NEU 409 Exam 3

Question 1

Cerebral Vascular Accident (CVA, a.k.a. stroke):

Ischemic Stroke:
Thrombus vs. Embolus

Hemorrhagic Stroke:
Aneurysm, AVM

Functions Affected:

Answer 1

Ischemic Stroke: Blockage of blood vessels; lack of blood flow to affected area
Motor and sensory issue - contralateral - anterior artery supply
Types:
Thrombus(bloodclot) vs. Embolus(ball and hits arteries)

Hemorrhagic Stroke: Rupture of blood vessels; leakage of blood
Medial artery supply
Plaque caused by cholesterol
Aneurysm, AVM(arteriovenous malformation) - arteries blooming
born with aneurysm or AVM - a balloon/bulge and if grow then very bad
high-pressure blood flow causes the vessels to expand balloning

Functions Affected:
Speech,
Language
Hearing,
Swallowing
Motor function

Question 2

Stroke Intervention(find stroke): symptoms stroke max 3 hours

Ischemia VS Aneurysm

Penumbral tissue:

Answer 2

CT scan to rule out hemorrhage(bursting blood clot can cause hemorrhage) (CT shows blood)
DWI and PWI - imaging looking at blood flow

No hemorrhage, treat ischemia(clot and no blood)
- tPA injection
- Surgical clot removal (endovascular surgery)

Aneurysm treatment
Clipping
Coiling

(tPA) Penumbral tissue:
Tissue at risk of being recruited into the ischemic core (i.e., brain cells that will die if they don’t receive blood very soon)

Question 3

Traumatic Brain Injury (TBI):
Open VS Closed

Acute brain injury (ABI)

Coup Injury:
Contrecoup:

Blast Injuries: War
Primary:
Secondary:
Tertiary:
Quaternary:

Answer 3

TBI → Open Head Injury (blunt force or gunshot)

TBI → Closed Head Injury(car accident) → Either Acceleration-deceleration closed head injury OR Impact-based closed head injury

Acute brain injury (ABI) → caused by disease, blows to the head, alcohol and drug use, or oxygen deprivation.

Coup Injury: toward front of head
Contrecoup: toward back of head

Blast Injuries: War
Primary: Directly from the air compressions of the blast
Secondary: Injury from flying objects
Tertiary: Person pushed into another object
Quaternary: From blood loss or toxic gas

Question 4

TBI Problems: Physical Issues

TBI Problems: Cognitive - Communication

Answer 4

TBI Problems: Physical
Coma
Drowsiness
Headache
Seizures
Hydrocephalus
Plegia/Paresis
Dyskinesias
Vision changes
Multiple traumas (e.g., blunt chest trauma)

TBI Problems: Cognitive - Communication
Attention
Orientation
Memory
New learning
Thought organization
Reasoning
Problem solving
Executive functions
Speech-language issues

Question 5

What is Dementia?

Diagnostic Criteria:
Multiple cognitive deficits manifested as impairment

Mild cognitive impairment:

Answer 5

What is Dementia?
- Dementia is classified as a syndrome because it is characterized by a constellation of symptoms
- Dementia results from varied etiologies and has varied clinical presentations
- Memory, Attention, Critical thinking, Language

Diagnostic Criteria:
- Learning new information
- Recalling previously learned information
- Produce a significant impairment in the ability to function
- Represent a significant decline from previous functioning
- Aphasia, Apraxia, Agnosia
(failure to recognize or identify objects, sounds, or words despite intact sensory functions)
- Disturbance in executive functioning:
planning, organizing, sequencing, abstracting

Mild cognitive impairment:
Mostly doesn’t affect everyday activities
Some impact on memory, attention

inability to remember a word (amnesia) and the inability to understand a word (aphasia) or the inability to recognize a fork as a fork (agnosia) and the inability to use it properly (apraxia)

Question 6

C-11 PIB (aka the “Pittsburgh Compound”):

Answer 6

Radiotracer used with PET scans (Carbon-11)

Images the build-up of beta-amyloid plaques in the brain - Associated with Alzheimer’s Disease and Dementia

Question 7

Alzheimer’s - What goes first and Largest change

Alzheimer’s Disease:

Brains atrophy with neuronal loss, neurofibrillary tangles, and senile plaques:

Answer 7

What goes first is cognition and memory

Largest change from mid-end stage is self care

Alzheimer’s Disease:
Abnormal tissue changes in the brain - Pathologic changes occur in the association areas of parietal, temporal, and frontal lobes and in the hippocampus

