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Phase 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

What plane is this?

A

Coronal plane

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2
Q

What plane is this?

A

Horizontal/transverse/axial plane

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3
Q

What plane is this?

A

Sagittal plane

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4
Q

What is the purple structure?
Label its parts:

A

Brainstem

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5
Q

What is this?

A

Cerebellum

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6
Q

What does the brainstem carry + function?

A

-Ascending sensory and descending motor tracts
-Breathing, consciousness, heart rate, sleep

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7
Q

What are the functions of the cerebellum?

A

-Balance & coordination
-Gait, posture, motor learning, fine skills

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8
Q

What is this?

A
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9
Q

What does the thalamus do?

A

Sensory relay station

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10
Q

What is this?

A

Hypothalamus

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11
Q

What is the function of the hypothalamus?

A

-Homeostasis
-Temperature, food intake, water content, endocrine control, body cycles

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12
Q

What are these?

A

Hippocampus & fornix

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13
Q

in what lobe are the hippocampus and fornix and what are their functions?

A

-Temporal lobe
-Learning & memory, spatial navigation

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14
Q

What is this?

A

Lateral ventricles (aqua)

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15
Q

What is the function of the lateral ventricles?

A

Cerebrospinal fluid (CSF) production and recycling

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16
Q

What is this?

A

Caudate nucleus

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17
Q

What is the function of the caudate nucleus?

A

-Planning & execution of movement
-Memory, cognition, emotion

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18
Q

What is this?

A

Putamen

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19
Q

What is the function of the putamen?

A

-Regulation of movement c.f caudate
-Cognition and reward

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20
Q

What is this?

A

Amygdala

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21
Q

What are the functions of the amygdala?

A

Emotional learning & behaviour, fear, anxiety and aggression

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22
Q

What is this?

A

White matter

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23
Q

What does this show?
Label the diagram:

A
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24
Q

What is the function of sub-cortical white matter?

A

Interconnects cortical and sub-cortical regions

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25
Q

What are the functions of the cortical grey matter?

A

-Higher processes - memory, thinking, problem solving, reasoning, consciousness, emotion
-Sensory processing
-Movement

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26
Q

Label this diagram:

A
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27
Q

What major landmarks can be identified to help locate brain structures?

A

-Corpus callosum
-Lateral sulcus
-Brainstem

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28
Q

How are myofibres arranged in skeletal muscle?

A

Fascicles

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29
Q

What connective tissues are in skeletal muscle?

A

-Epimysium
-Perimysium
-Endomysium

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30
Q

What surrounds each myofibre?
What is its role?

A

-Basement membrane
-Tensile strength, regeneration, development

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31
Q

What makes up the basement membrane surrounding myofibres?

A

-Collages
-Glycoproteins
-Proteoglycans

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32
Q

What three external things connect to skeletal muscle?

A

-Vascular supply
-Innervation
-Myotendinous junction - transmit force of contraction to tendon

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33
Q

What is the innervation to skeletal muscle?

A

-Each fibre innervated by one nerve
-Cell bodies in anterior horn of spinal cord or brainstem

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34
Q

What is a motor unit?

A

One neuron innervates multiple muscle fibres

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35
Q

What are neuromuscular junctions?
Neurotransmitter?

A

-Synapse - rapid transmission of depolarising impulse
-Acetyl choline - binds to post-synaptic AChR

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36
Q

Describe proprioception in skeletal muscle:

A

-Length and tension
-Muscle spindles - encapsulates intrafusal fibres
-Mediate stretch reflexes and propriorecpetion
-Golgi tendon organ

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37
Q

Label this diagram:
What does it show?

A

Skeletal muscles - control and sites of pathology

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38
Q

What is a myopathy?

A

Primary muscle disease

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39
Q

What are the 2 types of muscle fibre?

A

-Slow twitch (red fibres) - fatigue resistane
-Fast twitch - fatigue rapidly but generate a large peak of muscle tension

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40
Q

What are examples of slow and fast twitch muscle fibres?

A

-Slow: Type 1, oxidative
-Fast: - 2A glycolytic and oxidative (intermediate)
-2B glycolytic (white)

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41
Q

What does this show?

A

Motor unit

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42
Q

4 features of motor unit:

A

-Motor neuron (lower) and the fibres it innervates
-Neuron and its fibres of same type
-Fibre type dependant on neuron
-Size of motor unit varies between muscles

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43
Q

What does this show?

A

Denervation (loss of nerve supply)

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44
Q

What does this show?

A

Re-innervation (restoration of nerve supply)

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45
Q

What is utilised by the contractile apparatus?
What regenerates one of them?

A

-High ATP requirement
-Creatine phosphate as short term energy store
-CP replenished by creatine kinase
-CK release on muscle fibre damage (CK serum useful clinically)

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46
Q

What can be diagnosed via muscle biopsy and why?

A

-Mitochondrial cytopathy
-Affect muscle
-Ragged red fibres, ETC deficit, mitochondrial abnormal morphology

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47
Q

What maintains membrane stability in skeletal muscles?

A

Dystrophin and its associated proteins

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48
Q

Label this diagram:

A
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49
Q

What are dystrophies?

A

-Genetically determines
-Destructibe
-Mainly progressive disorders of muscle
-Defects in proteins conferring stability can be cause

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50
Q

What is the difference between the central and peripheral nervous system?

A

-CNS - Brain, spinal cord
-Peripheral - Division located outside the skull and spinal cord

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51
Q

What does somatic and autonomic mean?

A

-Somatic - of the body
-Autonomic - unconscious/automatic

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52
Q

What does somatic nervous system interact between?

A
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53
Q

What does autonomic nervous system interact between?

A
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54
Q

Where is the non-brain part of the central nervous system located?

A

Within vertebral column

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55
Q

What are the different divisions of the spinal CNS?

A
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56
Q

What are the two parts of the spinal CNS in each vertebrae?

A
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57
Q

What do dorsal and ventral roots contribute towards and what fibres are they?

A

-Dorsal root -> Afferent
-SENSORY (affected by the world)
-Ventral root -> Efferent
-MOTOR (having an effect on the world)

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58
Q

What is the first basic subdivision of the brain?

A

-Forebrain
-Midbrain
-Hindbrain

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59
Q

Label the basic 3 subdivisions of the brain:

A
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60
Q

What are the further sub-divisions of the forebrain?

A

-Telencephalon (cerebral cortex, basal ganglia, limbic system)
-Diencephalon (thalamus, hypothalamus)

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61
Q

What is the further sub-division of the midbrain?

A

Mesencephalon - tegmentum, tectum

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62
Q

What are the further sub-divisions of the hindbrain?

A

-Metencephalon (pons,cerebellum)
-Myelencephalon (medulla)

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63
Q

Label the further sub-divisions of the brain:

A
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64
Q

What does the brain compose of in terms of systems?

A

Brain comprises hierarchy of functional systems providing increasingly sophisticated competences

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65
Q

What does the medulla contain?

A

Tracts carrying signals between the rest of the brain and the body

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66
Q

What formation does the medulla contain and do?

A

-Caudal part of reticular formation
-Functions:
-Low level sensorimotor control (e.g. balance)
-Sleep/wakefulness
-Motor plant (movement, muscle tone)
-Reflexes of cardiac, circulatory, respiratory, excretory

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67
Q

Describe the pons and its functions:

A

-Relay from cortex and midbrain to cerebellum
-Contains millions of neuronal fibres
-Pontine reticular formation (pattern generators) - e.g. walking

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68
Q

What is the function of the cerebellum?

A

-“Motor errors” between intended movement and actual movement
-Adjusts synaptic weights to eliminate error
-Online correction during movement - motor learning
-Thought-exclusive for motor coordination

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69
Q

Label the parts of the midbrain:
What are they?

A

-Tegmentum - body of midbrain
-Tectum - roof of midbrain

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70
Q

What does the tectum do?

A

-Visual/spatial and auditory frequency maps

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71
Q

What is the tectum separated into?

A

-Superior colliculus:
-Sensitive to sensory change - orienting/defensive movements
-Inferior colliculus:
-Similar but for auditory events
-Connoliculi (little hills)

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72
Q

What is the tegmentum separated into?

A

-Periaqueductal gray
-Red nucleus
-Substantia nigra

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73
Q

Label the 3 parts of the tegmentum:

A
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74
Q

What are the functions of the periaqueductal gray of the tegmentum?

A

-Defensive behaviour role
-Role in pain (ascending and descending signals)
-Role in reproduction

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75
Q

What is the function of the red nucleus of the tegmentum?

A
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76
Q

What are the parts of the substantia nigra and their roles?

A

-Part of basal ganglia
-Sustantia nigra pars compacta (dopamine cells) - basal ganglia input
-Substantia nigra pars reticulata - basal ganglia output

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77
Q

What is the diencephalon divided into?

A

-Thalamus
-Hypothalamus

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78
Q

What is the relay structure of the thalamus:

A

-Specific nuclei - relay signals to cortex/limbic system for all sensations
-Non-specific nuclei - role in regulating state of sleep and wakefulness and levels of arousal

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79
Q

What is the role of the thalamus?

A

Important relays from basal ganglia and cerebellum back to cortex

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80
Q

What is the role of the hypothalamus?

A

-Regulates the pituitary gland which regulates hormonal secretion
-Interface between brain and hormones
-Hormonal control of motivated
-Hunger, thirst, temperature, pain, pleasure and sex

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81
Q

What are the sub-cortical portions of the cerebral cortex?

A

-Basal ganglia
-Limbic system

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82
Q

Describe the basal ganglia:

A

-Group of structures
-Loop organisation
-Thought to be involved in motor function since involvement in movement disorders

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83
Q

Describe the limbic system:

A

-Group of structures
-Emotion, motivation and emotional association with memory
-Influences formation of memory by integrating emotional states with memories of physical sensations

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84
Q

What parts make up the limbic system?

A
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85
Q

What is the function of the different limbic system parts?

A
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86
Q

What are the lobes of the brain?

A

-Frontal
-Temporal
-Parietal
-Occipital

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87
Q

Label this diagram:

A
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88
Q

Describe the structure of the cortical lobes of the brain:

A

-Gray matter (6 lobes) : cell bodies
-White matter : fibres/axons
-Biggest part of the brain in primates

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89
Q

What does the frontal lobe contain?

