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CNS 3 Flashcards

1
Q

Detects angular and linear acceleration of the head

A

Vestibular system

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2
Q

The vestibular organ consists of 3 _____, _____, & ______.

A

Semicircular canals, utricle, saccule

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3
Q

Gelatinous structure that embeds the cilia on the hair cells

A

Cupula

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4
Q

Smaller cilia

A

Stereocilia

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5
Q

A single long cilium

A

Kinocilium

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6
Q

Stereocilia bending toward kinocilium

A

Depolarization (excitation)

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7
Q

Stereocilia bending away from kinocilium

A

Hyperpolarization (inhibition)

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8
Q

Chorda tympani

A

Branch of cranial nerve VII (salty & sweet taste)

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9
Q

Posterior 1/3 of tongue.

Nerve for sour & bitter taste

A

Glossopharyngeal (IX)

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10
Q

Cranial nerve that detects noxious or painful odors like ammonia

A

CN V (trigeminal)

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11
Q

Knee jerk is _____ in upper motor neuron lesion and _____ in lower motor neuron lesion

A

Increased; decreased

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12
Q

Ib afferent stimulates inhibitory interneuron in spinal cord that inhibits alpha motoneurons and causes relaxation of contracted muscle

A

Golgi tendon reflex

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13
Q

Prevents muscle from replacing for some time

A

Afterdischarge

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14
Q

Ipsilateral flexion, contralateral extension

A

Flexor-withdrawal reflex

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15
Q

Sleep-wake cycle is controlled from?

A

Suprachiasmatic nucleus of hypothalamus

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16
Q

NREM stages

A

Stage 1: light sleep (5%)
Stage 2: deeper sleep (45%)
Stage 3-4: deepest (25%); bed wetting, sleepwalking, & night terrors

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17
Q

How can you decrease stage 4 sleep?

A

Benzodiazepines and Imipramine

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18
Q

REM

A 
25%
Every 90 min
Beta wave
Increased & variable pulse
Dreams
Tremendous loss of muscle tone
Erections
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19
Q

What condition is characterized by problem of insufficient sleep despite an adequate opportunity for sleep?

A

Insomnia

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20
Q

This is an intense and irresistible urge to sleep during daytime activities

A

Narcolepsy

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21
Q

Obstruction of respiratory airways during sleep

A

Sleep apnea

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22
Q

In this condition REM sleep is entered directly from waking state and there is profound reduction of muscle tone and paralysis. This results fall on ground and inability to move

A

Cataplexy

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23
Q

Sleep apnea d/t extreme obesity

A

Pickwickian syndrome

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24
Q

The stage of sleep related to bed wetting

A

3 & 4

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25
Q

Where is the primary motor cortex located?

A

Precentral gyrus (area 4)

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26
Q

The primary motor cortex is composed of pyramidal cells whose axons make up the______

A

Corticospinal tracts

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27
Q

Allows conscious control of precise, skilled, voluntary movements

A

Primary motor cortex

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28
Q

Controls learned, repetitious, or patterned motor skills

Coordinates simultaneous or sequential actions

Involved in planning and mental rehearsal of movement

A

Premotor cortex (area 6)

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29
Q

The most important output pathway from motor cortex to spinal cord

Relay on inter neurons and anterior horn cells of spinal cord

A

Pyramidal (corticospinal) tract- upper motor neurons

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30
Q

Signs of upper motor neuron lesions

A

Spastic paralysis, increased tendon reflexes, + bibinski sign

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31
Q

Signs of lower motor neuron lesion

A

Atrophy, flaccid paralysis, absent tendon reflex, - babinski sign

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32
Q

Non-arousal d/t damage to RAS

A

Coma

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33
Q

Damage to brain above cerebellum & brainstem

Upper extremities flexion and lower extremity extension

A

Decorticate rigidity

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34
Q

Damage to brainstem and cerebral lesions
Arms and legs extended
Mechanical ventilation require

A

Decerebrate rigidity

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35
Q

Superior most part of motor cortex (4) controls the movement of ?

