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Exam 2 Flashcards

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1
Q

Most ocular trauma

A

People <30 yrs
Occurs at home
With blunt or sharp objects
Without eye exam

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2
Q

With trauma induced lid injuries you must rule out

A

Associated ocular injury (globe rupture, hyphema)

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3
Q

Laceration danger zones

A

The eyelid margin (tarsus-must realign to avoid nothing, if not done correctly can cause exposure or epiphoria)
The lacrimal outflow system (Lacrimal canaliculus, must stent to avoid excess tearing)
Upper Eyelid retractors (see orbital fat, must get CT orbits)

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4
Q

What do we do for animal bites?

A

Copious irrigation
Debridement nonviable tissue
Early primary wound closure
Broad spectrum antibiotics

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5
Q

What do we do form chemical/contact injuries?

A

Irrigate to pH neutrality
Topical anesthetic
Identify acid vs base

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6
Q

Thermal injury

A

Usually affects eyelid
Must lubricate to preserve tissue viability
Late phase treatment

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7
Q

Abrasions and foreign bodies

A

Illuminate, anesthetic, fluorescein
Lid eversion
Topical cycloplegia, antibiotic, eye patch

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8
Q

Topical anesthetics should only be used

A

During exam or procedure
Never prescribed

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9
Q

How do we detect abrasions and foreign bodies

A

Fluorescein

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10
Q

Suspect a ruptured globe if

A

Severe blunt trauma
Sharp object
Metal on metal contact
High velocity injury

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11
Q

Warning signs of open globe

A

Laceration
Pigment
Pupil irregularity
Sub conjunctival hemorrhage
Uveal prolapse
Hyphema
Lens opacity/dislocate

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12
Q

Suspect an open globe if

A

Bullous sub conjunctival hemorrhage
Uveal prolapse
Peaked or keyhole pupil
Hyphema
Vitreous hemorrhage
Post-traumatic lens opacity
Low IOP
Anterior chamber is collapsed
Seidels sign
Gross inspection/symmetry

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13
Q

What do you do if the globe is ruptured?

A

Shield eye
No topical meds
Antiemetic narcotics
Tetanus prophylaxis
IMMEDIATELY refer to ophthalmologist

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14
Q

If you see post-traumatic proptosis you should suspect

A

Hemmhorage or orbital emphysema (air from sinus)
Must get CT orbits

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15
Q

What do you do for orbital hemorrhage?

A

Systemic corticosteroids
Ocular hypotensive agents
****Canthotomy/cantholysis
Therapeutic orbital floor fracture

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16
Q

Signs of an orbital fracture

A

Globe dystopia (enophthalmos)
Diplopia
Blepharoptosis
Hypoesthesia

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17
Q

Orbital imaging

A

CT (assessing for fractures, metallic FB may exist)
Orbit protocol (axial, coronal, sagittal)

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18
Q

Orbital fractures features

A

Fractures
Orbital heme
Orbital air
Optic neuropathy
Globe injury

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19
Q

Medical treatment for orbital fractures

A

Antibiotics
Nasal decongestion
Oral steroids
Abstinence from aspirin, NSAIDS, nose-blowing

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20
Q

Indications for surgery for orbital fractures

A

Enophthalmos
Restrictive diploplia
Defect >50% of orbital wall

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21
Q

Traumatic optic neuropathy is associated with

A

Closed head injury, mid facial fracture
Common in motor vehicle accidents

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22
Q

Traumatic optic neuropathy features

A

Loss of vision
Ipsilateral afferent pupillary defect (swinging flashlight test)

