NURS 5315: EXAM 4 WITH VERIFIED ANSWERS 2024

NURS 5315: EXAM 4 WITH VERIFIED ANSWERS 2024 "central nervous system - CORRECT ANSWER consists of the brain and spinal cord" "peripheral nervous system - CORRECT ANSWER consists of 12 pairs of cranial nerves and 31 spinal nerves subdivided into somatic and autonomic nervous system" "afferent nerves - CORRECT ANSWER sensory transmitters that send impulses from receptors in the skin, muscles, and joints to the central nervous system" "efferent nerves - CORRECT ANSWER Also called motor nerves; nerves that carry information from the CNS to cells, tissues and organs." "Neuron - CORRECT ANSWER a nerve cell; the basic building block of the nervous system fuel source: glucose" "Parts of a neuron - CORRECT ANSWER cell body, dendrites, axon" "Cerebrum - CORRECT ANSWER Location: largest part of the brain Function: Area of the brain responsible for all voluntary activities of the body Sign of injury/lesion/disorder: movements that are slow and uncoordinated" "cerebral cortex - CORRECT ANSWER the gray matter surrounding the cerebrum" "white matter - CORRECT ANSWER located beneath the cerebral cortex myelinated axons of the CNS" "Four lobes of the brain - CORRECT ANSWER frontal, parietal, occipital, temporal" "frontal lobe - CORRECT ANSWER located under forehead Function: directs voluntary skeletal actions; responsible for communication, emotions, intellect, reasoning, judgment and behavior. Contains Broca's area: responsible for speech Sign of injury/lesion/disorder: Head and eye movement to one side. Complete or partial unresponsiveness or difficulty speaking. Explosive screams, including profanities, or laughter." "parietal lobe - CORRECT ANSWER Located in the upper back half of the brain. Function: interprets tactile sensation such as touch, pain, temperature, shapes and 2-point discrimination Sign of injury/lesion/disorder:" "occipital lobe - CORRECT ANSWER Located:behind the parietal lobe on the top of a membrane that helps in separating it from cerebellum function: houses the ability to read with comprehension and is the primary visual receptor center Sign of injury/lesion/disorder: vision and perception problems" "temporal lobe - CORRECT ANSWER Located:The temporal lobes are located at the sides of the brain, and can be considered the "middle" region of each brain hemisphere. function: interprets impulses from the ear. contains Wernicke's area: auditory stimuli Sign of injury/lesion/disorder: Disturbance of auditory sensation and perception. Disturbance of selective attention of auditory and visual input. Disorders of visual perception. Impaired organisation and categorisation of verbal material. Disturbance of language comprehension. Impaired long-term memory." "Supratentorial - CORRECT ANSWER above the tentorium cerebelli" "Infratentorial - CORRECT ANSWER below the tentorium cerebelli" "tentorium cerebelli - CORRECT ANSWER separates cerebrum from cerebellum" "sympathetic nervous system - CORRECT ANSWER the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations" "parasympathetic nervous system - CORRECT ANSWER the division of the autonomic nervous system that calms the body, conserving its energy" "Beta 1 receptors - CORRECT ANSWER located in the heart increase the heart's rate and strength of contraction" "Beta 2 receptors - CORRECT ANSWER located in the bronchioles of the lungs and the arteries of the skeletal muscles cause vasodilation, reduces total peripheral resistance, bronchodilation" "Alpha 1 receptors - CORRECT ANSWER Located in blood vessels, smooth muscles vasoCONSTRICTION -> increase BP contraction of smooth muscles glucose metabolism" "Alpha 2 receptors - CORRECT ANSWER Gi • decreases sympathetic outflow (suppress norepinephrine release) • decreases insulin release, induce glucagon release • decrease lipolysis • platelet aggregation • vasoconstriction • mediate synaptic transmission in nerve terminals" "cerebrospinal fluid (CSF) - CORRECT ANSWER plasma-like clear fluid circulating in and around the brain and spinal cord" "Dermatone - CORRECT ANSWER sensory neurons on the skin (the sensation is carried to the spinal nerves)" Disappears: 5 months" "Neck righting reflex - CORRECT ANSWER Hold the infant in a vertical position, then tilt to one side. Infant should attempt to maintain their line of vision parallel to the ground. appears: 4 months Disappears: 24 months" "Landau reflex - CORRECT ANSWER Infant should attempt to raise the head and arch the back when placed in a prone position appears: 3 months Disappears: 24 months" "parachute reflex - CORRECT ANSWER extension of both arms when thrust downward in the prone position appears: 9 months Disappears: persists for life" "cerebral herniation types - CORRECT ANSWER supratentorial infratentorial" "Supratentorial: uncal herniation - CORRECT ANSWER gyri moves through the tentorial notch and compresses the third cranial nerve and mesencephalon CM: change in LOC, ipsilateral pupil, Cheyne stokes respiration, decorticate posturing" "Supratentorial: central herniation - CORRECT ANSWER diencephalon is forced down through the tentorial notch CM: lose consciousness quickly, develop apnea, reactive pupils that later dilate, decorticate posturing" "Partial seizures types - CORRECT