NBEO non-big 8 Flashcards
Warburg Effect
When a cell use aerobic & anaerobic glycolysis simultaneously. Ex Lens
Glycogenesis
Converting glucose to glycogen for storage. In muscle & liver. Glycogen can be stored under pressure w/out exploding
1. Happens in muscle & liver
2. store glucose as glyogen
3. end product: bound G6P -> glycogen
Glycogenolysis
breakdown of glycogen. ex muscles & liver. G6P can either go into glycolysis to make glucose or to the Pentose phosphate shunt.
End products: Free G6P
what is the role of the liver?
- maintain blood glucose
- if incr carb intake: does glycogenesis (store glucose & glycogen)
- lipolysis: store triglycerides
- if fasting or starved & no glucose: break down ketone bodies
Gluconeogenesis
- happens in liver»_space;> kidneys
- critical facts: get glucose & ATP w/o glucose breakdown
-uses 6 ATP in process - End product: glucose
Pentose phoshate Shunt
- happens in cell cytoplasm
- critical fact: detox cells from free 02. Done by cells that use FA & cholesterol
- End products: 12 NADPH/glucose, ribose-5-phosphate
Glycogenolysis
- happens in Muscle & liver
- free G6P -> glycolysis or pentose phosphate shunt
- end product: free G6P
what are the parts of a phospholipids?
3 carbon glycerol, 2 FA tails, and phoshpate head group.
- major component of lipid bilayer in cell membranes & myelin sheath (intraocular prelaminar ON is NOT myelinated)
Tay-sachs Disease?
affects enxyne breaks down small lipids, presentation similiar to Cherry red macula
what is a cholesterol?
made from Acetyl CoA: cytoplasm if liver cells
- precursor to steroids
-major component w/in LIPID MEMBRANE
what is Eicosanoids?
short rage signal molecule
made from Arachondonic acid by PLA2
- prostaglandins - pro-inflammatory; @ uveoscleral membrane: incrs outflow
- Thromboxone: promote arterial constriction & plaletet aggregation
- Lipoxygenase: makes leukotrienese -> WBC -> allergic rxns
Very low density lipoprotein VLDL:
delivers cholesterol to organs
Low density liprotein/ LDL?
what VLDL becomes LDL after it is delivers cholesterol -> lousy
HDL high denisty liproteins
returns excess cholesterol & lipids from organs to liver - GOOD
what is normal total cholesterol?
< 200
What is healthy level of LDL?
- Healthy or 2 or more risk factors for heart dz < 130
- if have cardiovascular dz or DM < 100
What is healthy level for HDL?
> 40
what is normal level for triglycerides?
< 150
What is Xanthelasma?
cholesterol deposit with periorbital skin use to high cholesterol or aging
what is resting potential of photoreceptor?
PR = -65mV charge is derived from Na+/K+ crossing membrane
Resting state?
conductivity @ rest
- K+ conductivity is high
- Na+/K+ pump
this two determines resting potential
What is conductivity?
measure of how easy ions can cross membrane exist if K+ had incrs conductivity = pass easily
The training of Na+ is what causes the DARK current, this allows for _________.
Allows for Depolarization
What are the Stages of neuro Action potential
- Na+ conductance increase (Na+ can cross membrane cells easily)
- In response to local depolarization - membrane potential incrs steeply = more Na+ channel open = snow ball effects
- Membrane potenial (Vm) = peaks @ 40 mV
- K+ conductance incrs = K+ exists cells = increase Na+ channel
- fall in Vm = hyper-polarization (more neg than resting state)
What are action potential cells?
Photoreceptor & horizontal
What are grades potential cells?
AP = IN the BAG,
what is MOA of Digoxin?
Digitalis have a NAK for getting digits
- inhibits Na+/K+ ATPase
what are synapse?
a physical meeting point btw cells
- facilitates communication btw cells
what is a chemical synapse?
Via Neurotransmitter
- limited by
1. Diffusion rate of NT
2. binding of NT to cell membrane = DAMAGED in MG
what is simplified cascade?
Action potential (hyperpolarized - more neg) to cell 1
- Ca2+ permeability incrs = Ca2+ enters
- NTs diffuse across across synaptic cleft
- NTs bind to cell 2
- Binding causes a post-synaptic potential (PSP) -> can be inhibitory or excitatory
- multiple PSP, have additive effect = total response to cell 2
- New Vm/ membrane potential is reached if = a > threshold then new AP is sent down line === DAMAGED in MS bc lose myelin sheath = lose charge
What is GABA?
most common inhibitory NTs
Glycine?
Inhibitory NT st brainstem, spinal cord, and retina
What is glutamate?
excitatory NT
Cholinergic receptor types (2)?
