Management Canadian 11th Edition Robbins Test Bank Full Chapter PDF

Management Canadian 11th Edition
Robbins Test Bank

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Management, 11ce
Chapter 7: Decision Making
Chapter 7 Decision Making
Question ID: 7-1

Question Type: TF
Question: Decision-making is considered a process rather than an act of choosing among
alternatives.
A) True
B) False
Answer: TRUE
Diff: 1 Page Ref: 163
Skill: Recall
Learning Objective: 7-1 Describe the eight steps in the decision-making process.
Question ID: 7-2

Question Type: TF
Question: A decision is a discrepancy between an existing and a desired state of affairs.
A) True
B) False
Answer: FALSE
Skill: Recall
Question ID: 7-3

Question Type: TF
Question: The decision-making process begins by identifying decision criteria.
A) True
B) False
Answer: FALSE
Skill: Recall
Question ID: 7-4

Question Type: TF
Question: The final step in the decision-making process is to implement the chosen
alternative.
A) True
B) False
Answer: FALSE
Skill: Recall
Copyright © 2016 Pearson Canada Inc. 7-1

Management, 11ce
Question ID: 7-5

Question Type: TF
Question: It is possible that at the end of the decision-making process you may be
required to start the decision process over again before making the final decision.
A) True
B) False
Answer: TRUE
Skill: Applied
Question ID: 7-6

Question Type: TF
Question: A decision criterion defines what is important or relevant to resolving a
problem.
A) True
B) False
Answer: TRUE
Skill: Recall
Question ID: 7-7

Question Type: TF
Question: All relevant criteria are equally important in decision-making.
A) True
B) False
Answer: FALSE
Skill: Applied
Question ID: 7-8

Question Type: TF
Question: Once the alternatives to solving a problem have been identified, the next step
in the decision-making process is selecting one of these alternatives.
A) True
B) False
Answer: FALSE
Skill: Applied

Management, 11ce
Question ID: 7-9

Question Type: TF
Question: Managerial decision-making is assumed to be rational.
A) True
B) False
Answer: TRUE
Skill: Applied
Learning Objective: 7-2 Explain the four ways managers make decisions.
Question ID: 7-10

Question Type: TF
Question: One assumption of rational decision making is that the decision maker is not
aware of all possible alternatives and consequences.
A) True
B) False
Answer: FALSE
Skill: Recall
Question ID: 7-11

Question Type: TF
Question: One assumption of rationality is that time and cost constraints exist.
A) True
B) False
Answer: FALSE
Skill: Recall
Question ID: 7-12

Question Type: TF
Question: The phenomenon of escalation of commitment refers to an increased
commitment to a previous decision despite evidence that it may have been wrong.
A) True
B) False
Answer: TRUE
Skill: Recall

Management, 11ce
Question ID: 7-13

Question Type: TF
Question: According to the concept of bounded rationality, managers make decisions
rationally but are limited by their ability to process information.
A) True
B) False
Answer: TRUE
Skill: Recall
Question ID: 7-14

Question Type: TF
Question: A satisficing decision is one that is satisfactory and sufficient in the situation,
and meets an acceptable level of performance.
A) True
B) False
Answer: TRUE
Skill: Recall
Question ID: 7-15

Question Type: TF
Question: Managers regularly use their intuition in decision-making.
A) True
B) False
Answer: TRUE
Skill: Recall
Question ID: 7-16

Question Type: TF
Question: Intuitive decision making is based on values and past experiences.
A) True
B) False
Answer: TRUE
Skill: Recall

Management, 11ce
Question ID: 7-17

Question Type: TF
Question: Intuitive decision making complements rational decision making but not
bounded rational decision making.
A) True
B) False
Answer: FALSE
Skill: Recall
Question ID: 7-18

Question Type: TF
Question: Evidence-based management relies heavily on the decision maker’s intuition.
A) True
B) False
Answer: FALSE
Skill: Recall
Question ID: 7-19

Question Type: TF
Question: Opinions, preferences, and values of decision-makers are an essential element
of evidence-based management.
A) True
B) False
Answer: TRUE
Skill: Recall
Question ID: 7-20

Question Type: TF
Question: A procedure is an explicit statement that tells a manager what he or she can or
cannot do.
A) True
B) False
Answer: FALSE
Skill: Recall
Learning Objective: 7-3 Classify decisions and decision-making conditions.

Management, 11ce
Question ID: 7-21

Question Type: TF
Question: A policy is a series of interrelated sequential steps that a manager can use for
responding to a structured problem.
A) True
B) False
Answer: FALSE
Skill: Recall
Question ID: 7-22

Question Type: TF
Question: A programmed decision is a repetitive decision that can be handled by a
routine approach.
A) True
B) False
Answer: TRUE
Skill: Recall
Question ID: 7-23

Question Type: TF
Question: Rules and policies are essentially the same.
A) True
B) False
Answer: FALSE
Diff: 2 Page Ref: 171-172
Skill: Applied
Question ID: 7-24

Question Type: TF
Question: Nonprogrammed decision-making relies on procedures, rules, and policies.
A) True
B) False
Answer: TRUE
Skill: Recall

Management, 11ce
Question ID: 7-25

Question Type: TF
Question: Most managerial decisions in the real world are nonprogrammed.
A) True
B) False
Answer: FALSE
Skill: Applied
Question ID: 7-26

Question Type: TF
Question: Unstructured problems require custom-made responses through programmed
decision-making.
A) True
B) False
Answer: FALSE
Skill: Applied
Question ID: 7-27

Question Type: TF
Question: Risk is a condition in which a decision maker has neither certainty nor
reasonable probability estimates.
A) True
B) False
Answer: FALSE
Skill: Recall
Question ID: 7-28

Question Type: TF
Question: An optimistic manager will follow a maximin approach.
A) True
B) False
Answer: FALSE
Skill: Applied

Management, 11ce
Question ID: 7-29

Question Type: TF
Question: A manager who desires to minimize his maximum "regret" will opt for a
minimax choice.
A) True
B) False
Answer: TRUE
Skill: Applied
Question ID: 7-30

Question Type: TF
Question: Nonlinear thinking style is characterized by feelings, hunches and internal
insights to guide decisions.
A) True
B) False
Answer: TRUE
Skill: Recall
Learning Objective: 7-4 Describe different decision-making styles and the impact of
biases.
Question ID: 7-31

Question Type: TF
Question: Linear thinking style ignores external data and facts and relies directly on the
decision maker’s internal information processing.
A) True
B) False
Answer: FALSE
Skill: Recall
biases.
Question ID: 7-32

Question Type: TF
Question: Heuristics are "rules of thumb" that managers use to simplify decision-making.
A) True
B) False
Answer: TRUE
Skill: Recall
biases.

Management, 11ce
Question ID: 7-33

Question Type: TF
Question: The confirmation bias occurs when decision makers tend to think they know
more than they actually do and hold unrealistically positive views of themselves.
A) True
B) False
Answer: FALSE
Skill: Recall
biases.
Question ID: 7-34

Question Type: TF
Question: A hindsight bias occurs when decision makers increase their commitment to a
previous decision despite evidence that it may have been wrong.
A) True
B) False
Answer: FALSE
Skill: Recall
biases.
Question ID: 7-35

Question Type: TF
Question: The self-serving bias occurs when decision makers take credit for their
successes and blame failure on outside factors.
A) True
B) False
Answer: TRUE
Skill: Recall
biases.
Question ID: 7-36

Question Type: TF
Question: Availability bias distorts the decision maker’s ability to recall events in an
objective manner and focus on events that are most recent and vivid in their memory.
A) True
B) False
Answer: TRUE
Skill: Recall
Learning Objective: 7-4 Describe different decision-making styles and the impact of biases.

Management, 11ce
Question ID: 7-37

Question Type: TF
Question: Highly reliable organizations (HROs) tap into their complexity to help them
adapt more effectively.
A) True
B) False
Answer: TRUE
Skill: Recall
Learning Objective: 7-5 Identify effective decision-making techniques.
Question ID: 7-38

Question Type: TF
Question: Highly reliable organizations (HROs) make decisions at the executive level.
Answer: FALSE
Skill: Recall
Question ID: 7-39

Question Type: TF
Question: Managers need to understand cultural differences to make effective decisions
in today's fast-moving world.
A) True
B) False
Answer: TRUE
Skill: Recall
Question ID: 7-40

Question Type: TF
Question: Highly reliable organizations (HROs) are easily tricked by their success.
A) True
B) False
Answer: FALSE
Skill: Recall

Management, 11ce
Question ID: 7-41

Question Type: TF
Question: Design thinking is an interesting new line of thinking with broad implications
for making effective business decisions by integrating emotional elements into the
process.
A) True
B) False
Answer: TRUE
Skill: Recall
Question ID: 7-42

Question Type: MC
Question: A __________ is a discrepancy between an existing and a desired state of
affairs.
A) process
B) problem
C) scenario
D) criterion
E) decision
Answer: B
Skill: Recall
Question ID: 7-43

Question Type: MC
Question: When a manager finds a disparity between their current situation and a desired
situation, they are at which step of the decision-making process?
A) develop alternatives
B) identify decision criteria
C) analyze alternatives
D) identify a problem
E) allocate weights to criteria
Answer: D
Skill: Applied

Management, 11ce
Question ID: 7-44

Question Type: MC
Question: After identifying a problem, the next step in the decision-making process is
________.
A) identifying decision criteria
B) allocating weights to decision criteria
C) analyzing alternatives
D) developing alternatives
E) implementing alternatives
Answer: A
Diff:1 Page Ref: 151644
Skill: Recall
Question ID: 7-45