Brains atrophy with neuronal loss, neurofibrillary tangles, and senile plaques:
- Plaques block neurotransmitter movement between cells
- Tangles disrupt the microtubules, which impacts transport of nutrients within cells

Question 8

Forms Of Dementia:

Pattern of Brain Tissue Loss:

Answer 8

Alzheimer’s disease (most common, 50%)

Vascular dementia (2nd most common, 20%) - small strokes due to high blood pressure

Lewy Body Dementia (3rd most common, 10-25%)

Parkinson’s disease & Huntington’s Disease

Pattern of Brain Tissue Loss: Alzemeirs is temporal lobe and frontal dementia is temporal and frontal lobe

Question 9

Vascular Dementia:

Answer 9

Small strokes due to high blood pressure

Due to vascular abnormalities including cerebrovascular disease, hypertension, and atherosclerosis.

Characterized by stepwise deterioration and focal neurological signs.

A person may acquire vascular dementia after sustaining large cerebral infarcts, ischemic events, and occlusion of fine capillaries in the cortex.

Question 10

Lewy Body Dementia:

Answer 10

Occurs in more men than women

Abnormal protein deposits

Confusion, memory loss, hallucinations, tremors, muscle rigidity, problems with balance

Sort of a hybrid between Alzheimer’s and Parkinson’s
- Motor symptoms similar to PD
- Cognitive symptoms similar to AD

Question 11

Fronto-Temporal Dementia:

Answer 11

These types of dementia are relatively rare (10%).

They usually have early onset (in the 40s and 50s)

associated with personality changes
(selfish, moody, unable to be empathic)

reduced language
difficulty executing complex tasks

Associated with Primary Progressive Aphasia - loss of ability to understand or express speech, caused by brain damage

Question 12

Meningitis:

Encephalitis:

Neoplasm:

Answer 12

Meningitis: Inflammation of meninges
- Bacterial, Viral, Fungal

Encephalitis: Inflammation of the brain
- Most commonly viral

Neoplasm: Brain tumor
- Benging(not cancer), Malignant

Question 13

Brain Tumor Grades (WHO):

Grade 1:

Grade 2:

Grade 3:

Grade 4:

Answer 13

Grade 1:
Least malignant tumors and are usually associated with long-term survival.
They grow slowly and have an almost normal appearance when viewed through a microscope.
Surgery alone may be an effective treatment for this grade tumor.

Grade 2:
These tumors are slow-growing and look slightly abnormal under a microscope.
Some can spread into nearby normal tissue and recur, sometimes as a higher grade tumor.

Grade 3:
These tumors are, by definition, malignant although there is not always a big difference between grade II and grade III tumors.
The cells of a grade III tumor are actively reproducing abnormal cells, which grow into nearby normal brain tissue.
These tumors tend to recur, often as a grade IV.

Grade 4:
These are the most malignant tumors.
They reproduce rapidly, can have a bizarre appearance when viewed under the microscope, and easily grow into nearby normal brain tissue.
These tumors form new blood vessels so they can maintain their rapid growth and have areas of dead cells in their centers.

Question 14

Structural imaging:

Functional imaging:

Spatial Resolution: From Best to Worst

Temporal Resolution: From Best to Worst

Answer 14

Structural imaging: viewing the anatomy of the brain

Functional imaging: viewing the physiology of the brain while it functions

Spatial Resolution: From Best to Worst
1. fMRI
2. PET
3. Electrophysiological techniques
(EEG & MEG)

Temporal Resolution: From Best to Worst
1. Electrophysiological techniques
(EEG & MEG)
2. fMRI
3. PET

Question 15

Structural Imaging: CT

Postitive:

Negative:

Answer 15

CT use in acute identification of stroke, most common

Not able to detect ischemic stroke for 1-2 days

Ideal for imaging structures/substances that will be radiopaque and show up as bright white on the image - Bones, Blood

NOT great for imaging soft tissues show up as variations of gray on image

Water/CSF shows up as black on image

Why is blood radiopaque when water isn’t? Iron and red color

Postitive:
Commonly used
Easily accessible
Inexpensive
Quick processing time
Ideal for imaging bony structures, detecting blood

Negative:
Use of X-rays/cancer risk
Shows structure only
Difficulty observing new damage
Clarity of images (difficulty seeing soft tissues)

Question 16

Structural Imaging: MRI

How dangerous is metal in an MRI scanner?

