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Pathophysiology > Unit 5 Chapter 15-18 > Flashcards

Unit 5 Chapter 15-18 Flashcards

1
Q

primary motor cortex responsible for

A

execution of a movement

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2
Q

premotor cortex is responsible for

A

generating a plan of movment

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3
Q

supplemental motor cortex is responsible for

A

rehearsing motor sequences of movement

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4
Q

upper motor neurons are in the

A

brain and spinal cord

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5
Q

upper motor neuron directly or indirectly innervate the

A

lower motor neurons or contracting muscles

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6
Q

2 motor systems

A

extrapyramidal and pyramidal

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7
Q

extrapyramidal

A

most go to the same side of the body

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8
Q

pyramidal

A

most cross to other side of body

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9
Q

upper motor neurons are located in

A

brain and spinal cord

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10
Q

lower motor neurons send axons out of the

A

spinal cord

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11
Q

hypotonia

A

reduced excitability of stretch reflex results in decreased muscle tone ranging from weakness to paralysis; decreased function of LMN, damage to stretch reflex or peripheral nerves

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12
Q

hypertonia/spasticity

A

abnormal increase in muscle tone due to increased excitation, loss of inhibition of LMN or UMN lesions

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13
Q

rigidity

A

greatly increased resistance

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14
Q

a disease that has rigidity (inhibition of alpha LMN)

A

parkinsons

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15
Q

clonus

A

rhythmic contraction and relaxation of limb

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16
Q

upper motor neuron damage causes

A

weakness and loss of voluntary motion

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17
Q

when there is upper motor neuron damage spinal reflexes remain intact but cannot be

A

modulated by the brain

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18
Q

upper motor neuron results in what

A

increased muscle tone
hyperreflexia
spasticity

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19
Q

lower motor neuron damage affects

A

directly innervating muslces

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20
Q

when there is lower motor neuron irritation there is

A

spontaneous muscle contractions; fasciculations

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21
Q

when there is lower motor neuron death there is

A

loss of spinal reflexes
flaccid paralysis
denervation atrophy of muscle

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22
Q

paralysis

A

loss of movement

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23
Q

paresis

A

weakness of incomplete loss of muscle function

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24
Q

hemiparesis/hemiplegia

A

both limbs on one side

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25
Q

paraparesis/paraplegia

A

paralysis of both lower limbs

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26
Q

quadriparesis/quadriplegia

A

all four limbs

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27
Q

example of disease that affects the skeletal muscle

A

muscular dystrophy

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28
Q

muscular dystrophy is inherited or environmental

A

inherited

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29
Q

muscular dystrophy is what chromosome and recessive or dominant

A

X chromosome recessive

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30
Q

muscular dystrophy is duchenne inherited mutation results in defective form of _______ protein associated with muscle cell _____________ faults to provide normal attachment for contractile proteins

A

large, membrane

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31
Q

muscular dystrophy will progress to

A

respiratory failure

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32
Q

decreased acetylcholine release is called

A

botulism (neurotoxins)

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33
Q

you can acquire botulism from where

A

dented canned good

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34
Q

decreased acetylcholine effects on muscle cells

A

curare (drugs), myasthenia gravis

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35
Q

myasthenia gravis is a disease of where

A

neuromuscular junction

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36
Q

myasthenia gravis is what kind of disorder

A

autoimmune

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37
Q

myasthenia gravis affects the _____________ at neuromuscular junction

A

transmission

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38
Q

myasthenia gravis is antibody mediated loss of ________________ receptors at junction

A

acetylcholine

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39
Q

myasthenia gravis ocular to generalized weakness from __________ to _______ portions of the body

