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ANAP 510 > TEST 2 > Flashcards

TEST 2 Flashcards

1
Q

There are ____ pairs of cranial nerves

A

12

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2
Q

What Nuclei of origin are found in the medulla?

A

CN IX, X, XI, XII

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3
Q

CN IX, X sensory nucleus

A

Nucleus solitarius

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4
Q

CN IX, X motor nucleus

A

Nucleus ambiguus

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5
Q

Nuclei of origin located in the Pons

A

CN V, VI, VII, VIII

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6
Q

Nuclei of origin located in the midbrain

A

CN III, IV

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7
Q

These CN do not have a nuclei of origin

A

CN I, II

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8
Q

Name the CN

A 
I Olefactory 
II Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facial
VIII Vestibulocochlear/acoustic
IX glossopharyngeal
X vagus
XI spinal accessory 
XII Hypoglossal
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9
Q

Which CN have sensory fibers only?

A

CN I, II, and VIII

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10
Q

A CN that has motor fibers will also have _______ fibers

A

Proprioceptive

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11
Q

CN that have parasympathetic fibers

A

CN III, VII, IX, X

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12
Q

Major parasympathetic nerve

A

CN X: vagus

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13
Q

Which CN have ALL 4 types of fibers? (Motor, sensory, proprioceptive and parasympathetic)

A

CN VII, IX, X

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14
Q

CN pathways are similar to descending motor pathways because they have ___ neurons in sequence.

What is the difference between the pathways?

A

2 neurons in sequence

CN pathways have upper motor neuron from both the left AND the right

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15
Q

Sensory fibers in CN have ____ neurons in sequence

A

3

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16
Q

Only sensory fibers, provides for sense of smell

A

Olefactory fibers

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17
Q

Olefactory fibers originate in the _________ and terminate in the __________.

A

Originate in the nasal passages

Terminate in the olefactory cortex

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18
Q

Olefactory fibers have collaterals to what two things?

A

Habenular nucleus

Limbic system

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19
Q

Located in epithalmus; plays role in gut responses to odors

A

Habenular nucleus

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20
Q

Plays a role in emotional responses to the environment, which is highly associated with smell

A

Limbic system

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21
Q

CN II pathways start where? Terminate where?

A

Start in rods and cones of the retina

Terminate in primary visual cortex

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22
Q

CN that provides motor innervation to most of the extraocular muscles; responsible for majority of the extraocular movements.

A

CN III Oculomotor

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23
Q

Parasympathetic fibers in CN III innervate the pupil and cause pupillary ________.

A

Constriction

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24
Q

Fibers that cause pupil dilation

A

Sympathetic

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25
Q

How do you test parasympathetic rxn of CN III?

A

Shine a light in the eye

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26
Q

When testing parasympathetic fxn of CN III with a light, you should have direct constriction, and also have ___________ constriction of the opposite eye.

A

Consensual

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27
Q

CN that pulls the eyelids open

A

CN III

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28
Q

CN that closes the eyelids

A

CN VII

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29
Q

Ptosis is indicative of a CN ____ lesion

A

III

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30
Q

Trochlear CN IV brings eyeball DOWN and OUT.

TRUE/FALSE

A

FALSE

Brings eyeball DOWN and IN

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31
Q

CN that moves the eyeball laterally

A

CN VI Abducens

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32
Q

What 3 CN’s move the eyeball

A

CN III, IV, and VI

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33
Q

If you look to the right, your left eye moves to the right via CN ___; your right eye moves laterally via CN __.

A

III; VI

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34
Q

3 branches of CN V (trigeminal)

A

Opthalamic
Maxillary
Mandibular

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35
Q

CN responsible for most sensations through the head and face

A

CN V Trigeminal

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36
Q

Branch of CN III; only sensory fibers, innervates upper part of head

A

Opthalamic branch

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37
Q

Trigeminal branch; only sensory fibers; innervates middle face/head

A

Maxillary

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38
Q

Trigeminal branch; motor fibers for chewing and proprioceptive feedback from these muscles

A

Mandibular branch

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39
Q

Facial CN VII is responsible for the majority of facial _________.

