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A&P 1 > Test 2 > Flashcards

Test 2 Flashcards

1
Q

a difference in polarization between the inside and the outside of the cell

A

polarization

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2
Q

what is the polarization of a resting cell

A

-80mv

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3
Q

to become less polar (or more positively charged)

A

depolarized

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4
Q

term used when a cell is stimulated/excited

A

depolarized

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5
Q

overshoot after repolarization

A

hyperpolarization

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6
Q

this makes a cell more difficult to excite, is used to suppress activity, and the cell now requires more stimulus to be activated

A

hyperpolarization

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7
Q

usually the result of slow K+ channels closing

A

hyperpolarization

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8
Q

__________ in the nervous system uses ____ to hyperpolarize the cell

A

GABA
Cl-

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9
Q

What neurotransmitter opens Cl- channels

A

GABA

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10
Q

What effect does Cl- have on the cell

A

hyperpolarization

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11
Q

return to resting membrane potential from depolarized state

A

repolarization

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12
Q

what happens if there is no repolarization

A

no reset of fast Na+ channels, no future action potentials

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13
Q

what is happening during repolarization

A

a mix of fast Na+ channels closing and K+ channels opening

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14
Q

name for Ca+2 channels

A

voltage-gated/L-type/slow

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15
Q

Ca+2 channels have the same structure as

A

Na+ channels

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16
Q

what blocks Ca+2 channels

A

dihydropyridine calcium antagonists

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17
Q

describe the process of a Ca+2 channel opening

A

resting
-activation/m-gate closed (ECF side) and inactivation/h-gate open (ICF side)

activation
-activation/m-gate open (both gates open)

inactivation
- inactivation/h-gate closes

reset (a part of inactivation)
- activation/m-gate closes
-inactivation/h-gate opens

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18
Q

propagation of electrical signals can be described as a _________ feedback loop

A

positive

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19
Q

describe the propagation of an electrical signal

A
  1. some stimulus causes local depolarization
  2. fast Na+ channels open at that location
  3. Na+ flooding into the cell at that point causes fast Na+ channels next to them to open
  4. this process speeds up bidirectionally around the cell
  5. repolarization begins at the origin point of depolarization, spreading and following the same pattern as depolarization
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20
Q

can propagation of an electrical signal be one directional

A

yes- but it takes longer

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21
Q

what structure comes in contact with the pacing nodes of the heart

A

vagus (X) nerve

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22
Q

what does the L vagus nerve innervate

A

AV node

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23
Q

what does the R vagus nerve innervate

A

SA node

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24
Q

what kind of receptor is a mAch receptor

A

GCPR/7TM

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25
Q

where are GCPR/7TM receptors found

A

pacing center of the heart, smooth muscle, and lungs

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26
Q

how does a mAch receptor work

A
  1. Ach binds to GCPR
  2. alpha subunit of GCPR binds to K+ channel (located directly next to mAch receptor)
  3. K+ channel opens, K+ leaves the cell
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27
Q

what is the function of mAch receptor

A

“put breaks on the heart” (inhibitory)

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28
Q

without mAch/Ach activity, the heart would beat at

A

100bpm

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29
Q

with mAch/Ach activity the heart beats at

A

70-72bpm

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30
Q

what can adjust how hyperpolarized the cell is

A

mAch receptors

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31
Q

how do mAch receptors contribute to hyperpolarization

A

K+ leaves the cell (which decreases resting membrane potential) and makes the cell harder to excite/effects how fast pacemaker activity works

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32
Q

increased vagal nerve activity has what effect on HR

A

decreases

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33
Q

decreased vagal nerve activity has what effect on HR

A

increases

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34
Q

compared to other places, the heart has an abnormally high amount of _____________ channels and basal __________ activity

A

leaky Na+
acetylcholine

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35
Q

mAch receptors are antagonistic of ________________ receptors and visa versa

A

catecholamine

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36
Q

what is Ohm’s law

A

V=IR (voltage = current x resistance)

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37
Q

current over a resistance leads to

A

voltage

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38
Q

where do paralytics work

A

NMJ (space between motor neuron and skeletal muscle)

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39
Q

how do motor neurons communicates with muscle

A

Ach (neurotransmitter)

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40
Q

where are nicotinic Ach (nAch) receptors found

A

skeletal muscles and brain

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41
Q

what kind of receptor is nAch

A

ion channel

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42
Q

nAch receptor is specific for what kind of ion

A

positive (mostly Na+ in, but some K+ goes out and some Ca+2 comes in)

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43
Q

what is the primary electrolyte flowing through nAch receptors

A

Na+

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44
Q

how do nAch receptors prevent negatively charged ions from entering

A

the receptor is lined with negatively charged amino acids which repel negative electrolytes

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45
Q

how dos nAch open

A

2 Ach molecules must bind simultaneously

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46
Q

steps of a nAch receptor (in skeletal muscles)

A
  1. motor neuron activated
  2. action potential goes down motor neuron towards skeletal muscle
  3. Ach is released from the motor neuron into the NMJ
  4. 2 Ach simultaneously bind to the nAch receptor on skeletal muscle
  5. Na+ floods into cell causing local depolarization- initiating action potential
  6. this triggers fast Na+ channels to open and cell depolarization begins
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47
Q

3 ways neural control can have an effect on resting membrane potential

A
  1. mAch receptors
  2. nAch receptors
  3. pressure sensors
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48
Q

steps of pressure sensor regulated depolarization

A
  1. sensor gets “smooshed which makes Na+ channels larger
  2. Na+ floods into cell- action potential begins
  3. action potential travels up neuron and “turns it on”
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49
Q

2 examples of pressure sensors

A
  1. arterial pressure regulation
  2. baroreceptors in the lungs
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50
Q

a stimulus always results in __________ but not always in ________

A

depolarization
action potential

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51
Q

what determines whether or not an action potential will occur

A

the individual cells threshold potential

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52
Q

what happens if a stimulus depolarizes above threshold

A

an action potential will occur

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53
Q

looking at a graph, how can you tell how strong the initial stimuli was

A

how vertical the action potential is

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54
Q

what is the purpose of the sustained action potential (plateau period) in the heart

A

gives the heart muscle more time to contract

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55
Q

what causes the plateau period in the heart

A

slow Ca+2 channels remaining open after depolarization

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56
Q

fast/slow: longer nerve

A

slow

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57
Q

fast/slow: shorter nerve

A

fast

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58
Q

fast/slow: narrow nerve

A

slow

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59
Q

fast/slow: wide nerve

A

fast

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60
Q

fast/slow: myelinated

A

fast

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61
Q

narrow nerves have _______ resistance

A

increased

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62
Q

insulating compound that speeds up action potentials

A

myelin

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63
Q

functions of myelin (3)

A
  1. speed
  2. protection
  3. efficiency- reduces energy requirements due to “covering up” Na/K ATPase
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64
Q

2 types of myelinating cells and where they are found

A

schwann (peripheral nervous system)
oligodendrocytes (central nervous system)

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65
Q

how do schwann/oligodentrocyte cells function

A

grow and wrap themselves in spirals around neurons, all the water becomes squeezed out, now just insulating/lipid compound wrapped around neuron

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66
Q

what is considered the CNS

A

brain. spinal cord, cranial nerve II (optic nerve), retinas

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67
Q

which is faster at myelin regeneration schwann cells or oligodendrocytes

A

schwann

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68
Q

the non-myelinated area of myelinated neurons is called

A

node of Ranvier

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69
Q

what is located in the node of ranvier

A

high density of fast Na+ channels

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70
Q

why do myelinated cells have lower energy requirements

A

not as many Na/K ATPase pumps, most are “covered up” by myelin

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71
Q

which has more fast Na+ channels: myelinated or non-myelinated neuron

A

non-myelinated
myelinated neurons have a higher “population density” of fast Na+ channels though

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72
Q

which needs higher doses of local anesthetic myelinated or non-myelinated neurons

A

myelinated neurons

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73
Q

jumping of Na+ from one node of Ranvier to the next

A

saltatory conduction

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74
Q

what is left under myelinated areas

A

Na/K ATPase pumps

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75
Q

what happens if myelin loss occurs

A

only Na/K ATPase is present under the previously myelinated area, so Na+ all or some Na+ gets pumped out before it can reach the next node of Ranvier (slowing down or stopping action potential)

