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Kerri's Part 2 Biomed Slides > Nervous System Part 2 > Flashcards

Nervous System Part 2 Flashcards

1
Q

State TWO ways in which the following central nervous system components are protected:

a. Spinal cord

b. Brain

A

a. Spinal cord:
Vertebral Column
Meninges

b. Brain
Cerebrospinal Fluid
Blood Brain Barrier
Cranium
Cranial memjnges

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2
Q

What are the Meninges?

A

Three layers of connective tissue that cover the brain and spinal chord

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3
Q

With regards to the layers of the meninges, compare functions of the:

a. Dura mater

b. Arachnoid mater

c. Pia mater

A

a. Dura mater –
* = Tough Mother
* Tough outer layer divided in to 2 layers in between which lie sinuses (or collections) of venous blood.
* Connects the meninges to the inside of the cranium

b. Arachnoid mater
* Spider web appearance made up of collagen and elastic fibres
* Bridges the gap between the outer Dura Mater and the inner Pia Mater

c. Pia mater
* Most delicate and fragile of the 3 membranes. Thin transparent layer containing lots of blood vessels that supply the spinal chord.
* Wraps around the contours of the brain much like cling wrap wraps around the contours of whatever it is covering.

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4
Q
  1. Name the spaces between and the liquid inside:

a. Dura mater and arachnoid mater

b. Arachnoid mater and pia mater

A

a. Dura mater and arachnoid mater
Subdural (under Dura) space - it is filled with interstitial fluid

b. Arachnoid mater and pia mater
Sub arachnoid (under arachnoid) space - it is filled with cerebrospinal fluid

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5
Q

Describe TWO key differences between ‘subdural haematoma’ and ‘subarachnoid haemorrhage’

A

Subdural haematoma is a venous bleed and therefore lower pressure and less rapid in development.

Subarachnoid Haemorrhage refers to an arterial bleed and is therefore rapid.

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6
Q

Explain why cerebrospinal fluid (CSF) is colourless.

A

It is made from filtered blood, but blood cells are too large to get in and are filtered out leaving mostly water with ions and glucose.

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7
Q

Name TWO locations where CSF can be found.

A

Subarachnoid space
Central canal of the Spinal chord
Ventricles in the brain

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8
Q

List FOUR functions of CSF.

A
  • Supports and protects the brain and spinal chord, acting as a shock aboserber.
  • Maintains uniform pressure around the brain – in case of brain enlargement, CSF reduces to compensate.
  • Keeps brain and spinal chord moist
  • Circulate nutrients such as oxygen and ions
  • Circulate ions for the optimal chemical environment for nerve signalling.
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9
Q

Describe the main role of the blood brain barrier (BBB).

A

To protect the brain from toxins, bacteria and other harmful substances by stopping them from getting into the blood steam

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10
Q

Name the neuroglial cell that maintains the BBB.

A

Astrocyte

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11
Q

Name TWO arteries that supply the brain.

A

Carotid and Vertebral

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12
Q

How are these molecules transported across the Blood Brain Barrier?

Lipid soluble:
Glucose:
Gases:
Ions:
Proteins:

A

Lipid soluble: cross easily
(for example alcohol and anaesthetics)

Glucose: crosses by active transport

Gases: diffuse easily
(or example oxygen in and carbon dioxide out)

Ions: diffuse slowly across

Proteins: do not pass because they’re too big

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13
Q

List FOUR major parts of the brain.

A
  1. Brainstem
  2. Diencephalon [interbrain]
  3. Cerebrum
  4. Cerebellum
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14
Q

Name the three parts of the brain stem

A
  1. Medulla oblongata
  2. Pons
  3. Midbrain
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15
Q

List the key functions of the three parts of the brainstem

A

Medulla oblongata:
1. **Respiratory and cardiac centre **
2. Controls reflexes such as vomiting, sneezing and hiccupping
3. Contains cranial nerves 9 to 12
4. Contains the motor tracts where they crossover, resulting in muscles being controlled by the opposite side of the brain.) So

Pons:
= Bridge (it bridges the gap between the medulla oblongata and the top part of the brainstem, the midbrain)
1. Helps to control breathing (it shares the respiratory system with the medulla oblongata)
2. Contains cranial nerves 5 to 8
3. Relays motor tracts downwards

Midbrain:
1. Contains the Substantia Nigra that contains dopamine releasing hormones the control subconscious muscle activity
2. Contains cranial nerves three and four so…
3. Eye reflexes and tracking
4. Auditory tracts
5. Movement of head and neck
6. Transfers the motor tract from the cerebral cortex of the cerebrum to the brainstem

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16
Q

Name the three parts of the Diencephalon

A

Thalamus
Hypothalamus
Epithalamus

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17
Q

List the main functions of the three parts of the Diencephalon

A

Thalamus:: The core of the brain making up 80% of the diencephalon.

