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Neuroscience > Exam 1 - Clinical Scenarios > Flashcards

Exam 1 - Clinical Scenarios Flashcards

1
Q

Branchial Fistula

A

Cyst along the lower mandible that is usually asymptomatic

Caused by lack of obliteration of embryonic structure (pharyngeal pouches that join together to create a cleft)

Treatment: no treatment needed, surgical removal if it’s a problem

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2
Q

Great Auricular Nerve

A

Must be careful with this one when performing certain plastic surgical procedures (rhytidectomy or facelift)

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3
Q

Thyroidectomy

A

Layers: Thyroid|Trachea|RLN + Thoracic Duct|Esophagus

Careful not to cut the Recurrent Laryngeal Nerve (RLN)
If cut = dysphonia, trouble breathing

Can cut/ligate the inferior laryngeal artery (ILA)

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4
Q

Lymphatic Drainage During Surgery

A

Pretracheal and paratracheal nodes drain to the deep cervical nodes

Input MUST EQUAL output; if not, cervical edema

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5
Q

Tracheotomy

A

Emergency airway cut through tracheal rings 2-4

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6
Q

Cricothyrotomy

A

Emergency airway cut through the cricothyroid membrane - cuts the median cricothyroid ligament

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7
Q

Tracheostomy

A

Extensive surgical procedure to open a long-term airway through tracheal rings 2-4 (usually for a vent)

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8
Q

Pneumothorax

A

Penetrating wounds to the base of the neck can puncture the pleural cavity and/or lung causing it to collapse

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9
Q

Dopamine Pathway Conditions

Parkinson’s

Addictions

Schizophrenia

A

Substantia nigra dopaminergic pathway usually does motor control; damaged here

Mesolimbic pathway usually does pleasure/rewards, altered with various addictions

Mesocortical pathway crucial for attention and higher levels of consciousness, dysfunctional here

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10
Q

Serotonin-Induced Depression

A

Caused by disruptions in serotonin delivery by the midline raphe nucleus

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11
Q

Alzheimer’s

A

Loss of function in the midbrain due to cortical neurons no longer producing acetylcholine may be one cause

CB-2 agonists (endocannibinoid receptor) causes macrophages to remove beta-amyloid and may be a treatment for Alzheimer’s

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12
Q

Denervation Hypersensitivity

A

Caused by the alpha motor neuron innervating skeletal muscle being transected and the muscle continues to respond to Ach

Nicotinic receptors at the motor end-plate will react with free floating Ach and cause random action potentials = fasciculations and twitches

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13
Q

Stiff Person Disease

A

Autoimmune response

GABA plays an important role here - without it, you get muscle cramps and tetany

Pancreatic beta cells make GABA too so antibodies may be detected in T1D as well

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14
Q

Subclavian Steal Syndrome (Vertebro-Basilar Insufficiency)

A

During exercise, blood is shunted from the brain to the extremities and may cause an occlusion at the vertebral artery

Decrease in blood flow to the brain may lead to a coma, quadriplegia, or cranial nerve abnormalities

This is a type of ischemia - may result in transient or permanent neurological dysfunction

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15
Q

Significant Shunting within the Carotids

A

May result in hyperperfusion and cerebral edema due to the Circle of Willis typically being incomplete and asymmetrical

if person has a complete and symmetrical Circle of Willis, they can survive an occlusion of these arteries

Components of the Circle of Willis: Internal Carotid (with anterior cerebral, middle cerebral, posterior cerebral, and branches) and the Vertebral Arteries
- 85% of aneurysms happen here

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16
Q

Superficial Temporal Artery

A

Pulse can be readily palpated anterior to the auricle

Sometimes used in neurosurgical procedures to bypass obstructions of the middle cerebral artery

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17
Q

Epidural Hematoma

A

Middle meninges like artery can be ruptured with head trauma leading to hemorrhaging and a blood clot in the epidural space

can be fatal if not treated promptly

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18
Q

Removal of the Internal Jugular Vein

A

When they remove this vein, they also remove the nearby lymph nodes (deep cervical)

Done in a Neck Dissecetion - usually as a preventative or curative procedure for metastasis of cancer; removes the IJV, CNXI, and SCM along with the lymph nodes

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19
Q

Paralysis of the Phrenic Nerve

A

Unilateral paralysis: usually asymptomatic or few symptoms

Bilateral paralysis: exertional dyspnea, scaphoid abdomen, hyperactivity of accessory breathing muscles, difficulty in coughing and sneezing
X-ray will show the diaphragm high in the chest

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20
Q

Phrenic Neuralgia

A

May result from neck tumors, aortic aneurysm, pericardial/mediastinal infections

Most cases, the pain is on the left side

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21
Q

Nuchal Rigidity

A

Stiffness occurs with neuralgia, various neck lesions, meningitis, or blood in the CSF (subarachnoid hemorrhage)

