Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
25 Cards in this Set
- Front
- Back
|
1. Distinguish between the central nervous system and the peripheral nervous system and list structure contained within each. P 411
|
Central nervous system – consists of brain and spinal cord. The peripheral nervous system is composed of the cranial nerves, spinal nerves, somatic nervous system, autonomic nervous system.
|
|
|
2. Compare and contrast the endothelium of the blood brain barrier with the other body endothelium. Chap 14
|
The blood brain barrier also regulates the transport of chemicals so that a lot medications, including penicillin, chemicals, etc. will not get through the blood brain barrier and cause injury to the brain.
7. The capillary-brain extracellular fluid. a. A glial membrane formed by the foot plate of astrocytes located between brain tissue and the capillaries. The key point here is that brain barrier capillary endothelium is unfenestrated. That is, unlike other capillary epithelium in the rest of the brain which is fenestrated (has pores), the endothelium of the blood brain barrier is tight and continuous. b. So, how do substances that the brain needs, get transported into the BBB? a. Diffusion of water, CO2, O2 and non-polar (aspirin, mannitol) substances b. Pinocytosis - Minimally c. Movement of solutes with cerebral spinal fluid (hormones secreted in pituitary) d. Active transport e. Mediated transport (carriers). For example, glucose is carried by hexoses. |
|
|
3. Discuss synaptic transmission of impulses by neurotransmitters, including the regulation mechanisms of the process. P. 416
|
Are responsible for chemical conduction across the synapse and myoneural junction. Nerve impulse is predominantly regulated by a balance of inhibitory postsynaptic potentials and excitatory postsynaptic potentials, temporal and spatial summation, and convergence and divergence.
|
|
|
4. Describe the three divisions of the brain with focus on location, discrete structures, function, and outputs. P418
|
Forebrain, midbrain, and hindebrain.
|
|
|
5. Discuss the effects of sympathetic and parasympathetic stimulation on the body systems. P 435
|
Parasympathetic nervous system
1. Usually the antagonist of the sympathetic nervous system 2. Regulates the day to day running of the body 3. A way to remember - SLUD S - Salivation L - Lacrimation U - Urination D - Defecation |
|
|
6. Describe the sensory and motor functions of the peripheral nervous system. P430
|
To relay information from the CNS to muscle and effector organs through cranial and spinal nerve tracts arranged in fascicles (multiple fascicles bound together form the peripheral nerve). The 31 pairs of spinal nerves contain both sensory and motor neurons.
20. Made up of the cranial and spinal nerves a. Spinal nerves a. 31 pair that get their names from the vertebral level from which they exit. b. Are "mixed" nerves - contain both motor and sensory c. Dermatomes b. Cranial nerves a. Sensory 1. Olfactory (I) 2. Optic (II) 3. Vestibulocochlear (VIII) - hearing and equilibrium b. Motor 1. Trochlear (IV) - supplies superior oblique muscle of the eye 2. Abducens (VI) - supplies lateral rectus muscle of the eye 3. Hypoglossal (XII) - supplies muscles of the tongue 4. Oculomotor (III) - supplies superior, inferior, and medial recti and inferior oblique muscle of the eye b. Mixed 1. Trigeminal (V) - Mostly sensory to face, eye, maxilla and mandible. Muscles of mastication 2. Facial (VII) - Mostly motor of face for facial expression. Sensory to anterior 2/3 of the tongue 3. Glossopharyngeal (IX) - supplies motor to pharynx, parotid and posterior lingual glands. Sensory to posterior 1/3 of the tongue 4. Vagus (X) - muscles of the soft palate and larynx. Part of the CNS with sensory to heart and GI tract 5. Spinal-accessory (XI) - sensory and motor to sternocleidomastoid and trapezius muscles. Allows us to shrug our shoulders. A way to help remember: On Old Olympic's Towering Top, A Fin and German Viewed Some Hops |
|
|
7. Describe the age-related changes in the nervous system. P 439
|
Major structural changes with aging include a decrease in number of neurons and a decrease in brain weight and size. Deposition of lipofuscin and the presence of senile plaques, multiple neurofibrillary tangles, and Lewy bodies are common cellular changes with aging. A progressive slowing of neurologic function occurs with advancing age.