ANSWER Simple partial with motor symptoms Simple partial with sensory symptoms Complex partial" "epilepsy - CORRECT ANSWER primary seizure condition for which no underlying correctable cause can be found" "postictal state - CORRECT ANSWER a state of decreased/altered level of consciousness following an epileptic seizure" "Increased ICP S/S - CORRECT ANSWER Lethargy, decreased LOC Widening pulse pressure Bradycardia Increased Systolic Cushing's Triad" "Increased ICP: stage 1 - CORRECT ANSWER Stage 1: brain compensates with vasoconstriction and external compression - patient may be asymptomatic" "increased ICP: stage 2 - CORRECT ANSWER Stage 2: increasing amount of contents inside intracranial vault, brain unable to compensate; CM: confusion, restlessness, lethargy, pupil and breathing changes, decreased LOC" "increased ICP: stage 3 - CORRECT ANSWER Stage 3: ICP approaches arterial pressure - patient decompensates quickly. CM: decreased LOC, widening pulse pressure, bradycardia, pupils small and sluggish, CO2 accumulation causes vasodilation > decreased hydrostatic pressure, and increased blood volume" "increased ICP: stage 4 - CORRECT ANSWER Stage 4: equalization of arterial pressure and ICP > no CPP > cellular hypoxia, cell death herniation occurs when the brain tissue moves from an area of high pressure to an area of low pressure" "Traumatic Brain Injury - CORRECT ANSWER a blow to the head or a penetrating head injury that damages the brain Complications: post-concussion syndrome, posttraumatic seizures, chronic traumatic encephalopathy" "Primary brain injury - CORRECT ANSWER An injury to the brain and its associated structures that is a direct result of impact to the head. Focal-limited to one area (closed head trauma) Diffuse-shaking force which strains the brain" "Secondary brain injury - CORRECT ANSWER The "after effects" of the primary injury; includes abnormal processes such as cerebral edema, increased intracranial pressure, cerebral ischemia and hypoxia, and infection; onset is often delayed following the primary brain injury." "closed traumatic brain injury - CORRECT ANSWER brain injury in which damage may occur to the underlying vessels, dura sinus, brain and cranial nerves without harming the integrity of the skull May cause immediate loss of consciousness, loss of reflexes, transient loss of respiration, bradycardia and low BP" "cord contusion - CORRECT ANSWER Bruising of the neural tissue" "cord concussion - CORRECT ANSWER temporary disruption of cord mediated functions" "spinal cord compression - CORRECT ANSWER pressure placed on the cord from a lesion, mass or swelling. Leads to ischemia and tissue damage." "spinal cord hemorrhage - CORRECT ANSWER bleeding directly in to the spinal cord not usually associated with loss of function" "spinal shock - CORRECT ANSWER complete but temporary loss of motor, sensory, reflex, and autonomic function immediately after injury- resolves 7-20 days s/s: flaccid, bradycardia, hypotension, paralytic ileus" "meingocele - CORRECT ANSWER sac-like protrusion through the bony defect in the spinal defect containing meninges and cerebral spinal fluid. Does not involve the spinal cord and it is possible that the infant will not have any neurologic deficits" "myelomeningocele - CORRECT ANSWER hernia of the spinal cord and meninges most common development abnormality of the nervous system most commonly located in the lumbar and lumbosacral areas, the last of the neural tube to close" "stroke: anterior cerebral artery - CORRECT ANSWER blood supplies: basal ganglia, the corpus callosum, the medial surface of the cerebral hemispheres, the superior surface of the frontal and parietal lobes CM: contralateral paralysis and loss of sensation, more pronounces in lower extremities" "Stroke: Middle Cerebral Artery (MCA) - CORRECT ANSWER Blood supplies: frontal, parietal, temporal lobes CM: aphasia in the dominant hemisphere, contralateral paralysis and loss of sensation" "Stroke: Posterior cerebral artery - CORRECT ANSWER Blood supplies: occipital lobe CM: visual changes contralateral to the occlusion" "Stroke: basilar artery - CORRECT ANSWER Blood supplies: pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve CM: quadriplegia, loss of voluntary facial, mouth, tongue movements, loss of horizontal eye movements, consciousness remains intact" "Stroke: anterior inferior cerebellar artery - CORRECT ANSWER Blood supplies: lateral pons, vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers CM: vomiting, vertigo, nystagmus, decreased lacrimation, decreased taste, a decreased corneal reflex, decreased pain and temp sensation in the face, decreased ipsilateral hearing" "Stroke: middle and inferior cerebellar artery - CORRECT ANSWER blood supplies: cerebellum CM: ataxia, dysmetria" "Stroke: posterior cerebellar artery - CORRECT ANSWER blood supplies: lateral medulla, spinal trigeminal nucleus, nucleus ambiguous, sympathetic fibers, inferior cerebellum CM: vomiting, vertigo, nystagmus, decreased pain and temperature sensation in teh ipsilateral face and contralateral body, dysphagia, hoarseness, decreased gag reflex, ataxia, dysmetria" "Dysmetria - CORRECT ANSWER inability to control the distance, power, and speed of a muscular action (lack of