Pathophysiology CNS CNS
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Quiz on first 50 slides of CNS pathophysiology
- 1.Leptomeningitis is an inflammatory process that is localized to the interfacing surfaces of the _______ and the _________, where ______ flows.
- A.
Dura, Pia, CSF
- B.
Arachnoid, Pia, Blood
- C.
Pia, Arachnoid, CSF
- D.
Dura, Arachnoid, CSF
- 2.Which of the following is TRUE about Pachymeningitis?
- A.
Inflammation of the Pia
- B.
Usually a consequence of traumatic brain injury.
- C.
The arachnoid acts as a barrier to infection.
- D.
The inflammation is restricted to the outer surface of the brain.
- 3.True or False: The vast majority of meningitis cases are caused by suppurative bacteria and the organsim relates to the sex of the patient.
- A.
True
- B.
False
- 4.Which of the following is not true of Bacterial Meningitis organisms and age?
- A.
E. Coli and Group B strep are most commonly found in neonates with bacterial meningitis
- B.
Group A strep and H. Pylori are most commonly found in adolescents with bacterial meningitis.
- C.
H. influenza is usually fuond in infants 3 months-3 years old with bacterial meningitis.
- D.
Strep pneumococcus is usually found in adults with bacterial meningitis.
- E.
N. meningitidis is usually found in military barracks when bacterial meningitis is going around.
- 5.What is the most difinitive diagnostic index of meningitis?
- A.
PMN's in the CSF
- B.
PMN's in the blood
- C.
RBC's in the CSF
- D.
Purulent discharge in the ears
- E.
Elevated white count
- 6.________ are the hallmark of meningitis caused by tuberculosis, viral meningitides, and chronic fungal infections (cryptococcal meningitis).
- A.
Macrophages
- B.
Lymphocytes
- C.
Eosinohpils
- D.
Monocytes
- 7.Grossly, the brain discloses an exudate of PMN's and fibrin which opacifies the _________, and giving a _______or _________ white appearance, usually over the convexities as well as the base of the brain.
- A.
Pia, creamy or white
- B.
Arachnoid, yellow or purulent
- C.
Arachnoid, creamy or white
- D.
Dura, Yellow or purulent
- E.
Arachnoid, grey or cloudy
- 8.True or False: H. influenza elicits a dense leukocytic exudate, which is rich in fibrin over the convexities and therefore creates a barrier to antibiotics.
- A.
True
- B.
False
- 9.True or false: Because the pia is so delicate, it is an ineffective barrier against the spread of infection and typically does not prevent spread to the underlying brain.
- A.
True
- B.
False
- 10.Which of the following is not a clinical manifestation of Bacterial Meningitis?
- A.
Head ache
- B.
Convulsions in adults
- C.
Fever
- D.
If untreated, coma and death
- E.
Vomiting
- 11.The classic signs of meningeal infection include all of the following EXCEPT:
- A.
Cervical rigidity
- B.
Kernig sign
- C.
Head retraction
- D.
Murphy's sign
- E.
Brudzinski sign
- 12.Which diseased is defined as a neurologic disorder characterized pathologically by the loss of neurons in the Substantia Nigra and clinically by tremors at rest, muscular rigidity, expressionless face, and emotional lability.
- A.
Bacterial Meningitis
- B.
Alzheimers Disease
- C.
Viral Meningitis
- D.
Multiple Sclerosis
- E.
Parkinsons Disease
- 13.Which of the following is NOT true of Parkinson's disease?
- A.
Most commonly occurs in white males
- B.
Typically effects those in the 6th-8th decade of their life.
- C.
Genetic factors do not play a role (except for a rare autosomal dominant disorder)
- D.
The vast majority of cases are idiopathic.
- E.
The disease has been recorded after viral encephalitis and after the intake of a toxic chemical (MPTP).
- 14.It has been suggested that Parkinsons disease is an acceleration of normal age related changes.The changes being referred to primarily have to do with the ___________ _______ which relays information to the _______ ________ through _________ synapses.
