NUR 529 Exam 1: Pathophysiology

Unit 1: Chapters 1-3

Concepts of Health and Disease

• Pathogenesis: explains how a disease process evolves from initial contact with an etiologic agent to the ultimate expression of disease
• Morphology: refers to the fundamental structure or form of cells or tissues
• Histology: deals with the study of cells and extracellular matrix of body tissues
• Clinical manifestations: symptoms that make it evident that a person is sick
• Diagnosis: designation as to the nature or cause of a health problem
• Clinical course: describes the evolution of a disease (acute, subacute, or chronic)

Disease

• An acute or chronic illness that one acquires or is born with, causing physiologic dysfunction in one or more body systems
• Each disease has specific signs and symptoms that characterize its pathology and identifiable etiology

Unit 2: Chapters 2-6

Cellular Adaptation: Hyperplasia

• Refers to an increase in the number of cells in an organ or tissue
• Occurs in tissues with cells capable of mitotic division (e.g., epidermis, intestinal epithelium, glandular tissue)
• Types: physiologic (hormonal and compensatory) and non-physiologic (excessive hormonal stimulation or growth factors)

Cellular Adaptation: Metaplasia

• Reversible change in which one adult cell type is replaced by another
• Occurs in response to chronic irritation and inflammation
• Examples: substitution of stratified squamous epithelial cells for ciliated columnar epithelial cells in the trachea and large airways of a habitual cigarette smoker

Cellular Adaptation: Dysplasia

• Characterized by deranged cell growth of a specific tissue, resulting in cells that vary in size, shape, and organization
• Associated with chronic irritation or inflammation
• Examples: cervical dysplasia, precursor to cancer of the uterine cervix

Cell Injury and Death

• Necrosis: cell death in an organ or tissue that is still part of a living organism
• Types: liquefaction necrosis, coagulation necrosis, caseous necrosis
• Ischemia: impaired oxygen delivery and removal of metabolic end-products; affects local tissue injury
• Infarction: occurs when an artery supplying an organ or part of the body becomes occluded, with no other source of blood supply

Unit 3: Chapters 7-8

Stress and Adaptation

• Acute stress: associated with the autonomic nervous system (ANS) and the fight-or-flight response
• Chronic stress: can lead to pathological changes and long-term health problems

Compartmental Distribution of Body Fluids

• Edema: palpable swelling produced by expansion of the interstitial fluid volume
• Assessment: daily weight, visual assessment, measurement of affected part, application of finger pressure to assess for pitting edema
• Treatment: directed towards maintaining life, correcting or controlling the cause, and preventing tissue injury

Unit 4: Chapters 10-12

Infectious Diseases

• Diagnosis: requires recovery of a probable pathogen or evidence of its presence from infected sites, accompanied by accurate documentation of clinical signs and symptoms
• Detection methods: culture, serology, and other techniques### Infectious Diseases
• A tentative diagnosis of an infectious disease can be made if the antibody level (titer) against a specific pathogen rises during the acute phase and falls during convalescence.
• Serologic identification of an infectious agent is not as accurate as a culture, but may be a useful adjunct.
• IgM specific antibodies generally rise and fall during the acute phase of the disease, whereas IgG synthesis increases during the acute phase and remains elevated until or beyond resolution.
• IgM antibodies do not cross the placenta, so if IgM is elevated in a neonate, it did not come from the mother.

Antimicrobial Agents

• Antibacterial agents (antibiotics) are effective only against other prokaryotic organisms.
• Antibiotics can be bactericidal (causing irreversible and lethal damage to the bacterial pathogen) or bacteriostatic (inhibiting bacterial growth, with effects reversed when the agent is eliminated).
• Antiviral agents interrupt viral replication, often by interfering with host cell enzymes.
• Antifungal agents target the cytoplasmic membranes of yeasts or molds.
• Antiparasitic agents target essential components of the parasite's metabolism or cellular anatomy that are not shared by the host.

