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PathoPhys > W5: NeuroPsych > Flashcards

W5: NeuroPsych Flashcards

1
Q

Nervous system overview

A

Central: Brain and spinal cord
Periph: cranial nerves, spinal nerves and pathways (neurons/NT)

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2
Q

The _____ is an integrated circuit composed of millions of neurons and receives 15-20% of cardiac output. This organ allows people to reason, function intellectually and express themselves.

A

Brain

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3
Q

Nerve injury- 2 pathways (lecture-more)

A
  1. Axonal
  2. Demylinization
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4
Q

Perpih Nervous System:

A

Somatic: motor/sensory, regulating motor control of skeletal muscle

Autonomic: motor/sensory regulating body’s internal environ. through involuntary control of organs
Sympathetic
Parasympathetic

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5
Q

Neurons what do they do and the 3 components function

A

Neuron: primary info/comms. cell; vary in size/structure
Cellular:
microtubules (transport)
Neurofibrils (structure sup)
Nissl Substances (protein synth)
-Some neurons-olfactory continue to divide, others die if not needed

  1. Cell body (soma) located in CNS; nuclei-desnsely packed
    ex: ganglia and plexuses-groups in the PNS
  2. Dendrites (receptive portion)
    -sends signals to the cell body
    -Dendritic Zone: receptive portion of neuron rec’ing signals and cont. conduction
  3. Axons: (carry away from cell)
    Axon hilcock: cone-shaped, organelle-free, area where axon leaves the cell body-closest portion has lowest threshold for stim.
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6
Q

Axons: what happens if injured

A

Myelin: segmented layer of lipids; insulating,
myelin sheath: Entire membrane; formed and maintained by SCHWANN cells

endoneurium: delicate layer of connective tissue around each axon

Neurilemma (Schwann sheath) thin membrane b/w myelin sheath and endoneurium

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7
Q

Neuroglia=”nerve glue”

A

5-10x > than neurons

astrocytes: fill space b/w neuron & surrounding Blvessels
Oligodendroglia: deposit myelin within CNS
Microglia: remove debris
Ependymal: line CSF cavities

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8
Q
A
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9
Q

Schwann Cells: aka neurolemmocytes

A

glial cells, wrapping around/covering axons in the PNS

Form/maintain myelin sheath

myelinated: wrapped tightly, many times around axons, creating-NODES of RANVIER
increasing velcocity of signal

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10
Q

Neurotransmitters-common types & effects postsynaptically

A

Types:
norepinephrine
acetylcholine
dopamine
histamine
serotonin

post-synapse:
excited-depolarized
inhibited: hyper polarized

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11
Q

Neurotransmitters & receptors

A
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12
Q

When neurotransmitters release their contents into the ______ ____, they diffuse across and bind to receptors on the ____ synaptic neurons and trigger an ____ ______

A

1 synaptic cleft, 2. post, 3. action potential

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13
Q

The parasympathetic system is also known as the ______ system due to it’s affinity for _______ which binds to ______ receptors

A

cholinergic, 2. acetylcholine, 3. muscarinic

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14
Q

Discuss Action Potential- all or none phenomenon

A

An action potential is a brief reversal of the electrical potential across the membrane of excitable cells like neurons and muscle cells. It is the fundamental mechanism by which information is transmitted along these cells.
threshold potential -55mV, voltage gated NA channels open allowing influx of + sodium—rapid depolarization to +30mV
Propogation of AP:
The depolarization zone propagates away from the initial site, causing adjacent regions to also depolarize in a wave-like manner by opening voltage-gated Na+ channels. This allows the action potential to travel rapidly along the axon toward the axon terminals
In myelinated cells, the AP jumps from node of Ranvier to Node, increasing in velocity

Repolarization and refractory
after peak, NA channels deactivate allowing in K+, therefore repolarinzing membrane back to resting potential.

