Untitled Quiz

Stress Response

• Stressors activate the hypothalamus, initiating the sympatho-adrenal medullary response (SAMR).
• Symptoms of stress include diaphoresis, increased blood pressure (BP), pulse rate (PR), and respiratory rate, along with cold, clammy skin.
• Catecholamines (epinephrine and norepinephrine) are secreted by the adrenal medulla during stress.
• Epinephrine acts as both a vasodilator (in coronary and cerebral arteries) and a vasoconstrictor (in peripheral vessels), influencing blood flow and heart rate.
• Norepinephrine primarily acts as a vasoconstrictor.
• The sympathetic nervous system (SNS) is responsible for rapid responses to stress, affecting various systems including gastrointestinal (GI) and urinary.
• Parasympathetic responses counterbalance SNS effects when stress diminishes.

Anterior Pituitary Hyposecretion

• Pituitary dwarfism results in a height about twice that of a newborn, characterized by shorter limbs.
• Frolich's syndrome combines dwarfism, obesity, genital atrophy, and mental retardation.
• Simmond's disease (pituitary cachexia) leads to premature senility, lethargy, and reproductive issues.
• Commercial growth hormones like somatotropin and somatrem are administered to manage these conditions.

Anterior Pituitary Hypersecretion

• Gigantism occurs when hypersecretion happens before epiphyseal closure, leading to excessive growth of long bones.
• Acromegaly is the result of hypersecretion post-epiphyseal closure, causing thickening of bones and soft tissues.
• Symptoms include pronounced jaw, enlarged hands, and abdominal organ enlargement.
• Management includes hormone suppression and possible hypophysectomy.

Posterior Pituitary Gland Disorders

• Diabetes insipidus is marked by a deficiency of antidiuretic hormone (ADH), leading to excessive urination and thirst.
• Urine output can range from 5 to 29 liters per day, with diluted urine and high serum osmolarity.
• Management involves administering ADH preparations such as vasopressin and desmopressin, with specifics for clinical administration routes.

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

• Characterized by excessive ADH secretion from the posterior pituitary, causing fluid retention and electrolyte dilution.
• Symptoms include hypervolemia, hypertension, and potential cerebral edema due to fluid shifts into brain tissue.
• Treatment strategies include surgical options and the use of demeclocycline to inhibit ADH.

Parathyroid Glands and Calcium Regulation

• Parathormone plays a crucial role in calcium reabsorption and phosphorus excretion, vital for blood coagulation and cardiac function.

Hypoparathyroidism, Hypocalcemia, and Tetany

• Tetany refers to uncontrolled muscle spasms, with positive Chvostek's and Trousseau's signs indicating hypocalcemia.
• Normal calcium levels are between 8-11 mg/dL; dietary management includes seafood for calcium and avoiding high-phosphorus foods.
• Commercially prepared calcium supplements include calcium carbonate and calcium gluconate, ideally taken after meals to maximize absorption.
• Vitamin D is also essential for calcium absorption and utilization.### Hypoglycemia, Hypoxia, Fluid & Electrolyte Imbalance
• Hypoglycemia: Low blood sugar levels, can lead to decreased energy and impaired brain function.
• Hypoxia: Lack of oxygen in tissues; can cause cellular damage and organ dysfunction.
• Fluid & Electrolyte Imbalance: Disruption in body fluids and electrolytes can result in complications affecting critical bodily functions.
• Toxic Drugs/Chemicals: Can lead to severe physiological effects such as CNS depression, respiratory failure, or organ failure.

Glasgow Coma Scale (GCS)

• GCS assesses eye opening, verbal response, and motor response, providing valuable data on a patient's level of consciousness.
• Decerebrate posturing indicates brain stem dysfunction and may lead to respiratory arrest.
• Decorticate posturing suggests damage above the brain stem; both postures can be present in cases of severe brain injury.
• GCS score below 7 indicates coma; 5-6 indicates a state of coma; scores of 3-4 indicate deep coma.

Brain Function Regulation

• Medulla Oblongata: Regulates respiratory rate and depth.
• Pons: Responsible for the rhythm of respiration.
• Broca’s Area: Located in the left hemisphere; controls speech production.
• Wernicke’s Area: Located in the temporal lobe; responsible for language comprehension.

Brain Lobes and Function

• Parietal Lobe: Processes sensory information such as pain, pressure, touch, and temperature.
• Occipital Lobe: Responsible for vision.
• Temporal Lobe: Involved in hearing, balance, and memory.
• Frontal Lobe: Controls voluntary movements, memory, speech, emotions, and abstract thinking.

Aphasia Types

• Motor Expressive Aphasia: Inability to speak or write due to frontal lobe damage.
• Sensory Receptive Aphasia: Inability to understand spoken or written language; can cause visual and auditory receptive aphasia.
• Global Aphasia: Combination of motor and sensory aphasia affecting both Broca’s and Wernicke’s areas.

Neuro Symptom Presentation

• Ipsilateral Symptoms: Manifest on the same side as the lesion.
• Contralateral Symptoms: Present on the opposite side of the lesion; results from nerve pathways crossing in the pyramidal tract.
• Lesions on the right side can present various symptoms depending on the impact on controlling pathways (e.g., drooping eyelid on the affected side, weakness on the opposite side).

