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HSC2008 Pathology & Pharmacology > Week 7 > Flashcards

Week 7 Flashcards

1
Q

sensory afferent pathways

A

spinothalamic, posterior column, spinocerebellar

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2
Q

spinothalamic afferent pathway transmits __

A

pain & temperature to cerebrum via thalamus

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3
Q

posterior column afferent pathway transmits __

A

touch, pressure, vibrations to cerebral cortex

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4
Q

spinocerebellar afferent pathway transmits __

A

kinesthesia / proprioception to cerebellum

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5
Q

descending efferent pathways

A

corticospinal & corticobulbar tracts

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6
Q

TIA

A

transient ischemic attack

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7
Q

TIA is defined as __

A

transient neurological dysfunction by focal brain, spinal cord or retinal ischemia without acute infarction under 24 hours

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8
Q

Amaurosis fugax

A

Transient one-sided visual loss due to atherothrombotic disease in ICA proximal to the ophthalmic artery

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9
Q

causes of Amaurosis fugax

A

carotic dissection
aortic embolism
atherothrombotic disease in ICA

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10
Q

risk of recurrent stroke after TIA is done via __

A

ABCD2 score to identify patient at high risk of ischemic stroke in first 7 days after TIA

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11
Q

stroke is defined as when __

A

interrupted blood flow to an area of the brain, resulting
in permanent neurological damage

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12
Q

types of strokes

A

ischemic (80%)
- embolism
- thrombosis

hemorrhagic (20%)

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13
Q

ischemic stroke pathophysiology

A

lack of sufficient blood flow to perfuse cerebral tissue due to narrowed/blocked arteries

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14
Q

significance of ischemic penumbra

A

potential to reverse neurological impairment with post stroke therapy as ischemic core is unsalvageable whereas the penumbra is

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15
Q

functioning brain is dependent on __

A

continuous blood supply for oxygen & glucose & remove end product metabolism

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16
Q

ATP is needed to __

A
  • maintain neuronal integrity
  • keep Ca2+ & Na+ outside cell, K+ inside cell
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17
Q

clinical syndromes of anterior stroke

A

lacunar & hemispheric syndrome

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18
Q

clinical syndromes of posterior stroke

A

lacunar
medullary
pontine
cerebellar
top of basilar
lock in

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19
Q

neuroanatomy ascending tract pathways

A

dorsal column-medial lemniscal pathway, anterolateral, spinocerebellar

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20
Q

cortical signs

A

aphasia
apraxia
gaze preference
homonymous hemianopia
visual extinction
agnosia
acalculia

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21
Q

hemispheric syndrome clinical symptoms

A
  • presence of higher cortical dysfunction
  • lateralization = label on side of lesion
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22
Q

aphasia & right sided weakness =

A

left hemispheric syndrome

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23
Q

left sided weakness, numbness & left visual neglect =

A

right hemispheric syndrome

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24
Q

lacunar syndrome clinical symptoms

A
  • absence of higher cortical dysfunction
  • lateralization = label on side of deficit
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25
Q

lacunar syndrome mainly affects

A

basal ganglia, internal capsule, thalamus, pons

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26
Q

cincinnati stroke scale includes identifying ___

A

FAS = face, arms, speech

prehospital notification done if stroke discovery time is less than 6 hrs

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27
Q

blood investigation of stroke includes

A
  • blood glucose level
  • bilateral blood pressure differential
  • pulse oximetry
  • ECG
  • brain imaging
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28
Q

assessment tool for stroke monitoring is ___

A

NIHSS monitoring

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29
Q

what is the neuro imaging exam ordered for stroke

A

CT brain + angiography
MRI/MRA
Doppler carotid / transcranial doppler US
DSA

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30
Q

decompressive craniectomy

A

surgical removal of skull portion to allow outward herniation of infarcted brain tissue before compression of healthy brain tissue occurs

decreased intracranial P & improve cerebral perfusion

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31
Q

hemorrhagic stroke pathophysiology

A

blood vessel rupture leading to compressed brain tissue from expanding hematoma leading to loss of blood supply to affected tissue

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32
Q

types of hemorrhagic stroke

A

intracerebral & subarachnoid hemorrhage

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33
Q

primary cause of hemorrhagic stroke

A

uncontrolled hypertension & cerebral amyloid angiopathy

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34
Q

secondary cause of hemorrhagic stroke

A

vascular abnormalities, aneurysm rupture, neoplasms

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35
Q

volume of ICH formula

A

longest axis (A) x longest axis perpendicular to A (B) x number of slices x slice thickness (C)

(A x B x C) / 2

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36
Q

spontaneous IVH + obstructive hydrocephalus intervention is __

A

EVD

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37
Q

spontaneous ICH < 30 mL, GCS > 3, IVH requiring EVD intervention is __

A

EVD + thrombolytic

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38
Q

spontaneous ICH < 30 mL, IVH requiring EVD intervention is __

A

neuroendoscopy + EVD + thrombolytic

39
Q

FLAIR can be used to detect __

A

edema a few hours after onset; not routine in stroke imaging

40
Q

DWI-FLAIR mismatch

A

infraction visible on DWI but not FLAIR

41
Q

DWI-FLAIR used to estimate __

A

onset time in wake-up / unwitnessed strokes

42
Q

rTPA

A

recombinant tissue plasminogen activator

43
Q

each hour where treatment fails, brain loses __

A

3.6 years of normal aging

44
Q

each minute where treatment fails, ___ neurons die

A

1.9 million

45
Q

keep SBP ___ mmHg post rTPA

A

< 180/105

46
Q

stroke unit care closely monitors for __ complications

A

pneumonia, deep vein thrombosis, pulmonary embolism, urinary tract infection

47
Q

large artery artherosclerosis

A

brief & recurrent obstructive vascular process in extracranial / intracranial arteries associated with stenotic atherosclerotic lesion

