NR-283 Pathophysiology - Set 5 - Part 3

Correct Answer: Falling eye and motor scores signal neurologic decline

The scale scores eye opening, verbal response and best motor response, and the total tracks arousal. A drop from command following to withdrawal from pain marks real deterioration, and the motor component carries the most prognostic weight. Option a is incorrect because orientation is only part of the verbal component. Memory and judgement are never scored, and the tool exists to grade arousal and responsiveness quickly at the bedside rather than to test cognition. Option b is incorrect because sleep does not abolish command following. A sleeping client rouses to voice and obeys once awake, so a slide toward pain only responses after head injury must be treated as deterioration. Option d is incorrect because the motor score, not the verbal one, is the single most useful predictor. Verbal scoring is also unobtainable in an intubated client, which is why it is recorded with a notation instead.

Correct Answer: Ankylosing spondylitis with sacroiliac and enthesis inflammation

Inflammatory back pain improves with activity and worsens with rest, the reverse of mechanical pain. Inflammation at the sacroiliac joints and entheses stiffens the spine and costovertebral joints, which limits chest expansion. Option a is incorrect because a pulled back muscle hurts more with movement and settles with rest, the opposite pattern. It also resolves within weeks and never restricts rib cage expansion. Option c is incorrect because facet joint degeneration appears in older adults, worsens through the day with loading, and brings only brief stiffness. Reduced chest expansion is not part of that degenerative pattern. Option d is incorrect because a collapsed vertebra produces sudden severe pain in an older person with thin bone, often after a minor fall. Months of gradual stiffness in a young man does not fit.

Correct Answer: Bleeding into brain tissue from a small artery

Chronic hypertension weakens small penetrating arteries until one ruptures into the parenchyma. The growing clot deforms and compresses nearby tissue, driving edema and pressure upward, so deficits worsen steadily rather than peaking at onset. Option a is incorrect because an arteriovenous malformation is a congenital knot of arteries feeding veins with no capillary bed between. It typically bleeds or seizes in a much younger client without long standing hypertension. Option b is incorrect because a traveling clot produces deficits that are worst the instant it lands. Headache and vomiting with steady decline over hours instead signal an expanding mass of blood. Option d is incorrect because that mechanism describes a transient attack, which fades within a day and leaves no injury. Worsening weakness and falling consciousness rule out anything temporary or self limited.

Correct Answer: Disordered remodeling laying down chaotic mosaic bone

Paget disease starts with frenzied osteoclastic resorption, then rapid disorganized formation that lays bone in a mosaic pattern. The result is enlarged, hypervascular, structurally weak bone with a markedly raised alkaline phosphatase. Option a is incorrect because osteoporotic loss shrinks bone mass and leaves the skull, hats and shoe size unchanged. It also runs with a normal alkaline phosphatase rather than the striking elevation reported here. Option b is incorrect because soft, poorly mineralized bone comes from vitamin D deficiency and carries low calcium and phosphate. This client's calcium is normal, and skull enlargement is not part of that picture. Option c is incorrect because tumor spread to bone destroys it focally, often raising serum calcium and producing pathologic fracture. Enlarging skull bones with hearing loss and local warmth point elsewhere entirely.

Correct Answer: Shear stretching and kinking deep vessels

When the skeleton slides downward while the skin stays fixed against the sheet, deep tissue is distorted and the perforating vessels kink and tear. That is shear, and it damages tissue beneath intact skin. Option a is incorrect because friction rubs away the surface of the epidermis and leaves a shallow abrasion that is visible immediately. It lowers skin tolerance but does not reach the deep tissue described. Option c is incorrect because moisture from incontinence or sweat softens the horny layer and raises surface friction, producing a diffuse inflamed rash. Maceration alone does not angulate the vessels feeding muscle over the sacrum. Option d is incorrect because straight downward pressure closes capillaries and starves the tissue, but the scenario adds sliding, which loads the tissue sideways as well. Pressure by itself would not produce this undermining pattern.