A

Expressions

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40
Q

CN VII provides sense of taste for what part of the tongue

A

Anterior 2/3

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41
Q

CN VII provides for sensory fibers from what 2 areas?

A

SKIN of the external ear

Palate

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42
Q

Parasympathetic fibers of CN VII to submandibular and sublingual glands for ___________ production

A

Saliva

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43
Q

CN VII parasympathetic fibers to lacrimal glands for ____ production

A

Tear

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44
Q

CN VII Parasympathetic fibers to glands of the palate and nasal cavity. TRUE/FALSE

A

TRUE

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45
Q

To assess facial nerve you may ask someone to raise their eyebrows, smile, frown, or puff their cheeks out; you are looking for ________ when you do this

A

Symmetry

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46
Q

CN VIII provides for special sense of ________ and _________.

A

Sense of hearing and balance

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47
Q

CN that provides motor input to pharyngeal muscles; responsible primarily for the function of swallowing

A

CN IX Glossopharyngeal

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48
Q

CN IX provides for sense of taste to what area of the tongue

A

Posterior 1/3

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49
Q

Contain sensory fibers that innervate the baroreceptors and chemoreceptors of internal carotids.

A

CN IX

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50
Q

Baroreceptors monitor ______

A

Pressure

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51
Q

Chemoreceptors at the carotid bodies are primarily monitoring ______

A

PaO2 (peripheral)

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52
Q

How do you assess CN IX?

A

Open mouth and say AHHH

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53
Q

When assessing CN IX, uvula should rise where?

A

In the midline

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54
Q

If uvula deviates to one side, it deviates towards the affected side. TRUE/FALSE

A

FALSE

Uvula Deviates towards the NORMAL side

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55
Q

Provides motor innervation to allow for voice production

A

CN X

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56
Q

Sensory fibers that Innervate the aortic arch where baroreceptors and chemoreceptors located

A

CN X

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57
Q

CN X parasympathetic fibers provide for innervation of many of the organs in what areas

A

Thoracic

Abdominal

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58
Q

CN X does NOT have parasympathetic fibers that innervate what 4 things that are innervated by sacral segments of the SC. (S2-S4)

A

Sigmoid colon
Rectum
Anus
Genitals

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59
Q

Nuclei of origin for CN XI is not in the cranium, where does it sit?

A

Below the foramen magnum; upper SC

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60
Q

CN XI provides for motor input to the ______ and ______ muscles

A

Trapezius

Sternocledomastoid

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61
Q

What two movements does CN XI allow us to do?

A

Rotate head

Shrug shoulders

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62
Q

Provides motor innervation to many of the tongue and throat muscles

A

CN XII

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63
Q

How do you assess the hypoglossal CN XII; normal result?

A

Have pt stick tongue out; should be midline

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64
Q

If pts tongue deviates to one side when assessing CN XII, it will deviate towards the side with the lesion. TRUE/FALSE

A

TRUE

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65
Q

Sits right above optic chiasm

A

Hypothalamus

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66
Q

Sits right below optic chiasm in the sella turcica of the sphenoid bone

A

Pituitary

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67
Q

Passes right through the optic chiasm; connects hypothalamus to pituitary

A

Infundibulum

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68
Q

Visual field projected onto the R lateral retina

A

R medial visual field

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69
Q

If rods and cones of retina from R lateral are excited, sends impulses to towards the optic chiasm through lateral fibers. TRUE/FALSE

A

TRUE

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70
Q

Lateral fibers cross over at the optic chiasm . TRUE/FALSE

A

FALSE

Lateral fibers DO NOT cross over at the optic chiasm

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71
Q

Lateral optic fibers synapse in ___________ ; part of the thalamus

A

Lateral geniculate bodies

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72
Q

Lateral optic fibers will go around the optic radiations, eventually terminate in primary visual cortex on the SAME side they originated; never crossing over. TRUE/FALSE

A

TRUE

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73
Q

The “optic radiations” are where the fibers have to radiate around the _________ of the brain

A

Lateral ventricles

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74
Q

Visual field projected to the medial part of the right retina?

A

Right lateral visual field

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75
Q

If rods and cones of retina are are excited on the right medial eye, then impulses are transmitted through medial fibers to get to the _________; where medial fibers cross over to the other side.