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23
Q

Flashing lights and floaters are associated with

A

Retinal detachment

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24
Q

A peaked iris toward an area of sub conjunctival hemorrhage indicates

A

Ruptured globe

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25
A laceration medial to the punctum may injure
The lacrimal canaliculus
26
The uvea includes
Iris Ciliary body Choroid
27
The fundus includes
Retina Macula Optic nerve
28
What is the dividing structure for pre-septal and post-septal infections
Orbital septum
29
_ is the key for red eye and pink eye
History (onset, progression, other people with eye condition, trauma, contact lenses, recent URI, visual disturbances, discharge, itching, photophobia, PMH, medications, allergies)
30
Key exam points for red or pink eye
Visual acuity Pattern of hyperemia Classify discharge Detect opacities Fluorescein Anterior chamber depth Pupil irregularities IOP proptosis
31
Red flags for people with red/pink eye
Blurred vision Sever pain Photophobia Colored halos
32
Reduced visual acuity indicates
Keratitis Iridocyclitis Glaucoma NEVER in simple conjunctivitis
33
Ciliary flush indicates
Ciliary or iris involvement
34
Corneal o pacification indicates
KP Diffuse haze Corneal ulceration
35
Other red flags
Pupil abnormalities elevated IOP proptosis Strabismus
36
Blepharitis
Inflammation along eyelid margin associated with normal skin flora If angular associated with Moraxella Burning sensation, mattering Toothpaste sign Swollen meibomian gland Treatment: remove debris with soap If staph use bacitracin
37
Hordeolum
Acute bacterial infection of sebaceous glands External (Zeus, moll) Internal (meibomian) Painful pustule formation (tenacious/gritty/purulent secretions) Treatment: massage and compress Antibiotics if systemic infection
38
Chalazion
Hail stone (hard, painless lump) Chronic lipo-granulomatous inflammation of Meibomian gland(may develop from internal Hordeolum) Same management as Hordeolum
39
Dacryocystitis
Inflammation of the lacrimal sac caused by flow obstruction and subsequent bacterial infection Erythema and edema over the lacrimal sac (mucopurulent drainage expression on massage of punctum) Treatment: ophthalmology consult, broad spectrum antibiotics Surgical correction
40
Dry eye syndrome
Tear defiency, abnormal tear film, Meibomian dysfunction Burning history, foreign body sensation Associated with aging Treatment: artificial tears, lubricating ointment, punctual occlusion
41
Bacterial Conjunctivitis
Self-limited ****Think purulent discharge Neonates-gonococcal conjunctivitis Adults-pseudomonas, proteus, bacillis Treatment: antibiotics
42
Conjunctivitis: Chlamydia
Trachomatis- leading cause of blindness in poverty stricken Adults- chronic, low grade hyperemia with inferior bulbar and palpebral mounds Elementary bodies on direct fluorescent AB stain Treatment: antibiotics, treat sexual partners for adults
43
Neonatal conjunctivitis
chlamydial: from infected cervix, onset >7 days after birth Gonococcal: <3 days after birth
44
Viral conjunctivitis
Most common caused of acute red eye- often adenovirus Watery/mucoid discharge
45
Allergic conjunctivitis
Itchy eyes with watery discharge Management: Vasoconstrictors H1 receptor antagonists NSAIDs Mast cell stabilizer H1 receptor antagonist and Mast cell stabilizer
46
Corneal abrasion
Pain, blurred vision, photophobia, tearing, miotic pupil Fluorescein stain Treatment: lubrication
47
Pterygium and pinguecula
Pterygium grows onto cornea, pinguecula does not Associated with UV exposure
48
Acute angle closure glaucoma
Ciliary flush, corneal edema, fixed mid dilated pupil, elevated IOP EMERGENCY: beta blocking agent to lower IOP Alpha agonists- decrease aqueous production and increase outflow Laser iridiotomy
49
Anterior Uveitis
Autoimmune reaction Inflammation of iris and ciliary muscle Periocular pain and photophobia URGENT referral to ophthomologist
50
Keratitis
Blurred vision, photophobia, periocular plain, FB sensation Ciliary flush with white cloud, irregular light reflex Dendritic ulcer on fluorescein stain= Herpes EMERGENT Referral Avoid steroids Risk of corneal perforation and endophthalmitis
51
Episcleritis and scleritis
Focal inflammation Ocular pain and hyperemia Urgent referral Systemic corticosteroids Severe ocular pain and and hyperemia Thinning and meting do sclera
52
Preseptal cellulitis
Pain, swelling edema Prevent spread to post-septal issues
53
Post-septal or orbital cellulitis
Bacterial infection of periocular tissue Papilledema Admit and ophthalmology consult Antibiotics
54
Thyroid eye disease
Retraction of upper lid Impaired eye movement and muscle edema (IR most common) May have systemic signs of hyperthyroidism Bring thyroid levels to normal range
55
Orbital tumors
Gradual development of proptosis, diplopia
56
Red eye conditions that are non-vision threatening
Conjunctivitis Corneal abrasions Small foreign body Pterygium
57
Red eye conditions that are vision threatening
Orbital cellulitis Scleritis/uveitis Chemical injury Keratitis Acute angle closure glaucoma Penetrating trauma/cranial perforation Corneal ulcerations
58
Optical coherence tomography
Uses tight to take cross sectional pictures of the retina In Vivo histology Takes a series of photos which can be used to create a 3D reconstruction
59
Central Retinal Artery Occlusion
Proximal to bifurcation at the optic nerve Severe vision loss, retinal whitening, cherry red spot, vessel attenuation Risk factors: HTN, coronary artery disease, smoking Associated with concurrent or future strokes
60
Branch retinal artery occlusion
Distal branch occlusion Segmental retinal whitening and vessel attenuation Emboli may or may not be present
61
Central rental vein occlusion
Painless vision loss Diffuse retinal homorrhage, disc edema, cotton wool spots Risks: HTN, vascular disease, >65
62
Branch retinal vein occlusion
Retinal hemorrhages, educate, cotton wool spots
63
Hypertensive retinopathy
Acute: malignant HTN/HTN emergency Chronic: leads to arteriosclerosis and predisposes to vascular occlusions and macroaneurysms
64
Rental findings in HTN emergency
Optic disc edema, diffuse retinal hemorrhages, cotton wool spots, macular star Bilateral **when patient presents with bilateral, adult, decline in vision must check BP Admit patient and reduce BP
65
Chronic HTN
no symptoms Can predispose to vein occlusions, arterial occlusions, macular edema, macroaneurysms Flame hemorrhage, AV nicking, cotton wool spots Control BP
66
Age related macular degeneration
Leading cause of blindness in developed world in people >50 Dry: non-exudative or non-neuvascular Wet: exudative or neuvascular Advanced ages, smoking, family history, Northern European ancestry Symptoms: blurry vision, decreased reading ability, metamorphopsia, central scotoma Advanced: Charles Bonnet syndrome Peripheral vision unaffected
67
AMD pathophysiology
Inflammation or oxidative stress leading to accumulation of drusen Deprivation of retinal pigment epithelium oxygen and nutrients leading to retinal atrophy
68
Dry AMD
Drusen and pigmentory changes NO hemorrhage Progressive Blindness may develop in late AMD
69
Stages of Dry AMD
Early: Few drusen, Good vision (20/20 to 20/40) Intermediate: many large drusen, vision still good (20/30 to 20/80) Late: drusen, pigmentary changes center involving, vision 20/100-20/200
70
Dry AMD treatment
Stop smoking AREDS2 vitamins to strop progression to Wet AMD Amsler grid testing to detect transition to Wet AMD
71
Wet, Exudative or Neovascular AMD
Damage to outer retinal layers to neovascular growth into the retina Hemmorage, subretinal fluid, macular edema, presence of retinal pigment epithelial detachments
72
Wet AMD pathophysiology
Choroidal neuvascularizzation forms due to brakes in Bruch’s membrane caused by drusen Subrential fluid, hemorrhage, and potentially irreversible scarring New onset distortion and loss of vision
73
Complications of Wet AMD
Disciform scar
74
Wet AMD treatment
Anti-VEGF agents to mediate growth of neovascular vessels (induction therapy: 3 injections at 4-6 week intervals, if dry extend interval between injections)
75
Normal vitreous structure
Collagen fibrils separated by hyaluronan
76
Posterior vitreous detachement
Hyaluronan loss with age Collagen fibrils collapse and vitreous shrinks (remain adherent Flashes and floaters, blurry vision
