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Patho Test Neuro
Patho Test Neurology
| Question | Answer |
|---|---|
| What are the cardinal signs of IICP? | HA, projectile vomiting, papilledema |
| What part of the brain is affected if a pt has altered perception of time first, then place, and lastly person? | Cerebral Cortical Fxn |
| What type of fxn's occur BELOW the CORTEX? | Pupillary fxn, Diencephalon fxn, Posterior Pituitary fxn, Midbrain Fxn |
| If a pt has an altered relay of ascending sensory (except smell) and/or descending motor information, what part of the brain is affected? | Thalamus |
| What is the Diencephalon consisted of? | Thalamus and Hypothalamus |
| If a pt has ALTERED ANS fxn what part of the brain is affected? | Hypothalamus |
| If a person has Diabetes Insipidus (decreased ADH, massive urine output) what part of the brain is affected? | Posterior Pituitary Fxn |
| If a pt has altered visual acuity and/or altered visual field response (homonymous hemianopsia) what part of the brain is affected? | Pupillary Fxn |
| If the hypothalamus is damaged, which layer that controls temperature is damaged first? | Hyperthermia control first and then Hypothermia control are affected respectively. |
| If a pt has Cheyne-Stokes Respiration, what part of the brain is affected? | Diencephalon Fxn |
| What will a pt experience if they damaged CN V? | Trigeminal Neuralgia |
| What does the Upper Pons control? | CN V, CN VII, Pupils, Motor Reflexes, and Respiratory Center. |
| What will a pt experience if they damaged CN VII? | Altered facial expression, taste, salviation = Bell's Palsy |
| If a pt is experiencing Central Neurogenic Hyperventilation what is damaged? | The Respiratory Center in the Upper Pons |
| If the Lower Pons is damaged what will the pt experience? | Flaccidity, Apneustic breathing |
| What is characteristic if Apneustic breathing? | Prolonged inspiration followed by prolonged expiration. |
| What nerves does the Medulla control? | Vomiting Center, Vasomotor and Cardiac Center (also Respiratory Center) |
| If a pt has Hemiparesis, hemiplegia, hyperreflexia, Babinski's sing, flexor posturing, or seizures, what part of the brain is damaged? | Cerebral Cortex |
| Are most people left or right side speech dominant? | Left Side dominant |
| What CN does the Midbrain control? | CN III, IV |
| What CN is damaged if a pt has loss of rxn to indirect light? | CN III |
| If a pt has projectile vomiting, what part of the brain may be damaged? | Medulla |
| If a person has impaired sensory (touch, pain, proprioception, sterognosis, graphesthesis) what part of the brain is affected? | Cerebral Cortex |
| What does the Parietal lobe of the Cerebral Cortex control? | Temperature, touch, pain, prioperception, stereognosis, graphesthesis |
| What does the Temporal lobe of the Cerebral Cortex control? | Hearing, smell |
| What does the Occipital lobe of the Cerebral Cortex control? | Vision |
| Where is Broca's area and what is it for? | Frontal lobe, it is used for Expression. |
| Where is Wernicke's area and what is it for? | Temporal-Parietal, it is Receptive. |
| If a person has APHASIA, what part of the brain is damaged? | Cerebral Cortex - Broca's Area |
| If a pt has Central Neurogenic Hyperventilation (continuous hyperventilation)what part of the brain is damaged? | Midbrain |
| If a pt has Ataxic breathing (Biot's)- irregular irregularity in pattern w/ long periods of apnea, shallow depth, what part of the brain is damaged? | Medulla |
| What part of the brain controls ALTERED SHORT TERM MEMORY? | Hippocampus-Temporal (Cerebral Cortex) |
| What part of the brain is affected if a pt has APHASIA? | Cerebral Cortex |
| What part of the brain is affected if a pt has Emotional Lability, irritability, restlessness? | Limbic System (Cerebral Cortex) |
| If a pt has Ipsilateral pupillary dilation first follwed by bilateral dilation what part of the brain and CN's are affected? | Midbrain CN III, IV |
