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YEAR 3 NEURO > PHYSIOLOGY - Somatosensory system and ascending tracts > Flashcards

PHYSIOLOGY - Somatosensory system and ascending tracts Flashcards

1
Q

what senses does the DCML pathway transmit

A

fine touch
proprioception
vibration

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2
Q

what are the 1st order neurones of the DCML

A

peripheral nerves to medulla oblongata

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3
Q

sensory information enters the spinal cord where

A

dorsal root ganglion

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4
Q

signals from where travel in the fasciculus cuneatus to the cuneate nucleus in the DCML

A

upper limb - T6 and above

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5
Q

signals from where travel in the fasciculus gracilis to the gracile nucleus in the DCML

A

lower limb - below T6

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6
Q

is the fasciculus gracilis or cuneatus more lateral

A

fasciculus gracilis is medial

fasciculus cuneatus is lateral

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7
Q

where do all fibres in the DCML decussate

A

medulla

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8
Q

what are the second order neurones in the DCML and where do they travel through

A

medulla (cuneate or gracile nucleus)
to the thalamus

contralateral medial lemniscus in brainstem

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9
Q

what are the 3rd order neurones in the DCML and what do they travel through

A

VP nucleus of thalamus to the primary sensory cortex of the brain through internal capsule

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10
Q

what does the spinothalamic tract transmit

A

pain
temperature
pressure

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11
Q

describe the path of the 1st order neurones of the spinothalamic tract

A

peripheral nerves, enter spinal cord, ascend 1-2 levels and synapse at tip of dorsal horn (substantia gelatinosa)

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12
Q

describe the path of second order neurones of the spinothalamic tract

A

substantia gelatinosa to the thalamus

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13
Q

where do fibres of the spinothalamic tract decussate

A

spinal cord

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14
Q

after decussating the spinothalamic splits to form how many pathways

A

anterior and lateral

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15
Q

which pathway transmits crude touch and pressure

A

anterior spinothalamic

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16
Q

what does the lateral spinothalamic tract transmit

A

pain and temperature

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17
Q

describe 3rd order neurones of the spinothalamic tract

A

VP nucleus of the thalamus through internal capsule to the primary sensory cortex

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18
Q

what does the spinocerebellar tract control

A

unconscious info from muscles to ipsilateral cerebellum

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19
Q

what are the 4 tracts of the spinocerebellar tract

A

posterior
anterior
cuneocerebellar
rostral tract

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20
Q

which tracts transmit info from muscles of upper limb to cerebellum

A

rostral and cuneocerebellar

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21
Q

which tracts transmit info from muscles of lower limbs to cerebellum

A

anterior and posterior

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22
Q

which tract decussates twice meaning the signals go to the ipsilateral cerebellum

A

anterior spinocerebellar

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23
Q

what are the 3 categories of the somatosensory system

A

exteroceptive - cutaneous
proprioceptive
enteroceptive - internal

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24
Q

what is the cell body location of 1st order sensory neurones

A

dorsal root ganglia

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25
Q

what has its 1st order neurone cell body in the cranial ganglia

A

CN V - sensory innervation of the anterior head

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26
Q

sensory 3rd order neurone cell bodys are all located where

A

thalamus

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27
Q

stimulus opens a anion/cation selective ion channel in peripheral terminal or primary sensory afferent eliciting a depolarising receptor potential

A

cation

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28
Q

the amplitude of the receptor potential is inversely proportional/proportional to the stimulus intensity

A

proportional

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29
Q

a supra-threshold receptor potential triggers an all or none action potential conducted by the axon, at a ____ proportional to its amplitude

A

frequency

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30
Q

what is the relationship between stimulus strength and amplitude of observed and why

A

non-linear

greater sensitivity to change at low stimulus strength

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31
Q

what is the term for the type of energy that a sensory cell is tuned to respond to

A

modality - the adequate stimulus

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32
Q

what detects mechanical forces on the skin (touch, pressure, vibration)

A

skin mechanoreceptors

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33
Q

what detects proprioception / mechanical forces acting on joints and muscles

A

joint and muscle mechanoreceptors

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34
Q

what detects temperature

A

cold and warm thermoreceptors

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35
Q

what detects pain

A

mechanical, thermal and polymodal nociceptors

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36
Q

what detects itch - irritant e.g. chemical on skin or mucous membranes

A

itch receptors

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37
Q

what mediates fine discriminatory touch

A

low threshold mechanoreceptors

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38
Q

what mediates cold through to hot temperatures but not extremes

A

low threshold thermoreceptors

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39
Q

if there is increasing stimulus strength resulting in an increased rate of firing of LRMs and perception of increased intensity, will the qualitative character of the perception e.g. pressure change e.g. to pain

