Study Guide for Bio 125 Final

Chapter 5 Innate Defenses: Inflammation Types of immunity-gained and/or how immunity may be compromised? Innate Resistance: natural/native immunity First Line of Defense: natural barriersphysical, mechanical, and biochemical Second Line of Defense: inflammation Adaptive Immunity Third Line of Defense: involves memory for a more rapid response to repeat exposure Compromise of Immunity: aging, stress, diet, illness, drugs What occurs at the injured besides redness and pain? Heat, swelling, loss of function 1) Redness (rubor) - Hyperemia from vasodilatation 2) Heat (color) - Increased metabolism a the inflammatory site 3) Pain (dolor) - Change in PH; Change in ionic concentration; nerve stimulation by chemicals (e.g. histamine, prostaglandins); pressure from fluid exudates 4) Swelling (tumor) - Fluid shift to interstitial spaces; fluid exudates accumulation 5) Loss of function - Swelling and pain Cellular infiltration would result from activation of the plasma system secondary to injury? Mast cell . What happens in the inflammation process? Who comes first; what causes what; what does what. Tissue injuryp cell damage p Mast cells and platelets release chemical mediators (histamines, serotonin, prostaglandins, and leukotrinines) into intestinal fluid and bloodp affect nerves and blood vessels in the area p local vasodilatation phyperemia (increased blood flow to the area) p capillary membrane permeability increases p increase of interstitial fluid p dilutes toxic material pglobulins serve as antibodies and fibrinogens form a mesh to localize the infection (vascular response) Histamine - Stored in granules of basophils, mast cells, platelets Causes vasodilatation & increased vascular permeability by stimulating contraction of endothelial cells and creating widened gap between cells Serotonin - Stored in platelets, mast cells, enterochromaffin cells of GI tract Causes increased vasodilatation and increased vascular permeability by stimulating endothelial class and creating widened gap between cells; stimulates smooth muscle contraction Kinins (bradykinin) -Produced from precursor factor kininogen as a result of activation of Hageman factors (XII) of clotting system Causes contraction of smooth muscle and dilation of blood vessels; result in stimulation of pain

Complement Components (C3a, C4a, and C5a) Anaphylaxis agents generated from complement pathway activation, Stimulate histamine release; stimulate chemo taxis Fibrinopeptides Produced from activation of the clotting system, Increases vascular permeability; stimulate chemotaxis from Europhiles and monocytes What is an alternative pathway? The alternative pathway is one of three complement pathways that opsonize and kill pathogens. The alternative pathway does not require a specific antibody to commence, and, so, can be effectively much faster than if antibody synthesis had to take place, as in the classical pathway. Rather, the C3 protein directly binds the microbe. The caveat of this faster activation is that only specific types of antigens can activate this pathway. Primary action of complement cascade? The complement system is inactive plasma proteins that, when activated, destroy foreign cells. Chapter 4: Fluids and Electrolytes, acids and bases Blood plasma is referred to as? Intravascular fluid Dehydration is most common in what population? Elderly and infants Difference between osmotic forces, plasma oncotic pressure, antidiuretic hormone, buffer systems? Osmotic Forces - pressure applied to a solution to prevent the passage of solvent into it when separated by a permeable membrane Buffer Systems - Absorbs excessive H and OH to prevent significant pH changes Plasma Oncotic Pressure - attracts water from the interstitial space back into the capillary Antidiuretic Hormone - increases permeability leading to increased water reabsorption Different types of edema? localized, generalized -occurs in extracellular compartment and can be isotonic, hypotonic, or hypertonic depending on the cause (concentration of solute in fluid) -an excessive amount of fluid in the interstitial compartment leads to swelling and enlargement of tissues. -Localized - limited to site of trauma - eg- Sprained finger, particular organ system, cerebral, pulmonary pleural effusion, pericardial effusion -Generalized- greatest in areas most affected by gravity, more uniformed distribution of fluid in interstitial space. -eg- feet, legs Hormone-secreting tumor (ADH)-what would the expected outcome be? Water excess caused by SIADH syndrome of inappropriate secretion of ADH caused by decreased renal excretion of water. If a hypertonic IV solution is given what would be the expected outcome? Cells shrink and

