Module 8 - New Flashcards
1
Q
usual and most common
usual manifestation of parkinson’s disease
A
Hyposmia
Patients with Parkinson’s Disease sometimes
testing for the olfaction is the most variant test kasi
hyposmia is the most common manifestation in
Parkinson’s disease. Minsan hindi nila naamoy yung mhga
bagay bagay.
2
Q
Carries signal from hippocampus to
mamillary bodies and septal nuclei
A
Fornix
Lesion: Memory impairment
3
Q
Is the “gateway” to the cerebral cortex
A
Thalamus
4
Q
You suspected a patient with RIGHT defective hearing loss, upon doing the WEBER’s test, the patient hears the sound louder on the RIGHT ear. What does this mean?
a. the patient has normal hearing
b. the patient has conductive hearing loss
c. the patient has sensorineural hearing loss
A
b. the patient has conductive hearing loss
Conductive hearing loss = defective ear hears tuning
fork sound louder
5
Q
________ one of the substances in garlic can be
smelled at very low concentration showing the remarkable
sensitivity of olfactory receptors
A
Methyl marcaptan
6
Q
produce antidiuretic hormone (ADH, Vasopressin)
A
Supraoptic nucleus
7
Q
Weber Test Procedure
A
Before the procedue, know which ear is defective
- Place tuning fork in the middle of the Px’s forehead,
or on top of head equi-distant from px’s ears. - Px must report which ear the sound is heard louder
8
Q
Responsible for the connection to
the limbic system.It is purely for emotions.
A
anterior nuclear group
9
Q
In testing for olfactory impairments, the following should be done EXCEPT:
A. Test the nostrils one at a time
B. Place the subtance in opaque/colored vial
C. Allow the patient to open his eyes during test
D. Use mild smelling stimuli such as bath soaps, orange peels, coffee, and mint;
E. Avoid strong smelling stimuli because these will
stimulate the nociceptors of the Trigeminal Nerve.
A
C.
You should ask the patient to close his eyes during the examination
10
Q
produce Oxytocin
A
Paraventricular nucleus
11
Q
short term memory to long term memory
A
hippocampus
Lesion: Can’t build new memories; everything new the px
experiences fades away but old memories before damage are
untouched
12
Q
Px comes to you “Doctor, 10 mins ago
ngumiwi yung left side ko; mas mahina po tong
arms ko kaysa sa face ko.” What arterial territory
affected?
A
- Middle cerebral artery
- Contralateral weakness face and arm > leg
- Somatic motor area
13
Q
Px would tell you “Dr. di ko makita yung
sa kanan banda taas”. What arterial territory
affected?
A
- posterior cerebral artery
- Homonymous hemianopsia with macular sparing Contralateral achromatopsia
- Occipital Lobe (Visual)
14
Q
Rinne test
A
- Place 512Hz (high frequency tuning fork) against px’s
mastoid bone - Ask px when sound is no longer heard
- Once px signals that there is no more sound, place
the still vibrating tuning fork 1-2cm from the auditory
canal - Ask px again if they can still hear the tuning fork
15
Q
Lesions central to cochlear nuclei
A
(affects both ears)
BILATERAL DEAFNESS (because CENTRAL PATHWAYS
are bilateral)
16
Q
Lesions of cochlear nuclei (or cochlear nerve)
a. UNILATERAL DEAFNESS
b. BILATERAL DEAFNESS
A
A.
17
Q
Humans can recognize how many odors?
A
more than 10,000 different odors
18
Q
is responsible for motor function
A
Lateral nuclear group
19
Q
Recognition/ recollection memory
A
Mamillary Body
Lesion: Amnesic syndromes
20
Q
All sensory info going to the brain has to make a pit stop at
the thalamus in order to be relayed appropriately EXCEPT
A
Olfactory
21
Q
- Triad: dementia, steppage gait/ataxia, sphincteric incontinence
- Px may complain of bifrontal or bioccipital headaches
- frontal lobe disorder of mentation or of gait
- Slowness of mental response (abulla), inattentiveness, distractibility, preservation, and inability to plan activity or to sustain any type of complex cognitive function are characteristic
A
CHRONIC HYDROPCEPHALUS (OCCULT)
- Misnomer since CSF pressure is elevated episodically when
measured over time (pressure may wax and wane) - Affects usually elderly patients.
