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Pathopharm Exam 3 > Module 6: Part 2 > Flashcards

Module 6: Part 2 Flashcards

27- 52

1
Q

Spinal Cord Trauma
Chemical and metabolic changes in tissues

A

When cells die…
* release toxic excitatory amino acids
* accumulation of endogenous opiates
* lipid hydrolysis producing active metabolites
* local free radical release
⬇️
further ischemia (vasoconstriction), vascular damage, & necrosis

slower spreading disorder after initial lesion

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2
Q

Necrosis resulting from SC trauma
consumes ____% of cross-sectional cord within 4 hours of trauma and ___% within 24 hours

A

Necrosis consumes cross-sectional cord
40% within 4 hours
70% within 24 hours

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3
Q

SC trauma
Release of toxic excitatory amino acids including __

A

glutamate

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4
Q

Spinal Cord Trauma
Cord will swell, causing what dysfunction?

A
  • Can really tell if loss of function will be permanent or not
  • In cervical region may be life threatening (autonomic functions here)
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5
Q

Difference in response when you have a spinal cord lesion

A

Reflexive responses & major SNS outflow (vasospasm, HTN, pallor, pilomotor spasms)

ex: visceral distention (full bladder)
Normal:
1. Spinothalmic tract will carry impulse to brain, which determines course of action.
2. The corticospinal tract carries motor impulse to empty our bladder.

Lesion:
1. Spinothalmic tract carries impulse to lesion (T6 & up)
2. reflex stimulus to major SNS outflow (vasospasm, HTN, pallor, pilomotor spasms)
3. HTN stimulates carotid sinus receptors
4. CN IX (glosspharyngeal) stimulated
vasomotor center of medulla→vagus nerve→SA node→brady🩷
5. travels back down to lesion
(dilation, flushing, headache, sweating)

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6
Q

Degenerative disk disease (DDD)

A

Spondylolysis
* Damage/degeneration of vertebrae (pars interarticularis)
* Most common in lumbar region

Spondylolisthesis
* Degeneration of vertebrae
* Forward displacement

Spinal stenosis
* Narrowing of spinal canal; pressure on nerve(s)

Herniated intervertebral disk

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7
Q

Low back pain
how much of it is sciatica vs idiopathic

A

1% sciatica
mostly idiopathic

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8
Q

Cerebrovascular accidents (CVAs)
(3)

A

Thrombotic stroke
Arterial occlusions by thrombi formed in arteries supplying the brain/intracranial vessels

Embolic stroke
Fragments that break from a thrombus formed outside the brain

Transient ischemic attacks
type of thombotic stroke

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9
Q

What is a thrombotic stroke?

A

Arterial occlusions by thrombi formed in arteries supplying the brain/intracranial vessels

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10
Q

transient ischemic attacks are a type of (thrombotic/embolic) stroke

A

thrombotic

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11
Q

What causes an embolic stroke? Is it formed in or outside of the brain?

A

Fragments that break from a thrombus formed outside the brain

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12
Q

Hemorrhagic stroke (ICH) usually occurs where? It is more common with what condition?

A
  • Usually occurs in brain tissue
  • More common in longer term HTN
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13
Q

Lacunar stroke is defined as ____, and associated with what?

A
  • Less than 1 cm diameter in pons, basil ganglia, internal capsules
  • a/w movement disorders & autonomic function
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14
Q

Cerebral infarction
vs
Cerebral hemorrhage

A

Cerebral infarction: Ischemic or hemorrhagic
loss of blood flow & summary damage

Cerebral hemorrhage: HTN is a major cause

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15
Q

Tends to cause worsening of stroke and extension of damage

A

Tissue releases substances at it dies
can affect surrounding tissue & damage can spread

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16
Q

Intracranial aneurysm
types (5)

A
  • Saccular (berry) aneurysms
  • Fusiform (giant) aneurysms
  • Mycotic aneurysms (bacterial infection of arterial wall)
  • Traumatic aneurysms
  • Dissecting aneurysms (surgery/accident weakens arterial wall)

Anuerysm overall involves weakening of arterial wall; outpouching

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17
Q

Most common cause of aneurysm

A

HTN

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18
Q

Mycotic aneurysms

A
  1. bacterial infection of arterial wall
  2. localized damage of inner memebrane
  3. weakens walls
  4. blood leaks betwen layers of vessel = aneurysm
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19
Q

Vascular malformations

A
  • Cavernous angiomas
  • Capillary telangiectasis
  • Venous angioma
  • Arteriovenous malformation
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20
Q

Large collection of blood vessels that rarely hemorrhage

A

Cavernous angiomas

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21
Q

Vascular malformation located deep in brain

A

Capillary telangiectasis

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22
Q

Capillary telangiectasis

A
  • Dilated capillary beds with brain tissue between
  • Located deep in brain
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23
Q

Venous angioma

A

Collection of veins radiating from a central venous supply

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24
Q

Vascular malformation that is more likely to hemorrhage than others

A

Arteriovenous malformation

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25
Q

Arteriovenous malformation

A
  • Malformed vessels connecting arterial supply to venous return
  • More likely to hemorrhage than others
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26
Q

Subarachnoid hemorrhage is when…..

