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Unit 2 Pharm Drugs > Phyiology: Neuro > Flashcards

Phyiology: Neuro Flashcards

1
Q

CN II Damage anterior to optic chiasm

A

Loss of vision in eye on the same side as the damage

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2
Q

CN II Damage in the optic chiasm

A

Loss of vision laterally in both visual fields. Bitemporal Hemianopia. may occur in large pituitary adenoma

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3
Q

CN II damage posterior to the optic chiasm

A

Loss of vision in the visual field opposite the side of damage

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4
Q

CN III Function

A

EOM, direct and consensual pupil response

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5
Q

Damge to CN III SYmptoms

A
  1. Pain over eye
  2. Diplopia
  3. Ptosis due to damage of levator palpebrae superioris muscle
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6
Q

CN III plasy can be caused by:

A

Tumors, trauma, demylinating disease (MS), Autoimmune disorders (myasthenia gravis), vascular disorders (DM, heart disease)

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7
Q

CN IV Damage

A

often have difficulty looking down or to the side

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8
Q

CN VI nucleus location

A

Pons

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9
Q

CN VI damage

A

Difficulty with lateral gaze.

Eye deviates medially (esotropia). Normal in infants 20 wks or less

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10
Q

Misalignment of the Eyes

A

Strabismus

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11
Q

CN III damage

A

Can result in eye looking out and down

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12
Q

CN V Function

A

Sensory and motor (muscles of mastication) to the face

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13
Q

CN V Neuralgia

A

AKA TIc Douloureauz

  1. INflammatio of the trigeminal nerve that most often causes paryoxysms of very intense lightening pain in the the areas of the V2 and V3 innervate.
  2. Diagnosis of exclusion
  3. Can be idiopathic in 6th decade
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14
Q

CN VII Function

A
  1. Sensory and motor to face
  2. Primary motor nerve for facial muscles
  3. Taste on anterior 2/3 of tongue
  4. parasymp fibers inc. flow of saliva and tears
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15
Q

CN VII Palsy

A

Bell’s palsy

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16
Q

CN VIII Damage

A

Balance and hearing problems: hearng loss, vertigo, nystagmus

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17
Q

CN IX Function

A

Sesnory and motor to head and neck and parasympathetic components.

  1. Sensory: posterior 1/3 of the tongue, pharynx, tonsils
  2. Motor: pharyngeal muscles for swallowing, hiccup reflex may be mediated by motor branch of CN IX
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18
Q

CN IX Damage

A
  1. Problems with swallowing, sensation of taste along pos. 1/3 of tongue
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19
Q

CN X Function

A

Sensory and motor to thorax and abdomen

  1. Sesnory: autonomic centers in medulla oblongata
  2. Visceral motor: muscles of palate, pharynx, digestive, resp, cardiovascular, gag reflex
  3. Parasympathetic innervation of the heart
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20
Q

CN X damage

A

Sxs: dysphagia,

Ahh test

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21
Q

CN XI Function

A

Motor to SCM and trapezius

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22
Q

CN XII Function

A
  1. Motor: muscles of tongue, muscles of speech food manipulation and swallowing. Primarily voluntary control except involuntary swallowing to clear mouth of saliva
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23
Q

CN XII damage

A
  1. May be caused by brain mets
  2. Loss of innervation on one side causes the tongue to lateralize to affected side due to unopposed action of opposite muscle at rest
  3. Loss of innervation on one side will cause the tongue to deviate away from affected side on protrusion b/c it has lost the strength to resist the push to that side (UMN lesion)
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24
Q
  1. To explain the term synapse:
A

• Specialized site where a neuron communicates with another neuron, muscle or gland. May be electrical or chemical

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25
Q
  1. To explain the sequence of events in a chemical synapse
A

a. Depolarization of neuron reaches synaptic bouton and opens Ca2+ ion channels
b. Influx of Ca 2+ ions results in release of neurotransmitter into synaptic cleft
c. Neurotransmitters diffuse across synaptic cleft and binds to membrane receptors on postsynaptic membrane
d. Binding to membrane receptors on postsynaptic membrane produces change in membrane potential
e. Chemical transmission occurs

