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A&P I Fall 2022 > Central Nervous System (Exam II) > Flashcards

Central Nervous System (Exam II) Flashcards

1
Q

What are the 4 major lobes of the brain? What do they control?

A
  1. Frontal (Personality, planning, thinking, etc.)
  2. Parietal (Sensory info processing, somatosensory cortex)
  3. Occipital (Vision primarily)
  4. Temporal (Right and Left, Hearing and Language)
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2
Q

What are the 3 neuron types found in mammals? Which one is not in mammals?

A
  1. Multipolar
  2. Pseudounipolar
  3. Bipolar

True Unipolar not found in mammals.

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3
Q

Which neuron type is the most common? What is the defining trait of these?

A
  • Multipolar
  • This is the “decision making” neuron.
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4
Q

What is the purpose of pseudounipolar cells? Where are pseudounipolar neurons found? What is the purpose of the nucleus in these cells?

A
  • Sensory information processing.
  • They are found in ganglia
  • The nucleus mainly just provides cell support.
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5
Q

Where are bipolar neurons found?

A
  • Eyes and ears (i.e. retinas and cochlear/vestibular structures of the ears.)
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6
Q

At resting state, are V-G Na+ channels of most somatic sensory nerve receptors open or closed? What changes this state?

A
  • V-G Na+ channels are closed at Vrm.
  • Changes by stretch or pressure opens V-G Na+ on your somatic sensory nerves. This is how we perceive our sensory information.
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7
Q

The Telencephalon is also known as what?

A

The cerebrum

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8
Q

The Diencephalon controls what functions of the brain? What incredibly important structure is located here?

A
  • Hypothalamus
  • Automated functions are controlled in the diencephalon (I.e. infection response, body temp, etc.)
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9
Q

What other name does the midbrain go by?

A

Mesencephalon

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10
Q

What are the three structures of the brain stem in descending order?

A
  1. Midbrain (mesencephalon)
  2. Pons
  3. Medulla Oblongata
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11
Q

What does the cerebellum control?

A
  • Complex movement coordination (I.e. sports, driving a car, etc.)
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12
Q

Where does the spinal cord terminate?

A

Around L1 to L2

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13
Q

What information does the anterior horn of the spinal cord process?

A

Motor

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14
Q

What information does the lateral horn of the spinal cord process?

A

Visceromotor

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15
Q

What information does the posterior horn of the spinal cord process?

A

Sensory

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16
Q

What differentiates vertebral arteries in the C-spine area from vertebral arteries throughout the rest of the spinal column?

A

Vertebral arteries in the c-spine area are protected by the cervical vertebrae.

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17
Q

Which spinal nerves are necessary for breathing?

A

C3, C4, and C5

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18
Q

Spinal nerves flow out alongside which bony structures?

A

Transverse Processes

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19
Q

What foramen do vertebral arteries pass through?

A

The tranverse foramen

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20
Q

What bony structure of the spine allows for “head swivel”? Which vertebrae is this structure located on? Where does this structure attach to?

A
  1. Dens Process
  2. C2 Axis
  3. C1 Atlas: Dens Facet
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21
Q

Which two facets fit to the base of the skull, connecting the skull with the vertebrae?

A

The right and left superior articular facets

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22
Q

What is another name for the C1 Vertebrae? How about the C2 Vertebrae?

A
  • C1 = Atlas
  • C2 = Axis
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23
Q

What are the 3 main arteries that feed the spinal cord?

A
  1. Anterior Spinal Artery
  2. Right Posterior Spinal Artery
  3. Left Posterior Spinal Artery
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24
Q

What thoracic arteries feed the main vertebral arteries? Are these normally located next to each other?

A

Posterior and Anterior Segmental Medullary Arteries.

No, they are normally staggered.

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25
Q

Which two vascular structures sit inside the Anterior Fissure of the spinal cord?

A

Anterior Spinal Artery and Anterior Spinal Vein

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26
Q

How many large veins run off the spinal cord? Where are they located?

A

4 run off the spinal cord. 1 anteriorly and 3 posteriorly.

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27
Q

How many pairs of spinal nerves run through the cervical spine? How many vertebrae are located in the c-spine?

A

8 pairs of nerves

7 vertebrae

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28
Q

How many pairs of spinal nerves run through the Thoracic spine?

A

12 pairs of nerves

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29
Q

How many pairs of spinal nerves run through the Lumbar spine?

A

5 pairs of spinal nerves

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30
Q

How many pairs of spinal nerves run through the Sacral spine?

A

5 pairs of spinal nerves

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31
Q

How many pairs of spinal nerves run through the Coccygeal spine?

