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2 PATHOPHARM > EXAM 3 NEURO MEMORIZE > Flashcards

EXAM 3 NEURO MEMORIZE Flashcards

1
Q

what are the basic cells of the nervous system

A

neurons

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2
Q

what are the 4 parts (and the function of each part) of a neuron

A

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)

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3
Q

why do we need a myelin sheath?

A

fast communication between peripheral NS and central NS

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4
Q

What is a sensory neuron

A

Gives info to the CNS

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5
Q

What are motor neurons

A

Helps us move

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6
Q

What’s different about association neurons vs. motor/sensory

A

Association neurons: most of CNS. They ‘ directly cause sensation or movement, but help process/create info

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7
Q

The recovery of the peripheral NS depends on…

A

where the damage occurs. Don’t expect a full recovery.

Crush injuries have a better recovery than cuts

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8
Q

What are neuroglia

A

Neuron support cells

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9
Q

What are neurotransmitters

A

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)

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10
Q

What makes up the Central Nervous System (CNS)

A

Brain and spine

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11
Q

What does the fore-brain do?

A

Is responsible for motor sensation, vision, visceral activities, thinking, and movement

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12
Q

What does contralateral control mean

A

the right brain controls the left side of the body, the left side controls the right side of the body

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13
Q

the substantia nigra produces

A

dopamine

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13
Q

What does the mid-brain do

A

Coordinates visual/motor movements, produces hormones in the pituitary gland, the substantia nigra produces dopamine

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14
Q

What does the hind brain do?

A

in charge of balancing and autonomic activity. Includes the brainstem (auto) and cerebellum (balance) IPSILATERAL CONTROL (controls the same side it’s on)

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15
Q

If the hind brain is injured on the left side, what side of the body is affected?

A

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.

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16
Q

What are the 5 divisions fo vertebrae?

A

cervical, thoracic, lumbar, sacral, and coccygeal

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17
Q

Describe the 3 protective structures of the brain

A

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

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18
Q

Describe the function of the blood brain barrier

A

Selective permeability to H2O, CO2, and O2

Keeps plasma proteins and non-lipid soluble molecules out

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19
Q

How many spinal nerves are in the peripheral nervous system

A

31

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20
Q

Are cranial nerves a part of the central or peripheral NS?

A

Peripheral, even though the cranial nerves come off of the brain

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21
Q

Does the autonomic NS include the peripheral or central NS?

A

Both.

Regulates HR, RR, and digestion

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22
Q

What are the two parts of the autonomic NS

A

sympathetic and parasympathetic

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23
Q

Describe the sympathetic NS

A

otherwise known as the “fight or flight” system

it increases metabolism and output

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24
Q

Describe the parasympathetic NS

A

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

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25
Q

What 2 things influence pressure and perfusion in the brain?

A

Intercranial pressure (ICP)

Cerebral Perfusion Pressure (CPP)

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26
Q

Describe intercranial pressure (ICP)

A

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

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27
Q

Describe Cerebral Perfusion Pressure (CPP)

A

(MAP)-(ICP)=CPP

CPP is the pressure required to perfuse the brain cells

IF CPP GETS BELOW 60 WORRY

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28
Q

How do you calculate CPP

A

(MAP)-(ICP)=CPP

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29
Q

What generally causes low CPP

A

Decreased MAP or Increased ICP

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30
Q

Describe stage 1 of the 4 compensatory stages of increasing ICP

A

Sx: restlessness and lethargy

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31
Q

Describe stage 2 of the 4 compensatory stages of increasing ICP

A

signs of neurological hypoxia

Symptoms include inattentiveness, poor judgment, memory loss, and a decrease in motor coordination

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32
Q

Describe stage 3 of the 4 compensatory stages of increasing ICP

A

Sx: difficulty staying awake, pinpoint pupils, slow breathing, increasing sys/dia BP space, decreased HR but bounding pulse

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33
Q

Describe stage 4 of the 4 compensatory stages of increasing ICP

A

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

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34
Q

Stage 4 of increased ICP is indicative of

A

Brain herniation

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35
Q

How do you decrease ICP

A

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)

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36
Q

What can cause cerebral edema?

