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Intro Anesthesia > Peripheral Nerve Anatomy and Physiology - Travis' Lecture > Flashcards

Peripheral Nerve Anatomy and Physiology - Travis' Lecture Flashcards

1
Q

3 divisions of CNS

A

Spinal Cord

Brain Stem

Brain

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2
Q

Autonomic nuclei of SNS and PSNS innervates what 3 things.

A

Cardiac muscle

Smooth muscle

Organs (not under out control)

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3
Q

Peripheral Nervous System (PNS) includes all the neural tissue outside the ______.

A

CNS

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4
Q

______ are sensory structures that detect changes in the internal or external environment.

A

Receptors

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5
Q

The _______ ________ of the PNS brings information to the CNS from receptors in peripheral tissue and organs.

A

Sensory division

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6
Q

Information processing includes the ______ and _______ of information in the CNS

A

Integration Distribution

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7
Q

The ______ ________ of the PNS carries motor commands from the CNS to peripheral tissues and systems.

A

Motor division

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8
Q

Somatic NS controls _____ muscle contractions

A

Skeletal

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9
Q

(Per Image from slides). ANS provides autonomic regulation of what 4 components? Travis only listed 3.

A

Smooth muscle Cardiac muscle Glands Adipose

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10
Q

______ are target organs who activities change in response to neuronal commands.

A

Effectors

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11
Q

Somatic NS includes both receiving ____information and relaying _____ commands to muscles.

A

Sensory Motor

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12
Q

Cell body of a neuron.

A

Soma

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13
Q

______ receive information and transmit to the cell body. (part of neuron)

A

Dendrites

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14
Q

“Functional unit” of a neuron. Carries response of a neuron in the form of a propagated action potential.

A

Axon

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15
Q

Supports and insulate axon Supply metabolites and distribute neurotransmitters

A

Schwann

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16
Q

Segments of neuron that do not contain myelin? Responsible for conduction propagation thru _____ channels.

A

Nodes of Ranvier Sodium

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17
Q

Why are nodes of ranvier thought to be the site of action of local anesthetics.

A

No myelin sheet means limited diffusion barriers for locals to get into the axon.

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18
Q

Nodes of Ranvier are responsible for _____ conduction.

A

Saltatory

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19
Q

(neuron component) Releases electric signal from presynaptic cell. Synapse with effector cell or another nerve cell.

A

Axon terminal

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20
Q

Space between axon terminal and dendrite (pre and post-synaptic area).

A

Synaptic cleft.

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21
Q

(PNS components) Surrounds perineurium Composed of connective tissue and holds fascicles together.

A

Epineurium

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22
Q

(PNS components) Connects tissue which surrounds each nerve fiber fascicle.

A

Perineurium

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23
Q

(PNS components) Surrounds and embeds axon within the fasciculi.

A

Endoneurium

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24
Q

A bundle of axons together

A

Fasciculi

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25
Q

Epineurium, perineurium and endoneurium are all types of _______ tissue that function as _____ in which local anesthetics must diffuse through in order to get to specific axons of neurons.

A

Connective Barriers

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26
Q

Which is a myelinated vs unmyelinated and label the parts.

A

a. myelinated
b. unmyelinated (all purple is single schwan cell)

A. Node of Ranvier

B. Axon

C. Myelin Sheeth

D. Axon

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27
Q

(Unmyelinated nerve) A single _____ cell covers several axons in a bundle.

A

Schwann

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28
Q

(Large Nerves) The schwann cells cover a single axon and form several layers of the liquid ______.

A

Myelin

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29
Q

Compared to unmyelinated nerves, myelinated nerves are…

A

Larger

Conduct impulses faster

More difficult to block with locals

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30
Q

Myelinated nerves work by ______ conduction.

A

Saltatory

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31
Q

Label

A
  1. Node of Ranvier
  2. Nucleus of Schwann cell
  3. Myelin sheath
  4. Plasma membrane of axon
  5. Neurofibrils, microfilaments, and microtubules
  6. Neurofibriles, microfilaments, and microtubules
  7. Plasma membrane of axon
  8. Axon
  9. Myelin Sheath
  10. Neurilemma
  11. Nucleus of Schwann cell
  12. Neurilemma (Sheath of Schwan cell)
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32
Q

žThe nerve membranes of the postsynaptic neurons have _____ which bind the neurotransmitters released from the Presyn or postsyn terminals.

žThis is ______ mediated and is different from the electrical transmission down the axon.

