Test 6 Flashcards
(325 cards)
1
Q
What are four hormones that can effect Blood Glucose Levels?
A
Cortisol, Glucagon, Epinephrine and the Growth Hormone
2
Q
Which hormones inhibit the release of Insulin?
A
Cortisol, Glucagon, Epinephrine and the Growth Hormone
3
Q
Most important of the Glucocorticoid Hormones from the Adrenal Cortex and it has to be present for other three Hormones to work
A
Cortisol
4
Q
Hormone secreted by the Islets of Langerhans that releases Glucose from stored Glycogen
A
Glucagon
5
Q
Helps to maintain blood Glucose levels during Stress by inhibiting Insulin release
A
Epinephrine
6
Q
Antagonizes the effects of Insulin by decreasing Glucose uptake and usage by the cells
A
Growth Hormone
7
Q
These Counter-Regulatory Hormones bind to specific receptors on cells and they stimulate the enzymes in a pathway to take stored Glycogen and turn it into _________
A
Glucose
8
Q
What produces insulin?
A
The Beta Cells in the Islets of Langerhans of the Pancreas
9
Q
Insulin release is regulated by _____________.
A
Blood glucose levels
10
Q
As Blood Glucose Levels rise (Increases), insulin secretion _________.
A
Increases
11
Q
As Blood Glucose Levels decrease, insulin secretion __________
A
Decreases
12
Q
The Only Hormone Known to Have a Direct Effect on Lowering Blood Glucose Levels is __________
A
Insulin
13
Q
Insulin is released within minutes of consuming a meal and serum Insulin reach a peak approximately __-__ minutes
A
3-5
14
Q
True or False
Insulin is required to move Glucose into the cells
A
True
15
Q
Insulin binds to a Receptor on a cell and causes what two things to occur:
A
- Proteins that are located in the cytoplasm of the cell are inserted into the cell membrane
* These proteins are what glucose binds to
2.Glucose moves into the cell by Facilitated Diffusion; does not require Energy
When Glucose binds to the proteins, it undergoes a confirmation change and shuttles Glucose in
16
Q
As long as the concentration of Glucose is high outside the cell and protein carriers are there, you will see movement of Glucose ____________.
A
Going into the cell
17
Q
What is the the reason Glucose isn’t always entering the cell?
A
Because the protein carriers are not always present
*You need Insulin to bind to the Receptor
18
Q
_________ get inserted into the cell membrane and
________ binds to the protein carrier and is shuttled into the cell
A
Protein carriers; Glucose
19
Q
What are the functions on insulin?
A
- Movement of Glucose into a Cell
- controls the production of enzymes responsible for Cellular Metabolism
- stimulates all the enzymes necessary for Glucose to get converted to Glycogen
20
Q
What cells store the greatest amounts of glycogen?
A
Liver and Muscle Cells
21
Q
Needed to produce the Enzymes required for the conversion of Glucose down Metabolic Pathways. __________
A
Insulin
22
Q
How is glucose converted to adipose tissue?
A
Glucose to Glycerol and Fatty Acids to Storage of Triglycerides in Adipose Tissue
23
Q
Do Epithelial cells of the Gut require/ don’t require Insulin for Glucose Uptake
A
DO NOT REQUIRE
*Absorbs Glucose from the Small Intestine and then Glucose enters the blood stream
24
Q
Do the neurons of the brain require Insulin for Glucose uptake?
A
DO NOT REQUIRE
Glucose can automatically enter a neuron via Facilitated Diffusion; Not Insulin Dependent
25
What is the the primary fuel for the Brain and the Nervous System?
Glucose
26
The fact that the Brain is limited to storing only Glucose for a few minutes, it requires a Continuous supply of ________.
Glucose
27
Chronic disorder of carbohydrate metabolism resulting from insufficient production of Insulin or from inadequate utilization of this hormone by the body's target cells. _________
Diabetes Mellitus (Hyperglycemia)
28
What can result in Hyperglycemia
Insulin Deficit
29
Type 1 Diabetes is also referred to as:
Insulin Dependent Diabetes Mellitus (IDDM)
| Child Onset / Juvenile Diabetes
30
What type of Diabetes is the most serious form?
Type 1 Diabetes
31
What type of Diabetes accounts for 10% of all Diabetics?
Type 1 Diabetes
32
Diagnosis is rare during the first 9 months of life and peaks at what age?
12 years old
33
Type 1 diabetes develops most commonly in what age group?
The Young
34
What is the range in which children are diagnosed with Type 1 diabetes?
1 in 400 – 500
35
Type 2 diabetes is also referred to as:
Non-Insulin Dependent Diabetes Mellitus (NIDDM)
36
What type of diabetes is the most common and mildest form?
Type 2
37
Incidence estimated at about 9% of the population (18 million) greater than ____ years of age
20 years of age
38
Type 2 diabetes effects people primarily after age ____.
40
39
Approximately half the cases are found in individuals greater than ____ years of age
55
40
What type of diabetes is becoming more common in obese adolescents and children?
Type 2
41
What are the common factors resulting in the initial stage of diabetes?
