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What is the primary function of the parasympathetic nervous system?

  • Decrease activity for nourishment and rest (correct)
  • Enhance respiratory function
  • Stimulate the 'fight or flight' response
  • Increase heart rate and blood pressure

    • Which neurotransmitter is released by the postganglionic neurons in the sympathetic nervous system?

  • Acetylcholine
  • Dopamine
  • Histamine
  • Norepinephrine (correct)

    • What type of receptors bind to acetylcholine in the target cells of the parasympathetic nervous system?

  • Beta receptors
  • Muscarinic receptors (correct)
  • Nicotinic receptors
  • Alpha receptors

    • Which statement correctly describes the structure of the sympathetic nervous system?

    <p>Preganglionic fibers are short and postganglionic fibers are long</p> Signup and view all the answers

    What best describes the anatomical origin of the parasympathetic nervous system?

    <p>Cranial nerves and sacral spinal cord</p> Signup and view all the answers

    Which of the following correctly identifies the type of receptors in the sympathetic nervous system?

    <p>Adrenergic receptors as alpha, beta, or both</p> Signup and view all the answers

    What condition characterized by drooping eyelids, constricted pupils, and absence of sweating is associated with disruption along the sympathics?

    <p>Horner's Syndrome</p> Signup and view all the answers

    Which cranial nerve is primarily involved in facial movements?

    <p>Cranial Nerve 7</p> Signup and view all the answers

    Where do the preganglionic nerve cell bodies of the sympathetic nervous system reside?

    <p>Thoracolumbar segments T1-L2 or L3</p> Signup and view all the answers

    What type of ischemic stroke is characterized by an unknown cause?

    <p>Cryptogenic Stroke</p> Signup and view all the answers

    Which condition primarily results in atherosclerotic thrombus formation?

    <p>Thrombosis</p> Signup and view all the answers

    What condition is characterized by impaired language processing due to brain lesions?

    <p>Aphasia</p> Signup and view all the answers

    Which cranial nerve is responsible for taste and sensation in the back of the throat?

    <p>Cranial Nerve 9</p> Signup and view all the answers

    What is the likely cause when a stroke occurs with no prior significant symptoms?

    <p>Cryptogenic stroke</p> Signup and view all the answers

    What is a common symptom of subarachnoid hemorrhage?

    <p>The worst headache of life</p> Signup and view all the answers

    What does dysphagia refer to in medical terms?

    <p>Difficulty in swallowing</p> Signup and view all the answers

    What is a common symptom of diabetic proximal motor neuropathy?

    <p>Thigh muscle atrophy</p> Signup and view all the answers

    Which of the following is NOT a risk factor for obstructive sleep apnea?

    <p>Family history of sleep disorders</p> Signup and view all the answers

    Which medication is primarily used to treat cataplexy associated with narcolepsy?

    <p>Solriamfetol</p> Signup and view all the answers

    A patient experiences excessive daytime sleepiness and difficulty describing sensations in their legs when recumbent. What condition might they have?

    <p>Restless leg syndrome</p> Signup and view all the answers

    What is a common preventative treatment for migraines?

    <p>Tricyclic antidepressants</p> Signup and view all the answers

    What defines central vertigo in the context of possible causes?

    <p>Strokes or tumors affecting the brain</p> Signup and view all the answers

    Which treatment is recommended for managing entrapment neuropathies?

    <p>NSAIDs</p> Signup and view all the answers

    Which of the following is a prominent symptom associated with venous sinus thrombosis?

    <p>Papilledema</p> Signup and view all the answers

    In which type of diabetes-related neuropathy is the dampening of pain response in a silent myocardial infarction a concern?

    <p>Autonomic neuropathy</p> Signup and view all the answers

    What distinguishes classic migraines from common migraines?

    <p>Aura symptoms</p> Signup and view all the answers

    Which of the following represents a degenerative neuromuscular disease?

    <p>Lou Gehrig's disease</p> Signup and view all the answers

    Which type of headache typically presents as bilateral and band-like?

    <p>Tension headache</p> Signup and view all the answers

    What is a common diagnostic tool for venous sinus thrombosis?

    <p>Cerebral venography</p> Signup and view all the answers

    What triggers the neurogenic inflammation associated with migraines?

    <p>Release of neuropeptides</p> Signup and view all the answers

    Which of the following treatments is not recommended for tension headaches?

    <p>Ergotamines</p> Signup and view all the answers

    Which symptom is often associated with seizures?

    <p>Tongue biting</p> Signup and view all the answers

    What role do calcium channel blockers play in the context of migraines?

    <p>Preventative treatment</p> Signup and view all the answers

    Which condition can commonly predispose individuals to venous sinus thrombosis?

    <p>Pregnancy or postpartum state</p> Signup and view all the answers

    What is the primary treatment for a hemorrhagic stroke?

    <p>Reverse coagulopathy</p> Signup and view all the answers

    Which condition is most commonly associated with a berry aneurysm rupture?

    <p>Subarachnoid hemorrhage</p> Signup and view all the answers

    What symptom is characteristic of temporal arteritis?

