Patho Midterm Flashcards by Jackie Spencer

What is the best way to monitor CBF?

Blood pressure! 
MAP 60-100mmHg
if it's < 50 or > 150 you lose autoregulation
> 50 = ischemia
> 30 = cell death

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What is a late sign of increased ICP

cushing’s triad

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A pt presents w fluid dripping from ears and nose, redness/bruising behind the ear and around the eyes, what do you think could have caused this and what is it called? What are the names of the terms described?

An attack causing a basilar skull fracture. 
fluid from nose - rhinorrhea
from ear - otorrhea
bruising behind ear - battle's sign
around eyes - raccoons eyes

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What is coup contracoup?

when the brain bounces back against hard skull resulting in 2 place of injury. hitting head on dashboard, shaken baby syndrome, etc

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Describe a contusion

bruising of brain tissue within focal area, usually death sentence if pt is on anticoag

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A pt presents with LOC, decortication, and global cerebral edema. These clinical findings are disproportionate to CT scan findings. What do you suggest?

Diffuse axonal injury (DAI)

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If a pt presents to the ER unconscious, then regains awareness but rapidly spirals back into unconscious state, what would you be thinking?

The pt is experiencing an epidural hematoma which is a neuro emergency! requires rapid sx intervention

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What is the less severe hematoma and how does it present?

Subdural hematoma.
presents more slowly than epidural bc its venous.
most commonly in elderly and alcoholics
s/s of IICP

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How can you differentiate between sensory/motor components of the spinal tract?

SAME DAVE

sensory afferent - motor efferent
dorsal afferent - ventral efferent

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What is the difference between ascending and descending nervces?

Ascending are responsible for carrying sensory info to higher level processing centers of CNS while descending are responsible for carrying motor impulses for muscle movement

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A pt arrives at the ED with a spinal cord injury. The mother frantically asks if this is permanent. What is the best response?

We can’t be sure for 72hrs d/t the possibility of secondary injury

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Spinal shock

TEMPORARY decrease in sensation and reflexes.
Pt is in active rehab.
Incontinence, erection, muscle spasms, etc may occur when reflexes begin to return.

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Neurogenic shock

LIFE THREATENING EMERGENCY
s/s hypotension and bradycardia!!
massive vasodilation without compensation
generally seen in higher level injuries

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What are the two different ways of describing the level of a spinal cord injury

skeletal which refers to where the bone is actually injured

neurologic which refers to the lowest level where everything is normal in the body!

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What is Cauda equina syndrome

deals with disc herniation and bowl/bladder dysfunction not being tx’d promptly

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A pt is recovering from spinal shock and hasn’t voided in quite some time. They’re suddenly c/o a throbbing HA. What are you thinking?

That they’re experiencing autonomic dysreflexia which is life threatening. First thing is to take BP.
This is a massive uncompensated CV reaction after reflexes return from SS in response to visceral stimulation

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What theory focuses on the here and now vs the past and unconscious

sullivan’s interpersonal theory

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What needs must be met first according to the humanistic theory

according to maslow, the physiological needs must be met before moving on

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Where is Broca’s area located?

frontal lobe

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Where is Wernike’s area located

L temporal lobe

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A pt presents w deficits in emotional/impulse control, language, and can’t seem to remember any new information. What area of the brain would you expect to find an injury?

Frontal lobe

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A pt presents w the inability to locate/identify their own body parts. What area of the brain would you expect to find an injury?

parietal lobe

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A pt looks in the mirror and is frightened by what they see. You ask what’s wrong, to which they ask you to repeat yourself in a fragmented/jumbled fashion. What area of the brain would you expect to find an injury?

inability to recognize familiar faces, hearing loss, and language issues are indications of temporal lobe injury

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A pt presents w visual field deficits and can’t identify simple colors or objects. What area of the brain would you expect to find an injury?

Occipital lobe

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A pt presents w dysphagia, and a disruption in a whole slew of other basic functions. Where would you expect to find an injury?

brain stem

A pt presents w an unsteady gait and generalized weakness. What area of the brain would you expect to find an injury?

Cerebellum

What conducts impulses to and from pre and post ganglionic __ in the parasympathetic/cholinergic NS

ACh

What conducts impulses to and from pre and post ganglionic __ in the sympathetic/adrenergic NS

ACh is preganglionic | NE at target gland

What receptors in the parasympathetic NS receive the ACh?

Nicotinic/muscarinic

What receptors in the sympathetic NS receive the NE?

alpha/beta

Progression of impulse through parasympathetic NS

ACh --> ganglia ACh --> nicotinic/muscarinic receptor catabolized by ACHe & pseudocholinesterase

Progression of impulse through sympathetic NS

ACh --> ganglia NE --> alpha/beta receptors catabolized by MAO & COMT

A pt w a hx of HTN presents w slight decrease in LOC which worsens over the first 72hrs of admission. Testing shows atherosclerotic plaques present in vessel walls and that a clot has formed. Due to the slow progression of symptoms what do you think is occuring?

