Xavier University
College of Nursing
Study Guide for Final Exam: Neuro, GI, Skin, Reproductive
Neurological
1. What is the difference between an ischemic and a hemorrhagic stroke? Which is more
common?
a. Similar s/s regardless of type of stroke, however it is important to determine the
type of stroke because treatments are vastly different for ischemic vs.
hemorrhagic
b. Ischemic Hemorrhagic
2. What is the difference between the infarct zone and the ischemic penumbra in a stroke?
a. Infarct zone
i. Region of ischemic damage; ischemia and reperfusion injury is
accompanied by an inflammatory response
b. Ischemic penumbra
i. Hypoperfused tissue surrounding the ischemic core in which blood flow is
too low to maintain electric activity but sufficient to preserve ion channels
3. Describe the difference between a focal and a generalized seizure, what are some types of
each? In particular, what is a tonic-clonic seizure? What does tonic refer to and what does
clonic refer to?
a. Focal: Arise from a neuronal area localized to one hemisphere
i. Simple: Does not lose consciousness, symptoms depend on location
ii. Complex: Altered level of consciousness or lose consciousness with
cognitive, affective, and psychomotor symptoms
b. Generalized: Arise within a hemisphere and rapidly involve neurons across both
hemispheres
i. Absence: Brief lapse of consciousness
ii. Tonic-clonic: Loses consciousness and rhythmic jerking movements
and stiffening of muscles
1. Tonic: Stiffening of muscles
2. Clonic: Rhythmic jerking movement
iii. Atonic: Loses muscle tone
iv. Myoclonic: Brief, shock-like jerks of muscles-rapid alternating contraction
and relaxation
4. What is an aura with seizures?
a. Perception of strange light, unpleasant smell, confusing thoughts, etc.
5. What is the pathology of Alzheimer disease? Describe the manifestations.
a. Patho
i. Mutation for encoding amyloid precursor protein
ii. Alteration in apolipoprotein E
iii. Loss of neurotransmitter stimulation of choline acetyltransferase
iv. Hallmarks of AD: Plaques and Tangle
v. The brains of people with AD have an abundance of two abnormal
structures:
1. Beta-amyloid plaques:
, a. Dense deposits of protein and cellular material that
accumulate outside and around nerve cells
b. Disrupts neurons affecting the hippocampus and other areas
of the cerebral cortex
i. Neurofibrillary Tangles
c. Tau protein
d. Microtubules to collapse
e. Tau proteins clump together to form neurofibrillary tangles
inside the neurons
b. Manifestations
i. Stage 1: 2-4 years, short term memory loss of significant issues
ii. Stage 2 (confusional stage): Emotional upset, disorientation, confusion,
lack of concentration, decline in abstraction, problem solving, and
judgement, swearing
iii. Stage 3 (terminal stage): Usually 1-2 years, becomes incapable of self-care
6. What is the role of dopamine in the body? What leads to the decreased levels of
dopamine in Parkinson disease? What are the manifestations of Parkinson disease?
a. Dopamine is a neurotransmitter and is normal opposed by acetylcholine; when
dopamine levels are reduced, the balance with acetylcholine is affected
b. Primary change is degeneration of nigrostriatal pathway with loss of dopamine
producing cells in substantial nigra
i. Normally, cells of substantia nigra synthesize dopamine and the axons of
the substantia nigra (which form the nigrostriatal pathway) supplies
dopamine to the striatum
c. Manifestations
i. Cardinal
1. Tremor: often described as “pill rolling”
ii. Rigidity: Resistance to passive movement and involves jerky, cogwheel-
type, or ratchetlike movements
1. Bradykinesia: slowed movement
iii. Other manifestations
1. Postural instability
2. Stiff facial expressions “Mask-like”
iv. Tongue, palate, and throat muscles may become rigid with drooling
v. Slow, poorly articulated speech
1. Mood disorders: such as depression are may occur
2. Cognitive dysfunction and dementia may occur
7. What neurons are affected by Amyotrophic Lateral Sclerosis? What is the typical cause of
death in someone with ALS?
a. Only motor neurons are affected
b. Respiratory muscle weakness
i. Respiratory failure usually causes death within 3 years of diagnosis
8. Describe the pathophysiology of Multiple Sclerosis. What is the usual role of myelin?
What happens when neurons are demyelinated?
