CNS 3 Flashcards
(99 cards)
1
Q
Detects angular and linear acceleration of the head
A
Vestibular system
2
Q
The vestibular organ consists of 3 _____, _____, & ______.
A
Semicircular canals, utricle, saccule
3
Q
Gelatinous structure that embeds the cilia on the hair cells
A
Cupula
4
Q
Smaller cilia
A
Stereocilia
5
Q
A single long cilium
A
Kinocilium
6
Q
Stereocilia bending toward kinocilium
A
Depolarization (excitation)
7
Q
Stereocilia bending away from kinocilium
A
Hyperpolarization (inhibition)
8
Q
Chorda tympani
A
Branch of cranial nerve VII (salty & sweet taste)
9
Q
Posterior 1/3 of tongue.
Nerve for sour & bitter taste
A
Glossopharyngeal (IX)
10
Q
Cranial nerve that detects noxious or painful odors like ammonia
A
CN V (trigeminal)
11
Q
Knee jerk is _____ in upper motor neuron lesion and _____ in lower motor neuron lesion
A
Increased; decreased
12
Q
Ib afferent stimulates inhibitory interneuron in spinal cord that inhibits alpha motoneurons and causes relaxation of contracted muscle
A
Golgi tendon reflex
13
Q
Prevents muscle from replacing for some time
A
Afterdischarge
14
Q
Ipsilateral flexion, contralateral extension
A
Flexor-withdrawal reflex
15
Q
Sleep-wake cycle is controlled from?
A
Suprachiasmatic nucleus of hypothalamus
16
Q
NREM stages
A
Stage 1: light sleep (5%)
Stage 2: deeper sleep (45%)
Stage 3-4: deepest (25%); bed wetting, sleepwalking, & night terrors
17
Q
How can you decrease stage 4 sleep?
A
Benzodiazepines and Imipramine
18
Q
REM
A
25% Every 90 min Beta wave Increased & variable pulse Dreams Tremendous loss of muscle tone Erections
19
Q
What condition is characterized by problem of insufficient sleep despite an adequate opportunity for sleep?
A
Insomnia
20
Q
This is an intense and irresistible urge to sleep during daytime activities
A
Narcolepsy
21
Q
Obstruction of respiratory airways during sleep
A
Sleep apnea
22
Q
In this condition REM sleep is entered directly from waking state and there is profound reduction of muscle tone and paralysis. This results fall on ground and inability to move
A
Cataplexy
23
Q
Sleep apnea d/t extreme obesity
A
Pickwickian syndrome
24
Q
The stage of sleep related to bed wetting
A
3 & 4
25
Where is the primary motor cortex located?
Precentral gyrus (area 4)
26
The primary motor cortex is composed of pyramidal cells whose axons make up the______
Corticospinal tracts
27
Allows conscious control of precise, skilled, voluntary movements
Primary motor cortex
28
Controls learned, repetitious, or patterned motor skills
Coordinates simultaneous or sequential actions
Involved in planning and mental rehearsal of movement
Premotor cortex (area 6)
29
The most important output pathway from motor cortex to spinal cord
Relay on inter neurons and anterior horn cells of spinal cord
Pyramidal (corticospinal) tract- upper motor neurons
30
Signs of upper motor neuron lesions
Spastic paralysis, increased tendon reflexes, + bibinski sign
31
Signs of lower motor neuron lesion
Atrophy, flaccid paralysis, absent tendon reflex, - babinski sign
32
Non-arousal d/t damage to RAS
Coma
33
Damage to brain above cerebellum & brainstem
Upper extremities flexion and lower extremity extension
Decorticate rigidity
34
Damage to brainstem and cerebral lesions
Arms and legs extended
Mechanical ventilation require
Decerebrate rigidity
35
Superior most part of motor cortex (4) controls the movement of ?
Foot
36
The postganglionic neurons that pass through gray rami are what type of fibers?
C fibers
37
Hemisection of spinal cord
Brown-Sequard’s Syndrome
38
Findings below lesion of Brown-Sequard’s Syndrome
Ipsilateral UMN signs (corticospinal tract)
Ipsilateral loss of fine touch, vibration, proprioception (dorsal column tract)
Contralateral loss of light touch, pain, temperature (spinothalamic tract)
Ipsilateral loss of ALL sensations at level of lesion
LMN signs at level of lesion
39
Horner’s syndrome is d/t the destruction of what? And causes loss of ________ tone and predominant ________ tone
Stellate (superior cervical) ganglion; sympathetic, parasympathetic
40
S/sx of lesion above T1 (Horner’s syndrome)
```
Ptosis (drooping of eyelids)
Anhidrosis (absence of sweating)
Miosis
Enophthalmos
Flushing, high temp
Nasal congestion
```
41
Autonomic dysreflexia/hyperreflexia occurs from spinal cord injury where?
At or above T6
42
Unopposed sympathetic outflow of NorEpi, Beta hydroxylase, and Dopamine
Autonomic dysreflexia
43
S/sx of autonomic dysreflexia below level of lesion
Hypertensive crisis
Headache
Vasoconstriction
Skin pallor
44
S/sx of autonomic dysreflexia above level of lesion
Bradycardia d/t baroreceptor reflex
Profuse sweating
Vasodilation
Skin flushing
45
Anesthesia considerations for autonomic dysreflexia
```
Prevent further cord damage
High dose steroid
Head stabilization
Monitor BP, CVP, PCWP
Regional & deep general anesthesia
```
46
Control balance and eye movements
Vestibulocerebellum
47
Planning and initiation of movement
Pontocerebellum
48
Control rate, force, range, and direction of movement
Spinocerebellum
49
Layers of cerebellum
1. Granular layer
2. Purkinjie cell layer- outputs are inhibitory
2. Molecular layer
50
Clinical disorders of cerebellum- ataxia
Lack of coordination, intention tremors
| Poor execution of movement, inability to perform alternating movements
51
Basal nuclei consists of ______, ______, ______, & ______.
