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Pathophysiology CHPT 13-15 Review Sheets

Terms in this set (204)

The divisions of the nervous system has been catagorized as?
Structural= CNS, PNS
Functional= SNS, ANS
(Somatic Nervous System)
(Autonomic Nervous System)
The CNS is contained within the?
Brain and spinal cord
The PNS is composed of?
Cranial and spinal nerves, which carry impulses toward the CNS (afferent—sensory) and away from the CNS (efferent—motor) to and from target organs or
skeletal muscle.
The neuron and neuroglial cells (nonnerve cells) constitute?
Nervous tissue
The neuron is specialized to transmit and receive ______________ and ___________ impulses, whereas the neuroglial cell provides _____________ and maintenance _______________.
electrical, chemical, supportive, functions
Neurons are categorized based on its structure and particular mechanics of impulse transmission, what are the categories of neurons?
Unipolar, pseudounipolar, bipolar, and multipolar
Neurons are composed of?
Cell body, dendrites, an axon and myelin sheath which coat around the axons to allow the nerve impulse to move faster down the axon.
The region between the neurons is the _______________, and the region between the neuron and
muscle is the ______________ ______________.
Synapse, myoneural junction
Neurotransmitters are responsible for _______________ conduction across the synapse.
Chemical
The myoneural junction nerve impulse is regulated predominantly by a _____________ of inhibitory
postsynaptic potentials (IPSPs) and excitatory postsynaptic potentials (EPSPs), _____________ and
___________ summation, and convergence and divergence.
balance, temporal, spatial
The brain is contained within the cranial vault and is divided into three distinct regions:
1. Forebrain
2. Hindbrain
3. Midbrain
The forebrain comprises the _____ cerebral hemispheres and allows _____________ perception of
internal and external stimuli, thought and ____________ processes, and ___________ control of skeletal muscles.
two, conscious, memory, voluntary
The deep portion of the forebrain is termed the _____________ and processes incoming sensory data.
diencephalon
The center for voluntary control of skeletal muscle movements is located along the ______________ gyrus in the frontal lobe, whereas the center for perception is along the _______________ gyrus in the parietal lobe.
precentral, postcentral
The Broca area (inferior frontal gyrus) and
the Wernicke area (superior temporal gyrus) are major _________ centers.
speech
The hindbrain allows sampling and comparison of _____________ data, which are received from the
periphery and motor impulses of the cerebral hemispheres, for the purpose of _________________
and ______________ of skeletal muscle movement.
sensory, coordination, refinement
The midbrain is primarily a relay center for motor and sensory tracts, as well as a center for _____________ and _________ reflexes.
auditory, visual
The spinal cord contains _______ ___ the nerve fibers that connect the brain with the periphery.
most of
The _________________ tracts are descending pyramidal (motor) pathways from the motor cortex.
corticospinal
The ________________ and ________________ tracts are descending extrapyramidal tracts that coordinate
movement.
rubrospinal, reticulospinal
The anterior, posterior, and lateral spinothalamic tracts carry sensory information to the _______________ and _____________, where information is relayed to the sensory cortex.
brainstem, thalamus
Reflex arcs are __________ and __________ circuits completed in the spinal cord and influenced by the higher centers in the brain.
sensory, motor
The CNS is protected by?
The scalp, bony cranium, meninges (dura mater, arachnoid, membrane, and pia mater), vertebral column, and cerebrospinal fluid (CSF).
CSF is formed from?
Blood components in the choroid plexuses of the ventricles and is reabsorbed in the arachnoid villi (located in the dural venous sinuses) after circulating through the brain and
subarachnoid space.
The paired carotid and vertebral arteries supply blood to the brain and connect to form the __________ ___ __________.
Circle of Willis
The major branches projecting from the circle of Willis are?
The anterior, middle, and posterior cerebral arteries.
Drainage of blood from the brain is accomplished
through? the venous sinuses and jugular veins.
The venous sinuses and jugular veins.