A

receptors

presynaptic

chemically

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33
Q

Label

A
  1. end of axon
  2. synaptic knob
  3. synaptic cleft
  4. dendrite
  5. mitochondria
  6. synaptic vesicle containing neurotransmitter substances
  7. pre-synaptic membrane
  8. post-synaptic membrane
  9. protein receptor
  10. ion channel
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34
Q

Label

A

a. Propogation
b. Depolarized
c. Resting
d. Resting

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35
Q

Label

A
  1. Refractory
  2. Depolarized
  3. Resting
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36
Q

Review

A
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37
Q

Review

A
38
Q

4 types of A Fibers

A
  1. A alpha- motor and sensory
  2. A beta- motor and sensory
  3. A gamma- motor
  4. A delta- sensory
39
Q

Which type of A Fiber does this describe?

Largest diameter, (15-20 µm) most heavily myelinated FAST

Somatic motor function, skeletal muscles, joints, muscle length/force, proprioception

A

A alpha- motor and sensory

40
Q

Which type of A Fiber does this describe?

Small (1-4 µm) : pain and cold temperature sensation

A

A delta- sensory

41
Q

Which type of A Fiber does this describe?

(4-15 µm) almost as fast as a alpha

Touch, pressure, proprioception

A

A beta- motor and sensory

42
Q

Which type of A Fiber does this describe?

( 3-6 µm) Innervate muscle spindle fibers, skeletal muscle tone, joints

A

A gamma- motor

43
Q

Which type of A Fiber does this describe?

(4-15 µm) almost as fast as a alpha

Touch, pressure, proprioception

Also skeletal muscles joints

A

A beta- motor and sensory

44
Q

Which type of Fiber does this describe?

Same size as delta

Slower conduction (less myelination that A)

Make up the preganglionic autonomic nerves

A

“B” Fiber

45
Q

Which type of Fiber does this describe?

Smallest of all fibers (0.3-1 µm)

Unmyelinated and slowest

Postganglionic sympathetic nerves and afferent sensory nerves

Autonomic functions, pain, warm and cold temperature, touch

A

C Fibers

46
Q

(Differential Block)

žIn most types of nerve blocks loss of function follows a similar pattern in this order.

A
  1. Autonomic function
  2. Pain
  3. Touch and temperature
  4. Motor function
  5. proprioception
47
Q

žDifferential block may be influenced by the rate of ______ of the local across barriers and _______the of nerve fiber types with the peripheral nerve

Specific anatomy factors of specific axons also play into differential blockade. Whether if the nerve is myelinated or not and its location in the actual peripheral nerve.

A

Diffusion

Location

48
Q

žNociception or pain perception takes place when a signal is carried to the brain via _____ _______ nerve fibers.

A

Sensory afferent

49
Q

žA delta and C fibers have their cell bodies in the _______ ______ __________

synapse with second order neurons in dorsal horn and carry impulse to different parts of the spinal cord and the brain.

A

Dorsal root ganglia

50
Q

žREMEMBER: A delta fibers are responsible for ___________ pain.

Duration of pain = duration of _______.

A

Fast, sharp

Stimulus

51
Q

žREMEMBER: C fibers are responsible for _____________ pain

Duration of pain exceeds the duration of stimulus

A

Slow, chronic

52
Q

What is associated with this ascending pathway?

(I think this was an FYI in lecture at this point in time)

žLateral Spinothalamic Tract

A

Transfer of pain and temperture

53
Q

What is associated with this ascending pathway?

(I think this was an FYI in lecture at this point in time)

Crude touch and pressure

A

žAnterior Spinothalamic Tract

54
Q

What is associated with this ascending pathway?

(I think this was an FYI in lecture at this point in time)

žSeveral Spino-cerebellar Tracts

A

Unconscious sensation and proprioception

55
Q

What is associated with this ascending pathway?

(I think this was an FYI in lecture at this point in time)

žDorsolateral Column Medial Lemniscal Tract

A

Proprioception

56
Q

FYI

Try to label if you just want to!

A

FYI

57
Q

žPain activation: What is stimulated

A

Free nerve ending stimulated within different muscles, tissues, glands via pain stimulus

58
Q

Pain pathway transmission occurs by what 2 fibers?

A

A-Delta

C-Fibers

59
Q

In A-delta and C-fiber pain transmission, cell bodies in dorsal root ganlia carry what 2 main signals?

(example: touch, pressure…)

A

Pain

Temperture

60
Q

Pain fibers A-delta and C-fibers enter, ascend or descend in the tract of _____, and then cross over in the spinal cord to the lateral spinothalamic tract to the brain.