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26
Q
  1. To differentiate between the various classes of neurotransmitters
A

a. Can be excitatory (depolarization) or inhibitory (hyperpolarization)
b. Cholinergic: Ach
c. Biogenic Amine: NE, Dopamine, serotonin,
d. Amino Acid derivative: Gamma aminobutyric acid (GABA)
e. Monoamine: Serotonin
f. Neuropeptides: Endogenous Opioid Peptides: substance P, pain sensation

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27
Q
  1. To explain the physiology of a nerve impulse at a neuromuscular junction
A

a. Specialized synapse where motor neurons communicate with skeletal muscles fibers
b. Most common is called alpha neuron, branches may form multiple NMJ
c. Motor unit
d. ACh usually causes muscle contraction
e. Can be inhibited by curare and botulism toxin A

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28
Q
  1. To describe the pathophysiology associated with Myasthenia Gravis
A

a. Autoimmune neuromuscular disease that affects Ach receptors at NMJ. Autoimmune antibodies block or damage Ach receptors of motor endplate
b. Inhibits normal effects of Ach and produces weakness of muscle
c. Cholinesterase inhibitors (neostigmine) are used to enhance effects of Ach on muscle contraction (inhibits AChE)
d. Exacerbated by physical exercise

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29
Q

To describe the 4 major lobes of the brain

A

a. Cerebrum
i. Largest part of brain
ii. Divided into right & left cerebral hemispheres
1. Frontal, parietal, occipital, temporal, and insula
b. Cerebellum
i. Second largest part of brain
c. Diencephalon
i. Contains the thalamus & hypothalamus
ii. Structural & functional link between the cerebral hemispheres & brain stem
d. Brain stem
i. Includes mesencephalon, pons, medulla oblongata

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30
Q

To list the 3 main functional areas of the cerebral cortex

A

a. Motor: control voluntary motor functions
b. Sensory Areas: provide conscious awareness of sensation
c. Association Areas: integrate diverse information to enable purposeful action

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31
Q
  1. To describe the functions of the premotor cortex
A

a. Premotor Cortex: Located just anterior to primary motor cortex and controls more complex movements than the primary motor complex. Receives visual, auditory and general somatic sensory information from other parts of cortex, esp. visual cortex. Controls voluntary actions that are dependent on sensory feedback about spatial relationships.
i. Most anterior portion of this area develops a motor image of the muscle movement that is going to be performed
ii. Posterior portion excites the motor fibers needed to accomplish the task
iii. Signals are sent to directly primary motor cortex or via the basal ganglia and thalamus back to the primary motor cortex

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32
Q

To describe the functions of the Primary motor cortex

A

b. Primary motor Cortex: Located just prior to central gyrus. Contains pyramidal cells whose axons signal motor neurons to perform specific voluntary movements esp. in fingers, forearms, facial muscles. Contralateral projection of pyramidal axons into the corticospinal tract that descends into brain stem and spinal cord to synapse on lower motor neurons that control skeletal muscles

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33
Q
  1. To describe the sensory portions of the cerebral cortex, including their functions
A

a. Primary somatosensory cortex: located along the post-central gyrus. Involved in conscious awareness of general somatic senses: touch, pain, pressure, vibration, temperature, proprioception
i. Sensory information is picked up by peripheral receptors in body and relayed through spinal cords via spinothalamic tract to somatosensory cortex. Cortical neurons than process the sensory information and identify the precise area being stimulated. The projection is contralateral
b. Somatosensory Association Area: Located posterior to the primary somatosensory cortex, connected to primary somatosensory area. Area integrates different sensory inputs into comprehensive understanding of what is being felt. Integrates stored memories of past sensory experiences

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34
Q
  1. To describe the clinical significance of a motor and sensory homunculus
A

a. Motor Homunculus: Activity of pyramidal cells in a specific area of motor cortex results in specific peripheral muscle contraction. Primary motor cortex corresponds point by point with specific regions of body. Mapping of these cortical areas has created a motor homunculus. The proportions of the motor homunculus are dependent on the number of motors fibers dedicated to a specific region. Hands, face, tongue appear very large on the motor homunculus
b. Sensory Homunculus: Lips and fingertips are the largest parts of the homunculus

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35
Q
  1. To describe the anatomical location of the four ventricles of the brain
A

a. Lateral Ventricles: lie in each cerebral hemisphere, separated by septum pellucidum
b. Third ventricle: lies in the diencephalon, connected to each lateral ventricle by the foramen of Monroe
c. Fourth Ventricle: Lies between posterior surface of pons and anterior surface of cerebellum. Connected to 3rd ventricle by cerebral aqueduct, extends in to medulla oblongata and spinal cord