A

1 pair

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32
Q

Spinal nerves emerge _____ respective vertebrae. Which spinal nerve is the exception and why?

A

Below

Spinal nerve 1 exits above the C1 Atlas

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33
Q

Why do vertebrae get larger as we progress from the cervical spine to the Lumbar spine?

A

Vertebrae become larger to account for more weight to hold.

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34
Q

What is scoliosis? Does it usually present with any other conditions? Is it hereditary?

A

Scoliosis is left or right abnormal curvature of the spine

It usually presents with a degree of kyphosis

Yes, it is hereditary.

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35
Q

What spinal condition could affect ventilation?

A

Excessive Thoracic Kyphosis could prevent adequate thoracic expansion and compress the heart as well.

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36
Q

What consequences are there when excessive kyphosis or lordosis of the spine is treated with spinal fusion?

A

Metal fusing plates in the spine prevent normal shock absorption and lung expansion.

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37
Q

What is the joint where C1 meets C2, and rotation of the skull occurs, called?

A

Atlanto-Axial Joint

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38
Q

Which portion of the Vertebrae is the weight supporting portion?

A

The Vertebral body

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39
Q

Which spinal nerve runs on top of it’s respective vertebrae as opposed to below?

A

Spinal Nerve 1.

Comes out above C1

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40
Q

What structural difference of the spinous process would differentiate cervical vertebrae from other vertebrae?

A

Biphid Spinous Processes

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41
Q

Which two vertebrae have no disc in between them?

A

C1 and C2

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42
Q

What differentiates newborn spinal curvature and adult spinal curvature? What does this do to a toddler’s gait?

A

Newborn spinal curvature is mostly kyphotic.

This means that a toddler’s spine development, not being complete yet, makes them unstable and prone to falling.

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43
Q

Where do spinal nerves exit out of the spinal cord space? What two bony structures are above and below this exit space?

A

The intervertebral foramen

The superior pedicle and the inferior pedicle

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44
Q

What are the portions of the sternum in descending order?

A

Manubrium

Sternal Angle

Sternal Body

Xyphoid Process

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45
Q

Which ribs are known as “true” ribs? Why?

A

Ribs 1-7 because the cartilage directly connects to the sternal bone

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46
Q

Which ribs are known as “false” ribs? Why?

A

Ribs 8-10

This is because the cartilage on these ribs attaches to the cartilage of the ribs above

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47
Q

Which rib connects to the sternal angle?

A

Rib 2

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48
Q

Which ribs are known as “floating” ribs? Why?

A

Ribs 11 and 12

This because these ribs have no connection to the sternum

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49
Q

What is the purpose of rib cartilage?

A

Flexibility for breathing

Shock absorption

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50
Q

From a top down view, what general shape would a lumbar vertebral body possess?

A

Kidney bean shape

need to verify

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51
Q

From a top down cut view, what shape do the vertebral body’s of thoracic vertebrae have?

A

Heart shape

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52
Q

What is the purpose of the flattened portion of the vertebral body on the thoracic vertebrae?

A

This provides room for the thoracic Aorta

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53
Q

Where do spinal nerves exit out of the vertebral foramen? What is directly above and below this exit site?

A

Spinal nerves exit out of the interveterbral foramen.

Directly above is the pedicle of the superior vertebrae

Below is the pedicle of the inferior vertebrae

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54
Q

What procedure makes access into the spinal column much more difficult?

A

Spinal fusion surgery.

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55
Q

What are two treatments for disc herniation? What is the problem with one of these?

A
  1. Discectomy (less invasive)
  2. Spinal Vertebral Fusion (last resort) more tension is placed on discs above and below, precluding them for the same problem later. Fusion usually has to be extended.
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56
Q

What is a really good, non-invasive way to treat back pain?

A

Physical Therapy (duh)

Strengthening of core muscles and hamstrings takes strain off of the vertebrae’s job in stabilizing the back.

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57
Q

Where are the most common sites of disc herniation?

A

L3 - Sacrum

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58
Q

What two functions does the CSF provide to the spinal cord?

A
  1. Nutrient support (glucose and such)
  2. Shock absorption
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59
Q

What are the 3 layers of the spinal meninges in order of superficial to deep? Is there any space in between these layers? If so, what inhabits this space?

A
  1. Dura Mater
  2. Arachnoid Mater
  3. Pia Mater

There is the Arachnoid space in between the arachnoid mater and the pia mater for blood vessels and CSF.

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60
Q

Where does the lumbo-sacral enlargement occur?

A

T11 - L1

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61
Q

What is the name of the tip of the spinal cord? Does this differ in newborns and adults?

