NSG 3280 Exam Pathophysiology 2026/2027
What happens to nerve tissue during ischemia? - Nerve tissue struggles with anaerobic metabolism
and is very sensitive to decreased oxygen.
What is ischemia? - Cell death.
What is hypoxia? - Decreased oxygen leading to mitochondrial failure and cell damage.
What is the main CNS neurotransmitter? - Glutamate.
What effect does ischemia have on glutamate? - Ischemia increases glutamate release.
What are the effects of too much glutamate? - Increased calcium and water enter the cell, causing
calcium overload and cytotoxic edema.
What does excessive glutamate production lead to? - Increased production of nitrous oxide, free
radical formation, and cell death.
What is the normal range for intracranial pressure (ICP)? - 0-15 mmHg
At what ICP level does brain impairment occur? - > 22 mmHg for > 5 minutes
What are the three main components of the cranial cavity according to the Monroe-Kellie doctrine?
- Brain, Cerebrospinal Fluid (CSF), Blood
What is intracranial compliance? - The ability of the cranial components to adjust to changes in
volume to minimize impact on ICP.
Name an everyday activity that can cause slight changes in ICP. - Sneeze, cough, bending, laugh
What is interstitial edema? - Swelling caused by fluid, electrolytes, and proteins forced into the
intercellular space due to vessel damage or increased pressure.
,What causes intracellular edema? - Global ischemia leading to cellular energy failure and Na+
accumulation, attracting water into the cell.
What is the most sensitive clinical manifestation of increased ICP? - Change in level of consciousness
(LOC), often increased drowsiness.
What are common symptoms of increased ICP? - Headache, nausea/vomiting, blurred vision, slow
pupillary response.
What is Cushing's Triad? - A late sign of increased ICP characterized by ↑BP, ↓HR, and respiratory
changes.
What does a decrease in the Glasgow Coma Scale (GCS) score indicate? - A potential decrease in
consciousness or brain function.
What is the maximum score for eye opening on the Glasgow Coma Scale? - 4 for spontaneous eye
opening.
What is the maximum score for verbal response on the Glasgow Coma Scale? - 5 for oriented verbal
response.
What is the maximum score for motor response on the Glasgow Coma Scale? - 6 for following
commands.
What does decreased pupil response indicate? - Increased intracranial pressure (ICP).
What is the normal response in the Doll's Eyes Test? - Eyes move in the opposite direction of head
movement.
What does an absent response in the Cold Calorics test indicate? - No eye movement, suggesting
potential brain dysfunction.
What is the normal response of the corneal reflex? - Blinking when a cotton swab touches the
cornea.
,What does fixed and dilated pupils indicate? - Poor brain perfusion.
What does small (pinpoint) pupils suggest? - Possible pons issue or drug effects.
Focal (Coup) - Injury localized to the site of impact
Polar (Coup-countercoup) - Injury at site of impact and on opposite side of the brain (due to brain's
forward-backward movement within the skull)
Diffuse - Widespread damage of the brain
Multiple movements of brain within the skull - Results in shifting and rotational forces causes
stretching and shearing of white matter
Primary vs secondary injury - Primary - original injury; Secondary - complications that form due to
the bodies response to the primary injury
Examples of secondary injury - Cerebral edema, vessel rebleed or spasm, CSF blockage, seizures
Epidural Hematoma - Location: between inner skull and dura mater
Subdural Hematoma - Location: between dura and outer arachnoid membrane
Subarachnoid hemorrhage - Location: Between outer arachnoid membrane and pia mater
Thrombotic Stroke - Clot forms at the site of atherosclerotic plaque.
Embolic Stroke - Clot or plaque travels to the brain.
Irreversible Damage - Begins after just several minutes.
Symptoms Onset - Start to show after about 1 minute.
, Infarction and Necrosis - Happen after a few hours.
Penumbra - Area around necrosis that's still viable due to collateral circulation.
Lacunar Infarcts - Occlusions of arterioles.
Causes of Lacunar Infarcts - Often due to HTN or diabetes.
Risk Factor: Atherosclerosis - Plaque in arteries.
Risk Factor: Carotid Stenosis - Narrowed carotid arteries due to plaque.
Risk Factor: HTN - Hypertension.
Risk Factor: Smoking - Use of tobacco products.
Risk Factor: Sedentary Lifestyle - Lack of physical activity.
Risk Factor: Atrial Fibrillation - Irregular heart rhythm.
Risk Factor: Obesity - Excess body weight.
Risk Factor: Hyperlipidemia - High levels of lipids in the blood.
Risk Factor: Diabetes - Chronic condition affecting blood sugar levels.
Risk Factor: Advanced Age - Older age increases risk.
Risk Factor: Alcoholism - Chronic alcohol abuse.
