• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/306

Click to flip

306 Cards in this Set

  • Front
  • Back
What organs/structures comprise the urinary system? ***
- kidneys
- ureters
- urinary bladder
- urethra
What is the function of the kidney? ***
- filters the blood
- removes toxins and waste products in form of urine
- helps maintain electrolyte balance (salts such as sodium, potassium, calcium) for normal nerve and muscle function
- helps maintain blood pH (7.35-7.45) to prevent either acidosis or alkalosis which can result in coma or death
- produces hormone erythropoietin, which stimulates RBC production
- contributes to control of BP by production of renin and fluid retention (both elevate BP) and fluid excretion (lowers BP)
What is the function of the ureter? ***
transports urine to the urinary bladder
What is the function of the urinary bladder? ***
serves as a reservoir for urine
What is the function of the urethra? ***
conveys urine to the exterior of the body
What hormones are produced by the kidneys? ***
- erythropoietin - stimulates RBC production

- renin - elevates BP
How do healthy kidneys regulate blood pressure? ***
abnormally high BP:
- stimulates dilation of renal arterioles,
- increases blood flow to kidneys,
- increases urine output,
- decreases blood volume,
- decreases blood pressure
What is the relationship between kidney disease and hypertension? ***
longstanding hypertension or diabetes results in:
- arteriosclerosis of renal arteries
- permanent kidney damage due to inadequate blood supply (arteries become ischemic)
- kidneys rendered incapable of regulating urine output and decreasing BP
- salt and water retention cause increased blood volume and increased blood pressure
Ischemic kidneys also worsen HTN by: ***
secreting large amounts of renin, which causes severe HTN

(shedding renin increases BP)
What is a nephron? ***
the functional unit of the kidney system

convoluted tubules which contain capillary beds (glomeruli)
Approximately how many nephrons are contained in each kidney? ***
approximately 1,000,000
What are glomeruli? ***
capillary beds within the nephrons of the kidney
What do nephrons do? ***
- receive and filter blood
- filter wastes/toxins and excessive salts
- reabsorb water and nutrients
What is the renal pelvis? ***
the juncture between the kidneys and ureters
What two general types of infections affect the urinary system? ***
ascending and descending
What is an ascending infection with respect to the urinary system? ***
an infection that works upward from urethra to bladder to kidneys
What types of bacteria are associated with ascending infections in the urinary system? ***
- E. coli
- staphylococcus
- streptococcus
What is a descending infection with respect to the urinary system? ***
infections from the bloodstream and lymph system that work downward into the urinary system
What types of bacteria are associated with descending infections in the urinary system? ***
- streptococcus
- staphylococcus
- tuberculosis
What is a neurogenic bladder? ***
lack of volitional control--an individual cannot control urine release
What can result from urinary obstructions or neurogenic bladder? ***
decreased urine flow, which can cause infection in the system secondary to stagnant urine (which is an ideal breeding ground for bacterial growth)
What can cause obstructions in the urinary system? ***
- congenital defects
- kidney stones
- enlarged prostate
- tumor
- cyst
What is a kidney infection also called? ***
pyelonephritis
What is glomerulonephritis? ***
acute or chronic inflammation of glomeruli
What is acute glomerulonephritis? ***
- generally occurs in children
- antigen-antibody reaction to post-strep infection
- usually resolves without complications with appropriate treatment
What is chronic glomerulonephritis? ***
- due to repeated acute exacerbations
- often results in permanent kidney damage
What are the signs and symptoms of acute glomerulonephritis? ***
- chills, fever, weakness
- edema in face and ankles
- hematuria
- albuminuria
- casts
What is pyelonephritis? ***
a suppurative (pus-forming) inflammation of the interstitial tissue of the kidney/renal pelvis caused by pyogenic bacteria (strep, staph, E. coli)

treated with antibiotics
What is pyelitis? ***
a suppurative (pus-forming) inflammation of the interstitial tissue of the renal pelvis caused by pyogenic bacteria (strep, staph, E. coli)

treated with antibiotics
Characteristics of renal cancer ***
- causes enlargement of kidney
- destroys organ
- metastasis to other sites often occurs before diagnosis
- surgical removal is best treatment
What are renal calculi? ***
kidney stones that obstruct path of urine flow
How do renal calculi form? ***
- from precipitates of salts (usually calcium)
What is the treatment for renal calculi? ***
- lithotripsy (crushing of the stones) via laser or extracorporeal shock wave (ESWL)
- drug therapy to prevent formation of stones
- treatment for any infections caused by stagnant urine
What is hydronephrosis? ***
restricted urine flow

results in severely dilated kidneys and infection from the ideal breeding ground of the stagnant urine
Causes of hydronephrosis ***
- cysts
- tumors
- calculi
Hydronephrosis may be ______ or ______. ***
- bilateral (from a blockage at the urethra/bladder) or

unilateral (from a blockage in one ureter/kidney)
What happens to the ureters with hydronephrois? ***
they also dilate and warp/twist
What is renal tuberculosis? ***
a secondary site infection of TB from the lungs

carried to the kidneys via bloodstream (descending infection)
What is a polycystic kidney? ***
a hereditary disease in which cysts enlarge and fuse, compressing kidney tissue

infection leads to HTN, kidney failure, and death
What is cystitis? ***
inflammation of the bladder secondary to E. coli bacteria or obstruction (ascending infection)
What is urethritis? ***
inflammation of the urethra secondary to E. coli bacteria or obstruction (ascending infection)
Characteristics of bladder carcinoma ***
often caused by toxic industrial chemicals

surgical removal
What are some signs and symptoms of kidney disease or UTI? ***
- low back pain (kidney infection)
- groin pain (bladder infection)
- dysuria
- increased frequency, urgency
- hematuria, pyuria
- edema in face/ankles (kidney infection)
- chills, fever
- abnormal abdominal masses
What are some urinary conditions that indicate kidney disease? ***
- low specific gravity - diluted urine, inability to concentrate urine
- hematuria
- albuminuria - protein in urine
- glucosuria - sugar in urine
- pyuria
- casts - coagulated protein that forms molds of kidney tubules
- bacteria (staph, strep, E. coli, TB)
What is acute renal failure? ***
a condition that rapidly develops due to sudden decreased blood flow (e.g., severe dehydration, hemorrhage, shock)

condition reverses if proper treatment is administered
What is chronic renal failure? ***
condition that develops slowly over time (longstanding HTN, diabetes, repeated infections)

serious, irreversible disease that results in death
What are the complications of renal failure? ***
- kidneys cannot filter waste from blood and toxins increase