A

not if only LTMs are activated

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40
Q

what is another name for high threshold units

A

nociceptors

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41
Q

mechanical nociceptors (HTMs) respond to what

A

high intensity mechanical stimuli

e.g. distension (stretch) and pressure in inflammation

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42
Q

thermal nociceptors respond to what

A

extreme degrees of heat - over 45 or under 10-15

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43
Q

chemical nociceptors respond to what

A

exogenous and endogenous chemical substances in the tissue e.g. in inflammation

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44
Q

give 4 chemicals that chemical nociceptors will respond to

A 
prostaglandins
bradykinin
serotonin (5-HT)
histamine
(also K+, H+ and ATP and others)
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45
Q

what do polymodal nociceptors respond to

A

more than one stimuli

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46
Q

what are the 3 types of adaptation of sensory nerve cells

A

tonic/static response - slow adapting (SA)
phasic/dynamic response - fast adapting (FA)
very phasic/dynamic response - very fast adapting

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47
Q

what kind of AP will tonic (SA) receptors produce

A

continuous information to CNS - greater the stimulation intensity the greater the firing rate

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48
Q

what kind of AP will phasic (FA) receptors produce

A

respond quickly to stimuli but stop responding upon continual stimulation

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49
Q

with FA receptors the number of impulses is proportional to the rate of ____

A

change of stimulus

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50
Q

VFA receptors respond only to

A

very fast movement

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51
Q

give an example of an SA receptor

A

stretch receptors

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52
Q

give an example of a FA receptor

A

some muscle spindle afferents

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53
Q

give an example of a VFA receptor

A

pacinian corpuscle

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54
Q

what are the 4 groups of primary sensory afferent fibres

A

Aa
Ab
Ad
C

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55
Q

which of the 4 groups of primary sensory afferent fibres has the biggest diameter

A

Aa

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56
Q

which of the 4 groups of primary sensory afferent fibres has the thickest myelination

A

Aa

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57
Q

which of the 4 groups of primary sensory afferent fibres has the fastest conduction velocity

A

Aa

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58
Q

which of the 4 groups of primary sensory afferent fibres is unmyelinated

A

C

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59
Q

nociceptors are tonic/phasic

A

phasic (FA)

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60
Q

what are the 2 types of pain fibre

A

Ad

C

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61
Q

how would you describe the receptors found on the ends of the type Ad and C pain fibres

A

free dendritic nerve endings

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62
Q

thermoreceptors are tonic/phasic

A

phasic

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63
Q

what kind of fibres respond to warm temperatures

A

C fibres

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64
Q

what kind of fibres respond to cold temperature

A

Ad fibres

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65
Q

are cold or warm thermoreceptors more common

A

cold

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66
Q

what allows adaptation to warm temperature if it remains constant

A

switch from initial phasic response which changes very quickly based on minute temperature changes
to tonic if it remains constant

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67
Q

what is the term for increased sensitivity to pain

A

hyperalgesia

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68
Q

primary hyperalgesia is thought to be due to what

A

nociceptor sensitisation

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69
Q

secondary hyperalgesia is thought to be due to what

A

central sensitisation

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70
Q

what drugs can induce hyperalgesia

A

opioids

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71
Q

what is a receptive field

A

target territory from which a single sensory unit can be excited - area on skin corresponding to the territory of one sensory neurone

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72
Q

how is RF related to innervation density and therefore sensory acuity

A

inversely related - bigger the RF the less densely innervated and therefore the less sensory acuity of that area

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73
Q

can skin contain overlapping RFs?