The blood-brain barrier is provided by tight junctions between the cells of brain capillary
endothelial cells and surrounding supporting cells
supporting
Blood supply to the spinal cord originates from the ______________ arteries and ___________ arising from the aorta.
vertebral, branches
The ________ and ________ nerves constitute the PNS.
cranial, spinal
The PNS relays information from the CNS
to muscle and effector organs through cranial and spinal nerve tracts arranged in ______________
(multiple fascicles bound together form the peripheral nerve).
fascicles
The ANS is responsible for?
Maintaining a steady state in the internal environment.
Two opposing systems make up the ANS:
(1) the sympathetic nervous system (thoracolumbar division) responds to stress by mobilizing energy stores and prepares the body to defend itself

(2) the parasympathetic nervous system (craniosacral division) conserves energy
and the body's resources. Both systems function, more or less, at the same time.
Pain (nociception) is a complex, unpleasant sensory experience involving ____________, _____________,
and _______________.
emotion, cognition, motivation
Pain is __________________.
protective
Three portions of the nervous system are responsible for the sensation, perception, and
response to pain:
(1) the afferent pathways
(2) the central nervous system
(3) the efferent pathways
What are two types of nociceptors?
Mylinated Aδ _fibers transmit sharp, "fast" pain.

Smaller, unmyelinated C fibers more slowly transmit dull, less localized pain.
Nociception involves four phases: transduction, transmission, perception, and modulators
Transduction, transmission, perception, and modulators
The somatosensory cortex mediates?
Localization and intensity of pain.
The reticular formation, limbic system, and brain stem control?
Emotional and affective responses to pain
The _________ coordinates the meaning an experience of pain.
cortex
Pain threshold is?
The least experience of pain that a person can recognize.
Pain tolerance is?
The greatest level of pain that an individual is prepared to tolerate.
Both are subjective and influenced by many factors.
Pain threshold and pain tolerance
Neuromodulators of pain include substances that
(1) stimulate pain nociceptors (e.g.,
prostaglandins, bradykinins, lymphokines, substance P, glutamate)

(2) suppress pain (e.g., GABA, endogenous opioids, endocannabinoids). Some substances excite peripheral nerves but inhibit central nerves (e.g., serotonin, norepinephrine).
Descending inhibitory and facilitatory pathways and nuclei inhibit or facilitate pain. Efferent pathways from the ventromedial thalamus and periaqueductal gray inhibit pain impulses at
the _________ horn.
dorsal
The _____________________ _________ (RVM) stimulates efferent pathways that facilitate or inhibit pain in the dorsal horn.
rostroventromedial medulla
Segmental pain inhibition occurs when impulses from ____________ (touch and vibration sensations) arrive at the same spinal level as impulses from ______________.
Aβ _fibers, Aδ _or C fibers
Diffuse noxious inhibitory control occurs when?
Pain signals from two different sites are transmitted simultaneously and inhibit pain through a spinal-meduallary-spinal pathway
Endogenous opioids inhibit pain transmission and include ______________, _______________, _______________, and ____________________. They are produced in the central nervous system.
enkephalins, endorphins, dynorphins, endomorphins
Classifications of pain include?
Nociceptive pain (with a known physiologic cause), nonnociceptive
pain (neurologic pain), acute pain (signal to the person of a harmful stimulus),
and chronic pain (persistence of pain of unknown cause or unusual response to therapy).
Acute pain may be?
(1) somatic (superficial)
(2) visceral (internal)
(3) referred (present in an area distant from its origin).
The area of referred pain is supplied by?
The same spinal segment as the actual site of pain.
Chronic pain is?
Pain lasting well beyond the expected normal healing time and may be
intermittent (e.g., low back pain) or persistent (e.g., migraine headaches).
Psychologic, behavioral, and physiologic responses to chronic pain includes?
Depression, sleep disorders, preoccupation with pain, lifestyle changes, and physiologic adaptation.
Neuropathic pain is?
Increased sensitivity to painful stimuli and results from abnormal processing of pain information in the peripheral or central nervous system.
Temperature regulation is achieved through?
Precise balancing of heat production, heat conservation, and heat loss.
Body temperature is maintained in a range around ______________.
37° C (98.6°F)
Temperature regulation is mediated by the hypothalamus through thermoreceptors in the?