Think of it like a router that sorts data

  1. Major relay centre relays sensory info to the cerebrum
  2. Integrates sensory and motor information - touch, temperature, pain, vibration and proprioception

Hypothalamus:: Part of the emotional brain

  1. Homeostasis and hormone regulation
  2. Receives sensory information
  3. Controls body temperature
  4. Controls the ANS - both sympathetic and parasympathetic divisions
  5. Regulates
    - emotional and behavioural patterns [limbic]
    - eating and drinking, (appetite/satiety)
    - regulation of circadian rhythms

Epithalamus
1. connects the limbic system to other parts of the brain
2. It is a big player in the maintenance of our bodies circadian rhythm because it contains the pineal gland which secrets melatonin

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18
Q

Name the area of the brain that contains the ‘pineal gland’.

A

Epithalamus

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19
Q

List THREE factors that can damage the cerebellum.

A
  • Chronic alcohol abuse
  • Coeliacs disease
  • Vitamin B1 deficiency
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20
Q

List TWO functions of the cerebellum.

A
  • Maintenance of posture and balance
  • Functions to coordinate and smooth complex sequences of movement
    Including correction of errors during ongoing movement.
    (the cerebellum is very active when you are learning things like how to walk or to ride a bike)
  • Thought to play a role in cognition, thought and language processing
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21
Q

Name the area that connects the two cerebral hemispheres.

A

Corpus Collosum

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22
Q

Name which cerebral lobe plays a role in:

a. Hearing

b. Vision

c. Motor skills

d. Sensory input

A

The Cerebrum’s functions are sensory perception and motor control of the skeletal muscles

a. Hearing - Temporal Lobe

b. Vision – Occipital Lobe

c. Motor skills – Frontal Lobe

d. Sensory input – Parietal Lobe contains the sensory cortex

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23
Q

Describe how the left and right side of the brain co-ordinates the body.

A

The left side of the Cerebrum controls the right side of the body and vice versa.

This means that the pathways need to cross over ands they do this over the medulla oblongata

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24
Q

Name THREE main structures within the limbic system.

A

The limbic system is the area of the brain that is active with different emotions. It is not isolated to one area of the brain and is formed of several interconnected structures including parts of the cerebrum, diencephalon and midbrain.

The three key structures are:

Hypothalamus – in the Diencephalon

Hippocampus - In the temporal lobe in the Cerebrum

Amygdala – In the temporal lobe of the Cerebrum

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25
Q

Name the area that plays a key role in emotions within the limbic system.

A

The amygdala

(The hippocampus plays an essential role in encoding and retrieving memories)

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26
Q

List the 12 cranial nerves, their functions and their location

A

CEREBRUM
1.Olfactory - Sense of smell
2. Optic -Vision (sight)

MIDBRAIN
3. Oculomotor - Eye Movements, eyelid opening, pupil size
4. Trochlear - Eye movements

PONS
5. Trigeminal - Facial sensations, chewing
6. Abducens -Eye movement
7. Facial - Taste, facial expressions, salivary glands
8. Vestibulochoclear - Hearing and balance

MEDULLA OBLONGATA
9. Glossopharyngeal - Taste, swallowing, tongue sensations
10. Vagus -Sensory/Motor functions in chest/abdomen
11. Accessory -Neck and shoulder movement
12. Hypoglossal -Tongue movement and speech

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27
Q

Name ONE cranial nerve which if damaged can lead to double vision.

A

Damage to any of these: 3, 4, or 6

Oculomotor, Trochlear, Abducens

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28
Q

Name the largest cranial nerve of the autonomic nervous system and one of its functions:

A

Vagus Nerve

Gut motility
Lowering heart rate
Lowering blood pressure
Sensation form the digestive or respiratory tract

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29
Q

Name TWO cranial nerves that exhibit both sensory and motor functions.