Striatum
Globes pallidus
Subthalamic nuclei
Substantia nigra
52
Modulates thalamic outflow to motor cortex to plan & execute smooth movements
Many synaptic connections are inhibitory & use GABA
Basal Nuclei
53
Lesion of subthalamic nucleus
Release of inhibition- wild, flinging movements (hemiballismus)
54
Lesion of striatum
Release of inhibition- Huntington’s dz (dancing movements)
55
Lesion of substantia nigra
Destruction of dopamine producing neurons - Parkinson’s dz
Overall inhibitory
Lead-pipe rigidity, tremors, and reduced voluntary movements
56
MAO-B inhibitor
Selegiline (deprenyl)
| Increased dopamine level in brain
57
Right hemisphere is dominant in?
Facial expression
58
Left hemisphere is dominant in? Lesion will cause?
Language; aphasia
59
Damage to Broca’s Area causes ______ in which speech & writing is affected by understanding is intact.
Motor aphasia
60
Damage to Wernicke’s Area causes _____ in which there is difficulty understanding written or spoken language
Sensory aphasia
61
Bilateral lesion of ______ block the ability to form new long-term memory
Hippocampus
62
Aspiration with multi-orificed catheter placing tip ____ the SVC
2cm below
63
Aspiration with single-orificed catheter placing tip ___ the SVC
3cm above
64
What position for tx of venous air embolism after posterior fossa surgery
Left lateral position, head 15 degrees down
65
Position for seated posterior fossa surgery
Knee at heart level and neck not hyperflexed
66
Avoid what in venous air embolism
Nitrous oxide
67
Total volume of CSF
150 ml
68
Formation of CSF by choroid plexus epithelium and ependymal cells =?
500ml/day @ 30ml/hr
69
CSF=Blood
Na
Cl
HCO3
Osmolarity
70
CSF < Blood
```
K
Ca
Glucose
Cholesterol
Protein
```
71
CSF> Blood
Mg
| Creatinine
72
Pathway of CSF
Choroid plexus> Lateral ventricle > foramina of Monro > 3rd ventricle > aqueduct of sylvius > 4th ventricle > foramina Lushka or foramina magendie > subarachnoid space of spinal cord > brain > arachnoid villi
73
Normal brain oxygen requirements = ___ of total body oxygen to produce ATP
ml/min?
ml/g?
20%; 50 ml/min; 3.5ml/100g of brain tissue
74
Irreversible brain damage occurs in ?
3-8 min
75
A decrease in __ degree Celsius would decrease ___ of CMRO2
1; 6%
76
H ions cause ____ of cerebral blood vessels
Vasodilation
77
Hypoxia cause _____
Vasodilation, increased CBF
78
Cerebral perfusion pressure is regulated by?
MAP (pushing blood into brain)
| ICP (keeps the blood out)
79
An increase in ICP equal a ____ in CPP and CBF
Decrease
80
Normal CPP
70-100 mmHg
81
Irreversible brain damage occurs at?
CPP < 25 mmHg
82
Decrease in CPP causes?
Vasodilation
83
Increase in CPP causes?
Vasoconstriction
84
CBF is directly proportional to PCO2 b/w
20-80 mmHg
85
___ % increase in CBF for each mmHg PCO2
2
86
___ % increase in CBF per 1 degree C
5-7
87
Normal ICP
5-15 mmHg
88
Signs of intracranial HTN
```
Irregular respiration
Bradycardia
HTN
Ipsilateral III CN compression- ipsilateral fixed dilated pupil
Cushings triad
```
89
Cushings triad
Irregular respiration, bradycardia, HTN
90
Reduce ICP by:
```
Fluid restriction
Corticosteroid
Hyperventilation
Thiopental for induction
AVOID Ketamine
Head-up position
Diuretics
CSF drainage
Avoid PEEP
Hypothermia
```
91
Promotes cerebral steal
Vasodilator or Hypoventilation (increased PCO2)
92
Heat loss is controlled by?
Anterior hypothalamus
93
```
Most common primary brain tumor
Grave prognosis
<1yr life expectancy
Found in cerebral hemisphere
Resection, radiation & chemo
```
Astrocytoma
94
Relatively rare intracranial tumor
| Slow growing
Oligodendroglioma
95
Found in the 4th ventricle
Can cause hydrocephalus
Poor prognosis
Ependymoma
96
2nd most common primary brain tumors
Occurs in convexities of brain and parasagittal region
Arise from arachnoid cells external to brain (NOT dura)
Slow growing
Resectable
Meningioma
97
Most commonly prolactinoma
Bitemporal hemianopia “tunnel vision”
Hyper or hypo pituitarism are sequelae
Pituitary adenoma
98
3rd most common primary brain tumors.
Schwann cell origin; often localize to CN VIII (acoustic)
Resectable
Schwannoma
99
Stimulation leads to contraction of the bulk of skeletal muscle
a-motor neuron
