Neuro I Quiz 1 Flashcards
(134 cards)
1
Q
whats the highest cranial cavity content?
A
blood and CSF (each 10%)
2
Q
vegetative state
brain death
have some self-awareness
A
vegetative: damage to gray and white matter
brain death: no brainstem reflex and motor response, apnea
self-awareness: minimally conscious state
3
Q
hypoxia vs ischemia
A
deficient delivery of O2 to the tissue
lack of oxygen/removal of waste within a tissue
4
Q
global ischemia can lead to
A
watershed infarct and reperfusion injury
5
Q
how do electrolyte imbalances lead to cerebral edema?
A
K, Na, Ca
accumulation or depletion of neurotransmitters
calcium cascade –> protein breakdown, DNA injury, free radical formation, lipid peroxidation, mitochondrial injury –> cell death
6
Q
What does monroe-kellie hypothesis say?
A
content compartments compensate to maintain homeostasis (BAD)
7
Q
min CPP and profound ischemia CPP
A
45mmHg, <40mmHg
8
Q
CPP is the pressure gradient between
A
internal carotid artery and subarachnoid veins
pressure required to perfuse the brain
9
Q
CPP=
A
MAP-ICP
10
Q
brain herniation happens when
A
ICP is too HIGH
11
Q
cushing triad
A
hypertension, wide pulse pressure, bradycardia
12
Q
two types of cerebral edema
A
vasogenic and cytotoxic
13
Q
vasogenic vs cytotoxic
A
BBB dysfunction (infection, hemorrhage, brain injury, tumor, prolonged ischemia) 外 intracellular fluid overload (electrolyte imbalance) 內
14
Q
4 treatment to preserve brain function
A
- cause
- ICP/cerebral edema
- maintain vital sign
- preserve function
15
Q
what is concussion
A
traumatic biomechanical forces
16
Q
s&s of concussion
A
headache, amnesia, confusion, heightened sensitivities, nausea, irritability, insomnia, poor concentration
17
Q
how to treat concussion
A
low stimulation, prevent more impact, slow return to normal activities
18
Q
what is post-concussion syndrome
A
when symptoms persist more than 3 months
19
Q
encephalomyelitis
A
brain and spinal cord
20
Q
myelitis
A
myelitis spinal cord
21
Q
encephalitis
A
brain parenchyma
22
Q
meningitis
A
meninges (pia matter, arachnoid, subarachnoid space)
23
Q
what does the CSF present
A
subarachnoid space
24
Q
common types of meningitis
A
bacterial and viral
25
Which pathogen causes the highest mortality in meningitis
Streptococcus pneumoniae
26
pathology of meningitis
severe inflammation --> BBB compromised 威脅 --> capillary leaking --> cerebral edema --> vascular congestion --> cellular death
meningeal thickening --> meningeal adhesions --> vascular congestion and decreased CSF outflow (hydrocephalus)
27
S&S of meningitis
Brudzinski sign (flexion of neck lead to flexion of hip and knee), petechial rash, stiff neck, headache, fever, N&V
28
treatment of meningitis
immediate broad-spectrum antibiotics & potent anti inflammatories
29
names of antibiotics for meningitis?
cephalosporins, penicillins, vancomycin
30
another drug for meningitis?
glucocorticosteroids (dexamethasone)
31
how is a brain tumor different from other cancers?
less rate of primary brain tumor metastasize
32
how is a brain tumor and seizure diagnosed?
MRI, EEG
33
treatment for brain tumors
surgery, radiation, chemotherapy
34
how does temozolomide work as chemotherapy?
alkylating agents that add alkyl group to DNA to damage
35
s/e of temozolomide
hair loss, GI upset, bone marrow suppression, low blood cell counts
36
"spontaneous, abnormally synchronous electrical discharges from neurons in the cerebral cortex" is _______.
seizures
37
two classifications of seizures and treatment type
1. idiopathic (genetic, unknown) --> long-term antiepileptic meds
2. symptomatic (brain injury) --> short-term antiepileptic meds
38
three classes of seizures
1. Focal- one hemisphere
2. generalized- both hemispheres (e.g. absence seizures, tonic-clonic seizures)
3. unknown- don't fit in either (e.g. febrile seizures)
39
S&S of seizures
loss of consciousness
aura
automatisms
40
seizures are localized to ______ region of the brain OR can span both ______
one region, both hemispheres
41
seizures may ______ to other seizures
progress
42
what life-threatening symptoms can seizures lead to?