A

Precentral gyrus from which motor instructions (fine motor control) that are sent to muscles controlling hands and feet

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90
Q

What are the divisions of the frontal lobe?

A

-Primary motor cortex : Contains many of cells giving in origin to the descending motor pathways (initiation of voluntary movements)
-Premotor and supplementary motor areas : higher level motor plans and initiation of voluntary movements

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91
Q

What are functions of the frontal lobe?

A

-“executive planning”:
-generating models of consequences of actions
-judgemental roles
-emotional modulation
-Working memory : short term info
-Control of behaviour depending on context or setting
-Prefrontal cortex

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92
Q

What does the prefrontal cortex do?

A

Generating sophisticated behavioural options that are mindful of consequences

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93
Q

What does the parietal lobe contain?

A

Postcentral gyrus which receives sensation from the rest of the body

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94
Q

Describe the parietal lobe:

A

-Primary somatosensory cortex
-Maintains representations of the body’s and head’s position in space
-Permits complicated spatio-temporal predictions e.g. catching something when you are moving

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95
Q

What does the temporal cortex contain?

A

Primary auditory cortex

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96
Q

Describe the temporal lobe:

A

-Inferotemporal cortex
-Recognition of faces and objects
-Important role in integrating sensory info from various parts of the body
-Interface between cortex and limbic system - association of affect/emotion with things

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97
Q

What does the occipital lobe contain?

A

Visual cortices

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98
Q

What are the two streams of the occipital lobe?

A

-Dorsal stream - vision for movement
-Ventral stream - vision for identification

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99
Q

How does the brain control behaviour?

A

-Sensory + selection + skill + memory + thought + emotion + motor = behaviour
-All actions will engage a bit of cortex interacting with a bit of basal ganglia, cerebellum and hippocampus all directing brainstem what to do

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100
Q

What is dystrophin?

A

-Large protein
-Confers stability to muscle cell membrane

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101
Q

Describe neuromuscular transmission:

A
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102
Q

Describe the basic histology of a peripheral nerve:

A
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103
Q

What does this show?

A

Axons within nerves can be myelinated or unmyelinated

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104
Q

In the PNS what is responsible for the myelin sheath?

A

-Schwann cells
-Each Schwann cell is responsible for one segment of myelin
-Allows saltatory conduction

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105
Q

What lie in between adjacent myelin segments?

A

-Nodes of Ranvier
-Where depolarisation of the membrane occurs
-Saltatory conduction

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106
Q

Describe axonal degeneration/regeneration (Wallerian degeneration):

A
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107
Q

Describe demyelination:

A
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108
Q

What is the range of human hearing?

A

-20-20KHz
-Range change during life

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109
Q

What are the components of the auditory system?

A

-Outer ear: air
-Middle ear: air
-Inner ear: fluid
-Central auditory pathways

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110
Q

What makes up the outer ear?

A

-Pinna
-Ear canal

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111
Q

Describe the pinna:

A

-Cartilaginous structure
-Formed from pharyngeal arches 1 & 2 (6x Hillocks of His) - 10th to 18th week in utero
-Direct soundwaves towards ear canal
-High pitch > low pitch

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112
Q

Describe the ear canal:

A

-1/3 cartilage
-2/3 bone

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113
Q

Label the structures of the outer ear:

A
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114
Q

What is this?
Describe it:

A

-Tympanic membrane
-8 x 10mm diameter
-84-55mm2

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115
Q

What makes up the middle ear?

A

-Bones: malleus, incus, stapes
-Muscles: tensor tympani, stapedius
-Tubes: eustachian tube

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116
Q

What does this show?

A

Bones of the middle ear

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117
Q

What is the role of the middle ear?

A

Acoustic impedance match between air and fluid-filled inner ear

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118
Q

How does the middle ear carry out its role (bones)?

A

-Amplification of the airborne sound vibration = makes it louder
-Area TM: Stapes 14:1
-Lever action of ossicles - handle of malleus is 1.3x longer than incus process
-Total gain = 20-35Db (18.3:1)

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119
Q

What is the increase in pressure generated in the inner ear?

A

200 fold increase boost in pressure from TM to inner ear

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120
Q

What is the role of muscles in the middle ear?

A

-Protection of the inner ear from acoustic trauma
-Stiffens ossicular chain
-Stapedius stimulated acoustically

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121
Q

Describe the nervous control of the muscles in the middle ear:

A

-Reflex arc: 3 or 4 neurones
-25ms
-Voluntary and involuntary control of tensor tympani

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122
Q

What is the role of the eustachian tube?

A

-Ventilation of the middle ear space
-Drainage of secretions
-Often dysfunctional in children

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123
Q

Label the structures of the middle ear:

A
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124
Q

What is contained within the inner ear?

A

Vestibulocochlear apparatus

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125
Q

Describe the vestibulocochlear apparatus and its innervation:

A

-Set of fluid filled sacs encased in bone
-Cochlear - hearing
-Labyrinth - balance
-Innervation - vestibulocochlear nerve

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126
Q

Describe the cochlear:

A

-2.5 turns
-2 openings (round & oval window)
-3 compartments
-2 ionic fluids

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127
Q

What are the 3 compartments of the cochlea?

A

-Scala tympanin
-Scala media
-Scala vestibuli

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128
Q

What are the 2 cochlear fluids?

A

-Endolymph: High K+
-Perilymph: Like ECF & CSF Na+ rich

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129
Q

How are gradients of cochlear fluids maintained?

A

-Na, K-ATPase
-NKCC1, CIC-K chlorine channels

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130
Q

Label this diagram of the cochlea:

A
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131
Q

Describe the basilar membrane:

A

-Narrow at base - stiff - high frequency detection
-Wide at apex - floppy - low frequency detection

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132
Q

Label this diagram to represent movement in inner ear:
What is it called?

A

Organ of corti

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133
Q

What does the basilar membrane cause?

A

-Displacement of basilar membrane causes movement of specialised mechanical transducing cells
-Hair cells

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134
Q

What are the two types of hair cell?

A

-Inner - mechanical transduction
-Outer - fine tuning

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135
Q

What is the structure of the hair cell of the ear?

A

-Base attached to basilar membrane
-Stereocillia anchored to tectorial membrane
-Shearing forces at sterocillia

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136
Q

What does this show?

A

Inner hair cell

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137
Q

What are neurons and their propagation?

A

-Specialised for electrical signalling
-Mainly formed during development
-Input via dendrite
-AP propagate along axon from axon hillock

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138
Q

How do neurones communicate?

A

-Via synapses
-Chemical - majority: neurotransmitters
-Electrical - less abundant: direct flow of ions that enable synchronized electrical activity e.g. brainstem

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139
Q

Describe chemical synaptic transmission:

A

-Axon potential depolarises synaptic terminal membrane
-Voltage-gated calcium channels open leading to calcium influx
-calcium influx triggers neurotransmitter release

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140
Q

What is the structure of an electrical synapse?

A

-Gap junctions mediate
-Direct movement of ions between two cells

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141
Q

Where are excitatory synapses often concentrated?

A

Dendritic spines

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142
Q

What is neural plasticity and why is it important?

A

-Changes in neuronal/synaptic structure and function in response to neural activity
-Basis of learning and memory

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143
Q

Describe features of dendritic spines:

A

-Dynamic structures - number, size composition
-Spine remodelling linked to neural activity
-Lower spine density linked to disease

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144
Q

Describe neuron heterogeneity:

A

Neurons differ in their:
-Size
-Morphology
-Neurotransmitter content
-Electrical properties

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145
Q

What are 2 examples of neuronal heterogeneity?

A

-Betz cells: upper motor, large, excitatory, long, pyramidal
-Medium spiny neurons: striatal interneurons, small, inhibitory

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146
Q

What does this show?

A

Arborisation of axons and dendrites

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147
Q

What are oligodendrocytes?

A

-Myelinating cells of the CNS
-Provide metabolic support for axons

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148
Q

What does myelin do?

A

-Insulates axon segments enabling rapid nerve conduction
-Myelin sheath segments interrupted by nodes of Ranvier - saltatory conduction
-Provide metabolic support for axons

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149
Q

How is the myelin sheath formed?

A

-Wrapping of axons by oligodendrocyte processes (membranes)
-Highly compacted - 70% lipid, 30% protein
-Myelin specific proteins used as markers

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150
Q

What are microglia?

A

-Resident immune cells of the CNS
-Originate from yolk sac progenitors that migrate to CNS

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151
Q

Describe the states and actions of the microglia:

A

-“resting state” highly ramified, motile processes survey environment
-Upon activation, retract processes, become amoeboid and motile
-proliferate at sites of injury - phagocytic

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152
Q

What are 4 features of microglia?

A

-immune surveillance
-Phagocytosis - debris/microbes
-Synaptic plasticity - pruning of spines
-good M2 and bad M1 microglia

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153
Q

What are astrocytes?

A

-Star like cells
-Most numerous glial cells in CNS
-Highly heterogeneous
-Common marker glial fibrillary acidic protein

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154
Q

What are the 5 functions of the astrocyte?

A

-Structural - define brain micro-architecture
-Envelope synapses
-Metabolic upport
-Neurovascular coupling - changes in cerebral blood flow
-Proliferate in disease

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155
Q

What is a nuclei in CNS?

A

Abundance of cell bodies

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156
Q

What do axons gather into and what are these called when they cross the midline in CNS?

A

-Tracts
-Commissures

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157
Q

What is grey matter abundant in?

A

-Neural cell bodies and processes
-Neutropil contains few cell bodies

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158
Q

What is white matter abundant of?

A

Myelinated tracts and commissures

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159
Q

What do cell bodies form in the PNS?

A

Ganglia

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160
Q

What do axons bundle into in the PNS?

A

Nerves

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161
Q

What are many PNS axons enveloped by?

A

Schwann cells

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162
Q

What forms the blood/brain barrier?

A

-Endothelial cell tight junctions
-Basement membrane (few fenestrations)
-Astrocyte end feet
-Pericytes (contractile-aid blood flow)

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163
Q

Describe the blood/brain barrier’s features:

A

-Dyes in blood can’t penetrate
-Sensitive to inflammation, hypertension, trauma and ischaemia
-Problem for drug delivery

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164
Q

What is special about circumventricular organs in the brain?

