Autonomic Nervous System and Brain Function 2

58. A person with type O blood is considered to be the universal blood donor because type O blood contains which of the following?  No antigens  Both A and B antigens  No antibodies  Both A and B antibodies No Antigens Because individuals with type O blood lack both types of antigens, they are considered universal donors, meaning that anyone can accept their red blood cells. Type O individuals, who have neither A or B antigen but have both anti-A and anti-B antibodies cannot accept blood from any of the other three blood types. 59. Immunoglobulin E (IgE) is associated with which type of hypersensitivity? Type I Hypersensitivity reactions have been divided into four distinct types: type I (IgEmediated; beesting, peanuts, fish ) hypersensitivity reactions, type II (tissue-specific; mismatched blood transfusion, Graves disease) hypersensitivity reactions, type III (immune complex-mediated; Raynauld disease) hypersensitivity reactions, and type IV (cell-mediated; graft rejection) hypersensitivity reactions. 60. Some clinical examples of type IV hypersensitivity reactions include (select all that apply):  Graft rejection  Allergic reactions  Autoimmune reactions  Delayed Graft rejection, allergic reaction, and delayed 61. Which disorders are considered autoimmune? (select all that apply):  Crohn disease  Addison disease  Systemic lupus erythematosus  Non-insulin dependent diabetes  Rheumatoid arthritis Crohn’s disease, Addison disease, systemic lupus erythematosus, and rheumatoid arthritis 62. Patients with Lupus can suffer from? Facial rash (butterfly), photosensitivity, neurological, renal, and hematological disorders 63. Immunodeficiency disorders are differentiated into primary verses secondary. Primary is rare. What factors can contribute to immunodeficiency disorders? Aging (decrease ability to fight infections), psychological issues (emotional trauma), poor diet, metabolic diseases, genetic syndromes, radiation, some medical treatments (anesthesia, splenectomy), and chemotherapy. 64. What is the first stage in the infectious process? Colonization From the perspective of the microorganisms that cause disease, the infectious process undergoes four separate stages of progression: 1) colonization, 2) invasion, 3) multiplication, and 4) spread. 65. Which type of microorganism reproduces on the skin? Bacteria and fungi Only bacteria and fungi have the capacity to reproduce on the skin. 66. Which statement is true concerning exotoxins?  Exotoxins are contained in cell walls of gram-negative bacteria  Exotoxins are released during the lysis of bacteria  Exotoxins are released during bacterial growth  Exotoxins are able to initiate the complement and coagulation cascades Exotoxins are released during bacterial growth 67. Which statement is true about vaccines?  Most bacterial vaccines contain attenuated organisms  Vaccines require booster injections to maintain life-long protection  Most viral vaccines are made by using dead organisms  Vaccines provide effective protection against most infections Vaccines require booster injections to maintain life-long protection In general, vaccine-induced protection does not persist as long as infection-induced immunity, thus booster injections may be necessary to maintain protection throughout life. 68. Definition of toxigenicity An important factor in determining a pathogen’s ability to produce disease Toxigenicity is the ability of a pathogen to produce soluble toxins or endotoxins, which are factors that greatly influence the pathogen’s degree of virulence. 69. The infectious process is made up of invasion verses evasion. Evasion is when? The body’s defenses such as the inflammatory process is exhausted. Evasion is when those body defenses results in microorganisms being transported through the blood such as septicemia. 70. Cytokines are thought to cause fevers by stimulating the synthesis of which chemical mediator? Prostaglandin Cytokines seem to raise the thermoregulatory set point through stimulation of prostaglandin synthesis and turnover in thermoregulatory (brain) and nonthermoregulatory (peripheral) tissues. 71. Exotoxins, those are actually released during bacterial growth, they are _immunogenic_ so that’s good, so they are going to illicit this response. 