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MED 412_2021 > Week 19 Lectures > Flashcards

Week 19 Lectures Flashcards

1
Q

What are the parasympathetic nerves come from?

A

CN III
CN VI
CN IX
CN X

S2 ,3,4

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2
Q

Where does the visceral motor cell bodies?

A

CN III
CN VI
CN IX
CN X

T1-L2

S2,3,4

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3
Q

Where does sympathetic innervation come from?

A

T1-L2

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4
Q

What are the layers in a nerve

A

epineurium

perineurium

endoneurium

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5
Q

Epineurium

A

surrounds entire nerve

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6
Q

Perineurium

A

encapsulates bundles of axons called fascicles

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7
Q

Endoneurium

A

m contained within the perineurium consists of axons

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8
Q

Axons require _______. _________ with soma for viability

A

Axons require cytoplasmic continuity with soma for viability

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9
Q

2 types of schwann cells associted with axons

A

1) myelinating
2) ensheathing

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10
Q

What 2 main variables influence AP propagation rate

A

1) Fibre diameter – larger diameter = faster AP propagation rate
2) Myelin - greater the thickness and segmental length of myelin = faster APs

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11
Q

Two classification schemes for Peripheral nerve axons

A

1) Conduction Velocity

A-fastest myelinated

alpha,beta, delta,gamma

B-slower myelinated

  • C-smallest unmyelinated
    2) Diameter

I,II,III,IV

a,b

  • for sensory axons only
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12
Q

Special senses

A

The special senses are modalities carried by cranial nerves

Olfaction – CN. I

  • Vision – CN. II
  • Taste – CN. VII and CrN IX
  • Hearing and balance (equilibrium) – CN. VIII
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13
Q

The general or somatic senses (Somatosensory)

A

Detected from all parts of the body (and head) and transmitted to CNS via:

  • CN. V (trigeminal)
  • All spinal nerves except CN.1
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14
Q

what is different about the Generating potential in the optic compared to all other cell types?

A

It is a hyperpolarization rather then a depolarztion

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15
Q

Where do the fibres for sensory of the body terminate

A

the VPL (Ventral posterolateral nucleus)

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16
Q

Where do the sensory fibres of the head-synapse in the thalamus?

A

VPM

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17
Q

Which sensory pathway is Lissauer tract a part of?

A

Spinothalamic tract

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18
Q

What do 3rd order neurons for sensory touch and pain travel through when traveling from the thalamus to the postcentral gyrus?

A

The internal capsule

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19
Q

Where do the motor neurons cross for the anterior corticospinal tract?

What is the percentage of fibres here?

A

It crosses in the spinal cord

15%

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20
Q

_- Motor neurons innervate ______ fibres which are responsible for muscle ________.

A

alpha- Motor neurons innervate extrafusal fibres which are responsible for muscle contraction.

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21
Q

How long do we have to reattach nerves if they are cut?

A

~12 months sooner is better!

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22
Q

What are the clues that a disease is demylinating (5)

A

1) Weakness without atrophy
2) Rapidly ascending
3) preceding infection
4) Areflexia
5) patchy distribution non-lenght dependent

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23
Q

peripheral neuropathy caused by diabetes is _______ and length _________

A

peripheral neuropathy caused by diabetes is Axonal and length dependent

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24
Q

Investigations lab tests for peripheral neuropathy (6)

A

1) CBC
2) A1C/ Blood glucose
3) B12
4) ESR- erythrocyte sedimentation rate_ inflammation
5) TSH
6) Serum protein electrophorisis

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25
Q

Positive motor symptoms for a peripheral neuropathy

A

Cramps/ twitching

26
Q

Positive sensory symptoms for peripheral neuropathy? (5)

A

1) paresthesia- Tingling pins and needles
2) burning
3) stabbing pain
4) Allodynia- discomfort to stimuli that are not typically painful
5) Hyperalgesia- Increased sensitive to pain stimuli

27
Q

What are the negative motor symptoms for peripheral neuropathy symptoms?

A

Weakness

Atrophy

28
Q

What are the negative symptoms for peripheral neuropathy?

A

1) Reduce sensation/numbness
2) Gair ataxia/imbalance

29
Q

What are some of the Autonamic symptoms of peripheral neuropathy? (4)

A

1) Cardiac
2) GI
3) Genitourinary
4) Vasomotor
- cold extremities
- skin color changes

30
Q

Fill in this table:

A
31
Q

Whar are the three categories of peripheral neuropathy and the types of neuropathy under those categories?