A

Conus Medularis

Adults CM terminates at L1

Newborns CM terminates at L2

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62
Q

What is the range of the Cauda Equina?

A

L3 - S5

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63
Q

What condition would occur from blocking the arachnoid granulations? What is this?

A

Communicating Hydrocephalus

Communicating hydrocephalus is characterized by CSF that can’t exit the CNS but all the ventricles are unblocked.

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64
Q

How much CSF circulates at any given time?

A

150cc

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65
Q

How much CSF is produced every day?

A

450cc

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66
Q

Is there a pump for CSF fluid? When is CSF produced most?

A

No CSF flow is passive.

When asleep or under anesthesia

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67
Q

What is the pH range for the CSF?

A

7.31 - 7.32

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68
Q

Are there proteins in the CSF? What does CSF fluid with proteins look like?

A

Proteins shouldn’t be in the CSF

If there are proteins in the CSF, it will be cloudy

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69
Q

What is the K+ concentration of the CSF?

A
  • 40% plasma concentration

(Ex. Serum Plasma k+ = 4, then CSF K+ = 2.4)

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70
Q

What is the Chloride concentration of the CSF?

A

15% greater than the plasma

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71
Q

What is the glucose level of the CSF? Is insulin used for glucose transport in the brain?

A

60 mg/dL

No, concentration gradient is required

Neurons need constant supply of O2 and glucose.

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72
Q

What is the pCO2 of the CSF?

A

≈ 47 mmHg

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73
Q

What is the bicarbonate level of the CSF?

A

20

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74
Q

What changes in this plasma electrolyte greatly effect the CSF?

A

Na+

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75
Q

What electrolyte is involved in the constant inhibitory effect exhibited by the brain? What neurotransmitter works in tandem with this electrolyte?

A

Cl-

GABA

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76
Q

What is the average adult male brain mass?

A

1350 grams

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77
Q

How much of Cardiac Output is utilized by the Brain? What is the takeaway from this?

A

12 - 15%

This is a large percentage of CO going to a single small organ.

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78
Q

What is the equation for cerebral blood flow?

A

50cc/ 100g/ min

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79
Q

What 4 stimuli cause an increase in blood flow to the brain?

A
  1. ⇡ CO2
  2. ⇡ Adenosine
  3. ⇣ O2
  4. ⇡ H+
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80
Q

What is the major driving force for determining cerebral blood flow?

A

MAP

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81
Q

CPP = _______________.

A

MAP - ICP

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82
Q

What is normal ICP?

A

5 -10 mmHg

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83
Q

Describe what autoregulation means?

A

The ability of the body to compensate for a Low MAP to a High MAP. Ex:

  1. Lower Limit of Autoregulation (LLA) = 60 mmHg
  2. Upper Limit of Autoregulation (ULA) = 140 mmHg
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84
Q

What is another name for the blood pressure autoregulating system of the brain?

A

The Myogenic Response

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85
Q

What would chronic hypertension due to the brain’s autoregulation capability? What other consequences should be considered?

A

It would shift it to the right so that the Upper Range of Autoregulation was higher (160mmHg rather than 140)

This adjustment makes the brain unable to compensate for hypotension. (Think Valley Stroke)

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86
Q

What are the components that utilize the most energy in the brain?

A

Electrophysiology = 60% (think action potentials and signaling)

Homeostasis = 40% (cell division, protein replacement, etc.)

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87
Q

What CNS energy expenditure component can be limited? By which drugs and by how much (percentage wise)?

A
  • Electrophysiologic Component (signaling)
  • Barbiturates, inhaled anesthetics, propofol
  • 60% decrease.
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88
Q

Which drugs do not affect CNS energy expenditure?

A

Nitrous Oxide and Ketamine

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89
Q

What is the equation for calculating brain O2 demand? How much O2 is used by the brain relative to the rest of the body?

A

3.5ml O2 / 100g/ min

Around 20% of all O2 usage comes from the brain.

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90
Q

How much O2 does the body, as a whole, use every minute?

A

250 ml

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91
Q

Why might one get latent results from a spinal tap done in the lumbar cistern?

A

The CSF located there is not as “fresh”.

92
Q

What structure does the cerebral aqueduct run through?

A

The Brainstem

93
Q

Where is the most common site of CSF blockage?

A

The cerebral aqueduct of sylvius

94
Q

What happens if the cerebral aqueduct becomes blocked? What is this condition known as? What is the treatment?

A

Ventricles 1,2, & 3 will become enlarged

Non-Communicating Hydrocephalus

Ventriculostomy to drain CSF

95
Q

How is CSF created in very very basic terms? What stops CSF production?