Question Type: MC
Question: Which of the following statements is true concerning problem identification?
A) Problems are generally obvious.
B) A symptom and a problem are basically the same.
C) Well-trained managers generally agree on what is considered a problem.
D) The problem must exert some pressure on the manager to act.
E) To be considered a problem, managers must be aware of the discrepancy but
not have sufficient resources to take action.
Answer: D
Skill: Applied
Question ID: 7-46

Question Type: MC
Question: The process of selecting decision criteria is accomplished by __________.
A) massaging the data that will support a given decision
B) flipping a coin to produce a 50-50 chance of being right
C) determining what is relevant in making the decision
D) examining the differences between potential opportunities
E) identifying a discrepancy between an existing and a desired state of affairs
Answer: C
Skill: Recall

Management, 11ce
Question ID: 7-47

Question Type: MC
Question: If all the decision criteria are equally important, weighting the criteria
__________.
A) is exceptionally important
B) is not necessary
C) produces excellent decisions
D) improves the criteria
E) results in more alternatives
Answer: B
Skill: Applied
Question ID: 7-48

Question Type: MC
Question: The final step in the decision-making process is to __________.
A) select the best alternative
B) reevaluate the weightings of the criteria until they indicate the correct outcome
C) evaluate the outcome of the decision
D) reassign the ratings on the criteria to find different outcomes
E) implement the alternative to solve the problem
Answer: C
Skill: Recall
Question ID: 7-49

Question Type: MC
Question: Which of the following must be present in order to initiate the decision-making
process?
A) plenty of time
B) established criteria
C) implementation procedures
D) viable alternatives
E) pressure to act
Answer: E
Skill: Applied

Management, 11ce
Question ID: 7-50

Question Type: MC
Question: To determine the __________, a manager must identify the factors that are
relevant to resolving the problem.
A) effectiveness of the decision
B) number of feasible alternatives
C) desired outcomes
D) decision criteria
E) implementation procedures
Answer: D
Skill: Recall
Question ID: 7-51

Question Type: MC
Question: In the purchase of a car, the assessment of factors such as speed, fuel
efficiency, and price occurs at which step of the decision-making process?
A) identify a problem
B) analyze alternatives
C) identify decision criteria
D) evaluate decision effectiveness
E) develop alternatives
Answer: C
Skill: Applied
Question ID: 7-52

Question Type: MC
Question: Which of the following steps in the decision-making process occurs before
developing alternatives?
A) allocate weights to criteria
C) select an alternative
D) implement the alternative
E) evaluate decision effectiveness
Answer: A
Skill: Recall

Management, 11ce
Question ID: 7-53

Question Type: MC
Question: In allocating weights to the decision criteria, which of the following is helpful
to remember?
A) All weights must be the same.
B) Assign a weight to the most important criterion, and then assign weights to the
rest against that standard.
C) Every criterion considered, regardless of its importance, must receive some
weighting.
D) The most important and least important criteria should be inversely weighted.
E) The total of the weights should sum to 1.0.
Answer: B
Skill: Applied
Question ID: 7-54

Question Type: MC
Question: Amanda, a single parent, is looking for a new job. Considering that she has two
school-age children, she is particularly keen on finding an employer who can provide her
with alternative work arrangements such as flexible work hours and telecommuting. In
terms of the decision-making process, these represent Amanda's ________.
A) criteria
B) problems
C) alternatives
D) guidelines
E) perceptions
Answer: A
Skill: Applied
Question ID: 7-55

Question Type: MC
Question: Max is planning on going away to college next year and is currently trying to
figure out which colleges he should apply to. He would like to major in English
Literature at an accredited liberal arts college but is also looking for a university that
offers financial aid and student housing. In terms of the decision-making process, these
represent Max's ________.
A) criteria
B) problems
C) alternatives
D) guidelines
E) perceptions
Answer: A

Management, 11ce
Skill: Applied
Question ID: 7-56

Question Type: MC
Question: Which step in the decision-making process involves conveying the decision to
those affected by it and getting their commitment to it?
A) allocating weights to criteria
B) analyzing alternatives
C) selecting an alternative
D) implementing the alternative
E) evaluating the decision effectiveness
Answer: D
Skill: Recall
Question ID: 7-57

Question Type: MC
Question: Which of the following is important in effectively implementing the chosen
alternative in the decision-making process?
A) getting upper management support
B) double checking your analysis for potential errors
C) implementing the decision quickly through power and persuasion
D) ignoring criticism concerning the chosen alternative
E) allowing those impacted by the outcome to participate in the process
Answer: E
Skill: Applied
Question ID: 7-58

Question Type: MC
Question: Which of the following is important to remember in evaluating decision
effectiveness?
A) Ignore criticism concerning the decision-making process.
B) You may have to start the whole decision-making process over again.
C) You should restart the decision-making process only if the decision is less than
50 percent effective.
D) 90 percent of problems with decision-making occur in the implementation
step.
E) The initial problem may still exist despite the implementation of an effective
decision.
Answer: B
Skill: Applied

Management, 11ce
Question ID: 7-59

Question Type: MC
Question: Which of the following decisions involves the management function of
planning?
A) How should jobs be designed?
B) How difficult should individual goals be?
C) How do I handle employees who appear to be low in motivation?
D) When is the right time to stimulate conflict?
E) When is a performance deviation significant?
Answer: B
Skill: Applied
Question ID: 7-60

Question Type: MC
organizing?
Answer: A
Skill: Applied
Question ID: 7-61

Question Type: MC
controlling?
Answer: E
Skill: Applied

Management, 11ce
Question ID: 7-62

Question Type: MC
Question: The assumption that managers make consistent, value-maximizing choices
within specified constraints is known as which of the following?
A) rational decision-making
B) unbounded rationality
C) organized decision-making
D) optimal decision-making
E) objective rationality
Answer: A
Skill: Recall
Question ID: 7-63

Question Type: MC
Question: A perfectly rational decision maker would __________.
A) have changing preferences
B) not consider profit maximization as an objective
C) offer inconsistent decisions
D) be objective and logical
E) have to overcome time and cost constraints
Answer: D
Skill: Applied
Question ID: 7-64

Question Type: MC
Question: Which of the following is an assumption of rationality?
A) The problem is ambiguous.
B) Multiple goals are to be achieved.
C) Time and cost constraints are known.
D) Preferences change quickly.
E) All alternatives and consequences are known.
Answer: E
Skill: Recall

Management, 11ce
Question ID: 7-65

Question Type: MC
Question: When managers make decisions that are rational but limited by their ability to
process the information, they are exhibiting the concept of ________.
A) cognitive decision-making
B) bounded rationality
C) escalation of commitment
D) intuitive decision-making
E) objective rationality
Answer: B
Skill: Recall
Question ID: 7-66

Question Type: MC
Question: An increased commitment to a previous decision despite evidence that it may
have been wrong is a phenomenon called __________.
A) confirmation bias
B) intuition
C) overconfidence bias
D) hindsight bias
E) escalation of commitment
Answer: E
Skill: Recall
Question ID: 7-67

Question Type: MC
Question: Arthur authorizes the expenditure of an additional $100,000 for the production
of a new product despite mounting concerns that it will be unprofitable. The cost of the
new product has already increased far beyond the initial plans and projections. Arthur's
continuing support for this project illustrates the phenomenon of __________.
B) escalation of commitment
D) hindsight bias
E) intuition
Answer: B
Skill: Applied

Management, 11ce
Question ID: 7-68

Question Type: MC
Question: Escalation of commitment refers to ________.
A) commitment to a bad decision due to an unwillingness to go against the
opinion of the majority
B) an increased commitment to a previous decision despite evidence that it may
have been wrong
C) the strengthening of commitment to a particular course of action due to greater
motivation by others
D) greater commitment to a decision because of one’s belief that it is "the right
thing to do"
E) a decision based on external evidence that has been evaluated by experts.
Answer: B
Skill: Recall
Question ID: 7-69

Question Type: MC
Question: Because managers can't possibly analyze all information on all alternatives,
they accept solutions that __________ rather than __________ payoff.
A) maximize; satisfice
B) maximize; minimize
C) satisfice; minimize
D) satisfice; maximize
E) minimize; maximize
Answer: D
Skill: Applied
Question ID: 7-70

Question Type: MC
Question: The type of decision-making in which the solution is considered "good
enough" is known as which of the following?
A) minimizing
B) rationalizing
C) maximizing
D) satisficing
E) optimizing
Answer: D
Skill: Recall

Management, 11ce
Question ID: 7-71

Question Type: MC
Question: The strap on Brad's backpack broke as he lifted it. On the way to class, he
stopped at the first store that carries backpacks and although it was not exactly what he
wanted, he purchased a new one from the front counter because it would do the job. Brad
has made a(n) __________ decision.
A) satisficing
B) irrational
C) escalating
D) optimizing
E) perfectly rational
Answer: A
Skill: Applied
Question ID: 7-72

Question Type: MC
Question: Relying on "gut feeling" over cognitive problem solving in decision-making is
a phenomenon called __________.
A) sunk costs error
B) intuition
D) hindsight bias
Answer: B
Skill: Recall
Question ID: 7-73

Question Type: MC
Question: Toby is hunting for a new apartment. He is specifically looking for one that is
located in the heart of the city and should be available for $600 per month. However,
Toby is also willing to pay up to $850 per month for a place situated slightly away from
the city centre. According to him, the second option "will also do." This is an example of
________.
A) experience-based decision-making
B) rational decision-making
C) bounded rationality
D) intuitive decision-making
E) non linear thinking
Answer: C
Skill: Applied

Management, 11ce
Question ID: 7-74

Question Type: MC
Question: Intuitive decision-making ________.
A) is the systematic use of the best available evidence to improve decision-
making practice
B) generally results in poor decisions, and hence managers should learn to ignore
their gut feelings
C) is only appropriate for simple problems
D) complements rational decision-making but not bounded rational decision-
making
E) is the process of making decisions based on experience, feelings, and
accumulated judgment
Answer: E
Skill: Applied
Question ID: 7-75