a. Patho:
, i. Activated T cells, B cells, and macrophages trigger inflammation and
demyelination
ii. Demyelination of nerve fibers in the brain, spinal cord, and optic nerve
1. Loss of myelin disrupts nerve transmissions
iii. Lesions of MS are called plaques and are areas of demyelinated sclerotic
patches
9. What is the genetic mechanism for Huntington disease? When do symptoms appear?
Why would the onset of symptoms at this age be important in a disease that is inherited in
this manner?
a. Inherited, autosomal dominant, progressively degenerative neurological disorder
that results in involuntary motor symptoms, cognitive decline, and emotional and
behavioral symptoms
b. Symptoms typically appear between 30-50 years of age and progress over 10-30
years
c. Clinical Presentation
i. Involuntary motor symptoms: dyskinesia and loss of voluntary movement
1. Chorea and athetosis
ii. Emotional and behavioral symptoms: including major depressive episodes
and anger, possibly delusion or hallucination
iii. Cognitive symptoms: apathy and slowed thought process
10. What typically triggers the onset of Gillian-Barre Syndrome? What are the
manifestations?
a. Flu-like illness
b. Manifestations
i. Progressive, ascending muscle weakness
ii. Symptoms of paresthesia and numbness often accompany loss of motor
function
iii. Paralysis may progress to involve respiratory muscles and require
mechanical ventilation
11. What is the role of acetylcholine in the neuromuscular junction? What is dysfunctional in
this junction with Myasthenia Gravis?
a. Antibody-mediated loss of acetylcholine receptors in the neuromuscular junction
b. Each release of acetylcholine from pre-synaptic membrane results in decreased
motor response -> muscle weakness and fatigability with sustained effort
12. Describe the Monro-Kellie hypothesis.
a. An increase in one of the components can be compensated for by a decrease in
one of the other components
13. What is a brain herniation?
a. Displacement of brain tissue
14. Describe the 2 types of abnormal posturing.
a. Decorticate and Decerebrate posturing
i. Abnormal respiratory patterns
ii. Severe injury may result in brain death
15. What is a diffuse axonal injury? What are the major symptoms?
a. Shearing of fragile axons by acceleration-deceleration forces
b. Symptoms
College of Nursing
Study Guide for Final Exam: Neuro, GI, Skin, Reproductive
Neurological
1. What is the difference between an ischemic and a hemorrhagic stroke? Which is more
common?
a. Similar s/s regardless of type of stroke, however it is important to determine the
type of stroke because treatments are vastly different for ischemic vs.
hemorrhagic
b. Ischemic Hemorrhagic
2. What is the difference between the infarct zone and the ischemic penumbra in a stroke?
a. Infarct zone
i. Region of ischemic damage; ischemia and reperfusion injury is
accompanied by an inflammatory response
b. Ischemic penumbra
i. Hypoperfused tissue surrounding the ischemic core in which blood flow is
too low to maintain electric activity but sufficient to preserve ion channels
3. Describe the difference between a focal and a generalized seizure, what are some types of
each? In particular, what is a tonic-clonic seizure? What does tonic refer to and what does
clonic refer to?
a. Focal: Arise from a neuronal area localized to one hemisphere
i. Simple: Does not lose consciousness, symptoms depend on location
ii. Complex: Altered level of consciousness or lose consciousness with
cognitive, affective, and psychomotor symptoms
b. Generalized: Arise within a hemisphere and rapidly involve neurons across both
hemispheres
i. Absence: Brief lapse of consciousness
ii. Tonic-clonic: Loses consciousness and rhythmic jerking movements
and stiffening of muscles
1. Tonic: Stiffening of muscles
2. Clonic: Rhythmic jerking movement
iii. Atonic: Loses muscle tone
iv. Myoclonic: Brief, shock-like jerks of muscles-rapid alternating contraction
and relaxation
4. What is an aura with seizures?
a. Perception of strange light, unpleasant smell, confusing thoughts, etc.