During absolute refractory: right after peak, the neuron CANNOT generate another charge

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15
Q

Anatomy of the brain-3 major divisions

A
  1. Forebrain: two cerebral hemispheres
  2. Midbrain: corpora quadrigemina, tegmentum, and crebral peduncles
  3. Hindbrain: cerebellum, pons, and medulla
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16
Q

Forebrain: telencephalon

A

Cerebrum
-cerebral cortex
-basal ganglia
-Gyri, sulk, and fissures
-gray matter (nuclei) and white matter (numberous tracts)

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17
Q

Brainstem: reticular formation

A

Midbrain, medulla, and pons

Retic: network of connected nuclei that reg. vital reflexes (cardio/resp)
maintains wakefulness

w/ cerebral cortex is refered to as reticular-activating system

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18
Q

Frontal Lobe: (know functions for stroke purposes)

A

Prefrontal: goal-oriented behavior; short-term mem/recall

premotor: programs motor movement; in the basal ganglia or extrapyramdial sys
efferent pathway outside of medulla pyramids.

primary motor area: homunculus (little man)
corticospinal tracts (pyramidal system) DESCEND the spinal cord. Contralateral control

Broca speech area:
Motor aspect of speech

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19
Q

Parietal, occipital & temporal lobes

A

parietal: somatic sensory input

occipital: visual cortex

temporal: auditory cortex
wernicke area (rec/interpr speech)
long-term memory

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20
Q

Corpus callous, limbic system, and Diencephalon

A

Corpus callous: aka transverse commissural fibers; connects the two hemispheres

Limbic: primitive behaviors/responses, visceral reactions to emotion/motivation, mood, feeding, biorhythms, and sense of smell;
Consolidation of memory

Diencephalon-
-epithalamus
-thalimus
-hypothalamus
-subthalamus

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21
Q

The _______ is composed of four areas: the ____ which forms the roof of the third ventricle and superior area, the ______ manages afferent (sensory) impulses to the cerebral cortex, the ______ maintains a constant internal environment by controlling the ______ nervous system via body temperature and endocrine function and finally the ______ serves as a center for motor activities.

A

Diencephalon, 2. epithalamus, 3. Thalamus, 4. hypothalamus, 5. autonomic, 6. subthalamus

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22
Q

Midbrain (mesencephalon)

A

Corpora quadrigemina (tectum): superior vision/inferior auditory

Tegmentum: red nuclei (motor output) and substantia nigra (synth dopamine)

Cerebral peduncles

Cerebral Aquaduct (Silvius) carrie CSF

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23
Q

HindBrain: (metencephalon)

A

Cerebellum-conscious & union. muscle synergy; maintains balance/posture
Damage- ipsilateral (same side) loss of equillibrium, bal, and motor coordination

Pons: helps control respiration

Medulla oblongata (myelencephalon) controls:
HR, RR, BP, cough, sneeze, swallow, & vomitting

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24
Q

Spinal cord: reflex arc

A

-receptor
both afferent & efferent neurons
Motor effectrs from the reflex arcs generally occur before the perception of the event in the higher centers of the brain
upper and lower neurons

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25
Q

What are some motor pathways (pyramidal system)

A

corticospinal (contalateral; voluntary movement of skeletal mucles and fine motor control)

corticobulbar (ipsilateral; vol movement of facial muscles, head and neck via the cranial nerves)

reticulospinal (medial tract=motor activity, lateral tract=inhibits motor activity; modulate muscle tone and locomotor patterns)

vestibulospinal (medial: extensor tone; lateral: facilitates flexor tone)

rubrospinal (red nucleus in midbrain; facilitates fflexor tone and suppresses extensor muscles.

Tectospinal: midbrain to coordinate visual reflexes like head/eye movements towards a stm.

26
Q

what are sensory pathways

A

Anterior Spinothalamic tract
vague touch
Lateral spintothalamic tract
pain/temperature
Posterior (dorsal) column
Fine touch, 2-pt discrimination & proprioception;
3 neuron chain
Ipsilateral transmisson
contralateral transmission

27
Q

Which ion causes neurotransmitter vesicles to fuse into the pre-synaptic membrane? (from class notes

A

Calcium

28
Q

Protective structures

A

Cranium (8 bones)
meninges-referred pain (around brain & spinal column)-dura matter, arachnoid, & pia matter
Spaces
subdural-b/w dura & arachnoid
subarachnoid: contains CSF &b/w arachnoid and pia matter
epidural: b/w dura matter & skull
CSF &ventricle system
Vertebral column-33 vertebrae, C, T, L, &S w/ intervertebral discs

29
Q

CSF facts

A

125-150 mL in the ventricles
prevents the brain from tugging on the meninges, nerve roots, and BV

produced by the choroid plexuses in lateral, 3rd &4th ventricles

reabsorbed thru the arachnoid villi

exerts pressure within brain & Spinal cord

30
Q

Blood supply to the brain

A

800-1000 mL/min
CO2 primary regulator for cns blood flow
*internal carotid
*vertebral arteries
*Circle of Wiles
*Blood brain barrier