77
Retinal tears
Breaks in retina created through localized traction of vitreous gel Retinal defect breaks suction that attaches retina Most occur as a result of posterior vitreous detachment (can be caused by trauma, myopia) Symptoms are identical to those of posterior vitreous detachment Treatment: laser retinopexy/cryotherapy
78
Retinal detachment
Separation of the neurosensory retina from the RPE 3 types: Rhegmatogenous (break/tear most common) -need to determine if macular is attached or detached Tractional (diabetes associated) Exudative Symptoms: flashes and floaters + painless black curtain, variable blurred vision Treatment: surgical retinal specialist (find breaks, plug breaks, seal breaks)
79
Sclera buckle
External repair Retinal detachment repair Pushes eye wall inward to relieve traction and re-apples retina to eyewall
80
Pars Plana Vitrectomy
Internal repair Remove vitreous gel and lose areas of adherer to relieve traction Hold retina in place with gas bubble Use laser to self the retina and seal breaks
81
Categories of Systemic Illness related to Eye disease
Infectious Autoimmune, non-infectious, inflammatory Neoplastic Vascular disease Toxic Hereditary Metabolic/nutritional
82
Diabetic retinopathy is the leading cause of _
blindness in working age
83
Diabetic Retinopathy pathogenesis
Multi factorial Hyperglycemia leads to endothelial damage (retinal capillary changes, basement membrane thickening) Loss of pericytes Endothelial barrier decompensation leads to leakage and edema
84
Consequences of proliferative diabetic retinopathy/traction retinal detachment
Preretinal hemorrhage TRD
85
Screening guidelines for diabetics
Type 1- annual screening for diabetic retinopathy beginning 5 years after disease onset Type 2- screening at time of diagnosis and annually thereafter
86
Diabetic retinopathy treatment:
NPDR: better glycemic and BP control, risk factor modification PDR: panretinal photocoagulation +/- intravitreal injection Diabetic macular edema: anti-VEGF Traction retinal detachment or vitreous hemorrhage: surgical vitrectomy
87
Anti-VEGF for diabetic macular edema
Injected into vitreous Decrease vascular permeability leading to resolution of macular edema
88
What is Uveitis?
Inflammation of uvea (choroid, ciliary body, iris) Defined by location affected (different causal conditions)
89
Warning signs of uveitis
Pain Photophobia Eye redness Vision loss
90
Infectious disease associated with uveitis
TB Syphilis Herpes simplex and varicella zoster retinitis CMV toxoplasmosis West Nile Zika Ebola virus
91
Chorodial tubercle
Tuberculosis
92
Syphilitis-associated uveitis
Can present many ways Conjunctivitis, scleritis, interstitial keratitis, granulomatous is uveitis, large keratic precipitates, iris nodules ****Chorioretinitis Vasculitis, vitritis Manage with IV penicillin
93
Retinal whiting is associated with
VZV
94
Endogenous endophalmitis
Infection in the body can hematogenously spread to eye Decreased vision, red, injected eye Anterior chamber and vitreous inflammation, pain Management: find systemic source, IV/intraocular antibiotics, surgery as indicated
95
Treatment of non-infectious uveitis
Prednisone If reoccurs/suboptimal response restart steroid taper an and add anti metabolic Add biologic
96
HLA-B27 associated anterior uveitis
Ankylosing spondylitis Pain, redness, photophobia Visual acuity decline Slit lamp-posterior synechiae Macular edema
97
Sarcoidosis uveitis
Bilateral granulomatous panuveitis Ocular involvement work up: CT chest, ACE, lysozyme, iCa Non-casceating epitheloid granuloma s PFTs and gallium scan
98
SLE retinal vasculitis
IV solumedrol, prednisone, IV cyclophosphamide Secondary complication: retinal neovascularization
99
Ocular malignancy
Usually uveal metastasis Men-lung Women-breast
100
Most common primary intraocular tumor
Choroidal melanoma
101
Metastatic lesions are likely to develop in
Choroid
102
Hydroxychloroquine toxicity causes
Bull’s eye maculopathy Ring of RPE depigmentation, sparing fovea Paracentrol scotoma that affects reading and eventually central vision Screening: Humphrey visual field 10-2, multifocal ERG, spectral domain optical coherence tomography scan, fundus autofluorescence ****flying saucer sign
103
Checkpoint inhibitor uveitis
Sunset glow fundus Headache, tinnitus, vitiligo
104
Space occupying lesions result in_
Proptosis
105
Thyroid ophthalmopathy
Most common cause of exophthalmos Immune mediated Extraocular (recuts muscle) enlargement due to accumulation of extracellular matrix proteins, endomysial edema, fibrosis, fatty infiltration and lymphocytic cell infiltration *****spares tendons and fat
106
Idiopathic orbital inflammation
Acute onset pain and proptosis Immune disorder May be ini or bi lateral May affect all of orbit or confined to lacrimal gland or eye muscles *****Tendons and fats involved Diagnosis of exclusion
107
Chalazion
Tensor nodule Lipid granuloma
108
Basal cell carcinoma
Most common malignancy of eyelid Lower lid Locally invasive
109
Acute purulent conjunctivitis
Bacterial or viral Redness, itching, exudate Neutrophils
110
Pinguecula/ Pterygium
Yello-white pacification Actinic damage in sun-exposed areas Solar elastosis Must rule out actinic induced tumors
111
Squamous cell carcinoma
Near limbus in situ: confined to epithelium SCC invaded through basement membrane into stroma
112
Keratitis/ulceration
Due to wide variety of pathogens (bacteria, fungi, viruses-Herpes simplex, parasites- ancanthameoba) Lots of neutrophils present
113
Keratoconus
Bilateral degeneration Progressive thinning and ectasia Conical shape generating astigmatism *****central thinning + breaks in Bowman’s layer
114
Fuchs Endothelial Dystrophy
Most common dystrophy Inherited disorder with incomplete penetrance 5th or 6th decade Common transplant indication Thickened Descemet’s membrane + Guttae Loss of endothelial cells (stroma and Bullous keratopathy)
115
Glaucoma
Evelvated IOP Open angle- increased resistance in open angle Angle closure- iris adheres to the trabecular meshwork
116
Cataract
O pacification of crystalline lens Common cause of vision loss Age- related results primarily from opacification of the lens nucleus (nuclear sclerosis)
117
What is the uvea
Highly vascularized, pigmented (melanocytes) Iris, ciliary body, choroid
118
Uveal melanoma
Most common primary intraocular malignancy of adults ****not associated with UV light Due to maturations in GNAQ and GNA11 Deletion in BAP1 Usually incidental finding or present due to visual symptoms related to retinal detachment Prognosis depends on size, cell type, proliferative index, cytogenetic profiles Hematogenous spread to liver (80% 5 year survival rate)
119
Histology of uveal melanoma
Spindle cell Mixed Epitheloid (worse prognosis)
120
Arteriolosclerosis
Thickening of vascular wall
121
Macular star
Exudate from damages vessels in outer plexiform layer in malignant hypertension
122
Hypertension histology features
Macular star Arteriosclerosis Nerve layer infarct (occlusion of retinal arterioles, cotton-wool spot)
123
Pathology of nonproliferative diabetic retinopathy
Retinal edema, exudates, hemorrhages, capillary microaneurysms, loss of pericytes
124
Proliferative diabetic retinopathy
New vessel sprouting on surface of retina Retinal neuvascularization (when breaching the internal limiting membrane) Vitreous hemorrhage and scarring
125
Age related macular degeneration
Leading cause of blindness in elderly Loss of central (fovea) vision Can be atrophic or exudative
126
Atrophic AMD
Dry Atrophy of RPE Photoreceptor degeneration
127
Neuvascular AMD
Wet Choroidal neovascularization Hemmhorrhage and scarring Detached RPE
128
Retinoblastoma
Most common primary intraocular tumor worldwide Most common intraocular tumor of children Leukocoria Loss of both RB alleles
129
Retinoblastoma pathology
Microscopic: Encephloid white Microscopic: -blue:blue cell tumor, hyper cellular, high nuclear to cytoplasmic ratio, numerous mitoses and karyorrhectic debris -pink: necrosis -purple: dystrophic calcifications Flexner-Wintersteiner rosettes
130
Anterior ischemic optic neuropathy
Similar to stoke -ischemia: transient interruption to blood flow, transient loss of vision -infarct: total interruption in blood flow, permanent loss of vision Bilateral infarcts have been reported in temporal arteritis
131
Giant cell arteritis
