Neurological alterations pt 1 Flashcards

1
Q

A person achieve cognitive and behavioral functional competence by integrated process of the following systems: __, ___ & ___ systems.

A

Cognitive; sensory; motor

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2
Q

The neuronal systems that are essential to the function of cognitive systems: (1)__ system (create arousal and maintain attention), (2) __ and __ systems (create communication, making speech) (3) __ or __ systems which mediate mood, emotion and intention

A

Attention; memory language; affective emotive

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3
Q

Consciousness has two components: __ (level of awakeness) & ___ (content of thought)

A
  • Arousal; awareness
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4
Q

Which term refers to a state of awareness both of oneself and of the environment, and a set of responses to that environment, where the individual initiates spontaneous, purposeful activity independently to a perceived stimulus?

Any decrease in this state of awareness and varied responses is a decrease in consciousness, which measuring it is called the level of consciousness or LOC

A

Full consciousness

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5
Q

Which term refers to the most critical clinical index of nervous system function, with changes indicating either improvement or deterioration of the individual’s condition, and it diminish in stages from confusion and disorientation (which can occur simultaneously) to coma?

Tested with a Glasgow coma scale, to assess if they are opening their eyes, oriented, follow commands

A

Level of consciousness

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6
Q

(Alterations in the cognitive systems)

Alterations in level of arousal may be caused by 3 categories: __, ___, or ___

A

Structural, metabolic, or psychogenic (functional) disorders.

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7
Q

(Alterations in the cognitive systems)

___ alterations in arousal are divided according to the original location of the pathological condition.

Causes include infection, vascular alterations (hemorrhage), neoplasms, traumatic injury, congenital alterations, degenerative changes (dementia), polygenic traits, & metabolic disorders

A

Structural

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8
Q

(Alterations in the cognitive systems)

___ ___ produce a decline in arousal by alterations in delivery of energy substrates as occurs with hypoxia, electrolyte disturbances, or hypoglycemia.

__ ___ caused by liver or renal failure cause alterations in neuronal excitability because of failure to metabolize or eliminate medications and toxins.

A

Metabolic disorders

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9
Q

(Alterations in the cognitive systems)
___ alterations in arousal (___), although uncommon, may signal general __ disorders.

Despite apparent unconsciousness, the person actually is physiologically awake and the neurological examination reflects normal responses

A

Psychogenic; unresponsiveness; psychiatric

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10
Q

(Terms describing altered level of consciousness)

Which term refers to the loss of ability to think rapidly and clearly; impaired judgement and decision making?

Which term refers to the person may exhibit restlessness, anxiety, and irritation; ___ to time occurs first, followed by ___ to place and familiar others (family members) and impaired memory; recognition of self is lost last?

Which term refers to limited spontaneous movement or speech; easy arousal with normal speech or touch; may or may not be oriented to time, place, or person?

Which term refers to mild to moderate reduction in arousal (awakeness) with limited response to environment; falls asleep unless stimulated verbally or tactilely; answers questions with minimal response?

Which term refers to a condition of deep sleep or unresponsiveness from which person may be aroused or caused to open eyes only by vigorous and repeated stimulation; response is often withdrawal or grabbing at stimulus?

Which term refers to no motor response to the external environment or to any stimuli, even deep pain or suctioning; there is no arousal to any stimulus, and reflexes may be present, abnormal movement (posturing) to pain may be present?

A
  • Confusion
  • Disorientation
  • Lethargy
  • Obtundation
  • Stupor or stuporous
  • Coma or comatose
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11
Q

(Alterations in arousal)

With normal breathing, which area of the brain produces rhythmic pattern

When consciousness decreases, which area of the brain regulates the breathing pattern by responding only to changes in partial pressure of carbon dioxide in arterial blood (PaCO2) levels?

Increases in PaCO2 levels lead to ___. The PaCO2 level then decreases to below normal and breathing stops (___) until the carbon dioxide reaccumulates and again stimulates ___. This phenomenon is called ____ ___

A
  • Forebrain (cerebrum)
  • Lower brainstem centres
  • Tachypnea; apnea; achypnea; Cheyne-Stokes respiration
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12
Q

(Alterations in arousal)

Which term indicates the presence and level of brainstem dysfunction because brainstem areas that control arousal are adjacent to areas that control the pupils, where some medications will also affect the pupils, such as anticholinergic medicatio?

A

Pupillary changes

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13
Q

(Alterations in arousal)

Which term refers to abnormal eye movements, including nystagmus which indicates alterations in brainstem function, where the eyes should move together, and are not dysconjugate in their movements? Also, no eye movement is indication of brain injury

A

Oculomotor responses

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14
Q

(Alterations in arousal)

Which term can be classified as (1) purposeful, (2) inappropriate, or (3) not present, where patients are asked to “squeeze my fingers” to determine their ___ ___?