*what is the fxn (need more)

31
Q

Cranial Nerves

A

1- olifactory/sensory
2-optic/sensory
3-oculomotor/motor
4-trochlear/motor
5-trigeminal/mixed
6- abducens/motor
7- facial/mixed
8- vestibulococchlear/sensory
9-glossopharyngeal/mixed
10-vagus/mixed
11-spinal accessory/motor
12-hypoglossal/motor

32
Q

Neuro receptors of the ANS

A
33
Q

Functions of Autonomic NS

A

stim of the sympathetic nervous
-decreases parastalsis
- incr blood, temp, and BP
-regulates vasomotor
Stim of a the parasympathetic
-promotes rest/tranqulity
-reduces HR
-Enhances visceral fxn for digestion
-controls pupil constriction and tears
-increases salivary secretions
-contracts urinary bladder

34
Q

Age: structural changes

A

of neurons decreased
brain wt/size decreased
fibrosis and thickening of the meninges
narrowed gyri and widened sulci
increased ventricles

cell changes:
decr myelin
deposition of lipofuscin
presence of senile plaques
multiple neurofibrillary tangles
Lewy Bodies

Fxnal changes:
dim sensory fxn
sleep disturbances
memory impairments

35
Q

Afferent vs. Efferent pathways (blueprint)
Afferent and efferent pathways refer to the directional flow of information in the nervous system.

A

afferent neurons/sensory: carry sensory information (information gained through touch, smell, pain temperature, & others) from the body’s receptors TO the brain and spinal column

Efferent (motor): carry motor information AWAY from CNS to periphery, signals to initiate actions/responses

36
Q

Tests of nervious system function (what do they show, and what are you looking for when you order them)?

A

Xray: roentgenograms
CT (bleeding, clots, or other abnorms)
CTA (CT w/ contrast in vascular- shows collateral circ)
MRI (magnetic fields to create detailed pics of brain tissue, detects brain tissue damaged by ischemia)
MRA: MRI w/ contrast to visualize blood flow through arteries and detect narrowing or clots
Positron-emission tomographic (PET)
Cerebral angiography (die)
single photon emisson CT (SPECT)
myelography (dye)
Echoencephalography (U/S)
EEG (brain waves) Seizure activity w/ abnormal spikes
Evoked potentials (stim activated)
CSF (L3 or L4 interspace) infection/ pressures
Magnetoencephalography (MEG)

37
Q

Functions of pain

A

adapative measure to avoid further tissue damage
protective measure
evoked responses:
w/d from noxious stim (spinal reflexes)
anticipatory movement (shielding face w/ arm)

38
Q

pain threshold vs tolerance

A

threshold:
lowest intensity of pain that a person can recognize
intense pain at 1 loc., may increase threshold at another location

tolerance:
greatest sensitivity to pain that a person can endure
-very individualized; varies greatly among persons over time

39
Q

Pathways of pain modulation

A

add pic

pain inhibitors:
Opiods
GABA
Cannabinoids
Serotonin
Norepinephrine

Pain facilitators
Glutamate
Substance P
Histamine
Prostaglandin
Bradykinin

40
Q

Ear anatomy (blueprint)

A
41
Q

Olifactory terminology (blueprint)
CN 1 and part of 4

A

taste and smell

hyposmia: impaired smell
Anosmia: complete loss of smell
Olfactory hallucinations: hyperactive cortical neurons smell odors that aren’t there
Parosmia: abnorm/perverted sense of smell

42
Q

Types of hearing loss(blueprint)

A

Conductive: (CHL) sound cannot be conducted through middle ear (occular chain & tympanic membrane)

Sensorineural (SNHL): impaired organ of Corti or connections; cochlea, cranial nerve 8, central auditory pathways)
_Presbycusis: age-related

Mixed: combo of the above

Functional: can be born with, no organic cause

43
Q

Ear infections
Otitis externa
otitis media

A

externa: inflam/infect outer ear; aka swimmers ear, or prolonged moisture exposure
tx: topical abt

media (acute): infect in middle ear w/ retention of fluid
-MC pathogens: strep pneumonae, H. influenza, Moraxella catanhalis
-Fever, otoalgia, decr hearing
DX: hx, otoscope (bulging membrane w/ decr mobility
tx: abt or sug if recurrent (“tubes” often in children)

44
Q

Lumbar puncture landmarks (blueprint)

A

the line connecting both iliac crests. This crosses the vertebra column at the level of the L4-L5 intervertebral space or L4 vertebra.

