EXAM 3 NEURO MEMORIZE Flashcards
what are the basic cells of the nervous system
neurons
what are the 4 parts (and the function of each part) of a neuron
cell body (norm cell function)
dendrites(where neurons receive info from other neurons)
synaptic knobs (where info leaves)
axon (tail where impulse is created from cell membrane that travels down the axon. it’s covered in myelin sheath to help conduct info down the axon)
why do we need a myelin sheath?
fast communication between peripheral NS and central NS
What is a sensory neuron
Gives info to the CNS
What are motor neurons
Helps us move
What’s different about association neurons vs. motor/sensory
Association neurons: most of CNS. They ‘ directly cause sensation or movement, but help process/create info
The recovery of the peripheral NS depends on…
where the damage occurs. Don’t expect a full recovery.
Crush injuries have a better recovery than cuts
What are neuroglia
Neuron support cells
What are neurotransmitters
Chemicals released by the synaptic knobs at the tail-end of neurons to spread correct information.
They pass through the “post-synaptic cleft” and are picked up by the dendrites of other neurons
They are taken into specific receptors of the dendrites of other neurons which changes the dendrites permeability (causes excitation or inhibition)
What makes up the Central Nervous System (CNS)
Brain and spine
What does the fore-brain do?
Is responsible for motor sensation, vision, visceral activities, thinking, and movement
What does contralateral control mean
the right brain controls the left side of the body, the left side controls the right side of the body
the substantia nigra produces
dopamine
What does the mid-brain do
Coordinates visual/motor movements, produces hormones in the pituitary gland, the substantia nigra produces dopamine
What does the hind brain do?
in charge of balancing and autonomic activity. Includes the brainstem (auto) and cerebellum (balance) IPSILATERAL CONTROL (controls the same side it’s on)
If the hind brain is injured on the left side, what side of the body is affected?
The left side. The hind brain consists of the cerebellum and brain stem. If the cerebellum is injured on the right side, the right side of the body will struggle to maintain balance. If the brain stem in injured on the left side, the left side will experience breathing and GI issues.
What are the 5 divisions fo vertebrae?
cervical, thoracic, lumbar, sacral, and coccygeal
Describe the 3 protective structures of the brain
Dura mater: hard outer layer of skull
Arachnoid mater: web-like hard structure below dura
Pia mater: adhered to brain/spinal cord to provide structural support for passing blood vessels
Describe the function of the blood brain barrier
Selective permeability to H2O, CO2, and O2
Keeps plasma proteins and non-lipid soluble molecules out
How many spinal nerves are in the peripheral nervous system
31
Are cranial nerves a part of the central or peripheral NS?
Peripheral, even though the cranial nerves come off of the brain
Does the autonomic NS include the peripheral or central NS?
Both.
Regulates HR, RR, and digestion
What are the two parts of the autonomic NS
sympathetic and parasympathetic
Describe the sympathetic NS
otherwise known as the “fight or flight” system
it increases metabolism and output
Describe the parasympathetic NS
Otherwise known as “feed and breed” system
slows everything down after a stimulus including HR, RR, and BP. It increases blood flow to the digestive areas
What 2 things influence pressure and perfusion in the brain?
Intercranial pressure (ICP)
Cerebral Perfusion Pressure (CPP)
Describe intercranial pressure (ICP)
the pressure against the cranial valve.
The normal pressure is 5-15mmHg
ANYTHING ABOVE 20 IS BAD
You need an invasive tool to get this measurement
Describe Cerebral Perfusion Pressure (CPP)
(MAP)-(ICP)=CPP
CPP is the pressure required to perfuse the brain cells
IF CPP GETS BELOW 60 WORRY
How do you calculate CPP
(MAP)-(ICP)=CPP
What generally causes low CPP
Decreased MAP or Increased ICP
Describe stage 1 of the 4 compensatory stages of increasing ICP
Sx: restlessness and lethargy
Describe stage 2 of the 4 compensatory stages of increasing ICP
signs of neurological hypoxia
Symptoms include inattentiveness, poor judgment, memory loss, and a decrease in motor coordination
Describe stage 3 of the 4 compensatory stages of increasing ICP
Sx: difficulty staying awake, pinpoint pupils, slow breathing, increasing sys/dia BP space, decreased HR but bounding pulse
Describe stage 4 of the 4 compensatory stages of increasing ICP
Sx: CUSHINGS TRIAD (bradycardia, hypertension, irregular respirations), eyes begin to dilate (may be one at a time), Cheyne-Stokes breathing, both sys/dia BP starts going down, irregular pulse last minute
pt is near death, surgery may do nothing
Stage 4 of increased ICP is indicative of
Brain herniation
How do you decrease ICP
Tx osmotic diuresis (Mana+1 Rx: diuretic that crosses the blood/brain barrier)
Infuse hypertonic solution (1,2,3% saline) which causes fluid to go into the vascular space
Craniotomy (skull removal, might use a drain)
What can cause cerebral edema?