coordination)" "substance use disorder - CORRECT ANSWER continued substance craving and use despite significant life disruption and/or physical risk" "substance intoxication - CORRECT ANSWER the acute effects of substance use" "Substance Withdrawal Disorder - CORRECT ANSWER Each substance has its own unique syndrome as symptoms of abrupt cessation of heavy and prolonged use" "vasogenic edema - CORRECT ANSWER clinically the most important type and is caused by the increased permeability of the capillary endothelium of the brain after injury to the vascular structure" "cytotoxic edema - CORRECT ANSWER toxic factors directly affect the cellular elements of the brain causing failure of the active transport systems" "interstitial edema (hydrocephalic edema) - CORRECT ANSWER occurs especially around the lateral ventricles when an increase in intravascular pressure causes an abnormal flow of fluid from the intraventricular CSF across the ependymal lining to the periventricular white matter" "contracoup injury - CORRECT ANSWER brain slams against cranium in one direction and then back in the other direction" Nephrolithiasis - CORRECT ANSWER also known as kidney stones or renal calculi, is the presence of renal stones within the renal pelvis and/or calyces" "Risk factors of Nephrolithiasis - CORRECT ANSWER age, male gender, fluid intake, Caucasian, diet, HTN, atherosclerosis, metabolic syndrome, obesity and DM Type 2" "High protein diets result in... - CORRECT ANSWER an increase in purine intake" "High sodium diet predisposes the individual to... - CORRECT ANSWER increased calcium excretion and therefore to calcium stone formation" "Essential HTN has a role in the formation of renal calculi... - CORRECT ANSWER but the association is not clear." "Acute kidney injury is... - CORRECT ANSWER an abrupt reduction in renal function with oliguria" "Stage 1 of AKI - CORRECT ANSWER characterized by a creatinine of 1.5-1.9 times higher than the baseline or ≥ 0.3mg/dL increase in creatinine" "Stage 2 of AKI - CORRECT ANSWER characterized by a creatinine of 2-2.9 times higher than the baseline." "Stage 3 of AKI - CORRECT ANSWER characterized by a creatinine of 3.0 times higher than the baseline or an increase in serum creatinine to ≥ 4.0 mg/dL or the initiation of renal replacement therapy or in person less than 18 years old a decrease in eGFR to < 35ml/minute per 1.732" "Cause of Pre-renal AKI... - CORRECT ANSWER impaired blood flow to the kidney resulting in a decreased GFR. Anything which decreases renal perfusion can cause a pre-renal AKI" "Etiologies of AKI include: - CORRECT ANSWER • Vasoconstriction of renal arteries from medications or shock states. • Hypotension • Hypovolemia • Hemorrhage • Inadequate cardiac output i.e. heart failure • NSAIDS • Renal artery stenosis" "Most common cause of AKI... - CORRECT ANSWER Pre-renal AKI; Laboratory findings consistent with AKI include a FeNa of < 1% and a BUN:Creatinine ratio of > 20." "What is used to evaluate an acute kidney injury and to differentiate between a pre-renal and acute tubular necrosis? - CORRECT ANSWER fractional excretion of sodium (FeNa)" "FeNa - CORRECT ANSWER a calculated measure based off the serum sodium, serum creatinine, urine sodium and urine creatinine. It is reported as a percentage and is a marker of renal sodium excretion." "A FeNa which is less than 1% indicates... - CORRECT ANSWER that the kidneys are conserving sodium and is indicative of a pre-renal AKI" "A FeNa which is greater than 2% indicates... - CORRECT ANSWER that the kidneys are wasting sodium and is consistent with an acute tubular necrosis." "FeNa values between 1-2% are... - CORRECT ANSWER indeterminate and are not helpful in differentiating between the two disease processes" "The BUN:Creatinine ratio greater than 20 is consistent with... - CORRECT ANSWER a pre-renal acute kidney injury (AKI)" "Intra-renal AKI is caused by... - CORRECT ANSWER an issue which has impaired renal function at the cellular level in the kidney." "The 2 main causes of intra-renal AKI are - CORRECT ANSWER inflammatory conditions and acute tubular necrosis (ATN)" "Inflammatory conditions which cause intra-renal AKI are... - CORRECT ANSWER glomerulonephritis, vasculitis, drug induced toxicity such as aminoglycosides" "Acute Tubular necrosis (ATN) results in... - CORRECT ANSWER a severe necrosis of tubular epithelial cells." "Causes of ATN include - CORRECT ANSWER sepsis, postsurgical complications, obstetrical complications, and medications. Any pre-renal etiology can be so profound that it progresses to ATN" "Most common cause of intra-renal injuries - CORRECT ANSWER ATN caused by ischemia" "Post-renal AKI is caused by - CORRECT ANSWER a urinary tract obstruction such as bladder outlet obstruction" "A bladder outlet obstruction may occur as a result of - CORRECT ANSWER prostatic hyperplasia or ureteral obstruction from a urinary stone" "Bladder outlet obstruction increases - CORRECT ANSWER retrograde pressure and causes an ATN. Regardless of the origin of ARF, all forms of acute renal failure, if left untreated, will all result in ATN." "Clinical manifestations of AKI - CORRECT ANSWER Oliguria, anuria • Fatigue, edema, dyspnea • Mental status changes secondary to uremia • Electrolyte