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Neuro > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Aqueous humor is produced by what structure?

A

the ciliary epithelium

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2
Q

Aqueous humor is able to drain from the eye when what is true about the ciliary muscle and trabecular meshwork?

A

the ciliary muscle is contracted and tension in the trabecular meshwork is high

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3
Q

What anterior eye structures receive parasympathetic innervation?

A

the sphincter pupillae and ciliary muscles

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4
Q

What anterior eye structure expresses alpha-adrenergic receptors?

A

the radial pupillae muscle

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5
Q

What anterior eye structure expresses beta-adrenergic receptors?

A

the ciliary epithelium

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6
Q

Sympathetics do what to pupil diameter?

A

dilating it

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7
Q

Is the accomodated eye best for seeing near or far objects?

A

near

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8
Q

Describe the accomodated eye.

A
  • constricted pupil
  • rounded lens
  • contracted ciliary muscle
  • relaxed zonular fibers
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9
Q

When the ciliary muscle is contracted, what happens to the lens?

A

it becomes rounder

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10
Q

Is a rounder lens better for seeing far or near objects?

A

near

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11
Q

Aqueous humor drains faster in response to stimulation by what division of the ANS?

A

parasympathetic

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12
Q

Describe all the changes in the anterior eye associated with parasympathetic stimulation.

A
  • near vision
  • accomodated eye
  • round lens
  • constricted pupil
  • contracted ciliary muscle
  • contracted sphincter pupillae muscle
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13
Q

Describe all the changes in the anterior eye associated with parasympathetic stimulation.

A
  • far vision
  • unaccommodated eye
  • flat lens
  • dilated pupil
  • relaxed ciliary muscle
  • contracted radial pupillae muscle
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14
Q

What division of the ANS stimulates lacrimation?

A

parasympathetic

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15
Q

What is carbachol?

A

a direct muscarinic agonist

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16
Q

What is physostigmine?

A

an indirect muscarinic antagonist (AChE inhibitor)

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17
Q

How do opiates elicit a constricted pupil?

A

via a central mechanism that inhibits radial pupillae contraction

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18
Q

What is tropicamide?

A

a muscarinic antagonist used to open the pupil for an opthalmic exam

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19
Q

What is mydriasis?

A

dilated pupil

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20
Q

What is miosis?

A

constricted pupil

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21
Q

What is phenylephrine?

A

a direct alpha-adrenergic agonist

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22
Q

What is timolol?

A

a beta-adrenergic antagnoist

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23
Q

Cocaine has what effect on the ANS of the eye?

A

it is an indirect adrenergic agonist

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24
Q

What medication can be used to treat open angle glaucoma?

A

timolol, a beta-adrenergic antagonist

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25
Q

How can we medically control derangements of pain conduction?

A

with anti-epileptics

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26
Q

Fast pain is carried via what class of sensory afferent fibers?

A

A(delta)

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27
Q

Fast pain is carried by what division of the spinothalamic tract?

A

neothalamic

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28
Q

In addition to the thalamus, the paleothalamic tract projects where?

A
  • periaqueductal grey
  • reticular formation
  • limbic system
  • hypothalamus
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29
Q

Visceral pain is conducted by what class of sensory afferent fibers?

A

C fibers

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30
Q

Abnormal pain can be due to what four derangements?

A
  • sensitization
  • conduction
  • modulation
  • perception
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31
Q

What is reflex sympathetic dystrophy?

A

a derangement of sensitization seen after periods of immbolization

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32
Q

What is trigeminal neuralgia?

A

a derangement of conduction in which focal demyelination leads to cross talk between bare axons

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33
Q

What is post-herpetic neuralgia?

A

a derangement of pain modulation in which there is too little non-pain input to the brain for gate-control theory

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34
Q

Describe the pathway for descending pain modulation.

A
  • cortex
  • periaqueductal grey matter (enkephalin neurons)
  • nucleus raphe magnus in medulla (NE/5HT neurons)
  • dorsal horn interneurons (enkephalin neurons)
  • A(delta) and C fibers
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35
Q

What NTs mediate the descending pain modulation pathway.

A
  • periaqueductal neurons are enkephalin-producing
  • nucleus raphe magnus are NE/5HT-producing
  • the interneurons in the dorsal horn are enkephalin-producing
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36
Q

What are four methods for decreasing peripheral sensitization of pain?

A
  • early mobility
  • capsacin
  • NSAIDs
  • steroids
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37
Q

What classes of medications improve descending modulation of pain?

A
  • antidepressants (NE/5HT)

- opiods

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38
Q

What are the components of the reticular activating system?