A

Na+ is pumped out of circulation, followed by Cl-, and then H2O.

Nothing (CSF production doesn’t stop unless you’re dead)

96
Q

What artery is arguably the worst to get a stroke in? Why?

A

The MCA (Middle Cerebral Artery)

The MCA feeds both the middle of the brain and the anterior of the brain through the Anterior Cerebral Artery

97
Q

Which communicating arteries are a part of the Circle of Willis? Which are not?

A

A1 and P1 are parts of the circle of Willis

A2 and P2 are outside of the circle of Willis

98
Q

What is the most common brain bleed for young people? What is the most common artery affected?

A

Epidural Hematoma’s w/ skull bone fracture

Middle Meningeal Artery

99
Q

What usually causes epidural hematoma’s? What are the usual symptoms?

A

Trauma

N/V, Balance issues, weakness

100
Q

Which brain bleed can have a delayed or quick onset? give an example of a delayed onset.

A

Subdural hematomas

Old person falls → develops symptoms a few days after fall

101
Q

Who is most affected by subdural hematoma’s?

A

Old people and young children (aspect of shaken baby syndrome)

102
Q

Where does bleeding most often occur from subdural hematoma’s?

A

Venous Sinuses or vessels that feed the sinuses

103
Q

What are 5 risk factors for subarachnoid hemorrhage?

A
  • Age
  • HTN
  • ETOH
  • DM
  • ↑ cholesterol
104
Q

Which brain bleed usually has a rapid onset? What is the usual cause?

A

Subarachnoid hemmorhage

Usual causes are aneurysm’s that “pop” from trauma

105
Q

What are the treatment’s for subarachnoid hemmorhage?

A
  1. Clip
  2. Coil
  3. Stent
106
Q

What is the most common form of hemorrhagic stroke?

A

Sub-Arachnoid Hemorrhage

107
Q

What makes veins in the CNS different than other portions of the body?

A

Veins in the CNS are more durable and rigid due to their characteristic of being extensions of the dura mater.

108
Q

Do large veins in the head have valves? What is the consequence of this?

A

No, this means that backflow can occur

109
Q

How much smooth muscle do cranial veins possess?

A

Trick question, no smooth muscle. Only small veins in the pia mater may have some smooth muscle.

110
Q

Where would one measure brain oxygen use?

What would normal parameters be?

What would an abnormal parameter be?

A
  • Internal Jugular Vein
  • 70 - 75% SvO2
  • 60 % SvO2 or less would be dangerous
111
Q

What portion of the population have a larger right jugular vein?

112
Q

What’s the difference between tracts and nerves?

A

Tracts are collections of axons in the CNS

Nerves are collections of axons in the PNS

113
Q

What 3 things makes C7 unique among cervical vertebrae?

A
  • No Biphid process.
  • No Carotid Artery runs through its foramen.
  • Longest spinous process (usually palpable).
114
Q

What is another name for the C7 vertebrae?

A

Vertebra Prominens

115
Q

What are two portions of the Dorsal Column Medial Lemniscus Pathway? What information do the two portions transmit?

A

Fasciculus Cuneatus - Upper Body Sensation

Fasciculus Grascilis - Lower Body Sensation

116
Q

What sensory information does the DCML pathway transmit? How fast is the signal propogation?

A
  • High Fidelity Sensory

(pinpoint touch, pressure, vibration, think hands)

  • Very Fast
117
Q

Where does crossover of the DCML pathway occur?

A

Crossover occurs at the Lemniscal Decussation of the Medulla Oblongata

need to verify

118
Q

Do any of the signals from the DCML interact with the gray matter of the spinal cord?

A

No

need to verify

119
Q

What structure organizes sensory information from the DCML and directs it to the appropriate processing region of the cerebrum?

A

Ventrobasal Complex of the Thalamus

120
Q

Where does sensory pain information crossover in the CNS?

How does this compare to regular sensory information?

A

Pain crosses over at spinal cord.

Sensory information crosses over at Medulla/Pons.

121
Q

Describe the path of a general motor signal through the corticalspinal tracts starting with the cortex.

A
  1. Cortex
  2. Internal Capsule
  3. Ventrobasal Complex of Hypothalamus
  4. Medulla Pyramids
  5. Medulla Decussation
  6. Lateral Corticospinal Pathway
122
Q

How much information is transmitted through the Lateral Corticospinal Pathway?

How does this compare to the Anterior Corticospinal Pathway?

A
  • Lateral Corticospinal = 90% of motor output
  • Anterior Corticospinal = 8-9% of motor output
123
Q

What portion of motor information never crosses over at the pyramidal decussation or further down in the spinal cord?

