Test 5 Flashcards
What is the most common cause of neurological disability?
Cerebrovascular disease
What are the three categories cerebral vascular disease can be dividied into?
- Ischemia stroke
- Transient ischemic attack
- Hemorrhagic stroke
What type of stroke results from an obstruction by a thrombus or embolus?
Ischemic
In an area of ischemia, cells are not given proper oxygen/nutrition which leads to _______.
Infarction
What are 3 causes of ischemic stroke?
- Cerebral arteriosclerosis
- Atrial fibrillation
- Carotid stenosis
What is the treatment of ischemic stroke?
Thrombolysis
How soon after an ischemic stroke should thrombolysis occur?
Within the first 4 1/2 hours
In a _________, an embolus occludes blood flow, but the body’s fibrinolytic system works quickly to dissolve in.
Transient Ischemic Attack (TIA)
What percent of TIA progress to stroke?
20%
In a _______ stroke, an artery ruptures which induces bleeding in the brain.
Hemorrhagic
Besides bleeding in the brain, what else can a hemorrhagic stroke cause?
Cerebral edema
What is the treatment of hemorrhagic stroke?
- Hemodynamic stabilization
- Clot forming agents
- Surgical procedures
What are five symptoms of stroke?
- Weakness on one side of body
- Loss of gag reflex
- Facial droop
- Slurred speech
- Aphasia
True or False: No reliable clinical presentation exists to differentiate between ischemic and hemorrhagic strokes.
True
How can you differentiate between stroke types?
- Computed Tomography
2. Magnetic Resonance Angiography
A condition characterized by recurring seizures
Epilepsy
A sudden discharge of electrical activity in the brain
Seizure
What are 4 contributors to seizures?
- Genetic disposition
- Head Trauma
- Brain tumors
- Infections
What are the two main types of seizures?
Focal Seizures
A seizure that begins in one hemisphere and quickly spreads to the other.
Generalized seizure
Seizures can be categorized based on what?
Symptoms and EEG results
What are 4 symptoms of seizures
- Disruption of senses
- Loss of consciousness
- Muscle spasms
- Repetitive convulsions
(some may report auras)
What is the most common type of headache?
Tension
What are the three types of headaches?
- Tension
- Migraine
- Trigeminal Autonomic Cephalagias (TAC)
What is one type of Trigeminal Autonomic Cephalagia?
Cluster headache
This type of headache appears bilaterally with mild to moderate pain, it may be accompanied with neck stiffness
Tension headache
This type of headache is described as throbbing, usually one-sided headache, worsens with movement and photophobia/phonophobia is present.
Migraine headache
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)
Slowly progressive disorders that affect motor or sensory neurons
Degenerative neurological disorders
- 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)
- Triads of symptoms: tremors, bradykinesia, and muscle rigidity
- Result of disrupted dopamine production by the basal ganglia
- Tx required: dopamine replacement
Parkinson’s disease
- Usually arises from post-infection
- Progressive, symmetric, and peripheral neuropathy
- Patients often recover w/supportive therapy
Guillain-Barre Syndrome
- Antibodies attack the myelin surrounding axons
- Causes sensory and motor dysfunction
Multiple sclerosis
- Acetylcholine receptors on skeletal muscle are attacked
- Treatment includes: Acetylcholinesterase inhibitors
Myasthenia gravis
What are the four ways Traumatic Brain injuries can happen?
- Blunt trauma
- Penetrating Trauma
- Acceleration/Deacceleration
- Blast trauma
What are the two pathophysiological alterations that result from a TBI?
- Change in intercranial pressure (ICP)
2. Change in level of consciousness (LOC)
Movement of the brain that results in rapid stretch and damage to the axons.
Diffuse axonal injury
What happens immediately in diffuse axonal injury?
Loss of consciousness
What type of TBI does a person normally remain in a coma?
Diffuse axonal injury
What type of mild TBI usually results from a blow to the head?