| If a pt has Cushing's Triad what part of the brain is affected? | Medulla |
| What comprises Cushing's Triad? | Increased Systolic BP, Wide Pulse Pressure, Bradycardia |
| If a pt has extensor (decebrate) posturing and/or pinpoint pupils, what part of the brain is affected? | Upper Pons |
| What part of the brain is responsible for Emotional Stability? | Cerebral Cortex |
| If a pt has Cheynes-Stokes Resperations w/ alternating apnea, what part of the brain is affected? | Cerebral Cortex |
| Are Cerebellar signs typically seen w/ a lesion causing IICP? | No unless the lesion is in the cerebellar lobes. |
| What are classic manifestations of cerebellar involvement? | Ipsilateral balance and Equilibrium disturbances. |
| If a pt has a wide-based gain (ataxic gait), intention tremors, and abnormal Romberg's sign what part of the brain is affected? | Cerebellum |
| Do signs of IICP secondary to basilar skull fracture present themselves in typical Cephalocaudal progression? | No |
| What is a normal ICP? | 5-15mm Hg |
| What causes normal fluctuations of ICP? | Respirations, BP changes, intrathoracic pressure changes |
| What is the Monro-Kellie Hypothesis? | An expansion of CSF, Blood, OR Brain Tissue requires a decrease in the other two to maintain a normal ICP. |
| What is the first to shift, CSF, Blood, or Brain? | CSF |
| What is the last to shift, CSF, Blood, or Brain? | Brain |
| What occurs if there is DECOMPENSATION? | Herniation |
| What are some variable that affect IICP? | Acuteness/Degree of injury, area of brain, age, co-morbidities, promptness of intervention |
| What is more likely to occur if there is a slower IICP? | Compensation and autoregulation |
| What are the etiologies of IICP? | ↑Brain Mass, ↑Blood, ↑CSF |
| What causes an ↑ in Brain mass? | Edema and tumors |
| What are some causes of brain edema? | Surgery/trauma, infection/inflammation, ischemia, infarct |
| What is the Tentorium? | An extension of the dura mater that separates the cerebellum from the inferior portion of the occipital lobes. |
| What is the Supratentorium comprised of? | Frontal, parietal, temporal, and occipital lobes |
| What is the Infratentorium comprised of? | Pons, Medulla, Brainstem, spinal cord, cerebellum |
| What are the S/S of Meningitis? | IICP, severe HA, photophobia, irritability, meningeal signs, papilledema, fever, petechial rash w/ meningococci |
| What are the meningeal signs? | Nuchal rigidity, Brudzinski's, Kernig's |
| What are two infections of the CNS? | Meningitis and Encephalitis |
| Do you get edema and exudate in meningitis or encephalitis? | Meningitis |
| What is the 3rd cause of death and the leading cause of disability in the USA? | CVA |
| What are characteristics of a TIA? | Focal deficit, NO deficit after 24 hrs (REVERSIBLE), high risk for CVA |
| What are characteristics of a CVA? | Sudden focal neuorological deficit >24hrs, infarcted zone (IRREVERSIBLE) surrounded by ischemic zone due to lack of 02 >4-5 minutes. |
| What is another name for an Ischemic Zone in a CVA? | Penumbra |
| What is a Penumbra? | An Ischemic zone around the infarction which can expan to and infarction. |
| Can a Penumbra be seen on the CT Scan? | No |
| What are CVA etiologies? | Thrombus, Embolus, Hemorrhage (less common) |
| What may cause an Embolus in a CVA? | Plaque, fat, air, tumor, amniotic fluid |
| Is an Embolus rapid or slow? | Rapid |
| What are the Hallmarks of a CVA caused by a Hemorrhage? | HA precedes |
| Where is the bleeding usually located in a CVA caused by a Hemorrhage? | Epidural, subdural, subarachnoid |
| What is the risk of rebleed in an Aneurysm? | 4-7 days and Vasospasm |
| What is the #1 risk for TIA/CVA risks? | HTN |
| What is the Emotional center of the brain called? | Limbic System |
| What is Homonymous Hemianopsia? | A type of partial blindness resulting in a loss of vision in the same visual field of both eyes. |