A

proximal to distal

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40
Q

will your respiratory system because compromised with myasthenia gravis

A

yes

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41
Q

what is a trigger for myasthenia gravis

A

thymus

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42
Q

peripheral nerve disorders

A

any primary disorder of the peripheral nerve

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43
Q

results of peripheral nerve disorders

A

muscle weakness, with to without atrophy and sensory changes

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44
Q

mononeruopathy does it affect multiple or one nerve

A

one

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45
Q

example of mononeuropathy

A

carpal tunnel

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46
Q

carpal tunnel is the compression of the

A

median nerve

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47
Q

carpal tunnel is caused by reduction in capacity which is _______ changes or increase on volume of contents which is ___________

A

bone, inflammation

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48
Q

polyneuropathy does it affect one or multiple nerves

A

multiple

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49
Q

example of polyneuropathy

A

Guillain barre

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50
Q

Guillain barre syndrome

A

infiltration of peripheral neurons, edema and demyelination

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51
Q

what is the cause of Guillain barre

A

unknown

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52
Q

Guillain barre is progressive ascending muscle weakness producing ________ _________

A

flaccid paralysis

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53
Q

is there recovery in Guillain barre

A

spontaneous recovery in 80-90%

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54
Q

back pain is what kind of nerve injury

A

peripheral

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55
Q

back pain is often due to

A

compression of nerve root by vertebrae or vertebral disc

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56
Q

basal gangila

A

inhibit and modulate movement patterns

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57
Q

2 main pathways of the basal ganglia

A

dopamine, y-aminobutyric acid (GABA) pathway

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58
Q

the dopamine pathway if from the substantia nigra to the

A

striatum

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59
Q

the GABA pathway is from the striatum to the globus pallidus and

A

substantia nigra

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60
Q

characteristics of disorders of the basal ganglia

A

involuntary movements, alterations in muscle tone, disturbances in body posture

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61
Q

chorea

A

irregular wriggling/writhing movement

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62
Q

athetosis

A

continuous twisting movement

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63
Q

ballismus

A

violent flinging movements

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64
Q

dystonia

A

rigidity

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65
Q

dyskinesias

A

wriggling, writhing movements

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66
Q

example of basal ganglia disorders

A

tics, tremors

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67
Q

which disease is a result of basal ganglia dysfunction

A

tourette syndrome

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68
Q

parkinsons is a degenerative disorder of BG caused by progressive deterioration of ___________ pathway

A

negrostriatal

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69
Q

parkinsons will have ______ depletion, tremors, rigidity, and what kind of movement

A

dopamine, bradykinesia (slow movement)

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70
Q

amyotrophic lateral sclerosis/Lou Gehrig affects what cells of the spinal cord

A

anterior horn

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71
Q

amyotrophic lateral sclerosis/Lou Gehrig affects what of the brain

A

motor nuclei (brain stem) and UMN (cerebral cortex

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72
Q

amyotrophic lateral sclerosis/Lou Gehrig will have fiber atrophy in the

A

CS tract and lateral and anterior columns

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73
Q

amyotrophic lateral sclerosis/Lou Gehrig the death of the LMN leads to ____________ with subsequent shrinkage of musculature and muscle fiber atrophy

A

denervation

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74
Q

does amyotrophic lateral sclerosis/Lou Gehrig lead to respiratory failure

A

yes

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75
Q

what is the most common non traumatic cause of neurologic disability among young and middle age adults

A

multiple sclerosis

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76
Q

multiple sclerosis is the destruction of _______ on axons

A

myelin

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77
Q

multiple sclerosis: when there is no myelin there is decreased

A

conduction velocity

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78
Q

multiple sclerosis there is demyelination of nerve fibers where

A

white matter of brain, spinal cord and optic nerve

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79
Q

multiple sclerosis demyelination is a result of

A

immune mediated inflammatory response in genetically susceptible individuals

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80
Q

multiple sclerosis is characterized by

A

exacerbations and remissions over many years in several different sites in the CNS (AKA: getting better and then getting worse but every time the get even worse)

