Brain Disorders
The earliest and most sensitive indicator of rising intracranial pressure is?
Decreased Level of Consciousness
Differentiate the signs/symptoms of hyper vs hypothyroidism.
Hyperthyroidism: nervousness, irritability, weight loss despite a large appetite. Other manifestations include tachycardia, palpitations, shortness of breath, excessive sweating, exophthalmos, muscle cramps, and heat intolerance. The hair and skin are usually thin and have a silky appearance.
Hypothyroidism: gradual onset of weakness and fatigue, a tendency to gain weight despite a loss of appetite, constipation, and cold intolerance. The skin becomes dry and rough and the hair becomes coarse and brittle. The face becomes puffy with edematous eyelids.
Severe hypertension, headache, sweating, and bradycardia indicate this medical emergency.
Autonomic Dysreflexia
Differentiate primary, secondary, and tertiary endocrine disorders.
Primary
Originate in the target endocrine gland responsible for producing the hormone.
Secondary
The gland is not producing appropriate levels of hormones due to not receiving appropriate stimulus from the pituitary gland.
Tertiary
Hypothalamic dysfunction; both the pituitary and target organ are under stimulated.
What are the early versus late clinical signs of Duchenne Muscular Dystrophy?
Early: Postural Changes, frequent falls, pseudohypertrophy of calves. ---> Gower's Sign
Late: Cardiomyopathy, respiratory muscle involvement (frequent infections), incontinence.
Differentiate gigantism vs acromegaly?
Gigantism:
Excess growth hormone before epiphyseal closure causes this condition.
Acromegaly:
Growth hormone excess after epiphyseal closure results in this disorder.
Leading to splayed teeth, enlarged hands, feet, forehead Deepening of the voice. Heart enlarges.
Loss of sympathetic control below the level of injury causes body temperature to match the environment, a condition called?
Poikilothermy
What is Guillain-Barre Syndrome and how does it affect the body?
An acute immune-mediated polyneuropathy..
Most people report having had an acute, influenza-like illness before the onset of symptoms.
Progressive ascending muscle weakness of the limbs, producing a symmetric flaccid paralysis, characterizes the disorder.
In myasthenia gravis, what neurotransmitter uptake is affected due to antibody-mediated destruction of receptors? What symptoms result due to impaired signal transmission leading to lack of muscle contraction.
Acetylcholine
The nicotinic acetylcholine receptors are destroyed leaving few receptors to uptake acetylcholine.
Signs/symptoms:
weakness (proximal limbs), ptosis, diplopia, chewing/swallowing/speech difficulties. Risk for myasthenic crisis.
Is Cushing Syndrome from an excess or depletion of cortisol?
What are the clinical manifestations?
Hypercortisolism
S/S:
Altered fat distribution, buffalo hump, moon face, muscle weakness, abdominal striae, osteoporosis.
What happens in a complete transection of the spinal cord?
Complete transection of the spinal cord results in complete loss of motor, sensory, reflex, and autonomic function below the level of injury (spinal shock).
Characterized by flaccid paralysis with loss of tendon reflexes, absence of bowel/bladder control, and loss of visceral/somatic sensation below the level of injury.
What is an acute adrenal crisis and what are potential causes?
Acute drop in adrenocorticoids.
Sudden d/c of glucocorticoid meds, severe trauma/stress (esp in someone with Addison disease or secondary adrenal insufficiency), and infection.
Explain the Monro-Kellie Hypothesis
Monro–Kellie hypothesis: if one volume increases, another must decrease to maintain normal pressure.
What is the difference between positive and negative feedback?
Negative feedback: Sensors detect change (high or low), adjust hormone secretion (increase secretion or decrease secretion) to maintain appropriate range.
Positive feedback: Rising hormone levels that stimulate more hormone release describe this type of feedback.
What is status epilepticus?
Repeated seizures without full recovery or a seizure lasting longer than 5 minutes defines this emergency.
What are the two main body structures that control hormone levels?
Hypothalamus: produces hormones (releasing/inhibiting) that act upon the anterior pituitary. Send signals to the posterior pituitary.
Pituitary: controls the function of many target glands/cells. "Master Gland"
Differentiate a epidural vs subdural hematoma in terms of where the bleed is located and the presenting symptoms.
Epidural:
Bleeding that develops between the inner table of the skull and dura.
A history of head injury and a brief period of unconsciousness followed by a lucid period in which consciousness is regained, followed by rapid progression to unconsciousness.(Related to rapid expansion in the brain).
Subdural:
Bleeding that develops between the dura and the arachnoid.
Result of a tear in the small bridging veins.
Develops more slowly in comparison to an epidural bleed related to venous source.
Based on the appearance of symptoms, may be labeled as acute (high mortality), subacute (less than two weeks for presentation), or chronic (greater than two weeks).
In assessing for primary hypothyroidism, what lab levels would you expect?
Low T4 and elevated TSH
What is the typical progression of a tonic-clonic seizure?
Vague sense of warning --> sharp tonic contraction of muscles with extension of extremities --> loss of consciousness --> rhythmic bilateral contraction & relaxation of extremities --> postictal state (confusion/tired).
Differentiate Meningitis vs Encephalitis.
Meningitis
Inflammation of the pia mater, the arachnoid, and the CSF-filled subarachnoid space.
Fever/chills/stiff neck/photophobia/rash. LOC should remains intact.
Encephalitis
Generalized infection of the brain or spinal cord parenchyma.
Fever/chills/stiff neck/photophobia/disorientation/lethargy/seizures.