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Neuro Big Ideas > Week 2 - Neuro Big Ideas > Flashcards

Week 2 - Neuro Big Ideas Flashcards

1
Q

lacrimation pathway (tearing)

A

parasympathetic, hypothalamus to superior salivatory nucleus

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2
Q

ptosis pathway (drooping of eyelid)

A

parasympathetic, hypothalamus to superior salivatory nucleus

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3
Q

pupil constriction pathway

A

parasympathetic, hypothalamus to superior salivatory nucleus

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4
Q

daiphoresis pathway (sweating)

A

sympathetic via muscarinic ACh receptors, hypothalamus to spinal trigeminal complex

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5
Q

vasoconstriction pathway

A

sympathetic via norepinephrine/epinephrine to andrenergic receptors, hypothalamus to spinal trigeminal complex

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6
Q

serotonergic synapse

A

pre - serotonin vesicle, 5HT1D autoreceptor, reuptake transporter; post - serotonin receptor (5HT1a)

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7
Q

5HT1d autoreceptor

A

serotonin, presynaptic, if activated - blocks serotonin release

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8
Q

monoamine oxidase and aldehyse dehydrogenase enzymes

A

break serotonin down into 5-hydroxyindoleacetic acid, leaves the brain in the blood

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9
Q

5HT1a receptor

A

activation in brainstem (raphe nuclei) inhibits serotonergic neurons

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10
Q

itch

A

perception, conscious process, brain modulates

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11
Q

touch

A

sense, has receptor

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12
Q

pressure

A

sense, has receptor

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13
Q

vibration

A

sense, has receptor

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14
Q

warmth

A

sense, has receptor

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15
Q

pain

A

perception, brain continually modulates

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16
Q

3 fundamental steps of information processing

A

transduction, transmission, and perception

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17
Q

perception

A

brain is capable of switching priority, paying attention, conscious process, ex: pain is perception, localized by stimulus modality

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18
Q

sensation

A

not a conscious process, brain can’t switch attention, ex: nociception is sensation, mapped to key orderly respresentation - hummunculus

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19
Q

transduction

A

all sensory systems, stimulus energy converted into electrical potential that can be interpreted by nervous system

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20
Q

stimulus energy

A

electromagnetic, mechanical, chemical

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21
Q

essential step for transduction

A

confirmational change in transducer protein, ex: stretch receptors

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22
Q

receptor potential

A

graded response to stimulus, can be depolarizing or hyperpolarizing

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23
Q

transduction

A

stimulus energy -> receptor -> receptor potential (graded) -> depolarization increase with stimulus increase -> action potential at node of ravier -> intensity of stimulus translates to number of action potentials

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24
Q

adequate stimulus

A

stimulus that receptor best responds to, hummunculus map in every sensory system, receptor will respond to other stimulus but interepret incorrectly, ex: pressure on eyes makes you see stars

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25
Q

receptors

A

encode stimulus modality by responding better to one form of energy in a narrow range

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26
Q

coding for stimulus intensity

A

increase in firing of primary afferent, saturation of response of individual receptor cell, recruitment of overlapping sensory neurons, lack of response to some stimuli (if not adequate)

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27
Q

dynamic range

A

between threshold and saturation point for a receptor

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28
Q

range of system of receptors

A

sum of the ranges of all receptors within system

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29
Q

population coding (recruitment)

A

as the stimulation increases, the number of sensory cells increases with increasing stimulus intensity

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30
Q

receptor potential threshold

A

stimulus amplitude that must be reached before a response is generated

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31
Q

receptor potential saturation

A

in response to intense stimulus

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32
Q

frequency coding

A

firing rate of sensory neurons increases with increasing stimulus intensity

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33
Q

adaptation

A

response of receptor to constant stimulus declines over time

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34
Q

tonic adaptation

A

receptor potential decreases slowly with constant stimulus

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35
Q

phasic adaptation

A

receptor potential decreases rapidly with constant stimulus

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36
Q

acuity

A

ability to localize stimulus, determined by receptive field size and receptor density

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37
Q

intensity and localizing paradox

A

as stimulus intensity increases, acuity decreases because more receptors respond making it harder to localize

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38
Q

lateral inhibition

A

for localizing and encoding intensity, inhibitory CNS interneurons synapse with collaterals from main sensory neuron, by inhibiting signal strength from more distant neurons - helps localize stimulus, ex: retina to help see contrast

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39
Q

can’t see marker on board

A

stimulus doesn’t reach threshold

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40
Q

allodynia

A

pain from stimulus that does not normally evoke pain, ex: sharp pain when brushed lightly

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41
Q

hyperalgesia

A

increased sensitivity to pain, ex: more sensitive to pain after being stabbed by a platypus