A

Foot

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36
Q

The postganglionic neurons that pass through gray rami are what type of fibers?

A

C fibers

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37
Q

Hemisection of spinal cord

A

Brown-Sequard’s Syndrome

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38
Q

Findings below lesion of Brown-Sequard’s Syndrome

A

Ipsilateral UMN signs (corticospinal tract)
Ipsilateral loss of fine touch, vibration, proprioception (dorsal column tract)
Contralateral loss of light touch, pain, temperature (spinothalamic tract)
Ipsilateral loss of ALL sensations at level of lesion
LMN signs at level of lesion

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39
Q

Horner’s syndrome is d/t the destruction of what? And causes loss of ________ tone and predominant ________ tone

A

Stellate (superior cervical) ganglion; sympathetic, parasympathetic

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40
Q

S/sx of lesion above T1 (Horner’s syndrome)

A 
Ptosis (drooping of eyelids)
Anhidrosis (absence of sweating)
Miosis 
Enophthalmos
Flushing, high temp
Nasal congestion
41
Q

Autonomic dysreflexia/hyperreflexia occurs from spinal cord injury where?

A

At or above T6

42
Q

Unopposed sympathetic outflow of NorEpi, Beta hydroxylase, and Dopamine

A

Autonomic dysreflexia

43
Q

S/sx of autonomic dysreflexia below level of lesion

A

Hypertensive crisis
Headache
Vasoconstriction
Skin pallor

44
Q

S/sx of autonomic dysreflexia above level of lesion

A

Bradycardia d/t baroreceptor reflex
Profuse sweating
Vasodilation
Skin flushing

45
Q

Anesthesia considerations for autonomic dysreflexia

A 
Prevent further cord damage
High dose steroid
Head stabilization
Monitor BP, CVP, PCWP
Regional & deep general anesthesia
46
Q

Control balance and eye movements

A

Vestibulocerebellum

47
Q

Planning and initiation of movement

A

Pontocerebellum

48
Q

Control rate, force, range, and direction of movement

A

Spinocerebellum

49
Q

Layers of cerebellum

A
  1. Granular layer
  2. Purkinjie cell layer- outputs are inhibitory
  3. Molecular layer
50
Q

Clinical disorders of cerebellum- ataxia

A

Lack of coordination, intention tremors

Poor execution of movement, inability to perform alternating movements

51
Q

Basal nuclei consists of ______, ______, ______, & ______.

A

Striatum
Globes pallidus
Subthalamic nuclei
Substantia nigra

52
Q

Modulates thalamic outflow to motor cortex to plan & execute smooth movements
Many synaptic connections are inhibitory & use GABA

A

Basal Nuclei

53
Q

Lesion of subthalamic nucleus

A

Release of inhibition- wild, flinging movements (hemiballismus)

54
Q

Lesion of striatum

A

Release of inhibition- Huntington’s dz (dancing movements)

55
Q

Lesion of substantia nigra

A

Destruction of dopamine producing neurons - Parkinson’s dz
Overall inhibitory
Lead-pipe rigidity, tremors, and reduced voluntary movements

56
Q

MAO-B inhibitor

A

Selegiline (deprenyl)

Increased dopamine level in brain

57
Q

Right hemisphere is dominant in?

A

Facial expression

58
Q

Left hemisphere is dominant in? Lesion will cause?

A

Language; aphasia

59
Q

Damage to Broca’s Area causes ______ in which speech & writing is affected by understanding is intact.

