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Step 1 > Neuroanatomy/Physiology > Flashcards

Neuroanatomy/Physiology Flashcards

1
Q

Nissl substance

A

RER

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2
Q

Astrocytes functions lesser known

A

K+ metabolism, glycogen fuel reserve buffer, reactive gliosis in response to neural injury. GFAP is astrocyte marker. Dervied from neuroectoderm.

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3
Q

Microglia lesser known facts

A

mesodermal origin. Not readily discernible in Nissl stains. irregular nuclei, small, little cytoplasm. HIV-infected microglia fuse to form multinucleated giant cells in the CNS.

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4
Q

What effect does myelin have

A

Increases space constant and inc. conduction velocity

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5
Q

Oligodendroglia lesser known facts

A

Neuroectoderm, “fried egg” on H&E stain. Injured in MS, progressive multifocal leukoencephalopathy (PML), and leukodystrophies.

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6
Q

Progressive multifocal leukoencephalopathy

A

JC virus in HIV patients. Breaks down white matter, attacking oligodendroglia.

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7
Q

Schwann cells lesser known facts (LNFs)

A

Neural crest origin. Destroyed in Guillain-Barre syndrome.

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8
Q

Acoustic neuroma

A

Type of schwannoma, internal acoustic meatus (CN VIII): bilateral is neurofibromatosis type 2

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9
Q

What layer of peripheral nerve attacked in Guillain-Barre

A

endoneurium

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10
Q

What layer is fixed with microsurgery in peripheral nerve?

A

perineurium (permeability barrier)

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11
Q

What is the epineurium

A

Deep connective tissue that surrounds entire nerve (fascicles and blood vessels)

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12
Q

What is endoneurium

A

It surrounds the axons, but is not the myelin. It holds the axon in the equivalent of CSF.

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13
Q

C fibers

A

slow, unmyelinated for pain and temp

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14
Q

Adelta fibers

A

fast, myelinated for pain and temp

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15
Q

Which sensory corpuscle adapts slowly

A

merkel discs

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16
Q

Locus ceruleus NT and location

A

NE and pons

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17
Q

Ventral tegmentum and SNc NT and location

A

DA and midbrain

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18
Q

Raphe nucleus NT and location

A

5-HT and pons, medulla, midbrain

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19
Q

Basal nucleus of Meynert NT

A

ACh

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20
Q

Nucleus accumbens NT

A

GABA

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21
Q

Openings in Blood-Brain Barrier

A

Area postrema: vomiting after chemo OVLT: osmotic sensing Neurohypophysis release of ADH/oxytocin

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22
Q

What is the OVLT?

A

Organum vasculosum of lamina terminalis. Senses osmotic pressure in blood. HYPOTHALAMUS

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23
Q

Hypothalamus functions

A

TAN HATS: Thirst and water balance. Adenohypophysis. Neurohypophysis. Hunger. Autonomic regulation. Thermoregulation. Sexual urges.

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24
Q

Where is ADH made?

A

Supraoptic nucleus

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25
Q

Where is Oxytocin made?

A

Paraventricular nucleus

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26
Q

Lateral hypothalamus

A

Makes you hungry (grow laterally), damage makes anorexic. Inhibited by leptin.

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27
Q

Ventromedial hypothalamus

A

Makes you satiety. Stimulated by leptin. Damage makes you grow laterally and ventrally. Can be damaged by craniopharyngioma.

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28
Q

Anterior hypothalamus

A

Anterior cooling. parasympathetic

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29
Q

Posteriro hypothalamus

A

Heating, sympathetic. If you destroy posterior, you become poikilotherm (cold-blooded)

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30
Q

Suprachiasmatic nucleus function

A

Sleep

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31
Q

Suprachiasmatic nucleus pathway

A

NE release to pineal gland to melatonin

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32
Q

What NTs controlled at night by circadian rhythm

A

ACTH, prolactin, melatonin, NE

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33
Q

What causes the EOMs of REM sleep

A

PPRF (paramedian pontine reticular formation/conjugate gaze center)

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34
Q

What affects REM sleep and delta wave sleep

A

Alcohol, benzos, and barbs decrease both REM and delta wave sleep

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35
Q

NE affects REM how

A

Dec. REM sleep

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36
Q

Treating sleep enuresis

A

DDAVP, better than imipramine

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37
Q

Treating night terrors and sleepwalking

A

Benzos

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38
Q

Highest frequency EEG waves

A

Beta, when eyes open, alpha is slowly frequency with eyes closed

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39
Q

Where are theta waves

A

N1 (5%)