A

Trigeminal
Facial
Glossopharyngeal
Vagus

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30
Q

State where the spinal cord terminates.

A

L2

However
- The meninges continue below this
- Where it terminates we find the Cause Equina which consists of spinal nerves that continue beyond L2

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31
Q

Describe the difference between ‘motor tracts’ and ‘sensory tracts’ in white matter.

A

Tracts are bundles of myelinated axons in the white matter of the spinal chord.

Motor tracts are descending. They are involved in voluntary and involuntary movement such as coordination, posture and balance.

Sensory tracts are ascending and transmit impulses from the skin, tendons, muscles and joints such as touch, vibration, proprioception.

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32
Q

Describe the difference between ‘dorsal horns’ and ‘ventral horns’ in grey matter.

A

Dorsal Horn is at the back of the spinal chord and it receives sensory impulses that it will send up one of the two sensory tracts.

SIDAA
Sensory
Input
Dorsal horn
Afferent
Ascending

Anterior Horn is at the front of the spinal chord and it sends out motor impulses that will come down the spinal chord.

MOVED
Motor
Output
Ventral
Efferent
Descending

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33
Q

Name the three spinal cord tracts, their function and type (sensory or motor).

A

CHECK THIS

Spinal cord tract: Spinothalamic Tract
Function: Pain, Temperature
Type: sensory

Spinal cord tract: Corticospinal Tracts
Function:Voluntary movement
Type: Motor

Spinal cord tract: Dorsal Columns
Function: Light touch, vibration, proprioception
Type: Sensory

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34
Q

Explain what could happen if there is damage to any of the spinal cords.

A

Loss of the tracts function below that level in the body

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35
Q

Describe in detail the ‘reflex arc’

A

A reflex is a fast, automatic, unplanned sequence of actions that occurs in response to a stimulus.

Most of the quick reflexes will be a spinal reflex which simply means it comes into the spinal cord and then go straight back out the spinal chord.

A reflex arc has five stages:
1. sensory receptor – Prick finger with a sharp object
2. sensory neuron – carries sensation message to the brain
3. integrating centre (interneuron) - Processes
4. motor neuron – Carries movement message
5. Effector organ - Muscle moves arm out of the way

36
Q

List TWO causes of raised intracranial pressure (ICP).

ICP describes an increase in the pressure within the cranial cavity which compresses blood vessels and leads to reduced oxygen to the brain

A
  1. Tumours – Gliomas or metastases
  2. Haemorrhage – subdural or subarachnoid
  3. Hydrocephalus which is excessive cerebrospinal fluid
  4. Meningitis
  5. Encephalitis
  6. Intracranial abscess
37
Q

List TWO signs and symptoms of ICP

A
  1. Headache that is worse on awakening
  2. Vomiting often without nausea due to pressure on the Medulla Oblongata
  3. Visual disturbance due to the optic nerve running through the cranium
  4. Pupil fixed/dilated in one eye
  5. Impaired mental state – lethargy, irritability
  6. Altered speech and seizures
  7. Papilloedema - Bulging of the optic disc that can only be seen with an ophthalmoscopy.
38
Q

Explain what is meant by papilloedema in ICP.

A

Bulging of the optic disc that can only be seen with an ophthalmoscopy. It indicates raised intercranial pressure.

39
Q

Describe the Cushing triad witnessed in ICP

A

Cushing’s triad refers to a set of signs that are indicative of increased intracranial pressure (ICP), or increased pressure in the brain. Cushing’s triad consists of

  1. Elevated Blood Pressure
  2. Slow and irregular pulse/ low heart rate - Bradycardia
  3. Slow Breathing - Bradypnoea
40
Q

Describe the pathophysiology of hydrocephalus.

A

An excessive accumulation of cerebrospinal fluid (CSF) occupying the cerebral ventricles and subarachnoid space.

 
Normally it is due to impaired absorption rather than a problem with excess production.
When we get too much CSF it can diffuse and permeate through the walls of the cerebrum into the surrounding white matter and directly damage the brain tissue leading to permanent brain damage.

