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patho
exam2info
| Question | Answer |
|---|---|
| nucleotides of a single DNA strand joined by __________ bonds | sugar-phosphate |
| DNA and RNA sugars are... | deoxyribose and ribose |
| 3 parts of a nucleotide | sugar, phosphate and base |
| thymine (t) replaced by __________ in RNA | urasil (u) |
| two DNA strands held in double helix by __________ bonds | hydrogen |
| enzyme responsible for DNA replication is... | DNA polymerase |
| enzyme responsible for gene transcription from DNA... | RNA polymerase |
| gene translation to protein occurs on... | ribosomes |
| role of chaperone or heat-shock proteins | folding and refolding of proteins |
| role of proteosomes | degrades old or abnormal proteins for recycling |
| role of ubiquitin in recycling proteins | guides proteins into proteosomes |
| crossing over during meiotic prophase 1 results in... | gene sharing and exchange |
| hemostasis is... | to stop bleeding |
| primary hemostasis | vasoconstriction and platelet plug formation |
| secondary hemostasis | coagulation cascade, fibrin clot formation and clot retraction |
| ____________ also triggered with hemostasis | fibrinolysis |
| how is fibrin degraded | plasminogen activated into plasmin which then degrades fibrin |
| platelet aggregation is ________ feedback | positive |
| 3 genes coding for same trait is... | trisomy (3 homologous) |
| platelets have ___ day lifespan | 4 |
| platelets produced in... | bone marrow |
| 30% of platelets stored in... | spleen |
| major anti-platelet drug that binds permanently to interfere with function | ASA also called aspirin |
| less than 100,000 platelets per cubic mm is... | thrombocytopenia |
| less than 50,000 platelets per cubic mm leads to... | signs and symptoms such as bruising or petechiae |
| less than 20,000 platelets per cubic mm can cause... | spontaneous bleeding |
| normal platelet count is... | 150,000 to 350,000 per cubic mm |
| excessive bleeding time of over 10 min indicates... | qualitative platelet dysfunction or clotting factor issue |
| normal bleeding time | less than 10 minutes |
| factors that decrease the lifespan of platelets | viral infections of immune system, drugs or mechanical heart valves- or idiopathic (unknown) |
| factors that decrease platelet production by suppressing bone marrow | drugs, radiation, cancer or aplastic anemia |
| etiologies of quantitative platelet disorder (thrombocytopenia) | bone marrow suppression, decreased platelet lifespan, excess sequestration in spleen or dilution due to fluid volume (relative) |
| 3 parts of clotting cascade | extrinsic, intrinsic and common pathways |
| factors that interfere with the extrinsic pathway of the clotting cascade and therefore lead to bleeding | vitamin K deficiency, liver disease, coumadin/ Warfarin that leads to vitamin K deficiency, factor 7 interference |
| factors that interfere with the intrinsic pathway of the clotting cascade and therefore lead to bleeding | hemophilia from factor 8 or 9 interference, advanced liver disease, heparin |
| intrinsic pathway bleeding test | PTT for heparin efficiency |
| extrinsic pathway bleeding test | PT or INR |
| DIC- disseminated intravascular coagulation | secondary issue arising from common pathway of clotting cascade, involves excessive bleeding and clotting |
| PT test goal assessing coumadin efficacy | 1.5 to 2.5 times the population mean |
| INR test goal assessing coumadin efficacy | 1.5 as prophylaxis, 2.0 to 3.0 as general therapeutic, 2.5 to 3.5 for extreme caution as w/ prosthetic heart |
| stem cells in bone marrow stimulated to produce RBCs by... | erythropoietin |
| erythroblasts become... | reticulocytes (immature) that become erythrocytes |
| clotting cascade triggered by... | immune response |
| microthromi and micro emboli can lead to... | vascular occlusion and organ failure/ ischemia |
| co factors for erythropoiesis that we must ingest | iron, folate, and vitamin B12 |
| what is needed to absorb vitamin B12? | intrinsic factor |
| erythropoietin sent to bone marrow by... | kidneys in response to oxygen level |
| MCV stands for | mean corpuscular volume (RBC size) |
| MCHC stands for | mean corpuscular hemoglobin concentration (color) |
| RDW is the... | range of RBC sizes |
| how to assess for anemia | look at MCV, MCHC, RDW, smear/shape, reticulocyte count and iron binding capacity |
| proper ratio for hematocrit to hemoglobin | hct to hgb should be 3 to 1 |
