HP4. Nervous System - 105 - Ethan Helm

3rd Year 2nd Semester 2020-2021 IPBN TSMC UHS, Human Pathology 4-2 : Nervous System by Ethan Helm,
MD
1. Which body system’s functions include sensation, maintaining homeostasis, the ability to
learn and think, and movement.
 circulatory
 respiratory
 endocrine
 nervous
2. Which part of the brain is responsible for vision?
 occipital lobe
 frontal lobe
 basal ganglia
 spinal cord
3. What is an electrically excitable cell which transmits electrical or chemical information?
 Schwann cell
 oligodendrocyte cell
 neuron
 microglial cell
4. What part of a neuron sends long projections that carry signals away from the cell body?
 soma
 axon
 dendrite
 nucleus
5. What is the name for the rapid changes in cell membrane potential that spread rapidly along
nerve fibers?
 hormone
 action potential
 synapse
 fascicle
6. What is the name for specialized points of contact between neurons in which neurotransmit-
ters are released?
 saltatory conduction
 resting membrane potential
 synapse
 epineurium
7. What cranial nerve is a sensory nerve which functions include hearing?
 Vagus
 Abducens
MD
 Trigeminal
 Vestibulocochlear
8. What part of the brain has the following functions: balance, posture, involuntary fine-tuning
of motor control?
 cerebellum
 medulla oblongata
 parietal lobe
 limbic system
9. What poison binds to heme on the red blood cell causing decreased oxygen delivery and organ
dysfunction?
 thiamine
 carbon dioxide
 carbon monoxide
 strychnine
10. Which of the following is not a cause of carbon monoxide poisoning?
 house fire
 excess white rice consumption
 poorly functioning heating system
 use of an electrical generator without appropriate ventilation
11. Which of the following is a function of thiamine?
 cofactor for multiple enzymes involved in carbohydrate metabolism
 cofactor for enzyme involved in folic acid recycling
 cofactor for enzymes involved in DNA and RNA production
 facilitates the binding of oxygen to hemoglobin
12. Beriberi is caused by deficiency of what vitamin?
 carbon monoxide
 vitamin D
 vitamin b12
 Thiamine
13. What is the name for the chronic disease that results from untreated Wernicke’s encephalo-
pathy and is associated with short-term memory problems, confabulation (making up stories
to fill in gaps in memory), and otherwise normal cognition?
 dry beriberi
 wet beriberi
 pernicious anemia
 Korsakoff syndrome
MD
14. Which protein is essential for absorption of Vitamin B12?
 folate
 intrinsic factor
 thiamine pyrophosphate
 tetrahydrofolate
15. What condition is associated with macrocytic anemia, cognitive slowing, progressive weak-
ness, ataxia, neuropathy, and painful swelling of the tongue?
 vitamin b12 deficiency
 hypothyroidism
 hyperthyroidism
 carbon monoxide poisoning
16. What autoimmune condition is associated with autoantibodies to intrinsic factor or gastric
parietal cells causing vitamin B12 deficiency?
 Hashimoto’s thyroiditis
 Graves’ disease
 pernicious anemia
 Parkinson’s disease
17. Which group of cells makes the majority of cerebrospinal fluid?
 dura mater
 pia mater
 choroid plexus
 arachnoid granulations
18. Which substance cushions the brain within its solid vault?
 gray matter
 cerebrospinal fluid
 arachnoid villi
 tentorium
19. A bulging fontanelle can be a sign of which of the following?
 increased intracranial pressure
 dehydration
 hypothyroidism
 Vitamin D deficiency
20. A 6-month-old boy presents with a very large head, inability to look up, prominent scalp
veins, and frontal bossing. The head has been enlarged since birth and has continued to grow.
The most likely diagnosis is:
 hyperthyroidism
 acromegaly
MD
 brain cancer
 hydrocephalus
21. What is the name of the area between the pia mater and the arachnoid mater that contains
cerebrospinal fluid in the spinal cord?
 the blood brain barrier
 the subarachnoid space
 arachnoid granulations
 the lateral ventricles
22. Which of the following is a common cause of bacterial meningitis in adults?
 S. Pneumoniae
 HIV
 Herpes
 Salmonella typhi
23. A 22-year-old college student presents with 2 hours of fever, stiff neck, headache, and nausea.
His roommate recently was admitted to the hospital with similar symptoms. A lumbar punc-
ture is done in the emergency department, and her CSF has many white cells. What is the
most likely diagnosis?
