Problem Set

List the 2 major divisions of the nervous system and the structures found in each.

The 2 divisions of the nervous system are the central nervous system (CNS) containing the brain and spinal cord and the peripheral nervous system (PNS) containing spinal nerves, cranial nerves, and ganglia that are outside of the CNS.

Describe the meninges and their function.

The meninges are connective tissue sheaths that surround the brain and spinal cord. The pia mater is the innermost layer and contains blood vessels that perfuse the brain and spinal cord. The arachnoid layer is delicate, nonvascular, waterproof, and CSF circulates beneath it in the subarachnoid space. The dura mater is the outermost strong connective tissue sheath that provides most of the protection for the brain and spinal cord.

Describe how CSF is produced and its function.

CSF serves as a cushion for the brain and spinal cord, protecting them from outside physical force. It maintains a constant ionic environment that allows diffusion of essential nutrients, electrolytes, and metabolic waste products around CNS neurons. CSF is produced by specialized ependymal cells called the choroid plexus that project into the ventricles.

What is the difference between afferent and efferent neurons?

Afferent neurons carry sensory information from the periphery to the spinal cord and brain, while efferent neurons carry motor output from the brain and spinal cord to the periphery.

List the neuroglial cells of the CNS and PNS.

CNS: oligodendrocytes, astrocytes, microglia, and ependymal cells. PNS: satellite cells and Schwann cells.

Describe each phase of an action potential.

Resting potential: sodium and potassium gates are closed. Depolarization: sodium gates open and sodium rushes into the axon, making the membrane potential more positive. Repolarization: sodium gates close and potassium gates open, allowing potassium to leave the axon and restoring a negative voltage. Hyperpolarization (after-polarization): potassium gates close slowly, causing an undershoot below the resting potential before returning to −70 mV.

Describe 3 ways in which neurotransmitters are removed from the synaptic cleft.

A neurotransmitter can be broken down by enzymatic activity into inactive substances.

A neurotransmitter can be drawn back into the presynaptic neuron by a process known as reuptake.

A neurotransmitter can diffuse into the intercellular fluid until its concentration is too low to elicit a postsynaptic response.

What type of EEG wave is associated with REM sleep?

Beta waves.

Alpha waves are characteristic of which stage of sleep?

Stage 1

Compare and contrast NREM and REM sleep regarding muscle tone, vital signs, and brain activity.

During NREM sleep, muscle tone is moderate; vital signs and brain activity are decreased.  During REM sleep, muscle tone decreases; vital signs and brain activity increase.

A patient with a diagnosis of Alzheimer's disease is able to function independently at home, but their family reports they have trouble planning and executing everyday tasks that used to come easy to them (e.g., paying their bills). What stage of Alzheimer's disease are they in?

Early or Mild Alzheimer’s

A patient with a diagnosis of Alzheimer's disease has no awareness of their surroundings and is completely dependent for all ADLs. What stage of Alzheimer's disease are they in?

Late or severe

List 3 non-medicinal interventions that can be used to address sleep changes in someone with Alzheimer's disease.

Maintain a consistent sleep schedule, avoid caffeine, and reduce screen time before bed. (Other acceptable answers include maintaining a regular daytime routine, exercising earlier in the day, keeping the room familiar and comfortable, and providing a security object.)

What is the main difference between focal and generalized seizures?

Focal seizures affect one specific part of the brain in 1 hemisphere.  Generalized seizures affect both hemispheres of the brain.

Describe the phenomenon of aura.

A warning sensation that people sometimes experience before a seizure.

Give 2 reasons why it is important for someone with a seizure disorder to regularly see their care team (Neurologist and PCP).

To make sure their current medication is managing their seizure disorder and to make sure there aren’t any new conditions that would require pharmacologic intervention that could interfere with their seizure medication. 

Parkinson's disease is characterized by a loss of which neurotransmitter?

Dopamine.

What are the 3 hallmark signs of Parkinson's disease?

Tremor, rigidity, and bradykinesia.

Why is levodopa given to treat Parkinson's disease as opposed to dopamine?

Levodopa is used because it can cross the blood-brain barrier, whereas dopamine cannot.

What are the 2 types of strokes? Describe the difference between them.

