Pathophysiology - Mid Term Exam Review Questions

What drugs affect pupillary reflexes?

a) miotic drugs -causes miosis or excessive constriction of the eye -Agents causing contraction of the pupil of the eye b) opiates -Most people who abuse these drugs or take them in high amounts will have pinpoint pupils that can last for several hours. Long-term intravenous abuse may even lead to blood clots in the eyes c) Cocaine/Meth/Marijuana use often causes dilated pupils d) Alcohol Someone who has been drinking in excess will often have eyes that have dilated pupils and delayed reaction times

Select all that apply a. What happens to the T lymphocytes when they travel to the thymus and differentiate? b. What do they differentiate into?

-first migrate to thymus gland where they: 1) divide rapidly and develop extensive diversity in their ability to react against different antigens a) CD4 (T-helper) - activated by antigen on MHC II molecules; can differentiate into: - T1H - macrophages and DCs produce IL-12 producing T1H - T2H - Mast cells and Tcells produce IL-4 incuding T2H; direct B lymphocytes to produce IgE antibodies b) CD8 (cytotoxic lymphocytes) - monitor activty of all cells in body and destroy anything that threatens integrity of body c) TREGS (T Regulatory Cells) - control immune system responses, inhibit proliferation of other potentially harmful self-reactive lymphocytes in order to limit inflammation and tissue damage 2) develop specificity against antigen 3) Once differentiation occurs, T-cells leave thymus gland and migrate via blood stream to lymphoid tissue a) differentiate into memory T cells and other mature lymphocytes upon encountering antigen

Be able to define the correct manifestation response pattern isolated in acute inflammation

-involves two major components; vascular, which leads to increase in blood flow and cellular stages causing migration of leukocytes 1) cardinal signs: pain, swelling, heat, redness, loss of function 2) exudate production -serous (water fluids low in protein content that result from plasma entering the inflammatory site -hemorrhagic (severe leakage of RBC from capillaries) -fibrinous (large amount of fibrinogen, thick and sticky meshwork) -membranous (composed of necrotic cells and fibrino purulent exodate) -purulent (suppurative exudate) (contains pus which is degraded WBC, proteins and tissue debris) 3) ulceration -site of inflammation where an epithelial surface has become necrotic and eroded, resulting in subepithileal inflammation 4) fever -occurs with widespread effects of inflammatory mediators, which produce fever and other systemic signs/symptoms

Child has fever and painful swelling in neck, Streptococcal infection. What is the problem?

-leukopenia -thrombocytopenia -lymphadenitis -neutropenia

Select all that apply? a. How is phantom limb pain treated?

-sympathetic blocks -TENS of the large myelinated afferents innervating the area -hypnosis -relaxation training -Mirror Therapy -Biofeedback, Integrative, and Behavioral Methods -Surgical Intervention -Electroconvulsive Therapy -Acetaminophen and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) -Opioids -Antidepressants -Anticonvulsants -Calcitonin

Select all that apply? a. What types of triggers set off trigeminal neuralgia?

-thought to be caused by demyelination of axons in the ganglion, root and nerve -consists of sharp, stabbing, pains without numbness in one or more nerve branches of CN V Triggers: -Hot, cold, spicy, or sour foods and beverages. Brushing your teeth. Gentle touch, including a breeze or face washing. -Hot or cold liquids and foods -Talking -Brushing your teeth -Gentle touch on your face -Smiling and laughing -Wind or a hair dryer blowing on your face -Shaving -Washing your face -Applying makeup

What is the earliest sign of decreased levels of consciousness

from powerpoint: •Earliest Signs •Inattention, mild confusion, disorientation, and blunted responsiveness the earliest signs of decreased level of consciousness include: 1.semicoma, pupil dilation 2.delirium, dementia 3.stupor, vomiting 4.restless, agitation (answer)

Disorders of the paramita tracks such as a stroke are characterized by what?

•Pyramidal Motor System •Originates in the motor cortex •Provides control of delicate muscle movement Disorders of the pyramidal tracts, such as a stroke, are characterized by: paralysis hypotonia muscle rigidity involuntary movements.

What pathogen causes infectious mono

-B-lymphotropic Epstein-barr virus (EBV) (member of herpes family) -few cases associated with cytomegalovirus (CMV) -The virus spreads through saliva, which is why it's sometimes called "kissing disease." -Mono occurs most often in teens and young adults. However, you can get it at any age. Symptoms of mono include: -Fever -Sore throat -Swollen lymph glands -Sometimes you may also have a swollen spleen. Serious problems are rare. -A blood test can show if you have mono. Most people get better in two to four weeks. However, you may feel tired for a few months afterward. Treatment focuses on helping symptoms and includes medicines for pain and fever, warm salt water gargles and plenty of rest and fluids.

If I were to remove part of the pre-frontal cortex or seizure disorder, which of the following effects could be seen or anticipated after surgery? a. What does pre-frontal cortex control

-Functionally, the pre-frontal cortex is thought to be involved in anticipation and prediction of consequences of behavior -Involved in Exectuve Function: 1) planning 2) decision making 3) problem-solving 4) self-control 5) acting with long-term goals in mind Damage to pre-frontal cortex: 1) deficits to executive functions 2) personality changes 3) abnormalities in emotional responses 4) general difficulty in functioning in daily life 5) poor performance in tasks that require long-term strategies 6) inhibition of impulses 7) short-term memory deficits 8) difficulties in planning -if you took away the pre-frontal cortex, you would be ruled by desires, impulses, lack an ability to plan for future or think about consequences of action

What is the definitive diagnosis of AIDS made based on laboratory data? a. How can we definitely say the client has developed AIDS?

-HIV infection progresses to AIDS when CD4 count less than 200cells/microL Lab counts -500~1500 CD4 for normal/recently infected person ~200-500 CD4 for Pre-Aids ~<200 for AIDS PCR very definitive in detecting HIV virus in body ELISA test very definitive in analysis of 96 samples for detection of HIV antibodies and antigens (surface proteins)

Client with poorly controlled low blood flow/hypertension and long history of smoking will exhibit psychomotor deficits; what are they? a. What type of brain damage is this likely the result of?

Answer is vascular dementia answer is located on page 474, not part of assigned reading credit for answer will be given on test

Female rheumatoid arthritis taking high doses of aspirin for several years to control inflammatory pain; what symptoms would this patient a) some drugs cause hearing issues; what symptoms indicated sucoming from odotoxicity from aspririn

Answer: "I've been getting dizzy and light-headed. I seem to have a constant ringing in my ear." A)"I can't go to the movies anymore. It's so noisy, I miss half the words." B)"I've been getting dizzy and light-headed. I seem to have a constant ringing in my ear." C)"I almost got hit by a garbage truck. I didn't hear its backup beeper." D)"When my grandchildren whisper, I can't hear a word they are saying."

What kind of blood gas would present with carpopedal spasm and respiratory rate of 28 (has answer)

Answer: respiratory alkylosis

How does botox work?

Blocks the calcium ion channels so acetylcholine cells become paralyzed Botox is a neurotoxin. These substances target the nervous system, disrupting the nerve signaling processes that stimulate muscle contraction. This is how the drug causes temporary muscle paralysis.

Signs/symptoms of Meniere's disesase

Definition -disorder of inner ear because of distention of the endolymphatic compartment of the inner ear Signs -"Classic Triad" - hearing loss, vertigo, and tinnitus -feelings of ear fullness -violent rotary vertigo that often renders a person unable to sit or walk; episodes of vertigo diminish, can be hard to walk and move around in the dark -fluctuating hearing loss, returns to normal after periodic episode -rotating nystagmus (rotating eyes) caused by an imbalance in vestibular control of eye movements; because initial sense of movement is unilateral and because sense of hearing is bilateral, most people not aware of extent of hearing loss Symptoms -pallor (unhealthy pale appearance) -sweating -nausea -vomitting Severe Manifestations -as disease progresses, hearing loss get worse -more severe the attack, more severe the autonomic response

Know what expressive aphasia is

Expressive aphasia, also known as Broca's aphasia, is a type of aphasia characterized by partial loss of the ability to produce language (spoken, manual, or written), although comprehension generally remains intact. A person with expressive aphasia will exhibit effortful speech.

Which area of the brain is responsible for respiration?

Medulla oblongata -primary respiratory control center; sends signals to muscles that control respiration that result in breathing Pons (just under MO) -controls rate or speed of involuntary respiration Cerebral Cortex (Motor Cortex) -controls voluntary respiration

What nitric oxide physiological effect on body is and be able to associate: a. Inhaling reduces vascular resistance (inhaling more effective, than oral route) b. Orally in form of nitroglycerine, what are the effects? c. What is the effect, what is it facilitating?

Nitroglycerine effects purpose is to relieve angina, improves hypoxemia associated with pulmonary hypertension, -vasodilator, reduces vascular resistance -smooth muscle relation -prevents platelet aggregation and adhesion -recruits leukocyte and mediates infection -forces degranulation (release of antimicrobial cytotoxic other other secretory vesicles; increases vascular permeability, local edema) -Inhaled NO improves oxygenation

Opioid receptors are concentrated in which region of the CNS?

Opioid receptors and opioid peptides are found on the peripheral processes of primary afferent neurons and in many CNS regions. Opioid receptors are expressed primarily in the cortex, limbic system, and brain stem. The μ-receptor The brain areas having this type of receptors include the medial thalamus, periaqueductal gray (PAG), median raphe, and clusters within the spinal cord -found in peripheral sensory neurons after inflammation, supports clinical use of locally applied opioids The δ-receptor They are predominantly found in forebrain structures such as the neocortex, striatum, olfactory areas, substantia nigra, and nucleus accumbens The κ-receptors found in the sub-cortical like, striatum and amygdala but additionally has a unique distribution in the hypothalamus and pituitory

If you were taking care of an AIDS population as nurses, what is the leading cause of death in that population?

TB remains the leading cause of death among people living with HIV, accounting for around one in three AIDS-related deaths.

Inflammatory mediators, what are they (has answers)

Test Question: Inflammatory mediators include (select all that apply)? Answer: all except endorphines --------------------------------------------------------------

Cellular regeneration T/F, what cells regenerate?

