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RRCCPA Clin Med Exam 2 > CNS Neuro 1 > Flashcards

CNS Neuro 1 Flashcards

1
Q

What are the ways of viewing brain fxn?

A

Database. Input> Process> Output.

Cortical vs Deep ares: higher vs primative.

Action areas: Motor, Sensory, Senses (Vision, Speech, Hearing, Smell, Balance).

Association/Integration Areas: Comprehension, coordination.

Reaction: Rapid response to stimuli, emotions, Fight or Flight.

Cognition: Measured response to stimuli, formation of thoughts, movment.

Memory: long term, short term.

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2
Q

What is the Central Sulcus?

A

“Rolandic Fissure”.

Seperates the Frontal and Parietal Lobes and Motor and Sensory cortices

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3
Q

What does damage to Broca’s Area cause?

A

Damage= Broca Aphasia (an expressive aphasia). Understand language but speech and writing labored and non-fluent

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4
Q

What is the prefrontal cortex? And what does damage to it cause?

A

Executive functions, attention, problem solving, and inhibiting, emotion.

Damage= Frontal lobe syndrome, mood and personality change, apathy, aggressiveness, emotional instability, impulsiveness

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5
Q

What does damage to Wernicke’s area cause?

A

Damage= Wernike Aphasia (a receptive aphasia). Cannot understand language, when speaking it is fast and incoherent.

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6
Q

What does occipital lobe damage cause?

A

Damage=visual impairment

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7
Q

What does damage to the primary auditory complex cause?

A

Damage= auditory impairment

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8
Q

What does damage to the hippocampus cause?

A

Damage= cannot convert short term memory into long term memory.

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9
Q

What is the basal ganglia?

A

(Putamen and Globus Pallidus= Lentiform Nucleus, Caudate Nucleus, Subthalamic Nuclei, and Substantia Nigra).

Interconnects with the Cortex, Thalamus, and Brain Stem

Responsible for skeletal motor function (initiation, control, and modulation), as well as learning, cognition, and emotion.

Disruption—–> movement disorders

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10
Q

What is the function of the thalamus?

A

Processes and relays sensory information from the body to the cortex, regulates sleep and awareness, has a motor role

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11
Q

What is the role of the hypothalamus?

A

Regulates and maintains homeostasis via endocrine, autonomic, and limbic systems.

Responsible for heat/cold tolerance and osmosis

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12
Q

Is heat regulation in the anterior or posterior hypothalamus? Describe some functions of it

A

Heat regulation= Anterior Hypothalamus (Dilation of peripheral blood vessels, ^ peripheral blood flow, ^ sweating, ^resp rate, dec body’s metabolic rate).

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13
Q

Is cold regulation in the anterior or posterior hypothalamus? Describe some functions of it

A

Cold regulation = Posterior Hypothalamus (Peripheral vasoconstriction, decreased peripheral blood flow, increased body metabolism, shivering of voluntary muscles, dec resp rate).

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14
Q

What is the hypothalamus’s role in osmosis?

A

Osmoregulation (water balance), and secretion of anterior pituitary hormonal secretions.

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15
Q

What is the cerebellum?

A

Has connections with the spinal cord and cortex. Sensory inputs are processed to regulate and control balance, posture, muscle tone and coordination or voluntary motor function.

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16
Q

What does damage to the cerebellum cause?

A

Damage= gait/balance/motor coordination dysfunction.

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17
Q

What is the limbic system?

A

Involved in the creation and modulation of emotions, memory, feeding, and mating.

Made up of: Amygdala, Hippocamus, Hypothalamus, Thalamus and Cingulate Gyrus, the olfactory system, and Pituitary Gland.

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18
Q

What is Wernicke Encephalopathy?

A

(different from Wernicke Syndrome).

Ocular motor weakness/ataxia/confusion caused by Thiamine deficiency.

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19
Q

Describe language function in relation to the brain (Hemispheric dominance)

A

Hemispheric Dominace. 90-95% of right handed ppl have L hemispheric language function.

75% of L handed ppl have L hemispheric language function (~20% have R hemispheric language function)

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20
Q

What is Broca’s Area and where is it located?

A

Broca’s Area (@ inferior frontal gyrus) = language expression.

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21
Q

What is Wernicke’s Area and where is it located?

A

Wernicke’s Area (@ superiro temporal gyrus)= Language comprehension

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22
Q

What is the Reticular System?

A

Determines state of arousal and alertness. Connected to the cortex, basal ganglia, thalamus, and spinal cord.

Think “what would help arousal to CNS?”

  • vision input
  • auditory input
  • sensory input
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23
Q

What is descending reticular formation?

A

Relays impulses form the hypothalamus to the ANS.

