Neuro - FA p478-498 Flashcards

1
Q

what induces the overlying ectoderm to differentiate into neuroectoderm and neural plate

A

notochord

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2
Q

notochord becomes what in adults

A

nucleus pulposus

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3
Q

list the 3 major region that makes up the three primary vesicles of developing the brain

A

fore, mid and hind brain

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4
Q

what do the proescephalon form

A

telencephalon & diencephalon

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5
Q

what does the telencephalon form

A

cerebral hemisphere, basal ggl and lateral ventricle

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6
Q

what does the diencephalon form

A

thalamus, hypothalamus and 3rd ventricle

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7
Q

what does the mesencephalon form

A

midbrain and aqueduct

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8
Q

what does the rhombocephalon divide into

A

metencephalon and mylencephalon

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9
Q

metencephalon forms

A

pons, cerebellum and upper part of 4th ventricle

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10
Q

myelencephalon forms

A

medulla and lower part of 4th ventricle

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11
Q

where do the microglia cells originate from

A

mesoderm

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12
Q

failure of the bony spinal canal to close with the dura intact is associated with what pathology

A

spinal bifida occulta (tuft of hair)

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13
Q

spinal problem with normal AFP

A

spinal bifida occulta

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14
Q

diff btw meningocele and meningomylocele

A

meningocele: meninges herniate only thru spinal canal meninogemylocele: meninges and spinal card herniation

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15
Q

anencephaly is due to which embryo error?

A

Failure of rostral neuropore to close –> no forebrain, open calvarium.

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16
Q

failure of left and right hemisphere to separate; which gene and diseases is it associated with? What does MRI show?

A

holoprosencephaly, sonic hedgehog gene & patau syndrome/fetal alcohol syndrome

MRI - monoventricle and fusion of basal ggl

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17
Q

Cyclopia seen with?

A

most severe form of holoprosencephaly; trisomy 13, fetal alchohol syndrome

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18
Q

lack of cerebral vermis and an cystic enlarged 4th ventricle? list 2 associations

A

Dandy walker

associated with non commmunicating hydrocephalus & spinal bifida

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19
Q

what disease is associated with meningomylocele; how does it present?

A

Arnold Chiari type II - Sx/ paralysis / sensory loss at or below level of lesion

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20
Q

Bilateral loss of pain and temperature sensation in upper limb?

A

Sphingomyelia

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21
Q

Which part of the spinal cord affected in Sphingomyelia?

A

Most common at C8–>T1

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22
Q

Intention tremor plus loss of pain and temp sensation in UL?

A

Chiari I malfomation - cerebellar tonisillar ectopia >3-5mm

assoc w/ syringomyelia

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23
Q

Which fibers are destroyed in Syringomyelia?

A

crossed fibers in ant white commissure ( spinothalamic tract)

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24
Q

Which arches are responsible for the ant 2/3 tongue? Gen sens’n nerve? Nerve for taste?

A

1st and 2nd arch, Mandibular n (V3), Facial n (VII)

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25
Q

Which arches for the post 1/3 of tongue? N for gen sens’n and taste?

A

3rd and 4th arch, CN IX, root is CN X

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26
Q

Function of hyoglossus, genioglossus, and styloglossus?

A

Hyo - retracts and lower tongue Genio - protrudes tongue Stylo - pulls sides of tongue upwards

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27
Q

Which nerves innervates which muscles of tongue?

A

All muscles of tongue inn by CN XII, except palatoglossus, by CN X

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28
Q

Nissl staining stains what (what parts of neuron) and what molecular structure?

A

rER, so therefore only stains the body of neuron, not axon

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29
Q

What is Wallerian degeneration?

A

disintegration of the axon and myelin sheath distal to site of axonal injury with macrophages removing debris.

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30
Q

Where can axons regenerate?

A

Peripheral Nervous System

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31
Q

Which neuro cell type is a buffer for EC K+ and removes excess neurotransmitter?

A

Astrocytes

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32
Q

Marker of Astrocytes? embryo origin?

A

GFAP; from neuroectoderm

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33
Q

Embryo origin of microglial cells?

A

mesodermal origin, from monocytes in Bone marrow

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34
Q

In HIV, what neurological reaction occurs in the CNS and with which cell type?

A

fomation of multinucleated giant cells from microglia

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35
Q

Which cells produce the myelin sheath in CNS and PNS?