1. constriction of muscles including the airway
2. impairs respiratory rate/depth
3. injury
4. severe VS changes (tachycardia, hypertension, reflex hypotension, hyperventilation)
43
treatment for seizures (aka. sedative hypnotic/CNS depressant drug)
benzodiazepines
barbiturates
anticonvulsants
44
benzodiazepines and barbituates increase effects of ____?
GABA
45
benzodiazepines and barbituates act as a ________agonist.
chloride channel
46
what is the kinetics for benzodiazepines?
hepatic metabolism, renal excretion, crosses placenta/breastmilk
47
benzodiazepines cannot be taken in which population
pregnant women
48
side effect of benzodiazepines and barbituates
respiratory depression (dose-dependent), drug to drug interactions, altered LOC & CNS activity (amnesia)
49
how to treat benzodiazepines overdose?
receptor antagonist Flumazenil
50
suffix for benzodiazepines?
-am
51
flunitrazepam is known as _____.
roofies
52
how is barbituates differ from benzodiazepines
more potent, narrow TI, more addictive and high degree of tolerance
53
how to treat barbituates overdose?
activated charcoal, sodium bicarbonate (urine alkalinization)
54
suffix for barbituates
-barbital
55
how much secobarbital is used for euthanasia
9 grams, PO
56
diazepam is combined with ____ and ____ agents for euthanasia
paralytic and anesthesia agents
57
anticonvulsant is _______ and _____ specific
calcium and sodium
58
anticonvulsant pathophysiology?
alter electrolyte movement
59
sides effect of anticonvulsants
arrhythmias, drug to drug interactions, bleeding (vitamin K interference), toxicity (Dilantin has narrow TI)
60
vitamin k is essential for
clotting
61
how does the ketogenic diet used in seizure control?
elimination of carbohydrates --> altered metabolic state changes neuronal function --> decrease in neural activity
62
status epilepticus occurs when
seizure type progresses to an unstoppable state (life-threatening)
63
treatment for status epilepticus
benzodiazepines IV (diazepam and lorazepam)
64
sleep is a state of _____
diminished consciousness (unconsciousness)
65
sleep is a period of ____ and ____
inactivity and restoration (cellular growth, repair)
66
what anatomical structures are involved during sleep
reticular formation, thalamus, cerebral cortex, hypothalamic suprachiasmatic nucleus, pineal gland
--> how each involves in sensory pathways
67
what is the hypothalamic suprachiasmatic nucleus responsible for?
circadian rhythm
68
melatonin is synthesized in and secreted by
pineal gland; pinealocytes
69
what is the precursor of melatonin
tryptophan
70
whats the relationship between SCN and melatonin
a feedback loop (night -->higher melatonin)
71
tryptophan is synthesized into and then converted to
serotonin and then melatonin
72
what happens when melatonin is in excess?
drowsiness, sleepiness, lethargy, depression
73
sleep onset steps
circadian rhythm input --> decreased RAS --> decreased cortical stimulation --> decreased excitory neurotransmitter activity & increased inhibitory neurotransmitter & increased melatonin synthesis
74
what neurotransmitter is increased and decreased during sleep?
increase: serotonin
decrease: norepinephrine and acetylcholine
75
what are the sleep stages?
nonREM 1-4 (light to deep)
REM (muscle paralysis, altered VS, decreased BMR & cerebral blood flow, dreaming)
76
what stage does nightmare and night terror occur
nightmare: REM
| night terror: non REM
77
insomnia is a type of
sleep disorder
78
definition of insomnia
difficulty with sleep initiation, quality, and duration, ability to resume sleep
79
sign and symptoms of insomnia
alternation in quality of ADLs (fatigue, decreased memory, GI upset, irritability)
80
what is the affected demographic for insomnia
elderly, post-menopausal, other illnesses, stimulant use (caffeine, nicotine, ETOH), drug side effects (glucocorticoids)
81
diagnosis for insomnia
sleep study (polysomnography), EEG, Vital sign, oximetry
82
treatment for insomnia
melatonin: feedback loop
benzodiazepines: -am meds
non-benzodiazepines: Buspirone
antihistamines; antidepressants: diphenhydramine
83
how does buspirone work to treat insomnia
serotonin agonist + dopamine 2 presynaptic binding (decreases post-synaptic dopamine)
84
CNS drugs withdrawal symptoms
fever, psychosis, agitation, anxiety, panic, seizures, disorientation, impaired memory and focus, VS changes, blurred vision, loss of appetite
85
avoid ____ when taking CNS drugs
ETOH
86
obstructive sleep apnea is a type of
sleep disorder
87
pathology of obstructive sleep apnea
the collapse of the upper airway --> pharyngeal wall collapse --> vocal cord approximation --> tongue obstruction of the oropharynx
88
where in the airway is collapsed in patients with obstructive sleep apnea
pharynx
89
what stage of sleep does obstructive sleep apnea prominent?