A

-Lack normal BBB
-Homeostatic & endocrine functions

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165
Q

What are ependymal cells?

A

-Epithelial-like
-Line ventricles & central canal of spinal cord

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166
Q

What are the functions of the ependymal cells?

A

-CSF production
-Flow & absorption
-Ciliated to facilitate flow
-Allow solute exchange between nervous tissue & CSF

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167
Q

What is choroid plexus?

A

-Frond-like projections in ventricles
-Formed from modified ependymal cells - villi form around network of capillaries
-Highly vascularised

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168
Q

What is the function of the choroid plexus?

A

-Main site CSF production by plasma filtration driven by solute secretion
-Gap junctions between cells form blood-CSF barrier

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169
Q

Describe the conversion of waves to electrical current in the ear:

A

-Movement of stereocilia
-Rapid response
-Mechanically gated K+ channels open cause depolarisation
-Results in opening of Ca2+ channels
-Neurotransmitter released - glutamate
-Repolarisation through K+ eflux into perilymph

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170
Q

What do nerves respond to on a basic level and is this a fully sound model?
Ear

A

-Each nerve responds maximally at a specific frequency
-Ability to discriminate different frequencies not fully explained in this frequency

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171
Q

What can outer hair cells alter and why is this important?

A

-Alter the stiffness of basilar membrane
-Ensures maximal stimulation at one site and dampened response at another
-Increase resolution

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172
Q

How is frequency (pitch) encoded?

A

In nerves by location along the basilar membrane

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173
Q

How is intensity (loudness) encoded?

A

In nerves by numbers responding and by firing rate

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174
Q

How is sound transduction encoded?

A

Inner hair cells (and OHC)

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175
Q

How is sound amplification encoded?

A

Outer hair cells

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176
Q

What is the nerve pathway from the ear to the brain?

A

-Auditory fibre - spiral ganglion
-Spiral ganglion -> cochlear nerve (VIII)
-Central auditory pathway

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177
Q

Label this diagram:

A
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178
Q

Describe the central auditory pathway:

A

-Cochlea -> brainstem via VIIIth nerve
-Brainstem -> medial geniculate body
-Medial geniculate body -> auditory cortex

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179
Q

Label the central auditory pathway:

A
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180
Q

Label the brainstem part of the central auditory pathway:

A
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181
Q

What does ITD stand for?

A

Interaural Time Differences

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182
Q

What is the central auditory pathway?

A

-8th nerve
-Cochlear nucleus
-Olive
-Lateral leminiscus
-Inferior colliculus
-Medial geniculate
-Auditory cortex

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183
Q

What does a defective outer/middle ear cause?

A

-Conductive hearing loss
-Treatment involves improving conduction or amplification

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184
Q

What does a defective inner ear cause?

A

-Sensorineural hearing loss
-Amplify/stimulate

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185
Q

What are the 4 key features of the blood brain barrier?

A

-Endothelial cell tight junctions
-Lack of BM fenestrations
-Astrocytic end feet
-Pericytes

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186
Q

What do these show?

A

Arterial territories

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187
Q

What is venous drainage of the brain?

A

-Veins drain into sinuses channels between 2 layers of dura
-Superior sagittal sinus
-Inferior sagittal sinus

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188
Q

What is the general vasculature of the spinal cord?

A

-Anterior spinal artery + vein
-Posterior spinal artery + vein
-Anterior + posterior radicular artery

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189
Q

What separates anterior vs posterior communication of circulation?

A

-Anterior = anterior communicating artery
-Posterior = basilar artery

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190
Q

Label this diagram:

A
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191
Q

Label this diagram:

A
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192
Q

What does the ventricular system contain?

A

CSF

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193
Q

What does interstitial fluid drain into?

A

-Into CSF via perivascular channels
Drains back via:
-Via arachnoid granulations
-Peripheral nerves to lymphatics
-Nasal mucosa lymphatics deep cervical lymph nodes

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194
Q

What are ependymal cells?

A

Have cilia to move CSF

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195
Q

Where is CSF produced?

A

Choroid plexus

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196
Q

What is this?

A

Brainstem

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197
Q

Label this diagram:
What does it show?

A

Midbrain

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198
Q

Label the cerebellum divisions:
NOT LOBES

A

.

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199
Q

What is the function of the archicerebellum floculonodular lobe?

A

-Balance
-Connected to vesibular nuclei and reticular nuclei

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200
Q

What is the function of the paleocerebellum?

A

Muscle tone and posture

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201
Q

What is the function of the neocerebellum?

A

Movements, coordination, muscle tone

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202
Q

What is the limbic system involved in?

A

-Memory
-Motivation
-Emotion
-Fight or flight

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203
Q

What is the hippocampus involved in?

A

Laying down memories

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204
Q

What is this?

A

Hippocampus

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205
Q

What is the thalamus composed of?

A

3 main groups of nuclei:
-Sensory relays
-Cerebellar and basal ganglia relays to motor frontal lobe
-Connected to associative and limbic areas of cerebral cortex

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206
Q

What does damage to the thalamus result in?

A

Loss of sensation, pain or movement disorders

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207
Q

What are the pathways through the basal ganglia?

A

Direct and indirect pathways of basal ganglia

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208
Q

Describe the hypothalamus:

A

-Multiple inputs
-Sits on top of pituitary gland and tells it what to do

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209
Q

Label this diagram:

A
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210
Q

What is the role of the spinothalamic tract and its pathway?

A

-Crude touch
-Pain
-Temperature
INPUT PATHWAY

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211
Q

What is the role of the corticospinal (pyramidal) tract and its pathway?

A

Movement
SOLE OUTPUT PATHWAY

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212
Q

What is the role of the dorsal column-medial lemniscus pathway?

A

-Vibrations
-Joint position
INPUT PATHWAY

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213
Q

How many extraocular muscles are there and their general functions?

A

-7 muscles
-Control movement of eyes
-Allow us to move our eyes without moving our head
-Conjugate movements (coordinated movements of both eyes) allow us to form one image

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214
Q

Where are the extraocular muscles?

A

Inside the orbit - attached to the outer surface of the eyeball

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215
Q

What is the natural orientation of the orbit?

A

-Orbit axis is off to an angle
-Does not line up with the optical axis (eye looking straight ahead)

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216
Q

What are the 7 extraocular muscles?

A

-1 lifts upper eyelid = levator palpabrae superioris (LPS)
-6 move eyeball
-4 recti
-2 obliques

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217
Q

What 3 cranial nerves are involved in extraocular muscle innervation?

A

-3 cranial nerves
-CN III -> Oculomotor
-CN IV -> Trochlea
-CN VI -> Abducens

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218
Q

How do you remember what cranial nerves innervate what extraocular muscles?

A

LR6 SO43
-Lateral rectus 6 (abducens)
-Superior Oblique 4 (trochlea)
-All rest 3 (oculomotor)

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219
Q

What is the origin and insertion of the extraocular muscles?

A

-Attached to orbital bones
-Insert onto the sclera (except LPS)
-LPS inserts upper eyelid

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220
Q

What does how the extraocular muscles move the eye depend on?

A

-Where muscle originates
-Where it inserts on eyeball
-Determines which way it will pull eyeball when it contracts

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221
Q

What movements of extraocular muscles are possible?

A

-Some only move eye in one direction
-Some in more than one direction
-Movement of eye involve several muscles acting together

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222
Q

Label this diagram of eye movements:

A
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223
Q

What is significant about the direction of muscle fibres of the orbit?

A

-Apex of orbit lies medially so optical axis does not coincide with orbital axis
-Direction of muscle fibres do not coincide with optical axis

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224
Q

What does the levator palpebrae superioris do?

A

-Inserts into upper eyelid and elevates it
-Innervated by oculomotor nerve (CN III) and sympathetic fibres

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225
Q

What can CN III injury cause?

A
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226
Q

Describe the medial and lateral recti muscles:

A

-Both only one action
-Medial rectus - moves eye medially (adducts)
-CN III
-Lateral rectus - moves eye laterally (abducts)
-CN VI

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227
Q

What can oculomotor nerve lesion lead to?

A

-Medial rectus weak
-Unopposed pull of lateral rectus
-Eye deviates laterally
-Diplopia

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228
Q

What can an abducens nerve lesion lead to?

A

-Lateral rectus weakness
-Unopposed pull of medial rectus
-Eye deviates medially
-Diplopia

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229
Q

Describe superior and inferior recti:

A

-More complex primary and secondary actions
-Superior: 1o elevates eye, 2o and medially rotate
-Inferior: 1o eye, 2o abducts and laterally rotate
-Both CN III

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230
Q

Describe super and inferior oblique:

A

-Superior : 1o medially rotates eye, 2o depresses and abducts
-Inferior: 1o laterally rotates eye, 2o elevates and abducts

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231
Q

Do extraocular muscles work by themselves with example?

A

-No they work together
-Looking down shows antagonistic movements of So and IR

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232
Q

Label which muscles provide which ocular movements:

A
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233
Q

What does the inner ear contain?

A

-Cochlea = sound
-Vestibular apparatus = balance

Vestibular structures:
-utricle and saccule
-3 semicircular ducts containing fluid

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234
Q

How are the semicircular ducts orientated?
What do they do?

A

-At right angles to each other
-Semicircular ducts and utricle contain sense organs for balance

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235
Q

What is in the semicircular ducts and what do they drain into?

A

-Endolymph fluid
-Empty into a sac called the utricle

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236
Q

Explain the function of the semicircular ducts:

A

-Detect movement of the head
-Head moves in one direction
-Endolymph, cupula and hair cells in ampulla bend in opposite direction
-Info sent centrally via 8th CN from right and left semicircular ducts to nuclei in medulla

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237
Q

Label these structures:

A
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238
Q

Describe the signal pathways from semicircular ducts when they reach the brain:

A

-Reach nuclei in brainstem
-Connections control posture, balance and conscious awareness of position
-Nuclei make connections with nuclei of CN III, IV and VI
-Coordinated head and eye movement

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239
Q

What is this called?

A

-Oculocephalic reflex
-Maintain fixed gaze whilst head is moving

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240
Q

Describe the oculocephalic reflex:

A

-Normally when head rotates the eyes move in the opposite direction and the gaze remains fixed
-Used to assess vestibular apparatus and brainstem
-Absent = eyes move in same direction as head = brainstem lesion

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241
Q

What is diplopia?