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22
Q

**Vernet’s Syndrome

A

Basilar skull fracture due to trauma that may involve the jugular foramen and result in ipsilateral IX, X, and XI paralysis

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23
Q

**Collet’s/Sicard’s Syndrome

A

May be due to injury in the retroparotid space that involves ipsilateral paralysis of CN IX-XII and the cervical sympathize trunk

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24
Q

Sedation by General Anesthesia

A

Two ways to accomplish this relevant to this section:

  1. Benzodiazepine sites found on GABA receptors to increase inhibition
  2. Benzodiazepine sites on AMPA subtype of non-NMDA receptors to decrease excitation
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25
Q

Rasmussen’s Encephalopathy

A

Rare condition in which severe, intractable seizures develop in child

Antibodies against metabotropic receptors have been found in people suffering with this condition

Causes brain damage, usually destroying a hemisphere

Treatment: surgical removal of damaged hemisphere

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26
Q

Excitotoxicity

A

Caused by over-stimulation of the EAA system following an insult to the brain leading to cell death in neurons

Strong evidence for involvement in: cerebral ischemia, stroke, hypoglycemia, epilepsy

weird, but can get domoic-acid poisoning after consuming mussels that can cause this

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27
Q

Cerebral Ischemia

A

Oxygen deprivation causes cells to not be able to meet metabolic demands

Can happen within 4 minutes of deprivation –> ATP levels drop to 0, cells depolarize (NTs are high), and there will be excessive activation of NMDA/non-NMDA receptors

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28
Q

Reperfusion Injury

A

Particularly common in drowning incidents –> slight cerebral edema

Caused by giving oxygen after a traumatic brain injury when the neurons have already been deprived –> O2 becomes a free radical and apoptotic pathway will be activated

Certain chemicals help potentiates further injury: epinephrine (increases K+ but inhibits protein synthesis), WBCs (hallmark of necrosis occurring), growth factors

There are “pre-treatments” available but these injuries are hard to predict; must be treated in the 4 minutes window

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29
Q

Lesion of Perivascular Plexuses or SNS Branch to the Ciliary Ganglion

A

Lose innervations to the eyes - specifically the dilator pupillae and tarsal muscles

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30
Q

Lesion to Deep Petrossal Nerve

A

Fibers travel to the palate, nasal cavity, pharynx, orbit, and lacrimal glands

Lose innervations to the nasal cavity and lacrimal gland specifically

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31
Q

Lesion to Carotico-tympanic Nerve

A

Courses through the middle ear (and the ganglion there) but a lesion here will cut innervation to the parotid gland

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32
Q

Horner’s Syndrome

A

Caused by spinal cord and neck trauma, specifically by an interruption to the cervical sympathetic trunk or cervical spinal cord (above the level of T1)

Symptoms: PAMELA’S HORNY
P = ptosis (paralysis of the tarsal muscle)
A = anhidrosis (vasodilation, on the skin of face due to loss of sympathetic innervation to blood vessels)
M = miosis (pupillary constriction due to paralysis of dilator papillae muscle)
E = enopthalamos (paralysis of muscle of Muller)
L = loss of reflex

These can be transient and thus hard to diagnose

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33
Q

Sacral Autonomic Plexus Injury

A

Important to check patients for bowel movements as this would typically innervate the colon, rectum, bladder

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34
Q

Hypercalcemia

A

Alters the permeability of the cell to sodium leading to hyperpolarization and muscle weakness

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35
Q

Hyperkalemia

A

Depolarizes the cells, making them more excitable

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36
Q

Changes in Blood Pressure

A

As blood pressure drops –> decrease in baroreceptor firing –> increase in RAAS systems (activation of nicotinic receptors in adrenal chromaffin)

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37
Q

Chronic Hypercapnia

A

CSF will have high CO2 –> acidosis

Cells making CSF will utilize carbonic anhydrase to add HCO3 to CSF and pump hydrogen ions into the blood to raise the pH

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38
Q

Chronic Hypocapnia

A

CSF will have too little CO2 –> alkalosis

Cells making CSF will move HCO3 out to the blood and keep hydrogen ions in order to lower pH

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39
Q

Normal Pressure Hydrocephalus

A

(based on the case study provided)
Present with neurological symptoms such as unaware, cognitive deficits, gait problems, positive snout and suckling reflex (abnormal in adults), ventriculomegaly

Caused by increased pressure due to CSF accumulation because of a mismatch between production and absorption

Intracranial pressure will usually be on the high side of normal - still dangerous

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40
Q

Epileptic Seizure due to BBB GLUT Deficiency

A

Caused by uncontrolled synchronization of neuronal discharges, typically from parts of the brain where cells are hyperexcitable