Chronic granulomatous inflammation of large to small sized arteries in the head Most common vasculitis in elderly adults Ophthalmic artery occlusion may lead to supper blindness Diagnosis based on temporal artery biopsy Treat with high dose steroids
132
Pathology of giant cell arteritis
****Transmural chronic inflammation with giant cells Intimal thickening Disruption of internal elastic lamina
133
What is the role of the somatosensory system
Mediates multiple senses with distinct neuroanatomical pathways
134
The dorsal column and medical lemniscus system, trigeminal lemniscus pathway senses
Fine touch, vibration, conscious proprioception
135
The anterolateral system, trigeminothalmic tract pathway senses
Crude touch, pain, temperature
136
Somatosensation for the body starts with the
DRG
137
Somatosensation for the face starts with the
Trigeminal ganglion
138
DRG neurons
Carry somatosensory info from body to spinal cord Pseudounipolar shape Peripheral processes of a DRG neuron extension into the skin via spinal nerve Central processes of a DRG neuron extend into the spinal cord
139
DRG cell bodies
Differ in size
140
small DRG cell bodies are
Associated with pain and temp
141
large DRG cell bodies are associated with
Fine touch and proprioception
142
Pain and temp are associated with which system
Anterolateral system -free nerve endings -pain receptors
143
Mechanoreceptors are associated with which system
Dorsal column, medial lemniscus system -meissners corpuscles -Merkel cells -pacinian corpuscles Ruffini’s corpuscles
144
Proprioception is associated with which system
Dorsal column/medial lemniscus (conscious) or system or spinocerebellar tracts (unconscious) -muscles spindles -Golgi tendon organ
145
Pain and temp DRG neurons have peripheral processes with
Free nerve endings
146
Meissners corpuscles account for _ receptors on finger tips
60%
147
Merkel cells account for _ of receptors on finger tips
30%
148
Pacinian corpuscles account for _ of receptors on finger tips
3%
149
Proprioception is mediated by
Muscle spindles and the Golgi tendon organs Information is transmitted to cerebral cortex (conscious) and cerebellum (unconscious)
150
How does primary somatosensory axon diameter and myelination affect conduction
Speed conduction
151
A Dermatomal loss indicates
Damage to a spinal nerve root
152
A more restricted pattern of loss will occur
If a specific peripheral nerve is affected
153
DRG axons project into _ and ascend _
Dorsal column (formed by fasciculis cuneatus and gracious) Ipsilaterally
154
Fasciculus cuneatus can be found in
Cervical spinal cord
155
The gracile column carry’s sensation from
The legs
156
The cuneate nucleus carries sensation from
The upper body
157
The dorsal column increase in width from
Sacral to cervical levels
158
Axons of gracile and cinematic fasciculi terminate
In the medulla in gracile and cuneate nuclei
159
Crossing axons of the gracile and cuneate nuclei give are known as
Internal accurate fibers
160
Ascending axons after crossing are known as
Medial lemniscus
161
Lesions of the medial lemniscus at any level will result in loss of fine touch and conscious proprioception on the _ side
Contralateral
162
Neurons in the VPL project via _ to _
Posterior limb of the internal capsule to the post-central gyrus of the cerebral cortex
163
Neurons in the primary somatosensory cortex project to
Other cortical areas
164
Somatosensory radiations originate from _ and project to _
Originate from VPL of thalamus Project to primary somatosensory cortex (post central gyrus)
165
The anteriolateral system conveys
Pain and temp information for the body
166
DRG neurons have axons that enter the spinal cord through _ and terminate _
Lissauer’s tract In the substantia gelatinousa of the dorsal horns
167
Pain information reaches the _ in the medulla and pons as well as the _ in the midbrain
Reticular formation Periaqueductal gray
168
Lesions of the spinothalamic tract at any level will result in
Loss of pain and temperature on the opposite side of the body
169
Neurons in the VPL project via _ to the _
Posterior limb of the internal capsule Post-central gyrus of the cerebral cortex
170
_ and _ are activated by painful stimuli which may be related to _
Cingulate gyrus and insula Suffering
171
_ receives pain information and projects to the reticular formation which provides feedback to the spinal cord
PAG
172
The PAG projects to
Reticular formation
173
What nuclei are part of the reticular formation and project to the dorsal horn?
Nuclei magnus and paragigantocellularis
174
Neuropathic pain
Described as burning Common in diabetes Can also occur after herpes zoster Irritation of the neurons but no tissue damage
175
Due to plasticity pain may occur as a result of inappropriate reorganization at higher levels of the nervous system
Phantom limb pain
176
Trigeminal ganglion neurons have axons which enter_ and terminate in the _
Pons Main trigeminal nucleus
177
Neurons in the main trigeminal nucleus have axons which cross the midline and ascend in
The trigeminal lemniscus
178
Neurons in the VPM project via _ to the _
Posterior limb of the internal capsule Post-central gyrus of the cerebral cortex
179
Neurons of the VPM project to
The lateral post central gyrus
180
Neuronal cell bodies in the trigeminal ganglion have axons that travel from
The PNS as the trigeminal nerve, enter the pons and descend as the spinal trigeminal tract
181
The spinal trigeminal nucleus nconveys
Pain and temp info
182
Axons from the spinal trigeminal nucleus ascend to _ via _
VPM trigeminothalamic tract
183
Neuronal cell bodies in the spinal nucleus of V have axons that cross and ascent to _ as the _
VPM Trigeminothalamic tract
184
Neurons of the VPM project to the
Postcentral gyrus
185
Mesencephalic nucleus of V
Displaced ganglion cells project to principle sensory nucleus and motor V Proprioceptive information for the face
186
The Mesencephalic trigeminal nucleus conveys
Proprioceptive information for the face
187
Lower motor neurons innervate
Muscles
188
Lesions in lower motor neurons cause
Flaccid paralysis
189
Upper motor neurons terminate on
Lower motor neurons
190
Lesions of upper motor neurons cause
Spastic paralysis
191
CN motor nuclei and the ventral horn of the spinal cord are
Lower motor nuclei
192
Pyramidal neurons in the pre central gyrus, red nucleus, superior colliculus, vestibular nuclei, and reticular nuclei are
Upper motor nuclei
193
Brain stem indirect motor control nuclei are
Upper motor neurons
194
Final common pathway
Lower motor neurons
195
The ventral horn in large in the _ and _
Cervical and lumbosacral enlargements
196
Lower motor neurons in the spinal cord are _ organized
Somatotopically organized The motor nucleus to axial muscles are located in the ventromedial cell group The motor nucleus to the limb muscles are in the dorsolateral cell group
197
Lower motor neurons in the ventral horn have axons that exit in the
Ventral roots
198
Lower motor neuron axons form _ with the muscle cells
Neuromuscular junctions
199
Lower motor neurons are found in _
The nuclei of the cranial nerves with motor components (axons terminate in muscles in the head and neck)
200
Edinger-westphal, superior and inferior salivary and dorsal motor vagal nuclei are part of the _ system
Parasympathetic
201
Rabies
Affects lower motor neurons Spreads retrograde
202
Polio
Affects lower motor neurons Picornavirus tranmitted via fecal oral route From gut it spreads to spinal cord and destroys neurons in ventral horn Can also kill lower motor neurons in brainstem
203
Spinal muscular atrophy
Neuroregeneration disorder that affects lower motor neurons in the ventral horn Loss of function mutation in the SMN1 gene (encodes survival motor neuron proteins Results in muscular atrophy
204
The primary motor cortex is in the
Precentral gyrus
205
The primary motor cortex receives info from
Premotor and supplementary motor cortex
206
The primary motor nucleus contributes to the
Corticospinal and corticobulbar tracts
207
The secondary motor cortex receives information from
Basal ganglia via the ventral anterior nucleus of the thalamus
208
The premotor cortex receives information from the cerebellum via
The ventral lateral nucleus of the thalamus
209
The supplementary and premotor cortex project to _ and contribute to _
The primary motor cortex and contributes to the corticospinal tract
