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quiz review and last lecture

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