- azotemia (increase in blood urea nitrogen); uremia develops
What are the signs and symptoms of azotemia? ***
- deep sighing
- urine smell to breath
- ammonia taste in mouth
- nausea, vomiting, diarrhea
- pyuria, hematuria, albuminuria
- casts
- drowsiness, mental cloudiness, dim vision
- convulsions, coma, death
Accumulation of waste products, urea, uric acid, creatinine in blood affect which bodily systems? ***
- respiratory (deep, sighing respiration and urine smell to breath)
- digestive (nausea, vomiting, diarrhea)
- nervous system (drowsiness, dim vision, mental cloudiness, convulsions, coma)
- urinary (pyuria, hematuria, albuminuria, casts)
What treatment is available for renal failure? ***
- dialysis

- transplant
What is dialysis? ***
artificial cleansing of the blood using a machine with a semipermeable filtering membrane

does not cure renal failure, but helps maintain life until kidney function is restored

generally not successful with chronic renal failure
What treatment is generally needed for chronic renal failure? ***
transplant
The endocrine system consists of ______ glands that secrete _______. ***
ductless

directly into lymph system or bloodstream
What glands comprise the endocrine system? ***
- pituitary (anterior and posterior--at base of brain)
- pineal (posterior to thalamus)
- hypothalamus (brain)
- thyroid (neck)
- parathyroids (behind thyroid)
- thymus (at bifurcation/split of trachea)
- adrenals (cortex and medulla--top of kidneys)
- Islets of Langerhans (pancreas)
- gonads (ovaries/testes)
Function of the endocrine system ***
production, storage, and secretion of hormones to maintain homeostasis of the body through regulation of functions such as:
- growth and development
- cell metabolism
- tissue repair
- sexual activity
- mental ability
- emotions
Of what are hormones comprised? ***
- proteins
- steroids
- amino acids
What controls the endocrine system? ***
the pituitary gland
What is the "master gland"? ***
pituitary gland
Which organ has CNS control over endocrine function? ***
hypothalamus

links nervous system to endocrine system via pituitary gland
How does the CNS-hypothalamus-pituitary connection operate? ***
- CNS transmits input to hypothalamus
- hypothalamus stimulates pituitary via hormonal secretion and/or neuronal impulses
- pituitary stimulates target endocrine glands via hormones specific to each gland
- endocrine glands stimulate target tissues via hormonal secretions
How is secretion of hormones controlled? ***
via negative feedback
How does negative feedback work in the endocrine system? ***
when hormone levels are adequate, secretion stops

when hormone levels are low, secretions are activated

(negative feedback, opposing stimuli)
Malfunctions in the endocrine system can result in two conditions: ***
hyperactivity

hypoactivity
What is hyperactivity in the endocrine system? ***
excessive secretion and hypertrophy of the gland
What is hypoactivity in the endocrine system? ***
inadequate secretion and atrophy of the gland
What other factors can cause malfunctions of the endocrine system? ***
- tumors
- ischemia
- autoimmune conditions
- nutritional depletions
- genetic components
- congenital defects
The pituitary is also known as ***
hypophysis
Why is the pituitary considered the "master gland"? ***
because it controls most other endocrine gland activities via hormonal secretions
How many hormones does the pituitary gland secrete? ***
8
Which portion of the pituitary gland is larger, the anterior or posterior? ***
anterior
What is the anterior portion of the pituitary called? ***
adenohypophysis
What is the posterior portion of the pituitary called? ***
neurohypophysis
What gland controls the pituitary? ***
hypothalamus
Pituitary hormone secretions either directly or indirectly affect: ***
- growth and development
- tissue repair
- cell metabolism
- sexual/reproductive functions
- mental alertness
- fluid balance
What issues are caused by disorders of the pituitary gland? ***
- gigantism/dwarfism (somatotropin/GH)
- sexual dysfunction (FSH, LH)
- decreased metabolic rate (TSH)
- mental dullness/lethargy (can lead to MR)
- diabetes insipidis (ADH)
What causes diabetes insipidus? ***
lack of secretion of antidiuretic hormone (ADH/vasopressin)

causes excessive water loss through kidneys, dehydration, polydipsia (insatiable thirst)
Signs and symptoms of diabetes insipidus ***
polyuria, dehydration, polydipsia (insatiable thirst)
Dysfunction of what organ causes diabetes insipidus? ***
- pituitary (specifically posterior lobe/neurohypophysis)
When does the hypothalamus signal the pituitary to release ADH/vasopressin? ***
when it senses (through osmotic pressure) blood concentration of water is too low

triggers neurohypophysis to release antidiuretic hormone to slow water output (through urination)
Where is the pineal gland located? ***
posterior to the thalamus
What is the function of the pineal gland? ***
secrete hormones which inhibit functions of the reproductive system
What is the function of the thyroid gland? ***
- stimulates cellular metabolism (rate at which calories are used, O2 is consumed by cells)

- energy and heat production

- metabolism affects cardiac/respiratory rates and digestive motility

- produce thyroid hormones containing iodine

- controlled by pituitary
Construct the thyroxine (T4) feedback loop. ***
- hypothalamus secretes releasing factor to stimulate anterior pituitary (adenohypophysis)
- anterior pituitary (adenohypophysis) is prompted to release thyroid-stimulating hormone (TSH) for thyroid gland
- thyroid gland is stimulated to release thyroxine (T4) into blood vessels
- low T4 prompts hypothalamus to secrete more releasing factor and repeat the loop
- high T4 prompts hypothalamus to stop secreting releasing factor
What is a goiter? ***
enlargement of the thyroid

most cases are caused by iodine deficiency

may be associated with hypothyroidism or hyperthyroidism
What is Graves' disease? ***
autoimmune hyperthyroidism
What are the signs and symptoms of hyperthyroidism? ***
- increase in metabolic rate
- nervousness
- diarrhea
- tachycardia
- weight loss
- expothalmos (bulging eyes)
- tremors
What is expothalmos? ***
bulging eyes, often associated with Graves' disease/hyperthyroidism

(also called exophthalmia or proptosis)
What are the signs and symptoms of hypothyroidism? ***
- extreme fatigue
- weight gain
- mental dullness
- lowered body temperature
- menstrual irregularities
- muscle aches
- thinning hair
- myxedema (adult manifestation of cretinism; usually consists of the more severe symptoms of hypothyroidism--hypotension, bradycardia, etc.)
- cretinism (severely stunted physical and mental growth in infants)
What does the thymus gland do? ***
secretes hormone that helps develop T-cells, and therefore, immunity
What are the two parts of the adrenal gland? ***
- cortex
- medulla
What does the adrenal cortex do? ***
secretes life-essential steroid hormones that:
- regulate fluid and electrolyte balance
- control metabolism of proteins and fats for energy

also secretes sex hormones that:
- stimulate development of sexual characteristics
What are two broad dysfunctions of the adrenal cortex? ***
- hyperadrenalism