Test Question: Permanent cells, once damaged, can easily be regenerated and their functioned recovered? True/False? Answer: False Regenerative Cells -Labile cells are those that continue to replicate throughout life, replacing cells that are continually being destroyed -Stable cells are those that normally stop dividing when growth ceases; capable of regeneration when proper stimulus applied and can regenerate their tissue type a) parenchymal cells (specific organ cells) of liver and kidney b) smooth muscle cells c) vascular endothelial cells Non-regenerative cells -Permanent or fixed cells cannot undergo mitotic division; don't normally regenerate; once destroyed, they are replaced with fibrous scar tissue that lacks functionality a) nerve cells b) skeletal muscle cells c) cardiac muscle cells

Be able to identify the correct way in which to use antibiotics (has answer)

Test Question: Which of the following are true concerning antibiotic use? Answer: overzealous antibiotic use predisposes to the emergence of clinically important resistance patterns --------------------------------------------------------------

What pathogens do not fit the typical description of an organism? (has answer)

Test Question: Which of the following pathogens does not fit the description of an organism? Answer: viruses --------------------------------------------------------------

Fill in the blank Culture, isolation, and identification are an example of what to an infection? (Has answer)

Test Question: culture, isolation, and identification is an example of ___________ of an infection Answer: diagnosis --------------------------------------------------------------

Who would be the most likely to develop neuropathic pain?

The distal symmetrical polyneuropathy (DSPN) is the commonest clinical form of diabetic neuropathy, affecting more than 90% of the patients[3]. Generally, DSPN affects the toes and distal foot, but slowly progresses proximally to involve the feet and legs in a stocking distribution. -diabetes often causes length-dependent neuropathy

What are the assessment components when assessing a clients pain? From bone issues

Types acute pain - less than 6 months chronic - more than 6 months, loss of appetite, sleep disturbances, depression, and debilitating responses 1) nature 2) severity 3) location 4) radiation of pain 6) elimination of causes 7) History a) pain onset b) description, localization, radiation, intensity, quality, and patter of pain c) anything that relieves or exacerbates it d) personal reaction to pain Pain Quantification -numeric pain intensity (1-10) -visual analog (1-10 cm long, with no pain or most intense pain imaginable) -visual descriptor scales (0-4, none to severe) -verbal descriptor scales For bones -x-rays of areas of pain (identification of breaks, fractures and abnormalities) -CT scan, MRI, or bone scan of affected area (identification of tumors/abnormalities) -blood studies -urine studies -hormone level studies -pituitary and adrenal gland function studies

Status epilepticus results in death if not treated; what is the concern if patient is having uncontrolled seizures i.e. s. epilepticus)?

-If status epilepticus is caused by neurological or systemic disease, seizures probably will not respond until underlying cause has been corrected -status epilepticus is said to occur when a seizure lasts too long or when seizures occur close together and the person doesn't recover between seizures -The longer a seizure lasts, the less likely it will stops on its own without medication -It is important that these long seizures are identified early, so they can be treated early. Occurs when: -The active part of a tonic-clonic seizure lasts 5 minutes or longer. -A person goes into a second seizure without recovering consciousness from the first one. -A person has repeated seizures for 30 minutes or longer.

What is a late indicator of late intracranial pressure?

-Late signs of intracranial pressure that comprise Cushing triad include hypertension with a widening pulse pressure, bradycardia, and abnormal respiration. -The presence of those signs indicates very late signs of brain stem dysfunction and that cerebral blood flow has been significantly inhibited. -Cushing triad is a response triggered to increase arterial pressure to overcome increased intracranial pressure. -When that occurs, patients are often in a comatose state.

Select all that apply: a. Drug reaction, lytic drug reaction does what? b. How would you measure this drug reaction

-Lytic drug reactions can produce transient anemia (low RBCs and hemoglobin), leukopenia, or thrombocytopenia (low platelet levels), which often are corrected by the removal of the offending drug. -located under hypersensitivity II reactions -lyse, to destroy, lysis of specific cellular component of body, slide 10 of lecture, erythrocytes (RBC), stands to reason, lysis of RBC, select all that apply -low RBC, hemoglobin, increase in platelets (thrombocytes) -You would measure RBC/Hemoglobin count, WBC count and platelet count to detect total damage to these cells? -Do same count once drug is removed, periodically, to detect improvements

What hormone is responsible for blood clot development and control of blood flow with a laceration?

-Thromboxan (TxA2) -promotes vasoconstriction, bronchoconstriction, and promotes platelet function -prostaglandins (PGI2/PFG2A) also promote clotting/vaso/bronchoconstriction Platelet Activating Factor -generated from complex lipid stored in cell membranes, inducted platelet aggregation

pathology behind development of multiple sclerosis a. Know treatments and medications used for this treatment

-data suggests MS is an immune system response to CNS protein -MS lesions consist of hard, sharp-edged, demyelinated patches (plaques) that are visible throughout the white matter and occasionally in the gray matter of the CNS -plaques form on optic nerves, periventricular white matter, brain stem, cerebellum, and spinal cord white matter; active plaques display active demyelination -decrease in oligodendrocytes (a glial cell similar to an astrocyte but with fewer protuberances, concerned with the production of myelin in the central nervous system) Pathogenesis 1) first stage involves the sequential development of small inflammatory lesions 2) second stage - lesions extend and consolidate and when demyelination and gliosis (scar formation) occur -no known whether inflammatory process directed against myelin or oligodendrocytes that produce myelin in first stage of pathogenesis Categories 1) relapsing-remitting -episodes of acute worsening with recovery and stable course between relapses 2) secondary progressive disease -gradual deterioration with or without superimposed acute relapses in a person with pervious relapsing-remitting disease 3) primary progressive disease -characterized by nearly continuous nuerologic deterioration from onset of symptoms 4) progressive relapsing -involves gradual neurologic deterioration from onset of symptoms, superimposed relapses Treatment Minimally affected -no special treatment, encourages to maintain healthy lifestyle, good nutrition, adequate rest -physical therapy maintains muscle tone Medicines acute attacks or initial demyelinating episodes -corticosteroids a) reduce imflammation b) improve nerve conduction c) have immunological effects -plasmapheresis/intravenous immunoglobulin also beneficial modification of course of disease -interferon beta (immune enhancer) (injection) -glatiramer acetate (stimulates part of myelin basic protein; seems to block myelin-damaging T cells by acting as myelin decoy) (subcutaneous) -mitoxantrone (prevents ligation of DNA strands; delays cell cycle progression, has immunomodulatory properties) *all reduce exacerbations in people relapsing -humanized monoclonal antibody (suppresses leukocyte entry into the CNS, natalizumab, approved for relapsing-remitting MS treating symptoms of disorder -dantrolene (spasticity) -baclofen (spasticity) -diazepam (spasticity) -cholinergic (bladder problems) -antidepressant drugs (depression) -high-fiber (constipation)

Parasympathetic nervous system functions how?

-focuses on conservation of energy, resource replenishment, and storage, maintenance of organ function (rest/digest), 1) slows heartrate 2) stimulates gastrointestinal function and related glandular secretion 3) promotes bowel and bladder elimination' 4) contracts the pupils, protecting retina from excessive light during periods when visual function is not vital to survival Stimulates following organs: -heart -trachea -lungs -esophagus -stomach -small intestines -proximal half of colon -liver -gallbladder -pancreas -kidneys -upper portions of uterers

Know patho process of bacterial meningitis

-most cases caused by Streptococcus pneumoniae (pneumococcus) or Neisseria meningitidis (meningococcus) -neonates caused by group B streptococci -others that cause include: 1) gram-negative bacilli 2) Listeria monocytogenes Epidemiology 1) risks for infection include: head trauma with basilar skull fractures, otitis media, sinusitis or mastoiditis, neurosurgery, dermal sinus tracts, systemic sepsis and immunocompromise 2) occurs when people reside in close contact 3) very young and old people at high risk for pneumococcal strain Pathophysiology 1) bacteria replicates and undergoes lysis in central nervous system, releasing endotoxins or cell wall fragments 2) pathogens initiate release of inflammatory mediators, permitting pathogens, neutrophils, and albumin to move across capillary wall into CSF 3) as pathogens enter subarachnoid space, they cause inflammation and a cloudy, purulent exudate 4) vascular congestion and infarction in surrounding tissues may occur 5) meninges thicken and adhesions form; may impinge on cranial nerves, giving rise to cranial nerve palsies, impair CSF outflow, and can potentially cause hydrocephalus

What causes the reaction from contact dermatitis (poison ivy), specifically poison ivy, what is the physiological process after contact. What are the pathophysiological manifestations?

-occurs in two phases, sensitization and elicitation -usually confined to sites on skin that have come in direct contact with hapten (cosmetics, hair dyes, metals, topical drugs, plant oils) -Sensitization Phase 1) haptens captured by dendritic cells, which the migrate to regional lymph nodes and stimulate T-cell production 2) in conjunction with step 1, local keratinocytes sense haptens and initiate/amplify local immune response 3) reexposure results in rapid recruitment/activation of memory-specific Tcells Manifestations a) erythematous b) papular c) vesicular rash w/ intense pruritus and weeping d) affected area becomes swollen and warm, with exudate formation and crusting e) possible secondary infection possible f) symptoms usually appear 12-24 hours after exposure; reaction may last days to weeks

Conductive hearing loss caused by what?

-occurs when auditory stimuli are not adequately transmitted through the auditory canal, tympanic membrane, middle ear, or ossicle chain to the inner ear -temporary hearing loss can occur as result of impacted cerumen in the outer ear or fluid in the middle ear -foreign bodies, including pieces of cotton or insects, can impair hearing -more permanent causes - thickening or damage of the tympanic membrane or involvement of the bony structures (ossicles and oval window) of the middle ear because of otosclerosis or Paget disease Paget disease: Paget's (PAJ-its) disease of bone interferes with your body's normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, bones can become fragile and misshapen Causes External ear condition -otitis externa (external inflammation) -impacted earwax or foreign body Middle Ear conditions -trauma -otitis media (acute and with effusion (fluid in cavity) -otosclerosis (abnormal hardening of ear tissue) -tumors Mixed Sensorinueral/Conductive Hearing Loss Middle Ear -barotrauma (pressure injury) -cholesteatoma (abnormal, noncancerous skin growth) -otosclerosis Temporal Bone Fracture -no further information

Need to know reflex circuitry produced by the autonomic nervous system a. What does it do when its stimulated?