A

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

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37
Q

What are the 3 categories of neurological concepts

A

Pain, cognition, and motors/sensory issues

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38
Q

What is the best way to diagnose neurological issues

A

Depends, a CT is faster but an MRI is clearer

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39
Q

What are the 3 types of pain?

A

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)

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40
Q

What is the difference between acute and chronic pain

A

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

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41
Q

Describe the 3 steps to feeling pain

A

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

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42
Q

What are the 2 chemicals that affect perception of pain

A

Neurotransmitters (serotonin, dopamine, endogenous opioids)

Mu receptors: Opioid receptors

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43
Q

What is the difference between COX 1 and 2

A

Both are prostaglandins

1: produces clotting factors and provides gastric protection

2: facilitates pain perception and fevers

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44
Q

What is the difference between First Gen NSAIDs and Second Gen NSAIDs?

A

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

45
Q

T/F: Acetaminophen is best used to decrease inflammation

A

FALSE: It does not decrease inflammation, just pain perception. It also doesn’t affect platelets

46
Q

Although Tylenol doesn’t affect platelets, how can it thin the blood

A

It increases the effects of warfarin

47
Q

What’s Tramadol

A

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

48
Q

Name an opioid agonist and antagonist

A

Agonist: Morphine

Antagonist: Noloxone

49
Q

What’s Morphine

A

a synthetic opioid that bonds to Mu receptors and mimics endorphins.

Can decrease cough but makes BP meds worse

50
Q

What are the 2 distinct components of consciousness

A

Arousal (moderated by reticular activating system) and Awareness (thoughts mediated by attention, memory, language, and executive systems)

51
Q

Name 2 disorders of arousal

A

Locked-in syndrome: fully conscious but can’t communicate except through blinking

Akinetic Mutism: can’t communicate because all voluntary movements don’t work

52
Q
A
53
Q

What is the difference between delirium and dementia

A

Delirium is reversible whereas dementia is not.

54
Q

T/F: If your geriatric pt is expereincing a servere episode of deliruim, a benzo is the best Rx

A

False, it might get stuck in their system and they’ll have bad resp/hr depression

55
Q
A
56
Q

What orders would you expect for a patient that has a new episode of delirium

A

liver function test, renal labs, ABGs, drug toxic, electrolytes, CT, MRI, LP

57
Q

What are the 3 types of dementia

A

Alzheimer’s, Vascular dementia, temporal dementia

58
Q

Describe Alzheimer’s

A

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

59
Q

How do you Dx Alzheimers

A

MRI reveals enlarged vasculature on a small brain

60
Q

What medications do you give a pt for Alzheimers

A

Colonesterase inhibitors

NMDA receptor antagonists

61
Q

How do focal/global seizures happen

A

shift in neuron polarity d/t Na channels opening up easily and

62
Q

What is the clonic phase of a seizure

A

rapid, jerking movement

63
Q

What is the tonic phase of a seizure

A

stiffening of muscles

64
Q

Describe the pathology of brain injury during a seizure

A

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

65
Q

What causes seizures

A

excitable fevers, hypoglycemia, hypo/hypernatremia, drugs, blinking lights, odors, trauma

66
Q

T/F: A patient is having a seizure if the are mentally altered but can still respond to questions, although slowly

A

False, the patient is not in the midst of a true seizure if they can talk

67
Q

What labs should you run in the ictal phase to find the cause of the seizure?

A

Glucose, Ca, BUN, Creatine as these all effect the brain and could be from something like renal failure

68
Q

Is valproic acid an anti-epileptic drug?

A

No, it is not an “AED”, but it does treat certain types of seizures

69
Q

Whats phenytoin

A

Stops Na from going into cells which can cause significant CNS depression (NO OTHER DEPRESSANT MEDS @ SAME TIME)

70
Q

Whats carbamazepine

A

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.

71
Q

When would you use valproic acid

A

For tonic/clonic seizure. Stops both Ca and Na from going into cells so you need to monitor the patient’s bones and liver

72
Q

What neurotransmitter is most involved in the Sx of Parkinsons

A

dopamine

73
Q

When do Parkinsons Sx appear

A

When at least 78% of substantia nigra (basal ganglia on SN produce dopamine) is destroyed

74
Q

What are some suspected causes of parkinsons?