72. Which statements are true regarding endotoxins? (select all that apply):  Endotoxins are lipopolysaccharides  Endotoxins are located in the walls of bacteria  Endotoxins are created during the process of lysis  Endotoxins are found in gram-negative microorganisms  Endotoxins are released during the destruction of its host Endotoxins are lipopolysaccharides, located in walls of bacteria, gram-negative, and are released during the destruction of the host. 73. Endotoxins if left unchecked can cause what? Disseminated intravascular coagulation (DIC) 74. Endotoxins work by? Causing incredible vasodilation 75. The CDC defines a diagnosis of AIDS is measured by a CD4 count less than _200__ cells per microliter. 76. Which secretion transmits HIV? (select all that apply):  Semen  Urine  Saliva  Breast milk  Sweat HIV is a blood-borne pathogen present in body fluids such as blood, vaginal fluid, semen, and breast milk. 77. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful? Adaptation This lack of adaptation ultimately causes impairment of the immune response, heart failure, and kidney failure, leading to death. 78. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? Norepinephrine Only the release of norepinephrine promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses. 79. What is the effect that low-serum albumin has on the central stress response? Impaired circulation of epinephrine and norepinephrine Low-serum albumin impairs circulation of both epinephrine and norepinephrine since both bind to plasma protein albumin. 80. Stress-age syndrome directly results in depressed function of which system? Immune system-we just discussed this 81. Stress-induced norepinephrine results in? Peripheral vasoconstriction During stress, norepinephrine raises blood pressure by constricting peripheral vessels; it dilates the pupils of the eye, causes piloerection, and increases sweat gland action in the armpits and palms. 82. The most influential factor in whether a person will experience a stress reaction is his or her? Ability to cope In other words, a person does not have a stress reaction unless the stress exceeds his or her coping abilities. 83. What constricts peripheral vessels to increase blood pressure Norepinephrine 84. What increases gastric secretions? Cortisol-think of that ulcer we are all working on, increased stress leads to increased cortisol, increased gastic acid and bam-you got an ulcer!! 85. What increases cardiac output by increasing heart rate and myocardial contractility? Epinephrine 86. Cortisol is an important player in the stress response. Cortisol _inhibits_ that initial inflammatory effect and it acts to _suppress__the activity of those helper T cells. Cortisol also __promotes__resolution of healing. So in a nutshell, cortisol actually acts to _suppress_the activities of those cytotoxic T cells. 87. A reduction is an individual’s number of natural killer (NK) cells appears to correlate with an increased risk for the development of? Depression A meta-analysis of studies shows a relationship between depression and the reduction in lymphocyte proliferation and natural killer cell activity. 88. The increased production of proinflammatory cytokines is associated with which considerations? Elevated anxiety levels and age/gender Increased levels of proinflammatory cytokines has been shown to have a possible link between stress and immune function. 89. Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? Hypothalamus The alarm phase of the GAS begins when a stressor triggers the actions of the hypothalamus and the sympathetic nervous system. 90. What is the difference between benign and malignant? Benign=cell’s appearance is well differentiated and slow growing and typically avascular, growth is expansive (pushing on other structures and cells. Malignant=the cell is a mess because the cells have gone rogue! And they spread rapidly, invasive, vascular, and metastasizing. 91. Which ctyokines initiate the production of corticotropin-releasing hormone (CRH)? IL-1 and IL-6 Although a number of stress factors initiate the production of CRH, only high levels of IL1 and IL-6 initiate a response. 92. What is the most common route for distant metastasis? Blood and lymphatic vessels-the Autobaun for cancer cells! 93. Staging of cancer provides a __framework__ to determine treatment. 