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76
Q

demyelinating diseases cause

A

progressive loss of function over time

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77
Q

multiple sclerosis is the progressive demyelination of

A

motor neurons

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78
Q

optic neuritis is the progressive demyelination of

A

optic nerve

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79
Q

guillian barre (GBS) occurs because

A

the body creates antibodies against myelin after illness

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80
Q

direct electrical synapse is also called

A

gap junction

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81
Q

gap junction composition

A

6 connexins form 1 connexon
2 connexons make 1 gap junction

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82
Q

which is faster chemical or electrical synapse

A

electrical (gap junction)

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83
Q

what can travel through gap junctions

A

all small ions

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84
Q

what is the main current flowing through gap junctions

A

Na+

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85
Q

what travels fastest in gap junctions

A

smallest ions travel fastest

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86
Q

why are there delays in the pacing center of the heart

A

few/spread out gap junctions

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87
Q

what is the purpose of having few/spread out gap junctions in the heart

A

allows for a functional pause needed for heart to work properly

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88
Q

what causes abnormal reentry arrythmias in the heart

A

delays and bidirectional flow in the gap junctions

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89
Q

increased numbers of gap junctions does what to resistance

A

decreases resistance

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90
Q

Ach is excitatory/inhibitory in the heart

A

inhibitory

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91
Q

Ach is excitatory/inhibitory in the skeletal muscles

A

excitatory

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92
Q

Ca+2 does what to a resting cell

A

inhibits (massive depolarization)
becomes more hyperpolarized, decreases electrical activity

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93
Q

Ca+2 has a ____________ effect and helps settle tissue that are _____________

A

calming
too depolarized

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94
Q

How does Ca+2 want to enter cell

A

through leaky Na+ channels (ends up being too big/clunky so just blocks Na+ from entering)

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95
Q

Ca+2 inhibits ___________

A

Na+ depolarization

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96
Q

low Ca+2 and high Na+ makes the cell

A

more positive (depolarized)

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97
Q

Ca+2 deficiency does what to the resting membrane potential

A

increases (makes more +)

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98
Q

why do we give exogenous Ca+2 for hyperkalemia

A

hyperkalemia causes increased resting membrane potential, Ca+2 can block leaky Na+ from entering the cell and making the resting membrane potential even more + (stabilizes heart)

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99
Q

what happens to the skeletal muscles if a motor neuron does not have enough Ca+2

A

increased activity of motor neurons leading to tetany, trousseaus sign, and chvosteks sign (increased contractions of skeletal muscles)

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100
Q

lack of Ca+2 leads to _______ of motor neurons

A

overactivity

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101
Q

what electrolyte has a similar effect as calcium

A

Mg+2

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102
Q

what electrolyte provides the “breaks for the nervous system”

A

Cl-

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103
Q

Cl- depolarizes/repolarizes/hyperpolarizes

A

hyperpolarizes

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104
Q

Cl- makes cell more difficult/easier to excite

A

more difficult

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105
Q

lack of Cl- causes

A

seizures

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106
Q

how are nerve fibers classified

A

size and myelination state

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107
Q

nonmyelinated neurons are usually larger/smaller

A

smaller

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108
Q

nerve fiber classifications: heavily myelinated, fastest

A

A fiber

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109
Q

nerve fiber classifications: subdivision of A fibers in order from largest to smallest and fastest to slowest)

A

alpha, beta, gamma, delta

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110
Q

nerve fiber classifications: non-myelinated, slowest

A

C fiber

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111
Q

nerve fiber classifications: lightly myelinated, 2nd fastest

A

B fiber

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112
Q

fastest kind of neuron

A

large, myelinated motor neuron

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113
Q

neuron structures: contains nucleus, lots of mitochondria, can be connected to other areas of the nervous system through synapses

A

soma (body)

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114
Q

neuron structures: receiving ends, form synaptic connections, no myelination

A

dendrites

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115
Q

neuron structures: sending end, specialized to send messages fast, myelinated

A

axon

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116
Q

neuron structures: where axon joins soma, no excitatory connections

A

axon hillock

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117
Q

the axon hillock has no excitatory/inhibitory connections

A

excitatory

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118
Q

what neurotransmitter affects axon hillock

A

GABA

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119
Q

what function does GABA play at the axon hillock

A

increases Cl- permeability into axon hillock increasing inhibition

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120
Q

what is the function of GABA

A

suppress overactivity of CNS

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121
Q

what happens if all GABA is removed

A

seizures

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122
Q

alcohol is a GABA receptor __________

A

agonist

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123
Q

describe alcoholism and GABA

A

alcohol is a GABA receptor agonist, so with alcoholism, the body does not produce enough endogenous GABA, so if alcohol is stopped, seizures occur

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124
Q

natural inhibition of the CNS is through

A

GABA

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125
Q

natural inhibition of the heart is through

A

mAch

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126
Q

is there ever direct excitation of the axon hillock

A

no

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127
Q

how many synaptic connections is a neuron capable of

A

10,000

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128
Q

what influences whether or not an action potential will occur

A

each synaptic connection of a neuron

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129
Q

EPSP make resting membrane potential more

A

positive

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130
Q

IPSP make resting membrane potential more

A

negative (hyperpolarized)

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131
Q

EPSP meaning

A

excitatory post synaptic potential

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132
Q

IPSP meaning

A

inhibitory post synaptic potential

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133
Q

macroglia (3)

A

astrocytes, ependymal cells, oligodendrocytes/schwann cells

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134
Q

which are more proliferative glial cells or neurons

A

glial cells

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135
Q

most abundant type of glial cell

A

astrocyte

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136
Q

glial cells: creates functional BBB

A

astrocyte

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137
Q

_________ of astrocyte connect with ___________ of BBB

A

appendages/end foot
endothelial cells

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138
Q

glial cells: help maintain electrolyte balance in CNS

A

astrocyte

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139
Q

glial cells: maintain CSF pH

A

astrocyte

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140
Q

do astrocytes constitute the BBB?

A

no

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141
Q

what is the BBB

A

tight junctions between endothelial cells and capillaries

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142
Q

glial cells: motility structures (cillia) produce and move CSF downstream

A

ependymal cells

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143
Q

glial cells: myelin producing cells

A

oligodendrocytes (CNS) and Schwann cells (PNS)

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144
Q

glial cells: immune system in CSF, function like macrophage (digest things that need to be removed)

A

microglia

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145
Q

what kind of neurons are multipolar

A

motor neurons (decision making cells)

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146
Q

what type of neuron are the majority of neurons

A

pseudounipolar

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147
Q

where is the decision made in a pseudounipolar neuron

A

dendrites (relayed down axon)

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148
Q

what does the cell body do in a pseudounipolar neuron

A

build proteins (not make decisions)

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149
Q

example of a psuedounipolar neuron

A

sensory cells in and around spinal cord

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150
Q

example of bipolar neuron

A

optic nerve

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151
Q

what is a bipolar neuron used for

A

specialized senses

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152
Q

do bipolar neurons communicate a lot with other cells

A

no

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153
Q

true unipolar neurons (not found in humans) look and function most like what kind of neuron

A

pseudounipolar

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154
Q

somatic means

A

sensible
conscious of sensation

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155
Q

somatic sensory receptors have _______ structures for _______ functions

A

specialized
specialized

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156
Q

examples of somatic receptors

A

pain receptors
pressure/stretch receptors

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157
Q

pain receptors are also called

A

nociceptors

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158
Q

what is an actual example of a pain receptor/nociceptor

A

free nerve endings

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159
Q

actual examples (4) of pressure/stretch receptors

A

pacinan corpuscle, meissner’s corpuscle, golgi tendon apparatus, muscle spindle

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160
Q

what is the purpose of a pressure/stretch receptor

A

change Na+ permeability in response to physical stretch

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161
Q

pressure/stretch receptors are also called

A

mechanoreceptor

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162
Q

in a pressure/stretch (mechanoreceptor) ________ change leads to ________ change

A

environmental
electrical

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163
Q

what kind of pressure/stretch receptors (2) give us feedback about what skeletal muscles are doing

A

golgi tendon apparatus
muscle spindle (confirms that a muscle has contracted)

