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AGM Flashcards

1
Q

Where does the trigeminal system connect to the brainstem at?

A

Pons

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2
Q

Name the 4 components of the trigeminal sensory nuclear complex

A
  1. Trigeminal main sensory nucleus
  2. Nucleus oralis
  3. Nucleus caudalis
  4. Nucleus interpolaris
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3
Q

What makes up the trigeminal spinal nucleus?

A
  • Nucleus oralis
  • Nucleus interpolaris
  • Nucleus caudalis
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4
Q

Where is the trigeminal ganglion located?

A

In the trigeminal fossa of the temporal bone in the middle cranial fossa

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5
Q

What neurons does the trigeminal ganglion contain?

A

1st order neurons for the trigeminothalamic tracts (pseudounipolar)

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6
Q

Function of trigeminal main sensory nucleus

A

Site for synapse for touch

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7
Q

Function of nucleus oralis

A

Receives nociceptive inputs, esp. from teeth –> essential for oral and dental pain (reflexes > sensation)

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8
Q

Function of nucleus caudalis

A

Site for synapse for facial pain, hot & cold

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9
Q

What does tractotomy at the nucleus caudalis result in?

A

Loss of ipsilateral facial pain, hot/cold; but can still feel touch

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10
Q

Name structures which help in the identification of the nucleus caudalis

A

foramen magnum; end of IVth ventricle

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11
Q

What do efferents of the motor root of peripheral trigeminal nerve supply?

A

Muscles of mastication

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12
Q

Where are the primary afferent cell bodies of the peripheral trigeminal nerve found?

A

In the trigeminal mesencephalic nucleus

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13
Q

What is unique about the motor root of the peripheral trigeminal nerve?

A

Primary afferent cell bodies are within the CNS

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14
Q

Define ganglion

A

A collection of nerve cell bodies in the PNS

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15
Q

Where in the brainstem is the motor nucleus located?

A

Pons

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16
Q

Is the motor nucleus located medially or distally w.r.t the main sensory nucleus?

A

Medially

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17
Q

What do afferents from the motor root of CN Vc supply?

A

From all muscle spindles and some peridontal ligament mechanoreceptors (PDLM)

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18
Q

Role of the mesencephalic nucleus

A

Carries the primary afferent cell bodies of CN Vc

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19
Q

Role of the motor nucleus

A

Site of synapse of the primary afferents of CN Vc

NOT IN TRIGEMINAL MESENCEPHALIC NUCLEUS

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20
Q

Define pain

A

An unpleasant sensory and emotional experience that is associated with actual or potential tissue damage.

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21
Q

Define nociception

A

The activation of neural pathways by stimuli that damage or threaten to damage tissues

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22
Q

Describe the anatomy of a nociceptor

A

Free nerve ending at one terminal; with C-fibre or Ad-fibre

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23
Q

Name the 2 types of fibre that could be present in a nociceptor

A
  1. C fibre

2. Ad-fibre (A-delta)

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24
Q

Which nerve fibre gives slow, burning pain?

A

C fibre

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25
Q

Which nerve fibre gives fast, sharp pain?

A

Ad-fibre

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26
Q

Which nerve fibre has a faster conduction velocity?

A

Ad-fibre (5-30m/s)

[vs C fibre - 0.2-2m/s]

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27
Q

Which nerve fibre has the smallest diameter size?

A

C fibre (0.2 - 1.5um)

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28
Q

Name 2 effects of substance P

A
  1. Vasodilatation of arteries

2. Stimulates mast cells, which releases histamine and serotonin, which sensitizes nociceptors

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29
Q

Describe the axon reflex

A

When a noxious stimulus is applied to a cell, instead of travelling to the CNS, the action potential goes in the other way, up another branch, resulting in the release of Substance P.

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30
Q

Name some algogenic substances (7)

A
  • H+
  • Serotonin
  • ATP
  • K+
  • Prostaglandins
  • Histamine
  • Bradykinin
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31
Q

Define the term “allodynia”

A

Allodynia refers to pain produced by a stimulus that would not normally produce pain

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32
Q

What results in allodynia?

