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5 Flashcards

1
Q

What is the gait cycle?

A

The period from heel strike of 1 limb until the next time that heel hits the ground.

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2
Q

What is the running pattern?

A

At some point having both feet off the ground simultaneously.

Absorbing and releasing energy stored in tendons biomechanically makes running a series of controlled leaps.

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3
Q

Stance phase

A

Heel strike
Mid-stance
Propulsion
Heel-off

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4
Q

Swing phase

A

Toe-off
Mid-swing
Heel strike

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5
Q

What is torque?

A

Rotational force; when most skeletal muscles contract the bones to which they are attached they rotate around a joint.

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6
Q

Differentiate between eccentric and concentric muscle action

A

Eccentric – a muscle length increases

Concentric – a muscle length shortens

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7
Q

How do muscle and joints provide the brain with info about body position and movement?

A

They have receptors that send sensory info to the brain.

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8
Q

What is the function of the cerebellum?

A

Motor correction – adjusting movement based on sensory and proprioceptive input.

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9
Q

Where does the cerebellum receive input from?

A

The spinal cord and other parts of the brain

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10
Q

What is motor learning?

A

Improving performance of motor sequence with repetition.

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11
Q

What term describes a bending movement that decreases the angle between a segment and its proximal segment?

A

Flexion

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12
Q

What term describes motion that pulls a structure toward the midline of the body?

A

Adduction

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13
Q

What term describes movement in a superior direction?

A

Elevation

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14
Q

What term describes toes brought closer to the shin; decreasing the angle between dorsum of the foot and leg?

A

Dorsiflexion

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15
Q

What term describes the decreasing angle between the sole of the floor and back of the leg?

A

Plantar flexion

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16
Q

What term describes motion that pulls a structure away from the midline of the body?

A

Abduction

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17
Q

What is the main extension muscle at the hip?

A

Gluteus maximus

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18
Q

What is the muscles that abduct the hip?

A

Gluteus medius and minimus

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19
Q

What does the extension at the hip move?

A

Moves thigh forward and backward.

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20
Q

What does abduction of the hip move?

A

Moves tight sideways.

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21
Q

What do quadriceps do?

A

Extended knee and flex the thigh

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22
Q

What does the hamstring do?

A

Flex the knee and extend the thigh

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23
Q

What acts on our centre of mass?

A

Gravity

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24
Q

Where is the centre of mass in humans?

A

Within the pelvis, in the midline anterior to 2nd sacral vertebra.

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25
Q

What is neurulation?

A

Sides of neural groove come together and form neural tube.

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26
Q

What happens to gait due to aging?

A

Decreased muscle bulk and flexibility –> decreased stride length and increased no. of steps

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27
Q

What type of structural damage can alter gait?

A

Damage to blood vessels, nerves, skeleton, joints, muscles and tendons.

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28
Q

What does wearing flip-flops do to the gait cycle?

A

Wearers take shorter steps and heels hit the floor with less vertical force.

Toes are not brought up as much, creating a larger ankle angle and shorter stride length.

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29
Q

What does wearing high heels do to the gait cycle?

A

Shoes are elevated, heel shortens the Achilles tendon, shortening of the calf muscles.

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30
Q

Name some inflammatory/degenerative conditions that alter the gait?

A

Rheumatoid arthritis, infectious arthritis and osteoarthritis, gout, and pseudo-gout.

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31
Q

What is an antalgic gait?

A

Any gait that reduces loading on the affected extremity by decreasing stance phase time or joint forces as to avoid pain on weight-bearing structures.

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32
Q

Give examples of an antalgic gait

A

Diabetic foot,

Osteoarthritis,

Gout,

Ingrown toenail

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33
Q

What is an ataxic gait?

A

Cerebellar gait.

Unsteady, uncoordinated walk, a wide base and the feet thrown out, coming down on the heel and then on the toes double tap.

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34
Q

What is a parkinsonian gait?

A

Patient involuntarily moves with short, accelerating steps, often on toe tip, with the trunk flexed forward and the legs flexed stiffly at the hips and knees.

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35
Q

What is a myopathic gait?

A

Waddling gait

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36
Q

What is a neuropathic gait?

A

High stepping gait

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37
Q

What is the neural folds?

A

Raised edges of the neural plate.

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38
Q

What is the neural plate?

A

A thickening to the ectoderm in (3rd week of gestation)

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39
Q

What is the neural groove?

A

A longitudinal groove formed as the neural plate folds’ inwards.

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40
Q

What is the function of the neural folds?

A

Increase in height and meet to form the neural tube

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41
Q

What 3 layers of cells differentiate from the walls that encloses the neural tube?

A

Marginal layer –> white matter

Mantel layer –> grey matter

Ependymal layer –> lining of the central canal of the spinal cord and ventricles of the brain

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42
Q

What is the neural crest?

A

Tissue between neural tube and skin ectoderm.

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43
Q

What does the neural crest differentiate into?

A

Forms the posterior root ganglia of spinal nerves, spinal nerves, ganglia of cranial nerves, cranial nerves, ganglia of the ANS, adrenal medulla and meninges.

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44
Q

What type of cells migrate and differentiate into pharyngeal arches?

A

Neural crest cells

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45
Q

What does the anterior part of the neural tube develop into at 3-4 weeks?

A

3 enlarged areas – primary brain vesicles

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46
Q

Name the 3 primary areas.

A

Prosencephalon (pros = before) – forebrain

Mesencephalon – midbrain

Rhombencephalon (rhomb = behind) – hindbrain

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47
Q

Which primary are of the developing brain develops into the follow secondary vesicles: telencephalon and diencephalon?

A

Prosencephalon

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48
Q

Which primary are of the developing brain develops into the follow secondary vesicles: metencephalon and myelencephalon?

A

Rhombencephalon

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49
Q

What does the metencephalon become?

A

Pons and cerebellum – houses part of the 4th ventricle

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50
Q

What does the myelencephalon become?

A

Medulla – houses part of the 4th ventricle

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51
Q

What does the telencephalon develop into?

A

2 cerebral hemispheres (including basal nuclei) – houses paired lateral ventricles (1st and 2nd)

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52
Q

What does the diencephalon develop into?

A

Thalamus, hypothalamus, epithalamus – houses 3rd ventricle

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53
Q

What does the mesencephalon develop into?

A

Midbrain which surrounds the cerebral aqueduct

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54
Q

What does the area of the neural tube inferior to myelencephalon give rise to?

A

The spinal cord

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55
Q

What is the 4 ventricles of brain associated with?

A

1st and 2nd in the cerebral hemispheres

3rd – thalamus, hypothalamus, epithalamus

4th – pons and medulla

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56
Q

What is the adult ventricular system a remnant of?

A

The neural tube that has folded up and expanded disproportionally in different regions.

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57
Q

What are the important structures associated with the C shaped lateral ventricles?

A

Thalamus,

Basal ganglia,

Hippocampus

Fornix

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58
Q

What is the internal capsule an important site in?

A

Strokes

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59
Q

What is the internal capsule?

A

Major tract of fibres passing through nuclei of basal ganglia and diencephalon.

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60
Q

Which structure forms the most posterior part of the neural tube?

A

Spinal cord

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61
Q

What type of fibres pass in the ventral side of spinal vertebrae?

A

Motor

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62
Q

What type of fibres pass in the dorsal side of spinal vertebrae?

A

Sensory

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63
Q

What neurons are found in the dorsal, ventral, lateral horns?

A

Dorsal – sensory neurons
Ventral – motor neurons
Lateral – autonomic neurons

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64
Q

What are efferent axons?

A

They are projections of the ventral root that growth toward muscle, glands etc

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65
Q

What are afferent fibres?

A

They have projections that growth into the spinal cord

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66
Q

What is spina bifida?

A

Incomplete closing of the backbone – associated with low folic acid levels in first few weeks of development.

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67
Q

What is anencephaly?

A

Absence of the skull and cerebral hemispheres – associated with low folate levels in first few weeks of development.

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68
Q

Which nerve is CN I?

A

Olfactory – Sensory (nose)

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69
Q

Which nerve is CN X?

A

Vagus – Both (laryngeal and pharyngeal muscles)

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70
Q

Which nerve is CN IV?

A

Trochlear – Motor (superior oblique muscle eye)

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71
Q

Which nerve is CN XII?

A

Hypoglossal – Motor (tongue, glossal muscles)

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72
Q

Which nerve is CN V?

A

Trigeminal – Both (mastication, face sensations)

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73
Q

Which nerve is CN XI?

A

Accessory – Both (muscles of neck and overlaps functions of vagus nerve)

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74
Q

Which nerve is CN IX?

A

Glossopharyngeal – Both (taste, parotid gland…)

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75
Q

Which nerve is CN II?

A

Optic – Sensory (visual info to brain)

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76
Q

Which nerve is CN III?

A

Oculomotor – Motor (eye movement muscles)

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77
Q

What are the 6 functions of the skeletal system?

A

Support, protection, assistance in movement, mineral homeostasis, blood cell production, triglyceride storage

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78
Q

In bones where are triglycerides storage?