1. Insulin deficit results in decreased transportation and use of Glucose in many cells of the body
2. Hyperglycemia: Increase in Blood Glucose Levels
3. Glucosuria: Excess Glucose in the Urine
42
Three “Ps” are the three most common signs and symptoms. What are they?
1. Polyuria: Excessive urination
2. Polydipsia: Excessive Thirst
3. Polyphagia: Increase in Appetite
43
Glucose acts as a _______ and causes large amount of urine to be excreted with loss of fluid and electrolytes (sodium) from the body tissues.
Diuretic
44
What results in fluid loss through the Urine?
Dehydration
45
A great loss of water occurs with __________.
Glucose
46
What occurs with Polydipsia?
Dehydration causes excess thirst
| By drinking large amounts of water, the person compensates for the fluid loss
47
Result of lack of nutrients entering the cells stimulates appetite
Polyphagia: Increase in Appetite
48
Progressive Effects are seen more with what type of diabetes?
Type 1
| *Occurs when Insulin Deficit is severe or prolonged
49
A decrease in Glucose is also seen with people on _________
Sarvation diets
50
Lack of Glucose in body cells results in what?
Catabolism of Proteins
Catabolism of Fats
Causes excessive amounts of Fatty Acids and their metabolic wastes: Ketones or Ketoacids
51
Name for Excessive Ketones in the blood
Ketoacidosis
52
Ketoacids bind with the ____________ in the blood
Bicarbonate Buffer
| *Leading to decreased Serum Bicarbonate
53
What is the end result of decreased Serum Bicarbonate?
Decrease in the pH of body fluids
54
As Dehydration occurs, GFR ___________
| Excretion of Ketoacids _____________
Decreases; Decreases
55
Decrease in GFR and Excretion of Ketoacids results in what?
Decompensated Metabolic Acidosis: Diabetic Ketoacidosis or Diabetic Coma
Life threatening
56
Type 1 Diabetes is sub-dived into what two types?
1. Autoimmune Disease (represents 95% of Type 1 Diabetes)
| 2. Idiopathic
57
Islet Cell Antibodies against the Beta Cells of the Pancreas can be detected in the blood of newly diagnosed patients with Type 1
Autoimmune Disease
58
Islet Cell antibodies may also exist for years before the onset of ____________
Hyperglycemia
59
Pathogenesis:
| Islets of Langerhans show a depletion of Beta cells in what type of diabetes?
Type 1
60
Cells are replaced by _________
Fibrous Tissue
61
Suggestive of an Autoimmune Reaction which may be triggered by an environmental agent (Viral Infection) that results in an Immune Response and ____________.
Antibody Production
62
Common Theory for Type 1 Diabetes is:
Genetic-Environmental Interaction
63
Environmental Factors for Type 1 Diabetes include:
Sudden onset of Type 1 Diabetes may be related to a Viral Infection
Seasonal occurrences of Type 1: More new cases documented during fall and winter in the northern hemisphere
Seasonal occurrences may be suggestive of “Mini-Epidemics" consistent with Viral Infections
64
Mechanisms of Type 1 Diabetes includes:
Loss of Beta Cells resulting in an absolute Insulin deficit
| Glucose uptake and metabolism are compromised
65
Disease results from _________________
A genetic susceptibility
66
What percentage of first degree relatives develop impaired Glucose Intolerance or Type 2 Diabetes
15-25%
67
Beta cells are essentially __________.
undamaged
68
Beta cells are capable of producing _________ but secretion in response to stimulation by Glucose may be Delayed
Glucose
69
Key Defects of Type 2 Diabetes include:
Insulin Resistance
Involves the inability of the uptake and utilization of Glucose in various target tissues such as Muscle and the Liver
Insulin resistance is based on slower cycling of the Glucose Carrier Proteins to the cell membrane surface
70
The Majority of Type 2 Diabetics are __________
Over weight
71
Individuals with __________ are at a greater risk for development of Type 2
Upper Body Obesity
| *Increased abdominal girth
72
Obese individuals have an _______ resistance to Insulin
Increase
73
Obese individuals also have an
impaired suppression of Glucose from their Liver
| Increased release of Glucose by the Liver
74
Mechanisms of Type 2 include:
Impaired Insulin Release from the Pancreas
Insulin Resistance
Increased Glucose Production from the Liver
75
Sings and symptoms of TYPE 2 diabetes include:
Glycosuria
76
TRUE OR FALSE
| If Glucose is 100 mg/dl in the plasma, then it will also be 100mg/dl in Bowman's Capsule space
TRUE
77
Glucose is reabsorbed by the _________
PCT by active transport via a protein pump
78
Normal Blood Glucose Levels (fasting) are:
70 - 110 mg/dl
79
Renal Threshold Levels are:
180/200 mg/dl
80
True or False
| Once we saturate these protein pumps, we can't move Glucose any faster into the blood stream
TRUE
81
Any excess Glucose will spill into the urine resulting in __________.
Glycosuria
82
Signs and symptoms of Diabetes include:
1. Polyuria
2. Polydipsia
3. Polyphagia
83
Metabolic changes result in poor use of food products, contributing to ________ and ____________.
Lethargy and Fatigue
84
Weight Loss is a symptom of what type of diabetes?
