Test 5 Flashcards
1
Q
What is the most common cause of neurological disability?
A
Cerebrovascular disease
2
Q
What are the three categories cerebral vascular disease can be dividied into?
A
- Ischemia stroke
- Transient ischemic attack
- Hemorrhagic stroke
3
Q
What type of stroke results from an obstruction by a thrombus or embolus?
A
Ischemic
4
Q
In an area of ischemia, cells are not given proper oxygen/nutrition which leads to _______.
A
Infarction
5
Q
What are 3 causes of ischemic stroke?
A
- Cerebral arteriosclerosis
- Atrial fibrillation
- Carotid stenosis
6
Q
What is the treatment of ischemic stroke?
A
Thrombolysis
7
Q
How soon after an ischemic stroke should thrombolysis occur?
A
Within the first 4 1/2 hours
8
Q
In a _________, an embolus occludes blood flow, but the body’s fibrinolytic system works quickly to dissolve in.
A
Transient Ischemic Attack (TIA)
9
Q
What percent of TIA progress to stroke?
A
20%
10
Q
In a _______ stroke, an artery ruptures which induces bleeding in the brain.
A
Hemorrhagic
11
Q
Besides bleeding in the brain, what else can a hemorrhagic stroke cause?
A
Cerebral edema
12
Q
What is the treatment of hemorrhagic stroke?
A
- Hemodynamic stabilization
- Clot forming agents
- Surgical procedures
13
Q
What are five symptoms of stroke?
A
- Weakness on one side of body
- Loss of gag reflex
- Facial droop
- Slurred speech
- Aphasia
14
Q
True or False: No reliable clinical presentation exists to differentiate between ischemic and hemorrhagic strokes.
A
True
15
Q
How can you differentiate between stroke types?
A
- Computed Tomography
2. Magnetic Resonance Angiography
16
Q
A condition characterized by recurring seizures
A
Epilepsy
17
Q
A sudden discharge of electrical activity in the brain
A
Seizure
18
Q
What are 4 contributors to seizures?
A
- Genetic disposition
- Head Trauma
- Brain tumors
- Infections
19
Q
What are the two main types of seizures?
A
Focal Seizures
20
Q
A seizure that begins in one hemisphere and quickly spreads to the other.
A
Generalized seizure
21
Q
Seizures can be categorized based on what?
A
Symptoms and EEG results
22
Q
What are 4 symptoms of seizures
A
- Disruption of senses
- Loss of consciousness
- Muscle spasms
- Repetitive convulsions
(some may report auras)
23
Q
What is the most common type of headache?
A
Tension
24
Q
What are the three types of headaches?
A
- Tension
- Migraine
- Trigeminal Autonomic Cephalagias (TAC)
25
What is one type of Trigeminal Autonomic Cephalagia?
Cluster headache
26
This type of headache appears bilaterally with mild to moderate pain, it may be accompanied with neck stiffness
Tension headache
27
This type of headache is described as throbbing, usually one-sided headache, worsens with movement and photophobia/phonophobia is present.
Migraine headache
28
These types of headaches are described as excruciating and stabbing, worsens with movement, typically appears on one side and can be accompanied with redness in the eyes and congestion.
Trigeminal Autonomic Cephalagia (TAC)
29
Slowly progressive disorders that affect motor or sensory neurons
Degenerative neurological disorders
30
- Also known as Lou Gehrig's disease
- Affects upper and lower motor neurons
- Cognition and Sensation are left in tact
- No cure exists
Amyotrophic Lateral Sclerosis (ALS)
31
- Triads of symptoms: tremors, bradykinesia, and muscle rigidity
- Result of disrupted dopamine production by the basal ganglia
- Tx required: dopamine replacement
Parkinson's disease
32
- Usually arises from post-infection
- Progressive, symmetric, and peripheral neuropathy
- Patients often recover w/supportive therapy
Guillain-Barre Syndrome
33
- Antibodies attack the myelin surrounding axons
| - Causes sensory and motor dysfunction
Multiple sclerosis
34
- Acetylcholine receptors on skeletal muscle are attacked
| - Treatment includes: Acetylcholinesterase inhibitors
Myasthenia gravis
35
What are the four ways Traumatic Brain injuries can happen?
1. Blunt trauma
2. Penetrating Trauma
3. Acceleration/Deacceleration
4. Blast trauma
36
What are the two pathophysiological alterations that result from a TBI?
1. Change in intercranial pressure (ICP)
| 2. Change in level of consciousness (LOC)
37
Movement of the brain that results in rapid stretch and damage to the axons.