-organized in spinal cord and brain stem -hypothalamus serves as control center for ANS reflex functions. 1) Visceral -contain contributions from LMNs that innervate skeletal muscles as part of their response patterns -blood pressure -blood flow -body temperature -respiration -digestion -metabolism -elimination 2) Posterior hypothalamus -causes cardiovascular control centers to increase arterial blood pressure to more than twice the normal 3) Other hypothalamic center -control body temperature -increase salivation and gastrointestinal activity 4) Brain Stem -reflex adjustments of cardiovascular system and respiratory functions 5) Parasympathetic Fibers from Vagus Nerve -control bronchial smooth muscle tone -causes mild to moderate constriction of bronchioles 6) Spinal Cord -controlled by input of higher centers; reflexes occur at unregulated manner without communication a) uncontrolled sweating b) vasomotor instability c) reflex bowel and bladder function 7) Emotional -blushing -pallor -palpitations of the heart -clammy hands -dry mouth 8) Biofeedback/Relaxation Exercises -modify subconscious functions of ANS

How is HEP B acquired? (has test answer)

-passed from person to person through blood, semen or other body fluids Hepatitis B is not spread through sneezing, coughing, hugging, or breastfeeding. Although the virus can be found in saliva, it is not believed to be spread through kissing or sharing utensils. Sexual contact. You may get hepatitis B if you have unprotected sex with someone who is infected. The virus can pass to you if the person's blood, saliva, semen or vaginal secretions enter your body. Sharing of needles. HBV easily spreads through needles and syringes contaminated with infected blood. Sharing IV drug paraphernalia puts you at high risk of hepatitis B. Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood. Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. Talk to your doctor about being tested for hepatitis B if you are pregnant or want to become pregnant. Risk Factors -Have unprotected sex with multiple sex partners or with someone who's infected with HBV -Share needles during IV drug use -Are a man who has sex with other men -Live with someone who has a chronic HBV infection -Are an infant born to an infected mother -Have a job that exposes you to human blood -Travel to regions with high infection rates of HBV, such as Asia, the Pacific Islands, Africa and Eastern Europe

the function of somatic nervous system a. Know the principles of this nervous system

-provides central nervous system (CNS) with information on touch, temperature, body position, and pain Divided into three types: 1) General somatic afferent neurons -branches distributed throughout the body with distinct types of receptors for sensations, including pain, touch and temperature 2) Special somatic afferent neurons -have receptors located primarily in muscles, tendons, and joints 3) General visceral afferent neurons -receptors on various visceral structures that sense fullness and discomfort Three primary levels of neural integration 1) sensory units, which contain the sensory receptors 2) ascending pathways 3) central processing centers in the thalamus and cerebral cortex Transmission of information 1) First-order neurons -transmit sensory information from the periphery to the CNS 2) Second-order neurons -communicate with various reflex networks and sensory pathways in the spinal cord and travel directly to the thalamus 3) Third-order neurons -relay information from the thalamus to the cerebral cortex *sensory information is usually relayed and processed in a cephalad (toward the head) direction by the three orders of neurons Somatosensory Pathways The main somatosensory pathways that communicate with the cerebellum are the ventral (or anterior) and dorsal (or posterior ) spinocerebellar tracts. The ventral spinocerebellar tract will cross to the opposite side of the body then cross again to end in the cerebellum (referred to as a double cross). Other Facts -Sensory receptors housed in the dorsal root ganglia project to secondary neurons of the spinal cord that decussate and project to the thalamus or cerebellum. -Tertiary neurons project to the postcentral gyrus of the parietal lobe, forming a sensory homunculus. -A sensory homunculus maps sub-regions of the cortical postcentral gyrus to certain parts of the body. Functionality -In the periphery, the primary neuron is the sensory receptor that detects sensory stimuli like touch or temperature. The cell body of the primary neuron is housed in the dorsal root ganglion of a spinal nerve or, if sensation is in the head or neck, the ganglia of the trigeminal or cranial nerves. -The secondary neuron acts as a relay and is located in either the spinal cord or the brainstem. This neuron's ascending axons will cross, or decussate, to the opposite side of the spinal cord or brainstem and travel up the spinal cord to the brain, where most will terminate in either the thalamus or the cerebellum. -Tertiary neurons have cell bodies in the thalamus and project to the postcentral gyrus of the parietal lobe, forming a sensory homunculus in the case of touch. Regarding posture, the tertiary neuron is located in the cerebellum.

Strabismus (crossed eyes) how to tell the mom of kid, the best treatment for this issue; the most current treatment

-refers to abnormality of eye coordination or alignment that results in loss of binocular vision -when images from the same spots in visual space do not fall on corresponding points of the two retinas, diplopia, or double vision occurs -affects 4% of children younger than 6 years old Treatment 1) directed toward the development of normal vision acuity (the clarity or sharpness of vision) 2) correction of the deviation 3) superimposition of the retinal images to provide binocular vision -early treatment crucial; delay can result in amblyopia (lazy eye) or permanent vision loss -can have major effects on interpersonal relationships, self-image, schoolwork, participation in extracurricular activities -surgical and non-surgical methods 1) surgical infantile estropia (infant inward deviation) treated by weakening the medial rectus muscle on each eye while the infant is under anesthesia; multiple surgeries usually required 2) non-surgical includes glasses, occlusive patching, and eye exercises -glasses used for accommodative estropia (eye crossing that is caused by the focusing efforts of the eyes as they try to see clearly) -patching, overminus glasses, and eye exercises useful in treating intermitten exotropia (a condition in which there are times when one eye has drifted outwards, and other times when the eyes are straight) -vision therapy involves exercises to stimulate convergence (focusing on reading distant targets up to 30 minutes several times a day) and techniques to recognize suppressed images 3) injections -botulinum toxin type A (Botox) injected into extraocular muscle to prouce a dose-dependent paralysis of that extraocular muscle -botox injection shifts the eye into the field of action of the antagonist muscle -two or more injections may be required for lasting effect

What are early signs of presentation Duchene's muscular dystrophy

-signs of muscle weakness manifested by frequent falling usually become evident at 2 to 3 years of age -postural muscles of hips and shoulders are usually the first to be affected, followed by pseudohypertrophy of the calf muscles -Frequent falls -Difficulty rising from a lying or sitting position -Trouble running and jumping -Waddling gait -Walking on the toes -Large calf muscles -Muscle pain and stiffness -Learning disabilities -Delayed growth

what happens if someone has complete spinal transection at C5 and what would you expect as a nurse?

-will result in loss of full head and neck control; shoulder strength; elbow flexion --dressing and eating will be independent with assistance -elimination is maximal assistance -mobility will be electric or modified manual wheelchair; needs transfer assistance 1) deltoid and biceps function is spared, allowing full head, neck, and diaphragm control with good shoulder strength and elbow flexion 2) partial/full diaphragmatic function 3) ventilation is diminished because of loss of intercostal muscle function, resulting in shallow breaths and a weak cough 4) Below C5 level, ability to take deep breath and cough is less impaired

epidemiology of non-ulcerative inflammation of the cornea (keratitis); select all that apply

1) Contact lens wear is the major risk factor for microbial keratitis a) poor storage case hygiene b) infrequent storage case replacement c) overnight lens wear 2) eye trauma 3) chemical exposure 4) UV light exposure -estimated 930,000 doctor's office and outpatient clinic visits and 58,000 emergency department visits for keratitis or contact lens disorders occur annually -76.5% of keratitis visits result in antimicrobial prescriptions -Episodes of keratitis and contact lens disorders cost an estimated $175 million in direct health care expenditures, including $58 million for Medicare patients and $12 million for Medicaid patients each year -Bacterial keratitis -herpes simplex keratitis -acanthamoeba keratitis

Which of the following vision deficits are attributable to normal aging processes?

1) Presbyopia (changes in vision from aging) a) Cataract -lens opacity that interferes with transmission of light to the retina b) Dry Eyes -deterioration of tear film that protects and hydrates the surface of the eye -occurs from loss of reflex of lacrimal gland secretion c) Arcus senilis -extremely common, bilateral, benign corneal degeneration where a grayish-whte infiltrate, approximately 2mm wide, occurs at the periphery of the cornea -may represent an extracellular lipid infiltration; commonly associated with hyperlipidemia d) Decreased contrast sensitivity and color saturation e) Lens selectively absorbs more blue light f) Increased dark absorption threshold g) Increased light sensitivity h) age related macular degeneration -changes in the central portion of retina and results in loss of central vision

Immune deficiency disorders arise when? How do they arise?

1) Primary immunodeficiency disorders (PIDDs) -either congenital (at birth) or inherited as sex-linked, autosomal dominant/recessive traits -caused by genetic abnormalities of the immune system with over 130 distinct disorders a) Humoral deficiencies: -result of impaired differentiation and maturation of lymphoid stem cells in the bone marrow b) Cell-mediated -result from defective expression of the TCR complex, defective cytokine production, and defects in T-cell activation 2) Secondary immunodeficiency disorders -develop later in life because of other pathophysiological states a) Humoral -caused by malnutrition, burns, gastrointestinal loss, nephrotic syndrome, and malignancy and side effects to certain medications b) Cell-mediated -frequently associated with viral infections, directly infecting specific T-lymphocyte subpopulations 3) Manifestations -depend on immunodeficiency disorder and degree of immune system dysfunction

A client present with something in my eye, when question the client admits to scratching and burning and light sensitivity. what type of disease might this indicate with regards to inflammatory eye diseases

A client presents to the clinic complaining, "I have something in my eye." When questioned, the client admits to a scratching and burning sensation and light sensitivity. The health care provider suspects the client has developed: A) Conjunctivitis B) Retinal detachment C) Acute glaucoma D) Corneal edema Answer: conjunctivitis -------------------------------------------------------------- Context -one of the most common forms of eye disease -results from bacterial or viral infections, allergens, chemical agents, physical irritants, or radiant energy Manifestations -foreign body sensations -burning sensation -itching -photophobia -discharge/exudate may be present

What is the pathophysiology behind decline in function from alcohol ingestion? a. How does alcohol effect the brain?

Answer: difficulty walking, blurred vision, slurred speech, slowed reaction times, impaired memory 1) once alcohol ingested, it is absorbed through lining of stomach quickly, going into blood stream, immediate effects take around 10 minutes 2) alcohol interferes with brains communication pathways, effecting processing of information a) alters funtions in cerebral cortex, lowering inhibitions. jokes seem funnier, less afriad to do things outside of comfort zone, causes falling and slurred speech b) alters function in cerebellum causing movement and balance issues c) hypothalamus/amygdala affected, emotional reactions are altered, person begins to start acting on animal instincts, all parts of brain regulating human reasoning have gone off line d) effects brain stem, inducing sleep, causing irregular breathing and even seizures -sufficient quantities of alcohol can harm gastric mucosa, liver, developing fetus, and other organs; causes inflammation and release of free radicals disrupting cell activity, causing genetic mutations, cell death -suppresses the release of ADH which aids in water retention -alcoholism is a major cause of Hypophosphatemia from low levels of phosphate in blood a) weakness b) trouble breathing c) loss of appetite d) seizures e) coma f) softening of bones g) rhabdomyolysis -Can lead to polyneuropathy (demyelination of peripheral nerves leading to symmetric sensory, motor, or mixed sensorimotor deficits

What are the systemic manifestations of inflammation that may be present in an infection?