|
|
|
8. Describe tests performed to assess the function and integrity of the nervous system. P 442
|
Include xrays, computed tomography, mri, angiography, positron emission tomography, brain scan, cerebral angiography, myelography, echoencephalography, electroencephalography, evoked potentials, and analysis of the cerebrospinal fluid.
|
|
|
9. Identify the clinical manifestations that occur dependent on the location and type of lesion involved. P.
|
10. Supratentorial - Thalamus, cerebral hemispheres, cranial nerves I and II, lateral and 3rd ventricles and hypothalamus. (thinking, vision, sensation, language, memory, emotion, sensation)
11. Infratentorial (the tentorium divides the cerebral hemispheres from the cerebellum and brain stem) brainstem, midbrain, pons, medulla, cerebellum, aqueduct of Silvus, cranial nerves III to XII, and 4th ventricle. (fine motor control, respirations, sleep, consciousness, blood pressure, cardiac). Remember the vagus nerve is also involved here and its effect on the cardiac system. 12. Spinal cord and canal - the manifestations will be below the level of the lesion 13. Peripheral level - afferent and efferent nerve fibers. These fibers do regenerate 14. Multilevel or multiple lesions such as MS, ALS,. 15. Focal and on the right side - the left side of the body will be affected 16. Focal and on the left side - the right side of the body will be affected (most usual in stroke) 17. Focal but involving midline structures on both sides - {abscesses, infarcts in central area of the brain (hypothalamus) - hydrocephalus}. 18. Diffuse and involving alike areas on both sides of the brain - post anoxia, toxins, subarachnoid hemorrhage 19. Vascular - CVA, hemorrhage, aneurysm, TIAs 20. Degenerative - polio, ALS, Diabetes, MS, peripheral neuropathies. Usually slow and long term 21. Inflammatory - meningitis, abscesses, encephalitis 22. Cancerous - usually supratentorial in adults, but also infratentorial with 40% of brain tumors metastisized from elsewhere 23. Toxic - metabolic 24. Trauma - head injuries 25. Any combination of 10 through 15 |
|
|
26. Describe the Plum and Posner rostal-caudal progression findings.
|
??
|
|
|
27. Demonstrate an understanding of the classification of seizures and the pathophysiology of seizure disorders. P 502
|
Seizures represent a sudden, chaotic discharge of cerebral neurons, with transient alterations in brain function. Seizures may be generalized or focal. There are 3 categories of epileptic syndrome: location-related, generalized, and undetermined.
|
|
|
28. Describe the types of cerebral edema, the causes, manifestations, and complications. P. 524
|
Increase in fluid content of the brain resulting from infection, hemorrhage, tumor, ischemia, infarct, or hypoxia. Read.
|
|
|
29. Compare and contrast upper motor neuron disease with lower motor neuron disease. P. 531
|
Lower motor neuron syndromes manifest with impaired voluntary and involuntary movements. Upper motor neuron syndrome is characterized by paresis of paralysis, hypertonia, and hyperreflexia.
|
|
|
30. Define the different types of head injury with examples of the type of force needed to produce each. P 548
|
A. Closed versus Open
B. Causes C. Pathophysiology 1. Primary injury 2. Secondary injury 3. Tertiary injury D. Hematomas - act as expanding masses that increase ICP 1. Epidural a. Artery is the source of the bleed b. Mostly in temporal fossa c. Uncal and hippocampal herniation d. Clinical manifestations e. Diagnosis f. Treatment 2. Subdural a. Between dura and pia mater b. Tearing of veins c. Can be acute with rapid development or subacute with development from 2 days to 2 weeks. Chronic bleeds may not manifest themselves over weeks to months d. Usually frontal e. Clinical manifestations f. Diagnosis g. Treatment 3. Intracerebral - Bleeding within the brain tissue a. Clinical manifestations b. Diagnosis c. Treatment 4. Diffuse brain injury (diffuse axonal injury) a. Cause b. Sheering, stretching, or tearing of brain tissue c. Progression of axonal damage d. Categories of diffuse brain injury a. Mild concussion b. Classic concussion c. Mild DAI d. Moderate DAI e. Severe DAI e. Clinical manifestations of DAI f. Diagnosis g. Treatment |
|
|
31. Discuss the signs and symptoms of spinal cord injury in both the acute and the rehabilitative stage. P. 556