```
Type 1 (Since there is no Insulin available, the body is burning both fats and proteins for energy)
Also occurs because of fluid loss in osmotic Diuresis
```
85
Obesity is a symptom of what type of diabetes?
Type 2
| *Not all Diabetics are obese, or not all obese individuals are Diabetics
86
Increase abdominal girth is a symptom of what type of diabetes?
TYPE 2
87
Major sign of Diabetes is ________
Glycosuria
88
Presence of Ketones (Ketone Bodies) in urine is another sign of Diabetes mellitus
Ketonuria
| *Result of Fat catabolism
89
Diagnostic test for Diabetes include:
Urinalysis
Fasting Blood Glucose (Sugar) - FBS
Glucose Tolerance Test (GTT)
Glycosylated Hemoglobin (HbA1C or A1C) *A1C is the preferred term
90
Normal values for FBS are:
70 - 110 mg/dl
91
A diagnosis of Diabetes is made if the FBS (plasma) level is ___________________
Is greater than 126 mg/dl for two consecutive tests
92
2 Hour post-load for FBS should be:
Should be less than 140 mg/dl
93
Glucose Tolerance Test (GTT):
| Within 3 hours, patient should be ______________________
Back to the baseline of Glucose
94
For the Glucose Tolerance Test (GTT) a Diabetic patient would:
May begin with an elevated FBS
Glucose levels increase after drinking glucose
May be equal or Greater than 200 mg/dl
They are not utilizing the Glucose they drank
95
When Hemoglobin is released from the Bone Marrow it normally ___________
Does not contain Glucose
96
The Glycosylated Hemoglobin Concentration (HbA1C or A1C) Represents what?
The average blood Glucose level over the past Several Weeks (2 – 3 months)
97
The goal for the average blood Glucose level is:
Less than 7.0%
98
Normal Glycemic Levels are:
Less than 6.0%
| *Beneficial in diagnosing a Non-compliant patient
99
Three major acute complications exist for Diabetes:
1. Hypoglycemia / Low Blood Sugar / Insulin Reaction (Shock)
2. Diabetic Ketoacidosis (DKA)
3. Hyperosmolar Hyperglycemic Nonketotic Coma
100
Hypoglycemia / Low Blood Sugar / Insulin Reaction (Shock) results from what?
An Inadequate level of circulating Glucose
| KNOW *Adults: 45 - 60 mg/dl
101
Hypoglycemia / Low Blood Sugar / Insulin Reaction (Shock) usually occurs suddenly in __________
Type 1
102
Inadequate level of circulating Glucose results of:
Strenuous exercise
An error in Insulin Dosage
Vomiting
Skipping a meal after taking Insulin
103
Lack of glucose affects the Nervous system by:
Neurons can’t use Fats or Proteins as an Energy Source
| Clinical manifestations relate to Low blood Glucose levels
104
Examples of Impaired Neurologic Function of Diabetes
Poor concentration
Slurred speech
Lack of coordination
Staggering gait
105
Stimulation of the Sympathetic Nervous System include:
Increased pulse
Pale, moist skin
Anxiety
Tremors
106
Hypoglycemia can affect the brain by:
Cause Brain damage if not treated promptly
| Patient can become unconscious, experience seizures and death can occur
107
Treatment for an Insulin Reaction / Hypoglycemia include:
Immediate administration of a concentrated Carbohydrate: Sweetened fruit juice or candy
If patient is unconscious: Administration of Glucose or Glucagon Intravenously
Administration of Epinephrine also raises blood sugar levels
108
A Diabetic Patient Going into a Coma Could be due to Either an __________ or ____________ in Blood Glucose Levels
Increase or Decrease
109
Necessary to administer Glucose to prevent _____________
Neuronal Death
110
If a coma is due to increase in blood sugar what will be done?
Glucose given will only raise blood sugar slightly
111
Specific to Type 1 Diabetes
Diabetic Ketoacidosis (DKA)
112
Often preceded by physical or emotional Stress and develops over a few days
*Infection, pregnancy, or extreme anxiety
Diabetic Ketoacidosis (DKA)
113
Stress results in the release of _________ and predisposes one to the development of DKA
Cortisol
114
Lipid metabolism results in the accumulation of___________ in the blood
Ketone Bodies
| *Can produce nausea and vomiting
115
Fruity, acetone smell characteristic odor that is often detected on the Breath of a diabetic patient.
Ketone Bodies
116
What is the pH of plasma:
Less than 7.3
117
Signs & Symptoms of Dehydration
```
Dehydration
Thirst
Decreased skin turgor
Skin with decreased turgor remains elevated and returns slowly to its normal position.
Dry oral mucosa
Warm, dry skin
Rapid, weak pulse
Low Blood Pressure
Oliguria
```
118
Signs & Symptoms: Ketoacidosis (DKA)
Deep, rapid respirations (Kussmaul’s Respirations) with Acetone Breath
Lethargy & decreased responsiveness
119
What happens if Diabetic Ketoacidosis (DKA) remains untreated?