- A.
Brain stem, sympathetic chain, adrenergic
- B.
Cerebral cortex, cranial nerves, muscarinic
- C.
Substantia Nigra, basal ganglia, dopaminergic
- D.
Prefrontal cortex, afferent neurons, cholinergic
- E.
Medulla oblongota, efferent neurons, achetylcholinestergic
- 15.What type of infection resulting in injury (gross loss of pigmentation) to the substantia nigra occured during the infuenza pandemic of 1916-1920 which lead to the clinical expression of "postencephalitic parkinsonism."
- A.
Bacterial meningitis
- B.
Acute hepatitis
- C.
Cholelithiasis
- D.
Sinusitis
- E.
Von Economo Encephalitis
- 16.Microscopically, what are the changes seen in Parkinson's disease?
- A.
Loss of pigmentation in the substantia nigra
- B.
Residual atrophic nerve cells are seen known as "Hewey Bodies"
- C.
Pigmented neurons are scarce with small extracellular deposits of melanin, from necrotic neurons.
- D.
Loss of pigmentation in the Locus Ceruleus
- 17.
![The picture displays an atrophic nerve cells which contain what? - ProProfs]( "The picture displays an atrophic nerve cells which contain what?")
The picture displays an atrophic nerve cells which contain what?- A.
Rod-shaped, smooth, basophilic mitochondrial inclusions.
- B.
Spherical, granular, eosinophilic cytoplasmic inclusions.
- C.
Square, gritty, lymphocytic periplasmic inclusions.
- D.
Triangular, soft, macrolytic endoplasmic inclusions.
- 18.An 82 year old male patient comes in to see you with a mask-like face and is slighty drooling. The paitent presents with slow voluntary movements and a muscular rigidity throughout the entire range of motion with each movement. He has "pill-rolling" of the distal extremities that is present only at rest but goes away each time he voluntarily moves. What is at the top of your differentials?
- A.
Alzheimers Disease
- B.
Multiple Sclerosis
- C.
Stroke
- D.
Parkinson's Disease
- E.
Myesthenia Gravis
- 19.All of the following are clinical manifestations of Parkinson's disease EXCEPT:
- A.
Depression
- B.
Hypertonia
- C.
Hypotonia
- D.
Dimentia
- E.
Akinesia
- 20.True or false: In early parkinsonism, Levadopa is beneficial, however this therapy does not rectify the underlying disorder, and several years later, becomes ineffective.
- A.
True
- B.
False
- 21.Other causes of Parkinson-like symptoms include all of the following EXCEPT:
- A.
Spider bites (black widow, tunnel spider)
- B.
Drugs (Phenothiazines, Haldol)
- C.
Poison (Carbon monoxide, Manganese)
- D.
Hydrocephalus
- E.
Tumors (Near the basal ganglia)
- 22.This disease is known as an insidious and progressive neurologic disorder characterized by a loss of memory, cognitive impairment, and eventual dementia?
- A.
Parkinson's disease
- B.
Age-related psychosis
- C.
Alzheimers Disease
- D.
Multiple Sclerosis
- E.
Acute Hemorrhagic Meningitis
- 23.True or False: Alzheimers Disease is restricted to patients younger than 65 years of age and already diagnosed with presenile dimentia.
- A.
True
- B.
False
- 24.Which of the following is a feature of Alzheimers Disease?
- A.
Advances of our pathologic understanding of AD relate to alpha-protein amyloid deposition in senile plaques.
- B.
Plaques located in the spinal cord are linked to intelectual funciton and are a constant feature of AD
- C.
Beta protein amyloid is found in the walls of the cerebral vessels may be the origin of deposits found in the brain in AD.
- D.
The pathogenisis of AD is fully understood
- E.
World wide, AD is the least common cause of dementia in the elderly, accounting for less than half of all the cases.