Can be triggered by reduced CSF glucose causing an unstable membrane potential due to a mutation in the genes coding for GLUT transporters

Treatment: low carb/high fat diet (provides ketone bodies to be used as energy for neurons)

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41
Q

Lumbar Puncture Effects

A

When CSF is taken out, it often causes headaches because of the blood vessels that are well innervated get pulled and causes pain

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42
Q

Phases of Swallowing

A
  1. Oral Phase: mastication (chewing)
  2. Oropharyngeal Phase: elevation of the floor of the mouth and tongue to push bolus into oropharynx
  3. Pharyngo-esophageal Phase: oropharynx elevates and constricts around bolus to push it into esophagus

Caused by the laryngeal aditus sphincter and epiglottis, aryepiglotic fold, thyroepiglottic muscle

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43
Q

Airway Protective Cough Reflex

A

Series of expiratory cough triggered by a noxious stimulus to the supraglottic laryngeal mucosa - VITAL

Example: acid reflux may cause this cough, but treatment of the acid will neutralize the stimulus

If they can’t cough, may be due to the abdominal oblique muscles

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44
Q

Laryngeal Cough Reflex (Inspiratory and Expiratory)

A

From infancy to adulthood, the larynx is displaced around months 2-4 to descend further back

Without this process, may have nasalized speech

Caused by the vagus nerve and the internal sphincters of the larynx (vocal folds, adductor muscles, thyroarytenoid)

This airway is protected by the internal branch of superior laryngeal nerve (afferent, sensory component)

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45
Q

Piriform Recesses

A

Secretions may gather here but should disappear when swallowing

When it doesn’t, patient is said to have a “pooling” sign which suggests an obstruction or paralysis of the upper esophagus

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46
Q

Nasopharynx Development

A

In infants, if this doesn’t close off properly, milk can reflux through to the ear cavity causing otitis media

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47
Q

Zenker’s Diverticulum

A

Can form within Killian’s Triangle (between the thryopharyngeal and cricopharyngeus muscles) due to it being a vulnerable area

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48
Q

Pharyngeal Speech in Total Laryngectomy

A

Have to learn to use esophageal speech, which is the vibration of the cricopharyngeus muscle by regurgitation of swallowed air

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49
Q

Retropharyngeal Space

A

Between the buccopharyngeal and prevertebral fascia

Can have infections spread to here because it is continuous from the skull to mediastinum (dangerous)

If a surgical fusion of vertebra was needed, they would approach it via this space

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50
Q

Gag Reflex

A

Glosspharyngeal (9) and vagus (10) nerves elicit a gag response when the back of the throat is touched

9 does the sensory portion while 10 mediates the motor response (in by 9, out by 10)

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51
Q

Arytenoid Cartilages

A

looks like two penguins facing each other

During phonation: they rotate along a vertical axis to control the tension on the vocal cords

During respiration: they slide laterally to open the rima glottidis (opening formed by the free margin of the vocal folds)

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52
Q

Intubation

A

During intubation, the blade is placed on the valleculae epiglottica to help move the tongue and epiglottis out of the way

Placing an NG tube into the airway can cause a pneumothorax

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53
Q

Fracture of the Larynx

A

May result from blows received during high impact sports or compression of the shoulder strap in MVA

Produces submucosal hemorrhage, edema, respiratory obstruction, hoarseness, and dysarthria

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54
Q

Movement of the Vocal Cords

A

Abduction: posterior cricoarytenoid
Adduction: lateral cricoarytenoid, arytenoideus

Tension: cricothyroid (increases tension) and vocalis (decreases tension)

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55
Q

Paralysis of the RLN

A

Lesions result in hoarseness and dysphagia; there may be coughing and choking due to collapse of the aryepiglottic fold and drainage of fluids into the larynx

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56
Q

Delphian Lymph Node

A

Located at the midline of the thyrohyoid membrane may become enlarged in thyroid carcinoma and subacute thyroiditis

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57
Q

Paralysis of a Vocal Cord

A

If one is paralyzed, it will remain fixed while the others move in and out

In elderly patients, vocal folds frequently do not completely adduct during phonation

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58
Q

Tumors of the Vocal Folds

A

Results in dysphonia (hoarseness) which can be detected pretty early and usually have a favorable diagnosis/prognosis

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59
Q

Inhalation of Sharp Objections

A

Results in choking, sharp pain, and progressive obstruction to breathing due to inflammation of the larynx and edema of the glottis

Produces an explosive cough reflex; aspiration into the larynx will cause the muscles there to spasm and close, blocking the airway until the object is removed or bypassed

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60
Q

Lemniscus

A

Definition: bundle or crossed, secondary nerve fibers in a conscious sensory fibers
- Lesion: always results in contralateral deficits