A

Lissauer

61
Q

When fibers cross over in the spinal cord, what is the word that describes this?

A

Decusate

62
Q

A-delta: first order neurons to connect at which Rexed Lamina?

A

A-delta: first order neurons to connect at Rexed Lamina 1,5.

63
Q

A-delta fibers: Release _______ to bind to ___ and ____ receptors on postsynaptic membrane.

Hint: Potentially how Ketamine exerts its pain controlling mechanism. Does not allow binding of this receptors to send pain receptors to the brain.

A

Release glutamate to bind to AMPA and NMDA receptors on postsynaptic membrane

64
Q

žC fibers: terminate primarily in rexed lamina __ and ___, and interneurons transmit to lamina __.

A

žC fibers: terminate primarily in rexed lamina 2 and 3 and interneurons transmit to lamina 5

65
Q

C-fibers: Release _____ to bind to NK-1 (neurokinin-1) receptors on ______ membrane

A

C-fibers: Release substance P to bind to NK-1 (neurokinin-1) receptors on postsynaptic membrane

66
Q

žSecond order neurons cross from Rexed Lamina (and other lamina in the dorsal horn) to & ascend via _________ _____ spinothalamic tract.

A

žSecond order neurons cross from Rexed Lamina (and other lamina in the dorsal horn) to & ascend via contralateral lateral spinothalamic tract

67
Q

Review this

A

Review this

68
Q

What is released into these interneurons from C-fibers? How pain transmission is achieved in spinal cord.

A

Substance P

69
Q

_________-releasing neurons also synapse on these interneurons to reduce pain impulses. This neuron decreases the release of what _________ which reduces the action potential and decreases pain transmission.

hint: Know as Descending pathway important in modulation of pain signals.

A

žEnkephalin-releasing neurons also synapse on these interneurons to reduce pain impulses. This neuron decreases the release of Substance P which reduces the action potential and decreases pain transmission.

hint: Know as Descending pathway important in modulation of pain signals.

How spinal opioids work.

70
Q

How spinal opioids work. Diffuse into _____ ______ where they are able to bind to the ______ receptors and block ______ release. Primarily mediated by mu-2 (primarily spinal pain control). mu-1 was mostly superspinal

A

How spinal opioids work. Diffuse into substantia gelatinosa where they are able to bind to the opioid receptors and block substance P release. Primarily mediated by mu-2 (primarily the spinal pain control). mu-1 mostly superspinal

71
Q

ž(Topic: membrane potential in the neuron)

_______ ________ exist in nearly all cell membranes and refer to the difference in charge between the outside and inside of the cell

A

žElectrical potentials exist in nearly all cell membranes and refer to the difference in charge between the outside and inside of the cell

72
Q

ž(Topic: membrane potential in the neuron)

In the neuron, ________ leak channels located in the ______ lipid bilayer (cell membrane of the neuron) allow _____to leak out down a concentration gradient into extracellular space leaving electrically charged proteins behind within the neuron.

A

ž(Topic: membrane potential in the neuron)

In the neuron, potassium leak channels located in the axolemma lipid bilayer (cell membrane of the neuron) allow K+ to leak out down a concentration gradient into extracellular space leaving electrically charged proteins behind within the neuron.

This leaves the inside of the cell relatively negative compared with the outside creating the membrane potential

NOTE: The resting membrane potential in excitable tissues is determined mostly by K+

73
Q

žAll other ions are impermeable in the resting neuron because _____ and ____ channels are closed

A

žAll other ions are impermeable in the resting neuron because Na+ and Ca++ channels are closed

74
Q

Describe what is happening in the diagram.

A
  1. Neuron resting at -70 mV
  2. Impluse transmitted down axon
  3. Sodium channels open
  4. Sodium rushes into cell
  5. Threshold potential reached = -50 mV
  6. Na channels open and Na continues to rush in
  7. -> inside neuron briefly POSITIVE + 30 mV - Depolarized
  8. Inactivation gate closes Na channel
  9. Refractory state
75
Q

žMembrane potential maintained by movement of ___ in and out of the nerve cell

A

žMembrane potential maintained by movement of ions in and out of the nerve cell

76
Q

žThe Na+/K+ pump actively transports Na+ out and K+ in to the cell, & also _______ “leak” channels constantly send K+ out of the cell. Requires _____ to push ions againsts their concentration gradiet.