water loss from ICF

ECF

What is the most common cause of pure water deficit? Increased renal clearance of free water as a result of impaired tubular function or inability to concentrate the urine as with diabetes insipidus. What is hypertonic hyponatremia (Na sodium)? Hypertonic hyponatremia results from the shift of water from ICF to ECF, which is caused by the presence of osmotically active particles (e.g. glucose) in the ECF space. Serum sodium concentration is reduced, but the osmolality of the ECF is normal or even above normal. What would most likely cause hypochloremia? Caused most commonly by intestinal malabsorption related to vitamin D deficiency Long-term potassium deficits result in damage to what? -Effects long term > 1 month -damage renal tissue, with intestinal fibrosis and tubular atrophy Changes in neuromuscular excitability, skeletal muscle weakness, loss of smooth muscle tone paralysis and respiratory arrest can occur Chapter 25: Structure and Function of pulmonary system Functions of ciliated mucosal membrane in nasopharynx? -warms and humidifies inspired air and removes form particles from it. What receptors are responsible for sneezing? -Irritant receptors in the nares What is the difference between type I and type II alveolar cells? Type I alveolar cells -provide structure (walls) through which gas exchange occurs. Type II alveolar cells -secrete surfactant, a lipid-type that coats the alveoli. -during inspiration, the alveolar surfactant allows the alveoli to expand uniformly. -during expiration, the surfactant prevents alveolar collapse. Know different kinds of membranes-mucus, serous, synovial? Mucus: throat, nose, mouth, urethra, rectum, and vagina Serous: peritoneum (surrounding the intestines), pleura (surrounding the lungs), and pericardium (surrounding the heart) Synovial: joints

Chapter 26: alterations of pulmonary function Know terminology Dyspnea subjective sensation of uncomfortable breathing, the feeling of being unable to get enough air movement. Described as breathlessness, air hunger, shortness of breath, labored breathing & preoccupation with breathing. Eupnea [normal breathing pattern]is rhythmic and effortless. Kussmaul Respiration [hyperpnea]is slightly increased ventilatory rate, very large tidal volume & no expiratory pause. Obstructed breathing [COPD]consists of slow ventilatory rate, large tidal volume, increased effort & prolonged inspiration or expiration, depending on site of obstruction. Audible wheezing or stridor sounds made during inspiration is often present. Restricted Breathingoccurs with disorders [pulmonary fibrosis] that stiffen the lungs or chest wall and decrease compliance & is characterized by small tidal volumes and rapid ventilatory rate. Panting occurs with exercise. Gasping Respirations with shock & sever cerebral hypoxia consist of irregular, quick inspirations with an expiratory pause. Sighing Respirationsirregular breathing characterized by frequent, deep sighing inspirations [anxiety induced]. Cheyne-Stokes Respirations alternating periods of deep and shallow breathing with apneic periods lasting 15-60 secs that increase in volume until a peak is reached, after which ventilation [tidal volume] decreases again to apnea. Hypoventilation inadequate alveolar ventilation in relation to metabolic demands. Hyperventilation alveolar ventilation that exceeds metabolic demands. Hemoptysis --- Coughing up of blood or bloody sections. Cyanosis -- A bluish discoloration of the skin and mucous membranes caused by increasing amounts of desaturated or reduced hemoglobin in the blood. Clubbing -- Selective bulbous enlargement of the end [distal segment] of a digit [finger or toe] Hypercapnia increased [Paco2] carbon dioxide in the arterial blood. Hypoxemia or reduced oxygenation of arterial blood (reduced Pao2) Acute Respiratory Failure -- inadequate gas exchange, hypoxemia. Pulmonary Edema -- Excess water in the lung (common cause is heart disease) Aspiration -- passage of fluid & solid particles into the lung. Atelectasis -- collapse of lung tissue. Compression Atelectasis caused by the external pressure exerted by a tumor, fluid, or air in the pleural space or by an abdominal distention pressing on a portion of the lung, causing the alveoli to collapse. Absorption Atelectasis -- results from removal of air from obstructed or hypoventilated alveoli or from inhalation of concentrated o2 or anesthetic agents. Bronchiectasis persistent abnormal dilation of the bronchi Bronchiolitis an inflammatory obstruction of the small airways of bronchioles Pneumothorax presence of air or gas in the pleural space caused by a rupture in the visceral pleura or the parietal pleura and chest wall. S/S Decreased breath sounds on affected side

Shortness of breath Tracheal deviation Decreased O2 saturation Open or Communicating Pneumothorax air pressure in the pleural space equals barometric pressure because air that is drawn into the pleural space during inspiration is forced back out during expiration Tension Pneumothorax site of pleural rupture acts a s a one way valve, permitting air entry on inspiration but preventing its escape by closing up during expiration Spontaneous Pneumothorax occurs unexpectedly in healthy individuals age 20 40 & is caused by the spontaneous rupture of blebs on the visceral pleura. Secondary Pneumothorax can be caused by chest trauma, such as rib fracture or stab and bullet wounds that tear the pleura Pleural Effusion presence of fluid in the pleural space. Empyema or presence of pus in the pleural space, is a complication of respiratory infection, usually pneumonia caused by Staph, E. coli, anaerobic bacteria or Klebsiella pneumonia. Pleurisy inflammation of the pleura. Pulmonary Fibrosis -- excessive amount of fibrous or connective tissue in the lung. Kussmaul respirations characterized by? Kussmaul Respiration [hyperpnea] -slightly increased ventilatory rate - very large tidal volume - No expiratory pause. Paroxysmal nocturnal dyspnea occurs with pulmonary fibrosis, left ventricular failure or hypertension? Paroxysmal nocturnal dyspnea [PND] positional dyspnea experienced by some individuals with left ventricular failure -waking up at night gasping for air and must sit up or stand to relieve the dyspnea. -this is caused from fluid in the lungs caused by the redistribution of body water while the individual is recumbent. What are presenting signs of emphysema? Emphysema -Signs and symptoms -increasing dyspnea -hyperventilation with prolonged expiration -weight loss -Clubbing What are the signs and symptoms of pulmonary edema? -Signs and Symptoms -cough, orthopnea, rales, hemoptysis -frothy blood tinged sputum -labored breathing, feeling of drowning Hypoxia and cyanosis