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40
Q

Sleep spindles and K complexes

A

N2 (45%)

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41
Q

Delta waves when

A

N3 (25%) deepest sleep

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42
Q

Where does sleepwalking, night terrors and bedwetting occur

A

N3

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43
Q

REM wave pattern

A

Beta

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44
Q

Sleep wave mnemonic

A

At night, BATS Drink Blood (beta, alpha, theta, sleep spindles/k complexes, delta, beta)

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45
Q

Thalamus receives what senses

A

Everything except smell

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46
Q

Thalamus VPL

A

Receives spinothalamic and dorsal columns/medial lemniscus: pain/temp, position/pressure/touch/vibration. Relays to primary somatosensory cortex.

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47
Q

Thalamus VPM

A

From trigeminal and Gustatory pathway for face sensation and taste to primary somatosensory cortex.

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48
Q

VPM mnemonic

A

Makeup goes on the face. (VPM)

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49
Q

Thalamus LGN

A

CN II for vision, goes to Calcarine sulcus

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50
Q

LGN mnemonic

A

Lateral = Light

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51
Q

Thalamus LGM

A

From superior olive and inferior colliculus of tectum for hearing. Goes to auditory cortex of temporal lobe.

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52
Q

MGN mnemonic

A

Medial = Music

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53
Q

Thalamsu VL

A

From basal ganglia and cerebellum for motor info, relays to the motor cortex

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54
Q

Structures of limbic system

A

Hippocampus, amygdala, fornix, mammillary bodies, and cingulate gyrus

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55
Q

Functions of limbic system

A

Emotion, long term memory, olfaction, behavior modulation, ANS function

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56
Q

Limbic system mnemonic

A

Famous 5 F’s: Feeding, fleeing, fighting, feeling, and sex

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57
Q

Cerebellum inputs

A

Contralateral cortex via middle cerebellar penducle Ipsilateral proprioceptive info via inferior cerebellar peduncle from the spinal cord (input nerves=climbing and mossy fibers)

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58
Q

What are the cerebellar peduncles

A

They are the tracts that connect the cerebellum to the brainstem.

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59
Q

Excitatory pathway of Basal Ganglia

A

This is the direct pathway. Inputs from contralateral cerebral cortex land on putamen (as well as D1 input from SNc) which inhibits the Globus Pallidus Internus which disinhibits the thalamus which increases movement.

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60
Q

Inhibitory pathway of Basal Ganglia

A

Indirect pathway. Putamen inactivates the GPe which disinhibits the STN which activates the GPi inhibition of the thalamus to decrease movement. D2 input stops the putamen efferents which decrease movement.

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61
Q

What makes up the striatum

A

Putamen (motor) + caudate (cognitive)

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62
Q

What is the lentiform nucleus

A

Putamen + globus pallidus

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63
Q

What does D2 receptors do

A

Inhibits the inhibitory pathway

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64
Q

What does D1 receptors do

A

Activates the excitatory pathway

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65
Q

What is the SNr

A

Along with the GPi inhibits the thalamus. Deactivated by the direct pathway and activated by the indirect pathway.

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66
Q

What disease has Lewy bodies and found where?

A

Parkinsons, intranuclear eosinophilic alpha-synuclein inclusions with loss of DA neurons in SNc

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67
Q

Signs of Parkinson’s

A

TRAPS: Tremor, cogwheel Rigidity, Akinesia (bradykinesia), Postural instability, Shuffling gait

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68
Q

Sxs of huntingtons

A

Choreiform movements, aggression, depression, dementia

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69
Q

Huntington path

A

Decreased GABA and ACh in brain. Neuron death from NMDA-R binding and glutamate toxicity.

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70
Q

Huntington genetics

A

CAG repeats (anticipation). Aut. dom. on Chromosome 4. Between ages 20-50.

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71
Q

Hemiballismus description and location

A

Contralateral subthalamuc nucleus (e.g. lacunar stroke), 1 arm +/- ipsilateral leg.

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72
Q

Athetosis seen where

A

Fingers, in huntingtons

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73
Q

Examples of myoclonus

A

Jerks; hiccups

74
Q

Myoclonus in what conditions

A

Renal, liver failure metabolic abnormalities

75
Q

Dystonia examples

A

Writer’s cramp; blepharospasm

76
Q

What worsens essential tremor

A

Holding posture/limb position

77
Q

Treating essential tremor

A

Beta blockers, Primidone, EtOH works

78
Q

Primidone MOA

A

Anticonvulsant that forms a benzo

79
Q

Intention tremor vs. Postural tremor

A

Intention tremor is Cerebellar dysfunction (swaying zigzag motion). Postural tremor is essential tremor and is a regular frequency.