- 25.Current advances in AD include the understanding of Neurofilbrillary tangles, which are paired _______ filaments. These filaments, consist of an abnormal form of a normally occuring ___________-____________ protein. When normal, the protein is responsible for proper _________ transport.
- A.
Pleated, macrotubule-associated, lipid
- B.
Helical, microtubule-associated, axonal
- C.
Round, cytoskeletal-associated, active
- D.
Helical, macrotubule-associated, lipid
- 26.
![Which of the following is NOT true of the gross Alzheimers brain? - ProProfs]( "Which of the following is NOT true of the gross Alzheimers brain?")
Which of the following is NOT true of the gross Alzheimers brain?- A.
Loss of neurons and neuritic processes
- B.
Narrow gyri
- C.
Widened sulci
- D.
Unilateral cortical atrophy
- E.
Atrophy in frontal, parietal, temporal, and hippocampal cortices.
- 27.True or False: The Alzheimers brain loses roughly 200 gms in an interval of 3-8 years.
- A.
True
- B.
False
- 28.What are discrete spherical masses of sliver-staining neuritic processes surrounding a central amyloid core?
- A.
Lewy Bodies
- B.
Neurofibrillary tangles
- C.
Signet ring cells
- D.
Hewey Bodies
- E.
Senile (neuritic) plaques
- 29.
![The following picture of microscopic AD plaques are most commonly found where? - ProProfs]( "The following picture of microscopic AD plaques are most commonly found where?")
The following picture of microscopic AD plaques are most commonly found where?- A.
Hyppocampus, amygdala, and cortex
- B.
Medulla, corpus colosum, hyppocampus
- C.
Cortex, brain stem, spinal cord
- D.
Frontal, temporal, parietal lobe
- 30.
![The above silver stain show bundles of paired, heliclal filaments in the cytoplasm of cortical neurons or hippocampal pyramidal cells that displace or encircle the nucleus (flame cells). These are known as: - ProProfs]( "The above silver stain show bundles of paired, heliclal filaments in the cytoplasm of cortical neurons or hippocampal pyramidal cells that displace or encircle the nucleus (flame cells). These are known as:")
The above silver stain show bundles of paired, heliclal filaments in the cytoplasm of cortical neurons or hippocampal pyramidal cells that displace or encircle the nucleus (flame cells). These are known as:- A.
Signet-ring cells
- B.
Senile plaques
- C.
Neurofibrillary tangles
- D.
Fire cells
- 31.
![The following picture shows what? Which type of stain? And where are they located? - ProProfs]( "The following picture shows what? Which type of stain? And where are they located?")
The following picture shows what? Which type of stain? And where are they located?- A.
Amyloid angiopathy, Congo red stain, spinal cord
- B.
Amyloid angiopathy, Congo red stain, cerebral blood vessels.
- C.
Neurofibrillary tangles, congo red stain, cerebral cortex
- D.
Senile plaque, Silver stain, cerebral blood vessels
- E.
Amyloid angiopathy, silver stain, cerebral blood vessels
- 32.The combination of clincal assessment and modern radiologic methods allow for acurate diagnosis in 80-90% of cases however, which of the following is necessary for a difinitive diagnosis.
- A.
Biopsy
- B.
Endoscopy
- C.
Pathologic examination of vessels in the brain
- D.
Pathologic examination of brain tissue
- 33.An 85 year old female patient gradual loss of memory, cognitive function, difficulty with language, and changes in behavior. What is the most likely diagnosis?
- A.
Multiple Sclerosis
- B.
Alzheimers Disease
- C.
Parkinson's Disease
- D.
Viral meningitis
- 34.True or False: Terminal bronchopneumonia is the usual cause of death in AD.
- A.
True
- B.
False
- 35.Which of the following is not true of Multiple Sclerosis?
- A.
A chronic demyelinating disease of the CNS
- B.
Characterized by numerous patches of demyelination througout the grey matter
- C.
