Patho Ch 9 Q & A

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Feedback systems respond to low glucose levels by stimulating the release of hormones designed to mobilize stored glucose, including glucagon, epinepherine, norepinepherine, growth hormone, and cortisol. These hormones are similar to those released during "fight or flight," leading to autonomic symptoms of shakiness, pounding/racing heart, nervousness, anxiety, perspiration, tingling, feeling hungry, and sensing that blood sugar is low. At extremely low glucose levels, manifestations of altered brain function appear, such as confusion, fatigue, drowsiness, warmth, difficulty with speech, loss of coordination, and unusual behavior.

The preferred energy source for the brain is glucose. What manifestations can be expected when adequate levels of glucose are unavailable?

Total body water would have a significant influence on CSF volume. Dehydration would increase risk for inadequate circulating CSF. This would decrease the protective functions provided by CSF. Fluid overload would contribute to increases in CSF volume, with the associated risks of pressure and ischemic injury due to increased intracranial pressure.

How would CSF volume be altered if fluid could move directly from the blood into the CSF?

Referred pain is caused when the sensory fibers from an internal organ enter the spinal cord in the same root as fibers from a dermatome. The brain interprets visceral pain as pain from the somatic area of the dermatome. So pain in the heart is often interpreted as pain in the left arm or shoulder.

When having a heart attack, a common manifestation is pain in the left arm or shoulder. How are dermatomes related to this phenomenon?

Many diseases and medication adverse effects are characterized by alterations in movement or coordination. An accurate description of the altered motion pattern may assist in targeting the nervous system component involved and lead to an accurate diagnosis.

Why is it important to characterize specific types of altered movement?

There are few known cures for altered neuronal transmission. Most treatment strategies are directed toward alleviation of associated symptoms. At times, the effectiveness of the medications leads a person to believe that they no longer have a need for them and they discontinue their treatments. This often leads to relapse and carries the risk of further degeneration of their condition. Some people have great difficulty complying with medication regimens due to the significant side effects they experience as a result of the medications. Appropriate management of these adverse effects may promote continued, regular use of medications. Cost may also be significant, especially for newer, more effective medications. Referral to programs providing financial medication assistance may be of great help to those with economic needs.

What are the challenges of maintaining a treatment plan for a person with clinical signs and symptoms related to altered neuronal transmission?

The timing of the injury may provide information on the cause of the injury, promoting the initiation of more effective treatments. This information may also be helpful in promoting the person's optimal functioning through early intervention and strategies that increase functional capacity and independence.

Why is it important to determine the timing of neurologic injury related to CP?

Myelin is important to neural transmission in many cells. The factors that promote myelin growth may be applicable to axon regeneration. The clinical applications of these findings have the potential to impact many neurodegenerative and injury conditions.

How will regrowth of myelin help treat or cure other neurologic diseases?

TCAs affect several neurotransmitters including acetylcholine, serotonin, dopamine, and norepinephrine. Many side effects that are most bothersome are anticholinergic (dry mouth, constipation, urinary retention, tachycardia, and vision problems). Drugs with mechanisms of action involving fewer neurotransmitters have fewer side effects, restricted to the specific neurotransmitter.

Why do TCAs have more side effects than other more selective antidepressants?

B

Neurons that carry sensory information to distant parts of the brain and spinal cord are called:
a. Efferent neurons
b. Afferent neurons
c. Interneurons
d. Extraneurons

A

Depolarization involves:
a. The rapid movement of sodium into the cell
b. The movement of potassium ions out of the cell
c. Movement of potassium ions into the cell
d. The absence of electrical activity

D

The lobe of the brain primarily involved in functions related to vision is the:
a. Frontal lobe
b. Parietal lobe
c. Temporal lobe
d. Occipital lobe

B

Which of the following areas of the spinal cord contains 12 segments?
a. Cervical
b. Thoracic
c. Sacral
d. Lumbar

B

Which cell type has the most potential for regeneration after injury?
a. Astrocyte
b. Peripheral axon
c. Glial cell
d. Oligodendrocytes

A

Coup/contercoup occurs due to which type of injury mechanism?
a. Traumatic injury
b. Pressure injury
c. Excitation injury
d. Ischemic injury

A

Neurogenic shock is due to altered transmission in which conduction system?
a. Sympathetic
b. Parasympathetic
c. Somatic
d. Peripheral

C

Seizure disorders are associated with which type of injury mechanism?
a. Traumatic injury
b. Pressure injury
c. Excitation injury
d. Ischemic injury

D

Which type of neuron synthesizes and secretes norepinephrine as the primary neurotransmitter?
a. Serotonergic
b. Cholinergic
c. Nicotinic
d. Adrenergic

Manifestations include hyperactivity, impulsivity, and inattention. Hyperactivity can be identified by a child's behavior: the child can't sit still, is running, climbing or walking around when others are sitting; speaks when others are talking. Impulsivity is seen when the child acts quickly without thinking the action through. This may be identified when the child speaks inappropriately or shows emotion without restraint. They may do something that has an immediate pay off, like grabbing a toy from another child, without consideration of the long-term consequences. Inattentiveness occurs when the child daydreams, is easily sidetracked, or has difficulty maintaining focus on a topic.

What are the clinical manifestations associated with ADD?