124
Q

Where does motor output crossover for the lateral corticospinal tract occur?

A

Medulla Pyramidal Decussation

125
Q

What are the two main paths of the Pyramidal Tracts? Which is the primary?

A
  • Lateral Corticospinal Tract (Primary)
  • Anterior Corticospinal Tract
126
Q

Where does crossover occur for the Anterior Corticospinal Tract?

A

The level of activity initiation

(Ex. Signal going to calf muscle, crossover occurs at spinal nerve controlling calf)

127
Q

What are the two Spinocerebellar Tracts?

A

Anterior Spinocerebellar Tract

Posterior Spinocerebellar Tract

128
Q

What information is carried by the spinocerebellar tracts?

A

Feedback on the Coordination of movement.

129
Q

What structure senses information for the Posterior SpinoCerebellar Tract?

A

Spindle Fibers in the Skeletal Muscle

130
Q

What is the structure of spindle fibers and how does this relate to the information they transmit?

Where is this information sent primarily?

A
  • Spring-like structure that “senses” contraction/stretch of muscle.
  • Information is sent primarily to the Posterior Spinocerebellar tract.
131
Q

Are muscle spindle fibers myelinated or unmyelinated? What does this mean in terms of pathophysiology?

A
  • Spindle fibers are myelinated.
  • Spindle fibers can be affected by demyelinating pathologies such as MS or Guillan Barre.
132
Q

What sensors located in tendons send information to the spinocerebellar tract on muscle contraction?

Which spinocerebellar tract is this information primarily sent to?

A
  • Golgi Tendon Stretch Sensors
  • Anterior spinocerebellar tract.
133
Q

Where do the Anterior (Ventral) spinocerebellar tracts end?

A

Superior Cerebellar Peduncle

134
Q

Where do the Posterior (Dorsal) spinocerebellar tracts end?

A

Inferior Cerebellar Peduncle

135
Q

What are the two divisions of the Spinothalamic (Anterolateral) Tracts?

A

Lateral Spinothalamic - Fast pain - A-δ

Anterior Spinothalamic - Slow pain - C

136
Q

Where are A-δ fibers found in the spinothalamic tract?

What neurotransmitter(s) is used by this pathway?

How precise is the information delivered by this pathway?

A
  • Lateral Pathway
  • Glutamate
  • Very precise (detailed pinpoint info)
137
Q

Where are C-fibers found in the spinothalamic tract?

What neurotransmitter(s) is used by this pathway?

How precise is the information delivered by this pathway?

A
  • Anterior Pathway
  • Glutamate, Substance P, CGRP
  • Imprecise (think stomach pain)
138
Q

What two sensory receptor types run alongside C-fibers?

What is the consequence of this?

A

Thermoreceptors and Vibration receptors

*When slow pain is “activated” you can feeling heat, cold, tickles, and itching* (needs verification)

139
Q

Which two neurotransmitters are slower to release, bind, and breakdown? Which neurotransmitter is faster in all aspects?

A

CGRP & Substance P = Slow

Glutamate = Fast

140
Q

Which lamina are associated with slow pain?

Which tract is utilized with these lamina?

What is another name for this tract?

A

Lamina II, III, and V

Anterior Spinothalamic Tract

“Paleospinothalamic Tract”

141
Q

Which lamina are associated with fast pain?

What tract is utilized with this lamina?

What is another name for this tract?

A

Lamina I

Lateral Spinothalamic Tract

Neospinothalamic Tract

142
Q

Where does fast pain processing occur?

What processing occurs alongside it?

A

Ventrobasal Complex of Hypothalamus

Sensory Information from DCML

143
Q

Where does slow pain cross over at? What tract carries this information?

A

Anterior White Commissure

Anterior Spinothalamic Tract

144
Q

Why is there poor localization of slow pain?

A

Only 15% of the signal progresses to the parietal lobe for higher level of processing.

145
Q

Where are both fast pain and slow pain processed?

Where does most of slow pain signalling terminate?

How does this compare to fast pain signaling?

A
  • Hypothalamus
  • Most slow pain signaling terminates in the pons.
  • Fast Pain → Ventrobasal complex of hypothalamus → Parietal Lobe
146
Q

What brain structure determines wakefulness and emotion processing?

Where is this structure located?

A

Reticular Formation

Interior of Brainstem (spans medulla, pons, and midbrain)

147
Q

What would two byproducts of chronic pain processing be? Why?

A

Feeling shitty and Sleeping shitty.

Wakefullness and Emotions are processes in Reticular formation of brainstem alongside C-fiber pain.

148
Q

Where does fast pain processing crossover?