A

yes

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74
Q

name an area with a very small RF and therefore high density of innervation and high acuity

A

finger tip (2mm)

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75
Q

what is 2 point discrimination

A

the minimum distance required between two simultaneous stimulations applied to be registered

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76
Q

how is 2 point discrimination clinically tested

A

applying 2 sharp point stimuli separated by a variable distance at different sites on the body surface

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77
Q

how are cutaneous receptors subdivided - 4 types

A

small field - type 1 unit
wide field - type 2 unit
SA or FA
SA1 SA2 FA1 FA2

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78
Q

what is the fibre type of free nerve endings

A

Ad or C

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79
Q

what is the fibre type of follicular nerve endings

A

Ab or Ad

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80
Q

what is the receptor and parent fibre type of merkel cell neurite complex

A

Ab

SA1

81
Q

what is the receptor and parent fibre type of meissner corpuscles

A

Ab

FA1

82
Q

what is the receptor and parent fibre type of Ruffini endings

A

Ab

SA2

83
Q

what is the receptor and parent fibre type of Pacinian corpuscles

A

Ab

FA2

84
Q

what nerve endings are encapsulated

A

pacinian corpuscles
ruffini endings
meissner corpuscles

85
Q

which of the following has the smallest RF
pacinian corpuscles
ruffini endings
meissner corpuscles

A

meissner corpuscles

86
Q

where are free nerve endings found in the skin

A

everywhere

87
Q

merkels discs are tonic/phasic

A

tonic (SA)

88
Q

where are merkel discs found in the skin and in what distribution

A

near border of dermis and epidermis

abundant in skin locations where 2 point discrimination is highest, also in moderate numbers in hairy skin

89
Q

what do merkel discs detect

A

pressure

differentiate texture and shape of objects

90
Q

what can merkel cells develop

A

high mortality cancer

91
Q

meissner’s corpuscles are tonic/phasic

A

phasic (FA)

92
Q

where are meissner’s corpuscles found in the skin and in what distribution

A

in dermis, mainly on palms of hands, soles of feet, lips and tongue

93
Q

are meissner’s corpuscles present in hairy skin

A

no

94
Q

what do meissner’s corpuscles detect

A

fine touch - allow 2PD

95
Q

what do pacinian corpuscles detect

A

pressure

96
Q

pacinian corpuscles are tonic/phasic

A

phasic (FA)

97
Q

pacinian corpuscles are the smallest/largest category of mechanoreceptors

A

largest

98
Q

where are pacinian corpuscles found

A

dermis, hypodermis, ligaments, external genitalia

fascia

99
Q

what is a group of merkel cells called

A

Iggo dome

100
Q

An iggo dome is innervated by a single/many myelinated fibre(s)

A

a single myelinated fibre innervates the merkel cells in an Iggo dome

101
Q

what do merkel cells express that makes them mechanosensitive

A

Piezo2 - mechanosensitive cation channel

102
Q

where are Krause end bulbs found

A

border of the skin and mucous membranes

103
Q

Ruffini end-organs are tonic/phasic

A

tonic (SA)

104
Q

Ruffini end-organs respond to what

A

stretch and shearing forces

105
Q

where are Ruffini end-organs found

A

dermis and joint capsules

106
Q

where are muscle spindles and golgi tendon organs

A

skeletal muscle

107
Q

what do muscle spindles and golgi tendon organs detect

A

stretch

108
Q

how many spinal nerves are there for each section

A 
C1-8
T1-12
L1-5
S1-5
coccygeal
109
Q

what is a dermatome

A

area of skin innervated by the left and right dorsal root of a single segment

110
Q

what nerve innervates the anterior head

A

CN V

111
Q

shingles is an infection of what

A

dorsal root ganglion

112
Q

what virus causes shingles

A

reactivation of varicella zoster

113
Q

what does varicella zoster cause in children

A

chicken pox

114
Q

does shingles usually occur in 1 or more ganglions

A

typically a single ganglion

115
Q

what does shingles look like

A

extremely painful, inflamed and blistered skin in the dermatome innervated by that ganglion

116
Q

what is found in the grey matter of the spinal cord

A

cell bodies and sensory afferent terminals

117
Q

what is found in the white matter of the spinal cord

A

fibre tracts

118
Q

how many laminae of rexed are there in the grey matter of the spinal cord

A

10

119
Q

nociceptors (Ad and C) terminate in which laminae of rexed

A

I and II (also V for Ad fibres)

visceral nociceptors terminate on laminae I and V but not II

120
Q

LTMs (AB) terminate in which laminae of rexed

A

III to VI

121
Q

proprioceptors (Aa) terminate in which laminae of rexed

A

VII to IX

122
Q

give and example of a sensory receptor that uses Aa fibres

A

proprioceptors of skeletal muscle

123
Q

give and example of a sensory receptor that uses Ab fibres

A

mechanoreceptors of skin

124
Q

give and example of a sensory receptor that uses Ad fibres

A

pain

temperature

125
Q

give and example of a sensory receptor that uses C fibres

A

temperature
pain
itch

126
Q

what 2 tracts make up the DCML pathway

A

cuneate (lateral) and gracile tract (medial)

