TEST 4 BRAIN ANAT & PHYS Flashcards

1
Q

What divides the L hemisphere from the R hemisphere of the brain?

A

Longitudinal fissure

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2
Q

Wide, deep separation of the brain tissue

A

Fissure

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3
Q

Infolding on the surface of the brain

A

Sulcus (sulce)

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4
Q

Upfolding on surface of the brain

A

Gyrus (gyri)

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5
Q

Separates the frontal lobe from the parietal lobe on each side of the brain

A

Central sulcus

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6
Q

Locations of the primary MOTOR cortices on each side of the brain

A

Precentral gyrus (gyri)

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7
Q

Location of the primary SENSORY cortices on each side of the brain

A

Postcentral gyrus

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8
Q

What divides the parietal and occipital lobes from each other?

A

Division based off of function, NO anatomic demarcation that separates them

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9
Q

Separates temporal lobe from the frontal lobe and the temporal lobe from most of the parietal lobe

A

Lateral Fissure

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10
Q

This is below the hemispheres of the brain, composed of tracts. It connects the R and L hemispheres so that each side of the brain knows what the other side is doing

A

Corpus callosum

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11
Q

Just the below the corpus callosum is the lateral ________ where CSF is.

A

Lateral ventricle

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12
Q

Most inferior part of the brain stem

A

Medulla

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13
Q

The opening below the medulla that separates most inferior brainstem to most superior SC

A

Foramen magnum.

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14
Q

What 3 structures compose the Brainstem?

A

Midbrain (mesencephalon)
Pons
Medulla oblongota

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15
Q

What 2 structures compose the Diencephalon

A

Thalamus

Hypothalamus

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16
Q

There are both ascending and descending pathways that MUST pass through the medulla to get info to higher brain centers and back to SC/skeletal muscle. TRUE/FALSE

A

TRUE

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17
Q

Where are the decussation of the pyramids located

A

Anterior/inferior surface of the medulla

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18
Q

This is where descending motor pathways cross over to the other side of the SC. Responsible for L side of brain controlling R side of body visversa

A

Decussation of the pyramids

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19
Q

About _____% of descending motor pathways will cross over to the other side of the SC when they get to the decussation of the pyramids

A

85%

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20
Q

Located in the medulla, recieve input from the inner ear and play a role in maintaining balance

A

Olives

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21
Q

Where are the inspiratory and expiratory centers located in the brainstem?

A

Medulla

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22
Q

Nerve cell bodies (nuclei) located in the medulla

A
CN
IX. glossopharyngeal
X. vagus
XI. Spinal accessory
XII. Hypoglossal
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23
Q

These nuclei are related to CN IX and X, and play a role in the baroreceptor reflex.

A

Nucleus Solitarius

Nucleus Ambiguus

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24
Q

Where do we find the baroreceptors for CN 9 and 10?

A

IX (glossopharyngeal): carotid sinuses; bifurcation of the internal carotids

X (vagus): Aortic arch

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25
Q

What activates the baroreceptors?

A

Increase in blood pressure

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26
Q

Increase in BP = activated baroreceptors = increase in ________transmission through the __________ portions of CN IX and X.

A

Increase in IMPULSE tx through the SENSORY portions of IX and X

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27
Q

As the impulses transmission approaches medulla, the pathways come together to form _________ and enter nucleus _________.

A

Tractus solitarius and enters nucleus solitarius

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28
Q

When nucleus solitarius activated, sends message to _________ which is the CV output center.

A

Nucleus ambiguus

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29
Q

When nucleus ambiguus activated, it excites what receptors?

A

Central Alpha II receptors

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30
Q

When central alpha II receptors are activated, it decreases ________ outflow and increases ________ outflow.

A

Decreases SNS outflow and increases PNS outflow

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31
Q

What happens with PNS outflow to help bring BP down?

A

HR decreases
Decreased strength of contraction
Blood vessels dilate

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32
Q

If we have low BP, the baroreceptors and nuclei are NOT excited and we end up having increased ________ outflow.
How does this increase BP?

A

Increases SNS outflow

HR increases, Contractility increases, and blood vessels constrict

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33
Q

These 3 structures are involved in modulating pain transmission and help decrease the intensity of pain.

A
  • Raphe magnus nucleus
  • Reticularis paragigantocellularis
  • Periaquaductal gray matter
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34
Q

What type of NT and receptors are abundant at the sites that modulate pain tx?

A

Endogenous opioids and MU, Kappa, Alpha receptors

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35
Q

All of these autonomic reflexes are mediated through nuclei in the medulla. (5)

A
CV/vasomotor center
Swallowing
Vomiting
Coughing 
Sneezing
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36
Q

This is located in the 4th ventricle and highly related to N/V

A

Chemoreceptors trigger zone (CTZ)

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37
Q

The CTZ is located OUTSIDE/INSIDE the BBB and comes DIRECTLY/INDIRECTLY in contact with CSF.