Answer: fever, leukocytosis or leukopenia, and the acute-phase response 1) Acute Phase Response (with hours/days) -changes in concentrations of plasma proteins -skeletal muscle catabolism -negative nitrogen balance -elevated RBC sedimentation rate (ESR) -increased numbers of WBC *all above in response to cytokine release -anorexia -somnolence -malaise -systemic inflammatory response syndrome (indicator of sepsis) a) generalized vasodilation b) increased vascular permeability c) intravascular fluid loss d) myocardial depression e) circulatory shock 2) White Blood Cell Response Viral Infections a) Lymphocytosis (increase of lymphocytes) b) Neutropenia (decrease in neutrophils Bacterial Infections a) Leukocytosis (increased WBC count) b) Neutrophilia (increase in neutrophils) Parasitic/Allergic Reactions a) Eosinophilia (increase in eosinophils) Overwhelming Infections/Immunosuppression a) Leukopenia (decrease in WBC) 3) Lymphadenitis -localized acute/chronic inflammation may lead to a reaction in the lymph nodes that drain the affected area -pain in lymph nodes typically associated with inflammatory processes/ non-pain likely associated with cancers (neoplasms)

What is rationale behind stroke team's restoration of cerebral perfusion?

Best outcomes are achieved when the aneurysm is secured early and prevention of complications initiated -salvaging brain tissues, preventing secondary stroke, and minimizing long-term disability are treatment goals of acute ischemic stroke; a small window exists to achieve these goals a) reversal of ischemic brain injury b) reperfusion techniques to salvage brain tissue, reverse brain injury c) Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored. -immediate transport to certified stroke centers the priority -Failure to restore blood flow creates a severe risk for future transient ischemic attacks. -Necrosis will continue unabated throughout the brain unless blood flow is restored. -Unless blood flow is restored, the patient faces the risk of progressing to hemorrhagic stroke.

A client has been open angel glaucoma during routine eye exam, proscribed beta adrenergic antagonist, how does the drug work?

Beta-adrenergic antagonists are used to treat high blood pressure, chest pain (angina), abnormal heart rate (arrhythmia), congestive heart failure, and several other conditions. They may also shrink certain types of vascular tumors, such as hemangiomas. Also called beta-adrenergic blocking agent and beta-blocker. 1) decrease myocardial oxygen requirements at rest and during exercise 2) works by blocking the neurotransmitters norepinephrine and epinephrine from binding to receptors. 3) preventing vasodilatation and reducing the speed and force of heart contractions

With a spinal injury and there is changes in distal forearm at 4th and 5th fingers, where would that injury be, select all that apply? a. Look at dermatome chart

C8 injury

What portion of the brain controls gait or movement a. Lesion in cerebellum, what would the issue be with this?

Cerebellum controls gait and movement Cerebellar lesions are most often associated with the clinical findings of -ataxia (lack of muscle control over voluntary movements), which may affect the limbs, trunk, or even speech (producing a specific type of dysarthria known as scanning speech), -dysequilibrium as manifested by a wide-based gait, and muscular hypotonia (decreased muscle tone) 1) loss of coordination of motor movement (asynergia) 2) the inability to judge distance and when to stop (dysmetria) 3) the inability to perform rapid alternating movements (adiadochokinesia) 4) movement tremors (intention tremor) 5) staggering, wide based walking (ataxic gait), 6) tendency toward falling 7) weak muscles (hypotonia) 8) slurred speech (ataxic dysarthria) 9) abnormal eye movements (nystagmus).

What was emphasized on presentation of pain that might indicate a myocardial infarction?

Chest pain is the most common presenting complaint of acute myocardial infarction. The classic manifestation of ischemia is usually described as a heavy chest pressure or squeezing, a "burning" feeling, or difficulty in breathing. The discomfort or pain often radiates to the left shoulder, neck, or arm. -jaw pain experienced by heart attack. •Referred Pain •Perceived site is different from its point of origin; i.e., jaw pain experienced by heart attack.

What principles should you choose when addressing pain control strategies in a child with a diagnosis with cancer?

Children feel pain, accurately report pain, and remember pain; evident in children with cancer, whose distress during painful procedures increases over time without intervention 1) overriding principle in all pediatric pain management is to treat each children's pain on an individual basis and to match the analgesic agent with the cause and level of pain 2) maintain balance such that pain relief is obtained with a little opioid and sedation as possible; regular dosing schedule helps achieve this 3) distraction can also be a great technique Diagnosis and Treatment of cancer same as adults

A 60 year old client of poorly controlled hypertension resulting in retinal detachment, what type is most likely to have experienced?

Choices a) Rhegmatogenous detachment b) Exudative retinal detachment c) Posterior vitreous detachment d) Traction retinal detachment Answer: Exudative retinal detachment -results from accumulation of serous or hemorrhagic fluid in the subretinal space due to severe hypertension, inflammation, or neoplastic effusions -usually resolves with treatment of underlying disease and without visual impairment

Know non-pharmacological components of pain control

Cognitive-Behavioral Interventions a) relaxation - slow, rhythmic breathing, brief jaw relaxation procedures b) distraction - focusing attention on other stimuli c) cognitive reappraisal - focusing on positive aspects of the experience vs. on pain imagery - using one's imagination to develop a mental picture meditation - self explanatory biofeedback - modification of body functions as a conscious level to include temperature, temporal artery pulsation, blood pressure, or muscle tension -taught before pain begins; should be used if person knows techniques after pain begins Physical Agents Heat -dilates blood vessels, increases blood flow, influences transmission of pain impulses and increases collagen extensibility -increased circulation reduces nociceptive stimulation by reducing local ischemia caused by muscle spasms or tension, increases removal of metabolites and inflammatory mediators, helps reduce swelling and relieves pressure on local nociceptive endings -may trigger release of endogenous opioids too much heat can result in tissue damage and pain Cold -vasoconstriction -alternating period of vasodilation (removes substances that stimulate nociceptive endings) -vasodil/constriction determined by body's determination of normal level of blood flow to prevent tissue damage -pain relief results from decreased swelling and decreased stimulation of nociceptive endings (constriction) Stimulus-Inducing Analgesia -electrical stimulation through TENS unit -electrical acupuncture TENS -neurostimulation through TENS Acupuncture -introducing needles into specific points on the surface of body to relieve pain Neurostimulation -delivers low-voltage electrical stimulation to spinal cord or targeted peripheral nerve to block sensation of pain -Melzack and Wall proposed that neurostimulation activated the body's pain-inhibiting system

Mutualism, what does it mean (has answer)

Context -one common misconception is that all interactions between microorganisms and humans are detrimental Definition -interaction in which both the microorganism and the host derive benefits from the interaction (test answer) Ex., certain inhabitants of the human intestinal tract extract nutrients from the host and secrete essential vitamin by-products of metabolism (Vitamin K) that are absorbed and used by the host

Cerebral Compliance (Disorder of Brain Functions)

Context -the brain is enclosed in rigid confines of the skull, making it susceptible to increases in intracranial pressure (ICP) -excessive ICP can obstruct cerebral blood flow, destroy brain cells, displace brain tissue and otherwise damage delicate brain structure -cranial cavity contains blood (~10%), brain tissue (~80%), and CSF (~10%) which contribute to ICP -normal ICP is around 0-15mmHg Definition: -Compliance is the brain's ability to maintain ICP during changes in intracranial volume -defined as ratio of change (Δ) in volume (V) to change in pressure (P): C = ΔV/ΔP Factors/Dynamics -increase in ICP will have little effect on ICP as long as compliance is high -compliance influenced by amount of volume increase, the time frame for accommodation, and size of compartments Ex. small volume increments over long time can be accommodated much easier than over short amount of time

Neutropenia means? How me as a nurse would response to this disorder?

Definition -decrease in neutrophils, a lot of times in response to viral infections Occurrence -acquired from birth or through autoimmune disorder or through response to therapeutic drugs (drug induced) Autoimmune Neutropenia -results from antibodies being directed against neutrophilic cell membrane antigens or bone marrow progenitors a) Primary: rare disorder of early childhood; usually a benign condition and rare in adults b) Secondary: associated with systemic autoimmune disorders Infection-Related Neutropenia -results from various forms of infections to include viral, bacterial, rickettsial, and parasitic, most common being viral Drug-Related -attributed to a number of drugs, to include those used in treatment of cancer -idiosyncratic reaction, or those that can't be explained in comparison to normal reactions can occur with drugs and their effects on neutrophil production Nursing Treatments -prevent further infections by avoiding unnecessary lines/drains/tubes, appropriate care and cleaning, discontinuing lines as soon as they are no longer needed; wear gowns when patients have respiratory secretions -promote oral care by regular flossing and brushing -promote hygiene -prevent skin breakdown -promote nutrition and ensure food is prepared and stored appropriately; low bacterial diets -educate on signs/symptoms of infection *research shows isolation does not necessarily prevent infection as patient's own body puts them at highest risk; avoid isolation as it will induce anxiety/depression

Types of herniations with traumatic brain injuries with 3 types of intracranial compartments (Disorder of Brain Functions)

Definition a displacement of brain tissue under the falx cerebri or through the tentorial notch or incisura of the tentorium cerebelli -occurs when an elevated ICP in one brain compartment causes displacement of the cerebral tissue toward an area of lower ICP •Divided by dural structures (tentorium structural framework and falx meningeal layer of dura mater)- Cerebellum and brainstem, Right and Left Cerebral hemispheres •When significant ICP and cerebral edema occur the brain can slide between openings in the dura, i.e., herniation 1) supratentorial herniations -occurs superior to the cerebellum 2) infratentorial herniations -occurs inferior to the cerebrum in the cerebellum area a) transtentorial (uncal) -A transtentorial herniation is the movement of brain tissue from one intracranial compartment to another. This includes uncal, central, and upward herniation. b) subfalcine -most common form of intracranial herniation and occurs when brain tissue is displaced under the falx cerebri. The cingulate gyrus is herniated under the falx, and if progression occurs, other areas of the frontal lobe are involved. c) central -is the subtype of downward transtentorial herniation of the brain that involves descent of the diencephalon and midbrain. It usually occurs with other types of downward herniation such as uncal herniation. d) updward transentorial -can occur when an infratentorial mass (eg, tumor in the posterior fossa, cerebellar hemorrhage) compresses the brain stem, kinking it and causing patchy brain stem ischemia. e) tonsillar Usually, the cause is an expanding infratentorial mass (eg, cerebellar hemorrhage), forcing the cerebellar tonsils, through the foramen magnum.