| What type of deficit will a pt have if they experience a left sided stroke? | Speech Deficit |
| Where is Broca's area? | Frontal Lobe |
| If a pt has EXPRESSIVE APHASIA/DYSPHASIA, what part of the brain is affected? | Broca's area, Frontal Lobe |
| If a pt has RECEPTIVE APHASIA/DYSPHASIA what part of the brain is affected? | Wernicke's are, Temporal & Parietal Lobes |
| If a pt has a loss of comprehension of what is seen and heard what part of the brain is affected? | Wericke's area |
| If a pt has a loss of verbal and written skills what part of the brain is affected? | Broca's area |
| What is a GLOBAL deficit? | Deficit in RECEPTIVE and EXPRESSIVE articulation. |
| What causes IICP due to ↑ Blood? | Hemorrhage, Hematomas, Altered Gases, HTN, Hypotension, ↓Jugular Venous drainage |
| What can occur if BP <100mmHg? | ↓CPP |
| What can occur if systolic is >160? | ↓CPP |
| What does a ↓02 cause? | Cerebral Vasodilation |
| What does a ↑CO2 cause? | Cerebral Vasodilation |
| What causes IICP due to ↑CSF? | Hydrocephalus |
| What causes Hydrocephalus? | Obstruction of flow, ↑production of CSF, ↓reabsorption of CSF |
| If a child has IICP due to ↑CSF before the sutures are closed what occurs to the skull? | the Skull Expands |
| What is a normal CPP? | 70-100 |
| How do you get the value of CPP? | MAP-ICP (MEAN ARTERIAL PRESSURE - CEREBRAL PERFUSION PRESSURE) |
| What are the S/S of Stage I Intracranial Compensation/Decompensation? | None |
| What are the characteristics of Stage I Intracranial Compensation/Decompensation? | Vasoconstricion, external compression of venous system, CSF displacement + autoregulation |
| What is AUTOREGULATION in Stage I Intracranial Compensation/Decompensation? | Instrinsic ability of tissues to regulate own blood flow to meet metabolic needs when altered by ICP by altering size of vessels. |
| What are the characteristics of Stage II of Compensation? | Compensation and autoregulation continues, systemic arterial vasoconstriction |
| What are the Early signs of Stage II of Compensation? | Mainly LOC changes (confusion, restlessness, irritability, lethargy) |
| How doe PERRL and VS look like in Stage II of Compensation? | WNL |
| What is Stage III? | Beginning Decompensation |
| What is characteristic of Stage III beginning decompensation? | ↑ICP (compresses cerebral vessels) = ↓CPP (<70mmHg) = ischemia and acidosis |
| If there is ↓CPP what is obviously occurring to the vessels? | They are being compressed. |
| What occurs due to Brain Hypoxia and Hypercapnia in Stage III Beginning Decompensation? | Vasodilation |
| What are the manifestations of Stage III Beginning Decompensation? | ↓LOC, small reactive pupils, altered respiratory patterns, widened pulse pressure (↑systolic), bradycardia |
| What type of breathing is seen in Stage III Beginning Decompensation? | Cheyne-Stokes, Neurogenic Hyperventilation |
| What occurs in Stage IV? | Decompenstation Herniation |
| How does Herniation occur? | From are of >PRESSURE to <PRESSURE and usually downward toward tentorium |
| What occurs if A waves (PLATEAU WAVES) are > 4-5 minute? | Brain Damage |
| What are the manifestations of Stage IV Decompensation Herniation? | Progressive ↓LOC, ipsilateral dilation to bilateral dilation/fixation, Neurongenic Hyperventilation to ATAXIC BREATHING, Cushing's Triad |
| What is Cushing's Triad? | ↑systolic BP, widened pulse pressure, bradycardia, = progressing to ventricular asystole |
| What type of pupillary change is the worst? | Fixed and Dilated |
| What is ipsilateral dilation? | Uneven pupil size |
| Name the five abnormal respiratory patterns from good to worse. CNACA | Cheyne-Stokes, Central Neurogenic Hyperventilation, Apneustic breathing, Cluster breathing, Ataxic breathing |
| What is the most common type of Herniation? | Downward & Lateral |
| Name the signs of IICP BELOW THE CORTEX. | Progressive pupillary signs, diencephalon signs, progressive respiratory signs, progressive posturing signs |