A

Yellow bone marrow

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79
Q

In red bone marrow where are developing adipocytes, fibroblasts, macrophages and blood cells found?

A

A network of reticular fibres

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80
Q

When is all bone marrow red?

A

Newborns

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81
Q

Which minerals does bone tissue store?

A

Calcium, phosphorus, among others

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82
Q

What cells does the skeleton develop from?

A

Neural crest – head

Mesoderm – body

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83
Q

Which part of the skeleton develops in cartilaginous bodies?

A

All skeleton below the head excluding the clavicles and base of skull.

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84
Q

Where are flat bones of the skull, most facial ones, mandible and medial part of clavicles formed?

A

In the neural crest which later ossifies.

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85
Q

When does vertebrae develop from somites?

A

Day 21-25

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86
Q

What does the cerebellum connect to brainstem via?

A

Cerebellar peduncles

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87
Q

When do limb buds develop?

A

4-5 weeks

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88
Q

What is intramembranous ossification?

A

Bone forms directly within mesenchyme.

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89
Q

What is endochondral ossification?

A

Bone forms within hyaline cartilage the develops from mesenchyme.

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90
Q

What happens to cartilage? .

A

Becomes calcified

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91
Q

What is the epiphyseal plate?

A

Growth plate. Layers of hyaline cartilage that allows the diaphysis to growth in length.

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92
Q

What is the periosteum?

A

Tough connective tissue sheath and associated blood vessels.

Covers bone where the articular cartilage doesn’t.

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93
Q

What is the diaphysis?

A

The bone’s shaft/body. Long, cylindrical main portion.

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94
Q

What is the articular cartilage?

A

Thin layer of hyaline cartilage covering the part of epiphysis where bone forms an articulation with another bone.

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95
Q

What is the epiphyses?

A

The proximal and distal ends of the bone.

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96
Q

What is the metaphysis?

A

Regions between the diaphysis and epiphysis

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97
Q

What is the function of the periosteum?

A

Assists in fracture repair; provides attachment point for ligaments and tendons; nourish bone tissue

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98
Q

What does the medullary cavity in the diaphysis contain?

A

Blood vessels, fatty yellow bone marrow

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99
Q

What is the endosteum?

A

Thin membrane that lines the medullary cavity.

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100
Q

What does the endosteum contain?

A

Single layer of bon-forming cells and small amount of connective tissue.

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101
Q

Why is damage repair limited in the articular cartilage?

A

It lacks blood vessels

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102
Q

What is the epiphyseal line?

A

When the cartilage in the epiphyseal plate is replaced by bone it forms a line.

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103
Q

Where is spongy bone found in long bones?

A

Epiphyses

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104
Q

Where is compact bond found in long bones?

A

Diaphysis

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105
Q

What are the 5 main types of bone shapes?

Give examples.

A

Long – tibia, fibula, femur
Short – carpal, tarsal

Flat – cranial, sternum, scapulae

Irregular – vertebrae, hip bones

Sesamoid – patellae, many small bones

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106
Q

What type of bone is cube shaped?

A

Short bone. Approx. equal length and width

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107
Q

What is cortical and cancellous bone tissue?

A

Cortical – compact bone; cancellous – spongy bone

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108
Q

What is the structural units of cortical bone?

A

Osteons

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109
Q

What doe osteons consist of?

A

Concentric lamellae arranged around a central canal

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110
Q

What are lacunae?

A

Little lakes that contain osteocytes between concentric lamellae

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111
Q

What are osteons parallel to?

A

Length of the diaphysis

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112
Q

What is the functions of cancellous bone?

A

Lighten bone, support and protect the red bone marrow

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113
Q

What is the units in cancellous bone tissue?

A

Trabeculae

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114
Q

How are the lamellae of spongy tissue arranged?

A

An irregular pattern of thin columns called trabeculae.

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115
Q

What fills the spaces between the trabeculae?

A

Red and yellow bone marrow

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116
Q

In cancellous bone, what do blood vessels provide nutrients to?

A

The lacunae and canaliculi that contain osteocytes

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117
Q

In bone, what is the extracellular matrix composed if?

A

15% - water
30% - collagen
55% - crystallised mineral salts

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118
Q

What is the most abundant mineral salt?

A

Calcium phosphate.

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119
Q

What the combination of calcium hydroxide and calcium phosphate form?

A

Hydroxyapatite

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120
Q

What are the 4 types of cells in bone tissue?

A

Osteoprogenitor cells; osteoblasts; osteoclast; osteocytes

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121
Q

What is the function of osteoblasts?

A

Forms bone extracellular matrix

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122
Q

What is the function of osteoclasts?

A

Functions in resorption, the breakdown of bone extracellular matrix

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123
Q

What is the function of osteocytes?

A

Maintains bone tissue; nutrient and waste exchange

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124
Q

What is the function of osteoprogenitor cells?

A

Develops into an osteoblast

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125
Q

What are osteocytes a fusion of?

A

Up to 50 monocytes.

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126
Q

Where are osteocytes found?

A

In the endosteum; on the side of the cell that faces the bone surface

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127
Q

How do osteocytes digest the protein and mineral components of bone matrix?

A

Lysosomal enzymes and acids

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128
Q

What are compound fractures?

A

The broken ends of the bone protrude through the skin.

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129
Q

What name is given to a fracture of the distal end of the fibula, with serious injury of the distal tibial articulation?

A

Pott

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130
Q

What are greenstick fractures?

A

A partial fracture in which one side of the bone is broken and other bends. Only occurs in children.

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131
Q

Which fracture has splintered, crushed, or bone broken into pieces at the site of impact?

A

Comminuted

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132
Q

What are simple fractures?

A

The fractured bone doesn’t break the skin.

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133
Q

What name is given to a fracture of the distal end of the radius in which the distal fragment is displaced posteriorly?

A

Colles

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134
Q

How are children’s bones different from adult?

A

They aren’t fully ossified and contain more organic than inorganic material

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135
Q

How do osteoblasts build bone?

A

Synthesise and secrete collagen fibres and initiate calcification

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136
Q

What type of cells get trapped in bone tissue?

A

Osteoblasts; they become osteocytes

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137
Q

Name 3 types of joints.

A

Fibrous, cartilaginous, synovial

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138
Q

Which type of joint has a synovial cavity?

A

Synovial a.k.a. diarthroses

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139
Q

Which type of joints have no synovial cavity?

A

Cartilaginous and fibrous

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140
Q

Which type of joints have bones held together by cartilage?

A

Cartilaginous

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141
Q

Which type of joints have bones held together by connective tissue?

A

Fibrous

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142
Q

What holds bones in synovial joints in place?

A

Accessory ligaments, the connective tissue of articular capsule and socket

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143
Q

In which nervous system is grey and white matter found?

A

CNS

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144
Q

Which type of matter makes up the tract?

A

White

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145
Q

Which type of matter makes up the cortex, horns and nuclei?

A

Grey

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146
Q

What are the differences between the nervous system and endocrine system?

A

N – responds quickly to stimuli by APs and NTs
E – responds to stimuli by secreting hormones into circulation that travels to target tissue

N – short-lived responses (fast)
E – long lasting responses (slow)

N – effects usually reversible
E – effects can be irreversible e.g. growth

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147
Q

What are somatic afferents and visceral afferents?

A

Somatic – external stimuli

Visceral – internal stimuli

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148
Q

What are glial cells?

A

Provide functional and structural support for neurones.

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149
Q

What are nerve cells?

A

Form the functional basis of the nervous system; responsible for transmitting signals

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150
Q

What are the cranial meninges?

A

Periosteum, dura mater, arachnoid mater, pia mater

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151
Q

Name some potential spaces of the skull.

A

Extradural, subdural, subpial

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152
Q

What is subarachnoid space and brain ventricles filled with?

A

CSF

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153
Q

Which is more superior: the midbrain or pons?

A

Midbrain

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154
Q

What is pons Latin for?

A

Bridge

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155
Q

What is medulla Latin for?

A

Marrow

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156
Q

What is the cerebellar vermis?

A

Vermis (L. worm) is in the medial,

Cortico-nuclear zone of the cerebellum

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157
Q

What are denticulate ligaments?

A

Projections of pia mater that anchors the spinal cord in the centre of the vertebral column.

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158
Q

In the spinal cord, where is white matter relative to grey matter?

A

White matter on outside.

Grey matter on inside.

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159
Q

Are cranial nerves a part of the CNS or PNS?

A

PNS

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160
Q

Describe the medullary cavity of bone.

A

Hollow cylindrical space which contains yellow bone marrow in adults. Reduces weight of bone.

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161
Q

How many spinal segments are there?

A

31

8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal

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162
Q

What is a myotome or dermatome?

A

An area of muscle or skin supplied by a single spinal segment.

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163
Q

Name the inorganic and organic components of bone.

A

Organic – type 1 collagen and non-collagenous proteins

Inorganic – calcium hydroxyapatite

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164
Q

Why do osteoclast have multiple nuclei?

A

Because they are formed by the fused of monocytes.

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165
Q

Which type of bone cells act as mechanoreceptors?