94. Staging system of cancer is as follows (example of breast cancer): refer to Workbook pg. 55  T1=within the breast tissue  T2=still within the breast tissue but getÝng larger  T3=start of invasion, either skin or chest wall  T4=metastasis to other organs 95. Node involvement means:  N2=fixed nodes involved 96. What are tumor cell markers? Hormones, enzymes, antigens, and antibodies that are produced by cancer cells Tumor (biologic) markers are substances produced by both benign and malignant cells that are found either in or on the tumor cells or in the blood, spinal fluid, or urine. Tumor markers may include hormones, enzymes, genes, antigens, and antibodies. 97. The function of the tumor cell marker is to? Screen individuals at high risk for cancer Screening and identifying individuals at high risk for cancer are ways tumor markers can be used. Keep in mind these markers are not used to definitively diagnosis or treat cancer and are not useful in predicting specific sites of cancer development. 98. Autocrine stimulation is the ability of cancer cells to? Secrete growth factors that stimulate their own growth Cancer cells must have mutations that enable them to proliferate in the absence of external growth signals. To achieve this, some cancers acquire the ability to secrete growth factors that stimulate their own growth, a process known as autocrine stimulation. All I can say is cancer cells are smart little shits! 99. Which cancers are all associated with chronic inflammation? Colon, thyroid gland, and urinary bladder Some organs appear to be more susceptible to the oncogenic effects of chronic inflammation; for example, the GI tract, prostate, thyroid gland, pancreas, urinary bladder, pleura, and skin. One large study found a 66% increase in the risk of lung cancer among women with chronic asthma, an inflammatory disease of the airways. 100. Chronic inflammation causes cancer by? Releasing compounds such as reactive oxygen species that promote mutations Inflammatory cells release compounds such as reactive oxygen species (ROS) and other reactive molecules, that can promote mutations and block the cellular response to DNA damage. 101. Review your Workbook pg. 55. I need you to determine the extent of this cancer. It has been determined that a tumor is in stage 2. What is the meaning of this finding? Cancer is locally invasive Cancer confined to the organ of origin is stage 1; cancer that is locally invasive is stage 2; cancer that has spread to regional structures, such as the lymph nodes, is stage 3; and cancer that has spread to distant sites, such as a liver cancer spreading to the lung or a prostate cancer spreading to bone is stage 4. 102. Many cancers create a mutation of ras. Ras is a? Intracellular-signaling protein that regulates cell growth Up to 1/3 of all cancers have an activating mutation in the gene for an intracellular signaling protein called ras. This mutant ras stimulates cell growth even when growth factors are missing. 103. The ras gene converts from a proto-oncogene to an oncogene by? Altering one or more nucleotide base pairs A point mutation is the alteration of one or a few nucleotide base pairs. This type of mutation can have profound effects on the activity of proteins. A point mutation in the ras gene converts it from a regulated proto-oncogene to an unregulated oncogene, an accelerator of cellular proliferation. 104. How do cancer cells use the enzyme telomerase? To switch on the telomerase to enable cells to divide indefinitely Cancer cells, when they reach a critical age, somehow activate telomerase to restore and maintain their telomeres and thereby make it possible for cells to divide over and over again. 105. What is the role of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in cell metastasis? To develop new blood vessels to feed cancer cells By recruiting new vascular endothelial cells and initiating the proliferation of existing blood vessel cells, the angiogenic factors, such as VEGF and growth factor bFGF, allow small cancers to become large cancers. 106. What statement is true regarding pain and cancer? Pain is generally associated with late-stage cancer Pain is generally associated with the late stages of cancer. Pressure, obstruction, invasion of a structure sensitive to pain, stretching, tissue destruction, and inflammation can cause pain. Pain is not the initial symptom of cancer nor does it indication that the cancer has metastasized. 