- hypoadrenalism
Three types of hyperadrenalism ***
- Cushing's syndrome
- Conn's syndrome
- Adrenal virilism
How is hyperadrenalism characterized? ***
by which form it takes, which depends on what hormones are secreted in excess
What is Cushing's syndrome? ***
- excess glucocorticoids
- hypertension
- hyperglycemia
- hyperlipidemia
- fluid retention
- weight gain
- fatigue
- weakness
- central obesity
- "moon face" and "buffalo hump"
- impaired wound healing
- loss of elastic tissues
- thinning of skin
- depression, even psychosis
What is Conn's syndrome? ***
- excess aldosterone
- hypertension
- muscle weakness
- polydipsia
What is adrenal virilism? ***
- excess androgens
- premature maturation of sex organs
- masculinization in females (hirsutism)
What is hypoadrenalism? ***
atrophy of the adrenal glands due to:
- overuse of steroidal hormones
- autoimmune disease
- Addison's disease
What are the signs and symptoms of hypoadrenalism caused by autoimmune disease? ***
- patient unable to retain salt
- dehydration
- low blood pressure
- muscle weakness
- fatigue
- GI problems
- yellow pigmentation of the skin
- weight loss

may be fatal, especially in the setting of another acute illness or trauma
What is Addison's disease? ***
chronic hypoadrenalism

adrenals do not produce enough steroid hormones
What is the adrenal medulla? ***
innermost part of adrenal gland

surrounded by adrenal cortex
What is the function of the adrenal medulla? ***
secretes epinephrine (adrenalin)

stimulated by sympathetic nervous system

increased secretion with "fight or flight"

works with SNS during responses of anger and fear to increase heart rate, BP, shunt blood to muscles, and increase blood glucose
What issues can dysfunction of the adrenal medulla cause? ***
- excessive secretion of epinephrine (adrenalin)

- can lead to sustained HTN and stroke

(e.g., pheochromocytoma - rare epinephrine- and norepinephrine-producing tumor)
What is the function of the parathyroids? ***
regulate the level of circulating calcium and phosphate to ensure proper muscle and nervous system function
How does parathormone function? ***
if blood calcium levels are too low, it will pull calcium from the digestive tract, bones, and prevent excretion from the kidneys
What is hypercalcemia? ***
hyperactivity of parathyroid glands
causes:
- kidney stones
- weakened bones
- calcium deposition in vessels and organs
- depressed nervous system (muscles atrophy, pulse slows, heart affected, mental depression)
What is hypocalcemia? ***
hypoactivity of parathyroid glands
causes:
- overexcitation of nervous system
- sustained muscle contractions (tetany, convulsions)
What are the Islets of Langerhans? ***
special endocrine tissue in the pancreas which secretes two hormones that regulate blood sugar levels
- insulin (beta cells)
- glucagon (alpha cells)
Where does glucagon come from and what does it do? ***
- secreted by alpha cells in Islets of Langerhans of pancreas

- increases blood sugar
Where does insulin come from and what does it do? ***
- secreted by beta cells in Islets of Langerhans of pancreas

- decreases blood sugar
Trace the workings of blood sugar level maintenance ***
- blood sugar level rises
- insulin secreted (beta cells)
- glucose swept into liver, skeletal muscle cells, fat cells to be stored as glycogen (liver) and fat (cells)
- blood sugar level decreases
- glucagon secreted (alpha cells)
- stimulates liver to release glycogen into bloodstream
What are some disorders of Islets of Langerhans? ***
- diabetes mellitus
- hypoglycemia
What are two causes behind diabetes mellitus? ***
- beta cells of Islets of Langerhans fail to secrete insulin

or

- target cells in system fail to respond to insulin due to receptor site dysfunction
In diabetes, cells are deprived of _______ ***
nutrients

(therefore, energy)
What are normal and typical diabetic blood sugar levels? ***
- normal 90mg
- hyperglycemic 90>140mg
- DM can be 300-1200mg

(per 100ml blood)
What is Type 1 diabetes? ***
- insulin-dependent diabetes mellitus

- juvenile onset
Characteristics of IDDM ***
- 10% of all DM cases
- most serious form
- probable autoimmune response
- possible genetic predisposition
- may occur in adults, although usually appears in younger people
- beta cells of Islets of Langerhans are damaged and do not produce insulin
- requires daily insulin injections
- symptoms appear quickly
- shortened life span (40 years)
Characteristics of Type II diabetes (NIDDM, maturity onset) ***
- most common
- 90% of cases of diabetes
- strong genetic connection (Latino population)
- frequently accompanies obesity; decreases cell response to insulin
- usually occurs after age 40
- females affected more often than males
- may or may not require insulin
- symptoms appear more slowly
- lifespan into 70s if controlled
Causes of Type II diabetes (NIDDM, maturity onset) ***
- high carbohydrate diet overstimulates beta cell insulin secretion and burns them out

- decreased/dysfunctional target cell insulin receptor sites
What is Type III diabetes? ***
- recognized in 2005
- insulin is produced in the brain

type III occurs when the brain stops or reduces acceptance of the brain's secreted insulin within its own cell receptors
What are some complications of diabetes mellitus? ***
- atherosclerosis - lipids metabolized instead of glucose, raising circulating lipids and leading to vascular stenosis and poor circulation; ketones formed in this process may cause ketoacidosis--->coma
- kidney failure - in DM > 10 years; kidneys overworked filtering glucose, ASVD, need dialysis
- nerves affected - neuropathy, numbness, tingling in hands and feet
- peripheral arteries affected - poor wound healing, ulcers, gangrene, amputation (usually LE)
- cerebral arteries - CVA
- coronary arteries - MI
- retinal arteries - blindness
Signs and symptoms of DM ***
- polyuria due to excess glucose being filtered by kidneys, requiring increased H2O (under normal conditions, glucose is reabsorbed by kidneys)
- glucosuria - excessive sugar in urine
- polydipsia - insatiable thirst due to excessive urination
- weight loss - body metabolizing fats and proteins because it can't use glucose
- weakness and fatigue
- ketoacidosis - lower blood pH due to metabolism of fat and protein; can cause coma and death if not reversed
- poor wound healing due to metabolism of tissue protein
- frequent infections
- blurred vision
- numbness and tingling of hands and feet (stocking/glove parasthesia)
- easily fatigued
Treatment of type I diabetes ***
- insulin injections
- exercise (increases body's ability to utilize insulin)
- diet (low carbohydrate so as not to cause excess glucose)
- self blood glucose monitoring (daily to B/QID)
- foot and skin care (watch for wounds and pressure ulcers)
Treatment of type II diabetes ***
- can be controlled with exercise and diet; SBGM
- may require oral insulin/hypoglycemic agents if uncontrolled
- foot and skin care very important

ANY CHANGE IN DIET, EXERCISE LEVEL, INSULIN INTAKE, ILLNESS, OR STRESS CAN AFFECT DM--SBGM IS ESSENTIAL TO MAINTAIN BALANCE
What types of DM patients will PTAs see? ***
- those in for exercise regimens
- stroke/cardiac rehabilitation
- wound care of diabetic ulcers
- amputation training
What is important to remember about exercise regimens and DM patients? ***
it can cause hypoglycemia

keep orange juice/candy handy
What is hypoglycemia? ***
abnormally low blood glucose level