Question Type: MC
Question: In intuitive decision making, managers ________.
A) often tend to ignore their feelings or emotions
B) use data from their subconscious mind to help make their decisions
C) use available evidence to improve their decision-making skills
D) do not depend on their past experiences to make decisions
E) ask for opinions and values of other stakeholders
Answer: B
Skill: Recall
Question ID: 7-76

Question Type: MC
Question: Decision-making where managers recognize and understand that the systematic
use of the best available data will improve their management practices and decision-
making is called ______________.
A) intuitive decision making
B) rational management
C) satisficing decision making
D) evidence based management
E) innovative management
Answer: D
Skill: Recall

Management, 11ce
Question ID: 7-77

Question Type: MC
Question: An important element in making decisions using evidence-based management
(EBMgt) is to consider ______________.
A) using the rational decision making process
B) applying design thinking to problems
C) opinions, preferences and values of all stakeholders
D) alternatives that are good enough for the situation
E) using linear thinking style
Answer: C
Diff: 2 Page Ref:170
Skill: Recall
Question ID: 7-78

Question Type: MC
Question: Problems that are straightforward, familiar, and easily defined are called
__________ problems.
A) opportunity
B) structured
C) unique
D) nonprogrammed
E) technical
Answer: B
Skill: Recall
Question ID: 7-79

Question Type: MC
Question: The most efficient way to handle a structured problem is through __________
decision-making.
A) linear
B) unique
C) focused
D) programmed
E) technical
Answer: D
Skill: Recall

Management, 11ce
Question ID: 7-80

Question Type: MC
Question: A __________ decision is repetitive and can be handled by a routine approach.
A) nonprogrammed
B) linear
C) satisficing
D) programmed
E) technical
Answer: D
Skill: Recall
Question ID: 7-81

Question Type: MC
Question: The inflight service manager for National Airlines is authorized to distribute
drycleaning vouchers to customers who complain about spilled drinks and food on their
clothes during turbulent flights. This is an example of a(n) __________ decision to a
__________ problem.
A) nonprogrammed; routine
B) programmed; unique
C) nonprogrammed; technical
D) programmed; structured
E) nonprogrammed; unstructured
Answer: D
Skill: Applied
Question ID: 7-82

Question Type: MC
Question: A customer gives Jan a request that she has never heard before in her 15 years
of experience at the hardware store. Since the request involves the application of a new
technology, Jan is not sure what to do. This is an example of a(n) __________ problem
that requires a(n) _____________ solution.
A) nonprogrammed, satisficing
B) programmed, rule based
C) technical, nonprogrammed
D) structured, programmed
E) unstructured, nonprogrammed
Answer: E
Skill: Applied

Management, 11ce
Question ID: 7-83

Question Type: MC
Question: When the petty cash in Elaine's drawer falls to less than $25, she places a
request for additional funds to bring the total back up to $100. This is an example of a(n)
__________ decision.
A) nonprogrammed
B) programmed
C) technical
D) structured
E) unstructured
Answer: B
Skill: Applied
Question ID: 7-84

Question Type: MC
Question: A procedure __________.
A) is an explicit statement detailing exactly how to deal with a decision
B) is a series of interrelated sequential steps to respond to a structured problem
C) is a set of guidelines that channel a manager's thinking in dealing with a
problem
D) allows a manager to use broad decision-making authority
E) is a series of steps designed to implement decisions for unique and
nonrecurring problems
Answer: B
Skill: Recall
Question ID: 7-85

Question Type: MC
Question: A __________ is an explicit statement that tells a manager what he or she can
or cannot do.
A) procedure
B) policy
C) precedent
D) heuristic
E) rule
Answer: E
Skill: Recall

Management, 11ce
Question ID: 7-86

Question Type: MC
Question: A __________ is series of interrelated sequential steps that a manager can use
for responding to a structured problem.
A) procedure
B) policy
C) precedent
D) heuristic
E) rule
Answer: A
Skill: Recall
Question ID: 7-87

Question Type: MC
Question: A policy __________.
A) typically contains an ambiguous term that leaves room for interpretation
B) is frequently used when a manager faces an unstructured problem
C) allows little discretion on the part of the manager
D) offers strict rules as to how a problem should be solved
E) is a type of nonprogrammed decision
Answer: A
Skill: Recall
Question ID: 7-88

Question Type: MC
Question: A business school's statement that it "strives for productive relationships with
local organizations" is an example of a __________.
A) rule
B) precedent
C) procedure
D) policy
E) mission
Answer: D
Skill: Applied

Management, 11ce
Question ID: 7-89

Question Type: MC
Question: To receive reimbursement for their travel expenses, managers at ABC
Company must first list each item in chronological order on an expense form, then attach
all receipts to the upper-left corner, then obtain their supervisor's authorizing signature,
and, finally, forward the form to the finance department. This is an example of a
__________.
A) rule
B) precedent
C) procedure
D) policy
E) heuristic
Answer: C
Skill: Applied
Question ID: 7-90

Question Type: MC
Question: “No smoking allowed” is an example of a __________.
A) rule
B) precedent
C) procedure
D) policy
E) guideline
Answer: A
Skill: Applied
Question ID: 7-91

Question Type: MC
Question: Whenever possible, managers at ABC Company try to promote employees
from within the organization before recruiting from external sources. This is an example
of a __________.
A) rule
B) precedent
C) procedure
D) policy
E) guideline
Answer: D
Skill: Applied

Management, 11ce
Question ID: 7-92

Question Type: MC
Question: “We strive to use environmentally safe materials” is an example of a
__________.
A) rule
B) policy
C) procedure
D) precedent
E) guideline
Answer: B
Skill: Applied
Question ID: 7-93

Question Type: MC
Question: "Before a health claim may be paid, the following steps must be taken" is an
example of a __________.
A) rule
B) precedent
C) procedure
D) policy
E) guideline
Answer: C
Skill: Applied
Question ID: 7-94

Question Type: MC
Question: Which of the following is an example of a procedure?
A) Without exception, all employees in customer-facing roles must be formally
attired at all times.
B) Before going on a leave of absence, fill up the application form available on
the company's online leave management system. All applications will be
approved/rejected within two days by the employee's immediate supervisor.
C) We promote from within, whenever possible. If qualified applicants are
available internally, a job posting will be issued by the HR department
providing the necessary details about all vacancies.
D) Employees working with power tools must wear safety glasses at all times.
E) All new employees are required to attend orientation and familiarization
training during their first week of employment.
Answer: B
Skill: Applied

Management, 11ce
Question ID: 7-95

Question Type: MC
Question: Which of the following is an example of a policy?
A) Before going on a leave of absence, fill up the application form available on
the company's online leave management system. All applications will be
approved/rejected within two days by the employee's immediate supervisor.
B) Employees working with power tools must wear safety glasses at all times.
C) Smoking and the consumption of alcohol are strictly prohibited inside the work
premises.
D) We are an equal opportunity employer with a diverse workforce. We do not
discriminate against employees and applicants on the basis of sex, race, color,
religion, national origin, age, disability, marital status, sexual orientation or
veteran status.
E) In order to attend company paid training, employees must first contact the HR
department for approval, then fill out an application form, and finally get
permission from their immediate supervisor for leave from their daily duties.
Answer: D
Skill: Applied
Question ID: 7-96

Question Type: MC
Question: Alanna has just been given the assignment of developing the marketing
strategy for the company's new product to be released in November. What type of
decision-making will be required of Alanna?
A) structured
B) unstructured
C) technical
D) programmed
E) nonprogrammed
Answer: E
Skill: Applied

Management, 11ce
Question ID: 7-97

Question Type: MC
Question: Nonprogrammed decisions are best described as __________.
A) recurring but difficult to make
B) very similar to problems in other areas of the organization
C) requiring more aggressive action on the decision maker's thought processes
D) unique and nonrecurring
E) routine and straightforward
Answer: D
Skill: Recall
Question ID: 7-98

Question Type: MC
Question: When problems are __________, managers must rely on __________ in order
to develop unique solutions.
A) structured; nonprogrammed decision-making
B) structured; intuition
C) unstructured; nonprogrammed decision-making
D) structured; programmed decision-making
E) technical; programmed decision-making
Answer: C
Skill: Applied
Question ID: 7-99

Question Type: MC
Question: If an individual knows the price of three similar cars at different dealerships, he
or she is operating under what type of decision-making condition?
A) risk
B) uncertainty
C) certainty
D) factual
E) nonprogrammed
Answer: C
Skill: Recall

Management, 11ce
Question ID: 7-100

Question Type: MC
Question: Nonprogrammed decisions are typically made under a condition of ______.
A) certainty
B) low levels of risk
C) uncertainty
D) reliability
E) rationality
Answer: C
Skill: Recall
Question ID: 7-101

Question Type: MC
Question: A retail clothing store manager who estimates how much to order for the
current spring season based on last spring's outcomes is operating under what kind of
decision-making condition?
A) reliability
B) risk
C) uncertainty
D) certainty
E) rationality
Answer: B
Skill: Applied
Question ID: 7-102

Question Type: MC
Question: A person at a horse racetrack who bets all of his or her money on the odds-
based long shot to "win" (rather than "place" or "show") is making what kind of
choice?
A) maximax
B) maximin
C) multimax
D) minimin
E) minimax
Answer: A
Skill: Applied

Management, 11ce
Question ID: 7-103

Question Type: MC
Question: Which of the following best describes "maximizing the minimum possible
payoff"?
A) maximax
B) maximin
C) multimax
D) minimin
E) minimax
Answer: B
Skill: Recall
Question ID: 7-104

Question Type: MC
Question: An individual making a "maximin" choice has what type of psychological
orientation toward uncertain decision-making?
A) optimist
B) realist
C) pessimist
D) opportunist
E) rationalist
Answer: C
Skill: Recall
Question ID: 7-105

Question Type: MC
Question: Optimistic managers typically select the alternative designed to __________.
A) maximize the maximum payoff
B) maximize the minimum payoff
C) minimize the maximum regret
D) minimize the minimum payoff
E) maximize the minimum regret
Answer: A
Skill: Recall

Management, 11ce
Question ID: 7-106

Question Type: MC
Question: A manager who desires to minimize his or her maximim "regret" will opt for a
__________ choice.
A) maximax
B) maximum
C) multimax
D) minimin
E) minimax
Answer: E
Skill: Applied
Question ID: 7-107

Question Type: MC
Question: Rules of thumb that managers use to simplify decision-making are called
__________.
A) intuition
B) heuristics
C) rules
D) policies
E) procedures
Answer: B
Skill: Recall
biases.
Question ID: 7-108

Question Type: MC
Question: A(n) __________ occurs when decision makers think they know more than
they do or hold unrealistically positive views of themselves and their performance.
A) hindsight bias
B) confirmation bias
D) sunk costs error
E) self-serving bias
Answer: C
Skill: Recall
biases.