A

CNS - oligodendrocytes PNS - Schwann cells

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36
Q

What type of channels are seen at the nodes of Ranvier?

A

Na+ channels (where AP happens!)

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37
Q

Schwann cells are injured in which disease, causing ascending paralysis? Assoc with which microbe?

A

Guillan Barre syndrome, C. jejuni

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38
Q

Embryo origin of Schwann cells?

A

neural crest

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39
Q

What is the difference in myelination between Schwann cells and oligodendrocytes? (other than location)

A

A Schwann cell can only myelinate one single PNS axon An oligodendrocyte can myelinate several (about 30) CNS axons

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40
Q

What neuro cell have a fried egg appearance histo wise?

A

Oligodendroglia

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41
Q

What 3 diseases are associated with damage to oligodendroglia?

A

MS, PML (Progressive multifocal leukoencephalopathy), leukodystrophy

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42
Q

Difference between C and A delta fibers?

A

C - slow and unmyelinated (C student is slow) A - fast, myelinated)

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43
Q

Where are meissner corpuscles located? What do they sense?

A

hairless skin, fine touch and position sense

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44
Q

Where are pacinian corpuscles located? What do they sense?

A

Deep skin layers, ligaments, joints vibration, pressure

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45
Q

Where are Merkel discs located? What do they sense?

A

Finger tips, superficial skin Pressure, deep touch, position sense

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46
Q

Where are ruffini corpuscles? What do they sense?

A

finger tips, joints Pressure, slippage of objects along surface of skin, joint angle change

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47
Q

Location of synthesis of Ach? Inc /Dec in which disease?

A

Made at Basal nucleus - Inc in Parkinsons, Dec in Alzheimer, Huntingtons

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48
Q

Synthesis location of Dopamine

A

Ventral tegmentum, Substancia Nigra (pars compacta)

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49
Q

Inc/Dec Dopamine in which diseases?

A

Dec in depression, parkinson, Inc in Schizophrenia, Huntington Dopamine involved in initiation of movement, so dec in depression (dec will to do activity) and parkinson (issue starting movement)

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50
Q

GABA is made in

A

Nucleus Accumbens (GABANA)

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51
Q

GABA dec in

A

Huntingtons, Anxiety ( dec inhibition of movement)

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52
Q

Where is NE made?

A

Locus ceruleus

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53
Q

NE inc/Dec in?

A

Inc = anxiety, dec = depression

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54
Q

Serotonin is made where?

A

Raphe nucleus

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55
Q

Serotonin is inc/dec where?

A

Dec in Anxiety, Depression and Parkinson’s

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56
Q

Embryo origin of dura mater vs arachnoid/pia mater?

A

Dura - mesoderm Arachnoid/pia - neural crest

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57
Q

3 parts to the BBB?

A

Tight junctions between nonfenestrated capillary endothelial cells, BM, Astrocyte foot processes

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58
Q

What substances can penetrate the blood brain barrier?

A

Glucose and amino acids cross slowly by carriermediated transport mechanisms. Nonpolar/lipid-soluble substances cross rapidly via diffusion.

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59
Q

Where is there a break in BBB to allow for secretion?

A

At the Hypothalamus for the secretion of ADH, Oxytocin and releasing factors.

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60
Q

2 major inputs to HT not protected by BBB?

A
  1. OVLT (organum vasculosum of lamina terminalis, senses changes in Osmo 2. Area postrema
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61
Q

Which area of HT manages hunger? Stimulated/inhibited by?

A

Lateral area - Inc by Ghrelin, inhibited by leptin

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62
Q

A cranipharyngioma of this area of the HT leads to hyperphagia, stimulated by what hormone?

A

VM - can be stimulated by leptin

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63
Q

Which autonomic nervous system affects the cooling center?

A

PANS - bc when you’re resting and digesting, you want to be cool.

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64
Q

Which nucleus causing cooling?

A

Ant - for A/C

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65
Q

Which nucleus is responsible for heating?

A

Post - her butt is HOT

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66
Q

Which nucleus is responsible for circadian rhythm?

A

Suprachiasmatic nucleus - You need to see light to have a good circadian rhythm

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67
Q

Ipsilateral proprioceptive information from spinal cord travel to cerebellum through ____ ?

A

inferior cerebellar peduncle

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68
Q

Input from contralateral cortex to cerebellum through ____ ?