- In most cases the cause is unknown
22
Q
Lateral geniculate body and Medial geniculate body are parts of
A. DORSAL THALAMUS
B. METATHALAMUS
C. PITUITARY
A
B. METATHALAMUS
Take note!! may dalawang part sa dorsal thalamus which
is really not part of the dorsal thalamus which are the
MEDIAL GENICULATE BODY and the LATERAL
GENICULATE BODY. They are part of the
MetathalamusREMEMBER THAT!
23
Q
fears, anxiety, pleasant and unpleasant
A
amygdala
Lesion: Social and emotional deficits
24
Q
Which ossicular bone rocks in and out, causing the oval window
to create pressure waves within the Perilymph of the
scala vestibuli
A
Stapes
25
vestibular organs for linear?
Utricle and saccule
26
Which part of diencephalon is responsible for melatonin- sleep-wake cycle
Epithalamus
27
Eye velocity compensates for head velocity
Vestibulo-ocular reflex
▪ Eye velocity compensates for head velocity
28
Gravity abd other linear accelerations
Otoliths
29
Cingulate Gyrus
- NEUROPATHIC PAIN
and NOCICEPTION, Autonomic function (heart rate, BP,
cognitive, and attention processing)
30
Which structure in CNS is responsible for conscious perception of smell
Frontal cortex
31
What is the formula for the Cerebral Perfusion
Pressure? \_\_\_\_\_\_\_\_\_
CPP=MAP-ICP
32
Responsible for the bsorption of CSF and thought to act as functional valves that permit unidirectional “bulk flow” of CSF into the vascular lumen
arachnoid villi
33
Lesion in lateral medulla with symptoms of Vertigo, nystagmus, vomiting, ipsilateral facial
numbness and dysmetria, Horner’s syndrome
PICA
34
Tests for increased ICP?
Brudzinki's and Kernig's tests
_KERNIG’S SIGN_
• With the Pt supine as for the straight-knee leg-
raising test, keep the knee flexed and flex the limb
at the hip. When the thigh reaches the vertical
position, gently, gently straighten the knee. The Pt
will wince with pain, and the reflex hamstring
spasm will prevent further straightening of the
knee
_BRUDZINKI’S SIGN_
• In Pts with suspected meningeal irritation, test for
nuchal rigidity and concomitant leg flexion (Brudzinski’s sign)
• When testing for nuchal rigidity, watch for
adduction and flexion of the legs
• Flexion of the neck places tension on the
entire cord and roots. Flexion of the legs
reduces stretch on nerve roots
35
In Rinne Test, if the result is BC \> AC what does it mean?
ABNORMAL HEARING
BC \> AC
Px not able to hear after mastoid placement test. There is
something inhibiting passage of sound waves from the ear
canal, thru middle ear apparatus and into the cochlea (i.e.,
conductive hearing loss)
\*In sensorineural hearing loss, both AC and BC are BOTH
diminished. Px usually can hear better on the mastoid process
than air process, but indicate the sound has stopped much
earlier than the conductive loss patients.
(In conductive hearing loss, yung air process lang yung hindi
na naririnig pero yung mastoid placement, rinig parin. Pero sa
sensorineural, pwedeng parehong air process and mastoid
placement process yung hindi na naririnig OR pwede marinig
yung sa mastoid placement process pero masyadong maikli
yung time ng pandinig compared sa normal)
36
CSF CIRCULATION
| (LIT AF)
LIT AF:
Lateral v. \> interventricular foramina of Monro \>
Third V. \> Aqueduct of Sylvius \> Fourth Ventricle \>
Foramen of Luschka (lateral) and Magendie (medial) \>
Subarachnoid space \> Arachnoid villi
37
Px comes in complaining, “Doc, 3 hrs ago
naka-experience ako mag-weaken yung right leg
ko“ What arterial territory affected?
