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Pathophysiology
Final Exam
56
Nursing
Graduate
08/16/2009

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Cards

Term

What structures are contained in the corpus callosum, and what do they do?

Where is the corpus callosum?

Definition

Basal ganglia (control of movement)

amygdala (regulation of emotion, stress, and appetite)

hippocampus (memory formation and learning)

Lies deep in the longitudinal fissure and interconnects the cerebral hemispheres

Term

What structures are in the diencephalon, and what do they do?

 

 

Definition

Thalamus--transmits sensory

Hypothalamus--master neurohormone organ

Term

What forms the brain stem?

What else is contained in the brainstem?

What is in the pons?

Definition

The midbrain pons and medulla form the brainstem.

Also contains the reticular activating system (alertness and consciousness).

The pons contain ascending and descending fiber tracts and the nuclei of the trigeminal nerve and facial nerve.

Term

What forms the spinal cord?

What control centers are located here?

What cranial nerve nuclei are here?

Definition

The medulla extends from the pons to the foramen magnum where it becomes the spinal cord.  

It has ascending and descending fiber tracts and contains the respiratory and cardiovascular control centers.

Cranial nerves VIII-XII

Term
What does the cerebellum help with?
Definition
Equilibrium, muscle tone regulation, and the coordination of voluntary muscle activity.
Term

What happens with over-stimulation of a nerve?  When is this helpful?

Why does this happen?

Definition

Fatigue

Seizure--most cease due to this

After a while, there is a washout of neurotransmitters.  Also, the ion concentrations in the post synaptic membrane become so imbalanced that the impulse c/n be propagated.

Term

What role does alkalosis play in neuron excitability?

Acidosis?

What about hypoxia?

Definition

Alkalosis greatly increases excitability--lowers the seizure threshold.

Acidosis decreases excitability--increasing the seizure threshold.

Reduces neuron excitability--this explains why a loss of oxygen will cause unconsciousness in 3-7 seconds.

Term

What cranial nerves innervate the dura matter?

 

What are the other meninges, and what are the spaces?

Definition

Olfactory

Optic 

Oculomotor

Trigeminal

 

Arachnoid mater (thin, avascular)

Pia mater (thin, avascular)

 

Between the dura mater and arachnoid mater is the subdural space (potential), and the subarachnoid space is between the arachnoid and pia mater.  Contains CSF.

Term
Where do the preganglionic neurons of the sympathetic nervous system originate?
Definition
Intermediolateral gray horn of the spinal cord between T1 and L2(3).  Thoracolumbar division.
Term
How many neurons are in the autonomic pathways?
Definition
2--a preganglionic and post ganglionic fiber.
Term
Describe the preganglionic fiber in the SNS.
Definition
Short, myelinated.  Releases acetylcholine at the junction which attaches to nicotinic receptors.
Term
Describe the post ganglionic fiber in the SNS.
Definition
Long, unmyelinated.  Synapses with efferent organ.  Secretes norepinephrine which attaches to alpha and beta receptors.
Term
What happens when the sympathetic preganglionic fibers exit the spinal cord?
Definition
The exit via the anterior ventral root and transfer through the white ramus communicans, then enter the sympathetic chain.  They may ascend, descend, or synapse at the level which they were generated.
Term
How is the adrenal medulla stimulated?
Definition
By preganglionic sympathetic fibers, which release acetylcholine to the adrenal medulla--no post ganglionic fibers.
Term
What's different about sweat glands?
Definition
Produced by sympathetic stimulation.  As always, the preganglion is short and the post ganglion is long, BUT both secrete acetylcholine!!!  The post ganglion secretes acetylcholine with binds with muscarinic receptors, stimulating sweat glands.
Term
Where does the parasympathetic system arise from?
Definition
Cranial nerves II, VII, IX, and X, and S2-S5.  Craniosacral division.
Term
Describe the pre and post ganglionic fibers in the parasympathetic system.
Definition

Pre ganglionic is LONG and myelinated.  Acetylcholine is released and attaches to nicotinic receptors.

Post ganglionic is SHORT and unmyelinated, releases ACETYLCHOLINE which attaches to muscarinic receptors on the organ.

Term
What is the para and sympathetic response of the iris?
Definition

Para = constrict

Symp = dilate

Term
What part of the brain controls the autonomic nervous system?
Definition
Hypothalamus
Term

The anterior and medial regions of the hypothalamus control what division of the ANS?

What about the posterior and lateral?

Definition

Parasympathetic 

Sympathetic

Term

What mediates the "fight or flight" response to emotional situations?

 

 

Definition
The connection of the limbic system to the hypothalamus
Term
Does the hypothalamus exert direct or indirect control over the ANS?
Definition
Both
Term
What allows our response to fear?
Definition
Relationship between the hypothalamus and the amygdala and periaquaductal gray
Term

How many spinal nerves are there?

Cranial?

Definition

31 pairs that connect with the spinal cord and innervate most areas of the body.

12 pairs.

Term
What is the function of the astrocyte?
Definition
Maintain the ion balance around neurons and control the exchange of materials between blood vessels and neurons.
Term
What is the function of the oligodendrocytes?
Definition
Wrap cytoplasmic processes around neurons to create an insulating barrier called a myelin sheath.
Term
What are microglia?
Definition
Neuroglial cells that are phagocytic macrophages that provide a protective function by engulfing micrroorganisms and cellular debris
Term
What do the ependymal cells do?
Definition
Line the fluid-filled cavities of the brain and spinal cord.
Term

What is the basal ganglia?

What are some of the functions associated with it?