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42
Q

acute nociceptive pain

A

fast - sharp, pricking, well localized, Adelta fibers; slow - dull, aching, poorly localized, C fibers; thermal, mechanical, chemical; visceral (smooth muscle), deep somatic (tendons, bones), superficial somatic (wounds, small burns)

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43
Q

inflammatory pain

A

damage or sensitization of peripheral nociceptors by PG, can lead to chronic pain syndromes

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44
Q

neuropathic pain

A

complex, pain state, peripheral / central neuron damage, can lead to chronic pain syndromes, burning / electrical / stabbing / needles, ex: bumping funny bone

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45
Q

nociceptor activation

A

heat, protons, and vanillinoids (capsacin) cause TRPV1 to open sending messages up C fibers

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46
Q

nociceptor sensitization

A

bradykinins, prostaglandins, protein kinases make receptor open more easily - blocking prostaglandins is key to some analgesic drugs

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47
Q

referred pain

A

two sensory receptors use same pathway, brain assumes that it is the most common sensation coming on the pathway, ex: heart and skin nociceptors share same tract and brain assumes skin pain when there is actually heart pain

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48
Q

key step in nociceptive stimuli transmission

A

activation of ligand gated channel -> 1st order neuron glutamate to 2nd order metabatropic AMPA receptor (excitatory) -> 1st order collaterals glutamate to mGluR receptor (normally closed) on interneuron, as transmission increases gate will open

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49
Q

Gate Theory of Pain

A

nociceptors -> ligand gated channel -> C fibers -> glutamate to 2nd order metabatropic AMPA receptor -> collaterals glutamate to mGluR receptors on inhibitory interneuron -> stimulus increase gate on inhibitory interneuron opens and sends message up AB fibers in mechanoreceptor

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50
Q

perception of pain

A

activation of nociceptors, modulation of nociceptors and inhibitory interneurons, inhibitory interneurons regulate transmission at 2nd order neuron level, explains phantom limb pain and TENS treatment and opioid analgesics

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51
Q

local anaesthetics

A

block pain at low concentrations

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52
Q

conduction velocity of fibers

A

diameter (thicker = faster) and degree of myelination (myelinated = faster)

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53
Q

Abeta fibers

A

fastest, largest diameter, myelinated, mechanoreceptors

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54
Q

Adelta fibers

A

fast, middle diameter, myelinated, mechanoreceptors, cold, fast pain

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55
Q

C fibers

A

slowest, narrow, unmyelinated, mechanoreceptors, thermoreception, slow pain

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56
Q

Adelta cold receptors open in response to…

A

menthol, CMR1

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57
Q

transduction channel

A

transient receptor potential ion channels

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58
Q

thermoreceptors

A

cold and warm, adapt rapidly to temp changes and chemical stimuli

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59
Q

mechanoreceptors

A

respond to deformation of cell membrane

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60
Q

nociceptors

A

respond to heat, protons, and vanillinoids (capsacin); responses potentiated by prostaglandins - blocking PG is mechanism of some analgesic drugs

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61
Q

dermatomes review

A

area supplied by one spinal nerve / dorsal root ganlgion; C1 no DRG, C2 top and back of head, C5-8 arm / hand, T4 nipples, T10 umbilicus, L1 inginal, L4-S1 lower lef / foot, S2-5 back of legs / butt / genitals; shingles is varicella-zoster latent on DRG - L6 / 7 most common area

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62
Q

cutting one dorsal root

A

has little effect on sensory due to overlap of sensory areas

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63
Q

cutting several dorsal roots

A

has anesthetic effect on sensory where all roots overlap

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64
Q

dorsal column

A

white matter, lesion here causes reduced (not absent due to overlap) fine touch / vibration / propioception below point

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65
Q

dorsal column - medial lemniscal pathway (somatosensation)

A

touch / proprioception / vibration, entire spine to thalamus, receptor in skin -> peripheral nerve -> cell body in DRG -> enter spine via dorsal root -> ascend in gracile and cuneate fasiculus on ipsilateral side -> synapse in gracile and cuneate nucleus -> cross to contralateral at medial lemniscus in caudal medulla -> synapse in ventral posterolateral nucleus of thalamus -> postcentral sensory gyrus

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66
Q

first order sensory neuron

A

receptor in peripheral nervous system, cell body outside CNS

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67
Q

second order sensory neuron

A

nuclei, 1st synapse, crossing over, cell body inside CNS

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68
Q

third order sensory neuron

A

nuclei to cortex, 2nd synapse

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69
Q

dorsal columns input

A

mechanoreceptors - Merkle disc endings (slow afferent type I), meisner corpuscles (indentation), pacinian corpusles (vibration / proprioception)