* Anterior Cerebral Artery
* Contralateral weakness leg and foot \> arm
* Mesiofrontal region bilateral
38
* The complete circle is seen in only 20 – 25% of individuals (Normal variants)
* One or both Pcom's are hypoplastic in 34%
* The precommunicating segment of ACA (A1) may be absent or hypoplastic (25%)
* Bilateral hypoplastic P1 segments (11%)
* Important in MRI and CT angio; know what are the normal variants
Circle of Willis
39
most accepted explanation of how
emotions occur
Papez circuit
hippocampal formation \> mamillary body \> anterior nuclei of thalamus \> gyrus cinguli \> hippocampal formation....
40
Correct pathway for auditory?
cochlear nerve synapse to dorsal and ventral cochlear nuclei \> decussate in trapezoid body \> ascend to lateral lemniscus \> into brachium of inferior colliculus \> Medial Geniculate Body \> Internal Capsule \> Primary Auditory Cortex
41
Which structure is beneath the dorsal thalamus and lies between the optic chiasm and the mammillary bodies
Hypothalamus
42
Ipsilateral dysmetria, hearing loss, Horner’s syndrome
AICA
43
Helps regulate behaviors like eating and reproduction
Limbic sysem with inputs via fornix
44
Parts of Limbic Lobes
\*COPS\*
_Cingulate gyrus_
_Orbitofrontal cortex_
_Parahippocampal gyrus_
_Subcallosal gyrus_ - depression
45
CSF is produced by the
Choroid plexus
46
Functions include the following:
• Control of the autonomic nervous system
• Control of emotional responses
• Regulation of body temperature
• Regulation of hunger and thirst sensations
• Control of behavior
• Regulation of sleep-wake cycles
• Control of the endocrine system
• Formation of memory
Hypothalamus
47
Expect behavioral problems if this area is damaged or affected
due to trauma because of the orbitofrontal cortex lesion
_Orbitofrontal Cortex\*_
- Function: Required for decision making
OTHERS:
_Entorhinal Cortex_
- Function: Important memory and associative
components
_Piriform Cortex_
- Function: Relates to olfactory system
48
Which structure in CNS is responsible for odor memory
Hippocampus
49
two important semipermeable barriers that protect the
brain and spinal cord from potentially harmful
substances while permitting gases and nutrients to
enter the nervous tissue
Biochemically, the _BCB_ is permeable to water-soluble
substances but not to liposoluble substances such as
anesthetics, psycho-active drugs, and analgesics
• The _BBB_, on the other hand, is generally permeable to
liposoluble substances (mol. Weight \< 500 daltons) but
not to water-soluble substances
50
Signs: Quadriplegia, horizontal gaze paralysis, bifacial paralysis
Locked in syndrome
Lesion: Lower Pons
Basilar Artery
51
Relay station of audition, Receive fibers from inferior colliculus, Projects to auditory area via acoustic radiation
Medial Geniculate Body (MGB)
M=MUSIC
52
demonstrated that the bilateral removal of the temporal lobes in monkeys—including the amygdala and the hippocampal formation, as well as the non-limbic temporal cortex produced an
extreme behavioral syndrome
Kluver and Bucy
This is not common to human
53
Oxytocin and ADH are produced in hypothalamus but secreted in
posterior lobe of hypophysis
54
Which part of the ventricular system contains
choroid plexus?
a. Cerebral aqueduct
b. Frontal horn
c. Interventricular foramen
d. Occipital horn
e. Third ventricle
E
55
\_\_\_\_ pain fibers found in olfactory membrane
trigeminal
• They are stimulated by irritating substances
• Are responsible for initiating sneezing, lacrimation and
other reflex responses.
So everybody asked you to test CN I. Diba sinasabi
naming sa inyo wag yung mga strong stimulant because it
will also stimulate the Trigeminal nerve. Because many
trigeminal nerve fibers are also found in the olfactory
membrane. So kapag yung mga irritating substances,
kapag gagamitin natin, It will only not stimulate CN I but
also stimulate CN V. that is the reason why ayaw natin ng
malalakas na substances katulad ng mga perfume, yung
alcohol, we don’t want that because it’s irritating.