41
Q

List 3 symptoms of Hydrocephalus

A
  1. Headache
  2. Neck pain
  3. Nausea and vomiting
  4. In infants the head circumference enlarges
42
Q
  1. ONE cause of hydrocephalus in:

a. Small children

b. Older children / adults

A

Hydrocephalus is a build-up of fluid in the brain. The excess fluid puts pressure on the brain, which can damage it.

a. Small children – Infection or congenital malformation

b. Older children / adults – Tumours, trauma , meningitis

43
Q

Explain why a headache associated with hydrocephalus is worse in the morning.

A

Overnight CSF does not drain very well so first thing in the morning CSF is at its peak and therefore applying the most pressure.

44
Q

Name TWO microorganisms that cause meningitis.

A
  1. Herpes Simplex in viral meningitis
  2. More severe cases may involve bacterial and the most common bacteria implicated is Streptococcus pneumoniae.
  3. May also be fungal or parasitic micro- organisms.
45
Q

Describe ONE skin sign in meningitis.

A

Petechiae:
* Small purple / red spots on the skin as a result of tiny haemorrhages
* non-blanching (do not disappear when pressed with a finger or a glass tumbler).

46
Q

List TWO symptoms of meningitis.

A
  1. Fever and sudden onset of severe headache.
  2. Marked neck stiffness, photophobia and vomiting.
  3. Petechiae: Small purple / red spots on the skin as a result of tiny haemorrhages — non-blanching (do not disappear when pressed with a finger or a glass tumbler).
47
Q

Name TWO signs that test for meningitis.

A
  1. Kernig’s sign: pain resistance to knee extension when lying with the hips fully flexed.
  2. Brudzinski sign: neck flexion causes flexion of hip and knee.
48
Q

Using definitions, describe the difference between:

a. Concussion:

b. Cerebral contusion:

c. Coup and contrecoup

A

a. Concussion:
It is a reversible/temporary head injury resulting from a significant blow to the head disrupting neurological function.

b. Cerebral contusion:
A type of traumatic brain injury that causes bruising of the brain with ruptured blood vessels (end therefore bleeding) and oedema. Usually caused by a blunt blow to the head

c. Coup and contrecoup
It refers to the common pattern of injury, as summarised below:
* Coup: Injury to the site of primary impact.
* Contrecoup: Damage to the brain at a site contra-lateral to the site of trauma.
* The skull acts to stop acceleration of the brain away from the site of impact, causing damage on the opposite side.

Most often cerebral contusions are Coup and Countercoup

49
Q

List FOUR causes of headaches

A
  1. Dehydration
  2. Cervicogenic (from the neck)
  3. TMJ (structural problems).
  4. Tension headache.
  5. Congested sinuses.
  6. Hypoglycaemia.
  7. Migraines and cluster headaches.
  8. Medication induced; i.e. paracetamol.
  9. Intra-cranial: e.g. brain tumour, haemorrhage, etc.
50
Q

With regards to migraine…

Location:
Duration:
Severity and pain character:
Aggravating factors:
Relieving factors:
Associated symptoms:

A

Location: Retro-orbital, frontal , unilateral

Duration: 4 - 72 hrs

Severity and pain character: Moderate — severe

Aggravating factors: Exertion, certain foods (e.g. dairy, caffeine), stress, light, noise.

Relieving factors: Being in dark room, rest, sleep.

Associated symptoms: Photophobia, phonophobia, nausea / vomiting, visual changes, aura.

51
Q

With regards to tension headache

Location:
Duration:
Severity and pain character:
Aggravating factors:
Relieving factors:
Associated symptoms:

A

Location: Diffuse (bilateral).

Duration: Hours to days.

Severity and pain character: Miild — moderate

Aggravating factors: Stress, muscle tension.

Relieving factors: Rest, massage, relaxation.

Associated symptoms: Occasionally loss of appetite / photophobia.

52
Q

List TWO aggravating factors for a cervicogenic headache.

A
  1. Neck movement
  2. sustained postures
53
Q

List TWO relieving factors for a cervicogenic headache.

A

Stretching and supporting neck, massage.

54
Q

Describe the difference in ‘headache duration’ with cervicogenic and migraine headaches.

A

Cervicogenic can last much longer than migraines.
Cervicogenic – one hour to weeks
Migraine – 4 to 72 hours but usually less than 24 hours

55
Q

Name TWO dietary causes of migraine.

A

Dairy
Caffeine

56
Q

Name ONE neurotransmitter deficiency in migraine.

