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NURS 611 – ADVANCED PATHOPHYSIOLOGY STUDY QUESTIONS FOR EXAM 4
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NURS 611 – ADVANCED PATHOPHYSIOLOGY STUDY QUESTIONS FOR EXAM 4
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NURS 611 – ADVANCED PATHOPHYSIOLOGY STUDY QUESTIONS FOREXAM 4
1. Define diffuse cortical dysfunction.
Disease process may PRODUCE DIFFUSE BILATERAL cortical dysfunction
2. Identify populations at risk for neurological pathophysiology.
Immunocompromised, HIV/AIDs, Cardiac problems (HTN), poor lifestyle (smoking, obese,
family history, etc)
3. Define the types of cerebral edema.
Vasogenic- occurs due to a breakdown of the tight endothelial junctions that make up the
blood–brain barrier. This allows intravascular proteins and fluid to penetrate into the
parenchymal extracellular space. Once plasma constituents cross the barrier, the edema
spreads; this may be quite rapid and extensive. As water enters white matter, it moves
extracellularly along fiber tracts and can also affect the gray matter. This type of edema may
result from trauma, tumors, focal inflammation, late stages of cerebral ischemia and
hypertensive encephalopathy.
Cytotoxic- blood–brain barrier remains intact but a disruption in cellular metabolism
impairs functioning of the sodium and potassium pump in the glial cell membrane, leading
to cellular retention of sodium and water.
Osmotic- Plasma dilution decreases serum osmolality, resulting in a higher osmolality in the
brain compared to the serum. This creates an abnormal pressure gradient and movement of
water into the brain, which can cause progressive cerebral edema, resulting in a spectrum of
signs and symptoms from headache and ataxia to seizures and coma.
Interstitial- occurs in obstructive hydrocephalus due to a rupture of the CSF–brain barrier.
4. Subarachnoid hemorrhage causes hydrocephalus by what mechanism?
Impaired absorption outside the ventricles
Hydrocephalus is common after subarachnoid hemorrhage, as the damage caused by
a hemorrhage can disrupt the production and drainage of cerebrospinal fluid (CSF).This can
lead to increased amounts of fluid around the brain.
5. List the sequence of events that lead to hyperreflexia induced bradycardia.
Visceral distention/Pain spinothalmic tracts carry sensory impulse to level of leasion, T6
and above Stimulation of sympathetic response (pallor, vasodilation, hypertension,
pilomotor spasms) Carotid sinus receptors stimulation d/t HTN 9th CN stimulated by
carotid, sends msg to medulla, vagus nerve stimulated, impulse sent to SA node
BRADYCARDIA
6. Differentiate the types of headaches: migraine, cluster, tension.
Migraine- Migraine is now viewed as a familial episodic disorder whose marker is headache.
Migraine is classified as a headache with and without aura and is precipitated by a
triggering event. The clinical phases of a migraine attack are the premonitory phase, the
, migraine aura, the headache phase, and the recovery phase. Cortical spreading depression is
thought to be followed by a compensatory overactivity of the trigeminovascular system of
the brain.
Cluster- Cluster headaches are acute and chronic. They occur in episodes several times
during a day for a period of days at different times of year. The pain is unilateral, intense,
tearing, and burning. Associated symptoms include ptosis, lacrimation, reddening of the eye,
and nausea.
Other characteristics:
• Sympathetic nervous system underactivity
• Parasympathetic overactivity
• Cause of trigeminal activation is unknown
Tension- Tension-type is the most common type of headache. There are acute and chronic
forms. Both a central mechanism and a peripheral mechanism are associated with the
etiology. The headache is bilateral, with the sensation of a tight band around the head. The
pain may last for hours or days.
7. Differentiate encephalitis, cerebral aneurysm and cerebral vascular accident (CVA).
ENCEPHALITIS- Acute febrile illness, viral,with nervous system involvement. Most common
encephalitis mosquito , viruses and herpes
INTRACRANIAL ANEURYSM- result from arteriosclerosis, congenital abnormality, trauma,
inflammation or infection.
CVA- ischemic (thrombolitic or embolic), global hypoperfusion (as in shock), or hemorrhage.
50% older than 70, 3:10 ratio 28% younger than 65, tends to run in family's, 2.5 times
higher in blacks than whites
8. Differentiate craniosacral and parasympathetic dysreflexia.
CRAINOSACRAL- nerve cell bodies located in crainal nerve nuclei and sacral region of spinal
cord known as CRANIOSACRAL DIVISION
PARASYMPATHEIC DYSREFLEXIA- known as autonomic hyperreflexia or autonomic
dysreflexia
9. Define autonomic hyperreflexia.
• Massive, uncompensated cardiovascular response to stimulation of the sympathetic
nervous system
• Stimulation of the sensory receptors below the level of the cord lesion
10. Define the relationship between sweating and a spinal cord injury.
Autonomic response to HTN. Seen above level of injury. SWEATING & INJURY- disturbed
thermal control because of hypothalamus unable to regulate a damaged sympathetic
nervous system. faulty control of sweating and radiation through capillary dilation.
11. List the most common cause of Hyperpituitarism.
Pituitary adenomas- benign and slow growing
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