A

Optic chiasm

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76
Q

_________ fibers CROSS; _________ fibers DO NOT CROSS.

A

Medial fibers cross

Lateral fibers do not

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77
Q

Where do the medial fibers synapse with the second group of fibers before continuing on to the primary visual cortex.

A

Lateral geniculate bodies

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78
Q

Medial fibers synapse in the primary visual cortex of the same side that it originated from. TRUE/FALSE

A

FALSE

Medial fibers synapse in the primary visual cortex of the OPPOSITE side they originated from

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79
Q

Left lateral visual field is projected where?

A

medial part of the Left retina

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80
Q

Left medial visual field is projected where?

A

Lateral part of the left retina

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81
Q

Where are the superior visual fields projected?

A

Inferior part of the retina

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82
Q

Where are the inferior visual fields projected?

A

Superior part of the retina

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83
Q

Lesion anterior to optic chiasm that involves both right lateral and medial fibers causes what type of vision loss?

A

Total blindness in right eye

84
Q

If location of lesion is anterior to optic chiasm that involves only Right lateral fibers leads to what visual loss?

A

Hemisphere loss in one eye; right medial visual field loss in this case.

85
Q

Lesion anterior to optic chiasm that involves only Left medial fibers leads to loss of what visual field?

A

Left lateral visual field loss (hemisphere loss)

86
Q

Lesion posterior to optic chiasm that involves only right lateral fibers lead to loss of what visual field?

A

Right medial visual field

87
Q

Lesion posterior to optic chiasm that involves only left Medial fibers leading to loss of what visual field?

A

Right lateral visual field

88
Q

Lesion on the right side posterior to the optic chiasm that involves both lateral and medial fibers leads to what visual field losses?
What is the term used?

A

Left lateral and right medial visual field losses

Left sided homonymous hemianopsia

89
Q

If you had 100% occlusion of the Left posterior cerebral artery, you would have a _________ sided homonymous hemianopsia.

A

RIGHT sided homonymous hemianopsia

90
Q

Lesion at the optic chiasm that involves medial fibers from Both eyes leads to what visual field losses?

A

Right and Left lateral visual field losses

91
Q

Right and left lateral visual field loss is referred to as ___________ hemianopsia; loss of peripheral vision.

A

Bitemporal

92
Q

Bitemporal hemianopsia is many times the first sign of a __________ tumor.

A

Pituitary

93
Q

Triggers for oculocardiac reflex (OCR)

A
  • Direct eye pressure (globe of eye)
  • Pain
  • Traction on extrinsic eye muscles
94
Q

Traction of the MEDIAL/LATERAL rectus muscle is a stronger trigger for OCR.

A

Medial rectus is a stronger trigger for OCR

95
Q

The pathway for the OCR starts with ___________ nerves; part of CN III.

A

Afferent Ciliary nerves

96
Q

Afferent ciliary nerves terminate in ciliary ganglion and synapse with CN ______ ophthalmic division

A

CN V Trigeminal

97
Q

After ciliary nerves synapse with CN V, a collateral of CN V terminates and integrates with CN ___ efferent fibers.

A

CN X

98
Q

In the OCR, when CN X results in _________ outflow

A

Parasympathetic

99
Q

OCR parasympathetic outflow; vagus innervation of the heart– what symptoms would you see?

A 
Bradycardia
Junctional rhythm
AV block
Ventricular tachycardia
Asystole
Hypotension
100
Q

What is the FIRST thing you do for management of OCR?

A

DC the stimulus; tell the surgeon to STOP!!!

101
Q

Besides stopping the stimulation with OCR, what else can you do to manage?

A
  • Increase anesthetic depth (blunts OCR)
  • IV glycopyrrolate/atropine
  • lidocaine infiltration into eye (also blunts)
102
Q

OCR will eventually fatigue with repeated manipulation of the eye; does not continue to cause bradycardia. TRUE/FALSE

A

TRUE

103
Q

Purpose of pain

A

Protective mechanism to protect body from unwanted tissue damage

104
Q

Pain is a VERY _______ experience; extremely difficult to measure ________.