 encephalitis
 hydrocephalus
 meningitis
 thiamine deficiency
24. A focal collection of pus within the brain is known as:
 meningitis
 brain abscess
 multiple sclerosis
 encephalitis
25. Which of the following can help rapidly decrease intracranial pressure?
 Mannitol infusion
 Lower the head of the bed
 Hypoventilation
 antibiotics
26. Which word may be defined as “the ability of an object to increase in volume with increasing
pressure?”
 autoregulation
 intracranial hypertension
 herniation
 compliance
MD
27. A hemostatic process that regulates cerebral blood flow across a wide range of blood pres-
sures is called?
 compliance
 herniation
 compensation
 autoregulation
28. Which of the following is a compensatory response to rising intracranial pressure?
 increased cerebrospinal fluid reabsorption
 increase in venous blood content in the brain
 increase in arterial blood flow
 neuronal swelling
29. Which of the following is a sign of impending herniation?
 tachycardia
 hypotension
 wide pulse pressure
 hypoxia
30. Which if the following is not a common cause of intracranial hypertension?
 traumatic brain injury
 multiple sclerosis
 brain cancer
 brain abscess
31. This test is used to gauge the level of consciousness of a patient?
 The patient health questionnaire 9 (PHQ-9)
 Mini-mental exam
 Vanderbilt assessment
 Glasgow Coma scale
32. Brain tissue shifting from a compartment with greater pressure to a compartment with lesser
pressure as a result of increased cranial pressure is also known as:
 coma
 herniation
 compliance
 autoregulation
33. Which answer can be defined as an alteration in brain function or other evidence of brain
pathology caused by an external force?
 traumatic brain injury
 stroke
MD
 demyelinating disease
34. Which of these is an example of a primary traumatic brain injury?
 cerebral edema
 hypoxia
 brain contusion
 blood-brain barrier dysfunction
35. What tool is used to determine the severity of a traumatic brain injury?
 Mini-mental status exam
 FAST exam
 PHQ-9 screening
 Glasgow Coma Scale
36. A patient is seen in the emergency department after a motor vehicle accident. He is noted to
have swollen ecchymoses around both eyes similar to racoon eyes. He has blood behind his
tympanic membrane. He Also has bruising behind bilateral ears. What is the likely dia-
gnosis?
 concussion
 subdural hematoma
 basilar skull fracture
 linear fracture
37. A fracture of the temporal bone of the skull causing damage to the middle meningeal artery
would most likely cause this time of vascular injury?
 epidural hematoma
 intracerebral hemorrhage
 subarachnoid hemorrhage
38. Increased permeability of the capillaries of the blood-brain barrier causing plasma protein to
leak into the extracellular space and drawing water describes the pathophysiology of which
process?
 cytotoxic edema
 interstitial edema
 vasogenic edema
 cerebrovascular disease
39. A spinal cord injury at this level could result in respiratory compromise?
 S2
 L2
 T2
 C2
MD
40. This kind of traumatic brain injury is characterized by asymmetric axonal swelling and focal
hemorrhagic lesions which appears within hours of the injury and is caused by a combination
of tensional forces, rotational forces, and shearing forces?
 diffuse axonal injury
 spinal cord injury
 brain contusion
41. Which blood vessel is the source for most of the blood supply to the brain?
 femoral artery
 radial artery
 facial artery
 internal carotid artery
42. Which is the following is the most important factor regulating cerebral blood flow?
 sodium
 carbon dioxide
 carbon monoxide
 calcium
43. Which of the following is an injury to the brain as a consequence of altered blood flow?
 stroke
 concussion
 meningitis
 herniation
44. Which of the following is a transient episode of neurologic dysfunction from focal brain, ret-
inal, or spinal cord ischemia?
 global cerebral ischemia
 concussion
 embolic stroke
 transient ischemic attack
45. A patient is admitted to the hospital after having a heart attack. A day later he has a stroke
when a clot formed in his heart and traveled through the blood stream to an artery in the
brain causing obstruction. What is this called?
 hemorrhagic stroke
 thrombotic stroke
 global cerebral ischemia
 embolic stroke
46. Which of the following is not a risk factor for stroke?
 smoking
MD
 hypertension
 mild alcohol consumption
 diabetes mellitus
47. Which test is most essential for differentiating between ischemic and hemorrhagic stroke?
 EKG
 CT or MRI
 Echocardiogram
 PT, PTT, and INR
48. This type of stroke is caused when a blood vessel in the brain, retina, or brain stem ruptures
resulting in focal ischemia?