<50mg/ml
Causes of hypoglycemia ***
- too much insulin (from injection or oral medication)
- not enough glucose (not enough food)
- tumor of beta cells - hypersecretion of insulin
Signs and symptoms of hypoglycemia ***
- faintness
- lightheadedness
- trembling
- sweating
- nervousness
- mental confusion
What is a diabetic coma? ***
caused by ketoacidosis or severe hyperglycemia
- severely elevated blood sugar
- lack of insulin results in acidosis and dehydration
- tends to develop over time
- can lead to death if not promptly and properly treated
Signs and symptoms of hyperglycemia ***
- deep, rapid, labored breathing
- fruity, acetone smell to breath
- skin flushed and dry
- dry tongue
- patient drowsy and lethargic before onset
Treatment for hypoglycemia
Treatment for hyperglycemia

***
- orange juice or candy

- insulin/fluid IV
Some causes of hypoglycemia? ***
- insulin shock
- too much insulin
- not enough food
- sudden exercise/exertion
If untreated, hypoglycemia can lead to: ***
coma and death
What is a neuron? ***
the basic functional unit of the nervous system, a specialized cell
What are the three components of a neuron? ***
- cell body - metabolic center of neuron
- dendrite - receptive part of neuron with threadlike projections radiating from cell body; carries information toward cell body
- axon - tubular extension with branches at terminal end that conducts information in the form of action potentials away from cell body
What is white matter? ***
areas of nervous tissue in CNS composed of myelinated axons

myelination makes them white
What are tracts? ***
(a.k.a. funiculus/funiculi)

vertical projections (e.g., spinal cord)

bundles of fibers in a tubular sheath
What are association fibers? ***
within hemispheres of the brain connect the lobes (e.g., frontal, parietal)

unite different parts of the same cerebral hemisphere
What are commissural fibers? ***
fibers which connect both hemispheres of the brain
What is myelin?

Are all nerves myelinated? ***
a lipoprotein covering that forms a sheath over the axon of a neuron to insulate and protect it

no
What part(s) of the neuron are myelinated? ***
only the axon
What is gray matter? ***
nervous tissue comprised of dense collections of nerve cell bodies (grayish in color)
What portions of the brain and spinal cord are gray matter? ***
- cerbral cortex of cerebrum is gray matter
- inner portion of spinal cord is gray matter
White matter and gray matter location ***
- in brain
- in spinal cord
- white inner; gray outer

- gray inner; white outer
What are the functions of neurons? ***
primary function of neurons is transmission of information to other nerve cells (neurons), muscle cells (causing contraction), or glandular cells (triggering secretion)
How does information flow through a neuron? ****
at cellular level, impulses are received at receptor sites (dendrites), travel through the cell body, and leave through the axon to another neuron, muscle cell, etc.
The nervous system is the ______ system of the body. ***
communication
How does communication through the nervous system occur in the body? ***
as a result of transmission of electrical impulses between neurons
How does transmission of electrical impulses occur between cells? ***
as a result of the electrical properties of the neuron's cell membrane

depolarization and action potential
What must happen to the neuronal cell membrane for information to travel through it? ***
it must depolarize
Depolarization ***
reversal of electrical charge at cell membrane

inside of cell becomes more positive than outside
If a cell depolarizes, an _______ ________ is generated and information will continue to travel.
action potential
What is an action potential? ***
an electrical message from the cell body to the axon's terminal branches (synapse)
What is a synapse? ***
a space between the junction of neurons (between terminal end of one axon and dendrite of another neuron)

or

between a neuron and an organ
How does a neuronal impulse travel across the synapse between neurons? ***
an electrical impulse from the presynaptic neuron (axon) causes release of a chemical neurotransmitter which either inhibits or stimulates an electrical impulse in the postsynaptic neuron (dendrite)
What is acetylcholine? ***
a neurotransmitter used by all neurons that synapse with muscle fiers
What is the nervous system more heavily involved in, inhibiting flow of information or increasing flow of information? ***
inhibiting
SAME ***
sensory - afferent (to brain)

motor - efferent (from brain)
Sensory input (smell, sight, hearing, touch, taste, heat, cold, pressure, and movement) travel: ***
to the brain via the posterior sensory/afferent tracts of the spinal cord
Major afferent (sensory) tracts carry information to: ***
the brain
Major efferent (motor) tracts transmit to: ***
smooth and skeletal muscle
Motor (efferent) signals from cortex travel: ***
to spinal cord, then muscles via the anterior motor tracts of the spinal cord
It is believed that pain is ***
an output, not an input

stimulus that causes pain is an input, but the pain itself is output
What are the divisions of the nervous system? ***
central nervous system
and
peripheral nervous system
What is the central nervous system? ***
brain and spinal cord
What is the peripheral nervous system? ***
all nervous tissue outside the vertebral canal

includes cranial and spinal nerves
What are the divisions of the peripheral nervous system? ***
autonomic nervous system
and
somatic nervous system
What does the autonomic nervous system control? ***
- smooth muscles
- glands
- blood vessels
What does the somatic nervous system control? ***
- muscles
- skin
- joints
How is the brain constructed? ***
cerebrum - two hemispheres, right and left

surface contains sulci (fissures) and gyri (ridges)

inner brain is white matter - where information is conveyed
outer cerebrum is gray matter - where information is processed and integrated
Four lobes of the cerebrum ***
- frontal
- parietal
- temporal
- occipital
Functions of the frontal lobe ***
- primary motor cortex
- influence of cognitive functions
- Broca's area plans movements of mouth for speech
Functions of the parietal lobe ***
- primary sensory cortex
- perception
- body region mapping (sensory homunuculus)
Four lobes, cerebellum, pons, medulla oblongata,
reading comprehension area,
sensory speech - area of Wernicke
motor speech - area of Broca
longitudinal fissure
premotor area
precentral/postcentral gyri
Functions of the temporal lobe ***
- primary auditory cortex
- Wernicke's area - hearing and comprehension
- visual perception, musical discrimination, long-term memory capabilities
Functions of the occipital lobe ***
- primary visual cortex
- organization, integration and interpretation of visual information received from eyes
What is the primary motor cortex? ***
located in frontal lobe

primarily responsible for contralateral voluntary movement of UE and facial movements
What is the premotor area? ***
- area just anterior to primary motor cortex

- controls muscles of the trunk and
- anticipatory postural adjustments and
- the supplementary motor area which controls initiation of movement, orientation of the eyes and head, and bilateral sequential movement