Asthma causes? -periodic episodes of severe but reversible bronchial obstruction in persons with hypersensitive or hyper responsive airways -2 types (many people have a combo) 1. Extrinsic - acute episodes triggered by a type I hypersensitivity rxn to inhaled antigen -usually a family history of allergies -usually occurs in kids and subsides with adolescents 2. Intrinsic -adult onset -other types of stimuli target hyper responsive tissues in airway and initiate acute attack -Stimuli include - infection, cold, exercise, drugs, stress, inhaled irritants Chapter 7: hypersensitivities, infection, immune deficiencies What is hypersensitivity and types, reactions? Hypersensitivity Rxns -allergic rxns to normally harmless substances -Type I Hypersensitivity - Allergy -tendency toward allergic conditions is inherited - Causative mechanism -IgE bound to mast cells; release of histamine and chemical mediators Clinical signs and symptoms -Inflammation and pruritus (itchy) -Pollen allergy - itchy watery eyes and mucosa -Food allergy - nausea, vomiting, diarrhea, hives -Atopic dermatitis/eczema - chronic with genetic component, most common in young kids -Asthma- allergic response in bronchial mucosa that restrict airflow Anaphylaxis/Anaphylactic shock -severe, life threatening, systemic, hypersensitivity rxn -rxn usually occurs within minutes of exposure -Pathophysiology -large amounts of chemical mediators released from mast cells into circulation quickly pvasodilatationp decreased BP p edema of mucosa in lungs p constriction of bronchiolesp decrease in O2p loss of consciousness -clinical signs and symptoms -itching or tingling sensation -coughing -weakness, dizziness, fainting -fear and panic -edema around the eyes, lips, tongue, hands and feet -hives -Collapse - loss of consciousness in min.

-Type II - (Cytotoxic Hypersensitivity) -antigen present on cell membrane (normal or foreign) -IgG antibodies react with antigen and lead to the destruction of the cell by releasing cytolytic enzyme Example: - Autoimmune hemolytic anemia -Erythroblastosis fetalis -Drug- induced hemolysis -Type III - immune complex hypersensitivity -antigen combines with antibody forming a complex which is deposited into tissue and activates compliment. This leads to inflammation and tissue destruction. -Type IV - cell-mediated or delayed hypersensitivity -delayed response by sensitized t-lymphocytes to antigens which leads to the release of lymphocytes or chem. Mediators and causes the inflammatory response and destruction of antigen. - Example - Contact Dermatitis - Transplant or Graft Rejection Cancer What is Neoplasm, adenocarcinoma, tumor marker, environmental risk factors? -Neoplasm/Tumor-cellular growth no longer responding to normal body Control -deprives other cells of nutrients -creates pressure on surrounding tissue and structure -lack function -Adenocarcinomas - Glandular tissue - arises from epithelial tissue - Most common form of breast cancer -Tumor Markers - substances, enzymes, antigens and hormones produced by malignant cells and circulating in blood or body fluid -chromosome markers -Environmental risk factors -ionizing radiation (x-rays), UV radiation, electromagnetic fields, diet and endogenous hormones, alcohol, sexual behavior, physical activity, occupational hazards, air pollution Cardiac Atherosclerosis caused by? - Accumulation of fibrous plaques and lipids (fat & fibrin) progressively over time harden narrows the lumen impedes blood flow to the myocardium Due to smoking, hypertension, diabetes, o LDL, q HDL, and hyperhomocystinemia Primary hypertension treated with? Treatment -modification of diet and lifestyle -mild diuretics and antihypertensive until BP is reduced -correcting underlying cause and controlling hypertension

Myocardial ischemia treated with? Increasing O2 supply -reducing myocardial oxygen consumption pharmacologic, manipulation of BP, heart rate, contractibility, left ventricle volume, -Meds that reduce vasospasms, q cholesterol & prevent clotting Differences between stable and unstable angina? -stable angina -pain is predictable and relived by rest or nitrates -unstable angina - occurs unpredictably and often at rest - Increases in frequency and duration Endocrine What hormone increases the permeability of renal tubules? Antidiuretic Hormone (ADH) increases permeability at distal tubules and collecting ducts.