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61
Q

Falx Herniation

A

The falx cerebri splits the two hemispheres of the brain – here, a unilateral separation may cause the cingulate gyrus to herniate across the midline
- Will see a midline shift, ventricles will be asymmetrical, not always clinical signs of herniation (less severe herniation)

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62
Q

Epidural Hematoma

A

Caused by a fracture of the pterion that ruptures a meningeal vessel causing the hematoma

Clinically: patient loses consciousness, rapid recovery, then loses consciousness again

  • There is an increase in supratentorial cranial volume that causes herniation
  • Can either press against the falx cerebri (falx herniation) or the tentorial notch (tentorial/uncal herniation)
  • Can also get a tonsillar herniation of the cerebellum
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63
Q

Tentorial Herniation

A

This can be caused by an epidural hematoma or tumors above the tentorial notch

  • This causes an opening in the cranial vault – BIG DEAL
  • When volume increases, so does pressure and affects consciousness
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64
Q

Subdural Hematoma

A

Head trauma might cause cerebral veins to rupture as they cross the subdural space

Clinically: onset of symptoms may be delayed for days or weeks – patient will display lethargy, seizures, and headaches

  • In children = due to skull fracture
  • In the elderly = head trauma due to more fragile blood vessels
  • May lead to seizure disorders or cause blood clots in the brain
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65
Q

Other Trauma to the Midbrain

A

Severe blows to the head may cause the incisura to lacerate or contuse the brainstem
- May result in temporary or permanent coma

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66
Q

Thrombosis of Venous Sinus

A

If a blood clot forms in either the straight venous sinus or the left transverse sinus results in ischemia and/or necrosis in the deep cerebrum - FATAL

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67
Q

Papilledema

A

Increased intracranial pressure also increases pressure on the small veins on the optic nerve causing edema of the retina and swelling of the optic disc

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68
Q

Subarachnoid Hemorrhage

A

All of the major blood vessels supplying the CNS pass through the subarachnoid space – rupture of one of these causes the hemorrhage
- Can be detected by blood in a CSF sample

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69
Q

Choroid Plexus Ependymomas

A

One or both of the interventricular foramen may be obstructed by tumors

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70
Q

Astrocytomas

A

Midbrain tumors that obstruct the cerebral aqueduct and causes hypertrophy of the lateral and third ventricles (supratentorial internal hydrocephalus)

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71
Q

Syringomyelias

A

Central canal in the fourth ventricle enlarges and develops a cavity in the center of the cord

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72
Q

Hydrocephalus

A

Symptoms: strabismus (abducens palsy) and papilledema

External Hydrocephalus: excessive of accumulation of CSF in the subarachnoid space

  • Supratentorial external hydrocephalus – most common with Alzheimer’s (senile atrophy of the cortex)
  • Infratentorial external hydrocephalus – seen with communicating hydrocephalus

Internal Hydrocephalus: noncommunicating hydrocephalus – may be due to obstruction of the interventricular foramen (by ependymoma) or cerebral aqueduct (astrocytoma)
- Results in dilation of the ventricles proximal to the obstruction

Communicating Hydrocephalus: combination of infratentorial external and internal hydrocephalus – space between the tentorial notch and midbrain works as communication for CSF and may become obstructed due to adhesions or fibrosis

  • Results in hypertrophy of ventricles and accumulation of CSF in the infratentorial subarachnoid space
  • Treatment: shunt or tube is inserted into the cisterna magna
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73
Q

Ischemic Stroke

A

85% of strokes, caused by an embolism or large artery stenosis

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74
Q

Hemorrhagic Stroke

A

15% of strokes, caused by parenchymal or subarachnoid hemorrhage

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75
Q

Neurohistological Status

A

Normal regional blood flow: ~53 - hypoxic symptoms appear when this drops below 30
Electrical failure:

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76
Q

Watershed Infarction

A

In global ischemia, distal areas of cerebral arterial circulation are hypoperfused and vulnerable to a watershed infarction
- Causes the tissue to be too ischemic to function but critically viable

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77
Q

Thrombosis of Anterior Choroidal Artery

A

Supplies several structures of the midbrain and prone to thrombosis due to its long course in the subarachnoid space
- This is important in Parkinson’s cases

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78
Q

Cerebral Aneurysms

A 
Highest incidence (35%) is in the Anterior Cerebral Artery (ACA)
25% of cases in the MCA, 25% in anterior communicating artery, 10% from basilar artery
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79
Q

Occlusion of ACA

A

Leads to sensory (dystesia of the contralateral leg and foot) and motor (spastic paralysis) deficits

Supplies the middle portion of the brain (in the midline on an angiogram)