80
Q

What does Sylvian fissure divide

A

Temporal and frontal lobes

81
Q

What is the other name for Wernicke’s

A

Associative auditory cortex

82
Q

Central sulcus divides what

A

Parietal and Frontal lobes

83
Q

Premotor area is part of what

A

Extrapyramidal circuit

84
Q

What is the homunculus distribution.

A

Feet is on the inside, progresses up to the thigh which is at the turning point, then goes to hand, then from top of face all the way down to the mouth. Tongue and swallowing are the lowest. Proximal muscles at risk for watershed infarcts.

85
Q

What happens if you lose function of both amygdala

A

Kluver-Bucy: hyperorality, hypersexuality, disinhibited. Associated with HSV-1

86
Q

What is Gerstmann’s syndrome

A

Damage to L parietal-temporal cortex: agraphia, acalculia, finger agnosia, and left-right disorientation

87
Q

Wernicke-Korsakoff presentation

A

ACE: ataxia, confusion, eye movement (nystagmus) Memory loss (anterograde/retrograde), confabulation, personality changes.

88
Q

Cerebellar vermis defects result in what

A

Truncal ataxia, dysarthria

89
Q

Cerebellar hemisphere defects

A

Intention tremor, limb ataxia, loss of balance, fall towards side of lesion

90
Q

Hippocampus b/l damage

A

Anterograde amnesia

91
Q

Paramedian pontine reticular formation damage

A

Eyes look away from side of lesion. This part of the brain initiates saccades towards the ipsilateral side.

92
Q

Frontal eye fields damage

A

Eyes look toward lesion

93
Q

Sxs of central pontine myelinolysis

A

Acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness. Can cause locked-in syndrome.

94
Q

Difference between aphasia and dysarthria

A

Dysarthria is motor inability, aphasia is higher order deficit in language processing

95
Q

Other name for Broca’s area

A

Inferior frontal gyrus of frontal lobe

96
Q

Broca description

A

Nonfluent with intact comprehension

97
Q

Wernicke other name

A

Superior temporal gyrus of temporal lobe.

98
Q

Wernicke presentation

A

Fluent, impaired comprehension and repetition

99
Q

Can Broca’s repeat?

A

???don’t think so

100
Q

Global aphasia

A

Nonfluent aphasia with impaired comprehension (broca and wernicke’s affected)

101
Q

Conduction aphasia cause

A

Repetition problem only. Damage to left superior temporal lobe and/or left supramarginal gyrus

102
Q

Transcortical motor

A

Nonfluent but good comprehension and repetition

103
Q

Transcortical sensory

A

Poor comprehension with fluent speech and reptition

104
Q

Mixed transcortical

A

Nonfluent speech, poor comprehension, good repetition

105
Q

Know the circle of willis blood flow

A

…….

106
Q

Anterior choroidal supplies and branches off

A

Branches off MCA, supplies a lot of things

107
Q

Lenticulostriate branches off and supplies

A

Branches off MCA, supplies deep cerebral structures

108
Q

What does PCA supply

A

Posterior, underside, and posterior inside of the cortex

109
Q

What regulates cerebral perfusion

A

PCO2 regulates it until it maxes out at PCO2 of 90 mmHg. PO2 does not regulate it until the PO2 is <50 mmHg

110
Q

What does therapeutic ventilation do

A

Blows off CO2 so blood flow decreases (vasoconstrict), works on the same curve as when PCO2 is rising.

111
Q

Lateral Medullary syndrome

A

Wallenberg. PICA infarction. Nucleus ambiguus effects are specific to PICA lesions. Hoarseness and dysphagia.

112
Q

Medial Medullary syndrome

A

Infarct of paramedian branches of ASA and vertebral arteries. Commonly bilateral stroke.

113
Q

Lateral pontine syndrome

A

AICA stroke. Facial nucleus effects are specific to AICA lesions.

114
Q

What stroke leads to Locked-In syndrome

A

Basilar artery stroke

115
Q

Tongue deviates to one side

A

ASA stroke leading to ipsilateral hypoglossal dysfunction

116
Q

PICA stroke

A

Ipsilateral face temp and pain; contralateral body pain and temp. DYSPHAGIA, HOARSENESS (NUCLEUS AMBIGUUS)

117
Q

AICA stroke

A

Similar to PICA with Vertigo, Vomiting, nystagmus, but facial PARALYSIS.