Four types of hormone-secreting cells in the Islets of LangerhansWhat do they do? 1 Alpha cells which secrete glucagon 2. Beta cells which secrete insulin and amylin 3. Delta which secrete gastrin and somatostatin 4. F (or PP) cells which secrete pancreatic polypeptide What is glucocorticoid? -Steroid hormones that have metabolic anti-inflammatory and growth suppressant effects and influence levels of awareness and sleep pattern. -direct effect in carbohydrate metabolism -increase blood glucose concentration through gluconeogenesis in the liver and by decreasing use of glucose -inhibit immune and inflammatory response -CORTISOL (most potent naturally occurring glucocorticoid) necessary for life and protection from stress What is mineralcocorticoid? -directly affect ion transport by renal tubular epithelial cells -causing sodium retention and potassium and hydrogen loss -ALDOSTERONE (most potent naturally occurring mineralcocorticoid) conserves sodium by increasing the activity of sodium pump of epithelial cells. Lymphadenopathy-finding that leads to diagnosis? - characterized by enlarged lymph nodes What is dissemintated intravascular coagulation-DIC? Disseminated intravascular coagulation is an acquired clinical syndrome characterized by

widespread activation of coagulation resulting in formation of fibrin in medium and small vessels throughout the body. -Caused by the pathologic release of pro-coagulant factors into the bloodstream, which sets off the clotting cascade in the bloodstream. Over-activation of the clotting cascade generation of excessive thrombin and plasmin excessive fibrin degradation products. Chapter 36: musculoskeletal system Know types of fractures, joints and disease? FRACTURE INJURIES Open (compound) fracture skin is open Closed (simple) fracture - skin is closed Unstable bone moves freely Impacted jammed together Angulated major curves. Dislocation frozen joint or locked joint Greenstick - children bones flex like a greenstick. Spiral - twists around the bone. Transverse - Horizontal fx right across the bone. Oblique - Diagonal fx right through the bone. Comminuted - splintered into pieces fx. Growth plate (epiphyseal plate) fractures in children. Five typesif not treated may result in permanent angulations or deformity of bone. OPEN FRACTURES Most common open fractures are tibia and fibula. Most commonly fractured bone open or closed is the clavicle. Do not put back in, unless it goes in on its own. Traction splint are specifically designed for femur mid-shaft fx. CLOSED FRACTURES Hemorrhage into soft tissue. Since skin is still closed Compartment Syndrome can take place. STRAIN Tendon (muscle) pulled. Days to weeks to heal. Lifting something heavy. SPRAIN Ligament damage. Can take up to 8 months to heal. Twisted an ankle on a sidewalk. I heard it pop. 3 degrees of sprains; 1st = no joint instability. 2nd = swelling and bruising but joint intact. 3rd = ligaments completely torn. Splint and ice for first 24 hours and x-ray. -Joints the body contains three major types of joints classified by how much they move. -synarthrosis joints which permit no movement

Ex. sutures of the skull -amphiarthrosis which allow slight movement Ex. joints between the vertebrae -diarthrosis joints which permit free movement: Ex. Ankle, wrist, knee, hip, and shoulder - in freely-moving joint, a fluid filled sac known as the joint sac exists between the bones. -synovial membrane, which lines the cavity and secretes a viscous lubricating substance called synovial fluid, which allows bones to move against one another -ligaments, tendons, and muscles help to stabilize the joint. Joints are further classified by shape and by connective structure, such as fibrous, cartilaginous, and synovial. Joint Diseases Noninflammatory Joint Disease: no synovial membrane inflammation, lack of systemic S/S- normal synovial fluid Osteoarthritis (Degenerative Joint Disease): characterized by loss and damage or articular cartilage, osteophytosis, subchondral bone changes, mild synovitis, and thickening of the joint capsule Inflammatory Joint Disease: characterized by inflammatory destruction in the synovial membrane or articular cartilage and systemic signs of inflammation Rheumatoid Arthritis: autoimmune disease with swelling and pain in multiple joints Ankylosing Sponylitis: stiffening and fusion of the spine and sacroiliac joints Gout: defective uric acid metabolism causing inflammation and pain What makes muscles contract, different kinds of muscle contractions? 1. Excitation - action potential from nerve to neuromuscular junction depolarization = muscle fiber action potential sarcolemma transverse tubules 2. Coupling - release of calcium ions from sarcoplasmic reticulum tropin and tropomysin bind to calcium actin free to bind to myosis 3. Contraction - myosin binds to actin forming cross bridges actin slides onto myosin causing the sarcomere to shorten = cross bridge theory 4. Relaxation - calcium is actively transported back into the sarcoplasmic reticulum causing cross bridge detachment Types of Muscle Contractions Isometric: muscle maintains constant length as tension is increased (pushing the arm or leg against an immovable object) Isotonic: the muscle maintains constant tension as it moves (eccentriclengthening, or concentricshortening)