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36
Q
  1. To list the main functions of cerebral spinal fluid (CSF) and name the location where it is formed
A

a. Cushions neural structures, supports brain, maintains pressure, transports nutrients and wastes. Acts as a shock absorber. Produced at a rate of 500 cc/day by the choroid plexi in the ventricles of the brain

37
Q
  1. To describe the flow of CSF from its point of origin through the CNS
A

a. Choroid plexus → lateral ventricles → foramen of Monroe → 3rd ventricle → cerebral aqueduct → 4th ventricle → lateral and median aperatures → subarachnoid space surrounding the brain, spinal cord, and cauda equina

38
Q
  1. To describe the functions of the medulla oblongata
A

a. Continuous with spinal cord, all communication between brain and spinal cord travels through tracts that ascend or descend through this area
b. Pyraminds: motor tracts (pyramidal/corticospinal tracts)
c. Center for coordination of complex autonomic reflexes and control of visceral functions through three groups of nuclei: autonomic center, sensory and motor nuclei, nucleus cuneatus and nucleaus gracilis

39
Q
  1. To describe the 3 groups of nuclei in the medulla
A

i. Autonomic nuclei: cardiac center, vasomotor center, and respiratory center
ii. Sensory and motor nuclei of cranial nerves CN VIII –XII
iii. Nucleus cuneatus and nucleus gracilis: relay stations that pass somatic sensory information through spinal cord to somatosensory cerebral cortex

40
Q
  1. To describe the nuclei located in the pons
A

a. Nuclei: modify/control of respiration: apneustic: depth of breathing, pneumotaxic: rate of breathing
b. Nuclei and tract that process and relay information heading t or from the cerebellum

41
Q
  1. To describe the important features of the mesencephalon (midbrain)
A

a. Cerebral peduncles: carry motor info from pyramidal tracts to spinal cord
b. Superior colliculi: visual reflexes
c. Inferior colliculi: auditory information
d. Cerebellar peduncles: connect midbrain to cerebellum
e. Red nuclei: motor coordination
f. Substantia nigra: regulate activity in basal nuclei: refine motor movements

42
Q
  1. To describe the important structures and functions of the diencephalon
A

a. Epithalamus: roof of the diencephalon superior to the 3rd ventricle, contains choroid plexus and pineal gland
b. Thalamus: Forms lateral wall of diencephalon, final relay point for ascending sensory information projected to the primary sensory cortex, coordinates activities of basal nuclei and cerebral cortex by relaying info between them. Processes sensory information as it is received. Lateral and medial geniculate nuclei receive visual and auditory information
c. Hypothalamus: inferior portion of the diencephalon, forms the inferiolaeral walls of the 3rd ventricle: Control of autonomic function (adjusts & coordinates activities in pons & medulla that regulate heart rate, BP, respirations), Coordination of activities between nervous & endocrine systems (production of regulatory hormones), Stimulates the secretion of ADH & oxytocin from posterior pituitary, Control of emotional responses, Regulation of body temperature, stimulates secretion of vasopressin from kidney, Regulation of thirst & hunger sensations, Control of certain behaviors (controls motivation for eating), Regulation of sleep-wake cycles (responsible for timing of sleep), Formation of memory, Nucleus in mammillary body receives input from memory processing portion of cerebrum

43
Q
  1. To list the functions of the limbic system and name at least 3 structures located in this system
A

a. Septal nuclei, cingulate gyrus, hippocampal formation, and part of the amygdala
Two most important structures: Amygdala: Contains nuclei for processing fear and Forms memories of experience based on their emotional impact. Cingulate cortex/gyrus: Allows us to shift between thoughts & expressing our emotions through gestures , Interprets pain as unpleasant
b. Function: establishing emotional states, facilitating memory storage and retrieval
c. Functions in forming & retrieving memories: Hippocampal formation encodes, consolidates, and later retrieves memories of facts & events, Receives info from cerebral cortex, processes the data, & returns them to the cortex where they are stored as long term memories

44
Q
  1. To describe the functions of the cerebellum
A

Refines & coordinates body movements that are directed by other brain regions
Helps to maintain posture & equilibrium