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164
Q

adaptation: baroreceptors __________ while pain receptors ___________

A

desensitize
sensitize

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165
Q

how long do baroreceptors take to adapt

A

2 days

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166
Q

how long do pressure receptors take to adapt

A

minutes

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167
Q

what is the point of desensitization

A

allow us to have room to change additionally and operate at different set points

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168
Q

pain sensitization can be called

A

reverse adaption

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169
Q

due to pain sensitization, if pain continues it

A

gets worse over time and we become more sensitive to pain

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170
Q

what could prevent an area from sensitizing to pain

A

nerve block

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171
Q

anatomical position

A

standing straight up with palms out

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172
Q

high in altitude, towards head

A

superior

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173
Q

lower in altitude, towards feet

A

inferior

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174
Q

towards back, posterior

A

dorsal

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175
Q

towards front, anterior

A

ventral

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176
Q

towards front

A

anterior

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177
Q

towards back

A

posterior

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178
Q

towards midline

A

medial

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179
Q

away from midline

A

lateral

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180
Q

front, upper, beak

A

rosteral

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181
Q

lower, towards rear, tail

A

caudal

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182
Q

another word for caudal

A

caudad

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183
Q

further from CNS

A

distal

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184
Q

closer to CNS

A

proximal

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185
Q

closer to skin

A

superficial

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186
Q

closer to center

A

deep

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187
Q

divides left and right sides

A

sagittal

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188
Q

divides front and back, anterior and posterior

A

coronal

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189
Q

divides superior and inferior

A

horizontal

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190
Q

the plane a magician would use to cut his assistant in half

A

horizontal

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191
Q

“goofy/odd angle”

A

oblique

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192
Q

another name for the telencephalon

A

cerebral hemispheres

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193
Q

what is the “outer upper portion” of the brain

A

telencephalon

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194
Q

what is the telencephalon composed of (4)

A

cerebral cortex, subcortical white matter, commissures, basal ganglia

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195
Q

what is the “inner” portion of the brain

A

diencephalon

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196
Q

what is the connecting point between cerebral hemispheres and brain stem

A

diencephalon

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197
Q

what is the diencephalon composed of (4)

A

thalamus, hypothalamus, epithalamus, subthalamus

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198
Q

the “relay center” between cerebral hemispheres and brain stem

A

thalamus

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199
Q

where is the hypothalmus located

A

underneath/deep to thalamus

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200
Q

“control center” for critical body functions like osmo sensors, infection sensors, and body temp sensors

A

hypothalamus

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201
Q

what is the brain stem composed of (in order from superior to inferior)

A

midbrain, pons, medulla oblongata

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202
Q

how would you describe the shape of the pons

A

olive shaped

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203
Q

another name for the midbrain

A

mesencephalon

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204
Q

anatomical name for groove

A

sulcus

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205
Q

anatomical name for lump of neurons and supporting tissues separated by sulcus

A

gyrus

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206
Q

what are many gyrus called

A

gyri

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207
Q

anatomical name for really deep groove

A

fissure

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208
Q

anatomical name for bony extension that can provide a palpable marker and allow vertebrae to connect to one another

A

process

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209
Q

__________ are located directly superficial to gray matter in the brain

A

blood vessels

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210
Q

where are the lightly myelinated/non myelinated areas of the brain located

A

superficial

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211
Q

neighboring neurons can take over some funciton

A

plasticity

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212
Q

describe a concussion

A

gray matter hits the inside of the skull

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213
Q

what does a concussion damage

A

cell body (not sending/receiving axon)

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214
Q

how can the corpous collosum be seen

A

if the brain is cut in half down a sagittal plan

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215
Q

brain can be pulled apart (not cut) at the

A

longitudinal fissure

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216
Q

brain divisions: responsible for thinking, talking to yourself in your head

A

frontal lobe

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217
Q

brain divisions: somatosensory cortex, pressure, sometimes pain, most sensations

A

parietal lobe

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218
Q

brain divisions: responsible for hearing, language comprehension, music, auditory processing

A

temporal lobe

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219
Q

brain divisions: responsible for vision/visual processing

A

occipital lobe

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220
Q

brain divisions: divides frontal and parietal lobes, the main anatomical marker of the brain

A

central sulcus

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221
Q

brain divisions: separates temporal lobe from parietal/lateral lobes

A

temporalateral fissure

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222
Q

brain divisions: executes movements, located precentral gyrus, anterior to the central sulcus, in the posterior part of the frontal lobe

A

motor cortex

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223
Q

brain divisions: post central gyrus, anterior part of the parietal lobe

A

somatosensory area

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224
Q

brain divisions: where right and left sides of the brain can communicate, a bridge for info from one side to the other, made of lots of myelinated neurons

A

corpus callosum

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225
Q

brain divisions: speaking/word formation, language formation

A

brocas area

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226
Q

what lobe is broca’s area found in

A

frontal

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227
Q

brain divisions: understanding language, language comprehension/processing

A

wernickes area

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228
Q

what lobe is wernickes area in

A

temporal

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229
Q

Brain divisions: emotional responses

A

limbic area

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230
Q

where is the limbic area located

A

mostly temporal, but can be found widespread through most lobes

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231
Q

Brain divisions: thinking about/planning to perform the movement

A

premotor cortex

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232
Q

where is the premotor cortex found

A

front of the frontal lobe

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233
Q

brain divisions: responsible for coordinating complex motor movements

A

cerebellum

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234
Q

how wide is the spinal cord

A

narrower than a quarter

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235
Q

what does this describe: transmits decisions, generally made up of axons, myelinated areas, not many cell bodies, sending/recieving

A

white matter

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236
Q

what does this describe: decision-making centers, less myelinated, mostly cell bodies, thinking part of CNS

A

grey matter

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237
Q

motor reflex arc only goes to ___________

A

spinal cord

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238
Q

posterior grey matter in cord

A

dorsal horn

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239
Q

what does the dorsal horn process

A

sensory info coming in back

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240
Q

anterior grey matter in cord

A

ventral horn

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241
Q

what does the ventral horn process

A

motor info going out front

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242
Q

separates right/left sides of spinal cord in the back

A

posterior median fissure

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243
Q

which is deeper: anterior median fissure or posterior median fissure

A

posterior median fissure

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244
Q

separates right/left sides of spinal cord in front

A

anterior median fissure

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245
Q

which is wider: anterior median fissure or posterior median fissure

A

anterior median fissure

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246
Q

where does the spinal artery sit

A

in the anterior median fissure

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247
Q

opening in the center of the spinal cord, lined with ciliated cells that send CSF down the spine

A

central canale

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248
Q

how does CSF get down the cord

A

central canal

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249
Q

is any CSF produced in the cord

A

no

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250
Q

grey matter that connects right and left sides of the spinal cord

A

lamina X (10)

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251
Q

white matter crossover between the right and left sides of the spinal cord located on the anterior side of the spinal cord

A

anterior white commissure (AWC)

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252
Q

located between the dorsal horn and ventral horn in some levels of the spinal cord

A

lateral horn

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253
Q

what provides the arterial blood supply for the spinal cords

A

intercostal arteries and neck vessels

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254
Q

2 arteries that sit off the sides on each side of the posterior spinal cord

A

posterior spinal arteries

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255
Q

spinal artery that sits in the anterior median fissure

A

anterior spinal artery

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256
Q

what is the ascending signaling pathway

A

sensory information going in/up

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257
Q

what is the descending signaling pathway

A

motor information going out/down

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258
Q

what is the defining point between the CNS and PNS

A

spinal nerves

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259
Q

how does sensory information enter the CNS

A

through the posterior rootlets, in the back (horizontally)

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260
Q

how does motor information leave the CNS

A

through anterior rootlets, in the front (horizontally)

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261
Q

where rootlets combine

A

roots

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262
Q

which root has ganglion

A

posterior

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263
Q

has a buldge/lump that is a collection of pseudounipolar cell bodies called ganglion

A

posterior root

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264
Q

what kind of neuron cell bodies are in the posterior root

A

pseudounipolar

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265
Q

does the anterior root have a ganglion

A

no

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266
Q

where are the cell bodies from the anterior root located

A

in the ventral horn

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267
Q

what makes up a spinal nerve

A

posterior rootlets join together to form a posterior root (with ganglion)
anterior rootlets join together to form an anterior root
the anterior and posterior root join together to form a spinal nerve

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268
Q

spinal nerves have what kind of function

A

mixed sensory and motor (due to the combination of the anterior and posterior root)

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269
Q

what do the ascending spinal cord columns process

A

sensory information that comes in the dorsal horn

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270
Q

where are ascending columns located

A

mostly posterior cord, some lateral cord, some anterior cord

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271
Q

what do the descending spinal cord columns process

A

motor information

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272
Q

where are descending columns located

A

lateral and anterior cord

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273
Q

how many cervical vertebra

A

7

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274
Q

how many pairs of cervical spinal nerves

A

8

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275
Q

how to name cervical spinal nerves

A

originate above vertebrae for which they are named (with C8 nerve below C7 vertebrae)