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81
Q

spinal cord injury is most common in

A

males

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82
Q

majority of causes of spinal cord injuries is because of

A

vehicular and falls

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83
Q

immediate damage of spinal cord injury is

A

spinal cord shock and primary neurologic damage

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84
Q

spinal cord shock

A

temporary complete loss of function below injury

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85
Q

primary neurologic injury

A

irreversible damage to neurons

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86
Q

neurogenic shock will have Brady or tachycardia

A

bradycardia

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87
Q

why would someone with neurogenic shock have bradycardia

A

because vagus nerve is stimulated

88
Q

primary injury

A

neurologic damage that occurs at the MOMENT of impact

89
Q

secondary injury

A

refers to the complex biochemical processes affecting cellular function. can be minutes or weeks after primary

90
Q

upper motor neurons are

A

t12 and above

91
Q

do spinal reflexes still work in upper motor neurons

A

yes

92
Q

in upper motor neuron damage they are no longer modulated by the

A

brain

93
Q

someone with upper motor neuron damage they will have what

A

hypertonia and spastic paralysis

94
Q

lower motor neurons are

A

t12 and below

95
Q

in lower motor neuron damage the cells in the spinal reflex arcs are

A

damaged

96
Q

lower motor neuron damage will present with what paralysis

A

flaccid

97
Q

you need what to grip hand

A

C7-C8

98
Q

c1-c4 injury

A

quadriplegic
no respiratory function

99
Q

c4-c5 injury

A

quadriplegic
possible loss of respiratory function due to edema

100
Q

c5-c6 injury

A

quadriplegic
gross arm movements
sparing of diaphragm

101
Q

neurogenic/spinal shock you will have

A

loss of vasomotor tone and sympathetic innervation to the heart

102
Q

lost sympathetic activity can lead to

A

hypotension due to vasodilation
bradycardia

103
Q

differentiate between hypovolemic and neurogenic

A

hypovolemia will have tachycardia and neurogenic will have Bradycardia

104
Q

autonomic dysreflexia

A

acute episode of exaggerated sympathetic reflex responses occurring with injuries T6 and above

105
Q

vasovagal response can lead to

A

dilatation

106
Q

in autonomic dysreflexia how will the patient appear above T6

A

flushed skin, headache, bradycardia

107
Q

in autonomic dysreflexia how will the patent appear below t6

A

cold and goosebumps

108
Q

three metabolic factors affect cerebral blood flow

A

CO2, O2, and H ion concentration

109
Q

CO2

A

dilates

110
Q

hypoxia causes ATP depletion or

A

power failure

111
Q

what is produced with anaerobic metabolism

A

lactic acid/pyruvate acid

112
Q

acid damages cells

A

membranes, structures and DNA

113
Q

ischemia is

A

reversible damage

114
Q

ischemia interfers with

A

delivery of energy sources, damage to blood vessels and changes in blood

115
Q

how does ischemia cause changes in blood

A

desaturation, clotting, sludging

116
Q

in excitotoxicity the neuron firing releases

A

glutamate

117
Q

glutamate causes

A

neighboring neurons to fire

118
Q

excitotoxicity causes ________ of injury across the ischemic area

A

spreading

119
Q

glutamate eventually causes calcium cascade which leads to

A

release of intracellular enzymes, protein breakdown, free radical formation, lipid per oxidation, fragmentation of DNA, nuclear breakdown

120
Q

ischemia can be focal which is, or global which is

A

focal= stroke
global= cardiac arrest

121
Q

ischemia can lead to excessive influx of ________ resulting in edema and ________ influx initiates a cascade of events including release of intracellular and nuclear enzymes causing cell destruction

A

sodium, calcium

122
Q

glutamate is a principal ____________ neurotransmitter

A

excitatory

123
Q

when you have intracranial pressure greater than arterial blood pressure

A

arteries collapse, blood flow to brain is cut off

124
Q

RAS controls your

A

cosniousness

125
Q

coma is diffuse or focal dysfunction in the

A

reticular activating system

126
Q

3 types of coma

A

metabolic, structural or psychogenic

127
Q

coma can be caused by 2 things

A

changes in structure
metabolic/toxic conditions

128
Q

coma induced by structure changes

A

structural lesions
vasular lesions
trauma
brain tumors
brain abscesses
increased ICP
non traumatic
hydrocephalus