Also relays motor impulses from the extrapyramidal motor system to the voluntary muscles

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24
Q

What is ascending reticular formation?

A

Ascending Reticular Formation= Reticular Activation
system=

Connected to all major sensory pathways (Spinothalamic- pain, temp, touch, pressure. Auditory and visual). Influences mental alertness and sleep.

Comatose states mc caused by drugs (alcohol, etc), head injuries or CVA

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25
Q

The external carotid arteries supply the face and scalp with blood. The internal carotid arteries supply blood to most of the anterior portion of the cerebrum. The vertebrobasilar arteries supply the posterior two-fifths of the cerebrum, part of the cerebellum, and the brain stem.

A

External carotid arteries supply the face and scalp with blood.

Internal carotid arteries supply blood to most of the anterior portion of the cerebrum.

The vertebrobasilar arteries supply the posterior two-fifths of the cerebrum, part of the cerebellum, and the brain stem.

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26
Q

How many miles of capillaries are there in the brain

A

400 miles of capillaries in the brain

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27
Q

What is the circle of willis?

A

A critical arterial circle at the base of the brain.

The circle of Willis receives all the blood that is pumped up the two internal carotid arteries that come up the front of the neck.

All the principal arteries that supply the two halves of the brain (hemispheres) branch off from the circle of Willis.

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28
Q

What does the sensory pathway consist of?

A

The Sensory Pathways are Dorsal and Lateral. The Motor Pathways are Lateral and Ventral

29
Q

What is the dorsal column?

A

Tactile discrimination, two point discrimination, fine pressure, conscious proprioception, kinesthetic sensation (position/movement)

30
Q

What is the spinocerebellar tracts responsible for?

A

Unconscious proprioception

31
Q

What are the spinothalamic tract responsible for?

A

Pain, temp and itch (LSTT); light touch/pressure (VSTT)

32
Q

What are the motor pathways?

A

Are lateral and Ventral (Anterior)

33
Q

What is the pyrimidal motor pathway?

A

Volitional motor activity

34
Q

What is the extrapyramidal motor pathway?

A

Modulation and regulation of movement

35
Q

What is a dessucation?

A

Crossover

36
Q

Motor dessucation

A

Motor: Crossover in medulla (=90% of Pyramidal tract).

The remainder that do not decussate descend in the Anterior Corticospinal tract

37
Q

Sensory dessucation

A

Dorsal Columns - Medial Lemniscus- Cross in the Medulla.

Lateral Spinothalamic Tract (pain and temperature) – cross at or near the level the sensory nerve enters the spinal cord.

Ventral (Anterior) Spinothalamic Tract - light (cotton) touch (and pressure) – some fibers cross at the level of the nerve entrance to spinal cord and others cross up to 10 levels above

38
Q

What is the motor pyramidal system?

A

Pyrimadal system = Controls movement (Pyramidal cells in cortex, Medullary Pyramids).

Extrapyramidal System= coordinates movement

39
Q

Spinal Cord: Motor (Lateral and Ventral Corticospinal Tracts/ Pyramidal tracts)

A

MOTOR – 90% decussate at Medulla Pyramids. Posterior Limb of Internal Capsule-Mediate volitional motor activity.
Tests:-Assess muscle strength, tone, and mass-Assess reflexes, both Pain and Myotatic

40
Q

Sensory Modalities Summary

A
  • Discriminative (highly localized) Touch, Position, Fine Pressure and Vibration – Dorsal Columns
  • Pain and Temperature – Lateral Spinothalamic Tract
  • Light (poorly localized) Touch – Ventral (Anterior) Spinothalamic Tract
  • Pressure – has been described as being carried in both the Dorsal Columns (fine) and the Anterior Spinothalamic Tracts
41
Q

Spinal Cord: Sensory (Dorsal column-Medial Lemniscus Pathway)

A

SENSORY – decussates in MedullaDorsal Columns mediate conscious proprioception. Mediates discriminatory tactile sense (fine touch, fine pressure, vibration). Mediates kinesthetic sense – (proprioception, position, movement)

42
Q

Spinal Cord: Sensory (Lateral Spinothalamic Tract)

A

SENSORY – decussates at or near cord entrance level. Mediate pain and temperature

Test: Pin Prick-Test tubes with warm and cold water

43
Q

Ventral (anterior) Spinothalmic tract: Sensory

A

Light (poorly localized ) touch. Decussates at level of entrance to cord and up to 10 levels above.

Test: Stroking skin with a wisp of cotton

44
Q

Pressure

A

Dorsal columns (fine), and Anterior Spinothalamic Tracts

45
Q

What does the Pyramidal System control?