Osteomalacia and Pagets disease Rickets in kids and Osteomalacia in adults Osteomalacia: a metabolic disease characterized by inadequate and delayed mineralization of osteoid in mature compact and spongy boneremodeling proceeds normally but calcification and deposition do not occur -deficit of vit D and phosphate -occurs with dietary deficits, malabsorption or lack of sun exposure -causes soft bone Pagets Disease - progressive bone disease in adults over 40 -abnormal breakdown of bone tissue followed by abnormal bone formation resulting in structural abnormality Larger, softer) -also causes cardiovascular disease and heart failure -cause not established, virus suspected with genetic factors -treatment is to reduce risk of fractures and deformity Chapter 33: Structure and function of Digestive System Enzymes that initiate digestion of Protein: stomachpepsin and HCl, small intestinetrypsin, chymotrypsin, carboxypeptidase, aminopeptidases, and dipeptidases Carbohydrates: mouth--salivary a-amylase (ptyalin), pancreatic amylase, small intestinelactase, maltase, sucrase Fat: small intestinebile acids, fatty acids, monoglycerides, lecithin, cholesterol, protein, and pancreatic lipases Autonomic and hormonal control is involved in gastrointestinal motility and what else? Absorption Parasympathetic stimulation to pancreas causes what reaction? -Gastric enzyme secretion Chapter 34: alterations of digestive function What are signs of hypothyroidism? -the increase in TSH will over-stimulate, and enlarge the thyroid gland, causing a goiter -hypothyroidism slows the metabolic rate and oxygen consumption; patients become cold-intolerant because they are generating less internal heat; they also may experience a slow heart rate, or bradycardia -protein synthesis is decreased; this causes brittle nails, thinning hair, and dry, thin skin in adults -symptoms also include slowed reflexes, slow speech and thought processes, and feelings of fatigue -Characteristic sign sever long standing hypothyroidism is MYXEDEMA What happens and why with bowel obstruction? Fluid + air + gas all start to combine above the area of the obstruction Peristalsis will temporarily increase injuring the mucosa inflammatory response distension of the bowel venous blood supply cut off absorptive

processes stop

bowel secrete H20, Na, K fluid builds in the lumen

Ulcerative Colitis A chronic inflammatory disease that causes ulceration of the colonic mucosa, usually in the rectum or sigmoid coloncause is unknown, but suggested causes include infectious, genetic, and immunologic factors -inflammation of rectum and colon ulcer development difficulty with absorption and increased cancer risk Signs and symptoms -diarrhea with blood and mucus -cramping pain -fever, weight loss and anemia may be present Treatment -prevent exacerbating stressors -anti-inflammatory, antimotility agents, antimicrobials -nutritional supplements -surgical resection may be necessary Chapter 29: alterations of renal and urinary tract function Common type of renal stone? -Calcium Stones: most common. Pyelonephritis, Glomerulonephritis-where inflammation is located, cause? Pyelonephritis -- kidney infection -Pathophysiology -inflammation of the renal pelvis and interstitial -most common rout - from bladder up to kidneys, but can occur from blood stream. -inflammation is usually focal and irregular, primarily affecting the pelvis, calyces, and medulla Caused by spread of infection by ascending microorganisms (most common E.coli) Glomerulonephritis -- Inflammation of the glomerulus -Pathophysiology -antibody complexes lodge in glomerular capillaries inflammatory response increased capillary permeability and cell proliferation leakage of protein and large number of erythrocytes into filtrate. Inflammation decreased filtration rate and retention of fluid and wastes renal failure, increased BP and edema, scaring Caused by immunologic abnormalities, ischemia, free radicals, drugs, toxins, vascular disorders, and systemic diseases (DM, lupus) Chapter 31: Structure and function of reproductive system Major hormonal determinant of sexual differentiation? -Testosterone

Anatomy of female reproductive system External Genitalia: mons pubis (fatty tissue over pubic symphysis) labia majora and minora (folds of skin) clitoris (erectile organ between labia minora), vestibule (openings to vagina and urethra) introitus (vaginal orifice) skene and bartholin glands (lubrication) perineum (area between vagina and anus) perineal body Internal Genitalia: vagina uterus fallopian tubes Ovaries Major hormonal determinant of sexual differentiation Anatomy of female reproductive system? Testosterone When does ovulation occur? - 15 days after menstruation What is the major difference between male and female sex hormone production? Male is constant Chapter 32: alteration of reproductive systems, including sexually transmitted infections What are the signs of dysfunctional uterine bleeding? -signs -unpredictable and variable bleeding time and duration -flooding and passing of large clots -irregular, prolonged and excessive bleeding What is difference rectocele, varicocele, cystocele, retrocede? -rectocele is the bulging of the rectum and posterior vaginal wall into the vaginal canal. -cytokine is decent of the bladder and the anterior vaginal wall into the vaginal canal (vaginal opening) -varicocele is an abnormal dilation of a vein within the spermatic cord and is classically described as a bag of worms. -urethrocele sagging of the urethra What is difference between follicular, dermoid, corpus luteal and atretic cyst? -follicular mature ovarian follicles that do not release their ova, benign -dermoid common ovarian neoplasm, growth contain mature tissue including skin, hair, sebaceous and sweat glands, muscle cartilage and bone.