A

Seratonin

57
Q

Explain what is meant by the ‘aura’.

A

Unusual visual, olfactory and sensory experiences preceding the headache. These symptoms can include flashes of light, blind spots, or tingling in the hands or face

58
Q

List TWO characteristic signs / symptoms of a brain tumour.

A

Symptoms that correlate with intercranial pressure such as

  1. Worse headaches in the morning
  2. vomiting without nausea
  3. uneven pupils or double vision
  4. Papilloedema - Bulging of the optic disc that can only be seen with an ophthalmoscopy
59
Q

Explain why a benign brain tumour can be life threatening.

A

It is growing within a confined cavity and leads to intracranial pressure

60
Q

Name TWO headache red flags.

A
  1. Sudden onset headache - thunderclap
  2. Headaches over the age of 50 when you didn’t get them before
  3. Signs of meningitis - non blanching rash, neck stiffness, positive Kernig/Brudzinski
  4. Sign of intercranial pressure - worsening morning headaches, uneven pupils, double vision, tunnel vision, vomiting without nausea
61
Q

Define epilepsy.

A

Sudden, hyper-excitable and uncontrolled neuronal activity in the brain.
It is a symptom of a disease

62
Q

List TWO causes of epilepsy.

A
  1. Idiopathic meaning it is not known what causes it
  2. Congenital malformation
  3. Chemical imbalance

Brain issues
4. Brain tumours
5. Cerebral infarction(stroke) or haemorrhage
6. Head trauma with loss of consciousness
7. CNS infection such as meningitis
8. Degenerative brain disease

63
Q

List TWO trigger factors for epilepsy.

A
  1. Flickering lights
  2. Fever
  3. Dehydration
  4. Stress
  5. Drugs and alcohol
  6. Pesticides that inhibit GABA
64
Q

Explain the difference between ‘tonic phase’ and ‘clonic phase’ of a tonic-clonic seizure.

A

Tonic Phase:
Contraction of all the body muscles - the patient will fall if sitting or standing)

Clonic Phase: Rapid contraction and relaxation of muscles causing convulsions. These can be from twitches to violent shaking.

65
Q

Describe how spina bifida develops.

A

It occurs in the first 8 weeks of gestation and is due to a lack of folate.

Incomplete closure of the spinal column, which means the back of the spinal cord is more vulnerable to damage.

Most commonly occurs at the lower part of the spine - lumbosacral junction (L5 / S1).
Types: Spina bifida occulta (overlying skin intact) and cystica (visible cystic mass).

66
Q

List ONE key nutrient deficiency that contributes to development of spin bifida.

A

B9 - Folate

67
Q

Describe how a herniated disc develops.

A

The nucleus pulposus of the disc can push out & leak through the annulus fibrosus, often compressing on spinal nerves and radiating pain down the extremities

68
Q

Describe the classic mechanism of injury with a herniated disc.

A

The classic mechanism of injury is combined lumbar spine flexion and rotation (bending and twisting

69
Q

List TWO signs / symptoms of a herniated disc.

A
  1. Radiating pain (sharp and linear)
  2. Pain aggravated by coughing / sneezing
  3. Positive Straight Leg Test
70
Q

Describe ONE way in which the pain of a herniated disc is aggravated.

A

Coughing or sneezing

71
Q

What age group is most prone to spinal disc protrusions?

A

Aged 30-40 when they are most moist

72
Q

Name the longest and widest nerve in the body.

A

Sciatic

73
Q

List TWO signs / symptoms of sciatica.

A
  1. Pain in the lower back and buttock.
  2. Pain radiating down the posterior leg, often into the foot. Usually unilateral.
  3. Pins and needles and numbness.
  4. Weak calf muscles and ‘foot drop’.
  5. Often absent ankle jerk reflex.
74
Q

Name TWO causes of sciatica.

A
  1. Disc herniation at L4 / 5 or L5 / S1.
  2. Compression against piriformis muscle (in buttock).
  3. Tumours in the spinal canal or pelvis.
75
Q

Name ONE diagnostic test for sciatica.

A

Straight leg raise test
Loss of sensation in sciatic nerve dermatome
Absent ankle jerk reflex.

76
Q

List ONE key side effect of aspartame.