Immunotherapy

• Involves supplementing or stimulating the host's immune response to limit or reverse the spread of a pathogen.
• Examples include IVIG and cytokines.

Surgical Intervention

• Involves surgical removal of infected tissues, organs, or limbs.
• May be necessary when the infective agent is resistant to all treatments.

Innate and Adaptive Immunity

• Epithelial barriers, including the skin and mucous membranes, provide a physical barrier to infection.
• Innate immune responses involve the recognition of common surface receptors on invading microorganisms by leukocytes.
• Adaptive immunity involves the development of an immune response to a specific antigen, either through vaccination or environmental exposure.

Immunoglobulins

• Classified into five categories based on their role in the humoral defense mechanism.
• Each Ig consists of four-polypeptide chains with at least two identical antigen-binding sites.

Anaphylaxis

• A catastrophic, systemic, life-threatening IgE-mediated hypersensitivity reaction.
• Clinical manifestations include vasodilation, hypotension, arterial hypoxia, and airway edema.
• Grades of anaphylaxis range from I (cutaneous and mucosal) to IV (cardiac arrest).

Innate Immunity Barriers

• The lungs have natural barriers to protect against pulmonary infections, including the presence of surfactant and the cough reflex.

Metabolic Requirements of Nervous Tissue

• Nervous tissue has a high rate of metabolism and requires a constant supply of oxygen and glucose.
• Interruption of the blood or oxygen supply to the brain can lead to clinically observable signs and symptoms.

Somatosensory Function, Pain, Headache, and Temperature Regulation

• Acute pain is elicited by injury to body tissues and activation of nociceptive stimuli.
• Chronic pain persists longer than expected after an inciting event.
• Types of pain include cutaneous, deep somatic, visceral, and referred pain.

Disorders of the Motor Unit

• Myasthenia gravis is a disorder of transmission at the neuromuscular junction, characterized by antibody-mediated attack on the nicotinic AChR or muscle-specific tyrosine kinase.

Disorders of Motor Function

• Multiple sclerosis is characterized by inflammation and destruction of the CNS myelin, leading to a range of symptoms including parathesias, optic neuritis, and diplopia.
• Parkinson's disease is a degenerative disorder of basal ganglia function, characterized by tremor, rigidity, akinesia/bradykinesia, and postural changes.

Mechanisms of Brain Injury

• Primary brain injuries are caused by impact, including focal or diffuse injuries.
• Secondary brain injuries result from subsequent brain swelling, infection, or cerebral hypoxia.

Brain Injury

• Hematomas are collections of blood that can occur in the brain, including epidural, subdural, and traumatic intracerebral hematomas.
• Stroke is a cerebrovascular accident, either ischemic or hemorrhagic.

Neurocognitive Disorders

• Alzheimer's disease is a degenerative disorder characterized by cognitive decline, memory loss, and personality changes.
• Guillain-Barré syndrome is an acute immune-mediated polyneuropathy, characterized by rapidly progressive ascending symmetrical limb weakness and loss of tendon reflexes.
• Schizophrenia is a neurocognitive disorder characterized by changes in the dysregulation of the dopamine and serotonergic system, leading to symptoms such as impaired cognition and hallucinations.### Neurocognitive Disorders: Mood Disorders
• Loss of cortical gray matter
• Abnormal cortical thinning
• Reduced numbers of synaptic structures on neurons
• Reduced dendritic spine density of pyramidal neurons in the prefrontal cortex
• Arrested migration of hippocampal neurons
• Interactions between biologic and psychosocial factors over time explain the risk of developing MDD
• Biologic theories for MDD development: inflammation, HPA axis hyperactivity, low levels of neurotrophic growth factor, and low levels of vitamin D
• Depression may be linked to ongoing inflammation in the body
• Neuroimaging: smaller hippocampal volumes and hippocampal hypertrophy in people who have depression and experienced early abuse
• Neurologic disorders of the limbic system and basal ganglia are involved in the development of mood disorders
• Dopamine plays a role in depression