127
Q

the dorsal columns are further divided into what from lateral to medial

A

cervical - thoracic - lumbar - sacral

128
Q

where do 1st order neurones of the DCML synapse for spinal reflexes

A

deep in the dorsal horn upon 2nd order neurones

129
Q

what is stereognosis

A

ability to recognise an object by feeling it

130
Q

how do you test fine touch

A

2PD

131
Q

how do you test conscious proprioception

A

ask patient to close eyes - can they recognise when body part moved up / down

132
Q

how can you test vibration sensation

A

128Hz tuning fork with onset offset reporting from bony prominence

133
Q

what is lateral inhibition

A

when one neurone is active it inhibits the activity of its neighbours via inhibitory interneurones to sharpen stimulus

134
Q

what does lateral inhibition lead to

A

contrast enhancement

135
Q

the trigeminal system conveys general somatic information from the anterior head including the …

A 
oral and nasal cavities
paranasal sinuses
teeth
intracranial dura
cerebral arteries
136
Q

where do impulses originate in the trigeminal system

A

terminals of the 2 trigeminal nerves each of which has 3 divisions

137
Q

what are the 3 divisions of CN v

A

v1 - ophthalmic
v2 - maxillary
v3 - mandibular

138
Q

where are the soma of the sensory neurones of the trigeminal system located

A

trigeminal sensory ganglion

139
Q

central terminals of the trigeminal nerve synapse upon second order neurones in the _______ or the _____

A

chief sensory nucleus or the spinal nucleus

140
Q

what stimuli go to the chief sensory nucleus

A

general tactile stimuli

141
Q

what stimuli go to the spinal nucleus

A

pain and temperature

142
Q

second order neurones decussate and project via _____ to the _____ of the _____

A

the trigeminal lemniscus to the VPM nucleus of the thalamus

143
Q

3rd order neurones relay information to the cortex via ___

A

thalamocortical neurones

144
Q

where is the somatosensory cortex (SI) located

A

post central gyrus of the parietal cortex immediately posterior to the central culcus

145
Q

what is the somatosensory cortex adjacent to

A

posterior parietal cortex (SII)

146
Q

SI is divided into _____ areas which are

A 
Broadmann areas 
BA 3a
BA 3b
BA 1
BA 2
147
Q

where does the somatosensory cortex receive input from

A

VP thalamus

148
Q

which broadman areas recieve most input from VP thalamus

A

70% - 3a and 3b - initial processing

30% - 1 and 2 - more complex processing

149
Q

BA 3a receives information from

A

proprioceptors

150
Q

BA 3b receives information from

A

cutaneous mechanoreceptors e.g. merkel cells and meissners corpuscles
3a

151
Q

BA 1 receives information from

A

cutaneous mechanoreceptors and 3b

152
Q

BA 2 receives information from

A

joint afferents, golgi tendon organs, deep tissues

3a and 3b

153
Q

how many cell layers does the somatosensory cortex have

A

6

154
Q

thalamic inputs to SI terminate mainly on neurones within layer ___ which projects cells ___

A

4 (IV)

which projects cells towards the surface of the cortex and deeper layers

155
Q

what extend across the layers of the sensory cortex

A

vertical columns

156
Q

each column consists of neurones with similar ____ and ____

A

inputs and responses

157
Q

if a finger is amputated what happens to the area of SI representing that finger

A

it will be utilised by other sensory inputs - cortical representation of adjacent fingers will expand into territory

158
Q

if the sensory input from a finger increases e.g. violin player what happens to its contralateral cortical representation

A

expands

e.g. use right finger a lot, part on left side of brain will expand as contralateral

159
Q

what does the posterior parietal cortex (SII) do

A

receives and integrates information from SI and other cortical areas - visual, auditory and sub-cortical areas - thalamus - deciphers the deeper meaning of the information

160
Q

damage to the posterior partial cortex can cause what

A

bizarre neurological disorders with simple sensory skill intact
e.g. agnosia, astereognosia, hemispatial neglect syndrome