REM due to muscle relaxation
90
what is a prominent risk factor for obstructive sleep apnea
obesity
91
difference between normal and abnormal occurrence in obstructive sleep apnea
normal: occasional snoring
abnormal: apnea frequency >5 per hours (
92
what can obstructive sleep apnea lead to?
fatigue, headache, irritability, poor memory, depression
93
treatment for obstructive sleep apnea
decrease risk factor (Weight loss)
| nighttime continuous airflow devices
94
what is NCPAP
an airflow device that allows nasal continuous positive airway pressure by an occlusive mask
95
What are the three types of anxiety?
1. generalized anxiety
2. panic
3. social phobia
96
treatment for anxiety
increase GABA (benzodiazepines)
increase (balance) serotonin (SSRIs)
behavioral and cognitive therapies
97
what is generalized anxiety
the excessive, uncontrollable worry with systemic symptoms and unable to modulate; 12% of population, women more affected
98
what is panic
an intense fear with systemic symptoms; duration is shorter; very common
99
what emotional centers are involved in panic anxiety
the amygdala, hippocampus, prefrontal cortex, hypothalamus, brainstem, HPA axis
100
resting
depolarization
repolarization
hyperpolarization
-70mV
-55mV
30mV
-90mV
101
What are the 4 major brain regions?
cerebrum, cerebellum, diencephalon, brainstem
102
what is the largest brain area?
cerebrum
103
gyrus function
increase SA
104
sulcus function
separate regions
105
Broca's area function
ability to speak
106
Wernicke's area function
language comprehension
107
basal nuclei function
motor control
108
patients with Parkinson's lack what brain structure?
basal nuclei
109
what are the three regions for diencephalon
hypothalamus, thalamus, and epithalamus
110
how to distinguish hypothalamus, thalamus, and epithalamus?
hypothalamus- emotions, autonomic functions, hormone production
thalamus- relays and processes sensory info
epithalamus- where the pineal gland is, and for melatonin
111
what are the three structures for brain stem?
midbrain
pons
medulla oblongata
112
how to distinguish midbrain, pons, and medulla oblongata?
midbrain: processes visual and auditory data, generate reflexive somatic motor responses, maintain consciousness
pons: relays sensory info to cerebellum and thalamus
113
medulla oblongata
relays sensory info to the thalamus, autonomic centers for visceral function regulations (cardio, GI, respiratory)
114
what are included in cranial meninges?
dura mater, arachnoid mater, and pia mater
115
what spaces are not present in cranial meninges?
epidural and subdural spaces
116
what space contains CSF?
subarachnoid space
117
what are the three functions of CSF?
support the brain, cushion the brain and spinal cord against trauma, transport nutrients
118
what are the ventricular systems of the brain?
lateral ventricle, third ventricle, and fourth ventricle
119
lateral ventricle communicates via ___
interventricular foramen
120
third and fourth ventricle communicates via ____
cerebral aqueduct
121
how is CSF produced
ependymal cells creates CSF --> choroid plexus secretes CSF --> flow across tight junction junction
122
how is CSF circulated
lateral ventricle --> third ventricle --> forth ventricle --> subarachnoid space --> arachnoid villi of dural venous sinuses --> heart and lungs --> back to the three choroid plexus
123
nervous tissue can survive without oxygen in how many seconds only
10 seconds
124
nervous tissue apoptosis in how many minutes (aka. depletion of resources)
4-6 minutes
125
nervous tissues do not store and recover what?
store oxygen and nutrition and recover nervous tissue injury
126
why cant nervous tissues recover?
no centrioles
127
brain uses ____ of all oxygen
20%
128
brain uses ___ of CO per minute
15%
129
brain has ___ of body weight
2%
130
how to assess consciousness?
LOC, gaslow coma scale
131
what can increased ICP lead to?
cushing triad and brain herniation
132
diphenhydramine is treatment for
insomnia
133
Buspirone is treatment for
insomnia
134
alprazolam is often misused for?
calming effects recreationally