How do we resolve hydrocephalus

Definition: -abnormal increase in CSF volume in any part or all of the ventricular system -enlargement of the CSF compartment occurs 1) Communicating -decreased absorption of CSF 2) Noncommunicating -Overproduction of CSF Treatments 1) MRI and CT diagnose 2) post infancy shunting - provides alternative route for CSF to return circulation (non-communicating) 3) in utero/infancy shunting - diverts excess CSF, preventing extreme enlargement of head and neurological defects (non-communicating) 4) surgical decompression (endoscopic third ventriculostomy (ETV)/shunting (acute onset hydrocephalis) 5) cauterize tissue from choroid plexus in infants 6) large volume lumbar puncture b) elevating head of bed 30 degrees c) decreasing stimulation in environment to decrease intracranial pressure Context -A shunt is a flexible tube placed into the ventricular system of the brain which diverts the flow of CSF into another region of the body, most often the abdominal cavity, where it can be absorbed. A valve within the shunt maintains CSF at normal pressure within the ventricles. -endoscopic third ventriculostomy (ETV) is used to puncture a membrane in the floor of the third ventricle creating a pathway for CSF flow within the cavities in the brain. This approach is an important alternative to shunting for obstructive hydrocephalus and may be useful in other cases as well. -neurosurgeon uses a device to burn or cauterize tissue from the choroid plexus. The choroid plexus is a network of vessels in the ventricles of the brain where cerebrospinal fluid is produced. -A large volume lumbar puncture is a special kind of lumbar puncture (spinal tap) specifically intended to remove 30 to 40 ml of cerebrospinal fluid (CSF) to both assess and temporarily relieve symptoms of hydrocephalus.

How to treat hydrocephalus

Definition: -abnormal increase in CSF volume in any part or all of the ventricular system -enlargement of the CSF compartment occurs 1) Communicating -decreased absorption of CSF 2) Noncommunicating -Overproduction of CSF Treatments 1) MRI and CT diagnose 2) post infancy shunting - provides alternative route for CSF to return circulation (non-communicating) 3) in utero/infancy shunting - diverts excess CSF, preventing extreme enlargement of head and neurological defects (non-communicating) 4) surgical decompression (endoscopic third ventriculostomy (ETV)/shunting (acute onset hydrocephalis) 5) cauterize tissue from choroid plexus in infants 6) large volume lumbar puncture b) elevating head of bed 30 degrees c) decreasing stimulation in environment to decrease intracranial pressure Context -A shunt is a flexible tube placed into the ventricular system of the brain which diverts the flow of CSF into another region of the body, most often the abdominal cavity, where it can be absorbed. A valve within the shunt maintains CSF at normal pressure within the ventricles. -endoscopic third ventriculostomy (ETV) is used to puncture a membrane in the floor of the third ventricle creating a pathway for CSF flow within the cavities in the brain. This approach is an important alternative to shunting for obstructive hydrocephalus and may be useful in other cases as well. -neurosurgeon uses a device to burn or cauterize tissue from the choroid plexus. The choroid plexus is a network of vessels in the ventricles of the brain where cerebrospinal fluid is produced. -A large volume lumbar puncture is a special kind of lumbar puncture (spinal tap) specifically intended to remove 30 to 40 ml of cerebrospinal fluid (CSF) to both assess and temporarily relieve symptoms of hydrocephalus.

Diabetic and hypertensive retinopathy characterized by what?

Diabetic Retinopathy -Nonproliferative - confined to the retina a) engorgement of the retinal veins, thickening of the capillary endothelial basement membrane, and development of capillary microaneurysms b) small intraretinal hemorrhages may develop and microinfarcts may cause cotton wool spots and leakage of exudates c) macular edema d) sensation of glare -Proliferative - characterized by formation of new fragile blood vessels -vessels grow in front of the retina along the posterior surface of the vitreous or into the vitreous a) bleed easily b) retinal detachment from permanent blood vessel attachment and movement of retina c) blood leaks into vitrous causing deceased vision sharpness Hypertensive Retinopathy 1) Initial stage -general narrowing of retinal arterioles -vasospasms and increase in retinal arterial tone 2) persistant hypertension -results in thickening of arteriole walls, reducing capillary perfusion pressure 3) severe, chronic hypertension -disruption of blood-retina barrier -necrosis of smooth muscle and endothelial cells -exudation of blood and lipids -retinal ischemia -swelling of optic disk (indicates severely elevated blood pressure AKA malignant hypertension) *caused my retinal microaneurisms, intraretinal hemorrhages, hard exudates, cotton wool spots Key Takeaways -can be controlled if BP is controlled -major indicator of death from stroke independent of elevated blood pressure and other risk factors

Symptoms specifically of rejection of a liver organ, what would show as a graphed rejection? a. What types of elevations in labs would indicate this?

Graft Rejection of Liver Signs/Symptoms -fever greater than 100F -Jaundice - yellowing of skin/eyes -dark urine -itching -abdominal swelling or tenderness -fatigue -irritability -headache Labs indicating rejection -elevated immune system cells (WBCs) -presence of tissue damage from liver biopsy -elevated level of liver enzymes in bloodstream -elevated bilirubin -elevated alanine aminotransferase -elevated aspartate aminotransferase =elevated gamma-glutamyl transpeptidase -decrease in total protein Transplant Rejection (3 types) 1) cellular rejection -CD8 cells target MHC I molecules on surface of antigen presenting cells directly attacking graft tissue -CD4 cells recognize MHC II molecules, differentiate into T-helpers, release cytokine, influencing other cells to kill foreign tissue 2) antibody-mediated rejection (humoral rejection) a) hyperacute rejection (type III hypersensitivity) -preformed antibodies against HLA antigens are deposited in the tissue endothelium and microvasculature where they activate the classic compliment pathway causing tissue necrosis and graft injury b) acute antibody mediated rejection -over period of several days, high titers of complement-fixing antibodies are generated, causing injury to several mechanisms including complement-dependent cytotoxicity, inflammation, and ADCC c) chronic rejection -most often due to inability to maintain adequate immunosuppression necessary to control residual circulating antigraft T lymphocytes or antibodies. -manifests as result of vascular damage and impaired blood sypply

leukocytes and what they do

Granular Neutrophils (55-65%) AKA polymorphonuclear leukocytes; segmented neutrophils -responsible for maintaining normal host defenses against invading bacteria and fungi, cell debris, and a variety of foreign substances -have short life span of around 5 hours to approximately 4-5 days -release by bone marrow in response to acute systemic bacterial infections, mostly comprised of band cells (immature neutrophils) -band cells make up for depletions of mature neutrophils Eosinophils (1-3%) -reside primarily in tissues rather than within circulation -important host defense roles in: a) allergic reactions b) parasitic/worm infections c) chronic immune response such as asthma *increase in number with above infections -release histaminase (vasodilator) that inactivate histamine and other inflammatory substances; decrease severity of inflammatory responses Basophils (0.3-0.5%) -contain heparin, an anticoagulant, histamine a vasodilator, and other mediators of inflammation such as bradykinin and leukotrienes -involved in allergic and hypersensitivity reactions -enzymatically digest viruses Agranular (Mononuclear Leukocytes) -have finer granules and single-lobed nucleus Lymphocytes (20-30%) -main functional cells of immune system -move between blood and lymph tissue -defend against microorganisms in lymph nodes and spleen a) T lymphocytes (80% of lymphocytes) -differentiate in the thymus; activate other cells of the immune system (helper T cells) and are involved in cell-mediated immunity (cytotoxic T cells) b) Natural Killer (NK) cells (10% of lymphocytes) -participate in innate immune response/natural immunity and destroy foreign cells c) B lymphocytes (10% of lymphocytes) -differentiate to form antibody-producing plasma cells and are involved in humoral-mediated immunity Monocytes (3-8% WBC) -large amount of cytoplasm and dark-stained nucleus in the shape of a kidney -survive for months to years in the tissues; life span of circulating monocyte is 1-3 days -produced in bone marrow; after leaving vascular system and entering tissues they become Macrophages Macrophages (Differentiated from Monocytes) -known as histiocytes in loose connective tissue -known as microglial cells in the brain -known as Kupfer cells in the liver -other macrophages function in the alveoli, lymph nodes, and other tissues *monocytes and macrophages comprise the mononuclear phagocyte system (reticuloendothelial system) *primary role is host defense; engulf larger amounts of foreign materials in comparison to neutrophils *can convert to antigen-presenting cells under right conditions *play an important role in chronic inflammation -release cytokines -phagocytosis -antigen presenting cells

If assessing Gullain-Barre syndrome, what would be most important finding identifiable or concerned with?

Guillain-Barré Syndrome is characterized by weakness and flaccid paralysis that generally starts in the lower extremities and ascends; influenza-like illness before onset of symptoms -considered an acute immune-mediated polynueropathy (damaging of multiple nerves) -caused by infiltration of mononuclear cells around the capillaries of peripheral neurons, edema of the endoneurial compartment and demyelination of ventrail spinal roots •Immune mechanisms (Guillain-Barré syndrome) -paresthesia and numbness accompany loss of motor function other symptoms: -postural hypotension -arrhythmias -facial flushing -abnormalities of sweating -urinary retention is common -pain is common -rapid development of ventilatory failure and autonomic disturbances or it may present as a slow, insidious process -facial, oculomotor, bulbar weakness (brainstem weakness)

How does immunotherapy or allergy shots achieve a therapeutic effect?

IV Immunoglobulin (IVIG) -polled preparation of antibodies obtained from normal, healthy immune human donors -contains high titers of antibodies against specific pathogens, including Hep B, cytomegalovirus, rabies, and varicella-zoster virus -Cytokines -stimulate white blood cell replication, phagocytosis, antibody production, fever, inflammation, and tissue repair - all counteract infectious agents and hasten recovery Immunization -effectively reduces spread of vaccine-preventable illnesses Allergy shots -work like a vaccine. -Your body responds to injected amounts of a particular allergen, given in gradually increasing doses, by developing immunity or tolerance to the allergen -decreases sensitivity to allergens and often leads to lasting relief of allergy symptoms even after treatment is stopped

Identify response to an antigen a. Differentiate different types of immune responses

Innate (Inherited/Inborn/Non-specific) provides general, non-specific defense against anything not "self" Adaptive (Specific/Acquired) acts as specific defense against specific threatening agents a) natural - occurs from nondeliberate exposure to antigens b) artificial - occurs from immunization (deliberate exposure to antigens) -Natural and artificial immunity may be passive or active a) active - immune system responds to harmful agent regardless of whether it was natural or artificial; lasts longer than passive b) passive - developed when immunity from another individual is passed to an individual who was not previously immune; temporary but provides immediate protection 1) primary -initial encounter with specific antigen triggers formation and release of antibodies that reaches it peak in a few days 2) secondary -later encounter with same antigen triggers a much quicker response; B memory cells rapidly divide, producing more plasma cells and thus more antibodies Self/Non-Self Immunity 1) self markers molecules on surface of human cells that are unique to an individual, thus identifying as "self" to the immune system 2) Non-self markers molecules on the surface of foreign or abnormal cells or particles and identify the particle as "non-self" to the immune system 3) self-tolerance is the ability to attack abnormal or foreign cells but spare own normal cells

What molecules induce endothelial cell retraction?