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70
Q

sensory entry into spinal cord

A

peripheral process -> cell body in DRG -> central process -> medial dorsal root ascends in dorsal column ipsilaterally (some branches terminate in dorsal horn)

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71
Q

organization of dorsal column

A

at thoracic level - sacral (medial) / lumbar / thoracic (lateral); at cervical level - sacral (medial) / lumbar / thoracic / cervical (lateral)

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72
Q

injury to lateral dorsal column

A

deficit on same side below point

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73
Q

injury to medial dorsal column

A

deficit on both sides below that point because ipsilateral tracts travel side by side

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74
Q

gracile fasciculus

A

medial to dorsal intermediate sulcus, carries T7 and lower (lumbar / sacral)

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75
Q

cuneate fasciculus

A

lateral to intermediate sulcus, T6 - C2 (thoracic / cervical)

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76
Q

lesion on dorsal column midline at L2

A

below L2 affected fine touch / proprioception / vibration on both sides

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77
Q

dorsal column nuclei

A

medulla, 1st synapse with 2nd order neuron, in gracile and cuneate nuclei

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78
Q

physiological class segregation

A

type of sensory axons end together in dorsal column nuclei, ex: slowly adapting type I, proprioceptors, pacinians, stimulus is dissected

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79
Q

dorsal column nuclei

A

many 2nd order neurons receive input from hand (cuneate nucleus) or foot (gracile nucleus) because they have many receptors to start with

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80
Q

dorsal column ascending ipsilateral fibers

A

25% end at dorsal column nuclei in the medulla, the rest make propriospinal connections to help produce complex movements

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81
Q

convergence in dorsal column nuclei

A

same type of 1st order neurons end together on same nuclei to synapse with 2nd order nuclei, receptive field is 40-100x larger than nuclei synapse in brain stem

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82
Q

population response for dorsal column sensory

A

overlapping receptive fields allow for finer touch descrimination

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83
Q

medial lemniscus

A

part of dorsal column sensory, caudal medulla, 2nd order neurons from gracile and cuneate nuclei cross over to contralateral, organized - cervical (dorsal), sacral (ventral), “person on pyramids”

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84
Q

lesion in medial lemniscus

A

contralateral sensory deficits

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85
Q

ventral posterior lateral nucleus (VPL) of thalamus

A

2nd synapse with 3rd order neurons, organized - sacral (lateral), cervical (medial), receptor segregation maintained

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86
Q

lesion in ventral posterior lateral nucleus of thalamus (VPL)

A

contralateral sensory deficits

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87
Q

thalamocortical projections from ventral posterior lateral nucleus in thalamus

A

3rd order neuron axons of VPL through posterior limb internal capsule to postcentral gyrus (primary somatosensory cortex) on ipsilateral side, homunculus

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88
Q

spinothalamic tract system (somatosensation)

A

pain and temp, damage reduces pain and temp (not touch), nociceptors and thermoreceptors -> peripheral nerve -> cell body in DRG -> synapse with 2nr order neuron in dorsal horn -> immediately cross over to contralateral in spinal cord -> ascend in spinothalamic tract to ventral posterior lateral nucleus in thalamus -> synapse with 3rd order neurons -> postcentral gyrus and insula

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89
Q

convergence and segregation of sensory type

A

persists in spinothalamic tract system

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90
Q

spinothalamic tract system receptors

A

nociceptors, thermoreceptors, and somewhat mechanoreceptors

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91
Q

nociceptors in spinothalamic tract system

A

enter lateral dorsal tract, pass through Lissauer’s Tract, enter dorsal horn and synapse with 2nd order neurons by releasing glutamate and SP

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92
Q

intense noxious stimuli

A

cause release of both glutamate and SP neurotransmitters at synapse in dorsal horn, both AMPA and NMDA receptors activated, other peptides released, changes synapse

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93
Q

second messenger changes at nociceptor synapse

A

changes in 2nd order neuron via second messenger / cascade -> new receptors or modified receptors, causes chronic pain

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94
Q

spinothalamic tract

A

2nd order neuron axons from marginal zone and lamina V in dorsal horn project to thalalmus after crossing over at anterior white commissure and ascending in spinothalamic tract in ventral lateral funiculus of spinal cord

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95
Q

marginal zone

A

most dorsal point of dorsal horn, 2nd order neurons of spinothalamic tract system

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96
Q

lamina V

A

lateral dorsal horn, 2nd order neurons of spinothalamic tract system

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97
Q

anterior white commissure

A

immediately ventral to central canal, crossing over of 2nd order spinothalamic neurons to contralateral side of spinal cord