Concussion
How long do the symptoms of a concussion usually resolve?
10-14 days
Symptoms of a concussion
- Dizziness
- Seeing “stars”
- Amnesia
What are the three types of intercranial bleeding?
- Epidural
- Subdural
- Subarachnoid
(Named for their location)
What are the two types of spinal cord injuries?
- Complete
2. Incomplete
What type of spinal cord injury does a patient lose all sensory and motor function below the level of injury?
Complete
Any significant injury to the spinal cord can result in what?
Spinal shock
What is the lack of reflexes during spinal shock called?
Bulbocavernosus reflex
A spinal cord injury at or above C4 affects what?
Respiration
A spinal cord injury at or above T6 may result in what?
Neurogenic shock
causes SNS depression, decrease cardiac output and hypotension
Injury to ascending tracts leads to loss of ______
sensation
Injury to descending tracts leads to loss of _____
motor function
If anything happens to the ________, condition is nearly incompatible with life.
brainstem
What area of the brain will extensive damage happen if the brain bleed occurs there?
Circle of Wills
Area around an infarct is called _______
Ischemic penumbra (damaged not dead)
What is the pathophysiology of an ischemic stroke?
- Occlusion of a cerebral artery
- Loss of perfusion
- Ischemia
- Release of glutamate outside of cell (Increase of Ca+ inside cell)
- Infarcation
- Perimeter cells hypo perfused= ischemic penumbra
- Cerebral edema
- Anoxic Encephalopathy
- Can lead to herniation of brain stem
What is elevated pressure in the brain called?
Anoxic Encephalopathy
In a TIA, how long do clots typically dissolve?
Within 24 hours
If a clot in a TIA takes longer than 24, but still reverse, the disorder is called ________
Reversible Ischemic Neurological Deficits (RINDs)
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
What type of aphasia is damage to the broca area of the left hemisphere?
Expressive aphasia
What type of aphasia is damage to the Wernicke’s area of the left hemisphere?
Receptive Aphasia
A stroke where symptoms occur on the same side
Ipsylateral
A stroke where symptoms occur on opposite sides
Contralateral
Mnemonic for stroke symptoms
Balance Eyes Face Arms Speech Time
The movement during a seizure is called
tonic clonic
After a seizure, a person is in the _____ stage
ictal
What are the two types of seizures?
- Grand mal
2. Petit mal (absent seizures)
Guillain-Barre is characterized by what kind of paralysis?
Ascending (starts from feet and moves upwards)
The _______ on the spinal cord, the greater the injury.
Higher
How much mass of the brain does brain tissue take up?
80%
How much mass of the brain does cerebrospinal fluid (CSF) take up?
10%
How much mass of the brain does blood take up?
10%
Self-awareness and ability to react with the environment
Level of consciousness
What are the four levels of consciousness?
- alert
- lethargic
- obtunded (stupor)– difficult to arouse
- coma
What is Cushing’s Triad?
Hypertension, Apnea, and Bradycardia
*Usually a sign of impending death
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
What type of coma are the feet plantar flexed, wrist and arms flexed, forearms pronated, elbows extended, and arms adducted?
Decerebrate posturing
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
What type of TBI is a result of vibrating trauma?
Blast injury
What type of TBI occurs when a bullet goes through a brain?
Penetrating trauma
What type of TBI happens when hit on the head with an object?
Blunt trauma
In a diffuse axonal injury, the injury happens to the _____ matter of brain.
White
What type of spinal cord injury happens as a result of twisting?
Rotational
What type of spinal cord injury happens as a result of a person hitting a chin on rock and head neck goes backwards?
Hyperextension
What type of spinal cord injury is caused by a downward force on top of head?
Vertical compression
What type of spinal cord injury happens when chin gets forced to chest?
Hyperflexion
The immediate damage to neurons and the trauma stretches or tears the spinal cord.
