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Medicine UOB > NAS > Flashcards

NAS Flashcards

1
Q

Manifestations of lower motor neurone damage

A

Flaccid muscle weakness
Hypotonia/atonia
Hyporeflexia/areflexia
Denervation muscle atrophy (muscle wasting)
Fasciculations

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2
Q

What do nerves supply?

A

Skeletal muscle
Smooth muscle
Glands

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3
Q

Caused of degeneration of nerves

A

Acquired through injury
Genetics of the body
Natural processes of aging

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4
Q

Which nerves regenerate?

A

Peripheral have the capacity to regenerate and Reinnervate

Central nervous system does not (capacity is there already)

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5
Q

Dysfunction of nerves

A

Environment damaged or interfered
Severity depends on nature of insult

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6
Q

Structured of neurone

A

Epineurium
Perineurium
Endoneurieum
Myelin sheath
Axon

(Getting more deep as you go down)

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7
Q

Fascicle

A

A collection of axons

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8
Q

Seddon’s classifications of nerve injuries

A

Neuropraxia
Axonotomesis
Neurotmesis

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9
Q

Neuropraxia

A

Most minimal
Damaged to peripheral aspects
Temporary loss of function
Most probably at level of myelin sheath
Restoration would be complete upon recovery (ie blood supply back to limbs)

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10
Q

Axonotomesis

A

Damage to axon
Connective tissue tubes remain intact but myelin and axon damaged -> means recovery can attract a new axon to restore function
Result of a severe crush injury to peripheral nerve

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11
Q

Neurotmesis

A

Fractioning of nerve/completely transected
Most severe
Axon and connective tissue all flanged
No recovery of function occurs

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12
Q

Nerve injury is divided into two parts called..

A

Proximal segment
Distal segment

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13
Q

Proximal segment will survive?

A

Yes as closer to cell body and will recurve support

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14
Q

Distal segment will survive?

A

No
Often cut off
Loses potential repairs
Loss of nutritional support
Becomes vulnerable to phagocytosis by glia, some tissues may be preserved to form hollow tubes
Sends signals of death
wallerian degeneration

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15
Q

3 classes of glial

A

Myelin forming -> oligodendrocytes, Schwann cells

Astrocytes (create a good environment)

Microglia (immune)

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16
Q

What happens to the axons after injury? minutes

A

Produce ?injury potentials from proximal
Axons will start leaking intracellular fluid
?neuroma
Sealing and swelling
Synaptic transmission stops

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17
Q

How do microglia react to damaged neurones?

A

Change from surveillance cells to phagocytes

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18
Q

What happens to synapses after injury?

A

hours after AstroGlia remove terminals and move away
So lose input and output
Synaptic terminal degenerates accumulation of neurofilaments/vesicles

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19
Q

Chromatolysis

A

Proximal segments undergoes a few days after injury
Cell body becomes very active -> produce proteins for repair
Swells with new products
Nucleus moves to peripheral
Nerve seals and forms neuroma
Change in colour of cell body

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20
Q

Minutes after injury…

A

Synaptic transmission cut off
Cut end swells

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21
Q

Denervation

A

Loss of nerve supply

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22
Q

Re-innervation

A

Re growth of nerve to re supply

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23
Q

Biochemical structure of muscle

A

Determined by chemicals released by neurone
Ie will change type of neurone that is connected is different

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24
Q

Acute phases of denervated muscle

A

Paralysis immediately
Areflexic
Fasciculate
Atonic
If not reinnervated then fasciculations will subside

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25
Q

Disuse atrophy

A

Loss of muscle due to no use

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26
Q

Chronic phase of denervated muscle

A

Fasciculation subside -> lose bulk due to lack of innervation
Will die
Muscle replaced with connective tissue including fat
State of fibrosis

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27
Q

Rhabdomyolysis

A

Life threatening disorder
Breakdown of skeletal muscle
Release of intracellular contents into circulation
Leads to acute renal failure
Possible death

Causes:
Crush syndrome
Vehicular accidents
Injected substances of abuse into muscle
Over exercise
Certain forms of pathologies that can damage muscles

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28
Q

Reflex definition

A

Stereotyped (predictable)
Involuntary
Rapid
In both somatic and autonomic

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29
Q

Autonomic system

A

Smooth muscles or glands

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30
Q

Somatic system

A

Skeletal muscle

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31
Q

Testing reflexes in clinical

A

Pupillary reflex
Deep tendon reflex

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32
Q

Function of reflexes

A

Protection (limb withdrawal)
Postural control (eg walking)
Homeostasis (Bp)

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33
Q

Neural components of a reflex arc…

A

Sensory receptor
Afferent neurones
Somatic: directly though integration or to efferent
Efferent
Effector

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34
Q

Interneurones

A

-> relay neurones

Take information from various inputs
Found in CNS - spinal cord, brain stem nuclei, and enteric
Part of integration

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35
Q

Can influence integration?