Leukocytes activate endothelial cell signals that stimulate endothelial cell retraction during localized dissociation of the endothelial cell junctions Which of the following molecules will induce endothelial cell retraction? A. Omega-3 fatty acids B. Leukotrienes C. Histamine D. VCAM Answer: Histamine

When you are intervening with patient with ALS (amyotrophic) (Lou Gehrig disease), what is the priority intervention for the client?

Management of symptoms, nutritional status, and respiratory muscle weakness allow people with ALS to live longer. -Dysphagia with recurrent aspiration and weakness of the respiratory muscles produces the most significant acute complications of the disease -Riluzole decreases glutamate accumulation and prolongs survival no cure for ALS currently

Which of the following messages is most likely to be carried by general somatic efferent (GSE) neurons?

Messages carried: -touch, pressure, pain, and temp sensations -carry signals from embryonic somites to skeletal muscles -carries messages from viscera and innervate viscera

What characteristics would differentiate a migraine with or without an aura?

Migraine without aura -pulsatile, throbbing, unilateral headache that typically lasts 1 to 2 days and is aggravate by routine physical activity -nausea, vomitting, sensitivity to light/sound -visual disturbances commonly occur and consist of hallucinations such as stars, sparks, and flashes of light Migraine with aura -similar symptoms as non-aura migraine with addition of reversible visual symptoms -includes positive features (flickering lights, spots or lines) -negative features (loss of vision) -fully reversible sensory symptoms (positive - feeling of pins/needles or negative - numbness) -fully reversible speech/neurological symptoms aura typically develops over 5-20 mins; lasts 5mins-hr; can appear before attack when aura doesn't occur; fatigue and irritability can last for hours/days after headache

Know the pain theories; specifically what theory proposes what receptors share what pathway with other sensory modalities

Pattern theory -group of theories that propose pain receptors share pathways with other sensory modalities but different patters of activity signal painful versus nonpainful stimuli Ex. light touch produces low frequency firing, intense pressure produces pain through high-frequency firing of the same receptor Specificity theory -regards pain as separate sensory modality evoked by the activity of specific receptors that transmit information to forebrain regions where pain is experienced -predicts how painful a specific acute injury may be, but does not encompass how the pain feels or how the person has experienced pain in the past gate control theory (1965 Melzack and Wall) -presence of neural gating mechanisms at the segmental spinal cord level to account for interactions between pain and other sensory modalities -proposed a spinal cord-level network of projection cells and internuncial neurons, forming a segmental-level gating mechanism that could block projection of pain information to the brain -internuncial neurons activated by large-diameter, faster-propagating fibers that carry tactile information Neuromatrix theory -brain contains a widely distributed neural network, the bodyself neuromatrix, that contains somatosensory, limbic and thalamocortical components. -sources a) somatosensory inputs b) other sensory inputs affecting interpretation of the situation c) phasic and tonic inputs from the brain addressing such things as attention, expectation, culture, and personality d) intrinsic neural inhibitory modulation e) various components of stress regulation systems

What metabolic factors cause vasodilation or dilatation of cerebral vessels?

Regulation of blood flow to the brain is controlled largely by autoregulatory or local mechanisms that respond to the metabolic needs of the brain (Cerebral autoregulation) -CO2, H+, and O2 affect cerebral blood flow a) increased CO2 provides stimulus for vasodilation - doubling PCO2 in the blood doubles cerebral blood flow b) increased H+ increased cerebral blood flow to wash away the neurally depressive acid materials c) decreased O2 also increased cerebral blood flow -deep cerebral blood vessels appear to be completely controlled by autoregulation -superficial/major cerebral vessels innervated by sympathetic nervous system

the pathophysiological effects of spina bifida?

Spina bifida is a birth defect that occurs when the spine and spinal cord don't form properly. It's a type of neural tube defect. The neural tube is the structure in a developing embryo that eventually becomes the baby's brain, spinal cord and the tissues that enclose them. Spina bifida occulta results in a small separation or gap in one or more of the bones of the spine (vertebrae). -Many people who have spina bifida occulta don't even know it, unless the condition is discovered during an imaging test done for unrelated reasons. Myelomeningocele known as open spina bifida, myelomeningocele is the most severe type. -The spinal canal is open along several vertebrae in the lower or middle back. -The membranes and spinal nerves push through this opening at birth, forming a sac on the baby's back, typically exposing tissues and nerves. -This makes the baby prone to life-threatening infections and may also cause paralysis and bladder and bowel dysfunction. 1) The spinal canal remains open along several vertebrae in the lower or middle back 2) Both the membranes and the spinal cord or nerves protrude at birth, forming a sac 3) Tissues and nerves usually are exposed, though sometimes skin covers the sac Issues associated with condition 1) Walking and mobility problems -The nerves that control the leg muscles don't work properly below the area of the spina bifida defect. This can cause muscle weakness of the legs and sometimes paralysis 2) Orthopedic complications -Curved spine (scoliosis) -Abnormal growth -Dislocation of the hip -Bone and joint deformities -Muscle contractures 3) Bowel and bladder problems -Nerves that supply the bladder and bowels usually don't work properly when children have myelomeningocele. This is because the nerves that supply the bowel and bladder come from the lowest level of the spinal cord. 4) Accumulation of fluid in the brain (hydrocephalus) 5) Chiari malformation type I -The brainstem, or lowest part of the brain above the spinal cord, is elongated and positioned lower than usual. This can cause problems with breathing and swallowing 6) Infection in the tissues surrounding the brain (meningitis) 7) Tethered spinal cord -results when the spinal nerves bind to the scar where the defect was closed surgically. The spinal cord is less able to grow as the child grows. This progressive tethering can cause loss of muscle function to the legs, bowel or bladder 8) Sleep-disordered breathing 9) Skin problems -may get wounds on their feet, legs, buttocks or back. They can't feel when they get a blister or sore. Sores or blisters can turn into deep wounds or foot infections that are hard to treat 10) Latex allergy -can result in anaphylaxis or allegic outbreaks 11) Other complications -urinary tract infections, gastrointestinal (GI) disorders and depression. Children with myelomeningocele may develop learning disabilities, such as problems paying attention, and difficulty learning reading and math.

Know how a patient that has Alzheimer's moves from initial to more advanced stages a. Criteria that identifies each stage of this disorder

Stage 1 (no impairment) -forgetfulness; memory domain affected Stage 2 (very mild decline) -occasional short term memory -occasional aphasia -memoray and language domains affected Stage 3 (mild decline) -memory, language and complex attention domains affected -short term memory, name recall -occasional aphasia -concentration issues Stage 4 (moderate decline) -short term memory -episodic long term memory issues -aphasia issues -difficulty completing multitask steps -memory, language, complex attention, and executive functioning affected Stage 5 (moderately severe decline) -disoriented to time and place -more long term memory deficits -difficulty dressing appropriately -memory, language, attention, executive function, and perceptual motor functioning affected Stage 6 (severe decline) -disoriented to person, time and place -more profound episodic long term mem issues -reversed sleep pattern -loss of bladder and bowel control -enhancement of previously suppressed personality characteristics -paranoid delusions -memory, language, attention, executive function, perceptual motor and social cognition functioning affected Stage 7 (very severe decline) -unresponsive -loss of motor control -abnormal reflexes -difficulty swallowing -death -memory, language, attention, executive functioning, perceptual motor and social cognition Progression -cortical atrophy (PCA) refers to gradual and progressive degeneration of the outer layer of the brain (the cortex) in the part of the brain located in the back of the head (posterior) -loss of neurons, particularly in parietal and frontal lobes -other causes of progression may include: 1) decreased cholinergic and glutamatergic transmission in the brain associated with cognitive impairments 2) neurotransmitter disruption 3) oxidative stress 4) neuroinflammation Classical neuropathological findings -neurofibrillary tangles and amyloid (neuritic) plaques -widespread cellular degeneration and diffuse synaptic and neuronal loss, and neurofibrillary tangles (resistant to chemical and enzymatic breakdown) -plaques build up caused by imbalance between production and removal of Aβ

Cytokines that affect hematopoiesis in bone marrow are called colony stimulating factors based on their ability to do something; what is it that they do? (has answer)

Test Question: Cytokines that affect bone marrow are called CSFs based on their ability to Answer: Regulate blood cells --------------------------------------------------------------

Epidemiology is refers to what in regards to infectious disease? (Has answer)

Test Question: Epidemiology refers to an _______ of an infectious disease: the portal of entry, site of infection, and virulence factors Answer: incidence and prevalence ----------------------------------------------------------- Definition study of disease occurrence in human populations -initially developed to explain spread of infectious diseases during epidemics and has emerged as science to study risk factors for multifactorial diseases, such as heart disease and cancer -looks for patterns of people affected with a particular disorder, such as age, race, dietary habits, lifestyle, or geographic location -used to determine how a disease is spread, how to control it, how to prevent it, how to eliminate it -studies the natural history of disease to evaluate new preventative and treatment strategies, to explore the impact of different patterns of health care delivery, and to predict future healthcare needs -serve as basis for clinical decision making, allocation of health care dollars, and development of policies related to public health issues

What is a eukaryote or eukaryotic cell? (Has answer)

Test Question: Fungi and parasites are examples of? Answer: Eukaryotic cells -------------------------------------------------------------- definition a cell that contains membrane-bound organelles and a nucleus. -organisms based on eukaryotic cell are protozoa, fungi, plants and animals -these organisms are grouped under the biological domain Eukaryota -larger and more complex than prokaryotic cells -doesn't have a cell wall, but a semipermeable cell membrane or phospholipid bilayer prokaryotic cells -no membrane bound organelles -free floating DNA in cytoplasm

A systemic manifestation of an infection, acute phase response, includes what and what doesn't it include? (Has answer)