Gait Types

• Ataxic Gait: Unsteady walking pattern indicative of cerebellar dysfunction.
• Dystonic Gait: Irregular movements seen in muscle atony conditions.
• Dystrophic/Waddling Gait: Characterized by sideways movements, common in muscle dystrophy.
• Hemiplegic Gait: Foot dragging due to pyramidal tract damage.
• Scissor Gait: Short steps with legs crossing, often associated with spastic paralysis.
• Steppage Gait: High, exaggerated steps indicative of lower motor neuron involvement.

Reflexes

• Superficial & Pathological Reflexes: Include responses like the knee-jerk and Babinski reflex.
• Babinski Reflex: Normal is toe flexion; pathological is toe extension and fanning.
• Kernig's Reflex: Pain upon leg extension indicates possible meningeal irritation.
• Brudzinski's Sign: Head flexion causing knee and ankle flexion can indicate meningeal irritation.

Diagnostic Tests

• Blood Tests: Determine NPO status and assess renal function before procedures.
• Lumbar Puncture: Diagnostic and therapeutic; involves CSF evaluation and management of ICP.
• Spinal Manometry: Evaluates CSF pressure response to jugular vein compression.
• Cerebral Angiogram: Imaging of cerebral vascular system with contrast medium; requires precautions against bleeding.

Parkinson's Disease

• Characterized by basal ganglia degeneration due to decreased dopamine levels.
• Major risk factors include history of encephalitis, head trauma, and smoking.
• Symptoms include tremors, rigidity, and bradykinesia, often leading to difficulties in movement and expression.
• L-Dopa (levodopa) is a common treatment as it converts to dopamine in the brain; short-term management includes monitoring for side effects like hypotension and dysrhythmias.### Hydrocephalus and Increased Intracranial Pressure (ICP)
• Caused by obstructed CSF flow from brain tumors or increased brain tissue size due to conditions like meningitis or abscesses.
• Elevated pCO2 levels lead to hypercarbia and hypercapnia, stimulating cerebral blood vessel dilation, increasing cerebral blood flow and ICP.

Management of Increased ICP

• Goal: Reduce ICP
  • Administer mannitol (hyperosmolar, promotes fluid movement from interstitial to intravascular, increases urinary output).
  • Dexamethasone (reduces cerebral edema, crosses blood-brain barrier).
  • Use mechanical ventilation to promote hyperventilation and decrease pCO2, leading to lower ICP.

Antithrombotic and Anticoagulation Therapies

• Aspirin used for anti-inflammatory effects, common side effect is GI upset.
• Anticoagulants like warfarin (oral) and heparin (subcutaneous/intravenous) require monitoring (PT/aPTT tests) for safety.
• Plasminogen activators (e.g., streptokinase, t-PA) dissolve blood clots but also increase bleeding risk.

Brain Tumors

• Classified by origin: gliomas (brain tissue), neuromas (cranial nerve), meningiomas (brain covering).
• Classified by location: supratentorial (cerebrum) and infratentorial (cerebellum/brainstem).
• Early symptom of a brain tumor is papilledema due to optic chiasm compression.

Post-Surgical Management for Brain Tumors

• Craniotomy involves coronal incision, burr holes created.
• Avoid Trendelenburg position post-surgery to prevent increased ICP.
• Elevated positioning is crucial post-surgery for venous return: 45 degrees for supratentorial, 15 degrees for infratentorial.

Tissue Response to Hypoxia

• Hypoxia triggers erythropoietin release, enhancing erythropoiesis and increasing red blood cell production.
• Results in capillary congestion, hemoconcentration, hypertension, and potential for joint pain and organ enlargement like splenomegaly or hepatomegaly.

Leukemia

• Neoplastic disease characterized by uncontrolled proliferation of immature white blood cells (blasts).
• Blast cells increase infection risk and can impede normal blood cell production, resulting in anemia and thrombocytopenia.
• Two major types: Acute lymphoblastic leukemia (ALL) in children and chronic myelocytic leukemia (CML) in adults.

Multiple Myeloma

• Cancer of plasma cells leading to increased production of abnormal immunoglobulins (M-protein).
• Causes hemoconcentration, hypertension, increased bone resorption, and risk of pathological fractures.
• Diagnosis primarily through bone marrow biopsy and detection of Bence-Jones protein in urine.

Hodgkin’s Lymphoma

• Cancer of lymphoid organs with lymphocyte proliferation; associated with Epstein-Barr virus.
• Risk factors include family history and exposure to carcinogens, particularly in males before age 20 and after 50.
• Diagnosed via lymph node biopsy identifying Reed-Sternberg cells.
• Symptoms include painless lymphadenopathy and systemic symptoms like fever and night sweats.

Chemotherapy Treatments

• Hormonal therapies reduce metabolism in cancer cells (e.g., estradiol, DES).
• Alkylating agents prevent cell replication by binding to DNA (e.g., busulfan, cyclophosphamide).
• Vinca alkaloids disrupt mitosis (e.g., vincristine).
• Antimetabolites interfere with cellular metabolism, promoting cell death.