Exam 4 Study Guide pt.2

• These notes cover key concepts but not all content on the exam.

Neurological Pathophysiology

• Cerebral Perfusion Pressure (CPP) is affected by blood pressure and intracranial pressure (ICP), impacting brain blood circulation.
• CPP = Mean Arterial Pressure (MAP) - ICP.
• Elevated ICP can result from various etiologies.
• Acceleration-deceleration injuries (coup and contrecoup) involve brain trauma due to rapid movement.
• Traumatic Brain Injury (TBI) presentation varies.
• Concussions do not show findings on CT/MRI scans.
• Complications of increased ICP include brain herniation.

Types of Edema

• Cytotoxic edema involves cellular swelling.
• Primary brain injury occurs at the time of the initial insult, while secondary injury evolves thereafter.
• Secondary brain injury involves inflammation and edema.
• Ischemic and hemorrhagic strokes have different risk factors and symptoms (FAST: Face, Arms, Speech, Time).
• Structural brain abnormalities like arteriovenous malformations (AVMs) and aneurysms are often asymptomatic until rupture.
• Autonomic dysreflexia leads to hypertensive crisis.
• Spinal shock causes paralysis at the time of injury.
• Parkinson's disease involves the loss of dopaminergic neurons.
• Seizures are classified as partial or generalized, sometimes preceded by an aura.
• Meningitis has specific clinical manifestations.
• Alzheimer's disease involves structural brain changes including a decrease in acetylcholine.

Genetics

• Autosomal recessive inheritance requires two copies of an abnormal gene for the disease to manifest.
• Autosomal dominant inheritance requires only one copy of an abnormal gene for the disease to manifest.
• Sex (X)-linked inheritance involves genes on the X chromosome.
• Understanding the chances of being affected or a carrier is crucial in genetic counseling.
• Penetrance refers to the proportion of individuals with a specific genotype that express the expected phenotype.
• Expressivity refers to the variation in phenotypic expression among individuals with the same genotype.
• Genotype is the genetic makeup and phenotype is the observable characteristics.

Shocks

• Different types of shock have varying signs and symptoms.

Renal Pathophysiology

• Acute pyelonephritis etiology involves a bacterial infection moving up to the kidneys, a common symptom is costovertebral angle (CVA) tenderness/flank pain.
• Acute pyelonephritis is an upper UTI.
• Chronic kidney disease leads to hypocalcemia and metabolic acidosis.
• Kidney stones are primarily composed of calcium.

Acute Kidney Disease

• Prerenal AKI is caused by heart failure, edema, ascites, hypotension and hypovolemia.
• Intrarenal AKI is caused by nephrotoxic (sepsis/septic shock, contrast media) insult.
• Postrenal AKI is caused by renal calculi, obstructed catheters and benign prostatic hyperplasia (BPH).
• Acute tubular necrosis is classified as intrarenal.
• Hypovolemia is classified as prerenal.
• Prostatic hypertrophy is classified as postrenal.
• UTIs have specific etiologies and symptoms.

GI System Pathophysiology

• Appendicitis pain is typically located in the right lower quadrant.
• Portal hypertension has key clinical manifestations.
• Hepatic encephalopathy is associated with increased ammonia levels.
• Jaundice is caused by hyperbilirubinemia.
• Acute pancreatitis pain location varies, treatment includes NPO and pain management, alcohol is a main etiology.
• Bowel obstruction risk factors include abdominal surgery, which is a main etiology.
• Peptic Ulcer Disease (PUD) has specific risk factors.
• PUD treatment includes prevention and proton pump inhibitor (PPI) medications.

Medications

• MAOIs have dietary restrictions that, if not followed, can lead to hypertensive crisis.
• SSRIs have advantages over other antidepressants.
• Fluoxetine (Prozac) requires specific instructions for discontinuation, including patient teaching.
• Cymbalta is used for peripheral neuropathy and depression.
• TCAs can cause cardiac toxicity, avoid prescribing to suicidal patients.
• Benzodiazepines work on the CNS, side effects require patient education.
• Seizure medications (Phenytoin, Valproic Acid, Keppra) require monitoring of plasma levels.
• Levodopa is used for Parkinson's disease, side effects require monitoring.
• Aricept and Memantine are used for dementia.

Additional Information

• Depression involves specific neuronal changes.
• Seizure disorders involve altered neuronal activities.
• Kidney disease can be identified through specific lab tests.