A

1) Focal
- Mononeuropathy: a single nerve
- Radiculopathy: A single nerve root
2) Multifocal

PolyRadiculopathy

Mononeuropathy multiplex

3) diffuse

Polyneuropahty

32
Q

Explain Lenght dependent polyneuropathy pathology

A

metabolic function is in the neuron cell body and then nutrients are transported down axon if there is a defect in this the distal axons die first

33
Q

what are some causes of distal axonapathy? (4)

A

1) diabetes
2) nutrient defiency
3) Toxins ETOH/ chemo
4) hereditary neuropathy

34
Q

What are the red flag signs that something is not a Distal axonopathy (5)

A

1) Asymmetry of onset and findings
2) Cranial nerve involvment
3) Motor> sensory
4) disproportionate reflex changes (Areflexia with mild symptoms)
5) Rapid progression with significant deficit over acute

35
Q

What is a Radiulopathy what is a example of this?

A

It involves a single nerve root. example is Sciatica

36
Q

What is mononeuropathy? what is an example of this?

A

Lesion of a single nerve, Carpal tunnel, medial nerve

37
Q

What is the order that we give drugs for neuropathic pain

A

1) Gabapentinoids/TCAs/SNRIs
2) Tramadol/Opiod ????
3) Cannabinoids
4) 4th line agents

38
Q

What is a marker in CFS that is indicative of GBS?

A

Albuminocytologic dissociation

39
Q

What is the gene that causes an CMT1A? Is those a demylinateing or axonal

A

PMP22

CMT1a is Demylinating

40
Q

What are some key features of CMT (3)

A

Often have distal weakness and sensory loss with little disability

presence of pes caus and hammertoes

family history

41
Q

The acute onset of perpherial neuropahty in the distribution of individual nerves is suggestive of what?

A

Vasculitis

42
Q

What are 3 ways to damage a nerve?

A

1) Ischaemia
2) Compression
3) Cut

43
Q

Neuropraxia

A

Demylinationg of a nerve. can be reduced thickness, to multiple segments of no myelin

44
Q

What happens when a nerve is cut and needs to regenerate?

A

1) Trophic factors and cytokines released by damaged Schwann cells
2) Macrophages come clean up
3) dedifferentiate Schwann cells mylin loss
4) distal end degenerates (Wallerian degeneration )
4) triggers proliferation of indifferent Schwann cells which some become new new myelinating cells
5) Sprouts produced at cut end

45
Q

What happens if a regenerating nerve cant reattach to a muscle

A

Neuroma- painful

46
Q

Tinels sign

A

At the Proximal end of the cut nerve can tap and will get a tingling sensation can tell you where the leading edge of regeneration is

47
Q

What are the two classes of Local anesthetics?

A

Aminoesters

aminoamides

48
Q

How do LA’s work

A

they attach to the inactivated Na channel and stop the regeneration of an Axon potential. Most work from inside the cell

49
Q

What is the difference between Bupivacaine and ropivacaine?

A

Bupivacaine is more cardiotoxic because it has a R and S enatiomers

Ropivacaine has just and S-isomer

Both are CNS toxic

50
Q

How do LAs cross into cells

A

LAs are amphoteric based on their pkas they dissociate into a base and charged cation. the base will cross the cell membranes and the cation works inside the cell to inhibit the Na chanel

51
Q

How do waling epidurals work?

A

LAs will target smaller unmyelinated fibres first. therefore the pain and temp fibres Type A-delta and C fibres will be target first and block pain and temp but not proprioception

52
Q

Details about Benzocain (3)

A

1) aminoester
2) Used as topical anesthesia only
3) risk for methemoglobin (cyanosis)

53
Q

Details about Lidocaine (3)

A

1) Aminoamide
2) Fast onset
3) used as IV as an antiarrhythmic and in acute and chronic pain

54
Q

Details about Bupivacaine (2)

A

Lipophilic and potent long duration of action

R isomer has high cardiotoxicity

good sencory motor seperation

55
Q

Ropivacaine detials

A

1) s isomer only of bupivacaine less cardiotoxic

even more motor sparing then bupivacaine

56
Q

Never inject a La with a ________ into peripheral body parts as it can cause tissue necrosis and gangrene

A

Never inject a LA with a Vasoconstrictor into peripheral body parts as it can cause tissue necrosis and gangrene

57
Q

LA potency cooraltes with ______ ______

A

LA potency correlates with Lipid solubility

58
Q

Onset of LA action cooraltes with?

A

Pka, Lower pka faster

59
Q

what is lipid rescue

A

Used to treat local anesthetic toxicity

20% lipid emulsion 1.5 ml/KF iV over a min

follow with continues infusion

60
Q
A

MED 412_2021 (12 decks)

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