A

middle cerebellar peduncle

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69
Q

output: Cerebellum to contralat cortex through ____ ? from what cell type, and is it stimulatory or inhibitory

A

Superior Cerebellar peduncle; from purkinje cells, inhibitory

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70
Q

patient has damage to lateral lobes of cerebellum. what are the symptoms?

A

fall towards injured sides affects voluntary movement extremities

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71
Q

Patient with truncal ataxia. which part of cerebellum, which other symptoms?

A

Medial lesions (vermis, fastigial nuclei, or flocculonodular lobe) - truncal ataxia w/ nystagmus, head tilting, bilateral motor defecits

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72
Q

Liste the Deep nuclei in cerebellum

A

Don’t Eat Greasy Food Dentate, Emboliform, Globose, Fastigal

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73
Q

circardian rhythm which nucleus

A

suprachiasmatic nucleus

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74
Q

describe the pathway of melatonin release

A

SupraChiasmaticNucleus –> NE –> pineal gland –> Melatonin

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75
Q

Extraocular movements during REM sleep is due to activity of what?

A

PPRF paramedian pontine reticular formation/conjugate gaze center

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76
Q

List the causes that decrease REM/ delta wave sleep

A

alcohol, benzo, barbituates - dec both. NE - dec REM sleep

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77
Q

How does Depression affect REM sleep?

A

Depression increases total REM sleep but decreases REM latency, dec N3, repeated nighttime awakenings, early morning awakening (terminal insomnia).

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78
Q

when stage of sleep does bedwetting occur? and what other 2 patho occurs in that stage too?

A

Stage N3 (Delta) others: sleep walking, night terrors

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79
Q

what are the difference between nightmares and night terrors?

A

nightmares in REM sleep

night terrors in Stage N3

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80
Q

treatment of night terrors and sleepwalking

A

BDZ - they lower stage 3 and REM sleep.

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81
Q

treatment of sleep enuresis

A

oral desmopressin ADH analog (nasal form is banned) Imipramine, Amitriptyline Nortriptyline (TCAs) not preferred bc of Side effects (alpha (-)’r so postural HTN, and anti-muscarinic). Tx of choice - motivational therapy

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82
Q

Bruxism, which stage

A

“You grind your teeth like spindles and complexes in most amount of time” - Sleep spindles and K complexes. -which is stage N2 (45% = most amount of time)

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83
Q

What happen in REM -eyes -motor -brain O2 -pulse and BP

A

-eyes: REM -motor: loss -brain O2: increased -pulse and BP: increased and variable - sex arousal -dream “BRAIN ON BODY OFF”

84
Q

What EEG waveforms are seen in sleep stages, in order?

A

at night, BATS Drink Blood

Beta
Alpha
Theta
Sleep spindles and K complexes
Delta
Beta

85
Q

Where do you see Beta?

A

eyes open (awake) and REM

86
Q

Characteristics of Beta wave

A

High frequency, low amplitude

87
Q

Which wave has low frequency and high amplitude

A

Delta wave slow and big

88
Q

Thalamus relay for all ascending sensory information except

A

olfactory

89
Q

VPL input/output, what does it sense?

A

from Spinothalamic and Dorsal Column to Primary somatosensory cortex Vibration, Pain, Pressure, Proprioception, Light touch, temperature

90
Q

where does trigeminal and gustatory pathway go?

A

VPM

91
Q

LGN is for?

A

vision (L=light)

92
Q

MGN (Medial Geniculate nucleus) is for? pathway?

A

hearing (M = music) Superior olive + inferior colliculus of tectum –> MGN –> auditory cortex of temporal lobe

93
Q

Motor info to which part of thalamus - which input?

A

Ventral Lateral nucleus

94
Q

What part of thalamus is affected in W-Korsakoff?

A

Ant + Dorsomedial thalamus ( project to mamillary bodies)

95
Q

what’s the famous 5 F’s of limbic system

A

Feeding, fighting, fleeing, feeling, Sex

96
Q

Parts of Limbic system?

A

Truef hippocampus (red arrows in A), amygdalae, mammillary bodies, anterior thalamic nuclei, cingulate gyrus (yellow arrows in A), entorhinal cortex.

97
Q

location of the primary motor is precentral or postcentral?

A

precentral

98
Q

What is postcentral?