A

Motor aphasia

60
Q

Damage to Wernicke’s Area causes _____ in which there is difficulty understanding written or spoken language

A

Sensory aphasia

61
Q

Bilateral lesion of ______ block the ability to form new long-term memory

A

Hippocampus

62
Q

Aspiration with multi-orificed catheter placing tip ____ the SVC

63
Q

Aspiration with single-orificed catheter placing tip ___ the SVC

64
Q

What position for tx of venous air embolism after posterior fossa surgery

A

Left lateral position, head 15 degrees down

65
Q

Position for seated posterior fossa surgery

A

Knee at heart level and neck not hyperflexed

66
Q

Avoid what in venous air embolism

A

Nitrous oxide

67
Q

Total volume of CSF

68
Q

Formation of CSF by choroid plexus epithelium and ependymal cells =?

A

500ml/day @ 30ml/hr

69
Q

CSF=Blood

A

Na
Cl
HCO3
Osmolarity

70
Q

CSF < Blood

A 
K
Ca
Glucose
Cholesterol
Protein
71
Q

CSF> Blood

A

Mg

Creatinine

72
Q

Pathway of CSF

A

Choroid plexus> Lateral ventricle > foramina of Monro > 3rd ventricle > aqueduct of sylvius > 4th ventricle > foramina Lushka or foramina magendie > subarachnoid space of spinal cord > brain > arachnoid villi

73
Q

Normal brain oxygen requirements = ___ of total body oxygen to produce ATP
ml/min?
ml/g?

A

20%; 50 ml/min; 3.5ml/100g of brain tissue

74
Q

Irreversible brain damage occurs in ?

75
Q

A decrease in __ degree Celsius would decrease ___ of CMRO2

76
Q

H ions cause ____ of cerebral blood vessels

A

Vasodilation

77
Q

Hypoxia cause _____

A

Vasodilation, increased CBF

78
Q

Cerebral perfusion pressure is regulated by?

A

MAP (pushing blood into brain)

ICP (keeps the blood out)

79
Q

An increase in ICP equal a ____ in CPP and CBF

80
Q

Normal CPP

A

70-100 mmHg

81
Q

Irreversible brain damage occurs at?

A

CPP < 25 mmHg

82
Q

Decrease in CPP causes?

A

Vasodilation

83
Q

Increase in CPP causes?

A

Vasoconstriction

84
Q

CBF is directly proportional to PCO2 b/w

A

20-80 mmHg

85
Q

___ % increase in CBF for each mmHg PCO2

86
Q

___ % increase in CBF per 1 degree C

87
Q

Normal ICP

88
Q

Signs of intracranial HTN

A 
Irregular respiration
Bradycardia
HTN
Ipsilateral III CN compression- ipsilateral fixed dilated pupil
Cushings triad
89
Q

Cushings triad

A

Irregular respiration, bradycardia, HTN

90
Q

Reduce ICP by:

A 
Fluid restriction
Corticosteroid
Hyperventilation
Thiopental for induction
AVOID Ketamine
Head-up position
Diuretics
CSF drainage
Avoid PEEP
Hypothermia
91
Q

Promotes cerebral steal

A

Vasodilator or Hypoventilation (increased PCO2)

92
Q

Heat loss is controlled by?

A

Anterior hypothalamus

93
Q 
Most common primary brain tumor
Grave prognosis
<1yr life expectancy
Found in cerebral hemisphere
Resection, radiation & chemo
A

Astrocytoma

94
Q

Relatively rare intracranial tumor

Slow growing

A

Oligodendroglioma

95
Q

Found in the 4th ventricle
Can cause hydrocephalus
Poor prognosis

A

Ependymoma

96
Q

2nd most common primary brain tumors
Occurs in convexities of brain and parasagittal region
Arise from arachnoid cells external to brain (NOT dura)
Slow growing
Resectable

A

Meningioma

97
Q

Most commonly prolactinoma
Bitemporal hemianopia “tunnel vision”
Hyper or hypo pituitarism are sequelae

A

Pituitary adenoma

98
Q

3rd most common primary brain tumors.
Schwann cell origin; often localize to CN VIII (acoustic)
Resectable

A

Schwannoma

99
Q

Stimulation leads to contraction of the bulk of skeletal muscle

A

a-motor neuron

Patho (13 decks)

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