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276
Q

how many thoracic vertebra

A

12

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277
Q

how many pairs of thoracic spinal nerves

A

12

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278
Q

how to name thoracic spinal nerves

A

originate below vertebrae for which they are named

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279
Q

how many lumbar vertebra

A

5

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280
Q

how many pairs of lumbar spinal nerves

A

5

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281
Q

how to name lumbar spinal nerves

A

originate below vertebrae for which they are named

282
Q

how many sacral vertebra

A

5 at birth that fuse into 1

283
Q

how many pairs of sacral spinal nerves

A

5

284
Q

how to name sacral spinal nerves

A

originate below vertebrae for which they are named

285
Q

how many coccyx bones

A

4 at birth, bottom 3 fuse into 1, so 2 as an adult

286
Q

how many pairs of coccygeal spinal nerves

A

1

287
Q

where does the coccygeal spinal nerve exit

A

below coccyx

288
Q

describe what each spinal nerve senses

A

dermatome

289
Q

dermatome for C2/C3 nerves

A

head/neck

290
Q

dermatome for the thoracic nerves

A

chest

291
Q

dermatome for the lumbar nerves

A

low back/legs

292
Q

dermatome for the sacral nerves

A

back of legs/butt

293
Q

what is the purpose of the s shaped curve of the back

A

provides cushioning/springy structure that absorbs shock and spressure

294
Q

anterior curve, convex (from front)

A

lordosis

295
Q

posterior curve, concave (from front)

A

kyphosis

296
Q

normal physiologic curvature of the spine

A

cervical lordosis, thoracic kyphosis, lumbar lordosis, sacral/coccygeal kyphosis

297
Q

abnormal lateral curvature of the spine

A

scoliosis

298
Q

most common “combo” curvature

A

kyphoscoliosis

299
Q

what is the spine like at birth

A

only kyphotic curvature (c shaped)

300
Q

anatomically why can’t babies hold their heads up

A

kyphotic curvature of spine

301
Q

most common pathologic curvature of the spine

A

thoracic kyphosis (hunchback that occurs with age)

302
Q

vertebral anatomy: weight supporting structure that the intervertebral disk sits on

A

vertebral body

303
Q

where are the vertebral bodies bigger

A

towards the base of the spine

304
Q

vertebral anatomy: encases cord, composed of the pedicle and lamina

A

vertebral arch

305
Q

vertebral anatomy: connects vertebral body and transverse process

A

pedicle

306
Q

vertebral anatomy: connects two pedicles

A

lamina

307
Q

vertebral anatomy: fits into the superior articular process of the vertebra below

A

inferior articular process

308
Q

vertebral anatomy: runs midline, comes off of lamina on the vertebral arch

A

spinous process

309
Q

vertebral anatomy: comes out the side of the vertebral arch laterally

A

transverse process

310
Q

vertebral anatomy: fits into inferior articular process of vertebrae above

A

superior articular process

311
Q

vertebral anatomy: located under pedicle, gives an area for the spinal nerve to exit

A

vertebral notch

312
Q

vertebral anatomy: where inferior articular process meets with superior articular process

A

inferior articular facet

313
Q

vertebral anatomy: where the spinal cord/nerve rootlets sit

A

vertebral foramen

314
Q

unique properties of cervical vertebra (3)

A

bifid spinous process, transverse foramen, transverse sulcus

315
Q

cervical vertebral anatomy: forked spinous process

A

bifid spinous process

316
Q

describe the spinous process of C1

A

no spinous process

317
Q

almost 100% of people have bifid spinous processes at these levels

A

C2-C5

318
Q

50% of people have a bifid spinous process at this level

A

C6

319
Q

99.2% of people have a single spinous process at this level

A

C7

320
Q

cervical vertebral anatomy: opening in the transverse process where vertebral arteries exit

A

transverse foramen

321
Q

at what levels do the vertebral arteries exit out the transverse foramen

A

C1-C6 (C7 has transverse foramen, but arteries do not go through them)

322
Q

what perfuses the posterior brain

A

spinal arteries

323
Q

what perfuses the anterior brain

A

carotid arteries

324
Q

cervical vertebral anatomy: hollowed out/notch in transverse process where spinal nerves enter/exit

A

transverse sulcus on transverse process for spinal nerves

325
Q

where is the spinal cord wider

A

closer to the brain

326
Q

where are the vertebral foramen larger

A

closer to the brain

327
Q

connects with the base of the skull and axis (C2)

A

atlas (C1)

328
Q

named after the mythical god who held the weight of the world on his shoulders

A

atlas (C1)

329
Q

C1 vertebral anatomy: C1 has this instead of a spinous process, located on the posterior arch

A

posterior tubercle

330
Q

C1 vertebral anatomy: C1 has this instead of vertebral body, cannot support a lot of weight

A

anterior arch

331
Q

C1 vertebral anatomy: nub/bump located on the anterior side of the anterior arch

A

anterior tubercle

332
Q

C1 vertebral anatomy: joint where dens (on C2) connects to the posterior side of the anterior arch of C1 and provides a rotational axis between C1/C2

A

facet for dens

333
Q

where does the facet for dens connect to the dens

A

on the posterior side of the anterior arch of C1

334
Q

C1 vertebral anatomy: joint that connects with occipital condyles on the base of the skull

A

superior articular facet

335
Q

set of ligaments (anterior and posterior) that connect the atlas with the occipital bone (opening of foramen magnum)

A

atlantooccipital ligament

336
Q

what does the atlantooccipital ligament connect

A

atlas to opening of foramen magnum

337
Q

downward projections on occipital bone that connect to superior articular facet of C1

A

occipital condyles

338
Q

what joint allows for the nodding of the head yes

A

atlas/occipital condyle joint

339
Q

C2 vertebral anatomy: connects with the facet for dens on C1

A

anterior articular facet

340
Q

C2 vertebral anatomy: bony projection that articulates with posterior side of anterior arch of C1

A

dens

341
Q

what joint allows for the swiveling of the head side to side

A

C1/C2 joint

342
Q

_____ side of dens connects with the _______ side of the _______ arch of C1

A

anterior
posterior
anterior

343
Q

expanded fan like ligament that is probably an extension of the interspinous ligaments

A

nuchal ligament

344
Q

where nuchal ligaments and supraspinous ligaments connect with the occipital bone

A

external occipital protuberance

345
Q

the “little bump on the back of your head”

A

external occipital protuberance

346
Q

where is the weak point of the head/neck

A

force coming from behind (hitting on back of head)

347
Q

describe the makeup of most spinal ligaments and what is the exception

A

fibrous, made of collagen, not a lot of stretch (ligmentum flava)

348
Q

spinal ligaments: runs the entire length of the anterior spine, strong/meaty

A

anterior longitudinal ligament

349
Q

spinal ligaments: runs the entire length of the posterior spine

A

posterior longitudinal ligament

350
Q

spinal ligaments: links the tips of the transverse processes

A

intertransverse ligament

351
Q

spinal ligaments: links the tips of spinous processes, sits on top of spinous processes

A

supraspinous ligament

352
Q

spinal ligaments: immediately deep to supraspinous ligament, connects the vast majority of spinous processes to one another

A

interspinous ligament

353
Q

spinal ligaments: connects anterior arches together between levels

A

ligamentum flava

354
Q

how can you see ligmentum flava posteriorly

A

cut off pedicles and vertebral bodies

355
Q

what spinal ligament has a different composition so feels different with a needle and can be used to gauge depth during spinal/epidurals

A

ligamentum flava

356
Q

how to avoid hitting the incomplete fusion of ligamentum flava

A

slightly off midline approach

357
Q

where the weight of the spine rests, prevents bone on bone connection

A

intervertebral disks

358
Q

how many pairs of ribs

A

12

359
Q

where is the least likely area for a back injury to occur

A

T-spine

360
Q

what creates so much stability in the T-spine

A

many connections points with lots of things

361
Q

spinous processes in T-spine are

A

angled steeply down

362
Q

if trying to do a T-spine epidural/spinal what technique would you use

A

have to approach from side due to steeply angled spinous processes

363
Q

curve of T-spine can be described as

A

kyphotic, posterior facing, concave curvature

364
Q

large bump on back of neck

A

vertebral prominens

365
Q

what bone causes the vertebral prominens

A

spinous process of T1 (textbook says C7)

366
Q

where do costal facets exist (3)

A

superior and inferior body of T-spine and some transverse processes of the T-spine

367
Q

describe all the places a rib connects

A

superior costal facet and facet on transverse process for which it is named and the inferior costal facet of the body above (7th rib connects to inferior costal facet of T6, superior costal facet of T7, and costal facet on transverse process of T7)