Skin, hypothalamus, spinal cord, and abdominal organs.
Heat is produced through chemical reactions of _______________ and ___________ muscle contraction.
metabolism, skeletal
Heat is lost through?
Radiation, conduction, convection, vasodilation, decreased muscle tone,
evaporation of sweat, increased respiration, and voluntary mechanisms.
Heat is conserved through ___________________ and _______________ mechanisms.
vasoconstriction, voluntary
Infants do not conserve heat well because of?
Their greater body surface/mass ratio and
decreased amounts of subcutaneous fat.
Elderly persons have poor responses to
environmental temperature extremes as a result of?
Slowed blood circulation, structural and
functional changes in the skin, and overall decrease in heat-producing activities.
Fever is triggered by?
The release of exogenous pyrogens from bacteria or the release of endogenous pyrogens (cytokines) from phagocytic cells.
Fever is both a normal __________________
mechanism and a symptom of ______________.
immunologic, disease
Fever involves the "resetting of the __________________ thermostat" to a higher level. When the fever breaks, the set point returns to normal.
hypothalamic
Fever production aids responses to _______________ processes.
infectious
Higher temperatures kill many microorganisms, promote immune responses, and decrease serum levels of _______,_______, and___________, which are needed for bacterial replication.
iron, zinc, copper
Fever of unknown origin is?
A body temperature greater than 38.3° C (101° F) for longer than 3 weeks that remains undiagnosed after 3 days of investigation.
Hyperthermia (marked warming of core temperature) can produce?
Nerve damage, coagulation of cell proteins, and death.
Forms of accidental hyperthermia include?
Heat cramps, heat exhaustion, heat stroke, and malignant hyperthermia.
Heat stroke and malignant hyperthermia are potentially ___________.
lethal
Hypothermia is?
(marked cooling of core temperature) slows the rate of chemical reaction (tissue metabolism), increases the viscosity of the blood, slows blood flow through the microcirculation, facilitates blood coagulation, and stimulates profound vasoconstriction.
Hypothermia may be _____________ or_______________.
accidental, therapeutic
Sleep is?
An active process and is divided into REM and non-REM stages, each of which has
its own series of stages.
While asleep, an individual progresses through ______ and ___________________ sleep in a predictable cycle.
REM, non-REM (slow wave)
REM sleep is controlled by mechanisms in the _______ and _____________________.
pons, mesencephalon
Non-REM sleep is controlled by release of inhibitory signals from the hypothalamus and accounts for ______ to ______ of sleep time.
75%, 80%
The sleep patterns of the ______________ and _______________ vary from those of the adult in total sleep
time, cycle length, and percentage of time spent in each sleep cycle.
newborn, young child
Elderly persons experience a total ______________ in sleep time.
decrease
The restorative, reparative, and growth processes occur during ______________________________ sleep.
slow-wave (non-REM)
Sleep deprivation can cause profound changes in ________________ and __________________.
personality, functioning
Sleep disorders include:
(1) dyssomnias (disorders of initiating sleep [i.e., insomnia, sleep disordered breathing, hypersomnia, or disorders of the sleep-wake schedule])

(2) parasomnias (i.e., sleepwalking or night terrors and restless legs syndrome).
The wall of the eye has three layers:
Sclera, choroid, and retina.
The retina contains millions of baroreceptors known as ______ and ________ that receive light through the lens and then convey signals to the optic nerve and subsequently to the visual cortex of the brain.
rods, cones
The eye is filled with vitreous and aqueous humor, which prevent it from _________________.
collapsing
The _____________, _______________, and _____________________________ protect the eye.
eyelids, conjunctivae, lacrimal apparatus
Infections are the most common disorders; they include?
Blepharitis, conjunctivitis, chalazion, and hordeolum.
Structural eye changes caused by aging result in?
Decreased visual acuity
The major alterations in ocular movement include?
Strabismus, nystagmus, and paralysis of
the extraocular muscles.
Alterations in visual acuity can be caused by?
Amblyopia, scotoma, cataracts, papilledema, glaucoma, and macular degeneration.
A cataract is?