A

Can modulate by other inputs
Eg your brain can over come something hot etc

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36
Q

Efferent neurones

A

Bring about response
Inner age effectors

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37
Q

Effectors

A

Glands/muscle
Appropriate response

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38
Q

Myotatic

A

Simple stretch reflex
Posture
Adjust degrees of contraction in skeletal muscle
Sensory receptors: proprioreceptors

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39
Q

Proprioreceptors types

A

Muscle spindle
Golgi tendon organ

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40
Q

Muscle spindle reflex

A

Found in skeletal muscles

Monosynaptic, no interneurone (Direct afferent efferent connection)

Increased stretch ie lifting weight
Increase sensory/Motor activity -> increase ach

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41
Q

Why is muscle spindle reflex useful?

A

Why?
Increase contraction so prevent damage

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42
Q

Why is it important that the muscle spindle sensor neurone branches?

A

Relaxes paired muscle

The branch will then go to interneurone where inhibits motor

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43
Q

Golgi tendon organ

A

Reverse myotatic reflex

Increase contraction
Increase sensory activity
Interneurone is inhibitory
So will block efferent activity
Muscle activity decrease

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44
Q

What does GTO help?

A

Prevent damage due to over work
Stops the ripping of muscle
Fine control of muscle tension

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45
Q

Crossed extensor reflex

A

Pain
Sensory neurone increased activity and branches
Communication with brain -> ouch
Effects motor neurones from many interneurones
Effect:
-lift foot with pair of muscle (contract and relax)
-transfer weight back onto other foot

Connections through spinal cord to other side of body

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46
Q

Electrical excitability

A

Are able to momentarily discharge the standing electrical potential between the intra and extra compartments

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47
Q

How all living cells establish a resting membrane potential

A

Selectively concentrating various combinations of species of charge carrying particles within the intracellular compartment

Results in conc differences

Energy differences then give rise to an electrical potential

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48
Q

Use of a cells membrane

A

Defines the cells boundaries
Encloses the organelles
Enables the cell to create an internal environment that promotes normal functions
Creates an internal environment that is different from outside

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49
Q

A phospholipid is made from…

A

Phosphate
Glycerol
Fatty acid

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50
Q

What are charge carrying molecules?

A

Organelle
Proteins
Anions and cations

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51
Q

What is the resting potential of nerve cells?

A

-65 to -70mv

Relatively negative inside cell

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52
Q

What happens to the resting membrane potential at death?

A

Discharge permanently

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53
Q

What are excitable tissues?

A

Nerve
Muscle
And some gland

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54
Q

How to create an intracellular compartment?

A

Selectively permeable membrane
Some particles can cross (assisted maybe)
Some can’t
Transport ATPases
Presence of ion channels
Non-selective ion channels

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55
Q

What factors effect the movement of a particle across the membrane?

A

Size
Electrical charge
Whether it’s recognised by transport systems

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56
Q

What are ion channels?

A

Protein in the membrane
Trans-membrane spanning proteins
Water filled central pore
Facilitate passive movement
Some are selective/some not

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57
Q

Most common ion channel types

A

Voltage gated
Ligand gates
Mechanically gated
Non-gated
Leak

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58
Q

What are ion pumps?

A

In cell membrane
maintain rmp
Don’t set up RMP
Some Known as ion-exchange pumps

Without max 10mv difference in RMP so not crucial

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59
Q

What is discharge?

A

No unequal distribution
No RMP
0mv

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60
Q

Concentration gradients of:
Na+
K+
Cl-
Ca2+

A

Inside
Low Na+ 15mM
High K+ 150mM
Low Cl- 9mM
Low Ca2+ 10^-7mM

Outside
High Na+
Low K+
High Cl-
High Ca2+

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61
Q

What is a graded depolarisation?