trauma, infection, ischemia can all cause the death of tissue which increase inflammation in the brain
Decreased serum Na leads to increased ICP, decreased MAP which means decreased CPP
What are the 3 categories of neurological concepts
Pain, cognition, and motors/sensory issues
What is the best way to diagnose neurological issues
Depends, a CT is faster but an MRI is clearer
What are the 3 types of pain?
Somatic (muscle, bone, skin, joint)
Visceral (internal organs, poorly localized)
Referred pain (pain distant from the point of origin, Ex: gall bladder pain in the shoulder)
What is the difference between acute and chronic pain
Acute: lasts seconds-months, sudden onset, improves w/ removal of chemical moderators, SX INCLUDE INCREASED BP/HR AND SWEATING
Chronic: Lasts 3-6 months Sx INCLUDE PSYCH ISSUES, NOT SYMP NS SX
Describe the 3 steps to feeling pain
Step 1 (TRANSDUCTION): Naceptorose receptors in the PNS sense chem/mech/therm injury
Step 2 (TRANSMISSION): Naceptorose receptors send info to spinal cord where info is regulated into different parts which causes to to Ex: quickly take hand away, decides if pain should be amplified
Step 3 (PERCEPTION): spinal cord sends info to brain where brain perceives, characterizes, locates, and further describes it
What are the 2 chemicals that affect perception of pain
Neurotransmitters (serotonin, dopamine, endogenous opioids)
Mu receptors: Opioid receptors
What is the difference between COX 1 and 2
Both are prostaglandins
1: produces clotting factors and provides gastric protection
2: facilitates pain perception and fevers
What is the difference between First Gen NSAIDs and Second Gen NSAIDs?
First Gen: Inhibits both COX 1 and 2 prostaglandins, causing decreased clotting, gastric ulcers, as well as decreased fever and pain perception
Second Gen: Only inhibits COX 2 so only decreases fever/pain perception, BUT causes blood clots, high BP, and is teratogenic
T/F: Acetaminophen is best used to decrease inflammation
FALSE: It does not decrease inflammation, just pain perception. It also doesn’t affect platelets
Although Tylenol doesn’t affect platelets, how can it thin the blood
It increases the effects of warfarin
What’s Tramadol
Inhibits the Mu (opioid) receptors AND inhibits the reuptake of norepinephrine/serotonin which decreases to transmission of pain perception
Can cause similar Sx of opiod overdose in large amounts
Won’t feel the effects until 1 hour after taking
Don’t take if you’re on psych meds
Name an opioid agonist and antagonist
Agonist: Morphine
Antagonist: Noloxone
What’s Morphine
a synthetic opioid that bonds to Mu receptors and mimics endorphins.
Can decrease cough but makes BP meds worse
What are the 2 distinct components of consciousness
Arousal (moderated by reticular activating system) and Awareness (thoughts mediated by attention, memory, language, and executive systems)
Name 2 disorders of arousal
Locked-in syndrome: fully conscious but can’t communicate except through blinking
Akinetic Mutism: can’t communicate because all voluntary movements don’t work
What is the difference between delirium and dementia
Delirium is reversible whereas dementia is not.