A

Osteocytes

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166
Q

How much calcium is in the body of an adult human body?

A

1kg

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167
Q

What critical roles does calcium have?

A

Neuromuscular function, blood coagulation, intracellular signalling.

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168
Q

Where is most of the phosphate in the adult body stored?

A

In the skeleton 85%

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169
Q

What is cholecalciferol?

A

Vitamin D3

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170
Q

How is cholecalciferol synthesised?

A

In skin from 7-dehydrocholesterol by UV light.

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171
Q

What in the liver produces 1,25 (OH)2 vitamin D3?

A

1-hydroxylation

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172
Q

Why is white matter on the outside in the spinal cord?

A

The axons have nerves that come off them which doesn’t need to cross the grey matter to leave and enter the spinal cord.

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173
Q

What is 1,25 (OH)2 vitamin D3 production regulated by?

A

PTH – stimulated

Serum calcium and phosphate – inhibited

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174
Q

What is PTH secreted by and in response to what?

A

The parathyroid gland; in response to low plasma Ca2+¬ levels.

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175
Q

What does high levels of PTH stimulate?

A

Osteoclastic bone resorption

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176
Q

What do intermittent-low levels of PTH stimulate?

A

Osteoblastic bone formation

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177
Q

What are the actions of 1,25 (OH)2 vitamin D3?

A

Ca2+ and PO43- absorptions from intestine.

Mobilises calcium and phosphate from bone.

Induces marrow monocytes to differentiate into osteoclasts to stimulate bone resorption.

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178
Q

What is calcitonin?

A

A 32-aa polypeptide released from the parafollicular cells of the thyroid in response to high plasma calcium levels.

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179
Q

How does calcitonin reduce bone resorption?

A

By activating calcitonin receptors expressed by osteoclasts.

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180
Q

How do androgens levels link to the bone marrow density?

A

Low levels of androgens are linked to lower bone density in men. It’s linked to hypogonadism.

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181
Q

What are some causes of hypercalcaemia?

A

Primary hyperparathyroidism - can be due to malignancy,

Sarcoidosis

Paget’s disease

Vitamin D toxicity.

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182
Q

How does the cerebellum improve accuracy of movements?

A

By providing feedback info to cortical motor areas

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183
Q

What are some causes of hypocalcaemia?

A

Renal failure, vitamin D deficiency

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184
Q

What are some symptoms of primary hyperparathyroidism?

A

Kidney stones,

Skull and phalanges most affected,

Periosteal erosions,

Bone pain

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185
Q

What is an AP?

A

Rapid change in electrical potential across the plasma membrane of a cell.

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186
Q

What is the purpose of APs?

A

Intracellular and intercellular communication.

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187
Q

What is the membrane potential?

A

The difference in electric potential between the interior and exterior of a cell, caused by a separation of electric charges. Measured in units of volts/millivolts.

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188
Q

What 3 things establish the resting potential?

A

Low protein-permeability; sodium/potassium pump (active transport); high potassium permeability (passive transport).

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189
Q

What are leak channels?

A

Ion channels that are always open, continually leak ions across the membrane.

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190
Q

What are voltage-gated channels?

A

The open or close in response to voltage change.

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191
Q

What are ligand-gated channels?

A

The open or close in response to a chemical or drug.

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192
Q

What can elevated potassium ion levels in the body cause?

A

The resting potential to be less negative (depolarised); interferes with cardiac muscle contraction, stopping the heart.

Used in lethal injections and heart transplant surgery.

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193
Q

At what millivolt is the threshold exceeded and an AP (depolarisation) initiated?

A

-55mV

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194
Q

Which channels open at -55mV?

A

Voltage-gated sodium

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195
Q

What happens to voltage-gated sodium channels in the absolute refractory period?

A

They are inactivated.

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196
Q

Which channels open at +40mV?

A

Voltage-gated potassium channels

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197
Q

How does conduction in an unmyelinated and myelinated axon differ?

A

Myelin sheath insulates axons and prevents ion leakage so sodium and potassium channels concentrate only at the nodes of Ranvier.

Conduction in myelinated axons = saltatory conduction so it’s generally faster

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198
Q

What does axon conduction velocity depend on?

A

Myelination and axon diameter

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199
Q

When are unmyelinated fibres faster than myelinated fibres?

A

When the fibre diameter is small (< 1 micrometre)

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200
Q

What are the 4 types of axons?

A

A-alpha, A-beta, A-gamma, C

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201
Q

Which type of axon conducts impulses the fastest?

A

A-alpha

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202
Q

Which fibres are myelinated?

A

A-alpha, A-beta, A-gamma,

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203
Q

Which fibres are unmyelinated?

A

C

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204
Q

Which myelinated fibre has the smallest diameter?

A

A-gamma

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205
Q

What is MS?

A

An autoimmune disease where T-lymphocytes attack myelin sheaths causing inflammation, lesions and sclerosis (scarring) in axon bundles in the brain, spinal cord, optic nerve.

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206
Q

What can be used to either block or increase APs?

A

Carbamazepine, Tetrodotoxin, local anaesthetics, rDCS (transcranial direct current stimulation)

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207
Q

How does carbamazepine work?

A

Prolongs inactivated state of sodium channel and absolute refractory period. Slows down AP firing rate.

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208
Q

How does tetroxotocin work?

A

Blocks fast-voltage-gated sodium channels –> paralysis

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209
Q

What millivolt corresponds to hyperpolarisation and is associated with voltage-gated potassium channels closing?

A

-80mV

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210
Q

Block which channels lead to prevention of APs?

A

Voltage-gated sodium

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211
Q

What is nociception?

A

The neural processes of detecting, encoding and processing noxious stimuli – physiological response

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212
Q

What is pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage – subjective response.

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213
Q

What are charges of the outside of neurons like?

A

Positively charged due to high sodium ions

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214
Q

What are charges of the inside of neurons like?

A

Negatively charged, high potassium but low sodium

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215
Q

What type of nerve cell endings do nociceptors have?

A

Unspecialised – free nerve endings

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216
Q

What sort of afferents does A-alpha, A-beta, A-gamma, C fibres conduct?

A

A-alpha, A-beta, – low-threshold mechanoreceptor

A-gamma, C nociceptors, thermos-receptors and pain

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217
Q

What is 1st pain and 2nd pain?

A

1st pain – fast; A-gamma fibres; sharp; easily localised

2nd pain – slow; C fibres; dull, arching, slow onset

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218
Q

What do voltage gated calcium ion channels trigger release of?

A

NTs (glutamate, substance P) which activate 2nd order neurons in the spinal cord, sending signals up to brain.

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219
Q

What is congenital analgesia?

A

Inability to feel pain externally or internally.

Otherwise normal sensory responses.

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220
Q

What is referred pain caused by?

A

Convergence of nociceptor inputs from viscera and skin

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221
Q

Nociceptive afferents from internal organs (viscera) and the skin enter the spinal cord through the same route. What does this cause?

A

Cross-talk which gives rise to referred pain. Pain doesn’t originate from the site that hurts.

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222
Q

In early stages of appendicitis where is pain referred?

A

To the umbilical region around the navel

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223
Q

What is phantom limb?

A

The sensation that a missing limb is still attached and moving appropriately.

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224
Q

What are some helpful treatments for phantom limb pain?

A

Mirror therapy, use of myoelectric prosthesis, stump stimulation to reverse remapping of the brain.

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225
Q

What is allodynia?

A

Pain from a stimulus that does not normally provoke pain i.e. light touch.

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226
Q

What is hyperalgesia?

A

Increased sensitivity (reduced threshold) to pain from a stimulus that normally provokes pain.

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227
Q

What can induce hyperalgesia and how?

A

Tissue damage and inflammation triggers release of substances that sensitise peripheral nociceptors.

E.g. substance P, prostaglandins, bradykinin and histamine.

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228
Q

What is fibromyalgia?

A

Chronic and widespread pain and allodynia.

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229
Q

What do opioids bind to?

A

Opioid receptors found in the brain.

There are 3 types: mu, delta and kappa.

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230
Q

What are endogenous morphine-like substances?

A

They are like natural opioids found in the brain which bind to opioid receptors and relieve pain. E.g. endorphins, enkephalins, dynorphins – all peptides

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231
Q

What is fentanyl?

A

An analgesic used during operation and an enhancement of anaesthesia

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232
Q

What is pethidine?

A

Used for mod – severe pain, obstetric analgesia.

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233
Q

What are some opioid side effects?

A

Respiratory depression, constipation, addiction, hypotension, nausea and vomiting, drowsiness

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234
Q

Which CN is the only 1 that emerges from dorsal aspect of the brainstem and runs towards the front?

A

CN IV – trochlear

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235
Q

How are cranial nerves ordered?

A

By their location on the brainstem. Superior to inferior, then media to lateral, and order of their exit from the cranium (anterior to posterior)

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236
Q

How many cranial nerves are there?

A

A set of 12 paired nerves

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237
Q

Where do the cranial nerves arise from?

A

Cerebrum (I, II); midbrain (III, IV), pons (V, VI, VII, VII); medulla (IX, X, XI, XII)

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238
Q

How many descending tracts pass through the internal capsule in the brain?