CNS Depression develops and results in a Coma
Caused by the combined effects of Ketoacidosis and Dehydration
Toxic effects of Ketone Bodies on the Brain
Develops in extreme elevation of blood Glucose level
120
Develops in extreme elevation of blood Glucose level
Blood Glucose levels above 250 mg/dl
121
May develop a Coma with blood sugars of 400 - 800 mg/dl
Type 1
122
Treatment of Diabetic Ketoacidosis (DKA) would be:
Administer Insulin as well as replacement of Fluid and Electrolytes
Bicarbonate administration is essential to reverse Acidosis
Resolve the initial cause
123
Hyperosmolar Hyperglycemic Nonketotic Coma Develops more frequently in _________.
Type 2 Diabetes
| *Blood Sugar levels of 800 - 1500 mg/dl
124
Dehydration is more severe due to ___________________
Extremely high blood sugar levels
125
Often associated with an infection or carbohydrate overload
Hyperosmolar Hyperglycemic Nonketotic Coma
126
Results in a decrease perfusion to the Brain and results in a Coma
Hypovolemia
127
Hyperglycemia and dehydration develop because of ________________
The relative Insulin deficit, but sufficient
128
What is able to prevent Ketoacidosis
Insulin
| *Patient’s will display S&S for Dehydration, but will not experience S&S of Ketoacidosis
129
Hyperosmolar Hyperglycemic Nonketotic Coma will experience _____________
Lethargy and Decreasing Responsiveness
130
Type 2 Diabetics have Insulin, but they have _________________
A decrease effect of Insulin
131
Chronic Complications occur when?
When blood Glucose levels are poorly controlled and result in Hyperglycemia
132
What is the most clearly established risk factor associated with the complications.
Hyperglycemia
133
Degenerative changes occur in the ________________.
Insulin-Independent Body Tissues
134
Tissues that __________ require Insulin for Glucose Uptake
DO NOT
135
What is the rationale for chronic complications:
Intracellular Glucose levels In these tissues approach or equal blood Glucose levels
136
What happens in Microangiopathy (Small Vessel Damage)
In small vessels, altered Carbohydrate metabolism causes faulty deposition of the Basement Membrane material
Basement membrane becomes thick and hard
Causes obstructions
Weakens the blood vessels and interferes with normal capillary permeability
Obstruction: Results in reduced blood flow
Rupture of capillaries and small blood vessels
137
What is the end result of Microangiopathy (Small Vessel Damage)?
Results in Tissue Necrosis, Loss of Function and Prolonged Healing!!!
138
Hypertension usually accompanies _________ Diabetics, especially with the obese
Type 2
139
Weakens the blood vessels which leads to Aneurysm formation and eventually they may rupture within the Retina
Diabetic Retinopathy
| *Some degree of Blindness
140
Examples of Microangiopathy are:
Diabetic Retinopathy
| Diabetic Nephropathy
141
Initially, filtration is increased, period of proteinuria, and in the later stages GFR progressively _____________
Declines (Decreases)
142
In Diabetic Nephropathy Glomerular vessels (Glomeruli) are also subject to _______________.
Basement Membrane Damage
143
With Diabetic Nephropathy what happens as complications:
Nephron function is progressively lost resulting in Chronic Renal Failure!!!
144
What is the leading cause of End-Stage Renal Disease?
```
Diabetic Nephropathy (Chronic Renal Failure)
*Responsible for 40% of patients in End-Stage Renal Failure
```
145
Macroangiopathy (Large Vessel Damage) results in _______________
Atherosclerosis (Developed prematurely)
146
Hyperlipidemia could also result in _____________
Atherosclerosis
147
Lipids are removed from Adipose Tissues and are delivered by the _______________.
Vascular System
| *Higher incidence of MI and CVA
148
Major cause of death in Diabetes is _____________
Myocardial Infarction
149
Atherosclerosis results in ___________
Myocardial Infarction
150
Examples of Macroangiopathy (Large Vessel Damage) would be:
Atherosclerosis
Peripheral Vascular Disease (Impairment of Wound Healing)
Peripheral Neuropathy
151
Minor wounds, which normally should heal quickly, can pose a serious threat that result ___________________
A Reduction of blood flow
Poor oxygen deliver which can result in the growth of anaerobic microbes
Development of Neuropathic Ulcers
Risk of Gangrene
152
Prolonged Healing is noted in ______________ AND ____________.
Microangiopathy and Mracoanigiopathy
153
Degenerative changes occur in ___________ and _________
both unmyelinated and myelinated axons
154
Examples of Peripheral Neuropathy would be:
a. Numbness
b. Tingling sensations
c. Pain
d. GI motility
Delayed gastric emptying leads to bouts of diarrhea, especially at night and constipation
Result of a Degeneration of the Autonomic Nervous System
e. Bladder Dysfunction
Bladder paralysis with urinary retention
Increases incidence of UTIs
f. Impotence in males
g. Abnormal reflexes
Absence of ankle and knee jerk reflexes
155
Chronic Complications of diabetes would include:
```
Microangiopathy (Small Vessel Damage)
Macroangiopathy (Large Vessel Damage)
Peripheral Neuropathy
Susceptibility to Infection
Cataracts
Glaucoma
```
156
Infections in the feet and legs persist and are slow to heal resulting in __________and _________
Gangrene and Amputation
157
Prevents Diabetics from detecting pain of their feet and unable to adjust their gait to avoid placing pressure which is potentially causing trauma and necrosis
Neuropathy
158
Degenerative process related to the abnormal metabolism of Glucose
Cataracts
159
Cataracts results in the accumulation of ___________
Sorbitol
160
Increased pressure in the Eye
| Increased incidence in Diabetes
Glaucoma
161
What is the treatment goal for diabetes?