2 receptor types:
- nicotinic in skeletal muscles: block by curare, snake venom (alpha Borgarotoxin)
- muscarinic: smooth & cardiac muscle
Adrenergic receptors
epinephrine, serotonin - release at SAN post-SAN
- Neuro-muscular junction
- ACH at PSAN pre and post PSAN
what is an Electrical synapse?
Gap junction and much faster than chemical synapse
What are the two SNS/sympathetic controls?
SNS - sensory and motor (somatic and autonomic)
what is a Ganglia?
Ganglia - location collection of cell nerve bodies (soma) ex. Superior Cervical ganglion
what is a nerve?
bundle of axons
What is the sensory division>
Ganglia near the spinal cord (dorsal root ganglia)
- the brainstem (cranial nerve ganglia)
What is somatic motor?
Innervate skeletal muscles
reponsible for voluntary behavior
what is the autonomic motor division?
innervate cardia, smooth muscle, glands
peripheral motor neuron: autonomic ganglia from the brainstem
sympathetics
ganglia near vertebral column -> go to periphery
ex Ciliospinal center of budge C8-T2
parasympathetics
goes to organs
Central Nervous system
organized in
1. Nuclei: collection of nuclei w/ similar function & location (CNS analogue to ganglia)
What is cortex?
Shelt-like layers of cells
- allows fro higher level cognition, sensory & motor processing
-divided into LOBES
Frontal lobes -> premotor- cortex functions?
- Pre-motor cortex = planning and execute movement. Developing during infancy
- general personality
lesion -> out of character behavior & comments
- Brocca Area = speech production
lesion -> broken speech/ cannot produce intended words = Brocca’s Aphasia
Which arteries supplies blood to frontal lobe?
Middle cerebral artery
Anterior Cerebral artery
Parietal lobe functions?
- Sensory activity & recognition
Lesion -> cannot identify object, but can describe what it does
ex. pencil
- Blood vessel: Middle cerebral artery
Occipital lobe blood supply?
Middle cerebral & posterior cerebral
- Visual processing
Lesion - VF defect
Temporal lobe?
Perception & sensory recognition: auditory stimuli & speech, memory
- Hippocampus: short term memory, spatial orientation
- Wernicke’s Area: Speeck recognition
- Lesion: Wordy speech
Blood supply; ICA -> Middle Cerebral, Anterior choroidal
Vertebral (basilar)
what makes up the division of the central nervous system?
Spinal cord, (Medulla, pons, midbrain) = brainstem
- Diencephalon, cerebral hemisphere, cerebellum
Spinal Cord?
center of spinal cord
- Gray matter: made of cell bodies & unmyelinated axons
What are the two roots of the spinal cord?
Dorsal Root: sensory
Ventral root: motor
What is white matter?
Myelinated, fasiculus tracts
What are the 3 division of White matter?
Post fasiculus
Lateral fasiculus
Anterior Fasiculus
What is the ascending pathway?
From periphery to brain
- carry sensory information
What are the 3 neurons of the Ascending pw?
- Ascending: small to large.
1st order: Soma bundle in dorsal root ganglion (1st synapse)
2nd order: connects 1st & 3rd order
3r order neuron: cell body in thalamus projects to cortex.
What is the descending pw?
Also called Pyramidal Tracts
- From brain to the muscle
- carry motor impulse from brain to muscle
what is the higher cervical region?
Nerve: C1-c8
- C8-T2: ciliospinal center of budge
Innervate: C1-C4
C5-C8 Upper extremities
What is the thoracic region?
Nerve: T1-T12
Innervate T1-T12 upper extremities
What is the lumber region?
Nerve: L1-L5
Innvervate: L1-L4: Thigh
L4-L5: thigh, leg foot
What is the sacral region?
Nerve: S1-S5
Innervate: S1-S3: thigh, leg, foot
S2-S4: pelvis
What is the coccygeal region?
Coccygeal nerve: Corgis … :> Butt and maintain balance
What is the brainstem?
Midbrain, pons, medulla
What is the midbrain function?
CN 3,4
control sensory & motor function
controls coordination of eye movement & reflex
What is does the upper midbrain function?
- has superior colliculus: controls saccades (w/ FEF)
- Red Nucleus: controls movement of arms and occulomotor nuclei. involved in executing hand-eye coordination
- EW nucleus = CN3: parasympathetic innervation of iris (ciliary muscles, sphincter muscle)
Lower midbrain?.
- Inferior colliculus - reflex of head and neck to auditory stimuli
- CN4 nucleus: inner controlled SO muscle (“SO contralateral SR” )
- Site of cerebella pedicules - connects to cerebellum
Function of pons?
- coordinate movement relayed info transfer btw cerebral hemispheres & cerebellum
- relays info btw midbrains & meddulla
- location of pontine nucleus -> relay information for motor relay info btw cortex and cerebellum
What is medulla?