A

Blood escapes from defective or injured vasculature into the subarachnoid space

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27
Q

Subarachnoid hemorrhage
Manifestations

A

Kernig sign
Back and neck pain when straightening the knee with the hip and knee in a flexed position

Brudzinski sign
neck pain and increased rigidity with passive neck flexion

Used for meningitis too

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28
Q

what is kernigs sign? what is it associated with?

A

Kernig sign
Back and neck pain when straightening the knee with the hip and knee in a flexed position

subarachnoid hemorrhage clincial manifestations

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29
Q

What is Brudzinski sign? What is it a/w?

A

Brudzinski sign
neck pain and increased rigidity with passive neck flexion

subarachnoid hemorrhage clinical manifestation

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30
Q

Subarachnoid hemorrhage is associated with what 3 risk factors?

A

Smoking, alcohol, hypertension

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31
Q

Headache characterized by trigger factors and an aura

A

migraine

32
Q

Cluster headache
pattern

A

Several attacks can occur during the day for days followed by a long period of spontaneous remission

33
Q

Chronic paroxysmal hemicrania

A

Cluster-type headache that occurs with more daily frequency but with shorter duration

34
Q

Tension-type headache

A

Mild to moderate bilateral headache with a sensation of a tight band or pressure around the head

35
Q

CNS Tumors

A

Cranial tumors:
Primary intracerebral tumors (gliomas)
Primary extracerebral tumors

Spinal cord tumors:
Intramedullary tumors
Extramedullary tumors
-Intradural
-Extradural

36
Q

Primary intracerebral tumors (gliomas)
vs
Primary extracerebral tumors

A

(Cranial tumors)

Primary intracerebral tumors (gliomas)
* Astrocytoma
* Oligodendroglioma
* Ependymoma

Primary extracerebral tumors
* Meningioma
* Nerve sheath tumors
* Metastatic carcinoma

37
Q

Which is not an example of a glioma?
A) Astrocytoma
B) Meningioma
C) Oligodendroglioma
D) Ependymoma
E) None of these

A

B) Meningioma

Primary intracerebral tumors (gliomas)
* Astrocytoma
* Oligodendroglioma
* Ependymoma

Primary extracerebral tumors
* Meningioma
* Nerve sheath tumors
* Metastatic carcinoma

38
Q

Spinal cord tumor
Manifestations

A
  • Compressive syndrome
  • Irritative syndrome:
    -Sensory root irritation, pain radiates and is less localized
  • Syringomyelic syndrome:
    -Inflammation of spinal cord
    -Results in tubular cavity development in spinal cord

Intramedullary tumors

Extramedullary tumors
-Intradural
-Extradural

39
Q

what is irritative syndrome? What is it a/w?

A
  • Irritative syndrome:
    -Sensory root irritation, pain radiates and is less localized
    Spinal cord tumor Manifestations
40
Q

Syringomyelic syndrome: what is it? what does it result in?

A
  • Syringomyelic syndrome:
    -Inflammation of spinal cord
    -Results in tubular cavity development in spinal cord
41
Q

Gliomas are (intra/extra)-cerebal

A

intra

intracerebral tumors (gliomas):
Astrocytoma
Oligodendroglioma
Ependymoma

42
Q

Meningitis
types

A
  • Bacterial meningitis
  • Aseptic (viral, nonpurulent, lymphocytic) meningitis
  • Fungal meningitis
  • Tubercular (TB) meningitis
43
Q

Sources of meningitis include all of the following except:
A) bacterial
B) viral
C) fungal
D) Tuberculosis
E) None of these are correct

A

E) None of these are correct

ALL can cause meningitis

44
Q

Suppurative cerebral masses

A
  • Cerebral abscess
  • Spinal cord abscess
    (Intramedullary spinal cord abscess)
45
Q

T/F
Encephalitis is usually of bacterial origin.

A

False
viral

46
Q

Encephalitis

A

Acute febrile illness, usually of viral origin with nervous system involvement

47
Q

Most common forms of encephalitis are caused by…

A

arthropod-borne viruses and herpes simplex virus

48
Q

Neurologic Complications of AIDS

A
  • HIV-associated cognitive dysfunction
  • HIV myelopathy
  • HIV neuropathy
  • Aseptic viral meningitis
  • Opportunistic infections
  • Cytomegalovirus infections
  • Parasitic infection
  • CNS neoplasms
49
Q

T/F
HIV Dementia affects adults and children.