imbalances include hyperkalemia, hyponatremia. • Metabolic acidosis • BUN:Creatinine Ratio will be > 20 in a pre-renal AKI. It will be normal in intra-renal AKI. • FeNa will be < 1% in pre-renal AKI and > 2% in an ATN. • Muddy Brown Cast cells are seen in the UA with ATN." "Chronic Kidney Disease (CKD) - CORRECT ANSWER progressive and irreversible loss of nephron function" "CKD Stage I is defined by a GFR of - CORRECT ANSWER ≥ 90 ml/min." "CKD Stage II is defined by a GFR of - CORRECT ANSWER 60-80 ml/min." "CKD Stage III is defined by a GFR of - CORRECT ANSWER 30-59 ml/min." "CKD Stage IV is defined by a GFR of - CORRECT ANSWER 15-29 ml/min." "Clinical manifestations of CKD Stage IV - CORRECT ANSWER increased triglycerides, metabolic acidosis, hyperkalemia, sodium and water retention and elevated BUN/creatinine. Additional symptoms include moderate HTN, hyperphosphatemia, and anemia." "Clinical manifestations of CKD STage III - CORRECT ANSWER erythropoietin deficiency, experience anemia, and have an increase in creatinine and urea. They will have mild HTN." "Clinical manifestations of CKD Stage II - CORRECT ANSWER increase in PTH, early bone disease, increasing plasma creatinine and urea. They may have subtle hypertension." "Clinical manifestations of CKD Stage I - CORRECT ANSWER These people are usually asymptomatic" "Clinical Manifestations of CKD Stage IV - CORRECT ANSWER This results in uremia. They will also experience severe HTN, anemia and hyperphosphatemia." "CKD Stage V is defined by a GFR of - CORRECT ANSWER < 15 ml/min or the need for hemodialysis." "Most common cause of CKD - CORRECT ANSWER Diabetes" "Second most common cause of CKD - CORRECT ANSWER HTN" "Third most common cause of CKD - CORRECT ANSWER Glomerulonephritis" "2 other processes that can cause CKD over time - CORRECT ANSWER Polycystic kidney disease and Obstructive problems such as renal stones" "Clinical manifestations of CKD - CORRECT ANSWER uremia, Anemia secondary to decrease erythropoietin levels, Fluid and electrolyte imbalances" "Common fluid and electrolyte imbalances found with CKD - CORRECT ANSWER Hyperkalemia Fluid volume deficit and Hyponatremia-during the early stages Fluid overload and hypernatremia- occur in late stages Hyperphosphatemia Hypocalcemia Metabolic Acidosis" "Fluid volume deficit and hyponatremia in CKD - CORRECT ANSWER during the early stages sodium and fluid wasting occurs secondary to lack of the kidney's ability to concentrate urine" "Fluid overload and hypernatremia in CKD - CORRECT ANSWER occur in late stages as the patient becomes oliguric. Sodium is not excreted and accumulates as does fluid." "Hyperphosphatemia in CKD - CORRECT ANSWER occurs due to a decreased excretion of phosphorus." "Hypocalcemia in CKD - CORRECT ANSWER occurs because calcium has an inverse relationship to phosphorus. A decreased production of the active form of vitamin D (calcitriol). This is needed for the absorption of calcium in the gut." "Metabolic Acidosis in CKD - CORRECT ANSWER occurs because of the kidney's inability to reabsorb urinary bicarb (HCO3) or excrete H+" "Secondary hyperparathyroidism occurs to... - CORRECT ANSWER compensate for the low calcium levels which are secondary to the hyperphosphatemia" "Osteodystrophy results from - CORRECT ANSWER secondary hyperparathyroidism. Remember PTH causes an increase in osteoclastic activity, which causes the breakdown of bone. Osteodystrophy is defective bone formation which leads to osteoporosis. The metabolic acidosis associated with CKD also contributes to the development of osteodystrophy" "A normocytic anemia commonly occurs and is due to... - CORRECT ANSWER a decreased secretion of erythropoietin from the kidney" "HTN occurs or worsens because - CORRECT ANSWER failing kidneys secrete more renin. This results in more angiotensin II and vasoconstriction" "Altered mental status can occur from - CORRECT ANSWER the increased levels of urea and other uremic toxins. This usually will not be seen unless the BUN is > 100" "Why is insulin resistance is common in CKD? - CORRECT ANSWER Hyperparathyroidism decreases insulin sensitivity and impairs glucose tolerance. As the kidney function decreases it is not able to clear adiponectin and leptin which can contribute to the insulin resistance. Also the failing kidney is not able to degrade insulin so insulin's half life is prolonged." "Why is dyslipidemia is common in CKD? - CORRECT ANSWER They tend to have high triglyceride levels, low HDLs and high LDLs" "What is the main cause of death in persons with CKD? - CORRECT ANSWER Cardiovascular disease; This is secondary to the dyslipidemia that they experience, anemia, increase release or renin and vascular calcification. All of these increase the risk for ischemic heart disease." "Why is there an impaired platelet function associated with CKD? - CORRECT ANSWER Impaired platelet function is caused by the uremic environment. Platelets are not able to aggregate in a uremic environment." "Polycystic Kidney Disease - CORRECT ANSWER an autosomal dominant disorder which produces a defect in the formation of epithelial cells and causes cyst formation and obstruction of the renal parenchyma, interstitial fibrosis and loss of functioning nephrons" "Clinical