1. What is 1. Upper medulla: had pyramidal?
- Medial longitudinal fasciculus?
- Lower middle medulla?
CN 9-12
Controls autonomic function (digestion, heart heart, breathing)
- Upper medulla: had pyramidal tracts (descending brain -> motor)
- Medial lemiscus (ascending dorsal tract). carries inform from lower body and trunk to brain - Medial longitudinal fasciculus: relay vestibular info to EOMs
-coordinates VOR
- lesion: INO - Lower middle medulla: location of vestibular nuclei, olivary nuclei
- do learning long-term memory in cerebellar function
- 4th ventricule
What is the Diencephalon?
- Epithalamus:
- thalamus
- subthalamus
-hypothalamus
extension of the eye
- Epithalamus: has pineal gland -> secretes melatonin
- Thalamus: relays info to cortex -> has nuclei for voluntary muscle control
- Subthalamus: communicate w/ basal ganglia. Helps to control muscle movement
- hypothalamus: regulate body temp, eating & sleeping behavior. start of sympathetic pw for dilation
What is the cerebral hemisphere?
do higher level processing for sensory interpretation, motor control, intelligence, emotion
2 hemisphere
A. Dominant hemisphere: help to understand and process language. - Interconnection of long-term memory.
- Word retrieval & emotional stability
B. Non-dominant hemisphere
- recognition of facial expression & vocal information, music, visual learning
What is Prosopagnosia?
can’t recognize faces due to occipital & temporal lobe damage
What is the cerebrum?
fine motor control
postural balance
what are the arteries that makes up the Circle of Willis (4)?
- Basilar
- Posterior cerebral - ICA
- Pcomm
- Ant. cerebral
- Ant. communicating
What is Diabetic papillopathy?
~ mild form of NAION
Epi: young <50 yr type 1 DM (70%)
Patho: mild form of NAION.
- reversible ischemia
Symptoms: mild to no decrs VA
- mild APD
- disc edema, 60% unilat
- mild VF defect = no cecocentral VFD, or altitudinal
- fellow ONH is disc at risk
Diagnosis: Dx of exclusion (like NAION)
- r/o GCA
-CME
- Malignant HTN -> BP check
what is CRVO?
Bleeding in all 4 quadrants, dilated & tortuous vessel
- collaterals: vein to vein connection
-due to thrombus (form at site)
- just post ONH
Hypotony
sx hx of trabelecutomy, trauma blunt, cyclodestruction sx, intracranular inflammation
- IOP < 6mmHg
- depends on scleral rigidity -> becomes more rigid w/ age
- may occur due to over-filtering bleb, wound, leak
S/S: painful, esp w/ corneal edema
Optic Disc Drusen
Epi: presents 3-24 ppl
patho: hyaline deposits @ optic disc
- can be hereditary acquired
Diagnosis: B-scan: drusen = hyper-reflective
S/S: asymptomatic
- buried when young -> surface w/ age
- excessive drusen -> compress ganglion cells @ ONH -> gluacoma like VF defects
- pseudo disc edema - rim elevated due to due
- true edema: due to compression of nerve. Uni or bilateral
- may cause CNVM - due to break bruch @ ONH -> at area of peripapillary atrophy
Sarcoidosis?
Epi: often affecting Middle-aged, AA, women, smoke
Patho: idiopathatic
S/S: chronic dacryoadenditis
- S-shape ptosis
Testing: ACE & chest xray -> granulomatous inflam
- 90% lung involvement
- only 1-5% have ON edema
Lists some Collagen Vascular Disorders ?
RA, SLE, polyarteritis nudosa, granulomatous w/ polyangitis
SLE = lupus
Epi: women > men
- 2nd-3rd decades of life
Patho: autoimmune effects multi organs
S/S: unilateral disc edema & papilledema
malar rash
Testing: ANA
Syphilis
Inflammatory, Infection unilateral disc edema
STD due to spirochete treponema pallidum
Testing:
1. FTA-ABS: ever had syphilis
2. VDRL, RPR: if have now/active
What is the 4 phases of syphilis?
- Primary chancer sore (painless genital ulcer)
- Secondary: involve eye, kidneys, mucus membrane inflamm, skin
—-»> latent phase
- CNS not involved - Tertiary : CNS involvement, Argyll-Robertson pw: btw pretectaL & EW
Stage 1-2: tx w/ PCN to prevent next stage
TB
Inflammatory Dz of lungs by Myobacterin Tuberculosis
Symptoms: NIGHT SWEATS, fever, chronic cough
- Bilateral granulomatous uveitis, CME, rarely optic disc edema
Testing: Chest-xRay, PPD skin test (Type 4 rxn)
-Indentation healthcare worker >10mm
immunocompromised > 15mm
Normal > 5mm
What is IIH/Pseudotumor cerebri?