 hemorrhagic stroke
 embolic stroke
 thrombotic stroke
 transient ischemic event
49. A bulging in a blood vessel through a weak spot in a vessel wall is a
 aneurysm
 arteriovenous malformation
 epidural hematoma
 cavernous malformation
50. Which of the following is the most common cause of subarachnoid hemorrhage?
 trauma
 stroke
 ruptured saccular aneurysm
51. A very thin or absent tunica media and a fragmented or absent internal elastic media are two
of the primary pathophysiologic mechanisms of which condition?
 diffuse axonal injury
 saccular aneurysm
52. Which of the following may be defined as a mass of dilated vessels between the arterial and
venous systems that lack a muscularis layer and have the absence of an intervening capillary
bed?
 fusiform aneurysm
 mycotic aneurysm
 arteriovenous malformation
 cavernous malformation
MD
53. Hereditary hemorrhagic telangiectasia is associated with which of the following conditions?
 hydrocephalus
 arteriovenous malformation
 myasthenia gravis
54. After a neuron is injured, the cell body swells, Nissl bodies are lost, and the nucleus increases
in size and moves laterally in a process called
 chromatolysis
 Wallerian degeneration
 retrograde changes
 saltatory conduction
55. Which of the following is false regarding factors that impact nerve regeneration?
 it occurs only in myelinated neurons of the central nervous system
 the closer the injury is to the neuron’s cell body, the more likely the neuron is to die
 cutting injuries are less likely to regenerate than crushing injuries
 neurons can only reconnect to its distal connection if the neurilemma remains intact
56. A collection of enlarged capillaries that have thin walls with reduced elasticity is known as:
 capillary telangiectasias
 developmental venous anomaly
 cavernous malformation
57. Which of the following is an example of a distal axonal polyneuropathy?
 Bells palsy
 diabetic neuropathy
 Polio
58. A patient has flaccid paralysis of bilateral legs with decreased deep tendon reflexes, decreased
motor tone, muscle atrophy, and fasciculations after having a car accident. What is the likely
cause?
 upper motor neuron disease
 lower motor neuron disease
 ischemic stroke of the motor cortex
 tumor in the basal ganglia
59. A disease which results from damage to the myelin nerve sheath and thus slowed saltatory
conduction is known as:
 neuromuscular junction disorder
 demyelinating disorder
MD
 focal neuropathy
60. Ocular neuritis, painful loss of vision in one eye, is often the first symptom of which of the fol-
lowing conditions?
 multiple sclerosis
 Bell’s palsy
 Guillain-barré syndrome
61. This condition causes ascending paralysis and weakness and may cause respiratory depres-
sion as it progresses.
 saccular aneurysm
 Guillain-barré syndrome
 Polio
62. In this condition, autoantibodies destroy nicotinic acetylcholine receptors?
 saccular aneurysm
 Lambert-Eaton myasthenic syndrome
 myasthenia gravis
63. Lambert-Eaton myasthenic syndrome is associated with disease?
 thymoma
 neuroendocrine carcinoma of the lungs
 HIV
 Diabetes
64. What bacteria causes the condition that causes life-threatening paralysis and is caused by eat-
ing improperly canned foods?