210
The cell bodies of the corticospinal and corticobulbar tracts originate in the
Pre-central gyrus of the cerebral cortex
211
The corticobulbar axons terminate in lower neurons of the
Ventral horn of the spinal cord
212
Most projections of the corticobulbar tract are
Bilateral (except facial and hypoglossal nuclei)
213
The projection from the corticospinal tract are primarily
Contralateral
214
The axons from the corticobulbar tract terminate in the brainstem and are not found
In the pyramids of the medulla or the spinal cord
215
The lateral area of the precentral gyrus controls _ and gives rise to _
Face and head movements Corticobulbar tract
216
All of the precentral gyrus except the lateral portion give rise to the
Cortispinal tract
217
Axons of the corticospinal and corticobulbar tracts are located in _ of the cerebral peduncle
The middle 1/3
218
Where are the lower motor neurons of the corticospinal tract?
Ventral horn of the spinal cord
219
Where are the upper motor neurons of the corticospinal tract located?
Precentral gyrus
220
The upper motor neuron axons of the corticospinal tract form the
Corticospinal tract
221
The axons of the lower motor neurons of the corticospinal tract form the
Ventral root
222
Axons from pyramidal neurons in layer 5 of the periphery grove rise to
Corticospinal and corticobulbar tracts
223
The precentral gyrus contains the
primary motor cortex
224
Corticospinal and corticobulbar tract axons descend in
The posterior limb and the gene of the internal capsule, respectively
225
The corticospinal tracts and corticobulbar tracts descend in the _ of the cerebral peduncles
Middle 1/3
226
Where are the cerebral peduncles are located
On the ventral surface of the midbrain
227
The corticospinal tract is somewhat dorsal in the _ but ventral in the _ and _
Pons Midbrain, medulla
228
The corticospinal tract crosses in the _
Pyramidal decussation of the caudal medulla
229
Pathway of the corticospinal axons
Descent in corticospinal tract Decussation in the caudal medulla Becomes lateral corticospinal tract as it travels to lateral funiculus of spinal cord
230
The lateral corticospinal tract primary influences
Lateral LMNs
231
The ventral corticospinal tract primarily influences
Medial LMNs
232
Most corticobulbar projections are bilateral except
Facial motor nucleus of the pons- partial bilateral input (control forehead) and completely crossed input (neurons controlling lower face) Hypoglossal nucleus receives contralateral input from the corticobulbar tract
233
The hypoglossal nucleus of the medulla receives primarily _ input from the corticobulbar axons
Contralateral
234
Craniobulbar lesion vs CN VII lesion
CN VII lesion- cannot wrinkle forehead corticobulbar lesion- can wrinkle forehead
235
Corticobulbar tracts do not extend past
Brainstem
236
Corticospinal tracts get smaller as it extends _
Causally toward the spinal cord
237
The frontal eye fields mediate
Lateral gaze and saccades
238
Frontal eye fields project to contralateral
PPRF
239
The PPRF projects to ipsilateral
CN nuclei III, IV, VI via MLF
240
Internuclear neurons in abducens nucleus project to the
contralateral occulomotor nucleus via MLF to the coordinate lateral and medial recuts muscles
241
Brainstem upper motor neurons receive input from _ and project to _
Cerebral cortex Lower motor neurons
242
Brainstem upper motor neurons
Superior colliculus- tectospinal tract Red nucleus- Rubrospinal tract Vestibular nuclei-vestibulospinal tracts Reticular formation- reticulospinal tracts
243
Propriospinal pathways
Communication between different segments of spinal cord allowing for movement coordination
244
Neurons in the superior colliculus (UMNs) project to the contralateral spinal cord via _ and influence _
Tectospinal tract (travels in the ventral funiculus) Medial LMNs
245
Neurons of the red nucleus of the midbrain project to the contralateral spinal cord via _ and influence _
Rubrospinal tract (travel in lateral funiculus) Influence lateral LMNs (facilitate flexion of upper extremities)
246
Vestibular nuclei project to the spinal cord via
Vestibulospinal tracts (travel in the ventral funiculus) Medial- projects bilateral from medial vestibular nuclei to medial LMNs, end at cervical levels Lateral- projects ipsilaterally from lateral vestibular nucleus to lateral LMNs, facilitates extensors and postural stability
247
Neurons in the reticular formation project to the spinal cord via _ and facilitates _
Ventral funiculus Postural control
248
Voluntary control of limbs, especially fine movements of the hands
Corticospinal
249
Voluntary control of facial movement, chewing swallowing and speech
Corticobulbar
250
Coordination of head and neck with eye movements
Tectospinal
251
Facilitation of upper limb flexors
Rubrospinal
252
Facilitation of extensors, postural stability
Lateral vestibulospinal Pontine reticulospinal
253
Inhibition of spinal segment reflexes
Medullary reticulospinal
254
ALS results in
Degeneration of both upper and lower motor neurons (degeneration of corticospinal tracts) Gain of function mutation in SOD1 gene
255
A reflex arc consists of
Afferent limb and efferent limb
256
A sensory neuron either synapses _ or _
Directly on lower motor neuron Interneuron that synapse on lower motor neuron
257
A functioning upper motor neuron is not necessary to elicit
A reflex (may result in abnormal reflex)
258
The neuronal cell body responsible for afferent limb of spinal cord reflex is in
Dorsal root ganglion
259
The neuronal cell body responsible for efferent limb of spinal cord reflex is in
Anterior (ventral horn
260
Medial muscles are represented in the _ ventral horn Lateral muscles are represented in the _ ventral horn Flexors are represented _ within the ventral horn Extensors are represented _ within the ventral horn
Medial Lateral Dorsally Ventrally
261
The afferent limb of the spinal can involve sensory info from
Muscle spindles, golgi tendon organs, or pain receptors
262
Pain may stimulate a _ reflex
Withdrawal
263
Flexor withdrawal reflex
Pain info enters dorsal horn Interneuron process leads to either motor excitation or inhibition Activation of flexors on same size as pain and extensors on opposite side
264
Components of stretch reflex
Afferent: DRG peripheral process in contact muscle spindle and central process in contact with inter neurons or lower motor neurons in ventral horn Efferent: lower motor neurons in the ventral horn with axons that innervate muscles
265
Sensory receptors of muscles and tendons
Golgi tendons Muscle tendons
266
Motor neurons of muscles and tendons
Alpha (extrafusal)- movement Gamma (intrafusal)- cause contraction allowing muscle spindles to respond to change in extrafusal muscle
267
Damage to upper motor neurons _ lower motor neurons resulting in _ stretch reflexes
Disinhibits Increased
268
Re-emergence if Babinski sign in adults is indicative of
Upper motor damage
269
Bladder control
Autonomic reflex involving the spinal cord descending input from the brain
270
Reflex incontinence occurs when
Spinal cord in completely damages from rostral to sacral levels No way to control reflex because you have no sensory input
271
_ spinal cord lesions can destroy the spinal micturation reflex
Sacral
272
Lesions _ causes decorticate posturing
Above the red nuclei
273
lesions _ cause decerebrate posturing
Below the red nuclei but above the vestibular nuclei
274
The basal ganglia are involved in
Cognition Emotion Movement
275
The caudate, putmen, and accumbens
Striatum
276
Putmen and globes pallidus
Lenticular nucleus
277
The caudate nucleus is found
Within the lateral ventricle
278
The globus pallidus is divided into
Globus pallidus externa and interna
279
_ is the part of the limbic system involved in addiction
Nucleus accumbens
280
What seperates the external and extreme capsules
Claustrum
281
What supplies the basal ganglia
Lenticulostriate arteries (branch off of middle cerebral arteries)
282
The subthalamic nucleus is located
in the diencephalon ventral to the thalamus
283
The substantia Niagara is located in
The mesencephalon
284
The substantia Niagara produces _ and projects to the _ and _ via the _ pathway
Domaine Caudate and putmen Nigrostriatal pathway
285
Damage to the substantia Niagara results in
Parkinson’s disease
286
Huntingtons disease
