2024 Pathophysiology Final Exam 5 with Correct Answers, Exams of Advanced Education

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2024 PATHO FINAL EXAM 5 WITH

CORRECT ANSWERS

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What are the two types of cells within the nervous system? - CORRECT- ANSWERSNeuron and neuroglial cells What are specialized cells that transmit and receive electrical and chemical impulses called? - CORRECT-ANSWERSNeurons What cells provide supportive functions to the neurons?> - CORRECT- ANSWERSNeruoglial cells What are the 3 components of a neuron? - CORRECT-ANSWERScell body (soma), dendrites, axons Kaposi sarcoma is what type of malignancy? - CORRECT-ANSWERSVascular malignancy What are the presentations of Kaposi sarcoma? - CORRECT-ANSWERS-Drug- induced immunosuppression (ex. after kidney suppression) -Endemic form in equatorial Africa -Classic form exhibited on the lower legs of older men -Epidemic and nonepidemic forms r/t AIDs What is the clinical manifestation of Kaposi sarcoma? - CORRECT- ANSWERSPurplish-brown macules, developing into plaques and nodules Basal cell carcinoma is associated with:

1. Depressed center and rolled boarders
2. Heavy smoking of cigarettes and cigars
3. Mutations in the BRAF and RAS genes
4. X-rays and gamma rays - CORRECT-ANSWERS1. Depressed center and rolled boarders Cold injury affects what? - CORRECT-ANSWERSFingers, toes, ears, nose , and cheeks What causes the burning reaction with cold injuries? - CORRECT- ANSWERSCaused by alternating cycles of vasoconstriction and vasodilation

What are the clinical manifestations of cold injuries? - CORRECT- ANSWERSSkin is white or yellowish with a waxy appearance and firm to the touch In cold injuries what are part of the pathophysiology? - CORRECT- ANSWERSInflammation and reperfusion What skin injury results from an exposure to extreme cold? - CORRECT- ANSWERSCold injury What is the general term that describes a cutaneous injury as a result of thermal, chemical, or electrical causes? - CORRECT-ANSWERSBurns Burns can be either ___________ or ____________- - CORRECT-ANSWERSthermal or nonthermal What cause blistering of the epithelial surfaces? - CORRECT- ANSWERSvesicants (ex. acids or bleach) A person arrives at the emergency department with a burn injury, The burn area is covered with thin-walled, fluid-filled blisters and is very painful. The nurse suspects this is a:

1. First-degree injury
2. Superficial partial-thickness injury
3. Deep partial-thickness injury
4. Full-thickness injury - CORRECT-ANSWERS2. Superficial partial-thickness injury This type of burn involves only the EPIDERMIS without injury to the underlying dermal or subcutaneous tissue? - CORRECT-ANSWERSPartial- thickness injury (Ex. sunburn or friction burn) This type of burn involves thin-walled, fluid-filled blisters develop within a few minutes after injury? - CORRECT-ANSWERSSuperficial partial-thickness injury (Ex. severe sunburn or friction burn) This type of burn involves the entire DERMIS, sparing skin appendages such as hair follicles and sweat glands (Normal skin barrier compromised)? - CORRECT-ANSWERSDeep partial-thickness injury This type of burn involves the ENTIRE EPIDERMIS, DERMIS, and often the underlying SUBCUTANEOUS tissue are destroyed? - CORRECT-ANSWERSFull- thickness injury are full thickness burns painful? - CORRECT-ANSWERSInjury is painless b/c nerve endings have been destroyed

Partial-thickness injury burns have what appearance? - CORRECT- ANSWERSLocal pain, erythema develops, no blisters until approx. 24 hrs after injury Superficial partial-thickness injury burns have what manifestations? - CORRECT-ANSWERSPainful, thin-walled and fluid filled blisters develop within a few minutes after injury Deep partial-thickness injury burns have what manifestations? - CORRECT- ANSWERSWaxy white skin surrounded by margins of the superficial partial- thickness injury, and the skin may peel off in sheets. When can you distinguish a deep partial-thickness burn from a full-thickness burn? - CORRECT-ANSWERS7-10 days at which time skin buds and hair reappear What are the characteristics of a full-thickness burn injury? - CORRECT- ANSWERS-Burn color is white, cherry red, or black -Blisters are rare

• Wound is dry and leathery -Delineation between normal and burned skin is not accompanied by a significant color change Burns severity is determined by using what? - CORRECT-ANSWERSage, medical history, extent and depth of the burn injury, and body area involved Which burn scale is typically used in children? - CORRECT-ANSWERSLund and Browder chart What 2 factors determine the effect of burns? - CORRECT-ANSWERSThe extent of body surface involved and depth of injury In adults what are considered major burn injuries? - CORRECT- ANSWERSBurns exceeding 20% of TBSA What is the rule of nines? - CORRECT-ANSWERSeach upper limb = 9% each lower limb = 18% anterior and posterior trunk = 18% each head and neck = 9% perineum and genitalia = 1% These are associated with massive evaporative water losses and flux of large amounts of fluid and electrolytes (generalized edema and circulatory hypovolemia)? - CORRECT-ANSWERSBurn injuries