368
Q

what part of the rib connects with the facet on the transverse process

A

costal tubercle

369
Q

features found only in T-spine (2)

A

costal facets
downward angled spinal processes

370
Q

describe the shape of the vertebral bodies in the T-spine

A

heart, L side flatter (due to aortic compression), R side rounder

371
Q

name the bones of the sternum from most superior to inferior

A

manubrium, body, xiphoid process

372
Q

numbers of the true ribs

A

1-7

373
Q

what is meant by true rib

A

tip of rib is connected directly to sternum via straight piece of costal cartilage

374
Q

the structure of the true ribs prevent what kind of injuries

A

crush

375
Q

numbers of the false ribs

A

8-10

376
Q

what is meant by false rib

A

ribs have an indirect connection to the sternum, the costal cartilage is connected to the costal cartilage of rib 7

377
Q

numbers of floating ribs

A

11-12

378
Q

what is meant by floating rib

A

ribs connect only with inferior costal facet on the body of T-spine (no connection with transverse facet)

379
Q

the rib neck comes into contact with the costal facet on the transverse process at the

A

costal tubercle

380
Q

spinal anatomy: located on the entire length of the spine in between pedicles where spinal nerves enter/exit the spine

A

intervertebral foramen

381
Q

what creates the intervertebral foramen

A

the space between the inferior vertebral notch and the superior vertebral notch

382
Q

describe the curvature of the lumbar spine

A

lordotic, convex, anterior curve

383
Q

how do you create more space between the spinous processes in the lumbar spine

A

ask the patient to lean forward

384
Q

what connects with the superior articular process of the sacrum

A

inferior articular process of L5

385
Q

how many sacral bones are you born with, how many do you end up with, and what age do they fuse

A

5
1
14-15

386
Q

weight supporting structure on top of the sacrum, intervertebral disks sit on top of the _________ and gives a place for L5 to rest

A

promontory

387
Q

connects with the inferior articular process of L5

A

superior articular process of the sacrum

388
Q

points of fusion of individual vertebrae in the sacrum

A

transverse lines

389
Q

where spinal nerves/nerve roots enter and exit the sacrum

A

anterior/posterior sacral foramina (depends on what side you are viewing from)

390
Q

how many sacral foramina are there

A

8 (4 on each side)

391
Q

in rise of a vertebral foramen in the sacrum, contains spinal nerves/nerve roots

A

sacral canal

392
Q

sacral anatomy: one on each side, created by the fusion of the transverse processes

A

lateral sacral crests

393
Q

sacral anatomy: palpable, runs midline, remnants of spinous processes from the original sacral vertebra

A

median sacral crest

394
Q

sacral anatomy: one on each side, located between the median and lateral crests, created by the fusion of the superior and inferior articular processes

A

medial sacral crests

395
Q

sacral anatomy: opening at base of sacrum where the coccygeal spinal nerve exits to allow ligaments to continue on to coccyx

A

sacral hiatus

396
Q

sacral anatomy: raised bumps on sides of sacral hiatus

A

sacral cornua

397
Q

how many coccyx bones are you born with, how many as an adult, and which fuse

A

4
2
fusion of bottom 3

398
Q

pelvic anatomy: most superior ridge of spine, should be palpable

A

iliac crest

399
Q

if you draw a line between the 2 iliac crests where are you

A

middle of L4 vertebral body (used for spinal/epidurals)

400
Q

pelvic anatomy: back dimples, should be able to see and palpate

A

posterior superior iliac spines

401
Q

how to access posterior S2 sacral foramina

A

1cm down and 1cm midline of the posterior superior iliac spines

402
Q

why would you give drugs in the S2 sacral foramina

A

shut down pain sensation in the legs

403
Q

pelvic anatomy: can palpate, but not really used as a marker for anything, located interior to posterior superior iliac spine

A

posterior inferior iliac spine

404
Q

pelvic anatomy: raise bump/nub that is used as an attachment point for the inguinal ligament

A

pubic tubercle

405
Q

pelvic anatomy: attaches pubic tubercle to anterior superior iliac spine

A

inguinal ligament

406
Q

pelvic anatomy: attachment point for inguinal ligament on the iliac

A

anterior superior iliac spine

407
Q

pelvic anatomy: connects transverse processes of L4/L5 to top/back of pelvis

A

iliolumbar ligament

408
Q

pelvic anatomy: cartilage connection point between 2 sides of pelvis in front

A

pubic symphysis

409
Q

the level of the umbilicus is at the

A

intervertebral disk of L3-L4

410
Q

what makes up the “2 sets of hips”

A

iliac crest, greater trochanter

411
Q

male v female pelvis

A

females have a wider opening and broader hips

412
Q

where are intervertebral disks not present

A

sacrum

413
Q

“resilient cushions” between each vertebra

A

intervertebral disks

414
Q

fibrous connective tissue wrapped around nucleus pulposus

A

anulus fibrosus

415
Q

describe the pattern of the anterior anulus fibrosus

A

cross-hatched/criss cross

416
Q

which direction is disk herniation more likely to happen and why

A

posterior, not as strong, no criss-cross pattern of fibers

417
Q

gel filled center of intervertebral disks

A

nucleus pulposa

418
Q

sandwiches each side of the intervertebral disk

A

hyaline cartiladge end plate

419
Q

nucleus pulposa leaks out and pushes on spinal nerve causing pain

A

herniation

420
Q

treatment for herniation: remove the part of the disk causing the issue

A

discectomy

421
Q

treatment for herniation: stabilization of vertebra (usually from frontal approach)

A

spinal fusion

422
Q

spinal fusion creates extra stress on the vertebra _______________ the point of fusion and those levels develop bad disks _________________ post procedure as it reduces the integrity of the shock absorbing ability of the spine

A

above and below
6-7 years

423
Q

treatment for herniation: remove part of the bone that is compressing the nerve which creates more space in the intervertebral foramen for the nerve

A

laminectomy

424
Q

____% of low back problems can be fixed by lifestyle modification and PT

A

80

425
Q

if the ___________ are tight, they will pull on vertebrae and cause intervertebral foramen to squish nerve

A

hamstrings

426
Q

who do you want operating on your back

A

neurosurgeon

427
Q

meninges cover the

A

CNS

428
Q

meninges stop where

A

spinal nerves start (where anterior and posterior root come together)

429
Q

connective tissues that surrounds the CNS allowing for controlled environmental conditions

A

meninges

430
Q

deepest meningeal layer, thin, stuck on top of neurons/glial cells, immediately deep to large blood vessels

A

pia mater

431
Q

space between pia mater and arachnoid matter, where CSF and large blood vessels are located

A

subarachnoid space

432
Q

where is CSF located

A

subarachnoid space

433
Q

what meningeal layer are spinals placed

A

subarachnoid

434
Q

why do spinals have a faster onset than epidurals

A

closer to proximity to affected structures

435
Q

what happens if the needle enters too far in a spinal

A

puncture cord

436
Q

meningeal layer that is more superficial to the pia mater and spinal arteries/veins

A

arachnoid mater

437
Q

meningeal layer: nothing is actually located here, just a potential space between the arachnoid and dura mater

A

subdural space

438
Q

meningeal layer that is tough, robust, leathery, the most superficial covering, and makes up the walls of the sinuses

A

dura mater

439
Q

what makes up the walls of the sinuses

A

dura mater

440
Q

meningeal layer just above dura mater, contains fat cells and venous vessels

A

epidural space

441
Q

why do epidurals have a slower onset and longer elimination

A

lipophilic meds are taken up by the fat cells in the epidural space

442
Q

length of the spinal cord

A

medulla to L1

443
Q

where is the cervical enlargement of the spinal cord

A

C3-C6

444
Q

why does the cervical enlargement exist and what do those nerves feed into

A

innervation of upper extremities
brachial plexus

445
Q

where is the lumbar enlargement of the spinal cord

A

T11-L1

446
Q

why does the lumbar enlargement exist and what do those nerves feed into

A

innervation of the lower extremities
sciatic nerve and lumbar plexus

447
Q

what is the end of the spinal cord called and where is it located in an adult

A

conus medullaris
L1

448
Q

what comes off the end of the conus medullaris

A

nerve roots

449
Q

are meninges continuous with nerve roots through the bottom of the sacrum

A

yes

450
Q

the collection of nerve roots (anterior and posterior) that come off the conus medullaris

A

cauda equina

451
Q

where does the cauda equina end

A

S2

452
Q

what does cauda equina mean

A

horses tail

453
Q

CSF filled structure from conus medularis to end of cauda equina (S2)