A

6

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239
Q

How are the ascending tracts arranged?

A

Layered in a very organised structure.

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240
Q

How are the descending tracts arranged?

A

Not ordered very neatly, however the tracts synapse in the anterior horn in a very organised way.

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241
Q

Where do nerves that innervate the trunk have cell bodies?

A

More medial in the anterior horn

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242
Q

Where do nerves that innervate most distal parts of the body have cell bodies?

A

More lateral in the anterior horn.

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243
Q

In general, are nerves innervating extensors or flexors of a given region of the body more posterior or anterior in the anterior horn?

A

Flexors more posterior than extensors in the anterior horn

Extensors more anterior

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244
Q

Which motor neurons are somatotrophically arranged?

A

LMN

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245
Q

What does somatotropic mean?

A

Point-for-point correspondence of an area of the body to a specific point on central nervous system.

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246
Q

Name 2 descending tracts.

A

Ventromedial and dorsolateral

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247
Q

What does the ventromedial descending system innervate?

A

Postural and griddle muscles (proximal limb – arm, thigh, trunk)

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248
Q

What does the dorsolateral descending system innervate?

A

Distal muscles fine movements (forearm/leg and extremities – hands and feet)

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249
Q

Is the pontine, tectal, vesicular tracts part of the dorsolateral or ventromedial system?

A

Ventromedial

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250
Q

What would be observed from a ventromedial tract injury?

A

Collides with objects,

Axial immobility and forward slump,

Cannot reach out due to lack of ballistic racing,

Can flex elbow and individual digits.

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251
Q

Where is the tectum?

A

Near part of the midbrain

252
Q

Which descending tract is predominantly ipsilateral?

A

Ventromedial

253
Q

Which descending tract is predominantly contralateral?

A

Dorsolateral

254
Q

Where does the dorsolateral tracts originate from?

A

Cerebral cortex, red nucleus

255
Q

Which ventromedial tracts run contralaterally?

A

Tectospinal tracts

256
Q

Which tracts play a role in antigravity activity in stance (keeps us upright by extending hip, etc.)?

A

The vestibulospinal tracts

257
Q

What would be observed from a dorsolateral tract injury?

A

Arms hang limply, elbow inactive, fingers flex together, normal: axial posture, walking, navigating

258
Q

Which system does corticospinal tracts belong to?

A

Dorsolateral.

259
Q

What is pyramidal tracts also known as?

A

Cortical / corticospinal

260
Q

What is anchored at the Z disc?

A

Actin

261
Q

Which tracts does the ventromedial tract contain?

A

Pontine, tectal, vestibular

262
Q

Which system does the pontine reticulospinal tracts belong to?

A

Ventromedial

263
Q

Where do corticospinal tracts decussate?

A

Medullary pyramids

264
Q

What are the main differences between the dorsolateral and ventromedial tracts?

A

Dorsolateral – voluntary, distal, flexors

Ventromedial – postural, proximal, extensors, non-voluntary

265
Q

What is the ventromedial tracts also known as?

A

Extra-pyramidal

266
Q

Are dorsolateral tracts voluntary or non-voluntary?

A

Voluntary

267
Q

Where is the primary motor cortex?

A

Pre-central gyrus (part of frontal lobe)

268
Q

What does the primary motor cortex control?

A

Force and direction of movement

269
Q

Where are pre-motor and supplementary motor areas found?

A

Frontal lobe

270
Q

What are the 2 main motor tracts and where to they run from?

A

Corticospinal – premotor, primary motor and primary sensory cortex –> anterior horn neurons

Rubrospinal – red nucleus –> cervical segments

271
Q

What percentage of the corticospinal tracts decussate at the medullary pyramids?

A

85-90%; the rest run ipsilaterally until the level of supply to muscles where they decussate and synapse

272
Q

When is Babinski’s sign positive?

A

When the corticospinal tracts are unmyelinated.

Newborns and people with disease.

273
Q

What are the corticospinal tracts involved in?

A

Voluntary skilled motor activity, independent flexion of single distal joints

274
Q

What does Babinski’s test for?

A

When the corticospinal tracts are unmyelinated.

Newborns and people with disease.

275
Q

What is the nucleus pulposus?

A

Inner, soft, pulpy, highly elastic substance in intervertebral disc.

276
Q

What is a positive Babinski result?

A

Upgoing toe

277
Q

What does the Rubrospinal tracts coordinate?

A

Movements

278
Q

What does an isolated rubrospinal tract lesion lead to?

A

Impaired distal arm and hand movement.

Intention tremors.

279
Q

What does the hypothalmospinal tract control?

A

Sympathetic nervous that control sweat glands of face (secrete) and vessels of face (dilate).

Also dilator muscle of eye and elevation of eyelid.

280
Q

Where do outputs from the cerebellar nuclei go to?

A

Thalamus –> premotor/primary motor cortex

281
Q

Which tract does Horner’s syndrome affect?

A

Hypothalamospinal tract (part of dorsolateral tract)

282
Q

What is Horner’s syndrome?

A

Lazy eyelid, pinpoint pupil, anhydrases

283
Q

How is brainstem death determined?

A

Criteria: unconscious and unresponsive, heartbeat and ventilation maintained using ventilator, evidence of incurable, serious brain damage, tests carried out by 2 doctors.

284
Q

Which system controls cortical arousal and conscious awareness?

A

Pontine reticular activating system

285
Q

Where does the spinal cord begin?

A

Where the medulla ends.

286
Q

Approx. how long the is spinal cord?

A

42-45cm

287
Q

Where does the spinal cord end?

A

L1-2

288
Q

Where does a subarachnoid haemorrhage occur?

A

Between the arachnoid mater and pia mater

289
Q

Which vessels a generally damaged in an subarachnoid haemorrhage?

A

Arterial bleeding

290
Q

Where does a subdural haemorrhage occur?

A

Between the dura mater and arachnoid mater

291
Q

Which vessels a generally damaged in an subdural haemorrhage?

A

Bridge vein tearing – low pressure venous bleed

292
Q

What does a subdural haemorrhage look like on a CT?

A

Crescent shaped / concave image on CT

293
Q

Where does an extradural haemorrhage occur?

A

Between the skull and dura mater

294
Q

Which vessels are damaged in an extradural haemorrhage?

A

Meningeal vessels

295
Q

What does an extradural haemorrage look like on CT?

A

Egg shaped / convex on CT

296
Q

Where does an intracerebral haemorrhage occur?

A

Within the brain tissue

297
Q

What does the subarachnoid space contain?

A

CSF and cerebral arteries

298
Q

Where is the epidural space?

A

Outside the dura but in the vertebral column.

299
Q

What is the inner (meningeal) dura mater continuous with?

A

Spinal cord dura

300
Q

What does pia mean?

A

Delicate

301
Q

What does the spinal nerve become as it leaves the vertebra?

A

The anterior and posterior ramus of the spinal nerve

302
Q

What does the cruciform ligament hold?

A

The odontoid process into the atlas

303
Q

What does compression of the cerebral aqueduct cause?

A

CSF pressure in ventricles leads to hydrocephalus.

Treatment = shunt

304
Q

Which arteries supply the anterior brain circulation?

A

Internal carotid – anterior and middle CA

305
Q

Which arteries supply the posterior brain circulation?

A

Vertebral arteries – posterior CA, basilar and branches

306
Q

How does the white matter change as you go down the spinal cord?

A

At superior end, there are a lot of axons = lots of white matter.

Inferior end there is less white matter.

307
Q

Where does the central canal go through?

A

The centre of the grey a matter.

308
Q

How many orders of neurons do ascending tracts have?

A

3

309
Q

Where are 2nd order neurons found?

A

In the CNS; spinal cord and brainstem –> thalamus

310
Q

Where do 3rd order neurons travel to?

A

From the thalamus to primary sensory cortex (somatosensory cortex) via internal capsule.

311
Q

Where do 1st order neurons travel to?

A

Peripheral receptorsto dorsal roots

312
Q

Where do 2nd order neurons travel to?

A

Thalamus

313
Q

What sensation does the spinothalamic pathway carry?

A

Pain, temperature, touch and pressure

314
Q

What sensation does the dorsal column carry?

A

Proprioception, vibration, 2-point discrimination

315
Q

In the dorsal column pathway, do 1st order neurons ascend ipsilaterally or contralaterally?

A

Ipsilaterally

316
Q

Where do 1st order dorsal column neurons synapse?

A

Medulla (ipsilaterally)

317
Q

What sensations foes the spinocerebellar pathway carry?

A

Proprioception and balance for control of axial muscles.

318
Q

How many neurons are there in the spinocerebellar pathway?

A

2

319
Q

Which ascending pathway does not decussate at all?

A

Spinocerebellar

320
Q

Which ascending pathway decussates in the medulla?

A

Dorsal column

321
Q

Which ascending pathway decussates via white commissure in the spinal cord?

A

Spinothalamic

322
Q

Which ascending pathway rise ipsilaterally 1-2 spinal segments and decussate at the medial lemniscus and ascended contralaterally?