-have malignant potential and should be removed -luteal persists abnormally instead of degenerating Benign -atretic???? Presenting symptoms of gonorrhea in males? -white, yellow, or green pus from the penis - pain burning sensations during urination that may be severe -swollen testicles. What is phimosis? -phimosis is a condition in which the foreskin cannot be retracted back over the gland What is Peyronie disease? -Peyronie (bent nail syndrome) is a fibrotic condition that causes lateral curvature of the penis during erection Chapter 12: structure and function of neurologic system What does the somatic nervous system control? -voluntary motor control (skeletal muscle) What does the reticular activating system do? -Contains vital reflexes such as controlling cardiovascular and respiration. It is essential for maintaining wakefulness and essential for consciousness. What area of the brain has to do with thought processes and goal-oriented behavior? -prefrontal area is responsible for goal oriented behavior Primary visual cortex located where? -Occipital lobe (brodmann area 17) is the primary visual cortex and receives input from the retinas Maintenance of homeostasis and instinctive behavioral control arise from where? -hypothalamus function to: 1. Maintain constant internal environment 2. Implement behavioral patterns, integrative center control ANS function, regulate body temperature, endocrine function, and regulate emotional expression Chapter 14: concepts of neurologic dysfunction Metabolically induced coma differs from structural coma how and why? -Metabolically induced coma doesnt occur directly to the brain -Metabolic causes of coma include conditions that deprive the brain of oxygen (hypoxia), such as respiratory failure, asphyxiation, or heart failure, and massive blood loss from trauma resulting in an inadequate blood supply to the brain. Carbon monoxide poisoning interferes with the delivery of oxygen to the brain. Coma can

be caused by an overdose of prescription or illegal drugs or alcohol. Failure of the lungs, kidneys, or liver may produce coma due to the accumulation of waste products toxic to the brain. Very low or high blood sugar, extremely high or low body temperature, and fluid or electrolyte imbalances may also produce coma. Certain bacteria and viruses can infect the brain and result in coma. Metabolically Induced Coma: Blink to threat is equal Optic discs are flat with good pulsation Roving eye movements, normal dolls eyes and calorics Pupils are equal and reactive, may be dilated, pinpoint, or midpositioned and fixed Corneal reflex is symmetric Grimace to pain is symmetric Symmetrical motor function movement Symmetric tone Symmetric posture Symmetric deep tendon reflexes Absent or symmetric Babinski sign Symmetric sensation -Structural Coma -Structural causes of coma include bleeding in or around the brain (e.g., hemorrhagic stroke, subarachnoid hemorrhage, subdural or epidural hematomas, or a ruptured aneurysm), major stroke with death of brain tissue (cerebral infarction), and brain tumors. Coma can result from blunt head trauma or a gunshot to the head. Structurally Induced Coma: Asymmetric blink to threat Optic discs have papilledema Gaze paresis, nerve palsy Pupils are asymmetric or nonreactive, may be midposition, pinpoint, or large Corneal reflex is asymmetric Grimace to pain is asymmetric Asymmetrical motor function movement Tone is paratonic, spastic, flaccid, especially if asymmetric Posture is decorticate if symmetric, decerebrate if asymmetric Asymmetrical deep tendon reflexes Babinski sign present Asymmetric sensation Cheyne-Stokes is causes by what? -results from increased ventilatory response to carbon dioxide stimulation causing hypercapnia and diminished ventilatory stimulus What is difference between coma, stupor, and confusion? -Coma: The patient usually cannot be aroused, and the eyes do not open in

response to any stimulation. -Stupor: The patient can be awakened only by vigorous physical stimulation -Confusion: disorientation regarding time, place, person, or situation. It causes perplexity, lack of orderly thought, and inability to choose or act decisively and perform the activities of daily living. It is usually symptomatic of an organic mental disorder, but it may accompany severe emotional stress and various psychological disorders Define brain death for legal purposes? -Brain death -cessation of brain function including cortex and brainstem -absence of reflexes or responses, spontaneous ventilation, -establishment of certainty of irreversible brain damage What is locked-in syndrome? -Locked-in syndrome is a condition in which a patient is aware and awake but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for the eyes. What is seizure? -Seizures -caused by spontaneous excessive, disorderly discharge of cerebral neurons and is characterized by a sudden transient alteration in brain function, usually involving motor, sensory, autonomic, or psychic clinical manifestations and altered level of arousal. -produce a brief disturbance in the brains electrical function

Different types of seizures? Partial Seizures (Produced by a small area of the brain) A. Simple (awareness is retained) 1. Simple Motor - Jerking, muscle rigidity, spasms, head-turning 2. Simple Sensory -Unusual sensations affecting either the vision, hearing, smell taste, or touch 3. Simple Psychological - Memory or emotional disturbances B. Complex (Impairment of awareness) Automatisms such as lip smacking, chewing, fidgeting, walking and other repetitive, involuntary but coordinated movements C. Partial seizure with secondary generalization Symptoms that are initially associated with a preservation of consciousness that then evolves into a loss of consciousness and convulsions Generalized Seizures (Produced by the entire brain) A. "Grand Mal" or Generalized tonic-clonic Unconsciousness, convulsions, muscle rigidity B. Absence Brief loss of consciousness C. Myoclonic Sporadic (isolated), jerking movements D. Clonic Repetitive, jerking movements E. Tonic Muscle stiffness, rigidity