    <p>Throbbing pain in the lateral temporal region</p> Signup and view all the answers

    What is the recommended treatment for cluster headaches?

    <p>100% oxygen via non-rebreathing facial mask</p> Signup and view all the answers

    Which of the following statements about headaches is true?

    <p>Migraine is a primary headache syndrome.</p> Signup and view all the answers

    What triggers should be considered in relation to cluster headaches?

    <p>Previous head trauma and alcohol use</p> Signup and view all the answers

    What vital sign threshold defines hypertensive urgency?

    <p>Systolic BP over 180, diastolic BP over 120</p> Signup and view all the answers

    What is the most significant risk associated with untreated temporal arteritis?

    <p>Vision loss</p> Signup and view all the answers

    Which symptom indicates a possible meningitis infection?

    <p>Diffuse headache with altered consciousness</p> Signup and view all the answers

    What should be the immediate treatment for a hypertensive crisis?

    <p>IV nitroprusside</p> Signup and view all the answers

    What is the typical memory outcome for a patient experiencing a generalized seizure?

    <p>The patient will not remember the event.</p> Signup and view all the answers

    Which is a risk factor for developing epilepsy?

    <p>Family history of epilepsy.</p> Signup and view all the answers

    What defines a febrile seizure?

    <p>Seizures occurring in the presence of a febrile illness.</p> Signup and view all the answers

    Which of the following describes acute viral meningitis?

    <p>It is self-limiting and usually requires supportive care.</p> Signup and view all the answers

    What percentage of dementia cases is attributed to Alzheimer's disease?

    <p>75%</p> Signup and view all the answers

    What is the main factor contributing to neurofibrillary tangles in Alzheimer's disease?

    <p>Abnormal accumulation of Tau proteins.</p> Signup and view all the answers

    Which of the following is NOT considered a reversible cause of dementia?

    <p>Huntington's disease.</p> Signup and view all the answers

    What is a common treatment for a prolonged febrile seizure?

    <p>Antiepileptic drugs.</p> Signup and view all the answers

    What characteristic distinguishes acute meningitis from meningoencephalitis?

    <p>Involvement of both meninges and brain parenchyma.</p> Signup and view all the answers

    Which condition is confirmed by a white blood cell count greater than 1000?

    <p>Bacterial meningitis.</p> Signup and view all the answers

    Which of the following symptoms is characteristic of Myasthenia Gravis?

    <p>Fatigable weakness proximal &gt; distal</p> Signup and view all the answers

    What is a key characteristic of Guillain-Barre Syndrome?

    <p>Can be triggered by an infection</p> Signup and view all the answers

    What does the presence of 'Dawson's fingers' indicate in multiple sclerosis?

    <p>Inflammatory lesions in the brain</p> Signup and view all the answers

    Which treatment is used in managing Myasthenia Gravis?

    <p>Acetylcholinesterase inhibitors</p> Signup and view all the answers

    Which type of neuropathy is characterized by loss of myelin sheath?

    <p>Demyelinating neuropathy</p> Signup and view all the answers

    What is the average lifespan from diagnosis for patients with a neuromuscular disease like ALS?

    <p>5 years</p> Signup and view all the answers

    What condition is described by symmetric involvement of peripheral nerves in a 'stocking glove distribution'?

    <p>Polyneuropathy</p> Signup and view all the answers

    Which condition is typically associated with optic neuritis as a first symptom?

    <p>Multiple Sclerosis</p> Signup and view all the answers

    In multiple sclerosis, what phenomenon occurs when symptoms worsen with increased temperature?

    <p>Uhthoff’s Phenomenon</p> Signup and view all the answers

    Which diagnostic method is NOT typically used for diagnosing neuromuscular diseases?

    <p>CT scan of the chest</p> Signup and view all the answers

    Which of the following mechanisms is implicated in the severe effects caused by H. Pylori in the stomach's epithelial cells?

    <p>Activation of the Type IV secretion system</p> Signup and view all the answers

    What is a characteristic change observed in chronic gastritis compared to acute gastritis?

    <p>Atrophy of gastric glands</p> Signup and view all the answers

    Which of the following factors is NOT associated with the development of increased gastrin production?

    <p>Consumption of high-fat diets</p> Signup and view all the answers

    What can be a long-term consequence of untreated H. Pylori infection?

    <p>Malignant transformation in gastric tissue</p> Signup and view all the answers

    Which specific change in gastric epithelium occurs as a compensatory response during chronic gastritis?

    <p>Metaplasia towards intestinal-type epithelium</p> Signup and view all the answers

    Which condition is characterized by heartburn occurring without the presence of dysphagia?

    <p>Old age-related carcinoma</p> Signup and view all the answers

    What is a potential complication of untreated esophagitis?

    <p>Esophageal stricture</p> Signup and view all the answers

    Which of the following conditions is likely to cause intermittent dysphagia with chest pain?

    <p>Diffuse Esophageal Spasm</p> Signup and view all the answers

    Which type of gastritis is most commonly associated with infection?

    <p>Helicobacter Pylori</p> Signup and view all the answers

    Eosinophilic esophagitis is most often seen in which demographic?