A

primary somato sensory

99
Q

cerebral perfusion is primarily driven by

A

pCO2

100
Q

what area of the brain is responsible for disinhibition and deficit in concentration, orientation, judgement and may have reemergence of primitive reflex?

A

frontal lobe

101
Q

Where is Broca’s area?

A

inf. frontal gyrus of frontal lobe

102
Q

where is wernicke area?

A

Superior temporal gyrus of the temporal lobe

103
Q

what is the equation for CPP?

A

MAP - ICP

104
Q

If CPP is zero, what does that mean?

A

no cerebral perfusion –> brain death

105
Q

so in response to inc ICP, what does the body do?

A

inc MAP to maintain CPP

106
Q

in what response/reflex do you see acute inc in ICP?

A

Cushing (hypertension, bradycardia, irregular breathing)

107
Q

What 2 Spinal tracts are ascending and sense pressure?

A

Dorsal column - pressure, vibration, fine touch,proprioception

ant Spinothalamic tract - crude touch, pressure

108
Q

which tract has a 2nd synapse on NMJ?

A

Lateral corticospinal tract

109
Q

Which 2 tracts decussate at the 2ND-ORDER NEURON?

A

Dorsal column Spinothalamic tract (Anterolateral)

110
Q

Which 2 tracts decussate in medulla?

A

Dorsal column Lateral corticospinal tract (pyramidal decussation)

111
Q

Which 2 tracts sense pressure?

A

Spinothalamic tract Dorsal column

112
Q

Which 2 tracts cell body in dorsal root ganglion?

A

Spinothalamic tract Dorsal column

113
Q

Which tract decussates at anterior white commissure?

A

Spinothalamic tract

114
Q

Where is the cell body of Lateral corticospinal tract?

A

cell body in 1° motor cortex

115
Q

Which 2 tracts have a 3RD-ORDER NEURON end in Sensory cortex?

A

Spinothalamic tract Dorsal column

116
Q

Which tract sends vibration, fine touch, and proprioception to the cortex?

A

Dorsal column

117
Q

Where does the Lateral corticospinal tract become LMN?

A

at spinal cord as 2ND-ORDER NEURON

118
Q

Which tract sends Lateral: pain, temperature Anterior: crude touch,

A

Spinothalamic tract

119
Q

Which artery supplies ASA below ∼ T8?

A

Adamkiewicz

120
Q

nerve at the belly button

A

T10

121
Q

nerve at nipple

A

T4

122
Q

nerve — is IL (Inguinal Ligament).

A

L1

123
Q

Nerves innervating the penis

A

S2,3,4

124
Q

Diaphragm and gallbladder pain referred to the right shoulder via — nerve

A

phrenic

125
Q

Gland for melatonin secretion, circadian rhythms?

A

Pineal gland (neroectoderm)

126
Q

CN nuclei that lie medially at brain stem:

A

III, IV, VI, XII. “Factors of 12, except 1 and 2.”

127
Q

Area for conjugate vertical gaze center?

A

Superior colliculi

128
Q

Area of midbrain for auditory?

A

Inferior Colliculi

129
Q

Midbrain contains which nuclei?

A

CN III, IV

130
Q

Pons contains nuclei of which CN?

A

CN V, VI, VII, VIII

131
Q

Medulla contains nuclei of which CN?

A

CN IX, X, XII

132
Q

Spinal cord contains nucleus of which CN?

A

CN XI

133
Q

CN nuclei position: Lateral nuclei = Medial nuclei =

A

Lateral nuclei = sensory (aLar plate). —Sulcus limitans— Medial nuclei = Motor (basal plate).

134
Q

Pathway of Miosis

A

ƒƒ 1st neuron: Edinger-Westphal nucleus to ciliary ganglion via CN III ƒƒ 2nd neuron: short ciliary nerves to pupillary sphincter muscles

135
Q

Pathway of Mydriasis

A

1st neuron: hypothalamus to ciliospinal center of Budge (C8–T2) ƒƒ 2nd neuron: exit at T1 to superior cervical ganglion (travels along cervical sympathetic chain near lung apex, subclavian vessels) ƒƒ 3rd neuron: plexus along internal carotid, through cavernous sinus; enters orbit as long ciliary nerve to pupillary dilator muscles. Sympathetic fibers also innervate smooth muscle of eyelids (minor retractors) and sweat glands of forehead and face.