Postitive:

Negative:

Answer 16

MRI = Magnetic Resonance Imaging
3-dimensional image produced
Strength of machine translates to the quality of the image
T = Tesla
3T strongest, clearest images, research & clinical
1.5T common for clinical use
Open MRI → 0.3 or 0.5 T–very weak magnetic field, produces very poor quality images

How dangerous is metal in an MRI scanner?
In an emergency, the magnet must be “quenched”
Sudden loss of superconductivity when temperature is raised
Deactivating the magnet releases massive amounts of boiling helium liquid, which is comes out as helium “steam”

Postitive:
Much better images
Images in multiple dimensions
No X-rays
No preparation needed (e.g., injections, etc.)

Negative:
More expensive than CT
Patients with metal in body
Patients must be still
Patients with claustrophobia will struggle with exam

Question 17

MRI
Types of images
T1 VS T2

Answer 17

T1:
Measured
Typically good for depicting anatomic detail
Good contrast between gray and white matter
Water & Edema appear dark
Fat appears bright
Gray matter is dark gray; white matter is light gray

T2:
Sensitive to changes in water content
Better diagnostic tool for identifying edema (swelling) and ischemia (blockage)
Water is bright
Fat is gray
Gray matter is light gray; white matter is dark gray

Question 18

Direct Comparison:
CT VS MRI

Answer 18

CT:
Less expensive
Faster to acquire images
5 min scan, 30 min exam, 30 min image processing
Not as sensitive to movement
Widely available
Metal implants and claustrophobia not an issue
Images are not as clear
Exposes patient to radiation
Ideal for showing blood in acute stroke

MRI:
More expensive
Takes longer to acquire images
30-45 min scan, 60 min exam, 30 min image processing
Very sensitive to movement
Not quite as widely available
Contraindicated for patients with metal implants or claustrophobia
Clearer images of anatomy
No radiation exposure
Can show ischemic areas before CT

Question 19

Structural imaging: Diffusion-Weighted Imaging (DWI)

Structural imaging: Perfusion weighted imaging (PWI)

Diffusion MRI - Diffusion Tensor Imaging (DTI):

Structural Imaging: Cerebral Angiography
Administered using CT or MRI

Answer 19

Diffusion-weighted MRI (DWI) is sensitive in detecting infarcted brain tissue, whereas perfusion-weighted MRI (PWI) can detect brain perfusion in the same imaging session. Combining these methods may help in identifying the ischemic penumbra, which is an important concept in the hemodynamics of acute stroke.

Structural imaging: Diffusion-Weighted Imaging (DWI)
Magnetic fields in the MRI are pulsed, which allows measurement of water diffusion (movement) over time

Structural imaging: Perfusion weighted imaging (PWI)
MRI that requires injection of radioactive contrast medium (gadolinium)

Diffusion MRI - Diffusion Tensor Imaging (DTI):
Imaging white matter tracts
Measures the direction of water diffusion
Fractional anisotropy (FA) values closer to 1 indicate water movement in all directions, lower values indicate interruptions
Detecting disruptions in the white matter tracts

Structural Imaging: Cerebral Angiography
Administered using CT or MRI
- x-rays to see how blood flows through the brain. A carotid arteriogram is an X-ray study designed to determine if there is narrowing or other abnormality in the carotid artery, a main artery to the brain.

Question 20

Spatial Resolution:

Temporal Resolution:

Answer 20

Spatial Resolution: location of brain activity when a stimulus is introduced

Temporal Resolution: time between when a stimulus is presented and the brain’s response to that stimulus

Question 21

Functional Imaging: PET
PET = Positron Emission Tomography

Positives:

Negatives:

Answer 21

Can be acquired using same scanner as for CT (CT/PET combo machine common)

Radiotracer injected into patient

Scanner measures photons given off to produce image

Relatively good spatial resolution (about 1 cm)

Poor temporal resolution (over 1 minute)

Positives:
Good image of location of brain activity
Provides information about cellular function
Good for pre/post treatment to examine changes in function

Negatives:
Invasive procedure because of injection
Radioactive material used
More expensive technique than CT and MRI

Question 22

Functional Imaging:
Electroencephalography (EEG)
Magnetoencephalography (MEG)

Commonly used for:

Positives:

Negatives:

Answer 22

Provides a graphic representation of the summated electrical activity in the brain
Place metal electrodes at different positions on the scalp
Electrical signal recorded from different areas of brain

Commonly used for:

Diagnosing seizures
Sometimes use techniques to evoke seizure
E.g., hyperventilation or sleep deprivation

Evaluating brain death
No response to external stimuli, cannot spontaneously breathe, no cranial nerve reflexes, flat line on EEG

Diagnosing sleep disorders
Measured in conjunction with other biological functions
E.g., heart rate, breathing

Positives:
Low cost
Readily available
Good information on brain function
Excellent temporal resolution (milliseconds)

Negatives:
The “image” produced does not show any structure

Question 23

Functional Imaging: fMRI
fMRI = Functional Magnetic Resonance Imaging

Positives:

Negatives:

Answer 23

Blood Oxygenation Level Dependent (BOLD) signal
Delayed HRF (hemodynamic response function) in hypoperfused tissue

Positives:
Can see structural & function at the same time (with addition of structural MRI)
No radiation exposure
Excellent spatial resolution (mm)
Mid-level temporal resolution (seconds)

Negatives:
Expensive
Not widely available for clinical use
Takes a long time to acquire

Question 24

Levels of Motor Speech System: 8

Answer 24

Conceptual
Planning
Motor programming
Motor control circuits
Direct motor pathway
Indirect motor pathway
Final common pathway
Sensory system

Come
People
My
Monkey
Dosent
Ignite
Fights
Slay

Question 25

Conceptual Level:

Answer 25

Involves our thoughts, feelings, and ideas
Prefrontal cortex
Limbic system

Question 26

Planning Level:
Involves 2 parts:

Language problem - Aphasia

Answer 26

Linguistic planning:
language content, form, and use (or semantics, grammar, and pragmatics), perisylvian region of left hemisphere

Motor planning: plans and arrangements of phonemes
Premotor cortex (BA 6) important area for planning

Aphasia: problem selecting the right word

Question 27

Motor Programming Level:

Answer 27

Execution of phonemes in time & space

Involve discrete movements of tongue, lips, etc.

Cerebellum, basal ganglia, and supplementary motor area (BA 6) are important areas to programming

Question 28

Direct Pathway:

Answer 28

a.k.a., pyramidal system

Involves lateral motor system—lateral corticobulbar and corticospinal LMN tracts

Function of pathway—voluntary motor movement of contralateral limbs/speech muscles → voluntary motor movement of contralateral limbs/speech muscles

Makes few stops

Crosses over (decussates) at medulla/spinal cord juncture

Question 29

Corticobulbar vs. Corticospinal:

Answer 29

Start in motor cortex
End in either:

Brainstem (corticobulbar)
Send signals from brain to cranial nerves

OR

Spinal cord (corticospinal)
Send signals from brain to spinal cord

Question 29

UMN vs LMN:

Direct Motor Pathway Damage:

UMN damage:

LMN damage:

Answer 29

Upper part of tract (brain and spinal cord) = Upper Motor Neurons (UMN)

Lower part of tract (cranial and spinal nerves) = Lower Motor Neurons (LMN)
Motor neurons in ventral horn of spinal cord
Command muscle contraction

UMN damage:
Spastic muscles
Hypertonia
Hyperreflexia (+ reflexes)
Clonus
(+) Babinski sign - reflex toe problem
No atrophy
No fasciculations

LMN damage:
Flaccid muscles
Hypotonic
Hyporeflexia (– reflexes)
No clonus
No Babinski sign
Marked atrophy
Fasciculations

Question 29

Indirect () Motor System:

Answer 29

a.k.a., extrapyramidal system

Function - Posture, muscle tone for fine movement

Indirect pathway with many stops - Includes the medial motor systems:
Vestibulospinal
Reticulospinal
Tectospinal
Decussation = none (except for tectospinal)
Basal ganglia = the main center of this system

Question 29

Speech Issues:

Damage to the pyramidal and/or extrapyramidal systems can lead to:

Damage to the basal ganglia control circuits can lead to:

Problem: ataxic dysarthria

Answer 29

Damage to the pyramidal and/or extrapyramidal systems can lead to:
Spastic dysarthria (UMN damage) - Harsh voice, monopitch, hypernasal, slow rate, imprecise consonants

Damage to the basal ganglia control circuits can lead to:

Hyperkinetic dysarthria (Huntington’s disease)
Harsh voice, monopitch, loud voice, imprecise consonants, distorted vowels
gaba not working