|
A. Cause
B. Pathophysiology 1. Microscopic hemorrhages in gray matter 2. Edema in white matter 3. Reduced vascular perfusion with ischemia 4. Decreased oxygen tension 5. Disrupture of myelin sheath, degenerations of axon, and ischemic endothelial injury 6. Release of chemicals and metabolites including free radicals 7. Sequence of healing C. Clinical Manifestations 1. Dependent on level of injury and extent of injury 2. Symptoms start at site of injury and extend to area below the site 3. Quadriplegia 4. Paraplegia 5. Spinal shock D. Autonomic Hyperreflexia 1. Occurs after spinal shock has resolved 2. Severe cardiovascular response to sympathetic stimulation i. Severe hypertension ii. Pounding headache iii. Blurred vision iv. Sweating above the level of the lesion with flushin v. Bradycardia (parasympathetic response related to baroreceptor stimulation) 3. Usually caused by a full bladder or stool in the rectum 4. Is life threatening 5. Treatment must be prompt - Remove stimulus, elevate head of bed, medications to decrease blood pressure. E. Evaluation and Treatment of Spinal Cord Injury F. Herniated Intervertebral Disk 1. Defined 2. Cause 3. Those most commonly affected 4. Pathophysiology 5. Clinical Manifestations 6. Evaluation and treatment |
|
|
32. Compare and contrast the pathophysiology and clinical manifestations of conditions which interrupt the flow of blood to the CNS. P. 585
|
6. Bacterial or purulent meningitis
a. Primarily an infection of the pia mater and arachnoid b. Enter by direct spread (sinus and ear infections, trauma) or by the way of the blood stream c. Organisms - Haemophilus in children, meningococcus and pneumococcus in adults d. CSF shows increased pressure, leukocytes, the organism, a low glucose, and high protein e. Pathophysiology i. Induction of the inflammatory response of the meninges ii. Meningeal vessels become hyperemic and permeable iii. Thickening of CSF by purulent exudate from the leaky blood vessels iv. Increased ICP related to swollen cells and the increasing exudate f. Signs and symptoms - fever, stiff neck, severe throbbing headache, Brukzinski's and Kernig's signs. Photophobia, projective vomiting, confusion, decreasing responsiveness g. Treat with vigorous antibiotic therapy h. Prevent with immunizations 7. Aseptic meningitis (viral)\ a. Enter by transnasal and or direct route b. Caused by herpes simplex, mumps, enteroviruses, arthropod viruses. c. Signs and symptoms are similar to bacterial, but more mild d. There is lymphocytic infiltration of the meninges and the brain with nodules, tissue necrosis, inclusion bodies, and reactive gliosis (overgrowth of glial cells). e. Treatment is supportive - Antibiotics to deter a secondary bacterial infection, antiviral medications, steroids, fluids 8. Brain Abscess a. The route of entry and the organisms involved are the same as meningitis. Associated with otitis media, sinus infections, open trauma, and lung abscesses. b. There is a local inflammatory process which leads to edema, hyperemia, softening, and petechial hemorrhage. c. There is pus filled cavitation d. Signs and symptoms include headaches, focal deficits, seizures, papilledema, herniation (from the abscess acting as a mass taking up space), vomiting, shaking chills, fever. e. Diagnosed by history, CT scan, MRI f. Treatments consists of surgical incision and drainage (controversial), antibiotics, and management of ICP by giving loop diuretics, steroids, mannitol |
|
|
33. Differentiate between the infectious processes occurring in the CNS, including CSF findings. P. 583
|
Can occur by bacteria, virusus, fungi, protozoans, and rickettsiae. The resulting infrection of bacterial infections is pus producing, or pyogenic.
|
|
|
34. Discuss the diseases of the CNS related to degeneration, heredity, infection, and autoimmunity. P 601
|
Read
|
|
|
36. escribe the six stages of nervous system development and give examples of disorders resulting from abnormal development of the system. P. 606
|
Develops from the ectoderm
Cranial end of tube forms the brain Rest of tube forms the spinal cord |
|
|
37. Compare and contrast the differences in growth and development of the nervous system between adults and children. P.609
|
????