Disorders of Eye Movement

• Strabismus (squint): any abnormality of eye coordination or alignment that results in loss of binocular vision
• Diplopia (double vision) occurs when images from the same spots in the visual space do not fall on corresponding points of the two retinas
• Forms of strabismus: nonparalytic (concomitant) and paralytic (nonconcomitant)
• Amblyopia (lazy eye): decrease in visual acuity resulting from abnormal visual development in infancy or early childhood
• Vision loss ranges from mild (worse than 20/25) to severe (legal blindness, 20/200 or worse)

Disorders of the Conjunctiva

• Allergic conjunctivitis: itching, bilateral tearing, and redness of the eye
• Treatment: allergen avoidance, cold compresses, eye washes with tear substitute, and oral antihistamines
• Viral conjunctivitis: generalized conjunctival hyperemia, copious tearing, and minimal exudate
• Treatment: cool compresses and artificial tears
• Bacterial conjunctivitis: burning, tearing, mucopurulent or purulent discharge
• Treatment: antibiotic drops or ointments
• N.gonorrhoeae is the most serious form of conjunctivitis

Disorders of Hearing and Vestibular Function: Otitis Media

• Clinical manifestations: acute onset of otalgia, fever, irritability, otorrhea, hearing loss, and evidence of middle ear inflammation
• Children older than 3 may have rhinorrhea, vomiting, and diarrhea
• Ear pain usually increases as the effusion accumulates behind the tympanic membrane
• Perforation of the tympanic membrane may occur acutely, allowing purulent material from the eustachian tube to drain into the external auditory canal
• Otitis media with effusion symptoms: intermittent ear pain, sensation of fullness in ear, complaint of hearing loss, dizziness, and decreased tympanic membrane mobility

Disorders of Hearing and Vestibular Function: Otitis Media-Risk Factors

• Risk factors: smoking in the house, prematurity, daycare attendance, having an unimmunized status, bottle-feeding, feeding in the supine position, being overweight or obese, family history of otitis media, being male, and sharing a bedroom
• More frequent in children with craniofacial anomalies or congenital syndromes associated with craniofacial abnormalities
• Strucutural immaturity contributes to the increased risk because the eustachian tube is shorter and more horizontal
• To reduce the risk of contracting otitis media: routine childhood vaccinations, elimination of household smoking, exclusive breast-feeding, avoiding feeding while lying down, and selecting daycare facilities with small staff-to-child ratio

Unit 1: Chapters 1-3

Concepts of Health and Disease

• Pathogenesis: explains how a disease process evolves from initial contact with an etiologic agent to the ultimate expression of disease
• Morphology: refers to the fundamental structure or form of cells or tissues
• Histology: deals with the study of cells and extracellular matrix of body tissues
• Clinical manifestations: symptoms that make it evident that a person is sick
• Diagnosis: designation as to the nature or cause of a health problem
• Clinical course: describes the evolution of a disease (acute, subacute, or chronic)

Disease

• An acute or chronic illness that one acquires or is born with, causing physiologic dysfunction in one or more body systems
• Each disease has specific signs and symptoms that characterize its pathology and identifiable etiology

Unit 2: Chapters 2-6

Cellular Adaptation: Hyperplasia

• Refers to an increase in the number of cells in an organ or tissue
• Occurs in tissues with cells capable of mitotic division (e.g., epidermis, intestinal epithelium, glandular tissue)
• Types: physiologic (hormonal and compensatory) and non-physiologic (excessive hormonal stimulation or growth factors)

Cellular Adaptation: Metaplasia

• Reversible change in which one adult cell type is replaced by another
• Occurs in response to chronic irritation and inflammation
• Examples: substitution of stratified squamous epithelial cells for ciliated columnar epithelial cells in the trachea and large airways of a habitual cigarette smoker