A

CTZ is OUTSIDE the bbb

DIRECTLY in contact with CSF

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38
Q

Any noxious stimuli to the CTZ leads to DECREASED N/V. TRUE/FALSE

A

FALSE

Any noxious stimuli leads to N/V

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39
Q

What type of drugs are directed at receptors in the CTZ?

A

Antiemetics

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40
Q

There are only ascending pathways that cross through the Pons. TRUE/FALSE

A

FALSE

Both ascending and descending tracts pass through the pons.

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41
Q

Tracts that connect the cerebrum to the cerebellum are here

A

Pons

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42
Q

Coordination of what two parts of the brain lead to coordinated skeletal muscle movement

A

Cerebrum and cerebellum

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43
Q

This has to do with conscious regulation of skeletal muscle movement

A

Cerebrum

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44
Q

Has to do with unconscious coordination of skeletal muscle movement

A

Cerebellum

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45
Q

Nuclei for which CN are located in the pons?

A

V: trigeminal
VI: abducens
VII: facial
VIII: vestibulocochlear

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46
Q

The pneumotaxic respiratory center is located here

A

Pons

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47
Q

Site for NE synthesis and secretion in the pons

A

Locus ceruleus

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48
Q

Locus cereleus is part of what system that has to do with awakeness, alertness, attentiveness.

A

Reticular activating system (RAS)

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49
Q

Midbrain contains the nuclei for what CN?

A

III: oculomotor
IV: trochlear

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50
Q

Nuclei for CN III - XII are all located in what structure?

A

Brainstem

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51
Q

Midbrain is divided into that two structures? (Roof and floor of midbrain)

A

Tectum (roof)

Tegmentum (floor)

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52
Q

What are the 4 twin bodies located in the tectum of the midbrain?

A

Corpora quadrigemina

  • 2 superior colliculi
  • 2 inferior colliculi
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53
Q

This part of the corpora quadrigemina receives sound impulses from the inner ear

A

Inferior colliculi

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54
Q

Where does the inferior colliculi send sound impulses after received

A

Superior colliculi

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55
Q

Part of the corpora quadrigemina that is for visual tracking of an object. Uses impulses from eyes, skin and cerebrum.

A

The 2 superior colliculi

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56
Q

Who is an example of someone who has very well developed superior colliculi?

A

MLB hitter

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57
Q

ASCENDING tracts pass through here after passing through the medulla an pons, before they get to the cerebrum.

A

Tegmentum (floor of midbrain)

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58
Q

This is the origin of the rubrospinal tract, has to do with unconscious coordination of movements.

A

Red nuclei

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59
Q

What animal has highly developed red nuclei?

A

Red nuclei

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60
Q

Origin of the nigrostriatal tract, part of the basal nuclei

A

Substantia Nigra

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61
Q

Red nuclei/rubrospinal tract, substantia nigra are located where in the brain?

A

Tegmentum of the midbrain

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62
Q

These are descending tracts that connect the cerebrum to the SC, located in the midbrain.

A

Cerebral peduncles

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63
Q

The nuclei of the RAS are scattered widely throughout the brainstem. TRUE/FALSE

A

TRUE

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64
Q

RAS receives impulses from nerves that innervated the face. (Eyes, skin, ears, nose, etc.) TRUE/FALSE

A

TRUE

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65
Q

These two things make up the medullary respiratory center

A

Medullary inspiratory center

Medullary expiratory center

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66
Q

Part of control of ventilation in the pons of the brainstem

A

Pontine pneumotaxic center

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67
Q

The cells that compose the medullary insp center SPONTANEOUSLY generate AP or are spontaneously active. TRUE/FALSE

A

TRUE

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68
Q

MIC sends impulse to the phrenic nerve that innervates the ___________ creating longitudinal distance in the lungs.

A

Diaphragm

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69
Q

MIC also synapses with intercostal nerves that innervates ___________ intercostal muscles and pull the ribcage _______ and _______ creating anterior and posterior size of the lungs.

A

Intercostal nerves activate EXTERNAL intercostal muscles that pull the ribcage UP and OUT.

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70
Q

As the size of the lungs increases, the volume of the lungs increases, which INCREASES/DECREASES intrapulmonary pressure

A

Decreases intrapulmonary pressure

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71
Q

When does air enter the lungs?

When does air movement stop?

A

When intrapulmonary pressure is less than atmospheric pressure, goes with gradient

Stops when pressure equilibrates.