A

dural sac (lumbar cistern)

454
Q

length of the dural sac (lumbar cistern)

A

conus medularis to end of cauda equina (S2)

455
Q

what does cistern mean

A

pool, storage area

456
Q

where is the last place CSF is “refreshed”

A

dural sac (lumbar cistern)

457
Q

CSF samples taken from the dural sac (lumbar cistern) reflect

A

older CSF

458
Q

the filum terminale internum and externum are extensions of what meningeal layer

A

pia mater

459
Q

extension of pia mater (that functions like ligament) that connects conus medullaris to end of the dural sac (@S2), found within the dural sac

A

filum terminale internum

460
Q

extension of the pia mater (that functions like ligament) that holds the dural sac in place (@S2) by connecting it with the bottom of the coccyx

A

filum terminal externum

461
Q

spinal bones grow ________ than the spinal cord _________ so ________________ needed to anchor or the cord would _________

A

faster
lengthens
filum terminale
retract up

462
Q

where is the conus medularis in an adult

A

L1

463
Q

where is the conus medularis in a newborn

A

L3

464
Q

where are spinals/epidurals done (3)

A

L3/L4 interspace, L4/L5 interspace, sacral hiatus

465
Q

which is quicker a spinal or epidural

A

spinal

466
Q

can be used as a conduit to get drugs to sacral nerves

A

sacral hiatus

467
Q

approach for a spinal/epidural at a ________ angle to ensure ___________

A

15 degree
you hit ligmentum flava (and avoid incomplete fusion)

468
Q

grey matter in cerebral hemispheres is

A

superficial

469
Q

corpus callosum is made of

A

white matter

470
Q

if looking at a sagittal section of the brain they have cut through the

A

corpus callosum

471
Q

stuck to the outside border of the brain on top of neurons/glial cells, deep to blood vessels

A

pia matter

472
Q

pillars that allow space for blood vessels and CSF in the subarachnoid space

A

arachnoid trabeculae

473
Q

if a bleed occurs in the subarachnoid space it is most likely

A

arterial

474
Q

if a bleed occurs in the subdural space it is most likely

A

venous

475
Q

thickest, strongest layer, one part of the walls of the venous sinuses

A

dura mater

476
Q

if a bleed occurs in the epidural space it is most likely
and due to what

A

arterial
skull fracture

477
Q

why are epidural bleeds mostly arterial

A

skull contains large blood vessels

478
Q

______ bleeds get worse quickly
_______ bleeds progress with time

A

arterial
venous

479
Q

properties of CSF: apperance

A

clear

480
Q

properties of CSF: RBCs

A

no RBCs

481
Q

properties of CSF: protein

A

no protein

482
Q

properties of CSF: WBCs

A

little/no WBCs

483
Q

properties of CSF: volume

A

150ml

484
Q

properties of CSF: amount produced per day

A

500ml/day

485
Q

properties of CSF: pH

A

7.31

486
Q

properties of CSF: HCO3- vs CO2

A

HCO3- < CO2

487
Q

properties of CSF: Na+

A

140

488
Q

properties of CSF: Cl-

A

140

489
Q

properties of CSF: K+

A

40% less than plasma

490
Q

properties of CSF: Mg+2

A

higher than plasma

491
Q

properties of CSF: glucose

A

60mg/dL

492
Q

CSF is replaced _____ times per day in most places

A

three

493
Q

why is there less HCO3- in CSF than plasma

A

HCO3- provides a buffer in the brain for the CO2 constantly being produced by metabolism

494
Q

what controls the composition of the CSF

A

astrocytes

495
Q

what is glucose in plasma

A

90mg/dL

496
Q

how does glucose enter CSF

A

glut-1

497
Q

what electrolytes help to hyperpolarize neurons, compare concentrations to plasma

A

lower than plasma K+
higher than plasma Mg+2

498
Q

what electrolytes (3) contribute to “putting the breaks on”/limiting neuron action potential

A

Cl-, K+, Mg+2

499
Q

what cells produce CSF

A

ependymal cells

500
Q

what separates CV circulation from CSF circulation

A

ependymal cells

501
Q

on the CSF side of the ependymal cell _____ and ____ follow _______ from the _______

A

Cl- and H2O
Na+
Na+ pump (requires ATP)

502
Q

some anesthetics speed up/slow down the ______ in the ependymal cell which effects the speed of CSF production

A

Na+ pump

503
Q

decreased Na+ from Na+ pump in ependymal cell would do what to Cl- and H2O

A

slow Cl- and H2O
lowering overall CSF production

504
Q

increased Na+ from Na+ pump in ependymal cell would do what to Cl- and H2O

A

speed up Cl- and H2O
increasing overall CSF production

505
Q

what dictates how much CSF is produced per day and what is normal

A

ependymal cell
500ml/day

506
Q

group of ependyamal cells where CSF is produced

A

choroid plexus

507
Q

where are the right and left lateral ventricles found

A

in cerebral cortex

508
Q

where is the 3rd ventricle located

A

right at diencephalon/hypothalamus

509
Q

where is the 4th ventricle located

A

middle of the brainstem, anterior to the cerbellum

510
Q

how CSF produced in the lateral ventricles drains into the 3rd ventricle

A

interventricular foramen (foramen of monroe)

511
Q

how CSF drain from the 3rd ventricle to the 4th ventricle

A

cerebral aqueduct (aqueduct of sylvius)

512
Q

how CSF exits out the lateral sides of the 4th ventricle

A

lateral aperture (foramen of lushka)

513
Q

comes off the 4th ventricle into the spinal cord to drain CSF

A

central canal

514
Q

how CSF exits the posterior of the 4th ventricle to circulate around the cerebellum

A

median aperture (foramen of magendie)

515
Q

“pressure blow off valves” where CSF is reabsorbed, located just above the longitudinal fissure

A

arachnoid granulations

516
Q

is CSF reabsorbed at the cord level

A

some, but not a lot

517
Q

what happens if ICP increases

A

arachnoid granulation “valves” open and allow CSF back into CV circulation

518
Q

normal ICP

A

10mmHg

519
Q

CSF should be being absorbed by the CV system….

A

at the same rate it is being produced

520
Q

pool of CSF that get fed via the median aperture (foramen of magendie) from the 4th ventricle

A

cerebellomedullary cistern (cisterna magna)

521
Q

where can you take a “fresh CSF” sample from

A

cerebellomedullary cistern (cisterna magna)

522
Q

block in the “way out” for CSF, ventricles expand and puts pressure on brain/neurons/glial cells

A

noncommunicating hydrocephalus

523
Q

most common blockage in noncommunicating hydrocephalus

A

cerebral aqueduct (aqueduct of sylvius)

524
Q

what is a temporary fix for noncommunicating hydrocephalus

A

bolt

525
Q

CSF isnt being properly reabsorbed but is draining properly, causes increased ICP but no enlarged ventricles

A

communicating hydrocephalus

526
Q

what encloses the ventricles

A

meninges

527
Q

“big vein with structure”

A

sinus

528
Q

cranial sinuses: top, midline in sagittal plane

A

superior sagittal sinus

529
Q

cranial sinuses: same plane as superior sagittal sinus, but inferior

A

inferior sagittal sinus

530
Q

cranial sinuses: very last, straight part of inferior sagittal sinus

A

straight sinus

531
Q

cranial sinuses: where superior sagittal sinus, straight sinus, and transverse sinuses meet

A

sinus confluence

532
Q

cranial sinuses: provides an exit point for all venous blood emptying from the superior and inferior sagittal sinuses

A

transverse sinus

533
Q

cranial sinuses: “hair pin” turn that connects the transverse sinus to the internal jugulars

A

sigmoid sinus

534
Q

cranial sinuses: venous collection pool from the front middle part of the brain and all venous runoff from the face, feeds into the sigmoid sinus

A

cavernous sinus

535
Q

connective tissue that separates the right and left hemispheres and connects superior and inferior sagittal sinuses

A

falx cerebri

536
Q

connective tissue that provides a shelf for the occipital lobe, superior to cerebellum