 Environmental
• Smoking during pregnancy
• Alcohol use during pregnancy
• High levels of lead
 Brain Injury
 Food additives/sugar
• Many parents believe that food additives and sugar are triggers. No studies have confirmed the link between ADD and these substances.
 Genetics
• Familial predisposition
• No genes identified as yet
The frontal lobe of the cerebrum has been implicated as a potential site of pathology. The ability of children/individuals with ADD to solve problems, plan ahead, understand others' behavior, and impulse restraint is altered, all functions of the frontal lobe.

What is the underlying pathophysiology associated with ADD?

Professionals particularly suited to diagnosing include child psychiatrists, psychologist, developmental/behavioral pediatricians, behavioral neurologists, clinical social workers, or mental health clinical nurse specialists or nurse practitioners. A profile of the child's behavior is made, based on feedback from the child's teachers (past and present) and the child's parents. Considerations may include an evaluation of social adjustment, mental health, learning achievement, intelligence and behavior during situations requiring self-control. In the absence of another medical condition and learning disability, the diagnosis is made based on criteria as outlined in the DSM-IV-TR.

How is ADD diagnosed?

Treatment involves both behavior modification and pharmacologic management. Behavior modification strategies support the development of academic, social, and sports skills in an effort to improve school, family, and peer relationships as well as self-image. Children may need help with organization and can benefit from maintaining a set schedule, organizing daily needs, and using organizers to assist with homework and other responsibilities.
When behavioral therapy is not fully effective, pharmacologic management may be initiated. The stimulant class of drugs has been most effective in the treatment of the manifestations. These medications exert their effects by manipulating the neurotransmitter, dopamine. Another drug, Strattera, is not a stimulant and works on the neurotransmitter norepinephrine

What are the possible treatments for ADD?

The stigma of having a mental illness is a concern for children. Many of the drugs used in the treatment were short acting, requiring children to have medication administered during the school day. This activity easily identified affected children. Today, there are a variety of long-acting, sustained-release formulations, which remove the need for administration during the school day.
Medication side effects are also a significant issue. Though often mild, they can be disruptive to daily life. Common side effects include decreased appetite, insomnia, increase in anxiety, irritability, stomachaches, and headaches. Altering the timing of administration or a modulating medication may relieve some of these symptoms.

What are the issues related to appropriate management of ADD?

A

Tom has difficulty moving and controlling his legs after a motor vehicle accident The neurons most likely involved are called:
A. Motor neurons
B. Sensory neurons
C. Afferent neurons
D. Central neurons

D

The way that nenurons communicate with other neurons and cells in the body is through:
A. Subthresholds
B. Schwann cells
C. Oligodendrocytes
D, Action Potentials

C

The components of the action potential in the neuron include all of the following except:
A. Resting membrane potential
B. Depolarization phase
C. Capacitor potential
D. Repolarization phase

B

The small gap that separates neurons is called the:
A. Neurotransmitter
B. Synapse
C. Dendrite
D. Axon

A

Adrian suffered from a cerebral vascular accident ( a stroke). After the stroke, Adrian had difficulty with his reasoning ability and his speech. The part of his brain most likely affected by the stroke is:
A. Frontal Lobe
B. Occipital lobe
C. Parietal lobe
D. Temporal lobe

D

Functions of the blood-brain barrier include all of the following methods of protection except:
A. Protection of the brain from foreign substances
B. Protection of the brain from hormones and neurotransmitters
C. Protection against drastic environmental changes
D. Protection from all bacteria

C

The cranial nerves mediate:
A. Repolarization
B. The glial response
C. Sensory and motor functions
D. Cerebral spinal fluid circulation

B

Cerebral spinal fluid is produced by the:
A. Pia mater
B. Choroid plexus
C. Ventricles
D. Meninges

D

Mary is experiencing a sympathetic response. You would expect to see all of the following except:
A. Increased heart rate and contractility
B. Smooth muscle relaxation of the bronchioles
C. Vasoconstriction
D. Constriction of the bronchiole smooth muscle

A

Anna has experienced damage to neurons in her brain due to Alzheimer disease. Her daughter asks you if Anna's body will ever be able to repair the damaged neurons. You know that:
A. Mature neurons do not divide
B. Sympathetic neurons divide
C. Neurons are able to divide
D. Only neurons in the afferent system can divide

D

Mark was in a motor vehicle accident and sustained a closed head injury. he hit his head on the steering wheel when his car hit a tree. The are where the initial impact occurred is called the:
A. Contercoup
B. Recoup
C. Post coup
D. Coup

C

Cerebral palsy involves damage to the:
A. Lower motor neurons
B. Peripheral nervous system
C. Upper motor neurons
D. Motor neuron synapse

C

Rowan has multiple sclerosis. They symptoms that she is experiencing include cognitive loss, bowel and bladder dysfunction, altered mobility, and spasticity. The symptoms that Rowan is experiencing result from:
A. Neuron tangles
B. Synapse hyperractivity
C. Impairment in neurologic transduction
D. Transmitter depolarization

D

Depression is recognized by a cluster of symptoms such as mood features and cognitive features. This cluster of symptoms is known as a:
A. Symptom
B. Clinical manifestation
C. Sign
D. Syndrome

C

Hydrocephalus is caused by:
A. Communication of spinal fluid between the ventricles
B. Increased cerebral spinal fluid excretion
C. The accumulation of cerebral spinal fluid
D. Increased cerebral spinal fluid absorption

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