Diffuse axonal injury
38
What happens immediately in diffuse axonal injury?
Loss of consciousness
39
What type of TBI does a person normally remain in a coma?
Diffuse axonal injury
40
What type of mild TBI usually results from a blow to the head?
Concussion
41
How long do the symptoms of a concussion usually resolve?
10-14 days
42
Symptoms of a concussion
1. Dizziness
2. Seeing "stars"
3. Amnesia
43
What are the three types of intercranial bleeding?
1. Epidural
2. Subdural
3. Subarachnoid
(Named for their location)
44
What are the two types of spinal cord injuries?
1. Complete
| 2. Incomplete
45
What type of spinal cord injury does a patient lose all sensory and motor function below the level of injury?
Complete
46
Any significant injury to the spinal cord can result in what?
Spinal shock
47
What is the lack of reflexes during spinal shock called?
Bulbocavernosus reflex
48
A spinal cord injury at or above C4 affects what?
Respiration
49
A spinal cord injury at or above T6 may result in what?
Neurogenic shock
| causes SNS depression, decrease cardiac output and hypotension
50
Injury to ascending tracts leads to loss of ______
sensation
51
Injury to descending tracts leads to loss of _____
motor function
52
If anything happens to the ________, condition is nearly incompatible with life.
brainstem
53
What area of the brain will extensive damage happen if the brain bleed occurs there?
Circle of Wills
54
Area around an infarct is called _______
Ischemic penumbra (damaged not dead)
55
What is the pathophysiology of an ischemic stroke?
1. Occlusion of a cerebral artery
2. Loss of perfusion
3. Ischemia
4. Release of glutamate outside of cell (Increase of Ca+ inside cell)
5. Infarcation
6. Perimeter cells hypo perfused= ischemic penumbra
7. Cerebral edema
8. Anoxic Encephalopathy
9. Can lead to herniation of brain stem
56
What is elevated pressure in the brain called?
Anoxic Encephalopathy
57
In a TIA, how long do clots typically dissolve?
Within 24 hours
58
If a clot in a TIA takes longer than 24, but still reverse, the disorder is called ________
Reversible Ischemic Neurological Deficits (RINDs)
59
What are some risk factors for CVAs?
- HTN
- Hormonal contraception
- Obesity
- Inactivity
- Binge drinking/substance abuse
- Smoking
- Previous stroke or TIA
- Age
- Family hx or ethnicity
- Heart disease and AF
- High cholesterol
- Diabetes
60
What type of aphasia is damage to the broca area of the left hemisphere?
Expressive aphasia
61
What type of aphasia is damage to the Wernicke's area of the left hemisphere?
Receptive Aphasia
62
A stroke where symptoms occur on the same side
Ipsylateral
63
A stroke where symptoms occur on opposite sides
Contralateral
64
Mnemonic for stroke symptoms
```
Balance
Eyes
Face
Arms
Speech
Time
```
65
The movement during a seizure is called
tonic clonic
66
After a seizure, a person is in the _____ stage
ictal
67
What are the two types of seizures?
1. Grand mal
| 2. Petit mal (absent seizures)
68
Guillain-Barre is characterized by what kind of paralysis?
Ascending (starts from feet and moves upwards)
69
The _______ on the spinal cord, the greater the injury.
Higher
70
How much mass of the brain does brain tissue take up?
80%
71
How much mass of the brain does cerebrospinal fluid (CSF) take up?
10%
72
How much mass of the brain does blood take up?
10%
73
Self-awareness and ability to react with the environment
Level of consciousness
74
What are the four levels of consciousness?
1. alert
2. lethargic
3. obtunded (stupor)-- difficult to arouse
4. coma
75
What is Cushing's Triad?
Hypertension, Apnea, and Bradycardia
| *Usually a sign of impending death
76
What type of coma posturing happens when the feet are plantar flexed, legs are internally rotated, elbows flexed, arms adducted, and wrist and fingers flexed?
Decorticate posturing
77
What type of coma are the feet plantar flexed, wrist and arms flexed, forearms pronated, elbows extended, and arms adducted?
Decerebrate posturing
78
What type of TBI is where the brain hits the front of the skull then hits the back of skull (whiplash/ shaken baby syndrome) ?
Coup-Contrecoup Injury
79
What type of TBI is a result of vibrating trauma?
Blast injury
80
What type of TBI occurs when a bullet goes through a brain?