Cellular Adaptation: Dysplasia

• Characterized by deranged cell growth of a specific tissue, resulting in cells that vary in size, shape, and organization
• Associated with chronic irritation or inflammation
• Examples: cervical dysplasia, precursor to cancer of the uterine cervix

Cell Injury and Death

• Necrosis: cell death in an organ or tissue that is still part of a living organism
• Types: liquefaction necrosis, coagulation necrosis, caseous necrosis
• Ischemia: impaired oxygen delivery and removal of metabolic end-products; affects local tissue injury
• Infarction: occurs when an artery supplying an organ or part of the body becomes occluded, with no other source of blood supply

Unit 3: Chapters 7-8

Stress and Adaptation

• Acute stress: associated with the autonomic nervous system (ANS) and the fight-or-flight response
• Chronic stress: can lead to pathological changes and long-term health problems

Compartmental Distribution of Body Fluids

• Edema: palpable swelling produced by expansion of the interstitial fluid volume
• Assessment: daily weight, visual assessment, measurement of affected part, application of finger pressure to assess for pitting edema
• Treatment: directed towards maintaining life, correcting or controlling the cause, and preventing tissue injury

Unit 4: Chapters 10-12

Infectious Diseases

• Diagnosis: requires recovery of a probable pathogen or evidence of its presence from infected sites, accompanied by accurate documentation of clinical signs and symptoms
• Detection methods: culture, serology, and other techniques### Infectious Diseases
• A tentative diagnosis of an infectious disease can be made if the antibody level (titer) against a specific pathogen rises during the acute phase and falls during convalescence.
• Serologic identification of an infectious agent is not as accurate as a culture, but may be a useful adjunct.
• IgM specific antibodies generally rise and fall during the acute phase of the disease, whereas IgG synthesis increases during the acute phase and remains elevated until or beyond resolution.
• IgM antibodies do not cross the placenta, so if IgM is elevated in a neonate, it did not come from the mother.

Antimicrobial Agents

• Antibacterial agents (antibiotics) are effective only against other prokaryotic organisms.
• Antibiotics can be bactericidal (causing irreversible and lethal damage to the bacterial pathogen) or bacteriostatic (inhibiting bacterial growth, with effects reversed when the agent is eliminated).
• Antiviral agents interrupt viral replication, often by interfering with host cell enzymes.
• Antifungal agents target the cytoplasmic membranes of yeasts or molds.
• Antiparasitic agents target essential components of the parasite's metabolism or cellular anatomy that are not shared by the host.

Immunotherapy

• Involves supplementing or stimulating the host's immune response to limit or reverse the spread of a pathogen.
• Examples include IVIG and cytokines.

Surgical Intervention

• Involves surgical removal of infected tissues, organs, or limbs.
• May be necessary when the infective agent is resistant to all treatments.

Innate and Adaptive Immunity

• Epithelial barriers, including the skin and mucous membranes, provide a physical barrier to infection.
• Innate immune responses involve the recognition of common surface receptors on invading microorganisms by leukocytes.
• Adaptive immunity involves the development of an immune response to a specific antigen, either through vaccination or environmental exposure.

Immunoglobulins

• Classified into five categories based on their role in the humoral defense mechanism.
• Each Ig consists of four-polypeptide chains with at least two identical antigen-binding sites.

Anaphylaxis

• A catastrophic, systemic, life-threatening IgE-mediated hypersensitivity reaction.
• Clinical manifestations include vasodilation, hypotension, arterial hypoxia, and airway edema.
• Grades of anaphylaxis range from I (cutaneous and mucosal) to IV (cardiac arrest).

Innate Immunity Barriers

• The lungs have natural barriers to protect against pulmonary infections, including the presence of surfactant and the cough reflex.