Test Question: Identify the correct manifestation response pattern isolated in acute inflammation Answer: vasodilation, increased capillary permeability, and influx of neutrophils. *all answers very similar, be careful Test Question: Systemic manifestations of infection in the acute phase response include all of the following except: Answer: Lethargy -------------------------------------------------------------- -Begins within hours or days of the onset of inflammation or infection and is self-limiting -Granulocytes respond to acute phase response, where as in chronic infection mononuclear cells (lymphocytes and macrophages) respond -response brought on by release of cytokines, particularly IL-1, IL-6, and TNF-a, which stimulate hypothalamus to produce fever (most obvious sign of acute-phase response) -also orchestrated by endothelial cells that line blood vessels, phagocytic leukocytes and tissue cells that direct the tissue responses -serves to coordinate the various changes in the body function to enable an optimal host response -involves hemodynamic phased during which blood flow and capillary permeability are increased and a cellular phase during which phagocytic WBCs move into the area to engulf and degrade the inciting agent -includes changes in: -production of exudates containing serous fluid (serous exudate) -red blood cells (hemorrhagic exudate) -fibrinogen (fibrinous exudate) -tissue debris and white blood cell breakdown products (purulent exudate -the concentrations of plasma protein (i.e. acute-phase proteins) -skeletal muscle catabolism -negative nitrogen balance -elevated erythrocyte sedimentation rate (ESR) -increased numbers leukocytes (elevated WBC) Other manifestations -anorexia -somnolence (state of strong desire for sleep, or sleeping for unusually long periods (compare hypersomnia) -malaise (a general feeling of discomfort, illness, or uneasiness) Metabolic Changes -skeletal muscle catabolism (breakdown), were amino acids are retrieved and used in immune response for tissue repair

What is the function of MHC molecules? (Has answer)

Test Question: The function of MHC molecules is to mark foreign proteins, rendering them antigenic. T/F? Answer: False -------------------------------------------------------------- Context -in order for adaptive immune response to function properly, it must be able to discriminate between molecules that are native to the body and those that are foreign or harmful -T lymphocytes are designed to response to a limitless number of antigens, but at the same time, need to be able to ignore self-antigens expressed on tissues -MHC molecules enable lymphocytes to do just this Definition -large cluster of genes located on short arm of chromosome -occupies approximately 4 million base pairs and contains 128 different genes, only some of which play a role in immune response -Divided into 3 classes, I, II, III based on function -each person has unique MHC profile based on amount of MHC genes and possibility for several alleles of each gene MHC Type I -responsible for encoding human leukocyte antigens (HLAs), which are proteins found on cell surfaces and define the person's tissue type -present on cell surface glycoproteins that form the basis for human tissue typing -contains groove fitted for peptide fragments -interact with cytotoxic T cells (CD8) and activate them when presented with a foreign antigen peptide -can present degraded viral protein fragments from infected cells -found on almost all nucleated cells in body and capable of signaling to immune system in response to all types of cellular changes -Restrict cytolysis to virus-infected cells, tumor cells, and transplanted cells HLA antigens: HLA-A, HLA-B, HLA-C MHC Type II -responsible for encoding human leukocyte antigens (HLAs), which are proteins found on cell surfaces and define the person's tissue type -present on cell surface glycoproteins that form the basis for human tissue typing -found only on phagocytic antigen presenting cells (APCs), immune cells that engulf foreign particles including bacteria, and other microbes. This includes macrophages, dendritic cells (DCs), and B lymphocytes, which communicate with the antigen receptor and CD4 molecules on T-helper lymphocytes -Present processed antigenic fragments to CD4 T Cells necessary for effective interaction among immune cells -have groove or cleft that binds a fragment of antigen from pathogens that have been engulfed and digested during process of phagocytosis; Type I signal presence of pathogen prior to phagocytosis -engulfed pathogen degraded into free peptide fragments within cytoplasmic vesicles and complexed with MHC II molecules on surface of cells; T-helper cells recognize these complexes of APCs and become activated MHC Type III -encode for many of the components of the complement system and plan an important role in the innate immune response

Pick all of the following except question: Defense mechanisms of the respiratory track includes what? (Has answer)

Test Question: The multi-tiered defense response of the respiratory tract includes all the following except Answer: epithelial cells --------------------------------------------------------------

What are symptoms of an infection obvious or apparent?

Test Question: The symptoms of an infection are always obvious and apparent, T/F? Answer: False -------------------------------------------------------------- Symptoms -localized redness, heat, swelling and pain -inflammation -may be specific and reflect the site of infection (e.g. diarrhea, rash, convulsions, hemorrhage, and pneumonia) -The classic symptoms of a bacterial infection are localized redness, heat, swelling and pain. One of the hallmarks of a bacterial infection is local pain, pain that is in a specific part of the body -very obvious with diseases such as chickenpox or measles Convert Symptoms -increased WBC count, will require labs to detect Non-diverse, shared by many infections -fever -headache -lethargy

Viral replication, can it occur inside or outside of a living cell? (Has answer)

Test Question: Viruses can replicate outside of the living cell. True or False? Answer: False -------------------------------------------------------------- -viral replication can't occur outside outside of cells Process -must penetrate a susceptible living cell and use the biosynthetic structure of the cell to replicate -not every viral agent causes lysis and death of the host cell during course of replication -some viruses enter host cell where it remains in a latent, nonreplicating state for long periods of time without causing disease; then causes disease month/years later

What promotes wound healing?

Test Question: What promotes wound healing Answer: increased blood flow and delivery Objective to fill the gap created by tissue destruction and to restore the structural continuity of the injured part Key Facts -injured tissue repair occurs through regeneration of parenchymal cells (organ specific cells) or by connective tissue repair in which scar tissue is substituted for the parenchymal cells of the injured tissue -when regeneration can't occur, scar tissue fills gap created by tissue death, but does not repair the function of the previous structure that died -Labile cells are those that continue to replicate throughout life, replacing cells that are continually being destroyed Regulatory Factors -healing regulated by actions of chemical mediators (cytokines) and growth factors, released by cells participating in tissue regeneration and healing process they mediate the healing process as well as orchestrate the interactions between the ECM and cell matrix Chemical Mediators include: a) Interleukins (IL) b) interferons c) tumor necrosis factor alpha (TNF-a) d) arachidonic acid derivatives (prostaglandins and LT) *all take part in inflammatory process Growth Factors -hormone-like molecules that interact with cell surface receptors to control processes involved in tissue repair and wound healing -Growth factors named for tissue of origin, biological activity, or cells on which they act -control proliferation, differentiation, and metabolism of cells during wound healing -assist in regulating the inflammatory process, serve a chemo attractants for neutrophils, monocytes (macrophages), fibroblasts, and epithelial cells; stimulate angiogenesis, and contribute to the generation of the ECM Phases 1) Inflammatory Response -begins at time of injury with blood clot and migration of phagocytic WBC into wound site -bacteria and debris removed -macrophages produce growth factors for proliferative phase 2) Proliferative Phase -new tissue is built to fill wound gap -fibroblasts, a key to this phase, synthesize and secrete collagen, proteoglycans, and glycoproteins needed for wound healing -fibroblasts also produce growth factors and induce angiogenesis (growth of new blood vessels) and endothelial cell proliferation and migration -epithelialization occurs, creating new surface layer that is similar to one that was destroyed previously 3) Wound Contraction and Remodeling Phase -begins around 3 weeks after injury through development of fibrous scar and continues for 6 months or longer, depending on extent of wound -decrease in vascularity and continued remodeling of scar tissue through synthesis of collagen by fibroblasts and lysis by collagenase enzymes -end result - scar is capable of increasing its tensile strength and shrinks so its less visible

What happens to immune system with aging

The immune system becomes less able to distinguish self from nonself (that is, to identify foreign antigens). As a result, autoimmune disorders become more common. Macrophages (which ingest bacteria and other foreign cells) destroy bacteria, cancer cells, and other antigens more slowly. -The immune system becomes less able to distinguish self from nonself (that is, to identify foreign antigens). As a result, autoimmune disorders become more common. -Macrophages (which ingest bacteria and other foreign cells) destroy bacteria, cancer cells, and other antigens more slowly. This slowdown may be one reason that cancer is more common among older people. -T cells (which remember antigens they have previously encountered) respond less quickly to the antigens. -There are fewer white blood cells capable of responding to new antigens. Thus, when older people encounter a new antigen, the body is less able to remember and defend against it. -Older people have smaller amounts of complement proteins and do not produce as many of these proteins as younger people do in response to bacterial infections. -Although the amount of antibody produced in response to an antigen remains about the same overall, the antibodies become less able to attach to the antigen. This change may partly explain why pneumonia, influenza, infective endocarditis, and tetanus are more common among older people and result in death more often. These changes may also partly explain why vaccines are less effective in older people and thus why it is important for older people to get booster shots (which are available for some vaccines). -6These changes in immune function may contribute to the greater susceptibility of older people to some infections and cancers.

Intracranial volume, brain tissue, volume, CSF; out of these things, what is most capable for compensating for increased intracranial pressure?

The intracranial volume that is most capable of compensating for increasing intracranial pressure is the: brain cell tissue intravascular blood surface sulci fluid cerebrospinal fluid (answer)

Emotional experiences come from what part of the brain?

The limbic system is a group of interconnected structures located deep within the brain. It's the part of the brain that's responsible for behavioral and emotional responses. Hypothalamus. In addition to controlling emotional responses, the hypothalamus is also involved in sexual responses, hormone release, and regulating body temperature. Hippocampus. The hippocampus helps preserve and retrieve memories. It also plays a role in how you understand the spatial dimensions of your environment. Amygdala. The amygdala helps coordinate responses to things in your environment, especially those that trigger an emotional response. This structure plays an important role in fear and anger. Limbic cortex. This part contains two structures, the cingulate gyrus and the parahippocampal gyrus. Together, they impact mood, motivation, and judgement.

Nociceptors are activated by what?