| normal RBC count is... | about 4 to 6 million per cubic mm (men have more RBCs than women) |
| elevated RBC count is called | polycythemia |
| decreased RBC count is called | anemia |
| hematocrit or hct is... | % of total blood volume that is RBCs |
| normal hematocrit value | men- 45%, women- 42% |
| relative change in hematocrit/ hct due to... | changes in plasma volume |
| hemoglobin or hgb refers to... | oxygen carrying capacity/ hgb per deciliter |
| normal hemoglobin values | men- 14 to 18 g/dl, women- 12 to 16 g/dl |
| oxygen content of blood = | dissolved oxygen + bound oxygen |
| polycythemia leads to... | increased blood viscosity |
| primary polycythemia | polycythemia vera (PV)- malignant proliferation |
| secondary polycythemia | compensation for hypoxia or increased altitude |
| relative polycythemia and anemia results from... | decrease or increase in plasma volume |
| anemia results from... | increased RBC loss or decreased RBC production |
| manifestations of anemia | fatigue, decreased activity tolerance, tachypnea, tachycardia, pallor from decreased hemoglobin or cyanosis from decreased saturation of hemoglobin |
| changes in MCHC (color) | hypochromic (indicates iron deficiency) vs. normochromic |
| site of RBC breakdown | spleen |
| large size RBC/high MCV/macrocytic cells due to | low vitB12 or folate |
| small size RBC/low MCV/microcytic cells due to | usually iron deficiency |
| aplastic anemia is | decreased RBC production in bone marrow |
| acute blood loss leads to... | increase in reticulocyte count |
| pernicious anemia due to... | vitB12 deficiency that causes decrease in production of intrinsic factor |
| increased bilirubin leads to... | hemolytic anemia (because bilirubin breaks down hemoglobin) |
| abnormal RBC shapes include... | sickle cells and schistocytes (helmet and burr cells) |
| hemolytic anemia results from... | increased RBC destruction |
| erythropoietin therapy for anemia must be given by the ___________ route | parenteral (as GI track destroys the peptide) |
| excessive erythropoietin use associated with | heart attack or stroke risk |
| erythropoietin made by the | kidneys to stimulate bone marrow to produce RBCs |
| erythropoietin therapy should be accompanied by... | iron supplements |
| cancers with highest mortality rates | lung and bronchus |
| most common cancers in men and women | prostate and breast |
| benign tumor suffix | oma, such as lipoma, exceptions are lymphoma, melanoma and neuroblastoma |
| malignant tumor suffix | carcinoma or sarcoma |
| characteristics of benign tumors | slow growth, local or encapsulated, cells have normal function, rarely recur, well differentiated histologically |
| characteristics of malignant tumors | fast growth, antisocial, often metastatic, invasive, anaplastic (odd looking), dysfunctional, often recur |
| cancer cell replication occurs over... | a long period of time |
| subclinical cancer phase involves... | rapid growth/ division |
| clinical cancer phase involves... | slower cell growth but symptoms can progress rapidly |
| higher grade of tumor indicates | more anaplasia- worse |
| stage 0 cancer | no tumor, cancer cells remain in same tissue layer (carcinoma in situ) |
| stage 1,2 and 3 cancers | cancer cells may have spread to other tissues or nodes, involve actual tumors or varying size |
| stage 4 cancer | metastatic- cancer has spread to another organ |
| metastasis | spread of cancer M0=no spread M1=spread |
| most common origin of cancers | 80 to 90% are epithelial in origin |
| cancer derived from... | mutations in tissue stem cells that can proliferate |
| carcinogens that stimulate cell turnover and increase cancer risk include | tobacco, obesity, UV light, chemicals, radiation, viruses such as HPV and EBV |
| steps of carcinogenesis | initiation from DNA mutation/damage, promotion by proliferation due to growth promoters, progression that leads to cancerous phenotype |
| growth control genes that impact cancer development include | proto-oncogenes that become oncogenes in cancer, and tumor suppression genes |
| proto-oncogenes in cancer | are overactive, become oncogenes that lead to over proliferation |
| tumor suppression genes in cancer are | inactivated to encourage promotion of cancer cells |
| which can be inherited, proto-oncogenes or tumor suppression | tumor suppression genes (also called anti-oncogenes) |
| pRb tumor suppression gene | master brake of cell cycle that inhibits transcription |
| p53 tumor suppression gene | suicide gene that leads to apoptosis |