A cloudy or opaque area in the ocular lens and leads to visual loss when located
on the visual axis.
Glaucomas are characterized by?
Intraocular pressures greater than 12 to 20 mm Hg with death of retinal ganglion cells and their axons.
Age-related macular degeneration is?
Irreversible loss of vision with dry or wet forms.
Alterations in accommodation develop with increased intraocular pressure, __________________,
and disease of the ________________ nerve.
inflammation, oculomotor
Presbyopia is loss of accommodation caused by?
Loss of elasticity of the lens with aging.
Alterations in refraction include?
Myopia, hyperopia, and astigmatism, are the most common visual disorders.
Alterations in color vision can be related to?
Yellowing of the lens with aging and color
blindness, an inherited trait.
Trauma or disease of the optic nerve pathways, or optic radiations, can cause?
Blindness in the visual fields.
Homonymous hemianopsia is caused by?
Damage of one optic tract.
Blepharitis is?
An inflammation of the eyelid
Hordeolum (stye) is?
An infection of the eyelid's sebaceous gland
Chalazion is
An infection of the eyelid's meibomian gland
Conjunctivitis:
Can be acute or chronic, bacterial, viral, or allergic.

Redness, edema, pain, and
lacrimation are common symptoms.
Chlamydial conjunctivitis is?
The leading cause of blindness in the world and is associated with poor sanitary conditions.
Keratitis is?
A bacterial or viral infection of the cornea that can lead to corneal ulceration.
Common symptoms of Keratitis are?
Photophobia, pain, and tearing
The ear is composed of?
External, middle, and inner structures.
The external structures are?
The pinna, auditory canal, and tympanic membrane.
The tympanic cavity (containing three bones:
The malleus, the incus, and the stapes), oval window, eustachian tube, and fluid compose the middle ear and transmit sound vibrations to the inner ear.
The inner ear includes the bony and membranous _______________ that transmit sound waves through the cochlea to the acoustic division of the ____________ cranial nerve.
labyrinths, eighth
The semicircular canals and vestibule help maintain _____________ through the _______________ receptors.
balance, equilibrium
Approximately ______ _________ of all people older than 65 years have hearing loss.
one third
Hearing loss can be classified as?
Conductive, sensorineural, mixed, or functional.
Conductive hearing loss occurs?
When sound waves cannot be conducted through the middle ear.
Sensorineural hearing loss develops with?
Impairment of the organ of Corti or its central connections.
_________________ is the most common form of sensorineural hearing loss in elderly people.
Presbycusis
A combination of conductive and sensorineural loss is a _________ hearing loss.
mixed
Loss of hearing with no known organic cause is a _______________ hearing loss.
functional
Ménière disease is?
A disorder of the middle ear that affects hearing and balance.
Otitis externa is?
An infection of the outer ear associated with prolonged exposure to moisture.
Otitis media is an infection of the middle ear that is common in __________. Accumulation of fluid (effusion) behind the ___________ membrane is a common finding.
children, tympanic
The perception of flavor is altered if ______________ or _________ dysfunctions occur.
olfaction, taste
Sensitivity to odor and taste decreases with __________.
aging
Hyposmia is?
A decrease in the sense of smell, and anosmia is the complete loss of the sense of smell.
Inflammation of the nasal ___________ and trauma or tumors of the ______________ nerve lead to a diminished sense of smell.
mucosa, olfactory
Hypogeusia is?
A decrease in taste sensation, and ageusia is the absence of the sense of taste.
Loss of taste buds or trauma to the _________ or _________________________ nerves decreases taste
sensation.
facial, glossopharyngeal
Tactile sensation is?
A function of receptors present in the skin (pacinian corpuscles), and the sensory response is conducted to the brain through the dorsal column and anterior
spinothalamic tract.
Alterations in touch can result from disruption of?
Skin receptors, sensory transmission, or central nervous system perception.
Proprioception is?
The position and location of the body and its parts.
Proprioceptors are located?
In the inner ear, joints, and ligaments.
Proprioceptive stimuli are necessary for?
Balance, coordinated movement, and grading of muscular contraction.