Hypokinetic dysarthria (Parkinson’s disease)
Stiff , rigid, slow movements
Breathy voice, monopitch, reduced syllable stress, variable speech rate, imprecise consonants
dopamine not working

ataxic dysarthria
Cerebellar lesion u sound drunk ataxia

Question 30

Motor Control Circuits:
when this system is damaged -

Motor Control Circuits: Cerebellum

Answer 30

Basal Ganglia Includes caudate nucleus, putamen, globus pallidus, substantia nigra, and subthalamic nuclei

Regulates motor functioning especially tone and posture so that we have smooth, precise motor movements

Dyskinesias results when this system is damaged - involuntary, erratic, writhing movements of the face, arms, legs or trunk

Motor Control Circuits: Cerebellum

Coordinates muscle movements so that they are skilled and sequential

When damaged, speech can become uncoordinated, resulting in a condition known as ataxic dysarthria.

Information is sent to and from the cerebellum to accomplish this

Question 30

Final Common Pathway (FCP):

Answer 30

FCP = last leg of a motor signal’s journey

Part of the lower motor neurons (LMNs)

Involves:
Alpha motor neurons - Muscle contraction
Gamma motor neurons - Proprioception
Cranial nerves

Question 31

Types of Muscle Tissue:
Striated/skeletal:
Smooth:
Cardiac:

Answer 31

Striated/skeletal:
Muscles affecting skeletal movement
Usually under voluntary control

Smooth:
Contraction is slow and sustained
Under involuntary control

Cardiac:
Designed for endurance
Involuntary control

Question 32

Alpha Motor Neurons:

Answer 32

• Initiate muscle contraction
• Muscle + neuron = motor unit
• All alpha motor neurons innervate single muscle = motor neuron pool
• Sustained contraction requires continual barrage of Action potentials
• Recruiting additional motor units
• Innervation ratios vary from muscle to muscle
• Muscles with large numbers of small motor units have more control

Question 33

Activity at Neuromuscular Junction: What happens when an action potential reaches a muscle cell?

Answer 33

• Action potential travels to axon terminal
• Ach binds to receptors, opening ion channels
• Membrane depolarizes, produces large EPSP in postsynaptic membrane
  Na+ flows into the muscle fiber,
  K+ flows out of muscle fiber
• Reaches threshold, Action potential propagates
• Triggers contraction of the muscle fiber

Question 34

Excitation-Contraction Coupling: What happens in the muscle fiber to cause contraction?

Answer 34

• Sequence of events that converts action potentials in a muscle fiber to a contraction
• Action potential across entire sarcolemma
• Proteins that control Ca++ release channels
• As action potential travels through membrane, opens Ca++ channels, allowing it to flow in the cell
• Rapid influx of Ca++ causes muscle contraction

Question 35

The Cross Bridge Cycle: What happens when the muscle fiber contracts?

Answer 35

Functional unit of contraction in muscle fiber called sarcomere

Cross bridges formed between myosin head and actin fibers

Power stroke: ADP released, activated myosin head pivots, sliding actin toward center of sarcomere

Cross bridges detach; another ATP binds to myosin head, link weakens and detaches

Reactivated myosin head; ATP to ADP, releasing energy, reactivates myosin head ready for next cycle

Cross bridge cycling ends when Ca++ actively transported back to Sarcoplasmic Reticulum

Question 36

FCP and Speech:
Components of speech Includes cranial nerves involved in

Respiration:
Phonation:
Resonance:
Articulation:
Prosody:

Flaccid dysarthria (LMN damage):

Apraxia of Speech: production and planning
Neurological damage leading to AOS can occur in:

Answer 36

Respiration: power for speech
Phonation: raw sound for speech
Resonance: tonal qualities of speech
Articulation: speech sounds
Prosody: musical quality of speech

Flaccid dysarthria (LMN damage): Breathy voice, monopitch, hypernasal, short phrases, imprecise consonants

Apraxia of Speech: production and planning
Neurological damage leading to AOS can occur in:
- Broca’s area (BA 44, 45)
- Supplementary motor area (BA 6)
- Insula (insular cortex)
- Basal ganglia

Question 37

Language:

Generative—

Dynamic—

Universal characteristics—

Ideas expressed—

Conventional—

Arbitrary symbols—

Answer 37

Language: a generative and dynamic code containing universal characteristics whereby ideas about the world are expressed through a conventional system of arbitrary symbols for communication

Generative—meaning that we produce new and different speech constructions all the time; we don’t have rote utterances, they are all slightly different even when expressing the same idea

Dynamic—languages change over time; study of historical linguistics, how language change occurred through history