| phosphorylation of pRb triggered by... | cyclins pRb releases transcription factors when phosphorylated |
| cancer must inactivate _______ to avoid apoptosis that is usually triggered by DNA damage | p53 gene |
| a malignant phenotype involves | excessive cell replication, cell immortality due to absence of shortening telomere, undifferentiated cells with lack of function, tissue invasion and distant metastasis |
| cancer cells result from | mutated chromosomes |
| metastasis of cancer usually follows | bloodstream or lymphatic ducts, making spread pattern predictable |
| metastasis depends upon enzymes and receptors because | proper conditions needed at tissue for cancer to successfully invade |
| cancer cells have a _________ rate of metabolism | higher/ faster, they consume more glucose |
| tumor markers are | enzymes or proteins secreted by tumor cells |
| tumor markers are best used as a... | prognostic tool or for assessing response to therapy, NOT for diagnosis because even healthy cells have these proteins (some level of them is normal) |
| PSA marker | used for prostate cancer but often leads to false diagnosis |
| CEA marker | used for colon cancer prognosis/ assessment |
| CA125 marker | used for ovarian cancer prognosis/ assessment |
| symptoms of cancer | cachexia, pain (often in bone), immunosuppression, infection, organ disfunction, sometimes asymptomatic |
| normal proliferation in response to infection is... | polyclonal- many types of WBCs are replicating |
| malignant proliferation characterized by being... | monoclonal- only one type of leukocyte is replicating, and is behaving invasively |
| leukemia- lymphoid- ALL or CLL | malignant transformation of lymphocyte stem cell |
| leukemia- myeloid- AML or CML | malignant transformation of granulocyte stem cell |
| leukemias are __________ from the start | metastatic |
| lymphoma vs leukemia | lymphoma is in lymph tissue, leukemia is in blood or bone marrow- but they appear to be the SAME type of cancer cell- differ only in location |
| polycythemia vera is... | cancer of the RBC |
| granulocytic leukemia is... | cancer of the neutrophil, basophil or eosinophil |
| hematologic malignancies are classified according to... | their specific genotype, and what stage they are in |
| lymphoblasts for B and T cells found in the blood indicate... | overproduction by stem cells in bone marrow- precursor to leukemia |
| acute vs. chronic myeloid leukemia | more cancerous cells in acute that are poorly differentiated, but more differentiated cells in CML |
| acute leukemias generally affect __________ people, while chronic leukemias tend to affect __________ people | acute- young chronic- older |
| chromosomal translocation can lead to... | new fusion genes that code for new proteins that lead to malignant cells |
| Hodgkins lymphoma is identified by... | Reed Sternberg cells |
| Hodgkins lymphoma tends to affect... | young adults |
| Hodgkins lymphoma has a ________ prognosis in early stages | good, because it spreads predictably |
| Non Hodgkins lymphomas tend to affect... | adults |
| Non Hodgkins lymphomas have a __________ prognosis | poor, they are unpredictable |
| Non Hodgkins lymphomas classified according to... | cell type, staging and grade |
| signs of leukemias | bone pain, decreased immune response, increased bleeding |
| signs of lymphomas | painless lymph node enlargement, weight loss, night sweats, and intermittent fevers (some of these are also common to AIDS and TB) |
| lymphadenopathy | nonspecific term meaning lymph gland pathology- does NOT necessarily indicate lymphoma |
| plasma cell myelomas lead to... | tumors in bone |
| signs of plasma cell myeloma | bone pain, high serum calcium from bone breakdown |
| Bence Jones proteins in urine indicate... | plasma cell myeloma- from breakdown of excess monoclonal antibodies |
| a malignant proliferation of B plasma cells | plasma cell myeloma |
| plasma cell myeloma considered a... | lymphoid malignancy- NOT myeloid despite its name |
| monoclonal antibody spike accompanied by albumin level drop on serum electrophoresis indicates... | plasma cell myeloma (B plasma cells are proliferating and making many more antibodies) |
| cancer drugs are aimed at... | interfering with different phases of mitosis |
| numerous chemo courses need because... | each course only kills a portion of the cancer cells (eventually, the body's immune system may be able to fight off the remaining cancer cells) |