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80
Q

Occlusion of the MCA

A

Leads to sensory and motor deficits in the contralateral arm, forearm, hand, and head

  • Also affects Broca’s, Warnecke’s, and auditory areas
  • Temporal branch: difficulty localizing sounds
  • Parietal branch: body neglect, agnosia, apraxia
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81
Q

Broca’s Aphasia

A

Thrombosis results in a motor language disorder where patients have cryptic speech, often frustrated because they can’t get the right words out
- Non-fluent aphasia, but can comprehend what they hear

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82
Q

Warnecke’s Aphasia

A

Obstruction of the MCA, patients are fluent (talkative) but lack content or meaning
- Fluent aphasia, but can’t comprehend what they hear/say

83
Q

Central Cord Syndrome

A

Disruption of blood flow to the anterior spinal artery leading to ischemia in the central region of the spinal cord

84
Q

Compromise of Great Anterior Artery of Adamkiewicz

A

Compromised secondary to thoracolumbar fracture or surgical repair of an abdominal aortic aneurysm (AAA)

85
Q

Lateral Medullary (Wallenburg) Syndrome

A

Thrombosis of the PICA

86
Q

Contralateral Homonymous Hemianopsia w/ Macular Sparing

A

Uncal herniation may compress the PCA (or it may be occluded by thrombosis) causing an ischemic necrosis of the primary visual cortex

87
Q

Coma

A

Neither awake nor aware

88
Q

Persistent Vegetative State

A

Identifiable sleep/wake cycles, no evidence of awareness

thalamus hit the hardest

89
Q

Minimally Conscious State

A

Sleep/wake cycles and reproducible awareness as they respond to simple commands

90
Q

Scalp Lacerations

A

Involves the close, subcutaneous tissue layer and in a deep cut, causes it to bleed profusely because this layer is highly vascular

91
Q

Scalp Avulsions

A

(Removal of the skin layers of the skull) Superficial temporal artery is the major blood source for the aponeurotic layer of the scalp (sutures are usually done here too)

92
Q

Infections of the Skull

A

Infections may readily spread via the emissary veins to the venous sinuses in the loose subaponeurotic layer

93
Q

Depressed Skull Fractures

A

Takes place in the loose subaponeurotic layer layer and includes a scalp hematoma and CSF leakage

Blood may push into the subarachnoid space and describe it as “the worst headache ever”

If the layers tear, may get a secondary chemical-induced meningitis

94
Q

Inflammation of the Parotid Gland

A

Grossly inflamed in cases of epidemic parotitis (bumps) and hypertrophied in chronic bulimia

95
Q

Face Lift Procedure

A

Typically operate in the Superficial Musculo-Aponeurotic System (SMAS) - fascia over the parotid gland

Good for a face lift because they can avoid the facial nerve

96
Q

Lesion to the Nerve to the Stapedius Muscle

A

Causes hyperacusis

97
Q

Temporal Branch Lesion in Frontalis Muscle

A

Normal: raising the eyebrows

Inability to elevate the eyebrows

98
Q

Temporal and Zygomatic Branch Lesion in Orbicularis Oculi Muscle

A

Normal: blinking or winking

Drooping of the lower lid, spilling of tears, corneal drying

99
Q

Zygomatic Branch Lesion in Zygomatic Major Muscle

A

Normal: smiling

Inability to elevate and retract the angle of the mouth (uneven smiling)

100
Q

Bucchal Branch Lesion in Orbicularis Oris Muscle

A

Normal: puckering the lips

Drooling of saliva from the corner of the mouth

101
Q

Cervical Branch Lesion in Platysma Muscle

A

Normal: flaring of neck

Flaring of anterior neck

102
Q

Bell’s or Facial Palsy

A

May be idiopathic, surgical, traumatic, or due to a tumor of the parotid gland (look for large mass on the cheek)

Symptoms: ectropion, spilling of tears, drying of cornea, inability to wink, unequal smile, drooling, hyperacusis

Usually one sided with the compression/lesion of the facial nerve

103
Q

Infections in the Nose

A

May spread to the veins and sinuses, which drain the brain via the anastomoses between the angular and opthalmic veins

104
Q

Trigeminal Neuralgia

A

Intractable pain of the face, usually associated with the dermatomes of the trigeminal nerve

Pain may be due to abnormal seizure-like activity in the trigeminal sensory nucleus

105
Q

Calcification of the Pterygospinous Ligament

A

Ligament may become calcified and obstruct the needle in a maxillary needle block

106
Q

Fracture/Dislocation of the Mandible

A

Neck of mandible fracture: middle meningeal artery and auriculotemporal nerve

Ramus fracture: lingual nerve and inferior alveolar nerve

Body fracture: only the inferior alveolar nerve

107
Q

Jaw Jerk Reflex

A

Used to test the status of a patient’s trigeminal nerve and to help distinguish an upper cervical cord compression from lesions that are above the foramen magnum