Are these axons carrying this information myelinated all the way through?

A

Lamina X

Yes, even through Lamina X

149
Q

What are the 4 extrapyramidal tracts?

What are all 4 of these extrapyramidal tracts characterized by?

A
  1. Vestibulospinal
  2. Olivospinal
  3. Reticulospinal
  4. Rubrospinal

All are CNS efferent outputs to spinal cord.

150
Q

What information is pertinent to the Vestibulospinal Tract?

A

Eye fixation w/ muscle coordination during acceleration

151
Q

What information is pertinent to the Olivospinal Tract?

A

Cerebellar output to coordinate movement

152
Q

What information is pertinent to the Reticulospinal Tract?

What would occur with injury to this tract?

A

Maintenance of Muscle Tone

Crazy Movement (flaccidity or jerkiness)

153
Q

What information is pertinent to the Rubrospinal Tract?

A

Modulation of Voluntary Movement

154
Q

What does DIC stand for in the context of the CNS?

What does the DIC do?

What activates the DIC?

A
  • Descending Inhibitor Complex
  • Pain suppression system from CNS output
  • Brain or hormones activate DIC
155
Q

Where are two origins for a DIC signal?

A
  1. Periventricular Nuclei
  2. Periaqueductal Gray Matter
156
Q

Where does the DIC synapse at?

Which portion of the DIC specifically?

What is released at this synapse?

A
  • The DIC synapses at the synapse of the 1st nociceptor and the 2nd signaling neuron.
  • 3rd Order Enkephalin Neurons.
  • Enkephalin
157
Q

How do enkephalins decrease pain?

A
  1. Enkephalins bind to receptors on the pre-synaptic neuron and the post-synaptic neuron
  2. ↑ pK+
  3. ↑ Action Potential Threshold
158
Q

How would physical damage to a free nerve ending cause an action potential?

A
  1. ↑ K+
  2. ↑ H+
  3. Physical damage to cell (crushing, burning, etc.) would cause an increase of both of the above, thus causing a Na+ influx.
159
Q

What three factors will indirectly augment a pain response?

A
  1. Histamine
  2. Prostaglandins
  3. NO
160
Q

How do opiates treat pain?

A

Opiates bind to receptors on the nociceptor and the synapsing neuron and ↑ pK+

161
Q

What other receptor is relevant (besides µ, δ and κ) in decreasing pain on the presynaptic nociceptor?

What drug would be relevant in utilizing this receptor?

A
  • α-2
  • Dexmedetomidine
162
Q

What 3 organs lack pain receptors?

A

Lungs - specifically alveoli and small airways

Brain - *Glial cells* (need to verify)

Liver - specifically inside the parenchyma

163
Q

What 5 areas in lecture were described as having a lot of pain receptors?

A
  1. Dura Mater/ Meninges
  2. Blood Vessels (i.e. coronary arteries)
  3. Joints
  4. Bones
  5. Periosteum
164
Q

What drug class preceded SSRI’s?

What usage do these drugs have now?

A
  • Tricyclic Antidepressants
  • Used to treat chronic pain and chronic arousal
165
Q

What are the two glutamate receptors?

What ion(s) are influxxed by these two receptors?

A
  1. AMPA - Na+
  2. NMDA - Na+ & Ca++
166
Q

What ion blocks NMDA receptors?

What removes this block?

What influxxes once the block is removed?

A
  1. Mg++
  2. AMPA depolarization “ejects” Mg++
  3. Na+ & Ca++ influx
167
Q

What occurs after after Ca++ influx from NMDA receptors?

A
  1. ↑ PKC
  2. ↑ iNOS
  3. ↑ NO
  4. ↑ COX-2 → ↑PG
168
Q

How do Prostaglandins affect the pain signaling process?

A

Prostaglandins produced in the 2nd neuron increase release of glutamate by the 1st nociceptor.

169
Q

What compound in the pain signaling process potentiates pain, causing it to become worse, and also influences chronic pain development?

How does this compound do this?

A

↑ NO

↑ NO = ↑ NMDA receptors = ↑ pain sensing

170
Q

What two components of the pain cycle increase pain by increasing glutamate release?

Of these two, which increases glutamate sensitivity?

A

NO and PG’s

NO

171
Q

In what two ways do inhalational anesthetics inhibit pain?

A
  1. Systemic ↑ pK+
  2. Activation of periventricular nuclei and periaqueductal gray matter to release enkephalins.
172
Q

How long before the chronic pain potentiation process starts to occur?

173
Q

Which two NMDA receptor antagonists were talked about in lecture?

A

Ketamine

Nitrous Oxide

174
Q

Describe the dissociative nature of ketamine.