Definition

A collection of nuclei found of both sides of the thalamus, which is interconnected with the cerebral cortex, thalamus, brainstem and cerebellum.

Motor control, emotion, cognition, and learning.

Term
What are some of the sub-divisions of the basal ganglia?
Definition
Putnum, caudate nucleus, pallidus, subthalmic nucleus, substantia nigra.
Term

In Parkinson's, where does the disorder occur?

What neurotransmitter is released, and what is the role?

Definition

Substantia nigra

Dopamine--inhibitory

Term
What is the extrapyramidal motor system?
Definition
Group of neurons that coordinate the motor movement, involved in complex movements, locomotion, and postural control.
Term
What modulates the EPS?
Definition
substantia nigra, vestibular system, cerebellum and some parts of the sensory cortex.
Term

What substance is low in Parkinson's?

What does this lead to?

What is the most important risk factor?

Definition

Dopamine

Acetylcholine, the EPS excitatory transmitter, is uninhibited.

Age

Term
What are the symptoms of Parkinson's
Definition

Tremors (worsens with rest)

Rigidity (first appears in neck)

Akinesia

Postural instability

Emotional disturbances (insomnia, depression, memory loss, hallucinations, dementia)

Term
What is the treatment for Parkinson's aimed at?
Definition
Either increasing the amount of dopamine in the substantia nigra or inhibiting the acetylcholine.
Term
What 2 substances breakdown dopamine?
Definition
MAO and COMT, so if you can inhibit those, you might improve the symptoms of Parkinsons
Term
Why should Parkinson's patients continue to take their L-dopa before surgery?
Definition
It has a short half-life, and abrupt withdrawal can worsen muscle rigidity and interfere with ventilation
Term
What can be used as an anti-emetic in Parkinson's?  Why?
Definition
Zofran can be used.  Phenergan, butyophenones, and reglan all have antidopaminergic effects that can exacerbate symptoms.
Term
What type of drugs might be useful in an exacerbation of Parkinson's?
Definition
Anticholinergics or benadryl (good for premedication and sedation + has antiemetic effect)
Term
Why would induction of someone on L-dopa cause hypo or hypertension?
Definition
L-dopa is a pre-curser to catecholamines, so if you just took a dose, you will be hypertensive.  However, this can lead to down-regulation of the catecholamine receptors, so when the dose wears off, you not only have fewer catecholamines, but you also have fewer receptors.
Term
What are some other considerations in Parkinson's?
Definition

Autonomic instability--use A-line

Use direct acting pressors

Term
What is the dysfunction in huntington's
Definition
Caudate nucleus of the basal ganglia is destroyed or dysfunctional, leading to too little acetylcholine and too much dopamine.
Term

How is dopamine moderated in the caudate nucleus?

What happens in huntingtons?

Definition
GABA inhibits dopamine, but GABA is reduced in Huntingtons
Term
Describe the symptoms of huntingtons
Definition

Jerking, uncontrolled, random movements

Prior to the movements, patients exhibit mood changes, rage issues.  Violent tendencies, egocentric behavior, compulsive behaviors

Term
What type of drugs are helpful in huntingtons?
Definition
Antidopaminergics (Haldol)--helps control movements and address behavior problems.
Term

What happens to the airway in Huntingtons?

What drugs have prolonged action, and why?

Definition

May lose control of pharyngeal muscles.

Succs, esters (locals) due to reduction in plasma cholinesterase

Term

What type of drugs can cause dystonias?

How is GABA thought to be related to spasmotic torticollis?

Definition

Antidopaminergic drugs

Thought to be a defect in the production or release of GABA

Term

What are some anesthetic implications of spasmotic torticollis?

What if it is caused by drugs?

Definition

If patient has chronic neck distortion, can alter vertebral structure and anatomy--may need fiberoptic intubation.

Benadryl 25-50 mg IV can reverse if caused by drugs.

Term

What happens in Alzheimers?

 

Are regionals a good idea for this population?

Definition

Progressive loss of grey matter.  Progressive impairment of memory, judgement, decision making and emotional lability.

 

Only if they are cooperative.

Term

What is the effect of central acting drugs with alzheimer's patients?  what type of dosing is best?

 

What drugs should be avoided?

Definition

Prolonged effects, post op confusion and delerium.  Better to use small doses more frequently.

 

Anticholinergics that cross the BBB (atropine, scopalamine) can cause delerium.  Glycopyrolate does not cross the BBB

Term

Describe MS

 

What is an important factor in conduction across demyelinated neurons?

Definition

Reversible demyelination at random sites in the brain and spinal cord.  Chronic inflammation eventually produces scarring and permanent effects.

 

Temperature--increases in body temp exacerbate symptoms.  As little as 0.5 degree increase may cause complete conduction block!

Term

What regionals are okay, and what should be avoided?

Are these patients CV stable or labile?

What about succs?

Definition

Spinals can exacerbate the disease, but epidurals and blocks do not.

CV may be unstable d/t autonomic dysfunction.

Succs should be avoided esp. if the pt has paralysis, paresthesia, or is chair or bed bound.

Term

What is ALS?

What is usually the cause of death?

Definition

Neurodegenerative disease that affects the MOTOR neurons.

Ventilatory failure d/t resp. muscle involvement

Term
What are the big anesthetic implications of ALS?
Definition

Respiratory care--may be difficult to wean.

Muscle weakness--do not use succs.  Also sensitive to NDMRs.

Avoid regionals.

Term

What is Guillain Barre?

What treatment do some people respond to?

Definition

Immune reaction against the myelin following viral or GI infection.  Also assoc. with HIV and neoplastic disease.

Plasmaphoresis.

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