manifestations that may occur as a result of PKD - CORRECT ANSWER Hypertension, heart valve disease, and cerebral and aortic aneurysms" "Hemolytic uremic syndrome - CORRECT ANSWER -the most common community acquired cause of AKI in young children -associated with bacterial and viral agents - Escherichia coli 0157:H7 and 0104:H4 strains -characterized by hemolytic anemia, thrombocytopenia and renal impairment -Children are exposed to these agents through animals, unpasteurized beverages, or contaminated meat and vegetables" “Cranial Nerve I: Olfactory - CORRECT ANSWER sensory, smell Sign of dysfunction: unable to identify aromatic substance" "Cranial Nerve II: Optic - CORRECT ANSWER -Function: sensory - carries impulse for vision -Testing procedure: eye chart testing, visual field testing" "Cranial Nerve III: Oculomotor - CORRECT ANSWER --Function: motor - fibers to the superior, inferior and medial rectus muscles of the eye and to the smooth muscle controlling lens shape. Medial and vertical eye movements; sensory - proprioception of the eye -Testing procedure: pupil sizes are compared for shape and equality, pupillary reflex is tested; visual tracking is tested" "Cranial Nerve IV: Trochlear Nerve - CORRECT ANSWER Motor: eye movement, extra ocular superior oblique muscle Tested the same as CN III" "Cranial Nerve V: Trigeminal - CORRECT ANSWER -Function: motor and sensory for face, conducts sensory impulses from mouth, nose, eyes; motor fibers for muscles of mastication. Control of jaw movements -Testing procedure: pain, touch, and temperature are tested with proper stimulus; corneal reflex tested with a wisp of cotton; person is asked to move jaw through full ranges of motion" "Cranial Nerve VI: Abducens - CORRECT ANSWER -Function: motor and proprioceptor fibers to/from lateral rectus muscle. Lateral eye movements -Testing procedure: tested in conjunction with cranial nerve III relative to moving eye laterally" "Cranial Nerve VII: Facial - CORRECT ANSWER -Function: mixed (sensory and motor) sensory fibers to taste buds and anterior 2/3 tongue; motor fibers to muscles of facial expression and to salivary glands -Testing procedure: check symmetry of face, ask person to attempt various facial expressions; sweet, salty, sour, and bitter substances are applied to tongue to test tasting ability" "Cranial Nerve VIII: vestibulocochlear - CORRECT ANSWER Function: Sensory - special senses of hearing and balance; Foramen: internal auditory canal; Consequence of Loss: loss of hearing, loss of balance and equilibrium, nausea, vertigo, vomiting" "Cranial nerve IX: glossopharyngeal - CORRECT ANSWER -Function: motor fibers for pharynx and salivary glands; sensory fibers for pharynx and posterior tongue. Taste sensation for sweet, bitter and sour -Testing procedure: gag and swallow reflexes are checked; posterior one third of tongue is tested for taste" "Cranial Nerve X: Vagus - CORRECT ANSWER -Function: sensory/motor impulses for larynx and pharynx; parasympathetic motor fibers supply smooth muscles of abdominal organs; sensory impulses from viscera -Testing procedure: tested in conjunction with cranial nerve IX" "Cranial Nerve XI: Spinal Accessory - CORRECT ANSWER Function: Motor - to sternocleidomastoid and trapezius; Foramen: foramen magnum, jugular foramen; Consequence of Loss: difficulty elevating scapula or rotating neck" "Cranial Nerve XII: Hypoglossal - CORRECT ANSWER -Function: motor/sensory fibers to/from tongue. Movement of tongue -Testing procedure: ask person to stick out tongue, positional abnormalities are noted" "Cerebellum - CORRECT ANSWER Location: the "little brain" at the rear of the brainstem; functions include processing sensory input and coordinating movement output and balance Sign of injury/lesion/disorder: ataxia, which may affect the limbs, trunk, or even speech" "Axonal reaction - CORRECT ANSWER peripheral nerve self-repair" "Neuroglia - CORRECT ANSWER cells that support and protect neurons Astrocytes, oligodendroglia, microglia, ependymal cells" "Schwann cells - CORRECT ANSWER Supporting cells of the peripheral nervous system responsible for the formation of myelin." "types of neurotransmitters - CORRECT ANSWER Acetylcholine: excitatory and inhibitory Monoamines: histamine, serotonin, dopamine, epinephrine, norepinephrine deficiency of dopamine leads to Parkinson Disease Amino Acids: glutamate, GABA, glycine" "brain stem - CORRECT ANSWER Location: area at the base of the brain that lies between the deep structures of the cerebral hemispheres and the cervical spinal cord Contains: midbrain, pons, medulla oblongata and reticular formation. Ten of the 12 cranial nerves arise from the brain stem. Function: It contains the respiratory and vasomotor centers, which are responsible, respectively, for breathing and the maintenance of blood pressure. Signs if injury/lesion/disorder: coma, irregular breathing, insomnia, balance issues, slurred speech, etc." "reticular activating system (reticular formation) - CORRECT ANSWER Responsible for alterations in arousal and sleep-wake transitions Extreme damage can cause coma" "Thalamus - CORRECT ANSWER the brain's sensory switchboard, located on top of the brainstem; it directs messages to the sensory receiving areas in the cortex