Maintain normal blood glucose levels in order to prevent or delay the Chronic Diabetes Complications
162
Treatment for Diabetes includes:
```
Diet
Exercise (Decreases the need for Insulin)
Oral Medications
Insulin Therapy
Transplantation
```
163
Exercise is a concern for Concern with Insulin-Dependent Diabetics because:
Increased risk of Hypoglycemia
164
True or False Type 2 Diabetes (only): :
| Many Type 2 patients would then be able to control their diabetes with a combination of weight loss and exercise
TRUE
165
True or False Type 2 Diabetes (only): :
| Over time, Insulin resistance may actually improve if the patient loses weight
TRUE
166
Oral Hypoglycemic drugs may be used with Type ______
Type 2 diabetics
*increase in the release of Insulin from the Beta cells
One would have to have healthy Beta cells and functional Insulin to benefit from these drugs
167
Which drug reduces Insulin Resistance?
Glucophage (metformin)
168
Which drug increases tissue sensitivity to Insulin?
Avandia (rosiglitazone)
169
Treatment always required for Type 1 for the remainder of their lives is __________
Insulin Therapy
170
Insulin must be administered by __________________
by Injections (subcutaneous) because the protein is destroyed in the GI tract
171
Newer forms of Insulin Therapy include:
Multiple daily Insulin injections
| Use of an Insulin Pump which provides continues infusion
172
The inhaled insulin is called __________
Afrezza
Taken before meals
Absorbe more quickly via cells from the Lungs
Rapid Peak
Peaks in the blood in 15 – 20 minutes (Injected Insulin taken before a meal typically peaks in 1 hour)
Also cleared more rapidly from
173
Pancreas Transplants have been performed since _____________
1966
174
Prognosis for Diabetes is ___________
Variable
175
Most common form of Hyperthyroidism would be __________
Graves’ Disease
| *increased levels of T3 and T4
176
Grave's Disease Occurs more frequently in women over _______
30 years old
177
Grave's Disease is what kind of disorder?
Autoimmune Disorder
178
Clinical Manifestations of Grave's Disease would be:
Toxic goiter: Hyperactivity & enlargement of the Thyroid Gland
Weight loss despite increased appetite
Heat intolerance, Excessive Sweating
Tremors, Nervousness, & Palpitations
Exophthalmos: Abnormal protrusion of the eyes
179
Form of severe Hypothyroidism would be ___________
Hashimoto’s Disease
180
What type of disorder would Hashimoto be:
Destructive, Chronic Autoimmune Disorder
181
Clinical Manifestations of Hashimato would be:
Inflammation of Thyroid Gland; Immune Mediated
Initially, presents with an enlarged Thyroid Gland (goiter) and is infiltrated with Lymphocytes
Eventually, Fibrosis may reduce the size of the Thyroid Gland
SYMPTOMS: Energy Loss, Fatigue, Forgetfulness, Sensitive to Cold, Weight Gain with Anorexia, Bradycardia, and Enlarged Heart
182
What is Cushing's Syndrome caused by?
Hypersecretion of ACTH from Pituitary Adenomas and excessive amount of Glucocorticoids (cortisol)
183
Clinical Manifestations of Cushing's Syndrome would be:
```
Moon Face, Buffalo Hump, Obese Trunk, Muscle Wasting in Extremities and Osteoporosis
Bruising and Striae of Skin
Hypertension, Glucose Intolerance
Fatigue, Weakness, Delayed Healing
High Risk of Infections
Poor Stress Response
```
184
Adrenal Insufficiency with deficiency of Adrenocortical secretions: Glucorticoids, Mineralocorticoids and Androgens
Addison’s Disease
185
70% of Addison's Disease cases associated with an _______________
Autoimmune Disorder (Adrenalitis)
186
What can also cause Addison's Disease:
Infections (TB and Fungal)
| Immunosuppression and AIDS
187
Clinical Manifestations of Addison's Disease would be:
High risk of Infection
Poor Stress Response
Weight Loss, Fatigue
Anorexia, Nausea, Diarrhea
Hypotension
Syncope (Fainting or loss of consciousness)
Hyperpigmentation (skin, nails and of the mucous membranes, especially of the mouth)
188
CSF Examination is commonly obtained by:
A Lumbar Puncture
| Between L3 and L4 or L4 and L5
189
A clear colorless fluid that fills the ventricles within the Brain and the Subarachnoid Spaces around the Brain and Spinal Cord
CSF
190
CSF is made up of _________
99% Water
| Glucose,proteins, urea, salts
191
CSF can be examined for _________
Gross appearance, pressure, glucose and protein content
192
The number and types of blood cells present and the presence of bacteria, viruses, and fungi can be determined by ________
A culture
193
May be attached to a syringe to measure the pressure
Monometer
| *Noted in patients with Increased Intracranial (ICP)
194
A closed, non-expandable vault which contains the Brain, Blood and CSF
Skull
195
Any increase in blood, inflammatory exudate or a mass, such as a tumor causes an __________________
Increase in pressure within the Brain
196
Increased ICP is associated with
```
Brain Hemorrhage
Trauma
Cerebral Edema
Infection
Tumors
Accumulation of Excessive Amounts of CSF
```
197
Clinical Manifestations of ICP:
```
Decreased level of consciousness
Headache
Vomiting
Changes in Vital Signs:
Increase blood pressure
Decrease heart rate
Signs Affecting Vision
Papilledema
Pupils, are fixed and dilated
```
198
Noninvasive X-ray technique that is more sensitive than the conventional X-ray
Computed Tomography (CT Scan)
199
Imaging procedure relies on Magnets and computers to produce images
An individual is surrounded by a magnetic field which causes hydrogen atoms to line up in a certain fashion
Magnetic Resonance Imaging (MRI)
* Ionizing Radiation is not required
* Radio waves provide the energy source
200
Process of recording the Electric currents developed in the brain by placing electrodes on the skull
Electroencephalogram (EEG)
201
Abnormal patterns in an EEG may result in:
Seizure disorders, tumors or injuries
202
In regards to seizures its also referred to as ____________
Convulsions
203
What causes seizures?