56
Connects to the limbic system (amygdala and hippocampus)
Median striae
So kunyare, diba may ibang tao na sobrang ‘Ay ayoko
nung amoy nay yun ang baho!’ pero sa ibang tao hindi
mabaho diba. So that is why ganun yung perception
natin the smell of things.. Kasi there is the
component..there is the limit component sa mga
naamoy natin. Ok so that is the function of the Medial
striae.
57
site for seizures (may be preceded by
hallucination of disagreeable odors, reflecting olfactory
function)
Temporal lobe seizures propagate to the other parts and since
ang pinakamalapit sa temporal lobe ay olfactory cortex, affected
agad ito pag nagkalesion sa temporal lobe
58
controls body temp
Anterior Hypothalamic Nucleus
59
When the hair cells move away, the direction of the
kinocilum, the potassium channel will close and the
calcium channel will also follow. There is no aspartate and
glutamate that will be released in the hair cells therefore it
will _______ the vestibular system therefore it will be
inhibited.
hyperpolarize
60
What makes olfactory pathway different from other cranial nerves?
It oes not pass through thalamus. mucous membrane, the stimulant will go to the receptors and then it will go up to the Cribriform plate. Then it will synapse with the mitral cells and the tufted cells (sa may loob na to ng olfactory bulb) which will form the glomeruli and then this glomeruli will synapse with the Granule releasing glutamate then going to the olfactory cortex.
61
When you ride a rollercoaster, even you close your eyes, you will know what direction you are spinning. This is because of?
Semicircular canals
62
white part of the thalamus.
Interthalamic adhesion
63
A condition in which there is ventricular enlargement
under tension as a result of an obstruction to the flow
at CSF at some point in the ventricular pathway
o Aqueduct of Sylvius
o Medullary foramens of exit (Luschka and
Magendie)
o Basal subarachnoid space
HYDROCEPHALUS
64
Rate of CSF production per day: \_\_\_\_
Site of CSF production: \_\_\_\_
Site of CSF absorption: \_\_\_\_
500ml/day
Choroid plexus
Arachnoid villi
65
Distorted sense of smell
Anosmia – absence of sense of smell
Hyposmia – diminished olfactory sensitivity
Dysosmia – distorted sense of smell (usually psychiatric patients)
66
In ______ acceleration, when there is movement of cupula/ cupula displacement, there will be \_\_\_\_\_\_. It matters
kung ano ang maactivated which is right or left. Pero ang \_\_\_\_,
unlike the haircells, wala siyang inhibition. Everytime it
moves, it always have depolarization.
Angular, depolarization, cupula
67
ALL these have NO protection or BBB Except
A. Vascular Organ of the Lamina Terminalis
B. Area postrema
C. Median eminence
D. Pineal body
E. Posterior pituitary
F. Subfornicial organ
G. NONE OF THE ABOVE
H. ALL OF THE ABOVE
H. ALL OF THE ABOVE
AREPECIALIZED AREAS WITHOUT BBB
68
is responsible for sensory
Medial Nuclear Group
69
* Ultimate drainage of superior sagittal sinus? \_\_\_\_\_
* Decreased CPP is caused by ___ ICP?
* Vertebral arteries unite to form what artery? \_\_\_\_\_
* Volume of CSF produced per day? \_\_\_\_\_
* Vertebral artery enters the skull through the \_\_\_\_
* Immediate drainage of inferior sagittal sinus? \_\_\_\_\_
* Internal Jugular Vein
* Increased
* Basilar Artery
* 150mL
* Foramen magnum
* Straight sinus
70
Contralateral weakness of leg and arm,
hemisensory loss, ipsilateral tongue paralysis
LESION: Medulla and cervical spinal cord
Vertebral Artery
71
Three nuclear group is divided by
divided by internal medullary lamina
- anterior, lateral and medial nuclear group
72
controls blood pressure
Medial Preoptic Nucleus – controls blood pressure
73
Lumbar puncture: lie on a lateral decubitus position
and insert spinal needle at \_\_\_\_\_\_; normal \_\_mmHg
L3-L4, 8mmHg
Importance: safe site for spinal tap/lumbar puncture; dito rin
pinakamarami ang CSF (Again, ilang ml nga ang meron sa area na
ito? _30ml of CSF)_
74
In Rinne test, if the result is AC \> BC what does it mean?