136
Q

(CN V2) goes through what foramen

A

Foramen Rotundum

137
Q

CN I goes through what foramen? and what reproductive pathology is associated with CN 1

A

cribriform plate kallman syndrome

138
Q

CN III, IV, V1, VI, goes thru

A

Superior Orbital Fissure

139
Q

central retina vein goes thru which foramen? with what?

A

optic canal & ophthalmic artery

140
Q

middle meningeal artery goes through

A

Foramen spinosum

141
Q

what cranial nerve is been tested when you look down from already adducted eye

A

Superior Oblique (CN 4) trochlear

142
Q

what nerve innervates the parotid gland

A

CN 9

143
Q

head turning what nerve is responsible

A

Spinal Accessory

144
Q

Visceral Sensory information (e.g., taste, baroreceptors, gut distention). is seen in what vagal nuclei

A

Nucleus Solitarius

145
Q

Motor innervation of pharynx, larynx, upper esophagus (e.g., swallowing, palate elevation) is seen in what nuclei

A

Nucleus aMbiguus

146
Q

tongue movement is innervated by what nerve

A

hypoglosseal

147
Q

Sends autonomic (parasympathetic) fibers to heart, lungs, upper GI. is by what vagal nuclei

A

dorsal motor nucleus

148
Q

list three muscles to close the jaw

A

Masseter, Temporalis and Medial ptyerigoid

149
Q

what muscles open the jaw

A

Lateral Ptyerigoid

150
Q

what cranial nerve pass through the cavernous sinus

A

CN 3, 4, V1, V2 & 6

151
Q

what artery is also found in the cavernous sinus

A

Internal Carotid Artery

152
Q

Bonus: what brachial arch does maleus incus and stapes come from

A

Malleus & Incus (first brachial arch) Stapes (2nd brachial arch)

153
Q

Snail shaped fluid filled cochlea that contains basilar membranes that vibrates secondary to sound waves refers to the…..

A

inner ear

154
Q

low frequency (wide ; flexible) of sound heard at apex in the inner ear is near what area?

A

Helicotrema

155
Q

High frequency (thin; rigid) is best heard at —-

A

base of cochlea

156
Q

what does CN V3 pass through

A

foramen ovale

157
Q

what nerve is responsible for the periauricular touch sensation of the ear

A

Vagus Nerve post auricular

158
Q

list 2 GABA receptors that works by Cl- influx

A

A and B A is in brain B is in retina

159
Q

What is the function of parasympathetic out of CN 3

A

pupillary light reflex

160
Q

What goes through internal capsule in the visual pathway?

A

Dorsal optic radiation

161
Q

Where is the uncus?

A

medial temporal lobe

162
Q

Inflammatory infiltrate in the endoneurium seen in which disease?

A

Guillan Barre

163
Q

Embryo origin of Meninges?

A

Dura mater - Derived from mesoderm. 􀂃 Arachnoid mater—. Derived from neural crest. 􀂃 Pia mater—Derived from neural crest.

164
Q

Dural venous thrombosis presents w.?

A

Signs of inc ICP- headache, focal neuro deficits, seizures.

165
Q

Aff / Eff path of corneal reflex?

A

Aff - V1 (ophthamic, nasociliary br) Eff - VII (temporal br, orbicularis oculi)

166
Q

Aff / Eff path of Lacrimation reflex?

A

Aff - V1 Eff - VII

167
Q

Aff / Eff path of Jaw jerk?

A

Aff - V3 (SS) Eff - V3 (SM - motor )

168
Q

Aff / Eff path of Pupillary reflex?

A

Aff - II Eff - III

169
Q

Aff / Eff path of gag reflex?

A

Aff - IX Eff - X

170
Q

Achilles reflex?

A

S1,S2

171
Q

Patellar reflex?

A

L3, L4

172
Q

Biceps reflex?

A

C5, C6

173
Q

Triceps reflex?

A

C7, C8

174
Q

Cremaster reflex?

A

L1, L2

175
Q

Anal wink reflex?

A

s3, s4

176
Q

Moro relfex?

A

“Hang on for life” reflex—abduct/extend arms when startled, and then draw together

177
Q

Movement of head toward one side if cheek or mouth is stroked (nipple seeking)

A

Rooting reflex

178
Q

Sucking relfex

A

Sucking response when roof of mouth is touched

179
Q

Palmar reflex

A

Curling of fingers if palm is stroked

180
Q

Dorsiflexion of large toe and fanning of other toes with plantar stimulation is sx of what in an adult?