This is a phenomenon consisting of both hypovolemic and cardiovascular component, and cellular component? - CORRECT-ANSWERSBurn shock (in acute/immediate) phase What does burn shock result from? - CORRECT-ANSWERSThe massive fluid shift from circulating blood volume This indicates the end of burn shock, when person has reached end point of burn shock, indicates vascular status? - CORRECT-ANSWERSCapillary seal What occurs in the ebb phase of burns? - CORRECT-ANSWERSCardiac contractility is diminished during the initial 24-hr resuscitation period with shunting blood away from the liver, kidney, and gut T or F: Burns are a multisystem injury vs. just a skin injury - CORRECT- ANSWERSTrue, they are a multisystem injury What is the pathophysiology of burns? - CORRECT-ANSWERSThe consequences of a major burn injury center around the development of a profound life-threatening hypovolemic shock that occurs in conjunction with cellular and immunologic disruption within a few hours of injury The cell body (soma) is located where? - CORRECT-ANSWERSMainly in the CNS What are the densely packed cell bodies in the PNS called? - CORRECT- ANSWERSGanglia or plexuses What are the densely packed cell bodies in the CNS called? - CORRECT- ANSWERSNuclei What do dendrites do? - CORRECT-ANSWERScarry nerve impulses toward the cell body (afferent) Afferent means what? - CORRECT-ANSWERSConduct impulses TOWARD CNS (Central Nervous System) Efferent means what? - CORRECT-ANSWERSConduct impulses AWAY from CNS (Central Nervous System) What do axons do? - CORRECT-ANSWERSCarry impulses away from the cell body (efferent)

How many axons do most neurons typically have? - CORRECT- ANSWERStypically only one sensory neurons do what? - CORRECT-ANSWERSTransmit impulses from sensory receptors to the CNS (afferent) What do associational (interneurons) do? - CORRECT-ANSWERSTransmit impulses from neuron to neuron Motor neurons do what? - CORRECT-ANSWERScarry impulses from the brain and spinal cord to muscles and glands (efferent) In skeletal muscles the end processes of neurons form what? - CORRECT- ANSWERSA complex neuromuscular junction What is a segmented layer of lipid material, that is an insulating substance, and is formed and maintained by the Schwann cell? - CORRECT- ANSWERSMyelin What is the delicate layer of connective tissue around each axon called? - CORRECT-ANSWERSEndoneurium This is a thin membrane between the myelin sheath and the endoneurium? - CORRECT-ANSWERSNeurolemma These are regular interruptions of the myelin sheath forming spaces on either side of the Schwann cell? - CORRECT-ANSWERSNodes of Ranvier The flow of ions between segments of myelin rather than along the entire length of the axon is called? - CORRECT-ANSWERSSaltatory conduction Saltatory conduction does what? - CORRECT-ANSWERSLeads to increased velocity What do conduction velocities depend on? - CORRECT-ANSWERSPresence of myelin coating, and diameter of the axon (I.E. larger axons transmit impulses at a faster rate) The neuroglial (glial) cells are sometimes called? - CORRECT-ANSWERSNerve glue What is the purpose of the neuroglial cells? - CORRECT-ANSWERSGive support, nurture, and protect neurons What are the types of neuroglial cells? - CORRECT-ANSWERSAstrocytes, oligodendroglia, Ependymal cells, and Microglia

What do astrocytes do? - CORRECT-ANSWERSform blood brain barrier, are the "Housekeepers" for neurons Where are astrocytes found? - CORRECT-ANSWERSFill the spaces between neurons and surround blood vessels in the CNS What are the oligodendroglia (oligodendrocytes)? - CORRECT-ANSWERSThe CNS counterpart of the Schwann cells that deposit myelin within the CNS What do ependymal cells do? - CORRECT-ANSWERSproduce CSF and line CSF filled cavities of the CNS (ventricles) What do microglia do? - CORRECT-ANSWERSRemove debris (phagocytosis) in the CNS What do Schwann cells do? - CORRECT-ANSWERSAlso called neurolemmocytes, these glial cells wrap around and cover axons in the PNS forming and maintaining the myelin sheath What is considered the CNS? - CORRECT-ANSWERSbrain and spinal cord What is the peripheral nervous system? - CORRECT-ANSWERSthe sensory and motor neurons that connect the central nervous system to the rest of the body The cranial nerves and the spinal nerves are considered part of which nervous system? - CORRECT-ANSWERSThe peripheral nervous system What project from the spinal cord and pass through intervertebral foramina in the skull? - CORRECT-ANSWERSThe cranial nerves What project from the spinal cord and pass through intervertebral foramina of the vertebrae? - CORRECT-ANSWERSThe spinal nerves What are the peripheral nerve pathways? - CORRECT-ANSWERSAfferent (ascending) and efferent (descending) pathways Organs that are innervated by specific components of the nervous system are called? - CORRECT-ANSWERSEffector organs The motor and sensory pathways regulating VOLUNTARY motor control of skeletal muscle (synapse directly on the skeletal muscle) are called? - CORRECT-ANSWERSThe somatic nervous system