161
Q

damage to the right parietal cortex resulting in neglect syndrome would present how

A

patient doesnt believe the left side of the world exists, will even discount left side of body

162
Q

what order neurones are nociceptors

A

first

163
Q

pathological pain is adaptive/maladaptive

A

maladaptive

164
Q

Ad fibres mediate ___ ___ pain

C fibres mediate ___ ___ pain

A

Ad - fast first

C - slow second

165
Q

Ad fibres respond to what noxious stimuli

A

thermal and mechanical

166
Q

C fibres respond to what kind of pain

A

all noxious stimuli - polymodal

167
Q

give 3 receptors that are activated by noxious heat

A

TRPA1
TRPC3
TRPV1

168
Q

H+ activates what channels

A

acid sensing ion channels (ASICs)

169
Q

ATP activates what receptors

A

P2X and P2Y receptors

170
Q

bradykinin activates what receptors

A

B2 receptors

171
Q

what are peptidergic polymodal nociceptors

A

subset of C fibres with afferent and efferent functions

172
Q

what does the afferent limb of peptidergic polymodal nociceptors do

A

transmits nociceptive information to the CNS via release of glutamate and peptides

173
Q

what does the efferent limb of peptidergic polymodal nociceptors do

A

release of pro-inflammatory mediators contributing to neurogenic inflammation

174
Q

noxious stimulation in the long term increases/decreases spinal excitability

A

increases - contributes to hyperalgesia and allodynia

175
Q

what is neurogenic inflammation

A

peptides such as substance P and CGRP (calcitonin gene-related peptide) released from free nerve endings of peptidergic nociceptor due to tissue damage or inflammatory mediators

176
Q

what does substance P do

A

vasodilation and extravasation of plasma proteins
release of histamine from mast cells
sensitises surrounding nociceptors

177
Q

what does CGRP do

A

induces vasodilation

178
Q

what follows on from neurogenic inflammation

A

primary and secondary hyperalgesia and allodynia

179
Q

visceral pain tends to be what in nature

A

dull aching throbbing

180
Q

visceral afferents from nociceptors follow _____ pathways before reaching the dorsal horn

A

sympathetic

181
Q

why can the brain interpret pain coming from the viscera as originating from an area of skin distant to the internal organ

A

some visceral and skin afferents converge upon the same spinothalamic neurones - all cells with a visceral RF will also have a separate cutaneous RF

182
Q

where may heart pain e.g. angina be referred

A

T1 - T5

183
Q

where may pain from the gall bladder be referred

A

C4

184
Q

what causes viscerosomatic pain

A

when inflammatory exudate from a diseased organ contacts a somatic (body wall) structure

185
Q

what is an example of viscerosomatic pain

A

appendicitis may start as diffuse visceral pain in the umbilical region that moves down to the iliac fossa and progresses to sharp viscerosomatic pain

186
Q

can nociception occur in the absence of pain

A

yes pain is just awareness of the nociception

187
Q

where can stomach/pancreas pain be referred

A

epigastric region

188
Q

liver can refer pain to

A

side of neck

189
Q

diaphragm/lungs can refer pain to

A

shoulder

190
Q

pain evoked by activity in nociceptors can be reduced by simultaneous activity in ___

A

LTMRs (AB)

191
Q

what theory explains the reduction in pain when AB fibres are stimulated

A

gate control theory

192
Q

what are the 2 major pain pathways

A

spinothalamic

spinoreticular

193
Q

spinoreticular transmits more ____ pain

spinothalamic more ___ pain

A

SRT - slow

STT - fast

194
Q

spino____ tract makes extensive connections with reticular nuclei in brainstem (e.g. PAG, parabrachial nucleus)

A

spinoreticular

195
Q

SRT is involved in what

A

autonomic responses to pain, arousal, emotional responses, fear of pain

196
Q

what temperate change can we perceive

A

as small as 0.01 degrees

197
Q

what lesion can be seen with vit B12 deficiency and tabes dorsalis (complication of syphilis)

A

DCML lesion

198
Q

if lesion to DCML is in spinal cord, sensory loss will be contra/ipsilateral

A

ipsilateral

199
Q

damage to the spinothalamic tract will have contra/ipsilateral sensory loss

A

contralateral

YEAR 3 NEURO (12 decks)

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