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72
Q

During normal quiet breathing expiration is an active process. TRUE/FALSE

A

FALSE

It is a passive process

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73
Q

The MIC has a collateral axon to the ________ that sends impulses down to MIC to stop sending AP

A

Pontine pneumotaxic center

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74
Q

When MIC is not activated, then diaphragm is no longer activated, so the muscle does what to decrease the longitudinal size of the lungs

A

Domes up/relaxes

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75
Q

MIC not activated, so external intercostals are not active, so they do what to decrease ant/post size of lungs

A

Pulled down and in

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76
Q

As lung size decreases, intrapulmonary pressure DECREASES/INCREASES.

A

INCREASES

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77
Q

When does air exit the lungs, according to pressures?

A

When intrapulmonary pressure exceeds atmospheric pressure

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78
Q

This is ONLY active during a forceful expiration; in the medullary respiratory center.

A

Medullary expiratory center

Ex) bday candles

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79
Q

MEC synapses with the intercostal nerves that innervate the __________ intercostal muscles

A

Internal intercostal muscles

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80
Q

When internal intercostal muscles are activated what happens to the ribs?

Causes what to happen to the size and intrapulmonary pressure?

A

Pulled further down and further in

which decreases size of the lungs, and increases the intrapulmonary pressure to exert a forceful exp

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81
Q

We can increase/decrease ventilation by higher brain centers, just by thinking about it. TRUE/FALSE

A

TRUE

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82
Q

Located in the medulla, they monitor the pH of the CSF; indirectly measures CO2 levels.

A

Central medullary chemoreceptors

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83
Q

An INCREASE/DECREASE in CO2 causes excitation of central medullary chemoreceptors

A

INCREASE

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84
Q

What happens to ventilation and pH when central medullary chemoreceptors are excited?

A

Increases rate and depth of ventilation, which blows off CO2 and decreases CO2 content and the pH of the CSF and receptors are no longer excited.

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85
Q

Where are peripheral chemoreceptors located; primarily monitor the PO2 of blood.

A

Bifurcation of the carotids and aortic arch

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86
Q

What excites peripheral chemoreceptors?

A

When PO2 gets below ~50-60

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87
Q

Peripheral chemoreceptors send a message to the MIC that INCREASES/DECREASES rate and depth of ventilation.

A

INCREASES

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88
Q

This reflex has to do with stretch receptors in the lungs that prevent overinflation of the lungs

A

Hering-brewer reflex

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89
Q

Increased muscle activity and Pain both INCREASE/DECREASE rate/depth of ventilation

A

INCREASE

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90
Q

Largest portion of the diencephalon

A

Thalamus

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91
Q

4 components of the diencephalon

A

Thalamus
Subthalamus
Epithalamus
Hypothalamus

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92
Q

Located between the 2 lobes of the thalamus

A

3rd ventricle of the brain

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93
Q

Why is the thalamus considered the “relay center”?

A

Where almost all sensory input arrives/stops before information is sent to higher brain centers

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94
Q

The thalamus INTERPRETS the sensory input that arrives. TRUE/FALSE.

A

FALSE

It just tells which area of the brain the sensation should be sent to, it does not interpret it.

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95
Q

Located on the thalamus, receive input form CN II (optic) visual pathways before transferred to higher brain centers.

A

Lateral geniculate bodies

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96
Q

Also located on the thalamus, and receive CN VIII (vestibulocochlear) auditory pathways before transferred to higher brain centers

A

Medial geniculate bodies

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97
Q

The thalamus plays a minor role in our UNCONSCIOUS response to pain and suffering. TRUE/FALSE

A

FALSE.

Plays a MAJOR role in our response to pain and suffering.

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98
Q

The subthalamus is one component of the ________ nuclei

A

Basal nuclei

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99
Q

What two structures compose the epithalamus

A

Habenular nucleus

Pineal body

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100
Q

Receives lots of input from CN I (olefactory) fibers, and lays a role in the limbic system; especially our emotional/visceral gut response to odors.

A

Habenular nucleus of the epithalamus

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101
Q

Where melatonin is secreted from

A

Pineal body

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102
Q

Melatonin is produced during ________ and suppressed during ______. Can be highly associated with ________.

A

Produced in darkness, suppressed in light.

Can be associated with depression.

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103
Q

Main fxn of the hypothalamus

A

Regulate the activity of the pituitary gland

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104
Q

How is the hyothalamus connected to the pituitary gland?

A

Infundibulum (stalk)

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105
Q

Connects the hypothalamus to the anterior pituitary

A

Hypothalamohypophyseal portal system

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106
Q

Two capillary networks connected by a vein.

A

Portal system

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107
Q

Another name for anterior pituitary

A

Adenohypophysis

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108
Q

Hypothamohypophyseal portal system allows _______ to be transported from hypothalamus to the anterior pituitary to regulate synthesis and secretion of the ant pit ______.