The motor and sensory pathways regulating the body's internal environment (viscera) through INVOLUNTARY control of organ systems is called? - CORRECT-ANSWERSThe Autonomic nervous system (SNS and PNS) Where is the autonomic nervous system located? - CORRECT-ANSWERSCNS and PNS Preganglionic neurons are what? - CORRECT-ANSWERSMyelinated postganglionic neuron are what and where? - CORRECT- ANSWERSunmyelinated and terminate on the effector organ (postsynaptic/secondary neurons) Where are the preganglionic neurons of the sympathetic nervous system located? - CORRECT-ANSWERSthe CNS (brain stem or spinal cord) In the PNS where do the preganglionic (efferent) neurons synapse? - CORRECT-ANSWERSWith ganglionic neuron located in PNS What is the path of an autonomic motor neuron? - CORRECT-ANSWERSCNS via preganglionic (primary neuron)--> autonomic ganglion-->post ganglionic (secondary neuron)-->terminates at target organ Where does the SNS originate from? - CORRECT-ANSWERSThoracolumbar division Sympathetic nervous system (SNS) releases what from the secondary order neurons? - CORRECT-ANSWERSEpinephrine (vasodilation) and norepinephrine (vasoconstriction) What is released in both the SNS and PNS at the primary/ first order neurons? - CORRECT-ANSWERSAcetylcholine This results in an injury to preganglionic SYMPATHETIC trunk or postganglionic sympathetic neurons of superior cervical ganglion? - CORRECT-ANSWERSHorner's Syndrome What are clinical manifestations of Horner's syndrome? - CORRECT- ANSWERSIpsilateral pupil constriction, sunken ipsilateral eyeball, ptosis of affected eye, lack of perspiration of ipsilateral side of face When there is a lesion interrupting an SNS fiber what would be some clinical manifestations? - CORRECT-ANSWERSreddened skin, lack of sweating, constricted pupil, and no goosebumps

PNS is also known as ____________ - CORRECT-ANSWERSRest and repose response Where does the PNS originate? - CORRECT-ANSWERSCranial nerve nuclei and sacral region (craniosacral division) What is the difference between preganglionic neurons of the PNS vs SNS - CORRECT-ANSWERSPreganglionic neurons are myelinated and longer What are the PNS receptors? - CORRECT-ANSWERSMuscarinic receptors How many neurotransmitters are there? - CORRECT-ANSWERSMore than 46 What are the effects of neurotransmitters on postsynaptic neurons? - CORRECT-ANSWERSexcitatory or inhibatory excitatory postsynaptic potentials (EPSPs) do what? - CORRECT- ANSWERSCause depolarization and initiate an AP inhibitory postsynaptic potential (IPSP) - CORRECT-ANSWERStemporary hyperpolarization of a membrane What is the main neurotransmitter released by the sympathetic postganglionic fibers? - CORRECT-ANSWERSNorepinephrine What are the SNS neuroreceptors? - CORRECT-ANSWERSAlpha adrenergic and Beta adrenergic receptors What are the cholinergic receptors? - CORRECT-ANSWERSnicotinic and muscarinic Nicotinic receptors are involved mostly in what? - CORRECT-ANSWERSmuscle contraction at NMJ muscarinic receptors do what? - CORRECT-ANSWERSControl smooth muscle control The neurotransmitter released by preganglionic parasympathetic fibers is? - CORRECT-ANSWERSAcetylcholine When an axon is severed what typical sequence occurs? - CORRECT- ANSWERSWallerian degeneration What is Wallerian degeneration? - CORRECT-ANSWERSDegeneration of a nerve fiber that has been separated from its nutritive source by injury or disease

Regeneration of nerve fibers occurs in what type of nerve (myelinated or unmyelinated)? - CORRECT-ANSWERSLimited to myelinated axons only What occurs in a nerve injury to the axon DISTAL (below)to the cut? - CORRECT-ANSWERSaxon portion degenerates and disappears (breakdown occurs in antegrade fashion) What occurs in an injury to a nerve that is PROXIMAL(Above) to the injury? - CORRECT-ANSWERSSimilar changes occur but only back as far as the next node of Ranvier, new terminal sprouts from proximal segment within 7- days What results when neurons generate and conduct electrical and chemical impulses by selectively changing the electrical portion of their plasma membranes and influencing other nearby neurons by the release of neurotransmitters? - CORRECT-ANSWERSNerve impulse What occurs when there is an increase in resting membrane potential making it more negative? - CORRECT-ANSWERShyperpolarization What occurs when there is a decrease in membrane potential making it more positive? - CORRECT-ANSWERSDepolarization Presynaptic (toward) neurons occur where and do what? - CORRECT- ANSWERSbefore/proximal to the synapse, and relay impulses TOWARD the synapse Postsynaptic neurons occur where and do what? - CORRECT-ANSWERSafter/distal to the synapse, and relay impulses AWAY from the synapse neuromuscular junction (NMJ) can also be called the? - CORRECT- ANSWERSMotor end plate If a neuron is deprived of what rapid changes in metabolism, transmitter receptor production, and even morphology of the postsynaptic cell can occur? - CORRECT-ANSWERSDeprived of synaptic contacts as a result of injury or disease What is the forebrain composed of? - CORRECT-ANSWERS2 cerebral hemispheres What is the midbrain composed of? - CORRECT-ANSWERSCorpora quadrigemina, tegmentum, and cerebral peduncles

What is the hindbrain composed of? - CORRECT-ANSWERSmedulla, pons, cerebellum What is the brainstem composed of? - CORRECT-ANSWERSmidbrain, pons, medulla oblongata What is the network of connected nuclei that regulate vital reflexes, such as cardiovascular and respiratory function? - CORRECT-ANSWERSReticular formation The reticular formation together with the cerebral cortex is referred to as the what? - CORRECT-ANSWERSReticular activating system (RAS) What does the reticular activating system do? - CORRECT- ANSWERSMaintains wakefullness What is the largest portion of the brain, made up of the cerebral cortex, basal ganglia, and includes the Gyri, sulci and fissures? - CORRECT- ANSWERSTHe cerebrum What includes the cell bodies and dendrites of neurons in the cerebral cortex? AKA the meat - CORRECT-ANSWERSGray matter (nuclei) What lies beneath the cerebral cortex and is composed of MYELINATED nerve fibers or the communication tracts? - CORRECT-ANSWERSWhite matter (numerous tracts) what do gyri and sulci do? - CORRECT-ANSWERSincrease surface area of each hemisphere What are located in the frontal lobe? - CORRECT-ANSWERSPrefrontal, premotor, primary motor area, and Broca speech area. What is the frontal lobe responsible for? - CORRECT-ANSWERSbehavior and voluntary motor control The prefrontal area is important for what? - CORRECT-ANSWERSGoal- oriented behavior, and ST or recall memory The premotor area does what? - CORRECT-ANSWERSPrograms motor movements (basal ganglia) The primary motor area is responsible for what? - CORRECT- ANSWERSPrimary voluntary motor area (homunculus, corticospinal tracts and contralateral control)