- speech area here as well, usually on left side--especially for right-handed people
What is the corpus callosum? ***
connects the right and left hemispheres of the brain
What is the diencephalon? ***
the "interbrain"

consists of the thalamus and hypothalamus
What role does the thalamus play in the diencephalon? ***
- central relay station
- receives all sensory impulses except those associated with smell
What role does the hypothalamus play in the diencephalon? ***
responsible for integrating the ANS through regulation of pituitary gland and its release of hormones

relay between nervous and endocrine systems

why the hypothalamus is known as the "center for homeostasis"
What is the basal ganglia? ***
a group of nuclei at the base of the cerebrum

subcortical structure made up of various other structures
For what is the basal ganglia responsible? ***
primarily responsible for regulation of posture/position, subconscious movement and muscle tone
What can result from dysfunction of the basal ganglia? ***
Parkinson's disease

(death of dopamine-producing cells in the substantia nigra)
What is the limbic system? ***
a system that includes parts of the thalamus, hypothalamus and a portion of the frontal and temporal lobes

located deep in the diencephalon and cortex
For what is the limbic system responsible? ***
guides emotions that regulate behavior
What structures comprise the brain stem and where is it located? ***
- midbrain
- pons
- medulla oblongata

located between the base of the cerebrum and spinal cord
What does the midbrain do? ***
connects the pons to the diencephalon and acts as a relay station for tracts passing between cerebrum and spinal cord or cerebellum
What does the pons do? ***
functions with the medulla to regulate breathing
What does the medulla do? ***
control center for heart and respiration rate, reflex center for vomiting, coughing, sneezing, and swallowing
What is the spinal cord? ***
- a direct continuation of the brain stem
- a means of communication between brain and peripheral nerves
What happens to the spinal cord as it runs down the back? ***
- at L1 it becomes a cone-shaped structure known as conus medullaris comprised of sacral spinal segments

- below this level it becomes the cauda equina--nerve roots for spinal nerves L2-S5
What is an anterior horn cell? ***
- large neuron in gray matter of spinal cord
- sends out axons through anterior spinal root
- eventually become peripheral nerves and innervate muscle fibers
Activation of an anterior horn cell initiates ***
skeletal muscle contraction
What is an alpha motor neuron? ***
a type of anterior horn cell that innervates skeletal muscles

due to axonal branching, several muscle fibers can be innervated by one neuron (it is not a 1:1 ratio)
What is a motor unit? ***

MEMORIZE THIS!!!
consists of an alpha motor neuron and the (skeletal) muscle fibers it innervates
Expanded definition of motor unit
- a motor unit is a single α-motor neuron and all of the corresponding muscle fibers it innervates; all of these fibers will be of the same type (either fast twitch or slow twitch)

- when a motor unit is activated, all of its fibers contract; groups of motor units often work together to coordinate the contractions of a single muscle; all of the motor units that subserve a single muscle are considered a motor unit pool

- larger motor units have stronger twitch tensions

- the number of muscle fibers within each unit can vary: thigh muscles can have a thousand fibers in each unit, eye muscles might have ten; in general, the number of muscle fibers innervated by a motor unit is a function of a muscle's need for refined motion

- the smaller the motor unit, the more precise the action of the muscle; muscles requiring more refined motion are innervated by motor units that synapse with fewer muscle fibers
How many spinal nerves do humans have? ***
31 pairs
Describe spinal nerves ***
consist of 31 pairs of:
- sensory (afferent—travels dorsal/posterior) and
- motor (efferent--travels ventral/anterior) components

- exit the intervertebral foramen
What is a dermatome? ***
a region of skin innervated by sensory afferent fibers from an individual spinal nerve
What is a myotome? ***
a group of muscles innervated by a spinal nerve
Where does the peripheral nervous system begin? ***
where the spinal nerve divides into two primary rami after exiting the foramen
Describe names of tracts and other structures of nervous system ***
- often named according to points of origin and destination

e.g.,
- corticospinal tract - origninates in cerebral cortex (cortico) and travels to spinal cord (spinal
- spinalthalmic tract travels from spinal cord to thalamus
12 Cranial Nerves ***
I - Olfactory
II - Optic
III - Oculomotor
IV - Trochlear
V - Trigeminal
VI - Abducens
VII - Facial
VIII - Vestibulocochlear
IX - Glossopharyngeal
X - Vagus
XI - Accessory
XII - Hypoglossal
Mnemonic for cranial nerves
OLd
OPie
OCcasionally
TRies

TRIGonometry,
ABruptly
Feeling
VEry

GLOomy
VAGUe
And
HYPOactive
Mnemonic for functions of cranial nerves (m-motor, s-sensory, b-both)
Some
Say
Marry
Money,

But
My
Brother
Says,

"Big
Breasts
Matter
More!"
Infectious diseases discussed in this lecture: ***

SHE SAID FOCUS ON THE DISEASES!!
- meningitis (infectious)
- encephalitis (infectious)
- poliomyelitis (infectious)
- Reye's syndrome (infectious)
- Bell's palsy (infectious)
- tic doloreaux (infectious)
- multiple sclerosis (demyelinating)
- Guillain-Barre (demyelinating)
- Parkinson's disease (degenerative)
- Amyotrophic Lateral Sclerosis (degenerative)
- Huntington's chorea (degenerative)
- Friedreich's ataxia (degenerative)
- Alzheimer's disease (degenerative)
- Spina bifida (congenital/developmental)
- cerebral palsy (congenital/developmental)
- transient ischemic attack (vascular)
- cerebrovascular accidents (vascular)
- hemorrhage (vascular)
- traumatic brain injury (brain injury)
- concussion (brain injury)
- contusion (brain injury)
- laceration (brain injury)
- hemorrage/hematoma (brain injury)
- seizure
What is meningitis and what causes it? ***
- inflammation of the meninges of brain and/or spinal cord (book says only pia mater and arachnoid mater)

- contagious, caused by bacteria or virus that can reach the meninges from the middle ear, upper respiratory tract, or frontal sinus, or through bloodstream from lungs or other infected sites

- bacterial can be fatal if not treated early, especially with infants and the elderly
Signs and symptoms of meningitis ***
- high fever (which may progress to delirium, convulsions, coma)
- chills
- severe headache (due to increased intracranial pressure)
- painful, stiff neck (moving neck muscles stretches inflamed meninges, causing pain)
- vomiting, nausea, rash

- if symptoms not resolved, leads to hydrocephalus, delirium, coma, death

- sequelae include neurological damage, hearing loss, mental retardation, seizures, and UMN sensory/motor deficits
Means of diagnosis of and treatment/prognosis for meningitis ***
dx: lumbar puncture to measure CSF pressure and check for infectious organisms, elevated protein, polymorphs/leukocytes, low sugar (bacteria may have used it for their growth and metabolism)

tx: antibiotics if bacterial, and supportive care

prognosis depends on cause and prompt treatment; without treatment 15% suffer permanent brain damage (vision/hearing loss, MR, paralysis) or death; hydrocephalus due to blockage of fourth ventricle also a complication
What are meninges?
system of membranes which envelops the central nervous system