129
Q

coma included by meatbolic/toxic conditions

A

ELECTROLYTES: HYPER/HYPONATREMIA (SODIUM) AND HYPERCALCEMIA

hypoxia/CO2 retention
decreased O2
shock
sepsis
hypoglycemia
DKA
HHS
poisoning
drugs
alcohol
hypertensive encephalopathy
acute hypertensive crisis
meningitis/encephalitis
renal failure

130
Q

pressure volume curve shows

A

units of volume and the associated pressure in the cranium

131
Q

earlier signs of diminution in LOC

A

inattention, mild confusion, disorientation and blunted responsivness

132
Q

signs of further deterioration in decrease of LOC

A

marked inattentive
lethargic and agitated
may only respond to vigorous or noxious stimuli

133
Q

normal person has a GSC of

A

15

134
Q

if GCS is under 8

A

intubate

135
Q

respiration problems

A

cheyne stokes
central neurogenic hyperventilation

136
Q

cheyne stokes occurs in

A

heart failure

137
Q

central neurogenic hyperventilation occurs with issues in the

A

BRAIN

138
Q

central neurogenic hyperventilation occurs when bleeding in head and puts pressure on

A

pons and medulla

139
Q

cushings triad is the last ditch effort to

A

perfuse the brain

140
Q

Cushing triads appears with

A

increased MAP, wide PP, bradycardia

141
Q

increased MAP of cushings is at least

A

60

142
Q

normal PP is

A

40

143
Q

coup injury

A

under direct impact area

144
Q

contrecoup

A

sustained injury on opposite side due to bounceback

145
Q

you want to avoid __________ and ____________ during resuscitation phase

A

hypotension, hypocarbia

146
Q

concussion

A

momentary interruption of brain function with or without LOC

147
Q

+ LOC

A

there was LOC

148
Q

diffuse axonal injury

A

diffuse microscopic changes, most common cause of PVS

149
Q

diffuse axonal injury is consequence of sudden ___________ movement

A

rotational

150
Q

diffuse axonal injury can only be detected

A

histologically

151
Q

contusion

A

bruise to cortical surface

152
Q

ipsilateral

A

same side (pupil dilatation)

153
Q

contralateral

A

opposite (hemiparesis

154
Q

epidural hemotoma

A

between skull and dura, arterial, LOC-lucid, LOC-decline

155
Q

is epidural hematoma fast or slow bleed

A

fast

156
Q

subdural hematoma

A

between dura/subarachnoid, venous, acute, subacute or chronic

157
Q

is subdural hematoma fast or slow bleed

A

slow

158
Q

intracerebral hematoma

A

in cerebrum, single or multiple, more common in older and alcoholic

159
Q

primary injuries are

A

immediate

160
Q

subdural space has bridging veins which leads to

A

slower bleeding

161
Q

increased IP pushes the

A

brain out of position

162
Q

herniation from side is an

A

unacal herination

163
Q

uncal herentaion presents with pupil dilatation why

A

compression of the ocularmotor nerve

164
Q

brain dead clinical exam

A

absence of brain stem reflexes and motor responses to pain
absence of respiration with PCO2 of 60 mm Hg or more

165
Q

chronic tramuatic encephalopathy

A

progressive deleting disease due to brain injury associated with sporting events, blast injuries

166
Q

what racial group is most likely to die from a stroke

A

black

167
Q

carotid bruit

A

turbulent sound in carotid artery

168
Q

what is the most common type of stroke

A

ischemic

169
Q

penumbra (halo)