Metabolic Requirements of Nervous Tissue

• Nervous tissue has a high rate of metabolism and requires a constant supply of oxygen and glucose.
• Interruption of the blood or oxygen supply to the brain can lead to clinically observable signs and symptoms.

Somatosensory Function, Pain, Headache, and Temperature Regulation

• Acute pain is elicited by injury to body tissues and activation of nociceptive stimuli.
• Chronic pain persists longer than expected after an inciting event.
• Types of pain include cutaneous, deep somatic, visceral, and referred pain.

Disorders of the Motor Unit

• Myasthenia gravis is a disorder of transmission at the neuromuscular junction, characterized by antibody-mediated attack on the nicotinic AChR or muscle-specific tyrosine kinase.

Disorders of Motor Function

• Multiple sclerosis is characterized by inflammation and destruction of the CNS myelin, leading to a range of symptoms including parathesias, optic neuritis, and diplopia.
• Parkinson's disease is a degenerative disorder of basal ganglia function, characterized by tremor, rigidity, akinesia/bradykinesia, and postural changes.

Mechanisms of Brain Injury

• Primary brain injuries are caused by impact, including focal or diffuse injuries.
• Secondary brain injuries result from subsequent brain swelling, infection, or cerebral hypoxia.

Brain Injury

• Hematomas are collections of blood that can occur in the brain, including epidural, subdural, and traumatic intracerebral hematomas.
• Stroke is a cerebrovascular accident, either ischemic or hemorrhagic.

Neurocognitive Disorders

• Alzheimer's disease is a degenerative disorder characterized by cognitive decline, memory loss, and personality changes.
• Guillain-Barré syndrome is an acute immune-mediated polyneuropathy, characterized by rapidly progressive ascending symmetrical limb weakness and loss of tendon reflexes.
• Schizophrenia is a neurocognitive disorder characterized by changes in the dysregulation of the dopamine and serotonergic system, leading to symptoms such as impaired cognition and hallucinations.### Neurocognitive Disorders: Mood Disorders
• Loss of cortical gray matter
• Abnormal cortical thinning
• Reduced numbers of synaptic structures on neurons
• Reduced dendritic spine density of pyramidal neurons in the prefrontal cortex
• Arrested migration of hippocampal neurons
• Interactions between biologic and psychosocial factors over time explain the risk of developing MDD
• Biologic theories for MDD development: inflammation, HPA axis hyperactivity, low levels of neurotrophic growth factor, and low levels of vitamin D
• Depression may be linked to ongoing inflammation in the body
• Neuroimaging: smaller hippocampal volumes and hippocampal hypertrophy in people who have depression and experienced early abuse
• Neurologic disorders of the limbic system and basal ganglia are involved in the development of mood disorders
• Dopamine plays a role in depression

Disorders of Eye Movement

• Strabismus (squint): any abnormality of eye coordination or alignment that results in loss of binocular vision
• Diplopia (double vision) occurs when images from the same spots in the visual space do not fall on corresponding points of the two retinas
• Forms of strabismus: nonparalytic (concomitant) and paralytic (nonconcomitant)
• Amblyopia (lazy eye): decrease in visual acuity resulting from abnormal visual development in infancy or early childhood
• Vision loss ranges from mild (worse than 20/25) to severe (legal blindness, 20/200 or worse)

Disorders of the Conjunctiva

• Allergic conjunctivitis: itching, bilateral tearing, and redness of the eye
• Treatment: allergen avoidance, cold compresses, eye washes with tear substitute, and oral antihistamines
• Viral conjunctivitis: generalized conjunctival hyperemia, copious tearing, and minimal exudate
• Treatment: cool compresses and artificial tears
• Bacterial conjunctivitis: burning, tearing, mucopurulent or purulent discharge
• Treatment: antibiotic drops or ointments
• N.gonorrhoeae is the most serious form of conjunctivitis