A

It is a neurotoxin with neuro excitatory properties and linked to widespread neurological damage such as MS, Parkinsons and balance problems.

77
Q

Diagnostic Test: Straight Leg Raised test:

How is the test performed? For what Pathologies is it used?

A

The patient lies supine, whilst the practitioner raises one straight leg at a time.

Reproduced pain in buttock and posterior leg experienced up to about 45 degrees from the ground indicate a positive result.

Used to assist the diagnosis of
- nerve tethering in the lower lumbar spine.
- Disc herniation

78
Q

Diagnostic Test: Romberg’s test:

How is the test performed? For what Pathologies is it used?

A

Ask the patient to stand with feet together and arms at side with eyes closed. Positive Romberg if the patient sways or shows imbalance

Used for:
- Problem with proprioceptive system.
- Potentially damage of dorsal column in spinal chord.

79
Q

Diagnostic Test: Absent knee jerk reflex

Diagnostic Test: Small knee jerk reflex

How is the test performed? For what Pathologies is it used?

A

CHeck this

Absent knee jerk reflex

Tapping the patellar tendon with a tendon hammer

Used for:
- disc herniation
- peripheral nerve compression.
- Small knee jerk reflex -Hypothyroidism

It could be normal in some people too

Exagerated Knee jerk reflex

Tapping the patellar tendon with a tendon hammer

Used for:
- CNS damage spinal cord
- MND
- Hyperthyroidism

80
Q

Diagnostic Test: Absent ankle reflex:

Diagnostic Test: Exaggerated ankle reflex:

How is the test performed? For what Pathologies is it used?

A

Absent ankle reflex

Tapping the Achilles tendon whilst the foot is dorsiflexed

Used for:
- nerve damage - peripheral nueropathy
- Sciatic nerve compression
- hypothyroidsm

Exagerated ankle reflex

Tapping the Achilles tendon whilst the foot is dorsiflexed

Used for:
- CNS damage; e.g. spinal cord
- MND
- Hyperthyroidism

81
Q

Diagnostic Test: Cuteneous Reflex

(i) Abnormal Babinski sign:
(ii) Absent Abdominal Reflex

How is the test performed? For what Pathologies is it used?

A

Cutaneous reflex - Abnormal Babinski sign

Stroking the lateral margin of the sole of the foot normally causes the toes to flex.

Babinski sign is when the stimulus will cause the big toe to extend (dorsiflex) and the other toes to fan out. Corticospinal tract damage, MS and MND

Used for:
- Corticospinal; tract damage
- MS
- MNS

Cutaneous reflex - Absent Abdominal Reflex

The patient should be supine and relaxed. Stroke medially across the upper and lower quadrant of the abdomen towards the umbilicus.

This should result in brisk contraction of abdominal muscles.

Used for:
- This reflex can be lost in corticospinal tract damage, MS and MND.
- It can also be physiological

82
Q

An adult has an up-going plantar response. What might this indicate?

A

Central Nervous system lesion

Ie: Babinski sign/Plantar response

83
Q

How do you diagnose meningitis?

A

Lumbar puncture withdrawing CSF between approximately L4 and L5

84
Q

What are the causes of migraine

A
  • Hypothesised to the complex series of intercranial vascular changes occur including initial vasoconstriction (creating aura) and subsequent vasodilation (creating headache)
  • Low levels of serotonin
  • Food allergies and editors, histamine, alcohol
  • Emotions (stress), hormonal changes, poor sleep
85
Q

List TWO aggravating factors for a headache associated with ICP

A

Increased ICP can result from *bleeding in the brain
* a tumor
* stroke
* aneurysm
* high blood pressure
* brain infection

86
Q

Compare the two types of seizures experienced in epilepsy

A

Grand Mal seizures:

TONIC - CLONIC
* Tonic phase: contraction of all the body muscles, causing the patient to fall is sitting or standing
* chronic phase: rapid contraction, and relaxation of muscles causing convulsions
* usually lasts around a minute
* followed by physical and nervous exhaustion

PETIT MAL SEIZURES
* Absence, seizure – can look like daydreaming
* last 10 to 30 seconds
* seen, mainly in children
* usually no lingering confusion

87
Q

What produces CSF?

A

Ependymal cells

A cluster of ependymal cells is called the choroid plexi.

Kerri's Part 2 Biomed Slides (8 decks)

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