Epi: women, overweight, child bearing age
Patho: incrs ICP from unknown etiology
Diagnose of exclusion/Dxe
Testing:
Check BP in office
MRI/MRV - r/o tumor
-CBC = no blood clot
Spinal Tap -> CSF analysis, r/o syphilis
-Opening pressure > 200 mmH2O or >21 cmH2O
Normal: <15.5cm H20 or 155mm H20
Causes: “CANT”
-Contraceptive
-Vit A
Nalidixic acid
-Tetracylines
Symptoms:
HA, transient vision/Amurosis fugax, nausea/vomiting, VA is normal
Signs: Enlarged blind spot VF, diplopia (CN 6 palsy) pinched by petrous ridge of temporal bone
-Variable VFD, bilateral ON atrophy
Orbital Cavernous Hemagioma?
MC benign orbital neoplasm in adults
- Epi: MC women in 4th - 5th decade
- affects muscle cone -> compresses the ON
Causes of unilateral vision/bilateral optic atrophy
- Excavation: loss of neuro rim tissue -> Glaucoma
- Pallor: whitening of neuroretinal rim tissue
- primary optic atrophy: ON has never ben edematous
- ex. Trauma, nutritional, orthograde degeneration /ascending -> eye to brain (PRP, CRAO, RP, geographic atrophy
- retrograde degeneration, brain -> Eye / Descending (ex. Pituitary tumor
- Hereditary: Leber’s Dominant Optic Atrophy
- Secondary Optic atrophy: ON has been edematous before
-any primary causes
Foster Kennedy
What is optic nerve atrophy?
distruction of RNFL -> axons of ganglion cell s
Toxic /Nutritional
Most Common/MC
- Alcohol -> Wernicke Korsakolf
-Malnutrition
- Med Toxicity (ethambutal, ioniazide, amiodarone)
Classically w/ temporal pallor of ON (papillomacular bundle)
-cecocentral w/ central VFD
- causes bilateral, painless, progressive
what is orthograde degeneration/ ascending?
Eye -> brain
Extensive RNFL damage -> cause neutro-retinal tissue damage
PRP, CRAO, RP (wavy optic, disc PSC, attenuated vessels), extensive geographic atrophy
What is retrograde degeneration?
Brain -> eye
-damage to retrobulbar ON -> descending degeneration of ON axons
ex Pituitary Tumor
Normally compresses nasal optic fiber
-> horizontal band of pallor on ON (Bow-tie atrophy)
- Junctional Scotoma
Hereditary
- Leber’s Optic neuropathy: mutation in mitochondrial DNA
-85% male, onset in early 20s
-sudden onset of decrs color vision (20/200-CF)
- Early signs: optic disc hyperemia -> OD pallor in late stage
- spontaneously improves in 35%
-Foster Kennedy Syndrome: rare, due to Frontal lobe tumor -> simultaneous OD edema in one eye vs OD atrophy (lesioned side) `
Congeneitcal optic nerve anomalies?
- Opticc nerve pit: unilateral depression of Optic disc Inf-temp
- may develop SRD from optic cup to macular
- asymptomatic unless macular involved
Morning Glory Syndrome: unilateral
- funnel-shaped, excavated optic nerve = poor VA
- spontaneous formation congenital
What is ON hypolasia?
incomplete development of ON, uni/bilateral
- double ring sign
- a ring of sclera or hyperpigmentation
What does a pt in a coma pupil look like?
Called Hutchinson Pupil
- dilated pupil in comatose state
- due to ipsilateral compression of CN23 hematoma or tumor
- sudden
If Miosis: in early coma miosis bc of loss of cortical control
- still responde to light (bc pretectaL nucleus nerve goes to cortex )
CN 4 palsy?
Innervates SO
- contralateral, dorsal, long, thin
** most susceptible to TRAUMA
Congenital CN4 vs Acquired, which have a larger vertical palsy?
Congenital CN4 palsy
- 0-2prism
- no diplopia, bc of Eccentric fixation or suppression/amblyopia = form deprivation
Acquired CN 4 palsy: vertical ranges, diplopia
- Head tilt AWAY
Dx = Park three step
what is park 3 step?
Vertical
head tilt
gaze
where is it WORSE?
where is the lesion?
Right Hyper
right head tilt
worse w/ left gaze = worse w/ R head turn
“walking in w/ left head tilt or left head turn
Right SO problem
CN 6 palsy?
Abducen -> LR
- travels in the Cavernous sinus laterally, btwn ICA and Petrosal ridge on the temporal bone - gets compress in btw
MC: microvascular Dz
MC affects EOM
Tumor
Incr ICP - papilledema
- Trauma
-cavernous sinus issue