A

The level that the membrane is depolarised is linked to the strength of the stimulation

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62
Q

Threshold level…

A

Is the level of membrane potential at which graded depolarisations become an action potential

It’s different in different tissue types

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63
Q

Factors that determine the movement during an action potential

A

The concentration differences at RMP
depolarisation
When the AP is generated

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64
Q

At rest, what is the movement of ions?

A

K+ under a conc gradient of them moving outside, however the negative charge prevent diffusion

Na+ large conc outside cell, want to diffuse in

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65
Q

Nernst equation used for?

A

Calculate the membrane potential at equilibrium for each of ions

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66
Q

Nernst equation is

A

Eion = RT/zF ln ([outside]/[inside])

R is gas Constant
T is temp in kelvin
Z is valency of ion
F is faradays number

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67
Q

What is the Goldman Hodgkin Katz equation?

A

Modification of Nernst equation
Takes into account relative permeability of ions
As ion channels can change permeability

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68
Q

How is RMP maintained?

A

Slow leak of Na+ ions into cell and K+ ions out of the cell

Sodium potassium ATPase maintains ionic conc grad over time

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69
Q

Why is the RMP close to the Ek?

A

As the membrane is more permeable to potassium

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70
Q

Why is there little cl- movement?

A

As RMP is very close to E Cl-

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71
Q

Depolarisation steps in AP

A

Na+ enters cell
Membrane depolarises
To threshold
Na+ channels open (vg)

K+ channels open (vg)
Peak
Inactivates Na+ channels
More vg K+
K+ efflux
Repolarises

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72
Q

What are the basic cell components of the CNS?

A

Neurones
And glia

73
Q

What’s soma?

A

The cell body of a neurone

74
Q

How is the nervous system organised? 3 ways

A

Peripheral vs central
Motor vs sensory
Somatic vs autonomic

75
Q

Structure of neurone?

A

Cell body
Dendrites
Axon
Synapses

76
Q

Parts of the CNS are?

A

Brain
Spinal cord
Three meningeal layers:
Dua mater, pia mater, arachnoid

77
Q

What does the PNS do?

A

Connect CNS to target organs
Connects sensory to CNS
CNS integrated information

78
Q

What does PNS include?

A

31 spinal nerve pairs
12 cranial nerve pairs
Ganglia
Nerve plexuses
Enteric nervous system

79
Q

What are ganglia?

A

Swelling or branches of nerve tissue

80
Q

What are nerve plexuses?

A

Networks of nerves carry both afferent and efferent
Brachial/lumbar/sacral

81
Q

Three main types of neurones

A

Multipolar (multi to one)
Bipolar (one to one)
Pseudo-unipolar (doesn’t go through cell body)

82
Q

What are glial cells used for?

A

Responsible for creating optimum micro environment for neuronal activity

83
Q

What are the four types of glial cells?

A

Astrocytes
Microglia
Ependymal
Oligodendrocytes

84
Q

What shape are astrocytes?

A

Star dhaped

85
Q

What are astrocytes used for?

A

Maintain BBB
Provide structural and metabolic support
Maintain synapses (clear up)

86
Q

What are microglia used for?

A

Immune function
So are phagocytic and clear up dead neurones as well as preventing pathogens

87
Q

What are ependymal cells used for?

A

synthesis of CSF

88
Q

What is CSF useful for?

A

Nutrients
Microenvironment
Protection
Boyancy

89
Q

What type of cells are ependymal cells?

A

Simple ciliated epithelial cells

90
Q

What do oligodendrocytes do?

A

Create myelin sheaths in CNS
Provide metabolic support
And electrical insulation

91
Q

What is a glial unit?

A

One oligodendrocyte wrapped around one part of an axon

92
Q

What do Schwann cells do?

A

Great myelin sheaths around PNS neurones
Provide metabolic support and electrical insulation

93
Q

What is myelination used for?

A

Increase speed of conduction
Provides protection
Structural support

94
Q

Do unmyelinated cells still have Schwann cells?

A

Yes
Still surrounded but no total encapsulation
So are still supported

95
Q

Propioception what is it?

A

The awareness of our body in 3d space

96
Q

What is the afferent part of the nervous system?

A

Sensory/input portion of NS
stimulus from PNS to CNS

97
Q

What is the efferent part of the nervous system?

A

Motor part of the nervous

98
Q

What types of muscles does the efferent innervate?

A

Skeletal (somatic)

Autonomic:
Smooth
Cardiac

99
Q

Bundles of axons are called…

A

Fascicles

100
Q

The outer layer of a fascicle is called..