A

Double vision

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242
Q

What happens at the third week of embryonic development?

A

Gastrulation:
-Ectoderm: skin, NS
-Mesoderm: Notochord, muscular system
-Endoderm: epithelial lining of gut + resp system, liver, pancreas

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243
Q

What is the first stage of the development of the spinal cord?

A

Ectoderm thickens in midline to form the neural plate

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244
Q

Describe the formation of the neural tube up until the end of the 4th week:

A
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245
Q

When does the neural tube close?

A

-Normally at the end of the 4th embryonic week
-Failure to close can cause abnormalities of spinal cord (anencephaly, spina bifida)
NEURAL TUBE DEFECTS

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246
Q

What are lateral to the neural groove?

A

Presumptive neural crest cells

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247
Q

Label this diagram:

A
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248
Q

What do cells of the neurual crest go on to form?

A

-Sensory dorsal root ganglia of spinal cord and V/VII/IX/X
-Schwann cells
-Adrenal medulla
-Bony skull
-Meninges

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249
Q

What stages of brain development do these show?

A

4 and 6 weeks

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250
Q

What structures are present in the developing brain at 4 weeks?

A

-Prosencephalon - cerebral hemispheres & thalamic structures
-Mesencephalon - midbrain
-Rhombencephalon - medulla, pons, cerebellum

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251
Q

Label this diagram:
What does it show?

A

Brain development at 4th week

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252
Q

What do microcephaly and macrocephaly mean?

A

Reduced or increased head circumference

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253
Q

What does the CSF circulate through and what is its volume?

A

-Through subarachnoid spaces and ventricles
-120mLs

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254
Q

How is CSF produced and what is its function?
Where is it absorbed?

A

-Produced as filtrate of blood at choroid plexus in ventricles
-Absorbed via arachnoid granulations in superior sagittal sinus
-Cushions brain and helps circulate metabolites

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255
Q

What is hydrocephalus?

A

-Accumulation of CSF with increased intracranial pressure
-Can cause macrocephaly in children
-Obstructive (non-communicating - tumour, haemorrhage) or non obstructive (increased production)

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256
Q

What are the causes and responses in stress?

A

-Cause = stressor
-Response = stress

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257
Q

What is stress?

A

-As a response it is often characterised as either somatic (physical) or psychological (mind)
-Overlap and mediated by brain
-Preceptions are both somatic and psychological - different connected neuronal networks

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258
Q

What is somatic (physical) stress?

A

-Physical, emotional and subjective experiences
-Associated with damage of body tissue and bodily threat (pain & inflammation)

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259
Q

What is psychological stress?

A

Emotional strain or tension resulting from adverse or demanding circumstances, often involving anticipation

260
Q

What are the two types of stress?

A

-Eustress (good stress) - beneficial and motivating: striving for a goal
-Distress (bad stress) - damaging and harmful: challenge is not resolved by coping or adaptation

Type of stressor less important than how it is experienced and how bearable

261
Q

Label this diagram of stress:

262
Q

Describe distress (previously psychological stress):

A

-Any uncomfortable emotional experience accompanied with predictable biochemical, physiological and behavioural changes
-Psychological & somatic responses when we must adapt to changing conditions
-individual perceives environmental demands exceed his adaptive capacity

263
Q

Describe general adaptation syndrome (Selye):

A

-Stress - the non-specific response of the body to any demand for change
-Stress response in 3 phases:
-Alarm - stressor identified, body’s response is state of alarm (fight or flight)
-Adaptation (resistance) - body engages defensive countermeasures
-Exhaustion - body runs out of defenses, resources depleted

264
Q

What is allostasis?

A

How complex systems adapt (e.g. via SAM and HPA axis) in changing environments by changing set-points (adaptation through change)

265
Q

What is allostatic load?

A

Cumulative exposure to stressors (and cost to the body of allostasis) which if unrelieved leads to systems ‘wearing out’

Continued attempts to restore balance have long-term effects on physiological systems, including structural changes

266
Q

What is acute stress?

A

-Short-lived response to a novel situation experienced by the body as a danger
-It is healthy & adaptive and necessary for survival

267
Q

What is chronic stress?

A

Repeated or continued exposure to threatening or dangerous situations, especially those that cannot be controlled
-Some involve appraisal and conscious perception

268
Q

What are important in stress?

A

Individual differences are important including differences in exposure to & perception of stress, experiences and physiological differences in stress response

269
Q

What are the 5 elements of the human stress response?

A

-Biochemical
-Physiological
-Behavioural
-Cognitive
-Emotional

270
Q

Describe stress responses:

A

-Generic and not stressor-specific
-Mediated via autonomic nervous system:
-Sympathetic-adrenal-medullary (SAM) system
-Hypothalmo-pituitary (HPA) axis

LEAD TO CHANGES THAT INFLUENCE FUTURE RESPONSES TO STRESS REFLECTING BRAIN PLASTICITY

271
Q

What is the sympathomedullary pathway of stress?

272
Q

What is the pituitary-adrenal system of stress?

273
Q

What are the biochemical and molecular stress responses?

A

-Glucocorticoids (cortisol)
-Catecholamines (adrenaline & noradrenaline)
-Inflammation and immune response (important and complex, mediated and modified by adrenaline and cortisol)

274
Q

What is the relationship between stress and immune suppression?

A

-Acute stress: immune suppression
-Chronic stress: partial immune suppression + low grade inflammatory response; effects on gene expression (balance between immune activation & autoimmunity disrupted in chronic stress response

275
Q

Name some (fast) physiological stress responses:

276
Q

Name some physical (somatic) effects of chronic stress:

277
Q

Name some behavioural responses to stress:

278
Q

name some cognitive responses to stress:

279
Q

Name some emotional responses to stress:

280
Q

What casual pathways are involved in stress?

A

-Stress is an interaction between person and environment, people vary
-Different parts of the brain mediate responses to different types of stressor
-Amygdala and hippocampus are key

281
Q

What stress events do these show?

282
Q

How are stress and illness related?

A

-Related to a host of illnesses esp cardio and GI (strong ANS connections)
-Exacerbated physical illnesses and slows recovery + higher susceptibility to infection

283
Q

Is there a lot of evidence between stress and illness?

A

-Evidence of casual association limited
-Emerging evidence that stress increases immune ageing
-Exposure is greater in those experiencing deprivation and less healthy lifestyles

284
Q

Name some diseases stress could be linked to?

285
Q

What mental illnesses are linked to stress?

A

-PTSD
-Shell shock

286
Q

What are some symptoms of PTSD?

287
Q

What can help stress management?

288
Q

What is natural selection?

A

-The differential survival and reproduction of individuals due to differences in phenotype

289
Q

What is fitness?

A

How successful a organism is at reproducing

290
Q

What is sexual selection?

A

Competition for mates

291
Q

What is Darwin’s theory of evolution?

A

-Natural selection - observation of more offspring are produced than can survive
-Traits vary (morphology, physiology, behaviour)
-Different survival rates + reproduction + passed on to generations
Darwinism = variation, selection, retention

292
Q

Darwinian or evolutionary medicine in modern application:

A

-Understand health and disease
-Humans evolved for simple hunter-gatherer in small tribal bands - different. tomodern
-Why are we left with traits vulnerable to disease?

293
Q

How does darwinism fit into evolutionary psychiatry?

A

-Mental processes naturally selected and important functions
-Evolution heritage lead to mental mechanisms (cognitive, motivational, affective, hedonic, linguistic, behavioural)
-Some mental conditions interfere with ability to perform functions they were selected for
-Disorder in evolutionary psychiatry must refer to dysfunctions that harm person in current environment and social circumstances

294
Q

What does evolutionary psychiatry consider?

A

-Species perspective with related interests to E-Psych and medicine
-Human social brain evolution and proposes some human psychiatric mechanisms are consequences of adaptations to reproductive problems encountered in Pleistocene environments (Environment for evolutionary adaptation)

295
Q

What are the important focuses of evolutionary psychiatry?

A

-Not why one individual has illness now
-Focuses on evolutionary significance of psychiatric vulnerability, symptoms and behaviours

296
Q

Why should psychiatry consider evolution?

A

-Proposes evolutionary theories to account for widespread existence of:
-Substance misuse
-Borderline states and schizo
-Bipolar
-Dementia
-Neurodevelopmnet disorders

297
Q

What is the cycle of Tinbergen’s questions?

298
Q

Label the diagram of Tinberg’s questions:

299
Q

What are Tinberg’s 4 questions?

300
Q

What are proximate and ultimate causation?

A

-Proximate - event closest responsible for observed result
-Ultlimate - evolutionary results

301
Q

What are the end products of the human brain/mind?

A

-Behaviour patterns
-Emotions and cognitions
-Phenotypic characteristics of our brains that have been shaped by selection

302
Q

What generate the end products of the brain/mind?

A

-Brain circuitry
-Genes
-Neurotransmitters
-Subservient systems that have evolved to generate those end products

303
Q

What 5 things are pathways that mediate influence of evolutionary processes on disease vulnerability?

304
Q

What pathways have mediated the influence of evolutionary processes on disease?

A

-Selected adaptations that help protect against injuries and infection:
-Pain, sickness illness behaviour
-Anxiety, depression
-Fever, lethargy, fatigue
-Nausea
-Itching
-Sneeze, vomit, cough

305
Q

What is smoke detector principle?

A

-Explains why evolved systems regulating protective responses often give rise to false alarms
-Anxiety and panic attacks whos cost tend to be small relative to possible catastrophic costs if no response is expressed when danger is present

306
Q

What is dunbar’s number?

A

-Cognitive limit on number of people with whom one can maintain stable social relationships

307
Q

What is compassion focused therapy?

A

-Therapy rooted in evolutionary and neuroscience approach to psychological processes
-Brains designed to function in certain ways, motives, emotions are products. ofevolution

308
Q

what are. the3 types of emotion regulation system?

A

-Threat and protection
-Drive and excitement
-Contentment, soothing and social safeness
CFT aims on development. ofsoothing and social safeness system

309
Q

What is stereopsis and what is required for it?

A

-3D vision
-Two eyes

310
Q

How many layers of the eye are there and what are they?