A

space between healthy and dead tissue

170
Q

in stroke the survival of tissue depends on

A

timely return of circulation, toxins, and edema

171
Q

what is the most fatal type of stroke

A

hemorrhagic

172
Q

hemorrhagic is the

A

rupturing of blood vessel

173
Q

TIA

A

temporary episode of neurologic dysfunction, caused by focal ischemia

174
Q

TIA is it ischemic

A

yes

175
Q

TIA long or short lasting

A

short

176
Q

TIA and ischemic stroke have the same

A

symptoms

177
Q

TIA

A

transitent ischemic attack

178
Q

what is the most common cause of hemorrhagic stroke

A

hypertension

179
Q

__% of strokes are ischemic

A

87

180
Q

Aneurysmal subarachnoid hemorrhage if it ruptures could lead to

A

hemorrhagic stroke

181
Q

Aneurysmal subarachnoid hemorrhage

A

bulge at site of localized weakness in muscular wall of arterial vessel

182
Q

Aneurysmal subarachnoid hemorrhage mortality rate

A

high

183
Q

Aneurysmal subarachnoid hemorrhage 50% might have __________ before

A

headache

184
Q

Aneurysmal subarachnoid hemorrhage symptoms

A

excruciating headache, nuchal rigidity, photophobia, diplopia, blurred vision, stroke syndrome, pituitary deficits

185
Q

what is FAST

A

Facial weakness
Arm weakness
Speech problems
Time to call 911

186
Q

meningitis is inflammation of

A

pia, arachnoid, and CSF filled arachnoid space

187
Q

meningitis can be caused by what types of bacteria

A

strep, H. influenza, meningoccus

188
Q

in meningitis bacteria replicate and undergo _______ in CSF which leads to the release the ___________ and leads to inflammatory mediator, ___________ bind and damage ____________ cells of BB barrier pathogens enter ______________ space causing cloudy purulent exudate

A

lysis, endotoxins, neutrophils, endothelial, subarachnoid

189
Q

meningitis have very similar symptoms of flu, what is some symptoms that differentiate between flu

A

meningeal signs (neck and light)

190
Q

can a benign tumor cause death

A

yes because of its locatio

191
Q

focal disturbances

A

seizures, hallucinations, weakness or palsies in specific areas, sensory deficits

192
Q

generalized disturbances

A

increased cranial pressure: headache, vomiting, visual problems

193
Q

unprovoked/primary/idiopathic=

A

seizure disorder

194
Q

epilepsy

A

recurrent seizures not provoked by other illnesses or circumstances

195
Q

provoked/secondary, CNS insults, metabolic conditions such as

A

hypoglycemia, hypoxia, hypocalcemia, rapid withdrawal of alcohol or barbs

196
Q

observe an _____ with seizures

A

aura

197
Q

when to call 911 with seizures

A

when they do not stop
last longer than normal with a patient with chronic seizures
seizure starts right after one ends

198
Q

status epilepticus

A

medical emergency seizure

199
Q

always _____ seizures

A

time

200
Q

delirium

A

acute, reversible, change in behavior

201
Q

delirium can be caused by

A

hospitalization/isolation

202
Q

alzheimers disease cause

A

multifactoral

203
Q

alzheimers disease diagnosis is by

A

exclusion

204
Q

alzheimers is most common form of

A

dementia

205
Q

what races are more likely to get alzheimers

A

blacks, hispanics

206
Q

alzheimers is atrophy or hypertrophy

A

atrophy

207
Q

alzheimers: decrease in level of ______ _________________ activity in cortex and hippocampus; enzyme required for synthesis of ___________

A

choline acetyltransferase, acetylcholine

208
Q

acetylcholine is associated with

A

memory

209
Q

microscopically amyloid

A

containing neurotic plaques and neurofibularry tangles

210
Q

alzheimers disease is insidious meaning

A

slow

211
Q

amyloid b form

A

amyloid plaques

212
Q

other causes pf dementia

A

microinfacts
crutzfeldt-Jakob disease
frontotemporal dementia
vit b 12 deficiency
inherited

213
Q

which cause of dementia is vasular in nature

A

microinfarcts

214
Q

alzheimer is believed to be caused by

A

amyloid plaque

215
Q

microinfarts

A

small infarction of brain

Pathophysiology (44 decks)

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