45
Q

Types of cerebral edema (blueprint)

A

Cytotoxic: d/t failure of ion pumps, leading to intracellular fluid accumulation

Vasogenic: MC; involves the break down of the blood brain barrier, allowing fluid to leak into the extracellular space; often asso w/ tumors.

Interstitial edema AKA: transependymal ) when CSF moves into the brain parenchyma; often asso w/ hydrocephalus

Osmotic: from osmostic gradient b/w blood and brain tissue, causing water to move into brain cells

Hydrostatic: incr capillary pressure leading to fluid movement to extracelluar space

High altitude edema

hemorrhagic d/t brain bleed

46
Q

ICP-increased intercranial pressure (blueprint)

A

SERIOUS-rise in pressure inside cranium
C/B: brain injury/traume
brain tumors
hemorrhage
swelling
hydrocephalus (excess CSF)
infections- meningitis or encephalitis
stroke
aneurysm rupture
HTN

s/s:
severe HA, N/V, blurred or diplopia, confusion/change in mental state,
weakness/difficulty w/ movement, seizures, LOC, changes in pupil size & reactivity.
Dx: phys exam, CT/MRI, LP, or insertion of ICP monitor into brain

tx: meds to reduce swelling, draining excess csf, surgical removal of tumors/clots, or part of skull to relieve pressure. Tx underlying cause

Prevent: wear protective head gear, managing underlying conditions-HTN,

47
Q

Pupillary response(blueprint)

A
48
Q

Types of Seizure activity (blueprint)
Focal
Generalized 4
Status epilepticus-see other slide

A

Seizures are a symptom, recurrent SZ=epilepsy (aura)
*Differentiation b/w SZ &epilepsy: LOC, Motor/Sensory deficits, and behaviors.

Focal (aware and impaired awareness)

Generalized:
tonic-clonic (grand-mal)
Absence (petit mal)
Atonic (drop sz)
tonic
clonic

Consequences of: increased blood flow
incr O2 consumption (60% more)
glucose depletion
accum of lactate–lots of sequelae-brain injury, exhaustion of brain cells.

49
Q

Seizure sequence

A

Resting potential instability

Seizure start-bursts of AP
Tonic, Clonic, post-ictal phases
Note: important psychosocial SE-embarassment, loss of control, sudden, etc

50
Q

Status epilepticus-more severe
more consequences

A

Increaseses in:
tremendous incr in ATP
incr cerebral O2 consumption (60%)
glucose depletion
hypoxia
acidosis
injury to brain
body injury d/t tonic/clonic-bite tongue, vertebral fractures

Psycho social:
alienated relationships
school/family/friends
unpredictable and scarry for others around.

51
Q

Subdural hematoma (blueprint)
medical emergency

A

a blood vessel near the surface of the brain ruptures, causing bleeding into the space between the brain and the outermost membrane covering the brain (the dura mater). This accumulation of blood puts pressure on the brain,

acute vs chronic

s/s: phys &neuro exam, CT, MRI
tx: depends on size/location
lg: surgery-craniotomy or burr hole to drain the blood
sm: managed w/ meds, obs, monitoring

52
Q

Coup and coutnercoup brain injury (blueprint)

A

fowrard and backward brain injury from force of originial hit
coup-frontal
countercoup-back of brain

both happen together-These injuries occur because the brain is floating in cerebrospinal fluid within the skull. When a sudden impact or deceleration occurs, the brain can slam against the inside of the skull, causing bruising, bleeding, or other damage. The initial impact causes the coup injury, while the rebounding of the brain against the opposite side of the skull causes the contrecoup injury
C/B: trama, mva, sports injury
s/s: HA, memory loss, sensory or motor fxn deficits, Cog impiarments, sev cases=coma/paralysis

53
Q

Gulian barre -
Periph NS
MC cause of acute paralysis
MC nerve illness of the PNS

A

MEDICAL EMERGENCY
Acquired, acute, inflammatory autoimmune ds;
Acute immune mediated polyneuropathy;

Demyelination of the periph nerves or axonal d/o
several types:
mc: has immune component d/t VIRAL exposure or offending vaccine (CMV, Epstein-barr, HIV, micoplasma or flu-like illness, or bacterial campylobacter

Manif: rapid progression of weakness of limbs from distal point and ASCENDS upward, leading to systemic flaccid paralysis

TX: vent support
mgmt of autonomic dysfxn
IVIG, plasmaphoresis (shortens process), aggressive rehab after symp subside

90%affected achieve full recovery 2-6 weeks to up to 2 years.