A

Controls volitional motor activity

In the corticospinal tract: via the spine to the internal capsule and dessucates in the pyramid of the medulla

46
Q

For the motor homunculus, what artery supplies the lower extremities?

A

Anterior cerebral artery

47
Q

For the motor homunculus, what artery supplies the hand and the face?

A

Middle cerebral artery

48
Q

What are the dermatomes?

A

Cutatneous innervation levels

49
Q

What are the sensory dermatomes?

A 
C2- Second cervical (sleep pillow)
C4- Four (Football shoulder pad)
C6- Six (Thumb suckers)
T4- nipple area
T10- Umbilicus
50
Q

Where does sensory input come from?

A 
Proprioception and position (spinocerebellar tracts)
Vestibular apparatus (CN 8) 
Extraocular muscles (CN 3,4,6)
51
Q

What are the leptomeninges?

A

Arachnoid and pia mater

52
Q

What is the blood brain barrier?

A

Tight junctions between capillary endothelial cells and astrocytes allowing metabolically necessary chemicals to cross but restricting others.

Will breakdown in infections, intracerebellar hemorrhages, and tumors.

**Important for pharmacology

53
Q

What is hydrocephalus?

A

“Water on the brain”.
Enlarged ventricules due2 interruption of absorption of CSF in the arachnoid granulations, malfromations, congenital obstruction of the Aqueduct of Sylvius (most common in kids).
Increased producton of CSF, tumors, idiopathic.

54
Q

What is an epidural hematoma?

A

Mostly due to head trauma and injury to the middle meningeal artery, beneath the a thin squamous portion of the temporal bone.

Beware of “Lucid Interval”

55
Q

What is a subdural hematoma?

A

Mostly common secondary to the rupture of bridging cerebral veins.

Blood lays flat along the skull. On a CT, acute blood is white.

After 4-5 days, blood losses density and becomes “isodense” with brain matter (= looks black).

56
Q

What is a subarachnoid hemorrhage?

A

Due to trauma or spontaneous (cerebral aneurysm in cirlce of willis especilly Anterior communicating artery, and internal carotid atery/posterior communicating artery).

@ Risk: HTN, women, Af. Americans, fam hx, alcohol use, bleeding disorders, cocaine and meth.

57
Q

Sx/sxs of subarachnoid hemorrhage?

A

Spontaneous = “Worse HA of my life”, meningismus (neck stiffness), impaired consciousness. Complications: Rebleled, hydrocephalus, cerebral vasospasm Dx: Noncontrast CT, Spinal tab, Crebral arteriogram (angiography). Tx: Surgical clipping or coiling.

58
Q

What is MS?

A

Autoimmune inflammatory demyelinating white matter disorder with axon loss.
Characterized by lesions seperated by time and location (space).
Sx: CN2 monocular or binocular visual loss and CN 3 motor deficits with diplopia, hemiparesis, paraparesis, gait ataxia, apendicular ataxia.
@risk: temperate climates, Ages 20-40, Women>men.

59
Q

What is the pneumonic for normal pressure hydrocephalus?

A

Wacky, Wobbly, and Wet. Sx: Dementia, ataxic gait, and urinary incontinence

60
Q

Dementia- What is multifarct/vascular dementia?

A

vascular changes in the brain caused by HTN, smoking

61
Q

A patient with an upper motor neuron lesion would exhibit which of the following findings?

A

Spasticity is an upper motor neuron lesion finding

62
Q

A patient with a lower motor neuron lesion would exhibit which of the following findings?

A

Fasciculations, areflexia and muscle atrophy are consistent with lower motor neuron lesions.

63
Q

Dx of MS

A

Dx: MRI, CSF analysis (leukocytosis with lympocytes in CSF).

64
Q

What are the three courses of MS?

A

Relapsing, Progressing, Remission

  • Relapsing-Remitting – acute onset, self limiting attacks of neurological dysfunction, with recovery of previous function.
  • Secondary Progressive- develops from existing relapsing-remitting, with reduction in rate of new attacks but with slow deterioration in function without acute episodes.
  • Primary Progressive, steady functional decline from onset
65
Q

What is Binswanger’s Disease?

A

Subcortical Atherosclerotic Encephalopaty ( a type of multi-infarct dementia)

66
Q

What is metastatic Bronchogenic Carcinoma?

A

about 1/2 of all tumors in brain and spine are metastatic. Outgrows blood source

67
Q

What is a meningioma?

A

Extra-axila tumor (outsiide the brainand spinal cord= dura)

68
Q

What is a glioma?

A

Intra-axillar tumor (within the brain). Is the most common primary brain tumor, and is very malignant.

69
Q

What is herpes simplex encephalitis?

A

Hemorrhagic necrosis of the temporal lobes.

RRCCPA Clin Med Exam 2 (4 decks)

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