A

Epineurium

101
Q

The connective tissue around fascicles are…

A

Perineurium

102
Q

What connective tissues surround individual axons?

A

Endoneurium

103
Q

What are the basic cell components of the PNS?

A

Neurones
Schwanna cells
Satellite cells

104
Q

What does the body of the neurone contain?

A

Nissl substance
Cytoskeleton

105
Q

What does nissl substance contain?

A

Aggregates of polyribosomes and RER

106
Q

What does cytoskeleton contain?

A

Neurofilaments
Neurotubules

107
Q

Functions of satellite cells

A

Electrically insulates PNS
regulates nutrients and waste exchange for cell bodies in ganglia

108
Q

What shape are ependymal cells?

A

Cuboidal
Some areas they are ciliated
Lack basal lamina

109
Q

Where are ependymal cells found?

A

Like Brain
spinal cord central canal

110
Q

How many legs or wraps can oligodendrocytes do?

A

Multiple
More than one

111
Q

What are the types of Astrocytes?

A

Protoplasmic
Fibrous

112
Q

Where are protoplasmic astrocytes found?

A

Grey matter

113
Q

Where are fibrous astrocytes found?

A

White matter

114
Q

What is an electrical synapse?

A

Rare in adults
Bidirectional
Fastest
Adjacent cells

Direct transfer of ionic current

115
Q

What are the major types of neurotransmitters?

A

Amino acids
Monoamines
Neuroactive peptides

116
Q

Neurotransmitter receptors mechanisms

A

Membrane spanning proteins
Transmitter binding causes conformational change
Specific to neurotransmitter
One neurotransmitter can have several receptors

117
Q

What are the two types of signalling mechanisms for receptors?

A

Ionotropic (conformational change)
Metabotropic (g protein- indirect effects)

118
Q

Spatial summation is

A

Summing of post synaptic potentials generated at separate synapses to the same cell body

119
Q

Temporal summation is…

A

Summing of post synaptic potentials generated at the same synapse

120
Q

Define the term motor unit

A

The nerve and the muscle fibres it supplies

It is the somatic efferent and all the muscles fibres it supplies

A-motoneurone
And all extrafusal muscle fibres

121
Q

What are the different types of motor unit?

A

Slow twitch (s)
Intermediate (fr)
Fast (ff)

122
Q

What are the components of a Motor unit?

A

Motor neurone
Skeletal muscle
Neuromuscular junction

123
Q

The three connective tissues in muscle fibres

A

Epimysium
Perimysium
Endomysium

124
Q

Different types of muscle fascicles based on their architecture

A

Convergent
Strap
Circular
Fusiform
Pennated (uni, bi and multi)

125
Q

Where are lower motor neurone found?

A

Cranial nerves
Lamina ix

126
Q

All muscle fibres in a motor unit have…

A

The same contraction speeds
Susceptibility to fatigue
Myosin fibre typing

127
Q

What’s the membrane of a muscle cells in a nmj called?

A

Sarcolemma

128
Q

What are the receptors in the folds of the sarcolemma?

A

Nicotinic ach receptors at top
Voltage gated sodium channels at bottom

129
Q

Steps of release of acetylcholine

A

High conc of ca2+ outside neurone
Action potential reaches pre synaptic terminal
Depolarisation Causes vg ca2+ channels to open
Synaptotagmin changes conformation as ca2+ binds
Triggers vesicle fusion and realise via exocytosis

130
Q

What is special about a NMJ?

A

Multi quanta release- way way more vesicles per synapse

Junctions fold in postsynaptic

131
Q

What happens when ach binds to NMJ?

A

Binds to Nicotinic ach receptor
Channels open
That are permeable to na+ and k+
Down conc and electrical gradient
Na+ influx, less k+
Produces an end plate potential

132
Q

What does an end plate potential trigger?

A

An action potential in muscle
V-g ion channels to open

133
Q

Why does a muscle always contract

A

Lots of vesicles
Lots of nachrs
So produces a EPP that is very large
So easy reach threshold

134
Q

What is a t tubule for?

A

Allows ap to transmit deep into muscle fibre

135
Q

What is the job of a DHP receptor?

A

When an action potential reaches it, it allows Ca2+ into muscle
This then causes Ryanodine receptor in SR to release ca2+

136
Q

What is a DHP receptor?

A

Dihydropyridine l type ca2+ voltage-gated channel

137
Q

What is acetyl choline broke down by?