Correct Answer: Absent dystrophin within the muscle fiber membrane

Duchenne dystrophy is an X linked disorder in which dystrophin is missing, so muscle fibers tear during contraction and are gradually replaced by fat and fibrous tissue. Gowers sign and pseudohypertrophy follow. Option b is incorrect because myoglobin flooding the circulation follows crush injury, prolonged compression or extreme exertion, and it presents acutely with dark urine and kidney injury. This boy has years of gradual weakness. Option c is incorrect because rickets softens growing bone and does produce a waddling gait, yet it bows the legs and widens the wrists rather than enlarging the calves. Creatine kinase stays normal. Option d is incorrect because thickened collagen in scleroderma binds skin and restricts movement without destroying muscle fibers. It appears in adults, spares the calves, and would not send the creatine kinase soaring.

Correct Answer: Osteoclast resorption now exceeding new osteoblast formation

Estrogen normally restrains osteoclast recruitment and lifespan. Once it falls away, resorption runs ahead of formation, and high turnover trabecular bone in the spine, hip and wrist thins first. Option a is incorrect because building outpacing breakdown would raise bone mass, which is what happens during adolescent growth toward peak bone mass near age thirty. Density would climb rather than drop. Option c is incorrect because faulty mineralization of osteoid describes osteomalacia, where enough matrix exists but stays soft. In osteoporosis the remaining bone is mineralized normally and there is simply less of it. Option d is incorrect because chaotic resorption followed by rapid disorganized formation belongs to Paget disease, which enlarges and thickens bone. Bone density scanning in this client shows loss of mass, not overgrowth.

Correct Answer: Brain function is disturbed without structural damage

Concussion is a functional disturbance, not a structural one. Biomechanical force triggers an ion flux and an energy crisis in neurons that routine imaging cannot show, so symptoms are real despite a clean scan. Option a is incorrect because an arterial collection in that space shows plainly on the scan as a lens shaped density. A normal study excludes it, and this client has no lucid interval story. Option b is incorrect because shearing of that severity leaves a client comatose from the moment of impact. Walking off the field with a headache and poor focus rules that devastating pattern out. Option c is incorrect because normal imaging never proves the brain escaped harm. Telling an athlete otherwise invites a same day return to play, and a second impact before recovery can swell the brain catastrophically.

Correct Answer: Encephalitis inflaming the brain tissue itself

Encephalitis inflames the parenchyma, so altered mental status, behavioral change, focal deficits and seizures dominate while meningeal signs stay mild. Mosquito borne viruses and herpes simplex are the usual culprits. Option b is incorrect because inflammation of the coverings produces a rigid neck, photophobia and pounding headache with thinking relatively spared early. This client has clear neck movement and a disordered mind. Option c is incorrect because a walled off pocket of pus usually follows sinus, ear or dental infection and grows as a focal mass. Headache with a steady localized deficit is its pattern, not diffuse delirium. Option d is incorrect because a passing ischemic episode brings sudden painless loss of function that clears quickly, without fever. Nothing about a febrile illness with seizures matches a brief circulatory interruption.

Correct Answer: Widespread shearing of axons from rotational force

Rotational acceleration tears axons at the grey white junction, corpus callosum and brainstem. The damage is microscopic and scattered, so early imaging looks nearly normal while the client is comatose from impact and rarely recovers fully. Option a is incorrect because a sizeable subdural collection is obvious on the first scan as a crescent along the surface. Imaging that looks nearly clean argues directly against a space occupying clot. Option b is incorrect because inward driven bone fragments are visible on bone windows and produce weakness matched to the compressed area. Immediate deep coma across all limbs points to a diffuse process instead. Option d is incorrect because bruised poles cause deficits tied to those lobes and typically worsen over the next day or two as swelling develops. They seldom produce coma from the first moment.