Penetrating trauma
81
What type of TBI happens when hit on the head with an object?
Blunt trauma
82
In a diffuse axonal injury, the injury happens to the _____ matter of brain.
White
83
What type of spinal cord injury happens as a result of twisting?
Rotational
84
What type of spinal cord injury happens as a result of a person hitting a chin on rock and head neck goes backwards?
Hyperextension
85
What type of spinal cord injury is caused by a downward force on top of head?
Vertical compression
86
What type of spinal cord injury happens when chin gets forced to chest?
Hyperflexion
87
The immediate damage to neurons and the trauma stretches or tears the spinal cord.
Primary Injury
88
What type of spinal cord injury can worsen primary injury and potentially cause cytotoxic edema?
Secondary injury
89
Skin area innervated by the sensory fibers of a single nerve root
Dematome
90
A group of muscles primarily innervated by the motor fibers of a single nerve root
Myotome
91
Spinal ______ can make estimating the extent of a permanent spinal injury difficult to assess
Shock
92
Neurogenic shock occurs when injury is located above ____.
T6
93
What does the musculoskeletal system include?
- bones
- cartilage
- tendons
- muscles
- ligaments
94
Name three things that can cause MSK trauma
1. motor vehicle accidents
2. work-related accidents
3. sports injuries
95
What 5 common traumas of the MSK?
1. Bone fractures
2. Nerve trauma
3. Sprains
4. Strains
5. Dislocations
96
Any disruption, either complete or incomplete, in the continuity of the bone.
Bone fracture
97
The type of bone fracture that occurs from repetitive or cumulative trauma
Stress fracture
98
What is the primary risk factor for a hip fracture?
Osteoporosis
99
What is the strongest bone in the body?
The femur
100
How can a femur break?
With significant traumatic force (MVAs, high-impact sports, ect)
101
What are the three types of femoral fractures?
Type 1: Spiral or Transverse
Type 2: Comminuted
Type 3: Open/Compound
102
A common fracture that occurs in the vertebrae that can lead to kyphosis
Compression fracture
103
What is the most common type of fracture in childhood?
Clavicle
104
What type of fractures are Colles and Smiths fractures?
Distal radius
105
What type of nerve complication effects the median nerve in the wrist?
Carpal tunnel syndrome
106
What type of nerve complication happens when a person experiences numbness and tingling?
Ulnar nerve damage
107
What type of nerve involvement happens in brachial plexus injury (violent pull of arm or shoulder)?
Multiple nerve involvement
108
Results from small tears in the muscle or tendon
Strain
109
Results from injury to a ligament
Sprain
110
Where do meniscus injuries occur?
In the knee
111
What is the most commonly dislocated join in the body?
Shoulder dislocation
112
Shoulder dislocation happens when the humeral separates from the scapula's _________ cavity.
Glenoid
113
A type of degenerative MSK disorder that is specific to bones
Osteoporosis
114
A type of degenerative MSK disorder that is specific to joints.
Osteoarthritis
115
A condition of low bone density and structural deterioration of the bone; caused by an imbalance of the normal process of bone breakdown
Osteoporosis
116
Bone breakdown is caused by
Osteoclasts
117
Bone formation is caused by
Osteoblasts
118
Net bone loss occurs after what age?
30
119
What are the risk factors for osteoporosis?
-Postmenopausal woman and elderly men
| Lack of estrogen; estrogen normally inhibits osteoclasts
120
A condition of the degeneration in joints (usually gets worse over time)
Osteoarthritis
121
What three nutrients are associated with degenerative diseases of the bone?
Vitamin D, Calcium, and Phosphorus
122
A disease in malnourished growing children characterized by the lack of Vitamin D, Calcium, or Phosphorus
Rickets
123
What are some symptoms of Rickets?
- Child's femur develops bow-shaped
- Child's thoracic cage develops asymmetrically
- Tooth development is delayed
124
What is the condition that is similar to Rickets, but happens in adults?
Osteomalacia
125
What are some causes for Osteomalacia?
- Cancer
- Liver and Malabsorption disorders
- Medications
126
What condition is characterized by the intervertebral discs flattening and collapsing?