A
  • the pontomesencephalic reticular formation
  • the intralaminar and thalamic reticular nuclei
  • the cortex
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39
Q

The reticular formation is divided into what three columns?

A
  • raphe nuclei (midline)
  • medial (magnocellular)
  • lateral (parvocellular)
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40
Q

What defines alpha, beta, theta, and delta waves?

A
  • beta 12 or more Hz
  • alpha: 8-11 Hz
  • theta: 5 to 7 Hz
  • delta: less than 5 Hz
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41
Q

In what state is alpha activity present in the brain?

A

a relaxed wakefulness with eyes shut

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42
Q

In what parts of the brain are alpha waves seen?

A

the back of the brain

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43
Q

Why is the thalamic reticular nucleus important?

A

it is the pacemaker of the brain responsible for synchronicity

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44
Q

The thalamic reticular nucleus works by modulating what?

A

the dorsal thalamus and thalamocortical circuits

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45
Q

Thalamic reticular neurons utilize what NT?

A

GABA

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46
Q

The thalamic reticular nucleus is modulated by what input?

A

that from the reticular activating formation

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47
Q

What sort of brain activity is seen in stage 1 sleep?

A

theta waves replace alpha waves

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48
Q

What sort of brain activity is seen in stage 2 sleep?

A

sleep spindles and k-complexes

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49
Q

What is synchronized EEG activity?

A

high-amplitude, low-frequency waves

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50
Q

What physiologic changes throughout the body accompany slow-wave sleep?

A
  • low metabolic rate
  • diminished sympathetic output (BP and HR drop)
  • minimal muscle tone and reflexivity
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51
Q

How is atonia achieved during REM sleep?

A

active inhibition of alpha motor neurons

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52
Q

What is the reticulo-spinal tract?

A

the descending tract responsible for inhibiting alpha motor neurons during REM sleep

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53
Q

Describe the involvement of the cholinergic system in sleep.

A

the basal forebrain is responsible for initiation of sleep

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54
Q

Describe the involvement of the noradrenergic system in sleep.

A

the locus ceruleus initiates wakefulness and REM sleep

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55
Q

Describe the involvement of the serotonergic system in sleep.

A

the median raphe of the reticular formation helps initiate slow wave sleep

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56
Q

Initiation of sleep, initiation of REM, and initiation of slow wave sleep are associated with which NT systems and structures, respectively?

A
  • initiation: cholinergic, basal forebrain
  • REM: noradrenergic, locus ceruleus
  • slow-wave: serotonergic: median raphe
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57
Q

What is the suprachiasmatic nucleus?

A

a brain structure responsible for monitoring light/dark cycles and setting the circadian rhythm

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58
Q

What is melanopsin?

A

a photopigment expressed by some retinal ganglion cells that are light sensitive and project to the suprachiasmatic nucleus

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59
Q

How does the suprachiasmatic nucleus set the circadian rhythm?

A

by stimulating the pineal gland to secrete melatonin

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60
Q

What is the retinohypothalamic tract?

A

a tract formed by photosensitive retinal ganglion cells projecting to the suprachiasmatic nucleus

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61
Q

Congenital cataracts are associated with what?

A

rubella infection

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62
Q

Which genetic conditions are associated with cataract formation?

A
  • Wilson’s disease

- Lowe syndrome

63
Q

What medication can cause cataracts?

A

steroids

64
Q

What is posterior capsular opacification?

A

the most common complication of cataract surgery in which bits of lens remain and proliferate on the posterior capsule

65
Q

What are the signs and symptoms of closed-angle glaucoma?

A
  • pain, blurred vision, seeing halos
  • nausea/vomiting
  • mid-dilated pupil with edematous cornea
  • history of hyperopia
66
Q

Glaucoma causes vision loss in what pattern?

A

peripheral to central

67
Q

What are drusens?

A

yellow deposits under the retina that form in those with macular degeneration

68
Q

What are AREDS vitamins?

A

those to treat and prevent instances of dry macular degeneration

69
Q

What is the treatment for neovascularizing ocular problems?

A

anti-VEGF injections

70
Q

What is panretinal photocoagulation?

A

ablation of the peripheral retina to limit the eye’s oxygen requirements and slow diabetic proliferative retinopathy

71
Q

What are the common causes of cherry red spot?

A
  • Tay-Sachs
  • Niemann Pick
  • Sandhoff
72
Q

What is exophthalmos?

A

a bulging of the eye due to any disease that increases the orbital contents

73
Q

Exophthalmos is a common feature of what endocrine disorder?

A

Grave’s disease

74
Q

Sties are caused by what?