A

Hormones; hormones

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109
Q

Growth hormone releasing hormone produces what hormone from the anterior pituitary

A

Growth hormone synthesis and secretion

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110
Q

Secreted from the hypothalamus and causes inhibition of growth hormone syn/sec from the ant pit

A

Growth hormone inhibiting hormone or somatostatin

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111
Q

Thyroid stimulating hormone releasing hormone = what hormone from the ant pit

A

Thyroid stimulating hormone synthesis and secretion

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112
Q

TSH stimulates receptors in the thyroid to produce what?

A

T3 and T4

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113
Q

Adrenocorticotropic hormone releasing hormone = syn/sec of what hormone in the ant pit

A

ACTH

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114
Q

Where are the primary receptors for ACTH, and what is released from this area.

A

Adrenal cortex

Primarily cortisol, also aldosterone and some androgens

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115
Q

What 2 hormones are syn/sec in response to gonadotrophin releasing hormone from the hypothalamus

A

Follicle stimulating hormone (FSH)

Luteinizing hormone (LH)

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116
Q

Target cell receptors in women for FSH and LH?
Men?

What hormones does it regulate in women/men?

A

Women: ovaries, regulates estrogen/progesterone

Men: testes, regulates testosterone production

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117
Q

Causes synthesis and secretion of prolactin from the ant pit

A

Prolactin releasing hormone

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118
Q

Target cell receptors for prolactin in women is in the _______, and causes milk ________.

A

Breast

Milk production

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119
Q

Secreted from the hypothalamus and inhibits syn/sec of prolactin from the ant pit

A

Prolactin inhibiting hormone

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120
Q

As the circulating ant pit hormones INCREASE/DECREASE, there is feedback to the hypothalamus to alter its output.

A

INCREASE

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121
Q

How is the hypothalamus connected to the posterior pituitary gland (neurohypophysis)

A

Hypothamohypophyseal TRACT

122
Q

Axons that originate in the hypothalamus and terminate in the post pit make up the hypothamohypophyseal PORTAL SYSTEM. TRUE/FALSE?

A

FALSE

Axons make up the TRACT.

123
Q

The supraoptic and paraventricular nuclei are r.t. The ANT/POST pituitary gland?

A

Posterior

124
Q

The hormones releases in the post pit are synthesized in the nerve cell bodies in the hypothalamus. TRUE/FALSE.

A

TRUE

125
Q

Two corresponding post pit hormones that are synthesized in the hypothalamus, travel down axons and are stored in secretory vesicles at the terminal buton in the post pit.

A

ADH

Oxytocin

126
Q

What will cause release of ADH and oxytocin?

A

APs

127
Q

ADH also known as

A

Vasopressin

128
Q

Vasopressin is released in response to excitation of ___________

A

Osmoreceptors

129
Q

Where are osmoreceptors located and what do they monitor?

A

Located in hypothalamus

Monitor osmolality

130
Q

Normal body fluid osm?

A

~300 mosm

131
Q

What excites hypothalamic osmoreceptors?

A

Increase in body fluid osmolality (above ~300)

132
Q

Activated osmoreceptors generates action potentials from what nuclei

A

Supraoptic and periventricular nuclei

133
Q

The AP released from osmoreceptors go down hypohypo tract and cause release of _______ from post pit.

A

ADH

134
Q

What are the two receptors for ADH and where are they located? What does activation of these receptors cause

A

V1: vascular smooth muscle; cause vasoconstriction

V2: found in the kidneys; causes increased water reabsorption from kidneys back to bloodstream

135
Q

Causes uterine contraction and milk expression

A

Oxytocin

136
Q

Control of HR, vasoconstriction/vasodilation, urination, peristalsis, and others are under autonomic control. These centers have synapses in this structure from higher brain centers.

A

Hypothalamus

137
Q

Where is the swallowing center, and hunger/satiety centers located?

A

Hypothalamus

138
Q

If someone were to have a hypothalamic lesion and have uncontrolled shivering/sweating; why is this?

A

Bc the temperature regulation center is located in the hypothalamus

139
Q

The hypothalamus coordinates the sleep/wake cycle with the __________ system

A

Reticular activating system (RAS)

140
Q

Precentral gyrus is in the _______ lobes

A

Frontal lobes

141
Q

Postcentral gyrus is in the ________ lobes

A

Parietal lobes

142
Q

This lobe is responsible for complex planning of behavior; moderates our personality, decision making, and social behavior

A

Prefrontal lobe

143
Q

_______ prefrontal dom = highly organized, good at math, linear/logical thinking

A

Left prefrontal dom

144
Q

__________ prefrontal dominant = musically talented, creative, and artistic

A

Right prefrontal dominant

145
Q

Play a role in pre-planning/coordinating muscle movement

A

Premotor area

146
Q

Where descending motor pathways originate

A

Primary motor cortex on the precentral gyrus

147
Q

The more _______ devoted on the primary motor cortex for that part of the body, the more complex muscle movement occurs there.

A

More space = more complex movement

148
Q

Left primary motor cortex innervates the right side of the body. TRUE/FALSE.