A

Subjective; Objective

105
Q

2 types of pain

A

Fast pain

Slow pain

106
Q

Fast pain is felt within ______ sec after stimulus

A

0.1 sec

107
Q

Fast pain is usually localized; superficial and not deep tissue. TRUE/FALSE

A

TRUE

108
Q

Fast pain activated the _______ nervous system

A

Sympathetic

109
Q

Slow pain is felt ~ ____ sec after stimulus

A

1 sec

110
Q

Type of pain usually related to tissue destruction and poorly localized; felt either superficial or deep tissue/organs

A

Slow pain

111
Q

Slow pain activated the ___________ nervous system

A

Parasympathetic

112
Q

This type of pain is highly associated with depression, Loss of E, and insomnia.

A

Slow pain

113
Q

Pain receptors are also called ________

A

Nociceptors

114
Q

Pain receptors start with _______ nerve endings; as opposed to pacinian corpuscles or golgi tendon bodies.

A

Free nerve endings

115
Q

Pain receptor free nerve endings are SCARCELY distributed throughout skin, periosteum, arterial walls, joint surfaces, falx cerebri, tentorium cerebelli, parietal peritonium, pericardium, pleura. TRUE/FALSE

A

FALSE; widely distributed in these areas

116
Q

This type of tissue has very few pain receptors

A

Deep tissue

117
Q

The ________ has absolutely no pain receptors

A

Brain

118
Q

Pain receptors DO NOT adapt to the stimulus. TRUE/FALSE

A

TRUE

119
Q

What 3 types of stimulants activate pain receptors

A

Chemical
Mechanical
Thermal

120
Q

Chemical stimulant of pain; very strong inflammatory mediator

A

Bradykinin

121
Q

Widely distributed NT throughout the CNS that can stimulate pain receptors

A

Serotonin

122
Q

Histamine is an inflammatory mediator and a _______ stimulant for pain receptors

A

Chemical

123
Q

Why would potassium ions stimulate pain receptors ?

A

Tissue destruction;

K primarily found intracellular, and K released bc of cell lysis, important that it stimulates pain receptors to let the brain know that there is tissue destruction present

124
Q

When excercising, ______ acids are released which are chemical stimulants for pain receptors

A

Lactic

125
Q

Condition that is a direct result of build up of proteolytic enzymes, activated pain receptors

A

Pancreatitis

126
Q

Ach can activate pain receptors. TRUE/FALSE

A

TRUE

127
Q

Prostaglandins can enhance pain receptors or make them more sensitive, TRUE/FALSE

A

TRUE

128
Q

When substance P is near pain receptors, it will decrease pain. TRUE/FALSE

A

FALSE; substance P can ENHANCE pain when at receptors

129
Q

Thermal stimulant can affect pain receptors especially WARM temperatures > ______ C.

A

45 degrees C

130
Q

Fast pain is typically transmitted bc of what two stimuli

A

Mechanical

Thermal

131
Q

Slow pain is primarily transmitted bc of what type of stimuli? But can be all 3!!!

A

Primarily Chemical stimuli

132
Q

The faster the rate of tissue damage, the greater the pain intensity. TRUE/FALSE

A

TRUE

133
Q

Fast pain is transmitted through the _________ pathway

A

Neospinothalamic

134
Q

The primary neuron for fast pain transmission is what type of neuron

A

Type A delta

135
Q

Type A delta fibers are typically multipolar neurons. TRUE/FALSE

A

FALSE

Unipolar neurons

136
Q

Type A delta fiber for fast pain will enter the spinal cord at the ________ horn of the gray matter and enter lamina of Rexed _____.

A

Dorsal horn; LofR 1

137
Q

NT for fast pain; excites secondary neuron

A

Glutamate

138
Q

Secondary neuron in fast pain pathway moves up the SC towards the thalamus; _____________ are sent to the RAS so that person is awake and removing painful stimulus

A

Collaterals

139
Q

Fast pain pathways terminate here for localization and interpretation of painful stimulus.

A

Sensory cortex/postcentral gyrus (according to layout of homunculus)

140
Q

Slow pain is transmitted through the ________ pathway; subdivision of spinothalamic; “Old pathway”

A

Paleospinothalamic

141
Q

Primary neuron for slow pain

A

Type C unmyelinated

142
Q

Primary NT for substance for slow pain

A

Substance P

Maybe a little glutamate

143
Q

Slow pain enters SC through dorsal horn of the gray matter, excites secondary neuron, and eventually crosses over to __________ tract.