T/F: If your geriatric pt is expereincing a servere episode of deliruim, a benzo is the best Rx
False, it might get stuck in their system and they’ll have bad resp/hr depression
What orders would you expect for a patient that has a new episode of delirium
liver function test, renal labs, ABGs, drug toxic, electrolytes, CT, MRI, LP
What are the 3 types of dementia
Alzheimer’s, Vascular dementia, temporal dementia
Describe Alzheimer’s
memory loss, disorientation, leading cognitive disorder in older adults
Caused by extracellular plaques that cause cell dysfunction, inflammation, and blockages in the vasculature of the brain
ALSO
Neurons that make acetylcholine (neurotransmitter that plays a role in memory, learning, attention, arousal and involuntary muscle movement) become damaged
How do you Dx Alzheimers
MRI reveals enlarged vasculature on a small brain
What medications do you give a pt for Alzheimers
Colonesterase inhibitors
NMDA receptor antagonists
How do focal/global seizures happen
shift in neuron polarity d/t Na channels opening up easily and
What is the clonic phase of a seizure
rapid, jerking movement
What is the tonic phase of a seizure
stiffening of muscles
Describe the pathology of brain injury during a seizure
Brain needs more blood flow d/t rapid use of glucose and O2 (which causes increased lactate biproduct). This results in brain inflammation, as well as increased levels of destructive lactate
What causes seizures
excitable fevers, hypoglycemia, hypo/hypernatremia, drugs, blinking lights, odors, trauma
T/F: A patient is having a seizure if the are mentally altered but can still respond to questions, although slowly
False, the patient is not in the midst of a true seizure if they can talk
What labs should you run in the ictal phase to find the cause of the seizure?
Glucose, Ca, BUN, Creatine as these all effect the brain and could be from something like renal failure
Is valproic acid an anti-epileptic drug?
No, it is not an “AED”, but it does treat certain types of seizures
Whats phenytoin
Stops Na from going into cells which can cause significant CNS depression (NO OTHER DEPRESSANT MEDS @ SAME TIME)
Whats carbamazepine
Stops Na from going into cells BUT you shouldn’t give to sick people because it decreases bone marrow, causes skin issues, and makes people photosensitive. Also affects your hormones and will make you have a false positive pregnancy test.
When would you use valproic acid
For tonic/clonic seizure. Stops both Ca and Na from going into cells so you need to monitor the patient’s bones and liver
What neurotransmitter is most involved in the Sx of Parkinsons
dopamine
When do Parkinsons Sx appear
When at least 78% of substantia nigra (basal ganglia on SN produce dopamine) is destroyed
What are some suspected causes of parkinsons?
Alzeihmers, old males, calcium channel blockrs, anti-psychotics, gi motility drugs
Describe the progression of parkinsons Sx
In the early stages you have difficulty sleeping/lose concentration easily. It progresses to hallucinations, loss of smell, dementia, and eventually dysphagia
Are manifestations of parkinsons always on both sides of the body or does it have to be bilateral?
Has to be bilateral
Whats levodopa/carbidopa for
Parkinson’s. Levodopa is the precursor to dopamine creation and Carbidopa protects Levodopa from being destroyed so dopamine levels can rise
What are the side effects for levodopa/carbidopa
Makes your sweat and urine dark AND causes GI issues that makes Parkinsons Sx worse at first, but improve after 6 months.
Be wary or orthostatic hypotension. DONT EAT A LOT OF PROTEIN
What does Pramipexole do
mimics action of dopamine. tkae with food
What does Selegiline (MAOI inhib) do
MAOB inhibits dopamine, so we inhibit MAOB.
Has to be given with Levo/Carbi
Can cause insomnia and hypertensive crisis
Don’t take with psych meds
What is ALS (Amyotrophic Lateral Sclerosis)
The progressive loss of upper/lower extremity motor function
Lu Gerricks Disease: Athletes disease from repeated head injury
3-5 years left to live after Dx. Fully cognitively aware, but slowly loses the ability to breath/swallow on their own. Can only slow with ROLORZOLE Rx.