A

TRUE

149
Q

Initial planning of muscle movement is in the anterior _______ lobe.

A

Ant frontal lobe

150
Q

Anterior frontal lobe sends commands to the _______ area

A

Premotor

151
Q

This decides what muscles to contract, and sends a message to the primary motor cortex according to the motor homunculus

A

Premotor area

152
Q

The motor homunculus activates those descending motor pathways so that they will end in ________

A

Skeletal muscle movement

153
Q

Sensory areas are located in the _________ lobes.

A

Parietal lobes

154
Q

Sensory impulses are sent here for initial interpretation and localization

A

Primary sensory cortex

155
Q

Impulse from the primary sensory Cortex is sent where?

A

Sensory association area

156
Q

What does the sensory association area do after receiving an impulse?

A

Compares current sensation with previous experience

Determines importance of that sensation

Begins process of determining appropriate response

157
Q

If you have a large amount of space devoted to a certain area of the body on the sensory homunculus, that means that there is a greater conc of ___________ in that area of the body.

A

Greater conc of sensory receptors

158
Q

In both the sensory and motor homunculus, where are the upper/lower areas distributed

A

Upper body/face on lateral side, lower body on medial portion

159
Q

Sensations form the LEFT side of the body will be transported to the primary sensory cortex on the LEFT side of the brain. TRUE/FALSE

A

FALSE

Sensations from left will be transported to the right side of the brain

160
Q

Sensory speech area for understanding/interpreting words; located in parietal lobe.

A

Wernickes area

161
Q

Occipital lobe is divided into what two things

A

Primary visual cortex

Visual association area

162
Q

Where images are initially sent, where image is seen but not yet interpreted or understood

A

Primary visual cortex

163
Q

Where image is compared with previous experience, importance determined, and transmitted to other parts of the brain for final processing, interpretation and what the response should be

A

Visual association area

164
Q

When you read words on paper, what is the first step from reading to spoken word?

A

Image is Projected onto rods and cones of the retina

165
Q

Those image projected onto the rods and cones of the retina activate what pathways?

A

CN II (optic)

166
Q

After impulse sent through CN II fibers, it is sent to the primary visual cortex where it is _______ but not _______.

A

Image is seen but not identified (in the primary visual cortex)

167
Q

From the primary visual cortex, the image is sent here, where the image is identified as words.

A

Visual association area

168
Q

After the the visual association area identifies an image is words, it is sent to what area to be interpreted?

A

Wernicke’s area

169
Q

Which area chooses the individual words and the sequence of those words for a logical thought.

A

Wernicke’s area

170
Q

From wernicke’s area, if we are going to speak these words chosen for logical thought, then that information is sent to _________ area to choose the sequence of muscle activity needed to speak the words.

A

Broca’s area

171
Q

From Broca’s area (premotor area), the information about what muscles to use to speak chose words is sent to what area ?

A

Primary motor cortex.

172
Q

From the primary motor cortex, the information about chosen words and the muscles needed to speak them, activated ____________ motor pathways to the muscles used to speak.

A

Descending motor pathways

173
Q

Where sounds are initially sent, basic processing (pitch, volume)

A

Primary auditory cortex

174
Q

Compares sound with previous experience with the sound, directs to other parts of the brain for understanding, interpretation and appropriate response

A

Auditory association area

175
Q

Sound is first transmitted through what CN fibers

A

CN VIII (vestibulocochlear)

176
Q

From CN VIII pathways, the impulse is sent to the __________ where sound is heard but not yet identified

A

Primary auditory cortex

177
Q

From the primary auditory cortex, words are sent to the auditory association area where the sound is further processed and identified as a _____.

A

Word

178
Q

After the auditory association area identifies a sound as a word, where does it sent the impulse, so that the words can be interpreted, and sequence of words chosen in response

A

Wernike’s area

179
Q

What happens to the auditory impulse after the words are interpreted and a response is formulated in the wernicke’s area? (All the way to using the muscles to speak them)

A

Sent to Broca’s area (muscle activity planned)

Sent from Broca’s to primary motor cortex

Descending motor pathways activated to the muscles used to speak

180
Q

If wernicke’s are affected in a stroke, will you have receptive aphasia or expressive aphasia??

A

Both bc wernicke’s are interprets, but its also formulates the sequence of words you speak

181
Q

If you have a lesion in Broca’s area, will you have receptive or expressive aphasia?

A

Expressive aphasia, bc wernicke’s is still intact–reception of words and interpretation is not affected

182
Q

In MOST people wernicke’s and Broca’s are is on the LEFT side of the brain, making L sided strokes more devastating. TRUE/FALSE

A

TRUE

183
Q

Purpose is to coordinate with the primary motor cortex and premotor areas to prevent unwanted muscular movements

A

Basal nuclei

184
Q

What 3 structures make up the basal nuclei?