Management, 11ce
Question ID: 7-109

Question Type: MC
Question: A(n) __________ occurs when decision makers incorrectly fixate on past
expenditures of time, money, or effort in assessing choices rather than focusing on future
consequences.
A) hindsight bias
D) sunk costs error
Answer: D
Skill: Recall
biases.
Question ID: 7-110

Question Type: MC
Question: A(n) __________ occurs when decision makers seek out information that
reaffirms their past choices and discount information that contradicts past judgments.
A) hindsight bias
D) sunk costs error
Answer: B
Skill: Recall
biases.
Question ID: 7-111

Question Type: MC
Question: A(n) __________ occurs when decision makers take credit for their successes
and blame failures on outside factors.
A) escalation of commitment
D) sunk costs error
Answer: E
Skill: Recall
biases.

Management, 11ce
Question ID: 7-112

Question Type: MC
Question: Sophie is in charge of recruitment at her company. During a particular
interview, the first thing Sophie noticed about the applicant was that he was improperly
attired. Though the candidate possessed the necessary qualifications and effectively
answered all her questions, Sophie rejected him. This is an example of the ________.
A) randomness bias
B) self-serving bias
C) selective perception bias
D) representation bias
E) hindsight bias
Answer: C
Skill: Recall
biases.
Question ID: 7-113

Question Type: MC
Question: Which of the following is a habit of successful highly reliable organizations
(HROs)?
A) They are preoccupied with their successes.
B) They defer decisions to the experts in upper management.
C) They let unexpected circumstances provide the solution.
D) They embrace simplicity.
E) They do not anticipate their limits.
Answer: C
Skill: Recall
Question ID: 7-114

Question Type: MC
Question: In order to make effective decisions in today's fast-moving world, managers
need to ________.
A) build organizations that shun complexity
B) know when it is time to call it quits
C) ignore cultural differences
D) build organizations that rely on their past successes
E) always use the rational decision-making process
Answer: B
Skill: Recall

Management, 11ce
Question ID: 7-115

Question Type: MC
Question: _________________ means that managers focus on opening up perspective
and gaining insights by using observation and inquiry skills and not relying simply on
rational analysis.
A) Intuitive decision making
B) Escalation of commitment
C) Design thinking
D) Nonlinear thinking
E) Evidence-based management
Answer: C
Skill: Applied
Question ID: 7-116

Question Type: MC
Question: Design thinking suggests that managers should look at problem identification
collaboratively and integratively with the goal of ________.
A) unveiling a rational approach to address the situation
B) analyzing the situation with deductive reasoning
C) developing solutions which somehow seem inevitable
D) gaining a deep understanding of the situation
E) using intuition and creativity
Answer: D
Skill: Recall
Refer to the scenario below to answer the following questions.
Management Decisions : Declining Income (Scenario)
Net income has fallen for the second consecutive quarter, and Amanda is understandably
worried. She knows there will be a lot of questions for her at the board of directors
meeting Wednesday, and she will be expected to reveal her plan to avoid any third-
quarter losses. Amanda begins to analyze the company's financial reports to try to
determine the cause of the loss. After much consideration, it appears that expenses have
risen dramatically over the last few months. Amanda wonders why. She decides a
meeting of the department heads is in order first thing tomorrow morning. At the
meeting, Amanda would like to generate several possible solutions to the increased
expenses. She wonders how to effectively explore all the options. Next morning, the first
option presented at the meeting is to downsize the research and development department,
since it is not essential to current operations. Several managers believe the plan will help
stem the losses and immediately move to approve it. However, Amanda suggests that

Management, 11ce
they need to look further at the issue and explore other potential solutions. Several
suggestions are made, many of which appear to be viable. Amanda wonders what to do
next.
Question ID: 7-117

Question Type: MC
Question: What is the first step in the decision-making process facing Amanda?
A) analyze alternatives
C) evaluate decision effectiveness
D) identify the problem
Answer: D
Skill: Recall
Question ID: 7-118

Question Type: MC
Question: According to the decision-making process, the second step Amanda should
take is to __________.
A) analyze alternatives
C) evaluate decision effectiveness
D) allocate weights to criteria
Answer: B
Skill: Recall
Question ID: 7-119

Question Type: MC
Question: When several managers move to approve the plan to downsize the research and
development department without first exploring other options, they are engaging in a type
of decision-making called __________.
A) maximizing
B) optimizing
C) rationalizing
D) minimizing
E) satisficing
Answer: E
Skill: Applied

Management, 11ce
Question ID: 7-120

Question Type: MC
Question: Amanda's group does not have complete information and must try to make a
decision rationally within the limits of their ability to process the available information.
They will make their decision under which assumptions?
A) certainty
B) rationality
D) escalation of commitment
E) programmed
Answer: C
Skill: Applied
Question ID: 7-121

Question Type: MC
Question: Amanda's group has proposed a solution that does not have much data or
evidence to support it. However, based on Amanda's 20 years of experience, the solution
just feels right, and so she proposes it to the board of directors. Amanda has made her
decision based on __________.
A) heuristics
B) intuition
C) hindsight bias
D) overconfidence bias
E) availability bias
Answer: B
Skill: Applied

Management, 11ce
The Loaned Car (Scenario)
Colleen is a student, and her older brother has loaned her an old car. The car is in need of
several repairs before she will feel comfortable driving it.
Question ID: 7-122

Question Type: MC
Question: Colleen needs a vehicle, but she has to decide if the loaned car is worth
repairing. She is facing a(n) __________, a discrepancy between an existing and a
desired state of affairs.
A) alternative
B) criterion
C) problem
D) crisis
E) decision
Answer: C
Skill: Applied
Question ID: 7-123

Question Type: MC
Question: Before talking with an automotive repair person, Colleen needs to assess which
factors are relevant to her decision. The car needs new brakes, tires, a muffler, a tune-up,
and could also use some bodywork to repair dents and scratches. After consideration,
Colleen decides that safety and reliability are relevant. This is which step in the decision-
making process?
A) weigh the decision criteria
C) identify decision criteria
D) develop alternatives
E) select an alternative
Answer: C
Skill: Applied

Management, 11ce
Question ID: 7-124

Question Type: MC
Question: Colleen decides to have all of the mechanical problems fixed on the car. She
assumes that the mechanic has found all the relevant problems and that he will be able to
perform all the required repairs within the estimated quote he provided. Colleen decides
to proceed with the repairs under which set of assumptions?
A) intuition
B) irrationality
C) escalation of commitment
D) rationality
E) uncertainty
Answer: D
Skill: Applied
Question ID: 7-125

Question Type: MC
Question: Colleen's brother has a different view of the repairs. He assumes that the
mechanic is using the best information available, but there may be other unexpected
repairs that surface once he begins the work. He warns Colleen not to be too surprised if
the final bill exceeds the mechanic's original estimate. Her brother's observations are
based on which assumptions?
A) rationality
B) certainty
D) escalation of commitment
E) heuristics
Answer: C
Skill: Applied

Management, 11ce
Question ID: 7-126

Question Type: MC
Question: Colleen's brother feels that the car is worth repairing because he has owned
several cars made by the same manufacturer, and he has driven this particular car for
several years. He also points out that he has invested hundreds of dollars in maintenance
and repairs over the years, so it is obviously worth investing in new repairs to keep it
running. Colleen's brother appears to be basing his decision on __________ but may also
be making an error known as __________.
A) intuition; confirmation bias
B) escalation of commitment; hindsight bias
C) satisficing; hindsight bias
D) framing bias; overconfidence bias
E) intuition; sunk costs error
Answer: E
Diff: 3 Page Ref: 169, 178
Skill: Applied
biases.
Types of Problems and Decisions (Scenario)
It seems Dave spends most of his day making decisions. Every time he turns around,
someone wants him to make a decision about something. This morning, the office
assistant came in and asked if she could reorder paper for the fax machine. That seemed
like a routine decision that he should not have to deal with. If Dave could avoid those
types of decisions, then he could focus more time and attention on the more complicated
issues, such as the one presented to him by the production supervisor this afternoon.
According to the supervisor, a major piece of equipment urgently needs repairs, and the
repair bill could cost almost as much as a new machine!
Question ID: 7-127

Question Type: MC
Question: The problem of whether to order more fax paper is __________.
A) programmed
B) nonprogrammed
C) structured
D) unstructured
E) technical
Answer: C
Skill: Applied