A

Sensitization of nociceptors by the effects of an axon reflex, which lowers the threshold potential

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33
Q

Site of 1st synapse of the trigeminal sensory pathway

A

Trigeminal sensory nucleus

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34
Q

Site of 1st synapse of pain pathways

A

Trigeminal nucleus caudalis (+ oralis?)

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35
Q

What type of drugs are simple analgesics?

A

COX inhibitors / Non-steroidal anti-inflammatory drugs

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36
Q

Describe hyperalgeria

A

When a noxious stimulus is applied on Area X, the primary afferent neurone diverges and synapses, sensitizing the 2nd order neurone of Y. Hence, it takes a less than normal noxious stimulus to reach threshold of Area Y, causing increased pain from a stimulus that normally provokes pain.

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37
Q

Describe discrete pain

A

When a noxious stimulus is applied on Area X, the primary afferent neurone diverges and synapses, but it is insufficient to reach the threshold potential to excite 2nd order neurone of Y. Hence, pain is felt only in Area X.

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38
Q

Describe radiating pain

A

When a noxious stimulus is applied on Area X, the primary afferent neurone diverges and synapses, resulting in pain felt in both Areas X and Y. (Pain appears to spread beyond the area affected)

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39
Q

Describe “referred” pain

A

Pain appears originate from an area that is different to the injured area.
(usually from a deep to superficial structure/tissue that produces sensory activity e.g. maxillary sinus to teeth / heart to left arm)

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40
Q

Where in the primary somatosensory cortex does the pain neurones terminate?

A

Cingulate gyrus of the insula

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41
Q

List excitatory neurotransmitters

A
  • Calcitonin gene related peptide
  • Substance P
  • Glutamate
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42
Q

List inhibitory neurotransmitters

A
  • Endogenous opiods
  • Glycine
  • GABA
43
Q

Name 2 similarities between the nociceptive nerves and thermoreceptive nerves

A
  1. Both have free nerve endings

2. Both involve C fibres and A-delta fibres

44
Q

What thermal stimuli are A-delta axons responsible for?

A

Cold

45
Q

What thermal stimuli are C-fibres responsible for?

A

Warm & cold

46
Q

Describe the trigeminal thermoreceptive pathway

A

Primary afferent neurone cell bodies in the trigeminal ganglion in the PNS
1st synapse at the trigeminal nucleus caudalis, takes the trigemino-thalamic tract to the contralateral thalamus
Synapse at the thalamus then at the somatosensory cortex

47
Q

Actions of warm receptors in response to warming and cooling

A

Warming: Results in an increase in frequency of action potentials
Cooling: Results in transient inhibition

48
Q

Actions of cold receptors in response to warming and cooling

A

Warming: Results in transient inhibition
Cooling: Results in excitation

49
Q

List the 3 types of proprioceptors in the masticatory system

A
  1. Joint receptors
  2. Muscle spindles
  3. Golgi tendon organs
50
Q

Function of the secondary nerve endings

A

Detects length of fibres

51
Q

Function of the primary annulo-spiral nerve ending

A

Detects length of fibres and speed of change of length

52
Q

What are the two types of fibres that make up the muscle structure?

A
  1. Extrafusal

2. Intrafusal

53
Q

Where do the cell bodies of muscle spindles lie in?

A

Trigeminal mesencephalic nucleus

54
Q

Where do muscle spindle afferents synapse in?

A

V motor nucleus

55
Q

What happens when the muscle contracts?

A

Contractile ends contract; non-contractile portion remain taut, hence shortening the muscle

56
Q

Role of muscle spindle (x3)

A
  1. Receive information about muscle length
  2. Acts to maintain muscle length
  3. Load compensation
57
Q

Name 3 types of joint receptors + where they can be found + function

A
  1. Pacinian - in ligaments - acceleration
  2. Golgi - in ligament - position
  3. Ruffini - in capsule - movement
58
Q

Where are golgi tendon organs found? What is their positioning in relation to muscle fibres?