| though promising, gene therapy for cancer treatment has... | not provided very high efficacy |
| selection of primary and additional cancer therapy guided by the... | grade and stage of the cancer |
| chemotherapy is... | cytotoxic, especially to rapidly dividing cells |
| for chemotherapy to be effective... | the cell must be dividing- this makes slow growing cancers difficult to kill |
| dose of chemo limited by... | toxicity to normal, healthy cells |
| chemotherapy is best used for ________, __________, and ____________ | blood cancers, lymph cancers and small solid tumors |
| why is chemo given into large vessels? | b/c it is toxic to vessels and smaller ones cannot handle it |
| toxic effects of chemotherapy | GI effects, alopecia, impaired sexual function or sterility, organ toxicity |
| effects due to chemo suppression of bone marrow | leukopenia, neutropenia, anemia, thrombocytopenia |
| how do monoclonal antibodies work for cancer treatment? | they target surface or intracellular proteins that are unique to cancer cells |
| actions of monoclonal antibodies for cancer treatment include... | blocking growth factors, stimulating apoptosis, or impeding enzyme systems |
| NO from endothelium of vessels | makes platelets slippery and prevents clotting |
| the liver needs vitamin _____ to make clotting factors | K |
| TPA initiates ____________ | fibrinolysis (clot break down), TPA stands for tissue plasminogen activator |
| a splenectomy will ___________ bleeding risk | increase, RBCs are not broken down |
| heparin is a... | blood thinner, blocks intrinsic pathway of clotting cascade |
| H bonds are ideal for double helix formation because... | they break easily to allow DNA synthesis (broken by DNA helicase) |
| pain receptors are... | free nerve endings called nociceptors |
| mediators of nociception released during inflammation or injury include... | bradykinins and prostaglandins |
| c fibers of nociception are... | NOT myelinated, slow signal transduction- noxious, persistant pain |
| A deltas of nociception are... | Myelinated, fast signal transduction, associated with more precise or localized pain signals |
| The RAS (reticular activation system) can __________ signals of perception, including pain | dampen |
| the _________ is the relay station for pain signals | Thalamus |
| pain is sensed and associated in the ____________ of the brain | cortex |
| the _____________ is tied to emotional connotations and learning experiences including pain memories | limbic system |
| chronic pain has a ________ physiological response, while acute pain has _____________ | decreased acute pain has more physical symptoms |
| pain threshold is the... | point of pain recognition and sensation, this is similar for most people |
| pain tolerance... | is the amount of acceptable pain, differs widely |
| factors that can lower the pain threshold | anxiety, sleep, tiredness, anger, isolation, depression, fear |
| factors that can raise the pain threshold | sleep, empathy, diversion, medication |
| three levels of pain modulation | nociceptor, spinal cord or brain |
| acute pain is often due to... | nociceptor activity, but not always |
| acute pain __________ the SNS response involving increased heart rate, blood pressure and respirations along with diaphoresis | triggers |
| chronic pain does not interfere so much with the SNS activation, but does lead to... | personality change, functional impairment, lifestyle changes |
| intrathecal vs epidural | intrathecal is into the CSF in the space of cord (more systemic), while epidural goes into nerve (more local) |
| pain syndromes are called ______________ and are NOT generated at the receptor | neuropathic pain or neuralgia- include trigeminal, post herpetic, lower back, diabetic and phantom limb |
| ____________ decreases the risk of developing phantom limb pain | relieving pain well before the amputation procedure |
| subjective data based on the _______, __________, _________ and ________ is the most useful for pain assessment | location, quality, intensity and referral pattern |
| PCA stands for... | patient controlled analgesia, and is less likely to lead to abuse than non-PCA |
| schedule 1 narcotics | have NO medical use and a high potential for abuse- LSD and heroine |
| schedule 2 narcotics | high abuse potential, but suitable for medical use- morphine and oxycodone |
| schedule 3 narcotics | may cause some dependance- codeine combos and hydrocodone |