    <p>Young white men</p> Signup and view all the answers

    What class of medications might contribute to drug-associated esophagitis?

    <p>Antibiotics</p> Signup and view all the answers

    Which of the following is a functional cause of dysphagia?

    <p>Scleroderma</p> Signup and view all the answers

    What is the primary diagnostic tool used to diagnose esophagitis?

    <p>Endoscopy</p> Signup and view all the answers

    What clinical presentation is NOT typically associated with gastritis?

    <p>Elevated blood pressure</p> Signup and view all the answers

    Which diagnostic test is most useful for confirming esophageal motility disorders?

    <p>Manometry</p> Signup and view all the answers

    What is the primary treatment used for achalasia?

    <p>Endoscopic dilation</p> Signup and view all the answers

    Which of the following is NOT a recommended management option for scleroderma?

    <p>Antibiotics</p> Signup and view all the answers

    Which type of esophageal carcinoma is more prevalent in the developed world?

    <p>Adenocarcinoma</p> Signup and view all the answers

    What physical exam finding is indicative of Boerhaave’s Syndrome?

    <p>Subcutaneous emphysema</p> Signup and view all the answers

    What symptom is NOT commonly associated with gastroesophageal reflux disease (GERD)?

    <p>Iron deficiency anemia</p> Signup and view all the answers

    What is the expected change in lower esophageal sphincter tone in patients with scleroderma?

    <p>Decreased tone</p> Signup and view all the answers

    What dietary factor is most strongly associated with squamous cell carcinoma of the esophagus?

    <p>Poor nutritional habits</p> Signup and view all the answers

    Which of the following is a common complication of peptic ulcer disease?

    <p>Hemorrhage</p> Signup and view all the answers

    Which characteristic differentiates NASH from NADL in non-alcoholic fatty liver disease?

    <p>Absence of inflammation</p> Signup and view all the answers

    What is the most common risk factor for hepatocellular carcinoma?

    <p>Cirrhosis</p> Signup and view all the answers

    Which diagnostic tool is considered the gold standard for liver disease assessment?

    <p>Liver biopsy</p> Signup and view all the answers

    What is the major cause of gastric ulcers, leading to inflammation and pain?

    <p>Helicobacter pylori infection</p> Signup and view all the answers

    Which conditions can contribute to the increased production of gastrin associated with Zollinger-Ellison Syndrome?

    <p>Presence of small tumors in the pancreas</p> Signup and view all the answers

    What is a primary cause of increased oxidative stress in non-alcoholic fatty liver disease?

    <p>Increased metabolism of free fatty acids</p> Signup and view all the answers

    Which symptom is most likely to be experienced in the early stages of non-alcoholic fatty liver disease?

    <p>Fatigue</p> Signup and view all the answers

    Which risk factor is NOT commonly associated with gastric cancer?

    <p>Chronic intake of iron supplements</p> Signup and view all the answers

    What is the estimated five-year survival rate for patients with hepatocellular carcinoma without treatment?

    <p>10-12%</p> Signup and view all the answers

    Which of the following factors is known to reduce mucosal injury protection in the stomach?

    <p>Use of non-steroidal anti-inflammatory drugs (NSAIDs)</p> Signup and view all the answers

    Which factor does NOT typically contribute to the development of liver metastases?

    <p>Metabolic syndrome</p> Signup and view all the answers

    What type of tumor is characteristic of diffuse Linitis Plastica associated with gastric cancer?

    <p>Infiltrative carcinoma with a thick wall</p> Signup and view all the answers

    What symptom is most commonly reported in patients experiencing gastric ulcers?

    <p>Epigastric pain occurring 2-5 hours after eating</p> Signup and view all the answers

    Which treatment option is most commonly pursued for resectable primary liver tumors?

    <p>Surgical resection</p> Signup and view all the answers

    Which factor can lead to ischemia associated with gastric ulcers?

    <p>Cocaine use</p> Signup and view all the answers

    In terms of prevalence, how do gastric ulcers compare to duodenal ulcers?

    <p>Duodenal ulcers are three times more common than gastric ulcers</p> Signup and view all the answers

    Which condition is characterized by an increase in bilirubin levels that can lead to jaundice?

    <p>Hyperbilirubinemia</p> Signup and view all the answers

    What is a common presentation of liver cirrhosis?

    <p>Scleral icterus</p> Signup and view all the answers

    Which diagnostic test is essential to evaluate liver function during suspected drug toxicity?

    <p>Coagulation studies</p> Signup and view all the answers

    What is the most likely consequence of untreated viral hepatitis?

    <p>Progression to cirrhosis</p> Signup and view all the answers

    What is the primary treatment for mushroom poisoning affecting the liver?

    <p>Liver transplant</p> Signup and view all the answers

    What is a common laboratory finding in a patient with cirrhosis?

    <p>Thrombocytopenia</p> Signup and view all the answers

    Which mode of transmission is NOT associated with Hepatitis A?

    <p>Blood transfusions</p> Signup and view all the answers

    In patients with alcoholic liver disease, what is a reversible stage?