- consists of three layers:
- dura mater,
- arachnoid mater, and
- pia mater

- primary function of the meninges and of the cerebrospinal fluid is to protect the central nervous system
What is encephalitis? ***
inflammation of the meninges and brain tissue

caused by virus, often spread by insects

can be epidemic, regional variations
also secondary encephalitis may develop from viral childhood diseases (chicken pox, measles, mumps, etc.)
Signs and symptoms of encephalitis ***
- fever and chills
- headache
- stiff neck
- drowsiness

- if unresolved, delirium, seizures, coma, death

- sequelae include neurological damage, hearing loss, mental retardation, seizures, UMN sensory/motor deficits
Means of diagnosis of and treatment for encephalitis ***
dx: lumbar puncture

tx: no cure, supportive care
What is poliomyelitis and what causes it? ***
- viral infection affecting motor neurons (primarily of medulla oblongata, pons, spinal cord)
- affects primarily children
- can be epidemic

- caused by polio virus
Sequelae of poliomyelitis ***
motor deficits (sensory not involved) of
- spinal nerves (paralysis) and/or
- cranial nerves (bulbar palsy)
- LMN lesion of anterior horn cell
- impairment can be mild to severe
- can be terminal if respiratory muscles or cranial nerves are involved
Treatment for poliomyelitis ***
actually prevention, vice treatment

prophylaxis includes
- Salk vaccine
- Sabin vaccine
What is postpolio syndrome? ***
- relatively new sequela
- occurs 30-40 years after polio contracted

- progressive paralysis/atrophy after acute polio
- due to aging and physiological changes resulting in further loss of anterior horn cells

- loss of giant motor units (one AMN serves 50 instead of 10 muscles); units regrown and substituting for ones destroyed by polio
- overworked and age-related changes
What is Reye's syndrome and what causes it? ***
- acute encephalopathy and fatty degeneration of viscera that tends to follow some acute viral infections

- usually affects children under 18

- cause is unknown, but it develops 4-5 days after initial viral infection
- seems to be associated with use of aspirin following viral infection
- associated viruses include EBV, Influenza B, and varicella
Signs and symptoms, treatment, and prognosis of Reye's syndrome ***
symptoms
- rash
- lethargy
- vomiting
- delirium
- can lead to seizures, coma, respiratory arrest
- cerebral swelling and elevated intracranial pressure

treatment - supportive care

prognosis - depends on severity of symptoms and how quickly intervention occurs

severe cases result in CNS damage with UMN characteristics, mental retardation
What is Bell's palsy and what causes it? ***
- acute inflammation of CN VII (Facial), resulting in unilateral facial paralysis
- affects salivation, lacrimation, eyelid closure, and facial expressions

- cause is viral (book says unknown, but autoimmunity and vascular ischemia are probable)
Treatment and prognosis for Bell's palsy ***
treatment
- eye drops
- corticosteroids

prognosis
- complete recovery is variable; good recovery usually within several months if only partial paralysis
What is tic douloureux and what causes it? ***
a.k.a. trigeminal neuralgia

- severe facial neuralgia due to irritation of CN V (trigeminal)

- lightning-like stabs of pain radiating over portions of face; may be momentary or last up to 20 seconds

cause - degeneration of or pressure on CN V, resulting in severe neuralgia (CN V is both sensory and motor, sensory for the face)
Treatment for tic douloureux ***
- alcohol or phenol or drug injections into nerve

- surgery to transect portions of involved CN V branches (rhizotomy)
How do neoplasms affect the nervous system? ***
can occur in
- bony skull/vertebrae (osteoma)
- meninges (meningioma)
- support cells (glioma)

may be benign or malignant

benign tumors are still dangerous as they can grow and strangle portions of brain/spinal cord
Most metastatic tumors affecting the nervous system are ***
secondary from other organs (e.g., lung, breast, melanoma)
Primary metastatic tumors of brain tissue are referred to as ______. ***
gliomas

(tumors of supportive cells, not neuronal tissue)
Signs and symptoms of brain tumors ***
- severe headache
- personality changes
- loss of memory
- visual/speech disturbances
- seizures
- unsteadiness
- drowsiness
- coma
Signs and symptoms of tumors of spinal cord ***
symptoms are usually from compression of nerve roots:
- pain
- paresthesia (pins and needles)
- muscle weakness (LMN lesion)
- can progress to invasion of spinal cord
- develops into UMN lesions (like SCI)

brain and spinal cord tumors are often initially misdiagnosed
Infectious neural diseases ***
- meningitis (infectious)
- encephalitis (infectious)
- poliomyelitis (infectious)
- Reye's syndrome (infectious)
- Bell's palsy (infectious)
- tic doloreaux (infectious)
Demyelinating neural diseases ***
- multiple sclerosis (demyelinating)
- Guillain-Barre (demyelinating)
Degenerative neural diseases ***
- Parkinson's disease (degenerative)
- Amyotrophic Lateral Sclerosis (degenerative)
- Huntington's chorea (degenerative)
- Friedreich's ataxia (degenerative)
- Alzheimer's disease (degenerative)
Congenital/developmental neural diseases ***
- Spina bifida (congenital/developmental)
- cerebral palsy (congenital/developmental)
Vascular neural diseases ***
- transient ischemic attack (vascular)
- cerebrovascular accidents (vascular)
- hemorrhage (vascular)
What is multiple sclerosis and what causes it? ***
- demyelinating disease of CNS (the axons are left intact)
- cause uncertain, but considered autoimmune disease

- sclerotic lesions (fibrous scarring of glial cells) develop in demyelinated areas of brain and spinal cord

- it is chronic and progressive

- affects young adults 20-40 y.o.a. and females slightly more so than males
- more common in temperate climates than tropical climates
Signs and symptoms of multiple sclerosis ***
UMN clinical manifestations which depend on location of lesions

- sensory impairment
- decreased motor function
- visual impairment (diplopia, blindness, nystagmus)
- cerebellar impairment (dysarthria, incoordination, ataxia)
- bowel/bladder dysfunction (incontinence)
- spasticity, hyperreflexia
- fatigue

can be chronic and ongoing or exhibit periods of exacerbation and remission

no cure, only treatment of symptoms and physical therapy
What is Guillain-Barre and what causes it? ***
demyelinating disease of peripheral nerves; rapidly progressing polyneuropathy

cause unknown, but often begins 1-3 weeks after "flu-like" illness, viral infection (measles, mono) or vaccinations
Signs and symptoms of Guillain-Barre ***
- abrupt onset of paralysis (3-7 days) beginning in LE and progressing to UE, then respiratory muscles

- CNS may become involved (swallowing, speech, facial muscles affected)

- can be medical emergency if respiratory muscle involvement

- hyporeflexia
- paresthesias
Treatment for and sequelae of Guillain-Barre ***
treatment - supportive care and physical therapy

usually good recovery within 6 months

10% of patients will remain in chronic severe state (severe paralysis, respiratory dysfunction, oral-motor dysfunction and require life support system)
What is Parkinson's disease and what causes it? ***
- degenerative disease of CNS (basal ganglia structures/extrapyramidal) resulting in decreased release of neurotransmitter dopamine