45
Q

To explain how the cerebellum is able to maintain balance

A

Cerebellum first receives information on the movements planned by the cerebral cortex
Cerebellum then compares intended movements to actual body movements
Cerebellum then sends instructions to cerebral cortex on how to resolve any differences between intended & actual movements
Using this feedback from cerebellum, the motor cerebral cortex continually adjusts motor commands it sends to spinal cord

46
Q

To describe the cerebellar peduncles

A

Thick tracts of nerve fibers that connect cerebellum to the brain stem
Superior: connect cerebellum to midbrain
Middle: connects to the pons, motor
Inferior: connects to medulla, equilibrium and proprioception

47
Q
  1. To identify the major blood vessels that supply the various parts of the brain
A

a. Frontal and Parietal lobes: Anterior cerebral artery
b. Mesencephalon and lateral surfaces of cerebral hemispheres: Middle cerebral artery
c. Spinal cord, medulla, pons, cerebellum: vertebral and basilar arteries
d. Occipital lobe and inferiomedial temporal lobes: posterior cerebral arteries

48
Q
  1. To explain the significance of the Circle of Willis
A

a. An anastomosis that unites the brain’s anterior and posterior blood supplies provided by the internal carotid and vertebral arteries

49
Q
  1. To identify the most common vessel involved in cerebrovascular accident (CVA)/ strokes
A

a. Middle cerebral artery (MCA)

50
Q
  1. To describe the symptoms associated with a left and right-sided CVA
A

a. Left side: aphasia (broca’s: expressive vs. Wernicke’s: Receptive), sensory and motor deficit on right side of body
b. Right Side: difficulty drawing or interpreting spatial relationships
c. Sensory and motor deficit on left side of body

51
Q

Epidural Hemorrhage

A

a. Epidural: occurs when blood is forced between dura mater and cranium, may be fatal. Meningeal artery is usually broken
i. Elevated pressure distorts underlying tissues of brain. Arterial pressure is very high
ii. Brief loss of consciousness followed by a period of awareness may last several hours before brain function deteriorates
b.

52
Q

Subdural Hematoma

A

Subdural: When blood in the subdural space between the dura and arachnoid mater

i. Usually a small vein or one of the dural sinuses,
ii. Can be lucid for hours to days, then progresses
iii. Venous pressure in a subdural hemorrhage is much lower than arterial pressure in an epidural hemorrhage, symptoms are more gradual and difficult to diagnose
iv. Acceleration/deceleration (MVA), shaken baby syndromw, impact head injury

53
Q
  1. To differentiate between grey and white matter of the spinal cord and how it differs from the brain’s grey and white matter
A

a. Grey matter contains cell bodies of neurons and unmyelinated axons. Inner part of spinal cord
b. White matter contains myelinated and unmyelinated axons (ascending and descending motor tracts)
Outer part of spinal cord

54
Q
  1. To determine the origin, termination and function (sensory or motor) of a fiber tract based upon its name, ie, spinothalamic tract, etc
A

a. Spinothalmic: sensory, starts at spine, ends at thalamus
b. Dorsal column: spinal cord →thalamus → post sensory gyrus
c. Corticospinal (pyramidal tract) → cerebral cortex→ spinal cord

55
Q
  1. To differentiate between the pyramidal tracts, spinothalamic tracts, dorsal column and extrapyramidal tracts
A

a. Spinothalmic tract: Carries information about pain and temperature. Crosses at the spinal cord
b. Dorsal column carries sensory information conveying touch/pressure and proprioception (medial lemniscal pathway). Crosses at the spinal cord
c. Corticospinal (pyramidal tract) → cerebral cortex→ spinal cord. Primary tract fro voluntary movements
d. Extrapyramidal (indirect pathway) originate in the midbrain and brainstem

56
Q
  1. To describe the physiology behind the Babinski Reflex
A

a. Corticospinal tract damage (UMN damage) stimulation of sole of foot causes extension of great toe upward and fanning of toes. Present in infants until they learn to walk, but not normal in adults

57
Q
  1. To identify and describe the diagnostic test for meningitis
A

a. Lumbar puncture to aspirate CSF from subarachnoid space and check for bacteria, viral, or fungus