Primary Injury
What type of spinal cord injury can worsen primary injury and potentially cause cytotoxic edema?
Secondary injury
Skin area innervated by the sensory fibers of a single nerve root
Dematome
A group of muscles primarily innervated by the motor fibers of a single nerve root
Myotome
Spinal ______ can make estimating the extent of a permanent spinal injury difficult to assess
Shock
Neurogenic shock occurs when injury is located above ____.
T6
What does the musculoskeletal system include?
- bones
- cartilage
- tendons
- muscles
- ligaments
Name three things that can cause MSK trauma
- motor vehicle accidents
- work-related accidents
- sports injuries
What 5 common traumas of the MSK?
- Bone fractures
- Nerve trauma
- Sprains
- Strains
- Dislocations
Any disruption, either complete or incomplete, in the continuity of the bone.
Bone fracture
The type of bone fracture that occurs from repetitive or cumulative trauma
Stress fracture
What is the primary risk factor for a hip fracture?
Osteoporosis
What is the strongest bone in the body?
The femur
How can a femur break?
With significant traumatic force (MVAs, high-impact sports, ect)
What are the three types of femoral fractures?
Type 1: Spiral or Transverse
Type 2: Comminuted
Type 3: Open/Compound
A common fracture that occurs in the vertebrae that can lead to kyphosis
Compression fracture
What is the most common type of fracture in childhood?
Clavicle
What type of fractures are Colles and Smiths fractures?
Distal radius
What type of nerve complication effects the median nerve in the wrist?
Carpal tunnel syndrome
What type of nerve complication happens when a person experiences numbness and tingling?
Ulnar nerve damage
What type of nerve involvement happens in brachial plexus injury (violent pull of arm or shoulder)?
Multiple nerve involvement
Results from small tears in the muscle or tendon
Strain
Results from injury to a ligament
Sprain
Where do meniscus injuries occur?
In the knee
What is the most commonly dislocated join in the body?
Shoulder dislocation
Shoulder dislocation happens when the humeral separates from the scapula’s _________ cavity.
Glenoid
A type of degenerative MSK disorder that is specific to bones
Osteoporosis
A type of degenerative MSK disorder that is specific to joints.
Osteoarthritis
A condition of low bone density and structural deterioration of the bone; caused by an imbalance of the normal process of bone breakdown
Osteoporosis
Bone breakdown is caused by
Osteoclasts
Bone formation is caused by
Osteoblasts
Net bone loss occurs after what age?
30
What are the risk factors for osteoporosis?
-Postmenopausal woman and elderly men
Lack of estrogen; estrogen normally inhibits osteoclasts
A condition of the degeneration in joints (usually gets worse over time)
Osteoarthritis
What three nutrients are associated with degenerative diseases of the bone?
Vitamin D, Calcium, and Phosphorus
A disease in malnourished growing children characterized by the lack of Vitamin D, Calcium, or Phosphorus
Rickets
What are some symptoms of Rickets?
- Child’s femur develops bow-shaped
- Child’s thoracic cage develops asymmetrically
- Tooth development is delayed
What is the condition that is similar to Rickets, but happens in adults?
Osteomalacia
What are some causes for Osteomalacia?
- Cancer
- Liver and Malabsorption disorders
- Medications
What condition is characterized by the intervertebral discs flattening and collapsing?
Degenerative disc disease
Narrowing of the spinal column caused by degenerative disc disease
Spinal stenosis
Severe spinal stenosis in the lumbar or sacral area that may result in bladder and bowel dysfunction
Cauda Equina Syndrome
Bone that is more solid and dense
Cortical bone
Bone that is more porous and spongy
Trabecular bone
Attaches muscles to bones
Tendons
Attaches bones to bones
Ligaments
A fractur in which the bone fragments separates completely; and the fractured bone stays in place
Complete non-displaced closed fracture
An incomplete break of the bone where the intact side of the bone flexes (usually seen in children)
Greenstick fracture
A fracture with more than one fracture line and more than two bone fragments that may be shattered or crushed
Comminuted fracture
______ is typically associated with comminuted fractures
Trauma
Stress fractures are most common in what body part?