| schedule 4 narcotics | mild dependence development- diazepam |
| schedule 5 narcotics | least potential for dependence- cough syrup |
| most common narcotics for acute pain | schedule 2 and 3 |
| narcotics have a high potential for dependency and are thus not prescribed for chronic pain unless... | it is a terminal condition such as some cancers |
| what is pruritus | itching |
| what is miosis | pupil constriction |
| the three opioid receptors are | mu, kappa, and delta |
| agonist opioids __________ mu and kappa receptors while antagonist drugs ___________ these receptors | trigger, block |
| two primary concerns with opioid use | abuse and dependence |
| do opioid drugs cross the placental and blood brain barrier? | yes |
| best pure opioid agonist for mild pain | schedule 2 to 5 codeine drugs |
| best pure opioid agonists for moderate to severe pain | morphine, methadone, hydrocodone, oxycodone |
| ADRs of opioid agonists | tolerance WILL develop, dependence with prolonged use, pruritus, rash, orthostatic hypotension, miosis, CNS depression, constipation |
| partial opioid agonists (also called opioid agonist-antagonists) are used less often but have... | less potential for abuse and less respiratory depression |
| anything that interferes with the action of pure opioid agonists in a dependent patient can... | initiate withdrawal- this includes partial agonists and antagonists |
| opioids are often combine with non- opioid analgesics including... | NSAIDs such as aspirin, acetaminophen and caffeine |
| the main opioid antagonist is... | naloxone HCL or Narcan |
| Narcan/ naloxone HCL is used to... | block agonist effects of mu and kappa receptors from opioid drugs- reverse ADRs of opioids including respiratory depression |
| issues in using opioid pain drugs in elders | pain assessment is difficult, altered pharm. kinetics, increased drug sensitivity and heightened risk for interactions with other substances |
| main issue in using opioid pain drugs in children | pain assessment challenge |
| effect of GABA binding to cell receptor | chloride influx that inhibits depolarization |
| benzodiazepines mechanism of action | enhance GABA effect of inhibiting depolarization of neurons by opening Cl- channels, therefore dampening signals of neurotransmission |
| diazepam and lorazepam are two important benzodiazepines also known as... | Valium and Ativan |
| benzodiazepines such as Valium and Ativan do or do not have dependence and abuse potential? | DO |
| GABA and benzodiazepines have ___________ binding sites, but have ____________ effect on the chloride channels. | different binding sites, but same effect |
| sleep agents are also know as hypnotics and are different from benzos in that... | they have less CNS depression, less abuse potential but may interfere with the function of sleep |
| Ambien, Lunesta and Benadryl are all considered | hypnotics |
| Psychoactive drugs, which are often used for anxiety and sedation, include... | benzos, hypnotics, barbs, amphetamines, antidepressants, mood stabilizers, antipsychotics and anti-epileptics |
| though benzos and barbiturates have similar effect on GABA, benzos are preferred because barbs... | have more ADRs and lead to numerous interactions by inducing the p450 enzyme system of liver |
| Amphetamines like Adderall are schedule 2 drugs and their mechanism of action is... | to increase norepinephrine release |
| Xanthenes, such as caffeine, stimulate the CNS by... | inhibiting breakdown of cAMP |
| psychoactive drugs exhibit their effects by... | interacting with different neurotransmitters, enzymes and receptors of a synapse |
| tricyclic antidepressants mechanism of action | inhibit re-uptake of NE, DA, and 5HT (norepinephrine, dopamine, and serotonin) |
| MAO inhibitor antidepressants mechanism of action | prevent breakdown of neurotransmitters, leaving more to be recycled and used in the presynaptic bulb |
| SSRI as an antidepressant means | selective serotonin re-uptake inhibitor ( such as Prozac/ fluoxetine) |
| SNRI as an antidepressant means | serotonin and norepinephrine re-uptake inhibitors |
| patients with heart trouble should avoid psychoactives like... | amphetamines, which increase HR and BP, and serotonin agonists that encourage vasoconstriction |
| the best treatment for bipolar disorder is... | Lithium, which is an ion that competes with sodium and iodine |
| antipsychotic drugs generally work by... | being dopamine antagonists |
| newer antipsychotic drugs are preferred due to... | fewer AEs (adverse effects) |