A

-3
-Outer layer: sclera and cornea
-Middle layer: uvea
-Inner layer: retina

311
Q

What makes up the outer layer of the eye?

A

-Sclera: tough fibrous outer coat, collagen
-Cornea: also made up of collagen

312
Q

What are the features and function of the outer eye layer?

A

-light transmission - must be transparent
-Barrier to trauma and infection - tough
-Responsible for ~ 2/3 refractive power of the eye (43D)

313
Q

What are the layers of the outer eye layer?

A

-5 layers
-Epithelium
-Bownman’s layer
-Stroma
-Descemet’s layer
-Endothelium

314
Q

Label the layers of the outer layer of the eye:

315
Q

What is the middle layer of the eye made up of?

A

-Iris
-Ciliary body
-Choroid

316
Q

What is the iris?

A

-Coloured part of front of eye
-Contains dilator and sphincter pupillae muscles
-Pupillary reflexes

317
Q

What is the ciliary body?

A

-Glandular epithelium produces aqueous humour
-Ciliary )smooth) muscle controls accommodation

318
Q

Label:

319
Q

What is the choroid?

A

-Blood supply to outer third of retina
-Heat sink
-Also called uveal tract

320
Q

What makes up the inner layer of the eye?

A

-Retina
-Specialised organ of phototransduction
-Many layers

321
Q

What main structures make up the retina?

A

-Macula lutea
-Fovea centralis
-Cones
-Rods

322
Q

What are the layers of the retina?

323
Q

What cells are present in the retina?

A

-Retinal photoreceptors
-Bipolar cells
-Amacrine & horizontal cells
-Mullers glial cells
-Retinal ganglion cells

324
Q

What does the anterior segment of the eye contain and do?

A

-Aqueous humour
-Nutrition to lens and cornea
-Maintains intraocular pressure

325
Q

Describe the lens of the eye:

A

-Biconvex
-Responsible ~ 1/3 refractive power of the eye (~20D)
-Accommodation

326
Q

What is emmetropia?

A

Naturally occurring clear vision

327
Q

What is hypermetropia?

A

-Underpowered to focus near objects on retina
-Corneal curvature too shallow
-Lens not flexible enough
-Axial length of eye too short

328
Q

What is myopia?

A

-Overpowered so can’t focus far objects on retina
-Corneal curvature too steep
-Axial length of eyeball too long

329
Q

What is in the posterior segment of the eye?

A

-Vitreous humour
-Avascular visoelastic gel
-Hyaluronic acid (GAG)
-Collagen

330
Q

What are the adnexae of the eye?

A

-Lids
-Conjuctiva
-Tear film

331
Q

What are the basic components of all neurons?

A

-Dendrites
-Cell body/mass
-Axon
-Presynaptic terminals

332
Q

What are the 4 different types of neurons?

333
Q

What are the 2 types of neuronal transmission?

A

-Axonal
-Synaptic

334
Q

Describe the important property of the neuronal cell membrane:

A

-Semi permeable
-Potassium and chloride readily permeable
-Sodium crosses with difficulty
-large organic proteins cant cross at all

335
Q

What forces determine distribution of charge ions in a neuron?

A

-Diffusion
-Electrostatic pressure

336
Q

What is the ion distribution of the neuronal cell?

A

-A- (anions/proteins) - restricted to inside
-K+ - mostly inside
-Na+ - mostly outside
-Cl- - mostly outside

337
Q

Describe the sodium-potassium pump:

A

-AT to transport Na+ out and K+ in neuron
-3Na+/2K+
-Energy via ATP

338
Q

What is the result of the sodium-potassium pump?

A

-Na+ high conc outside both forces pushing in
-Membrane and pump resists inwards Na+
-K+ & Cl- can move backwards and forwards across membrane to reach steady state determined by opposing diffusion and electrostatic pressure
-Some sodium back in but is pumped out

339
Q

What is the final resting potential?

340
Q

What is the action potential?

A

-Neuron fires - sudden pulse where -ve resting potential is temp reversed
-Transmits info
-Depol + threshold
-Reversal of membrane potential
-Repolarisation to resting potential
-Refractory period

341
Q

What is the first stage of an action potential?

342
Q

Describe excitatory neurotransmitters:

A

-Depolarise the cell membrane
-increases probability of a action potential being elicited
-cause excitatory post synaptic potential (EPSP)

343
Q

Describe inhibitory neurotransmitters:

A

-Hyperpolarise the cell membrane
-Decrease probability of an action potential being elicited
-Cause inhibitory post synaptic potential (IPSP)

344
Q

When will an action potential be elicited?

A

-If membrane potential is depolarised beyond the threshold of excitation

345
Q

What region is important in Postsynaptic potentials?

A

-Voltage charges spread away from point of origin - passive conduction
-Whether AP is generated depends of what reaches the axon hillock

346
Q

What is this?

A

Axon hillock

347
Q

What happens after the hillock has depolarised?

A

-ESPSs begin to depolarise cell membrane
-Threshold ~ -60mV
-When reached, Na+ channels open and polarity reverses to +30 inside

348
Q

What does this diagram show?
Describe the process:

349
Q

Describe the lids of the eye:

A

-Protect globe
-Anterior skin, eye lashes
-Meibomian glands
-Orbicularis oculi
-Tardal plate, tarsal conjuctiva
-Levator palpebrae superioris & sympathetic muscle

350
Q

Describe the conjunctiva:

A

-Palpebral (tarsal) vs bulbar (ocular)
-Conjuctival fornix
-Limbal stem cells
-Mucous membrane (goblet)
-Lymphoid cells

351
Q

Describe the tear film:

A

-3 layers
-Anterior lipid, middle aqueous, posterior mucous
-Protective
-Nutrition for cornea

352
Q

What is the basic arterial supply of the eye?

A

-Internal carotid a. -> opthalmic a.
-Branches of opthalmic a. -> ocular + orbital group
-External carotid a. -> facial a. -> angular artery

353
Q

What arterial supply to the eye is part of of the ocular group?

A

-Central retinal artery
-Posterior ciliary artery - > long + short
-Muscular artery -> anterior ciliary a.

354
Q

Label the arterial supply to the eye:

355
Q

What are these and what supplies them?

A

-Anterior ciliary a.
-Muscular artery

356
Q

What arteries are part of the orbital group of the eye?

A

-Lacrimal a.
-Several other branches supply face and lids

357
Q

What supplies blood to the inner 2/3 of retina?

A

-Inner 2/3 central retinal a.
-Branches into superior/inferior/temporal/nasal branches

358
Q

What drains venous blood from the retina?

A

-Branch retinal veins
-Central retinal v.
-Opthalmic v.
-Cavernous sinus
-Internal jugular v.

359
Q

Label the venous drainage of the eye:

360
Q

What supplies blood to the outer 1/3 of the retina?

A

-Choroid
-Posterior ciliary a. -> choroidal a. -> choriocapillaris
-Blood-retinal barrier at RPE regulates movement of nutrition and solutes from choroid into subretinal space

361
Q

What is the venous drainage of the outer 1/3 of retina?

A

-Vortex vains drain choroid
-One for each quadrant
-Superior drain to SOV, inferior drain to IOV

362
Q

What do the superior and inferior ophthalmic veins drain into?

A

-Superior -> directly into cavernous sinus
-Inferior -> pterygoid venous plexus
-Valveless system - orbital cellulitis-facial infection can precipitate cavernous sinus thrombosis

363
Q

Label the drainage of the ophthalmic veins:

364
Q

What is the lymphatic drainage of the eye?

A

-No lymphatic drainage of globe
-Conjunctiva and lids do have lymphatic drainage to submandibular and pre-auricular nodes

365
Q

What is the structure of rods and cones and their overall function?

A

-Outer segment contains discs containing light sensitive photopigment
-Inner segment made up of cell body, axon and synaptic terminals
-Phototransduction -> absorb light, send electrical signals

366
Q

Describe photopigments:

A

-Lies in discs of outer segments
-Rods - rhodopsin
-Cones - opsin

367
Q

Describe opsins:

A

-Transmembrane proteins which contain light sensitive molecule retinal
-Different opsin structures mean retinal absorbs different wavelengths of light

368
Q

What does this show?

A

Different opsins absorb different wavelengths of light depending on their structure

369
Q

What is the effect of a photon on a opsin molecule?

A

-Triggers conformational change to all-trans form
-Triggers changes in opsin structure
-Triggers a cascade within the cell

370
Q

What is the first stage of phototransduction?

A

-Sodium ions diffuse into rod cells through an ion channel activated by CGMP
-Cells remain in a depolarised state
-Continuous release of neurotransmitter glutamate

371
Q

What is the second stage of phototransduction?

A

-Retinal in rhodopsin absorbs light and its configuration changes
-Retinal activates transducin
-Transducin creates phosphodiesterase which breaks down CGMP

372
Q

What is the third stage of phototransduction?

A

-Sodium channels close
-Less sodium enters the cell
-Cells become hyperpolarised due to exit of potassium from cell
-Glutamate release decreases
-Acts as a signal that light stimulus is present
-Arestin blocks rhodopsin from forming transudcin to create back to original state

373
Q

What is the pathway of signals in the retina?

A

-Photoreceptor -> bipolar cell -> retinal ganglion cell

374
Q

Label the pathway of signals in the retina:

375
Q

First stage?

376
Q

Second stage?

377
Q

Third stage?

378
Q

Fourth stage?

379
Q

All stages?

380
Q

Describe the basics of the visual pathway:

A

-Temporal & nasal retinas
-Left and right visual field
-Right and left vision made by crossing of fibres

381
Q

Describe the pathways of nerves from the temporal and nasal retinas:

383
Q

What is the visual field divided into and where would their pathways go?

A

-Left and right/ Upper and lower quadrants

384
Q

Result of each of these?

385
Q

What makes up the CNS?

A

-Brain + spinal cord
-Nuclei = collection of cell bodies in CNS

386
Q

What is the PNS?

A

-Nervous system outside of CNS
-12 pairs cranial
-31 pairs spinal
-Ganglia = collection of cell bodies

387
Q

Describe the cranial nerves:

A

-12 pairs
-Peripheral nerves

388
Q

What info and how is transmitted by cranial nerves?