    <p>Steatosis</p> Signup and view all the answers

    Asterixis is a sign indicative of which hepatic condition?

    <p>Hepatic Encephalopathy</p> Signup and view all the answers

    What is the primary cause of ascites in patients with liver cirrhosis?

    <p>Portal hypertension</p> Signup and view all the answers

    What is the most common cause of small bowel obstruction?

    <p>Adhesions</p> Signup and view all the answers

    What is a transient functional cause of large bowel obstruction?

    <p>Ogilvie Syndrome</p> Signup and view all the answers

    Which of the following complications is most likely to occur with bowel obstruction?

    <p>Perforation</p> Signup and view all the answers

    Which symptom most commonly indicates a perianal abscess?

    <p>Fever and increased white blood count</p> Signup and view all the answers

    What is a common preventative measure for managing hemorrhoids?

    <p>Increased dietary fiber</p> Signup and view all the answers

    What treatment is typically considered for severe cases of hemorrhoids?

    <p>Surgery</p> Signup and view all the answers

    What is a distinguishing feature of complete rectal prolapse?

    <p>Protrusion of the entire bowel segment</p> Signup and view all the answers

    What significant symptom is associated with Crohn's disease?

    <p>Granulomatous inflammation</p> Signup and view all the answers

    What is a characteristic finding in patients with bowel obstruction upon percussion?

    <p>Dull sound due to fluid</p> Signup and view all the answers

    What symptom might indicate severe complications associated with a bowel obstruction?

    <p>Blood in stool</p> Signup and view all the answers

    What is the main inflammatory mediatory response type associated with Ulcerative Colitis?

    <p>TH2 response</p> Signup and view all the answers

    Which of the following findings is most likely associated with chronic intermittent diarrhea and weight loss in Crohn's disease?

    <p>Painless oral ulcers</p> Signup and view all the answers

    Which complication is NOT typically associated with diverticulitis?

    <p>Celiac disease</p> Signup and view all the answers

    What is the typical management approach for a patient diagnosed with Celiac disease?

    <p>Implement a gluten-free diet</p> Signup and view all the answers

    Which of the following conditions requires the presence of ganglion cells for normal bowel function?

    <p>Hirschsprung disease</p> Signup and view all the answers

    Which symptom is least likely to be associated with Ulcerative Colitis?

    <p>Painless oral ulcers</p> Signup and view all the answers

    Which genetic mutation is most commonly associated with Hirschsprung disease?

    <p>RET</p> Signup and view all the answers

    In the context of gastrointestinal diseases, what is a common risk factor for colorectal cancer?

    <p>Presence of adenomatous polyps</p> Signup and view all the answers

    What laboratory finding is consistently elevated in both Crohn's disease and Ulcerative Colitis?

    <p>Erythrocyte sedimentation rate</p> Signup and view all the answers

    What is a primary difference between diverticulosis and diverticulitis?

    <p>Diverticulitis typically presents with symptoms</p> Signup and view all the answers

    Which sign indicates a potential appendicitis when pain is elicited in the left lower quadrant at McBurney's point?

    <p>Rosving's sign</p> Signup and view all the answers

    What is the most common type of gallstone found in adults?

    <p>Cholesterol stones</p> Signup and view all the answers

    In the context of gallstone disease, what does biliary sludge refer to?

    <p>The same effect as stones</p> Signup and view all the answers

    What is a common complication of acute pancreatitis that can occur in severe cases?

    <p>Abscess formation</p> Signup and view all the answers

    Which diagnostic method is primarily used to identify cholelithiasis?

    <p>Ultrasound</p> Signup and view all the answers

    What clinical sign is described as an arrest of inspiration when deeply palpating the right upper quadrant?

    <p>Murphy's sign</p> Signup and view all the answers

    What is the primary cause of chronic pancreatitis?

    <p>Alcohol consumption</p> Signup and view all the answers

    Which sign indicates severe necrotizing pancreatitis and involves periumbilical hemorrhage?

    <p>Cullen's sign</p> Signup and view all the answers

    What condition is characterized by foul smelling floating greasy stools?

    <p>Steatorrhea</p> Signup and view all the answers

    Which type of diarrhea is characterized by greater than 3 loose or watery stools within a 24 hour period?

    <p>Acute diarrhea</p> Signup and view all the answers

    What is a common cause of non-inflammatory diarrhea?

    <p>Enterotoxins</p> Signup and view all the answers

    What enzyme deficiency characterizes lactose intolerance?

    <p>Lactase</p> Signup and view all the answers

    Which type of diarrhea results from the invasion and killing of epithelial cells?

    <p>Inflammatory/exudative diarrhea</p> Signup and view all the answers

    What is a typical risk factor for infectious diarrhea in adults?

    <p>Traveling</p> Signup and view all the answers

    Which condition is often associated with psychological factors contributing to diarrhea?

    <p>Irritable bowel syndrome</p> Signup and view all the answers

    What is the common dietary recommendation for managing gallbladder issues such as cholelithiasis?

    <p>Low fat meals</p> Signup and view all the answers

    What characterizes the abdominal pain associated with irritable bowel syndrome?