107. What statement is true concerning aging and the occurrence of cancer? Decline in immunologic functions, predisposition to nutritional inadequacies, and effects of immobility on the immune system Many common malignancies occur mostly in older age as a result of immunologic functions declining with age. Older persons are predisposed to nutritional inadequacies, and malnutrition impairs immunocompetence. Far-advanced cancer often results in immobility and general debility that worsens with age. No research supports a correlation between aging and a reluctance to seek health care, in general, or cancer screenings, in particular. 108. Paraneoplastic syndromes may be the first or most prominent manifestation of a _cancer_. Examples include; Cushing Syndrome (endocrine) mediated by humoral factors such as hormones or cytokines excreted by tumor cells or by an immune response. 109. What is the most commonly reported symptom of cancer treatment? Fatigue-duh! 110. The difference between focal and diffuse brain injury. Focal=is typically in one area such as a stroke, epidural hemorrhage or subdural hemorrhage. Diffuse=affects the entire brain such as hypoxia, meningitis, and encephalitis. Remember the brain is a very small vault. 111. In diabetes insipidus we watch for _increased__ intracranial pressure. 112. Pressure on the pituitary gland from ICP prevents _anti-diuretic__ hormone from being excreted which leads to _high_ output of urine. *Really got to watch that urine output because it will be really high! 113. What term is used to describe the complication that can result from a spinal cord injury above T6 that is producing paroxysmal hypertension, as well as piloerection and sweating above the spinal cord lesion? Autonomic hyperreflexia Individuals most likely to be affected have lesions at the T6 level or above. Paroxysmal hypertension (up to 300 mm Hg systolic), a pounding headache, blurred vision, sweating above the level of the lesion with flushing of the skin, nasal congestion, nausea, piloerection caused by pilomotor spasm, and bradycardia (30-40 beats/minute) characterize autonomic hyperreflexia. 114. Autonomic hyperreflexia can be triggered by? Full bladder, fecal impaction, or restrictive clothing 115. Autonomic hyperreflexia-induced bradycardia is a result of stimulation of the what? Carotid sinus to the vagus nerve to the sinoatrial node The intact autonomic nervous system reflexively responds with an arteriolar spasm that increases blood pressure. Baroreceptors in the cerebral vessels, the carotid sinus, and the aorta sense the hypertension and stimulate the parasympathetic system. The heart rate decreases, but the visceral and peripheral vessels do not dilate because efferent impulses cannot pass through the cord. 116. Bradycardia in autonomic hyperreflexia is due to? A reflexive mechanism due to stimulation of the carotid sinus to the vagus nerve to the SA node=causing the SA node to slow way down to that 30-40 beats per minute. 117. You might see a question on the exam like this…A man who sustained a cervical spinal cord injury 2 days ago suddenly develops severe hypertension and bradycardia. He reports severe head pain and blurred vision. The most likely explanation for these clinical manifestations is that he is? Developing autonomic hyperreflexia 118. Which person is at the greatest risk for developing delirium?  An individual with diabetes celebrating his 70th birthday  A man diagnosed with schizophrenia  An individual on the second day after hip replacement  A depressed Hispanic woman The individual on the second day after hip replacement. Delirium is associated with autonomic nervous system over-activity and typically develops in 2 to 3 days, most commonly in ICUs, post-surgically, or during withdrawal from CNS depressants (alcohol, narcotic agents). 119. What is the normal intracranial pressure (in mm Hg)? 5 to 15 mm Hg-Wunderlich did not elaborate on specifics related to increased ICP but I decided to include this question. 120. Dementia is commonly characterized by the deterioration in which abilities?  Decision making  Memory  Balance  Speech  Sociability Memory, speech, and decision making Dementia is the progressive failure (an acquired deterioration) of many cerebral functions that include impairment of intellectual function with a decrease in orienting, memory, language, executive attentional functions, and alterations in behavior. 121. Delirium is _acute__, comes on _suddenly___ with the onset of disorientation, incoherent, delusional, and usually caused by a __UTI__. 