A

Found in tendons; in series with muscle fibres

Very few are also found in masticatory muscles

59
Q

Function of golgi tendon organs

A

Play a role in (inhibitory) reflex - prevention of excessive stretch of muscle

60
Q

3 roles of mastication

A
  1. Breakdown of foodstuff in preparation for swallowing by increasing surface area for chemical digestion and release of chemicals for sense of taste
  2. Stimulation of salivary flow (Reflex stimulated by chewing)
  3. Growth and maintenance of oro-facial tissues
61
Q

How important is mastication

A

Mastication can be:

  • very important - for red meat and vegetables
  • quite important - for white meat
  • not very important - for fish, egg, bread, cheese, rice (not necessary but helps to speed up absorption)
62
Q

Sequence of ingestion of food

A
  • Stage I transport: From lips to cheek teeth
  • Mastication (chewing)
  • Stage II transport: From cheek teeth to back of tongue (bolus)
  • Swallowing
63
Q

Describe the chewing cycle

A
  1. Opening
  2. Fast closing
  3. Slow closing
  4. Intercuspal
64
Q

Describe the movements of the working side of the condylar head during opening

A

Rotation around vertical axis, slight lateral movement and very slight posterior movement

65
Q

Describe the movements of the non-working side of the condylar head during opening

A

Moves downwards, forwards and medially as described by Bennett’s angle

66
Q

Describe the movements of the working side of condylar head during closing

A

Moves medially to normal position in glenoid fossa and rotates back to normal orientation

67
Q

Describe the movements of the non-working side of the condylar head during closing

A

Moves upwards, backwards and laterally as described by Bennett’s angle

68
Q

Describe the condylar movements during the chewing cycle.

A

During opening, the working end of the condylar head rotates around the vertical axis, making a slight lateral movement and very slight posterior movement. The non-working end moves downwards, forwards and medially.

During closing, the working end of the condylar head moves medially back to its normal position in glenoid fossa and rotates back to normal orientation, while the non-working end moves upwards, backwards and laterally.

69
Q

Define reflex

A

A reflex is a predictable response to a given stimulus

70
Q

What is reflex latency?

A

The time from stimulus to effect.

71
Q

What is conduction time dependent on? (x2)

A
  1. Neurone speed –> Fibre Type

2. Distance

72
Q

Examples of stretch reflexes (x2)

A

Knee-jerk

Jaw-jerk

73
Q

Which receptor is involved in jaw jerk reflex?

A

Muscle spindle

74
Q

What is the effect of the jaw jerk reflex?

A

Contraction of the masseter muscle

75
Q

What are the roles of stretch reflexes? (x2)

A
  • tonic: resist gravity; maintain posture

- phasic: load compensation during chewing and stabilizes jaw during vigorous head movements

76
Q

How is the rest/postural position maintained?

A

When at rest and active, there is minimal jaw elevator muscle activity. The passive response is that the jaw elevators are relaxed. It is difficult to demonstrate as the passive visco-elastics come from within muscles.
During vigorous movement, visco-elastic forces supplemented by stretch reflexes keep it there.

77
Q

When is a protective reflex stimulated? Give an example of a protective reflex in the jaw.

A

Stimulated in response to a noxious stimulus.

e.g. jaw “opening” reflex

78
Q

How many synapses are there in the jaw opening reflex?

A

2

79
Q

Effect of jaw opening reflex

A
  • contraction of jaw depressors (i.e. jaw opening muscles: ABD, Mylohyoid, Geniohyoid) in animals
  • in humans: inactivation of jaw closers (i.e. masseter, temporalis, medial pterugoid) - INHIBITORY JAW RFLEX
80
Q

Role of the inhibitory jaw reflex

A

Prevents overloading of the masticatory system and facilitates opening to expel noxious material and minimize damage to intra/peri-oral structures