Monosynaptic reflex, usually absent or very slight, pathological if strongly present

Stimulus: rapid depression of chin
Afferent: masseteric nerve
Efferent: masseteric nerve
Response: contraction of masseter muscle

108
Q

Age Changes in the Mandible

A 
Mental angles:
Newborn - 175 degrees
Child - 140 degrees
Adult - 110-120 degrees
Elderly - 140 degrees
109
Q

Biting Your Cheek

A

Pain comes from the long bucchal branch of the mandibular nerve

110
Q

Cutting the Temporo-Buccinator Band

A

The distal portion of the long bucchal branch courses deep to this band so if it’s cut, the nerve will also be cut

111
Q

Deep Cut in the Retromandibular Region

A

May cut the spinal accessory nerve

112
Q

Dental and Lingual Referred Pain

A

Because of sensory distribution of the trigeminal nerve, pain from these regions may be perceived as originating from other sensory branches

i.e. infection of the tooth (inferior alveolar nerve) may cause pain that is referred to the ear (auriculotemporal)

113
Q

Nose Bleeds

A

2/3 of the nasal cavity supplied by the third portion of the maxillary artery (sphenopalatine portion)

114
Q

Artery Ruptured with an Epidural Hematoma

A

Middle Meningeal Artery

115
Q

Internal Branch of the Superior Laryngeal Nerve

A

chief sensory nerve to the interior of larynx

If this nerve is not functional, neuroprotection of the LCR is compromised and there is an increased risk for developing aspiration pneumonia.

116
Q

Branchial Arches (1, 2, and 3)

A

Arch 1: mastication

Arch 2: facial expression

Arch 3: pharynx and larynx

117
Q

Transient Hydrocephalus

A

Secondary to subarachnoid hemorrhage, arachnoid villi become temporarily blocked by RBCs causing this

118
Q

Great Vein of Galen

A

Since it drains most of the cerebrum, obstruction is usually fatal

119
Q

Types of Chief Complaints

A 
Abrupt = vascular, trauma, infectious
Progressive = neoplasms and degenerative diseases
Episodic = demyelinating diseases such as MS
120
Q

Babinski Reflex

A

Run monofilament along bottom of foot to see the toes stretch out (pathological except in infants)

Normally, in adults, should see the toes curl

121
Q

Ankle Clonus

A

Actively dorsiflex the ankle - pathological if there are involuntary waves of muscle contractions

122
Q

Glabellar Reflex

A

Tap on the forehead to see if the patient also blinks - pathological

123
Q

Vestibular System Symptoms

A

Nystagmus, vertigo, vomiting, postural impairment

124
Q

Cerebellar System Symptoms

A

Dysmetria, dysdiadochokinesia, ataxia, slurred speech

…may be mistaken for alcoholism lol

125
Q

Pyramidal System Symptoms

A

Spastic paralysis, hyperreflexia, hypertonia

126
Q

Type of Traumatic Brain Injury

A

Group 1: no external signs of injury
Group 2: external signs, no focal Neuro signs
Group 3: disorientation, loss of consciousness, trauma, change in vitals

127
Q

What is needed to go from coma to arousal/wakefulness?

A

EAA and acetylcholine

128
Q

What is needed to go from arousal/wakefulness to awareness?

A

Norepinephrine and serotonin

129
Q

What is needed to go from awareness to alertness?

A

Dopamine

130
Q

EAA: Reticular Activating System and Parabrachial Nuclei

A

RAS: dorsal and central pathways, medulla
PN: only ventral pathways, pons

MAJOR NT HERE: EAA/glutamate
Problems here = persistent vegetative state

131
Q

Cholinergic System

A

Location: PPT and LDT
Major NT: acetylcholine

Problems here: Alzheimer’s

132
Q

Noradrenergic System

A

Location: locus ceruleus
Major NT: norepinephrine

Responsible for the startle and alerting responses (can see this on an EEG)

133
Q

Serotonergic System

A

Location: raphe nuclei

Responsible for quiet awareness, paying attention, mood, pain

During release = euphoria
During depletion = dysphoria

134
Q

Dopaminergic System

A

Location: ventral tegmental area and substantia nigra

Responsible for alertness, cognitive functions, emotions

Might be able to give levadopa to people in vegetative state

135
Q

Lesion to the Greater Superficial Petrosal Nerve

A

Decreased lacrimation

136
Q

Lesion to Chorda Tympani

A

Loss of taste sensation from the anterior 2/3’s of the tongue and decreased salivation