F Atonic Loss of muscle tone Who would be most likely to experience acute confusional state? - withdraw from alcohol barbiturate or other sedative drugs is common What is dementia and its manifestations? -progressive failure of cerebral functions not caused by impaired levels of consciousness. -decreased in orienting, memory, language and executive attentional networks. -individuals exhibit alterations in behavior, due to declining intellectual ability. -Manifestations -cortical dementia -Agnosias -apraxa -difficulty with naming -decreased language comprehension -loss of recent memory -loss of remote memory -decreased mathematical skills -altered visuospatial relationship -sub cortical dementia -forgetfulness -apathy -depression -slowed thought processes -accident prone -personality change and inappropriate affect -loss of motor function: -wide shuffling gait with small steps -muscle rigidity -flexion posturing -tendency to fall -abnormal reflexes -bowel and bladder incontinence -immobility Direct consequence of increased intracranial pressure? - (IICP) Impaired blood supply What are differences between bradykinesia, akinesia, hyperkinesias, and duskinesias? -akinesis is a decrease in associated and voluntary movements. -bradykinesia is slowness of voluntary movements -hyperkinesias is excessive movements -duskinesias re abnormal involuntary movements that occur as spasms Chapter 15: Alterations of neurologic function

Common type of traumatic brain injury? -Concussion - interference of brain function from a mild blow to the head -cause excessive movement of brain loss of consciousness, amnesia, headaches -recovery usually within 24 hours with no permanent damage -Contusion- bruising of brain tissue -rupture of small blood vessels and edema from blunt blow to head -residual damage dependant on degree of injury -Closed head injury-skull not fractured by brain injured from force -may cause heavy damage -Open head injury - fractures or penetration of brain by sharp objects -Linear fracture- cracks in bone -Comminuted fractures -several uncomplicated fractures -Compound fractures- trauma in which brain tissue is exposed to environment -likely to be severe damage with high risk of infection and risk of bone penetrating the brain -Depressed skull fractures - displacement of bone below level of skull -compresses brain tissue and impairs blood supply -Basilar fractures - occur at base of skull and accompanied by leaking of CSF through ears or nose -occur when forehead hits a car windshield with force -cranial nerve damage and dark discoloration around eyes is common. -Contrecoup injury -area of brain contra lateral to site of direct damage is injured as brain bounces off the skull -usually causes minor injuries Who is most at risk of spinal cord injury from minor trauma? -Elderly people because if preexisting degenerative vertebral disorders, are at particularly at risk for minor trauma that results in serious spinal cord injury. What mechanism causes the transient nature of spinal shock? -Transient drop in BP, and poor venous circulation What is transient ischemic attack and length of symptoms? -A transient ischemic attack (TIA) -- sometimes called a ministroke -- is a brief episode of symptoms similar to those you'd have in a stroke. The cause of a transient ischemic attack is a temporary decrease in blood supply to part of your brain. Many TIAs last less than five minutes. What are the different kinds of strokes and causes? -Ischemic stroke occur when the arteries to your brain are narrowed or blocked, causing severely reduced blood flow (ischemia).

-Thrombotic stroke. This type of stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain -Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms in a blood vessel away from your brain commonly in your heart and is swept through your bloodstream to lodge in narrower brain arteries -Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from a number of conditions that affect your blood vessels, including uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms). A less common cause of hemorrhage is the rupture of an arteriovenous malformation (AVM) an abnormal tangle of thin-walled blood vessels, present at birth. There are two types of hemorrhagic stroke: -Intracerebral hemorrhage. In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging cells. Brain cells beyond the leak are deprived of blood and are also damaged. High blood pressure is the most common cause of this type of hemorrhagic stroke. Over time, high blood pressure can cause small arteries inside your brain to become brittle and susceptible to cracking and rupture. -Subarachnoid hemorrhage. In this type of stroke, bleeding starts in an artery on or near the surface of the brain and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, severe "thunderclap" headache. This type of stroke is commonly caused by the rupture of an aneurysm, which can develop with age or be present from birth. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow to parts of your brain What causes encephalitis, multiple sclerosis, amyotrophic lateral sclerosis (ALS) and what are presenting symptoms? Encephalitis: an acute febrile illness, usually with viral origin, with nervous system involvement most often caused by arthropod borne viruses and HSV 1, can also be caused by complications from polio, rabies, or mononucleosis, or after recovery from viral infections such as rubella or rubella Presenting symptoms include fever, delirium, or confusion progressing to unconsciousness, seizures, cranial nerves palsies, paresis, paralysis, involuntary movement, and abnormal reflexes Multiple Sclerosis: a disorder involving destruction of CNS myelin, sparing the peripheral nervous systemcaused by destruction of myelin forming cells (oligodendrites) by the combination of syncytin, inflammatory proteins, and free radicalsplaques are formed in the white matter causing demyelination Presenting symptoms include mixed, spinal, or cerebellar syndromes depending on the portion of the CNS most involved Amyotrophic Lateral Sclerosis: a degenerative disorder diffusely involving lower and