Excessive discharge of Neurons in the brain
204
Seizures may be precipitated by:
Inflammation
Hypoxia
Bleeding
*Seizure may be manifested by involuntary repetitive movements or abnormal sensations
205
Primary Malignant tumor of the Brain is called _________
Glioma
206
In the adult, the Neuroglial Cells of the CNS provide for what three things?
Repair, support and protection of the Neurons
207
The Supporting cells and not the Neurons are called?
Neuroglial Cells
208
Glioma tumor is classified according to what?
their cell of Origin and the Location of the tumor
209
True or False
| Primary Malignant Tumors very rarely metastasize outside the CNS
TRUE
210
Quite common and they usually metastasize from Breast or Lung Tumors
Secondary Brain Tumors
211
CNS progressive Demyelinated disorder
| Involves neurons of the Brain, Spinal Cord and Cranial Nerves
Multiple Sclerosis (MS)
212
What part of the Nervous system is involved with MS?
CNS (Peripheral Nervous System is not involved)
213
Chronic disease characterized by episodes of exacerbation and remission of neurologic symptoms over many years in several different locations of the CNS
Multiple Sclerosis (MS)
214
Approximately 85% of cases demonstrate this form of MS?
Relapsing-remitting MS (RRMS)
| *NO apparent progression of disease
215
After 10 to 20 years, the course of RRMS shifts to _____________
A progressive Type
216
Statistics of Multiple Sclerosis:
| Who is affected more?
Women are affected twice as often as men between age 20-40
217
What age is the peak of MS
30 years old
218
What race is more prone to MS?
Occurs in all races, but it is chiefly a disorder of Caucasians
219
What is the Etiology of MS?
Idiopathic
220
What is the Epidemiology of MS
Interaction between a Viral illness in the teen years and a genetic predisposition
221
Where is MS the most prevalent?
Areas far from the equator and thus in the colder northern latitudes
*More common in the Great Lakes, northern Atlantic states and Pacific Northwest than in the southern parts of the US
222
True or False
| MS disease is uncommon in the tropics
TRUE
223
What Vitamin appears to have an good impact on MS?
Vitamin D
| *Vitamin D supplementation with therapy
224
What is a predisposing factor to get MS and worsen it?
Smoking
| *Maybe involves Bronchial Mucosal Immunity
225
First degree relatives of an affected person have a _____________
15 times higher risk of developing the disease than the general population
226
Pathophysiology of Multiple Sclerosis
Involves the Demyelination of Nerve Fibers in the white matter of the Brain, Spinal Cord and Optic Nerves
*Characterized by the destruction of the Myelin Sheath
227
In the CNS, Myelin is produced by ________________
Oligodendrocytes
228
The lesions of MS consist of _______________
hard, sharp-edged demyelinated patches throughout the white matter of the CNS
229
The lesions OF MS are referred to as ___________
Plaque
230
In active plaque what is happening:
Myelin breakdown is ongoing
Lesions contain only a small amount of Myelin proteins and increased amounts of Proteolytic Enzymes, Macrophages, Lymphocytes and Plasma Cells
231
In older lesions what is happening:
Oligodendrocytes are decreased in number or absent
232
Multiple Sclerosis is considered an ______________
Autoimmune Disorder
233
The lesions of MS are thought to be a result of an ____________________
Immune-Mediated Inflammatory response that occurs in susceptible individuals
234
TRUE OR FALSE:
| Demyelination process is marked by Lymphocyte invasion into the CNS
TRUE
235
What two things contribute the damage to the Oligodendrocytes?