The Broca speech area is responsible for what? - CORRECT-ANSWERSMotor aspect of speech parietal lobe is responsible for - CORRECT-ANSWERSsensory information (somatic sensory input) The occipital lobe is responsible for - CORRECT-ANSWERSvisual processing/ visual cortex The temporal lobe is responsible for - CORRECT-ANSWERShearing. long term memory, and Wernicke area What does Wernicke's area do? - CORRECT-ANSWERScomprehension of speech A practitioner knows that the premotor area is: - CORRECT- ANSWERSinvolved in programming motor movements This is also called the commissural fibers, and connects the two cerebral hemispheres? - CORRECT-ANSWERSThe corpus callosum This area is responsible for primitive behavioral responses, expression of affect, and consolidation of memory? - CORRECT-ANSWERSThe limbic system This area of the brain processes incoming sensory data and is made up of 4 division: the epithalamus, thalamus, hypothalamus, and subthalamus? - CORRECT-ANSWERSThe diencephalon This area of the brain is the relay center for motor and sensory tracts, center for auditory and visual reflexes, and contains the cerebral aqueduct? - CORRECT-ANSWERSThe midbrain substania nigra - CORRECT-ANSWERSmidbrain structure where dopamine is produced; involved in control of movement The red nucleus is found where and responsible for what>? - CORRECT- ANSWERSThe midbrain and motor output This part of the brain maintains balance and posture? - CORRECT- ANSWERSThe cerebellum Damage to the cerebellum is characterized by: - CORRECT- ANSWERSIpsilateral(same side) loss of equilibrium, balance and motor coordination

The Pons is responsible for what? - CORRECT-ANSWERSControl of respiration, and contains CN V-VIII The medulla oblongata is responsible for what? - CORRECT- ANSWERSControls reflex activities (HR, RR, BP, cough, sneeze, swallow, and vomit), and contains the nuclei of CN IX-XII What lies within the vertebral canal and is protected by the vertebral column? - CORRECT-ANSWERSThe spinal cord The spinal cord connects what? - CORRECT-ANSWERSThe brain and body The spinal cord conducts what? - CORRECT-ANSWERSsomatic and autonomic reflexes What does the spinal cord provide? - CORRECT-ANSWERSMotor pattern control centers What modulates sensory and motor function? - CORRECT-ANSWERSThe spinal cord What is the end of the spinal cord called? - CORRECT-ANSWERSconus medullaris (L1 typically) What is the nerve bundle at the end of the spinal cord called? - CORRECT- ANSWERSCauda Equina What are the gray matter horns composed of? - CORRECT- ANSWERSPosterior/dorsal horn, lateral horn, and the anterior/ventral horn What is the posterior/ dorsal horn composed of? - CORRECT- ANSWERSPrimarily of sensory neurons (interneurons and axons) What does the lateral horn contain? - CORRECT-ANSWERSCell bodies involved with the ANS (involuntary control) What is the anterior/ventral horn composed of? - CORRECT-ANSWERSCell bodies for EFFERENT pathways leaving the spinal cord by way of spinal nerves (MOTOR) What make up the spinal tracks in the spinal cord? - CORRECT- ANSWERSWhite matter Some Afferent tracts are - CORRECT-ANSWERSsensory, and carry impulses to CNS and away from organs/receptors

Some efferent tracts - CORRECT-ANSWERSmotor, and carry impulses away from CNS to the organs Which sensory pathway/tract deals with pain and temperature? - CORRECT- ANSWERSThe spinothalamic tract What are the 3 major sensory pathways? - CORRECT-ANSWERS1. spinothalamic tract

2. Proprioception (Posterior column)
3. Anterior spinothalamic tract The proprioception pathway does what? - CORRECT-ANSWERSTells you where you are in space, vibratory sense, fine touch in posterior column. When does proprioception path crossover? - CORRECT-ANSWERSStays on the same side of the spinal cord until it reaches the brainstem What is the anterior spinothalamic tract responsible for? - CORRECT- ANSWERSVague light touch The spinothalamic tract responsible for pain and temperature change sides when? - CORRECT-ANSWERSAlmost immediately crosses over the cord (on the opposite side of where it entered) SO if there is a lesion of the spinothalamic tract (pain/temp) there will be what kind of loos? - CORRECT-ANSWERSLoss of pain-temperature contralaterally (opposite side) below the level of the lesion. If there is a lesion in the POSTERIOR column (proprioception) what type of loss will there be? - CORRECT-ANSWERSThere is an ipsilateral (same side) loss or decrease in stereogenesis and vibratory sense Where is the motor pathway for Upper motor neurons located? - CORRECT- ANSWERSContained within the CNS (efferent) What does disruption of UMNs result in? - CORRECT-ANSWERSInitial paralysis followed by partial recovery Lower motor neurons do what? - CORRECT-ANSWERSHave direct influence on muscles What occurs if there is disruption/destruction of the lower motor neurons? - CORRECT-ANSWERSLeads to permanent paralysis What type of neurons are afferent? - CORRECT-ANSWERSsensory neurons