A

Corpus striatum
Subthalamus nucleus
Substantia nigra

185
Q

The corpus striatum (of the basal nuclei) is made of what two nuclei

A

Caudate nucleus

Lentiform nucleus

186
Q

The lentiform nucleus is composed of what two structures

A

Globus pallidus

Putnamen

187
Q

The axon from the substantia nigra that synapses with the caudate nucleus is called the ________ tract.

A

Nigrostriatal tract

188
Q

What NT is released at the synapse of the nigrostriatal tract to the caudate nucleus?

A

Dopamine

189
Q

Dopamine is EXCITATORY/INHIBITORY to the caudate nucleus

A

Inhibitory

190
Q

Primary motor cortex also synapses with the caudate nucleus, the NTs here at this synapse are ________.

Are these NTs EXCITATORY/INHIBITORY?

A

Ach
Glutamate

EXCITATORY

191
Q

Besides the primary motor cortex, what other area of the brain synapses with caudate nucleus and releases Ach and glutamate?

A

Globus pallidus

192
Q

There has to be a very fine balance between excitatory and inhibitory impulses at the caudate nucleus in order to have smooth, coordinated muscle movement. TRUE/FALSE

A

TRUE

193
Q

If there was a dopamine deficit or deficiency of dopamine receptors on caudate nucleus, then what would this lead to?

What is a common disease that exhibits this?

A

Domination of excitatory effects and unwanted muscle movement

Parkinson’s

194
Q

Parkinson’s symptoms

A
Stooped posture
Pronating/supinating hands
Slow, shuffling gait
Diff speaking
RESTING NON INTENTION TREMORS
195
Q

Besides L-dopa, what is a procedure used to treat Parkinson’s/essential tremors?

A

deep brain stimulation (DBS)

196
Q

How many stages are there for DBS surgery?

What are they?

A

4 stages

Stage I: bone marker placement/MRI scan
Stage II: electrodes implanted
Stage III: generator implant; wire hook-up
Stage IV: activation and programming of DBS

197
Q

What type of anesthesia for Stage I DBS sx? LMA or ETT?

A

General anesthesia

LMA tube unless contraindicated

198
Q

During stage I DBS, they put ________ markers on the skull that will be used to attach a large contraption that will help guide wires down into the brain.

A

Bone markers

199
Q

Why is the MRI scan done in stage I DBS ?

A

So basal nuclei structures can be identified during sx

200
Q

In stage II, when the electrodes are implanted, the pt undergoes a general anesthesia craniotomy. TRUE/FALSE.

A

FALSE

Pt has an AWAKE craniotomy

201
Q

Why are pts taken off their meds for stage II DBS?

A

So tremors will be at their worst

202
Q

During this stage of DBS, only a small amount of remifentanil is given before local injection and the pt is kept awake for the remainder of the procedure

A

Stage II

203
Q

What other common medicine must pts be off of in order to complete stage II DBS, that may interfere with their tremors?

A

BETABLOCKERS

204
Q

Approximately how far apart is each stage of DBS sx?

A

One week

205
Q

The DBS generator is placed in the ______

A

Chest

206
Q

DBS generators are good for ______ yrs

A

5-10 yrs

207
Q

Both the limbic system and the prefrontal lobes play a role in _______

A

Motivation

208
Q

Part of the limbic system that plays a very large role in converting short term memory to long term memory

A

Hippocampus

209
Q

We store memories according to our __________ that we experienced when we formed the memory

A

Emotions

210
Q

When we recall a memory, emotions associated with those memories will return as well. TRUE/FALSE

A

TRUE

211
Q

Plays role in visceral gut response to odors

A

Habenula

212
Q

Play a role in human sexuality

A

Mammillary bodies

213
Q

This connects various parts of the limbic system, so emotions can be spread throughout the brain

A

Fornix

214
Q

What mental illness is especially linked to abnormalities in the limbic system?

A

Bipolar

215
Q

Pica is an example of a lesion of the _________

A

Limbic system

216
Q

You will be more likely to get angry if you have a lesion to your limbic system. TRUE/FALSE

A

FALSE

Ppl LOSE their ability to be angry with limbic system abnormality

217
Q

If lesion of limbic system, how do you respond to dangerous stimuli?

A

You lose the ability to fear dangerous stimuli

218
Q

Regulates skeletal muscle movement at the unconscious level

A

Cerebellum

Also basal nuclei

219
Q

The cerebellum does not initiate movement, but contributes to coordination, precision, and accurate timing of movement. TRUE/FALSE

A

TRUE

220
Q

Receives sensory input from SC and other parts of brain, fine-tunes motor activity

A

Cerebellum

221
Q

This informs the cerebellum of desired muscle movement

A

Collateral from the descending upper motor neuron

222
Q

Upper motor neuron synapses with lower motor neuron which activates ___________

A

Skeletal muscle

223
Q

What two structures sense changes in tension on muscle fibers

A

Muscle spindles

Golgi tendon bodies

224
Q

Golgi tendon bodies and muscle spindles send _________ info to the _______ by type A alpha fibers about the actual muscle movement.