A

-Sensory/motor/autonomic between brain + head/neck
-Different combinations of fibre types: Motor, general sensory, autonomic)
-Some contain just 1

389
Q

What are the cranial nerve names?

390
Q

What can be used to remember whether cranial nerves are sensory, motor or both?

391
Q

Which cranial nerves contain parasympathetic fibres?

392
Q

Which cranial nerves have nuclei?

A

-Nerve III-XII
-In the brainstem (MB, pons, MO)

393
Q

What is the function of cranial nerve nuclei?

A

-Receive sensory/afferent input from periphery (blue)
-Contain cells whose axons convery motor/efferent signal to periphery (red)
-Some nerves with both components have two separate nuclei
-Parasympathetic arise from specific nuclei in brainstem

394
Q

Describe CN1:

A

-Olfactory
-Function: smell
-Receptors: nasal cavity
-Axons: Trave, through cribriform plate -> olfactory bulb -> tracts -> temporal lobe
-Limbic system connections

395
Q

Describe CN2:

A

-Optic
-Function: Vision
-Fibres travel from retina to primary visual cortex

396
Q

Describe the optic chiasm:

A

-Info from nasal retinae decussates
-Info from temporal retinae remains ipsilateral
-Each optic tract contains info from contralateral visual field

397
Q

What are the 4 things to test for CN2 testing?

A
  1. Visual acuity
  2. Visual fields
  3. pupillary light reflex
  4. Fundoscopy
398
Q

What is the pupillary light reflex and what does it involve nerve wise?

A

-Normal reflex - both pupils constric when light shone in either eye
-Involves CN2 + Cn3

399
Q

What do CN3,4,6 all have in common?

A

-All eye related
-All motor
-Control extraocular muscles
-Pass through superior orbital fissure to enter the orbit

400
Q

Describe CN3:

A

-Oculomotor
-Innervates MR, SR, IR, IO, LPS
-Parasympathetic fibres to orbit for pupil constriction
-Midrain nuclei
-Nerves exit at junction between midbrain and pons

401
Q

What are the afferent and efferent for the pupillary light reflex?

A

-Afferent (input) - CNII
-Efferent (output) - CNIII parasympathetic

402
Q

What are the two different types of pupillary light response?

A

-Ipsilateral pupil constricts = direct response
-Contralateral pupil constricts = consensual response

403
Q

How can you test CNIII?

A

-Eye movements
-Pupillary light reflex
-LPS

404
Q

What are signs of lesion/problem with CNIII or pathway?

A

-Ptosis
-Lateral deviation of eye (unopposed lateral rectus)
-Dilated pupil that does not constrict

405
Q

Describe CNIV:

A

-Trochlear
-Innervates SO
-Nuclei in midbrain
-isolated lesions rare
-Paralysis of So = diplopia on looking down

406
Q

Describe CNVI:

A

-Abducens
-Innervates LR
-Nuclei in pons
-Paralysis of LR = medial deviation of eye

407
Q

What is testing for CNVI?

A

-Paralysis of left LR = medial deviation of left eye
-Able to look right
-Unable to abduct left eye on looking left

408
Q

Describe CNV:

A

-Trigeminal
-Attached to pons
-3 branches
-All contain sensory fibres -> extensive distribution in head
-Mandibular carrier motor fibres for muscles of mastication

409
Q

What are the three branches of CNV (trigeminal)?
Where do they pass through in the skull?

A

-Ophthalmic: V1 - superior orbital fissure
-Maxillary: V2 - foramen rotundum
-Mandibular: V3 - foramen ovale

410
Q

Describe the sensory fibres of CNV:

A

-Carry general sensation (touch, pressure, pain, temp)
-From dura, face and scalp, cornea, nose and mouth
-General sensation of anterior 2/3 of tongue
-Proprioception of TMJ joint

411
Q

How do you test CNV?

A

-General sensation over the face (compare left and right)
-Test corneal reflex: Between CNV (corneal sensation) and CNVII (muscles of facial expression) - gently touching the cornea should result in blinking

412
Q

Label which nerves innervate these parts of the face:

413
Q

What can CNV pathology cause?

A

-Anaesthesia over sensory distribution of nerve
-Paralysis of mastication muscles
-Trigeminal neuralgia - pain in face sudden attacks (usually unilateral)

414
Q

Describe CNVII:

A

-Facial
-Sensory, motor and parasympathetic
-Pontomedullary junction attachment at brainstem
-Two roots
-Complex course through temporal bone

415
Q

What are the two roots of the facial nerve?

A

-Medial - motor fibres
-Lateral - sensory and parasympathetic fibres (nervus intermedius)

416
Q

What do the different fibres of CNVII innervate?

A

-Special sensory - taste anterior 2/3 tongue
-Motor - muscles of facial expression
-parasympathetic - lacrimal gland, submandibular and sublingual glands
-Within parotid, terminal part divides into 5 branches

417
Q

How can you test CNVII?

A

-Special sensory - taste senasion in anterior 2/3 tongue, lacrimation (dry eye)
-Motor:
-Observe face for weakness, asymmetry
-test muscles of 5 branches - frown = raise eyebrows, screw eyebrows, puff cheeks, smile

418
Q

What injury/pathology can occur for CnVII?

A

-idiopathic (bells palsy) - nerve inflammation
-Tumour of parotid gland
-Acoustic neuroma
-Middle ear infection
-Wher it is depends on what branches are affected

419
Q

What can be confused to do with pathology of CNVII?

A

-Stroke and Bell’s palsy
-Stroke affects primary motor cortex

420
Q

Describe the motor cortex in terms of facial movement:

A

-Part of motor cortex is dedicated to upper face and lower face
-Cell bodies of UMN reside in motor cortex
-Axons travel to facial motor nuclei in pons

421
Q

Describe the motor neurons of the upper and lower face:

A

-UMN axons synapse with LMN cell bodies at facial motor nuclei (pons)
-Axons of UMN for upper and lower face cross midline and synapse with contralateral (opposite) facial motor nucleus
-facial motor nucleus also receives input from ipsilateral motor cortex which controls upper face

422
Q

How can you tell between a UMN and LMN lesion with facial weakness?

A

-If UMN on one side are injured:
-Lower contralateral weakness
-Upper contralateral face not weak as it has dual innervation from both sides of motor cortex
-facial nerve lesion = all ipsilateral facial muscles weak

423
Q

3 differences between somatic and autonomic nervous system:

424
Q

What are the main systems of the parasympathetic nervous system?

425
Q

What are the basic systems of the sympathetic nervous system?

426
Q

What is the main difference between somatic and autonomic motor neurons?

A

-Somatic - 1 neuron from spinal cord to effector
-Autonomic - Ganglion with two neurons (pre and post ganglionic)

427
Q

What are the neurotransmitters for somatic and autonomic motor neurons?

428
Q

Are pre and postganglionic fibres myelinated?

A

-Pre - yes
-Post - no

429
Q

What are the main functions of the autonomic nervous system?

A

-Thermoregulation
-Exercise
-Digestion
-Competition
-Sexual function

430
Q

What effect does sympathetic NS have on heart, blood vessels, lungs and GIT?

431
Q

What effect does parasympathetic NS have on heart, blood vessels, lungs and GIT?

432
Q

Outputs of the ANS?

A
  1. Parasympathetic
    -Cranial outflow
    -Sacral outflow
  2. Sympathetic
  3. Enteric
433
Q

Where do parasympathetic fibres communicate via?

A

-‘hitch a ride’ on cranial nerves 3, 7, 9, 10
-Apart from sacral outflow, S1, 2

434
Q

What do Sympathetic fibres communicate via?

A

-white and grey rami communicates, sympathetic chain
-splanchnic nerves to large thoraco-abdominal plexi

435
Q

What does this show?

A

Sympathetic pathway

436
Q

Label this autonomic pathway:

438
Q

Describe the pathway of the sympathetic chain:

439
Q

What is the white rami comunicantes?

A

Connect spinal nerve to sympathetic trunk

440
Q

What part of the autonomic nervous system causes fight or flight?

A

Sympathetic interaction on adrenal medulla causing massive amplification

441
Q

What is this?

A

Parasympathetic pathway

442
Q

Label this parasympathetic pathway:

443
Q

What is the cranial outflow pathways? (parasympathetic)

A

-Preganglionic fibres via:
-Cn III, VII, IX, X
-Cell bodies located in cranial nerve nuclei in the brains stem

444
Q

Describe the basic pathway of the enteric nervous system:

445
Q

What are the receptors and neurotransmitters of the autonomic nervous system?

446
Q

What are the basic sub-types of noradrenaline receptors?

A

Alpha (1 + 2)
Beta 1-3

447
Q

Is there just one receptor type of adrenergic receptor?

A

No, there are various different sub-types for each system of the body

448
Q

What goes into the brainstem nuclei of the autonomic nervous system?

A

Various inputs

449
Q

What is one of the most important receptor input of the autonomic nervous system?

A

-Carotid sinus receptors
-Baroreceptors
-Chemoreceptors
-Feedback

450
Q

Describe the basics of the autonomic cardiovascular control:

451
Q

What are the two basic groups of autonomic nervous system issues?

A

Primary - pure autonomic failure (parkinsons)
Secondary - alcohol induces, diabetes etc…

452
Q

How can you test autonomic nervous system?

A

-Heart rate, blood pressure (beat by beat)
-Head up tilt test HUT
-Pupillometry
-Sweat measurement

453
Q

What is pain affected by?

A

-Biological
-Psychological
-Social factors

454
Q

What is the psychological background to pain?

A

-All pain is real and doesnt require actual tissue damage
-Brains way of telling us it thinks you are in danger

455
Q

What components make up the cycle of pain in the body?

456
Q

What is DIM and SIM in terms of pain?

A

-DIM - danger in me
-SIM - safety in me

457
Q

How is pain created psychologically in the moment?

A

More credible evidence of DIM than SIM

458
Q

What can happen with pain in the long term?

A

-Sensitisation
-Catastrophic thinking
-Injury = high consequence

459
Q

Describe acute pain:

A

-Warning to protect from further physical damage
-Usually explained and treated
-temporary

460
Q

Describe chronic pain:

A

-No useful warning purpose
-Usually no diagnosis or explanation
-Widespread and ongoing effect

461
Q

What are the two common pathways of pain and activity?

A

-Take it easy trap
-Activity cycling

462
Q

What are the three Ps of pain management?