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98
Q

spinothalalmic tract system

A

max activation from noxious stimuli (pain, heat), respond weakly to innocuous tactile stimuli from mechanoreceptors (reason why dorsal column lesions do not completely eliminate sense of touch)

99
Q

crossing over of 2nd order neurons in spinaothalalmic tract system

A

axons cross over within two segments up spinal cord, then ascend to thalamus

100
Q

lesions in ventral lateral funiculus

A

cut off pain and temp completely two spinal segments below on opposite side, some fibers get past in segments closer to lesion, ex: cut at T6 = loss of pain and temp at T8 and lower

101
Q

unilateral lesion in ventral lateral funiculus

A

analgesia and athemia on contralateral side

102
Q

cordotomy

A

bilateral surgical cutting of ventral lateral funiculus to relieve pain in terminally ill, pain sensation returns within 6 months because other pathway begin to carry nociceptive information

103
Q

syringomyelia - central cord syndrome

A

rostrocaudal hole in central canal, cuts off spinothalamic axons that cross over in that area, ex: L2-L5 hole would cause L4-L5 loss

104
Q

reticular formation collateral branches of spinothalamic tract

A

2nd order neuron collateral branches to reticular formation in medulla / pons, controls waking /attention, depolarizes cortical neurons to wake you up

105
Q

central gray collateral branches of spinothalamic tract

A

collateral branches of 2nd order neurons in spinothalamic tract at central gray around cerebral aqueduct in midbrain, sends excitatory projections down spinal cord to inhibitory projections that inhibit nociceptive transmission - part of placebo effect

106
Q

termination of spinothalamic tract at ventral posterior lateral nucleus in thalamus

A

synapses with 3rd order neurons, organization helps localize pain - sacral / lumbar (lateral), cervical (medial)

107
Q

termination of spinothalamic tract at central lateral nucleus in thalamus

A

synapse with 3rd order neurons, no axon organization by location, responds to pain in all areas of body, projects to limbic system -> emotion

108
Q

spinothalamic tract termination at ventral posterior lateral nuclei in thalamus

A

somatotopic organization, 3rd order synapse, lesion -> blocks ability to localize pain but still suffer from it, projections to ipsilateral postcentral gyrus

109
Q

spinothalamic tract termination at central lateral nucleus in thalamus

A

no somatotopic organization, synapse with 3rd order neurons, lesion -> can localize pain but do not suffer from it, projections to ipsilateral limbic area like cingulate gyrus and insula

110
Q

pain from trigeminal dermatomes

A

tooth ache, sinus pain, tension headache, ear ache, TMJ disorder, trigeminal neuralgia

111
Q

3 trigeminal areas where pain only is sensed

A

teeth, cornea, tympanic membrane

112
Q

trigeminal afferent to ipsilateral

A

face, top of head, anterior 2/3 tongue, ear drums, jaw proprioceptors

113
Q

trigeminal efferent to ipsilateral

A

muscle of mastication, tensor tympani (dampens sound - if nerve injured problems with loud sounds)

114
Q

trigeminal motor portion (in V3 - mandibular)

A

ipsilateral muscles of mastication, tensor tympani, cell bodies and synapse in motor nucleus of V, axons to nueromuscular junction, releases ACh on nicotinic receptors

115
Q

trigeminal mechanoreceptors

A

bilateral, cell body in trigeminal ganglion, mostly to chief sensory nucleus of V in ipsilateral pons and synapse with 2nd order neuron with ipsilateral and contralateral projections to thalamus, few descend in spinal tract of V to spinal nucleus of V which synapses and crosses over to contralateral in trigeminialthalamic tract

116
Q

trigeminal nociceptors

A

contralateral, cell body in trigeminal ganglion, descends down spinal tract of V to spinal nucleus of V and synapses with 2nd order neurons, crosses to contralateral side as trigeminalthalamic tract and ascends

117
Q

trigeminal jaw proprioceptors

A

ipsilateral, cell body in trigeminal ganglion, ascends to mesencephalic tract of V to synapse in mesencephalic nucleus (midbrain), collateral branches to motor nucleus and synapse with motor fibers of trigeminal nerve - forms jaw jerk reflex loop

118
Q

brainstem lesions

A

lesions anywhere on brainstem affect trigeminal nerve in some what because it is so wide spread

119
Q

trigeminal tractotomy

A

treats chronic pain in trigeminal dermatomes by cutting spinal tract of V

120
Q

spinal nuclei of V (spinal trigeminal nuclei)

A

nociceptors and some mechanoreceptors descend to nuclei in spinal tract of V, synapse with 2nd order neuron, cross to contralateral side in trigeminalthalamic tract and ascend to ventral posterior medial nucleus of thalamus