Which term refers to flexion of arms, wrists, and fingers with adduction in upper extremities Bilateral extension, internal rotation, and plantar flexion in lower extremities (bringing into the core) associated with hemispheric damage above the midbrain?

Which term refers to all four extremities in rigid extension with hyperpronation of forearms and plantar extension of feet, associated with sever damage involving the midbrain and upper pons?

A

Motor responses
- Decorticate posturing/response
- Decerebrate posture/response

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15
Q

(Alterations in arousal)

The size of the pupil is under control by the ___ cranial nerve

A bilateral dilated, unreactive pupil may be due to …?

A unilateral dilated pupil may be due to…?

Other causes for puppillary changes includes..?

A
  • 3rd
  • Brainstem injury
  • Inter-cranial pressure
  • Hypothermia, anoxia, drugs, & ocular trauma
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16
Q

(Alterations in awareness - LOC)
Which term refers to the ability to select specific information to be processed from available, competing environmental and internal stimuli, and to focus on that stimulus (i.e., to concentrate on a specific task without being distracted)?

A

Selective attention (orienting)

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17
Q

(Alterations in awareness - LOC)

Which term can be temporary, permanent, or progressive, where disorders associated with ___ ____ ___ can be caused by seizures, ___ in brain structure, subdural __, stroke neoplasms, ___ disease, dementia

A

Selective attention deficits; contusions; hematomas; Alzheimer’s

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18
Q

(Alterations in awareness - LOC)

Which term refers to alterations in the recording, retention, & retrieval of information?

A

Alterations in memory

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19
Q

(Alterations in awareness - LOC)

Which term refers to mild or severe loss in memory and can be put into 2 categories?

Which category of amnesia refers to when a person has difficulty retrieving past personal history memories or past factual memories?

Which category of amnesia refers to the inability to form new personal or factual memories but memories of the distant past are retained and retrieved?

Memory disorders can be…?

A

Amnesia
- Retrograde amnesia
- Anterograde amnesia
- Temporary (e.g., after a seizure) or permanent (e.g., after severe head injury or in Alzheimer’s disease).

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20
Q

(Alterations in awareness - LOC)
Executive attention deficits include alterations in …?

An obvious example is..?

A
  • Abstract reasoning, planning, decision-making, judgement, error correction, & self-control
  • Attention- deficit/hyperactivity disorder (ADHD)
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21
Q

(Data processing alterations)

Which term refers to problems associated with recognizing & processing sensory information and include __, __, & acute confusional states & delirium.

A

Data-processing deficits
- Agnosia; dysphasia

22
Q

(Data processing alterations)

Which term refers to defects of pattern recognition & may be tactile, visual, or auditory pathways, they are caused by dysfunction in the primary sensory area or the interpretive areas of the cerebral cortex, but usually only one sense is affected; associated with damage caused by cerebral vascular accidents (such as stroke) or damage to specific areas of the brain?

For example, an individual may be unable to identify a safety pin by touching it with a hand but is able to name it when looking at it

A

Agnosia

23
Q

(Data processing alterations)

Which term refers to an impairment of comprehension or production of language with impaired communication, associated with cerebral vascular accidents involving specific areas of the brain?

Which term refers to an inability to understand written or spoken language?

Which term refers to loss of ability to produce spoken or written language?

A

Dysphasia
- Wernicke’s area
- Broca’s area

24
Q

(Cerebral hemodynamics Alterations)

Cerebral blood flow is normally maintained at a rate that matches…?

Cerebral perfusion pressure (70 to 90 mm Hg) is the pressure required to …?

Cerebral blood volume is the amount of blood …?

Cerebral blood oxygenation is measured by…?

Alterations in cerebral blood flow (CBF) are related to changes in cerebral ___ ___, cerebral ___ __, & cerebral __ __

A
  • local metabolic needs of the brain
  • perfuse the cells of the brain
  • in the intracranial vault at a given time.
  • oxygen saturation in the internal jugular vein.
  • perfusion pressure; blood volume; blood oxygenation
25
Q

(Cerebral hemodynamics Alterations)

What is related to the initial trauma of brain vessels or tissue, such as hematoma, contusions, or diffused injury?

What can occur due to other reasons or is a consequence of the alterations in cerebral blood flow, intracranial pressure, and oxygen delivery; occurring within seconds or days after the primary trauma to brain injury?

A
  • Primary brain injury or alterations
  • Secondary brain injury or alteration
26
Q

(Cerebral hemodynamics Alterations)

Which term may result from an increase in intracranial content (as occurs with tumour growth), edema, excess CSF, or hemorrhage?

& when ___ ____ ___ approaches arterial pressure, ___ & ___ produce brain damage.