|
|
|
38. Discuss the pathophysiology, clinical manifestations, treatment and prognosis of four congenital abnormalities of the CNS. P.609
|
A. Myelomeningocele (spina bifida cystica)
1. Defined 2. Clinical manifestations 3. Evaluation and treatment B. Spina Bifida Occulta 1. Defined 2. Abnormalities present C. Premature Closing of the Cranial Sutures (craniostenosis) 1. Pathophysiology 2. Clinical manifestations 3. Diagnosis and treatment D. Congenital Hydrocephalus 1. Related to a. Blockage in the ventricular system with obstruction of flow of CSF (most often the cause - atresia or blockage of the aqueduct drainage system) b. Imbalance in production of CSF c. Reduced reabsorption of CSF 2. Clinical Manifestations 1. Can cause fetal death 2. Cesarean section if head too large to deliver 3. No symptoms at birth with subsequent growth of head at an abnormal rate 4. Enlarging and bulging of fontanels 5. "Sunsetting" 6. Macewen sign (cracked pot sign) 7. Can't hold head up because of the weight 8. Prominent scalp veins 9. High pitched cry as ICP increases 10. Lethargy 11. Trouble eating 3. Diagnosis and Treatment 0. CT scan 1. MRI 2. Head circumference measurements 3. Surgical placement of a shunt |
|
|
39. Identify the cause, clinical manifestations, diagnosis and treatment of Cerebral Palsy. P.633
|
A. Cerebral Palsy
1. Defined 2. Major types 3. Pathophysiology a. Hypoxia b. Asphyxia c. Low birth weight d. Vascular abnormalities e. Physical trauma to nervous system 4. Clinical Manifestations a. Spastic CP b. Dyskinetic CP c. Ataxic CP d. Associated neurologic disorders |
|
|
40. Discuss the occurrence and causes of seizure disorders in children. P.637
|
A. Defined
B. Pathophysiology C. The reason seizure patterns may change with growth and development of the child D. Clinical Manifestations 1. Refer to the International Classification System in adult seizure material 2. Partial seizures a. Simple b. Complex 3. Generalized seizures 4. Infantile spasms 5. Lennox-Gastaut syndrome 6. Juvenile myoclonic epilepsy E. Diagnosis F. Treatment 1. Medications 2. Surgery - partial or complete severing of the corpus callosum 3. Ketogenic diet |
|
|
41. Describe the pathophysiology, clinical manifestations, and treatment of selected infectious disease of childhood. P.647
|
Read
|
|
|
42. Identify the common types of CNS tumors in children. P. 647
|
Childhood Tumors
A. Cause 1. Genetics, environment, immune factors 2. Parental employment 3. Alterations in embryonic development B. Types 1. Most are glial 2. 60% are infratentorial (compare with adult) C. Clinical Manifestations 1. Headache that is recurrent, progressive, frontal or occipital, worse on arising, worsened by lowering head, straining 2. Vomiting that is with or without nausea or presence of food, progressively more projectile, decreases as the day goes along and by moving about 3. Neuromuscular changes that include poor coordination, loss of balance, poor fine motor control, positive Babinski, spasticity in children > 1, paralysis 4. Behavioral changes - irritable, anorexia, fatigue, weight loss, lethargy, coma 5. Cranial nerve neuropathy - head tilt and visual defects 6. Vital sign disturbances - pulse and respirations decrease, blood pressure increases and pulse widens, hypo or hyperthermia 7. Other signs - seizures, cranial enlargement and bulging fontanels at rest in infants, nuchal rigidity, and papilledema D. Diagnosed by history and physical, CT scan, MRI, EEG, lumbar puncture unless signs of ICP. E. Treatment - Surgery, radiation, chemotherapy. X. Embryonal Tumors A. Neuroablastoma 1. Most common malignant tumor of infancy 2. Second only to brain tumors as the type of solid malignancy in children 10 years and younger 3. 50% of cases occur in children < 2 year of age 4. Arise from the neuronal crest that normally gives rise to the adrenal medulla and sympathetic ganglia so the majority of the tumors are of the adrenal gland or the retroperitoneal sympathetic chain 5. Is considered a silent tumor and most of the time it has metastasized to lymph nodes, bone marrow, skeletal system, skin, or liver when found 6. Clinical manifestations a. Abdominal mass that is firm, tender, irregular and crosses midline and compresses surrounding organs b. Increased catecholamines 7. Diagnosis a. History and physical b. CT scan c. MRI d. IVP to detect kidney involvement e. Urinary catecholamine tests 8. Treatment a. Accurate clinical staging b. Surgery to remove as much of the tumor as possible c. Radiation d. Chemotherapy which is the mainstay for extensive local or widely disseminated disease |