121
Q

organization of spinal nuclei of V

A

caudal medulla - ophthlamic (ventral), jaw (dorsal)

122
Q

chief sensory nucleus of V

A

lateral ventral pons, mostly mechanoreceptor input, synapse with 2nd order neuron, project to contralateral ventral posterior medial nucleus of thalamus via ventral trigeminothalamic tract, projects to ipsilateral ventral posterior medial nucleus of thalamus via dorsal trigeminothalamic tract

123
Q

intraoral trigeminal sensation

A

bilateral representation in both VPL and VPM, can still chew and swallow after a stroke

124
Q

trigeminothalamic axons to ventral posterior medial nucleus of thalamus

A

synapse with 3rd order neurons that project to cortex near lateral fissure, intraoral mechanoreception bilateral from chief sensory nucleus to VPM, contralateral from spinal nucleus of V and contralateral from chief sensory nucleus of V face region (lateral) VPM

125
Q

organization of ventral posterior medial nucleus of thalamus

A

face (lateral), intraoral cavity (middle), taste (medial)

126
Q

mesencephalic trigeminal nucleus

A

midbrain, stretch (proprioception) receptors in muscles of mastication and peridontium, cell bodies in pons/midbrain at edge of central gray (not in V ganglion), collateral axons to motor nucleus of V -> jaw jerk reflex

127
Q

trigeminal representation on homunculus

A

postcentral gyrus, lateral parietal lobe with face

128
Q

brain size and intelligence

A

not correlated

129
Q

2SQ - viral meningitis

A

<30, death uncommon, symptoms more mild than bacterial meningitis, HIV patients at time of seroconversion, caused by enteroviruses (ss + RNA), arboviruses (ss + / - RNA), HSV2 (ds DNA)

130
Q

2SQ - meningococcal meningitis

A

headache, photophobia, PMN (neutrophils) in CSF, low CSF glucose, high CSF protein, rash on legs, crowded spaces - dorms

131
Q

2SQ - neonatal meningitis

A

caused by Strep B agalactine (gram + cocci chain), E. coli (gram - rod), listeria monocytogenes (gram + rod), in vaginal tract during birth, go to upper respiratory tract -> pneumonia -> septicimia -> meningitis

132
Q

2SQ - crytococcal meningitis

A

encapsulated dimorphic yeast, worldwide, India ink

133
Q

NILMO - tension headache

A

dysfunction of serotonergic neural pathway

134
Q

NILMO - oral sumatriptan

A

does not work as well, takes longer to reach peak plasma concentration

135
Q

NILMO - migraine medication

A

causes dry mouth, constipation, sedation, blurred vision - result of action of drug at serotonin reuptake transport protein

136
Q

NILMO - headache onset while running

A

need to be evaluated for secondary causes of headache

137
Q

NILMO - patient with Hx of heart attack and migraines

A

can’t take DHE that antagonizes serotonin receptors, may cause vasospasm and heart attack

138
Q

2SQ - false myocardial infarction

A

normal ECG, referred pain from acute coronary syndrome, afferent pain fibers from heart enter posterior horn at brachial plexus level, pain perceived as neck and shoulder pain

139
Q

2SQ - brain size

A

sperm whale - largest brain, humans have largest brain to body weight ratio 1:50 (most mammals are 1:180)

140
Q

2SQ - damage to left accessory nerve (CN XI)

A

supplies trapezius (tested with shoulder shrug) and sternocleidomastoid (turns head opposite from side muscle is on)

141
Q

2SQ - C fiber pain conduction

A

slow pain conduction, burning / aching / throbbing, poorly localized, small unmyelinated fibers

142
Q

movie - CNI / II

A

tracts at superior brain stem

143
Q

movie - brainstem

A

midbrain, pons, medulla

144
Q

movie - midbrain nerves

A

CN III / IV

145
Q

movie - pons nerves

A

CN V / VI / VII / VIII

146
Q

movie - medulla nerves

A

CN IX / X / XI / XII

147
Q

movie - cranial nerves clinical findings

A

typically on same side as involved cranial nerve and nucleus

148
Q

movie - CN I olfactory

A

olfaction, sensory, direct to cortex - does not pass through thalamus, tract to uncus in temporal lobe

149
Q

movie - CN II optic

A

good localizing in x axis, lesion testing areas - view optic disc, acuity, fields, pattern of vision deficit - tells location (pre/post chiasmal, optic tract, optic radation, calcarine cortex)

150
Q

movie - CN III oculomotor

A

midbrain, controls eye adduction (MR) / elevation (SR) / depression (IR) / and elevation of eyelid (levator papillae superius), parasympathetics to pupil, lesion = eye turned out and down, with ptosis (drooping eye lids) and mydratic pupils (dilated)