What type of neurons are efferent? - CORRECT-ANSWERSmotor neurons What are the mandatory structures required for a reflex arc? - CORRECT- ANSWERSReceptor, afferent neuron, efferent neuron, and effector (muscle/gland) The neurons of the PNS are the what? - CORRECT-ANSWERSLower motor neurons How many pairs of spinal nerves are there? - CORRECT-ANSWERS31 pairs How many pairs of cranial nerves are there? - CORRECT-ANSWERS12 pairs What is a plexus? - CORRECT-ANSWERSnetwork of nerves, where they all come together before entering the spinal cord What are specific areas of cutaneous (skin) innervation at specific spinal cord segments called? - CORRECT-ANSWERSDermatomes What are cranial nerves? - CORRECT-ANSWERS1. Olfactory (S): smell

2. Optic (S): vision
3. Oculomotor (M): pupil reaction, EOM
4. Trochlear (M): EOM-superior oblique muscles (rotates laterally and intorts the eye)
5. Trigeminal (M,S): mastication & face sensation
6. Abducens (M): EOM-lateral rectus-abducts the eye
7. Facial (M,S): facial expression, and taste on anterior tongue
8. Vestibulocochlear (S): hearing
9. Glossopharyngeal (M, S): motor fibers serve pharynx and salivary glands; tastes from posterior of tongue
10. Vagus (M,S): motor and sensory for pharynx, parasympathetic motor fiber (supply smooth muscle of ABD organs)
11. Spinal accessory (M): sensory and motor fibers of sternocleidomastoid and trapezius muscles and muscles of soft palate, pharynx, and larynx
12. Hypoglossal (M): tongue muscles and sensory impulse from tongue What is the structure that encloses and protects the brain and its associated structures? - CORRECT-ANSWERSThe cranium How many bones is the cranium composed of? - CORRECT-ANSWERS8 bones What are the 3 meningeal layers? - CORRECT-ANSWERSdura mater (outer most), arachnoid, pia mater (inner most) What is the protective membranes surrounding the brain and spinal cord called? - CORRECT-ANSWERSMeninges

This space is between the dura and arachnoid space and contains venous supply? - CORRECT-ANSWERSThe subdural space The space is located between the arachnoid and pia mater, and contains CSF? - CORRECT-ANSWERSThe subarachnoid space This space is between the dura and the skull, and has the arterial supply for the meninges? - CORRECT-ANSWERSThe epidural space Which information is most accurate regarding the subarachnoid space? - CORRECT-ANSWERSIt contains CSF What is the purpose of CSF? - CORRECT-ANSWERScushions brain, carries nutrients, carries away wastes, provide proper environment for neurons of the brain (pH 7.3) What is the purpose of the intervertebral disks? - CORRECT-ANSWERSshock absorption, separate vertebrae to allow nerves to pass How many vertebrae are there? - CORRECT-ANSWERS33 vertebrae ( cervical, 12 Thoracic, 5 lumbar, 5 fused sacral, and 4 fused coccygeal) What is the primary regulator for the CNS blood flow? - CORRECT- ANSWERSCO What is the main blood supply to the brain? - CORRECT-ANSWERSCircle of Willis (arterial circle) What are the major branches of the circle of Willis? - CORRECT- ANSWERSanterior, middle, and posterior cerebral arteries What are the functions of the blood brain barrier? - CORRECT-ANSWERS1. Protect brain from foreign substances in blood that may injure it

2. Protect brain from hormones and NTs secreted by other organs
3. Maintain constant biochemical environment What can cause increased permeability or break down of the BBB? - CORRECT-ANSWERSHTN, dilutional hyponatremia, high doses of some anesthetics, vasodilation, and hypercapnia Where does the spinal cord receive its blood from? - CORRECT- ANSWERSVertebral arteries that arise from the aorta What occurs with aging of the nervous system? - CORRECT-ANSWERS1. Decreased number of neurons

2. decreased brain weight and size
3. Fibrosis and thickening of meninges
4. narrowed gyri and widened sulci
5. increased ventricles What are the principal cellular changes in aging and the nervous system? - CORRECT-ANSWERS1. Dendrite structure
6. Lipofuscin (fatty) deposition
7. Presence of neurofibrillary tangles
8. Senile plaques (areas of nerve degeneration)
9. Lewy bodies What is the state of being awake that is mediated by the reticular-activating system know as? - CORRECT-ANSWERSArousal What are the two components of counciousness? - CORRECT- ANSWERSarousal and awareness What is a coma produced by? - CORRECT-ANSWERSBilateral hemisphere damage/suppression, or brain stem lesions or metabolic derangement that damages/suppresses the reticular activating system This is loss of ability to think rapidly and clearly; impaired judgment and decision making? - CORRECT-ANSWERSConfusion This is beginning loss of consciousness; disorientation to time, followed by disorientation to place and impaired memory; recognition of self is lost? - CORRECT-ANSWERSDisorientation This is limited spontaneous movement or speech; easy arousal with normal speech or touch; may not be oriented to time, place, or person? - CORRECT- ANSWERSLethargy This is mild to moderate reduction in arousal (awakeness) with limited response to the environment; falls asleep unless verbally or tactilely stimulated; answers questions with minimum responses - CORRECT- ANSWERSObtundation This is a condition of deep sleep or unresponsiveness; person may be aroused or caused to open eyes only by vigorous and repeated stimulation; response is often withdrawal or grabbing at stimulus? - CORRECT- ANSWERSStupor This is when there is no verbal response to the external environment or to any stimuli; noxious stimuli such as deep pain or suctioning yields motor movement? - CORRECT-ANSWERSComa