Management, 11ce
Question ID: 7-128

Question Type: MC
Question: The problem of whether to repair a piece of equipment or to purchase a new
machine is an example of a(n) __________ problem.
A) programmed
B) nonprogrammed
C) structured
D) unstructured
E) technical
Answer: D
Skill: Applied
Question ID: 7-129

Question Type: MC
Question: Dave tells his office assistant that in future, she is authorized to order 10 boxes
of fax paper whenever they are down to their last box. To handle this problem, Dave has
used a type of decision called a __________.
A) heuristic
B) policy
C) rule
D) procedure
E) criterion
Answer: C
Skill: Applied
Question ID: 7-130

Question Type: MC
Question: The decision about how to handle the equipment repair or replacement is
__________.
A) programmed
B) nonprogrammed
C) structured
D) unstructured
E) technical
Answer: B
Skill: Applied

Management, 11ce
Question ID: 7-131

Question Type: MC
Question: Dave believes he should be spending more time making __________ decisions
and less time making __________ decisions.
A) nonprogrammed; programmed
B) programmed; technical
C) technical; unstructured
D) unstructured; structured
E) programmed; nonprogrammed
Answer: A
Skill: Applied
Decision-Making Conditions: Keep on Truckin' (Scenario)
Fiona Lui is general manager of Westcoast Trucks, a medium-sized hauling service

located in Vancouver, B.C. She is responsible for scheduling trucks, initiating new
routes, and staffing both existing and new routes. She is currently struggling to find more
information about the profitability of existing and future truck routes.
Question ID: 7-132

Question Type: MC
Question: Willy, Fiona's best driver, estimates that there is a 75 percent probability that
they can get the business of Northern Timbers Forest Products if they initiate a truck
route through the remote areas of northern B.C. Willy is operating under a condition of
__________.
A) certainty
B) risk
C) uncertainty
D) maximax
E) maximin
Answer: B
Skill: Applied

Management, 11ce
Question ID: 7-133

Question Type: MC
Question: Fiona can make accurate decisions if she is willing to pay $5,000 for research
about the profitability of various truck routes. If she pays for the research, she believes
that she will be operating under a condition of __________.
A) certainty
B) risk
C) uncertainty
D) maximax
E) maximin
Answer: A
Skill: Applied
Question ID: 7-134

Question Type: MC
Question: Fiona knows that she is operating in an uncertain environment, but she is an
optimist and will most likely follow a __________ strategy.
A) multimax
B) minimin
C) minimax
D) maximax
E) maximin
Answer: D
Skill: Applied
Question ID: 7-135

Question Type: MC
Question: Sylvia, Fiona's scheduling assistant, is pessimistic about the company's ability
to earn a profit from the proposed new truck route. Sylvia will most likely follow a
__________ strategy.
A) multimax
B) minimin
C) minimax
D) maximax
E) maximin
Answer: E
Skill: Applied

Management, 11ce
Question ID: 7-136

Question Type: MC
Question: If Fiona wishes to minimize her regret about the truck route decision, she
should follow a __________ strategy.
A) multimax
B) minimin
C) minimax
D) maximax
E) maximin
Answer: C
Skill: Applied
Decision-making Biases (Scenario)
Frank is president of Mega Manufacturing, a Canadian company that makes automobile

parts. Sales and profits are down sharply this quarter, and Frank needs to analyze the
series of events that have led to the poor performance. Frank begins by reviewing his
recent interactions with Mike, the vice-president of sales.
Question ID: 7-137

Question Type: MC
Question: Last week when Frank asked Mike how his presentation to a large Japanese car
maker went, Mike replied, "My presentation was brilliant! They loved me! I am positive
we will get the contract!" Mike's overly positive view of his performance demonstrates
which of the following?
B) hindsight bias
D) sunk costs error
Answer: C
Skill: Applied
biases.

Another random document with
no related content on Scribd:
mistake in the formation of a diagnosis. There are, nevertheless,
some pathological conditions, such as hemorrhages in the medulla
oblongata or thrombosis and embolism of the arteries supplying the
latter with blood, which may give rise to the same or very similar
phenomena, and thus render a correct diagnosis difficult. In such
cases it must be remembered that the cause of true labio-glosso-
laryngeal paralysis, depending upon degeneration and atrophy of the
nervous nuclei along the floor of the fourth ventricle, is very gradual,
while the symptoms produced by the causes before mentioned
generally make their appearance in a more acute and sudden
manner. The latter also, if not remaining stationary for some time,
have rather a tendency to improvement, wanting, therefore, the
progressive character of the former.
Tumors at the base of the brain also, by pressing upon the roots of
the cerebral nerves or upon the medulla oblongata itself, may
produce similar symptoms, which, on account of their comparatively
slow and gradual development, may prove more difficult to
distinguish from those characterizing genuine, progressive labio-
glosso-laryngeal paralysis. Errors of diagnosis, however, may here
be avoided by taking into consideration the special symptoms which
generally accompany the presence of tumors of the brain, such as
vertigo, headache, vomiting or even hemiplegia, and local paralysis.
The sensory nerves also may become affected by the pressure of
the tumor upon them. Thus, pressure upon the trifacial nerve may
give rise to neuralgic pains, feelings of tingling and numbness, or
even anæsthesia; while pressure upon the optic nerves or their
tracts, or upon the olfactory and lingual nerves, will be followed by
derangements of vision, smell, and taste. The symptoms produced
by the pressure of a tumor at the base of the brain, moreover, are
not strictly progressive, but may for some time appear, and
disappear again before becoming permanent.
Facial diplegia, in which the expression of the face somewhat

resembles that of a patient affected with labio-glosso-laryngeal
paralysis, is distinguished from the latter disease by the paralysis
affecting both divisions of the facial nerve, while the tongue remains
free and deglutition is undisturbed.
There are still other affections of the cerebro-spinal axis, such as

paralysis of the insane, disseminated sclerosis, etc., which in their
course present some or perhaps all of the symptoms characterizing
labio-glosso-laryngeal paralysis; these may be distinguished from
the latter disease by taking their own special symptoms into
consideration.
TREATMENT.—Although almost all cases of progressive labio-glosso-

laryngeal paralysis terminate fatally, some cases have been reported
by several observers in which a temporary improvement in the
symptoms of the disease, or even a total cure, had been obtained by
treatment. Of course such favorable results can only be obtained in
the initial or earlier stages of the disease. Thus, Kussmaul
recommends in the initial stage, when pains in the head and neck
are present, wet cupping of the nape of the neck in strong persons,
also the use of the shower-bath, while nitrate of silver may be given
internally. The application of galvanism in an alternate direction he
also recommends—first, through the neck, and later on through the
whole spinal column—and at the same time currents in an
alternating direction from the neck and hypoglossus nerve to the
tongue. Dowse reported a case of bulbar paralysis which he cured
by the application of the constant current upon the paralyzed parts,
subcutaneous injections of atropine and strychnine, with the internal
administration of cod-liver oil, quinine, and phosphorus. He attaches
great importance to the careful feeding of the patient through a tube
passed through the nose, and to the strict application of the galvanic
current; for excessive salivation he recommends atropine. Erb
recommends to regulate the diet and the habits of life of the patient
in such a manner as to avoid every irritation of the nervous system;
furthermore, to generally stimulate the nutrition in order to produce a
tonic effect upon the nervous system. For this purpose he principally
relies upon a cautious hydropathic treatment, to be continued for a
long time and with great regularity. The greatest importance,
however, he attaches to electricity, considering the best method of
galvanism as follows: “Galvanize with stabile application transversely
through the mastoid processes and longitudinally through the skull,
the so-called galvanism of the cervical sympathetic (anode on the
nuchus, and cathode at the angle of the lower jaw), and then induce
movements of deglutition (twelve to twenty at each sitting); besides
this, apply, according to circumstances, direct galvanic or faradic
currents to the tongue, lips, and palate.” The electric treatment must
be continued for some time, with from four to seven sittings a week.
Of the medicines taken internally, Erb recommends nitrate of silver,
iodide of potassium, iodide of iron, chloride of gold and sodium,
ergotin, belladonna, and preparation of iron and quinine.
DISEASES OF THE PERIPHERAL NERVES.
BY FRANCIS T. MILES, M.D.
The nervous system of the higher animals is the apparatus by which

stimuli coming from the external world or originating in the interior of
their own bodies are perceived (its sensitive functions), or cause
muscular contraction (its motor functions), or, lastly, cause molecular
changes in tissues (its trophic functions).
Besides this power which the nervous system possesses of
receiving impressions originating outside of itself and actively
replying to them, it appears also to possess the power of originating
within itself changes the result of which are sensations, movements,
and trophic alterations. In other words, it can act automatically.
The apparatus for the performance of these various functions

consists of the end-organs, the nervous centres, and the nerves.
The end-organs are peripheral mechanisms for the reception of

impressions. The structure and mode of action of some of them, as
the eye and the ear, are pretty well understood, while others, as
those connected with the sense of touch, temperature, etc., are but
imperfectly known. It is probable that there are also peripheral
mechanisms which facilitate the delivery of the impulses coming
from the nerve-centres to the organs, tissues, muscles, glands, etc.
The nervous centres are made up of nerve-cells variously connected

with each other. They are immediately concerned in receiving
impressions conveyed to them by the nerves and transforming them
into sensations, or transmitting them to other organs, causing reflex
actions, or in originating sensations and impulses.
The nerves are organs which, connected at one extremity with the
end-organs and at the other with the nervous centres, convey
peripheral impressions to the centres, and impulses and influences
from the centres to the various organs of the body.
As it is with diseases of the peripheral nerves that we are now

concerned, let us begin by looking more closely into their structure
and functions.
The nerves appear to the naked eye as white strands of variable