A

Proprioceptive information to the cerebellum

225
Q

What two types of information does the cerebellum receive, so that it can compare them.

A

Information about what the desired muscle movement and what the actual muscle movement is

226
Q

How does the cerebellum let you consciously/unconsciously try to bring about congruence of the desired and actual movement?

A

Consciously: info back up to brain through thalamus

Unconsciously: extrapyramidal pathway, activates rubrospinal tract

227
Q

Movement disorder associated with cerebellar lesions

A

Intention tremors

228
Q

Test for cerebellar lesion? Does positive or negative indicated a lesion?

A

Romberg test

Positive indicates lesion

229
Q

Membranes that surround the brain, protect the brain and anchor the brain in place

A

Meninges

230
Q

Meninges surround the brain and the ________

A

Spinal cord

231
Q

The meninges of the brain are __________ with the meninges around the SC

A

Continuous

232
Q

This is the layer just below the skull

A

Dura mater

233
Q

The dura mater is composed of ______ layers

A

2 layers

234
Q

When the two layers of the dura mater separate it forms what?

A

Dural venous sinuses

235
Q

What is in the dural venous sinuses

A

CSF

Venous blood

236
Q

The __________ sinus runs along the entire length of the longitudinal fissure

A

Superior sagittal sinus

237
Q

This type of bleed is just above the dura mater and just beneath the skull

A

Epidural bleed

238
Q

Potential space below the dura mater, lined with thin film of fluid

A

Subdural space

239
Q

Meninge around the brain composed of lots of tiny, fragile blood vessels. (Spider web like appearance)

A

Arachnoid mater

240
Q

Since blood vessels of arachnoid mater are very thin and fragile, they bleed easily and can lead to what?

A

Subarachnoid hemorrhage

241
Q

What is in the subarachnoid space around the brain and SC?

A

CSF

242
Q

This layer is inseparable from the brain, attached directly to the brain.

A

Pia mater

243
Q

This dural venous sinus sits right above the corpus collosum

A

Inferior sagittal sinus

244
Q

Infolding of the dura mater that separates the L and R cerebral hemisphere

A

Falx cerebri

245
Q

Infolding of dura mater that runs between L and R cerebellar hemispheres

A

Falx cerebelli

246
Q

Infolding of dura mater between cerebrum and cerebellum

A

Tentorium cerebelli

247
Q

Opening in the dura mater to allow passage of the brain stem

A

Tentorial notch

248
Q

A SUPRATENTORIAL/INFRATENTORIAL tumor is more lethal.

A

Infratentorial tumor is more lethal bc there is less space to grow and very vital structures present

249
Q

What is the difference in the dura mater of the brain and the dura mater of the SC? (2)

A

Dura mater around the SC is only one layer, instead of two.

Definite space between the dura mater and the vertebral column (epidural space: meds given here)

250
Q

The corroid plexuses are made up of ________ cells that synthesize the CSF from _________

A

Ependymal cells

Plasma

251
Q

These ventricles are located in the medial aspects of the cerebral hemispheres, right below the corpus collosum

A

Lateral ventricles 1&2

252
Q

This passageway allows CSF to move from the later ventricles to the 3rd ventricle

A

Foramen of Monro (intraventricular foramen)

253
Q

Where is the 3rd ventricle located

A

In between the 2 lobes of the thalamus

254
Q

What passageway allows CSF to move from the 3rd ventricle to the 4th?

A

Aqueduct of sylvius (cerebral aqueduct)

255
Q

The 4th ventricle is continuous with the ________ that allows CSF to flow the length of the SC.

A

Central Canal of the SC

256
Q

What is the only normal way that CSF can move from the ventricular system into the subarachnoid space around the brain and SC?

A

The 3 openings (foramina) in the 4th ventricle

257
Q

The CSF production remains constant regardless of the volume and pressure within the ventricular system and subarachnoid space. TRUE/FALSE

A

TRUE

258
Q

What causes hydrocephalus?

A

Accumulation of CSF

259
Q

Hydrocephalus due to a problem/obstruction within the ventricular system

A

Noncommunicating hydrocephalus

260
Q

Hydrocephalus when CSF gets to subarachnoid space but cannot be reabsorbed

A

Communicating hydrocephalus

261
Q

Projections from subarachnoid space into venous sinuses that allow for one way flow of CSF into venous sinuses

A

Arachnoid granulations

262
Q

Obstruction of ________ can lead to communicating hydrocephalus

A

Arachnoid granulations

263
Q

Which ventricles have the largest corroid plexuses and produce the most CSF?