122. Dementia is __insidious___ and usually affects __older_ populations. 123. The only way Alzheimer’s Disease can be definitively diagnosed is __post- mortem__. 124. Neurofibrillary tangles characterize which neurologic disorder? Alzheimer Disease-amyloid plaques, neurofibrillary tangles, as well as neuronal and synaptic losses in the brain. 125. Most common type of stroke is? Ischemic 126. Contributing factors for stroke include? Diabetes, hypertension, ethnicity (African-American), high cholesterol, atrial fibrillation 127. Most common location of strokes is in the _middle cerebral_. Most dysphasias are associated with cerebrovascular accidents involving which artery? Middle cerebral. Dysphasias are usually associated with a CVA involving the middle cerebral artery or one of its many branches. 128. NOTE: Interesting fact about the middle cerebral artery (MCA) is, contralateral homophonous and hemi-agnosia...if the right side, the contralateral sort they have right-sided homonymous agnosia, if they have right-sided think about what would be the left vision (it would be fine). So it is usually just on that one side that it is going to be affected. 129. Contralateral hemiparesis or hemiplegia is on the _opposite__ side of the brain that is going to be affected. 130. A right embolic CVA has resulted in left-sided paralysis and reduced sensation of the left foot and leg. Which cerebral artery is most likely affected by the emboli? Anterior cerebral Symptoms of an embolic stroke in only the right anterior cerebral artery would include left-sided contralateral paralysis or paresis (greater in the foot and thigh) and mild upper extremity weakness with mild contralateral lower extremity sensory deficiency with loss of vibratory and/or position sense and loss of two-point discrimination. 131. Atrial fibrillation, rheumatic heart disease, and valvular prosthetics are risk factors for which type of stroke? Embolic High-risk sources for the onset of embolic stroke are a atrial fibrillation (15% to 25% of strokes), left ventricular aneurysm or thrombus, left atrial thrombus, recent myocardial infarction, rheumatic valvular disease, mechanical prosthetic valve, nonbacterial thrombotic endocarditis, bacterial endocarditis, patent foramen ovale, and primary intracardiac tumors. 132. Since his cerebrovascular accident, a man has been denying his left hemiplegia. What term is used to describe this finding? Anosognosia, is ignorance or denial of the existence of disease 133. What term describes the loss of the comprehension or production of language? Aphasia 134. With receptive dysphasia (fluent), the individual is able to? Comprehend speech, but not verbally respond 135. To review…After a cerebrovascular accident, a man is unable to either feel or identify a comb with his eyes closed. This is an example of? Tactile agnosia 136. Tactile agnosia is related to injury of which area of the brain? Parietal Tactile agnosia (astereognosis) is the inability to recognize objects by touch as a result of damage to the parietal lobe. 137. Guillain-Barre Syndrome is an __autoimmune___ disease that is triggered by some type of bacterial or viral infection. 138. GB typically starts from an upper respiratory infection. Some studies are showing that it is linked to the __Zika__ virus. 139. Multiple sclerosis is another __automimmune_ disease marked by _exacerbations_ and _remissions__. 140. What is the central component of the pathogenic model of multiple sclerosis? Demyelination of nerve fibers in the CNS MS is an automimmune disorder diffusely involving the degeneration of CNS myelin and loss of axons. 141. Multiple sclerosis is best described as a? Central nervous system demyelination possibly from an immunogenetic virus MS is describe as occurring when a previous infectious insult to the CNS has occurred in a genetically susceptible individual with a subsequent abnormal immune response in the CNS. 142. Multiple sclerosis and Guillain-Barre syndrome are similar in that they are both? Result from demyelination by an immune reaction Acute inflammatory demyelinating polyneuropathy (AIDP) accounts for most occurrences of Guillain-Barre syndrome and MS is an autoimmune disorder diffusely involving degeneration of CNS myelin and loss of axons. 143. Myasthenia gravis is also an _automimmune_ disease characterized by antibodies attacking _acetylcholine_ receptors. 