A

Anterolateral

144
Q

With slow pain there are MULTIPLE collaterals. TRUE/FALSE

A

TRUE

145
Q

Slow pain pathways terminate here, then to sensory cortex/postcentral gyrus for interpretation and poor localization

A

Thalamus

146
Q

Slow pain activates the reticular formation. TRUE/FALSE

A

TRUE

147
Q

Slow pain has collaterals that terminate in this area of the brain; near 3rd and 4th ventricles– lead to pain modulation.

A

Periaqueductal gray matter

Periventricular areas

148
Q

Slow pain pathways terminate at the tectum in the midbrain at the superior/inferior colliculi, and are responsible for ________ response.

A

Reflex

149
Q

Slow pain has collaterals to the hyothalamus as well. TRUE/FALSE

A

TRUE

150
Q

How our body modulates and decreases the intensity of pain

A

Endogenous pain suppression systems

151
Q

Major components for endogenous pain suppression systems

A 
PAGM (periaqueductal..)
PV areas (periventricular)
RMN(Ralphe Magnus nucl)
PGC (perigigantocellularis)
Dorsal horns of gray matter
152
Q

Painful stimulus occurs, primary neuron enters the _________ root, _______ rootlets, into the _________ horn of the gray matter

A

Dorsal
Dorsal
Posterior horn

153
Q

NT for pain (fast/slow) will eventually activate the _______ neuron, which crosses over through ant white commissure into the _________ pathway of the anterolateral system.

A

Secondary; spinothalamic

154
Q

Secondary neuron ascends up SC, when gets to Medulla, sends collaterals to _________ neuron; part of the RAS to make sure alert/aware to painful stimuli.

A

Medullary reticular neuron

155
Q

Secondary neuron also has a collateral in the midbrain to what two areas?

A

PGM

PV areas

156
Q

The collateral at the PGM and PV areas excites a neuron that contains __________, which is released, and excites a descending pathway to the medulla.

A

Endorphins

Enkephalins

157
Q

After endorphins/enkephalins released the first time, descending pathway gets to medulla where end/enk are realeased again; activates _______ pathway which descends down SC and terminates at the short interneuron

A

SEROTONIN

158
Q

What NT is released at the interneuron?

A

Serotonin

159
Q

Serotonin release excites the interneuron and endorphins/enkephalins are released and bind to _______ neuron, which then decreases release of what NTs?

A

Primary neuron

Decrease release of glutamate and substance P

160
Q

How does the inhibition of glutamate and substance P modulate pain?

A

Less ascending sensory pain pathways are activated

161
Q

Exogenous opioids bind to different pain receptors (mu, kappa, delta) than endogenous opioids to modulate pain transmission. TRUE/FALSE

A

FALSE

They bind to the same receptors!

162
Q

Once Mu, Kappa, Delta pain receptors are activated (by enkephalins), all are VERY potent and cause prolonged target cell response—– days, weeks, months. TRUE/FALSE

A

TRUE

163
Q

Normal processing of painful stimuli; can be somatic or visceral.

A

Nociceptive pain

164
Q

Arrises from bone, joint, muscle, skin, connective tissue; aching, throbbing, well localized.

A

Somatic nociceptive pain

165
Q

Transmitted through type C fibers; usually related to ischemia, chemical damage, spasm, distention; usually referred to a surface of the body.

A

Visceral nociceptive pain

166
Q

Example of visceral distention pain

A

Gas pains

167
Q

Pain that is remote from the tissue causing the pain; usually from a visceral organ and referred to an area on the surface of the body.

A

Referred pain

168
Q

There are internal organs present on the sensory homunculus in order to localize pain there. TRUE/FALSE

A

FALSE

No internal organs present on homunculus

169
Q

The brain does not interpret pain from internal organs because there are no organs on the sensory homunculus; pain is referred to other areas because primary neurons of organs and skin synapse with the same secondary neuron. This explains what?