A

Lateral ventricles

264
Q

Movement of CSF/blood from dural venous sinuses to R heart

A
Empty into internal jugulars
Jugular foramen
Subclavian
Superior vena cava
R heart
265
Q

Total amount of CSF is ~ 150ml, how much is in the ventricles and subarachnoid space?

A

Ventricles ~ 23 ml

Subarachnoid space ~ 127ml

266
Q

CSF pressure (supine)

A

50-100 mm H2O

267
Q

About how much CSF do we produce each day? Reabsorption is about the same.

A

~500-750 ml

268
Q

What 3 electrolytes are more abundant in the CSF?

A

Sodium
Magnesium
Chloride

269
Q

CSF should be completely clear and colorless. TRUE/FALSE.

A

TRUE

270
Q

3 branches of the aorta in order

A

Brachiocephalic
Left common carotid
Left subclavian

271
Q

Brachiocephalic artery divides into what two arteries

A

R Common carotid

R subclavian

272
Q

R/L common carotids bifurcate into what arteries

A

Internal/external carotids

273
Q

R/L subclavian Arteries branch off to make what arteries that carry blood to the brain?

A

R/L vertebral arteries

274
Q

What are the 4 arteries supplying blood to the brain?

A

R/L internal/external carotids

R/L vertebral arteries

275
Q

Internal/external carotids pass through _______ to get to the base of the Brain

A

Carotid canal

276
Q

How do the vertebral arteries get blood to the base of the brain

A

Foramina of the Transverse processes of the cervical vertebra

277
Q

Where do the Middle cerebral arteries (internal carotids) provide blood flow to?

A

Lateral frontal lobes
Lateral parietal lobes
Part of temporal lobes

278
Q

Anterior cerebral arteries supply blood flow to what areas of the brain?

A

Prefrontal lobes
Medial frontal lobes
Medial parietal lobes

279
Q

Vertebral arteries form to make the _______ artery when they get to the brain

A

Basilar artery

280
Q

Provides bloodflow to the brainstem and Pons

A

Pontine arteries coming off of basilar artery

281
Q

Supply blood flow to the occipital lobes and much of the temporal lobes

A

Posterior cerebral arteries

282
Q

The anterior/posterior communicating arteries connect the cerebral arteries to each other and form what structure that allows blood to be diverted around obstructions, so brain is still perfused.

A

Circle of Willis

283
Q

What anatomic structures passes right through the circle of Willis ?

A

Optic Chiasm

Infundibulum (that connects hypothalamus and pituitary)

284
Q

3 main volumes in the intracranial vault

A

Brain tissue
Blood
CSF

285
Q

Abnormal volumes in the intracranial space

A

Tumor
Cancer
Water
Hemorrhage

286
Q

Increase of volume in one compartment of the brain must be compensated by decrease in volume of another compartment in order for total brain volume to remain fixed and ICP unchanged

A

Monro-Kellie doctrine

287
Q

What can be displaced the easiest out of all the normal volumes in the intracranial space

A

CSF

288
Q

The cranial vault has unlimited ability to compensate for increased ICP. TRUE/FALSE

A

FALSE

Has very limited ability to compensate, fixed compartment

289
Q

___ ml IC volume means normal IC volume

A

0 ml

290
Q

Normal ICP ______ mmhg

A

~5-15 mmHg

291
Q

ICP rises dramatically with each ml of volume starting @ _____ ml

A

5 mL

292
Q

The brain eats up about ______% of the oxygen delivered through out the body

A

~20%

293
Q

The brain MUST have continuous _________ to meet oxygen and glucose needs

A

Blood flow

294
Q

Explain coupling of CBF

A

If one part of the brain is more active, vessels will dilate to improve blood flow to that area, blood will be diverted from areas not as active

295
Q

Despite changes in BP, CBF remains relatively constant, what is this called?

A

Autoregulation

296
Q

CPP equation?

Normal CPP ~_____

A

MAP - ICP

Normal ~ 50-70

297
Q

If have a stroke pt, INCREASING/DECREASING blood pressure will maintain CPP in the face of increasing ICP

A

Increasing BP (MAP)

298
Q

Increased CO2 vasoconstricts cerebral blood vessels and decreases ICP. TRUE/FALSE

A

FALSE

Increases CO2 vasodilates and increases ICP

299
Q

If PaO2 decreases below ~________, vasodilation occurs to increase CBF

A

50-60

300
Q

Why do trauma pts need ICP monitored closely

A

Loss of autoregulation with severe brain injury

301
Q

FAST/SLOW growing brain tumors have more time to compensate and are LESS fatal

A

Slow growing brain tumors

302
Q

How can we decrease in IC volume? (4)

A

Hyperventilate
Osmotic diuretic (mannitol)
Lumbar drain
Positioning: reverse T