size, which a close inspection shows to be made up of threads or
fibrils (best seen when the cut end of a nerve is examined) bound
together by fine connective tissue and scantily supplied with blood-
vessels. A microscopic examination shows that each of the fibrils
visible to the naked eye is made up of a great number of fibres.
These are the medullated nerve-fibres, and they extend unbroken
between the nerve-centres, with the cells of which they are
connected, to the various organs and tissues, with which they also
enter into organic union.
If we examine the structure of a medullated nerve-fibre, we find it to

consist of a central thread called the central axis or axis-cylinder, in
which close microscopic investigation shows a longitudinal striation,
indicating that it is made up of fibrillæ. Surrounding the central axis
like a sheath is the white substance of Schwann, composed of an
oleo-albuminous substance, myeline, to which the nerves owe their
white appearance. According to some observers, the white
substance of Schwann is pervaded by a meshwork of fibres.
Surrounding the white substance of Schwann is the sheath of
Schwann, a structureless membrane having at intervals upon its
inner surface nuclei, around which is a small amount of protoplasm.
At intervals along the course of the nerve-fibres are seen

constrictions which involve the sheath and white substance of
Schwann, but which do not affect the central axis, which passes
unbroken the points of constriction. These are the nodes of Ranvier.
Each space on the fibre beneath the nodes of Ranvier contains one
of the nuclei of the sheath of Schwann, and probably, together with
the white substance of Schwann, represents a cellular element.
Diseased conditions sometimes respect the limits of these cellular
elements.
The central axis is the true conducting part of the nerve-fibre, and it
is probable that each of the fibrillæ of which it is composed has a
separate peripheral termination and possesses the power of isolated
conduction. The white substance of Schwann and the sheath of
Schwann protect the central axis and seem to be connected with its
nutrition.
The fibres in a nerve are bound together by loose connective tissue,

the endoneurium, into the primitive bundles, which are again united
by the perineurium, a membrane of laminated connective tissue, into
more definite funiculi seen by the naked eye, the secondary bundles.
The secondary bundles are tied together by connective tissue, in
which are found fat-cells and in which run the fine blood-vessels
supplying the nerves. This connective tissue has been named the
epineurium, and its condensed outer layers constitute the sheath of
the nerve. It is important to observe that the connective tissue of the
nerves is permeated by lymphatics which penetrate to the nerve-
fibres, so that these are brought in contact with, and as it were,
bathed in, the lymph.
Each nerve-fibre runs an isolated course from end to end, without

anastomosing with other fibres, and near its peripheral termination it
usually divides into two or more branches.
The fibres of the peripheral nerves depend for their integrity and
nutrition upon their connection with central organs. The large
multipolar cells of the anterior horns of gray matter of the spinal cord
preside over the nutrition of the motor fibres; the ganglia on the
posterior roots of the spinal nerves over the nutrition of the sensitive
fibres.
If a nerve be severed from its connection with these centres of

nutrition, it in a short while undergoes degenerative changes which
result in complete destruction of its fibres.
The nerve-fibres when in a state of functional activity conduct

impressions along their length to the end-organs or to the nerve-
centres with which they are in connection. This property of the fibres
we call their conductivity. Each fibre conducts impressions in an
isolated manner, not communicating them to other fibres with which
it may be in contact. The rapidity of this conduction in human nerve-
fibres is estimated at 33.9 meters (about 38 yds.) per second. This
rate may be diminished by cold or by the anelectrotonic condition
which is induced in the nerve by the passage through it of an electric
current.
The nerve-fibres are irritable; that is, the application to them of

stimuli excites their functional activity, and the impression made by
the stimulus is transmitted to their extremities.1
1 The nerve-fibres in man do not appear to attain their full irritability until the fifth or
tenth month after birth (Soltman).
The natural or physiological stimuli of the nerves act upon their

extremities. Either they act through the peripheral mechanisms,
giving rise to impressions which are conducted centripetally to the
cells of the nerve-centres and there cause sensations or reflex
actions, or they act upon the nerve-centres, giving rise to impulses
which are conducted centrifugally and cause the various phenomena
of contraction of muscles, inhibition of contraction, secretion, etc.
Besides the physiological, there are other stimuli which excite the
functional activity of nerve-fibres when applied at any point along
their course.
Mechanical stimuli, blows, concussions, pressure, traction, etc.,

excite the nerves, causing sensations when applied to sensitive
nerves, or contraction of muscles when applied to motor nerves.
When mechanical stimuli are pushed farther, the irritability of the
nerves may be destroyed. The gradual application of mechanical
stimuli may destroy the irritability of nerve-fibres without any
exhibition of excitation, as in paralysis from pressure. In nerve-
stretching it is probable that many of the results depend upon the
mechanical stimulation of the nerve-fibres by the traction. With a
certain amount of force used the irritability of the nerve may be
increased; carried farther, both the irritability and the conductivity
may be diminished, and finally destroyed. As the centripetal fibres
are soonest affected in the stretching, we can see how this
proceeding is most beneficial in neuralgias, where a potent factor, if
not the cause of the disease, is an abnormal excitability of the nerve-
fibres. It is to be observed, nevertheless, that in cases of continued
pressure upon mixed nerves the motor fibres are the first to suffer
loss of their conductivity.
Sudden alterations of temperature act as stimuli to nerves. Heat

increases their irritability, but its prolonged application diminishes it.
Cold in general diminishes the nervous irritability, and may be carried
to the point of completely destroying it temporarily.2
2 But at a certain age in freezing the ulnar nerve Mitchell found its irritability notably
increased.
Many substances of widely-different chemical constitution, as acids,

alkalies, salts, alcohol, chloroform, strychnine, etc., act as stimuli
when applied directly to the nerves, apparently by causing in them
rapid molecular changes. Also may be enumerated as chemical
stimuli to the nerves substances found naturally in the body, as bile,
bile salts, urea. The rapid withdrawal of water from nerve-tissue first
increases, and then diminishes, its irritability. The imbibition of water
decreases nervous irritability.
An electric current of less duration than the 0.0015 of a second does

not stimulate the nerve-fibres. It would appear that more time is
required for the electric current to excite in nerve-tissue the state of
electrotonus which is necessary to the exhibition of its functional
activity. The electric current stimulates a nerve most powerfully at the
moments of entrance into and exit from the nerve, and the more
abruptly this takes place the greater the stimulation. Thus the weak
interrupted currents of the faradic or induced electricity owe their
powerfully stimulating effects to the abruptness of their generation
and entrance into and exit from the nerves. At the moment of the
entrance of the electric current into the nerve—that is, upon closing
the circuit—the stimulating effect is at the negative pole or cathode;
when the current is broken—i.e. leaves the nerve—the stimulating
effect is at the positive pole or anode. A current of electricity very
gradually introduced into or withdrawn from a nerve does not
stimulate it. But if while a current is passing through a nerve its
density or strength be increased or diminished with some degree of
rapidity, the nerve is stimulated, and the degree of stimulation is in
proportion to the suddenness and amount of change in the density or
strength of the current. Although with moderate currents the
stimulation of the nerve takes place only upon their entrance and
exit, or upon variations of their density, nevertheless, with a very
strong current the stimulation continues during the passage of the
current through the nerve. This is shown by the pain elicited in
sensitive nerves, and the tetanic contraction of the muscles to which
motor nerves are distributed.
An important factor in electrical stimulation is the direction of the

current through the nerve. A current passed through a nerve at right
angles with its length does not stimulate it. Currents passing through
a nerve stimulate in proportion to the obliquity of their direction, the
most stimulating being those passing along the length of the nerve.
Motor nerves are more readily stimulated by the electric current the
nearer it is applied to their central connection. Experiments on the
lower animals would seem to indicate that the motor fibres in a
nerve-trunk do not all show the same degree of irritability when
stimulated by the electric current.
The irritability of the nerve-fibres may be modified or destroyed in

various ways. Separation of nerves from their nutritive centres
causes at first an increase of their irritability, which is succeeded by a
diminution and total loss, these effects taking place more rapidly in
the portions nearer the nerve-centres. It is important to observe that
an increase of irritability preceding its diminution is generally
observed in connection with the impaired nutrition of nerves, and is
the first phase of their exhaustion.
Prolonged and excessive activity or disuse of nerves causes

diminution of their irritability, which may go to the extent that neither
rest in the one case nor stimulation in the other can restore it. If a
galvanic current is passed through a nerve in its length, the irritability
of the fibres is increased in the region of catelectrotonus—viz. in the
part near the cathode—and diminished in the region of
anelectrotonus—viz. in the part near the anode. Certain substances,
as veratria, first increase and then destroy the irritability of the
nerves; others, as woorara, rapidly destroy it.
The fibres of the peripheral nerves are divided into two classes: first,
those which conduct impressions or stimuli to the nerve-centres, the
afferent or centripetal fibres; and, secondly, those which conduct
impulses from the centres to peripheral organs, the efferent or
centrifugal fibres. Belonging to the first class are (1) sensitive fibres,
whose stimulation sets up changes in the nerve-centres which give
rise to a sensation; (2) excito-motor fibres, whose stimulation sets up
in the nerve-centres changes by which impulses are sent along
certain of the centrifugal fibres to peripheral end-organs, causing
muscular contraction, secretion, etc. Belonging to the second class
are (1) motor fibres, through which impulses are sent from the nerve-
centres to muscles, causing their contraction; (2) secretory fibres,
through which impulses from nerve-centres stimulate glands to
secretion; (3) trophic fibres, through which are conveyed influences
from the centres, affecting the nutritive changes in the tissues; (4)
inhibitory fibres, through which central influences diminish or arrest
muscular contraction or glandular activity. No microscopic or other
examination reveals any distinction between these various fibres.
Every nerve-fibre has the power of conducting both centripetally and