58
Q
  1. To explain contrecoup injury in regards to spinal cord injury
A

a. Hyperextension of cervical spine: rear end collision, hitting the dashboard and then hyperextension of the neck. Results in the posterior compression of vertebral column. May result in hangman’s frx (C2)

59
Q
  1. To describe the two functional divisions of the PNS
A

a. Afferent Division: Brings sensory information to CNS from receptors in peripheral tissues and organs
b. Efferent Division: Carries motor commands form CNS to muscles, glands, and adipose tissues. Has both somatic and autonomic components

60
Q
  1. To differentiate between the 2 divisions of the efferent division of the PNS
A

a. Somatic NS: Control voluntary muscle movement: skeletal muscle contraction under conscious and unconscious control
b. Autonomic NS: control involuntary muscle movement and functions. Automatic regulation of smooth muscle, cardiac muscle, and glandular secretion at subconscious level

61
Q
  1. To describe the function of the somatic nervous system
A

a. Responsible for movement and maintaining posture: accomplished through actions skeletal muscle, motor neurons, spinal cord and brain
b. Involves involuntary spinal cord reflexes and both voluntary and involuntary muscle activity

62
Q
  1. To differentiate between upper motor neurons (UMN) and lower motor neurons (LMN) and give an example of each
A

a. UMN: cell body lies in the CNS processing center (primary motor cortex)
b. LMN: cell body lies in nucleus of brain stem or spinal cord: originates in brainstem or spinal cord
c. UMN synapse on LMN which innervates single motor unit in skeletal muscle fibers. UMN may excite or inhibit LMN. Activation of LMN triggers muscle contraction in innervated muscle
d. Destruction or damage to LMN eliminates voluntary muscle control over innervated motor unit

63
Q
  1. To identify the 3 pathways involved in coordinating and refining conscious and subconscious muscle control. Activity is monitored and adjusted by basal ganglia and cerebellum
A

i. Corticospinal pathway: voluntary control over skeletal muscles
ii. Medial pathway: gross movements of trunk ad proximal limb muscles
iii. Lateral pathway: gross movements of distal limb muscles

64
Q
  1. To explain the function of the cerebellum in regard to muscle movement
A

a. Coordinate and provide feedback control for voluntary muscle contractions: esp. proprioception (spinocerebellar tract), vision (superior colliculi), and balance (vestibular nuclei)
b. All motor pathways end information to cerebellum when motor commands are issued
c. Conveyed from pyramidal fibers in the cortex on the corticopontinecerebeller tract to the cerebellum

65
Q
  1. To describe the function of basal nuclei in motor activity
A

a. Coordinate and provide feedback control for voluntary muscle contractions
b. Involves 2 pathways: One group of axons synapse on thalmic neurons –> feedback alters pattern of instructions by corticospinal tract. Other group synapses in reticular formation à feedback can excite or inhibit reticulospinal tract
c. One group releases AcH (stimulatory) and the other releases GABA (inhibitory)

66
Q
  1. To explain the pathophysiology of Parkinson Disease and Huntington’s Disease
A

a. Huntington’s disease affects basal ganglia. Brain has trouble stopping unwanted movements
b. Parkinson’s disease also affects basal ganglia: Brain has trouble making big movements, cannot select the movement they want. Lose facial expressions

67
Q
  1. To describe the composition and general distribution of spinal nerves
A

a. All spinal nerves are distributed to skeletal muscle and skin : referred to as somatic nerves
b. Composed of:
i. Ventral root: motor neurons, cell bodies in grey matter, transmits impulses out of spinal cord
ii. Ventral rami: supply motor and sensory fibers to bones, muscle, skin of anterior thoracic and abdominal wall. Thoracic region: intercostal nerves, regular and segmented. Cervical, lumbar and sacral regions: form plexi: large composite networks tha intermingle wit hone another. Innervate skeletal muscles of limbs
iii. Dorsal Root: sensory neurons, cell bodies in dorsal root ganglion
iv. Dorsal rami: supply both motor and sensory fibers to bones, muscles and skin of posterior neck and trunk

68
Q
  1. To explain the term dermatome and its clinical significance
A

a. Geographically defined area of skin that is supplied by sensory branches of both dorsal & ventral rami of a specific spinal nerve. If pt tingles when pinching nerve, you may know which nerve is affected.
b. Able to assess the integrity of specific spinal nerves during a neurological exam. Ex. Herpes zoster
c. C5: shoulder, C6: hand, C7: middle finger, C8: little finger. L5: butt, leg, big toe, S1: butt, leg and little toe

69
Q
  1. To explain the events in a reflex arc
A

Begins at a receptor and ends at a peripheral effector. Events: arrival of stimulus and activation of a receptor, activation of a sensory neuron, information process sing, activation of a motor neuron, response of a peripheral effector.