A

-Pacing
-Prioritising
-Planning

464
Q

What is this?

A

Motor cortex

466
Q

What are features of lower motor neuron disorders?

A

-Weakness-flaccid
-Reduced tone
-Muscle wasting
=Absent deep tendon reflex
-Fasciculcations

467
Q

What does this diagram show and label it

468
Q

What do basal ganglia do?

A

-Process all information from vast amount of afferent info from muscle spindles

469
Q

What is the physiology behind motor control?

470
Q

What stimulates and inhibits basal ganglia?

471
Q

What does this show?

A

Grey matter
Cell bodies of motor neurosn

472
Q

Are peripheral neves motor or sensory?

473
Q

What fibres do peripheral nerves carry?

A

-Motor and sensory
-Some carry autonomic fibres
Pathology can be axonal, demylination or both

475
Q

Describe the steps of a neuromuscular junction:

476
Q

What are the first 3 steps of neuromuscular junction?

477
Q

What are the second three stages of neuromuscular junction?

478
Q

What causes myasthenia gravis?

479
Q

What makes up a skeletal muscle?

482
Q

What do the light and dark bands look like during the cycle of skeletal muscle contraction?

483
Q

What is the theory of skeletal muscle contraction called?
What are the different parts of it?

A

Sliding filament theory

484
Q

What are the first two parts of sliding filament theory?

485
Q

What are the third and fourth parts of the sliding filament theory?

487
Q

How many muscle fibres make up a muscle and what is the structure of the fibres (general)?

488
Q

What is this and what does it make up?

489
Q

What makes up a myofibril?

494
Q

What are association fibres?

A

White matter tracts connecting different parts of the same hemispheres?

496
Q

What are the blue, green and red fibres called?

A

-Blue = association
-Green = commisural
-Red = projection

504
Q

What is the insula and opercula?

A

-Floor of the lateral sulcus
-Disgust, emotion, homeostasis

505
Q

What is this?

506
Q

What are the main functions of the frontal lobes?

A

-Motor functions
-Problem solving
-Memory/judgement
-Impulse control
-Higher cognitive function
-Language
-Executive function

507
Q

What is the visual representation of the motor cortex?

508
Q

What is this?

509
Q

What are the functions of the temporal lobes?

A

-Semantic processing (meaning and identity of things)
-Memory
-Language
-Primary auditory cortex

510
Q

What is this?

511
Q

What are the functions of the parietal lobes?

A

-Somatosensory
-Dominant perception (usually left)
-Language and mathematics
-Non-dominant (usually right)
-Visuospatial function

512
Q

What is this?

513
Q

What is the function of the occipital lobe?

514
Q

How many layers does the neocortex have?

515
Q

What are the inputs and outputs of the neocortex?

A

-Inputs:
-Cortical areas
-Input from thalamus
-Projections:
-Other cortical areas
-Brainstem and spinal cord
-Thalamus

516
Q

What are Brodmann areas?

A

52 regions of the brain defined by their cytoarchitecture

517
Q

What are these different areas:

A

-Green = Broca’s area
-Blue = Wernicke’s area
-Yellow = corpus callosum

518
Q

Describe brain asymmetry:

A

-Dominance of the brain
-Overall left posterior and rightward anterior asymmetry

519
Q

First layers of the coverings of the brain?

520
Q

What are these levels of the coverings of the brain?

525
Q

What does the arachnoid mater form?

A

Arachnoid cisterns

526
Q

What are the key elements of the blood brain barrier?

A

-Endothelial cell tight junctions
-Lack of BM fenestrations
-Astrocytic end feet
-Pericytes

528
Q

Label the vessels in red:

529
Q

Label the vessels in blue:

530
Q

Draw the loop of Henle:

531
Q

What are these?

A

-Arterial territories
-Different areas of the brain separated based on their arterial supply

535
Q

What do ependymal cells do?

A

-Epithelial layer lining the ventricles of the brain
-Function in the flow of cerebral spinal fluid

536
Q

What is this mode of CSF drainage?

537
Q

What is this mode of CSF drainage?

538
Q

What is this mode of CSF drainage?

539
Q

What is this mode of CSF drainage?

540
Q

Label the blue:

541
Q

label the yellow:

542
Q

Label the yellow:

543
Q

Label the green:

544
Q

Label:

545
Q

Label the purple:

546
Q

Label the red:

547
Q

Label the green:

548
Q

Label the green:

549
Q

Label the pink:

550
Q

Label the pink:
(inferior pons)

551
Q

Label the blue:
(inferior pons)

552
Q

Label:

556
Q

What is the archicerebellum and its connections?

A

-(oldest) flocculonodular lobe
-Balance
-Connected to vesibular nuclei and reticular nuclei

557
Q

What is the paleocerebellum and its connections?

A

-Quite old
-Muscle tone and posture
-Afferent:
-Dorsal spinocerebellar tracts via inf cerebellar peduncle
-Ventral SC tract via superior CP
-Efferent:
-Globose and emboliform nuclei to red nucleus to rubrospinal tract

558
Q

What is the neocerebellum and their connections?

A

-More complicated movements (coordination, muscle tone)
Afferent:
-Cerebral cortex to pontocerebellar fibres (decussate) via MCP
Efferent:
-Purks to dentate to red nucleus & ventral thalamus via SCP

559
Q

Label the orange:

560
Q

Label the green:

561
Q

What are the conscious and unconscious tracts of the spinal cord?

A

Conscious -> DCML pathway and spinothalamic pathway
Unconscious -> spinocerebellar

562
Q

What does the DCML pathway carry and how?

A

-Fine touch, vibration and proprioception
-Info travels via dorsal columns in spinal cord and. is transmitted through medial lemniscus in brainstem

563
Q

What are the first order neurons of the DCML pathway?

A

-Sensory info from peripheral nerves to medulla
-upper limb = fasciculus cuneatus = nucleus cuneatus
-lower limb = fasciculus gracilis = nucleus graciilis

564
Q

What are the second order neurons of the DCML?

A

-From cuneate gracilis nuclei fibres carry infor to 3rd order neurons
-Decussate in medulla -> contralateral thalamus

565
Q

What are the third order neurons of the DCML?

A

-Transmit sensory info to thalamus and ipsilateral primary sensory cortex

566
Q

Describe the spinothalamic tracts:

A

-Anterolateral system
2 tracts:
-Anterior spinothalamic tract - crude touch + pressure
-Lateral spinothalamic tract - pain + temp

567
Q

What are the first order neurons of the spinothalamic tracts?

A

-Arise from sensory receptors in periphery
-Enter spinal cord and synapse in tip of dorsal horn

568
Q

Describe the second order neurons of the spinothalamic tracts:

A

-Carry info from dorsal horn to thalamus
-fibres decussate in spinal cord

569
Q

Describe the third order neurons of the spinothalamic tracts:

A

-From thalamus to ipsilateral primary sensory cortex
-pathways same for both tracts
-Alongisde each other

571
Q

Describe the spinocerebellar tracts:

A

-Group of tracts carrying unconscious proprioceptive info
-Carried from muscles to cerebellum
-4 types

572
Q

Describe the 4 spinocerebellar tracts and what they do:

A

-Posterior - lower limbs to ipsilateral cerebellum
-Cuneocerebellar - upper limbs to ipsilateral cerebellum
-Anterior - lower limbs to ipsilateral cerebellum, decussate twice
-Rostral - upper limb to ipsilateral cerebellum

573
Q

What is the overview of the descending tracts?

A

-Pyrimidal tracts -> originate in cerebral cortex and carry motor fibres to spinal cord and brainstem (voluntary muscle control)
-Extrapyramidal tracts -> originate brainstem and carry motor fibres to spinal cord (involuntary and autonomic control of muscles)

574
Q

Describe the corticospinal tracts:

A

-Pyramidal
-begins in cerebral cortex
-Inputs: primary motor cortex, premotor cortex, supplementary cortex
-Cortex -> descend internal capsule -> crus cerebri -> pons -> medulla
-Caudal medulla tract divides into 2

575
Q

Describe the lateral and anterior corticospinal tracts:

A

-Lateral decussates then descends terminating in ventral horn
-Anterior remains ipsilateral to spinal cord and decussates and terminates in ventral jorn of upper thoracic levels

576
Q

Describe the corticobulbar tracts:

A

-Pyramidal
-Begins in lateral primary motor cortex
-Inputs same as corticospinal
-Cortex -> descend internal capsule -> crus cerebri -> brainstem -> terminate motor nuclei of cranial nerves (facial + neck muscles)
-most fibres innervate motor neurons bilaterally except facial and hypoglossal

577
Q

Describe the exceptions of the corticobulbar tracts:

A

Facial nerve:
-Contralateral innervation
-Only affects muscles in lower quadrant of face
Hypoglossal:
-Only contralateral

578
Q

Describe the extrapyrimidal tracts:

A

-Originate in brainstem
-4 in total
-Rubrospinal and tectospinal decussate - others dont

579
Q

Describe the vistibulospinal tract:

A

-Arise vestibular nuclei
-Medial and lateral tracts
-Supply ipsilateral info
-Control balance and posture

580
Q

Describe the reticulospinal tract:

A

-Medial tract arises from pons
-Facilitate voluntary movements
-Increase muscle tone

-Lateral arise from medulla
-Inhibits voluntary movement
-Reduces muscle tone

581
Q

Describe the rubrospinal tract:

A

-Arises red nucleus
-Decussate and then descend
-Role in fine control of hand movement

582
Q

Describe the tectospinal tract:

A

-Arises superior colliculus
-Decussate then enter spinal cord
-Coordinates movements of the head in relation to vision stimuli

583
Q

What fibres does CNVII contain and where are they connected to the brain?

A

-Sensory, motor and parasympathetic fibres
-Attached to the brainstem at the pontomedullary junction

584
Q

What are the roots of CNVII?

A

Has two roots:
-Medial - motor fibres
-Lateral - sensory and parasympathetic fibres (the nervus intermedius)
-Complex course through temporal bone

585
Q

What are the 3 fibre types of CNVII?

A

Special sensory - taste anterior 2/3 tongue

Motor - muscles of facial expression

Parasympathetic - lacrimal gland, submandibular and sublingual salivary glands

586
Q

How can you test CN VII?