A

Ketamine is dissociative because it is a non-competitive NMDA receptor antagonist. This means it blocks signaling between neurons in the pain signaling system.

175
Q

What toxin is a known NMDA receptor antagonist and is especially unhealthy for children?

176
Q

Why does lead poisoning affect children more than adults?

A

Children are still in the process of developing of creating NMDA receptors and forming synapses.

177
Q

Which receptors are strongly associated with memory and learning?

A

NMDA receptors

178
Q

In which lamina do the 2° neuron of the DIC interface with the 3° neuron of the DIC?

A

Lamina 1, 2, 3

(dependent on fast pain or slow pain)

179
Q

Where does crossover occur for the DCML?

A

Lower Medulla

need to verify

180
Q

What is the termination point for the posterior spinocerebellar tract?

A

Inferior Cerebellar Peduncle

181
Q

What is the termination point for the anterior spinocerebellar tract?

A

Superior Cerebellar Peduncle

182
Q

Which sensors give feedback to the Posterior Spinocerebellar Track?

A

Muscle Spindle Feedback

183
Q

What sensors give feedback to the Anterior Spinocerebellar Tract?

A

Golgi Tendon Feedback

184
Q

What type of nerve fiber usually reduces pain in Lateral Inhibition?

185
Q

Differentiate Parietal and Visceral pain. Which is localizable?

A

Parietal - pericardium, peritoneum, (essentially fibrous coatings. Parietal is localizable.

Visceral - Deep organ interior. Not localizable.

186
Q

Why is visceral pain usually felt above where the pain is actually occuring?

A

Pain info is fed into SNS chain and is routed up a couple of levels. So signal is not localized well.

187
Q

Which type of pain works in conjunction with stretch receptors and lines up with dermatomes.

A

Parietal Pain

188
Q

What 3 examples of referred pain were given in class?

Where is the pain felt for each of these?

A
  • Myocardial Infarction - left shoulder/arm
  • Kidney Infection - lower back
  • Appendicitis - umbilicus
189
Q

What is the primary characteristic of where referred pain is felt?

Why is this?

A

Referred pain is felt above the site of injury/inflammation.

This is due to the signal traversing the SNS up a couple of interneurons. *better phrasing needed*

190
Q

What are the two generalized causes of pain that were discussed in lecture?

A

Inflammation and Muscle Spasms.

191
Q

What 5 factors lead to pain felt from inflammation?

A
  • ↑ H+
  • Ischemia
  • Bradykinin release
  • Poor Nutrient delivery
  • Proteolytic enzyme release (lysosome necrosis)
192
Q

What causes pain in the case of muscle spasms?

A

Excessive contraction causing acidosis and ischemia.

193
Q

Of Parietal and Visceral tissues/organs which has the larger pain receptor density?

194
Q

At which vertebral level would appendicitis be felt for Parietal pain?

At which vertebral level would appendicitis be felt for Visceral pain?

A

Parietal = L-1 dermatome

Visceral = T-10 dermatome

195
Q

How is an individual’s pain threshold determined in a pain study?

What would categorize as a low pain tolerance?

What would categorize as a high pain tolerance?

A

Thermal probe at 45°C on hand.

High Tolerance ≈ 50° C

Low Tolerance ≈ 40° C

196
Q

What concept is the basis for acupuncture?

A

Lateral (or Surround) Inhibition

197
Q

What passes through the Tract of Lissauer?

What does NOT pass through the Tract of Lissauer?

A

All Sensory information

Pain information

198
Q

How is the Tract of Lissaeur best described?

A

Myelinated Interneurons where multiple levels of the spinal cord are connected.

199
Q

What occurs during a stretch reflex?

A

In response to a stretch (say the quads):

  1. Contraction of Quads occurs to normalize length
  2. Antagonistic muscles (hamstrings) are relaxed.
200
Q

What receptor is associated with the stretch reflex?

A

Muscle Spindle Sensor

201
Q

What reflex keeps us from placing too great of a load on our muscles?

What sensor is used in this reflex?

A

Tendon Reflex

Golgi Tendon Stretch Sensors

202
Q

Give an example of the Tendon Reflex using the biceps and triceps as an example.

A
  1. A 400lb weight is caught (much too heavy)
  2. Biceps relax.
  3. Triceps contract (to speed movement away from trigger).
203
Q

What is the primary purpose of the Flexor Reflex?

What should be known about this reflex and the Tract of Lissaeur?

A

To withdraw from pain.

Pain sensors activated use tract of Lissaeur to activate multiple neurons quickly to contract muscle away from pain. (*wordy*)

204
Q

Which reflex involves communication up/down multiple levels of the spinal cord as well as across the cord?