151
Q

movie - CN VI trochlear

A

SO, turns eye downward and medially, lesion = eye up and out with head tilt to opposite should to minimize dyplopia (double vision)

152
Q

midline cranial nerves

A

III, IV (dorsally), VI, and XII

153
Q

movie - CN VI abducens

A

LR, adducts the eye, lesion = eye abduction lost and eye turns in

154
Q

dyplopia

A

double vision if CN III, IV, and VI do not work together to produce conjugate movement

155
Q

medial longitudinal fascicule

A

from CN III nucleus to CN VI nucleus on ventral, medial pons, aids conjugate eye movement

156
Q

oculomotor gaze systems

A

saccadic eye movement, smooth pursuit, vestibulo-ocular movement, vergence

157
Q

saccidic eye movement

A

rapid eye movement that brings new objects into view, frontal center to pyramidal pontine reticular formation

158
Q

smooth pursuit

A

eye movement to keep moving image on fovea, parietal-occipital gaze center via cerebellar and vestibular pathways

159
Q

vestibulo-ocular movement

A

vestibular system to motor movement nuclei, keeps image on fovea during head movement

160
Q

vergence

A

optic pathway to oculomotor nuclei, keeps image on fovea when object moves closer –> near triad with convergence accomidation and pupillary constriction

161
Q

movie - CN V facial

A

mid lateral pons, descending axons for pain / temp to spinal nucleus of V, synapse, cross over, ascend to VPM in thalamus; motor test - masseter and ptyergoids, sensory test - light touch + pin at V1 / V2 / V3

162
Q

movie - CN VII facial

A

motor to facial expression, parasympathetic to tear and salivary glands, sensory to taste, lesions = bell palsy, PNS lesion = ipsilateral, CNS lesion = contralateral lower face (bilateral innervation in upper)

163
Q

movie - CN VIII vestibulocochlear

A

sensory, auditory - acquity, Weber, Rinne, unilateral neurological hearing loss is lesion in sensory organ to cochlear nucleus, lesions above cochlear nucleus = no hearing loss; vestibular tests - balance, occulocephalic reflex, occulovestibular reflex

164
Q

movie - CN IX glossopharyngeal

A

clinically locked to CN X, superior lateral medulla, motor to pharynx and larynx, sensory to pharynx and post tongue (taste), voluntary “Ahhhh” reflex, involuntary gag reflex, lower motor neuron lesion = absent voluntary / unilateral palatine weakness with ulvula deviation to normal side and reflexes, upper motor neuron lesion = no voluntary/bilateral palatine and hyperreflexive gag

165
Q

movie - CN XI accessory

A

motor to SCM and trap, ipsilateral control, SCM turns head opposite from side of body it is on

166
Q

movie - CN XII hypoglossal

A

motor to tongue, LMN lesion = tongue deviated to side of lesion, UMN lesion = bilateral psuedobulbar palsy and slow movement side to side

167
Q

movie CN VI abducens

A

has longest intracranial route, most susceptible to ICP

168
Q

diplopia

A

double vision, max in direction of parelytic muscle, the most peripherally seen image is the false one and comes from eye with paralytic muscle, is horizontal if medial/lateral recti, verticle if superior/inferior recti

169
Q

intramuscular ophthamoplagia (INO)

A

lesion on medial longitudinal fasiculus, unilateral lesion = nystagmus in abducting eye and no adduction in other eye and lesion is on side that should be adducting, bilateral = neither eye adducting horizontally

170
Q

2SQ - cluster headache

A

due to hypothalamic activation of trigeminal autonomic nervous system

171
Q

2SQ - migraines

A

20-25% lifetime prevalence, common

172
Q

2SQ - acute disseminated encephalomyelitis (ADEM)

A

CNS, diffuse, monophasic demyelination following viral infection, looks like MS, rapid onset headache, lethargy, coma, higher mortality

173
Q

2SQ - Guillain Barr syndrome

A

PNS, demyelination following infection, ascending peripheral neuopathy, lower mortality

174
Q

2SQ - recurrent laryngeal nerve

A

loops under aortic arch and right subclavian, supplies muscles of larynx, damage causes hoarseness, branch of vagus nerve

175
Q

2SQ - Perinaud Syndrome

A

dorsal midbrain syndrome, MRI, tumor in pineal region, lateral ventricular dilation, paralyzed in upward gaze, lost pupil to light reflex, tumor in superior colliculus / pretectal area