A

-Taste sensation of anterior 2/3 tongue
-Lacrimation (dry eye)

Motor:
-Observe facial weakness
-Muscles of expression

587
Q

What kind of nerve is CNVIII?

A

Sensory nerve

588
Q

Describe the vestibular afferents:

A

-Go to vestibular nuclei
-Connections to spinal cord, cerebellum, nuclei of CN III, IV and VI
-Cerebral cortex for posture, balance, eye movement, conscious perception of position of head

589
Q

Describe the cochlear afferents:

A

-To 2 cochlear nuclei
-Primary auditory cortex (superior temporal gyrus) - conscious perception of sound
-Auditory association cortex (Wernicke’s area) - interpretation

590
Q

How can you test CNVIII?

A

Testing cochlear component:
-Crude testing - covering each ear and whispering into the other

Vestibular:
-Observing balance and gait
-Caloric testing

591
Q

What fibres are in CN IX?

A

-Sensory, motor and parasympathetic fibres
-Attached to medulla via several small rootlets

592
Q

What are the functions of the CN IX?

A

-Taste - posterior 1/3 of the tongue
-General sensation (touch, temp, pain) of:
-pharynx
-eustachian tube
-posterior 1/3 of tongue
-Afferents from carotid sinus (baroreceptors) and carotid body (chemoreceptors)
Parasympathetic fibres -> parotid gland

593
Q

What fibres are in CNX?

A

-Sensory, motor and parasympathetic fibres
-Attached to the medulla via several small rootlets

594
Q

Describe the sensory aspect of CNX:

A

-General sensation to pharynx, larynx, oesophagus, EAM, tympanic membrane
-Visceral afferents - thoracic and abdo viscera
-Afferents from the aortic bodies (chemoreceptors) and aortic arch (baroreceptors)

595
Q

Describe the motor and parasympathetic fibres of CNX:

A

-Motor -> soft palate, pharynx and larynx - vital for swallowing and speech
-Parasympathetic - thoracic and abdo viscera

596
Q

How can you test CNX?

A

Patient’s voice:
-hoarseness or nasal sound
-elicit the gag reflex (afferents = IX, efferents = X)
-Elevation of palate (‘ah’)

597
Q

What kind of nerve is XI?

A

Motor nerve

598
Q

What are the parts of CN XI and their functions?

A

Cranial part: Rootlets arise from the medulla and leaves via the jugular foramen by joining vagus

Spinal part: From ventral horn spinal cord C1-5
-Travels up through foramen magnum
-Leaves again through jugular foramen
-Innervates sternocleidomastoid and trapezius

599
Q

how can you test CN Xi?

A

Test SCM - turn head against resistance
-Trapezius - symmetry / atrophy?

600
Q

Describe CNXII:

A

-Motor nerve -> muscles of the tongue
-Arises from the medulla, leaves through the hypoglossal canal

601
Q

How do you test CNXII?

A

-Ask patient to stick their tongue out
-Deviation of tongue on one side?
-In lesion, ipsilateral tongue muscles are paralysed - contralateral musles still function and push tongue to weak side

602
Q

What are the 3 types of pain?

A

-Nociceptive - actual damage to non-neural tissue (nociceptors)
-Neuropathic - lesion or disease of somatosensory NS
-Nociplastic - altered nociception despite no clear evidence of actual of threatened tissue damage (activation of peripheral nociceptors)

603
Q

What is allodynia?

A

Pain due to a stimulus that does not normally provoke pain

604
Q

What is dyesthesia?

A

Unpleasant abnormal sensation whether spontaneous or evoked

605
Q

What are hyperalgesia and hypoalgesia?

A

-Hyper - increased pain from a stimulus that normally provokes pain
-Hypo - diminished pain in response to a normaly painful stimulus

606
Q

What are hyperalgesia and hypoalgesia?

A

-Hyper - increased pain from a stimulus that normally provokes pain
-Hypo - diminished pain in response to a normaly painful stimulus

607
Q

Describe the pain pathway generally (diagram):

608
Q

Describe the different nerves in the sensory pain response:

610
Q

What are nociceptors?

A

-Peripheral receptor for the pain system
-NOT simple touch and temperature which have their own specialised receptors cells
-Simply the free nerve endings of A-delta and C fibres (primary afferent neurons)

611
Q

What is a special trait of nociceptors?

A

-Poly-modal
-Thermal/chemical/mechanical)

612
Q

Describe the activation thresholds of nociceptors:

A

-Activation thresholds for mechanical and thermal stimulation are high compared to mechanoreceptors and thermoreceptors
-Extremes of pressure and temperature activate nociceptors

613
Q

What are the types of nociceptors and where are they found?

A

-AΔ fibres
-C fibres
-Found in any area of the body that can sense pain either externally or internally
-External: skin/cornea/mucosa
-Internal: viscera/joints/muscles/connective tissue

614
Q

Where do nociceptor cell bodies lie?

A

Either in:
-Dorsal root ganglion (body)
-Trigeminal ganglion (face/head/neck)

615
Q

What are the two nociceptors responsible for?

A

A-delta - mediate initial fast pain of injury (protective withdrawal reflex)
C - dull, throbbing pain that accompanies inflammation following injury

616
Q

What is the third type of nociceptor?

A

-Visceral nociceptors
-Similar to the other 2 types found in periphery
-Respond to distention and ischaemia rather than cutting and thermal damage
-Carried by alpha-delta and C fibres

617
Q

Describe the dorsal root ganglion:

A

-present on dorsal root (sensory)
-comprised of cell bodies of nerve fibres that are sensory
-first order neurons
-pseudo-unipolar neurons
-can be source of pain pathology

618
Q

What is the equivalent of the dorsal root ganglion of the head/neck?

A

Trigeminal ganglion is the equivalent for the face/head

619
Q

What is the equivalent of the dorsal root ganglion of the head/neck?

A

Trigeminal ganglion is the equivalent for the face/head

621
Q

What info is carried in the different types of sensory nerve fibres?

622
Q

Describe the myelination of different sensory fibres:

623
Q

Describe how diameter and speed differs between different sensory fibres:

624
Q

What is this and describe it:

A

-Dorsal horn
-Posterior aspect of SC grey matter forms two horns called dorsal horns
-Contain distal nerve endings of primary afferents and cell bodies of second order neurons
-Also excitatory and inhibitory interneurons that transmit somatosensory info from the SC to brain

625
Q

What do alpha-delta and C fibres do in the dorsal horn?

A

A-delta afferents synapse directly with secondary afferent which carry signal to thalamus

C fibres connect to secondary afferents via interneurons which are important in modulation of the pain signal

626
Q

How do visceral afferents differ from a-delta and c fibres in the dorsal horn?

A

-Fewer primary afferents activate a larger number of second order neurons, resulting in poorer localisation of pain
-Also converge with somatic inputs, may account for referred pain

627
Q

How do visceral afferents differ from a-delta and c fibres in the dorsal horn?

A

-Fewer primary afferents activate a larger number of second order neurons, resulting in poorer localisation of pain
-Also converge with somatic inputs, may account for referred pain

629
Q

What are spinothalamc tracts?

A

-Sensory that carries pain, temperature and crude touch info from the body
-2nd order neurons
-Originate in spinal cord (substantia gelatinosa and nucleus proprius)

630
Q

Describe the pathway of spinothalamic tract (STT):

A

-ORIGINATE SPINAL CORD
-DECUSSATE AT OR FEW LEVELS ABOVE THE SITE OF ENTRY (SPINAL SEGMENT)
-CROSS MIDLINE IN ANTERIOR COMMISSURE
-FORM ANTEROLATERAL TRACT
-TERMINATE IN THALAMUS (VENTRAL POSTERIOR LATERAL NUCLEUS)
-SOME AXONS TERMINATE IN RETICULAR FORMATION AND MIDBRAIN

631
Q

What spinothalamic tracts carry what info?

A

-Lateral STT - pain + temp
-Anterior STT - crude touch

633
Q

Describe the lateral spinothalamic tract:

A

-Neospinothalamic tract
-Runs superficially in the anterolateral white matter cord
-Ascends directly to the lateral thalamus
-Carries sensory, discriminative part of pain signal

634
Q

Describe the medial spinothalamic tract:

A

-Paleospinothalamic tract
-Deeper in the cord, sending collaterals to the reticular activating system, periaqueductal grey and hypothalamus before terminating in medial nucleus
-General arousal and sversive component of pain experience

636
Q

Describe the basics of the thalamus and its function:

A

-Midline paired symmetrical structure
-All sensations except olfactory relay/pass through
-Multiple nuclei: CPL, Medial group
-Reciprocal connections to all parts of cortex

637
Q

What do the thalamic nuclei contain in the pain pathway and what do each do?

A

-Cell bodies of third order neurons - projetions which make up the final part of the nociceptive pathway
-Medial nuclei - emotional component
-Lateral nuclei - sensory component

638
Q

What is this?

A

-Sensory cortex
-Brodmann area 3, 1, 2
-Every area on the body is represented in a spatial fashion sensory homonculus

639
Q

What is the pain matrix?

A

-Certain areas are consistently activated in response to painful stimulus
-From the thalamus, third order neurons make multiple connections to the somatosensory crtices and deeoer midbrain structures
-Important ones are limbic system and anterior cingulate cortex

640
Q

What is this and what does it do? (pain)

A

-Insula
-Degree of pain is judged
-Subjective aspect of pain perception
-Perception, motor control, self-awareness and interpersonal experience

641
Q

What role does the amygdala play in pain and why?

A

-Learned emotional responses
-Important for emotional-affective dimension of pain and for pain-modulation

642
Q

Describe the cingulate cortex and its aspect of pain:

A

-Medial aspect of cerebral hemispheres
-Linked with limbic system and associated with emotion formation and processing, learning and memory
-Maintains reciprocal connections with other pain processing areas

643
Q

Describe peri-acqueductal gray, particularly with pain:

A

-Grey matter around cerebral aqueduct
-Input from cortical and sub-cortical areas
-Projects onto neurons in dorsal horn
-Bear opioid receptors
-Pathways include noradrenergic and serotonergic neurons

644
Q

What can stimulus of the PAG result in?

A

Profound analgesia

645
Q

Where do different pain-killers target?

Phase 1 (23 decks)

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