118
Q

Most common site of saccular aneurysm

A

ACom meeting with ACA causes visual field defects

119
Q

PCom aneurysm

A

CN III palsy: eye down and out, ptosis and pupil dilation

120
Q

Most common compilcation of Berry aneurysms

A

Rupture leading to SAH. Another complication is bitemporal hemianopia via compression of optic chiasm.

121
Q

Berry aneurysm assoicated with

A

ADPKD, Ehlers-Danlos syndrome, and Marfans. Age, HTN, smoking, Blacks

122
Q

Charcot-Bouchard microaneurysm

A

Chronic HTN; affects small vessels (e.g. basal ganglia, thalamus)

123
Q

Central post-stroke pain syndrome

A

Neuropathic pain due to thalamic lesions. Paresthesias turn to dyesthesias and allodynia. Occurs in 10% of stroke patients.

124
Q

Epidural hematoma cause

A

Middle meningeal artery (from maxillary artery) secondary to temporal bone fracture.

125
Q

Epidural hematoma defects

A

Transtentorial herniation, CN III palsy

126
Q

Epidural appearance on imaging

A

Biconvex, does not cross suture lines, cross falx, tentorium

127
Q

Tentorium cerebelli

A

Between cerebrum and cerebellum

128
Q

Falx cerebri

A

Between the L and R hemispheres of cerebrum

129
Q

What are the suture lines?

A

The skull bone suture lines

130
Q

Why can’t epidural cross suture lines?

A

Because at suture lines, the dura is tightly bound to the calvarium.

131
Q

Why can’t subdural cross falx/tentorium

A

Because it is constrained within the dura which the falx is a part of. Epidurals aren’t within the dura so they can cross the falx.

132
Q

natural history of SAH and how to treat

A

Xanthochromic tap, 2-3 days afterwards vasopasm due to blood breakdown, treat with nimodipine, cannot be seen on CT.

133
Q

Causes of intraparenchymal (HTN) hemorrhage

A

MCC is systemic HTN: also seen with amyloid angiopathy, vasculitis, and neoplasm. Seen in basal ganglia and internal capsule, but can be lobar

134
Q

Most vulnerable parts of brain to ischemia

A

Hippocampus (hypoxia=hypocampus), neocortex, cerebellu, watershed areas. 5 minutes to irreversible damage.

135
Q

Imaging for ischemia

A

diffusion weight MRI detects it in 3-30 minutes. Dark abnormality on noncontrast CT in 12-24 hrs.

136
Q

Stroke histo 12-48 hrs

A

Red neurons

137
Q

Stroke histo 24-72 hrs

A

Necrosis + PMNs

138
Q

Stroke histo 3-5 days

A

Macrophages

139
Q

Stroke histo 1-2 weeks

A

Reactive gliosis + vascular proliferation

140
Q

Stroke histo >2 weeks

A

Glial scar

141
Q

Most common site of intracerebral hemorrhage

A

basal ganglia

142
Q

Common site of thrombotic stroke

A

MCA. Ischemic strokes result in liquefactive necrosis.

143
Q

tPA indications

A

Within 3-4.5 hr of onset and no hemorrhage/risk of hemorrhage

144
Q

Treating ischemic stroke

A

tPA. Aspirin. Clopidogrel; BP control, blood sugars and lipids, a. fib

145
Q

Name the venous sinuses

A

superior Sagittal sinus, transverse sinuses, straight sinus from the ventromedial aspects (Great cerebral vein of Galen and Inferior sagittal sinus from above the ventricles). Occipital sinus from inferior sinus. All of these meet up at the back, then drain through the transverse sinuses to the sigmoid sinus into the internal jugular.

146
Q

Cavernous sinus connections

A

Connects to sphenoparietal sinus which connects to superior sagittal sinus and transverse sinus

147
Q

Superior ophthalmic brain movement

A

Connects to cavernous sinus

148
Q

Lateral ventricle circulation

A

Choroid plexus in the lateral ventricles produces CSF which flows through the foramen of Monro into the third ventricle between the thalami which connects to the fourth ventricle between the cerebellum and brainstem by the cerebral aqueduct of Sylvius. From there CSF leaks out through the foramens of Luschka (lateral) and the foramen of Magendie into the subarachnoid space of the spinal cord which then circulates around to the top of the brain and is reabsorbed by the arachnoid granulations.