176
Q

2SQ - default network

A

network that is active in brain even though cognition is not happening

177
Q

2SQ - Neisseria meningitidis bacterial meningitis

A

gram -, diplococcus, dorms, fever, headache, coma, CSF - high PMNs (neutrophils), low glucose, high proteins

178
Q

2SQ - myelination

A

asynchronous, peaks in frontal / temporal at 50, peaks overall at 60

179
Q

2SQ - dorsal column / medial lemniscal system

A

touch/vibration/pressure sensory, synapses in dorsal column nuclei in caudal medulla, crosses over to thalamus in medial lemniscus

180
Q

2SQ - tumor inferior to left jugular foramen

A

compressed CN IX / X / XI, vagus motor fibers to palate / pharynx / larynx affect –> weakened gag reflex

181
Q

2SQ - hypoglossal nerve

A

motor to tongue, nerve damage -> denervation atrophy on affected side and deviation to side of injury

182
Q

2SQ - Horner’s syndrome

A

ptosis (drooping eyelids), anhidrosis (lack of sweating), miosis (constricted pupils), apical bronchogenic carcinoma causes interrupted sympathetic nerve fibers in cervical ganglion

183
Q

PBL - pain from GI

A

visceral pain, ulcer due to less mucus and more acid, sensory via vagus nerve, 1st order triggered by increased H+, 2nd order triggered by glutamate via NDMA and ADMN receptors

184
Q

PBL - pain from knees and spinal column

A

osteoclast activity –> increased H+ –> nociceptors triggered in periosteum -> 2nd order neuron in substantia gelatinosum –> cross over and ascend to VML, deep somatic pain

185
Q

PBL - acute nociceptive pain

A

fast (sharp/pricking) via Adelta fibers, slow (dull/aching) via C fibers, immediate stimulation of nociceptor

186
Q

PBL - inflammatory pain

A

damaged of sensitized (by prostaglandins) peripheral receptors, sensitization mean that stimulation threshold is lowered for nociceptor

187
Q

PBL - neuropathic pain

A

complex, CNS / PNS damage, burning / electrical, ex: funny bone

188
Q

PBL - chronic pain syndrome

A

increased stimulation of 2nd order neurons by glutamate via NMDA, AMDA receptors increased the number of receptors in the 2nd order cell membrane

189
Q

PBL - opioid constipation

A

act on receptors on GI tract in enteric NS, Tx with laxative (magnesium hydroxide)

190
Q

PBL - pain scales

A

not accurate, reliable, different for each person, good to track one person over time, Px look at palor / rigidity / guarding / high BP / high HR

191
Q

PBL - social support

A

better social support -> better health care outcomes, risk - single, elderly, poor, minorities

192
Q

PBL - sclerosis

A

white areas on x-ray showing calcification with osteoarthritis

193
Q

PBL - compression fracture

A

wedge shaped vertebra on x-ray

194
Q

PBL - disc space narrowing

A

bone on bone between vertebra in x-ray

195
Q

PBL - metastatic cancer

A

popcorn appearance inside bone on x-ray

196
Q

PBL - aged bones

A

bones look less calcified (blacker) with age

197
Q

PBL - osteoblastic lesions

A

bone deposition by osteoblasts stimulated to activity by metastatic cancer

198
Q

PBL - bone pain

A

disruption of periosteum

199
Q

PBL - pain management with metastatic cancer

A

addiction not an issue, morphine drip tappered to fentanyl patch for long term pain reduction, give laxative with it for constipation side effect

200
Q

PBL - aspirin (NSAIDs)

A

for inflammation, COX inhibitor -> less prostaglandins -> decreased inflammation

201
Q

PBL - nociceptor GATE THEORY

A

1st order nociceptor, 2nd order neuron, interneuron, shut gate by stimulating inhibitory interneuron (opioids can act at presynpatic 1st order, inhibitory interneuron itself; descending PAG inhibitory pathway acts at presynaptic 1st order)

202
Q

PBL - opioids

A

all pain, antagonizes Mu / Kappa / Delta opioid receptors in PAG which sends an descending inhibitory message to synapse in substantia gelatinosum, inhibits neuron by decreased Ca, increased K, decreased adenylcycline

203
Q

PBL - opioid receptors

A

Mu / Kappa / Delta, found in PAG and peripherally, normally acted on by endogenous enkephalons

204
Q

PBL - opioid addiction

A

opioid receptors stimulated by exogenous opioid, when taken away body does not have enough endogenous opioids and withdrawal happens, addiction also happend via ascending pathway to pleasure center, know addicted patient by constipation and small pupils in dark room

205
Q

PBL - prostate cancer metastasis

A

often to bone because venous drainage passes by prostate and then by spine on way back to heart, carries epithelial cells