| main mechanism of action for anti-epileptic drugs | affect ion channels and inhibit AP initiation and conduction |
| using a single or combination therapy, monitoring drug serum levels and looking for adverse effects, and tapering dose to discontinue are all ways to... | individualize drug treatment for anti-epileptic drugs |
| three important steps to remember during a patient seizure | we need to observe, document what we see and protect the person |
| acquired seizure disorder comes from... | trauma |
| cerebral storms refer to... | the involuntary and sequential firing of connected neurons during a seizure/ chaotic brain activity |
| an epileptocgenic focus is... | the starting point of neural activity that leads to seizure, can sometimes be removed if discovered |
| main diagnostic tool for seizure disorders is... | the EEG, or electroencephalogram, which can sometimes locate focus region of seizure in brain |
| generalized absence seizures, such as myoclonic and atonic are... | typically less severe and involve eyes rolling back |
| generalized tonic/ clonic seizures involve... | rigid muscle paralysis, then uncontrollable convulsions |
| partial, or focal seizures... | sometimes only affect one part of the body (simple), but can be complex and lead to generalized seizure |
| an _________ is when a patient can feel a generalized seizure coming on | aura |
| the __________ period after the seizure is when the patient is recovering | postical |
| prolonged or repeated seizure with no recovery is known as... | status epilepticus |
| nurse priorities during status epilepticus | maintain airway and provide oxygen, maintain physical safety, and medically terminate the seizure with benzos 1st then Dilantin |
| cause of brain injury | mechanical (traumatic), ischemia leading to necrosis (stroke), CNS infections, and CSF obstruction |
| jaundice and shistocytes (abnormally shaped RBCs) are evidence of... | hemolytic anemia |
| general headache called | tension headache- bilateral and not extreme, no throbbing |
| cluster headache sometimes leads to... | suicide because it is SEVERE, patients sometimes pace or beat head, no throbbing |
| migraine | throbbing and unilateral |
| headaches that require immediate attention and may indicate CVA involve... | very acute onset, stiff neck, altered cognition, visual loss, fever or hypertension |
| acute bacterial meningitis starts as... | nasopharyngeal infection |
| bacterial meningitis caused by... | proliferation of bacteria in CSF |
| inflammation of meningitis treated with... | steroids and antibiotics |
| brain ___________ can be caused by hypoglycemia | swelling |
| ischemia of cells leads to 3 major issues | increased glutamate production with lack of ATP, hypoxia leading to mitochondria failure, and reperfusion that produces free radicals |
| normal intracranial pressure is... | less than 15mm Hg |
| Monroe Kellie Hypothesis asserts 2 mechanisms to compensate for increased intracranial pressure | CSF redirected to spinal cord, hyperventilation leading to vasoconstriction |
| blood factors that increase ICP (intracranial pressure) | valsalva (grunting), increase in thoracic pressure, hypoxia, increased CO2 and acidosis, right heart failure |
| brain factors that increase ICP | tumor, hematoma, infection, ischemia, edema |
| hydrocephalus leads to increased ICP by... | altering CSF production/ flow |
| brain can accommodate around __________ of pressure before displacement that causes damage occurs | 25-30% |
| Cushing response is... | the brain last effort to establish brain blood flow during increased ICP |
| Cushing response evidenced by... | dramatically elevated systolic pressure, decreased heart rate due to widening pulse pressure |
| herniation is when brain tissue... | pushes through dura mater into another region and cause potential damage |
| evaluation of brain injury | airway, breathing and circulation first, then neurologic exam and CT scan |
| signs and symptoms of increased ICP | vomiting without nausea, vision and pupil changes, changes in motor function |
| goal of interventions for increased ICP | to maintain cerebral perfusion |
| interventions to lower ICP | diuretics, barb induced coma, seizure prophylaxis, MILDLY lowering CO2 levels, oxgen therapy, fever and pain control, induced hypothermia, RAISE HOB |
| primary prevention for traumatic brain injury includes use of... | seat belts and helmets |
| TBI, or traumatic brain injury, caused by... | acute mechanical injury |