149
Q

CSF made by what cells

A

Ependymal cells of choroid pleuxs

150
Q

Normal pressure hydrocephalus presentation

A

Urinary incontinence, dementia, ataxia. “Wet, wobbly, and wacky

151
Q

NPH path

A

No increased subarachnoid space volume, expansion of ventricles distorts corona radiata.

152
Q

Hydrocephalus ex vacuo

A

Cortical atrophy leads to increased CSF but no increased pressure (Alzheimers, advanced HIV, Pick disease)

153
Q

How many spinal nerves

A

31: 8C, 12T, 5L, 5S, 1Coccygeal (31 flavors of Baskin-Robbins ice cream)

154
Q

Lumbar disc herniations at what levels most common

A

L4-L5 and L5-S1

155
Q

Where does spinal cord end

A

L1-L2 vertebrae, subarachnoid space extends to S2 vetebrae.

156
Q

Lumbar puncture performed where

A

L3-L4 or L4-L5 (level of cauda equina)

157
Q

Organization of arms/legs in the spinal tracts

A

CST and STT are lower extremities laterally. Dorsal columns are lower extremities medially.

158
Q

Know the pathways and synapses of the tracts

A

Dorsal column: Dorsal root ganglion has the first cell body, synapses at nucleus gracilis/cuneatus in medulla, Decussates and moves up medial lemniscus to the VPL then to sensory cortex Spinothalamic tract: Dorsal root ganglion to synapse in ipsilateral gray matter, decussates at anterior white commissure and ascends contralaterally to the VPL. Corticospinal tract: UMN fibers decussate at caudal medulla (pyramidal decussation) and descend contralaterally to synapse on LMN in anterior horns.

159
Q

MS spinal cord lesions

A

White matter, random and assymetric; scanning speech, intention tremor, nystagmus

160
Q

Scanning speech

A

Pausing between words and weird enunciation

161
Q

Anterior horns spinal cord lesion

A

Poliomyelitis and spinal muscular atrophy (Werdnig-Hoffmann disease) Flaccid paralysis.

162
Q

Amyotrophic lateral sclerosis spinal lesion

A

Lateral CST and Anterior Horn damage, no sensory, cognitive, or oculomotor deficits

163
Q

Causes of ALS

A

Defect in superoxide dismutase 1.

164
Q

ALS presentation

A

Fasciculations with eventual atrophy and weakness of hands; fatal

165
Q

ALS tx

A

Riluzole inc. surivval by dec. presynaptic glutamate release

166
Q

ALS mnemonic

A

For Lou Gehrgis, give riLOUzole

167
Q

ASA occlusion spinal lesion

A

Spares dorsal columns and Lissauer tract

168
Q

Lissauer tract

A

???????

169
Q

Watershed in spinal cord

A

Upper thoracic ASA territory, artery of Adamkiewicz supplies ASA below T8

170
Q

Tabes dorsalis path

A

Tertiary syphilis demyelinates dorsal columns and roots.

171
Q

Tabes dorsalis associated with what

A

Charcot joints, shooting pain, Argyll Robertson pupils

172
Q

Tabes dorsalis exam findings

A

Absent DTRs and positive Romberg

173
Q

Syringomyelia path and presentation

A

Syrinx damages anterior white commissure of spinothalamic tract (2nd-order neurons). b/l loss of pain and temp (C8-T1); Chiari I; can expand and affect other tracts

174
Q

Subacute combined degeneration presentation

A

Demyelination of dorsal columns, lateral CST, and spinocerebellar tracts; ataxic gait, paresthesia, impaired position, and vibration sense

175
Q

Subacute combined degeneration causes

A

B12 or vitamin E deficiency

176
Q

Spinocerebellar tracts

A

Spinal cord to cerebellum, golgi tendon organs and muscle spindles, first order neurons

177
Q

Poliomyelitis path

A

Fecal-oral, replicates in oropharynx and small intestine before spreading via bloodstream to the CNS. Infection causes destruction of cells in ant. horn of spinal cord (LMN death).

178
Q

Poliomyelitis presentation

A

LMN signs, general constitutional signs of infection

179
Q

Poliomyelitis findings

A

CSF with inc. WBCs and slight inc. of protein (no CSF glucose change). Virus recovered from stool or throat.

180
Q

Werdnig-Hoffman disease

A

Spinal Muscular Atrophy. Congenital degeneration of ant. horns of spinal cord leading to LMN lesion. Floppy baby with hypotonia and tongue fasciculations. Infant type median age of death of 7 moonths. Aut. rec.

181
Q
A

Step 1 (34 decks)

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