Degenerative disc disease
127
Narrowing of the spinal column caused by degenerative disc disease
Spinal stenosis
128
Severe spinal stenosis in the lumbar or sacral area that may result in bladder and bowel dysfunction
Cauda Equina Syndrome
129
Bone that is more solid and dense
Cortical bone
130
Bone that is more porous and spongy
Trabecular bone
131
Attaches muscles to bones
Tendons
132
Attaches bones to bones
Ligaments
133
A fractur in which the bone fragments separates completely; and the fractured bone stays in place
Complete non-displaced closed fracture
134
An incomplete break of the bone where the intact side of the bone flexes (usually seen in children)
Greenstick fracture
135
A fracture with more than one fracture line and more than two bone fragments that may be shattered or crushed
Comminuted fracture
136
______ is typically associated with comminuted fractures
Trauma
137
Stress fractures are most common in what body part?
Feet
138
A type of fracture that is generally displaced, often results from trauma, carries a HIGH risk for infection, long bones are most at risk, requires surgical intervention.
(goes through the skin)
Open/Compound Fracture
139
Crushing of the bone due to pressure (Generally occurs in the vertebrae)
Compression
140
Occurs from a shearing, rotational force (Occurs when the body is in motion while one extremity is planted)
Spiral fracture
141
Occurs when one part of the fracture is compressed into the adjacent bone (occurs with impact)
Impacted fracture
142
Separation of bone fragments where ligaments or tendons attach
Avulsion fracture
143
Smith fracture of the wrist is related to _____
flexion
144
Colles fracture of the wrist is related to _______
extension
145
Fracture of the ________ can result in excessive blood loss
Femur
146
Only ___ of people with a hip fracture will make a full recovery
25%
147
What are the risk factors for bone fractures?
1. Age
2. Bone pathology
3. Post menopausal
4. Low Ca++ and Vitamin D
5. Activity
6. Medications
148
- Can accompany closed MSK injury in any compartment
| - Increased pressure leads to decrease vascularization
Compartment syndrome
149
Toxins that increase in the blood which can lead to renal failure (as seen in compartment syndrome)
Rhabdomyolysis
150
Spinal curvature seen more commonly in the elderly
Kyphosis
151
Spinal curvature that can be seen in pregnancy
Lordosis
152
Spinal curvature that is a deviation from being midline
Scoliosis
153
Cervical strains and sprains most commonly occur from?
- Acceleration/Deceleration Injury
| - Repetitive stress or posturing/positioning
154
Why are lumbar injuries the most common?
Because lumbar carries the heaviest load of back
155
What are the three types of shoulder injuries?
1. rotator cuff injury (1 of 4 mucles)
2. dislocation
3. frozen
156
Neonates are at risk for what type of MSK injury?
Brachial plexus injury (Erb's Palsy)
157
What type of MSK injury happens mainly in women, happens with inflammation in the plantar fascia, and is due to high impact on the feet?
Plantar Fasciitis
158
What two types of knee injuries are common in athletes?
- Rupture of the Anterior Cruciate Ligament (ACL)
| - Tear of the Meniscus
159
A mass of cells showing an uncoordinated and proliferative growth
Cancer
160
Cancer cells take on what appearance?
Abnormal appearance and lack differentiation
161
Specific immune (WBC) cells that function to destroy abnormally appearing cells
Natural Killer (NK) cells
162
If a cancer has spread, it has _____
metastasized
163
Cancer Grade I
Cells are well-differentiated
164
Cancer Grade III
Cells or poorly differentiated (anaplastic)
165
How is cancer staged?
By TNM Classification
| Tumor size, node involvement, and metastasis
166
ALL cancers arise from what?
Genetic defect
167
What gene mutation causes 50% of cancer cases?
TP53 (Tumor suppression gene)
168
When mutated, proto-oncogenes become what?
Oncogenes
169
Programmed cell death
Apoptosis
170
Failure of what two things can cause cause?
Apoptosis or NK cells
171
Regulates cell replication
Proto-oncogenes
172
Promotes uncontrolled cellular proliferation
Oncogenes
173
What can cause genes to mutate?
- Genetics
- Environment
- Diet and activity
- Viruses
174
Which Viruses are linked to cancer?
- HPV
- EBV
- Hep B and C
175
_____ insert genes into the host DNA to replicate and can inhibit tumor suppression
Viruses
176
Growth of abnormal cells (stays in the membrane)
Benign
177
Growth of abnormal cells that proliferates and moves (no membrane)
Malignant
178
Spread of cancer
Metastasis
179
The ability to tell cells appart
Differentiation
180
Lack of differentiation in cells
Anaplasia
181
The formation of blood vessels
Angiogenesis
182
Loss of a lot of weight (including muscle mass and fat)
Cachexia
183
Using new blood vessels as pathways to spread cancer
Vascular Endothelial Growth Factor (VEGF)
184
What type of cancer arises from endothelial cells?