and transmits replies to the cerebellum and medulla" "Hypothalamus - CORRECT ANSWER a neural structure lying below the thalamus; directs eating, drinking, body temperature; helps govern the endocrine system via the pituitary gland, and is linked to emotion" "limbic system - CORRECT ANSWER neural system (including the hippocampus, amygdala, and hypothalamus) located below the cerebral hemispheres; associated with emotions and drives." "Wernicke's area - CORRECT ANSWER location: temporal lobe on the left side of the brain Function: speech comprehension, language development Signs of injury/lesion/defect: difficulty speaking in coherent sentences or understanding speech" "Broca's area - CORRECT ANSWER Location: an area of the frontal lobe, usually in the left hemisphere, Function: Controls language expression - that directs the muscle movements involved in speech. Signs of injury/lesion/defect: Non-fluid primary progressive aphasia: this is a progressive deterioration of language." "autonomic nervous system (ANS) - CORRECT ANSWER the part of the peripheral nervous system that controls the glands and the muscles of the internal organs (such as the heart). Its sympathetic division arouses; its parasympathetic division calms." "Embryonic and infant Development of the Brain - CORRECT ANSWER Conception: brain begins to develop 3-4 weeks gestation: neural tube forms entire nervous system. 2-3 months gestation: forebrain develps 3-5 months gest: neronal proliferation, brain develops rapidly, 5 months gest: synapses form Myelin is formed in the post-natal period and may take many years to complete half of the post-natal growth is achieved in the first year and 90% complete by age 6 2-3 months: posterior fontanel closes 18 months: anterior fontanel closes" "stepping reflex - CORRECT ANSWER a neonatal reflex in which an infant lifts first one leg and then the other in a coordinated pattern like walking appears: Birth Disappears: 6 weeks" "Moro reflex (startle reflex) - CORRECT ANSWER Sudden loud noise will cause symmetric abduction and extension of the arms followed by adduction and flexion of the arms over the body. appears: Birth Disappears: Disappears by 3 to 4 months." "suckling reflex - CORRECT ANSWER Sucking response when roof of mouth is touched appears: Birth Disappears: 4 months awake, 7 months asleep" "rooting reflex - CORRECT ANSWER a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple appears: Birth Disappears: 4 months awake, 7 months asleep" "palmar grasp reflex - CORRECT ANSWER in response to stroking a baby's palm, the baby's hand will grasp. appears: Birth Disappears: 6 months" "Plantar Grasp Reflex - CORRECT ANSWER reaction to stimulation of the sole of the foot that causes the toes of the feet to "grasp" appears: Birth Disappears: 10 months" "Tonic neck reflex (fencer position) - CORRECT ANSWER Turn newborn head turned to the right: Right arm/leg EXTEND Left arm/leg flex appears: 2 months "age related nervous system changes - CORRECT ANSWER structural: decreased brain weight and size, fibrosis o meninges, widening sulci and narrowing gyri, increase in ventricles cellular: decrease in neurons, myellin, dendritic and synaptic processes, increased neuroinflammation, declines in melatonin, atrophy of the epithelial cells in the choroid plexus cerebrovascular: arteriosclerosis, increased permeability of the blood-brain barrier, decreased vascular density functional changes: decreased deep tendon reflexes, skeletal muscle atrophy, progressive decrease in taste and smell, decreased vibratory sense, decrease control of gai and posture, sleep disturbances and memory impairments" "cerebral blood flow - CORRECT ANSWER regulated to meet the metabolic needs of the brain. 20% of cardiac output altered by the concentration of CO2 and O2 CBF decreases when CO2 decreases and increases when the PaO2 < 50mmHg When PaO2 = 70-90 mmHg, CBF is maintained" "Cerebral Perfusion Pressure - CORRECT ANSWER pressure required to maintain perfusion to the brain CPP = MAP - ICP Normal is 70-90 mmHg Low CPP caused by hypovolemia or hypotension > brain ischemia High CPP caused by hypertension > increased in hydrostatic pressure > fluid moves into the interstitium in the brain and > increased ICP > decreased CPP" "intracranial pressure - CORRECT ANSWER pressure in the intracranial vault that must be overcome to be perfused normal ICP = 5-15 mmHg increased ICP > decreased CPP and impaired cerebral perfusion" "Four stages of ICP - CORRECT ANSWER Stage 1: brain compensates with vasoconstriction and external compression - patient may be asymptomatic Stage 2: increasing amount of contents inside intracranial vault, brain unable to compensate; CM: confusion, restlessness, lethargy, pupil and breathing changes, decreased LOC Stage 3: ICP appraches arterial pressure - patient decompensates quickly. CM: decreased LOC, widening pulse pressure, bradycardia, pupils small and sluggish, CO2 accumulation causes vsodilation > decreased hydrostatic pressure and increased blood volume Stage 4: equalization of arterial pressure and ICP > no CPP > cellular hypoxia, cell death" "Supratentorial: cingulate gyrus herniation - CORRECT ANSWER movement of the cingulate gyrus under the falx cerebri" "Supratentorial: transcalvarial