What happens to nerve tissue during ischemia? - Nerve tissue struggles with anaerobic metabolism
and is very sensitive to decreased oxygen.
What is ischemia? - Cell death.
What is hypoxia? - Decreased oxygen leading to mitochondrial failure and cell damage.
What is the main CNS neurotransmitter? - Glutamate.
What effect does ischemia have on glutamate? - Ischemia increases glutamate release.
What are the effects of too much glutamate? - Increased calcium and water enter the cell, causing
calcium overload and cytotoxic edema.
What does excessive glutamate production lead to? - Increased production of nitrous oxide, free
radical formation, and cell death.
What is the normal range for intracranial pressure (ICP)? - 0-15 mmHg
At what ICP level does brain impairment occur? - > 22 mmHg for > 5 minutes
What are the three main components of the cranial cavity according to the Monroe-Kellie doctrine?
- Brain, Cerebrospinal Fluid (CSF), Blood
What is intracranial compliance? - The ability of the cranial components to adjust to changes in
volume to minimize impact on ICP.
Name an everyday activity that can cause slight changes in ICP. - Sneeze, cough, bending, laugh
What is interstitial edema? - Swelling caused by fluid, electrolytes, and proteins forced into the
intercellular space due to vessel damage or increased pressure.
,What causes intracellular edema? - Global ischemia leading to cellular energy failure and Na+
accumulation, attracting water into the cell.
What is the most sensitive clinical manifestation of increased ICP? - Change in level of consciousness
(LOC), often increased drowsiness.
What are common symptoms of increased ICP? - Headache, nausea/vomiting, blurred vision, slow
pupillary response.
What is Cushing's Triad? - A late sign of increased ICP characterized by ↑BP, ↓HR, and respiratory
changes.
What does a decrease in the Glasgow Coma Scale (GCS) score indicate? - A potential decrease in
consciousness or brain function.
What is the maximum score for eye opening on the Glasgow Coma Scale? - 4 for spontaneous eye
opening.
What is the maximum score for verbal response on the Glasgow Coma Scale? - 5 for oriented verbal
response.
What is the maximum score for motor response on the Glasgow Coma Scale? - 6 for following
commands.
What does decreased pupil response indicate? - Increased intracranial pressure (ICP).
What is the normal response in the Doll's Eyes Test? - Eyes move in the opposite direction of head
movement.
What does an absent response in the Cold Calorics test indicate? - No eye movement, suggesting
potential brain dysfunction.
What is the normal response of the corneal reflex? - Blinking when a cotton swab touches the
cornea.
,What does fixed and dilated pupils indicate? - Poor brain perfusion.
What does small (pinpoint) pupils suggest? - Possible pons issue or drug effects.
Focal (Coup) - Injury localized to the site of impact
Polar (Coup-countercoup) - Injury at site of impact and on opposite side of the brain (due to brain's
forward-backward movement within the skull)
Diffuse - Widespread damage of the brain
Multiple movements of brain within the skull - Results in shifting and rotational forces causes
stretching and shearing of white matter
Primary vs secondary injury - Primary - original injury; Secondary - complications that form due to
the bodies response to the primary injury
Examples of secondary injury - Cerebral edema, vessel rebleed or spasm, CSF blockage, seizures
Epidural Hematoma - Location: between inner skull and dura mater
Subdural Hematoma - Location: between dura and outer arachnoid membrane
Subarachnoid hemorrhage - Location: Between outer arachnoid membrane and pia mater
Thrombotic Stroke - Clot forms at the site of atherosclerotic plaque.
Embolic Stroke - Clot or plaque travels to the brain.
Irreversible Damage - Begins after just several minutes.
Symptoms Onset - Start to show after about 1 minute.
, Infarction and Necrosis - Happen after a few hours.
Penumbra - Area around necrosis that's still viable due to collateral circulation.
Lacunar Infarcts - Occlusions of arterioles.
Causes of Lacunar Infarcts - Often due to HTN or diabetes.
Risk Factor: Atherosclerosis - Plaque in arteries.
Risk Factor: Carotid Stenosis - Narrowed carotid arteries due to plaque.
Risk Factor: HTN - Hypertension.
Risk Factor: Smoking - Use of tobacco products.
Risk Factor: Sedentary Lifestyle - Lack of physical activity.
Risk Factor: Atrial Fibrillation - Irregular heart rhythm.
Risk Factor: Obesity - Excess body weight.
Risk Factor: Hyperlipidemia - High levels of lipids in the blood.
Risk Factor: Diabetes - Chronic condition affecting blood sugar levels.
Risk Factor: Advanced Age - Older age increases risk.
Risk Factor: Alcoholism - Chronic alcohol abuse.