A

Alzeihmers, old males, calcium channel blockrs, anti-psychotics, gi motility drugs

75
Q

Describe the progression of parkinsons Sx

A

In the early stages you have difficulty sleeping/lose concentration easily. It progresses to hallucinations, loss of smell, dementia, and eventually dysphagia

76
Q

Are manifestations of parkinsons always on both sides of the body or does it have to be bilateral?

A

Has to be bilateral

77
Q

Whats levodopa/carbidopa for

A

Parkinson’s. Levodopa is the precursor to dopamine creation and Carbidopa protects Levodopa from being destroyed so dopamine levels can rise

78
Q

What are the side effects for levodopa/carbidopa

A

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

79
Q

What does Pramipexole do

A

mimics action of dopamine. tkae with food

80
Q

What does Selegiline (MAOI inhib) do

A

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

81
Q

What is ALS (Amyotrophic Lateral Sclerosis)

A

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.

82
Q

Demyelinating disorders are also known as

A

Multiple Sclerosis

83
Q

What is multiple sclerosis

A

Progressive autoimmunity against the myelin sheath

Sx: vision changes (aka, diplopia), memory issues, slurred speech, paresthesia, incontinence, weakness, balance issues, depression/anxiety

84
Q

How do you Dx Multiple Sclerosis

A

Dx: MRI and CSF analysis

85
Q

How do you Tx Multiple Sclerosis

A

Immunosuppressants slow the progression and corticosteroids during flares (trauma, stress, pregnancy, fever/hot outside)

86
Q

T/F: Multiple sclerosis can lead to dementia

A

true, if not treated w/ anti-immun/inflamm

87
Q

Whats the difference between a primary and secondary tbi

A

Primary: direct force caused a brain injury

Secondary: further injury caused by body’s response to heal the injury (inflammation/edema increases ICP)

88
Q

When is a brain injury considered to the the result of closed “blunt trauma”

A

Injury to brain from coup/counter coup

89
Q

Whats the difference between coup and counter-coup

A

Whiplash

First Countercoup: Injury to brain on the opposite side

Then Coup: Injury to brain on same side of rotary/forward force

90
Q

Describe open/penetrating trauma

A

Fractured skull (break in dura) that exposes brain

91
Q

Describe the epidural hematoma

A

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

92
Q

Describe a subdural hematoma

A

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_

93
Q

Describe an Intracerebral hematoma

A

The brain is bleeding internally (hematoma/hemorhage)

Sx: LOC change is slow

94
Q

Describe a Diffuse Axonal Injury

A

Massive axon damage (axon shearing) where axons are torn off their neurons in a “diffuse” (large area) injury

95
Q

Describe the physiological changes that happen as the brain becomes more edematous

A

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

96
Q

How do you read a Glasglow Coma Scale rating

A

15 is fine. he closer you get to a rating of 1 the worse you are

97
Q

What are characteristic later signs of a TBI?

A

Bradypnea and decorticate/decerebrate posturing

Cushings triad (increased BP, little pupil response, THEN wide pulse pressure, bradycardia, and irregular breathing)

98
Q

What medications should you avoid taking if you think you have a TBI

A

benzos and corticosteroids

99
Q

What are some Sx of post-concussion syndrome

A

head injury after concussion dx, seizure, ischemic changes

100
Q

What level of spinal injury causes decreased diaphragmatic function

A

C2-C3

101
Q

Whats the difference between Paraplegia and Tetraplegia

A

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)

102
Q

Tx for Paraplegia and Tetraplegia

A

immobilization, steroids, therapeutic hypothermia

103
Q

Whats the difference between a spinal shock and autonomic dysreflexia

A

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

104
Q

Whats another way to say stroke

A

cerebral vascular disorder

105
Q

What are the 3 types of strokes

A

hemorrhagic, ischemic, and cryptogenic

106
Q

Describe an ischemic stroke

A

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

107
Q

Describe a hemorrhagic stroke

A

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.

108
Q

Describe some Sx specific to stroke

A

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

109
Q

Whats the best way to Dx a stroke

A

MRI/CT with an angiogram

110
Q

Whats the difference in treatment between ischemic and hemorrhagic strokes

A

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

2 PATHOPHARM (9 decks)

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