A

acute folliculitis of teh Meibomian or Zeis glands

75
Q

The most common malignancy of the eyelid is what?

A

BCC

76
Q

What is pink eye?

A

a bacterial conjunctivitis

77
Q

What organisms are most likely to cause pink eye?

A

H. influenza and S. pneumoniae

78
Q

What is epidemic keratoconjunctivitis?

A

a viral conjunctivitis caused by adenovirus

79
Q

What is the leading cause of blindness worldwide?

A

chlamydia trachomitis

80
Q

What is opthalmia neonatorum?

A

a gonococcal infection of the eye acquired by newborns as they pass through the birth canal

81
Q

Yellow matting in the morning is a feature of what ocular disease?

A

pink eye

82
Q

What is keratoconjunctivitis sicca?

A

dry eye

83
Q

Dry eye is a feature of what syndrome?

A

Sjogren

84
Q

What populations are most likely to be affected by idiopathic dry eye?

A
  • post-menopausal women

- young, pregnant women

85
Q

What is pterygium?

A

a growth of vascularized conjunctival tissue over the iris

86
Q

Blue sclera is a feature of what pathology?

A

osteogenesis imperfecta

87
Q

How do corneal abrasions often present?

A

individual thinks they have something in their eye but can’t get anything out

88
Q

What is the “chinese character” sign?

A

a sign of herpes simplex corneal ulcers

89
Q

What are corneal degenerations and corneal dystrophies?

A
  • degenerations are non-familial

- dystrophies are familial and bilateral

90
Q

Senile cataracts is thought to be caused by what?

A

misfolding of lens fibers due to UV exposure

91
Q

Optic nerve cupping is a feature of what disease?

A

glaucoma

92
Q

What form of vasculitis principally affects the eyes?

A

Takayasu aortitis

93
Q

What is retinopathy of prematurity?

A

a proliferative retinopathy induced by high oxygen tension in premature infants

94
Q

What is toxocara spp.?

A

an organism contracted from dogs or cats and likely to cause retinitis in children

95
Q

What are the two types of retinal detachment?

A
  • rhegmatogenous: with a tear

- non-rhegmatogenous: without an associated tear

96
Q

Non-rhegmatogenous retinal detachments are most often caused by what?

A

choroiditis or melanoma

97
Q

What is papilledema?

A

edema of the head of the optic nerve due to elevations of CSF pressure

98
Q

Always check for papilledema before performing what other procedure?

A

spinal tap

99
Q

Retinoblastomas are typically present in what age group?

A

infants, younger than two years old

100
Q

Children diagnosed with a retinoblastoma are at risk for what other malignancy?

A

osteosarcoma

101
Q

What features of the eye constitute the uvea?

A

the iris, choroid, and ciliary body

102
Q

What is the first clinical sign of retinoblastoma?

A

no red reflex

103
Q

What is the most common malignancy of the eye?

A

a metastasis that involves the uveal tract

104
Q

Uveal tract melanomas typically metastasize to where?

A

the liver

105
Q

What is panophthalmitis?

A

a term used to describe inflammation of the interior eye that extends into the uvea and sclera

106
Q

What is endophthalmitis?

A

a term used to describe inflammation of the interior eye involving the vitreous

107
Q

Autism is a neurodevelopmental disorder affecting what?

A

social abilities and communication

108
Q

What is cerebral palsy?

A

a neurodevelopmental disorder affecting motor abilities

109
Q

What is the definition of intellectual disability?

A
  • intelligence below average that affects daily living

- IQ below 70 with an onset before age 18

110
Q

What are some causes of intellectual disability?

A
  • down’s
  • fragile X
  • Rett syndrome
  • lead exposure
  • neonatal injury
111
Q

What are the diagnostic criteria for autism?

A

impaired socialization detected before age three

112
Q

What is autism spectrum disorder?

A

includes people with more mild forms of autism that are detected after age three

113
Q

What is the theory of the mind?

A

the ability of humans to understand the mental state of others

114
Q

Why is early socialization normal even in autistic individuals?

A

because it is automatic and requires no consciousness

115
Q

What are the four types of cerebral palsy? What sort of lesion causes each?

A
  • spastic (upper motor neuron damage)
  • ataxic (cerebellar damage)
  • dyskinetic (basal ganglia damage)
  • hypotonic
116
Q

What is dyskinetic cerebral palsy?

A

that due to basal ganglia damage and characterized by rigidity and abnormal involuntary movements

117
Q

What are the features of ataxic cerebral palsy?

A

severe appendicular and gait ataxia

118
Q

What is the germinal matrix?