A

tentorium cerebelli

537
Q

where all sinus blood flow empties into

A

internal jugular

538
Q

drains superficial structures on each side of the head

A

external jugulars

539
Q

brain blood flow is considered

A

lopsided

540
Q

the brain gets a lot of blood flow relative to its size due to

A

high metabolic activity

541
Q

rate of blood flow to the brain in ml/min and ml/min/g

A

750ml/min
50ml/min/100g

542
Q

the brain receives what % of CO despite being what % of body weight

A

15
2-3

543
Q

what percentage of brain blood flow goes to white matter

A

20%

544
Q

what percentage of brain blood flow goes to grey matter

A

80%

545
Q

rate of blood flow to the brain is dependent on

A

cerebral metabolic activity

546
Q

4 “feed vessels” for arterial brain blood supply

A

2 vertebral arteries
2 internal carotid arteries

547
Q

what do the vertebral arteries perfuse

A

posterior brain

548
Q

what do the internal carotids perfuse

A

anterior brain

549
Q

cerebral arteries: combine inferior to the pons to form basilar artery

A

vertebral artery

550
Q

cerebral arteries: feeds into circle of willis at posterior midline

A

basilar artery

551
Q

cerebral arteries: supplies blood flow to superficial structures

A

external carotids

552
Q

cerebral arteries: name changes to middle cerebral artery once it enters the circle of willis

A

internal carotid

553
Q

what is the purpose of the circle of willis

A

increases the likelihood of collateral circulation if 1 artery becomes blocked

554
Q

what feeds the circle of willis

A

internal carotids (2) and basilar artery

555
Q

cerebral arteries: perfuses front to midline of brain

A

anterior cerebral artery

556
Q

cerebral arteries: portion of the anterior cerebral artery that is apart of the circle of willis

A

A1/precommunicating/early

557
Q

cerebral arteries: portion of the anterior cerebral artery that extends from the circle of willis to deliver perfusion

A

A2/postcommunicating/late

558
Q

cerebral arteries: comes from the internal carotid, perfuses lateral/middle brain

A

middle cerebral artery

559
Q

largest artery with the most branches, worst one to have a stroke

A

middle cerebral artery

560
Q

cerebral arteries: comes off of basilar artery, perfuses back/lateral brain

A

posterior cerebral artery

561
Q

cerebral arteries: portion of the posterior cerebral artery that is a part of the circle of willis

A

P1/precommunicating/early

562
Q

cerebral arteries: portion of the posterior cerebral artery that extends from the circle of willis

A

P2/postcommunicating/early

563
Q

cerebral arteries: connects the right and left sides of the anterior cerebral arteries together in the front of the circle of willis

A

anterior communicating artery

563
Q

cerebral arteries: connects the right and left sides of the posterior cerebral arteries to the middle cerebral arteries

A

posterior communicating artery

564
Q

cerebellar blood supply: perfuses the front/top of the cerebellum, projects from the basilar artery

A

superior cerebellar artery

565
Q

cerebellar blood supply: feeds the middle of the cerebellum, arises from the basilar artery

A

anterior inferior cerebellar artery

566
Q

cerebellar blood supply: arises from the vertebral arteries, located below the pons

A

posterior inferior cerebellar artery

567
Q

what an aneurysm or hemorrhagic stroke technically is

A

subarachnoid hemorrhage

568
Q

why is a subarachnoid hemorrhage an issue

A

hematoma infiltrates neuron/glial cells

569
Q

alcoholism causes

A

thin vessels

570
Q

cardiovascular health is linked to

A

the ability of the blood vessels to dilate under normal conditions

571
Q

volatile anesthetics reduce the amount of

A

autoregulation

572
Q

the more autoregulation is affected by an anesthetic what will the slope of the graph look like

A

steeper

573
Q

autoregulation graph: horizontal

A

perfect autoregulation

574
Q

cerebellar blood supply: linear

A

no autoregulation

575
Q

claims that not every anesthetic agent effect autoregulation are likely due to the effects not being

A

statistically significant

576
Q

brain blood flow is determined by

A

metabolic demands of the tissue

577
Q

Number 1 regulator of cerebral blood flow

A

CO2

578
Q

increased CO2 does what to brain blood flow

A

increases

579
Q

prevents over/under perfusion of the brain in the face of changing environmental conditions

A

autoregulation

580
Q

what would the brain blood flow graph look like if autoregulation did not exist

A

linear

581
Q

what drives autoregulation

A

systemic BP (MAP/ICP)

582
Q

__________ in brain adjust vascular resistance to prevent over/under perfusion

A

local vascular beds

583
Q

what happens to vascular resistance if pressure increases in the brain

A

increased vascular resistance (constriction)- brain blood flow stays steady

584
Q

what happens to vascular resistance if pressure decreases in the brain

A

decreased vascular resistance (dilation)- brain blood flow stays steady

585
Q

what happens if there is unchecked over perfusion in the brain

A

burst aneurysm

586
Q

what happens if there is unchecked under perfusion in the brain

A

cell death

587
Q

what is the lower limit of autoregulation (LLA)

A

50

588
Q

what is the upper limit of autoregulation (ULA)

A

150

589
Q

if someone has chronically high BP autoregulation adjusts and the entire graph shifts which direction

A

right (LLA and ULA get higher)

590
Q

what happens to blood vessels if they are constantly under high pressure (chronic, uncontrolled HTN)

A

arterial sclerosis

591
Q

what happens with autoregulation if arterial sclerosis is present

A

blood vessels can no longer dilate and can’t use collateral circulation so they are more susceptible to low/normal blood pressures

592
Q

other arteries can take over perfusion if a blockage occurs

A

collateral circulation

593
Q

a motor neuron is what kind of neuron

A

multipolar

594
Q

where is the cell body of a multipolar neuron found

A

ventral horn

595
Q

depolarization in motor neurons opens up

A

P-type Ca+2 channels

596
Q

_____ in motor neurons are the stimulus for the release of Ach

A

Ca+2

597
Q

vesicles containing Ach that fuse with the cell wall to release Ach into the synapse in response to Ca+2 entry

A

VP-2 (vesicular pool 2)

598
Q

Ach vesicles that aren’t full or close enough to be released into the synapse

A

VP-1 (vesicular pool 1)

599
Q

which are in greater proportion VP-1 or VP-2

A

VP-1

600
Q

ATP dependent pumps that remove Ca+2 from motor neurons to “shut off” Ach release

A

Ca+2 pumps

601
Q

Ca+2 acts as the key that opens up additional K+ channels to help repolarize the cell

A

Ca+2 sensitive K+ channels

602
Q

repolarization of the motor neuron is possible because (4)

A

slow V-G K+ channels, Na+/K+ ATPase, Ca+2 pumps, Ca+2 sensitive K+ channels

603
Q

describe the shape of the nicotinic Ach receptor

A

cylindrical

604
Q

where is the nicotinic Ach receptor located

A

on the post-synaptic (muscle) cell

605
Q

there are _______ of receptors at each NMJ concentrated around the motor neuron

A

millions

606
Q

describe nAch binding, conformation change, and what it does

A

2 Ach bind simultaneously opening the channel and allowing Na+ to flood into the post synaptic cell

607
Q

what all travels through nAch receptors and what is the MAIN influx

A

Na+ in (main), Ca+2 in, K+ out

608
Q

localized depolarization at muscle cell due to nAch receptors opening causes

A

end plate potential

609
Q

the end plate potential becomes an action potential when

A

fast Na+ channels next to the nAch receptor open

610
Q

why should end plate potential always give rise to an action potential

A

there is an excess of nAch receptors and Ach being released

611
Q

end plate potential always gives rise to

A

action potential (in a healthy muscle cell)

612
Q

need _________ receptors activated for an end plate potential to occur

A

500,000

613
Q

largest contributor to body weight and volume in a non-obese person

A

muscle

614
Q

2 ways to excite motor neurons

A
  1. descending pathways originating in the brain
  2. reflex arcs
615
Q

where do motor neuron cell bodies exist

A

anterior/ventral horn

616
Q

most skeletal muscle fibers are innervated by (one/many) motor neurons

A

one

617
Q

____________ are innervated by more than one motor neuron

A

ocular muscles

618
Q

sensory information goes in the back of the cord and immediately goes out the front as a motor output (never reaching the brain)

A

reflex arc

619
Q

example of a reflex arc

A

painful stimulus

620
Q

endoplasmic reticulum in the skeletal muscles

A

sarcoplasmic reticulum

621
Q

what is the function of the sarcoplasmic reticulum in the skeletal muscles

A

store Ca+2

622
Q

are skeletal muscle cells reliant on Ca+ from outside the skeletal muscle

A

no, they release their own stores from the SR

623
Q

infolding that carries action potential deep into the muscle cell

A

transverse tubule (T-tubule)

624
Q

contractile elements of the muscle cells that are arranged in tubelike structures