Ischemic stroke is caused by a blocked blood vessel that impairs blood flow to the brain. Hemorrhagic stroke is caused by a ruptured blood vessel that leads to bleeding in or around the brain.

What is a TIA and why are they important?

A transient ischemic attack (TIA) is a temporary disruption of blood flow to the brain that causes stroke-like symptoms which resolve within 24 hours without permanent brain damage. TIAs should not be ignored because they serve as a warning sign that a future stroke may occur.

What type of stroke are tPA drugs used to treat? How soon after the onset of a stroke must they be administered?

tPA drugs are used to treat ischemic strokes and must be administered within 3–4.5 hours after the onset of stroke symptoms.

What are the goals of acute treatment of a hemorrhagic stroke?

To stop bleeding and reduce pressure to stabilize the patient.

List 2 factors that could contribute to depression.

Any two of the following: inherited/familial link, chemical imbalance, hormonal imbalance/change, stress/trauma leading to an altered HPA axis.

A "nervous tick" is associated with what specific type of depression?

Catatonic depression.

Hypersomnia is associated with what specific type of depression?

Atypical depression.

List the 4 diagnostic characteristics of insomnia.

(1) Waking up too early. (2) Trouble staying asleep. (3) Trouble falling asleep. (4) Chronic nonrestorative or poor sleep.

What is sleep hygiene?

Sleep hygiene involves establishing consistent sleep patterns, creating a comfortable sleeping environment, avoiding screens and excessive light before bed, and avoiding stimulants (such as caffeine) several hours before bedtime.

What stage of sleep is impaired with a diagnosis of narcolepsy?

REM sleep.

What is the major difference between central sleep apnea and obstructive sleep apnea?

The brain does not properly signal the respiratory muscles with central sleep apnea.  With OSA, the airway collapses, but the respiratory muscles maintain their function.

List 3 risk factors for OSA.

Any three of the following: male gender, advanced age, family history, alcohol and drug abuse, obesity, large neck girth (>40 cm).

Describe a treatment option for moderate OSA.

A custom dental appliance that positions the tongue forward and protrudes the mandible can help maintain an open airway. Nasal/naso-oral continuous positive airway pressure (NCPAP/CPAP) can also be used during sleep to produce positive pressure that prevents airway collapse.

Olfaction (sense of smell)

CNI – Olfactory Nerve

Vision (sense of sight)

CNII – Optic Nerve

Pupillary constriction, accommodation, eye movement, and eyelid movement

CNIII – Oculomotor Nerve

Movement of the eye down and inward

CNIV – Trochlear Nerve

Mastication (chewing) and sensation to the face, nose, and mouth

CNV – Trigeminal Nerve

Movement of the eye laterally

CNVI – Abducens Nerve

Facial expression and sensation of taste to the anterior tongue

CNVII – Facial Nerve

Auditory sensation (hearing), balance, and equilibrium

CNVIII – Vestibulocochlear Nerve

Motor innervation to muscles involved in swallowing and sensation of taste to the posterior tongue

CNIX – Glossopharyngeal Nerve

Digestion, regulation of heart rate, and sensation to the digestive tract

CNX – Vagus Nerve

Motor innervation to cervical rotator muscles and the trapezius muscle

CNXI – Accessory Nerve

Voluntary tongue movements

CNXII – Hypoglossal Nerve

The Nervous System

CNS & PNS

PNS

SNS & ANS

ANS

Sympathetic and Parasympathetic

The somatic system nerves

generally under conscious (voluntary) control, innervating the movements of skeletal muscles, as well as controlling movement of the skin and joints.

The autonomic system nerves

control the glands and smooth muscles of the internal organs and is generally under involuntary control.

The sympathetic nervous system

activates and prepares the body for vigorous muscular activity, stress, and emergencies (flight and fight)

parasympathetic nervous system

generally operates during normal resting situations, permitting digestion and the conservation of energy (rest and digest)

Modifiable Risk Factors for Stroke

Hypertension, Hypercholesteremia, Diabetes, Hypercoagulopathy, Cardiac disease

Modifiable Behaviors Factors for Stroke

Smoking, Alcohol consumption , Birth control pills especially in combination with smoking, Immobility, Obesity, Illicit drug use

Non-Modifiable Risk Factors for Stroke

Age, Sex, Race, Prior history of stroke, family history of stroke