A

True

50
Q

HIV Dementia

A
  • Impaired concentration, short-term memory, retrieval
  • Insidious and unpredictable course
  • Affects adults and children

Generalized cognitive system deficits:
* Occur later
* Psychomotor slowing
* Decreased speech spontaneity and fluency
* Progressive loss of balance, ataxia, spastic paraparesis or paralysis, and generalized hyperreflexia

51
Q

Lyme Disease is a tick-borne ____ bacterial infection

A

spirochete

52
Q

Bacteria that causes Lyme Disease

A

Borrelia burgdorferi

53
Q

Lyme Disease
Progression

A
  • Introduced by tick bite
  • Incubates 3 to 32 days
  • Migrates to skin, lymph nodes, other systems
54
Q

Lyme Disease
The 3 Stages

A
  1. Bull’s eye rash, flu-like symptoms
  2. Cardiac and neurological manifestations
  3. Arthritis, enhanced neurological manifestations
    (may take up to 2 years to develop)
55
Q

Demyelinating Disorders include….

A

Multiple sclerosis (MS)

56
Q

Multiple sclerosis (MS)

A
  • Progressive, inflammatory, demyelinating, autoimmune disorder of the CNS
  • Degeneration of the myelin sheath in CNS neurons

Types:
* Mixed (general)
* Spinal
* Cerebellar

57
Q

Does MS cause degeneration of the myelin sheath in the CNS or PNS neurons?

A

CNS

58
Q

Multiple Sclerosis
vs
Guillain Barre
vs
Amyotrophic lateral sclerosis

A

MS:
* predominantly affects CNS
* Symptoms gradual & persist long term
* autoimmune

GBS:
* primarily targets peripheral nerves
* acute-onset muscle weakness & sensory issues
* acquired inflammatory Dz

ALS:
* affects upper & lower motor neurons of the cerebral cortex, brainstem, and spinal cord
* Progressive weakness→respiratory failure & death

59
Q

MS is an autoimmune disease T/F

A

TRUE

60
Q

What type of disease is GBS?

A

acquired inflammatory

61
Q

GBS primarily targets CNS nerouns T/F

A

FALSE
** peripheral nerves**

62
Q

What is Cross top? What is it associated with?

A
  • bad!
  • Broken down myelin sheath
  • nerves stimulate each other when theyre not supposed to
  • Multiple sclerosis (MS)
63
Q

Amyotrophic lateral sclerosis (ALS)
affects which stuctures?

A
  • Diffusely affects upper & lower motor neurons of the cerebral cortex, brainstem, and spinal cord (corticospinal tracts & anterior roots)
64
Q

Amyotrophic lateral sclerosis (ALS)
S/S

A
  • Progressive weakness leading to respiratory failure and death
  • Person has normal intellectual and sensory function until death
65
Q

Also called Lou Gehrig’s disease

A

Classic Amyotrophic lateral sclerosis (ALS)

66
Q

Neuropathies

A

Generalized symmetric polyneuropathies
-Distal axonal polyneuropathy
-Demyelinating polyneuropathy

Generalized
-Sensory neuropathies

Focal or multifocal

67
Q

Acquired inflammatory disease causing demyelination of the peripheral nerves with relative sparing of axons

A

Guillain-Barré syndrome

68
Q

Guillain-Barré syndrome

A
  • Acquired inflammatory disease causing demyelination of the peripheral nerves with relative sparing of axons
  • Acute onset, ascending motor paralysis
  • Humoral and cellular immunologic reaction
69
Q

T/F
Amyotrophic lateral sclerosis (ALS)
is characterized by ascending motor paralysis.

A

False
Guillain-Barré syndrome

70
Q

Guillain-Barré syndrome
Acquired inflammatory disease causing demyelination of the ____ with relative sparing of ___

A

peripheral nerves demyelinated
axons are spared

71
Q

Radiculopathies

A
  • Radicular pain
  • Radiculitis: Spinal nerve root inflammation
72
Q

Plexus injures involve the nerve plexus distal to the _____ but proximal to the …..

A

spinal roots

formation of the peripheral nerves

73
Q

T/F
Amyotrophic lateral sclerosis (ALS) Diffusely affects upper and lower sensory neurons of the cerebral cortex, brainstem, and spinal cord.

A

False
MOTOR neurons

74
Q

Neurologic Complications of AIDS include all of the follwing EXCEPT:
A) Opportunistic infections
B) Cytomegalovirus infections
C) HIV neuropathy
D) PNS neoplasms
E) HIV-associated cognitive dysfunction

A

D) PNS neoplasms

Should be CNS neoplasms

  • HIV-associated cognitive dysfunction
  • HIV myelopathy
  • HIV neuropathy
  • Aseptic viral meningitis
  • Opportunistic infections
  • Cytomegalovirus infections
  • Parasitic infection
  • CNS neoplasms
75
Q

Neck pain and increased rigidity with passive flexion of the neck is a positive ____ sign

A

Brudzinski sign

Pathopharm Exam 3 (18 decks)

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