A

Spinothalamic

323
Q

Which ascending pathway rise ipsilaterally until it decussates in the nuclei fasciculus and cuneatus?

A

Dorsal column

324
Q

Where do spinocerebellar pathways eventually synapse on?

A

Cerebellar hemisphere

325
Q

Where do spinothalamic and dorsal column impulses terminally reach?

A

Post-central gyrus after getting to the thalamus

326
Q

What does dorsal columns carry?

A

Proprioception and vibration, fine touch

327
Q

What does spinothalamic tracts carry?

A

Pain and temperature, crude touch

328
Q

Where do spinothalamic tracts synapse?

A

In spinal cord

329
Q

Where do ventral corticospinal tracts decussate?

A

At the level of ventral horn synapse.

330
Q

Where so lateral corticospinal tracts decussate?

A

In the medullary pyramids.

331
Q

What do brainstem lesions affect?

A

Pain, temp, touch, position, vibration – contralaterally

332
Q

What do spinal cord lesions affect?

A

Pain, temp, touch, position, vibration – ipsilaterally

333
Q

What are T-tubules filled with?

A

Interstitial fluids

334
Q

What is the function of T-tubules?

A

To ensure APs excite all parts of the muscle fibre at the same instant.

335
Q

What is sarcolemma?

A

Fine transparent tubular sheath that envelops the fibres of skeletal muscle

336
Q

What does the sarcoplasm contain?

A

Glycogen which can be turned to glucose for energy

337
Q

What gives skeletal muscle fibre a striated appearance?

A

The myofibrils which are composed of filaments.

338
Q

What does sarcoplasmic reticulum contain?

A

Fluid and calcium ions

339
Q

What is the function of the SR?

A

Release Ca2+ from the terminal cisterns –> triggers muscle contraction.

340
Q

What are sarcomeres?

A

Functional units of myofibrils

341
Q

What does the H-band contain?

A

Myosin

342
Q

What does the I-band contain

A

Actin

343
Q

What does the A-band contain?

A

Both actin and myosin

344
Q

Which neurotransmitter is found in neuromuscular junctions?

A

ACh

345
Q

What does calcium bind to and what does this lead to?

A

TnC –> TnI shifts to free myosin binding sites for myosin heads to bind

346
Q

What happens to overlap when the muscle fibre is stretched to 170% of its optimal length?

A

There is no overlap between thin and thick filaments.

347
Q

What is isometric contraction?

A

Same length, isolated muscle, muscle can develop tension but doesn’t shorten.

348
Q

How does atropine (belladonna) cause dilation of the pupil?

A

By blocking the parasympathetic outflow to the eye which acts as the constrictor

349
Q

What NT and receptors are found in the sympathetic preganglionic and postganglionic synapses?

A

PreG – ACh and nicotinic

PostG – NA and adrenergic

350
Q

Which NT and receptors are found in the sympathetic preG and postG synapses?

A

PreG – ACh and nicotinic

PostG – ACh and muscarinic

351
Q

Which receptor is found in all preG synapse in the ANS?

A

Nicotinic and ACh

352
Q

Where are alpha adrenergic receptors found?

A

Blood vessels

353
Q

What is the structure of muscarinic and nicotinic receptors?

A

Muscarinic – GPCRs (7 transmembrane spanning domains)

Nicotinic – ligand-gated ion channels?

354
Q

What is the annulus fibrosus?

A

Outer fibrous ring of intervertebral disc, made of fibrocartilage

355
Q

Why is suxamethonium used in tracheal intubation?

A

Because it’s broken down rapidly and is a nicotinic antagonist therefore relaxes the trachea.

356
Q

What causes the myosin head to attach?

A

Tropomyosin moving aside and exposing myosin binding sites on the actin molecule.

357
Q

What causes the myosin head to detach?

A

ATP binding to myosin

358
Q

What is isotonic (dynaptic) muscle contraction?

A

Contraction against natural resistance (no increase in muscle tone – no tension)

359
Q

What is the epimysium?

A

Sheath of fibrous elastic tissue surrounding a muscle.

360
Q

What is the perimysium?

A

Sheath of connective tissue surrounding a bundle of muscle fibres.

361
Q

What is the connective tissue surrounding the muscle fibres called?

A

Perimysium

362
Q

What is dissociated sensory loss?

A

Neurological damage caused by a lesion to a single tract in the spinal cord which involves selective loss of fine touch and proprioception wo/ loss of pain and temperature, or vice versa

363
Q

Where does the fibres of the spinothalamic pathway cross the midline?

A

1-2 spinal levels above or below the level they enter

364
Q

Where does the fibres of the dorsal column cross the midline?

A

Medulla

365
Q

Where is bladder pain referred to?

A

Lower back, abdomen, groin

366
Q

Where is ureter pain referred to?

A

Below the ribcage, lower abdo, groin, genital area

367
Q

What is the pterion?

A

Intersection of frontal, temporal, parietal and sphenoid bones.

368
Q

Where is the primary motor cortex?

A

Pre-central gyrus

369
Q

Where is the primary sensory area located?

A

Post-central gyrus

370
Q

Where is the motor speech area?

A

Broca’s area

371
Q

Where is the primary visual area located?

A

Occipital lobe

372
Q

Name alpha and beta 1 and 2 adrenergic receptor agonist and say what this leads to.

A

Alpha – NA –> vasoconstriction
Beta 1 – A –> increased HR
Beta 2 – salbutamol, terbutaline –> bronchodilation

373
Q

Where does the postcentral gyrus lie relative to the central sulcus?

A

POsterior

374
Q

Where is the calcarine fissure/sulcus and what is its function?

A

Divides the visual (calcarine) cortex into 2.
 Central visual field is in posterior portion of calcarine sulcus
 Peripheral visual field in the anterior portion.

375
Q

A unilateral spinal cord injury will produce a sensory loss of what on the same side and what on the opposite side?

A

Ipsilateral – fine touch, vibration, proprioception

Contralateral – pain and temperature, crude touch

376
Q

Which division of the ANS is a.k.a. thoracolumbar?

A

Sympathetic

377
Q

Which divisions of the ANS controls the rest-and-digest vs fight-or-flight responses?

A

Rest and digest = parasympathetic NS

Fight or flight = sympathetic NS

378
Q

Why is the parasympathetic nervous system a.k.a. craniosacral outflow?

A

Preganglionic neurons emerge from the brainstem (CN III, VII, IX, X) and sacral cord (S2, S3, S4)

379
Q

How does the size of the preG and postG neurons compare in the parasympathetic and sympathetic nervous systems?

A

Parasympathetic: preG – long, post G – short

Sympathetic: preG – short, post G – long

380
Q

Which division of the ANS has preG neurons from lateral horn that come off at T1-L2?

A

Sympathetic

381
Q

Where do basal ganglia/nuclei inputs come from?

A

Cortex and substantia nigra pars compacta –> striatum

382
Q

What is special about the spinous process of the cervical vertebrae C3-6?

A

It bifurcates into 2 parts so is known as a bifid spinous process

383
Q

What do the transverse foramina conduct?

A

Vertebral arteries, veins and sympathetic nerves.

384
Q

What shape is the vertebral foramen of the cervical vertebrae?

A

Triangular

385
Q

What does the occiput articulate with?

A

C1 atlas

386
Q

What movement does the atlanto-occipital joint allow?

A

Flexion/extension

387
Q

What movement does the atlantoaxial joint allow?

A

Rotation

388
Q

What is the axis?

A

C2

389
Q

What is the odontoid process?

A

On the axis (2nd vertebral vertebra)

390
Q

How does odontoid process fractures occur?

A

From hyperextension/hyperflexion of neck.

391
Q

How many cervical vertebrae are there?

A

7

392
Q

How many thoracic vertebrae are there?

A

12

393
Q

How does the size of the thoracic vertebrae changes as you do inferiorly?

A

Increases

394
Q

How does the thoracic vertebrae articulate with the ribs?

A

They have ‘demifacets’ on each side of its vertebral body.

These are known as costa facets.

395
Q

How is the spinous processes of the thoracic vertebrae slanted and why?

A

Inferiorly and anteriorly

Offers increased protection to the spinal cord; preventing sharp objects entering the spinal canal through the intervertebral disks.

396
Q

How does the vertebral foramen of the thoracic vertebrae differ from that of the cervical vertebrae?

A

Thoracic – circular

Cervical – triangular

397
Q

How are lumbar vertebrae specialised to support the weight of the upper body?

A

Very large vertebral bodies

398
Q

What size are the vertebral foramen of lumbar vertebrae?

A

Kidney shaped

399
Q

What is the sacrum made up of?

A

What is the sacrum made up of? 5 fused vertebrae

400
Q

What are the facets on the lateral walls of the sacrum for?

A

Articulation w /the pelvis at sacro-iliac joints

401
Q

What is the coccyx?

A

Small bone; articulates with the apex of the sacrum

402
Q

Which vertebra hasn’t got a body?

A

C1, Atlas

403
Q

How do you perform a sciatic nerve stretch?