5. What is the pathology of Alzheimer disease? Describe the manifestations.
a. Patho
i. Mutation for encoding amyloid precursor protein
ii. Alteration in apolipoprotein E
iii. Loss of neurotransmitter stimulation of choline acetyltransferase
iv. Hallmarks of AD: Plaques and Tangle
v. The brains of people with AD have an abundance of two abnormal
structures:
1. Beta-amyloid plaques:
, a. Dense deposits of protein and cellular material that
accumulate outside and around nerve cells
b. Disrupts neurons affecting the hippocampus and other areas
of the cerebral cortex
i. Neurofibrillary Tangles
c. Tau protein
d. Microtubules to collapse
e. Tau proteins clump together to form neurofibrillary tangles
inside the neurons
b. Manifestations
i. Stage 1: 2-4 years, short term memory loss of significant issues
ii. Stage 2 (confusional stage): Emotional upset, disorientation, confusion,
lack of concentration, decline in abstraction, problem solving, and
judgement, swearing
iii. Stage 3 (terminal stage): Usually 1-2 years, becomes incapable of self-care
6. What is the role of dopamine in the body? What leads to the decreased levels of
dopamine in Parkinson disease? What are the manifestations of Parkinson disease?
a. Dopamine is a neurotransmitter and is normal opposed by acetylcholine; when
dopamine levels are reduced, the balance with acetylcholine is affected
b. Primary change is degeneration of nigrostriatal pathway with loss of dopamine
producing cells in substantial nigra
i. Normally, cells of substantia nigra synthesize dopamine and the axons of
the substantia nigra (which form the nigrostriatal pathway) supplies
dopamine to the striatum
c. Manifestations
i. Cardinal
1. Tremor: often described as “pill rolling”
ii. Rigidity: Resistance to passive movement and involves jerky, cogwheel-
type, or ratchetlike movements
1. Bradykinesia: slowed movement
iii. Other manifestations
1. Postural instability
2. Stiff facial expressions “Mask-like”
iv. Tongue, palate, and throat muscles may become rigid with drooling
v. Slow, poorly articulated speech
1. Mood disorders: such as depression are may occur
2. Cognitive dysfunction and dementia may occur
7. What neurons are affected by Amyotrophic Lateral Sclerosis? What is the typical cause of
death in someone with ALS?
a. Only motor neurons are affected
b. Respiratory muscle weakness
i. Respiratory failure usually causes death within 3 years of diagnosis
8. Describe the pathophysiology of Multiple Sclerosis. What is the usual role of myelin?
What happens when neurons are demyelinated?
a. Patho:
, i. Activated T cells, B cells, and macrophages trigger inflammation and
demyelination
ii. Demyelination of nerve fibers in the brain, spinal cord, and optic nerve
1. Loss of myelin disrupts nerve transmissions
iii. Lesions of MS are called plaques and are areas of demyelinated sclerotic
patches
9. What is the genetic mechanism for Huntington disease? When do symptoms appear?
Why would the onset of symptoms at this age be important in a disease that is inherited in
this manner?
a. Inherited, autosomal dominant, progressively degenerative neurological disorder
that results in involuntary motor symptoms, cognitive decline, and emotional and
behavioral symptoms
b. Symptoms typically appear between 30-50 years of age and progress over 10-30
years
c. Clinical Presentation
i. Involuntary motor symptoms: dyskinesia and loss of voluntary movement
1. Chorea and athetosis
ii. Emotional and behavioral symptoms: including major depressive episodes
and anger, possibly delusion or hallucination
iii. Cognitive symptoms: apathy and slowed thought process
10. What typically triggers the onset of Gillian-Barre Syndrome? What are the
manifestations?
a. Flu-like illness
b. Manifestations
i. Progressive, ascending muscle weakness
ii. Symptoms of paresthesia and numbness often accompany loss of motor
function
iii. Paralysis may progress to involve respiratory muscles and require
mechanical ventilation
11. What is the role of acetylcholine in the neuromuscular junction? What is dysfunctional in
this junction with Myasthenia Gravis?
a. Antibody-mediated loss of acetylcholine receptors in the neuromuscular junction
b. Each release of acetylcholine from pre-synaptic membrane results in decreased
motor response -> muscle weakness and fatigability with sustained effort
12. Describe the Monro-Kellie hypothesis.
a. An increase in one of the components can be compensated for by a decrease in
one of the other components
13. What is a brain herniation?
a. Displacement of brain tissue
14. Describe the 2 types of abnormal posturing.
a. Decorticate and Decerebrate posturing
i. Abnormal respiratory patterns
ii. Severe injury may result in brain death
15. What is a diffuse axonal injury? What are the major symptoms?
a. Shearing of fragile axons by acceleration-deceleration forces
b. Symptoms