herniation - CORRECT ANSWER brain tissue which moves through an opening in the skull" "Infratentorial: cerebellar tonsillar herniation - CORRECT ANSWER Most common downward movement of the cerebellum through the foramen magnum CM: stiff neck, decreased LOC, respiratory abnormalities and pulse variations" "Sodium imbalance effect on CNS - CORRECT ANSWER hyponatremia causes water movement out of the vessels and into the interstitium and then into the cell. in the brain, they enter the neuron causing cerebral edema associated with CNS symptoms Hypernatremia is associated with a rapid decrease in intracellular water content and brain volume caused by an osmotic shift of free water out of the cells causing dehydrated neurons" "expressive dysphasia - CORRECT ANSWER The inability to produce language ( despite being able to understand language) Location of dysfunction: Broca's area of the frontal lobe" "receptive dysphasia - CORRECT ANSWER The inability to understand language (despite being able to hear it and produce it) Location of dysfunction: Wernicke's area of the temporal lobe" "global aphasia - CORRECT ANSWER Nonfluent aphasia w/ impaired comprehension. Both Broca's and Wernicke's areas affected." "simple partial seizure with motor symptoms - CORRECT ANSWER CM: motor symptoms which most often begin in the face and hands, tend to be clonic" "Simple partial seizure with sensory symptoms - CORRECT ANSWER CM: tactile, visual auditory or olfactory sensations, most often in the lips, fingers and toes" "complex partial seizure - CORRECT ANSWER CM: impairment in their consciousness during the seizure, usually have some sort of sensory experience prior to the onset of automatism. Automatisms may include lip smacking, chewing, facial grimacing, swallowing, movements, patting, picking, rubbing oneself" "generalized absence seizure - CORRECT ANSWER - staring spell or brief loc> no convulsions - can be precipitated by hyperventilation or flashing lights - can be short (30 sec)" "generalized tonic seizure - CORRECT ANSWER CM: muscle contraction" "Generalized Clonic Seizure - CORRECT ANSWER CM: quick repetitive jerks" "Generalized tonic-clonic (grand mal) - CORRECT ANSWER CM: alternating stiffening and jerking, incontinent and disoriented after" "status epilepticus - CORRECT ANSWER A condition in which seizures recur every few minutes or last more than 30 minutes. medical emergency" "Non-convulsive status epilepticus - CORRECT ANSWER CM: no signs of seizure activity, altered mental status that is not explained by any other cause. Diagnosed with EEG" "spinothalamic tract - CORRECT ANSWER Ascending sensory tract: carries info from skin to brain - includes anterior spinal thalamic tract and the lateral spinal thalamic tract. An afferent tract that transmits sensations of pain, temperature, itching, tickling, pressure, and crude touch crossover tract - so lesion/disorders are on the opposite side" "posterior column - CORRECT ANSWER ascending sensory tract: includes fasciculus gracilis and fasciculus cuneatus tracts carries sensations of position (proprioception), vibration, stereognosis and fine touch crossover is high - so defects will be ipsilateral to a lesion. exception: if the lesion is in the cerebral cortex, it will be contralateral defect." "pyramid tract - CORRECT ANSWER descending motor tract: made of corticospinal and corticobulbar tracts impulses are generated in the brain and sent to control voluntary movements of purpose and skill. crossover at the junction between the spinal cord and brain defects in this tract will be contralateral to the brain. Upper motor neuron deficits manifest as spastic paralysis, hyperreflexia, and Babinski reflex i.e. Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) lower motor neuron deficits manifest as flaccid paralysis, muscular atrophy, fasciculations, fibrillations or hyporeflexia. i.e. poliomyelitis" "extrapyramidal tracts - CORRECT ANSWER descending motor tract: made of rubrospinal tract, the reticulospinal tract, tectospinal tract, and vestibulospinal tract crosses over at the junction between the brain stem and spinal cord. deficits are manifested contralaterally responsible for gross motor movements, automatic motor movements, facial expression, posture, muscle tone, speech, and swallowing. CM: spastic increase in muscle tone, abnormal postures, involuntary movements, tremors, i.e. Parkinson's Disease" "Open Traumatic Brain Injury - CORRECT ANSWER dura is damaged and the contents of the cranial vault are open to the environment Affecting a specific area of the brain tissue, Focal/localized damage. Example: Skull fracture." "diffuse axonal injury - CORRECT ANSWER occurs from shaking which strains the brain - type of brain injury characterized by shearing, stretching, or tearing of nerve fibers with subsequent axonal damage." "post concussive syndrome (PCS) - CORRECT ANSWER Symptoms of concussion >3 months. Generally occurs in about 80% of persons with mild and moderate TBI" "hemiparesis - CORRECT ANSWER slight paralysis or weakness affecting one side of the body" "Kernig's sign - CORRECT ANSWER inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down" "Brudzinski's sign - CORRECT ANSWER Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed." "transection