Lecture 7+8+DLA

Question 1

area of the brain responsible for arousal

Answer 1

reticular activating system

Question 2

part of the brain for conscious awareness

Answer 2

higher-order thalamic nuclei

Question 3

part of the brain that controls the content of awareness

Answer 3

specific thalamic relay nuclei

content-specific sensory regions

Question 4

levels of unconsciousness

Answer 4

lethargic - patient is fully aroused
obtunded - patient cannot be fully aroused
stuporous - sleep-like status
comatose - no purposeful response to stimuli

Question 5

major inputs to the RAS come from???

Answer 5

association cortices 
limbic system 
sensory pathways 
thalamic reticular nucleus 
brain stem 
hypothalamus

Question 6

cholinergic pathways (consciousness)

Answer 6

The brain stem and basal forebrain cholinergic
systems work together to abolish cortical slow
wave activity and promote an alert state.

cholinergic = acetylcholine

Question 7

burst vs transmission mode (EEG)

Answer 7

burst = slow wave sleep
bursts seen on EEG

transmission = waking
single spikes seen on EEG
desynchronized

Question 8

vegetative state

Answer 8

develops after coma
loss of ability to think, speak, and respond
no awareness of environment

brainstem is still intact:
still breathe and circulate
autonomic functions

Question 9

locked-in syndrome

Answer 9

blockage of the basilar A. = pons infarction

Tetraplegia: paralysis of all voluntary muscles with
exception of vertical eye movements

are fully aware of environment
can think, remember, and see
cortical brain activity is normal usually

Question 10

brain death

Answer 10

irreversible loss of all brain functions due to a number of reasons

Ex: anoxia, ischemia, trauma, tumors,

Question 11

how to diagnose brain death

Answer 11

no response to speech, pain, or other stimuli
no spontaneous respiration
pupils are dilated, no reaction to light
no vestibulo-ocular reflex
no corneal reflex
isoelectric EEG

Question 12

what are some reasons for coma?

Answer 12

small lesions in the mesencephalon

lesion of posterior lateral hypothalamus

lesion of thalamus

impairment of both cortical hemispheres (metabolic or trauma)

mass lesion (hemorrhage or tumor)

brain stem lesion, tumor, or hemorrhage

metabolic cerebral disorder (anoxia, infection, concussion, hypoglycemia etc.)

Question 13

Glasgow coma scale

Answer 13

looks at eye opening, motor response, and verbal response.

score can be from 3 to 15

score below 8 = coma

Question 14

what kind of breathing is seen in a comatose patient with a forebrain lesion??

Answer 14

Cheyne-Stokes respiration

lots of breathes.. then nothing… then lots of breaths again

Question 15

what kind of lesion will lead to hyperventilation when in coma

Answer 15

midbrain lesion

Question 16

lesion seen in the pons.. what kind of breathing?

Answer 16

apneusis (inspiratory cramps)

Question 17

what kind of lesion will lead to ataxic breathing?

Answer 17

lower pons / upper medulla

Question 18

bilateral medullary lesion

Answer 18

respiratory arrest

Question 19

lesion in diencephalon would lead to what eye appearance?

Answer 19

both pupils are small

Question 20

pretectal lesion does what to pupils?

Answer 20

both will be large

Question 21

pons lesion does what to the pupils

Answer 21

both are very small or pinpoint

Question 22

lesion in the midbrain at mid point does what to the pupils

Answer 22

no change; stuck in midway pupil size

Question 23

CN III lesion does what to the pupils

Answer 23

one pupil is very dilated the other is normal

Question 24

anorexia nervosa

Answer 24

restriction of food that leads to a person being underweight
or having a BMI that is under 18.5 (normal is 19-25)

intense fear of gaining weight
body image disturbance (thinking they are fat)

must occur for 3 months or longer

Question 25

For anorexia nervosa you can be of two subtypes.. which are?

Answer 25

binge-eating/ purge type:
someone who recurrently will binge then purge

restricting type:
person does no recurrently binge and purge
weight loss is through dieting, fasting, and exercise

Question 26

associated features of anorexia nervosa?

Answer 26

amenorrhea (if female)
decreased sex drive
constipation
hair loss

low BMI
hypothermia, bradycardia, hypotension
lanugo (soft, fine hair)
dry brittle nails

can also have low bone density, anemia, leukopenia, and hypocholesteremia

Question 27

what associated features are seen those with the binge-purge subtype of anorexia??

Answer 27

Russell’s sign (calloused knuckles)

dental enamel erosion

salivary gland inflammation (chipmunk cheeks)

hypokalemia

Question 28

treatment for those with anorexia

Answer 28

weight gain is the first step for in-patient care

will be combined with behavioral principles to encourage weight gain (CBT)

no FDA drug

short-term is usually good, long-term prognosis is usually poor

Question 29

Bulimia nervosa

Answer 29

recurrent binge eating
recurrent inappropriate compensatory behaviors (purging/ non-purging)

these episodes must occur at least once a week for 3 months

BMI is usually normal or slightly high (unlike AN were the BMI is low)

Question 30

associated features seen in BN

Answer 30

electrolyte imbalance
enamel erosion
parotid gland enlargement (seen alot in BN)
russell’s sign

Question 31

treatment for BN

Answer 31

treatment is usually out-patient
CBT is a must
can use an antidepressant for impulse control

prognosis tend to be better compared to AN

Question 32

Binge- eating disorder

Answer 32

binge-eating is done, BUT there is not compensatory behavior

must be done 1 time per week for 3 months

Question 33

associated features with binge-eating disorder

Answer 33

usually have a higher BMI, not always

Question 34

treatment for BED

Answer 34

CBT

lisdexamfetamine

Question 35

unspecified eating disorder

Answer 35

do not meet the criteria for the other eating disorders but do have subclinical eating issues