centrifugally, but the organs with which they are connected at their
extremities permit the exhibition of their conductivity only in one
direction. Thus, if a nerve-fibre in connection with a muscle at one
end and a motor nerve-cell at the other be stimulated, although the
stimulus is conducted to both ends of the fibre, the effect of the
stimulus can only be exhibited at the end in connection with the
muscle, causing the muscle to contract. Or if a fibre in connection
with a peripheral organ of touch be stimulated, we can only
recognize the effects of such stimulation by changes in the nerve-
cells at its central end which give rise to a sensation.
When we consider the extensive distribution and exposed position of

the peripheral nerves, their liability to mechanical injury and to the
vicissitudes of heat and cold, we cannot but anticipate that they will
be the frequent seat of lesions and morbid disturbances. It may be
that not a few of their diseased conditions have escaped observation
from a too exclusive looking to the central nervous system as the
starting-point of morbid nervous symptoms. This occurs the more
readily as many of the symptoms of disease of the peripheral nerves,
as paralysis of muscles, anæsthesia, hyperæsthesia, etc., may
equally result from morbid conditions of the brain or spinal cord, and
not unfrequently the peripheral and central systems are conjointly
affected in a way which leaves it doubtful in which the disease began
or whether both systems were simultaneously affected.
The elucidation of such cases involves some of the most difficult

problems in diagnosis, and requires not only a thorough
acquaintance with the normal functions of the peripheral nerves, but
also the knowledge of how those functions are modified and
distorted in disease.
The symptoms arising from injuries and diseases of the peripheral

nerves are referable to a loss, exaggeration, or perversion of their
functions, and we often see several of these results combined in a
single disease or as the result of an injury.
The fibres may lose their conductivity or have it impaired, causing

feebleness or loss of motion (paralysis), or diminution or loss of
sensation (anæsthesia). Or there may be induced a condition of
over-excitability, giving rise to spasm of muscles and sensations of
pain upon the slightest excitation, not only from external agents, but
from the subtler stimulation of molecular changes within themselves
(hyperæsthesia). Or diseased conditions may induce a state of
irritation of the nerve-fibres, which shows itself in apparently
spontaneous muscular contraction or in sensations abnormal in their
character, and not corresponding to those ordinarily elicited by the
particular excitation applied, as formication or tingling from simple
contact, etc. (paræsthesiæ), or in morbid alterations of nutrition in
the tissues to which the fibres are distributed (trophic changes).
If we could recognize the causes of all these varied symptoms and

discover the histological changes invariably connected with them, it
would enable us to separate and classify the diseases of the
peripheral nerves, and give us a sound basis for accurate
observation and rational therapeutics. But, although the progress of
investigation is continually toward the discovery of an anatomical
lesion for every functional aberration, we are still so far from a
complete pathological anatomy of the peripheral nerves that of many
of their diseases we know nothing but their clinical history. We are
therefore compelled in treating of the diseases of the peripheral
nerves to hold still to their classification into anatomical and
functional, as being most useful and convenient, remembering,
however, that the two classes merge into each other, so that a rigid
line cannot be drawn between them, and that such a classification
can only be considered as provisional, and for the purpose of more
clearly presenting symptoms which we group together, not as
entities, but as pictures of diseased conditions which may thus be
more readily observed and studied.
It is well to begin the study of the diseases of the peripheral nerves

by a consideration of nerve-injuries, because in such cases we are
enabled to connect the symptoms which present themselves with
known anatomical alterations, and thus obtain important data for the
elucidation of those cases of disease in which, although their
symptomatology is similar, their pathological anatomy is imperfectly
or not at all known.
Injuries of the Peripheral Nerves.
If the continuity of the fibres of a mixed nerve be destroyed at some

point in its course by cutting, bruising, pressure, traction, the
application of cold, the invasion of neighboring disease, etc., there
will be an immediate loss of the functions dependent on the nerve in
the parts to which it is distributed. The muscles which are supplied
by its motor fibres are paralyzed; they no longer respond by
contraction to the impulse of the will. No reflex movements can be
excited in them either from the skin or the tendons. They lose their
tonicity, which they derive from the spinal cord, and are relaxed, soft,
and flabby. As the interrupted sensory fibres can no longer convey
impressions to the brain, we might naturally look for an anæsthesia,
a paralysis of sensation, in the parts to which they are distributed, as
complete as is the loss of function in the muscles. Such, however, is
not the fact. Long ago cases were observed in which, although
sensitive nerves were divided, the region of their distribution retained
more or less sensation, or seemed to recover it so quickly that an
explanation was sought in a supposed rapid reunion of the cut fibres.
Recent investigations, moreover, show that in a large number of
cases where there is complete interruption of continuity in a mixed
nerve the region to which its sensitive fibres are distributed retains,
or rapidly regains, a certain amount of sensation, and that absolute
anæsthesia is confined to a comparatively small area, while around
this area there is a zone in which the sensations of pain, touch, and
heat are retained, though in a degree far below the normal condition;
in short, that there is not an accurate correspondence between the
area of anæsthesia consequent upon cutting a sensitive nerve and
the recognized anatomical distribution of its fibres. We find the
explanation of this partly in the abnormal distribution of nerves, but
principally in the fact of the frequent anastomoses of sensitive
nerves, especially toward their peripheral distribution, thus securing
for the parts to which the cut nerve is distributed a limited supply of
sensitive fibres from neighboring nerves which have joined the trunk
below the point of section. This seems proved not only by direct
anatomical investigation, but also from the fact that the peripheral
portion of the divided nerve may be sensitive upon pressure, and
that the microscope shows normal fibres in it after a time has
elapsed sufficiently long to allow all the divided fibres to degenerate,
in accordance with the Wallerian law. Some of the sensation
apparently retained in parts the sensitive nerve of which has been
divided may be due to the excitation of the nerves in the adjacent
uninjured parts, caused by the vibration or jar propagated to them by
the mechanical means used to test sensation, as tapping, rubbing,
stroking, etc.3 It is to be observed that this retained sensation after
the division of nerves exists in different degrees in different regions
of the body; thus it is greatest in the hands, least in the face.
3 Létiévant, Traité des Sections nerveuses.
As the vaso-motor and trophic nerve-fibres run in the trunks of the

cerebro-spinal nerves, destructive lesions of these trunks cut off the
influence of the centres with which those fibres are connected, and
hence they are followed by changes in the circulation, calorification,
and nutrition of the parts to which they are distributed. Thus, the loss
of the vaso-motor influence is at first shown in the dilation of the
vessels and the unvarying warmth and4 congestion of the part.5 This
gives way in time to coldness, due to sluggish circulation and
diminished nutritive activity. Marked trophic changes occur in the
paralyzed muscles. They atrophy, their fibres becoming smaller and
losing the striations, while the interstitial areolar tissues proliferates,
and finally contracts cicatricially. The skin is sometimes affected in its
nutrition, becoming rough and scaly. Other trophic changes of the
skin resembling those produced by irritation of a nerve are very
rarely seen, and they may probably be referred to irritation of fibres
with which the part is supplied from neighboring trunks.
4 A remarkable exception is seen, however, in the effect of gradual pressure
experimentally applied to nerve-trunks until there is complete interruption of sensation
and motion, in which case the temperature invariably falls.
5 In a case of gunshot wound that came under the writer's care in 1862, the leg and
foot, which were paralyzed from lesion of the popliteal nerve, remained warm and
natural in color during repeated malarial chills, which caused coldness and pallor of
the rest of the body.
Anatomical Changes in the Divided Nerve and Muscles.—The

peripheral portion of a divided nerve separated from its nutritive
centres degenerates and loses its characteristic appearance, looking
to the naked eye like a grayish cord, and being shrunken to one-
fourth of its natural size. The changes which take place in the
degeneration of the nerve-fibres, and which proceed from the point
of lesion toward the periphery, are, first, an alteration of the white
substance of Schwann, which breaks into fragments, these melting
into drops of myeline, and finally becoming reduced to a granular
mass. The central axis at a later period likewise breaks up, and is
lost in the granular contents of the sheath of Schwann. Meanwhile,
absorption of the débris of the fibres goes on, until, finally, there
remains but the empty and collapsed sheath of Schwann with its
nuclei, the whole presenting a fibrous appearance. When this has
taken place the degenerated motor nerve-fibres can no longer be
excited, and no stimulation applied to them can cause the muscles to
contract. At the same time, the muscles atrophy and undergo
degenerative changes in their tissue. The fibres become smaller and
their transverse striæ indistinct, with the appearance of fatty
degeneration, and finally there is proliferation of the interstitial
cellular tissue. They do not, however, lose their contractility, and
upon a mechanical stimulus being applied directly to them they
contract in a degree that is even exaggerated, but with a slowness
that is abnormal. If, now, we apply the stimulus of electricity to the
muscles themselves, we encounter phenomena of the greatest
interest and importance. The application of the faradic current,
however strong, elicits no contraction; there is loss of faradic
excitability. But if the galvanic current be applied the muscles
contract, and that, too, in reply to a current too weak to excite
healthy muscles to action; there is increased galvanic excitability.
The kind of contraction thus induced is peculiar, differing from that
ordinarily seen in muscles. Instead of its being short, and
immediately followed by relaxation, as when we make or break the
galvanic current in healthy muscles, it is sluggish, long-drawn out,
and almost peristaltic in appearance. This is characteristic of
degenerated muscles, and is the degenerative reaction. But there is
also a change in the manner in which the degenerated muscles reply
to the two poles of the galvanic current. Instead of the strongest
contraction being elicited, as in the normal condition, by the
application of the negative pole to the muscle (C. C. C., cathode
closing contraction), an equally strong or stronger is obtained by the
application of the positive pole (A. C. C., anode closing contraction),
while the contraction normally caused on opening the circuit by
removal of the positive pole (A. O. C., anode opening contraction)
becomes weaker and weaker, until it is at last exceeded by the
contraction upon opening the current by the removal of the negative
pole (C. O. C., cathode opening contractions). In short, the formula
for the reply of the healthy muscles to galvanic excitation is reversed;
there is a qualitative galvanic change in the paralyzed and
degenerated muscles.
If no regeneration of the nerve takes place, the reaction of the