Feet
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
Crushing of the bone due to pressure (Generally occurs in the vertebrae)
Compression
Occurs from a shearing, rotational force (Occurs when the body is in motion while one extremity is planted)
Spiral fracture
Occurs when one part of the fracture is compressed into the adjacent bone (occurs with impact)
Impacted fracture
Separation of bone fragments where ligaments or tendons attach
Avulsion fracture
Smith fracture of the wrist is related to _____
flexion
Colles fracture of the wrist is related to _______
extension
Fracture of the ________ can result in excessive blood loss
Femur
Only ___ of people with a hip fracture will make a full recovery
25%
What are the risk factors for bone fractures?
- Age
- Bone pathology
- Post menopausal
- Low Ca++ and Vitamin D
- Activity
- Medications
- Can accompany closed MSK injury in any compartment
- Increased pressure leads to decrease vascularization
Compartment syndrome
Toxins that increase in the blood which can lead to renal failure (as seen in compartment syndrome)
Rhabdomyolysis
Spinal curvature seen more commonly in the elderly
Kyphosis
Spinal curvature that can be seen in pregnancy
Lordosis
Spinal curvature that is a deviation from being midline
Scoliosis
Cervical strains and sprains most commonly occur from?
- Acceleration/Deceleration Injury
- Repetitive stress or posturing/positioning
Why are lumbar injuries the most common?
Because lumbar carries the heaviest load of back
What are the three types of shoulder injuries?
- rotator cuff injury (1 of 4 mucles)
- dislocation
- frozen
Neonates are at risk for what type of MSK injury?
Brachial plexus injury (Erb’s Palsy)
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
What two types of knee injuries are common in athletes?
- Rupture of the Anterior Cruciate Ligament (ACL)
- Tear of the Meniscus
A mass of cells showing an uncoordinated and proliferative growth
Cancer
Cancer cells take on what appearance?
Abnormal appearance and lack differentiation
Specific immune (WBC) cells that function to destroy abnormally appearing cells
Natural Killer (NK) cells
If a cancer has spread, it has _____
metastasized
Cancer Grade I
Cells are well-differentiated
Cancer Grade III
Cells or poorly differentiated (anaplastic)
How is cancer staged?
By TNM Classification
Tumor size, node involvement, and metastasis
ALL cancers arise from what?
Genetic defect
What gene mutation causes 50% of cancer cases?
TP53 (Tumor suppression gene)
When mutated, proto-oncogenes become what?
Oncogenes
Programmed cell death
Apoptosis
Failure of what two things can cause cause?
Apoptosis or NK cells
Regulates cell replication
Proto-oncogenes
Promotes uncontrolled cellular proliferation
Oncogenes
What can cause genes to mutate?
- Genetics
- Environment
- Diet and activity
- Viruses
Which Viruses are linked to cancer?
- HPV
- EBV
- Hep B and C
_____ insert genes into the host DNA to replicate and can inhibit tumor suppression
Viruses
Growth of abnormal cells (stays in the membrane)
Benign
Growth of abnormal cells that proliferates and moves (no membrane)
Malignant
Spread of cancer
Metastasis
The ability to tell cells appart
Differentiation
Lack of differentiation in cells
Anaplasia
The formation of blood vessels
Angiogenesis
Loss of a lot of weight (including muscle mass and fat)
Cachexia
Using new blood vessels as pathways to spread cancer
Vascular Endothelial Growth Factor (VEGF)
What type of cancer arises from endothelial cells?
Carcinomas
What type of cancer arises from blood and lymph?
Lymphomas and Leukemias
What type of cancer arises from connective tissue?