144. Acetylcholine is one of our neuromuscular enzymes, hormones that help the muscles to __contract_. 145. MG can be _insidious__, marked by __exertional__ fatigue. 146. Individuals with myasthenia gravis begin to have _microaspirations_ which leads to chronic respiratory infections. 147. As myasthenia gravis progresses, individuals will display? Bouts of pneumonia; ptosis (drooping of eyelids); facial drooping; difÏculty chewing/swallowing; and weight loss 148. Clinical manifestations of Parkinson disease are caused by a deficit in which of the brain’s neurotransmitters? Dopamine Parkinson disease is a commonly occurring degenerative disorder involving deficits of dopamine. 149. Tremors at rest, rigidity, akinesia, and postural abnormalities are a result of the atrophy of neurons in the brain’s what? Substantia nigra that produces dopamine The hallmark characteristics of Parkinson disease are a result of a loss of dopaminergicpigmented neurons in the substantia nigra pars compacta with dopaminergic deficiency in the putamen portion of the striatum (the striatum includes the putamen and caudate nucleus). 150. The clinical manifestations of Parkinson’s disease include. Fragmented sleep, depression, muscle stiffness, and bradykinesia. 151. Parkinson disease is a degenerative disorder of the brain’s Basal ganglia 152. The clinical manifestations of Parkinson disease include: (select all that apply) A. Fragmented sleep B. Drooping eyelids C. Depression D. Muscle stiffness E. Bradykinesia Fragmented sleep, depression, muscle stiffness, and bradykinesia 153. In Parkinson disease the basal ganglia influence the hypothalamic function to produce which clinical manifestations? (select all that apply) A. Inappropriate diaphoresis B. Gastric retention C. Vomiting D. Diarrhea E. Urinary retention Inappropriate diaphoresis, gastric retention, and urinary retention The basal ganglia influence hypothalamic function (autonomic and neuroendocrine) through pathways connecting the hypothalamus with the basal ganglia and cerebral cortex. Common autonomic symptoms in Parkinson disease include inappropriate diaphoresis, gastric retention, constipation, and urinary retention. 154. Individual’s with Parkinson’s disease typically exhibit… Pill-rolling tremors, shufÒing gait, difÏculty starting and stopping, expressionless face, and bent over posture 155. Mirgaines are typically seen in _women_ compared to __men__. 156. Migraines are characterized by either _slow_ or _rapid_ onset, can be episodic, quality can be _throbbing__, include _aura_ or _prodromal__ event. 157. Cluster headaches tend to happen around the _same_ time. What hormone peaks in the morning when we wake up? Cortisol 158. With sleep deprivation is that whole circadian rhythm is disrupted so this cortisol influx/release is messed up in the body. What happens is the cortisol will be released at the _wrong_ time and cause our blood pressure to _increase_. 159. Another molecule that gets released during sleep deprivation is _glucose_ which leads to increases in pro-inflammatory cytokines which leads to reduced natural killer cell activity. 160. Glaucoma is the leading cause of _vision impairment_ and _blindness__. 161. _Open_ angle glaucoma is the most common. Extremely high pressure can be within days or hours, but loss of that visual acuity is mainly a result of that pressure mainly on the optic nerve. 162. There are 3 types of hearing loss. Conductive hearing loss occurs when there is some sort of _interference/blockage_ typically caused by impacted cerumen. The individual will usually speak _softly__. With sensorineural hearing loss, individuals typically speak _loudly_. 163. Meniere’s disease can also cause _sensorineural_ hearing loss along with diabetes. 164. Which factors contribute to sensorineural hearing loss? (select all that apply)  Meniere disease  Aging  Outer ear trauma  Noise exposure  Diabetes mellitus Meniere disease, aging, diabetes mellitus, and noise exposure Impairment of the organ of Corti or its central connections causes a sensorineural hearing loss. The hearing loss may be gradual or sudden. Condition s that commonly cause sensorineural hearing loss include congenital and hereditary factors, noise exposure, aging, Meniere disease, ototoxicity and systemic disease (syphilis, Paget disease, collagen disease, diabetes mellitus). 165. NOTE: make sure to know the difference between migraines, cluster, and tension headaches