    <p>Chronic and varies with time</p> Signup and view all the answers

    Which organism is a common cause of non-inflammatory diarrhea and is known for its enterotoxins?

    <p>Escherichia coli</p> Signup and view all the answers

    Study Notes

    Overview of the Autonomic Nervous System

    • Composed of two systems: parasympathetic (rest and nourishment) and sympathetic (stimulatory).
    • Each system includes two nerve cells:
      • Preganglionic Neuron: Originates from the CNS (brain stem/spinal cord), synapses in a ganglion.
      • Postganglionic Neuron: Extends from the ganglion to target cells.
    • In sympathetic system, preganglionic fibers are short, while postganglionic fibers are long; acetylcholine is released by postganglionic neurons.
    • Parasympathetic targets utilize muscarinic receptors for ACh; sympathetic targets utilize adrenergic receptors (alpha, beta, or both) for norepinephrine.

    Parasympathetic Nervous System

    • Also called craniosacral system; cell bodies located in cranial nuclei and sacral spinal cord.
    • Key cranial nerves include:
      • Cranial nerve 3: Oculomotor
      • Cranial nerve 7: Facial
      • Cranial nerve 9: Glossopharyngeal
      • Cranial nerve 10: Vagus
      • Pelvic Splanchnic Nerves: S2-S4

    Sympathetic Nervous System Output

    • Known as the thoracolumbar system; preganglionic neurons located from T1-L2/L3 spinal segments.
    • Innervates viscera in head/neck/thorax via T1-T5 and in abdomen/pelvis via T5-L2/L3.
    • Preganglionic sympathetic fibers travel in white ramus communicantes.

    Hypothalamus in Sympathetic Output

    • Hypothalamus drives sympathetic output and maintains homeostasis.
    • Disruption can lead to Horner's syndrome, presenting with:
      • Ptosis (drooping eyelid)
      • Miosis (constricted pupil)
      • Anhidrosis (lack of sweating)

    Ischemic Stroke

    • Types include embolic (cardiogenic, artery-to-artery) and thrombolic (associated with atherosclerosis).
    • Cryptogenic strokes have unknown causes, while global cerebral ischemia correlates with hypotension.

    Thrombosis

    • Most thromboses are linked to atherosclerosis; risk factors include hypertension, male gender, smoking, certain drug use.
    • Common thrombosis sites: carotid bifurcation, middle cerebral artery origin, basilar artery.

    Headaches

    • Pain-sensitive structures include scalp blood supply, head/neck muscles, and cranial nerve fibers.
    • Primary syndromes: migraines, cluster headaches, tension-type headaches.
    • Secondary causes: tumors, abscesses, meningitis, hypertension.

    Acute Headaches

    • Meningitis presents with diffuse headache and altered consciousness.
    • Temporal arteritis predominantly affects elderly females with temple pain and significant risk of blindness.

    Hemorrhagic Stroke

    • Intracerebral hemorrhage often linked to hypertension or mass lesions; common sites include basal ganglia.
    • Treatment focuses on reversing coagulopathy; do not use TPA.

    Cerebral Aneurysms

    • 40-60% occur in the Circle of Willis; potentially rupturing leading to subarachnoid hemorrhage.
    • Presentation includes thunderclap headaches; larger aneurysms may compress cranial nerves.

    Seizures

    • Multifactorial causes including neurotransmitter imbalances and increased autonomic stimulation.
    • Postictal confusion is characteristic of generalized tonic-clonic seizures.

    Epilepsy and Febrile Seizures

    • Epilepsy results in unprovoked seizures; risk factors include perinatal conditions and family history.
    • Febrile seizures occur in children aged 6 months to 5 years, triggered by elevated temperature.

    Acute Meningitis

    • Inflammation affects the leptomeninges and cerebrospinal fluid; can be caused by infections or non-infectious factors.
    • Signs include light sensitivity and nuchal rigidity; bacterial meningitis shows elevated WBC count and low glucose.

    Dementia

    • Defined as the decline in higher cognitive functions, with Alzheimer's disease being the most prevalent form.
    • Mild cognitive impairment can precede Alzheimer's, with a significant yearly conversion rate.

    Metabolic Neuropathy and Diabetic Neuropathy

    • Metabolic neuropathy sources: diabetes, thyroid disease, and vitamin deficiencies; presents as chronic, progressive symptoms.
    • Diabetic neuropathy manifests as distal symmetric polyneuropathy and autonomic neuropathy affecting various bodily functions.

    Sleep Disorders

    • Obstructive sleep apnea characterized by daytime sleepiness and fragmented sleep; risk factors include obesity and age.
    • Restless leg syndrome involves urge to move legs, often linked to iron deficiency or uremia.