70
Q

Monosynaptic reflex arc

A

a. Monosynaptic reflexes: Involve a single segment of spinal cord, control most rapid motor responses of nervous system. A sensory neuron synapses directly on a motor neuron. Stretch reflex (patellar reflex)

71
Q

POlysynaptic reflex arc

A

b. Polysynaptic reflexes: Involve many segments of spinal cord, more complex, slower responses. Contain at least one interneuron between sensory and motor neurons. Interneurons may produce excitatory or inhibitory postsynaptic potentials
i. Intersegmental reflex arc: Many segments interact to produce a coordinated highly variable motor response
ii. Withdrawal reflex

72
Q
  1. To list the functions of the ANS
A

a. Controls visceral functions of the body, innervates involuntary muscle and glands,

73
Q
  1. To describe the 2 divisions of the ANS
A

a. Sympathetic: short-long, uses Ach and NE, diffuse effect, excitatory, fight and flight
b. Parasympathetic: long-short, uses Ach only, local effect, inhibitory, rest and digest

74
Q
  1. To identify the 3 target organs or tissues that receive sympathetic stimulation only
A

a. Sweat glands, skin, and blood vessels

75
Q
  1. To identify the neurotransmitters associated with preganglionic and post-ganglionic sympathetic and parasympathetic nerve fibers
A

a. Preganglionic Symp and Parasymp: Ach
b. Postganglionic Symp: NE (mostly)
c. Postganglionic Parasymp: ACh

76
Q
  1. To explain why acetylcholine (Ach) only functions for a few seconds
A

a. Broken down in the synaptic space by AChE

77
Q
  1. To explain how the receptors of effector organs are able to excite or inhibit a cell
A

a. Depolarize or hyperpolarize the neuron. Depolarization crates an action potential, hyperpolarization makes it less likely an action potential will occur

78
Q
  1. To describe the cholinergic and adrenergic receptors
A

a. Cholinergic receptors: secrete/bind Ach

b. Adrenergic receptors: Bind/secrete NE

79
Q
  1. To describe the location of preganglionic parasympathetic neurons
A

a. Cell bodies in CN III, VII, IX, and X

80
Q
  1. To identify the primary nerve in the parasympathetic nervous system:
A

Vagus nerve

81
Q

Cardiac, pulmonary and esophageal plexi

A

Thorax

82
Q

Celiac, sup mesenteric and inf mesenteric plexuses

A

Abdomen

83
Q

Hypogastric & renal plexuses

A

Pelvis

84
Q

MOA of Cocaine

A

Blocks the reuptake of dopamine and norepinephrine into the presynaptic axon terminals
Results in stimulation of target cells
Vasoconstriction of coronary arteries
Myocardial ischemia, MI, and left ventricular hypertrophy

85
Q

Pheochromocytoma

A

Tumors of adrenal medulla that secrete NE & epinephrine
Signs and symptoms are associated with paroxysmal sympathetic stimulation
Headache, sweating, flushing, anxiety, palpitations, weakness, tremor, HTN

86
Q

Alpha 1 Receptors

A
  1. Vasoconstriction
  2. Increased peripheral resistance
  3. Increased bp
  4. Mydriasis
  5. Increased closure of the internal sphincter of the bladder
87
Q

Alpha 2 Receptors

A
  1. Inhibit NE release
  2. Inhibit ACh release
  3. INhibit insulin release
88
Q

Beta 1 receptors

A
  1. tachycardia
  2. increased lipolysis
  3. Increased myocardial contactility
  4. INcreased release of renin
89
Q

Beta 2 receptors

A
  1. Vasodilation
  2. SLightly decreased peripheral resistance
    3 Bronchodilation
  3. Increased muscle and liver glycogenolysis
  4. Increased release of glucagon
  5. Relaxed uterine smooth muscle

Unit 2 Pharm Drugs (9 decks)

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