81
Q

Response of inhibitory jaw reflex

A

Inactivation of jaw closing muscles - masseter, temporalis, medial pterygoid

82
Q

Stimulus of jaw unloading reflex

A

Sudden closure following hard biting e.g. when a hard/brittle food breaks

83
Q

Response of jaw unloading reflex

A

Inactivation of jaw closing muscles + Activation of jaw opening muscles

84
Q

Nerves involved in the parasympathetic control of saliva secretion

A

CN VII (Submandibular and Sublingual glands) + CN IX (Otic ganglion - parotid gland + lingual glands)

85
Q

Neurotransmitter of preganglionic axon involved in parasympathetic control of saliva secretion

A

Acetycholine

86
Q

Neurotransmitter of postganglionic axon involved in parasympathetic control of saliva secretion

A

Acetylcholine

87
Q

Type of receptor involved in the parasympathetic control of saliva secretion

A

Muscarinic

88
Q

Effects of parasympathetic control of saliva secretion (x3)

A
  1. Responsible for most of the increase in volume of saliva flow
  2. Small, variable increase in organic components
  3. Contraction of myoepithelial cells
89
Q

Effects of sympathetic control of saliva secretion (x3)

A
  1. Production of viscous saliva (which gives the impression of a dry mouth, but in actual fact, salivary secretion has not been inhibited)
  2. Increased exocytosis of organic components
  3. Contraction of myoepithelial cells
90
Q

Antagonist in the parasympathetic control of saliva secretion

A

Atropine

91
Q

Short preganglionic axon; Long postganglionic axon

parasympathetic / sympathetic control of salivary secretion?

A

Sympathetic

92
Q

Long preganglionic axon; Short postganglionic axon

A

Parasympathetic

93
Q

How does gustatory sweating result? What syndrome is this called?

A

Frey’s syndrome -
During parotid gland surgery, there is a damage to the auriculotemporal nerve. The nerves regenerate but are however mixed and misdirected. The nerve that was parasympathetic to salivary glands get attached to those sympathetic for facial sweat glands and vice versa. This results in the activation of sweat glands upon salivary stimulant.

94
Q

What are the 3 types of control of oro-facial blood vessels?

A
  1. Neural
  2. Hormonal
  3. Metabolic
95
Q

What are the autonomic nerves responsible for the control of pulpal blood vessels?

A
  1. a1 receptor - sympathetic vasoconstrictor (main)

2. b2 receptors = sympathetic vasodilator

96
Q

What does the speech process involve? (x2)

A
  1. Generation of sound by vocal folds setting the air particles into vibration (phonation)
  2. Modify the sound to produce specific complex speech sounds (resonance & articulation)
97
Q

Where is Wernicke’s area located?

A

Left cortex; in the junction between parietal and temporal lobes

98
Q

Where does Wernicke’s area receive its input from?

A
  • Visual cortex (Occipital lobe) - reading comprehension and describing what is seen
  • Auditory cortex (Temporal lobe) - understanding spoken words
99
Q

Role of Broca’s area in the actual production of speech (x2)

A
  • Coordination of breathing and muscles involved in the speech process
  • Controls word formation
    (i. e. speaking ability)
100
Q

Role of Wernicke’s area in the actual production of speech (x3)

A
  • Understanding written + spoken words
  • Generation of meaningful language
  • Formulates coherent patterns of speech which are transferred to Broca’s area to control motor activity
101
Q

Describe the myoelastic aerodynamic theory

A

Vocal folds are initially closed and air pressure builds up from expiration as the airway is obstructed. The build up of pressure opens the folds and air quickly rushes through. The decrease in pressure and elasticity of vocal folds will result in them closing off subsequently. The build up of air pressure from expiration results in a repeating cycle.

102
Q

Define phonation

A

Phonation refers to the production of sound in the larynx by the vibration of the vocal folds in the larynx.
It is initiated by the active closing of the vocal folds followed by passive vibration of the folds

103
Q

What is the frequency of fold vibration determined by? (x4)

A
  1. Size of the vocal fold
  2. Fold tension
  3. Force of expiration
  4. Frequency of fold vibration

NEURO (3 decks)

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