 Staphylococcus aureus
 Bacteroides fragilis
 Clostridium botulinum
 Chlamydia pneumonia
65. A sudden, transient disruption in brain electrical function caused by abnormal excessive dis-
charges of cortical neurons describes
 epilepsy
 manic episode
 seizure
 action potential
MD
66. A chronic condition of recurrent seizures is known as:
 epilepsy
 status epilepticus
 depolarization
 encephalitis
67. A discrete area of the brain where seizure activity originates is known as:
 neurotransmitter
 propagation
 repolarization
 epileptogenic focus
68. Which structure of the brain propagates generalized seizures to the rest of the brain?
 epileptogenic focus
 thalamus
 frontal lobe
 occipital lobe
69. A seizure lasting over 5 minutes can cause neuronal death through which of the following
mechanisms:
 cytotoxic edema
 vasogenic edema
 hypercalcemia
 hypoxia
70. A focal seizure experienced as a peculiar sensation proceeding the onset of a generalized or
complex partial seizure is called a/an:
 aura
 prodroma
 ictal phase
 autonomic seizure
71. This type of seizure consists of a sudden loss of muscle tone and falling:
 atonic
 myoclonic
 tonic clonic
 autonomic
72. This type of seizure is defined as non-responsive staring spells with preservation of tone that
lasts 5-30 seconds
 cognitive
 behavior arrest or absence
 clonic
MD
 emotional
73. A fifty-year-old homeless man is brought to clinic by his family. Since the age of 20, he has
heard voices that tell him people are out to get him and has been unable to hold a job. He
talks a lot but repeats the same phrases and uses relatively few words. He often gets inappro-
priately angry. His face looks emotionless. He hasn’t cut his hair in years, and he does not
bathe himself. He has no other medical problems. What is the most likely diagnosis?
 Type 1 bipolar disorder
 Type 2 bipolar disorder
 schizophrenia
 major depressive disorder
74. For the past 2 months, an otherwise healthy thirty-year-old female has felt depressed and
hopeless. She has gained 3 kg in this time. She is unable to sleep. She says she feels worthless,
and she has no energy. She tells you, “I sometimes think of killing myself.” Her work per-
formance has suffered, and she is afraid she might get fired. What is the most likely dia-
gnosis?
 type 1 bipolar disorder
 generalized anxiety disorder
 major depressive disorder
75. A 20-year-old female presents to clinic because “I always worry about everything.” She does
well in school, but before tests she often has panic attacks where she hyperventilates. She
can’t sleep well because of her worries. Her roommate says that she is irritable, and her
roommate is looking for a new roommate as a result. She feels tired all the time and her
muscles often feel tense. She is not sad, and she has no suicidal thoughts. She has no other
medical problems. What is the most likely diagnosis?
 generalized anxiety disorder
 schizophrenia
76. An otherwise healthy 30-year-old male presents to clinic because he hasn’t slept in two weeks.
He reports, “I feel like I’m the king of the world,” and proclaims himself to be “the best busi-
nessman of all time!” He has been working hard to start a new company and won’t start talk-
ing about how “I’m going to be rich!” His wife is concerned that his company might be break-
ing the law, to which he responds, “you have to take risks to make money!” He paces around
the room at the clinic and quickly changes from one thought to another. His wife states that
prior to this episode, “I was worried that he was depressed; I couldn’t get him off the couch.”
He has no other medical problems. This episode likely represents which of the following:
 manic episode
 hypomanic episode
 panic attack
 psychotic episode
MD
77. A fifty-year-old man with known schizophrenia treated with the 1st generation anti-psychotic
chlorpromazine starts to involuntarily smack his lips and grimace with his face, what is the
likely reason?
 focal seizure
 generalized seizure
 tardive dyskinesia
 hypocalcemia
78. Patients with depression often exhibit which of the following characteristics?
 decreased anterior pituitary size
 increased hippocampus size
 decreased adrenal cortex size
 elevated cortisol levels
79. Which medicine used to treat bipolar disorder is associated with hypothyroidism, hyperpara-
thyroidism, polyuria, and polydipsia?
 quetiapine
 valproate
 lurasidone
 lithium
80. What non-pharmaceutical treatment is recommended for generalized anxiety disorder and
major depressive disorder?
 cognitive behavioral therapy
 acupuncture
 gluten free diet
 ultraviolet light therapy
81. A disorder marked by the progressive loss of neurons is known as:
 neuropsychiatric disorder
 parasomnia
 demyelinating disorder
 neurodegenerative disorder
82. Which of the following is common pathophysiological characteristic of many neurodegenerat-
ive diseases?
 the formation of protein aggregates which elicit a stress response from the cell
 demyelination of neurons
 prolonged depolarization leading to excess glutamate activity
 Excessive activity of GABA
MD
83. A disease that typically affects the elderly causing progressive failure of many cerebral func-
tions including impairment of intellectual processes such as orientation, memory, language,
judgment, and decision making
 delirium
 dementia
 cerebrovascular disease
84. Which of the following is a test used to track the progression of dementia?
 polysomnogram
 electroencephalogram (EEG)
 Mini-mental state examination (MMSE)
 Glasgow Coma Scale
85. Which of the following is a neurodegenerative disease with premature aging of the brain pro-
gressing rapidly to extreme loss of cognitive function?
 Parkinson disease
 Alzheimer disease
 Frontotemporal dementia
 Huntington disease
86. Which disease is marked by improper processing of α-synuclein leading to the formation of
protofibrils then fibrils and ultimately lewy body formation?