upper motor neurons resulting in progressive muscle weaknesscause is unknown, maybe a genetic factor is involved Presenting symptoms include weakness, and flaccid and spastic paralysis -Amyotrophic Lateral Sclerosis (ALS)/ Lou Gehrigs disease -cause not identified, but familial form is located on chromosome 21 -affects more men ages 40-60 -continuous rapid decline of motor function while cognitive function remains intact -commonly used in ethical debates about euthanasia -Pathophysiology -progressive degenerative disease affecting both upper motor neurons in cerebral cortex (causes spastic paralysis and hyperreflexia) and lower motor neurons in brainstem and spinal cord (causes flaccid paralysis) -sensory neurons and cognitive function not affected -loss of neurons occurs in diffuse and asymmetrical pattern and proceeds without remission -Signs and Symptoms -Upper extremities manifest weakness and muscle atrophy and loss of fine motor coordination -stumbling and falls common -muscle cramps and twitching -loss of ability to talk, then swallow then respiration, requiring a respirator *keep in mind that the person is totally aware the entire time Myasthenia gravis results from? Myasthenia Gravis -Pathophysiology -autoimmune disorder that impairs receptors for acetylcholine (Ach) at the neuromuscular junction -cause unknown but many have thymus disorders -more frequently women age of onset 20-30 and men over 50 -antibodies form against Ach receptors and block and destroy receptor site and prevent stimulation of the muscle weakness, fatigue Chapter 13: pain Where are nociceptors found? -Nociceptors are free nerve endings that respond to chemical, mechanical, and thermal stimuli. They are found under the epidermis and within joint and bone surfaces, the deep tissues, muscles, tendons, and subcutaneous tissue. They are not evenly distributed, so relative sensitivity to pain differs according to the area of the body. System responsible for individuals conditioned or learned approach or avoidance behavior in response to pain is? -the motivational/affective system determines the individuals conditioned or learned approach/avoidance behaviors

What is gate control theory, neuromatrix theory, specificity theory? -Gate-control theory Pain transmission is modulated by a balance of impulses transmitted to the spinal cord by large and small fibers. Stimulation of large fibers, such as touch, vibration, or thermal regulation, closes the gate and diminishes pain perception. This is why rubbing a pinched finger can reduce pain. This theory is inadequate to explain some chronic pain problems, such as phantom limb pain. -Neuromatrix theory When there is no discernable cause for chronic pain, i.e. phantom limb pain/some neuropathy, the brain produces patterns of nerve impulses from a widely distributed neural network with multidimensional inputs (genetic, affective, cognitive, evaluative, and other components). The patterns may be triggered by sensory inputs from the periphery or originate independently in the brain with no external input. -Specificity theory It proposes that the intensity of pain is directly related to the amount of associated tissue injury. For example, pricking ones finger with a needle causes minimal pain whereas cutting ones hand with a knife produces more tissue injury and thus is more painful. This theory is useful for pain associated with specific injury and acute pain but does not account for chronic pain or cognitive and psychological contributions to pain. What are the different types of pain: chronic, referred, visceral, neuropathic, peripheral, central, somatic -Acute protective mechanism that alerts the individual to a condition or experience that is immediately harmful to the body. It mobilizes the individual to take prompt action to relieve it. This type of pain begins suddenly and is relieved after the chemical mediators that stimulate pain receptors are removed. Acute anxiety and hope of recovery are associated with this pain (can be classified as somatic, visceral, or referred.) -Chronic persistent usually defined as lasting at least 3-6 months and is related to tissue damage, inflammation, or injury of the nervous system; decreased level of endorphins and predominance of C neuron stimulation persistence: allows for physiological adaptation; normal heart/resp rates, BP (low back pain) intermittent: responses similar to acute pain; changes in VS (migraines) -Referred Pain pain that is present in an area removed or distant from its point of origin. It can be acute or chronic. the area is supplied by the same spinal segment as the actual site of pain, and the brain cannot distinguish between the two impulses.

-Somatic superficial and is sharp and well-localized or dull, aching, and poorly localized and accompanied by nausea and vomiting. It is carried by sensory nerves. -Visceral pain in internal organs, the abdomen, or skeleton. It is poorly localized and is associated with nausea and vomiting, hypotension, restlessness, and in some cases, shock. this pain often radiates or is referred. It is carried by sympathetic nerve fibers. -Neuropathic chronic pain that is characterized by increased sensitivity to painful stimuli (hyperalgesia), the perception of innocuous stimuli as painful (allodynia), and spontaneous pain. It results from abnormal processing of sensory information by the peripheral and central nervous systems -Peripheral Is the result of trauma or disease to the peripheral nerves, such as nerve entrapment or diabetic neuropathy. -Central Is caused by a lesion or dysfunction in the brain or spinal cord such as phantom pain or complex regional pain syndrome ( reflex sympathetic dystrophy syndrome or causalgia), which is intense burning and swelling with extremity pain after an injury. What is the pain threshold in children? -lower or the same as adults