What is a light coma? - CORRECT-ANSWERSAssociated with purposeful movement on stimulation What is a deep coma? - CORRECT-ANSWERSAssociated with unresponsiveness or no response to any stimulus What is one of the most critical indicators of how the nervous system and how it is functioning? - CORRECT-ANSWERSLevel of Conciousness The pattern of breathing helps to evaluate what? - CORRECT-ANSWERSThe level of brain dysfunction and level of coma Pupillary changes reflect what? - CORRECT-ANSWERSChanges in level of brainstem function, drug action, and response to hypoxia and ischemia Oculomotor responses help determine what? - CORRECT-ANSWERSLevel of brain dysfunction (Ex. dolls eyes) A + dolls eyes reflex indicates what? - CORRECT-ANSWERSIntact brainstem negative dolls eye reflex indicates what? - CORRECT-ANSWERSBrainstem is not intact vomiting without nausea indicates the direct involvement of__________ - CORRECT-ANSWERSthe central neural mechanism (or pyloric obstruction) A person is diagnosed with an alteration in arousal. Which clinical manifestation is typical of the diagnosis? - CORRECT-ANSWERSVomiting w/o nausea What are the 6 types of dysphasia? - CORRECT-ANSWERS1. Wernicke

2. Conductive
3. Anomic
4. Transcortical
5. Broca aphasia
6. Global aphasia Wernicke's dysphasia - CORRECT-ANSWERSreceptive dysphasia; can't decipher words Conductive dysphasia - CORRECT-ANSWERSDisruption of temporal lobe fibers with a failure to repeat words but an ability to initiate speech, writing, and reading aloud

anomic dysphasia - CORRECT-ANSWERSinability to name objects, people, or qualities transcortical dysphasia - CORRECT-ANSWERSability to repeat and recite Broca's aphasia - CORRECT-ANSWERSinability to produce speech, but with retention of comprehension global aphasia - CORRECT-ANSWERSWhen both production and understanding of language is damaged (expressive/broca and receptive/Wernicke) What are transient disorders of awareness that result from cerebral dysfunction? - CORRECT-ANSWERSAcute confusional states (ACS) Clinical manifestations os acute confusional states include: - CORRECT- ANSWERSAbrupt onset, and demonstrate irrelevant or inappropriate responses Delirium is also know as? - CORRECT-ANSWERSHyperkinetic confusional state What is associated with right middle temporal gyrus or left-temporal occipital junction disruption? - CORRECT-ANSWERSDelirium Delirium develops over and resolves in - CORRECT-ANSWERS2-3 days What are the clinical manifestations of delirium? - CORRECT-ANSWERSearly s/s are difficulty in concentrating, restlessness, irritability, insomnia, tremulousness, and poor appetite T or F: Dementia is more progressive than delirium? - CORRECT- ANSWERSTrue, is more progressive What is the progressive failure of many cerebral functions known as? - CORRECT-ANSWERSDementia What is the onset of dementia? - CORRECT-ANSWERSSlowly and gradual, over months What is the onset of delirium? - CORRECT-ANSWERSabrupt, rapid Progressive dementia produce what? - CORRECT-ANSWERSNerve cell degeneration and brain atrophy

What is occurring in delirium? - CORRECT-ANSWERSAutonomic nervous system is overactive What is common in critical care units, postsurgically, or during withdrawal from CNS depressants (e.g. alcohol, narcotics, and after physiologic stress)? - CORRECT-ANSWERSDelirium What is the greatest risk factor for dementia? - CORRECT-ANSWERSage What is most commonly lost in dementia? - CORRECT-ANSWERSMemory What is the leading cause of dementia? - CORRECT-ANSWERSAlzheimer's disease What are the types of Alzheimer's disease? - CORRECT-ANSWERSFamilial (early/late onset) and nonhereditary (sporadic/late onset) Familial Alzheimer's Disease is - CORRECT-ANSWERSautosomal dominant linked to 3 gene defects (chr. 21, 14, and 1) What limit blood flow in Alzheimer's disease? - CORRECT-ANSWERSAmyloid deposits What are the 3 things seen in Alzheimer's disease? - CORRECT-ANSWERS1. Degeneration of the basal forebrain

2. Neurofibrillary tangles
3. Senile plaques Where do the neurofibrillary tangles and senile plaques typically occur? - CORRECT-ANSWERSAre more concentrated in the cerebral cortex and hippocampus The greater number of senile plaques and neurofibrillary tangles lead to what? - CORRECT-ANSWERSMore dysfunction associated with Alzheimer's disease When is a definitive diagnosis of Alzheimer's disease made? - CORRECT- ANSWERSOn postmortem exam What are the clinical manifestations of Alzheimer's disease? - CORRECT- ANSWERSforgetfulness, emotional upset, disorientation, confusion, lack of concentration, decline in abstraction, problem solving, and judgment Mutations for encoding amyloid precursor protein (amyloid deposits limit blood flow), alteration in apolipoprotein E, and loss of neurotransmitter

stimulation of choline acetyltransferase are all what? - CORRECT- ANSWERSTheories for cause of Alzheimer's disease What is a sudden, transient alteration of the brain function caused by an abrupt explosive, disorderly discharge of cerebral neurons know as? - CORRECT-ANSWERSA seizure This is a recurrence of seizures and a disorder for which NO cause can be found (a chronic disorder)? - CORRECT-ANSWERSEpilepsy This is a tonic-clonic (jerky, contract-relax) movements associated with some seizures? - CORRECT-ANSWERSConvulsion What are some causes of seizure disorders? - CORRECT-ANSWERS1. Epilepsy, metabolic disorders, infection, or fever

