Patho Exam 4 - Alterations in the nervous system

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Patho Exam 4 - Alterations in the nervous system
2014-11-27 00:32:04
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  1. What carries well localized, sharp pain and is important in initiating rapid reactions to stimuli causing fast pain?
    medium-sized A-delta fibers

  2. What can stimulation of large, fast, heavy myelinated Alpha-beta fibers do?
    close pain gates
  3. What contributes to pain modulation (inhibition) in medulla gates and pons?
    norepinephrine and serotonin
  4. Where do large, fast, heavy myelinated Alpha-beta fibers synapse?
    dorsal horn of spinal cord along with their nociceptive Alpha-delta and C fiber counterparts
  5. Describe referred pain.
    area removed or distant from point of origin
  6. Describe somatic pain.
    skin or close to surface, sharp and localized
  7. Describe acute pain.
    somatic, visceral, or referred
  8. What are the 4 types of endogenous opioids?
    • 1. enkephalins
    • 2. endorphins
    • 3. dynorphins
    • 4. endomorphins
  9. Where does endogenous opioids inhibit transmission of pain impulses?
    spinal cord and brain
  10. Morphine-like neuropeptides act as neurotransmitters by binding to one or more opioid receptors, what do you call this?
    endogenous opioids
  11. Why might pain be increased if someone has inadequate sleep?
    because serotonin is produced during sleep, and serotonin decreases pain
  12. What does "gate" in the spinal chord do?
    regulates transmission of pain impulses that proceed cephalad for further processing and interpretation in the brain
  13. What will a patient's LOC be in decerebrate posturing?
    stupor to coma
  14. What does someone look like in decerebrate posturing?
    arms are rigid turned away from the body
  15. What area of the brain is involved in decerebrate posturing?
    midbrain and/or pons
  16. What will some look like in decorticate posturing?
    flexed upper extremities, extended lower extremities
  17. What area of the brain is involved in decorticate posturing?
  18. What are the sign associated with stage 2 nonresponsiveness (midbrain)?
    stupor or coma, neurogenic hyperventilation, midposition fixed pupils (MFP)
  19. What are the signs associated with the eyes related to stage 1 nonresponsiveness (diencephalon)?
    pupils respond briskly, full-range eye movements only on "doll's eyes" (eyes won't move while move head, fixed position) or after injection of hot or cold water in eat canal  (caloric posturing)
  20. What are some manifestations of the first stage of non responsiveness (diencephalon)?
    agitated, dull, lethargic, obtundation
  21. What the progression of nonresponsiveness?
    • 1. diencehpalon (thalamus/hypothalamus)
    • 2. midbrain
  22. What is stuporous?
    can wake back up but go back to sleep, brain still functioning but lose consciousness
  23. What are some signs of hypothermia?
    shivering, thinking becomes sluggish, decreased coordination, stuporous, decreased HR and RR, decreased cardiac output, and moderate to severe acidosis
  24. What is hypothermia secondary to?
    hypothyroidism, hypopituitarism, malnutrition, Parkinson's disease, rheumatoid arthritis
  25. When does some have hypothermia, at what degree?
    94 degrees F or lower, so 95 degrees F is NOT hypothermia yet.
  26. Slows chemical reactions, increases blood viscosity, slows blood flow, facilities blood coagulation, stimulates profound vasoconstriction, what is this?
  27. What are some signs of a heatstroke?
    sweating ceases (core temp rises rapidly), skin dry and flushed (vascular collapse), irritability, confusion, stuporous, comatose (cerebral edema, degeneration of CNS, and renal tubular necrosis)
  28. What will the regulatory center do is a fever goes above 105 degrees F?
    cease to function
  29. What happens if a fever goes higher than 105 degrees F?
    damages the neurons
  30. Up to what degree can the brain tolerate?
    105 degrees F
  31. Why does a heatstroke happen?
    the thermoregulatory center is overstressed
  32. What age group is most at risk for a heatstroke?
    babies and the elderly
  33. What is a potentially lethal consequence of a fever?
  34. Interleukin-1 (IL-1), IL-6, interferons and TNF produced and released as exogenous bacteria are destroyed and absorbed by phagocytic cells in host, when does this process occur?