Universal characteristics—all languages follow specific rules and have the same categories of words (nouns, verbs, adjectives, etc)

Ideas expressed—goal of language is to transmit information or a message from one person to another in an abbreviated way; E.g., communication can be achieved by other means (gesture, pointing, drawing pictures), but language allows us to simplify that process and make it more efficient

Conventional—shared by a speaking community; we can all understand each other because we all speak the same language

Arbitrary symbols—sounds or letters in words do not usually have a direct or specific relationship to the object (e.g., “book” is just the agreed upon string of sounds we use to label that thing made of paper that you read)

Question 38

The Parts of Language:
Content
Form
Use

Answer 38

Content= semantics, meaning of language
- The meaning of words (e.g., “dog”)
- The meaning of words in combination
- (i.e., semantic relations; e.g., “dog barks”

Form=
- Phonology – Study of phonemes, the smallest units in a language system, and sound structure (e.g., /p/)
- Morphology – Study of morphemes, the smallest units of meaning in a language, and word structure (e.g., /pet/)
- Syntax – Study of phrase/sentence structure; specifically, word order and sentence organization (e.g., /My pet is a dog./)

Use= pragmatics, practical use of language; interactions with others, turn taking, eye contact
- Pragmatics - take turns
- Practical use of language; in what manner the language is used with others
- Example of a pragmatic rule: “In conversation, it is appropriate to take turns.

Question 39

Classical Wernicke-Lichtheim-Geschwind Model:

Broca’s area =

Wernicke’s area =

Arcuate fasciculus =

Answer 39

Broca’s area = language production, frontal gyrus
BA 44 = pars opercularis
BA 45 = pars triangularis
1. Selects relevant information from competing irrelevant information - NOT specific to language, but processes all kinds of information
2. Specific role in processing complex syntactic structure - Only role is specific to language
3. Some areas specific to language and other areas more general - Used mostly for language processing BUT other parts of this area more general
4. Morphological manipulation - E.g., Adding/interpreting word endings -ed, -ing

Wernicke’s area = language comprehension

Arcuate fasciculus = interaction between comprehension & production (e.g., repetition, reading aloud)

Question 40

An updated alternative view:
Memory, Unification, and Control Model

White matter tracts involved in language network:

Answer 40

Language is NOT separated into comprehension and production, but is a unification of different types of linguistic processing

Language is not processed by single brain regions

Language is processed by a DYNAMIC NETWORK of brain regions - Role of each brain region is dependent on the interaction with other regions

White matter tracts involved in language network:
Connectivity between language regions much more extended than previously thought
Notice, the arcuate fasciculus is not just one direction!

Question 41

Auditory Comprehension of Language:

Answer 41

STEPS:
Cochlea to cochlear nuclear complex (CNC) via cranial nerve VIII-8 to thalamus to primary auditory cortex (41,42) to Wernicke’s area (22) to BA 44 of Broca’s area (syntax)

• Primary auditory cortex analyzes all types of sound, speech or otherwise
• Left primary auditory cortex more sensitive to speech characteristics (e.g., timing, transitions between speech sounds)
• Right primary auditory cortex more sensitive to pitch of speech
• Planum temporale on Wernicke’s area, brings information in from surrounding brain areas
• Planum temporale on Wernicke’s area, function not entirely known, but possibly acoustic analysis
• Some syntactic processing, but mostly implicated in storage of verb arguments
• Broca’s possibly related to more complex syntactic processing

Question 42

Visual Comprehension of Language (Reading):

Steps:

3 cortical areas involved:

Answer 42

Steps:
Eyes to lateral geniculate nucleus (LGN) of thalamus via optic tracts
LGN to visual cortex (17,18,19) via geniculocalcarine tract
Visual areas to ventral and dorsal streams of vision

For reading, 3 other cortical areas involved:

Parietotemporal system
Word analysis: Decoding semantics & phonology
Includes angular gyrus (BA39), supramarginal gyrus (BA40), posterior superior temporal lobe

Occipitotemporal system
Word form recognition: Sight reading, fast access to whole words, assists with mapping letters to corresponding sounds
Left inferior occipital, left inferior-posterior temporal areas, fusiform gyrus (face & word recognition)

Anterior reading system
Word analysis: Decoding syntax and articulation; maybe role in silent reading
Broca’s area, premotor areas

Question 43

Oral Production of Language:

Steps:

Answer 43

Decision to speak formed in the prefrontal cortex.

