Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 20: Alterations of Neurologic Function in ChildrenMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. The neural groove closes dorsally during which week of gestational life?a. Secondb. Fourthc. Eighthd. TwelfthANS: BDuring the fourth week of gestation, the neural groove deepens, its folds develop laterally, and it closes dorsally to form the neural tube, epithelial tissue that ultimately becomes the central nervous system (CNS). The second week is too early, and the other options represent times periods after the groove closes.PTS: 1 DIF: Cognitive Level: Remembering 2. A healthcare professional advises a pregnant woman to add supplements of which nutrient to her diet to prevent birth defects?a. Ironb. Vitamin Cc. Zincd. FolateANS: DMaternal folate deficiency is associated with neural tube defects such as meningocele. All the listed substances are part of a healthy diet, but only folate is associated with a specific birth defect.PTS: 1 DIF: Cognitive Level: Remembering 3. Which defect of neural tube closure is most common?a. Anteriorb. Posteriorc. Laterald. MidlineANS: BPosterior defects are most common.PTS: 1 DIF: Cognitive Level: Remembering 4. What is the anomaly in which the soft bony component of the skull and much of the brain is missing?a. Anencephalyb. Myelodysplasiac. Cranial meningoceled. HydrocephalyANS: AAnencephaly is an anomaly in which the soft, bony component of the skull and much of the brain are missing. Myelodysplasia is a defect in the formation of the spinal cord. Meningocele is a saclike cyst of meninges filled with spinal fluid and is a mild form of spina bifida. Hydrocephalus is a common cause of accelerating head growth and macrocephaly. Increased intracranial pressure results in enlargement of the cerebrospinal fluid (CSF) compartment (ventricles).PTS: 1 DIF: Cognitive Level: Remembering 5. What is the most common cause of obstructive hydrocephalus in infants?a. Obstructed arachnoid villib. Stenosis of the aqueduct of Sylviusc. Excessive production of cerebrospinal fluidd. Impaired cerebrospinal fluid circulation in the subarachnoid spaceANS: BCongenital aqueduct stenosis most commonly causes obstructive hydrocephalus. The other options do not represent the most common cause of this condition.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. A student reads in a chart that a baby was born with an encephalocele. The student asks the healthcare professional to explain this condition. What explanation by the healthcare professional is best?a. A herniation or protrusion of brain and meninges through a defect in the skullb. A protruding saclike cyst of meninges filled with spinal fluid and is a mild form of spina bifidac. Protrusion of a saclike cyst containing meninges, spinal fluid, and a portion of the spinal cord through a defect in the posterior arch of a vertebrad. Premature closure of one or more of the cranial sutures during the first 18 to 20 months of an infant’s lifeANS: AEncephalocele refers to a herniation or protrusion of brain and meninges through a defect in the skull, resulting in a saclike structure. A meningocele is a saclike cyst of meninges filled with spinal fluid. A myelomeningocele contains meninges, spinal fluid, and a portion of the spinal cord with nerves. Craniosynostosis causes malformations due to premature closure of sutures.PTS: 1 DIF: Cognitive Level: Understanding 7. What is the result of a Chiari type II malformation associated with a myelomeningocele?a. Upward displacement of the cerebellum into the diencephalonb. Motor and sensory lesions below the level of the myelomeningocelec. Downward displacement of the cerebellum, brainstem, and fourth ventricled. Generalized cerebral edema and hydrocephalusANS: COne serious, potentially life-threatening problem associated with myelomeningocele is the Chiari type II malformation. This deformity involves the downward displacement of the cerebellum, cerebellar tonsils, brainstem, and fourth ventricle. The other options do not appropriately describe the pathologic characteristics resulting from a Chiari type II malformation.PTS: 1 DIF: Cognitive Level: Remembering 8. A baby is born with a myelomeningocele and needs urgent surgery to repair the defect. The parents want to take the baby home instead. What does the healthcare professional tell the parents about the purpose of this surgery?a. “Surgery is much easier on a tiny infant than on a larger, older baby.”b. “If your baby has surgery this young, he/she cannot feel pain.”c. “Additional nervous system damage will occur the longer we wait.”d. “Prompt surgery is needed to prevent total paralysis later on.”ANS: CUntil the myelomeningocele is surgically closed, cerebrospinal fluid (CSF) may accumulate, resulting in further dilation and enlargement of the sac, which may risk more damage to the nervous system. The surgery may or may not be easier on a smaller infant, but that is not the rationale for having surgery as soon as possible. Pain can be felt by newborns. A child with a myelomeningocele will have motor, sensory, reflex, and autonomic function below the level of the lesion and will not have total paralysis.PTS: 1 DIF: Cognitive Level: Understanding 9. A baby demonstrates asymmetric pathological reflexes and microcephaly at a 9-month checkup. The baby appeared normal at birth. What action by the healthcare professional is best?a. Determine the baby’s risk for developing an HIV infection since birth.b. Assess the baby for other signs of child abuse or neglect.c. Ask the mother if she uses drugs or alcohol in excess.d. Perform spinal cord imaging and other diagnostic studies.ANS: AA particularly vulnerable site of HIV-1 infection in infants and children is the CNS. This baby demonstrates manifestations of HIV infection, which include failure to attain or loss of previously developed milestones or intellectual functioning, impaired brain growth or acquired microcephaly, and acquired symmetric motor deficits manifested by two or more of these: paresis, pathologic reflexes, ataxia, or gait disturbances. The healthcare professional should assess the baby for his or her risks of contracting HIV infection. Part of the assessment would include the mother’s drug history, but many other factors must be considered. Since
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