  1. ___ Na out and ___ K in
  2. RMP _______
  3. This ATPase pump requires energy to pump against the concentration gradient.
A

žThe Na+/K+ pump actively transports Na+ out and K+ in to the cell, & also potassium “leak” channels constantly send K+ out of the cell. .

  1. 3 Na out and 2 K in
  2. RMP -70
  3. This ATPase pump requires energy to pump against the concentration gradient.
77
Q

Na+/K+ channel requires _____ to push ions against their concentration gradient.

A

Requires energy to push ions againsts their concentration gradient

78
Q

Membrane Potential

During initial depolarization __ is moving ____ a concentration into neuron; potassium is _____ the cell. During repolarization: it has to pump Na back out of neuron and resequester the K back into neuron to reestablish _____ membrane potential thru the _____ Channel.

A

Membrane Potential

During initial depolarization Na is moving down a concentration into neuron; potassium is leaving the cell. During repolarization: it has to pump Na back out of neuron and resequester the K back into neuron to reestablish negative membrane potential thru the Na/K Channel.

79
Q

žNeuronal Action Potential

Neurons have voltage-gated ____and ___ channels that open in response to a stimulus and produce ____________.

A

žNeuronal Action Potential

Neurons have voltage-gated Na+ and K+ channels that open in response to a stimulus and produce depolarization.

80
Q

žNeuronal Action Potential

Once a stimulus has occurred, (i.e. touching a hot stove) conductance to Na+ and K+ increases. If the conductance is enough to reach Threshold which is approximately ____mV then depolarization will occur.

A

žžNeuronal Action Potential

Once a stimulus has occurred, (i.e. touching a hot stove) conductance to Na+ and K+ increases. If the conductance is enough to reach Threshold which is approximately -50mV then depolarization will occur.

81
Q

____________ occurs when the voltage-gated Na+ channel snaps open and Na+ flows inward.

A

žDepolarization occurs when the voltage-gated Na+ channel snaps open and Na+ flows inward.

82
Q

Depolarization

žNa flows inward: For a very brief time the inside of the membrane becomes ______ and outside ________. (membrane potential ___mV)

A

Depolarization

žžNa flows inward: For a very brief time the inside of the membrane becomes positive and outside negative. (membrane potential +30mV)

83
Q

__________ State

  1. žThe Na+ channel now closes in a different configuration (the _______ state.)
  2. žWhen the Na+ channels begin to change their configuration to________, voltage-gated ___ channels open and ___ begins to flow out of the cell.
  3. žWhen the voltage-gated Na+ channels are in the this state it is referred to as the ______ ________ __________.
A

Inactivated State

  1. žThe Na+ channel now closes in a different configuration (the inactivated state.)
  2. žWhen the Na+ channels begin to change their configuration to inactivated, voltage-gated K+ channels open and K+ begins to flow out of the cell.
  3. žWhen the voltage-gated Na+ channels are in the inactivated state it is referred to as the Absolute Refractory Period
84
Q

In which state of membrane activity, can local anesthetics bind to Na channels?

A

Local anesthetics bind to Na channels in the inactivated/open channel state.

Cannot bind them in the closed state!

85
Q

Phase of return to -70mV membrane potential.

A

A return to -70mV membrane potential is called Repolarization.

86
Q

žAfter repolarization has occurred the Na+/K+ pump will extrude the ____ that entered and recapture the _____ that was lost and restore the ion balance.

A

žAfter repolarization has occurred the Na+/K+ pump will extrude the Na+ that entered and recapture the K+ that was lost and restore the ion balance.

87
Q

Review

A

Review

88
Q

žOn any given axon the Na+ channels can be found in three states:

A

žOn any given axon the Na+ channels can be found in three states:

  1. Resting-closed
  2. Activated-open
  3. Inactivated-closed
89
Q

Local anesthetics must bind what channel in the inactivated or open state.

A

Local anesthetics must bind the Na+ channel in the inactivated or open state.

Cannot bind in closed state.

90
Q

Conduction block with local anesthetics is dependent on what?

A

conduction block with local anesthetics is frequency dependent

91
Q

Describe frequency dependence of conduction block.

A

Frequency dependence of conduction block.

The more often the nerve is firing the more opportunity the local anesthetic has to “catch” the Na+ channel in the open or inactivated state.

92
Q

What terms/phrase describes this process?

The more time you stimulate that nerve the more opportunities that local will have to bind to the inactivated state because more time is spent in these states.

A

Use-dependent Block

or

Phasic Block

Intro Anesthesia (5 decks)

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