137
Q

Bucchal Branch Lesion to Buccinator Muscle

A

Normal: manipulation of food in the mouth and sucking or blowing actions

138
Q

Great Vein of Galen

A

Since it drains most of the cerebrum, obstruction is usually fatal

139
Q

Types of Chief Complaints

A 
Abrupt = vascular, trauma, infectious
Progressive = neoplasms and degenerative diseases
Episodic = demyelinating diseases such as MS
140
Q

Babinski Reflex

A

Run monofilament along bottom of foot to see the toes stretch out (pathological except in infants)

Normally, in adults, should see the toes curl

141
Q

Ankle Clonus

A

Actively dorsiflex the ankle - pathological if there are involuntary waves of muscle contractions

142
Q

Glabellar Reflex

A

Tap on the forehead to see if the patient also blinks - pathological

143
Q

Vestibular System Symptoms

A

Nystagmus, vertigo, vomiting, postural impairment

144
Q

Cerebellar System Symptoms

A

Dysmetria, dysdiadochokinesia, ataxia, slurred speech

…may be mistaken for alcoholism lol

145
Q

Pyramidal System Symptoms

A

Spastic paralysis, hyperreflexia, hypertonia

146
Q

Type of Traumatic Brain Injury

A

Group 1: no external signs of injury
Group 2: external signs, no focal Neuro signs
Group 3: disorientation, loss of consciousness, trauma, change in vitals

147
Q

What is needed to go from coma to arousal/wakefulness?

A

EAA and acetylcholine

148
Q

What is needed to go from arousal/wakefulness to awareness?

A

Norepinephrine and serotonin

149
Q

What is needed to go from awareness to alertness?

A

Dopamine

150
Q

EAA: Reticular Activating System and Parabrachial Nuclei

A

RAS: dorsal and central pathways, medulla
PN: only ventral pathways, pons

MAJOR NT HERE: EAA/glutamate
Problems here = persistent vegetative state

151
Q

Cholinergic System

A

Location: PPT and LDT
Major NT: acetylcholine

Problems here: Alzheimer’s

152
Q

Noradrenergic System

A

Location: locus ceruleus
Major NT: norepinephrine

Responsible for the startle and alerting responses (can see this on an EEG)

153
Q

Bucchal Branch Lesion to Buccinator Muscle

A

Normal: manipulation of food in the mouth and sucking or blowing actions

154
Q

Lesion to Chorda Tympani

A

Loss of taste sensation from the anterior 2/3’s of the tongue and decreased salivation

155
Q

Lesion to the Greater Superficial Petrosal Nerve

A

Decreased lacrimation

156
Q

Dopaminergic System

A

Location: ventral tegmental area and substantia nigra

Responsible for alertness, cognitive functions, emotions

Might be able to give levadopa to people in vegetative state

157
Q

Serotonergic System

A

Location: raphe nuclei

Responsible for quiet awareness, paying attention, mood, pain

During release = euphoria
During depletion = dysphoria

158
Q

Oligodendrocytes

A

Myelinate the CNS only! (brain and spinal cord)

Covers multiple axons at once, opposite to Schwann Cels

159
Q

Microglia

A

Act like monocytes/macrophages = do phagocytosis

160
Q

Ependymal Cells

A

Outline the choroid plexus and produces the CSF

Also broken down into ependymal cells vs tanycytes which also make CSF

161
Q

Dural Venous Sinus Blood Flow

A

Goes from the brain to the heart

162
Q

Landmarks of the Neck

A

Greater cornu of the hyoid bone
Cervical vertebra 6
Anterior scalene muscle

163
Q

VNM ANM

A 
V = subclavian vein
N = phrenic nerve
M = anterior scalene muscle
A = subclavian artery
N = brachial plexus
M = middle scalene muscle
164
Q

1/6 of the time…

A

The suprascapular comes off of the transverse cervical artery instead of the thyrocervical trunk

165
Q

Innervation of Submandibular Gland

A

Parasympathetic: Superior salivatory nucleus –> (CN7) –> chorda tympani –> joins with the lingual nerve –> submandibular ganglion –> glands

Sympathetic: facial plexus delivers postganglionic fibers

166
Q

GSE Fibers to ALL Intrinsic Muscles of the Tongue

A

Hypoglossal Nerve (CN 12)

167
Q

Thyroid Arteries

A

Superior: comes from the common or external carotids
Inferior: comes from thyrocervical trunk

168
Q

Surgical access to the esophagus is easier from the ____ side

A

LEFT

169
Q

NE and Epi Receptors

A

Alpha 1: Gq
Alpha 2: Gi
Beta: Gs
(metabotropic)

170
Q

Dopamine Receptors

A

D1-like (D1 and D5): Gs
D2-like (D2, 3, 4): Gi
(metabotropic)