A

an area within the brain that populates the cerebral cortex with neurons during development

119
Q

Why is the germinal matrix clinically important?

A

it has a very fragile capillary network and is prone to ischemic strokes and hemorrhage in babies born before 32 weeks gestation

120
Q

Which infants are likely to suffer a germinal matrix hemorrhage?

A

those born before 32 weeks gestation when the GM involutes

121
Q

Hypoperfusion is most likely to affect what brain regions in preterm infants?

A

watershed zones (periventricular)

122
Q

What is periventricular leukomalacia?

A

ischemia in the watershed territory of preterm infants

123
Q

Vascular insult to the brain in the perinatal period is most likely to result in ischemia where in the brain?

A

the periventricular region

124
Q

A brain scan will reveal what in infants that suffered a periventricular leukomalacia?

A

diminished white matter

125
Q

Why is diplegic cerebral palsy most common?

A

because it CP often results from a periventricular hemorrrhage or leukomalacia and those events affect the leg fibers first, and the arm fibers second due to anatomy

126
Q

A vascular insult in a preterm infant is most likely to cause what kind of cerebral palsy?

A

a diplegic spastic cerebral palsy

127
Q

A vascular insult in a term infant is most likely to cause what kind of cerebral palsy?

A

a hemiplegic spastic cerebral palsy

128
Q

Intellectual disability is most likely to result from what sort of vascular insult?

A

a pure hypoxia affecting the cerebral cortex

129
Q

Dyskinetic CP is most likely to result from what sort of vascular insult?

A

a pure hypoxia affecting the basal ganglia

130
Q

Ataxic CP is most likely to result from what sort of vascular insult?

A

a pure hypoxia affecting the purkinje cells of the cerebellum

131
Q

What is kernicterus?

A

a bilirubin-induced neurologic dysfunction

132
Q

Kernicterus is likely to cause what developmental encephalopathy?

A

dyskinetic cerebral palsy

133
Q

List the brain structures most sensitive to hypoxia?

A
  • cerebral cortex
  • basal ganglia
  • cerebellum
134
Q

Where are the watershed areas in the adult brain?

A

in the cortex

135
Q

Problems with sleep initiation are often linked to what emotional disturbance?

A

anxiety

136
Q

Problems staying asleep are often linked to what emotional disturbance?

A

depression

137
Q

What is parasomnia?

A

abnormal behavior during sleep

138
Q

What is sleep inertia?

A

problems transitioning from sleep to wakefulness

139
Q

Failure of REM paralysis often precedes the onset of what disease?

A

Parkinson’s

140
Q

What are extrinsic circadian rhythm disorders?

A

those due to changes in the environment (e.g. time zone change)

141
Q

What is non-24-hour sleep-wake syndrome?

A

a person that is unable to entrain their circadian rhythm to the environment (often due to blindness)

142
Q

Excessive daytime sleepiness can be due to what four things?

A
  • inadequate quantity
  • inadequate quality
  • narcolepsy
  • idiopathic
143
Q

What might cause poor quality of sleep and therefore excessive daytime sleepiness?

A
  • parasomnia

- sleep apnea

144
Q

What are the features of narcolepsy?

A
  • daytime sleepiness
  • cataplexy
  • sleep paralysis
  • hypnagogic hallucinations
145
Q

What is cataplexy?

A

abrupt and reversible loss of muscle tone elicited by strong emotion

146
Q

What is abnormal about the sleep cycle of individuals with narcolepsy?

A

they often enter REM as they are falling asleep rather than going to stage 1

147
Q

Narcolepsy is thought to arise from dysfunction regulating what process?

A

REM sleep

148
Q

What are hypnagogic hallucinations?

A

an almost dream like hallucination that accompanies sleep paralysis

149
Q

Convulsions are often associated with what other event?

A

syncope

150
Q

What is a seizure?

A

a clinical manifestation of abnormal synchronous discharge of cerebral cortical neurons

151
Q

How are seizures categorized?

A

focal (partial)
- with retained awareness (simple)
- with impaired awareness (complex)
- focal to bilateral (secondary generalized)
generalized (primary generalized)
- motor: tonic-clonic (grand mal) or myoclonic (brief jerk)
- nonmotor (absence)

152
Q

What is epilepsy?

A

an intrinsic tendency of the brain to have seizures

153
Q

What is the diagnostic criteria for epilepsy?

A

two or more unprovoked seizures

154
Q

Focal epilepsies are usually due to ___ while generalized epilepsies are due to ___.

A
  • focal: structural damage

- generalized: genetic predisposition

Neuro (7 decks)

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