    Neuromuscular Disease

    • Degenerative conditions like ALS result in motor neuron loss, leading to muscle atrophy while sensory function remains intact.
    • Weakness often begins in the hands and progresses to other areas over time.### FASCICULATION AND MUSCLE ATROPHY
    • Fasciculation refers to involuntary contractions of individual motor units.
    • Progressive muscle atrophy leads to respiratory distress in end-stage cases.
    • Some patients exhibit degeneration of the lower brain stem, resulting in progressive bulbar palsy.
    • Treatment options include:
      • Riluzole: Slows functional decline, extends survival by 2-4 months.
      • Edaravone: Acts as a free radical scavenger, reducing oxidative stress.
      • Sodium Phenylbutyrate taurusodiol: Decreases neuronal cell death.
    • No known cure; symptom management is critical.
    • Average lifespan post-diagnosis is 5 years.
    • More prevalent in men aged 65-70.
    • Diagnosis involves MRI of the brain and spine, serological tests, and lumbar puncture.

    OTHER CAUSES OF NEUROMUSCULAR DISEASE

    • Hereditary disorders include spinal muscular atrophy and Kennedy’s syndrome.
    • Infections can lead to conditions such as poliomyelitis and West Nile Syndrome.

    PERIPHERAL NEUROPATHY

    • Classified by pathology into:
      • Axonal degenerative neuropathies.
      • Demyelinating neuropathies resulting in loss of myelin sheath.
    • Small fiber neuropathy symptoms: pain, impaired temperature sensation, autonomic dysfunction.
    • Large fiber neuropathy symptoms: weakness, decreased reflexes, diminished vibration, and joint position sense.
    • Radiculopathy involves painful spinal nerve root involvement.
    • Plexopathy pertains to nerve network involvement, including brachial and lumbosacral plexuses.
    • Mononeuropathy affects a single nerve, while mononeuropathy multiplex affects one nerve in multiple locations.
    • Polyneuropathy features symmetric peripheral nerve involvement, typically presenting in a "stocking-glove" distribution.

    NEUROMUSCULAR JUNCTION AND MYASTHENIA GRAVIS

    • Presynaptic disorders include Lambert-Eaton syndrome, botulism, and tick paralysis.
    • Myasthenia Gravis (MG) characteristics:
      • Fatigable proximal muscle weakness predominating over distal weakness.
      • Thymic shadow present, with significant ocular involvement (ptosis and diplopia); pupils are never affected.
      • Bulbar muscles often involved; associated with thymic hyperplasia in younger patients and thymoma in older patients.
      • Antibodies target postsynaptic acetylcholine receptors at the muscle fiber.
    • EMG findings include decreased response with repetitive stimulation and increased jitter on single-fiber EMG.
    • Management options include:
      • Acetylcholinesterase inhibitors (e.g., Pyridostigmine).
      • Corticosteroids and steroid-sparing agents.
      • Intravenous immunoglobulin (IVIg) and plasmapheresis.
      • Thymectomy.

    MULTIPLE SCLEROSIS (MS)

    • Initial symptom often unilateral vision impairment due to optic neuritis or retrobulbar neuritis.
    • Cranial nerve signs may include ataxia, nystagmus, and internuclear ophthalmoplegia.
    • Spinal cord lesions can cause spasticity and urinary incontinence.
    • Chérmitté’s sign is a shock-like sensation along the spine with neck flexion or extension.
    • Uhthoff’s phenomenon refers to symptom exacerbation with increased body temperature.
    • Causes of MS are complex, involving environmental, genetic, and immune factors.
    • Peak onset age is 20-30 years; rare in childhood or after age 50.
    • Risk is sixfold greater with a first-degree relative.
    • More common in white women.
    • Characteristic lesions include multiple white matter plaques, often found near lateral ventricles (“Dawson's fingers”) and in the brain stem, spinal cord, and optic nerves.
    • MS primarily affects the central nervous system (CNS).
    • Th1 cells release gamma interferon, activating macrophages that produce tumor necrosis factor-alpha.

    GUILLAIN-BARRÉ SYNDROME

    • Often follows an infection, particularly with Campylobacter.
    • Characterized by weakness in extremities; respiratory insufficiency occurs in 25% of cases.
    • Complement activation causes neuronal damage.
    • Most patients experience full recovery with IV immunoglobulin or plasma exchange.

    Dysphagia

    • Dysphagia categorized by type: solid food only vs. solids and liquids.
    • Solid food only:
      • Intermittent due to esophageal ring.
      • Progressive: heartburn from peptic stricture; no heartburn can indicate carcinoma in older patients.
    • Solids and liquids:
      • Intermittent: chest pain linked to Diffuse Esophageal Spasm (DES).
      • Progressive: heartburn from scleroderma; nocturnal symptoms indicating achalasia (failure to relax lower esophageal sphincter).
    • Mechanical causes include strictures (benign or malignant), esophageal webs/rings, diverticula, and hernias.
    • Functional causes involve achalasia, scleroderma, and DES.
    • Oropharyngeal issues are often neurological, seen in ALS, diabetic neuropathy, or multiple sclerosis.

    Esophagitis

    • Esophagitis is inflammation of the esophageal mucosa with four categories:
      • Gastroesophageal Reflux Disease (GERD): Acidity-related.
      • Medication-induced: Certain antibiotics, NSAIDs, and bisphosphonates.
      • Infectious: Cytomegalovirus, herpes, candida.
      • Eosinophilic: Triggered by food allergies, more common in young white men.
    • Symptoms include odynophagia, dysphagia, heartburn, and retrosternal pain.
    • Diagnosis is through endoscopy; treatment varies based on type, including PPIs and antibiotics.
    • Recurrence leads to esophageal strictures.

