ between ischemic and hemorrhagic stroke. The goals of therapy

for ischemic stroke are to minimize infarct size and preserve neurologic function. Secondary

prevention for thrombotic stroke includes lifestyle modification to address risk factors. It is

critical to prevent further hypoxia or ischemia after ischemic stroke regardless of the age of

the patient.

Intracranial pressure normally ranges from ______ mm Hg.

a. 0 to 15

b. 10 to 20

c. 15 to 25

d. 20 to 30

ANS: A

ICP is the pressure exerted by the contents of the cranium, and it normally ranges from 0 to

15 mm Hg. Normal ICP ranges from 0 to 15 mm Hg. Fifteen to 25 mm Hg is considered to

be high. Elevated ICP may occur in most types of acute brain injury. ICP of 20 to 30 mm

Hg is high and is associated with impaired neurologic function because of compression of

brain structures.

________ edema occurs when ischemic tissue swells because of cellular energy failure.

a. Interstitial

b. Osmotic

c. Vasogenic

d. Cytotoxic

ANS: D

Cytotoxic edema occurs when ischemic tissue swells because of cellular energy failure. A

lack of ATP allows Na+

to accumulate in the cell, creating an osmotic force to draw in

water. Interstitial edema is usually secondary to increased capillary pressure, damage to the

capillary endothelium from a chemical injury, or sudden increase in vascular pressure

beyond autoregulatory limits. A lack of ATP allows Na+

to accumulate in the cell, creating

an osmotic force to draw in water. Vasogenic edema is a consequence of stroke, ischemia,

and severe hypertension, and may occur surrounding brain tumors.

A severe complication of elevated intracranial pressure is

a. Cushing reflex.

b. brain herniation.

c. burr hole.

d. hydrocephalus

ANS: B

A dreaded complication of elevated ICP is brain compression and herniation. Compression

of midbrain and brainstem structures is associated with rapid neurologic demise unless

corrected quickly. An extreme increase in ICP precipitates a reaction by the sympathetic

nervous system as it attempts to maintain perfusion. Cushing reflex is the brain's effort to

reestablish cerebral perfusion. A burr hole is an opening in the skull which is used to

monitor ICP. A cause of increased ICP is an excessive accumulation of CSF

(hydrocephalus).

A tool used to assess levels of consciousness is

a. magnetic resonance imaging (MRI).

b. intracranial pressure (ICP) monitoring.

c. Glasgow Coma Scale (GCS).

d. central perfusion pressure (CPP).

ANS: C

The Glasgow Coma Scale (GCS) is a standardized tool developed for the purpose of

assessing the level of consciousness in acutely brain-injured patients. An MRI is useful in

evaluating a patient with an increase in ICP or change in mental status. ICP monitoring is

useful in monitoring and treating patients with head trauma or other sources of excessive

CSF. Central perfusion pressure is a useful tool in guiding therapy along with ICP

The first indication of brain compression from increasing intracranial pressure (ICP) may be

a. decorticate posturing.

b. absence of verbalization.

c. sluggish pupil response to light.

d. Glasgow Coma Scale score of 13

ANS: C

Careful monitoring of the pupillary response to light during the acute phase is critical, as a

failing response may be the first indication of brain compression from increasing ICP. Mild

dilation of a pupil with sluggish or absent light response is ominous. Decorticate posturing

is related to a deteriorating motor status. Absence of verbalization is not the first indication

of brain compression. A GCS score of 13 is not the first indication of brain compression.

Although, acute changes in level of consciousness should be further investigated

A level of ____ on the Glasgow Coma Scale indicates likely fatal damage.

a. 3

b. 8

c. 12

d. 15

ANS: A

On the GCS, the lowest total score of 3 indicates likely fatal damage, especially if both

pupils fail to respond to light and oculovestibular responses are absent; however, the

severity and prognosis are predicted more accurately by also considering diagnostic imaging

and other factors. A GCS level of 8 indicates severe damage. A GCS level of 12 or higher

indicates mild damage. A GCS level of 15 is considered to be normal