Carcinomas
185
What type of cancer arises from blood and lymph?
Lymphomas and Leukemias
186
What type of cancer arises from connective tissue?
Sarcomas
187
What type of cancer arises from the muscles?
Myomas
188
What type of cancer arises from the lining of of the breast glandular tissue?
Adenomas
189
Cancer Grade II
Moderately differentiated
190
Which cancer stage is the worst?
Stage V: Includes distal metastasis
191
What is the common site of metastasis for lung cancer?
Bone and Brain
192
What is the common site of metastasis for colon cancer?
Liver, Peritoneum, Ovary, Lungs
193
What is the common site of metastasis for Breast Cancer?
Bone, Brain, Liver, and Lungs
194
What is the common site of metastasis for Prostate cancer
Vertebrae, Bone, Liver, Lungs
195
What is the common site of metastasis for Melanma?
Brain
196
An unexpected pathologic condition provoked by a secretion of hormones or substances secondary to the presence of cancer
Paraneoplastic syndrome
197
What are 3 examples of a paraneoplastic syndrome?
1. Increased ATCH
2. Increased parathyroid like hormone
3. Increased ADH
198
What is the leading cancer death in the United States?
Lung cancer
199
What are some risk factors to lung cancer?
1. Environmental
2. Smoking
3. Family History
4. Ethnicity
5. COPD
200
What is the number one risk factor for developing breast cancer?
Having breasts
201
What age group is colon cancer usually found in?
The elderly population
202
An overwhelming inflammation reaction initiated by a severe insult to the body
Systemic Inflammatory Response Syndrome (SIRS)
203
What can SIRS be caused by?
- Trauma
- Elongated asthma attack (status asmaticus)
- Surgical
204
The initial body response in SIRS resembles which phase of the stress response
Alarm
205
Why does SIRS often result in sepsis?
After initial injury, body's immune system is exhausted from working hard and eventually immune system gets tired
206
When a patient experiences SIRS, what type of infection generally causes sepsis?
Healthcare-Acquired
207
What are the risk factors associated with sepsis?
- Elderly
- Infants
- Immunosuppressed
- Diabetes
208
What is the pathophysiology of shock?
1. Inadequate blood flow to tissue
2. Leads to cellular hypoxia
3. Anaerobic metabolism in cells
4. Lactic acidosis
209
What are the three main treatments for cancer?
1. Surgery
2. Radiation
3. Chemotherapy
210
What are the five types of shock?
1. Neurogenic
2. Anaphylactic
3. Hypovolemic
4. Septic
5. Cardiogenic
211
A life-threatening condition in which perfusion and oxygenation needs are not met
Shock
212
Signs and symptoms of shock
- Hypotension
- Increased respiratory rate
- Tachycardia
- Oliguria
213
What are the three stages of shock?
1. Initial
2. Progressive
3. Irreversible
214
This stage of shock involves the SNS and RAAS due to lack of perfusion
Initial
215
This stage of shock is where the blood flow to the heart and brain are decreased
Irreversible
216
This stage of shock is where vasoconstriction to the GI tract, liver, and kidneys occur
Progressive
217
How does shock affect the liver and kidneys??
- Leads to lactic acidosis (increased RR)
| - Decreases urine output
218
How does shock affect the GI tract?
GI mucosa breakdown
219
How does shock affect the pancreas?
Pancreas does not provide enough insulin, glucose in the blood increases
220
During shock, which hormones released by the adrenal gland exacerbates hyperglycemia?
Cortisol and epinephrine
221
How does shock affect the blood?
Makes blood more susceptible to clot formation
222
Shock that results when the heart is unable to meet the output demands requires (severe hypotension)
Cardiogenic
223
What is the systolic blood pressure in someone suffering from cardiogenic shock?
Below 90 mm Hg
224
Shock that occurs when blood volume is inadequate for tissue perfusion; usually caused by trauma
Hypovolemic
225
What type of shock is IgE mediated, rapid, and systemic allergic reaction?
Anaphylactic Shock
226
What happens during anaphylactic shock?
Massive vasodilation and bronchospasm
227
What type of shock is caused by a disruption of the SNS?
Neurogenic shock
228
What type of shock is the result of a severe infection?
Septic
229
Septic shock is usually due to what?
Release of vasoactive toxins
230
Viruses need what to survive?
Host cell
231
What are the 5 P’s of compartment syndrome?
- pain
- pallor
- paresthesia
- pulselessness
- paralysis