54
Q

Multiple Sclerosis CNS demyelination

A

1 demyelinating ds in world.

MC reason for disability-life limiting
prevents normal conduction of nerve signal (slow/blocked)
W>M
age of onset: 20-40’s
Progressive, chronic, inflammatory, autoimmune (T cell mediated immune reaction by oligodendracytes)

occurs in gray & white matter
exam: hard/white patches of nerve; plaques in CNS
2 types/stages of lesions:
1: inflamm
2. Scaring

S/s: relapsing/remitting
progressively worsen
each relapse will worse ds. speech changes, dysphagia, vision changes-diplopia, abnorm gait,

Tx: NO CURE, mgmt sympt.
steroids, immunotherapy, Vit D, stem cells

55
Q

Depression serum marker changes (blueprint)

A

increase in inflammatory markers
CRP, IL-6, IL-12, and tumor necrosis factor (TNF-a)
Enzyme: MAO-A
hormones: decr estrogen/progesteron

56
Q

Basic sleep disorder terminology

A

dyssomnia: intrinsic/extrins. sleep d/o and cirrcadian ryth. d/o (hard to fall or stay asleep)
-insomnia
-osa
- RLS
-obesity hypovent
-hypersomnia-excess daytime sleepiness
Narcolepsy: hypersomnia, cataplexy, hallu, sleep paralysis

Parasomnias: arousal and sleep/wake transition d/o; REM sleep d/o
-sleepwalking; night terrors
-d/o r/t REM sleep
-sleep paralysis, nightmares, osa, SIDS

Sleep d/o asso w/ med/psych d/o

Proposed sleep d/o

57
Q

Proprioceptive dysfunction

A

Vestibular nystagmus-constant involun. eyeball movement; over stim semicircular canal system

Vertigo: sensation of spinning r/t inflam of semicircular canals

Menieres ds: idiopathic, episodic, vestibular d/o r/t abnorms of endolymph in mid ear

peripheral neuropathies

58
Q

VIsion disorders

A

Blepharitis: inflam of eyeball
hordeolum (stye)
Chalazion (non-infect, lipogranuloma of oil gland)
Entropion: eyelid malposition, margin turns against eyeball

**Conjunctivitis: inflam of conjunctiva (pink eye), highly contagious, mucopurlulent drng
-viral
-allergic
-chronic
–trachoma (chlamydial) leading cause of blindness in world

59
Q

Visual dysfunction (terms) Acuity

A

Strabismus: deviation from one eye to the other (diplopia-double vision)
nystagmus: invol uni/bi lateral rhythmic movement
cataracts: cloudy/opaque vision loss
galucoma: optic nerve neuropathy–>atrophy of optic nerve (pressure-: 12-20 in aqueous fluid)

Retinal detachment: if lost vision=emergent
separation of neurosensory retina from retinal pigmnented epithelium in the chorcoid (incr fluid accum)
progressive vision field loss
photoopsia: flashes of light
floaters: hrs or weeks
*once detachment occurs, visual prog=poor

60
Q

alterations in vision Refraction of light

A

Myopia: in front of retina, c/b eye too long w/ too much curvature
r/s: cant focus distant objects

Hyperopia: behind retina; c/b eye too short, cornea w/ decr curvature
r/s: can’t focus near objects

Astigmatism: multiple sites, c/b uneven curvature; =blurry vision

61
Q

Data processing terminology

A

Agnosia: fx to recog the form and nature of objects

Aphaisa: loss of comprehension/production of language

Dysphasia: expressive vs receptive or transcortial

acute confusional states: delerium
Dementias

62
Q

3 types of dysphasia

A

Wernke’s: disturbance in understanding all language-verbal and reading

Conductive: disruption of temporal lobe fibers w/ fx to repeat words but ability to initiate speech, writing, and reading aloud

Anoic: inability to name objects, people, or qualities

Transcortical: Brocha’s area

PathoPhys (19 decks)

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