A

Theory of referred pain

170
Q

Referred pain from heart

A

Side of neck
Shoulder
Down the arm
Substernal area

171
Q

Referred pain from stomach

A

Anterior epigastrium

172
Q

Referred pain from appendix

A

Umbilical area

173
Q

Referred pain from kidneys

A

Right or left hypogastric area

174
Q

Referred pain from ureters

A

Groin

175
Q

Headache is a type of _______ pain

A

Nociceptive

176
Q

Pain referred to the surface of the head from deep inside the cranium or from sinuses

A

Headache

177
Q

Brain tissue has NO pain receptors. Pain receptors are found where in the brain

A

Venous sinuses
Tentorium cerebelli
Dura mater
Blood vessels in meninges

178
Q

Pain is __________ if referred to from half of head

A

Supratentorial

179
Q

Pain stimulus is _________ if referred to posterior part of head; such as pain from meninges/BS

A

Infratentorial

180
Q

Usually describes as the worst headache you have ever had in your life

A

Meningeal inflammation

181
Q

Headaches from low CSF pressure can be cause by what anesthesia intervention?

A

Postdural puncture; too far with epidural needle.

182
Q

Causes the aura in a migraine headache

A

Initial Intense vasoconstriction

183
Q

Causes throbbing, pulsating migraine headache

A

Rebound vasodilation from intense vasoconstriction

184
Q

Prevention of migraine is directed at preventing what?

A

Intense vasoconstriction

185
Q

Acute treatment of migraine is directed at

A

Throbbing/pulsating vasodilation

186
Q

Abnormal processing of painful stimuli

A

Neuropathic pain

187
Q

Neuropathic pain can be __________ or __________ generated

A

Centrally; peripherally

188
Q

Examples of centrally generated neuropathic pain

A

Deafferentation pain: phantom pain

Sympathetically maintained pain: reflex sympathetic pain (complex regional pain syndrome)

189
Q

Type of pain when amputees feel pain in the absent extremity; probably due to the same primary neuron from the distal extremities to the SC

A

Phantom pain

190
Q

Examples of peripherally generated neuropathic pain

A

Polyneuropathies

Mononeuropathies

191
Q

Pain distribution along many peripheral nerves

A

Polyneuropathies

192
Q

Type of neuropathy caused by malnutrition and vitamin deficit

A

Alcoholic neuropathy

193
Q

Polyneuropathic virus that effects motor fibers, but does not effect sensory fibers.

A

Guillain Barre

194
Q

Lays dormant in dorsal root ganglion; stress activated; manifests in the dermatomes on the trunk usually

A

Herpes zoster

195
Q

Examples of mononeuropathies

A

Nerve root compression
Nerve entrapment
Trigeminal neuralgia

196
Q

CN V nerve is sitting up against a blood vessel as it pulsates; causing excruciating pain not relieved by medication; “suicide disease”

A

Trigeminal neuralgia

197
Q

Sx intervention for trigeminal neuralgia

A

Craniotomy; stick a little piece of gauze between trigeminal and blood vessel. (4-5 hr case)

198
Q

Chronic pain condition most often affecting one of the limbs, usually after an injury or trauma; cause unknown

A

Complex Regional Pain Syndrome (CRPS)

199
Q

CRPS is characterized by ? (4)

A
  • Prolonged/excessive pain
  • Mild/dramatic changes in skin color
  • Changes in temperature
  • Swelling in affected area
200
Q

Treatments for CRPS are the same, whether type I or II. TRUE/FALSE

A

TRUE

201
Q

Treatments for CRPS from most conservative to most invasive

A

1) Physical therapy
2) medications (antidepressants, anti inflammatory, gaba analogs, opioids, lidocaine injections, …)
3) surgery (SC stimulators, sympathectomy, amputation)

202
Q

Type of CRPS in individuals without confirmed nerve injury

A

CRPS I

203
Q

What is the most common form of CRPS

A

Type I

204
Q

CRPS I was previously called ?

A

Reflex sympathetic dystrophy syndrome

205
Q

Type of CRPS in individuals with confirmed nerve injury

A

CRPS II

206
Q

Type of CRPS that is more painful and difficult to control

A

Type II

207
Q

CRPS II previously called ?

A

Causalgia

ANAP 510 (5 decks)

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