Killer T Cells and Macrophages
236
IgG secreted by ______________
Plasma Cells (Found in CFS)
237
With Immunoelectrophoresis, it is shown that the IgG in the CNS is composed of ________________
oligoclonal bands
238
What is useful in the Diagnosis of MS
CSF Oligoclonal IgG
239
In time, neural degeneration becomes _______________
Irreversible
| * Function is lost permanently
240
The clinical presentation depends on:
Location, extent and pattern of the development of the Plaques
241
Signs and Symptoms include:
```
Optic Neuritis
Diplopia: Double vision
Scotoma: A spot in the visual field
Fatigue
Paresthesias
Nystagmus
```
242
About _______ of patients presenting with Optic Neuritis are eventually diagnosed with MS
50%
243
Loss of sensation of touch accompanied by tingling or burning sensation on the face or extremities
Symptoms may range from annoying to severe
Paresthesias
244
One of the most common problems
| Seen in about 70% of patients with MS is ____________
Fatigue
245
Motor Signs and Symptoms of Multiple Sclerosis include:
```
Muscular Weakness
Unsteady Gait
Hyperreflexia is detectable
Paraplegia or Quadriplegia
Dysphagia
Speech Problems
```
246
Initially weakness of the legs often occurs
| Related to Plaques on the Corticospinal Tract
Muscular Weakness
247
Loss of balance and poor coordination
Unsteady Gait
248
Occurs occasionally as MS plaque and associated edema block transmission in the Spinal Cord
Paraplegia or Quadriplegia
249
Person may experience increased urinary frequency and urgency
Difficulty in urinating
Urinary Incontinence
250
Rare, but constipation is common with severe disease
Bowel Incontinence
251
Poor articulation
Clumsiness in the uttering of words
Speech may be difficult to understand
Dysarthria
252
MS may be a challenge to diagnose because:
S&S are so variable and sporadic
253
Diagnostic Test for MS include:
History & Physical
MRI
CT Scans
Evoked Response Studies
254
The MRI Diagnostic Test imaging procedure of choice for either:
Confirming the diagnosis of MS
| Monitoring the disease progression in the CNS
255
May be useful if MRI is unavailable or MRI findings are ________________
nondiagnostic
256
Most patients become physically incapacitated over a period of ____________.
20-30 years
257
Complications of MS include:
```
Paralysis
Respiratory Infection:
Because of impaired Ventilation
Cystitis / Kidney Infection
Death
```
258
Treatment for MS includes:
Palliative
No specific treatment
Interferon beta-1b – (Betaseron)
Physical Therapy
259
The number of exacerbations of MS may be reduced by
Avoiding excessive fatigue, stress, injury, or infection
260
Mainstay for acute relapses of MS is _______________
Corticosteroids
261
What is the prognosis of MS
Unpredictable course
262
Approximately, 1/3 of the patients with MS, suffer from significant physical disability within __________________
20-25 years of the onset
263
A slowly degenerative CNS disorder is called ________________
Parkinson's Disease
264
What are the statistics of Parkinson's Disease?
Approximately 500,000 - 1.5 million people in the US
265
What age does Parkinson's Disease typically begin?
After Age 60
266
What is the course of Parkinson's Disease
10-20 years
267
Basal Nuclei are important in:
Starting, stopping and monitoring the intensity of movements executed by the Cerebral Cortex
268
Pathophysiology of Parkinson's Disease results from _______________.
Degeneration of the dopamine-releasing neurons of the Substantia Nigra
269
Two darkly pigmented, brain stem nuclei that are located in the Midbrain
Substantia nigra
270
Substantia Nirgra send their axons up to the Basal Ganglia (Corpus Striatum) and release the inhibitory neurotransmitter ________________
Dopamine
271
The Basal Ganglia produce an excess of signals that effect __________________
Voluntary muscles in several areas of the body
272
Inhibits the excitatory effects of the Acetylcholine produced by other Neurons in the Basal Ganglia
Dopamine
273
What is the Etiology of Parkinson's Disease?
Unknown
274
A secondary form of Parkinson's Disease is called?
Parkinsonism
| *Occurs with Poisoning / Toxins
275
Etiology: Secondary Parkinson's Disease
Post Encephalitis
Rare
Associated with Viral Encephalopathy
Trauma or Vascular Disease
276
What is the most common cause of the Secondary form of PD?
Drug induced Parkinson’s Disease (reversible)
| *Side effect of Major Tranquilizers
277
Signs and Symptoms of Parkinson's Disease include:
```
Resting Tremor
Pill Rolling Tremor
Nodding Movement of the Head
Muscle Rigidity
Bradykinesia
Akinesia
Shuffling Gait
Postural Changes
Mask-like Facial Expression
```
278
Typically enhanced by emotional stress
Resting Tremor
279
Complete or partial loss of muscle movement would be called ___________.
Akinesia
280
Basal Ganglia also influence the _______.
ANS
281
Signs and Symptoms: Autonomic Nervous System (ANS)
```
Excessive Production Saliva
Excessive Sebaceous Gland Secretion
Constipation
Urinary retention
Orthostatic Hypotension
```
282
Diagnostic Test for PD include:
H&P
Urinalysis
EEG
283
Decreased levels of Dopamine would be seen on what Diagnostic Test:
Urinalysis
284
Complications of PD:
```
Debilitating disease
Dementia
Progressive Dementia may be associated with the advance stages of the disease
Occurs in about 20% of the patients
Involves the Cortical Neurons
Pneumonia
Leading cause of death
```
285
The leading cause of Death would be:
Pneumonia
286
The treatment for PD would be:
NO CURE
287
Nonpharmacologic Treatment of PD include:
Physical therapy helps the patient to maximize his or her mobility
Daily exercise
Heat and massage help to relieve muscle cramps
Adequate Nutrition
288
Pharmacologic Treatment Include:
Levadopa (l-dopa)
| Selegiline (Eldepryl)
289
Surgical procedure used to relieve some of the S&S
Deep Brain Stimulation (DBS)
| *Use MRI/CT scanning to map out the precise area of the brain
290
What is the most common targeted in Deep Brain Stimulation?