A

Crossed Extensor Reflex

205
Q

What feeds the radicular arteries of the neck?

How many radicular arteries does the cervical spinal cord have?

A

Vertebral Arteries

1-3 Radicular Arteries (usually 3)

206
Q

In what surgery is the Great Radicular Artery relevant?

What consequences could occur from blocking of the Great Radicular Artery?

Is it better to have a GRA thats higher or lower?

A
  • Aortic Aneurysm repair.
  • Prolonged Ischemia of the GRA = Paralysis
  • ↑ GRA = Better
207
Q

How is Spinal Cord Perfusion Pressure Calculated?

A

CordPP = MAP - Cord CSF Pressure (5-10 cmH20)

208
Q

Which 3 arteries perfuse the cervical Posterior Spinal Arteries?

A
  1. Vertebral Arteries
  2. Anterior Inferior Cerebellar Artery
  3. Posterior Inferior Cerebellar Artery
209
Q

In Brown-Sequard Syndrome which 3 consequences would you expect to see from transection of half of the spinal cord?

A
  1. Loss of Motor ipsilateral of the injury
  2. Loss of Sensation ipsilateral of the injury
  3. Loss of Pain contralateral the injury
210
Q

How can horrible pain from terminal cancer be treated?

A

Cordectomy of the spinothalamic tracts to sever pain sensation.

211
Q

What happens to ICP when the aorta is clamped?

Can this be counteracted?

A
  • It increases by 10cmH20
  • A prophylactic spinal tap can be done during aneurysm repair to lower pressure. Controversial.
212
Q

Which spinal tracts are inhibitory to motor function?

What can loss of these tracts cause?

A

Non-pyramidal tracts

Skeletal Muscle Rigidity (Decorticate & Decerebrate)

213
Q

What is a shingles infection?

What virus causes this?

How is the pain in this infection?

A
  • An infection of the Dorsal Root Ganglia
  • Herpes Zoster
  • Painful (follows dermatomes)
214
Q

What is Tic Douloureux?

Can this be treated?

A
  • Overactive and painful Cranial Nerve 5 (Trigeminal) and Cranial Nerve 9 (Glossopharyngeal).
  • CN 5 can be cut but CN 9 is too hard to access.
215
Q

Which neurotransmitter is always inhibitory in the spinal cord?

216
Q

Which neurotransmitter is excitatory and utilized in our pain pathways?

217
Q

Which neurotransmitter is the main inhibitory transmitter of the CNS?

What would happen without this neurotransmitter?

A

GABA

Seizures, rampant electrical activity, etc.

218
Q

GABA receptors always increase cell wall permeability to _______ and to a lesser degree _______.

219
Q

What electrolyte might be utilized for pain control?

What are three theories as to how this might work?

A
  • Mg2+
  1. NMDA receptor blocking
  2. Ca2+ receptor antagonism
  3. Blocking Na+ Channels
220
Q

Which drugs potentiate GABA?

A

EtOH, Benzo’s, and Barbiturates

221
Q

What is the difference between Barbiturates and Benzodiazepines in regards to GABA potentiation?

Which is considered more dangerous?

A

Barbiturates are direct GABA Agonists.

Benzodiazepines potentiate endogenous GABA.

Barbiturates are far more dangerous, especially when used with another CNS depressant.

222
Q

AcetylCholine, in regards to the CNS, typically makes one more _______.

Thus, AChEsterase Inhibitors would do what?

A

Aware, Awake, etc.

AChE inhibitors would potentiate CNS awareness.

223
Q

Which type of ACh receptors are found in the CNS?

What other receptor are they similar to?

A
  • muscarinicACh Receptors
  • Histamine1 Receptors
224
Q

How does benadryl makes you sleepy?

Why do new antihistamines not have a drowsiness effect?

A

Benadryl crosses the BBB blocks mACh receptors.

New antihistamines are too large to cross the BBB.

225
Q

Regarding the Pyramidal Tracts, where does crossover occur for:

  1. Lateral Corticospinal Pathway?
  2. Anterior Corticospinal Pathway?
A
  1. Lateral Corticospinal Crossover: Medulla
  2. Anterior Corticospinal Crossover: Spinal Cord
226
Q

Regarding the Pyramidal Tracts, where does crossover occur for:

  1. Lateral Corticospinal Pathway?
  2. Anterior Corticospinal Pathway?
A
  1. Lateral Corticospinal Crossover: Medulla
  2. Anteriro Corticospinal Crossover: Spinal Cord

A&P I Fall 2022 (18 decks)

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