The receptors for pain (nociceptors) are free nerve endings -they are activated in response to actual or impending tissue injury, nociceptive pain is the consequence; chemical, thermal, and chemical stimuli activate receptors -Once stimulated (trauma, ischemia, inflammation) chemical mediators are released from injured tissue and sensitize nociceptors -composed of first, second, and third-order neurons a) first order detect stimuli that threaten the integrity of innervated tissues b) second-order located in spinal cord and process nociceptive information c) third-order project pain information to the brain -the thalamus and somatosensory cortex integrate and modulate pain as well as the person's subjective reaction to the experience -nociceptive simulation activates C fibers to cause neurogenic inflammation, producing vasodilation and increased release of chemical mediators to which nociceptors respond

Identify hypersensitivity reaction types

Type I: reaction mediated by IgE antibodies. -involves the activation of mast cells or basophils through the binding of antigen receptors to IgE on the cell surface -release of these mediators causes redness, swelling, itching, mucus, ect -most are localized reactions due to inhaled or ingested antigens -severe reactions can be fatal with loss of BP and breathing issues (anaphylactic shock) usually due to animal venoms or certain foods Type II: cytotoxic reaction mediated by IgG or IgM antibodies. -involves destruction of cells bound by IgG or IgM antibodies vie the activation of complement -most commonly observed with blood transfusions; symptoms occur over hours Type II: Drug-Induced reaction -involves drugs that bind to surface of cells -can stimulate humoral immunity -antibody binding triggers complement activation, lysis of cells binding the drug Type III: reaction mediated by immune complexes. -caused by high levels of antigen-antibody complex's not cleared efficiently by phagocytes and tend to deposit in certain tissues -can result in local cell damage Type IV: delayed reaction mediated by cellular response. -antigens active Tc that kill target cells Ex. rejection of transplanted tissues, contact dermatitis (poison ivy), certain chronic disease like TB

How would a vistibulo cerebellar disorder present itself/clinical manifestation, what kind of disorder in this part of the brain?

Vestibulocerebellar Pathway -functions in close association with brain stem vestibular nuclei to maintain equilibrium and posture Disorder damage to the cerebellar area by congenital defect, vascular accident or growing tumor -visual monitoring of movement cannot compensate for cerebellar defects, and the abnormalities occur whether the eyes are open or closed Manifestations -difficulty or inability to maintain a steady posture of the trunk; can be so severe that standing is not possible -fixing eyes on targeting can also be issue; results in constant readjustment (nystagmus) making reading extremely difficult

Which hematopoiesis growth factor has been cloned to produce a protein to treat anemia of kidney disease and cancer?

Which of the following genes for the hematopoietic growth factors has been cloned and its recombinant protein is now used to treat anemia of kidney failure and cancer? A)Epogen (EPO) B)Immunoglobulin genes C)Monoclonal immunoglobulin D)Interleukins (IL-3) Answer Epogen

What are clinical manifestations of upward herniation from midbrain infratentorial compartment a. Select all that apply for this

a, c, e Infratentorial herniation results from increased pressure in the infratentorial compartment. Herniation may occur superiorly (upward) through the tentorial incisura or inferiorly (downward) through the foramen magnum. The most prominent signs of upward herniation include immediate onset of deep coma; small equal, fixed pupils; and abnormal respirations (slow rate with intermittent sighs or ataxia) and other vital signs. Downward displacement of the midbrain through the tentorial notch or of the cerebellar tonsils through the foramen magnum can interfere with medullary functioning and cause cardiac or respiratory arrest. Tissue infarction and intracranial bleeding are causes of cerebral edema, rather than an outcome of herniation. Rhythmic movement of arms and legs could be caused by many things and is not specific to infratentorial herniation. A) Deep coma B) Rhythmic movement of arms and legs C) Respiratory rate of 8 with intermittent sighs D) Intracranial bleeding from nose and ears E) Bilateral small, fixed pupils

What happens in car accident to the brain with acute acceleration/deceleration type forces?

because brain floats freely in the CSF, blunt force to the head accelerates abruptly upon hitting the inner skull surfaces •The brain floats freely in the CSF; blunt force to the head accelerates the brain within the skull, and then the brain decelerates abruptly on hitting the inner skull surfaces. •Coup—direct contusion of the brain at the site of external force •Contrecoup—rebound injury on the opposite side of the brain -direct contusion of the brain at the site of external force is a coup injury; the rebound injury on the opposite side of the brain is the contrecoup injury -results in bruised/torn: 1) brain tissue 2) blood vessels 3) nerve tracts 4) sometimes skull fracture *results in contusions/hematomas Primary injuries from damage of impact -contusion -laceration -hemorrhage -concussion -diffuse axonal injury Secondary injuries from brain swelling, infection, hypoxia -edema -infection -hypoxic brain damage Post concussion syndrom •Concussion refers to "an immediate and transient loss of consciousness accompanied by a brief period of amnesia after a blow to the head." •Recovery usually takes place in 24 hours. •Mild symptoms may persist for months: •Headache •Irritability •Insomnia •Poor concentration and memory TBIs •Epidural Hematoma •Usually caused by head injury in which the skull is fractured •Accumulation of blood between the dura matter (tough outer membrane covering the brain), and the skull. •Subdural Hematoma •Usually is the result of a tear in the small bridging veins that connect veins on the surface of the cortex to dural sinuses •Develops in the area between the dura and the arachnoid (subdural space) •Traumatic Intracerebral Hematomas •May be single or multiple •Occur in any lobe of the brain but are most common in the frontal or temporal lobes.

Know what happens below the site of a complete transection of spinal cord injury, what physiological changes occur

complete transection (what occurs below site of injruy) -results in complete loss of motor, sensory, reflex, and autonomic function below the level of the injury (spinal shock) -flaccid paralysis with loss of tendon reflexes and absence of somatic and visceral sensations below the level of injury -loss of bowel and bladder function -loss of systemic sympathetic vasomotor tone may result in vasodilation, increased venous capacity, and hypotension -spinal shock may last for hours to weeks; if reflex function returns by time patient gets to hospital, neuromuscular changes may be reversible -persistent loss of reflexes may result in critical hypotension and bradycardia, although manageable -higher level of injury, greater the effect

epidemiology of Medulloblastoma?

referred to now as a primitive neuroectodermal tumor (PNET) -accounts for approximately 7-8% of all intracranial tumors and 30% of pediatric brain tumors -the most common malignant pediatric tumor in the central nervous system (CNS), accounting for nearly 20% of all childhood brain cancers and ~40% of all childhood tumors in the posterior fossa -considered the most common brain malignancy among pediatric population -a type of embryonal tumor. Embryonal tumors were described over the years as a collection of histologic entities that includes medulloblastoma and also included medulloepithelioma, CNS neuroblastoma, CNS ganglioneuroblastoma and atypical teratoid/rhabdoid tumor (ATRT) as well as primitive neuroectodermal tumors (PNET) -Medulloblastomas are more common in males than females, with the male:female ratio ranging from 1.4:1 to greater than 2:1, depending on the series -Medulloblastoma (MB) is the most common malignant brain tumor in childhood. Annual incidence varies according to age a group, and is estimated in the USA at 0.47/100,000 in children (0-14 years of age), 0.11/100,000 in adolescents and young adults, 0.02/100,000 in adults (over 40 years of age). Males are more affected than females.

Somatic afferent sensory (SAS) neurons, sense what?

sensory input from body to CNS (towards) General somatic afferent neurons: branches are widespread. Result in sensations such as pain, touch, temp. Special somatic afferent neurons: receptors located in muscle, tendons, and joints. Sense position, movement General visceral afferent neurons: receptors in visceral structures that sense fullness and discomfort.

Select all that appy: a. What is involved in the final processing of the somatosensory information?

thalamus and cerebral cortex -the somatosensory cortex is located in the parietal lobe -primary somatosensory cortex receives direct projections from the thalamus -the sensory homunculus reflects the density of cortical neurons devoted to sensory input from corresponding peripheral areas -cortical surface devoted to areas of the body such as thumb, forefinger, lips, tongue, where fine touch and pressure discrimination are essential -somatosensory association areas transform raw data of sensation into meaningful learned perception (body sensation)

Myasthenia gravis, how does it present, what does the patient complain of?

•Definition •Disorder of transmission at the neuromuscular junction that affects communication between the motoneuron and the innervated muscle cell. •Etiology •Autoimmune disease caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction -a disorder of neuromuscular junction (NMJ) transmission due to antibody-mediated attack on naChR or muscle-specific tyrosine kinase (MuSK) -weakness and fatigue with sustained effort; things are more difficult later in the day -eye and periorbital muscles are commonly affected, with ptosis due to eyelid weakness or diplopia due to extraocular muscle weakness as an initial symptom -chewing/swallowing may be difficult -weakness in limb movement usually is more pronounced in proximal than in distal parts of extremity; climbing stairs and lifting objects becomes difficult -muscles of lower face are affected, causing speech impairment -experience myasthenic crisis, or sudden exacerbation of symptoms with weakness a) ventilation is compromised, prompting ventilation/airway support b) usually occurs during period of emotional crisis c) Cholinergic crisis results from inadequate/excessive doses of the AChE drug used in treatment of myasthenia gravis

What common findings of Parkinson's disease presentation are there?

•Definition •A degenerative disorder of basal ganglia function that results in variable combinations of tremor, rigidity, and bradykinesia •Characteristics •Progressive destruction of the nigrostriatal pathway, with subsequent reduction in striatal concentrations of dopamine •Clinical syndrome •Parkinsonism -tremors (most visible manifestation); affects mainly hands and feet, head, neck, face, lips, tongue, and jaw -rhythmic, alternating flexion and contraction movements that resemble rolling a pill between the thumb and forefinger Primary Symptoms -Resting Tremor- A typical onset is tremor in one finger. The tremor usually appears when 'resting'. Tremor slowly spreads to the other side of the body and is worse when excited / stressed -Bradykinesia- general reduction of spontaneous movement, which can give the appearance of abnormal stillness and a decrease in facial expressivness. Causes shuffling and quiet speech -Rigidity- the muscle tone of an affected limb is always stiff and does not relax, sometimes contributing to a decreased range of motion. -Postural Instability-unstable when standing upright

1) Know the following terms a) ptosis b) hordeolum c) chilazion d) blepharitis out of these which is not an inflammatory disease

a) ptosis (muscle issues) -is when the upper eyelid droops over the eye and can result from weakness of the levator muscle in conjunction with unopposed action of the orbicularis oculi that forces eyelids to closes -The eyelid may droop just a little, or so much that it covers the pupil (the black dot at the center of your eye that lets light in). -can limit or even completely block normal vision. -Children and adults can have ptosis. -Fortunately, this condition can be treated to improve vision as well as appearance. b) hordeolum (stye) (infection, with inflammation issues) -usually caused by an S. aureus infection of the mebomian gland or other structures of eyelid margin -symptoms include pain, redness and swelling c) chilazion (inflammation) -focal chronic inflammation developing when the meibomian gland becomes obstructed -small, painless nodule develops on the tarsus d) Blepharitis (inflammation or infection) -common chronic inflammation involving the lashes and lid margins -two types - inflammatory and infectious -inflammatory usually associated with dandruff of scalp and brows -infection usually caused by S. epidermidis/aureus causing ulcers