Subthalamic nucleus
291
Electrodes are surgically planted in one of the three targeted Brain regions which are:
1. Subthalamic nucleus (most common target)
2. Globus pallidus (Basal Nuclei/Ganglia)
3. Thalamus (primarily used to treat tremor)
292
Proposed treatment of the Vaccine is to slow or stop PD
Parkinson’s Vaccine - PD01A
293
What is the prognosis of PD:
Chronic, progressive disorder
| Not fatal, but it will shorten life expectancy significantly
294
Progressive loss of intellectual function to the point where it interferes with work, relationships and personal hygiene
Alzheimer's Disease (AD)
295
Accounts for over 50% of all cases of Dementia. _______________
Alzheimer's Disease (AD)
296
What age does Alzheimer's Disease affect?
Older people greater than 65 years of age
| *Occurs in 25% of people older than 85 years of age
297
Effects approximately _____-______ million Americans
4.5 – 5.4
298
Which gender does Alzheimer's Disease affect primarily?
WOMEN
299
What is the pathophysiology of AD?
Characterized by atrophy of the Cortical parts of the Frontal and Temporal parts of the Brain
300
What are the microscopic Features of AD?
Widening of the Sulci and slender Gyri
| Atrophy leads to dilated Ventricles
301
Neurochemical Features of Alzheimer’s would be:
A decrease in the level of Choline Acetyltransferase activity in the Cerebral Cortex and the Hippocampus
302
Enzyme required for the synthesis of Acetylcholine, a Neurotransmitter which is associated with Memory
Choline Acetyltransferase
303
Are abnormal proteins that are produced by the same Neurons that produce Acetylcholine
Neurotransmitter for Short Term Memory
Beta Amyloid Proteins
304
Resistant to chemical or enzymatic breakdown and thus are persistent and remain long after the Neurons die
Neurofibrillary Tangles
305
Microscopic exam of the areas of degeneration reveal Plaquelike material
Neuritic (Senile) Plaques
306
Senile Dementia is onset _________
After 65
307
Etiology: Genetic Factors of AD
Early-Onset / Pre-senile
| Develops between ages 30 – 60 years
308
Presenilin-1 (PS1) Gene on Chromosome #____
14
309
Presenilin-2 (PS2) on Chromosome #_____
1
310
AD is inherited as _____________
An Autosomal Dominant
311
Amyloid Precursor Protein (APP) Gene) on Chromosome #___
21
312
One form of Late-Onset is associated with a mutation on Chromosome #___
19
313
Signs and Symptoms: First Stage
May last 2 – 4 years
Involves Short Term Memory Loss
Initially the symptoms are insidious
Patient is unaware of the onset of the disease and often attributed to forgetfulness
Individual will become progressively more forget-full, particularly in relationship to recent events
314
Signs and Symptoms: Second (Confusional) Stage
May last several years
Long Term Memory Loss occurs as the disease progresses
Marked by impairment of cognitive functioning
Person becomes disorientated and confused
315
Signs and Symptoms: Second (Confusional) Stage (continued)
Ability to concentrate declines
Lose ability to problem solve or perform mathematical calculations
Judgment gradually deteriorates
Language Impairment
Difficulty in remembering or retrieving words
Managing activities of daily living becomes a challenge
Mental Status
Depression occurs when a person is aware of their deficits
Irritability
Agitation and hostility
Prone to mood swings
316
Signs and Symptoms: Terminal Stage
Lasts 1 – 2 years, although in some patients it has persisted for up to 10 years
Person becomes incontinent and unable to recognize family or friends
Usually institutionalized at this point
317
Diagnostic Tests for AD are:
History& Physical
CT Scan or MRI
Autopsy
318
Treatment for AD:
No specific treatment and to date no Cure has been identified
Medications
319
What is the prognosis of AD:
Survival ranges up to 20 Years, with an average of 7 years
320
Treatment Modalities for Type 2 diabetes include:
Adequate diet specific to the patients needs, Insulin therapy (eventually), Exercise, Liver transplant, Oral hypoglycemic drugs (when diet and exercise are INadequate), glucophage (which lowers insulin resistance), and Avandia (which raises the tissues sensitivity to insulin).
321
Which of the following conditions is caused by long-term exposure to high levels of cortisol?
Crushing's Disease
322
A fasting blood glucose test level of _________________ indicates diabetes
126 mg/dl or higher on two separate tests
323
Early-Onset / Pre-senile of Alzheimer's develops in what age?
30-60
324
Neurotransmitter for Short Term Memory
Beta Amyloid Proteins
325
What are the signs of Addison's Disease
Fatigue
Weight Loss
Hypotenstion
Hyperpigmentation