A

Acetyl choline esterase

138
Q

What is myesthenia gravis cause by?

A

Autoimmune
Reduced number of nAChR in NMJ

139
Q

What is syncytium

A

Many nuclei within one muscle fibre as cells are fused

140
Q

Structure of skeletal muscle

A

Parallel regular
Single units
No branches
Nuclei at periphery

141
Q

Structure of cardiac muscle

A

Striations less obvious
As branched
Nuclei in middle
Intercalated discs- where cells meet

142
Q

Structure of smooth muscle

A

Single cells
With one nucleus
Spindle shaped
No striations
Not distinct

143
Q

What is a sarcomere?

A

Contractile unit

144
Q

A band has…

A

all of the myosin

145
Q

H zone is…

A

Purely myosin

146
Q

I band is…

A

Purely the actin

147
Q

What are the three major types of skeletal muscle?

A

Red fibres (i)
Intermediate red (iia)
White (iib)

148
Q

Triads vs Diads?

A
149
Q

What muscles type are t tubules present?

A

Striated only

150
Q

What is a myofilament?

A

The actin and myosin

151
Q

What is a myofibril?

A

Chain of sarcomeres

152
Q

Actin-myosin cross bridge steps

A

Attachment of ATP
Bending of myosin head
Due to energy of hydrolysis of ATP
attached to actin to form a bridge
The release of phosphate allows to return to normal
New ATP bonds and releases actin

153
Q

The binding of ca2+ to troponin causes…

A

The exposure of tropomyosin

154
Q

Triads have what components?

A

A t tubule next to two sarcoplasmic recticulums

155
Q

Terminal cisternae is part of what organelle?

A

Sarcoplasmic reticulum in muscle
Next to t tubules

156
Q

Calsequestrin holds what in the SR lumen?

A

Ca2+

157
Q

Why are red fibres red?

A

High levels of myoglobin
To fully use o2

158
Q

What shape are intercalated discs in cardiac muscle?

A

Irregular lines

159
Q

Local anaesthetics key points

A

Reversibly block
Without loss of consciousness

160
Q

What type of receptor does local anaesthetics block?

A

Nociception (pain)
Block voltage gated sodium channels

161
Q

Name ending of local anaesthetic

A

-caine

162
Q

What are the components of local anaesthetics?

A

Aromatic ring (hydrophobic)
Linkage group (amine or ester)
Basic amine group (water soluble)

163
Q

What pH is the local anaesthetics?

A

Weak base

164
Q

If normal pH is more alkaline, then which part of the equilibrium is favoured?

A

More dissociation
More ions

165
Q

What part of the local anaesthetic can diffuse across the membrane?

A

Only the whole version
Not ion

166
Q

Which part can block the receptor of a local anaesthetic?

A

The charged
But only from the inside

167
Q

What factors effect the local anaesthetics effectiveness?

A

Tissue pH
-from inflammation or infection
Size of neurone
Routes of administration

168
Q

What are the 6 routes of administration of local anaesthetic?

A

Topical
Infiltration
Nerve block
Epidural
Spinal
Regional

169
Q

What are the side effects of local anaesthetics?

A

Hypersensitivity
Affect on other excitable tissues
-heart attack
-blood vessels etc

170
Q

Why are vasoconstrictor given with local anaesthetics?

A

Promotes blood vessels constricting
Reduce unwanted effects
Increase duration, as not dispersed into blood as much so doesn’t reach liver

171
Q

What are the 3 sources of dysfunction in a motor system?

A

Lower motor neurone
Upper motor neurone
Muscle

172
Q

Re-innervation is the…

A

Realignment of nerve with an organ different to its original one

173
Q

Loss or damage to cell body of a motor neurone would lead to…

A

Death of the motoneuron

174
Q

Diseases that target cell bodies of neurones

A

Polio myelitis
-caused by polio virus
-cell bodies in the central horn

175
Q

What are the two variants of motoneurone disease?

A

Kills both upper and lower

Or

Only the lower motoneurone

176
Q

Which motoneurones are not susceptible to MD?

A

Ones that supply extraocular muscles
Supply Anal sphincter

177
Q

Demyelination of axons could be a result of what diseases…

A

Guillain-barre
Diabetes neuropathy

178
Q

Lower motor neurone symptoms

A

Paralysis
Fibrillations
Fasciculation

Medicine UOB (8 decks)

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