| What does the term DERCORTICATE mean? | Pressure at the Cortex |
| What does the term DECEREBRATE mean? | Pressure moving down MIDBRAIN (Worst) |
| What indicates Decorticate injury? | Flexor posturing |
| What indicates Decerebrate injury? | Extensor posturing |
| What does FLACCIDITY indicate? | No response (coma - gravest sign) |
| What is a normal score in the Glasgow Coma Scale (GCS)? | 15 |
| What score indicates COMA in the Glasgow Coma Scale (GCS)? | 7 or less |
| Name two variations in Herniation. | Cerebellar involvement and Basilar Skull Fracture |
| Name the characteristics of Cerebellar involvement in Herniation. | Ipsilateral loss of balance/equillibrium, ataxic gait, intention tremor, abnormal Romberg's sign |
| Name the characteristics of a Basilar Skull Fracture involvement in Herniation. | Lateral deviation of pressure, CEPHALOCAUDAL progressive signs NOT SEEN |
| If an injury occurs on the Cerebellum, what part of the pt's body is affected? | The same side of the injury. |
| If an injury occurs on the Cortex, what part of the pt's body is affected? | The opposite side of the injury. |
| Describe the Vegetative State. | Cerebral Death, brainstem fxn's still intact, no purposeful responses, doll's eyes |
| Describe Brain Death. | Irreversible cessation of the ENTIRE BRAIN, flat EEG for 6 hrs, absence/abnormal responses to doll eyes |
| Define a seizure. | Sudden alteration in discharge of cerebral neurons, ALTERED BRAIN FXN W/ VARIABLE EXPRESSION |
| Name a SEIZURE RISK. | Any disorder that alters neuronal environment. |
| What are the types of seizures? | Partial, Generalized, Status Epilepticus |
| Name the Generalized Seizure types. | Absence, myoclonic, tonic-clonic |
| Name the Partial Seizure types. | Jacksonian, psychomotor |
| How does an INCREASING SPINAL CORD INJURY manifest itself? | As an ASCENDING DYSFUNCTION |
| Is INFARCTION reversible? | No |
| Is ISCHEMIA reversible? | Yes |
| Is edema in the spinal cord life threatening? | Yes |
| What are the two types of Nerve Tracts in the Spinal Cord? | Ascending and Descending |
| What are ASCENDING tracts responsible for? | Sensory, Pain, Temperature |
| What does the Lateral Spinothalmic tract control? | Pain and Temperature |
| What are the DESCENDING tracts responsible for? | Motor, Pyramidal tract, Voluntary Skeletal Muscles |
| What is another name for the PYRAMIDAL TRACT? | Lateral Corticospinal Tract |
| If there is an injury to C 1-2 (odotoid) what occurs? | Either Neurologically intact OR death |
| What vertebrae need to be affected for QUADRAPLEGIA? | C 3-8 and T 1 |
| What is C 3-4 responsible for? | Phrenic Nerve, Neck, Scapula |
| What is C 5-6 responsible for? | Deltoid/biceps/DTR fxn |
| What is C 6-7 responsible for? | Triceps/DTR fxn |
| What is C8 - T1 responsible for? | Finger fxn |
| What is affected in Paraplegia? | S 1-2, Thoracic/Lumbar vertebrae |
| What is S 1-2 responsible for? | Neurogenic bladder/bowel/sexual/DTR dsyfxn |
| What is Neurogenic shock? | Sever SPINAL SHOCK |
| What occurs in spinal shock/neurogenic shock? | loss of ALL NEURONAL MESSAGES BELOW area of lesion |
| How long does spinal shock last? | Days to months |
| What signifies the end of the spinal shock? | a Return of Reflexic action (Hyperreflexia, spasms, bladder emptying, erection) |
| What occurs ANYTIME spinal shock is over? | Autonomic Dysreflexia (Hyperreflexia) |
| What is a risk of Autonomic Dysrelfexia (Hyperreflexia)? | Cord damage at or above T 7 |
| What is the Pathology of Autonomic Dysreflexia (Hyperreflexia)? | Massive, uncompensated cardiovascular response to SNS stimuli |
| What type of BP is seen in Autonomic Dysreflexia (Hyperreflexia)? | BP > 300mmHg |
| What type of nerves pick up pain first? | Afferent Peripheral nerves |
Created by:
jesusrvillarreal
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