It is the most common demyelinating disorder (prevelence 1 in 1000)
- D.
Disease effects both sensory and motor functions
- E.
Characterized by exacerbations and remissions over a period of years.
- 36.Risk factors for MS include all of the following EXCEPT:
- A.
Tropical climates
- B.
Most common in 40 year olds (uncommon before 14 and after 60 y.o.)
- C.
Women afflicted twice as often as men
- D.
Possibly other infectious, genetic, and infectious etiology
- 37.Which of the following is true of genetic and immune factors related to MS?
- A.
A familial aggregation of the disease with an increased risk in 1st degree relatives.
- B.
Dizygotic twins show a 25% concordance for MS (2% for monozygotic)
- C.
Immune factors related to perivascular lymphocytes and macrophages with numerous CD4+, CD8+, and t-cells
- D.
Direct evidence exists for the involvement of certain viruses including mumps, rubella, herpes, and measles.
- E.
JC virus has recently been studied, due to its role in preventing demyelination in the CNS.
- 38.Which of the following is NOT true of the "hallmark of the disease" in MS?
- A.
The plaque is the hallmark of the disease
- B.
Usually situated in the white matter, but occassionaly breech the gray-white junction
- C.
Exhibit a preference for the optic nerves and chiasm and uniformly localizes in to the periventricular white matter.
- D.
Can also involve the cerebellum, brainstem, and spinal cord.
- E.
Usually 2-4 mm in size with a jagged, irregular contour
- 39.All of the following are true about MS, EXCEPT:
- A.
Histologically, there is a selective loss of myelin in a region of axonal preservation.
- B.
Perivascular inflammation lymophocytes and macrophages with focal edema.
- C.
Astrocytes traverse the aging plaque and the tissue becomes dense with glial processes.
- D.
As the plaque ages, it becomes less discrete and the edema progresses.
- 40.True or false: Some patients with MS exhibit a relentless course without any exacerbations or remissions.
- A.
True
- B.
False
- 41.
![The following picture shows what characteristic hallmark of MS? - ProProfs]( "The following picture shows what characteristic hallmark of MS?")
The following picture shows what characteristic hallmark of MS?- A.
Plaques
- B.
Shrinking sulki
- C.
Widened gyri
- D.
Thunder bolts
- 42.Your 37 year old patient presents with blurred vision and vertigo. Due to a history of exacerbations and remissions you begin to suspect MS. Upon radiographic studies, where do you expect to find the initial lesion?
- A.
Optic nerves
- B.
Brain Stem
- C.
Prefrontal cortex
- D.
Spinal cord
- E.
Basal ganglia
- 43.You're 37 year old patient presents with blurred vision and loss of vision altogether in one eye. Based on the patients age and her description of exacerbations and remissions, you begin to suspect:
- A.
Alzheimers Disease
- B.
Viral Meningitis
- C.
Bacterial Meningitis
- D.
Multiple Sclerosis
- E.
Myesthenia Gravis
- 44.Your 42 year old patient presents with weakness in both legs and numbness of lower extremities that bothers them intensely for 6-7 weeks and then subsides. This is the 3rd time they have been to your office because the symptoms keep coming back. You are beginning to suspect MS and expect to find what after radiologic testing?
- A.
A lesion at the optic nerve
- B.
A plaque in the brain stem
- C.
A plaque within the spinal cord
- D.
A lesion at the substantia nigra
- E.
A plaque within the basal ganglia
- 45.The degree of functional impairment with MS is variable, ranging from minor disability to severe incapacity. The range of symptoms include all of the following, EXCEPT:
- A.
Widespread paralysis
- B.
Severe nausea and vomiting
- C.
Dysarthria
- D.
Severe visual defects
- E.
Incontincence and dementia
- 46.True or false: In MS, patients usually die of respiratory paralysis or UTI's in terminal coma 10-15 years after the onset of symptoms.
- A.
True
- B.
False
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