Disorders of proprioception can occur at any level of the nervous system and result in impaired ____________ and lack of __________________ movement.
balance, coordinated
Full consciousness is?
An awareness of oneself and the environment with an ability to respond
to external stimuli with a wide variety of responses.
Consciousness has two components:
Arousal (level of awakeness) and awareness (content of thought).
An altered level of arousal occurs by?
Diffuse bilateral cortical dysfunction, bilateral subcortical (reticular formation, brainstem) dysfunction, localized hemispheric dysfunction, and metabolic disorders.
An alteration in breathing pattern and the level of consciousness reflect the level of brain
________________.
dysfunction
Pupillary changes reflect changes in level of?
Brainstem function, drug action, and response to hypoxia and ischemia.
Abnormal ______ movements, including nystagmus and divergent ________, reflect alterations in
brainstem function.
eye, gaze
Level of brain function manifests by changes in generalized ________ responses or ____ responses
motor, no
Loss of cortical inhibition associated with decreased consciousness produces?
Abnormal flexor and extensor movements.
Cerebral death or irreversible coma represents permanent brain damage, with an ability to
maintain?
Cardiac, respiratory, and other vital functions.
Brain death results from irreversible brain damage, with an inability to maintain internal ___________________.
homeostasis
Alterations in awareness include alterations in?
Executive attention (abstract reasoning,
planning, decision making, judgment, error correction, and self-control) and memory.
With a deficit in selective attention, mediated by midbrain, thalamus, and parietal lobe
structures, the individual ____________ focus on selective stimuli and thus neglects those stimuli.
cannot
In amnesia, some past memories are ________ and new memories __________ be stored.
lost, cannot
____________ areas mediate vigilance, detection, and working (short-term) memory.
Frontal
With vigilance deficits, the person cannot maintain sustained __________________.
concentration
With detection deficits, the person is ________________ and _________ to set goals and plan.
unmotivated, unable
Data processing deficits include?
Agnosias, dysphasias, acute confusional states, and dementias.
Agnosias are defects of recognition and may be?
Tactile, visual, or auditory
Agnosias are caused by?
Dysfunction in the primary sensory area or the interpretive areas of the cerebral cortex.
Dysphasia (aphasia) is an impairment of?
Comprehension or production of language.
Dysphasia may be _____________ or______________.
expressive, receptive
Acute confusional states are characterized chiefly by?
A loss of detection and, in the case of delirium, intense autonomic nervous system hyperactivity.
Alzheimer disease is?
A chronic irreversible dementia that is related to altered production or
failure to clear amyloid from the brain with plaque formation, formation of neurofibrillary tangles, and loss of basal forebrain cholinergic neurons.
______________________ dementias are rare early-onset degenerative diseases similar to Alzheimer
disease.
Frontotemporal
Seizures represent?
A sudden, chaotic discharge of cerebral neurons with transient alterations
in brain function.
Seizures may be ________________ or________ and can result from cerebral lesions, biochemical disorders, trauma, or epilepsy.
generalized, focal
Alterations in cerebral blood flow are related to?
Changes in cerebral perfusion pressure,
changes in cerebral blood volume, and cerebral blood oxygenation.
Increased intracranial pressure (IICP) may result from?
Edema, excess cerebrospinal fluid,
hemorrhage, or tumor growth.
When intracranial pressure approaches arterial pressure, hypoxia and hypercapnia produce brain ____________.
damage
Cerebral edema is an increase in the fluid content of the brain resulting from?
Infection, hemorrhage, tumor, ischemia, infarction, or hypoxia.
Cerebral edema can cause ________.
IICP
The ____________ or ______________ of brain tissue from one compartment to another disrupts the blood
flow of both compartments and damages brain tissue
shifting, herniation
Supratentorial herniation involves?
The temporal lobe and hippocampal gyrus shifting from the middle fossa to posterior fossa.
Transtentorial herniation involves?
A downward shift of the diencephalon through the tentorial notch
Shifting of the cingulate gyrus can occur under
the _______ ___________.
falx cerebri
The most common infratentorial herniation is?
A shift of the cerebellar tonsils through the
foramen magnum
Hydrocephalus comprises a variety of disorders characterized by?