| coup/ focal TBI caused by... | blunt trauma to ONE spot |
| coup-contracoup/ polar TBI caused by... | double impact trauma, such as stopping suddenly and bouncing to other side |
| diffuse TBI involves | many different spots |
| intracranial hematoma is... | a bleed |
| contusion is identified by... | bruising on the brain, generally more serious than concussion |
| concussion is identified by... | symptoms only, not visible on brain |
| grade 1 concussion identified by... | confusion with no loss of consciousness that resolves within 15 minutes |
| grade 2 concussion identified by... | confusion with no loss of consciousness that does not resolve within 15 minutes |
| grade 3 concussion identified by... | any loss of consciousness |
| epidural hematoma is... | an arterial bleed above the dura mater |
| subdural hematoma is... | a venous bleed between pia and dura mater |
| subarachnoid hematoma is... | blood entering the CSF |
| risk for stroke increased 6x by... | atrial fibrillation |
| stroke is... | large number of cell death caused by obstructed blood supply to brain |
| thrombotic stroke caused by... | atherosclerotic plaque |
| most common type of stroke is... | thrombotic |
| TIA is... | minor stroke like symptoms that warn of larger episode but resolve under 24 hours with no loss of function |
| embolic stroke caused by... | dislodged thrombi that occlude flow |
| hemorrhagic stroke caused by... | cerebral arterial vessel wall rupture |
| normal blood flow of brain tissue | 50 ml per 100g |
| ischemia of brain tissue results when flow falls to __________, while infarction results when flow falls to ____________ | 20 ml per 100g, 12ml per 100g |
| secondary injury of stroke caused by... | inflammation and apoptosis |
| zone of injured brain tissue that might be salvaged | penumbra |
| signs of stroke | dysphagia, loss of bowel function, ptosis (drooping eyelid), decreased LOC, emotional changes, aphasia (language deficits), motor and sensory loss |
| stroke on left side of brain will impact... | right side body functions |
| unique symptoms of hemorrhagic stroke | photophobia, seizure, very rapid decrease in LOC, nuchal rigidity |
| type of stroke can only truly be determined by... | CT scan |
| ischemic stroke treated by... | thrombolytic therapy (tPA) to break clots |
| hemorrhagic stroke treated by.... | BP management and invasive interventions |
| acute stroke can be managed by... | lowering ICP |
| the syndrome associated with deterioration of memory and cognition is... | dementia |
| Alzheimer dementia is... | PROGRESSIVE and begins with mild cognitive impairment that still allows for independence |
| possible etiologies of Alzheimer include... | 2 Apo-E or E4 genes, toxins and viral |
| pathology of Alzheimer includes... | amyloid plagues (protein globs), neurofibrillary tangles (shriveled neurons), cerebral atrophy |
| neurofibrillary tangles of Alzheimer's caused by... | tau disfunction in microtubules |
| deficiency of Ach secretion, 5HT dysfunction, glutamate dysfunction, and increased brain cholesterol are all abnormalities associated with... | Alzheimer's |
| does a normal aging brain have amyloid plaques and tangles? | YES, but many more in Alzheimer |
| before an Alzheimer diagnosis, we must explore... | other treatable causes of dementia such as depression, substance abuse, infections, and hypoxia or hypoglycemia |
| only two meds approved for Alzheimer treatment | acetylcholinesterase inhibitors and glutamate (NMDA receptor) inhibitors |
| etiology of Parkinson Disease associated with... | early onset genes, and possibly a neurotoxin of some sort (this is a PROGRESSIVE disorder) |
| main pathology of Parkinson | LOW DOPAMINE LEVELS in basal ganglia, but also excessive action of ACh |
| dopamine has multiple receptors, and therefore deficiency found in Parkinson interferes with the function of many downstream _____________________ | inhibitory and excitatory neurotransmitters |
| three main signs of Parkinson | 1. Akinesia ( trouble initiating movement) which leads to shuffling/ propulsive gait 2. Rigidity leading to mask like face and speech issues 3. resting tremors ***also often involves dementia |
| Levodopa, or carbidopa, is used to treat Parkinson by... | acting as a DA precursor to lead to more dopamine production- the carbidopa part prevents peripheral breakdown to allow levodopa to reach the CNS |
Created by:
NurseJoel
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