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Patho3Finalprep
quiz review and last lecture
| Question | Answer |
|---|---|
| Obtain CPP by | MAP-ICP = CPP |
| MAP is | SBP + 2(DBP) / 3 |
| what cells are most sensitive to hypoxia? | purkinje cells are GABA neurons in cerebellum that control motor funcion, hypoxia destroys them causing paralysis |
| widened pulse pressure can be caused by | anxiety, anemia, aortic regurg, elev ICP, thyrotoxicosis |
| cushing reflex or cushings triad inc what three factors and indicates? | HTN, wide pulse pressure, bradycardia > severely elev ICP, impending herniation |
| normal value for ICP | 0-15mmhg |
| where is CSF produced | choroid plexus and ancillary cells |
| where is CSF reabsorbed | sinus and ancillary structures |
| glutamate is principle _________neurotransmitter | excitatory |
| neuronal destruction following hypoxia is due to | influx of Na+ leading to cell swelling |
| true or false: intracellular K+ is higher than extracellular K+ concentration | true |
| true or false: intracellular Na+ is lower than extracellular Na+ concentration | true |
| true or false: intracellular glutamate concentration is higher than extracellular glutamate concentration | true |
| true or false: intracellular Ca++ is lower than extracellular | true |
| pupils don't react to light, no corneal reflex present, no oculovestibular reflex | sx of brain death |
| Negative Doll's eyes would stay fixed midorbit, and having negative "doll's eyes" is therefore a sign that | a comatose patient's brainstem is functionally not intact. |
| a positive oculovestibular reflex corresponds to what terminology? | positive dolls eyes |
| global ischemia can be caused by | CHF |
| local ischemia is caused by | CVA, embolus in cerebral artery, other causes |
| edema of neurons following ischemic attack is due to | diffusion of Na+ into cell |
| Cerebral perfusion pressure is determined by | MAP - ICP |
| hydrocephalus is due to | abnormal increase in CSF volume |
| depletion of ATP will cause increase in | glutamate in interstitial space |
| the GCS compares | eye movement, verbal response and motor response |
| measures BS average in last 2-3 months | HgA1C |
| HgA1C norm = | <5.7 |
| chemically alzheimers is due to lack of | acetylcholine |
| white matter in the CNS is composed of | axons (myelin sheath) |
| what differentiates alzheimers from other dementias? | alzheimers is age related |
| lower motor neurons exit from | the spinal cord |
| hemiparesis is | weakness on one side |
| motor area of the brain is composed of | pyramidal cells |
| lower motor neuron syndrome is ipsilateral or contralateral to the nervous lesion? | ipsilateral |
| the pyramidal tract forms the | primary motor area |
| true or false: the spinal reflex is intact in upper motor neuron syndrome? | true |
| flaccid paralysis, muscle atrophy, hyporeflexia are characteristic of | lower motor neuron syndrome |
| what lobes are affected in alzheimer's ? | frontal and temporal |
| damage to sciatic nerve will result in what syndrome? | lower motor neuron syndrome |
| list 2 types of motor function disorder | hyper and hypotonia |
| hypoxia most affects what pathways in the brain? | motor pathways of GABA purkinje cells |
| 2 types of brain injuries | primary (conc, lac, hem, contusion) secondary (hypoxic, ischemic, edema, hematoma, infection, infest) |
| what is torn in subdural hematoma? | the bridging vein |
| what is torn in an epidural hematoma? | middle meningeal artery |
| what is the pathogenesis of meningitis? | inflammation wrecks blood brain barrier, plasma extravasates, albumin leaks into CSF, edema, compression result |
| whats the pathogenesis of encephalitis? | local necrotizing hemorrhage, degeneration of neurons, inflammation, edema |
| when do astrocytomas show up? | in 60 yr olds |
| what is the neurotransmitter imbalance in sz disorders? | increased acetylcholine, lower GABA |
| hyper reflexia and spasticity are seen with | UMN disorders |
| hyporeflexia and flaccidity are seen with | LMN disorders |
| 2 skeletal muscle disorders | atrophy and dystrophy |
| neurotransmitter of neuromuscular junction whose release, receptors and degrading impact function | acetylcholine |
| symmetrical sensory motor or mixed deficit beginning at extremities and progressing centrally is caused by | demyelinization from alcohol, diabetes, lead/arsenic poisoning, guillian barre |
| pain in thumb, index, middle and half ring finger, atrophy of abductor pollicis | carpal tunnel (median nerve compression) |
| pain along dermatome, worse with increase pressure of cough sneeze stoop straining or jarring, some motor weakness, diminished reflexes, numbness | herniated disc |
| caudate nucleus, globus pallidus, subthalamus, substantia nigra are parts of | basal ganglia |
| cogwheel type movement, tremor, mask, balance impaired, orthostatic hypostension, tearing, drooling, sweating, incont of urine | parkinsons |
| hemisection post/ant cord, ipsilateral motor loss, proprioception loss, contralateral pain and temp loss | Brown Sequard syndrome |
| motor, pain and temp loss | ant cord syndrome, damage to ant 2/3 cord and ant spinal artery |
| ventilation and communication | C3-C5 phrenic nerve |
| above what vertebrae does total paralysis occur? | C3 |
| CV decomp at what level | T4 and above |
| lesion above S2 | incont urine stool but can have erection expansion |
| lesion below S2 | stool and urine retention w no erection, expansion |
| meissner and pacini corpuscles: fast or slow to adapt? | fast |
| meckels and ruffini corpuscles: fast or slow to adapt? | slow |
| subtle light touch sensor | meissner |
| heavy touch pressure sensor | ruffini |
| temp range warm receptors | 77-113 F |
| temp range cold receptors | 50-68 F |