    Gastritis

    • Gastritis is inflammation of the gastric mucosa; the infectious type is predominant, primarily due to Helicobacter pylori.
    • Other causes include autoimmune diseases, Crohn's, IBS, and drug-induced (especially NSAIDs and alcohol).
    • Acute gastritis affects the antrum, increasing gastrin and acid secretion.
    • Chronic gastritis leads to gland atrophy and metaplasia, reducing acid and vitamin B12 absorption, elevating cancer risk such as MALT lymphoma.
    • Presentations: heartburn, dyspepsia, hematemesis, iron deficiency anemia, glossitis.
    • Diagnosis includes CBC, stool blood tests, and endoscopic biopsy.

    Esophageal Motility Disorders

    • Disorders involve diffuse spasm, scleroderma, and achalasia.
    • Presentation includes dysphagia, chest pain; may be aggravated by temperature.
    • Diagnosis by manometry shows increased pressure contractions; barium swallow can reveal a corkscrew pattern.
    • Management includes peppermint oil, calcium channel blockers, and botulinum toxin for severe cases.

    Scleroderma

    • A systemic autoimmune disorder characterized by atrophy and scarring, affecting lower esophageal sphincter tone.
    • Symptoms include massive reflux, diminished or absent peristalsis.
    • Diagnosis involves specific antibody tests, treatments focus on immune suppression and PPIs.

    Achalasia

    • Degeneration of ganglion cells causes peristalsis dysfunction and non-relaxation of lower esophageal sphincter.
    • Symptoms include dysphagia, weight loss, regurgitation; diagnosed via imaging (barium swallow, endoscopy).
    • Management includes muscle stretching interventions and medication like nitrates or botulinum toxin.

    Esophageal Carcinoma

    • Eighth most common cancer, sixth leading cause of cancer-related mortality; more prevalent in males.
    • Includes squamous cell (diet-related) and adenocarcinoma (linked to reflux and Barrett’s esophagus).
    • Symptoms include severe weight loss, dysphagia, bleeding, pain (odynophagia), and cough indicative of tracheal invasion.
    • Diagnosis requires imaging and biopsy; management emphasizes early detection and surgical options.

    GERD

    • Characterized by chest pain, heartburn, regurgitation, and potentially dysphagia.
    • Diagnosis is symptom-driven, sometimes confirmed with endoscopy and pH monitoring.
    • Symptoms can include “water brash,” a reflex hypersalivation.

    Esophageal Tears and Perforations

    • Includes Mallory-Weiss and Boerhaave’s syndromes, typically more common in men.
    • Rapid pressure changes during retching or vomiting can lead to tears, presenting as chest or epigastric pain.
    • Diagnosis based on symptoms and endoscopy; Boerhaave’s needs urgent surgical intervention.

    Peptic Ulcer Disease

    • Commonly affects the duodenum, with major causes including H. pylori infection and NSAID use.
    • Symptomatic patients often experience epigastric pain 2-5 hours after meals, potential for bleeding.
    • Diagnosis involves endoscopy; treatment includes avoiding risk factors, PPIs, and possibly surgical intervention.

    Gastric Cancer

    • Third leading cause of cancer deaths, notably higher rates in Eastern Asia and Europe.
    • Causes include genetic and environmental factors like H. pylori.
    • Symptoms progress from asymptomatic to weight loss and gastrointestinal distress.
    • Diagnosis through imaging and biopsy; treatment options may include surgery and chemotherapy.

    Acute Liver Disease

    • Acute liver injury affects synthetic function; acetaminophen is a common cause.
    • Other causes include viral infections, alcohol, and autoimmune hepatitis.
    • Presentation often includes jaundice and abdominal pain; diagnosis focuses on lab work and imaging.

    Viral Hepatitis

    • Liver inflammation primarily from hepatitis B and C; hepatitis A generally benign.
    • Can lead to chronic carriers and subsequent cirrhosis.

    Hyperbilirubinemia

    • Elevated bilirubin levels result in jaundice of skin/eyes; caused by excessive production or poor metabolism.
    • Presentation includes jaundice, skin itching, and dark urine.
    • Diagnosis through lab tests and imaging.

    Cirrhosis

    • Late-stage liver damage characterized by fibrosis and functional failure.
    • Causes include chronic hepatitis, alcoholic liver disease, and iron overload.
    • Symptoms include jaundice, ascites, and hepatosplenomegaly; diagnosis through lab tests and imaging.

    Alcoholic Liver Disease

    • Progresses from reversible fatty liver (steatosis) to alcoholic steatohepatitis and potentially cirrhosis.
    • Risk linked to daily alcohol intake; treatment involves cessation and supportive measures.

    Non-Alcoholic Fatty Liver Disease (NAFLD)

    • Characterized by liver fat accumulation, can evolve into NASH.
    • Risk factors include obesity and metabolic syndromes; management focuses on lifestyle changes.