A

Patient lies on their back; Straight leg raise, dorsiflex foot, knee flexion, knee extension

404
Q

How do you perform a femoral nerve stretch?

A

Patient lies on their front; Knee flexion (check for back pain), hip extension (pain worse)

405
Q

Name the upper and lower limb dermatomes to test for in a sensory examination.

A

UL: C4, C5, C6, C7, C8, T1
LL: L1, L2, L3, L4, L5, S1, S2

406
Q

What are somatic and autonomic efferents?

A

Somatic – skeletal muscles

Autonomic – smooth and cardiac muscle, glands

407
Q

What does the somatic nervous system include?

A

Both sensory and motor neurons

408
Q

What do somatic sensory neuron convey input from?

A

 Receptors for somatic senses (tactile, thermal, pain, proprioceptive)
 Receptors for special senses (sight, hearing, taste, smell and equilibrium)

409
Q

Which NTs does the somatic motor neurones release?

A

ACh only

410
Q

Which NTs does the autonomic neurons release?

A

Sympathetic – NA, ACh (glands)

Parasympathetic – ACh

411
Q

Where are cell bodies of preganglionic neurons?

A

In CNS

412
Q

What is the ENS?

A

Separate from the ANS specialised collection of nerves and ganglia forming a neuronal network within the walls of the GIT, heart, pancreas and gallbladder.

413
Q

What type of motor output does the ANS control?

A

Involuntary control from hypothalamus, brainstem, limbic system and spinal cord. Limited control from cerebral cortex

414
Q

What do nitroxidergic postG release?

A

NO (causes vasodilation)

415
Q

What are the 3 types of movement?

Give examples of each

A

Reflex – limb withdrawal in response to painful stimulus
Rhythmic – walking, chewing
Voluntary – playing golf

416
Q

What are type Ia sensory fibres?

A

Primary afferent fibres. It’s the stretch receptor found in the muscle spindle. It monitors the velocity of the stretch.

417
Q

What role does the cerebral hemisphere have in movement?

A

Executive function; involved in voluntary control; can modify auto movements

418
Q

What role does cerebellum have in movement?

A

Involved in coordinating movements and earning some fine motor skills

419
Q

What role does the brainstem have in movement?

A

Involved in automated movements

420
Q

What role does the spinal cord have in movement?

A

Contains circuitry (motor programs) for coordinating and executing automatic or repetitive movements; gets input from sensory systems and main output (muscles)

421
Q

Do sensory neurons enter or exit the spinal cord and where do they do this?

A

Enter at the dorsal horn

motor neurons exit at ventral horn

422
Q

Where are sensory and motor cell bodies found?

A

Sensory – dorsal root ganglion

Motor – ventral horn

423
Q

Why is there no ventral root ganglion?

A

Because a ganglion is a bundle of nerve fibre cell bodies outside the spinal cord/CNS.

Motor neurons originate in the ventral horn of the spinal cord.

424
Q

Describe the diameter of the spinal cord.

A

Not uniform; has enlargements which have large ventral horns thus large no. of motor neurons.

425
Q

Where are spinal enlargements found?

A

Cervical enlargement: C3-T1 (arms)

Lumbar enlargements: L1-S3 (legs)

426
Q

How are motor neurons arranged in the spinal cord?

A

Topographically

Motor neurons controlling axial body parts (trunk) and proximal limbs are in the medial part of the spinal cord. Those controlling the distal parts (hands/feet) are in the lateral parts.

427
Q

What do the axial muscles control?

A

Trunk – posture

428
Q

What do the proximal muscles control?

A

Upper limbs – locomotion

429
Q

What do the distal muscles control?

A

Hands/feet – object manipulation

430
Q

After a command has been sent from the brain/brainstem which neurons do they travel down in the spinal cord?

A

Alpha motor neuron; myelinated; large axons

431
Q

What are the differences between UMNs and LMNs?

A

UMNs – axons remain in CNS and synapse on LMNs directly/indirectly
LMNs – axons leave CNS and synapse on muscle fibres

432
Q

What are muscle fibres a type of?

A

Proprioceptor

433
Q

From what 5 places does alpha motor neurons receive and integrate inputs from?

A 
Muscle spindles (Ia afferents)
Golgi tendon organs (Ib afferents)
Cutaneous receptors
Spinal interneurons
UMNs
434
Q

What are Golgi tendon organs?

A

A proprioceptive sensory receptor organ that senses changes in muscle tension.

435
Q

What does ALS do?

A

Progressive degeneration of alpha motor neurons (upper – from brain and lower – from spinal cord)

436
Q

What are symptoms of ALS?

A

Muscle weakness, atrophy, twitching, abnormal reflexes, difficulty breathing and swallowing

437
Q

What is the aetiology (cause) of ALS?

A

Unknown; theory: too much glutamate

438
Q

Describe the Ia fibres.

A

Largest and fastest fibres; the fire when the muscle is stretching.

Characterised by their rapid adaptation.

439
Q

What is a reflex?

A

Involuntary movements that occurs because of sensory stimulation and involves impulses travelling through a reflex arc.

440
Q

What is a reflex arc?

A

Composed of: a sensory neuron, interneurons (0 to many) and a motor neuron

441
Q

How does no. of synapses and speed of conduction of APs correlate?

A

More synapses = slow conduction

442
Q

What are extrafusal muscles?

A

Muscles that moves the bone (motor) – controlled by alpha motor neurons

443
Q

What are intrafusal muscles?

A

In the muscle spindle; part of the proprioception system (sensory); detect amount and rate of change of muscle length – controlled by gamma motor neurons

444
Q

Where are intrafusal muscles imbedded?

A

Imbedded in the muscle spindle (parallel to extrafusal fibres)

445
Q

Why do gamma motor neurons adjust the intrafusal muscle length?

A

To allow the muscle spindle to be maximally sensitive at any given limb position

446
Q

When the extrafusal muscle is short (flexed) what is the length of the intrafusal muscle fibres?

A

Shorter

447
Q

When the extrafusal muscle is extended, what is the length of the intrafusal muscle fibres?

A

Longer

448
Q

What does stretching the muscle spindle increase?

A

Ia afferent activity

449
Q

What happens when the load on a limb increases?

A

It’s detected and arm automatically contracts to keep the arm upright.

450
Q

There is a single synapse between muscle sensory fibre and alpha motor neuron. What is the purpose of this?

A

Monosynaptic – makes it fast

451
Q

What is reciprocal inhibition?

A

When the antagonist muscle relaxes for the agonist muscle to contract.

452
Q

What is the inverse stretch reflex a.k.a and what does this do?

A

Golgi tendon; prevents muscle overloading by forcing it to relax and drop load when lifting/carrying heavy loads.

453
Q

Activation of the Ib afferents do what to the activity of the alpha motor neurons?

A

Decreases alpha motor neuron activity.

454
Q

What do the Ib afferents from the Golgi tendon organs synapse with?

A

Inhibitory interneurons in spinal cord

455
Q

What is the function of the inverse stretch reflex?

A

Prevent muscle and tendon damage from very high muscle tension.

456
Q

What is the flexor withdrawal reflex?

A

Polysynaptic flexion of one limb and extension of the other (opposite of the other limb). This is so that the affected limb is flexed (withdrawal) whilst the other is extended to provide compensatory postural support.

457
Q

What does the spinal cord circuitry use to produce complex rhythmic movements such as running?

A

Spinal central pattern generators (CPGs)

458
Q

What does CPGs do?

A

Produce rhythmic outputs wo/ sensory feedback.

459
Q

Give examples of rhythmic movements.

A

Locomotion, chewing, sucking, swallowing, respiration, swimming in animals

460
Q

What is the area directly adjacent to the neural tube called?

A

The paraxial mesoderm

461
Q

What does the paraxial mesoderm differentiate into?

A

Segments (somites)

462
Q

How many pairs of somites are formed?

A

44 but they regress until 31 pairs remain

463
Q

What do the somites correspond to in the adult?

A

31 pairs of spinal nerves

464
Q

What are somites composed of?

A

Dorsal and ventral portion

465
Q

What does the ventral portion of somites form?

A

Sclerotome (precursor of ribs and vertebral column)

466
Q

What does the dorsal portion of somites consist of?

A

Dermomyotomes –> myotome proliferates –> muscle

467
Q

What is the C7 myotome associated with?

A

Elbow extension

468
Q

What is the C5 myotome associated with?

A

Elbow flexion

469
Q

What is the L5 myotome associated with?

A

Great toe extension

470
Q

What is the L3 myotome associated with?

A

Knee extension

471
Q

What is the S1 myotome associated with?

A

Ankle plantar flexion

472
Q

What is the C6 myotome associated with?

A

Wrist extension

473
Q

What is the T1 myotome associated with?

A

Finger abduction

474
Q

What is contained in the dorsal root ganglion?

A

Cell bodies of 1st order afferents

475
Q

Where do basal ganglia/nuclei outcomes go to?

A

Globus pallidus and substantia nigra pars reticulata

476
Q

In which sensory pathway is the 1st synapse at the level of the medulla?

A

Dorsal column

477
Q

In the dorsal column pathway where is the tertiary neuron located?