Sarcomas
What type of cancer arises from the muscles?
Myomas
What type of cancer arises from the lining of of the breast glandular tissue?
Adenomas
Cancer Grade II
Moderately differentiated
Which cancer stage is the worst?
Stage V: Includes distal metastasis
What is the common site of metastasis for lung cancer?
Bone and Brain
What is the common site of metastasis for colon cancer?
Liver, Peritoneum, Ovary, Lungs
What is the common site of metastasis for Breast Cancer?
Bone, Brain, Liver, and Lungs
What is the common site of metastasis for Prostate cancer
Vertebrae, Bone, Liver, Lungs
What is the common site of metastasis for Melanma?
Brain
An unexpected pathologic condition provoked by a secretion of hormones or substances secondary to the presence of cancer
Paraneoplastic syndrome
What are 3 examples of a paraneoplastic syndrome?
- Increased ATCH
- Increased parathyroid like hormone
- Increased ADH
What is the leading cancer death in the United States?
Lung cancer
What are some risk factors to lung cancer?
- Environmental
- Smoking
- Family History
- Ethnicity
- COPD
What is the number one risk factor for developing breast cancer?
Having breasts
What age group is colon cancer usually found in?
The elderly population
An overwhelming inflammation reaction initiated by a severe insult to the body
Systemic Inflammatory Response Syndrome (SIRS)
What can SIRS be caused by?
- Trauma
- Elongated asthma attack (status asmaticus)
- Surgical
The initial body response in SIRS resembles which phase of the stress response
Alarm
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
When a patient experiences SIRS, what type of infection generally causes sepsis?
Healthcare-Acquired
What are the risk factors associated with sepsis?
- Elderly
- Infants
- Immunosuppressed
- Diabetes
What is the pathophysiology of shock?
- Inadequate blood flow to tissue
- Leads to cellular hypoxia
- Anaerobic metabolism in cells
- Lactic acidosis
What are the three main treatments for cancer?
- Surgery
- Radiation
- Chemotherapy
What are the five types of shock?
- Neurogenic
- Anaphylactic
- Hypovolemic
- Septic
- Cardiogenic
A life-threatening condition in which perfusion and oxygenation needs are not met
Shock
Signs and symptoms of shock
- Hypotension
- Increased respiratory rate
- Tachycardia
- Oliguria
What are the three stages of shock?
- Initial
- Progressive
- Irreversible
This stage of shock involves the SNS and RAAS due to lack of perfusion
Initial
This stage of shock is where the blood flow to the heart and brain are decreased
Irreversible
This stage of shock is where vasoconstriction to the GI tract, liver, and kidneys occur
Progressive
How does shock affect the liver and kidneys??
- Leads to lactic acidosis (increased RR)
- Decreases urine output
How does shock affect the GI tract?
GI mucosa breakdown
How does shock affect the pancreas?
Pancreas does not provide enough insulin, glucose in the blood increases
During shock, which hormones released by the adrenal gland exacerbates hyperglycemia?
Cortisol and epinephrine
How does shock affect the blood?
Makes blood more susceptible to clot formation
Shock that results when the heart is unable to meet the output demands requires (severe hypotension)
Cardiogenic
What is the systolic blood pressure in someone suffering from cardiogenic shock?
Below 90 mm Hg
Shock that occurs when blood volume is inadequate for tissue perfusion; usually caused by trauma
Hypovolemic
What type of shock is IgE mediated, rapid, and systemic allergic reaction?
Anaphylactic Shock
What happens during anaphylactic shock?
Massive vasodilation and bronchospasm
What type of shock is caused by a disruption of the SNS?
Neurogenic shock
What type of shock is the result of a severe infection?
Septic
Septic shock is usually due to what?
Release of vasoactive toxins
Viruses need what to survive?
Host cell
What are the 5 P’s of compartment syndrome?
- pain
- pallor
- paresthesia
- pulselessness
- paralysis