An excess of fluid within the ventricles, subarachnoid space, or both.
Hydrocephalus occurs because of?
Interference with cerebrospinal fluid flow caused by increased fluid production or obstruction within the ventricular system or by defective reabsorption of the fluid.
Motor dysfunction may be characterized as?
Alterations of motor tone, movement, and
complex motor performance.
______________ and ______________ are the main categories of altered tone.
Hypotonia, hypertonia
Hypotonia is associated with?
Pyramidal tract or cerebellar injury.

Muscles are flaccid and weak with atrophy.
The four types of hypertonia are?
Spasticity paratonia (gegenhalten), dystonia, and rigidity.
Paresis, paraplegia, hyperkinesia, and hypokinesia are the main categories of ________________________________.
altered movement
Two subtypes of paresis/paralysis are described:
Upper motor neuron spastic paresis/ paralysis and lower motor neuron flaccid paresis/ paralysis.
An upper motor neuron syndrome is characterized by?
Paresis/ paralysis, hypertonia, and
hyperreflexia.
Interruption of the pyramidal tract below the pons results in _______________________.
spinal shock
Lower motor neuron syndromes manifest by impaired _____________ and _________________ movements
and flaccid paralysis.
voluntary, involuntary
Partial paralysis occurs with only __________ loss of alpha motor neurons, and total paralysis is
complete _______ of alpha motor neurons.
partial, loss
Loss of ___________ motor neurons impairs muscle tone
and decreases tendon reflexes.
gamma
Included in the category of hyperkinesia are?
Chorea, athetosis, ballism, akathisia, tremor, and myoclonus.
Huntington disease (chorea) is?
A rare hereditary disease involving the basal ganglia and cerebral cortex that commonly manifests between 25 and 45 years of age.
The major pathologic feature of Huntington disease is?
Severe degeneration of the basal ganglia and the frontal cerebral cortex with an excess of dopaminergic activity that causes involuntary, fragmentary hyperkinetic movements.
Types of hypokinesia include?
Akinesia, bradykinesia, and loss of associated movements.
Parkinson disease is?
A commonly occurring degenerative disorder of the basal ganglia (corpus striatum) involving degeneration of the dopamine-secreting nigrostriatal pathway.
_______________ ______________ in the basal ganglia and excess cholinergic activity in the cortex, basal
ganglia, and thalamus cause tremor and rigidity in Parkinson disease.
Dopamine depletion
Progressive dementia may be associated with an advanced stage of the disease.
Parkinsons
Upper motor neuron syndromes are the result of?
Damage to descending motor pathways at
cortical, brainstem, or spinal cord levels and result in spastic paralysis.
Spinal _________ is temporary loss of all spinal cord functions below the lesion (below the level of the pons).
shock
It is characterized by complete flaccid paralysis, absence of reflexes, and marked disturbances of bowel and bladder function.
Spinal shock
Lower (primary, alpha) motor neuron syndromes involve?
The large motor neurons in the anterior (or ventral) horn of the spinal cord and the motor nuclei of the brainstem and cause flaccid paralysis.
Amyotrophic lateral sclerosis involves?
Degeneration of both upper and lower motor neurons with progressive muscle weakness and atrophy.
Alterations in complex motor performance include?
Disorders of posture (stance), disorders of
gait, and disorders of expression.
Disorders of posture include?
Dystonic posture, decerebrate posture/ response, basal ganglion posture, and senile posture.
Disorders of gait include?
Upper motor neuron gait, cerebellar (ataxic) gait, basal ganglion gait, and frontal lobe ataxic gait.
Disorders of expression include?
Hypermimesis, hypomimesis, and apraxia (dyspraxia).
Apraxia is an impairment of the?
Conceptualization or execution of a complex motor act
Extrapyramidal motor syndromes include?
Basal ganglia and cerebellar motor syndromes.
Basal ganglia disorders manifest by?
Alterations in muscle tone and posture, including rigidity, involuntary movements, and loss of postural reflexes.
Cerebellar motor syndromes result in?
Loss of muscle tone, difficulty with coordination, and disorders of equilibrium and gait.
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