A

Thalamus

478
Q

Is the tectospinal tract sensory or motor?

A

Motor

479
Q

Where does the spinothalamic and spinocerebellar synapse?

A

Spinal cord

480
Q

Which fibres convey proprioceptive info?

A

A-beta

481
Q

How does a receptor potential differ from an AP?

A

It is gated to stimulus intensity by frequency.

482
Q

What is the structure of neurons that convey only somatic pain?

A

Small diameter, unmyelinated; C-fibres

483
Q

What can A-delta fibres be activated by?

A

Innocuous, non-painful pressure and pain

484
Q

What can A-delta fibres be activated by?

A

Innocuous, non-painful pressure and pain

485
Q

Which ascending pathway carries vibration sense?

A

Dorsal columns

486
Q

Which ascending pathway carries proprioception sense?

A

Dorsal columns

487
Q

Which ascending pathway carries temperature sense?

A

Spinothalamic

488
Q

Which ascending pathway carries 2-point discrimination?

A

Dorsal columns

489
Q

In a right-sided, thoracic hemisection of the cord, which sensory modality will be lost from the left leg but not the right?

A

Pain; cord hemisection causes a Brown-Sequard syndrome where below the level of the lesion there is; ipsilateral loss of dorsal column function and UMN innervation + contralateral loss of spinothalamic function.

Due to position of the pathway decussation.

490
Q

What are muscle spindles comprised of?

A

What is the role of the substantia gelatinosa? Location of synapse for spinothalamic primary neurons (pain and temp)

491
Q

High threshold, mechanical nociceptors signal through which afferent fibre type?

A

A-delta fibres

492
Q

What is the role of the substantia gelatinosa?

A

Location of synapse for spinothalamic primary neurons (pain and temp)

493
Q

What is the substantia gelatinosa?

A

A collection of cells in the dorsal horns of the spinal cord found at every level. It’s the location of the cell bodies of second order spinothalamic neurons

494
Q

What does the following describe: pain is influenced by ascending and descending influences, controlled at the spinal cord?

A

Gate control theory of pain.

Pain is a multifaceted experience that is controlled at the spinal cord level. A-beta fibres inhibit pain sensation. A-delta and C fibres carry perception of pain.

495
Q

What effects do opioid have outside the CNS?

A

Reduced GI motility, pupil constriction, analgesia, sedation, reduced CO2 sensitivity, euphoria.

496
Q

How do opioids cause euphoria?

A

Disinhibition of nucleus accumbens.

By reducing GABAergic transmission from interneurons from the ventral tegmental area to the nucleus accumbens –> increasing dopaminergic neuron activation in the limbic system –> euphoria

497
Q

Where are gustatory sensory cells located?

A

Lateral walls of tongue papillae.

498
Q

What is a central pattern generator?

A

Spinal cord circuits for repetitive movements

499
Q

Which motor pathways is most important in supply of distal limb flexors?

A

Corticospinal

500
Q

What pathways are needed for postural control and head/eye movements?

A

Ventromedial pathways

501
Q

Where does the tectospinal tract originate?

A

Superior colliculus in the midbrain

502
Q

What collection of clinical features are found in an upper motor neuron lesions?

A

Hypertonia, hyperreflexia, muscle weakness, up-going plantars (extensor plantar response – +ve Babinski sign)

503
Q

What causes UMN lesions?

A

Stroke, MS, cerebral palsy, trauma

504
Q

What causes LMN lesions?

A

Bell’s Palsy, Guillen-barre syndrome

505
Q

What collection of clinical features are found in a LMN lesion?

A

Hypotonia, hyperreflexia, muscle atrophy, muscle weakness, down-going plantars, muscle fasciculation

506
Q

Which part of the brain is most important for sequencing of movements?

A

2 hemispheres, vermis + deep nuclei

507
Q

What is the main role of the cerebellar vermis?

A

Maintain posture and head position

508
Q

What can the cerebellum be divided into anatomically?

A

2 hemispheres, vermis + deep nuclei

509
Q

What can the cerebellum be divided into functionally?

A

Spinocerebellum, vestibulo-cerebellum and cerebro-ponto-cerebellum.

510
Q

What does the cerebellar hemispheres control?

A

Force and timing of movement

511
Q

What does the basal ganglia influence?

A

Speed and movement initiation.

512
Q

What controls fine flexor movements?

A

The cortex

513
Q

What is the collective term given to the caudate nucleus and putamen?

A

Striatum

514
Q

What is the globus pallidus anatomically and functionally divided into?

A

The globus pallidus interna and externa.

515
Q

What is the limbic system comprised of?

A

Amygdala, nucleus accumbens, hippocampus, mammillary bodies and parts of the hypothalamus

516
Q

What is the substantia nigra divided into?

A

Pars compacts and pars recularis.

517
Q

What is dysarthria?

A

Inability to form words properly.

518
Q

What is dysdiadochokinesis?

A

Reduction in ability to perform rapidly alternating movements

519
Q

How do you differentiate between a LMN or UMN lesion of CN VII?

A

UMN – facial dropping, eyes are NOT affected

LMN – (a.k.a Bell’s Palsy) facial dropping and eyes affected

520
Q

What is Brown-Sequard syndrome?

A

Damage to one half of the spinal cord. It’s rare.

521
Q

What does Brown-Sequard syndrome cause?

A

Ipsilateral loss of find-touch and proprioception

Contralateral loss of pain and temperature sense

522
Q

What is anterior cord syndrome?

A

Where the anterior spinal artery is interrupted causing ischaemia or infarction of the spinal cord.

523
Q

What is anterior cord syndrome characterised by?

A

Loss of pain/temp sensation below the level of injury and preservation of sensations carried by the posterior columns (fine touch, vibration and proprioception)

524
Q

What is central cord syndrome?

A

Cervical spinal cord injury. Variable sensory loss

525
Q

What is central cord syndrome characterised by?

A

Motor deficits greater in UL than LL. Loss of motion and sensation in arms and hands

526
Q

Where does pain and temp pathways decussate?

A

At the spinal level, itself unlike fine touch and proprioception.

527
Q

Wo/ ATP but in the presence of calcium ions what happens to myosin and actin?

A

Myosin heads remain bound to actin

528
Q

What does the precentral gyrus form?

A

Primary motor cortex

529
Q

Where is the primary somatosensory area?

A

Postcentral gyrus.

530
Q

What is the cerebral cortex?

A

A region of grey matter that forms the outer rim of the cerebrum.

531
Q

What are gyri, fissures and sulci?

A

Gyri – the folds

Fissures – deepest grooves between folds

Sulci – shallow grooves between folds

532
Q

What is the falx cerebri?

A

The longitudinal fissure that separates the cerebrum in L and R hemispheres.

533
Q

What is the corpus callosum?

A

Broad band of white matter that connects the L and R hemispheres together.

534
Q

What does the central sulcus separate?

A

Frontal lobe from parietal lobe

535
Q

Where is the primary visual area?

A

Posterior tip of occipital lobe.

536
Q

Where is the primary auditory area?

A

Superior part of the temporal lobe, near lateral cerebral sulcus

537
Q

Where is the primary gustatory area?

A

Base of postcentral gyrus.

538
Q

Where is the primary olfactory area?

A

Temporal lobe

539
Q

Where is Broca’s area?

A

L frontal lobe in 97% of population. R in 3%

540
Q

Where is Wernicke’s area?

A

Post section of the superior temporal gyrus in L hemisphere.

541
Q

In the somatotropic arrangement where are nerve endings for the LL and trunk relative to head and UL?

A

More medial

542
Q

Why isn’t the face usually paralysed when there is a UMN lesion of the facial nerve?

A

Because face is supplied by 2 UMN pathways so damage to 1 doesn’t affect other.

543
Q

A lesion that isn’t purely motor might me located there in the brain and why?

A

UMN

544
Q

How does dopamine influence the direct pathway of the basal ganglia?

A

Increase pathway activity to promote movement.

545
Q

What does lemniscus mean?

A

Greek for ribbon or band

546
Q

Where is the lemniscus found and what is it?

A

A bundle of secondary sensory fibres in the brainstem

547
Q

Which half of the body is the R hemisphere of the cerebellum concerned with?

A

The right side

548
Q

Where does the cerebellum receive input from?

A

The entire body

549
Q

Where does the cerebellum output info?

A

Up the cerebral cortex

550
Q

What do clinicians mean when they say pyramidal lesion?

A

Internal capsule lesion

551
Q

Which motor pathways are distal in the spinal cord?

A

Dorsolateral

552
Q

What are compensatory movements?

A

Anticipatory postural reflexes

553
Q

What is the role of the basal ganglia?

A

Selection/inhibition of voluntary movements.

554
Q

What info does the cerebellum need to coordinate muscle contraction?

A

How contracted the muscle is and where it is

555
Q

What percentage does the cerebellum constitute of the total volume of the brain?

A

10%

556
Q

Relative to the putamen where is the globus pallidus?

A

Medial

557
Q

How does movements like riding a bike become unconscious?

A

Once the cerebellum stores it.