    Hepatocellular Carcinoma and Liver Metastases

    • Primary liver cancer primarily linked to cirrhosis and environmental exposures.
    • Symptoms include abdominal pain and signs of liver dysfunction; diagnosis via imaging and alpha-fetoprotein marker.
    • Metastatic liver disease is more common than primary; management often limited by overall liver function.

    Acute Abdomen

    • Appendicitis: Pain transitioning from periumbilical to right lower quadrant with associated symptoms.

    • Diagnostic signs include McBurney’s point tenderness and variations like Rosvings or psoas sign.

    • Cholelithiasis: Gallstones impacting a large portion of adults; often asymptomatic, managed through diet and potentially surgery.

    • Acute Pancreatitis: Mainly due to gallstones and alcohol, with severe abdominal pain characteristic of the condition; diagnosis relies on lab results and imaging.### Gastrointestinal Conditions and Disorders

    • Steatorrhea: Presence of foul-smelling, floating, greasy stools; associated with high-fat meals.

    • Diagnosis of Steatorrhea: Normal amylase and lipase levels, possibly increased IFTS; imaging modalities include CT, MRI, and ultrasound; ERCP may be needed if a stone is present.

    • Gallbladder Disease: Cholelithiasis (gallstones) common; management involves low-fat meals, abstaining from alcohol and smoking, and supplementation of fat-soluble vitamins A, D, E, and K.

    Diarrhea Types

    • Diarrhea Definition: More than three loose or watery stools within 24 hours.
    • Acute Diarrhea: Self-limited, typically resolves quickly.
    • Persistent Diarrhea: Lasts several days to weeks.
    • Chronic Diarrhea: Ongoing; differentiated by inflammatory and non-inflammatory causes.

    Causes of Diarrhea

    • Infectious Causes:

      • Inflammatory: Shigella, Salmonella, Campylobacter.
      • Non-inflammatory: E.coli, Vibrio cholera; linked to toxins.
      • Viral: Rotavirus, adenovirus.
      • Protozoan: Giardia, Cyclospora.

    • Risk Factors for Infectious Diarrhea: Contaminated food/water, daycare settings, nursing homes, travel.

    • Antibiotic-Associated Diarrhea: Clostridium difficile in patients with prior antibiotic use; presents with pseudomembranous colitis.

    Non-Infectious Diarrhea Types

    • Secretory Diarrhea: Laxative abuse.
    • Osmotic Diarrhea: Lactose intolerance, celiac disease.
    • Inflammatory Diarrhea: Crohn's disease, ulcerative colitis, and hyperthyroidism.

    Irritable Bowel Syndrome (IBS)

    • IBS Overview: Functional bowel disorder with chronic abdominal pain and altered bowel motility, especially in women aged 20-40.
    • Symptoms: Pain without blood, normal bowel sounds; calprotectin negative.
    • Diagnosis Criteria: Pain at least once a week for three months.
    • Management: Anti-diarrheals, fiber diet, and stress reduction.

    Bowel Obstruction

    • Types: Small Bowel Obstruction (SBO) and Large Bowel Obstruction (LBO).
    • SBO Causes: Adhesions, hernias, tumors, Crohn's disease; may involve functional issues (ileus).
    • LBO Causes: Cancer (especially lesions in the sigmoid colon), strictures, volvulus; Ogilvie syndrome for functional causes.
    • Complications: Pain, distention, dehydration; may require surgery or endoscopy for removal.

    Perianal Abscess and Hemorrhoids

    • Perianal Abscess: Painful collection of pus, more common in men; associated with trauma, prior infections, and IBD.
    • Hemorrhoids: Dilated vessels in the anorectal canal, commonly occur in pregnant women due to increased venous pressure; can lead to blood in the stool (hematochezia) and itching.

    Inflammatory Bowel Diseases (IBD)

    • Crohn's Disease: Affects any part of the GI tract; characterized by granulomatous inflammation, non-bloody diarrhea, crampy abdominal pain, and various systemic symptoms.
    • Ulcerative Colitis (UC): Primarily affects the colon and rectum, leading to mucosal inflammation and ulcers; presents with bloody diarrhea, urgency, and extraintestinal manifestations.

    Celiac Disease

    • Pathophysiology: Triggered by gliadin; leads to malabsorption and nutrient deficiencies.
    • Symptoms: Diarrhea, bloating, fatigue, skin rash, anemia.
    • Diagnosis: Biopsy necessary to confirm; must exclude gluten for management.

    Colorectal Cancer

    • Statistics: Second most common cause of cancer death; most cases are adenocarcinomas arising from pre-existing polyps.
    • Risk Factors: Hereditary syndromes (Lynch syndrome), ulcerative colitis, lifestyle factors (diet high in processed meats).
    • Symptoms: Altered bowel habits, blood in stool, iron deficiency anemia. Diagnosis involves biopsy, imaging, and lab tests.

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    Description

    This quiz covers the autonomic nervous system, focusing on its two components - the sympathetic and parasympathetic systems. You'll explore how these systems function to regulate bodily activities and the roles of preganglionic and postganglionic neurons. Test your understanding of these critical concepts in neurobiology.

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