Enlarged lateral ventricles due to degeneration of striatum Behavior change, cognitive impairment, involuntary movements/neural rigidity (indirect pathway is disrupted) Autosomal dominant (CAG repeat)= polyglutamine tracts, genetic anticipation
287
Wilson disease
Copper accumulation in the basal ganglia Kayser-Feisher Rings Autosomal recessive, loss of function mutation in ATPB7
288
What is the effect of a lesion of the subthalmic nucleus in the diencephalon
Hemiballismus (hyperkinetic movement on contralateral side of body
289
Lesion of substantia nigra causes
Hypokinetic disorders like Parkinson’s
290
Dopamine is excitatory for _ and inhibitory for _
D1 receptors (direct pathway) D2 receptors (indirect pathway)
291
Activation of the direct pathway _ from the cerebral cortex
Increases output
292
Activation of the indirect pathway _ from the cerebral cortex
Decreases
293
Parkinson’s pathways
Death to neurons in the substantia nigra leads to decreased inhibition of globus pallidus interna and increased inhibition of globus pallidus externa leading to increase inhibition increased inhibition of the thalamus by globus pallidus interna and less output to the cerebral cortex leading to hypokinetic disorders
294
Degradation of GABA neurons in the striatum causes
Huntington disease
295
Inputs to the cerebellum
pons via middle cerebral peduncle Spinal cord via inferior cerebral peduncle
296
The cerebellum sends info to the _ via the _
Thalamus Superior cerebellar peduncle
297
Damage to the cerebellum causes
Ataxia and other forms of incoordination
298
The cerebellar peduncles are
Collections of axons
299
The vermis and paravermis make up the
Spinocerebellum
300
Lateral cerebellar hemisphere
Cerebrocerebellum
301
Flocculonodular lobe
Vestibulocerebellum
302
The cerebellar cortex receives input from
Spinal cord, vestibular nuclei, inferior olive, pons
303
Layers of the cerebellar cortex
304
Mossy fibers terminate on
Granule cells
305
Mossy and climbing fibers project contralaterally to
Deep nuclei
306
Deep cerebellar nuclei project
Out of the cerebellum
307
The inferior Olivia ray nucleus projects to the contralateral Purkinje cells via _ as _
The inferior cerebellar peduncle Climbing fibers
308
Axons originating from the frontal cerebral cortex travel in the _ of the cerebral peduncle
Medial 1/3
309
Axons originating from the rest of the temporal lobe cortex travel in the _ of the cerebral peduncle
Lateral 1/3
310
The superior cerebral peduncle is comprised of axons that leave the cerebellum from _ and decussate in the _
Dentate nucleus Midbrain
311
Blood supply of cerebellum:
Superior cerebellar artery- superior Cerebellum, superior cerebellar peduncle, part of middle cerebellar peduncle Anterior inferior cerebellar artery - Ventral an inferior Cerebellum, middle cerebellar peduncle Posterior cerebellar artery- inferior and posterior Cerebellum, inferior cerebellar peduncle
312
Lesion of the vestibulocerebellum
Impaired balance and wide based gait Nystagmus Symptoms due to damage to vestibular system
313
Lesions of the spinocerebellar pathways result in
Stomping gate due to lack of Proprioceptive information which makes patients unaware of where there legs and feet are without visual input
314
Lesions of the cerebrocerebellum pathway
Intention tremor Difficulty with skilled movements Suptle nystagmus
315
Other symptoms of cerebellar damage
Dysarthria Abnormal swallowing
316
Symptoms of lesions of cerebellar pathways will be _ to the side of the cerebellum
Ipsilateral
317
Lateral Medullary syndrome
Stokes involving branch of vertebral artery or posterior inferior cerebellar artery Ipsilateral pain and temp loss for the face Contralateral pain and temp loss for body Ataxia
318
_ is a common cause of cerebellar damage
Alcohol
319
Freidreich ataxia
Autosomal recessive GAA trinucleutude repeat in intron 1 of MRDA gene Accumulation of iron in mitochondria kills neurons with long axons Spasticity loss of fine touch (corticospinal, tract), vibration (dorsal root ganglion loss), ataxia, including stopping gate (dorsal root ganglion and spinocerebellar tract loss)
320
Ataxia telangiectasia
Loss of function mutation in ATM gene Purkinje cells degenerate after birth leading to ataxia Problems with balance, hand coordination, eye movements, and slurred speech
321
Spinocerebellar ataxias
Autosomal dominant Abnormal gait, incoordination of limbs, abnormal eye movements, degeneration of cerebellum
322
The vestibular apparatus is located
Within the labyrinth of the temporal bone
323
The orientation of the semicircular canals is different to
Allow for representation of the 3 special dimensions
324
The vestibular apparatus consists of
Urticle, saccule, 3 semicircular ducts
325
Sensory receptors for the vestibular apparatus are found
In five locations: 3 ampullae associated within the semicircular canals, the urticle, and the saccule
326
The crisae within the three ampullae detect
Rotational acceleration
327
The maculae within the urticle and the saccule detect
Linear acceleration and head position
328
he air cells are the _ of the vestibular system and are found in both _ and _
Sensory receptors Cristae of the ampullae and the maculae of the urticle and saccule
329
Hair cells are embedded in the
Cupula of the ampullae
330
The cristae of the ampullae detect
Rotary movement
331
The maculae of the utricle and saccule detect
Linear motion and gravity Utricle- acceleration in the horizontal plane Saccule- acceleration in the verticals plane
332
The vestibular nuclei are located
In the dorsal lateral medulla and pons
333
The vestibular cortex is composed of
Parietal operculum and posterior insula
334
_ is critical for coordinated movements
Medial longitudinal fasciculus
335
The abducens nucleus projects to the contralateral occulomotor nucleus via _ so the muscles of the two eyes are in sync
MLF
336
Which lobe of the cerebellum interacts with the vestibular system to produce coordinated eye movements
Flocculonodular lobe
337
The lateral vestibulospinal tract facilitates
Extensor muscles
338
Damage to the vestibulospinal system may cause difficulty with
Balance and motor coordination (ataxia)
339
Disturbances of the vestibular system can result in
Nausea and vomiting (vomiting center in the medulla)
340
The taste pathway is _
Ipsilateral
341
What cranial nerves convey taste information
CN VII, IX, X
342
All cranial nerves conveying taste information contribute to _ and terminate on _
Solitary tract Solitary nucleus
343
Taste buds are in
Papilla
344
How do taste buds work
Fluids enter taste port Microvilli contain taste receptors (salty, sweet, bitter, sour, umami) Receptor cells release transmitters onto afferent nerve fibers
345
Ageusia
Absence of taste
346
Hypogeusia
Decreased taste
347
Dysgeusia
Abnormal taste
348
The olfactory epithelium lines
The superior nasal concha
349
Sustentacular cells are
Supporting cells near olfactory receptor cells
350
Basal cells are
Stem cells that give rise to neurons in adults Located in olfactory epithelium
351
The axons of olfactory receptor neurons form the _ which protects to _ in the olfactory bulb
Olfactory nerve Mitral cells
352
Is the olfactory nerve myelinated?
No but it is ensheathed by Schwann cells
353
The olfactory bulb is part of the
Telencephalon
354
The olfactory stria form the
Olfactory trigone
355
The amygdala projects to _ and is involved in _
Hypothalamus Feeding behavior
356
The piriform cortex is involved in
Fine discrimination of odors
357
The entorhinal cortex is involved in
Associations between odors and memories
358
Anosmia
Absence of smell
359
Hyposmia
Decreased smell
360
Dysosmia
Abnormal smell
361
Kallmann’s syndrome
Anosmia (olfactory nerves do not enter brain Hypogonadal
362
Uncinate fits
Olfactory hallucinations Feelings of unreality
363
Olfactory nerve transection
Loss of smell
364
Age related loss of olfactory receptor neurons
Diminished smell (hyposmia)
365
Loss of smell is one of the first signs of
Parkinson’s Alzheimer’s Other forms of dementia Distinguishing sign of COVID
366
How does COVID affect olfaction
Infection of sustentacular cells where virus replicates
367
Unilateral deafness implies
Unilateral lesion of cochlear nuclei, CN VIII or the choclea
368
The cochlear duct contains
Endolymph
369
Ménière’s disease
Excessive amounts of endolymph Low frequency ringing, hearing loss and dizziness Only one ear is affected
370
Organ of Corti