171
Q

Serotonin Receptors

A 
5HT1 - Gi
5HT2 - Gq
5HT3 - vomiting (ionotropic)
5HT6 - anti-depressants
5HT2c - normal body weight/prevent seizures
172
Q

Histamine Receptors and Location

A

Location: hypothalamus

H1 and H2: neuronal effects (metabotropic)
H3: inhibits release of histamine

173
Q

Acetylcholine Receptors

A 
Muscarinic (metabotropic)
M1 - neuronal - Gq
M2 - cardiac - Gi
M3 - smooth muscle - Gq
M4 - glands - Gi

Nicotinic: all ionotropic for sodium

174
Q

GABA Receptors and Location

A

Location: higher CNS
GABA-A: ionotropic for chloride
GABA-B: metabotropic, Gi and Gq (Gi wins though)

175
Q

Glycine Receptor and Location

A

Location: Lower CNS

only one receptor, ionotropic for chloride

176
Q

Opioid Precursors

A

Proenkephalins, POMCs, prodynorphins, orphanin Q

177
Q

Opioid Receptors

A

Metabotropic: Mu, Kappa, and Delta

Delta important for treating only pain!

178
Q

Endocannabinoid Receptors

A

Metabotropic:
CB-1: reduces NT release, Gi
CB-2: anti-inflammatory

179
Q

Ascending Cervical Artery runs with ____

A

Phrenic Nerve

180
Q

Inferior Laryngeal Artery runs with ____

A

Recurrent Laryngeal Nerve

181
Q

Common Carotids bifurcate at the level of ____

A

The Hyoid

182
Q

Which vein primarily drains the brain?

A

Internal Jugular Vein

183
Q

Solitary Nucleus deals with ____

A

sensory innervation from the posterior 1/3 of the tongue all the way down to the transverse colon

184
Q

EAA (glutamate/aspartate) Receptors and Location

A

Location: widespread
Receptors: ionotropic - NMDA and non-NMDA

185
Q

Sympathetics to the Head

A

Comes from T1 mostly

186
Q

Innervation to the Parotid Gland

A

Parasympathetic: inferior salivatory nucleus –> (CN9) –> lesser petrosal nerve –> otic ganglion –> auriculotemporal nerve –> parotid gland

Sympathetic: carotico-tympanic nerve from the SCG/internal carotid plexus

187
Q

Innervation to the Lacrimal Gland

A

Parasympathetic: superior salivatory nucleus –> (CN7) –> greater petrosal nerve –> vidian nerve –> sphenopalatine ganglion –> zygomatic nerve –> lacrimal gland

Sympathetic: deep petrosal nerve from internal carotid plexus forms the vidian nerve

188
Q

Innervation to the Eye

A

Parasympathetic: Edinger-Westphal nucleus –> (CN3) –> ciliary ganglion –> ciliary muscle + sphincter pupillae

Sympathetic: SNS branch to the ciliary ganglion from the internal carotid plexus

189
Q

Circumventricular Organs (those not covered by the BBB)

A
  1. Posterior Pituitary
  2. Area Postrema
  3. Organum Vasculosum of the Lamina Terminalis (OVLT)
  4. Subfornical Organ
190
Q

Larynx stretches from which vertebra?

A

CV4-6

191
Q

Name for “Adam’s Apple”

A

Laryngeal Prominence

192
Q

Where does the recurrent laryngeal nerve come from?

A

VAGUS NERVE!

193
Q

GSE Nerve Fibers

A

Innervate voluntary skeletal muscles

CN 3, 4, 6, 12 (eyes and tongue)

194
Q

GSA Nerve Fibers

A

Innervates skin, oral/nasal cavity, sensory

CN 5, 7, 9, 10

195
Q

GVE Nerve Fibers

A

CN 3, 7, 9, 10 and their respective innervations (both parasympathetic and sympathetic)

196
Q

GVA Nerve Fibers

A

CN 7, 9, 10 (both parasympathetic and sympathetic)

197
Q

SSA Nerve Fibers

A

Seeing and hearing

CN 2 and 8

198
Q

SVA Nerve Fibers

A

Smell and taste

CN 1 and 7, 9, 10

199
Q

SVE Nerve Fibers

A

Motor to muscles of the face

CN 5, 7, 9, 10, 11

200
Q

Anastomoses Around the Orbit

A

Includes the facial artery and vein, supratrochlear artery and vein, and the supraorbital artery and vein

201
Q

Retromandibular Vein Drains ____

A

The temporal and cheek regions.

Important for dissection of the facial artery

202
Q

What passes between the sphenomandibular ligament?

A

Maxillary artery and auriculotemporal nerve

203
Q

Importance of the Stylomandibular Ligament

A

Biomechanically makes it much easier to open the mouth

Neuroscience (4 decks)

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