2. Acute alcohol withdrawal, brain trauma, congenital defects
3. Electrolyte disturbances, brain tumor, or vascular problems What occurs when neurons BILATERALLY misfire? - CORRECT- ANSWERSGeneralized seizure (whole brain) A partial (focal) seizure occurs? - CORRECT-ANSWERSIn neurons UNILATERALLY, and begin in a specific region of cortex What occurs in a SIMPLE partial seizure? - CORRECT-ANSWERSConciousness is maintained What occurs in COMPLEX partial seizure? - CORRECT-ANSWERSLoss of consciousness What is meant by a secondary generalization seizure? - CORRECT- ANSWERSPartial becomes generalized This is a medical emergency, and is a state of continuous seizures lasting more than 5 minutes, or second seizure is experienced before the person has fully regained consciousness from the preceding seizure, or a single seizure lasting longer than 30 min? - CORRECT-ANSWERSStatus epilepticus Seizures are initiated by: - CORRECT-ANSWERShypersynchronization and bursts of action potentials What follows the seizure? - CORRECT-ANSWERSPostictal state What is the sequence of a seizure? - CORRECT-ANSWERSResting potential instability leads to seizure initiation

What is responsible for initiating seizures? - CORRECT-ANSWERS1. Bursts of action potentials (produced by long-lasting depolarizations d/t influx of extracellular Ca++ that opens voltage-dependent Na+ channels

2. Hypersynchronization (discharge spreads through brain and then to brain stem) A practitioner knows the onset of an acute confusional state is: - CORRECT- ANSWERSSudden This is thought to be causes by abnormalities in brain wiring, imbalance in the brain's NTs, and development of abnormal nerve connections after injury

• CORRECT-ANSWERSEpilepsy The tonic phase of a seizure is what? - CORRECT-ANSWERSThe contraction phase The clonic phase of a seizure is what? - CORRECT-ANSWERSThe relaxation phase This is experienced in partial seizures as a peculiar sensation preceding the onset of a generalized seizure or complex partial seizure that may take the form of gustatory, visual, or auditory experience? - CORRECT-ANSWERSAn aura This period can have early clinical manifestations, such as malaise, h/a, or a sense of depression, that may occur hours to a few days before onset of a seizure? - CORRECT-ANSWERSProdromal period What are the 3 types of Cerebral edema? - CORRECT-ANSWERSvasogenic, cytotoxic, interstitial What type of cerebral edema caused by increased permeability of the capillary endothelium of the brain after injury to the vasculature structure? - CORRECT-ANSWERSVasogenic (most clinically important) Cytotoxic Cerebral Edema develops from: - CORRECT-ANSWERSMetabolic that results from toxic factors directly affecting the cellular elements of the brain parenchyma causing failure of the active transport. The cells swell by loss of K+ and gain of Na+ with water following Na+. vasogenic cerebral edema results in - CORRECT-ANSWERSdisruption of blood brain barrier Cytogenic cerebral edema does or does not disrupt the BBB? - CORRECT- ANSWERSIt does NOT disrupt the blood brain barrier

Interstitial cerebral edema is seen most commonly when? - CORRECT- ANSWERSWith non-communication hydrocephalus What is Interstitial cerebral edema caused by? - CORRECT- ANSWERSTransependymal movement of CSF from the ventricles into the extracellular spaces of brain tissues What is hydrocephalus caused by? - CORRECT-ANSWERSinterference in CSF flow (too much CSF): decreased reabsorption, increased fluid production, and obstruction w/in the ventricular system What is Cushing's triad? - CORRECT-ANSWERShypertension bradycardia irregular respirations Communicating (extraventricular) hydrocephalus results from - CORRECT- ANSWERSimpaired absorption (CSF can flow through ventricles), no obstruction What are the most common causes of Communicating (extraventricular) hydrocephalus? - CORRECT-ANSWERSSubarachnoid hemorrhage, developmental malformation, head injury, and neoplasm Which type of hydrocephalus occurs mostly in middle aged (50-60s) adults? - CORRECT-ANSWERSNormal-pressure hydrocephalus What is the triad of normal pressure hydrocephalus? - CORRECT- ANSWERSmemory decline, gait disturbances, and incontinence This type of hydrocephalus is the result of an obstruction that impairs communication? - CORRECT-ANSWERSNoncommunicating hydrocephalus What is the most common cause of noncommunicating hydrocephalus? - CORRECT-ANSWERSNarrowing of the aqueduct of Sylvius "aqueductal stenosis" between 3rd and 4th ventricles This type of hydrocephalus develops quickly, w/in several hours, and presents with rapid increase in ICP and rapid deterioration? - CORRECT- ANSWERSAcute hydrocephalus paresis means - CORRECT-ANSWERSweakness Paralysis means - CORRECT-ANSWERSloss of motor function