Contains hair cells which transducer sound waves into neural signals
371
What type of ganglion cells are in the spiral ganglion
Bipolar type I ganglion cells
372
What type of cells are in teh superior Olivia ray complex
Unipolar type II ganglion cells in the spiral ganglion
373
Damage to hair cells can result in
Hearing loss
374
Intensity
Loudness
375
Frequency
Tone
376
High frequencies are represented at the _ of the cochlea while low frequencies are at the _
Base (often loose ability to hear high frequencies with age, also sensitive to toxic drug effects Apex
377
What causes bilateral hearing loss
Aging, toxicity, genetic factors
378
Most frequent mutation in deaf individuals
gap junction protein beta 2 (disruption of hair cell function)
379
What kills hair cells?
Loud noises
380
CN VIII enters the brainstem at the _ and terminates
Junction between the medulla and the pons Cochlear nuclei
381
The caudate nucleus is separated from the putamen by
Anterior limb of internal capsule
382
In Huntington disease the _ are among the earlies to degenerate
Caudate and the putamen
383
Huntington disease
Autosomal dominant Gain of function mutation in HTT Symptoms include chorea
384
The putamen and globus pallidus are seperated from the thalamus by the
Posterior limb of the internal capsule
385
The claustrum seperates the
External and extreme capsule
386
Where is the amygdala located
Anterior temporal lobe
387
The striatum receives inputs from the
Cerebral cortex via corticostriatal pathway Substantia nigra via nigrostriatal pathway
388
Degeneration of dopaminergic neurons in the substantia nigra causes
Parkinson’s disease (problems initiating movements and resting tremor)
389
Unilateral damage of the subthalamic nucleus can result in
Hemiballismus (flinging of the contralateral arm)
390
Wilson disease
Signs related to damage to basal ganglia Autosomal recessive Loss of function in ATP7B Abnormal accumulation of copper Kayser-Fleuscher rings
391
Lesion of the subthalamic nucleus
Hemiballismus (sudden, violent, involuntary movements of limb on contralateral side)
392
Function of the vestibular system
Sensory and motor components that provide information about the position of the head in three dimensional space to the brain Coordinates eye movements and maintains balance
393
Damage to the vestibular system cause
Dizziness, vertigo, imbalance, and nystagmus
394
Three semicircular canals
Anterior, posterior, lateral
395
Sensory cells are located
3 crystal ampullarii in each semicircular canal 2 maculae associated with the utricle and saccule
396
What structures detect movement
Hair cells
397
Sensory information from the vestibular nuclei travels to the cerebellum via inferior cerebellar peduncle
398
Four deep nuclei of the cerebellum
Dentate, emboliform, globose, fastigial
399
Damage to the vermis results in
Truncus ataxia
400
Damage to the cerebellar hemispheres
Impairs skilled movements especially involving the hands (dysmetria)
401
The three main cellular layers in the cerebellar cortex are the
Molecular, Purkinje, and granule
402
Ataxia Telangiectasia
Purkinje cells degenerate in children as a result of a loss of function mutation in ATM gene
403
Damage from the dentate nucleus to the ventral lateral nucleus of the thalamus results in
Intention tremor
404
Where is the reticular formation located
Core of midbrain, medulla, and pons
405
The dendites of the reticular formation
Respond to extreme stimuli
406
Where are the gaze centers located?
In the reticular formation Midbrain- INC, riMLF (vertical gaze) Pons- PPRF (horizontal gaze)
407
The reticular formation acts as _ and projects to _
UMN LMN in the spinal cord
408
The reticular formation coordinates rhythmic movements such as walking via the
Reticulospinal tract
409
What controls swallowing?
Swallowing centers in the reticular formation
410
Emesis is controlled by
Vomiting centers in the reticular formation of the medulla
411
The vomiting center can be activated by
Strong emotion (limbic system) Vertigo (vestibular system) Chemicals from the blood (chemoreceptor trigger zone) Visceral afferents (from the vagus)
412
The vomiting center coordinates emesis by
Causing closure of pharynx, larynx, glottis (via nucleus ambiguus) Gastrointestinal chances (via dorsal motor vagus) Respiratory changes (ventral respiratory group, another reticular formation center)
413
Micturition is controlled by
A center in the pontine reticular formation
414
Voluntary control of micturition
Frontal lobe receives sensory information from thalamus about bladder state The pontine micturition center (reticular formation) receives input from the cerebral cortex and communicates with the spinal cord to trigger emptying of the bladder
415
Reticular formation role in respiration and cardiac function
Nucleus of the solitary tract receives chemo sensory information relevant to cardiac and resp function Cardiac info is transferred to rostral ventral lateral medulla (reticular formation) which sends input to the IML to exert sympathetic control Cardiac info is transferred to nucleus ambiguus (exerts parasympathetic function via vagus) respiratory info is sent to the rostral ventral respiratory group (reticular formation) which projects to the phrenic nucleus via the spinal cord
416
Locus coeruleus
Located in pons, lateral to fourth ventricle Releases noradrenalin (wakefulness, increased attention response, learning)
417
Serotonin-containing neurons
Found in the raphe nuclei of the midbrain, pons, and medulla Involved in sleep-wake cycle Lesion or impairment causes insomnia Also important for mood
418
Pedunculopontine and laterodorsal tegmental nuclei
Acetylcholine pathways Located in the midbrain and project to diencephalon and brainstem
419
Medial septal nucleus
Acetylcholine pathway Projects to the hippocampal formation
420
The nucleus basalis
Acetylcholine pathway Projects widely within the cerebral cortex
421
Acetylcholinergic
Acetylcholine pathway Projections important in mood, sleep, learning
422
Where is the nucleus basalis located
Ventral to the anterior commissure and ventral pallidum
423
The ascending reticular activating system projects to
Hypothalamus and thalamus
424
The reticular formation is important for
Sleep regulation
425
Orexin is involved in
Wakefulness and appetite Mutation= narcolepsy
426
Melatonin regulates
Circadian rhythms
427
The primary somatosensory cortex corresponds to
Postcentral gyrus
428
Premotor cortex corresponds to
Caudal portion of middle frontal gyrus
429
Primary auditory cortex corresponds
Anterior transverse temporal gyrus
430
Primary visual cortex corresponds to
Cuneate and lingual gyri
431
Supplementary motor cortex corresponds to
Caudal portion of superior frontal gyrus
432
3 types of cerebral cortex
Archicortex (3 layers, hippocamplal formation) Paleocortex (3-4 layers, olfactory cortex) Neocortex (6 layers, majority of cerebral cortex
433
Brodmann’s areas
434
Layers of cerebral cortex
435
Information is processed by
Columns in the cerebral cortex
436
3 main types of projections involving cerebral cortex
Projection fiber bundles: connect cortex with sub cortical structures Commissural bundles: connect two cerebral hemispheres Association bundles: connect one area of cortex with another area in the same hemisphere
437
The anterior commisure connects
Olfactory and limbic structures connects two olfactory bulbs and the two amygdala
438
Most information is transmitted between left and right cerebral hemispheres via
corpus callosum
439
Parts of the corpus callosum and their connections
Forceps minor fiber bundle in the genu- connects frontal lobes Rostrum fibers- orbital regions Body- connect parietal and temporal lobes Forceps major fiber bundle in the splenium- connects occipital lobes
440
The left hemisphere is usually dominant for
Language
441
The right hemisphere does
Visual special processing Facial recognition
442
_ is responsible for expressive speech and is located primary within the inferior frontal gyrus of the dominant hemisphere
Broca’s area
443
_ is responsible for receptive speech and is located primarily in the superior temporal gyrus close to the parietal lobe of the dominant hemisphere
Wernicke’s area
444
Planum temporal
Higher order processing center for sound
445
Wernicke and Broca’s areas are connected by
Arcuate fasciculus Lesions result in conduction aphasia
446
Prosody is primarily represented in
Right hemisphere