Disorders of Hearing and Vestibular Function: Otitis Media

• Clinical manifestations: acute onset of otalgia, fever, irritability, otorrhea, hearing loss, and evidence of middle ear inflammation
• Children older than 3 may have rhinorrhea, vomiting, and diarrhea
• Ear pain usually increases as the effusion accumulates behind the tympanic membrane
• Perforation of the tympanic membrane may occur acutely, allowing purulent material from the eustachian tube to drain into the external auditory canal
• Otitis media with effusion symptoms: intermittent ear pain, sensation of fullness in ear, complaint of hearing loss, dizziness, and decreased tympanic membrane mobility

Disorders of Hearing and Vestibular Function: Otitis Media-Risk Factors

• Risk factors: smoking in the house, prematurity, daycare attendance, having an unimmunized status, bottle-feeding, feeding in the supine position, being overweight or obese, family history of otitis media, being male, and sharing a bedroom
• More frequent in children with craniofacial anomalies or congenital syndromes associated with craniofacial abnormalities
• Strucutural immaturity contributes to the increased risk because the eustachian tube is shorter and more horizontal
• To reduce the risk of contracting otitis media: routine childhood vaccinations, elimination of household smoking, exclusive breast-feeding, avoiding feeding while lying down, and selecting daycare facilities with small staff-to-child ratio

Unit 1: Chapters 1-3

Concepts of Health and Disease

• Pathogenesis: explains how a disease process evolves from initial contact with an etiologic agent to the ultimate expression of disease
• Morphology: refers to the fundamental structure or form of cells or tissues
• Histology: deals with the study of cells and extracellular matrix of body tissues
• Clinical manifestations: symptoms that make it evident that a person is sick
• Diagnosis: designation as to the nature or cause of a health problem
• Clinical course: describes the evolution of a disease (acute, subacute, or chronic)

Disease

• An acute or chronic illness that one acquires or is born with, causing physiologic dysfunction in one or more body systems
• Each disease has specific signs and symptoms that characterize its pathology and identifiable etiology

Unit 2: Chapters 2-6

Cellular Adaptation: Hyperplasia

• Refers to an increase in the number of cells in an organ or tissue
• Occurs in tissues with cells capable of mitotic division (e.g., epidermis, intestinal epithelium, glandular tissue)
• Types: physiologic (hormonal and compensatory) and non-physiologic (excessive hormonal stimulation or growth factors)

Cellular Adaptation: Metaplasia

• Reversible change in which one adult cell type is replaced by another
• Occurs in response to chronic irritation and inflammation
• Examples: substitution of stratified squamous epithelial cells for ciliated columnar epithelial cells in the trachea and large airways of a habitual cigarette smoker

Cellular Adaptation: Dysplasia

• Characterized by deranged cell growth of a specific tissue, resulting in cells that vary in size, shape, and organization
• Associated with chronic irritation or inflammation
• Examples: cervical dysplasia, precursor to cancer of the uterine cervix

Cell Injury and Death

• Necrosis: cell death in an organ or tissue that is still part of a living organism
• Types: liquefaction necrosis, coagulation necrosis, caseous necrosis
• Ischemia: impaired oxygen delivery and removal of metabolic end-products; affects local tissue injury
• Infarction: occurs when an artery supplying an organ or part of the body becomes occluded, with no other source of blood supply

Unit 3: Chapters 7-8

Stress and Adaptation

• Acute stress: associated with the autonomic nervous system (ANS) and the fight-or-flight response
• Chronic stress: can lead to pathological changes and long-term health problems

Compartmental Distribution of Body Fluids

• Edema: palpable swelling produced by expansion of the interstitial fluid volume
• Assessment: daily weight, visual assessment, measurement of affected part, application of finger pressure to assess for pitting edema
• Treatment: directed towards maintaining life, correcting or controlling the cause, and preventing tissue injury