A

Increased intracranial pressure (increased ICP)
- Hypoxia; hypercapnia

27
Q

(Cerebral hemodynamics Alterations)

What needs to be maintained to control ICP?

A

A consistent cerebral perfusion pressure

28
Q

(Cerebral hemodynamics Alterations)

When the intracranial pressure is increasing beyond the ability of the brain to compensate the patient will start to show signs of increased ICP, such as …?

A

Confusion & restlessness, decreased level of consciousness

29
Q

(Cerebral hemodynamics Alterations)

What refers to a set of signs that are indicative of increased intracranial pressure (ICP), occuring in late stages of acute head injury, indicating that a brain stem herniation is imminent; Where pts presenting with 2 of the 3 signs have 2X higher rate of mortality?

The signs in said condition are…?

A

Cushing’s triad
- Increased Bp, decreased pulse rate, & an irregular breathing rate

30
Q

(Cerebral edema)

Which term refers to an increase in the fluid content of the brain resulting from infection, hemorrhage, tumour, ischemia, infarction, or hypoxia, which can cause distortion of blood vessels, displacement of brain tissues, increase in ICP, & eventually herniation?

A

Cerebral edema

31
Q

(Cerebral edema)

Three types of cerebral edema are: (1) __ edema, (2) ___ (metabolic) edema, & (3) ___ edema

A
  • Vasogenic; cytotoxic; interstitial
32
Q

(Cerebral edema)

Which term refers to the most clinically important type of edema caused by increased permeability of the capillary endothelium of the brain after injury to the vascular structure, where the blood–brain barrier is disrupted? The mechanism of action is that plasma proteins leak into the extracellular spaces, drawing water to them, beginning at area of injury & spreading to white matter of the same side. Also edema promotes more edema due to ischemia from increasing ICP

Which term refers to the failure of the active transport system in cells’ membrane, where the cells lose potassium & gain sodium, so water follows sodium & cells swell?

Which term refers to edema caused by blockage of CSF pathways?

A
  • Vasogenic edema
  • Cytotoxic edema
  • Interstitial edema
33
Q

(Alterations in neuromotor function) –> Alterations in muscle tone

Which term refers to decreased muscle tone, characterized by passive movement of a muscle that occurs with little or no resistance?

Which term refers to increased muscle tone, characterized by passive movement of a muscle occurs with resistance to stretch?

A
  • Hypotonia
  • Hypertonia
34
Q

(Alterations in neuromotor function) –> Alterations in muscle movement

Which term refers to the excessive, purposeless movement; which could be tremors or abnormal involuntary movements?

Which term refers to abnormal movements that occur as spasms, such as ___ ___ which is the involuntary movement of the face or complex tics such as ___ ___

A
  • Hyperkinesia
  • Dyskinesia; Tardive dyskinesia; Tourette syndrome
35
Q

(Alterations in neuromotor function) –> Alterations in muscle movement

Which term refers to the loss of voluntary movement (decrease or slowness of voluntary movements), with a delay in time that it takes to start to perform a movement?

A
  • Hypokinesia
36
Q

(Upper & Lower Motor Neuron Syndromes) –> Upper motor neuron syndromes

Which term refers to the temporary loss of all spinal cord functions below the lesion (below the level of the pons), characterized by complete flaccid paralysis, absence of reflexes, motor, sensory, autonomic function & marked disturbances of bowel & bladder function? Lasting hours to weeks

A

Spinal shock

37
Q

(Upper & Lower Motor Neuron Syndromes) –> Upper motor neuron syndromes

Over time spinal shock will resolve, where damage to spinal cord remains. So, initially they may have loss of all function, but as their ___ return we get a clearer picture of what damage has been done. Return of spinal reflexes marks …?

A

Reflexes; the end of spinal shock (1st sign)

38
Q

(Upper & Lower Motor Neuron Syndromes) –> Upper motor neuron syndromes

Which term refers to a condition of muscle weakness caused by nerve damage or disease (partial paralysis) & can be confined to one area, such as the limb or lower body or can be general or progressive as we may see in dementia?

Which term refers to loss of muscle function in part of your body?

A
  • Paresis
  • Paralysis
39
Q

(Upper & Lower Motor Neuron Syndromes) –> Upper motor neuron syndromes

Which term refers to paresis/paralysis of the upper and lower extremities on one side, associated with strokes?

Which term refers to paralysis of corresponding parts of both sides of the body as a result of cerebral
hemisphere injuries?

Which term refers to weakness/paralysis of the lower extremities as a result of lower spinal
cord injury (cervical 7 vertebrae)?

Which term refers to paresis/paralysis of all four extremities as a result of upper spinal
cord injury?