of spinal cord - CORRECT ANSWER ascending and descending tracts are partially or completely severed" "Autonomic Dysreflexia - CORRECT ANSWER patients with spinal cord injuries are at risk for developing autonomic dysreflexia (T-6 or above) parasympathetic nervous system is unable to send signals below the area of injury. Above injury: flushing sweating and bradycardia below injury: pale and cool skin Other CM: SBP up to 300mmHg, HA, blurred vision and nausea" "Anterior Cord Lesion - CORRECT ANSWER Cause: trauma, ruptured intervertebral disk, anterior spinal artery occlusion, primary spinal cord tumors or metastatic CA CM: loss of pain and temperature sensation, motor weakness" "Central cord lesion - CORRECT ANSWER Cause: primary spinal cord tumors and hyperextension injuries CM: loss of pain and temperature at level of lesion with other modalities preserved" "posterior cord lesion - CORRECT ANSWER Cause: cervical spondylosis, epidural abscess, vit B12 deficiency, syphilis, multiple sclerosis, primary spinal cord tumors, metastatic CA CM: loss of fine touch, loss of vibratory sensation, loss of proprioception, motor weakness" "Migraine Phases - CORRECT ANSWER Premonitory Phase - early warning signs, can occur several hours before the headache (e.g. depression, irritability, craving for foods etc.) Aura Phase - 1 in 5 people have an aura phase with: visual ( can include hallucinations), skin ( pin prick or needles) or language (expressing thoughts) difficulties HA Phase - throbbing pain and can last from several hours to days; may have fatigue, N/V or dizziness Recovery: After the Storm -patient feels extreme tiredness, weakness and or confusion, irritability, may take days to resolve" "Anencephaly - CORRECT ANSWER defect in closure of the cephalic portion of the neural tube that results in incomplete development of the brain and bones of the skull; the most drastic neural tube defect usually results in a stillbirth" "encephalocele - CORRECT ANSWER herniation of brain tissue, most commonly the occipital area" "Renal calculi are made up of - CORRECT ANSWER calcium, struvite, uric acid or cystine (an amino acid found in most proteins)" "idiopathic hypercalciuria or in the setting of hyperparathyroidism. - CORRECT ANSWER Calcium stones typically occur from" "What is the second most common type of renal calculi? - CORRECT ANSWER Struvite stones" "The most common type of renal calculi? - CORRECT ANSWER Calcium stones" "Struvite stones are made of - CORRECT ANSWER magnesium, ammonium, and phosphate salts" "Which stones are the most troubling ones? - CORRECT ANSWER Struvite stones because they frequently cause complications with intractable urinary tract infections, pain, bleeding, and abscess" "What are the third most common renal calculi? - CORRECT ANSWER Uric Acid stones" "What is the least common type of stone and most commonly occurs in children? - CORRECT ANSWER Cystine stones" "What results from the obstruction of the ureter and causes the urine to back up into the kidney? - CORRECT ANSWER Hydronephrosis and renal failure" "Gout results from.... - CORRECT ANSWER an accumulation of uric acid" "Dehydration's link to the pathophysiology of nephrolithiasis is... - CORRECT ANSWER unknown" "Clinical Manifestations of nephrolithiasis - CORRECT ANSWER flank pain that radiates to the groin (testicles in men or labia in women), anuria (bilateral obstruction), azotemia (bilateral obstruction), and hematuria." "The term used to describe the condition of hypercellularity of the glomeruli - CORRECT ANSWER Proliferative" "The term used to describe the thickening of the glomeruli basement membrane - CORRECT ANSWER Membranous" "Primary glomerular disease involves... - CORRECT ANSWER only the kidney and the cause of the disease is directly related to the kidney" "secondary glomerular disease - CORRECT ANSWER the injury is caused by a mechanism outside of the kidney which is what occurs with lupus or diabetes" "Hypercellularity - CORRECT ANSWER An increased number of cells in the glomerulus" "cellular proliferation of the mesangial or endothelial cells; leukocytic infiltration of the glomerulus; and the formation of crescents, which result from the accumulation of cells made of proliferating epithelial cells and infiltrating leukocytes. This tends to occur after an immune or inflammatory response - CORRECT ANSWER Hypercellularity inlcudes...." "Basement membrane thickening results in... - CORRECT ANSWER a thickening of the capillary walls of the glomerulus" "Hyalinosis - CORRECT ANSWER the accumulation of homogeneous and eosinophilic cells in the lumen of the glomerular capillaries" "Hyalinosis occurs as a result of... - CORRECT ANSWER capillary wall injury, and it is usually the end result of glomerular damage. This is commonly seen with focal segmental glomerulosclerosis" "Sclerosis - CORRECT ANSWER the accumulation of extracellular collagenous matrix" "Sclerosis may be limited to... - CORRECT ANSWER may be limited to the mesangial cells (which is what happens with diabetic glomerulosclerosis) or involve the capillary loops of the glomerulus or both. This may obliterate capillary lumens in the glomeruli and result in the formation of adhesions in the Bowman capsule."