Unit 4: Chapters 10-12

Infectious Diseases

• Diagnosis: requires recovery of a probable pathogen or evidence of its presence from infected sites, accompanied by accurate documentation of clinical signs and symptoms
• Detection methods: culture, serology, and other techniques### Infectious Diseases
• A tentative diagnosis of an infectious disease can be made if the antibody level (titer) against a specific pathogen rises during the acute phase and falls during convalescence.
• Serologic identification of an infectious agent is not as accurate as a culture, but may be a useful adjunct.
• IgM specific antibodies generally rise and fall during the acute phase of the disease, whereas IgG synthesis increases during the acute phase and remains elevated until or beyond resolution.
• IgM antibodies do not cross the placenta, so if IgM is elevated in a neonate, it did not come from the mother.

Antimicrobial Agents

• Antibacterial agents (antibiotics) are effective only against other prokaryotic organisms.
• Antibiotics can be bactericidal (causing irreversible and lethal damage to the bacterial pathogen) or bacteriostatic (inhibiting bacterial growth, with effects reversed when the agent is eliminated).
• Antiviral agents interrupt viral replication, often by interfering with host cell enzymes.
• Antifungal agents target the cytoplasmic membranes of yeasts or molds.
• Antiparasitic agents target essential components of the parasite's metabolism or cellular anatomy that are not shared by the host.

Immunotherapy

• Involves supplementing or stimulating the host's immune response to limit or reverse the spread of a pathogen.
• Examples include IVIG and cytokines.

Surgical Intervention

• Involves surgical removal of infected tissues, organs, or limbs.
• May be necessary when the infective agent is resistant to all treatments.

Innate and Adaptive Immunity

• Epithelial barriers, including the skin and mucous membranes, provide a physical barrier to infection.
• Innate immune responses involve the recognition of common surface receptors on invading microorganisms by leukocytes.
• Adaptive immunity involves the development of an immune response to a specific antigen, either through vaccination or environmental exposure.

Immunoglobulins

• Classified into five categories based on their role in the humoral defense mechanism.
• Each Ig consists of four-polypeptide chains with at least two identical antigen-binding sites.

Anaphylaxis

• A catastrophic, systemic, life-threatening IgE-mediated hypersensitivity reaction.
• Clinical manifestations include vasodilation, hypotension, arterial hypoxia, and airway edema.
• Grades of anaphylaxis range from I (cutaneous and mucosal) to IV (cardiac arrest).

Innate Immunity Barriers

• The lungs have natural barriers to protect against pulmonary infections, including the presence of surfactant and the cough reflex.

Metabolic Requirements of Nervous Tissue

• Nervous tissue has a high rate of metabolism and requires a constant supply of oxygen and glucose.
• Interruption of the blood or oxygen supply to the brain can lead to clinically observable signs and symptoms.

Somatosensory Function, Pain, Headache, and Temperature Regulation

• Acute pain is elicited by injury to body tissues and activation of nociceptive stimuli.
• Chronic pain persists longer than expected after an inciting event.
• Types of pain include cutaneous, deep somatic, visceral, and referred pain.

Disorders of the Motor Unit

• Myasthenia gravis is a disorder of transmission at the neuromuscular junction, characterized by antibody-mediated attack on the nicotinic AChR or muscle-specific tyrosine kinase.

Disorders of Motor Function

• Multiple sclerosis is characterized by inflammation and destruction of the CNS myelin, leading to a range of symptoms including parathesias, optic neuritis, and diplopia.
• Parkinson's disease is a degenerative disorder of basal ganglia function, characterized by tremor, rigidity, akinesia/bradykinesia, and postural changes.

Mechanisms of Brain Injury

• Primary brain injuries are caused by impact, including focal or diffuse injuries.
• Secondary brain injuries result from subsequent brain swelling, infection, or cerebral hypoxia.

Brain Injury

• Hematomas are collections of blood that can occur in the brain, including epidural, subdural, and traumatic intracerebral hematomas.
• Stroke is a cerebrovascular accident, either ischemic or hemorrhagic.