- extrapyramidal dysfunction - no paralysis but movement quality affected

- appears gradually, progresses slowly
- cause unknown, possibly hereditary
- usual onset is after age 40, and incidence increases with age
- stress worsens condition
- increased risk of suicide has been noted
Signs/symptoms and treatment of Parkinson's disease ***
signs and symptoms:
- akinesia (unable to initiate movement due to difficulty selecting/activating motor programs in CNS)
- bradykinesia (slowness in execution)
- joint rigidity
- resting tremor (pill-rolling tremor)
- mask-like expression
- stooped posture
- shuffling, festinating (hurried) gait
- muscle weakness
- leg cramps
- loss of appetite
- visual degeneration
- headache
- difficulty swallowing
- monotone speech
- aching back
- loss of libido, impotence

- no cure, but Levodopa used to alleviate symptoms; however, not all can tolerate its side effects
- also dopamine-producing tissue transplant from mouse or pig
What is amyotrophic lateral sclerosis (ALS) and what causes it? ***
- degenerative motor neuron disease
- progressive loss of motor neurons in anterior horn of spinal cord
- can also affect nuclei of cranial nerves in brain stem (V, VII, XII)

- cause unknown
- affects males more often than females
- manifests 50-60 y.o.a.

- terminal (usually within 3-5 years after onset of symptoms)
Signs and symptoms of and treatment for ALS ***
signs and symptoms
- muscle atrophy
- paralysis
- fasiculations (spontaneous, uncontrolled discharges of motor neurons seen as irregular twitching)
- oral-motor dysfunction (loss of speech, swallowing)
- respiratory dysfunction (usually causes death)

no cure, only supportive care (especially to prevent pathologic aspiration)
What is Huntington's chorea and what causes it? ***
degenerative disease of the brain (atrophy of portions of basal ganglia) which results in progressive dementia and bizarre involuntary movements (choreiform-dancing; rapid, jerky movements)

cause is hereditary, via autosomal dominant gene (50% of children of a parent with HC will inherit)
- excess dopamine production, insufficient acetylcholine production
Signs and symptoms and treatment of Huntington's chorea ***
signs and symptoms
- generally do not appear until middle age (30-50 y.o.a.)
- choreiform movements (rapid, twisting, jerky movements of face, extremities)
- progressive intellectual deterioration

- treatment - no cure
- death normally in 15-20 years
What is Friedreich's ataxia and what causes it? ***
- slowly progressive spinocerebellar degeneration which affects
- corticospinal tracts,
- spinocerebellar tract,
- posterior columns,
- cerebellum

cause is hereditary (autosomal recessive)
Signs and symptoms of Friedreich's ataxia ***
- progressive ataxia, incoordination
- dysarthria
- muscle weakness, esp LE; to confinement in a wheelchair
- cardiomyopathy
- intelligence unaffected

onset of symptoms 5-15 years
What is Alzheimer's disease and what causes it? ***
- most common cause of dementia (decline in intellectual function)
- progressive presenile dementia
- atrophy of brain tissue secondary to neuronal loss (frontal lobe)
- malformation of neurons
- deterioration of Ach receptors in cortex
- affects females slightly more than males
- onset as early as 40s, most commonly 50s-60s
- well advanced in 4-5 years

cause is unknown, but seems to be genetic
Signs and symptoms of Alzheimer's disease ***
stages I, II, and III
- mild memory loss, attention deficits
- depression; personality changes
- confusion
- speech difficulty
- incontinence
- progresses to severe confusion, hallucinations, death (usually due to UTI or pneumonia)
Types of spina bifida ***
- spina bifida occulta
- meningocele
- myelomeningocele
- myelocele
Types of cerebral palsy ***
- athetoid
- spastic

book has
- spastic (muscles tense; reflexes exaggerated)
- choreoathetoid (constant, purposeless movements uncontrollable)
- atactic (poor balance, prone to falling, staggering gait)
- mixed
What is spina bifida? ***
condition in which vertebrae fail to fuse, usually in lower vertebral regions (thoracic or lumbar)

occurs in utero

consequences depend on extent of the opening, degree to which the vertebral column is exposed, and the involvement of the spinal cord
Spina bifida occulta ***
vertebral defect but cord remains inside vertebral canal

usually no defects
Meningocele ***
meninges protrude through defective opening in the vertebrae into an external sac filled with CSF

spinal cord not directly involved

corrected with surgery

usually no residual spinal cord damage/defects
Myelomeningocele ***
spinal cord and meninges protrude into external sac

requires surgery to repair defect

will exhibit residual spinal cord impairments below level of lesion
may be paralyzed, fail to develop, lack sensation, experience MR
Myelocele ***
most severe form

failure of neural tube to close

usually fatal
Signs and symptoms of spina bifida ***
variable, depending on severity

- developmental malformation - hydrocephalus (corrected with shunt); cleft palate/lip; club foot; strabismus
- mental retardation/developmental delay
- sensorimotor deficits below level of lesion
- bowel and bladder incontinence
- scoliosis
What is cerebral palsy and what causes it? ***
- non-progressive brain damage occurring at or near time of birth
- delay in cognitive and/or motor development
- level of involvement varies from mild to severe

results from hemorrhage, anoxia, infections, Rh incompatibility
Types of cerebral palsy and signs and symptoms ***
- athetoid (purposelss, poorly controlled fluctuating movement)

- spastic (hypertonicity) - most common

- abnormal tone (spasticity, athetosis)
- sensorimotor impairment
- seizures
- impaired hearing, speech, vision
- orthopedic deformities (e.g., if spastic and pt never extends wrist, the bones will fuse that way)
- mental retardation (not always present)
What is a transient ischemic attack (TIA) and what causes it? ***
- results from brief, temporary reduction in blood flow in a cerebral artery, causing temporary loss of neurological function (visual, speech disturbance, transient hemiparesis, etc.)

- often thought of as "mini strokes" and may be a precursor to a significant CVA (chance of CVA increases tenfold with prior TIAs)

caused by
- stenosis of cerebral artery
- small emboli temporarily occluding vessel
What is a cerebrovascular accident (CVA) and what causes it? ***
- results from restricted blood supply to the brain or excessive bleeding causing permanent cell damage and impaired neurologic function

causes
- main cause is HTN, which leads to the below:
- thrombus (atherosclerosis)
- embolus (atherosclerosis, air, fat, disease)
- hemorrhage (aneurysm, arteriosclerosis)
What are the common characteristics of CVA? ***
- depend on site of infarct/lesion
- usually contralateral sensory and motor impairments (hemiparesis, hemiplegia)
- abnormal tone (spasticity, synergies)
- speech/language disorders (Broca/Wernike areas)
- visual/perceptual deficits
- behavioral changes (depression, lability, impulsiveness) frontal lobe
Name three cerebral arteries and state which one is most often affected by CVA. ***
- anterior cerebral artery
- middle cerebral artery
- posterior cerebral artery