Thrombotic ischemic stroke

A pt presents with a fib and rapidly develops neurologic deficits but remains conscious. What do you think the pt is experiencing? What can you say about the deficits?

Embolic ischemic stroke. The deficits may be temporary if the clot were to dislodge again.

Which stroke is most closely associated with A fib?

Embolic ischemic stroke

A pt presents with HA, N/V, decreased LOC and has difficulty seeing you. A ruptured cerebral vessel is found. What is occurring and what is the most likely cause? What can you say about the px?

Intracerebral hemorrhage caused by a cerebral aneurysm. The px is very poor

What is the worst location a pt could experience a intracerebral hemorrhage and why?

In the pons bc it controls basic functioning such as respiratory, etc

Where do cerebral aneurysms usually occur and which type is most likely to rupture?

In the circle of willis and saccular

A pt presents with the "worst HA of my life" and a stiff neck. What do you suspect and what could be the cause?

A subarachnoid hemorrhage | causes: ruptured aneurysm, trauma, cocaine use.

What are some motor function manifestations of a stroke?

akinesia - loss of voluntary movements swallowing/speech gag reflex

You walk into a pts room and ask what they'd like for lunch, to which they respond "I took my octapus on a walk around the moon and then my tractor came to football for tea." You ask him to repeat himself and he stares at you with a confused look. What's going on?

The pt is experiencing Wernicke's aphasia, resulting from L temporal lobe damage

You walk into a pt room and it appears as if they are in distress. You ask what's wrong and the pt replies, with some difficulty, "me pee". What is going on

The pt is experiencing broca's aphasia, from damage to the frontal lobe

Explain Wenike's aphasia

wernicke's area is in the L temporal lobe pt exhibits fluent speech that makes no sense has difficulty understanding speech aka fluent aphasia

Explain broca's aphasia

Broca's area is in the frontal lobe no difficulty understanding others broken speech "dog walk" aka non-fluent aphasia

What is the term for a pt who is missing half of the visual field in each eye?

homonymous hemianopsia

when looking into a mirror, a pt asks you who is on the other side of the window. After which she goes on to pick up a pencil and attempts to call her son. What do you think is going on

Pt is experiencing agnosia

A pt is having difficulty corrdinating sequential movements... what is this called

apraxia

explain the concept of gliosis

It is a consequence of seizures. Scar tissue forms around foci, which in turn increases the likelihood of repeat seizures.

What are the phases of a seizure and what's important to know about them

``` prodromal - weird feeling aural - sensory warning ictal - seizure itself postictal - rest and recovery imp to know that not everyone goes through each ```

A pt presents to the ER w an altered LOC and appears to be typing in the air. What do you suspect

A complex partial sz (automatisms present)

A pt presents to the ER with periods of muscle rigidity followed by clonic, jerking motions. They have complete loss of consciousness and have been incontinent of urine. What do you suspect

pt experiencing a tonic-clonic sz and is at risk for tongue biting

What is suspected if a child is frequently accused of daydreaming in class and reports seeing flashing lights.

experiencing absence sz

What type of sz is aka a "drop attack" where the pt loses consciousness, falls to the ground as a result of a sudden loss in muscle tone

Atonic

What is the best determination of HAs?

patient history!

what HA are directly related to time of day and would be classified as the most severe pain assoc w a HA

cluster HAs

What HA is classified by repetitious vascular vasoconstriction followed by vasodilation?

Migraine HAs

A pt visits their PCP and c/o excruciating pain that comes out of nowhere and only lasts for seconds. Pt describes the pain as burning and knife like. What would you predict and what else would you expect to see?

I'd suspect Trigeminal Neuralgia and would expect to see tic's.. twitching, grimacing, blinking, & tearing.

A pt w a hx of HSV presents w herpes vesicles and pain behind the ear, and reports they can't taste their food one side of their mouth. What's going on and what are some key mgmt points?

Bell's palsy and the pt is at risk for malnutrition and corneal abrasion

What are the 4 As of Alzheimer's

Amnesia - memory impairment Aphasia - loss of language Apraxia - loss of purposeful movements Agnosia - loss of ability to recognize objects

What's the difference between delirium and dementia

delirium has an abrupt onset and is reversible | dementia slowly develops and is irreversible

Explain the phenomenon of sundown syndrome

pts w delirium get rowdy at night

a pt reports hearing voices and seeing people that you can't see. What phase of delirium would you expect this pt to be in

late phase. (these are late signs)

What 3 things would you expect to observe in an assessment w a pt who has dementia

denial, confabulation, and perseveration

What are the clin mans of anorexia nervosa

cachetic 85% less than ideal body weight lanugo low BP, temp, pulse

Clin Mans of bulemia nervosa

ideal weight or even a little over weight dental erosion report harmful behaviors Russell's sign - calluses on knuckles