Neurocognitive Disorders

• Alzheimer's disease is a degenerative disorder characterized by cognitive decline, memory loss, and personality changes.
• Guillain-Barré syndrome is an acute immune-mediated polyneuropathy, characterized by rapidly progressive ascending symmetrical limb weakness and loss of tendon reflexes.
• Schizophrenia is a neurocognitive disorder characterized by changes in the dysregulation of the dopamine and serotonergic system, leading to symptoms such as impaired cognition and hallucinations.### Neurocognitive Disorders: Mood Disorders
• Loss of cortical gray matter
• Abnormal cortical thinning
• Reduced numbers of synaptic structures on neurons
• Reduced dendritic spine density of pyramidal neurons in the prefrontal cortex
• Arrested migration of hippocampal neurons
• Interactions between biologic and psychosocial factors over time explain the risk of developing MDD
• Biologic theories for MDD development: inflammation, HPA axis hyperactivity, low levels of neurotrophic growth factor, and low levels of vitamin D
• Depression may be linked to ongoing inflammation in the body
• Neuroimaging: smaller hippocampal volumes and hippocampal hypertrophy in people who have depression and experienced early abuse
• Neurologic disorders of the limbic system and basal ganglia are involved in the development of mood disorders
• Dopamine plays a role in depression

Disorders of Eye Movement

• Strabismus (squint): any abnormality of eye coordination or alignment that results in loss of binocular vision
• Diplopia (double vision) occurs when images from the same spots in the visual space do not fall on corresponding points of the two retinas
• Forms of strabismus: nonparalytic (concomitant) and paralytic (nonconcomitant)
• Amblyopia (lazy eye): decrease in visual acuity resulting from abnormal visual development in infancy or early childhood
• Vision loss ranges from mild (worse than 20/25) to severe (legal blindness, 20/200 or worse)

Disorders of the Conjunctiva

• Allergic conjunctivitis: itching, bilateral tearing, and redness of the eye
• Treatment: allergen avoidance, cold compresses, eye washes with tear substitute, and oral antihistamines
• Viral conjunctivitis: generalized conjunctival hyperemia, copious tearing, and minimal exudate
• Treatment: cool compresses and artificial tears
• Bacterial conjunctivitis: burning, tearing, mucopurulent or purulent discharge
• Treatment: antibiotic drops or ointments
• N.gonorrhoeae is the most serious form of conjunctivitis

Disorders of Hearing and Vestibular Function: Otitis Media

• Clinical manifestations: acute onset of otalgia, fever, irritability, otorrhea, hearing loss, and evidence of middle ear inflammation
• Children older than 3 may have rhinorrhea, vomiting, and diarrhea
• Ear pain usually increases as the effusion accumulates behind the tympanic membrane
• Perforation of the tympanic membrane may occur acutely, allowing purulent material from the eustachian tube to drain into the external auditory canal
• Otitis media with effusion symptoms: intermittent ear pain, sensation of fullness in ear, complaint of hearing loss, dizziness, and decreased tympanic membrane mobility

Disorders of Hearing and Vestibular Function: Otitis Media-Risk Factors

• Risk factors: smoking in the house, prematurity, daycare attendance, having an unimmunized status, bottle-feeding, feeding in the supine position, being overweight or obese, family history of otitis media, being male, and sharing a bedroom
• More frequent in children with craniofacial anomalies or congenital syndromes associated with craniofacial abnormalities
• Strucutural immaturity contributes to the increased risk because the eustachian tube is shorter and more horizontal
• To reduce the risk of contracting otitis media: routine childhood vaccinations, elimination of household smoking, exclusive breast-feeding, avoiding feeding while lying down, and selecting daycare facilities with small staff-to-child ratio

This quiz is based on Porth's Pathophysiology, 10th edition, and covers key concepts in altered states. It is designed for NUR 529 students at the University of Alabama's Capstone College of Nursing.