    during fever
  35. What does the hypothalamus do during a fever?
    raises the set point
  36. What does fever begin with?
    introduction of exogenous pyrogens or endotoxins
  37. What is failure of normal thermoregulatory mechanism?
  38. In thermoregulation, what does release of epinephrine and adrenal medulla cause?
    vasoconstriction, glycolysis, and increased metabolic rates
  39. In thermoregulation, what does thyroxine cause release of?
    epinephrine from adrenal medulla
  40. In thermoregulation, what does TSH cause release of?
    thyroxine from thyroid
  41. What results in release of TSH from anterior pituitary?
    heat production/thermoregulation
  42. Besides infection, what is something else fever can result from?
    head trauma
  43. What is released with heat production?
  44. Where does heat production begin?
    in hypothalamus
  45. Cutaneous and visceral neurons converge on same ascending neuron and brain cannot distinguish between origin of the two, what type  of pain is this?
  46. Area supplied by same spinal segment as actual site of injury (upper abdomen - T8, L1, L2), what type of pain is this?
  47. Describe visceral pain.
    internal organs, abdomen, skeleton
  48. What can cause obtundation?
    anesthesia or intracranial pressure
  49. What is coma?
    no arousal to any stimulus but brainstem reflexes intact
  50. What is stupor?
    arouses only to painful stimuli
  51. What is obtundation?
    awakens in response to stimulation, continuous stimulation needed for arousal, eyes usually closed
  52. What is lethargy?
    orientation X3 but slow vocalization, decreased motor skills
  53. What is confusion?
    alteration of perception of stimuli (time, then place, then person)
  54. What is consciousness?
    alertness with orientation to person, place and time
  55. No correctable cause for seizures is found and seizures are recurrent without treatment, what is this?
  56. Follows a generalized tonic-clonic seizure and they are sleepy, what is this?
    postictal sate
  57. What is the occurrence of second, third or multiple seizures before the person has fully regained consciousness from preceding seizure and causes cerebral hypoxia?
    status epilepticus
  58. What are two age groups who have unclassified epileptic seizures?
    neonatal seizures and infantile seizures
  59. What happens in an atonic seizure?
    pass out
  60. What happens in a tonic-clonic seizure?
    aura precedes and they're stiff and jerk
  61. What happens in a tonic seizure?
    muscle contraction with excessive muscle tone
  62. What happens with a clonic seizure?
    alternating contraction and relaxation of muscles
  63. What are 5 different types of generalized seizures?
    absence, clonic, tonic, tonic-clonic, and atonic
  64. Bilaterally symmetric and without local onset, consciousness is always impaired or lost, what type of seizure is this?
    generalized seizure
  65. Partial onset evolving into generalized tonic-clonic seizures, what is this called?
    secondarily generalized
  66. With impairment of consciousness, with to without automatisms, what type of seizure is this?
    partial - complex
  67. without impairment of consciousness, with motor signs, special sensory or somatosensory symptoms [prodroma] hours to days before seizure, autonomic symptoms and psychic symptoms, what type of seizure is this?
    partial - simple seizure
  68. begin locally, involve neurons unilaterally, what type of seizure is this?
    partial seizure
  69. What are seizures characterized by?
    sudden transient alterations in brain function
  70. Caused by abnormal excessive hypersynchronous discharges of CNS neurons, what is this?
  71. What is death of cerebral hemispheres exclusive of brainstem and cerebellum?
    cerebral death
  72. What may the brain continue to do in cerebral death?
    maintain cardiovascular and respiratory functions. Normal T control, and normal GI functions
  73. When someone is permanently unable to respond in any way to environment, what has happened to them?
    they have cerebral death
  74. What is irreversible coma?
    cerebral death
  75. What do you have destruction of in brain death?
    destruction of the brainstem and cerebellum
  76. When irreversible brain damage allows no potential recovery and can no longer maintain respiratory and cardiovascular functions, what is this?
    Brain death (brainstem death)
  77. Why does someone with cerebral death still have a heart beat and is still breathing?
    because is doesn't involve the brainstem and cerebellum
  78. What is responsible for transmission of diffuse burning or aching sensations causing slow pain?
    small unmyleinated C polymodal nociceptors