Decision sent to Broca’s area (44,45) for language encoding and speech planning.

Speech plans sent to supplementary motor area (SMA) (6), which activates the plans.

SMA (6) sends to motor cortex (4), which sends activated plans to speech muscles

Question 44

Written Expression of Language:

Steps:

Answer 44

Decision to write formed in the prefrontal cortex.

Decision sent to Broca’s area (44,45) for language encoding.

Writing plans sent to premotor area (6), which forms grapheme motor plans.

Premotor area (6) sends to the motor cortex (4), which sends plans to hand muscles.

Areas 5 and 7 aid visual spatial elements of writing.

Question 45

Aphasia:

An acquired multimodality language disorder

Fluent aphasia VS Non fluent aphasia

Answer 45

Acquired = caused by stroke, brain injury, etc.

Multimodality = problem in multiple language modalities (listening, speaking, reading, writing)

Language = the symbolic code we use to communicate

Disorder = language system does not function as it should
NOT a disorder of intellect or cognition expect for working memory or a disorder of perception

Fluent aphasia - wernickes

Non fluent aphasia - broca’s

Question 46

Symptoms of Aphasia:

Expressive language problems:
Agrammatism:
Anomia:
Jargon:
Paraphasias: semantic, phonemic, Verbal, Neologistic
Stereotypic utterances:
Agraphia:

Receptive(reading) language problems:
Auditory comprehension loss:
Alexia:
Peripheral alexia:
Central alexia:

Writing Problems:
Agraphia:
Peripheral agraphia:
Central agraphia:

Answer 46

Expressive language problems:
Agrammatism: Broca bad grammar
Anomia: inability to name or retrieval specific - all types of aphasias
Jargon: wernickes - fluent speech not making sense
Paraphasias: semantic (mixing up like cat for dog - related), phonemic (sound similar - model bottle), Verbal, Neologistic (same as jargon but made up mixed up words)
Stereotypic utterances: only say one word
Agraphia: all types of aphasias - writing problems

Receptive(reading) language problems:
Auditory comprehension loss: all aphasia won’t understand everything 100% mostly broca also werencikes
Alexia: reading problems
Peripheral alexia: reading difficulty due to visuospatial and attentional issues
Central alexia: reading system damaged

Writing Problems:
Agraphia: an acquired disorder of writing
Peripheral agraphia: writing difficulty due to visuospatial and attentional issues
Central agraphia: writing system damaged

Question 47

What is Cognition?

General Cognition Functions:
Executive Function:
Attention:

Answer 47

What is Cognition?
Perceiving, remembering, understanding, judging, memory, attention, and reasoning

Executive Function: Orientation, Memory, New Learning, Reasoning, Problem Solving, Thought Organization
Cognitive functions that order and manage all other cognitive functions (e.g., attention, memory) for the purpose of setting and attaining goals
The prefrontal cortex is located at areas 9, 10, 11, 46 and 47.

Attention: a person’s ability to focus (i.e., focused attention) on a stimulus in the environment.

Question 48

Attention: a person’s ability to focus (i.e., focused attention) on a stimulus in the environment.

Attention Types: Sustained
Attention Types: Selective
Attention Types: Alternating
Attention Types: Divided

Answer 48

Attention Types: Sustained
Focus on a stimulus over a period of time
Examples:Reading a book, Listening to a lecture

Attention Types: Selective
Focusing on a stimulus while filtering out competing stimuli
Example: Listening to this lecture while ignoring the texts coming in on your phone and the conversation your neighbors are having

Attention Types: Alternating
Shifting focus from one task to another and then back
Example: In class, focusing on this lecture, then discussing a question with your neighbor, then focusing on the lecture again

Attention Types: Divided
Focus on two stimuli at the same time
Example: Taking notes in class while simultaneously listening to the lecture

Question 49

Memory:
Sensory memory =
Working memory =
Short-term memory =
Long-term memory =

Answer 49

Memory: the storage of information

Sensory memory = memory related to senses, visual, auditory, olfactory, etc.