- middle cerebral artery most often affected
Vertebral/basilar arteries supply
the brain stem and cerebellum
If vertebral/basilar arteries are affected by CVA
result in
- coma
- "locked-in" syndrome
If cerebellar branch is affected by CVA
- ataxia
- cerebellar dysfunction
What is a hemorrhage and what causes it? ***
- bleeding secondary to a ruptured vessel

- if uncontrolled arterial bleeding, can lead to rapid compression of brain tissue and death

caused by aneurysm resulting from
- chronic HTN
- vascular malformations
- atherosclerosis
- infection
What is a traumatic brain injury and what are the mechanisms of injury? ***
an insult or blow to the head resulting in injury, displacement, and/or distortion of brain tissue

mechanisms of injury (MOI)
- concussion
- contusion
- laceration
- hemorrhage/hematoma
Describe a concussion ***
caused by blow to the head

temporary/transient loss of consciousness

brain may not be damaged, but entire body is affected:
- pusle rate weak
- nausea and dizziness on regaining consciousness
- headache
- coma possible
Describe a contusion ***
caused by blow to head

damage to brain tissue underneath point of impact, although skull or skin at site of trauma may not be broken

results in local hemorrhage, which may cause swelling and pain

flow of CSF could also be blocked, causing hydrocephalus
What is a countercoup? ***
damage to two sites in brain
1) initial point of contact
2) at opposite point where brain rebounds against skull
Describe a laceration ***
abrasion of brain tissue secondary to skull fracture

exposes tissue to infection
Describe the effect of a hemorrhage/hematoma on brain ***
results from tearing of vascular structures

increased fluid occupies space and compresses brain
Name three types of hematomas/hemorrhages ***
- epidural (extradural) hematoma - arterial bleed between dura mater and skull, rapidly occurring neurological signs (loss of consciousness, etc.) can be fatal within hours

- subdural hematoma - venous bleed under the dura mater, cerebral pressure/symptoms develop more slowly (over days/weeks)

- subarachnoid hemorrhage - bleeding into subarachnoid space where CSF circulates, blood in CSF (diagnosed with lumbar puncture)
What are the clinical manifestations of traumatic brain injury? ***
- UMN characteristics like a CVA, but more variable depending on area(s) affected

- deficits can range from severe involvement (coma) to very minimal involvement to complete resolution

- behavioral problems
- cognitive deficits (decreased attention span/judgment)
- sensorimotor impairments
- abnormal tone
- visual/perceptual deficits
- speech/language impairments
What is a seizure and what causes it? ***
- excessive, disorganized neural activity characterized by sudden attacks or one or more of:
- altered consciousness
- abnormal/altered motor activity
- sensory phenomenon
- inappropriate behavior

caused by
- brain injury (TBI, birth trauma--CP)
- tumor
- alcoholism
What is a grand mal seizure? ***
tonic-clonic (contraction-alternating contracting/relaxing)

characterized by:
- pre-seizure aura (ringing, tingling, spots before eyes, odors)
- sudden loss of consciousness; falls to floor
- followed by massive involuntary muscle contractions (convulsions) and often incontinence, hypersalivation
- can last for minutes (status epilepticus if sustained)
- afterward person is unaware of what happened
What is a petit mal seizure? ***
absence
- mild, brief seizure of only a few seconds
- appears as inattentiveness, staring blankly
- may see muscular twitching around eyes/mouth
- can have several hundred in a day
- usually disappears by late teens or early 20s
How are seizures treated? ***
- Tegretol is most commonly prescribed anti-seizure medication
- Dilantin and/or Phenobarbitol also used, but many side effects
What happens when there is deterioration of the myelin sheath of an axon?
- decreased impulse velocity
- impaired function

when deterioration becomes profuse
- misfiring
- incomplete impulses
What are the three meninges?
- pia mater (innermost)
- arachnoid (middle)
- dura mater (outermost)
What do the meninges cover?
brain and spinal cord (CNS)
What are the three major anatomical areas of the brain?
- cerebrum (largest)
- cerebellum
- brain stem
How many ventricles in the brain and what do they do?
four

where cerebrospinal fluid is formed from plasma

connected to spinal cord to circulate CSF throughout CNS
What occurs with obstruction of CSF flow?
hydrocephalus

swelling of the ventricles
What does the cerebellum control?
voluntary movement
What does the brain stem control?
it is called the "vitals center"

controls heart and respiratory rates
How do the sympathetic and parasympathetic nervous systems work?
antagonistically on generally the same organs to promote homeostasis
The ANS comprises the ________ and _________ nervous systems.
sympathetic

parasympathetic
The ANS acts on which types of muscles?
smooth and cardiac

(the somatic nervous system deals with skeletal)
How does the nervous system handle a simple stimulus and simple reflex response?
e.g., if you burn your hand on a pot and quickly pull it away

that stimulus and response will not rise higher than the spinal cord, the spinal cord will receive the simple stimulus and direct the simple response
How does the nervous system handle complex sensory information?
it must travel to specialized parts of the brain

- brain stem and cerebellum bring about unconscious autonomic actions

- if thought processes are needed, must go to the highest area of the brain, the cerebral cortex
How does the brain create/store memories?
association areas of the brain interpret deeper meanings of sensations received

many sensory messages are integrated and stored as memory

creative thought becomes possible through use of sensory input
What substances have been implicated in the pathogenesis of migraines?
- serotonin
- nitric oxide
Difference between benign and malignant brain tumors
both are dangerous, however

- benign tumors tend to be encapsulated, therefore more easily removed in their entirety

- malignant tumors tend to have extensive roots and are very difficult, if not impossible to remove completely
Endocrine functions can be affected by anomalies in
- primary gland responsible for producing a certain hormone
- defects in circulating concentrations of stimulating or releasing hormones
- anomalies in both the primary gland and the target or receiving gland/organ

result is either hypofunction or hyperfunction
Some hormones affect the whole body, while others act only on
target or distant organs
What can cause hyperactivity in a gland?
hypertrophy

glandular tumor
What can cause hypoactivity in a gland?
- disease
- tumor
- trauma
- surgery
- radiation
- atrophy
Where are hormones of the neurohypophysis produced?
in the hypothalamus
6 adenohypophysis hormones
- FSH
- LH
- prolactin
- TSH
- ACTH
- Growth hormone (somatotropin)
2 neurohypophysis hormones
- ADH (vasopressin)
- Oxytocin
Adrenal cortex secretes what three types of hormones?
- mineralocorticoids - regulate salt balance (principal hormone in this group is aldosterone, which causes sodium retention and potassium secretion by kidneys)

- glucocorticoids - help regulate carbohydrate, lipid, and protein metabolism (principal hormone is cortisol or hydrocortisone)

- sex hormones - androgens and estrogens
Adrenal medulla secretes....
epinephrine (increases vasodilation, heart rate, blood pressure, and respiration)

norepinephrine (vasoconstriction)