206
Q

PBL - opioid administration to specific spot

A

prevents opioid action in the brain

207
Q

chronic pain barriers

A

Pt - fear / acceptance / concerns, Provider - training / biases / legal fear, System - time / tools / fragemented / insurance / EMR / reimbursement, Cultural - language / racial bias / access, Legal - controlled sub act, DEA, REMS, medical boards

208
Q

overcoming chronic pain barriers

A

acknowledge bias, evidence based care, team, comprehensive pt. eval, educate, share goals

209
Q

chronic pain managment

A

integrated care, addiction support, conditional Rx, tox screening, pill counts, quantity / frequency of prescribing, longer acting meds, contract, records sharing

210
Q

chronic pain (hyperallgesia, allodynia)

A

glutamate released by 1st order to AMPA receptors on 2nd order, enough glutamate kicks Mg+ off NMDA and Ca+ enters NMDA receptor, Ca+ second messengers cause more AMPA receptors in the cell membrane = less glutamate needed to stimulate pathway

211
Q

hyperallgesia

A

excessive pain

212
Q

allodynia

A

pain from a stimulus that should not be painful

213
Q

sympathetic control of eye

A

dilator pupillae muscle (pupil dilation), superior tarsal muscle in upper eye lid

214
Q

parasympathetic control of eye

A

sphincter pupillar muscle (pupil constriction), ciliary muscle

215
Q

facial / ophthalmic vein anastomoses

A

how infections spread to dural venous sinuses

216
Q

superior tarsal muscle

A

in upper eyelid, innervated by postganlionic sympathetic fibers from superior cervical ganglion, elevates eyelid

217
Q

optic disc appears choked

A

ICP

218
Q

olfactory stimuli : gustatory stimuli

A

10,000 (1,000 receptors) : 5

219
Q

olfaction

A

chemical stimuli, 1,000 receptor proteins, separated in multiple dimensions to give 10,000 orderants, sense receptor is on 1st order neuron (unlike all other senses), 1st order neurons replaced regularly, few receptor types on an olfactory neuron

220
Q

gustation

A

chemical stimuli, 5 tastants - sweet, sour, salty, bitter, umami

221
Q

steps of olfactory transduction

A

oderant -> diffuses through mucus layer by olfactory binding protein -> receptor on 1st order neuron membrane -> activated g protein (Golf) messanger -> adenylate cyclase (effector protein) -> increases cAMP -> opens ligand gated cation channels -> Na+ entry -> area depolarizes (graded potential) -> neuron depolarizes (action potential)

222
Q

labelled line coding (homunculus) in olfaction

A

receptor 1st order neurons segregated by type at 2nd order synapse in olfactory bulb - creates an odourtypic map

223
Q

olfactory inhibition

A

response to one odor decreased by another similar odor

224
Q

olfactory redundancy

A

different odorants can activate same receptors

225
Q

olfactory receptor patterns

A

patterns of stimulation allow 1,000 receptors to code of 10,000 ordorants

226
Q

lateral inhibition in olfaction

A

occurs in olfactory bulb to sharp response and definition of olfactory map

227
Q

gustation receptors

A

taste cell receptors are scattered equally throughout the tongue, the old taste map is wrong, different papillae can be seen in different places on the tongue

228
Q

bitter

A

transduced by gustducin activation

229
Q

salty

A

transduced by Na+ through ion channel

230
Q

sour

A

transduced by H+ through ion channel

231
Q

sweet

A

transduced by gustducin activation

232
Q

umami

A

transduced by gustducin activation

233
Q

steps of gustation transduction

A

no chaperoning protein - through mucus membrane -> gustducin g protein receptor (effector protein) -> ligand gated nonspecific cation channel -> depolarized area (graded potential) -> voltage gated Ca2+ channels open -> NT release -> primary neuron action potential

234
Q

bitter / sweet / umami

A

no chaperoning protein, diffuses through mucus membrane on its own

235
Q

flavour

A

combination of smell, taste, and texture; patients with anosmia often complain of agustia too

236
Q

peripheral hypogustia

A

rhinitis (cold), cystic fibrosis (saliva)

237
Q

neuroepithelial anosmia

A

chemical burn of receptors, head trauma to cribriform plate

238
Q

central anosmia / agustia

A

stroke, schizophrenia (hallucinations)

239
Q

Parkinsons

A

loss of chemosensation due to loss of dopamine in CNS

240
Q

increased sensory stimulation

A

causes increased amplitude of receptor potentials

241
Q

efferent means

A

going away from neuron

242
Q

afferent means

A

coming into neuron

243
Q

corneal reflex

A

sensory of cornea via V1 triggers motor to close eye via CN VII

Neuro Big Ideas (3 decks)

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