Working memory = space for manipulation

Short-term memory = time in seconds

Long-term memory = time in days to years - biographical info
Decelerative: episodic and semantic = dementia in MT and diencephalon
Non Decelerative: Disease in BG is parkinsons and huntingtons

Question 50

PHASES OF SWALLOWING:

Answer 50

1. Oral preparatory phase
2. Oral phase
3. Pharyngeal phase
4. Esophageal phase

Question 51

PHASES OF SWALLOWING:
1. Oral preparatory phase:

Answer 51

Voluntary stage of the swallow, Food is placed in the mouth and prepared for swallowing, Oral breathing ceases, and nasal breathing takes its place. Mastication (chewing) involves
- Trigeminal nerve (CN V) innervates the muscles for mastication (i.e., chewing)
- Mandibular elevators: masseter, temporalis, and pterygoid
- Mandibular depressors: mylohyoid and anterior belly of digastric muscle
then gland secretion with saliva works along side mastication to break down food using CN IX 9 and CN VII(7)

Question 52

PHASES OF SWALLOWING:
2. Oral phase:

Answer 52

Voluntary stage of the swallow
Tongue forms ramp and moves bolus from the oral cavity to the pharyngeal cavity
Labial seal and nasal breathing maintained
then
Tounge retraction using trigeminal nerve CN VII controlled by Digastric muscle and Mylohyoid muscle then anterior - posterior bolus movement where Hypoglossal nerve (CN XII 12) controls most of the intrinsic and extrinsic tongue muscles

Question 53

PHASES OF SWALLOWING:
3. Pharyngeal phase:

Answer 53

Involuntary stage as bolus contacts faucial arches: Soft palate elevates, Vocal cords adduct, Respiration pauses, Larynx elevates, and Cricopharyngeus relaxes. Brainstem involved when Nucleus tractus solitarius (NTS) acts as a swallowing sensory center and receives afferent information from CN V, VII, IX, and X. Then Nucleus ambiguous (NA) is the motor swallowing center and Innervates the swallowing muscles via CN IX 9, X 10, and XII 12. Then triggering of sensory information sent to brainstem & cortex decided by medulla, then laryngeal closure so valves close to protect the airway from the bolus entering it. Then laryngeal elevation - various suprahyoid muscles contract during the pharyngeal stage so normal swallow example. Then pharyngeal constriction is controlled by CN X 10 and XI 11.

Question 54

PHASES OF SWALLOWING:
4. Esophageal phase:

Answer 54

Involuntary swallowing stage when peristaltic waves move bolus through the esophagus. Esophagus opening by upper esophageal sphincter (UES) is controlled by the cricopharyngeus (CP) muscle which is innervated by the vagus nerve. Then Esophagus constriction collapsed when a bolus is not present and contains 3 parts

Cervical region: made up of striated muscle
Thoracic region: made up of striated and smooth muscle
Abdominal region: made up of smooth muscle

Question 55

NEUROLOGICAL SWALLOWING DISORDERS:

Silent Aspiration:

Dysphagia:
Causes

Oral Preparatory Stage:

Oral Stage:

Pharyngeal Stage:

Esophageal Stage:

Answer 55

Silent Aspiration: bolus penetrates the airway below the level of the vocal cords.
About one-third of dysphasic patients aspirate without any signs (i.e., no cough).

Dysphagia: Diffculty swallowing
Causes - Neurological Causes:
Stroke, TBI, Spinal cord injury, Degenerative diseases, Brain tumors OR Mechanical Causes: Acute inflammations, Cancer, Cervical spinal disease, NG tubes, Artificial airways

Oral Preparatory Stage:
Difficulty chewing
Food falling out of mouth (poor lip seal)

Oral Stage:
Food remaining in mouth (pocketing)
Difficulty forming bolus
Difficulty moving bolus backwards in mouth (anterior to posterior movement)

Pharyngeal Stage:
Swallow delay
Swallow absence
Pooling of bolus

Esophageal Stage:
Bolus staying in esophagus (dysmotility due to lack of peristaltic waves)

Question 56

The McGurk Effect

Answer 56

The illusion occurs when the auditory component of one sound is paired with the visual component of another sound, leading to the perception of a third sound.

difference between /da/ and /ta/?

Question 57

Neural Basis Of Hearing

Two Main Divisions:

Peripheral Auditory System

Central Auditory System - processing is bilateral

Answer 57

Hearing → Acoustic Energy Waves → Neural Impulses → Interpreted By Brain

Peripheral Auditory System:
Outer Ear Stage: Sound located in the environment, Pinna collects sound
Middle Ear Stage: Tympanic membrane vibrates, Energy transmitted through ossicles
Inner Ear Stage: Waves in the cochlear fluids

Central Auditory System:
Auditory Cortex - Thalamus - Brainstem Midbrain - Brainstem Medulla Pons - CN V11 7
Hair cells depolarize similar to neurons.