What are the 2 subgroups of alterations of movement? - CORRECT- ANSWERSUpper motor neuron syndromes, and lower motor neuron syndromes (peripheral nerves) Upper motor neuron (within the CNS) syndromes are known as: - CORRECT- ANSWERSSpastic paresis or paralysis What is usually associated with upper motor neuron syndromes? - CORRECT- ANSWERSUsually associated with hyperreflexia What occurs when there is complete cessation of spinal cord functions below the lesion? - CORRECT-ANSWERSSpinal shock During the morning report, a nurse is assigned care for a person who is AREFLEXIC. The nurse understands this means the person has: - CORRECT- ANSWERSNo tendon reflexes Dysfunction of the lower motor neurons results in: - CORRECT- ANSWERSimpaired voluntary and involuntary movement What is the degree of paralysis or paresis proportional to? - CORRECT- ANSWERSThe number of LMNs affected What type of muscle tone is expected in people with lower motor neuron dysfunctions? - CORRECT-ANSWERSFlaccid paresis or flaccid paralysis, and muscle has reduced or absent tone What is usually associated with lower motor neuron dysfunction? - CORRECT- ANSWERSHyporeflexia or areflexia upper motor neurons = - CORRECT-ANSWERSspastic/hyperreflexia lower motor neurons= - CORRECT-ANSWERSflaccid/hyporeflexia or areflexia What type of motor neuron dysfunction is associated with fasciculations (quivering or rippling of muscles under the skin that can be seen) and fibrillation (isolated contraction of single muscle fiber that is not visible to eyes but on EMG)? - CORRECT-ANSWERSLower motor neuron dysfunction What is involuntary movement of the face, trunk, and extremities that occurs as a side effect of prolonged first and second gen antipsychotics? - CORRECT-ANSWERSTardive dyskinesia (hyperkinesia) This is an autosomal dominant hereditary degenerative disorder and has a short arm chromosome 4? - CORRECT-ANSWERSHuntington disease (chorea)

What is Huntington's disease? - CORRECT-ANSWERSSevere degeneration of basal ganglia and frontal cerebral atrophy-depletion of GABA. excess dopaminergic activity, and loss of glutamate What are the classic manifestations of Huntington's disease? - CORRECT- ANSWERSabnormal movements and progressive dysfunction of intellectual processes (dementia) and thought processes which marks onset of disease What is the most common type of abnormal movement? - CORRECT- ANSWERSChorea What type of neurotransmitter is GABA? - CORRECT-ANSWERSinhibitory neurotransmitter What occurs in Parkinson's disease? - CORRECT-ANSWERSSevere degeneration of the basal ganglia (corpus striatum) involving the dopaminergic nigrostriatal pathway (dopamine secreting) Hallmark pathologic features of Parkinson Disease are: - CORRECT- ANSWERSloss of dopaminergic pigmented neurons in the SUBSTANTIA NIGRA with dopaminergic deficiency in the putamen portion of the striatum What type of spasticity is seen in Parkinson's disease? - CORRECT- ANSWERSCogwheeling In Parkinson's disease, degeneration of the dopaminergic pathway to the basal ganglia causes an underactivity of __________________ and over activity of _________________. - CORRECT-ANSWERSthe direct motor pathway (normally facilitates movement); the indirect motor loop (normally inhibits movement) How do symptoms in Parkinson's occur? - CORRECT-ANSWERSOnset of symptoms is insidious What are the classic motor manifestations of Parkinson's disease? - CORRECT-ANSWERSBradykinesia, tremor at rest, muscle rigidity (cogwheel), hypoakinesia, slow steady shuffling gait, and stopped posture. What are the nonmotor manifestations of Parkinson's disease? - CORRECT- ANSWERSHyponosmia, fatigue, pain, autonomic dysfunction, sleep fragmentation, depression, and dementia w or w/o psychosis What are the types of disorders with posture? - CORRECT-ANSWERSDystonia, decorticate posture, and decerebrate posture

This occurs due to maintenance of an abnormal posture through muscular contractions - CORRECT-ANSWERSDystonia When do dystonic postures occur? - CORRECT-ANSWERSWhen contractions last for longer periods (torticollis) This type of posturing is characterized by upper extremities FLEXED at the elbows and held close to the body and lower extremities that are externally rotated and extended? - CORRECT-ANSWERSDecorticate posturing What does decorticate posturing indicate? - CORRECT-ANSWERSWhen brainstem is not inhibited by the motor function of the cerebral cortex This type of posturing is characterized by increased tone in the extensor muscles and trunk muscles, with active tonic neck reflexes; all four limbs are rigidly extended with head in neutral position - CORRECT- ANSWERSDecerebrate posturing This type of posturing is caused by severe injury to the brain and brainstem; resulting in overstimulation of postural righting and vestibular reflexes - CORRECT-ANSWERSDecerebrate posturing What is the term used when brain has NO potential for recovery and can no longer maintain body's internal homeostasis? - CORRECT-ANSWERSBrain death Brain death criteria - CORRECT-ANSWERS-Completion of all appropriate and therapeutic procedures. -Unresponsive coma (absence of motor and reflex responses). -No spontaneous respirations (apnea). -No ocular responses. -No brainstem functions -Isoelectric EEG. -Persistence 6 to 12 hours after onset. What is the term for death of the cerebral hemispheres is exclusive of the brainstem and cerebellum (intact); brainstem may continue to maintain internal homeostasis (normal respiratory and CV functions, temp control, and GI function)? - CORRECT-ANSWERSCerebral death In brain death, state laws require: - CORRECT-ANSWERS-entire brain, brainstem, and cerebellum stop functioning -brain is autolyzing or has already autolyzed on postmortem exam What type of brain trauma is the dura intact? - CORRECT-ANSWERSBlunt trauma