A

actin/myosin

625
Q

what drives cross bridge cycling between actin and myosin

A

Ca+2

626
Q

prefix meaning muscle

A

sarco-

627
Q

muscles (shorten/lengthen) with contraction

A

shorten

628
Q

where motor neuron comes in contact with skeletal muscle cells

A

neuromuscular junction (NMJ)

629
Q

primary infolding found on post-synaptic cell

A

subneural cleft

630
Q

infoldings found on subneural cleft

A

secondary clefts

631
Q

Ca+2 entry into the presynaptic cell is the result of

A

an action potential that passes through the motor neuron

632
Q

______ entry causes Ach vesicles to move towards the cell wall and release Ach into NMJ

A

Ca+2

633
Q

how does acetylcholinesterase work and what are the products

A

hydrolysis of ester bonds to breakdown into acetyl (acetate) and choline

634
Q

what is acetyl

A

a small starch group

635
Q

where does acetylcholinesterase come from

A

expressed by skeletal muscles

636
Q

what is the purpose of acetylcholinesterase

A

limit the length of depolarization

637
Q

what happens to choline after it is broken down by acetylcholinesterase in the NMJ

A

reuptaked into the motor neuron

638
Q

sits at the terminal end of the motor neuron and manages myelination all the way back to the spinal cord

A

schwann cell

639
Q

how many nicotinic acetylcholine receptors are located at the NMJ

A

5 million

640
Q

how many nicotinic acetylcholine receptors are activated in a typical synaptic response

A

500,000 (10%)

641
Q

how many Ach molecules need to be released in order to trigger a typical synaptic response

A

at least 1 million (2 per activated receptor)

642
Q

how many Ach molecules are actually released

A

about 2 million

643
Q

exocytosis of Ach is dependent on

A

Ca+2

644
Q

anything that can cause an action potential in the neuron causes

A

an action potential in the skeletal muscle

645
Q

how many subunits in a nicotinic acetylcholine receptor (describe)

A

5
2 alpha, 1 beta, 1 delta, 1 epsilon

646
Q

where does Ach or something that resembles it bind on the nAchR

A

both alpha subunits

647
Q

what is the primary current through the nicotinic acetylcholine receptor (and what are the secondary currents)

A

Na+
Ca+2 and K+

648
Q

naturally occurring paralytic found in the rainforest used to paralyze prey

A

curare

649
Q

curare is a (2)

A

nAchR antagonist
non-depolarizing paralytic

650
Q

all non-depolarizing paralytics are modeled after

A

curare

651
Q

do nAchR antagonists need to block both sites or only one

A

only one to make the entire receptor inactive

652
Q

voltage sensor in muscle cell wall that can detect action potential

A

DHP receptor (dihydropyridine)

653
Q

what does the DHP receptor (dihydropyridine) do

A

opens Ca+2 release channels (ryanodine receptors) in the SR which liberates Ca+2 into skeletal muscle cells

654
Q

where are DHP receptors (dihydropyridine) located

A

skeletal muscle cell wall and transverse tubules (T-tubules)

655
Q

what other receptor does a DHP receptor (dihydropyridine) resemble

A

V-G Ca+2 channel

656
Q

the DHP receptor (dihydropyridine) is tethered to the door of the Ca_2 release channel (ryanodine receptor) by

A

a physical attachment

657
Q

does any amount of calcium come into the skeletal muscle cell from the NMJ, if so what lets it in

A

DHP receptor (dihydropyridine) lets a small amount of Ca+2 in

658
Q

where the majority of Ca+2 in the muscle cell is released from and reabsorbed to

A

sarcoplasmic reticulum (SR)

659
Q

the SR is located in close proximity to (3)

A

DHP receptor (dihydropyridine), cell wall, and transverse tubules

660
Q

structure located in the middle of the SR

A

transverse tubules

661
Q

the opening of this channel is triggered by DHP receptor (dihydropyridine) activation

A

Ca+2 release channel (ryanodine receptors)

662
Q

pump that uses ATP to put Ca+2 back into the SR

A

SERCA pump

663
Q

what does SERCA stand for

A

sacroplasmic endoplasmic reticulum calcium ATPase

664
Q

E-C coupling steps (14)

A
  1. signal to motor neuron to depolarize from the brain or reflex arc, this leads to an action potential
  2. Ca+2 influx from motor neurons through P-type Ca+2 channels
  3. Ach vesicles (VP-2) fuse to presynaptic neural cell wall
  4. Ach secreted by presynaptic neuron into NMJ
  5. Ach interacts with nAchR on skeletal muscle cells
  6. Na+ floods in, along with Ca+2
  7. influx through nAchR generates end plate potential (EPP)
  8. local depolarization (EPP) causes action potential in skeletal muscle
  9. action potential spread down muscle fiber in both directions away from NMJ (via fast Na+ channels)
  10. muscle depolarization sensed by DHP receptor (dihydropyridine)in cell wall or T-tubules
  11. DHP receptor (dihydropyridine) pulls open Ca+2 release channels (ryanodine receptor)
  12. Ca+2 influx into sacroplasm and muscle contraction occurs
  13. Ca+2 is tucked back into SE by SERCA
  14. muscle stops contracting
665
Q

where does acetyl (acetate) come from

A

mitochondria

666
Q

where is extra choline stored

A

in the cell wall as phosphatidylcholine

667
Q

choline is pumped back into the motor neuron through (2)

A

choline ATPase pump
choline/Na+ 2nd active transporter

668
Q

are leaky K+ channels always open

A

yes

669
Q

when do fast V-G Na+ channels reset

A

during repolarization

670
Q

___________ channels opening speeds up repolarization

A

slow K+ channels

671
Q

________ channels should be enough for the cell to repolarize

A

leaky K+ channels

672
Q

body produces antibodies against nAchR

A

myasthenia gravis

673
Q

what happens in the NMJ with myasthenia gravis

A

nAchR are destroyed and cleft scars over, less surface area, and fewer fast Na+ channels

674
Q

does myasthenia gravis get better or worse throughout the day

A

worse

675
Q

dysfunction in what organ is linked to myasthenia gravis

A

thymus

676
Q

drugs to treat myasthenia gravis end in

A

-stigmine

677
Q

-stigmine drugs belong to what family

A

acetylcholinesterase inhibitors

678
Q

drug that allows Ach to stay in the NMJ longer to allow more time for Ach to interact with nAchR

A

acetylcholinesterase inhibitors

679
Q

long name for LEMS/ELMS

A

lambert-eatom myasthenic syndrome

680
Q

what kind of cancer is associated with LEMS/ELMS

A

lung

681
Q

body produces antibodies to P-type calcium channels

A

LEMS/ELMS

682
Q

how does LEMS/ELMS affect Ach release

A

less p-type Ca+2 channels so less Ca+2 entering the motor neuron, Ach cannot be released

683
Q

drug class that treats LEMS/ELMS

A

V-G K+ channel blocker

684
Q

drugs (2) mentioned for the treatment of LEMS/ELMS

A

TEA (tetraethylammonium)
4-5 diaminopuridine

685
Q

what is the major side effect of V-G K+ channel blocker and why do they occur

A

cardiotoxic
drugs aren’t specific for motor neuron V-G K+ channels

686
Q

prevent action potential from ever occurring

A

non-depolarizing muscle relaxer

687
Q

example of a depolarizing muscle relaxer

A

succinylcholine

687
Q

drug that is essentially just 2 Ach molecules stuck together

A

succinylcholine

688
Q

causes a sustained depolarization because it binds to nAchR to keep it open

A

succinylcholine (depolarizing muscle relaxer)

689
Q

how long does the depolarization period with succinylcholine last

A

up to 10 minutes

690
Q

can succinylcholine be broken down by acetylcholinesterase

A

no

691
Q

the initial action potential/depolarization after succinylcholine is administered causes what

A

fasciculation (twitch/quiver of muscles)

692
Q

what is the effect of nAchR staying open due to the administration of succinylcholine

A

fast Na+ channels cannot reset to be able to repolarize

693
Q

after administration of succinylcholine is the whole muscle unable to repolarize

A

no- just at the NMJ

694
Q

what happens to the Vrm with the administration of succinylcholine

A

increases (more positive)

695
Q

what happens to K+ with the administration of succinylcholine and why

A

K+ leaves through K+ leak channels in an attempt to repolarize the cell

696
Q

administration of succinylcholine increases the K+ by how much

A

0.5

697
Q

in what cases does the serum K+ raise more than expected with the administration of succinylcholine (3)

A

denervation injuries, strokes, paralysis

698
Q

people with denervation injuries, strokes, and paralysis have an increased number of ____________ at places other than the NMJ

A

nAchR

A&P 1 (3 decks)

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