Demyelinating disorders are also known as
Multiple Sclerosis
What is multiple sclerosis
Progressive autoimmunity against the myelin sheath
Sx: vision changes (aka, diplopia), memory issues, slurred speech, paresthesia, incontinence, weakness, balance issues, depression/anxiety
How do you Dx Multiple Sclerosis
Dx: MRI and CSF analysis
How do you Tx Multiple Sclerosis
Immunosuppressants slow the progression and corticosteroids during flares (trauma, stress, pregnancy, fever/hot outside)
T/F: Multiple sclerosis can lead to dementia
true, if not treated w/ anti-immun/inflamm
Whats the difference between a primary and secondary tbi
Primary: direct force caused a brain injury
Secondary: further injury caused by body’s response to heal the injury (inflammation/edema increases ICP)
When is a brain injury considered to the the result of closed “blunt trauma”
Injury to brain from coup/counter coup
Whats the difference between coup and counter-coup
Whiplash
First Countercoup: Injury to brain on the opposite side
Then Coup: Injury to brain on same side of rotary/forward force
Describe open/penetrating trauma
Fractured skull (break in dura) that exposes brain
Describe the epidural hematoma
Injury to the top of the duramater which results in an ARTERIAL bleed.
Sx: include losing consciousness at accident, then regaining consciousness and seeming mostly fine, then losing consciousness again a few hours later
Describe a subdural hematoma
Injury below the duramater than causes venous vessel damage.
Sx: include a slower build the LOC rather than dramatic loss of consciousness.
Common for people on blood thinners (Old people_
Describe an Intracerebral hematoma
The brain is bleeding internally (hematoma/hemorhage)
Sx: LOC change is slow
Describe a Diffuse Axonal Injury
Massive axon damage (axon shearing) where axons are torn off their neurons in a “diffuse” (large area) injury
Describe the physiological changes that happen as the brain becomes more edematous
Depolarization of neuron membranes, Ca overload inside of cells which hurt cell organelles, makes the blood brain barrier more permeable to stuff it usually filters out because it causes inflammation, sever increase in ICP that could result in herniation
How do you read a Glasglow Coma Scale rating
15 is fine. he closer you get to a rating of 1 the worse you are
What are characteristic later signs of a TBI?
Bradypnea and decorticate/decerebrate posturing
Cushings triad (increased BP, little pupil response, THEN wide pulse pressure, bradycardia, and irregular breathing)
What medications should you avoid taking if you think you have a TBI
benzos and corticosteroids
What are some Sx of post-concussion syndrome
head injury after concussion dx, seizure, ischemic changes
What level of spinal injury causes decreased diaphragmatic function
C2-C3
Whats the difference between Paraplegia and Tetraplegia
Paraplegia is bilateral appendage not working (both legs not works OR both arms not working)
Tetraplegia is all four limbs are not responding (from c-spine injury)
Tx for Paraplegia and Tetraplegia
immobilization, steroids, therapeutic hypothermia
Whats the difference between a spinal shock and autonomic dysreflexia
Spinal shock is the complete loss of autonomic functions (pee themselves, placid paralysis, hypothermic, hypotensive)
Autonomic dysreflexia is injury to T6 or above and their parasympathetic system doesn’t work SO they can still feel painful stimuli which just causes their HR/BP to go up and up until you remove the painful stimuli
Whats another way to say stroke
cerebral vascular disorder
What are the 3 types of strokes
hemorrhagic, ischemic, and cryptogenic
Describe an ischemic stroke
An embolus from somewhere or a thrombus forms locally which decreases/occludes blood flow in some vessel in the brain. Whatever tissue the vessel was feeding becomes necrotic and damages other nearby well-fed cells
Describe a hemorrhagic stroke
Same pathology as ischemia but MOI is a RUPTURE of a vessel instead of occlusion. Its usually caused by hypertension and weak vessels combo. Also A-fib, atherosclerosis of the carotid artery, heart valve injury, tumor, and prolonged cocaine use.
Describe some Sx specific to stroke
Receptive aphasia (can’t understand things), expressive aphasia (can’t express things), tongue deviation, paralysis of half of body
Then the usual altered LOC, weird pup responses, altered speech
Whats the best way to Dx a stroke
MRI/CT with an angiogram
Whats the difference in treatment between ischemic and hemorrhagic strokes
Ischemic give TPN to break up clot, which could turn into a hemorrhagic stroke but whateva
DO NOT give TPN to hemorrhagic strokes unless you want a herniated brain