| three theories of pain | specific receptors, patterns of receptors, small diameter neurons act as gates |
| which order neuron activates withdrawal reflex | second |
| what type of pain is diffuse and radiates? | somatic, deep |
| hunting reflex or lewis reaction | alternating vasoconstriction and vasodilation in extremities exposed to cold. |
| tens units work via what pain theory? | gate, small diam neurons, contrairritant, or stim release of endorphins/enkaphalins |
| acupuncture pain relief works via | endogenous analgesics (because narcan antagonizes effect) |
| aura occurs in what percent migraines | 85 % |
| migraine mechanism | vasodilation, spasm, slow neural wave of depolarization w histamine serotonin and prostaglandin release |
| tension headache | bilateral tight pain due to occipital muscle tension |
| cluster headaches | around eyes, temporal, radiate to ipsilateral trigeminal nerve, pain can last days to months accomp by tearing and nose running |
| Factors in Assessment of Pain | cause location intensity radiation quality pattern;what makes it better or worse, subjective reaction 'story' about it |
| what is used as adjuvant analgesic? | tricyclic antidepressants |
| how much of pain control is placebo | 20-40% |
| causes of periph neuropathy | autoimmune, metabolic, nutritional, ischemic, toxic, infectious, radiation, compression, trauma |
| sympathetic nerves to bladder | T11 -L3 allow relaxation for filling |
| sympathetic innervation of bowel | T6-L3 slow peristalsis and increase internal sphincter tone |
| what stimulates internal sphincter function and decreases motility by inhibiting the intramural plexus neurons | sympathetic nervous system |
| how is mucosal layer of stomach formed | tight junctions |
| protect stomach lining by increasing bicarb, mucous production and blood flow | prostaglandins |
| 2 factors in PUD | ASA and H Pylori |
| how does ASA harm stomach | irritant and inhibits prostaglandin synthesis |
| what type of jaundice is hemolytic, or r/t genetic blood cell disorder | prehepatic |
| what type of jaundice is r/t decreased bilirubin uptake or conjugation due to hepatitis, cirrhosis or CA | intrahepatic |
| what type of jaundice is due to bile duct obstruction | post hepatic |
| fibrotic changes in liver | cirrhosis |
| endo and exocrine gland | pancreas |
| somatic neuropathies of diabetes | polyneuropathies, mononeuropathies and amyotrophic neuropathies |
| autonomic neuropathies of diabetes | vasomotor dysfunction, GI/GU dysfxn, eye problems |
| pupil dilated on one side, weak limbs on the other | epidural hematoma ipsilateral to pupil |
| N/V fever chills photophobia nuchal rigidity | meningitis ss |
| pre motor cortex innervates | primary motor area |
| can be ipsi or contra lateral, but is hyper reflexive and spastic | upper motor neuron lesion |
| lost spinal cord reflex w obvious muscle atrophy, hyporeflexive, flaccid limbs | lesion in anterior horn LMN |
| example of mono neuropathy | carpal tunnel syndrome - median nerve |
| truncal ataxia, intention tremor one side | ipsilateral cerebellar lesion |
| spinal cord injury occurring w trauma fracture | irreversible hemorrhage in gray matter causing ischemia and infarct of neurons at site |
| spinal cord secondary injury | hypoxia, edema, vasoconstriction, infarction, necrosis, scarring |
| loss of motor fxn, pain and temp sensing ability | anterior cord syndrome |
| ipsilateral motor and proprioception loss, contralateral pain and temp loss | brown sequard hemisection of post and ant cord |
| intercostal muscle innervation | T 1 - T 7 |
| abdominal muscle innervation | T 6 - T 12 |
| level of spinal injury resulting in bradycardia, hypotension, orthostatic hypotension | T 4 and above |
| radicular means | radiating along spinal nerve along dermatome |
| sympathetic affect on bladder | T11-L3 |
| parasympathetic affect on bladder | S2-3 |
| UMN effect on bladder | incont |
| LMN effect on bladder | retention below S2 |
| level that has sympathetic effect on bowel | T6 - L3 |
| level that has parasympathetic effect on bowel | S2-S4 |
| lesion above S2 affects sexual function | can have erection/tenting |
| lesion below S2 affects sexual function | no erection/tenting |
| what nervous system involved in erection/tenting | parasympathetic |
| what nervous system involved in ejaculation | sympathetic |
| parasympathetic innervation at what level increases motility | Sacrum |
| LFTs include | ALT/AST, S, albumin, s, bilirubin, alk phos (ALP), PT, alpha-1 antitrypsin |
| RFTs include | BUN/Cr, creatinine clearance, creatinine blood and urine |
| can become chronic hepatitis | HBV HCV HDV |
| portal hypertension causes | ascites, esophageal varices, splenomegaly, bleeding disorders, skin disorders, hepatorenal syndrome and hepatic encephalopathy (elev ammonia) |
| polyuria, polydipsia, unexplained wt loss and a casual BG > 200 | Dx for DM |
| FPL indicating DM | >126 |
| OGTT indicating DM | >200 |
| muscle weakness wasting and pain in pelvic girdle and thigh | amyotrophy - diabetic neuropathy |
| postural hypotension | impaired vasomotor fxn - autonomic neuropathy of DM |
| how many pairs of spinal nerves are there | 31 |
| PAG region (peri aqueductal gray) | produces enkaphalin, electrical stimulation of the PAG results in immediate and profound analgesia (r/t gate theory) |
| what pain perception is uniform in population | threshold, tolerance changes w training |
| tens units decrease pain by | gate theory, at high freq as counter irritant, muscle contractions cause endorphin release, may block conduction |
| acupuncture proven pain relief by | endogenous analgesics since narcan interrupts relief |
Created by:
kalyana
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