48
Q

what antiplatelets are given for stroke

A

aspirin, dipyridamole, clopidogrel, ticlodipine

49
Q

what is given with aspirin

A

dipyridamole

50
Q

clopidogrel AKA __

A

plavix

51
Q

anticoagulants given for stroke are __

A

NOACS = apixaban, rivaroxaban, dabigatran

warfarin

52
Q

LDL lower agents

A

anything that ends with “-statin” & ezemtimibe

53
Q

indications for LDL lowering agents

A

stabilize plaque & keep bad cholesterol < 1.8 mmol/L

improve endothelial dysfunction

54
Q

antihypertensive meds

A

ACE = angiotensin converting enzyme
angiotensin II receptor blocker
beta blocker
Ca2+ channel blocker

55
Q

early rehab within 24 hrs of acute stroke must be done __

A

with caution who are severely affected or had ICH

56
Q

medical guidelines to drive vocationally with TIA

A

single TIA = only once free of TIA for 6 months
multiple TIA = “ for > 1 year

57
Q

medical guidelines to drive privaltey with TIA

A

single TIA = only once free of TIA for 1 months
multiple TIA = “ for > 6 months

58
Q

seizure definition

A

transient occurrence of signs or symptoms due to abnormal excessive neuronal activity in the brain

59
Q

neurons in a seizure may be __

A

abnormally developed, damaged, functioning abnormally due to environmental factors

60
Q

typical signs of seizure

A

loss of awareness, abnormal movement & sensations

61
Q

most seizures self abort after __

A

several seconds to mins

62
Q

types of partial seizures

A

simple, complex, with secondary generalization

63
Q

types of generalized seizures

A

generalized tonic clonic seizure, absence, myoclonic

64
Q

status epilepticus is when __

A

seizure >5 mins & risk of neuronal injury is high; emergency situation

65
Q

epilepsy vs seizure

A

Epilepsy is a disease with a tendency to have recurrent unprovoked seizures

seizure is 1 event

66
Q

seizure 1st aid is done by putting patient in __

A

recovery position

67
Q

how to prevent seizure recurrence

A

anti-epileptic drug & lifestyle modification

68
Q

what drugs alter neuronal excitability

A

Na+ channels, GABA, Receptors

69
Q

common side effects of AEDs

A

fatigue, toxicity, rash, weight gain, hair fall, low platelets,

70
Q

Broca’s area

A

expressive speech area

71
Q

Wernicke’s area

A

comprehensive area for both written & spoken language

72
Q

left hemisphere of brain

A

responsible for mathematical, problem solving & logical reasoning

73
Q

right hemisphere of brain

A

artistic ability, creativity, spatial relationship, emotional and behavioural characteristics

74
Q

limbic system

A

emotional reactions & feelings

75
Q

functions of cerebral spinal fluid

A

1) provides a cushion for the brain & spinal cord;
2) supplies nutrient to nervous system tissue; and
3) removes waste products from cerebral metabolism

76
Q

brain excitatory molecules

A

dopamine, serotonin

77
Q

brain inhibitory molecules

A

gamma-aminobutyric acid (GABA)

78
Q

spinal cord inhibitory molecules

A

glycine

79
Q

ischemic stroke

A

total occlusion of a cerebral blood vessel by atheroma (thrombus) or embolus

80
Q

hemorrhagic stroke

A

Ruptured cerebral vessels leading to compression of brain tissues from an expanding haemotoma

81
Q

5 mins of ischemia leads to __

A

irreversible nerve cell damage

82
Q

classic signs of acute stroke

A

FAST
- facial droop
- arm weakness
- slurred speech
- time (call 995)

83
Q

pharmacotherapy for ischemic stroke

A
  • IV rTPA within 4.5 hours of stroke onset
  • antiplatelet therapy for non-cardioembolic stroke
  • anticoagulation therapy for cardioembolic stroke
  • statins to stabilize plaque & improve endothelial dysfunction
84
Q

Endovascular therapy for large vessel occlusion with
symptoms onset within __

A

6 hours

85
Q

pharmacotherapy for long term CVRF control

A
  • antiplatelets
  • anticoagulants
  • statin according to SPARCL trial
86
Q

Convulsive status epilepticus

A

recurrent or continuous seizures without
recovery of consciousness.

Impaired respiration and intense muscle activity can lead to severe hypoxia, hypoglycemia, acidosis and decreased blood pressure

87
Q

EEG use in seizures

A

determine type & location

88
Q

routine blood study in seizures

A

identify metabolic causes

89
Q

neuroimaging study in seizures

A

identify structural abnormalities

90
Q

seizures managed using __

A

pharmacotherapy = anti-epileptic drugs & sedatives
vagus nerve stimulation

91
Q

cerebellum function

A

movement, posture, equilibrium

92
Q

medulla function

A

respiratory & cardiovascular control center

93
Q

grey matter parts

A
  • anterior horns = motor neurons
  • lateral horns = visceral motor neurons
  • posterior horns = receives sensory info

HSC2008 Pathology & Pharmacology (14 decks)

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