Normal hearing. Px should be able to hear tuning fork next to the pinna after they can no longer hear it when placed against the mastoid
75
Postural changes in response to vestibular signals
Vestibulospinal reflex
▪ Postural changes in response to vestibular signals
76
they cannot tell what’s wrong with them so lethargy is
one of the manifestations; sunset sign. Common in children. In children There is frontal bossing and the skull tends to be
brachiocephalic. With marked enlargement of the skull, the face looks relatively small and pinched and the skin over the cranial bones is tight and thin, revealing prominent
distended veins
CHRONIC HYDROCEPHALUS (CONGENITAL)
77
Dorsal thalamus, Metathalamus, Epithalamus, Subthalamus, Hypothalamus are collectively called as
Diencephalon
* It has numerous connections
* Forms the center core of the forebrain
* Surrounded by the cerebral hemispheres
* Composed of three paired structures:
▪ Thalamus, hypothalamus, and epithalamus
* Border the third ventricle
* Primarily composed of gray matter
* What does it mean? The Gray matter is composed of cell
bodies. White matter is composed of axons and dendrites.
So it means, siya yung nagrerelay ng information because
it consists of cell bodies.
78
Which striae in olfactory pathway is not found in all humans?
Intermediate stria (function is unknow). All humans have medial and lateral stria.
79
You suspected a patient with RIGHT defective hearing loss, upon doing the WEBER's test, the patient hears the sound better on the LEFT ear. What does this mean?
a. the patient has normal hearing
b. the patient has conductive hearing loss
c. the patient has sensorineural hearing loss
c. the patient has sensorineural hearing loss
Sensorineural hearing loss = normal ear hears tuning
fork sound better (indicates sensorineural hearing
loss on the other (defective) ear
80
Ipsilateral limb ataxia, vertigo, nystagmus, dysarthria, gait ataxia
lesion involving dorsolateral upper brainstem, cerebellum, superior cerebellar peduncle
SCA
81
each Glomerulus can
be stimulated by how many stimuli?
one
82
Triad: Ptosis, Anhidrosis, Miosis
Horner’s syndrome
83
Which structure in CNS is responsible for motivational and emotional aspect
Hypothalamus and amygdala
84
Kahit sirain mo yung cortical areas ng animals, meron
pa rin daw silang emotion. Which theory?
Cannon-Bard Theory of Emotions
85
angular accelerations
Semicircular canals
86
45F comes to your clinic with severe headache and backace, nausea, fever, photophobia and phonophobia and with altered mental status. What is your clinical impression?
MENINGITIS
Presence of the triad: Fever, focal neurologic signs, nuchal rigidity
with altered mental status
OTHER CNS INFECTIONS:
* _Meningitis:_ leptomeninges and CSF spaces
* _Ventriculitis_: ventricular system
* _Encephalitis:_ gray and white matter of the brain
* _Myelitis:_ spinal cord
87
\_\_\_\_\_\_\_\_\_ frequency traveling waves displaces the base of cochlea and _______ frequency traveling waves displaces the apex
high, low
88
All because of high ICP
Palsies: compression of CN6
Upward gaze
Sometimes no symptoms in severe cases, mostly coma na sila
Headache of varying severity
Vomiting
Becomes drowsy or stuporous
Bilateral Babinski sign are the rule
ACUTE HYDROCEPHALUS
89
Which nuclei relays station of vision, receives fibers from optic tract, projects to visual area via optic radiation
Lateral Geniculate Body (LGB)
L for LIGHT
90
Manifestations (triad) of normal pressure
hydrocephalus\_\_\_\_\_\_\_\_\_
What are the components of the Monro-Kellie
doctrine? \_\_\_\_\_\_\_\_\_\_
triad:
dementia, steppage gait/ataxia, sphincteric incontinence
Monro-kellie doctrine:
Blood, CSF and brain parenchyma
91
Where is the vascular lesion of patient suffering with Locked-in Syndrome: Px aware of surroundings but cannot move
Basilar Artery