A

Sign of an UMN lesion

181
Q

Galant reflex?

A

Stroking along one side of the spine while newborn is in ventral suspension (face down) causes lateral flexion of lower body toward stimulated side

182
Q

Testing for reflexes: Biceps = Triceps = Patella = Achilles =

A

Biceps = C5,C6 nerve root. Triceps = C6,C7 nerve root. Patella = L3,L4 nerve root. Achilles = S1,S2 nerve root

183
Q

Level of cremaster reflex?

A

L1,L2

184
Q

Level of anal wink reflex?

A

S3,S4

185
Q

What is Lissencephaly?

A

Failure of neuronal migration resulting in a “smooth brain” that lacks sulci and gyri.

186
Q

Ependymal cells are covered with cilia and microvilli, for what?

A

. Apical surfaces are covered in cilia (which circulate CSF) and microvilli (which help in CSF absorption)

187
Q

Reaction of neuronal cell body to axonal injury. Changes reflect Inc protein synthesis in effort to repair the damaged axon - what is this?

A

Chromatolysis

188
Q

Characteristics of Chromatolysis?

A

Round cellular swelling Displacement of the nucleus to the periphery Dispersion of Nissl substance throughout cytoplasm

189
Q

Vomiting center coordinated by which tract? rec info from?

A

Solitary tract, info from the chemoreceptor trigger zone (CTZ, located within area postrema in 4th ventricle), GI tract (via vagus nerve), vestibular system, and CNS

190
Q

5 receptors input into the CTZ - what are they?

A

: muscarinic (M1), dopamine (D2), histamine (H1), serotonin (5-HT3), and neurokinin (NK-1) receptors.

191
Q

Drugs that target CTZ?

A

5-HT3, D2, and NK-1 antagonists used to treat chemotherapy-induced vomiting. H1 and M1 antagonists treat motion sickness; H1 antagonists treat hyperemesis gravidarum.

192
Q

How is mesocortical pathway affected in schizophrenia?

A

dec activity = “negative” symptoms (eg, anergia, apathy, lack of spontaneity).

193
Q

how is mesolimbic pathway affected in schizophrenia ?

A

inc activity = “positive” symptoms (eg, delusions, hallucinations).

194
Q

What disease affects the nigrostriatal pathway - how so?

A

Dec activity = extrapyramidal symptoms (eg, dystonia, akathisia, parkinsonism, tardive dyskinesia). Affected in Parkinson’s

195
Q

If tuberoinfundibular pathway is affected, then?

A

dec activity –> inc prolactin –> dec libido, sexual dysfunction, galactorrhea, gynecomastia (in men).

196
Q

When does hypoxemia increase CPP?

A

Hypoxemia increases CPP only if pO2 < 50 mm Hg

197
Q

CPP is directly proportional to Pco2 until Pco2 _______?

A

CPP is directly proportional to Pco2 until Pco2 > 90 mm Hg.

198
Q

Infarct in watershed areas lead to what sx?

A

Infarct due to severe hypotension –> proximal upper and lower extremity weakness (“manin-the-barrel syndrome”), higher order visual dysfunction (if posterior cerebral/middle cerebral cortical border zone stroke).

199
Q

Presentation of venous sinus thrombosis

A

—presents with signs/symptoms of inc ICP (eg, headache, seizures, papilledema, focal neurologic deficits). May lead to venous hemorrhage

200
Q

Which conditions inc the chance of venous thrombosis

A

hypercoagulable states (eg, pregnancy, OCP use, factor V Leiden).

201
Q

Solitary tract - fxn and CN?

A

Visceral Sensory information (eg, taste, baroreceptors, gut distention)
CN VII, IX, X

202
Q

Nucl ambiguus - fxn and CN?

A

Motor innervation of pharynx, larynx, upper esophagus (eg, swallowing, palate elevation)
IX, X, XI (cranial portion)

203
Q

Dorsal motor nucleus - fxn, CN?

A
Sends autonomic (parasympathetic) fibers to heart, lungs, upper GI
CNX
204
Q

What level of spine is LP done?

A

b/w L3 and L5

205
Q

Subarachnoid space extends to what level of spine?

A

S2 vertebra lower border

206
Q
A