A
  • Hemiparesis/hemiplegia
  • Diplegia
  • Paraplegia
  • Quadriplegia
40
Q

(Outcomes of Alterations in Arousal)

Which term refers to brain damage beyond the point of recovery, where brainstem functions have stopped, such as a drug overdose?

Absence of motor responses, no spontaneous __, no brain functions – __ __(comatose patient’s brainstem is not intact.), corneal reflex, ice in ears, Absent confounding factors – ___

They are very meticulous when they perform this assessment in the clinical setting.

A
  • Brain death (total brain death)
  • Respirations; doll’s eyes; hypothermia
41
Q

(Outcomes of Alterations in Arousal)

Which term refers to permanent brain damage, with an ability to maintain cardiac, respiratory, and other vital functions, where the person does not speak, open their eyes or have purposeful movements?

A

Cerebral death or irreversible coma

42
Q

(Outcomes of Alterations in Arousal)

Which term refers to where arousal returns, but awareness is absent, and the person does not speak or understand speech, cannot follow commands, sleep-wake cycles present, spontaneous eye opening, __ & __ are maintained without support; if this state lasts longer than ___ months then its considered permanent without the possibility of recovery?

A

Persistent vegetative state
- BP; RR; 12

43
Q

(Outcomes of Alterations in Arousal)

Which term refers to a state similar to a vegetative state but the individual can respond to some commands, can blink or communicate simple commands?

A

Minimally conscious state (MCS)

44
Q

(Outcomes of Alterations in Arousal)

Which term refers to complete paralysis of voluntary muscles, except the eyes, and is fully conscious but unable to communicate except through eye movements?

A

Locked-in syndrome

45
Q

(Neoplasms)

Which term refers to the most common brain tumour (35-50% of all brain tumours are of this kind), where they begin in the __ in the brain & grow at different rates slow to very quickly; where most are grade 1-3 & are more common in __ & __ people?

Which term refers to the most common & lethal type of brain tumour (more common in older adults & a greater incidence in men), which are also highly vascular, irregular, & infiltrative making surgery difficult; & 50% will occupy more than one lobe at time of death?

A
  • Astrocytoma; astrocytes; children; younger
  • Grade 4 astrocytoma or a glioblastoma
46
Q

(Neoplasms)

Which term refers to tumours originating on the outside substances of the brain?

Which term refers to a tumour which is 34% of all intracranial tumours & usually originate from the meningeal cells in the dura mater, & is sharply circumscribed and adapts to the shape it occupies; It’s also slow growing , where manifestations are present when it indents the functional areas of the brain?

Which term refers to a group of autosomal dominant disorders of the nervous system (neurofibromas), which include can occur ___ (Type 1) or
__ (type 2)?

A
  • Primary Extracerebral tumours
  • Meningiomas
  • Nerve sheath tumours; peripherally; centrally
47
Q

(Metastatic brain tumours)

Which term refers to a secondary tumour that has ___ to the brain and is 10 times more common than __ tumours 20-40%, where the primary sites include __, breast, __, colon, & __?

Carrying a poor __ & is dependent on primary site of cancer, where the average survival is __ months. :(

__ is better if there has been a longer lag time between development of primary cancer & identification of ___ in brain

A

Metastatic brain tumours
- Metastasized; primary; lung; kidney; skin
- Prognosis; 6
- Prognosis; metastasis

48
Q

(Benign v.s. malignant)

The cause of __ ___ ___ - is unknown, although genetic and environmental factors may contribute to their development.

Depending on location a __ __ can cause severe debility or death

Some tumours are not ___ and they are difficult to remove & can cause more ___ ___ to remove

Primary malignant tumours rarely ____:

(1) The capillary basement membrane can act as a physical barrier against migration of the __ __ into the __ ___ in the brain.

(2) The short life span of involved patients due to aggressive disease, intrinsically eliminates or radically reduces the opportunity of ___ ___

A
  • Primary brain tumours
  • Benign tumour
  • Accessible; irreversible damage
  • Metastasize
  • Glioma cells: blood stream
  • Detectable metastases
49
Q

(Signs & Symptoms of Brain Tumours)

Include diffuse, nonspecific signs, such as ___, irritability, ___ changes –> progresses to increased ____, ___ (swelling of the optic disc), vomiting or ___ – can further progress to hemiparesis, ___, visual field deficits

A
  • Headache; personality; ICP; papilledema; seizures; dysphasia
50
Q

(Signs & Symptoms of Brain Tumours)

Metastatic brain tumours manifestations resemble __:

Where encephalopathy causes headache, ___, ____, trembling, ___, forgetfulness, & __ ___

& new neurological symptoms in a cancer patient should have brain __ ruled out first

A
  • Glioblastomas
    -Nervousness; depression; confusion; gait disorders
  • Metastasis