muscles to the galvanic current is finally lost, and they exhibit those
rigid contractions which probably result from a sclerotic condition of
the intramuscular areolar tissue.
After complete destruction of the fibres of a nerve at some point of its

course, even when a considerable length of it is involved, and after
the consequent degeneration of the peripheral portion has taken
place, we have, with lapse of time, restoration of its function,
consequent upon its regeneration and the re-establishment of its
continuity. The histological changes by which the degenerated fibres
are restored and the divided ends reunited have not been made out
with such certainty as to preclude difference of opinion as to the
details. But the process in general seems to be a proliferation of the
nuclei in the sheath of Schwann, with increase of the protoplasm
which surrounds them, filling the sheath of Schwann with the
material from which the new fibre originates. In this mass within the
sheath is formed first the central axis of the new fibre, which is later
surrounded by the white substance of Schwann. With the
regeneration of the nerve-fibres the functions of the nerve return, but
in the order of sensation first, and afterward the power of transmitting
the volitional impulse to the muscles. Even after regeneration has so
far advanced that the muscles may be made to contract by an
exercise of the will, the newly-formed fibres fail to respond to other
stimuli; thus, the faradic current applied to the nerve does not cause
the muscles to contract; the stimulation is not transmitted along the
imperfectly restored fibres.
It may be here remarked that after regeneration has restored the

functions of a divided nerve the muscles to which it is distributed
may still exhibit for a time the degenerative reaction in consequence
of unrepaired changes in themselves. In the end we may look for
complete restoration in both nerve and muscles.
The time required for the regeneration and reunion of a divided

nerve depends somewhat upon the manner in which the destruction
has been caused. Thus, a nerve which has been divided by a clean
cut, and where the cut ends remain in apposition or close proximity,
unites much more readily than one in which bruising, tearing, or
pressure has destroyed an appreciable length of its fibres or the
divided ends have been thrust apart.
In complete division of a nerve we must not look for regeneration

and restoration of its functions, even in favorable circumstances,
before the lapse of several months, although cases have been
recorded where the process has been much more rapid.
Injuries of mixed nerves, with incomplete destruction of the fibres,

give rise to many and varied symptoms, some of which are the direct
result of the injury—many others of subsequent changes of an
inflammatory character (neuritis) in the nerves or in the parts to
which they are distributed. Pain is one of the most prominent
symptoms immediately resulting from nerve-injury, although as a rule
it soon subsides. There is sometimes merely numbness or tingling,
or there may be no disturbance of sensation at the moment of injury.
Rarely is spasm of muscles an immediate effect. Generally, motion is
at first very much impaired, but if the injury is not grave enough to
cause a lasting paralysis, the muscles may rapidly regain their
activity. In observing the effects of injuries of mixed nerves one
remarkable fact strikes us: it is the very much greater liability of the
motor fibres to suffer loss or impairment of function. Thus, it is
common to see sensation but little or only transiently affected by
injuries which cause marked paralysis of muscles. So in the progress
of recovery the sensory disturbances usually disappear long before
restoration of the motor function; indeed, sensation may be entirely
restored while the muscular paralysis remains permanent. Direct
experimental lesions of the mixed nerve-trunks of animals give the
same result.6 For this immunity of the sensitive nerve-fibres no
explanation can be given other than an assumed difference in their
inherent endowments.
6 Luderitz, Zeitschrift für klin. Med., 1881.
According to the amount of damage the nerve has sustained will

there remain after the immediate effects of the injury have passed off
more or less of the symptoms already described as due to loss of
conductivity in the fibres—viz. paralysis of motion, and anæsthesia.
Sometimes the impairment of conductivity in the sensitive fibres
shows itself by an appreciable time required for the reception of
impressions transmitted through them, giving rise to the remarkable
phenomenon of delayed sensation. Degeneration of the nerve
peripherally from the point of lesion, and consequently of the
muscles, will likewise take place in a greater or less degree,
according to the amount of the injury and the subsequent morbid
changes, and give rise to the degenerative reaction which has been
already described. We will not, however, always encounter the
degenerative reaction in the typical form which presents itself after
the complete division of nerves. Many variations from it have been
observed; as, for instance, Erb's middle form of degenerative
reaction, in which the nerve does not lose the power of replying to
the faradic or galvanic current, but the muscles show both the loss of
the faradic with increased galvanic excitability, with also the
qualitative change in regard to the poles of the galvanic current.
Such irregularities may be explained by the supposition of an
unequal condition of degeneration in the nerve and the muscles. A
rare modification has been recorded which has once come under the
writer's observation, in which the muscles reply with the sluggish
contraction characteristic of the degenerative reaction to the
application of the faradic current.
A highly important class of symptoms arise later in injuries of nerves,

due not so much to a loss as to an exaggeration or perversion of
their functions: they are the result of molecular changes in the
nerves, giving rise to the condition called irritation. Irritation of motor
nerves shows itself in muscular spasm, or contractions of a tonic or
clonic character, or in tremor. If the sensitive fibres are irritated by an
injury or the subsequent changes in the nerve resulting from it, we
may have hyperæsthesia of the skin, in which, although the sense of
touch may be blunted, the common sensation is exaggerated, it may
be, to such a degree that the slightest contact with the affected part
gives rise to pain or to an indescribable sensation of uneasiness
almost emotional in its character—something of the nature of the
sensation of the teeth being on edge. There may be hyperæsthesia
of the muscles, shown by a sensitiveness upon deep pressure, in
which the skin has no part. Pain, spontaneous in its character, is a
very constant result of nerve-irritation, whether caused by gross
mechanical interference or by the subtler processes of inflammation
in the nerve-tissue. It is generally felt in the distribution of the
branches of the nerve peripheral to the point of lesion, although it is
occasionally located at the seat of the injury. Neuralgias are a
common result of the irritation of nerves from injuries.
Causalgia, a burning pain, differing from neuralgia, and sometimes

of extreme severity, is very frequent after injuries of nerves,
especially in parts where the skin has undergone certain trophic
changes (glossy skin). A number of abnormal sensations
(paræsthesiæ) result from the irritation of sensitive fibres, and are
common after nerve injuries. Among these we may mention a
sensation of heat (not the burning pain of causalgia) in the region of
the distribution of the nerve, which does not coincide with the actual
temperature of the part; it occurs not unfrequently after injury to a
nerve-trunk, and may be of value in diagnosis.
The effect of irritative lesions of mixed nerves upon nutrition is very

marked, and sometimes gives rise to grave complications and
disastrous results. Any or all of the tissues of the part to which the
injured nerve is distributed may be the seat of morbid nutritive
changes.
In the skin we may have herpetic or eczematous eruptions or

ulcerations. It may become atrophied, thin, shining, and, as it were,
stretched tightly over the parts it covers, its low nutrition showing
itself in the readiness with which it ulcerates from trifling injuries. This
condition, called glossy skin, usually appears about the hands or
feet, and is very frequently associated with causalgia. The hair may
drop off, or, as has been occasionally seen, be increased in amount
and coarsened, and the nails become thickened, crumpled, and
distorted.
The subcutaneous cellulo-adipose tissue sometimes becomes

œdematous, sometimes atrophies, and rarely has been known to
become hypertrophied. The bones and joints, finally, may, under the
influence of nerve-irritation, undergo nutritive changes, terminating in
various deformities.
With regard to the trophic changes, as well as to the pain and

paræsthesiæ resulting from nerve-injury, we must bear in mind that
they may be attributed not only to the direct irritation of trophic and
sensitive fibres in the injured nerve, but also, in part, to influences
reflected from abnormally excited nutritive centres in the spinal cord,
and to the spread of the sensitive irritation conveyed to the brain by
the injured fibres to neighboring sensitive centres, thus multiplying
and exaggerating the effect, causing, as it were, sensitive echoes
and reverberations. Indeed, the variety of the symptoms resulting
from apparently similar nerve lesions would seem to point to the
introduction of other factors in their causation than the simple injuries
of the nerve-fibres themselves.
DIAGNOSIS OF NERVE INJURIES.—Although in the great majority of

cases the circumstances attending nerve injuries render their
diagnosis a matter of little difficulty, it is yet important to keep in mind
those symptoms which distinguish them from lesions or diseases of
the brain and spinal cord, inasmuch as in cases of multiple lesion,
injuries to the spinal column, or where the history of the case is
imperfect, it may be difficult to determine to which part of the nervous
system, peripheral or central, some of the gravest resulting troubles
are due. Paralysis, spasm, anæsthesia, atrophy, etc. may be of
central or spinal as well as peripheral origin, and an intelligent
prognosis and rational treatment alike demand that we should
distinguish between them. Moreover, many diseased conditions of
the peripheral nerves of whose pathology we are ignorant, and in
which localizing symptoms—i.e. those indicating the exact point at
which the nerve is implicated—are wanting, can only be
distinguished as peripheral affections by the occurrence of
symptoms which we recognize as identical with those arising from
injuries of nerves, in which definite histological changes are known to
occur. Indeed, cases of disease of the nervous system are not
infrequent in which a careful study of their symptomatology leads to
a difference of opinion in the minds of the best observers as to

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Robbins Test Bank

Chapter 7 Decision Making

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