 Parkinson disease
 Alzheimer disease
 Frontotemporal dementia
87. A 60-year-old female presents with her family to the clinic because of “strange” behavior for
the past two months. When she leaves the house, she often runs up to strangers and kisses
them. She seems fixated on washing her hands, and she has been found binge eating chocol-
ates she normally buys for her grandkids. She also seems to not care about things she used to
care about. What is the likely diagnosis?
 Parkinson disease
 Frontotemporal dementia
88. A 80-year-old has been admitted to the hospital for a week for management of a thrombotic
embolism. He has been gradually improving, when he suddenly developed a fever. He was
later found to have a urinary tract infection. After he developed fever, he became agitated
with hallucinations causing him to scream. What is the likely diagnosis?
 Vascular dementia
 delirium
MD
 Panic attack
89. Which is a primary functions of sleep?
 to build muscle strength
 to digest food
 to regulate immune function
 promote memory consolidation and assist in learning
90. Which phase of sleep is referred to as deep sleep?
 NREM- N1
 NREM- N2
 NREM- N3
 REM
91. Insufficient sleep quality or quantity due to difficulty initiating or maintaining sleep that res-
ults in daytime dysfunction best describes
 insomnia
 restless leg syndrome
 narcolepsy
 parasomnias
92. Which of the following is one of the goals of cognitive behavioral therapy for insomnia?
 Scheduled naps
 Lying in bed even when not sleepy
 Start sleeping at different times each day
 Promote sleep hygiene
93. A disorder characterized by disordered breathing caused by repetitive collapse of the upper
airway during sleep and associated with snoring, reduced oxygen saturation, and hypercapnia
is known as:
 obstructive sleep apnea
 narcolepsy
 parasomnia
 restless leg syndrome
94. What is the best treatment for obstructive sleep apnea?
 Cognitive Behavioral Therapy
 bell pad
 CPAP
 iron
MD
95. Emotionally triggered transient muscle weakness involving muscles of the face, neck, and
knees which may even cause a patient to fall are known as which of the following:
 sleep paralysis
 cataplexy
 night terrors
 hypnagogic hallucinations
96. Restless leg syndrome is associated with deficiency of what vitamin or mineral?
 vitamin b12
 vitamin b6
 iron
 calcium
97. Night terrors, sleep walking, and confusional arousal occur in which phase of sleep?
 NREM- N1
 NREM- N2
 NREM- N3
 REM
98. What is the most common cause of neonatal encephalopathy?
 intracerebral hemorrhage
 metabolic disease
 infection
 hypoxia-ischemic encephalopathy
99. This test is done after a baby is born to assess the health of the baby?
 Apgar score
 Glasgow Coma score
 Ballard score
 Center score
100. Which of the following is a clinical feature suggestive of hypoxic-ischemic encephalopathy?
 Fetal umbilical artery pH >7.0
 Apgar <5 at 5 and 10 minutes
 blood glucose < 40 mg/dl
 CSF pleocytosis
101. Which of the following is caused by a defect in closure or subsequent reopening of the neural
tube?
 neural tube defects
 cerebral palsy
 hypoxic ischemic encephalopathy
 hydrocephalus
MD
102. A non-progressive neurologic motor disorder of movement, muscle tone, or posture caused
by an injury occurring during the prenatal or perinatal periods describes:
 spina bifida
 hypoxic-ischemic encephalopathy
 cerebral palsy
 anencephaly
103. Dyskinetic cerebral palsy is associated with chorea and athetosis. What is athetosis?
 involuntary sustained muscle contraction resulting in twitching and repetitive movements or pos-
tures
 rapid, irregular, unpredictable contractions of individual muscle groups or small groups of muscles
 slow, smooth, writhing movements that involve distant muscles
 difficulty with coordination, balance, and speech difficulties
104. What is the most important step in neonatal resuscitation?
 positive pressure ventilation
 IV epinephrine
 chest compressions
 therapeutic cooling
105. Which of the following is the best way to prevent neural tube defects?
 high dose folic acid supplementation for neonates
 high dose folic acid supplementation for pregnant mothers
 iron supplementation for pregnant mothers
 vitamin d supplementation for neonates

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3rd Year 2nd Semester 2020-2021 IPBN TSMC UHS, Human Pathology 4-2 : Nervous System by Ethan Helm,

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