558
Q

What does damage to the cerebellum cause?

A

Jerky, uncoordinated, inaccurate (ataxia) movements

559
Q

Where does the cerebrocerebellum receive input from?

A

From cerebral cortex

560
Q

Where do spinocerebellar outputs from the cerebellum enter?

A

Interposed + fastigial nucleus

561
Q

What is a core feature of idiopathic Parkinson’s?

A

Bradykinesia, postural instability, rigidity, tremor.

562
Q

What molecule is dopamine synthesised from?

A

Tyrosine –> DOPA –> DA

563
Q

What is the mechanism of action of naloxone?

A

Competitive antagonist at mu-receptors

564
Q

Which structure passes through the foramen ovale?

A

Mandibular division of trigeminal nerve

565
Q

What structures pass through the foramen magnum?

A

Accessory nerve, medulla oblongata, anterior spinal artery,

566
Q

Which ligament is most important in preventing posterior subluxation of the odontoid process?

A

Transverse ligament

567
Q

What is the falx cerebri composed of?

A

Double-layer meningeal dura mater

568
Q

What vessels are most commonly the origin of bleeding in atraumatic subdural haemorrhages?

A

Bridging veins

569
Q

Does the direct or indirect pathway suppress movement?

A

Indirect

570
Q

Which part of the ventricular system connects the 3rd and 4th ventricles, passing through the midbrain?

A

Cerebral aqueduct

571
Q

Where is most CSF re-absorbed into the vascular system?

A

Sagittal sinus arachnoid granulations

572
Q

Which structure lies immediately to the 3rd ventricle?

A

Thalamus and hypothalamus

573
Q

At what level does the common carotid artery bifurcate?

A

C3/4

574
Q

Which arteries are formed from the bifurcation of the internal carotid artery?

A

Anterior and middle cerebral

575
Q

Where is Wernicke’s area located?

A

Supero-posterior temporal lobe

576
Q

What is contained within the epidural space of the spinal canal?

A

Fat

577
Q

What is contained within the subarachnoid space?

A

CSF

578
Q

What is the role of the filum terminale?

A

Attachment of the conus medullaris

579
Q

What is the filum terminale?

A

Thickened extension of the pia mater that attaches the conus medullaris to posterior wall of the sacrum.

580
Q

What is the main consequence of interruption to the anterior spinal artery?

A

Loss of motor function

581
Q

What is the output zone of the basal ganglia?

A

Globus pallidus and substantia nigra (par reticulate)

582
Q

What is the basal ganglia made up of?

A

Collection of functionally distinct nuclei.

583
Q

How can chronic alcohol misuse affect the gait?

A

Degeneration of the anterior cerebellum –> wide and staggering gait but little impairment of arm/hand movements.

584
Q

What fibres are the main cell types that input into to cerebellar cortex?

A 
Climbing fibres (originate from inferior olive)
Mossy fibres (all other inputs
585
Q

What do climbing fibres twist around?

A

Densrites of Purkinje cells

586
Q

Which fibres carry the output from the cerebellum?

A

Purkinje cell

587
Q

How are sensory and motor info represented on the cerebellum?

A

Ipsilaterally

588
Q

What does damage of the cerebrocerebellum cause?

A

Highly skilled sequences of learned movements disturbances

589
Q

What does damage of the vestibulocerebellum impair?

A

Balance and eye movement disturbances.

590
Q

What does damage to the spinocerebellum impair?

A

Gait

591
Q

Name 3 inpus to the basal ganglia

A

Corticostriatal pathway
Nigrostriatal pathway
Medium spiny neurons

592
Q

Where do most inputs to. the basal ganglia come to?

A

Stratum

593
Q

Which 2 pathways does the stratum send most of its info out through?

A

Substantia nigra par reticulata

Globus pallidus internus

594
Q

What is the direct and indirect corticostratial loops?

A

Info in the corticostraiatal sstem is transmitted to basal ganglia via the direct and indirect pathways

595
Q

What is Parkinson’s caused by?

A

Death of cells in substantia nigra reduces dopaminergic effects of both D1 and D2 receptors –>

Reduced excitation of the direct pathway (D1) and reduced inhibition of the indirect pathway (D2) –>

Increased inhibition of thalamus and decreased excitation of motor cortex –>

Reduction of movement

596
Q

How is the indirect pathway affected in Parkinson’s?

A

Increased stimulation leads to reduction of movement

597
Q

Does Huntington’s cause increased or decreased movement and how?

A

Increased movement by death of. stratal inputs to globus pallidus externa which reduces inhibition of subthalamic nucleus which reduces excitation of globus pallidus interna meaning less tonic inhibition of thalamus occurs

598
Q

What is the inferior olivary nucleus?

A

Provides instructions for the cerebellum to adjust muscle activity as you learn new motor skills

599
Q

What is the pineal gland?

A

Endorine gland behind 3rd ventricle

Secretes melatonin

600
Q

What is the tectum made up of?

A

The inferior and superior colliculi (2 of both).

It’s responsible for auditory (inferior) and visual (superior) reflexes.

601
Q

What is the choroid plexus?

A

Ependymal cells of the choroid plexus = where CSF is produced.

602
Q

What is raloxifene?

A

Selective oestrogen receptor modulator; prevents osteoclast activation

603
Q

Calciferol

A

Vitamin D; essential of calcium and phosphorus absorption.

604
Q

Alendronic acid

A

Inhibits osteoclast bone resorption; can be used with vitamin D.

605
Q

HRT

A

HRT replaces lowered oestrogen and progesterone post-menopause; oestrogen prevents osteoclast activity.

606
Q

What is osteomalacia and rickets?

A

Softening of bones; can be caused by vitamin D deficiency.

607
Q

What are the 2 types of alpha receptors?

A

α1 - Vasoconstriction

α2 - Glucose metabolism

608
Q

What are the risk factors for osteoporosis?

A

Age – low oestrogen levels; vitamin D or calcium deficiency; inactive lifestyle; tobacco smoking; drinking excessively

609
Q

What are the 3 types of beta receptors?

A

β1 – Targets heart (increases HR, conduction, contraction), vasoconstrictor

β2 – Bronchodilator

β3 – Thermogenesis (heat production) in brown adipose tissue

610
Q

Give examples of beta agonists.

A

Dobutamine (β1) - Increase CO, treatment for HF

Isoprenaline (non-selective) - Bradycardia treatment

Salbutamol (β2) - Bronchodilation, treatment for asthma

Malmeterol (β2) - Long acting, maintenance/prevention of
asthma and COPD

611
Q

Give examples of alpha agonists.

A

NA (non-selective) - Causes vasoconstriction, treats hypotension

612
Q

What do NSAIDs inhibit synthesis of?

A

Prostaglandins and thromboxanes

by binding to COX enzyme

613
Q

What is Huntington’s diseas

A

Loss of output neurons of striatum that provide input to indirect pathway.

Causes greater excitation of motor cortex, increase of movement due to less inhibition of thalamus.

614
Q

What is Hemiballismus?

A

Damage to the subthalamic nucleus.

Causes rapid, flinging, and violent movements of limbs on 1 side of the body (contralateral)

615
Q

What is Parkinson’s disease?

A

Lesion to substantia nigra pars compacta.

Decrease in dopaminergic neurons.

Excited indirect pathway, inhibited direct pathway (less motor function).

Result = tremor, muscular rigidity, slow imprecise movements.

616
Q

What are the 2 types of peripheral fibres of the ANS?

A

PreG – Myelinated B fibres (small diameter)

PostG – Unmyelinated C fibres (smaller diameter)

617
Q

In what structure in brain do pain fibres synapse?

A

Thalamus

618
Q

Which 3 nuclei does the basal ganglia consist of?

A

Caudate nucleus,
Putamen,
Globus pallidus

619
Q

Where is the primary visual area?

A

Calcarine fissure.

620
Q

What are gyri?

A

Folds

621
Q

What are sulci?

A

Grooves

622
Q

Describe the corticospinal pathway.

A
  • Voluntary skilled motor activity (pyramidal)
  • Contralateral - 90% decussate in medulla (lateral), 10% decussate in spinal cord (anterior)
  • Dorsolateral
  • Lateral controls distal movement, anterior controls proximal movemen
623
Q

Describe the spinocerebellar pathway.

A
  • Proprioception to cerebellum
  • Ipsilateral – Posterior stay ipsilateral, anterior decussate x2
  • Synapse in Clarke’s nucleus (posterior grey horn)
  • Travel to cerebellum
624
Q

Describe the dorsal column-medial lemniscus pathway.

A
  • Fine touch, pressure, vibration, conscious proprioception
  • Contralateral – Decussate in medulla
  • Synapse in medulla and thalamus
  • Travel to primary sensory cortex
625
Q

Describe the spinothalamic pathway.

A
  • Pain, temperature, itch, tickle, crude touch
  • Contralateral – Decussate in spinal cord (2-3 levels above entry)
  • Synapse in posterior horn and thalamus
  • Travel to primary sensory cortex
626
Q

What is the functions of compact bone?

A

Protection, support, stress resistance, movement

A (22 decks)

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