447
What connects adjacent gyri
Short association fiber, arcuate fibers, or adjacent gyri
448
The uncinate fasciculus connects limbic structures in the
Temporal lobe with the frontal lobe
449
The cingulum connects the _ with _
Cingulate gyrus Limbic
450
Reading involves multiple areas of the brain
Inferior frontal gyrus- vocalization, articulation Parieto-temporal- word analysis Occipito-temporal- word recognition, automaticity
451
People with dyslexia have a greater reliance on structures in the _ lobe
Frontal
452
Some dyslexia has been associated with a neuronal migration disorder called
Periventricular nodular heteropia
453
Gerstmann Syndrome
Dysgraphia Dyscalculia Finger agnosia Left right confusion Lesion on angular gyrus of dominant hemisphere
454
Hemineglect
Lesion in parietal cerebral cortex causes patient to disregard opposite side
455
Prosopagnosia
Facial blindness Damage to right fusiform gyrus
456
Types of dementia resulting from damage to the cerebral cortex
457
The autonomic nervous system is also known as the
General visceral efferent system
458
The ANS acts on
Cardiac and smooth muscle as well as organs
459
ANS divisions
Parasympathetic Sympathetic
460
The parasympathetic system has _ preganglionic axons and _ postganglionic axons
Long Short
461
The sympathetic system has _ preganglionic axons and _ postganglionic axons
Short Long
462
ANS preganglionic neurotransmitter
ACH
463
Parasympathetic postganglionic neurotransmitter
ACH
464
ANS sympathetic nervous system postganglionic neurotransmitters
NE- most tissues Ach- sweat glands Adrenal medulla- releases epinephrine or norepinephrine
465
The cell bodies of postganglionic neurons are located in
Autonomic ganglia (multipolar)
466
What controls the sympathetic and parasympathic nervous systems via projections to preganglionic neurons
Hypothalamospinal tract
467
Preganglionic neuronal cell bodies of the ANS are located in the _ while postganglionic cell bodies are located in the
CNS PNS
468
Preganglionic sympathetic neurons are located in the _
IMLCC at T1-L2
469
Preganglionic myelinated neuron axons exit in the _ and travel in the _ before terminating in _
Ventral roots White ramus Paravertebral or prevertebral ganglia
470
Postganglionic neurons are located in _ and their unmyelinated axons travel within the _
Paravertebral or prevertebral ganglia Gray ramus
471
Sympathetic nervous system Postganglionic neurons are _ Axons are _ and travel in _ They release _ as their neurotransmitter
Multipolar Unmyelinated, gray ramus Noradrenaline
472
Postganglionic sympathetic neurons that innervate sweat glands release _
Ach
473
Central horners syndrome
Miosis, ptosis, anhydrous is
474
The hypothalamus controls the adrenal gland in two ways
Short term- ANS Long term- endocrine
475
Preganglionic neurons of the parasympathetic system are located
In the brainstem and sacral spinal cord
476
The _ is located in the occulomotor complex in the midbrain and is responsible for constricting pupils
Nucleus of Edinger-Westphal (preganglionic parasympathic neurons) Ciliary ganglion (postganglionic parasympathetic neurons)
477
Lacrimation and salivation
Superior salivatory nucleus is located in the pons (preganglionic) Pterygopalatine and submandibular ganglia (postganglionic) Also under control of hypothalamus
478
Dorsal motor nucleus of the Vagus
Medulla Control lung, hearing, gastrointestinal
479
Parasympathic postganglionic neurons are
Multipolar, unmyelinated
480
Presynaptic fibers of the sympathetics synapse
Paravertebral ganglia or prevertebral ganglia
481
Pathways in the sympathetic chain
Ascend then synapse (head, cardiopulmonary, neck, upper limb) Synapse at level (thoracic cardiopulmonary) Descend then synapse (spinal nerves to lower trunk and lower limb) Bypass to synapse in the prevertebral ganglia (innervation for abdominopelvis viscera)
482
Parasympathetics
Craniosacral system
483
Presynaptic parasympathetic fibers
Very long Most synapse with postsynaptic cell bodies in or all wall or target organ EXCEPTIONS: ciliary, pterygopalatine, optic, submandibular
484
The suprarenal gland uses _ as a postsynaptic neurotransmitter
Epinephrine
485
Does the skin have Parasympathetics
No
486
Skin sympathetics
Gray rami to periphreal nerve Contracts arrector pili (Ach/NE) , Vascoconstrictiion (Ach/NE), Increases sweating (Ach/Ach)
487
Eyes sympathetics
Carotid plexus to long and short ciliary nerves Dilation of pupils (Ach/NE)
488
Eyes Parasympathetics
CN III to ciliary ganglion to short ciliary nerve Constricts pupil Contracts ciliary muscle (accommodation) (Ach/Ach)
489
Lacrimal glands sympathetics
Carotid plexus to -deep petrosal nerve -nerve of Pterygoid canal -maxillary nerve -zygomatic nerve -lacrimal nerve Descreases secretion due to vasoconstriction (Ach/NE)
490
Lacrimal glands Parasympathetics
CN VII to nerve of pterygoid canal to pterygopalatine ganglion (synapse) Promotes secretion (Ach/Ach)
491
Salivary gland sympathetic
Via carotid plexus Decreases secretion due to vascoconstriction Thicker secretions (Ach/NE)
492
Salivary glands Parasympathetics
CN IX to optic ganglion CN VII to submandibular ganglion Follows branches of mandibular nerve Makes secretions more abundant and fluid (Ach/Ach)
493
Heart Sympathetics
Cervical and upper thoracic sympathetic ganglia to cardiac plexus Increases heart rate Increases strength of contraction Dilates coronary vessels (Ach/NE)
494
Heart Parasympathetics
Vagus nerve to the cardiac plexus Decreases heart rate Weaker contractions Constriction of coronary vessels (Ach/Ach)
495
Lungs Sympathetics
Upper thoracic sympathetic ganglia to pulmonary plexus Inhibits parasympathic effects Constriction of vessels (Ach/NE)
496
Lungs parasympathics
Vagus nerve to pulmonary plexus Constriction of bronchi Bronchial secretion (Ach/Ach)
497
Splanchnic nerves
Carry autonomic supply to and from viscera Cardiopulmonary- postsynaptic sympathetic to heart and lungs Abdominopelvic- Presynaptic sympathetic to prevertebral ganglia -greater- to celiac ganglia -lesser- to superior mesenteric and aorticorenal ganglia -least- to renal plexus -lumbar- to inferior mesenteric ganglia Sacral- Presynaptic sympathetic to pelvic viscera Pelvic- Presynaptic parasympathics to lower digestive and pelvic viscera
498
Suprarenal medulla sympathetics
T10-L1 spinal cord Through Paravertebral ganglia Splanchnic nerves Through prevertebral ganglia Synapses in suprarenal medulla Releases epinephrine directly into bloodstream (Ach/Epi)
499
Suprarenal medulla Parasympathetics
None
500
Digestive tract sympathies
Splanchnic nerves to prevertebral ganglia Decreases peristalsis Reduces blood supply Contracts internal anal sphincter (Ach/NE)
501
Digestive tract sympathetics
Vagus and pelvic Splanchnic nerves Promotes peristalsis Increases digestive juices Allows for defecation (Ach/Ach)
502
Urinary tract Sympathetics
Splanchnic nerves to prevertebral ganglia Decreases urine formation Maintains urinary continence (Ach/NE)
503
Urinary tract Parasympathetics
Vagus nerve and pelvic Splanchnic nerves Contracts bladder wall Relaxes internal sphincter of the bladder (Ach/Ach)
504
Liver and gallbladder sympathetics
Splanchnic nerves to prevertebral ganglia Activates glycogenolysis (Ach/NE)
505
Liver and gallbladder Parasympathetics
Vagus nerve Promotes conservation of glycogen Increases bile secretion (Ach/Ach)
506
Genital system sympathetics
Splanchnic nerves to inferior hypogestric plexus Causes ejaculation Decreases erection (Ach/NE)
507
Genital system Parasympathetics
Pelvic Splanchnic nerves Increases erection (Ach/Ach)
508
Sympathetic lesions
Oculosympathetic palsy Ptosis Miosis Anhidrosis Enophthalmos
509
Parasympathetic lesion
CN III- enlarged pupil CN VII- dry eyes CN VII/IX- dry mouth
510
Hypothalamus function
Control ANS Control endocrine Memory formation Maintain homeostasis
511
Anterior hypothalamus contains
Paraventricular nucleus Supraoptic nucleus Suprachiasmatic nucleus
512
SON and PVN
Vasopressin/oxytocin containing mango cellular neurons Project to posterior pituitary which releases vasopressin and oxytocin into general circulation PVN also has parvocellular neurons which project to the median eminence and release TRH and CRH
513
SCN
Receives input from the retina Project to area ventral to PVN Involved in circadian rhythm

Neuro (5 decks)

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